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Sample records for receiving home mechanical

  1. A new system for continuous and remote monitoring of patients receiving home mechanical ventilation

    NASA Astrophysics Data System (ADS)

    Battista, L.

    2016-09-01

    Home mechanical ventilation is the treatment of patients with respiratory failure or insufficiency by means of a mechanical ventilator at a patient's home. In order to allow remote patient monitoring, several tele-monitoring systems have been introduced in the last few years. However, most of them usually do not allow real-time services, as they have their own proprietary communication protocol implemented and some ventilation parameters are not always measured. Moreover, they monitor only some breaths during the whole day, despite the fact that a patient's respiratory state may change continuously during the day. In order to reduce the above drawbacks, this work reports the development of a novel remote monitoring system for long-term, home-based ventilation therapy; the proposed system allows for continuous monitoring of the main physical quantities involved during home-care ventilation (e.g., differential pressure, volume, and air flow rate) and is developed in order to allow observations of different remote therapy units located in different places of a city, region, or country. The developed remote patient monitoring system is able to detect various clinical events (e.g., events of tube disconnection and sleep apnea events) and has been successfully tested by means of experimental tests carried out with pulmonary ventilators typically used to support sick patients.

  2. Nutritional status in patients with chronic respiratory failure receiving home mechanical ventilation: impact on survival.

    PubMed

    Hitzl, Andre P; Jörres, Rudolf A; Heinemann, Frank; Pfeifer, Michael; Budweiser, Stephan

    2010-02-01

    In patients with chronic respiratory diseases body mass index (BMI) is a predictor of long-term survival, whereas the prognostic value of body composition, especially fat-free mass index (FFMI), is unknown. In a prospectively collected cohort of 131 patients (50 females, 81 males; 71% chronic obstructive pulmonary disease, 29% severe restrictive disorders) undergoing home mechanical ventilation (HMV) due to chronic hypercapnic respiratory failure (CHRF), the prognostic value of nutritional composition assessed by bioelectrical impedance analysis was evaluated during a 4-year follow-up and compared to that of BMI, anthropometrics, and functional parameters. After follow-up, 53 patients (40.5%) had died. Regarding all-cause mortality cumulative survival percentages after 1, 2 and 3 years were 89.3, 76.3 and 67.9%, respectively. In univariate analyses, FFMI, BMI, sex, age, leukocyte number, FEV1 and 6-min walking distance were associated with survival (p<0.05). Multivariate analyses using the most significant percentiles identified by univariate analysis revealed FFMI (25th percentile; hazard ratio 0.338 [95% confidence interval: 0.189-0.605]), sex, leukocyte number (50th percentile) and FEV1 (50th percentile) as independent predictors of mortality. In patients with CHRF and HMV, body composition in terms of FFMI was an independent predictor of long-term survival. FFMI was superior to BMI and seems informative in the multidimensional assessment of these patients. Copyright 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  3. Characteristics of clients who receive home health aide service.

    PubMed

    Hays, B J; Willborn, E H

    1996-02-01

    Nurses who plan and supervise home health aide service must have a good understanding of the amount and intensity of nursing care and the amount of home health aide service that individual clients will need. However, there is little in the nursing literature that describes how clients who receive both RN and home health aide services differ from clients who receive only RN care. Indeed, there have been few reports on how need for home health aide service relates to the amount of nursing care received. Secondary analysis of data from a study on resource consumption in home care revealed that clients who receive home health aide service: 1) are older; 2) are more likely to be women; 3) have a higher rating using the Community Health Intensity Rating Scale; and 4) are discharged from the caseload due to death or institutionalization at a higher rate than those who receive only RN care. Clients who received both home health aide services and RN care needed assistance with activities of daily living, but they also required more RN care than did clients who received only RN care. These data hold implications for nurses in addressing agency staffing, focusing home health aide training, and advocating for resources to address service needs of this segment of their care population.

  4. Home Mechanical Ventilation in Children.

    PubMed

    Preutthipan, Aroonwan

    2015-09-01

    The number of children dependent on home mechanical ventilation has been reported to be increasing in many countries around the world. Home mechanical ventilation has been well accepted as a standard treatment of children with chronic respiratory failure. Some children may need mechanical ventilation as a lifelong therapy. To send mechanically ventilated children back home may be more difficult than adults. However, relatively better outcomes have been demonstrated in children. Children could be safely ventilated at home if they are selected and managed properly. Conditions requiring home ventilation include increased respiratory load from airway or lung pathologies, ventilatory muscle weakness and failure of neurologic control of ventilation. Home mechanical ventilation should be considered when the patient develops progressive respiratory failure or intractable failure to wean mechanical ventilation. Polysomnography or overnight pulse oximetry plus capnometry are used to detect nocturnal hypoventilation in early stage of respiratory failure. Ventilator strategy including non-invasive and invasive approach should be individualized for each patient. The author strongly believes that parents and family members are able to take care of their child at home if they are trained and educated effectively. A good team work with dedicated members is the key factor of success.

  5. Restraint Use in Older Adults Receiving Home Care.

    PubMed

    Scheepmans, Kristien; Dierckx de Casterlé, Bernadette; Paquay, Louis; Van Gansbeke, Hendrik; Milisen, Koen

    2017-08-01

    To determine the prevalence, types, frequency, and duration of restraint use in older adults receiving home nursing care and to determine factors involved in the decision-making process for restraint use and application. Cross-sectional survey of restraint use in older adults receiving home care completed by primary care nurses. Homes of older adults receiving care from a home nursing organization in Belgium. Randomized sample of older adults receiving home care (N = 6,397; mean age 80.6; 66.8% female). For each participant, nurses completed an investigator-constructed and -validated questionnaire collecting information demographic, clinical, and behavioral characteristics and aspects of restraint use. A broad definition of restraint was used that includes a range of restrictive actions. Restraints were used in 24.7% of the participants, mostly on a daily basis (85%) and often for a long period (54.5%, 24 h/d). The most common reason for restraint use was safety (50.2%). Other reasons were that the individual wanted to remain at home longer, which necessitated the use of restraints (18.2%) and to provide respite for the informal caregiver (8.6%). The latter played an important role in the decision and application process. The physician was less involved in the process. In 64.5% of cases, there was no evaluation after restraint use was initiated. Use of restraints is common in older adults receiving home care nursing in Belgium. These results contribute to a better understanding of the complexity of use of restraints in home care, a situation that may be even more complex than in nursing homes and acute hospital settings. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  6. X-Ray Protection Standards for Home Television Receivers.

    ERIC Educational Resources Information Center

    National Council on Radiation Protection and Measurements, Washington, DC.

    Levels of X-Ray emission and exposure from home television receivers are being questioned and found greater than previous public health and safety cautions and measurement limits have suggested. The latest changes in television components, designs, function, and manufacturing, have caused equipment standards and the effects of radiation to be…

  7. X-Ray Protection Standards for Home Television Receivers.

    ERIC Educational Resources Information Center

    National Council on Radiation Protection and Measurements, Washington, DC.

    Levels of X-Ray emission and exposure from home television receivers are being questioned and found greater than previous public health and safety cautions and measurement limits have suggested. The latest changes in television components, designs, function, and manufacturing, have caused equipment standards and the effects of radiation to be…

  8. Mechanical ventilation in the home.

    PubMed

    Make, B J; Gilmartin, M E

    1990-07-01

    Despite advances in the application of mechanical ventilation as a short-term, life-saving technique, intensive care units are increasingly faced with patients who cannot be weaned from ventilatory assistance and who require mechanical ventilation as a long-term, life-supporting necessity. Because of limited resources in health care facilities for the management of chronic ventilator-assisted individuals, home care has become an important option. With careful selection of appropriate candidates, home care for ventilator-assisted individuals can result in not only decreased respiratory symptoms, reduction in hospitalization, and improved physiologic measures, but also an improved quality of life with substantial survival and a reduction in the costs of medical care.

  9. The personal significance of home: habitus and the experience of receiving long-term home care.

    PubMed

    Angus, Jan; Kontos, Pia; Dyck, Isabel; McKeever, Patricia; Poland, Blake

    2005-03-01

    The physical, symbolic and experiential aspects of receiving long-term care are examined in this paper using Bourdieu's concepts of habitus and field. We draw on data from an ethnographic study of home care in 16 homes in urban, rural and remote locations in Ontario, Canada. Across all cases, data about domestic and caregiving routines were gathered through observation, interviews with clients and/or the primary family caregiver, interviews with service providers and videotaped tours of the home. Based on the analysis of these data, we argue that a transposition of logics and practices occurred when the domestic and health care fields were superimposed within the spaces of the home. Although all of the care recipients and their family caregivers indicated a strong preference for home care over institutional care, their experiences and practices within their homes were disrupted and reconfigured by the insertion of logics emanating from the healthcare field. These changes were manifested in three main themes: the politics of aesthetics; the maintenance of order and cleanliness; and transcending the limitations of the home. In each of these dimensions, it became apparent that care recipients engaged in improvisatory social practices that reflected their ambiguous and changing habitus or social location. The material spaces of their homes signified, or prompted, altered or changing social placement.

  10. Vitamin D deficiency in patients receiving home parenteral nutrition.

    PubMed

    Thomson, Patti; Duerksen, Donald R

    2011-07-01

    In addition to its role in bone metabolism, vitamin D has important immunomodulatory and antineoplastic effects. Patients on home parenteral nutrition (HPN) receive most of their vitamin D from intravenous (IV) supplementation. Vitamin D deficiency is common in the general population, and the adequacy of vitamin D supplementation in HPN patients is unclear. The purpose of this study is to determine the vitamin D status of patients on HPN. Consecutive patients seen in a regional home nutrition program had their oral and IV vitamin D intakes determined. Plasma 25-hydroxyvitamin D levels were measured in all patients. Intake of calcium, magnesium, and phosphate were also determined. The mean 25-hydroxyvitamin D level in 22 patients receiving HPN for a mean of 33.5 months (range, 1-177) was 42 nmol/L. Vitamin D deficiency was present in 15 (68%) patients and vitamin D insufficiency in 6 (27%) patients. The mean dietary vitamin D intake was 79.5 IU per day, while the mean IV supplementation was 166 IU per day. In this study of a regional Canadian HPN program, there was a high prevalence of vitamin D deficiency/insufficiency affecting virtually all patients. All patients receiving HPN should be supplemented with vitamin D and have their 25-hydroxyvitamin D levels monitored. Further studies are required to determine optimal methods and dosing of vitamin D replacement using oral supplements or ultraviolet light therapy.

  11. Advance Directives and Care Received by Older Nursing Home Residents.

    PubMed

    Manu, Erika R; Mody, Lona; McNamara, Sara E; Vitale, Caroline A

    2017-03-01

    Research shows variable success as to whether care provided aligns with individual patient preferences as reflected in their advance directives (AD). We aimed to study AD status and subsequent care received in older nursing home (NH) residents deemed at risk for infections and care transitions: those with a urinary catheter (UC), feeding tube (FT), or both. Design/participants/measurements: A subgroup analysis of a prospective cohort of 90 residents with a UC and/or FT from 15 NHs in southeast Michigan. Outcomes assessed at enrollment and at 30-day intervals were hospitalizations and antibiotic use. The ADs were divided as follows: (1) comfort oriented: comfort measures only, no hospital transfer; (2) palliative oriented: comfort focused, allowing hospital transfer (except intensive care unit), antibiotic use, but no cardiopulmonary resuscitation; (3) usual care: full code, no limitations to care. We calculated incidences for these outcomes. Seventy-eight (87%) residents had ADs: 18 (23%) comfort oriented, 32 (41%) palliative oriented, and 28 (36%) usual care. The groups did not differ regarding demographics, comorbidity, function, device presence, or time in study. Using the usual care group as comparison, the comfort-oriented group was hospitalized at a similar rate (Incidence rate [IR] = 15.6/1000 follow-up days vs IR = 8.8/1000 follow-up days, Incident rate ratio [IRR] 0.6 [95% confidence interval, CI, 0.3 -1.1], P value .09) but received fewer antibiotics (IR = 18.9/1000 follow-up days vs IR = 7.5/1000 follow-up days, IRR 0.4 [95% CI, 0.2-0.8], P value .005). Nursing home residents with comfort-oriented ADs were hospitalized at a rate similar to those with usual-care ADs but received fewer antibiotics, although the small sample size of this analysis suggests these findings deserve further study.

  12. 42 CFR 436.217 - Individuals receiving home and community-based services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Individuals receiving home and community-based... receiving home and community-based services. The agency may provide Medicaid to any group or groups of... if institutionalized. (b) In the absence of home and community-based services under a waiver granted...

  13. 42 CFR 435.217 - Individuals receiving home and community-based services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Individuals receiving home and community-based... receiving home and community-based services. The agency may provide Medicaid to any group or groups of... if institutionalized. (b) In the absence of home and community-based services under a waiver granted...

  14. Characteristics of elderly people receiving home-help in three regions of France.

    PubMed

    Curtis, S; Bucquet, D

    1987-01-01

    This study examined the allocation of home-help to the elderly using survey data collected on 3153 elderly respondents living at home in Haute-Normandie, Lille, and Ile-de-France. The samples of respondents were stratified by age, sex and area of residence, and were randomly selected from the electoral registers. The analysis identified 399 elderly people "in need": of home-help - living alone with disability. Of these, only 21% received home help. Of 174 home help recipients, 49% were "in need", and they received 52% of the volume (hours) of help allocated. The pattern of allocation varied regionally.

  15. 42 CFR 435.217 - Individuals receiving home and community-based services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Individuals receiving home and community-based... receiving home and community-based services. The agency may provide Medicaid to any group or groups of individuals in the community who meet the following requirements: (a) The group would be eligible for...

  16. 42 CFR 436.217 - Individuals receiving home and community-based services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Individuals receiving home and community-based... receiving home and community-based services. The agency may provide Medicaid to any group or groups of individuals in the community who meet the following requirements: (a) The group would be eligible for...

  17. Predictors of treatment response in depressed mothers receiving in-home cognitive-behavioral therapy and concurrent home visiting.

    PubMed

    Ammerman, Robert T; Peugh, James L; Putnam, Frank W; Van Ginkel, Judith B

    2012-07-01

    Home visiting is a child abuse prevention strategy that seeks to optimize child development by providing mothers with support, training, and parenting information. Research has consistently found high rates of depression in mothers participating in home visiting programs and low levels of obtaining mental health treatment in the community. Successful treatment of depressed mothers in home visiting programs holds the potential to improve maternal and child outcomes. In-Home Cognitive-Behavioral Therapy (IH-CBT) is an adapted treatment for depressed mothers, which is provided alongside home visiting and seeks to optimize engagement and impact through delivery in the home setting; a focus on issues important to young, low-income mothers; and a strong collaborative relationship between therapists and home visitors. This study examined predictors of depression status at posttreatment in 60 mothers who received IH-CBT and concurrent home visiting. Variables considered included demographics, illness history, severity, and numbers of treatment sessions and home visits. Results indicated that young maternal age, fewer episodes of major depressive disorder, lower depression severity at pretreatment, lower levels of symptoms of personality disorders, and more treatment sessions and home visits predicted asymptomatic status at posttreatment.

  18. Home Mechanics for the Visually Impaired.

    ERIC Educational Resources Information Center

    Utrup, Robert G.

    The manual is intended to be used in a course on home mechanics for the visually handicapped and is organized into 17 lessons. Lessons cover the following topics: adhesives (such as Elmer's glue), cleaning drains, faucet repairs, fire extinguishers, the flush tank, the fuse box, glazing, hammers, hand sanding, handsaws, hangers, nails and wood…

  19. Home Mechanics for the Visually Impaired.

    ERIC Educational Resources Information Center

    Utrup, Robert G.

    The manual is intended to be used in a course on home mechanics for the visually handicapped and is organized into 17 lessons. Lessons cover the following topics: adhesives (such as Elmer's glue), cleaning drains, faucet repairs, fire extinguishers, the flush tank, the fuse box, glazing, hammers, hand sanding, handsaws, hangers, nails and wood…

  20. [Study of Appropriate Risk Management for People Receiving Care at Home - Actions of the High-Risk People Receiving Care at Home in Times of Disasters].

    PubMed

    Hata, Kiyomi; Hata, Masao

    2016-12-01

    Although preparation for frequently occurring disasters is required in the context of preparing a home care environment wherein people reside and receive care, existing preparations cannot be described as sufficient. Therefore, effective preparation has become a research focus. This study aimed to identify the risks faced by people receiving home care in disaster situations and to clarify the risk-related actions taken by various stakeholders in order to study appropriate risk management for people receiving care. We interviewed 8 individuals, including people receiving care and their family members, who were victims in the large-scale disasters associated with the Great Hanshin-Awaji Earthquake(1995)or later, conducted the factorsearch qualitative analysis, and mapped the actions taken by stakeholders. As a result, identified risks were classified into 5 categories and 13 subcategories. Risk actions taken by professionals and others could be elucidated from the stakeholder map. Our findings indicate the necessity of establishing risk management protocols for people receiving home care and preparing in ordinary times.

  1. [A consideration in the care of elderly patients receiving home hospice care: administration of parenteral nutrition at home].

    PubMed

    Tomita, M; Nagura, Y; Honda, K; Shimizu, C

    1998-12-01

    Due to the recent increase in the elderly population in Japan, the number of elderly patients with gastric cancer has also increased. As a result, not only the need for care of these patients has increased but also the care system has become diverse. In our hospital, more than 30% of patients who received home hospice care were over 70 years old and home hospice care of elderly patients with terminal cancer has become an important activity of our hospital. Whether home parenteral nutrition (HPN) procedures should be administered in the home for these patients is controversial. Our hospital has decided to inform patients with malignant disease of their true diagnosis under the doctrine of informed consent. In 1997, 94.1% of patients above 70 years, of age were informed of the actual nature of their disease. As a result, they were allowed to make a choice regarding home hospice care. An 81-year-old patient with terminal gastric cancer chose home hospice care and successfully managed the treatment procedures, including the use of a pump for intravenous alimentation. Through this case, we report here an ideal model of home hospice care of elderly patients under the concept of informed consent.

  2. [Endocarditis caused by Trichoderma longibrachiatumin a patient receiving home parenteral nutrition].

    PubMed

    Rodríguez Peralta, Laura I; Mañas Vera, Ma Reyes; García Delgado, Manuel J; Pérez de la Cruz, Antonio J

    2013-01-01

    Home parenteral nutrition (HPN) improves the quality of life of the patients although it has complications. Catheter-related infections and mechanical complications are the most frequent ones. We report the case of endocarditis over catheter in a man suffering from short bowel and receiving HPN. The special features of the case are firstly the catheter was a remaining fragment on the right atrial and secondly the infection was caused by Trichoderma longibrachiatum, an isolated fact regarding this pathology so far. Conventional surgery was applied to take the catheter out. Staphylococcus epidermidis, Ochrobactrum anthropi and Trichoderma longibrachiatum were isolated from the surgical specimen. The extraction of the infected catheter along with antibiotic therapy led to the complete recovery of the subject. Ochrobactrum anthropi and Trichoderma longibrachiatum are unusual microorganisms but they are acquiring more relevance. Although there is no agreement about intravascular retained catheter management, the most recommended approach consists on monitoring them and removing the device in case of complications.

  3. Advance Directives and End-of-Life Care among Nursing Home Residents Receiving Maintenance Dialysis.

    PubMed

    Kurella Tamura, Manjula; Montez-Rath, Maria E; Hall, Yoshio N; Katz, Ronit; O'Hare, Ann M

    2017-03-07

    Little is known about the relation between the content of advance directives and downstream treatment decisions among patients receiving maintenance dialysis. In this study, we determined the prevalence of advance directives specifying treatment limitations and/or surrogate decision-makers in the last year of life and their association with end-of-life care among nursing home residents. Using national data from 2006 to 2007, we compared the content of advance directives among 30,716 nursing home residents receiving dialysis to 30,825 nursing home residents with other serious illnesses during the year before death. Among patients receiving dialysis, we linked the content of advance directives to Medicare claims to ascertain site of death and treatment intensity in the last month of life. In the last year of life, 36% of nursing home residents receiving dialysis had a treatment-limiting directive, 22% had a surrogate decision-maker, and 13% had both in adjusted analyses. These estimates were 13%-27%, 5%-11%, and 6%-13% lower, respectively, than for decedents with other serious illnesses. For patients receiving dialysis who had both a treatment-limiting directive and surrogate decision-maker, the adjusted frequency of hospitalization, intensive care unit admission, intensive procedures, and inpatient death were lower by 13%, 17%, 13%, and 14%, respectively, and hospice use and dialysis discontinuation were 5% and 7% higher compared with patients receiving dialysis lacking both components. Among nursing home residents receiving dialysis, treatment-limiting directives and surrogates were associated with fewer intensive interventions and inpatient deaths, but were in place much less often than for nursing home residents with other serious illnesses. Copyright © 2017 by the American Society of Nephrology.

  4. Home Mechanical Ventilation in South Korea

    PubMed Central

    Kim, Dong Hyun; Choi, Won Ah

    2014-01-01

    Purpose To survey the use of invasive and noninvasive home mechanical ventilation (HMV) methods in South Korea from the perspective of physical medicine and rehabilitation (PM&R). Materials and Methods For 413 users of HMV, retrospective reviews of PM&R interventions and survey of HMV methods employed from Mar 2000 to Dec 2009. Results Of the 413 users, the majority of whom with progressive neuromuscular disorders (NMDs) (n=358), 284 patients initially used noninvasive mechanical ventilation (NIV), while 63 others who were using tracheostomy mechanical ventilation switched to NIV as part of their rehabilitation. The NMD patients began HMV at an earlier age (34.9±20.3 yrs), and used for longer (14.7±7.5) hours than patients with non-neuromuscular causes of respiratory impairment. Conclusion Noninvasive management was preferred over invasive ones, and transition to the former was a result of PM&R interventions. PMID:25323913

  5. Prevalence of urinary incontinence among community-dwelling adults receiving home care.

    PubMed

    Du Moulin, M F M T; Hamers, J P H; Ambergen, A W; Janssen, M A P; Halfens, R J G

    2008-12-01

    We conducted a cross-sectional survey in 2005 to determine the prevalence of and factors associated with urinary incontinence (UI) in adults receiving home care. Of the 2,866 patients surveyed, 46% suffered from UI; 6.5% had stress, 16.6% had urge, 9% had mixed, and 17.6% had functional incontinence. No diagnosis regarding type of UI had been established in 50.2%. Factors associated with UI were advanced age, higher body mass index, and impaired mobility. UI is prevalent in older persons receiving home care, but the lack of diagnosis of type of UI in half of the participants surveyed impedes management of UI.

  6. Homing orientation in salamanders: A mechanism involving chemical cues

    NASA Technical Reports Server (NTRS)

    Madison, D. M.

    1972-01-01

    A detailed description is given of experiments made to determine the senses and chemical cues used by salamanders for homing orientation. Sensory impairment and cue manipulative techniques were used in the investigation. All experiments were carried out at night. Results show that sense impaired animals did not home as readily as those who were blind but retained their sensory mechanism. This fact suggests that the olfactory mechanism is necessary for homing in the salamander. It was determined that after the impaired salamander regenerated its sensory mechanism it too returned home. It was concluded that homing ability in salamanders is direction independent, distant dependent, and vision independent.

  7. Parent Perspectives of Participation in Home and Community Activities when Receiving Part C Early Intervention Services

    ERIC Educational Resources Information Center

    Khetani, Mary A.; Cohn, Ellen S.; Orsmond, Gael I.; Law, Mary C.; Coster, Wendy J.

    2013-01-01

    The authors examined the extent to which parent expectations, perceptions about resource availability and supports, and strategies used to promote participation in home and community activities varied by setting and activity type. Sixteen 90-min semistructured interviews were completed with families receiving Part C early intervention services in…

  8. 41 CFR 302-14.3 - Am I eligible to receive a home marketing incentive payment?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Am I eligible to receive a home marketing incentive payment? 302-14.3 Section 302-14.3 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES...

  9. The importance of knowing the home conditions of patients receiving long-term oxygen therapy

    PubMed Central

    Godoy, Ilda; Tanni, Suzana Erico; Hernández, Carme; Godoy, Irma

    2012-01-01

    Purpose Long-term oxygen therapy (LTOT) is one of the main treatments for patients with chronic obstructive pulmonary disease. Patients receiving LTOT may have less than optimal home conditions and this may interfere with treatment. The objective of this study was, through home visits, to identify the characteristics of patients receiving LTOT and to develop knowledge regarding the home environments of these patients. Methods Ninety-seven patients with a mean age of 69 plus or minus 10.5 years were evaluated. This study was a cross-sectional descriptive analysis. Data were collected during an initial home visit, using a questionnaire standardized for the study. The results were analyzed retrospectively. Results Seventy-five percent of the patients had chronic obstructive pulmonary disease, and 11% were active smokers. The patients’ mean pulse oximetry values were 85.9% plus or minus 4.7% on room air and 92% plus or minus 3.9% on the prescribed flow of oxygen. Most of the patients did not use the treatment as prescribed and most used a humidifier. The extension hose had a mean length of 5 plus or minus 3.9 m (range, 1.5–16 m). In the year prior to the visit, 26% of the patients received emergency medical care because of respiratory problems. Few patients reported engaging in leisure activities. Conclusion The home visit allowed us to identify problems and interventions that could improve the way LTOT is used. The most common interventions related to smoking cessation, concentrator maintenance and cleaning, use of a humidifier, and adjustments of the length of the connector hose. Therefore, the home visit is a very important tool in providing comprehensive care to patients receiving LTOT, especially those who show lack of adequate progress and those who show uncertainty about the treatment method. PMID:22848155

  10. Longitudinal prevalence and correlates of elder mistreatment among older adults receiving home visiting nursing.

    PubMed

    Friedman, Bruce; Santos, Elizabeth J; Liebel, Dianne V; Russ, Ann J; Conwell, Yeates

    2015-01-01

    The objectives of this study were to identify elder mistreatment (EM) prevalence among a cohort of older adults receiving visiting nurse care in their homes, determine EM subtypes, and identify factors associated with EM. EM data were collected by nurses during monthly home visits for up to 24 months. It took the nurses a mean of 10.5 visits to discern EM. Fifty-four (7.4%) of 724 patients were identified as mistreated, of which 33 had enough information to subtype the EM. Of these 33, 27 were victims of neglect, 16 of psychological abuse, and 10 of financial exploitation, and 17 suffered more than one type. Among the entire sample, 11 variables were positively correlated with EM presence. Nurses visiting older adults in their homes should be aware that their patients are, as a group, vulnerable to EM, and that the factors identified here may be specific markers of greater risk.

  11. Effects of anorexia on mortality among older adults receiving home care: an observation study.

    PubMed

    Landi, F; Liperoti, R; Lattanzio, F; Russo, A; Tosato, M; Barillaro, C; Bernabei, R; Onder, G

    2012-01-01

    We describe the prevalence of secondary anorexia in a population of older people living in community and receiving home care. In addition, we examined the relationship between secondary anorexia and mortality. We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programs. A total of twelve Home Health Agencies participated in such project evaluating the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 2757 patients were enrolled in the present study. The main outcome measures were the prevalence of anorexia, weight loss and survival. More than 25% (744 subjects) of the study sample suffered from anorexia. During a mean follow-up of 10 months from initial MDS-HC assessment, 468 patients (17%) died. There was uneven distribution of the risk. After adjusting for age, gender and for all other possible risk factors for death (living alone, physical and cognitive disability, behavior problems, urinary incontinence, pressure ulcer, hearing impairment, congestive heart failure, hypertension, depression, diabetes, renal failure, cancer), subjects with anorexia were more likely to die relative to patients without anorexia (RR, 1.83; 95% CI 1.45-2.31). Even though the risk of mortality was higher among subjects suffering from anorexia and weight loss, the anorexia per se was associated with higher risk compared with subjects without anorexia (RR, 1.45; 95% CI 1.01-2.19). Anorexia is associated with a significant higher risk of all-cause mortality. The present findings support the possibility that anorexia has an independent effect on survival even among old people receiving home care.

  12. Barriers to patient portal access among veterans receiving home-based primary care: a qualitative study.

    PubMed

    Mishuris, Rebecca G; Stewart, Max; Fix, Gemmae M; Marcello, Thomas; McInnes, D Keith; Hogan, Timothy P; Boardman, Judith B; Simon, Steven R

    2015-12-01

    Electronic, or web-based, patient portals can improve patient satisfaction, engagement and health outcomes and are becoming more prevalent with the advent of meaningful use incentives. However, adoption rates are low, particularly among vulnerable patient populations, such as those patients who are home-bound with multiple comorbidities. Little is known about how these patients view patient portals or their barriers to using them. To identify barriers to and facilitators of using My HealtheVet (MHV), the United States Department of Veterans Affairs (VA) patient portal, among Veterans using home-based primary care services. Qualitative study using in-depth semi-structured interviews. We conducted a content analysis informed by grounded theory. Fourteen Veterans receiving home-based primary care, surrogates of two of these Veterans, and three home-based primary care (HBPC) staff members. We identified five themes related to the use of MHV: limited knowledge; satisfaction with current HBPC care; limited computer and Internet access; desire to learn more about MHV and its potential use; and value of surrogates acting as intermediaries between Veterans and MHV. Despite their limited knowledge of MHV and computer access, home-bound Veterans are interested in accessing MHV and using it as an additional point of care. Surrogates are also potential users of MHV on behalf of these Veterans and may have different barriers to and benefits from use. © 2014 John Wiley & Sons Ltd.

  13. [Suicidal drug overdose while receiving palliative home care: a case report].

    PubMed

    Mosich, Veronika; Müller-Busch, H Christof

    2014-05-01

    Suicidal thoughts are a common phenomenon in palliative care which can be seen in around 10% of the patients. There is very little knowledge about attempted and committed suicide. This article is a case report about a patient with lung cancer in a terminal state of illness who ingested drugs in a toxic dose while receiving palliative home care. This article deals with ethical issues in medical treatment and various ways of decision-making.

  14. Variability in home mechanical ventilation prescription.

    PubMed

    Escarrabill, Joan; Tebé, Cristian; Espallargues, Mireia; Torrente, Elena; Tresserras, Ricard; Argimón, J

    2015-10-01

    Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV). The aim of this study was to characterize the prevalence of HMV and variability in prescriptions from administrative data. Prescribing rates of HMV in the 37 healthcare sectors of the Catalan Health Service were compared from billing data from 2008 to 2011. Crude accumulated activity rates (per 100,000 population) were calculated using systematic component of variation (SCV) and empirical Bayes (EB) methods. Standardized activity ratios (SAR) were described using a map of healthcare sectors. A crude rate of 23 HMV prescriptions per 100,000 population was observed. Rates increase with age and have increased by 39%. Statistics measuring variation not due to chance show a high variation in women (CSV=0.20 and EB=0.30) and in men (CSV=0.21 and EB=0.40), and were constant over time. In a multilevel Poisson model, hospitals with a chest unit were associated with a greater number of cases (beta=0.68, P<.0001). High variability in prescribing HMV can be explained, in part, by the attitude of professionals towards treatment and accessibility to specialist centers with a chest unit. Analysis of administrative data and variability mapping help identify unexplained variations and, in the absence of systematic records, are a feasible way of tracking treatment. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  15. [Perception of the mothers concerning the received social support in home care to the premature children].

    PubMed

    Simioni, Angelita Dos Santos; Geib, Lorena Teresinha Consalter

    2008-01-01

    This study of qualitative approach aimed at knowing the perception of mothers of premature newborn concerning the social support received in the home care. The sample included 12 mothers of premature, older than 20 years, in the coverage area of Family Health Units of Passo Fundo-RS. The data were collected through semi-structured interview, genogram and echomap. The thematic analysis evidenced the grandmothers as builders and maintaining of the social nest; the discouragement of the abandonment; the safe base; and the social inclusion promoted by the friends. The social support not supplied is centered in the care to the newborn and in the activities of the home. This way, the mothers' perception reveals a predominant intrafamiliar support, whose expansion would allow configuring a more effective social net for the strengthness of the maternal care.

  16. 41 CFR 302-14.5 - Under what circumstances will I receive a home marketing incentive payment?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... independent marketing efforts; (d) You transfer the residence to the relocation services company; (e) Your... will I receive a home marketing incentive payment? 302-14.5 Section 302-14.5 Public Contracts and... 14-HOME MARKETING INCENTIVE PAYMENTS Payment of Incentive to the Employee § 302-14.5 Under...

  17. Older home nursing patients' perception of social provisions and received care.

    PubMed

    Dale, Bjørg; Saevareid, Hans Inge; Kirkevold, Marit; Söderhamn, Olle

    2010-09-01

    Social loneliness and isolation may be some of the consequences that older people experience regarding age-related changes and losses, and nurses should be engaged in identifying social networks and social needs in this group. The aims of this study were to describe perceived social provisions in a group of older home-dwelling care-dependent patients, and to explore the relationship between perceived social provisions, physical functioning, mental state and reception of formal and informal care. The sample consisted of 242 persons aged 75+ years from seven municipalities in southern Norway, all receiving home nursing. Data were collected by means of structured interviews. Social support was assessed using the revised Social Provisions Scale. Physical functioning was assessed using the Barthel Index, and mental state using questions about loneliness, depressive symptoms and anxiety. Types and frequencies of social network contacts and formal and informal care were registered. Descriptive statistics, Mann-Whitney U-tests, Cronbach's alpha coefficient and stepwise multiple regression were used in the analyses. In general, the level of perceived social provisions and togetherness in the study group was high, especially among women and the married. Decreased physical functioning and declined mental state were related to lower level of social provisions. The majority of the individuals had frequently contacts with several types of social networks, like friends, neighbours and religious communities, in addition to close family. Contact with these informal networks was found to be close related to perceived social support and togetherness. Reduced social provisions was related to increased amount of home nursing, which could indicate that demand for home care may work as a strategy to gain social contact. In this sense, dependence in daily life functioning could possibly contribute to social contact rather than reduce it.

  18. Determinants of received long-term care - Individual responses to regional nursing home provisions.

    PubMed

    Pilny, Adam; Stroka, Magdalena A

    2016-12-01

    Existing literature analyzing the choice of received long-term care by frail elderly (65+ years) predominantly focuses on physical and psychological conditions of elderly people as factors that influence the decision for a particular type of care. Until now, however, the regional in-patient long-term care supply has been neglected as influential factor in this decision-making process. In this study, we analyze the determinants of received long-term care in Germany by explicitly taking the regional supply of nursing homes into account. We estimate a multinomial probit model to illustrate this decision-making process. Therefore, within this discrete choice setting we distinguish between all available types of long-term care in Germany, i.e. four different types of formal and informal care provision. We find that the decision for long-term in-patient care is significantly correlated with the regional supply of nursing home beds, while controlling for physical and psychological conditions of the individual.

  19. Malnutrition is related to functional impairment in older adults receiving home care.

    PubMed

    Kiesswetter, E; Pohlhausen, S; Uhlig, K; Diekmann, R; Lesser, S; Heseker, H; Stehle, P; Sieber, C C; Volkert, D

    2013-04-01

    The aims of this work were (a) to provide a detailed description of the association between nutritional (Mini Nutritional Assessment; MNA®) and functional status in a sample of older adults receiving home care, using both questionnaire- and performance-based functional methods, and (b) to investigate the impact of different MNA subscales on this association. Multi-centre, cross-sectional. Home care. 296 persons ≥65 years in need of care (80.7±7.7 y). Nutritional status was determined by the MNA and functional status by two questionnaires (Instrumental and Basic Activities of Daily Living; IADL, ADL) and three performance tests (handgrip strength, HGS; Short Physical Performance Battery, SPPB; Timed 'Up and Go' Test, TUG). A categorical and a covariance analytical approach were used to test for differences in functional status between MNA groups (well nourished, risk of malnutrition, malnourished). In addition, functional parameters were correlated with total MNA, a modified MNA version (modMNA), where functional items were excluded, and MNA subscales ('functionality', 'general assessment', 'anthropometry', 'dietary assessment', and 'subjective assessment'). 57% of the participants were at risk of malnutrition and 12% malnourished. 35% reported severe limitations in IADL, 18% in ADL. 40%, 39% and 35% had severe limitations in HGS, SPPB and TUG; 9%, 28% and 34% were not able to perform the tests. Functional status deteriorated significantly from the well nourished to the malnourished group in all functional measures. The modMNA was weak but still significantly related to all functional parameters except TUG. The subscale 'functionality' revealed strongest correlations with functional measures. All other MNA subscales showed only weak or no associations. More than one half of the seniors receiving home care were at nutritional risk and poor functional level, respectively. Malnutrition according to MNA was significantly associated to both questionnaire- and

  20. Home-based functional walking program for advanced cancer patients receiving palliative care: a case series

    PubMed Central

    2013-01-01

    Background Although meta-analyses have demonstrated that physical activity can positively impact quality of life outcomes in early stage cancer patients, it is not yet known whether these benefits can be extended to patients with advanced cancer. In a previous pilot survey of patients with advanced cancer with a median survival of 104 days, participants felt willing and able to participate in a physical activity intervention, and reported a strong preference for walking and home-based programming. Here, we report on the initial development and feasibility of a home-based functional walking program in patients with advanced cancer receiving palliative care. Methods Nine adult patients were recruited from outpatient palliative care clinics and palliative home care. A pilot intervention trial was conducted over a 6-week period. The McGill Quality of Life Questionnaire (MQOL), Late Life Function and Disability Instrument (LLFDI), Edmonton Symptom Assessment System (ESAS), Seniors Fitness Test, four-test balance scale, and grip strength, were performed pre- and post-intervention. Participants wore activPAL™ accelerometers to monitor ambulatory activity levels. Results Of the nine recruited participants, three participants dropped out prior to baseline testing due to hospital admission and feeling overwhelmed, and three participants dropped out during the intervention due to severe symptoms. Only three participants completed the intervention program, pre- and post-intervention assessments: two reported improvements in total MQOL scores, yet all three shared an overall trend towards worsening symptom and total fatigue scores post-intervention. Two participants passed away within 90 days of completing the intervention. Conclusions This case series demonstrates the challenges of a physical activity intervention in patients with advanced cancer receiving palliative care. Further feasibility research is required in this patient population. Trial registration This study is

  1. Seasonal influenza vaccination among homebound elderly receiving home-based primary care in New York City.

    PubMed

    Banach, David B; Ornstein, Katherine; Factor, Stephanie H; Soriano, Theresa A

    2012-02-01

    Seasonal influenza vaccination is recommended for all persons aged ≥50 years to reduce influenza related morbidity and mortality, but vaccination coverage among community-dwelling elderly remains low. Homebound elderly receiving home-based primary care (HBPC) have fewer barriers to vaccination than other community-dwelling elderly. The Mount Sinai Visiting Doctors (MSVD) program provides HBPC to homebound elderly in New York City. This study assessed seasonal influenza vaccination coverage within an urban HBPC program and identified factors associated with vaccine refusal. A cross-sectional analysis of data from the 2008-2009 influenza season was completed and influenza vaccination coverage was assessed. The association between social, demographic and health-related characteristics and vaccine refusal was evaluated using bivariate analysis and multivariable logistic regression. Of 689 people aged >65 eligible for influenza vaccination, 578 (84%) accepted and 111 (16%) refused vaccination. In multivariable analysis, vaccine refusal was positively associated with female gender (adjusted odds ratio [AOR] = 1.85, 95% confidence interval [CI] 1.02, 3.35), black race (AOR = 2.04, 95% CI 1.28, 3.25), and living alone (AOR = 1.71, 95% CI 1.10, 2.67), and negatively associated with dementia (AOR = 0.59, 95% CI 0.37, 0.91). Seasonal influenza vaccine coverage in the MSVD program was high compared to nursing home and community-dwelling elderly. Offering patients vaccination at home without additional expense will likely improve vaccine coverage among urban homebound elderly. Understanding why vaccine refusal rates are higher among females, black patients, and those living alone should guide interventions to increase vaccine acceptance among this population.

  2. Mild vitamin D deficiency and secondary hyperparathyroidism in nursing home patients receiving adequate dietary vitamin D.

    PubMed

    McMurtry, C T; Young, S E; Downs, R W; Adler, R A

    1992-04-01

    To compare the vitamin D metabolite and nutritional status of institutionalized elderly males with a noninstitutionalized control group. Case-control study. Veterans Administration Medical Center Nursing Home (NH) in Richmond, Virginia. Fifty-seven consecutive nursing home subjects were screened. After excluding blacks, those receiving anticonvulsants, glucocorticoids, or vitamin supplements, and those with liver or renal failure (creatinine greater than 1.5 mg/dL), 35 subjects were enrolled, and 22 completed the study. The noninstitutionalized control group (n = 18) consisted of consecutive volunteers, meeting the above criteria, from either a senior citizen group or a geriatric clinic. The serum 25-hydroxy-vitamin D level in the NH residents was significantly lower than in community dwellers (17.4 +/- 5.2 ng/mL vs 31.2 pg/mL +/- 8.0 ng/mL, P less than 0.0001). No significant difference was demonstrated in 1,25-dihydroxyvitamin D levels (36.5 pg/mL +/- 10.5 in NH residents vs 42.0 pg/mL +/- 11.1 in controls). In the NH group PTH levels were inversely correlated with 25 OHD levels (P less than 0.008) and positively correlated with length of stay in the NH (P less than 0.016). There was no significant seasonal variation in vitamin D metabolite levels in the NH group. In the NH patients, the mean dietary intake of vitamin D was 232 +/- 378 mg/day and of calories was 1811 +/- 447 kcal/day. Despite apparently adequate calories, calcium, and vitamin D intake, hypovitaminosis D with compensatory PTH elevations occurs, regardless of season, in the nursing home population.

  3. More nutritious food is served in child-care homes receiving higher federal food subsidies.

    PubMed

    Monsivais, Pablo; Kirkpatrick, Shannon; Johnson, Donna B

    2011-05-01

    The US Department of Agriculture's Child and Adult Care Food Program (CACFP) serves 2.3 million children by providing monetary subsidies for food to participating child-care providers. This cross-sectional study tested the hypothesis that higher reimbursement rates for food result in higher food expenditures and higher nutritional quality of foods served in family child-care homes participating in CACFP. Sixty family home child-care providers were recruited in 2008-2009 from King County, Washington. Half the sample received higher reimbursements and the other half received the lower rates. Participants provided a 5-day menu of meals/snacks served and food shopping receipts. The nutritional quality of foods served was assessed from portion-standardized menus. Nutritional quality was quantified as the mean adequacy (mean percent of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking menus with receipts. Student's t tests for independent samples and general linear models were used to test for between-group differences. The two groups of providers were socioeconomically and demographically similar with comparable professional backgrounds. However, higher reimbursement providers had significantly greater menu expenditures than the lower reimbursement group ($2.36 vs $1.96/child/day; P=0.031). Reimbursement level was not associated with a difference in calories, but menus of higher reimbursement providers showed a significantly higher mean nutritional adequacy (64.5% vs 56.3%; P=0.033). The finding that reimbursement rates were positively associated with food expenditures and the nutritional quality of foods served suggests that raising CACFP reimbursements can improve child nutrition.

  4. [Changes of general and oral health status of elderly patients receiving home-visit dental services].

    PubMed

    Nishiyama, Yoshihide

    2005-06-01

    This study investigated the changes of general and oral health status of elderly patients who received home-visit dental services. The subjects were 51 patients (male: 19, female: 32, age: 83.0+/-9.1). The results of initial and re-examination (5.4 months later) by questionnaire survey, oral status and oral microbes were compared. The following results were obtained. 1. More than half of the subjects were bedridden and about 70% were affected by dementia. Three-quarters needed special care for daily activities. 2. The general health condition of the subjects became worse after 5.4 months. Moreover, 11 subjects died within 6 months after re-examination. However, oral health status, such as status of oral hygiene (p < 0.01), inflammation of gingiva (p < 0.01), tongue coating (p < 0.05) and oral malodor (p < 0.01) improved significantly. 3. There was a significant difference in the rate of people with dysphagic problems between the living and dead groups (p < 0.05). 4. The initial general and oral health status of the people with dysphagic problems was significantly worse than that of those without it. After receiving home-visit dental services, general condition became worse. However oral status, such as status of oral hygiene, inflammation of gingiva, oral malodor, and lactobacillus count significantly improved in both groups. These results suggest that dysphagic problems of elderly patients may affect their general health condition and might increase the risk of death. It is recommended to judge dysphagic problems accurately when performing certification of need for long-term care and to provide professional oral care periodically for the dependent elderly needing care.

  5. Predictors of Treatment Response in Depressed Mothers Receiving In-Home Cognitive-Behavioral Therapy and Concurrent Home Visiting

    ERIC Educational Resources Information Center

    Ammerman, Robert T.; Peugh, James L.; Putnam, Frank W.; Van Ginkel, Judith B.

    2012-01-01

    Home visiting is a child abuse prevention strategy that seeks to optimize child development by providing mothers with support, training, and parenting information. Research has consistently found high rates of depression in mothers participating in home visiting programs and low levels of obtaining mental health treatment in the community.…

  6. Predictors of Treatment Response in Depressed Mothers Receiving In-Home Cognitive-Behavioral Therapy and Concurrent Home Visiting

    ERIC Educational Resources Information Center

    Ammerman, Robert T.; Peugh, James L.; Putnam, Frank W.; Van Ginkel, Judith B.

    2012-01-01

    Home visiting is a child abuse prevention strategy that seeks to optimize child development by providing mothers with support, training, and parenting information. Research has consistently found high rates of depression in mothers participating in home visiting programs and low levels of obtaining mental health treatment in the community.…

  7. [A study of 31 terminally ill cancer patients who received pure oxycodone injections at home].

    PubMed

    Sasaki, Tsubasa; Kawagoe, Izumi

    2014-11-01

    Since the launch of pure oxycodone injections in May 2012, it has been possible to use oxycodone without opioid rotation. Although an extremely important step showing progress, very few studies regarding the use of pure oxycodone injections have been performed. In this study, we evaluated the safety and efficacy of pure oxycodone injections in 31 terminally ill cancer patients receiving home care. The difficulty in oral oxycodone intake was the main reason for changing to pure oxycodone injections. The mean administered period of subcutaneous pure oxycodone was 5.6 ± 6.7 days. One out of 5 patients receiving pure oxycodone injections complained of worsening sleepiness. However, other symptoms improved. In addition, in cases wherein pure oxycodone injection was the initiating opioid, 1 out of 6 patients showed no improvement of respiratory discomfort, while other symptoms improved. It was difficult to evaluate more patients because of the short period for administration. Although 5 patients experienced skin problems, they were successfully managed by changing the injection site. Of these 5 patients, 2 patients had sensitive skin, with a previous history of alcohol rash. In conclusion, our study suggests that pure oxycodone injections are beneficial over oral oxycodone treatment for terminally ill cancer patients. However, further evaluation of skin problems associated with pure oxycodone injections is required by performing larger studies.

  8. Low-cost mechanical filters for OMEGA receivers

    NASA Technical Reports Server (NTRS)

    Burhans, R. W.

    1976-01-01

    A pair of prototype low frequency mechanical filters were obtained for use as the RF front-end components of an OMEGA-VLF navigation receiver. The filter units are of interest because of very narrow bandwidths and high skirt selectivity to minimize noise and off-channel carriers in the reception of OMEGA signals. In addition, the filters have a characteristic low impedance of 75 to 5,000 ohms which results in less critical PC board circuitry compared to some previous resonators with termination resistances of 25,000 ohms to 5 megohms.

  9. [Mechanical ventilation at home: facts and questions].

    PubMed

    Fitting, J W

    1993-06-15

    Treatment of respiratory insufficiency with retention of CO2 by mechanic ventilation has come into use over the last decade, favored by use of non-invasive methods like nasal ventilation. Best results have been observed in hypercapnic respiratory insufficiency caused by neuromuscular disease or restrictive pathologic changes of the lung. Nocturnal use of nasal ventilation alone is often sufficient to correct also the daily CO2-values. Mechanisms explaining this beneficial effect are not yet known-The respiratory CNS-centers, respiratory muscles or thoracopulmonary mechanics may play etiologically an important role. Medical indications for nasal ventilation in chronic obstructive pulmonary disease are not clear, since results from several studies are controversial. Also in severe or progressive neurologic diseases a critical evaluation is mandatory for assessment of benefits including improvement of quality of life.

  10. Do youth in out-of-home care receive recommended mental health and educational services following screening evaluations?

    PubMed

    Petrenko, Christie L M; Culhane, Sara E; Garrido, Edward F; Taussig, Heather N

    2011-10-01

    For children in out-of-home care, a significant gap exists between those who need services and those who receive them. Screening all children in out-of-home care is recommended to reduce this gap. This study was designed to determine if recommendations from mental health and educational screening evaluations were related to service implementation for youth in out-of-home care. Screening evaluations were completed with 171 maltreated youth (ages 9 to 11) in out-of-home care within the prior year. Written reports summarizing the findings were provided to children's caseworkers. Service utilization was assessed at baseline (T1; before screening reports were completed) and follow-up (T2; 9-12 months later) interviews. For children not already receiving services at T1, logistic regression analyses tested the association between T1 recommendations for services and new service implementation by T2. Mental health (youth-report) and educational (teacher-report) outcomes were analyzed separately. Screening evaluations identified 22% of children with unmet mental health needs and 36% with unmet educational needs at T1. Children who received a recommendation for new services (i.e., all of those with unmet needs) were more likely to receive mental health (OR=2.50, p=.06) and/or educational (OR=3.54, p=.04) services by T2 than children who did not receive recommendations for services. While recommendations increased the odds of receiving services, almost half of the children with unmet mental health needs did not receive services, and 84% of children with unmet educational needs did not receive services by T2. Much work remains to ensure youth receive needed services.

  11. Do youth in out-of-home care receive recommended mental health and educational services following screening evaluations?

    PubMed Central

    Petrenko, Christie L. M.; Culhane, Sara E.; Garrido, Edward F.; Taussig, Heather N.

    2011-01-01

    For children in out-of-home care, a significant gap exists between those who need services and those who receive them. Screening all children in out-of-home care is recommended to reduce this gap. This study was designed to determine if recommendations from mental health and educational screening evaluations were related to service implementation for youth in out-of-home care. Screening evaluations were completed with 171 maltreated youth (ages 9 to 11) in out-of-home care within the prior year. Written reports summarizing the findings were provided to children's caseworkers. Service utilization was assessed at baseline (T1; before screening reports were completed) and follow-up (T2; 9-12 months later) interviews. For children not already receiving services at T1, logistic regression analyses tested the association between T1 recommendations for services and new service implementation by T2. Mental health (youth-report) and educational (teacher-report) outcomes were analyzed separately. Screening evaluations identified 22% of children with unmet mental health needs and 36% with unmet educational needs at T1. Children who received a recommendation for new services (i.e., all of those with unmet needs) were more likely to receive mental health (OR=2.50, p=.06) and/or educational (OR=3.54, p=.04) services by T2 than children who did not receive recommendations for services. While recommendations increased the odds of receiving services, almost half of the children with unmet mental health needs did not receive services, and 84% of children with unmet educational needs did not receive services by T2. Much work remains to ensure youth receive needed services. PMID:21912444

  12. Who receives oral nutritional supplements in nursing homes? Results from the nutritionDay project.

    PubMed

    Streicher, Melanie; Themessl-Huber, Michael; Schindler, Karin; Sieber, Cornel Christian; Hiesmayr, Michael; Volkert, Dorothee

    2017-10-01

    Oral nutritional supplements (ONS) can be helpful for nursing home (NH) residents to prevent or treat malnutrition. Presently little is known about the use of ONS in NHs and the factors associated with its use. Thus, the aim of this analysis was to describe the use of ONS in NHs participating in the nutritionDay project and to determine characteristics of NH residents receiving ONS. Data from nutritionDay (nD), a cross-sectional multicenter study with standardized questionnaires on resident and NH level were analyzed. NH residents participating between 2007 and 2014 aged 65 years or older were included. Unit characteristics (2 variables), general residents' characteristics (18), residents' nutritional status (3) and residents' nutrition (4) were of interest as potential predictors of the use of ONS (no vs yes). Univariate binary logistic regression (LR) analyses were performed for all variables, and significant predictors (p < 0.05) subsequently included in a multivariate analysis (backwards LR). 13.9% of 23,689 NH residents received ONS. Univariate analysis identified all variables as predictors. After multivariate analysis 19 variables remained in the model (Nagelkerke's R(2) = 0.319). Odds ratios (OR [95% Confidence Interval]) of receiving ONS were highest in residents receiving supplementary parenteral nutrition (29.05 [14.85-56.81]; however only 1.1% of all participants) and fortified diet (11.91 [8.52-16.64]; 5.7%). The odds ratio of receiving ONS was 3.26 ([2.86-3.71]; 18.3%) for residents being classified as at risk of malnutrition and 4.56 ([3.86-5.40]; 10.0%) for malnourished residents according to NH staff. Low BMI and weight loss in the last year increased the odds of receiving ONS by 2.34 ([1.93-2.84]; 16.0%) and 1.38 ([1.23-1.54]; 32.8%), respectively. Furthermore, increasing age, cognitive and functional impairment, low food intake on nD, neurological disease and cancer were associated with an increased likelihood of the use of ONS. In NH units

  13. Aims and tasks in parental caregiving for children receiving palliative care at home: a qualitative study.

    PubMed

    Verberne, Lisa M; Kars, Marijke C; Schouten-van Meeteren, Antoinette Y N; Bosman, Diederik K; Colenbrander, Derk A; Grootenhuis, Martha A; van Delden, Johannes J M

    2017-03-01

    In paediatric palliative care (PPC), parents are confronted with increasing caregiving demands. More children are cared for at home, and the need for PPC of children is lengthened due to technical and medical improvements. Therefore, a clear understanding of the content of parental caregiving in PPC becomes increasingly important. The objective is to gain insight into parental caregiving based on the lived experience of parents with a child with a life-limiting disease. An interpretative qualitative study using thematic analysis was performed. Single or repeated interviews were undertaken with 42 parents of 24 children with a malignant or non-malignant disease, receiving PPC. Based on their ambition to be a 'good parent', parents caring for a child with a life-limiting disease strived for three aims: controlled symptoms and controlled disease, a life worth living for their ill child and family balance. These aims resulted in four tasks that parents performed: providing basic and complex care, organising good quality care and treatment, making sound decisions while managing risks and organising a good family life.

  14. Physical symptoms of children receiving pediatric hospice care at home during the last week of life.

    PubMed

    Hendricks-Ferguson, Verna

    2008-11-01

    To identify symptoms of greatest parental concern on the last day and during the last week of their children's lives, the five most common symptoms of parental concern, and symptom-management strategies used during the last week of the children's lives. Descriptive, exploratory, and retrospective. A pediatric hospice program in St. Louis, MO. Convenience sampling of 28 bereaved parents. The Krippendorff method for semantical content analysis of data collected from semistructured telephone interviews with parents. Parents' perceptions of their children's symptoms and symptom-management strategies. On the last day of life, change in the children's breathing was the most frequent symptom of concern. During the last week of life, loss of motor function was the most frequent symptom of concern. Physical comfort actions and use of pharmaceutical agents were the strategies perceived as most helpful in managing symptoms. The study is the first to document parents' perceptions of their children's symptoms and of symptom-management strategies during the last week of life while receiving care in the home from staff of the pediatric hospice program. Symptoms experienced by dying children during the last week of life and symptom-management strategies used by pediatric hospice programs to support dying children and their families have not been well described. Additional research is warranted to further identify pediatric symptoms at the end of life and effective symptom-management strategies.

  15. Satisfaction in different life domains in children receiving home parenteral nutrition and their families.

    PubMed

    Gottrand, Frédéric; Staszewski, Pierre; Colomb, Virginie; Loras-Duclaux, Irène; Guimber, Dominique; Marinier, Evelyne; Breton, Anne; Magnificat, Sabine

    2005-06-01

    To assess the quality-of-life (QOL) of children receiving home parenteral nutrition (HPN). A national multicenter study of 72 patients (median age 4 years) presenting with a digestive disease requiring HPN, and 90 siblings, 67 fathers, and 69 mothers of these children. Median duration of HPN was 2 years (3 months-18 years). QOL was measured using validated, nondisease-specific questionnaires appropriate to the children's ages. The QOL scores were high in patients of all ages and were not significantly different from scores in a reference population of healthy children and adolescents. Lower QOL scores were recorded in the domains related to hospital, health, doctors, medications, and obligations. The QOL was not affected in siblings but was significantly impaired in parents, especially in mothers, who showed a lower level of satisfaction than did fathers for items related to work, inner life, and freedom. Presence of an ileostomy was the only factor that influenced QOL, especially of adolescents. QOL of HPN-dependent children and siblings is not different from that of healthy children, suggesting that these children actively use effective coping strategies. In contrast, the QOL of parents of HPN-dependent children is low.

  16. Older persons' experience of being assessed for and receiving public home help: do they have any influence over it?

    PubMed

    Janlöv, Ann-Christin; Hallberg, Ingalill Rahm; Petersson, Kerstin

    2006-01-01

    The aim of this qualitative study was to explore older persons' experience of participation in and influence on decisions about public home help/care when undergoing needs assessment and receiving public home help. A purposive sample of 28 home help recipients over the age of 75 were selected. Data were collected by means of in-depth interviews. A content analysis revealed one overarching category: 'Having to be satisfied, adjust, and walk a fine line when balancing between needs and available help'; and three principal categories: Balancing the comfort and guilt--receiving help from the family at the limits of their capacity; 'A necessary evil'--balancing feelings and resources against having no choice but to accept; Incorporating the home help into daily life to gain a sense of continuity. The findings indicate that older persons have difficulties coping and adapting to their new life situation and have no actual influence over the decisions about their home help. The officer told them what was available. This implies a need to pay attention to the frail persons' mental state in the needs assessment and to ensure adequate understanding of information. Further, it suggests that the needs assessment and the home help officer should to a larger extent focus on individual needs as a whole, involve and encourage the older person to strengthen his or her sense of being in control.

  17. Initiation of home mechanical ventilation at home: a randomised controlled trial of efficacy, feasibility and costs.

    PubMed

    Hazenberg, A; Kerstjens, H A M; Prins, S C L; Vermeulen, K M; Wijkstra, P J

    2014-09-01

    Home mechanical ventilation (HMV) in the Netherlands is normally initiated in hospital, but this is expensive and often a burden for the patient. In this randomised controlled study we investigated whether initiation of HMV at home in patients with chronic respiratory failure is non-inferior to an in hospital based setting. Seventy-seven patients were included, of which 38 patients started HMV at home. All patients were diagnosed with chronic respiratory failure due to a neuromuscular or thoracic cage disease. Primary outcome was the arterial carbon dioxide (PaCO2) while quality of life and costs were secondary outcomes. Telemonitoring was used in the home group to provide therapeutic information, for example; transcutaneous carbon dioxide, oxygen saturation and ventilator information, to the caregivers. Follow-up was six months. PaCO2, improved by 0.72 (SE ± 0.16) kPa in the hospital group and by 0.91 (±0.20) in the home group, both improvements being significant and the latter clearly not inferior. There were also significant improvements in quality of life in both groups, again not being inferior with home treatment. This study is the first to show that initiation of HMV at home in a selective group of patients with chronic respiratory failure is as effective for gas exchange and quality of life as hospital initiation. In addition we found that it is safe, technically feasible and that more than € 3000 per patient can be saved compared to our standard care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. 41 CFR 302-14.5 - Under what circumstances will I receive a home marketing incentive payment?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Under what circumstances will I receive a home marketing incentive payment? 302-14.5 Section 302-14.5 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION...

