Looking in the wrong place for healthcare improvements: a system dynamics study of an accident and emergency department

Accident and Emergency (A&E) units provide a route for patients requiring urgent admission to acute hospitals. Public concern over long waiting times for admissions motivated this study, whose aim is to explore the factors which contribute to such delays. The paper discusses the formulation and calibration of a system dynamics model of the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers; and the outputs of policy analysis runs of the model which vary a number of the key parameters. Two significant findings have policy implications. One is that while some delays to patients are unavoidable, reductions can be achieved by selective augmentation of resources within, and relating to, the A&E unit. The second is that reductions in bed numbers do not increase waiting times for emergency admissions, their effect instead being to increase sharply the number of cancellations of admissions for elective surgery. This suggests that basing A&E policy solely on any single criterion will merely succeed in transferring the effects of a resource deficit to a different patient group.

Parenting difficulties and postnatal depression: implications for primary healthcare assessment and intervention

Postnatal depression (PND) is associated with impairments in the mother–child relationship, and these impairments are themselves associated with adverse child outcomes. Thus, compared to the children of non-depressed mothers, children of mothers with PND are more likely to be insecurely attached, and to have externalising behaviour problems and poor cognitive development. Each of these three child outcomes is predicted by a particular pattern of difficulty in parenting: insecure attachment is related to maternal insensitivity, particularly in relation to infant distress and emotional vulnerability; externalising problems are particularly common in the context of hostile parenting; and poor cognitive development is related to parental difficulties in noticing infant signs of interest and supporting their engagement with the environment. This article sets out procedures for how parenting could be assessed in ways that are sensitive to the domain-specific associations between parenting and child outcome, while remaining sensitive to the child's developmental stage. This set of assessments requires field testing.

A cross layer protocol based on mac and routing protocols for healthcare applications using Wireless Sensor Networks

Using Wireless Sensor Networks (WSNs) in healthcare systems has had a lot of attention in recent years. In much of this research tasks like sensor data processing, health states decision making and emergency message sending are done by a remote server. Many patients with lots of sensor data consume a great deal of communication resources, bring a burden to the remote server and delay the decision time and notification time. A healthcare application for elderly people using WSN has been simulated in this paper. A WSN designed for the proposed healthcare application needs efficient MAC and routing protocols to provide a guarantee for the reliability of the data delivered from the patients to the medical centre. Based on these requirements, A cross layer based on the modified versions of APTEEN and GinMAC has been designed and implemented, with new features, such as a mobility module and routes discovery algorithms have been added. Simulation results show that the proposed cross layer based protocol can conserve energy for nodes and provide the required performance such as life time of the network, delay and reliability for the proposed healthcare application.

MAC protocols and mobility management module for healthcare applications using Wireless Sensor Networks

Using Wireless Sensor Networks (WSNs) in healthcare systems has had a lot of attention in recent years. In much of this research tasks like sensor data processing, health states decision making and emergency message sending are done by a remote server. Many patients with lots of sensor data consume a great deal of communication resources, bring a burden to the remote server and delay the decision time and notification time. A healthcare application for elderly people using WSN has been simulated in this paper. A WSN designed for the proposed healthcare application needs efficient Medium Access Control (MAC) and routing protocols to provide a guarantee for the reliability of the data delivered from the patients to the medical centre. Based on these requirements, the GinMAC protocol including a mobility module has been chosen, to provide the required performance such as reliability for data delivery and energy saving. Simulation results show that this modification to GinMAC can offer the required performance for the proposed healthcare application.

MAC protocols and mobility management module for healthcare applications using wireless sensor networks

Using Wireless Sensor Networks (WSNs) in healthcare systems has had a lot of attention in recent years. In much of this research tasks like sensor data processing, health states decision making and emergency message sending are done by a remote server. Many patients with lots of sensor data consume a great deal of communication resources, bring a burden to the remote server and delay the decision time and notification time. A healthcare application for elderly people using WSN has been simulated in this paper. A WSN designed for the proposed healthcare application needs efficient MAC and routing protocols to provide a guarantee for the reliability of the data delivered from the patients to the medical centre. Based on these requirements, the GinMAC protocol including a mobility module has been chosen, to provide the required performance such as reliability for data delivery and energy saving. Simulation results show that this modification to GinMAC can offer the required performance for the proposed healthcare application.

