Summary Background and aims Type 2 intestinal failure (IF) commonly results from post-operative short bowel leading to metabolic instability. Specialist multi-disciplinary management is often ...required for nutritional, fluid and/or electrolyte support, either intermediate term or until revision surgery. This can lead to prolonged or repeated acute hospital admission. Methods A virtual ward model was developed to address the need for on-going specialist support and facilitate home discharge. This provides an outreach specialist service with structured patient education, remote biochemical monitoring, telemedicine consultations and open access outpatient clinics. Patients' status is reviewed at multi-disciplinary virtual ward rounds. Results A prospective audit assessed effectiveness of the programme. Of 20 patients referred with post-operative type 2 IF and metabolic instability, 18 were discharged home for a total of 2731 days, with a mean readmission days of 2.0%. 12 patients were managed with modified enteral nutrition. Management was unsuccessful in only 1 patient due to non-compliance. A patient satisfaction study suggested high levels of patient satisfaction. Conclusions The IF virtual ward is associated with low levels of hospital readmission amongst complex and metabolically unstable IF patients. It provided integrated multi-disciplinary management and is associated with high levels of patient satisfaction.
The author analyzes knowledge reuse in a Big-5 professional service firm. He investigates how reuse affects design, provides a methodology for evaluating systems to increase reuse, and discusses the ...impact of differential costs and benefits on the organization.
Abstract We evaluated the spatiotemporal distribution of photic driving (PDR), photoparoxysmal (PPR), and photoconvulsive (PCR) responses recorded by intracranial electrodes (ic-EEG) in a patient ...with generalized photosensitivity and right frontal lobe cortical dysplasia. Intermittent light stimulation (ILS) was performed thirteen times in nine days. Cortical responses to ILS recorded by ic-EEG were reviewed and classified as PDRs, PPRs, and PCRs. Photic driving responses were restricted to the occipital lobe at ILS frequencies below 9 Hz, spreading to the parietal and central regions at > 9 Hz. Photoparoxysmal responses commonly presented as focal, medial occipital, and parietal interictal epileptic discharges (IEDs), the latter propagating to the sensorimotor cortices. Generalized IEDs were also generated in the setting of PPRs. Photoconvulsive responses, characterized by repetitive bilateral upper extremity myoclonus sustained until the end of the stimulus, were associated with propagation of the medial parieto-occipital discharge to the primary sensorimotor and supplementary area cortices, while generalized myoclonic seizures were associated with a generalized spike-and-wave discharge with an interhemispheric posterior cingulate onset sparing the sensorimotor cortices. Both types of PCR could occur during the same stimulus. Regardless of the pathway, PCRs only occurred when PDRs involved the parietal cortices. While there may be more than one pathway underlying PCRs, parietal lobe association cortices appear to be critical to their generation.
Understanding the behavior of particles subjected to forces is a basic theme in physics. The simplest system is a set of particles confined to motion along a line, but even this type of system ...presents computational challenges. For the harmonic oscillator, a particle is subjected to a force directed toward the origin and proportional to the distance between the particle and the origin. The resulting potential is V(x) = 1/2 /spl alpha/x/sup 2/ where /spl alpha/ is a constant. This system is quite thoroughly understood, and quantities of interest can be computed in closed form. Alternatively, the Ginzburg-Landau anharmonic potential, - 1/2 /spl alpha/x/sup 2/ + 1/4 /spl beta/x/sup 4/ (/spl alpha/ and /spl beta/ are constant), is related to solution of the Schrodinger equation, and quantities of interest are computed approximately. One method of obtaining such approximations is numerical integration, which is our focus in this assignment.
Virtually cost-free publication on the World Wide Web has led to information overload. Artificial intelligence (AI), with its roots in knowledge representation, is experiencing a renaissance as new ...tools emerge to make the Web more tractable. Why do these Internet-based applications herald an AI renaissance? AI has come to play a crucial role in Information Age retrieval strategies. Internet-based applications can exploit a wide range of AI developments. In this survey, we look at examples of the following AI technologies: natural language processing (concept-based Internet searching); machine-learning (WebWatcher); heuristic rules for establishing preference (Letizia); rule-based/heuristic natural language processing (ContactFinder, FAQFinder, Globenet); and neural networks (Autonomy). This isn't AI for AI's sake-this renaissance is not one of stand-alone AI applications. Unlike first-generation AI applications, AI can now be embedded in heterogeneous networked computing environments and used for searching, retrieval and analysis of previously unimaginable quantities of data. Because the wealth of data makes direct human analysis impossible, AI-based support has become necessary to help users fully exploit that information. Our increasingly competitive and technology-driven world has reduced the time available to us for decision-making. To survive in this environment, we are increasingly turning to advanced computer technologies, such as intelligent agents, and delegating some of that decision-making to these electronic surrogates.
Knowledge management is inherently interdisciplinary. It involves human resource management and enterprise organization and culture, as well as the information technology methods and tools that ...support and enable it. Knowledge management can improve the enterprise’s competitiveness only by fully integrating technological aspects with the human and organizational aspects.
The overall scheme for control is as follows: central command sets basic patterns of cardiovascular effector activity, which is modulated via muscle chemo- and mechanoreflexes and arterial ...mechanoreflexes (baroreflexes) as appropriate error signals develop. A key question is whether the primary error corrected is a mismatch between blood flow and metabolism (a flow error that accumulates muscle metabolites that activate group III and IV chemosensitive muscle afferents) or a mismatch between cardiac output (CO) and vascular conductance a blood pressure (BP) error that activates the arterial baroreflex and raises BP. Reduction in muscle blood flow to a threshold for the muscle chemoreflex raises muscle metabolite concentration and reflexly raises BP by activating chemosensitive muscle afferents. In isometric exercise, sympathetic nervous activity (SNA) is increased mainly by muscle chemoreflex whereas central command raises heart rate (HR) and CO by vagal withdrawal. Cardiovascular control changes for dynamic exercise with large muscles. At exercise onset, central command increases HR by vagal withdrawal and "resets" the baroreflex to a higher BP. As long as vagal withdrawal can raise HR and CO rapidly so that BP rises quickly to its higher operating point, there is no mismatch between CO and vascular conductance (no BP error) and SNA does not increase. Increased SNA occurs at whatever HR (depending on species) exceeds the range of vagal withdrawal; the additional sympathetically mediated rise in CO needed to raise BP to its new operating point is slower and leads to a BP error. Sympathetic vasoconstriction is needed to complete the rise in BP. The baroreflex is essential for BP elevation at onset of exercise and for BP stabilization during mild exercise (subthreshold for chemoreflex), and it can oppose or magnify the chemoreflex when it is activated at higher work rates. Ultimately, when vascular conductance exceeds cardiac pumping capacity in the most severe exercise both chemoreflex and baroreflex must maintain BP by vasoconstricting active muscle.
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