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Toggle navigation Topics by WorldWideScience.org Home About News Advanced Search Contact Us Site Map Help Sample records for hospital advanced life « 1 2 3 4 5 » 1. Appropriateness of medications prescribed to elderly patients with advanced heart failure and limited life expectancy who died during hospitalization. Science.gov (United States) Barceló, Montserrat; Torres, Olga; Ruiz, Domingo; Casademont, Jordi 2014-07-01 Drug therapy in patients with advanced heart failure and limited life expectancy may be of no benefit or even inappropriate. The aim of this study was to analyze the appropriateness of medication prescribed to patients with advanced heart failure and limited life expectancy, considering as such an expected median survival of less than 6 months. We retrospectively reviewed data on all patients with advanced heart failure who met criteria for limited life expectancy and who died in the geriatric ward of a tertiary hospital over a four-and-a-half-year period. We analyzed treatments prescribed before admission, especially drugs used for prophylaxis or to prolong life. A total of 72 patients were included. The mean age was 85.4 years, and 52.3 % were women. Mean Charlson index was 3.2. Prophylactic medications taken by patients at admission were antiplatelets in 40 patients (55.6 %), oral anticoagulants in 17 (23.6 %), statins in 14 (19.4 %), and osteoporosis medication in nine (12.5 %). Medications taken to prolong survival were angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists in 29 patients (40.3 %). Other medications were iron supplements in 19 patients (26.4 %), vitamins in two (2.8 %), and acetylcholinesterase inhibitors in two (2.8 %). Our results show that patients with advanced heart failure and limited life expectancy were receiving an excessive number of prophylactic medications, drugs to prolong life, and other inappropriate treatments. These findings emphasize the need to review drug therapy in an individualized manner in elderly patients with advanced stages of heart disease and a poor prognosis. 2. [Pediatric advanced life support]. Science.gov (United States) Muguruma, Takashi 2011-04-01 Important changes or points of emphasis in the recommendations for pediatric advanced life support are as follows. In infants and children with no signs of life, healthcare providers should begin CPR unless they can definitely palpate a pulse within 10 seconds. New evidence documents the important role of ventilations in CPR for infants and children. Rescuers should provide conventional CPR for in-hospital and out-of-hospital pediatric cardiac arrests. The initial defibrillation energy dose of 2 to 4J/kg of either monophasic or biphasic waveform. Both cuffed and uncuffed tracheal tubes are acceptable for infants and children undergoing emergency intubation. Monitoring capnography/capnometry is recommended to confirm proper endotracheal tube position. 3. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital Directory of Open Access Journals (Sweden) Kanwalpreet Sodhi 2011-01-01 Full Text Available Background: Guidelines on performing cardiopulmonary resuscitation (CPR have been published from time to time, and formal training programs are conducted based on these guidelines. Very few data are available in world literature highlighting the impact of these trainings on CPR outcome. Aim: The aim of our study was to evaluate the impact of the American Heart Association (AHA-certified basic life support (BLS and advanced cardiac life support (ACLS provider course on the outcomes of CPR in our hospital. Materials and Methods : An AHA-certified BLS and ACLS provider training programme was conducted in our hospital in the first week of October 2009, in which all doctors in the code blue team and intensive care units were given training. The retrospective study was performed over an 18-month period. All in-hospital adult cardiac arrest victims in the preBLS/ACLS training period (January 2009 to September 2009 and the post-BLS/ACLS training period (October 2009 to June 2010 were included in the study. We compared the outcomes of CPR between these two study periods. Results: There were a total of 627 in-hospital cardiac arrests, 284 during the pre-BLS/ACLS training period and 343 during the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 52 patients (18.3% had return of spontaneous circulation, compared with 97 patients (28.3% in the postBLS/ACLS training period (P < 0.005. Survival to hospital discharge was also significantly higher in the post-BLS/ACLS training period (67 patients, 69.1% than in the preBLS/ACLS training period (12 patients, 23.1% (P < 0.0001. Conclusion : Formal certified BLS and ACLS training of healthcare professionals leads to definitive improvement in the outcome of CPR. 4. Patient life in hospital DEFF Research Database (Denmark) Ludvigsen, Mette Spliid Patient life in hospital.A qualitative study of informal relationships between hospitalised patients Introduction Within a patientology framework, this PhD dissertation is about an empirical study on patient life that provides insight into the nature of informal relationships between patients...... in hospitals today. Purpose The purpose was to explore how informal relationships between patients affect their hospital experiences in the hospital. The assumption is that, on the one hand, the impacts on patients' suffering affect the way they act and experience encounters with fellow patients for good....... Methods The study is designed within a phenomenological-hermeneutical philosophic frame of reference and is based on ethnographic fieldwork among hospitalised patients in a Danish university hospital. Data for the study were collected through participant observations over a period of 18 months. Nine males... 5. Advanced life support therapy and on out-of-hospital cardiac arrest patients: Applying signal processing and pattern recognition methods Directory of Open Access Journals (Sweden) Trygve Eftestøl 2005-10-01 Full Text Available In the US alone, several hundred thousands die of sudden cardiac arrests each year. Basic life support defined as chest compressions and ventilations and early defibrillation are the only factors proven to increase the survival of patients with out-of-hospital cardiac arrest, and are key elements in the chain of survival defined by the American Heart Association. The current cardiopulmonary resuscitation guidelines treat all patients the same, but studies show need for more individualiza- tion of treatment. This review will focus on ideas on how to strengthen the weak parts of the chain of survival including the ability to measure the effects of therapy, improve time efficiency, and optimize the sequence and quality of the various components of cardiopulmonary resuscitation. 6. IT for advanced Life Support in English DEFF Research Database (Denmark) Sejerø Pedersen, Birgitte; Jeberg, Kirsten Ann; Koerner, Christian 2009-01-01 In this study we analyzed how IT support can be established for the treatment and documentation of advanced life support (ALS) in a hospital. In close collaboration with clinical researchers, a running prototype of an IT solution to support the clinical decisions in ALS was developed and tried out... 7. Advanced Life Support Project Plan Science.gov (United States) 2002-01-01 Life support systems are an enabling technology and have become integral to the success of living and working in space. As NASA embarks on human exploration and development of space to open the space frontier by exploring, using and enabling the development of space and to expand the human experience into the far reaches of space, it becomes imperative, for considerations of safety, cost, and crew health, to minimize consumables and increase the autonomy of the life support system. Utilizing advanced life support technologies increases this autonomy by reducing mass, power, and volume necessary for human support, thus permitting larger payload allocations for science and exploration. Two basic classes of life support systems must be developed, those directed toward applications on transportation/habitation vehicles (e.g., Space Shuttle, International Space Station (ISS), next generation launch vehicles, crew-tended stations/observatories, planetary transit spacecraft, etc.) and those directed toward applications on the planetary surfaces (e.g., lunar or Martian landing spacecraft, planetary habitats and facilities, etc.). In general, it can be viewed as those systems compatible with microgravity and those compatible with hypogravity environments. Part B of the Appendix defines the technology development 'Roadmap' to be followed in providing the necessary systems for these missions. The purpose of this Project Plan is to define the Project objectives, Project-level requirements, the management organizations responsible for the Project throughout its life cycle, and Project-level resources, schedules and controls. 8. Hospital Costs Of Extracorporeal Life Support Therapy NARCIS (Netherlands) Oude Lansink-Hartgring, Annemieke; van den Hengel, Berber; van der Bij, Wim; Erasmus, Michiel E.; Mariani, Massimo A.; Rienstra, Michiel; Cernak, Vladimir; Vermeulen, Karin M.; van den Bergh, Walter M. 2016-01-01 Objectives: To conduct an exploration of the hospital costs of extracorporeal life support therapy. Extracorporeal life support seems an efficient therapy for acute, potentially reversible cardiac or respiratory failure, when conventional therapy has been inadequate, or as bridge to transplant, but 9. NASA Advanced Exploration Systems: Advancements in Life Support Systems Science.gov (United States) Shull, Sarah A.; Schneider, Walter F. 2016-01-01 The NASA Advanced Exploration Systems (AES) Life Support Systems (LSS) project strives to develop reliable, energy-efficient, and low-mass spacecraft systems to provide environmental control and life support systems (ECLSS) critical to enabling long duration human missions beyond low Earth orbit (LEO). Highly reliable, closed-loop life support systems are among the capabilities required for the longer duration human space exploration missions assessed by NASA’s Habitability Architecture Team. 10. Transition from hospital to daily life DEFF Research Database (Denmark) Missel, Malene; Schønau, Mai Nanna; Pedersen, Jesper Holst 2014-01-01 PURPOSE: To assess the effect of nurse-led systematic rehabilitation counseling performed before discharge to prevent concerns in the hospital-to-home gap in rehabilitation of lung cancer patients after surgery. DESIGN AND METHOD: A quasi-experimental intervention study. One hundred twenty patients...... with operable non-small cell lung cancer admitted for surgery participated. Outcome was assessed by a validated self-rating questionnaire. The intervention was performed at the Department of Thoracic Surgery, University Hospital of Copenhagen, Denmark. RESULTS: Following nurse-led rehabilitation counseling...... in the transition from hospital to daily life. CLINICAL RELEVANCE: Despite promising results, there is still a need to improve support for patients with lung cancer requiring rehabilitation.... 11. Modeling Advance Life Support Systems Science.gov (United States) Pitts, Marvin; Sager, John; Loader, Coleen; Drysdale, Alan 1996-01-01 Activities this summer consisted of two projects that involved computer simulation of bioregenerative life support systems for space habitats. Students in the Space Life Science Training Program (SLSTP) used the simulation, space station, to learn about relationships between humans, fish, plants, and microorganisms in a closed environment. One student complete a six week project to modify the simulation by converting the microbes from anaerobic to aerobic, and then balancing the simulation's life support system. A detailed computer simulation of a closed lunar station using bioregenerative life support was attempted, but there was not enough known about system restraints and constants in plant growth, bioreactor design for space habitats and food preparation to develop an integrated model with any confidence. Instead of a completed detailed model with broad assumptions concerning the unknown system parameters, a framework for an integrated model was outlined and work begun on plant and bioreactor simulations. The NASA sponsors and the summer Fell were satisfied with the progress made during the 10 weeks, and we have planned future cooperative work. 12. Advanced cardiac life support training. Science.gov (United States) Despott, Edward J; Schreiber, Florian 2010-01-01 The OMED/ESGE consensus statements of the International Symposium on Sedation in Endoscopy, Athens, September 2009, in keeping with guidelines and position statements published by other societies, underline the need for sedation providers to be adequately trained in dealing with scenarios involving patients in respiratory and/or cardiovascular distress. This training should prepare the sedation provider with the necessary acumen to prevent, recognize and remedy sedation-related emergencies. Life support training that adheres to the International Liaison Committee on Resuscitation (ILCOR) guidelines should be a mandatory component of this instruction that should be governed by formal assessment and quality assurance reappraisal. 13. Advanced Stirling Radioisotope Generator Life Certification Plan Science.gov (United States) Rusick, Jeffrey J.; Zampino, Edward 2013-01-01 An Advanced Stirling Radioisotope Generator (ASRG) power supply is being developed by the Department of Energy (DOE) in partnership with NASA for potential future deep space science missions. Unlike previous radioisotope power supplies for space exploration, such as the passive MMRTG used recently on the Mars Curiosity rover, the ASRG is an active dynamic power supply with moving Stirling engine mechanical components. Due to the long life requirement of 17 years and the dynamic nature of the Stirling engine, the ASRG project faced some unique challenges trying to establish full confidence that the power supply will function reliably over the mission life. These unique challenges resulted in the development of an overall life certification plan that emphasizes long-term Stirling engine test and inspection when analysis is not practical. The ASRG life certification plan developed is described. 14. Advanced Life Support in Obstetrics (ALSO) and postpartum hemorrhage: A prospective intervention study in Tanzania DEFF Research Database (Denmark) Sorensen, Bjarke Lund; Rasch, Vibeke; Massawe, Siriel 2011-01-01 Objective. To evaluate the impact of Advanced Life Support in Obstetrics (ALSO) training on staff performance and the incidences of postpartum hemorrhage (PPH) at a regional hospital in Tanzania. Design. Prospective intervention study. Setting. A regional, referral hospital. Population. A total o... 15. The Life Saving Effects of Hospital Proximity DEFF Research Database (Denmark) Bertoli, Paola; Grembi, Veronica We assess the lifesaving effect of hospital proximity using data on fatality rates of road-traffic accidents. While most of the literature on this topic is based on changes in distance to the nearest hospital triggered by hospital closures and use OLS estimates, our identification comes from the ...... more when the road safety is low; the emergency service is not properly organized, and the nearest hospital has lower quality standards.......We assess the lifesaving effect of hospital proximity using data on fatality rates of road-traffic accidents. While most of the literature on this topic is based on changes in distance to the nearest hospital triggered by hospital closures and use OLS estimates, our identification comes from... 16. Advanced Cardiac Life Support: 2016 Singapore Guidelines. Science.gov (United States) Ching, Chi Keong; Leong, Siew Hon Benjamin; Chua, Siang Jin Terrance; Lim, Swee Han; Heng, Kenneth; Pothiawala, Sohil; Anantharaman, Venkataraman 2017-07-01 The main areas of emphasis in the Advanced Cardiac Life Support (ACLS) guidelines are: early recognition of cardiac arrest and call for help; good-quality chest compressions; early defibrillation when applicable; early administration of drugs; appropriate airway management ensuring normoventilation; and delivery of appropriate post-resuscitation care to enhance survival. Of note, it is important to monitor the quality of the various care procedures. The resuscitation team needs to reduce unnecessary interruptions to chest compressions in order to maintain adequate coronary perfusion pressure during the ACLS drill. In addition, the team needs to continually look out for reversible causes of the cardiac arrest. Copyright: © Singapore Medical Association. 17. Advances in through-life engineering services CERN Document Server Roy, Rajkumar; Shaw, Andy 2017-01-01 This edited book offers further advances, new perspectives, and developments from world leaders in the field of through-life engineering services (TES). It builds up on the earlier book by the same authors entitled: “Through-life Engineering Services: Motivation, Theory and Practice.†This compendium introduces and discusses further, the developments in workshop-based and 'in situ' maintenance and support of high-value engineering products, as well as the application of drone technology for autonomous and self-healing product support. The links between ‘integrated planning’ and planned obsolescence, risk and cost modelling are also examined. The role of data, information, and knowledge management relative to component and system degradation and failure is also presented. This is supported by consideration of the effects upon the maintenance and support decision by the presence of 'No Fault Found' error signals within system data. Further to this the role of diagnostics and prognostics is also discusse... 18. The Life Saving Effects of Hospital Proximity DEFF Research Database (Denmark) Bertoli, Paola; Grembi, Veronica the exogenous variation in the proximity to cities that are allowed by law to have a hospital based on their population size. Our instrumental variable results, based on Italian municipalities data from 2000 to 2012, show that an increase by a standard deviation of distance to the nearest hospital (5 km... 19. Nanomaterials for Advanced Life Support in Advanced Life Support in Space systems Science.gov (United States) Allada, Rama Kumar; Moloney, Padraig; Yowell, Leonard 2006-01-01 A viewgraph presentation describing nanomaterial research at NASA Johnson Space Center with a focus on advanced life support in space systems is shown. The topics include: 1) Introduction; 2) Research and accomplishments in Carbon Dioxide Removal; 3) Research and Accomplishments in Water Purification; and 4) Next Steps 20. NASA Advanced Explorations Systems: Advancements in Life Support Systems Science.gov (United States) Shull, Sarah A.; Schneider, Walter F. 2016-01-01 The NASA Advanced Exploration Systems (AES) Life Support Systems (LSS) project strives to develop reliable, energy-efficient, and low-mass spacecraft systems to provide environmental control and life support systems (ECLSS) critical to enabling long duration human missions beyond low Earth orbit (LEO). Highly reliable, closed-loop life support systems are among the capabilities required for the longer duration human space exploration missions assessed by NASA's Habitability Architecture Team (HAT). The LSS project is focused on four areas: architecture and systems engineering for life support systems, environmental monitoring, air revitalization, and wastewater processing and water management. Starting with the international space station (ISS) LSS systems as a point of departure (where applicable), the mission of the LSS project is three-fold: 1. Address discrete LSS technology gaps 2. Improve the reliability of LSS systems 3. Advance LSS systems towards integrated testing on the ISS. This paper summarized the work being done in the four areas listed above to meet these objectives. Details will be given on the following focus areas: Systems Engineering and Architecture- With so many complex systems comprising life support in space, it is important to understand the overall system requirements to define life support system architectures for different space mission classes, ensure that all the components integrate well together and verify that testing is as representative of destination environments as possible. Environmental Monitoring- In an enclosed spacecraft that

is constantly operating complex machinery for its own basic functionality as well as science experiments and technology demonstrations, it's possible for the environment to become compromised. While current environmental monitors aboard the ISS will alert crew members and mission control if there is an emergency, long-duration environmental monitoring cannot be done in-orbit as current methodologies « 1 2 3 4 5 » « 1 2 3 4 5 » 21. Life Expectancy after Myocardial Infarction, According to Hospital Performance. Science.gov (United States) Bucholz, Emily M; Butala, Neel M; Ma, Shuangge; Normand, Sharon-Lise T; Krumholz, Harlan M 2016-10-01 Background Thirty-day risk-standardized mortality rates after acute myocardial infarction are commonly used to evaluate and compare hospital performance. However, it is not known whether differences among hospitals in the early survival of patients with acute myocardial infarction are associated with differences in long-term survival. Methods We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries who were hospitalized for acute myocardial infarction between 1994 and 1996 and who had 17 years of follow-up. We grouped hospitals into five strata that were based on case-mix severity. Within each case-mix stratum, we compared life expectancy among patients admitted to high-performing hospitals with life expectancy among patients admitted to low-performing hospitals. Hospital performance was defined by quintiles of 30-day risk-standardized mortality rates. Cox proportional-hazards models were used to calculate life expectancy. Results The study sample included 119,735 patients with acute myocardial infarction who were admitted to 1824 hospitals. Within each case-mix stratum, survival curves of the patients admitted to hospitals in each risk-standardized mortality rate quintile separated within the first 30 days and then remained parallel over 17 years of follow-up. Estimated life expectancy declined as hospital risk-standardized mortality rate quintile increased. On average, patients treated at high-performing hospitals lived between 0.74 and 1.14 years longer, depending on hospital case mix, than patients treated at low-performing hospitals. When 30-day survivors were examined separately, there was no significant difference in unadjusted or adjusted life expectancy across hospital risk-standardized mortality rate quintiles. Conclusions In this study, patients admitted to high-performing hospitals after acute myocardial infarction had longer life expectancies than patients treated in lowperforming hospitals. This survival benefit 22. Hospital Executives’ Perceptions of End-of-Life Care Directory of Open Access Journals (Sweden) Kimberly K. Garner 2015-06-01 Full Text Available Hospital executives are key stakeholders in the hospital setting. However, despite extensive medical and nursing literature on the importance of end-of-life (EOL care in hospitals, little is known about hospital executives’ perceptions of the provision of EOL care in their facilities. The objective of this study was to capture hospital executives’ perceptions of the provision of EOL care in the hospital setting. This descriptive, naturalistic phenomenological, qualitative study utilized in-person interviews to explore executives’ opinions and beliefs. The sample consisted of 14 individuals in the roles of medical center directors, chiefs of staff, chief medical officers, hospital administrators, hospital risk managers, and regional counsel in Arkansas, Louisiana and Texas. An interview guide was developed and conducted utilizing a global question followed by probes concerning perceptions of EOL care provision. Hospital executives acknowledged that EOL care was a very important issue, and more attention should be paid to it in the hospital setting. Their comments and suggestions for improvement focused on (a current EOL care, (b barriers to changing EOL care, and (c enhancing provision of EOL care in the hospital setting. The findings of this study suggest that hospital executives although key change agents, may have insufficient EOL information to implement steps toward cultural and infrastructural change and should therefore be included in any EOL discussions and education. 23. [Technological advances and hospital-at-home care]. Science.gov (United States) Tibaldi, Vittoria; Aimonino Ricauda, Nicoletta; Rocco, Maurizio; Bertone, Paola; Fanton, Giordano; Isaia, Giancarlo 2013-05-01 Advances in the miniaturization and portability of diagnostic technologies, information technologies, remote monitoring, and long-distance care have increased the viability of homebased care, even for patients with serious conditions. Telemedicine and teleradiology projects are active at the Hospital at Home Service of Torino. 24. ['Advanced trauma life support' in Netherlands]. Science.gov (United States) van Vugt, A B 2000-10-28 Introduction of the principles of advanced trauma life support (ATLS) in the management of accident victims has been in progress in the Netherlands since 1995. The main ATLS principles are that the aid giver treats the most dangerous disorder first and does no further damage. After assessment and, if necessary, treatment of the airways, the respiration, the circulation and any craniocerebral injury, an exploratory examination is carried out. Physicians receive theoretical and practical instructions in this form of management during an intensive two-day course, counselled by a coordinating organization in the USA. Most of those attending are interns in general surgery, traumatology and orthopaedics, gatekeeper doctors of emergency rooms and army medical officers. The standardized way of thinking improves the communication and understanding between the various disciplines involved in trauma care, in part because there exist comparable programmes for ambulance care and emergency care. Other measures improving the quality of trauma care are regionalization of the trauma care, medical helicopter teams and evaluation of the effects of ATLS as an operating procedure. 25. The Effect of Advance Directive Completion on Hospital Care Among Chronically Homeless Persons: a Prospective Cohort Study. Science.gov (United States) Leung, Alexander K; To, Matthew J; Luong, Linh; Vahabi, Zahra Syavash; Gonçalves, Victor L; Song, John; Hwang, Stephen W 2016-12-27 Advance care planning is relevant for homeless individuals because they experience high rates of morbidity and mortality. The impact of advance directive interventions on hospital care of homeless individuals has not been studied. The objective of this study was to determine if homeless individuals who complete an advance directive through a shelter-based intervention are more likely to have information from their advance directive documented and used during subsequent hospitalizations. The advance directive included preferences for life-sustaining treatments, resuscitation, and substitute decision maker(s). A total of 205 homeless men from a homeless shelter for men in Toronto, Canada, were enrolled in the study and offered an opportunity to complete an advance directive with the guidance of a trained counselor from April to June 2013. One hundred and three participants chose to complete an advance directive, and 102 participants chose to not complete an advance directive. Participants were provided copies of their advance directives. In addition, advance directives were electronically stored, and hospitals within a 1.0-mile radius of the shelter were provided access to the database. A prospective cohort study was performed using chart reviews to ascertain the documentation, availability, and use of advance directives, end-of-life care preferences, and medical treatments during hospitalizations over a 1-year follow-up period (April 2013 to June 2014) after the shelter-based advance directive intervention. Chart reviewers were blinded as to whether participants had completed an advance directive. The primary outcome was documentation or use of an advance directive during any hospitalization. The secondary outcome was documentation of end-of-life care preferences, without reference to an advance directive, during any hospitalization. After unblinding, charts were studied to determine whether advance directives were available, hospital care was consistent with 26. Phases management for advanced life support processes NARCIS (Netherlands) Eckhard, F.; Brunink, J.A.J.; Tuinstra, B.; Assink, J.W.; Ten Asbroek, N.; Backx, V.; Klaassen, A.; Waters, G.; Stasiak, M.A.; Dixon, M.; Ordoñez-Inda, L. 2005-01-01 For a planetary base, a reliable life support system including food and water supply, gas generation and waste management is a condition sine qua non. While for a short-term period the life support system may be an open loop, i.e. water, gases and food provided from the Earth, for long-term missions 27. Barriers to work-life balance for hospital nurses. Science.gov (United States) Mullen, Kathleen 2015-03-01 Nurses are loyal to their patients and coworkers. They often put the needs of others before their own and sometimes even before the needs of their families. This concern for others can cause conflicts that manifest as stress. Of the more than 2 million nurses in the United States, more than 62% work in hospitals. Hospitals are known to be both rewarding and stressful places to work. Like most workers, nurses face the challenge of balancing demands and achievements of work with those in their private lives. Hospital leaders can facilitate improved work-life balance (WLB) for hospital nurses by using tools already in place. Equally important, nurses can use their knowledge and resources to nurse the nurse within, which can greatly improve their experience of WLB, independent of the demands of their work environment. © 2015 The Author(s). 28. Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care Science.gov (United States) Mazutti, Sandra Regina Gonzaga; Nascimento, Andréia de Fátima; Fumis, Renata Rego Lins 2016-01-01 Objective To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. Methods This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. Results A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. Conclusion The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means. PMID:27626949 29. A new data architecture for advancing life cycle assessment Science.gov (United States) IntroductionLife cycle assessment (LCA) has a technical architecture that limits data interoperability, transparency, and automated integration of external data. More advanced information technologies offer promise for increasing the ease with which information can be synthesized... 30. A new data architecture for advancing life cycle assessment Science.gov (United States) IntroductionLife cycle assessment (LCA) has a technical architecture that limits data interoperability, transparency, and automated integration of external data. More advanced information technologies offer promise for increasing the ease with which information can be synthesized... 31. [Quality of life and pain in hospitalized geriatric patients]. Science.gov (United States) Pipam, W; Penz, H; Janig, H; Plank, H; Gatternig, K; Likar, R 2008-02-01 To determine objective and subjective indications of quality of life in hospitalized geriatric patients. Data were collected on 267 items using standardized interviews of 90 patients, including B-L and SF-36. In comparison to the control population, geriatric patients have worse SF-36 values; 91% have pain, and 63% depression and elevated B-L values. Pain therapy is usually with non-opiates and with warm/cold physical therapies. Pain therapy in the geriatric population surveyed does not reach the same standard as is usually offered to hospitalized medical and surgical patients. 32. Biomedical ethics and the withdrawal of advanced life support. Science.gov (United States) Henig, N R; Faul, J L; Raffin, T A 2001-01-01 It is common for health care providers to deal with the complex and difficult issue of withdrawing advanced life support. The patient is always the key source of authority in these decisions. The most important ingredient in end-of-life decision making is effective communication. It is important to try to ascertain what the patient thought about quality-of-life values before surrogate decisions can be made on the patient's behalf. The concepts of beneficence, nonmaleficence, autonomy, and justice are the foundation of ethical decision making. Numerous legal precedents have laid the groundwork for end-of-life decision making. Most state courts have supported withholding and withdrawing life support from patients who will not regain a reasonable quality of life. The recent Patient Self-Determination Act encourages patients to fill out advance directives that state their desires. When continued intensive care is futile, advanced life support should be withdrawn. However, a narrow definition of futility in this situation is the key, since the concept of futility could lead to inappropriate decisions. It is best to consider a situation futile when the patient is terminally ill, the condition is irreversible, and death is imminent. During the withdrawal of advanced life support, terminal or rapid weaning is preferable to extubation. Combinations of opiates, benzodiazepines, and other agents help provide comfort to patients who are suffering. 33. Inpatient Hospitalization of Oncology Patients: Are We Missing an Opportunity for End-of-Life Care? Science.gov (United States) Rocque, Gabrielle B.; Barnett, Anne E.; Illig, Lisa C.; Eickhoff, Jens C.; Bailey, Howard H.; Campbell, Toby C.; Stewart, James A.; Cleary, James F. 2013-01-01 Introduction: Despite advances in the care of patients with cancer over the last 10 years, cancer remains the second leading cause of death in the United States. Many patients receive aggressive, in-hospital end-of-life care at high cost. There are few data on outcomes after unplanned hospitalization of patients with metastatic cancer. Methods: In 2000 and 2010, data were collected on admissions, interventions, and survival for patients admitted to an academic inpatient medical oncology service. Results: The 2000 survey included 191 admissions of 151 unique patients. The 2010 survey assessed 149 admissions of 119 patients. Lung, GI, and breast cancers were the most common cancer diagnoses. In the 2010 assessment, pain was the most common chief complaint, accounting for 28%. Although symptoms were the dominant reason for admission in 2010, procedures and imaging were common in both surveys. The median survival of patients after discharge was 4.7 months in 2000 and 3.4 months in 2010. Despite poor survival in this patient population, hospice was recommended in only 23% and 24% of patients in 2000 and 2010, respectively. Seventy percent of patients were discharged home without additional services. Conclusion: On the basis of our data, an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of fewer than 6 months. We believe that hospital admission represents an opportunity to commence and/or consolidate appropriate palliative care services and end-of-life care. PMID:23633971 34. Pre-hospital advanced airway management by anaesthesiologists: is there still room for improvement? Science.gov (United States) Sollid, Stephen J M; Heltne, Jon Kenneth; Søreide, Eldar; Lossius, Hans Morten 2008-07-21 Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted. 35. Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement? Directory of Open Access Journals (Sweden) Søreide Eldar 2008-07-01 Full Text Available Abstract Background Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Method Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Results Of the 17 available respondents, most (88% felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. Conclusion The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted. 36. Can advanced paramedics in the field diagnose patients and predict hospital admission? LENUS (Irish Health Repository) Cummins, Niamh Maria 2013-02-13 BACKGROUND: Accurate patient diagnosis in the prehospital environment is essential to initiate suitable care pathways. The advanced paramedic (AP) is a relatively recent role in Ireland, and refers to a prehospital practitioner with advanced life-support skills and training. OBJECTIVES: The objectives of this study were to compare the diagnostic decisions of APs with emergency medicine (EM) physicians, and to investigate if APs, as currently trained, can predict the requirement for hospital admission. METHODS: A prospective study was initiated, whereby each emergency ambulance call received via the statutory 999 system was recorded by the attending AP. The AP was asked to provide a clinical diagnosis for each patient, and to predict if hospital admission was required. The data was then cross-referenced with the working diagnosis of the receiving emergency physician and the hospital admission records. RESULTS: A total of 17 APs participated in the study, and 1369 emergency calls were recorded over a 6-month period. Cases where a general practitioner attended the scene were excluded from the concordance analysis. Concordance with the receiving emergency physician represents 70% (525\\/748) for all cases of AP diagnosis, and is mirrored with 70% (604\\/859) correct hospital admission predictions. CONCLUSIONS: AP diagnosis and admission prediction for emergency calls is similar to other emergency medical services systems despite the relative recency of the AP programme in Ireland. Recognition of non-concordance case types may identify priorities for AP education, and drive future AP practice in areas such as \\'treat and refer\\'. 37. Human life support for advanced space exploration. Science.gov (United States) Schwartzkopf, S H 1997-01-01 The requirements for a human life support system for long-duration space missions are reviewed. The system design of a controlled ecological life support system is briefly described, followed by a more detailed account of the study of the conceptual design of a Lunar Based CELSS. The latter is to provide a safe, reliable, recycling lunar base life support system based on a hybrid physicochemical/biological representative technology. The most important conclusion reached by this study is that implementation of a completely recycling CELSS approach for a lunar base is not only feasible, but eminently practical. On a cumulative launch mass basis, a 4-person Lunar Base CELSS would pay for itself in approximately 2.6 years relative to a physicochemical air/water recycling system with resupply of food from the Earth. For crew sizes of 30 and 100, the breakeven point would come even sooner, after 2.1 and 1.7 years, respectively, due to the increased mass savings that can be realized with the larger plant growth units. Two other conclusions are particularly important with regard to the orientation of future research and technology development. First, the mass estimates of the Lunar Base CELSS indicate that a primary design objective in implementing this kind of system must be to minimized the mass and power requirement of the food production plant growth units, which greatly surpass those of the other air and water recycling systems. Consequently, substantial research must be directed at identifying ways to produce food more efficiently. On the other hand, detailed studies to identify the best technology options for the other subsystems should not be expected to produce dramatic reductions in either mass or power requirement of a Lunar Base CELSS. The most crucial evaluation criterion must, therefore, be the capability for functional integration of these technologies into the ultimate design of the system. Secondly, this study illustrates that existing or near 38. Advanced Energy Design Guide for Small Hospitals and Healthcare Facilities Directory of Open Access Journals (Sweden) Eric Bonnema 2010-01-01 Full Text Available The Advanced Energy Design Guide for Small Hospitals and Healthcare Facilities (AEDG-SHC was recently completed. It is the sixth document in a series of guides designed to achieve 30% savings over the minimum code requirements of ANSI/ASHRAE/IESNA Standard 90.1-1999. The guide [1] is available for print purchase or as a free download from http://www.ashrae.org/aedg and provides user-friendly assistance and recommendations for the building design, construction, and owner communities to achieve energy savings. Included in the guide are prescriptive recommendations for quality assurance and commissioning; design of the building envelope; fenestration; lighting systems (including electric lighting and daylighting; heating, ventilation, and air-conditioning (HVAC systems; building automation and controls; outside air (OA treatment; and service water heating (SWH. The guide educates, provides practical recommendations for exceeding code minimums, and provides leadership to help design teams and owners produce higher efficiency commercial buildings.

39. QUALITY OF WORKING LIFE IN COMMODITIZED HOSPITALS AND UNIVERSITIES Directory of Open Access Journals (Sweden) Josep M. Blanch 2014-01-01 Full Text Available New Public Management (NPM turns public hospital and university services into market enterprises. The aim of the paper is to analyze and describe the impact of this metamorphosis on the labor subjectivity of the staff employed in such services. Empirical studies in Spanish and Latin American hospitals and universities uncover a paradoxical experience: relative manifest satisfaction with material and technical conditions allowing them to work harder and better, but also latent discomfort with the task overload, and professional and ethical dilemmas posed by new organizational demands, in the face of which staff develop ways of coping ranging from manifest obedience to latent resistance. This supports the reasons for the redesign of these services based on a better balance between commercial and social demands, managerial and professional values, and between business efficiency and quality of working life. 40. Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand Directory of Open Access Journals (Sweden) Manisha Bisht 2008-01-01 Full Text Available Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33  ± 0.67 (mean ± SE. The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 ± 0.38 (mean ± SE drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions. « 1 2 3 4 5 » « 1 2 3 4 5 » 41. Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals Directory of Open Access Journals (Sweden) Amy J. Thurston 2011-01-01 Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital. 42. Advancing life cycle economics in the Nordic countries DEFF Research Database (Denmark) Haugbølle, Kim; Hansen, Ernst Jan de Place 2005-01-01 Advancing construction and facilities management requires the ability to estimate and evaluate the economic consequences of decisions in a lifetime perspective. A survey of state-ofthe-art on life cycle economics in the Nordic countries showed that, despite a number of similarities, no strong co... 43. Quality-of-life assessment in advanced cancer. LENUS (Irish Health Repository) Donnelly, S 2000-07-01 In the past 5 years, quality-of-life (QOL) assessment measures such as the McGill, McMaster, Global Visual Analogue Scale, Assessment of QOL at the End of Life, Life Evaluation Questionnaire, and Hospice QOL Index have been devised specifically for patients with advanced cancer. The developers of these instruments have tried to respond to the changing needs of this specific population, taking into account characteristics including poor performance status, difficulty with longitudinal study, rapidly deteriorating physical condition, and change in relevant issues. Emphasis has been placed on patient report, ease and speed of completion, and the existential domain or meaning of life. Novel techniques in QOL measurement have also been adapted for palliative care, such as judgment analysis in the Schedule for the Evaluation of Individual Quality of Life. It is generally agreed that a single tool will not cover all QOL assessment needs. 44. Canadian advanced life support capacities and future directions Science.gov (United States) Bamsey, M.; Graham, T.; Stasiak, M.; Berinstain, A.; Scott, A.; Vuk, T. Rondeau; Dixon, M. 2009-07-01 Canada began research on space-relevant biological life support systems in the early 1990s. Since that time Canadian capabilities have grown tremendously, placing Canada among the emerging leaders in biological life support systems. The rapid growth of Canadian expertise has been the result of several factors including a large and technically sophisticated greenhouse sector which successfully operates under challenging climatic conditions, well planned technology transfer strategies between the academic and industrial sectors, and a strong emphasis on international research collaborations. Recent activities such as Canada's contribution of the Higher Plant Compartment of the European Space Agency's MELiSSA Pilot Plant and the remote operation of the Arthur Clarke Mars Greenhouse in the Canadian High Arctic continue to demonstrate Canadian capabilities with direct applicability to advanced life support systems. There is also a significant latent potential within Canadian institutions and organizations with respect to directly applicable advanced life support technologies. These directly applicable research interests include such areas as horticultural management strategies (for candidate crops), growth media, food processing, water management, atmosphere management, energy management, waste management, imaging, environment sensors, thermal control, lighting systems, robotics, command and data handling, communications systems, structures, in-situ resource utilization, space analogues and mission operations. With this background and in collaboration with the Canadian aerospace industry sector, a roadmap for future life support contributions is presented here. This roadmap targets an objective of at least 50% food closure by 2050 (providing greater closure in oxygen, water recycling and carbon dioxide uptake). The Canadian advanced life support community has chosen to focus on lunar surface infrastructure and not low Earth orbit or transit systems (i.e. microgravity 45. Implementation of Advanced Warehouses in a Hospital Environment - Case study Science.gov (United States) Costa, J.; Sameiro Carvalho, M.; Nobre, A. 2015-05-01 In Portugal, there is an increase of costs in the healthcare sector due to several factors such as the aging of the population, the increased demand for health care services and the increasing investment in new technologies. Thus, there is a need to reduce costs, by presenting the effective and efficient management of logistics supply systems with enormous potential to achieve savings in health care organizations without compromising the quality of the provided service, which is a critical factor, in this type of sector. In this research project the implementation of Advanced Warehouses has been studied, in the Hospital de Braga patient care units, based in a mix of replenishment systems approaches: the par level system, the two bin system and the consignment model. The logistics supply process is supported by information technology (IT), allowing a proactive replacement of products, based on the hospital services consumption records. The case study was developed in two patient care units, in order to study the impact of the operation of the three replenishment systems. Results showed that an important inventory holding costs reduction can be achieved in the patient care unit warehouses while increasing the service level and increasing control of incoming and stored materials with less human resources. The main conclusion of this work illustrates the possibility of operating multiple replenishment models, according to the types of materials that healthcare organizations deal with, so that they are able to provide quality health care services at a reduced cost and economically sustainable. The adoption of adequate IT has been shown critical for the success of the project. 46. End-of-Life Decisions and Advanced Old Age Directory of Open Access Journals (Sweden) Stoyles 2014-07-01 Full Text Available Despite the fact that most people die in advanced old age, little attention is given to cases involving older people in debates about the moral and legal dimensions of end-of-life decision making. The purpose of this paper is to establish some of the ways our discussions should change as we pay attention to important factors influencing end-oflife decisions for people in advanced old age. Focusing on the prevalence of comorbidities and the likelihood that people in advanced old age will experience an extended period of declining function before death, I argue that our debates should be expanded to include greater consideration of how we want to live in the final stages of life. With this, I am arguing against the tendency to think that “end-of-life†decision making concerns only making decisions about when and how it is appropriate to terminate a person’s life. I argue, further, that we should move away from the medicalization of dying. 47. Globular Clusters as Cradles of Life and Advanced Civilizations Science.gov (United States) Di Stefano, Rosanne; Ray, Alak 2016-01-01 Globular clusters are bound groups of about a million stars and stellar remnants. They are old, largely isolated, and very dense. We consider what each of these special features can mean for the development of life, the evolution of intelligent life, and the long-term survival of technological civilizations. We find that, if they house planets, globular clusters provide ideal environments for advanced civilizations that can survive over long times. We therefore propose methods to search for planets in globular clusters. If planets are found and if our arguments are correct, searches for intelligent life are most likely to succeed when directed toward globular clusters. Globular clusters may be the first places in which distant life is identified in our own or in external galaxies. 48. Managing occupations in everyday life for people with advanced cancer living at home. Science.gov (United States) Peoples, Hanne; Brandt, Ã…se; Wæhrens, Eva E; la Cour, Karen 2017-01-01 People with advanced cancer are able to live for extended periods of time. Advanced cancer can cause functional limitations influencing the ability to manage occupations. Although studies have shown that people with advanced cancer experience occupational difficulties, there is only limited research that specifically explores how these occupational difficulties are managed. To describe and explore how people with advanced cancer manage occupations when living at home. A sub-sample of 73 participants from a larger occupational therapy project took part in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data. Managing occupations were manifested in two main categories; (1) Conditions influencing occupations in everyday life and (2) Self-developed strategies to manage occupations. The findings suggest that people with advanced cancer should be supported to a greater extent in finding ways to manage familiar as well as new and more personally meaningful occupations to enhance quality of life. 49. Application of NASA's advanced life support technologies in polar regions. Science.gov (United States) Bubenheim, D L; Lewis, C 1997-01-01 NASA's advanced life support technologies are being combined with Arctic science and engineering knowledge in the Advanced Life Systems for Extreme Environments (ALSEE) project. This project addresses treatment and reduction of waste, purification and recycling of water, and production of food in remote communities of Alaska. The project focus is a major issue in the state of Alaska and other areas of the Circumpolar North; the health and welfare of people, their lives and the subsistence lifestyle in remote communities, care for the environment, and economic opportunity through technology transfer. The challenge is to implement the technologies in a manner compatible with the social and economic structures of native communities, the state, and the commercial sector. NASA goals are technology selection, system design and methods development of regenerative life support systems for planetary and Lunar bases and other space exploration missions. The ALSEE project will provide similar advanced technologies to address the multiple problems facing the remote communities of Alaska and provide an extreme environment testbed for future space applications. These technologies have never been assembled for this purpose. They offer an integrated approach to solving pressing problems in remote communities. 50. Effect of ionizing radiation on advanced life support medications Energy Technology Data Exchange (ETDEWEB) Sullivan, D.J.; Hubbard, L.B.; Broadbent, M.V.; Stewart, P.; Jaeger, M. 1987-06-01 Advanced life support medications stored in emergency department stretcher areas, diagnostic radiology rooms, and radiotherapy suites are exposed to ionizing radiation. We hypothesized that radiation may decrease the potency and thus the shelf life of medications stored in these areas. Atropine, dopamine, epinephrine, and isoproterenol were exposed to a wide range of ionizing radiation. The potency of the four drugs was unaffected by levels of radiation found in ED stretcher areas and high-volume diagnostic radiograph rooms (eg, chest radiograph, computed tomography, fluoroscopy). The potency of atropine may be reduced by gamma radiation in high-use radiotherapy suites. However, dopamine, epinephrine, and isoproterenol were unaffected by high doses of gamma radiation. Atropine, dopamine, epinephrine, and isoproterenol may be safely kept in ED stretcher areas and diagnostic radiology rooms without loss of potency over the shelf life of the drugs. 51. Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study. Science.gov (United States) Tarpgaard, Mona; Hansen, Troels Martin; RognÃ¥s, Leif 2015-08-27 Pre-hospital advanced airway management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital advanced airway management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital advanced airway management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants). A prospective descriptive study based on data collected from eight anaesthetist-staffed pre-hospital critical care teams between February 1st 2011 and November 1st 2012. Primary endpoints were 1) pre-hospital endotracheal intubation success rate in children 2) pre-hospital endotracheal intubation first-pass success rate in children and 3) complications related to prehospital advanced airway management in children. The pre-hospital critical care anaesthetists attempted endotracheal intubation in 25 children, 13 of which were less than 2 years old. In one patient, a neonate (600 g birth weight), endotracheal intubation failed. The patient was managed by uneventful bag-mask ventilation. All other 24 children had their tracheas successfully intubated by the pre-hospital critical care anaesthetists resulting in a pre-hospital endotracheal intubation success rate of 96 %. Overall first pass success-rate was 75 %. In the group of patients younger than 2 years old, first pass success-rate was 54 %. The total rate of airway management related complications such as vomiting, aspiration, accidental intubation of the oesophagus or right main stem bronchus, hypoxia (oxygen saturation advanced airway management. Compared with the total population of patients receiving pre-hospital advanced airway management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but 52. Quality of Life in Emergency Medicine Specialists of Teaching Hospitals Directory of Open Access Journals (Sweden) Afshin Amini 2014-08-01 Full Text Available Introduction: Quality of life (QOL of emergency medicine specialists can be effective in providing services to patients. The aim of the present study was evaluating the lifestyle of emergency medicine practitioners, understanding their problems, and addressing the solutions to enhance and improve their lifestyles, in teaching hospitals in Iran. Method: This descriptive cross-sectional study was conducted on emergency medicine physicians in 10 teaching hospitals of Iran in 2011. Emergency physicians with at least three years of experience who interested in the study, were enrolled in the project. All participants filled out the consent form and QOL questionnaires, then underwent physical examinations and some medical laboratory tests. Categorical variables were reported as percentages, while continuous variables expressed as means and standard deviations. p <0.05 was considered statistically significant. Results: Totally, 100 subjects participated in the study, of whom 48 were male. The mean and standard deviation of the physicians’ age were 38.7±5.1 years. 43% of physicians had an average QOL, while 37% good. 96% of studied physicians had a good condition regarding habitual history, while 93% of them had a poor condition in performing screening tests. Exercise program and personal health in individuals with normal BMI were correlated with higher levels of QOL. BMI was higher in 40-50 years old subjects than youngers. Hypertension was present in five cases (5%, hypercholesterolemia in six (6%, hypertriglyceridemia in six (6%, increased LDL in four (4%, low HDL in four (4%, and impaired FBS in 4 (4%. Conclusion: The findings showed that 63% of studied emergency physicians had an average level of QOL and other ones good. The majority of physicians had undesirable situation regarding the performance of screening tests. 53. Tool for Sizing Analysis of the Advanced Life Support System Science.gov (United States) Yeh, Hue-Hsie Jannivine; Brown, Cheryl B.; Jeng, Frank J. 2005-01-01 Advanced Life Support Sizing Analysis Tool (ALSSAT) is a computer model for sizing and analyzing designs of environmental-control and life support systems (ECLSS) for spacecraft and surface habitats involved in the exploration of Mars and Moon. It performs conceptual designs of advanced life support (ALS) subsystems that utilize physicochemical and biological processes to recycle air and water, and process wastes in order to reduce the need of resource resupply. By assuming steady-state operations, ALSSAT is a means of investigating combinations of such subsystems technologies and thereby assisting in determining the most cost-effective technology combination available. In fact, ALSSAT can perform sizing analysis of the ALS subsystems that are operated dynamically or steady in nature. Using the Microsoft Excel spreadsheet software with Visual Basic programming language, ALSSAT has been developed to perform multiple-case trade studies based on the calculated ECLSS mass, volume, power, and Equivalent System Mass, as well as parametric studies by varying the input parameters. ALSSAT s modular format is specifically designed for the ease of future maintenance and upgrades. 54. Life-cycle cost analysis of advanced design mixer pump Energy Technology Data Exchange (ETDEWEB) Hall, M.N., Westinghouse Hanford 1996-07-23 This analysis provides cost justification for the Advanced Design Mixer Pump program based on the cost benefit to the Hanford Site of 4 mixer pump systems defined in terms of the life-cycle cost.A computer model is used to estimate the total number of service hours necessary for each mixer pump to operate over the 20-year retrieval sequence period for singleshell tank waste. This study also considered the double-shell tank waste retrieved prior to the single-shell tank waste which is considered the initial retrieval. 55. Student Pharmacists’ Clinical Interventions in Advanced Pharmacy Practice Experiences at a Community Nonteaching Hospital OpenAIRE Shogbon, Angela O.; Lundquist, Lisa M. 2014-01-01 Objective. To assess student pharmacists’ clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used. 56. End-of-life hospital transfers in out-of-hours general practice. NARCIS (Netherlands) Korte-Verhoef, M.C. de; Pasman, H.R.W.; Schweitzer, B.P.M.; Francke, A.L.; Onwuteaka-Philipsen, B.D.; Deliens, L. 2012-01-01 Background: During the end of life, many patients experience transfers from home to hospital, and the majority of them die in a hospital. Aim: To explore the reasons for hospital transfers of palliative care patients in out-of-hours general practices. Methods: A retrospective descriptive chart study 57. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Science.gov (United States) RognÃ¥s, Leif; Hansen, Troels Martin; Kirkegaard, Hans; Tønnesen, Else 2013-07-25 We report data from the first Utstein-style study of physician-provided pre-hospital advanced airway management. Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) prospectively registered data according to the template for reporting data from pre-hospital advanced airway management. Data collection took place from February 1st 2011 to October 31st 2012. Included were patients of all ages on whom pre-hospital advanced airway management was performed. The objective was to estimate the incidences of failed and difficult pre-hospital endotracheal intubation, and complications related to pre-hospital

advanced airway management. The overall incidence of successful pre-hospital endotracheal intubation among 636 intubation attempts was 99.7%, even though 22.4% of prehospital endotracheal intubations required more than one intubation attempt. The overall incidence of complications related to pre-hospital advanced airway management was 7.9%. Following rapid sequence intubation, the incidence of first pass success was 85.8%, the overall incidence of complications was 22.0%, the incidence of hypotension 7.3% and that of hypoxia 5.3%. Multiple endotracheal intubation attempts were associated with an increased overall incidence of complications. No airway management related deaths occurred. The overall incidence of successful pre-hospital endotracheal intubations compares to those found in other physician-staffed pre-hospital systems. The incidence of pre-hospital endotracheal intubations requiring more than one attempt is higher than suspected. The incidence of hypotension or hypoxia after pre-hospital rapid sequence intubation compares to those found in UK emergency departments. Pre-hospital advanced airway management including pre-hospital endotracheal intubation performed by experienced anaesthesiologists is associated with high success rates and relatively low 58. Advanced Technologies to Improve Closure of Life Support Systems Science.gov (United States) Barta, Daniel J. 2016-01-01 As NASA looks beyond the International Space Station toward long-duration, deep space missions away from Earth, the current practice of supplying consumables and spares will not be practical nor affordable. New approaches are sought for life support and habitation systems that will reduce dependency on Earth and increase mission sustainability. To reduce launch mass, further closure of Environmental Control and Life Support Systems (ECLSS) beyond the current capability of the ISS will be required. Areas of particular interest include achieving higher degrees of recycling within Atmosphere Revitalization, Water Recovery and Waste Management Systems. NASA is currently investigating advanced carbon dioxide reduction processes that surpass the level of oxygen recovery available from the Sabatier Carbon Dioxide Reduction Assembly (CRA) on the ISS. Candidate technologies will potentially improve the recovery of oxygen from about 50% (for the CRA) to as much as 100% for technologies who's end product is solid carbon. Improving the efficiency of water recycling and recovery can be achieved by the addition of advanced technologies to recover water from brines and solid wastes. Bioregenerative technologies may be utilized for water reclaimation and also for the production of food. Use of higher plants will simultaneously benefit atmosphere revitalization and water recovery through photosynthesis and transpiration. The level at which bioregenerative technologies are utilized will depend on their comparative requirements for spacecraft resources including mass, power, volume, heat rejection, crew time and reliability. Planetary protection requirements will need to be considered for missions to other solar system bodies. 59. Impact of work-life imbalance on job satisfaction and quality of life among hospital nurses in Japan. Science.gov (United States) Makabe, Sachiko; Takagai, Junko; Asanuma, Yoshihiro; Ohtomo, Kazuo; Kimura, Yutaka 2015-01-01 This study investigated the status of work-life imbalance among hospital nurses in Japan and impact of work-life imbalance on job satisfaction and quality of life. A cross-sectional survey of 1,202 nurses (81% response rate) was conducted in three Japanese acute care hospitals. Participants were divided into four groups for actual work-life balance (Group A: 50/50, including other lower working proportion groups [e.g., 40/50]; Group B: 60/40; Group C: 70/30; and Group D: 80/20, including other higher working proportion groups [e.g., 90/10]). We also asked participants about desired work-life balance, and private and work-related perspectives. Satisfactions (job, private life, and work-life balance), quality of life, and stress-coping ability were also measured. All data were compared among the four groups. Most nurses sensed that they had a greater proportion of working life than private life, and had a work-life imbalance. Actual WLB did not fit compared to desired WLB. When the actual working proportion greatly exceeds the private life proportion, nurses' health could be in danger, and they may resign due to lower job satisfaction and QOL. Simultaneous progress by both management and individual nurses is necessary to improve work-life imbalance. 60. Gastrostomy tube placement in patients with advanced dementia or near end of life. Science.gov (United States) Schwartz, Denise Baird; Barrocas, Albert; Wesley, John R; Kliger, Gustavo; Pontes-Arruda, Alessandro; Márquez, Humberto Arenas; James, Rosemarie Lembo; Monturo, Cheryl; Lysen, Lucinda K; DiTucci, Angela 2014-12-01 Based on current scientific literature, gastrostomy tube (G-tube) placement or other long-term enteral access devices should be withheld in patients with advanced dementia or other near end-of-life conditions. In many instances healthcare providers are not optimally equipped to implement this recommendation at the bedside. Autonomy of the patient or surrogate decision maker should be respected, as should the patient's cultural, religious, social, and emotional value system. Clinical practice needs to address risks, burdens, benefits, and expected short-term and long-term outcomes in order to clarify practice changes. This paper recommends a change in clinical practice and care strategy based on the results of a thorough literature review and provides tools for healthcare clinicians, particularly in the hospital setting, including an algorithm for decision making and a checklist to use prior to the placement of G-tubes or other long-term enteral access devices. Integrating concepts of patient-centered care, shared decision making, health literacy, and the teach-back method of education enhances the desired outcome of ethical dilemma prevention. The goal is advance care planning and a timely consensus among health team members, family members, and significant others regarding end-of-life care for patients who do not have an advance directive and lack the capacity to advocate for themselves. Achieving this goal requires interdisciplinary collaboration and proactive planning within a supportive healthcare institution environment. « 1 2 3 4 5 » « 2 3 4 5 6 » 61. Advanced communication infrastructure for pre-hospital EMS care. Science.gov (United States) Orthner, Helmuth; Mazza, Giovanni; Mazza, Giovanni Giorgio; Shenvi, Rohit; Battles, Marcie 2008-11-06 The traditional communication infrastructure of the pre-hospital Emergency Medical System (EMS) is limited to voice communication using radio or cell phone technologies. With the emergence of 3rd Generation wireless networks (3G) and enhanced mobile devices capable of data communication (e.g., mobile tablets, PDAs with cell phones, or cell phones with PDA capabilities), the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication. However, video requires substantially more bandwidth which 4th Generation (4G) systems are promising. However, their availability is limited. We present an infrastructure that allows dynamic selection of the best data transport mode in the pre-hospital EMS environment. 62. Uncaria tomentosa (cat's claw) improves quality of life in patients with advanced solid tumors. Science.gov (United States) de Paula, Larissa Carvalho Lopes; Fonseca, Fernando; Perazzo, Fabio; Cruz, Felipe Melo; Cubero, Daniel; Trufelli, Damila Cristina; Martins, Suelen PatrÃcia Dos Santos; Santi, PatrÃcia Xavier; da Silva, Eliana Araújo; Del Giglio, Auro 2015-01-01 Cat's claw (Uncaria tomentosa) is a native Amazon plant that exhibits anti-inflammatory and antitumor properties. We wanted to assess its activity for symptom management of terminal cancer patients. This prospective phase II study assessed the effects of a 100-mg dose of a dry extract of U. tomentosa three times per day in patients with advanced solid tumors who had no further therapeutic options and a life expectancy of at least 2 months. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) and Functional Assessment of Chronic Illness Therapy - Fatigue questionnaires were used to assess the participants' quality of life, the Hospital Anxiety and Depression Scale questionnaire was used to assess anxiety and depression, and the Pittsburgh Sleep Quality Index was used to assess sleep quality. In addition, several biochemical and inflammatory parameters were analyzed. Fifty-one volunteers were recruited. Their median age was 64 (range, 33-85) years, and 47% of patients were female. More than 65% of patients had scores on the Karnofsky Performance Scale of 80% or less. Treatment improved the patients' overall quality of life (p=0.0411) and social functioning (p=0.0341), as assessed by the EORTC QLQ C-30, and reduced fatigue (p=0.0496) according to the Chalder Fatigue Questionnaire. None of the biochemical or inflammatory parameters assessed (interleukin-1 and -6, C-reactive protein, tumor necrosis factor-α, erythrocyte sedimentation rate, and α-1-acid glycoprotein) changed significantly. No tumor response was detected according to the Response Evaluation Criteria In Solid Tumors; however, the disease stabilized for more than 8 months in four participants. The medication was well tolerated by most patients. Use of cat's claw might be beneficial in patients with advanced cancer by improving their quality of life and reducing fatigue. The mechanism of action does not seem to be related to the anti 63. Becoming Food Aware in Hospital: A Narrative Review to Advance the Culture of Nutrition Care in Hospitals Directory of Open Access Journals (Sweden) Celia Laur 2015-06-01 Full Text Available The Nutrition Care in Canadian Hospitals (2010–2013 study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as posthospitalization. It is anticipated that a multi-level approach that promotes being “food aware†for all involved will help hospitals to achieve patient-centred care with respect to nutrition. 64. Symptom clusters and quality of life among patients with advanced heart failure. Science.gov (United States) Yu, Doris Sf; Chan, Helen Yl; Leung, Doris Yp; Hui, Elsie; Sit, Janet Wh 2016-07-01 To identify symptom clusters among patients with advanced heart failure (HF) and the independent relationships with their quality of life (QoL). This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale (ESAS) and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hierarchical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities. The patients were at an advanced age (82.9 ± 6.5 years). Three distinct symptom clusters were identified: they were the distress cluster (including shortness of breath, anxiety, and depression), the decondition cluster (fatigue, drowsiness, nausea, and reduced appetite), and the discomfort cluster (pain, and sense of generalized discomfort). These three symptom clusters accounted for 63.25% of variance of the patients' symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress (β = -0.635, P < 0.001), the decondition (β = -0.148, P = 0.01), and the discomfort (β = -0.258, P < 0.001) symptom clusters independently predicted their QoL. This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease. 65. Complications of tube thoracostomy using Advanced Trauma Life Support technique in chest trauma. Science.gov (United States) Iribhogbe, P E; Uwuigbe, O 2011-01-01 Tube thoracostomy (TT) is central in the management of chest trauma sufficing in over 80% of cases. As a result the procedure is commonly performed in most emergency departments. The aim of this study was to assess the efficacy and complications of TT using Advanced Trauma Life Support (ATLS) technique in chest trauma. This prospective study was done at the Trauma Unit of the University of Benin Teaching Hospital in Nigeria. All patients with chest trauma who needed tube thoracostomy between February 2006 and February 2009 were studied. Data recorded for each patient included injury, mechanism of injury, Glasgow Coma score, revised trauma score, and indications for tube thoracostomy. Chest radiographs were obtained preinsertion, post insertion and post extubation for all the cases. Patients were monitored for tube thoracostomy complications. Of 9415 trauma patients seen during the period 105 patients had tube thoracostomy but only 70 (56 male, 14 female) had adequate data for analysis. Seventy-four tubes were passed in the 70 patients with unilateral tubes in 66 (94.3%) and bilateral tubes in 4 (5.7%). Blunt chest trauma occurred in 32 (45.7%) and penetrating chest trauma in 38 (54.3%) of the patients. Simple haemothorax and haemopneumothorax were the commonest indications for tube thoracostomy. Complications recorded include four cases of kinked tubes, four of superficial wound infection and 10 cases of residual haemothorax. Tube thoracostomy in the emergency department using advanced trauma life support principles is effective in chest trauma and associated with few complications. 66. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management Directory of Open Access Journals (Sweden) Ahmadi Koorosh 2013-06-01 Full Text Available ã€Abstract】Objective: Since appropriate and time-table methods in trauma care have an important impact on patients’ outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS program on medical interns' performance in simulated trauma patient management. Methods: A descriptive and analytical study before and after the training was conducted on 24 randomly se-lected undergraduate medical interns from Imam Reza Hos-pital in Mashhad, Iran. On the first day, we assessed in-terns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre-and post- ATLS periods, were compared through SPSS ver-sion 15.0 software. P values less than 0.05 were considered statistically significant. Results: Our findings showed that interns’ ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P<0.001, P=0.016 and P=0.01 respectively. Conclusion: ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns. Key words: Advanced Trauma Life Support Care; Knowledge; Inservice training; Wounds and injuries 67. Refraining from pre-hospital advanced airway management: a prospective observational study of critical decision making in an anaesthesiologist-staffed pre-hospital critical care service. Science.gov (United States) RognÃ¥s, Leif; Hansen, Troels Martin; Kirkegaard, Hans; Tønnesen, Else 2013-10-25 We report prospectively recorded observational data from consecutive cases in which the attending pre-hospital critical care anaesthesiologist considered performing pre-hospital advanced airway management but decided to withhold such interventions. Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) registered data from February 1st 2011 to October 31st 2012. Included were patients of all ages for whom pre-hospital advanced airway management were considered but not performed. The main objectives were to investigate (1) the pre-hospital critical care anaesthesiologists' reasons for considering performing pre-hospital advanced airway management in this group of patients (2) the pre-hospital critical care anaesthesiologists' reasons for not performing pre-hospital advanced airway management (3) the methods used to treat these patients (4) the incidence of complications related to pre-hospital advanced airway management not being performed. We registered data from 1081 cases in which the pre-hospital critical care anaesthesiologists' considered performing pre-hospital advanced airway management. The anaesthesiologists decided to withhold pre-hospital advanced airway management in 32.1% of these cases (n = 347). In 75.1% of these cases (n = 257) pre-hospital advanced airway management were withheld because of the patient's condition and in 30.8% (n = 107) because of patient co-morbidity. The most frequently used alternative treatment was bagmask ventilation, used in 82.7% of the cases (n = 287). Immediate complications related to the decision of not performing pre-hospital advanced airway management occurred in 0.6% of the cases (n = 2). We have illustrated the complexity of the critical decision-making associated with pre-hospital advanced airway management. This study is the first to identify the most common reasons why pre-hospital critical care 68. End-of-Life Care in an Acute Care Hospital: Linking Policy and Practice Science.gov (United States) Sorensen, Ros; Iedema, Rick 2011-01-01 The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be… 69. Radio Searches for Signatures of Advanced Extraterrestrial Life Science.gov (United States) Siemion, Andrew Over the last several decades, observational astronomy has produced a flood of discoveries that suggest that the building blocks and circumstances that gave rise to life on Earth may be the rule rather than the exception. It has now been conclusively shown that planets are common and that some 5-15% of FGKM stars host planets existing in their host star's habitable zone. Further, terrestrial biology has demonstrated that life on our own planet can thrive in extraordinarily extreme environments, dramatically extending our notion of what constitutes habitability. The deeper question, yet unanswered, is whether or not life in any form has ever existed in an environment outside of the Earth. As humans, we are drawn to an even more profound question, that of whether or not extraterrestrial life may have evolved a curiosity about the universe similar to our own and the technology with which to explore it. Radio astronomy has long played a prominent role in searches for extraterrestrial intelligence (SETI), beginning with the first suggestions by Cocconi and Morrison (1959) that narrow-band radio signals near 1420 MHz might be effective tracers of advanced technology and early experiments along these lines by Frank Drake in 1961, continuing through to more recent investigations searching for several types of coherent radio signals indicative of technology at a wider range of frequencies. The motivations for radio searches for extraterrestrial intelligence have been throughly discussed in the literature, but the salient arguments are the following: 1. coherent radio emission is commonly produced by advanced technology (judging by Earth’s technological development), 2. electromagnetic radiation can convey information at the maximum velocity currently known to be possible, 3. radio photons are energetically cheap to produce, 4. certain types of coherent radio emissions are easily distinguished from astrophysical background sources, especially within the so 70. Microbial astronauts: assembling microbial communities for advanced life support systems. Science.gov (United States) Roberts, M S; Garland, J L; Mills, A L 2004-02-01 Extension of human habitation into space requires that humans carry with them many of the microorganisms with which they coexist on Earth. The ubiquity of microorganisms in close association with all living things and biogeochemical processes on Earth predicates that they must also play a critical role in maintaining the viability of human life in space. Even though bacterial populations exist as locally adapted ecotypes, the abundance of individuals in microbial species is so large that dispersal is unlikely to be limited by geographical barriers on Earth (i.e., for most environments "everything is everywhere" given enough time). This will not be true for microbial communities in space where local species richness will be relatively low because of sterilization protocols prior to launch and physical barriers between Earth and spacecraft after launch. Although community diversity will be sufficient to sustain ecosystem function at the onset, richness and evenness may decline over time such that biological systems either lose functional potential (e.g., bioreactors may fail to reduce BOD or nitrogen load) or become susceptible to invasion by human-associated microorganisms (pathogens) over time. Research at the John F. Kennedy Space Center has evaluated fundamental properties of microbial diversity and community assembly in prototype bioregenerative systems for NASA Advanced Life Support. Successional trends related to increased niche specialization, including an apparent increase in the proportion of nonculturable types of organisms, have been consistently observed. In addition, the stability of the microbial communities, as defined by their resistance to invasion by human-associated microorganisms, has been correlated to their diversity. Overall, these results reflect the significant challenges ahead for the assembly of stable, functional communities using gnotobiotic approaches, and the need to better define the basic biological principles that define ecosystem 71. Microbial astronauts: assembling microbial communities for advanced life support systems Science.gov (United States) Roberts, M. S.; Garland, J. L.; Mills, A. L. 2004-01-01 Extension of human habitation into space requires that humans carry with them many of the microorganisms with which they coexist on Earth. The ubiquity of microorganisms in close association with all living things and biogeochemical processes on Earth predicates that they must also play a critical role in maintaining the viability of human life in space. Even though bacterial populations exist as locally adapted ecotypes, the abundance of individuals in microbial species is so large that dispersal is unlikely to be limited by geographical barriers on Earth (i.e., for most environments "everything is everywhere" given enough time). This will not be true for microbial communities in space where local species richness will be relatively low because of sterilization protocols prior to launch and physical barriers between Earth and spacecraft after launch. Although community diversity will be sufficient to sustain ecosystem function at the onset, richness and evenness may decline over time such that biological systems either lose functional potential (e.g., bioreactors may fail to reduce BOD or nitrogen load) or become susceptible to invasion by human-associated microorganisms (pathogens) over time. Research at the John F. Kennedy Space Center has evaluated fundamental properties of microbial diversity and community assembly in prototype bioregenerative systems for NASA Advanced Life Support. Successional trends related to increased niche specialization, including an apparent increase in the proportion of nonculturable types of organisms, have been consistently observed. In addition, the stability of the microbial communities, as defined by their resistance to invasion by human-associated microorganisms, has been correlated to their diversity. Overall, these results reflect the significant challenges ahead for the assembly of stable, functional communities using gnotobiotic approaches, and the need to better define the basic biological principles that define ecosystem 72. Advanced Space Suit Portable Life Support Subsystem Packaging Design Science.gov (United States) Howe, Robert; Diep, Chuong; Barnett, Bob; Thomas, Gretchen; Rouen, Michael; Kobus, Jack 2006-01-01 This paper discusses the Portable Life Support Subsystem (PLSS) packaging design work done by the NASA and Hamilton Sundstrand in support of the 3 future space missions; Lunar, Mars and zero-g. The goal is to seek ways to reduce the weight of PLSS packaging, and at the same time, develop a packaging scheme that would make PLSS technology changes less costly than the current packaging methods. This study builds on the results of NASA s in-house 1998 study, which resulted in the "Flex PLSS" concept. For this study the present EMU schematic (low earth orbit) was used so that the work team could concentrate on the packaging. The Flex PLSS packaging is required to: protect, connect, and hold the PLSS and its components together internally and externally while providing access to PLSS components internally for maintenance and for technology change without extensive redesign impact. The goal of this study was two fold: 1. Bring the advanced space suit integrated Flex PLSS concept from its current state of development to a preliminary design level and build a proof of concept mockup of the proposed design, and; 2. "Design" a Design Process, which accommodates both the initial Flex PLSS design and the package modifications, required to accommodate new technology. 73. Advanced Biotelemetry Systems for Space Life Sciences: PH Telemetry

