A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

Online brands: Branding, possible worlds, and interactive grammars

This paper proposes to reflect from a semiotic perspective on the transformation that brands have undergone since the rise of the Internet. After a brief theoretical introduction to digital communication and the semiotics of brands, the case of the Google brand is analyzed by applying concepts of generative and interpretive semiotics. The paper holds that the iconic and linguistic enunciations are secondary with respect to interaction. In digital media interaction — the interactive experience that the Internet user lives — is a fundamental component of the hypermedia cocktail and occupies a central position in the brand building process. The article concludes with some of the questions and special characteristics raised by so-called eBranding.

Modelo de indicadores para evaluar los formatos digitales para la preservación de video

La preservación de los fondos audiovisuales en soporte analógico está amenazada por la degradación de las cintas magnéticas. La revisión de la literatura científica indica que este proceso de degradación no se puede evitar y que su solución pasa por la migración de los contenidos audiovisuales a soportes digitales. La complejidad técnica de los formatos de vídeo digital y la no existencia de formatos claros con finalidades de preservación hacen que sea difícil la elección del formato al cual migrar. Ante este panorama se propone la utilización de un modelo de indicadores que sirva para valorar las características de los formatos de vídeo digital de cara a su uso en la preservación de los fondos audiovisuales Abstract: The preservation of audiovisual content recorded on analogical media is threatened by the physical degradation of magnetic tape over time. A review of the literature shows that this degradation cannot be avoided and that the only solution consists of migrating audiovisual content to digital media. Choosing a digital format for this migration is difficult due to the technical complexity of video formats and to the lack of a specific format aimed at preservation. In this context, the article suggests the use of a model of indicators to evaluate the features of existing digital video formats for their potential use in audiovisual content preservation

Sistema d'adquisició de temperatures de 2 canals via R.F.

Poder mesurar i enregistrar diferents tipus de magnituds com pressió, força, temperatura etc. s’ha convertit en una necessitat per moltes aplicacions actuals. Aquestes magnituds poden tenir procedències molt diverses, tals com l’entorn, o poden ser generades per sistemes mecànics, elèctrics, etc. Per tal de poder adquirir aquestes magnituds, s’utilitzen els sistemes d’adquisició de dades. Aquests sistemes, prenen mostres analògiques del món real, i les transformen en dades digitals que poden ser manipulades per un sistema electrònic. Pràcticament qualsevol magnitud es pot mesurar utilitzant el sensor adient. Una magnitud molt utilitzada en sistemes d’adquisició de dades, és la temperatura. Els sistemes d’adquisició de temperatures estan molt generalitzats, i podem trobar-los com a sistemes, on l’objectiu és mostrar les dades adquirides, o podem trobar-los formant part de sistemes de control, aportant uns inputs necessaris per el seu correcte funcionament, garantir-ne l’estabilitat, seguretat etc. Aquest projecte, promogut per l’empresa Elausa, s’encarregarà d’adquirir, el senyal d’entrada de 2 Termoparells. Aquests mesuraran temperatures de circuits electrònics, que es trobaran dintre la càmera climàtica de Elausa, sotmesos a diferents condicions de temperatura, per tal de rebre l’homologació del circuit. El sistema haurà de poder mostrar les dades adquirides en temps real, i emmagatzemar-les en un PC que estarà ubicat en una oficina, situada a uns 30 m de distància de la sala on es farà el test. El sistema constarà d’un circuit electrònic que adquirirà, i condicionarà el senyal de sortida dels termoparells, per adaptar-lo a la tensió d’entrada d’un convertidor analògic digital, del microcontrolador integrat en aquesta placa. Seguidament aquesta informació, s’enviarà a través d’un mòdul transmissor de radiofreqüència, cap al PC on es visualitzaran les dades adquirides. Els objectius plantejats són els següents: - Dissenyar el circuit electrònic d’adquisició i condicionament del senyal. - Dissenyar, fabricar i muntar el circuit imprès de la placa d’adquisició. - Realitzar el programa de control del microcontrolador. - Realitzar el programa per presentar i desar les dades en un PC. - El sistema ha d’adquirir 2 temperatures, a través de Termoparells amb un rang d’entrada de -40ºC a +240ºC - S’ha de transmetre les dades via R.F. Els resultats del projecte han estat satisfactoris i s’han complert els objectius plantejats.

