Home and community care services: a major opportunity for preventive health care

BACKGROUND In Australia, the Home and Community Care (HACC) program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk. METHODS We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models. RESULTS 4,978 (4.8%) participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis. CONCLUSIONS HACC clients have high rates of modifiable lifestyle risk factors and health conditions that are amenable to primary and secondary prevention, presenting the potential for implementing preventive health care programs in the HACC service setting.This study was supported by a HACC grant from the NSW Department of Ageing, Disability and Home Care

Measuring multimorbidity using Australian linked administrative health data sources

The growing number of individuals living with multimorbidity – the presence of two or more chronic conditions – is a challenge facing many healthcare systems internationally. Multimorbidity has been hailed a priority for research and practice, but Australian studies of multimorbidity are impeded by the lack of national primary care data, data silos, researcher access to data, and limited information contained within the data that are available. This thesis demonstrates how data linkage can be used to enhance the understanding of multimorbidity and its outcomes via a series of studies using Australian linked data sources, including claims-based, cohort study and clinical registry datasets for residents of NSW, Australia's most populous state. Thesis studies found variations in the recording of common health conditions between hospitals, under ascertainment of multimorbidity in administrative data, and differences in the estimates of multimorbidity dependent on the data used. Thesis studies also showed we can enhance our understanding of multimorbidity by exploring related concepts of patient risk and complexity. Within administrative hospital inpatient data, one-third of hospitalised patients had both multimorbidity and elevated risks of frailty – and these patients had worse outcomes than those with one or neither factor. The addition of clinical registry data also improved risk adjustment for hospital readmission performance indicators for total knee and hip replacement over and above models including multimorbidity measured using administrative hospital inpatient data. The research presented here highlights the benefits of the use of linked data in Australian multimorbidity research in three ways. Firstly, it underlines the need for incorporation of chronic disease information from multiple databases, including self-reported, inpatient, and claims-based data to accurately capture the extent of chronic disease and to identify people with multimorbidity. Secondly, it emphasises the need to examine complexities in the interplay between drivers of adverse outcomes – including multimorbidity, frailty and clinical assessment of a patient's overall health – in identifying patients with increased risk of complications and informing future hospital resource planning. And thirdly, it demonstrates the value of integrating new data sources, such as clinical registries with linked administrative data for improving risk-adjustment of hospital performance measures

SymED: Adaptive and Online Symbolic Representation of Data on the Edge

The edge computing paradigm helps handle the Internet of Things (IoT) generated data in proximity to its source. Challenges occur in transferring, storing, and processing this rapidly growing amount of data on resource-constrained edge devices. Symbolic Representation (SR) algorithms are promising solutions to reduce the data size by converting actual raw data into symbols. Also, they allow data analytics (e.g., anomaly detection and trend prediction) directly on symbols, benefiting large classes of edge applications. However, existing SR algorithms are centralized in design and work offline with batch data, which is infeasible for real-time cases. We propose SymED - Symbolic Edge Data representation method, i.e., an online, adaptive, and distributed approach for symbolic representation of data on edge. SymED is based on the Adaptive Brownian Bridge-based Aggregation (ABBA), where we assume low-powered IoT devices do initial data compression (senders) and the more robust edge devices do the symbolic conversion (receivers). We evaluate SymED by measuring compression performance, reconstruction accuracy through Dynamic Time Warping (DTW) distance, and computational latency. The results show that SymED is able to (i) reduce the raw data with an average compression rate of 9.5%; (ii) keep a low reconstruction error of 13.25 in the DTW space; (iii) simultaneously provide real-time adaptability for online streaming IoT data at typical latencies of 42ms per symbol, reducing the overall network traffic.Comment: 14 pages, 5 figure

Application of lean principles within SMEs in Kosovo manufacturing industry and benefits of implementation

By changing the way of production with the same resources engineers and managers always trying to increase outcomes. Lean is a method that is focused on reducing waste, it is used to manufacturing industries to reduce waste and, in the meantime, the quality is higher. Application of lean manufacturing into enterprises may bring many benefits and advantages such as time reduction to the customers, efficient usage of processes, less utilization of inventory, improvement of knowledge management, cost savings, and rework reduction. This paper has attempted to understand how lean manufacturing is being used in the Kosovo Manufacturing Industry and benefits implementation of lean manufacturing techniques and their facilities

Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study

Background: Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. Methods: This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage. Results: There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9–91.4) in Aboriginal children and 44.9/1000 person-years (44.8–45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7–1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6–10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6–9.7)). Conclusions: We observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap

U susret poboljšanju procene rasta ribe: multi-modelna analiza i njena primena kod slatkovodnih riba

Cilj ovog istraživanja je bio da se uporedi multi-modelna analiza (MMI) u modelovanju rasta riba sa tradicionalnom metodom odabira najbolje odgovarajućeg modela kod slatkovodne ribe Carassius gibelio (Bloch 1782). Korištena su četiri modela (Von Bertalanffy, Gompertz, Robertson i power funkcije) za modelovanje rasta jedinki vrste Carassius gibelio iz reke Stari Begej. Iako je Power funkcija bila najbolje odgovarajuća, u svim slučajevima je više od jednog modela bilo značajno podržano te je stoga primenjeno usrednjavanje modela kako bi se dobili srednji model i tempo rasta. Kada je više od jednog modela podržano, preporučeno je da se koristi MMI koja omogućuje preciznije određivanje parametara rasta

Ribe kao biološki indikator u proceni kvaliteta vode reke Tamiš

Materijal za istraživanje ihtiofaune Tamiša sakupljen je avgusta i oktobra 2009. u periodu srednjeg vodostaja kao i aprila 2010. godine u periodu visokog vodostaja na lokacijama Sečanj, Banatski Despotovac i Opovo. Prikupljanje uzoraka vršeno je pomoću aparata za elektroribolov i stajaćim mrežarskim alatima dužine od 37 do 100 metara, promera okaca od 45 do 100 mm i dubine 3 do 5 metara. Ovom prilikom evidentirano je 28 vrsta riba iz 8 familija. Prema sastavu ihtiofaune određen je indeks saprobnosti prema Pantle-Buck-u koji iznosi 2.15 i koji ukazuje na to da voda Tamiša pripada drugoj klasi boniteta