Science.gov (United States) Hines, John W.; Somps, Chris; Ricks, Robert; Kim, Lynn; Connolly, John P. (Technical Monitor) 1995-01-01 The SENSORS 2000! (S2K!) program at NASA's Ames Research Center is currently developing a biotelemetry system for monitoring pH and temperature in unrestrained subjects. This activity is part of a broader scope effort to provide an Advanced Biotelemetry System (ABTS) for use in future space life sciences research. Many anticipated research endeavors will require biomedical and biochemical sensors and related instrumentation to make continuous inflight measurements in a variable-gravity environment. Since crew time is limited, automated data acquisition, data processing, data storage, and subject health monitoring are required. An automated biochemical and physiological data acquisition system based on non invasive or implantable biotelemetry technology will meet these requirements. The ABTS will ultimately acquire a variety of physiological measurands including temperature, biopotentials (e.g. ECG, EEG, EMG, EOG), blood pressure, flow and dimensions, as well as chemical and biological parameters including pH. Development activities are planned in evolutionary, leveraged steps. Near-term activities include 1) development of a dual channel pH/temperature telemetry system, and 2) development of a low bandwidth, 4-channel telemetry system, that measures temperature, heart rate, pressure, and pH. This abstract describes the pH/temperature telemeter. 74. Technical Support Document: Development of the Advanced Energy Design Guide for Large Hospitals - 50% Energy Savings Energy Technology Data Exchange (ETDEWEB) Bonnema, E.; Leach, M.; Pless, S. 2013-06-01 This Technical Support Document describes the process and methodology for the development of the Advanced Energy Design Guide for Large Hospitals: Achieving 50% Energy Savings Toward a Net Zero Energy Building (AEDG-LH) ASHRAE et al. (2011b). The AEDG-LH is intended to provide recommendations for achieving 50% whole-building energy savings in large hospitals over levels achieved by following Standard 90.1-2004. The AEDG-LH was created for a 'standard' mid- to large-size hospital, typically at least 100,000 ft2, but the strategies apply to all sizes and classifications of new construction hospital buildings. Its primary focus is new construction, but recommendations may be applicable to facilities undergoing total renovation, and in part to many other hospital renovation, addition, remodeling, and modernization projects (including changes to one or more systems in existing buildings). 75. Relation between a career and family life for English hospital consultants: qualitative, semistructured interview study Science.gov (United States) Dumelow, Carol; Littlejohns, Peter; Griffiths, Sîan 2000-01-01 Objective To explore the relation between work and family life among hospital consultants and their attitude towards the choices and constraints that influence this relation. Design Qualitative study of consultants' experiences and views based on tape recorded semistructured interviews. Setting Former South Thames health region in southeast England. Participants 202 male and female NHS hospital consultants aged between 40 to 50 years representing all hospital medical specialties. Results Three types of relation between work and family life (career dominant, segregated, and accommodating) were identified among hospital consultants. Most consultants had a segregated relation, although female consultants were more likely than male consultants to have a career dominant or an accommodating relation. Many male consultants and some female consultants expressed considerable dissatisfaction with the balance between their career and family life. A factor influencing this dissatisfaction was the perceived lack of choice to spend time on their personal or family life, because of the working practices and attitudes within hospital culture, if they wanted a successful career. Conclusions Consultants are currently fitting in with the profession rather than the profession adapting to enable doctors to have fulfilling professional and personal lives. Current government policies to increase the medical workforce and promote family friendly policies in the NHS ought to take account of the need for a fundamental change in hospital culture to enable doctors to be more involved in their personal or family life without detriment to their career progress. PMID:10827044 76. End-of-life hospital care for cancer patients: an update. Science.gov (United States) Dudevich, Alexey; Chen, Allie; Gula, Cheryl; Fagbemi, Josh 2014-01-01 Cancer is the leading cause of death in Canada, and the number of new cases is expected to increase as the population ages and grows. This study examined the use of hospital services in the last month of life by adult cancer patients who died in Canadian acute care hospitals in fiscal year 2012-2013. Almost 25,000 Canadian cancer patients - excluding those in Quebec - died in acute care hospitals, representing approximately 45% of the estimated cancer deaths in 2012-2013. The proportion of in-hospital deaths varied across jurisdictions. Twenty-three percent of these patients were admitted to acute care multiple times in their last 28 days of life, with a higher percentage for rural (29%) compared to urban (21%) patients. Relatively few patients used intensive care units or received inpatient chemotherapy in their last 14 days of life. 77. Goals of care in advanced dementia: quality of life, dignity and comfort. Science.gov (United States) Volicer, L 2007-01-01 provision of care. Van der Steen et al. present evidence that lower respiratory tract infection leads frequently but not always to functional decline. However, it is significant that the Dutch participants in this study were never hospitalized and always treated in a nursing home. Hospitalization leads to functional deterioration even in cognitively intact elderly individuals (4). In addition, treatment of lower respiratory infection is more effective when provided in a nursing home than when the resident is transferred to an acute care setting (5). It should also be considered that antibiotic treatment of lower respiratory tract infections in individuals with terminal dementia does not increase their comfort and lifespan (6). Dignity is an often invoked goal of care in dementia but it is often poorly defined and characterized. Holmerova et al. provide a detailed description of the concept of dignity and its application in dementia care. They also present two specific examples of problems encountered when individuals with advanced dementia are treated insensitively in an acute care setting. Dignity oriented care should treat everybody as an individual and provide care according to the goals of care determined before any crisis situation (7). Namaste Care is an example of care setting that respects individual's dignity until death; respecting "the spirit within". Tube feeding in individuals with advanced progressive dementia does not promote quality of life, dignity or comfort. Tube feeding deprives individuals from contact with the caregiver during hand feeding and from enjoyment of the taste of food. Tube feeding often requires use of restraints that decreases an individual's dignity and comfort. Despite the lack of beneficial effects and the burdens that the tube feeding imposes (8), it is still widely used in individuals with advanced dementia. Pang et al. compare the use of tube feeding in two different settings of dementia care, one in which tube feeding is not used 78. Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer. Science.gov (United States) Smith, Alexander K; Earle, Craig C; McCarthy, Ellen P 2009-01-01 To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illness. Retrospective, secondary data analysis. Surveillance, Epidemiology, and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31, 2001. Forty thousand nine hundred sixty non-Hispanic white, non-Hispanic black, Asian, and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung, colorectal, breast, and prostate cancer. Hospice use and indicators of highintensity care at the end of life. Whereas 42.0% of elderly white patients with advanced cancer enrolled in hospice, enrollment was lower for black (36.9%), Asian (32.2%), and Hispanic (37.7%) patients. Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors. Higher proportions of black and Asian patients than of white patients were hospitalized two or more times (11.7%, 15.0%, 13.7%, respectively), spent more than 14 days hospitalized (11.4%, 17.4%, 15.6%, respectively), and were admitted to the intensive care unit (ICU) (12.0%, 17.0%, 16.2%, respectively) in the last month of life and died in the hospital (26.5%, 31.3%, 33.7%, respectively). Unadjusted differences in receipt of high-intensity care according to race or ethnicity remained after adjustment. Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods, be admitted to the ICU, die in the hospital, and be enrolled in hospice at lower rates. Further research is needed to examine the degree to which patient preferences or other factors explain these differences. 79. Escalation of oncologic services at the end of life among patients with gynecologic cancer at an urban, public hospital. Science.gov (United States) Wu, Eijean; Rogers, Anna; Ji, Lingyun; Sposto, Richard; Church, Terry; Roman, Lynda; Tripathy, Debu; Lin, Yvonne G 2015-03-01 Use of oncology-related services is increasingly scrutinized, yet precisely which services are actually rendered to patients, particularly at the end of life, is unknown. This study characterizes the end-of-life use of medical services by patients with gynecologic cancer at a safety-net hospital. Oncologic history and metrics of medical use (eg, hospitalizations, chemotherapy infusions, procedures) for patients with gynecologic oncology who died between December 2006 and February 2012 were evaluated. Mixed-effect regression models were used to test time effects and construct usage summaries. Among 116 subjects, cervical cancer accounted for the most deaths (42%). The median age at diagnosis was 55 years; 63% were Hispanic, and 65% had advanced disease. Only 34% died in hospice care. The median times from do not resuscitate/do not intubate documentation and from last therapeutic intervention to death were 9 days and 55 days, respectively. Significant time effects for all services (eg, hospitalizations, diagnostics, procedures, treatments, clinic appointments) were detected during the patient's final year (P care used significantly fewer resources toward the end of life. To our knowledge, this is the first report enumerating medical services obtained by patients with gynecologic cancer in a large, public hospital during the end of life. Marked changes in interventions in the patient's final 2 months highlight the need for cost-effective, evidence-based metrics for delivering cancer care. Our data emphasize continuity of care as a significant determinant of oncologic resource use during this critical period. Copyright © 2015 by American Society of Clinical Oncology. 80. A Study on Quality of Work Life among Nurses in a Medical College Hospital in Bangalore OpenAIRE Naveen Ramesh, Catherine Nisha, Andre Mary Josephine, Seena Thomas, Bobby Joseph 2013-01-01 Introduction: Quality of Work Life (QWL) is defined as the extent to which an employee is satisfied with personal and working needs through participating in the workplace while achieving the goals of the organization. Objectives: To assess the quality of life of nurses working in a medical college hospital in Bangalore and the factors associated with it. Methods: Ethical approval from the institution and informed consent from the study participants was obtained and quality of life que... « 2 3 4 5 6 » « 3 4 5 6 7 » 81. Quality of life at work among nurses of a university hospital Directory of Open Access Journals (Sweden) Eliane de Fátima Almeida Lima 2013-12-01 Full Text Available The objective of this cross-sectional study was to evaluate the quality of life at work of nurses from a university hospital, between January and April of 2011. A sample of 90 nurses answered the WHOQOL-Bref and a questionnaire addressing their sociodemographic profile and working conditions. Most subjects were female, aged between 23 and 40 years, married, and holding a specialization degree. The Physical domain had the highest mean (73.05 and the Environment domain the lowest (63.12. Subjects with the best scores in the quality of life domains were male, married, public servants, holding a master’s/doctorate degree, and working three jobs or more. The chosen instrument allowed for outlining the nurses’ profile and learning the domains and variables that affect their quality of life. It is suggested that university hospitals encourage nurses to pursue a stricto sensu graduate course. Descriptors: Quality of Life; Nurses, Male; Working Conditions; Hospitals, University. 82. ESL for Hotel/Hospitality Industry. Level: Advanced Beginner/Intermediate. Science.gov (United States) Western Suffolk County Board of Cooperative Educational Services, Northport, NY. This document contains 16 lesson plans for an advanced beginning and intermediate course in work-related English for non-English- or limited-English-speaking entry-level employees in the hotel and hospitality industry. Course objectives are as follows: helping participants understand and use job-specific vocabulary; receive and understand… 83. Application of life cycle assessment for hospital solid waste management: A case study. Science.gov (United States) Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz 2016-10-01 This study was meant to determine environmental aspects of hospital waste management scenarios using a life cycle analysis approach. The survey for this study was conducted at the largest hospital in a major city of Pakistan. The hospital was thoroughly analyzed from November 2014 to January 2015 to quantify its wastes by category. The functional unit of the study was selected as 1 tonne of disposable solid hospital waste. System boundaries included transportation of hospital solid waste and its treatment and disposal by landfilling, incineration, composting, and material recycling methods. These methods were evaluated based on their greenhouse gas emissions. Landfilling and incineration turned out to be the worst final disposal alternatives, whereas composting and material recovery displayed savings in emissions. An integrated system (composting, incineration, and material recycling) was found as the best solution among the evaluated scenarios. This study can be used by policymakers for the formulation of an integrated hospital waste management plan. This study deals with environmental aspects of hospital waste management scenarios. It is an increasing area of concern in many developing and resource-constrained countries of the world. The life cycle analysis (LCA) approach is a useful tool for estimation of greenhouse gas emissions from different waste management activities. There is a shortage of information in existing literature regarding LCA of hospital wastes. To the best knowledge of the authors this work is the first attempt at quantifying the environmental footprint of hospital waste in Pakistan. 84. End-of-life care during and after an acute hospitalization in older patients with cancer, end-stage organ failure, or frailty : A sub-analysis of a prospective cohort study NARCIS (Netherlands) Huijberts, Sanne; Buurman, Bianca M.; de Rooij, Sophia E. Background: Many patients show deterioration in functioning and increased care needs in the last year of life. End-of-life care needs and health care utilization might differ between groups of acutely hospitalized older patients. Aim: To investigate differences in geriatric conditions, advance care 85. The Effects of Pediatric Advanced Life Support Guidelines on Pediatric Trauma Airway Management. Science.gov (United States) Sperka, Jana; Hanson, Sheila J; Hoffmann, Raymond G; Dasgupta, Mahua; Meyer, Michael T 2016-08-01 Recent Pediatric Advanced Life Support (PALS) guidelines have deemphasized the use of advanced airways in short transport. It is unclear if guideline recommendations have altered practice. We sought to determine if a temporal change exists in the number of prehospital pediatric trauma intubations since the 2005 PALS guidelines update. This is an institutional review board-approved, retrospective, single-center study. Reviewed all pediatric trauma activations where patients younger than 19 years were intubated at the scene, en route or at the level 1 trauma center during 2006 to 2011. Specific complications collected were esophageal intubations, mainstem intubations and need for re-intubations. There were 1012 trauma activations, 1009 pediatric patients, 300 (29.7%) intubated during transport to Children's Hospital of Wisconsin Pediatric Trauma Center (PTC) or upon arrival. Mean age of 9.5 ± 5.9 years. Fifty-seven percent (n = 172) were intubated before PTC, 31.7% (n = 95) field intubations, 25.7% (n = 77) outside facility intubations. 44% (n = 132) at PTC. Age was not a significant variable. There was no difference in the proportion of injured children requiring intubation who were intubated before arrival to the PTC. Those intubated in the field versus a facility had significantly increased mortality (P = 0.0002), longer hospital days (P = 0.0004) including intensive care unit days (P = 0.0003) and ventilator days (P = 0.0003) even when adjusted for illness severity. There was no significant change in the proportion of pretrauma room intubations following the 2005 PALS guidelines even when adjusted for illness or injury severity. Children injured farther from the PTC and more severely injured children were more likely to be intubated before arrival at the PTC. 86. Patient with stroke: hospital discharge planning, functionality and quality of life Directory of Open Access Journals (Sweden) Henrique José Mendes Nunes Full Text Available ABSTRACT Stroke still causes high levels of human inability and suffering, and it is one of the main causes of death in developed countries, including Portugal. Objective: analyze the strategies of hospital discharge planning for these patients, increasing the knowledge related to hospitalhome transition, discharge planning processes and the main impact on the quality of life and functionality. Method: integrative literature review using the PICOD criteria, with database research. Results: 19 articles were obtained, using several approaches and contexts. For quality of life, the factors related to the patient satisfaction with care and the psychoemotional aspects linked with functionality are the most significant. Conclusion: during the hospitalization period, a careful hospital discharge planning and comprehensive care to patients and caregivers - in particular the functional and psychoemotional aspects - tend to have an impact on the quality of life of patients. 87. Prospective quality of life study of South African women undergoing treatment for advanced-stage cervical cancer. Science.gov (United States) du Toit, George Campbell; Kidd, Martin 2015-10-01 The majority of South African cervical cancer patients present with advanced-stage disease. Chemoradiation therapy, in comparison with radiation therapy, results in marginally improved survival in women with advanced cervical cancer. The impact on the quality of life due to the addition of a chemosensitizer in a situation of limited survival benefits warrants objective assessment. This prospective study compares the quality of life for women with cervical cancer and treated with radiation or chemoradiation therapy at Tygerberg Hospital, South Africa. A prospective study was done in a population with a high incidence of advanced cervical cancer. Quality of life measurements were done at pretreatment, post treatment, and follow-up. The European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire and the Cervix Cancer Module were used. The study included 219 women. Forty-four women were treated with primary surgery. A total of 102 women completed primary radiation therapy and 73 women completed primary chemoradiation therapy. The demographic characteristics of the last 2 treatment groups were different. Women receiving chemoradiation therapy had a higher educational level (P cervical cancer (P treatment options based on clinical factors unrelated to quality of life. Chemoradiation therapy resulted in statistically more improvement in the pain (P treatment. In post hoc analysis, the global health domain was significantly more improved (P = 0.03) by chemoradiation. Peripheral neuropathy was not increased by chemoradiation. Chemoradiation therapy improved quality of life more than radiation therapy in certain domains. This allows for selection of chemoradiation as a treatment option in situations where quality of life is the end point of treatment. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved. 88. Comparison of severe trauma care effect before and after advanced trauma life support training Institute of Scientific and Technical Information of China (English) WANG Peng; LI Neng-ping; GU Yong-feng; LU Xiao-bing; CONG Jian-nong; YANG Xin; LING Yun 2010-01-01 Objective: To study the emergency care effect of in-hospital severe trauma patients with the injury severity score (ISS)≥ 16 after medical staff received advanced trauma life support (ATLS) training.Methods: ATLS training was implemented by lectures,scenarios, field practices, and examinations. The clinical effect of in-hospital severe trauma care was compared 2 years before and after ATLS training.Results: During 2 years (from January 1, 2004, to December 31, 2005) before ATLS training, 438 cases of severe trauma were admitted and treated emergently in our department. Among them, ISS score was 28.6±7.8 on average, and 87 cases died with the mortality of 19.9%. The duration in emergency department and from admission to operation were 69.5 min±l 1.5 min and 89.6 min±9.3 min respectively. Two years (from January 1,2007, to December 31, 2008) after ATLS training, 382 cases of severe trauma were admitted and treated. The ISS was 25.3 ±6.1 on average and 62 cases died with the mortality of 15.1%. The duration in emergency department and from admission to operation were 47.8 min±10.7 min and 61.5 min±9.9 min respectively. The ISS score showed no significant difference between the two groups (P>0.05), but the mortality, the duration in emergency department and from admission to operation were markedly decreased after ATLS training and showed significant difference between the two groups (P<0.05).Conclusion: ATLS course training can improve the emergency care effect of in-hospital severe trauma patients,and should be put into practice as soon as possible in China. 89. Quality Nursing Care for Hospitalized Patients with Advanced Illness: Concept Development Science.gov (United States) Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A. 2011-01-01 The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability. PMID:20572095 90. The relationship between time management behaviour, flow, happiness and life satisfaction in the hospitality training environment OpenAIRE 2013-01-01 M.Comm. (Industrial Psychology) There is ample evidence to suggest that optimal experience (flow), happiness and life satisfaction are related to one another in the creative culinary training environment. In this study, the effect of time management behaviour on these relationships was investigated within the hospitality training environment. Furthermore, the mediating role of perceived control of time on flow was explored, as well as the direct effect of happiness and life satisfaction on... 91. Advancing palliative and end-of-life science in cardiorespiratory populations: The contributions of nursing science. Science.gov (United States) Grady, Patricia A Nursing science has a critical role to inform practice, promote health, and improve the lives of individuals across the lifespan who face the challenges of advanced cardiorespiratory disease. Since 1997, the National Institute of Nursing Research (NINR) has focused attention on the importance of palliative and end-of-life care for advanced heart failure and advanced pulmonary disease through the publication of multiple funding opportunity announcements and by supporting a cadre of nurse scientists that will continue to address new priorities and future directions for advancing palliative and end-of-life science in cardiorespiratory populations. Published by Elsevier Inc.

92. Overview of the consortium of hospitals advancing research on tobacco (chart Directory of Open Access Journals (Sweden) Riley William T 2012-08-01 Full Text Available Abstract Background The Consortium of Hospitals Advancing Research on Tobacco (CHART is a network of six projects and a research coordinating unit funded by the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institutes of Health (NIH Office of Behavioral and Social Science Research. The CHART projects will assess the effectiveness and cost-effectiveness of smoking cessation interventions initiated during hospitalization and continued post-discharge. Methods/design Along with a seventh project funded previously under the NIH Challenge grants, the CHART projects will assess smoking cessation strategies delivered to approximately 10,000 hospitalized smokers across a geographically diverse group of nearly 20 private, public, academic, and community hospitals. The CHART research coordinating unit at Kaiser Permanente Center for Health Research provides organizational and data coordination support, facilitating the development of common measures for combining data from multiple CHART projects. Discussion The targeted enrollment in CHART, if achieved, will represent the largest, most diverse pooled dataset of hospitalized smokers receiving smoking cessation assistance, and is designed to contribute to the dissemination and implementation of smoking cessation interventions provided by hospital systems. 93. Barriers to the implementation of advanced clinical pharmacy services at Portuguese hospitals. Science.gov (United States) Brazinha, Isabel; Fernandez-Llimos, Fernando 2014-10-01 In some countries, such as Portugal, clinical pharmacy services in the hospital setting may be implemented to a lower extent than desirable. Several studies have analysed the perceived barriers to pharmacy service implementation in community pharmacy. To identify the barriers towards the implementation of advanced clinical pharmacy services at a hospital level in Portugal, using medication follow-up as an example. Hospital pharmacies in Portugal. A qualitative study based on 20 face-to-face semi-structured interviews of strategists and hospital pharmacists. The interview guide was based on two theoretical frameworks, the Borum's theory of organisational change and the Social Network Theory, and then adapted for the Portuguese reality and hospital environments. A constant comparison process with previously analysed interviews, using an inductive approach, was carried out to allow themes to emerge. Themes were organised following the Leavitt's Organizational Model: functions and objectives; hospital pharmacist; structure of pharmacy services; environment; technology; and medication follow-up based on the study topic. Barriers towards practice change. Medication follow-up appeared not to be a well-known service in Portuguese hospital pharmacies. The major barriers at the pharmacist level were their mind-set, resistance to change, and lack of readiness. Lack of time, excessive bureaucratic and administrative workload, reduced workforce, and lack of support from the head of the service and other colleagues were identified as structural barriers. Lack of access to patients' clinical records and cumbersome procedures to implement medication follow-up were recognised as technological barriers. Poor communication with other healthcare professionals, and lack of support from professional associations were the major environmental barriers. Few of the barriers identified by Portuguese hospital pharmacists were consistent with previous reports from community pharmacy. The mind 94. Recent advances in chemical evolution and the origins of life Science.gov (United States) Oro, John; Lazcano, Antonio This paper discusses the already 60 year old ideas of Oparin and Haldane, who suggested that the first forms of life were anaerobic, heterotrophic bacteria coming from chemical abiotic synthesis of organic compounds. 95. Health-related quality of life and anemia in hospitalized patients with heart failure NARCIS (Netherlands) Kraai, I. H.; Luttik, M. L. A.; Johansson, P.; De Jong, R. M.; Van Veldhuisen, D. J.; Hillege, H. L.; Jaarsma, T. 2012-01-01 Background: Anemia is a serious and highly prevalent co-morbidity in chronic heart failure (HF) patients. Its influence on health-related quality of life (HR-QoL) has rarely been studied, and no data is available regarding the role it plays in hospitalized HF patients. Methods: Baseline data from th 96. Health-related quality of life and anemia in hospitalized patients with heart failure NARCIS (Netherlands) Kraai, I. H.; Luttik, M. L. A.; Johansson, P.; De Jong, R. M.; Van Veldhuisen, D. J.; Hillege, H. L.; Jaarsma, T. 2012-01-01 Background: Anemia is a serious and highly prevalent co-morbidity in chronic heart failure (HF) patients. Its influence on health-related quality of life (HR-QoL) has rarely been studied, and no data is available regarding the role it plays in hospitalized HF patients. Methods: Baseline data from 97. Obesity and Hospitalization over the Adult Life Course: Does Duration of Exposure Increase Use? Science.gov (United States) Schafer, Markus H.; Ferraro, Kenneth F. 2007-01-01 Consistent with a new genre of research on life-course analyses of health-service use, this study explores the consequences of long-term exposure to a risk factor. Drawing from cumulative-disadvantage theory, the study examines whether obesity, especially chronic obesity, increases hospitalization admission and length of stay. Analyses make use of… 98. Early weaning and hospitalization with alcohol-related diagnoses in adult life DEFF Research Database (Denmark) Sørensen, Holger J; Mortensen, Erik Lykke; Reinisch, June M 2006-01-01 OBJECTIVE: This study attempted to determine whether lack of breast-feeding or a short duration of breast-feeding during infancy is associated with an elevated risk of hospitalization with alcohol-related diagnoses in adult life. METHOD: The study was a prospective longitudinal birth cohort design... 99. Advanced SiC-Matrix Composites with Improved Oxidation Resistance and Life Project Data.gov (United States) National Aeronautics and Space Administration — The objective of this proposed effort is to demonstrate the promise of advanced C/SiC and SiC/SiC composites having improved environmental durability and longer life... 100. 2 of 3 Americans Don't Have 'Advance Directive' for End of Life Science.gov (United States) ... Videos & Tools About MedlinePlus Search Search MedlinePlus GO GO About ... 2 of 3 Americans Don't Have 'Advance Directive' for End of Life Document lets family members know your wishes To use the ... « 3 4 5 6 7 » « 4 5 6 7 8 » 101. Fatigue in Patients With Advanced Terminal Cancer Correlates With Inflammation, Poor Quality of Life and Sleep, and Anxiety/Depression. Science.gov (United States) Rodrigues, Alex Rua; Trufelli, Damila Cristina; Fonseca, Fernando; de Paula, Larissa Carvalho; Giglio, Auro Del 2016-12-01 To assess which laboratory and clinical factors are associated with fatigue in patients with terminal cancer. We evaluated 51 patients with advanced incurable solid tumors using the Chalder Fatigue Questionnaire (CFQ) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale for fatigue; the Pittsburgh Sleep Quality Index (PSQI-BR) for sleep quality; the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression; the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire, Version 3.0 (QLQ C-30); and Functional Assessment of Cancer Therapy (FACT) for quality of life. We also analyzed several inflammatory markers and the modified Glasgow prognostic score (mGPS). We observed severe fatigue in 19 (38%) patients (FACIT-F score >36). There was a significant correlation between fatigue as evaluated by the CFQ and quality of sleep and between the CFQ mental fatigue subscale scores and TNF-α level. When fatigue was evaluated using the FACIT-F scale, we observed a significant association between fatigue and anxiety/depression, quality of sleep, mGPS, and hemoglobin levels. Fatigue measured both with the CFQ and FACIT-F scale correlated with poor quality of life according to the EORTC QLQ C-30. In patients with advanced cancer, fatigue is a common symptom associated with the presence of inflammation, poor quality of sleep, depression/anxiety, and poor quality of life. © The Author(s) 2015. 102. WOMEN AND ADVANCEMENT IN NEUROPSYCHOLOGY:REAL-LIFE LESSONS LEARNED Science.gov (United States) Hilsabeck, Robin C.; Martin, Eileen M. 2013-01-01 The number of women in neuropsychology has been increasing over the past 20 years while the number of women in senior and leadership positions within neuropsychology has not. The field of neuropsychology has much to gain by facilitating the advancement of women into leadership roles, including access to some of the brightest and creative minds in the field. The purpose of this article is to offer practical advice about how to overcome barriers and advance within neuropsychology. Suggestions for professional organizations, women, and mentors of women are provided that will likely benefit trainees and junior colleagues regardless of their gender. PMID:18841516 103. Women and advancement in neuropsychology: real-life lessons learned. Science.gov (United States) Hilsabeck, Robin C; Martin, Eileen M 2010-04-01 The number of women in neuropsychology has been increasing over the past 20 years while the number of women in senior and leadership positions within neuropsychology has not. The field of neuropsychology has much to gain by facilitating the advancement of women into leadership roles, including access to some of the brightest and creative minds in the field. The purpose of this article is to offer practical advice about how to overcome barriers and advance within neuropsychology. Suggestions for professional organizations, women, and mentors of women are provided that will likely benefit trainees and junior colleagues regardless of their gender. 104. Advanced physical-chemical life support systems research Science.gov (United States) Evanich, Peggy L. 1988-01-01 A proposed NASA space research and technology development program will provide adequate data for designing closed loop life support systems for long-duration manned space missions. This program, referred to as the Pathfinder Physical-Chemical Closed Loop Life Support Program, is to identify and develop critical chemical engineering technologies for the closure of air and water loops within the spacecraft, surface habitats or mobility devices. Computerized simulation can be used both as a research and management tool. Validated models will guide the selection of the best known applicable processes and in the development of new processes. For the integration of the habitat system, a biological subsystem would be introduced to provide food production and to enhance the physical-chemical life support functions on an ever-increasing basis. 105. Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients. Science.gov (United States) Delgado-Guay, Marvin; Ferrer, Jeanette; Rieber, Alyssa G; Rhondali, Wadih; Tayjasanant, Supakarn; Ochoa, Jewel; Cantu, Hilda; Chisholm, Gary; Williams, Janet; Frisbee-Hume, Susan; Bruera, Eduardo 2015-09-01 There are limited data on the effects of financial distress (FD) on overall suffering and quality of life (QOL) of patients with advanced cancer (AdCa). In this cross-sectional study, we examined the frequency of FD and its correlates in AdCa. We interviewed 149 patients, 77 at a comprehensive cancer center (CCC) and 72 at a general public hospital (GPH). AdCa completed a self-rated FD (subjective experience of distress attributed to financial problems) numeric rating scale (0 = best, 10 = worst) and validated questionnaires assessing symptoms (Edmonton Symptom Assessment System [ESAS]), psychosocial distress (Hospital Anxiety and Depression Scale [HADS]), and QOL (Functional Assessment of Cancer Therapy-General [FACT-G]). The patients' median age was 60 years (95% confidence interval [CI]: 58.6-61.5 years); 74 (50%) were female; 48 of 77 at CCC (62%) versus 13 of 72 at GPH (18%) were white; 21 of 77 (27%) versus 32 of 72 (38%) at CCC and GPH, respectively, were black; and 7 of 77 (9%) versus 27 of 72 (38%) at CCC and GPH, respectively, were Hispanic (p functioning, social/family distress, and emotional distress by 45 (30%), 46 (31%), 64 (43%), and 55 (37%) AdCa, respectively (all significantly worse for patients at GPH) (p teams to develop interventions to improve financial distress and its impact on quality of life of advanced cancer patients. ©AlphaMed Press. 106. Recent advances in chemical evolution and the origins of life Science.gov (United States) Oro, John; Lazcano, Antonio 1992-01-01 Consideration is given to the ideas of Oparin and Haldane who independently suggested more than 60 years ago that the first forms of life were anaerobic, heterotrophic bacteria that emerged as the result of a long period of chemical abiotic synthesis of organic compounds. It is suggested that at least some requirements for life are met in the Galaxy due to the cosmic abundance of carbon, nitrogen, oxygen, and other biogenic elements; the existence of extraterrestrial organic compounds; and the processes of stellar and interstellar planetary formation. 107. Level of Knowledge of specialist cardiologists and anesthesiologists in Basic and Advanced Life Support Directory of Open Access Journals (Sweden) Maria Vachla 2013-01-01 Full Text Available Health professionals often witness in-hospital episodes of cardiac arrest. The quality of the Cardiopulmonary Resuscitation (CPR depends on the level of theoretical background and practical skills. Purpose: The aim of the present study was to investigate the level of theoretical knowledge of skilled cardiologists and anesthesiologists in the Basic and Advanced Life Support (BLS/ ALS. Material - method: In this study, sample included 240 cardiologists and anesthesiologists, chosen randomly from employers of 17 General Public Hospitals of Athens. For data collection, a questionnaire with 16 theoretical questions was designed, based on the guidelines of the European Resuscitation Council (ERC 2005. Significance level was set at p=≤0,05. The analysis was performed with the Statistical Package IBM SPSS Statistics 19. Results: No statistically significant difference was observed between specialists cardiologists and anesthesiologists in overall performance in theoretical knowledge on the BLS and ALS. Additionally, no statistical significance was observed between the two separate groups of theoretical background. Statistically significant difference was observed among those who had participated in a training seminar in BLS and ALS and those who had not participated (p<0,001. Also, there was statistical significance between the follow-up seminar in BLS/ ALS and specialty for the right answer to the question "which is the right ratio of chest compressions and ventilation", (p<0,001. Conclusions: The level of background knowledge of specialist cardiologists and anesthesiologists in the algorithms of BLS and ALS seem to correlate to the attendance of a training course. 108. The impact of Advanced Life Support in Obstetrics (ALSO) training in low-resource countries. Science.gov (United States) Dresang, Lee T; González, MarÃa Mercedes Ancheta; Beasley, John; Bustillo, Maura Carolina; Damos, Jim; Deutchman, Mark; Evensen, Ann; de Ancheta, Norma González; Rojas-Suarez, José A; Schwartz, Jonathan; Sorensen, Bjarke L; Winslow, Diana; Leeman, Lawrence 2015-11-01 To examine the effects of the Advanced Life Support in Obstetrics (ALSO) program on maternal outcomes in four low-income countries. Data were obtained from single-center, longitudinal cohort studies in Colombia, Guatemala, and Honduras, and from an uncontrolled prospective trial in Tanzania. In Colombia, maternal morbidity and the number of near misses increased after ALSO training, but maternal mortality decreased. In Guatemala, sustained reductions in overall maternal mortality and mortality from postpartum hemorrhage (PPH) were recorded after ALSO implementation. In Honduras, there was a significant decrease in episiotomy rates, and increases in active management of the third stage of labor (AMTSL), vacuum-assisted delivery, and reported comfort managing obstetric emergencies. In Tanzania, the frequency of PPH and severe PPH decreased after training, while management improved. In low-income countries, ALSO training was associated with decreased in-hospital maternal mortality, episiotomy use, and PPH. AMTSL and vacuumassisted vaginal delivery increased in frequency after ALSO training. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 109. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management Institute of Scientific and Technical Information of China (English) Koorosh Ahmadi; Mohammad Sedaghat; Mahdi Safdarian; Amir Masoud Hashemian; Zahra Nezamdoust; Mohammad Vaseie; Vafa Rahimi-Movaghar 2013-01-01 Since appropriate and timetable methods in trauma care have an important impact on patients' outcome,we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns'performance in simulated trauma patient management.Methods:A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad,Iran.On the first day,we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients.After 2 days of ATLS training,we performed the same study and evaluated their score again on the fourth day.The two findings,preand postATLS periods,were compared through SPSS version 15.0 software.P values less than 0.05 were considered statistically significant.Results:Our findings showed that interns' ability in all the three tasks improved after the training course.On the fourth day after training,there was a statistically significant increase in interns' clinical knowledge of ATLS procedures,the sequence of procedures and skill performance in trauma situations (P<0.001,P=0.016 and P=0.01 respectively).Conclusion:ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns. 110. Life prediction of advanced materials for gas turbine application Energy Technology Data Exchange (ETDEWEB) Zamrik, S.Y.; Ray, A.; Koss, D.A. 1995-12-31 Emphasis is placed on life characterization based on low cycle fatigue under isothermal conditions and thermomechanical fatigue. Microstructure of failed coated and uncoated specimens is being analyzed. IN 738 LC is the material; the coating is either overlay (NiCoCrAly) or NiAl-based aluminide. 111. In-Service Aircraft Engine System Life Monitor Using Advanced Life-Estimating Technique Project Data.gov (United States) National Aeronautics and Space Administration — It is proposed to develop an accurate in-service aircraft engine life monitor system for the prediction of remaining component and system life for aircraft engines.... 112. The Effect of Quality of Work Life on Social Capital in Employees of Shahid Modarres Hospital Directory of Open Access Journals (Sweden) Suri Mashayekhi 2016-03-01 Full Text Available Improvement of quality of work life is one of the most important goals of organization and its employees. Many plans of quality of work life include efforts done to enhance satisfaction and performance of employees through theirintrinsic motivation. The main purpose of this study is identification of effect of quality of work life on social capital in Shahid Modarres Hospital employees. Applied method in this study is descriptive-survey method. For purpose of data collection, two library and field methods have been applied. In order to measure quality of work life,Walton's eight components model is applied and to measure social capital, Putnam model is applied. For this purpose, two standard questionnaires of quality of work life and researcher-made questionnaires of social capital have been applied. Statistical population of the study consists of 390 employees of Shahid Modarres Hospital and 194 people have been selected as sample using limited sampling strategy. In this study, after ensuring that collected data has normal distribution, multivariate regression analysis is applied to investigate research hypotheses. Obtained results from the study indicate that all components of quality of work life have positive effect on social capital and there is significant correlation between them. Finally, required suggestions have been presented. 113. Advanced cancer patients' self-assessed physical and emotional problems on admission and discharge from hospital general ward - a questionnaire study DEFF Research Database (Denmark) Sølver, Lisbeth; Østergaard, Birte; Rydahl Hansen, Susan; 2012-01-01 SOELVER L., OESTERGAARD B., RYDAHL-HANSEN S. & WAGNER L. (2012) European Journal of Cancer Care21, 667-676 Advanced cancer patients' self-assessed physical and emotional problems on admission and discharge from hospital general wards - a questionnaire study Most cancer patients receiving life......-prolonging or palliative treatment are offered non-specialist palliative services. There is a lack of knowledge about their problem profile. The aim of this article is to describe the incidence of patient-reported

physical and emotional problems on admission and discharge from general hospital wards and health staff......-reported problems and reported intervention for physical function, pain, constipation and loss of appetite. Palliative cancer patients' self-reported problem profile on admission and discharge from hospital has not previously been described and the results indicate a need to focus on improvements to palliative... 114. Life Change Units (LCU) rating as stressors in Iranian hospitals' nurses. Science.gov (United States) Dargahi, Hossein; Shaham, Golsa 2012-01-01 Healthcare workers suffer from work-related or occupational stress. This can lead to severe distress, burnout or physical illness, and finally to decrease quality of work life and services provision. Nurses must be aware of retential stressors, because they add to the cumulative effect of other stressful events. Holmes and Rahe both found a relationship between life change unit as stressors and health changes. This research reported here aims to measure the life change units as stressors among Iranian Hospitals Nurses by LCU rating. A cross - sectional, descriptive and analytical study was conducted among 389 nurses working in 15 teaching hospitals in Tehran, Iran. The respondents were asked to select each of 54 events that cause stress ranked in order of their life change units developed by Holmes and Rahe as stress scale. Before beginning the main study, the reliability and coincidental validity was performed. All data were analyzed using SPSS for windows version 18, t-test, Anova statistical methods. Approximately, half of the nurses associated major mortgage, foreclosure of mortgage or loan. More than 50% of the Iranian nurses had 150-300 and more than 300 LCU rating which had the chance to expose to extremely serious risk to health.Iranian hospitals nurses suffer from stress that caused by Life Change Units organizational factors such as change in the financial state, change in the work environment and major mortgage. We recommend to Iranian nursing policy-makers to choose strategies to help nurses' cope effectively with workplace stressors. Nursing managers and / or nursing management should develop strategies to address and improve the quality of working conditions for nurses in the hospitals. Providing educational and career prospects can contribute to decrease nurses' occupational stress level, the maintaining their work ability. 115. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims OpenAIRE Gholipour, Changiz; Vahdati, Samad Shams; NOTASH, Mehdi; MIRI, Seyed Hassan; Ghafouri, Rouzbeh Rajaei 2016-01-01 SUMMARY Objectives Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a s... 116. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims OpenAIRE Gholipour, Changiz; Vahdati, Samad Shams; NOTASH, Mehdi; MIRI, Seyed Hassan; Ghafouri, Rouzbeh Rajaei 2016-01-01 SUMMARY Objectives Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a s... 117. Life cycle assessment of advanced waste water treatment DEFF Research Database (Denmark) Larsen, Henrik Fred; Hansen, Peter Augusto .g. pharmaceuticals, heavy metals and endocrine disrupters). As part of this work a holistic based prioritisation among technologies and optimisations is to be done. Tools for this prioritisation include life cycle assessment (LCA) and cost/efficiency. The LCA is performed as a comparative LCA and the concept...... of induced impacts as compared to avoided impacts is introduced in the life cycle impact assessment (LCIA) part. Furthermore, as novel approaches, potential ecotoxicity impact from a high number of micropollutants and the potential impact from pathogens (and whole effluent toxicity) are to be included......The EU FP6 NEPTUNE project is related to the EU Water Framework Directive and the main goal is to develop new and optimize existing waste water treatment technologies (WWTT) and sludge handling methods for municipal waste water. Besides nutrients, a special focus area is micropollutants (e... 118. How trained volunteers can improve the quality of hospital care for older patients. A qualitative evaluation within the Hospital Elder Life Program (HELP) NARCIS (Netherlands) Steunenberg, Bas; van der Mast, Roos; Strijbos, Marije J.; Inouye, Sharon K.; Schuurmans, Marieke J. 2016-01-01 The aim of this study was to investigate, using a mixed-methods design, the added value of a trained Hospital Elder Life Program (HELP) volunteer to the quality of hospital care in the Netherlands. The trained volunteers daily stimulate older patients, at risk of a delirium, to eat, to drink, and to 119. Barcode of life: Advancing species identification and discovery Digital Repository Service at National Institute of Oceanography (India) Chandramohan, D. approach overlooks morphologically cryptic taxa, which are seen very commonly in many groups. 3. Since morphological keys are often effective only for a particular life stage or gender, many individuals in their early stages of development can...-based identification systems and the dwindling pool of taxonomists highlight the need for alternate methods for species identification which should be quick, cost effective and efficient. DNA barcoding emerges as a most favoured alternate method by the researchers... 120. Life prediction of advanced materials for gas turbine application Energy Technology Data Exchange (ETDEWEB) Zamrik, S.Y.; Ray, A.; Koss, D.A. [Pennsylvania State Univ., University Park, PA (United States) 1995-10-01 Most of the studies on the low cycle fatigue life prediction have been reported under isothermal conditions where the deformation of the material is strain dependent. In the development of gas turbines, components such as blades and vanes are exposed to temperature variations in addition to strain cycling. As a result, the deformation process becomes temperature and strain dependent. Therefore, the life of the component becomes sensitive to temperature-strain cycling which produces a process known as {open_quotes}thermomechanical fatigue, or TMF{close_quotes}. The TMF fatigue failure phenomenon has been modeled using conventional fatigue life prediction methods, which are not sufficiently accurate to quantitatively establish an allowable design procedure. To add to the complexity of TMF life prediction, blade and vane substrates are normally coated with aluminide, overlay or thermal barrier type coatings (TBC) where the durability of the component is dominated by the coating/substrate constitutive response and by the fatigue behavior of the coating. A number of issues arise from TMF depending on the type of temperature/strain phase cycle: (1) time-dependent inelastic behavior can significantly affect the stress response. For example, creep relaxation during a tensile or compressive loading at elevated temperatures leads to a progressive increase in the mean stress level under cyclic loading. (2) the mismatch in elastic and thermal expansion properties between the coating and the substrate can lead to significant deviations in the coating stress levels due to changes in the elastic modulii. (3) the {open_quotes}dry{close_quotes} corrosion resistance coatings applied to the substrate may act as primary crack initiation sites. Crack initiation in the coating is a function of the coating composition, its mechanical properties, creep relaxation behavior, thermal strain range and the strain/temperature phase relationship. « 4 5 6 7 8 » « 5 6 7 8 9 » 121. Elimination of pharmaceutical residues in biologically pre-treated hospital wastewater using advanced UV irradiation technology: A comparative assessment Energy Technology Data Exchange (ETDEWEB) Koehler, C., E-mail: [email protected] [Public Research Centre Henri Tudor/Resource Centre for Environmental Technologies, 66 rue de Luxembourg, BP 144, L-4002 Esch-sur-Alzette (Luxembourg); Venditti, S.; Igos, E.; Klepiszewski, K.; Benetto, E.; Cornelissen, A. [Public Research Centre Henri Tudor/Resource Centre for Environmental Technologies, 66 rue de Luxembourg, BP 144, L-4002 Esch-sur-Alzette (Luxembourg) 2012-11-15 UV irradiation technology as a membrane bioreactor (MBR) post-treatment was investigated and assessed. Both UV low pressure (LP) and medium pressure (MP) lamps were examined. The technology was installed in a pilot plant treating hospital wastewater to provide the study with adequate field data. The effect of the UV irradiation was enhanced with varying dosages of H{sub 2}O{sub 2} to establish an advanced oxidation process (AOP). The efficiency of the pharmaceutical removal process was assessed by examining 14 micropollutants (antibiotics, analgesics, anticonvulsants, beta-blockers, cytostatics and X-ray contrast media) which are typically released by hospitals and detected with liquid chromatography coupled tandem mass spectrometry (LC-MS/MS). While the MBR treatment generally showed only a low degradation capacity for persistent pharmaceuticals, much better degradation was obtained by applying UV irradiation and H{sub 2}O{sub 2} as AOP. The 'conventional' cost-benefit analysis of the different technology options taking into account both electrical energy consumption and pharmaceutical removal efficiency, revealed clearly better performance of low pressure UV lamps as AOP. However, a holistic comparison between the different scenarios was carried out by evaluating their environmental impacts using the life cycle assessment (LCA) methodology. Decisive advantages were highlighted to include this approach in the decision making process. 122. [Subjective Workload, Job Satisfaction, and Work-Life-Balance of Physicians and Nurses in a Municipal Hospital in a Rural Area Compared to an Urban University Hospital]. Science.gov (United States) Körber, Michael; Schmid, Klaus; Drexler, Hans; Kiesel, Johannes 2017-02-15 Medical and nursing shortages in rural areas represent a current serious public health problem. The healthcare of the rural population is at risk. This study compares perceived workload, job satisfaction and work-life balance of physicians and nurses at a clinic in a rural area with two clinics of a University hospital. Physicians and nurses were interviewed anonymously with a standardized questionnaire (paper and pencil), including questions on job satisfaction, subjective workload and work-life balance. The response rate was almost 50% in the University hospital as well as in the municipal hospital. 32 physicians and 54 nurses from the University hospital and 18 physicians and 137 nurses from the municipal hospital participated in the survey. Nurses at the University hospital assessed the organization of the daily routine with 94.1% as better than those at the municipal hospital (82.4%, p=0.03). Physicians at the University hospital were able to better implement acquired knowledge at a University clinic with 87.5% than their counterparts at the municipal hospital (55.5%, p=0.02). In contrast to their colleagues at the municipal hospital, only 50% of the physicians at the University hospital subjectively considered their workload as just right (83.3% municipal, p=0.02). 96.9% of the physicians at the University hospital were "daily" or "several times a week" under time pressure (municipal 50%, pwork and family life (62.9% University hospital, 72.8% Municipal hospital). In contrast, only 20% of the physicians at the University Hospital but 42.9% of the physicians of the municipal hospital had sufficient opportunities to balance workload and family (p=0.13). The return rate of almost 50% can be described as good. Due to the small number of physicians, especially from the municipal hospital, it can be assumed that some interesting differences could not be detected. There were only slight differences between the nurses from the two hospitals. In contrast, subjective 123. Globular Clusters as Cradles of Life and Advanced Civilizations Science.gov (United States) Di Stefano, R.; Ray, A. 2016-08-01 Globular clusters are ancient stellar populations in compact dense ellipsoids. There is no star formation and there are no core-collapse supernovae, but several lines of evidence suggest that globular clusters are rich in planets. If so, and if advanced civilizations can develop there, then the distances between these civilizations and other stars would be far smaller than typical distances between stars in the Galactic disk, facilitating interstellar communication and travel. The potent combination of long-term stability and high stellar densities provides a globular cluster opportunity. Yet the very proximity that promotes interstellar travel also brings danger, as stellar interactions can destroy planetary systems. We find, however, that large portions of many globular clusters are “sweet spots,†where habitable-zone planetary orbits are stable for long times. Globular clusters in our own and other galaxies are, therefore, among the best targets for searches for extraterrestrial intelligence (SETI). We use the Drake equation to compare the likelihood of advanced civilizations in globular clusters to that in the Galactic disk. We also consider free-floating planets, since wide-orbit planets can be ejected to travel through the cluster. Civilizations spawned in globular clusters may be able to establish self-sustaining outposts, reducing the probability that a single catastrophic event will destroy the civilization. Although individual civilizations may follow different evolutionary paths, or even be destroyed, the cluster may continue to host advanced civilizations once a small number have jumped across interstellar space. Civilizations residing in globular clusters could therefore, in a sense, be immortal. 124. Life cycle assessment of advanced waste water treatment DEFF Research Database (Denmark) Larsen, Henrik Fred; Hansen, Peter Augusto . In total more that 20 different waste water and sludge treatment technologies are to be assessed. This paper will present the preliminary LCA results from running the induced versus avoided impact approach (mainly based on existing LCIA methodology) on one of the advanced treatment technologies, i......The EU FP6 NEPTUNE project is related to the EU Water Framework Directive and the main goal is to develop new and optimize existing waste water treatment technologies (WWTT) and sludge handling methods for municipal waste water. Besides nutrients, a special focus area is micropollutants (e... 125. Predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge. Science.gov (United States) Johari, Nuruljannah; Manaf, Zahara Abdul; Ibrahim, Norhayati; Shahar, Suzana; Mustafa, Norlaila 2016-01-01 Diabetes mellitus is prevalent among older adults, and affects their quality of life. Furthermore, the number is growing as the elderly population increases. Thus, this study aims to explore the predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge in Malaysia. A total of 110 hospitalized geriatric patients aged 60 years and older were selected using convenience sampling method in a cross-sectional study. Sociodemographic data and medical history were obtained from the medical records. Questionnaires were used during the in-person semistructured interviews, which were conducted in the wards. Linear regression analyses were used to determine the predictors of each domain of quality of life. Multiple regression analysis showed that activities of daily living, depression, and appetite were the determinants of physical health domain of quality of life (R(2)=0.633, F(3, 67)=38.462; Ppsychological domain (R(2)=0.558, F(2, 68)=42.953; Pdiabetes mellitus. Nutritional, functional, and psychological aspects should be incorporated into rehabilitation support programs prior to discharge in order to improve patients' quality of life. 126. Improving hospital food: Evaluating the impact of the Soil Association Food for Life programme OpenAIRE Gray, S.; Means, R.; Orme, J.; Pitt, H.; Jones, M.; Salmon, D. 2015-01-01 Food for Life (FFL) is an initiative which aims to encourage a healthy, sustainable food culture in communities, and is led by the Soil Association (SA), a UK charity. Thanks to a Big Lottery Fund grant, FFL have been able to develop the programme within hospitals. The Soil Association (SA) also runs the Food for Life Catering Mark scheme that provides an independent endorsement that food providers are taking steps to improve the food they serve, using fresh ingredients which are free from un... 127. Globular Clusters as Cradles of Life and Advanced Civilizations CERN Document Server Di Stefano, R 2016-01-01 Globular clusters are ancient stellar populations with no star formation or core-collapse supernovae. Several lines of evidence suggest that globular clusters are rich in planets. If so, and if advanced civilizations can develop there, then the distances between these civilizations and other stars would be far smaller than typical distances between stars in the Galactic disk. The relative proximity would facilitate interstellar communication and travel. However, the very proximity that promotes interstellar travel also brings danger, since stellar interactions can destroy planetary systems. However, by modeling globular clusters and their stellar populations, we find that large regions of many globular clusters can be thought of as "sweet spots" where habitable-zone planetary orbits can be stable for long times. We also compute the ambient densities and fluxes in the regions within which habitable-zone planets can survive. Globular clusters are among the best targets for searches for extraterrestrial intellig... 128. Health-related quality of life assessment in Serbian schoolchildren hospitalized for malignant disease Directory of Open Access Journals (Sweden) Nedović Goran 2013-01-01 Full Text Available Background/Aim. Although long-term survival of childhood cancer patients is significantly improved, prolonged treatment and hospitalization might have negative impacts on child development. The aim of this study was to verify profile of health-related quality of life parameters in population of schoolchildren during hospitalization and treatment for malignant disease. Methods. The Serbian version of Pediatric Quality of Life Inventory Version 4.0 (PedsQLTM4.0 Generic Core Scales was applied. A total of 120 schoolchildren were analyzed: 60 patients hospitalized for prolonged malignant disease treatment and 60 healthy schoolchildren from public schools. The study was done at the Institute for Oncology and Radiology of Serbia, as well as in four schools. Results. Generally, schoolchildren hospitalized for cancer treatment demonstrated lower scores on physical, emotional, social and school functioning when compared to healthy schoolchildren from regular public schools. Significant differences were observed for all the 8 items of the Physical Health Scale, in 2 out of 5 items of the Emotional Functioning Scale, in 4 out of 5 items of the Social Functioning Scale, and 3 out of 5 items of the School Functioning Scale. Conclusions. The Serbian version of PedsQLTM 4.0 Generic Core Scales could be successfully used to evaluate physical, emotional, social and school functioning of hospitalized children and adolescent. Schoolchildren hospitalized for prolonged tumor treatment have poorer HRQOL scores compared to general healthy population, however the level of remaining physical, emotional and social parameters should provide solid foundation for their potential rehabilitation, education and inclusion. 129. Efficacy of a simple and inexpensive exercise training program for advanced chronic obstructive pulmonary disease patients in community hospitals. Science.gov (United States) Pothirat, Chaicharn; Chaiwong, Warawut; Phetsuk, Nittaya 2015-04-01 Exercise training is an important part of pulmonary rehabilitation; however it may not be appropriate for large-scale practice in community hospitals due to the complexity of the program and expensive training equipment, including cycle ergometry and treadmills. This study therefore aims to evaluate the efficacy of a more simplified exercise training program with inexpensive training equipment. A multicentre study of a mild to moderate intensity exercise training program was conducted based on incremental strength and endurance with two 35-40-minute sessions per week for 8 weeks. The program was performed by 30 outpatients from five community hospitals. Patients were monitored regularly for various parameters including strength of trained muscles, level of dyspnea, 6-minute walk distance, and quality of life (QoL) at baseline at 1, 2, 3, 6, 9 and 12 months. Unpaired t-tests were applied to determine the progress of trained muscle strength and minimal clinically important differences (MCIDs) were used to assess clinical outcomes. Thirty patients (13 males, 17 females) were enrolled with a mean age of 69.1±8.9 years, body mass index 20.5±4.4 kg/m(2), and mean % of predicted forced expiratory volume in the first second (FEV1) 45.1±10.8. According to GOLD classification, eight (26.7%) cases were in stage II, 20 (66.7%) cases in stage III, and two (6.6%) cases in stage IV. Limb and chest wall muscle strength, dyspnea level, exercise capacity and QoL showed statistically significant improvements throughout the 12-month follow-up (Pprogram was shown to be effective for advanced chronic obstructive pulmonary disease patients in community hospitals. 130. [Development and Hosting of a Perioperative Advanced Life Support Training Course for Anesthesiologists]. Science.gov (United States) Komasawa, Nobuyasu; Fujiwara, Shunsuke; Haba, Masanori; Ueshima, Hironobu; Okada, Daisuke; Minami, Toshiaki 2015-05-01 Participation in the American Heart Association advanced cardiac life support provider course is a prerequisite for taking the anesthesiology specialist examination in Japan. The course teaches fundamental resuscitation methods for different types of cardiac arrest. However, crisis in the perioperative period can result from airway trouble, central venous catheter displacement, or massive hemorrhage. We report our experience of holding a problem- and learning-based perioperative advanced life support training course, Advanced Life Support for Operation (ALS-OP). Main contents of the course included circulation management, airway management central venous catheters, and pain clinic-related complications. ALS-OP simulation training may be beneficial for educating anesthesiologist and promoting perioperative patient safety. 131. [Life experiences of Korean patients with Hansen's disease in Sorok Island Hospital]. Science.gov (United States) Yang, Ya Ki 2014-12-01 The purpose of this study was to identify life experiences of Korean patients with Hansen's disease (leprosy). For this study, 5 participants from Sorok Island Hospital were purposively chosen. Data were collected through in-depth individual interviews from June to July 2014. Data analysis method was based on Colaizzi's approach. The study results showed that experiences of patients with Hansen's disease consisted of 14 themes and six theme clusters: 1) Bad disease approaching as fate; 2) Family breakup and far from the village; 3) New life in Sorok Island Hospital; 4) Treatment of Hansen's disease and disability; 5) Life in the disease community; 6) Comfort and hope of life. The findings of this study indicate that health care professionals should pay attention to patients with Hansen's disease not only to reduce their physical and psychological suffering, but also to help the community and public culture to reduce the social stigma surrounding this disease and causing suffering for the patients. The results of the present study can help us to have a better understanding of various aspects of patients' lived experiences. 132. Adherence and Quality of Life of Hypertension Patients in Gunung Jati Hospital, Cirebon, Indonesia Directory of Open Access Journals (Sweden) Dyah A.Perwitasari 2015-12-01 Full Text Available The treatment effectiveness of hypertension could be influenced by patients’ characteristics and patients’ adherence with medication. Besides reaching

the goal of blood pressure decrease after the treatment, their quality of life has become the main concern regarding effectiveness of hypertension treatment. This study aimed to explore the hypertension patients’ adherence and quality of life. In addition, it was studied which factors associated with adherence and quality of life in hypertension patients treated with antihypertensive at Gunung Jati Hospital, Cirebon. We recruited 85 adult hypertension patients who were treated with antihypertensive agents for at least 6 months. The patients’ adherence was measured by Medication Adherence Report Scale and the patients’ quality of life was measured by Indonesian version of Short Form-36 questionnaire. The patients’ adherence was found as 24.03 (SD: 1.98 and there were no significant differences of patients’ adherence using monotherapy and combination therapy. The patients’ characteristics such as, age, gender and education level could not predict patients’ adherence (p>0.05. The average of Physical Component Summary (PCS and Mental Component Summary (MCS were 43.35 (SD: 9.4 and 52.13 (SD:5.59. Age and gender may predict PCS, however, education and comorbidity may predict MCS (p<0.05. Hypertension patients’ adherence in Gunung Jati hospital is good. The PCS and MCS scores in this study are comparable to the other previous studies. The patients’ characteristic could not be the predictor of patients’ adherence. 133. Advancing Integrated Systems Modelling Framework for Life Cycle Sustainability Assessment Directory of Open Access Journals (Sweden) Anthony Halog 2011-02-01 Full Text Available The need for integrated methodological framework for sustainability assessment has been widely discussed and is urgent due to increasingly complex environmental system problems. These problems have impacts on ecosystems and human well-being which represent a threat to economic performance of countries and corporations. Integrated assessment crosses issues; spans spatial and temporal scales; looks forward and backward; and incorporates multi-stakeholder inputs. This study aims to develop an integrated methodology by capitalizing the complementary strengths of different methods used by industrial ecologists and biophysical economists. The computational methodology proposed here is systems perspective, integrative, and holistic approach for sustainability assessment which attempts to link basic science and technology to policy formulation. The framework adopts life cycle thinking methods—LCA, LCC, and SLCA; stakeholders analysis supported by multi-criteria decision analysis (MCDA; and dynamic system modelling. Following Pareto principle, the critical sustainability criteria, indicators and metrics (i.e., hotspots can be identified and further modelled using system dynamics or agent based modelling and improved by data envelopment analysis (DEA and sustainability network theory (SNT. The framework is being applied to development of biofuel supply chain networks. The framework can provide new ways of integrating knowledge across the divides between social and natural sciences as well as between critical and problem-solving research. 134. Beyond advance directives: importance of communication skills at the end of life. Science.gov (United States) Tulsky, James A 2005-07-20 Patients and their families struggle with myriad choices concerning medical treatments that frequently precede death. Advance directives have been proposed as a tool to facilitate end-of-life decision making, yet frequently fail to achieve this goal. In the context of the case of a man with metastatic cancer for whom an advance directive was unable to prevent a traumatic death, I review the challenges in creating and implementing advance directives, discuss factors that can affect clear decision making; including trust, uncertainty, emotion, hope, and the presence of multiple medical providers; and offer practical suggestions for physicians. Advance care planning remains a useful tool for approaching conversations with patients about the end of life. However, such planning should occur within a framework that emphasizes responding to patient and family emotions and focuses more on goals for care and less on specific treatments. 135. In-hospital organization of primary care of patients presenting a life-threatening emergency: A French national survey in 32 university hospitals. Science.gov (United States) Quintard, Hervé; Severac, Mathilde; Martin, Claude; Ichai, Carole 2015-08-01 The development of specialized units dedicated to life-threatening management has demonstrated to improve the prognosis of patients requiring such treatments. However, apart those focused on trauma and stroke, networks are still lacking in France. Despite, the implementation of standardisation of practices and guidelines, particularly in prehospital care, inhospital clinical practices at admission remain heterogenous. This survey aimed to assess the structural and human organization of teaching hospitals in France concerning the primary in-hospital care for critically ill patients. A questionnaire of 45 items was sent by e-mail to 32 teaching hospitals between January and March 2013. It included information related to the description of the emergency department, of ICUs, and both structural and human organizations for primary in-hospital care of life-threatening patients. Seventy-five percent of teaching hospitals answered to the survey. Seven hundred to 1400 patients were admitted to emergency units per week and among them 10 to 20 were admitted for critically ill conditions. These latter were addressed in a specialized room of the emergency unit (Service d'admission des urgences vitales [SAUV]) in 40% of hospitals and in specialized room in ICU in 18% of cases. Intensivists were involved in 50% of hospitals, emergency physicians in 26% and it was mixed in 24% of hospitals. This survey is the first to assess the inhospital organization of primary care for instable and life-threatening patients in France. Our results confirmed the extreme heterogeneity of structural and human organizations for primary in-hospital care of patients presenting at least one organ failure. Thus, a consensus is probably needed to homogenize and improve our practices. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved. 136. The management of subjective quality of life by short-stay hospital patients: An exploratory study Directory of Open Access Journals (Sweden) Karlinski Evelyn 2003-09-01 Full Text Available Abstract Background This study tested the homeostatic model of subjective quality of life in a group of 47 short stay patients as they progressed through the stages of hospitalization for surgery. Method Participants completed a questionnaire measuring subjective quality of life, positive and negative affect, self-esteem, optimism and cognitive flexibility, the day prior to admission (T1, two days post-operation (T2 and one week after discharge (T3. Neuroticism and Extroversion were measured at Time 1. Results All variables remained stable across the three times, apart from positive affect, which dropped significantly post-operation but returned to its previous level post discharge. Conclusion Although the homeostatic model of subjective quality of life was supported at Time 1, the analyses raise doubts about the stability of personality. This finding is consistent with recent discussions of personality. 137. Psychological symptoms and quality of life of dermatology outpatients and hospitalized dermatology patients DEFF Research Database (Denmark) Zachariae, Robert; Zachariae, Claus; Ibsen, Hans Henning 2004-01-01 The aim of the investigation was to compare psychological symptoms and health-related quality of life of dermatology patients and healthy controls. The sample consisted of 333 consecutively recruited patients from four dermatology outpatient clinics, 172 hospitalized dermatological patients from...... and older patients, and patients with atopic dermatitis and psoriasis were more distressed than patients with urticaria and eczemas. Disease-related impairment of quality of life was the main predictor of psychological symptoms, when controlling for diagnosis, age, gender, disease duration and disease...... severity. Although older age was associated with fewer psychological symptoms, our data suggest that skin disease affects quality of life equally in young and older patients. The findings highlight the importance of recognizing disease-related psychological problems and possible psychiatric comorbidity... 138. PREVALENCE AND QUALITY OF LIFE OF PEMPHIGUS PATIENTS AT SANGLAH GENERAL HOSPITAL BALI-INDONESIA Directory of Open Access Journals (Sweden) M Wardhana 2013-01-01 Full Text Available Objectives: Pemphigus vulgaris (PV is an autoimmune-blistering disease of the skin and mucous membranes caused by auto-antibodies against desmoglein-3 (Dsg-3 on the keratinocyte cell surface of squamous stratified epithelia. Pemphigus is a life-threatening autoimmune bullous disease resulting in the widespread denudation of skin and mucous membrane and severe impact of quality of life. Thepurpose of this study was to evaluate retrospectively the prevalence of pemphigus and to elucidate the clinical variants, clinical course, prognosis and quality of life (QOL of pemphigus patients after discharge from hospitalized.Method: Observational non analytical retrospective study was conducted by observation of the medical records of all the newly registered patients with pemphigus at SanglahGeneral Hospital in Bali-Indonesia during the period of January 1995 and December 2002, and analyzed with regard to personal statistic, history of the diseases including onset, site of affected, symptoms, clinical diagnosis, severity, associated illness, therapy, and quality of life based on theFinlay’s methods.Results: During the 8-year periods studies, 33 pemphigus patients were admitted, represented 5.8 % of all patients admitted in our in-patient ward during the periods. Our patients consist of female 20 patients (60.6 % and male 13 patients (39.4 %. The most common of clinicaltype was pemphigus vulgaris 26 patients (78.78 %, followed by pemphigus foleaceous and pemphigus vegetans. Six patients (18.18 % of 16 severe patients with severe condition at the clinical course of the diseases was death during the course of hospitalized. A number of 2 patients, in thisstudy were observed with severe impact of quality of life.Conclusion: Our finding showed that pemphigus vulgaris is common type of our cases has a relatively high prevalence our hospital (5.8 %, and relatively high death rate (18.18 %. In our study, systemic corticosteroid was still applied 139. Quality of life among dentists in teaching hospitals in South Canara, India Directory of Open Access Journals (Sweden) Dolar Doshi 2011-01-01 Full Text Available Objectives : This paper reports on the quality of life among dentists using World Health Organization Abbreviated Instrument for Quality of Life Assessment, comprising 26 items which measure the following broad domains: Physical health, psychological health, social relationships, and environment. Materials and Methods : The instrument was self-administered among dentists in four teaching dental institutions. A total of 191 questionnaires were given out. Of those, 187 were consented and answered, making up a response rate of 97.9%. The internal consistency of the questionnaire, measured by Cronbach′s alpha was estimated at 0.75. Results : Highest mean score was seen for Domain 3 (Social relationships (16.15 + 2.38 and the least score was for Domain 4 (Environment (14.72 + 2.12. Higher proportions of respondents rated their quality of life as good (65.1 percent, and also majority of dentists (63.5 percent were satisfied with their health. Conclusion : Quality of life recognizes the value of an individual′s health in the broader psychologic and social aspects of his/her life. In this study, the overall rating of quality of life among dentists in teaching hospitals is good. 140. DAWN (Design Assistant Workstation) for advanced physical-chemical life support systems Science.gov (United States) Rudokas, Mary R.; Cantwell, Elizabeth R.; Robinson, Peter I.; Shenk, Timothy W. 1989-01-01 This paper reports the results of a project supported by the National Aeronautics and Space Administration, Office of Aeronautics and Space Technology (NASA-OAST) under the Advanced Life Support Development Program. It is an initial attempt to integrate artificial intelligence techniques (via expert systems) with conventional quantitative modeling tools for advanced physical-chemical life support systems. The addition of artificial intelligence techniques will assist the designer in the definition and simulation of loosely/well-defined life support processes/problems as well as assist in the capture of design knowledge, both quantitative and qualitative. Expert system and conventional modeling tools are integrated to provide a design workstation that assists the engineer/scientist in creating, evaluating, documenting and optimizing physical-chemical life support systems for short-term and extended duration missions. « 5 6 7 8 9 » « 6 7 8 9 10 » 141. Clinical outcomes of primary palatoplasty in pre-school-aged cleft palate children in Srinagarind hospital: quality of life. Science.gov (United States) Pradubwong, Suteera; Mongkholthawornchai, Siriporn; Keawkhamsean, Natda; Patjanasoontorn, Niramol; Chowchuen, Bowornsilp 2014-10-01 Cleft lips and cleft palates are common congenital anomalies, which affects facial appearance, speech, hearing, teeth alignment and other structures. Craniofacial anomalies and speech disorders are crucial problems in the preschool-aged children (5-6 years old), when they start attending school and become more engaged in the community. This condition, which differentiates them from other students, can lead to teasing or mocking which can cause low-self esteem, an inferiority complex, andfoster bad relationships with friends. Missing class in order to receive treatment and other additional care can affect a student's learning, development and overall-quality of life. The purpose of this research was to study the quality of life in preschool-aged cleftpalate children and satisfaction with their level of speech. This was a retrospective, descriptive study. The data were collected by reviewing medical records of patients with cleft lip and cleft palate aged 5-6 years old who underwent operation and treatment with the Tawanchai Center at Srinagarind Hospital. There were 39patients in this study. Data collection was conducted for 5 months (June to October 2013). The research instruments were: (1) General Demographic Questionnaire, (2) Quality of Life Questionnaire with 5 Domains, and (3) the Satisfaction of Speech Questionnaire. The descriptive statistics, percentages and the standard deviation were analyzed in the present study. The findings revealedfamily information pertaining to CLP treatment and the impact it has on consumption, speech training, hearing test, development, dental treatment, communication skills, participation, referral treatment as well as the quality ofcoordinationfor advanced treatment. The present study revealed that all ofthe aforementioned criteria were met at a high level. Moreover the child's sickness had only a moderate impact on family life. In conclusion, the overall satisfaction was at a very high level. It was concluded that the 142. Advanced life events (ALEs) that impede aging-in-place among seniors. Science.gov (United States) Lindquist, Lee A; Ramirez-Zohfeld, Vanessa; Sunkara, Priya; Forcucci, Chris; Campbell, Dianne; Mitzen, Phyllis; Cameron, Kenzie A 2016-01-01 Despite the wishes of many seniors to age-in-place in their own homes, critical events occur that impede their ability to do so. A gap exists as to what these advanced life events (ALEs) entail and the planning that older adults perceive is necessary. The purpose of this study was to identify seniors' perceptions and planning toward ALEs that may impact their ability to remain in their own home. We conducted focus groups with 68 seniors, age ≥65 years (mean age 73.8 years), living in the community (rural, urban, and suburban), using open-ended questions about perceptions of future heath events, needs, and planning. Three investigators coded transcriptions using constant comparative analysis to identify emerging themes, with disagreements resolved via consensus. Subjects identified five ALEs that impacted their ability to remain at home: (1) Hospitalizations, (2) Falls, (3) Dementia, (4) Spousal Loss, and (5) Home Upkeep Issues. While recognizing that ALEs frequently occur, many subjects reported a lack of planning for ALEs and perceived that these ALEs would not happen to them. Themes for the rationale behind the lack of planning emerged as: uncertainty in future, being too healthy/too sick, offspring influences, denial/procrastination, pride, feeling overwhelmed, and financial concerns. Subjects expressed reliance on offspring for navigating future ALEs, although many had not communicated their needs with their offspring. Overcoming the reasons for not planning for ALEs is crucial, as being prepared for future home needs provides seniors a voice in their care while engaging key supporters (e.g., offspring). 143. Health related quality of life and care dependency among elderly hospital patients: an international comparison. Science.gov (United States) Dijkstra, Ate; HakverdioÄŸlu, Gülendam; Muszalik, Marta; Andela, Richtsje; Korhan, Esra Akın; KÄ™dziora-Kornatowska, Kornelia 2015-01-01 Many countries in Europe and the world have to cope with an aging population. Although health policy in many countries aims at increasing disability-free life expectancy, elderly patients represent a significant proportion of all patients admitted to different hospital departments. The aim of the research was to investigate the relationship between health-related quality of life (HRQOL) and the care dependency status among elderly hospital patients. In 2012, a descriptive survey was administered to a convenience sample of 325 elderly hospital patients (> 60 years) from The Netherlands (N = 125), from Poland (N = 100), and from Turkey (N = 100). We employed the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System and the Care Dependency Scale. FACIT is a collection of HRQOL questionnaires that assess multidimensional health status in people with various chronic illnesses. From demographic variables, gender (female) (r = -0.13, p Poland and Turkey) and functional wellbeing (The Netherlands) are significantly associated with the decrease in care dependency status. Thus, the FACIT variables are the most powerful indicators for care dependency. The study provides healthcare professionals insight into improvement of quality of care in all three countries. 144. QUALITY OF LIFE IN PATIENTS HOSPITALIZED WITH HEART FAILURE: A NOVEL TWO QUESTIONNAIRE STUDY Directory of Open Access Journals (Sweden) Z. N. Hatmi 2007-09-01 Full Text Available Heart failure (HF is a common disease with high health care costs and high mortality rate Knowledge of the health-related quality of life (QOL outcomes of HF may guide decision making and be useful in assessing new therapies for population. Yet little is known about QOL of HF patients in Iran. Objectives: To assess health related QOL of patients with HF with two different instrument and to correlate these two measures and to assess the role of relevant factors. Analytic cross sectional study was conducted involving 230 adult patients hospitalized with HF, demographic data and health -related quality of life were determined by interview; for assessing of quality of life was used SF-36 and Minnesota questionnaires. Simple random sampling from ward patients list choose patients. Patients had no other man diseases that affected their quality of life. Results: 118 female (53.3% and 112 male (48.7% with mean age of 51.4 +/-13.18 were collected. 61 patients (26.5% were smoker and 100 patients (43.5% had positive familial hearth disease history. Quality of life in some subscale: Physical functioning, Role physical and vitality, and Minnesota scare affected from patients age. Male patients had better quality of life than female in Minnesota scale and physical functioning, body pain, general health, vitality and emotional well-being. Duration of diagnosis affected Minnesota scale and role physical. Positive familial heart disease history affected physical functioning. Iranian patients have worse quality of life than other patients. This shows patients age, sex, duration of diagnosis, smoking and positive familial hearth disease history affected quality of life in heart failure patients. 145. Exploring the opinion of CKD patients on dialysis regarding end-of-life and Advance Care Planning. Science.gov (United States) Sánchez-Tomero, J A; RodrÃguez-Jornet, A; Balda, S; Cigarrán, S; Herrero, J C; Maduell, F; MartÃn, J; Palomar, R 2011-01-01 Advance care planning (ACP) and the subsequent advance directive document (ADD), previously known as "living wills", have not been widely used in Spain. The Ethics Group from the Spanish Society of Nephrology has developed a survey in order to investigate the opinion of dialysis patients regarding the ADD and end-of-life care. Patients received documentation explaining ACP and filled out a survey about their familiarity with and approval of the ADD. Seven hospital dialysis centres participated in the study for a total of 416 active dialysis patients. Questionnaires were distributed to 263 patients, 154 of which answered (69.2% completed them without assistance). The rates for ADD implementation (7.9%) and designation of a representative person (6.6%) were very low. Most of the patients clearly expressed their wishes about irreversible coma, vegetative state, dementia and untreatable disease. More than 65% did not want mechanical ventilation, chronic dialysis, tube feeding or resuscitation if cardiorespiratory arrest occurred. They reported that an ADD could be done before starting dialysis but most thought that it should be offered only to those who requested it (65% vs 34%). In conclusion, patients have clear wishes about end-of-life care, although these desires had not been documented due to the very low implementation of the ADD. 146. Poverty and violence, frustration and inventiveness: hospital ward life in Bangladesh. Science.gov (United States) Zaman, Shahaduz 2004-11-01 An ethnographic exploration was done in an orthopaedic ward of a government teaching hospital in Bangladesh to understand the nature of hospital culture in the context of Bangladeshi society at large. Life and work in the ward result in a culture that is simultaneously created by its inhabitants and the conditions in which they are situated. The study shows that biomedicine is a product of particular social conditions and that the hospital reflects features of its society. Behind the injuries and broken limbs in the ward are stories of violence, crime, and intolerance occurring in a society where masses of people fight over limited resources. In the ward people interact in an extremely hierarchical manner. The patients, who are mainly from poor economic backgrounds, remain at the bottom of the hierarchy. Doctors and other staff members are often professionally frustrated. Strikes related to hospital staff's various professional demands hamper the regular flow of work in the ward. Family members are engaged in nursing and provide various kinds of support to their hospitalized relatives. Patients give small bribes to ward boys and cleaners to obtain their day-to-day necessities. Patients joke with each other and mock senior doctors. Thus, they neutralize their powerlessness and drive away the monotony of their stay. Doctors develop 'indigenous' solutions to orthopaedic problems. Instead of using high-tech devices, they employ instruments made of bamboo, bricks, and razor blades. This study shows how medical practice takes shape in an understaffed, under-resourced and poorly financed hospital operating in a low-income country. 147. Managing occupations in everyday life for people with advanced cancer living at home DEFF Research Database (Denmark) Peoples, Hanne; Brandt, Ã…se; Wæhrens, Eva Elisabet Ejlersen 2017-01-01 limited research that specifically explores how these occupational difficulties are managed. Objective: To describe and explore how people with advanced cancer manage occupations when living at home. Material and methods: A sub-sample of 73 participants from a larger occupational therapy project took part......Background: People with advanced cancer are able to live for extended periods of time. Advanced cancer can cause functional limitations influencing the ability to manage occupations. Although studies have shown that people with advanced cancer experience occupational difficulties, there is only...... in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data. Results: Managing occupations were manifested in two main categories; 1) Conditions influencing... 148. [Standardised primary care of multiple trauma patients. Prehospital Trauma Life Support und Advanced Trauma Life Support]. Science.gov (United States) Wölfl, C G; Gliwitzky, B; Wentzensen, A 2009-10-01 Standardised management improves treatment results in seriously injured patients. For conditions like stroke or acute coronary syndrome (ACS) there are set treatment pathways which have been established for prehospital and primary hospital care. The treatment of critical trauma patients, however, follows varying procedures in both the prehospital and primary hospital phases. From an analysis of the trauma register of the German Society for Trauma Surgery (DGU), we know that a seriously injured patient remains on the road for 70 min on average before transferral to hospital. This requires improvement. With the 2003 introduction of the ATLS programme in Germany, the initial clinical phase could be improved upon simply by means of standardised training. PHTLS und ATLS complement one another. PHTLS und ATLS represent training concepts which teach standardised, priority-based prehospital and hospital trauma management. The aim is to make an initial rapid and accurate assessment of the patient's condition, thereby identifying the"critical" patient. The concepts also make priority-based treatment possible and facilitate decision-making as to whether patients can receive further on-the-spot treatment or whether immediate transport is necessary. The procedure is identical in the shock room. The primary consideration is to prevent secondary damage, not to lose track of time and to ensure consistent quality of care. The courses teach systematic knowledge, techniques, skills and conduct in diagnosis and therapy. The courses are oriented to all medical specialities associated with

