Spatial inequalities in charitable fundraising and income generation for NHS acute trusts in England.

IMPACT: This article presents novel analyses of the income sources of National Health Service (NHS) acute trusts in England. The results suggest that there are variations according to deprivation in the extent of private financial resources available to NHS institutions. They suggest a need to open up discussions about how best to mitigate spatial differences in the charitable and private patient income of NHS trusts, particularly if these sources of income grow in importance going forward. ABSTRACT: The article provides-for the first time-an analysis of spatial variation in the income sources of National Health Service (NHS) acute trusts in England. It shows that, compared to trusts serving less deprived communities, trusts serving more deprived communities receive a lower proportion of income from charitable sources; and that trusts serving deprived communities also receive a lower proportion of income from private patients. The study serves to provide evidence of spatial inequality in the private resources that support local public institutions.

Detection of Management-Frames-Based Denial-of-Service Attack in Wireless LAN Network Using Artificial Neural Network.

Wireless Local Area Networks (WLANs) have become an increasingly popular mode of communication and networking, with a wide range of applications in various fields. However, the increasing popularity of WLANs has also led to an increase in security threats, including denial of service (DoS) attacks. In this study, management-frames-based DoS attacks, in which the attacker floods the network with management frames, are particularly concerning as they can cause widespread disruptions in the network. Attacks known as denial of service (DoS) can target wireless LANs. None of the wireless security mechanisms in use today contemplate defence against them. At the MAC layer, there are multiple vulnerabilities that can be exploited to launch DoS attacks. This paper focuses on designing and developing an artificial neural network (NN) scheme for detecting management-frames-based DoS attacks. The proposed scheme aims to effectively detect fake de-authentication/disassociation frames and improve network performance by avoiding communication interruption caused by such attacks. The proposed NN scheme leverages machine learning techniques to analyse patterns and features in the management frames exchanged between wireless devices. By training the NN, the system can learn to accurately detect potential DoS attacks. This approach offers a more sophisticated and effective solution to the problem of DoS attacks in wireless LANs and has the potential to significantly enhance the security and reliability of these networks. According to the experimental results, the proposed technique exhibits higher effectiveness in detection compared to existing methods, as evidenced by a significantly increased true positive rate and a decreased false positive rate.

An Interface Setup Optimization Method Using a Throughput Estimation Model for Concurrently Communicating Access Points in a Wireless Local Area Network.

The IEEE 802.11 wireless local-area network (WLAN) has been deployed around the globe as a major Internet access medium due to its low cost and high flexibility and capacity. Unfortunately, dense wireless networks can suffer from poor performance due to high levels of radio interference resulting from adjoining access points (APs). To address this problem, we studied the AP transmission power optimization method, which selects the maximum or minimum power supplied to each AP so that the average signal-to-interference ratio (SIR) among the concurrently communicating APs is maximized.However, this method requires measurements of receiving signal strength (RSS) under all the possible combinations of powers. It may need intolerable loads and time as the number of APs increases. It also only considers the use of channel bonding (CB), although non-CB sometimes achieves higher performance under high levels of interference. In this paper, we present an AP interface setup optimization method using the throughput estimation model for concurrently communicating APs. The proposed method selects CB or non-CB in addition to the maximum or minimum power for each AP. This model approach avoids expensive costs of RSS measurements under a number of combinations. To estimate the RSS at an AP from another AP or a host, the model needs the distance and the obstacles between them, such as walls. Then, by calculating the estimated RSS with the model and calculating the SIR from them, the AP interface setups for a lot of APs in a large-scale wireless network can be optimized on a computer in a very short time. For evaluation, we conducted extensive experiments using Raspberry Pi for APs and Linux PCs for hosts under 12 network topologies in three buildings at Okayama University, Japan, and Jatiya Kabi Kazi Nazrul Islam University, Bangladesh. The results confirm that the proposed method selects the best AP interface setup with the highest total throughput in any topology.

[Research on Visualized Traceability Supervision System of Medical Equipment Based on Wireless Local Area Network Real-time Positioning System].

