The adherence to initial processes of care in elderly patients with acute venous thromboembolism.

BACKGROUND We aimed to assess whether elderly patients with acute venous thromboembolism (VTE) receive recommended initial processes of care and to identify predictors of process adherence. METHODS We prospectively studied in- and outpatients aged ≥65 years with acute symptomatic VTE in a multicenter cohort study from nine Swiss university- and non-university hospitals between September 2009 and March 2011. We systematically assessed whether initial processes of care, which are recommended by the 2008 American College of Chest Physicians guidelines, were performed in each patient. We used multivariable logistic models to identify patient factors independently associated with process adherence. RESULTS Our cohort comprised 950 patients (mean age 76 years). Of these, 86% (645/750) received parenteral anticoagulation for ≥5 days, 54% (405/750) had oral anticoagulation started on the first treatment day, and 37% (274/750) had an international normalized ratio (INR) ≥2 for ≥24 hours before parenteral anticoagulation was discontinued. Overall, 35% (53/153) of patients with cancer received low-molecular-weight heparin monotherapy and 72% (304/423) of patients with symptomatic deep vein thrombosis were prescribed compression stockings. In multivariate analyses, symptomatic pulmonary embolism, hospital-acquired VTE, and concomitant antiplatelet therapy were associated with a significantly lower anticoagulation-related process adherence. CONCLUSIONS Adherence to several recommended processes of care was suboptimal in elderly patients with VTE. Quality of care interventions should particularly focus on processes with low adherence, such as the prescription of continued low-molecular-weight heparin therapy in patients with cancer and the achievement of an INR ≥2 for ≥24 hours before parenteral anticoagulants are stopped.

Adapting public agricultural extension services to climate change: Insights from Kenya

This paper analyses the adaptiveness of the Public Agricultural Extension Services (PAES) to climate change. Existing literature, interviews and group discussions among PAES actors in larger Makueni district, Kenya, provided the data for the analyses. The findings show that the PAES already have various elements of adaptiveness in its policies, approaches and methods of extension provision. However, the hierarchical structure of the PAES does not augur well for self-organisation at local levels of extension provision, especially under conditions of abrupt change which climate change might trigger. Most importantly, adpativeness presupposes adaptive capacity but the lack of resources in terms of funding for extension, limited mobility of extension officers, the low extension staff/farmer ratio, the aging of extension staff and significant dependence on donor funding limits the adaptiveness of the PAES. Accordingly criteria and indicators were identified in literature with which an initial assessement of the adaptiiveneess of PAES was conducted. However this assessment framework needs to be improved and future steps will integrate more specific inputs from actors in PAES in order to make the framework operational.

Constraining age distributions of groundwater from public supply wells in diverse hydrogeological settings in Scania, Sweden

Twenty-five public supply wells throughout the hydrogeologically diverse region of Scania, southern Sweden are subjected to environmental tracer analysis (³H–³He,⁴He, CFCs, SF₆ and for one well only also ⁸⁵Kr and ³⁹Ar) to study well and aquifer vulnerability and evaluate possibilities of groundwater age distribution assessment. We find CFC and SF₆ concentrations well above solubility equilibrium with modern atmosphere, indicating local contamination, as well as indications of CFC degradation. The tracer-specific complications considerably constrain possibilities for sound quantitative regional ground- water age distribution assessment and demonstrate the importance of initial qualitative assessment of tracer-specific reliability, as well a need for additional, complementary tracers (e.g. ⁸⁵Kr,³⁹Ar and potentially also ¹⁴C). Lumped parameter modelling yields credible age distribution assessments for representative wells in four type aquifers. Pollution vulnerability of the aquifer types was based on the selected LPM models and qualitative age characterisation. Most vulnerable are unconfined dual porosity and fractured bedrock aquifers, due to a large component of very young groundwater. Unconfined sedimentary aquifers are vulnerable due to young groundwater and a small pre-modern component. Less vulnerable are semi-confined sedimentary or dual-porosity aquifers, due to older age of the modern component and a larger pre-modern component. Confined aquifers appear least vulnerable, due an entirely pre-modern groundwater age distribution (recharged before 1963). Tracer complications aside, environmental tracer analyses and lumped parameter modelling aid in vulnerability assessment and protection of regional groundwater resources.

