bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Manifestations and Longterm Outcome for Patients with Takayasu Arteritis in China
Authors: Yang Lirui , Zhang Huimin , Jiang Xiongjing , Zou Yubao , Qin Fang , Song Lei , Guan Ting , Wu Haiying , Xu Lianjun , Liu Yaxin , Zhou Xianliang , Bian Jin , Hui Rutai , Zheng Deyu
Published: October 2014

Objective.

To describe a large cohort of patients with Takayasu arteritis in China.

Methods.

We retrospectively analyzed 566 patients hospitalized in Fuwai Hospital between 2002 and 2013. Data collected were clinical characteristics, laboratory findings, angiographic features, treatment, and longterm outcome.

Results.

The female to male ratio was 3.8 to 1, and the mean age of onset was 28.9 ± 12.0 years. The most common inflammatory symptom, initial symptom, and coexisting disease were fever (52, 9.2%), dizziness (214, 37.8%), and hypertension (HTN; 392, 69.3%), respectively. Pulmonary artery, coronary artery involvement, and aortic regurgitation were found in 83 (14.7%), 66 (11.7%), and 181 (36.7%) patients, respectively. Elevation of the erythrocyte sedimentation rate was observed in 131 patients (23.1%). Treatment included drugs, interventional therapy, autologous blood vessel transplant, artificial blood vessel transplant, and aortic valve replacement. During a mean followup of 5.0 ± 0.2 years, 32 patients died, including 1 patient who died suddenly during coronary angiography. HTN, major complications, and a progressive disease course were significant prognostic markers.

Conclusion.

HTN, rather than fever, is the leading reason for patients with Takayasu arteritis to see a doctor in China. HTN, major complications, and a progressive disease course are statistically significant predictors of survival. Because of cardiovascular events associated with the disease, early diagnosis and treatment are urgent to improve prognosis.
L'Afrique subsaharienne et le monde arabe : des espaces agricoles déconnectés
Authors: Mezouaghi Mihoub
Published: October 2014

La déconnexion des économies agricoles africaine et arabe, confrontées à une crise agricole structurelle, se traduit par des flux commerciaux bilatéraux limités et concentrés sur un nombre restreint de produits. Leur dépendance alimentaire au marché mondial tend à s’accroître. La croissance démographique, le changement climatique, l’instabilité politique et la libéralisation économique débridée sont autant de facteurs aggravants du déficit agricole. La faiblesse des échanges agricoles entre l’Afrique subsaharienne et le monde arabe résulte principalement de leurs structures économiques, des défaillances des politiques agricoles, de régimes commerciaux non incitatifs et de la faible qualité des infrastructures de transport. Le déficit logistique accroît considérablement la marginalisation de ces espaces agricoles par rapport à l’économie internationale et affecte la compétitivité des producteurs agricoles en générant des surcoûts de production et de transaction. Pour autant, la menace de l’insécurité alimentaire, d’une part, et la contrainte de la concurrence internationale, d’autre part, ont favorisé des flux d’investissement, leviers potentiels d’une meilleure intégration des espaces agricoles. Dans un contexte marqué par une croissance soutenue du continent africain et par une situation d’excès de liquidités financières dans le monde arabe, de nouvelles dynamiques financières et productives sont de nature à accroître les échanges agricoles, à participer à une valorisation des terres agricoles et à favoriser le développement et l’internationalisation des industries de transformation. Néanmoins, faute d’une approche intégrée et stratégique des relations agricoles entre les pays d’Afrique subsaharienne et les pays arabes, ces dynamiques relèvent davantage d’une logique opportuniste d’états voulant réduire leur insécurité alimentaire et d’entreprises cherchant à développer des niches d’exportation. Cette logique ne peut suffire à inverser la logique structurelle et institutionnelle de déconnexion des espaces agricoles.
L'Iran et l'Afrique : une coopération à l'épreuve des faits
Authors: Bouba Nouhou Alhadji
Published: October 2014

L’accord conclu le 24 novembre 2013 à Genève entre l’Iran et le groupe « 5+1 » (France, Russie, Grande-Bretagne, Etats-Unis, Chine et Allemagne) sur la levée progressive des sanctions contre Téhéran est perçu comme de bon augure par l’Afrique. Cependant, si la coopération irano-africaine a été sérieusement affectée par les sanctions, peut-elle pour autant retrouver sa référence de base construite sur la solidarité tiers-mondiste et sur une perception binaire « opprimés » versus « oppresseurs » ? Quelle sera la réaction des Etats du Golfe, dont certains, comme l’Arabie saoudite, restent opposés à toute offensive diplomatique de la part de l’Iran ?
Démilitariser Gaza, sans plus : un piège ?
Authors: Bistolfi Robert
Published: October 2014