  19. 41 CFR 302-14.7 - Are there tax consequences when I receive a home marketing incentive payment?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Are there tax consequences when I receive a home marketing incentive payment? 302-14.7 Section 302-14.7 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION...

  20. 42 CFR 435.726 - Post-eligibility treatment of income of individuals receiving home and community-based services...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Necessary medical or remedial care recognized under State law but not covered under the State's Medicaid... receiving home and community-based services furnished under a waiver: Application of patient income to the..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS ELIGIBILITY IN THE...

  1. [The phrenic nerve stimulator, a valid ventilatory support in the management of quadriplegic patients receiving home health care services. A case report].

    PubMed

    Giglio, A M; Rovella, C; Botindari, E; Alba, M

    2002-06-01

    The authors describe the case of a quadriplegic child with post-traumatic respiratory insufficiency and total dependency on mechanical ventilation. The child was a long-term inpatient at the Pediatric Intensive Care Unit of Palermo. Considering the patient's long life expectancy, psychological distress and determination of the patient and family members to have the patient at home again, the plan for dehospitalization included the use of a phrenic stimulator as a supplement to conventional mechanical ventilation that would simplify home health care and improve the patient's quality of life. Electromyography, fluoroscopy and gas analysis were conducted to evaluate whether the patient was physically fit to receive a stimulator. The device was then implanted at the Spinal Cord Injury Treatment Unit in Sondalo. The stimulator is compact in design, operates silently, and affords more natural ventilation without interfering with breathing rhythm, and maintains muscle trophism. In combination with mechanical ventilation, the pacing device is an ideal system for home respiratory assistance. Additional benefits include increased patient mobility outside the home and improved quality of life. The system provides good respiration, as shown by EtCO2 and SpO2 measurements and long-term monitoring performed at our unit.

  2. Outcomes of Morbidly Obese Patients Receiving Invasive Mechanical Ventilation

    PubMed Central

    Kumar, Gagan; Majumdar, Tilottama; Jacobs, Elizabeth R.; Danesh, Valerie; Dagar, Gaurav; Deshmukh, Abhishek; Taneja, Amit

    2013-01-01

    Background: Critically ill, morbidly obese patients (BMI ≥ 40 kg/m2) are at high risk of respiratory failure requiring invasive mechanical ventilation (IMV). It is not clear if outcomes of critically ill, obese patients are affected by obesity. Due to limited cardiopulmonary reserve, they may have poor outcomes. However, literature to this effect is limited and conflicted. Methods: We used the Nationwide Inpatient Sample from 2004 to 2008 to examine the outcomes of morbidly obese people receiving IMV and compared them to nonobese people. We identified hospitalizations requiring IMV and morbid obesity using International Classification of Diseases, 9th Revision, Clinical Modification codes. Primary outcomes studied were inhospital mortality, rates of prolonged mechanical ventilation (≥ 96 h), and tracheostomy. Multivariable logistic regression was used to adjust for potential confounding variables. We also examined outcomes stratified by number of organs failing. Results: Of all hospitalized, morbidly obese people, 2.9% underwent IMV. Mean age, comorbidity score, and severity of illness were lower in morbidly obese people. The adjusted mortality was not significantly different in morbidly obese people (OR 0.89; 95% CI, 0.74-1.06). When stratified by severity of disease, there was a stepwise increase in risk for mortality among morbidly obese people relative to nonobese people (range: OR, 0.77; 95% CI, 0.58-1.01 for only respiratory failure, to OR, 4.14; 95% CI, 1.11-15.3 for four or more organs failing). Rates of prolonged mechanical ventilation were similar, but rate of tracheostomy (OR 2.19; 95% CI, 1.77-2.69) was significantly higher in patients who were morbidly obese. Conclusions: Morbidly obese people undergoing IMV have a similar risk for death as nonobese people if only respiratory failure is present. When more organs fail, morbidly obese people have increased risk for mortality compared with nonobese people. PMID:23349057

  3. [Home support for a child receiving palliative care provided by a self-employed nurse].

    PubMed

    Diamantidis-Zinchiri, Catherine

    2011-01-01

    Complex and demanding, paediatric palliative care at home is beginning to develop. How can a self-employed nurse, by definition isolated, care for a child approaching the end of life and his/her family at home? What resources and tools does the nurse have to provide this support?

  4. Swallowing Function and Nutritional Status in Japanese Elderly People Receiving Home-care Services: A 1-year Longitudinal Study.

    PubMed

    Okabe, Y; Furuta, M; Akifusa, S; Takeuchi, K; Adachi, M; Kinoshita, T; Kikutani, T; Nakamura, S; Yamashita, Y

    2016-01-01

    Malnutrition is a serious health concern for frail elderly people. Poor oral function leading to insufficient food intake can contribute to the development of malnutrition. In the present study, we explored the longitudinal association of malnutrition with oral function, including oral health status and swallowing function, in elderly people receiving home nursing care. Prospective observational cohort study with 1-year follow-up. Two mid-sized cities in Fukuoka, Japan from November 2010 to March 2012. One hundred and ninety-seven individuals, aged ≥ 60 years, living at home and receiving home-care services because of physical disabilities, without malnutrition. Oral health status, swallowing function, taking modified-texture diets such as minced or pureed foods, nutritional status, cognitive function, and activities of daily living were assessed at baseline. The associations between malnutrition at 1-year follow-up and these related factors were analyzed using a logistic regression model. Swallowing disorders [risk ratio (RR): 5.21, 95% confidence interval (95% CI): 1.65-16.43] were associated with malnutrition. On the other hand, oral health status did not have a direct association with malnutrition. Swallowing disorders may be associated with the incidence of malnutrition in elderly people receiving home-care. The findings indicate that maintaining swallowing function may contribute to the prevention of malnutrition in frail elderly people.

  5. Impact of Depression and Childhood Trauma in Mothers Receiving Home Visitation

    PubMed Central

    Ammerman, Robert T; Shenk, Chad E.; Teeters, Angelique R.; Noll, Jennie G.; Putnam, Frank W.; Van Ginkel, Judith B.

    2011-01-01

    Research has documented the deleterious effects of maternal depression and childhood trauma on parenting and child development. There are high rates of both depression and childhood trauma in new mothers participating in home visitation programs, a prevention approach designed to optimize mother and child outcomes. Little is known about the impacts of maternal depression and childhood trauma on parenting in the context of home visitation. This study contrasted depressed and non-depressed mothers enrolled in the first year of a home visitation program on parenting stress, quality of home environment, social network, and psychiatric symptoms. Mothers were young, low income, and predominantly unmarried. Results indicated that depressed mothers displayed impairments in parenting, smaller and less robust social networks, and increased psychiatric symptoms relative to their non-depressed counterparts. Path analyses for the full sample revealed a path linking childhood trauma, depression, and parenting stress. Path analyses by group revealed several differential relationships between dimensions of social network and parenting. Number of embedded networks, namely the number of different domains in which the mother is actively interacting with others, was associated with lowered parenting stress among non-depressed mothers and increased parenting stress in their depressed counterparts with childhood trauma histories. In depressed mothers, social network size was associated with lower levels of parenting stress but decreased quality of the home environment, whereas number of embedded networks was positively related to quality of the home environment. Implications of findings for home visitation programs are discussed. PMID:23710123

  6. Impact of Depression and Childhood Trauma in Mothers Receiving Home Visitation.

    PubMed

    Ammerman, Robert T; Shenk, Chad E; Teeters, Angelique R; Noll, Jennie G; Putnam, Frank W; Van Ginkel, Judith B

    2012-08-01

    Research has documented the deleterious effects of maternal depression and childhood trauma on parenting and child development. There are high rates of both depression and childhood trauma in new mothers participating in home visitation programs, a prevention approach designed to optimize mother and child outcomes. Little is known about the impacts of maternal depression and childhood trauma on parenting in the context of home visitation. This study contrasted depressed and non-depressed mothers enrolled in the first year of a home visitation program on parenting stress, quality of home environment, social network, and psychiatric symptoms. Mothers were young, low income, and predominantly unmarried. Results indicated that depressed mothers displayed impairments in parenting, smaller and less robust social networks, and increased psychiatric symptoms relative to their non-depressed counterparts. Path analyses for the full sample revealed a path linking childhood trauma, depression, and parenting stress. Path analyses by group revealed several differential relationships between dimensions of social network and parenting. Number of embedded networks, namely the number of different domains in which the mother is actively interacting with others, was associated with lowered parenting stress among non-depressed mothers and increased parenting stress in their depressed counterparts with childhood trauma histories. In depressed mothers, social network size was associated with lower levels of parenting stress but decreased quality of the home environment, whereas number of embedded networks was positively related to quality of the home environment. Implications of findings for home visitation programs are discussed.

  7. A specific home care program improves the survival of patients with chronic obstructive pulmonary disease receiving long term oxygen therapy.

    PubMed

    Rizzi, Maurizio; Grassi, Mario; Pecis, Marica; Andreoli, Arnaldo; Taurino, Anna Eugenia; Sergi, Margherita; Fanfulla, Francesco

    2009-03-01

    To analyze the influence of a home care (HC) program on outcomes of patients with chronic obstructive pulmonary disease (COPD) receiving long-term oxygen therapy (LTOT) in comparison with outcomes of patients receiving standard care (SC). A 10-year follow-up study with 2 parallel cohorts (HC vs SC). University hospital. One hundred and eight patients in the HC program and 109 patients managed conventionally. The HC program consisted of outpatient clinical and functional evaluations every 6 months, and domiciliary assessments by a specific team including a pneumologist, a respiratory nurse, and a rehabilitation therapist every 2 to 3 months or more, as needed. Mortality; exacerbation, hospital and intensive care unit admission rate. One hundred and eight patients entered the HC program and 109 patients were managed conventionally. The 2 groups of patients did not differ for age, sex, body mass index, COPD severity or comorbid conditions. The overall mortality during the follow-up was 63% and the median survival was 96+/-38 months. The survival curves for HC and SC patients were statistically significantly different (log-rank, -16.04; P=.0001). In the Cox proportional hazards model, inclusion in the HC program was associated with an increased survival rate, whereas comorbid conditions and requirement of mechanical ventilation during the follow-up were associated with a decreased survival rate. During the entire follow-up, HC patients had a lower number of exacerbations/year than SC patients. A disease-oriented HC program is effective in reducing mortality and hospital admissions in COPD patients requiring LTOT.

  8. Physiological responses to passive exercise in adults receiving mechanical ventilation.

    PubMed

    Amidei, Christina; Sole, Mary Lou

    2013-07-01

    Critical illness may weaken muscles, with long-term consequences. To assess physiological responses to an early standardized passive exercise protocol to prevent muscle weakness in adults receiving mechanical ventilation. A quasi-experimental within-subjects repeated-measures design was used. Within 72 hours of intubation, 30 patients had 20 minutes of bilateral passive leg movement delivered by continuous-passive-motion machines at a standardized rate and flexion-extension. Heart rate, mean blood pressure, oxygen saturation, and cytokine levels were measured before, during, and after the intervention. The Behavioral Pain Scale was used to measure patients' comfort. Repeated-measures analysis of variance was used to analyze the effect of the exercise on independent variables. Patients were mostly white men with a mean age of 56.5 years (SD, 16.9) with moderate mortality risk and illness severity. Heart rate, mean blood pressure, and oxygen saturation did not differ from baseline at any time measured. Pain scores were significantly reduced (F(2.43,70.42) = 4.08; P = .02) 5 and 10 minutes after exercise started and remained reduced at the end of exercise and 1 hour later. Interleukin 6 levels were significantly reduced (F(1.60,43.1) = 4.35; P = .03) at the end of exercise but not after the final rest period. Interleukin 10 levels did not differ significantly. Ratios of interleukin 6 to interleukin 10 decreased significantly (F(1.61,43.38) = 3.42; P = .05) at the end of exercise and again after 60 minutes' rest. The exercise was well tolerated, and comfort improved during and after the intervention. Cytokine levels provided physiological rationale for benefits of early exercise.

  9. [Low back load and satisfaction rating of caregivers & care receivers in bathing assistance given in a nursing home for the elderly practicing individual care].

    PubMed

    Tomioka, Kimiko; Kumagai, Shinji; Higuchi, Yumi; Tsujimura, Hiroji; Arai, Yastomo; Yoshida, Jin

    2007-03-01

    Since the public nursing care insurance system was enacted by the Japanese government, a transition from conventional group treatment to the individual care is required. In Japanese nursing homes for the elderly, bathing assistance methods have shifted from use of traditional mechanical bathtubs or a big bathtub to methods using small homestyle bathtubs, known as "individual bathing assistance". A study on the work load of caregivers with individual bathing assistance has never been conducted. Therefore, in a nursing home for the elderly practicing the individual bathing assistance method, we explored low back load using surface electromyography and trunk inclination angle measurement. Moreover, subjective evaluations by not only the caregivers but also the care receivers were investigated. The individual bathing assistance time per person was about 35 min. When caregiver used the mechanical lift equipment to assist getting into and out of the bathtub, trunk inclination angle and muscle load were lower than with manual handling. Mechanical lift equipment had the advantage of reducing low back load. When caregivers gave assistance with dressing and ablution of the lower limbs, and in setting wheelchair footrests, trunk inclination angle and muscle load showed high values. The satisfaction rating of using the mechanical lift equipment showed the best score, and ratings of perceived exertion were about the same. Thus, the importance of safe and comfortable care for both caregivers and care receivers should be stressed to make effective use of assistance products and care equipment.

  10. Take-Home Experiments in Undergraduate Fluid Mechanics Education

    NASA Astrophysics Data System (ADS)

    Cimbala, John

    2007-11-01

    Hands-on take-home experiments, assigned as homework, are useful as supplements to traditional in-class demonstrations and laboratories. Students borrow the equipment from the department's equipment room, and perform the experiment either at home or in the student lounge or student shop work area. Advantages include: (1) easy implementation, especially for large classes, (2) low cost and easy duplication of multiple units, (3) no loss of lecture time since the take-home experiment is self-contained with all necessary instructions, and (4) negligible increase in student or teaching assistant work load since the experiment is assigned as a homework problem in place of a traditional pen and paper problem. As an example, a pump flow take-home experiment was developed, implemented, and assessed in our introductory junior-level fluid mechanics course at Penn State. The experimental apparatus consists of a bucket, tape measure, submersible aquarium pump, tubing, measuring cup, and extension cord. We put together twenty sets at a total cost of less than 20 dollars per set. Students connect the tube to the pump outlet, submerge the pump in water, and measure the volume flow rate produced at various outflow elevations. They record and plot volume flow rate as a function of outlet elevation, and compare with predictions based on the manufacturer's pump performance curve (head versus volume flow rate) and flow losses. The homework assignment includes an online pre-test and post-test to assess the change in students' understanding of the principles of pump performance. The results of the assessment support a significant learning gain following the completion of the take-home experiment.

  11. Mechanism of Hydrogen Formation in Solar Parabolic Trough Receivers

    SciTech Connect

    Moens, L.; Blake, D. M.

    2008-03-01

    Solar parabolic trough systems for electricity production are receiving renewed attention, and new solar plants are under construction to help meet the growing demands of the power market in the Western United States. The growing solar trough industry will rely on operating experience it has gained over the last two decades. Recently, researchers found that trough plants that use organic heat transfer fluids (HTF) such as Therminol VP-1 are experiencing significant heat losses in the receiver tubes. The cause has been traced back to the accumulation of excess hydrogen gas in the vacuum annulus that surrounds the steel receiver tube, thus compromising the thermal insulation of the receiver. The hydrogen gas is formed during the thermal decomposition of the organic HTF that circulates inside the receiver loop, and the installation of hydrogen getters inside the annulus has proven to be insufficient for controlling the hydrogen build-up over the lifetime of the receivers. This paper will provide an overview of the chemical literature dealing with the thermal decomposition of diphenyl oxide and biphenyl, the two constituents of Therminol VP-1.

  12. The use of the Nursing Interventions Classification (NIC) with cardiac patients receiving home health care.

    PubMed

    Schneider, Julia Stocker; Slowik, Linda Haynes

    2009-01-01

    To identify Nursing Interventions Classification interventions (NICs) commonly provided to cardiac home care patients and to explore differences among patients with coronary artery disease, congestive heart failure, and patients with other cardiac disorders. The NICs provided to cardiac home care patients were recorded and analyzed to determine differences in frequencies across cardiac diagnoses. Frequent NICs provided in cardiac home care are similar across diagnoses, and include tissue perfusion management and patient education NICs. Variations can be detected and involve fluid monitoring/management, exercise promotion/teaching, and cardiac care NICs. Differences in nursing care among patients with similar medical diagnoses can be detected using NIC. Relevant knowledge of nursing care can be gleaned from analyzing NIC data generated in practice and can be used to plan, evaluate, and determine the effectiveness of nursing care.

  13. Grip strength impairments among older adults receiving physical therapy in a home-care setting.

    PubMed

    Bohannon, Richard W

    2010-12-01

    A hand-grip dynamometer was used to assess the magnitude and prevalence of grip strength impairments among 41 home-care patients with diverse diagnoses (e.g., stroke, cancer, fracture, osteoarthritis). Based on published reference values, patients (as a whole) were weaker than normal for age and sex. The prevalence of weakness was 85.4% on one or the other side and 70.7% on both sides. Considering the prognostic importance of grip strength, this study emphasized the potential value of its measurement in a home-care population.

  14. Impact of Depression and Childhood Trauma in Mothers Receiving Home Visitation

    ERIC Educational Resources Information Center

    Ammerman, Robert T.; Shenk, Chad E.; Teeters, Angelique R.; Noll, Jennie G.; Putnam, Frank W.; Van Ginkel, Judith B.

    2012-01-01

    Research has documented the deleterious effects of maternal depression and childhood trauma on parenting and child development. There are high rates of both depression and childhood trauma in new mothers participating in home visitation programs, a prevention approach designed to optimize mother and child outcomes. Little is known about the…

  15. Relationship between cognition and gait performance in older adults receiving physical therapy interventions in the home.

    PubMed

    Whitney, Susan L; Marchetti, Gregory F; Ellis, Jennifer; Otis, Laurie; Asiri, Faisal; Alghadir, Ahmad

    2013-01-01

    Persons undergoing physical therapy home services often have difficulty with mobility and gait. The purpose of this study was to determine whether there was a relationship between gait and a rating of cognitive functioning in persons undergoing home-care physical therapy services. Patients over the age of 65 (n = 11,601) seen by a home-care agency between 2007 and 2008 were included in the retrospective analysis, and 10,953 (mean +/- standard deviation age 83.2 +/- 7.1; 31%) met the criteria of being able to ambulate independently or with an assistive device. All patients attempted to perform the modified Clinical Test of Sensory Integration and Balance plus either the Performance Oriented Measurement Assessment (POMA) or the Dynamic Gait Index (DGI). Mental function was scored as part of the Outcome and Assessment Information Set. A multivariate model with adjustment for age and sex identified gait performance as measured by the DGI to be independently associated with the likelihood that a patient required cognitive prompting (p = 0.03). Both the DGI and POMA scores were independently associated with requiring assistance/dependence with cognitive tasks. There was a strong relationship between cognition and gait performance in persons undergoing physical therapy interventions in the home. Changes in gait may be related to cognitive decline.

  16. Impact of Depression and Childhood Trauma in Mothers Receiving Home Visitation

    ERIC Educational Resources Information Center

    Ammerman, Robert T.; Shenk, Chad E.; Teeters, Angelique R.; Noll, Jennie G.; Putnam, Frank W.; Van Ginkel, Judith B.

    2012-01-01

    Research has documented the deleterious effects of maternal depression and childhood trauma on parenting and child development. There are high rates of both depression and childhood trauma in new mothers participating in home visitation programs, a prevention approach designed to optimize mother and child outcomes. Little is known about the…

  17. Clinical characteristics and patterns of health deficits of centenarians receiving home care and long-term care services.

    PubMed

    Freeman, Shannon; Armstrong, Joshua J; Tyas, Suzanne L; Neufeld, Eva

    2017-09-21

    Centenarians (persons aged 100years and older) are one of the fastest growing cohorts in countries across the world. With the increasing prevalence of centenarians and growing amount of clinical information in large administrative health databases, it is now possible to more fully characterize the health of this unique and heterogeneous population. This study described patterns of health deficits in the centenarian population receiving care from community-based home care services and long-term care facilities (LTCFs) in Ontario, Canada. All centenarians who received home care and were assessed using the interRAI-Home Care Assessment instrument between 2007 and 2011 (n=1163) and all centenarians who resided in LTCFs between 2005 and 2011 who were assessed using the interRAI Minimum Data Set (MDS 2.0) (n=2228) were included in this study. Bivariate analyses described the centenarian population while K-means clustering analyses were utilized to identify relatively homogeneous subgroups within this heterogeneous population. The 3391 centenarians were aged 100 to 114 (mean age 101.5years ±1.9 SD) and the majority were women (84.7%). Commonly reported deficits included cognitive impairment, physical impairment, and bladder problems. Centenarians residing in LTCFs were significantly more likely than centenarians receiving home care services to report cognitive or functional impairment, or to exhibit symptoms of depression. The commonalities and uniqueness of four clusters of centenarians are described. Although there is great variability, there is also commonality within the centenarian population. Recognizing patterns within the heterogeneity of centenarians is key to providing high-quality person-centered care and to targeting health promotion and intervention strategies. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Home mechanical ventilation: a Canadian Thoracic Society clinical practice guideline.

    PubMed

    McKim, Douglas A; Road, Jeremy; Avendano, Monica; Abdool, Steve; Cote, Fabien; Duguid, Nigel; Fraser, Janet; Maltais, Fracois; Morrison, Debra L; O'Connell, Colleen; Petrof, Basil J; Rimmer, Karen; Skomro, Robert

    2011-01-01

    Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of userfriendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV) exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information.

  19. A review of self-rated generic quality of life instruments used among older patients receiving home care nursing.

    PubMed

    Leegaard, Marit; Utne, Inger; Halvorsrud, Liv; Valeberg, Berit Taraldsen; Torbjørnsen, Astrid; Bjørnnes, Ann Kristin; Bjørge, Heidi; Grov, Ellen Karine; Løyland, Borghild

    2017-03-28

    In the last two decades, quality of life and health-related quality of life have become commonly used outcome measures in the large number of studies evaluating healthcare and home care nursing. The objective of this systematic search and review was to evaluate studies that include self-rated generic quality of life instrument used among elderly patients receiving home care nursing. Searches were conducted in Medline, Embase, PsycINFO and Cinahl for articles published between January 2005 and June 2016, with 17 studies in eight countries meeting the inclusion criteria and assessed for quality. Overall, the review shows great variations in the included studies regarding characteristics of the participants and place of origin, the generic quality of life instruments applied and their dimensions. In this review, we raise the question of whether the generic questionnaires used to measure quality of life do in fact measure what is essential for quality of life in elderly users of home care nursing. The psychological and physical dimensions of quality of life were assessed in almost all included studies, while older-specific dimensions like autonomy, control and sensation were less frequently assessed. There is reason to believe that generic quality of life instruments frequently do not capture the dimensions that are most important for elderly people with health problems in need of home care nursing.

  20. Aseptic non-touch technique and catheter-related bloodstream infection in children receiving parenteral nutrition at home

    PubMed Central

    Evans, Victoria; Hughes, Anna; Hill, Susan

    2015-01-01

    Objectives Parenteral nutrition (PN) at home is an acceptable form of delivering long-term PN for children with intestinal failure. Catheter-related bloodstream infection (CRBSI) is one of the serious complications of long-term PN and can lead to increasing morbidity and mortality. Using aseptic non-touch technique (ANTT) was proven to decrease the incidence of CRBSI in hospital patients. In this study we aimed to review the incidence of CRBSI in children receiving PN at home in our institution using the ANTT and a simplified training programme for parents and carers. Methods We retrospectively collected clinical and microbiological data on all children with intestinal failure (IF) who were on treatment with PN at home under our specialist IF rehabilitation service between November 2012 and November 2013. Results Thirty-five children were included, 16 of whom did not have any infection recorded during the study period. The overall CRBSI rate was 1.3 infections per 1000 line-days, with Staphylococcus being the commonest organism. Twenty-one children did not require catheter change and the overall catheter changes were 1.8 per 1000 line-days. Conclusion In this article, we report a low incidence of CRBSI in a single institution by using the principle of ANTT for accessing central venous catheters combined with a simplified, nurse-led, two-week standardised training programme for parents of children going home on PN. PMID:26279849

  1. Despite small improvement, black nursing home residents remain less likely than whites to receive flu vaccine.

    PubMed

    Cai, Shubing; Feng, Zhanlian; Fennell, Mary L; Mor, Vincent

    2011-10-01

    Vaccination is a key deterrent to influenza and its related complications and outcomes, including hospitalization and death. Using 2006-09 data, we found a small improvement in vaccination rates among nursing home residents, particularly for blacks. Nonetheless, overall vaccination rates remained well below the 90 percent target for high-quality care, and black nursing home residents remained less likely to be vaccinated than whites. Blacks were less likely to be vaccinated than were whites in the same facility and were more likely to live in facilities with lower vaccination rates. Blacks were also more likely to be noted as refusing vaccination. Strategies are needed to ensure that facilities offer vaccination to all residents and to make vaccination more acceptable to black residents and their families.

  2. Deciding when it's labor: the experience of women who have received antepartum care at home for preterm labor.

    PubMed

    Palmer, Lynne; Carty, Elaine

    2006-01-01

    To describe how women who had received antepartum care at home for preterm labor managed subsequent episodes of preterm labor symptoms. Grounded theory method. 2 Canadian antepartum home care programs. 12 women who received antepartum care at home for preterm labor that had been diagnosed in hospital prior to 34 weeks gestation. The core psychosocial process was reconciling body knowledge and professional knowledge. Study participants reported knowing something's not right and followed decision guides to seek help. If, when they returned to the hospital to see what's going on, they felt dissonance between what their bodies were telling them (body knowledge) and what their health care providers were telling them (professional knowledge) an overriding tension developed between not wanting to take a risk for the baby versus not wanting to overreact. These women reestablished their baselines of nonthreatening symptoms at a higher level by setting a new normal to avoid the humiliation associated with appearing to overreact. Attempting to ignore recurring symptoms of preterm labor delayed help seeking and caused anxiety. To avoid delayed help seeking, nursing interventions should be geared to reducing anxiety and validating the experiences of women with recurring preterm labor symptoms.

  3. Predicting falls in elderly receiving home care: the role of malnutrition and impaired mobility.

    PubMed

    Meijers, J M; Halfens, R J; Neyens, J C; Luiking, Y C; Verlaan, G; Schols, J M

    2012-07-01

    To investigate the role of malnutrition, impaired mobility and care dependency in predicting fallers in older Dutch home care clients. This study is a secondary analysis of data of the annual independent national prevalence measurement of care problems of Maastricht University. The design involves a cross-sectional, multicentre point prevalence measurement (malnutrition, mobility), and a 30 days incidence measurement (falls). Dutch home care organisations. 2971 clients (older than 65 years) from 22 home care organizations participated. A standardized questionnaire was used to register amongst others data of weight, height, number and type of diseases (like for example neurologic diseases, dementia, CVA, COPD, eye/ear disorders, musculoskeletal disorders), nutritional intake, use of psychopharmaca, undesired weight loss, fall history, mobility, and care dependency. The study was able to show that fallers are more often malnourished than non-fallers in the univariate analysis. Most importantly the study indicated by multivariate analysis that fallers could be predicted by the risk factors immobility ((OR 2.516 95% CI 1.144-5.532), high care dependency (OR 1.684 95% CI 1.121-2.532) and malnutrition (OR 1.978 95% CI 1.340-2.920). The findings of this study stress that malnutrition, impaired mobility and care dependency are potential reversible factors related to falls. Therefore early identification and management of nutritional status, impaired mobility and care dependency are important aspects for a possible fall prevention strategy.

  4. Development and validation of a new quality of life scale for patients receiving home-based medical care: The Observational Study of Nagoya Elderly with Home Medical Care.

    PubMed

    Kamitani, Hiroko; Umegaki, Hiroyuki; Okamoto, Kazushi; Kanda, Shigeru; Asai, Atsushi; Maeda, Keiko; Nomura, Hideki; Shimojima, Takuya; Suzuki, Yusuke; Ohshima, Hiroko; Kuzuya, Masafumi

    2017-03-01

    To develop and validate a scale that assesses quality of life in patients receiving home-based medical care. A new quality of life scale was developed and evaluated in four phases: (i) item generation; (ii) first field study with a 14-item questionnaire; (iii) preliminary validation study, to reduce the number of items to four; and (iv) second field study comprising 40 patients, to evaluate the validity of the final version. Participants were requested to answer both the final version of the scale and the Short Form-8, to enable identification of any relationship between the two. Items were generated after discussions with doctors and care managers, and 14 items were selected for the draft version. In the preliminary validation study, 10 items were deleted, based on the results of statistical analysis of the data from the first field study. A psychometric analysis showed that the final four-item questionnaire had internal consistency (Cronbach's α = 0.7), and a significant association with the Short Form-8. We created the first quality of life scale for patients receiving home-based medical care. The scale's internal consistency was confirmed, as well as its external validity. This scale can be used independently of factors such as a patient's age, sex, level of independence in the presence of dementia or disability, swallowing function, hearing ability and communication ability, and can be used with ease in routine clinical practice. Geriatr Gerontol Int 2017; 17: 440-448. © 2016 Japan Geriatrics Society.

  5. [Management of patients receiving home respiratory care with tracheostomy and positive-pressure ventilation].

    PubMed

    Aoki, Masashi

    2013-01-01

    On March 11, 2011, the Great East Japan Earthquake occurred and a massive tsunami hit the northeastern coast of Japan. In Miyagi prefecture in Tokoku district, 49 patients with amyotrophic lateral sclerosis were supported by home respiratory care with tracheostomy and positive-pressure ventilation at that time. Among them, two patients were died in the tsunami and 25 patients were forced to evacuate to hospitals. We should hurry to submit a guideline for medical transportation for patients with neuromuscular diseases requiring artificial ventilation. We also should research the disaster medicine in the field of neurology.

  6. A national overview of the training received by certified nursing assistants working in U.S. nursing homes.

    PubMed

    Sengupta, Manisha; Harris-Kojetin, Lauren D; Ejaz, Farida K

    2010-01-01

    A few geographically limited studies have indicated that training of direct care workers may be insufficient. Using the first-ever nationally representative sample of certified nursing assistants (CNAs) from the 2004 National Nursing Assistant Survey (NNAS), this descriptive article provides an overview of the type of initial training and continuing education received by CNAs working in nursing homes, reports CNAs' assessments of the adequacy of their training, and identifies perceived training needs from the points of view of CNAs. Findings could be used to inform changes to the initial training and continuing education curriculum for this essential labor workforce.

  7. Dry skin in nursing care receivers: A multi-centre cross-sectional prevalence study in hospitals and nursing homes.

    PubMed

    Lichterfeld, A; Lahmann, N; Blume-Peytavi, U; Kottner, J

    2016-04-01

    Maintaining and improving skin health of patients and long-term care receivers is a widely agreed upon goal in health and nursing care. Care dependent and aged persons have a high predisposition to develop dry skin conditions. The aim of this study was to estimate the prevalence and severity of skin dryness in hospitals and nursing homes and to identify person- and health-related variables associated with this skin condition. The study was part of a bigger annual multicentre descriptive cross-sectional prevalence study of health problems. Fourteen nursing homes and six hospitals in Germany participated in this study in 2014. A total of 1710 subjects (n=1091 long-term care residents and n=619 in-patients) were included. Skin assessments were conducted and skin dryness was measured using the Overall Dry Skin Score. Mobility was measured using the respective item of the Care Dependency Scale. Demographic, functional and physiological parameters were compared between subjects with and without dry skin. A logistic regression model predicting skin dryness was created. The prevalence of skin dryness was 48.8% (95% CI 46.5-51.2). Nursing home residents were most often affected (52.6%; 95% CI 49.6-55.6) compared to in-patients (42.2%; 95% CI 38.3-46.1). The skin of feet and legs were most often affected by skin dryness (42.9%) compared to other skin areas. Being older (OR 1.01; 95% CI 1.01-1.02), having pruritus (OR 14.21; 95% CI 8.00-22.95), oncological (OR 1.95; 95% CI 1.30-2.91), musculoskeletal diseases (OR 1.31; 95% CI 1.04-1.64), being skin care independent (OR 0.48; 95% CI 0.32-0.70) were the strongest covariates for the presence of dry skin in the multivariate model. Based on a large sample results indicate that approximately every second nursing home resident and hospital in-patient are affected by dry skin. Severe forms occur more often in hospital in-patients compared to nursing home residents. Skin care interventions to tackle dry skin are recommended

  8. Switching hierarchical leadership mechanism in homing flight of pigeon flocks

    NASA Astrophysics Data System (ADS)

    Chen, Duxin; Vicsek, Tamás; Liu, Xiaolu; Zhou, Tao; Zhang, Hai-Tao

    2016-06-01

    To explore the fascinating inter-individual interaction mechanism governing the abundant biological grouping behaviors, more and more efforts have been devoted to collective motion investigation in recent years. Therein, bird flocking is one of the most intensively studied behaviors. A previous study (Nagy M. et al., Nature, 464 (2010) 890.) claims the existence of a well-defined hierarchical structure in pigeon flocks, which implies that a multi-layer leadership network leads to the occurrence of highly coordinated pigeon flock movements. However, in this study, by using high-resolution GPS data of homing flight of pigeon flocks, we reveal an explicit switching hierarchical mechanism underlying the group motions of pigeons. That is, a pigeon flock has a long-term leader for smooth moving trajectories, whereas the leading tenure passes to a temporary one upon sudden turns or zigzags. Therefore, the present observation helps explore more deeply into the principle of a huge volume of bird flocking dynamics. Meanwhile, from the engineering point of view, it may shed some light onto industrial multi-robot coordination and unmanned air vehicle formation control.

  9. Complementary home mechanical ventilation techniques. SEPAR Year 2014.

    PubMed

    Chiner, Eusebi; Sancho-Chust, José N; Landete, Pedro; Senent, Cristina; Gómez-Merino, Elia

    2014-12-01

    This is a review of the different complementary techniques that are useful for optimizing home mechanical ventilation (HMV). Airway clearance is very important in patients with HMV and many patients, particularly those with reduced peak cough flow, require airway clearance (manual or assisted) or assisted cough techniques (manual or mechanical) and suctioning procedures, in addition to ventilation. In the case of invasive HMV, good tracheostomy cannula management is essential for success. HMV patients may have sleep disturbances that must be taken into account. Sleep studies including complete polysomnography or respiratory polygraphy are helpful for identifying patient-ventilator asynchrony. Other techniques, such as bronchoscopy or nutritional support, may be required in patients on HMV, particularly if percutaneous gastrostomy is required. Information on treatment efficacy can be obtained from HMV monitoring, using methods such as pulse oximetry, capnography or the internal programs of the ventilators themselves. Finally, the importance of the patient's subjective perception is reviewed, as this may potentially affect the success of the HMV. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  10. Using Telehealth to Reduce All-Cause 30-Day Hospital Readmissions among Heart Failure Patients Receiving Skilled Home Health Services

    PubMed Central

    O’Connor, Melissa; Dempsey, Mary Louise; Huffenberger, Ann; Jost, Sandra; Flynn, Danielle; Norris, Anne

    2016-01-01

    Summary Background The reduction of all-cause hospital readmission among heart failure (HF) patients is a national priority. Telehealth is one strategy employed to impact this sought-after patient outcome. Prior research indicates varied results on all-cause hospital readmission highlighting the need to understand telehealth processes and optimal strategies in improving patient outcomes. Objectives The purpose of this paper is to describe how one Medicare-certified home health agency launched and maintains a telehealth program intended to reduce all-cause 30-day hospital readmissions among HF patients receiving skilled home health and report its impact on patient outcomes. Methods Using the Transitional Care Model as a guide, the telehealth program employs a 4G wireless tablet-based system that collects patient vital signs (weight, heart rate, blood pressure and blood oxygenation) via wireless peripherals, and is preloaded with subjective questions related to HF and symptoms and instructional videos. Results Year one all-cause 30-day readmission rate was 19.3%. Fiscal year 2015 ended with an all-cause 30-day readmission rate of 5.2%, a reduction by 14 percentage points (a 73% relative reduction) in three years. Telehealth is now an integral part of the University of Pennsylvania Health System’s readmission reduction program. Conclusions Telehealth was associated with a reduction in all-cause 30-day readmission for one mid-sized Medicare-certified home health agency. A description of the program is presented as well as lessons learned that have significantly contributed to this program’s success. Future expansion of the program is planned. Telehealth is a promising approach to caring for a chronically ill population while improving a patient’s ability for self-care. PMID:27437037

  11. Falls in older people receiving in-home informal care across Victoria: influence on care recipients and caregivers.

    PubMed

    Meyer, Claudia; Dow, Briony; Bilney, Belinda E; Moore, Kirsten J; Bingham, Amanda L; Hill, Keith D

    2012-03-01

    Older people receiving informal care at home appear at high falls risk. This study investigates frequency, circumstances and factors associated with falls risk for older care recipients, and their informal caregivers. Ninety-six dyads, recruited from caregiver agencies, underwent a home assessment, including falls risk, function, depression, quality of life, self-rated health and carer burden. Care recipients were at high falls risk. In the past 12 months, 58% had fallen and 26% twice or more. Common falls risk factors were polypharmacy, multiple medical conditions and requiring functional assistance. Caregivers exhibited multiple health problems, moderate burden and reduced quality of life. Where care recipients had high falls risk, caregivers had significantly higher carer burden and depression. Low functional level and high care recipient health problems were independently associated with risk of falling (P < 0.05). Strategies to reduce falls risk in this cohort are necessary, together with supporting the needs of the caregiver. © 2010 The Authors. Australasian Journal on Ageing © 2010 ACOTA.

  12. Variation in nutritional risk among Mexican American and non-Mexican American homebound elders who receive home-delivered meals.

    PubMed

    Sharkey, Joseph R

    2004-01-01

    Good nutritional health is essential to prevent functional decline and improve quality of life. Little is known of disparities in the extent of risk for poor nutritional health among homebound Mexican American (MA) elders who receive Older American Act Nutrition Program (OAANP) home-delivered meals. In order to assist OAANP service providers in understanding racial/ethnic differences in nutritional risk, this study examined routinely collected data on 908 homebound MA and non-MA in the Texas Lower Rio Grande Valley. Homebound MA were more likely to report poverty, risk factors for and indicators of poor nutritional health. Independent of poverty and covariates,MA were more likely to report very high nutritional risk. This underscores the importance of understanding racial/ethnic disparities in the extent of risk for poor nutritional health for the development, implementation, and evaluation of effective strategies to alleviate nutritional health disparities.

  13. 41 CFR 302-10.300 - May I receive an advance of funds when a commercial carrier transports the mobile home?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 41 Public Contracts and Property Management 4 2012-07-01 2012-07-01 false May I receive an advance of funds when a commercial carrier transports the mobile home? 302-10.300 Section 302-10.300 Public... Advance of Funds § 302-10.300 May I receive an advance of funds when a commercial carrier transports...

  14. Nurse-family conflict beyond the walls of Iranian homes who have the mechanical ventilation dependent patient: a qualitative research

    PubMed Central

    Moradian, ST; Nourozi, K; Ebbadi, A; Khankeh, HR

    2015-01-01

    Rationale. Home health care (HHC) has been developed more than any other industry in the past decade. Conflict between nurse and family can diminish the aid produced to the home care patients. Objective. This research was guidance to explore the nature of conflicts between the patient’s families and nurses in homes of dangerous care patients, in an Iranian context. Methods and results. Using the qualitative comfortable study system and the purposive sampling, 15 participants including 7 nurses (4 males and 3 females) operating in houses and 8 members of family who had a care receiving mechanical ventilation at house, were interviewed during 2013 and 2014. The main sources of conflict were due to nurse expectations, family belief, and personal qualities of nurses. The team guider tried to prevent the conflict by different measures, but in some samples, the conflict arose. Both members of family and nurses accepted the team leader as the judge. At first, he tried to keep the situation stable and gave some notification to the nurse and some descriptions to the members of family. In some samples, that the family could not adapt to the position and efforts to solve the conflict were unsuccessful, the team relation with the family being cut. Conclusion. Home care situation is prone to conflict due to various factors. The mentioned sources of conflict in home trial were changed from the ones of the hospital. Based on these results appropriate interventions suitable for home conditions should be implemented. PMID:28316661

  15. Undernutrition at baseline and health services utilization and mortality over a 1-year period in older adults receiving Medicare home health services.

    PubMed

    Yang, Yongbin; Brown, Cynthia J; Burgio, Kathryn L; Kilgore, Meredith L; Ritchie, Christine S; Roth, David L; West, Delia Smith; Locher, Julie L

    2011-05-01

    Older adults receiving Medicare home health services who experience undernutrition may be at increased risk of experiencing adverse outcomes. We sought to identify the association between baseline nutritional status and subsequent health service utilization and mortality over a 1-year period in older adults receiving Medicare home health services. This was a longitudinal study using questionnaires and anthropometric measures designed to assess nutritional status (Mini-Nutritional Assessment) at baseline and health services utilization and mortality status at 6-month and 1-year follow-ups. Participants were evaluated in their homes. A total of 198 older adults who were receiving Medicare home health services. Based on Mini-Nutritional Assessment, 12.0% of patients were malnourished, 51.0% were at risk for malnourishment, and 36.9% had normal nutritional status. Based on body mass index, 8.1% of participants were underweight, 37.9% were normal weight, 25.3% were overweight, and 28.8% were obese. Using multivariate binary logistic regression analyses, participants who were malnourished or at risk for malnourishment were more likely to experience subsequent hospitalization, emergency room visit, home health aide use, and mortality for the entire sample and hospitalization and nursing home stay for overweight and obese participants. Experiencing undernutrition at the time of receipt of Medicare home health services was associated with increased health services utilization and mortality for the entire sample, and with increased health services utilization only for the overweight and obese subsample. Opportunities exist to address risk of undernutrition in patients receiving home health services, including those who are overweight or obese, to prevent subsequent adverse health outcomes. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

  16. Under-nutrition at baseline and health services utilization and mortality over a one-year period in older adults receiving Medicare home health services

    PubMed Central

    Yang, Yongbin; Brown, Cynthia J.; Burgio, Kathryn L.; Kilgore, Meredith L.; Ritchie, Christine S.; Roth, David L.; West, Delia Smith; Locher, Julie L.

    2010-01-01

    Objective Older adults receiving Medicare home health services who experience under-nutrition may be at increased risk of experiencing adverse outcomes. We sought to identify the association between baseline nutritional status and subsequent health service utilization and mortality over a one-year period in older adults receiving Medicare home health services. Design This was a longitudinal study using questionnaires and anthropometric measures designed to assess nutritional status (Mini-Nutritional Assessment [MNA]) at baseline and health services utilization and mortality status at six-month and one-year follow-ups. Setting Participants were evaluated in their homes. Participants 198 older adults who were receiving Medicare home health services. Results Based upon MNA, 12.0% of patients were Malnourished, 51.0% were At Risk for Malnourishment, and 36.9% had Normal Nutrition Status. Based upon body mass index (BMI), 8.1% of participants were underweight, 37.9% were normal weight, 25.3% were overweight, and 28.8% were obese. Using multivariate binary logistic regression analyses, participants who were Malnourished or At Risk for Malnourishment were more likely to experience subsequent hospitalization, emergency room visit, home health aide use, and mortality for the entire sample and hospitalization and nursing home stay for overweight and obese participants. Conclusions Experiencing under-nutrition at the time of receipt of Medicare home health services was associated with increased health services utilization and mortality for the entire sample, and with increased health services utilization only for the overweight and obese subsample. Opportunities exist to address risk of under-nutrition in patients receiving home health services, including those who are overweight or obese, to prevent subsequent adverse health outcomes. PMID:21527170

  17. Update on clinical trials in home mechanical ventilation.

    PubMed

    Hodgson, Luke E; Murphy, Patrick B

    2016-02-01

    Home mechanical ventilation (HMV) is an increasingly common intervention and is initiated for a range of pathological processes, including neuromuscular disease (NMD), chronic obstructive pulmonary disease (COPD) and obesity related respiratory failure. There have been important recent data published in this area, which helps to guide practice by indicating which populations may benefit from this intervention and the optimum method of setting up and controlling sleep disordered breathing. Recent superficially conflicting data has been published regarding HMV in COPD, with a trial in post-exacerbation patients suggesting no benefit, but in stable chronic hypercapnic patients suggesting a clear and sustained mortality benefit. The two studies are critiqued and the potential reasons for the differing results are discussed. Early and small trial data is frequently contradicted with larger randomised controlled trials and this has been the case with diaphragm pacing being shown to be potentially harmful in the latest data, confirming the importance of non-invasive ventilation (NIV) in NMD such as motor neurone disease. Advances in ventilator technology have so far appeared quicker than the clinical data to support their use; although small and often unblinded, the current data suggests equivalence to standard modes of NIV, but with potential comfort benefits that may enhance adherence. The indications for NIV have expanded since its inception, with an effort to treat sleep disordered breathing as a result of chronic heart failure (HF). The SERVE-HF trial has recently demonstrated no clear advantage to this technology and furthermore detected a potentially deleterious effect, with a worsening of all cause and cardiovascular mortality in the treated group compared to controls. The review serves to provide the reader with a critical review of recent advances in the field of sleep disordered breathing and HMV.

  18. 25 CFR 256.26 - Can I receive Housing Improvement Program services if I am living in a mobile home?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... am living in a mobile home? 256.26 Section 256.26 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE... I am living in a mobile home? Yes. If you meet the eligibility criteria in § 256.6 and there is... § 256.7. If you require Category B services and your mobile home has exterior walls of less than...

  19. 25 CFR 256.26 - Can I receive Housing Improvement Program services if I am living in a mobile home?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... am living in a mobile home? 256.26 Section 256.26 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE... I am living in a mobile home? Yes. If you meet the eligibility criteria in § 256.6 and there is... § 256.7. If you require Category B services and your mobile home has exterior walls of less than...

  20. Prevention of Subsequent Catheter-Related Bloodstream Infection Using Catheter Locks in High-Risk Patients Receiving Home Parenteral Nutrition.

    PubMed

    Davidson, Jacob B; Edakkanambeth Varayil, Jithinraj; Okano, Akiko; Whitaker, Jennifer A; Bonnes, Sara L; Kelly, Darlene G; Mundi, Manpreet S; Hurt, Ryan T

    2017-05-01

    Catheter-related bloodstream infection (CRBSI) is a serious complication in patients receiving home parenteral nutrition (HPN). Antibiotic lock therapy (ALT) and ethanol lock therapy (ELT) can be used to prevent CRBSI episodes in high-risk patients. Following institutional review board approval, all patients enrolled in the Mayo Clinic HPN program from January 1, 2006, to December 31, 2013, with catheter locking were eligible to be included. Patients without research authorization and <18 years old at the initiation of HPN were excluded. Total number of infections before and after ALT or ELT were estimated in all patients. A total of 63 patients were enrolled during the study period. Of 59 eligible patients, 29 (49%) were female, and 30 (51%) were male. The median duration of HPN was 3.66 (interquartile range, 0.75-8.19) years. The mean age ± SD at initiation of HPN was 49.89 ± 14.07 years. A total of 51 patients were instilled with ALT, and 8 patients were instilled with ELT during their course of HPN. A total of 313 CRBSI episodes occurred in these patients, 264 before locking and 49 after locking ( P < .001). Rate of infection per 1000 catheter days was 10.97 ± 25.92 before locking and 1.09 ± 2.53 after locking ( P < .001). The major findings of the present study reveal that ALT or ELT can reduce the overall rate of infections per 1000 catheter days. ALT or ELT can be used in appropriate clinical setting for patients receiving HPN.

  1. Prevalence of 'being at risk of malnutrition' and associated factors in adult patients receiving nursing care at home in Belgium.

    PubMed

    Geurden, Bart; Franck MPsych, Erik; Lopez Hartmann, Maja; Weyler, Joost; Ysebaert, Dirk

    2015-10-01

    Malnutrition is a known problem in hospitals and nursing homes. This study aims to evaluate the prevalence of being at risk of malnutrition in community living adults receiving homecare nursing and to determine factors independently associated with this risk of malnutrition. Furthermore, it also aimed to describe aspects of current nutritional nursing care. Patients (n = 100) are screened with the Malnutrition Universal Screening Tool to evaluate their risk of malnutrition. A patient survey was used to analyse associated factors. In this population, 29% are at risk for malnutrition. Following a multivariate logistic regression analysis, 'loss of appetite' proved the most important factor. A survey for nurses (n = 61) revealed low awareness, poor knowledge, poor communication between stakeholders and a moderate approach of malnutrition. These findings should encourage homecare nurses to use a recommended screening tool for malnutrition and to actively observe and report loss of appetite to initiate the prescription of individual tailored interventions. Belgian homecare nurses' management does not yet fully comply with international recommendations. Additional training in nutritional nursing care and screening methods for malnutrition is needed. Systematic screening should be further developed and evaluated in this at-risk population.

  2. Optimising Health Literacy and Access of Service Provision to Community Dwelling Older People with Diabetes Receiving Home Nursing Support.

    PubMed

    Goeman, Dianne; Conway, Sue; Norman, Ralph; Morley, Jo; Weerasuriya, Rona; Osborne, Richard H; Beauchamp, Alison

    Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS). Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

  3. Optimising Health Literacy and Access of Service Provision to Community Dwelling Older People with Diabetes Receiving Home Nursing Support

    PubMed Central

    Conway, Sue; Norman, Ralph; Morley, Jo; Weerasuriya, Rona; Osborne, Richard H.; Beauchamp, Alison

    2016-01-01

    Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS). Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management. PMID:27668261

  4. Treating Dehydration at Home Avoids Healthcare Costs Associated With Emergency Department Visits and Hospital Readmissions for Adult Patients Receiving Home Parenteral Support.

    PubMed

    Konrad, Denise; Roberts, Scott; Corrigan, Mandy L; Hamilton, Cindy; Steiger, Ezra; Kirby, Donald F

    2017-06-01

    Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P < .001) and may be attributed to a shift in the patient population, with more patients having malabsorption as the indication for therapy in 2010 ( P = .003). There were more than twice as many episodes of dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.

  5. Does receiving care in a medical home reduce racial/ethnic disparities in ED visits among children with asthma in the United States?

    PubMed

    Lin, Susan X; Younge, Richard G; Kleinman, Lawrence C

    2016-07-14

    Evidence has shown the implementation of medical home model improves care quality and outcomes. However, it is not clear whether receiving care from a medical home has any impact on racial/ethnic disparities in emergency department (ED) use by children with asthma. This study using the US National Survey of Children with Special Health Care Needs, 2009-2010, estimated racial/ethnic disparities in ED use. Generalized liner models were used to examine factors associated with ED use. Racial/ethnic differences in ED use were attenuated after adjusting for socio-economic variables. Ratios of prevalence ratios were calculated to examine the effect modification of medical home on ED use associated with race/ethnicity. The adjusted prevalence ratio of ED use of the Black to non-Hispanic White was 1.51 (95% confidence interval (CI): 1.36-1.67) with medical home and 1.35 (95% CI: 1.24-1.47) without medical home. Among those with care from a medical home Latino children had higher ED use compared with White children. There is no evidence that the self-reported care from a medical home narrows the gaps in ED use between non-Hispanic White and Black or Latino children with asthma.

  6. 41 CFR 302-10.3 - What is the maximum amount my agency may authorize me to receive for transporting a mobile home?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 41 Public Contracts and Property Management 4 2012-07-01 2012-07-01 false What is the maximum amount my agency may authorize me to receive for transporting a mobile home? 302-10.3 Section 302-10.3 Public Contracts and Property Management Federal Travel Regulation System RELOCATION...

  7. 41 CFR 302-10.3 - What is the maximum amount my agency may authorize me to receive for transporting a mobile home?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 41 Public Contracts and Property Management 4 2013-07-01 2012-07-01 true What is the maximum amount my agency may authorize me to receive for transporting a mobile home? 302-10.3 Section 302-10.3 Public Contracts and Property Management Federal Travel Regulation System RELOCATION...

  8. Inner power, physical strength and existential well-being in daily life: relatives' experiences of receiving soft tissue massage in palliative home care.

    PubMed

    Cronfalk, Berit Seiger; Strang, Peter; Ternestedt, Britt-Marie

    2009-08-01

    This article explores relatives' experiences of receiving soft tissue massage as a support supplement while caring for a dying family member at home. In palliative home care, relatives play an important role as carers to seriously ill and dying family members. To improve their quality of life, different support strategies are of importance. Complementary methods, such as soft tissue massage have become an appreciated supplement for these patients. However, only few studies focus on relatives experiences of receiving soft tissue massage as a supplemental support. Qualitative design Nineteen relatives received soft tissue massage (hand or foot) nine times (25 minutes) in their homes. Open-ended semi-structured tape-recorded interviews were conducted once per relative after the nine times of massage, using qualitative content analysis. Soft tissue massage gave the relatives' feelings of 'being cared for', 'body vitality' and 'peace of mind'. For a while, they put worries of daily life aside as they just experienced 'being'. During massage, it became apparent that body and mind is constituted of an indestructible completeness. The overarching theme was 'inner power, physical strength and existential well-being in their daily lives'. All relatives experienced soft tissue massage positively, although they were under considerable stress. Soft tissue massage could be an option to comfort and support relatives in palliative home care. In palliative nursing care, soft tissue massage could present a worthy supplement in supporting caring relatives.

  9. A universal data access and protocol integration mechanism for smart home

    NASA Astrophysics Data System (ADS)

    Shao, Pengfei; Yang, Qi; Zhang, Xuan

    2013-03-01

    With the lack of standardized or completely missing communication interfaces in home electronics, there is no perfect solution to address every aspect in smart homes based on existing protocols and technologies. In addition, the central control unit (CCU) of smart home system working point-to-point between the multiple application interfaces and the underlying hardware interfaces leads to its complicated architecture and unpleasant performance. A flexible data access and protocol integration mechanism is required. The current paper offers a universal, comprehensive data access and protocol integration mechanism for a smart home. The universal mechanism works as a middleware adapter with unified agreements of the communication interfaces and protocols, offers an abstraction of the application level from the hardware specific and decoupling the hardware interface modules from the application level. Further abstraction for the application interfaces and the underlying hardware interfaces are executed based on adaption layer to provide unified interfaces for more flexible user applications and hardware protocol integration. This new universal mechanism fundamentally changes the architecture of the smart home and in some way meets the practical requirement of smart homes more flexible and desirable.

  10. Development and Validation of a Mortality Prediction Model for Patients Receiving 14 Days of Mechanical Ventilation.

    PubMed

    Hough, Catherine L; Caldwell, Ellen S; Cox, Christopher E; Douglas, Ivor S; Kahn, Jeremy M; White, Douglas B; Seeley, Eric J; Bangdiwala, Shrikant I; Rubenfeld, Gordon D; Angus, Derek C; Carson, Shannon S

    2015-11-01

    The existing risk prediction model for patients requiring prolonged mechanical ventilation is not applicable until after 21 days of mechanical ventilation. We sought to develop and validate a mortality prediction model for patients earlier in the ICU course using data from day 14 of mechanical ventilation. Multicenter retrospective cohort study. Forty medical centers across the United States. Adult patients receiving at least 14 days of mechanical ventilation. None. Predictor variables were measured on day 14 of mechanical ventilation in the development cohort and included in a logistic regression model with 1-year mortality as the outcome. Variables were sequentially eliminated to develop the ProVent 14 model. This model was then generated in the validation cohort. A simplified prognostic scoring rule (ProVent 14 Score) using categorical variables was created in the development cohort and then tested in the validation cohort. Model discrimination was assessed by the area under the receiver operator characteristic curve. Four hundred ninety-one patients and 245 patients were included in the development and validation cohorts, respectively. The most parsimonious model included age, platelet count, requirement for vasopressors, requirement for hemodialysis, and nontrauma admission. The area under the receiver operator characteristic curve for the ProVent 14 model using continuous variables was 0.80 (95% CI, 0.76-0.83) in the development cohort and 0.78 (95% CI, 0.72-0.83) in the validation cohort. The ProVent 14 Score categorized age at 50 and 65 years old and platelet count at 100×10(9)/L and had similar discrimination as the ProVent 14 model in both cohorts. Using clinical variables available on day 14 of mechanical ventilation, the ProVent 14 model can identify patients receiving prolonged mechanical ventilation with a high risk of mortality within 1 year.

  11. [Home mechanical ventilation: Invasive and noninvasive ventilation therapy for chronic respiratory failure].

    PubMed

    Huttmann, S E; Storre, J H; Windisch, W

    2015-06-01

    Home mechanical ventilation represents a valuable therapeutic option to improve alveolar ventilation in patients with chronic respiratory failure. For this purpose both invasive ventilation via tracheostomy and noninvasive ventilation via facemasks are available. The primary goal of home mechanical ventilation is a reduction of symptoms, improvement of quality of life and in many cases reduction of mortality. Elective establishment of home mechanical ventilation is typically provided for noninvasive ventilation in respect to clinical symptoms and partial pressure of carbon dioxide depending on the underlying disease. However, invasive mechanical ventilation is increasingly being used to continue ventilatory support in polymorbid patients following unsuccessful weaning. Recommendations and guidelines have been published by the German Respiratory Society (DGP).

  12. Effect of Antipyretic Therapy on Mortality in Critically Ill Patients with Sepsis Receiving Mechanical Ventilation Treatment

    PubMed Central

    Ye, Sheng; Xu, Dan; Zhang, Chenmei; Li, Mengyao

    2017-01-01

    Purpose. The study aimed to investigate the effectiveness of antipyretic therapy on mortality in critically ill patients with sepsis requiring mechanical ventilation. Methods. In this study, we employed the multiparameter intelligent monitoring in intensive care II (MIMIC-II) database (version 2.6). All patients meeting the criteria for sepsis and also receiving mechanical ventilation treatment were included for analysis, all of whom suffer from fever or hyperthermia. Logistic regression model and R language (R version 3.2.3 2015-12-10) were used to explore the association of antipyretic therapy and mortality risk in critically ill patients with sepsis receiving mechanical ventilation treatment. Results. A total of 8,711 patients with mechanical ventilator were included in our analysis, and 1523 patients died. We did not find any significant difference in the proportion of patients receiving antipyretic medication between survivors and nonsurvivors (7.9% versus 7.4%, p = 0.49). External cooling was associated with increased risk of death (13.5% versus 9.5%, p < 0.001). In our regression model, antipyretic therapy was positively associated with mortality risk (odds ratio [OR]: 1.41, 95% CI: 1.20–1.66, p < 0.001). Conclusions. The use of antipyretic therapy is associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation. External cooling may even be deleterious. PMID:28386165

  13. Thermo-mechanical and optical optimization of the molten salt receiver for a given heliostat field

    NASA Astrophysics Data System (ADS)

    Augsburger, Germain; Das, Apurba K.; Boschek, Erik; Clark, Michael M.

