Lite4Life (Tier 2 adult weight management service)

This service Aims: To provide a multi-component weight management service that supports sustainable behaviour change and weight loss in adults 16 years and over with a BMI 28. To enable patients to develop the necessary personal attributes for their own long term weight management and to understand the impact of their weight on their health and co-morbidities. Objectives: To provide an evidence based, multi-component tier 2 weight management service that improves patients knowledge and skills for effective and sustainable weight loss helps patients identify their own facilitators for positive behaviour change and to address underlying barriers to long-term behaviour changeincreases patients self-efficacy and confidence in their ability to address their weight To be an integral part of the tiered approach to weight management services for the population of Stockton. To ensure equitable service provision across Stockton-on-Tees. To provide intensive group based service, one-to-one support and maintenance support. To support the service user to develop and review a personalised goal setting plan phase 2 and at discharge after phase 2. To ensure a smooth transition from the service (tier2) to tier 1 services to ensure continuity of care for service users.Recruit referrals using a variety of and appropriate methods. To establish a single point of contact for referrals into the service.Continually promote the service across a range of mediums and liaise and work in partnership with key interdependencies (refer to 2.4) To establish a robust database and data collection system in line with information governance. To ensure the access criteria, care pathway and referral process is clearly understood by all health care professionals and those who may refer into the service. To establish close links with, and signpost and/or enable service users to access suitable services where patient needs indicate this. This may include access to Tees Time to Talk (IAPT) for psychological therapies; Specialist Weight Management Service; physical activity programmes; Tier 1 services; and primary care. To provide the necessary venues, equipment and assets needed to deliver the programme, ensuring due regard is given to the quality and safety of all materials used. To collect and provide data in quarterly reports to the Commissioner to allow for continued monitoring and evaluation of the service in line with the Standard Evaluation Framework (available at www.noo.org.uk/core/SEF) and as specified by the Commissioner.

Primary medical care in Irish prisons

An industrial dispute between prison doctors and the Irish Prison Service (IPS) took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review.   This study utilised a mixed methods approach. An independent expert medical evaluator (one of the authors, DT) inspected the medical facilities, equipment and relevant custodial areas in eleven of the fourteen prisons within the IPS. Semistructured interviews took place with personnel who had operational responsibility for delivery of prison medical care. Prison doctors completed a questionnaire to elicit issues such as allocation of clinician's time, nurse and administrative support and resources available.   There was wide variation in the standard of medical facilities and infrastructure provided across the IPS. The range of medical equipment available was generally below that of the equivalent general practice scheme in the community. There is inequality within the system with regard to the ratio of doctor-contracted time relative to the size of the prison population. There is limited administrative support, with the majority of prisons not having a medical secretary. There are few psychiatric or counselling sessions available.   People in prison have a wide range of medical care needs and there is evidence to suggest that these needs are being met inconsistently in Irish prisons.This resource was contributed by The National Documentation Centre on Drug Use.

Construcción de un entorno integral automatizado de una metodología de gestión de proyectos informáticos.

Treball que aborda una de les disciplines més complexes i apassionants del desenvolupament de projectes informàtics: la gestió. Hi ha molta bibliografia i informació sobre aquest tema, i la comesa d'aquest text és dissenyar una metodologia per a l'automatització integral de la gestió de projectes informàtics sigui quina sigui la seva naturalesa, tipificant-los en tres grans categories: projectes de desenvolupament, equipament i millora, ampliació o reposició.

Bottlefeeding

This booklet provides new safety information on the preparation and storage of infant formula milk and is aimed at minimising the risk of infection from bacteria that may sometimes be present in the milk powder. It explains how to sterilise feeding equipment and make up formula milk, and highlights the safety precautions that need to be observed.

