Using health-related quality of life instruments for children with long-term conditions : On the basis of a national quality registry system

Introduction: There has been a continuous development of new technologies in healthcare that are derived from national quality registries. However, this innovation needs to be translated into the workflow of healthcare delivery, to enable children with long-term conditions to get the best support possible to manage their health during everyday life. Since children living with long-term conditions experience different interference levels in their lives, healthcare professionals need to assess the impact of care on children’s day-to-day lives, as a complement to biomedical assessments. Aim: The overall aim of this thesis was to explore and describe the use of instruments about health-related quality of life (HRQOL) in outpatient care for children with long-term conditions on the basis of a national quality registry system. Methods: The research was conducted by using comparative, cross-sectional and explorative designs and data collection was performed by using different methods. The questionnaire DISABKIDS Chronic Generic Measure -37 was used as well as semi-structured interviews and video-recordings from consultations. Altogether, 156 children (8–18 years) and nine healthcare professionals participated in the studies. Children with Type 1 Diabetes (T1D) (n 131) answered the questionnaire DISABKIDS and children with rheumatic diseases, kidney diseases and T1D (n 25) were interviewed after their consultation at the outpatient clinic after the web-DISABKIDS had been used. In total, nine healthcare professionals used the HRQOL instrument as an assessment tool during the encounters which was video-recorded (n 21). Quantitative deductive content analysis was used to describe content in different HRQOL instruments. Statistical inference was used to analyse results from DISABKIDS and qualitative content analysis was used to analyse the interviews and video-recordings. Results: The findings showed that based on a biopsychosocial perspective, both generic and disease-specific instruments should be used to gain a comprehensive evaluation of the child’s HRQOL. The DISABKIDS instrument is applicable when describing different aspects of health concerning children with T1D. When DISABKIDS was used in the encounters, children expressed positive experiences about sharing their results with the healthcare professional. It was discovered that different approaches led to different outcomes for the child when the healthcare professionals were using DISABKIDS during the encounter. When an instructing approach is used, the child’s ability to learn more about their health and how to improve their health is limited. When an inviting or engaging approach is used by the professional, the child may become more involved during the conversations. Conclusions: It could be argued that instruments of HRQOL could be used as a complement to biomedical variables, to promote a biopsychosocial perspective on the child’s health. According to the children in this thesis, feedback on their results after answering to web-DISABKIDS is important, which implies that healthcare professionals need to prioritize time for discussions about results from HRQOL instruments in the encounters. If healthcare professionals involve the child in the discussion of the results of the HRQOL, misinterpreted answers could be corrected during the conversation. Concurrently, this claims that healthcare professionals invite and engage the child.

Analyzing the Effect of Soiling on the Performance of a Photovoltaic System of Different Module Technologies in Kalkbult, South Africa

The fact that most of the large scale solar PV plants are built in arid and semi-arid areas where land availability and solar radiation is high, it is expected the performance of the PV plants in such locations will be affected significantly due to high cell temperature as well as due to soiling. Therefore, it is essential to study how the different PV module technologies will perform in such geographical locations to ensure a consistent and reliable power delivery over the lifetime of the PV power plants. As soiling is strongly dependent on the climatic conditions of a particular location a test station, consisted of about 24 PV modules and a well-equipped weather station, was built within the fences of Scatec’s 75 MW Kalkbult solar PV plant in South Africa. This study was performed to a better understand the effect of soiling by comparing the relative power generation by the cleaned modules to the un-cleaned modules. Such knowledge can enable more quantitative evaluations of the cleaning strategies that are going to be implemented in bigger solar PV power plants. The data collected and recorded from the test station has been analyzed at IFE, Norway using a MatLab script written for this thesis project. This thesis work has been done at IFE, Norway in collaboration with Stellenbosch University in South Africa and Scatec Solar a Norwegian independent power producer company. Generally for the polycrystalline modules it is found that the average temperature corrected efficiency during the period of the experiment has been 15.00±0.08 % and for the thin film-CdTe with ARC is 11.52% and for the thin film without ARC is about 11.13% with standard uncertainty of ±0.01 %. Besides, by comparing the initial relative average efficiency of the polycrystalline-Si modules when all the modules have been cleaned for the first time and the final relative efficiency; after the last cleaning schedule which is when all the reference modules E, F, G, and H have been cleaned for the last time it is found that poly3 performs 2 % and 3 % better than poly1 and poly16 respectively, poly13 performs 1 % better than poly15 as well as poly5 and poly12 performs 1 % and 2 % better than poly10 respectively. Besides, poly5 and poly12 performs a 9 % and 11 % better than poly7. Furthermore, there is no change in performance between poly6 and poly9 as well as poly4 and poly15. However, the increase in performance of poly3 to poly1, poly13 to poly15 as well as poly5 and poly12 to poly10 is insignificant. In addition, it is found that TF22 perform 7% better than the reference un-cleaned module TF24 and similarly; TF21 performs 7% higher than TF23. Furthermore, modules with ARC glass (TF17, TF18, TF19, and TF20) shows that cleaning the modules with only distilled water (TF19) or dry-cleaned after cleaned with distilled water(TF20) decreases the performance of the modules by 5 % and 4 % comparing to its respective reference uncleanedmodules TF17 and TF18 respectively.

