Categories Of Residents Research Articles

PROFICIENCY PERFORMANCE BENCHMARKS FOR REMOVAL OF SIMULATED BRAIN TUMORS USING NEUROTOUCH

BACKGROUND: Objective assessment of neurosurgical technical skills involved in the resection of cerebral tumors in operative environments is complex. Educators emphasize the need to develop and use objective and meaningful assessment tools that are reliable and valid for assessing trainees' progress in acquiring surgical skills. Novel technologies, such as virtual-reality simulation, have the potential to play important roles in the training of neurosurgeons. The purpose of this study was to develop benchmarks for a newly proposed set of objective measures (metrics) of neurosurgical technical skills performance during simulated brain tumor resection using a new virtual reality simulator (NeuroTouch). METHODS: A total of 31 participants were recruited including 16 ‘experts’ (neurosurgery staff) and 15 neurosurgery residents (‘novices’, 7 junior and 8 senior). Each participant performed 18 simulated brain tumor resections utilizing the NeuroTouch platform. The metrics for assessing surgical performance were computed using the NeuroTouch simulator and consisted of 1) Safety metrics including, volume of surrounding normal tissue removed, maximum force applied and sum of forces utilized during tumor resection 2) Quality of Operation metric which involved the percentage of tumor removed and 3) Efficiency metrics including duration for task completion, instrument path lengths and pedal activation frequency. RESULTS: The results demonstrated that ‘expert’ neurosurgeons (neurosurgery staff) resected less surrounding simulated normal brain tissue and less tumor tissue then residents. This data is consistent with the concept that ‘experts’ focused more on safety of the surgical procedure compared to novices. By analyzing experts' neurosurgical technical skills performance on these different metrics we were able to establish benchmarks for goal proficiency-based training of neurosurgery residents. CONCLUSIONS: Examining ‘expert’ neurosurgical performance in simulated settings such as NeuroTouch provides researchers with novel metrics for assessment of technical skills and development of proficiency based benchmarks. Identification of expert proficiency can led to improvements in resident training and assessment SECONDARY CATEGORY: n/a.

A framework for a context-aware elderly entertainment support system.

Elderly people constitute a major portion of world's population. Many of them are physically and mentally vulnerable and need continuous support for their health and well-being. There is a growing trend that these elderly people are placed in an ambient assisted living environment (AAL) with an aim to receive better care and support. In such settings, a lot of attention has been given to continuous health monitoring for maintaining physical health status. However, much less attention has been given toward understanding the entertainment needs of the elderly people, which is an important factor relevant to their mental health and joyful living. This paper thus addresses the entertainment needs of the elderly and proposes a framework of an elderly entertainment support system. The proposed framework enables different categories of residents (e.g., elderly people and caregivers) to access various media services in both implicit and explicit manner in order to enhance the quality of their living experience in different contexts. Our experimental results demonstrate the viability of the proposed framework. We believe that the proposed approach will establish the need to develop entertainment systems and services for the elderly people and allow us to sensibly address the problems associated with their independent, happy and active living.

Profile and treatment outcome of smear-positive TB patients who failed to smear convert after 2 months of treatment in Nigeria.

In Nigeria, little is known about the profile and treatment outcomes of smear-positive pulmonary TB (SPPTB) patients with persistent smear positivity after 2 months of treatment. A retrospective cohort study was carried out to determine the characteristics and treatment outcomes of patients with persistent smear positivity after 2 months of treatment among adults with SPPTB between 2011 and 2012 in two large health facilities in Nigeria. Findings were compared with SPPTB patients who had a negative smear conversion in the same period. Of 929 eligible patients, 187 (20.1%) had persistent smear positivity after 2 months of treatment. Independent predictors for persistent smear positivity were older age (p<0.001) and care at a public facility (p<0.001). Patients with persistent smear positivity had a higher proportion of unsuccessful treatment outcomes compared with those with a negative smear conversion (21.9% vs 12.4%; p<0.001), mainly due to treatment failure (p<0.001). Across treatment category (new versus previously treated cases), age group and residence category (urban versus rural), rates of unsuccessful outcomes were significantly higher among patients with persistent smear positivity. Treatment outcomes of SPPTB patients with persistent smear positivity were inferior to those who smear converted, with treatment failure being a major problem. This needs to be urgently addressed by the National Tuberculosis Control Programme.