Alors que les ruines de Gaza fument encore, un premier bilan politique montre qu’Israël n’a pas atteint ses objectifs et que la Hamas a conforté son autorité sur fond d’impuissance de l’Autorité palestinienne. Même si ses appuis occidentaux demeurent, Israël connaît une profonde détérioration de son image sur le plan international. Un aggiornamento de la politique israélienne n’est cependant pas à attendre. L’intervention à Gaza visait d’abord et surtout à empêcher le rapprochement inter-palestinien qui se dessinait. Cet objectif de division de l’adversaire demeure central pour un gouvernement israélien qui poursuit sa politique de colonisation et refuse la « solution à deux Etats ». Le second objectif qui en découle pour lui est de parvenir à tout prix à une démilitarisation de Gaza, et ce qu’il n’a pu obtenir par les armes sera maintenant recherché à travers une intervention internationale qui sécuriserait Israël sans qu’il ait à payer le prix politique de la paix. S’il est de plus en plus évident qu’une solution du conflit conforme au droit international ne pourra qu’être imposée par la « communauté internationale », il ne faudrait pas que cette intervention ait pour objectif premier, sinon pour but unique, de réduire la capacité de résistance du Hamas. En d’autres termes, toute action concernant Gaza devrait avoir pour pendant des pressions fortes sur Israël, touchant à la colonisation et à l’enclenchement d’un vrai processus de négociation en vue d’une paix juste.
Un adolescent seul n'existe pas
Authors: Cabrol Guy
Published: October 2014

Ce texte propose une réflexion sur les présupposés d’une possible institution de la crise adolescente. Ces réflexions ont été mises à l’épreuve, durant 20 ans, dans mon expérience de psychanalyste sans divan, à travers les références de la psychothérapie institutionnelle et des théories de la groupalité. Les enjeux de la subjectivation sont, entre destructivité et créativité, imprégnés du fantasme masturbatoire central et du nécessaire meurtre des objets œdipiens, sans endommager ses objets internes. Comment résoudre ce paradoxe de finir sans en finir ? La crise adolescente est l’expression d’une tentative de solution de ce dilemme dans des changements catastrophiques qui traversent aussi l’institution familiale, car un adolescent, toujours "grand prématuré," seul, n’existe pas. Peut-on jamais en finir avec la part adolescente de la personnalité ?
La déconnexion aux technologies de communication
Authors: Jauréguiberry Francis
Published: October 2014

Les conduites de déconnexion apparaissent comme une volonté de maîtrise des technologies de communication. Elles sont toujours ponctuelles et la plupart du temps partielles. Il s’agit de ne pas se laisser envahir par trop d’informations non désirées, d’échapper à un mode d’interpellations incessantes, à l’urgence et à la pression managériale, au contrôle hiérarchique ou à l’impression d’être surveillé. La déconnexion équivaut alors à reprendre souffle et distance, à retrouver son rythme et un temps à soi. Mais elle est aussi parfaitement révélatrice de la figure de l’homme hypermoderne qui ne se contente pas de suivre l’accélération du mouvement moderne (capacité instrumentale à agir rationnellement sur le réel et soif d’inédit et de changement), mais l’interroge au contraire par une réflexivité accrue sur ses choix et dans l’inquiétude qui en résulte.
Moduler sa connexion : les enseignants-chercheurs aux prises avec leur courriel
Authors: Chaulet Johann , Datchary Caroline
Published: October 2014

Cet article se propose d’appréhender la façon dont les enseignants-chercheurs tentent de résister à la norme de connexion permanente, en prêtant attention aux dispositifs qui équipent l’activité, en particulier la messagerie électronique. Si l’outil n’est pas jugé négativement par tous, il est malgré tout possible de dire que, dans la quasi-totalité des situations investiguées, le courriel pose problème dans le sens où il génère au mieux un questionnement, au pire une situation douloureuse. Nous questionnons ici la tension permanente entre, d’un côté, la maîtrise et le sentiment de liberté que renforce cet outil, et de l’autre, la perte de contrôle, voire l’aliénation dont il semble responsable. Dans les faits, les usagers oscillent alors entre deux modalités de gestion de leur connexion : le cloisonnement équipé et l’hyperconnexion maîtrisée. Les résultats de cette enquête permettent de fournir des bases à une réflexion sur les formes contemporaines d’entretien du lien et les modulations de connexions toujours plus nombreuses et présentes.
L'aspect sentimental du savoir
Authors: Monnier Pascalle
Published: October 2014

Résumé Sachant qu’elle ne rencontrerait personne au cours de sa promenade, elle n’avait pas jugé utile de se coiffer d’un chapeau et le soleil nimbait de lumière ses boucles blondes légèrement en désordre - sa silhouette parfaite et sa taille de guêpe étaient mises en valeur par une blouse en mousseline blanche d’une simplicité exquise et une longue jupe d’équitation à la coupe parfaite.
Pierre ou les ambiguïtés
Authors: Guillemeau-Chartier Christine , Renouard Jean-Philippe
Published: October 2014

Résumé entretien avec Pierre Chevalier, Arte (unité Fictions)
Images du territoire des indiens pueblos en Amérique du nord
Authors: Warburg Aby , Muller Sibylle
Published: October 2014

Résumé Ce texte est un extrait de la conférence de Aby Warburg sur son voyage en Amérique, inédite et pour la première fois traduite en français. Nous tenons à remercier Jean Clay des Éditions Macula pour nous avoir aimablement autorisé à le reproduire en avant-première dans nos pages.
Contribution of microbiota to the intestinal physicochemical barrier
Authors: Malago J.J.
Published: October 2014