Aiming at the shortcomings of traditional medical device tracking and supervision mode, such as delayed feedback of medical device positioning information, poor visual tracking effect of medical device, and missing early warning of medical device working state supervision, a medical device visual tracking and supervision system based on wireless Local Area Network (LAN) real-time positioning system is developed. Introduction of wireless LAN real-time positioning system, using standard coding algorithm generating device object ID tags, with the only attribute based on RFID read-write terminal complete physical mapping of medical equipment and material ID label, we realize a real-time positioning and traceability of medical equipment, with the help of active warning algorithm based on depth of learning medical equipment working state supervision for early warning, with the help of indoor map generation and trajectory playback medical equipment to realize visualization back regulation. Choose equipment of hospital of Linyi Central Hospital for performance evaluation of the carrier, the evaluation model of engineering practice and clinical statistical analysis, the results show that the system has a complete real-time positioning, visible trace, abnormal warning function. In medical equipment real-time positioning information visual tracing feedback, abnormal state warning etc, medical equipment has obvious advantages.

Battery Draining Attack and Defense against Power Saving Wireless LAN Devices.

Wi-Fi technology connects sensor-based things that operate with small batteries, and allows them to access the Internet from anywhere at any time and perform networking. It has become a critical element in many areas of daily life and industry, including smart homes, smart factories, smart grids, and smart cities. The Wi-Fi-based Internet of things is gradually expanding its range of uses from new industries to areas that are intimately connected to people's lives, safety, and property. Wi-Fi technology has undergone a 20-year standardization process and continues to evolve to improve transmission speeds and service quality. Simultaneously, it has also been strengthening power-saving technology and security technology to improve energy efficiency and security while maintaining backward compatibility with past standards. This study analyzed the security vulnerabilities of the Wi-Fi power-saving mechanism used in smart devices and experimentally proved the feasibility of a battery draining attack (BDA) on commercial smartphones. The results of the experiment showed that when a battery draining attack was performed on power-saving Wi-Fi, 14 times the amount of energy was consumed compared with when a battery draining attack was not performed. This study analyzed the security vulnerabilities of the power-saving mechanism and discusses countermeasures.

Time-Domain Investigation of Switchable Filter Wide-Band Antenna for Microwave Breast Imaging.

This paper investigates the time-domain performance of a switchable filter impulse radio ultra-wideband (IR-UWB) antenna for microwave breast imaging applications. A miniaturized CPW-fed integrated filter antenna with switchable performance in the range of the Worldwide Interoperability for Microwave Access (WiMAX) and Wireless Local Area Network (WLAN) bands could operate well within a 3.0 to 11 GHz frequency range. The time-domain performance of the filter antenna was investigated in comparison to that of the designed reference wideband antenna. By comparing both antennas' time-domain characteristics, it was seen that the switchable filter antenna had good time-domain resolution along with the frequency-domain operation. Additionally, the time-domain investigation revealed that the switchable filter wide-band antenna performed similarly to the reference wide band antenna. This antenna was also utilized for a tumor detection application, and it was seen that the switchable filter wide-band antenna could detect a miniaturized irregularly shaped tumor easily, which is quite promising. Such an antenna with a good time-domain resolution and tumor detection capability will be a good candidate and will find potential applications in microwave breast imaging.

CA-CWA: Channel-Aware Contention Window Adaption in IEEE 802.11ah for Soft Real-Time Industrial Applications.

In 2016, the IEEE task group ah (TGah) released a new standard called IEEE 802.11ah, and industrial Internet of Things (IoT) is one of its typical use cases. The restricted access window (RAW) is one of the core MAC mechanisms of IEEE 802.11ah, which aims to address the collision problem in the dense wireless networks. However, in each RAW period, stations still need to contend for the channel by Distributed Coordination Function and Enhanced Distributed Channel Access (DCF/EDCA), which cannot meet the real-time requirements of most industrial applications. In this paper, we propose a channel-aware contention window adaption (CA-CWA) algorithm. The algorithm dynamically adapts the contention window based on the channel status with an external interference discrimination ability, and improves the real-time performance of the IEEE 802.11ah. To validate the real-time performance of CA-CWA, we compared CA-CWA with two other backoff algorithms with an NS-3 simulator. The results illustrate that CA-CWA has better performance than the other two algorithms in terms of packet loss rate and average delay. Compared with the other two algorithms, CA-CWA is able to support industrial applications with higher deadline constraints under the same channel conditions in IEEE 802.11ah.

