Veerbeek, Marjolein; Oude Voshaar, Richard; Depla, Marja; Pot, Anne Margriet
Information on which older adults attend mental health care and whether they profit from the care they receive is important for policy-makers. To assess this information in daily practice, the "Mental health care Monitor Older adults" (MEMO) was developed in the Netherlands. The aim of this paper is to describe MEMO and the older adults who attend outpatient mental health care regarding their predisposing and enabling characteristics and need for care. In MEMO all patients referred to the division of old age psychiatry of the participating mental health care organisations are assessed at baseline and monitored at 4, 8 and 12-month follow-up. Primary outcomes are mental and social functioning, consumer satisfaction, and type of treatment provided (MEMO Basic). Over the years, MEMO Basic is repeated. In each cycle, additional information on specific patient groups is added (e.g. mood disorders). Data collection is supported by a web-based system for clinicians, including direct feedback to monitor patients throughout treatment. First results at baseline showed that the majority of patients that entered the division of old age psychiatry was female (69%), had low education (83%), lived alone (53%), was depressed (42%) and had a comorbid condition (82%). It seemed that older immigrants were not sufficiently reached. The current study is the first in the Netherlands to evaluate patient characteristics and outcome in mental health care provided for older adults in day-to-day practice. If MEMO works out successfully, the method should be extended to other target groups.
Adams, William G; Anderson, Nicholas; Berner, Eta S; Schauer, Daniel P; Zottola, Ralph J; McClure, Elizabeth S; Wyatt, Matthew
There is a pressing need for better tools to support comparative effectiveness research (CER) on a national scale. In addition, little is known about within-class outcome disparities for commonly used cardiovascular and diabetes medications. In this presentation, we will describe our experience implementing a new i2b2 cell, the Health Outcome Monitoring and Evaluation Cell (HOME), at 5 collaborating Clinical Translational Science Award sites (CTSAs) in the U.S. We will also describe the motivations to developing a common query framework, and findings related to the implementation and use of the HOME cell, to perform distributed CER queries. Our focus is on the assessment of race, gender, and location-based disparities in outcomes for patients treated with similar mediations for hypertension, dyslipidemias, and diabetes.
Hicks, Lanis L; Fleming, David A; Desaulnier, Adam
The objective of this study was to evaluate the impact of remote monitoring home telehealth on client and provider satisfaction, clinical outcomes, and cost. The project design was a pragmatic evaluation of the technology in a real-world setting at an operational scale rather than a controlled clinical trial. Patients receiving monitoring were selected by the home health agency, and a random sample of other agency clients was selected for comparative purposes. Data were collected on additional costs and benefits associated with home telehealth monitoring. Quantitative and qualitative data suggest that when remote monitoring telehealth technology was utilized in the home-care setting, both clients and providers were very satisfied with services; they felt it was easy to communicate, and that the technology was convenient and user friendly. Clients also felt that home telehealth technology had a very positive impact on the provider-client relationship and improved care. The study also suggests that home care monitoring reduces hospitalizations and decreases personnel expenses. This preliminary study provides evidence as to the value of remote monitoring home telehealth in the delivery of services to home care populations. It also provides evidence as to the positive impact that this form of technology may have on healthcare systems, provider and client satisfaction, and on the relationships that form between providers and clients.
Alshurafa, Nabil; Sideris, Costas; Pourhomayoun, Mohammad; Kalantarian, Haik; Sarrafzadeh, Majid; Eastwood, Jo-Ann
Remote health monitoring (RHM) systems are becoming more widely adopted by clinicians and hospitals to remotely monitor and communicate with patients while optimizing clinician time, decreasing hospital costs, and improving quality of care. In the Women's heart health study (WHHS), we developed Wanda-cardiovascular disease (CVD), where participants received healthy lifestyle education followed by six months of technology support and reinforcement. Wanda-CVD is a smartphone-based RHM system designed to assist participants in reducing identified CVD risk factors through wireless coaching using feedback and prompts as social support. Many participants benefitted from this RHM system. In response to the variance in participants' success, we developed a framework to identify classification schemes that predicted successful and unsuccessful participants. We analyzed both contextual baseline features and data from the first month of intervention such as activity, blood pressure, and questionnaire responses transmitted through the smartphone. A prediction tool can aid clinicians and scientists in identifying participants who may optimally benefit from the RHM system. Targeting therapies could potentially save healthcare costs, clinician, and participant time and resources. Our classification scheme yields RHM outcome success predictions with an F-measure of 91.9%, and identifies behaviors during the first month of intervention that help determine outcome success. We also show an improvement in prediction by using intervention-based smartphone data. Results from the WHHS study demonstrates that factors such as the variation in first month intervention response to the consumption of nuts, beans, and seeds in the diet help predict patient RHM protocol outcome success in a group of young Black women ages 25-45.
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Dobkin, Bruce H; Dorsch, Andrew
Mobile health tools that enable clinicians and researchers to monitor the type, quantity, and quality of everyday activities of patients and trial participants have long been needed to improve daily care, design more clinically meaningful randomized trials of interventions, and establish cost-effective, evidence-based practices. Inexpensive, unobtrusive wireless sensors, including accelerometers, gyroscopes, and pressure-sensitive textiles, combined with Internet-based communications and machine-learning algorithms trained to recognize upper- and lower-extremity movements, have begun to fulfill this need. Continuous data from ankle triaxial accelerometers, for example, can be transmitted from the home and community via WiFi or a smartphone to a remote data analysis server. Reports can include the walking speed and duration of every bout of ambulation, spatiotemporal symmetries between the legs, and the type, duration, and energy used during exercise. For daily care, this readily accessible flow of real-world information allows clinicians to monitor the amount and quality of exercise for risk factor management and compliance in the practice of skills. Feedback may motivate better self-management as well as serve home-based rehabilitation efforts. Monitoring patients with chronic diseases and after hospitalization or the start of new medications for a decline in daily activity may help detect medical complications before rehospitalization becomes necessary. For clinical trials, repeated laboratory-quality assessments of key activities in the community, rather than by clinic testing, self-report, and ordinal scales, may reduce the cost and burden of travel, improve recruitment and retention, and capture more reliable, valid, and responsive ratio-scaled outcome measures that are not mere surrogates for changes in daily impairment, disability, and functioning.
Dobkin, Bruce H.; Dorsch, Andrew
Mobile health tools that enable clinicians and researchers to monitor the type, quantity, and quality of everyday activities of patients and trial participants have long been needed to improve daily care, design more clinically meaningful randomized trials of interventions, and establish cost-effective, evidence-based practices. Inexpensive, unobtrusive wireless sensors, including accelerometers, gyroscopes, and pressure-sensitive textiles, combined with Internet-based communications and machine-learning algorithms trained to recognize upper- and lower-extremity movements, have begun to fulfill this need. Continuous data from ankle triaxial accelerometers, for example, can be transmitted from the home and community via WiFi or a smartphone to a remote data analysis server. Reports can include the walking speed and duration of every bout of ambulation, spatiotemporal symmetries between the legs, and the type, duration, and energy used during exercise. For daily care, this readily accessible flow of real-world information allows clinicians to monitor the amount and quality of exercise for risk factor management and compliance in the practice of skills. Feedback may motivate better self-management as well as serve home-based rehabilitation efforts. Monitoring patients with chronic diseases and after hospitalization or the start of new medications for a decline in daily activity may help detect medical complications before rehospitalization becomes necessary. For clinical trials, repeated laboratory-quality assessments of key activities in the community, rather than by clinic testing, self-report, and ordinal scales, may reduce the cost and burden of travel, improve recruitment and retention, and capture more reliable, valid, and responsive ratio-scaled outcome measures that are not mere surrogates for changes in daily impairment, disability, and functioning. PMID:21989632
Keune, Lobke H; de Vogel, Vivienne; van Marle, Hjalmar J C
This study examined if a macro-, meso-, and micro outcome measurement instrument that constitutes the evaluation stage of a Dutch forensic psychiatric outcome monitor, the Hoeven Outcome Monitor (HOM), can provide a first step towards a more evidence based groundwork in forensic mental health. General, serious, very serious, special, and tbs meriting recidivism during treatment, after treatment, and overall were charted for forensic psychiatric patients discharged from a Dutch forensic psychiatric centre between 1999 and 2008 (N=164). Re-conviction data were obtained from the official Criminal Records System, and the mean follow-up time was 116.2months. First, the results showed that the macro-measurements provide comparative outcome measures to generate insight into the overall effectiveness of forensic psychiatric treatment. Second, the meso-measurements yielded clinically relevant treatment outcome data for all discharged patients to generate a complete view of treatment effectiveness. Finally, the micro-measurements allowed access to detailed patient and treatment effectiveness assessments that provides the empirical foundation to conduct aetiological research into the prediction and control of high-risk behaviour. Thus, an outcome measurement instrument in line with Evidence Based Medicine and best practice guidelines was designed that provides an empirically sound evaluation framework for treatment effectiveness, and an impetus for the development of effective interventions to generate an evidence based groundwork in forensic mental health.
Patty, Willard W.
This 1949 paper considers the evaluation of health education outcomes. It describes the nature of health education, discusses whether it is possible to measure all health education outcomes, then examines how to evaluate student health habits and skills, health attitudes, and health knowledge. It concludes that it is important to evaluate health…
Background Patient-reported Outcomes (PROs) capturing e.g., quality of life, fatigue, depression, medication side-effects or disease symptoms, have become important outcome parameters in medical research and daily clinical practice. Electronic PRO data capture (ePRO) with software packages to administer questionnaires, storing data, and presenting results has facilitated PRO assessment in hospital settings. Compared to conventional paper-pencil versions of PRO instruments, ePRO is more economical with regard to staff resources and time, and allows immediate presentation of results to the medical staff. The objective of our project was to develop software (CHES – Computer-based Health Evaluation System) for ePRO in hospital settings and at home with a special focus on the presentation of individual patient’s results. Methods Following the Extreme Programming development approach architecture was not fixed up-front, but was done in close, continuous collaboration with software end users (medical staff, researchers and patients) to meet their specific demands. Developed features include sophisticated, longitudinal charts linking patients’ PRO data to clinical characteristics and to PRO scores from reference populations, a web-interface for questionnaire administration, and a tool for convenient creating and editing of questionnaires. Results By 2012 CHES has been implemented at various institutions in Austria, Germany, Switzerland, and the UK and about 5000 patients participated in ePRO (with around 15000 assessments in total). Data entry is done by the patients themselves via tablet PCs with a study nurse or an intern approaching patients and supervising questionnaire completion. Discussion During the last decade several software packages for ePRO have emerged for different purposes. Whereas commercial products are available primarily for ePRO in clinical trials, academic projects have focused on data collection and presentation in daily clinical practice and
Kabo, Ibrahim; Otolorin, Emmanuel; Williams, Emma; Orobaton, Nosa; Abdullahi, Hannatu; Sadauki, Habib; Abdulkarim, Masduk; Abegunde, Dele
Objective This study assessed the correlation between compliance with set performance standards and maternal and neonatal deaths in health facilities. Design Baseline and three annual follow-up assessments were conducted, and each was followed by a quality improvement initiative using the Standards Based Management and Recognition (SBM-R) approach. Setting Twenty-three secondary health facilities of Bauchi state, Nigeria. Participants Health care workers and maternity unit patients. Main outcome measures We examined trends in: (i) achievement of SBM-R set performance standards based on annual assessment data, (ii) the use of maternal and newborn health (MNH) service delivery practices based on data from health facility registers and supportive supervision and (iii) MNH outcomes based on routine service statistics. Results At the baseline assessment in 2010, the facilities achieved 4% of SBM-R standards for MNH, on average, and this increased to 86% in 2013. Over the same time period, the study measured an increase in the administration of uterotonic for active management of third stage of labor from 10% to 95% and a decline in the incidence of postpartum hemorrhage from 3.3% to 1.9%. Institutional neonatal mortality rate decreased from 9 to 2 deaths per 1000 live births, while the institutional maternal mortality ratio dropped from 4113 to 1317 deaths per 100 000 live births. Conclusion Scaling up SBM-R for quality improvement has the potential to prevent maternal and neonatal deaths in Nigeria and similar settings. PMID:27512125
Keune, Lobke H; de Vogel, Vivienne; van Marle, Hjalmar J C
To comply with the need for a more evidence based risk assessment and management in forensic mental health, an outcome monitor is being developed in the Dutch forensic psychiatric centre Van der Hoeven Kliniek in Utrecht, the Hoeven Outcome Monitor (HOM). Conform evidence based medicine (EBM) guidelines, the HOM is subdivided into three consecutive stages, (1) the evaluation stage, (2) the aetiology stage and (3) the implementation stage. In this article an account is provided for the design of the evaluation stage. To account for predicaments in previous research that pertain to a lack of uniformity and disregard of specific context- and patient-related characteristics, a macro-, meso- and micro-treatment evaluation instrument is developed. This instrument provides for the first step to build an evidence base for specific interventions and treatments in forensic psychiatry.