EPA-0576 - Depression at the elderly without family support at nursing home in pristina

I. Introduction Depression is more present among psychiatric disorders in the world, global trends is known that cause high levels of human and social disability. A depression for elderly is not easy, especially to the elderly that are in institutional care without family support. II. Objectives Measuring level of depression, recognition of characteristics for depression and relation with psychotic symptoms in elderly at the nursing home. III. Aims Presentation and description of depression in elderly, without family support at the Nursing Home for Elders in Pristina. III. Methodology It is a quantitative study. Nursing home residents are assesed with the Beck questionnaire for depression and anxiety, was clinically interviewed and also with the Geriatric Depression scale. Data were analyzed with SPSS 21 and Microsoft Excel 2007. IV. Results Number of resident = 85 samples. Residents above 65 years old (the oldest at age of 84). 74 residents have had psychiatric difficulties; in 15 residents were identified psychotic symptoms. A level of depression was found in all cases, the presence of depression with Geriatric scale is confirmed in 83% of cases. Various findings are evident in correlation with socio-demographic data's, gender, somatic diseases, neurological problems. This shows the low level of their involvement in daily activities and rehabilitation. V. Conclusions Institutional, social and mental health care is essential for the category of elderly residents in nursing home. High levels of depression require appropriate therapeutic and psychotherapeutic approach in order to facilitate the quality of their lives.

Overweight and Obesity Categories of Residents in A Local Urban Area

The purpose of this study was to determine the applicability of the WHO categories of overweight and obesity in Gweru residents. Measurements of body mass index (BMI), waist circumference and skin fold were carried out. The manifestation of either hypertension, type 2 diabetes or both in individuals were self reported. Findings revealed that hypertension and Type 2 diabetes were prevailing at significantly higher BMI categories in Gweru residents. The number of individuals who were obese was significantly higher posing them at an increased risk of the consequences sooner or later. The researcher recommends intervention that will increase the population's awareness on how to prevent obesity.

A Multidimensional Exploration of the Foundations of Community Attachment among Seasonal and Year‐Round Residents

AbstractUtah is a popular second‐home destination because of its unique landscapes offering numerous natural amenities. This research utilized data from a mail survey of residents in six Utah counties and had two objectives: (1) to test a multidimensional conceptualization of community attachment and (2) to determine if the foundations of community attachment, based on those conceptual dimensions, are different for year‐round and seasonal residents. The study utilized structural equation models, which allow the use of latent variables, to complete those objectives. Results revealed that a multidimensional conceptualization of community attachment is appropriate. The conceptual dimensions (social bonds, participation, and sentiments) used in this research all proved to be important elements of the higher order construct “community attachment” for both year‐round and seasonal residents. For year‐round residents, community attachment is best predicted by the social bonds dimension, while for seasonal residents the participation dimension is most important. However, all three of the dimensions of attachment used herein are important among both residence categories, indicating that future research on this topic would be best served by using a multidimensional conceptualization of community attachment.

Periconception Diet does not Vary by Duration of US Residence for Mexican Immigrant Women

This cross-sectional study assessed the influence of duration of residence in the United States on periconception dietary intake of pregnant Mexican immigrant women, using baseline data from Healthy Mothers on the Move, a randomized control trial conducted with 234 women from 2004 to 2006 in Detroit, MI. Average maternal age was 27.3±5.2 years (range=18 to 41 years) with 5.99±4.76 years of US residence (range=0 to 36 years). Women's usual dietary intake during the past 12 months was recorded on a validated food frequency questionnaire (17.3 weeks average gestation). Intakes of selected micronutrients, macronutrients, and food groups were compared by US residence categories (≤5, 6 to 10, or ≥11 years) using analysis of covariance. The percent of women with intakes below the Estimated Average Requirement and the percent not meeting US dietary guidelines were calculated. There was no association between dietary intake and duration of US residence in this population. Percentages of women with dietary intake below the Estimated Average Requirement were: 12.0% for folate, 7.7% for vitamin C, 23.9% for calcium, 11.2% for protein, and 5.1% for carbohydrates. US dietary guidelines were not met for fruit by 17.5% and for vegetables by 74.8% of women. Typical diets were high in saturated fat and cholesterol. Of the 2,195 kcal average daily energy intake, >25% came from saturated fats, trans fats, and added sugars that may replace nutrients important for healthy fetal growth and development and women's health. Interventions to improve intake before, during, and after pregnancy are important in this population, regardless of duration of US residence.

