Exploring Healthcare Experiences of Transgender Individuals

The purpose of this study was to explore how transgender individuals were supported to navigate the healthcare system to achieve positive healthcare experiences. A single case study was conducted in Southern Ontario, which included ten individual interviews. Data was analyzed through thematic analysis, allowing for seven themes to emerge within macro (large-scale system), meso (local/interpersonal), and micro (individual/internal) levels of healthcare system support. Themes that emerged within the levels of system support included: 1) existing deficits with hope for change; 2) significant external supports; 3) importance of informal networking; 4) support from local area family physicians and walk-in clinics; 5) navigating the healthcare system alone; 6) personality traits for successful healthcare experiences; and 7) the development of strategies to achieve positive healthcare experiences. This study outlined factors that contributed to positive healthcare experiences for transgender individuals, showing that meso and micro level support are compensating for large-scale healthcare system deficits.

Unintended Consequences of Strategies Implemented in Canadian Healthcare Organizations to Reduce Wait Times for Elective Hip and Knee Surgeries

Introduction: En réponse aux exigences du gouvernement fédéral en ce qui concerne les temps d'attente pour les chirurgies électives d’hanche et du genou, les Organismes Canadiens de santé ont adopté des stratégies de gestion pour les listes d'attente. Cependant, il n'existe pas actuellement aucune information disponible concernant les effets imprévus, positive ou négative, de ces stratégies. Méthodologie: Un modèle qui a été construit est tombé en panne la gestion de la chirurgie d’hanche et du genou en différentes étapes, afin d'identifier les effets imprévus possibles pour chaque étape; le modèle a été validé auprès d'un panel d'experts. Cette étude a choisi quatre études de cas en fonction de leur durabilité: un cas qui a été durable, un cas qui a été modérément durable, et deux cas peu probable d'être durable. Dans cette étude qualitative, nous avons mené 31 entretiens semi-structurés entre Novembre 2010 et Juin 2011 avec les gestionnaires, les infirmières, les thérapeutes et les chirurgiens impliqués dans la gestion des stratégies du temps d’attente pour les chirurgies électives d’hanche et du genou. Les quatre cas ont été sélectionnés à partir de trois provinces / régions. Nous avons analysé les conséquences non intentionnelles aux niveaux systémique et organisationnelle en utilisant les stratégies dans chaque contexte. Enregistrements des entrevues ont été transcrits mot à mot et soumis à l'analyse du cadre. Résultats: Les effets négatifs sont la précarité des stratégies en raison du non-récurrente financement, l'anxiété chez les patients qui ne sont pas prêts pour la chirurgie, une redistribution du temps de chirurgie vers l’orthopédie au détriment des autres interventions chirurgicales, tensions entre les chirurgiens et entre les orthopédistes et anesthésistes, et la pression sur le personnel dans le bloc opératoire et postopératoire. Conclusion: La stratégie d’implémentation aux niveaux national et local devrait prendre en compte les conséquences potentielles, positives et négatives. Il y a des conséquences inattendues à chaque niveau de l'organisation des soins de santé. Individuellement et collectivement, ces conséquences peuvent positivement et négativement affecter les résultats. Par conséquent, la planification de la santé doit analyser et prendre en compte les conséquences inattendues en termes de bonnes résultats inattendues, compromis et les conséquences négatives afin d'améliorer les résultats.

The Erasure of Sex and Gender Minorities in the Healthcare System

Étude de cas / Case study

classification and content based retrieval of digital mammograms and placental sonograms

Image processing has been a challenging and multidisciplinary research area since decades with continuing improvements in its various branches especially Medical Imaging. The healthcare industry was very much benefited with the advances in Image Processing techniques for the efficient management of large volumes of clinical data. The popularity and growth of Image Processing field attracts researchers from many disciplines including Computer Science and Medical Science due to its applicability to the real world. In the meantime, Computer Science is becoming an important driving force for the further development of Medical Sciences. The objective of this study is to make use of the basic concepts in Medical Image Processing and develop methods and tools for clinicians’ assistance. This work is motivated from clinical applications of digital mammograms and placental sonograms, and uses real medical images for proposing a method intended to assist radiologists in the diagnostic process. The study consists of two domains of Pattern recognition, Classification and Content Based Retrieval. Mammogram images of breast cancer patients and placental images are used for this study. Cancer is a disaster to human race. The accuracy in characterizing images using simplified user friendly Computer Aided Diagnosis techniques helps radiologists in detecting cancers at an early stage. Breast cancer which accounts for the major cause of cancer death in women can be fully cured if detected at an early stage. Studies relating to placental characteristics and abnormalities are important in foetal monitoring. The diagnostic variability in sonographic examination of placenta can be overlooked by detailed placental texture analysis by focusing on placental grading. The work aims on early breast cancer detection and placental maturity analysis. This dissertation is a stepping stone in combing various application domains of healthcare and technology.