Rossi, Meredith; Lee, Lesley; Wear, Mary; Van Baalen, Mary; Rhodes, Bradley
The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. A better understanding of the individual, population, and mission impacts of astronaut occupational exposures is critical to providing clinical care, targeting occupational surveillance efforts, and planning for future space exploration. The ability to characterize the risk of latent health conditions is a significant component of this understanding. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA-Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential long-term health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging populations are necessary to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography); and expanded monitoring will increase NASA's ability to better characterize conditions resulting from astronaut occupational exposures. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of e an Astronaut Occupational Health program to include expanded medical monitoring of former NASA astronauts. Increasing the breadth of monitoring services will ultimately enrich the existing evidence base of occupational health risks
Farrar, C. R.
Structural health monitoring is the implementation of a damage detection strategy for aerospace, civil and mechanical engineering infrastructure. Typical damage experienced by this infrastructure might be the development of fatigue cracks, degradation of structural connections, or bearing wear in rotating machinery. The goal of the research effort reported herein is to develop a robust and cost-effective structural health monitoring solution by integrating and extending technologies from various engineering and information technology disciplines. It is the authors opinion that all structural health monitoring systems must be application specific. Therefore, a specific application, monitoring welded moment resisting steel frame connections in structures subjected to seismic excitation, is described along with the motivation for choosing this application. The structural health monitoring solution for this application will integrate structural dynamics, wireless data acquisition, local actuation, micro-electromechanical systems (MEMS) technology, and statistical pattern recognition algorithms. The proposed system is based on an assessment of the deficiencies associated with many current structural health monitoring technologies including past efforts by the authors. This paper provides an example of the integrated approach to structural health monitoring being undertaken at Los Alamos National Laboratory and summarizes progress to date on various aspects of the technology development.
Farrar, Charles R.; Sohn, Hoon; Fugate, Michael L.; Czarnecki, Jerry J.
Structural health monitoring is the implementation of a damage detection strategy for aerospace, civil and mechanical engineering infrastructure. Typical damage experienced by this infrastructure might be the development of fatigue cracks, degradation of structural connections, or bearing wear in rotating machinery. The goal of the research effort reported herein is to develop a robust and cost-effective structural health monitoring solution by integrating and extending technologies from various engineering and information technology disciplines. It is the author's opinion that all structural health monitoring systems must be application specific. Therefore, a specific application, monitoring welded moment resisting steel frame connections in structures subjected to seismic excitation, is described along with the motivation for choosing this application. The structural health monitoring solution for this application will integrate structural dynamics, wireless data acquisition, local actuation, micro-electromechanical systems (MEMS) technology, and statistical pattern recognition algorithms. The proposed system is based on an assessment of the deficiencies associated with many current structural health monitoring technologies including past efforts by the authors. This paper provides an example of the integrated approach to structural health monitoring being undertaken at Los Alamos National Laboratory and summarizes progress to date on various aspects of the technology development.
Lisy, Frederick J.
Orbital Research, Inc., has developed a low-profile, wearable sensor suite for monitoring astronaut health in both intravehicular and extravehicular activities. The Lunar Health Monitor measures respiration, body temperature, electrocardiogram (EKG) heart rate, and other cardiac functions. Orbital Research's dry recording electrode is central to the innovation and can be incorporated into garments, eliminating the need for conductive pastes, adhesives, or gels. The patented dry recording electrode has been approved by the U.S. Food and Drug Administration. The LHM is easily worn under flight gear or with civilian clothing, making the system completely versatile for applications where continuous physiological monitoring is needed. During Phase II, Orbital Research developed a second-generation LHM that allows sensor customization for specific monitoring applications and anatomical constraints. Evaluations included graded exercise tests, lunar mission task simulations, functional battery tests, and resting measures. The LHM represents the successful integration of sensors into a wearable platform to capture long-duration and ambulatory physiological markers.
The shrinking size and weight of electronic circuitry has given rise to a new generation of smart clothing that enables biological data to be measured and transmitted. As the variation in the number and type of deployable devices and sensors increases, technology must allow their seamless integration so they can be electrically powered, operated, and recharged over a digital pathway. Nyx Illuminated Clothing Company has developed a lightweight health monitoring system that integrates medical sensors, electrodes, electrical connections, circuits, and a power supply into a single wearable assembly. The system is comfortable, bendable in three dimensions, durable, waterproof, and washable. The innovation will allow astronaut health monitoring in a variety of real-time scenarios, with data stored in digital memory for later use in a medical database. Potential commercial uses are numerous, as the technology enables medical personnel to noninvasively monitor patient vital signs in a multitude of health care settings and applications.
Iverson, David L.
The Inductive Monitoring System (IMS) software was developed to provide a technique to automatically produce health monitoring knowledge bases for systems that are either difficult to model (simulate) with a computer or which require computer models that are too complex to use for real time monitoring. IMS uses nominal data sets collected either directly from the system or from simulations to build a knowledge base that can be used to detect anomalous behavior in the system. Machine learning and data mining techniques are used to characterize typical system behavior by extracting general classes of nominal data from archived data sets. IMS is able to monitor the system by comparing real time operational data with these classes. We present a description of learning and monitoring method used by IMS and summarize some recent IMS results.
Loan, Lori A; Patrician, Patricia A; McCarthy, Mary
The current and future climates in health care require increased accountability of health care organizations for the quality of the care they provide. Never before in the history of health care in America has this focus on quality been so critical. The imperative to measure nursing's impact without fully developed and tested monitoring systems is a critical issue for nurse executives and managers alike. This article describes a project to measure nursing structure, process, and outcomes in the military health system, the Military Nursing Outcomes Database project. Here we review the effectiveness of this project in monitoring changes over time, in satisfying expectations of nurse leaders in participating hospitals, and evaluate the potential budgetary impacts of such a system. We conclude that the Military Nursing Outcomes Database did meet the needs of a monitoring system that is sensitive to changes over time in outcomes, provides interpretable data for nurse leaders, and could result in cost benefits and patient care improvements in organizations.
Bhutta, Zulfiqar A; Lassi, Zohra S; Blanc, Ann; Donnay, France
Some interventions in women before and during pregnancy may reduce perinatal and neonatal deaths, and recent research has established linkages of reproductive health with maternal, perinatal, and early neonatal health outcomes. In this review, we attempted to analyze the impact of biological, clinical, and epidemiologic aspects of reproductive and maternal health interventions on perinatal and neonatal outcomes through an elucidation of a biological framework for linking reproductive, maternal and newborn health (RHMNH); care strategies and interventions for improved perinatal and neonatal health outcomes; public health implications of these linkages and implementation strategies; and evidence gaps for scaling up such strategies. Approximately 1000 studies (up to June 15, 2010) were reviewed that have addressed an impact of reproductive and maternal health interventions on perinatal and neonatal outcomes. These include systematic reviews, meta-analyses, and stand-alone experimental and observational studies. Evidences were also drawn from recent work undertaken by the Child Health Epidemiology Reference Group (CHERG), the interconnections between maternal and newborn health reviews identified by the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS), as well as relevant work by the Partnership for Maternal, Newborn and Child Health. Our review amply demonstrates that opportunities for assessing outcomes for both mothers and newborns have been poorly realized and documented. Most of the interventions reviewed will require more greater-quality evidence before solid programmatic recommendations can be made. However, on the basis of our review, birth spacing, prevention of indoor air pollution, prevention of intimate partner violence before and during pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring during pregnancy, insecticide-treated mosquito nets, birth and newborn care preparedness via community-based intervention
Gundersen, Craig; Ziliak, James P
Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes.
van Os, Jim; Delespaul, Philippe; Barge, Daniela; Bakker, Roberto P.
Background Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM). Method In a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA). EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects) and context (eg stressors, situations, activities) at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18). Results EMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states), with standardized effect sizes of 0.4–0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time. Conclusion This study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment – as an index of health, obviating the need for an
Hoenders, Rogier H J; Bos, Elisabeth H; Bartels-Velthuis, Agna A; Vollbehr, Nina K; van der Ploeg, Karen; de Jonge, Peter; de Jong, Joop T V M
There is considerable debate about routine outcome monitoring (ROM) for scientific or benchmarking purposes. We discuss pitfalls associated with the assessment, analysis, and interpretation of ROM data, using data of 376 patients. 206 patients (55 %) completed one or more follow-up measurements. Mixed-model analysis showed significant improvement in symptomatology, quality of life, and autonomy, and differential improvement for different subgroups. Effect sizes were small to large, depending on the outcome measure and subgroup. Subtle variations in analytic strategies influenced effect sizes substantially. We illustrate how problems inherent to design and analysis of ROM data prevent drawing conclusions about (comparative) treatment effectiveness.
Petit, Lionel; Lefeuvre, Elie; Guyomar, Daniel; Richard, Claude; Guy, Philippe; Yuse, Kaori; Monnier, Thomas
The integration of autonomous wireless elements in health monitoring network increases the reliability by suppressing power supplies and data transmission wiring. Micro-power piezoelectric generators are an attractive alternative to primary batteries which are limited by a finite amount of energy, a limited capacity retention and a short shelf life (few years). Our goal is to implement such an energy harvesting system for powering a single AWT (Autonomous Wireless Transmitter) using our SSH (Synchronized Switch Harvesting) method. Based on a non linear process of the piezoelement voltage, this SSH method optimizes the energy extraction from the mechanical vibrations. This AWT has two main functions : The generation of an identifier code by RF transmission to the central receiver and the Lamb wave generation for the health monitoring of the host structure. A damage index is derived from the variation between the transmitted wave spectrum and a reference spectrum. The same piezoelements are used for the energy harvesting function and the Lamb wave generation, thus reducing mass and cost. A micro-controller drives the energy balance and synchronizes the functions. Such an autonomous transmitter has been evaluated on a 300x50x2 mm 3 composite cantilever beam. Four 33x11x0.3 mm 3 piezoelements are used for the energy harvesting and for the wave lamb generation. A piezoelectric sensor is placed at the free end of the beam to track the transmitted Lamb wave. In this configuration, the needed energy for the RF emission is 0.1 mJ for a 1 byte-information and the Lamb wave emission requires less than 0.1mJ. The AWT can harvested an energy quantity of approximately 20 mJ (for a 1.5 Mpa lateral stress) with a 470 μF storage capacitor. This corresponds to a power density near to 6mW/cm 3. The experimental AWT energy abilities are presented and the damage detection process is discussed. Finally, some envisaged solutions are introduced for the implementation of the required data
Bowen, Sonya E
The Medicare Health Outcomes Survey (HOS) provides a rich source of outcomes data on the Medicare Advantage (MA) program for the US Department of Health and Human Services, managed care organizations participating in Medicare, quality improvement organizations, and health services researchers working to improve quality of care for Medicare enrollees. Since 1998, the Centers for Medicare and Medicaid Services has collected longitudinal functional status information to assess the performance of Medicare managed care organizations. This introduction reviews the goals of the HOS program, how the HOS supports health care reform, and outlines recent HOS studies exploring data applications for monitoring outcomes and implementing quality improvement activities.
