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Fels J.,Cen Health
Home healthcare now | Year: 2015

The shift in focus from individual episodes of illness to a focus on health and wellness, and population health, has created a need for care coordination to address the complex needs of high-risk patients as they transition through the healthcare continuum. A Vermont medical center identified the Clinical Nurse Specialist as having the requisite skills to fill the role of care coordinator. This article describes the development of the Transitional Care Nurse (TCN) program and includes case studies that exemplify how the TCN can intervene to improve care coordination.


Cerqueira G.M.,Instituto Butantan | McBride A.J.A.,Oswaldo Cruz Foundation | Hartskeerl R.A.,Cen Health | Ahmed N.,University of Hyderabad | And 4 more authors.
PLoS ONE | Year: 2010

Background: Leptospirosis is one of the most widespread zoonoses in the world and with over 260 pathogenic serovars there is an urgent need for a molecular system of classification. The development of multilocus sequence typing (MLST) schemes for Leptospira spp. is addressing this issue. The aim of this study was to identify loci with potential to enhance Leptospira strain discrimination by sequencing-based methods. Methodology and Principal Findings: We used bioinformatics to evaluate pre-existing loci with the potential to increase the discrimination of outbreak strains. Previously deposited sequence data were evaluated by phylogenetic analyses using either single or concatenated sequences. We identified and evaluated the applicability of the ligB, secY, rpoB and lipL41 loci, individually and in combination, to discriminate between 38 pathogenic Leptospira strains and to cluster them according to the species they belonged to. Pairwise identity among the loci ranged from 82.0-92.0%, while interspecies identity was 97.7-98.5%. Using the ligB-secY-rpoB-lipL41 superlocus it was possible to discriminate 34/38 strains, which belong to six pathogenic Leptospira species. In addition, the sequences were concatenated with the superloci from 16 sequence types from a previous MLST scheme employed to study the association of a leptospiral clone with an outbreak of human leptospirosis in Thailand. Their use enhanced the discriminative power of the existing scheme. The lipL41 and rpoB loci raised the resolution from 81.0-100%, but the enhanced scheme still remains limited to the L. interrogans and L. kirschneri species. Conclusions: As the first aim of our study, the ligB-secY-rpoB-lipL41 superlocus demonstrated a satisfactory level of discrimination among the strains evaluated. Second, the inclusion of the rpoB and lipL41 loci to a MLST scheme provided high resolution for discrimination of strains within L. interrogans and L. kirschneri and might be useful in future epidemiological studies. © 2010 Cerqueira, et al.


Meskens G.,Cen Health | Meskens G.,Ghent University
Energy Strategy Reviews | Year: 2013

The way nuclear energy technology 'escapes' a deliberate justification approach as an energy technology on a transnational level is today in sharp contrast with the way fossil fuel energy technologies are subject of global negotiations driven by the doom of climate change. The claim put forward is that this 'denial' is a symptom of a contemporary settled 'comfort of polarisation' around the use of nuclear energy technology that is deeply rooted in the organisational structures of politics, science and informed civil society. The article argues for the need to develop a new rationale that aims to seek societal trust 'by method instead of proof', taking into account that the outcome of such a justification process might as well be an acceptance or a rejection of the technology. It sketches what this 'deliberate-political' approach would be in theory and practice, briefly hits at two contemporary myths that would relativize the need for this approach and concludes with a 'pragmatic' list of elements of an advanced framework for deliberation on nuclear energy technology and on energy in general. © 2013 Elsevier Ltd.


Clauer N.,CNRS Hydrology and Geochemistry Laboratory of Strasbourg | Fallick A.E.,Scottish Universities Environmental Research Center | Eberl D.D.,U.S. Geological Survey | Honty M.,Cen Health | And 2 more authors.
American Mineralogist | Year: 2013