Persistently elevated troponin I in heart failure patients - a suitable prognosticator and a possible boon to public health?

Baseline elevation of troponin I (TnI) has been associated with worse outcomes in heart failure (HF). However, the prevalence of persistent TnI elevation and its association with clinical outcomes has not been well described. HF is a major public health issue due to its wide prevalence and prognosticators of this condition will have a significant impact on public health. Methods: A retrospective study was performed in 510 patients with an initial HF admission between 2002 to 2004, and all subsequent hospital admissions up to May 2009 were recorded in a de-identified database. Persistent TnI elevation was defined as a level ≥0.05 ng/ml on ≥3 HF admissions. Baseline characteristics, hospital readmissions and all cause mortality were compared between patients with persistent TnI elevation (Persistent), patients with no persistence of TnI (Nonpersistent) and patients who had less than three hospital admissions (admission <3) groups. Also the same data was analyzed using the mean method in which the mean value of all recorded troponin values of each patient was used to define persistence i.e. patients who had a mean troponin level ≥0.05 ng/ml were classified as persistent. Results: Mean age of our cohort was 68.4 years out of which 99.6% subjects were male, 62.4% had ischemic HF. 78.2% had NYHA class III to IV HF, mean LVEF was 25.9%. Persistent elevation of TnI was seen in 26% of the cohort and in 66% of patients with more than 3 hospital admissions. Mean TnI level was 0.67 ± 0.15 ng/ml in the 'Persistent' group. Mean TnI using the mean method was 1.11 ± 7.25 ng/ml. LVEF was significantly lower in persistent group. Hypertension, diabetes, chronic renal insufficiency and mean age did not differ between the two groups. 'Persistent' patients had higher mortality (HR = 1.26, 95% CI = 0.89–1.78, p = 0.199 when unadjusted and HR = 1.29, 95% CI = 0.89–1.86, p = 0.176 when adjusted for race, LVEF and ischemic etiology) HR for mortality in persistent patients was 1.99 (95% CI = 1.06–3.73, p = 0.03) using the mean method. The following results were found in those with ischemic cardiomyopathy (HR = 1.44034, 95% CI = 0.92–2.26, p = 0.113) and (HR = 1.89, 95% CI = 1.01–3.55, p = 0.046) by using the mean method. 2 out of three patients with HF who were readmitted three or more times had persistent elevation of troponin I levels. Patients with chronic persistence of troponin I elevation showed a trend towards lesser survival as compared to patients who did not have chronic persistence, however this did not reach statistical significance. This trend was seen more among ischemic patients than non ischemic patients, but did not reach statistical significance. With the mean method, patients with chronic persistence of troponin I elevation had significantly lesser survival than those without it. Also ischemic patients had significantly lesser survival than non ischemic patients. ^

Should Texas use public funding for bariatric surgery?