Transplantacija spermatogonija kao nova metoda u akvakulturi i konzervaciji riba

Poslednjih godina, primena primordijalnih germinativnih ćelija (primordial germ cells - PGCs) i spermatogonijalnih stem ćelija (spermatogonial stem cells - SSCs) riba je postala veoma značajna zbog razvoja metode transplantacije ovih ćelija. Od kada su Brinster i Avarbock (1994) razvili ovu metodu, ona se uspešno koristi za čuvanje genetskog materijala ugroženih vrsta i u stvaranju novih transgenih linija kod miševa i domaćih životinja. Uvođenje ove metode kod riba predstavlja značajan napredak u oblasti reproduktivne biotehnologije, akvakulture, konzervacione biologije, kao i u razvoju novih transgenih linija različitih vrsta riba. Osnovu ove metode predstavlja transplantacija germinativnih ćelija (PGC, SSC) iz donorskog organizma u organizam primaoca. Najinteresantnija u tom smislu je upotreba nediferenciranih spermatogonija A tipa (Aund) koje imaju sposobnost samoobnavljanja ali i proizvodnje ćelija kasnijih faza spermatogeneze. Postoji takođe nekoliko specifičnih osobina SSC koje ih čine pogodnim za transplantaciju: (1) sposobnost da kolonizuju testis primaoca odakle produkuju donorsku spermu, (2) mogućnost da se nakon transplantacije u primaocu muškog pola razviju u spermatogonije, a u primaocu ženskog pola u oogonije i (3) mogućnost genske manipulacije sa ciljem produkcije transgenih riba (Lacerda i sar., 2010). Prilikom transplantacije SSC, posebna pažnja mora biti usmerena ka izboru vrste donora i primaoca. Najbolje bi bilo da donor i primalac ne budu filogenetski previše udaljeni, kao i da primalac ima kratak reproduktivni ciklus i manje dimenzije tela kako bi ekonomski bio pogodniji za gajenje. Donorska vrsta je obično vrsta za koju postoji određneni interes, bilo ekonomski, naučni ili konzervacioni. Tokom transplantacije, kompatibilnost između primaoca i donora može biti ograničavajući faktor u uspehu samog procesa. U najgorem slučaju, primalac, usled imune reakcije, može u potpunosti odbaciti transplantirano tkivo ili ćelije. To je najčešće slučaj ukoliko se vrši transplantacija SSC iz odraslog donora u odraslog primaoca. Kako bi se izbegao problem izazvan transplantacijom između dve odrasle jedinke, koristi se prednost ontogenije primaoca, posebno ontogenije njegovog imunog sistema, tako što se za primaoca koriste embrioni ili larve. Ovi stadijumi kod riba nemaju razvijen imuni sistem niti diferencirane T-ćelije (Takeuchi et al., 2003; Yoshizaki et al., 2011) te s toga nemaju mehanizam pomoću kojeg bi odbacili donorsko tkivo. Takođe, lakše je blokirati razvoj endogenih primordijalnih germinativnih ćelija kod larvi, nego ukloniti SSC iz već razvijenih gonada kod odraslog donora. Pored odabira odgovarajuće vrste donora i primaoca, neophodno je na pravi način izolovati specifične ćelije koje treba da budu transplantirane. Ovaj proces je donekle jednostavniji kada je u pitanju tansplantacija PGC s obzirom na njihov daleko manji broj u odnosu na spermatogonije i na to da one još uvek nisu potpuno razvijene u gonadama. S druge strane, SSC su dobro razvijene u gonadama i najčešće zauzimaju karakteristično mesto unutar pojedinačnih niša u testisu specifičnih za tu vrstu ćelija. Prilikom izolacije nediferenciranih spermatogonija A tipa iz testisa odrasle jedinke, veome je bitno voditi računa od morfologiji tih ćelija kao i specifičnim markerima pomoću kojih ih je moguće razlikovati od ostalih tipova spermatogonija (Adiff, B), spermatocita i spermatida. Osnovne histološke metode u kombinaciji sa imunohistohemijom, in situ hibridizacijom ili in situ PCR metodom se mogu koristiti za identifikaciju spefifičnih molekularnih markera (proteina ili RNK) u ćelijama unutar ćelijskih niša i koji se u daljem toku rada mogu koristiti za izolaciju određenih ćelija. Pre transplantacije PGC ili SSC, neophodno je izolovati željene ćelije iz donorskog tkiva. Nakon multienzimske razgradnje tkiva testisa, ćelije se izoluju na osnovu njihove morfologije i veličine i/ili specifičnih molekularnih markera zbog kojih čitav proces može biti species-specifičan. Kombinacija transplantacije PGS i SSC sa krioprezervacijom daje dodatni značaj ovoj metodi s obzirom da još uvek ne postoji optimizovan protokol za uspešnu krioprezervaciju jaja i embriona riba, pre svega zbog prisustva velike količine žumanceta i masti. Krioprezervacija ćelija kao što su PGS i SSC, koje imaju mogućnost da produkuju spermatozoide ili oocite u zavisnosti od pola jedinke primaoca, ima izuzetno veliku perspektivu primene u konzervacionoj biologiji i akvakulturi. Istraživanja su pokazala da krioprezervirane SSC nakon odmrzavanja i transplantacije u telo primaoca mogu proizvesti spermatozoide i oocite donorske vrste (Kobayashi et al., 2007). Na taj način, čuvanje gameta nije