Query routing in cooperative semi-structured peer-to-peer information retrieval networks

Conventional web search engines are centralised in that a single entity crawls and indexes the documents selected for future retrieval, and the relevance models used to determine which documents are relevant to a given user query. As a result, these search engines suffer from several technical drawbacks such as handling scale, timeliness and reliability, in addition to ethical concerns such as commercial manipulation and information censorship. Alleviating the need to rely entirely on a single entity, Peer-to-Peer (P2P) Information Retrieval (IR) has been proposed as a solution, as it distributes the functional components of a web search engine – from crawling and indexing documents, to query processing – across the network of users (or, peers) who use the search engine. This strategy for constructing an IR system poses several efficiency and effectiveness challenges which have been identified in past work. Accordingly, this thesis makes several contributions towards advancing the state of the art in P2P-IR effectiveness by improving the query processing and relevance scoring aspects of a P2P web search. Federated search systems are a form of distributed information retrieval model that route the user’s information need, formulated as a query, to distributed resources and merge the retrieved result lists into a final list. P2P-IR networks are one form of federated search in routing queries and merging result among participating peers. The query is propagated through disseminated nodes to hit the peers that are most likely to contain relevant documents, then the retrieved result lists are merged at different points along the path from the relevant peers to the query initializer (or namely, customer). However, query routing in P2P-IR networks is considered as one of the major challenges and critical part in P2P-IR networks; as the relevant peers might be lost in low-quality peer selection while executing the query routing, and inevitably lead to less effective retrieval results. This motivates this thesis to study and propose query routing techniques to improve retrieval quality in such networks. Cluster-based semi-structured P2P-IR networks exploit the cluster hypothesis to organise the peers into similar semantic clusters where each such semantic cluster is managed by super-peers. In this thesis, I construct three semi-structured P2P-IR models and examine their retrieval effectiveness. I also leverage the cluster centroids at the super-peer level as content representations gathered from cooperative peers to propose a query routing approach called Inverted PeerCluster Index (IPI) that simulates the conventional inverted index of the centralised corpus to organise the statistics of peers’ terms. The results show a competitive retrieval quality in comparison to baseline approaches. Furthermore, I study the applicability of using the conventional Information Retrieval models as peer selection approaches where each peer can be considered as a big document of documents. The experimental evaluation shows comparative and significant results and explains that document retrieval methods are very effective for peer selection that brings back the analogy between documents and peers. Additionally, Learning to Rank (LtR) algorithms are exploited to build a learned classifier for peer ranking at the super-peer level. The experiments show significant results with state-of-the-art resource selection methods and competitive results to corresponding classification-based approaches. Finally, I propose reputation-based query routing approaches that exploit the idea of providing feedback on a specific item in the social community networks and manage it for future decision-making. The system monitors users’ behaviours when they click or download documents from the final ranked list as implicit feedback and mines the given information to build a reputation-based data structure. The data structure is used to score peers and then rank them for query routing. I conduct a set of experiments to cover various scenarios including noisy feedback information (i.e, providing positive feedback on non-relevant documents) to examine the robustness of reputation-based approaches. The empirical evaluation shows significant results in almost all measurement metrics with approximate improvement more than 56% compared to baseline approaches. Thus, based on the results, if one were to choose one technique, reputation-based approaches are clearly the natural choices which also can be deployed on any P2P network.