Morphodynamic analysis of cerebral aneurysm pulsation from time-resolved rotational angiography

This paper presents a technique to estimate and model patient-specific pulsatility of cerebral aneurysms over onecardiac cycle, using 3D rotational X-ray angiography (3DRA) acquisitions. Aneurysm pulsation is modeled as a time varying-spline tensor field representing the deformation applied to a reference volume image, thus producing the instantaneousmorphology at each time point in the cardiac cycle. The estimated deformation is obtained by matching multiple simulated projections of the deforming volume to their corresponding original projections. A weighting scheme is introduced to account for the relevance of each original projection for the selected time point. The wide coverage of the projections, together with the weighting scheme, ensures motion consistency in all directions. The technique has been tested on digital and physical phantoms that are realistic and clinically relevant in terms of geometry, pulsation and imaging conditions. Results from digital phantomexperiments demonstrate that the proposed technique is able to recover subvoxel pulsation with an error lower than 10% of the maximum pulsation in most cases. The experiments with the physical phantom allowed demonstrating the feasibility of pulsation estimation as well as identifying different pulsation regions under clinical conditions.

Corrigendum to "On randomized matching mechanisms" [Economic Theory 8(1996)377-381]

Ma (1996) studied the random order mechanism, a matching mechanism suggested by Roth and Vande Vate (1990) for marriage markets. By means of an example he showed that the random order mechanism does not always reach all stable matchings. Although Ma's (1996) result is true, we show that the probability distribution he presented - and therefore the proof of his Claim 2 - is not correct. The mistake in the calculations by Ma (1996) is due to the fact that even though the example looks very symmetric, some of the calculations are not as ''symmetric.''

Paths to stability for matching markets with couples

We study two-sided matching markets with couples and show that for a natural preference domain for couples, the domain of weakly responsive preferences, stable outcomes can always be reached by means of decentralized decision making. Starting from an arbitrary matching, we construct a path of matchings obtained from `satisfying' blocking coalitions that yields a stable matching. Hence, we establish a generalization of Roth and Vande Vate's (1990) result on path convergence to stability for decentralized singles markets. Furthermore, we show that when stable matchings exist, but preferences are not weakly responsive, for some initial matchings there may not exist any path obtained from `satisfying' blocking coalitions that yields a stable matching.

On group strategy-proof mechanisms for a many-to-one matching model

For the many-to-one matching model in which firms have substitutable and quota q-separable preferences over subsets of workers we show that the workers-optimal stable mechanism is group strategy-proof for the workers. In order to prove this result, we also show that under this domain of preferences (which contains the domain of responsive preferences of the college admissions problem) the workers-optimal stable matching is weakly Pareto optimal for the workers and the Blocking Lemma holds as well. We exhibit an example showing that none of these three results remain true if the preferences of firms are substitutable but not quota q-separable.

Testing low-altitude infrared digital photography from a mini-UAV to retrieve information for biological conservation

