Frequent users of the emergency department in a universal health coverage system : a randomized controlled trial of a case-management intervention

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system. The participants' QoL was evaluated by a study nurse using the WHOQOL-BREF five times during the study (at baseline, and at 2, 5.5, 9, and 12 months). Four of the six WHOQOL dimensions of QoL were retained here: physical health, psychological health, social relationship, and environment, with scores ranging from 0 (low QoL) to 100 (high QoL). A linear, mixed-effects model with participants as a random effect was run to analyze the change in QoL over time. The effects of time, participants' group, and the interaction between time and group were tested. These effects were controlled for sociodemographic characteristics and health-related variables (i.e., age, gender, education, citizenship, marital status, type of financial resources, proficiency in French, somatic and mental health problems, and behaviors at risk).

Code Generator for Key Management Protocols - Design and Implementation

Key management has a fundamental role in secure communications. Designing and testing of key management protocols is tricky. These protocols must work flawlessly despite of any abuse. The main objective of this work was to design and implement a tool that helps to specify the protocol and makes it possible to test the protocol while it is still under development. This tool generates compile-ready java code from a key management protocol model. A modelling method for these protocols, which uses Unified Modeling Language (UML) was also developed. The protocol is modelled, exported as an XMI and read by the code generator tool. The code generator generates java code that is immediately executable with a test software after compilation.

When Langmuir is too simple: H2 dissociation on Pd(111) at high coverage

Recent experiments of H2 adsorption on Pd(111) [T. Mitsui et al., Nature (London) 422, 705 (2003)] have questioned the classical Langmuir picture of second order adsorption kinetics at high surface coverage requiring pairs of empty sites for the dissociative chemisorption. Experiments find that at least three empty sites are needed. Through density functional theory, we find that H2 dissociation is favored on ensembles of sites that involve a Pd atom with no direct interaction with adsorbed hydrogen. Such active sites are formed by aggregation of at least 3 H-free sites revealing the complex structure of the "active sites."

Who's fault is it ? : An analysis of the press coverage of football betting scandals in France and the United Kingdom

Sport betting is a lucrative business for bookmakers, for the lucky (or wise) punters, but also for governments and for sport. While not new or even recent, the deviances linked to sport betting, primarily match-fixing, have gained increased media exposure in the past decade. This exploratory study is a qualitative content analysis of the press coverage of sport betting-related deviances in football in two countries (UK and France), using in each case two leading national publications over a period of five years. Data analysis indicates a mounting coverage of sport betting scandals, with teams, players and criminals increasingly framed as culprits, while authorities and federations primarily assume a positive role. As for the origin of sport betting deviances, French newspapers tend to blame the system (in an abstract way); British newspapers, in contrast, focus more on individual weaknesses, notably greed. This article contributed to the growing body of literature on the importance of these deviances and on the way they are perceived by sport organizations, legislators and the public at large.

A survey on coverage path planning for robotics

Coverage Path Planning (CPP) is the task of determining a path that passes over all points of an area or volume of interest while avoiding obstacles. This task is integral to many robotic applications, such as vacuum cleaning robots, painter robots, autonomous underwater vehicles creating image mosaics, demining robots, lawn mowers, automated harvesters, window cleaners and inspection of complex structures, just to name a few. A considerable body of research has addressed the CPP problem. However, no updated surveys on CPP reflecting recent advances in the field have been presented in the past ten years. In this paper, we present a review of the most successful CPP methods, focusing on the achievements made in the past decade. Furthermore, we discuss reported field applications of the described CPP methods. This work aims to become a starting point for researchers who are initiating their endeavors in CPP. Likewise, this work aims to present a comprehensive review of the recent breakthroughs in the field, providing links to the most interesting and successful works

Transforming Maritime Safety Culture. Evaluation of the impacts of the ISM Code on maritime safety culture in Finland

The purpose of the METKU Project (Development of Maritime Safety Culture) is to study how the ISM Code has influenced the safety culture in the maritime industry. This literature review is written as a part of the Work Package 2 which is conducted by the University of Turku, Centre for Maritime Studies. The maritime traffic is rapidly growing in the Baltic Sea which leads to a growing risk of maritime accidents. Particularly in the Gulf of Finland, the high volume of traffic causes a high risk of maritime accidents. The growing risks give us good reasons for implementing the research project concerning maritime safety and the effectiveness of the safety measures, such as the safety management systems. In order to reduce maritime safety risks, the safety management systems should be further developed. The METKU Project has been launched to examine the improvements which can be done to the safety management systems. Human errors are considered as the most important reason for maritime accidents. The international safety management code (the ISM Code) has been established to cut down the occurrence of human errors by creating a safety-oriented organizational culture for the maritime industry. The ISM Code requires that a company should provide safe practices in ship operation and a safe working environment and establish safeguards against all identified risk. The fundamental idea of the ISM Code is that companies should continuously improve safety. The commitment of the top management is essential for implementing a safety-oriented culture in a company. The ISM Code has brought a significant contribution to the progress of maritime safety in recent years. Shipping companies and ships’ crews are more environmentally friendly and more safety-oriented than 12 years ago. This has been showed by several studies which have been analysed for this literature research. Nevertheless, the direct effect and influence of the ISM Code on maritime safety could not be isolated very well. No quantitative measurement (statistics/hard data) could be found in order to present the impacts of the ISM Code on maritime safety. In this study it has been discovered that safety culture has emerged and it is developing in the maritime industry. Even though the roots of the safety culture have been established there are still serious barriers to the breakthrough of the safety management. These barriers could be envisaged as cultural factors preventing the safety process. Even though the ISM Code has been effective over a decade, the old-established behaviour which is based on the old day’s maritime culture still occurs. In the next phase of this research project, these cultural factors shall be analysed in regard to the present safety culture of the maritime industry in Finland.