The large number of intestinal microorganisms, which exceeds the total number of human cells by ten folds, alludes to a significant contribution to human health. This is vivid in enteric and some systemic diseases emanating from disruption of the microbiota. As life style keeps shifting towards disruption of the microbiota in most societies worldwide, interest in the contribution of the microbiota to gut health has grown enormously. Many studies have been conducted to elucidate the exact contribution of the microbiota to human health. The knowledge gained from these studies indicates that the microbiota interacts with the intestinal milieu to maintain gut health. In this review, the crosstalk of microbiota with the intestinal physicochemical barrier pivotal to the gut innate immunity is highlighted. In particular, the review focuses on the role of the microbiota on competitive exclusion of pathogens, intestinal pH, epithelial mechanical barrier integrity, apical actin cytoskeleton, antimicrobial peptides, and the mucus layer. Understanding this microbe-host relationship will provide useful insight into overcoming some diseases related to the disruption of the host microbiota.
Heritability study of eGFP-transformedAspergillus flavus strains
Authors: Moore G.G.
Published: October 2014

Field inoculation with non-aflatoxigenicAspergillus flavus is a preferred method for pre-harvest biocontrol of aflatoxin contamination of maize, cottonseed, and groundnut. Rationale for using theseA. flavus strains is that they (1) maintain persistent control of aflatoxigenic fungi in the field, and (2) are incapable of out-crossing. Trackable field-released biocontrol strains will be beneficial to study the movement and longevity of non-aflatoxigenicA. flavus strains. Incorporating a naturally-occurring compound such as enhanced green fluorescent protein (eGFP) into a biocontrol strain might allow observation of its behaviour in field settings. The success of long-term field testing of eGFP-expressingA. flavus strains depends on their ability to maintain fluorescence throughout growth. Additionally, to ensure accurate tracking of the fluorescent atoxigenic strain, the likelihood of their out-crossing with individuals from the native population must be determined.In vitro mating experiments paired each of six different eGFP-transformed atoxigenic strains with a highly fertile toxigenicA. flavus isolate. Findings indicate that the eGFP gene, and possibly the aflatoxin cluster, is heritable by the F1 progeny. Not all cultured ascospores were fluorescent, but subsequent growth arising from a single fluorescent ascospore exhibited fluorescence similar to the eGFP parent. Observed mixed-fluorescence among conidia in a single chain suggests heterokaryosis at the moment of conidiogenesis. Mycotoxin assays showed that some fluorescent F1 individuals produce aflatoxin and/or cyclopiazonic acid which would indicate they are recombinant offspring. The findings in this laboratory study lend support to concern that atoxigenic strains are not impervious to genetic recombination and for which, if possible in a natural environment, repeated use could pose a risk of increasing the occurrence of aflatoxigenic individuals in treated fields.
The awareness about mycotoxin contamination of food and feed: a survey in the Flemish population
Authors: Sanders M. , De Middeleer G. , Vervaet S. , Walravens J. , van de Velde M. , Detavernier C. , De Saeger S. , Sas B.
Published: October 2014

The objective of this quantitative survey (n=520) was to determine the awareness of the risks of mycotoxin contaminated food and feed throughout the Flemish population. The study highlighted gaps in food and feed safety knowledge regarding mould growth and consequently the presence of mycotoxins. Most people were aware of the negative effects of mould species in food or feed. Around 60% of the people picked out moulds as the producers of mycotoxins, but the majority did not have an idea about the toxicity of these toxins, especially towards plants. Respondents were also asked about possible food products where mould growth could occur and who is responsible for guarding the safety of food and feed with respect to moulds and mycotoxins. All answers and considerations are presented and discussed. Education on mycotoxins should be the focus of the whole population in the near future.
Mycotoxins as antagonistic or supporting agents in the interaction between phytopathogenicFusarium andAlternaria fungi
Authors: Müller M.E.H. , Urban K. , Köppen R. , Siegel D. , Korn U. , Koch M.
Published: October 2014

The role of mycotoxins in the microbial competition in an ecosystem or on the same host plant is still unclear. Therefore, a laboratory study was conducted to evaluate the influence of mycotoxins on growth and mycotoxin production ofFusariumandAlternariafungi.Fusarium culmorumFc13,Fusarium graminearumFg23 and twoAlternaria tenuissimaisolates (At18 and At220) were incubated on wheat kernels supplemented with alternariol (AOH), tetramic acid derivates (TeA), deoxynivalenol (DON) and zearalenone (ZEA) in anin vitrotest system. Fungal biomass was quantified by determining ergosterol content. ThreeFusariumtoxins (DON, nivalenol and ZEA) and threeAlternariatoxins (AOH, alternariol methyl ether (AME) and altenuene) were analysed by HPLC-MS/MS. IfAlternariastrains grew in wheat kernels spiked withFusariummycotoxins, their growth rates were moderately increased, their AOH and AME production was enhanced and they were simultaneously capable of degrading theFusariummycotoxins DON and ZEA. In contrast, bothFusariumstrains behaved quite differently. The growth rate of Fc13 was not distinctly influenced, while Fg23 increased its growth in wheat kernels spiked with AOH. TeA depressed the ergosterol content in Fc13 as well as in Fg23. The DON production of Fc13 was slightly depressed, whereas the ZEA production was significantly increased. In contrast, Fg23 restricted its ZEA production. BothFusariumstrains were not capable of degrading theAlternariamycotoxin AOH. Mycotoxins might play an important role in the interfungal competitive processes. They influence growth rates and mycotoxin production of the antagonistic combatants. The observed effects between phytopathogenicAlternariaandFusariumstrains and their mycotoxins aid the understanding of the complexity of microbial competitive behaviour in natural environments.
Biotecnología: bioseguridad y biocustodia en la investigación biotecnológica
Authors: Pérez Mellado Rafael
Published: October 2014