Local clothing thermal properties of typical office ensembles under realistic static and dynamic conditions.

An accurate local thermal sensation model is indispensable for the effective development of personalized conditioning systems in office environments. The output of such a model relies on the accurate prediction of local skin temperatures, which in turn depend on reliable input data of the local clothing thermal resistance and clothing area factor. However, for typical office clothing ensembles, only few local datasets are available in the literature. In this study, the dry thermal resistance was measured for 23 typical office clothing ensembles according to EN-ISO 15831 on a sweating agile manikin. For 6 ensembles, the effects of different air speeds and body movement were also included. Local clothing area factors were estimated based on 3D scans. Local differences can be found between the measured local insulation values and local area factors of this study and the data of other studies. These differences are likely due to the garment fit on the manikin and reveal the necessity of reporting clothing fit parameters (e.g., ease allowance) in the publications. The increased air speed and added body movement mostly decreased the local clothing insulation. However, the reduction is different for all body parts, and therefore cannot be generalized. This study also provides a correlation between the local clothing insulation and the ease allowance for body parts covered with a single layer of clothing. In conclusion, the need for well-documented measurements is emphasized to get reproducible results and to choose accurate clothing parameters for thermo-physiological and thermal sensation modeling.

An Improved Compressive Sensing and Received Signal Strength-Based Target Localization Algorithm with Unknown Target Population for Wireless Local Area Networks.

In this paper a two-phase compressive sensing (CS) and received signal strength (RSS)-based target localization approach is proposed to improve position accuracy by dealing with the unknown target population and the effect of grid dimensions on position error. In the coarse localization phase, by formulating target localization as a sparse signal recovery problem, grids with recovery vector components greater than a threshold are chosen as the candidate target grids. In the fine localization phase, by partitioning each candidate grid, the target position in a grid is iteratively refined by using the minimum residual error rule and the least-squares technique. When all the candidate target grids are iteratively partitioned and the measurement matrix is updated, the recovery vector is re-estimated. Threshold-based detection is employed again to determine the target grids and hence the target population. As a consequence, both the target population and the position estimation accuracy can be significantly improved. Simulation results demonstrate that the proposed approach achieves the best accuracy among all the algorithms compared.

Compact Planar Ultrawideband Antennas with 3.5/5.2/5.8 GHz Triple Band-Notched Characteristics for Internet of Things Applications.

Ultrawideband (UWB) antennas, as core devices in high-speed wireless communication, are widely applied to mobile handsets, wireless sensor networks, and Internet of Things (IoT). A compact printed monopole antenna for UWB applications with triple band-notched characteristics is proposed in this paper. The antenna has a very compact size of 10 x 16 mm2 and is composed of a square slotted radiation patch and a narrow rectangular ground plane on the back of the substrate. First, by etching a pair of inverted T-shaped slots at the bottom of the radiation patch, one notched band at 5-6 GHz for rejecting the Wireless Local Area Network (WLAN) is generated. Then, by cutting a comb-shaped slot on the top of the radiation patch, a second notched band for rejecting 3.5 GHz Worldwide Interoperability for Microwave Access (WiMAX) is obtained. Further, by cutting a pair of rectangular slots and a C-shaped slot as well as adding a pair of small square parasitic patches at the center of the radiating patch, two separate notched bands for rejecting 5.2 GHz lower WLAN and 5.8 GHz upper WLAN are realized, respectively. Additionally, by integrating the slotted radiation patch with the narrow rectangular ground plane, an enhanced impedance bandwidth can be achieved, especially at the higher band. The antenna consists of linear symmetrical sections only and is easy for fabrication and fine-tuning. The measured results show that the designed antenna provides a wide impedance bandwidth of 150% from 2.12 to 14.80 GHz for VSWR < 2, except for three notched bands of 3.36-4.16, 4.92-5.36, and 5.68-6.0 GHz. Additionally, the antenna exhibits nearly omnidirectional radiation characteristics, low gain at the stopbands, and flat group delay over the whole UWB except at the stopbands. Simulated and experimental results show that the proposed antenna can provide good frequency-domain and time-domain performances at desired UWB frequencies and be an attractive candidate for portable IoT applications.