High-density electric source imaging (esi) in focal epilepsy: a prospective study of 150 operated patients

Purpose: EEG is mandatory in the diagnosis of the epilepsy syndrome. However, its potential as imaging tool is still under estimated. In the present study, we aim to determine the prerequisites of maximal benefit of electric source imaging (ESI) to localize the irritative zone in patients with focal epilepsy. Methods: One hundred fifty patients suffering from focal epilepsy and with minimum 1 year postoperative follow-up were studied prospectively and blinded to the underlying diagnosis. We evaluated the influence of two important factors on sensitivity and specificity of ESI: the number of electrodes (low resolution, LR-ESI: <30 versus high resolution, HR-ESI: 128-256 electrodes), and the use of individual MRI (i-MRI) versus template MRI (t-MRI) as the head model. Findings: ESI had a sensitivity of 85% and a specificity of 87% when HR-ESI with i-MRI was used. Using LR-ESI, sensitivity decreased to 68%, or even 57% when only t-MRI was available. The sensitivity of HR-ESI/i-MRI compared favorably with those of MRI (76%), PET (69%) and ictal/interictal SPECT (64%). Interpretation: This study on a large patient group shows excellent sensitivity and specificity of ESI if 128 EEG channels or more are used for ESI and if the results are coregistered to the patient's individual MRI. Localization precision is as high as or even higher than established brain imagery techniques. HR-ESI appears to be a valuable additional imaging tool, given that larger electrode arrays are easily and rapidly applied with modern EEG equipment and that structural MRI is nearly always available for these patients.

Open source software expectations in retail businesses of Igualada : an exploratory study

The emergence of open source software in the last years has become a common topic of study in different fields, from the most technical characteristics to the economical aspects. This paper examines the current status about the literature dealing with economics of open source and explores the uses, infrastructure and expectations of retail businesses and institutions of the town of Igualda about it. This qualitative case study finds out that the current equipment and level of uses of ICTs are low and that the current situation of the town stores is receptive to a potential introduction of open source software.

Diagnostic reliability of an immunochromatographic test for Chagas disease screening at a primary health care centre in a rural endemic area

Many patients with Chagas disease live in remote communities that lack both equipment and trained personnel to perform a diagnosis by conventional serology (CS). Thus, reliable tests suitable for use under difficult conditions are required. In this study, we evaluated the ability of personnel with and without laboratory skills to perform immunochromatographic (IC) tests to detect Chagas disease at a primary health care centre (PHCC). We examined whole blood samples from 241 patients and serum samples from 238 patients. Then, we calculated the percentage of overall agreement (POA) between the two groups of operators for the sensitivity (S), specificity (Sp) and positive (PPV) and negative (NPV) predictive values of IC tests compared to CS tests. We also evaluated the level of agreement between ELISAs and indirect haemagglutination (IHA) tests. The readings of the IC test results showed 100% agreement (POA = 1). The IC test on whole blood showed the following values: S = 87.3%; Sp = 98.8%; PPV = 96.9% and NPV = 95.9%. Additionally, the IC test on serum displayed the following results: S = 95.7%; Sp = 100%; PPV = 100% and NPV = 98.2%. Using whole blood, the agreement with ELISA was 96.3% and the agreement with IHA was 94.1%. Using serum, the agreement with ELISA was 97.8% and the agreement with IHA was 96.6%. The IC test performance with serum samples was excellent and demonstrated its usefulness in a PHCC with minimal equipment. If the IC test S value and NPV with whole blood are improved, then this test could also be used in areas lacking laboratories or specialised personnel.

Proyecto de climatización de un estabulario para un laboratorio de investigación

Mediante el presente Proyecto Final de Carrera se pretende dar una solución a la climatización de un edificio destinado a la investigación con elementos bacteriológicos sobre animales vivos. Se entenderá por instalación de climatización, la instalación encargada de asegurar las condiciones de temperatura, humedad y calidad del aire requeridas por el uso del edificio. La instalación objeto del presente proyecto corresponde a un laboratorio con clasificación de Contención Biológica de nivel III: agente patógeno que pueda causar una enfermedad grave en el hombre y presente serio peligro para los trabajadores; existe el riesgo de que se propague a la colectividad pero existen generalmente profilaxis o tratamientos eficaces. La instalación de control formará parte de otro proyecto que deberá ser complementario a éste

Prototip culata del vehicle de baix consum (equip EPS-UdG Shell Eco)

