On the performance of massive and woodframe passivehouses in Belgium : a field study

In this paper we present the results of a field study in which the indoor climate and the energy use for space heating in 6 passive houses in Belgium were monitored. The test group consisted of 4 houses with a massive shell construction and 2 timber frame houses. 2 houses were inhabited and 4 were used for promotional activities by the builders. The results are compared to the performance predicted by the PHPP method. We can conclude that the results are in good agreement with the predictions and that no significant difference in performance is found between the massive and timber frame constructions

Identifying barriers in telesurgery by studying current team practices in robot-assisted surgery

This paper investigates challenges in current practices in robot-assisted surgery. In addition, by using the method of proxy technology assessment, we provide insights into the current barriers to wider application of robot-assisted telesurgery, where the surgeon and console are physically remote from the patient and operating team. Research in this field has focused on the financial and technological constraints that limit such application; less has been done to clarify the complex dynamics of an operating team that traditionally works in close symbiosis. Results suggest that there are implications for working practices in transitioning from traditional robot-assisted surgery to remote robotic surgery that need to be addressed, such as possible communication problems which might have a negative impact on patient outcomes

Health workers\u27 counselling practices on and women\u27s awareness of pregnancy danger signs in selected rural health facilities in Burkina Faso, Ghana and Tanzania

Background: This study assessed health workers’ counselling practices on danger signs during antenatal consultation and pregnant women’s awareness of these signs and identified factors affecting counselling practices and women’s awareness. The study is part of QUALMAT, an intervention research project funded by the European Commission aiming to improve maternal and newborn health. QUALMAT is conducted in Burkina Faso, Ghana and Tanzania. Methods: A cross-sectional study was performed in 12 selected primary healthcare facilities in each country. WHOguidelines were used as standard for good counselling. We assessed providers’ counselling practice on seven danger signs through direct observation study (35 observations/facility). Exit interviews (63 interviews/facility) were used to assess women’s awareness of the same seven signs. We used negative binomial regression to assess associations with health services’ and sociodemographic characteristics. Results: About one in three women were not informed on any danger sign. For most single signs, less than half of the women were counselled. Vaginal bleeding and severe abdominal pain were the signs most counselled on (between 52 and 66%). At study facilities in Burkina Faso 58% of women were not able mentioning a danger sign, in Ghana this was 22% and in Tanzania 30%. Fever, vaginal bleeding and severe abdominal pain were signs most frequently mentioned. Kind of health worker (depending on training) was significantly associated with counselling practices. Depending on the study site, characteristics significantly associated with awareness of signs were women’s age, gestational age, gravidity and women’s educational level. Conclusion: Counselling practice is poor and not very efficient. A new approach of informing pregnant women ondanger signs is needed. Adopting a more client-centred approach might be an option. However as effects of ANC education remain largely unknown it is very well possible that improved counselling will not have effect on maternal and newborn mortality and morbidity

Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania : a cross-sectional study

Background: Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The main objective of this study was to assess the actual dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning. Methods: This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described. Results: The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency. Conclusions: Differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the performance results to gauge progress and reward efficiency through performance based incentives

An ontology co-design method for the co-creation of a continuous care ontology

Ontology engineering methodologies tend to emphasize the role of the knowledge engineer or require a very active role of domain experts. In this paper, a participatory ontology engineering method is described that holds the middle ground between these two 'extremes'. After thorough ethnographic research, an interdisciplinary group of domain experts closely interacted with ontology engineers and social scientists in a series of workshops. Once a preliminary ontology was developed, a dynamic care request system was built using the ontology. Additional workshops were organized involving a broader group of domain experts to ensure the applicability of the ontology across continuous care settings. The proposed method successfully actively engaged domain experts in constructing the ontology, without overburdening them. Its applicability is illustrated by presenting the co-created continuous care ontology. The lessons learned during the design and execution of the approach are also presented

Dried yeast cell walls high in beta-glucan and mannan-oligosaccharides positively affect microbial composition and activity in the canine gastrointestinal tract in vitro

