The Effect of Patient and Hospital-level Factors on 30-Day Readmission After Initial Hospitalization Due to Stroke

Background: Hospital readmissions account for a large part of healthcare costs, especially among stroke patients. Readmission is common among disabled stroke survivors because they often suffer some neurological deficits, functional impairment, and other preexisting cardiovascular conditions. Although previous studies have explored the relationship between hospital readmissions after initial hospitalization due to stroke and a set of predictors using various analytical models, it often remains uncertain which predictors are most influential or essential. This study aimed to assess the effect of patient and hospital-levels factors on 30-day readmission after initial hospitalization due to stroke using the Anderson model of healthcare utilization as a guide. Methods: Data for this study was the 2014 National Readmissions Database. A generalized mixed-effect linear regression using a hierarchical modeling approach was run based on the Andersen model\u27s main block to assess the predictive capabilities of both individual and hospital-level factors on 30-day readmission. Models also assessed geographic differences that may exist among stroke patients. Results: Overall, the addition of variables blocks corresponding to the Anderson model of health utilization accounted for only a small variance in 30-day readmission. However, the addition of the enabling and need factors resulted in the most significant R2 change for hospitals in rural areas and urban areas, respectively. Conclusion: The predictive powers of individual and hospital factors on readmission within 30 days of initial stroke-caused hospitalization is weak. The results of this study suggest a holistic approach should be the goal for policymakers and legislators when developing policies to reduce readmissions

Real-time Adaptive Sensor Attack Detection and Recovery in Autonomous Cyber-physical Systems

Cyber-Physical Systems (CPS) tightly couple information technology with physical processes, which rises new vulnerabilities such as physical attacks that are beyond conventional cyber attacks.Attackers may non-invasively compromise sensors and spoof the controller to perform unsafe actions. This issue is even emphasized with the increasing autonomy in CPS. While this fact has motivated many defense mechanisms against sensor attacks, a clear vision of the timing and usability (or the false alarm rate) of attack detection still remains elusive. Existing works tend to pursue an unachievable goal of minimizing the detection delay and false alarm rate at the same time, while there is a clear trade-off between the two metrics. Instead, this dissertation argues that attack detection should bias different metrics (detection delay and false alarm) when a system sits in different states. For example, if the system is close to unsafe states, reducing the detection delay is preferable to lowering the false alarm rate, and vice versa. This dissertation proposes two real-time adaptive sensor attack detection frameworks. The frameworks can dynamically adapt the detection delay and false alarm rate so as to meet a detection deadline and improve usability according to different system statuses. We design and implement the proposed frameworks and validate them using realistic sensor data of automotive CPS to demonstrate its efficiency and efficacy. Further, this dissertation proposes \textit{Recovery-by-Learning}, a data-driven attack recovery framework that restores CPS from sensor attacks. The importance of attack recovery is emphasized by the need to mitigate the attack\u27s impact on a system and restore it to continue functioning. We propose a double sliding window-based checkpointing protocol to remove compromised data and keep trustful data for state estimation. Together, the proposed solutions enable a holistic attack resilient solution for automotive cyber-physical systems

Promoting Self-Determined Motivation For Exercise In Stroke Rehabilitation: The Role Of Autonomy Support

