Perinatal care at the limit of viability between 22 and 26 completed weeks of gestation in Switzerland. 2011 revision of the Swiss recommendations

Perinatal care of pregnant women at high risk for preterm delivery and of preterm infants born at the limit of viability (22-26 completed weeks of gestation) requires a multidisciplinary approach by an experienced perinatal team. Limited precision in the determination of both gestational age and foetal weight, as well as biological variability may significantly affect the course of action chosen in individual cases. The decisions that must be taken with the pregnant women and on behalf of the preterm infant in this context are complex and have far-reaching consequences. When counselling pregnant women and their partners, neonatologists and obstetricians should provide them with comprehensive information in a sensitive and supportive way to build a basis of trust. The decisions are developed in a continuing dialogue between all parties involved (physicians, midwives, nursing staff and parents) with the principal aim to find solutions that are in the infant's and pregnant woman's best interest. Knowledge of current gestational age-specific mortality and morbidity rates and how they are modified by prenatally known prognostic factors (estimated foetal weight, sex, exposure or nonexposure to antenatal corticosteroids, single or multiple births) as well as the application of accepted ethical principles form the basis for responsible decision-making. Communication between all parties involved plays a central role. The members of the interdisciplinary working group suggest that the care of preterm infants with a gestational age between 22 0/7 and 23 6/7 weeks should generally be limited to palliative care. Obstetric interventions for foetal indications such as Caesarean section delivery are usually not indicated. In selected cases, for example, after 23 weeks of pregnancy have been completed and several of the above mentioned prenatally known prognostic factors are favourable or well informed parents insist on the initiation of life-sustaining therapies, active obstetric interventions for foetal indications and provisional intensive care of the neonate may be reasonable. In preterm infants with a gestational age between 24 0/7 and 24 6/7 weeks, it can be difficult to determine whether the burden of obstetric interventions and neonatal intensive care is justified given the limited chances of success of such a therapy. In such cases, the individual constellation of prenatally known factors which impact on prognosis can be helpful in the decision making process with the parents. In preterm infants with a gestational age between 25 0/7 and 25 6/7 weeks, foetal surveillance, obstetric interventions for foetal indications and neonatal intensive care measures are generally indicated. However, if several prenatally known prognostic factors are unfavourable and the parents agree, primary non-intervention and neonatal palliative care can be considered. All pregnant women with threatening preterm delivery or premature rupture of membranes at the limit of viability must be transferred to a perinatal centre with a level III neonatal intensive care unit no later than 23 0/7 weeks of gestation, unless emergency delivery is indicated. An experienced neonatology team should be involved in all deliveries that take place after 23 0/7 weeks of gestation to help to decide together with the parents if the initiation of intensive care measures appears to be appropriate or if preference should be given to palliative care (i.e., primary non-intervention). In doubtful situations, it can be reasonable to initiate intensive care and to admit the preterm infant to a neonatal intensive care unit (i.e., provisional intensive care). The infant's clinical evolution and additional discussions with the parents will help to clarify whether the life-sustaining therapies should be continued or withdrawn. Life support is continued as long as there is reasonable hope for survival and the infant's burden of intensive care is acceptable. If, on the other hand, the health car...

Design and implementation of a 3D computer game controller using inertial MEMS sensors

Though 3D computer graphics has seen tremendous advancement in the past two decades, most available mechanisms for computer interaction in 3D are high cost and targeted for industry and virtual reality applications. Recent advances in Micro-Electro-Mechanical-System (MEMS) devices have brought forth a variety of new low-cost, low-power, miniature sensors with high accuracy, which are well suited for hand-held devices. In this work a novel design for a 3D computer game controller using inertial sensors is proposed, and a prototype device based on this design is implemented. The design incorporates MEMS accelerometers and gyroscopes from Analog Devices to measure the three components of the acceleration and angular velocity. From these sensor readings, the position and orientation of the hand-held compartment can be calculated using numerical methods. The implemented prototype is utilizes a USB 2.0 compliant interface for power and communication with the host system. A Microchip dsPIC microcontroller is used in the design. This microcontroller integrates the analog to digital converters, the program memory flash, as well as the core processor, on a single integrated circuit. A PC running Microsoft Windows operating system is used as the host machine. Prototype firmware for the microcontroller is developed and tested to establish the communication between the design and the host, and perform the data acquisition and initial filtering of the sensor data. A PC front-end application with a graphical interface is developed to communicate with the device, and allow real-time visualization of the acquired data.