A Case Based approach to assess Waiting Time Prediction at an Intensive Care Unity

Waiting time at an intensive care unity stands for a key feature in the assessment of healthcare quality. Nevertheless, its estimation is a difficult task, not only due to the different factors with intricate relations among them, but also with respect to the available data, which may be incomplete, self-contradictory or even unknown. However, its prediction not only improves the patients’ satisfaction but also enhance the quality of the healthcare being provided. To fulfill this goal, this work aims at the development of a decision support system that allows one to predict how long a patient should remain at an emergency unit, having into consideration all the remarks that were just stated above. It is built on top of a Logic Programming approach to knowledge representation and reasoning, complemented with a Case Base approach to computing.

Length of Stay in Intensive Care Units - A Case Base Evaluation

As a matter of fact, an Intensive Care Unit (ICU) stands for a hospital facility where patients require close observation and monitoring. Indeed, predicting Length-of-Stay (LoS) at ICUs is essential not only to provide them with improved Quality-of-Care, but also to help the hospital management to cope with hospital resources. Therefore, in this work one`s aim is to present an Artificial Intelligence based Decision Support System to assist on the prediction of LoS at ICUs, which will be centered on a formal framework based on a Logic Programming acquaintance for knowledge representation and reasoning, complemented with a Case Based approach to computing, and able to handle unknown, incomplete, or even contradictory data, information or knowledge.

Offshore Wind Energy Conversion System Connected to the Electric Grid: Modeling and Simulation

This paper is on modeling and simulation for an offshore wind system equipped with a semi-submersible floating platform, a wind turbine, a permanent magnet synchronous generator, a multiple point clamped four level or five level full-power converter, a submarine cable and a second order filter. The drive train is modeled by three mass model considering the resistant stiffness torque, structure and tower in deep water due to the moving surface elevation. The system control uses PWM by space vector modulation associated with sliding mode and proportional integral controllers. The electric energy is injected into the electric grid either by an alternated current link or by a direct current link. The model is intend to be a useful tool for unveil the behavior and performance of the offshore wind system, especially for the multiple point clamped full-power converter, under normal operation or under malfunctions.

