Risk assessment during preventive home visits among older people

Background: Preventive home visits (PHV) may contribute to identify risks and needs in older people, and thereby delay the onset of functional decline and illness, otherwise often followed by home care or admission to hospital or nursing homes. There is a need to increase knowledge about which factors are associated with different risk areas among older people, so that the PHV questionnaire focuses on relevant tests and questions to make the PHV more specific and have a clear focus and purpose. Objective: The objective of this study was to examine associations between five kinds of risks: risk of falls, malnutrition, polypharmacy, cognitive impairment, and risk of developing illness and factors related to lifestyle, health, and medical diagnoses among older people living at home. Methods: A cross-sectional study design was applied. PHV were conducted by nurses among 77-year-old people in an urban municipality and among ≥75-year-old people in a rural municipality. A questionnaire including tests and a risk assessment score for developing illness was used. Descriptive and inferential statistics including regression models were analyzed. Results: The total sample included 166 persons. Poor perceived health was associated with increased risk of developing illness and risk of fall, malnutrition, and polypharmacy. Lifestyle and health factors such as lack of social support, sleep problems, and feeling depressed were associated with risk of developing illness. Risk of falls, malnutrition, polypharmacy, and cognitive impairment were also associated with increased risk of developing illness. None of the independent factors related to lifestyle, health, or medical diagnosis were associated with risk of cognitive impairment. Conclusion: Poor perceived health was associated with health-related risks in older persons living at home. Preventive health programs need to focus on social and lifestyle factors and self-reported health assessment to identify older people at risk of developing illnesses.publishedVersio

What Automated Planning Can Do for Business Process Management

Business Process Management (BPM) is a central element of today organizations. Despite over the years its main focus has been the support of processes in highly controlled domains, nowadays many domains of interest to the BPM community are characterized by ever-changing requirements, unpredictable environments and increasing amounts of data that influence the execution of process instances. Under such dynamic conditions, BPM systems must increase their level of automation to provide the reactivity and flexibility necessary for process management. On the other hand, the Artificial Intelligence (AI) community has concentrated its efforts on investigating dynamic domains that involve active control of computational entities and physical devices (e.g., robots, software agents, etc.). In this context, Automated Planning, which is one of the oldest areas in AI, is conceived as a model-based approach to synthesize autonomous behaviours in automated way from a model. In this paper, we discuss how automated planning techniques can be leveraged to enable new levels of automation and support for business processing, and we show some concrete examples of their successful application to the different stages of the BPM life cycle

Feasibility of determining Pu-239 environmental and occupational levels in urinary excretion by fission track analysis

The results of bioassay programs for detecting human exposure to plutonium are currently playing a role that they were never intended or prepared to fulfill. With little resistance or support from the scientific community, the regulatory community established exposure limits for plutonium burdens based largely on imprecise inference of causes and effects; thus, to an extent, incomplete data and analysis formed the basis for most existing bioassay programs. At the time these early programs were developed, they were used only to determine the occupational exposure to radiation workers and populations unintentionally exposed to occupational levels during open air testing. The results from these programs are now used in litigation to determine cause, negligence and responsibility for health problems associated with the populations surrounding facilities that store, handle and process nuclear materials. As this role is beyond the scope of most bioassay programs` designs, concern for the use of existing bioassay programs in this manner is rising. It is imperative that defendable, scientifically-based, more sensitive techniques be researched and developed to measure the presence of Plutonium (Pu), which in turn can be used to establish and predict the health effects of a minimal Pu exposure. Currently, estimates to predict systemic deposition using urinalysis data are several times greater than the exposure levels measured by autopsy. The scientific research conducted in this study can serve to narrow this discrepancy and provide the regulatory community with a more reliable basis for establishing regulatory exposure limits and accurately predicting systemic deposition. Furthermore, this research and the continued development of more sophisticated detection techniques can serve to dispel general public concern over the possibility of radiation exposure from ongoing site remediation and closure efforts

