Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study.

BACKGROUND: Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. METHODS: A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. RESULTS: We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). CONCLUSIONS: Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted.

Marco teórico y conceptual para la definición y evaluación de competencias del profesional de enfermería en el ámbito hospitalario. Parte I

El objetivo de este artículo es presentar el marco teórico y conceptual empleado en el desarrollo del proyecto COM VA© de definición y evaluación de competencias asistenciales y de gestión asistencial del profesional de enfermería en el ámbito hospitalario. El marco teórico recoge principalmente los trabajos de la Dra. Benner y de los profesores Dreyfus en relación con el modelo de adquisición de competencia que define 5 niveles de pericia, de aprendiz a experto. El marco conceptual explora los significados y las interrelaciones de los términos competencia, expertez, pericia, experiencia e inteligencia, entre otros. El artículo incluye también una revisión sobre los principales aspectos relacionados con los instrumentos y los métodos de evaluación de competencias.

La vida quotidiana : exploració d'un marc conceptual i d'una proposta d'indicadors

L'interès per la vida quotidiana ha crescut de manera paral•lela a la necessitat d'augmentar el coneixement racional sobre la realitat social. I, més específicament, si hem de fer cas al que diuen algunes especialistes, aquest interès neix, lligat a la clarificació del que s'entén per benestar. Tal com aquest breu estudi exploratori posa de manifest, la complexitat comença en la polisèmia que acompanya el concepte de vida quotidiana, afavoridora de no poques confusions. I, continua amb una de les dificultats més greus amb les que pot ensopegar el coneixement científic. L'interès per clarificar conceptualment la vida quotidiana, en aquesta ocasió, com en tantes d'altres, ha sorgit de la necessitat de conèixer millor per actuar de manera més acurada. Els objectius de l'informe han estat deutors d'aquesta orientació. En concret, han perseguit una doble fita. En primer lloc, han anat dirigits a aconseguir la clarificació i racionalització de la polisèmia conceptual esmentada. En segon lloc, els objectius de l'informe s'han dirigit a obtenir informació sobre els indicadors socials més adients per fer visible l'abast de la vida quotidiana. Això ha suposat la revisió d'una sèrie de bases de dades existents. L'interès d'aquesta revisió és la possibilitat de reconèixer l'existència d'una sèrie de dades objectives, resultatd'enquestes o d'altres tipus de recollida de dades. Els resultats d'aquesta part de l'informe es presenten, de manera ordenada, mostrant les característiques de les bases de dades revisades. I senyalant la informació que, a parer nostre,resulta més pertinent per a ser reutilitzada com a indicadors objectius capaços de mostrar l'àmbit i abast de la vida quotidiana. Aquesta informació es completa amb una sèrie de consideracions sobre aquest tipus d'indicadors socials i la conveniència d'utilitzar els indicadors de tipus subjectiu. I sobre laconveniència de dibuixar una prova pilot sobre uns possibles itineraris de vida quotidiana.

Developing a conceptual framework to analyse professionalisation in sport federations

Existing research on sport organisations is imprecise in the use of the concept 'professionalisation'. Furthermore, we do not know if analytical concepts of professionalisation correspond with the understanding in practice. This study explores the perceptions of practitioners and proposes a framework to analyse professionalisation in national sport federations. Expert interviews were conducted with six key people from Swiss national sport federations and then analysed these for characteristics of professionalisation using a hermeneutic approach. The characteristics were divided into three areas: (1) changed management philosophy, (2) functional differentiation and specialisation, and (3) application of management tools. However, professionalisation is primarily perceived to be a matter of 'professional' attitude that transforms into federation culture. The practitioners disclose an ambivalent view of professionalisation, e.g. business-like culture vs. voluntarism, for-profit vs. non-profit orientation, autonomy vs. control. A framework is developed that synthesises analytical concepts and practitioners' perceptions to support future comprehensive research into causes, forms and consequences of professionalisation in national sport federations.

Conceptual Interpretation of LOM and its Mapping to Common Sense Ontologies

Peer-reviewed

A conceptual model for grid learning services automatic composition

Peer-reviewed

Conceptual Design of Embedded Weather Display

The objective of this thesis work is to describe the Conceptual Design process of an embedded electronic display device. The work presents the following sub processes: definition of device specifications, introduction to the technological alternatives for system components and their comparison, comparative photometric measurements of selected display panels, and the design and building of a functional concept prototype. This work focuses mainly on electronics design, albeit the mechanical issues and fields of the software architecture that significantly affect the decisions are also discussed when necessary. The VESA Flat Panel Display Measurement (FPDM) 2.0 Standard was applied to the appropriate extent into photometric measurements. The results were analyzed against the requirement standards of a customer-specific display development project. An Active Matrix LCD was selected as the display of concept prototype, but also the excellent visual characteristics of Active Matrix OLED technology were noted. Should the reliability of the OLED products be significantly improved in the future, utilizing such products in the described application must be reconsidered.

