Health care workers' influenza vaccination: motivations and mandatory mask policy

BACKGROUND: Vaccination of health care workers (HCW) against seasonal influenza (SI) is recommended but vaccination rate rarely reach >30%. Vaccination coverage against 2009 pandemic influenza (PI) was 52% in our hospital, whilst a new policy requiring unvaccinated HCW to wear a mask during patient care duties was enforced. AIMS: To investigate the determinants of this higher vaccination acceptance for PI and to look for an association with the new mask-wearing policy. METHODS: A retrospective cohort study, involving HCW of three critical departments of a 1023-bed, tertiary-care university hospital in Switzerland. Self-reported 2009-10 SI and 2009 PI vaccination statuses, reasons and demographic data were collected through a literature-based questionnaire. Descriptive statistics, uni- and multivariate analyses were then performed. RESULTS: There were 472 respondents with a response rate of 54%. Self-reported vaccination acceptance was 64% for PI and 53% for SI. PI vaccination acceptance was associated with being vaccinated against SI (OR 9.5; 95% CI 5.5-16.4), being a physician (OR 7.7; 95% CI 3.1-19.1) and feeling uncomfortable wearing a mask (OR 1.7; 95% CI 1.0-2.8). Main motives for refusing vaccination were: preference for wearing a surgical mask (80% for PI, not applicable for SI) and concerns about vaccine safety (64%, 50%) and efficacy (44%, 35%). CONCLUSIONS: The new mask-wearing policy was a motivation for vaccination but also offered an alternative to non-compliant HCW. Concerns about vaccine safety and efficiency and self-interest of health care workers are still main determinants for influenza vaccination acceptance. Better incentives are needed to encourage vaccination amongst non-physician HCW.

Life cycle costs in heating, ventilation and air-conditioning systems with drive

Energy consumption and energy efficiency have become an issue. Energy consumption is rising all over the world and because of that, and the climate change, energy is becoming more and more expensive. Buildings are major consumers of energy, and inside the buildings the major consumers are heating, ventilation and air-conditioning systems. They usually run at constant speed without efficient control. In most cases HVAC equipment is also oversized. Traditionally heating, ventilation and air-conditioning systems have been sized to meet conditions that rarely occur. The theory part in this thesis represents the basics of life cycle costs and calculations for the whole life cycle of a system. It also represents HVAC systems, equipment, systems controls and ways to save energy in these systems. The empirical part of this thesis represents life cycle cost calculations for HVAC systems. With these calculations it is possible to compute costs for the whole life cycle for the wanted variables. Life cycle costs make it possible to compare which variable causes most of the costs from the whole life point of view. Life cycle costs were studied through two real life cases which were focused on two different kinds of HVAC systems. In both of these cases the renovations were already made, so that the comparison between the old and the new, now existing system would be easier. The study indicates that energy can be saved in HVAC systems by using variable speed drive as a control method.

Performance of diagnostic centers in the classification of opportunistic screening mammograms from the Brazilian public health system (SUS)

Objective To evaluate the performance of diagnostic centers in the classification of mammography reports from an opportunistic screening undertaken by the Brazilian public health system (SUS) in the municipality of Goiânia, GO, Brazil in 2010. Materials and Methods The present ecological study analyzed data reported to the Sistema de Informação do Controle do Câncer de Mama (SISMAMA) (Breast Cancer Management Information System) by diagnostic centers involved in the mammographic screening developed by the SUS. Based on the frequency of mammograms per BI-RADS® category and on the limits established for the present study, the authors have calculated the rate of conformity for each diagnostic center. Diagnostic centers with equal rates of conformity were considered as having equal performance. Results Fifteen diagnostic centers performed mammographic studies for SUS and reported 31,198 screening mammograms. The performance of the diagnostic centers concerning BI-RADS classification has demonstrated that none of them was in conformity for all categories, one center presented conformity in five categories, two centers, in four categories, three centers, in three categories, two centers, in two categories, four centers, in one category, and three centers with no conformity. Conclusion The results of the present study demonstrate unevenness in the diagnostic centers performance in the classification of mammograms reported to SISMAMA from the opportunistic screening undertaken by SUS.

CHARACTERISING THE EOS SLOT-SCANNING SYSTEM WITH THE EFFECTIVE DETECTIVE QUANTUM EFFICIENCY.

NlmCategory="UNASSIGNED">As opposed to the standard detective quantum efficiency (DQE), effective DQE (eDQE) is a figure of merit that allows comparing the performances of imaging systems in the presence of scatter rejection devices. The geometry of the EOS™ slot-scanning system is such that the detector is self-collimated and rejects scattered radiation. In this study, the EOS system was characterised using the eDQE in imaging conditions similar to those used in clinical practice: with phantoms of different widths placed in the X-ray beam, for various incident air kerma and tube voltages corresponding to the phantom thickness. Scatter fractions in EOS images were extremely low, around 2 % for all configurations. Maximum eDQE values spanned 9-14.8 % for a large range of air kerma at the detector plane from 0.01 to 1.34 µGy. These figures were obtained with non-optimised EOS setting but still over-performed most of the maximum eDQEs recently assessed for various computed radiology and digital radiology systems with antiscatter grids.