Nanometric (<0.02, 0.02-0.05, 0.05-0.1, 0.1-0.2 μm) illite fractions were separated from K-bentonite samples from northwestern Georgia, and studied by X-ray diffraction, oxygen and hydrogen isotope geochemistry, and K-Ar dated to more tightly constrain the tectono-thermal history of the Appalachian orogeny. Their XRD patterns are very similar for a given sample with respect to the peak shapes and positions. They are ordered illite-smectite mixed layers with only small variations in the relative proportions of illite and smectite interlayers. The illite crystal thickness distributions also are very homogeneous across the various size fractions of the same sample, but crystallite thickness varies from sample to sample. It can be concluded from the α-β2 diagram that illitization occurred in all fractions by simultaneous nucleation and crystal growth, except for one sample. In that sample, a period of growth without nucleation was detected on top of the nucleation and growth episode. The K-Ar ages organize into two isochrons, the first at 319.9 ± 2.0 Ma with an initial 40Ar/36Ar ratio of 271 ± 66 Ma, and the second at 284.9 ± 1.2 Ma with an initial 40Ar/36Ar ratio of 310 ± 44. One data point above the older isochron and three between the two isochrons suggest a detrital contamination for the former separate and a possible further generation of nanoparticles for the three others. The samples with the older crystallization age consist of illite and illite-rich mixed-layers, and those with the younger age contain smectite-rich mixed-layers without illite, or illite-enriched illite-smectite mixed-layers. The K-Ar ages fit the age trends published previously for similar K-bentonites with regional age patterns between 240 and 270 Ma in the southwestern region, between 270 and 300 Ma in the central zone and the southern Appalachians, and between 315 and 370 Ma in the northernmost. Each of the two generations of illite crystals yields very consistent δ18O (V-SMOW) values at 17 ± 1‰ for the older and at 21 ± 1‰ for the younger. If crystallization temperatures of the nanometric illite were between 100 and 200 °C, as suggested by microthermometric determinations, the hydrothermal fluids had δ18O values of 4 ± 1‰ in the Dalton district and of 8 ± 1‰ in the Lafayette, Trenton, and Dirtseller districts at 100 °C, and of 11 ± 1 and 15 ± 1‰ in the same locations at 200 °C, probably because the water-rock isotope exchanges at elevated temperature occurred in rock-dominated systems. The d18O of the fluids remained unchanged during local crystal growth, but varied depending on the geographic location of the samples and timing of illitization. The δD (V-SMOW) values of the different size fractions do not provide consistent information; they range from -70 to -45‰ for most nanometric and micrometric fractions (V-SMOW), but with no apparent coherent pattern. Nanometric illite-rich crystals from K-bentonite that underwent tectono-thermal alteration yield constant ages, constant clay mineralogy, constant crystallite size distributions for all of the nucleating and growing illite-type crystals of each sample, as well as constant δ18O values implying constant fluid chemistry, all pointing to geologically sudden crystallization.


Honty M.,Cen Health | De Craen M.,Cen Health | Wang L.,Cen Health | Madejova J.,Slovak Academy of Sciences | And 4 more authors.
Applied Geochemistry | Year: 2010

Boom Clay is currently viewed as a reference host formation for studies on deep geological disposal of radioactive waste in Belgium. The interactions between bulk rock Boom Clay and 0.1M KOH, 0.1M NaOH, 0.1M Ca(OH)2, young cement water and evolved cement water solutions, ranging in pH from 12.5 to 13.2, were examined as static batch experiments at 60°C to simulate alkaline plume perturbations, which are expected to occur in the repository due to the presence of concrete. Both liquids and solids were investigated at specific times between 90 and 510days in order to control the elemental budget and to search for potential mineralogical alterations. Also, the clay fraction was separated from the whole-rock Boom Clay at the end of each run and characterized for its mineralogical composition. Thereby, the importance of the mineral matrix to buffer the alkaline attack and the role of organic matter to protect clay minerals were also addressed. The results indicate that the degree of geochemical perturbation in Boom Clay is dependent on the initial pH of the applied solution together with the nature of the major cation in the reactant fluids. The higher the initial pH of the media, the stronger its interaction with Boom Clay. No major non-clay mineralogical alteration of the Boom Clay was detected, but dissolution of kaolinite, smectite and illite occurred within the studied experimental conditions. The dissolution of clays is accompanied by the decrease in the layer charge, followed by a decrease in the cation-exchange capacity. The highest TOC values coincide with the highest total elemental concentrations in the leachates, and correspondingly, the highest dissolution degree. However, no quantitative link could be established between the degree of organic matter decomposition and clay dissolution. © 2010 Elsevier Ltd.


Cruz-Tapias P.,Tel Aviv University | Cruz-Tapias P.,Cen Health | Cruz-Tapias P.,El Rosario University | Blank M.,Tel Aviv University | And 2 more authors.
Current Opinion in Rheumatology | Year: 2012

Purpose of review: To present scientific evidence supporting the infectious origin for the antiphospholipid syndrome (APS) by molecular mimicry between pathogens, infection and vaccination with β2-glycoprotein I (β2-GPI) molecule. Recent findings: APS is characterized by the presence of pathogenic autoantibodies against β2-GPI. The infection etiology of APS was well established. Likewise, a link between vaccination such as tetanus toxoid may trigger antibodies targeting tetanus toxoid and β2-GPI, due to molecular mimicry between the two molecules. During the years, the pathogenic potential of anti-tetanus toxoid antibodies cross reactive with β2-GPI were found to be pathogenic in animal models, inducing experimental APS. Summary: Accumulated evidence supports that the presence of anti-β2-GPI antibodies is associated with a history of infections and the main mechanism to explain this correlation is molecular mimicry. The relationship between tetanus toxoid vaccination and APS reveals a novel view on the autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA). © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Hao J.,Cen Health | Hao J.,Inner Mongolia Medical College | Wang C.,Cen Health | Yuan J.,Cen Health | And 2 more authors.
PLoS ONE | Year: 2013