[Resting-state network evaluation of chronic smokers by functional magnetic resonance imaging.]

Objective: To explore the neuromechanism of nicotine smoking, we use independent component analysis (ICA) of resting-state functional magnetic resonance imaging (fMRI) to investigate the differences of functional connectivity of resting-state networks (RSN) in chronic smokers. Methods: Forty-five chronic smokers and thirty-four age and gender matched normal nonsmoking controls experienced resting-state fMRI scanning in 3.0T MRI scanner.Differences of the function connection in each RSN between chronic smokers group and nonsmoking controls group were analyzed by SPM software which was based on Matlab platform. Results: Compared with normal nonsmoking controls, changes of functional connectivity within each RSN in chronic smokers: (1) medial visual network: functional connectivity decreased in right cuneus (t=4.17, P<0.05) and left calcarine (t=3.08, P<0.05); (2) lateral visual network: decreased in left gyrus occipital superior (t=3.42, P<0.05); (3) occipital pole visual network: decreased in right gyrus occipital medius and left gyrus occipital medius (t=3.58, P<0.05); (4) dorsal attention network (DAN): increased in right gyrus occipital superior (t=3.42, P<0.05); (5) left frontoparietal network: decreased in left inferior parietal lobe (t=3.77, P<0.05); (6) right frontoparietal network: increased in right gyrus frontalis medius (t=3.42, P<0.05). Conclusion: There are some RSNs changes of chronic smokers compared with normal nonsmoking controls, with multiple brain regions functional connectivity abnormalities.

Counties eliminating racial disparities in colorectal cancer mortality.

BACKGROUND: Although colorectal cancer (CRC) mortality rates are declining, racial-ethnic disparities in CRC mortality nationally are widening. Herein, the authors attempted to identify county-level variations in this pattern, and to characterize counties with improving disparity trends. METHODS: The authors examined 20-year trends in US county-level black-white disparities in CRC age-adjusted mortality rates during the study period between 1989 and 2010. Using a mixed linear model, counties were grouped into mutually exclusive patterns of black-white racial disparity trends in age-adjusted CRC mortality across 20 three-year rolling average data points. County-level characteristics from census data and from the Area Health Resources File were normalized and entered into a principal component analysis. Multinomial logistic regression models were used to test the relation between these factors (clusters of related contextual variables) and the disparity trend pattern group for each county. RESULTS: Counties were grouped into 4 disparity trend pattern groups: 1) persistent disparity (parallel black and white trend lines); 2) diverging (widening disparity); 3) sustained equality; and 4) converging (moving from disparate outcomes toward equality). The initial principal component analysis clustered the 82 independent variables into a smaller number of components, 6 of which explained 47% of the county-level variation in disparity trend patterns. CONCLUSIONS: County-level variation in social determinants, health care workforce, and health systems all were found to contribute to variations in cancer mortality disparity trend patterns from 1990 through 2010. Counties sustaining equality over time or moving from disparities to equality in cancer mortality suggest that disparities are not inevitable, and provide hope that more communities can achieve optimal and equitable cancer outcomes for all. Cancer 2016;122:1735-48. © 2016 American Cancer Society.

Measuring regional and district variations in the incidence of pregnancy-induced hypertension in Ghana: challenges, opportunities and implications for maternal and newborn health policy and programmes.

OBJECTIVES: The objectives were to assess the quality of health management information system (HMIS) data needed for assessment of local area variation in pregnancy-induced hypertension (PIH) incidence and to describe district and regional variations in PIH incidence. METHODS: A retrospective review of antenatal and delivery records of 2682 pregnant women in 10 district hospitals in the Greater Accra and Upper West regions of Ghana was conducted in 2013. Quality of HMIS data was assessed by completeness of reporting. The incidence of PIH was estimated for each district. RESULTS: Key variables for routine assessment of PIH such as blood pressure (BP) at antenatal visits, weight and height were 95-100% complete. Fundal height, gestational age and BP at delivery were not consistently reported. The incidence of PIH differed significantly between Greater Accra region (6.1%) and Upper West region (3.2%). Prevalence of obesity among pregnant women in Greater Accra region (13.9%) was significantly higher than that of women in Upper West region (2.2%). CONCLUSIONS: More attention needs to be given to understanding local area variations in PIH and possible relationships with urbanisation and lifestyle changes that promote obesity, to inform maternal and newborn health policy. This can be done with good quality routine HMIS data.