trauma care. With the support of the German Society for Trauma Surgery (DGU) and the German Society for Anesthesiology and Intensive Medicine (DGAI), the German Professional Organisation of Rescue Services (DBRD) has adopted the PHTLS course system on licence from the National Association of Emergency Medical Technicians (NAEMT) and the American College of Surgeons (ACS) and has been offering it in 149. Newly graduated doctors' competence in managing cardiopulmonary arrests assessed using a standardized Advanced Life Support (ALS) assessment DEFF Research Database (Denmark) Jensen, Marianne Lidang; Hesselfeldt, R.; Rasmussen, M.B. 2008-01-01 and to study whether teaching site affects their resuscitation competence. Materials and methods: The entire cohort of medical students from Copenhagen University expected to graduate in June 2006 was invited to participate in the study. Participants’ ALS- competence was assessed using the Advanced Life...... Support Provider (ALS) examination standards as issued by the European Resuscitation Council (ERC). The emergency medicine course is con- ducted at three different university hospital teaching sites and teaching and assessment might vary across sites, despite the common end objectives regarding...... resuscitation teaching issued by the university. Results: Participation was accepted by 154/240 (64%) graduates. Only 23% of the participants met the ALS pass criteria. They primarily lacked skills in managing cardiopulmonary arrest. There were significant differences in ALS-competence between teaching sites.... 150. Transfers to acute care hospitals at the end of life: do rural/remote regions differ from urban regions? Science.gov (United States) Menec, Verena H; Nowicki, Scott; Kalischuk, Alison 2010-01-01 In population-based studies, transfers into hospitals and hospital deaths are typically considered to be indicators of potentially inappropriate care settings at the end of life. Despite a plethora of research into where people die, few studies have examined whether hospital transfers at the end of life differ in rural versus urban areas. In the present study hospitalizations in the last month before death in one mid-Western Canadian province were examined. The study had three main objectives, to: (1) compare hospitalizations in rural/remote with urban regions; (2) examine the role of healthcare resources in hospitalizations; and (3) explore more specifically whether day-to-day patterns of hospitalization shortly before death differ between rural/remote and urban areas. The source of data was administrative healthcare records, with the study including all adults (aged over 19 years; excluding nursing home residents) who died in the province of Manitoba in 2003-2004 (n = 6523). Whether the decedents were hospitalized in the 30 days before death was determined from hospital files. The number of hospital days incurred was counted. Region of residence was defined along regional health authority boundaries, with 7 regions identified as rural/remote and 2 as urban. Healthcare resources were measured in terms of the number of: physicians, hospital beds, nursing home beds, and home care services per 1000 population. Age, sex and trajectory groups, which categorized decedents according to their cause of death, were included in all analyses. Residents of 4 of the 7 rural/remote regions had increased odds of being hospitalized relative to the comparison, the larger urban region (adjusted odds ratios [AOR] ranged from 1.25 to 1.70). Hospital days did not differ across regions. Further analyses showed that having more physicians (AOR = .75) and more hospital beds per 1000 population (AOR = .95) both significantly reduced the odds of being hospitalized. Nursing home beds and 151. Matters of life and death: the hospital of San Pedro in Puebla, 1790-1802. Science.gov (United States) Hernández-Sáenz, Luz MarÃa 2002-01-01 The last decade of the eighteenth century may be described as a "golden age" in the history of the Hospital of San Pedro of Puebla. Under the stewardship of its director, Father Ignacio Domenech, San Pedro underwent an extensive renovation of its physical plant and a thorough administrative reorganization that turned it into one of the best medical care and research institutions in New Spain. The article draws a profile of the patients who filled the hospital's wards and adds a human dimension to the many names and ailments listed in the registries. It also describes the valiant efforts of the medical staff who daily shared the patients' struggle against illness. Fighting immense odds, the practitioners sought to provide good-quality care and to further their limited understanding of disease. A detailed analysis of San Pedro's everyday life reveals a portrait of human suffering, professional dedication, and humanity's pursuit of knowledge. 152. [Validation of a scale to assess the labour quality of life in public hospitals from Tlaxcala]. Science.gov (United States) Hernández-Vicente, Irma Alejandra; Lumbreras-Guzmán, Marivel; Méndez-Hernández, Pablo; Rojas-Lima, Elodia; Cervantes-RodrÃguez, Margarita; Juárez-Flores, Clara Arlina 2017-01-01 To validate a scale for assessing the labour quality of life in public hospitals (LQL-PH) from Tlaxcala, Mexico. The instrument was validated among 669 health workers from six hospitals from the Ministry of Health of Tlaxcala, Mexico. Content validity was by inquiry to experts, construct validity by factor analysis, criterion validity by comparing with other scales, and reliability with Cronbach's Alpha. The factor analysis uncovered four dimensions: "individual welfare", "conditions and labour environment", "organization", and "wellbeing accomplished by the work"; reliability was 0.921. Workers who perceibed better LQL-PH were: under 50 years old, with temporary contract, with less seniority in job, with work schedule at daytime of weekends, and those with academic degree. LQL-PH showed to be an instrument phsycometrically valid and reliable. It's recommendable to prove this scale in other public and private health institutions, as well as its relationship with key health care indicators of labour performance and management. 153. Early weaning and hospitalization with alcohol-related diagnoses in adult life DEFF Research Database (Denmark) Sørensen, Holger J; Mortensen, Erik L; Reinisch, June M; 2006-01-01 OBJECTIVE: This study attempted to determine whether lack of breast-feeding or a short duration of breast-feeding during infancy is associated with an elevated risk of hospitalization with alcohol-related diagnoses in adult life. METHOD: The study was a prospective longitudinal birth cohort design...... conducted in a sample of 6,562 men and women, all of whom were born in Copenhagen, Denmark, between October 1959 and December 1961. The sample was divided into two categories based on duration of breastfeeding, as assessed by a physician interview with mothers at a 1-year examination. Psychiatric...... hospitalizations with alcohol-related diagnoses according to ICD-8 or ICD-10 were identified in the Danish Psychiatric Central Register in 1999. Nine potential confounders were included as covariates: gender of the cohort member, maternal age, parental social status, maternal prenatal smoking, unwanted pregnancy... 154. Hospitals Data.gov (United States) Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and... 155. Fluctuating functions related to quality of life in advanced Parkinson disease: effects of duodenal levodopa infusion DEFF Research Database (Denmark) Isacson, D; Bingefors, K; Sønbø Kristiansen, Ivar 2008-01-01 OBJECTIVE: To assess fluctuations in quality of life (QoL) and motor performance in patients with advanced Parkinson disease (PD) treated with continuous daytime duodenal levodopa/carbidopa infusion or conventional therapy. METHODS: Of 18 patients completing a 6-week trial (DIREQT), 12 were... 156. Microbial detection and monitoring in advanced life support systems like the international space station NARCIS (Netherlands) van Tongeren, Sandra P.; Krooneman, Janneke; Raangs, Gerwin C.; Welling, Gjalt W.; Harmsen, Hermie J. M. 2007-01-01 Potentially pathogenic microbes and so-called technophiles may form a serious threat in advanced life support systems, such as the International Space Station (ISS). They not only pose a threat to the health of the crew, but also to the technical equipment and materials of the space station. The dev 157. Microbial detection and monitoring in advanced life support systems like the International Space Station NARCIS (Netherlands) van Tongeren, Sandra P.; Krooneman, Janneke; Raangs, Gerwin C.; Welling, Gjalt W.; Harmsen, Hermie J. M. 2006-01-01 Potentially pathogenic microbes and so-called technophiles may form a serious threat in advanced life support systems, such as the International Space Station (ISS). They not only pose a threat to the health of the crew, but also to the technical equipment and materials of the space station. The dev 158. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service. NARCIS (Netherlands) Gerritse, B.M.; Schalkwijk, A.; Pelzer, B.J.; Scheffer, G.J.; Draaisma, J.M.T. 2010-01-01 BACKGROUND: To determine the advanced life support procedures provided by an Emergency Medical Service (EMS) and a Helicopter Emergency Medical Service (HEMS) for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures 159. Advanced Trauma Life Support. ABCDE from a radiological point of view. NARCIS (Netherlands) Kool, D.R.; Blickman, J.G. 2007-01-01 Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support(R) (ATLS) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS, and we will discuss discrepancies with 160. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service. NARCIS (Netherlands) Gerritse, B.M.; Schalkwijk, A.; Pelzer, B.J.; Scheffer, G.J.; Draaisma, J.M.T. 2010-01-01 BACKGROUND: To determine the advanced life support procedures provided by an Emergency Medical Service (EMS) and a Helicopter Emergency Medical Service (HEMS) for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures r « 6 7 8 9 10 » « 7 8 9 10 11 » 161. Microbial detection and monitoring in advanced life support systems like the international space station NARCIS (Netherlands) van Tongeren, Sandra P.; Krooneman, Janneke; Raangs, Gerwin C.; Welling, Gjalt W.; Harmsen, Hermie J. M. 2007-01-01 Potentially pathogenic microbes and so-called technophiles may form a serious threat in advanced life support systems, such as the International Space Station (ISS). They not only pose a threat to the health of the crew, but also to the technical equipment and materials of the space station. The 162. Microbial detection and monitoring in advanced life support systems like the International Space Station NARCIS (Netherlands) van Tongeren, Sandra P.; Krooneman, Janneke; Raangs, Gerwin C.; Welling, Gjalt W.; Harmsen, Hermie J. M. 2006-01-01 Potentially pathogenic microbes and so-called technophiles may form a serious threat in advanced life support systems, such as the International Space Station (ISS). They not only pose a threat to the health of the crew, but also to the technical equipment and materials of the space station. The 163. Long-term intended and unintended experiences after Advanced Life Support training DEFF Research Database (Denmark) Rasmussen, M.B.; Dieckmann, Peter; Issenberg, Berry 2012-01-01 Highly structured simulation-based training (SBT) on managing emergency situations can have a significant effect on immediate satisfaction and learning. However, there are some indications of problems when applying learned skills to practice. The aim of this study was to identify long-term intend...... and unintended learner reactions, experiences and reflections after attending a simulation based Advanced Life Support (ALS) course.... 164. In-hospital end-of-life decisions after new traumatic spinal cord injury in the Netherlands NARCIS (Netherlands) Osterthun, R.; van Asbeck, F. W. A.; Nijendijk, J. H. B.; Post, M. W. M. 2016-01-01 Study design: Explorative retrospective files study. Objectives: To document end-of-life decisions (ELDs) in in-hospital deaths after new traumatic spinal cord injury (TSCI). Setting: The Netherlands. Methods: Discharge letters concerning patients with TSCI discharged from Dutch acute hospitals in 165. Quality of life in hemodialysis patients and the relationship with mortality, hospitalizations and poor treatment adherence Directory of Open Access Journals (Sweden) Araiê Prado Berger Oliveira Full Text Available Abstract Introduction: Chronic kidney disease (CKD causes sudden changes in the daily lives of patients, creates limitations to perform activities of daily life and creates a great impact on emotions and quality of life (QOL of patients. Objective: To understand the relationship between QOL of patients on dialysis and mortality rates, hospitalization and absences. Methods: A prospective descriptive study with 286 patients on hemodialysis, by applying demographic questionnaire, KDQOL SF-36 and electronic medical record analysis Dialsist. Results: The mean age was 54.71 ± 14.12 years, with a mean score of QOL 60.53 having as higher factor encouraging the support team (85.03 and lowest in work status (21.11. The days of hospitalization is negatively correlated to the compounds of the instrument, particularly in physical functioning (p = 0.000, mean score (p = 0.001 and emotional well-being (p = 0.005. Women had lower QOL in physical role scores, symptoms/problems, physical functioning, emotional well-being, energy and fatigue mean score (p ≤ 0.05. The lowest score was found to be related to treatment of patients in 1 year and 7 months and 5 years (59.93 and higher in patients with more than five years and one month (61.39. Conclusion: Hospitalizations decrease QV emotional and physical scores and absences are directly related to social support and age. The study looked through the data raise subsidies for the work of the aspects that need stimulation and adaptation in the lives of patients, providing a better balance in the individual's life. 166. [Pre-hospital management of adults with life-threatening emergencies]. Science.gov (United States) Wattel, Francis; Dubois, François 2012-01-01 , fewer voluntary firemen, hospital reorganization, tight funding, difficulties of medical dispatching, and the varying skills of "first-on-the-scene "emergency workers. Grievances include late emergency responses, inappropriate medical care, and dispatching to the wrong facility. This raises the question of equal opportunity for all in a country with widely varying geographic features and population density. Improvement in the system's efficiency will require a series of objectives to be met in varied and complementary--Enhanced functional coordination, by speeding up the deployment of the ANTARES digital radio-frequency transmission network (Adaptation Nationale des Transmissions Aux Risques Et aux Secours).--Implementation of a network of emergency services with varying degrees of emergency healthcare management related to the technical nature of the facilities. Three levels of emergency healthcare must be made available: level 1 is provided by local hospitals, level 2 includes support facilities available in general hospitals (not necessarily the nearest hospital), and level 3 provides specialized healthcare in large and/or training hospitals with specialized departments. Life-threatening emergency situations are to be handled by level 2 or 3 facilities. Specific facilities must be selected as reference centers. In France, the ARS (Agences Régionales de Santé) is in charge of this procedure, as it provide funding for healthcare continuity--Reducing inequalities in access to emergency care. This will involve improving the network of SDIS brigades, making local medical facilities more responsive, delegating more medical procedures, on-site telemedicine, providing more helicopters equipped with healthcare facilities, more automated external defibrillators, and more dedicated neuro-vascular units.--First aid training must be made widely available. The French National Academy of Medicine has approved ten recommendations regarding organization and facilities. 167. Closure of a local public hospital in Korea: focusing on the organizational life cycle Directory of Open Access Journals (Sweden) Yeo YH 2016-11-01 Full Text Available Young Hyun Yeo,1 Keon-Hyung Lee,2 Hye Jeong Kim3 1Department of Public Administration, Sunmoon University, Asan, ChungNam, South Korea; 2Askew School of Public Administration and Policy, Florida State University, Tallahassee, FL, USA; 3Department of Public Administration, Sunmoon University, Asan, ChungNam, South Korea Abstract: Just as living organisms have a creation-maintenance-extinction life cycle, organizations also have a life cycle. Private organizations will not survive if they fail to acquire necessary resources through market competition. Public organizations, however, continue to survive because the government has provided financial support in order to enhance public interest. Only a few public organizations in Korea have closed. With the introduction of new public management since the economic crisis in 1997, however, public organizations have had to compete with private organizations. Public hospitals are not free to open or close their business. They are also controlled by the government in terms of their prices, management, budgets, and operations. As they pursue public interest by fulfilling the government’s order such as providing free or lowerpriced care to the vulnerable population, they tend to provide a lower quality of care and suffer a financial burden. Employing a case study analysis, this study attempts to understand the external environment that local public hospitals face. The fundamental problem of local public hospitals in Korea is the value conflict between public interest and profitability. Local public hospitals are required to pursue public interest by assignment of a public mission including building a medical safety net for low-income patients and managing nonprofitable medical facilities and emergent health care situations. At the same time, they are required to pursue profitability by achieving high-quality care through competition and the operation of an independent, self-supporting system according to 168. Effect of pre-hospital advanced airway management for out-of-hospital cardiac arrest caused by respiratory disease: a propensity score-matched study. Science.gov (United States) Ohashi-Fukuda, N; Fukuda, T; Yahagi, N 2017-05-01 Optimal pre-hospital care for out-of-hospital cardiac arrest (OHCA) caused by respiratory disease may differ from that for OHCA associated with other aetiologies, especially with respect to respiratory management. We aimed to investigate whether pre-hospital advanced airway management (AAM) was associated with favourable outcomes after OHCA caused by intrinsic respiratory disease. This nationwide, population-based, propensity score-matched study of adult patients in Japan with OHCA due to respiratory disease from 1 January 2005 to 31 December 2012 compared patients with and without pre-hospital AAM. The primary outcome was neurologically favourable survival at one month after the OHCA. Of 49,534 eligible patients, 20,458 received pre-hospital AAM and 29,076 did not. In a propensity score-matched cohort (18,483 versus 18,483 patients), the odds of neurologically favourable survival were significantly lower for patients receiving pre-hospital AAM (0.6% versus 1.5%; odds ratio [OR] 0.42 [95% confidence interval {CI} 0.34 to 0.52]). The results from multivariable logistic regression analysis also showed that pre-hospital AAM was significantly associated with a decreased chance of neurologically favourable survival (adjusted OR 0.43 [95% CI 0.35 to 0.52]). Similar findings were observed for one-month survival and pre-hospital return of spontaneous circulation. In subgroup analyses, pre-hospital AAM was associated with poor neurological outcomes, regardless of the type of airway device used (laryngeal mask airway, adjusted OR 0.35 [95% CI 0.19 to 0.57]; oesophageal obturator airway, adjusted OR 0.44 [95% CI 0.35 to 0.55]; and endotracheal tube, adjusted OR 0.47 [95% CI 0.30 to 0.69]). In conclusion, pre-hospital AAM was associated with poor neurological outcome among patients with OHCA caused by intrinsic respiratory disease. 169. Activity and meaning-making in everyday life of people with advanced cancer DEFF Research Database (Denmark) la Cour, Karen; Johannessen, Helle; Josephsson, Staffan 2009-01-01 Objective: This study aims to explore and understand how people with advanced cancer create meaning and handle everyday life through activity. Methods: A purposive sample of seven participants was recruited from a larger study. Data were collected through qualitative interviews and participant....... A narrative of “being healthy although ill†provided an arena for exploring the contrast between simultaneously feeling well and severely ill. Further emplotment of activities in “routines and continuity†was identified as a means to provide a safe, familiar framework stimulating participants’ everyday agency....... “My little Mecca†was identified as a narrative reflecting the activity of life-confirming experiences and taking time out. Significance of results: The identified narratives performed and told in daily life may guide the development of palliative care services to support

people with advanced cancer... 170. MAXILLOFACIAL TRAUMA MANAGEMENT IN POLYTRAUMATIZED PATIENTS – THE USE OF ADVANCED TRAUMA LIFE SUPPORT (ATLS PRINCIPLES. Directory of Open Access Journals (Sweden) Elitsa G. Deliverska 2013-03-01 Full Text Available Management of the multiply injured patient requires a co-ordinated multi-disciplinary approach in order to optimise patients’ outcome. A working knowledge of the sort of problems these patients encounter is therefore vital to ensure that life-threatening injuries are recognised and treated in a timely pattern and that more minor associated injuries are not omitted. This article outlines the management of polytraumatized patients using the Advanced Trauma Life Support (ATLS principles and highlights the areas of specific involvement of the engaged medical team. Advanced Trauma Life Support is generally regarded as the gold standard and is founded on a number of well known principles, but strict adherence to protocols may have its drawbacks when facial trauma co-exists. These can arise in the presence of either major or minor facial injuries, and oral and maxillofacial surgeons need to be aware of the potential problems. 171. Development of advanced techniques for life management and inspection of advanced heavy water reactor (AWHR) coolant channel components Energy Technology Data Exchange (ETDEWEB) Madhusoodanan, K.; Sinha, S.K.; Kumar, K.; Shyam, T.V.; Panwar, S.; Sharma, B.S.V.G. [Bhabha Atomic Research Centre, Reactor Engineering Div., Trombay, Mumbai (India); Sinha, R. K. [Bhabha Atomic Research Centre, Reactor Design and Development Group., Trombay, Mumbai (India) 2011-07-01 Operating life of pressure tubes of Pressurized Heavy Water Reactor (PHWR) is limited due to the presence of various issues associated with the material like hydrogen pick up, delayed hydride cracking, axial elongation and increase in diameter due to irradiation creep and growth. Periodic monitoring of the health of the pressure tube under in-situ conditions is essential to ensure the safe operation of the reactor. New designs of reactor call for innovative design philosophy, modification in fabrication route of pressure tube, development of reactor specific tools, both analytical and hardware for assessing the fitness for service of the pressure tube. Feedback from existing reactors has enhanced the understanding about life limiting parameters. This paper gives an insight into the life limiting issues associated with pressure tube and the efforts pursued for development of life management techniques for coolant channel of Advanced Heavy Water Reactor (AHWR) designed in India. The tools and techniques for in-situ property/hydrogen measurement, pulsed eddy current technique for zirconium alloy in-homogeneity characterization, horizontal shear wave EMAT system for dissimilar metal weld inspection, sliver sampling of vertical channel etc. are elaborated in the paper. (author) 172. Quality of life in children with primary headache in a general hospital. Science.gov (United States) Bruijn, J; Arts, W-F; Duivenvoorden, H; Dijkstra, N; Raat, H; Passchier, J 2009-06-01 Knowledge on the quality of life of children with headache is lacking. Until now only a few studies in this field have provided information on a limited number of life domains. The aim of this study was to assess the quality of life in a comprehensive number of life domains in children with primary headache presenting at an out-patient paediatric department in a general hospital. From October 2003 to October 2005 all children referred to the out-patient paediatric department of the Vlietland Hospital because of primary headache were investigated by protocol. A thorough history was taken and a general physical and neurological examination was performed. The International Headache Society criteria were used for classification. Quality of life (QoL) was measured using the Dutch version of the Child Health Questionnaire (CHQ-PF50 Dutch edition) and compared with data from a previously investigated cohort of healthy children from the same region, and with data from a cohort of children from the USA with asthma or with attention deficit hyperactivity disorder (ADHD), investigated with the CHQ-PF50. A total of 70 primary headache patients were included in the study (25 with tension-type headache, 36 with migraine, seven with chronic tension-type headache, two with both tension-type headache and migraine). Their mean age was 10.6 years (range 4-17 years); 37 children were male. On all but one subscale (self-esteem) the QoL of the children with primary headache was decreased compared with the cohort of healthy children, especially on the domains of mental health, parental impact time and family cohesion. Compared with the cohort of children with asthma the QoL was significantly worse for our headache group on seven subscales and significantly better on one subscale (general health perception). Compared with the cohort of children with ADHD, the QoL was significantly worse on six subscales but significantly better on three subscales. There were no significant differences on 173. End-of-Life Care for Undocumented Immigrants With Advanced Cancer: Documenting the Undocumented. Science.gov (United States) Jaramillo, Sylvia; Hui, David 2016-04-01 There are approximately 11.1 million undocumented immigrants in the United States, with a majority being Latino. Cancer is now the leading cause of death in Latinos. There is little research guiding providers on how to deliver optimal end-of-life care in this population. We describe a case of an undocumented Latino patient with advanced cancer, and provide a review of the literature on end-of-life care in undocumented immigrants. Our patient encountered many challenges as he navigated through the healthcare system in the last months of life. These included delayed diagnosis, limited social support, financial issues, fear of deportation, and language and cultural barriers, which resulted in significant physical and psychological distress. Within the undocumented patient population, there is often a lack of advance care planning, prognostic understanding, mistrust, religious practices, and cultural beliefs that may affect decision making. Given the growing number of undocumented immigrants in the United States, it is important for clinicians and policy makers to have a better understanding of the issues surrounding end-of-life care for undocumented immigrants, and work together to improve the quality of life and quality of end-of-life care for these disadvantaged individuals. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. 174. Does physical exercise improve quality of life of advanced cancer patients? Science.gov (United States) Navigante, Alfredo; Morgado, Pablo Cresta 2016-12-01 We discuss the principal issues about physical activity in advanced cancer patients through the analyses of the last articles and our experience in this field. The efficacy of exercise training intervention could improve quality of life (QOL), fatigue and well being in advanced cancer patients. Several published studies have included, nevertheless, patients with early stage of disease and more recently, populations of patients with local advanced tumors of the breast, rectum and lung, who are undergoing neoadjuvant therapy. Despite the insufficient sample of patients in these studies, physical exercise is considered to improve both cardiopulmonary function and physical muscle fitness. Cancer-related fatigue is a devastating symptom in advanced cancer patients that implies loss of mobility and independence. Physical exercise could be a treatment to increase skeletal muscle endurance and improve well being. In palliative medicine, physical activity could be applied to medical assistance or to design prospective and controlled trials so as to evaluate possible usefulness. 175. Health-related quality of life in elderly patients hospitalized with chronic heart failure Directory of Open Access Journals (Sweden) Erceg P 2013-11-01 Full Text Available Predrag Erceg,1,2 Nebojsa Despotovic,1,2 Dragoslav P Milosevic,1,2 Ivan Soldatovic,3 Sanja Zdravkovic,2 Snezana Tomic,2 Ivana Markovic,2 Gordana Mihajlovic,2 Milan D Brajovic,4,5 Ognjen Bojovic,6 Bojana Potic,2 Mladen Davidovic1 1Department of Gerontology, Faculty of Medicine, University of Belgrade, 2Clinical Department of Geriatrics, Zvezdara University Hospital, 3Institute of Medical Statistics and Informatics, Faculty of Medicine, 4Department of Internal Medicine, Faculty of Dentistry, University of Belgrade, 5Clinical Department of Cardiology, Zvezdara University Hospital, Belgrade, Serbia; 6Department of Biomedicine, University of Bergen, Bergen, Norway Background: Chronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong impact on health-related quality of life (HRQOL. Previous studies of HRQOL in elderly heart failure subjects have included mostly outpatients, and little is known about determinants of HRQOL in hospitalized elderly population, especially in Serbia. In this study, we tried to identify factors that influence HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Methods: The study population consisted of 136 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis. Results: Univariate analysis showed that patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Presence of depressive symptoms (P<0.001, higher NYHA class (P=0.021, lower income (P=0.029, and longer duration of heart failure (P=0.049 were 176. Accuracy of a decision aid for advance care planning: simulated end-of-life decision making. Science.gov (United States) Levi, Benjamin H; Heverley, Steven R; Green, Michael J 2011-01-01 Advance directives have been criticized for failing to help physicians make decisions consistent with patients' wishes. This pilot study sought to determine if an interactive, computerbased decision aid that generates an advance directive can help physicians accurately translate patients' wishes into treatment decisions. We recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios. From the three individual physicians' responses, a "consensus physician response" was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions. Patient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR). Across the six vignettes, patient-participants' rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians' overall rating of their confidence at accurately translating patients' wishes into clinical decisions was 7.8 (range = 6.1-9.3, 1 = not at all confident, 10 = extremely confident). For simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse. 177. Nurses' daily life: gender relations from the time spent in hospital Directory of Open Access Journals (Sweden) Audrey Vidal Pereira 2015-10-01 Full Text Available Objective: to analyze the everyday life of nurses through the sexual work division as well as through interdependence relations and the time in hospital.Method: quanti-qualitative study, based on the Time Use Survey and in Norbert Elias's Configuration Theory of Interdependencies. Daily shifts distribution record, directed by 42 participants - with self-confrontation - by interviews which drew dialogues on subjective aspects of the everyday experiences related to use of time, based on a job at a university hospital. The theoretical intake that founded data analysis was based on concepts of conflicts of interest, power struggles, sexual work division and polychronic-monochronic concepts - whether the work environment demands multitasking nurses or not.Results: time records allowed to observe differences between the groups studied, useful to identify conflicts, tensions, power struggles and gender inequalities in interviewees' everyday affairs that do not only affect physical and mental health, but also their way of life.Conclusion: the analytical path pointed out the need for public policies that promote equity in gender relations, keeping at sight the exercise of plural discourses and tolerant stances capable to respect differences between individual and collective time. 178. Quality of life estimate in stomach, colon, and rectal cancer patients in a hospital in China. Science.gov (United States) Deng, Muhong; Lan, Yanhong; Luo, Shali 2013-10-01 The objective of this study was to investigate the outcome and coping patterns of patients with stomach, colon, and rectal cancer in a hospital in China. Health-related quality of life was assessed in 118 stomach, colon, and rectal cancer patients in Chinese People's Liberation Army General Hospital, Beijing, China, using the generic version of the European Organization for Research and Treatment of Cancer Quality of Life (QOL) Questionnaire Core 30 Items, Self-rated Anxiety Scores (SAS), Self-rated Depression Scores (SDS), Medical Coping Modes of Questionnaire (MCMQ), and Social Support Requirement Scale (SSRS) questionnaires. The overall QOL was 50.7 ± 6.5, 48.1 ± 7.7, and 47.6 ± 6.4, respectively, for stomach, colon, and rectal cancer groups. Correlations between QOL and SAS and SDS in stomach cancer patients were significantly higher than observed in the cohort of colon or rectal cancer patients (Spearman coefficient of 0.366 and 0.129, respectively). Cluster analysis of MCMQ data revealed four identifiable patterns (resign, confront, avoid-confront, and avoid-resign) of coping in the study group. Subjective support was significantly higher than objective support (p Stomach, colon, and rectal cancer patients had anxiety and depression stemming from their cancer diagnosis and postdiagnosis treatment, and sex dependency was prevalent in SSRS response. Coping patterns were reliable indicators of psychosocial side effects in patients with stomach, colon, and rectal cancers. 179. Nurses' daily life: gender relations from the time spent in hospital1 Science.gov (United States) Pereira, Audrey Vidal 2015-01-01 Objective: to analyze the everyday life of nurses through the sexual work division as well as through interdependence relations and the time in hospital. Method: quanti-qualitative study, based on the Time Use Survey and in Norbert Elias's Configuration Theory of Interdependencies. Daily shifts distribution record, directed by 42 participants - with selfconfrontation - by interviews which drew dialogues on subjective aspects of the everyday experiences related to use of time, based on a job at a university hospital. The theoretical intake that founded data analysis was based on concepts of conflicts of interest, power struggles, sexual work division and polychronic-monochronic concepts - whether the work environment demands multitasking nurses or not. Results: time records allowed to observe differences between the groups studied, useful to identify conflicts, tensions, power struggles and gender inequalities in interviewees' everyday affairs that do not only affect physical and mental health, but also their way of life. Conclusion: the analytical path pointed out the need for public policies that promote equity in gender relations, keeping at sight the exercise of plural discourses and tolerant stances capable to respect differences between individual and collective time. PMID:26487146 180. Validation of dipslides as a tool for environmental sampling in a real-life hospital setting. Science.gov (United States) Ibfelt, T; Foged, C; Andersen, L P 2014-05-01 Environmental sampling in hospitals is becoming increasingly important because of the rise in nosocomial infections. In order to monitor and track these infections and optimize cleaning and disinfection, we need to be able to locate the fomites with the highest amount of microorganisms, but the optimal method for this is not clear. The aim of this study was to evaluate which of four different dipslides or a standard TSA contact plate were best at recovering human bacteria from the environment. We tested four different dipslides with selective and non-selective agars versus a standard TSA contact plate in order to find the best sampling media. Two hundred sites in a children's medical ward in Copenhagen University hospital were sampled in autumn 2012. There was no difference in total bacteria count between the TSA contact plate and the dipslides. Faecal indicator bacteria recovery was the same for the dipslides and the TSA contact plate. Dipslides may be equally well suited for environmental sampling and hygiene assessment as TSA contact plates. Dipslides have some advantages, such as better sample security, easier sampling in confined spaces and longer shelf life that may speak in favour of choosing these for bacteria environmental sampling in hospitals, depending on the task. « 7 8 9 10 11 » « 8 9 10 11 12 » 181. [Hospital nurses' knowledge of the patient care plan for immediate life threatening situations]. Science.gov (United States) RodrÃguez-Borrajo, Sara; MartÃnez de Lahidalga-MartÃnez, Olga; Gutiérrez-GarcÃa de Cortazar, Aitziber; Arriaran-Mendialdua, Izaskun; Latorre-GarcÃa, Kepa 2008-01-01 To evaluate knowledge of nurses in adult hospital units in Txagorritxu Hospital (Vitoria) on care plans for immediate life-threatening (ILT) situations and to determine their selfevaluation of knowledge of cardiopulmonary resuscitation and the main sociodemographic characteristics that could influence the need for better training in this field. We performed a cross-sectional, analytical, observational study through a survey of 207 nurses in adult hospital units. Data were collected using a self-administered 20-item questionnaire. Five of these items measured knowledge of the care plan for ILT situations. The response rate was 74.39%. Of the five questions measuring knowledge, 32.4% of the nurses answered four or more questions correctly. Of the total, 38.3% knew when to activate the ILT plan; 12.99% did not know how to remove or lower the bed head when the patient was experiencing an ILT situation, and 24.03% did so with difficulty. No significant differences were found in nurses' experience, age, or the percentage of correct responses. Training courses should be organized to enable nurses to act in an ILT situation, including when to activate the care plan, how to perform the measures, and how to handle the center's materials/equipment. 182. Stress associated with hospitalization in patients with COPD: the role of social support and health related quality of life Directory of Open Access Journals (Sweden) Medinas-Amorós Magdalena 2012-12-01 Full Text Available Abstract Background The objective of this study was to determine stress levels during hospitalization in patients with Chronic Obstructive Pulmonary Disease (COPD. We wanted to relate stress to previous level of quality of life and patients’ Social Support. Methods 80 patients (70.43; SD = 8.13 years old with COPD were assessed by means of: Hospital Stress Rating Scale, Nottingham Health Profile, St. George’s Respiratory Questionnaire and Social Support Scale. Results COPD patientsâ €™ stress levels are lower than expected independently from the severity or number of previous hospitalizations. Linear regression analysis shows the predictive value of Quality of Life and Social Support on stress level during hospitalization (p  Conclusion HRQOL and social support can be associated with stress during hospitalization. 183. Impact of complications and hospital-free days on health related quality of life 1 year after radical cystectomy. Science.gov (United States) Ritch, Chad R; Cookson, Michael S; Chang, Sam S; Clark, Peter E; Resnick, Matthew J; Penson, David F; Smith, Joseph A; May, Alex T; Anderson, Christopher B; You, Chaochen; Lee, Haerin; Barocas, Daniel A 2014-11-01 We determined the extent to which complications as well as number of hospital-free days within 30 and 90 days of surgery predicted health related quality of life 1 year after radical cystectomy. We used data from a prospective health related quality of life study using a validated instrument, the Vanderbilt Cystectomy Index-15. Complications were graded by the Clavien system, and hospital length of stay and length of stay during readmissions were used to calculate 30 and 90-day hospital-free days, respectively. We compared the number of hospital-free days among patients with varying levels of complications. Multivariate analysis was performed to determine predictors of Vanderbilt Cystectomy Index-15 score 1 year after surgery adjusting for demographic (age, gender, comorbidities) and clinical variables (stage and diversion type). A total of 100 patients with complete baseline and 1-year followup health related quality of life data were included in the analysis. Median (IQR) 30 and 90-day hospital-free days were 24 (22-25) and 84 (82-85), respectively. Patients who experienced any complications had significantly fewer 30-day hospital-free days (22 vs 24 days, p free days (81 vs 84 days, p free days than those with lower grade or no complications (p quality of life scores. Patients who experience complications after radical cystectomy have fewer 30 and 90-day hospital-free days. However, neither predicts health related quality of life at 1 year. Instead, long-term health related quality of life appears to be driven largely by baseline health related quality of life and gender. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved. 184. Impact of hand eczema severity on quality of life: a hospital based cross-sectional study Directory of Open Access Journals (Sweden) Bharat Bhushan Mahajan 2016-01-01 Full Text Available Introduction: Hands are important organs of expression, communication, and are necessary for household and work-related activity. Thus, hand eczema can deteriorate quality of life. This study aims to find impact of hand eczema severity on quality of life. Methods: A cross-sectional study was done in a tertiary care hospital in Punjab from January to July, 2014. A total of 69 hand eczema patients of either gender aged ≥16 years were enrolled after taking an informed consent. Disease severity was assessed by hand eczema severity index (HECSI score; and quality of life by dermatology life quality index (DLQI questionnaire. The data was evaluated using statistical tests like frequency, chi-square, oneway ANOVA, t-test etc. Results: Out of 69 patients, 63.8% were males and 36.2% females. The commonest age group affected was 21-40 years (55.1% cases. Aggravating factors were reported by 76.8% patients, the commonest trigger being summer season (47.8% followed by soaps and detergents (21.7%. The mean±S.D. for DLQI was 6.22±5.42 and for HECSI was 18.54±17.05. There was no statistically significant impact of age, occupation and duration of disease on DLQI or disease severity except gender (p-value being 0.028 for DLQI; 0.035 for HECSI. There was no significant correlation between HECSI score and DLQI. Conclusion: Majority of the patients with hand eczema had a significant impairment of their quality of life. There was a statistically significant impact of gender on hand eczema severity; although no correlation was found between DLQI and HECSI score in this study. 185. Effectiveness of low vision services in improving patient quality of life at Aravind Eye Hospital Directory of Open Access Journals (Sweden) Anna T Do 2014-01-01 Full Text Available Context: In India, where the heavy burden of visual impairment exists, low vision services are scarce and under-utilized. Aims: Our study was designed to survey the effectiveness of low vision exams and visual aids in improving patient quality of life in southern rural India. Subjects and Methods: The low vision quality of life (LVQOL questionnaire measures vision-related quality of life through 25 questions on a Likert scale of 0-5 that pertain to (1 mobility, distance vision, and lighting; (2 psychological adjustment; (3 reading and fine work; and (4 activities of daily living. This tool was translated into Tamil and verbally administered to 55 new low vision referral patients before their first visit at the low vision clinic at Aravind Eye Hospital. Low vision aids (LVAs were prescribed at the discretion of the low vision specialist. 1-month later, the same questionnaire was administered over the phone. Results: About 44 of 55 low vision patients completed baseline and follow-up LVQOL surveys, and 30 normal vision controls matched for age, gender, and education were also surveyed (average 117.34 points. After the low vision clinic visit, the low vision group demonstrated a 4.55-point improvement in quality of life (from 77.77 to 82.33 points, P = 0.001. Adjusting for age, gender, and education, the low vision patients who also received LVAs (n = 24 experienced an even larger increase than those who did not (n = 20 (8.89 points, P < 0.001. Conclusion: Low vision services and visual aids can improve the quality of life in South Indian rural population regardless of age, gender, and education level. Thus, all low vision patients who meet the criteria should be referred for evaluation. 186. Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: a cohort study Directory of Open Access Journals (Sweden)

Cleghorn Geoffrey 2010-05-01 Full Text Available Abstract Background Length of hospital stay (LOS is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Identifying pretreatment factors associated with LOS in surgical patients may enable early intervention in order to reduce postoperative LOS. Methods This cohort study enrolled 157 patients with suspected or proven gynecological cancer at a tertiary cancer centre (2004-2006. Before commencing treatment, the scored Patient Generated - Subjective Global Assessment (PG-SGA measuring nutritional status and the Functional Assessment of Cancer Therapy-General (FACT-G scale measuring quality of life (QOL were completed. Clinical and demographic patient characteristics were prospectively obtained. Patients were grouped into those with prolonged LOS if their hospital stay was greater than the median LOS and those with average or below average LOS. Results Patients' mean age was 58 years (SD 14 years. Preoperatively, 81 (52% patients presented with suspected benign disease/pelvic mass, 23 (15% with suspected advanced ovarian cancer, 36 (23% patients with suspected endometrial and 17 (11% with cervical cancer, respectively. In univariate models prolonged LOS was associated with low serum albumin or hemoglobin, malnutrition (PG-SGA score and PG-SGA group B or C, low pretreatment FACT-G score, and suspected diagnosis of cancer. In multivariable models, PG-SGA group B or C, FACT-G score and suspected diagnosis of advanced ovarian cancer independently predicted LOS. Conclusions Malnutrition, low quality of life scores and being diagnosed with advanced ovarian cancer are the major determinants of prolonged LOS amongst gynecological cancer patients. Interventions addressing malnutrition and poor QOL may decrease LOS in gynecological cancer patients. 187. Symptoms and health-related quality of life in patients with advanced cancer DEFF Research Database (Denmark) Augustussen, Mikaela; Sjøgren, Per; Timm, Helle 2017-01-01 and role functioning and 19% had reduced emotional and cognitive functioning. Furthermore, 48% reported fatigue, and 33% reported financial problems. The Greenlandic version of the EORTC had good applicability in the assessment of symptoms and quality of life. Acceptable Cronbach's alpha coefficients...... functioning. This indicates a potential for improving palliative care service and increasing the focus on symptom management. The Greenlandic version of the EORTC-QLQ-C30 represents an applicable and reliable tool to describe symptoms and health-related quality of life among Greenlandic patients with advanced...... (above 0.70) were observed for the physical, role and social functioning scales, the fatigue scale and the global health status scale. Conclusions Patients with undergoing palliative treatment in Greenland for advanced cancer reported high levels of social and financial problems and reduced physical... 188. Improving quality of life in patients with advanced cancer: Targeting metastatic bone pain OpenAIRE von Moos, Roger; Costa, Luis; Ripamonti, Carla Ida; Niepel, Daniela; Santini, Daniele 2017-01-01 Metastatic bone disease in patients with advanced cancer is frequently associated with skeletal complications. These can be debilitating, causing pain, impaired functioning and decreased quality of life, as well as reduced survival. This review considers how the management of metastatic bone pain might be optimised, to limit the considerable burden it can impose on affected patients. Cancer-related pain is notoriously under-reported and under-treated, despite the availability of many therapeu... 189. End-of-Life Decisions and Palliative Care in Advanced Heart Failure. Science.gov (United States) Meyers, Deborah E; Goodlin, Sarah J 2016-09-01 Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decisionmaking for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and riskscoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions. 190. Life-Cycle Assessment of Advanced Nutrient Removal Technologies for Wastewater Treatment. Science.gov (United States) Rahman, Sheikh M; Eckelman, Matthew J; Onnis-Hayden, Annalisa; Gu, April Z 2016-03-15 Advanced nutrient removal processes, while improving the water quality of the receiving water body, can also produce indirect environmental and health impacts associated with increases in usage of energy, chemicals, and other material resources. The present study evaluated three levels of treatment for nutrient removal (N and P) using 27 representative treatment process configurations. Impacts were assessed across multiple environmental and health impacts using life-cycle assessment (LCA) following the Tool for the Reduction and Assessment of Chemical and Other Environmental Impacts (TRACI) impact-assessment method. Results show that advanced technologies that achieve high-level nutrient removal significantly decreased local eutrophication potential, while chemicals and electricity use for these advanced treatments, particularly multistage enhanced tertiary processes and reverse osmosis, simultaneously increased eutrophication indirectly and contributed to other potential environmental and health impacts including human and ecotoxicity, global warming potential, ozone depletion, and acidification. Average eutrophication potential can be reduced by about 70% when Level 2 (TN = 3 mg/L; TP = 0.1 mg/L) treatments are employed instead of Level 1 (TN = 8 mg/L; TP = 1 mg/L), but the implementation of more advanced tertiary processes for Level 3 (TN = 1 mg/L; TP = 0.01 mg/L) treatment may only lead to an additional 15% net reduction in life-cycle eutrophication potential. 191. Exposure to vehicular traffic is associated to a higher risk of hospitalization for bronchiolitis during the first year of life. Science.gov (United States) Lanari, Marcello; Vandini, Silvia; Prinelli, Federica; Adorni, Fulvio; DI Santo, Simona; Silvestri, Michela; Musicco, Massimo 2016-12-01 The most common cause of hospitalization for children younger than age one is bronchiolitis. Several prenatal and environmental risk factors may affect the incidence of hospitalization for bronchiolitis. The aim of this study was to investigate the relation between exposure to vehicular traffic and the incidence of hospitalization for bronchiolitis in children during their first year of life in Italy. A multicenter prospective birth cohort study, where equal numbers of newborns of 33-34, 35-37 and ≥38 wGA were recruited at birth (1814 children) in 30 Italian neonatology units. Two interviewer-administered questionnaires were used to collect data. The first interview was carried out at the end of the Italian epidemic season. The second interview was carried out when the child was one year old. Data on possible prenatal, perinatal, and postnatal/environmental risk factors and on vehicular traffic density in the zone of residence were collected. On each interview, parents were also asked about any hospitalizations of the child. The outcome measure was the hospitalization for bronchiolitis (International Health Service ICD-9 code 466). Univariate analysis demonstrated that exposure to air pollution due to vehicular traffic, was significantly associated with an increased risk of hospitalization for bronchiolitis. The adjusted risk from logistic regression model confirmed that children exposed to air pollution due to vehicular traffic were at increased risk of hospitalization for bronchiolitis. Exposure to air pollution due to vehicular traffic may increase the risk of hospitalization for bronchiolitis in the first year of life. 192. Most prevalent unmet supportive care needs and quality of life of breast cancer patients in a tertiary hospital in Malaysia. Science.gov (United States) Edib, Zobaida; Kumarasamy, Verasingam; Binti Abdullah, Norlia; Rizal, A M; Al-Dubai, Sami Abdo Radman 2016-02-22 Addressing breast cancer patients' unmet supportive care needs in the early stage of their survivorship have become a prime concern because of its significant association with poor quality of life (QOL), which in turn increases healthcare utilization and costs. There is no study about unmet supportive care needs of breast cancer patients in Malaysia. This study aims to assess the most prevalent unmet supportive care needs of Malaysian breast cancer patients and the association between QOL and patients' characteristics, and their unmet supportive care needs. A cross-sectional study was conducted at the Surgery and Oncology Clinic between May 2014 and June 2014 in a tertiary hospital in Malaysia. A total of 117 patients out of 133 breast cancer patients recruited by universal sampling were interviewed using a structured questionnaire consisted of three parts: participants' socio-demographic and disease characteristics, Supportive Care Needs Survey-Short Form Questionnaire (SCNS-SF34) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30). The highest unmet supportive care needs were observed in the psychological domain (Mean 53.31; SD ± 21.79), followed by physical domain (Mean 38.16; SD ± 27.15). Most prevalent unmet supportive care needs were uncertainty about the future (78.6 %), fears about the cancer spreading (76.1 %), feelings of sadness (69.2 %), feelings about death and dying (68.4 %), concerns about those close to the patient (65.0 %) and feeling down or depressed (65.0 %). Multivariate linear analysis showed that early breast cancer survivors diagnosed at an advanced stage and with greater physical and psychological needs were significantly (p < 0.05) associated with poorer QOL. Most prevalent unmet needs among Malaysian breast cancer patients were found in the psychological domain. Early breast cancer survivors with late stage diagnosis who had more unmet needs in psychological and physical 193. Work-Related Quality of Life among Medical Residents at a University Hospital in Northeastern Thailand. Science.gov (United States) Somsila, Nattamon; Chaiear, Naesinee; Boonjaraspinyo, Sirintip; Tiamkao, Somsak 2015-12-01 1) To assess work-related quality of life (WRQOL) among medical residents at a university hospital in northeast Thailand. 2) To determine the strength of the association between personal and working condition components and WRQOL among medical residents. A descriptive study was used to describe the WRQOL among medical residents. The study population comprised of all 375 residents affiliated with the university hospital. The Thai version of a self-administered work-related quality of life scale-2 was used for data collection. Testing the reliability revealed a Cronbach's alpha of 0.908. Questionnaires were completed by 259 of 375 (68.3%). The study found that the mean rating by residents for overall WRQOL was 113.8 out of 170 (SD 14.8). Most rated WRQOL as moderate (76.6%). The seven sub-factors were rated as moderate to high for employee engagement and control at work, moderate for home/work interface, general well-being and working conditions, high-moderate for job career satisfaction, and low-moderate for stress at work. Relationships between the personal and working condition components and WRQOL were analyzed using binary logistic regression. Residents in minor specialties had a higher WRQOL than those in major specialties (OR 2.522, 95% CI: 1.37, 4.63). Residents who had less than eight duty shifts/week had a higher WRQOL than those with more than eight duty shifts/week (OR 2.263, 95% CI: 1.16, 4.41). Similarly, residents working with less than 80 hours/week had a higher WRQOL than those working more than 80 hours/week (OR 2.344, 95% CI: 1.17, 4.72). A subgroup analyzes of those working in minor specialties showed the trend that working less than eight shifts/month and working less than 80 hours/week had the potential association with good quality of work-life (QWL). This phenomenon is presented in the subgroup analyses of those working in major specialties. Therefore, working hours and number of shifts might have played important role in contributing good QWL 194. hospital African Journals Online (AJOL) Pattern of congenital orthopaedic malformations in an African teaching hospital ... malformation in this environment while congenital hip dislocation (CDH) is rare when .... malformations of radial dysplasia and other congenital malformations. 195. Feasibility and Acceptability of a Dignity Therapy/Life Plan Intervention for Patients With Advanced Cancer. Science.gov (United States) Dose, Ann Marie; Hubbard, Joleen M; Mansfield, Aaron S; McCabe, Pamela J; Krecke, Catherine A; Sloan, Jeff A 2017-09-01 To determine the feasibility and acceptability of a dignity therapy/life plan intervention in the outpatient oncology setting.
. Pilot descriptive study.
. Outpatient clinic in a tertiary oncology center. 
. 18 patients within 12 months after diagnosis undergoing treatment for advanced pancreatic cancer or non-small cell lung cancer.
. Patients received dignity therapy, consisting of a focused life review/values clarification interview session and two subsequent sessions to produce a generativity document, which they can use later as they wish. Participants also wrote a life plan, in which they listed future hopes and dreams. Intervention feasibility and acceptability for patients and oncology clinician satisfaction were assessed.
. Among the 18 patients completing the intervention, almost all felt it was worthwhile, would do it again, had their expectations met or exceeded, would recommend it to others, and said the timing was just right.
. This psychosocial intervention was found to be feasible and acceptable to patients with cancer undergoing active treatment.
. Nurses may be in an ideal position to offer a dignity therapy/life plan intervention to patients with advanced cancer during treatment. 196. DOES URINARY DIVERSION IMPROVE THE QUALITY OF LIFE IN OBSTRUCTIVE UROPATHY SECONDARY TO ADVANCED PELVIC MALIGNANCY? Directory of Open Access Journals (Sweden) Shivashankarappa 2016-02-01 Full Text Available INTRODUCTION The incidence of patients presenting with advanced pelvic malignancy with obstructive uropathy is high in our country. Relentless progress of the malignancy will cause deterioration of renal function, aggravation of pain, infection, deterioration of Quality of Life (QOL, uremia and death. Decreased renal function is considered as a contraindication for palliative chemo and radiotherapy. However urinary diversion in these patients will lead to improvement in renal function and may help in administration of palliative therapy and thus, improve the quality of life of these patients. MATERIALS AND METHODS The present study includes the obstructive uropathy patients secondary to pelvic malignancy referred to our institution for urinary diversion between Jan 2010 to Dec 2014. Total 40 patients were included, of which, 25 patients underwent PCN, 9 patients retrograde DJ stenting, 4 patients refused the treatment, 2 patients were not fit for any intervention due to coagulopathy & comorbid conditions. Of 34 treated patients, 30 were female patients and 4 were male patients. All the patients were explained about the procedure and proper consent taken. Laboratory investigations like CBC, coagulation profile, LFT, routine urine analysis, urine C&S and serum electrolytes were carried out. Haemodialysis was done for 10 patients whose serum creatinine was >6mg% & potassium >6meq. USG guided PCN insertion was done in 8 patients, and in those who failed in this procedure, fluoroscopic C-ARM guided PCN insertion done in 17 patients. Post operatively RFT and serum electrolytes were assessed on 3, 7, 15, & 30th day. PCN catheter was changed once in 3 months. RESULTS 8 patients succeeded in USG guided PCN insertion and 17 patients who failed USG PCN insertion, was done under C–Arm guidance. 3 patients received blood transfusion. No deaths were seen during or post procedure in the hospital. Renal functions improved and normalised in most of the 197. Managing occupations in everyday life for people with advanced cancer at home DEFF Research Database (Denmark) Peoples, Hanne; Brandt, Ã…se; Wæhrens, Eva Elisabet Ejlersen; 2016-01-01 in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data. Results: Managing occupations were manifested in two main categories; 1) Conditions influencing...... limited research that specifically explores how these occupational difficulties are managed. Objective: To describe and explore how people with advanced cancer manage occupations when living at home. Material and methods: A subsample of 73 participants from a larger occupational therapy project took part... 198. Managing occupations in everyday life for people with advanced cancer at home DEFF Research Database (Denmark) Peoples, Hanne; Brandt, Ã…se; Wæhrens, Eva Elisabet Ejlersen; university hospital. Qualitative interviews were performed in the participant’s homes. Interviews were audio recorded and transcribed verbatim. Information on demographic and use of social service was included. Thematic and content analysis were performed. Results: The analysis resulted in a core category......, there are limited research that more specifically explore how these are managed. The objective was to describe and explore how people with advanced cancer manage occupations at home. Material and methods: A qualitative descriptive design was applied. 73 participants were consecutively recruited from a Danish... 199. Advanced services in hospital logistics in the German health service sector National Research Council Canada - National Science Library Kriegel, Johannes; Jehle, Franziska; Dieck, Marcel; Mallory, Patricia 2013-01-01 ...: What are the developmental options to expand the current capabilities of the hospital contract logistics service providers on the basis of the priorities of the decision-makers in the German hospital sector... 200. Meaning and Practice of Palliative Care for Hospitalized Older Adults with Life Limiting Illnesses Directory of Open Access Journals (Sweden) Bethel Ann Powers 2011-01-01 Full Text Available Objective. To illustrate distinctions and intersections of palliative care (PC and end-of-life (EOL services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses. « 8 9 10 11 12 » « 9 10 11 12 13 » 201. Physical activity history and end-of-life hospital and long-term care DEFF Research Database (Denmark) von Bonsdorff, Mikaela B; Rantanen, Taina; Leinonen, Raija 2009-01-01 persons aged 66-98 years at death, who, on average 5.8 years prior to death, had participated in an interview about their current and earlier physical activity. Data on the use of care in the last year of life are register-based data and complete. RESULTS: Men needed on average 96 days (SD 7.0) and women...... had been consistently physically active, whereas use of long-term care did not correlate with physical activity history. Among women, the risk for long-term care was higher for those who had been sedentary (IRR 2.03, 95% CI 1.28-3.21) or only occasionally physically active (IRR 1.60, 95% CI 1.......06-2.43), than for those who had been consistently active from midlife onward, whereas use of hospital care did not correlate with physical activity history. CONCLUSION: People who had been physically active since midlife needed less end-of-life inpatient care but patterns differed between men and women.... 202. [The quality of life after chemotherapy in advanced non-small cell lung cancer patients]. Science.gov (United States) SÅ‚owik-Gabryelska, A; Szczepanik, A; Kalicka, A 1999-01-01 The intensity of complains, short survival and great number of patients makes many oncologists to apply chemotherapy in advanced non-small cell lung cancer/NSCLC/. The achieved median duration of life after chemotherapy was 6 to 12 month. From the other hand non small cell lung cancer chemotherapy is a big burden even to healthy persons. It can worsen the quality of life. That was the reason we evaluated the quality of life after chemotherapy in advanced non small cell lung cancer patients. Taking into account, that the evaluation of quality of life, used in most diseases is useless in advanced NSCLC patients, for appreciation the quality of life in these cases the lung cancer symptoms scale/LCSS/was adopted. In 110 non small cell lung cancer patients in stage IIIB and IV, who received combined chemotherapy by Le Chevalier/Vindesine, Cisplatin, Cyclophosphamide, Lomustin/or by Rosell/Mitomycin, Cyclophosphamide, Cisplatin/the quality of life was evaluated. In 20-persons control group all patients received the symptomatic treatment. In observed group of 110 patients, tumor regressions after 4 courses of chemotherapy allowed to resect cancer in 14 cases, to apply radiotherapy in 42 and to continue chemiotherapy in 23 persons. In every person from above mentioned group the quality of life was evaluated on the basis of intensity of cancer symptoms, accordingly to LCSS. The intensity of cancer symptoms was compared before and after treatment. There were compared; the innensity of complains, weakness, appetite, malnutrition, and hematological, neurological, performans state as well as respiratory sufficiency, infections, cardiac disorders and pain. Apart it, the side effects of applied therapy were assessed in 5 degree scale. The level of hemoglobin, the number of leucocytes, thrombocytes, bilirubine and transaminases in peripheral blood, hematurie, proteinurie, bleedings, appetite, nausea, vomitings, diarrhea, mucosal lesions, infections, skin lesions, cardiac lesions 203. Respiratory syncytial virus hospitalization risk in the second year of life by specific congenital heart disease diagnoses Science.gov (United States) Friedman, Deborah; Fryzek, Jon; Jiang, Xiaohui; Bloomfield, Adam; Ambrose, Christopher S.; Wong, Pierre C. 2017-01-01 Children with hemodynamically significant congenital heart disease (CHD) are at elevated risk of morbidity and mortality due to respiratory syncytial virus (RSV) disease compared to their healthy peers. Previous studies have demonstrated lower RSV hospitalization risk among all children with CHD at 12–23 months of age versus 0–11 months of age. However, RSV hospitalization risk at 12–23 months of age by specific CHD diagnosis has not been characterized. Both case-control and cohort studies were conducted using data from the US National Inpatient Sample from 1997 to 2013 to characterize relative risk of RSV hospitalization among children 12–23 months of age with CHD. Related CHD diagnoses were combined for analysis. Hospitalizations for RSV and unspecified bronchiolitis were described by length of stay, mechanical ventilation use, mortality, and total charges. Over the 17-year period, 1,168,886 live birth hospitalizations with CHD were identified. Multiple specific CHD conditions had an elevated odds ratio or relative risk of RSV hospitalization. Mean total RSV hospitalization charges were significantly higher among children with CHD relative to those without CHD ($19,650 vs $7,939 in 2015 dollars) for this period. Compared to children without CHD, children with Ebstein’s anomaly, transposition of the great arteries, aortic stenosis, heterotaxia, and aortic arch anomalies had 367-, 344-, 203-, 117- and 47-fold increased risk of inpatient RSV mortality, respectively. Unspecified bronchiolitis hospitalization odds and relative risk across CHD diagnoses were similar to those observed with RSV hospitalization; however, unspecified bronchiolitis hospitalizations were associated with shorter mean days of stay and less frequently associated with mechanical ventilation or mortality. Among children with more severe CHD diagnoses, RSV disease remains an important health risk through the second year of life. These data