Background. Obesity in America has increased exponentially since the 1970s with no sign of slowing down. It is a major public health problem, and is currently the second leading cause of preventable deaths in America (Flegal et al., 2010). Bariatric surgery is currently the only approved therapy that has shown to have a lasting impact on obese patients. While the initial cost of the surgery remains high, numerous cost-benefit analyses have demonstrated an overall cost saving within two to five years (McEwen et al., 2010). Only three states, including Texas, do not currently fund bariatric surgery through Medicare and Medicaid. ^ Objectives. To determine whether the current data on the cost-benefit analysis of bariatric surgery supports Texas' decision to not publicly fund bariatric surgery through its Medicare and Medicaid programs. ^ Methods. We conducted literature reviews to determine the current cost of obesity in Texas as well as the methods being employed to treat obesity currently. We then analyzed the history of bariatric surgery and its current implementation, looking at safety and the future benefits of bariatric surgery. We then looked at key cost-benefit analyses and meta-analyses to determine the cost effectiveness of bariatric surgery. We then analyzed both direct medical expenditures and indirect benefits of bariatric surgery. ^ Conclusions. If the obesity epidemic continues unabated, it will become one of the leading health expenditures in Texas within decades. Given that surgery is currently the only approved therapy for obesity that has been shown to be effective in the majority of patients, Texas' decision not to publicly fund bariatric surgery is short sighted.^

The role of youth sports in public health

Study 1: Schools provide a range of opportunities for youth to be active, however, over the past decade, these opportunities have been declining. Sports teams are a promising venue to promote physical activity yet limited research has examined the gender an ethnic differences in sport participation. The purpose of this study is to examine trends in sport participation from 1991-2009 among US high school students. Secondly, we examined the association between gender and ethnicity with sports over time. This serial cross-sectional study used surveillance data from the Youth Risk Behavior Survey, a probability based sample weighted to represent gender and race/ethnic subpopulations of US high school students. The findings of this paper reveal persistent gender and ethnic disparities for sports participation among US youth. Since sports teams may provide a substantial source of physical activity, greater efforts should be undertaken to increase the participation of girls, especially minorities, in sports teams. ^ Study 2: Sports team participation is congruent with teaching and supporting healthy eating, yet limited research has examined the association between sports participation and dietary behaviors. This study aims to determine the association between youth sports participation and dietary behaviors among elementary-aged children. Significant dose-response associations were observed between number of sports teams and consumption of most fruits and vegetables. The likelihood of eating fruit for boys increased with the number of sports teams (1 team: OR=1.89; 3 teams: OR=3.44, p<0.001) and the likelihood of consuming green vegetables for girls was higher with the number of sports teams (1 team: OR=1.50; 3 teams: OR=2.39; p<0.001). For boys, the odds of consuming fruit-flavored drinks was higher ( p=0.019) and the odds of drinking soda was lower (p=0.018) with participation in increasing number of sports teams whereas for girls, sports participation was positively associated with diet soda consumption (p=0.006). ^ Study 3: Parents and peers have been shown to have a strong influence over the physical activity, dietary, and sedentary behaviors of youth. Youth sports teams have the potential to offer physical activity, displace sedentary behaviors, and promote a healthy diet. The purpose of this study is to assess how peer and parental support for physical activity and healthy eating, coupled with sport participation, is associated obesity related risk factors including diet and sedentary behaviors. A secondary analysis of data from the School Physical Activity and Nutrition study, a state-representative survey, was conducted. Eighth (n=3,931) and 11th (n=2,785) grade students were categorized into four groups based upon the level of peer and parental support derived from a three item scale and their participation in sports (sports/high support, sports/low support, no sports/high support, no sports/low support). Linear models were conducted to determine the difference in means between these groups for the following outcome variables: previous day fruit and vegetable intake, scores for an unhealthy and healthy food index, and hours spent watching television, playing video games, and working on a computer. Eighth graders had significantly greater levels of parental support for healthy eating and physical activity compared to 11th grade. Both 8 th and 11th graders in the sport/high support for healthy eating from peers and parents scored significantly higher on the healthy food index than other groups. Eighth and 11th graders in the sport/high support for physical activity from peers participated in fewer hours of sedentary behaviors than any other group (p ≤ 0.032). Although it is thought that sport participation may offer opportunities to support a healthy diet and displace sedentary time by offering providing physical activity, our study found that parental and peer support for activity and healthy eating may further attenuate this association. Parents and peer support should be an important target when developing strategies to improve healthy diets and reduce sedentary time among youth, especially in the context of youth sports. (Abstract shortened by UMI.)^

Resilience in Cloud Computing for Critical Systems. Resilience, Dependability, Reliability in the use of Cloud Computing in Critical Systems in Public Organizations.