Los avances en Biotecnología y en Bioinformática han sido tan espectaculares en los últimos años que han llevado a la reconstrucción de agentes biológicos y al diseño y síntesis de cromosomas artificiales. Paradójicamente han sido estos avances los que han dificultado la puesta en práctica de mecanismos que permitiesen el control a nivel nacional e internacional sobre la transferencia de agentes biológicos naturales, genéticamente modificados o sintéticamente reconstruidos, limitando las capacidades nacionales para hacer frente a los compromisos contraídos en Tratados o Resoluciones Internacionales que prohíben el desarrollo, producción almacenamiento de armas biológicas y toxínicas, elevando las armas biológicas a la categoría de armas de destrucción masiva. Los códigos de conducta parecen una medida sencilla, de escasa interferencia en el desarrollo de la investigación científica y que permite evidenciar la transparencia del trabajo científico.
Biotecnología marina y acuicultura
Authors: Figueras Antonio , Novoa Beatriz
Published: October 2014

Debido a la situación de los caladeros y al encarecimiento del proceso extractivo, el consumo de pescado y marisco se apoya cada vez más en la acuicultura. España es el tercer país consumidor de pescado del mundo, por detrás tan solo de Japón y Noruega. La biotecnología puede acelerar la consecución de estos objetivos. Sin embargo, no todo es producción de alimento; gracias a la biotecnología asociada al mundo acuático podemos generar combustible, energía, medicamentos y muchas otras aplicaciones que nos permiten valorar cada vez con más la riqueza del mar y su biodiversidad.
La biotecnología en sanidad animal
Authors: Rodríguez García Mª José , Ranz Casares Ana , Barreiro Morán Belén , Delbecque Peña Jacques , Sanz Fernández Antonio , Rueda Pérez Paloma
Published: October 2014

El crecimiento de la población mundial en los próximos años, provocará un incremento en la demanda de alimentos. Como consecuencia, el número de animales de producción sufrirá un aumento importante y la Sanidad Animal constituirá un elemento crítico a la hora de tratar y prevenir las enfermedades, garantizando el abastecimiento y la seguridad. La biotecnología contribuye de múltiples formas al desarrollo de la Sanidad Animal. Fundamentalmente, aporta herramientas que ayudan al control y erradicación de las enfermedades. El desarrollo de la ingeniería genética en las últimas décadas ha favorecido el avance de la industria biotecnológica aplicada a la sanidad humana y animal. Existen un gran número de ensayos de diagnóstico basados en desarrollos biotecnológicos, así mismo, cada vez hay más vacunas recombinantes contra enfermedades animales. La prevención y control eficientes de las enfermedades dependerán de mecanismos de detección temprana, que faciliten la toma de decisiones y una respuesta rápida.
Biotecnología industrial
Authors: Rendueles Manuel , Díaz Mario
Published: October 2014

La Biotecnología Industrial, como campo tecnológico de aprovechamiento industrial de materiales biológicos, se conforma como un área muy amplia con aplicaciones nuevas y tradicionales, que ha incorporado los nuevos desarrollos iniciados con el conocimiento del material genético, así como las nuevas tecnologías precisas para la obtención eficiente de los productos. En este trabajo se lleva a cabo una descripción de distintos productos de base biológica con interés comercial, así como unos breves comentarios sobre los procesos para su obtención.
Procesos físicos en biotecnología: enseñanza y diseño
Authors: Collado Sergio , Díaz Mario
Published: October 2014

Los procesos de base física son fundamentales para las aplicaciones de la Biotecnología, en etapas como, por ejemplo, la preparación de los sustratos, la separación y purificación de los bioproductos o la transferencia de energía hacia o desde los biorreactores. Se discuten aquí los factores más importantes en el diseño de operaciones de base física en un proceso de tipo biotecnológico, se tratan las especificidades al trabajar con moléculas de base biológica, y se analiza cómo se enseña el diseño de operaciones básicas en los grados en Biotecnología de distintas universidades españolas.
Literatura y cine en la vanguardia francesa: una arqueología visual
Authors: Ansón Antonio
Published: October 2014