Rehabilitation Interventionists (RIs) usually spend a great deal of time and effort trying to improve the functional abilities of stroke patients. Stroke rehabilitation through current studies has been recognized as an important and effective modality in the treatment of stroke. Despite the known benefits of SR to stroke patients, a number of them drop out resulting in a decline the benefits from the program. Objective: To examine the predictive relationship between perceived autonomy support provided by Stroke Rehabilitation Interventionists, and the participants\u27 subsequent stroke rehabilitation program attendance rate. The study also examines the predictive relationship between participants\u27 perceived autonomy support and their motivation to exercise, which in turn, would predict higher stroke rehabilitation program attendance rate. Research Method: Stroke rehabilitation outpatients (N = 35; Male = 20; Female = 15; Mage = 52.79 years: SD = 12.16). This study examined the predictive relationship between participants\u27 perceived autonomy support and motivation for exercise at weeks 2 and 3 of stroke rehabilitation participation. It also examined the predictive relationship between participants\u27 perceived autonomy support and stroke rehabilitation attendance rate. Stroke rehabilitation attendance was tracked for a period of 5 weeks. Descriptive statistics, bivariate correlations and hierarchical linear regression were calculated to assess the predictive relationships between perceived autonomy support, self-determined motivation and stroke rehabilitation program attendance rate. Results: Perceived autonomy support was not positively correlated with relative autonomy index, r(35) = .13, p \u3e .05. The relationship between perceived autonomy support and all other forms of controlled motivation was also not significant. The regression model predicting program attendance showed significant positive effect for perceived autonomy support (β = .56, R2 = .32, p \u3c .001). However, the regression model predicting program attendance showed a non-significant effect for self-determined motivation (β = .56, R2 = .32, p = NS). Conclusion: Results supports Self-Determination Theory in predicting the attendance rate of participants in SR. The higher the perceived autonomy support provided by RI to stroke patients, the higher their attendance rate in a stroke rehabilitation program. RIs supporting stroke patients\u27 autonomy support rather than interfering with their autonomy or neglecting them during the SR process helps create an environment where stroke patients can feel an engagement-fostering balance between what they want to do and what they are actually told to do

The role of urban regeneration initiatives in the creation of sustainable inner cities : a case study of the Durban Point regeneration initiative.

Master of Town and Regional Planning. University of KwaZulu-Natal, Durban, 2015.Inner-cities are perceived as the driving force for socio-economic development of municipalities and the core commercial hub for creative opportunities. Nonetheless, they still face significant urban management challenges and a myriad of complex issues, which threaten their sustainability. This requires urban regeneration, revitalization, and renewal programmes to invigorate them. Through the application of both qualitative and quantitative methods and underpinning theories as Just city, Equity, Collaborative, and New urbanism, the study examined the role of urban regeneration in the creation of sustainable inner city using Durban Point area as a case study. The study revealed that regeneration approaches employed as a turnaround strategy by city managers, have become a spectacle of property-driven and “banal” flagships projects. This is legitimised to boost inner-city sustainability and to mobilise support for entrepreneurial urbanism activities that rebrand the inner-city for „massification‟ of private, and public, investment that has resulted unto ad-hoc, disjointed and uncoordinated implementation, which have no correlation with practical challenges manifested in the inner city realm. The findings shows that this approach does not guarantee long-term sustainability of the inner city, but only purport to raise the image of the city to attract investment without tackling socio spatial challenges deeply entrenched in this urban organism. It is proposed that if the inner city areas are to be sustained, and then it will demand a reconstruction of current policy narratives behind inner city regeneration, which presently tends to side-line the plight of the unheard voices within the inner-city areas. Municipalities are therefore encouraged to embrace integrated and multifaceted approach to regeneration implementation, which guarantees long-term sustainability of the inner-city areas

Assessing The Security Posture Of Openemr Using Capec Attack Patterns

Attack patterns describe the common methods of exploiting software. Good software engineering practices and principles alone are not enough to produce secure software. It is also important to know how software it attacked and to guard against it. Knowledge of attack patterns provides a good perspective of an attacker, thus enabling developers and testers to build secure software. CAPEC list is a taxonomy of attack patterns which we believe can enhance security testing. This research seeks to assess the security posture of OpenEMR 4.1.1, an open source Electronic Medical Record (EMR) system, based on CAPEC attack patterns. Five categories of CAPEC attack patterns were analyzed to find their relevance and applicability to OpenEMR. Whereas inapplicable attack patterns were not further considered, applicable attack patterns were further tested to assess OpenEMR vulnerability to them. Various security testing tools were used to carry out the tests. Attack patterns helped to focus black-box and white-box testing procedures on what and where to test. OpenEMR was found to be vulnerable to a number of vulnerabilities such as cross site scripting, authentication bypass, session sidejacking, among others. A number of exploitations were carried out based on the vulnerabilities discovered

