Analysis of patient flows for orthopedic procedures using small area analysis in Switzerland

BACKGROUND: In general cantons regulate and control the Swiss health service system; patient flows within and between cantons are thereby partially disregarded. This paper develops an alternative spatial model, based upon the construction of orthopedic hospital service areas (HSAOs), and introduces indices for the analysis of patient streams in order to identify areas, irrespective of canton, with diverse characteristics, importance, needs, or demands. METHODS: HSAOs were constructed using orthopedic discharge data. Patient streams between the HSAOs were analysed by calculating three indices: the localization index (% local residents discharged locally), the netindex (the ratio of discharges of nonlocal incoming residents to outgoing local residents), and the market share index (% of local resident discharges of all discharges in local hospitals). RESULTS: The 85 orthopedic HSAOs show a median localization index of 60.8%, a market share index of 75.1%, and 30% of HSAOs have a positive netindex. Insurance class of bed, admission type, and patient age are partially but significantly associated with those indicators. A trend to more centrally provided health services can be observed not only in large urban HSAOs such as Geneva, Bern, Basel, and Zurich, but also in HSAOs in mountain sport areas such as Sion, Davos, or St.Moritz. Furthermore, elderly and emergency patients are more frequently treated locally than younger people or those having elective procedures. CONCLUSION: The division of Switzerland into HSAOs provides an alternative spatial model for analysing and describing patient streams for health service utilization. Because this small area model allows more in-depth analysis of patient streams both within and between cantons, it may improve support and planning of resource allocation of in-patient care in the Swiss healthcare system.

Exploiting OSGi capabilities from MHP applications

In this paper we introduce a cooperative environment between the Interactive Digital TV (IDTV) and home networking with the aim of allowing the interaction between interactive TV applications and the controllers of the in-home appliances in a natural way. More specifically, our proposal consists of merging MHP (Multimedia Home Platform), one of the main standard frameworks for IDTV, with OSGi (Open Service Gateway Initiative), the most widely used open platform to set up Residential Gateways. To overcome the radically different nature of these specifications the function-oriented MHP middleware and the service-oriented OSGi framework , we define a new kind of application, coined as XbundLET. Although this software bridge is suitable to enable the interaction between MHP and OSGi applications in both directions, we concretely focus on exposing our implementation experience in only one direction: from MHP to the OSGi world.

Behavior Problems of Maltreated Children Receiving In-Home Child Welfare Services

This study evaluates the level of behavior problems in a previously little studied group—children with founded cases of abuse and neglect receiving child welfare services in their own homes. A sample of 149 maltreated children, living at home, were evaluated on the CBCL as they entered a service program to which they were referred by a large public child protective service system. These children were found to have elevated levels of behavior problems, with 43.6% scoring in the problematic range, a rate similar to children entering foster care. Practice and policy implications of these findings are discussed and highlighted.

[Pilot Project: Improved Lung Deposition via a New Nasal Inhalation Procedure].

INTRODUCTION Inhaled drugs can only be effective if they reach the middle and small airways. This study introduces a system that combines a trans-nasal application of aerosols with noninvasive pressure support ventilation. METHODS In a pilot study, 7 COPD patients with GOLD stages II and III inhaled a radiolabeled marker dissolved in water via a trans-nasal route. The mean aerosol particle size was 5.5 µm. Each patient took part in two inhalation sessions that included two application methods and were at least 70 hours apart. During the first session ("passive method"), the patient inhaled the aerosol through an open tube system. The second session ("active method") included pressure support ventilation during the inhalation process. A gamma camera and planar scintigraphy was used to determine the distribution of aerosol particles in the patient's body and lung. RESULTS The pressure supported inhalation ("active method") results in an increased aerosol lung deposition compared to the passive method. Above all, we could demonstrate deposition in the lung periphery with relatively large aerosol particles (5.5 µm). DISCUSSION The results prove that the combination of trans-nasal inhalation with noninvasive pressure support ventilation leads to significantly increased particle deposition in the lung.