En este trabajo llevamos a cabo una investigación sobre el modo en que el cine fue recibido e interpretado por los escritores e intelectuales de vanguardia afincados en París durante primera mitad del siglo XX. La investigación hace posible hacernos una idea de cómo se entendió el cine por sus primeros espectadores, tanto desde un punto de vista técnico como cultural.
UML MARTE Time Model and Its Clock Constraint Specification Language
Authors: Mallet Frédéric , Peraldi-Frati Marie-Agnès , Deantoni Julien , de Simone Robert
Published: October 2014

The UML Profile for MARTE extends the UML with constructs dedicated to the modeling and analysis of real-time and embedded systems. Its time profile provides a rich model of time based on the notion of logical clocks that can be used consistently through all modeling elements/diagrams. The MARTE time profile comes with a companion language, called CCSL. CCSL is a formal declarative language used to handle the MARTE logical clocks and schedule the execution of the different parts of a model. This chapter gives a snapshot on modeling and analysis facilities that have been developed specifically around the time profile of MARTE and CCSL. A second objective is to show how MARTE can be combined with other profiles such as EAST-ADL. The last objective is the use of CCSL as a common language for specifying the semantics of models to allow their execution in a common framework. The MARTE and EAST-ADL constructs are illustrated on an example of a simplified cruise control. The example starts with a description of functional and timing requirements captured using a specific profile called EAST-ADL dedicated to the automotive domain. Then some of the requirements are refined with UML state machines and activities adorned with MARTE stereotypes. All these models rely on MARTE clocks. The semantics of these diagrams is given by a CCSL description that is automatically derived from the models. The resulting CCSL specification can be used to execute the UML/EAST-ADL specification, to animate the model, or to perform various kinds of analyses.
Vulnerabilities of Secure and Reliable Low-Power Embedded Systems and Their Analysis Methods
Authors: Druml Norbert , Menghin Manuel , Steger Christian , Krieg Armin , Genser Andreas , Haid Josef , Bock Holger , Grinschgl Johannes
Published: October 2014

Due to the increase in popularity of mobile devices, it has become necessary to develop a low-power design methodology in order to build complex embedded systems with the ability to minimize power usage. In order to fulfill power constraints and security constraints if personal data is involved, test and verification of a design's functionality are imperative tasks during a product's development process. Currently, in the field of secure and reliable low-power embedded systems, issues such as peak power consumption, supply voltage variations, and fault attacks are the most troublesome. This chapter presents a comprehensive study over design analysis methodologies that have been presented in recent years in literature. During a long-lasting and successful cooperation between industry and academia, several of these techniques have been evaluated, and the identified sensitivities of embedded systems are presented. This includes a wide range of problem groups, from power and supply-related issues to operational faults caused by attacks as well as reliability topics.
Studying Individualized Transit Indicators Using a New Low-Cost Information System
Authors: Castillo P. A. , Fernández-Ares A. , García-Fernández P. , García-Sánchez P. , Arenas M. G. , Mora A. M. , Rivas V. M. , Asensio J. J. , Romero G. , Merelo J. J.
Published: October 2014

Current information systems used for data collection and to generate information on the state of the roads have two drawbacks: the first is that they have no ability to identify target-detected vehicles; the second is their high cost, which makes them expensive to cover the secondary road network, so they are usually located just on main routes. Thus, a new low-cost information system to monitor the traffic in real-time is proposed in this chapter. This system is based on scanning Bluetooth devices that are near the detection node. A large amount of data from passes of Bluetooth devices by different nodes (movements or displacements) have been collected. From this data, the frequency of appearance, average speed, or the number of devices that pass a certain site each day (on both working or non-working days) can be determined. The analysis of collected data has given statistics and indicators about the use of vehicles by the population of the monitored area. Specifically, the authors have obtained information about the total number of vehicles that each node has detected, on weekdays or holidays, information on traffic density by time range, on individual movements, the average speed on a section delimited by two consecutive nodes, and what demonstrates the power and features of the developed system.
Big Data in Healthcare
Authors: Koumpouros Yiannis
Published: October 2014

The era of open data in healthcare is under way. The progress in technologies along with their adoption by the healthcare providers and the maturity of the citizens has brought the healthcare industry to the tipping point. An unprecedented amount of healthcare data is being generated today. This data comes from researchers, healthcare professionals and organizations, and patients. If we can harness this data, it can help us improve our understanding of disease and pinpoint new and improved therapies more efficiently than ever before. Big Data technologies are coming to market in a rapid way. The challenges, however, are still there due to fragmented systems and databases, semantic differences, legal barriers, and others. The hidden and unexploited knowledge is hindered by these barriers. The big data revolution promises a solution both to this situation, as well as to act as a catalyst to the viability of the healthcare systems. This is supported by the numerous efforts and explored in this chapter.
Making a Case for Information Integrity in Healthcare
Authors: Khurana Reema , Mandke Vijay V.
Published: October 2014

This chapter presents a medical error example, which revolves around the issue regarding the nature of knowledge factors required in healthcare problem solving. Given the open system view of a healthcare system, the error presented here is of not correctly originating important, but less obvious, information requirements of the case. This leads to the loss of Information Origination Integrity, resulting in delivery of unsafe healthcare.
Implementation of Electronic Records in a Medical Practice Setting
Authors: Clark Jami M.
Published: October 2014