Evans, Elizabeth; Hser, Yih-Ing
Timely information provided by an effective outcome monitoring system (OMS) is key to making improvements in treatment program effectiveness, service provision, and client outcomes. The California Treatment Outcome Project (CalTOP) developed and pilot-tested an automated outcome monitoring system for California's alcohol and other drug (AOD) system of care. CalTOP was designed to track client movement through treatment programs, measure standardized assessment of client service needs, record service utilization, assess treatment outcomes and client satisfaction, and determine the extent to which treatment produces cost-offsets in other health and social service systems. Information collected by CalTOP revealed that client problem severity at admission was high, services needed were diverse, and treatment services were generally not well matched to the level of problem severity or needs of clients. Also, client retention and length of stay in treatment were generally insufficient to maximize the potential benefits associated with treatment. This article presents the type of information on client demographics and treatment retention that was provided by CalTOP and outlines recommendations for implementing an AOD outcome monitoring system statewide.
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Currie, Janet; Stabile, Mark; Manivong, Phongsack; Roos, Leslie L.
Research has shown a strong connection between birth weight and future outcomes. We ask how health problems after birth affect outcomes using data from public health insurance records for 50,000 children born between 1979 and 1987 in the Canadian province of Manitoba. We compare children to siblings born an average of three years apart. We find…
Espelt, Albert; Continente, Xavier; Domingo-Salvany, Antonia; Domínguez-Berjón, M Felicitas; Fernández-Villa, Tania; Monge, Susana; Ruiz-Cantero, M Teresa; Perez, Glòria; Borrell, Carme
Public health surveillance is the systematic and continuous collection, analysis, dissemination and interpretation of health-related data for planning, implementation and evaluation of public health initiatives. Apart from the health system, social determinants of health include the circumstances in which people are born, grow up, live, work and age, and they go a long way to explaining health inequalities. A surveillance system of the social determinants of health requires a comprehensive and social overview of health. This paper analyses the importance of monitoring social determinants of health and health inequalities, and describes some relevant aspects concerning the implementation of surveillance during the data collection, compilation and analysis phases, as well as dissemination of information and evaluation of the surveillance system. It is important to have indicators from sources designed for this purpose, such as continuous records or periodic surveys, explicitly describing its limitations and strengths. The results should be published periodically in a communicative format that both enhances the public's ability to understand the problems that affect them, whilst at the same time empowering the population, with the ultimate goal of guiding health-related initiatives at different levels of intervention.
Environmental exposures range across multiple domains to affect human health. In an effort to learn how environmental factors combine to contribute to health outcomes we constructed a multiple environmental domain index (MEDI) for use in health research. We used principal compone...
Southern Regional Education Board, Atlanta, GA.
Outcome evaluation assesses the results or benefits of mental health services received by clients or communities by comparing descriptive data on the mental health status of clients at different points in time. It aids clinicians and managers in planning programs and managing clinical services. A mental health center should establish goal-oriented…
Behavioral health risks during long-duration space exploration missions are among the most difficult to predict, detect, and mitigate. Given the anticipated extended duration of future missions and their isolated, extreme, and confined environments, there is the possibility that behavior conditions and mental disorders will develop among astronaut crew. Pulsar Informatics, Inc., has developed a health monitoring tool that provides a means to detect and address behavioral disorders and mental conditions at an early stage. The tool integrates all available behavioral measures collected during a mission to identify possible health indicator warning signs within the context of quantitatively tracked mission stressors. It is unobtrusive and requires minimal crew time and effort to train and utilize. The monitoring tool can be deployed in space analog environments for validation testing and ultimate deployment in long-duration space exploration missions.
Lundborg, Petter; Nilsson, Anton; Rooth, Dan-Olof
Whereas a large literature has shown the importance of early life health for adult socioeconomic outcomes, there is little evidence on the importance of adolescent health. We contribute to the literature by studying the impact of adolescent health status on adult labor market outcomes using a unique and large-scale dataset covering almost the entire population of Swedish males. We show that most types of major conditions have long-run effects on future outcomes, and that the strongest effects result from mental conditions. Including sibling fixed effects or twin pair fixed effects reduces the magnitudes of the estimates, but they remain substantial.
Pereira Lima, Vera Lucia Góes; Arruda, José Maria; Barroso, Maria Auxiliadora Bessa; Lobato Tavares, Maria de Fátima; Ribeiro Campos, Nora Zamith; Zandonadil, Regina Celi Moreira Basílio; da Rocha, Rosa Maria; Parreira, Clélia Maria de Souza Ferreira; Cohen, Simone Cynamon; Kligerman, Débora Cynamon; Sperandio, Ana Maria Girotti; Correa, Carlos Roberto Silveira; Serrano, Miguel Malo
This article focuses on health promotion (HP) outcomes, illustrated through evaluation of case studies and identification of strategies which have contributed to their success and sustainability. Evaluation research and practice in three distinct sceneries are discussed: (i) institutional and governmental agencies; (ii) communities in the "Manguinhos Complex" and Nova Iguaqu Municipality, and (iii) building of potentially healthy municipality networks. The effectiveness of a social program in a health promotion perspective was based in the "School for Parents" program, undertaken by the First Court of Childhood and Youth of Rio de Janeiro, between 2001 and 2004. The analysis was grounded in the monitoring of 48 parents in charge of children under 18, who were victims of abuse, violence or negligence, and social exclusion, most of all. The study's objectives were: illustrating the evidence of effectiveness of health promotion, discussing the concept of HP effectiveness under macro unfavorable conditions, and identifying strategies that foster sustainability of results. Institutional resources included a multi-professional staff, multidisciplinary approaches, participatory workshops, family case management, partnership with public and private institutions, and volunteer and civil society sponsorship of the families. Evaluation was based on social impact indicators, and psychosocial and contextual determinants. Evaluation methods included program monitoring and quantitative-qualitative methods, through a longitudinal evaluation of 3 years, including one year post program. The evaluation showed highly favorable results concerning "family integration', "quality of family relations" and "human rights mobilization". Unsatisfactory results such as "lack of access to formal employment" are likely related to structural factors and the need for new public policies in areas such as education, professional training, housing, and access to formal employment. The training process
Background The District Health Information System was developed in South Africa to collect aggregated routine data from public health facilities. In Amajuba District, KwaZulu-Natal, ward-based data collection has been initiated to facilitate improved responsiveness to community health needs and improve health outcomes and patient satisfaction. Aim To assess the application of the municipal ward-based health data in the decision-making process to improve child health outcomes. Setting The study was conducted in 25 primary health care service sites in Amajuba. Methods A cross-sectional mixed methods’ approach was used. The study population comprised operational managers, professional nurses, ward-based outreach team leaders and supervisors. Quantitative data were collected using a semi-structured questionnaire and analysed using descriptive statistics. Qualitative data were collected using focus group discussions and analysed using thematic analysis. Results Of the 131 respondents, 83 (67.5%) provided targeted child interventions to a certain or a large extent to improve child health outcomes, but only 74 (57.4%) respondents reported using municipal ward-based health data to a certain or large extent in order to inform their decisions. This discrepancy indicates poor utilisation of local health information for decision-making. Conclusion The study showed that municipal ward-based health data are not fully utilised for making informed decisions to improve child health outcomes. It is imperative to inculcate a culture of evidence-informed decisions that leads to provision of targeted interventions in order to mitigate the challenge of scarcity of resources and to improve child health outcomes. PMID:28155323
Suciu, George; Butca, Cristina; Ochian, Adelina; Halunga, Simona
In this paper we describe several wearable sensors, designed for monitoring the health condition of the patients, based on an experimental model. Wearable sensors enable long-term continuous physiological monitoring, which is important for the treatment and management of many chronic illnesses, neurological disorders, and mental health issues. The system is based on a wearable sensors network, which is connected to a computer or smartphone. The wearable sensor network integrates several wearable sensors that can measure different parameters such as body temperature, heart rate and carbon monoxide quantity from the air. After the portable sensors measuring parameter values, they are transmitted by microprocessor through the Bluetooth to the application developed on computer or smartphone, to be interpreted.
Varekojis, Sarah M.; Miller, Larry; Schiller, M. Rosita; Stein, David
Purpose: This paper aims to describe the relationship between functional health literacy level and smoking cessation outcomes. Design/methodology/approach: Participants in an inpatient smoking cessation program in a mid-western city in the USA were enrolled and the Short Test of Functional Health Literacy in Adults was administered while the…
This paper examines the relationship between the inequality in workplace conditions and health-related outcomes in Japan. It analyzes the effect of changes in the work conditions and work arrangements on the subjective health, activity restriction, and depression symptoms, using the Japanese Life Course Panel Survey (JLPS). The 2007 JLPS consists of nationally representative sample of the youth (20 to 34 yr old) and the middle-aged (35 to 40 yr old). The original respondents were followed up in 2008, and 2,719 respondents for the youth panel and 1,246 for the middle-aged panel returned the questionnaires. The first major conclusion is that there are substantial changes in health conditions between the two waves even though the distributions of health-related outcomes are very similar at two time points. The second major conclusion is that the effects of work conditions depend on different health-related outcomes. Self-reported health and depression symptoms are affected by a variety of job-related factors. The atmosphere of helping each other and the control over the pace of work are two important factors which affect both depression and self-reported health. All these findings suggest that the workplace conditions and job characteristics have profound influence on the workers' health.
Delaney, Michael M.; Flynn, James G.; Browder, Mark E.
A method of monitoring the health of selected solder joints, called SJ-BIST, has been developed by Ridgetop Group Inc. under a Small Business Innovative Research (SBIR) contract. The primary goal of this research program is to test and validate this method in a flight environment using realistically seeded faults in selected solder joints. An additional objective is to gather environmental data for future development of physics-based and data-driven prognostics algorithms. A test board is being designed using a Xilinx FPGA. These boards will be tested both in flight and on the ground using a shaker table and an altitude chamber.
Tsasis, Peter; Evans, Jenna M; Forrest, David; Jones, Richard Keith
Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care.
Tsasis, Peter; Evans, Jenna M; Forrest, David; Jones, Richard Keith
Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care. PMID:23526058
Farag, Marwa; Nandakumar, A K; Wallack, Stanley; Hodgkin, Dominic; Gaumer, Gary; Erbil, Can
This paper examines the relationship between country health spending and selected health outcomes (infant mortality and child mortality), using data from 133 low and middle-income countries for the years 1995, 2000, 2005, and 2006. Health spending has a significant effect on reducing infant and under-5 child mortality with an elasticity of 0.13 to 0.33 for infant mortality and 0.15 to 0.38 for under-5 child mortality in models estimated using fixed effects methods (depending on models employed). Government health spending also has a significant effect on reducing infant and child mortality and the size of the coefficient depends on the level of good governance achieved by the country, indicating that good governance increases the effectiveness of health spending. This paper contributes to the new evidence pointing to the importance of investing in health care services and the importance of governance in improving health outcomes.
