Opinions and attitudes of experts to the digitization of the Czech healthcare: preliminary report on the implementation of the first wave of the DELPHI study.

The article provides an overview of the opinions and attitudes of a selected group of experts on the introduction of electronic healthcare in the Czech healthcare system. The research used the DELPHI method, the first wave of which took place in the first quarter of this year and the second wave is planned for the second half of this year. A total of forty respondents assessed the relevance of the individual steps of electronization and digitization, as well as the obstacles that need to be overcome in the implementation of the National eHealth Strategy. Respondents consider electronic information on health promotion and prevention programs (87%) and support for chronic patients (77%) to be the most appropriate or important, while the least supported is the publication of service level assessments of providers (27%) and on-line access to documentation of the authorizing person (30%), less support is also given to the optimization of waiting times with the help of digitization (35%) and electronic consultation with a doctor (35%). Respondents see the biggest obstacles to eHealth implementation in the resistance of providers (up to 70% for some measures) and in unsatisfactory or missing legislation (up to 85% for some steps). The survey was carried out as part of the project Structural Reform Support Service (SRSS) of the European Commission at the Ministry of Health and under coordination of National eHealth Centre (NeHC).

A Novel Virtual Coaching System Based on Personalized Clinical Pathways for Rehabilitation of Older Adults-Requirements and Implementation Plan of the vCare Project.

Home-based rehabilitation after an acute episode or following an exacerbation of a chronic disease is often problematic with a clear lack of continuity of care between hospital and home care. Secondary prevention is an essential element of long-term rehabilitation where strategies oriented toward risk reduction, treatment adherence, and optimization of quality of life need to be applied. Frail and sometimes isolated, the patient fails to adhere to the proposed post-discharge clinical pathway due to lack of appropriate clinical, emotional, and informational support. Providing a suitable rehabilitation after an acute episode or a chronic disease is a major issue, as it helps people to live independently and enhance their quality of life. However, as the rehabilitation period usually lasts some months, the continuity of care is often interrupted in the transition from hospital to home. Virtual coaches could help these patients to engage in a personalized rehabilitation program that complies with age-related conditions. These coaches could be a key technology for empowering patients toward increasing their adherence to the care plan and to improve their secondary prevention measures. In this paper, we are presenting a novel virtual coaching system that will address these challenges by combining recent technological advances with clinical pathways, based on joint research and validation activities from researchers from the medical and information and communication technology (ICT) domains.

Measurements and quasi-quantum modeling of the steric asymmetry and parity propensities in state-to-state rotationally inelastic scattering of NO (2Pi1/2) with D2.

Relative integrated cross sections are measured for spin-orbit-conserving, rotationally inelastic scattering of NO (2Pi1/2), hexapole-selected in the upper Lambda-doublet level of the ground rotational state (j = 0.5), in collisions with D2 at a nominal energy of 551 cm-1. The final state of the NO molecule is detected by laser-induced fluorescence (LIF). The state-selected NO molecule is oriented with either the N end or the O end toward the incoming D2 molecule by application of a static electric field E in the scattering region. This field is directed parallel or antiparallel to the relative velocity vector v. Comparison of signals taken for the different applied field directions gives the experimental steric asymmetry SA, defined by SA = (sigma v upward arrow downward arrow E - sigma v upward arrow upward arrow E)/(sigma v upward arrow downward arrow E + sigma v upward arrow upward arrow E), which is equal to within a factor of -1 to the molecular steric effect, Si-->f identical with (sigmaD2-->NO - sigmaD2-->ON)/(sigmaD2-->NO + sigmaD2-->ON). The dependence of the integral inelastic cross section on the incoming Lambda-doublet component is also measured as a function of the final rotational (jfinal) and Lambda-doublet (epsilonfinal) state. The measured steric asymmetries are similar to those previously observed for NO-He scattering. Spin-orbit manifold-conserving collisions exhibit a larger propensity for parity conservation than their NO-He counterparts. The results are interpreted in the context of the recently developed quasi-quantum treatment (QQT) of rotationally inelastic scattering [Gijsbertsen, A.; Linnartz, H.; Taatjes, C. A.; Stolte, S. J. Am. Chem. Soc. 2006, 128, 8777]. The QQT predictions can be inverted to obtain a fitted hard-shell potential that reproduces the experimental steric asymmetry; this fitted potential gives an empirical estimate of the anisotropy of the repulsive interaction between NO and D2. QQT computation of the differential cross section using this simple model potential shows reasonable agreement with the measured differential cross sections.