Improving Health Literacy in Connecticut: A Prescription for Healthy Lives and Communities

The Practicum Project is a supervised service-learning experience that integrates curriculum with hands-on experience in a public health setting. All 2nd year students are expected to work collaboratively in assessing the extent, causes and public health responses to a selected public health problem confronting citizens of Connecticut. The focal topic for the 2006 Project was Health Literacy in Connecticut. During this past spring, 17 students of our program, working alongside and in partnership with more than 75 community-based stakeholders across Connecticut, completed over 1800 hours of service-learning in pursuit of answers to 3 questions: Can the present and future burden of health literacy be estimated for Connecticut? What is the current capacity of Connecticut’s health and social service system to halt the crisis we confront today? Can new policy and regulatory strategies be put forth to reduce the severity and scope of the problem? This occasion and the accompanying report mark the completion of their project and acknowledge the considerable contributions that many have made to the success of this educational experience. Through those combined efforts, students gained experience and skill addressing one of the most significant public health issues of our time; also, they gained insight into the breadth and capacity of our public health system and established invaluable relationships with public health practitioners, agencies and institutions around the state. Their report documents a rich campus-community partnership to advance public health goals.

Halting Childhood Obesity in Connecticut

The Practicum Project is a supervised service-learning experience that integrates curriculum with hands-on experience in a public health setting. All 2nd year students are expected to work collaboratively in assessing the extent, causes and public health responses to a selected public health problem confronting citizens of Connecticut. The focal topic for the 2005 Project was Control of Childhood Obesity in Connecticut. During this past spring, 25 students of our program, working alongside and in partnership with more than 130 community-based stakeholders across Connecticut, completed 2,083 hours of service-learning in pursuit of answers to 3 questions: Can the present and future burden of childhood obesity be estimated for Connecticut? What is the current capacity of Connecticut’s health and social service system to address the crisis we confront today? Can new policy and regulatory strategies be put forth to reduce the severity and scope of the problem? This occasion and the accompanying report mark the completion of their project and acknowledges the considerable contributions that many have made to the success of this educational experience. Through those combined efforts, students gained experience and skill addressing one of the most significant public health issues of our time; also, they gained insight into the breadth and capacity of our public health system and established invaluable relationships with public health practitioners, agencies and institutions around the state. Their report documents a rich campus-community partnership to advance public health goals.

Walking Our Talk in the Neighborhoods: Building Professional/Natural Helper Partnerships

This article describes our efforts in Tacoma, Washington, to establish professional and natural helper partnerships to work with families involved in the child protective service system. It uses our experiences to describe the ways that natural helpers and professionals can help one another in getting better results for families.

Intersystem Collaboration: A Statewide Initiative to Support Families

The study described in this paper utilized a qualitative case study method to assess the processes involved in inter-system collaboration in the context of one state's system change initiative. The collaborative experience is described from the perspective of participating service system professionals and family members. The major themes of collaboration that emerged from the study included changes in communication across systems, changes in inter-system relationships, changes in attitudes, changes in interactions with families, and changes in the ways services are delivered. Lessons learned and practice implications of each theme are discussed.

A telematics solution for the remote follow-up of malnourished children in underserved areas

The identification of malnourished children living under extreme poverty conditions in isolated areas is crucial to trigger urgent interventions like supplementary or therapeutic feeding. This work aims to strengthen the task of following-up malnourished maternal-child population in rural areas of developing countries like Nicaragua. The solution facilitates low-cost health nutritional remote monitoring to support rural communities at the point of care. Thus, the system allows medical staff to communicate with brigades, who transmit anthropometric measurements, such as weight and height of the children, from communities which are sited about 12 km. far away. A hybrid WiMAX/WiFi architecture was deployed to provide affordable communications between the isolated communities and the health center. Furthermore, a free PBX software and an open information system, installed at the health center, support WiFi based mobile communications and information management to support the care needs of maternal-child population at risk.

Implementación de una herramienta de productividad para el desarrollo y despliegue de aplicaciones

