Can ICU admission be predicted?

After intensive care (IC), patients report poor health-related quality of life (HRQoL). Many factors affect the patients and influence the HRQoL after discharge. One of these factors is the patient's health status before the critical care period. In a previous study we found that the IC patients have a high frequency of pre-existing diseases. However, it is unknown to what extent these pre-existing diseases affect the consumption of hospital resources (measured as days as inpatients) in the time period before admission to the ICU and during the years following it. The consumption prior to the ICU event may also be claimed to herald an increased risk for a later ICU admittance? The aim of this study was to examine the hospital care consumption of former ICU patients 3 years prior to and 3 years after the intensive care period. This was examined in relation to the pre-existing health status

Baltic Ecological Recycling Agriculture and Society (BERAS project) - a case of Juva milk system

The aim of the study was to determine the potential, impact and prerequisites of localization and enhanced recycling in a rural food system, illustrated by the case of Juva milk. An interdisciplinary scenario based on the increase of local, organic milk to 50 % of milk comsumption was created and the sustainability was compared, on the basis of the statistics and data collected from the actors, with the present milk system

How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children's hospital, Stockholm, Sweden

<p>Abstract</p> <p>Background</p> <p>There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department.</p> <p>Methods</p> <p>We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses.</p> <p>Results</p> <p>Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a "scientific method". Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration.</p> <p>Conclusions</p> <p>Drawing on Spear and Bowen's theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean's success (or failure).</p

Model for the Quasifree Polarization-Transfer Measurements in the (p,n) reaction at 495 MeV

The recent (p,n) polarization transfer experiments at LAMPF are explained in terms of a dropping rho-meson mass in the medium.Comment: 12 pages of text (LATEX), 4 figures (not included, available from the authors). February 199

Cognitive and neural plasticity in aging: General and task-specific limitations

There is evidence for cognitive as well as neural plasticity across the adult life span, although aging is associated with certain constraints on plasticity. In the current paper, we argue that the age-related reduction in cognitive plasticity may be due to (a) deficits in general processing resources, and (b) failure to engage in task-relevant cognitive operations. Memory-training research suggests that age-related processing deficits (e.g., executive functions, speed) hinder older adults from utilizing mnemonic techniques as efficiently as the young, and that this age difference is reflected by diminished frontal activity during mnemonic use. Additional constraints on memory plasticity in old age are related to difficulties that are specific to the task, such as creating visual images, as well as in binding together the information to be remembered. These deficiencies are paralleled by reduced activity in occipito-parietal and medial–temporal regions, respectively. Future attempts to optimize intervention-related gains in old age should consider targeting both general processing and task-specific origins of age-associated reductions in cognitive plasticity

Reduced functional brain activity response in cognitively intact apolipoprotein E ε4 carriers

The apolipoprotein E {varepsilon}4 (APOE {varepsilon}4) is the main known genetic risk factor for Alzheimer's disease. Genetic assessments in combination with other diagnostic tools, such as neuroimaging, have the potential to facilitate early diagnosis. In this large-scale functional MRI (fMRI) study, we have contrasted 30 APOE {varepsilon}4 carriers (age range: 49–74 years; 19 females), of which 10 were homozygous for the {varepsilon}4 allele, and 30 non-carriers with regard to brain activity during a semantic categorization task. Test groups were closely matched for sex, age and education. Critically, both groups were cognitively intact and thus symptom-free of Alzheimer's disease. APOE {varepsilon}4 carriers showed reduced task-related responses in the left inferior parietal cortex, and bilaterally in the anterior cingulate region. A dose-related response was observed in the parietal area such that diminution was most pronounced in homozygous compared with heterozygous carriers. In addition, contrasts of processing novel versus familiar items revealed an abnormal response in the right hippocampus in the APOE {varepsilon}4 group, mainly expressed as diminished sensitivity to the relative novelty of stimuli. Collectively, these findings indicate that genetic risk translates into reduced functional brain activity, in regions pertinent to Alzheimer's disease, well before alterations can be detected at the behavioural level

Self-consistent calculations within the Extended Theory of Finite Fermi Systems

The Extended Theory of Finite Fermi Systems(ETFFS) describes nuclear excitations considering phonons and pairing degrees of freedom, using experimental single particle energies and the effective Landau-Migdal interaction. Here we use the Skyrme interactions in order to extend the range of applicability of the ETFFS to experimentally not yet investigated short-lived isotopes. We find that Skyrme interactions which reproduce at the mean field level both ground state properties and nuclear excitations are able to describe the spreading widths of the giant resonances in the new approach, but produce shifts of the centroid energies. A renormalization of the Skyrme interactions is required for approaches going beyond the mean field level.Comment: 7 pages, 5 figures, corrected typo