neophodno jer krioprezervacijom germinativnih ćelija i njihovom transplantacijom, moguće je dobiti gamete oba pola.In recent years, the importance of manipulations of primordial germ cells (PGCs) and spermatogonial stem cells (SSCs) in fish has drastically increased due to development of transplantation method of these cells. Since its development by Brinster and Avarbock (1994), this method has been successfully used in the preservation of genetic material of endangered species and in the creation of new transgenic lines of mice and farm animals. Introduction of this method in fish leads to advances in reproductive biotechnology, aquaculture, development of new transgenic lines and conservation biology of fish. The base of this method lies in the transplantation of the germinative cells (PGCs, SSCs) from donor organism into recipient organism. Undifferentiated spermatogonia type A (Aund) which have the ability of self-renewal are the most interesting for transplantation since they have the ability of self-renewal, but can also produce later stage cells. There are several advantages of using SSCs in transplantation process: (1) the capability of SSCs to colonize the testis of the recipients where they are able to produce donor-derived sperm, (2) plasticity in development since SSCs can develop into spermatogonia in male recipients and oogonia in female recipients and (3) the possibility of genetic manipulation in SSCs in order to produce transgenic fish (Lacerda et al., 2010). When transplanting SSCs, special attention must be given to the choice of donors and recipients species. It is best that donor and recipient organisms are phylogenetically not too distant, that recipient organisms have a short reproductive cycle and that they are small for a more economic rearing. Donor species are usually species which attract certain interest, whether its an economic, scientific or conservation interest. During transplantation, compatibility between recipient and donor may be a very limiting factor in transplantation success. In the worst-case scenario, recipients may completely reject the transplanted tissue or cells due to immunological reaction. This is especially the case when transplanting SSCs isolated from adult donors into adult recipients. In order to evade the problems caused by adult-adult transplantations, scientists have taken advantage of the ontogeny of recipients, mainly the ontogeny of their immune system, and used embryos and larvae as recipients. Embryos and larvae do not have a developed immune system nor differentiated T-cells (Takeuchi et al., 2003; Yoshizaki et al., 2011), therefore they do not have mechanisms to reject the donor tissue. Furthermore, it is easier to knock-out larval endogenous PGCs than to deplete SSCs from already developed gonad. Apart from choosing the right donor and recipient organisms, it is necessary to isolate specific cells that need to be transplanted. This is to some extent easier when transplanting PGCs, since there are fewer of them than SSCs, and they have not yet fully developed inside the gonads. On the other hand, SSCs are well developed inside the gonads and usually take their specific place within the spermatogonial stem niche. When isolating undifferentiated spermatogonia type A from adult testis, special attention must be given to their morphology and specific markers that distinguish them from other types of spermatogonia (Adiff, B), spermatocytes and spermatids. Basic histology may be coupled with immunohistochemistry, in situ hybridization or in situ PCR which would enable the identification of specific molecular markers within the cells of the niche (proteins or RNA). All this data can be further used in isolation of particular cells. Prior to transplantation, PGCs and spermatogonia need to be isolated from the donor tissue. After multi-enzymatic digestion it is possible to isolate cells based on their morphology and size, and/or specific molecular markers and the whole process can be species-specific. A great advantage of transplantation of PGCs and SSCs is that this method can be very well combined with cryopreservation. There are still no optimized protocols for cryopreservation of fish eggs and embryos, mostly due to presence of large amount of yolk and fat. Since PGCs and SSCs can develop into both sperm and eggs, cryopreservation of these cells could have a great perspective in conservation biology but also in aquaculture. Studies have shown that frozen/thawed SSCs transplanted into recipients give rise to potent donor sperm and eggs in the recipients (Kobayashi et al., 2007). In this way, there is no need to conserve both sperm and eggs since successful cryopreservation of germ cells can give rise to both sperm and eggs after transplantation