can help inform decisions regarding 204. Respiratory syncytial virus hospitalization risk in the second year of life by specific congenital heart disease diagnoses. Science.gov (United States) Friedman, Deborah; Fryzek, Jon; Jiang, Xiaohui; Bloomfield, Adam; Ambrose, Christopher S; Wong, Pierre C 2017-01-01 Children with hemodynamically significant congenital heart disease (CHD) are at elevated risk of morbidity and mortality due to respiratory syncytial virus (RSV) disease compared to their healthy peers. Previous studies have demonstrated lower RSV hospitalization risk among all children with CHD at 12-23 months of age versus 0-11 months of age. However, RSV hospitalization risk at 12-23 months of age by specific CHD diagnosis has not been characterized. Both case-control and cohort studies were conducted using data from the US National Inpatient Sample from 1997 to 2013 to characterize relative risk of RSV hospitalization among children 12-23 months of age with CHD. Related CHD diagnoses were combined for analysis. Hospitalizations for RSV and unspecified bronchiolitis were described by length of stay, mechanical ventilation use, mortality, and total charges. Over the 17year period, 1,168,886 live birth hospitalizations with CHD were identified. Multiple specific CHD conditions had an elevated odds ratio or relative risk of RSV hospitalization. Mean total RSV hospitalization charges were significantly higher among children with CHD relative to those without CHD ($19,650 vs $7,939 in 2015 dollars) for this period. Compared to children without CHD, children with Ebstein's anomaly, transposition of the great arteries, aortic stenosis, heterotaxia, and aortic arch anomalies had 367-, 344-, 203-, 117- and 47-fold increased risk of inpatient RSV mortality, respectively. Unspecified bronchiolitis hospitalization odds and relative risk across CHD diagnoses were similar to those observed with RSV hospitalization; however, unspecified bronchiolitis hospitalizations were associated with shorter mean days of stay and less frequently associated with mechanical ventilation or mortality. Among children with more severe CHD diagnoses, RSV disease remains an important health risk through the second year of life. These data can help inform decisions regarding interventions to 205. Calendar Life Studies of Advanced Technology Development Program Gen 1 Lithium Ion Batteries Energy Technology Data Exchange (ETDEWEB) Wright, Randy Ben; Motloch, Chester George 2001-03-01 This report presents the test results of a special calendar-life test conducted on 18650-size, prototype, lithium-ion battery cells developed to establish a baseline chemistry and performance for the Advanced Technology Development Program. As part of electrical performance testing, a new calendar-life test protocol was used. The test consisted of a onceper-day discharge and charge pulse designed to have minimal impact on the cell yet establish the performance of the cell over a period of time such that the calendar life of the cell could be determined. The calendar life test matrix included two states of charge (i.e., 60 and 80%) and four temperatures (40, 50, 60, and 70°C). Discharge and regen resistances were calculated from the test data. Results indicate that both discharge and regen resistance increased nonlinearly as a function of the test time. The magnitude of the discharge and regen resistance depended on the temperature and state of charge at which the test was conducted. The calculated discharge and regen resistances were then used to develop empirical models that may be useful to predict the calendar life or the cells. 206. Cycle Life Studies of Advanced Technology Development Program Gen 1 Lithium Ion Batteries Energy Technology Data Exchange (ETDEWEB) Wright, Randy Ben; Motloch, Chester George 2001-03-01 This report presents the test results of a special calendar-life test conducted on 18650-size, prototype, lithium-ion battery cells developed to establish a baseline chemistry and performance for the Advanced Technology Development Program. As part of electrical performance testing, a new calendar-life test protocol was used. The test consisted of a onceper-day discharge and charge pulse designed to have minimal impact on the cell yet establish the performance of the cell over a period of time such that the calendar life of the cell could be determined. The calendar life test matrix included two states of charge (i.e., 60 and 80%) and four temperatures (40, 50, 60, and 70°C). Discharge and regen resistances were calculated from the test data. Results indicate that both discharge and regen resistance increased nonlinearly as a function of the test time. The magnitude of the discharge and regen resistance depended on the temperature and state of charge at which the test was conducted. The calculated discharge and regen resistances were then used to develop empirical models that may be useful to predict the calendar life or the cells. 207. Students′ satisfaction to hybrid problem-based learning format for basic life support/advanced cardiac life support teaching Directory of Open Access Journals (Sweden) Geetanjali Chilkoti 2016-01-01 Full Text Available Background and Aims: Students are exposed to basic life support (BLS and advanced cardiac life support (ACLS training in the first semester in some medical colleges. The aim of this study was to compare students′ satisfaction between lecture-based traditional method and hybrid problem-based learning (PBL in BLS/ACLS teaching to undergraduate medical students. Methods: We conducted a questionnaire-based, cross-sectional survey among 118 1 st -year medical students from a university medical college in the city of New Delhi, India. We aimed to assess the students′ satisfaction between lecture-based and hybrid-PBL method in BLS/ACLS teaching. Likert 5-point scale was used to assess students′ satisfaction levels between the two teaching methods. Data were collected and scores regarding the students′ satisfaction levels between these two teaching methods were analysed using a two-sided paired t-test. Results: Most students preferred hybrid-PBL format over traditional lecture-based method in the following four aspects; learning and understanding, interest and motivation, training of personal abilities and being confident and satisfied with the teaching method (P < 0.05. Conclusion: Implementation of hybrid-PBL format along with the lecture-based method in BLS/ACLS teaching provided high satisfaction among undergraduate medical students. 208. The Relation of Work, Family Balance, and Life Quality of Nurses Working at Teaching Hospitals of Kerman-Iran Directory of Open Access Journals (Sweden) Zeynab Sedoughi 2016-08-01 Full Text Available Background: Work and family are the source of tranquility and if the balance between these two is not provided, pleasure, happiness and peace of human being would be lost, which will cause unreturnable loss for him. Regarding the importance of nurses’ role in health system, the present study aimed to study the relation of work-family balance and quality of life of nurses working at selected Iranian teaching hospitals. Methods: Present study is a cross sectional, descriptive-analytical study which was carried out on 306 nurses working at three teaching hospitals of Iran. The sampling method was stratified sampling and questionnaire was the data collection instrument. Data analysis was carried out using inferential statistics through SPSS Ver18. Findings: nurses spent more time to work than family and they had more satisfaction of their family life than their work. This suggests the imbalance of nurses in two dimension of time balance and satisfaction balance, which has resulted a decrease in quality of life of studied nurses. Nurse’s involvement in work and life as the third component of work-life balance concept, was balanced and it did not indicate significant correlation with quality of life. Nurses experiencing less workfamily conflict and more stress in their life, had higher level of quality of life. Conclusion: Nurses will be more exposed to the negative outcomes of work-life imbalance than other groups of employees, so paying attention to managing the demands of work and family aimed at improving the nurses’ quality of life, has specific importance. Hence, designing a plan which defines main components of work-family balance among various groups of hospital staff including nurses, should be put at the top agenda of Iran’s health system policy makers. 209. Estimated costs of advanced lung cancer care in a public reference hospital. Science.gov (United States) Knust, Renata Erthal; Portela, Margareth Crisóstomo; Pereira, Claudia Cristina de Aguiar; Fortes, Guilherme Bastos 2017-08-17 To estimate the direct medical costs of advanced non-small cell lung cancer care. We assessed a cohort of 277 patients treated in the Brazilian National Cancer Institute in 2011. The costs were estimated from the perspective of the hospital as a service provider of reference for the Brazilian Unified Health System. The materials and procedures used were identified and quantified, per patient, and we assigned to them monetary values, consolidated in phases of the assistance defined. The analyses had a descriptive character with costs in Real (R$). Overall, the cohort represented a cost of R$2,473,559.91, being 71.5% related to outpatient care and 28.5% to hospitalizations. In the outpatient care, costs with radiotherapy (34%) and chemotherapy (22%) predominated. The results pointed to lower costs in the initial phase of treatment (7.2%) and very high costs in the maintenance phase (61.6%). Finally, we identified statistically significant differences of average cost by age groups, education levels, physical performance, and histological type. This study provides a current, useful, and relevant picture of the costs of patients with non-small cell lung cancer treated in a public hospital of reference and it provides information on the magnitude of the problem of cancer in the context of public health. The results confirm the importance of radiation treatment and hospitalizations as the main components of the cost of treatment. Despite some losses of follow-up, we assess that, for approximately 80% of the patients included in the study, the estimates presented herein are satisfactory for the care of the disease, from the perspective of a service provider of reference of the Brazilian Unified Health System, as it provides elements for the management of the service, as well as for studies that result in more rational forms of resource allocation. Estimar os custos médicos diretos da assistência ao câncer de pulmão não pequenas células avançado. Foi avaliada uma 210. End-of-life costs of medical care for advanced stage cancer patients Directory of Open Access Journals (Sweden) KovaÄević Aleksandra 2015-01-01 Full Text Available Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care, hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25% had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR and the lowest (4.00 EUR ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs, followed by oncology medical care (21%, radiation therapy and interventional radiology (11%, surgery (9%, imaging diagnostics (9% and laboratory costs (8%. Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [Projekat Ministarstva nauke 211. Delay in referring and related factors in patients with advanced breast cancer - Emam Hospital (2000 Directory of Open Access Journals (Sweden) "Ghaem Maghami F 2002-07-01 Full Text Available Background: The aim of study was to determine the frequency of delay referring and related factors in patients with advanced breast cancer, in Imam Khomeini Hospital in the 2000. Materials and Methods: Successively 200 patients were entered the study if they were consentient. A questionnaire was constructed and information was obtained through interviewing. Results: From the cases, 64 patients (32 percent referred without delay and 136 patients (68 percent referred tardily. The patients who were late in comparison with patients who didn’t late, had significantly higher mean age (P=0.004, lower education level (P=0.002, and lower economic status (P=0.001. The frequency rate of single were lower among them (P=0.001, fewer percent were residual of big cities (P=0.01 and they had less rate of available physician (P=0.004. 24.3 percent of delay referring patients and 53.1 percent of patients without delay has a positive family history of breast cancer (P=0.001. 62.5 percent of delay referring patients and 85 percent of patients without delay were aware about importance of Self Breast Examination (S.B.E (P=0.002 and respectively 84.4 percent and 98.4 percent were award about symptoms of breast cancer (P=0.01. 23.5 percent and 33 percent of patients with and without delay Knew the method of B.S.E respectively. It wasn’t a significant difference. Conclusion: Lack of awareness about necessity of medical consultation, fear, carelessly, unavailable physician and poverty were the major causes of delay in patients who referred late. 212. Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest. Science.gov (United States) Ohashi-Fukuda, Naoko; Fukuda, Tatsuma; Doi, Kent; Morimura, Naoto 2017-05-01 Respiratory care may be important in pediatric out-of-hospital cardiac arrest (OHCA) due to the asphyxial nature of the majority of events. However, evidence of the effect of prehospital advanced airway management (AAM) for pediatric OHCA is scarce. This was a nationwide population-based study of pediatric OHCA in Japan from 2011 to 2012 based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients aged between 1 and 17 years old. The primary outcome was one-month neurologically favorable survival defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1-2 (corresponding to a Pediatric CPC score of 1-3). A total of 2157 patients were included in the final cohort; 365 received AAM and 1792 received bag-valve-mask (BVM) ventilation only. Among the 2157 patients, 213 (9.9%) survived with favorable neurological outcomes (CPC of 1-2) one month after OHCA. There were no significant differences in neurologically favorable survival between the AAM and BVM groups after adjusting for potential confounders, although there was a tendency favoring BVM ventilation: propensity score matching, OR 0.74 (95%CI 0.35-1.59), and multivariable logistic regression modeling, ORadjusted 0.55 (95%CI 0.24-1.14). Subgroup analyses demonstrated that there were no subgroups in which AAM was associated with neurologically favorable survival, including the non-cardiac (primarily asphyxial) etiology group. In pediatric OHCA, prehospital AAM was not associated with an increased chance of neurologically favorable survival compared with BVM-only ventilation. However, careful consideration is required to interpret the findings, as there may be unmeasured residual confounders and selection bias. Copyright © 2017 Elsevier B.V. All rights reserved. 213. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel Directory of Open Access Journals (Sweden) Camila Uanne Resende Avelino 2015-04-01 Full Text Available OBJECTIVE: Non-small cell lung carcinoma (NSCLC is the most common type of lung cancer. Most patients are diagnosed at an advanced stage, palliative chemotherapy therefore being the only treatment option. This study was aimed at evaluating the health-related quality of life (HRQoL of advanced-stage NSCLC patients receiving palliative chemotherapy with carboplatin and paclitaxel. METHODS: This was a multiple case study of advanced-stage NSCLC outpatients receiving chemotherapy at a public hospital in Rio de Janeiro, Brazil. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire was used in conjunction with its supplemental lung cancer-specific module in order to assess HRQoL. RESULTS: Physical and cognitive functioning scale scores differed significantly among chemotherapy cycles, indicating improved and worsened HRQoL, respectively. The differences regarding the scores for pain, loss of appetite, chest pain, and arm/shoulder pain indicated improved HRQoL. CONCLUSIONS: Chemotherapy was found to improve certain aspects of HRQoL in patients with advanced-stage NSCLC. 214. Experimental Creep Life Assessment for the Advanced Stirling Convertor Heater Head Science.gov (United States) Krause, David L.; Kalluri, Sreeramesh; Shah, Ashwin R.; Korovaichuk, Igor 2010-01-01 The United States Department of Energy is planning to develop the Advanced Stirling Radioisotope Generator (ASRG) for the National Aeronautics and Space Administration (NASA) for potential use on future space missions. The ASRG provides substantial efficiency and specific power improvements over radioisotope power systems of heritage designs. The ASRG would use General Purpose Heat Source modules as energy sources and the free-piston Advanced Stirling Convertor (ASC) to convert heat into electrical energy. Lockheed Martin Corporation of Valley Forge, Pennsylvania, is integrating the ASRG systems, and Sunpower, Inc., of Athens, Ohio, is designing and building the ASC. NASA Glenn Research Center of Cleveland, Ohio, manages the Sunpower contract and provides technology development in several areas for the ASC. One area is reliability assessment for the ASC heater head, a critical pressure vessel within which heat is converted into mechanical oscillation of a displacer piston. For high system efficiency, the ASC heater head operates at very high temperature (850 C) and therefore is fabricated from an advanced heat-resistant nickel-based superalloy Microcast MarM-247. Since use of MarM247 in a thin-walled pressure vessel is atypical, much effort is required to assure that the system will operate reliably for its design life of 17 years. One life-limiting structural response for this application is creep; creep deformation is the accumulation of time-dependent inelastic strain under sustained loading over time. If allowed to progress, the deformation eventually results in creep rupture. Since creep material properties are not available in the open literature, a detailed creep life assessment of the ASC heater head effort is underway. This paper presents an overview of that creep life assessment approach, including the reliability-based creep criteria developed from coupon testing, and the associated heater head deterministic and probabilistic analyses. The approach also 215. Physical sciences and engineering advances in life sciences and oncology a WTEC global assessment CERN Document Server Fletcher, Daniel; Gerecht, Sharon; Levine, Ross; Mallick, Parag; McCarty, Owen; Munn, Lance; Reinhart-King, Cynthia 2016-01-01 This book presents an Assessment of Physical Sciences and Engineering Advances in Life Sciences and Oncology (APHELION) by a panel of experts. It covers the status and trends of applying physical sciences and engineering principles to oncology research in leading laboratories and organizations in Europe and Asia. The book elaborates on the six topics identified by the panel that have the greatest potential to advance understanding and treatment of cancer, each covered by a chapter in the book. The study was sponsored by the National Cancer Institute (NCI) at the National Institute of Health (NIH), the National Science Foundation (NSF) and the National Institute of Biomedical Imaging and Bioengineering at the NIH in the US under a cooperative agreement with the World Technology Evaluation Center (WTEC). 216. Poststroke anxiety disorders in a Nigerian hospital: Prevalence, associated factors, and impacts on quality of life Directory of Open Access Journals (Sweden) Osunwale Dahunsi Oni 2017-01-01 Full Text Available Background and Purpose: Anxiety disorders impact negatively on morbidity and mortality poststroke. Few studies have, however, been done on poststroke anxiety disorders (PSAD, particularly in Africa. The study aims to determine the prevalence, associated clinicodemographic factors, and impact of PSAD on quality of life (QoL among outpatients at a tertiary hospital in Nigeria. Methods: Seventy stroke survivors attending Outpatient Clinics at Lagos University Teaching Hospital, Nigeria, were recruited into the study. Participants were assessed using sociodemographic/clinical questionnaire, the modified Mini–Mental State Examination, the Modified Rankin Scale, the Schedule for Clinical Assessment in Neuropsychiatry, and the World Health Organization-QoL-Bref. Data collection took 5 months and analyzed using the Statistical Package for the Social Sciences (SPSS® software version 17.0. Results: The mean age of respondents was 57.43 (±9.67 years and 38 respondents (54% were male. Majority of the stroke survivors had infarctive stroke 55 (78.6%, right hemispheric lesions 37 (52.9%, and significant poststroke disabilities 57 (81.4%. The prevalence of PSAD was 10% and agoraphobia with panic attacks was elicited in 42.8% of those diagnosed with PSAD. Participants with PSAD were significantly more likely to be unemployed (P = 0.01 and pay more than ₦10,000 ($62.50 at December 2013 monthly for health care. The mean QoL scores were lower in participants with PSAD across all QoL spheres, and significantly so for overall health (P = 0.04, health satisfaction (P = 0.02, and physical health (P = 0.01 domains. Conclusion: PSAD, especially agoraphobia in association with unemployment and high health-care costs correlated with poor well-being among stroke survivors. Proactive measures to ensure prompt identification and management may potentially improve outcome and QoL after stroke. 217. The importance of older patients ’ experiences with care delivery for their quality of life after hospitalization NARCIS (Netherlands) J.M. Hartgerink (Jacqueline); J.M. Cramm (Jane); T.J.E.M. Bakker (Ton); J.P. Mackenbach (Johan); A.P. Nieboer (Anna) 2015-01-01 markdownabstractAbstract Background:Older patients’experiences with care delivery may be important for their quality of life over time.Evidence is however lacking. Therefore, this study aims to identify the longitudinal relationship between older patients’experiences with hospital care, perceived 218. Assessment of Advanced Life Support competence when combining different test methods--reliability and validity DEFF Research Database (Denmark) Ringsted, C; Lippert, F; Hesselfeldt, R 2007-01-01 Summary Robust assessment of Advanced Life Support (ALS) competence is paramount to the credibility of ALS-provider certification and for estimating the learning outcome and retention of ALS competence following the courses. The Euro- pean Resuscitation Council (ERC) provides two sets of MCQs and...... Correlation Coefficients between 0.766 and 0.977. Inter-rater agreements on pass/fail decisions were not perfect. The one MCQ test was significantly more difficult than the other. There were no significant differences between CASTests.... 219. Advanced Trauma Life Support. ABCDE from a radiological point of view. Science.gov (United States) Kool, Digna R; Blickman, Johan G 2007-07-01 Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support(R) (ATLS) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS, and we will discuss discrepancies with day to day practice and the radiological literature. Because the ATLS is neither thorough nor up-to-date concerning several parts of radiology in trauma, it should not be adopted without serious attention to defining the indications and limitations pertaining to diagnostic imaging. 220. Advanced Trauma Life Support®. ABCDE from a radiological point of view OpenAIRE 2007-01-01 Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support® (ATLS®) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS®, and we will discuss discrepancies with day to day practice and the radiological literature. Because the ATLS® is neither thorough nor up-to-date concerning several parts of radiology in trauma, it should not be adopted without serious a... « 9 10 11 12 13 » « 10 11 12 13 14 » 221. Considerations in miniaturizing simplified agro-ecosystems for advanced life support

Science.gov (United States) Volk, T. 1996-01-01 Miniaturizing the Earth's biogeochemical cycles to support human life during future space missions is the goal of the NASA research and engineering program in advanced life support. Mission requirements to reduce mass, volume, and power have focused efforts on (1) a maximally simplified agro-ecosystem of humans, food crops, and microbes; and, (2) a design for optimized productivity of food crops with high light levels over long days, with hydroponics, with elevated carbon dioxide and other controlled environmental factors, as well as with genetic selection for desirable crop properties. Mathematical modeling contributes to the goals by establishing trade-offs, by analyzing the growth and development of experimental crops, and by pointing to the possibilities of directed phasic control using modified field crop models to increase the harvest index. 222. Demonstration of Advanced Technologies for Multi-Load Washers in Hospitality and Healthcare -- Wastewater Recycling Technology Energy Technology Data Exchange (ETDEWEB) Boyd, Brian K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Parker, Graham B. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Petersen, Joseph M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Sullivan, Greg [Efficiency Solutions, LLC (United States); Goetzler, W. [Navigant Consulting, Inc. (United States); Foley, K. J. [Navigant Consulting, Inc. (United States); Sutherland, T. A. [Navigant Consulting, Inc. (United States) 2014-08-14 The objective of this demonstration project was to evaluate market-ready retrofit technologies for reducing the energy and water use of multi-load washers in healthcare and hospitality facilities. Specifically, this project evaluated laundry wastewater recycling technology in the hospitality sector and ozone laundry technology in both the healthcare and hospitality sectors. This report documents the demonstration of a wastewater recycling system installed in the Grand Hyatt Seattle. 223. Effort-reward imbalance and quality of life of healthcare workers in military hospitals: a cross-sectional study Directory of Open Access Journals (Sweden) Tzeng Dong-Sheng 2012-09-01 Full Text Available Abstract Background Taiwan’s National Defense Bureau has been merging its hospitals and adjusting hospital accreditation levels since the beginning of 2006. These changes have introduced many stressors to the healthcare workers in these hospitals. This study investigates the association between job stress, psychological morbidity and quality of life in healthcare workers in three military hospitals. Methods We posted surveys to 1269 healthcare workers in three military hospitals located in southern Taiwan. The surveys included the General Health Questionnaire (GHQ, the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF, and the Effort-Reward Imbalance (ERI Questionnaire. High effort-reward (ER ratio and overcommitment were defined when scores fell into the upper tertile of the total distribution. Results The survey was completed by 791 healthcare workers. On average, women reported a higher ERI than men. High ERI was associated with younger age, higher psychological morbidity, and poor physical and psychological QOL domains in this population. High ER ratio and high overcommitment were associated with psychological morbidity and poor QOL in both sexes. However, high ER ratio was not significantly associated with the social QOL domain in either sexes or the physical QOL domain in males. Conclusions There was a clear association between ERI and QOL in the healthcare workers in the military hospitals under reorganization and accreditation in this study. We found ER ratio and overcommitment to be suitable indicators of job stress. 224. Effort-reward imbalance and quality of life of healthcare workers in military hospitals: a cross-sectional study. Science.gov (United States) Tzeng, Dong-Sheng; Chung, Wei-Ching; Lin, Chi-Hung; Yang, Chun-Yuh 2012-09-08 Taiwan's National Defense Bureau has been merging its hospitals and adjusting hospital accreditation levels since the beginning of 2006. These changes have introduced many stressors to the healthcare workers in these hospitals. This study investigates the association between job stress, psychological morbidity and quality of life in healthcare workers in three military hospitals. We posted surveys to 1269 healthcare workers in three military hospitals located in southern Taiwan. The surveys included the General Health Questionnaire (GHQ), the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), and the Effort-Reward Imbalance (ERI) Questionnaire. High effort-reward (ER) ratio and overcommitment were defined when scores fell into the upper tertile of the total distribution. The survey was completed by 791 healthcare workers. On average, women reported a higher ERI than men. High ERI was associated with younger age, higher psychological morbidity, and poor physical and psychological QOL domains in this population. High ER ratio and high overcommitment were associated with psychological morbidity and poor QOL in both sexes. However, high ER ratio was not significantly associated with the social QOL domain in either sexes or the physical QOL domain in males. There was a clear association between ERI and QOL in the healthcare workers in the military hospitals under reorganization and accreditation in this study. We found ER ratio and overcommitment to be suitable indicators of job stress. 225. Crop Production for Advanced Life Support Systems - Observations From the Kennedy Space Center Breadboard Project Science.gov (United States) Wheeler, R. M.; Sager, J. C.; Prince, R. P.; Knott, W. M.; Mackowiak, C. L.; Stutte, G. W.; Yorio, N. C.; Ruffe, L. M.; Peterson, B. V.; Goins, G. D. 2003-01-01 The use of plants for bioregenerative life support for space missions was first studied by the US Air Force in the 1950s and 1960s. Extensive testing was also conducted from the 1960s through the 1980s by Russian researchers located at the Institute of Biophysics in Krasnoyarsk, Siberia, and the Institute for Biomedical Problems in Moscow. NASA initiated bioregenerative research in the 1960s (e.g., Hydrogenomonas) but this research did not include testing with plants until about 1980, with the start of the Controlled Ecological Life Support System (CELSS) Program. The NASA CELSS research was carried out at universities, private corporations, and NASA field centers, including Kennedy Space Center (KSC). The project at KSC began in 1985 and was called the CELSS Breadboard Project to indicate the capability for plugging in and testing various life support technologies; this name has since been dropped but bioregenerative testing at KSC has continued to the present under the NASA s Advanced Life Support (ALS) Program. A primary objective of the KSC testing was to conduct pre-integration tests with plants (crops) in a large, atmospherically closed test chamber called the Biomass Production Chamber (BPC). Test protocols for the BPC were based on observations and growing procedures developed by university investigators, as well as procedures developed in plant growth chamber studies at KSC. Growth chamber studies to support BPC testing focused on plant responses to different carbon dioxide (CO2) concentrations, different spectral qualities from various electric lamps, and nutrient film hydroponic culture techniques. 226. Influence of comorbidity on survival, toxicity and health-related quality of life in patients with advanced non-small-cell lung cancer receiving platinum-doublet chemotherapy DEFF Research Database (Denmark) Grønberg, Bjørn H; Sundstrøm, Stein; Kaasa, Stein; 2010-01-01 AIM OF THE STUDY: To investigate whether patients with severe comorbidity receiving platinum-based chemotherapy for advanced non-small-cell lung cancer (NSCLC) have a shorter overall survival, experience more toxicity or more deterioration of health-related quality of life (HRQoL) than other....... Comorbidity was assessed from hospital medical records using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Toxicity was graded using the CTCAE v3.0 and the patients reported HRQoL on the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30...... neutropenic fevers (12% versus 5%; p=.012) and deaths from neutropenic infections (3% versus 0%; p=.027). They had more thrombocytopenia (46% versus 36%; p=.03), but not more thrombocytopenic bleedings (3% versus 4%; p=.65). In general, the patients with severe comorbidity reported poorer HRQoL... 227. Relationship between Quality of Work-Life and Job Satisfaction of the Employees in Public Hospitals in Rasht Directory of Open Access Journals (Sweden) Mehrdad Goudarznand-Chegini 2012-04-01 Full Text Available Background: The aim of this study was to determine the relationship between quality of work-life and job satisfaction regarding their educational level of hospital employees in Rasht, Gilan.Materials and Method: Statistical society included 2,800 staffs of governmental hospitals in Rasht, in which 338 persons were selected by categorized sampling. Using a standard questionnaire, we collected necessary data and analyzed them using Pearson correlation, correlation coefficient and regression analysis.Results: Our findings showed that between each component of the quality of working life and job satisfaction of employees with 99% confidence level and 1% alpha according to the correlation coefficient (R and a significant positive relationship.Conclusion: Overall results expression and a significant positive correlation between the components of quality of work life and job satisfaction and variable reduction effect on the severity of education relationship between dependent and independent variables 228. The Study of Life Change Unit as Stressor Agents among Tehran University of Medical Sciences Hospitals' Employees Directory of Open Access Journals (Sweden) Hossein Dargahi 2010-08-01 Full Text Available Life crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (Life Change Unit Rating. This allocates a number of Life Crisis Units or Life Change Units (LCUs to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A Cross - sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS Employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range and 60% of them have 150300 or more than 300 LCU rating (abnormal range. In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger. 229. The study of life change unit as stressor agents among Tehran University of Medical Sciences Hospitals' employees. Science.gov (United States) Dargahi, Hossein; Sharifiy Yazdi, Mohammad Kazem 2010-01-01 Life crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (life change unit) rating. This allocates a number of life crisis units or life change units (LCUs) to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A cross-sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS) employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range) and 60% of them have 150-300 or more than 300 LCU rating (abnormal range). In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger. 230. The Study of Life Change Unit as Stressor Agents among Tehran University of Medical Sciences Hospitals' Employees Directory of Open Access Journals (Sweden) Hossein Dargahi 2010-07-01 Full Text Available "nLife crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (Life Change Unit Rating. This allocates a number of Life Crisis Units or Life Change Units (LCUs to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A Cross - sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS Employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range and 60% of them have 150300 or more than 300 LCU rating (abnormal range. In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger. 231. Does hospital need more hospice beds? Hospital charges and length of stays by lung cancer inpatients at their end of life: A retrospective cohort design of 2002-2012. Science.gov (United States) Kim, Sun Jung; Han, Kyu-Tae; Kim, Tae Hyun; Park, Eun-Cheol 2015-10-01 Previous studies found that hospice and palliative care reduces healthcare costs for end-of-life cancer patients. To investigate hospital inpatient charges and length-of-stay differences by availability of hospice care beds within hospitals using nationwide data from end-of-life inpatients with lung cancer. A retrospective cohort study was performed using nationwide lung cancer health insurance claims from 2002 to 2012 in Korea. Descriptive and multi-level (patient-level and hospital-level) mixed models were used to compare inpatient charges and lengths of stay. Using 673,122 inpatient health insurance claims, we obtained aggregated hospital inpatient charges and lengths of stay from a total of 114,828 inpatients and 866 hospital records. Hospital inpatient charges and length of stay drastically increased as patients approached death; a significant portion of hospital inpatient charges and lengths of stay occurred during the end-of-life period. According to our multi-level analysis, hospitals with hospice care beds tend to have significantly lower end-of-life hospital inpatient charges; however, length of stay did not differ. Hospitals with more hospice care beds were associated with reduction in hospital inpatient charges within 3 months before death. Higher end-of-life healthcare hospital charges were found for lung cancer inpatients who were admitted to hospitals without hospice care beds. This study suggests that health policy-makers and the National Health Insurance program need to consider expanding the use of hospice care beds within hospitals and hospice care facilities for end-of-life patients with lung cancer in South Korea, where very limited numbers of resources are currently available. © The Author(s) 2015. 232. Weighing environmental advantages and disadvantages of advanced wastewater treatment of micro-pollutants using environmental life cycle assessment DEFF Research Database (Denmark) Wenzel, Henrik; Larsen, Henrik Fred; Clauson-Kaas, Jes 2008-01-01 -off was investigated using Life Cycle Assessment (LCA) methodology and based on a literature review of advanced treatment performance. The LCA evaluation comprised sand filtration, ozonation and MBRs and assessed the effect of extending existing tertiary treatment with these technologies on a variety of micro......; life cycle assessment; MBR; micropollutants; ozonation; sand filtration.... 233. Advanced airway management does not improve outcome of out-of-hospital cardiac arrest. Science.gov (United States) Hanif, M Arslan; Kaji, Amy H; Niemann, James T 2010-09-01 The goal of out-of-hospital endotracheal intubation (ETI) is to reduce mortality and morbidity for patients with airway and ventilatory compromise. Yet several studies, mostly involving trauma patients, have demonstrated similar or worse neurologic outcomes and survival-to-hospital discharge rates after out-of-hospital ETI. To date, there is no study comparing out-of-hospital ETI to bag-valve-mask (BVM) ventilation for the outcome of survival to hospital discharge among nontraumatic adult out-of-hospital cardiac arrest (OOHCA) patients. The objective was to compare survival to hospital discharge among adult OOHCA patients receiving ETI to those managed with BVM. In this retrospective cohort study, the records of all OOHCA patients presenting to a municipal teaching hospital from November 1, 1994, through June 30, 2008, were reviewed. The type of field airway provided, age, sex, race, rhythm on paramedic arrival, presence of bystander cardiopulmonary resuscitation (CPR), whether the arrest was witnessed, site of arrest, return of spontaneous circulation (ROSC), survival to hospital admission, comorbid illnesses, and survival to hospital discharge were noted. A univariate odds ratio (OR) was first computed to describe the association between the type of airway and survival to hospital discharge. A multivariable logistic regression analysis was performed, adjusting for rhythm, bystander CPR, and whether the arrest was witnessed. A cohort of 1,294 arrests was evaluated. A total of 1,027 (79.4%) received ETI, while 131 (10.1%) had BVM, 131 (10.1%) had either a Combitube or an esophageal obturator airway, and five (0.4%) had incomplete prehospital records. Fifty-five of 1,294 (4.3%) survived to hospital discharge; there were no survivors in the Combitube/esophageal obturator airway cohort. Even after multivariable adjustment for age, sex, site of arrest, bystander CPR, witnessed arrest, and rhythm on paramedic arrival, the OR for survival to hospital discharge for BVM 234. Intraduodenal levodopa-carbidopa intestinal gel infusion improves both motor performance and quality of life in advanced Parkinson's disease. Science.gov (United States) Chang, Florence C F; Kwan, Vu; van der Poorten, David; Mahant, Neil; Wolfe, Nigel; Ha, Ainhi D; Griffith, Jane M; Tsui, David; Kim, Samuel D; Fung, Victor S C 2016-03-01 We report the efficacy and adverse effect profile of intraduodenal levodopa-carbidopa intestinal gel (LCIG) infusion from patients treated in a single Australian movement disorder centre. We conducted an open-label, 12 month prospective study of treatment with LCIG in patients with advanced Parkinson's disease in a single tertiary referral hospital unit specialising in movement disorders. Patients with levodopa-responsive, advanced Parkinson's disease with motor fluctuations despite optimal pharmacological treatment were enrolled and underwent a 16 hour daily infusion of LCIG for 12 months. Fifteen participants completed the trial. The mean (± standard deviation) improvement in Unified Parkinson's Disease Rating Scale part III was 37 ± 11%, mean daily "off" period reduced from 6.3 ± 2 to 1.9 ± 2 hours, total daily "on" time increased from 10.2 ± 3 to 13.7 ± 2 hours, "on" period without dyskinesia increased from 4.5 ± 3 to 7.5 ± 5 hours, and 39-item Parkinson's Disease Questionnaire Summary Index score improved by 32.5 ± 35%. The most common adverse event was reversible peripheral neuropathy secondary to vitamin B12 ± B6 deficiency (40%), local tube problems (40%), and impulse control disorder (ICD) (27%). No patient had stoma bleeding or peritonitis. All patients with ICD had a past psychiatric diagnosis of depression with or without anxiety and a higher daily levodopa intake at 6 and 12 months of LCIG infusion. Intraduodenal LCIG improves motor performance, quality of life and daily "on" period. Prior to and during duodenal LCIG infusion, clinicians should monitor for peripheral neuropathy and vitamin B12 and B6 deficiency, as supplementation can reverse peripheral neuropathy. This trial is registered at Clinicaltrials.gov as CT00335153. 235. Hospitals DEFF Research Database (Denmark) Mullins, Michael 2013-01-01 focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... in treating disease can be supported by architecture which is sensitive to the contextual conditions of healing in health facilities. It is not the intention to supplant technology, but a question of supplementing the incredible advances that have been made in medicine in recent decades. The central premise...... hour rhythm of sleep, depression, admission length and mortality etc. Sound, in order to keep decibel levels at 40db as recommended, reverberation times, type and quantity of equipment in terms of its noise and how it affects stress levels, acoustic screening to allow privacy and single wards... 236. Improving advanced cardiovascular life support skills in medical students: simulation-based education approach Directory of Open Access Journals (Sweden) Hamidreza Reihani 2015-01-01 Full Text Available Objective: In this trial, we intend to assess the effect of simulation-based education approach on advanced cardiovascular life support skills among medical students. Methods: Through convenient sampling method, 40 interns of Mashhad University of Medical Sciences in their emergency medicine rotation (from September to December 2012 participated in this study. Advanced Cardiovascular Life Support (ACLS workshops with pretest and post-test exams were performed. Workshops and checklists for pretest and post-test exams were designed according to the latest American Heart Association (AHA guidelines. Results: The total score of the students increased significantly after workshops (24.6 out of 100 to 78.6 out of 100. This demonstrates 53.9% improvement in the skills after the simulation-based education (P< 0.001. Also the mean score of each station had a significant improvement (P< 0.001. Conclusion: Pretests showed that interns had poor performance in practical clinical matters while their scientific knowledge, such as ECG interpretation was acceptable. The overall results of the study highlights that Simulation based-education approach is highly effective in Improving ACLS skills among medical students. 237. Technology assessment for the advanced life detector. Final technical report, May 1987-January 1988 Energy Technology Data Exchange (ETDEWEB) Burrows, W.D.; George, D.T. 1988-01-29 This report summarizes an assessment of technology available to develop a noninvasive life detector for use on the battlefield. The detectors determine if casualties wearing chemical protective overgarments are alive or dead without further exposing either the casualties or the aidmen to the contaminated environment. Seven technology approaches sponsored by the Department of Defense (comprising 11 devices), four technologies identified in a market survey, and one device described in a Broad Agency Announcement proposal were examined as candidate Advanced Life Detectors. The technologies and instruments surveyed included three transmitter-receiver technologies, an electrocardiogram (ECG) technology, pacemaker-transmitter/receiver, dry electrode heart rate monitor, five microwave technologies, flash reflectance oximetry, an ultrasound technology, a streaming potential technology, a dry electrode ECG monitor coupled to a microphone, a statometric technique for determining heart rate and blood pressure, and a vital-signs monitor that determines heart rate and blood pressure using blood pressure cuff and microphones incorporated into the cuff. Analysis of the state-of-the-art of each device indicates that none of them are advanced enough to fulfill all the requirements of the draft Joint Services Operational Requirement. Three of the devices identified are recommended for further evaluation. 238. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Science.gov (United States) Sollid, Stephen J M; Lockey, David; Lossius, Hans Morten 2009-11-20 Advanced airway management is a critical intervention that can harm the patient if performed poorly. The available literature on this subject is rich, but it is difficult to interpret due to a huge variability and poor definitions. Several initiatives from large organisations concerned with airway management have recently propagated the need for guidelines and standards in pre-hospital airway management. Following the path of other initiatives to establish templates for uniform data reporting, like the many Utstein-style templates, we initiated and carried out a structured consensus process with international experts to establish a set of core data points to be documented and reported in cases of advanced pre-hospital airway management. A four-step modified nominal group technique process was employed. The inclusion criterion for the template was defined as any patient for whom the insertion of an advanced airway device or ventilation was attempted. The data points were divided into three groups based on their relationship to the intervention, including system-, patient-, and post-intervention variables, and the expert group agreed on a total of 23 core data points. Additionally, the group defined 19 optional variables for which a consensus could not be achieved or the data were considered as valuable but not essential. We successfully developed an Utstein-style template for documenting and reporting pre-hospital airway management. The core dataset for this template should be included in future studies on pre-hospital airway management to produce comparable data across systems and patient populations and will be implemented in systems that are influenced by the expert panel.

239. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management Directory of Open Access Journals (Sweden) Lockey David 2009-11-01 Full Text Available Abstract Background Advanced airway management is a critical intervention that can harm the patient if performed poorly. The available literature on this subject is rich, but it is difficult to interpret due to a huge variability and poor definitions. Several initiatives from large organisations concerned with airway management have recently propagated the need for guidelines and standards in pre-hospital airway management. Following the path of other initiatives to establish templates for uniform data reporting, like the many Utstein-style templates, we initiated and carried out a structured consensus process with international experts to establish a set of core data points to be documented and reported in cases of advanced pre-hospital airway management. Methods A four-step modified nominal group technique process was employed. Results The inclusion criterion for the template was defined as any patient for whom the insertion of an advanced airway device or ventilation was attempted. The data points were divided into three groups based on their relationship to the intervention, including system-, patient-, and post-intervention variables, and the expert group agreed on a total of 23 core data points. Additionally, the group defined 19 optional variables for which a consensus could not be achieved or the data were considered as valuable but not essential. Conclusion We successfully developed an Utstein-style template for documenting and reporting pre-hospital airway management. The core dataset for this template should be included in future studies on pre-hospital airway management to produce comparable data across systems and patient populations and will be implemented in systems that are influenced by the expert panel. 240. Health behaviors and quality of life predictors for risk of hospitalization in an electronic health record-linked biobank Directory of Open Access Journals (Sweden) Takahashi PY 2015-08-01 Full Text Available Paul Y Takahashi,1,2 Euijung Ryu,3 Janet E Olson,3 Erin M Winkler,4 Matthew A Hathcock,3 Ruchi Gupta,3 Jeff A Sloan,3 Jyotishman Pathak,3 Suzette J Bielinski,3 James R Cerhan3 1Division of Primary Care Internal Medicine, 2Department of Internal Medicine, 3Department of Health Sciences Research, 4Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA Background: Hospital risk stratification models using electronic health records (EHRs often use age and comorbid health burden. Our primary aim was to determine if quality of life or health behaviors captured in an EHR-linked biobank can predict future risk of hospitalization. Methods: Participants in the Mayo Clinic Biobank completed self-administered questionnaires at enrollment that included quality of life and health behaviors. Participants enrolled as of December 31, 2010 were followed for one year to ascertain hospitalization. Data on comorbidities and hospitalization were derived from the Mayo Clinic EHR. Hazard ratios (HR and 95% confidence interval (CI were used, adjusted for age and sex. We used gradient boosting machines models to integrate multiple factors. Different models were compared using C-statistic. Results: Of the 8,927 eligible Mayo Clinic Biobank participants, 834 (9.3% were hospitalized. Self-perceived health status and alcohol use had the strongest associations with risk of hospitalization. Compared to participants with excellent self-perceived health, those reporting poor/fair health had higher risk of hospitalization (HR =3.66, 95% CI 2.74–4.88. Alcohol use was inversely associated with hospitalization (HR =0.57 95% CI 0.45–0.72. The gradient boosting machines model estimated self-perceived health as the most influential factor (relative influence =16%. The predictive ability of the model based on comorbidities was slightly higher than the one based on the self-perceived health (C-statistic =0.67 vs 0.65. Conclusion: This study demonstrates that self « 10 11 12 13 14 » « 11 12 13 14 15 » 241. Health-related quality of life among patients with advanced cancer: an integrative review Directory of Open Access Journals (Sweden) Maria Eliane Moreira Freire 2014-04-01 Full Text Available This integrative literature review aimed to characterize scientific articles on health-related quality of life – HRQoL – among patients with advanced cancer from national and international literature, and summarize those factors evidenced in the literature that contributed to the improvement or worsening of HRQoL among patients with advanced cancer. The search for materials was conducted in the following databases: CINAHL, EMBASE, PubMed, SciELO and LILACS. Among the 21 articles in the sample, 13 showed an improvement of HRQoL among patients with advanced cancer related to the development of physical, emotional and spiritual interventions. In eight studies, we identified predictive symptoms of low HRQoL, such as pain, fatigue, sleep disorders, depression, nutritional changes, and others. The results showed that clinical manifestations, which many times were inherent in cancer, such as factors that can lower patients’ HRQoL, while physical, psychological and spiritual benefits resulting from therapeutic interventions may promote its improvement. 242. QUALITY OF LIFE IN PATIENTS WITH PSORIASIS AT A TERTIARY CARE TEACHING HOSPITAL and ndash;A CROSS SECTIONAL STUDY Directory of Open Access Journals (Sweden) Preksha A Barot 2015-06-01 Full Text Available Background: Psoriasis is linked with social stigmatization, pain, discomfort, physical disability and psychological distress. It has a significant negative impact on quality of life. Since there is paucity of the data related to quality of life assessment in Indian psoriatic patients, this study was an earnest attempt in this direction The aim of this study was to evaluate the impact of psoriasis on the quality of life in patients with psoriasis. Materials and Methods: A cross sectional study was carried out in 60 patients at Dermatology outpatient department of a tertiary care teaching hospital. The quality of life assessment was done by DLQI questionnaire in patients above the age of 16 years. Results: The Health related Quality of Life was assessed by DLQI questionnaire in 60 patients at Dermatology outpatient department. The M: F ratio was 2.16:1. The mean DLQI score was 8.95 +/8.48 (Mean +/- SD and 66.7% of the patients had moderate to extremely large impact on the quality of life. Highest DLQI Mean score 15.21 was noted in younger (20-29 yrs age group. Conclusion: Psoriasis is chronic recurring disease and has significant negative impact on patients quality of life. These findings provide significant new insights into factors that affect the life quality of patients with psoriasis. [Natl J Med Res 2015; 5(2.000: 93-97 243. [Health-related quality of life in children with epilepsy in a Mexican hospital]. Science.gov (United States) Dávila-Ãvila, Ned M; Delgado-De la Mora, Jesús; Candia-Plata, M Carmen; Alvarez-Hernández, Gerardo 2014-07-16 Introduccion. La epilepsia es un sindrome neurologico cronico que cursa con descargas anormales, sincronicas y exageradas de la corteza cerebral. La epilepsia se relaciona inversamente con la calidad de vida relacionada con la salud de los pacientes (CVRS); sin embargo, esta relacion se ha documentado poco en niños de Latinoamerica. Objetivo. Examinar la relacion entre epilepsia y la CVRS en un grupo de niños escolares de 8-12 años atendidos en un hospital pediatrico de Sonora, Mexico. Pacientes y metodos. Se comparo transversalmente la CVRS de niños con diagnostico de epilepsia con respecto a la CVRS de dos grupos control. Se utilizo el cuestionario validado Pediatric Quality of Life Inventory para evaluar la CVRS. Las diferencias se examinaron mediante la prueba de ANOVA, y la asociacion entre epilepsia y CVRS se modelo mediante regresion logistica multiple. Resultados. Los niños con epilepsia mostraron la menor puntuacion de CVRS (62,4 ± 14,8) entre los sujetos estudiados, y tuvieron 5,2 veces mas riesgo de deterioro de su CVRS (intervalo de confianza al 95% = 2,43-11,06) en comparacion con el de niños sanos. El deterioro fue mayor en las escalas cognitiva (54,6 ± 15,0) y emocional (55,9  ± 23,6). La polifarmacia –ingestion concomitante de tres o mas farmacos– (p epilepsia. Conclusiones. La epilepsia provoca un deterioro global en la CVRS de los niños, especificamente en las esferas cognitiva y emocional, lo que se relaciona con la progresion cronologica de la enfermedad y la polifarmacia. 244. Improving the efficiency of advanced life support training: a randomized, controlled trial. Science.gov (United States) Perkins, Gavin D; Kimani, Peter K; Bullock, Ian; Clutton-Brock, Tom; Davies, Robin P; Gale, Mike; Lam, Jenny; Lockey, Andrew; Stallard, Nigel 2012-07-03 Each year, more than 1.5 million health care professionals receive advanced life support (ALS) training. To determine whether a blended approach to ALS training that includes electronic learning (e-learning) produces outcomes similar to those of conventional, instructor-led ALS training. Open-label, noninferiority, randomized trial. Randomization, stratified by site, was generated by Sealed Envelope (Sealed Envelope, London, United Kingdom). (International Standardized Randomized Controlled Trial Number Register: ISCRTN86380392) 31 ALS centers in the United Kingdom and Australia. 3732 health care professionals recruited between December 2008 and October 2010. A 1-day course supplemented with e-learning versus a conventional 2-day course. The primary outcome was performance in a cardiac arrest simulation test at the end of the course. Secondary outcomes comprised knowledge- and skill-based assessments, repeated assessment after remediation training, and resource use. 440 of the 1843 participants randomly assigned to the blended course and 444 of the 1889 participants randomly assigned to conventional training did not attend the courses. Performance in the cardiac arrest simulation test after course attendance was lower in the electronic advanced life support (e-ALS) group compared with the conventional advanced life support (c-ALS) group; 1033 persons (74.5%) in the eALS group and 1146 persons (80.2%) in the c-ALS group passed (mean difference, -5.7% [95% CI, -8.8% to -2.7%]). Knowledge- and skill-based assessments were similar between groups, as was the final pass rate after remedial teaching, which was 94.2% in the e-ALS group and 96.7% in the c-ALS group (mean difference, -2.6% [CI, -4.1% to 1.2%]). Faculty, catering, and facility costs were $438 per participant for electronic ALS training and $935 for conventional ALS training. Many professionals (24%) did not attend the courses. The effect on patient outcomes was not evaluated. Compared with conventional ALS 245. Next Generation Life Support Project: Development of Advanced Technologies for Human Exploration Missions Science.gov (United States) Barta, Daniel J. 2012-01-01 Next Generation Life Support (NGLS) is one of several technology development projects sponsored by the National Aeronautics and Space Administration s Game Changing Development Program. NGLS is developing life support technologies (including water recovery, and space suit life support technologies) needed for humans to live and work productively in space. NGLS has three project tasks: Variable Oxygen Regulator (VOR), Rapid Cycle Amine (RCA) swing bed, and Alternative Water Processing. The selected technologies within each of these areas are focused on increasing affordability, reliability, and vehicle self sufficiency while decreasing mass and enabling long duration exploration. The RCA and VOR tasks are directed at key technology needs for the Portable Life Support System (PLSS) for an Exploration Extravehicular Mobility Unit (EMU), with focus on prototyping and integrated testing. The focus of the Rapid Cycle Amine (RCA) swing-bed ventilation task is to provide integrated carbon dioxide removal and humidity control that can be regenerated in real time during an EVA. The Variable Oxygen Regulator technology will significantly increase the number of pressure settings available to the space suit. Current spacesuit pressure regulators are limited to only two settings while the adjustability of the advanced regulator will be nearly continuous. The Alternative Water Processor efforts will result in the development of a system capable of recycling wastewater from sources expected in future exploration missions, including hygiene and laundry water, based on natural biological processes and membrane-based post treatment. The technologies will support a capability-driven architecture for extending human presence beyond low Earth orbit to potential destinations such as the Moon, near Earth asteroids and Mars. 246. Assessment of quality of life in children with nephrotic syndrome at a teaching hospital in South India OpenAIRE Sonia Agrawal; Sriram Krishnamurthy; Bijaya Nanda Naik 2017-01-01 This study was conducted to assess the quality of life (QOL) in children between 2 and 18 years of age with primary idiopathic nephrotic syndrome (NS) using Pediatric Quality of Life Inventory (PedsQL 4.0 Generic Core Scales). This cross-sectional comparative study was conducted at a tertiary care hospital in South India between December 2014 and February 2015. In this questionnaire-based study, 50 children with primary idiopathic NS and an equal number of age-matched controls with other chro... 247. Advancing Translational Research through Facility Design in Non-AMC Hospitals. Science.gov (United States) Pati, Debajyoti; Pietrzak, Michael P; Harvey, Thomas E; Armstrong, Walter B; Clarke, Robert; Weissman, Neil J; Rapp, Paul E; Smith, Mark S; Fairbanks, Rollin J; Collins, Jeffreyg M 2013-01-01 This article aims to explore the future of translational research and its physical design implications for community hospitals and hospitals not attached to large centralized research platforms. With a shift in medical services delivery focus to community wellness, continuum of care, and comparative effectiveness research, healthcare research will witness increasing pressure to include community-based practitioners. The roundtable discussion group, comprising 14 invited experts from 10 institutions representing the fields of biomedical research, research administration, facility planning and design, facility management, finance, and environmental design research, examined the issue in a structured manner. The discussion was conducted at the Washington Hospital Center, MedStar Health, Washington, D.C. Institutions outside the AMCs will be increasingly targeted for future research. Three factors are crucial for successful research in non-AMC hospitals: operational culture, financial culture, and information culture. An operating culture geared towards creation, preservation, and protection of spaces needed for research; creative management of spaces for financial accountability; and a flexible information infrastructure at the system level that enables complete link of key programmatic areas to academic IT research infrastructure are critical to success of research endeavors. Hospital, interdisciplinary, leadership, planning, work environment. 248. Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals. Science.gov (United States) Peicius, Eimantas; Blazeviciene, Aurelija; Kaminskas, Raimondas 2017-06-05 This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania. A cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods. The analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents' profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice. Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives. The study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD's improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations. 249. Development of expanded extrusion food products for an Advanced Life Support system. Science.gov (United States) Zasypkin, D V; Lee, T C 1999-01-01 Extrusion processing was proposed to provide texture and to expand the variety of cereal food products in an isolated Advanced Life Support (ALS) system. Rice, wheat, and soy are the baseline crops selected for growing during long-term manned space missions. A Brabender single-screw laboratory extruder (model 2003, L/D 20:1), equipped with round nozzles of various lengths, was used as a prototype of a small-size extruder. Several concepts were tested to extend the variety and improve the quality of the products, to decrease environmental loads, and to promote processing stability. These concepts include: the blending of wheat and soybean flour, the extrusion of a coarser rice flour, separation of wheat bran, and optimization of the extruder nozzle design. An optimal nozzle length has been established for the extrusion of rice flour. Bran separating was necessary to improve the quality of wheat extrudates. 250. Impact of an Advanced Cardiac Life Support Simulation Laboratory Experience on Pharmacy Student Confidence and Knowledge. Science.gov (United States) Maxwell, Whitney D; Mohorn, Phillip L; Haney, Jason S; Phillips, Cynthia M; Lu, Z Kevin; Clark, Kimberly; Corboy, Alex; Ragucci, Kelly R 2016-10-25 Objective. To assess the impact of an advanced cardiac life support (ACLS) simulation on pharmacy student confidence and knowledge. Design. Third-year pharmacy students participated in a simulation experience that consisted of team roles training, high-fidelity ACLS simulations, and debriefing. Students completed a pre/postsimulation confidence and knowledge assessment. Assessment. Overall, student knowledge assessment scores and student confidence scores improved significantly. Student confidence and knowledge changes from baseline were not significantly correlated. Conversely, a significant, weak positive correlation between presimulation studying and both presimulation confidence and presimulation knowledge was discovered. Conclusions. Overall, student confidence and knowledge assessment scores in ACLS significantly improved from baseline; however, student confidence and knowledge were not significantly correlated. 251. Advanced Spacesuit Portable Life Support System Packaging Concept Mock-Up Design & Development Science.gov (United States) O''Connell, Mary K.; Slade, Howard G.; Stinson, Richard G. 1998-01-01 A concentrated development effort was begun at NASA Johnson Space Center to create an advanced Portable Life Support System (PLSS) packaging concept. Ease of maintenance, technological flexibility, low weight, and minimal volume are targeted in the design of future micro-gravity and planetary PLSS configurations. Three main design concepts emerged from conceptual design techniques and were carried forth into detailed design, then full scale mock-up creation. "Foam", "Motherboard", and "LEGOtm" packaging design concepts are described in detail. Results of the evaluation process targeted maintenance, robustness, mass properties, and flexibility as key aspects to a new PLSS packaging configuration. The various design tools used to evolve concepts into high fidelity mock ups revealed that no single tool was all encompassing, several combinations were complimentary, the devil is in the details, and, despite efforts, many lessons were learned only after working with hardware. 252. Solid Waste Management Requirements Definition for Advanced Life Support Missions: Results Science.gov (United States) Alazraki, Michael P.; Hogan, John; Levri, Julie; Fisher, John; Drysdale, Alan 2002-01-01 Prior to determining what Solid Waste Management (SWM) technologies should be researched and developed by the Advanced Life Support (ALS) Project for future missions, there is a need to define SWM requirements. Because future waste streams will be highly mission-dependent, missions need to be defined prior to developing SWM requirements. The SWM Working Group has used the mission architecture outlined in the System Integration, Modeling and Analysis (SIMA) Element Reference Missions Document (RMD) as a starting point in the requirement development process. The missions examined include the International Space Station (ISS), a Mars Dual Lander mission, and a Mars Base. The SWM Element has also identified common SWM functionalities needed for future missions. These functionalities include: acceptance, transport, processing, storage, monitoring and control, and disposal. Requirements in each of these six areas are currently being developed for the selected missions. This paper reviews the results of this ongoing effort and identifies mission-dependent resource recovery requirements. 253. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service Directory of Open Access Journals (Sweden) Scheffer Gert J 2010-03-01 Full Text Available Abstract Background To determine the advanced life support procedures provided by an Emergency Medical Service (EMS and a Helicopter Emergency Medical Service (HEMS for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures restricted to the HEMS-physician and procedures for which the HEMS is more experienced than the EMS. Methods Prospective study of a consecutive group of children examined and treated by the HEMS of the eastern region of the Netherlands. Data regarding type of emergency, physiological parameters, NACA scores, treatment, and 24-hour survival were collected and subsequently analysed. Results Of the 558 children examined and treated by the HEMS on scene, 79% had a NACA score of IV-VII. 65% of the children had one or more advanced life support procedures restricted to the HEMS and 78% of the children had one or more procedures for which the HEMS is more experienced than the EMS. The HEMS intubated 38% of all children, and 23% of the children intubated and ventilated by the EMS needed emergency correction because of potentially lethal complications. The HEMS provided the greater part of intraosseous access, as the EMS paramedics almost exclusively reserved this procedure for children in cardiopulmonary resuscitation. The EMS provided pain management only to children older than four years of age, but a larger group was in need of analgesia upon arrival of the HEMS, and was subsequently treated by the HEMS. Conclusions The Helicopter Emergency Medical Service of the eastern region of the Netherlands brings essential medical expertise in the field not provided by the emergency medical service. The Emergency Medical Service does not provide a significant quantity of procedures obviously needed by the paediatric patient. 254. Comparison of three shortened questionnaires for assessment of quality of life in advanced cancer. Science.gov (United States) Chiu, Leonard; Chiu, Nicholas; Chow, Edward; Cella, David; Beaumont, Jennifer L; Lam, Henry; Popovic, Marko; Bedard, Gillian; Poon, Michael; Wong, Erin; Zeng, Liang; Bottomley, Andrew 2014-08-01 Quality of life (QoL) assessment questionnaires can be burdensome to advanced cancer patients, thus necessitating the need for shorter assessment instruments than traditionally available. We compare three shortened QoL questionnaires in regards to their characteristics, validity, and reliability. A literature search was conducted to identify studies that employed or discussed three abridged QoL questionnaires: the European Organization for Research and Treatment of Cancer Quality of Life Core 15-Palliative Care (EORTC QLQC15-PAL), the Functional Assessment of Cancer Therapy-General-7 (FACT-G7), and the Functional Assessment of Chronic Illness Therapy-Palliative Care-14 (FACIT-PAL-14). Articles that discussed questionnaire length, intended use, scoring procedure, and validation were included. The 7-item FACT-G7 is the shortest instrument, whereas the EORTC QLQ-C15-PAL and the FACIT-PAL-14 contain 14 and 15 items, respectively. All three questionnaires have similar recall period, item organization, and subscale components. Designed as core questionnaires, all three maintain content and concurrent validity of their unabridged original questionnaires. Both the EORTC QLQ-C15-PAL and the FACT-G7 demonstrate good internal consistency and reliability, with Cronbach's α ≥0.7 deemed acceptable. The developmental study for the FACIT-PAL-14 was published in 2013 and subsequent validation studies are not yet available. The EORTC QLQ-C15-PAL and the FACT-G7 were found to be reliable and appropriate for assessing health-related QoL issues-the former for palliative cancer patients and the latter for advanced cancer patients receiving chemotherapy. Conceptually, the FACIT-PAL-14 holds promise to cover social and emotional support issues that are not completely addressed by the other two questionnaires; however, further validation is needed. 255. Predictors of Physical Restraint Use in Hospitalized Veterans at End of Life: An Analysis of Data from the BEACON Trial. Science.gov (United States) Kvale, Elizabeth; Dionne-Odom, J Nicholas; Redden, David T; Bailey, F Amos; Bakitas, Marie; Goode, Patricia S; Williams, Beverly R; Haddock, Kathlyn Sue; Burgio, Kathryn L

2015-06-01 The use of physical restraints in dying patients may be a source of suffering and loss of dignity. Little is known about the prevalence or predictors for restraint use at end of life in the hospital setting. The objective was to determine the prevalence and predictors of physical restraint use at the time of death in hospitalized adults. Secondary analysis was performed on data from the "Best Practices for End-of-Life Care for Our Nation's Veterans" (BEACON) trial conducted between 2005 and 2011. Medical record data were abstracted from six Veterans Administration Medical Centers (VAMCs). Data on processes of care in the last seven days of life were abstracted from the medical records of 5476 who died in the six VAMCs. We prospectively identified potential risk factors for restraint use at the time of death from among the variables measured in the parent trial, including location of death, medications administered, nasogastric tube, intravenous (IV) fluids, family presence, and receipt of a palliative care consultation. Physical restraint use at time of death was documented in 890 decedents (16.3%). Restraint use varied by location of death, with patients in intensive settings being at higher risk. Restraint use was significantly more likely in patients with a nasogastric tube and those receiving IV fluids, benzodiazepines, or antipsychotics. This is the first study to document that one in six hospitalized veterans were restrained at the time of death and to identify predictors of restraint use. Further research is needed to identify intervention opportunities. 256. Role of demographic and job-related variables in determining work-related quality of life of hospital employees. Science.gov (United States) Shukla, K; Shahane, S; D'Souza, W 2017-01-01 Considering a huge working population in health sector faced with stressful work life, limited autonomy in work and declining work contentment calls for an overemphasis on evaluating and monitoring their satisfaction associated with work-related quality of life (WRQoL). This study evaluates WRQoL of hospital employees and validates the bilingual (English and Marathi) version of WRQoL scale. The study was conducted during March-April'2014 on employees of a corporate hospital of Pune, India after ethical approval and informed consent from employees. The bilingual WRQoL scale has been tested for reliability and validity, and WRQoL scores have been reported. A total of 132 hospital employees (mean age 31 [±8] years, 55% males) who participated in the study reported overall moderate WRQoL scores. The scale showed high internal consistency (Cronbach's alpha = 0.82, P Stress at work" score of WRQoL increased with age of employees. Higher work experience, employment at higher positions and those working in clinical and diagnostic departments reported a higher WRQoL. WRQoL scale is a reliable and valid instrument. Better WRQoL in employees placed in higher organizational positions indicates a need for focused measures to enhance WRQoL of employees in lower hierarchical levels, especially in control at work and home life interface domains. WRQoL needs regular monitoring for employees in lower positions and aging employees. 257. Impact of Duodopa on Quality of Life in Advanced Parkinson's Disease: A UK Case Series Directory of Open Access Journals (Sweden) T. Foltynie 2013-01-01 Full Text Available Treatment options in advanced Parkinson’s disease (PD include subcutaneous apomorphine, pallidal or subthalamic nucleus Deep Brain Stimulation (DBS, or levodopa/carbidopa intestinal gel (LCIG/Duodopa. In this study, we describe the outcome of 12 PD patients with PD related complications started on LCIG, with respect to their quality of life measured by a disease specific validated scale—the PDQ39, together with diaries recording time spent “On,†“Off,†“Dyskinetic,†or “Asleep.†At the time of latest follow up, improvements were observed in both the PDQ39 Summary index as well as diary reports of PD symptom control following introduction of LCIG, supporting its use in well selected patients. The use of a trial period of LCIG via naso-jejunal administration allows objective evaluation of improvement in PD symptom control in advance of the placement of the more invasive percutaneous jejunostomy procedure. The decision to embark on LCIG, apomorphine or DBS should be supported by input from centres with experience of all 3 approaches. Since LCIG is an expensive option, development of the most appropriate future commissioning of this therapy in the absence of Class 1 evidence requires careful scrutiny of the outcomes of its use in a broad range of published series. 258. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims. Science.gov (United States) Gholipour, Changiz; Vahdati, Samad Shams; Notash, Mehdi; Miri, Seyed Hassan; Ghafouri, Rouzbeh Rajaei 2014-06-01 Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a study on the success rate of PHEMS personnel in implementing PHTLS guidelines at the scene of trauma. Severe trauma patients who had been transferred to the emergency department were included in the study. Evaluations included transfer time, airway management, spinal immobilization, external bleeding management, intravenous (IV) line access, and fluid therapy. All evaluations were performed by an expert emergency physician in the emergency department. The mean response time was 17.87±9.1 minutes. The PHEMS personnel immobilized cervical spine in 60.4% of patients, out of whom 16.7% were not properly immobilized. Out of 99 (98%) cases of established IV line access by the PHEMS providers, 57% were satisfactory. Fluid therapy, which was carried out in 99 (98%) patients by the PHEMS personnel, was appropriate in 92% of the cases. PHEMS personnel need more education and supervising to provide services according to PHTLS guidelines. 259. Study for requirement of advanced long life small modular fast reactor Science.gov (United States) Tak, Taewoo; Choe, Jiwon; Jeong, Yongjin; Lee, Deokjung; Kim, T. K. 2016-01-01 To develop an advanced long-life SMR core concept, the feasibility of the long-life breed-and-burn core concept has been assessed and the preliminary selection on the reactor design requirement such as fuel form, coolant material has been performed. With the simplified cigar-type geometry of 8m-tall CANDLE reactor concept, it has demonstrated the strengths of breed-and-burn strategy. There is a saturation region in the graph for the multiplication factors, which means that a steady breeding is being proceeded along the axial direction. The propagation behavior of the CANDLE core can be also confirmed through the evolution of the axial power profile. Coolant material is expected to have low melting point, density, viscosity and absorption cross section and a high boiling point, specific heat, and thermal conductivity. In this respect, sodium is preferable material for a coolant of this nuclear power plant system. The metallic fuel has harder spectrum compared to the oxide and carbide fuel, which is favorable to increase the breeding and extend the cycle length. 260. Hydroponics Database and Handbook for the Advanced Life Support Test Bed Science.gov (United States) Nash, Allen J. 1999-01-01 During the summer 1998, I did student assistance to Dr. Daniel J. Barta, chief plant growth expert at Johnson Space Center - NASA. We established the preliminary stages of a hydroponic crop growth database for the Advanced Life Support Systems Integration Test Bed, otherwise referred to as BIO-Plex (Biological Planetary Life Support Systems Test Complex). The database summarizes information from published technical papers by plant growth experts, and it includes bibliographical, environmental and harvest information based on plant growth under varying environmental conditions. I collected 84 lettuce entries, 14 soybean, 49 sweet potato, 16 wheat, 237 white potato, and 26 mix crop entries. The list will grow with the publication of new research. This database will be integrated with a search and systems analysis computer program that will cross-reference multiple parameters to determine optimum edible yield under varying parameters. Also, we have made preliminary effort to put together a crop handbook for BIO-Plex plant growth management. It will be a collection of information obtained from experts who provided recommendations on a particular crop's growing conditions. It includes bibliographic, environmental, nutrient solution, potential yield, harvest nutritional, and propagation procedure information. This handbook will stand as the baseline growth conditions for the first set of experiments in the BIO-Plex facility. « 11 12 13 14 15 » « 12 13 14 15 16 » 261. Requirements Development Issues for Advanced Life Support Systems: Solid Waste Management Science.gov (United States) Levri, Julie A.; Fisher, John W.; Alazraki, Michael P.; Hogan, John A. 2002-01-01 Long duration missions pose substantial new challenges for solid waste management in Advanced Life Support (ALS) systems. These possibly include storing large volumes of waste material in a safe manner, rendering wastes stable or sterilized for extended periods of time, and/or processing wastes for recovery of vital resources. This is further complicated because future missions remain ill-defined with respect to waste stream quantity, composition and generation schedule. Without definitive knowledge of this information, development of requirements is hampered. Additionally, even if waste streams were well characterized, other operational and processing needs require clarification (e.g. resource recovery requirements, planetary protection constraints). Therefore, the development of solid waste management (SWM) subsystem requirements for long duration space missions is an inherently uncertain, complex and iterative process. The intent of this paper is to address some of the difficulties in writing requirements for missions that are not completely defined. This paper discusses an approach and motivation for ALS SWM requirements development, the characteristics of effective requirements, and the presence of those characteristics in requirements that are developed for uncertain missions. Associated drivers for life support system technological capability are also presented. A general means of requirements forecasting is discussed, including successive modification of requirements and the need to consider requirements integration among subsystems. 262. Study for requirement of advanced long life small modular fast reactor Energy Technology Data Exchange (ETDEWEB) Tak, Taewoo, E-mail: [email protected]; Choe, Jiwon, E-mail: [email protected]; Jeong, Yongjin, E-mail: [email protected]; Lee, Deokjung, E-mail: [email protected] [Ulsan National Institute of Science and Technology, 50, UNIST-gil, Eonyang-eup, Ulju-gun, Ulsan, 689-798 (Korea, Republic of); Kim, T. K., E-mail: [email protected] [Argonne National Laboratory, 9700 South Cass Avenue, Argonne, IL 60564 (United States) 2016-01-22 To develop an advanced long-life SMR core concept, the feasibility of the long-life breed-and-burn core concept has been assessed and the preliminary selection on the reactor design requirement such as fuel form, coolant material has been performed. With the simplified cigar-type geometry of 8m-tall CANDLE reactor concept, it has demonstrated the strengths of breed-and-burn strategy. There is a saturation region in the graph for the multiplication factors, which means that a steady breeding is being proceeded along the axial direction. The propagation behavior of the CANDLE core can be also confirmed through the evolution of the axial power profile. Coolant material is expected to have low melting point, density, viscosity and absorption cross section and a high boiling point, specific heat, and thermal conductivity. In this respect, sodium is preferable material for a coolant of this nuclear power plant system. The metallic fuel has harder spectrum compared to the oxide and carbide fuel, which is favorable to increase the breeding and extend the cycle length. 263. Insurance Status and Hospital Payer Mix Are Linked With Variation in Metastatic Site Resection in Patients With Advanced Colorectal Cancers. Science.gov (United States) Healy, Mark A; Pradarelli, Jason C; Krell, Robert W; Regenbogen, Scott E; Suwanabol, Pasithorn A 2016-11-01 Despite substantially improved survival with metastatic site resection in colorectal cancers, uptake of aggressive surgical approaches remains low among certain patients. It is unknown whether financial determinants of care, such as insurance status, play a role in this treatment gap. We sought to evaluate the effect of insurance status on metastasectomy in patients with advanced colorectal cancers. This was a retrospective cohort study. Using the National Cancer Data Base Participant User File, incident cases of colorectal cancer metastatic to the lung and/or liver with diagnosis from 2010 to 2013 were identified. We identified 42,300 patients in our cohort with a mean age 64 years. Controlling for patient, tumor, and hospital characteristics, hierarchical regression was used to examine associations between hospital payer mix and metastatic site resection. Metastatic site resection occurred in 12.3% of all patients. Adjusting for patient and hospital fixed effects, we found that patients who were uninsured or on Medicaid were 38% less likely to undergo metastasectomy (OR = 0.62 (95% CI, 0.56-0.66)). Patients in hospitals with staff treating a high percentage of uninsured patients or patients with Medicaid were less likely to undergo metastasectomy, even after controlling for individual patient insurance status. The study was limited by its retrospective design and the granularity and accuracy of the National Cancer Data Base. Differences in insurance status and hospital payer mix are associated with differences in rates of metastatic site resection in patients with colorectal cancer that is metastatic to the lung and/or liver. There is a need for improved access to metastatic site resection for individual patients who are uninsured or who have Medicaid insurance, as well as for all patients who seek care at hospitals treating a large proportion of patients who are uninsured or on Medicaid. Remedies for individual patients could include improved access to private 264. Impact of nutritional status on the quality of life of advanced cancer patients in hospice home care. Science.gov (United States) Shahmoradi, Negar; Kandiah, Mirnalini; Peng, Loh Su 2009-01-01 Cancer patients frequently experience malnutrition and this is an important factor in impaired quality of life. This cross-sectional study examined the association between global quality of life and its various subscales with nutritional status among 61 (33 females and 28 males) advanced cancer patients cared for by selected hospices in peninsular Malaysia. The Patient Generated-Subjective Global Assessment (PG-SGA) and the Hospice Quality of Life Index (HQLI) were used to assess nutritional status and quality of life, respectively. Nine (14.7%) patients were well-nourished, 32 (52.5%) were moderately or suspected of being malnourished while 20 (32.8%) of them were severely malnourished. The total HQLI mean score for these patients was 189.9-/+51.7, with possible scores ranging from 0 to 280. The most problem areas in these patients were in the domain of functional well-being and the least problems were found in the social/spiritual domain. PG-SGA scores significantly correlated with total quality of life scores (r2= 0.38, pnutritional status exhibited a lower quality of life. Advanced cancer patients with poor nutritional status have a diminished quality of life. These findings suggest that there is a need for a comprehensive nutritional intervention for improving nutritional status and quality of life in terminally ill cancer patients under hospice care. 265. Advanced air distribution method combined with deodorant material for exposure reduction to bioeffluents contaminants in hospitals DEFF Research Database (Denmark) Bivolarova, Mariya Petrova; Mizutani, Chiyomi; Melikov, Arsen Krikor 2015-01-01 -bed hospital patient room at reduced background ventilation rare of 1.6 air changes per hour. The bed of the patient was equipped with the ventilated mattress (VM) having an exhaust opening from which bioeffluents generated from human body were sucked and discharged from the room. To enhance the pollutant......The separate and combined effect of a ventilated mattress and acid-treated activated carbon fibre (ACF) fabric on reducing the exposure to body generated gaseous pollutants in hospital environment was studied. Full-scale experiments were performed in a climate chamber furnished as a single...... removal, acid-treated activated carbon fibre material was used in some of the experiments in the form of patient’s cover. The simulated pollution source was ammonia gas released from the patient’s groins. The results show that when using the ventilated mattress the ammonia gas concentration in the room... 266. Scoping Report: Advanced Technologies for Multi-Load Washers in Hospitality and Healthcare Energy Technology Data Exchange (ETDEWEB) Parker, Graham B.; Boyd, Brian K.; Petersen, Joseph M.; Goetzler, W.; Foley, K. J.; Sutherland, T. A. 2013-03-27 The purpose of this demonstration project is to quantify the energy savings and water efficiency potential of commercial laundry wastewater recycling systems and low-temperature detergent supply systems to help promote the adoption of these technologies in the commercial sector. This project will create a set of technical specifications for efficient multi-load laundry systems (both new and retrofit) tailored for specific applications and/or sectors (e.g., hospitality, health care). The specifications will be vetted with the appropriate Better Buildings Alliance (BBA) members (e.g., Commercial Real Estate Energy Alliance, Hospital Energy Alliance), finalized, published, and disseminated to enable widespread technology transfer in the industry and specifically among BBA partners. 267. An advanced control strategy of an electrical--powered hospital bed. Science.gov (United States) Nguyen, Huy Hoang; Nguyen, Tuan Nghia; Clout, Raymont; Nguyen, Hung T 2014-01-01 This paper develops a multivariable control technique for low-level control of an intelligent hospital bed. First, multivariable hospital bed models, nominal, upper bounded and lower bounded models, are obtained via an experimental identification procedure. Based on the obtained nominal model, the triangular diagonal dominance (TDD) decoupling technique is applied to reduce a complex multivariable system into a series of scalar systems. For each scalar system, an online adaptive control strategy is then developed to cope with system uncertainties. Compared to the conventional control method, real-time experimental results showed that our proposed multivariable control technique achieved better performance. Experimental results also confirmed that desirable system performance was guaranteed under system uncertainty conditions. 268. Sofosbuvir plus simeprevir for the treatment of HCV genotype 4 patients with advanced fibrosis or compensated cirrhosis is highly efficacious in real life. Science.gov (United States) Willemse, S B; Baak, L C; Kuiken, S D; van der Sluys Veer, A; Lettinga, K D; van der Meer, J T M; Depla, A C T M; Tuynman, H; van Nieuwkerk, C M J; Schinkel, C J; Kwa, D; Reesink, H W; van der Valk, M 2016-12-01 Chronic hepatitis C virus (HCV) infection is a major cause of chronic liver disease and liver-related death. Recently, multiple regimens of different direct-acting antiviral agents (DAAs) have been registered. Although treatment with sofosbuvir (SOF) and simeprevir (SMV) is registered for the treatment of genotype 4 patients in some countries, data on efficacy of this combination are lacking. We aimed to assess the efficacy of SOF and SMV with or without RBV during 12 weeks in a real-life cohort of genotype 4 HCV patients. A retrospective multicentre observational study was conducted in 4 hospitals in Amsterdam, the Netherlands, including patients with advanced liver fibrosis or liver cirrhosis treated with SOF plus SMV with or without RBV during 12 weeks for a genotype 4 chronic HCV infection from 1 January 2015 to 1 August 2015. Sustained viral response (SVR) was established at week 12 after end of treatment. A total of 53 patients with genotype 4 HCV infection, treatment naïve and experienced, were included. SVR was achieved in 49 of 53 patients (92%). The four failures all had a virological relapse and did not receive ribavirin. Three were nonresponder to earlier interferon-based treatment, and one was treatment naive. In this real-life cohort of patients with HCV genotype 4 infection and advanced liver fibrosis/cirrhosis, we show that treatment with SOF and SMV is effective. The addition of RBV could be considered in treatment-experienced patients as recommended in guidelines. 269. Practice development using video-reflexive ethnography: promoting safe space(s towards the end of life in hospital Directory of Open Access Journals (Sweden) Aileen Collier 2016-05-01 Full Text Available Background: There is international consensus of the need for improved palliative and end-of-life care in hospital settings. What is less clear is how such improvements might be realised in practice. Research and practice improvement methodologies need to acknowledge the relational, spiritual, moral and ethical as well as physical dimensions of death and dying if improvements in care are to be achieved. Aims and objectives: The aim of this article is to explore the potential of video-reflexive ethnography as a practice development methodology to improve care of people with a life-limiting illness in the hospital setting. Methods: The study used video-reflexive ethnography and was underpinned by an indigenous research ethical framework. Findings: Study findings highlight the potential of video-reflexive ethnography as a practice development methodology. The reach of video extended internally and externally beyond immediate practice research sites to make hospital dying tangible. The research acted as a disruptive innovation, foregrounding peoples’ (patients and families expertise as well as that of healthcare workers. For some patient and family participants, the research offered a visual legacy. Conclusions: The theories underpinning video-reflexive ethnography and practice development are closely aligned; the former has potential as a practice development methodology to promote person-centred palliative and end-of-life care. The underpinning philosophical, ethical and values framework through which it is applied, along with the skills and aptitude of facilitation, are critical if its potential is to be realised. Implications for practice development: The delivery of person-centred end-of-life care may be facilitated by: Healthcare workers seeing themselves and those they care for differently Healthcare organisations seeing their employees as well as patients and families differently Researchers also being prepared to see themselves differently 270. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital Directory of Open Access Journals (Sweden) Jane Andreasen 2015-06-01 Full Text Available Introduction: Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. Methods: The qualitative methodological approach was interpretive description. Data were gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. Results: Four main categories were identified: “The system,†⠀œKeeping a social life,†“Being in everyday life,†and “Handling everyday life.†These categories affected the way the frail elderly experienced daily life and these elements resulted in a general feeling of well-being or non-well-being. The transition to home was experienced as unsafe and troublesome especially for the more frail participants, whereas the less frail experienced this less. Conclusion and discussion: Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged. Stakeholders should evaluate present practice to seek to improve care across health care sectors. 271. The Quality-of-Life Effects of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer Energy Technology Data Exchange (ETDEWEB) Herman, Joseph M., E-mail: [email protected] [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Narang, Amol K. [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Griffith, Kent A. [Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Zalupski, Mark M. [Department of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Reese, Jennifer B. [Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Gearhart, Susan L. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Azad, Nolifer S. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Chan, June; Olsen, Leah [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Efron, Jonathan E. [Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Lawrence, Theodore S.; Ben-Josef, Edgar [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States) 2013-01-01