    2016-05-01

    The tower type molten salt solar thermal power plant has proven to be advantageous over other utility scale solar power plant configurations due to its scalability and provision of storage, thereby improving the dispatchability. The configuration consists of a molten salt central receiver (MSCR) located atop an optimally located tower within a heliostat field with thousands of mirrors. The MSCR receives the concentrated energy from the heliostat field which heats a molten salt heat transfer fluid for thermal storage and utilization in producing steam as and when required for power generation. The MSCR heat transfer surface consists of banks of tangent tubes arranged in panels. The combined cost of the heliostat field and the receiver is 40%-50% of the total plant cost, which calls for optimization to maximize their utilization. Several previous studies have looked into the optimum solar power plant size based on various site conditions. However, the combined optimization of the receiver and the heliostat field has not been reported before. This study looks into the optimum configuration of the receiver for a given heliostat field. An in-house tool has been developed to select and rank a few receiver surface configurations (typically <50) from a list of hundreds of thousands of possible options. The operating limits which the heliostat field needs to obey are defined for the ranked surface configurations based on several different design considerations (e.g. mechanical integrity, corrosion limits). The thermal output of the receiver configurations for a given heliostat field is maximized. A combined rank indicating the optimum configurations in descending order of preference is presented based on the performance and various other practical considerations (e.g. total surface area, cost of material, ability of aiming strategies to distribute the flux). The methodology thus provided can be used as a guideline to arrive at an optimum receiver configuration for a given

  14. A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: study protocol for a randomised controlled trial.

    PubMed

    Bjerk, Maria; Brovold, Therese; Skelton, Dawn A; Bergland, Astrid

    2017-08-14

    Falls and fall-related injuries in older adults are associated with great burdens, both for the individuals, the health care system and the society. Previous research has shown evidence for the efficiency of exercise as falls prevention. An understudied group are older adults receiving home help services, and the effect of a falls prevention programme on health-related quality of life is unclear. The primary aim of this randomised controlled trial is to examine the effect of a falls prevention programme on quality of life, physical function and falls efficacy in older adults receiving home help services. A secondary aim is to explore the mediating factors between falls prevention and health-related quality of life. The study is a single-blinded randomised controlled trial. Participants are older adults, aged 67 or older, receiving home help services, who are able to walk with or without walking aids, who have experienced at least one fall during the last 12 months and who have a Mini Mental State Examination of 23 or above. The intervention group receives a programme, based on the Otago Exercise Programme, lasting 12 weeks including home visits and motivational telephone calls. The control group receives usual care. The primary outcome is health-related quality of life (SF-36). Secondary outcomes are leg strength, balance, walking speed, walking habits, activities of daily living, nutritional status and falls efficacy. All measurements are performed at baseline, following intervention at 3 months and at 6 months' follow-up. Sample size, based on the primary outcome, is set to 150 participants randomised into the two arms, including an estimated 15-20% drop out. Participants are recruited from six municipalities in Norway. This trial will generate new knowledge on the effects of an exercise falls prevention programme among older fallers receiving home help services. This knowledge will be useful for clinicians, for health managers in the primary health care service

  15. Validation of the Portuguese Severe Respiratory Insufficiency Questionnaire for home mechanically ventilated patients.

    PubMed

    Ribeiro, C; Ferreira, D; Conde, S; Oliveira, P; Windisch, W

    The aim of this study was to develop and validate the professional translation and cultural adaptation of the Portuguese Severe Respiratory Insufficiency (SRI) Questionnaire. The sample was composed of 93 patients (50 male patients, 53.8%) with a mean age of 66.3 years. The most frequent diagnostic groups were chronic obstructive pulmonary disease, obesity hypoventilation syndrome and restrictive chest wall disorders. The patients were asked to fill in both the SRI and SF-36 questionnaires. Factor analysis of the SRI questionnaire was performed leading to an explained variance of 73%, and resulted in 13 components. When analyzing the reliability, we obtained values for Cronbach's alpha above 0.70 for most subscales with the reliability of the summary scale being even higher (0.84). This professional translation and cultural adaptation of the Portuguese SRI Questionnaire has good psychometric properties which are similar, not only to the original, but also to other translations. These characteristics make this questionnaire applicable to the Portuguese population receiving home mechanical ventilation for severe respiratory insufficiency. Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  16. 25 CFR 256.26 - Can I receive Housing Improvement Program services if I am living in a mobile home?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Can I receive Housing Improvement Program services if I... INTERIOR HOUSING HOUSING IMPROVEMENT PROGRAM § 256.26 Can I receive Housing Improvement Program services if... sufficient funding available, you can receive any of the Housing Improvement Program services identified...

  17. Risk and presence of food insufficiency are associated with low nutrient intakes and multimorbidity among homebound older women who receive home-delivered meals.

    PubMed

    Sharkey, Joseph R

    2003-11-01

    This study examined the independent association of food sufficiency status with lowest nutrient intakes and multimorbidity among homebound older women who received home-delivered meals. Baseline data from the Nutrition and Function Study were used to identify three categories of food sufficiency status [food sufficient (FS), risk of food insufficiency (RFI) and food insufficient (FI)], calculate summary measures of musculoskeletal (calcium, vitamin D, magnesium and phosphorus) and overall nutrient intakes, and examine, using multivariable logistic regression models, the association of food sufficiency status with nutrition and health outcomes among 279 women who received regular home-delivered meals service (5 weekday meals/wk) and completed an in-home assessment and three 24-h dietary recalls. Independent of income and other variables, the adjusted odds for reporting lowest intakes in individual and multiple nutrients (> or = 2 musculoskeletal and > or = 5 overall) were significantly greater among women who reported RFI [odds ratio (OR) = 1.96 to 2.91] and FI (OR = 2.85 to 5.21). In addition, FI women were more likely to report a burden of multimorbidity (OR = 3.69). Considering the importance of home-delivered meals as a primary source of food assistance to homebound older women, the results of this study suggest the need to reevaluate the traditional model of home-delivered meals and to include measures of food sufficiency status as an integral component of program assessment and evaluation for the targeting and monitoring of new, innovative and cost-effective strategies to alleviate risk and the presence of food insufficiency.

  18. Formal and informal support of family caregivers managing medications for patients who receive end-of-life care at home: a cross-sectional survey of caregivers.

    PubMed

    Joyce, Brian T; Berman, Rebecca; Lau, Denys T

    2014-10-01

    Managing medications is a complex responsibility of family caregivers caring for end-of-life patients. This study characterizes caregivers with and without formal/informal support managing medications for patients who receive end-of-life care at home. To explore factors related to caregivers' support with managing medications for end-of-life home hospice patients. A convenience-sampled, cross-sectional telephone survey. Computer-assisted telephone interviews were administered to 120 caregivers managing medications, who were referred by five Chicago-based home hospice services. We measured caregivers' additional formal (paid) and informal (unpaid) support with managing medications, and caregiver/patient socio-demographic, relational, and health characteristics. While 47 (39%) had no additional support with managing medications, 27 (22.5%) had formal support, 37 (31%) informal, and 9 (7.5%) both. Seven caregivers (19%) with formal and 13 (31%) with informal support reported disagreements concerning treatment plans. Caregivers lacking formal support tended to be racial/ethnic minorities, live with the patient in their home, or report greater emotional burden. Caregivers with formal support tended to report higher education/income, lower mutuality, or care for a patient with over 6 months' hospice enrollment. Caregivers lacking informal support tended to be spousal caregivers, live with the patient, or have experience caring for another dying person. Our study suggests that high proportions of caregivers may not have support managing medications for patients receiving hospice care at home. More research should examine whether the observed variations in obtaining support indicate disparities or unmet needs among caregivers. Disagreement about treatment with formal/informal support also warrants further investigation. © The Author(s) 2014.

  19. Rehabilitation and home care for ventilator-assisted individuals.

    PubMed

    Make, B J; Gilmartin, M E

    1986-12-01

    An increasing number of patients with chronic irreversible respiratory disorders are receiving mechanical ventilation in the home. Rehabilitation prior to hospital discharge allows improved independence and mobility in the home for these individuals.

  20. HIV-1 selectively targets gut-homing CCR6+CD4+ T cells via mTOR-dependent mechanisms

    PubMed Central

    Planas, Delphine; Zhang, Yuwei; Monteiro, Patricia; Goulet, Jean-Philippe; Gosselin, Annie; Hope, Thomas J.; Routy, Jean-Pierre

    2017-01-01

    Gut-associated lymphoid tissues are enriched in CCR6+ Th17-polarized CD4+ T cells that contribute to HIV-1 persistence during antiretroviral therapy (ART). This raises the need for Th17-targeted immunotherapies. In an effort to identify mechanisms governing HIV-1 permissiveness/persistence in gut-homing Th17 cells, we analyzed the transcriptome of CCR6+ versus CCR6– T cells exposed to the gut-homing inducer retinoic acid (RA) and performed functional validations in colon biopsies of HIV-infected individuals receiving ART (HIV+ART). Although both CCR6+ and CCR6– T cells acquired gut-homing markers upon RA exposure, the modulation of unique sets of genes coincided with preferential HIV-1 replication in RA-treated CCR6+ T cells. This molecular signature included the upregulation of HIV-dependency factors acting at entry/postentry levels, such as the CCR5 and PI3K/Akt/mTORC1 signaling pathways. Of note, mTOR expression/phosphorylation was distinctively induced by RA in CCR6+ T cells. Consistently, mTOR inhibitors counteracted the effect of RA on HIV replication in vitro and viral reactivation in CD4+ T cells from HIV+ART individuals via postentry mechanisms independent of CCR5. Finally, CCR6+ versus CCR6– T cells infiltrating the colons of HIV+ART individuals expressed unique molecular signatures, including higher levels of CCR5, integrin β7, and mTOR phosphorylation. Together, our results identify mTOR as a druggable key regulator of HIV permissiveness in gut-homing CCR6+ T cells. PMID:28768913

  1. [Intrathoracic drainage of a compressive pulmonary bulla in a patient receiving mechanical ventilation].

    PubMed

    Sleth, J C; Aldebert, S; Safont, L; Knoerr, M F

    1998-01-01

    A lung suppuration may result in a lung bulla with its own course. We report such a case following a Pseudomonas aeruginosa pneumonia of the upper right lobe, after aspiration of gastric contents, in a 21-year-old tracheotomized patient in chronic post-traumatic coma. Mechanical ventilation (IPPV) was indicated because of respiratory insufficiency. The pneumonia was followed by an abscess and later a lung bulla, increasing in size under the effect of mechanical ventilation with progressive mediastinal compression. Surgery was contraindicated because of poor physical status. An acute episode of cardiac tamponade was controlled with an emergency transthoracic drain insertion into the bulla. The course was favourable after a drainage for 23 days and a persisting small cavity in the lung apex. All weaning attempts being unsuccessful, the patient was discharged under home mechanical ventilation. A CT-scan control 6 months later showed a normal lung parenchyma. The various alternative techniques to surgery for treatment of a lung bulla are discussed.

  2. Enhancing provider knowledge and patient screening for palliative care needs in chronic multimorbid patients receiving home-based primary care.

    PubMed

    Wharton, Tracy; Manu, Erika; Vitale, Caroline A

    2015-02-01

    This article describes a pilot model to increase palliative care (PC) knowledge and collaboration among providers and to systematically identify chronic multimorbid home care patients who would benefit from focused discussion of potential PC needs. Thirty health care providers from a home-based primary care team attended interdisciplinary trainings. The Palliative Performance Scale (PPS) tool was used to trigger discussions of potential palliative needs at team rounds for patients who scored below a cutoff point on the tool. Palliative Performance Scale implementation added little burden on nurses and triggered a discussion in 51 flagged patients. The tool successfully identified 75% of patients who died or were discharged. Screening was systematic and consistent and resulted in targeted discussions about PC needs without generating additional burden on our PC consult service. This model shows promise for enhancing collaborative patient care and access to PC.

  3. Advantages and Disadvantages for Receiving Internet-Based HIV/AIDS Interventions at Home or at Community Based Organization

    PubMed Central

    Green, Shana M.; Lockhart, Elizabeth; Marhefka, Stephanie L.

    2015-01-01

    Within recent years public health interventions have become technologically based to reflect the digital age we currently live in and appeal to the public in innovative and novel ways. The Internet breaks down boundaries distance imposes and increases our ability to reach and connect with people. Internet-based interventions have the potential to expand access to effective behavioral interventions. The US National HIV/AIDS Strategy states that people living with HIV should have access to effective behavioral interventions like Healthy Relationships (HR) to help them develop safe sex and disclosure skills. However, access to HR is limited across the country, especially for people in remote or rural areas. Internet-based Healthy Relationships Video Groups (HR-VG) delivered at home or community based organizations (CBOs) can possibly expand access. This study assesses the preferences of women living with HIV (WLH) for participation in HR-VG among 21 WLH who participated in a randomized control trial (RCT) testing HR-VG and completed open-ended semi-structured telephone interviews. Transcripts were thematically analyzed to determine advantages, disadvantages and overall preference for home or agency delivery of HR-VG. Themes relating to convenience, technology access, privacy, distractions, HIV serostatus disclosure and social opportunities were identified as advantages or disadvantages to participating in HR-VG at each location. Overall privacy was the most salient concern of accessing HR-VG at home or at a CBO. Considering the concerns expressed by WLH, further studies are needed to assess how an Internet-based intervention delivered at home for WLH can maintain privacy while being cost effective. PMID:26357907

  4. Advantages and disadvantages for receiving Internet-based HIV/AIDS interventions at home or at community-based organizations.

    PubMed

    Green, Shana M; Lockhart, Elizabeth; Marhefka, Stephanie L

    2015-01-01

    Within recent years, public health interventions have become technology based to reflect the digital age we currently live in and appeal to the public in innovative and novel ways. The Internet breaks down boundaries distance imposes and increases our ability to reach and connect with people. Internet-based interventions have the potential to expand access to effective behavioral interventions (EBIs). The US National HIV/AIDS Strategy states that people living with HIV should have access to EBIs such as healthy relationships (HR) to help them develop safe sex and disclosure skills. However, access to HR is limited across the country, especially for people in remote or rural areas. Internet-based healthy relationships video groups (HR-VG) delivered at home or community-based organizations (CBOs) can possibly expand access. This study assesses the preferences of women living with HIV (WLH) for participation in HR-VG among 21 WLH who participated in a randomized control trial (RCT) testing HR-VG and completed open-ended semi-structured telephone interviews. Transcripts were thematically analyzed to determine advantages and disadvantages of home or CBO delivery of HR-VG. Themes relating to convenience, technology access, privacy, distractions, HIV serostatus disclosure, and social opportunities were identified as advantages or disadvantages to participating in HR-VG at each location. Overall, privacy was the most salient concern of accessing HR-VG at home or at a CBO. Considering the concerns expressed by WLH, further studies are needed to assess how an Internet-based intervention delivered at home for WLH can maintain privacy while being cost effective.

  5. Physiological mechanisms of imprinting and homing migration in Pacific salmon Oncorhynchus spp.

    PubMed

    Ueda, H

    2012-07-01

    After several years of feeding at sea, salmonids have an amazing ability to migrate long distances from the open ocean to their natal stream to spawn. Three different research approaches from behavioural to molecular biological studies have been used to elucidate the physiological mechanisms underpinning salmonid imprinting and homing migration. The study was based on four anadromous Pacific salmon Oncorhynchus spp., pink salmon Oncorhynchus gorbuscha, chum salmon Oncorhynchus keta, sockeye salmon Oncorhynchus nerka and masu salmon Oncorhynchus masou, migrating from the North Pacific Ocean to the coast of Hokkaido, Japan, as well as lacustrine O. nerka and O. masou in Lake Toya, Hokkaido, where the lake serves as the model oceanic system. Behavioural studies using biotelemetry techniques showed swimming profiles from the Bering Sea to the coast of Hokkaido in O. keta as well as homing behaviours of lacustrine O. nerka and O. masou in Lake Toya. Endocrinological studies on hormone profiles in the brain-pituitary-gonad axis of O. keta, and lacustrine O. nerka identified the hormonal changes during homing migration. Neurophysiological studies revealed crucial roles of olfactory functions on imprinting and homing during downstream and upstream migration, respectively. These findings are discussed in relation to the physiological mechanisms of imprinting and homing migration in anadromous and lacustrine salmonids. © 2012 The Author. Journal of Fish Biology © 2012 The Fisheries Society of the British Isles.

  6. Provision of home mechanical ventilation and sleep services for England survey.

    PubMed

    Mandal, S; Suh, E; Davies, M; Smith, I; Maher, T M; Elliott, M W; Davidson, A C; Hart, N

    2013-09-01

    The Department of Health is promoting the generation of specialist networks to manage long term ventilatory weaning and domiciliary non-invasive ventilation patients. Currently the availability of these services in England is not known. We performed a short survey to establish the prevalence of sleep and ventilation diagnostic and treatment services. The survey focussed on diagnostic services and Home Mechanical Ventilation (HMV) provision, and was divided into (a) availability of diagnostics, (b) funding, and (c) patient groups. This survey has confirmed that the majority of Home Mechanical Ventilation set-ups are currently for Obesity Related Respiratory Failure and Chronic Obstructive Pulmonary Disease. We have found that there is variable provision of diagnostic services, with the majority of units offering overnight oximetry (95%) but only 55% of responders providing a home mechanical ventilation service. Even more interestingly, less than two thirds of units charged their primary care trust for this service. These data may assist in the development of regional networks and specialist home mechanical ventilation centres.

  7. Home-based exercise therapy in ankylosing spondylitis: short-term prospective study in patients receiving tumor necrosis factor alpha inhibitors.

    PubMed

    Yigit, Semra; Sahin, Zerrin; Demir, Saliha Eroglu; Aytac, Deniz Hatun

    2013-01-01

    The importance of exercise and regular physiotherapy in patients with ankylosing spondylitis (AS) under treatment with tumor necrosis factor alpha inhibitors (TNFα inhibitors) was reported in some studies, but the literature on this topic is still scarce. The aim of this study was to assess the effects of home-based exercise therapy on functional capacity, disease activity, spinal mobility, quality of life, emotional state and fatigue in patients with AS receiving TNFα inhibitors. Forty-two AS patients were trained on the disease, and home-based exercise program was demonstrated to all the patients. At baseline and at the end of 10 week, we evaluated Bath AS Disease Activity Index, Bath AS Functional Index, Bath AS Metrology Index, Multidimensional Assessment of Fatigue Scale, Beck Depression Inventory and Short-Form 36. Patients following home-based exercise program five times a week at least 30 min per session (exercise group) were compared with those exercising less than five times a week (control group). At baseline, exercise and control group had similar demographic features. After 10 weeks, all outcome parameters showed statistically significant improvements in exercise group. There were significant differences in all the parameters except social functioning subscale of Short-Form 36 between groups in favor of exercise group at 10th week (P < 0.05). Home-based exercise program is an effective therapy in increasing functional capacity and joint mobility, decreasing disease activity, improving emotional state, fatigue and quality of life for AS patient receiving TNFα inhibitors. We need to find out new ways to provide continuity of AS patients with it.

  8. Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: study protocol for a pragmatic randomised controlled trial

    PubMed Central

    2013-01-01

    Background Restorative home care services help older people maximise their independence using a multi-dimensional approach. They usually include an exercise program designed to improve the older person’s strength, balance and function. The types of programs currently offered require allocation of time during the day to complete specific exercises. This is not how the majority of home care clients prefer to be active and may be one of the reasons that few older people do the exercises regularly and continue the exercises post discharge. This paper describes the study protocol to test whether a Lifestyle Functional Exercise (LiFE) program: 1) is undertaken more often; 2) is more likely to be continued over the longer term; and, 3) will result in greater functional gains compared to a standard exercise program for older people receiving a restorative home care service. Methods/Design Design: A pragmatic randomised controlled trial (RCT) design was employed with two study arms: LiFE program (intervention) and the current exercise program (control). Setting: Silver Chain, a health and community care organisation in Perth, Western Australia. Participants: One hundred and fifty restorative home care clients, aged 65 years and older. Measurements: The primary outcome is a composite measure incorporating balance, strength and mobility. Other outcome measures include: physical functioning, falls efficacy, and levels of disability and functioning. Discussion If LiFE is more effective than the current exercise program, the evidence will be presented to the service management accompanied by the recommendation that it be adopted as the generic exercise program to be used within the restorative home care service. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12611000788976. PMID:24134491

  9. Assessment of Status of Patients Receiving Palliative Home Care and Services Provided in a Rural Area—Kerala, India

    PubMed Central

    Thayyil, Jayakrishnan; Cherumanalil, Jeeja Mathummal

    2012-01-01

    Context: For the first time in India, a Pain and Palliative Care policy to guide the community-based home care initiatives was declared by the Government of Kerala state. In Kerala, majority of the panchayats (local self-governments) are now conducting home-based palliative care as part of primary health care. National focus domain areas in palliative care research are structure and process, the physical aspects, and also the social aspects of care. Aims: The study was conducted to assess the patient's status and the services provided by palliative home care. Settings and Design: The descriptive study was conducted at Mavoor panchayat—Kozhikode district of Kerala, India by collecting information from the case records, nurses diary notes of all enrolled patients. Materials and Methods: Collecting information from the case records, nurses diary notes of all enrolled patients. Statistical Analysis: The data were entered using Microsoft excel for Windows XP and analyzed using SPSS 16.0 (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL, USA). Results: Totally, 104 patients were enrolled. Diagnosis wise major category was degenerative diseases. There were 27% persons suffering from cerebrovascular accidents, 15.3% with malignancies, 8.7% with coronary artery disease, 5.8% with complications of diabetes, and 8.7% were with fracture of bones. The major complaints were weakness (41.3%), tiredness (31.7%), and pain (27%). Twenty-five percent persons complained of urinary incontinence, 12.5% complained of ulcer, 10.6% of edema, and 9.6% of mental/emotional agony. The activity of daily living status was as follows. Twenty-five percent subjects were completely bed ridden. 5.8% were feeding through Ryles tube, 16.3% had urinary incontinence, 9.6% were having no bowel control. Conclusions: The service could address most of the medical, psychosocial, and supportive needs of the patients and reduce their pain and symptoms. The interface between institutional

  10. The Impact of Strong for Life on the Physical Functioning and Health of Older Adults Receiving Home and Community-Based Services.

    PubMed

    Danilovich, Margaret; Corcos, Daniel; Eisenstein, Amy; Marquez, David; Hughes, Susan

    2017-01-01

    To test the effects of Strong for Life (SFL) on the physical performance and self-rated health of older adults receiving Home and Community-Based Services (HCBS). Randomized, two-group trial with pre-post measures. In-home exercise program. Clients aged 65-95 (n=42) and their Home Care Aide (HCA) (n=32) were randomly assigned to a usual care and SFL intervention or usual care control group. Clients were instructed in SFL by their HCA and completed SFL 3 times per week for 12-weeks. Outcomes included grip and quadriceps strength, Timed Up and Go, gait speed, Self-Efficacy for Exercise, pain, and PROMIS-global health measured at baseline and immediately following the intervention. Clients completed opened ended survey items on SFL program evaluation. Effect sizes were moderate for grip strength (d= .38), pain (d= .34), and PROMIS-global health (d= .27). Small effect sizes were found for all other measures. Median quadriceps and TUG scores differentially improved among intervention participants versus controls. No adverse health events and high program satisfaction were reported. Frailty prevalence in the control group increased between baseline and post-test while frailty prevalence in the intervention group decreased during the same time period. Strong for Life has the potential to improve the strength, mobility, health, and frailty of older adults receiving HCBS. This study provides initial evidence of the impact of SFL for older adults receiving HCBS, as well as the safety of the intervention evidenced by the lack of reported adverse events.

  11. An assessment of food supplementation to chronically sick patients receiving home based care in Bangwe, Malawi : a descriptive study

    PubMed Central

    Bowie, Cameron; Kalilani, Linda; Marsh, Reg; Misiri, Humphrey; Cleary, Paul; Bowie, Claire

    2005-01-01

    Background The effect of food supplementation provided by the World Food Programme to patients and their families enrolled in a predominantly HIV/AIDS home based care programme in Bangwe Malawi is assessed. Methods The survival and nutritional status of patients and the nutritional status of their families recruited up to six months before a food supplementation programme started are compared to subsequent patients and their families over a further 12 months. Results 360 patients, of whom 199 died, were studied. Food supplementation did not improve survival but had an effect (not statistically significant) on nutritional status. Additional oil was given to some families; it may have improved survival but not nutritional status. Conclusion Food supplementation to HIV/AIDS home based care patients and their families does not work well. This may be because the intervention is too late to affect the course of disease or insufficiently targeted perhaps due to problems of distribution in an urban setting. The World Food Programme's emphasis on supplementary feeding for these families needs to be reviewed. PMID:15777483

  12. Etiology and Epidemiology of Catheter Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition in a Gastromedical Center at a Tertiary Hospital in Denmark

    PubMed Central

    Nielsen, Xiaohui Chen; Chen, Ming; Hellesøe, Anne-Marie Blok; Jeppesen, Palle Bekker; Gyldenlykke, Jonna; Tvede, Michael; Andersen, Leif Percival

    2012-01-01

    We conducted a retrospective epidemiologic study of catheter related bloodstream infections (CRBSI) in patients receiving long-term home parenteral nutrition (HPN) from January 2002 to December 2005. Our results showed that coagulase negative staphylococci (CoNS) were the most prevalent pathogens (44.7% of all CRBSI episodes), followed by Enterobacteriaceae (33.2%). Prevalence for candidemia and Enterococcus bacteremia was relatively high (14.4% and 10.8%, respectively). Cefuroxime resistance was observed in 65.4% CoNS and 31.5% Enterobacteriaceae. Based on the results from the study, a new empiric antimicrobial treatment regiment was suggested. PMID:23248717

  13. Opto-mechanical subsystem of a 10 micrometer wavelength receiver terminal. Waveguide laser local oscillator. Servo system

    NASA Technical Reports Server (NTRS)

    1975-01-01

    An engineering model opto-mechanical subsystem for a 10.6-micrometer laser heterodyne receiver is developed, and a CO2 waveguide local oscillator and servo electronics are provided for the receiver. Design goals are presented for the subsystems and overall package design is described. Thermal and mechanical distortion loading tests were performed and the results are included.

  14. Contributors to fatigue in patients receiving mechanical ventilatory support: A descriptive correlational study.

    PubMed

    Chlan, Linda L; Savik, Kay

    2015-10-01

    To describe levels of fatigue and explore clinical factors that might contribute to fatigue in critically ill patients receiving mechanical ventilation. Descriptive, correlational design. Sample was a sub-set of patients enrolled in a randomised clinical trial testing patient-directed music for anxiety self-management. Clinical factors included age, gender, length of ICU stay, length of ventilatory support, illness severity (APACHE III), and sedative exposure (sedation intensity and frequency). Descriptive statistics and mixed models were used to address the study objectives. Medical and surgical intensive care units in the Midwestern United States. Fatigue was measured daily via a 100-mm Visual Analogue Scale, up to 25 days. A sample of 80 patients (50% female) receiving ventilatory support for a median 7.9 days (range 1-46) with a mean age of 61.2 years (SD 14.8) provided daily fatigue ratings. ICU admission APACHE III was 61.5 (SD 19.8). Baseline mean fatigue ratings were 60.7 (SD 27.9), with fluctuations over time indicating a general trend upward. Mixed models analysis implicated illness severity (β(se(β))=.27(.12)) and sedation frequency (β(se(β))=1.2(.52)) as significant contributors to fatigue ratings. Illness severity and more frequent sedative administration were related to higher fatigue ratings in these mechanically ventilated patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. [Characteristics and factors associated with mortality in patients receiving mechanical ventilation: first Chilean multicenter study].

    PubMed

    Tomicic, Vinko; Espinoza, Mauricio; Andresen, Max; Molina, Jorge; Calvo, Mario; Ugarte, Héctor; Godoy, Jorge; Gálvez, Sergio; Maurelia, Juan Carlos; Delgado, Iris; Esteban, Andrés

    2008-08-01

    The outcome of mechanically ventilated patients can be influenced by factors such as the indication of mechanical ventilation (MV) and ventilator parameters. To describe the characteristics of patients receiving MV in Chilean critical care units. Prospective cohort of consecutive adult patients admitted to 19 intensive care units (ICU) from 9 Chilean cities who received MV for more than 12 hours between September lst, 2003, and September 28th, 2003. Demographic data, severity of illness, reason for the initiation of MV, ventilation modes and settings as well as weaning strategies were registered at the initiation and then, daily throughout the course of MV for up to 28 days. ICU and hospital mortality were recorded. Of 588 patients admitted, 156 (26.5%) received MV (57% males). Mean age and Simplified Acute Physiology Score-II (SAPS II) were 54.6+/-18 years and 40.6+/-16.4 points respectively The most common indications for MV were acute respiratory failure (71.1%) and coma (22.4%). Assist-control mode (71.6%) and synchronized intermittent mandatory ventilation (SIMV) (14,2%) were the most frequently used. T-tube was the main weaning strategy. Mean duration of MV and length of stay in ICU were 7.8+/-8.7 and 11.1+/- 14 days respectively. Overall ICU mortality was 33.9% (53 patients). The main factors independently associated with increased mortality were (1) SAPS II > or =60 points (Odds Ratio (OR), 10.5; 95% CI, 1.04-106.85) and (2) plateau pressure > or =30 cm H2O at second day (OR, 3.9; 95% CI, 1.17-12.97). Conditions present at the onset of MV and ventilator management were similar to those reported in the literature. Magnitude of multiorgan dysfunction and high plateau pressures are the most important factors associated with mortality.

  16. Hospital readmissions for catheter-related bloodstream infection and use of ethanol lock therapy: comparison of patients receiving parenteral nutrition or intravenous fluids in the home vs a skilled nursing facility.

    PubMed

    Corrigan, Mandy L; Pogatschnik, Cassandra; Konrad, Denise; Kirby, Donald F

    2013-01-01

    Catheter-related bloodstream infection (CRBSI) is the most serious long-term infectious complication of long-term home parenteral nutrition (PN). Ethanol is being used more commonly as a catheter locking solution in the home PN setting for prevention of CRBSI; however, no current literature reports the use of ethanol lock (ETL) in skilled nursing facility (SNF) patients. The authors evaluated the number of hospital readmissions for CRBSI and length of stay between SNF (not receiving ETL) and home patients (receiving or not receiving ETL) receiving PN or intravenous fluid therapy. SNF patients had a significantly longer length of stay (LOS) for CRBSI hospital admissions compared with patients receiving PN at home with or without ETL (P < .001; 16 vs 8 vs 8 days). There was no LOS difference for CRBSI between home patients with or without ETL. Home PN patients not receiving ETL were more likely to have a CRBSI from Staphylococcus sp (48% vs 27%; P = .015), whereas SNF PN patients not receiving ETL were more likely to have a CRBSI from Enterococcus sp (16% vs 3%; P = .004). Despite different causative organisms and medical acuity likely affecting the differences observed in LOS, the SNF population is another setting ETL can be used to prevent CRBSI.

  17. Testing the effectiveness of in-home behavioral economics strategies to increase vegetable intake, liking, and variety among children residing in households that receive food assistance.

    PubMed

    Leak, Tashara M; Swenson, Alison; Vickers, Zata; Mann, Traci; Mykerezi, Elton; Redden, Joseph P; Rendahl, Aaron; Reicks, Marla

    2015-01-01

    To test the effectiveness of behavioral economics strategies for increasing vegetable intake, variety, and liking among children residing in homes receiving food assistance. A randomized controlled trial with data collected at baseline, once weekly for 6 weeks, and at study conclusion. Family homes. Families with a child (9-12 years) will be recruited through community organizations and randomly assigned to an intervention (n = 36) or control (n = 10) group. The intervention group will incorporate a new behavioral economics strategy during home dinner meal occasions each week for 6 weeks. Strategies are simple and low-cost. The primary dependent variable will be child's dinner meal vegetable consumption based on weekly reports by caregivers. Fixed independent variables will include the strategy and week of strategy implementation. Secondary dependent variables will include vegetable liking and variety of vegetables consumed based on data collected at baseline and study conclusion. Mean vegetable intake for each strategy across families will be compared using a mixed-model analysis of variance with a random effect for child. In additionally, overall mean changes in vegetable consumption, variety, and liking will be compared between intervention and control groups. Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  18. Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

    PubMed Central

    Teno, Joan M.; Gozalo, Pedro; Khandelwal, Nita; Curtis, J. Randall; Meltzer, David; Engelberg, Ruth; Mor, Vincent

    2016-01-01

    IMPORTANCE Mechanical ventilation may be lifesaving, but in certain persons, such as those with advanced dementia, it may prolong patient suffering without a clear survival benefit. OBJECTIVE To describe the use and outcomes of mechanical ventilation and its association with the increasing numbers of intensive care unit (ICU) beds in the United States for patients with advanced dementia residing in a nursing home 120 days before that hospital admission. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study evaluated Medicare beneficiaries with advanced dementia hospitalized from January 1, 2000, to December 31, 2013, using the Minimum Data Set assessments linked with Medicare part A claims. A hospital fixed-effect, multivariable logistic regression model examined the effect of changes in ICU beds within individual hospitals and the likelihood of receiving mechanical ventilation, controlling for patients’ demographic characteristics, function, and comorbidities. MAIN OUTCOMES AND MEASURES Mechanical ventilation. RESULTS From 2000 to 2013, a total of 635 008 hospitalizations of 380 060 eligible patients occurred (30.5% male and 69.5% female; mean [SD] age, 84.4 [7.4] years). Use of mechanical ventilation increased from 39 per 1000 hospitalizations in 2000 to 78 per 1000 hospitalizations in 2013 (P < .001, test of linear trend). As the number of ICU beds in a hospital increased over time, patients with advanced dementia were more likely to receive mechanical ventilation (ie, adjusted odds ratio per 10 ICU bed increase, 1.06; 95% CI, 1.05–1.07). In 2013, hospitals in the top decile in the number of ICU beds were reimbursed $9611.89 per hospitalization compared with $8050.24 per hospitalization in the lower decile (P < .001) without an improvement in 1-year mortality (65.2% vs 64.6%; P = 54). CONCLUSIONS AND RELEVANCE Among hospitalized nursing home residents with advanced dementia, we found an increase in the use of mechanical ventilation over time

  19. Mechanisms Underpinning Increased Plasma Creatinine Levels in Patients Receiving Vemurafenib for Advanced Melanoma.

    PubMed

    Hurabielle, Charlotte; Pillebout, Evangéline; Stehlé, Thomas; Pagès, Cécile; Roux, Jennifer; Schneider, Pierre; Chevret, Sylvie; Chaffaut, Cendrine; Boutten, Anne; Mourah, Samia; Basset-Seguin, Nicole; Vidal-Petiot, Emmanuelle; Lebbé, Céleste; Flamant, Martin

    2016-01-01

    Serum creatinine has been reported to increase in patients receiving Vemurafenib, yet neither the prevalence nor the mechanism of this adverse event are known. We aimed to evaluate the frequency and the mechanisms of increases in plasma creatinine level in patients receiving Vemurafenib for advanced melanoma. We performed a retrospective monocentric study including consecutive patients treated with Vemurafenib for an advanced melanoma. We collected clinical and biological data concerning renal function before introduction of Vemurafenib and in the course of monthly follow-up visits from March 2013 to December 2014. Cystatin C-derived glomerular filtration rate was evaluated before and after Vemurafenib initiation, as increase in serum cystatin C is specific to a decrease in the glomerular filtration rate. We also performed thorough renal explorations in 3 patients, with measurement of tubular secretion of creatinine before and after Vemurafenib initiation and a renal biopsy in 2 patients. 70 patients were included: 97% of them displayed an immediate, and thereafter stable, increase in creatinine (+22.8%) after Vemurafenib initiation. In 44/52 patients in whom Vemurafenib was discontinued, creatinine levels returned to baseline. Serum cystatin C increased, although proportionally less than serum creatinine, showing that creatinine increase under vemurafenib was indeed partly due to a renal function impairment. In addition, renal explorations demonstrated that Vemurafenib induced an inhibition of creatinine tubular secretion. Thus, Vemurafenib induces a dual mechanism of increase in plasma creatinine with both an inhibition of creatinine tubular secretion and slight renal function impairment. However, this side effect is mostly reversible when Vemurafenib is discontinued, and should not lead physicians to discontinue the treatment if it is effective.

  20. Mechanisms Underpinning Increased Plasma Creatinine Levels in Patients Receiving Vemurafenib for Advanced Melanoma

    PubMed Central

    Hurabielle, Charlotte; Pillebout, Evangéline; Stehlé, Thomas; Pagès, Cécile; Roux, Jennifer; Schneider, Pierre; Chevret, Sylvie; Chaffaut, Cendrine; Boutten, Anne; Mourah, Samia; Basset-Seguin, Nicole; Vidal-Petiot, Emmanuelle; Lebbé, Céleste; Flamant, Martin

    2016-01-01

    Context Serum creatinine has been reported to increase in patients receiving Vemurafenib, yet neither the prevalence nor the mechanism of this adverse event are known. Objective We aimed to evaluate the frequency and the mechanisms of increases in plasma creatinine level in patients receiving Vemurafenib for advanced melanoma. Methods We performed a retrospective monocentric study including consecutive patients treated with Vemurafenib for an advanced melanoma. We collected clinical and biological data concerning renal function before introduction of Vemurafenib and in the course of monthly follow-up visits from March 2013 to December 2014. Cystatin C-derived glomerular filtration rate was evaluated before and after Vemurafenib initiation, as increase in serum cystatin C is specific to a decrease in the glomerular filtration rate. We also performed thorough renal explorations in 3 patients, with measurement of tubular secretion of creatinine before and after Vemurafenib initiation and a renal biopsy in 2 patients. Results 70 patients were included: 97% of them displayed an immediate, and thereafter stable, increase in creatinine (+22.8%) after Vemurafenib initiation. In 44/52 patients in whom Vemurafenib was discontinued, creatinine levels returned to baseline. Serum cystatin C increased, although proportionally less than serum creatinine, showing that creatinine increase under vemurafenib was indeed partly due to a renal function impairment. In addition, renal explorations demonstrated that Vemurafenib induced an inhibition of creatinine tubular secretion. Conclusion Thus, Vemurafenib induces a dual mechanism of increase in plasma creatinine with both an inhibition of creatinine tubular secretion and slight renal function impairment. However, this side effect is mostly reversible when Vemurafenib is discontinued, and should not lead physicians to discontinue the treatment if it is effective. PMID:26930506

  1. The Prevalence of Vitamin D Insufficiency and Deficiency and Their Relationship with Bone Mineral Density and Fracture Risk in Adults Receiving Long-Term Home Parenteral Nutrition.

    PubMed

    Napartivaumnuay, Navaporn; Gramlich, Leah

    2017-05-10

    It has been demonstrated that low bone mass and vitamin D deficiency occur in adult patients receiving home parenteral nutrition (HPN). The aim of this study is to determine the prevalence of vitamin D insufficiency and deficiency and its relationship with bone mineral density (BMD) and fracture risk in long-term HPN patients. Methods: A retrospective chart review of all 186 patients in the HPN registry followed by the Northern Alberta Home Parenteral Nutrition Program receiving HPN therapy >6 months with a 25 (OH) D level and BMD reported were studied. Results: The mean age at the initiation of HPN was 53.8 (20-79) years and 23 (37%) were male. The mean HPN duration was 56 (6-323) months and the most common diagnosis was short bowel syndrome. Based on a total of 186 patients, 62 patients were categorized based on serum vitamin D status as follows: 1 (24.2%) sufficient, 31 (50%) insufficient and 16 (25.8%) deficient. Despite an average of 1891 IU/day orally and 181 IU/day intravenously vitamin D, the mean vitamin D level was 25.6 ng/mL (insufficiency) and 26.2 ± 11.9 ng/mL in patients with the highest 10-year fracture risk. Conclusion: Suboptimal vitamin D levels are common among patients on long-term HPN despite nutrient intake that should meet requirements.

  2. Snapshots of Conformational Changes Shed Light into the NtrX Receiver Domain Signal Transduction Mechanism.

    PubMed

    Fernández, Ignacio; Otero, Lisandro H; Klinke, Sebastián; Carrica, Mariela del Carmen; Goldbaum, Fernando A

    2015-10-09

    Brucella abortus is an important pathogenic bacterium that has to overcome oxygen deficiency in order to achieve a successful infection. Previously, we proved that a two-component system formed by the histidine kinase NtrY and the response regulator NtrX is essential to achieve an adaptive response to low oxygen tension conditions. Even though the relevance of this signaling pathway has already been demonstrated in other microorganisms, its molecular activation mechanism has not yet been described in detail. In this article, we report the first crystal structures from different conformations of the NtrX receiver domain from B. abortus, and we propose a sequence of events to explain the structural rearrangements along the activation process. The analysis of the structures obtained in the presence of the phosphoryl group analog beryllofluoride led us to postulate that changes in the interface formed by the α4 helix and the β5 strand are important for the activation, producing a reorientation of the α5 helix. Also, a biochemical characterization of the NtrX receiver domain enzymatic activities was performed, describing its autophosphorylation and autodephosphorylation kinetics. Finally, the role of H85, an important residue, was addressed by site-directed mutagenesis. Overall, these results provide significant structural basis for understanding the response regulator activation in this bacterial two-component system.

  3. [Liver regeneration after its mechanical injury in rats receiving biologically active substances "Trepel" and "Suvar"].

    PubMed

    Romanova, L P; Malysheva, I I

    2011-01-01

    The effect of biologically active substances (BAS) "Trepel" and "Suvar" on liver regeneration 1-30 days after its mechanical injury was studied using histological and morphometric methods in 110 rat pups aged 18 days. The control group comprised 90 animals that received no treatment following liver injury. It was shown that both BAS studied inhibited the inflammatory reaction around the injury focus, suppressed collagenogenesis and activated hepatocyte proliferation.This resulted in the significant substitution of the damaged area by the hepatocytes, that was absent in the control animals. In animals treated with BAS, the numbers of binucleated and mitotically dividing hepatocytes was increased, while the amount of hepatocytes with dystrophic changes was reduced. Authors associate the positive effect of BAS on liver structure regeneration with their growth-promoting activity, resulting in the hypertrophy of different organs, including the thyroid and the adrenal glands, that is accompanied by an excessive production of the respective hormones displaying their physiological actions.

  4. Personal care assistants' experiences of caring for people on home mechanical ventilation.

    PubMed

    Israelsson-Skogsberg, Åsa; Lindahl, Berit

    2017-03-01

    The aim of this study was to describe personal care assistants' (PCA) experiences of working with a ventilator-assisted person at home. Data were collected from fifteen audiotaped semistructured interviews with PCAs supporting a child or adult using home mechanical ventilation (HMV). Thirteen women and two men participated; their working experience with HMV users ranged from one to 17 years (median 6 years). Data were subjected to qualitative content analysis in an inductive and interpretive manner. Five categories emerged from the data: Being part of a complex work situation; Taking on a multidimensional responsibility; Caring carried out in someone's home; Creating boundaries in an environment with indistinct limits; and Being close to another's body and soul. The participants felt very close to the person they worked with, both physically and emotionally. They had a great responsibility and therefore a commensurate need for support, guidance and a well-functioning organisation around the HMV user. There is international consensus that advanced home care will continue to expand and personal care assistance is key in this development. We suggest that one way to move forward for PCAs working with HMV users is to create multiprofessional teams led by a key-person who coordinates the individual needs. More research is needed within this area from a broad perspective including the HMV-assisted persons, relatives, personal care assistants and management organisations. © 2016 Nordic College of Caring Science.

  5. Energy and Protein Intake, Anthropometrics, and Disease Burden in Elderly Home-care Receivers--A Cross-sectional Study in Germany (ErnSIPP Study).

    PubMed

    Pohlhausen, S; Uhlig, K; Kiesswetter, E; Diekmann, R; Heseker, H; Volkert, D; Stehle, P; Lesser, S

    2016-03-01

    To date, no study has examined the nutritional status and disease burden of elderly home-care receivers living in Germany. Aim of this cross-sectional study was, first, to assess disease burden and nutritional status, denoted in anthropometrics, and, second, to investigate associations between anthropometrics and disease burden. Cross-sectional multi-centre study. Home-care receivers living in three urban areas of Germany in 2010. 353 elderly (>64 years) in home care (128 males aged 79.1 ±7.8 years, 225 females aged 82.0 ±7.5 years). Nutritional status was assessed by body mass index (BMI), mid upper arm circumference (MUAC) and calf circumference (CC). Medical conditions were assessed in personal interviews. A 3-day prospective nutrition diary was kept. Metric data are reported as mean±SD or median (interquartile range), p<0.05 was considered significant. Most participants were substantially (59%), and 11% severest in need of care. The seniors suffered from 5 (4-7) chronic diseases; dementia, depression, stroke, and respiratory illness were most prevalent (each 20-40%). More than one-third of participants had only moderate or poor appetite, nearly half were unable to eat independently. Chewing problems were reported for 52% of study participants, and more than one quarter of elderly had swallowing problems. Daily mean energy intake was 2017±528 kcal in men (n=123) and 1731±451 kcal in women (n=216; p<0.001). Mean protein intake amounted to 1.0 g/kg body weight. Mean BMI was 28.2±6.2 kg/m² (n=341), 14% of seniors had a BMI <22 kg/m² (including 4% with BMI <20 kg/m²). Critical MUAC (<22 cm) was indicated in 6% of subjects; and CC <31 cm in 11% of men, 21% of women (p<0.05). After adjusting for sex and age, BMI, MUAC and CC were negatively associated with high care level, hospitalization in the previous year, nausea/vomiting, prevalence of dementia, poor appetite, and eating difficulties like dependency, chewing and swallowing problems. We recommend to pay

  6. Nasal versus oronasal mask in home mechanical ventilation: the preference of patients as a strategy for choosing the interface.

    PubMed

    Fernandez, Ramón; Cabrera, Cristina; Rubinos, Gemma; Pando, Ana; Galindo, Rosa; Rodríguez, Francisco; Lopez, Francisco; Gonzalez, Isidro; Casan, Pere

    2012-09-01

    In home mechanical ventilation (HMV), the mask is a key factor for patient comfort and therapeutic adherence. There is no evidence on the best strategy for choosing the mask in HMV. To explore patient preference when prescribing the mask for HMV treatment and assess its relationship with effectiveness. A prospective study with repeated measures in stable patients receiving home nocturnal ventilation. Alternating oronasal mask (ONM) and nasal mask (NM) were tested in day and overnight sessions, with arterial blood gas measured and S(pO(2)) monitored. At the end of each evening session, patients rated interface comfort using a visual analog scale. At 3 months we evaluated adherence and effectiveness of the treatment. Twenty-nine subjects (mean ± SD age 65 ± 13 y, 44% male) completed the study. Initial functional values were P(CO(2)) 57.4 ± 5.2 mm Hg and time with S(pO(2)) < 90% (T90) 81.5 ± 9.5%. Both ONM and NM significantly decreased P(CO(2)) and T90. Over a third (38%) of our subjects preferred ONM, while NM was deemed more comfortable in general. At 3 months, effectiveness and adherence showed no differences between those treated with NM or ONM. Patient choice is an effective criterion for selecting the interface in HMV treatment. Copyright 2012 Daedalus Enterprises

  7. A systematic review on the effectiveness of continuity of care and its role in patient satisfaction and decreased hospital readmissions in the adult patient receiving home care services.

    PubMed

    Santomassino, Michelle; Costantini, Gwendolyn D; McDermott, Michele; Primiano, Denise; Slyer, Jason T; Singleton, Joanne K

    2012-01-01

    Continuity of care, a concept that in its broadest terms describes patient and provider coordination across time and settings, has evidenced a positive correlation with patient satisfaction and hospital readmission rates. Home health care, where patients receive care from a variety of healthcare practitioners, is one area where these measures are being investigated to determine the effectiveness of continuity of care. To examine and synthesize the best available evidence related to the effectiveness of continuity of care interventions and their impact on patient satisfaction and all-cause hospital readmissions rates in the adult patient who is receiving home care services. Male and female aged 18 years or older receiving home care services, regardless of diagnosis, stage or severity of disease, co-morbidities, or previous treatment received.All types and models of interventions for continuity of care delivered by nurses to patients receiving home care services were considered for inclusion in the review.Patient satisfaction and hospital readmissions.In this review randomised controlled trials were considered for inclusion. In their absence, other research designs, such as non-randomised controlled trials, quasi-experimental studies, and before and after studies were considered for inclusion. Published and unpublished literature in the English language was sought from the inception of the databases through November 1, 2011.The databases searched included: Academic Search Premier, CINAHL ERIC, Health Reference Center Academic, MEDLINE via PubMed, ProQuest Nursing and Allied Health Source, ProQuest Health Management, Cochrane Central Register of Controlled Trials, EMBASE, Health Source Nursing Academic, PsycINFO and Bio-Med. A search of the grey literature and virtual hand searching of relevant journals was also performed. Two reviewers evaluated the included studies for methodological quality using standardised critical appraisal instruments from the Joanna Briggs

  8. [Pain behaviour indicator scale (ESCID) application in severe non-communicative trauma patients receiving mechanical ventilation].

    PubMed

    López López, C; Murillo Pérez, M A; Torrente Vela, S; Cornejo Bauer, C; García Iglesias, M; Orejana Martín, M; Morales Sánchez, C; Cuenca Solanas, M; Alted López, E

    2013-01-01

    To assess pain in non-communicative patients with severe trauma undergoing mechanical ventilation prior to, during and after tracheal suctioning, mobilization and wound care. A prospective and observational study from October to December 2011 was performed. Study variables were ESCID scale and monitoring of vital signs (blood pressure, heart rate, and respiratory rate). Data were gathering 5 minutes before, during and 15 minutes after the 3 procedures. The nursing evolutive report recorded pain assessment, administration and effectiveness of the analgesia. Descriptive analysis of variables included Student's T test/ANOVA for multivariate analysis with SPSS 17.0. A hundred eighty four observations: 46.8% tracheal suctioning, 38.5% mobilization and 14.7% wound care were performed in 29 patients. ESCID score was 0.4±1 before, 3.4±2.7 during and 0.4±1 after for wound care; 0.4±1.1 before, 3.6±2.2 during and 1.1±0.5 for tracheal suctioning; 0.5±1.1 before, 3±2.8 during and 0.2±0.8 after for mobilization. These increased significantly during the performance of the 3 procedures before-during/during-after: P=.000. All the hemodynamic variables were significantly modified during mobilization and tracheal suctioning: before-during/during-after: P=.000, with the exception of the cures that only affected respiratory rate. 27% of the procedures received analgesia: 9% received it before, 15% during and 3.2% after, with more analgesia being required for the wound care (33.3%). The data collected in the nursing report on the evaluation of pain/effectiveness of the analgesia showed 20.66%. An increase on the ESCID score was observed while performing the procedures. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.

  9. “Picking up the pieces”—Meanings of receiving home nursing care when being old and living with advanced cancer in a rural area

    PubMed Central

    Devik, Siri Andreassen; Hellzen, Ove; Enmarker, Ingela

    2015-01-01

    Rural home nursing care is a neglected area in the research of palliative care offered to older cancer patients. Because access to specialized services is hampered by long distances and fragmented infrastructure, palliative care is often provided through standard home nursing services and delivered by general district nurses. This study aimed to illuminate the lived experience and to interpret the meaning of receiving home nursing care when being old and living with advanced cancer in a rural area in Norway. Narrative interviews were conducted with nine older persons, and a phenomenological hermeneutic approach was used to interpret the meaning of the lived experience. The analysis revealed three themes, each with subthemes: being content with what one gets, falling into place, and losing one's place. The phrase picking up the pieces was found useful to sum up the meaning of this lived experience. The three respective themes refer to how the pieces symbolize the remaining parts of life or available services in their environment, and how the older persons may see themselves as pieces or bricks in a puzzle. A strong place attachment (physical insideness, social insideness, and autobiographical insideness) is demonstrated by the informants in this study and suggests that the rural context may provide an advantageous healthcare environment. Its potential to be a source of comfort, security, and identity concurs with cancer patients’ strong desire for being seen as unique persons. The study shows that district nurses play an essential role in the provision of palliative care for older rural patients. However, the therapeutic value of being in one's familiar landscape seems to depend on how homecare nurses manage to locate it and use it in a more or less person-centred manner. Communication skills and attentiveness to psychosocial aspects of patient care stand out as important attributes for nursing in this context. PMID:26362533

  10. "Picking up the pieces" - Meanings of receiving home nursing care when being old and living with advanced cancer in a rural area.

    PubMed

    Devik, Siri Andreassen; Hellzen, Ove; Enmarker, Ingela

    2015-01-01

    Rural home nursing care is a neglected area in the research of palliative care offered to older cancer patients. Because access to specialized services is hampered by long distances and fragmented infrastructure, palliative care is often provided through standard home nursing services and delivered by general district nurses. This study aimed to illuminate the lived experience and to interpret the meaning of receiving home nursing care when being old and living with advanced cancer in a rural area in Norway. Narrative interviews were conducted with nine older persons, and a phenomenological hermeneutic approach was used to interpret the meaning of the lived experience. The analysis revealed three themes, each with subthemes: being content with what one gets, falling into place, and losing one's place. The phrase picking up the pieces was found useful to sum up the meaning of this lived experience. The three respective themes refer to how the pieces symbolize the remaining parts of life or available services in their environment, and how the older persons may see themselves as pieces or bricks in a puzzle. A strong place attachment (physical insideness, social insideness, and autobiographical insideness) is demonstrated by the informants in this study and suggests that the rural context may provide an advantageous healthcare environment. Its potential to be a source of comfort, security, and identity concurs with cancer patients' strong desire for being seen as unique persons. The study shows that district nurses play an essential role in the provision of palliative care for older rural patients. However, the therapeutic value of being in one's familiar landscape seems to depend on how homecare nurses manage to locate it and use it in a more or less person-centred manner. Communication skills and attentiveness to psychosocial aspects of patient care stand out as important attributes for nursing in this context.

  11. Integrity mechanism for eHealth tele-monitoring system in smart home environment.

    PubMed

    Mantas, Georgios; Lymberopoulos, Dimitrios; Komninos, Nikos

    2009-01-01

    During the past few years, a lot of effort has been invested in research and development of eHealth tele-monitoring systems that will provide many benefits for healthcare delivery from the healthcare provider to the patient's home. However, there is a plethora of security requirements in eHealth tele-monitoring systems. Data integrity of the transferred medical data is one of the most important security requirements that should be satisfied in these systems, since medical information is extremely sensitive information, and even sometimes life threatening information. In this paper, we present a data integrity mechanism for eHealth tele-monitoring system that operates in a smart home environment. Agent technology is applied to achieve data integrity with the use of cryptographic smart cards. Furthermore, the overall security infrastructure and its various components are described.

  12. Oral health-related quality of life in patients receiving home-care nursing: associations with aspects of dental status and xerostomia.

    PubMed

    Willumsen, Tiril; Fjaera, Brit; Eide, Hilde

    2010-12-01

    To explore the differences in oral status, dental attendance and dry mouth problems between patients with long-term disease with high and low scores on Oral Health Impact Profile 14 (OHIP 14) and how patients cope with oral problems such as xerostomia and a reduced ability to brush their teeth. There has been a lack of studies of oral health and oral health-related quality of life in the frail elderly within the community services. A cross-sectional questionnaire study was conducted with 137 patients receiving home-care nursing. Structured interviews were conducted by student nurses using OHIP-14, items from the Xerostomia Inventory and questions concerning dental visit habits, brushing of teeth and data from medical records. Eighty-three per cent of patients had natural teeth and 60% had only natural teeth. 'Natural teeth only' indicated a low score on OHIP-14. Problems with brushing and items concerning xerostomia indicated a high score on OHIP-14. Contrasts in the assessments concerning brushing of teeth and xerostomia indicated low priority from the patients themselves and the nursing staff. Community health services should focus upon oral health. Both patients and nurses should assess the need for regular brushing of teeth carried out by home-care nurses. Assessment and treatment of dry mouth problems should have higher priority. © 2009 The Gerodontology Society and John Wiley & Sons A/S.

  13. Emergency department-reported injuries associated with mechanical home exercise equipment in the USA.

    PubMed

    Graves, Janessa M; Iyer, Krithika R; Willis, Margaret M; Ebel, Beth E; Rivara, Frederick P; Vavilala, Monica S

    2014-08-01

    The goal of this study was to generate national estimates of injuries associated with mechanical home exercise equipment, and to describe these injuries across all ages. Emergency department (ED)-treated injuries associated with mechanical home exercise equipment were identified from 2007 to 2011 from the National Electronic Injury Surveillance System. Text narratives provided exercise equipment type (treadmill, elliptical, stationary bicycle, unspecified/other exercise machine). Approximately 70 302 (95% CI 59 086 to 81 519) mechanical exercise equipment-related injuries presented to US EDs nationally during 2007-2011, of which 66% were attributed to treadmills. Most injuries among children (≤4 years) were lacerations (34%) or soft tissue injuries (48%); among adults (≥25 years) injuries were often sprains/strains (30%). Injured older adults (≥65 years) had greater odds of being admitted, held for observation, or transferred to another hospital, compared with younger ages (OR: 2.58; 95% CI 1.45 to 4.60). Mechanical exercise equipment is a common cause of injury across ages. Injury awareness and prevention are important complements to active lifestyles. 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.

  14. Invasive home mechanical ventilation: living conditions and health-related quality of life.

    PubMed

    Huttmann, Sophie Emilia; Windisch, Wolfram; Storre, Jan Hendrik

    2015-01-01

    The number of patients with invasive home mechanical ventilation (HMV) following unsuccessful weaning is steadily increasing, but little is known about the living conditions and health-related quality of life (HRQL) in these patients. To establish detailed information on living conditions and HRQL in patients with invasive HMV. The Severe Respiratory Insufficiency Questionnaire (SRI) was used to measure specific HRQL aspects in addition to patient interviews on individual living conditions during home visits. Thirty-two patients with lung disease, most prominently COPD (n = 18), and neuromuscular disorders (n = 14) were included. The overall mean SRI summary scale score (range 0-100) was 53 ± 16, with a broad range amongst individuals (23-86). Neuromuscular patients were younger than those with lung diseases (49 ± 18 vs. 67 ± 11 years; p < 0.005), and although they had a higher nursing dependency and fewer comorbidities, they tended to have higher (better) SRI summary scale scores (58 ± 16 vs. 48 ± 15; p = 0.092). Living in a private home compared to living in nursing facilities did not influence the SRI scores. Patients undergoing invasive HMV primarily following unsuccessful weaning reported an individual HRQL which, when taken together, was highly heterogeneous and ranged from very good to extremely bad. Older patients with COPD and more comorbidities are likely to have a worse HRQL than neuromuscular patients, while the living situation does not influence the HRQL. © 2015 S. Karger AG, Basel.

  15. [Long-term effects of home mechanical ventilation with positive pressure using a nasal mask].

    PubMed

    Escarrabill, J; Estopà, R; Robert, D; Casolivé, V; Manresa, F

    1991-10-05

    Home mechanical ventilation (HMV) is an efficient alternative in the treatment of patients with chronic respiratory failure secondary to restrictive mechanical disorders (neuromuscular disease, such as Duchenne's disease, thorax deformities due to kyphoscoliosis or tuberculosis sequelae). The case of a patient with severe kyphoscoliosis in the phase of chronic respiratory failure (PaO2 34 mmHg and PaCO2 61 mmHg, breathing ambient air) is presented in which, following the failure of negative pressure mechanical ventilation ("poncho"), positive pressure ventilation was tested with a silicon made-to-measure nasal mask as the access via. Adaptation to HMV was good with the patient using the ventilation nightly. Following 12 months of treatment the patient is able to carry out everyday activities and arterial gasometry breathing ambient air is PaO2 77 mmHg and PaCO2 43 mmHg.

  16. A Pilot Study Comparing 2 Oral Rehydration Solutions in Patients With Short Bowel Syndrome Receiving Home Parenteral Nutrition: A Prospective Double-Blind Randomized Controlled Trial.