Bridging the gap between business processes and IoT

© 2020 ACM. This paper discusses a novel way of making business processes and Internet of Things (IoT) work together. Indeed each suffers from many limitations that the other could help address them and vice versa. On the one hand, business processes are known for capturing organizations\u27 best practices when satisfying users\u27 demands but do not have the capabilities of controlling the physical surrounding that comprises millions of devices/things. On the other hand, IoT is known for provisioning contextualized services to users thanks to millions of devices/things but does not have the capabilities of making these devices/things collaborate. The paper presents a framework to support the collaboration of business processes and IoT. This collaboration is exemplified with 2 types of processes referred as thing-Aware processes (TaP) and process-of-Things (PoT). A system illustrating the development of PoT is presented in the paper as well

The Shape and Figure Rotation of NGC 2915's Dark Halo

NGC 2915 is a blue compact dwarf galaxy with a very extended HI disk showing a short central bar and extended spiral arms, both reaching far beyond the optical component. We use Tremaine & Weinberg (1984) method to measure the pattern speed of the bar from HI radio synthesis data. Our measurements yield a pattern speed of 0.21+/-0.06 km/s/arcsec (8.0+/-2.4 km/s/kpc for D=5.3 Mpc), in disagreement with the general view that corotation in barred disks lies just outside the end of the bar, but consistent with recent models of barred galaxies with dense dark matter halos. Our adopted bar semi-length puts corotation at more than 1.7 bar radii. The existence of the pattern is also problematic. Because NGC 2915 is isolated, interactions cannot account for the structure observed in the HI disk. We also demonstrate that the low observed disk surface density and the location of the pseudo-rings make it unlikely that swing amplification or bar-driven spiral arms could explain the bar and spiral pattern. Based on the similarity of the dark matter and HI surface density profiles, we discuss the possibility of dark matter distributed in a disk and following closely the HI distribution. The disk then becomes unstable and can naturally form a bar and spiral pattern. However, this explanation is hard to reconcile with some properties of NGC 2915. We also consider the effect of a massive and extended triaxial dark matter halo with a rotating figure. The existence of such halos is supported by CDM simulations showing strongly triaxial dark halos with slow figure rotation. The observed structure of the HI disk can then arise through forcing by the rotating triaxial figure. We associate the measured pattern speed in NGC 2915 with the figure rotation of its dark halo.Comment: 37 pages, including 8 figures and 2 tables (AASTeX, aaspp4.sty). Fig.1 and 2 available as jpg. Accepted for publication in The Astronomical Journal. Online manuscript with PostScript figures available at: http://www.strw.leidenuniv.nl/~bureau/pub_list.htm

Full endoscopic versus open discectomy for sciatica:randomised controlled non-inferiority trial

OBJECTIVE: To assess whether percutaneous transforaminal endoscopic discectomy (PTED) is non-inferior to conventional open microdiscectomy in reduction of leg pain caused by lumbar disc herniation. DESIGN: Multicentre randomised controlled trial with non-inferiority design. SETTING: Four hospitals in the Netherlands. PARTICIPANTS: 613 patients aged 18-70 years with at least six weeks of radiating leg pain caused by lumbar disc herniation. The trial included a predetermined set of 125 patients receiving PTED who were the learning curve cases performed by surgeons who did not do PTED before the trial. INTERVENTIONS: PTED (n=179) compared with open microdiscectomy (n=309). MAIN OUTCOME MEASURES: The primary outcome was self-reported leg pain measured by a 0-100 visual analogue scale at 12 months, assuming a non-inferiority margin of 5.0. Secondary outcomes included complications, reoperations, self-reported functional status as measured with the Oswestry Disability Index, visual analogue scale for back pain, health related quality of life, and self-perceived recovery. Outcomes were measured until one year after surgery and were longitudinally analysed according to the intention-to-treat principle. Patients belonging to the PTED learning curve were omitted from the primary analyses. RESULTS: At 12 months, patients who were randomised to PTED had a statistically significantly lower visual analogue scale score for leg pain (median 7.0, interquartile range 1.0-30.0) compared with patients randomised to open microdiscectomy (16.0, 2.0-53.5) (between group difference of 7.1, 95% confidence interval 2.8 to 11.3). Blood loss was less, length of hospital admission was shorter, and timing of postoperative mobilisation was earlier in the PTED group than in the open microdiscectomy group. Secondary patient reported outcomes such as the Oswestry Disability Index, visual analogue scale for back pain, health related quality of life, and self-perceived recovery, were similarly in favour of PTED. Within one year, nine (5%) in the PTED group compared with 14 (6%) in the open microdiscectomy group had repeated surgery. Per protocol analysis and sensitivity analyses including the patients of the learning curve resulted in similar outcomes to the primary analysis. CONCLUSIONS: PTED was non-inferior to open microdiscectomy in reduction of leg pain. PTED resulted in more favourable results for self-reported leg pain, back pain, functional status, quality of life, and recovery. These differences, however, were small and may not reach clinical relevance. PTED can be considered as an effective alternative to open microdiscectomy in treating sciatica. TRIAL REGISTRATION: NCT02602093ClinicalTrials.gov NCT02602093