Kindig, D A
OBJECTIVE: To review the concept of population health, including its definition, measurement, and determinants, and to suggest an approach for aligning financial incentives toward this goal. DATA SOURCE, STUDY DESIGN, DATA EXTRACTION. Literature review, policy analysis PRINCIPAL FINDINGS: The article presents the argument that a major reason for our slow progress toward health outcome improvement is that there is no operational definition of population health and that financial incentives are not aligned to this goal. Current attempts at process measures as indicators of quality or outcome are not adequate for the task. It is suggested that some measure of health-adjusted life expectancy be adopted for this purpose, and that integrated delivery systems and other agents responsible for nonmedical determinants be rewarded for improvement in this measure. This will require the development of an investment portfolio across the determinants of health based on relative marginal return to health, with horizontal integration strategies across sectoral boundaries. A 20-year three-phase development strategy is proposed, including components of research and acceptance, integrated health system implementation, and cross-sectoral integration. CONCLUSIONS: The U.S. healthcare system is a $1 trillion industry without a definition of its product. Until population outcome measures are developed and rewarded for, we will not solve the twenty-first century challenge of maximizing health outcome improvement for the resources available. Images Figure 1 PMID:9618669
Despas, Noémie; Larock, Anne-Sophie; Jacqmin, Hugues; Douxfils, Jonathan; Chatelain, Bernard; Chatelain, Marc; Mullier, François
Traditional anticoagulant agents such as unfractionated heparin (UFH), low molecular weight heparins (LMWHs), fondaparinux, danaparoid and bivalirudine are used in the prevention and treatment of thromboembolic diseases. However, these agents have limitations: their constraining parenteral route of administration and the need for regular coagulation monitoring for HNF. The LMWHs, with their more predictable anticoagulant response, don't require a systematic monitoring. The usefulness of LMWHs monitoring in several clinical situations such as pregnancy, obesity and renal insufficiency is a matter of debate. Indeed, there is no agreement between French and American recommendations on this question. Others aspects are also controversial: the measure of trough anti-Xa activity during pregnancy and the optimal monitoring of LMWHs for patients with antithrombin deficiency (hepatic disease, new-borns). Different tests are available to ensure the monitoring of these drugs, we will see in this review their principle, their advantages and inconvenients. The management of heparin induced thrombocytopenia also needs parenteral anticoagulants: danaparoïd, bivalirudine or argatroban. The modalities of their monitoring are relatively unknown and are presented. Furthermore, platelet monitoring is capital. This article aims to provide guidance about laboratory testing of classic parenteral anticoagulants.
Pinkerton, JoAnn V; Stovall, Dale W
Changes in ovarian hormone production may affect numerous health outcomes including vasomotor symptoms, cardiovascular disease (CVD), osteoporosis, cognition, depression, mood disorders, sexual function, and vaginal atrophy. We will compare age-related changes to those associated with reproductive aging and menopause and the effects of estrogen therapy on selected health outcomes. Hormone therapy (HT) reduces frequency and severity of hot flashes, prevents bone loss and osteoporotic fractures, and relieves vaginal atrophy. Nonhormone therapy trials with antidepressants or gabapentin for hot flash relief are promising. To date, clinical trial data are insufficient to recommend the use of HT for prevention or treatment of CVD, mood disorders, cognition, or sleep disorders. For some disease states, such as CVD and cognition, a "critical time window" has been proposed but not proven, such that estrogen use early in the menopause transition may be beneficial while estrogen use later in life would lead to increased health risks.
Elrod, Susan Vinz (Inventor); Dabney, Richard W. (Inventor)
A health monitoring system for use with a child car seat has sensors mounted in the seat to monitor one or more health conditions of the seat's occupant. A processor monitors the sensor's signals and generates status signals related to the monitored conditions. A transmitter wireless transmits the status signals to a remotely located receiver. A signaling device coupled to the receiver produces at least one sensory (e.g., visual, audible, tactile) output based on the status signals.
Loehr, Janeen D; Kourtis, Dimitrios; Vesper, Cordula; Sebanz, Natalie; Knoblich, Günther
We investigated whether people monitor the outcomes of their own and their partners' individual actions as well as the outcome of their combined actions when performing joint actions together. Pairs of pianists memorized both parts of a piano duet. Each pianist then performed one part while their partner performed the other; EEG was recorded from both. Auditory outcomes (pitches) associated with keystrokes produced by the pianists were occasionally altered in a way that either did or did not affect the joint auditory outcome (i.e., the harmony of a chord produced by the two pianists' combined pitches). Altered auditory outcomes elicited a feedback-related negativity whether they occurred in the pianist's own part or the partner's part, and whether they affected individual or joint action outcomes. Altered auditory outcomes also elicited a P300 whose amplitude was larger when the alteration affected the joint outcome compared with individual outcomes and when the alteration affected the pianist's own part compared with the partner's part. Thus, musicians engaged in joint actions monitor their own and their partner's actions as well as their combined action outcomes, while at the same time maintaining a distinction between their own and others' actions and between individual and joint outcomes.
Bonsel, Gouke J.
Background Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. Objective To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. Design The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002–2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems’ responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Results Health determinants’ indicators – access to improved drinking sources, accountability, and average years of schooling – were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the
Limburg, H.; Foster, A.; Vaidyanathan, K.; Murthy, G. V.
Two simple methods of assessing visual outcome following cataract surgery were evaluated in India. The first used data obtained from standardized patient records of cataract surgery. The second used data from population-based rapid epidemiological assessments. Analysis of 4168 hospital and eye camp records showed that, with the available standard correction, a good outcome (visual acuity > or = 6/18) was achieved in 37.8%, a borderline outcome (visual acuity 6/246-6/60) in 45.6% and a poor outcome (visual acuity 6/60) in 16.6% of instances. Of 2401 aphakic/pseudophakic eyes examined in a cross-sectional population-based study, outcome was good in 43.5% and poor in 26.4%. For 776 eyes examined in a similar study in a different state, outcome was good in 49.9% and poor in 23.9%. These assessments indicate that outcome with available correction was poor in 15-25% of eyes following cataract surgery. Visual outcome is likely to improve when better correction for aphakia can be provided. Further assessment of the causes of poor visual outcome is needed. The visual outcome following cataract surgery could be monitored on a regular basis by ophthalmologists, using either of the methods evaluated, an exercise which in itself is likely to improve the outcome of surgery. When the proportion of poor outcomes is high (> 10%) further investigation into the causes is warranted. PMID:10427929
Eisner, Mark D.; Blanc, Paul D.; Omachi, Theodore A.; Yelin, Edward H.; Sidney, Stephen; Katz, Patricia P.; Ackerson, Lynn M.; Sanchez, Gabriela; Tolstykh, Irina; Iribarren, Carlos
Background Although COPD is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race-ethnicity on health outcomes. Methods We aimed to determine the independent impacts of SES and race-ethnicity on COPD severity status, functional limitations, and acute exacerbations of COPD among patients with access to health care. Data were used from the FLOW cohort study of 1,202 Kaiser Permanente Northern California Medical Care Plan members with COPD. Results Lower educational attainment and household income were consistently related to greater disease severity, poorer lung function, and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index, and occupational exposures). Both lower education and income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively). Conclusion Low SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes. PMID:19854747
monitoring, the monitoring system consists of several design elements with defined interfaces. The raw monitoring signals are generated by a sensor with...is directly connected or integrated in the structure or repair. In Figure 2.3-1, the design element 1 is showing a surface mounted sensor. The...aircraft bus system. The monitoring data from the bus system are transferred to the next design element (element 4), where an onboard processing
Zotti, Marianne E; Williams, Amy M; Robertson, McKaylee; Horney, Jennifer; Hsia, Jason
We examined methodological issues in studies of disaster-related effects on reproductive health outcomes and fertility among women of reproductive age and infants in the United States (US). We conducted a systematic literature review of 1,635 articles and reports published in peer-reviewed journals or by the government from January 1981 through December 2010. We classified the studies using three exposure types: (1) physical exposure to toxicants; (2) psychological trauma; and (3) general exposure to disaster. Fifteen articles met our inclusion criteria concerning research focus and design. Overall studies pertained to eight different disasters, with most (n = 6) focused on the World Trade Center attack. Only one study examined pregnancy loss, i.e., occurrence of spontaneous abortions post-disaster. Most studies focused on associations between disaster and adverse birth outcomes, but two studies pertained only to post-disaster fertility while another two examined it in addition to adverse birth outcomes. In most studies disaster-affected populations were assumed to have experienced psychological trauma, but exposure to trauma was measured in only four studies. Furthermore, effects of both physical exposure to toxicants and psychological trauma on disaster-affected populations were examined in only one study. Effects on birth outcomes were not consistently demonstrated, and study methodologies varied widely. Even so, these studies suggest an association between disasters and reproductive health and highlight the need for further studies to clarify associations. We postulate that post-disaster surveillance among pregnant women could improve our understanding of effects of disaster on the reproductive health of US pregnant women.
Hincapie, A.; Warholak, T.
Background and Objective Healthcare professionals, industry and policy makers have identified Health Information Exchange (HIE) as a solution to improve patient safety and overall quality of care. The potential benefits of HIE on healthcare have fostered its implementation and adoption in the United States. However,there is a dearth of publications that demonstrate HIE effectiveness. The purpose of this review was to identify and describe evidence of HIE impact on healthcare outcomes. Methods A database search was conducted. The inclusion criteria included original investigations in English that focused on a HIE outcome evaluation. Two independent investigators reviewed the articles. A qualitative coding approach was used to analyze the data. Results Out of 207 abstracts retrieved, five articles met the inclusion criteria. Of these, 3 were randomized controlled trials, 1 involved retrospective review of data, and 1 was a prospective study. We found that HIE benefits on healthcare outcomes are still sparsely evaluated, and that among the measurements used to evaluate HIE healthcare utilization is the most widely used. Conclusions Outcomes evaluation is required to give healthcare providers and policy-makers evidence to incorporate in decision-making processes. This review showed a dearth of HIE outcomes data in the published peer reviewed literature so more research in this area is needed. Future HIE evaluations with different levels of interoperability should incorporate a framework that allows a detailed examination of HIE outcomes that are likely to positively affect care. PMID:23616891
Tang, S. S.; Riccardella, P. C.; Andrews, R. J.; Grady, J. E.; Mucciaradi, A. N.
An automated system was developed to monitor the health status of composites. It uses the vibration characteristics of composites to identify a component's damage condition. The vibration responses are characterized by a set of signal features defined in the time, frequency and spatial domains. The identification of these changes in the vibration characteristics corresponding to different health conditions was performed using pattern recognition principles. This allows efficient data reduction and interpretation of vast amounts of information. Test components were manufactured from isogrid panels to evaluate performance of the monitoring system. The components were damaged by impact to simulate different health conditions. Free vibration response was induced by a tap test on the test components. The monitoring system was trained using these free vibration responses to identify three different health conditions. They are undamaged vs. damaged, damage location and damage zone size. High reliability in identifying the correct component health condition was achieved by the monitoring system.
Bhuiya, Abbas; Hanifi, S M A; Mahmood, Shehrin Shaila
Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are often missing in many of the health agenda. The health programmes fail to address these important dimensions unless these are specifically included in the planning stage of a programme and are continually monitored for progress. This paper presents the situation of equity in health in Bangladesh, innovations in monitoring equity in the use of health services in general and by the poor in particular, and impact of targeted non-health interventions on health outcomes of the poor. It was argued that an equitable use of health services might also result in enhanced overall coverage of the services. The findings show that government services at the upazila level are used by the poor proportionately more than they are in the community, while at the private facilities, the situation is reverse. Commonly-used monitoring tools, at times, are not very useful for the programme managers to know how well they are doing in reaching the poor. Use of benefit-incidence ratio may provide a quick feedback to the health facility managers about their extent of serving the poor. Similarly, Lot Quality Assurance Sampling can be an easy-to-use tool for monitoring coverage at the community level requiring a very small sample size. Although health problems are biomedical phenomena, their solutions may include actions beyond the biomedical framework. Studies have shown that non-health interventions targeted towards the poor improve the use of health services and reduce mortality among children in poor households. The study on equity and health deals with various interlocking issues, and the examples and views presented in this paper intend to introduce their importance in designing and managing health and development programmes.
Kim, Insoo; Lai, Po-Hsiang; Lobo, Ryan; Gluckman, Bruce J
Wearable sensors give the users convenience in daily health monitoring, though several challenges in such sensor systems should be overcome. This paper discusses the challenges in wearable health monitoring sensors and solutions for multi-modal and multi-functional wrist-worn devices based on novel circuit design techniques to reject DC offset. This paper also presents a novel sophisticated algorithm to reject motion artifacts. The system has the capability to simultaneously acquire several biomedical signals (i.e. electrocardiogram, PPG, and body-electrode impedance). The system can also help patients who want to monitor their psychological signals to mitigate health risks.