Emergetic evaluation of cattle rearing in a montado farm

O Montado, em Portugal, é um complexo sistema silvopastoril de uso da terra, tipicamente Mediterrânico, com diversos estratos de vegetação, incluindo sobreiro e azinheira em várias densidades, onde é frequente a criação de gado. Esta actividade pecuária beneficia das pastagens no sob-coberto, de algumas espécies arbustivas e também das bolotas que caem do coberto arbóreo, contribuindo para evitar a invasão da pastagem por matos. No entanto, dependendo da sua gestão, este gado pode comprometer a regeneração do sistema. Nos últimos 20 anos, os subsídios no âmbito da Política Agrícola Comum da União Europeia têm promovido a criação de gado bovino em detrimento de outras espécies e raças mais leves, bem como a intensificação desta produção. Esta intensificação pode impossibilitar a regeneração natural das árvores ameaçando o equilíbrio do Montado. Por esta razão é necessária uma avaliação focada na criação de gado bovino e nos seus impactos sobre o sistema. O objectivo deste estudo foi obter uma melhor compreensão do funcionamento de uma exploração silvopastoril num sistema de Montado, através da aplicação do Método de Avaliação Emergética e do cálculo de índices emergéticos. Pretende-se assim compreender a melhor forma de o gerir, bem como conceber estratégias que maximizem o fluxo de emergia na exploração. Uma comparação deste método com a avaliação económica permitiu perceber em que aspectos esta pode ser complementada pelo método da avaliação emergética. O método da avaliação emergética permite a avaliação de sistemas multifuncionais complexos à escala de uma exploração individual, fornecendo informação extra em relação à avaliação económica como a renovabilidade dos inputs do sistema, ou a quantidade de fluxos livres da natureza que é valorada por preços de mercado. Este método permite a integração das emternalidades e das externalidades à contabilização económica, transformando uma avaliação tendencialmente separada do seu sistema mais vasto, numa avaliação de um sistema em conexão com aqueles mais vastos nos quais se integra; Abstract: The Montado, in Portugal, is a complex silvo-pastoral system of land use, typically Mediterranean, with different strata of vegetation, including cork and holm oaks in various densities, and where cattle rearing is common. This stockfarm benefits from the herbaceous layer under the trees, as well as from some species in the shrub layer, and also from the acorns faling down from the tree cover, while contributing to prevent the invasion of pastures by shrubs. Nevertheless, depending on its management, livestock can affect the system regeneration. Over the past 20 years, subsidies of the European Union's common agricultural policy have promoted the cattle rearing at expense of other lighter species and breeds, as well as its intensification. This intensification may impair the natural regeneration of trees threatening the balance of the Montado. Therefore an assessment focused on cattle and their impact on the system is required. The purpose of this study was to obtain a better understanding of the functioning of a silvo-pastoral farm in a Montado system, by applying the emergy evaluation method and through the calculation of emergy indices. It is intended to understand the best way to manage and design strategies that maximize the emergy flow on the farm. A comparison of this method with the economic evaluation allowed to realize in what aspects it can be complemented by the emergy evaluation method. The emergy evaluation method alows the assessment of complex multi-functional systems at the scale of an individual farm, providing extra information in relation to economic avaluation as the renewability of the inputs to a system and the amount of free flows of nature that is valued by market prices. This method allows the integration of the emternalities and the externalities to the economic accounting, transforming an evaluation tended separated from its wider system, in an evaluation of a system in connection with the larger ones on which it is incorporated.

Emergy analysis of a silvo-pastoral system, a case study in southern Portugal

The Mediterranean silvo-pastoral system known as Montado, in Portugal, is a complex land use system composed of an open tree stratum in various densities and an herbaceous layer, used for livestock grazing. Livestock also profit from the acorns, and the grazing contributes to avoid shrub encroachment. In the last 20 years, subsidies from the European Union have greatly promoted cattle rearing in this system and the introduction of heavy breeds, at the expense of sheep, goats or the native cattle breeds. The balance of the traditional system is thus threatened, and a precise assessment of the balance between the different components of the system, therefore is highly needed. The goal of this study was to gain a better under- standing of a Montado farm system with cattle rearing as the major economic activity by applying the emergy evaluation method to calculate indices of yield, investment, environmental loading and sustainability. By integrating different ecosystem components, the emergy evaluation method allows a comprehensive evaluation of this complex and multifunctional system at the scale of an individual farm. This method provides a set of indices that can help us understand the system and design management strategies that maximize emergy flow in the farm. In this paper, we apply the emergy evaluation method to a Montado farm with cattle rearing, as a way to gain a better understanding of this system at the farm scale. The value for the transformity of veal (2.66E?06 sej J-1) is slightly higher, when compared to other systems producing protein. That means that the investment of nature and man in this product was higher and it requires a premium price on the market. The renewa- bility for Holm Oaks Farm (49 %), lower than for other similar systems, supports the assumption that this is a farm in which, comparing with others, the number of purchased inputs in relation to renewable inputs provided by nature, is higher. The Emergy Investment Ratio is 0.91 for cattle rearing compared to a value of 0.49 for cork and 0.43 for firewood harvesting, making it clear that cattle rearing is a more labor demanding activity comparing with extractive activities as cork and firewood harvesting.

Climatic zoning of viticultural production periods over the year in the tropical zone: application of the methodology of the géoviticulture MCC System.