A New MAC Address Spoofing Detection Technique Based on Random Forests.

Media access control (MAC) addresses in wireless networks can be trivially spoofed using off-the-shelf devices. The aim of this research is to detect MAC address spoofing in wireless networks using a hard-to-spoof measurement that is correlated to the location of the wireless device, namely the received signal strength (RSS). We developed a passive solution that does not require modification for standards or protocols. The solution was tested in a live test-bed (i.e., a wireless local area network with the aid of two air monitors acting as sensors) and achieved 99.77%, 93.16% and 88.38% accuracy when the attacker is 8-13 m, 4-8 m and less than 4 m away from the victim device, respectively. We implemented three previous methods on the same test-bed and found that our solution outperforms existing solutions. Our solution is based on an ensemble method known as random forests.

Queuing Theory Based Co-Channel Interference Analysis Approach for High-Density Wireless Local Area Networks.

Increased co-channel interference (CCI) in wireless local area networks (WLANs) is bringing serious resource constraints to today's high-density wireless environments. CCI in IEEE 802.11-based networks is inevitable due to the nature of the carrier sensing mechanism however can be reduced by resource optimization approaches. That means the CCI analysis is basic, but also crucial for an efficient resource management. In this article, we present a novel CCI analysis approach based on the queuing theory, which considers the randomness of end users' behavior and the irregularity and complexity of network traffic in high-density WLANs that adopts the M/M/c queuing model for CCI analysis. Most of the CCIs occur when multiple networks overlap and trigger channel contentions; therefore, we use the ratio of signal-overlapped areas to signal coverage as a probabilistic factor to the queuing model to analyze the CCI impacts in highly overlapped WLANs. With the queuing model, we perform simulations to see how the CCI influences the quality of service (QoS) in high-density WLANs.

Electroencephalographic findings in schizophreniform and affective disorders.

OBJECTIVE: Pathological findings in electroencephalography (EEG) are discussed as a possible marker of organic mental disorders and a therapeutic response to anticonvulsive medication under these conditions. METHODS: We compared the prevalence of EEG abnormalities in 100 patients with schizophrenia, 100 patients with schizoaffective disorder, 51 patients with acute polymorphic psychotic disorder, 100 patients with bipolar disorder, 100 patients with unipolar major depression and 76 healthy control subjects with the findings of a previous study using well-diagnosed, large control samples (13,658 pilots and aircrew personnel). RESULTS: We detected an increased number of pathological EEG findings with intermittent rhythmic delta or theta activity in 7% of patients with schizophrenia, 7% of patients with schizoaffective disorder, 5.9% of patients with acute polymorphic psychosis, 6% of patients with bipolar disorder, 4% of unipolar depressed patients and 3.9% of the own control group, compared to 1% of strictly controlled healthy subjects. One-sided logistic regression revealed an association between pathological EEGs and the diagnosis of schizophrenia (Wald W = 3.466, p = 0.0315), schizoaffective disorder (W = 3.466, p = 0.0315) and bipolar disorder (W = 2.862, p = 0.0455). CONCLUSIONS: We suggest that the previously developed local area network inhibition model for a potential paraepileptic pathomechanism can explain the relevance of such findings in different psychiatric disorders.

Paths to health equity: Local area variation in progress toward eliminating breast cancer mortality disparities, 1990-2009.

