Telemedicine in diabetes foot care delivery: health care professionals’ experience

Background: Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals’ experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers. Methods: Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2). Results: The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants’ attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high. Conclusions: Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way. Keywords: telemedicine, diabetic foot ulcer, focus groups, interpretive description, health care professional

Young children's research: children aged 4-8 years finding solutions at home and at school

Children's research capacities have become increasingly recognised by adults, yet children remain excluded from the academy, with reports of their research participation generally located in adults' agenda. Such practice restricts children's freedom to make choices in matters affecting them, underestimates children’s capabilities and denies children particular rights. The present paper reports on one aspect of a small-scale critical ethnographic study adopting a constructivist grounded approach to conceptualise ways in which children's naturalistic behaviours may be perceived as research. The study builds on multi-disciplinary theoretical perspectives, embracing 'new' sociology, psychology, economics, philosophy and early childhood education and care (ECEC). Research questions include: 'What is the nature of ECEC research?' and 'Do children’s enquiries count as research?' Initially, data were collected from the academy: professional researchers (n=14) confirmed 'finding solutions' as a research behaviour and indicated children aged 4-8 years, their practitioners and primary carers as 'theoretical sampling'. Consequently, multi-modal case studies were constructed with children (n=138) and their practitioners (n=17) in three ‘good’ schools, with selected children and their primary carers also participating at home. This paper reports on data emerging from children aged 4-8 years at school (n=17) and at home (n=5). Outcomes indicate that participating children found diverse solutions to diverse problems, some of which they set themselves. Some solutions engaged children in high order thinking, whilst others did not; selecting resources and trialing activities engaged children in 'finding solutions'. Conversely, when children's time, provocations and activities were directed by adults, the quality of their solutions was limited, they focused on pleasing adults and their motivation to propose solutions decreased. In this study, professional researchers recognised 'finding solutions' as research behaviour and children aged 4-8 years naturalistically presented with capacities for finding solutions; however, the children's encounters with adults affected the solutions they found

Structure of isobaric analog states in 91Nb populated by the 90Zr(a,t) reaction

Decay via proton emission of isobaric analog states (IAS's) in $^{91}{Nb}$ was studied using the $^{90}{Zr}(\alpha,t)$ reaction at $E_\alpha$=180 MeV. This study provides information about the damping mechanism of these states. Decay to the ground state and low-lying phonon states in $^{90}{Zr}$ was observed. The experimental data are compared with theoretical predictions wherein the IAS `single-particle' proton escape widths are calculated in a continuum RPA approach. The branching ratios for decay to the phonon states are explained using a simple model.Comment: 3 figures. submitted to Phys. Lett.

Imprint of past and present environmental conditions on microbiology and biogeochemistry of coastal Quaternary sediments

To date, North Sea tidal-flat sediments have been intensively studied down to a depth of 5 m below seafloor (mbsf). However, little is known about the biogeochemistry, microbial abundance, and activity of sulfate reducers as well as methanogens in deeper layers. In this study, two 20 m-long cores were retrieved from the tidal-flat area of Spiekeroog Island, NW Germany. The drill sites were selected with a close distance of 900 m allowing to compare two depositional settings: first, a paleo-channel filled with Holocene sediments and second, a mainly Pleistocene sedimentary succession. Analyzing these cores, we wanted to test to which degree the paleo-environmental imprint is superimposed by present processes. <br><br> In general, the numbers of bacterial 16S rRNA genes are one to two orders of magnitude higher than those of <i>Archaea</i>. The abundances of key genes for sulfate reduction and methanogenesis (<i>dsr</i>A and <i>mcr</i>A) correspond to the sulfate and methane profiles. A co-variance of these key genes at sulfate-methane interfaces and enhanced ex situ AOM rates suggest that anaerobic oxidation of methane may occur in these layers. Microbial and biogeochemical profiles are vertically stretched relative to 5 m-deep cores from shallower sediments in the same study area, but still appear compressed compared to deep sea sediments. Our interdisciplinary analysis shows that the microbial abundances and metabolic rates are elevated in the Holocene compared to Pleistocene sediments. However, this is mainly due to present environmental conditions such as pore water flow and organic matter availability. The paleo-environmental imprint is still visible but superimposed by these processes

Controle Local na era de responsabilidades: Um caso de estudo de pré-escola infantil (preK) em Wisconsin