    PubMed

    Hurt, Ryan T; Vallumsetla, Nishanth; Edakkanambeth Varayil, Jithinraj; Bonnes, Sara L; Nanda, Sanjeev; Nadeau, Joseph; Mundi, Manpreet S

    2017-06-01

    Short bowel syndrome (SBS) is a common indication for home parenteral nutrition (HPN). Oral rehydration solutions (ORSs) have the ability to supplement or reduce HPN dependence. However, ORSs have suffered from poor taste profiles, making long-term consumption and compliance unlikely. The goal of the current study was to assess the taste and compliance of 2 ORSs among patients with SBS requiring HPN. All participants with SBS receiving HPN with anticipated duration >3 months were offered enrollment: 31 participants met inclusion criteria; 3 declined enrollment; and 28 were randomized to receive a modified World Health Organization ORS (group A) or a commercially available ORS (DripDrop; group B). Six participants dropped out shortly after randomization (3 in each group) due to poor taste or intolerance. An additional 3 (1 in group A and 2 in group B) discontinued the ORS before the end of the study at 6 months. At the end of the study, 19 remained. The mean taste rating given by the participants was, on a scale of 1-10, 7.3 ± 1.9 for group A and 7.6 ± 1.6 for group B ( P = .61). The mean number of days that ORSs were consumed each week was 6.0 ± 1.3 for group A and 6.6 ± 1 days for group B ( P = .06). Taste rating was not different for both ORSs; however, a significant number of participants did not complete the study.

  17. Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care.

    PubMed

    Leff, Bruce; Burton, Lynda; Mader, Scott L; Naughton, Bruce; Burl, Jeffrey; Koehn, Debbie; Clark, Rebecca; Greenough, William B; Guido, Susan; Steinwachs, Donald; Burton, John R

    2008-01-01

    To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care. Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model. Three Medicare managed care health systems and a Veterans Affairs Medical Center. Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis. Treatment in a substitutive HaH model. Fifteen-question survey questionnaire asking family members whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care. The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean +/- standard deviation 1.7 +/- 1.8 vs 4.3 +/- 3.1, P<.001; median 1 vs 4, P<.001). HaH care was associated with lower odds of developing mean levels of family member stress (adjusted odds ratio=0.12, 95% confidence interval=0.05-0.30). HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members.

  18. Fiber-based free-space optical coherent receiver with vibration compensation mechanism.

    PubMed

    Zhang, Ruochi; Wang, Jianmin; Zhao, Guang; Lv, Junyi

    2013-07-29

    We propose a novel fiber-based free-space optical (FSO) coherent receiver for inter-satellite communication. The receiver takes advantage of established fiber-optic components and utilizes the fine-pointing subsystem installed in FSO terminals to minimize the influence of satellite platform vibrations. The received beam is coupled to a single-mode fiber, and the coupling efficiency of the system is investigated both analytically and experimentally. A receiving sensitivity of -38 dBm is obtained at the forward error correction limit with a transmission rate of 22.4 Gbit/s. The proposed receiver is shown to be a promising component for inter-satellite optical communication.

  19. It 'makes you feel more like a person than a patient': patients' experiences receiving home-based primary care (HBPC) in Ontario, Canada.

    PubMed

    Smith-Carrier, Tracy; Sinha, Samir K; Nowaczynski, Mark; Akhtar, Sabrina; Seddon, Gayle; Pham, Thuy-Nga Tia

    2017-03-01

    The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.

  20. The determinants of the propensity to receive publicly funded home care services for the elderly in Canada: a panel two-stage residual inclusion approach.

    PubMed

    Mery, Gustavo; Wodchis, Walter P; Laporte, Audrey

    2016-12-01

    The role of Home Care (HC) services for the elderly will be increasingly important in meeting populations' future needs for care. HC services include Home Health Care (HHC) and Homemaking/Personal Support (HMPS), distinction rarely seen in the literature. This paper argues that it is important to distinguish between these types of HC, since the factors that drive the likelihood of the receipt of each type of care may differ, and also to investigate the interrelationship between them. We explored the interrelationship between receipt of publicly funded HMPS and HHC, and the determinants of the receipt of each type of services. A Panel Two-Stage Residual Inclusion approach was applied to estimate the likelihood of the receipt of HC services using data for those aged 65 and over from 9 biannual waves of the Canadian National Population Health Survey (1994-95 to 2010-11). We found that there are in fact differences in the determinants of the likelihood of HHC and HMPS receipt. Moreover, receipt of publicly funded HMPS was found to be complementary with receipt of publicly funded HHC services after adjusting for functional and health status. Dependence on help with activities of daily living, health status, household arrangement, and income were found to be determinants of the propensity to receive both publicly funded HHC and HMPS services. This study aims to contribute to the existent literature by taking a step toward explicitly modelling the potential interaction between the determinants of the receipt of different types of HC services simultaneously, as a system. Our methodological approach, a Panel Two-Stage Residual Inclusion method, seems to effectively address problems that are known to be a source of bias in the literature.

  1. Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey.

    PubMed

    Lloyd-Owen, S J; Donaldson, G C; Ambrosino, N; Escarabill, J; Farre, R; Fauroux, B; Robert, D; Schoenhofer, B; Simonds, A K; Wedzicha, J A

    2005-06-01

    The study was designed to assess the patterns of use of home mechanical ventilation (HMV) for patients with chronic respiratory failure across Europe. A detailed questionnaire of centre details, HMV user characteristics and equipment choices was sent to carefully identified HMV centres in 16 European countries. A total of 483 centres treating 27,118 HMV users were identified. Of these, 329 centres completed surveys between July 2001 and June 2002, representing up to 21,526 HMV users and a response rate of between 62% and 79%. The estimated prevalence of HMV in Europe was 6.6 per 100,000 people. The variation in prevalence between countries was only partially related to the median year of starting HMV services. In addition, there were marked differences between countries in the relative proportions of lung and neuromuscular patients using HMV, and the use of tracheostomies in lung and neuromuscular HMV users. Lung users were linked to a HMV duration of <1 yr, thoracic cage users with 6-10 yrs of ventilation and neuromuscular users with a duration of > or =6 yrs. In conclusion, wide variations exist in the patterns of home mechanical ventilation provision throughout Europe. Further work is needed to monitor its use and ensure equality of provision and access.

  2. R&D 100, 2016: T-Quake – Quantum-Mechanical Transmitter/Receiver Microchip

    SciTech Connect

    Tauke-Pedretti, Anna; Camacho, Ryan; Thayer, Gayle

    2016-11-07

    Applying advanced microfabrication techniques and innovative microdesign, the Sandia Enabled Communications and Authentication Network (SECANT) team has designed and produced photonic microchips capable of sending, receiving, and processing quantum signals for applications in cyber and physical security.

  3. Reducing Mechanical and Flow-Induced Noise in the Surface Suspended Acoustic Receiver

    DTIC Science & Technology

    1997-05-06

    John Spiesberger . Surface Suspended Acoustic Receiver: A free-drifting acoustic tomography receiver features real-time data processing, telemetry. Sea...Technology, 36:43-48, 1995. [7] Daniel E. Frye, Lee Freitag, Walter Paul, Mark Grosenbuagh, and John Spiesberger . Sur- face Suspended Acoustic...Press, Cambridge, MA, 1977. [17] J.L. Spiesberger , D.E. Frye, J. O’Brien, H. Hurlburt, J.W. McCaffrey, M. Johnson, and J. Kenny. Global acoustic

  4. Catheter-related Blood Stream Infection in Patients Receiving Long-term Home Parenteral Nutrition: Tertiary Care Hospital Experience in Saudi Arabia

    PubMed Central

    Al-Tawil, Esraa S.; Almuhareb, Alanoud M.; Amin, Hamdy M.

    2016-01-01

    Background/Aim: Parenteral nutrition (PN) is a lifesaving therapy for patients with many severe conditions, including intestinal failure. Some patients require long-term PN therapy, which makes home parenteral nutrition (HPN) an attractive option to improve the quality of life. Among the most common and serious complications observed in these patients are catheter-related blood stream infections (CRBSIs). The aim of our study is to determine the frequency of CRBSI among patients receiving long-term HPN. Patients and Methods: A retrospective chart review was conducted for patients enrolled in the HPN program between 2006 and 2012. Data on the demographic characteristics, indications and duration of PN therapy, catheter type, number of admissions because of CRBSI, and blood culture results were recorded. Results: Eight pediatric patients were included (mean age of 3.5 years at the start of HPN). Microvillus inclusive disease was noted in 50% of these patients, and 75% of them received HPN under parents' care. CRBSI resulted in 60 admissions with a median of 182 days of hospital stay and 74 changes of central venous catheters. The rate of CRBSI was 2.9 per 1000 catheter days. Staphylococcus species were the most prevalent pathogens (32%), followed by Klebsiella pneumoniae (5%). Conclusion: In this small group of HPN patients, the BSI rate was 2.9 infections per 1000 catheter days, and most common causative organisms were Staphylococcus species. We believe that a well-established training program for caregivers can reduce the rate of infectious complications associated with long-term PN support. PMID:27488325

  5. Characterization of the dominant structural vibration of hearing aid receivers: Towards the moderation of mechanical feedback in hearing aids

    NASA Astrophysics Data System (ADS)

    Varanda, Brenno R.

    Presented are the results from the experimental, analytical, and computational analyses accomplished to characterize the mechanical vibration of hearing aid receivers, a key electro-acoustic component of hearing aids. The function of a receiver in a hearing aid is to provide an amplified sound signal into the ear canal. Unfortunately, as the receiver produces sound, it also undergoes vibration which can be transmitted through the hearing aid package to the microphones, resulting in undesirable feedback oscillations. To gain more knowledge and control on the source of these feedback oscillations, a dynamic rigid body model of the receiver is proposed. The rigid body model captures the essential dynamic features of the receiver. The model is represented by two hinged rigid bodies, under an equal and opposite dynamic moment load, and connected to each other by a torsional spring and damper. The mechanical coupling ratio between the two rigid bodies is proved to be acoustically independent. A method is introduced to estimate the parameters for the proposed model using experimental data. An equivalent finite element analysis model is established and tested against a known and characterized mechanical attachment. The simulated model successfully predicts the structural dynamic response showing excellent agreement between the finite element analysis and measured results.

  6. Home mechanical ventilation: outcomes according to remoteness from health center and different family education levels.

    PubMed

    Pekcan, Sevgi; Aslan, Ayşe Tana; Kiper, Nural; Köse, Mehmet; Cobanoglu, Nazan; Yalçin, Ebru; Doğru, Deniz; Ozçelik, Uğur

    2010-01-01

    Throughout the world, home mechanical ventilation (HMV) is being increasingly employed to treat patients suffering from chronic respiratory failure. This present study aimed to examine the characteristics and outcomes of 27 children seen in our department over a four-year period who were treated with HMV. The causes of chronic respiratory failure were as follows: 16 (59.3%) neuromuscular disease, 6 (22.2%) primary respiratory diseases, 3 (11.1%) congenital heart disease, and 2 (7.4%) storage disease. The mean age was 59.4 months (1 day-15 years); mean follow-up for invasive ventilation was 356 (0-1200) days and for non-invasive HMV was 517 (30-1440) days. With respect to maternal educational level, 13 had graduated from elementary school and 14 from high school or university. Nine of our patients resided in Ankara, while 18 lived in rural areas of Turkey. Eleven of the 27 patients died during the HMV period (1-36 months) at home. Five patients were weaned from HMV between 1-19 months. Our experience showed that HMV can be applied successfully in chronic respiratory failure patients in Turkey. Length of the follow-up period and mortality rate were not affected by the patient's place of residence (city center or rural) or maternal level of education.

  7. Transcriptional programs of lymphoid tissue capillary and high endothelium reveal control mechanisms for lymphocyte homing

    PubMed Central

    Lee, Mike; Kiefel, Helena; LaJevic, Melissa D.; Macauley, Matthew S.; Kawashima, Hiroto; O'Hara, Edward; Pan, Junliang; Paulson, James C.; Butcher, Eugene C.

    2014-01-01

    Lymphocytes are recruited from blood by high-endothelial venules (HEVs). We performed transcriptomic analyses and identified molecular signatures that distinguish HEVs from capillary endothelium and that define tissue-specific HEV specialization. Capillaries displayed gene programs for vascular development. HEVs were enriched in genes for immune defense and lymphocyte migration. We identify capillary and HEV markers and candidate mechanisms for regulated lymphocyte recruitment including a lymph node HEV-selective transmembrane mucin; transcriptional control of functionally specialized carbohydrate ligands for lymphocyte L-selectin; HEV expression of molecules for transendothelial migration; and metabolic programs for lipid mediators of lymphocyte motility and chemotaxis. We also elucidate a carbohydrate recognition pathway that targets B cells to intestinal lymphoid tissues, defining CD22 as a lectin-homing receptor for mucosal HEVs. PMID:25173345

  8. Characteristics of Older Georgians Receiving Older Americans Act Nutrition Program Services and Other Home- and Community-Based Services: Findings from the Georgia Aging Information Management System (GA AIMS).

    PubMed

    Lee, Jung Sun; Shannon, Jerry; Brown, Arvine

    2015-01-01

    This descriptive study examined characteristics of older Georgians receiving Older Americans Act Nutrition Program Services and other home- and community-based services (HCBS) using state aging administrative data (N = 31,341, mean age: 76.6 ± 9.2 y, 71.2% female, 52.3% White). Home-delivered meals (HDM) was used most frequently. The characteristics of older Georgian HCBS participants varied by the type and number of HCBS received. Those receiving HDM and other in-home and caregiving services were more likely to show poorer sociodemographic, economic, and functional characteristics, and food insecurity. Those receiving multiple HCBS were most vulnerable, but showed lower level of food insecurity than those receiving single HCBS, suggesting potential combined benefits of receiving multiple programs. This study underscores the importance of documenting dynamic needs for HCBS, especially HDM, among vulnerable older adults as part of standard administrative process to identify those at high risk of institutionalization, optimize HCBS delivery and coordination, and maximize HCBS benefits.

  9. Propranolol inhibits endothelial progenitor cell homing: a possible treatment mechanism of infantile hemangioma.

    PubMed

    Zou, Hai-Xiao; Jia, Jun; Zhang, Wen-Feng; Sun, Zhi-Jun; Zhao, Yi-Fang

    2013-01-01

    Propranolol effectively treats infantile hemangioma, but its mechanisms of action remain poorly understood. Although the antiangiogenesis role of propranolol has been previously demonstrated, several lines of evidence suggest that this therapeutic agent may affect the neovascular formation in infantile hemangioma by targeting vasculogenesis. In addition, the homing of endothelial progenitor cells to the lesion of infantile hemangioma plays an important role during the process of vasculogenesis. The purpose of this study was to investigate whether propranolol inhibits the vasculogenesis in infantile hemangioma by targeting endothelial progenitor cells recruitment. Endothelial progenitor cells were treated with different concentrations (0, 1, 5, 10, 20, 40, 60, 80, 100 μM) of propranolol for indicated times (24, 48, 72 h). Cell proliferation and viability were assessed by MTT assay and trypan blue staining. Cell migration was determined by wound healing assay and Boyden chamber assay. The expression levels of extracellular signal regulated kinase, phospho-extracellular signal regulated kinase, Akt, and phospho-Akt were measured by Western blot analysis to explore the molecular mechanism of propranolol on endothelial progenitor cells. In addition, the expression of CXCR4 was measured by Western blot and reverse transcriptase polymerase chain reaction. Propranolol did not significantly affect the proliferation of endothelial progenitor cells. It inhibited stromal-cell-derived factor 1α-induced migration of endothelial progenitor cells through the Akt and MAPK pathways and the expression of CXCR4 in a dose- and time-dependent manner. In addition, the expression of CXCR4 was suppressed by propranolol most likely through the Akt and MAPK pathways. Propranolol inhibits stromal-cell-derived factor 1α-induced endothelial progenitor cell homing by suppressing the expression of CXCR4 most likely through the Akt and MAPK pathways. Copyright © 2013 Elsevier Inc. All rights

  10. How the Quantity of Agricultural Mechanics Training Received at the Secondary Level Impact Teacher Perceived Importance of Agricultural Mechanics Skills

    ERIC Educational Resources Information Center

    Rasty, John; Anderson, Ryan G.; Paulsen, Thomas H.

    2017-01-01

    Preservice teacher candidates in agricultural education have expressed concerns with teaching agricultural mechanics content yet the number of required courses in agricultural mechanics has dwindled. To determine the root of current teachers' perceptions, it is important to look at the developmental experiences that have led to those perceptions.…

  11. Interim Report on the Examination of Corrosion Damage in Homes Constructed With Imported Wallboard: Examination of Samples Received September 28, 2009.

    PubMed

    Pitchure, D J; Ricker, R E; Williams, M E; Claggett, S A

    2010-01-01

    Since many household systems are fabricated out of metallic materials, changes to the household environment that accelerate corrosion rates will increase the frequency of failures in these systems. Recently, it has been reported that homes constructed with imported wallboard have increased failure rates in appliances, air conditioner heat exchanger coils, and visible corrosion on electrical wiring and other metal components. At the request of the Consumer Product Safety Commission (CPSC), the National Institute of Standards and Technology (NIST) became involved through the Interagency Agreement CPSC-1-09-0023 to perform metallurgical analyses on samples and corrosion products removed from homes constructed using imported wallboard. This document reports on the analysis of the first group of samples received by NIST from CPSC. The samples received by NIST on September 28, 2009 consisted of copper tubing for supplying natural gas and two air conditioner heat exchanger coils. The examinations performed by NIST consisted of photography, metallurgical cross-sectioning, optical microscopy, scanning electron microscopy (SEM), and x-ray diffraction (XRD). Leak tests were also performed on the air conditioner heat exchanger coils. The objective of these examinations was to determine extent and nature of the corrosive attack, the chemical composition of the corrosion product, and the potential chemical reactions or environmental species responsible for accelerated corrosion. A thin black corrosion product was found on samples of the copper tubing. The XRD analysis of this layer indicated that this corrosion product was a copper sulfide phase and the diffraction peaks corresponded with those for the mineral digenite (Cu9S5). Corrosion products were also observed on other types of metals in the air conditioner coils where condensation would frequently wet the metals. The thickness of the corrosion product layer on a copper natural gas supply pipe with a wall thickness of 1

  12. Interim Report on the Examination of Corrosion Damage in Homes Constructed With Imported Wallboard: Examination of Samples Received September 28, 2009

    PubMed Central

    Pitchure, D. J.; Ricker, R. E.; Williams, M. E.; Claggett, S. A.

    2010-01-01

    Since many household systems are fabricated out of metallic materials, changes to the household environment that accelerate corrosion rates will increase the frequency of failures in these systems. Recently, it has been reported that homes constructed with imported wallboard have increased failure rates in appliances, air conditioner heat exchanger coils, and visible corrosion on electrical wiring and other metal components. At the request of the Consumer Product Safety Commission (CPSC), the National Institute of Standards and Technology (NIST) became involved through the Interagency Agreement CPSC-1-09-0023 to perform metallurgical analyses on samples and corrosion products removed from homes constructed using imported wallboard. This document reports on the analysis of the first group of samples received by NIST from CPSC. The samples received by NIST on September 28, 2009 consisted of copper tubing for supplying natural gas and two air conditioner heat exchanger coils. The examinations performed by NIST consisted of photography, metallurgical cross-sectioning, optical microscopy, scanning electron microscopy (SEM), and x-ray diffraction (XRD). Leak tests were also performed on the air conditioner heat exchanger coils. The objective of these examinations was to determine extent and nature of the corrosive attack, the chemical composition of the corrosion product, and the potential chemical reactions or environmental species responsible for accelerated corrosion. A thin black corrosion product was found on samples of the copper tubing. The XRD analysis of this layer indicated that this corrosion product was a copper sulfide phase and the diffraction peaks corresponded with those for the mineral digenite (Cu9S5). Corrosion products were also observed on other types of metals in the air conditioner coils where condensation would frequently wet the metals. The thickness of the corrosion product layer on a copper natural gas supply pipe with a wall thickness of 1

  13. Factors associated with (risk of) undernutrition in community-dwelling older adults receiving home care: a cross-sectional study in the Netherlands.

    PubMed

    van der Pols-Vijlbrief, Rachel; Wijnhoven, Hanneke Ah; Molenaar, Hilde; Visser, Marjolein

    2016-08-01

    It is generally thought that causes of undernutrition are multifactorial, but there are limited quantitative studies performed. We therefore examined a wide range of potential factors associated with undernutrition in community-dwelling older adults. Cross-sectional study. Community-dwelling older adults (≥65 years) receiving home care in the Netherlands. Data on potential factors associated with (risk of) undernutrition were collected among 300 older adults. Nutritional status was assessed by the SNAQ65+ instrument. Undernutrition was defined as mid-upper arm circumference <25 cm or unintentional weight loss of ≥4 kg in 6 months. Being at risk of undernutrition was defined as having poor appetite and inability to walk up and down stairs of fifteen steps, without resting. Of all participants, ninety-two (31·7 %) were undernourished and twenty-four (8·0 %) were at risk of undernutrition. Based on multivariate logistic regression analyses, the statistically significant factors associated with (risk of) undernutrition (P<0·05) were: unable to go outside (OR=5·39), intestinal problems (OR=2·88), smoking (OR=2·56), osteoporosis (OR=2·46), eating fewer than three snacks daily (OR=2·61), dependency in activities of daily living (OR=1·21), physical inactivity (OR=2·01), nausea (OR=2·50) and cancer (OR=2·84); a borderline significant factor was depression symptoms (OR=1·83, P=0·053). The study suggests that (risk of) undernutrition is a multifactorial problem and that associated factors can be found in several domains. These findings may support the development of intervention trials for the prevention and treatment of undernutrition in community-dwelling older adults.

  14. Interrelationship of oral health status, swallowing function, nutritional status, and cognitive ability with activities of daily living in Japanese elderly people receiving home care services due to physical disabilities.

    PubMed

    Furuta, Michiko; Komiya-Nonaka, Manae; Akifusa, Sumio; Shimazaki, Yoshihiro; Adachi, Munehisa; Kinoshita, Toshinori; Kikutani, Takeshi; Yamashita, Yoshihisa

    2013-04-01

    Malnutrition and cognitive impairment lead to declines in activities of daily living (ADL). Nutritional status and cognitive ability have been shown to correlate with oral health status and swallowing function. However, the complex relationship among the factors that affect decline in ADL is not understood. We examined direct and indirect relationships among oral health status, swallowing function, nutritional status, cognitive ability, and ADL in Japanese elderly people living at home and receiving home care services because of physical disabilities. Participants were 286 subjects aged 60 years and older (mean age, 84.5±7.9 years) living at home and receiving home care services. Oral health status (the number of teeth and wearing dentures) was assessed, and swallowing function was examined using cervical auscultation. Additionally, ADL, cognitive ability, and nutritional status were assessed using the Barthel Index, the Clinical Dementia Rating Scale, and the Mini Nutritional Assessment-Short Form, respectively. Path analysis was used to test pathways from these factors to ADL. The mean number of teeth present in the participants was 8.6±9.9 (edentates, 40.6%). Dysphagia, malnutrition, and severe cognitive impairment were found in 31.1%, 14.0%, and 21.3% of the participants, respectively. Path analysis indicated that poor oral health status and cognitive impairment had a direct effect on denture wearing, and the consequent dysphagia, in addition to cognitive impairment, was positively associated with malnutrition. Malnutrition as well as dysphagia and cognitive impairment directly limited ADL. A lower number of teeth are positively related to swallowing dysfunction, whereas denture wearing contributes to recovery of swallowing function. Dysphagia, cognitive impairment, and malnutrition directly and indirectly decreased ADL in elderly people living at home and receiving home nursing care. The findings suggest that preventing tooth loss and encouraging denture

  15. Stress Coping Mechanisms in Elderly Adults: An Initial Study of Recreational and Other Coping Behaviors in Nursing Home Patients

    ERIC Educational Resources Information Center

    Hunter, I. Roy; Gillen, Mark C.

    2009-01-01

    Residents (N = 32) of 3 skilled nursing homes participated in a study designed to document the nature of the stressors they experienced and the coping mechanisms they used. Medical issues were the most common stressors. The most common coping responses were prayer, reading, watching television, listening to music, and talking to friends and…

  16. Stress Coping Mechanisms in Elderly Adults: An Initial Study of Recreational and Other Coping Behaviors in Nursing Home Patients

    ERIC Educational Resources Information Center

    Hunter, I. Roy; Gillen, Mark C.

    2009-01-01

    Residents (N = 32) of 3 skilled nursing homes participated in a study designed to document the nature of the stressors they experienced and the coping mechanisms they used. Medical issues were the most common stressors. The most common coping responses were prayer, reading, watching television, listening to music, and talking to friends and…

  17. The association between self-image and defence mechanisms in a group of adolescent patients receiving psychiatric treatment.

    PubMed

    Treger, Bartosz; Matusiak, Feliks; Pilecki, Maciej; Rogoż, Monika

    2015-01-01

    The aim of the study was to explore the relationship between various areas of self-image and defence mechanisms in adolescents. The study included a division into groups according to whether or not they were receiving psychiatric treatment. Data were obtained from two groups: a clinical group (30 persons), consisting of adolescent patients of the Adolescent Inpatient Ward of the Child and Adolescent Psychiatry Clinic and a control group (40 persons), adolescents attending upper secondary school. The Defence Style Questionnaire DSQ-40 and the Offer Self Image Questionnaire were used in the study. Results showed no differences, in the maturity levels of the defence mechanisms, between the two groups. Subjects from the clinical group had a significantly lower self-image of themselves than subjects from the control group.. In both groups, the use of mature defence mechanisms was accompanied by a positive self-image, while the use of less mature defence mechanisms was associated with a lower self-image. Comparison of the groups revealed different relationships between the aspects of self-image and used defence mechanisms, in particular the mechanism of projection. Number of significant correlations was greater in the clinical group. In the context of lower self-image, the study revealed the importance of such defence mechanisms as projection, acting out, somatization or schizoid fantasies. The obtained results seem to confirm a hypothesis that the assessment of the maturity of defence mechanisms in the period of adolescence is less clear and clinically useful.

  18. Time of elevation of head of bed for patients receiving mechanical ventilation and its related factors.

    PubMed

    Martí-Hereu, L; Arreciado Marañón, A

    2017-06-08

    The semirecumbent position is a widespread recommendation for the prevention of pneumonia associated with mechanical ventilation. To identify the time of elevation of head of bed for patients under mechanical ventilation and the factors related to such elevation in an intensive care unit. An observational, descriptive cross-sectional study. Conducted in an intensive care unit of a tertiary hospital from April to June 2015. The studied population were mechanically ventilated patients. Daily hours in which patients remained with the head of the bed elevated (≥30°), socio-demographic data and clinical variables were recorded. 261 head elevation measurements were collected. The average daily hours that patients remained at ≥30° was 16h28' (SD ±5h38'), equivalent to 68.6% (SD ±23.5%) of the day. Factors related to elevations ≥30° for longer were: enteral nutrition, levels of deep sedation, cardiac and neurocritical diagnostics. Factors that hindered the position were: sedation levels for agitation and abdominal pathologies. Sex, age and ventilation mode did not show a significant relationship with bed head elevation. Although raising the head of the bed is an easy to perform, economical and measurable preventive measure, its compliance is low due to specific factors specific related o the patient's clinical condition. Using innovations such as continuous measurement of the head position helps to evaluate clinical practice and allows to carry out improvement actions whose impact is beneficial to the patient. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Effectiveness of new sedation and rehabilitation methods for critically ill patients receiving mechanical ventilation

    PubMed Central

    Yamashita, Kouji; Takami, Akiyoshi; Wakayama, Saichi; Makino, Misato; Takeyama, Yoshihiro

    2017-01-01

    [Purpose] The purpose of this study was to investigate the effects of new sedation management methods and cooperation between nurses and physical therapists on the duration of mechanical ventilation and hospitalization. [Subjects and Methods] Patients who had been treated at the study hospital 2 years before and after the implementation of the new methods were analyzed retrospectively and classified into a “control group” and an “intervention group”, respectively. Both groups were analyzed and subsequently compared regarding the effects of the new sedation and cooperative rehabilitation. [Results] A total of 70 patients met the inclusion criteria and were divided evenly into the two groups. No significant differences were found between the groups in age, APACHE II score, or duration of stay in hospital. On the other hand, significant decreases were seen in the duration of sedation and intubation, mechanical ventilation, and stay in the emergency ward, as well as time until standing. In addition, after intervention, three patients undergoing ventilator treatment were able to be ambulated. [Conclusion] These results suggest that the new sedation and cooperative rehabilitation methods for critically ill patients were effective in the early stage of treatment and shortened the duration of stay in the ward. PMID:28210060

  20. A Tool for Music Preference Assessment in Critically Ill Patients Receiving Mechanical Ventilatory Support

    PubMed Central

    CHLAN, LINDA; HEIDERSCHEIT, ANNIE

    2010-01-01

    Music is an ideal intervention to reduce anxiety and promote relaxation in critically ill patients. This article reviews the research studies on music-listening interventions to manage distressful symptoms in this population, and describes the development and implementation of the Music Assessment Tool (MAT) to assist professionals in ascertaining patients’ music preferences in the challenging, dynamic clinical environment of the intensive care unit (ICU). The MAT is easy to use with these patients who experience profound communication challenges due to fatigue and inability to speak because of endotracheal tube placement. The music therapist and ICU nursing staff are encouraged to work collaboratively to implement music in a personalized manner to ensure the greatest benefit for mechanically ventilated patients. PMID:24489432

  1. Perceptions of Patients and Families who Received a Music Intervention During Mechanical Ventilation

    PubMed Central

    Chlan, Linda; Staugaitis, Abbey

    2015-01-01

    The intensive care unit (ICU) is a technologically-driven environment where critically ill patients and their families have significant physical and emotional experiences. Mechanically ventilated (MV) patients can experience significant distress from anxiety and pain. Music listening is one integrative intervention that has been shown to reduce anxiety as well as other symptoms that contribute to distress in MV patients. This is a report of MV patient and family experiences from a larger research study whose aim was to evaluate levels of anxiety and sedative exposure with use of a patient-directed music intervention. Understanding perceptions of MV patients and families regarding the effectiveness of music listening will guide improvement of their care. PMID:26301046

  2. Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation.

    PubMed

    Unoki, Takeshi; Kawasaki, Yuri; Mizutani, Taro; Fujino, Yoko; Yanagisawa, Yaeko; Ishimatsu, Shinichi; Tamura, Fumiko; Toyooka, Hidenori

    2005-11-01

    Expiratory rib-cage compression, a chest physiotherapy technique, is well known as the "squeezing" technique in Japan. To determine the effects of rib-cage compression on airway-secretion removal, oxygenation, and ventilation in patients receiving mechanical ventilation. An intensive care unit of an emergency and critical care center at a tertiary-care teaching hospital in Tokyo, Japan. Thirty-one intubated, mechanically ventilated patients in an intensive care unit were studied in a randomized, crossover trial. The patients received endotracheal suctioning with or without rib-cage compression, with a minimum 3-hour interval between the 2 interventions. Rib-cage compression was performed for 5 min before endotracheal suctioning. Arterial blood gas and respiratory mechanics were measured 5 min before endotracheal suctioning (baseline) and 25 min after suctioning. The 2 measurement periods were carried out on the same day. There were no significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen, P(aCO2), or dynamic compliance of the respiratory system between the 2 periods (before and after endotracheal suctioning). Moreover, there were no significant differences in airway-secretion removal between the 2 periods. This study suggests that rib-cage compression prior to endotracheal suctioning does not improve airway-secretion removal, oxygenation, or ventilation after endotracheal suctioning in this unselected population of mechanically ventilated patients.

  3. Living with severe physical impairment, Duchenne's muscular dystrophy and home mechanical ventilation

    PubMed Central

    Dreyer, Pia S.; Steffensen, Birgit F.; Pedersen, Birthe D.

    2010-01-01

    Aim To study life-experiences of people living with Duchenne's muscular dystrophy (DMD), home mechanical ventilation (HMV) and physical impairment. Background Since the introduction of invasive HMV in the late 1980s people with DMD in Denmark live longer and have the experience of adulthood and a high degree of physical dependency. Method Nineteen patients with DMD and invasive HMV were interviewed in 2007. The interviews were recorded, transcribed verbatim and analysed according to a method inspired by Ricoeur's theory of interpretation. Findings HMV not only extended the participants lifespan, it also gave them the capacity to live an active life. They were totally dependent in everyday living, but in spite of this, they did not see themselves as physically impaired. They realised that there were activities that were physically impossible, but they considered themselves to be just the same person they had always been. This dependency was described as “independent dependency”. Conclusion The lived-experience of physical impairment is found to be “independent dependency” in an active life. To solve problems with loneliness, society needs to work with prejudice and misunderstanding and for better physical accessibility to enable full participation. PMID:20689774

  4. Living with severe physical impairment, Duchenne's muscular dystrophy and home mechanical ventilation.

    PubMed

    Dreyer, Pia S; Steffensen, Birgit F; Pedersen, Birthe D

    2010-08-02

    To study life-experiences of people living with Duchenne's muscular dystrophy (DMD), home mechanical ventilation (HMV) and physical impairment. Since the introduction of invasive HMV in the late 1980s people with DMD in Denmark live longer and have the experience of adulthood and a high degree of physical dependency. Nineteen patients with DMD and invasive HMV were interviewed in 2007. The interviews were recorded, transcribed verbatim and analysed according to a method inspired by Ricoeur's theory of interpretation. HMV not only extended the participants lifespan, it also gave them the capacity to live an active life. They were totally dependent in everyday living, but in spite of this, they did not see themselves as physically impaired. They realised that there were activities that were physically impossible, but they considered themselves to be just the same person they had always been. This dependency was described as "independent dependency". The lived-experience of physical impairment is found to be "independent dependency" in an active life. To solve problems with loneliness, society needs to work with prejudice and misunderstanding and for better physical accessibility to enable full participation.

  5. Home mechanical ventilation in the aftermath of the Hanshin-Awaji earthquake disaster.

    PubMed

    Shimada, S; Funato, M

    1995-12-01

    Children who were dependent upon home mechanical ventilation (HMV), suffered in various ways from the disastrous Hanshin-Awaji earthquake disaster. The earthquake abruptly cut the supplies of water, gas and electricity, causing intense anxiety for those families. Through loss of the respirator function, some of them experienced an unexpected catastrophe. In the disaster area, there were children who were dependent upon HMV (19 cases) and children who were preparing for HMV in hospitals (nine cases). Information was gathered from questionnaires about the disaster, communication and correspondence with families. None of the 28 cases died or were injured. Nineteen cases had a variety of problems. In eight cases, respiratory support problems were acute. Nevertheless, all of them survived the crisis successfully even in the midst of such a catastrophic situation. An organization of HMV children's families, called the Baku-Baku Club, helped families with HMV problems by supplying water, food, oxygen and compressed air cylinders among other things. Additional outside batteries for portable respirators are essential equipment for HMV, especially for emergencies. A manual for clarifying the system for support in the Baku-Baku Club and a registration system for public medical service should be established in preparation for such a crisis.

  6. Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation.

    PubMed

    Hodgson, Carol; Goligher, Ewan C; Young, Meredith E; Keating, Jennifer L; Holland, Anne E; Romero, Lorena; Bradley, Scott J; Tuxen, David

    2016-11-17

    Recruitment manoeuvres involve transient elevations in airway pressure applied during mechanical ventilation to open ('recruit') collapsed lung units and increase the number of alveoli participating in tidal ventilation. Recruitment manoeuvres are often used to treat patients in intensive care who have acute respiratory distress syndrome (ARDS), but the effect of this treatment on clinical outcomes has not been well established. This systematic review is an update of a Cochrane review originally published in 2009. Our primary objective was to determine the effects of recruitment manoeuvres on mortality in adults with acute respiratory distress syndrome.Our secondary objective was to determine, in the same population, the effects of recruitment manoeuvres on oxygenation and adverse events (e.g. rate of barotrauma). For this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), Embase (OVID), the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO), Latin American and Caribbean Health Sciences (LILACS) and the International Standard Randomized Controlled Trial Number (ISRCTN) registry from inception to August 2016. We included randomized controlled trials (RCTs) of adults who were mechanically ventilated that compared recruitment manoeuvres versus standard care for patients given a diagnosis of ARDS. Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Ten trials met the inclusion criteria for this review (n = 1658 participants). We found five trials to be at low risk of bias and five to be at moderate risk of bias. Six of the trials included recruitment manoeuvres as part of an open lung ventilation strategy that was different from control ventilation in aspects other than the recruitment manoeuvre (such as mode of ventilation, higher positive end-expiratory pressure (PEEP) titration and lower tidal volume or plateau

  7. Erythroid cell mitochondria receive endosomal iron by a "kiss-and-run" mechanism.

    PubMed

    Hamdi, Amel; Roshan, Tariq M; Kahawita, Tanya M; Mason, Anne B; Sheftel, Alex D; Ponka, Prem

    2016-12-01

    In erythroid cells, more than 90% of transferrin-derived iron enters mitochondria where ferrochelatase inserts Fe(2+) into protoporphyrin IX. However, the path of iron from endosomes to mitochondrial ferrochelatase remains elusive. The prevailing opinion is that, after its export from endosomes, the redox-active metal spreads into the cytosol and mysteriously finds its way into mitochondria through passive diffusion. In contrast, this study supports the hypothesis that the highly efficient transport of iron toward ferrochelatase in erythroid cells requires a direct interaction between transferrin-endosomes and mitochondria (the "kiss-and-run" hypothesis). Using a novel method (flow sub-cytometry), we analyze lysates of reticulocytes after labeling these organelles with different fluorophores. We have identified a double-labeled population definitively representing endosomes interacting with mitochondria, as demonstrated by confocal microscopy. Moreover, we conclude that this endosome-mitochondrion association is reversible, since a "chase" with unlabeled holotransferrin causes a time-dependent decrease in the size of the double-labeled population. Importantly, the dissociation of endosomes from mitochondria does not occur in the absence of holotransferrin. Additionally, mutated recombinant holotransferrin, that cannot release iron, significantly decreases the uptake of (59)Fe by reticulocytes and diminishes (59)Fe incorporation into heme. This suggests that endosomes, which are unable to provide iron to mitochondria, cause a "traffic jam" leading to decreased endocytosis of holotransferrin. Altogether, our results suggest that a molecular mechanism exists to coordinate the iron status of endosomal transferrin with its trafficking. Besides its contribution to the field of iron metabolism, this study provides evidence for a new intracellular trafficking pathway of organelles. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. [From the poliomyelitis epidemic to the founding of artificial respiration centres, intensive care units and centres for home mechanical ventilation].

    PubMed

    Meinesz, A F; Wijkstra, P J; Zijlstra, J G; Albers, M J I J; Köter, G H

    2006-02-25

    In 1952, Copenhagen was confronted with a poliomyelitis epidemic that involved the respiratory musculature in large numbers of patients. The anaesthetist B. Ibsen, who established carbon dioxide intoxication due to severe hypoventilation as the cause of death, proposed that the patients be treated by tracheostomy and positive pressure respiration in order to achieve better ventilation than with an iron lung. In the Netherlands, it was decided to organise the control ofthe epidemics on a nationwide basis. Various hospitals were asked to set up artificial respiration centres. In addition, the Beatrix Fund was set up in order to collect money for combating poliomyelitis. The epidemic reached the Netherlands in 1956. In Groningen University Medical Centre, 74 patients were admitted, of whom 36 had to be ventilated. In two cases, the mechanical ventilation could not be stopped and one of these was ultimately discharged home with chronic ventilation in 1960, thus becoming the first patient in the Netherlands to be given mechanical ventilation at home. The mechanical ventilation centres developed into the intensive care units as we know them today. Most of the forms of treatment now in use are based on the techniques thought up and elaborated by the pioneers working in the mechanical ventilation centres. The latest development in this series is the development of centres for home mechanical ventilation.

  9. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis.

    PubMed

    Klompas, Michael; Speck, Kathleen; Howell, Michael D; Greene, Linda R; Berenholtz, Sean M

    2014-05-01

    Regular oral care with chlorhexidine gluconate is standard of care for patients receiving mechanical ventilation in most hospitals. This policy is predicated on meta-analyses suggesting decreased risk of ventilator-associated pneumonia, but these meta-analyses may be misleading because of lack of distinction between cardiac surgery and non-cardiac surgery studies, conflation of open-label vs double-blind investigations, and insufficient emphasis on patient-centered outcomes such as duration of mechanical ventilation, length of stay, and mortality. To evaluate the impact of routine oral care with chlorhexidine on patient-centered outcomes in patients receiving mechanical ventilation. PubMed, Embase, CINAHL, and Web of Science from inception until July 2013 without limits on date or language. Randomized clinical trials comparing chlorhexidine vs placebo in adults receiving mechanical ventilation. Of 171 unique citations, 16 studies including 3630 patients met inclusion criteria. Eligible trials were independently identified, evaluated for risk of bias, and extracted by 2 investigators. Differences were resolved by consensus. We stratified studies into cardiac surgery vs non-cardiac surgery and open-label vs double-blind investigations. Eligible studies were pooled using random-effects meta-analysis. Ventilator-associated pneumonia, mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay, antibiotic prescribing. There were fewer lower respiratory tract infections in cardiac surgery patients randomized to chlorhexidine (relative risk [RR], 0.56 [95% CI, 0.41-0.77]) but no significant difference in ventilator-associated pneumonia risk in double-blind studies of non-cardiac surgery patients (RR, 0.88 [95% CI, 0.66-1.16]). There was no significant mortality difference between chlorhexidine and placebo in cardiac surgery studies (RR, 0.88 [95% CI, 0.25-2.14]) and nonsignificantly increased mortality in non-cardiac surgery studies (RR

  10. Instituting a music listening intervention for critically ill patients receiving mechanical ventilation: Exemplars from two patient cases

    PubMed Central

    Heiderscheit, Annie; Chlan, Linda; Donley, Kim

    2011-01-01

    Music is an ideal intervention to reduce anxiety and promote relaxation in critically ill patients receiving mechanical ventilatory support. This article reviews the basis for a music listening intervention and describes two case examples with patients utilizing a music listening intervention to illustrate the implementation and use of the music listening protocol in this dynamic environment. The case examples illustrate the importance and necessity of engaging a music therapist in not only assessing the music preferences of patients, but also for implementing a music listening protocol to manage the varied and challenging needs of patients in the critical care setting. Additionally, the case examples presented in this paper demonstrate the wide array of music patients prefer and how the ease of a music listening protocol allows mechanically ventilated patients to engage in managing their own anxiety during this distressful experience. PMID:22081788

  11. Effect of home mechanical in-exsufflation on hospitalisation and life-style in neuromuscular disease: a pilot study.

    PubMed

    Moran, Fiona C E; Spittle, Alicia; Delany, Clare; Robertson, Colin F; Massie, John

    2013-03-01

    Mechanical in-exsufflation (MI-E) augments the weakened cough of patients with neuromuscular disease (NMD), clearing secretions and overcoming atelectasis. Little has been published on the impact of MI-E alone on rates of hospitalisation and quality of life (QOL). The aim of this study was to assess the impact of home MI-E on hospital admissions and life-style in children with NMD. A retrospective chart review was performed on children using MI-E, including data on the number of admissions to hospital, length of stay and hours of ventilation. A parental survey was used to gather information on the impact of MI-E on life-style for the child and family. Ten children with NMD (seven spinal muscular atrophy, two Duchenne muscular dystrophy and one centronuclear myopathy) using MI-E at home were identified. MI-E use commenced at mean age of 8.5 years (range 1.1-16.9) with 1.4 years of use (range 0.3-3.8). MI-E pressures ranged from +/-30 to 40 cmH2 O with no complications reported. There was a significant reduction in hospital days at 6 (P = 0.036) and 12 (P = 0.028) months following commencement of home MI-E compared with the same period preceding MI-E use. The survey highlighted positive benefits of MI-E use, in particular the ability to treat many pulmonary exacerbations at home. Home MI-E use by children with NMD can reduce hospitalisation and benefit families by maintaining their child at home. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  12. Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation

    PubMed Central

    Chuang, Ming-Lung; Chou, Yi-Ling; Lee, Chai-Yuan; Huang, Shih-Feng

    2017-01-01

    Abstract Background: Endotracheal intubation and prolonged immobilization of patients receiving mechanical ventilation may reduce expectoration function. High-frequency chest wall oscillation (HFCWO) may ameliorate airway secretion movement; however, the instantaneous changes in patients’ cardiopulmonary responses are unknown. Moreover, HFCWO may influence ventilator settings by the vigorous oscillation. The aim of this study was to investigate these issues. Methods: Seventy-three patients (52 men) aged 71.5 ± 13.4 years who were intubated with mechanical ventilation for pneumonic respiratory failure were recruited and randomly classified into 2 groups (HFCWO group, n = 36; and control group who received conventional chest physical therapy (CCPT, n = 37). HFCWO was applied with a fixed protocol, whereas CCPT was conducted using standard protocols. Both groups received sputum suction after the procedure. Changes in ventilator settings and the subjects’ responses were measured at preset intervals and compared within groups and between groups. Results: Oscillation did not affect the ventilator settings (all P > 0.05). The mean airway pressure, breathing frequency, and rapid shallow breathing index increased, and the tidal volume and SpO2 decreased (all P < 0.05). After sputum suction, the peak airway pressure (Ppeak) and minute ventilation decreased (all P < 0.05). The HFCWO group had a lower tidal volume and SpO2 at the end of oscillation, and lower Ppeak and tidal volume after sputum suction than the CCPT group. Conclusions: HFCWO affects breathing pattern and SpO2 but not ventilator settings, whereas CCPT maintains a steadier condition. After sputum suction, HFCWO slightly improved Ppeak compared to CCPT, suggesting that the study extends the indications of HFCWO for these patients in intensive care unit. (ClinicalTrials.gov number NCT02758106, retrospectively registered.) PMID:28248854

  13. Temporal disorganization of circadian rhythmicity and sleep-wake regulation in mechanically ventilated patients receiving continuous intravenous sedation.

    PubMed

    Gehlbach, Brian K; Chapotot, Florian; Leproult, Rachel; Whitmore, Harry; Poston, Jason; Pohlman, Mark; Miller, Annette; Pohlman, Anne S; Nedeltcheva, Arlet; Jacobsen, John H; Hall, Jesse B; Van Cauter, Eve

    2012-08-01

    Sleep is regulated by circadian and homeostatic processes and is highly organized temporally. Our study was designed to determine whether this organization is preserved in patients receiving mechanical ventilation (MV) and intravenous sedation. Observational study. Academic medical intensive care unit. Critically ill patients receiving MV and intravenous sedation. Continuous polysomnography (PSG) was initiated an average of 2.0 (1.0, 3.0) days after ICU admission and continued ≥ 36 h or until the patient was extubated. Sleep staging and power spectral analysis were performed using standard approaches. We also calculated the electroencephalography spectral edge frequency 95% SEF₉₅, a parameter that is normally higher during wakefulness than during sleep. Circadian rhythmicity was assessed in 16 subjects through the measurement of aMT6s in urine samples collected hourly for 24-48 hours. Light intensity at the head of the bed was measured continuously. We analyzed 819.7 h of PSG recordings from 21 subjects. REM sleep was identified in only 2/21 subjects. Slow wave activity lacked the normal diurnal and ultradian periodicity and homeostatic decline found in healthy adults. In nearly all patients, SEF₉₅ was consistently low without evidence of diurnal rhythmicity (median 6.3 [5.3, 7.8] Hz, n = 18). A circadian rhythm of aMT6s excretion was present in most (13/16, 81.3%) patients, but only 4 subjects had normal timing. Comparison of the SEF₉₅ during the melatonin-based biological night and day revealed no difference between the 2 periods (P = 0.64). The circadian rhythms and PSG of patients receiving mechanical ventilation and intravenous sedation exhibit pronounced temporal disorganization. The finding that most subjects exhibited preserved, but phase delayed, excretion of aMT6s suggests that the circadian pacemaker of such patients may be free-running.

  14. The effects of positive expiratory pressure on isovolume flow and dynamic hyperinflation in patients receiving mechanical ventilation.

    PubMed

    Gay, P C; Rodarte, J R; Hubmayr, R D

    1989-03-01

    The use of continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) has been advocated by some to assist in the weaning process of patients receiving mechanical ventilation for respiratory failure. The efficacy of this technique and its effect on respiratory system mechanics are not well understood. The theoretical advantage of CPAP or PEEP during the weaning process can be obliterated if excessive dynamic hyperinflation is induced. A key determinant of the individual response to this proposed weaning technique is the recognition of the presence or absence of expiratory flow limitation. We studied the effect of progressively increased levels of applied PEEP on isovolume expiratory flow and end-expiratory lung volume in seven patients during controlled mechanical ventilation. In the absence of expiratory flow limitation, passive expiratory flow decreased and end-expiratory lung volume increased when any level of PEEP was applied. In contrast, flow-limited patients did not demonstrate a change in isovolume expiratory flow or end-expiratory lung volume until the applied PEEP reduced the driving pressure for expiratory flow below a critical value. All patients demonstrated dynamic hyperinflation during controlled ventilation as evident by the existence of intrinsic PEEP. The nominal value of applied PEEP that caused a reduction in isovolume expiratory flow was unrelated to the initial level of intrinsic PEEP. The clinical implications of these findings with respect to CPAP therapy during weaning from mechanical ventilation are discussed.

  15. Asymptomatic urinary tract infection among pregnant women receiving ante-natal care in a traditional birth home in Benin City, Nigeria.

    PubMed

    Oladeinde, Bankole H; Omoregie, Richard; Oladeinde, Oladapo B

    2015-01-01

    A good proportion of pregnant women patronize traditional birth homes in Nigeria for ante-natal care. This study aimed at determining the prevalence, risk factors, and susceptibility profile of etiologic agents of urinary tract infection among ante-natal attendees in a traditional birth home in Benin City, Nigeria. Clean-catch urine was collected from 220 pregnant women attending a traditional birth home in Benin City, Nigeria. Urine samples were processed, and microbial isolates identified using standard bacteriological procedures. A cross-sectional study design was used. The prevalence of urinary tract infection among pregnant women was 55.0%, significantly affected by parity and gestational age (P<0.05). Mixed infection was recorded among 13(10.7%) pregnant women, and was unaffected by maternal age, parity, gravidity, gestational age, and educational status. Irrespective of trimester Escherichia coli was the most prevalent etiologic agent of urinary tract infection, followed by Staphylococcus aureus. The flouroquinolones were the most effective antibacterial agents, while Sulphamethoxazole-trimetoprim, Amoxicillin, Nalidixic acid, and Nitrofurantoin had poor activity against uropathogens isolated. The prevalence of urinary tract infection among pregnant women was 55.0% and significantly affected by gestational age and parity. The most prevalent etiologic agent observed was Escherichia coli. With the exception of the flouroquinolones, aminoglycoside, and Amoxicillin-cluvanate, the activity of other antibiotics used on uropathogens were poor. Health education of the traditional birth attendant and her clients by relevant intervention agencies is strongly advocated.

  16. A randomised controlled trial of an automated oxygen delivery algorithm for preterm neonates receiving supplemental oxygen without mechanical ventilation

    PubMed Central

    Zapata, James; Gómez, John Jairo; Araque Campo, Robinson; Matiz Rubio, Alejandro; Sola, Augusto

    2014-01-01

    Aim Providing consistent levels of oxygen saturation (SpO2) for infants in neonatal intensive care units is not easy. This study explored how effectively the Auto-Mixer® algorithm automatically adjusted fraction of inspired oxygen (FiO2) levels to maintain SpO2 within an intended range in extremely low birth weight infants receiving supplemental oxygen without mechanical ventilation. Methods Twenty extremely low birth weight infants were randomly assigned to the Auto-Mixer® group or the manual intervention group and studied for 12 h. The SpO2 target was 85–93%, and the outcomes were the percentage of time SpO2 was within target, SpO2 variability, SpO2 >95%, oxygen received and manual interventions. Results The percentage of time within intended SpO2 was 58 ± 4% in the Auto-Mixer® group and 33.7 ± 4.7% in the manual group, SpO2 >95% was 26.5% vs 54.8%, average SpO2 and FiO2 were 89.8% vs 92.2% and 37% vs 44.1%, and manual interventions were 0 vs 80 (p < 0.05). Brief periods of SpO2 < 85% occurred more frequently in the Auto-Mixer® group. Conclusion The Auto-Mixer® effectively increased the percentage of time that SpO2 was within the intended target range and decreased the time with high SpO2 in spontaneously breathing extremely low birth weight infants receiving supplemental oxygen. PMID:24813808

  17. Can the Accuracy of Home Blood Glucose Monitors be affected by the Received Signal Strength of 900 MHz GSM Mobile Phones?

    PubMed Central

    Eslami, J.; Ghafaripour, F.; Mortazavi, S.A.R.; Mortazavi, S.M.J.; Shojaei-fard, M.B.

    2015-01-01

    Background People who use home blood glucose monitors may use their mobile phones in the close vicinity of medical devices. This study is aimed at investigating the effect of the signal strength of 900 MHz GSM mobile phones on the accuracy of home blood glucose monitors. Methods Sixty non-diabetic volunteer individuals aged 21 - 28 years participated in this study. Blood samples were analyzed for glucose level by using a common blood glucose monitoring system. Each blood sample was analyzed twice, within ten minutes in presence and absence of electromagnetic fields generated by a common GSM mobile phone during ringing. Blood samples were divided into 3 groups of 20 samples each. Group 1: exposure to mobile phone radiation with weak signal strength. Group2: exposure to mobile phone radiation with strong signal strength. Group3: exposure to a switched–on mobile phone with no signal strength. Results The magnitude of the changes in the first, second and third group between glucose levels of two measurements (׀ΔC׀) were 7.4±3.9 mg/dl, 10.2±4.5 mg/dl, 8.7±8.4 mg/dl respectively. The difference in the magnitude of the changes between the 1st and the 3rd groups was not statistically significant. Furthermore, the difference in the magnitude of the changes between the 2nd and the 3rd groups was not statistically significant. Conclusion Findings of this study showed that the signal strength of 900 MHz GSM mobile phones cannot play a significant role in changing the accuracy of home blood glucose monitors. PMID:26688798

  18. Auditory mechanics in a bush-cricket: direct evidence of dual sound inputs in the pressure difference receiver

    PubMed Central

    Montealegre-Z, Fernando; Soulsbury, Carl D.; Robson Brown, Kate A.; Robert, Daniel

    2016-01-01

    The ear of the bush-cricket, Copiphora gorgonensis, consists of a system of paired eardrums (tympana) on each foreleg. In these insects, the ear is backed by an air-filled tube, the acoustic trachea (AT), which transfers sound from the prothoracic acoustic spiracle to the internal side of the eardrums. Both surfaces of the eardrums of this auditory system are exposed to sound, making it a directionally sensitive pressure difference receiver. A key feature of the AT is its capacity to reduce the velocity of sound propagation and alter the acoustic driving forces at the tympanum. The mechanism responsible for reduction in sound velocity in the AT remains elusive, yet it is deemed to depend on adiabatic or isothermal conditions. To investigate the biophysics of such multiple input ears, we used micro-scanning laser Doppler vibrometry and micro-computed X-ray tomography. We measured the velocity of sound propagation in the AT, the transmission gains across auditory frequencies and the time-resolved mechanical dynamics of the tympanal membranes in C. gorgonensis. Tracheal sound transmission generates a gain of approximately 15 dB SPL, and a propagation velocity of ca 255 m s−1, an approximately 25% reduction from free field propagation. Modelling tracheal acoustic behaviour that accounts for thermal and viscous effects, we conclude that reduction in sound velocity within the AT can be explained, among others, by heat exchange between the sound wave and the tracheal walls. PMID:27683000

  19. Auditory mechanics in a bush-cricket: direct evidence of dual sound inputs in the pressure difference receiver.

    PubMed

    Jonsson, Thorin; Montealegre-Z, Fernando; Soulsbury, Carl D; Robson Brown, Kate A; Robert, Daniel

    2016-09-01

    The ear of the bush-cricket, Copiphora gorgonensis, consists of a system of paired eardrums (tympana) on each foreleg. In these insects, the ear is backed by an air-filled tube, the acoustic trachea (AT), which transfers sound from the prothoracic acoustic spiracle to the internal side of the eardrums. Both surfaces of the eardrums of this auditory system are exposed to sound, making it a directionally sensitive pressure difference receiver. A key feature of the AT is its capacity to reduce the velocity of sound propagation and alter the acoustic driving forces at the tympanum. The mechanism responsible for reduction in sound velocity in the AT remains elusive, yet it is deemed to depend on adiabatic or isothermal conditions. To investigate the biophysics of such multiple input ears, we used micro-scanning laser Doppler vibrometry and micro-computed X-ray tomography. We measured the velocity of sound propagation in the AT, the transmission gains across auditory frequencies and the time-resolved mechanical dynamics of the tympanal membranes in C. gorgonensis Tracheal sound transmission generates a gain of approximately 15 dB SPL, and a propagation velocity of ca 255 m s(-1), an approximately 25% reduction from free field propagation. Modelling tracheal acoustic behaviour that accounts for thermal and viscous effects, we conclude that reduction in sound velocity within the AT can be explained, among others, by heat exchange between the sound wave and the tracheal walls.

  20. What Is Home Schooling?

    ERIC Educational Resources Information Center

    Ohio State Legislative Office of Education Oversight, Columbus.

    The Ohio Department of Education estimates that 15,000 children were being home-schooled in Ohio, based on a 1991 survey of school superintendents. This document presents an overview of home schooling and describes the nature and extent of home schooling in Ohio. Data are based on a review of literature, information received from national and…

  1. Investigation of three home-applied bleaching agents on enamel structure and mechanical properties: an in situ study

    NASA Astrophysics Data System (ADS)

    Sa, Yue; Wang, Zhejun; Ma, Xiao; Lei, Chang; Liang, Shanshan; Sun, Lili; Jiang, Tao; Wang, Yining

    2012-03-01

    The safety of at-home tooth bleaching, based upon carbamide peroxide (CP) or hydrogen peroxide (HP) as the active agent, has been questioned. The aim of the present study was to investigate the effects of three differently concentrated home-applied bleaching agents on human enamel under in situ conditions. Sixty specimens were divided randomly into four groups and treated with 10% CP, 15% CP, 20% CP, and distilled water, respectively. Raman spectroscopy, attenuated total reflectance-infrared (ATR-IR) spectroscopy, atomic force microscopy (AFM), microhardness, and fracture toughness (FT) measurements were conducted to determine variations on enamel structure and mechanical properties before and after the bleaching process. Raman revealed little variation of Raman relative intensity after treatment with CP, which was consistent with the results of ATR-IR, AFM, and microhardness analyses. In addition, laser-induced fluorescence (LIF) intensity, and FT showed significant decreases on CP-treated specimens. These findings suggested there were minimal demineralization effects of the three at-home bleaching agents on enamel in situ. However, the decrease of LIF intensity and FT on enamel seemed to be inevitable.

  2. Electronic and mechanical improvement of the receiving terminal of a free-space microwave power transmission system

    NASA Technical Reports Server (NTRS)

    Brown, W. C.

    1977-01-01

    Significant advancements were made in a number of areas: improved efficiency of basic receiving element at low power density levels, improved resolution and confidence in efficiency measurements mathematical modelling and computer simulation of the receiving element and the design, construction, and testing of an environmentally protected two-plane construction suitable for low cost, highly automated construction of large receiving arrays.

  3. Wearable interrupter module for home-based applications in a telemedical system dedicated to respiratory mechanics measurements.