Patient and public involvement in healthcare quality improvement: how organizations can help patients and professionals to collaborate

Citizens across the world are increasingly called upon to participate in healthcare improvement. It is often unclear how this can be made to work in practice. This 4- year ethnography of a UK healthcare improvement initiative showed that patients used elements of organizational culture as resources to help them collaborate with healthcare professionals. The four elements were: (1) organizational emphasis on nonhierarchical, multidisciplinary collaboration; (2) organizational staff ability to model desired behaviours of recognition and respect; (3) commitment to rapid action, including quick translation of research into practice; and (4) the constant data collection and reflection process facilitated by improvement methods.

Temperature and oxygen dependent metabolite utilization by Salmonella enterica Serovars Derby and Mbandaka

Salmonella enterica is a zoonotic pathogen of clinical and veterinary significance, with over 2500 serovars. In previous work we compared two serovars displaying host associations inferred from isolation statistics. Here, to validate genome sequence data and to expand on the role of environmental metabolite constitution in host range determination we use a phenotypic microarray approach to assess the ability of these serovars to metabolise ~500 substrates at 25°C with oxygen (aerobic conditions) to represent the ex vivo environment and at 37°C with and without oxygen (aerobic/anaerobic conditions) to represent the in vivo environment. A total of 26 substrates elicited a significant difference in the rate of metabolism of which only one, D-galactonic acid-g-lactone, could be explained by the presence (S. Mbandaka) or the absence (S. Derby) of metabolic genes. We find that S. Mbandaka respires more efficiently at ambient temperatures and under aerobic conditions on 18 substrates including: glucosominic acid, saccharic acid, trehalose, fumaric acid, maltotriose, N-acetyl-D-glucosamine, N-acetyl-beta-D-mannosamine, fucose, L-serine and dihydroxy-acetone; whereas S. Derby is more metabolically competent anaerobically at 37°C for dipeptides, glutamine-glutamine, alanine-lysine, asparagine-glutamine and nitrogen sources glycine and nitrite. We conclude that the specific phenotype cannot be reliably predicted from the presence of metabolic genes directly relating to the metabolic pathways under study.

Big data architecture for pervasive healthcare: a literature review

Pervasive healthcare aims to deliver deinstitutionalised healthcare services to patients anytime and anywhere. Pervasive healthcare involves remote data collection through mobile devices and sensor network which the data is usually in large volume, varied formats and high frequency. The nature of big data such as volume, variety, velocity and veracity, together with its analytical capabilities com-plements the delivery of pervasive healthcare. However, there is limited research in intertwining these two domains. Most research focus mainly on the technical context of big data application in the healthcare sector. Little attention has been paid to a strategic role of big data which impacts the quality of healthcare services provision at the organisational level. Therefore, this paper delivers a conceptual view of big data architecture for pervasive healthcare via an intensive literature review to address the aforementioned research problems. This paper provides three major contributions: 1) identifies the research themes of big data and pervasive healthcare, 2) establishes the relationship between research themes, which later composes the big data architecture for pervasive healthcare, and 3) sheds a light on future research, such as semiosis and sense-making, and enables practitioners to implement big data in the pervasive healthcare through the proposed architecture.