Imagery and imaginary of islander identity: Older people and migration in Irish small-island communities

This article examines the imagery and imaginaries of islander identity and makes an original contribution to the fields of gerontology and nissology. Drawing on data collected through in-depth interviews with 19 older residents of two small-island communities located off the island of Ireland, we address the central roles played by older people in creating and sustaining islander identities. Reflecting both public and private representations of islander identity, the article contrasts an island ‘imagery’ with an island ‘imaginary’, resulting in a complex ‘imag(in)ery’ of islander identity. We explore three main themes. To what extent do older residents of island communities perceive an ‘imag(in)ery’ of islander identity? In what ways do older islanders contribute to, substantiate or perpetuate the imag(in)ery of the islander identity? Are there alternative imag(in)eries of the islander identity for different groups of older people who live in island communities? Our analysis identified two imag(in)eries of islander identity. An historical islander identity was structured by the shared hardships and enforced self-sufficiency associated with residence in remote communities. Contemporary islander identities are founded on the positively perceived isolation of islands, an historical and cultural sense of belonging, frequent social interaction within cohesive, safe and secure communities, and a persistence of ‘traditional’ values. Older people were actively engaged in the (re)production of islander identity, such as helping visitors discover their island origins, producing traditional cultural artefacts, passing knowledge of culture down through the generations, and acting to maintain the civic life of the island community. Knowledge of local and traditional skills imbued some older islanders with the ability to perform island-specific symbolic rituals. Our study revealed subtle forms of differentiation between over-arching categories of island residents based on migration histories. In particular, older people's narratives revealed a hierarchy in relation to claims to islander status.

Technology and Pro-Environmental Behavior in Urban Households: How Technologies Mediate Domestic Routines

This paper investigates environmental behavior in Russian households by the analysis of 24 in-depth interviews conducted in typical households of the city of Moscow. Using the STS tools such as ‘script’ and ‘moral agency’ it discovers how technologies shape domestic routines and pro-environmental behavior of their users and how the users shape the resource consumption of technological artifacts. Depending on their environmental values and believes three types of residents are identified: committed environmentalists, occasional environmentalists and non-environmentalists. Each of the group of people appeared to have different agencies in relation to their domestic technologies. Technologies also seem to play different role in shaping moral actions of the three categories of residents.

Ant-based service selection framework for a smart home monitoring environment

Selecting ambient media services in a smart home monitoring environment is challenging. Services in such an environment should be ubiquitous, adaptive, and robust with respect to access and delivery. Many different techniques exist for selecting services in smart environments, for example, dynamic programming, genetic algorithms, and fuzzy logic. However, existing approaches to service selection fail to address the dynamic nature of the services and the requirement of considering the user context and user satisfaction. We address this issue by proposing an ant-inspired service selection framework based on dynamic user preferences and satisfaction. This ant-inspired approach is robust to failures and adaptive to dynamic context. The proposed framework enables different categories of residents (e.g., elderly people, fathers with children, mothers, and so on) to access various media services in such a way that their experiences are optimized with regard to their surrounding environment. Experimental results demonstrate the viability of the proposed framework.

Differences in Diet Pattern Adherence by Nativity and Duration of US Residence in the Mexican-American Population