En la actualidad se está viviendo el auge del Cloud Computing (Computación en la Nube) y cada vez son más las empresas importantes en el sector de las Tecnologías de la Información que apuestan con fuerza por estos servicios. Por un lado, algunas ofrecen servicios, como Amazon y su sistema IaaS (Infrastructure as a Service) Amazon Web Services (AWS); por otro, algunas los utilizan, como ocurre en el caso de este proyecto, en el que Telefonica I+D hace uso de los servicios proporcionados por AWS para sus proyectos. Debido a este crecimiento en el uso de las aplicaciones distribuidas es importante tener en cuenta el papel que desempeñan los desarrolladores y administradores de sistemas que han de trabajar y mantener todas las máquinas remotas de uno o varios proyectos desde una única máquina local. El ayudar a realizar estas tareas de la forma más cómoda y automática posible es el objetivo principal de este proyecto. En concreto, el objetivo de este proyecto es el diseño y la implementación de una solución software que ayude a la productividad en el desarrollo y despliegue de aplicaciones en un conjunto de máquinas remotas desde una única máquina local, teniendo como base una prueba de concepto realizada anteriormente que prueba las funcionalidades más básicas de las librerías utilizadas para el desarrollo de la herramienta. A lo largo de este proyecto se han estudiado las diferentes alternativas que se encuentran en el mercado que ofrecen al menos parte de la soluci6n a los problemas abordados, pese a que los requisitos de la empresa indicaban que la herramienta debía implementarse de forma completa. Se estudió a fondo después la prueba de concepto de la que se partía para, con los conocimientos adquiridos sobre el tema, mejorarla cumpliendo los objetivos marcados. Tras el desarrollo y la implementaci6n completa de la herramienta se proponen posibles caminos a seguir en el futuro. ---ABSTRACT---Nowadays we are experiencing the rise of Cloud Computing and every day more and more important IT companies are betting hard for this kind of services. On one hand, some of these companies offer services such as Amazon IaaS (Infrastructure as a Service) system Amazon Web Services (AWS); on the other hand, some of them use these services, as in the case of this project, in which Telefonica I+D uses the services provided by AWS in their projects. Due this growth in the use of distributed applications it is important to consider the developers and system administrators' roles, who have to work and do the maintenance of all the remote machines from one or several projects from a single local machine. The main goal of this project is to help with these tasks making them as comfortable and automatically as possible. Specifically, the goal of this project is the design and implementation of a software solution that helps to achieve a better productivity in the development of applications on a set of remote machines from a single local machine, based on a proof of concept developed before, in which the basic functionality of the libraries used in this tool were tested. Throughout this project the different alternatives on the market that offer at least part of the solution to the problem addressed have been studied, although according to the requirements of the company, the tool should be implemented from scratch. After that, the basic proof of concept was thoroughly studied and improved with the knowledge acquired on the subject, fulfilling the marked goals. Once the development and full implementation of the tool is done, some ways of improvement for the future are suggested.

A framework for adaptive e-learning for continuum mechanics and structural analysis

This paper presents a project for providing the students of Structural Engineering with the flexibility to learn outside classroom schedules. The goal is a framework for adaptive E-learning based on a repository of open educational courseware with a set of basic Structural Engineering concepts and fundamentals. These are paramount for students to expand their technical knowledge and skills in structural analysis and design of tall buildings, arch-type structures as well as bridges. Thus, concepts related to structural behaviour such as linearity, compatibility, stiffness and influence lines have traditionally been elusive for students. The objective is to facilitate the student a teachinglearning process to acquire the necessary intuitive knowledge, cognitive skills and the basis for further technological modules and professional development in this area. As a side effect, the system is expected to help the students improve their preparation for exams on the subject. In this project, a web-based open-source system for studying influence lines on continuous beams is presented. It encompasses a collection of interactive user-friendly applications accessible via Web, written in JavaScript under JQuery and Dygraph Libraries, taking advantage of their efficiency and graphic capabilities. It is performed in both Spanish and English languages. The student is enabled to set the geometric, topologic, boundary and mechanic layout of a continuous beam. While changing the loading and the support conditions, the changes in the beam response prompt on the screen, so that the effects of the several issues involved in structural analysis become apparent. This open interaction with the user allows the student to simulate and virtually infer the structural response. Different levels of complexity can be handled, whereas an ongoing help is at hand for any of them. Students can freely boost their experiential learning on this subject at their own pace, in order to further share, process, generalize and apply the relevant essential concepts of Structural Engineering analysis. Besides, this collection is being added to the "Virtual Lab of Continuum Mechanics" of the UPM, launched in 2013 (http://serviciosgate.upm.es/laboratoriosvirtuales/laboratorios/medios-continuos-en-construcci%C3%B3n)

Controle cooperativo aplicado a sistemas de posicionamento dinâmico.