Seneca Medical Center is a primary care practice that implemented an electronic medical record system in 2005. Since implementation, the practice has added different practice locations and its own lab. The implementation was smooth because the practice leadership had a positive message about the change and reasons for it. Physical space for housing charts of a growing practice, the drive toward quality, safety, efficiency, and future growth were factors that led to the transition to an electronic medical record system. Choosing a quality vendor, understanding the concerns and components involved, and excitement about change create an environment for a successful implementation.
A Formal Investigation of Semantic Interoperability of HCLS Systems
Authors: Sahay Ratnesh , Zimmermann Antoine , Fox Ronan , Polleres Axel , Hauswirth Manfred
Published: October 2014

Semantic interoperability facilitates Health Care and Life Sciences (HCLS) systems in connecting stakeholders at various levels as well as ensuring seamless use of healthcare resources. Their scope ranges from local to regional, national and cross-border. The use of semantics in delivering interoperable solution for HCLS systems is weakened by fact that an Ontology Based Information System (OBIS) has restrictions in modeling, aggregating, and interpreting global knowledge in conjunction with local information (e.g., policy, profiles). This chapter presents an example-scenario that shows such limitations and recognizes that enabling two key features, namely the type and scope of knowledge, within a knowledge base could enhance the overall effectiveness of an OBIS. This chapter provides the idea of separating knowledge bases in types with scope (e.g., global or local) of applicability. Then, it proposes two concrete solutions on this general notion. Finally, the chapter describes open research issues that may be of interest to knowledge system developers and broader research community.
Implementation of Evidence-Based Practice and the PARIHS Framework
Authors: Zaheer Shahram
Published: October 2014

Patients receiving healthcare are commonly exposed to harm that is systematic and often severe. Clinical decisions based on inaccurate sources of information can lead to medical errors, high treatment costs, and poor patient outcomes. Evidence-based practice has the potential to overcome these problems by improving clinical decision-making processes. The PARIHS framework was developed to address the inability of traditional unidimensional models to successfully implement evidence-based practice. The PARIHS framework proposes that successful implementation of evidence into practice is a function of evidence, culture, and facilitation. The PARIHS framework can be used to design, implement, and evaluate knowledge translation projects at both acute and chronic care facilities. This chapter discusses the PARIHS framework as well as its advantages for implementing change at a healthcare setting compared to traditional models. The chapter also outlines a feasible knowledge translation project based on the principles of the PARIHS framework while highlighting health informatics and availability of easily accessible high quality patient outcome data as key enablers in designing and successfully implementing such a project at a healthcare setting.
Modelling the Growing Process of Integrated Healthcare Supply Networks
Authors: Battini Daria , Faccio Maurizio , Persona Alessandro , Sgarbossa Fabio
Published: October 2014

This work contributes to the practice of healthcare system modelling, by presenting an urgent issue: the growing process of integrated healthcare supply networks in reducing public healthcare systems' annual expenses and improving performance. Various critical aspects affect the strategic design and development of healthcare logistic networks in practice. The conceptual discussion is empirically derived on the basis of the challenge created by the development of centralized healthcare supply networks supported by the implementation of new IT/IS investments and advanced logistic hubs for hospital material inventory management. The study moves towards the development of a newer “Healthcare Supply Network Causal Loop Diagram”, to analyse and predict the growth pattern of a healthcare logistic network in its complexity, and understand how well the supply network will fit with the benefit provided by new logistic economies of scale and the risk of failures under uncertainty.
Healthcare Information System Modelling
Authors: Hainaut Jean-Luc , Brogneaux Anne-France , Cleve Anthony
Published: October 2014

This chapter studies the requirements for a wide range of healthcare information systems, including, but not limited to, clinical pathways management, patient record management, home care management, and medical personnel and resource management. The analysis concentrates on the description and management of medical activities, leaving aside the standard management processes common to all enterprises. It develops a generic architecture for these information systems comprising four central submodels devoted to the description, respectively, of organizational structures, care processes, information, and resources. Each submodel is analysed independently of the others then integrated into a consistent global model. Extensions of this model to other facets of the healthcare information system are discussed and some practical applications are suggested.
Sensorized Garments Developed for Remote Postural and Motor Rehabilitation
Authors: Saggio Giovanni , Sabato Valentina , Mugavero Roberto
Published: October 2014

Every day, all around the world, millions of people request postural and/or motor rehabilitation. The rehabilitation process, also known as Tertiary Prevention, intends to be a sort of therapy to restore functionality and self-sufficiency of the patient, and regards not only millions of patients daily, but involves also a huge number of professionals in medical staffs, i.e. specialists, nurses, physiotherapists and therapists, social workers, psychologists, physiatrists. The care is given in hospitals, clinics, geriatric facilities, and with territorial home care. For the large number of patients as well as the medical staff and facilities necessary to support the appropriate postural and motor training, the monetary costs of rehabilitation is so large, it is difficult to estimate. So, every effort towards a simplification of the rehabilitation route is desirable and welcome, and this chapter covers this aspect.
Use of Mobile Applications for Hospital Discharge Letters
Authors: Maher Bridget , Drachsler Hendrik , Kalz Marco , Hoare Cathal , Sorensen Humphrey , Lezcano Leonardo , Henn Pat , Specht Marcus
Published: October 2014