Wray, N P; Ashton, C M; Kuykendall, D H; Petersen, N J; Souchek, J; Hollingsworth, J C
Health care payors and providers are increasingly monitoring hospital discharge data bases for adverse events as markers for quality of care. The principal criticisms of these analyses have focused on the impediments to risk adjustment posed by the incompleteness and inaccuracy of the data bases. However, efforts to address the inadequacies of the data bases will not correct deficiencies of the analytic process. These deficiencies arise from the application of one adverse outcome to all disease states. Instead, analysis should be restricted to comparisons of subgroups of patients in which a close fit exists between the quality of care for the disease state and the expected outcome. Furthermore, these disease-outcome pairs should be minimally subject to measurement error. The authors present a conceptual framework for developing such meaningful disease-outcome pairs, and using the hospital discharge data base of the Department of Veterans Affairs, show how the framework can be used to devise a monitoring strategy for re-admission.
Haskell, William L; Blair, Steven N; Hill, James O
This manuscript presents a brief summary of the substantial data supporting an inverse relationship between the amount of habitual physical activity performed and a variety of negative health outcomes throughout the lifespan. It points out that despite these data a large segment of the US population remain insufficiently active resulting in a high population attributable risk for chronic disease due to inactivity. The accumulated data support the need for more comprehensive health promoting physical activity policies and programs, especially for the economically and socially disadvantaged and medically underserved.
Stevenson, John F.; And Others
Application of computer technology to psychiatric outcome measurement offers the promise of coping with increasing demands for extensive patient interviews repeated longitudinally. Described is the development of a cost-effective multi-dimensional tracking device to monitor psychiatric functioning, building on a previous local computer interview…
Summary Objectives To provide a review of the current excellent research published in the field of Consumer Health Informatics. Method We searched MEDLINE® and WEB OF SCIENCE® databases for papers published in 2013 in relation with Consumer Health Informatics. The authors identified 16 candidate best papers, which were then reviewed by four reviewers. Results Five out of the 16 candidate papers were selected as best papers. One paper presents the key features of a system to automate the collection of web-based social media content for subsequent semantic annotation. This paper emphasizes the importance of mining social media to collect novel data from which new findings in drug abuse research were uncovered. The second paper presents a practical method to predict how a community structure would impact the spreading of information within the community. The third paper presents a method for improving the quality of online health communities. The fourth presents a new social network to allow the monitoring of the evolution of individuals’ health status and diagnostic deficiencies, difficulties or barriers in rehabilitation. The last paper reports on teenage patients’ perception on privacy and social media. Conclusion Selected papers not only show the value of using social media in the medical field but how to use these media to detect emergent diseases or risks, inform patients, promote disease prevention, and follow patients’ opinion on healthcare resources. PMID:25123742
Electronic multidimensional health assessment questionnaire (eMDHAQ): past, present and future of a proposed single data management system for clinical care, research, quality improvement, and monitoring of long-term outcomes.
the physician formatted as a medical record note of past medical history for entry into any EMR without typing or dictation, and a periodic "tickler" function to monitor long-term outcomes with minimal effort of the physician and staff. Nonetheless, clinical use of an eMDHAQ should be guided primarily not by the latest technology, but by value and feasibility in clinical care, the same principles that guided development of the pencil-and-paper MDHAQ/RAPID3.
Hevey, D; French, D P
People tend to be comparatively optimistic (i.e., believe that negative outcomes are less likely for themselves than for typical others) regarding their susceptibility to negative health outcomes. The present study investigates the extent to which perceptions of the severity of these health outcomes show similar comparative optimism. A student sample (study 1; N = 200) and a healthy non-student adult sample (study 2; N = 257) completed self-report measures of susceptibility, severity, worry, control and experience in relation to negative health outcomes. Participants in both studies demonstrated significant levels of comparative optimism for both perceived likelihood and severity of health outcomes. Comparative optimism concerning severity was very strongly associated (r = 0.85 to 0.89) with comparative optimism concerning susceptibility. In addition to being comparatively optimistic over their chances of experiencing negative health outcomes, people are also comparatively optimistic regarding how severe the health outcomes will be.
Russell-Minda, Elizabeth; Jutai, Jeffrey; Speechley, Mark; Bradley, Kaitlin; Chudyk, Anna; Petrella, Robert
Background The primary objective of this review was to determine the strength of evidence for the effectiveness of self-monitoring devices and technologies for individuals with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) based on specific health-related outcome measures. Self-monitoring devices included those that assist patients with managing diabetes and preventing cardiovascular complications (CVCs). A secondary objective was to explore issues of feasibility, usability, and compliance among patients and providers. Methods Study criteria included individuals ≥14 years and youth (7–14 years) with T1DM or T2DM, intervention with a self-monitoring device, assessment of clinical outcomes with the device, literature in English, and ≥10 participants. Relevant published literature was searched from 1985 to 2008. Randomized controlled trials and observational studies were included. Data were extracted for clinical outcomes, feasibility and compliance methods, and results. Selected studies were independently evaluated with a validated instrument for assessing methodological quality. Results Eighteen trials were selected. Predominant types of device interventions included self-monitoring of blood glucose, pedometers, and cell phone or wireless technologies. Feasibility and compliance were measured in the majority of studies. Conclusions Self-monitoring of blood glucose continues to be an effective tool for the management of diabetes. Wireless technologies can improve diabetes self-care, and pedometers are effective lifestyle modification tools. The results of this review indicate a need for additional controlled trial research on existing and novel technologies for diabetes self-monitoring, on health outcomes associated with diabetes and CVCs, and device feasibility and compliance. PMID:20144402
Thomas, M R; Stoyva, J; Rosenberg, S A; Kassner, C; Fryer, G E; Giese, A A; Dubovsky, S L
Managed care organizations increasingly tout clinical outcomes assessment as the mechanism by which we will ensure quality and compare providers. The authors report on their experience with a multisite inpatient outcomes monitoring project by comparing patients who accepted (N = 51), refused (N = 36), or were not asked (N = 110) to participate in the project. The patients who were asked to participate had significantly longer inpatient stays compared with the unasked group (11.2 vs 6.9 days). Patients who agreed to participate in the project were more likely to have a bipolar (43.1% vs 19.2%) or any affective disorder (94.1% vs 79.5%), and less likely to have a schizophrenic disorder (2.0% vs 11.6%) than the refused and unasked groups. The project participants also had higher 90-day readmit rates (27.5% vs 9.6%), more readmissions (0.51 vs 0.16), and more education (14.59 vs 13.51 years) than nonparticipating patients. In this preliminary study, patient-related variables were found to influence who the staff asked and who consented to participate in this clinical outcomes monitoring project. The authors distinguish clinical outcomes monitoring from treatment effectiveness research and discuss the need to develop methodologies that deal with nonrepresentative patient sampling and intersite variability in recruitment practices.
H. SOHN; C. FARRAR; M. FUGATE; J. CZARNECKI
Structural health monitoring is the implementation of a damage detection strategy for aerospace, civil and mechanical engineering infrastructure. Typical damage experienced by this infrastructure might be the development of fatigue cracks, degradation of structural connections, or bearing wear in rotating machinery. The goal of the research effort reported herein is to develop a robust and cost-effective monitoring system for welded beam-column connections in a moment resisting frame structure. The structural health monitoring solution for this application will integrate structural dynamics, wireless data acquisition, local actuation, micro-electromechanical systems (MEMs) technology, and statistical pattern recognition algorithms. This paper provides an example of the integrated approach to structural health monitoring being undertaken at Los Alamos National Laboratory and summarizes progress to date on various aspects of the technology development.
Scientific Monitoring Inc. was awarded a Phase I Small Business Innovation Research (SBIR) project by NASA's Dryden Flight Research Center to create a new, simplified health-monitoring approach for flight vehicles and flight equipment. The project developed a hybrid physical model concept that provided a structured approach to simplifying complex design models for use in health monitoring, allowing the output or performance of the equipment to be compared to what the design models predicted, so that deterioration or impending failure could be detected before there would be an impact on the equipment's operational capability. Based on the original modeling technology, Scientific Monitoring released I-Trend, a commercial health- and performance-monitoring software product named for its intelligent trending, diagnostics, and prognostics capabilities, as part of the company's complete ICEMS (Intelligent Condition-based Equipment Management System) suite of monitoring and advanced alerting software. I-Trend uses the hybrid physical model to better characterize the nature of health or performance alarms that result in "no fault found" false alarms. Additionally, the use of physical principles helps I-Trend identify problems sooner. I-Trend technology is currently in use in several commercial aviation programs, and the U.S. Air Force recently tapped Scientific Monitoring to develop next-generation engine health-management software for monitoring its fleet of jet engines. Scientific Monitoring has continued the original NASA work, this time under a Phase III SBIR contract with a joint NASA-Pratt & Whitney aviation security program on propulsion-controlled aircraft under missile-damaged aircraft conditions.
Jensen, Scott L. (Inventor); Drouant, George J. (Inventor)
An in situ health monitoring apparatus may include an exciter circuit that applies a pulse to a piezoelectric transducer and a data processing system that determines the piezoelectric transducer's dynamic response to the first pulse. The dynamic response can be used to evaluate the operating range, health, and as-mounted resonance frequency of the transducer, as well as the strength of a coupling between the transducer and a structure and the health of the structure.
Small air vehicles offer challenging power, weight, and volume constraints when considering implementation of system health monitoring technologies. In order to develop a testbed for monitoring the health and integrity of control surface servos and linkages, the Autonomous Aircraft Servo Health Monitoring system has been designed for small Uninhabited Aerial Vehicle (UAV) platforms to detect problematic behavior from servos and the air craft structures they control, This system will serve to verify the structural integrity of an aircraft's servos and linkages and thereby, through early detection of a problematic situation, minimize the chances of an aircraft accident. Embry-Riddle Aeronautical University's rotary-winged UAV has an Airborne Power management unit that is responsible for regulating, distributing, and monitoring the power supplied to the UAV's avionics. The current sensing technology utilized by the Airborne Power Management system is also the basis for the Servo Health system. The Servo Health system measures the current draw of the servos while the servos are in Motion in order to quantify the servo health. During a preflight check, deviations from a known baseline behavior can be logged and their causes found upon closer inspection of the aircraft. The erratic behavior nay include binding as a result of dirt buildup or backlash caused by looseness in the mechanical linkages. Moreover, the Servo Health system will allow elusive problems to be identified and preventative measures taken to avoid unnecessary hazardous conditions in small autonomous aircraft.
Shahriyar, Rifat; Bari, Md. Faizul; Kundu, Gourab; Ahamed, Sheikh Iqbal; Akbar, Md. Mostofa
Health monitoring is repeatedly mentioned as one of the main application areas for Pervasive computing. Mobile Health Care is the integration of mobile computing and health monitoring. It is the application of mobile computing technologies for improving communication among patients, physicians, and other health care workers. As mobile devices have become an inseparable part of our life it can integrate health care more seamlessly to our everyday life. It enables the delivery of accurate medical information anytime anywhere by means of mobile devices. Recent technological advances in sensors, low-power integrated circuits, and wireless communications have enabled the design of low-cost, miniature, lightweight and intelligent bio-sensor nodes. These nodes, capable of sensing, processing, and communicating one or more vital signs, can be seamlessly integrated into wireless personal or body area networks for mobile health monitoring. In this paper we present Intelligent Mobile Health Monitoring System (IMHMS), which can provide medical feedback to the patients through mobile devices based on the biomedical and environmental data collected by deployed sensors.
Buckner, Benjamin D.; Markov, Vladimir; Earthman, James C.
