Discovery of the potential role of sensors in a personal emergency response system: what can we learn from a single workshop?

Capturing knowledge from domain experts is important to effectively integrate novel technological support in existing care processes. In this paper, we present our experiences in using a specific type of workshop, which we identified as a decision-tree workshop, to determine the process and information exchange during the usage of a Personal Emergency Response System (PERS). We conducted the workshop with current and possible future users of a PERS system to investigate the potential of context-and social awareness for such a system. We discuss the workshop format as well as the results and reflection on this workshop

Unusual Formation of Point-Defect Complexes in the Ultrawide-Band-Gap Semiconductor β-Ga2 O3

Understanding the unique properties of ultra-wide band gap semiconductors requires detailed information about the exact nature of point defects and their role in determining the properties. Here, we report the first direct microscopic observation of an unusual formation of point defect complexes within the atomic-scale structure of β-Ga2O3 using high resolution scanning transmission electron microscopy (STEM). Each complex involves one cation interstitial atom paired with two cation vacancies. These divacancy-interstitial complexes correlate directly with structures obtained by density functional theory, which predicts them to be compensating acceptors in β-Ga2O3. This prediction is confirmed by a comparison between STEM data and deep level optical spectroscopy results, which reveals that these complexes correspond to a deep trap within the band gap, and that the development of the complexes is facilitated by Sn doping through increased vacancy concentration. These findings provide new insight on this emerging material's unique response to the incorporation of impurities that can critically influence their properties

Case report of increased left ventricular end-diastolic pressure with pulsatile left ventricular assist device

Background Left ventricular assist devices (LVADs) are increasingly utilized in cardiogenic shock and high-risk percutaneous coronary interventions (PCIs). These devices aspirate and expel blood from the left ventricle (LV) into the aorta, consequently reducing left ventricular end-diastolic pressure (LVEDP). We report a case of unexpected LVEDP rise under LV-to-aorta LVAD in the context of transcatheter aortic valve implantation (TAVI) and concomitant multi-vessel PCI.Case summary A patient with acute heart failure, severely depressed systolic LV function, severe aortic stenosis, and multi-vessel coronary artery disease underwent TAVI and concomitant PCI under pulsatile LVAD. Notably, the patient experienced unexpected shortness of breath and elevated LVEDP while under LVAD, which normalized immediately upon LVAD removal.Discussion Pulsatile LVAD enhances cardiac output by providing pulsatile support through a percutaneous bi-directional flow catheter. Despite expectations of reduced LVEDP and improved myocardial oxygen supply under LVAD support, we observed high LVEDP and clinical complaints of shortness of breath following TAVI and multi-vessel PCI. This case illustrates that an LVAD across the aortic valve may immobilize aortic leaflets and generate acute aortic regurgitation

The human environmental balance

A future policy instrument for assessing the consequences of changes (already made) to the physical environment can be found in the instrument known as the human environmental balance. By taking all relevant aspects into account when using this instrument, present and future serious defects along with necessary areas of focus will become clear. In this way, the balance will fulfil an important evaluative and indicative function, serving as an integral conceptual framework to find out what investments to make and where they should be made. This report describes a survey, representing an initial step on the road to a balanced physical environment, charting further work along the way. It is also meant to stimulate a broad debate on how to audit this physical environment and what to study. The concept of the physical environment is defined as consisting of (stocks of) various objects in a certain (spatial) arrangement. These objects are evaluated from three perspectives: ecological, economic and social/psychological. The first two perspectives focus on long-term issues on sustainability. In the third perspective the central theme is the perception of the environment by humans themselves; here, we are concerned about short-term issues on the sub-national (local) level. The 1970-1995 draft balance also saw its first elaboration in this report.De leefomgevingsbalans is een door VROM voorgesteld toekomstig beleidsinstrument om gedane ingrepen in het fysieke milieu op hun integrale gevolgen voor de leefomgeving te beoordelen. De leefomgevingsbalans zou hiermee een belangrijke evaluerende en signalerende functie hebben: door beschouwing van alle relevante aspecten maakt de balans zichtbaar waar tekorten zijn of dreigen te ontstaan en waar extra inspanningen nodig zijn. Hiermee vormt de leefomgevingsbalans een integratief raamwerk dat richtinggevend kan zijn voor de aard en locatie van gewenste investeringen. Dit rapport is een verkenning van een mogelijk invulling van een dergelijke leefomgevingsbalans en dient uitsluitend als basis voor discussie. Het beschouwt de fysieke leefomgeving als een verzameling van (voorraden) van allerlei objecten in een bepaalde ruimtelijke configuratie. Deze objecten worden vanuit verschillende invalshoeken verschillend gewaardeerd. Hierbij is onderscheid gemaakt in een ecologisch, economisch en sociaal-psychologisch perspectief. De eerste twee perspectieven zijn vooral gericht op lange termijn-vraagstukken waarbij duurzaamheid voorop staat. Bij het laatste perspectief gaat om de individuele leefbaarheid van de burger, veelal handelend over korte termijn-vraagstukken op vooral lokaal niveau. Op deze wijze wordt het 'leefomgevingskapitaal' gepresenteerd als een drieluik van economische, ecologische en sociaal-psychologische waarden. In het rapport is ook een eerste uitwerking van dit concept voor de periode 1970-1995 gegeven