Aquest projecte s’ha portat a terme per tal de millorar en diferentsaspectes el motor Honda Gx35 , del vehicle de baix consum de la Universitat deGirona (Udg). Aquest és un motor de combustió interna de gasolina (cicle Otto).L’objectiu és el disseny d’una culata per poder minimitzar el consum de gasolina, la qual s’ha de poder acoblar amb el motor Honda Gx35. Aquest motor,prèviament s’haurà de modificar per poder-hi instal•lari la nova culata

The use of expert systems on the differential diagnosis of urinary incontinence

The differential diagnosis of urinary incontinence classes is sometimes difficult to establish. As a rule, only the results of urodynamic testing allow an accurate diagnosis. However, this exam is not always feasible, because it requires special equipment, and also trained personnel to lead and interpret the exam. Some expert systems have been developed to assist health professionals in this field. Therefore, the aims of this paper are to present the definition of Artificial Intelligence; to explain what Expert System and System for Decision Support are and its application in the field of health and to discuss some expert systems for differential diagnosis of urinary incontinence. It is concluded that expert systems may be useful not only for teaching purposes, but also as decision support in daily clinical practice. Despite this, for several reasons, health professionals usually hesitate to use the computer expert system to support their decision making process.

Two-Lift Portland Cement Concrete Pavements to Meet Public Needs, September 2004

The report reviews the past work in the United States and internationally in the development of two-lift pavements. It points out the strengths and limitations in the construction of such portland cement concrete pavements. Certain cost, mix design, and construction problems are inhibiting the growth of this product. Changes in the availability of aggregates, knowledge of materials and new construction equipment, and the desire for specific surfaces to meet noise, durability, and safety are prompting the need to reconsider this type of construction.

Two Lift Portland Cement Concrete Pavements to Meet Public Needs, September 2004

The report reviews the past work in the United States and internationally in the development of two-lift pavements. It points out the strengths and limitations in the construction of such portland cement concrete pavements. Certain cost, mix design, and construction problems are inhibiting the growth of this product. Changes in the availability of aggregates, knowledge of materials and new construction equipment, and the desire for specific surfaces to meet noise, durability, and safety are prompting the need to reconsider this type of construction.

Efficacy of clinical guideline implementation to improve the appropriateness of chest physiotherapy prescription among inpatients with community-acquired pneumonia

BACKGROUND: Although there is no strong evidence of benefit, chest physiotherapy (CP) seems to be commonly used in simple pneumonia. CP requires equipment and frequently involves the assistance of a respiratory therapist, engendering a significant medical workload and cost. AIM: To measure and compare the efficacy of two modalities of chest physiotherapy (CP) guideline implementation on the appropriateness of CP prescription among patients hospitalised for community-acquired pneumonia (CAP). PATIENTS AND METHODS: We measured the CP prescription rate and duration in all consecutive CAP inpatients admitted in a division of general internal medicine at an urban teaching community hospital during three consecutive one-year time periods: (1) before any guideline implementation; (2) after a passive implementation by medical grand rounds and guideline diffusion through mailing; (3) after adding a one-page reminder in the CAP patient's medical chart highlighting our recommendations. Death and recurrent hospitalisation rates within one year after hospitalisation were recorded to assess whether CP prescription reduction, if any, impaired patient outcomes. RESULTS: During the three successive phases, 127, 157, and 147 patients with similar characteristics were included. Among all CAP inpatients, the CP prescription rate decreased from 68% (86/127) to 51% (80/157), and to 48% (71/147), respectively (P for trend <0.01 for trend). A significant reduction in CP duration was observed after the active guideline implementation (12.0, 11.0, 7.0days, respectively) and persisted after adjustment for length of stay. Reductions in CP prescription rate and duration were also observed among CAP patients with COPD CP prescription rate: 97% (30/31), 67% (24/36), 75% (35/47), respectively (P<0.01 for trend). The mean cost of CP per patient was reduced by 56%, from $709 to $481, and to $309, respectively. Neither the in-hospital deaths, the one-year overall recurrent hospitalisation nor the one-year CAP-specific recurrent hospitalisation significantly differed between the three phases. CONCLUSION: Both passive and active implementation of guidelines appear to improve the appropriateness of CP prescription among inpatients with CAP without impairing their outcomes. Restricting CP use to patients who benefit from this treatment might be an opportunity to decrease CAP medical cost and workload.