2005

Determinazione gascromatografica di composti organici volatili e semi-volatili (VOCs e SVOCs) in poliolefine ed effetti delle condizioni di lavorazione

A relevant problem of polyolefins processing is the presence of volatile and semi-volatile compounds (VOCs and SVOCs) such as linear chains alkanes found out in final products. These VOCs can be detected by customers from the unpleasant smelt and can be an environmental issue, at the same time they can cause negative side effects during process. Since no previously standardized analytical techniques for polymeric matrix are available in bibliography, we have implemented different VOCs extraction methods and gaschromatographic analysis for quali-quantitative studies of such compounds. In literature different procedures can be found including microwave extraction (MAE) and thermo desorption (TDS) used with different purposes. TDS coupled with GC-MS are necessary for the identification of different compounds in the polymer matrix. Although the quantitative determination is complex, the results obtained from TDS/GC-MS show that by-products are mainly linear chains oligomers with even number of carbon in a C8-C22 range (for HDPE). In order to quantify these linear alkanes by-products, a more accurate GC-FID determination with internal standard has been run on MAE extracts. Regardless the type of extruder used, it is difficult to distinguish the effect of the various processes, which in any case entails having a lower-boiling substance content, lower than the corresponding virgin polymer. The two HDPEs studied can be distinguished on the basis of the quantity of analytes found, therefore the production process is mainly responsible for the amount of VOCs and SVOCs observed. The extruder technology used by Sacmi SC allows to obtain a significant reduction in VOCs compared to the conventional screw system. Thus, the result is significantly important as a lower quantity of volatile substances certainly leads to a lower migration of such materials, especially when used for food packaging.

Obesity And Inflammation And The Effect On The Hematopoietic System.

Bone marrow is organized in specialized microenvironments known as 'marrow niches'. These are important for the maintenance of stem cells and their hematopoietic progenitors whose homeostasis also depends on other cell types present in the tissue. Extrinsic factors, such as infection and inflammatory states, may affect this system by causing cytokine dysregulation (imbalance in cytokine production) and changes in cell proliferation and self-renewal rates, and may also induce changes in the metabolism and cell cycle. Known to relate to chronic inflammation, obesity is responsible for systemic changes that are best studied in the cardiovascular system. Little is known regarding the changes in the hematopoietic system induced by the inflammatory state carried by obesity or the cell and molecular mechanisms involved. The understanding of the biological behavior of hematopoietic stem cells under obesity-induced chronic inflammation could help elucidate the pathophysiological mechanisms involved in other inflammatory processes, such as neoplastic diseases and bone marrow failure syndromes.

The Value Of The 2005 International Society Of Urological Pathology (isup) Modified Gleason Grading System As A Predictor Of Biochemical Recurrence After Radical Prostatectomy.

To compare time and risk to biochemical recurrence (BR) after radical prostatectomy of two chronologically different groups of patients using the standard and the modified Gleason system (MGS). Cohort 1 comprised biopsies of 197 patients graded according to the standard Gleason system (SGS) in the period 1997/2004, and cohort 2, 176 biopsies graded according to the modified system in the period 2005/2011. Time to BR was analyzed with the Kaplan-Meier product-limit analysis and prediction of shorter time to recurrence using univariate and multivariate Cox proportional hazards model. Patients in cohort 2 reflected time-related changes: striking increase in clinical stage T1c, systematic use of extended biopsies, and lower percentage of total length of cancer in millimeter in all cores. The MGS used in cohort 2 showed fewer biopsies with Gleason score ≤ 6 and more biopsies of the intermediate Gleason score 7. Time to BR using the Kaplan-Meier curves showed statistical significance using the MGS in cohort 2, but not the SGS in cohort 1. Only the MGS predicted shorter time to BR on univariate analysis and on multivariate analysis was an independent predictor. The results favor that the 2005 International Society of Urological Pathology modified system is a refinement of the Gleason grading and valuable for contemporary clinical practice.

The Applicability Of Ordered Mesoporous Sba-15 And Its Hydrophobic Glutaraldehyde-bridge Derivative To Improve Ibuprofen-loading In Releasing System.