Raman spectra of KTP crystal in an in situ electric field

Raman spectra of the KTP single crystal are recorded in electric fields (dc and ac) applied along the polar axis c. Spectra with the laser beam focused near the cathode end, anode end and the centre of the crystal are recorded. The cathode end of the crystal develops a spot ‘grey track’ where the laser beam is focused after a lapse of 5 h from the application of a dc electric field of 38 V/cm. The spectra recorded at the cathode end after the application of field show variations in intensity of bands. A new band appears at 177 cm21. Changes in band intensities are explained on the basis of changes in polarizability of the crystal due to the movement of K1 ions along the polar axis. K1 ions accumulate at the cathode end, where the ‘Grey track’ formation occurs. The intensity enhancement observed for almost all bands in the ac field is attributed to the improvement of crystalline quality.

A qualitative analysis of immigrant population health practices in the Girona Healthcare Region

The research we present here forms part of a two-phase project - one quantitative and the other qualitative - assessing the use of primary health care services. This paper presents the qualitative phase of said research, which is aimed at ascertaining the needs, beliefs, barriers to access and health practices of the immigrant population in comparison with the native population, as well as the perceptions of healthcare professionals. Moroccan and sub-Saharan were the immigrants to who the qualitative phase was specifically addressed. The aims of this paper are as follows: to analyse any possible implications of family organisation in the health practices of the immigrant population; to ascertain social practices relating to illness; to understand the significances of sexual and reproductive health practices; and to ascertain the ideas and perceptions of immigrants, local people and professionals regarding health and the health system. Methods: qualitative research based on discursive analysis. Data gathering techniques consisted of discussion groups with health system users and semi-structured individual interviews with healthcare professionals. The sample was taken from the Basic Healthcare Areas of Salt and Banyoles (belonging to the Girona Healthcare Region), the discussion groups being comprised of (a) 6 immigrant Moroccan women, (b) 7 immigrant sub-Saharan African women and (c) 6 immigrant and native population men (2 native men, 2 Moroccan men and 2 sub-Saharan men); and the semi-structured interviews being conducted with the following healthcare professionals: (a) 3 gynaecologists, (b) 3 nurses and 1 administrative staff. Results: use of the healthcare system is linked to the perception of not being well, knowledge of the healthcare system, length of time resident in Spain and interiorization of traditional Western medicine as a cure mechanism. The divergences found among the groups of immigrants, local people and healthcare professionals with regard to healthcare education, use of the healthcare service, sexual and reproductive healthcare and reticence with regard to being attended by healthcare personnel of the opposite sex demonstrate a need to work with the immigrant population as a heterogeneous group. Conclusions: the results we have obtained support the idea that feeling unwell is a psycho-social process, as it takes place within a specific socio-cultural situation and spans a range of beliefs, perceptions and ideas regarding symptomology and how to treat it

Microwave spectrum of CHD2CN and CHD2NC, and the harmonic force field and rz structure of methyl cyanide and isocyanide

The microwave spectra of CHD2CN and CHD2NC have been measured from 18 to 40 GHz; about 20 type A and 30 type C transitions have been observed for each molecule. These have been fitted to a Hamiltonian using 3 rotational constants, and 5 quartic and 4 sextic distortion constants, in the IrS reduction of Watson [in “Vibrational spectra and structure” Vol. 6 (1977)]; the standard error of the fit is 26 kHz. For methyl cyanide the 5 quartic distortion constants have been used to further refine the recent harmonic force field of Duncan et al. [J. Mol. Spectrosc. 69, 123 (1978)], but the changes are small. Finally, for both molecules, the harmonic force field has been used to determine zero point average moments of inertia Iz from the ground state rotational constants for many isotopic species, and these have been used to determine an rz structure. The results are compared with rs structure calculations.

The harmonic force field and rz structure of HNCO

The presently available microwave, millimeter wave, and far-infrared data of five isotopic species of isocyanic acid, namely, HNCO, H15NCO, HN13CO, HNC18O, and DNCO, have been used to obtain improved values of the ground-state rotational constants, the five quartic distortion constants, and some higher-order distortion constants in the Ir S reduced Hamiltonian of Watson. The appropriate planarity relation among the quartic centrifugal distortion constants has been imposed in the fitting procedure. The general harmonic force field of isocyanic acid has been determined using all existing data, and assuming a trans bent equilibrium geometry of the molecule with an NCO angle of 170°. Finally an rz structure has been obtained using the Az, Bz, and Cz rotational constants of five isotopic species. The bending of the NCO chain is found to be 8° in the trans configuration.