Calculation of radio electrical coverage in Medium-Wave Frequencies

The aim of this project is to accomplish an application software based on Matlab to calculate the radioelectrical coverage by surface wave of broadcast radiostations in the band of Medium Wave (WM) all around the world. Also, given the location of a transmitting and a receiving station, the software should be able to calculate the electric field that the receiver should receive at that specific site. In case of several transmitters, the program should search for the existence of Inter-Symbol Interference, and calculate the field strenght accordingly. The application should ask for the configuration parameters of the transmitter radiostation within a Graphical User Interface (GUI), and bring back the resulting coverage above a map of the area under study. For the development of this project, it has been used several conductivity databases of different countries, and a high-resolution elevation database (GLOBE). Also, to calculate the field strenght due to groundwave propagation, it has been used ITU GRWAVE program, which must be integrated into a Matlab interface to be used by the application developed.

Modelling of the PWR PACTEL vertical steam generator with the TRACE code

The behavior of the nuclear power plants must be known in all operational situations. Thermal hydraulics computer applications are used to simulate the behavior of the plants. The computer applications must be validated before they can be used reliably. The simulation results are compared against the experimental results. In this thesis a model of the PWR PACTEL steam generator was prepared with the TRAC/RELAP Advanced Computational Engine computer application. The simulation results can be compared against the results of the Advanced Process Simulator analysis software in future. Development of the model of the PWR PACTEL vertical steam generator is introduced in this thesis. Loss of feedwater transient simulation examples were carried out with the model.

Efficiency of the ISM Code in Finnish Shipping Companies

Due to increasing waterborne transportation in the Gulf of Finland, the risk of a hazardous accident increases and therefore manifold preventive actions are needed. As a main legislative authority in the maritime community, The International Maritime Organization (IMO) has set down plenary laws and recommendations which are e.g., utilised in the safe operations in ships and pollution prevention. One of these compulsory requirements, the ISM Code, requires proactive attitude both from the top management and operational workers in the shipping companies. In this study, a crosssectional approach was taken to analyse whether the ISM Code has actively enhanced maritime safety in the Gulf of Finland. The analysis included; 1) performance of the ISM Code in Finnish shipping companies, 2) statistical measurements of maritime safety, 3) influence of corporate top management to the safety culture and 4) comparing safety management practices in shipping companies and port operations of Finnish maritime and port authorities. The main results found were that maritime safety culture has developed in the right direction after the launch of the ISM Code in the 1990´s. However, this study does not exclusively prove that the improvements are the consequence of the ISM Code. Accident prone ships can be recognized due to their behaviour and there is a lesson to learn from the safety culture of some high standard safety disciplines such as, air traffic. In addition, the reporting of accidents and nearmisses should be more widely used in shipping industry. In conclusion, there is still much to be improved in the maritime safety culture of the Finnish Shipping industry, e.g., a “no blame culture” needs to be adopted.

Soil water evaporation under densities of coverage with vegetable residue

This study was conducted at the Agronomic Institute of Paraná (IAPAR) in Londrina, State of Paraná (PR), Brazil (latitude 23º18'S, longitude 51º09'W and average altitude of 585 m). The local climate, according to the classification of Köeppen, is Cfa type, i.e., humid subtropical climate, with rain in all seasons and can occur dry seasons during the winter. It was determined soil evaporation (E) under different coverage densities with residue from the wheat crop. The treatments were installed in weighting lysimeters of 2.66 m² and 1.3 m deep, which allows to determine E by the mass difference with measuring precision of 0.1mm at one hour intervals. Treatments consisted of 0; 2.5; 5 and 10 t ha-1 of wheat crop residues, placed evenly over each lysimeter. In the first cycle (September 22nd to October 20th, 2008), the reduction of E, as compared to a bare soil, was 4; 15 and 24%, while in the second cycle (December 1st to 30th, 2008), the reduction was of 15; 22 and 25%, respectively, for the treatments of 2.5; 5 and 10 t ha-1.