The opposing principles of local control and increased standardization are a prominent tension in the United States’ education system. Since at least the early 1990s, this tension has taken shape around the accountability movement, defined by educational reforms that hold schools, teachers, and students accountable for performance on new standards, assessments, and curricula. While many scholars have examined the manifestations of the current accountability movement, few have looked at this phenomenon within the growing public preK movement. Drawing from interviews with state policymakers and district-level actors, this paper describes how the seemingly contradictory principles of local control and increased state and national standards (what we refer to simply as standardization) are shaping the policy and practice of Wisconsin’s preK system, known as 4K. We argue that rational models of policy making fail to explain the coexistence and blending of the strands of local control and standardization we found in our data, and suggest that Deborah Stone’s (2001) policy paradox provides a better theoretical framework for our findings.Los principios opuestos al control local y el aumentado de exámenes estandarizados han causado bastante tensión en el sistema de educación en los Estados Unidos. Desde el inicio del 1990, esta tensión ha tomado forma alrededor del movimiento de responsabilidad, que se distingue por las reformas educativas que tratan de asumir la responsabilidad a las escuelas, los profesores y estudiantes sobre las nuevas normas, evaluaciones y planes de estudio. Mientras muchos han examinado las manifestaciones del movimiento de la responsabilidad actual, pocos han observado este fenómeno que va creciendo dentro del movimiento preescolar (preK). Usando entrevistas con diseñadores de políticas de estado y autores a nivel del distrito, en este artículo se describe cómo aparentemente se contradicen los principios de control local y se aumentan las pólices estándares, nacionales y estatales (las que nos referimos simplemente como la estandarización) son mol-da la política y la práctica del sistema de pre-escolar (preK) de Wisconsin, conocido como "4K". Nuestro argumento es que los modelos racionales de la formulación de políticas fallan al explicar la convivencia y la mezcla de aspectos de control local y la paradoja política que encontramos en nuestros datos, sugieren que la política de Deborah Stone (2011) proporciona una mejor estructura teórico para nuestras recomendaciones.Os princípios opostos de controle local e o aumento na padronização são uma tensão proeminente no sistema de ensino dos Estados Unidos. Pelo menos desde o início dos anos 1990, essa tensão tem tomado forma em torno do movimento de responsabilidade, definido por reformas educacionais que sustentam escolas, professores, e estudantes responsáveis pelo desempenho de novos padrões, avaliações e currículos. Enquanto muitos estudiosos têm examinado as manifestações do atual movimento de responsabilização, poucos têm olhado para esse fenômeno dentro do crescimento público do movimento pré-escolar infantil (preK). Tomando de entrevistas com formuladores de políticas estatais e autores de nível distrital, este artigo descreve como princípios aparentemente contraditórios de controle local e o aumento de padrões nacionais e estatais (o que nos referimos simplesmente como padronização) estão moldando a política e a prática do sistema de pré-escola infantil (preK) de Wisconsin, conhecido como “4K”. Defendemos que os modelos racionais de formulação de políticas falham em explicar a coexistência e mistura dos fios de controle local e padronização que encontramos em nossos dados, e sugerem que o paradoxo da política de Deborah Stone (2011) proporciona uma melhor estrutura teórica para as nossas descobertas

Health-related quality of life of children with attention-deficit/hyperactivity disorder versus children with diabetes and healthy controls

The impact of attention-deficit/hyperactivity disorder (ADHD) on health-related quality of life (HRQoL) is reported to be similar to that of other mental health and physical disorders. In this cross-sectional study, we hypothesized that children with ADHD and children with type 1 diabetes mellitus (T1DM) would have significantly worse HRQoL compared with healthy children, and that better clinical status in ADHD and T1DM would be associated with better HRQoL. Children were recruited from three outpatient services in Scotland. Responses to two frequently used validated HRQoL instruments, the Paediatric Quality of Life Inventory (PedsQL) and Child Health and Illness Profile-child edition (CHIP-CE), were obtained from parents/carers and children (6–16 years) with/without ADHD or T1DM. Child and parent/carer-completed HRQoL measurements were evaluated for 213 children with ADHD, 58 children with T1DM and 117 healthy children (control group). Significantly lower self and parent/carer ratings were observed across most PedsQL (P < 0.001) and CHIP-CE (P < 0.05) domains (indicating reduced HRQoL) for the ADHD group compared with the T1DM and control groups. Parent/carer and child ratings were significantly correlated for both measures of HRQoL (PedsQL total score: P < 0.001; CHIP-CE all domains: P < 0.001), but only with low-to-moderate strength. Correlation between ADHD severity and HRQoL was significant with both PedsQL and CHIP-CE for all parent/carer (P < 0.01) and most child (P < 0.05) ratings; more ADHD symptoms were associated with poorer HRQoL. These data demonstrate that ADHD has a significant impact on HRQoL (as observed in both parent/carer and child ratings), which seems to be greater than that for children with T1DM

Prediction and optimization techniques to streamline surgical scheduling

Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management; and, (S.M.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics; in conjunction with the Leaders for Global Operations Program at MIT, 2013.This electronic version was submitted and approved by the author's academic department as part of an electronic thesis pilot project. The certified thesis is available in the Institute Archives and Special Collections.Cataloged from department-submitted PDF version of thesisIncludes bibliographical references (p. 72-76).Abstract We have created a set of decision support tools to streamline the surgical case scheduling process by allowing surgical wait list cases (elective cases that cannot be assigned a slot on the operating room schedule at the time of booking) to be confirmed onto the operating room schedule up to three weeks in advance of the day of surgery. Prior to our research, wait list cases could not be confirmed more than a few days prior to the desired day of surgery due to uncertainty about available time prior to the release of dedicated OR capacity. Earlier confirmation of wait list cases serves three purposes: (1) to improve patients' ability to plan logistics to prepare for their visits, (2) to reduce wait list case backlogs for surgeons' offices, and (3) to reduce variability in the total daily caseload through proactive decision making. Our contributions assist scheduling personnel in confirming wait list case dates sooner to help medical institutions achieve these benefits. We have developed two Excel-based pieces of software: a prediction tool and a schedule optimization tool. The prediction tool predicts time that is available each day between one and three weeks in advance to accommodate wait list cases, and the schedule optimization tool automates the consolidation process for all cases that are currently booked on a future date so that rooms and equipment are used as efficiently as possible. Our platform lets users interact with simple GUIs in which they make selections to generate prediction results and optimized daily case schedules. Specifically, our prediction algorithm employs a multiple linear regression model over historical data to forecast unused time, and the optimization tool uses a mixed integer linear program to optimize the daily schedule by consolidating cases into a minimum number of rooms and closing any gaps between cases, subject to constraints that are specific to the facility and the date in question. We have achieved our desired outcome of maximizing operating room resource utilization by giving human schedulers a set of tools to use on a daily basis that simplifies the scheduling process and confirms wait list cases with more advance notice. This system is generalizable to other areas within healthcare delivery environments and any other industry where tasks are scheduled in advance into a fixed set of resources with a record of historical demand over time.by Ryan M. Graue.S.M.M.B.A