Substituting home care for hospitalization:The role of a quick response service for the elderly

The purpose of the present study was to examine the role of a rapid access home-based service as a means for the elderly to avoid admission to an acute-care hospital. The setting for the study included emergency departments in three acute care hospitals and a home care program in a mid-size Canadian city. Multiple sources of information were obtained to evaluate the service. Hospital emergency department records and home care records were reviewed. Patients who participated in the service (n=96) and physicians and nurses (n =119) who had involvement with the service were surveyed appraising the service in terms of relevance, access, quality and coordination. Study results revealed that elderly women with multiple health problems who lived alone were the most frequent users of the service. The majority of the patients admitted to the service presented with problems of a functional nature that were the result of a fall or mobility problems. The results indicated that the service did avert hospital admissions and facilitated a process by which patients could avoid the intermediate step of hospitalization before placed in a higher level of care or returning to previous levels of functioning. Economic analysis indicated that the value of the service stemmed from the benefits to patients and caregivers rather than from cost savings offered to acute care hospitals.

A quinazoline derivative as quick-response red-shifted reporter for nanomolar Al3+ and applicable to living cell staining

A newly synthesized and structurally characterized quinazoline derivative (L) has been shown to act as a quick-response chemosensor for Al3+ with a high selectivity over other metal ions in water-DMSO. In the presence of Al3+, L shows a red-shifted ratiometric enhancement in fluorescence as a result of internal charge transfer and chelation-enhanced fluorescence through the inhibition of a photo-induced electron transfer mechanism. This probe detects Al3+ at concentrations as low as 1.48 nM in 100 mM HEPES buffer (DMSO-water, 1 : 9 v/v) at biological pH with a very short response time (15-20 s). L was applied to biological imaging to validate its utility as a fluorescent probe for monitoring Al3+ ions in living cells, illustrating its value in practical environmental and biological systems.

Renal and cardiovascular effects of caffeine:a dose-response study

The effects of increasing oral doses of caffeine (45, 90, 180 and 360 mg) on effective renal plasma flow (ERPF), plasma renin activity (PRA), serum electrolytes, plasma noradrenaline, blood pressure and heart rate were studied in eight healthy male volunteers. Urine volume was increased by 360 mg of caffeine only. At caffeine doses greater than 90 mg urinary sodium excretion was significantly increased. There were no changes in ERPF. Serum potassium was significantly reduced by 360 mg of caffeine. Caffeine increased systolic pressure in a dose related manner. Diastolic pressure was also increased, but not in relation to dose. A 360 mg dose of caffeine produced a late increase in heart rate. These changes were not associated with any alterations in PRA or in plasma noradrenaline.

The effect of hunger level on predation dynamics in the spider Nesticodes rufipes: a functional response study

It is well known that a predator has the potential to regulate a prey population only if the predator responds to increases in prey density and inflicts greater mortality rates. Predators may cause such density-dependent mortality depending on the nature of the functional and numerical responses. As spiders are usually faced with a shortage of prey, the killing behavior of the spider Nesticodes rufipes at varying densities of Musca domestica was examined here through laboratory functional response experiments where spiders were deprived of food for 5 (well-fed) or 20 days (hungry). An additional laboratory experiment was also carried out to assess handling time of spiders. The number of prey killed by spiders over 24- and 168-h periods of predator-prey interaction was recorded. Logistic regression analyses revealed the type II functional response for both well-fed and hungry spiders. We found that the lower predation of hungry spiders during the first hours of experimentation was offset later by an increase in predation ( explained by estimated handling times), resulting in similarity of functional response curves for well-fed and hungry spiders. It was also observed that the higher number of prey killed by well-fed spiders over a 24- h period of spider-prey interaction probably occurred due to their greater weights than hungry spiders. We concluded that hungry spiders may be more voracious than well-fed spiders only over longer time periods, since hungry spiders may spend more time handling their first prey items than well-fed spiders.

Weigh-in-motion and response study of four inservice bridges. Final report.

Federal Highway Administration, Office of Engineering and Highway Operations Research, Development and Technology, McLean, Va.

Riskfyllt vatten : Hur individen skapar sig en förståelse av oväntad parasitförekomst i dricksvattnet

Risky water How the individual makes sense of unexpected parasites in the drinking water This quick response study was carried out with the aim to study how individuals made sense of the outbreak of the parasite Cryptosporidium in the drinking water in Ostersund. In total 24 interviews were made with people in Ostersund. The result shows that the interviewees related to social as well as spatial dimensions when they made sense of this risky situation, which can be understood in relation to the concept of sensemaking of risk. Six groups among the interviewees emerged in the analysis, illustrating how different aspects of the risk where focused in the process of sensemaking. Further, the study shows that the process of sensemaking was built upon direct as well as indirect social relations, where the interviewees made sense of the risk by relating to people who were close to them as well as to people to whom they had no personal relation. These indirect social relations were defined as: elderly, children and people in other countries, which also points at the fact that the interviewees made sense of the risk in a global context. Finally, the results suggest that social relations could be further explored in future studies in sensemaking of risk.