Coarse-grained reconfigurable array architectures

Coarse-Grained Reconfigurable Array (CGRA) architectures accelerate the same inner loops that benefit from the high ILP support in VLIW architectures. By executing non-loop code on other cores, however, CGRAs can focus on such loops to execute them more efficiently. This chapter discusses the basic principles of CGRAs, and the wide range of design options available to a CGRA designer, covering a large number of existing CGRA designs. The impact of different options on flexibility, performance, and power-efficiency is discussed, as well as the need for compiler support. The ADRES CGRA design template is studied in more detail as a use case to illustrate the need for design space exploration, for compiler support and for the manual fine-tuning of source code

General practitioner practices in requesting laboratory tests for patients with gastroenteritis in the Netherlands, 2001–2002

BACKGROUND: The objective of this study was to estimate the (selective) proportion of patients consulting their GP for an episode of gastroenteritis for whom laboratory tests were requested. In addition adherence of GPs to the guidelines for diagnostic test regime was ascertained. METHODS: Data were collected from a GP network in the Netherlands. Information was also collected on the reason for requesting the test, test specifications, and test results. RESULTS: For 12% of the GP patients with gastroenteritis, a stool sample was requested and tested for enteric pathogens. In most patients, the duration, followed by severity of complaints or a visit to a specific, high-risk country were reported as reasons to request laboratory diagnostics. Tests were requested most often in summer months and in February. Campylobacter (requested for 87% of the tests), Salmonella (84%), Shigella (78%) and Yersinia (56%) were most frequently included in the stool tests. Campylobacter was detected most often in patients. CONCLUSION: Test requests did not always comply with existing knowledge of the etiology of gastroenteritis in GP patients and were not always consistent with the Dutch GP guidelines. Therefore, the data of this study can be used to develop educational approaches for GP's as well as for revision of the guidelines

Overexpression of Full-Length ETV1 Transcripts in Clinical Prostate Cancer Due to Gene Translocation

ETV1 is overexpressed in a subset of clinical prostate cancers as a fusion transcript with many different partners. However, ETV1 can also be overexpressed as a full-length transcript. Full-length ETV1 protein functions differently from truncated ETV1 produced by fusion genes. In this study we describe the genetic background of full-length ETV1 overexpression and the biological properties of different full-length ETV1 isoforms in prostate cancer. Break-apart FISH showed in five out of six patient samples with overexpression of full-length ETV1 a genomic rearrangement of the gene, indicating frequent translocation. We were able to study the rearrangements in more detail in two tumors. In the first tumor 5′-RACE on cDNA showed linkage of the complete ETV1 transcript to the first exon of a prostate-specific two exon ncRNA gene that maps on chromosome 14 (EST14). This resulted in the expression of both full-length ETV1 transcripts and EST14-ETV1 fusion transcripts. In chromosome spreads of a xenograft derived from the second prostate cancer we observed a complex ETV1 translocation involving a chromosome 7 fragment that harbors ETV1 and fragments of chromosomes 4 and 10. Further studies revealed the overexpression of several different full-length transcripts, giving rise to four protein isoforms with different N-terminal regions. Even the shortest isoform synthesized by full-length ETV1 stimulated in vitro anchorage-independent growth of PNT2C2 prostate cells. This contrasts the lack of activity of even shorter N-truncated ETV1 produced by fusion transcripts. Our findings that in clinical prostate cancer overexpression of full-length ETV1 is due to genomic rearrangements involving different chromosomes and the identification of a shortened biologically active ETV1 isoform are highly relevant for understanding the mechanism of ETV1 function in prostate cancer

In-hospital outcomes by insurance type among patients undergoing percutaneous coronary interventions for acute myocardial infarction in New South Wales public hospitals

Background: International evidence suggests patients receiving cardiac interventions experience differential outcomes by their insurance status. We investigated outcomes of in-hospital care according to insurance status among patients admitted in public hospitals with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods: We conducted a cohort study within the Australian universal health care system with supplemental private insurance. Using linked hospital and mortality data, we included patients aged 18 + years admitted to New South Wales public hospitals with AMI and undergoing their first PCI from 2017–2020. We measured hospital-acquired complications (HACs), length of stay (LOS) and in-hospital mortality among propensity score-matched private and publicly funded patients. Matching was based on socio-demographic, clinical, admission and hospital-related factors. Results: Of 18,237 inpatients, 30.0% were privately funded. In the propensity-matched cohort (n = 10,630), private patients had lower rates of in-hospital mortality than public patients (odds ratio: 0.59, 95% CI: 0.45–0.77; approximately 11 deaths avoided per 1,000 people undergoing PCI procedures). Mortality differences were mostly driven by STEMI patients and those from major cities. There were no significant differences in rates of HACs or average LOS in private, compared to public, patients. Conclusion: Our findings suggest patients undergoing PCI in Australian public hospitals with private health insurance experience lower in-hospital mortality compared with their publicly insured counterparts, but in-hospital complications are not related to patient health insurance status. Our findings are likely due to unmeasured confounding of broader patient selection, socioeconomic differences and pathways of care (e.g. access to emergency and ambulatory care; delays in treatment) that should be investigated to improve equity in health outcomes