Field validation of radar systems for monitoring bird migration

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Advances in information technology are increasing the use of radar as a tool to investigate and monitor bird migration movements. We set up a field campaign to compare and validate outputs from different radar systems. Here we compare the pattern of nocturnal bird migration movements recorded by four different radar systems at a site in southern Sweden. Within the range of the weather radar (WR) Ängelholm, we operated a "BirdScan" (BS) dedicated bird radar, a standard marine radar (MR), and a tracking radar (TR). The measures of nightly migration intensities, provided by three of the radars (WR, BS, MR), corresponded well with respect to the relative seasonal course of migration, while absolute migration intensity agreed reasonably only between WR and BS. Flight directions derived from WR, BS and TR corresponded very well, despite very different sample sizes. Estimated mean ground speeds differed among all four systems. The correspondence among systems was highest under clear sky conditions and at high altitudes. Synthesis and applications. While different radar systems can provide useful information on nocturnal bird migration, they have distinct strengths and weaknesses, and all require supporting data to allow for species level inference. Weather radars continuously detect avian biomass flows across a wide altitude band, making them a useful tool for monitoring and predictive applications at regional to continental scales that do not rely on resolving individuals. BirdScan and marine radar's strengths are in local and low altitude applications, such as collision risks with man-made structures and airport safety, although marine radars should not be trusted for absolute intensities of movement. In quantifying flight behaviour of individuals, TR is the most informative.We acknowledge the support provided by COST – European Cooperation in Science and Technology through the Action ES1305 ‘European Network for the Radar Surveillance of Animal Movement’ (ENRAM) in facilitating this collaboration. The study received financial support from Gyllenstierna Krapperup ́s Foundation and the Centre for Animal Movement Research (CAnMove) financed by a Linnaeus grant (349-2007-8690) from the Swedish Research Council and Lund University

l-Dopa induced dyskinesias in Parkinsonian mice: Disease severity or l-Dopa history

AbstractIn Parkinson’s disease, the efficacy of l-Dopa treatment changes over time, as dyskinesias emerge with previously beneficial doses. Using MitoPark mice, that models mitochondrial failure in dopamine (DA) neurons and mimics the progressive loss of dopamine observed in Parkinson’s disease, we found that the severity of DA denervation and associated adaptations in striatal neurotransmission at the time of initiation of l-Dopa treatment determines development of l-Dopa induced dyskinesias. We treated 20-week, and 28-week old MitoPark mice with l-Dopa (10mg/kg i.p. twice a day) and found locomotor responses to be significantly different. While all MitoPark mice developed sensitization to l-Dopa treatment over time, 28-week old MitoPark mice with extensive striatal DA denervation developed abnormal involuntary movements rapidly and severely after starting l-Dopa treatment, as compared to a more gradual escalation of movements in 20-week old animals that started treatment at earlier stages of degeneration. Our data support that it is the extent of loss of DA innervation that determines how soon motor complications develop with l-Dopa treatment. Gene array studies of striatal neurotransmitter receptors revealed changes in mRNA expression levels for DA, serotonin, glutamate and GABA receptors in striatum of 28-week old MitoPark mice. Our results support that delaying l-Dopa treatment until Parkinson’s disease symptoms become more severe does not delay the development of l-Dopa-induced dyskinesias. MitoPark mice model genetic alterations known to impair mitochondrial function in a subgroup of Parkinson patients and provide a platform in which to study treatments to minimize the development of dyskinesia

Longitudinal dopamine D2 receptor changes and cerebrovascular health in aging

BACKGROUND AND OBJECTIVES: Cross-sectional studies suggest marked dopamine (DA) decline in aging, but longitudinal evidence is lacking. The aim of this study was to estimate within-person decline rates for DA D2-like receptors (DRD2) in aging and examine factors that may contribute to individual differences in DRD2 decline rates. METHODS: We investigated 5-year within-person changes in DRD2 availability in a sample of older adults. At both occasions, PET with 11C-raclopride and MRI were used to measure DRD2 availability in conjunction with structural and vascular brain integrity. RESULTS: Longitudinal analyses of the sample (baseline: n = 181, ages: 64-68 years, 100 men and 81 women; 5-year follow-up: n = 129, 69 men and 60 women) revealed aging-related striatal and extrastriatal DRD2 decline, along with marked individual differences in rates of change. Notably, the magnitude of striatal DRD2 decline was ∼50% of past cross-sectional estimates, suggesting that the DRD2 decline rate has been overestimated in past cross-sectional studies. Significant DRD2 reductions were also observed in select extrastriatal regions, including hippocampus, orbitofrontal cortex (OFC), and anterior cingulate cortex (ACC). Distinct profiles of correlated DRD2 changes were found across several associative regions (ACC, dorsal striatum, and hippocampus) and in the reward circuit (nucleus accumbens and OFC). DRD2 losses in associative regions were associated with white matter lesion progression, whereas DRD2 losses in limbic regions were related to reduced cortical perfusion. DISCUSSION: These findings provide the first longitudinal evidence for individual and region-specific differences of DRD2 decline in older age and support the hypothesis that cerebrovascular factors are linked to age-related dopaminergic decline