Oesphageal Stenting for palliation of malignant mesothelioma

Dyspahgia in patients with malignant mesothelioma is usually due to direct infiltration of the eosophagus by the tumour. It can be distressing for the patient and challenging for the physician to treat. We describe three cases in which this condition has been successfully palliated with self expanding esophageal stents

Multi-channel SPR biosensor based on PCF for multi-analyte sensing applications

This paper presents a theoretical investigation of a novel holey fiber (Photonic Crystal Fiber (PCF)) multi-channel biosensor based on surface plasmon resonance (SPR). The large gold coated micro fluidic channels and elliptical air hole design of our proposed biosensor aided by a high refractive index over layer in two channels enables operation in two modes; multi analyte sensing and self-referencing mode. Loss spectra, dispersion and detection capability of our proposed biosensor for the two fundamental modes (HE x 11 and HE y 11 ) have been elucidated using a Finite Element Method (FEM) and Perfectly Matching Layers (PML)

Effect of Some Agronomic Practices to Increase Maize Yield in Ghana

Low plant densities of maize are often observed in fields of farmers practising no-till agriculture which causes low grain yield in Ghana. With the increasing population and consumption of maize in the country, research must be directed to solve this problem to enhance maize production. In this paper, a 2x3 factorial experiment in randomized complete block design with 4 replications was carried out at Wioso in the Atwima-Nwabiagya District in the Ashanti Region of Ghana during the major season of 2007 in order to come out with the best practices in maize production. The objectives of the study were to determine the right period of refilling maize field and the comparative effect of refilling with seed and seedling on the growth, optimum population density, and yield of maize. The factors were material for refill, which was either seeds or seedlings, and time of refilling either at 5, 10, and 15 days after planting. The results showed that refilling with seedlings produced the greatest positive effect in the number of leaves per plant, leaf length, leaf diameter, plant height and stem girth. Furthermore, refilling with seedlings contributed more to the optimum plant population density. Total grain yield when seedlings were used as refill was 967kg per hectare more than when seeds were used as refill material. On the other hand, plants from seeds refill were weak, lodged more and allowed much solar radiation penetration to the ground. Grain yield from seed refill plants was 6%, whilst seedling refill plants contributed 34% to the total grain yield. Refilling at 5 days after planting induced greater growth than 10 or 15 days after planting. The results indicate that it is possible to do refilling in maize field by using seedling as this contributes more than the traditional method of using seeds

Influence of Drying Temperature and Storage Duration on Fissuring and Milling Quality of Jasmine 85 Rice Variety

Moisture and temperature gradients induce the development of fissures during drying of paddy kernels. This affects the milling quality of the paddy and eventually reduces the head rice yield. To this effect, a study was conducted to investigate the influence of drying temperature and storage duration on the cracking behaviour and head rice yield of a local rice variety - Jasmine 85. Freshly harvested paddy samples were thin layer dried in a tunnel dryer with varying drying temperatures (45°C, 50°C, 55°C) as treatments and direct sun drying as control. The drying experiment was performed under three replications using a completely randomised design. Samples after drying were stored for three months in sealed plastic bags at room temperature (28°C). Percentage fissures and head rice yield at each drying treatment was determined using a grain scope and a Satake grading machine respectively after the storage period. The highest head rice yield (76.3%) and the least fissure rate (10%) were attained at the control temperature. This was followed by the 45°C and 50°C treatments which gave head rice yields of 70.8%, and 69.8%, with fissure rates of 13% and 16% respectively. The least head rice yield (64.7%) and the highest fissure rate of 29% were observed at 55°C. There was a significant difference (p ≤ 0.05) between head rice yields obtained at 55°C and the control experiment. However, there was no significant difference (p ≤ 0.05) between head rice yield obtained at 45°C, 50°C and the control temperature. It is evident from this study that, Jasmine 85 can be dried by using a mechanical dryer at higher temperatures of 45°C and 50°C without affecting its milling qualities