    PubMed

    Jabłoński, Ireneusz

    2011-03-01

    The mobile interrupter module, dedicated to the enhanced interrupter (EIT) measurement of respiratory mechanics in a home environment and capable of cooperation with a telemedical system, is presented. Characterized by noninvasiveness and minimal requirements regarding patient cooperation, the EIT algorithm is especially suitable for newborns, preschool children, and patients suffering from respiratory muscle impairment. Furthermore, this device enables access to raw data--without initial preprocessing--in a fully flexible measurement protocol (which is not available in any commercial apparatus), and the EIT procedure improves insight (the number and precision of assessed parameters) into the physiological system with respect to the classical occlusive methods.

  4. Acquired Genetic Mechanisms of a Multiresistant Bacterium Isolated from a Treatment Plant Receiving Wastewater from Antibiotic Production

    PubMed Central

    Johnning, Anna; Moore, Edward R. B.; Svensson-Stadler, Liselott; Shouche, Yogesh S.; Larsson, D. G. Joakim

    2013-01-01

    The external environment, particularly wastewater treatment plants (WWTPs), where environmental bacteria meet human commensals and pathogens in large numbers, has been highlighted as a potential breeding ground for antibiotic resistance. We have isolated the extensively drug-resistant Ochrobactrum intermedium CCUG 57381 from an Indian WWTP receiving industrial wastewater from pharmaceutical production contaminated with high levels of quinolones. Antibiotic susceptibility testing against 47 antibiotics showed that the strain was 4 to >500 times more resistant to sulfonamides, quinolones, tetracyclines, macrolides, and the aminoglycoside streptomycin than the type strain O. intermedium LMG 3301T. Whole-genome sequencing identified mutations in the Indian strain causing amino acid substitutions in the target enzymes of quinolones. We also characterized three acquired regions containing resistance genes to sulfonamides (sul1), tetracyclines [tet(G) and tetR], and chloramphenicol/florfenicol (floR). Furthermore, the Indian strain harbored acquired mechanisms for horizontal gene transfer, including a type I mating pair-forming system (MPFI), a MOBP relaxase, and insertion sequence transposons. Our results highlight that WWTPs serving antibiotic manufacturing may provide nearly ideal conditions for the recruitment of resistance genes into human commensal and pathogenic bacteria. PMID:24038701

  5. Acquired genetic mechanisms of a multiresistant bacterium isolated from a treatment plant receiving wastewater from antibiotic production.

    PubMed

    Johnning, Anna; Moore, Edward R B; Svensson-Stadler, Liselott; Shouche, Yogesh S; Larsson, D G Joakim; Kristiansson, Erik

    2013-12-01

    The external environment, particularly wastewater treatment plants (WWTPs), where environmental bacteria meet human commensals and pathogens in large numbers, has been highlighted as a potential breeding ground for antibiotic resistance. We have isolated the extensively drug-resistant Ochrobactrum intermedium CCUG 57381 from an Indian WWTP receiving industrial wastewater from pharmaceutical production contaminated with high levels of quinolones. Antibiotic susceptibility testing against 47 antibiotics showed that the strain was 4 to >500 times more resistant to sulfonamides, quinolones, tetracyclines, macrolides, and the aminoglycoside streptomycin than the type strain O. intermedium LMG 3301T. Whole-genome sequencing identified mutations in the Indian strain causing amino acid substitutions in the target enzymes of quinolones. We also characterized three acquired regions containing resistance genes to sulfonamides (sul1), tetracyclines [tet(G) and tetR], and chloramphenicol/florfenicol (floR). Furthermore, the Indian strain harbored acquired mechanisms for horizontal gene transfer, including a type I mating pair-forming system (MPFI), a MOBP relaxase, and insertion sequence transposons. Our results highlight that WWTPs serving antibiotic manufacturing may provide nearly ideal conditions for the recruitment of resistance genes into human commensal and pathogenic bacteria.

  6. Home Mechanical Ventilation in Childhood-Onset Hereditary Neuromuscular Diseases: 13 Years’ Experience at a Single Center in Korea

    PubMed Central

    Han, Young Joo; Park, June Dong; Lee, Bongjin; Choi, Yu Hyeon; Suh, Dong In; Lim, Byung Chan; Chae, Jong-Hee

    2015-01-01

    Introduction Children with hereditary neuromuscular diseases (NMDs) are at a high risk of morbidity and mortality related to respiratory failure. The use of home mechanical ventilation (HMV) has saved the lives of many children with NMD but, due to a lack of studies, dependable guidelines are not available. We drew upon our experience to compare the various underlying NMDs and to evaluate HMV with regard to respiratory morbidity, the proper indications and timing for its use, and to develop a policy to improve the quality of home noninvasive ventilation (NIV). Methods We retrospectively analyzed the medical records of 57 children with childhood-onset hereditary NMDs in whom HMV was initiated between January 2000 and May 2013 at Seoul National University Children's Hospital. The degree of respiratory morbidity was estimated by the frequency and duration of hospitalizations caused by respiratory distress. Results The most common NMD was spinal muscular atrophy (SMA, n = 33). Emergent mechanical ventilation was initiated in 44% of the patients before the confirmed diagnosis, and the indicators of pre-HMV respiratory morbidity (e.g., extubation trials, hypoxia, hospitalizations, and intensive care unit stay) were greater in these patients than in others. The proportion of post-HMV hospitalizations (range, 0.00−0.52; median, 0.01) was lower than that of pre-HMV hospitalizations (0.02−1.00; 0.99) (P < 0.001). Eight patients were able to maintain home NIV. The main causes of NIV failure were air leakage and a large amount of airway secretions. Conclusions The application of HMV helped reduce respiratory morbidity in children with childhood-onset hereditary NMD. Patients with SMA type I can benefit from an early diagnosis and the timely application of HMV. The choice between invasive and noninvasive HMV should be based on the patient’s age and NIV trial tolerance. Systematic follow-up guidelines provided by a multidisciplinary team are needed. PMID:25822836

  7. Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial.

    PubMed

    Jacobsen, Paul B; Phillips, Kristin M; Jim, Heather S L; Small, Brent J; Faul, Leigh Anne; Meade, Cathy D; Thompson, Lora; Williams, Charles C; Loftus, Loretta S; Fishman, Mayer; Wilson, Rick W

    2013-06-01

    Research has shown that self-directed stress management training improves mental well-being in patients undergoing chemotherapy. The present study extends this work by evaluating separate and combined effects of stress management training and home-based exercise. Following assessment of mental and physical well-being, depression, anxiety, exercise, and stress reduction activity before chemotherapy started, patients were randomized to stress management training (SM), exercise (EX), combined stress management and exercise (SMEX), or usual care only (UCO). Outcomes were reassessed 6 and 12 weeks after chemotherapy started. Significance testing of group-by-time interactions in 286 patients who completed all assessments was used to evaluate intervention efficacy. Interaction effects for mental and physical well-being scores were not significant. Depression scores yielded a linear interaction comparing UCO and SMEX (p = 0.019), with decreases in SMEX but not UCO. Anxiety scores yielded a quadratic interaction comparing UCO and SMEX (p = 0.049), with trends for changes in SMEX but not UCO. Additional analyses yielded quadratic interactions for exercise activity comparing UCO and SMEX (p = 0.022), with positive changes in SMEX but not UCO, and for stress management activity comparing UCO and SM (p < 0.001) and UCO and SMEX (p = 0.013), with positive changes in SM and SMEX but not UCO. Only the combined intervention yielded effects on quality of life outcomes, and these were limited to anxiety and depression. These findings are consistent with evidence that only the combined intervention yielded increases in both exercise and stress management activity. Future research should investigate ways to augment this intervention to enhance its benefits. Copyright © 2012 John Wiley & Sons, Ltd.

  8. [Effect of increasing protein ingestion on the nitrogen balance of mechanically ventilated critically ill patients receiving total parenteral nutrition].

    PubMed

    van der Heijden, A; Verbeek, M J; Schreurs, V V; Akkermans, L M; Vos, A

    1993-01-01

    The amount of protein recommended to minimise N loss in critically ill patients receiving total parenteral nutrition (TPN) varies in the literature. Therefore, we studied the effect of increased protein intake on the N balance, administering TPN with either 1.2 g protein/kg/day (low N diet) or 1.8 g protein/kg/day (high N diet). Fifteen mechanically ventilated critically ill patients were studied in a surgical intensive care unit. After at least two days of standard TPN, patients were randomly assigned to either the low or the high N diet. Ten patients were studied on the low N diet and 11 on the high N diet; 6 patients were studied on both diets. Nonprotein energy was supplied according to estimated energy requirements. For five consecutive days, the N balance was measured daily. Total urinary nitrogen (TUN) was analysed using the Kjeldahl method. There was no difference in N balance between the groups. On the low N diet, N balance was -0.113 +/- 0.088 and on the high N diet -0.113 +/- 0.109 g N/kg/day. In patients studied twice, N balance was -0.087 +/- 0.054 and -0.050 +/- 0.060 g N/kd/day respectively. Results of a previous pilot study showed that in 20 similar patients the N balance became 80% less negative (from -5.7 +/- 5.1 to -1.1 +/- 8.2 g N/day) when protein intake was increased from 0.9 to 1.5 g/kg/day. Since these results are consistent with other studies, we conclude that the optimal range of protein supply in this type of critically ill patients is approximately 1.1-1.5 g protein/kg/day.

  9. Mechanical Designs and Developement of Advanced ACT: A Transfomative Upgrade to the ACTPol Receiver on the Atacama Cosmology Telescope.

    NASA Astrophysics Data System (ADS)

    Ward, Jonathan; Advanced ACT Collaboration, NASA Space Technology Research Fellowship

    2017-06-01

    The Atacama Cosmology Telescope is a six-meter diameter telescope located at 17,000 feet (5,200 meters) on Cerro Toco in the Andes Mountains of northern Chile. The next generation Advanced ACT (AdvACT) experiment is currently underway and will consist of three multichroic TES bolometer arrays operating together, totaling 5800 detectors on the sky. Each array will be sensitive to two frequency bands: a high frequency (HF) array at 150 and 230 GHz, two middle frequency (MF) arrays at 90 and 150 GHz, and a low frequency (LF) array at 28 and 41 GHz. The AdACT detector arrays will feature a revamped design when compared to ACTPol, including a transition to 150mm wafers equipped with multichroic pixels, allowing for a more densely packed focal plane. Each set of detectors consists of a feedhorn array of stacked silicon wafers which form a corrugated profile leading to each pixel. This is then followed by a four-piece detector stack assembly of silicon wafers which includes a waveguide interface plate, detector wafer, backshort cavity plate, and backshort cap. Each array is housed in a custom designed structure manufactured out of gold-plated, high purity copper. In addition to the detector array assembly, the array package also encloses the majority of our readout electronics. We present the full mechanical design of the AdvACT HF and MF detector array packages along with a detailed look at the detector array assemblies. We also highlight the use of continuously rotating warm half-wave plates (HWPs) at the front of the AdvACT receiver. We review the design of the rotation system and also early pipeline data analysis results. This experiment will also make use of extensive hardware and software previously developed for ACT, which will be modified to incorporate the new AdvACT instruments. Therefore, we discuss the integration of all AdvACT instruments with pre-existing ACTPol infrastructure.

  10. Effect of dynamic random leaks on the monitoring accuracy of home mechanical ventilators: a bench study

    PubMed Central

    2013-01-01

    Background So far, the accuracy of tidal volume (VT) and leak measures provided by the built-in software of commercial home ventilators has only been tested using bench linear models with fixed calibrated and continuous leaks. The objective was to assess the reliability of the estimation of tidal volume (VT) and unintentional leaks in a single tubing bench model which introduces random dynamic leaks during inspiratory or expiratory phases. Methods The built-in software of four commercial home ventilators and a fifth ventilator-independent ad hoc designed external software tool were tested with two levels of leaks and two different models with excess leaks (inspiration or expiration). The external software analyzed separately the inspiratory and expiratory unintentional leaks. Results In basal condition, all ventilators but one underestimated tidal volume with values ranging between -1.5 ± 3.3% to -8.7% ± 3.27%. In the model with excess of inspiratory leaks, VT was overestimated by all four commercial software tools, with values ranging from 18.27 ± 7.05% to 35.92 ± 17.7%, whereas the ventilator independent-software gave a smaller difference (3.03 ± 2.6%). Leaks were underestimated by two applications with values of -11.47 ± 6.32 and -5.9 ± 0.52 L/min. With expiratory leaks, VT was overestimated by the software of one ventilator and the ventilator-independent software and significantly underestimated by the other three, with deviations ranging from +10.94 ± 7.1 to -48 ± 23.08%. The four commercial tools tested overestimated unintentional leaks, with values between 2.19 ± 0.85 to 3.08 ± 0.43 L/min. Conclusions In a bench model, the presence of unintentional random leaks may be a source of error in the measurement of VT and leaks provided by the software of home ventilators. Analyzing leaks during inspiration and expiration separately may reduce this source of error. PMID:24325396

  11. Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities.

    PubMed

    Turcotte, Pier-Luc; Larivière, Nadine; Desrosiers, Johanne; Voyer, Philippe; Champoux, Nathalie; Carbonneau, Hélène; Carrier, Annie; Levasseur, Mélanie

    2015-08-01

    Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers. A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods. Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility. This study

  12. R&D 100, 2016: T-Quake – Quantum-Mechanical Transmitter/Receiver Microchip

    ScienceCinema

    Tauke-Pedretti, Anna; Camacho, Ryan; Thayer, Gayle

    2016-12-14

    Applying advanced microfabrication techniques and innovative microdesign, the Sandia Enabled Communications and Authentication Network (SECANT) team has designed and produced photonic microchips capable of sending, receiving, and processing quantum signals for applications in cyber and physical security.

  13. Evidence for geomagnetic imprinting as a homing mechanism in Pacific salmon.

    PubMed

    Putman, Nathan F; Lohmann, Kenneth J; Putman, Emily M; Quinn, Thomas P; Klimley, A Peter; Noakes, David L G

    2013-02-18

    In the final phase of their spawning migration, Pacific salmon use chemical cues to identify their home river, but how they navigate from the open ocean to the correct coastal area has remained enigmatic. To test the hypothesis that salmon imprint on the magnetic field that exists where they first enter the sea and later seek the same field upon return, we analyzed a 56-year fisheries data set on Fraser River sockeye salmon, which must detour around Vancouver Island to approach the river through either a northern or southern passageway. We found that the proportion of salmon using each route was predicted by geomagnetic field drift: the more the field at a passage entrance diverged from the field at the river mouth, the fewer fish used the passage. We also found that more fish used the northern passage in years with warmer sea surface temperature (presumably because fish were constrained to more northern latitudes). Field drift accounted for 16% of the variation in migratory route used, temperature 22%, and the interaction between these variables 28%. These results provide the first empirical evidence of geomagnetic imprinting in any species and imply that forecasting salmon movements is possible using geomagnetic models. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Evaluation of a problem-solving (PS) techniques-based intervention for informal carers of patients with dementia receiving in-home care.

    PubMed

    Chiu, Mary; Pauley, Tim; Wesson, Virginia; Pushpakumar, Dunstan; Sadavoy, Joel

    2015-06-01

    The value of care provided by informal carers in Canada is estimated at $26 billion annually (Hollander et al., 2009). However, carers' needs are often overlooked, limiting their capacity to provide care. Problem-solving therapy (PST), a structured approach to problem solving (PS) and a core principle of the Reitman Centre CARERS Program, has been shown to alleviate emotional distress and improve carers' competence (Chiu et al., 2013). This study evaluated the effectiveness of problem-solving techniques-based intervention based on adapted PST methods, in enhancing carers' physical and emotional capacity to care for relatives with dementia living in the community. 56 carers were equally allocated to a problem-solving techniques-based intervention group or a control arm. Carers in the intervention group received three 1 hr visits by a care coordinator (CC) who had been given advanced training in PS techniques-based intervention. Coping, mastery, competence, burden, and perceived stress of the carers were evaluated at baseline and post-intervention using standardized assessment tools. An intention-to-treat analysis utilizing repeated measures ANOVA was performed on the data. Post-intervention measures completion rate was 82% and 92% for the intervention and control groups, respectively. Carers in the intervention group showed significantly improved task-oriented coping, mastery, and competence and significantly reduced emotion-oriented coping, burden and stress (p < 0.01-0.001). Control carers showed no change. PS techniques, when learned and delivered by CCs as a tool to coach carers in their day-to-day caregiving, improves carers' caregiving competence, coping, burden, and perceived stress. This may reduce dependence on primary, psychiatric, and institutional care. Results provide evidence that establishing effective partnerships between inter-professional clinicians in academic clinical health science centers, and community agencies can extend the reach of the

  15. Being the lifeline: the parent experience of caring for a child with neuromuscular disease on home mechanical ventilation.

    PubMed

    Mah, Jean K; Thannhauser, Jennifer E; McNeil, Deborah A; Dewey, Deborah

    2008-12-01

    We describe the experience of parents caring for children with neuromuscular disease (NMD) on home mechanical ventilation (HMV). Data was obtained from semi-structured interviews and analyzed using a phenomenological framework. Fifteen families including 19 parents of children with DMD (n=3), SMA (n=5), and other NMD (n=7) participated. The central theme of these parents' experience was being the "lifeline" for their child's life and quality of life. The families' lives changed significantly with the decision to place their child on HMV; over time, these changes became part of their new "normal". Despite becoming expert caregivers, the parents experienced a recurrent sense of loss and uncertainty. Those who perceived insufficient support felt the weight of responsibility as sole care providers for their child with NMD. Beyond recognizing the parents as experts, more support by health care professionals, their extended family, and their community are needed to enable parents to fulfill their vital role.

  16. CALUTRON RECEIVER

    DOEpatents

    Barnes, S.W.

    1959-06-16

    An improved receiver and receiver mount for calutrons are described. The receiver can be manipulated from outside the tank by a single control to position it with respect to the beam. A door can be operated exteriorly also to prevent undesired portions of the beam from entering the receiver. The receiver has an improved pocket which is more selective in the ions collected. (T.R.H.)

  17. Modest reduction in risk for ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation following topical oral chlorhexidine.

    PubMed

    Scannapieco, Frank A; Binkley, Catherine J

    2012-09-01

    The sample (N = 547) included patients older than 18 years (328 men and 219 women from a total population of 10,913) admitted to 3 intensive care units (ICUs) (medical, surgical/trauma, and neuroscience) at Virginia Commonwealth University Medical Center. The sample size required to detect an interaction (ie, the effect of chlorhexidine and toothbrushing in combination) was determined to be larger than that required to detect main effects (ie, chlorhexidine alone or toothbrushing alone) for a test at a given level of significance. The study was designed to detect an interactive effect resulting in a 0.755 difference in mean Clinical Pulmonary Infection Score (CPIS) at a power of 80% and a significance level of .05. An interim analysis was done and a Bonferroni adjustment was used to avoid inflation in the overall significance level related to interim analyses; for this reason, the level of significance for final analysis was .025. This was a randomized controlled clinical trial with a 2 × 2 factorial design. Patients were randomized to treatment within each ICU according to a permuted block design developed by the biostatistician before the start of the study. Staff who performed interventions (oral care) had no knowledge of patients' CPIS. Patients receiving mechanical ventilation were enrolled within 24 hours of intubation and were followed for up to 14 days. Dates of recruitment were not disclosed. Lung infection, resulting from aspiration of potential bacterial pathogens, such as Staphylococcus aureus, Streptococcus pneumoniae, or gram-negative rods that first colonize the oral cavity and oropharynx. Oral topical 0.12 % chlorhexidine gluconate, toothbrushing, or both (applied 4 times per day) were tested to determine their impact, if any, on incidence of lung infection in this cohort. The CPIS was assessed as the primary outcome variable. This score consists of the sum of points assigned to 6 clinical and laboratory variables (yielding a score from 0 to 12

  18. CALUTRON RECEIVER

    DOEpatents

    Brunk, W.O.

    1959-09-29

    A description is given for an improved calutron receiver having a face plate lying at an angle to the direction of the entering ion beams but having an opening, the plane of which is substantially perpendicular to that of the entering ion beams. By so positioning the opening in the receiver, the effective area through which the desired material may enter the receiver is increased, and at the same time the effective area through which containattng material may enter the receiver is reduced.

  19. Facilitation of ultrasonic microvesicles on homing and molecular mechanism of bone marrow mesenchymal stem cells in cerebral infarction patients.

    PubMed

    Chang, F; Xiong, W; Wang, D; Liu, X-Z; Zhang, W; Zhang, M; Jing, P

    2017-10-01

    Cerebral infarction, or ischemia brain stroke, is a common cerebrovascular disease. Bone marrow mesenchymal stem cells (BMSCs) are widely used to treating ischemia disease such as cardiac infarction. Ultrasonic microvesicles may help the targeting of exogenous factors via localized energy blast. Therefore, this study aims to investigate the effect of ultrasonic microvesicles on the homing of BMSCs on artery thrombosis and the associated molecular mechanisms. Rat BMSCs were isolated and cultured. Rats were divided into sham, model, BMSCs, and microvesicles groups. Cerebral infarction model was prepared by ligation of cervical artery and middle cerebral artery. 3×106/kg BMSCs were transplanted via tail veins. Microvesicles were used for assisting BMSCs infusion. Sex-determining region Y (SRY) gene expression was measured by Real-time PCR, while 2,3,5-triphenyltetrazolium chloride (TTC) staining was employed for describing the area of cerebral infarction. The activity of caspase 3 was assayed by test kit. Vascular endothelial growth factor (VEGF), nuclear factor kappa B (NF-κB) mRNA/protein levels, were quantified by Real-time PCR, and Western blotting, respectively. Microvesicle group had significantly elevated SRY expression (p<0.05 compared to BMSCs group). Transplantation of BMSCs remarkably decreased cerebral infarction area, caspase 3 activity or NF-κB expression, and increased VEGF expression (p<0.05 compared to model group). Microvesicle induced BMSCs had more potent effects (p<0.01). Ultrasound microvesicle facilitated homing of BMSCs in cerebral infarction, and improved infarction disease via up-regulating VEGF expression, inhibiting NF-κB expression, and modulating apoptosis.

  20. CALUTRON RECEIVER

    DOEpatents

    York, H.F.

    1959-07-01

    A receiver construction is presented for calutrons having two or more ion sources and an individual receiver unit for each source. Design requirements dictate that the face plate defining the receiver entrance slots be placed at an angle to the approaching beam, which means that ions striking the face plate are likely to be scattcred into the entrance slots of other receivers. According to the present invention, the face plate has a surface provided with parallel ridges so disposed that one side only of each ridge's exposed directly to the ion beam. The scattered ions are directed away from adjacent receivers by the ridges on the lace plate.

  1. Use of mechanical airway clearance devices in the home by people with neuromuscular disorders: effects on health service use and lifestyle benefits.

    PubMed

    Mahede, Trinity; Davis, Geoff; Rutkay, April; Baxendale, Sarah; Sun, Wenxing; Dawkins, Hugh J S; Molster, Caron; Graham, Caroline E

    2015-05-06

    People with neuromuscular disorders (NMD) exhibit weak coughs and are susceptible to recurrent chest infections and acute respiratory complications, the most frequent reasons for their unplanned hospital admissions. Mechanical insufflation-exsufflation (MI-E) devices are a non-invasive method of increasing peak cough flow, improving cough efficacy, the clearance of secretion and overcoming atelectasis. There is limited published evidence on the impact of home use MI-E devices on health service utilisation. The aims of the study were: to assess the self-reported health and lifestyle benefits experienced as a result of home use of MI-E devices; and evaluate the effects of in-home use of MI-E devices on Emergency Department (ED) presentations, hospital admissions and inpatient length of stay (LOS). Individuals with NMD who were accessing a home MI-E device provided through Muscular Dystrophy Western Australia were invited to participate in a quantitative survey to obtain information on their experiences and self-assessed changes in respiratory health. An ad-hoc record linkage was performed to extract hospital, ED and mortality data from the Western Australian Department of Health (DOHWA). The main outcome measures were ED presentations, hospital separations and LOS, before and after commencement of home use of an MI-E device. Thirty seven individuals with NMD using a MI-E device at home consented to participate in this study. The majority (73%) of participants reported using the MI-E device daily or weekly at home without medical assistance and 32% had used the machine to resolve a choking episode. The survey highlighted benefits to respiratory function maintenance and the ability to manage increased health care needs at home. Not using a home MI-E device was associated with an increased risk of ED presentations (RR = 1.76, 95% CI 1.1-2.84). The number of hospital separations and LOS reduced after the use of MI-E device, but not significantly. No deaths were

  2. CALUTRON RECEIVERS

    DOEpatents

    Schmidt, F.H.; Stone, K.F.

    1958-09-01

    S>This patent relates to improvements in calutron devices and, more specifically, describes a receiver fer collecting the ion curreot after it is formed into a beam of non-homogeneous isotropic cross-section. The invention embodies a calutron receiver having an ion receiving pocket for separately collecting and retaining ions traveling in a selected portion of the ion beam and anelectrode for intercepting ions traveling in another selected pontion of the ion beam. The electrode is disposed so as to fix the limit of one side of the pontion of the ion beam admitted iato the ion receiving pocket.

  3. Mechanism of Developmental Change in the PLAY Project Home Consultation Program: Evidence from a Randomized Control Trial.

    PubMed

    Mahoney, Gerald; Solomon, Richard

    2016-05-01

    This investigation is a secondary analysis of data from a randomized control trial of the PLAY Home Consultation Intervention Program which was conducted with 112 preschool children with Autism Spectrum Disorders and their parents (Solomon et al. in J Dev Behav Pediatr 35:475-485, 2014). Subjects were randomly assigned to either a community standard (CS) treatment group or to the PLAY Project plus CS Treatment (PLAY). PLAY subjects received monthly parent-child intervention sessions for 1 year during which parents learned how to use the rationale and interactive strategies of the Developmental, Individual-differences, Relationship-based (DIR) intervention model (Greenspan and Weider in The child with special needs: encouraging intellectual and emotional growth. DeCapo Press, Cambridge, MA, 1998) to engage in more responsive, affective and less directive interactions with their children. This investigation examined whether PLAY intervention effects on parents' style of interacting with their children as well as on children's social engagement mediated the effects of PLAY on children's autism severity as measured by ADOS calibrated severity scores. Regression procedures were used to test for mediation. There were two main findings. First the effects of PLAY on children's social engagement were mediated by the increases in parental responsiveness and affect that were promoted by PLAY. Second, the effects of PLAY on the severity children's Social Affect disorders were mediated by changes in parental responsiveness and affect; however, the effects of Responsive/Affect were mediated by the impact these variables had on children's social engagement. Results are discussed in terms of contemporary models of developmental change including the developmental change model that is the foundation for DIR.

  4. Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome.

    PubMed

    Palm, Andreas; Midgren, Bengt; Janson, Christer; Lindberg, Eva

    2016-01-01

    Obesity hypoventilation syndrome (OHS) is often diagnosed late. The aim of this study was to analyse gender differences at initiation of long-term mechanical ventilation (LTMV) in patients with (OHS), to analyse gender differences in treatment effect and to study how the prescription of LTMV due to OHS has changed over time. Data on patients on LTMV due to OHS between 1996 and 2014 were obtained from Swedevox, a nationwide health quality registry of patients on LTMV in Sweden. When starting LTMV, women were generally older (age 64.4 ± 11.2 vs. 60.1 ± 12.1 years, p < 0.001), more obese (BMI 43.0 ± 8.2 vs. 41.5 ± 7.9 kg/m2, p < 0.001), more hypoxic (PaO2 7.6 ± 1.5 vs. 7.9 ± 1.6 kPa, p = 0.001), had more hypercapnia (PaCO2 7.2 ± 1.3 vs. 6.9 ± 1.3 kPa, p = 0.001), had higher base excess (6.9 ± 4.1 vs. 5.8 ± 4.7 kPa, p < 0.001) and more frequently started LTMV in a non-elective situation (43.2% vs. 37.5%, p = 0.026) than men. Improvement of arterial blood gas values or in age-adjusted mortality at one-year follow-up did not differ. During the study period, the age of patients at the initiation of LTMV rose by 3.4 years/decade (P = 0.001) in women and with 1.9 years/decade (P = 0.048) in men but there were no significant changes in BMI (P = 0.425). Diagnosis of OHS is more delayed in women and as a consequence the disease is more advanced when diagnosed. In spite of this, there is no gender difference in survival rate in patients with OHS treated with LTMV. More and older patients with OHS nowadays gain access to LTMV. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Radiation receiver

    DOEpatents

    Hunt, A.J.

    1983-09-13

    The apparatus for collecting radiant energy and converting same to alternate energy form includes a housing having an interior space and a radiation transparent window allowing, for example, solar radiation to be received in the interior space of the housing. Means are provided for passing a stream of fluid past said window and for injecting radiation absorbent particles in said fluid stream. The particles absorb the radiation and because of their very large surface area, quickly release the heat to the surrounding fluid stream. The fluid stream particle mixture is heated until the particles vaporize. The fluid stream is then allowed to expand in, for example, a gas turbine to produce mechanical energy. In an aspect of the present invention properly sized particles need not be vaporized prior to the entrance of the fluid stream into the turbine, as the particles will not damage the turbine blades. In yet another aspect of the invention, conventional fuel injectors are provided to inject fuel into the fluid stream to maintain the proper temperature and pressure of the fluid stream should the source of radiant energy be interrupted. In yet another aspect of the invention, an apparatus is provided which includes means for providing a hot fluid stream having hot particles disbursed therein which can radiate energy, means for providing a cooler fluid stream having cooler particles disbursed therein, which particles can absorb radiant energy and means for passing the hot fluid stream adjacent the cooler fluid stream to warm the cooler fluid and cooler particles by the radiation from the hot fluid and hot particles. 5 figs.

  6. Radiation receiver

    DOEpatents

    Hunt, Arlon J.

    1983-01-01

    The apparatus for collecting radiant energy and converting same to alternate energy form includes a housing having an interior space and a radiation transparent window allowing, for example, solar radiation to be received in the interior space of the housing. Means are provided for passing a stream of fluid past said window and for injecting radiation absorbent particles in said fluid stream. The particles absorb the radiation and because of their very large surface area, quickly release the heat to the surrounding fluid stream. The fluid stream particle mixture is heated until the particles vaporize. The fluid stream is then allowed to expand in, for example, a gas turbine to produce mechanical energy. In an aspect of the present invention properly sized particles need not be vaporized prior to the entrance of the fluid stream into the turbine, as the particles will not damage the turbine blades. In yet another aspect of the invention, conventional fuel injectors are provided to inject fuel into the fluid stream to maintain the proper temperature and pressure of the fluid stream should the source of radiant energy be interrupted. In yet another aspect of the invention, an apparatus is provided which includes means for providing a hot fluid stream having hot particles disbursed therein which can radiate energy, means for providing a cooler fluid stream having cooler particles disbursed therein, which particles can absorb radiant energy and means for passing the hot fluid stream adjacent the cooler fluid stream to warm the cooler fluid and cooler particles by the radiation from the hot fluid and hot particles.

  7. Evaluation of the mechanical properties and surface topography of as-received, immersed and as-retrieved orthodontic archwires

    PubMed Central

    POP, SILVIA IZABELLA; DUDESCU, MIRCEA; MERIE, VIOLETA VALENTINA; PACURAR, MARIANA; BRATU, CRISTINA DANA

    2017-01-01

    Background and aims This experimental study mainly aims at comparing the most important mechanical properties of the new orthodontic archwires, those immersed in fluorinated solution, the as-retrieved ones and the intra-oral used ones. Methods A total of 270 arch wires were tested, using tensile testing and three-point bending tests. The tested archwires were made of Stainless Steel, Nickel Titanium, Beta-Titanium and physiognomic covered Nickel Titanium. The tested archwires were subjected to three types of treatments: immersion into fluorinated solution, immersion into carbonated drinks and intra-oral use. Results The immersion caused variations of the activation and deactivation forces of all arch wires. The most affected arch wires, in terms of bending characteristics, were the intra-oral used ones. Conclusions The alteration of mechanical properties of the orthodontic arch wires by their immersion into fluorinated solutions and soft drinks could not be statistically demonstrated. PMID:28781528

  8. "Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?": Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals.

    PubMed

    Gilmore, Amanda K; Davis, Margaret T; Grubaugh, Anouk; Resnick, Heidi; Birks, Anna; Denier, Carol; Muzzy, Wendy; Tuerk, Peter; Acierno, Ron

    2016-05-01

    Home-based telemedicine (HBT) is a validated method of evidence-based treatment delivery for posttraumatic stress disorder (PTSD), and justification for its use has centered on closing gaps related to provider availability and distance to treatment centers. However, another potential use of HBT may be to overcome barriers to care that are inherent to the treatment environment, such as with female veterans who have experienced military sexual trauma (MST) and who must present to VA Medical Centers where the majority of patients share features with perpetrator (e.g. gender, clothing) and may function as reminders of the trauma. Delivering evidence-based therapies to female veterans with MST-related PTSD via HBT can provide needed treatment to this population. This manuscript describes an ongoing federally funded randomized controlled trial comparing Prolonged Exposure (PE) delivered in-person to PE delivered via HBT. Outcomes include session attendance, satisfaction with services, and clinical and quality of life indices. It is hypothesized that based on intent-to-treat analyses, HBT delivery of PE will be more effective than SD at improving both clinical and quality of life outcomes at post, 3-, and 6-month follow-up. This is because 'dose received', that is fewer sessions missed, and lower attrition, will be observed in the HBT group. Although the current manuscript focuses on female veterans with MST-related PTSD, implications for other populations facing systemic barriers are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Road traffic injury mortality and its mechanisms in India: nationally representative mortality survey of 1.1 million homes

    PubMed Central

    Hsiao, Marvin; Malhotra, Ajai; Thakur, J S; Sheth, Jay K; Nathens, Avery B; Dhingra, Neeraj; Jha, Prabhat

    2013-01-01

    Objectives To quantify and describe the mechanism of road traffic injury (RTI) deaths in India. Design We conducted a nationally representative mortality survey where at least two physicians coded each non-medical field staff's verbal autopsy reports. RTI mechanism data were extracted from the narrative section of these reports. Setting 1.1 million homes in India. Participants Over 122 000 deaths at all ages from 2001 to 2003. Primary and secondary outcome measures Age-specific and sex-specific mortality rates, place and timing of death, modes of transportation and injuries sustained. Results The 2299 RTI deaths in the survey correspond to an estimated 183 600 RTI deaths or about 2% of all deaths in 2005 nationally, of which 65% occurred in men between the ages 15 and 59 years. The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records. Pedestrians (68 000), motorcyclists (36 000) and other vulnerable road users (20 000) constituted 68% of RTI deaths (124 000) nationally. Among the study sample, the majority of all RTI deaths occurred at the scene of collision (1005/1733, 58%), within minutes of collision (883/1596, 55%), and/or involved a head injury (691/1124, 62%). Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods. Conclusions In India, RTIs cause a substantial number of deaths, particularly among pedestrians and other vulnerable road users. Interventions to prevent collisions and reduce injuries might address over half of the RTI deaths. Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths. PMID:23959748

  10. Prospective observational cohort study of patients with weaning failure admitted to a specialist weaning, rehabilitation and home mechanical ventilation centre

    PubMed Central

    Mifsud Bonnici, Denise; Sanctuary, Thomas; Murphy, Patrick B; Steier, Joerg; Marino, Philip; Pattani, Hina; Creagh-Brown, Ben C; Hart, Nicholas

    2016-01-01

    Objectives According to National Health Service England (NHSE) specialist respiratory commissioning specification for complex home ventilation, patients with weaning failure should be referred to a specialist centre. However, there are limited data reporting the clinical outcomes from such centres. Setting Prospective observational cohort study of patients admitted to a UK specialist weaning, rehabilitation and home mechanical ventilation centre between February 2005 and July 2013. Participants 262 patients admitted with a median age of 64.2 years (IQR 52.6–73.2 years). 59.9% were male. Results 39.7% of patients had neuromuscular and/or chest wall disease, 21% were postsurgical, 19.5% had chronic obstructive pulmonary disease (COPD), 5.3% had obesity-related respiratory failure and 14.5% had other diagnoses. 64.1% of patients were successfully weaned, with 38.2% weaned fully from ventilation, 24% weaned to nocturnal non-invasive ventilation (NIV), 1.9% weaned to nocturnal NIV with intermittent NIV during the daytime. 21.4% of patients were discharged on long-term tracheostomy ventilation. The obesity-related respiratory failure group were most likely to wean (relative risk (RR) for weaning success=1.48, 95% CI 1.35 to 1.77; p<0.001), but otherwise weaning success rates did not significantly vary by diagnostic group. The median time-to-wean was 19 days (IQR 9–33) and the median duration of stay was 31 days (IQR 16–50), with no difference observed between the groups. Weaning centre mortality was 14.5%, highest in the COPD group (RR=2.15, 95% CI 1.19 to 3.91, p=0.012) and lowest in the neuromuscular and/or chest wall disease group (RR=0.34, 95% CI 0.16 to 0.75, p=0.007). Of all patients discharged alive, survival was 71.7% at 6 months and 61.8% at 12 months postdischarge. Conclusions Following NHSE guidance, patients with weaning delay and failure should be considered for transfer to a specialist centre where available, which can demonstrate

  11. What do you do with the antiplatelet agents in patients with drug eluting stents who then receive a mechanical valve?

    PubMed Central

    Rossi, Michele; Serraino, Giuseppe Filiberto; Spadafora, Andrea; Renzulli, Attilio

    2012-01-01

    Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is a cornerstone of treatment during and after percutaneous coronary interventions with drug-eluting stent (DES) implantation. Oral anticoagulation (OAC) is the recommended treatment for patients with mechanical heart valves. When patients with DES need a mechanical heart valve or vice versa, we face the difficult choice of their antithrombotic therapy. Different institutions empirically follow a combination of OAC and single or DAT, the so-called triple antithrombotic therapy (TT) aiming to find the best balance between the thrombotic and bleeding risk for this subset of patients. A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether there is an optimal antithrombotic management for patients with DES undergoing mechanical heart valve or vice versa. Altogether, more than 148 papers were found using the reported search, of which 16 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that DES implantation in patients who could potentially need valve surgery in the future should be discouraged and bare-metal stent or an aortic bioprosthesis preferred. However, in high-risk patients with DES, the recommendation is to postpone elective surgery for 1 year and, if surgery cannot be deferred, continue aspirin during the perioperative period. Moreover, when OAC is given in combination with clopidogrel and/or low-dose aspirin, the target INR should be 2.0–2.5 (Class IIb, level of evidence C). As per the long-term management, antithrombotic management with DAT alone in mechanical aortic valve replacement might be possible, but there is not enough evidence to support it. The available evidence suggests that triple anticoagulation (OAC + DAT) is associated with the best

  12. The structure of Tim50(164–361) suggests the mechanism by which Tim50 receives mitochondrial presequences

    SciTech Connect

    Li, Jingzhi; Sha, Bingdong

    2015-08-25

    The Tim50 crystal structure indicates that the IMS domain of Tim50 exhibits significant structural plasticity within the putative presequence-binding groove. Mitochondrial preproteins are transported through the translocase of the outer membrane (TOM) complex. Tim50 and Tim23 then transfer preproteins with N-terminal targeting presequences through the intermembrane space (IMS) across the inner membrane. The crystal structure of the IMS domain of Tim50 [Tim50(164–361)] has previously been determined to 1.83 Å resolution. Here, the crystal structure of Tim50(164–361) at 2.67 Å resolution that was crystallized using a different condition is reported. Compared with the previously determined Tim50(164–361) structure, significant conformational changes occur within the protruding β-hairpin of Tim50 and the nearby helix A2. These findings indicate that the IMS domain of Tim50 exhibits significant structural plasticity within the putative presequence-binding groove, which may play important roles in the function of Tim50 as a receptor protein in the TIM complex that interacts with the presequence and multiple other proteins. More interestingly, the crystal packing indicates that helix A1 from the neighboring monomer docks into the putative presequence-binding groove of Tim50(164–361), which may mimic the scenario of Tim50 and the presequence complex. Tim50 may recognize and bind the presequence helix by utilizing the inner side of the protruding β-hairpin through hydrophobic interactions. Therefore, the protruding β-hairpin of Tim50 may play critical roles in receiving the presequence and recruiting Tim23 for subsequent protein translocations.

  13. Homes away from Home.

    ERIC Educational Resources Information Center

    Hansen, Laurel D.; And Others

    1993-01-01

    Describes the construction of a variety of inexpensive, escape-proof, and safe insect homes--each complete with window, ventilation screen, and cover--so students can observe firsthand the intriguing world of insects. (PR)

  14. The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia

    PubMed Central

    Meinberg, Maria Cristina de Avila; Cheade, Maria de Fátima Meinberg; Miranda, Amanda Lucia Dias; Fachini, Marcela Mascaro; Lobo, Suzana Margareth

    2012-01-01

    Objective To evaluate the effects of oral chlorhexidine hygiene with toothbrushing on the rate of ventilator-associated pneumonia in a mixed population of critically ill patients under prolonged mechanical ventilation. Methods Prospective, randomized, and placebo-controlled pilot study. Patients who were receiving mechanical ventilation, had been admitted less than 24 hours prior, and were anticipated to require mechanical ventilation for more than 72 hours were included in the study. The patients were randomly divided into one of the following groups: chlorhexidine hygiene with toothbrushing or a placebo group (gel with the same color and consistency and toothbrushing). Results The planned interim analysis was conducted using 52 patients, and the study was terminated prematurely. In total, 28 patients were included in the chlorhexidine / toothbrushing group, and 24 patients were included in the placebo group. Ventilator-associated pneumonia occurred in 45.8% of the placebo group and in 64.3% of the chlorhexidine hygiene with toothbrushing group (RR=1.4; 95% CI=0.83-2.34; p=0.29). Conclusion Because the study was terminated due to futility, it was not possible to evaluate the impact of oral hygiene using 2% chlorhexidine and toothbrushing on the incidence of ventilator-associated pneumonia in this heterogeneous population of critical patients receiving long-term mechanical ventilation, and no beneficial effect was observed for this intervention. PMID:23917935

  15. Comparing the similarity of responses received from studies in Amazon's Mechanical Turk to studies conducted online and with direct recruitment.

    PubMed

    Bartneck, Christoph; Duenser, Andreas; Moltchanova, Elena; Zawieska, Karolina

    2015-01-01

    Computer and internet based questionnaires have become a standard tool in Human-Computer Interaction research and other related fields, such as psychology and sociology. Amazon's Mechanical Turk (AMT) service is a new method of recruiting participants and conducting certain types of experiments. This study compares whether participants recruited through AMT give different responses than participants recruited through an online forum or recruited directly on a university campus. Moreover, we compare whether a study conducted within AMT results in different responses compared to a study for which participants are recruited through AMT but which is conducted using an external online questionnaire service. The results of this study show that there is a statistical difference between results obtained from participants recruited through AMT compared to the results from the participant recruited on campus or through online forums. We do, however, argue that this difference is so small that it has no practical consequence. There was no significant difference between running the study within AMT compared to running it with an online questionnaire service. There was no significant difference between results obtained directly from within AMT compared to results obtained in the campus and online forum condition. This may suggest that AMT is a viable and economical option for recruiting participants and for conducting studies as setting up and running a study with AMT generally requires less effort and time compared to other frequently used methods. We discuss our findings as well as limitations of using AMT for empirical studies.

  16. In vivo kinematics of the thumb during flexion and adduction motion: Evidence for a screw-home mechanism.

    PubMed

    D'Agostino, Priscilla; Dourthe, Benjamin; Kerkhof, Faes; Stockmans, Filip; Vereecke, Evie E

    2017-07-01

    The thumb plays a crucial role in basic hand function. However, the kinematics of its entire articular chain have not yet been quantified. Such investigation is essential to improve our understanding of thumb function and to develop better strategies to treat thumb joint pathologies. The primary objective of this study is to quantify the in vivo kinematics of the trapeziometacarpal (TMC) and scaphotrapezial (ST) joints during flexion and adduction of the thumb. In addition, we want to evaluate the potential coupling between the TMC and ST joints during these tasks. The hand of 16 asymptomatic women without signs of thumb osteoarthritis were CT scanned in positions of maximal thumb extension, flexion, abduction, and adduction. The CT images were segmented and three-dimensional surface models of the radius, scaphoid, trapezium, and the first metacarpal were created for each thumb motion. The corresponding rotations angles, translations, and helical axes were calculated for each sequence. The analysis shows that flexion and adduction of the thumb result in a three-dimensional rotation and translation of the entire articular chain, including the trapezium and scaphoid. A wider range of motion is observed for the first metacarpal, which displays a clear axial rotation. The coupling of axial rotation of the first metacarpal with flexion and abduction during thumb flexion supports the existence of a screw-home mechanism in the TMC joint. In addition, our results point to a potential motion coupling between the TMC and ST joints and underline the complexity of thumb kinematics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1556-1564, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  17. Potential Mechanisms of Hematological Adverse Drug Reactions in Patients Receiving Clozapine in Combination With Proton Pump Inhibitors.

    PubMed

    Wiciński, Michał; Węclewicz, Mateusz M; Miętkiewicz, Mateusz; Malinowski, Bartosz; Grześk, Elżbieta; Klonowska, Joanna

    2017-03-01

    Clozapine is a second-generation antipsychotic which has proven efficacy in treating the symptoms of schizophrenia. Although clozapine therapy is associated with a number of adverse drug reactions, it is frequently used. One of the most common adverse drug reactions is gastroesophageal reflux disease which is an indication for treatment with proton pump inhibitors (PPIs). Coadministration of clozapine and PPIs increases the risk of hematological adverse drug reactions, including neutropenia and agranulocytosis. The mechanism in idiosyncratic agranulocytosis is not dose related and involves either a direct toxic or an immune-allergic effect. It is suspected that the clozapine metabolites nitrenium ion and N-desmethylclozapine may cause apoptosis or impair growth of granulocytes. Formation of N-desmethylclozapine is correlated with activity of the cytochrome P450 enzymes 1A2 and 3A4 (CYP1A2 and CYP3A4). Nitrenium ion is produced by the flavin-containing monooxygenase system of leukocytes. A drug interaction between clozapine and a PPI is a consequence of the induction of common metabolic pathways either by the PPI or clozapine. Findings to date suggest that indirect induction of flavin-containing monooxygenase by omeprazole through the aryl hydrocarbon receptor increases the expression of the enzyme mRNA and in the long term may cause the increase in activity. Moreover, induction of CYP1A2, especially by omeprazole and lansoprazole, may increase the serum concentration of N-desmethylclozapine, which can accumulate in lymphocytes and may achieve toxic levels. Another hypothesis that may explain hematological adverse drug reactions is competitive inhibition of CYP2C19, which may contribute to increased serum concentrations of toxic metabolites.

  18. Home Modifications

    MedlinePlus

    ... My Home HomeFit ? (AARP) (PDF) Back to top Financial Assistance Minor improvements and repairs can cost between $ ... Learn more by visiting https://www.ncoa.org/economic-security/home-equity/ . Search for additional resources in ...

  19. Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical-ventilatory support: a randomized clinical trial

    PubMed Central

    Chlan, Linda L.; Weinert, Craig R.; Heiderscheit, Annie; Tracy, Mary Fran; Skaar, Debra J.; Guttormson, Jill L.; Savik, Kay

    2013-01-01

    Context Alternatives to sedative medications are needed to reduce anxiety in mechanically ventilated patients. Music is an integrative therapy without adverse effects that may alleviate the anxiety associated with ventilatory support. Objective To test whether patient-directed, self-initiated music listening can reduce anxiety and sedative exposure during ventilatory support in critically ill patients as compared with 2 control conditions. Design, Setting, and Patients Randomized, controlled trial that enrolled 373 ICU patients from the Minneapolis-St. Paul area receiving acute mechanical-ventilatory support for respiratory failure between September 2006 and March 2011. Patients were Caucasian (86%), female (52%), with mean age 59 (SD 14), APACHE III 63 (SD 21.6), on protocol 5.7 (SD 6.4) days. Intervention Patients (1) self-initiated music listening (patient-directed music; PDM) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, (2) self-initiated use of noise-abating headphones (HP), or (3) received usual ICU care (UC). Main Outcome Measures Daily assessments of anxiety (100-mm visual analog scale) and two aggregate measure of sedative exposure (sedation intensity and sedation frequency). Results Mixed-models analysis showed that PDM patients had decreased levels of anxiety compared with the UC group of −19.5 (p=.003). By the fifth study day anxiety was reduced by 36.5% in PDM patients. The interaction between treatment and time showed PDM significantly reduced both measures of sedative exposure. PDM reduced sedation intensity by −.18 (−.36, −.004) points per day and frequency by −.21 (−.37, −.05) points per day compared to UC (p = .05, .01 respectively). PDM reduced sedation frequency by −.18 (−.36, −.004) points per day compared to HP (p = .04). By the fifth study day, PDM patients received two fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity

  20. A new intravenous fat emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil: a single-center, double-blind randomized study on efficacy and safety in pediatric patients receiving home parenteral nutrition.

    PubMed

    Goulet, Olivier; Antébi, Helena; Wolf, Claude; Talbotec, Cécile; Alcindor, Louis-Gérald; Corriol, Odile; Lamor, Michèle; Colomb-Jung, Virginie

    2010-01-01

    SMOFlipid 20% is an intravenous lipid emulsion (ILE) containing soybean oil, medium-chain triglycerides, olive oil, and fish oil developed to provide energy, essential fatty acids (FAs), and long-chain ω-3 FAs as a mixed emulsion containing α-tocopherol. The aim was to assess the efficacy and safety of this new ILE in pediatric patients receiving home parenteral nutrition (HPN) compared with soybean oil emulsion (SOE). This single-center, randomized, double-blind study included 28 children on HPN allocated to receive either SMOFlipid 20% (n = 15) or a standard SOE (Intralipid 20%, n = 13). ILE was administered 4 to 5 times per week (goal dose, 2.0 g/kg/d) within a parenteral nutrition regimen. Assessments, including safety and efficacy parameters, were performed on day 0 and after the last study infusion (day 29). Lipid peroxidation was determined by measurement of thiobarbituric acid reactive substances (TBARS). There were no significant differences in laboratory safety parameters, including liver enzymes, between the groups on day 29. The mean ± standard deviation changes in the total bilirubin concentration between the initial and final values (day 29 to day 0) were significantly different between groups: SMOFlipid group -1.5 ± 2.4 µmol/L vs SOE group 2.3 ± 3.5 µmol/L, P < .01; 95% confidence interval [CI], -6.2 to -1.4). In plasma and red blood cell (RBC) phospholipids, the ω-3 FAs C20:5ω-3 (eicosapentaenoic acid) and + C22:6ω-3 (docosahexaenoic acid) increased significantly in the SMOFlipid group on day 29. The ω-3:ω-6 FA ratio was significantly elevated with SMOFlipid 20% compared with SOE group (plasma, day 29: 0.15 ± 0.06 vs 0.07 ± 0.02, P < .01, 95% CI, 0.04-0.11; and RBC, day 29: 0.23 ± 0.07 vs 0.14 ± 0.04, P < .01, 95% CI, 0.04-0.13). Plasma α-tocopherol concentration increased significantly more with SMOFlipid 20% (15.7 ± 15.9 vs 5.4 ± 15.2 µmol/L, P < .05; 95% CI, -2.1 to 22.6). The low-density lipoprotein-TBARS concentrations were

  1. Mechanisms of homing in the fiddler crab Uca rapax. 2. Information sources and frame of reference for a path integration system.

    PubMed

    Layne, John E; Barnes, W Jon P; Duncan, Lindsey M J

    2003-12-01

    Fiddler crabs Uca rapax are central-place foragers, making feeding excursions of up to several meters from their burrows. This study investigates the sources of directional and distance information used by these crabs when returning to their burrows. We tested the spatial frame of reference (egocentric or exocentric), and the source of spatial information (idiothetic or allothetic) used during homing. We also tested which components of their locomotion they integrated (only voluntary, or voluntary plus reflexive). Fiddler crabs in their natural mudflat habitat were passively rotated during normal foraging behavior using experimenter-controlled disks, before they returned home. Crabs resisted passive rotations on the disk by counter-rotating when the disk turned, which was a compensatory response to unintended movement. Crabs were usually situated eccentrically on the disk, and therefore were also subjected to a translation when the disk rotated. No crab actively compensated for this translation. Crabs that fully compensated for disk rotation made no directional homing error. Crabs that did not fully compensate homed in a direction that reflected their new body orientation. In other words, if we succeeded in reorienting a crab (i.e. it undercompensated for disk rotation), its homing error was equal to the angle by which it had been reoriented, regardless of the magnitude of the optomotor compensation. Computer-modelled crabs, each equipped with a path integrator utilizing different combinations of external (allothetic) and path-related (idiothetic) input, traversed the digitized paths of the real crabs. The home vector computed by the model crab was then compared to the homing direction observed in the real crab. The model home vector that most closely matched that of the real crab was taken to comprise the path integration mechanism employed by fiddler crabs. The model that best matched the real crab gained direction and distance idiothetically (from internal

  2. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial.

    PubMed

    Reignier, Jean; Mercier, Emmanuelle; Le Gouge, Amelie; Boulain, Thierry; Desachy, Arnaud; Bellec, Frederic; Clavel, Marc; Frat, Jean-Pierre; Plantefeve, Gaetan; Quenot, Jean-Pierre; Lascarrou, Jean-Baptiste

    2013-01-16

    Monitoring of residual gastric volume is recommended to prevent ventilator-associated pneumonia (VAP) in patients receiving early enteral nutrition. However, studies have challenged the reliability and effectiveness of this measure. To test the hypothesis that the risk of VAP is not increased when residual gastric volume is not monitored compared with routine residual gastric volume monitoring in patients receiving invasive mechanical ventilation and early enteral nutrition. Randomized, noninferiority, open-label, multicenter trial conducted from May 2010 through March 2011 in adults requiring invasive mechanical ventilation for more than 2 days and given enteral nutrition within 36 hours after intubation at 9 French intensive care units (ICUs); 452 patients were randomized and 449 included in the intention-to-treat analysis (3 withdrew initial consent). Absence of residual gastric volume monitoring. Intolerance to enteral nutrition was based only on regurgitation and vomiting in the intervention group and based on residual gastric volume greater than 250 mL at any of the 6 hourly measurements and regurgitation or vomiting in the control group. Proportion of patients with at least 1 VAP episode within 90 days after randomization, as assessed by an adjudication committee blinded to patient group. The prestated noninferiority margin was 10%. In the intention-to-treat population, VAP occurred in 38 of 227 patients (16.7%) in the intervention group and in 35 of 222 patients (15.8%) in the control group (difference, 0.9%; 90% CI, -4.8% to 6.7%). There were no significant between-group differences in other ICU-acquired infections, mechanical ventilation duration, ICU stay length, or mortality rates. The proportion of patients receiving 100% of their calorie goal was higher in the intervention group (odds ratio, 1.77; 90% CI, 1.25-2.51; P = .008). Similar results were obtained in the per-protocol population. Among adults requiring mechanical ventilation and receiving

  3. HPXML to Home Energy Score Translator

    SciTech Connect

    Market, Noel

    2014-09-08

    Home Energy Score is a simulation-based rating method for existing homes. Home Performance XML (HPXML) is a data transfer standard for home energy audit and retrofit data used throughout the industry. This software receives an HPXML document and translates the building characteristics into HEScore inputs compliant with their API.

  4. The correlation between subordinate fish eye colour and received attacks: a negative social feedback mechanism for the reduction of aggression during the formation of dominance hierarchies.

    PubMed

    Miyai, Caio A; Carretero Sanches, Fábio H; Costa, Tânia M; Colpo, Karine Delevati; Volpato, Gilson L; Barreto, Rodrigo E

    2011-12-01

    Eye darkening has been linked to social status in fish. The subordinate's eyes darken, while the eyes of the dominant fish become pale. Although this phenomenon has been described in salmonid fishes and in the African cichlid Nile tilapia Oreochromis niloticus, it is unclear whether eye darkening correlates with a reduction in aggressive behaviour. Thus, we evaluated the link between social status and eye darkening. We evaluated whether the eye colours of subordinate fish correlate with the frequency of received attacks in a neotropical fish, the pearl cichlid Geophagus brasiliensis. We paired pearl cichlids and quantified both the aggressive behaviour and the eye darkening of each fish. As has been described for Nile tilapia and Atlantic salmon, a clear-cut hierarchical relationship formed, where dominance and subordination were associated with pale and dark eye colours, respectively. Initially, eye colour darkening was positively correlated with the frequency of received attacks; however, a negative association occurred following eye darkening, in which the intensity of aggressive interactions decreased. Thus, fish that initially received a high number of attacks signalled subordination more rapidly and intensely (rapid and dramatic eye darkening), thereby inducing a negative social feedback mechanism that led to reduced aggression.

  5. The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation.

    PubMed

    Shahabi, Mehdi; Yousefi, Hojatollah; Yazdannik, Ahmad Reza; Alikiaii, Babak

    2016-01-01

    Ventilator-associated pneumonia (VAP) is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients. In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA), Chi-square, and independent t-test. The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05). The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.

  6. CALUTRON RECEIVER

    DOEpatents

    Barnes, S.W.

    1959-08-25

    An improvement in a calutron receiver for collecting the isotopes ts described. The electromagnetic separation of the isotopes produces a mass spectrum of closely adjacent beams of ions at the foci regions, and a dividing wall between the two pockets is arranged at an angle. Substantially all of the tons of the less abundant isotope enter one of the pockets and strike one side of the wall directly, while substantially none of the tons entering the other pocket strikes the wall directly.