Purpose: Existing studies that examine the effect of neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer on patient quality of life (QOL) are limited. Our goals were to prospectively explore acute changes in patient-reported QOL endpoints during and after treatment and to establish a distribution of scores that could be used for comparison as new treatment modalities emerge. Methods and Materials: Fifty patients with locally advanced rectal cancer were prospectively enrolled at 2 institutions. Validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) and colorectal cancer-specific (EORTC QLQ-CR38 and EORTC QLQ-CR 29) QOL questionnaires were administered to patients 1 month before they began CRT, at week 4 of CRT, and 1 month after they had finished CRT. The questionnaires included multiple symptom scales, functional domains, and a composite global QOL score. Additionally, a toxicity scale was completed by providers 1 month before the beginning of CRT, weekly during treatment, and 1 month after the end of CRT. Results: Global QOL showed a statistically significant and borderline clinically significant decrease during CRT (-9.50, P=.0024) but returned to baseline 1 month after the end of treatment (-0.33, P=.9205). Symptoms during treatment were mostly gastrointestinal (nausea/vomiting +9.94, P<.0001; and diarrhea +16.67, P=.0022), urinary (dysuria +13.33, P<.0001; and frequency +11.82, P=.0006) or fatigue (+16.22, P<.0001). These symptoms returned to baseline after therapy. However, sexual enjoyment (P=.0236) and sexual function (P=.0047) remained persistently diminished after therapy. Conclusions: Rectal cancer patients undergoing neoadjuvant CRT may experience a reduction in global QOL along with significant gastrointestinal and genitourinary symptoms during treatment. Moreover, provider-rated toxicity scales may not fully capture this decrease in patient-reported QOL. Although most symptoms are transient 272. Advanced Cardiac Life Support (ACLS) utilizing Man-Tended Capability (MTC) hardware onboard Space Station Freedom Science.gov (United States) Smith, M.; Barratt, M.; Lloyd, C. 1992-01-01 Because of the time and distance involved in returning a patient from space to a definitive medical care facility, the capability for Advanced Cardiac Life Support (ACLS) exists onboard Space Station Freedom. Methods: In order to evaluate the effectiveness of terrestrial ACLS protocols in microgravity, a medical team conducted simulations during parabolic flights onboard the KC-135 aircraft. The hardware planned for use during the MTC phase of the space station was utilized to increase the fidelity of the scenario and to evaluate the prototype equipment. Based on initial KC-135 testing of CPR and ACLS, changes were made to the ventricular fibrillation algorithm in order to accommodate the space environment. Other constraints to delivery of ACLS onboard the space station include crew size, minimum training, crew deconditioning, and limited supplies and equipment. Results: The delivery of ACLS in microgravity is hindered by the environment, but should be adequate. Factors specific to microgravity were identified for inclusion in the protocol including immediate restraint of the patient and early intubation to insure airway. External cardiac compressions of adequate force and frequency were administered using various methods. The more significant limiting factors appear to be crew training, crew size, and limited supplies. Conclusions: Although ACLS is possible in the microgravity environment, future evaluations are necessary to further refine the protocols. Proper patient and medical officer restraint is crucial prior to advanced procedures. Also emphasis should be placed on early intubation for airway management and drug administration. Preliminary results and further testing will be utilized in the design of medical hardware, determination of crew training, and medical operations for space station and beyond. 273. Optical Breath Gas Extravehicular Activity Sensor for the Advanced Portable Life Support System Science.gov (United States) Wood, William R.; Casias, Miguel E.; Pilgrim, Jeffrey S.; Chullen, Cinda; Campbell, Colin 2016-01-01 The function of the infrared gas transducer used during extravehicular activity (EVA) in the current space suit is to measure and report the concentration of carbon dioxide (CO2) in the ventilation loop. The next generation portable life support system (PLSS) requires highly accurate CO2 sensing technology with performance beyond that presently in use on the International Space Station extravehicular mobility unit (EMU). Further, that accuracy needs to be provided over the full operating pressure range of the suit (3 to 25 psia). Accommodation within space suits demands that optical sensors meet stringent size, weight, and power requirements. A laser diode (LD) sensor based on infrared absorption spectroscopy is being developed for this purpose by Vista Photonics, Inc. Version 1.0 prototype devices were delivered to NASA Johnson Space Center (JSC) in September 2011. The prototypes were upgraded with more sophisticated communications and faster response times to version 2.0 and delivered to JSC in July 2012. The sensors incorporate a laser diode based CO2 channel that also includes an incidental water vapor (humidity) measurement. The prototypes are controlled digitally with an field-programmable gate array microcontroller architecture. Based on the results of the iterative instrument development, further prototype development and testing of instruments were performed leveraging the lessons learned where feasible. The present development extends and upgrades the earlier hardware for the advanced PLSS 2.5 prototypes for testing at JSC. The prototypes provide significantly enhanced accuracy for water vapor measurement and eliminate wavelength drift affecting the earlier versions. Various improvements to the electronics and gas sampling are currently being advanced including the companion development of engineering development units that will ultimately be capable of radiation tolerance. The combination of low power electronics with the performance of a long wavelength 274. Impact on carbon footprint: a life cycle assessment of disposable versus reusable sharps containers in a large US hospital. Science.gov (United States) Grimmond, Terry; Reiner, Sandra 2012-06-01 Hospitals are striving to reduce their greenhouse gas (GHG) emissions. Targeting supply chain points and replacing disposable with reusable items are among recommendations to achieve this. Annually, US hospitals use 35 million disposable (DSC) or reusable sharps containers (RSC) generating GHG in their manufacture, use, and disposal. Using a life cycle assessment we assessed the global warming potential (GWP) of both systems at a large US hospital which replaced DSC with RSC. GHG emissions (CO(2), CH(4), N(2)O) were calculated in metric tons of CO(2) equivalents (MTCO(2)eq). Primary energy input data was used wherever possible and region-specific conversions used to calculate the GWP of each activity. Unit process GHGs were collated into manufacture, transport, washing, and treatment and disposal. The DSC were not recycled nor had recycled content. Chemotherapy DSC were used in both systems. Emission totals were workload-normalized per 100 occupied beds-yr and rate ratio analyzed using Fisher's test with P ≤0.05 and 95% confidence level. With RSC, the hospital reduced its annual GWP by 127 MTCO(2)eq (-83.5%) and diverted 30.9 tons of plastic and 5.0 tons of cardboard from landfill. Using RSC reduced the number of containers manufactured from 34,396 DSC annually to 1844 RSC in year one only. The study indicates sharps containment GWP in US hospitals totals 100,000 MTCO(2)eq and if RSC were used nationally the figure could fall by 64,000 MTCO(2)eq which, whilst only a fraction of total hospital GWP, is a positive, sustainable step. 275. Assessing the feasibility, acceptability and potential effectiveness of Dignity Therapy for people with advanced cancer referred to a hospital-based palliative care team: Study protocol Directory of Open Access Journals (Sweden) Chochinov Harvey 2009-05-01 Full Text Available Abstract Background Loss of dignity for people with advanced cancer is associated with high levels of psychological and spiritual distress and the loss of the will to live. Dignity Therapy is a brief psychotherapy, which has been developed to help promote dignity and reduce distress. It comprises a recorded interview, which is transcribed, edited then returned to the patient, who can bequeath it to people of their choosing. Piloting in Canada, Australia and the USA, has suggested that Dignity Therapy is beneficial to people with advanced cancer and their families. The aims of this study are to assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to reduce psychological and spiritual distress in people with advanced cancer who have been referred to hospital-based palliative care teams in the UK, and to pilot the methods for a Phase III RCT. Design A randomised controlled open-label trial. Forty patients with advanced cancer are randomly allocated to one of two groups: (i Intervention (Dignity Therapy offered in addition to any standard care, and (ii Control group (standard care. Recipients of the 'generativity' documents are asked their views on taking part in the study and the therapy. Both quantitative and qualitative outcomes are assessed in face-to-face interviews at baseline and at approximately one and four weeks after the intervention (equivalent in the control group. The primary outcome is patients' sense of dignity (potential effectiveness assessed by the Patient Dignity Inventory. Secondary outcomes for patients include distress, hopefulness and quality of life. In view of the relatively small sample size, quantitative analyses are mainly descriptive. The qualitative analysis uses the Framework method. Discussion Dignity Therapy is brief, can be delivered at the bedside and may help both patients and their families. This detailed exploratory research shows if it is feasible to offer Dignity Therapy to 276. Effect of Intermittent Androgen Blockade on the Quality of Life of Patients with Advanced Prostate Carcinoma Institute of Scientific and Technical Information of China (English) æ— 2007-01-01 OBJECTIVE To investigate the effect of intermittent androgen blockade (IAB) on the quality of life (QOL) of patients with advanced prostatic carcinoma (APC).METHODS Investigations on the QOL of 51 APC patients receiving IAB treatment, totaling 3 times, i.e. 6 months before and after, and 12 months after treatment, were perform using the EORTC QLQ-C30 measuring scale and QLQ-PR25 scale.RESULTS Although IAB became an economic burden for the families, it was lessened during the intermission (P<0.05). The overall health status significantly improved 6 months after IAB treatment (P<0.01), especially during the intermission (P<0.05), with a total or local easement of pain (P<0.01) and an improvement of urinary function (P<0.01). Although there was impairment,to various degrees, in many functions of the patients on the 6th month of treatment, such as the physical function (P<0.05), role function (P<0.05), the emotional (P<0.01) and the social functions (P<0.01), with an enhancement of fatigue (P<0.01), these functions gradually recovered by the 12th month as the intermission started. Treatment-related symptoms such as flushing and mammary swelling significantly emerged on the 6th treatment month (P<0.01), and lessened on the 12th (P<0.01). During the treatment period,therewas an notable drop in sexual interest (P<0.01), with a deprivation of sex life, but revived to various degrees during the intermission (P<0.01).CONCLUSION Although IAB treatment of APC patients did impair the physiologic and psychologic status of patients to varying degrees, these were improved and restored during the intermission. 277. Written evaluation is not a predictor for skills performance in an Advanced Cardiovascular Life Support course. Science.gov (United States) Rodgers, David L; Bhanji, Farhan; McKee, Barbara R 2010-04-01 Both a written cognitive knowledge evaluation and a practical evaluation that tests psychomotor skills, cognitive knowledge, and affective behaviors such as leadership and team skills are required for successful completion of American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course. The 2005 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations noted that in Basic Life Support (BLS) there is little to no correlation between written and practical skills. The current study was conducted to determine if there is a correlation between written and practical evaluations in an ACLS course. 34 senior nursing students from four nursing programs participated in two separate ACLS classes, completing both the written and practical evaluations. Immediately following the courses, all participants served as team leader for a video recorded simulated cardiac arrest event. A panel of expert ACLS instructors who did not participate as instructors in the courses reviewed each video and independently scored team leaders' performances. Spearman's rho correlation coefficient between the written test scores and practical skills performance was 0.194 (2-tailed significance=0.272). The ACLS written evaluation was not a predictor of participant skills in managing a simulated cardiac arrest event immediately following an ACLS course. The single case simulations used in ACLS skills evaluation test a narrow portion of ACLS content while written evaluation tests can more practically test a broader spectrum of content. Both work in concert to define participant knowledge and neither should be used exclusively to determine participant competence. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved. 278. [The second report from Sapporo Tsukisamu hospital--chemotherapy for patients with advanced colorectal cancer]. Science.gov (United States) Yamamitsu, Susumu; Kimura, Hiromichi; Yamada, Yoshiyuki; Inui, Noriaki; Hiyama, Shigemi; Hirata, Koichi; Kimura, Yasutoshi; Shirasaka, Tetsuhiko 2007-08-01 The remedy,especially recent chemotherapy,against colorectal cancer is improving median survival time (MST) of patients with Stage IV advanced colorectal cancer. According to other reports,however,it seems to be difficult to improve it longer than 20 months. In May 2002, we devised a new regimen by intermittent dosage of 5-FU (-->S-1), CDDP and paclitaxel utilizing the difference of cell cycle between normal and cancer cells, and thirteen patients with advanced colorectal cancer (Stage IV) were treated with this regimen. As a result, a satisfactory efficacy rate of 53.8%, 1-year survival rate of 69 .2%, 2-year survival rate of 53.9%, 3-year survival rate of 44.9%, 5-year survival rate of 17.9%, and MST 36 months were achieved. Five patients had hematological toxicities over grade 3 (38.5%) and most of them were anemia (3 cases) and neutropenia (5 cases). Thrombocytopenia and gastroenterological toxicity were all under grade 2. Adverse effects related to this regimen were clinically manageable. These results, although for a limited number of patients, indicated that this may contribute to the extension of survival time of patients with Stage IV advanced colorectal cancer. 279. Assessment of voice, speech, and related quality of life in advanced head and neck cancer patients 10-years+ after chemoradiotherapy NARCIS (Netherlands) Kraaijenga, S.A.C.; Oskam, I.M.; van Son, R.J.J.H.; Hamming-Vrieze, O.; Hilgers, F.J.M.; van den Brekel, M.W.M.; van der Molen, L. 2016-01-01 Objectives: Assessment of long-term objective and subjective voice, speech, articulation, and quality of life in patients with head and neck cancer (HNC) treated with concurrent chemoradiotherapy (CRT) for advanced, stage IV disease. Materials and methods: Twenty-two disease-free survivors, treated 280. Assessment of voice, speech, and related quality of life in advanced head and neck cancer patients 10-years+ after chemoradiotherapy NARCIS (Netherlands) Kraaijenga, S.A.C.; Oskam, I.M.; van Son, R.J.J.H.; Hamming-Vrieze, O.; Hilgers, F.J.M.; van den Brekel, M.W.M.; van der Molen, L. 2016-01-01 Objectives: Assessment of long-term objective and subjective voice, speech, articulation, and quality of life in patients with head and neck cancer (HNC) treated with concurrent chemoradiotherapy (CRT) for advanced, stage IV disease. Materials and methods: Twenty-two disease-free survivors, treated « 12 13 14 15 16 » « 13 14 15 16 17 » 281. The effect of the Advanced Paediatric Life Support course on perceived self-efficacy and use of resuscitation skills. NARCIS (Netherlands) Turner, N.M.; Dierselhuis, M.P.; Draaisma, J.M.T.; Cate, O.T. ten 2007-01-01 BACKGROUND: Perceived self-efficacy is a predictor of behaviour and therefore an important dimension of resuscitation training which may have consequences for patient care. The Advanced Paediatric Life Support (APLS) course makes use of techniques which would be expected to increase self-efficacy. W 282. Weighing environmental advantages and disadvantages of advanced wastewater treatment of micro-pollutants using environmental life cycle assessment DEFF Research Database (Denmark) Wenzel, Henrik; Larsen, Henrik Fred; Clauson-Kaas, Jes; 2007-01-01 -off was investigated using Life Cycle Assessment (LCA) methodology and based on a literature review of advanced treatment performance. The LCA evaluation comprised sand filtration, ozonation and MBRs and assessed the effect of extending existing tertiary treatment with these technologies on a variety of micro... 283. Education for Life: Assessment of the Role of a Recreational Programme in the Rehabilitation of Day Patients in a Psychiatric Hospital. Science.gov (United States) Hamilton, Robert 1984-01-01 With a working definition of rehabilitation, the author assesses the therapeutic recreation program at a psychiatric hospital to determine whether it enabled psychiatric day patients to overcome social disabilities and make a full return to community life. (SK) 284. Awareness about basic life support and emergency medical services and its associated factors among students in a tertiary care hospital in South India Directory of Open Access Journals (Sweden) Akshatha Rao Aroor 2014-01-01 Full Text Available Background: The knowledge and skills about the basic life support (BLS and the advanced life support are the most important determining factors of the cardiopulmonary resuscitation (CPR success rates. Objectives: To determine the level of awareness on BLS and skills among undergraduate and postgraduate students of medical and dental profession, as well as nursing students and interns in a tertiary care hospital. Materials and Methods: This descriptive cross-sectional study was conducted in a tertiary care hospital in South India. The awareness level on BLS and factors associated which include age, sex, level of training (undergraduate, internship, and postgraduate groups, course of study (nursing, dental, and medical groups, and previous exposure to BLS were assessed by using a structured questionnaire. The association of these variables with awareness level was assessed by independent t test, analysis of variance, and linear regression analysis. Results: Among 520 study subjects, 229 were students, 171 were interns, and 120 were postgraduate students. The overall mean score of awareness was 4.16 ± 1.40 (score range: 0-10. Age, sex, level of training, course of study, and previous exposure to BLS were significantly associated with awareness level in univariate analysis (P < 0.05. Linear regression model also showed that all the above variables were significantly associated with awareness level (P < 0.05. About 322 (61.9% subjects attributed lack of awareness about BLS to lack of available professional training. About 479 (92.1% responded that BLS training should be a part of medical curriculum. Conclusion: Awareness level on BLS is below average indicating the importance of professional training at all levels in a tertiary care health institution. 285. The Relationship Between Quality of Life With Marital Satisfaction in Nurses in Social Security Hospital in Zahedan. Science.gov (United States) Gharibi, Maliheh; Sanagouymoharer, Gholamreza; Yaghoubinia, Fariba 2015-06-25 Marital satisfaction is one of the most important determinative factors of healthy function in family and can be affected by some factors. This study was conducted aimed to determine the relationship between quality of life and marital satisfaction in nurses in Social Security hospital in Zahedan. In this descriptive and correlational study, the population was the all of the nurses in various wards in Social Security hospital in Zahedan. The sample size was 103 and data collection was done through quality of life questionnaire (War and Sherborn) and Enrich Marital Satisfaction Scale. Data analysis was done through SPSS15 and using pearsons' correlation coefficient and stepwise regression. The aspects of physical functioning, role limitations due to physical health problems, role limitation due to emotional problems had a significant positive correlation and the bodily pain had a significant reverse correlation with aspects of marital satisfaction. The aspects of role limitations due to physical health problems and bodily pain were predictors of marital satisfaction. The results of study demonstrated the importance of pay attention to family issues and marital satisfaction and in this regard, the promotion of all aspects of quality of life is essential. 286. [End-of-life care in special elderly nursing home for very elderly adults in comparison with emergency palliative therapy in general hospitals]. Science.gov (United States) Kurita, Akira; Shinagawa, Naosuke; Kotani, Eitarou; Takase, Bonpei; Kusama, Yoshiki; Atarashi, Hirotsugu 2010-01-01 Although the facilities for end-of-life care in the special elderly (SE) nursing home are increasing, there are no standard guidelines for end-of-life care interventions. Furthermore, in the SE nursing home, there are not enough data concerning those who have had end-of-life care and/or emergency hospital palliative therapy. Therefore, we compared the clinical outcome of end-of-life care patients and emergency palliative therapy patients. Five end-of-life care patients (99+/-10 years old) in the SE nursing home, and 48 emergency palliative therapy patients (89+/-15 years old) in the hospitals. All end-of-life care patients are still living after 300+/-70 days by standard nursing care (mainly fluid diets with small doses of vasodilators and antibiotics) with bed side music. Their average CRP values in terminal end-of-life care patients decreased from 10+/-12 mg/dl to 1.2+/-0.5 (ppalliative patients, 32 patients were discharged to our facility after 120+/-26 days of hospitalization, whereas 16 patients died in hospital after 100+/-36 days of hospitalization (aspiration pneumonia: 11 patients, heart failure: 3 patients and G-I causes: 2 patients). End-of-life care in the SE nursing home prolonged their life expectancy despite centenarian status. Hospital mortality rates of palliative emergency therapy were higher than usual end-of-life care. These data suggest that end-of-life care interventions, including bed side music, could provide physical satisfaction. 287. Assessment of knowledge and practice of nutritional and life style risk factors associated with cancer among hospital workers at two university teaching hospitals in Osun State, Nigeria. Science.gov (United States) Ojofeitimi, E O; Aderounmu, A O; Lomuwagun, A F; Owolabi, O O; Fadiora, A O; Asa, S S; Bamiwuye, S O; Ihedioha, O D 2003-01-01 The objectives of this study were to assess both the predisposing and precipitating risk factors in the aetiology of any form of cancer among hospital workers at two teaching Hospitals in Osun State, Nigeria. Pre-tested and modified questionnaires were administered to 250 respondents. One hundred and seventy questionnaires were duly filled and completed. Less than 9% of the respondents consumed fruits and vegetables on a daily basis; while the highest percentage (65%) regularly consumed butter/margarine, followed with consumption of red meat. Twenty nine percent (29%) from both locations were classified as overweight and obese. Half did physical exercise twice a week. Of the 168 respondents. 34 (20.2%) did meet the criteria for completely emptying their bowels within a specified time of three minutes. It is concluded that whilst predisposing risk factors do not pose a threat to the onset of any form of cancer among respondents, precipitating factors are real major factors that need to be addressed through information, education and communication (I.E.C). Such an I.E.C. should be geared towards promotion of healthy eating and life style strategies. Alter all, 'the first step in cancer prevention is knowing the risk profile'. 288. The impact of Roman Catholic moral theology on end-of-life care under the Texas Advance Directives Act. Science.gov (United States) Zientek, David M 2006-04-01 This essay reviews the Roman Catholic moral tradition surrounding treatments at the end of life together with the challenges presented to that tradition by the Texas Advance Directives Act. The impact on Catholic health care facilities and physicians, and the way in which the moral tradition should be applied under this statute, particularly with reference to the provision dealing with conflicts over end-of-life treatments, will be critically assessed. I will argue, based on the traditional treatment of end-of-life issues, that Catholic physicians and institutions should appeal to the conflict resolution process of the Advance Directives Act only under a limited number of circumstances. The implications, under the Texas statute, of varied interpretations of Pope John Paul II's recent allocution on artificial feeding and hydration in the persistent vegetative state will also be considered. 289. Health-Related Quality of Life after surgery for primary advanced rectal cancer and recurrent rectal cancer DEFF Research Database (Denmark)

Thaysen, Henriette Vind; Jess, Per; Laurberg, Søren 2012-01-01 Aim: A review of the literature was undertaken to provide an overview of Health-related quality of life (HRQoL) after surgery for primary advanced or recurrent rectal cancer and to outline proposals for future HRQoL studies in this area. Method: A systematic literature search was undertaken. Only...... studies concerning surgery for primary advanced or recurrent rectal cancer and describing methods used for measuring HRQoL were considered. Results Seven studies were identified including two prospective longitudinal, three cross-sectional and two based on qualitative data. Global quality of life...... cancer. Larger prospective longitudinal studies are needed to improve information on the effects of this extensive surgery on quality of life.... 290. Recent advances in the treatment of life-threatening, invasive fungal infections. Science.gov (United States) Drew, Richard H; Townsend, Mary L; Pound, Melanie W; Johnson, Steven W; Perfect, John R 2013-12-01 Invasive fungal infections (IFIs) pose significant morbidity and are often life-threatening to many high-risk patients. Timely diagnosis and treatment of these infections with optimal therapy is imperative. Advances have been made in diagnostic biomarkers such as peptide nucleic acid fluorescent in situ hybridization, β-D-glucan and galactomannan, although more research is needed in this area to assist with both diagnosis and monitoring for improvement of IFI management. Novel antifungal agents (azole antifungals and echinocandins) are being investigated that have activity against Candida spp. and Aspergillus spp. Optimizing the pharmacodynamics (PD) of our current antifungal therapies through such strategies as continuous infusion of amphotericin B and dose escalation of echinocandins and liposomal formulations of amphotericin B have also been investigated with mixed results. Therapeutic drug monitoring (TDM) shows promise as evident from data with such agents as flucytosine, itraconazole, voriconazole and posaconazole. The goal for the future of biomarkers in IFIs will be to have excellent sensitivity and specificity to ideally identify a particular fungus causing the infection or eliminate its existence to prevent unnecessary costs, resistance and antifungal usage. In addition, further developments of new antifungals are needed and judicious use of the current regimens needs to be optimized through antifungal PD properties and TDM. 291. Evaluation of a 3D serious game for advanced life support retraining. Science.gov (United States) Buttussi, Fabio; Pellis, Tommaso; Cabas Vidani, Alberto; Pausler, Daniele; Carchietti, Elio; Chittaro, Luca 2013-09-01 Advanced life support (ALS) knowledge and skills decrease in as little as three months, but only a few ALS providers actually attend retraining courses. We assess the effectiveness of a 3D serious game as a new tool for frequent ALS retraining. We developed a 3D serious game for scenario-based ALS retraining. The serious game, called EMSAVE, was designed to promote self-correction while playing. We organized a retraining course in which 40 ALS providers played two cardiac arrest scenarios with EMSAVE and took a test with 38 multiple-choice questions before and after playing. We administered the same test again 3 months later to evaluate retention. Participants also rated EMSAVE and the overall retraining experience. After using EMSAVE, the number of correct answers per participant increased by 4.8 (95%CI +3.4, +6.2, pserious game. A 3D serious game for scenariobased retraining proved effective to retrain in ALS and supported retention of acquired knowledge and skills at 3 months. EMSAVE also positively engaged and motivated participants. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. 292. Pediatric Basic and Advanced Life Support: An Update on Practice and Education Directory of Open Access Journals (Sweden) Mohamed Al-Shamsi 2012-11-01 Full Text Available This review aims to summarize the major changes in the2010 Heart and Stroke foundation of Canada (HSFC andthe American Heart Association (AHA Pediatric Basic andAdvanced Life Support Guidelines. The Guidelines were based onthe International Liaison Committee on Resuscitation’s (ILCORcomprehensive, evidencebased review of the resuscitationliterature. The key recommendations from the Guidelines include:the removal of “look, listen and feel†and a de-emphasis on theuse of the pulse check by healthcare providers to diagnose cardiacarrest; a change in the sequence of resuscitation for patientsin cardiac arrest from the previously well-known “A-B-C†i.e.Airway, Breathing, and Chest Compressions to “C-A-B†i.e.Chest Compressions first; modification to the appropriate depthof compression (at least 1/3 of the anteriorposterior depth of thechest wall or about 4 cm in infants and 5 cm in children; end-tidalCO2 monitoring (in intubated patients to assess the quality ofchest compressions and optimize cardiopulmonary resuscitation(CPR; and titrating Fi0O2 once “Return of SpontaneousCirculation†(ROSC is achieved to maintain an oxygen saturationbetween 94-99%. Overall, pediatricians, family and communityphysicians who may care for acutely ill children should be aware ofthese updated guidelines in order to provide the best possible careto their patients. 293. Perceptions of interprofessional education in the Australian Advanced Life Support in Obstetrics (ALSO) course. Science.gov (United States) Walker, Laura; Fetherston, Catherine; McMurray, Anne 2015-06-01 Interprofessional education (IPE) was investigated in the context of an evaluation of the Advanced Life Support in Obstetrics (ALSO) course in Australia. Our objectives were to examine doctors' and midwives' perceptions regarding interprofessional learning and measure changes in self-reported confidence in specific interprofessional clinical situations. A prospective, mixed methods design was used to survey 165 ALSO course participants before the course and 6 weeks after the course (n=101). Quantitative data were analysed using the Wilcoxon signed rank test, and all P levels lower than .05 were considered significant. Qualitative data were analyzed using content analysis. There were significant increases in midwives' confidence in all four aspects of interprofessional interaction measured 6 weeks following the course. However, the doctors only reported a significant increase in one aspect, the confidence that their clinical decisions were respected by the midwives with whom they worked. The qualitative data demonstrated an appreciation of different professional approaches to clinical situations and the importance of teamwork, communication, respect, and understanding. While most participants were positive about the advantages of IPE, just under half also believed there were some disadvantages, particularly due to the variable learning needs of individual professionals. Both doctors and midwives reported various benefits from IPE, and many believed that IPE assisted maternity team collaboration and communication in the workplace. However, educators need to skillfully manage IPE sessions to ensure a similar distribution of learning and that opportunities for discussion are equivalent for all individuals and professional groups. 294. Helmet Exhalation Capture System (HECS) Sizing Evaluation for an Advanced Space Suit Portable Life Support System Science.gov (United States) Paul, Heather L.; Waguespack, Glenn M.; Paul, Thomas H.; Conger, Bruce C. 2008-01-01 As part of NASA s initiative to develop an advanced portable life support system (PLSS), a baseline schematic has been chosen that includes gaseous oxygen in a closed circuit ventilation configuration. Supply oxygen enters the suit at the back of the helmet and return gases pass over the astronaut s body to be extracted at the astronaut s wrists and ankles through the liquid cooling and ventilation garment (LCVG). The extracted gases are then treated using a rapid cycling amine (RCA) system for carbon dioxide and water removal and activated carbon for trace gas removal before being mixed with makeup oxygen and reintroduced into the helmet. Thermal control is provided by a suit water membrane evaporator (SWME). As an extension of the original schematic development, NASA evaluated several Helmet Exhalation Capture System (HECS) configurations as alternatives to the baseline. The HECS configurations incorporate the use of full contact masks or non-contact masks to reduce flow requirements within the PLSS ventilation subsystem. The primary scope of this study was to compare the alternatives based on mass and volume considerations; however other design issues were also briefly investigated. This paper summarizes the results of this sizing analysis task. 295. Nile tilapia Oreochromis niloticus as a food source in advanced life support systems: Initial considerations Science.gov (United States) Gonzales, John M.; Brown, Paul B. 2006-01-01 Maintenance of crew health is of paramount importance for long duration space missions. Weight loss, bone and calcium loss, increased exposure to radiation and oxidative stress are critical concerns that need to be alleviated. Tilapia are currently under evaluation as a source of food and their contribution to reducing waste in advanced life support systems (ALSS). The nutritional composition of tilapia whole bodies, fillet, and carcass residues were quantitatively determined. Carbon and nitrogen free-extract percentages were similar among whole body (53.76% and 6.96%, respectively), fillets (47.06% and 6.75%, respectively), and carcass (56.36% and 7.04%, respectively) whereas percentages of N, S, and protein were highest in fillet (13.34, 1.34, and 83.37%, respectively) than whole body (9.27, 0.62, and 57.97%, respectively) and carcass (7.70, 0.39, and 48.15%, respectively). Whole body and fillet meet and/or exceeded current nutritional recommendations for protein, vitamin D, ascorbic acid, and selenium for international space station missions. Whole body appears to be a better source of lipids and n-3 fatty acids, calcium, and phosphorous than fillet. Consuming whole fish appears to optimize equivalent system mass compared to consumption of fillets. Additional research is needed to determine nutritional composition of tilapia whole body, fillet, and carcass when fed waste residues possibly encountered in an ALSS. 296. Systems Engineering and Integration for Advanced Life Support System and HST Science.gov (United States) Kamarani, Ali K. 2005-01-01 Systems engineering (SE) discipline has revolutionized the way engineers and managers think about solving issues related to design of complex systems: With continued development of state-of-the-art technologies, systems are becoming more complex and therefore, a systematic approach is essential to control and manage their integrated design and development. This complexity is driven from integration issues. In this case, subsystems must interact with one another in order to achieve integration objectives, and also achieve the overall system's required performance. Systems engineering process addresses these issues at multiple levels. It is a technology and management process dedicated to controlling all aspects of system life cycle to assure integration at all levels. The Advanced Integration Matrix (AIM) project serves as the systems engineering and integration function for the Human Support Technology (HST) program. AIM provides means for integrated test facilities and personnel for performance trade studies, analyses, integrated models, test results, and validated requirements of the integration of HST. The goal of AIM is to address systems-level integration issues for exploration missions. It will use an incremental systems integration approach to yield technologies, baselines for further development, and possible breakthrough concepts in the areas of technological and organizational interfaces, total information flow, system wide controls, technical synergism, mission operations protocols and procedures, and human-machine interfaces. 297. Validation of dipslides as a tool for environmental sampling in a real-life hospital setting DEFF Research Database (Denmark) Ibfelt, T; Foged, Charlotte Bernhardt Laiho; Andersen, L P 2014-01-01 Environmental sampling in hospitals is becoming increasingly important because of the rise in nosocomial infections. In order to monitor and track these infections and optimize cleaning and disinfection, we need to be able to locate the fomites with the highest amount of microorganisms, but the o......Environmental sampling in hospitals is becoming increasingly important because of the rise in nosocomial infections. In order to monitor and track these infections and optimize cleaning and disinfection, we need to be able to locate the fomites with the highest amount of microorganisms... 298. Role of demographic and job-related variables in determining work-related quality of life of hospital employees Directory of Open Access Journals (Sweden) K Shukla 2017-01-01 Full Text Available Background: Considering a huge working population in health sector faced with stressful work life, limited autonomy in work and declining work contentment calls for an overemphasis on evaluating and monitoring their satisfaction associated with work-related quality of life (WRQoL. This study evaluates WRQoL of hospital employees and validates the bilingual (English and Marathi version of WRQoL scale. Methods: The study was conducted during March-April′2014 on employees of a corporate hospital of Pune, India after ethical approval and informed consent from employees. The bilingual WRQoL scale has been tested for reliability and validity, and WRQoL scores have been reported. Results: A total of 132 hospital employees (mean age 31 [±8] years, 55% males who participated in the study reported overall moderate WRQoL scores. The scale showed high internal consistency (Cronbach′s alpha = 0.82, P < 0.0001 and moderate to high validity. WRQoL did not significantly vary across marital status, family size, and gender. "Stress at work" score of WRQoL increased with age of employees. Higher work experience, employment at higher positions and those working in clinical and diagnostic departments reported a higher WRQoL. Conclusion: WRQoL scale is a reliable and valid instrument. Better WRQoL in employees placed in higher organizational positions indicates a need for focused measures to enhance WRQoL of employees in lower hierarchical levels, especially in control at work and home life interface domains. WRQoL needs regular monitoring for employees in lower positions and aging employees. 299. Hospital diversification strategy. Science.gov (United States) Eastaugh, Steven R 2014-01-01 To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger. 300. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. Science.gov (United States) Hasegawa, Kohei; Hiraide, Atsushi; Chang, Yuchiao; Brown, David F M 2013-01-16 It is unclear whether advanced airway management such as endotracheal intubation or use of supraglottic airway devices in the prehospital setting improves outcomes following outof-hospital cardiac arrest (OHCA) compared with conventional bag-valve-mask ventilation. To test the hypothesis that prehospital advanced airway management is associated with favorable outcome after adult OHCA. Prospective, nationwide, population-based study (All-Japan Utstein Registry) involving 649,654 consecutive adult patients in Japan who had an OHCA and in whom resuscitation was attempted by emergency responders with subsequent transport to medical institutions from January 2005 through December 2010. Favorable neurological outcome 1 month after an OHCA, defined as cerebral performance category 1 or 2. Of the eligible 649,359 patients with OHCA, 367,837 (57%) underwent bag-valve-mask ventilation and 281,522 (43%) advanced airway management, including 41,972 (6%) with endotracheal intubation and 239,550 (37%) with use of supraglottic airways. In the full cohort, the advanced airway group incurred a lower rate of favorable neurological outcome compared with the bag-valve-mask group (1.1% vs 2.9%; odds ratio [OR], 0.38; 95% CI, 0.36-0.39). In multivariable logistic regression, advanced airway management had an OR for favorable neurological outcome of 0.38 (95% CI, 0.37-0.40) after adjusting for age, sex, etiology of arrest, first documented rhythm, witnessed status, type of bystander cardiopulmonary resuscitation, use of public access automated external defibrillator, epinephrine administration, and time intervals. Similarly, the odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.41; 95% CI, 0.37-0.45) and for supraglottic airways (adjusted OR, 0.38; 95% CI, 0.36-0.40). In a propensity score-matched cohort (357,228 patients), the adjusted odds of neurologically favorable survival were significantly lower both for « 13 14 15 16 17 » « 14 15 16 17 18 » 301. Shift work, quality of life and work ability among Croatian hospital nurses. Science.gov (United States) Sorić, Masa; Golubić, Rajna; Milosević, Milan; Juras, Karin; Mustajbegović, Jadranka 2013-06-01 This paper is a report of a study of the associations of shift work with work ability and quality of life (QoL) among clinical nurses. A cross-sectional study was conducted in 20072008 on 1124 nurses using the Work Ability Index Questionnaire and the Quality of Life Questionnaire (WHOQOL-BREF). Lower education was a predictor for low level of work ability and low physical health domain of QoL. Older age and having no partner were statistically significantly related to lower social interaction. Predictors significantly related to low environment domain of QoL were low education and shift work. Shift workers had higher level of level of work ability, but clinically insignificant. The study provides no evidence of a significant association between shift work and work ability or quality of life. Education has a positive association with nurses' work ability and quality of life. 302. Assessment of airborne bacteria and noroviruses in air emission from a new highly-advanced hospital wastewater treatment plant DEFF Research Database (Denmark) Uhrbrand, Katrine; Schultz, Anna Charlotte; Koivisto, A. J. 2017-01-01 Exposure to bioaerosols can pose a health risk to workers at wastewater treatment plants (WWTPs) and to habitants of their surroundings. The main objective of this study was to examine the presence of harmful microorganisms in the air emission from a new type of hospital WWTP employing advanced...... wastewater treatment technologies. Air particle measurements and sampling of inhalable bacteria, endotoxin and noroviruses (NoVs) were performed indoor at the WWTP and outside at the WWTP ventilation air exhaust, downwind of the air exhaust, and upwind of the WWTP. No significant differences were seen...... in particle and endotoxin concentrations between locations. Bacterial concentrations were comparable or significantly lower in the exhaust air than inside the WWTP and in the upwind reference. Bacterial isolates were identified using matrix-assisted laser desorption-ionization time-of-flight mass spectrometry... 303. [Frequency and assessment of symptoms in hospitalized patient with advanced chronic diseases: is there concordance among patients and doctors?]. Science.gov (United States) Palma, Alejandra; Del RÃo, Ignacia; Bonati, Pilar; Tupper, Laura; Villarroel, Luis; Olivares, Patricia; Nervi, Flavio 2008-05-01 Physicians tend to over or underestimate symptoms reported by patients. Therefore standardized symptom scoring systems have been proposed to overcome this drawback. To estimate the prevalence and the diagnostic accuracy of physical and psychological symptoms and delirium in patients admitted to an internal medicine service at a university hospital. We studied 58 patients, 45 with metastasic cancer and 13 with other advanced chronic diseases. The following scales were used: the Confusion Assessment Method for the diagnosis of delirium; the Edmonton Symptom Assessment Scale (ESAS) for pain and other physical symptoms; the Hospital Anxiety and Depression Scale to assess anxiety and depression. The ESAS was simultaneously applied to patients without delirium and their doctors to assess the level of diagnostic concordance. Twenty two percent of patients had delirium. Among the 45 patients without delirium, 11 (25%) had at least eight symptoms and 39 (88.6%) had four symptoms. The prevalence of symptoms was very high, ranging from 22 to 78%. Pain, restlessness, anorexia and sleep disorders were the most common. The concordance between symptoms reported by patients and those recorded by doctor was very low, with a Kappa index between 0.001 and 0.334. In our sample of chronic patients, there is a very high frequency of psychological and physical symptoms that are insufficiently recorded by the medical team. 304. Axisymmetric whole pin life modelling of advanced gas-cooled reactor nuclear fuel Science.gov (United States) Mella, R.; Wenman, M. R. 2013-06-01 Thermo-mechanical contributions to pellet-clad interaction (PCI) in advanced gas-cooled reactors (AGRs) are modelled in the ABAQUS finite element (FE) code. User supplied subroutines permit the modelling of the non-linear behaviour of AGR fuel through life. Through utilisation of ABAQUS's well-developed pre- and post-processing ability, the behaviour of the axially constrained steel clad fuel was modelled. The 2D axisymmetric model includes thermo-mechanical behaviour of the fuel with time and condition dependent material properties. Pellet cladding gap dynamics and thermal behaviour are also modelled. The model treats heat up as a fully coupled temperature-displacement study. Dwell time and direct power cycling was applied to model the impact of online refuelling, a key feature of the AGR. The model includes the visco-plastic behaviour of the fuel under the stress and irradiation conditions within an AGR core and a non-linear heat transfer model. A multiscale fission gas release model is applied to compute pin pressure; this model is coupled to the PCI gap model through an explicit fission gas inventory code. Whole pin, whole life, models are able to show the impact of the fuel on all segments of cladding including weld end caps and cladding pellet locking mechanisms (unique to AGR fuel). The development of this model in a commercial FE package shows that the development of a potentially verified and future-proof fuel performance code can be created and used. The usability of a FE based fuel performance code would be an enhancement over past codes. Pre- and postprocessors have lowered the entry barrier for the development of a fuel performance model to permit the ability to model complicated systems. Typical runtimes for a 5 year axisymmetric model takes less than one hour on a single core workstation. The current model has implemented: Non-linear fuel thermal behaviour, including a complex description of heat flow in the fuel. Coupled with a variety of 305. Advance Directives for End-of-Life Care and the Role of Health Education Specialists: Applying the Theory of Reasoned Action Science.gov (United States) Tremethick, Mary Jane; Johnson, Maureen K.; Carter, Mary R. 2011-01-01 Quality end-of-life care is subjective and based on individual values and beliefs. An advance directive provides a legal means of communicating these values and beliefs, as well as preferences in regards to end-of-life care when an individual is no longer able to make his or her desires known. In many nations, advance directives are underused… 306. The CELSS Antarctic Analog Project: An Advanced Life Support Testbed at the Amundsen-Scott South Pole Station, Antarctica Science.gov (United States) Straight, Christian L.; Bubenheim, David L.; Bates, Maynard E.; Flynn, Michael T. 1994-01-01 CELSS Antarctic Analog Project (CAAP) represents a logical solution to the multiple objectives of both the NASA and the National Science Foundation (NSF). CAAP will result in

direct transfer of proven technologies and systems, proven under the most rigorous of conditions, to the NSF and to society at large. This project goes beyond, as it must, the generally accepted scope of CELSS and life support systems including the issues of power generation, human dynamics, community systems, and training. CAAP provides a vivid and starkly realistic testbed of Controlled Ecological Life Support System (CELSS) and life support systems and methods. CAAP will also be critical in the development and validation of performance parameters for future advanced life support systems. 307. Comparison of biological and advanced treatment processes for ciprofloxacin removal in a raw hospital wastewater. Science.gov (United States) Guney, Gokce; Sponza, Delia Teresa 2016-12-01 The treatability of ciprofloxacin (CIP) antibiotic was investigated using a single aerobic, a single anaerobic, an anaerobic/aerobic sequential reactor system, a sonicator and a photocatalytic reactor with TiO2 nanoparticles in a raw hospital wastewater in Izmir, Turkey. The effects of increasing organic loading on the performance of all biological systems were investigated, while the effects of power and time on the yields of sonication and photocatalysis were determined. The maximum COD and CIP yields were 95% and 83% in anaerobic/aerobic sequential reactor system at an HRT of 10 days and at an OLR of 0.19 g COD/L × day after 50 days of incubation, respectively. The maximum CH4 gas production was 580 mL day(-1) at an HRT of 6.7 days. The maximum COD and CIP yields were 95% and 81% after 45 min sonication time at a power of 640 W and a frequency of 35 kHz while the maximum yield of COD and CIP were 98% and 88% after 45 min UV irradiation time with a UV power of 210 W using 0.5 g L(-1) TiO2. Among the aforementioned treatment processes, it was found that the highest treatment yields for COD (98%) and CIP (88%) pollutants were obtained with the photocatalytic process due to high OH((â—)) radical productions. 308. Living the good life? Mortality and hospital utilization patterns in the Old Order Amish. Science.gov (United States) Mitchell, Braxton D; Lee, Woei-Jyh; Tolea, Magdalena I; Shields, Kelsey; Ashktorab, Zahra; Magder, Laurence S; Ryan, Kathleen A; Pollin, Toni I; McArdle, Patrick F; Shuldiner, Alan R; Schäffer, Alejandro A 2012-01-01 Lifespan increases observed in the United States and elsewhere throughout the developed world, have been attributed in part to improvements in medical care access and technology and to healthier lifestyles. To differentiate the relative contributions of these two factors, we have compared lifespan in the Old Order Amish (OOA), a population with historically low use of medical care, with that of Caucasian participants from the Framingham Heart Study (FHS), focusing on individuals who have reached at least age 30 years.Analyses were based on 2,108 OOA individuals from the Lancaster County, PA community born between 1890 and 1921 and 5,079 FHS participants born approximately the same time. Vital status was ascertained on 96.9% of the OOA cohort through 2011 and through systematic follow-up of the FHS cohort. The lifespan part of the study included an enlargement of the Anabaptist Genealogy Database to 539,822 individuals, which will be of use in other studies of the Amish. Mortality comparisons revealed that OOA men experienced better longevity (p<0.001) and OOA women comparable longevity than their FHS counterparts.We further documented all OOA hospital discharges in Lancaster County, PA during 20022004 and compared OOA discharge rates to Caucasian national rates obtained from the National Hospital Discharge Survey for the same time period. Both OOA men and women experienced markedly lower rates of hospital discharges than their non-Amish counterparts, despite the increased lifespan.We speculate that lifestyle factors may predispose the OOA to greater longevity and perhaps to lesser hospital use. Identifying these factors, which might include behaviors such as lesser tobacco use, greater physical activity, and/or enhanced community assimilation, and assessing their transferability to non-Amish communities may produce significant gains to the public health. 309. Height loss with advancing age in a hospitalized population of Polish men and women: magnitude, pattern and associations with mortality Directory of Open Access Journals (Sweden) Chmielewski Piotr 2015-06-01 Full Text Available The connection between the rate of height loss in older people and their general health status has been well documented in the medical literature. Our study was aimed at furthering the characterization of this interrelationship in the context of health indices and mortality in a hospitalized population of Polish adults. Data were collated from a literature review and from a longitudinal study of aging carried out in the Polish population which followed 142 physically healthy inmates, including 68 men and 74 women, for at least 25 years from the age of 45 onwards. Moreover, cross-sectional data were available from 225 inmates, including 113 men and 112 women. These subjects were confined at the same hospital. ANOVA, t-test, and regression analysis were employed. The results indicate that the onset of height loss emerges in the fourth and five decade of life and there is a gradual acceleration of reduction of height at later stages of ontogeny in both sexes. Postmenopausal women experience a more rapid loss of height compared with men. The individuals who had higher rate of loss of height (≥3 cm/decade tend to be at greater risk of cardiovascular events and all-cause mortality. In conclusion, our findings suggest that a systematic assessment of the rate of loss of height can be useful for clinicians caring for elderly people because of its prognostic value in terms of morbidity and mortality. 310. Astrobiology Sample Analysis Program (ASAP) for Advanced Life Detection Instrumentation Development and Calibration Science.gov (United States) Glavin, Daniel; Brinkerhoff, Will; Dworkin, Jason; Eigenbrode, Jennifer; Franz, Heather; Mahaffy, Paul; Stern, Jen; Blake, Daid; Sandford, Scott; Fries, marc; 2008-01-01 Scientific ground-truth measurements for near-term Mars missions, such as the 2009 Mars Science Laboratory (MSL) mission, are essential for validating current in situ flight instrumentation and for the development of advanced instrumentation technologies for life-detection missions over the next decade. The NASA Astrobiology Institute (NAI) has recently funded a consortium of researchers called the Astrobiology Sample Analysis Program (ASAP) to analyze an identical set of homogenized martian analog materials in a "round-robin" style using both state-of-the-art laboratory techniques as well as in-situ flight instrumentation including the SAM gas chromatograph mass spectrometer and CHEMIN X-ray diffraction/fluorescence instruments on MSL and the Urey and MOMA organic analyzer instruments under development for the 2013 ExoMars missions. The analog samples studied included an Atacama Desert soil from Chile, the Murchison meteorite, a gypsum sample from the 2007 AMASE Mars analog site, jarosite from Panoche Valley, CA, a hydrothermal sample from Rio Tinto, Spain, and a "blind" sample collected during the 2007 MSL slow-motion field test in New Mexico. Each sample was distributed to the team for analysis to: (1) determine the nature and inventory of organic compounds, (2) measure the bulk carbon and nitrogen isotopic composition, (3) investigate elemental abundances, mineralogy and matrix, and (4) search for biological activity. The experimental results obtained from the ASAP Mars analog research consortium will be used to build a framework for understanding the biogeochemistry of martian analogs, help calibrate current spaceflight instrumentation, and enhance the scientific return from upcoming missions. 311. Maintenance Chemotherapy for Advanced Non–Small-Cell Lung Cancer: New Life for an Old Idea Science.gov (United States) Gerber, David E.; Schiller, Joan H. 2013-01-01 Although well established for the treatment of certain hematologic malignancies, maintenance therapy has only recently become a treatment paradigm for advanced non–small-cell lung cancer. Maintenance therapy, which is designed to prolong a clinically favorable state after completion of a predefined number of induction chemotherapy cycles, has two principal paradigms. Continuation maintenance therapy entails the ongoing administration of a component of the initial chemotherapy regimen, generally the nonplatinum cytotoxic drug or a molecular targeted agent. With switch maintenance (also known as sequential therapy), a new and potentially non–cross-resistant agent is introduced immediately on completion of first-line chemotherapy. Potential rationales for maintenance therapy include increased exposure to effective therapies, decreasing chemotherapy resistance, optimizing efficacy of chemotherapeutic agents, antiangiogenic effects, and altering antitumor immunity. To date, switch maintenance therapy strategies with pemetrexed and erlotinib have demonstrated improved overall survival, resulting in US Food and Drug Administration approval for this indication. Recently, continuation maintenance with pemetrexed was found to prolong overall survival as well. Factors predicting benefit from maintenance chemotherapy include the degree of response to first-line therapy, performance status, the likelihood of receiving further therapy at the time of progression, and tumor histology and molecular characteristics. Several aspects of maintenance therapy have raised considerable debate in the thoracic oncology community, including clinical trial end points, the prevalence of second-line chemotherapy administration, the role of treatment-free intervals, quality of life, economic considerations, and whether progression-free survival is a worthy therapeutic goal in this disease setting. PMID:23401441 312. Plant Growth Experiments in Zeoponic Substrates: Applications for Advanced Life Support Systems Science.gov (United States) Ming, Douglas W.; Gruener, J. E.; Henderson, K. E.; Steinberg, S. L.; Barta, D. J.; Galindo, C.; Henninger, D. L. 2001-01-01 A zeoponic plant-growth system is defined as the cultivation of plants in artificial soils, which have zeolites as a major component (Allen and Ming, 1995). Zeolites are crystalline, hydrated aluminosilicate minerals that have the ability to exchange constituent cations without major change of the mineral structure. Recently, zeoponic systems developed at the National Aeronautics and Space Administration (NASA) slowly release some (Allen et at., 1995) or all of the essential plant-growth nutrients (Ming et at., 1995). These systems have NH4- and K-exchanged clinoptilolite (a natural zeolite) and either natural or synthetic apatite (a calcium phosphate mineral). For the natural apatite system, Ca and P were made available to the plant by the dissolution of apatite. Potassium and NH4-N were made available by ion-exchange reactions involving Ca(2+) from apatite dissolution and K(+) and NH4(+) on zeolitic exchange sites. In addition to NH4-N, K, Ca, and P, the synthetic apatite system also supplied Mg, S, and other micronutrients during dissolution (Figure 1). The overall objective of this research task is to develop zeoponic substrates wherein all plant growth nutrients are supplied by the plant growth medium for several growth seasons with only the addition of water. The substrate is being developed for plant growth in Advanced Life Support (ALS) testbeds (i.e., BioPLEX) and microgravity plant growth experiments. Zeoponic substrates have been used for plant growth experiments on two Space Shuttle flight experiments (STS-60; STS-63; Morrow et aI., 1995). These substrates may be ideally suited for plant growth experiments on the International Space Station and applications in ALS testbeds. However, there are several issues that need to be resolved before zeoponics will be the choice substrate for plant growth experiments in space. The objective of this paper is to provide an overview on recent research directed toward the refinement of zeoponic plant growth substrates. 313. Can course format influence the performance of students in an advanced cardiac life support (ACLS program? Directory of Open Access Journals (Sweden) F.D. Garrido 2011-01-01 Full Text Available Advanced cardiac life support (ACLS is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003 and Model 2 (N = 2085; 2003-2007. Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given. Compared to Model 1, Model 2 presented odds ratios (OR indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64, practical (OR = 1.19; 95%CI = 0.90-1.57, and combined (OR = 1.38; 95%CI = 1.13-1.68 outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students. 314. Can course format influence the performance of students in an advanced cardiac life support (ACLS) program? Science.gov (United States) Garrido, F D; Romano, M M D; Schmidt, A; Pazin-Filho, A 2011-01-01 Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64), practical (OR = 1.19; 95%CI = 0.90-1.57), and combined (OR = 1.38; 95%CI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students. 315. End-of-life experiences of mothers with advanced cancer: perspectives of widowed fathers Science.gov (United States) Park, Eliza M; Deal, Allison M; Yopp, Justin M; Edwards, Teresa; Wilson, Douglas J; Hanson, Laura C; Rosenstein, Donald L 2017-01-01 Objective Despite the importance of parenting-related responsibilities for adult patients with terminal illnesses who have dependent children, little is known about the psychological concerns of dying parents and their families at the end of life (EOL). The aim of this study was to elicit widowed fathers’ perspectives on how parental status may have influenced the EOL experiences of mothers with advanced cancer. Subjects Three hundred and forty-four men identified themselves through an open-access educational website as widowed fathers who had lost a spouse to cancer and were raising dependent children. Methods Participants completed a web-based survey about their wife’s EOL experience and cancer history, and their own depression (Center for Epidemiologic Studies Depression Scale, CES-D) and bereavement (Texas Revised Inventory of Grief, TRIG) symptoms. Descriptive statistics, Fisher’s exact tests, and linear regression modeling were used to evaluate relationships between variables. Results According to fathers, 38% of mothers had not said goodbye to their children before death and 26% were not at all “at peace with dying.†Ninety percent of widowed fathers reported that their spouse was worried about the strain on their children at the EOL. Fathers who reported clearer prognostic communication between wife and physician had lower CES-D and TRIG scores. Conclusions To improve EOL care for seriously ill patients and their families, we must understand the concerns of parents with dependent children. These data underscore the importance of parenting-related worries in this population and the need for additional clinical and research programs devoted to addressing these issues. PMID:26685117 316. Development of Advanced Life Cycle Costing Methods for Technology Benefit/Cost/Risk Assessment Science.gov (United States) Yackovetsky, Robert (Technical Monitor) 2002-01-01 The overall objective of this three-year grant is to provide NASA Langley's System Analysis Branch with improved affordability tools and methods based on probabilistic cost assessment techniques. In order to accomplish this objective, the Aerospace Systems Design Laboratory (ASDL) needs to pursue more detailed affordability, technology impact, and risk prediction methods and to demonstrate them on variety of advanced commercial transports. The affordability assessment, which is a cornerstone of ASDL methods, relies on the Aircraft Life Cycle Cost Analysis (ALCCA) program originally developed by NASA Ames Research Center and enhanced by ASDL. This grant proposed to improve ALCCA in support of the project objective by updating the research, design, test, and evaluation cost module, as well as the engine development cost module. Investigations into enhancements to ALCCA include improved engine development cost, process based costing, supportability cost, and system reliability with airline loss of revenue for system downtime. A probabilistic, stand-alone version of ALCCA/FLOPS will also be developed under this grant in order to capture the uncertainty involved in technology assessments. FLOPS (FLight Optimization System program) is an aircraft synthesis and sizing code developed by NASA Langley Research Center. This probabilistic version of the coupled program will be used within a Technology Impact Forecasting (TIF) method to determine what types of technologies would have to be infused in a system in order to meet customer requirements. A probabilistic analysis of the CER's (cost estimating relationships) within ALCCA will also be carried out under this contract in order to gain some insight as to the most influential costs and the impact that code fidelity could have on future RDS (Robust Design Simulation) studies. 317. Practical Considerations of Waste Heat Reuse for a Mars Mission Advanced Life Support System Science.gov (United States) Levri, Julie; Finn, Cory; Luna, Bernadette (Technical Monitor) 2000-01-01 Energy conservation is a key issue in design optimization of Advanced Life Support Systems (ALSS) for long-term space missions. By considering designs for conservation at the system level, energy saving opportunities arise that would otherwise go unnoticed. This paper builds on a steady-state investigation of system-level waste heat reuse in an ALSS with a low degree of crop growth for a Mars mission. In past studies, such a system has been defined in terms of technology types, hot and cold stream identification and stream energy content. The maximum steady-state potential for power and cooling savings within the system was computed via the Pinch Method. In this paper, several practical issues are considered for achieving a pragmatic estimate of total system savings in terms of equivalent system mass (ESM), rather than savings solely in terms of power and cooling. In this paper, more realistic ESM savings are computed by considering heat transfer inefficiencies during material transfer. An estimate of the steady-state mass, volume and crewtime requirements associated with heat exchange equipment is made by considering heat exchange equipment material type and configuration, stream flow characteristics and associated energy losses during the heat exchange process. Also, previously estimated power and cooling savings are adjusted to reflect the impact of such energy losses. This paper goes one step further than the traditional Pinch Method of considering waste heat reuse in heat exchangers to include ESM savings that occur with direct reuse of a stream. For example, rather than exchanging heat between crop growth lamp cooling air and air going to a clothes dryer, air used to cool crop lamps might be reused directly for clothes drying purposes. When thermodynamically feasible, such an approach may increase ESM savings by minimizing the mass, volume and crewtime requirements associated with stream routing equipment. 318. Astrobiology Sample Analysis Program (ASAP) for Advanced Life Detection Instrumentation Development and Calibration Science.gov (United States) Glavin, Daniel; Brinkerhoff, Will; Dworkin, Jason; Eigenbrode, Jennifer; Franz, Heather; Mahaffy, Paul; Stern, Jen; Blake, Daid; Sandford, Scott; Fries, marc; Steele, Andrew; Amashukeli, Xenia; Fisher, Anita; Grunthaner, Frank; Aubrey, Andrew; Bada, Jeff; Chiesl, Tom; Stockton, Amanda; Mathies, Rich 2008-01-01 Scientific ground-truth measurements for near-term Mars missions, such as the 2009 Mars Science Laboratory (MSL) mission, are essential for validating current in situ flight instrumentation and for the development of advanced instrumentation technologies for life-detection missions over the next decade. The NASA Astrobiology Institute (NAI) has recently funded a consortium of researchers called the Astrobiology Sample Analysis Program (ASAP) to analyze an identical set of homogenized martian analog materials in a "round-robin" style using both state-of-the-art laboratory techniques as well as in-situ flight instrumentation including the SAM gas chromatograph mass spectrometer and CHEMIN X-ray diffraction/fluorescence instruments on MSL and the Urey and MOMA organic analyzer instruments under development for the 2013 ExoMars missions. The analog samples studied included an Atacama Desert soil from Chile, the Murchison meteorite, a gypsum sample from the 2007 AMASE Mars analog site, jarosite from Panoche Valley, CA, a hydrothermal sample from Rio Tinto, Spain, and a "blind" sample collected during the 2007 MSL slow-motion field test in New Mexico. Each sample was distributed to the team for analysis to: (1) determine the nature and inventory of organic compounds, (2) measure the bulk carbon and nitrogen isotopic composition, (3) investigate elemental abundances, mineralogy and matrix, and (4) search for biological activity. The experimental results obtained from the ASAP Mars analog research consortium will be used to build a framework for understanding the biogeochemistry of martian analogs, help calibrate current spaceflight instrumentation, and enhance the scientific return from upcoming missions. 319. Sexual life satisfaction and its associated socio-demographic and workplace factors among Chinese female nurses of tertiary general hospitals. Science.gov (United States) Ji, Feng; Jiang, Deguo; Lin, Xiaodong; Zhang, Wei; Zheng, Weifang; Cheng, Ce; Lin, Chongguang; Hu, Lirong; Zhuo, Chuanjun 2017-08-15 Adverse workplace factors such as job stress are reported to be associated with poor physical and mental health of nurses. However, associations between occupational factors and sexual life satisfaction (SLS) of nurses remain understudied. This study investigated SLS of Chinese female nurses of tertiary general hospitals and socio-demographic and occupational factors associated with reduced SLS of nurses. In this cross-sectional survey, 393 Chinese female nurses of four tertiary general hospitals completed a standardized socio-demographic and occupational characteristics questionnaire, Zung's Self-rating Scale for Depression, Job Content Questionnaire, and a self-report SLS question. Multiple ordinal logistic regression was used to identify factors related to reduced SLS. Fourteen point five percent female nurses were dissatisfied with their current sex lives. In multiple regression, related factors for decreased SLS included being unmarried (OR = 1.49), shift work (OR = 1.92), contract employment (OR = 1.63), high job demands (OR = 2.21), low job control (OR = 1.88), inadequate social support (OR = 2.32), and depression (OR = 3.14). Chinese female nurses of tertiary general hospitals have poor SLS. Reducing job stress and providing psycho-social support may help improve SLS of nurses. 320. A study of relationship between job stress, quality of working life and turnover intention among hospital employees. Science.gov (United States) Mosadeghrad, Ali Mohammad; Ferlie, Ewan; Rosenberg, Duska 2011-11-01 Job stress is a serious threat to the quality of working life (QWL) of health-care employees and can cause hostility, aggression, absenteeism and turnover, as well as reduced productivity. In addition, job stress among employees affects the quality of health-care services. The purpose of this study was to gain a better understanding of the relationships between job stress and QWL of employees, and their impact on turnover intention at Isfahan hospitals, Iran. The study employed a cross-sectional research design. A validated questionnaire was used to collect data from hospital employees. Overall, 26% of employees graded their job stress high. The major sources of stress were inadequate pay, inequality at work, too much work, staff shortage, lack of recognition and promotion prospects, time pressure, lack of job security and lack of management support. An inverse relationship was found between job stress and QWL among hospital employees. The most important predictor of QWL was disturbance handling, followed by job proud, job security and job stress. Finally, while QWL was negatively associated with turnover intentions, job stress was positively related to employees' intention to quit. Since job stress has a strong correlation with employee QWL and turnover intention, it is very important to apply the right human resources policies to increase employees' QWL and decrease subsequent turnover. This study invites further research to explore, implement and evaluate intervention strategies for prevention of occupational stress and improvement in QWL. « 14 15 16 17 18 » « 15 16 17 18 19 » 321. Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments Directory of Open Access Journals (Sweden) Noortgate Nele 2009-12-01 Full Text Available Abstract Background The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. Methods A cross-sectional mail survey was sent to all acute hospitals (67 main campuses in Flanders (Belgium. The questionnaire asked about hospital characteristics, the prevalence of policies on five types of endof-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. Results The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-notresuscitate decisions: 98%, palliative sedation: 79%. While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to