Literature on the diet of the Mexican-American population suggests that food consumption differs by nativity and duration of residence in the United States. However, no studies have used dietary pattern analysis to investigate these differences. To create dietary patterns, we used principal components analysis on food frequency questionnaire data for all adult respondents of the National Health and Nutrition Examination Survey years 2003-2006. Four dietary patterns were identified: Western, Healthy, Tomato/Tortilla, and Coffee/Sugar. Least squares means regression was used to test differences in adjusted mean dietary adherence scores among Mexico-born Mexican-American adults residing in the United States for <15 years (n=302), Mexico-born Mexican-American adults residing in the United States for ≥15 years (n=234), US-born Mexican-American adults (n=509), and US-born non-Hispanic whites (n=2,530) aged 18 to 69 years. Mean score for each diet pattern did not differ significantly by duration of US residence category in the Mexico-born Mexican-American population. However, in comparison to all Mexico-born Mexican Americans, US-born Mexican Americans had significantly lower score for the Tomato/Tortilla pattern, and significantly higher score for the Western pattern. Scores for the Healthy pattern were relatively low in all Mexican-American subgroups, indicating low adherence to the Healthy diet. However, Healthy diet scores of Mexico-born Mexican Americans among those aged ≤41 years appeared more similar to those of US-born non-Hispanic whites than US-born Mexican Americans. Education and policy action promoting healthy food access in Hispanic neighborhoods could help limit consumption of Western and Coffee/Sugar diet patterns and promote healthier choices in the Mexican-American population.

Being born in Sweden increases the risk for type 1 diabetes – a study of migration of children to Sweden as a natural experiment

To investigate whether the age of first exposure to a high-incidence country like Sweden determines the risk of T1DM in children with an origin in a low incidence region of the world. Register study in a Swedish study population in the age 6-25 years in three categories of residents with an origin in low incidence regions of T1DM (Eastern Europe, East Asia, South Asia and Latin America); 24,252 international adoptees; 47,986 immigrants and 40,971 Swedish-born with two foreign-born parents and a comparison group of 1,770,092 children with Swedish-born parents. Retrieval of a prescription of insulin during 2006 was used as an indicator of T1DM and analysed with logistic regression. The odds ratios (OR) for T1DM were lower than the Swedish majority population for residents with an origin in the four low incidence regions. Being Swedish-born implied a higher risk for T1DM in the four low incidence study groups compared with the internationally adopted with an OR of 1.68 (CI 1.03-2.73). Being born in Sweden increases the risk for T1DM in children with an origin in low incidence countries. This may imply that exposures in utero or very early infancy are important risk factors for T1DM.

Population-based comparison of breast cancer screening and treatment utilization by remoteness of residence in British Columbia.

593 Background: Cancer care is difficult for rural residents due to limited access to cancer screening and treatment. This study assessed whether breast cancer screening and treatment was lower for patients from rural communities, in a jurisdiction with universal publicly-funded health coverage for mammography and cancer treatment. Methods: All patients diagnosed with breast cancer in British Columbia (BC) during 2002 were identified from the cancer registry and linked to the provincial Screening Mammography database. Patient demographics, pathology, stage, treatments delivered, mammography use, and death dates were abstracted. Patients were categorized as residing in rural, semi-urban or urban locations based on postal code. Use of health care resources and outcomes were compared across residence categories. Results: All 2,872 women diagnosed with breast cancer in 2002 were included. Patients from rural communities (n=138; 4.8%) presented with more advanced stage than those from urban (p=0.010) and semi-urban (p=0.077) regions. On multivariable analysis, patients from rural, compared to urban communities, were significantly less likely to be screening mammography attendees (OR=0.587; p=0.004). Mammography use was most disparate among women in their 40s; 18.8% versus 55.4% (p=0.004) were mammogram attendees in rural versus urban communities, respectively. Women from rural communities with early-stage breast cancer were significantly more likely to undergo mastectomy (multivariable OR=2.364; p<0.001). Among patients receiving breast conserving surgery, adjuvant radiotherapy use was not significantly different by residence (p=0.967). Likewise, there was no significant difference in use of chemotherapy (p=0.712) or hormonal therapy (p=0.989) by residence category. With a median follow up of 7.4 years, overall survival (HR=1.235; 95% CI=0.804-1.899) and breast cancer specific survival (HR=1.213; 95% CI=0.704-2.088) were not significantly worse for rural compared to urban patients. Conclusions: Breast cancer screening and treatment use varied by community remoteness, but with short follow-up, did not translate into significantly worse outcomes.