  7. Mechanism of Developmental Change in the PLAY Project Home Consultation Program: Evidence from a Randomized Control Trial

    ERIC Educational Resources Information Center

    Mahoney, Gerald; Solomon, Richard

    2016-01-01

    This investigation is a secondary analysis of data from a randomized control trial of the PLAY Home Consultation Intervention Program which was conducted with 112 preschool children with Autism Spectrum Disorders and their parents (Solomon et al. in "J Dev Behav Pediatr" 35:475-485, 2014). Subjects were randomly assigned to either a…

  8. Mechanism of Developmental Change in the PLAY Project Home Consultation Program: Evidence from a Randomized Control Trial

    ERIC Educational Resources Information Center

    Mahoney, Gerald; Solomon, Richard

    2016-01-01

    This investigation is a secondary analysis of data from a randomized control trial of the PLAY Home Consultation Intervention Program which was conducted with 112 preschool children with Autism Spectrum Disorders and their parents (Solomon et al. in "J Dev Behav Pediatr" 35:475-485, 2014). Subjects were randomly assigned to either a…

  9. Can routine oral care with antiseptics prevent ventilator-associated pneumonia in patients receiving mechanical ventilation? An update meta-analysis from 17 randomized controlled trials

    PubMed Central

    Li, Longti; Ai, Zhibing; Li, Longzhu; Zheng, Xuesong; Jie, Luo

    2015-01-01

    Background: Whether oral antiseptics could reduce the risk of ventilator associated pneumonia (VAP) in patients receiving mechanical ventilation remains controversial. We performed a meta-analysis to assess the effect of oral care with antiseptics on the prevalence of ventilator associated pneumonia in adult critically ill patients. Methods: A comprehensive search of PubMed, Embase and Web of Science were performed to identity relevant studies. Eligible studies were randomized controlled trials of mechanically ventilated adult patients receiving oral care with antiseptics. The quality of included studies was assessed by the Jadad score. Relative risks (RRs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated and pooled using a fixed-effects model or random-effects model. Heterogeneity among the studies was assessed with I 2 test. Results: 17 studies with a total number of 4249 met the inclusion criteria. Of the 17 studies, 14 assessed the effect of chlorhexidine, and 3 investigated the effect of povidone-iodine. Overall, oral care with antiseptics significantly reduced the prevalence of VAP (RR=0.72, 95% CI: 0.57, 0.92; P=0.008). The use of chlorhexidine was shown to be effective (RR=0.73, 95% CI: 0.57, 0.93; P=0.012), whereas this effect was not observed in povidone-iodine (RR=0.51, 95% CI: 0.09, 2.82; P=0.438). Subgroup analyses showed that oral antiseptics were most marked in cardiac surgery patients (RR=0.54, 95% CI: 0.39, 0.74; P=0.00). Patients with oral antiseptics did not have a reduction in intensive care unit (ICU) mortality (RR=1.11, 95% CI: 0.95, 1.29; P=0.201), length of ICU stay (WMD=-0.10 days, 95% CI: -0.25, 0.05; P=0.188), or duration of mechanical ventilation (WMD=-0.05 days, 95% CI: -0.14, 0.04; P=0.260). Conclusion: Oral care with antiseptics significantly reduced the prevalence of VAP. Chlorhexidine application prevented the occurrence of VAP in mechanically ventilated patients but povidone-iodine did not

  10. Assessment of 1-year Outcomes in Survivors of Severe Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation or Mechanical Ventilation: A Prospective Observational Study

    PubMed Central

    Wang, Zhi-Yong; Li, Tong; Wang, Chun-Ting; Xu, Lei; Gao, Xin-Jing

    2017-01-01

    Background: Little is known about the long-term outcomes of severe acute respiratory distress syndrome (ARDS) patients requiring extracorporeal membrane oxygenation (ECMO). This study aimed to investigate the 1-year outcomes of these patients or patients receiving mechanical ventilation (MV) and compare their health-related quality of life (HRQoL) to the general population. Methods: Severe ARDS survivors admitted to two ICUs in China between January 2012 and January 2014 were enrolled. Of the severe ARDS survivors enrolled, 1-year postdischarge, HRQoL assessment using the Short-Form 36 (SF-36) and EuroQol questionnaire dimensions, 6-min walking distance, chest computed tomography scan, pulmonary function, and arterial blood gas analysis were compared for ARDS patients with or without ECMO. Results: ARDS patients receiving ECMO had a significantly higher Acute Physiology and Chronic Health Evaluation II score (30.3 ± 6.7 vs. 26.5 ± 7.3, P = 0.036), lung injury score (3.3 ± 0.4 vs. 2.8 ± 0.5, P = 0.000), Sequential Organ Failure Assessment score (10.8 ± 3.5 vs. 7.9 ± 3.1, P = 0.000), lower PaO2/FiO2 ratio ([mmHg, 1 mmHg = 0.133 kPa], 68.3 ± 16.1 vs. 84.8 ± 16.5, P = 0.000), and increased extrapulmonary organ failure (2 [1, 3] vs. 1 [1, 1], P = 0.025) compared with patients not receiving ECMO. ECMO and non-ECMO survivors showed similar pulmonary function, morphological abnormalities, resting arterial blood gas values, and 6-min walking distance. Mild pulmonary dysfunction and abnormal morphology were observed in a few survivors. In addition, ECMO and non-ECMO survivors showed a similar quality of life. ECMO survivors showed lower SF-36 physical functioning and role-physical domain scores (minimum clinically significant difference at least 5 points), and non-ECMO survivors had similar outcome. Conclusions: One-year posthospital discharge, severe ARDS survivors receiving ECMO or MV demonstrated comparable outcomes. Compared with the general population, ARDS

  11. Nursing Homes

    MedlinePlus

    ... Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day. Some nursing ... speech and occupational therapy. There might be a nurses' station on each floor. Other nursing homes try ...

  12. The efficacy of a home-mechanical traction unit for patients with mild to moderate cervical osteoarthrosis: A pilot study

    PubMed Central

    Bagheripour, Batoul; Kamyab, Mojtaba; Azadinia, Fatemeh; Amiri, Ali; Akbari, Mohammad

    2016-01-01

    Background: Traction has been suggested to be an effective treatment for symptoms of neck disorder in patients with no contraindications. However, according to previous researches, the effectiveness of traction is controversial, particularly compared to other conservative treatments. This trial was conducted to evaluate the effect of sustained traction, using an over-the-door home cervical traction unit in combination with routine physical therapy on reducing cervical osteoarthrosis symptoms including neck pain, medication use and disability level compared to routine physical therapy alone. Methods: In this double- blinded pilot study with a pre-post test design and a control group, 20 women with mild to moderate osteoarthrosis were systematically assigned to the over-the-door home cervical traction (mean±SD age: 50.5±4.45yrs) or control groups (mean±SD age: 55.6±7.34yrs). Pain, level of disability, and drug consumption were evaluated before and after 10 sessions of intervention. Data were analyzed using parametric or non-parametric statistic including the paired-sample t-test, independent sample t-test, and Wilcoxon and Mann-Whitney u test for intra and inter groups comparison based on the Kolmogorov-Smirnov test results. Results: Patients in both groups showed a significant decrease in pain intensity and disability level (p<0.05). Despite the greater improvement in pain levels and disability in the experimental group compared to the controls, the differences were not significant (p>0.05). No significant differences were found in terms of drugs consumption within and between the groups at the end of the treatment (p>0.05). Conclusion: The results revealed that applying sustained traction using an over-the-door home cervical traction unit was not significantly superior to the routine physical therapy and ergonomic training to manage symptoms including neck pain and disability in a small group of mild to moderate cervical osteoarthrosis patients. PMID:27493930

  13. The role of the Carer Support Needs Assessment Tool in palliative home care: A qualitative study of practitioners' perspectives of its impact and mechanisms of action.

    PubMed

    Ewing, Gail; Austin, Lynn; Grande, Gunn

    2016-04-01

    The importance of supporting family carers is well recognised in healthcare policy. The Carer Support Needs Assessment Tool is an evidence-based, comprehensive measure of carer support needs to facilitate carer support in palliative home care. To examine practitioner perspectives of the role of the Carer Support Needs Assessment Tool intervention in palliative home care to identify its impact and mechanisms of action. Qualitative - practitioner accounts of implementation (interviews, focus groups, reflective audio diaries) plus researcher field notes. A total of 29 staff members from two hospice home-care services - contrasting geographical locations, different service sizes and staff composition. A thematic analysis was conducted. Existing approaches to identification of carer needs were informal and unstructured. Practitioners expressed some concerns, pre-implementation, about negative impacts of the Carer Support Needs Assessment Tool on carers and expectations raised about support available. In contrast, post-implementation, the Carer Support Needs Assessment Tool provided positive impacts when used as part of a carer-led assessment and support process: it made support needs visible, legitimised support for carers and opened up different conversations with carers. The mechanisms of action that enabled the Carer Support Needs Assessment Tool to make a difference were creating space for the separate needs of carers, providing an opportunity for carers to express support needs and responding to carers' self-defined priorities. The Carer Support Needs Assessment Tool delivered benefits through a change in practice to an identifiable, separate assessment process for carers, facilitated by practitioners but carer-led. Used routinely with all carers, the Carer Support Needs Assessment Tool has the potential to normalise carer assessment and support, facilitate delivery of carer-identified support and enable effective targeting of resources. © The Author(s) 2015.

  14. There's no place like home? An exploration of the mechanisms behind plant litter-decomposer affinity in terrestrial ecosystems.

    PubMed

    Austin, Amy T; Vivanco, Lucía; González-Arzac, Adelia; Pérez, Luis I

    2014-08-08

    Litter decomposition in terrestrial ecosystems is an important first step for carbon and nutrient cycling, as senescent plant material is degraded and consequently incorporated, along with microbial products, into soil organic matter. The identification of litter affinity effects, whereby decomposition is accelerated in its home environment (home-field advantage, HFA), highlights the importance of plant-soil interactions that have consequences for biogeochemical cycling. While not universal, these affinity effects have been identified in a range of ecosystems, particularly in forests without disturbance. The optimization of the local decomposer community to degrade a particular combination of litter traits is the most oft-cited explanation for HFA effects, but the ways in which this specialized community can develop are only beginning to be understood. We explore ways in which HFA, or more broadly litter affinity effects, could arise in terrestrial ecosystems. Plant-herbivore interactions, microbial symbiosis, legacies from phyllosphere communities and attractors of specific soil fauna could contribute to spatially defined affinity effects for litter decomposition. Pyrosequencing soil communities and functional linkages of soil fauna provide great promise in advancing our mechanistic understanding of these interactions, and could lead to a greater appreciation of the role of litter-decomposer affinity in the maintenance of soil functional diversity.

  15. Prediction of Arterial Blood pH and Partial Pressure of Carbon dioxide from Venous Blood Samples in Patients Receiving Mechanical Ventilation.

    PubMed

    Tavakol, Kamran; Ghahramanpoori, Bahareh; Fararouei, Mohammad

    2013-07-01

    Substitution of arterial with venous blood samples to estimate blood gas status is highly preferable due to practical and safety concerns. Numerous studies support the substitution of arterial by venous blood samples, reporting strong correlations between arterial and venous values. This study further investigated the predictive ability of venous blood samples for arterial Acid-Base Balance (pH) and pressure of carbon dioxide (pCO2). Participants were 51 post-brain surgery patients receiving mechanical ventilation, who had blood samples taken simultaneously from radial artery of the wrist and elbow vein. Results showed significant associations between arterial and venous pH and pCO2. However, the variation of regression residuals was not homogenous, and the regression line did not fit properly to the data, indicating that simple linear regression is sub-optimal for prediction of arterial pH and pCO2 by venous blood sample. Although highly significant correlations were found between arterial and venous blood pH and pCO2, the results did not support the reliability of prediction of arterial blood pH and pCO2 by venous blood samples across a range of concentrations.

  16. Home Visits in Geropsychiatry Fellowship Training

    ERIC Educational Resources Information Center

    Roane, David M.; Teusink, J. Paul; Wortham, Jennifer A.

    2002-01-01

    Purpose: The psychiatric home visit is an effective intervention for elderly patients who otherwise would not receive mental health services. Home visits also have potential to be useful for training. Here, the current practice of home visits in geropsychiatry fellowship programs is examined. Design and Methods: The directors of 55 current…

  17. High Performance Builder Spotlight: Treasure Homes Inc.

    SciTech Connect

    2011-01-01

    Treasure Homes, Inc., achieved a HERS rating of 46 without PV on its prototype “Gem” home, located on the shores of Lake Michigan in northern Indiana, thanks in part to training received from a Building America partner, the National Association of Home Builders Research Center.

  18. [Responding to patients with home mechanical ventilation after the Great East Japan Earthquake and during the planned power outages. How should we be prepared for a future disaster ?].

    PubMed

    Takechi, Yukako

    2011-12-01

    The unprecedented earthquake(magnitude-9 in the Japanese seismic intensity scale)hit off the east coast of Japan on March 11, 2011. Consequently, there were planned power outages in the area nearby Tokyo to avoid massive blackouts caused by a stoppage of Fukushima nuclear plants.Our clinic located in Kawasaki city was also hit by the earthquake(magnitude- 5).During the period of two months(March and April 2011), we had a total of 52 patients with home respiratory care (5-TPPV, 11-NPPV and 36-HOT)at that time.Two out of three 24 hour-TPPV users had no external battery.After the earthquake, there was a 7-hour electricity failure in some areas, and a patient with ASV(adaptive servo ventilator)was living there.Moreover, 3-hour/day power outages were carried out from March 14 to March 28, affecting people's everyday lives. However, the patient had no harmful influences from the power failure because a ventilation company lent us an external battery(4-9 hour life capacity)for the patients, and we were able to avoid an emergency situation caused by the power failure.In conclusion, we ought to be prepared for patients with home mechanical ventilation in the future toward unforeseen large scale power outages.

  19. High Energy-Efficiency Retrofits to Baltimore's Row Homes

    SciTech Connect

    Chalk, J.; Johnson, A.L.; Lipscomb, L.; Wendt, R.

    1999-04-19

    The purpose of the research project is to develop high-perfommnce, energy-eflicient retrofits of existing row homes in Baltimore, Maryland. These efficiency enhancements are to optimize building envelope improvements, mechanical equipment improvements and operational improvements to the highest cost-effective level. Furthermore, this project is to investigate and demonstrate the impact of high-performance energy-efficiency retrofit improvements on row homes in the Historic East area of Baltimore. Three homes awaiting renovation are planned to receive building envelope, mechanical system, and electrical system improvements that will improve their energy petiormance. An incremental additional cost ceiling of $4000 for the energy eftlciency improvements, beyond those normally installed, has been set by the project.

  20. Home front.

    PubMed

    2001-04-04

    Ninety-year-old Ivy Tabberer protested against the closure of her care home at the Houses of Parliament last week. She was joined by fellow residents in the Havering Action Against Home Closures group and three generations of her family. Ms Tabberer is pictured with daughter Doreen Walpole (left), granddaughter Annette (far right) and great granddaughter Shereen (middle). 'If all the homes close,' said Ms Tabberer, 'where are we going to stay?'

  1. Homing of hemopoietic precursor cells to the embryonic thymus: characterization of an invasive mechanism induced by chemotactic peptides

    PubMed Central

    1986-01-01

    During embryonic development, T cell precursors migrate to the thymus, where immunocompetency is acquired. Our previous studies have shown that avian hemopoietic precursor cells are recruited to the thymus by chemotactic peptides secreted by thymic epithelial cells (Champion, S., B. A. Imhof, P. Savagner, and J. P. Thiery, 1986, Cell, 44:781-790). In this study, we have characterized the homing of these precursor cells to the thymus in vivo by electron and light microscopy. Hemopoietic precursors could be seen to extravasate from blood or lymphatic vessels, migrate in the mesenchyme, traverse the perithymic basement membrane, and finally intercalate into the thymic epithelium. Labeled hemopoietic precursors injected into the blood circulation also followed the same pathway. Migrating hemopoietic precursor cells were found to express the fibronectin receptor complex. In the presence of thymic chemotactic peptides, hemopoietic precursors traverse a human amniotic basement membrane. This invasive process was inhibited by antibodies to laminin or to fibronectin, two major glycoproteins of the amniotic membrane, by monovalent Fab' fragments of antibodies to the fibronectin receptor, and, finally by synthetic peptides that contain the cell-binding sequence Arg-Gly-Asp-Ser of fibronectin. These results indicate that hemopoietic precursors respond to thymic chemotactic peptides by invasive behavior. Direct interactions between basement membrane components and fibronectin receptors appear to be required for this developmentally regulated invasion process. PMID:3793754

  2. Research in home care.

    PubMed

    Martin, K

    1988-06-01

    Past and present research in the home care setting predicts future trends. Home care research studies will continue to reflect social and economic issues of the future since research and researchers do not exist in a vacuum but are influenced by their era. Because of the generalized concern about economic stability and health care costs and the heightened interest in home care, investigations related to nursing interventions, client outcomes, and reimbursement will increase. As researchers search to identify long-term, positive client outcomes, the role of physical and psychosocial environmental factors will receive greater attention. Clients, too, do not exist in a vacuum but reflect the family and support systems which do, or do not, surround them. For home care research to serve as the scientific base for practice, continuing and increasing collaboration must occur between nursing service and education. More joint appointments or shared positions are likely as blending occurs in researchers' roles and nursing service staff assume more responsibility for research projects. The struggles involved with financial support of home care research will not cease. Home care researchers will continue to compete for funding with other nursing, health care, and research investigators. Specific strategies will enhance funding opportunities for home care nursing. These include: (1) increasing methodologic soundness, (2) increasing sophistication of studies and investigators, (3) publicizing findings and benefits of projects, and (4) developing a successful history of obtaining funding and conducting studies. Research in the home care setting will thrive if it attracts more and more nurses with scientific skills similar to those identified by Sir Medawar: "Among scientists are collectors, classifiers, and compulsive tidiers-up; many are detectives by temperament and many are explorers; some are artists and others artisans. There are poet-scientists and philosopher

  3. Home Care

    MedlinePlus

    ... also available to help with home assessment. Assistive Technology to improve home safety can also be an option. For example, necklace or wrist radio devices that allow the older person to call for help. There ... technologies can provide help in administering and tracking medications, ...

  4. Home Schooling.

    ERIC Educational Resources Information Center

    Gordon, William M.; And Others

    Cases that address the issue of home schooling are summarized in this report. Organized chronologically, each case description includes quoted material from the court ruling. Issues involve parent actions regarding compulsory student enrollment, parent qualifications for home teaching, student certification, church-state separation, constitutional…

  5. Home Groups.

    ERIC Educational Resources Information Center

    Stahler, Theresa M.

    All students enrolled in the entry level foundations course in the College of Education of Kutztown University (Pennsylvania) participate in home groups, a cooperative learning strategy. Each student is assigned to a five- or six-person home group on the first day of class. Although group placements are made on the basis of class lists, every…

  6. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...

  7. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...

  8. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...

  9. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...

  10. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...

  11. On-the-job training makes the difference: healthcare assistants' perceived competence and responsibility in the care of patients with home mechanical ventilation.

    PubMed

    Swedberg, Lena; Michélsen, Hans; Chiriac, Eva Hammar; Hylander, Ingrid

    2015-06-01

    To describe and analyse perceived competence and perceived responsibility among healthcare assistants (HC assistants), caring for patients with home mechanical ventilation (HMV) and other advanced caring needs, adjusted for socio-demographic and workplace background factors. A cross-sectional study was conducted including 128 HC assistants employed in Stockholm County, Sweden. The HC assistants responded to a study-specific questionnaire on perceived competence and perceived responsibility, provided socio-demographic and workplace background data, as well as information on the patient characteristics for the understanding of their work situations. Descriptive statistics and logistic regression analyses were performed. Eighty per cent of the HC assistants rated their perceived competence as high, and fifty-nine per cent rated their perceived responsibility as high. Fifty-five per cent lacked formal healthcare training, and only one in five of the HC assistants had a formal training equivalent with a licensed practical nurse (LPN) examination. Males lacked formal training to a greater extent than females and rated their competence accordingly. On-the-job training was significantly associated with high ratings on both perceived competence and perceived responsibility, and clinical supervision was associated with high rating on perceived responsibility. HC assistants with limited formal training self-reported their competence as high, and on-the-job training was found to be important. Also, clinical supervision was found important for their perception of high responsibility. In Sweden, HC assistants have a 24-hour responsibility for the care and safety of their patient with HMV and other advanced caring needs. The study results point out important issues for further research regarding formal training requirements as well as the needs for standardised workplace training and supervision of HC assistants. The consequences of transfer of responsibility by delegation from

  12. Housing and Home Furnishings. In-Depth Curriculum. Vocational Home Economics Education.

    ERIC Educational Resources Information Center

    Sawatzky, Joyce

    This curriculum guide for home economics instructors of eleventh and/or twelfth grade students builds on content received in Home Economics I and II, and provides a 12- to 18-week course of study designed to increase basic knowledge and develop skills in living space and its design, home selection and finance, housing exteriors and interiors,…

  13. Nursing Homes

    MedlinePlus

    ... estimated 50-70% of residents. More than three fourths of nursing-home residents have problems making daily ... to communicate the needs of the resident. Updated: July 2017 Posted: March 2012 © 2017 Health in Aging. ...

  14. IV treatment at home

    MedlinePlus

    ... venous catheter - home; Port - home; PICC line - home; Infusion therapy - home; Home health care - IV treatment ... is given quickly, all at once. A slow infusion, which means the medicine is given slowly over ...

  15. Residential Mechanical Precooling

    SciTech Connect

    German, a.; Hoeschele, M.

    2014-12-01

    This research conducted by the Alliance for Residential Building Innovation team evaluated mechanical air conditioner pre-cooling strategies in homes throughout the United States. EnergyPlus modeling evaluated two homes with different performance characteristics in seven climates. Results are applicable to new construction homes and most existing homes built in the last 10 years, as well as fairly efficient retrofitted homes.

  16. Nursing homes in China.

    PubMed

    Chu, Leung-Wing; Chi, Iris

    2008-05-01

    China will face a dramatic transition from a young to an aged society in the coming 30 to 40 years. In 2000, there were 88,110,000 persons aged 65 years and older, which represented 7% of the population. This percentage is projected to increase to 23% in 2050. Regarding health and long-term care for older adults, the current challenge is to build a comprehensive system of care for older adults. Nursing home care is an inevitable care model for frail older adults in China, which is largely sponsored by the government of China with contributions from some nongovernment organizations and private investors. China is a large country. Within the country, long-term care varies greatly between rural and urban areas, and among the different economic developing areas. In urban and better-developed areas, the range of services exists; however, in rural and less-developed areas, the range of services is limited. The "Star Light Program" and "Beloved Care Engineering" were recent government initiatives to improve aged care. They were launched in 2001 and have dramatically increased the number of both senior centers and nursing homes for older adults. While the quantity of nursing homes is still inadequate with an additional mismatch problem between the supply and demand, the quality of care in most nursing homes is suboptimal. At present, most administrative and frontline workers in nursing homes have received little training in elder care. There is a need for good-quality structured training in long-term care for all types of staff. Moreover, quality standard for care, including standard setting, assessment, and monitoring, is an important issue and needs substantial improvement for nursing homes in China. Currently, 1.5% of older people live in nursing homes and apartments for older people. Because of the peculiar 4-2-1 family structure in China, we expect the prevalence of nursing home placement of older adults will increase in the coming years. The government of China has

  17. Snails home

    NASA Astrophysics Data System (ADS)

    Dunstan, D. J.; Hodgson, D. J.

    2014-06-01

    Many gardeners and horticulturalists seek non-chemical methods to control populations of snails. It has frequently been reported that snails that are marked and removed from a garden are later found in the garden again. This phenomenon is often cited as evidence for a homing instinct. We report a systematic study of the snail population in a small suburban garden, in which large numbers of snails were marked and removed over a period of about 6 months. While many returned, inferring a homing instinct from this evidence requires statistical modelling. Monte Carlo techniques demonstrate that movements of snails are better explained by drift under the influence of a homing instinct than by random diffusion. Maximum likelihood techniques infer the existence of two groups of snails in the garden: members of a larger population that show little affinity to the garden itself, and core members of a local garden population that regularly return to their home if removed. The data are strongly suggestive of a homing instinct, but also reveal that snail-throwing can work as a pest management strategy.

  18. Home Insulation

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Under the Guaranteed Watt Savers (GWS) system, plans for a new home are computer analyzed for anticipated heat loss and gain. Specifications are specifically designed for each structure and a Smart- House Radiant Barrier is installed. Designed to reflect away 95% of the Sun's radiant energy, the radiant barrier is an adaptation of an aluminum shield used on Apollo spacecraft. On completion of a home, technicians using a machine, check for air tightness, by creating a vacuum in the house and computer calculations that measure the amount of air exchanged. A guarantee that only the specified number kilowatt hours will be used is then provided.

  19. Nursing Home Checklist

    MedlinePlus

    Nursing home checklist Name of nursing home: ____________________________________________________ Address: ________________________________________________________________ Phone number: __________________________________________________________ Date of visit: _____________________________________________________________ Basic information Yes No Notes Is the nursing home Medicare certified? Is the nursing ...

  20. 77 FR 26183 - Technical Revisions To Update Reference to the Required Assessment Tool for State Nursing Homes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-03

    ... Tool for State Nursing Homes Receiving Per Diem Payments From VA AGENCY: Department of Veterans Affairs... State homes that receive per diem from VA for providing nursing home care to veterans. It requires State nursing homes receiving per diem from VA to use the most recent version of the Centers for Medicare and...

  1. Home Economics.

    ERIC Educational Resources Information Center

    Ontario Dept. of Education, Toronto. School Planning and Building Research Section.

    This presentation of suggested layouts and specifications for home economics facilities has been prepared to be of service to school boards, architects, teachers, and administrators who are planning new schools or making renovations to existing structures. Room layouts are shown for a foods and nutrition room, or the foods and nutrition area of a…

  2. 7 CFR 226.12 - Administrative payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... for day care homes. 226.12 Section 226.12 Agriculture Regulations of the Department of Agriculture... day care homes. (a) General. Sponsoring organizations for day care homes shall receive payments for... organization's: (i) Initial 50 day care homes by 42 dollars; (ii) Next 150 day care homes by 32 dollars;...

  3. European Home Mechanical Ventilation Registry

    ClinicalTrials.gov

    2016-10-25

    Pulmonary Disease, Chronic Obstructive; Amyotrophic Lateral Sclerosis; Spinal Cord Injury; Muscular Dystrophies; Obesity Hypoventilation Syndrome; Kyphoscoliosis; Congenital Central Hypoventilation Syndrome; Duchenne Muscular Dystrophy; Myopathies; Myotonic Dystrophy

  4. Effects of manual rib-cage compression versus PEEP-ZEEP maneuver on respiratory system compliance and oxygenation in patients receiving mechanical ventilation.

    PubMed

    Santos, Flavio Renato Antunes Dos; Schneider Júnior, Luiz Carlos; Forgiarini Junior, Luiz Alberto; Veronezi, Jefferson

    2009-06-01

    Patients unable to perform breathing functions may be submitted to invasive mechanical ventilation. Chest physiotherapy acts directly on the treatment of these patients for the purpose of improving their lung function. The objective of this study was to evaluate the effects of manual rib-cage compression versus the positive end expiratory pressure-zero end expiratory pressure (PEEP-ZEEP) maneuver, on compliance of the respiratory system and oxygenation in patients under invasive mechanical ventilation. A double centric, prospective, randomized and crossover study, with patients under invasive mechanical ventilation, in controlled mode for more than 48 hours was carried out. The protocols of chest physiothe-rapy were randomly applied at an interval of 24 hours. Data of respiratory system compliance and oxygenation were collected before application of the protocols and 30 minutes after. Twelve patients completed the study. Intragroup analysis, for both techniques showed a statistically significant difference in tidal volume (p=0.002), static compliance (p=0.002) and dynamic compliance (p=0.002). In relation to oxygenation, in the group of manual rib-cage compression, peripheral oxygen saturation increased with a significant difference (p=0.011). Manual rib-cage compression and PEEP-ZEEP maneuver have positive clinical effects. In relation to oxygenation we found a favorable behavior of peripheral oxygen saturation in the group of manual rib-cage compression.

  5. Postpartum Mental Health Promotion: Perspectives from Mothers and Home Visitors.

    PubMed

    Chartier, Mariette J; Attawar, Dhiwya; Volk, Jennifer S; Cooper, Marion; Quddus, Farzana; McCarthy, Julie-Anne

    2015-01-01

    The object of this study was to examine the implementation of the Towards Flourishing Mental Health Promotion Strategy, a demonstration project designed to promote the mental well-being of parents and their children that was added to an existing public health home visiting program. Structured interviews were conducted with program stakeholders including 13 women receiving home visiting services in the postpartum period and 6 home visitors. Thematic analysis of individual transcripts was conducted and results were compiled according to common themes. The results indicate that women and home visitors perceived the integration of a mental health promotion strategy into an existing public health program as feasible, acceptable and useful. The strategy provides a mechanism for women and home visitors to dialog about mental health and appears to have early positive impacts on the women. Factors that facilitated and impeded the successful implementation of the strategy are described. These results point to promising strategies to reach women early in the postpartum period to support their mental health. They also shed light on the barriers to supporting mental health, indicating the need to address stigma related to mental health and the social determinants of health. © 2015 Wiley Periodicals, Inc.

  6. Communications Satellite Receiver Systems for Public Schools: A Technical Primer.

    ERIC Educational Resources Information Center

    Texas Education Agency, Austin.

    Designed to aid school districts contemplating use of some of the telecommunications services now available by satellite, this document contains information on home satellite receiving dishes (Television Receive-Only--TVROs), which can receive radio signals carrying television, sound, and data. This information includes: some factors involved in…

  7. Communications Satellite Receiver Systems for Public Schools: A Technical Primer.

    ERIC Educational Resources Information Center

    Texas Education Agency, Austin.

    Designed to aid school districts contemplating use of some of the telecommunications services now available by satellite, this document contains information on home satellite receiving dishes (Television Receive-Only--TVROs), which can receive radio signals carrying television, sound, and data. This information includes: some factors involved in…

  8. Home Health Care

    MedlinePlus

    ... Page Resize Text Printer Friendly Online Chat Home Health Care Home health care helps older adults live independently for as long ... need for long-term nursing home care. Home health care may include occupational and physical therapy, speech therapy, ...

  9. RETRACTED: Effect of early versus late or no tracheostomy on mortality of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis.

    PubMed

    Siempos, Ilias I; Ntaidou, Theodora K; Filippidis, Filippos T; Choi, Augustine M K

    2014-06-26

    Delay of tracheostomy for roughly 2 weeks after translaryngeal intubation of critically ill patients is the presently recommended practice and is supported by findings from large trials. However, these trials were suboptimally powered to detect small but clinically important effects on mortality. We aimed to assess the mortality benefit of early versus late or no tracheostomy in critically ill patients who need mechanical ventilation. We systematically searched PubMed, CINAHL, Embase, Web of Science, DOAJ, the Cochrane Library, references of relevant articles, scientific conference proceedings, and grey literature up to Aug 31, 2013, to identify randomised controlled trials comparing early tracheostomy (done within 1 week after translaryngeal intubation) with late (done any time after the first week of mechanical ventilation) or no tracheostomy and reporting on mortality or incidence of pneumonia in critically ill patients under mechanical ventilation. Our primary outcomes were all-cause mortality during the stay in the intensive-care unit and incidence of ventilator-associated pneumonia. We calculated pooled odds ratios (OR), pooled risk ratios (RR), and 95% CIs with a random-effects model. All but complications analyses were done on an intention-to-treat basis. Analyses of 13 trials (2434 patients, 800 deaths) showed that all-cause mortality in the intensive-care unit was significantly lower in patients assigned to the early versus the late or no tracheostomy group (OR 0·72, 95% CI 0·53-0·98; p=0·04). This finding represents an 18% reduction in the relative risk of death, translating to a 5% absolute improvement in survival (from 65% to 70%). This result persisted when we considered only trials with a low risk of bias (663 deaths; OR 0·68, 95% CI 0·49-0·95; p=0·02; eight trials with 1934 patients). There was no evidence of a difference between the compared groups for 1-year mortality (788 deaths; RR 0·93, 95% CI 0·85-1·02; p=0·14; three trials with

  10. Home Energy Score

    SciTech Connect

    2011-12-16

    The Home Energy Score allows a homeowner to compare her or his home's energy consumption to that of other homes, similar to a vehicle's mile-per-gallon rating. A home energy assessor will collect energy information during a brief home walk-through and then score that home on a scale of 1 to 10.

  11. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis.

    PubMed

    Siempos, Ilias I; Ntaidou, Theodora K; Filippidis, Filippos T; Choi, Augustine M K

    2015-02-01

    Delay of tracheostomy for roughly 2 weeks after translaryngeal intubation of critically ill patients is the presently recommended practice and is supported by findings from large trials. However, these trials were suboptimally powered to detect small but clinically important effects on mortality. We aimed to assess the benefit of early versus late or no tracheostomy on mortality and pneumonia in critically ill patients who need mechanical ventilation. We systematically searched PubMed, CINAHL, Embase, Web of Science, DOAJ, the Cochrane Library, references of relevant articles, scientific conference proceedings, and grey literature up to Aug 31, 2013, to identify randomised controlled trials comparing early tracheostomy (done within 1 week after translaryngeal intubation) with late (done any time after the first week of mechanical ventilation) or no tracheostomy and reporting on mortality or incidence of pneumonia in critically ill patients under mechanical ventilation. Our primary outcomes were all-cause mortality during the stay in the intensive-care unit and incidence of ventilator-associated pneumonia. Mortality during the stay in the intensive-care unit was a composite endpoint of definite intensive-care-unit mortality, presumed intensive-care-unit mortality, and 28-day mortality. We calculated pooled odds ratios (OR), pooled risk ratios (RR), and 95% CIs with a random-effects model. All but complications analyses were done on an intention-to-treat basis. Analyses of 13 trials (2434 patients, 648 deaths) showed that all-cause mortality in the intensive-care unit was not significantly lower in patients assigned to the early versus the late or no tracheostomy group (OR 0·80, 95% CI 0·59-1·09; p=0·16). This result persisted when we considered only trials with a low risk of bias (511 deaths; OR 0·80, 95% CI 0·59-1·09; p=0·16; eight trials with 1934 patients). Incidence of ventilator-associated pneumonia was lower in mechanically ventilated patients assigned

  12. Follow-up at the corrected age of 24 months of preterm newborns receiving continuous infusion of fentanyl for pain control during mechanical ventilation.

    PubMed

    Ancora, Gina; Lago, Paola; Garetti, Elisabetta; Pirelli, Anna; Merazzi, Daniele; Pierantoni, Luca; Ferrari, Fabrizio; Faldella, Giacomo

    2017-02-24

    The neurodevelopmental impact of fentanyl given to preterm newborns for pain control is still unknown. The aim of this study was to assess the neurodevelopmental impact of 2 regimens of fentanyl administration by a prospective follow-up evaluation. In our previous multicenter, double-blind, randomized controlled trial, 131 mechanically ventilated newborns (gestational age ≤32 weeks) were randomized to fentanyl (continuous infusion of fentanyl + open label boluses of fentanyl) or placebo (continuous infusion of placebo + open label boluses of fentanyl). Infant development was evaluated using Griffiths Mental Developmental Scales (Griffiths, 1996) until 24 months of corrected age by trained psychologists who were not aware of the group allocation. 106/131 infants survived at discharge; 3 died after discharge, 25 were lost to follow-up (12 in the fentanyl and 13 in the placebo group). Seventy-eight patients were evaluated at 2 years of corrected age. Children in the fentanyl group, compared with those in the placebo group, obtained significantly lower Griffiths general developmental quotient (mean [SD]: 89.95 [13.64] vs 97.18 [12.72], P = 0.024) together with the scores on the eye-hand coordination (mean [SD]: 89.09 [12.13] vs 99.19 [13.19], P = 0.002) and performance skills (mean [SD]: 79.71 [15.80] vs 90.09 [15.28], P = 0.009) scales. After adjustment for clinical confounders (gestational age, CRIB score, and sex) only eye-hand co-ordination was associated with fentanyl infusion. This study demonstrates that continuous infusion of fentanyl in very preterm infants, given at 1 mcg·kg·h during mechanical ventilation, is associated with a significant decrease in eye and hand co-ordination skills. Longer follow-up is needed to evaluate the impact on future motor, cognitive, and behavioral functions.

  13. Examining pediatric emergency home ventilation practices in home health nurses: Opportunities for improved care.

    PubMed

    Kun, Sheila S; Beas, Virginia N; Keens, Thomas G; Ward, Sally S L; Gold, Jeffrey I

    2015-07-01

    To assess the pediatric home health nurses' knowledge in tracheostomy and ventilator emergency care on home mechanical ventilation (HMV). Emergencies are frightening experiences for solo home health nurses and require advanced skills in emergency response and care, especially in pediatric patients who pose unique challenges. Nurses with greater years of nursing experience would perform better on emergency HMV case-based scenarios than nurses with less years of experience. An exploratory online survey was used to evaluate emergency case-based pediatric scenarios. Demographic and professional experiences were profiled. Seventy-nine nurses had an average of 6.73 (SD = 1.41) years in pediatric nursing. Over 70% received their HMV training in their agency, 41% had less than 4 years of experience, and 30.4% had encountered at least one emergency situation at home. The online survey was distributed by managers of 22 home health agencies to nurses providing pediatric HMV care. Nurses scored an average of 4.87 out of 10 possible points. There were no significant differences between nurses with <4 years of experience versus those with more experience on ventilator alarms knowledge or total knowledge. Ninety-seven percent of the nurses favored more training in HMV from a variety of settings (e.g., agency, on-line training). Nurses did not perform well in case-based ventilator alarm scenarios. Length of nursing experience did not differentiate greater knowledge. It is clear that nurses require and want more training in emergency-based HMV. Recommendations for an enhanced curriculum are suggested. © 2014 Wiley Periodicals, Inc.

  14. Putting the "receive" in accounts receivable.

    PubMed

    McDaniel, John W; Baum, Neil

    2006-01-01

    There isn't a practice in the United States that doesn't have a concern about accounts receivable. The financial success of any practice depends on the care and feeding of the accounts receivable. This is not an area of practice management that can be taken lightly or delegated to someone who is not attentive to detail and doggedly persistent. In this article, we will discuss how to identify problematic accounts receivable and what can be done to bring the accounts receivable under control. We will provide you with a plan of action that can be adopted by any practice regardless of size, number of physicians, or whether the practice uses in-house billing or outsources its billing arrangements.

  15. Comparing the Similarity of Responses Received from Studies in Amazon’s Mechanical Turk to Studies Conducted Online and with Direct Recruitment

    PubMed Central

    Bartneck, Christoph; Duenser, Andreas; Moltchanova, Elena; Zawieska, Karolina

    2015-01-01

    Computer and internet based questionnaires have become a standard tool in Human-Computer Interaction research and other related fields, such as psychology and sociology. Amazon’s Mechanical Turk (AMT) service is a new method of recruiting participants and conducting certain types of experiments. This study compares whether participants recruited through AMT give different responses than participants recruited through an online forum or recruited directly on a university campus. Moreover, we compare whether a study conducted within AMT results in different responses compared to a study for which participants are recruited through AMT but which is conducted using an external online questionnaire service. The results of this study show that there is a statistical difference between results obtained from participants recruited through AMT compared to the results from the participant recruited on campus or through online forums. We do, however, argue that this difference is so small that it has no practical consequence. There was no significant difference between running the study within AMT compared to running it with an online questionnaire service. There was no significant difference between results obtained directly from within AMT compared to results obtained in the campus and online forum condition. This may suggest that AMT is a viable and economical option for recruiting participants and for conducting studies as setting up and running a study with AMT generally requires less effort and time compared to other frequently used methods. We discuss our findings as well as limitations of using AMT for empirical studies. PMID:25876027

  16. Tracing Changes in Families Who Participated in the Home-Start Parenting Program: Parental Sense of Competence as Mechanism of Change

    PubMed Central

    Asscher, Jessica J.; Hermanns, Jo; Reitz, Ellen; Prinzie, Peter; van den Akker, Alithe L.

    2010-01-01

    The present study aimed to (1) determine the long-term effectiveness of Home-Start, a preventive parenting program, and (2) test the hypothesis that changes in maternal sense of competence mediate the program’s effects. Participants were 124 mothers (n = 66 intervention, n = 58 comparison). Four assessments took place during a 1-year period. Latent growth modeling showed that Home-Start enhanced growth in maternal sense of competence and supportive parenting, and led to a decrease in the use of inept discipline. Results of mediational and cross-lagged analyses were consistent with the hypothesized model: Participation in Home-Start was related to the changes in maternal sense of competence, which in turn predicted changes in parenting. The results affirm the importance of directly targeting parental sense of competence in the context of prevention work with parents. PMID:20101464

  17. Tracing changes in families who participated in the home-start parenting program: parental sense of competence as mechanism of change.

    PubMed

    Deković, Maja; Asscher, Jessica J; Hermanns, Jo; Reitz, Ellen; Prinzie, Peter; van den Akker, Alithe L

    2010-09-01

    The present study aimed to (1) determine the long-term effectiveness of Home-Start, a preventive parenting program, and (2) test the hypothesis that changes in maternal sense of competence mediate the program's effects. Participants were 124 mothers (n = 66 intervention, n = 58 comparison). Four assessments took place during a 1-year period. Latent growth modeling showed that Home-Start enhanced growth in maternal sense of competence and supportive parenting, and led to a decrease in the use of inept discipline. Results of mediational and cross-lagged analyses were consistent with the hypothesized model: Participation in Home-Start was related to the changes in maternal sense of competence, which in turn predicted changes in parenting. The results affirm the importance of directly targeting parental sense of competence in the context of prevention work with parents.

  18. Foraging optimally for home ranges

    USGS Publications Warehouse

    Mitchell, Michael S.; Powell, Roger A.

    2012-01-01

    Economic models predict behavior of animals based on the presumption that natural selection has shaped behaviors important to an animal's fitness to maximize benefits over costs. Economic analyses have shown that territories of animals are structured by trade-offs between benefits gained from resources and costs of defending them. Intuitively, home ranges should be similarly structured, but trade-offs are difficult to assess because there are no costs of defense, thus economic models of home-range behavior are rare. We present economic models that predict how home ranges can be efficient with respect to spatially distributed resources, discounted for travel costs, under 2 strategies of optimization, resource maximization and area minimization. We show how constraints such as competitors can influence structure of homes ranges through resource depression, ultimately structuring density of animals within a population and their distribution on a landscape. We present simulations based on these models to show how they can be generally predictive of home-range behavior and the mechanisms that structure the spatial distribution of animals. We also show how contiguous home ranges estimated statistically from location data can be misleading for animals that optimize home ranges on landscapes with patchily distributed resources. We conclude with a summary of how we applied our models to nonterritorial black bears (Ursus americanus) living in the mountains of North Carolina, where we found their home ranges were best predicted by an area-minimization strategy constrained by intraspecific competition within a social hierarchy. Economic models can provide strong inference about home-range behavior and the resources that structure home ranges by offering falsifiable, a priori hypotheses that can be tested with field observations.

  19. Utility of video consultation to improve the outcomes of home enteral nutrition in a population of frail older patients.

    PubMed

    Orlandoni, Paolo; Jukic Peladic, Nikolina; Spazzafumo, Liana; Venturini, Claudia; Cola, Claudia; Sparvoli, Debora; Giorgini, Natascia; Basile, Redenta; Fagnani, Donata

    2016-06-01

    To determine whether the outcomes of home enteral nutrition for frail older patients can be improved by video consultation between home visiting staff and a hospital physician, specialized in clinical nutrition, during monthly home visits. A randomized prospective study out of patients aged older than 65 years receiving home enteral nutrition from the Department of Clinical Nutrition of an Italian geriatric hospital in 2013 was carried. A total of 100 patients were randomly assigned to receive video consultation in addition to regular monthly home visits, 88 patients only had regular monthly home visits. Therapy outcomes - incidence rates of complications, outpatient hospital visits and hospitalizations - were compared between two groups. A logistic regression analysis was carried out to evaluate the usefulness of the video consultation to improve therapy outcomes. Incidence rates for metabolic and gastrointestinal complications were significantly lower for patients who received a video consultation, respectively: 0.032/year "video consultation" versus 0.055/year "no video consultation" (P = 0.0001) and 0.006/year "video consultation" versus 0.028/year "no video consultation" (P < 0.0001). No differences were found for incidence rates of mechanical complications, outpatient hospital visits and hospitalizations. Logistic regression showed that the video consultation was significantly correlated with a reduction of metabolic complications (OR 2.63, 95% CI 1.00-6.91; P = 0.049 after adjustment for duration of home enteral nutrition and diabetes mellitus 2). The present study provides evidence that a video consultation between home visiting staff and hospital physicians specialized in clinical nutrition during monthly home visits is associated with a reduction of metabolic complications in a population of frail older patients. Geriatr Gerontol Int 2015; ●●: ●●-●●. © 2015 Japan Geriatrics Society.

  20. TRANSPORT OF LAWN-APPLIED 2,4-D FROM TURF TO HOME: ASSESSING THE RELATIVE IMPORTANCE OF TRANSPORT MECHANISMS AND EXPOSURE PATHWAYS

    EPA Science Inventory

    Transport of 2,4-D from the residential lawn into the home was measured following both homeowner and commercial application of this herbicide. Collection of floor dust in five rooms of each house, both prior to and after application, indicated that turf residues are transported...

  1. Mechanisms of homing in the fiddler crab Uca rapax. 1. Spatial and temporal characteristics of a system of small-scale navigation.

    PubMed

    Layne, John E; Barnes, W Jon P; Duncan, Lindsey M J

    2003-12-01

    Fiddler crabs Uca rapax are central-place foragers, making feeding excursions of up to 2 m from their burrows. We describe the natural feeding excursions of path-integrating fiddler crabs and analyze their paths for signs of significant systematic or random navigation errors. No signs of any systematic errors are evident. Random errors are small, probably due to a combination of the short length and low sinuosity of the foraging paths, as well as the fiddler crabs' unique method of locomotion that allows them to remain oriented to their burrows throughout the foraging path and to minimize large body turns. We further examined the extent to which their body orientation during foraging (transverse body axis pointing more or less towards home) accurately represented their stored home vector. By examining sequences of fast escape, we have shown that crabs can correct for deviations of their transverse body axis from home during their escape path. Thus their stored home vector is independent of their moment-to-moment body orientation. Crabs were subjected to passive translational displacements and barrier obstructions. Responses to translational displacements were identical to those observed by previous authors, namely that crabs returned in the correct egocentric direction and distance as though no displacement had occurred. Covering the burrow entrance resulted in crabs returning to the correct position of the burrow, and then beginning to search. When a barrier was placed between foraging crabs and their burrow, crabs oriented their bodies toward the burrow as accurately as with no barrier.

  2. TRANSPORT OF LAWN-APPLIED 2,4-D FROM TURF TO HOME: ASSESSING THE RELATIVE IMPORTANCE OF TRANSPORT MECHANISMS AND EXPOSURE PATHWAYS

    EPA Science Inventory

    Transport of 2,4-D from the residential lawn into the home was measured following both homeowner and commercial application of this herbicide. Collection of floor dust in five rooms of each house, both prior to and after application, indicated that turf residues are transported...

  3. [New system for testing mechanical heart valves. Self-monitoring at home of anti-vitamin K therapy means greater freedom for the patient].

    PubMed

    Svensson, P J; Follrud, C; Thulin, L; Berntorp, E

    1999-05-19

    Self-monitoring of anti-vitamin K treatment by patients with heart valve prostheses is a good alternative to hospital control. Self-monitoring at home allows patients more freedom and opportunity to take greater responsibility for their treatment. Experience from over a years' complication-free treatment of 12 patients is reported in the article.

  4. Frequency and management of respiratory incidents in invasive home ventilation.

    PubMed

    Stieglitz, Sven; George, Sandhya; Priegnitz, Christina; Hagmeyer, Lars; Randerath, Winfried

    2013-08-01

    There has been a rise in the number of patients requiring long-term ventilation, both in the in-hospital and the out-of-hospital setting. Despite this, little is known about the subsequent clinical course of these patients following hospital discharge. The purpose of this study was to determine the frequency and management of respiratory incidents in patients with invasive out-of-hospital ventilation living in a nursing home allied to a weaning centre. We evaluated retrospectively the protocols that are used to monitor the patients over a period of 2 months. The average time from hospital discharge was 386 ± 330 days. Of the total 17 patients, 9 (53%) patients remained free from any respiratory incidents, while the remaining 8 (47%) patients were responsible for a total of 95 respiratory incidents. Patients that suffered respiratory incidents had been ventilated at home for an average of 194 days, while the others were receiving out-of-hospital ventilation for an average of 557 days. Desaturation (17), dyspnoea (17) and reduced general condition (10) were the most common respiratory incidents. Also, the use of an Ambu bag (bag valve mask; 17), request for a pneumologist review (12) and replacement of the tracheal cannula (7) were the most common interventions. Respiratory incidents are common in invasive home mechanical ventilation, and so home mechanical ventilation needed to be organized safely. Being allied to a weaning centre helps to organize invasive home mechanical ventilation in a safe manner over the long-term ventilation.

  5. Spaceborne receivers: Basic principles

    NASA Technical Reports Server (NTRS)

    Stacey, J. M.

    1984-01-01

    The underlying principles of operation of microwave receivers for space observations of planetary surfaces were examined. The design philosophy of the receiver as it is applied to operate functionally as an efficient receiving system, the principle of operation of the key components of the receiver, and the important differences among receiver types are explained. The operating performance and the sensitivity expectations for both the modulated and total power receiver configurations are outlined. The expressions are derived from first principles and are developed through the important intermediate stages to form practicle and easily applied equations. The transfer of thermodynamic energy from point to point within the receiver is illustrated. The language of microwave receivers is applied statistics.

  6. Solar heat receiver

    DOEpatents

    Hunt, A.J.; Hansen, L.J.; Evans, D.B.

    1982-09-29

    A receiver is described for converting solar energy to heat a gas to temperatures from 700 to 900/sup 0/C. The receiver is formed to minimize impingement of radiation on the walls and to provide maximum heating at and near the entry of the gas exit. Also, the receiver is formed to provide controlled movement of the gas to be heated to minimize wall temperatures. The receiver is designed for use with gas containing fine heat absorbing particles, such as carbon particles.

  7. Solar heat receiver

    DOEpatents

    Hunt, Arlon J.; Hansen, Leif J.; Evans, David B.

    1985-01-01

    A receiver for converting solar energy to heat a gas to temperatures from 700.degree.-900.degree. C. The receiver is formed to minimize impingement of radiation on the walls and to provide maximum heating at and near the entry of the gas exit. Also, the receiver is formed to provide controlled movement of the gas to be heated to minimize wall temperatures. The receiver is designed for use with gas containing fine heat absorbing particles, such as carbon particles.

  8. Nursing home ownership: an historical analysis.

    PubMed

    Kaffenberger, K R

    2000-01-01

    The need to care for dependent elderly in the United States has been a constant since colonial times. Today, as in the earliest days, most care is provided at home by family members. Personal and health services outside the home are sometimes provided by nursing homes. The nursing home industry is large, dominated by private, for-profit ownership, and receives much of its income from public funds. Why are nursing homes publicly funded? Why are nursing homes privately rather than publicly owned? Why is ownership for-profit or proprietary rather than not-for-profit or voluntary? The answers to these questions are found in the history of social policies in the United States.

  9. A clinical trial of in-home CBT for depressed mothers in home visitation.

    PubMed

    Ammerman, Robert T; Putnam, Frank W; Altaye, Mekibib; Stevens, Jack; Teeters, Angelique R; Van Ginkel, Judith B

    2013-09-01

    Despite negative outcomes for depressed mothers and their children, no treatment specifically designed to address maternal depression in the context of home visitation has emerged. In-Home Cognitive Behavioral Therapy (IH-CBT) is an adapted treatment that is delivered in the home, focuses on the needs of new mothers, and leverages ongoing home visiting to optimize engagement and outcomes. This study examined the efficacy of IH-CBT using a randomized clinical trial. Subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3months postpartum were randomized into IH-CBT and ongoing home visitation (n=47) or standard home visitation (SHV; n=46) in which they received home visitation alone and could obtain treatment in the community. Depression was measured at pre- and posttreatment, and 3-month follow-up using interviews, clinician ratings, and self-report. Mothers receiving IH-CBT showed improvements in all indicators of depression relative to the SHV condition and these gains were maintained at follow-up. For example, 70.7% of mothers receiving IH-CBT were no longer depressed at posttreatment in terms of meeting criteria for major depressive disorder compared to 30.2% in the SHV group. These findings suggest that IH-CBT is an efficacious treatment for depressed mothers in home visitation programs. Copyright © 2013. Published by Elsevier Ltd.

  10. A Clinical Trial of In-Home CBT for Depressed Mothers in Home Visitation

    PubMed Central

    Ammerman, Robert T.; Putnam, Frank W.; Altaye, Mekibib; Stevens, Jack; Teeters, Angelique R.; Van Ginkel, Judith B.

    2013-01-01

    Despite negative outcomes for depressed mothers and their children, no treatment specifically designed to address maternal depression in the context of home visitation has emerged. In-Home Cognitive Behavioral Therapy (IH-CBT) is an adapted treatment that is delivered in the home, focuses on the needs of new mothers, and leverages ongoing home visiting to optimize engagement and outcomes. This study examined the efficacy of IH-CBT using a randomized clinical trial. Subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3 months postpartum were randomized into IH-CBT and ongoing home visitation (n=47) or standard home visitation (SHV; n=46) in which they received home visitation alone and could obtain treatment in the community. Depression was measured at pre- and posttreatment, and 3-month follow-up using interviews, clinician ratings, and self-report. Mothers receiving IH-CBT showed improvements in all indicators of depression relative to the SHV condition and these gains were maintained at follow-up. For example, 70.7% of mothers receiving IH-CBT were no longer depressed at posttreatment in terms of meeting criteria for major depressive disorder compared to 30.2% in the SHV group. These findings suggest that IH-CBT is an efficacious treatment for depressed mothers in home visitation programs. PMID:23768664

  11. Home-range allometry in coral reef fishes: comparison to other vertebrates, methodological issues and management implications.

    PubMed

    Nash, Kirsty L; Welsh, Justin Q; Graham, Nicholas A J; Bellwood, David R

    2015-01-01

    Body size has been identified as a key driver of home-range area. Despite considerable research into home-range allometry, the relatively high variability in this relationship among taxa means that the mechanisms driving this relationship are still under debate. To date, studies have predominantly focused on terrestrial taxa, and coral reef fishes in particular have received little attention. We quantitatively reviewed studies examining home range in reef fishes, and assessed the interspecific relationship between body mass and home-range area. Body mass and home range are positively related in reef fishes (slopes of 1.15-1.72), with predators having larger home ranges than herbivorous species. This may be attributed to the mobility and lower abundance of predators' food items. Coral reef fishes, and fishes in general, appear to occupy a smaller area per unit mass than terrestrial vertebrates (intercepts of -0.92 to 0.07 versus ≥1.14). This is likely linked to the relative metabolic costs of moving through water compared to air. The small home ranges of reef fishes and their apparent reluctance to cross open areas suggest that reserves aimed at protecting fish species may be more effective if located across whole reefs, even if those reefs are comparatively small, rather than if they cover subsections of contiguous reef, as home ranges in the former are less likely to cross reserve boundaries.

  12. Assessment of Anxiety in Older Home Care Recipients

    ERIC Educational Resources Information Center

    Diefenbach, Gretchen J.; Tolin, David F.; Meunier, Suzanne A.; Gilliam, Christina M.

    2009-01-01

    Purpose: This study determined the psychometric properties of a variety of anxiety measures administered to older adults receiving home care services. Design and Methods: Data were collected from 66 adults aged 65 years and older who were receiving home care services. Participants completed self-report and clinician-rated measures of anxiety and…

  13. Assessment of Anxiety in Older Home Care Recipients

    ERIC Educational Resources Information Center

    Diefenbach, Gretchen J.; Tolin, David F.; Meunier, Suzanne A.; Gilliam, Christina M.

    2009-01-01

    Purpose: This study determined the psychometric properties of a variety of anxiety measures administered to older adults receiving home care services. Design and Methods: Data were collected from 66 adults aged 65 years and older who were receiving home care services. Participants completed self-report and clinician-rated measures of anxiety and…

  14. Genetics Home Reference

    MedlinePlus

    ... MENU Toggle navigation Home Page Search Share: Email Facebook Twitter Home Health Conditions Genes Chromosomes & mtDNA Resources Help Me Understand Genetics Genetics Home Reference provides consumer-friendly information about the effects of genetic variation ...

  15. Genetics Home Reference

    MedlinePlus

    Skip Navigation Bar Home Current Issue Past Issues Genetics Home Reference Past Issues / Spring 2007 Table of ... of this page please turn Javascript on. The Genetics Home Reference (GHR) Web site — ghr.nlm.nih. ...

  16. Respiratory Home Health Care

    MedlinePlus

    ... Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources Immunizations Pollution Nutrition ... Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at home can contribute to improved ...

  17. Home Care Services

    MedlinePlus

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

  18. Exercise at Home

    MedlinePlus

    ... Home Health Insights Exercise & Weight Exercise at Home Exercise at Home Make an Appointment Ask a Question ... with the movement and contact your provider. Posture Exercises Better posture means better breathing and movement. Axial ...

  19. Exercise at Home

    MedlinePlus

    ... Training Home Health Insights Exercise Exercise at Home Exercise at Home Make an Appointment Ask a Question ... with the movement and contact your provider. Posture Exercises Better posture means better breathing and movement. Axial ...

  20. Eldercare at Home: Choosing a Nursing Home

    MedlinePlus

    ... you see smoke detectors, sprinkler systems, and emergency lighting? Does the home have a security system to ... wheelchairs to move around the home? Is the lighting appropriate for what residents are doing? Are there ...

  1. Relationships, Expertise, Incentives, and Governance: Supporting Care Home Residents' Access to Health Care. An Interview Study From England

    PubMed Central

    Goodman, Claire; Davies, Sue L.; Gordon, Adam L.; Meyer, Julienne; Dening, Tom; Gladman, John R.F.; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C.

    2015-01-01

    Objectives To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Methods Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Results Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. Conclusion The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations. PMID:25687930

  2. Relationships, expertise, incentives, and governance: supporting care home residents' access to health care. An interview study from England.

    PubMed

    Goodman, Claire; Davies, Sue L; Gordon, Adam L; Meyer, Julienne; Dening, Tom; Gladman, John R F; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C

    2015-05-01

    To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All

  3. Intravenous enzyme replacement therapy: hospital vs home.

    PubMed

    Parini, Rossella; Pozzi, Katia; Di Mauro, Stefania; Furlan, Francesca; Rigoldi, Miriam

    Two surveys were carried out to establish the status of enzyme replacement therapy (ERT) for lysosomal storage diseases in Italy. The first was a national survey covering the regional reference centres (RRCs) for these diseases; replies disclosed that 57.7% of patients are on ERT, administered almost exclusively in hospital settings (local hospital 60.7%, RRC 34.8%, home 2.6%); Italian health service procedures do not support ERT at home. The second survey was a regional survey in Lombardy, involving 48 patients (six of whom were on ERT at home). According to 40% of the patients, hospital-based ERT is disruptive, causing loss of days at school/work, stress and family issues. The patients on home therapy did not have these problems. However, 93% of patients receiving ERT in hospital perceived the advantages of greater safety, closer monitoring and more support from health professionals and experts. A total of 55% were willing to receive ERT at home, but 33% were against it. This may be the result of a lack of experience with ERT at home in Italy, or because of different opinions between family members and physicians. As international experience shows that ERT at home saves healthcare resources and improves quality of life, the issue should be raised with Italian healthcare policy makers, who should ensure nursing support for home-based ERT.

  4. Data-fusion receiver

    SciTech Connect

    Gabelmann, Jeffrey M.; Kattner, J. Stephen; Houston, Robert A.

    2006-12-19

    This invention is an ultra-low frequency electromagnetic telemetry receiver which fuses multiple input receive sources to synthesize a decodable message packet from a noise corrupted telemetry message string. Each block of telemetry data to be sent to the surface receiver from a borehole tool is digitally encoded into a data packet prior to transmission. The data packet is modulated onto the ULF EM carrier wave and transmitted from the borehole to the surface and then are simultaneously detected by multiple receive sensors disbursed within the rig environment. The receive sensors include, but are not limited to, electric field and magnetic field sensors. The spacing of the surface receive elements is such that noise generators are unequally coupled to each receive element due to proximity and/or noise generator type (i.e. electric or magnetic field generators). The receiver utilizes a suite of decision metrics to reconstruct the original, non noise-corrupted data packet from the observation matrix via the estimation of individual data frames. The receiver will continue this estimation process until: 1) the message validates, or 2) a preset "confidence threshold" is reached whereby frames within the observation matrix are no longer "trusted".

  5. Hybrid receiver study

    NASA Technical Reports Server (NTRS)

    Stone, M. S.; Mcadam, P. L.; Saunders, O. W.