La informática se está convirtiendo en la quinta utilidad (gas, agua, luz, teléfono) en parte debido al impacto de Cloud Computing en las mayorías de las organizaciones. Este uso de informática es usada por cada vez más tipos de sistemas, incluidos Sistemas Críticos. Esto tiene un impacto en la complejidad internad y la fiabilidad de los sistemas de la organización y los que se ofrecen a los clientes. Este trabajo investiga el uso de Cloud Computing por sistemas críticos, centrándose en las dependencias y especialmente en la fiabilidad de estos sistemas. Se han presentado algunos ejemplos de su uso, y aunque su utilización en sistemas críticos no está extendido, se presenta cual puede llegar a ser su impacto. El objetivo de este trabajo es primero definir un modelo que pueda representar de una forma cuantitativa las interdependencias en fiabilidad y interdependencia para las organizaciones que utilicen estos sistemas, y aplicar este modelo en un sistema crítico del campo de sanidad y mostrar sus resultados. Los conceptos de “macro-dependability” y “micro-dependability” son introducidos en el modelo para la definición de interdependencia y para analizar la fiabilidad de sistemas que dependen de otros sistemas. ABSTRACT With the increasing utilization of Internet services and cloud computing by most organizations (both private and public), it is clear that computing is becoming the 5th utility (along with water, electricity, telephony and gas). These technologies are used for almost all types of systems, and the number is increasing, including Critical Infrastructure systems. Even if Critical Infrastructure systems appear not to rely directly on cloud services, there may be hidden inter-dependencies. This is true even for private cloud computing, which seems more secure and reliable. The critical systems can began in some cases with a clear and simple design, but evolved as described by Egan to "rafted" networks. Because they are usually controlled by one or few organizations, even when they are complex systems, their dependencies can be understood. The organization oversees and manages changes. These CI systems have been affected by the introduction of new ICT models like global communications, PCs and the Internet. Even virtualization took more time to be adopted by Critical systems, due to their strategic nature, but once that these technologies have been proven in other areas, at the end they are adopted as well, for different reasons such as costs. A new technology model is happening now based on some previous technologies (virtualization, distributing and utility computing, web and software services) that are offered in new ways and is called cloud computing. The organizations are migrating more services to the cloud; this will have impact in their internal complexity and in the reliability of the systems they are offering to the organization itself and their clients. Not always this added complexity and associated risks to their reliability are seen. As well, when two or more CI systems are interacting, the risks of one can affect the rest, sharing the risks. This work investigates the use of cloud computing by critical systems, and is focused in the dependencies and reliability of these systems. Some examples are presented together with the associated risks. A framework is introduced for analysing the dependability and resilience of a system that relies on cloud services and how to improve them. As part of the framework, the concepts of micro and macro dependability are introduced to explain the internal and external dependability on services supplied by an external cloud. A pharmacovigilance model system has been used for framework validation.

Dashboard configurable para la gestión y administración de una instancia de OpenStack