Iowa Technology Governance Board Annual Report, January 2, 2008

This Technology Governance Board Annual Report provides information on the FY05 – FY09 Information Technology Personnel Spending; FY05 – FY09 Technology Equipment and Services Spending; and FY05 – FY09 Internal IT Expenditures with the Iowa Communications Network and Department of Administrative Services - Information Technology Enterprise. The report also contains a projection of technology cost savings. This report was produced in compliance with Iowa Code §8A.204(3a) and was submitted to the Governor, the Department of Management, and the General Assembly on January 2, 2008.

A estação arqueológica de Salamansa (ilha de São Vicente, República de Cabo Verde)

Apresentam‑se os principais resultados obtidos nas duas missões arqueológicas patrocinadas pelo Centro Português de Actividades Subaquáticas (CPAS) à ilha de São Vicente (República de Cabo Verde), em 1998 e em 2005. Em 1998, confirmou‑se o efectivo interesse arqueológico do sítio, localizado sobre o mar, em local abrigado da vasta baía de Salamansa, situada na parte setentrional da ilha, tendo‑se registado a respectiva extensão e estratigrafia e procedido à colheita de amostras para datação. Embora os resultados dessa campanha tivessem sido publicados, indicando estação de carácter habitacional, revelada pela notável acumulação de conchas, acompanhada de abundantes fragmentos de cerâmicas manuais, de produção africana, mantinha‑se indefinida a sua verdadeira natureza. Impunha‑se, assim, proceder à escavação integral da área que ainda subsistia da estação — sujeita de forma contínua a forte erosão marinha — bem como à colheita de novos materiais para datação, de forma a confirmar as conclusões preliminares anteriormente obtidas, objectivos que se concretizaram em 2005. Deste modo, foi possível concluir que, contrariando a hipótese, de início considerada, de poder corresponder a um testemunho da ocupação da ilha em época anterior à chegada dos Portugueses — hipótese que já as primeiras datas de radiocarbono contradiziam — se trata de um sítio onde uma unidade habitacional construída por muros de pedra seca, de planta ortogonal, revela inspiração europeia, aliás sublinhada pelos materiais exumados, onde estão representados produtos com tal origem, como cachimbos de caulino, vidros, faianças portuguesas, e projécteis de armas de fogo, a par de objectos oriundos do Extremo Oriente, num quadro dominado pelas produções cerâmicas africanas. Esta situação evidencia um estabelecimento cuja ocupação se centrou no século XVII, conforme indicam os materiais recolhidos e os resultados das datações obtidas, francamente aberto aos contactos de longa distância, apesar do isolamento do local escolhido. Os restos faunísticos recolhidos, com a presença deburro e de boi, sugerem um estacionamento sedentário, sendo a alimentação assegurada essencialmente pela captura de tartarugas, pela pesca e pela recolecção de moluscos marinhos (especialmente grandes lapas) e complementada pelo consumo de cabra, que poderia ser doméstica ou caçada, dado o estado selvagem a que retornou ali esta espécie. na última parte do trabalho, discutem‑se as diversas hipóteses susceptíveis de explicar esta estação — desde um entreposto comercial relacionado com a exploração agro‑pecuária da ilha de Santo Antão, passando por pequeno estabelecimento especializado de apoio à navegação, com a produção de carne salgada de tartaruga, até ter constituído refúgio relacionado com a intensa pirataria vigente à época no arquipélago, tendo presente os elementos históricos conhecidos, que, aliás, indicam que o início da ocupação permanente de São Vicente só se produziu a partir da segunda década do século XIX. Seja como for, a forte componente cultural africana revelada pelo espólio destes primeiros ocupantes da ilha expressa‑se também pelos rituais que terão envolvido o abandono do estabelecimento, com o enterramento de dois vasos emborcados sob o chão da habitação explorada, e a deposição de uma pequena taça, nas mesmas circunstâncias, junto à parede da mesma, do lado externo.