    1977-01-01

    The results are presented of a 4 month study to design a hybrid analog/digital receiver for outer planet mission probe communication links. The scope of this study includes functional design of the receiver; comparisons between analog and digital processing; hardware tradeoffs for key components including frequency generators, A/D converters, and digital processors; development and simulation of the processing algorithms for acquisition, tracking, and demodulation; and detailed design of the receiver in order to determine its size, weight, power, reliability, and radiation hardness. In addition, an evaluation was made of the receiver's capabilities to perform accurate measurement of signal strength and frequency for radio science missions.

  6. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing home...

  7. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing home...

  8. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing home...

  9. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing home...

  10. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing home...

  11. UWB communication receiver feedback loop

    DOEpatents

    Spiridon, Alex; Benzel, Dave; Dowla, Farid U.; Nekoogar, Faranak; Rosenbury, Erwin T.

    2007-12-04

    A novel technique and structure that maximizes the extraction of information from reference pulses for UWB-TR receivers is introduced. The scheme efficiently processes an incoming signal to suppress different types of UWB as well as non-UWB interference prior to signal detection. Such a method and system adds a feedback loop mechanism to enhance the signal-to-noise ratio of reference pulses in a conventional TR receiver. Moreover, sampling the second order statistical function such as, for example, the autocorrelation function (ACF) of the received signal and matching it to the ACF samples of the original pulses for each transmitted bit provides a more robust UWB communications method and system in the presence of channel distortions.

  12. Home Page, Sweet Home Page: Creating a Web Presence.

    ERIC Educational Resources Information Center

    Falcigno, Kathleen; Green, Tim

    1995-01-01

    Focuses primarily on design issues and practical concerns involved in creating World Wide Web documents for use within an organization. Concerns for those developing Web home pages are: learning HyperText Markup Language (HTML); defining customer group; allocating staff resources for maintenance of documents; providing feedback mechanism for…

  13. Right to Receive.

    ERIC Educational Resources Information Center

    Oborn, Richard

    The concept of a United States citizen's right to receive information is acquiring increased judicial recognition. This report traces the evolution of that right from its philosophical basis in the United States Consitution, through its interpretation by the Supreme Court, up to the current concern that the public receive certain economic…

  14. Flight termination receiver catalog

    NASA Astrophysics Data System (ADS)

    1993-02-01

    This catalog provides reference information on ultra-high frequency flight termination receivers used at various U.S. missile ranges and test facilities. It is not intended to be a comprehensive review of all available flight termination receivers. Inclusion in this catalog does not constitute approval or endorsement for use at any government installation. Information in this catalog was extracted from manufacturers' specifications.

  15. Marie Curie nurses: enabling patients with cancer to die at home.

    PubMed

    Higginson, Irene J; Wilkinson, Susie

    2002-05-01

    Marie Curie Cancer Care established its nursing service in 1958; however, the service has had little formal evaluation. This study aimed to describe and evaluate the care provided by Marie Curie nurse, and in particular to determine whether patients in their care remained and died at home. Two existing data sets were used: data on all patients referred to the Marie Curie Nursing Services in 147 areas of England, Wales, Scotland and Northern Ireland for 26 months, and data on cancer death registrations in England. A request for a Marie Curie nurse was made for 26,632 patients, 97% of whom had cancer and 11% of whom lived alone. The amount of care provided varied enormously (<1 hour-2862 hours), although the vast majority of patients less than 300 hours of nursing care. Place of death was recorded for only half these patients; 94% died at home, 2.5% in a hospice, 2.3% in a hospital, 0.2% in a nursing home and 0.6% other. Home death was most often associated with patients receiving medication via a syringe driver, patients living with other people, patients with cancer, other than prostate cancer, shorter time between referral and death and younger age. The results lend support to the theory that the care given to patients in their homes by Marie Curie nurses facilitated home death for many patients. Services need to ensure that mechanisms are in place to achieve data collection. Rigorous prospective evaluation is needed in the future.

  16. Caring at home until death: enabled determination.

    PubMed

    Robinson, Carole A; Bottorff, Joan L; McFee, Erin; Bissell, Laura J; Fyles, Gillian

    2017-04-01

    The importance of family caregivers in providing palliative care at home and in supporting a home death is well supported. Gaining a better understanding of what enables palliative family caregivers to continue caring at home for their family members until death is critical to providing direction for more effective support. The purpose of the study was to describe the experiences of bereaved family caregivers whose terminally ill family members with advanced cancer were successful in achieving a desired home death. A qualitative interpretive descriptive approach was used. Data were collected using semi-structured, audio-recorded interviews conducted in-person or via telephone in addition to field notes and reflective journaling. The study took place in British Columbia, Canada, and included 29 bereaved adult family caregivers who had provided care for a family member with advanced cancer and experienced a home death. Four themes captured the experience of caring at home until death: context of providing care, supportive antecedents to providing care, determination to provide care at home, and enabled determination. Factors that enabled determination to achieve a home death included initiation of formal palliative care, asking for and receiving help, augmented care, relief or respite, and making the healthcare system work for the ill person. Clarifying caregiving goals and supporting the factors that enable caregiver determination appear to be critical in enhancing the likelihood of a desired home death.

  17. Flight termination receiver catalog

    NASA Astrophysics Data System (ADS)

    1984-07-01

    This catalog provides reference information on ultrahigh-frequency flight termination receivers used at various U.S. missile ranges and test facilities. It is not intended to be a comprehensive review of all available flight termination receivers, and inclusion of hardware in this catalog does not constitute approval or endorsement for use at any government installation. Use of a specific receiver at a missile range or test facility requires the approval of the Commander of that installation. Approval for use of a particular receiver on a given missile at one installation does not constitute automatic approval for use of the same receiver on other missiles at the same installation or on the same missile at other installations. The information in this catalog has been extracted from manufacturers' specifications. It is provided as reference material only and is not intended as an endorsement of any model.

  18. [Are domiciliary care patients receiving adequate thromboprophylaxis?].

    PubMed

    Cátedra, B; Muñoz, F; Cabello, L

    2014-01-01

    The study aims to determine the percentage of patients treated at home with an indication of prophylaxis of thromboembolic disease (TED) according to the PRETEMED guidelines and whether they receive such prophylaxis. A cross-sectional descriptive study was conducted in Segovia Palace Health Centre (Madrid). to be included in the domiciliary care protocol. terminal patient, hospitalised or surgery in the last 3 months. The variables used include, age, sex, duration of domiciliary care, mobility, anticoagulant or antiplatelet treatment and reason, and associated and precipitating factors to calculate the risk of TED according to the PRETEMED guidelines, and if they receive such prophylaxis, by reviewing computerised medical records and meeting with the staff responsible. The study included a total of 187 patients, of whom 81% were women There was a significant differences in mean age by sex (men, 76.91 years, 95% CI; 72.59-81.24, and women, 86.72 years, 95% CI; 72.59-81.24, P<.05). Almost two-thirds (65%) walked in the home. There were 3.7% patients who had an indication for receiving prophylaxis, but did not receive it, although 85.8% of them were on anticoagulants or antiplatelet therapy for other reasons. Most patients in domiciliary care have a low baseline risk of developing a TED episode in our study. There should be more emphasis placed on the prophylaxis of TED in acute medical episodes in which patients with slightly elevated risk may increase the likelihood of TED. Observational studies should be conducted to study the baseline risk and the subsequent development of TED in the population receiving home care. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  19. (Home Economics Education).

    ERIC Educational Resources Information Center

    Clark, Virginia; And Others

    1988-01-01

    Consists of six articles on home economics education, with some emphasis on Hawaiian education. Topics include (1) home economics history; (2) the secondary curriculum; (3) teaching practical reasoning; (4) the basics in Hawaiian home economics; (5) teaching family living and human relations; and (6) changes in home economics. (CH)

  20. Effectiveness of Home Study.

    ERIC Educational Resources Information Center

    Diehl, Grover E.; And Others

    Home study has enjoyed a slow but steady growth in popularity and acceptance. The growth of independent home study may be attributed to both the realities of the present educational environment and the consistently positive results of the home study method. At least one researcher has suggested that the initially slow growth of home study may have…

  1. CALUTRON RECEIVER STRUCTURE

    DOEpatents

    Roush, J.L.

    1959-09-01

    A receiver is described for collecting isotopes in a calutron The receiver has several compartments, formed by a sertes of parallel metal plates and an open front. Each plate has flanges which space it from the other plates and a flexible extension pressing against a common supporting red to maintain the plate in assembled relation when all but the last rod is removed. The plates may be removed individualy from the front of the receiver, cleaned ard replaced without disturbing the alignment of the other plates.

  2. 30-micron heterodyne receiver

    NASA Technical Reports Server (NTRS)

    Kostiuk, Theodor; Spears, David L.

    1987-01-01

    Advantages and constraints of remote measurements using heterodyne spectroscopy near 30 microns are discussed. The state of the art of wideband HgCdTe photomixers and PbSnSe diode-laser local oscillators being developed for FIR heterodyne receivers is described. The first compact 30-micron heterodyne radiometer was built, and initial results at 28-microns show about 2-percent mixer efficiency for a 500-MHz-bandwidth receiver. Factors limiting receiver performance are discussed, along with the projected sensitivity of new interdigitated-electrode HgCdTe photoconductor mixers being developed for operation up to 200 microns.

  3. Ultrasonic pulser-receiver

    DOEpatents

    Taylor, Steven C.

    2006-09-12

    Ultrasonic pulser-receiver circuitry, for use with an ultrasonic transducer, the circuitry comprising a circuit board; ultrasonic pulser circuitry supported by the circuit board and configured to be coupled to an ultrasonic transducer and to cause the ultrasonic transducer to emit an ultrasonic output pulse; receiver circuitry supported by the circuit board, coupled to the pulser circuitry, including protection circuitry configured to protect against the ultrasonic pulse and including amplifier circuitry configured to amplify an echo, received back by the transducer, of the output pulse; and a connector configured to couple the ultrasonic transducer directly to the circuit board, to the pulser circuitry and receiver circuitry, wherein impedance mismatches that would result if the transducer was coupled to the circuit board via a cable can be avoided.

  4. Cryogenic microwave channelized receiver

    SciTech Connect

    Rauscher, C.; Pond, J.M.; Tait, G.B.

    1996-07-01

    The channelized receiver being presented demonstrates the use of high temperature superconductor technology in a microwave system setting where superconductor, microwave-monolithic-integrated-circuit, and hybrid-integrated-circuit components are united in one package and cooled to liquid-nitrogen temperatures. The receiver consists of a superconducting X-band four-channel demultiplexer with 100-MHz-wide channels, four commercial monolithically integrated mixers, and four custom-designed hybrid-circuit detectors containing heterostructure ramp diodes. The composite receiver unit has been integrated into the payload of the second-phase NRL high temperature superconductor space experiment (HTSSE-II). Prior to payload assembly, the response characteristics of the receiver were measured as functions of frequency, temperature, and drive levels. The article describes the circuitry, discusses the key issues related to design and implementation, and summarizes the experimental results.

  5. Ceramic Solar Receiver

    NASA Technical Reports Server (NTRS)

    Robertson, C., Jr.

    1984-01-01

    Solar receiver uses ceramic honeycomb matrix to absorb heat from Sun and transfer it to working fluid at temperatures of 1,095 degrees and 1,650 degrees C. Drives gas turbine engine or provides heat for industrial processes.

  6. Solar energy receiver

    DOEpatents

    Schwartz, Jacob

    1978-01-01

    An improved long-life design for solar energy receivers provides for greatly reduced thermally induced stress and permits the utilization of less expensive heat exchanger materials while maintaining receiver efficiencies in excess of 85% without undue expenditure of energy to circulate the working fluid. In one embodiment, the flow index for the receiver is first set as close as practical to a value such that the Graetz number yields the optimal heat transfer coefficient per unit of pumping energy, in this case, 6. The convective index for the receiver is then set as closely as practical to two times the flow index so as to obtain optimal efficiency per unit mass of material.

  7. Receiver Gain Modulation Circuit

    NASA Technical Reports Server (NTRS)

    Jones, Hollis; Racette, Paul; Walker, David; Gu, Dazhen

    2011-01-01

    A receiver gain modulation circuit (RGMC) was developed that modulates the power gain of the output of a radiometer receiver with a test signal. As the radiometer receiver switches between calibration noise references, the test signal is mixed with the calibrated noise and thus produces an ensemble set of measurements from which ensemble statistical analysis can be used to extract statistical information about the test signal. The RGMC is an enabling technology of the ensemble detector. As a key component for achieving ensemble detection and analysis, the RGMC has broad aeronautical and space applications. The RGMC can be used to test and develop new calibration algorithms, for example, to detect gain anomalies, and/or correct for slow drifts that affect climate-quality measurements over an accelerated time scale. A generalized approach to analyzing radiometer system designs yields a mathematical treatment of noise reference measurements in calibration algorithms. By treating the measurements from the different noise references as ensemble samples of the receiver state, i.e. receiver gain, a quantitative description of the non-stationary properties of the underlying receiver fluctuations can be derived. Excellent agreement has been obtained between model calculations and radiometric measurements. The mathematical formulation is equivalent to modulating the gain of a stable receiver with an externally generated signal and is the basis for ensemble detection and analysis (EDA). The concept of generating ensemble data sets using an ensemble detector is similar to the ensemble data sets generated as part of ensemble empirical mode decomposition (EEMD) with exception of a key distinguishing factor. EEMD adds noise to the signal under study whereas EDA mixes the signal with calibrated noise. It is mixing with calibrated noise that permits the measurement of temporal-functional variability of uncertainty in the underlying process. The RGMC permits the evaluation of EDA by

  8. Advanced Solar Receivers

    NASA Technical Reports Server (NTRS)

    Owen, W. A.

    1984-01-01

    Low thermal efficiencies in solar receivers are discussed in terms of system design. It is recommended that careful attention be given to the overall thermal systems design, especially to conductive losses about the window and areas of relatively thin insulation. If the cavity design is carefully managed to insure a small, minimally reradiating aperture, the goal of a very high efficiency cavity receiver is a realistic one.

  9. OCD RADIO ALERT RECEIVERS.

    DTIC Science & Technology

    for methods of operating a radioalert system were established in conjunction with OCD representatives. Four types of operation were selected. Three...models each of these four receiver types were fabricated and tested. The total of 12 laboratory models were delivered to OCD . Test equipment...suitable for demonstrating the two most promising receiver types was also assembled, and delivered to OCD . A preliminary analysis of the cost of mass

  10. Project Echo: Receiving System

    NASA Technical Reports Server (NTRS)

    Ohm, E. A.

    1961-01-01

    A tracking horn-reflector antenna, a maser preamplifier (and standby parametric preamplifier), and a special FM demodulator were combined to form a low-noise receiving system which made possible the establishment of a high-quality voice circuit via the Echo I passive satellite. This paper describes the 2390-Mc receiving system located at the Bell Telephone Laboratories facility in Holmdel, New Jersey.

  11. Home advantage in sport: an overview of studies on the advantage of playing at home.

    PubMed

    Nevill, A M; Holder, R L

    1999-10-01

    This review identifies the most likely causes of home advantage. The results of previous studies have identified 4 factors thought to be responsible for the home advantage. These can be categorised under the general headings of crowd, learning, travel and rule factors. From the accumulated evidence, rule factors were found to play only a minor role (in a limited number of sports) in contributing to home advantage. Studies investigating the effect of learning factors found that little benefit was to be gained from being familiar with the local conditions when playing at home. There was evidence to suggest that travel factors were responsible for part of the home advantage, provided the journey involved crossing a number of time zones. However, since high levels of home advantage are observed within countries where travel distances are not great. travel factors were not thought to be a major cause of home advantage. The evidence from studies investigating crowd factors appeared to provide the most dominant causes of home advantage. A number of studies provide strong evidence that home advantage increases with crowd size, until the crowd reaches a certain size or consistency (a more balanced number of home and away supporters), after which a peak in home advantage is observed. Two possible mechanisms were proposed to explain these observations: either (i) the crowd is able to raise the performance of the home competitors relative to the away competitors; or (ii) the crowd is able to influence the officials to subconsciously favour the home team. The literature supports the latter to be the most important and dominant explanation. Clearly, it only takes 2 or 3 crucial decisions to go against the away team or in favour of the home team to give the side playing at home the 'edge'.

  12. Perspectives on Home Care Quality

    PubMed Central

    Kane, Rosalie A.; Kane, Robert L.; Illston, Laurel H.; Eustis, Nancy N.

    1994-01-01

    Home care quality assurance (QA) must consider features inherent in home care, including: multiple goals, limited provider control, and unique family roles. Successive panels of stakeholders were asked to rate the importance of selected home care outcomes. Most highly rated outcomes were freedom from exploitation, satisfaction with care, physical safety, affordability, and physical functioning. Panelists preferred outcome indicators to process and structure, and all groups emphasized “enabling” criteria. Themes highlighted included: interpersonal components of care; normalizing life for clientele; balancing quality of life with safety; developing flexible, negotiated care plans; mechanisms for accountability and case management. These themes were formulated differently according to the stakeholders' role. Providers preferred intermediate outcomes, akin to process. PMID:10140158

  13. An open trial of in-home CBT for depressed mothers in home visitation.

    PubMed

    Ammerman, Robert T; Putnam, Frank W; Stevens, Jack; Bosse, Nicole R; Short, Jodie A; Bodley, Amy L; Van Ginkel, Judith B

    2011-11-01

    Research has demonstrated that low income mothers participating in home visitation programs have high rates of depression. This study used an open trial design to evaluate In-Home Cognitive Behavioral Therapy (IH-CBT), an evidence-based treatment for depression that is delivered in the home setting and has been adapted to address the needs of low income mothers participating in home visitation. 64 depressed mothers recruited from a home visitation program and who had completed IH-CBT were compared to 241 mothers from the same setting who met identical screening criteria at enrollment but did not receive the treatment. In addition, pre- and post-treatment measures of depression and related clinical features were contrasted in the 64 mothers receiving IH-CBT. There was a significantly greater reduction in depressive symptoms in the IH-CBT group relative to their counterparts who did not receive the treatment. Results from pre-post comparisons showed that treated mothers had decreased diagnosis of major depression, lower reported stress, increased coping and social support, and increased positive views of motherhood at post-treatment. Findings suggest that IH-CBT is a promising approach to addressing maternal depression in the context of home visitation and warrants further study. Public health implications for home visiting programs are discussed.

  14. An Open Trial of In-Home CBT for Depressed Mothers in Home Visitation

    PubMed Central

    Putnam, Frank W.; Stevens, Jack; Bosse, Nicole R.; Short, Jodie A.; Bodley, Amy L.; Van Ginkel, Judith B.

    2013-01-01

    Research has demonstrated that low income mothers participating in home visitation programs have high rates of depression. This study used an open trial design to evaluate In-Home Cognitive Behavioral Therapy (IH-CBT), an evidence-based treatment for depression that is delivered in the home setting and has been adapted to address the needs of low income mothers participating in home visitation. 64 depressed mothers recruited from a home visitation program and who had completed IH-CBT were compared to 241 mothers from the same setting who met identical screening criteria at enrollment but did not receive the treatment. In addition, pre- and post-treatment measures of depression and related clinical features were contrasted in the 64 mothers receiving IH-CBT. There was a significantly greater reduction in depressive symptoms in the IH-CBT group relative to their counterparts who did not receive the treatment. Results from pre-post comparisons showed that treated mothers had decreased diagnosis of major depression, lower reported stress, increased coping and social support, and increased positive views of motherhood at post-treatment. Findings suggest that IH-CBT is a promising approach to addressing maternal depression in the context of home visitation and warrants further study. Public health implications for home visiting programs are discussed. PMID:20936338

  15. The 24-h recall instrument for home nursing to measure the activity profile of home nurses: development and psychometric testing.

    PubMed

    De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Gosset, Christiane; Heyden, Isabelle; Van Geert, Michel; Moons, Philip

    2015-01-01

    Home health care today is challenged by a shift from an acute to a chronic health-care model, moving the focus of care from the hospital to home-care setting. This increased focus on care at home emphasizes the need for an efficient, effective, and transparent management of home health care. However, it is not precisely known what home-care nurses do; what kind of care is received by patients; what the performance of home nurses is; and what the impact of the increasing need for home nursing is on the current and future role of home nurses. In this respect, it is necessary to gain a clear insight into the activity profile of home nurses, but there is no gold standard to measure their activities. This study reports on the development and psychometric testing of the '24-hour recall instrument for home nursing' to measure the activity profile of home nurses. Five home nurses in Belgium, simultaneously with the researcher, registered the performed activities in a total of 69 patients, using the 24-h recall instrument for home nursing. The validity and the interrater reliability of this instrument were high: the proportions that observed agreement were very high; the strength of kappa agreement was substantial to almost perfect; the prevalence index showed great variety; and the bias index was low. The findings in this study support the validity evidence based on test content and the interrater reliability of the 24-h recall instrument. This instrument can help to shape practice and policy by making the home nursing profession more transparent: a clear insight into the kind of care that is provided by home nurses and is received by the patients in primary care contributes to the development of a clear definition of the role of home nurses in health care.

  16. Highly directional acoustic receivers

    NASA Astrophysics Data System (ADS)

    Cray, Benjamin A.; Evora, Victor M.; Nuttall, Albert H.

    2003-03-01

    The theoretical directivity of a single combined acoustic receiver, a device that can measure many quantities of an acoustic field at a collocated point, is presented here. The formulation is developed using a Taylor series expansion of acoustic pressure about the origin of a Cartesian coordinate system. For example, the quantities measured by a second-order combined receiver, denoted a dyadic sensor, are acoustic pressure, the three orthogonal components of acoustic particle velocity, and the nine spatial gradients of the velocity vector. The power series expansion, which can be of any order, is cast into an expression that defines the directivity of a single receiving element. It is shown that a single highly directional dyadic sensor can have a directivity index of up to 9.5 dB. However, there is a price to pay with highly directive sensors; these sensors can be significantly more sensitive to nonacoustic noise sources.

  17. Central solar energy receiver

    DOEpatents

    Drost, M. Kevin

    1983-01-01

    An improved tower-mounted central solar energy receiver for heating air drawn through the receiver by an induced draft fan. A number of vertically oriented, energy absorbing, fin-shaped slats are radially arranged in a number of concentric cylindrical arrays on top of the tower coaxially surrounding a pipe having air holes through which the fan draws air which is heated by the slats which receive the solar radiation from a heliostat field. A number of vertically oriented and wedge-shaped columns are radially arranged in a number of concentric cylindrical clusters surrounding the slat arrays. The columns have two mirror-reflecting sides to reflect radiation into the slat arrays and one energy absorbing side to reduce reradiation and reflection from the slat arrays.

  18. Home Energy Assessments

    SciTech Connect

    Dispenza, Jason

    2010-01-01

    A home energy assessment, also known as a home energy audit, is the first step to assess how much energy your home consumes and to evaluate what measures you can take to make your home more energy efficient. An assessment will show you problems that may, when corrected, save you significant amounts of money over time. This video shows some of the ways that a contractor may test your home during an assessment, and helps you understand how an assessment can help you move toward energy savings. Find out more at: http://www.energysavers.gov/your_home/energy_audits/index.cfm/mytopic=11160

  19. Home Energy Assessments

    ScienceCinema

    Dispenza, Jason

    2016-07-12

    A home energy assessment, also known as a home energy audit, is the first step to assess how much energy your home consumes and to evaluate what measures you can take to make your home more energy efficient. An assessment will show you problems that may, when corrected, save you significant amounts of money over time. This video shows some of the ways that a contractor may test your home during an assessment, and helps you understand how an assessment can help you move toward energy savings. Find out more at: http://www.energysavers.gov/your_home/energy_audits/index.cfm/mytopic=11160

  20. Early discharge hospital at home.

    PubMed

    Gonçalves-Bradley, Daniela C; Iliffe, Steve; Doll, Helen A; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha

    2017-06-26

    0.40 to 0.98; N = 574, 4 trials, low-certainty evidence) and might slightly improve patient satisfaction (N = 795, low-certainty evidence). Hospital at home probably reduces hospital length of stay, as moderate-certainty evidence found that people assigned to hospital at home are discharged from the intervention about seven days earlier than people receiving inpatient care (95% CI 10.19 to 3.17 days earlier, N = 528, 4 trials). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).Studies recruiting people with a mix of medical conditionsEarly discharge hospital at home probably makes little or no difference to mortality (RR 1.07, 95% CI 0.76 to 1.49; N = 1247, 8 trials, moderate-certainty evidence). In people with chronic obstructive pulmonary disease (COPD) there was insufficient information to determine the effect of these two approaches on mortality (RR 0.53, 95% CI 0.25 to 1.12, N = 496, 5 trials, low-certainty evidence). The intervention probably increases the risk of hospital readmission in a mix of medical conditions, although the results are also compatible with no difference and a relatively large increase in the risk of readmission (RR 1.25, 95% CI 0.98 to 1.58, N = 1276, 9 trials, moderate-certainty evidence). Early discharge hospital at home may decrease the risk of readmission for people with COPD (RR 0.86, 95% CI 0.66 to 1.13, N = 496, 5 trials low-certainty evidence). Hospital at home may lower the risk of living in an institutional setting (RR 0.69, 0.48 to 0.99; N = 484, 3 trials, low-certainty evidence). The intervention might slightly improve patient satisfaction (N = 900, low-certainty evidence). The effect of early discharge hospital at home on hospital length of stay for older patients with a mix of conditions ranged from a reduction of 20 days to a reduction of less than half a day (moderate-certainty evidence, N = 767). It is uncertain whether hospital at home has an effect on cost (very low

  1. Hanson receives Macelwane Medal

    NASA Astrophysics Data System (ADS)

    Ravishankara, A. R.; Hanson, David R.

    At the 1996 Spring Meeting in Baltimore, Maryland, David R. Hanson received the 1996 James B. Macelwane Medal, which recognizes significant contributions to the geophysical sciences by a young scientist of outstanding ability. The medal citation and Hanson's response are given here.

  2. Zero-power receiver

    SciTech Connect

    Brocato, Robert W.

    2016-10-04

    An unpowered signal receiver and a method for signal reception detects and responds to very weak signals using pyroelectric devices as impedance transformers and/or demodulators. In some embodiments, surface acoustic wave devices (SAW) are also used. Illustrative embodiments include satellite and long distance terrestrial communications applications.

  3. Submillimeter wave heterodyne receiver

    NASA Technical Reports Server (NTRS)

    Chattopadhyay, Goutam (Inventor); Manohara, Harish (Inventor); Siegel, Peter H. (Inventor); Ward, John (Inventor)

    2011-01-01

    In an embodiment, a submillimeter wave heterodyne receiver includes a finline ortho-mode transducer comprising thin tapered metallic fins deposited on a thin dielectric substrate to separate a vertically polarized electromagnetic mode from a horizontally polarized electromagnetic mode. Other embodiments are described and claimed.

  4. Received Pronunciation and "Realphonetik."

    ERIC Educational Resources Information Center

    Shibles, Warren

    1995-01-01

    This article argues that British Received Pronunciation (RP) is inconsistently defined, arbitrary, and anachronistic, and that it should be replaced as an instructional concept by British Pronunciation (BP), which would be based on an actual and adequate descriptive phonetics, called here "Realphonetik." Contains 77 references. (MDM)

  5. Help Seeking and Receiving.

    ERIC Educational Resources Information Center

    Nadler, Arie

    Although social psychology has always had an interest in helping behavior, only recently has the full complexity of helping relations begun to be researched. Help seeking and receiving in the educational setting raise many issues regarding the use and effectiveness of the help itself. Central to all helping relations is the seeking/receiving…

  6. Olympus beacon receiver

    NASA Technical Reports Server (NTRS)

    Ostergaard, Jens

    1988-01-01

    A medium-size Beacon Receiving System for reception and processing of the B1 (20 GHz) and B2 (30 GHz) beacons from Olympus has been developed. Integration of B1 and B2 receiving equipment into one system using one antenna and a common computer for control and data processing provides the advantages of a compact configuration and synchronization of the two receiver chains. Range for co-polar signal attenuation meaurement is about 30 dB for both beacons, increasing to 40 dB for B2 if the receivers are synchronized to B1. The accuracy is better than 0.5 dB. Cross-polarization discriminations of the order of 10 to 30 dB may be determined with an accuracy of 1 to 2 dB. A number of radiometers for complementary measurements of atmospheric attenuation of 13 to 30 GHz has also been constructed. A small multi-frequency system for operation around 22 GHz and 31 GHz is presently under development.

  7. Simplified OMEGA receivers

    NASA Technical Reports Server (NTRS)

    Burhans, R. W.

    1974-01-01

    The details are presented of methods for providing OMEGA navigational information including the receiver problem at the antenna and informational display and housekeeping systems based on some 4 bit data processing concepts. Topics discussed include the problem of limiters, zero crossing detectors, signal envelopes, internal timing circuits, phase counters, lane position displays, signal integrators, and software mapping problems.

  8. English soccer teams' aggressive behavior when playing away from home.

    PubMed

    Thomas, Sion; Reeves, Colin; Smith, Andrew

    2006-04-01

    Speculation about key factors affecting home advantage still exists. The present study investigated aggressive behavior amongst English Football Premiership (soccer) players and its relation to home advantage. The frequency of aggressive behaviour, identified by the award of a penalty or disciplinary card (yellow for caution or red for dismissal) was analysed over 2000-2003. Chi-square analyses assessed whether a greater frequency of aggressive behavior was performed by teams away from home. In decided matches, teams playing away received significantly more cautions (yellow cards) than home teams. A further analysis of tied matches indicated that away teams received significantly more cautions (yellow cards) than home teams. No significant differences between home and away teams were found for dismissals and penalties awarded. Reasons for these findings are considered.

  9. Finding home: the final step of the pigeons' homing process studied with a GPS data logger.

    PubMed

    Gagliardo, Anna; Ioalè, Paolo; Savini, Maria; Lipp, Hans-Peter; Dell'Omo, Giacomo

    2007-04-01

    Experiments have shown that homing pigeons are able to develop navigational abilities even if reared and kept confined in an aviary, provided that they are exposed to natural winds. These and other experiments performed on inexperienced birds have shown that previous homing experiences are not necessary to determine the direction of displacement. While the cues used in the map process for orienting at the release site have been extensively investigated, the final step of the homing process has received little attention by researchers. Although there is general agreement on the relevance of visual cues in navigation within the home area, there is a lack of clear evidence. In order to investigate the final step of the homing process, we released pigeons raised under confined conditions and others that had been allowed to fly freely around the loft and compared their flight paths recorded with a Global-Positioning-System logger. Our data show that a limited view of the home area impairs the pigeons' ability to relocate the loft at their first homing flight, suggesting that the final step of the homing process is mediated via recognition of familiar visual landmarks in the home area.

  10. Home-Based Exercise

    MedlinePlus

    ... a Vestibular Disorder Family Support Network Desorden Vestibular/Vértigo - En Español הפרעות ... What is a Home VRT program? During vestibular rehabilitation therapy (VRT), home exercises ...

  11. Alternatives to Nursing Homes

    MedlinePlus

    ... this website may not be available. Alternatives to nursing homes Before you make any decisions about long ... live and what help you may need. A nursing home may not be your only choice. Discharge ...

  12. Planning Home Economics Facilities.

    ERIC Educational Resources Information Center

    Arcy, Thomas H.; Schultz, Jerelyn B.

    1980-01-01

    Discusses modernizing, remodeling, or developing new home economic facilities. Equipment considerations, curriculum objectives, the making of a master plan, and planning reminders are provided along with a basic sketch to review prior to planning home economics laboratories. (Author)

  13. Home blood sugar testing

    MedlinePlus

    Diabetes - home glucose testing; Diabetes - home blood sugar testing ... Usual times to test your blood sugar are before meals and at bedtime. Your provider may ask you to check your blood sugar 2 hours after a ...

  14. Genetics Home Reference: otulipenia

    MedlinePlus

    ... Facebook Share on Twitter Your Guide to Understanding Genetic Conditions Search MENU Toggle navigation Home Page Search ... Conditions Genes Chromosomes & mtDNA Resources Help Me Understand Genetics Home Health Conditions otulipenia otulipenia Enable Javascript to ...

  15. National Nursing Home Survey

    Cancer.gov

    The National Nursing Home Survey provides includes characteristics such as size of nursing home facilities, ownership, Medicare/Medicaid certification, occupancy rate, number of days of care provided, and expenses.

  16. Integrated terahertz transmitters and receivers

    NASA Astrophysics Data System (ADS)

    Crowe, Thomas W.; Porterfield, David W.; Hesler, Jeffrey L.; Bishop, William L.; Kurtz, David S.

    2004-02-01

    Through a US Army sponsored SBIR project we are developing terahertz components based on integrated GaAs Schottky diodes for the frequency range from 200 - 700 GHz. These new components are inherently broadband and therefore require no mechanical tuners. Rather, they can be electronically swept across significant frequency bands and are therefore useful for chemical and biological spectroscopy. This talk will focus on our demonstration of a terahertz frequency Transmit / Receive capability which may be of use for CB detection and secure communications.

  17. Family Involvement in School-Based Health Promotion: Bringing Nutrition Information Home.

    PubMed

    Blom-Hoffman, Jessica; Wilcox, Kaila R; Dunn, Liam; Leff, Stephen S; Power, Thomas J

    2008-12-01

    Family-school collaboration related to children's physical development has become increasingly important as childhood obesity rates continue to rise. The present study described the development and implementation of a literacy-based, family component of a school-based health education program and investigated its viability, acceptability, and effectiveness. Interactive children's books were the mechanism by which students, parents, and teachers received consistent messages at home and school regarding nutrition information. The home-school intervention served to bridge home and school cultures in an urban population. Preliminary process evaluation results indicated that the interactive children's books were feasible to implement in the school context. Parents, children, and teachers had positive perceptions of the books. Parents who received the books demonstrated increased knowledge of 5 a Day, the primary nutrition message communicated in the program. Although not statistically significant, after the first and second years of intervention, parents in the experimental group reported that their children were eating 0.54 and 0.36 additional servings of fruit and vegetables per day compared with children in the control group. The program did not seem to impact the availability and accessibility of fruits and vegetables at home.

  18. Home Energy Savers' Workbook.

    ERIC Educational Resources Information Center

    Federal Energy Administration, Washington, DC.

    This workbook is intended as a guide for the homeowner in taking steps to reduce home energy costs. It allows the homeowner to identify procedures applicable to his/her home and then implement those procedures most cost-effective for the particular situation. It provides methods for estimating savings in home heating and cooling costs by taking…

  19. Meals in nursing homes.

    PubMed

    Kofod, Jens; Birkemose, Anna

    2004-06-01

    Undernutrition is present among 33% of nursing home residents in Denmark. Hence, it is relevant to examine the meal situation at nursing homes to single out factors that may increase or reduce the residents' food intake. In the ongoing Danish nursing home debate it is claimed that a new type of nursing home improves the residents' meal situation with a positive effect on nutrition. The aim of this work is to test the general hypothesis that (i) residents appreciate the meal situation in these nursing homes and (ii) nutritional status of the residents is improved in this type of nursing home. This study was carried out in four Danish nursing homes at various locations in Denmark. The methods used are qualitative interviews and observations at four nursing homes in combination with measurement of body mass index (BMI) at two of the four nursing homes. Undernutrition is defined as a BMI below 20. The study could not confirm the general hypothesis, as a consistent improvement in the meal situation was not found in the nursing homes studied. But an indication of improved nutritional status was found in two of the nursing homes where the degree of undernutrition was lower than generally found in Denmark. Furthermore, the study indicated that the staff and the residents conceived the nursing homes differently.

  20. Asthma Home Environment Checklist

    EPA Pesticide Factsheets

    This checklist guides home care visitors in identifying environmental asthma triggers most commonly found in homes. It includes sections on the building, home interior and room interior and provides low-cost action steps for remediation. EPA 402-F-03-030.

  1. Home Schooling Goes Mainstream

    ERIC Educational Resources Information Center

    Gaither, Milton

    2009-01-01

    This article reports that while home schooling may have particular appeal to celebrities, over the last decade families of all kinds have embraced the practice for widely varying reasons: no longer is home schooling exclusive to Christian fundamentalism and the countercultural Left. Along with growing acceptance of home schooling nationally has…

  2. Home Schooling Goes Mainstream

    ERIC Educational Resources Information Center

    Gaither, Milton

    2009-01-01

    This article reports that while home schooling may have particular appeal to celebrities, over the last decade families of all kinds have embraced the practice for widely varying reasons: no longer is home schooling exclusive to Christian fundamentalism and the countercultural Left. Along with growing acceptance of home schooling nationally has…

  3. Healthy Homes Tools

    ERIC Educational Resources Information Center

    Peek, Gina; Lyon, Melinda; Russ, Randall

    2012-01-01

    Extension is focusing on healthy homes programming. Extension educators are not qualified to diagnose consumers' medical problems as they relate to housing. We cannot give medical advice. Instead, we can help educate consumers about home conditions that may affect their well-being. Extension educators need appropriate healthy homes tools to…

  4. Schooling at Home.

    ERIC Educational Resources Information Center

    Long, Joyce Fleck

    2001-01-01

    Presents one family's experience with home schooling, explaining that no two home schools are alike, which is both a strength and a weakness of the movement. The paper discusses the parent's educational philosophy and the family's personal curriculum and pedagogical choices. It concludes by examining the growing trend in home schooling. (SM)

  5. School@Home.

    ERIC Educational Resources Information Center

    Hammons, Christopher W.

    2001-01-01

    Describes home schooling movement and argues home schooling is viable alternative to public education system. Discusses increase in home-schooled students applying to college, taking and performing well on college entrance exams (ACT and SAT), engaging in extracurricular activities, and succeeding in college. Addresses and refutes criticisms of…

  6. Home Schooling, What's That?

    ERIC Educational Resources Information Center

    Preiss, Jane S.

    Home schooling, the educational alternative in which parents (or guardians) assume the primary responsibility for the education of their children, when responsibly done, is legally protected by the United States Constitution; however, home educators face a conglomeration of regulations, statutes, and laws. Home schools are regulated by individual…

  7. Healthy Homes Tools

    ERIC Educational Resources Information Center

    Peek, Gina; Lyon, Melinda; Russ, Randall

    2012-01-01

    Extension is focusing on healthy homes programming. Extension educators are not qualified to diagnose consumers' medical problems as they relate to housing. We cannot give medical advice. Instead, we can help educate consumers about home conditions that may affect their well-being. Extension educators need appropriate healthy homes tools to…

  8. Investigating staff knowledge of safeguarding and pressure ulcers in care homes.

    PubMed

    Ousey, K; Kaye, V; McCormick, K; Stephenson, J

    2016-01-01

    To investigate whether nursing/care home staff regard pressure ulceration as a safeguarding issue; and to explore reporting mechanisms for pressure ulcers (PUs) in nursing/care homes. Within one clinical commissioning group, 65 staff members from 50 homes completed a questionnaire assessing their experiences of avoidable and unavoidable PUs, grading systems, and systems in place for referral to safeguarding teams. Understanding of safeguarding was assessed in depth by interviews with 11 staff members. Staff observed an average of 2.72 PUs in their workplaces over the previous 12 months, judging 45.6% to be avoidable. Only a minority of respondents reported knowledge of a grading system (mostly the EPUAP/NPUAP system). Most respondents would refer PUs to the safeguarding team: the existence of a grading system, or guidance, appeared to increase that likelihood. Safeguarding was considered a priority in most homes; interviewees were familiar with the term safeguarding, but some confusion over its meaning was apparent. Quality of written documentation and verbal communication received before residents returned from hospital was highlighted. However, respondents expressed concern over lack of information regarding skin integrity. Most staff had received education regarding ulcer prevention or wound management during training, but none reported post-registration training or formal education programmes; reliance was placed on advice of district nurses or tissue viability specialists. Staff within nursing/care homes understand the fundamentals of managing skin integrity and the importance of reporting skin damage; however, national education programmes are needed to develop knowledge and skills to promote patient health-related quality of life, and to reduce the health-care costs of pressure damage. Further research to investigate understanding, knowledge and skills of nursing/care home staff concerning pressure ulcer development and safeguarding will become increasingly

  9. A digital beacon receiver

    NASA Technical Reports Server (NTRS)

    Ransome, Peter D.

    1988-01-01

    A digital satellite beacon receiver is described which provides measurement information down to a carrier/noise density ratio approximately 15 dB below that required by a conventional (phase locked loop) design. When the beacon signal fades, accuracy degrades gracefully, and is restored immediately (without hysteresis) on signal recovery, even if the signal has faded into the noise. Benefits of the digital processing approach used include the minimization of operator adjustments, stability of the phase measuring circuits with time, repeatability between units, and compatibility with equipment not specifically designed for propagation measuring. The receiver has been developed for the European Olympus satellite which has continuous wave (CW) beacons at 12.5 and 29.7 GHz, and a switched polarization beacon at 19.8 GHz approximately, but the system can be reconfigured for CW and polarization-switched beacons at other frequencies.

  10. Effect of early mobilization on discharge disposition of mechanically ventilated patients

    PubMed Central

    Ota, Hideki; Kawai, Hideki; Sato, Makoto; Ito, Kazuaki; Fujishima, Satoshi; Suzuki, Hiroko

    2015-01-01

    [Purpose] The purpose of this study was to clarify the benefits of early mobilization for mechanically ventilated patients for their survival to discharge to home from the hospital. [Subjects and Methods] Medical records were retrospectively analyzed of patients who satisfied the following criteria: age ≥ 18 years; performance status 0–2 and independent living at their home before admission; mechanical ventilation for more than 48 h; and survival after mechanical ventilation. Mechanically ventilated patients in the early mobilization (EM) group (n = 48) received mobilization therapy, limb exercise and chest physiotherapy, whereas those in the control group (n = 60) received bed rest alone. Univariate and multivariate logistic regression analyses were performed to identify clinical variables associated with discharge disposition. [Results] Early mobilization was a positive independent factor and the presence of neurological deficits was a negative factor contributing to discharge to home. Among patients surviving mechanical ventilation without neurological deficits, the rate of discharge to home was significantly higher among patients in the EM group that in the control group (76% vs. 40%). [Conclusion] Early mobilization can improve the rate of discharge to home of patients requiring mechanical ventilation because of non-neurological deficits. PMID:25931747

  11. Multichannel homodyne receiver

    DOEpatents

    Landt, J.A.

    1981-01-19

    A homodyne radar transmitter/receiver device which produces a single combined output which contains modulated backscatter information for all phase conditions of both modulated and unmodulated backscatter signals is described. The device utilizes taps along coaxial transmission lines, strip transmission line, and waveguides which are spaced by 1/8 wavelength or 1/6 wavelength, etc. This greatly reduces costs by eliminating separate transmission and reception antennas and an expensive arrangement of power splitters and mixers utilized in the prior art.

  12. Multichannel homodyne receiver

    DOEpatents

    Landt, Jeremy A.

    1982-01-01

    A homodyne radar transmitter/receiver device which produces a single combined output which contains modulated backscatter information for all phase conditions of both modulated and unmodulated backscatter signals. The device utilizes taps along coaxial transmission lines, strip transmission line, and waveguides which are spaced by 1/8 wavelength or 1/6 wavelength, etc. This greatly reduces costs by eliminating separate transmission and reception antennas and an expensive arrangement of power splitters and mixers utilized in the prior art.

  13. Home non-invasive mechanical ventilation and long-term oxygen therapy in stable hypercapnic chronic obstructive pulmonary disease patients: comparison of costs.

    PubMed

    Clini, Enrico M; Magni, Giovanna; Crisafulli, Ernesto; Viaggi, Stefano; Ambrosino, Nicolino

    2009-01-01

    A cost analysis of nocturnal non-invasive ventilation (NNV) in stable chronic obstructive pulmonary disease (COPD) patients would be helpful in decision making, when the balance between the increased demand and the availability of resources should be checked. Based on data from the Italian trial in stable hypercapnic COPD patients, this study compares the cost of care associated with the use of NNV when added to the usual long-term oxygen therapy (LTOT) with the cost of care of LTOT regimen alone. Cost was calculated in 77 of 90 patients included into that trial. Analysis included drug therapy, hospitalisations due to acute exacerbation, oxygen and ventilator equipment. An estimation of charges was made according to the national sources of cost for drugs and hospital admissions and the actualised reimbursement for the home care provided to both oxygen and ventilator users. The cost/day comparison was made between the individual patients in the 2 groups (NNV + LTOT, n = 35; LTOT, n = 42). The mean cost of drugs and oxygen was similar in both groups, whereas the cost of hospitalisation tended to be lower in NNV + LTOT compared to LTOT alone (8.25 +/-10.29 vs. 12.50 +/- 20.28 EUR/patient/day, p < 0.05). Inclusion of the ventilator equipment increased the total cost to 23.73 EUR/day in the NNV + LTOT compared to 21.42 EUR/day in the LTOT group (not significant). The present report suggests that long-term management with addition of non-invasive ventilation does not increase costs compared with the usual LTOT regimen: the hospital-related costs were reduced when using the ventilator in these hypercapnic COPD patients. (c) 2008 S. Karger AG, Basel.

  14. Home advantage and player nationality in international club football.

    PubMed

    Poulter, Damian R

    2009-06-01

    The home advantage effect was investigated at a team and player level in Union of European Football Associations (UEFA) Champions League football using in-depth performance and disciplinary variables. Performance analysis revealed that the home team scored more goals, had more shots on and off target, had a greater share of possession, and won more corners than the away team. There was an opposite trend for disciplinary variables, with the home team committing less fouls than the away team, and receiving less yellow and red cards. There were home advantage effects at player level for goals, total shots, shots on target, assists, and yellow cards, as found in the team analysis. In addition, foreign players demonstrated a home advantage effect for goals scored, whereas domestic players scored an equivalent number of goals at home and away venues. Results are discussed in relation to the home advantage literature and wider implications for the sport.

  15. The Themis solar receiver

    NASA Astrophysics Data System (ADS)

    Gravrand, J. M.; Pouget-Abadie, X.

    The theoretical modeling, materials, and design of the central receiver heat exchanger on the tower of the Themis solar power plant are presented. The receiver was conceived based on the incident solar flux at different times of the day and year and the efficiency of transferring the heat to molten salts. The square aperture admits energy at a peak rate of 3.402 MWth at some points, with heat transfer to the power loop resulting in a maximum efficiency of 25 percent. Optimization studies indicated a receiver inclined 30 deg from the horizontal to face the heliostat field, and the flux incident on the walls was mapped. Tubes filled with the salts at 250 C form the walls behind radiator fins and elevate the salt to temperatures up to a limit of 490 C. Measures taken to allow for the expansion of the cavity walls and to mount the heat exchange tubes for easy replacement are described, along with the instrumentation to measure performance, flux, and detect malfunctions due to perturbations in the fluid flow or failure of any of the components.

  16. Foster family care: an innovative home care option.

    PubMed

    Frenkel, E R; McGibney, S

    1998-04-01

    Home care agencies can extend the range of long-term care service they provide by including foster family care. With this care option, clients move into host homes, where they receive room, board, and other necessary care. Foster family care is yielding benefits to clients, care providers, and agencies alike--and it's helping to achieve long-term care cost savings.

  17. Indicators of Home Care Use in Urban and Rural Settings

    ERIC Educational Resources Information Center

    Mitchell, Lori A.; Strain, Laurel A.; Blandford, Audrey A.

    2007-01-01

    This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba (n = 855) were…

  18. Indicators of Home Care Use in Urban and Rural Settings

    ERIC Educational Resources Information Center

    Mitchell, Lori A.; Strain, Laurel A.; Blandford, Audrey A.

    2007-01-01

    This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba (n = 855) were…

  19. Status of the Home-Based Effort Within Head Start.

    ERIC Educational Resources Information Center

    Children First, Inc., Washington, DC.

    This status report is an attempt to provide a comprehensive picture of Head Start home-based programs which aimed at helping parents provide children with the same kinds of activities and support in their own homes that children would receive in any quality child development center. Data was collected through: (1) Children (1st) First, Inc.'s…

  20. Use of Pets in Therapy with Elderly Nursing Home Residents.

    ERIC Educational Resources Information Center

    Sutton, Diana M.

    In order to test the effectiveness of the use of pets with the elderly in a nursing home setting, three concurrent studies were conducted. The 29 residents participating in the experiment were selected by nursing home personnel as meeting the criteria of being depressed and withdrawn, and receiving no regular (weekly) visitors. Study I compared…

  1. Communication between key stakeholders within a medical home: a qualitative study.

    PubMed

    Nelson, Catherine S; Tandon, S Darius; Duggan, Anne K; Serwint, Janet R

    2009-04-01

    The objective of this study was to determine perceived benefits, detriments, and barriers to communication between pediatric providers and home visitors. The authors performed a cross-sectional, qualitative study consisting of 3 focus groups with paraprofessional home visitors (n=12), 6 with parents receiving home visiting (n=33), and 4 with pediatric providers whose patients received home visiting (n=19). Emerging themes were generated by an inductive analytic approach. Perceived benefits included home visitors assisting parents with communication, giving providers family information, and reinforcing providers' guidance. Detriments included parental concern of sharing confidential information and providers becoming aware of family issues for which they are unprepared to act. Barriers included parental consent, logistics of home visitor-provider communication, and providers' lack of knowledge about home visitor programs/roles. Greater coordination between home visitation programs and pediatric providers may strengthen home visiting services and reinforce advice and anticipatory guidance given by providers.

  2. High stable remote photoelectric receiver for interferometry

    NASA Astrophysics Data System (ADS)

    Yang, Hongxing; Zhu, Pengfei; Tan, Jiubin; Hu, Pengcheng; Fan, Zhigang

    2017-03-01

    A high sensitive and high stable remote photoelectric receiver has been developed to reduce noise and phase delay drift caused by thermal pollution and environmental interference. The phase delay drift model is analyzed and built based on a traditional photoelectric receiver. According to the model, a new mechanical isolation structure and a temperature control system are designed to keep the photoelectric receiver in a low constant temperature. Comparison experiments with traditional bias voltage compensation method and temperature control method are carried out between photoelectric receivers. The results verify that the output voltage fluctuation of photoelectric receiver used is reduced by 65% while the phase drift between measurement and reference photoelectric receivers decreases from 1.05° to 0.02°.

  3. Visual homing: an insect perspective.

    PubMed

    Zeil, Jochen

    2012-04-01

    The ability to learn the location of places in the world and to revisit them repeatedly is crucial for all aspects of animal life on earth. It underpins animal foraging, predator avoidance, territoriality, mating, nest construction and parental care. Much theoretical and experimental progress has recently been made in identifying the sensory cues and the computational mechanisms that allow insects (and robots) to find their way back to places, while the neurobiological mechanisms underlying navigational abilities are beginning to be unravelled in vertebrate and invertebrate models. Studying visual homing in insects is interesting, because they allow experimentation and view-reconstruction under natural conditions, because they are likely to have evolved parsimonious, yet robust solutions to the homing problem and because they force us to consider the viewpoint of navigating animals, including their sensory and computational capacities. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Strategy Guideline. Demonstration Home

    SciTech Connect

    Hunt, A.; Savage, C.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  5. Strategy Guideline: Demonstration Home

    SciTech Connect

    Savage, C.; Hunt, A.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  6. 76 FR 70076 - Technical Revisions To Update Reference to the Required Assessment Tool for State Nursing Homes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-10

    ... Tool for State Nursing Homes Receiving Per Diem Payments From VA AGENCY: Department of Veterans Affairs... diem from VA for providing nursing home care to veterans. The proposed rule would require State nursing... Required Assessment Tool for State Nursing Homes Receiving Per Diem Payments From VA.'' Copies of...

  7. Impact of a Home Leisure Educational Program for Older Adults Who Have Had a Stroke (Home Leisure Educational Program).

    ERIC Educational Resources Information Center

    Nour, Kareen; Desrosiers, Johanne; Gauthier, Pierre; Carbonneau, Helene

    2002-01-01

    Examined the effectiveness of leisure education for older adults having difficulty adjusting psychologically after a stroke. Participants received either an experimental home leisure education program (intervention group) or a friendly home visit (control group) after discharge from rehabilitation. The intervention group performed significantly…

  8. Impact of a Home Leisure Educational Program for Older Adults Who Have Had a Stroke (Home Leisure Educational Program).

    ERIC Educational Resources Information Center

    Nour, Kareen; Desrosiers, Johanne; Gauthier, Pierre; Carbonneau, Helene

    2002-01-01

    Examined the effectiveness of leisure education for older adults having difficulty adjusting psychologically after a stroke. Participants received either an experimental home leisure education program (intervention group) or a friendly home visit (control group) after discharge from rehabilitation. The intervention group performed significantly…

  9. The Technological Revolution in the Home.

    ERIC Educational Resources Information Center

    Rubin, Philip A.

    This exploration of possible information and communications developments in the future focuses on the picture of the family or individual depending on access to information as a key to their status in society. The scenario involves the home as the center for conducting business, banking, shopping, and receiving lifelong education, and this paper…

  10. The Technological Revolution in the Home.

    ERIC Educational Resources Information Center

    Rubin, Philip A.

    This exploration of possible information and communications developments in the future focuses on the picture of the family or individual depending on access to information as a key to their status in society. The scenario involves the home as the center for conducting business, banking, shopping, and receiving lifelong education, and this paper…

  11. Guidelines for Home Study in Vermont, 2002

    ERIC Educational Resources Information Center

    Vermont Department of Education, 2005

    2005-01-01

    During the 2001-2002 school year, over 2,100 Vermont children received their education in a homestudy program. Parents or guardians who decide to educate their children at home assume a great responsibility. In effect they are responsible for writing a curriculum, finding learning materials, providing resources, presenting instruction, adapting…

  12. The Homing Frog: High Homing Performance in a Territorial Dendrobatid Frog Allobates femoralis (Dendrobatidae)

    PubMed Central

    Pašukonis, Andrius; Ringler, Max; Brandl, Hanja B; Mangione, Rosanna; Ringler, Eva; Hödl, Walter; Tregenza, T

    2013-01-01

    Dendrobatidae (dart-poison frogs) exhibit some of the most complex spatial behaviors among amphibians, such as territoriality and tadpole transport from terrestrial clutches to widely distributed deposition sites. In species that exhibit long-term territoriality, high homing performance after tadpole transport can be assumed, but experimental evidence is lacking, and the underlying orientation mechanisms are unknown. We conducted a field translocation experiment to test whether male Allobates femoralis, a dendrobatid frog with paternal extra-territorial tadpole transport, are capable of homing after experimental removal, as well as to quantify homing success and speed. Translocated individuals showed a very high homing success for distances up to 200 m and successfully returned from up to 400 m. We discuss the potential orientation mechanisms involved and selective forces that could have shaped this strong homing ability. PMID:25104869

  13. The Homing Frog: High Homing Performance in a Territorial Dendrobatid Frog Allobates femoralis (Dendrobatidae).

    PubMed

    Pašukonis, Andrius; Ringler, Max; Brandl, Hanja B; Mangione, Rosanna; Ringler, Eva; Hödl, Walter

    2013-09-01

    Dendrobatidae (dart-poison frogs) exhibit some of the most complex spatial behaviors among amphibians, such as territoriality and tadpole transport from terrestrial clutches to widely distributed deposition sites. In species that exhibit long-term territoriality, high homing performance after tadpole transport can be assumed, but experimental evidence is lacking, and the underlying orientation mechanisms are unknown. We conducted a field translocation experiment to test whether male Allobates femoralis, a dendrobatid frog with paternal extra-territorial tadpole transport, are capable of homing after experimental removal, as well as to quantify homing success and speed. Translocated individuals showed a very high homing success for distances up to 200 m and successfully returned from up to 400 m. We discuss the potential orientation mechanisms involved and selective forces that could have shaped this strong homing ability.

  14. LANL receiver system development

    SciTech Connect

    Laubscher, B.; Cooke, B.; Cafferty, M.; Olivas, N.

    1997-08-01

    The CALIOPE receiver system development at LANL is the story of two technologies. The first of these technologies consists of off-the-shelf mercury-cadmium-telluride (MCT) detectors and amplifiers. The vendor for this system is Kolmar Technologies. This system was fielded in the Tan Trailer I (TTI) in 1995 and will be referred to in this paper as GEN I. The second system consists of a MCT detector procured from Santa Barbara Research Center (SBRC) and an amplifier designed and built by LANL. This system was fielded in the Tan Trailer II (TTII) system at the NTS tests in 1996 and will be referred to as GEN II. The LANL CALIOPE experimental plan for 1996 was to improve the lidar system by progressing to a higher rep rate laser to perform many shots in a much shorter period of time. In keeping with this plan, the receiver team set a goal of developing a detector system that was background limited for the projected 100 nanosecond (ns) laser pulse. A set of detailed simulations of the DIAL lidar experiment was performed. From these runs, parameters such as optimal detector size, field of view of the receiver system, nominal laser return power, etc. were extracted. With this information, detector physics and amplifier electronic models were developed to obtain the required specifications for each of these components. These derived specs indicated that a substantial improvement over commercially available, off-the-shelf, amplifier and detector technologies would be needed to obtain the goals. To determine if the original GEN I detector was usable, the authors performed tests on a 100 micron square detector at cryogenic temperatures. The results of this test and others convinced them that an advanced detector was required. Eventually, a suitable detector was identified and a number of these single element detectors were procured from SBRC. These single element detectors were witness for the detector arrays built for another DOE project.

  15. Custom accounts receivable modeling.

    PubMed

    Veazie, J

    1994-04-01

    In hospital and clinic management, accounts are valued as units and handled equally--a $20 account receives the same minimum number of statements as a $20,000 account. Quite often, the sheer number of accounts a hospital or clinic has to handle forces executives to manage accounts by default and failure--accounts mature on an aging track and, if left unpaid by patients, eventually are sent to collections personnel. Of the bad-debt accounts placed with collections agencies, many are misclassified as charity or hardship cases, while others could be collected by hospital or clinic staff with a limited amount of additional effort.

  16. Ultra-wideband receiver

    DOEpatents

    McEwan, Thomas E.

    1996-01-01

    An ultra-wideband (UWB) receiver utilizes a strobed input line with a sampler connected to an amplifier. In a differential configuration, .+-.UWB inputs are connected to separate antennas or to two halves of a dipole antenna. The two input lines include samplers which are commonly strobed by a gating pulse with a very low duty cycle. In a single ended configuration, only a single strobed input line and sampler is utilized. The samplers integrate, or average, up to 10,000 pulses to achieve high sensitivity and good rejection of uncorrelated signals.

  17. Ultra-wideband receiver

    DOEpatents

    McEwan, Thomas E.

    1994-01-01

    An ultra-wideband (UWB) receiver utilizes a strobed input line with a sampler connected to an amplifier. In a differential configuration, .+-.UWB inputs are connected to separate antennas or to two halves of a dipole antenna. The two input lines include samplers which are commonly strobed by a gating pulse with a very low duty cycle. In a single ended configuration, only a single strobed input line and sampler is utilized. The samplers integrate, or average, up to 10,000 pulses to achieve high sensitivity and good rejection of uncorrelated signals.

  18. Ultra-wideband receiver

    DOEpatents

    McEwan, T.E.

    1996-06-04

    An ultra-wideband (UWB) receiver utilizes a strobed input line with a sampler connected to an amplifier. In a differential configuration, {+-}UWB inputs are connected to separate antennas or to two halves of a dipole antenna. The two input lines include samplers which are commonly strobed by a gating pulse with a very low duty cycle. In a single ended configuration, only a single strobed input line and sampler is utilized. The samplers integrate, or average, up to 10,000 pulses to achieve high sensitivity and good rejection of uncorrelated signals. 21 figs.

  19. Ultra-wideband receiver

    DOEpatents

    McEwan, T.E.