Development of a technological innovation capability assessment model:a case study of manufacturing SMEs in Sialkot, Pakistan

Small and Medium Enterprises (SMEs) play an important part in the economy of any country. Initially, a flat management hierarchy, quick response to market changes and cost competitiveness were seen as the competitive characteristics of an SME. Recently, in developed economies, technological capabilities (TCs) management- managing existing and developing or assimilating new technological capabilities for continuous process and product innovations, has become important for both large organisations and SMEs to achieve sustained competitiveness. Therefore, various technological innovation capability (TIC) models have been developed at firm level to assess firms‘ innovation capability level. These models output help policy makers and firm managers to devise policies for deepening a firm‘s technical knowledge generation, acquisition and exploitation capabilities for sustained technological competitive edge. However, in developing countries TCs management is more of TCs upgrading: acquisitions of TCs from abroad, and then assimilating, innovating and exploiting them. Most of the TIC models for developing countries delineate the level of TIC required as firms move from the acquisition to innovative level. However, these models do not provide tools for assessing the existing level of TIC of a firm and various factors affecting TIC, to help practical interventions for TCs upgrading of firms for improved or new processes and products. Recently, the Government of Pakistan (GOP) has realised the importance of TCs upgrading in SMEs-especially export-oriented, for their sustained competitiveness. The GOP has launched various initiatives with local and foreign assistance to identify ways and means of upgrading local SMEs capabilities. This research targets this gap and developed a TICs assessment model for identifying the existing level of TIC of manufacturing SMEs existing in clusters in Sialkot, Pakistan. SME executives in three different export-oriented clusters at Sialkot were interviewed to analyse technological capabilities development initiatives (CDIs) taken by them to develop and upgrade their firms‘ TCs. Data analysed at CDI, firm, cluster and cross-cluster level first helped classify interviewed firms as leader, follower and reactor, with leader firms claiming to introduce mostly new CDIs to their cluster. Second, the data analysis displayed that mostly interviewed leader firms exhibited ‗learning by interacting‘ and ‗learning by training‘ capabilities for expertise acquisition from customers and international consultants. However, these leader firms did not show much evidence of learning by using, reverse engineering and R&D capabilities, which according to the extant literature are necessary for upgrading existing TIC level and thus TCs of firm for better value-added processes and products. The research results are supported by extant literature on Sialkot clusters. Thus, in sum, a TIC assessment model was developed in this research which qualitatively identified interviewed firms‘ TIC levels, the factors affecting them, and is validated by existing literature on interviewed Sialkot clusters. Further, the research gives policy level recommendations for TIC and thus TCs upgrading at firm and cluster level for targeting better value-added markets.

A forced titration study of the antioxidant and immunomodulatory effects of Ambrotose AO supplement

Background Oxidative stress plays a role in acute and chronic inflammatory disease and antioxidant supplementation has demonstrated beneficial effects in the treatment of these conditions. This study was designed to determine the optimal dose of an antioxidant supplement in healthy volunteers to inform a Phase 3 clinical trial. Methods The study was designed as a combined Phase 1 and 2 open label, forced titration dose response study in healthy volunteers (n = 21) to determine both acute safety and efficacy. Participants received a dietary supplement in a forced titration over five weeks commencing with a no treatment baseline through 1, 2, 4 and 8 capsules. The primary outcome measurement was ex vivo changes in serum oxygen radical absorbance capacity (ORAC). The secondary outcome measures were undertaken as an exploratory investigation of immune function. Results A significant increase in antioxidant activity (serum ORAC) was observed between baseline (no capsules) and the highest dose of 8 capsules per day (p = 0.040) representing a change of 36.6%. A quadratic function for dose levels was fitted in order to estimate a dose response curve for estimating the optimal dose. The quadratic component of the curve was significant (p = 0.047), with predicted serum ORAC scores increasing from the zero dose to a maximum at a predicted dose of 4.7 capsules per day and decreasing for higher doses. Among the secondary outcome measures, a significant dose effect was observed on phagocytosis of granulocytes, and a significant increase was also observed on Cox 2 expression. Conclusion This study suggests that Ambrotose AO® capsules appear to be safe and most effective at a dosage of 4 capsules/day. It is important that this study is not over interpreted; it aimed to find an optimal dose to assess the dietary supplement using a more rigorous clinical trial design. The study achieved this aim and demonstrated that the dietary supplement has the potential to increase antioxidant activity. The most significant limitation of this study was that it was open label Phase 1/Phase 2 trial and is subject to potential bias that is reduced with the use of randomization and blinding. To confirm the benefits of this dietary supplement these effects now need to be demonstrated in a Phase 3 randomised controlled trial (RCT).