Integrierte Sicherheitsmerkmale als Schutz vor Produktpiraterie im Maschinen- und Anlagenbau

Die Bedrohung durch Produktpiraterie wächst ständig, besonders der deutsche Maschinen- und Anlagenbau ist mehr und mehr davon betroffen. Um Komponenten und Ersatzteile zu schützen, wurde ein technisches Konzept zur Abwehr von Produktpiraterie entwickelt. In diesem System werden Teile mit kopiersicheren Echtheitsmerkmalen gekennzeichnet, welche an diversen Identifikations- und Prüfpunkten entlang der Supply-Chain und besonders beim Einsatz in der Maschine ausgelesen und geprüft werden. Die Prüfergebnisse werden in einer zentralen Datenbank gespeichert, um neue Services zu ermöglichen und die Kommunikation zwischen Hersteller und Kunde zu erleichtern.

Social skills as predictors of communication, performance and quality of collaboration in project-based learning

The assumption that social skills are necessary ingredients of collaborative learning is well established but rarely empirically tested. In addition, most theories on collaborative learning focus on social skills only at the personal level, while the social skill configurations within a learning group might be of equal importance. Using the integrative framework, this study investigates which social skills at the personal level and at the group level are predictive of task-related e-mail communication, satisfaction with performance and perceived quality of collaboration. Data collection took place in a technology-enhanced long-term project-based learning setting for pre-service teachers. For data collection, two questionnaires were used, one at the beginning and one at the end of the learning cycle which lasted 3 months. During the project phase, the e-mail communication between group members was captured as well. The investigation of 60 project groups (N = 155 for the questionnaires; group size: two or three students) and 33 groups for the e-mail communication (N = 83) revealed that personal social skills played only a minor role compared to group level configurations of social skills in predicting satisfaction with performance, perceived quality of collaboration and communication behaviour. Members from groups that showed a high and/or homogeneous configuration of specific social skills (e.g., cooperation/compromising, leadership) usually were more satisfied and saw their group as more efficient than members from groups with a low and/or heterogeneous configuration of skills.

Towards Information-Centric Wireless Multi-hop Communication

Information-centric networking (ICN) addresses drawbacks of the Internet protocol, namely scalability and security. ICN is a promising approach for wireless communication because it enables seamless mobile communication, where intermediate or source nodes may change, as well as quick recovery from collisions. In this work, we study wireless multi-hop communication in Content-Centric Networking (CCN), which is a popular ICN architecture. We propose to use two broadcast faces that can be used in alternating order along the path to support multi-hop communication between any nodes in the network. By slightly modifying CCN, we can reduce the number of duplicate Interests by 93.4 % and the number of collisions by 61.4 %. Furthermore, we describe and evaluate different strategies for prefix registration based on overhearing. Strategies that configure prefixes only on one of the two faces can result in at least 27.3 % faster data transmissions.

Impact of a communication strategy on family satisfaction in the intensive care unit.

BACKGROUND Family satisfaction of critically ill patients has gained increased interest as important indicator to evaluate the quality of care in the intensive care unit (ICU). The family satisfaction in the ICU questionnaire (FS-ICU 24) is a well-established tool to assess satisfaction in such settings. We tested the hypothesis that an intervention, aiming at improved communication between health professionals and patients' next of kin in the ICU improves family satisfaction, as assessed by FS-ICU 24. METHODS Using a multicenter before-and-after study design, we evaluated medium-term effectiveness of VALUE, a recently proposed strategy aiming at improved communication. Satisfaction was assessed using the FS-ICU 24 questionnaire. Performance-importance plots were generated in order to identify items highly correlated with overall satisfaction but with low individual score. RESULTS A total of 163 completed family questionnaires in the pre-intervention and 118 in the post-intervention period were analyzed. Following the intervention, we observed: (1) a non-significant increase in family satisfaction summary score and sub-scores; (2) no decline in any individual family satisfaction item, and (3) improvement in items with high overall impact on satisfaction but quoted with low degree of satisfaction. CONCLUSION No significant improvement in family satisfaction of critically ill adult patients could be found after implementing the VALUE strategy. Whether these results are due to insufficient training of the new strategy or a missing effect of the strategy in our socio-economic environment remains to be shown.

PSHARE: Stata module to compute and graph percentile shares

-pshare- computes and graphs percentile shares from individual level data. Percentile shares are often used in inequality research to study the distribution of income or wealth. They are defined as differences between Lorenz ordinates of the outcome variable. Technically, the observations are sorted in increasing order of the outcome variable and the specified percentiles are computed from the running sum of the outcomes. Percentile shares are then computed as differences between percentiles, divided by total outcome. pshare requires moremata to be installed on the system; see ssc describe moremata.