This non-destructive, optical fatigue detection and monitoring system relies on a small and unobtrusive light-scattering sensor that is installed on a component at the beginning of its life in order to periodically scan the component in situ. The method involves using a laser beam to scan the surface of the monitored component. The device scans a laser spot over a metal surface to which it is attached. As the laser beam scans the surface, disruptions in the surface cause increases in scattered light intensity. As the disruptions in the surface grow, they will cause the light to scatter more. Over time, the scattering intensities over the scanned line can be compared to detect changes in the metal surface to find cracks, crack precursors, or corrosion. This periodic monitoring of the surface can be used to indicate the degree of fatigue damage on a component and allow one to predict the remaining life and/or incipient mechanical failure of the monitored component. This wireless, compact device can operate for long periods under its own battery power and could one day use harvested power. The prototype device uses the popular open-source TinyOS operating system on an off-the-shelf Mica2 sensor mote, which allows wireless command and control through dynamically reconfigurable multi-node sensor networks. The small size and long life of this device could make it possible for the nodes to be installed and left in place over the course of years, and with wireless communication, data can be extracted from the nodes by operators without physical access to the devices. While a prototype has been demonstrated at the time of this reporting, further work is required in the system s development to take this technology into the field, especially to improve its power management and ruggedness. It should be possible to reduce the size and sensitivity as well. Establishment of better prognostic methods based on these data is also needed. The increase of surface roughness with
Steiner, S H; Cook, R J; Farewell, V T
Correlated binary data are encountered in many areas of medical research, system reliability and quality control. For monitoring failures rates in such situations, simultaneous bivariate cumulative sum (CUSUM) charts with the addition of secondary control limits are proposed. Using an approach based on a Markov chain model, the run length properties of such a monitoring scheme can be determined for sudden, or gradual, changes in the failure rates. The proposed control charts are easy to implement, and are shown to be very effective at detecting small changes in the rate of undesirable outcomes, especially when the changes are gradual. This procedure is illustrated using bivariate outcome data arising from a series of paediatric surgeries. The methodology is sufficiently general that it may be adapted for multivariate normal, binomial or Poisson responses.
Person, Suzette; Rungta, Neha
Software health management (SWHM) techniques complement the rigorous verification and validation processes that are applied to safety-critical systems prior to their deployment. These techniques are used to monitor deployed software in its execution environment, serving as the last line of defense against the effects of a critical fault. SWHM monitors use information from the specification and implementation of the monitored software to detect violations, predict possible failures, and help the system recover from faults. Changes to the monitored software, such as adding new functionality or fixing defects, therefore, have the potential to impact the correctness of both the monitored software and the SWHM monitor. In this work, we describe how the results of a software change impact analysis technique, Directed Incremental Symbolic Execution (DiSE), can be applied to monitored software to identify the potential impact of the changes on the SWHM monitor software. The results of DiSE can then be used by other analysis techniques, e.g., testing, debugging, to help preserve and improve the integrity of the SWHM monitor as the monitored software evolves.
Hoffman, Karen; Cole, Elaine; Playford, E. Diane; Grill, Eva; Soberg, Helene L.; Brohi, Karim
Importance Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. Objective To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. Data Sources MEDLINE, EMBASE, and CINAHL (from 2006–2012) were searched for studies evaluating health outcome after traumatic injuries. Study selection and data extraction Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. Results 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Conclusion Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care. PMID:25051353
The historical roots of IT-based monitoring in health care are described. Since the 1970ies monitoring has been spreading to more and more domains of health care and public health. Today one can observe monitoring of persons in many environments and regarding widely different questions. While these monitoring applications have been introduced ethical questions have been raised to balance the possible positive and negative outcomes of the approaches. Today IT-technology is entering many parts of our life - IT eventually became what had been coined already in the last century by IBM as "electronic dust" which one can find in every part of our environment. As most of these "dust-particles" are able to observe something one can also understand this development as a development into ubiquitous monitoring of nearly everything at any time. The foreseen ambient intelligence worlds are also spaces of ambient monitoring. This article describes this historical development. It emphasizes why ethical and data protection questions are an absolute must in most IT activities today.
Warren, James W.
The Augmented Fish Health Monitoring Project (Project) had its origin, in the mid-1980's, in perceived differences or inconsistencies in fish disease detection, diagnosis and control capabilities between the five conservation agencies rearing and releasing anadromous salmonids for fishery resource management and mitigation purposes in the Columbia River basin. Agency fish health programs varied greatly. Some agencies had personnel, equipment and funding to frequently monitor the health status of both juvenile production fish and adult salmon or steelhead trout at the time of spawning. Other agencies had much smaller programs and limited resources. These differences became better understood when the Pacific Northwest Fish Health Protection Committee developed its Model Fish Health Protection Program including recommendations for standard fish disease detection procedures. Even though some agencies could not immediately attain the goals set by the Model Program it was unanimously adopted as a desirable objective. Shortly thereafter, a multi-party planning group was assembled to help the Bonneville Power Administration (BPA) find ways to improve agency fish health programs and implement measures under the Fish and Wildlife Program of the Northwest Power Planning Council. The planning group assessed existing agency fish health monitoring capabilities, agreed upon satisfactory levels of capability to detect and identify important fish pathogens, and designed a five-year project establishing comparable fish health monitoring capability in each agency. It was strongly believed that such a project would improve the health and quality of the millions of hatchery fish released annually in the Columbia River basin and improve interagency communications and disease control coordination. During 1986 and 1987 BPA individually negotiated five separate contracts with the fishery agencies to standardize fish health monitoring, develop a common data collection and reporting format
Dyson, R. J. E.
The advanced propulsion monitoring system is described. The system was developed in order to fulfill a growing need for effective engine health monitoring. This need is generated by military requirements for increased performance and efficiency in more complex propulsion systems, while maintaining or improving the cost to operate. This program represents a vital technological step in the advancement of the state of the art for monitoring systems in terms of reliability, flexibility, accuracy, and provision of user oriented results. It draws heavily on the technology and control theory developed for modern, complex, electronically controlled engines and utilizes engine information which is a by-product of such a system.
Frankenstein, B.; Augustin, J.; Hentschel, D.; Schubert, F.; Köhler, B.; Meyendorf, N.
Future safety and maintenance strategies for industrial components and vehicles are based on combinations of monitoring systems that are permanently attached to or embedded in the structure, and periodic inspections. The latter belongs to conventional nondestructive evaluation (NDE) and can be enhanced or partially replaced by structural health monitoring systems. However, the main benefit of this technology for the future will consist of systems that can be differently designed based on improved safety philosophies, including continuous monitoring. This approach will increase the efficiency of inspection procedures at reduced inspection times. The Fraunhofer IZFP Dresden Branch has developed network nodes, miniaturized transmitter and receiver systems for active and passive acoustical techniques and sensor systems that can be attached to or embedded into components or structures. These systems have been used to demonstrate intelligent sensor networks for the monitoring of aerospace structures, railway systems, wind energy generators, piping system and other components. Material discontinuities and flaws have been detected and monitored during full scale fatigue testing. This paper will discuss opportunities and future trends in nondestructive evaluation and health monitoring based on new sensor principles and advanced microelectronics. It will outline various application examples of monitoring systems based on acoustic techniques and will indicate further needs for research and development.
The concept of privacy by design is becoming increasingly popular among regulators of information and communications technologies. This paper aims at analysing and discussing the ethical implications of this concept for personal health monitoring. I assume a privacy theory of restricted access and limited control. On the basis of this theory, I suggest a version of the concept of privacy by design that constitutes a middle road between what I call broad privacy by design and narrow privacy by design. The key feature of this approach is that it attempts to balance automated privacy protection and autonomously chosen privacy protection in a way that is context-sensitive. In personal health monitoring, this approach implies that in some contexts like medication assistance and monitoring of specific health parameters one single automatic option is legitimate, while in some other contexts, for example monitoring in which relatives are receivers of health-relevant information rather than health care professionals, a multi-choice approach stressing autonomy is warranted.
Cotton, Sian; Zebracki, Kathy; Rosenthal, Susan L; Tsevat, Joel; Drotar, Dennis
Religion/spirituality is important to adolescents, is usually considered a protective factor against a host of negative health outcomes, and is often included in adolescent health outcomes research. Previous reviews of the relationship among spirituality, religion, and adolescent health have been limited by scope, focusing primarily on distal aspects of religion/spirituality (e.g., attendance at religious services). We reviewed the literature examining proximal domains of religion/spirituality (e.g., spiritual coping) in adolescent health outcomes research. Constructs such as spiritual coping and religious decision-making were the ones most often studied and were generally positively associated with health outcomes. Measurement of proximal domains, associations of proximal domains with health outcomes, methodological issues and recommendations for future research were covered in this review.
protocol as part of enabling a network health status service that is tightly integrated with a remotely accessible wireless sensor network testbed, Kansei ...tation on a heterogenous WSN testbed, Kansei , comprising hundreds of Motes (of multiple types, specifically XSMs and TMoteSkys), Stargates, and PCs...predicted by the analysis. It is also necessary for enabling a health monitoring service that is a crucial and tightly integrated component of Kansei
Lam, T J G M; van Veersen, J C L; Sampimon, O C; Olde Riekerink, R G M
In this article an on-farm monitoring approach on udder health is presented. Monitoring of udder health consists of regular collection and analysis of data and of the regular evaluation of management practices. The ultimate goal is to manage critical control points in udder health management, such as hygiene, body condition, teat ends and treatments, in such a way that results (udder health parameters) are always optimal. Mastitis, however, is a multifactorial disease, and in real life it is not possible to fully prevent all mastitis problems. Therefore udder health data are also monitored with the goal to pick up deviations before they lead to (clinical) problems. By quantifying udder health data and management, a farm is approached as a business, with much attention for efficiency, thought over processes, clear agreements and goals, and including evaluation of processes and results. The whole approach starts with setting SMART (Specific, Measurable, Acceptable, Realistic, Time-bound) goals, followed by an action plan to realize these goals.
Santi, L. Michael
Monitoring the health of rocket engine systems is essentially a two-phase process. The acquisition phase involves sensing physical conditions at selected locations, converting physical inputs to electrical signals, conditioning the signals as appropriate to establish scale or filter interference, and recording results in a form that is easy to interpret. The inference phase involves analysis of results from the acquisition phase, comparison of analysis results to established health measures, and assessment of health indications. A variety of analytical tools may be employed in the inference phase of health monitoring. These tools can be separated into three broad categories: statistical, rule based, and model based. Statistical methods can provide excellent comparative measures of engine operating health. They require well-characterized data from an ensemble of "typical" engines, or "golden" data from a specific test assumed to define the operating norm in order to establish reliable comparative measures. Statistical methods are generally suitable for real-time health monitoring because they do not deal with the physical complexities of engine operation. The utility of statistical methods in rocket engine health monitoring is hindered by practical limits on the quantity and quality of available data. This is due to the difficulty and high cost of data acquisition, the limited number of available test engines, and the problem of simulating flight conditions in ground test facilities. In addition, statistical methods incur a penalty for disregarding flow complexity and are therefore limited in their ability to define performance shift causality. Rule based methods infer the health state of the engine system based on comparison of individual measurements or combinations of measurements with defined health norms or rules. This does not mean that rule based methods are necessarily simple. Although binary yes-no health assessment can sometimes be established by
Hudson, Laurel R; Hamar, G Brent; Orr, Patty; Johnson, Jeffrey H; Neftzger, Amy; Chung, Richard S; Williams, Myra L; Gandy, William M; Crawford, Albert; Clarke, Janice; Goldfarb, Neil I
This article reports on the outcomes associated with remote physiological monitoring (RPM) conducted as part of a heart failure disease management program. Claims data, medical records, data transmission records, and survey results for 91 individuals ages 50-92 (mean 74 years) successfully completing a heart failure RPM program were analyzed for time periods before, during, and after the monitoring intervention. The program was associated with significant reductions in per member per month costs and emergency room and hospital utilization. More detailed analyses were performed for specific gender and age subgroups. Participant surveys indicated high levels of satisfaction, and improvements in self-perceived health status, self-efficacy, and self-management behaviors. This study is the first to assess the impact of a RPM program following removal of the monitoring equipment. The results indicate that RPM, as a component of a traditional disease management program, has a sustained, beneficial effect on participants' lifestyles after the monitoring period has ended.