Handover of patient care is a time of particular risk and it is important that accurate and relevant information is clearly communicated. The hospital discharge letter is an important part of handover. However, the quality of hospital discharge letters is variable and letters frequently omit important information. The Cork Letter-Writing Assessment Scale (CLAS) checklist is an itemized checklist developed to improve the quality of discharge letters. The CLAS checklist, with an inbuilt scoring system, is available as the CLAS mobile application. Mobile applications offer an exciting opportunity for ‘point of practice' knowledge acquisition and are widely used by medical students. Content quality is integral to the success of educational mobile applications. In a recent study, the CLAS checklist improved the quality (content, structure and clarity) of discharge letters written by medical students. Though retention of these skills into the work-place and effects on patient safety have yet to be demonstrated, the development of standardized electronic discharge letters allows faster and safer transfer of information between healthcare providers and is a welcome advance. Using Near Field Communication for mobile applications to seamlessly transfer discharge letters between devices is another important feature.
Implementation of Case Costing with Ontario Case Costing Initiative (OCCI)
Authors: Hoang Thuy Thi Thanh
Published: October 2014

Over the past decade there has been a tremendous spread of computerized systems in hospitals. The advancement provided an opportunity for hospitals to gain access to computerized clinical, financial, and statistical data. Case costing information is the integration of clinical, financial, and statistical data to provide costing information at the patient level. Ontario Case Costing Initiative (OCCI) is an undertaking of the Ontario Ministry of Health and Long-Term Care (MOHLTC). This chapter focuses on the implementation of case costing using OCCI as a guideline for a hospital. It addresses the process of implementation by discussing proposals for planning, implementing, transitioning, and evaluation of case costing. The adoption of the OCCI allows health care professionals to analyze integrated health information and further enables evidence-based decision making.
Personnel Rostering Management by ICT Techniques
Authors: Della Croce Federico , Salassa Fabio
Published: October 2014

In this chapter, the authors discuss the technological aspects of solutions and applications in staff rostering by means of ICT techniques. Three different applications are presented related to nurse rostering in a public hospital ward, nurse rostering in a private hospital ward, and physician rostering in a public hospital intensive care unit. For all applications, the use of efficient operations research techniques, models, and related solvers guided by the suggestions of the healthcare staff is introduced. The peculiarity of this work is the combination of mathematical programming techniques and solvers under the classical neighborhood search framework.
Application Portfolio Management in Hospitals
Authors: van Angeren Joey , Blijleven Vincent , Batenburg Ronald
Published: October 2014

Application portfolio management concerns the management of all technology and applications, and is a complex task under pressure of increasing collaboration among hospitals. Various approaches to application portfolio management are described in existing literature, but are directed at commercial enterprises rather than health care organizations. Addressing this deficiency, this article presents the results of three case studies conducted at Dutch hospitals surveying current application portfolio management processes. Results show differences between the three hospitals. One hospital implemented a continuous application portfolio management process. The other hospitals perform ad-hoc IT management due to, among others, lacking support from management, decentralized IT governance structures and an increasing need for technical integration. This article can assist IT executives in making better informed decisions, while it provides a step towards a better understanding of the complex application portfolio management process in hospitals for academia.
Design of an ICT Tool for Decision Making in Social and Health Policies
Authors: Grimaldo Francisco , Ródenas Francisco , Lozano Miguel , Carretero Stephanie , Orduña Juan M. , Garcés Jorge , Duato José , Fatas Enrique
Published: October 2014

The governance requires technical support regarding the complexity in deciding health policies to assist people who require long-term care. Long-term care policies require the use of ICT simulation tools that can provide policy makers with the option of going into a decision theatre and virtually knowing the consequences of different policies prior to finally determining the real policy to be adopted. In this sense, there is an absence of simulation tools for decision making about long-term care policies. In this chapter, the authors propose the foundations and guidelines of SSIMSOWELL, a new scalable, multiagent simulation tool that increases the prediction capacity of governance in the long term care policies, improving the decision making in short, medium, and large term in different European regions. The simulation tool implements a previously validated Social Sustainability Model (SSM). The main goal of SSIMSOWELL is the prediction of policy impacts and the development of new governance models, since it increases the budgetary efficiency and the sustainability of long term policies. In addition, it improves the capacity of policy makers in modelling, planning, and evaluating social-health policies at different scales, ranges, and times in the European Union.
Information Systems for Management Decision Support in Portuguese Public Hospital
Authors: Esteves Francisco Madeira , Lagartinho Luís Manuel de Macedo Gomes , Fernandes da Anunciação Pedro
Published: October 2014