    1994-09-06

    An ultra-wideband (UWB) receiver utilizes a strobed input line with a sampler connected to an amplifier. In a differential configuration, [+-] UWB inputs are connected to separate antennas or to two halves of a dipole antenna. The two input lines include samplers which are commonly strobed by a gating pulse with a very low duty cycle. In a single ended configuration, only a single strobed input line and sampler is utilized. The samplers integrate, or average, up to 10,000 pulses to achieve high sensitivity and good rejection of uncorrelated signals. 16 figs.

  20. Weather Data Receiver

    NASA Technical Reports Server (NTRS)

    1982-01-01

    Northern Video Graphics, Inc. developed a low-cost satellite receiving system for users such as independent meteorologists, agribusiness firms, small airports or flying clubs, marine vessels and small TV stations. Called Video Fax, it is designed for use with certain satellites; the GOES (Geostationary Operational Environmental Satellite) spacecraft operated by the National Oceanic and Atmospheric Administration, the European Space Agency's Meteosat and Japan's Geostationary Meteorological Satellite. By dictum of the World Meteorological Organization, signals from satellites are available to anyone without cost so the Video Fax user can acquire signals directly from the satellite and cut out the middle man, enabling savings. Unit sells for about one-fifth the cost of the equipment used by TV stations. It consists of a two-meter antenna; a receiver; a microprocessor-controlled display computer; and a video monitor. Computer stores data from the satellites and converts it to an image which is displayed on the monitor. Weather map can be preserved as signal data on tape, or it can be stored in a video cassette as a permanent image.

  1. Participation Patterns among Families Receiving Part C Early Intervention Services

    ERIC Educational Resources Information Center

    Khetani, Mary Alunkal

    2010-01-01

    Participation in the natural settings of home and community is one of four major goals for families receiving Part C early intervention services. While participation has been formally recognized as an important service-related outcome, there is a need to build knowledge about its key features to adequately apply the concept in practice. The need…

  2. Programs and Services Received by Older Persons with Mental Retardation.

    ERIC Educational Resources Information Center

    Lakin, K. Charlie; And Others

    1991-01-01

    A national sample of 370 older persons with mental retardation in 235 facilities (foster care, small group homes, large private facilities, and state-operated facilities) was surveyed. Information is presented on resident characteristics, day program participation, services received, and differences in programs and services by facility type. The…

  3. Participation Patterns among Families Receiving Part C Early Intervention Services

    ERIC Educational Resources Information Center

    Khetani, Mary Alunkal

    2010-01-01

    Participation in the natural settings of home and community is one of four major goals for families receiving Part C early intervention services. While participation has been formally recognized as an important service-related outcome, there is a need to build knowledge about its key features to adequately apply the concept in practice. The need…

  4. Lymphocyte 'homing' and chronic inflammation.

    PubMed

    Sakai, Yasuhiro; Kobayashi, Motohiro

    2015-07-01

    Chronic inflammation is a response to prolonged exposure to injurious stimuli that harm and destroy tissues and promote lymphocyte infiltration into inflamed sites. Following progressive accumulation of lymphocytes, the histology of inflamed tissue begins to resemble that of peripheral lymphoid organs, which can be referred to as lymphoid neogenesis or formation of tertiary lymphoid tissues. Lymphocyte recruitment to inflamed tissues is also reminiscent of lymphocyte homing to peripheral lymphoid organs. In the latter, under physiological conditions, homing receptors expressed on lymphocytes adhere to vascular addressin expressed on high endothelial venules (HEVs), initiating a lymphocyte migration process composed of sequential adhesive interactions. Intriguingly, in chronic inflammation, HEV-like vessels are induced de novo, despite the fact that the inflamed site is not originally lymphoid tissue, and these vessels contribute to lymphocyte recruitment in a manner similar to physiological lymphocyte homing. In this review, we first describe physiological lymphocyte homing mechanisms focusing on vascular addressins. We then describe HEV-like vessel-mediated pathogenesis seen in various chronic inflammatory disorders such as Helicobacter pylori gastritis, inflammatory bowel disease (IBD), autoimmune pancreatitis and sclerosing sialadenitis, as well as chronic inflammatory cell neoplasm MALT lymphoma, with reference to our work and that of others.

  5. Home range and travels

    USGS Publications Warehouse

    Stickel, L.F.; King, John A.

    1968-01-01

    The concept of home range was expressed by Seton (1909) in the term 'home region,' which Burr (1940, 1943) clarified with a definition of home range and exemplified in a definitive study of Peromyscus in the field. Burt pointed out the ever-changing characteristics of home-range area and the consequent absence of boundaries in the usual sense--a finding verified by investigators thereafter. In the studies summarized in this paper, sizes of home ranges of Peromyscus varied within two magnitudes, approximately from 0.1 acre to ten acres, in 34 studies conducted in a variety of habitats from the seaside dunes of Florida to the Alaskan forests. Variation in sizes of home ranges was correlated with both environmental and physiological factors; with habitat it was conspicuous, both in the same and different regions. Food supply also was related to size of home range, both seasonally and in relation to habitat. Home ranges generally were smallest in winter and largest in spring, at the onset of the breeding season. Activity and size also were affected by changes in weather. Activity was least when temperatures were low and nights were bright. Effects of rainfall were variable. Sizes varied according to sex and age; young mice remained in the parents' range until they approached maturity, when they began to travel more widely. Adult males commonly had larger home ranges than females, although there were a number of exceptions. An inverse relationship between population density and size of home range was shown in several studies and probably is the usual relationship. A basic need for activity and exploration also appeared to influence size of home range. Behavior within the home range was discussed in terms of travel patterns, travels in relation to home sites and refuges, territory, and stability of size of home range. Travels within the home range consisted of repeated use of well-worn trails to sites of food, shelter, and refuge, plus more random exploratory travels

  6. Digital Receiver Phase Meter

    NASA Technical Reports Server (NTRS)

    Marcin, Martin; Abramovici, Alexander

    2008-01-01

    The software of a commercially available digital radio receiver has been modified to make the receiver function as a two-channel low-noise phase meter. This phase meter is a prototype in the continuing development of a phase meter for a system in which radiofrequency (RF) signals in the two channels would be outputs of a spaceborne heterodyne laser interferometer for detecting gravitational waves. The frequencies of the signals could include a common Doppler-shift component of as much as 15 MHz. The phase meter is required to measure the relative phases of the signals in the two channels at a sampling rate of 10 Hz at a root power spectral density <5 microcycle/(Hz)1/2 and to be capable of determining the power spectral density of the phase difference over the frequency range from 1 mHz to 1 Hz. Such a phase meter could also be used on Earth to perform similar measurements in laser metrology of moving bodies. To illustrate part of the principle of operation of the phase meter, the figure includes a simplified block diagram of a basic singlechannel digital receiver. The input RF signal is first fed to the input terminal of an analog-to-digital converter (ADC). To prevent aliasing errors in the ADC, the sampling rate must be at least twice the input signal frequency. The sampling rate of the ADC is governed by a sampling clock, which also drives a digital local oscillator (DLO), which is a direct digital frequency synthesizer. The DLO produces samples of sine and cosine signals at a programmed tuning frequency. The sine and cosine samples are mixed with (that is, multiplied by) the samples from the ADC, then low-pass filtered to obtain in-phase (I) and quadrature (Q) signal components. A digital signal processor (DSP) computes the ratio between the Q and I components, computes the phase of the RF signal (relative to that of the DLO signal) as the arctangent of this ratio, and then averages successive such phase values over a time interval specified by the user.

  7. Home infusion of intravenous velaglucerase alfa: Experience from pooled clinical studies in 104 patients with type 1 Gaucher disease.

    PubMed

    Elstein, Deborah; Burrow, T Andrew; Charrow, Joel; Giraldo, Pilar; Mehta, Atul; Pastores, Gregory M; Lee, Hak-Myung; Mellgard, Björn; Zimran, Ari

    The introduction of a home therapy option during clinical trials of velaglucerase alfa in patients with type 1 Gaucher disease marked the first time that home infusions have been permitted during a clinical trial for an investigational drug for Gaucher disease. Home infusions were an available option in 4 open-label velaglucerase alfa clinical studies to eligible patients who received their initial infusions at a clinic. Patients who participated in the home therapy option and received at least 10% of their infusions at home (n=100) received a range of 11.6%-100% of their scheduled infusions at home (median 87.5%), excluding infusions received at the clinic during protocol-mandated visits. The length of time over which individual patients received home therapy ranged from 13days to 4.56years (median 0.57years). During the time that home therapy was available, 2904 of 3572 (81.3%) infusions were administered at home. Ten patients experienced 62 infusion-related adverse events (IRAEs) during 38 home infusions, with malaise, pain, hypertension, fatigue, and headache being reported most frequently. No notable differences were found between the type and severity of IRAEs experienced at home and those experienced at the clinic. Home infusions administered by trained and qualified medical personnel were successfully introduced into the velaglucerase alfa clinical development program, and fewer than 10% of patients experienced IRAEs in the home setting. Local labeling and practice guidelines should be consulted for administration of velaglucerase alfa infusions at home.

  8. Solar thermal energy receiver

    NASA Technical Reports Server (NTRS)

    Baker, Karl W. (Inventor); Dustin, Miles O. (Inventor)

    1992-01-01

    A plurality of heat pipes in a shell receive concentrated solar energy and transfer the energy to a heat activated system. To provide for even distribution of the energy despite uneven impingement of solar energy on the heat pipes, absence of solar energy at times, or failure of one or more of the heat pipes, energy storage means are disposed on the heat pipes which extend through a heat pipe thermal coupling means into the heat activated device. To enhance energy transfer to the heat activated device, the heat pipe coupling cavity means may be provided with extensions into the device. For use with a Stirling engine having passages for working gas, heat transfer members may be positioned to contact the gas and the heat pipes. The shell may be divided into sections by transverse walls. To prevent cavity working fluid from collecting in the extensions, a porous body is positioned in the cavity.

  9. Contingent Take-Home Incentive: Effects on Drug Use of Methadone Maintenance Patients.

    ERIC Educational Resources Information Center

    Stitzer, Maxine L.; And Others

    1992-01-01

    Examined contingent methadone take-home privileges for effectiveness in reducing supplemental drug use of methadone maintenance patients. Assigned 53 new intakes to begin receiving take-home privileges after 2 consecutive weeks of drug-free urines or to noncontingent procedure in which take-homes were delivered independently of urine results.…

  10. DOE Zero Energy Ready Home Case Study: New Town Builders, Denver, Colorado

    SciTech Connect

    none,

    2013-09-01

    All homes in the Stapleton community must be ENERGY STAR certified; New Town Builders has announced that it will build 250–300 new homes over the next 7–10 years, all of which will be Challenge Homes. New Town received a 2013 Housing Innovation Award in the production builder category.

  11. 77 FR 76952 - Energy Conservation Program for Consumer Products: Association of Home Appliance Manufacturers...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-31

    ... Part 430 Energy Conservation Program for Consumer Products: Association of Home Appliance Manufacturers...) received a petition from the Association of Home Appliance Manufacturers (AHAM) requesting reconsideration..., amendment, or repeal of a rule.'' (5 U.S.C. 553(e)). The Association of Home Appliance Manufacturers (AHAM...

  12. Implementation Differences of Two Staffing Models in the German Home Visiting Program "Pro Kind"

    ERIC Educational Resources Information Center

    Brand, Tilman; Jungmann, Tanja

    2012-01-01

    As different competencies or professional backgrounds may affect the quality of program implementation, staffing is a critical issue in home visiting. In this study, N = 430 women received home visits delivered either by a tandem of a midwife and a social worker or by only one home visitor (primarily midwives, continuous model). The groups were…

  13. Receiver System: Lessons Learned from Solar Two

    NASA Astrophysics Data System (ADS)

    Litwin, R. Z.

    2002-03-01

    The Boeing Company fabricated the Solar Two receiver as a subcontractor for the Solar Two project. The receiver absorbed sunlight reflected from the heliostat field. A molten-nitrate-salt heat transfer fluid was pumped from a storage tank at grade level, heated from 290 to 565DGC by the receiver mounted on top of a tower, then flowed back down into another storage tank. To make electricity, the hot salt was pumped through a steam generator to produce steam that powered a conventional Rankine steam turbine/generator. This evaluation identifies the most significant Solar Two receiver system lessons learned from the Mechanical Design, Instrumentation and Control, Panel Fabrication, Site Construction, Receiver System Operation, and Management from the perspective of the receiver designer/manufacturer. The lessons learned on the receiver system described here consist of two parts: the Problem and one or more identified Solutions. The appendix summarizes an inspection of the advanced receiver panel developed by Boeing that was installed and operated in the Solar Two receiver.

  14. Receiver System: Lessons Learned From Solar Two

    SciTech Connect

    LITWIN, ROBERT Z.; PACHECO, JAMES E.

    2002-03-01

    The Boeing Company fabricated the Solar Two receiver as a subcontractor for the Solar Two project. The receiver absorbed sunlight reflected from the heliostat field. A molten-nitrate-salt heat transfer fluid was pumped from a storage tank at grade level, heated from 290 to 565 C by the receiver mounted on top of a tower, then flowed back down into another storage tank. To make electricity, the hot salt was pumped through a steam generator to produce steam that powered a conventional Rankine steam turbine/generator. This evaluation identifies the most significant Solar Two receiver system lessons learned from the Mechanical Design, Instrumentation and Control, Panel Fabrication, Site Construction, Receiver System Operation, and Management from the perspective of the receiver designer/manufacturer. The lessons learned on the receiver system described here consist of two parts: the Problem and one or more identified Solutions. The appendix summarizes an inspection of the advanced receiver panel developed by Boeing that was installed and operated in the Solar Two receiver.

  15. Activities of daily living in nursing home and home care settings: a retrospective 1-year cohort study.

    PubMed

    Lee, Tae Wha; Cho, Eunhee; Yim, Eun Shil; Lee, Hye Sun; Ko, Yu Kyung; Kim, Bok Nam; Kim, Sinhye

    2015-02-01

    Korea introduced universal long-term care insurance (LTCI) for physically dependent older adults in 2008. Older adults, their family members, and policy makers in Korea want to know patient outcomes in different care modalities because older adults who have a similar functional status and LTC needs can choose either nursing home care or home care. The aim of this study was to compare activities of daily living (ADLs) in nursing home care and home care settings for physically dependent older adults in Korea. A retrospective 1-year cohort study using national LTCI data. This study used the LTCI dataset from the National Health Insurance Service in Korea. Participants were identified from among those in the LTCI dataset who enrolled from July 2008 to June 2010. We extracted a sample consisting of 22,557 older adults who consistently received either nursing home care (n = 11,678) or home care (n = 10,879) for 1 year. The outcome variable was change in ADLs after 1 year. Covariates were an older adult's home geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. Multiple regression analysis of all participants unmatched and a paired t-test with a propensity-score-matched cohort were performed to explain the association of changes in ADLs with the types of LTC. Multiple regression analysis with all participants (n = 22,557) unmatched showed that compared with older adults who received home care, those who received nursing home care had deteriorated further in terms of ADLs after 1 year (β = 0.44108, P < .0001). After propensity-score matching, paired t-test analysis also found that the ADLs of older adults had deteriorated less in the home care group compared with the nursing home group after 1 year (P < .0001). The ADLs of older adults who received home care showed significantly less

  16. Essential newborn care after home delivery in Nepal.

    PubMed

    Målqvist, Mats; Pun, Asha; Kc, Ashish

    2017-03-01

    Postnatal care of the newborn is essential in order to reduce neonatal mortality. Nepal has made great efforts to improve maternal and child health by focusing on accessibility and outreach over the past decades. This study aims to examine trends, over the past decade, in levels and equity of facility delivery rates and the provision of newborn care after home delivery in Nepal. Household-level data from the Demographic Health Surveys (DHS) 2006 and 2011 and the Multiple Indicator Cluster Survey (MICS5) from 2014 performed in Nepal was sourced for the study. Coverage rates of facility delivery and newborn care after home delivery were calculated and logistic regression models were used to ascertain inequity. Home delivery rate dropped from 79.2% in 2006 to 46.5% in 2014, a development showing an inequitable distribution, with a larger share of better-off families shifting to facility delivery. For those who still delivered at home there was an increased rate of early initiation of breastfeeding and adequate temperature control, but only 2.2% of women delivering at home received a home visit by a health professional in the first week of delivery. No inequity in receiving newborn care after home delivery could be detected. There have been significant improvements in facility delivery rates over the last 10 years in Nepal and postnatal care at home has improved. There is, however, an alarmingly low level of home visits during an infant's first week.

  17. Paranal Receives New Mirror

    NASA Astrophysics Data System (ADS)

    2008-04-01

    A 4.1-metre diameter primary mirror, a vital part of the world's newest and fastest survey telescope, VISTA (the Visible and Infrared Survey Telescope for Astronomy) has been delivered to its new mountaintop home at Cerro Paranal, Chile. The mirror will now be coupled with a small camera for initial testing prior to installing the main camera in June. Full scientific operations are due to start early next year. VISTA will form part of ESO's Very Large Telescope facility. ESO PR Photo 10d/08 ESO PR Photo 10d/08 The VISTA Mirror The mirror arrived over the Easter weekend at the Paranal Observatory where the telescope is being assembled at an altitude of 2518m, in Chile's Atacama Desert. VISTA Project Manager Alistair McPherson from STFC's UK Astronomy Technology Centre (UK ATC) accompanied the mirror on its journey to Chile: "This is a major milestone for the VISTA project. The precious mirror was loaded on to a plane in a special cradle that used tennis balls to cushion it from impact for its arduous journey across three continents. " "The mirror had a difficult four-day journey, by air and by road. It arrived in perfect condition and now that it has been coated, we will install the mirror in the telescope with a small test camera for about four weeks testing. We plan to install the main camera in June," said the Project Scientist on VISTA, Will Sutherland of Queen Mary, University of London, UK. The VISTA 4.1-metre diameter primary mirror is the most strongly curved large mirror ever polished to such a precise and exacting surface accuracy - deviations from a perfect surface of less than 1/3000th of the thickness of a human hair. On arrival at Cerro Paranal it was safely craned into the telescope dome where it was washed and coated with a thin layer of protected silver in the facility's coating plant. Silver is the best metal for the purpose since it reflects over 98% of near-infrared light, better than the more commonly used aluminium. To date, the reflectivity

  18. Early Childhood Home Visiting.

    PubMed

    Duffee, James H; Mendelsohn, Alan L; Kuo, Alice A; Legano, Lori A; Earls, Marian F

    2017-09-01

    High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home. Copyright © 2017 by the American Academy of Pediatrics.

  19. [Home enteral nutrition].

    PubMed

    Virgili, N; Vilarasau, M C

    1999-04-01

    Enteral nutrition in the home is applied to stabilized patients who do not require hospitalization or to chronically ill patients who can stay in their homes. However, ensuring the correct administration of this treatment requires a coordinated, expert multidisciplinary team. This article reviews the conditions for use of enteral nutrition in the home, the means of access, the nutritional formulas, the administrative technique, and the complications enteral nutrition in the home may present. Furthermore, the composition and characteristics of the multidisciplinary team which will be in charge of carrying out this treatment is discussed.

  20. Ozark Mountain solar home

    SciTech Connect

    Miller, B.

    1998-03-01

    If seeing is believing, Kyle and Christine Sarratt are believers. The couple has been living in their passive solar custom home for almost two years, long enough to see a steady stream of eye-opening utility bills and to experience the quality and comfort of energy-efficient design. Skeptical of solar homes at first, the Sarratts found an energy-conscious designer that showed them how they could realize their home-building dreams and live in greater comfort while spending less money. As Kyle says, {open_quotes}We knew almost nothing about solar design and weren`t looking for it, but when we realized we could get everything we wanted in a home and more, we were sold.{close_quotes} Now the couple is enjoying the great feeling of solar and wood heat in the winter, natural cooling in the summer and heating/cooling bills that average less than $20/month. The Sarratts` home overlooks a large lake near the town of Rogers, tucked up in the northwest corner of Arkansas. It is one of three completed homes out of 29 planned for the South Sun Estates subdivision, where homes are required by covenant to incorporate passive solar design principles. Orlo Stitt, owner of Stitt Energy Systems and developer of the subdivision, has been designing passive solar, energy-efficient homes for twenty years. His passive solar custom home development is the first in Arkansas.

  1. ADMX Receiver and Analysis

    NASA Astrophysics Data System (ADS)

    Malagon, Ana; ADMX Collaboration

    2016-03-01

    ADMX looks for the excess radiation deposited into a cavity from the conversion of a dark matter axion into a microwave photon. The sensitivity of the experiment increases by reducing the background thermal noise and minimizing the electronic noise of the readout system. The axion masses that the experiment can detect are determined by the resonant frequency of the cavity mode of interest, which is tuned using a two rod configuration. One can also increase the search rate by measuring the output from two cavity modes at once, which requires two separate readout schemes. I will discuss the ADMX dual-channel receiver which has been upgraded to have near quantum-limited sensitivity on both channels, and describe how the correct modes are verified, using simulations, in the presence of dense electromagnetic structure. I conclude by describing upgrades to the ADMX analysis which allow for real-time exclusion limits. Supported by DOE Grants DE-FG02-97ER41029, DE-FG02-96ER40956, DE- AC52-07NA27344, DE-AC03-76SF00098, and the Livermore LDRD program.

  2. On-line hemodiafiltration at home.

    PubMed

    Vega, Almudena; Abad, Soraya; Macías, Nicolás; Aragoncillo, Inés

    2017-10-03

    Survival with online hemodiafiltration (OL-HDF) is higher than with hemodialysis; frequent hemodialysis has also improved survival and quality of life. Home hemodialysis facilitates frequent therapy. We report our experience with 2 patients with stage 5 CKD who started home hemodialysis with OL-HDF in November 2016. After a training period at the hospital, they started home hemodialysis with OL-HDF after learning how to manage dialysis monitors and how to administer water treatment. We used the "5008-home" (FMC(©) ) monitor, and the Acqua C(©) (Fresenius Medical Care) for water treatment. Water conductivity was always checked before and during dialysis sessions and was always 2.5 to 3 mS/cm. Water cultures always fulfilled the criteria for ultrapurity. As far as we know, this is the first report on patients receiving OL-HDF at home. The technique proved to be safe and valid for renal replacement therapy and transfers the benefits of hospital convective therapy to the home setting. Future data will enable us to determine whether survival has also improved. © 2017 International Society for Hemodialysis.

  3. Caregivers' acceptance of electronic documentation in nursing homes.

    PubMed

    Yu, Ping; Hailey, David; Li, Haocheng

    2008-01-01

    A comparative study was conducted in two Australian nursing homes operated by the same organization. One home had implemented an electronic documentation system and the other remained paper-based. Survey questionnaires were answered by 14 of the 17 caregivers at the electronic documentation site (82%) and 10 of the 23 caregivers at the paper documentation site (43%). They provided opinions about satisfaction with their home's documentation system, and the training and support provided. Information was also obtained on the caregivers' attitudes towards using electronic documentation. The caregivers at the electronic documentation site quickly adapted to the use of the new technology after receiving effective training and support. Caregivers at both homes were satisfied with their homes' documentation system, and had positive attitudes towards using electronic documentation systems. As an important communication tool, electronic nursing documentation may lead to improved efficacy of telemedicine in nursing home settings.

  4. Homing of cancer cells to the bone.

    PubMed

    Mishra, Anjali; Shiozawa, Yusuke; Pienta, Kenneth J; Taichman, Russell S

    2011-12-01

    A variety of tumor cells preferentially home to the bone. The homing of cancer cells to the bone represents a multi-step process that involves malignant progression of the tumor, invasion of the tumor through the extracellular matrix and the blood vessels and settling of the tumor cells in the bone. Gaining a greater understanding as to the mechanisms used by cancer cells in these processes will facilitate the design of drugs which could specifically target the homing process. In this review we will discuss the properties of tumor cells and the bone microenvironment which promote homing of a cancer cell to the bone. We will highlight the different steps and the molecular pathways involved when a cancer cell metastasize to the bone. Since bone is the major home for hematopoietic stem cells (HSCs), we will also highlight the similarities between the homing of cancer and HSC to the bone. Finally we will conclude with therapeutic and early detection strategies which can prevent homing of a cancer cell to the bone.

  5. [Palliative Care at Home by Anesthesiologists].

    PubMed

    Koitabashi, Toshiya

    2016-03-01

    Governmental policies recommend the palliative care at home for cancer patients. However, there are some barriers to discharge cancer patients from the hospital who want to receive end-of-life care at their homes. Anesthesiologists whose main job is to perform general anesthesia in the operating theater usually have little contact with general practitioners giving community palliative care. So it is important to communicate each other to make opportunities to discuss an organized system and care plan for these patients, and to improve information transfer.

  6. The calibration of Doppler receivers

    NASA Astrophysics Data System (ADS)

    Jaks, W.

    A study to determine the relative positions of the antennas of two simultaneously operating Doppler receivers and the systematic corrections needed for a given type of receiver is presented. The types of receivers included in the study are listed and results showing the differences between the geocentric coordinates of the antenna phase centers of the receivers are given. It is found that, for DOG receivers, each antenna phase center must be determined separately.

  7. The "H" Word: Home Schooling.

    ERIC Educational Resources Information Center

    Butler, Shery

    2000-01-01

    This article discusses home schooling gifted children, including reasons families choose to home school their children, laws regulating home schooling, the educational background of parents who home school, and curriculum options. Advantages and disadvantages of home schooling are explored, along with data indicating the higher achievement of home…

  8. Loneliness and nursing home admission among rural older adults.

    PubMed

    Russell, D W; Cutrona, C E; de la Mora, A; Wallace, R B

    1997-12-01

    In this study, the authors tested the relation between loneliness and subsequent admission to a nursing home over a 4-year time period in a sample of approximately 3,000 rural older Iowans. Higher levels of loneliness were found to increase the likelihood of nursing home admission and to decrease the time until nursing home admission. The influence of extremely high loneliness on nursing home admission remained statistically significant after controlling for other variables, such as age, education, income, mental status, physical health, morale, and social contact, that were also predictive of nursing home admission. Several mechanisms are proposed to explain the link between extreme loneliness and nursing home admission. These include loneliness as a precipitant of declines in mental and physical health and nursing home placement as a strategy to gain social contact with others. Implications for preventative interventions are discussed.

  9. Pigeons home faster through polluted air

    NASA Astrophysics Data System (ADS)

    Li, Zhongqiu; Courchamp, Franck; Blumstein, Daniel T.

    2016-01-01

    Air pollution, especially haze pollution, is creating health issues for both humans and other animals. However, remarkably little is known about how animals behaviourally respond to air pollution. We used multiple linear regression to analyse 415 pigeon races in the North China Plain, an area with considerable air pollution, and found that while the proportion of pigeons successfully homed was not influenced by air pollution, pigeons homed faster when the air was especially polluted. Our results may be explained by an enhanced homing motivation and possibly an enriched olfactory environment that facilitates homing. Our study provides a unique example of animals’ response to haze pollution; future studies are needed to identify proposed mechanisms underlying this effect.

  10. Home ranges, habitat and body mass: simple correlates of home range size in ungulates

    PubMed Central

    Herfindal, Ivar; Solberg, Erling Johan; Sæther, Bernt-Erik

    2016-01-01

    The spatial scale of animal space use, e.g. measured as individual home range size, is a key trait with important implications for ecological and evolutionary processes as well as management and conservation of populations and ecosystems. Explaining variation in home range size has therefore received great attention in ecological research. However, few studies have examined multiple hypotheses simultaneously, which is important provided the complex interactions between life history, social system and behaviour. Here, we review previous studies on home range size in ungulates, supplementing with a meta-analysis, to assess how differences in habitat use and species characteristics affect the relationship between body mass and home range size. Habitat type was the main factor explaining interspecific differences in home range size after accounting for species body mass and group size. Species using open habitats had larger home ranges for a given body mass than species using closed habitats, whereas species in open habitats showed a much weaker allometric relationship compared with species living in closed habitats. We found no support for relationships between home range size and species diet or mating system, or any sexual differences. These patterns suggest that the spatial scale of animal movement mainly is a combined effect of body mass, group size and the landscape structure. Accordingly, landscape management must acknowledge the influence of spatial distribution of habitat types on animal behaviour to ensure natural processes affecting demography and viability of ungulate populations. PMID:28003441

  11. INNOVATION IN HOME ECONOMICS.

    ERIC Educational Resources Information Center

    Department of Home Economics, Washington, DC.

    THIS GUIDE IS FOR TEACHER USE IN PLANNING A SHORT COURSE IN HOME ECONOMICS PROGRAM FOR 11TH AND 12TH GRADE BOYS AND GIRLS. IT WAS DEVELOPED BY ARLINGTON COUNTY SCHOOLS, VIRGINIA, AND THE CONTENT WAS DETERMINED BY A COMMITTEE OF HOME ECONOMICS TEACHERS, A PRINCIPAL, AND A FEW SELECTED STUDENTS. THE OBJECTIVE OF THE COURSE IS TO PROVIDE A SERIES OF…

  12. No Place Like Home.

    ERIC Educational Resources Information Center

    Austin, Elizabeth

    2000-01-01

    To fight rampant consumerism (Martha Stewart Inc.), reduce the divorce rate, prevent cancer and heart disease, and ensure domestic tranquility, educators should bring back home economics. Workers must put more energy into the home front, and we must begin teaching our children how to live well on less. (MLH)

  13. Home Schooling: The Facts.

    ERIC Educational Resources Information Center

    Menendez, Albert J.

    Home schooling, practiced as an alternative to both public and private schooling, is on the increase. This booklet provides an overview of the home schooling movement's statistical and demographic background. It also describes the legal context in states across the United States; the advocacy groups that are involved; the reasons why parents home…

  14. Classroom at Home.

    ERIC Educational Resources Information Center

    Simmons, Betty Jo

    1994-01-01

    Parents applying for home schooling should be informed about such matters as curriculum options, testing procedures, teaching qualifications, and opportunities for socialization. Home-schooled children should be allowed to participate in as many of the regular school offerings as schools can legitimately accommodate. Provides statistics about home…

  15. Home Teaching and Herbart.

    ERIC Educational Resources Information Center

    Rust, Val D.; Reed, Frances

    1979-01-01

    Viewing the growing disenchantment with state-controlled schooling, the authors predict that home teaching will become an established educational alternative within a short time, and they reflect on the teachings and writings of Johann Friedrich Herbart, an eighteenth-century advocate of educating children at home. (Editor/SJL)

  16. Children and Home Fires

    MedlinePlus

    CHILDREN AND HOME FIRES Fast Facts Children under the age of five are twice as likely to die in a home fire than the rest of the population, and child-playing fires are the leading cause of fire deaths among ...

  17. No Place Like Home.

    ERIC Educational Resources Information Center

    Austin, Elizabeth

    2000-01-01

    To fight rampant consumerism (Martha Stewart Inc.), reduce the divorce rate, prevent cancer and heart disease, and ensure domestic tranquility, educators should bring back home economics. Workers must put more energy into the home front, and we must begin teaching our children how to live well on less. (MLH)

  18. Home Education in Russia

    ERIC Educational Resources Information Center

    Staroverova, T. I.

    2011-01-01

    From the eighteenth through the early twentieth centuries, home education (home schooling) by tutors and governesses in Russia was a customary form of schooling for an overwhelming majority of members of the nobility. Social and political transformations of the twentieth century led to substantial changes as the state got actively involved with…

  19. Home Fires Involving Grills

    MedlinePlus

    ... 8,700) of the injuries were thermal burns. Children under five accounted for 1,600 or one-third of the 4,900 thermal non-fire grill burns. These were typically contact burns rather than flame burns. 1 Homes include one- or two-family homes, apartments, town ...

  20. Home Visitor's Notebook

    ERIC Educational Resources Information Center

    Gotts, Edward E., Ed.

    This training manual for home visitor trainers and trainees was developed for use in home-based preschool programs. The notebook is part of a learning package which instructs prospective family workers, family worker trainers, and parents in the entry level skills, knowledge, and orientations needed to provide children from birth through 8 years…

  1. Sex Away from Home

    ERIC Educational Resources Information Center

    Greenwald, Harold

    1971-01-01

    The reasons why people who are normally truthful to their spouses engage in sex away from home are discussed. These reasons can include loneliness, ego building or the opportunity to have homosexual relations. Sex away from home is likely to increase since the number of people traveling is increasing. (Author/CG)

  2. Asbestos in the Home.

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Washington, DC.

    The United States Government is concerned about asbestos-containing products in the home because sometimes asbestos fibers can be released from these produces. If asbestos fibers are inhaled, certain types of cancer may later develop. Asbestos in homes poses several problems. Household members have little or no protection from exposure to asbestos…

  3. Aerospace technology comes home.

    PubMed

    Coleman, C

    1997-07-01

    Science is expanding the options for homebound patients. Many of the new technologies coming into the home care industry are the result of aerospace innovations. What are these new technologies, and what can the home care industry expect to see in the future.

  4. Home and Family Life.

    ERIC Educational Resources Information Center

    Frese, Millie K., Ed.

    1996-01-01

    The "Goldfinch" is a magazine that introduces children to different aspects of Iowa History. Each issue contains articles to provide in-depth knowledge of a topic about Iowa. The focus of this issue is homes and family life in Iowa history. Selections address what has been important to Iowa's families over time and what homes were like…

  5. Home Maintenance Manual.

    ERIC Educational Resources Information Center

    Richmond, Jim; And Others

    This manual, written especially for the Navajo and Hopi Indian Relocation Commission, is a simply worded, step-by-step guide to home maintenance for new homeowners. It can be used for self-study or it can serve as instructional material for a training class on home ownership. The manual is organized in nine sections that cover the following…

  6. Home Activities for Fours.

    ERIC Educational Resources Information Center

    Ferguson-Florissant School District, Ferguson, MO.

    These home learning activity guides have been developed for parents to use with their 4-year-old children. Most of the activities require only household items that are often thrown away and can be recycled for learning activities. Some require no materials at all. The guides frequently begin with a discussion of home activities; progress through…

  7. The Home Stretch.

    ERIC Educational Resources Information Center

    Cansler, Dot

    Originally conceived as an adjunct to the publication "A Planning Guide to the Preschool Curriculum," this home activities guide can be used by any parent of a young child. The guide consists of 44 units (each centered on a specific concept) designed to provide a variety of cognitive, sensory, and motor experiences. Most of the home activities…

  8. Home Study Advertising Handbook.

    ERIC Educational Resources Information Center

    Lambert, Michael P., Ed.; Welch, Sally R., Ed.

    This handbook contains a collections of nine articles on the subject of direct-response advertising. The handbook gives advice on how to create effective advertisements for home study courses. The nine articles are the following: "Overview of Home Study Advertising in the 1990s" (Michael P. Lambert); "Ad Features that Sell"…

  9. Asbestos in the Home.

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Washington, DC.

    The United States Government is concerned about asbestos-containing products in the home because sometimes asbestos fibers can be released from these produces. If asbestos fibers are inhaled, certain types of cancer may later develop. Asbestos in homes poses several problems. Household members have little or no protection from exposure to asbestos…

  10. Marketing home care services.

    PubMed

    Moore, S T

    1987-08-01

    With the decline in inpatients, hospital administrators and marketers are seeking revenue opportunities in meeting the needs of a new market, home care patients. The challenge for managers in the home care arena is to target their marketing efforts towards the important decision makers. Managers who can best meet the goal of patients, families and professionals will be most successful.

  11. Home Education in Russia

    ERIC Educational Resources Information Center

    Staroverova, T. I.

    2011-01-01

    From the eighteenth through the early twentieth centuries, home education (home schooling) by tutors and governesses in Russia was a customary form of schooling for an overwhelming majority of members of the nobility. Social and political transformations of the twentieth century led to substantial changes as the state got actively involved with…

  12. Home Start Curriculum Guide.

    ERIC Educational Resources Information Center

    Roggman, Lori; And Others

    This curriculum guide contains monthly work plans and weekly activity units for a Home Start Program. Emphasis is placed on the importance of the home, the family unit, and the education and development of young children by their own parents. Yearly goals include concern for the following: physical and dental health, nutrition, mental health and…

  13. The Home Microbiome Project

    ScienceCinema

    Gilbert, Jack

    2016-07-12

    The Home Microbiome Project is an initiative aimed at uncovering the dynamic co-associations between people's bacteria and the bacteria found in their homes.The hope is that the data and project will show that routine monitoring of the microbial diversity of your body and of the environment in which you live is possible.

  14. The Home Microbiome Project

    SciTech Connect

    Gilbert, Jack

    2014-08-25

    The Home Microbiome Project is an initiative aimed at uncovering the dynamic co-associations between people's bacteria and the bacteria found in their homes.The hope is that the data and project will show that routine monitoring of the microbial diversity of your body and of the environment in which you live is possible.

  15. A Home Intervention Handbook.

    ERIC Educational Resources Information Center

    Lafayette County School District, Oxford, MS.

    A home intervention program for 18 learning disabled and educable mentally retarded elementary school children and their families included biweekly home visits during which parents were shown specific learning activities or games. Analysis of pre and post tests on the Peabody Individual Achievement Test (PIAT), the Wechsler Intelligence Scale for…

  16. Hospice use among nursing home and non-nursing home patients.

    PubMed

    Unroe, Kathleen T; Sachs, Greg A; Dennis, M E; Hickman, Susan E; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M

    2015-02-01

    For nursing home patients, hospice use and associated costs have grown dramatically. A better understanding of hospice in all care settings, especially how patients move across settings, is needed to inform debates about appropriateness of use and potential policy reform. Our aim was to describe characteristics and utilization of hospice among nursing home and non-nursing home patients. Medicare, Medicaid and Minimum Data Set data, 1999-2008, were merged for 3,771 hospice patients aged 65 years and above from a safety net health system. Patients were classified into four groups who received hospice: 1) only in nursing homes; 2) outside of nursing homes; 3) crossover patients utilizing hospice in both settings; and 4) "near-transition" patients who received hospice within 30 days of a nursing home stay. Differences in demographics, hospice diagnoses and length of stay, utilization and costs are presented with descriptive statistics. Nursing home hospice patients were older, and more likely to be women and to have dementia (p < 0.0001). Nearly one-third (32.3 %) of crossover patients had hospice stays > 6 months, compared with the other groups (16 % of nursing home hospice only, 10.7 % of non-nursing home hospice and 7.6 % of those with near transitions) (p < 0.0001). Overall, 27.7 % of patients had a hospice stay <1 week, but there were marked differences between groups-48 % of near-transition patients vs. 7.4 % of crossover patients had these short hospice stays (p < 0.0001). Crossover and near-transition hospice patients had higher costs to Medicare compared to other groups (p < 0.05). Dichotomizing hospice users only into nursing home vs. non-nursing home patients is difficult, due to transitions across settings. Hospice patients with transitions accrue higher costs. The impact of changes to the hospice benefit on patients who live or move through nursing homes near the end of life should be carefully considered.

  17. Measure Guideline: Selecting Ventilation Systems for Existing Homes

    SciTech Connect

    Aldrich, R.

    2014-02-01

    This document addresses adding -or improving - mechanical ventilation systems to existing homes. The purpose of ventilation is to remove contaminants from homes, and this report discusses where, when, and how much ventilation is appropriate in a home, including some discussion of relevant codes and standards. Advantages, disadvantages, and approximate costs of various system types are presented along with general guidelines for implementing the systems in homes. CARB intends for this document to be useful to decision makers and contractors implementing ventilation systems in homes. Choosing the "best" system is not always straightforward; selecting a system involves balancing performance, efficiency, cost, required maintenance, and several other factors. It is the intent of this document to assist contractors in making more informed decisions when selecting systems. Ventilation is an integral part of a high-performance home. With more air-sealed envelopes, a mechanical means of removing contaminants is critical for indoor environmental quality and building durability.

  18. Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees.

    PubMed

    Li, Qijuan; Keohane, Laura M; Thomas, Kali; Lee, Yoojin; Trivedi, Amal N

    2017-07-01

    Several policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy. To determine the association of home health copayments with use of home health services. A difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans. Introduction of copayments for home health care between 2007 and 2011. Proportion of enrollees receiving home health care, annual numbers of home health episodes, and days receiving home health care. Copayments for home health visits ranged from $5 to $20 per visit, which were estimated to be associated with $165 (interquartile range [IQR], $45-$180) to $660 (IQR, $180-$720) in out-of-pocket spending for the average user of home health care. The increased copayment for home health care was not associated with the proportion of enrollees receiving home health care (adjusted difference-in-differences, -0.15 percentage points; 95% CI, -0.38 to 0.09), the number of home health episodes per user (adjusted difference-in-differences, 0.01; 95% CI, -0.01 to 0.03), and home health days per user (adjusted difference-in-differences, -0.19; 95% CI, -3.02 to 2.64). In both intervention and control plans and across all levels of copayments, we observed higher disenrollment rates among enrollees with greater baseline use of home health care. We found no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. The findings raise questions about the potential effectiveness of this cost-containment strategy.

  19. Seasonal variation in self-measured home blood pressure among patients on antihypertensive medications: HOMED-BP study.

    PubMed

    Hanazawa, Tomohiro; Asayama, Kei; Watabe, Daisuke; Hosaka, Miki; Satoh, Michihiro; Yasui, Daisaku; Obara, Taku; Inoue, Ryusuke; Metoki, Hirohito; Kikuya, Masahiro; Imai, Yutaka; Ohkubo, Takayoshi

    2017-03-01

    Seasonal variation of blood pressure (BP) has been reported in small populations or by BP levels captured at only a few points in a year, for example, summer and winter. We aimed to investigate the multiyear seasonal variation in self-measured home BP among hypertensive patients receiving antihypertensive medications. We selected 1649 eligible patients receiving antihypertensive drug treatment, and weekly averaged home BPs were analyzed throughout the follow-up period. Systolic and diastolic home BPs were fitted with the cosine function: 'Variation+Other Effects+Intercept', in which the 'Variation' was expressed by a cosine curve with three parameters representing: (1) maximum-minimum difference of home BP in one cycle of the cosine curve; (2) time required for one cycle of the cosine curve for home BP variation; and (3) time at which home BP reached the maximum point. Maximum-minimum differences in home BP were 6.7/2.9 mm Hg, and the highest home BPs were observed in mid-to-late January. In the multivariable-adjusted model, a large maximum-minimum difference in home BP was associated with lower body mass index and older age, and larger differences were observed in men compared with women. Summer-winter difference in home BP was essentially similar every year, though it was marginally reduced by 0.14/0.04 mm Hg per year, under long-term antihypertensive treatment. Records of daily home BP measurements enable us to capture long-term factors such as seasonal variation. Home BP should therefore be carefully monitored, particularly in patients with increased BP in winter, to mitigate cardiovascular risk.

  20. Home Start: How a Home-Based Preschool Program Raised Black Achievements.

    ERIC Educational Resources Information Center

    Scott, Ralph

    This presentation discusses longitudinal results of a home-based program for low SES black and white children whose parents received weekly visits designed to chart children's individualized enrichment when they were from 2 to 5 years of age. The program drew upon school and community resource personnel when appropriate, to provide parents with…

  1. A Fiber-Optic Coupled Telescope for Water Vapor DIAL Receivers

    NASA Technical Reports Server (NTRS)

    DeYoung, Russell J.; Lonn, Frederick

    1998-01-01

    A fiber-optic coupled telescope of low complexity was constructed and tested. The major loss mechanisms of the optical system have been characterized. Light collected by the receiver mirror is focused onto an optical fiber, and the output of the fiber is filtered by an interference filter and then focused onto an APD detector. This system was used in lidar field measurements with a 532-nm Nd:YAG laser beam. The results were encouraging. A numerical model used for calculation of the expected return signal agreed with the lidar return signal obtained. The assembled system was easy to align and operate and weighed about 8 kg for a 30 cm (12") mirror system. This weight is low enough to allow mounting of the fiber-optic telescope receiver system in a UAV. Furthermore, the good agreement between the numerical lidar model and the performance of the actual receiver system, suggests that this model may be used for estimation of the performance of this and other lidar systems in the future. Such telescopes are relatively easy to construct and align. The fiber optic cable allows easy placement of the optical detector in any position. These telescope systems should find widespread use in aircraft and space home DIAL water vapor receiver systems.

  2. A Fiber-Optic Coupled Telescope for Water Vapor DIAL Receivers

    NASA Technical Reports Server (NTRS)

    DeYoung, Russell J.; Lonn, Frederick

    1998-01-01

    A fiber-optic coupled telescope of low complexity was constructed and tested. The major loss mechanisms of the optical system have been characterized. Light collected by the receiver mirror is focused onto an optical fiber, and the output of the fiber is filtered by an interference filter and then focused onto an APD detector. This system was used in lidar field measurements with a 532-nm Nd:YAG laser beam. The results were encouraging. A numerical model used for calculation of the expected return signal agreed with the lidar return signal obtained. The assembled system was easy to align and operate and weighed about 8 kg for a 30 cm (12") mirror system. This weight is low enough to allow mounting of the fiber-optic telescope receiver system in a UAV. Furthermore, the good agreement between the numerical lidar model and the performance of the actual receiver system, suggests that this model may be used for estimation of the performance of this and other lidar systems in the future. Such telescopes are relatively easy to construct and align. The fiber optic cable allows easy placement of the optical detector in any position. These telescope systems should find widespread use in aircraft and space home DIAL water vapor receiver systems.

  3. Protocols for Home Energy Upgrades

    EPA Pesticide Factsheets

    Remodeling or renovating an existing home not only has the potential to release pollutants into the home; it is also an opportunity to make changes that will improve the indoor air quality in your home.

  4. Functional Grouping in Residential Homes for People with Intellectual Disabilities.

    ERIC Educational Resources Information Center

    Mansell, Jim; Beadle-Brown, Julie; Macdonald, Susan; Ashman, Bev

    2003-01-01

    The effects of functional grouping of 303 people with intellectual disabilities on care practices in English group homes were investigated. Residents who were non-ambulant were rated as receiving care with less interpersonal warmth and residents with severe challenging behavior were rated as receiving care with less interpersonal warmth and…

  5. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... administrative funds from a sponsoring organization to assist them in obtaining their license. Day care homes that, at the option of their sponsoring organization, receive administrative funds for licensing... to receiving any funds. The agreement must be signed by the sponsoring organization and the provider...

  6. Autism-Specific Primary Care Medical Home Intervention

    ERIC Educational Resources Information Center

    Golnik, Allison; Scal, Peter; Wey, Andrew; Gaillard, Philippe

    2012-01-01

    Forty-six subjects received primary medical care within an autism-specific medical home intervention (www.autismmedicalhome.com) and 157 controls received standard primary medical care. Subjects and controls had autism spectrum disorder diagnoses. Thirty-four subjects (74%) and 62 controls (40%) completed pre and post surveys. Controlling for…

  7. Admission avoidance hospital at home.

    PubMed

    Shepperd, Sasha; Iliffe, Steve; Doll, Helen A; Clarke, Mike J; Kalra, Lalit; Wilson, Andrew D; Gonçalves-Bradley, Daniela C

    2016-09-01

    or no difference on mortality at six months' follow-up (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.60 to 0.99; P = 0.04; I(2) = 0%; 912 participants; moderate-certainty evidence), little or no difference on the likelihood of being transferred (or readmitted) to hospital (RR 0.98, 95% CI 0.77 to 1.23; P = 0.84; I(2) = 28%; 834 participants; moderate-certainty evidence), and may reduce the likelihood of living in residential care at six months' follow-up (RR 0.35, 95% CI 0.22 to 0.57; P < 0.0001; I(2) = 78%; 727 participants; low-certainty evidence). Satisfaction with healthcare received may be improved with admission avoidance hospital at home (646 participants, low-certainty evidence); few studies reported the effect on caregivers. When the costs of informal care were excluded, admission avoidance hospital at home may be less expensive than admission to an acute hospital ward (287 participants, low-certainty evidence); there was variation in the reduction of hospital length of stay, estimates ranged from a mean difference of -8.09 days (95% CI -14.34 to -1.85) in a trial recruiting older people with varied health problems, to a mean increase of 15.90 days (95% CI 8.10 to 23.70) in a study that recruited patients recovering from a stroke. Admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of elderly patients requiring hospital admission. However, the evidence is limited by the small randomised controlled trials included in the review, which adds a degree of imprecision to the results for the main outcomes.

  8. Considerations for Future IGS Receivers

    NASA Astrophysics Data System (ADS)

    Humphreys, T. E.; Young, L. E.; Pany, T.

    2008-12-01

    Future International GNSS Service (IGS) receivers are considered against the backdrop of GNSS signal modernization and the IGS's goal of further improving the accuracy of its products. The purpose of this paper is to provide the IGS ---and any other group that uses geodetic-quality GNSS receivers---with a guide to making decisions about GNSS receivers. Modernized GNSS signals are analyzed with a view toward IGS applications. A schedule for minimum IGS receiver requirements is proposed. Features of idealized conceptual receivers are discussed. The prospects for standard commercial receivers and for software-defined GNSS receivers are examined. Recommendations are given for how the IGS should proceed in order to maximally benefit from the transformation in GNSS that will occur over the next decade. There are two reasons why it makes sense for the IGS to study GNSS receivers that will be integrated into its network in the coming years. First, the new GNSS signals that will come on line over the next decade will render current IGS receivers obsolete, so it is prudent to examine receiver options going forward. Second, the push to improve the accuracy of IGS products beyond current limits demands greater accuracy in the models used to describe receiver measurements. As a result, the IGS must demand from vendors more transparency into receiver firmware or adoption of user-specified algorithms. This paper considers future IGS receivers from four different points of view. Section 2 looks at modernized GNSS signals and their benefits for the IGS. Section 3 surveys the range of expected receiver capability. Section 4 considers current and future commercial geodetic-quality receivers. Section 5 considers software GNSS receivers as an alternative to less reconfigurable traditional receivers. Section 6 lays out the authors' recommendations to the IGS.

  9. A 30 GHz monolithic receive module

    NASA Technical Reports Server (NTRS)

    Mondal, J.; Contolatis, T.; Geddes, J.; Bauhahn, P.; Sokolov, V.

    1990-01-01

    The technical achievements and deliveries made during the duration of the program to develop a 30 GHz monolithic receive module for communication feed array applications and to deliver submodules and 30 GHz monolithic receive modules for experimental evaluation are discussed. Key requirements include an overall receive module noise figure of 5 dB, a 30 dB RF-to-RF gain with six levels of intermediate gain control, a five bit phase shifter, and a maximum power consumption of 250 mW. In addition, the monolithic receive module design addresses a cost goal of less than one thousand dollars (1980 dollars) per module in unit buys of 5,000 or more, and a mechanical configuration that is applicable to a spaceborne phase array system. An additional task for the development and delivery of 32 GHz phase shifter integrated circuit (IC) for deep space communication is also described.

  10. Real-time software receiver

    NASA Technical Reports Server (NTRS)

    Ledvina, Brent M. (Inventor); Psiaki, Mark L. (Inventor); Powell, Steven P. (Inventor); Kintner, Jr., Paul M. (Inventor)

    2006-01-01

    A real-time software receiver that executes on a general purpose processor. The software receiver includes data acquisition and correlator modules that perform, in place of hardware correlation, baseband mixing and PRN code correlation using bit-wise parallelism.

  11. Real-time software receiver

    NASA Technical Reports Server (NTRS)

    Ledvina, Brent M. (Inventor); Psiaki, Mark L. (Inventor); Powell, Steven P. (Inventor); Kintner, Jr., Paul M. (Inventor)

    2007-01-01

    A real-time software receiver that executes on a general purpose processor. The software receiver includes data acquisition and correlator modules that perform, in place of hardware correlation, baseband mixing and PRN code correlation using bit-wise parallelism.

  12. High-temperature ceramic receivers

    SciTech Connect

    Jarvinen, P. O.

    1980-01-01

    An advanced ceramic dome cavity receiver is discussed which heats pressurized gas to temperatures above 1800/sup 0/F (1000/sup 0/C) for use in solar Brayton power systems of the dispersed receiver/dish or central receiver type. Optical, heat transfer, structural, and ceramic material design aspects of the receiver are reported and the development and experimental demonstration of a high-temperature seal between the pressurized gas and the high-temperature silicon carbide dome material is described.

  13. High temperature solar thermal receiver

    NASA Technical Reports Server (NTRS)

    1979-01-01

    A design concept for a high temperature solar thermal receiver to operate at 3 atmospheres pressure and 2500 F outlet was developed. The performance and complexity of windowed matrix, tube-header, and extended surface receivers were evaluated. The windowed matrix receiver proved to offer substantial cost and performance benefits. An efficient and cost effective hardware design was evaluated for a receiver which can be readily interfaced to fuel and chemical processes or to heat engines for power generation.

  14. Misalignment between Medicare Policies and Depression Care in Home Health Care: Home health provider perspectives

    PubMed Central

    Bao, Yuhua; Eggman, Ashley; Richardson, Joshua; Bruce, Martha

    2013-01-01

    Objective Depression affects one in four older adults receiving home health care. Medicare policies are influential in shaping home health practice. This study aims to identify Medicare policy areas that are aligned or misaligned with depression care quality improvement in home health care. Methods Qualitative study based on semi-structured interviews with nurses and administrators from five home health agencies in five states (n=20). Digitally recorded interviews were transcribed and analyzed using the grounded theory method. A multi-disciplinary team iteratively developed a codebook from interview data to identify themes. Results Several important Medicare policies are largely misaligned with depression care quality improvement in home health care: Medicare eligibility requirements for patients to remain homebound and to demonstrate a need for skilled care restrict nurses’ abilities to follow up with depressed patients for sufficient length of time; the lack of explicit recognition of nursing time and quality of care in the home health Prospective Payment System (PPS) provides misaligned incentives for depression care; incorporation of a two-item depression screening tool in Medicare-mandated comprehensive patient assessment raised clinician awareness of depression; however, inclusion of the tool at Start-of-Care only but not any other follow-up points limits its potential in assisting nurses with depression care management; under-development of clinical decision support for depression care in vendor-developed electronic health records constitutes an important barrier to depression quality improvement in home health care. Conclusions Several influential Medicare policies and regulations for home health practice may be misaligned with evidence-based depression care for home health patients. PMID:24632686

  15. Home-Study Microlabs

    NASA Astrophysics Data System (ADS)

    Kennepohl, Dietmar

    1996-10-01

    This article presents the use of microscaled chemistry experiments for individual home study and how it can be incorporated into a course with traditional laboratory work. A portable home kit containing four experiments that can be carried out unsupervised by a distance education student in first-year university chemistry is described. Experiments include the physical chemistry of solutions, reactions and identification of aqueous cations, calorimetry, and quantitative determination of phosphorus. The results of a student survey of this home-study microlab kit are also presented and discussed.

  16. Organizational relationships between nursing homes and hospitals and quality of care during hospital-nursing home patient transfers.

    PubMed

    Boockvar, Kenneth S; Burack, Orah R

    2007-07-01

    To identify organizational factors and hospital and nursing home organizational relationships associated with more-effective processes of care during hospital-nursing home patient transfer. Mailed survey. Medicare- or Medicaid-certified nursing homes in New York State. Nursing home administrators, with input from other nursing home staff. Key predictor variables were travel time between the hospital and the nursing home, affiliation with the same health system, same corporate owner, trainees from the same institution, pharmacy or laboratory agreements, continuous physician care, number of beds in the hospital, teaching status, and frequency of geriatrics specialty care in the hospital. Key dependent variables were hospital-to-nursing home communication, continuous adherence to healthcare goals, and patient and family satisfaction with hospital care. Of 647 questionnaires sent, 229 were returned (35.4%). There was no relationship between hospital-nursing home interorganizational relationships and communication, healthcare goal adherence, and satisfaction measures. Geriatrics specialty care in the hospital (r=0.157; P=.04) and fewer hospital beds (r=-0.194; P=.01) were each associated with nursing homes more often receiving all information needed to care for patients transferred from the hospital. Teaching status (r=0.230; P=.001) and geriatrics specialty care (r=0.185; P=.01) were associated with hospital care more often consistent with healthcare goals established in the nursing home. No management-level organizational relationship between nursing home and hospital was associated with better hospital-to-nursing home transfer process of care. Geriatrics specialty care and characteristics of the hospital were associated with better hospital-to-nursing home transfer processes.

  17. A Study of the Association Between Multidisciplinary Home Care and Home Death Among Thai Palliative Care Patients.

    PubMed

    Nagaviroj, Kittiphon; Anothaisintawee, Thunyarat

    2017-06-01

    Many terminally ill patients would prefer to stay and die in their own homes, but unfortunately, some may not be able to do so. Although there are many factors associated with successful home deaths, receiving palliative home visits from the multidisciplinary care teams is one of the key factors that enable patients to die at home. Our study was aimed to find whether there was any association between our palliative home care program and home death. A retrospective study was conducted in the Department of Family Medicine at Ramathibodi Hospital between January 2012 and May 2014. All of the patients who were referred to multidisciplinary palliative care teams were included. The data set comprised of patient's profile, disease status, functional status, patient's symptoms, preferred place of death, frequency of home visits, types of team interventions, and patient's actual place of death. Multiple logistic regression was applied in order to determine the association between the variables and the probability of dying at home. A total of 142 patients were included into the study. At the end of the study, 50 (35.2%) patients died at home and 92 (64.8%) patients died in the hospital. The multivariate logistic regression analysis demonstrated a strong association between multidisciplinary home care and home death (odds ratio 6.57, 95% confidence interval [CI] 2.48-17.38). Palliative home care was a significant factor enabling patients who want to die at home. We encourage health policy makers to promote the development of community-based palliative care programs in Thailand.

  18. Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia

    PubMed Central

    2014-01-01

    Background A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Methods Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. Results There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program. Conclusions The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not

  19. Moving Parkinson care to the home.

    PubMed

    Dorsey, E Ray; Vlaanderen, Floris P; Engelen, Lucien Jlpg; Kieburtz, Karl; Zhu, William; Biglan, Kevin M; Faber, Marjan J; Bloem, Bastiaan R

    2016-09-01

    In many ways, the care of individuals with Parkinson disease does not meet their needs. Despite the documented benefits of receiving care from clinicians with Parkinson disease expertise, many patients (if not most) do not. Moreover, current care models frequently require older individuals with impaired mobility, cognition, and driving ability to be driven by overburdened caregivers to large, complex urban medical centers. Moving care to the patient's home would make Parkinson disease care more patient-centered. Demographic factors, including aging populations, and social factors, such as the splintering of the extended family, will increase the need for home-based care. Technological advances, especially the ability to assess and deliver care remotely, will enable the transition of care back to the home. However, despite its promise, this next generation of home-based care will have to overcome barriers, including outdated insurance models and a technological divide. Once these barriers are addressed, home-based care will increase access to high quality care for the growing number of individuals with Parkinson disease. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  20. Managing the body work of home care.

    PubMed

    England, Kim; Dyck, Isabel

    2011-02-01

    Body work is a key element of home healthcare. Recent restructuring of health and social care services means the home is increasingly a key site of long-term care. While there is a growing literature on the social dynamics between care recipients and their family caregivers, less is known about the formal work dynamic between paid care workers and care recipients and family caregivers. Drawing on interview data from an Ontario-based study of long-term home care, we explore how body work is negotiated through the embodied practices of care in the home and through care relationships associated with home care. In particular we focus on how the practices of intimate body care (such as bathing, toileting, and catheter management) show the diverse dynamics of care work through which caregivers, care recipients and homespace are constituted. We argue that the practices of care are shaped by a complex interweaving of regulatory mechanisms associated with home care along with the physical and affective dimensions of intimate body work. In turn this suggests the need for new ways of understanding body work in contemporary landscapes of care.