Enhancing the efficiency of freight transport by using simulation

The role of transport in the economy is twofold. As a sector of economic activity it contributes to a share of national income. On the other hand, improvements in transport infrastructure create room for accelerated economic growth. As a means to support railways as a safe and environmentally friendly transportation mode, the EU legislation has required the opening of domestic railway freight for competition from beginning of year 2007. The importance of railways as a mode of transport has been great in Finland, as a larger share of freight has been carried on rails than in Europe on average. In this thesis it is claimed that the efficiency of goods transport can be enhanced by service specific investments. Furthermore, it is stressed that simulation can and should be used to evaluate the cost-efficiency of transport systems on operational level, as well as to assess transportation infrastructure investments. In all the studied cases notable efficiency improvements were found. For example in distribution, home delivery of groceries can be almost twice as cost efficient as the current practice of visiting the store. The majority of the cases concentrated on railway freight. In timber transportation, the item with the largest annual transport volume in domestic railway freight in Finland, the transportation cost could be reduced most substantially. Also in international timber procurement, the utilization of railway wagons could be improved by combining complementary flows. The efficiency improvements also have positive environmental effects; a large part of road transit could be moved to rails annually. If impacts of freight transport are included in cost-benefit analysis of railway investments, up to 50 % increase in the net benefits of the evaluated alternatives can be experienced, avoiding a possible inbuilt bias in the assessment framework, and thus increasing the efficiency of national investments in transportation infrastructure. Transportation systems are a typical example of complex real world systems that cannot be analysed realistically by analytical methods, whereas simulation allows inclusion of dynamics and the level of detail required. Regarding simulation as a viable tool for assessing the efficiency of transportation systems finds support also in the international survey conducted for railway freight operators; operators use operations research methods widely for planning purposes, while simulation is applied only by the larger operators.

A Preliminary Review of Behavioural Biometrics for Health Monitoring in the Elderly

This article explores the potential of ICT-based biometrics for monitoring the health status of the elderly people. It departs from specific ageing and biometric traits to then focus on behavioural biometric traits like handwriting, speech and gait to finally explore their practical application in health monitoring of elderly.

Implantació d'un sistema de gestió integrada: ISO 9001:00, ISO 14001:04 i OHSAS 18001:07, en un centre d'estètica i perruqueria

En aquests últims anys, són moltes les empreses que han optat per la utilització de sistemes de gestió normalitzats, per a garantir la rendibilitat i fiabilitat dels resultats de la implantació del sistema de gestió en qüestió. A la dècada dels 90 va ser quan la implantació de sistemes de gestió va començar a ser important en la majoria de sectors econòmics. L’evolució en els sistemes de gestió a trets generals va iniciar-se primerament en l’àmbit de la qualitat, seguidament en la gestió ambiental i en última instància en la prevenció de riscos laborals. Aquests tres tipus de sistemes de gestió, en els últims anys s’han anat integrant, de manera que s’han reduït els recursos i els esforços emprats en la gestió, millorant significativament l’eficàcia i l’eficiència d’aquests sistemes. L’objectiu principal que persegueix aquest projecte, és definir un sistema de gestió que permeti a l’empresa conduir les seves activitats de forma simplificada i ordenada, i que alhora faciliti la informació necessària per a corregir i millorar les activitats. Un altre objectiu que pretén aconseguir aquest projecte, és el de dissenyar un SGI que aprofiti les sinèrgies generades en els diferents àmbits de la pròpia empresa i fomenti les interaccions entre els diferents nivells de l’organització. En conseqüència, millorarà de forma important els fluxos d’informació dins de l’empresa minimitzant els esforços i la pèrdua d’informació. El mètode escollit per a la implantació del SGI, ha estat la Gestió per Processos, la qual es basa en la definició i seguiment dels processos de l’empresa, partint de les necessitats del client i acabant quan aquestes estan satisfetes. En conclusió, a la finalització del present projecte s’obtindrà un SGI, amb tots els processos de l’empresa definits i implantats, que doni compliment a les normes UNEEN-ISO 9001:00, UNE-EN-ISO 14001:04 i OHSAS 18001:07. Aquest SGI, que s’ha realitzat des d’un punt de vista documental i teòric, suposarà una millora de l’eficàcia operativa dels processos i una important millora competitiva de l’empresa.