Dealing with living in poor neighbourhoods

In this prologue to the special issue, the guest editors place the contributions in the context of current debates on living in concentrated poverty neighbourhoods. These debates concern two broad categories of residents: poor households that are assisted to move from concentrations of poverty to lower-poverty areas (movers); and households (not exclusively the poor) that cannot move out of poor neighbourhoods or are not willing to do so, for various reasons (stayers). For the first category, the main issue is whether housing vouchers provide movers only with better housing or also with other social, psychological and economic benefits. A wealth of (partly contradictory) evidence justifies exploring a fundamental question: What should housing vouchers do? With regard to those unwilling or unable to move out of poor neighbourhoods, we focus on how residents cope with the recurrent problems and stressful circumstances in poor neighbourhoods. Here, four interrelated concepts are central to our discussion: place attachment, coping tactics, territoriality, and social network formation. Our discussion paves the way for the subsequent five papers, each dealing with one of the selected topics. The aim of this special issue is to provide new evidence that underpins or questions the current debates on living in or leaving neighbourhoods with concentrated poverty. The research reported here was done in the United States, Great Britain and the Netherlands.

Multi-Sensory Environment and Agitated Behavior in Ageing Residents with Dementia

This research paper explores selected behavioral outcomes of a multi-sensory environment. An experimental study was conducted at a specialized facility for the ageing in Sweden. The objective was to explore the effects of agitated behaviors of ageing residents with dementia and to identify any short-term effects. Appointed nursing staff was instructed to record physically and verbally agitated behaviors on three occasions; pre-session, mid-session, and post-session. Over seven months, nine participants received sixty-one sessions in the multi-sensory room. ANOVA and Post hoc multiple comparisons were performed to identify the differences in mean between each session. Generally irritated/frustrated behavior and eating/drinking non foods revealed statistically significant differences, while there were no significant results in verbally agitated behavior. One short-term effect was observed in one agitated category; a reduction of generally irritated/frustrated behavior. These results suggest that the multi-sensory environment can have positive effects on some manifestations of agitated behavior. This study proposes that a multi-sensory environment may be recommended as an alternative intervention for physically agitated behavior among this category of residents. However, more research is needed to understand the specific effects and the best use of the multi-sensory environment for this population.

Survey of healthcare-associated infection rates in a nursing home resident population

In this study we assessed the incidence and types of healthcare-associated infection (HCAI) in a nursing home resident population. The influences of home size, resident category, gender and age were also examined. Fifteen homes were recruited and infection rates recorded from 1 October 2006 to 2 December 2006. A rate of 6.04 infections/1000 bed days was recorded for the complete study. Infection rates for the four main categories of infection (number of infections/ 1000 bed days) were respiratory (2.52), urinary (1.87), skin and soft tissue (1.57) and gastrointestinal (0.41). Infection rates for small, medium and large homes were 4.64 (range 1.95—6.51), 5.9 (range 0.49—10.76) and 7.79 (range 5.79—9.39), respectively; however, statistical significance was not achieved ( p = 0.335). Results indicate that respiratory infection rates are higher in larger homes (4.08) than in small (1.88) or medium size homes (2.22). Urinary infection rates were similar in small (1.89), medium (1.88) and large (1.82) homes and skin and soft tissue infections were lower in small homes (0.87) but similar in medium (1.69) and large (1.90) homes. We found a statistically significant relationship between the type of infection acquired and both resident category ( p = 0.017) and gender ( p = 0.005); the relationship between type of infection and age did not reach statistical significance ( p = 0.346).

Cholera Outbreak in Kenyan Refugee Camp: Risk Factors for Illness and Importance of Sanitation

An outbreak of watery diarrhea struck within the Kakuma refugee camp in Kenya in April 2005; 418 people were treated, and 4 persons died. Vibrio cholerae O1 was isolated from 33 patients. In June 2005, we conducted a retrospective matched case-control study to define risk factors associated with cholera among camp residents and identify interventions that could prevent further cases and future outbreaks. We identified cases of cholera through medical records at the main health facility in the camp and matched controls (without watery diarrhea since November 2004) to the cases by age category (< 2, 2-4, 5-14, and > 14 years) and location of residence within the camp. Cases were defined as any person of any age with profuse, effortless watery diarrhea (three or more stools in 24 hours). A multivariate model showed that storing drinking water at home in sealed or covered containers was protective against cholera (matched odds ratio [MOR] = 0.49 [0.25, 0.96]), whereas "sharing a latrine with at least three households" (MOR = 2.17 [1.01, 4.68]) and arriving at the Kakuma camp on or after November 2004 (MOR = 4.66 [1.35, 16.05]) were risk factors. Improving sanitation and promoting methods to ensure safe drinking water are likely to be effective measures in moderating future cholera outbreaks in this setting. Higher risks for cholera illness among refugees recently "in-migrated" suggest that there may be value in targeting new arrivals in the camp for risk reduction messages and interventions, such as covered water storage containers, to prevent cholera.