SEUROP Classification of Bovine Carcasses in Strumica Region

Beef production in the R. of Macedonia is 5.000 to 8.000 tons, but its consumption is 14.000 to 16.000 tons of beef annually. For that market gap, our country spends a lot of money for beef import every year. From 2010 a New Law for quality of agricultural product ruled, according to new estimation of bovine carcasses by conformation and fat covering according SEUROP standards. According to our research, most of controlled bovine carcasses belong to R, O and P class by conformation, and 3 and 4 class by fat covering of carcasses

Randman trogodišnjeg šarana iz kaveznog sistema uzgoja

Uzgoj šarana (Cyprinus carpio L.) u kaveznom sistemu predstavlja posebnu vrstu intenzivne proizvodnje. Odlikuje se malim početnim ulaganjima u izgradnju kaveznog ribnjaka, ne zahteva značajno angažovanje radne snage i obezbeđuje veliku proizvodnju po jedinici zapremine. Izbor lokacije je od velikog značaja jer utiče na ekonomsku održivost, proizvodnju i mortalitet šarana. U odnosu na druge uzgojne sisteme, utvrđeno je da u kaveznom sistemu morbiditet i mortalitet mogu značajno varirati i u slučaju odstupanja vrednosti parametara kvaliteta vode od optimalnih, gubici mogu nastupiti brzo i biti dramatični. Nedostatak kaveznog sistema gajenja ogleda se u olakšanoj transmisiji bolesti i zagađenju vodenog ekosistema u kome je kavezni sistem postavljen, što se može sprečiti uvođenjem zaštitnih sistema. Uz poštovanje načela dobre proizvođačke prakse, održavanjem dobrog kvaliteta vode i optimalno izbalansiranu hranu primerenu starosnoj kategoriji uzgajanog šarana, očekivan mortalitet je 1-5%. Zahtevi savremenog tržišta su sve više usmereni ka obrađenoj ribi, posebno filetima. Uklanjanjem kože i odstranjivanjem unutrašnjih organa i intramuskularnih kostiju, fileti šarana i ostalih ciprinida koje se gaje u polikulturi sa šaranom, postaju visokovredni obroci, koji se lako i brzo spremaju. Randman riba je ekonomski parametar čija je vrednost značajna pri svim tehnološkim operacijama vezanim za preradu ribe. Iskazuje se kao odnos primarno obrađenog trupa u odnosu na masu trupa žive ribe. Odnos jestivog i nejestivog dela trupa ribe može značajno da varira u zavisnosti od vrste, mase i veličine ribe i sezone ulova). Od njega direktno zavisi ekonomičnost proizvodnje i neopravdano je zanemaren kao parameter u istraživanjima. Razlika u randmanu između različitih linija i njihovih hibrida javlja se zbog različitog oblika, dužine glave, debljine i širine tela. Randman riba značajno je povoljniji od randmana kod ostalih vrsta životinja. Delovi koji se odbacuju mogu sadržati sve ili samo neke delove glave, krljušti, kože, creva, gonada i peraja. Cilj istraživanja bio je određivanje randmana kod trogodišnjeg šarana poreklom iz kaveznog sistema uzgoja. Uzorkovanje je obavljeno iz dva kavezna sistema na Tikveškom jezeru (Makedonija) (41°20′51″N 21°57′58″E) i iz jednog na Bilećkom jezeru (Bosna i Hercegovina) (42°49′31″N 18°26′17″E). Ishrana riba vršena je kompletnim krmnim smešama različitih proizvođača. Iz svakog kaveznog sistema uzorkovano je po 8 jedinki muškog i 8 jedinki ženskog pola (ukupno po 24 jedinke svakog pola). Morfometrijske osobine riba utvrđene su sa ciljem da se ispita uticaj pola na randman trogodišnjeg šarana gajenog u kaveznom sistemu. Nakon što su izlovljeni, šarani su držani na ledu. Krljušt je skinuta ručno nazubljenim nožem. Glava je odsečena cirkularnim rezom ispred pojasa pektoralnog peraja tako da je peraje ostalo na trupu. Peraja su odsečena na početku perajnih žbica. Egzenteracija organa zajedno sa gonadama obavljena je ručno. Dobijeni su obrađen trup, koji podrazumeva trup ribe bez krljušti, peraja, unutrašnjih organa i glave. Posle odstranjivanja krljušti, unutrašnji oragni, gonade, glava, peraja i obrađen trup su izmereni. Rezultati su obrađeni t-testom kako bi se utvrdio uticaj pola na randman trogodišnjeg šarana gajenog u kaveznom sistemu proizvodnje. U odnosu na pol (ženke naspram mužjaka šarana) pažnja je usmerena na parametre koji su važni sa aspekta gajenja i što povoljnijeg randmana. U našem istraživanju randman je određen kao odnos mase cele ribe i mase trupa bez glave, krljušti, peraja i unutrašnjih organa. Rezultati dobijeni u našem istraživanju pokazuju veću težinu ženskih u odnosu na muške jedinke (FW), ali nemaju statističku značajnost. Ukupna dužina (TL), standardna dužina (SL) i dužina trupa (CL) ženki u odnosu na mužjake imaju statistički značajnu razliku (p < 0,01), dok razlike u telesnoj masi ženki i mužjaka nisu statistički značajne. Rezultati dobijeni merenjem težine trupa (CW) i težine unutrašnjih organa (VW) ženki u odnosu na iste parametre kod mužjaka imaju statistički značajnu razliku (p < 0,01). Vrednosti dobijene merenjem težine glave (HW), težine gonada (GW) mužjaka, kao i vrednosti gonadosomatskog indeksa (GSI) u odnosu na vrednosti istih parametara kod ženki imaju statistički značaj (p < 0,01). Razlike u dužini glave (HL), visini tela (BH), masi peraja (FW), masi jedinki (FW) i obrađenih fileta (FilletW) mužjaka i ženki, nemaju statistički značaj. Vrednosti dobijene izračunavanjem relativne težine fileta i randmana uzorkovanih trogodišnjih jedinki šarana muškog i ženskog pola nemaju statistički značajnu razliku