784 resultados para Duty of Care


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Detection of pathogens from infected biological samples through conventional process involves cell lysis and purification. The main objective of this work is to minimize the time and sample loss, as well as to increase the efficiency of detection of biomolecules. Electrical lysis of medical sample is performed in a closed microfluidic channel in a single integrated platform where the downstream analysis of the sample is possible. The device functions involve, in a sequence, flow of lysate from lysis chamber passed through a thermal denaturation counter where dsDNA is denatured to ssDNA, which is controlled by heater unit. A functionalized binding chamber of ssDNA is prepared by using ZnO nanorods as the matrix and functionalized with bifunctional carboxylic acid, 16-(2-pyridyldithiol) hexadecanoic acid (PDHA) which is further attached to a linker molecule 1-ethyl-3-(3-dimethylaminopropyl) (EDC). Linker moeity is then covalently bound to photoreactive protoporphyrin (PPP) molecule. The photolabile molecule protoporphyrin interacts with -NH2 labeled single stranded DNA (ssDNA) which thus acts as a probe to detect complimentary ssDNA from target organisms. Thereafter the bound DNA with protoporphyrin is exposed to an LED of particular wavelength for a definite period of time and DNA was eluted and analyzed. UV/Vis spectroscopic analysis at 260/280 nm wavelength confirms the purity and peak at 260 nm is reconfirmed for the elution of target DNA. Quantitative and qualitative data obtained from the current experiments show highly selective detection of biomolecule such as DNA which have large number of future applications in Point-of-Care devices.

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Receptor-based detection of pathogens often suffers from non-specific interactions, and as most detection techniques cannot distinguish between affinities of interactions, false positive responses remain a plaguing reality. Here, we report an anharmonic acoustic based method of detection that addresses the inherent weakness of current ligand dependant assays. Spores of Bacillus subtilis (Bacillus anthracis simulant) were immobilized on a thickness-shear mode AT-cut quartz crystal functionalized with anti-spore antibody and the sensor was driven by a pure sinusoidal oscillation at increasing amplitude. Biomolecular interaction forces between the coupled spores and the accelerating surface caused a nonlinear modulation of the acoustic response of the crystal. In particular, the deviation in the third harmonic of the transduced electrical response versus oscillation amplitude of the sensor (signal) was found to be significant. Signals from the specifically-bound spores were clearly distinguishable in shape from those of the physisorbed streptavidin-coated polystyrene microbeads. The analytical model presented here enables estimation of the biomolecular interaction forces from the measured response. Thus, probing biomolecular interaction forces using the described technique can quantitatively detect pathogens and distinguish specific from non-specific interactions, with potential applicability to rapid point-of-care detection. This also serves as a potential tool for rapid force-spectroscopy, affinity-based biomolecular screening and mapping of molecular interaction networks.

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ENGLISH: One primary duty of the Inter-American Tropical Tuna Commission is to estimate the maximum sustainable catches of yellowfin tuna (Neothunnus macropterus) and skipjack (Katsuwonus pelamis), and to investigate and recommend proposals to maintain the stocks at levels which will permit these catches to be obtained. To do this, there is required some means of predicting yields relative to fishing intensity. . . The age composition of catch, and growth rate of yellowfin tuna for recent years have now been estimated (Hennemuth, 1961). In this paper, relative abundance at age of yellowfin tuna shall be estimated -and used, in turn, to estimate total mortality rate. Yield-per-recruit calculations, based on Beverton and Holt's (1957) simple equation, will be presented to compare present utilization with theoretical maxima under varying levels of fishing mortality and different ages at first capture. SPANISH: Uno de los principales deberes de la Comisión Interamericana del Atún Tropical es estimar las pescas máximas sostenibles de los atunes aleta amarilla (Neothunnus macropterus) y barrilete (Katsuwonus pelamis) , así como estudiar y recomendar proposiciones para mantener los stocks a niveles que permitan obtener estas pescas. Para lograr este propósito se requieren algunos medios que permitan predecir el rendimiento en relación con la intensidad de la pesca. . La composición de edades de la pesca y la tasa de crecimiento del atún aleta amarilla en años recientes han sido estimadas ahora (Hennemuth, 1961). En este trabajo, la abundancia relativa a una edad dada de esta especie será estimada y usada, a su vez, para estimar la tasa de mortalidad total. Los cálculos del rendimiento por recluta, basados en la ecuación simple de Beverton y Holt (1957), serán presentados para comparar la utilización actual con los máximos teóricos bajo valores variables de mortalidad por la pesca y a diferentes edades a la primera captura.