Environmental policy instruments concerning industrial end-use energy efficiency

Energy efficiency and saving energy are the main question marks when thinking of reducing carbon dioxide emissions or cutting costs. The objective of thesis is to evaluate policy instruments concerning end-use energy efficiency of heavy industry in European Union. These policy instruments may be divided in various ways, but in this thesis the division is to administrative, financial, informative and voluntary instruments. Administrative instruments introduced in this thesis are Directive on Integrated Pollution Prevention and Control, Directive on Energy End-use Efficiency and Energy Services, and Climate and Energy Package. Financial means include energy and emission taxation, EU Emission Trading Scheme and diverse support systems. Informative instruments consist of horizontal BAT Reference Document for Energy Efficiency, as well as substantial EU documents including Green Paper on Energy Efficiency, Action Plan for Energy Efficiency and An Energy Policy for Europe. And finally, voluntary instruments include environmental managements systems like ISO 14001 and EMAS, energy auditing and benchmarking. The efficiency of different policy instruments vary quite a lot. Informative instruments lack the commitment from industry and are thus almost ineffective, contrary to EU Emission Trading Scheme, which is said to be the solution to climate problems. The efficiency of administrative means can be placed between those mentioned and voluntary instruments are still quite fresh to be examined fruitfully. However, each instrument has their potential and challenges. Cases from corporate world strengthen the results from theoretical part. Cases were written mainly on the basis of interviews. The interviewees praised the energy efficiency contract of Finnish industry, but the EU ETS takes the leading role of policy instruments. However, for industry the reductions do not come easily.

Machine Learning and Clinical Text. Supporting Health Information Flow

Fluent health information flow is critical for clinical decision-making. However, a considerable part of this information is free-form text and inabilities to utilize it create risks to patient safety and cost-­effective hospital administration. Methods for automated processing of clinical text are emerging. The aim in this doctoral dissertation is to study machine learning and clinical text in order to support health information flow.First, by analyzing the content of authentic patient records, the aim is to specify clinical needs in order to guide the development of machine learning applications.The contributions are a model of the ideal information flow,a model of the problems and challenges in reality, and a road map for the technology development. Second, by developing applications for practical cases,the aim is to concretize ways to support health information flow. Altogether five machine learning applications for three practical cases are described: The first two applications are binary classification and regression related to the practical case of topic labeling and relevance ranking.The third and fourth application are supervised and unsupervised multi-class classification for the practical case of topic segmentation and labeling.These four applications are tested with Finnish intensive care patient records.The fifth application is multi-label classification for the practical task of diagnosis coding. It is tested with English radiology reports.The performance of all these applications is promising. Third, the aim is to study how the quality of machine learning applications can be reliably evaluated.The associations between performance evaluation measures and methods are addressed,and a new hold-out method is introduced.This method contributes not only to processing time but also to the evaluation diversity and quality. The main conclusion is that developing machine learning applications for text requires interdisciplinary, international collaboration. Practical cases are very different, and hence the development must begin from genuine user needs and domain expertise. The technological expertise must cover linguistics,machine learning, and information systems. Finally, the methods must be evaluated both statistically and through authentic user-feedback.

Sustainable drugs and global health care

Each day, Earth's finite resources are being depleted for energy, for material goods, for transportation, for housing, and for drugs. As we evolve scientifically and technologically, and as the population of the world rapidly approaches 7 billion and beyond, among the many issues with which we are faced is the continued availability of drugs for future global health care. Medicinal agents are primarily derived from two sources, synthetic and natural, or in some cases, as semi-synthetic compounds, a mixture of the two. For the developed world, efforts have been initiated to make drug production "greener", with milder reagents, shorter reaction times, and more efficient processing, thereby using less energy, and reactions which are more atom efficient, and generate fewer by-products. However, most of the world's population uses plants, in either crude or extract form, for their primary health care. There is relatively little discussion as yet, about the long term effects of the current, non-sustainable harvesting methods for medicinal plants from the wild, which are depleting these critical resources without concurrent initiatives to commercialize their cultivation. To meet future public health care needs, a paradigm shift is required in order to adopt new approaches using contemporary technology which will result in drugs being regarded as a sustainable commodity, irrespective of their source. In this presentation, several approaches to enhancing and sustaining the availability of drugs, both synthetic and natural, will be discussed, including the use of vegetables as chemical reagents, and the deployment of integrated strategies involving information systems, biotechnology, nanotechnology, and detection techniques for the development of medicinal plants with enhanced levels of bioactive agents.

Utilizing Near Field Communication in Health Care

In this master’s thesis, possibilities to utilize Near Field Communication (NFC) technology in health care applications are examined. NFC is a short-range wireless communication technology that enables the exchange of data between devices. Main components in NFC are tag, which contains data, a NFC reader device, which can be for instance embedded to mobile phone and also act as a tag, and an antennae in both tag and reader. In this work NFC technology is discussed and its utilization in health care information systems that are in use or in trial. Utilization of information technology in health care field is examined superficially. In this thesis, a system utilizing NFC is designed and its requirements and architecture presented. NFC is used in identification of care worker. When care worker arrives at the house of a patient, she brings the NFC-enabled mobile phone near NFC tag. This sends information to the application server. This information contains the time of arrival and patient and location identifier. When care worker leaves the place, she repeats the procedure. Information gathered can be used in reporting and real time tracking.