Modeling requirement driven architecture of adaptive healthcare system based on semiotics

In order to improve the quality of healthcare services, the integrated large-scale medical information system is needed to adapt to the changing medical environment. In this paper, we propose a requirement driven architecture of healthcare information system with hierarchical architecture. The system operates through the mapping mechanism between these layers and thus can organize functions dynamically adapting to user’s requirement. Furthermore, we introduce the organizational semiotics methods to capture and analyze user’s requirement through ontology chart and norms. Based on these results, the structure of user’s requirement pattern (URP) is established as the driven factor of our system. Our research makes a contribution to design architecture of healthcare system which can adapt to the changing medical environment.

Interplanetary magnetic field control of dayside auroral activity and the transfer of momentum across the dayside magnetopause

The orientation of the Interplanetary Magnetic Field (IMF) during transient bursts of ionospheric flow and auroral activity in the dayside auroral ionosphere is studied, using data from the EISCAT radar, meridian-scanning photometers, and an all-sky TV camera, in conjunction with simultaneous observations of the interplanetary medium by the IMP-8 satellite. It is found that the ionospheric flow and auroral burst events occur regularly (mean repetition period equal to 8.3 ± 0.6 min) during an initial period of about 45 min when the IMF is continuously and strongly southward in GSM coordinates, consistent with previous observations of the occurrence of transient dayside auroral activity. However, in the subsequent 1.5 h, the IMF was predominantly northward, and only made brief excursions to a southward orientation. During this period, the mean interval between events increased to 19.2 ± 1.7 min. If it is assumed that changes in the North-South component of the IMF are aligned with the IMF vector in the ecliptic plane, the delays can be estimated between such a change impinging upon IMP-8 and the response in the cleft ionosphere within the radar field-of-view. It is found that, to within the accuracy of this computed lag, each transient ionospheric event during the period of predominantly northward IMF can be associated with a brief, isolated southward excursion of the IMF, as observed by IMP-8. From this limited period of data, we therefore suggest that transient momentum exchange between the magnetosheath and the ionosphere occurs quasi-periodically when the IMF is continuously southward, with a mean period which is strikingly similar to that for Flux Transfer Events (FTEs) at the magnetopause. During periods of otherwise northward IMF, individual momentum transfer events can be triggered by brief swings to southward IMF. Hence under the latter conditions the periodicity of the events can reflect a periodicity in the IMF, but that period will always be larger than the minimum value which occurs when the IMF is strongly and continuously southward.

Shared-decision making in designing new healthcare environments : ready to take off for improved quality

Background Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. Discussion This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. Summary We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

Effect of target bias on magnetic field enhanced plasma immersion ion implantation

Recent studies have demonstrated that sheath dynamics in plasma immersion ion implantation (PIII) is significantly affected by an external magnetic field, especially in the case when the magnetic field is parallel to the workpiece surface or intersects it at small angles. In this work we report the results from two-dimensional, particle-in-cell (PIC) computer simulations of magnetic field enhanced plasma immersion implantation system at different bias voltages. The simulations begin with initial low-density nitrogen plasma, which extends with uniform density through a grounded cylindrical chamber. Negative bias voltage is applied to a cylindrical target located on the axis of the vacuum chamber. An axial magnetic field is created by a solenoid installed inside the target holder. A set of simulations at a fixed magnetic field of 0.0025 T at the target surface is performed. Secondary electron emission from the target subjected to ion bombardment is also included. It is found that the plasma density around the cylindrical target increases because of intense background gas ionization by the electrons drifting in the crossed E x B fields. Suppression of the sheath expansion and increase of the implantation current density in front of the high-density plasma region are observed. The effect of target bias on the sheath dynamics and implantation current of the magnetic field enhanced PIII is discussed. (C) 2007 Elsevier B.V. All rights reserved.

Exchange and crystal field effects in the ESR spectra of Eu(2+) in LaB(6)

Electron spin resonance of Eu(2+) (4f(7), S=7/2) in a La hexaboride (LaB(6)) single crystal shows a single anisotropic Dysonian resonance. From the observed negative g shift of the resonance, it is inferred that the Eu(2+) ions are covalent exchange coupled to the B 2p-like host conduction electrons. From the anisotropy of the spectra (linewidth and field for resonance), we found that the S ground state of Eu(2+) ions experience a cubic crystal field of a negative fourth order crystal field parameter (CFP), b(4)=-11.5(2.0) Oe, in agreement with the negative fourth order CFP, A(4), found for the non-S ground state R hexaborides. These results support covalency as the dominant contribution to the fourth order CFP for the whole R hexaboride family.

Surveillance Programme for Healthcare Associated Infections in the State of São Paulo, Brazil. Implementation and the first three years' results

Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of São Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of São Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Magnetic field dependence of the magnetic susceptibility and the specific heat of the doped plasticized polyaniline (PANI-DB3EPSA)0.5

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)