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ENGLISH: The Inter-American Tropical Tuna Commission, pursuant to the provisions of the Convention, has the duty of collecting and interpreting factual information to facilitate maintaining the populations of tunas, and of tuna baitfishes, supporting the fisheries pursued by nationals of its Member Governments in the Eastern Pacific Ocean, at levels which will permit maximum sustainable average harvests year after year. This requires a wide variety of research into the biology, life history, ecology and population dynamics of the several species, and investigations into the effects of both natural factors and fishing activity on their abundance and on the harvests they can sustain. The research is conducted by a permanent, internationally recruited scientific staff, employed directly by the Commission, selected on the basis of professional competence by the Director of Investigations. SPANISH: La Comisión Interan1ericana del Atún Tropical, de informidad con las disposiciones de la Convención, tiene el deber de recolectar e interpretar la información que facilite el mantenimiento de las poblaciones del atún y de los peces de carnada que sirven para la pesca de este, sosteniendo las pesquerías a que se dedican los habitantes de sus Gobiernos Miembros en el Océano Pacifico Oriental, a niveles ,de abundancia que permitan un promedio máximo sostenible de cosechas ano tras ano. Esto requiere una amplia variedad de investigaciones dentro de la biología, historia natural, ecología y dinámica de las poblaciones de diversas especies, y sabre los efectos, tanto de los factores naturales como de la actividad pesquera, en la abundancia de las mismas y en el rendimiento que puedan dar. La investigación es conducida por un grupo científico permanente, cuyos miembros son reclutados internacionalmente empleados directamente por la Comisión, una vez que han sido seleccionados sobre la base de su competencia profesional, por el Director de Investigaciones. (PDF contains 149 pages.)

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Background: Neonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. The objective of this work was to identify the major criteria considered necessary for selecting neonatal intensive care units that are able to perform drug evaluations competently. Methodology and Main Findings: This Delphi process was conducted with an international multidisciplinary panel of 25 experts from 13 countries, selected to be part of two committees (a scientific committee and an expert committee), in order to validate criteria required to perform drug evaluation in neonates. Eighty six items were initially selected and classified under 7 headings: "NICUs description - Level of care'' (21), "Ability to perform drug trials: NICU organization and processes (15), "Research Experience'' (12), "Scientific competencies and area of expertise'' (8), "Quality Management'' (16), "Training and educational capacity'' (8) and "Public involvement'' (6). Sixty-one items were retained and headings were rearranged after the first round, 34 were selected after the second round. A third round was required to validate 13 additional items. The final set includes 47 items divided under 5 headings. Conclusion: A set of 47 relevant criteria will help to NICUs that want to implement, conduct or participate in drug trials within a neonatal network identify important issues to be aware of. Summary Points: 1) Neonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. 2) The present Delphi study was conducted with an international multidisciplinary panel of 25 experts from 13 countries and aims to identify the major criteria considered necessary for selecting neonatal intensive care units (NICUs) that are able to perform drug evaluations competently. 3) Of the 86 items initially selected and classified under 7 headings - "NICUs description - Level of care'' (21), "Ability to perform drug trials: NICU organization and processes (15), "Research Experience'' (12), "Scientific competencies and area of expertise'' (8), "Quality Management'' (16), "Training and educational capacity'' (8) and "Public involvement'' (6) - 47 items were selected following a three rounds Delphi process. 4) The present consensus will help NICUs to implement, conduct or participate in drug trials within a neonatal network.

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Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.