patients and/or family (between 17% and 50%. More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Conclusions Most Flemish acute hospitals have developed a policy on end-of-life practices 322. The Effect of Palliative Care in Home Care and Hospital on Quality of Life NARCIS (Netherlands) Jocham, Hubert R.; Dassen, Theo; Widdershoven, Guy; Middel, Berry; Halfens, Ruud 2009-01-01 The aims of this study were to assess in two different settings and at two different points of time the quality of life of patients with cancer who are terminally ill, to get an insight into the changes that occur in the course of time, and to evaluate the differences between the groups. A stratifie 323. The Effect of Palliative Care in Home Care and Hospital on Quality of Life NARCIS (Netherlands) Jocham, Hubert R.; Dassen, Theo; Widdershoven, Guy; Middel, Berry; Halfens, Ruud 2009-01-01 The aims of this study were to assess in two different settings and at two different points of time the quality of life of patients with cancer who are terminally ill, to get an insight into the changes that occur in the course of time, and to evaluate the differences between the groups. A stratifie 324. A Cross-Sectional Study of Quality of Life among Subjects with Epilepsy Attending a Tertiary Care Hospital Science.gov (United States) Suresh, K; Basavanna, P.L 2016-01-01 Introduction Epilepsy is a chronic disorder associated with profound physical and psychological consequences leading to impaired quality of life (QoL). Evaluation of the QoL among epileptics would throw light on various factors that impair or affect the QoL in such a population. Aim To study the QoL among epileptic patients attending outpatient departments of a tertiary care hospital and to identify various factors that affect the QoL in such a population. Materials and Methods A cross-sectional observational questionnaire based study, including patients with epilepsy, who were on antiepileptic drugs, on follow-up for minimum one year, aged more than 18years, both sexes and who were seizure free in the previous 24hours. The World Health Organisation Quality of Life (WHOQOL-BREF) questionnaire was administered to those included in the study. The data was analysed using Statistical Package for Social Sciences (SPSS) version 20 and statistical tests like t-test for independent variables and Analysis of Variance (ANOVA) were used to compare the QoL scores. Results Of the 98 subjects 61.2% were males, majority were educated upto high school level and most of them were employed in unskilled labour. The mean total QOL score was 53.9 (15.8). There was a significant lower mean total QOL score among people with low educational status and poor seizure control. Conclusion Epilepsy is a syndrome associated with chronic drug use and regular long term follow-ups to hospitals. These treatment and disease associated problems affects the QOL of the subjects significantly in various squares of life. We found that a lower education and having seizure in the recent past affected the QOL scores. PMID:28208904 325. Impact of oral diseases on quality of life in subjects attending out-patient department of a dental hospital, India Directory of Open Access Journals (Sweden) N Saimadhavi 2013-01-01 Full Text Available Context: Currently there is a growing interest in oral health outcomes in how oral health affects quality of life. When oral health related quality of life measures are used alongside traditional clinical methods of measuring oral health status, a more comprehensive assessment of the impact of oral diseases on the several dimensions of subjective wellbeing becomes possible. In this context, we attempted to study the impact of oral diseases on quality of life, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Aims: To evaluate the impact of different oral diseases on quality of life using a modified OHIP-14 questionnaire, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Settings and Design: The study was carried out among 302 subjects, attending the outpatient department a dental hospital, India, for check up and treatment of their oral condition. Subjects aged above 20 years, who gave their consent for the study were included. Materials and Methods: The study sample was categorized in to two groups based upon the duration of the affecting disease - group 1 consisted of subjects suffering with chronic diseases and group 2 of subjects suffering with acute diseases. All the subjects were asked to fill up their responses in the given OHIP-14 questionnaires. The completed questionnaires were then collected and statistically analyzed. Statistical Analysis Used: To evaluate the role of age on QOL, age was divided in to 2 groups using median split procedure. For inter and intragroup comparisions, independent sample t test, anova followed by post hoc test and Chi-square tests were employed. Results: Chi square test revealed a moderately impaired quality of life among all the diseases investigated. On comparing the mean domain and total OHIP score between the two groups, the domain of psychological discomfort and disability and the total 326. [Life style, dietary habits and nutritional evaluation of Hospital de Mérida health professionals]. Science.gov (United States) Márquez Moreno, Raúl; Beato VÃbora, Pilar Isabel; Tormo GarcÃa, M Ãngeles 2015-04-01 INTRODUCCIÓN Y OBJETIVOS: Se estudiaron hábitos de vida y diversos aspectos nutricionales y la relación entre ellos en personal sanitario del Hospital de Mérida del Servicio Extremeño de Salud (SES). MÉTODO: Se contó con la participación voluntaria de 43 trabajadores en activo los cuales autorrealizaron un cuestionario de datos personales, estilos de vida y un registro alimentario de siete dÃas. Además se les midieron una serie de datos antropométricos. 327. What is inappropriate hospital use for elderly people near the end of life? DEFF Research Database (Denmark) Cardona-Morrell, Magnolia; Kim, James C H; Brabrand, Mikkel 2017-01-01 : English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995-December 2016) covering community and nursing home residents aged ≥60years admitted to hospital. OUTCOMES: measurements of inappropriateness. A 17-item quality score was estimated...... availability of community alternatives for the management of ambulatory-sensitive conditions and facilitate skilling of staff to manage the terminally ill in non-acute settings. Only then would the evaluation of local variations in clinically inappropriate admissions and inappropriate length of stay... 328. Patterns of dignity-related distress at the end of life: a cross-sectional study of patients with advanced cancer and care home residents. Science.gov (United States) Hall, Sue; Davies, Joanna M; Gao, Wei; Higginson, Irene J 2014-10-01 To provide effective palliative care in different settings, it is important to understand and identify the sources of dignity-related distress experienced by people nearing the end of life. To describe and compare the sources of dignity-related distress reported by cancer patients and care home residents. Secondary analysis of merged data. Participants completed the Patient Dignity Inventory (assessing 25 sources of dignity-related distress) and measures of quality of life and depression. A total of 45 adult patients with advanced cancer referred to hospital-based palliative care teams in London, United Kingdom, and 60 residents living in one of 15 care homes in London. Care home residents were older and had poorer functioning. Both groups reported a wide range of dignity-related problems. Although the number or problems reported on the Patient Dignity Inventory was similar for the two groups (mean (standard deviation): 5.9 (5.5) for cancer patients and 4.1 (4.3) for care home residents, p = 0.07), there was a tendency for more cancer patients to report some existential problems. Experiencing physically distressing symptoms and functional limitations were prevalent problems for both groups. Patient Dignity Inventory problems were associated with poorer performance status and functioning for residents, with age and cognitive impairment for cancer patients and with poorer quality of life and depression for both groups. Although characteristics of the samples differed, similarities in the dignity-related problems reported by cancer patients and care home residents support research suggesting a common pathway towards death for malignant and non-malignant disease. A wider understanding of the sources of dignity-related distress would help clinicians provide more effective end-of-life care. © The Author(s) 2014. 329. Adapting the Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP course for emergency care education in Rwanda Directory of Open Access Journals (Sweden) William E. Cayley Jr 2011-02-01 Full Text Available The Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP course uses a case-based curriculum to teach emergency resuscitation principles to experienced health care professionals. This article describes the adaptation of the ACLS-EP curriculum to be used in a family medicine training programme in Rwanda, including lessons learned and recommendations for future use of this material for emergency care education in the African setting. 330. Adapting the Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP) course for emergency care education in Rwanda OpenAIRE Cayley Jr, William E 2011-01-01 The Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP) course uses a case-based curriculum to teach emergency resuscitation principles to experienced health care professionals. This article describes the adaptation of the ACLS-EP curriculum to be used in a family medicine training programme in Rwanda, including lessons learned and recommendations for future use of this material for emergency care education in the African setting. 331. The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians Directory of Open Access Journals (Sweden) Schopper Andrea 2010-10-01 Full Text Available Abstract Background Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation. In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008. Methods Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. Results There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. Conclusion A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward. 332. QUALITY OF LIFE IN PATIENTS WITH PERIPHERAL ARTERIAL OCCLUSIVE DISEASE ATTENDING TERTIARY CARE HOSPITAL Directory of Open Access Journals (Sweden) Rahul J 2013-12-01 Full Text Available Peripheral arterial occlusive disease (PAOD is a prevalent atherosclerotic disorder characterized by exertional limb pain , loss of limband a high mortality rate.All the aspects of health status , life style , life satisfaction , mental state or well - being to gether reflect the multi - dimensional nature of Quality of Life in an individual . MATERIAL &METHODS: A cross sectional study was conducted over a period of 6 months from October 2012 to march 2013. P atients with signs and symptoms of peripheral arterial occlusive disease were ref erred for further evaluation by Color Doppler Ultrasonography to the Department of Radiodiagnosis. The evaluation of QO L in respondents with PAOD was performed , by means of WHO QOL - BREF questionnaire , after obtaining clearance from the Institution’s Ethics Committee. RESULTS: - The mean scores in each of the four domains for both men and women were found to be similar. The difference between men and women was not found to be statist ically significant for any of the four domains.The mean scores of the gangrene absent groups and gangrene present groups were found to differ significantly inthe domainsof physical (p=0.025 , psychological (p=0.031 , environmental(p=0.048and social relatio ns (p=0.017. The mean scores of the age groups of 70 years were found to differ significantly in the domains of physical (p=0.046 , psychological (p=0.037.The mean scores , of thegroups according to the Stage of PAD in accordance with Fontaine classification , were found to differ significantly in thedomains of physical (p=0.0316 , psychological (p=0.0241 , environmental(p=0.0472and social relations (p=0.0126. KEYWORDS: - Quality of life (QOL , WHOQOL BREF , Peripheral arterial occlusive disease ( PAOD 333. Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories Science.gov (United States) Amblà s-Novellas, J; Murray, S A; Espaulella, J; Martinez-Muñoz, M; Blay, C; Gómez-Batiste, X 2016-01-01 Objectives 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues. Setting 3 primary care services, an acute care hospital, an intermediate care centre and 4 nursing homes in a mixed urban–rural district in Barcelona, Spain. Participants 782 patients (61.5% women) with a positive NECPAL CCOMS-ICO test, indicating they might benefit from a PC approach. Outcome measures The characteristics and distribution of the indicators of the NECPAL CCOMS-ICO tool are analysed with respect to the 3 trajectories and have been arranged by domain (functional, nutritional and cognitive status, emotional problems, geriatric syndromes, social vulnerability and others) and according to their static (severity) and dynamic (progression) properties. Results The common indicators associated with early end-of-life identification are functional (44.3%) and nutritional (30.7%) progression, emotional distress (21.9%) and geriatric syndromes (15.7% delirium, 11.2% falls). The rest of the indicators showed differences in the associations per illness trajectories (ppalliative approach. PMID:27645556 334. [Advance Care Planning and Decisions to limit treatment at the end of life - the view from medical ethics and psychooncology]. Science.gov (United States) Winkler, Eva C; Heußner, Pia 2016-03-01 Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment. In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions. 335. The Need for Technology Maturity of Any Advanced Capability to Achieve Better Life Cycle Cost (LCC) Science.gov (United States) Robinson, John W.; Levack, Daniel J. H.; Rhodes, Russel E.; Chen, Timothy T. 2009-01-01 Programs such as space transportation systems are developed and deployed only rarely, and they have long development schedules and large development and life cycle costs (LCC). They have not historically had their LCC predicted well and have only had an effort to control the DDT&E phase of the programs. One of the factors driving the predictability, and thus control, of the LCC of a program is the maturity of the technologies incorporated in the program. If the technologies incorporated are less mature (as measured by their Technology Readiness Level - TRL), then the LCC not only increases but the degree of increase is difficult to predict. Consequently, new programs avoid incorporating technologies unless they are quite mature, generally TRL greater than or equal to 7 (system prototype demonstrated in a space environment) to allow better predictability of the DDT&E phase costs unless there is no alternative. On the other hand, technology development programs rarely develop technologies beyond TRL 6 (system/subsystem model or prototype demonstrated in a relevant environment). Currently the lack of development funds beyond TRL 6 and the major funding required for full scale development leave little or no funding available to prototype TRL 6 concepts so that hardware would be in the ready mode for safe, reliable and cost effective incorporation. The net effect is that each new program either incorporates little new technology or has longer development schedules and costs, and higher LCC, than planned. This paper presents methods to ensure that advanced technologies are incorporated into future programs while providing a greater accuracy of predicting their LCC. One method is having a dedicated organization to develop X-series vehicles or separate prototypes carried on other vehicles. The question of whether such an organization should be independent of NASA and/or have an independent funding source is discussed. Other methods are also discussed. How to make the 336. Collaborative virtual reality based advanced cardiac life support training simulator using virtual reality principles. Science.gov (United States) Khanal, Prabal; Vankipuram, Akshay; Ashby, Aaron; Vankipuram, Mithra; Gupta, Ashish; Drumm-Gurnee, Denise; Josey, Karen; Tinker, Linda; Smith, Marshall 2014-10-01 Advanced Cardiac Life Support (ACLS) is a series of team-based, sequential and time constrained interventions, requiring effective communication and coordination of activities that are performed by the care provider team on a patient undergoing cardiac arrest or respiratory failure. The state-of-the-art ACLS training is conducted in a face-to-face environment under expert supervision and suffers from several drawbacks including conflicting care provider schedules and high cost of training equipment. The major objective of the study is to describe, including the design, implementation, and evaluation of a novel approach of delivering ACLS training to care providers using the proposed virtual reality simulator that can overcome the challenges and drawbacks imposed by the traditional face-to-face training method. We compare the efficacy and performance outcomes associated with traditional ACLS training with the proposed novel approach of using a virtual reality (VR) based ACLS training simulator. One hundred and forty-eight (148) ACLS certified clinicians, translating into 26 care provider teams, were enrolled for this study. Each team was randomly assigned to one of the three treatment groups: control (traditional ACLS training), persuasive (VR ACLS training with comprehensive feedback components), or minimally persuasive (VR ACLS training with limited feedback components). The teams were tested across two different ACLS procedures that vary in the degree of task complexity: ventricular fibrillation or tachycardia (VFib/VTach) and pulseless electric activity (PEA). The difference in performance between control and persuasive groups was not statistically significant (P=.37 for PEA and P=.1 for VFib/VTach). However, the difference in performance between control and minimally persuasive groups was significant (P=.05 for PEA and P=.02 for VFib/VTach). The pre-post comparison of performances of the groups showed that control (P=.017 for PEA, P=.01 for VFib/VTach) and 337. Lesbian, gay, bisexual and transgender people's attitudes to end-of-life decision-making and advance care planning. Science.gov (United States) Hughes, Mark; Cartwright, Colleen 2015-10-01 To examine lesbian, gay, bisexual and transgender (LGBT) people's attitudes to advance care planning (ACP) options and alternative decision-making at the end of life. Three hundred and five LGBT people completed an online or paper-based questionnaire, comprising fixed-choice questions and open-ended questions. Most respondents, particularly those identifying as female or transgender, preferred a partner to be their alternative decision-maker at the end of life should the need arise. Fifty-two per cent of respondents had spoken to this person about their wishes. Regarding legal options enabling end-of-life decision-making, 29% had an enduring power of attorney, 18% an enduring guardian and 12% an advance care directive. Despite the significance of ACP for promoting the rights of LGBT people at the end of life, the take-up of these options was nearly as low as for the general population. The potential for targeted strategies to increase the take-up of ACP is identified. © 2015 AJA Inc. 338. Quality of life in women with cervical precursor lesions and cancer:a prospective, 6-month, hospital-based study in China Institute of Scientific and Technical Information of China (English) Zhi-Mei Zhao; Xiong-Fei Pan; Si-Han Lv; Yao Xie; Shao-Kai Zhang; You-Lin Qiao; Xiao-Rong Qi; Chun-Xia Yang; Fang-Hui Zhao 2014-01-01 The overal survival of patients with cervical cancer has improved due to detection at an early stage and availability of comprehensive treatments in China. As patients’ lives prolonged, it is important to understand their health-related quality of life (QoL) during and after treatment. We used the EQ-5D questionnaire to assess QoL of 194 patients with cervical lesions at Sichuan University West China Second Hospital between May 2010 and January 2011. Patients were surveyed before primary treatment and at 1, 3, and 6 months after primary treatment. Results showed a consistent decline in EQ-5D scores in the spectrum of cervical lesions at each time point after treatment (alP < 0.05). For patients with precursor lesions, there was an increasing trend along the timeline of treatment (P < 0.01). For patients with early-stage cervical cancer, EQ-5D scores declined in the first month (P = 0.01) and gradualy increased to higher levels at 6 months post-treatment than those before treatment (P < 0.01). EQ-5D scores followed a similar trend in patients with advanced cervical cancer (P = 0.04), though they did not statisticaly rebound after 6 months (0.84± 0.19 vs. 0.86± 0.11,P = 0.62). Regarding advanced cervical cancer, EQ-5D scores for women above 40 years of age appeared to recover more rapidly and reached higher levels than those for women below 40 years (P = 0.03). Caution and extra care are recommended in the early period of cervical cancer treatment given the slight deterioration in the QoL, and in particular, for younger cervical cancer patients. Our study implies that health care providers may need to improve the health-related QoL of cervical cancer patients. 339. Objective working hour characteristics and work-life conflict among hospital employees in the Finnish public sector study. Science.gov (United States) Karhula, Kati; Puttonen, Sampsa; Ropponen, Annina; Koskinen, Aki; Ojajärvi, Anneli; Kivimäki, Mika; Härmä, Mikko 2017-06-07 This epidemiological cohort study, based on Finnish public sector data, investigated the associations between objective working hour characteristics and work-life conflict in day and shift work. The comprehensive data of hospital workers (n = 8 931, 92% women, average age 45 years), consisted of survey responses from 2012, linked with the payroll data of working hour characteristics from 91 days preceding the survey. Logistic regression analysis was used to investigate the associations between working hour characteristics and experiencing work-life conflict often/very often. The analyses were adjusted for age (50 years), sex, level of education, marital status, number of small (0-6 years) and school-aged (718 years) children, and the overall stressfulness of the life situation. We also conducted stratified analyses of age and sex on the basis of significant interactions. Difficulties in combining work and life were more often associated with shift work without night shifts and shift work with night shifts than with day work (41% and 34 versus 27%; OR for shift work with night shifts 1.78, 95% CI 1.59-2.00, OR for shift work without night shifts 1.42, 95% CI 1.26-1.60). A high proportion (> 25%) of long (> 40h, (OR 1.26, 95% 1.141.39) and very long (> 48h, OR 1.31, 95% CI 1.15-1.49) weekly working hours were associated with work-life conflict, and in the stratified analysis, the latter was also true among women (OR 1.54, 95% CI 1.25-1.89). Of the unsocial working hour characteristics, a relatively large amount (> 10% of all shifts) of evening (OR 1.56, 95% CI 1.41-1.72) and night shifts (OR 1.46, 95%CI 1.32-1.61), a high proportion (> 25% of all shifts) of quick returns (life conflict. A large amount of single days off (> 25% of all days off) was associated with work-life conflict among men (OR 1.90, 95% CI 1.11-3.25), but not in the whole sample. When the two types of shift work were analyzed separately, shift work without night shifts and very long work weeks 340. Correlation between Helicobacter pylori infection, gastric diseases and life habits among patients treated at a university hospital in Southeast Brazil Directory of Open Access Journals (Sweden)

José Luiz Proença Módena 2007-02-01 Full Text Available Helicobacter pylori is considered a significant agent in the development of various gastric diseases. However, the diseases caused by this bacterium are known as being multi-factorial, with the genotype, immune system and life habits of the host playing important roles in the establishment of the clinical outcome. Also, H. pylori exhibit a high degree of genetic variability, contributing to the complexity of the host-pathogen relationship. These observations, considered together with the widely-varying origins and social habits of the Brazilian population, lead us to speculate about the influence of these life habits on H. pylori infection and the clinical outcome. Therefore, in this study we evaluated the relationship between H. pylori infection and certain diseases in 172 patients treated at the Hospital das ClÃnicas of Ribeirão Preto (HCRP, Brazil, taking into account their different life habits, such as non-steroidal anti-inflammatory drugs and alcohol ingestion, and smoking habit. Our analysis indicated that H. pylori infection is not affected by any of the life habits evaluated but is associated with the development of peptic ulcers (gastric and duodenal ulcer and inverse correlate with gastroesophageal reflux disease (GERD. No correlation was found between the infection with this bacterium and gastritis or intestinal metaplasia. However, gastritis and erosive gastritis were directly correlated with non-steroidal antiinflammatory drugs (NSAID ingestion. Moreover, ingestion of alcohol beverages exhibited a protective effect on gastritis development in men. Our data also indicated that to achieve reliable detection of this bacterium in biopsies, two or three detection methods should be used. « 15 16 17 18 19 » « 16 17 18 19 20 » 341. Satisfaction with hospital rehabilitation: is it related to life satisfaction, functional status, age or education? Science.gov (United States) Franchignoni, Franco; Ottonello, Marcella; Benevolo, Emilio; Tesio, Luigi 2002-05-01 Satisfaction with care, functional and cognitive status, life satisfaction, anxiety, and sociodemographic variables were correlated in 55 in-patients admitted to a rehabilitation unit after hip or knee surgery. The study aimed at investigating whether, as an index of care quality, patient satisfaction can be considered as a distinct domain or instead is subsidiary to other patient characteristics. Patient satisfaction with rehabilitation care was measured through a questionnaire, SAT-16. The SAT-16 scores were moderately correlated with a short form of the Life Satisfaction Index (LSI-11: rs = 0.41, p = 0.001), but did not correlate with either the Functional Independence Measure (FIM), the STAI form X (the Spielberger StateTrait Anxiety Inventory), age or educational level. According to the "discrepancy model", the fair degree of correlation between SAT-16 and LSI-11 could be explained by connecting both expressions of satisfaction with personal background expectations and their perceived degree of fulfilment. The results confirm, also for rehabilitation care, that patient satisfaction should be considered as a valuable specific outcome, independent of most of the patient characteristics investigated (functional and cognitive status, anxiety, age, and education). 342. [Quality of life in chronic obstructive lung disease. Experience in a hospital from Western Mexico]. Science.gov (United States) Durán-Montes, Luis Alfonso; Cisneros-Sandoval, Francisco Javier; Gutiérrez-Román, Elsa Armida 2015-01-01 The chronic obstructive lung disease (COPD) is a common, expensive and preventable disease, and the evaluation of the quality of life in patients with the condition widens the scope of the results in their attention. The objective was to evaluate the health related quality of life (HRQL) according to the severity of the COPD. Descriptive study. Patients with COPD diagnosis according with the severity and related with the HRQL measured using a specific questionnaire. Statistical analyses were made using c2 or ANOVA in ranks according with the variables. A p value = 0.05 was considered significant. 62 patients were included; 61% women. HRQL questionnaire showed the Activity dimension as the more negatively affected (65 ± 24 points, p < 0.05). In the Impact dimension, severity groups III and IV were more affected compared with groups I and II (p < 0.05). There was a directly correlation between a better FEV1 with better HRQL results (r2-0.544 p < 0.0001). HRQL is affected and clinically meaningful in patients with a major severity degree of the COPD condition. The parameters that better predicts a worst HRQL was % FEV1 and FVC. 343. Working condition of nurses in Japan: awareness of work-life balance among nursing personnel at a university hospital. Science.gov (United States) Tanaka, Sachiko; Maruyama, Yukie; Ooshima, Satoko; Ito, Hirotaka 2011-01-01 The aim of this study was to examine the awareness of work-life balance (WLB) among the nursing personnel at a university hospital in Japan. Survey. A questionnaire was sent to 1236 nursing personnel working at a university hospital and 1081 (87·5%) responses received. The questions concerned the following: (1) respondent demographical characteristics, (2) living background, (3) wishes for working environments and (4) motivation to work and health condition. The data were analysed by simple and cross-tabulations. The results can be summarised as follows: (1) the concept and significance of WLB has not yet been established among nurses in Japan, (2) three factors were found, which nurses need as working environment, 1st quality-of-life benefits, 2nd flexible working style, 3rd lifelong learning and (3) nurses who reported good WLB also reported higher job satisfaction and job motivation. The concept and significance of WLB has not yet been established among nurses. Thus, it is needed to enlighten nurses on the concept and significance of WLB as well as how they should practise WLB. Approximately half of the nurses gave their jobs first priority in reality, although they had various needs for their private lives and household affairs, as well as jobs. WLB cannot be achieved only by individual attitudes; thus, organisational efforts are necessary. In the correlation between WLB and 'job satisfaction' and 'job motivation,' nurses who were satisfied with their job and those who were highly motivated showed higher WLB. There was a significant correlation between satisfaction and motivation. It is necessary that nurses understand and have any information about working policy to improve working conditions to get better conditions which they need. © 2010 Blackwell Publishing Ltd. 344. The modifying role of caregiver burden on predictors of quality of life of caregivers of hospitalized chronic stroke patients. Science.gov (United States) Jeong, Yeon-Gyu; Myong, Jun-Pyo; Koo, Jung-Wan 2015-10-01 Caregiver burden is an important predictor of quality of life (QoL) among caregivers of stroke patients. While caregiver burden and QoL might be closely related, caregiver burden seems also to be a potential modifier of the associations between patients' and caregivers' characteristics and caregivers' QoL. The purpose of this study was to investigate the effect of caregiver burden in caregivers of hospitalized chronic stroke patients and the predictors of caregivers' QoL by level of caregiver burden. A total of 238 patients and their caregivers were interviewed using questionnaires consisting of the Zarit Burden Interview and the Korean-version of the World Health Organization Quality of Life-BREF. Multiple hierarchical regression analyses were performed to determine the predictors of caregivers' QoL among caregivers stratified by median caregiver burden score (high/low). Caregiver burden had a modifying effect on caregivers' QoL. In caregivers with high burden, the patient characteristics of being unemployed and the caregiver characteristics of poor health status, lower income, and being a spouse were negative predictors of caregivers' QoL. In caregivers with low burden, the patient characteristics of being hospitalized for a longer duration and the caregiver characteristics of poor health status were negative predictors of caregivers' QoL (all ps stroke patients, particularly with regard to their health status and financial problems. Further studies are needed to examine the impact of factors not examined in the Korean cultural context. Copyright © 2015 Elsevier Inc. All rights reserved. 345. A study of psoriasis and quality of life in a tertiary care teaching hospital of Kottayam, Kerala Directory of Open Access Journals (Sweden) V D Manjula 2011-01-01 Full Text Available Background: Psoriasis is a chronic skin disease which has an impact on health-related quality of life (QoL. The psoriasis disability index (PDI is a simple 15-item questionnaire which is used to assess overall psoriasis disability. Objectives: (1 To assess the health-related QoL among patients with psoriasis, attending dermatology OPD of Medical College Hospital, Kottayam. (2 To find out the association of QoL with age and gender. Materials and Methods: This was a descriptive case series study conducted in Dermatology OPD of Medical College Hospital, Kottayam, Kerala. Psoriasis patients attending the Dermatology OPD of Medical College Hospital for 2 months were assessed. Results: Out of the total 32 patients, 56.2% were males, whose mean age was 45; 72% were married, 47% had education above plus two and were employed. Also, 34% had income above Rs. 3000 per month. Among the PDI subsets, daily activities were affected the most (90.6%, followed by work (84.4%, leisure activities (71.9%, problems with treatment (68.7% and the least affected was personal relations (62.5%. Overall PDI score (median 14.5, interquartile range 4.5-22 showed that the QoL was affected in 75% of which 9.4% were mild (score 18. There was no association between the total PDI score and age or gender. Conclusion: QoL was affected in 75% of psoriasis patients. There was no association between QoL and age or gender. 346. Neurodevelopment of very low birth weight infants in the first two years of life in a Havana tertiary care hospital. Science.gov (United States) Cejas, Gianny; Gómez, Yahima; Roca, MarÃa del Carmen; DomÃnguez, Fernando 2015-01-01 Improved survival rates of neonates with very low birth weight (Havana tertiary care hospital. A case-series study was conducted to assess neurodevelopment outcomes of very low birth weight infants over their first two years of life. The study population comprised 116 surviving neonates with very low birth weight (Havana, Cuba, 2006-2010. A longitudinal, multidisciplinary and interdisciplinary follow up of all infants' neurodevelopment was performed, from hospital discharge to age two years, corrected for gestational age at birth. Data on each infant's perinatal variables were collected: birth weight in grams, gestational age at birth, and 1-minute and 5-minute Apgar scores. Patients were classified as having normal neurodevelopment, mild abnormalities and moderate-to-severe abnormalities. Pearson's chi-square test was used to determine possible relationships between perinatal variables studied and neurodevelopment, with exact sampling distribution and 95% confidence level. Normal neurodevelopment was observed in 69% of very low birth weight infants, 25.9% had mild abnormalities, and 5.2% displayed moderate-to-severe abnormalities. The results demonstrate a statistically significant relationship between gestational age and neurodevelopmental outcomes; more neurodevelopmental abnormalities were found in infants born at earlier gestational age (<30 weeks). Surviving very low birth weight neonates with lower gestational age at birth face a higher risk of neurodevelopmental abnormalities. 347. Determinants of quality of life in advanced kidney disease: time to screen? Science.gov (United States) Iyasere, Osasuyi; Brown, Edwina A 2014-06-01 The incidence of older patients with end stage renal disease is on the increase. This group of patients have multiple comorbidities and a high symptom burden. Dialysis can be life sustaining for such patients. But it is often at the expense of quality of life, which starts to decline early in the pathway of chronic kidney disease. Quality of life is also important to patients and is a major determinant in decisions regarding renal replacement. As a result, validated patient-reported outcome measures are increasingly used to assess quality of life in renal patients. Cognitive impairment, depression, malnutrition and function decline are non-renal determinants of quality of life and mortality. They are under-recognised in the renal population but are potentially treatable, if not preventable. This review article discusses aetio-pathogenesis, prevalence and impact of these four outcomes, advocating regular screening for early identification and management. 348. Treating retinoblastoma in the first year of life in a national tertiary paediatric hospital in Mexico. Science.gov (United States) Asencio-López, Laura; Torres-Ojeda, Alan A; Isaac-Otero, Gabriela; Leal-Leal, Carlos A 2015-09-01 Retinoblastoma is the most common primary ocular malignancy in childhood, but little has been documented on the clinical and biological differences in children diagnosed before one year of age. We observed patients in this age group and followed them for up to 19 years. This retrospective, descriptive, observational study reviewed the medical records of Mexican patients, who were diagnosed with retinoblastoma before one year of age at a national paediatric hospital from 1995 to 2014. The variables analysed were age at diagnosis, weight, presenting signs, the time from first symptoms to diagnosis, family history, laterality, ocular rescue and survival rate. The 108 patients had a mean age of 7.65 months and 15.7% had a family history of retinoblastoma. The majority (55.5%) had bilateral retinoblastoma, the most common presenting sign was leukocoria (86.1%), and the most common stage of diagnosis was Group V (84.1%). More than half were underweight for their age. The overall survival rate was 92% and the disease-free survival rate was 84%. Retinoblastoma is a malignancy that can be present at birth, especially if it is a bilateral hereditary form of the disease. Leukocoria was the main presenting sign. Early diagnosis dramatically improved the prognosis for ocular rescue. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd. 349. Comparison of Quality of Life for People with Schizophrenia and Mental Health of Caregivers Between Community-Based and Hospital-based Services Directory of Open Access Journals (Sweden) Dong-Sheng Tzeng 2004-09-01 Full Text Available This study is a comparison of the quality of life and family stress levels in community-based and hospital-based services for people with schizophrenia. Fiscal considerations of the health insurance industry in Taiwan require the evaluation of a community support program versus the traditional, hospital-centered program for reform of mental health policy concerning schizophrenia. The study involved 52 schizophrenic patients, 27 in a community-based program and 25 in a hospital-based treatment model, and was conducted from January to December 2001 in the psychiatric department of a general teaching hospital in southern Taiwan. Outcomes were determined using the World Health Organization quality of life questionnaire (WHOQoL-BREF, Taiwan version, Brief Psychiatric Rating Scale (BPRS, General Health Questionnaire (Chinese version, rate of loss to follow-up, job conditions, and social function. Comparisons of quality of life and caregiver mental health between the two groups were accomplished using descriptive analysis, independent sample t test, and the generalized estimating equation-I. No significant differences between the two groups were found in quality of life or family mental stress according to the General Health Questionnaire after controlling for sex, age, disease duration, full IQ, and total BPRS score. Long disease duration predicted a hospital setting, while a high IQ was predictive of a community setting. We found no decrease in quality of life for schizophrenic patients in a hospital-based program and no increase in family mental stress among the community-based group. To improve patients' quality of life and the mental health of caregivers in both services, it is important to ameliorate severe symptoms associated with schizophrenia. 350. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: A pilot trial Directory of Open Access Journals (Sweden) Strauss Ingrid 2011-07-01 Full Text Available Abstract Background Tumor patients exhibit an increased peripheral demand of fatty acids and protein. Contrarily, tumors utilize glucose as their main source of energy supply. Thus, a diet supplying the cancer patient with sufficient fat and protein for his demands while restricting the carbohydrates (CHO tumors thrive on, could be a helpful strategy in improving the patients' situation. A ketogenic diet (KD fulfills these requirements. Therefore, we performed a pilot study to investigate the feasibility of a KD and its influence on the quality of life of patients with advanced metastatic tumors. Methods Sixteen patients with advanced metastatic tumors and no conventional therapeutic options participated in the study. The patients were instructed to follow a KD (less than 70 g CHO per day with normal groceries and were provided with a supply of food additives to mix a protein/fat shake to simplify the 3-month intervention period. Quality of life [assessed by EORTC QLQ-C30 (version 2], serum and general health parameters were determined at baseline, after every two weeks of follow-up, or after drop out. The effect of dietary change on metabolism was monitored daily by measuring urinary ketone bodies. Results One patient did not tolerate the diet and dropped out within 3 days. Among those who tolerated the diet, two patients died early, one stopped after 2 weeks due to personal reasons, one felt unable to stick to the diet after 4 weeks, one stopped after 6 and two stopped after 7 and 8 weeks due to progress of the disease, one had to discontinue after 6 weeks to resume chemotherapy and five completed the 3 month intervention period. These five and the one who resumed chemotherapy after 6 weeks report an improved emotional functioning and less insomnia, while several other parameters of quality of life remained stable or worsened, reflecting their very advanced disease. Except for temporary constipation and fatigue, we found no severe adverse side 351. Conditions and procedures for in-hospital extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR) of adult patients. Science.gov (United States) Swol, Justyna; Belohlávek, Jan; Haft, Jonathan W; Ichiba, Shingo; Lorusso, Roberto; Peek, Giles J 2016-04-01 The use of extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR; ECPR) has been repeatedly published as non-randomized studies, mainly case series and case reports. The aim of this article is to support physicians, perfusionists, nurses and extracorporeal membrane oxygenation (ECMO) specialists who regularly perform ECPR or are willing to start an ECPR program by establishing standards for safe and efficient ECPR procedures. This article represents the experience and recommendations of physicians who provide ECPR routinely. Based on its survival and outcome rates, ECPR can be considered when determining the optimal treatment of patients who require CPR. The successful performance of ECLS cannulation during CPR is a life-saving measure and has been associated with improved outcome (including neurological outcome) after CPR. We summarize the general structure of an ECLS team and describe the cannulation procedure and the approaches for post-resuscitation care. The differences in hospital organizations and their regulations may result in variations of this model. © The Author(s) 2015. 352. Prevalence of lymphoedema and quality of life among patients attending a hospital-based wound management and vascular clinic. LENUS (Irish Health Repository) Gethin, Georgina 2012-04-01 Lymphoedema is a chronic, incurable, debilitating condition, usually affecting a limb and causes discomfort, pain, heaviness, limited motion, unsatisfactory appearance and impacts on quality of life. However, there is a paucity of prevalence data on this condition. This study aimed to determine the prevalence of lymphoedema among persons attending wound management and vascular clinics in an acute tertiary referral hospital. Four hundred and eighteen patients meeting the inclusion criteria were assessed. A prevalence rate of 2.63% (n = 11) was recorded. Thirty-six percent (n = 4) had history of cellulitis and broken skin, 64% (n = 7) had history of broken skin and 36% (n = 4) had undergone treatment for venous leg ulcers. The most common co-morbidities were hypertension 55% (n = 6), deep vein thrombosis (DVT) 27% (n = 3), hypercholesterolemia 36% (n = 4) and type 2 diabetes 27% (n = 3). Quality of life scores identified that physical functioning was the domain most affected among this group. This study has identified the need to raise awareness of this condition among clinicians working in the area of wound management. 353. Quality of life, job satisfaction and their related factors among nurses working in king Abdulaziz University Hospital, Jeddah, Saudi Arabia. Science.gov (United States) Ibrahim, Nahla Khamis; Alzahrani, Nujood Abdulwahed; Batwie, Afnan Ateeg; Abushal, Razan Abdulaziz; Almogati, Ghazwa Ghazzay; Sattam, Munirah Abdulrahman; Hussin, Bodour Khalid 2016-08-01 To assess Quality of Life, job satisfaction and their related factors among nurses working in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. A cross-sectional survey was conducted among 268 nurses, 2014/2015. A validated, confidential data collection sheet was utilized. It contained the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and Job Descriptive Index/Job in General (JDI/JIG) scales. The majority of nurses (83.5%) perceived their general QOL as very good and good. Age, marital status, having children, nationality, income, education, residence, working experience, department and shift time were associated with QOL domains (p < 0.05). Similarly, working experience, income, shifts, working in inpatient and surgical departments were associated with job satisfaction. Positive correlations were found between job satisfaction and different QOL domains, and between different JDI/JIG subscales together. Improvement of the modifiable factors as nurses' income and shift time is needed for better QOL and job satisfaction. 354. Health Related Quality of Life (HRQoL) among Breast Cancer Patients Receiving Chemotherapy in Hospital Melaka: Single Centre Experience Science.gov (United States) Chee Chean, Dang; Kuo Zang, Wong; Lim, Michelle; Zulkefle, Nooraziah 2016-12-01 Objective: To investigate the impact of chemotherapy on quality of life (QoL) among breast cancer patients and to evaluate the relationship with age, cancer stage and presence of any comorbidity. Methods: A prospective study was conducted among breast cancer patients receiving chemotherapy in Hospital Melaka from 1st January 2014 to 31st July 2014. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was given to patients to fill in prior chemotherapy (baseline) and after the third cycle of chemotherapy. Socio-demographic and clinical data were collected and analyzed using SPSS version 20. Result: Respondents were 32 female patients [mean age (SD): 49.7(9.93) years]. They reported a significant lower global health status (P 0.05). Conclusion: Chemotherapy did reduce the QoL of breast cancer patients. Management of chemotherapy-induced loss of appetite, diarrhea, nausea and vomiting should be improved for a better outcome. 355. Clinical and psychometric validation of the quality of life assessment system for advanced gastric cancer based on traditional Chinese medicine. Science.gov (United States) Quan, Peng; Zheng, Pei-Yong; You, Sheng-Fu; Hua, Yong-Qiang; Song, Yi; Liu, Tao; Wan, Chong-Hua; Lu, Jin-Gen 2016-08-01 To establish questionnaire scaling and reliability and examine the clinical and psychometric validity of the quality of life assessment based on Traditional Chinese Medicine for advanced gastric cancer (QLASTCM-Ga). The QLASTCM-Ga was developed based on programmed decision procedures with multiple nominal and focus group discussions, indepth interview, pretesting and quantitative statistical procedures. The questionnaire was administered to 240 patients diagnosed with advanced gastric cancer before and after treatment. Structured group methods were employed to establish a general and a specifific module respectively. The psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness. The three identified scales of the QLASTCM-Ga and the total score demonstrated good psychometric properties. Test-retest reliability of the total scale and all domains ranged from 0.90 to 0.94, and internal consistency ranged from 0.86 to 0.93. Correlation and factor analysis demonstrated good construct validity. Signifificant difference in the subscales and the total score were found among groups differing in traditional Chinese medicine syndrome, supporting the clinical sensitivity of the QLASTCM-Ga. Statistically signifificant changes were found for each scale and the total score. Responsiveness was also good. The QLASTCM-Ga demonstrates good psychometric and clinical validity to assess quality of life in patients with advanced gastric cancer undergoing traditional Chinese medicine therapy. This study is an important fifirst step for future research in this area. 356. Focus on the legislative approach to short half life radioactive hospital waste releasing. Science.gov (United States) Petrucci, Caterina; Traino, Antonio Claudio 2015-11-01 We propose to summarize the advancements introduced by the new Directive 2013/59/Euratom concerning the concept of clearance, for which the radioactive medical waste represents a typical candidate. We also intend to spotlight disputable points in the regulatory scheme in force in Italy, as well to make a contribution to evaluate whether the practice of patients' urine storing, stated by it, can be regarded to be proper. With directing our interest to radionuclides used in Nuclear Medicine, we first present an overview of how the clearance concept, and that of exemption closely related to it, have been developed from the previous Directive 96/29 to the new one; then we describe the implementation of these concepts in the Italian legislation. Subsequently we estimate the exposure due both to keeping the effluent on site and to direct discharging it to the environment. In line with a well

established international consensus, the Directive 2013/59 drives simple and harmonized regulation of clearance. On the contrary, some complexity and lack of consistency can be found in the framework of the national legislation affecting the radioactive medical waste handling. In addition the practice of excreta storing is disputed not to be really beneficial. The opportunity should be taken to make the whole system of these requirements simpler and more consistent and effective when it is revised to transpose the new Directive. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved. 357. Design and methods of the Hospital Elder Life Program (HELP), a multicomponent targeted intervention to prevent delirium in hospitalized older patients: efficacy and costeffectiveness in Dutch health care NARCIS (Netherlands) Strijbos, Marije; Steunenberg, Bas; Mast, Roos van der; Inouye, Sharon; Schuurmans, Marieke 2013-01-01 The Hospital Elder Life Program (HELP) has been shown to be highly efficient and (cost-)effective in reducing delirium incidence in the USA. HELP provides multicomponent protocols targeted at specific risk factors for delirium and introduces a different view on care organization, with trained volunt 358. [The Moodle platform: A useful tool for training in life support. Analysis of satisfaction questionnaires from students and instructors of the semFYC advanced life support courses]. Science.gov (United States) Cordero Torres, Juan Antonio; Caballero Oliver, Antonio 2015-01-01 The aim of this study is to assess the validity and use of a mixed method of training in life support. The use of Moodle to implement an online pre-sessional phase prior to a "classic" classroom phase of teaching in this type of course is the main novelty. Analysis of satisfaction questionnaires of students and instructors of a mixed course in the advanced life support program of SemFYC (ESVAP). Moodle platform. semFYC Virtual Classroom. Students and instructors participating in the semFYC advanced life support program, ESVAP. Qualitative analysis. The majority of students rate as very useful (50%) or useful (45.37%) the existence of an online pre-sessional phase, and consider that it has helped them very much (42.20%) or quite a lot (48.62%) to make the most of the face-to-face sessions. For instructors, they considered that the existence of an online pre-sessional phase was very useful (89%) or useful (11%) for the development of the face-to-face sessions. The analysis of the results concluded that: 1) the students considered a prior non-face to face phase as very useful, and it helped them much/very much in the face to face phase, and 2) the instructors believe that the non-face to face phase had helped them a lot in the presentations and efficiency of the workshops in the face-to-face phase. Copyright © 2014 Elsevier España, S.L.U. All rights reserved. 359. Comparison of quality of life and causes of hospitalization between hemodialysis and peritoneal dialysis patients in China Directory of Open Access Journals (Sweden) Sun Ling-Hua 2007-08-01 Full Text Available Abstract Background Hemodialysis (HD and peritoneal dialysis (PD are important renal replacement treatment in end stage renal disease (ESRD, but the comparison of quality of life (QOL and causes of hospitalisation between the two modalities in China is lacking. In the present study, we compared the two modalities in a multicenter study. Subjects and methods Six hundred and fifty four HD and 408 PD patients were investigated from 10 hospitals in China from Sept, 2004 to Jan, 2005. Among the HD patients, there were 360 males and 294 females with a mean age of 57.22 ± 12.49 years (18–88 y. Among PD patients, there were 165 males and 243 females, with a mean age of 61.59 ± 12.65 years (22–89 y. Health related 36 items short form questionnaires (SF-36 were used to assess the quality of life. Hospitalisation data were collected and analyzed. Results SF-36 domains of Body Pain (BP, General Health (GH, Role-Emotional (RE, Social Functioning (SF, Vitality (VT and Mental Health (MH were all significantly higher in the PD patients as compared to the HD patients although there was no significant difference in Physical Functioning (PF and Role-Physical (RP between the two groups. The two most common causes of hospitalisation in HD patients were cardiovascular disease (39.8% and pulmonary infection (21.3%, while they were infectious peritonitis (47.6% and cardiovascular disease (31.9% in PD patients. The ever hospitalised patients had lower SF-36 scores in the domains of PF, BP, GH, RE, SF, VT and MH as compared to those of non-hospitalised patients. Conclusion Our study indicated that with the current practice in China, PD patients may enjoy better quality of life than their HD counterparts. Our results also showed that the most common cause of hospitalisation was cardiovascular disease in HD patients and peritonitis in PD patients. 360. HEALTH SURVEY AND LIFE HABITS OF NURSES WHO WORK AT THE MEDICAL FACULTY HOSPITAL AT AIBU Directory of Open Access Journals (Sweden) Fatih DENIZ 2005-04-01 Full Text Available Objectives: Nursing is an occupation needed renunciation, patience and physical endurance. Nurses have to prevent their physical and mental health, because they can be more beneficial to patients. A cross-sectional study was conducted on AIBU Duzce Medical School Nurses to determine health problems and nutritional habits. Materials and Methods: The questionnaires forms filled by 79 nurses(%86 and analysed the data using an statistical package programme. Results: Mean age of the study group was 23.5 ± 0.2(Standard Erroryears. The answer to ‘Do you satisfied in your life?’question was reported ‘fair’ in 39.7% of the group. 65.7% reported no physical activity. Skipped meals were 80.9%. The most frequent health problems were reported as low back pain (52.9%, back pain (48.5%, stomach pain (48.5%, shoulder pain (38.2% and neck pain (38.2%. Twenty-six and half percent of the group were not immunized against to Hepatitis B. Conclusion: Occupational health and safety unit must be established in workplace. Training about occupational risks and stress management must be given to nurses. [TAF Prev Med Bull 2005; 4(2.000: 55-65 « 16 17 18 19 20 » « 17 18 19 20 21 » 361. Quality of Life and Migraine Disability among Female Migraine Patients in a Tertiary Hospital in Malaysia Directory of Open Access Journals (Sweden) Munvar Miya Shaik 2015-01-01 Full Text Available Background. Disability caused by migraine may be one of the main causes of burden contributing to poor quality of life (QOL among migraine patients. Thus, this study aimed to measure QOL among migraine sufferers in comparison with healthy controls. Methods. Female diagnosed migraine patients (n= 100 and healthy controls (n=100 completed the Malay version of the World Health Organization QOL Brief (WHOQOL-BREF questionnaire. Only migraine patients completed the Malay version of the Migraine Disability Assessment questionnaire. Results. Females with migraines had significantly lower total WHOQOL-BREF scores (84.3 than did healthy controls (91.9, P<0.001. Similarly, physical health (23.4 versus 27.7, P<0.001 and psychological health scores (21.7 versus 23.2, P< 0.001 were significantly lower than those for healthy controls. Seventythree percent of patients experienced severe disability, with significantly higher number of days with headaches (13.8 days/3 months, P< 0.001 and pain scores (7.4, P< 0.013. Furthermore, migraine patients with lower total QOL scores had 1.2 times higher odds of having disability than patients with higher total QOL scores. Conclusions. The present study showed that migraine sufferers experienced significantly lower QOL than the control group from a similar population. Disability was severe and frequent and was associated with lower QOL among the migraine patients. 362. Advanced, Long-Life Cryocooler Technology for Zero-Boil-Off Cryogen Storage Project Data.gov (United States) National Aeronautics and Space Administration — Long-life, high-capacity cryocoolers are a critical need for future space systems utilizing stored cryogens. The cooling requirements for planetary and... 363. The Space Exploration Initiative: a challenge to advanced life support technologies: keynote presentation. Science.gov (United States) Mendell, W W 1991-10-01 President Bush has enunciated an unparalleled, open-ended commitment to human exploration of space called the Space Exploration Initiative (SEI). At the heart of the SEI is permanent human presence beyond Earth orbit, which implies a new emphasis on life science research and life support system technology. Proposed bioregenerative systems for planetary surface bases will require carefully designed waste processing elements whose development will lead to streamlined and efficient and efficient systems for applications on Earth. 364. Advanced Energy Storage Life and Health Prognostics (INL) FY 2012 Annual Progress Report Energy Technology Data Exchange (ETDEWEB) Jon P. Christophersen 2012-10-01 The objective of this work is to develop methodologies that will accurately estimate state-of-health (SOH) and remaining useful life (RUL) of electrochemical energy storage devices using both offline and online (i.e., in-situ) techniques through: · A statistically robust offline battery calendar life estimator tool based on both testing and simulation, and · Novel onboard sensor technology for improved online battery diagnostics and prognostics. 365. Assessment of Predictable Productivity of Nurses Working in Kerman University of Medical Sciences' Teaching Hospitals via the Dimensions of Quality of Work Life. Science.gov (United States) Borhani, Fariba; Arbabisarjou, Azizollah; Kianian, Toktam; Saber, Saman 2016-10-01 Despite the existence of a large community of nurses, specific mechanisms have not been developed yet to consider their needs and the quality of their work life. Moreover, few studies have been conducted to analyze the nature of nursing, nursing places or nurses' quality of work life. In this regard, the present study aimed to assess predictable productivity of nurses working in Kerman University of Medical Sciences' teaching hospitals via the dimensions of Quality of Work Life. The present descriptive-correlational study was conducted to assess predictable productivity of nurses via the dimensions of Quality of Work Life. The study's population consisted of all nurses working in different wards of teaching hospitals associated with Kerman University of Medical Sciences. Out of the whole population, 266 nurses were selected based on the simple random sampling method. To collect data, the questionnaires of 'Quality of Nursing Work Life' and 'Productivity' were used after confirming their reliability (test-retest) and content validity. Finally, the collected data were analyzed through the SPSS software (version 16). Although the quality of work life for nurses was average and their productivity was low but the results showed that quality of life is directly related to nurses' productivity. Quality of life and its dimensions are predictive factors in the in the nurses' productivity. It can conclude that by recognizing the nurses' quality of work life situation, it can realize this group productivity and their values to the efficiency of the health system. For the quality of working life improvement and increasing nurses' productivity more efforts are needed by authorities. The findings can be applied by managers of hospitals and nursing services along with head nurses to enhance the quality of health services and nursing profession in general. 366. End-Of-Life Care for Persons with Advanced Chronic Obstructive Pulmonary Disease: Report of a National Interdisciplinary Consensus Meeting Directory of Open Access Journals (Sweden) DM Goodridge 2009-01-01 Full Text Available While systemic shortcomings in meeting the needs of individuals with progressive chronic illnesses at the end of life have been well documented, there is growing interest in improving both care and quality of life for persons with advanced chronic obstructive pulmonary disease (COPD. For instance, the American Thoracic Society has issued an official statement on palliative care for patients with respiratory diseases, affirming that the prevention, relief, reduction and soothing of symptoms “without affecting a cure†must become an integral component of standard care. A recent Medline search located 1015 articles related to palliative or end-of-life care for people with COPD published between 2001 and 2008, compared with only 336 articles published before 2001. To address the needs of Canadian patients, an interdisciplinary consensus meeting, funded by the Canadian Institutes of Health Research and supported by the Canadian Thoracic Society, the Canadian Respiratory Health Professionals and the Canadian Lung Association was convened in Toronto, Ontario, on November 22, 2008, to begin examining the quality of end-of-life care for individuals with COPD in Canada. The present report summarizes the background to and outcomes of this consensus meeting. 367. Developing an Advanced Life Support System for the Flexible Path into Deep Space Science.gov (United States) Jones, Harry W.; Kliss, Mark H. 2010-01-01 Long duration human missions beyond low Earth orbit, such as a permanent lunar base, an asteroid rendezvous, or exploring Mars, will use recycling life support systems to preclude supplying large amounts of metabolic consumables. The International Space Station (ISS) life support design provides a historic guiding basis for future systems, but both its system architecture and the subsystem technologies should be reconsidered. Different technologies for the functional subsystems have been investigated and some past alternates appear better for flexible path destinations beyond low Earth orbit. There is a need to develop more capable technologies that provide lower mass, increased closure, and higher reliability. A major objective of redesigning the life support system for the flexible path is achieving the maintainability and ultra-reliability necessary for deep space operations. 368. Quality of Life and Physical Ability Changes After Hospital-Based Cardiac Rehabilitation in Patients With Myocardial Infarction Science.gov (United States) 2017-01-01 Objective To evaluate the effect of hospital-based cardiac rehabilitation (CR) on quality of life (QOL) and physical ability in patients with myocardial infarction (MI). Methods Patients with MI who were referred to the Cardiac Health and Rehabilitation Center 2 weeks after percutaneous coronary intervention were divided into CR and non-CR groups. The CR group performed supervised exercises 3 times a week for 2 months. QOL assessment, using the 36-item Short-Form Health Survey (SF-36) and physical ability evaluation were performed at the beginning and end of CR. Results The CR group demonstrated statistically significant improvements in physical functioning (PF), physical role functioning (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social role functioning (SF), emotional role functioning (RE), mental health (MH), physical component summary (PCS), and mental component summary (MCS). The non-CR group showed improvement in RP. Secondary outcomes, including resting heart rate (RHR), maximal oxygen consumption (VO2max), metabolic equivalent of task (MET), maximal exercise time (ETmax), stage 3 Borg rating of perceived exertion (3RPE), maximal Borg rating of perceived exertion (RPEmax), and stage 3 rate pressure product (3RPP), improved in the CR group. The non-CR group showed improvements in VO2max, MET, ETmax, and 3RPE. There were significant differences in improvements in PF, RP, BP, VT, SF, MH, MCS, RHR, VO2max, MET, ETmax, 3RPE, and 3RPP between the two groups. Conclusion Male patients with MI demonstrated improvements in QOL and physical ability following hospital-based CR; the impact on the mental component was greater than that on the physical component. PMID:28289644 369. An investigation into the association between nutritional status and quality of life in older people admitted to hospital. Science.gov (United States) Rasheed, S; Woods, R T 2014-04-01 Malnutrition is prevalent in acute hospitals and malnourished patients have an increased risk of morbidity and mortality. Studies of malnutrition and quality of life (QoL) are generally limited by both the nutritional and QoL assessment methods employed. The present study aimed to evaluate the relationship between malnutrition, as assessed using a range of nutritional assessment methods, and QoL, as measured by EuroQol-5D-3L and Short-Form (SF)-36 questionnaires. The study comprised a prospective cross-sectional study of malnutrition and QoL in 149 inpatients aged 65-99 years. Exclusion criteria were: terminal illness, active malignancy, lack of capacity to consent and severe communication difficulties. Spearman's rank correlation coefficient was used to test the association between QoL indices and nutritional markers. QoL scores for those scoring above and below thresholds for nutritional risk were compared. Regression models were created to identify nutritional indices contributing to the variability of QoL. There were significant associations between QoL scores and the Mini Nutritional Assessment (MNA)-SF. Clear differences were evident between malnourished and well-nourished patients (on the MNA-SF), those with low and normal arm muscle circumference and those with good and poor physical function. Regression analysis showed that nutritional scores and functional status made independent contributions to the prediction of QoL. The effect on food intake, mobility and psychological stress/acute disease also had a significant influence. Malnutrition risk is linked to a poorer QoL in older people on admission to hospital. Functional status and eating-related factors are major influencers on QoL in this group. These findings reinforce the role of nutrition as a priority with respect to achieving improvements in QoL. © 2013 The Authors Journal of Human Nutrition and Dietetics © 2013 The British Dietetic Association Ltd. 370. Family caregivers' involvement in caring for a hospitalized patient with cancer and their quality of life in a country with strong family bonds NARCIS (Netherlands) Effendy, C.; Vernooij-Dassen, M.; Setiyarini, S.; Kristanti, M.S.; Tejawinata, S.; Vissers, K.; Engels, Y.M. 2015-01-01 BACKGROUND: Being involved in caring for family members during illness is part of the Indonesian culture, even during hospitalization. It is unknown which factors influence the quality of life (QoL) of family members taking care of their loved ones. The present study aims to identify factors influen 371. Organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced laryngeal cancer Energy Technology Data Exchange (ETDEWEB) Olthoff, Arno; Hess, Clemens F. [Dept. of Phoniatrics and Pedaudiology, Univ. of Goettingen (Germany); Ewen, Andreas; Wolff, Hendrik Andreas; Hermann, Robert Michael; Vorwerk, Hilke; Hille, Andrea; Christiansen, Hans [Dept. of Radiotherapy, Univ. of Goettingen (Germany); Roedel, Ralph; Steiner, Wolfgang [Dept. of Otorhinolaryngology, Univ. of Goettingen (Germany); Pradier, Olivier [Dept. of Cancerology, CHU Morvan, Brest (France) 2009-05-15 Background and purpose: transoral laser microsurgery (TLM) and adjuvant radiotherapy are an established therapy regimen for locally advanced laryngeal cancer at our institution. Aim of the present study was to assess value of quality of life (QoL) data with special regard to organ function under consideration of treatment efficacy in patients with locally advanced laryngeal cancer treated with larynx-preserving TLM and adjuvant radiotherapy. Patients and methods: from 1994 to 2006, 39 patients (ten UICC stage III, 29 UICC stage IVA/B) with locally advanced laryngeal carcinomas were treated with TLM and adjuvant radiotherapy. Data concerning treatment efficacy, QoL (using the VHI [Voice Handicap Index], the EORTC QLQ-C30 and QLQ-H and N35 questionnaires) and organ function (respiration, deglutition, voice quality) were obtained for ten patients still alive after longterm follow-up. Correlations were determined using the Spearman rank test. Results: after a median follow-up of 80.8 months, the 5-year overall survival rate was 46.8% and the locoregional control rate 76.5%, respectively. The larynx preservation rate was 89.7% for all patients and 100% for patients still alive after follow-up. Despite some verifiable problems in respiration, speech and swallowing, patients showed a subjectively good QoL. Conclusion: TLM and adjuvant radiotherapy is a curative option for patients with locally advanced laryngeal cancer and an alternative to radical surgery. Even if functional deficits are unavoidable in the treatment of locally advanced laryngeal carcinomas, larynx preservation is associated with a subjectively good QoL. (orig.) 372. Alkali metal pool boiler life tests for a 25 kWe advanced Stirling conversion system Science.gov (United States) Anderson, W. G.; Rosenfeld, J. H.; Noble, J. The overall operating temperature and efficiency of solar-powered Stirling engines can be improved by adding an alkali metal pool boiler heat transport system to supply heat more uniformly to the heater head tubes. One issue with liquid metal pool boilers is unstable boiling. Stable boiling is obtained with an enhanced boiling surface containing nucleation sites that promote continuous boiling. Over longer time periods, it is possible that the boiling behavior of the system will change. An 800-h life test was conducted to verify that pool boiling with the chosen fluid/surface combination remains stable as the system ages. The apparatus uses NaK boiling on a - 100 + 140 stainless steel sintered porous layer, with the addition of a small amount of xenon. Pool boiling remained stable to the end of life test. The pool boiler life test included a total of 82 cold starts, to simulate startup each morning, and 60 warm restarts, to simulate cloud cover transients. The behavior of the cold and warm starts showed no significant changes during the life test. In the experiments, the fluid/surface combination provided stable, high-performance boiling at the operating temperature of 700 C. Based on these experiments, a pool boiler was designed for a full-scale 25-kWe Stirling system. 373. Evaluation of the effects of the Advanced Paediatric Life-Support course NARCIS (Netherlands) Turner, N.M. 2008-01-01 Doctors are generally unacceptably poor at resuscitation and this has been shown to lead to unnecessary mortality. This problem has led to the development of structured resuscitation training in the form of life-support courses, which have become very popular and are widely advocated, but which are 374. Life-Cycle Inventory Analysis of Bioproducts from a Modular Advanced Biomass Pyrolysis System Science.gov (United States) Richard Bergman; Hongmei Gu 2014-01-01 Expanding bioenergy production has the potential to reduce net greenhouse gas (GHG) emissions and improve energy security. Science-based assessments of new bioenergy technologies are essential tools for policy makers dealing with expanding renewable energy production. Using life cycle inventory (LCI) analysis, this study evaluated a 200-kWe... 375. Quality of life after hyperthermic isolated limb perfusion for locally advanced extremity soft tissue sarcoma NARCIS (Netherlands) Thijssens, KMJ; Hoekstra-Weebers, JEHM; van Ginkel, RJ; Hoekstra, HJ 2006-01-01 Background: Quality of life (QoL) and posttraumatic stress symptoms (PTSS) were studied in patients with soft tissue sarcoma (STS) of the extremities treated with isolated limb perfusion and delayed resection, with or without adjuvant irradiation. Methods: Forty-one patients received a questionnaire 376. Breast cancer quality of life evaluation in Mexican Women at La Raza Hospital, Mexico City: A preliminary approach Directory of Open Access Journals (Sweden)