The mesoporous SBA-15 silica with uniform hexagonal pore, narrow pore size distribution and tuneable pore diameter was organofunctionalized with glutaraldehyde-bridged silylating agent. The precursor and its derivative silicas were ibuprofen-loaded for controlled delivery in simulated biological fluids. The synthesized silicas were characterized by elemental analysis, infrared spectroscopy, (13)C and (29)Si solid state NMR spectroscopy, nitrogen adsorption, X-ray diffractometry, thermogravimetry and scanning electron microscopy. Surface functionalization with amine containing bridged hydrophobic structure resulted in significantly decreased surface area from 802.4 to 63.0 m(2) g(-1) and pore diameter 8.0-6.0 nm, which ultimately increased the drug-loading capacity from 18.0% up to 28.3% and a very slow release rate of ibuprofen over the period of 72.5h. The in vitro drug release demonstrated that SBA-15 presented the fastest release from 25% to 27% and SBA-15GA gave near 10% of drug release in all fluids during 72.5 h. The Korsmeyer-Peppas model better fits the release data with the Fickian diffusion mechanism and zero order kinetics for synthesized mesoporous silicas. Both pore sizes and hydrophobicity influenced the rate of the release process, indicating that the chemically modified silica can be suggested to design formulation of slow and constant release over a defined period, to avoid repeated administration.

Electronic And Structural Study Of Pt-modified Au Vicinal Surfaces: A Model System For Pt-au Catalysts.

Two single crystalline surfaces of Au vicinal to the (111) plane were modified with Pt and studied using scanning tunneling microscopy (STM) and X-ray photoemission spectroscopy (XPS) in ultra-high vacuum environment. The vicinal surfaces studied are Au(332) and Au(887) and different Pt coverage (θPt) were deposited on each surface. From STM images we determine that Pt deposits on both surfaces as nanoislands with heights ranging from 1 ML to 3 ML depending on θPt. On both surfaces the early growth of Pt ad-islands occurs at the lower part of the step edge, with Pt ad-atoms being incorporated into the steps in some cases. XPS results indicate that partial alloying of Pt occurs at the interface at room temperature and at all coverage, as suggested by the negative chemical shift of Pt 4f core line, indicating an upward shift of the d-band center of the alloyed Pt. Also, the existence of a segregated Pt phase especially at higher coverage is detected by XPS. Sample annealing indicates that the temperature rise promotes a further incorporation of Pt atoms into the Au substrate as supported by STM and XPS results. Additionally, the catalytic activity of different PtAu systems reported in the literature for some electrochemical reactions is discussed considering our findings.

Inhibitory Effects Of A Cured Antibacterial Bonding System On Viability And Metabolic Activity Of Oral Bacteria.

To evaluate the antimicrobial efficacy of Clearfil SE Protect (CP) and Clearfil SE Bond (CB) after curing and rinsed against five individual oral microorganisms as well as a mixture of bacterial culture prepared from the selected test organisms. Bacterial suspensions were prepared from single species of Streptococcus mutans, Streptococcus sobrinus, Streptococcus gordonii, Actinomyces viscosus and Lactobacillus lactis, as well as mixed bacterial suspensions from these organisms. Dentin bonding system discs (6 mm×2 mm) were prepared, cured, washed and placed on the bacterial suspension of single species or multispecies bacteria for 15, 30 and 60 min. MTT, Live/Dead bacterial viability (antibacterial effect), and XTT (metabolic activity) assays were used to test the two dentin system's antibacterial effect. All assays were done in triplicates and each experiment repeated at least three times. Data were submitted to ANOVA and Scheffe's f-test (5%). Greater than 40% bacteria killing was seen within 15 min, and the killing progressed with increasing time of incubation with CP discs. However, a longer (60 min) period of incubation was required by CP to achieve similar antimicrobial effect against mixed bacterial suspension. CB had no significant effect on the viability or metabolic activity of the test microorganisms when compared to the control bacterial culture. CP was significantly effective in reducing the viability and metabolic activity of the test organisms. The results demonstrated the antimicrobial efficacy of CP both on single and multispecies bacterial culture. CP may be beneficial in reducing bacterial infections in cavity preparations in clinical dentistry.