Grondel, S; Assaad, J; Delebarre, C; Moulin, E
This work was devoted to the development of a health monitoring system assigned to aerospace applications. Those applications concerned the detection of damaging impacts and debonding between stiffeners and composite skins, since they are the major causes of in-service damage of aircraft structures. The chosen health monitoring system was first based on the excitation and reception of Lamb waves along the structure by using thin piezoelectric transducers (active mode) and secondly on a continuous monitoring taking the same transducers used as acoustic emission sensors (passive mode). The composite specimen used was consistent with aircraft wingbox in terms of structure and loading. Several impacts with increasing energy increments were applied on the composite specimen. In passive mode, the study showed the ability of using the acoustic signature of an impact to detect possible damage. Moreover, the damage emergence in the case of damaging impact was confirmed in active mode. Further measurements during fatigue testing were performed. The aim was to demonstrate the ability of the system to monitor disbond growth between the stiffener and the composite skin. The sensitivity of the health monitoring system to the disbond growth was further demonstrated.
Trent, Ava M.
Provides a brief overview of the process of outcomes assessment and examples of its application in professional health science education. Provides a background for other articles in this issue describing ongoing activities in outcomes assessment in veterinary education and for programs considering developing a plan. Focuses on health professions…
Dutton, Mary Ann; Green, Bonnie L.; Kaltman, Stacey I.; Roesch, Darren M.; Zeffiro, Thomas A.; Krause, Elizabeth D.
The high prevalence of adverse health outcomes related to intimate partner violence (IPV) is well documented. Yet we know little about the pathways that lead to adverse health outcomes. Research concerning the psychological, biological, neurological, behavioral, and physiological alterations following exposure to IPV--many of which are associated…
Albanese, Mark A.; Dast, Laura
Over the past 30 years, problem-based learning (PBL) has become a major force in health professions education and even in the broader educational world. This article focuses on the outcomes that have been found from using PBL in the health professions based on at least 20 reviews done since 1990. The outcomes identified in these reviews are…
... 42 Public Health 4 2014-10-01 2014-10-01 false Participant health outcomes data. 460.202 Section 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) Data Collection, Record Maintenance, and Reporting § 460.202 Participant...
... 42 Public Health 4 2013-10-01 2013-10-01 false Participant health outcomes data. 460.202 Section 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) Data Collection, Record Maintenance, and Reporting § 460.202 Participant...
... 42 Public Health 4 2012-10-01 2012-10-01 false Participant health outcomes data. 460.202 Section 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) Data Collection, Record Maintenance, and Reporting § 460.202 Participant...
... 42 Public Health 4 2011-10-01 2011-10-01 false Participant health outcomes data. 460.202 Section 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) Data Collection, Record Maintenance, and Reporting § 460.202 Participant...
Majumder, Sumit; Mondal, Tapas; Deen, M Jamal
Life expectancy in most countries has been increasing continually over the several few decades thanks to significant improvements in medicine, public health, as well as personal and environmental hygiene. However, increased life expectancy combined with falling birth rates are expected to engender a large aging demographic in the near future that would impose significant burdens on the socio-economic structure of these countries. Therefore, it is essential to develop cost-effective, easy-to-use systems for the sake of elderly healthcare and well-being. Remote health monitoring, based on non-invasive and wearable sensors, actuators and modern communication and information technologies offers an efficient and cost-effective solution that allows the elderly to continue to live in their comfortable home environment instead of expensive healthcare facilities. These systems will also allow healthcare personnel to monitor important physiological signs of their patients in real time, assess health conditions and provide feedback from distant facilities. In this paper, we have presented and compared several low-cost and non-invasive health and activity monitoring systems that were reported in recent years. A survey on textile-based sensors that can potentially be used in wearable systems is also presented. Finally, compatibility of several communication technologies as well as future perspectives and research challenges in remote monitoring systems will be discussed.
Majumder, Sumit; Mondal, Tapas; Deen, M. Jamal
Life expectancy in most countries has been increasing continually over the several few decades thanks to significant improvements in medicine, public health, as well as personal and environmental hygiene. However, increased life expectancy combined with falling birth rates are expected to engender a large aging demographic in the near future that would impose significant burdens on the socio-economic structure of these countries. Therefore, it is essential to develop cost-effective, easy-to-use systems for the sake of elderly healthcare and well-being. Remote health monitoring, based on non-invasive and wearable sensors, actuators and modern communication and information technologies offers an efficient and cost-effective solution that allows the elderly to continue to live in their comfortable home environment instead of expensive healthcare facilities. These systems will also allow healthcare personnel to monitor important physiological signs of their patients in real time, assess health conditions and provide feedback from distant facilities. In this paper, we have presented and compared several low-cost and non-invasive health and activity monitoring systems that were reported in recent years. A survey on textile-based sensors that can potentially be used in wearable systems is also presented. Finally, compatibility of several communication technologies as well as future perspectives and research challenges in remote monitoring systems will be discussed. PMID:28085085
Flynn, Eric B.
Sensor networks drive decisions. Approach: Design networks to minimize the expected total cost (in a statistical sense, i.e. Bayes Risk) associated with making wrong decisions and with installing maintaining and running the sensor network itself. Search for optimal solutions using Monte-Carlo-Sampling-Adapted Genetic Algorithm. Applications include structural health monitoring and surveillance.
Liu, Pengxiang; Rao, Vittal S.
A structural health monitoring method for determination of damages in structural system is developed using state variable model. A time-domain identification method, the subspace system identification algorithm, is first applied to get a state-space model of the structure. The identified state-space model is then transformed to two special realization forms, for determination of the equation of motion of multiple- degrees-freedom of the structure. The parameters of equation of motion, mass and stiffness matrices or damage indices are used to determine the location and extent of the damage. This method is also extended for the health monitoring of substructural system. Unlike the health monitoring of the whole structure, the health monitoring of substructure uses localized parameter identification which only involves the measurement of substructure parameters. Using this method, the number of unknown parameters and the computational requirement for each identification can be significantly reduced, hence the accuracy of estimation can be improved. Illustrative cases studies using both numerical and experimental structures are presented.
Asada, H. Harry; Reisner, Andrew
Wearable sensors for continuous monitoring of vital signs for extended periods of weeks or months are expected to revolutionize healthcare services in the home and workplace as well as in hospitals and nursing homes. This invited paper describes recent research progress in wearable health monitoring technology and its clinical applications, with emphasis on blood pressure and circulatory monitoring. First, a finger ring-type wearable blood pressure sensor based on photo plethysmogram is presented. Technical issues, including motion artifact reduction, power saving, and wearability enhancement, will be addressed. Second, sensor fusion and sensor networking for integrating multiple sensors with diverse modalities will be discussed for comprehensive monitoring and diagnosis of health status. Unlike traditional snap-shot measurements, continuous monitoring with wearable sensors opens up the possibility to treat the physiological system as a dynamical process. This allows us to apply powerful system dynamics and control methodologies, such as adaptive filtering, single- and multi-channel system identification, active noise cancellation, and adaptive control, to the monitoring and treatment of highly complex physiological systems. A few clinical trials illustrate the potentials of the wearable sensor technology for future heath care services.
Garg, Sanjay; Kumar, Aditya; Mathews, H. Kirk; Rosenfeld, Taylor; Rybarik, Pavol; Viassolo, Daniel E.
Advanced model-based control architecture overcomes the limitations state-of-the-art engine control and provides the potential of virtual sensors, for example for thrust and stall margin. "Tracking filters" are used to adapt the control parameters to actual conditions and to individual engines. For health monitoring standalone monitoring units will be used for on-board analysis to determine the general engine health and detect and isolate sudden faults. Adaptive models open up the possibility of adapting the control logic to maintain desired performance in the presence of engine degradation or to accommodate any faults. Improved and new sensors are required to allow sensing at stations within the engine gas path that are currently not instrumented due in part to the harsh conditions including high operating temperatures and to allow additional monitoring of vibration, mass flows and energy properties, exhaust gas composition, and gas path debris. The environmental and performance requirements for these sensors are summarized.
Primack, Brian A.; Carroll, Mary V.; McNamara, Megan; Klem, Mary Lou; King, Brandy; Rich, Michael O.; Chan, Chun W.; Nayak, Smita
Context Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it may also be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes. Evidence acquisition Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source), sample data (e.g., number of study participants, demographics), intervention and control details, outcomes data, and quality measures were abstracted independently by two researchers. Evidence synthesis Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers. Conclusions There is potential promise for video games to improve
Lima, Lílian Moura de; Harter, Jenifer; Tomberg, Jéssica Oliveira; Vieira, Dagoberta Alves; Antunes, Muriel Lucero; Cardozo-Gonzales, Roxana Isabel
Objectives To monitor and assess the outcome of treatment for pulmonary tuberculosis in the tuberculosis control program in a prioritized municipality in Southern Brazil. Methods a quantitative study, descriptive, documentary, using records of people with tuberculosis in treatment between 2009-2013, the collection took place between June and July 2014 in the Tuberculosis Control Program. Descriptive statistics was used. Results The average number of consultations among the 629 patients was 7.2 per patient, with a mean interval of 1.03 months between visits. The average of smears was 2.7 tests per patient during the study period. The outcome of treatment was a cure rate of 87.8%, an abandonment rate of 8.3% and 6.5% of deaths. Conclusions despite the cure rate, abandonment is still high, thus, it is necessary to explore strategies for better adherence to treatment, and the commitment of the municipal administration in articulating monitoring in primary health care.
Hsieh, Yu-Chin Jerrie; Apostolopoulos, Yorghos; Hatzudis, Kiki; Sönmez, Sevil
The poor working conditions of Latina hotel cleaners render them particularly vulnerable to elevated occupational hazards that lead to adverse health outcomes. This article presents a comprehensive review of occupational risks (including physical, chemical, biological, and psychosocial risk factors) and health outcomes (including musculoskeletal disorders, respiratory diseases, dermatological diseases and allergies, and psychological disorders) for Latina hotel cleaners, within their unique sociocultural contexts. Preventive interventions for improving Latina hotel cleaners' work and health conditions are recommended.
Prevention of non-communicable diseases is more important than ever especially for the elderly to live a healthy life in the super-aged society of Japan. In 2000, the Ministry of Health, Labor and Welfare of Japan started Health Japan 21 as goal-oriented health promotion plan like Healthy People in the US and the Health of the Nation in the UK. Its second term started in 2013 with the aim of prolonging healthy life expectancy and reducing health inequalities. Improvement in both individuals' lifestyle and their social environment will help achieve the goal of the 2nd Health Japan 21. The National Health and Nutrition Survey (NHNS) is conducted every year to monitor the health and nutritional situation of the Japanese using a representative population. The NHNS data are useful for target setting and evaluation of the 2nd Health Japan 21, and the NHNS has shown an increasing trend of overweight (BMI≥25) only for male adults in the most recent 10 y. In contrast, the dietary intake survey of the NHNS shows a decreasing trend of total energy intake both in male and female adults aged 69 y old or younger, and the trend for physical activity is not well known. Thus, we need further investigations on the causes of the obesity trend in Japan.
Pentaris, F. P.; Makris, J. P.; Stonham, J.; Vallianatos, F.