BACKGROUND: US breast cancer deaths have been declining since 1989, but African American women are still more likely than white women to die of breast cancer. Black/white disparities in breast cancer mortality rate ratios have actually been increasing. METHODS: Across 762 US counties with enough deaths to generate reliable rates, county-level, age-adjusted breast cancer mortality rates were examined for women who were 35 to 74 years old during the period of 1989-2010. Twenty-two years of mortality data generated twenty 3-year rolling average data points, each centered on a specific year from 1990 to 2009. Mixed linear models were used to group each county into 1 of 4 mutually exclusive trend patterns. The most recent 3-year average black breast cancer mortality rate for each county was also categorized as being worse or not worse than the breast cancer mortality rate for the total US population. RESULTS: More than half of the counties (54%) showed persistent, unchanging disparities. Roughly 1 in 4 (24%) had a divergent pattern of worsening black/white disparities. However, 10.5% of the counties sustained racial equality over the 20-year period, and 11.7% of the counties actually showed a converging pattern from high disparities to greater equality. Twenty-three counties had 2008-2010 black mortality rates better than the US average mortality rate. CONCLUSIONS: Disparities are not inevitable. Four US counties have sustained both optimal and equitable black outcomes as measured by both absolute (better than the US average) and relative benchmarks (equality in the local black/white rate ratio) for decades, and 6 counties have shown a path from disparities to health equity.

Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states.

BACKGROUND: Despite evidence-based prevention and practice guidelines, asthma prevalence, treatment, and outcomes vary widely at individual and community levels. Asthma disproportionate/ly affects low-income and minority children, who comprise a large segment of the Medicaid population. METHODS: 2007 Medicaid claims data from 14 southern states was mapped for 556 counties to describe the local area variation in 1-year asthma prevalence rates, emergency department (ED) visit rates, and racial disparity rate ratios. RESULTS: One-year period prevalence of asthma ranged from 2.8% in Florida to 6.4% in Alabama, with a median prevalence rate of 4.1%. At the county level, the prevalence was higher for Black children and ranged from 1.03% in Manatee County, FL, to 21.0% in Hockley County, TX. Black-White rate ratios of prevalence ranged from 0.49 in LeFlore County, MS, to 3.87 in Flagler County, FL. Adjusted asthma ED visit rates ranged from 2.2 per 1000 children in Maryland to 16.5 in Alabama, with a median Black-White ED-visit rate ratio of 2.4. Rates were higher for Black children, ranging from 0.80 per 1000 in Wicomico County, MD, to 70 per 1000 in DeSoto County, FL. Rate ratios of ED visits ranged from 0.25 in Vernon Parish, LA, to 25.28 in Nelson County, KY. CONCLUSIONS AND RELEVANCE: Low-income children with Medicaid coverage still experience substantial variation in asthma prevalence and outcomes from one community to another. The pattern of worse outcomes for Black children also varies widely across counties. Eliminating this variation could substantially improve overall outcomes and eliminate asthma disparities.

Integrated Community Care Delivered by Public Health-Care and Social-Care Systems: Results from a Realist Synthesis.

Introduction: Integrated community care (ICC) is defined as an interweaving of health-care and social-care interventions deployed in spatial and relational proximity using an interdisciplinary and cross-sectoral approach. Consideration of territory scale and time scale are at the center of ICC practices. Its deployment in public health and social care networks (HSCN) can be complex due to their broad mandate, the complexity of their management, and accountability. Therefore, we aimed to describe ICC delivered by public HSCN to determine how, why, for whom, and in what circumstances ICC works and produces outcomes. Methods: A realist synthesis was conducted consisting of five steps consistent with realist synthesis standards (RAMESES projects) to produce configurations of Context - Mechanism - Outcomes (CMOc) and development of a middle-range explanatory theory of why and how the identified outcomes may have occurred. Results: In total, 26 studies were selected and used, as evidence, to support-either partially or fully-the production of CMOc based on the initial program theory. Nine unique CMO configurations were identified based on the data analyses and team discussion. ICC middle-range theory is informed by the CMO configurations identified. Discussion: This realist synthesis allowed us to identify the central mechanisms of ICC delivered by public HSCN and to produce a middle range theory. ICC is based on a specific philosophy and deployed by a professional agency oriented toward a community agency within a local system of interdisciplinary and cross-sectoral action. Conclusion: Our middle-range theory will provide a solid analytical framework as a foundation for ICC implementation and future research.