O uso de pseudopotenciais e modelos HF/MP2/DFT na previsão de freqüências vibracionais em complexos metálicos

Four different pseudopotentials and three methodologies were employed in the calculation of the geometry and the frequencies of metal complexes like [M(NH3)2X2] [X=halogen, M=Zn, Cd], and [Hg(NH3)2]Cl2. The vibrational assignments were carefully checked and compared to the theoretically calculated ones. Graphical procedures were employed to estimate family errors and their average behavior. The calculated results show the SBK-X basis set with the best results for the geometries and calculated frequencies, for individual species and statistical results. Its use is recommend, mainly if the neighborhood atoms are described with similar pseudopotentials. Excellent results were also obtained with the Hay and Wadt pseudopotential.

Do general chemistry textbooks facilitate conceptual understanding?

Research in chemistry education has recognized the need for facilitating students' understanding of different concepts. In contrast, most general chemistry curricula and textbooks not only ignore the context in which science progresses but also emphasize rote learning and algorithmic strategies. A historical reconstruction of scientific progress shows that it inevitably leads to controversy and debate, which can arouse students' interest and thus facilitate understanding. The objective of this article is to review research related to the evaluation of general chemistry textbooks (based on history and philosophy of science, HPS) and suggest alternatives that can facilitate conceptual understanding.

El reposicionamiento: análisis conceptual y causal del fenómeno desde su origen hasta el (re)planteamiento actual

El present estudi té com a finalitat estudiar què és el reposicionament i quins són els factors que l’envolten. Pretén establir quines són les principals causes que condueixen a reposicionar una marca, així com també analitzar si el reposicionament és equivalent que quan va sorgir, o si pel contrari ha evolucionat, i com ho ha fet. Amb aquest estudi intentarem esbrinar com es reposicionen les marques en l’actualitat.

Aproximación conceptual a los sectores y ámbitos de intervención de la educación social

En este artículo, en primer lugar, se define Educación social y Pedagogía social y, a continuación, se desarrolla una aproximación a los sectores y los ámbitos de intervención de la educación social. Así, se describen diversas variables interdependientes que configuran los sectores de intervención y las áreas institucionales de la educación social, remarcándose el carácter complementario y los puntos de intersección existentes entre las mencionadas variables. A continuación, se describen los ámbitos específicos de intervención de la educación social que presentan carácter transversal, ya que afectan a diversos grupos de edad, a diferentes necesidades o problemáticas singulares y desde posiciones institucionales plurales. Finalmente, se apuntan unas breves reflexiones acerca de algunos nuevos posibles espacios de acción de la educación social que pueden tomar fuerza y singularidad a lo largo de las primeras décadas del nuevo milenio.

Caracterización de la reactividad intrínseca de los halobencenos en el modelo conceptual de la teoría de funcionales de la densidad (TFD)

The aim of this paper is to study the family of halobenzenes for characterizing their intrinsic reactivity and in this way to establish a rational order of the intrinsic reactivity of this family of molecules in the electrophilic aromatic substitution. This study was carried out in the framework of Density Functional Theory which provides a global and local index that can be used in the characterization of the reactivity. This index is related to some concept derivatives of experimental chemistry, being a good approach to the characterization of halobenzenes.

Synthesis, characterization, DFT and Td-dfT study of the [Fe(mnt)(L)(t-BuNC) 2] octahedral complex (L = phen, bipy)

FeBr2 has reacted with an equivalent of mnt2- (mnt = cis-1,2-dicyanoethylene-1,2-dithiolate) and the α-diimine L (L = 1,10'-phenantroline, 2,2'-bipyridine) in THF solution, and followed by adding of t-butyl-isocyanide to give [Fe(mnt)(L)(t-BuNC)2] neutral compound. The products were characterized by infrared, UV-visible and Mössbauer spectroscopy, besides thermogravimetric and conductivity data. The geometry in the equilibrium was calculated by the density functional theory and the electronic spectrum by the time-dependent. The experimental and theoretical results in good agreement have defined an octahedral geometry with two isocyanide neighbours. The π→π* intraligand electronic transition was not observed for cis-isomers in the near-IR spectral region.

Structural and reactivity analyses of 2-benzylamino-1,4-naphthoquinone by X-ray characterization, electrochemical measurements, and dft single-molecule calculations

This study represents an integrated approach towards understanding the electronic and structural aspects of 2-benzylamino-1,4-naphthalenedione, a representative 2-amino-napfthoquinone. To this end, theoretical calculations performed at the B3PW91/6-31+G(d) level of density functional theory, electrochemical and X-ray structural investigation were employed. Two intramolecular H-bonds and other two intermolecular H-bonds were observed, including non-classical interactions. Cyclic voltammogram (CV) and differential pulse voltammetry (DPV) show two pairs of peaks, being each one a monoelectronic process.

Combined experimental powder X-ray diffraction and DFT data to obtain the lowest energy molecular conformation of friedelin

Friedelin molecular conformers were obtained by Density Functional Theory (DFT) and by ab initio structure determination from powder X-ray diffraction. Their conformers with the five rings in chair-chair-chair-boat-boat, and with all rings in chair, are energy degenerated in gas-phase according to DFT results. The powder diffraction data reveals that rings A, B and C of friedelin are in chair, and rings D and E in boat-boat, conformation. The high correlation values among powder diffraction data, DFT and reported single-crystal data indicate that the use of conventional X-ray diffractometer can be applied in routine laboratory analysis in the absence of a single-crystal diffractometer.