Does Rural Residence Affect Access to Prenatal Care in Oregon?

Identifying how maternal residential location affects late initiation of prenatal care is important for policy planning and allocation of resources for intervention. To determine how rural residence and other social and demographic characteristics affect late initiation of prenatal care, and how residence status is associated with self-reported barriers to accessing early prenatal care. This observational study used data from the 2003 Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) (N = 1,508), with late initiation of prenatal care (after the first trimester) as the primary outcome. We used Rural-Urban Commuting Area (RUCA) codes to categorize maternal residence as urban, large rural, or small/isolated rural. Multivariate logistic regression was used to evaluate whether category of residence was associated with late initiation of prenatal care after adjusting for other maternal factors. Association between categories of barriers to prenatal care and maternal category of residence were determined using the Cochran-Mantel-Haenszel test of association. We found no significant association between residence category and late initiation of prenatal care, or residence category and barriers to prenatal care initiation. Urban women tended to be over age 34 or nonwhite. Women from large rural areas were more likely to be younger than 18 years, unmarried, and have an unintended pregnancy. Women from small rural areas were more likely to use tobacco during pregnancy. Maternal residence category is not associated with late initiation of prenatal care or with barriers to initiation of prenatal care. Differences in maternal risk profiles by location suggest possible new foci for programs, such as tobacco education in small rural areas.

A comparison of the effectiveness of group‐based and pharmacy‐led smoking cessation treatment in Glasgow

To compare the characteristics and outcomes of users accessing pharmacy and group-based smoking treatment. Observational study of administrative information linked with survey data. Glasgow, Scotland. A total of 1785 service users who set a quit date between March and May 2007. Smoking treatment services based in pharmacies providing one-to-one support, and in the community offering group support. Routine monitoring data included information about basic demographic characteristics, deprivation category of residence, nature of intervention and smoking status at 4-week follow-up determined by carbon monoxide (CO) readings < or = 10. These data were supplemented by information about socio-economic status and smoking-related behaviours obtained from consenting service recipients by treatment advisers. In the pharmacy-based service 18.6 % of users (n = 1374) were CO-validated as a quitter at 4 weeks, compared with 35.5 % (n = 411) in the group-based service. In a multivariate model, restricted to participants (n = 1366) with data allowing adjustment for socio-demographic and behavioural characteristics and including interaction terms, users who accessed the group-based services were almost twice as likely (odds ratio 1.980; confidence interval 1.50-2.62) as those who used pharmacy-based support to have quit smoking at 4-week follow-up. Specialist-led group-based services appear to have higher quit rates than one-to-one services provided by pharmacies but the pharmacy services treat many more smokers. More research is needed to determine what can be done to bring the success rates of pharmacy services up to those of specialist-led groups and how to expand access to group-based services.

Who Wants to Leave the Neighbourhood? The Effect of Being Different from the Neighbourhood Population on Wishes to Move

Little attention has been paid to date to the role of the neighbourhood as a factor influencing residential mobility and the residential choice process. The question addressed here is to what extent neighbourhood characteristics (percentage of rented dwellings, low-income households, and ethnic minorities in the neighbourhood) influence different categories of residents to wish to leave their neighbourhood. The answer to this question can enhance our understanding of residential mobility and of the mechanisms causing segregation by income and ethnic groups. We use data from the 2002 Netherlands Housing Demand Survey, enriched with neighbourhood characteristics. Whether or not people wish to leave their neighbourhood is estimated using a multilevel logistic regression model with cross-level interaction effects between individual and neighbourhood characteristics. The main result shows that, with an increasing percentage of people from an ethnic minority in the neighbourhood, more people have the wish to leave the neighbourhood. However, this is to a lesser extent the case for members of ethnic minorities themselves.