Evaluating nitrogen utilization efficiency of nonpregnant dry cows offered solely fresh cut grass at maintenance levels

The present study aimed to identify key parameters influencing N utilization and develop prediction equations for manure N output (MN), feces N output (FN), and urine N output (UN). Data were obtained under a series of digestibility trials with nonpregnant dry cows fed fresh grass at maintenance level. Grass was cut from 8 different ryegrass swards measured from early to late maturity in 2007 and 2008 (2 primary growth, 3 first regrowth, and 3 second regrowth) and from 2 primary growth early maturity swards in 2009. Each grass was offered to a group of 4 cows and 2 groups were used in each of the 8 swards in 2007 and 2008 for daily measurements over 6 wk; the first group (first 3 wk) and the second group (last 3 wk) assessed early and late maturity grass, respectively. Average values of continuous 3-d data of N intake (NI) and output for individual cows ( = 464) and grass nutrient contents ( = 116) were used in the statistical analysis. Grass N content was positively related to GE and ME contents but negatively related to grass water-soluble carbohydrates (WSC), NDF, and ADF contents ( < 0.01), indicating that accounting for nutrient interrelations is a crucial aspect of N mitigation. Significantly greater ratios of UN:FN, UN:MN, and UN:NI were found with increased grass WSC contents and ratios of N:WSC, N:digestible OM in total DM (DOMD), and N:ME ( < 0.01). Greater NI, animal BW, and grass N contents and lower grass WSC, NDF, ADF, DOMD, and ME concentrations were significantly associated with greater MN, FN, and UN ( < 0.05). The present study highlighted that using grass lower in N and greater in fermentable energy in animals fed solely fresh grass at maintenance level can improve N utilization, reduce N outputs, and shift part of N excretion toward feces rather than urine. These outcomes are highly desirable in mitigation strategies to reduce nitrous oxide emissions from livestock. Equations predicting N output from BW and grass N content explained a similar amount of variability as using NI and grass chemical composition (excluding DOMD and ME), implying that parameters easily measurable in practice could be used for estimating N outputs. In a research environment, where grass DOMD and ME are likely to be available, their use to predict N outputs is highly recommended because they strongly improved of the equations in the current study.

Utilization of organic nitrogen by ectomycorrhizal fungi (Hebeloma spp.) of arctic and temperate origin

Arctic and temperate strains of Hebeloma spp. were grown in axenic culture on glutamic acid, alanine, lysine and NH4+ as sole sources of nitrogen (N), with excess carbon (C) or deficient C (supplied as glucose). Their ability to utilize seed protein as a natural N source was also assessed. All strains tested had the capacity to assimilate amino acids and generally utilized alanine and glutamic acid more readily than NH4+. Some strains were able to utilize amino C when starved of glucose C, and could mineralize amino-N to NH3-N. Arctic strains, in particular, appeared to be pre-adapted to the utilization of seed protein N and glutamic acid N, which is often liberated in high concentrations after soil freezing. The results are discussed in relation to their possible ecological importance.

Biorefinery development through utilization of biodiesel industry by-products as sole fermentation feedstock for 1,3-propanediol production

Rapeseed meal (RSM) hydrolysate was evaluated as substitute for commercial nutrient supplements in 1,3-propanediol (PDO) fermentation using the strain Clostridium butyricum VPI 1718. RSM was enzymatically converted into a generic fermentation feedstock, enriched in amino acids, peptides and various micro-nutrients, using crude enzyme consortia produced via solid state fermentation by a fungal strain of Aspergillus oryzae. Initial free amino nitrogen concentration influenced PDO production in batch cultures. RSM hydrolysates were compared with commercial nutrient supplements regarding PDO production in fed-batch cultures carried out in a bench-scale bioreactor. The utilization of RSM hydrolysates in repeated batch cultivation resulted in a PDO concentration of 65.5 g/L with an overall productivity of 1.15 g/L/h that was almost 2 times higher than the productivity achieved when yeast extract was used as nutrient supplement.