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Este estudo teve por objetivo analisar as características do financiamento da atenção básica e do Programa de Saúde da Família (PSF), na 10 RS do Estado do Paraná, e sua relação como indutor do modelo assistencial à saúde. Identifica o comportamento das receitas para o PSF na 10 RS do Paraná, o comportamento das despesas com atenção básica em relação à despesa total com saúde da regional e o papel dos incentivos financeiros do PSF como indutores de manutenção e expansão do PSF na assistência à saúde dos municípios selecionados. O financiamento estável e suficiente é imprescindível para que o acesso às ações e serviços de saúde a todos os cidadãos brasileiros possa efetivamente acontecer. A implementação do SUS traz consigo um desafio na mudança do modelo assistencial: de um acesso restrito aos beneficiários do INPS ao acesso universal, o SUS garante a saúde como um direito de todos e dever do Estado, mediante políticas públicas que são os pilares básicos da transição de um modelo curativo para um modelo preventivo com ações pautadas na integralidade. Os desafios na mudança do modelo assistencial estão intimamente ligados aos desafios pelo financiamento. O embate constante por financiamento e as tentativas de vinculação de receita para garantir a suficiência e estabilidade de recursos para o SUS constituem imperativos para que o sistema possa dar conta de atender a todos os cidadãos. A 10 Regional de Saúde do Estado do Paraná, sediada na cidade de Cascavel, possui 25 municípios e apenas um não tem implantada a Estratégia Saúde da Família. Para a análise das características do financiamento da atenção básica e do PSF para o caso analisado, foram utilizados dados provenientes de sistemas de informação oficiais de caráter público, sendo eles: Sistema de Informação sobre Orçamentos Públicos em Saúde (SIOPS), Cadastro Nacional dos Estabelecimentos de Saúde (CNES), Departamento Nacional de Atenção Básica (DAB) e Fundo Nacional de Saúde (FNS). A partir da análise dos dados, foi possível identificar o papel indutor dos recursos do PAB variável ao PSF nos municípios, pois a maioria possui menos de 20 mil habitantes e sua organização dos serviços no nível municipal tem a atenção básica como único nível de assistência. As transferências intergovernamentais, entre elas os incentivos financeiros, têm alto peso no total de recursos dos municípios, mas a capacidade de gestão e a possibilidade de implantação das equipes com atuação nos moldes que se propõem a adotar a ESF precisam ser repensadas e discutidas no nível municipal, para que a implantação da estratégia não seja apenas a maneira através da qual os municípios buscam recursos. Desta forma, o Governo Federal continua sendo o agente definidor da política de saúde no território nacional. Num país onde os municípios são caracterizados por enorme heterogeneidade de tamanho e renda, os repasses federais cumprem e deverão continuar cumprindo papel fundamental no gasto do PSF, o que se confirma nos municípios analisados.

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O trabalho que ora apresentamos tem como objetivo analisar o exercício profissional dos Assistentes Sociais em uma emergência de grande porte da cidade do Rio de Janeiro. A importância desta análise se inscreve na centralidade alcançada pela saúde na constituição da cidadania brasileira, após a Carta Constitucional de 1988. Este documento assegurou a saúde como direito de todos e dever do Estado, contudo a conjuntura política e econômica iniciada nos anos 90 e aprofundada nos anos 2000, capitaneada pela Contrarreforma do Estado, imporá limites à materialização da política de saúde preconizada pelo Sistema Único de Saúde, impossibilitando que esta seja implementada de acordo com a nova concepção. O que percebemos nos anos 2000 é uma política de saúde focalizada no atendimento emergencial, que abandonou a dimensão da prevenção e da promoção da saúde e que se distancia, progressivamente, do principio da universalidade. Neste contexto de adversidade e limitação do acesso e do atendimento se insere o Assistente Social. Nosso objetivo é delinear o exercício profissional, por nós analisado, a fim de identificar as possibilidades de materialização do projeto ético-político profissional em condições tão adversas e contrárias àquelas que nortearam a interlocução entre o Serviço Social e a saúde nos anos 80. Para tanto este trabalho busca oferecer elementos que nos permitam compreender não somente a dinâmica interna do Hospital por nós analisado, como também a política de saúde em sua totalidade, além de identificar as potencialidades da rede do entorno. Nessa perspectiva, buscamos compreender a dinâmica dos Conselhos de Saúde e a configuração adquirida por estes em tempos de restrição de direitos, sucateamento e desmonte da saúde pública. Nossos estudos indicam que possibilidades de atuação profissional congruentes com o Projeto Ético-Político Profissional estão colocadas na realidade, imiscuídas nas dificuldades impostas pela conjuntura e somente podem ser apreendidas sob a perspectiva de um trabalho coletivo em saúde.