Comparing Psychological Type and Explanatory Between Nursing Students and Clinical Faculty: A Pilot Study

Negotiation of complex collaboration and effective teamwork among health care providers is essential to patient safety and to quality of care. This study examined characteristics of nursing students and faculty influencing communication between them. Psychological type (Myers-Briggs Type Inventory (MBTI) (Myers, McCaulley, Quenk, & Hammer, 1998) and explanatory style (Attributional Style Questionnaire) (ASQ) (Peterson et al., 1982) were compared for participating first year baccalaureate nursing students (N=286), and clinical nursing faculty (N=59) from both two- and four-year nursing programs. Modal student psychological type was ESFJ; modal faculty psychological type was ISTJ. The two groups demonstrated significant differences in processing information, and making decisions and judgments. Students were slightly more optimistic than faculty. Psychological type and level of optimism did not appear to correlate. Data from this pilot study provide an initial framework on which to base further research that could enhance the quality of teamwork among healthcare providers.

A process evaluation of a health literacy intervention targeting pediatric providers' communication skills at the Texas Children's Health Plan

Background. Health literacy is an important determinant for quality health care, and affects communication between patients and physicians. Poor communication may result in negative effects in health. Improved communication between patients and physicians could positively affect health outcomes. Communication skills are teachable.^ Objectives. (1) to evaluate the process involved in the design and implementation of a health literacy intervention targeting pediatric providers’ communication skills at the Texas Children’s Health Plan in Houston, Texas; and (2) to describe lessons learned from this process that may be used in future attempts to address the issue of health literacy and health communication. ^ Design/methods. The process evaluation of the implementation of a health literacy strategy at the Texas Children’s Health Plan (TCHP) consisted of a critical analysis of all documents and minutes from meetings of the team of investigators. It also involved a secondary analysis of data collected between December 2006 and June 2007. Descriptive statistics, paired t-test and Wilcoxon-signed-rank test were employed in analyzing the data. This information was complemented with a limited review of existing literature on communication skills training programs. ^ Results. The design of the educational intervention followed recommendations from experts in the field of health literacy. The delivery of the intervention was possible and benefited from existing resources and logistics within the TCHP. Very few targeted providers participated in two offerings of the workshop (6.6% and 1.7% respectively). After the educational intervention, providers showed increased knowledge of health literacy facts and its effects in health (p=0.001); increased awareness of the low health literacy problem (p=0.003); increased expectations for change in practice (p=0.002), and intent to use health literacy strategies for communication immediately following the intervention (p=0.001). Low participation indicated the need for further investigation of barriers to, and means for successful implementation of programs aimed to improving health communication. ^ Conclusions. A short, focused intervention utilizing health literacy strategies for communication appeared effective in increasing knowledge and intentions for change in a small group of pediatric providers. ^

Doctor-patient communication in the medical interaction: Context, implications, and practice

Effective communication; whether from an interpersonal, mass media, or global perspective, is a critical component in public health. It is an essential conduit in increasing public awareness of available health resources, potential health hazards and related disease prevention strategies, and in delivering better health care. Within this context, available literature asserts doctor-patient communication as central to healthcare delivery. It has been shown to affect patient health outcomes, satisfaction with care, adherence to treatment recommendations, and even understanding of medical information. While research supports the essential imperative of interventions aimed at teaching doctors and patients the communication skills necessary for a successful and meaningful medical interaction, most interventions to date, focus on teaching these communication skills to doctors and seem to rely, largely, on mass media for providing patients with the information needed to increase communication efficacy. This study sought to fill a significant gap in the doctor-patient communication literature by reviewing the context of the doctor-patient exchange in the medical interaction, the implications of this exchange in resulting care of the patient, and the potential improvements to practice through interventions aimed at improving the communication exchange. Closing with an evaluation of a patient-centered communication intervention, the “How to Talk to Your Doctor” (HTTTYD) program that combines previously identified optimal strategies for improving communication between doctors and patients, this study examined the patients’ perspective of their potential as better communicators in the medical interaction. ^ Specific Aims, Hypotheses or Questions (Aim I) To examine the context of health communication within a public health framework and its relation to health care delivery. (Aim II) To review doctor-patient communication as a central focus within health care delivery and the resulting implications to patient care. (Aim III) To assess the utility of interventions to improve doctor-patient communication. Specifically, to evaluate the effectiveness of a patient-centered community education intervention, the “How to Talk to Your Doctor” (HTTTYD) program, aimed at improving patient communication efficacy.^

Standardization of data collection for the Lifetime Surveillance of Astronaut Health (LSAH)