Analysis of phosphorus use efficiency traits in Coffea genotypes reveals Coffea arabica and Coffea canephora have contrasting phosphorus uptake and utilization efficiencies

Background and Aims: Phosphate (Pi) is one of the most limiting nutrients for agricultural production in Brazilian soils due to low soil Pi concentrations and rapid fixation of fertilizer Pi by adsorption to oxidic minerals and/or precipitation by iron and aluminum ions. The objectives of this study were to quantify phosphorus (P) uptake and use efficiency in cultivars of the species Coffea arabica L. and Coffea canephora L., and group them in terms of efficiency and response to Pi availability. Methods: Plants of 21 cultivars of C. arabica and four cultivars of C. canephora were grown under contrasting soil Pi availabilities. Biomass accumulation, tissue P concentration and accumulation and efficiency indices for P use were measured. Key Results: Coffee plant growth was significantly reduced under low Pi availability, and P concentration was higher in cultivars of C. canephora. The young leaves accumulated more P than any other tissue. The cultivars of C. canephora had a higher root/shoot ratio and were significantly more efficient in P uptake, while the cultivars of C. arabica were more efficient in P utilization. Agronomic P use efficiency varied among coffee cultivars and E16 Shoa, E22 Sidamo, Iêmen and Acaiá cultivars were classified as the most efficient and responsive to Pi supply. A positive correlation between P uptake efficiency and root to shoot ratio was observed across all cultivars at low Pi supply. These data identify Coffea genotypes better adapted to low soil Pi availabilities, and the traits that contribute to improved P uptake and use efficiency. These data could be used to select current genotypes with improved P uptake or utilization efficiencies for use on soils with low Pi availability and also provide potential breeding material and targets for breeding new cultivars better adapted to the low Pi status of Brazilian soils. This could ultimately reduce the use of Pi fertilizers in tropical soils, and contribute to more sustainable coffee production.

Inequalities in dental services utilization among Brazilian low-income children: the role of individual determinants

Objectives: To assess the role of the individual determinants on the inequalities of dental services utilization among low-income children living in the working area of Brazilian`s federal Primary Health Care program, which is called Family Health Program (FHP), in a big city in Southern Brazil. Methods: A cross-sectional population-based study was performed. The sample included 350 children, ages 0 to 14 years, whose parents answered a questionnaire about their socioeconomic conditions, perceived needs, oral hygiene habits, and access to dental services. The data analysis was performed according to a conceptual framework based on Andersen`s behavioral model of health services use. Multivariate models of logistic regression analysis instructed the hypothesis on covariates for never having had a dental visit. Results: Thirty one percent of the surveyed children had never had a dental visit. In the bivariate analysis, higher proportion of children who had never had a dental visit was found among the very young, those with inadequate oral hygiene habits, those without perceived need of dental care, and those whose family homes were under absent ownership. The mechanisms of social support showed to be important enabling factors: children attending schools/kindergartens and being regularly monitored by the FHP teams had higher odds of having gone to the dentist, even after adjusting for socioeconomic, demographic, and need variables. Conclusions: The conceptual framework has confirmed the presence of social and psychosocial inequalities on the utilization pattern of dental services for low-income children. The individual determinants seem to be important predictors of access.

What aspects of shiftwork influence off-shift well-being of healthcare workers?

Characteristics of shiftwork schedules have implications for off-shift well-being. We examined the extent to which several shift characteristics (e.g., shift length, working sundays) are associated with three aspects of off-shift well-being: work-to-family conflict, physical well-being, and mental wellbeing. We also investigated whether these relationships differed in four nations. The Survey of Work and Time was completed by 906 healthcare professionals located in Australia, Brazil, Croatia, and the USA. Hierarchical multiple regression analyses supported the hypothesis that shiftwork characteristics account for significant unique variance in all three measures of well-being beyond that accounted for by work and family demands and personal characteristics. The patterns of regression weights indicated that particular shiftwork characteristics have differential relevance to indices of work-to-family conflict, physical well-being, and mental well-being. Our findings suggest that healthcare organizations should carefully consider the implications of shiftwork characteristics for off-shift well-being. Furthermore, although our findings did not indicate national differences in the nature of relationships between shift characteristics and well-being, shiftwork characteristics and demographics for healthcare professionals differ in systematic ways among nations; as such, effective solutions may be context-specific. (c) 2008 Elsevier Ltd. All rights reserved.