Hoje em dia com o crescente aumento da exploração de petróleo e gás em águas profundas, há um aumento na demanda por operações offshore envolvendo a cooperação entre unidades flutuantes. Tais operações requerem um alto nível de planejamento e coordenação, o que na maioria dos casos é feito com a troca de informação no nível de operação, com cada unidade flutuante comandada independentemente. Exemplos de operações deste tipo vão desde operações de alívio passando por operações de instalação de equipamento submarino, até operações de pesquisa envolvendo múltiplas unidades flutuantes dotadas de sistema de posicionamento dinâmico (DP). As vantagens do controle cooperativo surgem com a redução do erro da distância relativa durante a manutenção do posicionamento ou durante a execução de manobras de posicionamento conjuntas. No presente trabalho, os conceitos de controle de consenso são aplicados de forma combinada com o sistema DP de cada navio. A influência dos ganhos do controlador cooperativo no sistema como um todo será discutida, utilizando-se técnicas de análise da resposta em frequência. Simulações completas no domínio do tempo e experimentos usando modelos em escala serão utilizados para se demonstrar o funcionamento do controle cooperativo. Todas as simulações serão conduzidas no simulador Dynasim e os ensaios experimentais no tanque de provas da Engenharia Naval da Escola Politécnica da Universidade de São Paulo. Além disso, serão feitas comparações entre os experimentos em tanque de provas e simulações numéricas equivalentes, demonstrando-se a validade dos ensaios numéricos. Será também demonstrado que os requisitos de projetos adotados são atendidos pelos ensaios em tanque de provas. .

Development and programming of Geophonino: A low cost Arduino-based seismic recorder for vertical geophones

The commercial data acquisition systems used for seismic exploration are usually expensive equipment. In this work, a low cost data acquisition system (Geophonino) has been developed for recording seismic signals from a vertical geophone. The signal goes first through an instrumentation amplifier, INA155, which is suitable for low amplitude signals like the seismic noise, and an anti-aliasing filter based on the MAX7404 switched-capacitor filter. After that, the amplified and filtered signal is digitized and processed by Arduino Due and registered in an SD memory card. Geophonino is configured for continuous registering, where the sampling frequency, the amplitude gain and the registering time are user-defined. The complete prototype is an open source and open hardware system. It has been tested by comparing the registered signals with the ones obtained through different commercial data recording systems and different kind of geophones. The obtained results show good correlation between the tested measurements, presenting Geophonino as a low-cost alternative system for seismic data recording.

Shell size, body mass and average pO2 in mantle cavity water of different marine mollusc species

Marine invertebrates with open circulatory system establish low and constant oxygen partial pressure (Po2) around their tissues. We hypothesized that as a first step towards maintenance of low haemolymph and tissue oxygenation, the Po2 in molluscan mantle cavity water should be lowered against normoxic (21 kPa) seawater Po2, but balanced high enough to meet the energetic requirements in a given species. We recorded Po2 in mantle cavity water of five molluscan species with different lifestyles, two pectinids (Aequipecten opercularis, Pecten maximus), two mud clams (Arctica islandica, Mya arenaria), and a limpet (Patella vulgata). All species maintain mantle cavity water oxygenation below normoxic Po2. Average mantle cavity water Po2 correlates positively with standard metabolic rate (SMR): highest in scallops and lowest in mud clams. Scallops show typical Po2 frequency distribution, with peaks between 3 and 10 kPa, whereas mud clams and limpets maintain mantle water Po2 mostly <5 kPa. Only A. islandica and P. vulgata display distinguishable temporal patterns in Po2 time series. Adjustment of mantle cavity Po2 to lower than ambient levels through controlled pumping prevents high oxygen gradients between bivalve tissues and surrounding fluid, limiting oxygen flux across the body surface. The patterns of Po2 in mantle cavity water correspond to molluscan ecotypes.

Long-term changes in beach fauna at Duck, North Carolina /

Long-term changes in the beach fauna at Duck, North Carolina, were investigated. Twenty-one stations located on three transects on the oceanside and twenty-four stations located on three transects on the sound side were sampled seasonally from November 1980 to July 1981. The data collected in this study were compared to a previous study conducted in 1976 (Matta, 1977) to investigate the potential effects of the construction of the CERC Field Research Facility pier on the adjacent beaches. No effects on the benthic fauna were found. Changes observed in the benthic macrofauna on the ocean beaches were well within the range attributable to the natural variation of an open coast system. The ocean beach macrofauna was observed to form a single community migrating on an off the beach with the seasons. On the sound beaches, changes were detected in the benthic macrofauna; however, these were attributed to a salinity increase during the 1981 sampling year. (Author).