En este documento está descrito detalladamente el trabajo realizado para completar todos objetivos marcados para este Trabajo de Fin de Grado, que tiene como meta final el desarrollo de un dashboard configurable de gestión y administración para instancias de OpenStack. OpenStack es una plataforma libre y de código abierto utilizada como solución de Infraestructura como Servicio (Infrastructure as a Service, IaaS) en clouds tanto públicos, que ofrecen sus servicios cobrando el tiempo de uso o los recursos utilizados, como privados para su utilización exclusiva en el entorno de una empresa. El proyecto OpenStack se inició como una colaboración entre la NASA y RackSpace, y a día de hoy es mantenido por las empresas más potentes del sector tecnológico a través de la Fundación OpenStack. La plataforma OpenStack permite el acceso a sus servicios a través de una Interfaz de Linea de Comandos (Command Line Interface, CLI), una API RESTful y una interfaz web en forma de dashboard. Esta última es ofrecida a través del servicio Horizon. Este servicio provee de una interfaz gráfica para acceder, gestionar y automatizar servicios basados en cloud. El dashboard de Horizon presente algunos problemas como que: solo admite opciones de configuración mediante código Python, lo que hace que el usuario no tenga ninguna capacidad de configuración y que el administrador esté obligado a interactuar directamente con el código. no tiene soporte para múltiples regiones que permitan que un usuario pueda distribuir sus recursos por distintos centros de datos en diversas localizaciones como más le convenga. El presente Trabajo de Fin de Grado, que es la fase inicial del proyecto FI-Dash, pretende solucionar estos problemas mediante el desarrollo de un catálogo de widget de la plataformaWireCloud que permitirán al usuario tener todas las funcionalidades ofrecidas por Horizon a la vez que le ofrecen capacidades de configuración y añaden funcionalidades no presentes en Horizon como el soporte de múltiples regiones. Como paso previo al desarrollo del catálogo de widgets se ha llevado a cabo un estudio de las tecnologías y servicios ofrecidos por OpenStack, así como de las herramientas que pudieran ser necesarias para la realización del trabajo. El proceso de desarrollo ha sido dividido en distintas fases de acuerdo con los distintos componentes que forman parte del dashboard cada uno con una funcion de gestion sobre un tipo de recurso distinto. Las otras fases del desarrollo han sido la integración completa del dashboard en la plataforma WireCloud y el diseño de una interfaz gráfica usable y atractiva.---ABSTRACT---Throughout this document it is described the work performed in order to achieve all of the objectives set for this Final Project, which has as its main goal the development of a configurable dashboard for managing and administrating OpenStack instances. OpenStack is a free and open source platform used as Infrastructure as a Service (IaaS) for both public clouds, which offer their services through payments on time or resources used, and private clouds for use only in the company’s environment. The OpenStack project started as a collaboration between NASA and Rackspace, and nowadays is maintained by the most powerful companies in the technology sector through the OpenStack Foundation. The OpenStack project provides access to its services through a Command Line Interface (CLI), a RESTful API and a web interface as dashboard. The latter is offered through a service called Horizon. This service provides a graphical interface to access, manage and automate cloud-based services. Horizon’s dashboard presents some problems such as: Only supports configuration options using Python code, which grants the user no configuration capabilities and forces the administrator to interact directly. No support for multiple regions that allow a user to allocate his resources by different data centers in different locations at his convenience. This Final Project, which is the initial stage of the FI-Dash project, aims to solve these problems by developing a catalog of widgets for the WireCloud platform that will allow the user to have all the features offered by Horizon while offering configuration capabilities and additional features not present in Horizon such as support for multiple regions. As a prelude to the development of the widget catalog, a study of technologies and services offered by OpenStack as well as tools that may be necessary to carry out the work has been conducted. The development process has been split in phases matching the different components that are part of the dashboard, having each one of them a function of management of one kind of resource. The other development phases have been the achieving of full integration with WireCloud and the design of a graphical interface that is both usable and atractive.

O PIBID - Programa Institucional de Bolsas de Iniciação à Docência e a crise das Licenciaturas: o caso de um Curso de Pedagogia a Distância