The information systems have assumed a central role in the health sector. Particularly in the public domain, health institutions have traditionally been marked by management practices based on contextual contingencies without much concern of the accurate results and their assessment. The traditional concern about the low efficiency and effectiveness in managing public resources has been replaced by the emerging and urgent need for rational management instruments and methods. This need presents the opportunity for a new management paradigm that should not be restricted to the financial aspects of health institutions, but it should include all dimensions of core and non-core activities. The budget slippages and ruptures cannot continue being used as the excuse for the need of systematic and permanent increase of financial resources spent on provision of public health services, often justified by an increasing of the population or the average life expectancy. The budget problems and difficulties of the Portuguese State, particularly the urgent need of the expenditure growth control, show the need of a new management paradigm. This demand has caused, on the one hand, a heavy investment in information technologies to support management decisions, and on the other hand, it has shown other problems, such as the difficulty experienced in the architectural integration of information and technologies as well as problems of a significant complexity and high resource consumption. This chapter discusses the current information systems for management decision support in Portuguese public hospitals based on the analysis of a district hospital in Portugal.
One System of Care, One Electronic Chart
Authors: Gholson Jennifer , Tennyson Heidi
Published: October 2014

Regional Health made a commitment as part of quality and patient safety initiatives to have an electronic health record before the federal government developed the concept of “meaningful use.” The “One System of Care, One Electronic Chart” concept was a long-term goal of their organization, accomplished through electronically sharing a patient's medical record among Regional Health's five hospitals and other area health care facilities. Implementing a hybrid electronic record using a scanning and archiving application was the first step toward the long-term goal of an electronic health record. The project was successfully achieved despite many challenges, including some limited resources and physician concerns.
Physician Interaction with EHR
Authors: Noteboom Cherie
Published: October 2014

Research Medical Center is a regional medical center that meets the needs of residents of a rural area in the Midwest. It is part of a large healthcare system. The primary care hospital implemented the Electronic Health Record (EHR). The endeavor to implement Health IT applications including Computerized Physician Order Entry (CPOE), EHRs, nursing documentation, and paperless charts, adverse drug reaction alerts, and more were introduced with the corporate initiative. The core applications were clinical and revenue cycle systems, including CPOE. The planning, implementation, and training was developed by the parent operating company and efforts to engage the local physicians were minimal. There were over 300 physicians involved. The physicians were primarily not hospital employees. They had the ability to choose to adopt the EHR and adapt their social, work, and technology practices, or to avoid usage. Follow up research indicated the change management and support efforts were not successful for the physician stakeholder.
User and Data Classification for a Secure and Practical Approach for Patient-Doctor Profiling Using an RFID Framework in Hospital
Authors: Mohammadian Masoud , Jentzsch Ric
Published: October 2014

Utilization and application of the latest technologies can save lives and improve patient treatments and well-being. For this it is important to have accurate, near real-time data acquisition and evaluation. The delivery of patient's medical data needs to be as fast and as secure as possible. Accurate almost real-time data acquisition and analysis of patient data and the ability to update such a data is a way to reduce cost and improve patient care. One possible solution to achieve this task is to use a wireless framework based on Radio Frequency Identification (RFID). This framework can integrate wireless networks for fast data acquisition and transmission, while maintaining the privacy issue. This chapter discusses the development of an intelligent multi-agent system in a framework in which RFID can be used for patient data collection. This chapter presents a framework for the knowledge acquisition of patient and doctor profiling in a hospital. The acquisition of profile data is assisted by a profiling agent that is responsible for processing the raw data obtained through RFID and database of doctors and patients. A new method for data classification and access authorization is developed, which will assist in preserving privacy and security of data.
The Sociotechnical Challenge of Integrating Telehealth and Telecare into Health and Social Care for the Elderly
Authors: Eason Ken , Waterson Patrick , Davda Priya
Published: October 2014

Telehealth and telecare have been heralded as major mechanisms by which frail elderly people can continue to live at home but numerous pilot studies have not led to the adoption of these technologies as mainstream contributors to the health and social care of people in the community. This paper reviews why dissemination has proved difficult and concludes that one problem is that these technologies require considerable organisational changes if they are to be effective: successful implementation is not just a technical design issue but is a sociotechnical design challenge. The paper reviews the plans of 25 health communities in England to introduce integrated health and social care for the elderly. It concludes that these plans when implemented will produce organisational environments conducive to the mainstream deployment of telehealth and telecare. However, the plans focus on different kinds of integrated care and each makes different demands on telehealth and telecare. Progress on getting mainstream benefits from telehealth and telecare will therefore depend on building a number of different sociotechnical systems geared to different forms of integrated care and incorporating different forms of telehealth and telecare.
Using Case Costing Data and Case Mix for Funding and Benchmarking in Rehabilitation Hospitals
Authors: Liu Grace
Published: October 2014

The concern for Ontario hospitals in Canada is that the funding model has recently changed from global- to activity-based funding, which will affect hospitals' operational budget and cost management. Hospitals will be reimbursed based on a pre-set payment price for each patient type or case mix treated. Specifically, the purpose of this chapter is to describe how case costing data and case mix information are collected and used for funding. A framework is proposed for health administrators, policy makers, and researchers to understand the input variables for determining resource utilization and long stay trim point. A clinical decision-making tool is demonstrated to assist hospital administrators to define admission criteria and predict length of stay and volumes with clinical teams. The chapter highlights the importance of data quality and use of comparative data and concludes with 10 key success factors for better funding and benchmarking for rehabilitation hospitals.