Direct measurement of phase coexistence in DPPC/cholesterol vesicles using Raman spectroscopy.

The phase behavior of bilayers of binary mixtures of 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) and cholesterol has been studied using Raman spectroscopy. It is observed that the shape of the cholesterol vibrational spectrum in lipid-cholesterol binary mixtures does not vary significantly with either the cholesterol concentration or the temperature. This permits determination of the lipid vibrational signatures of the liquid-disordered (l(d)), solid-ordered (s(o)) and liquid-ordered (l(o)) phases. Within the phase coexistence region, the measured spectra are described very well by a linear combination of the different spectral components, which permits a quantitative analysis of the phase diagram. In contrast to earlier findings, our experiments provide no indication of a phase boundary at low cholesterol concentration. The upper boundary of the phase coexistence region is found at approximately 27 and approximately 22 mol% for l(d)-l(o) and s(o)-l(o) coexistence region, respectively. Within these phase coexistence regions, the partitioning of cholesterol between the cholesterol-poor and the cholesterol-rich phases is in close agreement with the lever rule.

Species distribution and ribotype diversity of Burkholderia cepacia complex isolates from French patients with cystic fibrosis.

A total of 153 Burkholderia cepacia strains obtained from 153 French patients with cystic fibrosis were identified as Burkholderia multivorans (51.6%) or Burkholderia cenocepacia (45.1%). Eighty-two genotypes were identified using PvuII and EcoRI ribotyping. B. multivorans genotype A (found in 32 French patients) and two other genotypes were also identified among isolates from Austrian, German, Italian, and Canadian patients.

Steric asymmetry and lambda-doublet propensities in state-to-state rotationally inelastic scattering of NO(2Pi(1/2)) with He.

Relative integrated cross sections are measured for rotationally inelastic scattering of NO(2Pi(1/2)),hexapole selected in the upper lambda-doublet level of the ground rotational state (j = 0.5), in collisions with He at a nominal energy of 514 cm(-1). Application of a static electric field E in the scattering region, directed parallel or antiparallel to the relative velocity vector v, allows the state-selected NO molecule to be oriented with either the N end or the O end towards the incoming He atom. Laser-induced fluorescence detection of the final state of the NO molecule is used to determine the experimental steric asymmetry, [formula: see text], which is equal to within a factor of (- 1) to the molecular steric effect, S(i-->f) is identical with (sigma(He-->NO) - (sigma(He-->ON))/(sigma(He-->NO) + sigma(He-->ON)). The dependence of the integral inelastic cross section on the incoming lambda-doublet component is also observed as a function of the final rotational (j'), spin-orbit (omega'), and lambda-doublet (epsilon') state. The measured steric asymmetries are significantly larger than previously observed for NO-Ar scattering, supporting earlier proposals that the repulsive part of the interaction potential is responsible for the steric asymmetry. In contrast to the case of scattering with Ar, the steric asymmetry of NO-He collisions is not very sensitive to the value of omega'. However, the lambda-doublet propensities are very different for [omega=0.5(F1)-->omega'= 1.5(F2)] and [omega=0.5(F1)-->omega'=0.5(F1)] transitions. Spin-orbit manifold conserving collisions exhibit a propensity for parity conservation at low deltaj, but spin-orbit manifold changing collisions do not show this propensity. In conjunction with the experiments, state-to-state cross sections for scattering of oriented NO(2Pi) molecules with He atoms are predicted from close-coupling calculations on restricted coupled-cluster methods including single, double, and noniterated triple excitations [J. Klos, G. Chalasinski, M. T. Berry, R.Bukowski, and S. M. Cybulski, J. Chem. Phys. 112, 2195 (2000)] and correlated electron-pair approximation [M. Yang and M. H. Alexander, J. Chem. Phys. 103, 6973 (1995)] potential energy surfaces. The calculated steric asymmetry S(i-->f) of the inelastic cross sections at Etr= 514 cm(-1) is in reasonable agreement with that derived from the present experimental measurements for both spin-manifold conserving (F1-->Fl) and spin-manifold changing (F1 --F2) collisions, except that the overall sign of the effect is opposite. Additionally, calculated field-free integral cross sections for collisions at Etr = 508 cm(-1) are compared to the experimental data of Joswig et al. [J. Chem. Phys.85, 1904 (1986)]. Finally, the calculated differential cross section for collision energy Etr= 491 cm(-1) is compared to experimental data of Westley et al. [J. Chem. Phys. 114, 2669 (2001)] for the spin-orbit conserving transition F1 (j = 0.5) -F1f (j' = 3.5).