Problems due to the lack of data standardization and data management have lead to work inefficiencies for the staff working with the vision data for the Lifetime Surveillance of Astronaut Health. Data has been collected over 50 years in a variety of manners and then entered into a software. The lack of communication between the electronic health record (EHR) form designer, epidemiologists, and optometrists has led to some level to confusion on the capability of the EHR system and how its forms can be designed to fit all the needs of the relevant parties. EHR form customizations or form redesigns were found to be critical for using NASA's EHR system in the most beneficial way for its patients, optometrists, and epidemiologists. In order to implement a protocol, data being collected was examined to find the differences in data collection methods. Changes were implemented through the establishment of a process improvement team (PIT). Based on the findings of the PIT, suggestions have been made to improve the current EHR system. If the suggestions are implemented correctly, this will not only improve efficiency of the staff at NASA and its contractors, but set guidelines for changes in other forms such as the vision exam forms. Because NASA is at the forefront of such research and health surveillance the impact of this management change could have a drastic improvement on the collection of and adaptability of the EHR. Accurate data collection from this 50+ year study is ongoing and is going to help current and future generations understand the implications of space flight on human health. It is imperative that the vast amount of information is documented correctly.^

Neogene calcareous nannofossils in the Caribbean and the eastern equatorial Pacific

Principal components analysis of nannofossil assemblages in five ODP sites in the Caribbean and the eastern equatorial Pacific was used to monitor Neogene surface water circulation changes. In 15.83-10.71 Ma, floral distributions clearly show the existence of the Circum-tropical Current between the Caribbean and the eastern equatorial Pacific and no surface water communication between the northern and southern Caribbean. In 10.71-9.36 Ma, the Circum-tropical Current weakened and the northward intra-Caribbean current had been initiated. Northern and southern Caribbean surface waters again became separated in 8.35-3.65 Ma and the Circum-tropical Current was regenerated. After 2.76 Ma, the northward intra-Caribbean current has completely been established and the Circum-tropical Current disappeared. This suggests that a barrier to the Circum-tropical Current had formed, indicating the final closure of the Isthmus of Panama.

Modelling of the TICS Catalyse : Realization of a project

An action of modelling of the Territorial Intelligence Community Systems or TICS began in 2009 at the end of the CaEnti project. It has several objectives: - Establish a set of documents understandable by computer specialists who are in charge of software developments, and by territorial intelligence specialists. - Lay the foundation of a vocabulary describing the main notions of TICS domain. - Ensure the evolution and sustainability of tools and systems, in a highly scalable research context. The definition of models representing the data manipulated by the tools of the suitcase Catalyse is not sufficient to describe in a complete way the TICS domain. We established a correspondence between this computer vocabulary and vocabulary related to the theme to allow communication between computer scientists and territorial intelligence specialists. Furthermore it is necessary to describe the roles of TICS. For that it is interesting to use other kinds of computing models. In this communication we present the modelling of TICS project with business process

Modelling of the TICS Catalyse : Realization of a project

An action of modelling of the Territorial Intelligence Community Systems or TICS began in 2009 at the end of the CaEnti project. It has several objectives: - Establish a set of documents understandable by computer specialists who are in charge of software developments, and by territorial intelligence specialists. - Lay the foundation of a vocabulary describing the main notions of TICS domain. - Ensure the evolution and sustainability of tools and systems, in a highly scalable research context. The definition of models representing the data manipulated by the tools of the suitcase Catalyse is not sufficient to describe in a complete way the TICS domain. We established a correspondence between this computer vocabulary and vocabulary related to the theme to allow communication between computer scientists and territorial intelligence specialists. Furthermore it is necessary to describe the roles of TICS. For that it is interesting to use other kinds of computing models. In this communication we present the modelling of TICS project with business process

Modelling of the TICS Catalyse : Realization of a project

An action of modelling of the Territorial Intelligence Community Systems or TICS began in 2009 at the end of the CaEnti project. It has several objectives: - Establish a set of documents understandable by computer specialists who are in charge of software developments, and by territorial intelligence specialists. - Lay the foundation of a vocabulary describing the main notions of TICS domain. - Ensure the evolution and sustainability of tools and systems, in a highly scalable research context. The definition of models representing the data manipulated by the tools of the suitcase Catalyse is not sufficient to describe in a complete way the TICS domain. We established a correspondence between this computer vocabulary and vocabulary related to the theme to allow communication between computer scientists and territorial intelligence specialists. Furthermore it is necessary to describe the roles of TICS. For that it is interesting to use other kinds of computing models. In this communication we present the modelling of TICS project with business process