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Receptor-based detection of pathogens often suffers from non-specific interactions, and as most detection techniques cannot distinguish between affinities of interactions, false positive responses remain a plaguing reality. Here, we report an anharmonic acoustic based method of detection that addresses the inherent weakness of current ligand dependant assays. Spores of Bacillus subtilis (Bacillus anthracis simulant) were immobilized on a thickness-shear mode AT-cut quartz crystal functionalized with anti-spore antibody and the sensor was driven by a pure sinusoidal oscillation at increasing amplitude. Biomolecular interaction forces between the coupled spores and the accelerating surface caused a nonlinear modulation of the acoustic response of the crystal. In particular, the deviation in the third harmonic of the transduced electrical response versus oscillation amplitude of the sensor (signal) was found to be significant. Signals from the specifically-bound spores were clearly distinguishable in shape from those of the physisorbed streptavidin-coated polystyrene microbeads. The analytical model presented here enables estimation of the biomolecular interaction forces from the measured response. Thus, probing biomolecular interaction forces using the described technique can quantitatively detect pathogens and distinguish specific from non-specific interactions, with potential applicability to rapid point-of-care detection. This also serves as a potential tool for rapid force-spectroscopy, affinity-based biomolecular screening and mapping of molecular interaction networks. © 2011 Elsevier B.V.

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Background: ‘Birth Satisfaction’ is a term that encompasses a woman’s evaluation of her birth experience. The term includes factors such as her appraisal of the quality of care she received, a personal assessment of how she coped, and her reconstructions of what happened on that particular day. Her accounts may be accurate or skewed, yet correspond with her reality of how events unfolded. Objective: To evaluate properties of an instrument designed to measure birth satisfaction in a Greek population of postnatal women. Study design: We assessed factor structure, internal consistency, divergent validity and known-groups discriminant validity of the 30-item Greek Birth Satisfaction Scale – Long Form (30-item G-BSS-LF) and its revised version the 10-item Greek-BSS-Revised (10-item-G-BSS-R), using survey data collected in Athens. Participants: A convenience sample of healthy Greek postnatal women (n = 162) aged 22–46 years who had delivered between 34 and 42 weeks’ gestation. Results: The 30-item-G-BSS-LF performed poorly in terms of factor structure. The short-form 10-item-G-BSS-R performed well in terms of measurement replication of the English equivalent version as a multidimensional instrument. The short-form 10-item-G-BSS-R comprises three subscales which measure distinct but correlated domains of: (1) quality of care provision (4 items), (2) women’s personal attributes (2 items), and (3) stress experienced during labour (4 items). Key conclusions: The 10-item-G-BSS-R is a valid and reliable multidimensional psychometric instrument for measuring birth satisfaction in Greek postnatal women.

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Cooper, J. & Urquhart, C. (2004). Confidentiality issues in information systems in social care. In K. Grant, D.A. Edgar & M. Jordan (Eds.), Reflections on the past, making sense of today and predicting the future of information systems, 9th annual UKAIS (UK Academy of Information Systems) conference proceedings, Annual conference, 5-7 May 2004, Glasgow Caledonian University (CD-ROM). Glasgow: Glasgow Caledonian University for UKAIS Sponsorship: AHRC

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Cooper, J. & Urquhart, C. (2008). Homecare and the informal information grapevine: implications for the electronic record in social care. Health Informatics Journal, 14(1), 59-69. Sponsorship: AHRC