Streamflow response of a small forested catchment on different timescales

The hydrological response of a catchment to rainfall on different timescales is result of a complex system involving a range of physical processes which may operate simultaneously and have different spatial and temporal influences. This paper presents the analysis of streamflow response of a small humid-temperate catchment (Aixola, 4.8 km(2)) in the Basque Country on different timescales and discusses the role of the controlling factors. Firstly, daily time series analysis was used to establish a hypothesis on the general functioning of the catchment through the relationship between precipitation and discharge on an annual and multiannual scale (2003-2008). Second, rainfall-runoff relationships and relationships among several hydrological variables, including catchment antecedent conditions, were explored at the event scale (222 events) to check and improve the hypothesis. Finally, the evolution of electrical conductivity (EC) during some of the monitored storm events (28 events) was examined to identify the time origin of waters. Quick response of the catchment to almost all the rainfall events as well as a considerable regulation capacity was deduced from the correlation and spectral analyses. These results agree with runoff event scale data analysis; however, the event analysis revealed the non-linearity of the system, as antecedent conditions play a significant role in this catchment. Further, analysis at the event scale made possible to clarify factors controlling (precipitation, precipitation intensity and initial discharge) the different aspects of the runoff response (runoff coefficient and discharge increase) for this catchment. Finally, the evolution of EC of the waters enabled the time origin (event or pre-event waters) of the quickflow to be established; specifically, the conductivity showed that pre-event waters usually represent a high percentage of the total discharge during runoff peaks. The importance of soil waters in the catchment is being studied more deeply.

元谋盆地河湖相沉积记录的上新世印度季风转型事件

The Indian monsoon, an integral part of the global climate system, has been extensively investigated during the past decades. Most of the proxy records are derived from marine sediments and focused on time periods of the late Miocene and Pleistocene. The Pliocene represents a period when Earth’s boundary conditions underwent dramatic changes. However, variations of the Indian monsoon during the Pliocene and its forcing mechanisms have remained unclear. The Yuanmou Basin, located in the region of the Indian monsoon, provides an ideal target for understanding the Pliocene history of Indian monsoon variations. Detailed investigations on the lithostratigraphy, magnetostratigraphy and limnology of a 650-m-thick fluvio-lacustrine sedimentary sequence from the basin are carried out in the present study. The clay and clay-plus-fine-silt fractions of the sediments are referred to the midlake-facies components, and changes in the percentages of both fractions generally reflect changes in the water level of the lakes developed in the basin closely related to variations in the intensity of the Indian monsoon. Whereas the greenish-gray lacustrine mud beds represent the environment of deep-water lakes, and the frequency of individual lacustrine mud beds is considered to indicate the frequency of the deep-water lakes developed in the basin associated with the variability of the Indian monsoon. The proxy data suggest that the Indian monsoon experienced abrupt shifts at 3.53, 3.14, 2.78 and 2.42 Ma, respectivey. 1) Since 3.53 Ma, the midlake-facies components displayed a general trend of increase in the concentrations, accompanied by an increase in the sedimentation rate from an average ~10 to 25 cm ka–1. The data suggest that high stands of the lakes in the basin rose progressively, implying a gradual intensification of the Indian monsoon since that time. This shift occurred coeval with the accelerated uplift of the northern Tibetan Plateau, denoting a close link between the Indian monsoon strengthening and the Tibetan Plateau uplifting. 2) 2.78 Ma ago, the concentrations of the midlake-facies components decreased abruptly and the dominant fraction of the sediments turned to fluvial sands. The data indicate that lakes in the basin disappeared, reflecting a dramatic decline in the intensity of the Indian monsoon at that time. This shift coincided with the formation of extensive Northern Hemisphere ice sheets, implying a quick response of the low-latitude monsoon regime to the high-latitude glaciation. 3) At 3.14 Ma, the initial appearance of blackish-grey mud beds with long durations and occasional occurrences of lacustrine mud beds indicate that the basin was overall dominated by shallow lakes, implying a shift to decreased variability of the Indian monsoon at that time. At 2.42 Ma, an increase in the frequency and a decrease in the duration of the lacustrine mud beds suggest that deep-water lakes were frequently developed in the basin, denoting a shift to increased variability of the Indian monsoon at that time. The former shift coincides with the onset of large-scale glaciation in the circum Atlantic region and the latter corresponds to the inception of predominance of the 41 ka periodicity in Northern Hemisphere ice-sheet cover fluctuations, presumably suggesting a physical link between the Indian monsoon system and the high-latitude ice sheets in the Northern Hemisphere.

Qualidade de vida relacionada com a saúde oral

Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para a obtenção do grau de Mestre em Psicologia, ramo de Psicologia Clínica e da Saúde

The structural response of an oscillating wave surge converter to wave slamming

This paper describes the problems in experimentally obtaining hydrodynamic loads on an oscillating wave surge converter during slamming events, with the aim of furthering understanding of full scale hydrodynamic loads that flap type devices must be designed to withstand. Including how hydro-elastic effects and structural response are linked and why they are essential to the measurement of impulsive hydrodynamic loads. A combined experimental and numerical structural response study carried out on a 40th scale Oyster model drew conclusions on the structural vibration observed in the strain gauge load cell measurement. A further structural response study on a piezo electric load measurement device gave an insight into the advantages it could bring to reducing hydro-elastic effects.