Molecular analysis and experimental virulence of French and North American Escherichia coli neonatal meningitis isolates: identification of a new virulent clone.

Phylogenetic relationships, virulence factors, alone and in specific combinations, and virulence in a rat meningitis model were examined among 132 isolates of Escherichia coli neonatal meningitis from France and North America. Isolates belonging to phylogenetic groups A (n=11), D (n=20), and B2 (n=99) had similar high prevalence rates of the siderophores aerobactin and yersiniabactin and the K1 capsule (>/=70%) yet induced different level of experimental bacteremia. Ectochromosomal DNA-like domains involved in blood-brain barrier passage (PAI III(536) [sfa/foc and iroN; 34%]; GimA [ibeA and ptnC; 38%]; PAI II(J96) [hly, cnf1, and hra; 10%]) were restricted to B2 isolates. Among group B2 isolates, representatives of the O45:K1 clonal group (n=30), which lacked these domains, were as able as the archetypal O18:K1 strain C5 to cause meningitis. Molecular epidemiology combined with experimental virulence assays demonstrate that known virulence factors are insufficient to fully explain the pathophysiology of ECNM and to allow for rational search for new virulence factors.

Characterization of members of the Legionellaceae family by automated ribotyping.

In order to implement a new and reliable method for characterizing different species of Legionella, a genetic fingerprinting study with an automated ribotyping system (RiboPrinter) was completed with members of this genus which were deposited at the American Type Culture Collection. The RiboPrinter examined the different patterns of EcoRI digestion fragments from the rRNA operons of 110 strains, representing 48 of the 49 described Legionella species as well as 70 serogroups of those species. Distinctive and consistent patterns were obtained for the type strains of the 48 species investigated. Legionella pneumophila subsp. fraseri and L. pneumophila subsp. pascullei each generated a specific pattern, whereas L. pneumophila subsp. pneumophila produced six different fingerprint patterns. No correlation seemed to exist between the ribotypes obtained and the 15 serotypes of L. pneumophila. For the other species, those with two known serogroups presented two distinctive patterns with the RiboPrinter with the exception of L. hackeliae and L. quinlivanii, which yielded only one pattern. We also encountered ribotypes for strains which were not identified to the species level. The ribotypes generated for these strains with the RiboPrinter did not match those generated for known type strains, suggesting the putative description of new serogroups or species. Although the automated system did not have sufficient discriminatory ability to serve as an epidemiological tool in a clinical setting, it appeared to be a powerful tool for general genomic analysis of the Legionella isolates (e.g., determination of new species) and assessment of the interrelationship among Legionella strains through the RiboPrinter database connection.