Medical Information Representation Framework for Mobile Healthcare

In mobile healthcare, medical information are often expressed in different formats due to the local policies and regulations and the heterogeneity of the applications, systems, and the adopted Information and communication technology. This chapter describes a framework which enables medical information, in particular clinical vital signs and professional annotations, be processed, exchanged, stored and managed modularly and flexibly in a mobile, distributed and heterogeneous environment despite the diversity of the formats used to represent the information. To deal with medical information represented in multiple formats the authors adopt techniques and constructs similar to the ones used on the Internet, in particular, the authors are inspired by the constructs used in multi-media e-mail and audio-visual data streaming standards. They additionally make a distinction of the syntax for data transfer and store from the syntax for expressing medical domain concepts. In this way, they separate the concerns of what to process, exchange and store from how the information can be encoded or transcoded for transfer over the internet. The authors use an object oriented information model to express the domain concepts and their relations while briefly illustrate how framework tools can be used to encode vital sign data for exchange and store in a distributed and heterogeneous environment

MEMO: Gemeenschapsanalyse bodemschaafgegevens 2009-2012 en boxcorermonsters 2009–2011 in de Zeeuwse banken

Occupational Therapists (OTs) who recommend housing adaptations for people with disabilities, funded through public finance, must satisfy professional codes of practice and the employing local authority requirement to allocate finite resources effectively and fairly. At the same time they must also meet service user expectations. Ethical reasoning will be required to balance these demands whilst practising to a personally acceptable professional standard. This study investigates how OTs understand themselves to develop a sense of fairness and how they use their community of practice in developing professional ethical practice. This was a 2 part methodology. Firstly, OTs from 2 community services were invited to participate in small discussion groups. 3 group sessions, of different sizes ranging from 2-6 participants and duration of 2-3 hours, were recorded in which OTs discussed cases which posed ethical challenges with respect to fairness. All participants were female. Secondly, 4 individual interviews with volunteers from the groups were recorded to collect OT narratives of personal ethical development. Transcripts were analysed using a literary-critical approach focussing for transcripts of group sessions on dialogue in community of practice and ethical approaches used; focussing for interview transcripts on the process of ethical development. OTs were shown developing professional practice dialogically within their own community of practice groups. This finding confirms the importance for professional development of encouraging opportunities for dialogical interaction between OTs. Practical reasoning about justice as theorised by Sen (2009) better characterised OT ethical reasoning practices than biomedical-ethical approach applying universal, abstract ethical principles. OT narratives of ethical development fitted the Aristotelian model of growth in virtue as a whole, across both professional and personal aspects of life. Empathy was tentatively categorised as a virtue rather than a technical skill in this context. Empathy contributed to OT clinical reasoning processes as well as ethical reasoning.<br/

Responsiveness of the innate immune system and glucose concentrations in the oldest old

Abstract Patients with diabetes mellitus show in-creased risk of infectious disease as well as dis-turbances in innate immunity. In critical care settings, hyperglycemia is associated with increased risk of sepsis. It is unclear whether elevated glucose concen-trations and innate immunity are associated in a non-clinical setting. We aimed to assess the association between glucose concentrations and innate immune response in the oldest old, who are at increased risk of both disturbed glucose metabolism as well as infec-tious disease. This study was part of the Leiden 85-plus Study. In 562 subjects aged 85 years old of the general population, venous blood samples were taken for measurement of morning glucose, C-reactive protein (CRP) and glycated hemoglobin (HbA1c). The innate immune response was assessed by performing ex vivo whole blood lipopolysaccharide (LPS) stimulation for production capacity of tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 1-beta (IL1-β), interleukin 10 (IL-10) and interleukin 1 receptor antagonist (IL-1Ra). Using linear regression analysis, cross-sectional analysis between glucose and cytokine production capacity was performed. We found a significant negative association between glucose concentrations, but not HbA1c, and cytokine response capacity in four out of five measured cytokines (all p&lt;0.05). Both glucose and HbA1c were positively associated with circulat-ing levels of CRP. Higher glucose concentrations in non-diabetic elderly are associated with lower innate immune response. As elderly show increased vulner-ability for disturbances in glucose metabolism as well as infectious disease, this relation could be of clinical significance

Management options for restoring estuarine dynamics and implications for ecosystems: a quantitative approach for the Southwest Delta in the Netherlands

The Delta Works, a series of dams and barriers constructed in the 1960's–1980's changed the estuarine landscape of the Rhine-Meuse-Scheldt delta (SW Netherlands) into more stagnant and disengaged freshwater, brackish water or saltwater lakes. The remaining tidal systems were adapted by building a storm surge barrier in the Oosterschelde and dike reinforcement works along the Westerschelde. The Delta Works brought protection against flooding, but at the same time resulted in environmental and socio-economic problems, such as degradation of ecological quality and ecosystem functioning, disruption of fish migration routes, water and sediment quality problems.In this study we explore in an integrated, quantitative way the consequences of a number of management options for the Southwest Delta and their implications for the occurrence and distribution of aquatic and estuarine habitats, considering the mutual coherence between the water basins. Five scenarios were evaluated using a 1D hydraulic, water quality and primary production numerical model and GIS habitat mapping. Scenarios vary from small-scale interventions, such as changes in day-to-day management of hydraulic infrastructures or creation of small inlets in dams, feasible in the short term, to restoration of an open delta by removing dams and barriers, as a long term potential. We evaluate the outcomes in relation to the restoration of estuarine dynamics, as this is in policy plans proposed as a generic solution for the current ecological and environmental problems. Net water flow rates show more complex patterns when connectivity between water basins is increased and when sluice management is less strict. Estuarine transition zones and fish migration routes are partly restored, but only fully develop when basins are in open connection with each other. Area of intertidal habitats, tidal flats and tidal marshes, increases in each scenario, ranging between 7 and 83%, 1–56%, and 8–100% respectively, depending on scenario. Large scale infrastructural adaptations are needed to restore estuarine dynamics at large scale.The use of a 1D numerical model allowed to quantify the effect of different management measures for all water basins simultaneously, but also has its limitations. The model does not resolve more complex processes such as vertical mixing and morphodynamic changes. This requires expert judgment and more detailed 3D modelling

Declining trends in student performance in lower secondary education

Student performance is related to motivation to learn. As motivation generally declines during lower secondary education, one might expect performance to decline as well during this period. Though, until now, it has been unclear whether this pattern exists. In the present study, we examined student performance during the early years of secondary education from a developmental perspective. Participants were 1544 Dutch secondary school students across three grades (grades 7 to 9). To investigate student performance trends, we analysed report card grades by using hierarchical linear modelling with two levels (level 1, time point; level 2, student). Potential moderators to be examined were (1) gender, (2) school type and (3) initial level. A linear decline in report card grades from grade 7 to 9 was found for boys and girls, in all school types, and regardless of initial level. Two variables moderated the steepness of the decline: school type and initial level. Gender and school type had a main effect on performance level. The same pattern was observed for the subset of 'core subjects'-Dutch, English and mathematics. Motivational and cognitive factors that may explain the performance decline are discussed