Jacobo Alejandro Gómez-Rico 2008-11-01 Full Text Available Jacobo Alejandro Gómez-Rico1, Marina Altagracia-MartÃnez1, Jaime Kravzov-Jinich1, Rosario Cárdenas-Elizalde1, Juan Carlos Hinojosa-Cruz2, Consuelo Rubio-Poo31Departments of Biological Systems and Healthcare, Biological and Health Sciences Division (DCBS, Universidad Autónoma Metropolitana–Xochimilco (UAM-X, Xochimilco, Mexico; 2La Raza Hospital of the Mexican Social Security Institute (IMSS, Mexico City, Mexico; 3Universidad Nacional Autónoma de México (UNAM, Faculty of Professional Studies, Zaragoza (FES-Zaragoza, MexicoAbstract: Breast cancer (BC is the second leading cause of death among Mexican women over 40 years of age. This study aimed to identify and examine the effects of cancer stage and surgical treatment on the quality of life (QOL of Mexican women with early stage breast cancer (ESBC treated with either modified radical mastectomy (MRM or breast conservative surgery (BCS, plus adjuvant chemotherapy. The QLQ-C30 and QLQ BR-23 questionnaires were used to assess QOL. Sociodemographic characteristics and clinical factors of 102 women with early BC were also evaluated; analysis of variance (ANOVA was performed and a statistical significance of p < 0.05 was assumed. Most women were of reproductive age. Meaningful differences in QOL as a result of surgical treatment, in women receiving BCS compared with those receiving MRM, were limited to body image. We conclude that MRM and BCS are essentially equivalent choices in terms of QOL, with the exception of the impact on body image. In general, women who received BCS had a better perceived QOL.Keywords: quality of life, breast cancer, Mexican women 377. Demonstration of Advanced Technologies for Multi-Load Washers in Hospitality and Healthcare -- Ozone Based Laundry Systems Energy Technology Data Exchange (ETDEWEB) Boyd, Brian K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Parker, Graham B. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Petersen, Joseph M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Sullivan, Greg [Efficiency Solutions, LLC (United States); Goetzler, W. [Navigant Consulting, Inc. (United States); Sutherland, T. A. [Navigant Consulting, Inc. (United States); Foley, K. J. [Navigant Consulting, Inc. (United States) 2014-08-14 The objective of this demonstration project was to evaluate market-ready retrofit technologies for reducing the energy and water use of multi-load washers in healthcare and hospitality facilities. Specifically, this project evaluated laundry wastewater recycling technology in the hospitality sector and ozone laundry technology in both the healthcare and hospitality sectors. This report documents the demonstration of ozone laundry system installations at the Charleston Place Hotel in Charleston, South Carolina, and the Rogerson House assisted living facility in Boston, Massachusetts. 378. AFEM Consensus Conference, 2013. AFEM Out-of-Hospital Emergency Care Workgroup Consensus Paper: Advancing Out-of-Hospital Emergency Care in Africa-Advocacy and Development Directory of Open Access Journals (Sweden) N.K. Mould-Millman 2014-06-01 Future directions of the AFEM Out-of-Hospital Emergency Care Workgroup include creating an online Toolkit. This will serve as a repository of template documents to guide implementation and development of clinical care, education, transportation, public access, policy and governance. 379. Association of out-of-hospital advanced airway management with outcomes after traumatic brain injury and hemorrhagic shock in the ROC hypertonic saline trial. Science.gov (United States) Wang, Henry E; Brown, Siobhan P; MacDonald, Russell D; Dowling, Shawn K; Lin, Steve; Davis, Daniel; Schreiber, Martin A; Powell, Judy; van Heest, Rardi; Daya, Mohamud 2014-03-01 Prior studies suggest adverse associations between out-of-hospital advanced airway management (AAM) and patient outcomes after major trauma. This secondary analysis of data from the Resuscitation Outcomes Consortium Hypertonic Saline Trial evaluated associations between out-of-hospital AAM and outcomes in patients suffering isolated severe traumatic brain injury (TBI) or haemorrhagic shock. This multicentre study included adults with severe TBI (GCS ≤8) or haemorrhagic shock (SBP ≤70 mm Hg, or (SBP 7190 mm Hg and heart rate ≥108 bpm)). We compared patients receiving out-of-hospital AAM with those receiving emergency department AAM. We evaluated the associations between airway strategy and patient outcomes (28-day mortality, and 6-month poor neurologic or functional outcome) and airway strategy, adjusting for confounders. Analysis was stratified by (1) patients with isolated severe TBI and (2) patients with haemorrhagic shock with or without severe TBI. Of 2135 patients, we studied 1116 TBI and 528 shock; excluding 491 who died in the field, did not receive AAM or had missing data. In the shock cohort, out-of-hospital AAM was associated with increased 28-day mortality (adjusted OR 5.14; 95% CI 2.42 to 10.90). In TBI, out-of-hospital AAM showed a tendency towards increased 28-day mortality (adjusted OR 1.57; 95% CI 0.93 to 2.64) and 6-month poor functional outcome (1.63; 1.00 to 2.68), but these differences were not statistically significant. Out-of-hospital AAM was associated with poorer 6-month TBI neurologic outcome (1.80; 1.09 to 2.96). Out-of-hospital AAM was associated with increased mortality after haemorrhagic shock. The adverse association between out-of-hospital AAM and injury outcome is most pronounced in patients with haemorrhagic shock. 380. Life Cycle Assessment of an Advanced Bioethanol Technology in the Perspective of Constrained Biomass Availability DEFF Research Database (Denmark) Hedegaard, Karsten; Thyø, Katrine; Wenzel, Henrik of alternative uses. Since natural gas and coal will be used as fuels for heat and power production at least within this time frame, the lost alternatives include substitution of natural gas or coal in the heat and power sector. In a case study, we investigate the environmental feasibility of using advanced...... show that for the case of this advanced bioethanol technology, in terms of reducing greenhouse emissions and fossil fuel dependency, more is lost than gained when prioritizing biomass or land for bioethanol. Technology pathways involving heat and power production and/or biogas, natural gas...... or electricity for transport are advantageous. This is mainly caused by the significant energy conversion losses in bioethanol production compared to use of biomass in the energy sector. The losses lie in the need for pretreatment (lignocellulosic based production), the relatively low fermentation yield... « 17 18 19 20 21 » « 18 19 20 21 22 » 381. Application of NASA's Advanced Life Support Technologies for Waste Treatment, Water Purification and Recycle, and Food Production in Polar Regions Science.gov (United States) Bubenheim, David L.; Lewis, Carol E.; Covington, M. Alan (Technical Monitor) 1995-01-01 NASA's advanced life support technologies are being combined with Arctic science and engineering knowledge to address the unique needs of the remote communities of Alaska through the Advanced Life Systems for Extreme Environments (ALSEE) project. ALSEE is a collaborative effort involving NASA, the State of Alaska, the University of Alaska, the North Slope Borough of Alaska, and the National Science Foundation (NSF). The focus is a major issue in the state of Alaska and other areas of the Circumpolar North, the health and welfare of its people, their lives and the subsistence lifestyle in remote communities, economic opportunity, and care for the environment. The project primarily provides treatment and reduction of waste, purification and recycling of water. and production of food. A testbed is being established to demonstrate the technologies which will enable safe, healthy, and autonomous function of remote communities and to establish the base for commercial development of the resulting technology into new industries. The challenge is to implement the technological capabilities in a manner compatible with the social and economic structures of the native communities, the state, and the commercial sector. Additional information is contained in the original extended abstract. 382. [Six years of Advanced Trauma Life Support (ATLS) in Germany: the 100th provider course in Hamburg]. Science.gov (United States) Münzberg, M; Mahlke, L; Bouillon, B; Paffrath, T; Matthes, G; Wölfl, C G 2010-07-01 With over 1 million certified physicians in more than 50 countries worldwide, the Advanced Trauma Life Support (ATLS) concept is one of the most successful international education programs. The concept is simple, priority-orientated (ABCDE scheme) and assesses the situation of the trauma patient on the basis of vital signs to treat the life-threatening injuries immediately. With over 100 ATLS provider courses and 10 instruction courses accomplished in less than 6 years, no other land in the world has successfully established this concept in such a short time as Germany. Meanwhile nearly 1,600 colleagues have been trained and certified. Evaluation of the first 100 ATLS courses in Germany supports this concept. The total evaluation of all courses is 1.36 (1.06-1.8, n=100). The individual parts of the course were marked as followed: presentations 1.6 (1.0-2.81, n=100), practical skills stations 1.46 (1.0-2.4, n=100) and surgical skills stations 1.38 (1.0-2.38, n=100). In 2009 a total of 47 ATLS courses were accomplished which will clearly increase in 2010. Other ATLS formats, such as ATCN (Advanced Trauma Care for Nurses) and refresher courses are planned for the beginning of 2010. 383. Application of NASA's Advanced Life Support Technologies for Waste Treatment, Water Purification and Recycle, and Food Production in Polar Regions Science.gov (United States) Bubenheim, David L.; Lewis, Carol E.; Covington, M. Alan (Technical Monitor) 1995-01-01 NASA's advanced life support technologies are being combined with Arctic science and engineering knowledge to address the unique needs of the remote communities of Alaska through the Advanced Life Systems for Extreme Environments (ALSEE) project. ALSEE is a collaborative effort involving NASA, the State of Alaska, the University of Alaska, the North Slope Borough of Alaska, and the National Science Foundation (NSF). The focus is a major issue in the state of Alaska and other areas of the Circumpolar North, the health and welfare of its people, their lives and the subsistence lifestyle in remote communities, economic opportunity, and care for the environment. The project primarily provides treatment and reduction of waste, purification and recycling of water. and production of food. A testbed is being established to demonstrate the technologies which will enable safe, healthy, and autonomous function of remote communities and to establish the base for commercial development of the resulting technology into new industries. The challenge is to implement the technological capabilities in a manner compatible with the social and economic structures of the native communities, the state, and the commercial sector. Additional information is contained in the original extended abstract. 384. Palliative Care Improves Survival, Quality of Life in Advanced Lung Cancer | Division of Cancer Prevention Science.gov (United States) Results from the first randomized clinical trial of its kind have revealed a surprising and welcome benefit of early palliative care for patients with advanced lung cancer—longer median survival. Although several researchers said that the finding needs to be confirmed in other trials of patients with other cancer types, they were cautiously optimistic that the trial results could influence oncologists’ perceptions and use of palliative care. | 385. The influence of an advanced agriculture & life science course on students' views of the nature of science Science.gov (United States) Anderson, Megan N. One of the goals in today's society is to ensure that students exiting school have the ability to understand, develop, and comprehend scientific information. For students to be able to meet these goals, it is imperative that they become scientifically literate and understand the concept of the Nature of Science (NOS). The discipline of Agricultural Education has strong connections with science and today many students are earning science credit and developing science understanding through Agricultural Education courses. If students are continuing to gain science mastery through their Agricultural Education courses, they should also be gaining adequate conceptions of science and the NOS. Overall, many studies have indicated that students exiting the K-12 education system lack these vital skills and understanding. The purpose of this study was to explore the conceptions of the NOS of advanced agriculture students in Indiana. This study explored the conceptions of agricultural science students before and after taking a semester of an advanced life science course (N=48). Conceptions were explored through a qualitative case study utilizing the VNOS-C questionnaire. Responses were coded into one of three categories: Naive, Emerging, or Informed. Demographic data were also collected and analyzed. Overall, results of this study indicate that students in advanced agricultural science courses lack NOS understanding. The study's conclusions are discussed along with implications for theory, research and practice in addition to future directions for research. 386. Cost of physician-led home visit care (Zaitaku care) compared with hospital care at the end of life in Japan. Science.gov (United States) Kinjo, Kentaro; Sairenji, Tomoko; Koga, Hidenobu; Osugi, Yasuhiro; Yoshida, Shin; Ichinose, Hidefumi; Nagai, Yasunori; Imura, Hiroshi; South-Paul, Jeannette E; Meyer, Mark; Honda, Yoshihisa 2017-01-17 Physician-led home visit care with medical teams (Zaitaku care) has been developed on a national scale to support those who wish to stay at home at the end of life, and promote a system of community-based integrated care in Japan. Medical care at the end of life can be expensive, and is an urgent socioeconomic issue for aging societies. However medical costs of physician-led home visits care have not been well studied. We compared the medical costs of Zaitaku care and hospital care at the end of life in a rapidly aging community in a rural area in Japan. A cross-sectional study was performed to compare the total medical costs during patients' final days of life (30 days or less) between Zaitaku care and hospital care from September 2012 to August 2013 in Fukuoka Prefecture, Japan. Thirty four patients died at home under Zaitaku care, and 72 patients died in the hospital during this period. The average daily cost of care during the last 30 days did not differ significantly between the two groups. Although Zaitaku care costs were higher than hospital care costs in the short-term (≦10 days, Zaitaku care $371.2 vs. Hospital care $202.0, p = 0.492), medical costs for Zaitaku care in the long-term care (≧30 days) were less than that of hospital care ($155.8 vs. $187.4, p = 0.055). Medical costs of Zaitaku care were less compared with hospital care if incorporated early for long term care, but it was high if incorporated late for short term care. For long term care, medical costs for Zaitaku care was 16.7% less than for hospitalization at the end of life. This physician-led home visit care model should be an available option for patients who wish to die at home, and may be beneficial financially over time. 387. The Utilization of Urine Processing for the Advancement of Life Support Technologies Science.gov (United States) Grossi-Soyster, Elysse; Hogan, John; Flynn, Michael 2014-01-01 The success of long-duration missions will depend on resource recovery and the self-sustainability of life support technologies. Current technologies used on the International Space Station (ISS) utilize chemical and mechanical processes, such as filtration, to recover potable water from urine produced by crewmembers. Such technologies have significantly reduced the need for water resupply through closed-loop resource recovery and recycling. Harvesting the important components of urine requires selectivity, whether through the use of membranes or other physical barriers, or by chemical or biological processes. Given the chemical composition of urine, the downstream benefits of urine processing for resource recovery will be critical for many aspects of life support, such as food production and the synthesis of biofuels. This paper discusses the beneficial components of urine and their potential applications, and the challenges associated with using urine for nutrient recycling for space application. 388. [Advances in psychosocial interventions on quality of life of cancer survivors]. Science.gov (United States) Chen, Xuefen; Wang, Jiwei; Gong, Xiaohuan; Yu, Jinming 2015-02-01 In recent years, there has been increasing recognition of the importance of psychosocial interventions' studies on quality of life in cancer survivors because of improving cancer survival rate. This paper was an integrative literatures review of various psychosocial interventions including cognitive behavioral therapy, group-based supportive therapy, counseling or psychotherapy, education or psychoeducation and music therapy et al, and analyzing the complexity of psychosocial interventions' RCTs in oncology and the current characteristic of these studies in China. 389. Advances and critical aspects in the life-cycle assessment of battery electric cars OpenAIRE HELMERS Eckard; WEISS MARTIN 2016-01-01 Concerns over climate change, air pollution, and oil supply have stimulated the market for battery electric vehicles (BEVs). The environmental impacts of BEVs are typically evaluated through a standardized life-cycle assessment (LCA) methodology. Here, the LCA literature was surveyed with the objective to sketch the major trends and challenges in the impact assessment of BEVs. It was found that BEVs tend to be more energy efficient and less polluting than conventional cars. BEVs decrease expo... 390. Advances in Modeling Concrete Service Life : Proceedings of 4th International RILEM PhD Workshop CERN Document Server Gulikers, Joost 2012-01-01 In this book, a critical analysis is made on service life models related to reinforcement corrosion. The contributors are on the frontier of knowledge in the field of durability of reinforced concrete. Topics covered in the book include: causes and mechanisms of deterioration, transport mechanisms in concrete, numerical modeling of concrete behavior, durability modeling and prediction, reliability approach to structural design for durability, structural behavior following degradation of concrete structures, deterioration and repair of concrete structures, and corrosion measurement techniques. 391. Learning new lines. New 'playbook' advises hospitals how to win bigger reimbursement for medical procedures that use expensive advanced technology. Science.gov (United States) Taylor, Mark 2003-07-28 If hospitals' tough negotiating tactics with managed care often seem to be taken from an instruction manual, then that perception would be correct. Profiting From Innovation is a research group's latest report to its hospital clients, telling them just how to get managed-care plans to pay for pricey medical technology. 392. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries. Science.gov (United States) Coffey, Alice; McCarthy, Geraldine; Weathers, Elizabeth; Friedman, M Isabel; Gallo, Katherine; Ehrenfeld, Mally; Chan, Sophia; Li, William H C; Poletti, Piera; Zanotti, Renzo; Molloy, D William; McGlade, Ciara; Fitzpatrick, Joyce J; Itzhaki, Michal 2016-06-01 Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care. 393. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries. LENUS (Irish Health Repository) Coffey, Alice 2016-01-28 Nurses\\' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses\\' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients\\' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care. 394. Reseach of psychological and pain care of patients with advanced kidney cancer and quality of life%晚期肾癌患者心ç†åŠç–¼ç—›æŠ¤ç†ä¸Žç”Ÿæ´»è´¨é‡ç›¸å…³æ €§ç ”究 Institute of Scientific and Technical Information of China (English) å™å©· 2011-01-01 Objective To study the pain associated with quality of life of patients with advanced kidney cancer psychological care. Methods Hospitalized patients with advanced renal cell carcinoma extract 25 cases for the study. Results Before Psychological care and pain care compared with 1 month psychological care and pain care the QL - Index, there has significant difference ( P < 0. 05 ). Conclusions Psychological and pain care of patients with advanced cancer was positively correlated with quality of life.%目的 ç ”ç©¶æ™šæœŸè‚¾ç™Œæ‚£è€…å¿ƒç†æŠ¤ç†åŠç–¼ç—›æŠ¤ç†ä¸Žç”Ÿæ´»è´¨é‡çš„相关性.方法 抽å–晚期ä½é™¢è‚¾ç™Œæ‚£è€…45ä¾‹ä½œä¸ºç ”ç©¶å¯¹è± ¡.结果 未进行心ç†æŠ¤ç†åŠç–¼ç—›æŠ¤ç†ä¹‹å‰ä¸Žè¿›è¡Œ1个月心ç†æŠ¤ç†å’Œç–¼ç—›æŠ¤ç†ä¹‹åŽçš„QL - Index å˜åœ¨æ˜¾è‘—性差异(P<0.05).结论 晚期癌症患者心ç†æŠ¤ç†åŠç–¼ç—›æŠ¤ç†ä¸Žç”Ÿæ´»è´¨é‡å‘ˆæ£ç›¸å…³. 395. Symptom burden, quality of life, advance care planning and the potential value of palliative care in severely ill haemodialysis patients. Science.gov (United States) Weisbord, Steven D; Carmody, Sharon S; Bruns, Frank J; Rotondi, Armando J; Cohen, Lewis M; Zeidel, Mark L; Arnold, Robert M 2003-07-01 There has been little research on the potential value of palliative care for dialysis patients. In this pilot study, we sought (i) to identify symptom burden, health-related quality of life (HRQoL) and advance directives in extremely ill haemodialysis patients to determine their suitability for palliative care and (ii) to determine the acceptability of palliative care to patients and nephrologists. Nineteen haemodialysis patients with modified Charlson co-morbidity scores of > or =8 were recruited. Each completed surveys to assess symptom burden, HRQoL and prior advance care planning. Palliative care specialists then visited patients twice and generated recommendations. Patients again completed the surveys, and dialysis charts were reviewed to assess nephrologists' (i) compliance with recommendations and (ii) documentation of symptoms reported by patients on the symptom assessment survey. Patients and nephrologists then completed surveys assessing their satisfaction with palliative care. Patients reported 10.5 symptoms, 40% of which were noted by

nephrologists in patients' charts. HRQoL was significantly impaired. Thirty-two percent of patients had living wills. No differences were observed in symptoms, HRQoL or number of patients establishing advance directives as a result of the intervention. Sixty-eight percent of patients and 76% of nephrologists rated the intervention worthwhile. Extremely ill dialysis patients have marked symptom burden, considerably impaired HRQoL and frequently lack advance directives, making them appropriate candidates for palliative care. Patients and nephrologists perceive palliative care favourably despite its lack of effect in this study. A more sustained palliative care intervention with a larger sample size should be attempted to determine its effect on the care of this population. 396. Hospitality within hospital meals – DEFF Research Database (Denmark) Justesen, Lise; Gyimóthy, Szilvia; Mikkelsen, Bent Egberg 2016-01-01 Hospital meals and their role in nutritional care have been studied primarily from a life and natural science perspective. This article takes a different approach and explores the idea of hospitality inspired by Jacques Derrida’s work on the ontology of hospitality. By drawing on ethnographic...... fieldwork in a Danish hospital, hospitality practices were studied using a socio-material assemblage approach. The study showed that rethinking the meal event could change the wards into temporary “pop-up-restaurants,†transcending the hospital context and providing a scene for shifting host...... and management involved in hospital food service and in nutritional care to work more systematically with the environment for improved hospital meal experiences in the future... 397. [Truth telling and advance care planning at the end of life]. Science.gov (United States) Hu, Wen-Yu; Yang, Chia-Ling 2009-02-01 One of the core values in terminal care the respect of patient 'autonomy'. This essay begins with a discussion of medical ethics principles and the Natural Death Act in Taiwan and then summarizes two medical ethical dilemmas, truth telling and advance care planning (ACP), faced in the development of hospice and palliative care in Taiwan. The terminal truth telling process incorporates the four basic principles of Assessment and preparation, Communication with family, Truth-telling process, and Support and follow up (the so-called "ACTs"). Many experts suggest practicing ACP by abiding by the following five steps: (1) presenting and illustrating topics; (2) facilitating a structured discussion; (3) completing documents with advanced directives (ADs); (4) reviewing and updating ADs; and (5) applying ADs in clinical circumstances. Finally, the myths and challenges in truth telling and ADs include the influence of healthcare system procedures and priorities, inadequate communication skills, and the psychological barriers of medical staffs. Good communication skills are critical to truth telling and ACP. Significant discussion about ACP should help engender mutual trust between patients and the medical staffs who take the time to establish such relationships. Promoting patient autonomy by providing the opportunity of a good death is an important goal of truth telling and ACP in which patients have opportunities to choose their terminal treatment. 398. Life expectancy with perioperative chemotherapy and chemoradiotherapy for locally advanced gastric adenocarcinoma Directory of Open Access Journals (Sweden) Sadighi S 2008-12-01 Full Text Available "nBackground: Although postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach, curative surgery occurs in less than 50% of nonmetastatic gastric cancers. A regimen of docetaxel, cisplatin and infusional fluorouracil improves survival of patients with incurable locally-advanced gastric adenocarcinoma. So we assessed the perioperative regimen of docetaxel, cisplatin and infusions 5FU (TCF and postoperative chemoradiotherapy to improve outcomes in patients with potentially resectable gastric adenocarcinoma. "nMethods: Between March 2005 and March 2008, we 100 enrolled patients with stage II to IV (M0 adenocarcinoma of the stomach who had not been treated previously. Treatment consisted of three preoperative and one postoperative cycles of TCF followed by chemoradiotherapy. The primary end point was overall survival. The secondary end points were progression-free survival and toxicity of treatment. "nResults: A total of 100 patients participated, 83 of whom received neoadjuvant and 17 received adjuvant chemotherapy. Seventy-five patients underwent at least D0 gastrectomy. After chemotherapy, tumor stages were significantly lower than before beginning the protocol. Out of 100 patients, 44 had stage IV before chemotherapy versus 15 after the treatment. Three patients showed complete pathologic response. The median survival time was 25 months. "nConclusion: Docetaxel, cisplatin and 5FU combination chemotherapy is an active preoperative treatment in locally advanced gastric cancer. Perioperative chemoradio-therapy should be considered as an option to lengthen patient survival. 399. Life Cycle Assessment of Environmental and Economic Impacts of Advanced Vehicles Directory of Open Access Journals (Sweden) Zach C. Winfield 2012-03-01 Full Text Available Many advanced vehicle technologies, including electric vehicles (EVs, hybrid electric vehicles (HEVs, and fuel cell vehicles (FCVs, are gaining attention throughout the World due to their capability to improve fuel efficiencies and emissions. When evaluating the operational successes of these new fuel-efficient vehicles, it is essential to consider energy usage and greenhouse gas (GHG emissions throughout the entire lifetimes of the vehicles, which are comprised of two independent cycles: a fuel cycle and a vehicle cycle. This paper intends to contribute to the assessment of the environmental impacts from the alternative technologies throughout the lifetimes of various advanced vehicles through objective comparisons. The methodology was applied to six commercial vehicles that are available in the U.S. and that have similar dimensions and performances. We also investigated the shifts in energy consumption and emissions through the use of electricity and drivers’ behavior regarding the frequencies of battery recharging for EVs and plugin hybrid electric vehicles (PHEVs. This study thus gives insight into the impacts of the electricity grid on the total energy cycle of a vehicle lifetime. In addition, the total ownership costs of the selected vehicles were examined, including considerations of the fluctuating gasoline prices. The cost analysis provides a resource for drivers to identify optimal choices for their driving circumstances. 400. Patient life in hospital DEFF Research Database (Denmark) Ludvigsen, Mette Spliid basic tool for emplotting the encounters between patients with the message that we are in an awaiting position and obliged to stay here for a while is a specific set of behaviours that patients perform. The emplotment of waiting is communicated as a frame within which minor plots appear. These plots... « 18 19 20 21 22 » « 19 20 21 22 23 » 401. The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial Directory of Open Access Journals (Sweden) Pellegrini Fabio 2011-01-01 Full Text Available Abstract Background Most cancer patients still die in hospital, mainly in medical wards. Many studies in different countries have shown the poor quality of endof-life care delivery in hospitals. The Program "Liverpool Care Pathway for the dying patient" (LCP, developed in the UK to transfer the hospice model of care into hospitals and other care settings, is a complex intervention to improve the quality of end-of-life care. The results from qualitative and quantitative studies suggest that the LCP Program can improve significantly the quality of end-of-life care delivery in hospitals, but no randomised trial has been conducted till now. Methods and design This is a randomized cluster trial, stratified by regions and matched for assessment period. Pairs of eligible medical wards from different hospitals will be randomized to receive the LCP-I Program or no intervention until the end of the trial. The LCP-I Program will be implemented by a Palliative Care Unit. The assessment of the end-points will be performed for all cancer deaths occurred in the six months after the end of the LCP-I implementation in the experimental wards and, in the same period of time, in the matched control wards. The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families, assessed using the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview". Discussion This study can be interpreted as a Phase III trial according to the Medical Research Council Framework. In this study, the effectiveness of a fully defined intervention is assessed by comparing the distribution of the endpoints in the experimental and in the control arm. Research ID RFPS-2006-6-341619 Trial registration ClinicalTrials.gov Identifier: NCT01081899 402. Uncertainties in Life Cycle Greenhouse Gas Emissions from Advanced Biomass Feedstock Logistics Supply Chains in Kansas Directory of Open Access Journals (Sweden) Long Nguyen 2014-11-01 Full Text Available To meet Energy Independence and Security Act (EISA cellulosic biofuel mandates, the United States will require an annual domestic supply of about 242 million Mg of biomass by 2022. To improve the feedstock logistics of lignocellulosic biofuels in order to access available biomass resources from areas with varying yields, commodity systems have been proposed and designed to deliver quality-controlled biomass feedstocks at preprocessing “depotsâ€. Preprocessing depots densify and stabilize the biomass prior to long-distance transport and delivery to centralized biorefineries. The logistics of biomass commodity supply chains could introduce spatially variable environmental impacts into the biofuel life cycle due to needing to harvest, move, and preprocess biomass from multiple distances that have variable spatial density. This study examines the uncertainty in greenhouse gas (GHG emissions of corn stover logistics within a bio-ethanol supply chain in the state of Kansas, where sustainable biomass supply varies spatially. Two scenarios were evaluated each having a different number of depots of varying capacity and location within Kansas relative to a central commodity-receiving biorefinery to test GHG emissions uncertainty. The first scenario sited four preprocessing depots evenly across the state of Kansas but within the vicinity of counties having high biomass supply density. The second scenario located five depots based on the shortest depot-to-biorefinery rail distance and biomass availability. The logistics supply chain consists of corn stover harvest, collection and storage, feedstock transport from field to biomass preprocessing depot, preprocessing depot operations, and commodity transport from the biomass preprocessing depot to the biorefinery. Monte Carlo simulation was used to estimate the spatial uncertainty in the feedstock logistics gate-to-gate sequence. Within the logistics supply chain GHG emissions are most sensitive to the 403. Advanced Failure Determination Measurement Techniques Used in Thermal Fatigue Life Testing of Electronic Packaging Science.gov (United States) Wallace, A. P.; Cornford, S. L.; Gross, M. A. 1996-01-01 Thermal fatigue life testing of various electronic packaging technologies is being performed by the Reliability Technology Group at the Jet Propulsion Laboratory. These testing efforts are in progress to improve uderstanding of the reliability issues associated with low volume packaging technologies for space applications and to develop qualification and acceptance approaches for these technologies. The work described here outlines the electrical failure detection techniques used during testing by documenting the circuits and components used to make these measurements, the sensitivity of the measurements, and the applicability of each specific measurement. 404. Design and methods of the Hospital Elder Life Program (HELP), a multicomponent targeted intervention to prevent delirium in hospitalized older patients: efficacy and costeffectiveness in Dutch health care OpenAIRE Strijbos, Marije; Steunenberg, Bas; Schuurmans,, Marieke J.; Mast, van der, N.; Inouye, Sharon 2013-01-01 Background The Hospital Elder Life Program (HELP) has been shown to be highly efficient and (cost-)effective in reducing delirium incidence in the USA. HELP provides multicomponent protocols targeted at specific risk factors for delirium and introduces a different view on care organization, with trained volunteers playing a pivotal role. The primary aim of this study is the quantification of the (cost-)effectiveness of HELP in the Dutch health care system. The second aim is to investigate the... 405. Effect of intermittent pneumatic compression on disability, living circumstances, quality of life, and hospital costs after stroke: secondary analyses from CLOTS 3, a randomised trial OpenAIRE 2014-01-01 Background\\ud \\ud The results of the CLOTS 3 trial showed that intermittent pneumatic compression (IPC) reduced the risk of deep vein thrombosis and improved survival in immobile patients with stroke. IPC is now being widely used in stroke units. Here we describe the disability, living circumstances, quality of life, and hospital costs of patients in CLOTS 3.\\ud \\ud Methods\\ud \\ud In CLOTS 3, a parallel group trial in 94 UK hospitals, immobile patients with stroke from days 0 to 3 of admissio... 406. Anaerobic fungi (phylum Neocallimastigomycota): advances in understanding their taxonomy, life cycle, ecology, role and biotechnological potential. Science.gov (United States) Gruninger, Robert J; Puniya, Anil K; Callaghan, Tony M; Edwards, Joan E; Youssef, Noha; Dagar, Sumit S; Fliegerova, Katerina; Griffith, Gareth W; Forster, Robert; Tsang, Adrian; McAllister, Tim; Elshahed, Mostafa S 2014-10-01 Anaerobic fungi (phylum Neocallimastigomycota) inhabit the gastrointestinal tract of mammalian herbivores, where they play an important role in the degradation of plant material. The Neocallimastigomycota represent the earliest diverging lineage of the zoosporic fungi; however, understanding of the relationships of the different taxa (both genera and species) within this phylum is in need of revision. Issues exist with the current approaches used for their identification and classification, and recent evidence suggests the presence of several novel taxa (potential candidate genera) that remain to be characterised. The life cycle and role of anaerobic fungi has been well characterised in the rumen, but not elsewhere in the ruminant alimentary tract. Greater understanding of the 'resistant' phase(s) of their life cycle is needed, as is study of their role and significance in other herbivores. Biotechnological application of anaerobic fungi, and their highly active cellulolytic and hemi-cellulolytic enzymes, has been a rapidly increasing area of research and development in the last decade. The move towards understanding of anaerobic fungi using -omics based (genomic, transcriptomic and proteomic) approaches is starting to yield valuable insights into the unique cellular processes, evolutionary history, metabolic capabilities and adaptations that exist within the Neocallimastigomycota. 407. Life prediction methodology for ceramic components of advanced vehicular heat engines: Volume 1. Final report Energy Technology Data Exchange (ETDEWEB) Khandelwal, P.K.; Provenzano, N.J.; Schneider, W.E. [Allison Engine Co., Indianapolis, IN (United States) 1996-02-01 One of the major challenges involved in the use of ceramic materials is ensuring adequate strength and durability. This activity has developed methodology which can be used during the design phase to predict the structural behavior of ceramic components. The effort involved the characterization of injection molded and hot isostatic pressed (HIPed) PY-6 silicon nitride, the development of nondestructive evaluation (NDE) technology, and the development of analytical life prediction methodology. Four failure modes are addressed: fast fracture, slow crack growth, creep, and oxidation. The techniques deal with failures initiating at the surface as well as internal to the component. The life prediction methodology for fast fracture and slow crack growth have been verified using a variety of confirmatory tests. The verification tests were conducted at room and elevated temperatures up to a maximum of 1371 {degrees}C. The tests involved (1) flat circular disks subjected to bending stresses and (2) high speed rotating spin disks. Reasonable correlation was achieved for a variety of test conditions and failure mechanisms. The predictions associated with surface failures proved to be optimistic, requiring re-evaluation of the components` initial fast fracture strengths. Correlation was achieved for the spin disks which failed in fast fracture from internal flaws. Time dependent elevated temperature slow crack growth spin disk failures were also successfully predicted. 408. Discussing advance preferences for end-of-life: The role of nurses and other health proffessionals Directory of Open Access Journals (Sweden) Apolo GarcÃa Palomares 2006-01-01 Full Text Available Our society keeps on achieving goals regarding individual liberties. This fact has been reinforced since the law 41/2002 (basic law on patient rights, duties and autonomy regarding health information and documentation was approved on May 16th 2003. This law establishes the ethic boundaries not to be crossed regarding health attention. Additionally to the patient autonomy, this law includes the reference to the living wills, defined as an anticipated declaration about the desired care in case of loosing the capability to give an opinion about it when the end of life is coming.Literature makes clear that living wills are a phenomena in which not only the patients and the health professionals are involved, but the whole society.This article aims to revise the participation of the health and medical professionals in this process, as well as to think about the role of the health carer leading this process. The objective is not to reduce the caring process to a simple document signing, but to plan health decisions when the end of life is coming from a global conception of the caring process. 409. Life Cycle Assessment of an Advanced Bioethanol Technology in the Perspective of Constrained Biomass Availability DEFF Research Database (Denmark) Hedegaard, Karsten; Thyø, Kathrine Anker; Wenzel, Henrik 2008-01-01 of whether a global or European perspective is applied, the amount of biomass, which can become available for bioethanol or other energy uses, will be physically and economically constrained. This implies that use of biomass or land for bioethanol production will most likely happen at the expense......Among the existing environmental assessments of bioethanol, the studies suggesting an environmental benefit of bioethanol all ignore the constraints on the availability of biomass resources and the implications competition for biomass has on the assessment. We show that toward 2030, regardless...... of alternative uses. In this perspective, we show that for the case of a new advanced bioethanol technology, in terms of reducing greenhouse emissions and fossil fuel dependency, more is lost than gained when prioritizing biomass or land for bioethanol. Technology pathways involving heat and power production and... 410. Training for my Life: Lived Experiences of Dislocated Workers in an Advanced Manufacturing Training Program Directory of Open Access Journals (Sweden) Marquita R. Walker 2012-07-01 Full Text Available This qualitative paper explores the lived experiences of one group of workers dislocated because of globalized trade policies who completed a hybrid Advanced Manufacturing Training Program (AMTP by taking advantage of Trade Adjustment Assistance (TAA, a federally-funded program for retraining workers dislocated because of trade policies. The research questions focus on how satisfied these workers are with the services and programs provided by TAA. Focus groups and survey instrument results indicate these workers found TAA services and processes cumbersome and time- consuming and actually had the effect of discouraging their education, training, and self- employment. The consequences of their dislocation as it relates to TAA experiences are increased frustration and dissatisfaction with the TAA program. Serious consideration for TAA policy changes should be deemed of utmost importance. 411. Easetech Energy: Advanced Life Cycle Assessment of Energy from Biomass and Waste DEFF Research Database (Denmark) Astrup, Thomas Fruergaard; Turconi, Roberto; Tonini, Davide SUMMARY: Biomass and waste are expected to play a key role in future energy systems based on large shares of renewable energy resources. The LCA model EASETECH Energy was developed specifically for modelling large and complex energy systems including various technologies and several processing...... steps. The model allows simultaneous balancing of mass and energy flows of the system under assessment, and is equipped with advanced tools for sensitivity/uncertainty analysis. EASETECH Energy was used to assess the environmental footprint of the Danish energy system in 2050 (based on 100% renewables......) and compare it to the current situation. The results show that the future Danish energy systems will have a rather different environmental footprint than the current one.... 412. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE planning – anxiety, depression, quality of life Directory of Open Access Journals (Sweden) Maureen E Lyon 2010-02-01 Full Text Available Maureen E Lyon1, Patricia A Garvie2, Linda Briggs3, Jianping He4, Robert Malow5, Lawrence J D’Angelo1, Robert McCarter41Children’s National Medical Center and George Washington School of Medicine and Health Sciences, Washington, District of Columbia; 2St Jude Children’s Research Hospital, Memphis, Tennessee; 3Gundersen Lutheran Medical Foundation, Inc., Madison, Wisconsin; 4Children’s Research Institute, Washington, District of Columbia; 5Florida International University, Miami, FloridaPurpose: To determine the safety of engaging HIV-positive (HIV+ adolescents in a Family Centered Advance Care (FACE planning intervention.Patients and methods: We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76. Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices® interview, and completion of The Five Wishes©. The Healthy Living Control (HLC received: Developmental History, Healthy Tips, Future Planning (vocational, school or vocational rehabilitation. Threemonth post-intervention outcomes were: completion of advance directive (Five Wishes©; psychological adjustment (Beck Depression, Anxiety Inventories; quality of life (PedsQLâ„¢; and HIV symptoms (General Health Self-Assessment.Results: Adolescents had a mean age, 16 years; 40% male; 92% African-American; 68% with perinatally acquired HIV, 29% had AIDS diagnosis. FACE participants completed advance directives more than controls, using time matched comparison (P < 0.001. Neither anxiety, nor depression, increased at clinically or statistically significant levels post-intervention. FACE adolescents maintained quality of life. FACE families perceived their adolescents as worsening in their school (P = 0.018 and emotional (P = 0.029 quality of life at 3 months, compared with controls.Conclusions: Participating 413. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center Directory of Open Access Journals (Sweden) Leppert W 2014-05-01 Full Text Available Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL in cancer patients treated at home, at an in-patient palliative care unit (PCU, and at a day care center (DCC. Patients and methods: QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL, the Edmonton Symptom Assessment System (ESAS, and the Karnofsky Performance Status (KPS scale. Results: A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and

deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. Conclusions: QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home. Keywords: oncology, patient care 414. Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness Science.gov (United States) Kutner, Jean S.; Blatchford, Patrick J.; Taylor, Don H.; Ritchie, Christine S.; Bull, Janet H.; Fairclough, Diane L.; Hanson, Laura C.; LeBlanc, Thomas W.; Samsa, Greg P.; Wolf, Steven; Aziz, Noreen M.; Currow, David C.; Ferrell, Betty; Wagner-Johnston, Nina; Zafar, S. Yousuf; Cleary, James F.; Dev, Sandesh; Goode, Patricia S.; Kamal, Arif H.; Kassner, Cordt; Kvale, Elizabeth A.; McCallum, Janelle G.; Ogunseitan, Adeboye B.; Pantilat, Steven Z.; Portenoy, Russell K.; Prince-Paul, Maryjo; Sloan, Jeff A.; Swetz, Keith M.; Von Gunten, Charles F.; Abernethy, Amy P. 2015-01-01 IMPORTANCE For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy. OBJECTIVE To evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, parallel-group, unblinded, pragmatic clinical trial. Eligibility included adults with an estimated life expectancy of between 1 month and 1 year, statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease, recent deterioration in functional status, and no recent active cardiovascular disease. Participants were randomized to either discontinue or continue statin therapy and were monitored monthly for up to 1 year. The study was conducted from June 3, 2011, to May 2, 2013. All analyses were performed using an intent-to-treat approach. INTERVENTIONS Statin therapy was withdrawn from eligible patients who were randomized to the discontinuation group. Patients in the continuation group continued to receive statins. MAIN OUTCOMES AND MEASURES Outcomes included death within 60 days (primary outcome), survival, cardiovascular events, performance status, quality of life (QOL), symptoms, number of nonstatin medications, and cost savings. RESULTS A total of 381 patients were enrolled; 189 of these were randomized to discontinue statins, and 192 were randomized to continue therapy. Mean (SD) age was 74.1 (11.6) years, 22.0% of the participants were cognitively impaired, and 48.8% had cancer. The proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different (23.8% vs 20.3%; 90% CI, −3.5% to 10.5%; P = .36) and did not meet the noninferiority end point. Total QOL was better for the group 415. Cultural and social factors and quality of life of Maori in advanced age. Te puawaitanga o nga tapuwae kia ora tonu - Life and living in advanced age: a cohort study in New Zealand (LiLACS NZ). Science.gov (United States) Dyall, Lorna; Kepa, Mere; Teh, Ruth; Mules, Rangimarie; Moyes, Simon A; Wham, Carol; Hayman, Karen; Connolly, Martin; Wilkinson, Tim; Keeling, Sally; Loughlin, Hine; Jatrana, Santosh; Kerse, Ngaire 2014-05-02 To establish 1) the socioeconomic and cultural profile and 2) correlates of quality of life (QOL) of Maori in advanced age. A cross sectional survey of a population based cohort of Maori aged 80-90 years, participants in LiLACS NZ, in the Rotorua and Bay of Plenty region of New Zealand. Socioeconomic and cultural engagement characteristics were established by personal interview and QOL was assessed by the SF-12. In total 421 (56%) participated and 267 (63%) completed the comprehensive interview. Maori lived with high deprivation areas and had received a poor education in the public system. Home ownership was high (81%), 64% had more than 3 children still living and social support was present for practical tasks and emotional support in 82%. A need for more practical help was reported by 21%. Fifty-two percent of the participants used te reo Maori me nga tikanga (Maori language and culture) daily. One in five had experienced discrimination and one in five reported colonisation affecting their life today. Greater frequency of visits to marae/sacred gathering places was associated with higher physical health-related QOL. Unmet need for practical help was associated with lower physical health-related QOL. Lower mental health-related QOL was associated with having experienced discrimination. Greater language and cultural engagement is associated with higher QOL for older Maori and unmet social needs and discrimination are associated with lower QOL. 416. The university hospital as centre of excellence for the production and dissemination of the advanced biomedical culture Directory of Open Access Journals (Sweden) Romano Del Nord 2015-04-01 Full Text Available University hospitals are characterized by the coexistence of care, research and training facilities and by the mission to achieve excellent results in the healthcare services provided. These activities, which are respectively subordinate to the Hospitals and University Institutions of Medicine, reach their maximum level of efficiency when programmed and managed with the principles of maximum integration and synergy in organizational, functional and, not least, physical and spatial terms. Based on this knowledge, a group of researchers from the Interuniversity Centre TESIS developed a PRIN research project – this article summarizes its contents and results – aimed at defining the design approach principles on the basis of which to work out innovative solutions to be tested in the creation of Cities of Health, IRCCSs (Scientific Institutes for Research, Hospitalization and Health Care and Hospitals of excellence. 417. Bioregenerative technologies for waste processing and resource recovery in advanced space life support system Science.gov (United States) Chamberland, Dennis 1991-01-01 The Controlled Ecological Life Support System (CELSS) for producing oxygen, water, and food in space will require an interactive facility to process and return wastes as resources to the system. This paper examines the bioregenerative techologies for waste processing and resource recovery considered for a CELSS Resource Recovery system. The components of this system consist of a series of biological reactors to treat the liquid and solid material fractions, in which the aerobic and anaerobic reactors are combined in a block called the Combined Reactor Equipment (CORE) block. The CORE block accepts the human wastes, kitchen wastes, inedible refractory plant materials, grey waters from the CELLS system, and aquaculture solids and processes these materials in either aerobic or anaerobic reactors depending on the desired product and the rates required by the integrated system. 418. Proposed Schematics for an Advanced Development Lunar Portable Life Support System Science.gov (United States) Conger, Bruce; Chullen, Cinda; Barnes, Bruce; Leavitt, Greg 2010-01-01 The latest development of the NASA space suit is an integrated assembly made up of primarily a Pressure Garment System (PGS) and a Portable Life Support System (PLSS). The PLSS is further composed of an oxygen (O2) subsystem, a ventilation subsystem, and a thermal subsystem. This paper baselines a detailed schematic of the PLSS to provide a basis for current and future PLSS development efforts. Both context diagrams and detailed schematics describe the hardware components and overall functions for all three of the PLSS subsystems. The various modes of operations for the PLSS are also presented. A comparison of the proposed PLSS to the Apollo and Shuttle PLSS designs is presented, highlighting several anticipated improvements over the historical PLSS architectures. 419. Life cycle assessment of advanced bioethanol production from pulp and paper sludge. Science.gov (United States) Sebastião, Diogo; Gonçalves, Margarida S; Marques, Susana; Fonseca, César; GÃrio, Francisco; Oliveira, Ana C; Matos, Cristina T 2016-05-01 This work evaluates the environmental performance of using pulp and paper sludge as feedstock for the production of second generation ethanol. An ethanol plant for converting 5400 tons of dry sludge/year was modelled and evaluated using a cradle-to-gate life cycle assessment approach. The sludge is a burden for pulp and paper mills that is mainly disposed in landfilling. The studied system allows for the valorisation of the waste, which due to its high polysaccharide content is a valuable feedstock for bioethanol production. Eleven impact categories were analysed and the results showed that enzymatic hydrolysis and neutralisation of the CaCO3 are the environmental hotspots of the system contributing up to 85% to the overall impacts. Two optimisation scenarios were evaluated: (1) using a reduced HCl amount in the neutralisation stage and (2) co-fermentation of xylose and glucose, for maximal ethanol yield. Both scenarios displayed significant environmental impact improvements. 420. Intelligent Human Machine Interface Design for Advanced Product Life Cycle Management Systems CERN Document Server Ahmed, Zeeshan 2010-01-01 Designing and implementing an intelligent and user friendly human machine interface for any kind of software or hardware oriented application is always be a challenging task for the designers and developers because it is very difficult to understand the psychology of the user, nature of the work and best suit of the environment. This research paper is basically about to propose an intelligent, flexible and user friendly machine interface for Product Life Cycle Management products or PDM Systems since studies show that usability and human computer interaction issues are a major cause of acceptance problems introducing or using such systems. Going into details of the proposition, we present prototype implementations about theme based on design requirements, designed designs and technologies involved for the development of human machine interface. « 19 20 21 22 23 » « 20 21 22 23 24 » 421. [Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP?]. Science.gov (United States) Shafizadeh, S; Tjardes, T; Steinhausen, E; Balke, M; Paffrath, T; Bouillon, B; Bäthis, H 2010-08-01 There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room. 422. Cancer-related therapies at the end of life in hospitalized cancer patients from four Swiss cantons: SAKK 89/09. Science.gov (United States) Matter-Walstra, Klazien W; Achermann, Rita; Rapold, Roland; Klingbiel, Dirk; Bordoni, Andrea; Dehler, Silvia; Jundt, Gernot; Konzelmann, Isabelle; Clough-Gorr, Kerri; Szucs, Thomas; Pestalozzi, Bernhard C; Schwenkglenks, Matthias 2015-01-01 The use of cancer-related therapies in cancer patients hospitalized at the end of life has increased in many countries over time. Given the scarcity of published Swiss data, the objective of this study was to evaluate the influence of hospital type and other factors on the delivery of health care during the last month before death. Claims data were used to assess health care utilization of cancer patients (identified by cancer registry data of four participating Swiss cantons) who deceased between 2006 and 2008. Primary endpoints were delivery of cancer-related therapies during the last 30 days before death. Multivariate logistic regression assessed the explanatory value of hospital type, patient and geographic characteristics. Of 3,809 identified cancer patients in the claims database, 2,086 patients dying from cancer were hospitalized during the last 30 days before death, generating 2,262 inpatient episodes. Anticancer drug therapy was given in 22.2% and radiotherapy in 11.7% of episodes. Besides age and cancer type, the canton of residence and hospital type showed independent, statistically significant associations with intensity of care, which was highest in university hospitals. These results should initiate a discussion among oncologists in Switzerland and may question the compliance with standard of care guidelines for terminal cancer patients. 423. Identifying and Managing Undue Influence From Family Members in End-of-Life Decisions for Patients With Advanced Cancer. Science.gov (United States) Baker, Francis X; Gallagher, Colleen M 2017-10-01 Undue influence from family members of patients with advanced cancer remains a serious ethical problem in end-of-life decision making. Despite the wealth of articles discussing the problem of undue influence, little has been written by way of practical guidance to help clinicians identify and effectively manage situations of undue influence. This article briefly lays out how to identify and manage situations of undue influence sensitively and effectively. We explain how undue influence may present itself in the clinic and distinguish it from ethically permissible expressions of relational autonomy. In addition, we lay out a process by which any clinician suspecting undue influence may gather additional information and, if necessary, conduct a family meeting to address the undue influence. It is our hope that by providing clinicians at all levels of patient care with such guidance, they will feel empowered to respond to cases of undue influence when they arise. 424. Spacesuit Water Membrane Evaporator; An Enhanced Evaporative Cooling Systems for the Advanced Extravehicular Mobility Unit Portable Life Support System Science.gov (United States) Bue, Grant C.; Makinen, Janice V.; Miller, Sean.; Campbell, Colin; Lynch, Bill; Vogel, Matt; Craft, Jesse; Petty, Brian 2014-01-01 Spacesuit Water Membrane Evaporator - Baseline heat rejection technology for the Portable Life Support System of the Advanced EMU center dot Replaces sublimator in the current EMU center dot Contamination insensitive center dot Can work with Lithium Chloride Absorber Radiator in Spacesuit Evaporator Absorber Radiator (SEAR) to reject heat and reuse evaporated water The Spacesuit Water Membrane Evaporator (SWME) is being developed to replace the sublimator for future generation spacesuits. Water in LCVG absorbs body heat while circulating center dot Warm water pumped through SWME center dot SWME evaporates water vapor, while maintaining liquid water - Cools water center dot Cooled water is then recirculated through LCVG. center dot LCVG water lost due to evaporation (cooling) is replaced from feedwater The Independent TCV Manifold reduces design complexity and manufacturing difficulty of the SWME End Cap. center dot The offset motor for the new BPV reduces the volume profile of the SWME by laying the motor flat on the End Cap alongside the TCV. 425. Effect of simulation on knowledge of advanced cardiac life support, knowledge retention, and confidence of nursing students in Jordan. Science.gov (United States) Tawalbeh, Loai I; Tubaishat, Ahmad 2014-01-01 This study examined the effect of simulation on nursing students' knowledge of advanced cardiac life support (ACLS), knowledge retention, and confidence in applying ACLS skills. An experimental, randomized controlled (pretest-posttest) design was used. The experimental group (n = 40) attended an ACLS simulation scenario, a 4-hour PowerPoint presentation, and demonstration on a static manikin, whereas the control group (n = 42) attended the PowerPoint presentation and a demonstration only. A paired t test indicated that posttest mean knowledge of ACLS and confidence was higher in both groups. The experimental group showed higher knowledge of ACLS and higher confidence in applying ACLS, compared with the control group. Traditional training involving PowerPoint presentation and demonstration on a static manikin is an effective teaching strategy; however, simulation is significantly more effective than traditional training in helping to improve nursing students' knowledge acquisition, knowledge retention, and confidence about ACLS. 426. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer Science.gov (United States) Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A. 2015-01-01 Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553 427. Effects of paraplegia on quality of life and family economy among patients with spinal cord injuries in selected hospitals of Sri Lanka. Science.gov (United States) Kalyani, H H N; Dassanayake, S; Senarath, U 2015-06-01 The study was conducted with the aim of assessing the effects of paraplegia caused by spinal cord injuries on the quality of life of patients and their family economy. A descriptive cross-sectional study. The study was carried out in Accident Service, Orthopedic and Neurosurgery Units of the National Hospital of Sri Lanka and the Spinal Injury Unit of Rehabilitation Hospital Ragama. One hundred traumatic paraplegic patients were included as the study sample. Modified Ferrans and Powers quality of life index: spinal cord injury version was used to measure the quality of life. Pre- and post-family economic data were collected using an interviewer-administered questionnaire. Quality of Life was calculated under four major components. Paraplegics' family component (mean=3.50) and social, economic aspects (mean=3.24) are considerably good when compared with health and functioning (mean=2.83) and psychological (mean=2.78) components. Also the study revealed that expenditures are significantly high (P=0.001) and income is significantly less (P=0.001) after injury than before. Quality of life is relatively good on family and social aspects, whereas the physical and psychological aspects are somewhat poor. Regarding family economy, expenses are significantly high and earnings are significantly less after the injury. Contribution to the income from self-employment shows the most significant decline. Findings suggest that the family economy of such patients should be supported. 428. Overturning refusal of a hospital to terminate life support for a brain-dead mother until the fetus was born: What is the law in South Africa? Science.gov (United States) McQuoid-Mason, David Jan 2014-06-19 In a Texas case the court granted a husband an order for the removal of life support from his brain-dead pregnant wife after a hospital tried to keep her on it until the fetus was born. In South Africa the court would have issued a similar order, but for different reasons. Here, unlawfully and intentionally subjecting a pregnant corpse to life-support measures to keep a fetus alive against the wishes of the family would amount to the crime of violating a corpse. 429. Biogenicity and Syngeneity of Organic Matter in Ancient Sedimentary Rocks: Recent Advances in the Search for Evidence of Past Life Energy Technology Data Exchange (ETDEWEB) Oehler, Dorothy Z.; Cady, Sherry L. 2014-12-01 he past decade has seen an explosion of new technologies for assessment of biogenicity and syngeneity of carbonaceous material within sedimentary rocks. Advances have been made in techniques for analysis of in situ organic matter as well as for extracted bulk samples of soluble and insoluble (kerogen) organic fractions. The in situ techniques allow analysis of micrometer-to-sub-micrometer-scale organic residues within their host rocks and include Raman and fluorescence spectroscopy/imagery, confocal laser scanning microscopy, and forms of secondary ion/laser-based mass spectrometry, analytical transmission electron microscopy, and X-ray absorption microscopy/spectroscopy. Analyses can be made for chemical, molecular, and isotopic composition coupled with assessment of spatial relationships to surrounding minerals, veins, and fractures. The bulk analyses include improved methods for minimizing contamination and recognizing syngenetic constituents of soluble organic fractions as well as enhanced spectroscopic and pyrolytic techniques for unlocking syngenetic molecular signatures in kerogen. Together, these technologies provide vital tools for the study of some of the oldest and problematic carbonaceous residues and for advancing our understanding of the earliest stages of biological evolution on Earth and the search for evidence of life beyond Earth. We discuss each of these new technologies, emphasizing their advantages and disadvantages, applications, and likely future directions. 430. Biogenicity and Syngeneity of Organic Matter in Ancient Sedimentary Rocks: Recent Advances in the Search for Evidence of Past Life Directory of Open Access Journals (Sweden) Dorothy Z. Oehler 2014-08-01 Full Text Available The past decade has seen an explosion of new technologies for assessment of biogenicity and syngeneity of carbonaceous material within sedimentary rocks. Advances have been made in techniques for analysis of in situ organic matter as well as for extracted bulk samples of soluble and insoluble (kerogen organic fractions. The in situ techniques allow analysis of micrometer-to-sub-micrometer-scale organic residues within their host rocks and include Raman and fluorescence spectroscopy/imagery, confocal laser scanning microscopy, and forms of secondary ion/laser-based mass spectrometry, analytical transmission electron microscopy, and X-ray absorption microscopy/spectroscopy. Analyses can be made for chemical, molecular, and isotopic composition coupled with assessment of spatial relationships to surrounding minerals, veins, and fractures. The bulk analyses include improved methods for minimizing contamination and recognizing syngenetic constituents of soluble organic fractions as well as enhanced spectroscopic and pyrolytic techniques for unlocking syngenetic molecular signatures in kerogen. Together, these technologies provide vital tools for the study of some of the oldest and problematic carbonaceous residues and for advancing our understanding of the earliest stages of biological evolution on Earth and the search for evidence of life beyond Earth. We discuss each of these new technologies, emphasizing their advantages and disadvantages, applications, and likely future directions. 431. End-of-life issues in advanced dementia: Part 2: management of poor nutritional intake, dehydration, and pneumonia. Science.gov (United States)

Arcand, Marcel 2015-04-01 To answer frequently asked questions about management of end-stage pneumonia, poor nutritional intake, and dehydration in advanced dementia. Ovid MEDLINE was searched for relevant articles published until February 2015. No level I studies were identified; most articles provided level III evidence. The symptom management suggestions are partially based on recent participation in a Delphi procedure to develop a guideline for optimal symptom relief for patients with pneumonia and dementia. Feeding tubes are not recommended for patients with end-stage dementia. Comfort feeding by hand is preferable. Use of parenteral hydration might be helpful but can also contribute to discomfort at the end of life. Withholding or withdrawing artificial nutrition and hydration is generally not associated with manifestations of discomfort if mouth care is adequate. Because pneumonia usually causes considerable discomfort, clinicians should pay attention to symptom control. Sedation for agitation is often useful in patients with dementia in the terminal phase. Symptomatic care is an appropriate option for end-stage manifestations of advanced dementia. The proposed symptom management guidelines are based on a literature review and expert consensus. Copyright© the College of Family Physicians of Canada. 432. Death anxiety in hospitalized end-of-life patients as captured from a structured electronic health record: differences by patient and nurse characteristics. Science.gov (United States) Lodhi, Muhammad Kamran; Cheema, Umer Iftikhar; Stifter, Janet; Wilkie, Diana J; Keenan, Gail M; Yao, Yingwei; Ansari, Rashid; Khokhar, Ashfaq A 2014-01-01 The nursing outcomes of hospitalized patients whose plans of care include death anxiety, which is a diagnosis among patients at the end-of-life, are obscure. The authors of the current article applied data mining techniques to nursing plan-of-care data for patients diagnosed with death anxiety, as defined by North American Nursing Diagnosis Association International, from four different hospitals to examine nursing care outcomes and associated factors. Results indicate that patients met the expected outcome of comfortable death. Gerontology unit patients were more likely to meet the expected outcome than patients from other unit types, although results were not statistically significant. Younger patients (i.e., age patients (i.e., age ≥65) (χ(2)(1) = 9.266, p patients who face the end-of-life transition. 433. Increasing prevalence of advanced colonic polyps in young patients undergoing colonoscopy in a referral academic hospital in Hong Kong Institute of Scientific and Technical Information of China (English) æ— 2007-01-01 AIM: To investigate the distribution and frequency of advanced polyps over eight years.METHODS: 6424 colonoscopies were reviewed during the study period 1998 to 2005. The study period was subdivided into period â… : 1998 to 2001 and period â…¡:2002-2005.RESULTS: 1856 polyps (33% advanced polyps) and 328 CRCs were detected. The mean ages of the patients with advanced polyps and cancer were 69.2 ± 12.0 and 71.6 ±13.8 years, respectively. Advanced polyps were mainly left sided (59.5%). Advanced polyps were found in patients ≤ 60 years from 17.7% in period â… to 26.3% in period â…¡ (P < 0.05), especially in male subjects ≤ 60 years (21.6% vs 31.6%, P < 0.05). Advanced tubulovillous polyps rose from 21.5% in period â… to 29.5% in period â…¡ (P < 0.05).Whereas cancers in male patients ≤ 60 years were similar in both periods: 23.2% vs 16.5% (P > 0.05).CONCLUSION: Advanced polyps increased significantly in the younger male group in the most recent period and there seems to be a shift towards a proximal location. 434. Social workers' roles in addressing the complex end-of-life care needs of elders with advanced chronic disease. Science.gov (United States) Kramer, Betty J 2013-01-01 This study examined social workers' roles in caring for low-income elders with advanced chronic disease in an innovative, community-based managed care program, from the perspective of elders, family, team members, and social workers. The results are drawn from a larger longitudinal, multimethod case study. Sources of data include survey reports of needs addressed by social workers for 120 deceased elders, five focus groups with interdisciplinary team members, and in-depth interviews with 14 elders and 10 of their family caregivers. A thematic conceptual matrix was developed to detail 32 distinctive social work roles that address divergent needs of elders, family, and team members. Distinctive perceptions of social workers' roles were identified for the different stakeholder groups (i.e., elders, family caregivers, team members, and social workers). Findings from this study may inform supervisors and educators regarding training needs of those preparing to enter the rapidly growing workforce of gerontological social workers who may be called upon to care for elders at the end of life. Training is particularly warranted to help social workers gain the skills needed to more successfully treat symptom management, depression, anxiety, agitation, grief, funeral planning, and spiritual needs that are common to the end of life. 435. Life after radiotherapy: the psychological and social effects experienced by women treated for advanced stages of cervical cancer. Science.gov (United States) Klee, M; Thranov, I; Machin, D 2000-01-01 The aim of this study was to describe the psychological and social reactions of women with advanced stages of cancer of the cervix during and after radiotherapy. A questionnaire about health-related quality of life was used, which consisted of the EORTC QLQ-C30 and additional specific questions. One-hundred eighteen patients filled out the questionnaire at the end of treatment and 1, 3, 6, 12, 18, and 24 months later. The scores from the disease-free patients were compared to those from 236 healthy controls. Many patients experience psychological and social consequences at the end of treatment and 1 to 3 months later. Patients continue to think about their illness and treatment throughout the 24-month study period, but find it increasingly hard to share their worries with others. Their score on overall quality of life never reaches that of the controls. Disease-free patients treated for cancer of the cervix with radiotherapy have psychological reactions. The interpretation of the results should take into consideration that the patients change their personal frame of reference over the course of time. Professionals should be aware of patients' needs to talk about their disease long after treatment. Patients should be informed about the risk of psychological reactions. The more information about possible symptoms they receive the better their ability to cope with them should they arise. Copyright 2000 Academic Press. 436. Safety of new DAAs for chronic HCV infection in a real life experience: role of a surveillance network based on clinician and hospital pharmacist OpenAIRE Nappi, A.; Perrella, A; Bellopede, P.; Lanza, A.; Izzi, A.; Spatarella, M.; Sbreglia, C 2017-01-01 Background Direct Antiviral Agents (DAAs) for HCV therapy represents a step ahead in the cure of chronic hepatitis C. Notwithstanding the promising results in several clinical trials, few data are available on adverse effects in real life settings. Methods We have evaluated 170 patients with persistent infection and on those eligible to treatment we have followed up them through a network managed by clinician and hospital pharmacist. Results According to our data we have found that 41% (32 ou... 437. Life Cycle Assessment as a tool for green Chemistry: Application to different advanced oxidation processes for wastewater treatment Energy Technology Data Exchange (ETDEWEB) Munoz Ortiz, I.; Domenech Antunez, X.; Malato Rodriguez, S. 2006-07-01 The development of chemistry during the twentieth century has changed our lives. In fact, chemistry and chemicals surrounds US in our daily activities, due to the huge supply of products aimed at improving our quality of life. Chemistry has resulted in the medical revolution of the past century, in which drugs as antibiotics have been used to cure diseases that affected mankind for centuries. These advances have led to the rise in the average life expectancy from 47 in 1900, to 75 years in the 1990s (Breslow 1997). On the other hand, the world's food supply has seen an explosive expansion because of the development of pesticides as well as fertilisers that protect crops and improve their productivity. Other common chemicals are those related to hygiene, such as soaps, detergents, disinfectants, toothpaste, etc. Therefore, there is practically no facet in material life-transportation communication, clothing, shelter, office- in which chemistry does not play an important role, either to supply consumer products or to improve services addressed to society in general (Domenech 2005). In spite of all these clear benefits, the chemical industry is often viewed by the general public as causing more harm than good (Lancaster 2002). A major reason for this is that the industry is perceived as being polluting and causing significant environmental damage. Indeed, the manufacture, use and disposal of chemicals consume large amounts of resources, and originates emissions of pollutants to all environmental compartments, not to mention the numerous accidents and disasters in which the chemical industry has been involved in the recent past. (Author) 438. Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil Directory of Open Access Journals (Sweden) Pauline Lorena Kale Full Text Available Abstract: We aimed to evaluate factors associated with cases of neonatal near miss and neonatal deaths at six public maternity hospitals in São Paulo and Rio de Janeiro States, Brazil, in 2011. A prospective hospital-based birth cohort investigated these outcomes among live births with life-threatening conditions. Associations were tested using multinomial logistic regression models with hierarchical levels. High rates of near miss were observed for maternal syphilis (52.2‰ live births and lack of prenatal care (80.8†° live births. Maternal black skin color (OR = 1.9; 95%CI: 1.2-3.2, hemorrhage (OR = 2.2; 95%CI: 1.3-3.9, hypertension (OR = 3.0; 95%CI: 2.0-4.4, syphilis (OR = 3.3; 95%CI: 1.5-7.2, lack of prenatal care (OR = 5.6; 95%CI: 2.6-11.7, cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,8-11.3, lack of prenatal care (OR = 17.4; 95%CI: 6.5-46.8 and hospital, with death. Improvements in access to qualified care for pregnant women and newborns are necessary to reduce neonatal life-threatening conditions. 439. Diversification in the hospital industry. Science.gov (United States) Eastaugh, Steven R 2008-01-01 An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. Hospital diversification and its impact on the operating ratio are studied for 172 hospitals during the period 2002-2007. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependant. Institutional diversification is found to yield better financial position, and the better operating profits allow the institution the wherewithal to diversify. The impact of external government planning and hospital competition is also measured. Some services are in a growth phase, like bariatric weight loss surgery and sleep disorder clinics. Management's attitude concerning risk and reward is considered. 440. Development of a 1-week cycle menu for an Advanced Life Support System (ALSS) utilizing practical biomass production data from the Closed Ecology Experiment Facilities (CEEF). Science.gov (United States) Masuda, Tsuyoshi; Arai, Ryuuji; Komatsubara, Osamu; Tako, Yasuhiro; Harashima, Emiko; Nitta, Keiji 2005-01-01 Productivities of 29 crops in the Closed Ecology Experiment Facilities (CEEF) were measured. Rice and soybean showed higher productivities than these given by the Advanced Life Support System Modeling and Analysis Project Baseline Values and Assumption Document (BVAD), but productivities of some other crops, such as potato and sweet potato, were lower. The cultivation data were utilized to develop a 1-week cycle menu for Closed Habitation Experiment. The menu met most of the nutritional requirements. Necessary cultivation area per crew was estimated to be 255 m2. Results from this study can be used to help design the future Advanced Life Support System (ALSS) including the CEEF. « 20 21 22 23 24 » « 21 22 23 24 25 » 441. Advances in nutrition support for quality of life in HIV+/AIDS. Science.gov (United States) Suttajit, Maitree 2007-01-01 Globally, acquired immunodeficiency syndrome (AIDS) is an epidemic, severe and fatal disease. Along with the etiological factors of human immunodeficiency virus infection (HIV+) and decreased immunity, there are a number of other risk factors including opportunistic infection, malnutrition, wasting syndrome, and oxidative stress. The nutritional problems have been shown to be significant and contribute to health and death in HIV+/AIDS patients. Weight loss, lean tissue depletion, lipoatrophy, loss of appetite, diarrhea, and the hypermetabolic state each increase risk of death. The role of nutrition and how oxidative stress is involved in the pathogenesis of HIV+ leading to AIDS is reviewed. Studies consistently show that serum antioxidant vitamins and minerals decrease while oxidative stress increases during AIDS progression. The optimization of nutritional status, intervention with foods and supplements, including nutrients and other bio-active food components, are needed to maintain the immune system. Various food components may be recommended to reduce the incidence and severity of infectious illnesses by forms of bio-protection which include reduced oxidative stress due to reactive oxygen species which stimulate HIV replication and AIDS progression. Probiotics or lactic acid bacteria and prebiotics are sometimes given on the presumed basis that they help maintain integrity of mucosal surfaces, improve antibody responses and increase white blood cell production. People with HIV+/AIDS can be informed about the basic concepts of optimal nutrition by identifying key foods and nutrients, along with lifestyle changes, that contribute to a strengthened immune system. Moreover, nutritional management, counseling and education should be beneficial to the quality and extension of life in AIDS. 442. Advanced anaerobic bioconversion of lignocellulosic waste for the melissa life support system Science.gov (United States) Lissens, G.; Verstraete, W.; Albrecht, T.; Brunner, G.; Creuly, C.; Dussap, G.; Kube, J.; Maerkl, H.; Lasseur, C. The feasibility of nearly-complete conversion of lignocellulosic waste (70% food crops, 20% faecal matter and 10% green algae) into biogas was investigated in the context of the MELiSSA loop (Micro-Ecological Life Support System Alternative). The treatment comprised a series of processes, i.e. a mesophilic laboratory scale CSTR (continuously stirred tank reactor), an upflow biofilm reactor, a fiber liquefaction reactor employing the rumen bacterium Fibrobacter succinogenes and a hydrothermolysis system in near-critical water. By the one-stage CSTR, a biogas yield of 75% with a specific biogas production of 0.37 l biogas g-1 VSS (volatile suspended solids) added at a RT (hydraulic retention time) of 2025 d was obtained. Biogas yields could not be increased considerably at higher RT, indicating the depletion of readily available substrate after 25 d. The solids present in the CSTReffluent were subsequently treated in two ways. Hydrothermal treatment (T Ëœ 310-350C, p Ëœ 240 bar) resulted in effective carbon liquefaction (50-60% without and 83% with carbon dioxide saturation) and complete sanitation of the residue. Application of the cellulolytic Fibrobacter succinogenes converted remaining cellulose contained in the CSTReffluent into acetate and propionate mainly. Subsequent anaerobic digestion of the hydrothermolysis and the Fibrobacter hydrolysates allowed conversion of 48-60% and 30%, respectively. Thus, the total process yielded biogas corresponding with conversions up to 90% of the original organic matter. It appears that particularly mesophilic digestion in conjunction with hydrothermolysis offers interesting features for (nearly) the MELiSSA system. The described additional technologies show that complete and hygienic carbon and energy recovery from human waste within MELiSSA is technically feasible, provided that the extra energy needed for the thermal treatment is guaranteed. 443. The Giant Snail Achatina fulica as a Candidate Species for Advanced Bioregenerative Life Support Systems Science.gov (United States) Verbitskaya, Olga; Manukovsky, Nickolay; Kovalev, Vladimir Maintenance of crew health is of paramount importance for long duration space missions. Weight loss, bone and calcium loss, increased exposure to radiation and oxidative stress are critical concerns that need to be alleviated. Rational nutrition is a resource for mitigating the influence of unfavorable conditions. The insufficiency of vegetarian diet has been examined by the Japanese, Chinese and U.S. developers of bioregenerative life support systems (BLSS). Hence, inclusion of animals such as silkworm in BLSS looks justified. The giant snail is currently under studying as a source of animal food and a species of reducing waste in BLSS. An experimental system to conduct cultivation of giant snail was developed. It was established that there are some reasons to use the giant snails in BLSS. It could be a source of delicious meat. A. fulica is capable of consuming a wide range of feedstuffs including plant residues. Cultivation of snail in the limited volume does not demand the big expenditures of labor. The production of crude edible biomass and protein of A. fulica was 60±15 g and 7±1.8 g respectively per 1 kg of consumed forage (fresh salad leaves, root and leafy tops of carrot). To satisfy daily animal protein needs (30-35 g) a crewman has to consume 260-300 g of snail meat. To produce such amount of snail protein it takes to use 4.3-5.0 kg of plant forage daily. The nutritional composition of A. fulica whole bodies (without shell) and a meal prepared in various ways was quantitatively determined. Protein, carbohydrate, fat acid and ash content percentages were different among samples prepared in various ways. The protein content was highest (68 %) in the dry sample washed with CH3 COOH solution. Taking into consideration the experimental results a conceptual configuration of BLSS with inclusion of giant snail was developed and mass flow rates between compartments were calculated. Keywords: animal food; protein; giant snail; BLSS; conceptual configuration. 444. Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI NARCIS (Netherlands) Heesch, M.M. van; Evers, J.L.; Hoeven, M.A. van der; Dumoulin, J.C.; Beijsterveldt, C.E. van; Bonsel, G.J.; Dykgraaf, R.H.; Goudoever, J.B. van; Koopman-Esseboom, C.; Nelen, W.L.D.M.; Steiner, K.; Tamminga, P.; Tonch, N.; Torrance, H.L.; Dirksen, C.D. 2015-01-01 STUDY QUESTION: Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5? SUMMARY ANSWER: Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when 445. Factors influencing the departure of South African advanced life support paramedics from pre-hospital operational practice Directory of Open Access Journals (Sweden) Stuart Hackland 2011-06-01 Conclusion: Whilst the job of an ALS paramedic is difficult and demanding, it was not operational factors that appeared to cause the majority of ALS paramedics to leave operational practice, but rather organisational and career-based factors. These factors should be addressed in order to improve job satisfaction, with the objective of retaining more operational paramedics for longer. 446. Advancing Innovation Through Collaboration: Implementation of the NASA Space Life Sciences Strategy Science.gov (United States) Davis, Jeffrey R.; Richard, Elizabeth E. 2010-01-01 On October 18, 2010, the NASA Human Health and Performance center (NHHPC) was opened to enable collaboration among government, academic and industry members. Membership rapidly grew to 90 members (http://nhhpc.nasa.gov ) and members began identifying collaborative projects as detailed in this article. In addition, a first workshop in open collaboration and innovation was conducted on January 19, 2011 by the NHHPC resulting in additional challenges and projects for further development. This first workshop was a result of the SLSD successes in running open innovation challenges over the past two years. In 2008, the NASA Johnson Space Center, Space Life Sciences Directorate (SLSD) began pilot projects in open innovation (crowd sourcing) to determine if these new internet-based platforms could indeed find solutions to difficult technical problems. From 2008 to 2010, the SLSD issued 34 challenges, 14 externally and 20 internally. The 14 external challenges were conducted through three different vendors: InnoCentive, Yet2.com and TopCoder. The 20 internal challenges were conducted using the InnoCentive platform, customized to NASA use, and promoted as [email protected] The results from the 34 challenges involved not only technical solutions that were reported previously at the 61st IAC, but also the formation of new collaborative relationships. For example, the TopCoder pilot was expanded by the NASA Space Operations Mission Directorate to the NASA Tournament Lab in collaboration with Harvard Business School and TopCoder. Building on these initial successes, the NHHPC workshop in January of 2011, and ongoing NHHPC member discussions, several important collaborations have been developed: (1) Space Act Agreement between NASA and GE for collaborative projects (2) NASA and academia for a Visual Impairment / Intracranial Hypertension summit (February 2011) (3) NASA and the DoD through the Defense Venture Catalyst Initiative (DeVenCI) for a technical needs workshop (June 2011) (4 447. Exploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life. Science.gov (United States) Melhado, Lolita; Bushy, Angeline 2011-11-01 African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans. 448. Design and methods of the Hospital Elder Life Program (HELP), a multicomponent targeted intervention to prevent delirium in hospitalized older patients: efficacy and costeffectiveness in Dutch health care. Science.gov (United States) Strijbos, Marije J; Steunenberg, Bas; van der Mast, Roos C; Inouye, Sharon K; Schuurmans, Marieke J 2013-07-23 The Hospital Elder Life Program (HELP) has been shown to be highly efficient and (cost-)effective in reducing delirium incidence in the USA. HELP provides multicomponent protocols targeted at specific risk factors for delirium and introduces a different view on care organization, with trained volunteers playing a pivotal role. The primary aim of this study is the quantification of the (cost-)effectiveness of HELP in the Dutch health care system. The second aim is to investigate the experiences of patients, families, professionals and trained volunteers participating in HELP. A multiple baseline approach (also known as a stepped-wedge design) will be used to evaluate the (cost-) effectiveness of HELP in a cluster randomized controlled study. All patients aged 70 years and older who are at risk for delirium and are admitted to cardiology, internal medicine, geriatrics, orthopedics and surgery at two participating community hospitals will be included. These eight units are implementing the intervention in a successive order that will be determined at random. The incidence of delirium, the primary outcome, will be measured with the Confusion Assessment Method (CAM). Secondary outcomes include the duration and severity of delirium, quality of life, length of stay and the use of care services up to three months after hospital discharge. The experiences of patients, families, professionals and volunteers will be investigated using a qualitative design based on the grounded theory approach. Professionals and volunteers will be invited to participate in focus group interviews. Additionally, a random sample of ten patients and their families from each hospital unit will be interviewed at home after discharge. We hypothesize that HELP will reduce delirium incidence during hospital admission and decrease the duration and severity of delirium and length of hospital stays among these older patients, which will lead to reduced health care costs. The results of this study may 449. STUDY OF DERMATOLOGICAL QUALITY OF LIFE IN PATIENTS WITH VITILIGO ATTENDING THE OUT PATIENT DEPARTMENT OF DERMATOLOGY IN A TERTIARY CARE HOSPITAL Directory of Open Access Journals (Sweden) Ashiq