Tendo em vista a atual crise das licenciaturas, especialmente em termos da pouca atratividade que a formação para a docência vem apresentando em nosso contexto educacional e, considerando, ainda, as críticas sobre a fragilidade da formação inicial de professores ocorrer na modalidade a distância (no caso, o curso de Pedagogia), o PIBID - Programa Institucional de Bolsas de Iniciação à Docência surge como uma política de incentivo e valorização do magistério com o propósito de contribuir para uma formação mais sólida e articulada em termos da relação teoria-prática, especialmente pela proximidade que favorece aos alunos bolsistas, com o cotidiano escolar – este é o foco desta investigação que teve por objetivos: refletir sobre o histórico da formação docente em interface com a desvalorização do magistério que, consequentemente, levou à crise das licenciaturas e, a partir disso, analisar a proposição do PIBID como uma política pública para o enfrentamento desta crise; analisar as representações de bolsistas do PIBID, de um curso de Pedagogia a distância, sobre a experiência que estão tendo, e se ela contribui, no caso dos licenciandos, para o fortalecimento da escolha pela carreira docente; verificar as contribuições do programa para a formação dos licenciandos, dos supervisores (professores das escolas públicas parceiras) e do coordenador de área e se este oportuniza uma complementação na preparação para o exercício da docência. A pesquisa realizou uma revisão da literatura sobre a crise das licenciaturas e o contexto do aparecimento do PIBID, bem como sobre a formação de professores ocorrer na modalidade a distância, tendo como referencial teórico autores como Libâneo (1998), Gatti e Barreto (2009), Bahia e Duran (2011), Scheibe (2006), Sommer (2010), FCC (2009), Tardif (2005). Realizou, também, uma pesquisa de campo que teve como sujeitos sete bolsistas do PIBID de um curso de Pedagogia a distância (de uma instituição de ensino superior, particular, de São Paulo), sendo: quatro licenciandas, duas supervisoras e uma coordenadora de área do subprojeto. Foram aplicados dois instrumentos para a coleta de dados: um questionário para o delineamento do perfil dos sujeitos e a realização de entrevistas de aprofundamento. As reflexões realizadas a partir da revisão da literatura e das análises dos dados coletados junto aos sujeitos indicam que: em relação à proposição da formação inicial de professores a distância, esta denota maiores críticas, diferentemente da formação continuada de professores a distância, que apresenta uma maior aceitabilidade; em relação ao PIBID, os estudos vêm apontando a positividade das diversas experiências que vêm se desenvolvendo no território nacional e que denotam um trabalho articulado entre teoria e prática, bem como no resgate da identidade docente, com uma ênfase na valorização, inserção e permanência dos licenciandos nos seus cursos; as representações dos sujeitos investigados sobre a experiência que estão tendo com o PIBID apontam para: o reconhecimento de que o Programa garante, efetivamente, a reflexão e vivência entre a teoria e prática; a contribuição para a aquisição de maior segurança na relação com os alunos das escolas parceiras e também no desenvolvimento das atividades práticas; a certeza e/ou convicção de que realmente querem ser professoras

Food, nutrition and public health in contemporary Spain, 1900-1936

Within the context of the health reforms introduced in Spain in the early 20th century and the influence of international health organisations on their development, this article analyses the growing interest that surrounded nourishment and food-related problems at that time in relation to healthcare, the diagnosis provided by hygienists of such problems, and the public health measures applied to resolve them. The issue of hygienic diet and the collective aspect of nutritional problems became priorities in the field of healthcare. Two of the most prominent initiatives involved setting up a Department of Nutrition and Food Hygiene and Bromatological Technique during the early years of the Second Republic, as part of the National School of Health, as well as a Food Hygiene Service. Spanish hygienists underlined the importance of education and the dissemination of information about food hygiene, health and nutrition, in order to overcome the qualitative and quantitative deficiencies observed in the average diet of the Spanish population.

Initial evaluation of the existing technologies for vehicle detection.

Texas Department of Transportation, Austin

Selected data on initial operations under the disability freeze provision of the Social Security Amendments of 1954.

Mode of access: Internet.

An initial assessment of the literature on the measurement, control, transport, transformation and health effects of urregulated diesel engine emissions /

Final report, January 1979.

Competency rosters of NIH initital [i.e. initial] review groups, beginning July 1, 1985.

Mode of access: Internet.