The outer cell wall of yeast is characterized by high levels of beta-glucans and mannan-oligosaccharides (MOS), which have been linked with beneficial effects on intestinal health and immune status in dogs. In this study, a standardized in vitro simulation of the canine gastrointestinal tract (Simulator of the Canine Intestinal Microbial Ecosystem; SCIME) was used to evaluate the effect of a Saccharomyces cerevisiae-based product, consisting of 27.5% beta-glucans and 22.5% MOS, on the activity (as assessed by measurement of fermentative metabolites) and composition (as assessed by 16S-targeted Illumina sequencing) of canine intestinal microbiota. The S. cerevisiae-based product was tested at three different dosages, i.e., 0.5, 1.0, and 2.0 g/d. A dose-dependent fermentation pattern was observed along the entire length of the colon, as shown by the increased production of the health-related acetate, propionate, and butyrate for the three concentrations tested (0.5, 1.0, and 2.0 g/d). A consistent finding for all three tested concentrations was the increased propionate production (P < 0.05) in the simulated proximal and distal colon. These changes in terms of fermentative metabolites could be linked to specific microbial alterations at the family level, such as the specific stimulation of the propionate-producing families Porphyromonadaceae and Prevotellaceae upon in vitro exposure to the S. cerevisiae-based product. Other consistent changes in community composition upon repeated exposure included the decrease in the Enterobacteriaceae and the Fusobacteriaceae families, which both contain several potentially opportunistic pathogens. Altogether, the generated data support a possible health-promoting role of a product high in beta-glucans and MOS when supplemented to the dogs' diet

Lactobacillus rhamnosus GG and Saccharomyces cerevisiae boulardii exert synergistic antipathogenic activity in vitro against enterotoxigenic Escherichia coli

Short-term colonic in vitro batch incubations were performed to elucidate the possible synergistic effects of Lactobacillus rhamnosus GG (CNCM-I-4798) and Saccharomyces cerevisiae boulardii (CNCM-1-1079) (associated in Smebiocta/Smectaflora Protect (R)) on the colonic microbial fermentation process, as well as their antipathogenic activity against enterotoxigenic Escherichia coli (LMG2092) (ETEC). These incubations adequately simulate the native microbiota and environmental conditions of the proximal colon of both adult and toddler donors, including the colonic mucosal layer. Results indicated that both strains were capable of growing together without showing antagonistic effects. Co-cultivation of both strains resulted in increased butyrate (stimulated by L. rhamnosus GG), propionate (stimulated by S. boulardii), and ethanol (produced by S. boulardii) production compared to the control incubations, revealing the additive effect of both strains. After inoculation of ETEC under simulated dysbiotic conditions, a 40 and 46% reduction in the concentration of ETEC was observed upon addition of both strains during the experiments with the adult and toddler donor, respectively. Furthermore, ETEC toxin levels decreased upon S. boulardii inoculation, probably due to proteolytic activity of this strain, with a synergistic effect being observed upon co-cultivation of L. rhamnosus GG and S. boulardii resulting in a reduction of 57 and 46% for the adult and toddler donor, respectively. Altogether, the results suggest that both probiotics together may help microbiota functionality, in both adults and toddlers and under healthy or impaired conditions, which could be of great interest when the colonic microbiota is dysbiotic and therefore sensitive to pathogenic invasion such as during antibiotic treatment

A synbiotic concept containing spore-forming Bacillus strains and a prebiotic fiber blend consistently enhanced metabolic activity by modulation of the gut microbiome in vitro

A standardized in vitro simulation of the human gastrointestinal tract (M-SHIME (R)) was used to assess the effect of repeated daily administration of a synbiotic formulation, containing five spore-forming Bacillus strains and a prebiotic fiber blend, on the microbial activity and composition of three simulated human subjects. Firstly, while confirming recent findings, deeper phylogenetic insight was obtained in the resident M-SHIME (R) microbiota, demonstrating that the model maintains a diverse and representative, colon region-specific luminal and mucosal microbial community. Supplementation of the synbiotic concept increased microbial diversity in the distal colon areas, whereas specific enhancement of Bacillaceae levels was observed in the ascending colon suggesting a successful engraftment of the Bacillus spores, which probably resulted in a stimulatory effect on, among others, Bifidobacteriaceae, Lactobacillaceae, Prevotellaceae, Tannerellaceae and Faecalibacterium prausnitzii contributing directly or indirectly to stimulation of acetate, propionate and butyrate production. When compared with a previous study investigating the Bacillus strains, the generated data suggest a synergistic effect on the intestinal microbiota for the synbiotic formulation. Given the fact that the probiotic strains have been shown to impact post-prandial metabolic endotoxemia in human individuals, it might be interesting to further investigate the efficacy of the synbiotic concept in protecting against obesity-related disorders