Background:The complement system is crucial for the development of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). In particular, C5a and its receptor on neutrophils, CD88, play a central role. The functional role of the second receptor of C5a, C5L2, remains unclear. In the current study, we investigated the role of C5L2 in C5a-primed neutrophils for ANCA-induced activation.Methods:The effect of blocking C5L2 by anti-human C5L2 blocking antibody were tested on respiratory burst and degranulation of C5a-primed neutrophils activated with ANCA, as well as on membrane-bound proteinase 3 (mPR3) and concentration of myeloperoxidase (MPO) in supernatant of C5a-primed neutrophils. An antagonist for CD88 was also employed.Results:Blocking C5L2 resulted in a significantly decreased MPO concentration in the supernatant of C5a-primed neutrophils. mPR3 expression increased from 209.0±43.0 in untreated cells to 444.3±60.8 after C5a treatment (P<0.001), and decreased to 375.8±65.44, 342.2±54.3 and 313.7±43.6 by pre-incubating blocking C5L2 antibody at 2.5 μg/ml, 5 μg/ml or 10 μg/ml (compared with C5a-priming group, P<0.001, P<0.001, and P<0.001), respectively. In C5a-primed neutrophils, subsequently activating with MPO-ANCA-positive IgG, the MFI value was 425.8±160.6, which decreased to 292.8±141.2, 289.7±130.0 and 280.3±136.4 upon pre-incubation with mouse anti-human C5L2 blocking antibody at 2.5 μg/ml, 5 μg/ml or 10 μg/ml (compared with C5a-primed neutrophils, for MPO-ANCA-positive IgG-induced activation, P<0.05, P<0.05, and P<0.05), respectively. Blocking C5L2 also resulted in significantly decreased C5a-primed neutrophils for PR3-ANCA-positive IgG-induced activation. Moreover, the lactoferrin concentration in the supernant significantly decreased in pre-incubation with anti-human C5L2 blocking antibody, compared with C5a-primed neutrophils induced by PR3- or MPO-ANCA-positive IgG.Conclusions:C5L2 may be implicated in the pro-inflammatory role in C5a-primed neutrophils for ANCA-induced activation. © 2013 Hao et al.


In order to build confidence in describing the hydrological cycle under future global change, hydrological models not only need to be calibrated and validated with recent data, but should also be tested against different boundary conditions from the past. This requires building a dataset of hydrological state variables against which the modelling output can be tested. We use pedogeomorphological and historical data to monitor hydraulic heads at specific time slices during the last 500. years for a sandy interfluve in the Nete catchment, NE Belgium. The nature of the archive is temporally and spatially highly discontinuous but allows to observe a systematic drop in phreatic groundwater levels during the second half of the 19th century. It is concluded that the approach yields promising results and that it might be of use elsewhere in drift sand landscapes across the European sand belt. © 2015 Elsevier B.V.


PubMed | Cen Health
Type: Journal Article | Journal: The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses | Year: 2016

Depression after stroke is common and is associated with poor functional recovery, suicidal ideation, decreased quality of life, and increased mortality. Despite this knowledge, poststroke depression (PSD) is often underdetected and thus undertreated. PSD is clinically important for the caregiver, the family, and the stroke survivor. Inconsistencies in screening and treatment practices may further contribute to these negative outcomes.The purposes of this evidence-based clinical scholarship project were to (1) determine the efficacy of an evidence-based depression screening protocol in improving early detection and treatment of PSD and (2) identify if there were any relationships between the protocol interventions, depression scores, and diagnosis.A retrospective chart review was conducted in a convenience sample of 79 hospitalized patients with acute stroke. Depression was assessed using the Patient Health Questionnaire-9. Demographic data and medical and protocol variables were also collected. Descriptive statistics, chi-square test, and Pearson correlation test were used for data analysis.Of the 79 participants, 56% were men, 65% were White, 77% were admitted with ischemic stroke, and 48% were identified as being depressed (Patient Health Questionnaire-9 depression scale > 4). Individuals with a history of depression ( = 17.09, p = .002) were also more likely to have higher levels of depression severity as compared with patients who did not have a history of depression. After the intervention, patients screening positive were more likely to receive an educational booklet on stroke and depression ( = 30.0, p = .000) and be medically treated for PSD before discharge ( = 5.57, p = .018). Nurses documentation of screening results also improved ( = 9.19, p = .002).Implementation of the Evidence Based Depression Screening and Treatment (EBDST) protocol improved early detection and treatment of PSD in the hospitalized patients with acute stroke before discharge. The EBDST protocol promoted systematic evidence-based depression screening in the hospitalized patients with acute stroke. Use of the EBDST protocol may further improve long-term health outcomes, decrease mortality, and improve functional recovery and quality of life.


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