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The healthcare industry is beginning to appreciate the benefits which can be obtained from using Mobile Health Systems (MHS) at the point-of-care. As a result, healthcare organisations are investing heavily in mobile health initiatives with the expectation that users will employ the system to enhance performance. Despite widespread endorsement and support for the implementation of MHS, empirical evidence surrounding the benefits of MHS remains to be fully established. For MHS to be truly valuable, it is argued that the technological tool be infused within healthcare practitioners work practices and used to its full potential in post-adoptive scenarios. Yet, there is a paucity of research focusing on the infusion of MHS by healthcare practitioners. In order to address this gap in the literature, the objective of this study is to explore the determinants and outcomes of MHS infusion by healthcare practitioners. This research study adopts a post-positivist theory building approach to MHS infusion. Existing literature is utilised to develop a conceptual model by which the research objective is explored. Employing a mixed-method approach, this conceptual model is first advanced through a case study in the UK whereby propositions established from the literature are refined into testable hypotheses. The final phase of this research study involves the collection of empirical data from a Canadian hospital which supports the refined model and its associated hypotheses. The results from both phases of data collection are employed to develop a model of MHS infusion. The study contributes to IS theory and practice by: (1) developing a model with six determinants (Availability, MHS Self-Efficacy, Time-Criticality, Habit, Technology Trust, and Task Behaviour) and individual performance-related outcomes of MHS infusion (Effectiveness, Efficiency, and Learning), (2) examining undocumented determinants and relationships, (3) identifying prerequisite conditions that both healthcare practitioners and organisations can employ to assist with MHS infusion, (4) developing a taxonomy that provides conceptual refinement of IT infusion, and (5) informing healthcare organisations and vendors as to the performance of MHS in post-adoptive scenarios.

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The health of a nation tells much about the nature of a social contract between citizen and state. The way that health care is organised, and the degree to which it is equitably accessible, constitutes a manifestation of the effects of moments and events in that country's history. Using four case studies, this thesis uses a historical genealogical approach to explain the evolution of Ireland's particular version of health care provision. The total social fact of the gift relationship, central to all human relations, will be used to form a theoretical and conceptual framework on which to build an analysis of Ireland's health and welfare conditions. Additionally, social contract theory will enable an examination of the role of solidarity in relation to social expectations around health care provision. Through the analysis of these cases, the complex matrix of the influential forces that have shaped current conditions are exposed and revealed, enabling a critical understanding of the extent of acquiescence to the inequitable system that arguably exists. The vulnerability of citizens in need of care to the external and global effects of market forces and neoliberalism, therefore, becomes central to any argument for state-provided health and welfare. The hegemony of such forces can be seen to influence the manner in which the idea of individual self-reliance, in place of collective solidarity, is conceptualised and subsequently infiltrated into a range of aspects of the social world. For example, the particular discourse of the market and of economic concerns succeeds in shaping understandings of responsibilities around central areas of health and welfare. Similarly the 'possessor principle' can be seen to be misplaced within the context of health and social care, but yet has become normalised within this discourse. Within this matrix of complex influencing factors, the welfare state struggles to impose a balance between market values and social values. Responsibilities of the state to support and compensate its citizens for the ills of the market have become devalued, as the core values of classical liberalism have become distorted beyond recognition, leaving instead bare neoliberal concerns. This thesis traces the genealogical origins of this transition within the recent history of Irish health care and thereby reveals the embedding of individualism in place of solidarity, the on going reneging of the social contract and the corruption of the gift relationship.

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Background: The treatment of oral cancer is complex and lengthy. Curative treatment implies a combination of surgery, radiotherapy and chemotherapy. The main goal of treatment is to guarantee long-term tumour free survival with as little functional and cosmetic damage. Despite progress in developing these strategies, cancers of the oral cavity continue to have high mortality rates that have not improved dramatically over the past ten years. Aim: The aim of this study was to uniquely explore the dynamic changes in the physical, psychological, social and existential experiences of newly diagnosed patients with oral cancer at two points across their cancer illness trajectory i.e. at the time of diagnosis and at the end of treatment. Methodology: A qualitative prospective longitudinal design was employed. Non-probability purposive sampling allowed the recruitment of 10 participants. The principal data collection method used was a digital audio taped semi-structured interview along with drawings produced by the participants. Analysis: Data was analysed using latent content analyses. Summary: Three ‘dynamic’ themes, physical, psychosocial and existential experiences were revealed that interact and influence each other in a complex and compound whole. These experiences are present at different degrees and throughout the entire trajectory of care. Patients have a number of specific concerns and challenges that cannot be compartmentalised into unitary or discrete aspects of their daily lives. Conclusion & Implications: An understanding of the patient’s experience of their illness at all stages of the disease trajectory, is essential to inform service providers’ decision making if the delivery of care is to be client centred. Dynamic and fluctuating changes in the patient’s personal experience of the cancer journey require dynamic, energetic and timely input from health care professionals.