2015-11-01 Full Text Available : BACKGROUND: Vitiligo is an autoimmune, chronic pigmentary disorder causing considerable amount of social stigma leading to low self-esteem. AIM: To assess the quality of life in patients with vitiligo who are attending the outpatient department in Sri Ramachandra Hospital. The study was done over a period of 2 years. Parameters that were studied included gender distribution, occupation, type of Vitiligo. METHODS: 200 vitiligo patients answered a ten point questionnaire designed by Cardiff to assess the quality of life. RESULTS: Out of the 200 patients, 66 were male & 134 female, 158 were married and 42 unmarried, vitiligo vulgaris being the commonest type. Mean DLQI was higher in housewife (Occupation-13.5, vitiligo vulgaris (Type of vitiligo-16.34, diabetes mellitus (Association with vitiligo-27. CONCLUSION: The results demonstrate that vitiligo has a very large to extremely large effect on the quality of life. 450. Hospital diversification and financial management. Science.gov (United States) Eastaugh, S R 1984-08-01 Hospital diversification and its impact on the operating ratio are studied for 62 New York hospitals during the period 1974-1979. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependent. Institutional diversification is found to yield better financial position, and the better operating ratio allows the institution the wherewithal to diversify. The impact of external government planning and hospital competition are also measured. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. These results should not be generalized beyond the New York State context. Restructuring of the organization, unrelated business ventures, and transactions with related organizations were not a problem in this sample. However, in 1983, many a new corporation is set up whose revenues do not become part of the hospital's and whose complex transactions conceal unallowable costs and maximize reimbursement. A number of hypotheses are advanced concerning hospital administrator's attitude toward risk. 451. Evaluation of malnutrition detected with the Nutritional Risk Screening 2002 (NRS-2002) and the quality of life in hospitalized patients with chronic obstructive pulmonary disease. Science.gov (United States) Arslan, M; Soylu, M; Kaner, G; Ä°nanç, N; BaÅŸmısırlı, E 2016-01-01 Patients with severe chronic obstructive pulmonary disease (COPD) have impaired quality of life, but the relationship between their nutritional status and quality of life has not been established. The aim of this study was to determine the relationship between quality of life and nutritional status in hospitalized COPD patients. Demographic data, quality of life and nutritional status of 90 inpatients with a mean age of 68.76 ± 10.85 years were enrolled in the study. The Nutritional Risk Screening 2002 (NRS-2002) tool was used to evaluate their nutritional status. The quality of life was assessed using the Short Form-36 (SF-36) questionnaire. The correlation analysis was used for the relationship between SF-36 subscales and nutritional status variables. Of the 90 COPD patients included in the study, 54.4 % were men, and 45.6 % were women. Moderate, severe, and very severe COPD were detected in 37.8 %, 38.9 %, and 23.3 % of the patients, respectively. At risk of malnutrition were 55.6 % of the 90 COPD patients, whereas 44.4 % were not. The scores for physical function, physical role functioning, pain, general health, emotional role functioning, vitality, social function, and mental function subscales were lower in the patients at risk of malnutrition (p nutritional status of COPD patients should be an integral part of their clinical treatment plans aiming towards improving their quality of life. Hippokratia 2016, 20(2):147-152. 452. [The third report from Sapporo Tsukisamu Hospital--chemotherapy for patients with advanced gastric cancer (peritoneal dissemination, peritonitis carcinomatosa)]. Science.gov (United States) Yamamitsu, Susumu; Kimura, Hiromichi; Yamada, Yoshiyuki; Inui, Noriaki; Hiyama, Shigemi; Hirata, Koichi; Kimura, Yasutoshi; Yamaguchi, Kouji; Shirasaka, Tetsuhiko 2007-09-01 Recently, it became possible to reduce the size of tumors in patients with advanced or relapsed gastric cancer by chemotherapy with the combination of several kinds of anti-cancer drugs which are all effective and allowed for use with gastric cancer patients. However, chemotherapy alone can not cure patients with advanced gastric cancer that was shown to improve median survival time (MST), compared with patients provided with the best supportive care (BSC). According to reports from Europe, US and Japan,the MST of patients with advanced gastric cancer and those with peritoneal expansion treated by chemotherapy is almost 7-12 months and 5-6 months,respectively, both of which are short and unsatisfactory. From March 2002, we started to treat patients with advanced gastric cancer (stage IV) with a new regimen; intermittent dosage of 5-FU (-->S-1), CDDP and paclitaxel utilizing the difference of cell cycle between normal and cancer cells (intermittent FP . weekly PTX). In the present study, therefore, we analyzed advanced gastric cancer patients with peritoneal expansion (9 cases, 4 with cancerous peritonitis) treated with this regimen. The results were as follows. The one-and 2-year survival rate was 55.6% and 27.8%, respectively, and the MST was 14 months. Four patients (44.4%) had hematological toxicities over grade 3. All of them had anemia (3 cases) and neutropenia (3 cases). Toxicities of thrombocytopenia were all under grade 1 and nonhematological toxicities were all under grade 2, which were clinically manageable. These results, although the sample was small, suggested that this may contribute to the extension of survival time of patients with stage IV advanced gastric cancer with peritoneal expansion. 453. Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies. Directory of Open Access Journals (Sweden) Susi Lund Full Text Available Advance Care Plans (ACPs enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges.To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice.An explanatory systematic review of qualitative implementation studies.Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched.Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes.13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations.This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows. 454. Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies Science.gov (United States) Lund, Susi; Richardson, Alison; May, Carl 2015-01-01 Context Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges. Objective To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice. Design An explanatory systematic review of qualitative implementation studies. Data sources Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched. Methods Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes. Results 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations. Conclusions This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows. PMID:25679395 455. Advances in Electromyogram Signal Classification to Improve the Quality of Life for the Disabled and Aged People Directory of Open Access Journals (Sweden) M. D.R. Ahsan 2010-01-01 Full Text Available Problem statement: The social demands for the Quality Of Life (QOL are increasing with the exponentially expanding silver generation. To improve the QOL of the disabled and elderly people, robotic researchers and biomedical engineers have been trying to combine their techniques into the rehabilitation systems. Various biomedical signals (biosignals acquired from a specialized tissue, organ, or cell system like the nervous system are the driving force for the entire system. Examples of biosignals include ElectroEncephalogram (EEG, Electrooculogram (EOG, Electroneurogram (ENG and (EMG. Approach: Among the biosignals, the research on EMG signal processing and controlling is currently expanding in various directions. EMG signal based research is ongoing for the development of simple, robust, user friendly, efficient interfacing devices/systems for the disabled. The advancement can be observed in the area of robotic devices, prosthesis limb, exoskeleton, wearable computer, I/O for virtual reality games and physical exercise equipments. An EMG signal based graphical controller or interfacing system enables the physically disabled to use word processing programs, other personal computer software and internet. Results: Depending on the application, the acquired and processed signals need to be classified for interpreting into mechanical force or machine/computer command. Conclusion: This study focused on the advances and improvements on different methodologies used for EMG signal classification with their efficiency, flexibility and applications. This review will be beneficial to the EMG signal researchers as a reference and comparison study of EMG classifier. For the development of robust, flexible and efficient applications, this study opened a pathway to the researchers in performing future comparative studies between different EMG classification methods. 456. "It's been an Experience, a Life Learning Experience": A Qualitative Study of Hospitalized Patients with Substance Use Disorders. Science.gov (United States) Velez, Christine M; Nicolaidis, Christina; Korthuis, P Todd; Englander, Honora 2017-03-01 Individuals with substance use disorders (SUD) have high rates of chronic illness and readmission, yet few are engaged in addiction treatment. Hospitalization may be a reachable moment for initiating and coordinating addiction care, but little is known about motivation for change in the inpatient setting. To explore the experiences of hospitalized adults with SUD and to better understand patient and system level factors impacting readiness for change. We performed a qualitative study using individual interviews. The study was nested within a larger mixed-methods needs assessment. Hospitalized adults admitted to medical or surgical units at an urban academic medical center who reported high-risk alcohol or drug use on AUDIT-C or single-item drug use screener. We conducted a thematic analysis, using an inductive approach at a semantic level. Thirty-two patients participated. The mean age was 43 years; 75% were men, and 68% identified as white. Participants reported moderate to high-risk alcohol (39%), amphetamine (46%), and opioid (65%) use. Emergent themes highlight the influence of hospitalization at the patient, provider, and health system levels. Many patients experienced hospitalization as a wake-up call, where mortality was motivation for change and hospitalization disrupted substance use. However, many participants voiced complex narratives of social chaos, trauma, homelessness, and chronic pain. Participants valued providers who understood SUD and the importance of treatment choice. Patient experience suggests the importance of peers in the hospital setting, access to medication-assisted treatment, and coordinated care post-discharge. This study supports that hospitalization offers an opportunity to initiate and coordinate addiction care, and provides insights into patient, provider, and health system factors which can leverage the reachability of this moment. 457. Predictors of intensive end-of-life and hospice care in Latino and white advanced cancer patients. Science.gov (United States) Loggers, Elizabeth T; Maciejewski, Paul K; Jimenez, Rachel; Nilsson, Matthew; Paulk, Elizabeth; Stieglitz, Heather; Prigerson, Holly G 2013-10-01 The role of end-of-life (EOL) care preferences and conversations in receipt of care near death for Latinos is unclear. This study examines rates and predictors of intensive EOL and hospice care among Latino and white advanced cancer patients. Two-hundred-and-ninety-two self-reported Latino (n=58) and white (n=234) Stage IV cancer patients participated in a U.S. multisite, prospective, cohort study from September 2002 to August 2008. The Latino and white, non-Hispanic participants were interviewed and followed until death, a median of 118.5 days from baseline. Patient-reported, baseline predictors of EOL care included EOL care preference; terminal illness acknowledgement; EOL discussion; completion of a DNR order; and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit. Hospice was either in- or outpatient. Latino and white patients received intensive EOL and hospice care at similar rates (5.2% and 3.4% for intensive care, p=0.88; 70.7% versus 73.4% for hospice, p=0.33). No white or Latino patient who reported a DNR order or EOL discussion at baseline received intensive EOL care. Religious coping and a preference for life-extending care predicted intensive EOL care for white patients (adjusted odds ratio [aOR] 6.69 [p=0.02] and aOR 6.63 [p=0.01], respectively), but not for Latinos. No predictors were associated with Latino hospice care. EOL discussions and DNR orders may prevent intensive EOL care among Latino cancer patients. Efforts should continue to engage Latino patients and caregivers in these activities. 458. Exploring the relationship between the engineering and physical sciences and the health and life sciences by advanced bibliometric methods. Directory of Open Access Journals (Sweden) Ludo Waltman Full Text Available We investigate the extent to which advances in the health and life sciences (HLS are dependent on research in the engineering and physical sciences (EPS, particularly physics, chemistry, mathematics, and engineering. The analysis combines two different bibliometric approaches. The first approach to analyze the 'EPS-HLS interface' is based on term map visualizations of HLS research fields. We consider 16 clinical fields and five life science fields. On the basis of expert judgment, EPS research in these fields is studied by identifying EPS-related terms in the term maps. In the second approach, a large-scale citation-based network analysis is applied to publications from all fields of science. We work with about 22,000 clusters of publications, each representing a topic in the scientific literature. Citation relations are used to identify topics at the EPS-HLS interface. The two approaches complement each other. The advantages of working with textual data compensate for the limitations of working with citation relations and the other way around. An important advantage of working with textual data is in the in-depth qualitative insights it provides. Working with citation relations, on the other hand, yields many relevant quantitative statistics. We find that EPS research contributes to HLS developments mainly in the following five ways: new materials and their properties; chemical methods for analysis and molecular synthesis; imaging of parts of the body as well as of biomaterial surfaces; medical engineering mainly related to imaging, radiation therapy, signal processing technology, and other medical instrumentation; mathematical and statistical methods for data analysis. In our analysis, about 10% of all EPS and HLS publications are classified as being at the EPS-HLS interface. This percentage has remained more or less constant during the past decade. 459. Management practices for end-of-life cathode ray tube glass: Review of advances in recycling and best available technologies. Science.gov (United States) Iniaghe, Paschal O; Adie, Gilbert U 2015-11-01 Cathode ray tubes are image display units found in computer monitors and televisions. In recent years, cathode ray tubes have been generated as waste owing to the introduction of newer and advanced technologies in image displays, such as liquid crystal displays and high definition televisions, among others. Generation and subsequent disposal of end-of-life cathode ray tubes presents a challenge owing to increasing volumes and high lead content embedded in the funnel and neck sections of the glass. Disposal in landfills and open dumping are anti-environmental practices considering the large-scale contamination of environmental media by the potential of toxic metals leaching from glass. Mitigating such environmental contamination will require sound management strategies that are environmentally friendly and economically feasible. This review covers existing and emerging management practices for end-of-life cathode ray tubes. An in-depth analysis of available technologies (glass smelting, detoxification of cathode ray tube glass, lead extraction from cathode ray tube glass) revealed that most of the techniques are environmentally friendly, but are largely confined to either laboratory scale, or are often limited owing to high cost to mount, or generate secondary pollutants, while a closed-looped method is antiquated. However, recycling in cementitious systems (cement mortar and concrete) gives an added advantage in terms of quantity of recyclable cathode ray tube glass at a given time, with minimal environmental and economic implications. With significant quantity of waste cathode ray tube glass being generated globally, cementitious systems could be economically and environmentally acceptable as a sound management practice for cathode ray tube glass, where other technologies may not be applicable. 460. Exploring the relationship between the engineering and physical sciences and the health and life sciences by advanced bibliometric methods. Science.gov (United States) Waltman, Ludo; van Raan, Anthony F J; Smart, Sue 2014-01-01 We investigate the extent to which advances in the health and life sciences (HLS) are dependent on research in the engineering and physical sciences (EPS), particularly physics, chemistry, mathematics, and engineering. The analysis combines two different bibliometric approaches. The first approach to analyze the 'EPS-HLS interface' is based on term map visualizations of HLS research fields. We consider 16 clinical fields and five life science fields. On the basis of expert judgment, EPS research in these fields is studied by identifying EPS-related terms in the term maps. In the second approach, a large-scale citation-based network analysis is applied to publications from all fields of science. We work with about 22,000 clusters of publications, each representing a topic in the scientific literature. Citation relations are used to identify topics at the EPS-HLS interface. The two approaches complement each other. The advantages of working with textual data compensate for the limitations of working with citation relations and the other way around. An important advantage of working with textual data is in the in-depth qualitative insights it provides. Working with citation relations, on the other hand, yields many relevant quantitative statistics. We find that EPS research contributes to HLS developments mainly in the following five ways: new materials and their properties; chemical methods for analysis and molecular synthesis; imaging of parts of the body as well as of biomaterial surfaces; medical engineering mainly related to imaging, radiation therapy, signal processing technology, and other medical instrumentation; mathematical and statistical methods for data analysis. In our analysis, about 10% of all EPS and HLS publications are classified as being at the EPS-HLS interface. This percentage has remained more or less constant during the past decade. « 21 22 23 24 25 » « 21 22 23 24 25 » 461. Health-Related Quality of Life in Locally Advanced Cervical Cancer Patients After Definitive Chemoradiation Therapy Including Image Guided Adaptive Brachytherapy: An Analysis From the EMBRACE Study DEFF Research Database (Denmark) Kirchheiner, Kathrin; Pötter, Richard; Tanderup, Kari 2016-01-01 Purpose This study analyzed functioning and symptom scores for longitudinal quality of life (QoL) from patients with locally advanced cervical cancer who underwent definitive chemoradiation therapy with image guided adaptive brachytherapy in the EMBRACE study. Methods and Materials In total, 744 ... 462. The prevalence in the general population of advance directives on euthanasia and discussion of end-of-life wishes: a nationwide survey. Science.gov (United States) De Vleminck, Aline; Pardon, Koen; Houttekier, Dirk; Van den Block, Lieve; Vander Stichele, Robert; Deliens, Luc 2015-12-07 To determine the extent to which members of the general population have talked to their physician about their wishes regarding medical treatment at the end of life, to describe the prevalence of advance directives on euthanasia, and to identify associated factors. This study used data from the cross-sectional Health Interview Study (HIS) 2008 that collected data from a representative sample (N = 9651) of the Belgian population. Of all respondents, 4.4 % had spoken to their physician about their wishes regarding medical treatment at the end of life, while 1.8 % had an advance directive on euthanasia. Factors positively associated with discussions regarding wishes for medical treatment at the end of life were being female, being older in age, having poorer health status and having more GP contacts. People older than 55 years and living in Flanders or Brussels were more likely than the youngest age categories to have an advance directive on euthanasia. Younger people, men, people living in the Walloon region of Belgium, people without a longstanding illness, chronic condition or disability and people with few GP contacts could represent a target group for education regarding advance care planning. Public information campaigns and education of physicians may help to enable the public and physicians to engage more in advance care planning. 463. Changes in and Associations Among Functional Status and Perceived Quality of Life of Patients With Metastatic/Locally Advanced Cancer Receiving Rehabilitation for General Disability. Science.gov (United States) Sekine, Ryuichi; Ogata, Masami; Uchiyama, Ikuyo; Miyakoshi, Koichi; Uruma, Megumi; Miyashita, Mitsunori; Morita, Tatsuya 2015-11-01 The primary aims were to clarify the changes in the functional status and quality of life of patients with metastatic/locally advanced cancer who received rehabilitation therapy. This is a cohort study, and all consecutive patients who received rehabilitation therapy were evaluated before and 2 weeks after. Outcome measures were the Functional Independence Measure (FIM), perceived independence, and overall quality of life (European Organization for Research and Treatment of Cancer C30). A total of 128 patients were included. Although the FIM score significantly decreased, the overall quality of life significantly increased. Even in the patients with deteriorated FIM scores, the overall quality of life was maintained despite a significantly decreased perceived independence. Terminally ill patients with cancer who received a rehabilitation program maintained their overall quality of life despite an objective decline in the physical functional status. 464. Reduction of psycho-spiritual distress of an elderly with advanced congestive heart failure by life review interview in a palliative care day center Directory of Open Access Journals (Sweden) Kwok-Ying Chan 2016-08-01 Full Text Available Objectives: Major depression is common in patients hospitalized with congestive heart failure and is independently associated with increased re-hospitalization and mortality. Methods: Hereby, we report the treatment for an elderly congestive heart failure patient with frequent emergency department visits having major depression and hopelessness. Results: Treatment outcomes measured showed that depressed scores of psychosocial needs were reduced with life review interview therapy in a palliative care day center. Conclusion: We hypothesize that multidisciplinary team’s approach to treatment was important for this case. 465. Life satisfaction in patients with and without spinal cord ischemia after advanced endovascular therapy for extensive aortic disease at mid-term follow-up. Science.gov (United States) Mehmedagic, Irma; Santén, Stefan; Jörgensen, Sophie; Acosta, Stefan 2016-11-11 Advanced endovascular aortic repair can be used to treat patients with extensive and complex aortic disease who are at risk of spinal cord ischaemia. The aim of this study was to compare whether life satisfaction differs between patients with and without spinal cord ischaemia at mid-term follow-up. Nested case-control study. Among patients undergoing advanced endovascular aortic repair between 2009 and 2012, 18 patients with spinal cord ischaemia and 33 without were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were used. LiSat-11 found that patients with spinal cord ischaemia were more dissatisfied with their activities of daily living than were patients without spinal cord ischaemia (p=0.012). Both groups had similar, very low, scores in the sexual life domain; median 2.0 (interquartile range (IQR) 1.5-3.0) and 3.0 (IQR 2.0-4.0), respectively. There was no difference in SWLS between the groups. This study cohort of patients who underwent advanced endovascular aortic repair was rather

homo-genous in their rating of life satisfaction and there was little difference between mid-term survivors who had spinal cord ischaemia and those who did not. 466. Advanced airway management in an anaesthesiologist-staffed Helicopter Emergency Medical Service (HEMS): A retrospective analysis of 1047 out-of-hospital intubations. Science.gov (United States) Piegeler, Tobias; Neth, Philippe; Schlaepfer, Martin; Sulser, Simon; Albrecht, Roland; Seifert, Burkhardt; Spahn, Donat R; Ruetzler, Kurt 2016-08-01 Airway management in the out-of-hospital emergency setting is challenging. Failed and even prolonged airway management is associated with serious clinical consequences, such as desaturation, bradycardia, airway injuries, or aspiration. The overall success rate of tracheal intubation ranges between 77% and 99%, depending on the level of experience of the provider. Therefore, advanced airway management should only be performed by highly-skilled and experienced providers. 9765 patients were treated in the out-of-hospital emergency setting by the anaesthesiologist-staffed Helicopter Emergency Medical Services (HEMS) between 2002 and 2014. Patients successfully intubated upon the first attempt were compared to patients who required more than one intubation attempts regarding several potential confounding factors such as age, gender, on-going CPR, NACA Score, initial GCS, prior administration of anaesthetic drugs, neuromuscular blocking agents, and vasopressors. 1573 out of 9765 patients (16.1%) required advanced airway management. 459 patients had already been intubated upon arrival of the HEMS, whereas 1114 patients (11.4%) underwent advanced airway management by the HEMS physician. 67 patients had to be excluded. Data for the remaining 1047 patients (790 males and 257 females) were analyzed further. Primary use of an alternative airway device was reported in 59 patients (5.6%), whereas 988 patients (94.4%) underwent laryngoscopy-guided tracheal intubation. 952 patients (96.4%) could be intubated upon the first attempt and overall intubation success was 99.5% (983 out of 988). Our study demonstrates that HEMS physicians performed airway management frequently and that both the first attempt as well as the overall success rate of tracheal intubation was high. Together with the fact that all failed and difficult intubations were successfully recognized and handled and that no surgical airway had to be established, the current study once more underlines the importance of 467. Advanced life support (ALS) instructors experience of ALS education in Western Australia: a qualitative exploratory research study. Science.gov (United States) Taplin, John; McConigley, Ruth 2015-04-01 When cardiac arrest occurs, timely competent advanced life support (ALS) interventions by nursing staff can influence patient outcomes. Ongoing ALS education influences maintenance of competency and avoids skill decay. To explore the methods of ALS education delivery for nurses in the workplace; describe the issues relating to maintaining ALS competency; explore ALS competency decay for nurses and develop recommendations for the provision of continuing ALS education. A qualitative exploratory design was used to study ALS education provision in the workplace. Data were collected from ALS nurse experts in Western Australia by face-to-face and phone interviews. Semi-structured interviews were conducted and organised around a set of predetermined questions. Two major themes were identified; the first theme Demand and Supply describes the increasing demand for ALS education for nurses and the challenges with providing timely cost effective traditional face-to-face ALS education. The second theme, Choosing The Best Education Options describes new ways to provide ALS education using emerging technologies. The study suggested that using e-learning methods would assist with educating the maximum amount of nurses in a timely manner and e-learning and teleconferencing offer opportunities to reach nurses in distant locations. Delivering ALS education more frequently than annually would increase skills maintenance and lessen skill decay. Further research is required to explore which blended e-learning model is best suited to ALS education. Copyright © 2014 Elsevier Ltd. All rights reserved. 468. Teaching paediatric resuscitation skills in a developing country: introduction of the Advanced Paediatric Life Support course into Vietnam. Science.gov (United States) Young, Simon; Hutchinson, Adrian; Nguyen, Van Tu; Le, Thanh Hai; Nguyen, Dich Van; Vo, Thi Kim Hue 2008-06-01 In 2001, a nationwide study revealed deficiencies in the emergency care of seriously ill and injured children in Vietnam. In response, a project was initiated to conduct the Advanced Paediatric Life Support course in Vietnam and ascertain whether this course would provide a practical and sustainable method of improving the knowledge and skills of medical and nursing staff in this area. After approval to use the course was secured and funding obtained, the project commenced in 2003. Key Vietnamese personnel travelled to Australia to complete the course, undertake instructor training and gain organizational experience. Teaching materials were translated, reviewed and modified to account for local diseases and clinical practices while maintaining the fundamental principles of the parent course. Commencing in March 2004, 10 courses were conducted by Australian and Vietnamese instructors, training 239 doctors and nurses from a wide variety of clinical backgrounds. Additionally, three instructor courses were conducted, training 52 new instructors. As the skill and confidence of the Vietnamese instructors grew, the number and responsibilities of the international faculty reduced. The infrastructure now exists for the course to operate in a sustainable fashion within Vietnam. We believe that this project demonstrates that the course can be successfully modified to provide teaching in paediatric emergency care in a developing country. 469. The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study Directory of Open Access Journals (Sweden) Monique Venter 2016-11-01 Full Text Available Background. Critical care transfers (CCT refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft of patients who are of high acuity. In South Africa (SA, advanced life support (ALS paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7, consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81 of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners. 470. A census of fishes and everything they eat: How the census of marine life advanced fisheries science Science.gov (United States) O'Dor, Ron; Boustany, Andre M.; Chittenden, Cedar M.; Costello, Mark J.; Moustahfid, Hassan; Payne, John; Steinke, Dirk; Stokesbury, Michael J. W.; Vanden Berghe, Edward 2012-01-01 The Census of Marine Life was a 10-year, international research effort to explore poorly known ocean habitats and conduct large-scale experimentation with new technology. The goal of Census 2010 in its mission statement was to describe what did live in the oceans, what does live in the oceans, and what will live in the ocean. Many of the findings and techniques from census research may prove valuable in making a transition, which many governments have publicly endorsed, from single-species fisheries management to more holistic ecosystem management. Census researchers sampled continental margins, mid-Atlantic ridges, ocean floor vents and seeps, and abyssal plains and polar seas and organized massive amounts of past and new information in a public online database called the Ocean Biogeographic Information System (www.iobis.org). The census described and categorized seamount biology worldwide for its vulnerability to fishing, advanced large-scale animal tracking with acoustic arrays and satellite archival tags, and accelerated species identification, including nearshore, coral reef, and zooplankton sampling using genetic barcoding and pyrotag sequencing for microbes and helped to launch the exciting new field of marine environmental history. Above all, the census showed the value of investing in large-scale, collaborative projects and sharing results publicly. 471. Agreement between personally generated areas of quality of life concern and standard outcome measures in people with advanced cancer. Science.gov (United States) Aburub, Ala' S; Gagnon, B; RodrÃguez, A M; Mayo, Nancy E 2016-09-01 People with advanced cancer experience different sequelae which have unique effects on quality of life (QOL). The patient-generated index (PGI) is a personalized measure that allows patients to nominate, rate, and value areas that have the most impact on QOL. Fatigue, pain, and aspects of physical function are among the top 10 areas with QOL impact. An area of validation that is lacking for the PGI is the extent to which spontaneously nominated areas of QOL that patients are concerned with, agree with ratings obtained from standard patient reported outcomes (PROs). Data from 192 patients were used to compare ratings on fatigue, pain, and physical function obtained from PGI to those from standard outcome measures. Within one severity rating, agreement ranged from 32.1 to 76.9 % within the fatigue domain, 34.2 to 95.24 % for pain, and between 84.2 and 94.7 % for physical function. Of the 10 items where the PGI had the highest agreement, 7 came from the RAND-36. At the domain level, people nominating an area scored in the more impaired range on standard measures than people who did not. PGI gives comparable information as do standard measures. PGI provides important information to guide clinical care of the patient and also produces a legitimate total score suitable for research. 472. Developing a Simulation-Based Mastery Learning Curriculum: Lessons From 11 Years of Advanced Cardiac Life Support. Science.gov (United States) Barsuk, Jeffrey H; Cohen, Elaine R; Wayne, Diane B; Siddall, Viva J; McGaghie, William C 2016-02-01 Curriculum development in medical education should follow a planned, systematic approach fitted to the needs and conditions of a local institutional environment and its learners. This article describes the development and maintenance of a simulation-based medical education curriculum on advanced cardiac life support skills and its transformation to a mastery learning program. Curriculum development used the Kern 6-step model involving problem identification and general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation and feedback. Curriculum maintenance and enhancement and dissemination are also addressed. Transformation of the simulation-based medical education curriculum to a mastery learning program was accomplished after a 2-year phase-in trial. A series of studies spanning 11 years was performed to adjust the curriculum, improve checklist outcome measures, and evaluate curriculum effects as learning outcomes among internal medicine residents and improved patient care practices. We anticipate wide adoption of the mastery learning model for skill and knowledge acquisition and maintenance in medical education settings. 473. Quality of life assessment with different radiotherapy schedules in palliative management of advanced carcinoma esophagus: A prospective randomized study Directory of Open Access Journals (Sweden) Shaveta Mehta 2008-01-01 Full Text Available Aim: To investigate the quality of life (QOL of patients with advanced carcinoma esophagus treated with different palliative radiation schedules. Methods: Sixtytwo consecutive patients with inoperable, non-metastatic carcinoma of the esophagus were randomly allocated to Arm-A (external radiotherapy 30 Gy/10 fractions + brachytherapy 12 Gy/two sessions, Arm-B (external radiotherapy 30 Gy /10 fractions and Arm-C (external radiotherapy 20Gy /five fractions. The QOL was assessed using the European Organization for Research and Treatment of Cancer questionnaire at presentation, after treatment and at 3 months follow-up. Results: The mean QOL score improved, in arm-A from 38 to 52 after treatment and 56 at 3 months, in arm-B from 30 to 44 after treatment and 55 at 3 months and in arm-C from 24 to 40 after treatment but decreased to 37 at 3 months. Improvement in dysphagia scores at the first follow-up was 46.1% in arm-A, 25.0% in arm-B and 22.6% in arm-C. The difference was maintained at 3 months, with maximum improvement in arm-A (57.6%. No significant differences were found between the three arms with regard to complications and additional procedures needed for relief of dysphagia. Conclusion: In comparison with external radiotherapy alone, external radiotherapy with intraluminal brachytherapy has shown a trend toward better QOL and consistent dysphagia relief without significant difference in adverse effects. 474. Days spent in acute care hospitals at the end of life of cancer patients in four Swiss cantons: a retrospective database study (SAKK 89/09). Science.gov (United States) Matter-Walstra, K W; Achermann, R; Rapold, R; Klingbiel, D; Bordoni, A; Dehler, S; Konzelmann, I; Mousavi, M; Clough-Gorr, K M; Szucs, T; Schwenkglenks, M; Pestalozzi, B C 2016-02-09 Number of days spent in acute hospitals (DAH) at the end of life is regarded as an important care quality indicator for cancer patients. We analysed DAH during 90 days prior to death in patients from four Swiss cantons. Claims data from an insurance provider with about 20% market share and patient record review identified 2086 patients as dying of cancer. We calculated total DAH per patient. Multivariable generalised linear modelling served to evaluate potential explanatory variables. Mean DAH was 26 days. In the multivariable model, using complementary and alternative medicine (DAH = 33.9; +8.8 days compared to non-users) and canton of residence (for patient receiving anti-cancer therapy, Zürich DAH = 22.8 versus Basel DAH = 31.4; for other patients, Valais DAH = 22.7 versus Ticino DAH = 33.7) had the strongest influence. Age at death and days spent in other institutions were additional significant predictors. DAH during the last 90 days of life of cancer patients from four Swiss cantons is high compared to most other countries. Several factors influence DAH. Resulting differences are likely to have financial impact, as DAH is a major cost driver for end-of-life care. Whether they are supply- or demand-driven and whether patients would prefer fewer days in hospital remains to be established. 475. [The first report from Sapporo Tsukisamu Hospital--chemotherapy and chemoradiotherapy for patients with advanced pancreatic cancer]. Science.gov (United States) Yamamitsu, Susumu; Kimura, Hiromichi; Yamada, Yoshiyuki; Inui, Noriaki; Hiyama, Shigemi; Hirata, Koichi; Kimura, Yasutoshi; Koito, Kazumitsu; Shirasaka, Tetsuhiko 2007-07-01 The remedy, especially chemotherapy, for advanced pancreatic cancer is hardly ever successful in terms of efficacy rate and survival period, because it is virtually unable to contribute to the improvement of median survival time (MST). Thus,we devised a new intermittent dosage regimen utilizing the cell cycle difference of normal GI tract, bone marrow cell and pancreatic cancer cell, making use of 5-FU (-->S-1), CDDP and paclitaxel in March 2002. Ten patients with advanced pancreatic cancer (4 in Stage IVa and 6 in Stage IVb) were treated with this new regimen. As a result, an efficacy ratio of 50.0% and a 1-year survival ratio of 60.0% were achieved. However, 2-year survival ratio of 12.0% was low, and there was no 3-year survivor. The MST was 19 months as of December 31, 2006. All of the non-hematological toxicities were under grade 2. Eight patients had hematological toxicities over grade 3 and most of them were anemia and neutropenia. Only 2 cases had thrombocytopenia. Although adverse effects related to this regimen were clinically manageable, it was difficult to improve MST of patients with advanced pancreatic cancer with chemotherapy alone including this regimen. Hence, we devised another regimen with the joint use of radiotherapy along with the same chemotherapy regimen in January 2003. Twenty patients with advanced pancreatic cancer (Stage IV) were treated with this regimen. It is presently under way, and an efficacy ratio of 35.0%, 1-year survival ratio of 86.3% and 2-year survival ratio of 64.0% were obtained by May 2005, showing that this may contribute to the extension of survival time of Stage IV pancreatic cancer patients. 476. Nutrition of premature infants after hospital discharge. Effect on growth and the risk of allergic disease within the first year of life DEFF Research Database (Denmark) Zachariassen, Gitte; Færk, Jan; Halken, Susanne to continue with fortification or premature formula after hospital discharge. The aim of the study is to describe breast-feeding rate at discharge among very preterm infants, whether it is possible to supply breastfeeding with fortification after discharge, eating habits after discharge, growth...... Background and Aims: Human milk offers many advantages for the premature infant, but the content of macro-nutrients might be inadequate. Fortification of mothers own milk or premature formula have shown to improve growth among premature infants while they are hospitalized. It might be beneficial......-velocity and registration of allergic symptoms within the first year of life among premature infants. Methods: The study is a randomized controlled study where premature infants born with a gestational age (GA) ≤ 32+0 weeks are fed premature formula or (if the mother is breastfeeding) randomized to either breastfeeding... 477. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. Science.gov (United States) Parker, Sharon M; Clayton, Josephine M; Hancock, Karen; Walder, Sharon; Butow, Phyllis N; Carrick, Sue; Currow, David; Ghersi, Davina; Glare, Paul; Hagerty, Rebecca; Tattersall, Martin H N 2007-07-01 Evidence-based recommendations concerning how to discuss dying, life expectancy, and likely future symptoms with patients with a limited life expectancy and their families are lacking. The aim of this systematic review was to review studies regarding prognostic/end-of-life communication with adult patients in the advanced stages of a life-limiting illness and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases up to November 2004. One hundred twenty-three studies met the criteria for the full review, and 46 articles reported on patient/caregiver preferences for content, style, and timing of information. The majority of the research was descriptive. Although there were individual differences, patients/caregivers in general had high levels of information need at all stages of the disease process regarding the illness itself, likely future symptoms and their management, and life expectancy and information about clinical treatment options. Patient and caregiver information needs showed a tendency to diverge as the illness progressed, with caregivers needing more and patients wanting less information. Patients and caregivers preferred a trusted health professional who showed empathy and honesty, encouraged questions, and clarified each individual's information needs and level of understanding. In general, most patients/caregivers wanted at least some discussion of these topics at the time of diagnosis of an advanced, progressive, life-limiting illness, or shortly after. However, they wanted to negotiate the content and extent of this information. 478. Study examines quality of life factors at end of life for patients with cancer | Division of Cancer Prevention Science.gov (United States) Better quality of life at the end of life for patients with advanced cancer was associated with avoiding hospitalizations and the intensive care unit, worrying less, praying or meditating, being visited by a pastor in a hospital or clinic, and having a therapeutic alliance with their physician, according to a Dana-Farber Cancer Institute report published Online First by Archives of Internal Medicine, a JAMA Network publication. | 479. [Localization Establishment of an Interdisciplinary Intervention Model to Prevent Post-Operative Delirium in Older Patients Based on 'Hospital Elder Life Program']. Science.gov (United States) Wang, Yan-Yan; Liao, Yu-Lin; Gao, Lang-Li; Hu, Xiu-Ying; Yue, Ji-Rong 2017-06-01 Postoperative delirium is a significant complication in elderly patients. The occurrence of delirium may increase the related physical and psychological risks, delay the length of hospital stays, and even lead to death. According to the current evidence-based model, the application of interdisciplinary intervention may effectively prevent delirium, shorten the length of hospital stays, and save costs. To establish a culturally appropriate interdisciplinary intervention model for preventing postoperative delirium in older Chinese patients. The authors adapted the original version of the Hospital Elder Life Program (HELP©) from the Hebrew Senior Life Institute for Aging Research of Harvard University by localizing the content using additional medical resources and translating the modified instrument into Chinese. Furthermore, the final version of this interdisciplinary intervention model for postoperative delirium was developed in accordance with the "guideline of delirium: diagnosis, prevention and management produced by the National Institute for Health and Clinical Excellence in 2010" and the "clinical practice guideline for postoperative delirium in older adults" produced by American geriatrics society in 2014. Finally, the translated instrument was revised and improved using discussions, consultations, and pilot study. The abovementioned procedure generated an interdisciplinary intervention model for preventing postoperative delirium that is applicable to the Chinese medical environment. The content addresses personnel structure and assignment of responsibility; details of interdisciplinary intervention protocols and implementation procedures; and required personnel training. The revised model is expected to decrease the occurrence of post-operative delirium and other complications in elderly patients, to help them maintain and improve their function, to shorten the length of their hospital stays, and to facilitate recovery. 480. The relationship between traits optimism and anxiety and health-related quality of life in patients hospitalized for chronic diseases: data from the SATISQOL study Science.gov (United States) 2013-01-01 Background The impact of psychological factors is often taken into account in the evaluation of quality of life. However, the effect of optimism and trait anxiety remains controversial and they are rarely studied simultaneously. We aimed to study the effect of this factor on health-related quality of life (HRQOL) of patients after a hospitalization in relation with their chronic disease. Methods Using cross-sectional data from the SATISQOL cohort, we conducted a multicentric study, including patients hospitalized for an intervention in connection with their chronic disease. Six months after hospitalization, patients completed a generic HRQOL questionnaire (SF-36), and the STAI and LOT-R questionnaires to evaluate optimism and trait anxiety. We studied the effect of each trait on HRQOL separately, and simultaneously, taking account of their interaction in 3 models, using an ANOVA. Results In this study, 1529 patients were included in three participating hospitals and there existed wide diversity in the chronic diseases in our population. The HRQOL score increased for all dimensions of SF36 between 15,8 and 44,5 when the level of anxiety decreased (p optimism (optimism on HRQOL. In the model 3, assessing the effect of both anxiety and optimism on HRQOL, and their interaction, the HRQOL score for all dimensions of the SF36 increased when the level of anxiety decreased (p optimism (p optimism was significant for the Social Functioning dimension (p = 0.0021). Conclusions Optimism and trait anxiety appeared to be significantly correlated with HRQOL. Furthermore, an interaction existed between the trait anxiety and optimism for some dimensions of SF36. Contrary to optimism, it seems essential to evaluate trait anxiety in future studies about HRQOL, since it could represent a confounding factor. PMID:23914779 « 21 22 23 24 25 » « 21 22 23 24 25 » 481. The Relationship between Self-esteem and Quality of Life of Patients with Idiopathic Thrombocytopenic Purpura at Isfahan's Sayed Al-Shohada Hospital, Iran, in 2013. Science.gov (United States) Hemati, Zeinab; Kiani, Davood 2016-04-01 Idiopathic thrombocytopenic purpura (ITP) is a chronic disease which is accompanied with hopelessness and loss of the sense of well-being due to its symptoms and treatment. It also affects patients' sense of social and spiritual well-being. This disorder decreases patients' self-esteem and their quality of life by changing their mental image and self-confidence. This study was performed to find the relationship between self-esteem and quality of life of patients with ITP. This was a descriptive-analytical study on 64 patients with ITP who referred to Isfahan's Sayed Al-Shohada Hospital, Iran. In this study, patients with ITP were selected randomly using a random number chart. The data collection tools consisted of the World Health Organization Quality of Life (WHOQOL)-BREF and Coopersmith Self-esteem Inventory (CSEI). Data were analyzed using SPSS and chi-square and Mann-Whitney tests and the Pearson and Spearman's rank correlation coefficients. In total, 64 patients completed the questionnaires. RESULTS showed that 32% of subjects were over 36 years of age and 59% were women. In addition, 29.7% of ITP patients had low self-esteem and quality of life. Chi-square test showed a significant relationship between self-esteem and quality of life of patients with ITP. The results of the present study showed that considerable attention must be paid to self-esteem, as one of the most important factors influencing the promotion of quality of life. Therefore, it is suggested that patient's self-esteem be improved by the implementation of educational and psychological programs in order to decrease the consequences of poor quality of life. 482. Telecare for diabetes, CHF or COPD: effect on quality of life, hospital use and costs. A randomised controlled trial and qualitative evaluation. Directory of Open Access Journals (Sweden) Timothy W Kenealy Full Text Available To assess the effect of telecare on health related quality of life, self-care, hospital use, costs and the experiences of patients, informal carers and health care professionals.Patients were randomly assigned either to usual care or to additionally entering their data into a commercially-available electronic device that uploaded data once a day

to a nurse-led monitoring station. Patients had congestive heart failure (Site A, chronic obstructive pulmonary disease (Site B, or any long-term condition, mostly diabetes (Site C. Site C contributed only intervention patients - they considered a usual care option to be unethical. The study took place in New Zealand between September 2010 and February 2012, and lasted 3 to 6 months for each patient. The primary outcome was health-related quality of life (SF36. Data on experiences were collected by individual and group interviews and by questionnaire.There were 171 patients (98 intervention, 73 control. Quality of life, self-efficacy and disease-specific measures did not change significantly, while anxiety and depression both decreased significantly with the intervention. Hospital admissions, days in hospital, emergency department visits, outpatient visits and costs did not differ significantly between the groups. Patients at all sites were universally positive. Many felt safer and more cared-for, and said that they and their family had learned more about managing their condition. Staff could all see potential benefits of telecare, and, after some initial technical problems, many staff felt that telecare enabled them to effectively monitor more patients.Strongly positive patient and staff experiences and attitudes complement and contrast with small or non-significant quantitative changes. Telecare led to patients and families taking a more active role in self-management. It is likely that subgroups of patients benefitted in ways that were not measured or visible within the quantitative data, especially 483. Effects of live music therapy sessions on quality of life indicators, medications administered and hospital length of stay for patients undergoing elective surgical procedures for brain. Science.gov (United States) Walworth, Darcy; Rumana, Christopher S; Nguyen, Judy; Jarred, Jennifer 2008-01-01 The physiological and psychological stress that brain tumor patients undergo during the entire surgical experience can considerably affect several aspects of their hospitalization. The purpose of this study was to examine the effects of live music therapy on quality of life indicators, amount of medications administered and length of stay for persons receiving elective surgical procedures of the brain. Subjects (N = 27) were patients admitted for some type of surgical procedure of the brain. Subjects were randomly assigned to either the control group receiving no music intervention (n = 13) or the experimental group receiving pre and postoperative live music therapy sessions (n = 14). Anxiety, mood, pain, perception of hospitalization or procedure, relaxation, and stress were measured using a self-report Visual Analog Scale (VAS) for each of the variables. The documented administration of postoperative pain medications; the frequency, dosage, type, and how it was given was also compared between groups. Experimental subjects live and interactive music therapy sessions, including a pre-operative session and continuing with daily sessions until the patient was discharged home. Control subjects received routine hospital care without any music therapy intervention. Differences in experimental pretest and posttest scores were analyzed using a Wilcoxon Matched-Pairs Signed-Rank test. Results indicated statistically significant differences for 4 of the 6 quality of life measures: anxiety (p = .03), perception of hospitalization (p = .03), relaxation (p = .001), and stress (p = .001). No statistically significant differences were found for mood (p > .05) or pain (p > .05) levels. Administration amounts of nausea and pain medications were compared with a Two-Way ANOVA with One Repeated Measure resulting in no significant differences between groups and medications, F(1, 51) = 0.03; p > .05. Results indicate no significant differences between groups for length of stay (t = .97 484. Impact of chronic urticaria on the quality of life of patients followed up at a university hospital * Science.gov (United States) Dias, Gabriela Andrade Coelho; Pires, Gisele Viana; do Valle, Solange Oliveira Rodrigues; Dortas Júnior, Sérgio Duarte; Levy, Soloni; França, Alfeu Tavares; Baiardini, Ilaria; Canonica, Walter Giorgio 2016-01-01 BACKGROUND Chronic urticaria is a debilitating disease that considerably affects health-related quality of life, and the Chronic Urticaria Quality of Life Questionnaire is the only questionnaire specifically designed for its evaluation. OBJECTIVE To evaluate the quality of life of patients with chronic urticaria, using the Brazilian Portuguese version of the Chronic Urticaria Quality of Life Questionnaire. METHODS The Chronic Urticaria Quality of Life Questionnaire was self-administered in 112 chronic urticaria patients and disease activity was assessed through the Urticaria Activity Score. Clinical and socio-demographic characteristics of patients were studied, such as: age, sex, etiologic diagnosis of chronic urticaria, duration of disease and Urticaria Activity Score. RESULTS The population studied was composed 85.72% of women with a mean age of 46 years (18-90), while the median disease duration period was 10 years (3 months-60 years). Regarding the etiologic diagnosis, 48.22% had chronic spontaneous urticaria; 22.32% associated with inducible urticaria, 28.57% with chronic autoimmune urticaria, and 23.21% had physical urticaria alone. Disease activity evaluated using the Urticaria Activity Score was 1.04 ± 1.61 (0-6). The total score for the Chronic Urticaria Quality of Life Questionnaire was 36 (0-100) and dimension I (sleep/mental status/eating) had a greater impact on quality of life. The items with the highest mean scores were nervousness and shame over lesions, while the items with the lowest scores were lip swelling and limitations on sporting activities. CONCLUSIONS Chronic urticaria compromises patients' quality of life, mainly those with more severe disease or who are diagnosed with chronic autoimmune urticaria. PMID:28099596 485. Evaluation of an open-rota system in a Danish psychiatric hospital: a mechanism for improving job satisfaction and work-life balance. Science.gov (United States) Pryce, Joanna; Albertsen, Karen; Nielsen, Karina 2006-05-01 To evaluate the impact of an open-rota scheduling system on the health, work-life balance and job satisfaction of nurses working in a psychiatric ward in Denmark. The effects of shift rotation and scheduling are well known; however, little is known about the wider benefits of open-rota systems. Method A structured questionnaire was distributed to control and intervention groups preintervention and postintervention (20 months). Nurses within the intervention group trialed an open-rota system in which nurses designed their own workrest schedules. Nurses in the intervention group reported that they were more satisfied with their work hours, less likely to swap their shift when working within the open-rota system and reported significant increases in work-life balance, job satisfaction, social support and community spirit when compared with nurses in the control groups. The ownership and choice over work-rest schedules has benefits for nurses, and potentially the hospital. 486. Do unto others: doctors' personal end-of-life resuscitation preferences and their attitudes toward advance directives. Directory of Open Access Journals (Sweden) Vyjeyanthi S Periyakoil Full Text Available OBJECTIVE: High-intensity interventions are provided to seriously-ill patients in the last months of life by medical sub-specialists. This study was undertaken to determine if doctors' age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitudes toward Advance Directives (AD and to compare a cohort of 2013 doctors to a 1989 (one year before the Patient Self Determination Act in 1990 cohort to determine any changes in attitudes towards AD in the past 23 years. DESIGN: Doctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989. OUTCOMES: Resuscitation and organ donation preferences (2013 cohort and attitudes toward AD (1989 and 2013 cohorts. RESULTS: In 2013, 1081 (94.2% doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p<0.001, AUC = 0.77; had greater confidence in their treatment decisions if guided by an AD (p<.001, AUC = 0.58 and were less worried about legal consequences of limiting treatment when following an AD (p<.001, AUC  = 0.57. The gender (p = 0.00172, ethnicity (χ2 14.68, DF = 3,p = .0021 and sub-specialty (χ2 28.92, p = .004, DF = 12 influenced their attitudes towards AD. 88.3% doctors chose do-not-resuscitate status and wanted to become organ donors. Those less supportive of AD were more likely to opt for "full code" even if terminally ill and were less supportive of organ donation. CONCLUSIONS: Doctors' attitudes towards AD has not changed significantly in the past 23 years. Doctors' gender, ethnicity and sub-specialty influence their attitudes towards AD. Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally 487. Esophagus and contralateral lung-sparing IMRT for locally advanced lung cancer in the community hospital setting Directory of Open Access Journals (Sweden) Johnny eKao 2015-06-01 Full Text Available Background: The optimal technique for performing lung IMRT remains poorly defined. We hypothesize that improved dose distributions associated with normal tissue sparing IMRT can allow for safe dose escalation resulting in decreased acute and late toxicity. Methods: We performed a retrospective analysis of 82 consecutive lung cancer patients treated with curative intent from 1/10 to 9/14. From 1/10 to 4/12, 44 patients were treated with the community standard of 3-dimensional conformal radiotherapy or IMRT without specific esophagus or contralateral lung constraints (standard RT. From 5/12 to 9/14, 38 patients were treated with normal tissue-sparing IMRT with selective sparing of contralateral lung and esophagus. The study endpoints were dosimetry, toxicity and overall survival.Results: Despite higher mean prescribed radiation doses in the normal tissuesparing IMRT cohort (64.5 Gy vs. 60.8 Gy, p=0.04, patients treated with normal tissue-sparing IMRT had significantly lower lung V20, V10, V5, mean lung, maximum esophagus and mean esophagus doses compared to patients treated with standard RT (p≤0.001. Patients in the normal tissue-sparing IMRT group had reduced acute grade ≥3 esophagitis (0% vs. 11%, p<0.001, acute grade ≥2 weight loss (2% vs. 16%, p=0.04, late grade ≥2 pneumonitis (7% vs. 21%, p=0.02. The 2-year overall survival was 52% with normal tissue-sparing IMRT arm compared to 28% for standard RT (p=0.015.Conclusion: These data provide proof of principle that suboptimal radiation dose distributions are associated with significant acute and late lung and esophageal toxicity that may result in hospitalization or even premature mortality. Strict attention to contralateral lung and esophageal dose volume constraints are feasible in the community hospital setting without sacrificing disease control. 488. Spacesuit Water Membrane Evaporator; An Enhanced Evaporative Cooling System for the Advanced Extravehicular Mobility Unit Portable Life Support System Science.gov (United States) Bue, Grant C.; Makinen, Janice V.; Miller, Sean; Campbell, Colin; Lynch, Bill; Vogel, Matt; Craft, Jesse; Wilkes, Robert; Kuehnel, Eric 2014-01-01 Development of the Advanced Extravehicular Mobility Unit (AEMU) portable life support subsystem (PLSS) is currently under way at NASA Johnson Space Center. The AEMU PLSS features a new evaporative cooling system, the Generation 4 Spacesuit Water Membrane Evaporator (Gen4 SWME). The SWME offers several advantages when compared with prior crewmember cooling technologies, including the ability to reject heat at increased atmospheric pressures, reduced loop infrastructure, and higher tolerance to fouling. Like its predecessors, Gen4 SWME provides nominal crew member and electronics cooling by flowing water through porous hollow fibers. Water vapor escapes through the hollow fiber pores, thereby cooling the liquid water that remains inside of the fibers. This cooled water is then recirculated to remove heat from the crew member and PLSS electronics. Test results from the backup cooling system which is based on a similar design and the subject of a companion paper, suggested that further volume reductions could be achieved through fiber density optimization. Testing was performed with four fiber bundle configurations ranging from 35,850 fibers to 41,180 fibers. The optimal configuration reduced the Gen4 SWME envelope volume by 15% from that of Gen3 while dramatically increasing the performance margin of the system. A rectangular block design was chosen over the Gen3 cylindrical design, for packaging configurations within the AEMU PLSS envelope. Several important innovations were made in the redesign of the backpressure valve which is used to control evaporation. A twin-port pivot concept was selected from among three low profile valve designs for superior robustness, control and packaging. The backpressure valve motor, the thermal control valve, delta pressure sensors and temperature sensors were incorporated into the manifold endcaps, also for packaging considerations. Flight-like materials including a titanium housing were used for all components. Performance testing 489. Correlation of Simulation Examination to Written Test Scores for Advanced Cardiac Life Support Testing: Prospective Cohort Study Directory of Open Access Journals (Sweden) Suzanne L. Strom 2015-11-01 Full Text Available Introduction: Traditional Advanced Cardiac Life Support (ACLS courses are evaluated using written multiple-choice tests. High-fidelity simulation is a widely used adjunct to didactic content, and has been used in many specialties as a training resource as well as an evaluative tool. There are no data to our knowledge that compare simulation examination scores with written test scores for ACLS courses. Objective: To compare and correlate a novel high-fidelity simulation-based evaluation with traditional written testing for senior medical students in an ACLS course. Methods: We performed a prospective cohort study to determine the correlation between simulationbased evaluation and traditional written testing in a medical school simulation center. Students were tested on a standard acute coronary syndrome/ventricular fibrillation cardiac arrest scenario. Our primary outcome measure was correlation of exam results for 19 volunteer fourth-year medical students after a 32-hour ACLS-based Resuscitation Boot Camp course. Our secondary outcome was comparison of simulation-based vs. written outcome scores. Results: The composite average score on the written evaluation was substantially higher (93.6% than the simulation performance score (81.3%, absolute difference 12.3%, 95% CI [10.6-14.0%], p<0.00005. We found a statistically significant moderate correlation between simulation scenario test performance and traditional written testing (Pearson r=0.48, p=0.04, validating the new evaluation method. Conclusion: Simulation-based ACLS evaluation methods correlate with traditional written testing and demonstrate resuscitation knowledge and skills. Simulation may be a more discriminating and challenging testing method, as students scored higher on written evaluation methods compared to simulation. 490. Effectiveness of beneficial plant-microbe interactions under hypobaric and hypoxic conditions in an advanced life support system Science.gov (United States) MacIntyre, Olathe; Stasiak, Michael; Cottenie, Karl; Trevors, Jack; Dixon, Mike An assembled microbial community in the hydroponics solution of an advanced life support system may improve plant performance and productivity in three ways: (1) exclusion of plant pathogens from the initial community, (2) resistance to infection, and (3) plant-growth promotion. However, the plant production area is likely to have a hypobaric (low pressure) and hypoxic (low oxygen) atmosphere to reduce structural mass and atmosphere leakage, and these conditions may alter plant-microbe interactions. Plant performance and productivity of radish (Raphanus sativus L. cv. Cherry Bomb II) grown under hypobaric and hypoxic conditions were investigated at the University of Guelph's Controlled Environment Systems Research Facility. Changes in the microbial communities that routinely colonized the re-circulated nutrient solution, roots, and leaves of radishes in these experiments were quantified in terms of similarity in community composition, abundance of bacteria, and community diversity before and after exposure to hypobaric and hypoxic conditions relative to communities maintained at ambient growth conditions. The microbial succession was affected by extreme hypoxia (2 kPa oxygen partial pressure) while hypobaria as low as 10 kPa total pressure had little effect on microbial ecology. There were no correlations found between the physiological profile of these unintentional microbial communities and radish growth. The effects of hypobaric and hypoxic conditions on specific plant-microbe interactions need to be determined before beneficial gnotobiotic communities can be developed for use in space. The bacterial strains Tal 629 of Bradyrhizobium japonicum and WCS417 of Pseudomonas fluorescens, and the plant pathogen Fusarium oxysporum f. sp. raphani will be used in future experiments. B. japonicum Tal 629 promotes radish growth in hydroponics systems and P. fluorescens WCS417 induces systemic resistance to fusarium wilt (F. oxysporum f. sp. raphani) in radish under ambient 491. Decay in chest compression quality due to fatigue is rare during prolonged advanced life support in a manikin model Directory of Open Access Journals (Sweden) Bjørshol Conrad A 2011-08-01 Full Text Available Abstract Background The aim of this study was to measure chest compression decay during simulated advanced life support (ALS in a cardiac arrest manikin model. Methods 19 paramedic teams, each consisting of three paramedics, performed ALS for 12 minutes with the same paramedic providing all chest compressions. The patient was a resuscitation manikin found in ventricular fibrillation (VF. The first shock terminated the VF and the patient remained in pulseless electrical activity (PEA throughout the scenario. Average chest compression depth and rate was measured each minute for 12 minutes and divided into three groups based on chest compression quality; good (compression depth ≠¥ 40 mm, compression rate 100-120/minute for each minute of CPR, bad (initial compression depth 120/minute or decay (change from good to bad during the 12 minutes. Changes in no-flow ratio (NFR, defined as the time without chest compressions divided by the total time of the ALS scenario over time was also measured. Results Based on compression depth, 5 (26%, 9 (47% and 5 (26% were good, bad and with decay, respectively. Only one paramedic experienced decay within the first two minutes. Based on compression rate, 6 (32%, 6 (32% and 7 (37% were good, bad and with decay, respectively. NFR was 22% in both the 1-3 and 4-6 minute periods, respectively, but decreased to 14% in the 7-9 minute period (P = 0.002 and to 10% in the 10-12 minute period (P Conclusions In this simulated cardiac arrest manikin study, only half of the providers achieved guideline recommended compression depth during prolonged ALS. Large inter-individual differences in chest compression quality were already present from the initiation of CPR. Chest compression decay and thereby fatigue within the first two minutes was rare. 492. [Impact of the integral allergological treatment on quality of life of patients with allergic rhinitis at the University Hospital of Puebla]. Science.gov (United States) Cisneros DÃaz, Gregoria LucÃa; López GarcÃa, AÃda Inés; Paz MartÃnez, David; Galindo GarcÃa, José Arturo; Papaqui Tapia, Sergio; Borboa Olivares, Lilia Margarita; Arana Muñoz, Oswaldo; Olmedo Atenco, VÃctor 2006-01-01 In order to determine the impact of allergic rhinitis on the quality of life of the patients, standardized and validated questionnaires have been developed. The quality of life is the perception of the patient of the functional effects of his illness and its therapeutics consequences. To determine the modification of index the quality of life on the patients with allergic rhinitis attended at the external consultation of the service of allergy and clinical immunology of the Hospital Universitario de Puebla when they were submitted to integral allergologic treatment. It was carried out a longitudinal, prospective, experimental and prolective study in patients of both sexes, older than 18 years with diagnosis of allergic rhinitis, a validated and standardized questionnaire was applied to assess the quality of life index every 14 days during 6 months. It was measured severity degree at the beginning and the end of the study. It was assessed the sample size considering a reasonable size of the effect 1 and a variability of 0.8 for usual techniques. The severity degree was compared with RIDIT analysis and the mean with variance, a value of p smaller than 0.05 was considered significant. Sixteen patients were included, 75% were women. The average age was 34.2 years old. When the severity degrees were compared it was an average RIDIT of 0.014 with a "z" of -5.0 that implicated a value of p < 0.001. The comparison among the initial quality of life and the subsequently visits mean was significantly different since third visit. The integral allergologic treatment modifies the quality of life and the severity degree in the patients with allergic rhinitis. 493. Breast cancer quality of life evaluation in Mexican Women at La Raza Hospital, Mexico City: A preliminary approach OpenAIRE 2008-01-01 Jacobo Alejandro Gómez-Rico1, Marina Altagracia-MartÃnez1, Jaime Kravzov-Jinich1, Rosario Cárdenas-Elizalde1, Juan Carlos Hinojosa-Cruz2, Consuelo RubioPoo31Departments of Biological Systems and Healthcare, Biological and Health Sciences Division (DCBS), Universidad Autónoma Metropolitana–Xochimilco (UAM-X), Xochimilco, Mexico; 2La Raza Hospital of the Mexican Social Security Institute (IMSS), Mexico City, Mexico; 3Universidad Nacional Au... 494. Palliative care consultation services in hospitals in the Netherlands: The design of the COMPASS study NARCIS (Netherlands) A. Brinkman-Stoppelenburg (Arianne); S. Polinder (Suzanne); Y. Vergouwe (Yvonne); A. van der Heide (Agnes) 2015-01-01 textabstractBackground: Patients with an advanced incurable disease are often hospitalised for some time during the last phase of life. Care in hospitals is generally focussed at curing disease and prolonging life and may therefore not in all cases adequately address the needs of such patients. We p 495. Academic Hospitality Science.gov (United States) Phipps, Alison; Barnett, Ronald 2007-01-01 Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with… 496. A retrospective review on successful management of Penicillium marneffei infections in patients with advanced HIV in Hospital Sungai Buloh. Science.gov (United States) Nor-Hayati, S; Sahlawati, M; Suresh-Kumar, C; Lee, K C Christopher 2012-02-01 Penicillium marneffei is a dimorphic fungus which commonly causes a life threatening systemic fungal infection in an immunocompromised host. It has been recognized as an AIDS defining illness in Malaysia since the beginning of the HIV pandemic. The presence of various non specific clinical presentations, especially the characteristic umbilicated papular rashes with central necrosis which lead to significant ill health in immunocompromised patients should alarm clinicians to the possibility of Penicillium marneffei infection and prompt investigations accordingly. Simple investigations like blood culture and fungal staining of the skin scrapping can confirm the diagnosis in the majority of cases. Early treatment with appropriate systemic antifungal for a definite duration will significantly decrease the mortality rate from penicilliosis. 497. Life review in advanced age: qualitative research on the 'start in life' of 90-year-olds in the Lothian Birth Cohort 1921. Science.gov (United States) Lapsley, Hilary; Pattie, Alison; Starr, John M; Deary, Ian J 2016-04-01 This research report presents findings on 'start in life' from a qualitative study of 90-year-olds from the Lothian Birth Cohort 1921. The study aimed to contextualise the LBC1921 cohort in time and place, describe cohort members' experiences of family and schooling and stimulate further inquiry into the relationships between 'start in life' and risk and resilience factors relating to longevity and healthy ageing. Scottish education and family life in the early 1930s are briefly described. Life review questionnaire: A qualitative Life Review Questionnaire was developed, requiring free-text handwritten responses. Its 'Start in Life' section focused on schooling and family support. Wave 4 of the Lothian Birth Cohort 1921 involved testing 129 members near to their 90(th) birthday. They reside largely in Edinburgh and its environs. The Life Review Questionnaire was administered to 126 participants, 54 % women. Qualitative analysis: Thematic analysis was the qualitative technique used to categorise, code and extract meaning from questionnaire text. Narratives were extracted from the data to present illustrative stories. Narratives of start in life gave contextual description. Thematic analysis showed LBC1921 members enjoying their schooling, highlighting teachers, academic achievement, school activities and school friendships. Personal qualities, family circumstances and aspects of schooling sometimes hindered educational performance. Family life was recalled mostly with warmth and parents were often portrayed as valuing education and supporting learning and development. Family adversity from poverty, parental illness and parental death was often mitigated by support from parents (or the remaining parent). Overall, most cohort members believed that they had got off to a good 'start in life'. This qualitative investigation of 'start in life' adds context and richness to quantitative investigations of the sizeable LBC1921 cohort, stimulating fresh insights and hypotheses 498. Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis. Science.gov (United States) Vellone, Ercole; Fida, Roberta; Ghezzi, Valerio; D'Agostino, Fabio; Biagioli, Valentina; Paturzo, Marco; Strömberg, Anna; Alvaro, Rosaria; Jaarsma, Tiny Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations. This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and χ test were used to examine the characteristics of each cluster. Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. The 4 clusters identified in this study and their associated 499. Effect of music intervention on quality of life in advanced cancer patients during chemotherapy%音ä¹å¹²é¢„对晚期肿瘤患者化疗期间生活质é‡çš„å½±å“ Institute of Scientific and Technical Information of China (English) æŽæ˜¥æ¢…; è°åŽå‡¤; åˆ˜è‰³åŽ 2011-01-01 Objective To explore the effect of music therapy on reducing chemotherapy toxicity, improving the quality of life of the patients with advanced cancer patients during chemotherapy.Methods According to psychological law characteristics of patients, we design a music system, including: morning nursing "A" song, analgesia "B", dine "C" song, sleep "D" song. 100 advanced cancer patients from the affiliated hospital of guangdong medical college, between June 2009 and June 2010, were enrolled in this study. They were randomly divided into two groups according to numerical table. The control group (50 patients) received routine nursing, while the experimental group (50 patients) received music therapy intervention during each chemotherapy process or break. The effects were evaluated from two aspects: the side effects of chemotherapy and the changes of blood-routine

after chemotherapy.Results The experimental group feel cheerfulness, tranquil at every time after chemotherapy and the degree of adverse reaction is light, than the control group, and there were significant differences between them (P.05), and the SANS scores were significantly different between the two groups(P.05);治疗åŽä¸ ¤ç»„SANS评分比较差异有统计å¦æ„义(P<0.05).结论 在患者化疗期间实施音ä¹å¹²é¢„å¯å‡è½»åŒ–疗副作用,ç¨³å®šæ‚£è€…è¡€è± ¡,å‡è½»æ‚£è€…心ç†æ惧,直接æ高患者生å˜è´¨é‡. 500. Development of a curriculum for advanced nurse practitioners working with older people with frailty in the acute hospital through a modified Delphi process. Science.gov (United States) Goldberg, Sarah Elizabeth; Cooper, Jo; Blundell, Adrian; Gordon, Adam Lee; Masud, Tahir; Moorchilot, Ravisankar 2016-01-01 advanced nurse practitioners (ANPs) are experienced nurses who undertake some activities traditionally performed by medical staff. There are four pillars of advanced practice: advanced clinical skills, leadership, education and research. ANPs are starting to specialise in the management of older adults with frailty in the acute hospital. However, the role and competencies required for this have not been well defined. This study aimed to establish an expert consensus on the role description and essential competencies for ANPs working with older people with frailty to develop a curriculum. a literature review and workshops including multi-professional and lay representatives generated a role description and a list of 69 competencies. A modified Delphi process was then conducted with three rounds involving a panel of 31 experts including representatives from the RCN, BGS Education and Training Committee, BGS Senior Nurses and Practitioners Group, Chartered Society of Physiotherapy Older People Network, College of Occupational Therapists Older People Specialist Section and lay representatives. Consensus on the statements was established by 70% panel agreement. the role description reached 100% agreement within three rounds. Twenty-five essential competencies were agreed after Round 1, increasing to 43 after Round 2 and 49 after Round 3. this Delphi study has allowed, for the first time, a national panel of clinical experts and lay representatives to refine and agree a set of competencies for ANPs working with older people with frailty. It is the first step towards ensuring consistency in the training of ANPs in geriatric medicine. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: [email protected] « 21 22 23 24 25 » Some links on this page may take you to non-federal websites. Their policies may differ from this site. Website Policies/Important Links



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