Satellite remote sensing imagery is used for forestry, conservation and environmental applications, but insufficient spatial resolution, and, in particular, unavailability of images at the precise timing required for a given application, often prevent achieving a fully operational stage. Airborne remote sensing has the advantage of custom-tuned sensors, resolution and timing, but its price prevents using it as a routine technique for the mentioned fields. Some Unmanned Aerial Vehicles might provide a “third way” solution as low-cost techniques for acquiring remotely sensed information, under close control of the end-user, albeit at the expense of lower quality instrumentation and instability. This report evaluates a light remote sensing system based on a remotely-controlled mini-UAV (ATMOS-3) equipped with a color infra-red camera (VEGCAM-1) designed and operated by CATUAV. We conducted a testing mission over a Mediterranean landscape dominated by an evergreen woodland of Aleppo pine (Pinus halepensis) and (Holm) oak (Quercus ilex) in the Montseny National Park (Catalonia, NE Spain). We took advantage of state-of-the-art ortho-rectified digital aerial imagery (acquired by the Institut Cartogràfic de Catalunya over the area during the previous year) and used it as quality reference. In particular, we paid attention to: 1) Operationality of flight and image acquisition according to a previously defined plan; 2) Radiometric and geometric quality of the images; and 3) Operational use of the images in the context of applications. We conclude that the system has achieved an operational stage regarding flight activities, although with meteorological limits set by wind speed and turbulence. Appropriate landing areas can be sometimes limiting also, but the system is able to land on small and relatively rough terrains such as patches of grassland or short matorral, and we have operated the UAV as far as 7 km from the control unit. Radiometric quality is sufficient for interactive analysis, but probably insufficient for automated processing. A forthcoming camera is supposed to greatly improve radiometric quality and consistency. Conventional GPS positioning through time synchronization provides coarse orientation of the images, with no roll information.

Embodied Autonomy in Digital Ecosystems: From Bio-Inspired Agents to Cognitive Systems

This paper proposes to promote autonomy in digital ecosystems so that it provides agents with information to improve the behavior of the digital ecosystem in terms of stability. This work proposes that, in digital ecosystems, autonomous agents can provide fundamental services and information. The final goal is to run the ecosystem, generate novel conditions and let agents exploit them. A set of evaluation measures must be defined as well. We want to provide an outline of some global indicators, such as heterogeneity and diversity, and establish relationships between agent behavior and these global indicators to fully understand interactions between agents, and to understand the dependence and autonomy relations that emerge between the interacting agents. Individual variations, interaction dependencies, and environmental factors are determinants of autonomy that would be considered. The paper concludes with a discussion of situations when autonomy is a milestone

Standardizing admission and discharge processes to improve patient flow: A cross sectional study

Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00 am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann–Whitney test for non-normal continuous variables. Results: The median patients’ global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p<0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p<0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p<0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00 am was 5 patients in 2007 and 3 patients in 2009 (p<0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.

Standardizing admission and discharge processes to improve patient flow: A cross sectional study

Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00¿am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann¿Whitney test for non-normal continuous variables. Results:The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p<0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p<0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p<0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00¿am was 5 patients in 2007 and 3 patients in 2009 (p<0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.

Patient with hepatocellular carcinoma related to prior acute arsenic intoxication and occult HBV: epidemiological, clinical and therapeutic results after 14 years of follow-up

Little is known about the long-term survivors of acute arsenic intoxication. We present here a clinical case report of a man with chronic hepatitis B virus (HBV) infection who developed hepatocellular carcinoma four years after acute arsenic poisoning. HBsAg was detected in serum in 1990 when he voluntarily donated blood. In 1991, the patient suffered from severe psychological depression that led him to attempt suicide by massive ingestion of an arsenic-containing rodenticide. He survived with polyneuropathy and paralysis of the lower limbs, and has been wheelchair-bound since then. During participation in a follow-up study conducted among HBV carriers, abdominal ultrasound detected a two-centimeter liver mass consistent with hepatocellular carcinoma. The tumor was confirmed by computed tomography (CT) and magnetic resonance image (MRI). Because of his significant comorbidity, the patient received palliative treatment with transarterial lipiodol chemoembolization (TACE) on three occasions (1996, 1997 and 1999). At his most recent visit in May 2005, the patient was asymptomatic, liver enzymes were normal and the tumor was in remission on ultrasound.

Beyond the Net Generation debate: A comparison between digital learners in face-to-face and virtual universities

This paper is based on the hypothesis that the use of technology to support learning is not related to whether a student belongs to the Net Generation, but that it is mainly influenced by the teaching model. The study compares behaviour and preferences towards ICT use in two groups of university students: face-to-face students and online students. A questionnaire was applied to asample of students from five universities with different characteristics (one offers online education and four offer face-to-face education with LMS teaching support).