Introduction: Les interventions en santé et services sociaux intégrées en proximité des communautés (IIPC) sont définies comme une imbrication d'interventions de soins de santé et de services sociaux à l'échelle du territoire et considérant la temporalité, déployées dans une proximité spatiale et relationnelle au moyen d'une approche interdisciplinaire et intersectorielle. Son déploiement dans les réseaux publics de santé et de soins sociaux (RSSS) peut s'avérer complexe en raison de l'étendue de leur mandat, de la complexité de leur gestion et de leur responsabilité. C'est pourquoi nous avons cherché à décrire les IIPC dispensées par les RSSS publics afin de déterminer comment, pourquoi, pour qui et dans quelles circonstances les IIPC fonctionnent et produisent des résultats. Méthodes utilisées: Une synthèse réaliste a été réalisée en cinq étapes conformes aux normes de synthèse réaliste (projet RAMESES) afin de produire des configurations Contexte ­ Mécanisme ­ Effets (CMOc) et de développer une théorie explicative de moyenne portée sur le pourquoi et le comment des résultats identifiés. Résultats: Au total, 26 études ont été sélectionnées et utilisées comme preuves pour étayer ­ partiellement ou totalement ­ la production de CMOc sur la base de la théorie initiale de programme. Neuf configurations uniques CMO ont été identifiées sur la base des analyses de données et des discussions de l'équipe. La théorie de moyenne portée des IIPC s'appuie sur les configurations CMO identifiées. Discussion: Cette synthèse réaliste nous a permis d'identifier les mécanismes centraux des IIPC déployées par les RSSS publics et de produire une théorie de moyenne portée. Les IIPC sont fondées sur une philosophie et le développement d'une capacité d'agir professionnelle mise en action vers le renforcement de la capacité d'agir de la communauté au sein d'un système local d'action interdisciplinaire et intersectoriel. Conclusion: L'utilisation de notre théorie de moyenne portée pour la mise en œuvre d'IIPC fournira un cadre analytique solide comme base pour des implantations ou des recherches futures.

Biochemical Changes in Adult Male Gamers During Prolonged Gaming: Pilot Study.

BACKGROUND: Gaming has become an integrated part of life for children and adults worldwide. Previous studies on the impact of gaming on biochemical parameters have primarily addressed the acute effects of gaming. The literature is limited, and the study designs are very diverse. The parameters that have been investigated most thoroughly are blood glucose and cortisol. OBJECTIVE: This exploratory study is the first to investigate the effects of long gaming sessions on the biochemical parameters of healthy male adults. The extensive testing allowed us to observe short-term changes (within 6 hours), long-term changes during the duration of the gaming sessions, and follow-up after 1 week to determine whether any changes were longer lasting. METHODS: In total, 9 experienced gamers completed 2 back-to-back 18-hour gaming sessions interspersed with a 6-hour rest period. All participants adhered to a structured sleep pattern due to daytime employment or attending university. Blood, saliva, and urine samples were collected from the participants every 6 hours. Linear mixed-effect models were used to analyze the repeated-measures data accumulated during the study. A total of 51 biochemical parameters were investigated. RESULTS: In total, 12 of the 51 biochemical parameters significantly changed during the study: alkaline phosphatase, aspartate aminotransferase, bilirubin, chloride, creatinine, glucose, hemoglobin, immature reticulocyte fraction, lactate, methemoglobin, sodium, and thrombocytes. All changes were within the normal range. The mean glucose level of the participants was 4.39 (SD 0.07) mmol/L at baseline, which increased significantly by 0.24 (SD 0.07) mmol/L per 6 hours during the first period and by 0.38 (SD 0.07) mmol/L per 6 hours in the second period (P<.001). The glucose levels during the second session increased even though the participants had little energy intake. Cortisol levels did not change significantly, although the cortisol pattern deviated from the typical circadian rhythm. During both gaming sessions, we observed increasing cortisol levels from 6 AM until noon. The participants were relatively dehydrated at the start of the study. The patients were asked to fast before the first blood sampling. Within the first 6 hours of the study, the participants rehydrated, followed by relative dehydration during the remainder of the study. This pattern was identified using the following parameters: albumin, creatinine, hemoglobin, erythrocytes, potassium, and platelets. CONCLUSIONS: This study is the first of its kind, and many of the analyses in the study yielded novel results. The study was designed to emulate the behavior of gamers during the weekend and other long gaming sessions. At this point, we are not able to determine the difference between the effects of gaming and behavior during gaming. Regardless, the results of this study suggest that healthy gamers can partake in long gaming sessions, with ample amounts of unhealthy foods and little rest, without acute impacts on health.