Performance of triage systems in emergency care: a systematic review and meta-analysis

Objective To assess and compare the performance of triage systems for identifying high and low-urgency patients in the emergency department (ED). Design Systematic review and meta-analysis. Data sources EMBASE, Medline OvidSP, Cochrane central, Web of science and CINAHL databases from 1980 to 2016 with the final update in December 2018. Eligibility criteria Studies that evaluated an emergency medical triage system, assessed validity using any reference standard as proxy for true patient urgency and were written in English. Studies conducted in low(er) income countries, based on case scenarios or involving less than 100 patients were excluded. Review methods Reviewers identified studies, extracted data and assessed the quality of the evidence independently and in duplicate. The Quality Assessment of studies of Diagnostic Accuracy included in Systematic Reviews -2 checklist was used to assess risk of bias. Raw data were extracted to create 2×2 tables and calculate sensitivity and specificity. ED patient volume and casemix severity of illness were investigated as determinants of triage systems’ performance. Results Sixty-six eligible studies evaluated 33 different triage systems. Comparisons were restricted to the three triage systems that had at least multiple evaluations using the same reference standard (Canadian Triage and Acuity Scale, Emergency Severity Index and Manchester Triage System). Overall, validity of each triage system to identify high and low-urgency patients was moderate to good, but performance was highly variable. In a subgroup analysis, no clear association was found between ED patient volume or casemix severity of illness and triage systems’ performance. Conclusions Established triage systems show a reasonable validity for the triage of patients at the ED, but performance varies considerably. Important research questions that remain are what determinants influence triage systems’ performance and how the performance of existing triage systems can be improved

Social meanings and understandings in patient-nurse interaction in the community practice setting: a grounded theory study

Provisional: Background: The patient-nurse relationship is a traditional concern of healthcare research. However, patient-nurse interaction is under examined from a social perspective. Current research focuses mostly on specific contexts of care delivery and experience related to medical condition or illness, or to nurses' speciality. Consequentially, this paper is about the social meanings and understandings at play within situated patient-nurse interaction in the community practice setting in a transforming healthcare service. Methods: Grounded theory methodology was used and the research process was characterised by principles of theoretical sensitivity and constant comparative analysis. The field of study was four health centres in the community. The participants were patients and nurses representative of those attending or working in the health centres and meeting there by scheduled appointment. Data collection methods were observations, informal interviews and semi-structured interviews. Results: Key properties of 'Being a good patient, being a good nurse', 'Institutional experiences' and 'Expectations about healthcare' were associated with the construction of a category entitled 'Experience'. Those key properties captured that in an evolving healthcare environment individuals continually re-constructed their reality of being a patient or nurse as they endeavoured to perform appropriately; articulation of past and present healthcare experiences was important in that process. Modus operandi in role as patient was influenced by past experiences in healthcare and by those in non-healthcare institutions in terms of engagement and involvement (or not) in interaction. Patients' expectations about interaction in healthcare included some uncertainly as they strived to make sense of the changing roles and expertise of nurses and, differentiating between the roles and expertise of nurses and doctors. Conclusions: The importance of social meanings and understandings in patient-nurse interaction is not fully apparent to nurses, but important in the patient experience. Seeking understanding from a social perspective makes a contribution to enhancing knowledge about patient-nurse interaction with subsequent impact on practice, in particular the development of the patient-nurse relationship. The implications are that the meanings and understandings patients and nurses generate from experiences beyond and within their situated interaction are pivotal to the development of their relationship in the transforming community healthcare environment