Induction Motor Drive Energy Efficiency - Simulation and Analysis

A coupled system simulator, based on analytical circuit equations and a finite element method (FEM) model of the motor has been developed and it is used to analyse a frequency-converterfed industrial squirrel-cage induction motor. Two control systems that emulate the behaviour of commercial direct-torque-controlled (DTC) and vector-controlled industrial frequency converters have been studied, implemented in the simulation software and verified by extensive laboratory tests. Numerous factors that affect the operation of a variable speed drive (VSD) and its energy efficiency have been investigated, and their significance in the simulation of the VSD results has been studied. The dependency of the frequency converter, induction motor and system losses on the switching frequency is investigated by simulations and measurements at different speeds for both the vector control and the DTC. Intensive laboratory measurements have been carried out to verify the simulation results.

Toimintaprosessin kehittäminen sairaalaympäristössä teollisuustalouden menetelmin

Työn tavoitteena on tutkia reaaliaikaisen sanelunpurun vaikuttavuutta ja kannattavuutta. Reaaliaikaisen sanelunpurun vaikuttavuuden tarkastelun pohjana käytetään teollisuustalouden puolella tunnettuja ja yrityksissä laajasti käytössä olevia ajatusmalleja, kuten Leania ja Six Sigmaa. Lean –ajattelu perustuu läpimenoajan nopeuttamiseen, hukkaa ja ei lisäarvoa luovien vaiheiden eliminoimisella. Six Sigma keskittyy taas laatuun, jolloin tuote ja palveluvirheitä karsitaan. Lisäksi teoriaosassa käsitellään palveluiden ulkoistamista, tietosuojaa ja palkkakustannusten rakennetta. Empiriaosassa kuvataan kirurgianpoliklinikan ja leikkausosaston prosesseja. Prosesseissa keskitytään nykytilan sekä reaaliaikaisen sanelunpurun vaikutuksiin. Prosessien kuvaamisella saadaan tietoa toiminnan ongelmista ja kehittämiskohteista. Henkilökunnan haastatteluin selvitettiin sanelujonon vaikutuksia sekä kokemuksia ulkoistamisesta. Kustannusanalyysin avulla selvitettiin ulkoistamisen kannattavuutta reaaliaikaisessa sanelunpurussa. Työn tuloksena saatiin vaikuttavuus tarkastelu reaaliaikaisesta sanelunpurusta sekä ulkoistamisen kannattavuudesta. Prosessien kuvaaminen osoittaa, että useissa prosessin eri vaiheissa sanelujen puuttuminen aiheuttaa kustannuksia ja vaikuttaa henkilökunnan työhön. Kustannusanalyysin pohjalta sanelunpurun ulkoistaminen todettiin kannattavaksi. Jatkossa sanelunpurun ulkoistamisessa tulee kiinnittää huomiota siihen, mitkä osat sanelunpurkuprosessista halutaan ulkoistaa. Sähköisten järjestelmien kehittyminen vaikuttaa osaltaan tähän päätökseen. Lisäksi suoritepohjaisen hinnoittelun kehittäminen on tärkeä osa sanelunpurkuprosessin tehokkuutta.

Components of customer value in nurse call solutions

This study aimed to identify the value components of nurse call solutions. The value creation of such systems was analyzed by using a framework that was created based on the existing customer value literature. The empirical part of the study was conducted as a multiple-case study by using qualitative research methods. The data for the analysis was gathered through structured interviews in ten Finnish eldercare centers. The results indicate that a nurse call solution creates value for eldercare centers by increasing the safety of the residents, and by improving the efficiency of the staff while also providing cost savings.

Design of marine generators for alternative diesel-electric power systems

This study compares different electric propulsion systems. Results of the analysis of all the advantages and disadvantages of the different propulsion systems are given. This thesis estimates possibilities to apply different diesel-electric propulsion concepts for different vessel types. Small and medium size vessel’s power ranges are studied. The optimal delivery system is chosen. This choice is made on the base of detailed study of the concepts, electrical equipment market and comparison of mass, volume and efficiency parameters. In this thesis three marine generators are designed. They are: salient pole synchronous generator and two permanent magnet synchronous generators. Their electrical, dimensional, cost and efficiency parameters are compared. To understand all the benefits diagrams with these parameters are prepared. Possible benefits and money savings are estimated. As the result the advantages, disadvantages and boundary conditions for the permanent magnet synchronous generator application in marine electric-power systems are found out.