Signatures of immune selection in intact and defective proviruses distinguish HIV-1 elite controllers

Increasing evidence suggests that durable drug-free control of HIV-1 replication is enabled by effective cellular immune responses that may induce an attenuated viral reservoir configuration with a weaker ability to drive viral rebound. Here, we comprehensively tracked effects of antiviral immune responses on intact and defective proviral sequences from elite controllers (ECs), analyzing both classical escape mutations and HIV-1 chromosomal integration sites as biomarkers of antiviral immune selection pressure. We observed that, within ECs, defective proviruses were commonly located in permissive genic euchromatin positions, which represented an apparent contrast to autologous intact proviruses that were frequently located in heterochromatin regions; this suggests differential immune selection pressure on intact versus defective proviruses in ECs. In comparison to individuals receiving antiretroviral therapy, intact and defective proviruses from ECs showed reduced frequencies of escape mutations in cytotoxic T cell epitopes and antibody contact regions, possibly due to the small and poorly inducible reservoir that may be insufficient to drive effective viral escape in ECs. About 15% of ECs harbored nef deletions in intact proviruses, consistent with increased viral vulnerability to host immunity in the setting of nef dysfunction. Together, these results suggest a distinct signature of immune footprints in proviral sequences from ECs.This work is supported by NIH grants HL134539 (to X.G.Y.), AI155171 (to X.G.Y.), AI116228 (to X.G.Y.), AI078799 (to X.G.Y.), DA047034 (to X.G.Y.), AI150396 (to X.G.Y.), the Bill and Melinda Gates Foundation (INV-002703) (to X.G.Y.), AI114235 (to M.L.), AI117841 (to M.L.), AI120008 (to M.L.), AI130005 (to M.L.), DK120387 (to M.L.), AI152979 (to M.L.), AI135940 (to M.L.), AI155233 (to M.L.), and the American Foundation for AIDS Research (amfAR#110181) (to M.L.). X.G.Y. and M.L. are members of the DARE Collaboratory (UM1AI126611) and the BEAT-HIV Martin Delaney Collaboratory (UM1 AI126620). E.R.-M. was supported by Consejo Superior de Investigaciones Científicas (CSIC) and by grant PI19/01127, Instituto de Salud Carlos III, Fondos FEDER, and Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades Junta de Andalucia (P20_01276). Support was also provided by the Harvard University and University of California at San Francisco (UCSF)/Gladstone Institute for HIV Cure Research Centers for AIDS Research (P30 AI060354 and P30 AI027763, respectively), which are supported by the following institutes and centers co-funded by and participating with the U.S. National Institutes of Health: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, and OAR. Additional support for the SCOPE cohort was provided by the Delaney AIDS Research Enterprise (DARE; AI096109 and A127966) and the amfAR Institute for HIV Cure Research (amfAR 109301). The International HIV Controller Cohort is supported by the Bill and Melinda Gates Foundation (OPP1066973), the Ragon Institute of MGH, MIT and Harvard, the NIH (R37 AI067073 to B.D.W.), and the Mark and Lisa Schwartz Family Foundation. This project has been funded in whole or in part with federal funds from the Frederick National Laboratory for Cancer Research, under contract no. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. This research was supported in part by the Intramural Research Program of the NIH, Frederick National Lab, Center for Cancer Research