Monitoring the structural state of a building is essential for the safety of the people who work, live, visit or just use it as well as for the civil protection of urban areas. Many factors can affect the state of the health of a structure, namely man made, like mistakes in the construction, traffic, heavy loads on the structures, explosions, environmental impacts like wind loads, humidity, chemical reactions, temperature changes and saltiness, and natural hazards like earthquakes and landslides. Monitoring the health of a structure provides the ability to anticipate structural failures and secure the safe use of buildings especially those of public services. This work reviews the state of the art and the challenges of a wireless Structural Health Monitoring (WiSHM). Literature review reveals that although there is significant evolution in wireless structural health monitoring, in many cases, monitoring by itself is not enough to predict when a structure becomes inappropriate and/or unsafe for use, and the damage or low durability of a structure cannot be revealed (Chintalapudi, et al., 2006; Ramos, Aguilar, & Lourenço, 2011). Several features and specifications of WiSHM like wireless sensor networking, reliability and autonomy of sensors, algorithms of data transmission and analysis should still be evolved and improved in order to increase the predictive effectiveness of the SHM (Jinping Ou & Hui Li, 2010; Lu & Loh, 2010) . Acknowledgments This work was supported in part by the ARCHEMEDES III Program of the Ministry of Education of Greece and the European Union in the framework of the project entitled «Interdisciplinary Multi-Scale Research of Earthquake Physics and Seismotectonics at the front of the Hellenic Arc (IMPACT-ARC) ».
... HUMAN SERVICES Centers for Disease Control and Prevention Emergency Responder Health Monitoring and... responder safety and health by monitoring and conducting surveillance of their health and safety during the... of a response. The proposed system is referred to as the ``Emergency Responder Health Monitoring...
Ashwear, Nasseradeen; Eriksson, Anders
Tensegrities are assembly structures, getting their equilibrium from the interaction between tension in cables and compression in bars. During their service life, slacking in their cables and nearness to buckling in their bars need to be monitored to avoid a sudden collapse. This paper discusses how to design the tensegrities to make them feasible for vibrational health monitoring methods. Four topics are discussed; suitable finite elements formulation, pre-measurements analysis to find the locations of excitation and sensors for the interesting modes, the effects from some environmental conditions, and the pre-understanding of the effects from different slacking scenarios.
Iverson, David L.
Model-based reasoning is a powerful method for performing system monitoring and diagnosis. Building models for model-based reasoning is often a difficult and time consuming process. The Inductive Monitoring System (IMS) software was developed to provide a technique to automatically produce health monitoring knowledge bases for systems that are either difficult to model (simulate) with a computer or which require computer models that are too complex to use for real time monitoring. IMS processes nominal data sets collected either directly from the system or from simulations to build a knowledge base that can be used to detect anomalous behavior in the system. Machine learning and data mining techniques are used to characterize typical system behavior by extracting general classes of nominal data from archived data sets. In particular, a clustering algorithm forms groups of nominal values for sets of related parameters. This establishes constraints on those parameter values that should hold during nominal operation. During monitoring, IMS provides a statistically weighted measure of the deviation of current system behavior from the established normal baseline. If the deviation increases beyond the expected level, an anomaly is suspected, prompting further investigation by an operator or automated system. IMS has shown potential to be an effective, low cost technique to produce system monitoring capability for a variety of applications. We describe the training and system health monitoring techniques of IMS. We also present the application of IMS to a data set from the Space Shuttle Columbia STS-107 flight. IMS was able to detect an anomaly in the launch telemetry shortly after a foam impact damaged Columbia's thermal protection system.
Sharick, Joe T.; Gil, Daniel A.; Choma, Michael A.; Skala, Melissa C.
The health of the tracheal mucosa and submucosa is a vital yet poorly understood component of critical care medicine, and a minimally-invasive method is needed to monitor tracheal health in patients. Of particular interest are the ciliated cells of the tracheal epithelium that move mucus away from the lungs and prevent respiratory infection. Optical metabolic imaging (OMI) allows cellular-level measurement of metabolism, and is a compelling method for assessing tracheal health because ciliary motor proteins require ATP to function. In this pilot study, we apply multiphoton imaging of the fluorescence intensities and lifetimes of metabolic co-enzymes NAD(P)H and FAD to the mucosa and submucosa of ex vivo mouse trachea. We demonstrate the feasibility and potential diagnostic utility of these measurements for assessing tracheal health and pathophysiology at the single-cell level.
An exploratory study examined the relationship between individual, family, and work variables and working mothers' health. The study also investigated the relationship between health management strategies and health. A cross-sectional survey design was used to gather data from 85 women who were married, employed 20 hours a week or more, and had…
Dimsdale, Joel E
Health care systems want quality but struggle to find the right tools because, typically, they track quality in only one or two ways. Because of the complexity of health care, high quality will emerge only when health care systems employ multiple approaches, including, importantly, patient-reported outcome perspectives. Sustained changes are unlikely to emerge in the absence of such multipronged interventions. PMID:28123314
... 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE... outcomes data. (a) A PACE organization must establish and maintain a health information system...
Chen, Robert H.; Ng, Hok K.; Speyer, Jason L.; Guntur, Lokeshkumar S.; Carpenter, Russell
A health monitoring system based on analytical redundancy is developed for satellites on elliptical orbits. First, the dynamics of the satellite including orbital mechanics and attitude dynamics is modelled as a periodic system. Then, periodic fault detection filters are designed to detect and identify the satellite's actuator and sensor faults. In addition, parity equations are constructed using the algebraic redundant relationship among the actuators and sensors. Furthermore, a residual processor is designed to generate the probability of each of the actuator and sensor faults by using a sequential probability test. Finally, the health monitoring system, consisting of periodic fault detection lters, parity equations and residual processor, is evaluated in the simulation in the presence of disturbances and uncertainty.
Walter, P. B.; Edwards, R. M.
An integrated control and health monitoring architecture is being developed for the Pratt & Whitney XNR2000 nuclear rocket. Current work includes further development of the dynamic simulation modeling and the identification and configuration of low level controllers to give desirable performance for the various operating modes and faulted conditions. Artificial intelligence and knowledge processing technologies need to be investigated and applied in the development of an intelligent supervisory controller module for this control architecture.
Qing, Xinlin; Kuo, Fuo
A generic design for a type of flexible structural-health-monitoring sheet with multiple sensor/actuator types and a method of manufacturing such sheets has been developed. A sheet of this type contains an array of sensing and/or actuation elements, associated wires, and any other associated circuit elements incorporated into various flexible layers on a thin, flexible substrate. The sheet can be affixed to a structure so that the array of sensing and/or actuation elements can be used to analyze the structure in accordance with structural-health-monitoring techniques. Alternatively, the sheet can be designed to be incorporated into the body of the structure, especially if the structure is made of a composite material. Customarily, structural-health monitoring is accomplished by use of sensors and actuators arrayed at various locations on a structure. In contrast, a sheet of the present type can contain an entire sensor/actuator array, making it unnecessary to install each sensor and actuator individually on or in a structure. Sensors of different types such as piezoelectric and fiber-optic can be embedded in the sheet to form a hybrid sensor network. Similarly, the traces for electric communication can be deposited on one or two layers as required, and an entirely separate layer can be employed to shield the sensor elements and traces.
Perotti, José; Lucena, Angel; Burns, Bradley
The health of electromechanical systems (actuators) and specifically of solenoid valves is a primary concern at Kennedy Space Center (KSC). These systems control the storage and transfer of such commodities as liquid hydrogen. The potential for the failure of electromechanical systems to delay a scheduled launch or to cause personnel injury requires continual maintenance and testing of the systems to ensure their readiness. Monitoring devices need to be incorporated into these systems to verify the health and performance of the valves during real operating conditions. It is very advantageous to detect degradation and/or potential problems before they happen. This feature will not only provide safer operation but save the cost of unnecessary maintenance and inspections. Solenoid valve status indicators are often based upon microswitches that work by physically contacting a valve's poppet assembly. All of the physical contact and movement tends to be very unreliable and is subject to wear and tear of the assemblies, friction, breakage of the switch, and even leakage of the fluid (gas or liquid) in the valve. The NASA Instrumentation Branch, together with its contractor, ASRC Aerospace, has developed a solenoid valve smart current signature sensor that monitors valves in a noninvasive mode. The smart system monitors specific electrical parameters of the solenoid valves and detects and predicts the performance and health of the device. The information obtained from the electrical signatures of these valves points to not only electrical components failures in the valves but also mechanical failures and/or degradations.
Manly, Jennifer J
A crucial issue for health researchers is how to measure health and health-related behaviors across racial/ethnic groups. This commentary outlines an approach that involves the deconstruction of race/ethnicity, which clarifies the independent influences of acculturation, quality of education, socioeconomic class, and racial socialization on outcomes of interest. Research on the influence of these variables on health outcomes in general, and cognitive test performance specifically, is presented. This research indicates that when variables such as quality of education, wealth, and perceived racism are taken into account, the effect of race/ethnicity on health outcomes is greatly reduced. In other words, race/ethnicity serves as a proxy for these more meaningful variables, and explicit measurement of these constructs will improve research of health within majority and minority ethnic groups.
The purpose of this study was to determine the use and perceived usefulness of outcomes assessment methods in health information management programs. Additional characteristics of the outcomes assessment practices were recognized. The findings were evaluated for significant differences in results based on age of the program, type of institution,…
Taddei, Graziano; Marrelli, Alfonso; Trovarelli, Donatella; Ricci, Alessandro; Galzio, Renato J.
Objective: Even though advances in surgical techniques have improved facial nerve outcomes, functional preservation is still an issue because injury to the facial nerve has significant physical and psychological consequences for the patient. We retrospectively review our data in VS surgery to compare the facial outcome in intraoperative facial monitored versus not-monitored patients. Materials and Methods: 51 consecutive patients with unilateral vestibular schwannoma in the period from 2005 to 2010 were treated in our Institution. In according to the type of neurophysiological tool used during surgical procedures, two patients groups were identified: Group 1 (facial stimulator only) and Group 2 (stimulator and facial monitoring). Statistical comparison of the two groups was made with the t- test, and facial function results were evaluated with the Fisher's exact test. Results: In the Group 1, of the 22 patients with anatomically preserved facial nerves, 3 (13.6%) showed excellent facial nerve function, 14 (63.6%) showed intermediate function, and 5 (22.7%) showed poor function. In the Group 2, all the 27 patients got anatomically preserved facial nerves, and 18 (66.7%) showed excellent facial nerve function, 9 (33.3%) showed intermediate function, and no one showed poor function. Conclusions: We found that retrosigmoid approach associated with continuous EMG facial monitoring combined with the use of bipolar stimulation is a safe and effective treatment for vestibular schwannomas. PMID:27695545
Adolescence has long been regarded as a transition from childhood to adulthood. More recently it is become a concern of those wishing to avoid adverse health outcomes during middle and late adulthood. Most of this effort has been focused on behavioural risk factors such as tobacco and excessive alcohol use, physical exercise habits, dietary habits, as well as sexual and injury-related behaviours. The concern is that these habits are established during adolescence, continue into adulthood, and come to constitute ongoing risk factors for adverse health outcomes during middle and late adulthood. There is good reason to criticize this approach. These behaviours are themselves shaped by adolescents' living and working conditions and even then constitute a small proportion of the variance predicting adverse health outcomes during adulthood. More complex models of how adolescence serves as a gateway to adult health outcomes are presented. These are the socio-environmental, public policy, and political economy approaches. The argument is made that adolescence is a period during which public policy plays an especially important role in predicting future health outcomes. Yet, these public policies influence health all across the life span with adolescence providing only one of many important periods during which public policy shapes health prospects during middle and later adulthood. Ultimately one should consider a range of approaches ranging from the behavioural to the political to examine how adolescence serves as a gateway towards future adult prospects. An Adolescent Gateway Towards Adult Health Model is provided to assist in this process.
Riley, William T.; Pilkonis, Paul; Cella, David
Background The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institutes of Health initiative to develop item banks measuring patient-reported outcomes (PROs) and to create and make available a computerized adaptive testing system (CAT) that allows for efficient and precise assessment of PROs in clinical research and practice. Aims of the Study Based on the presentation from a symposium on “Evidence-based Outcomes in Psychiatry: Updates on Measurement Using Patient-Reported Outcomes (PRO)” at the 2011 American Psychiatry Association Convention, this paper provides an overview of PROMIS and its application to mental health research. Methods The PROMIS methodology for item bank development and testing is described, with a focus on the implications of this work for mental health research. Results Utilizing qualitative item review and state-of-the-art applications of item response theory (IRT), PROMIS investigators have developed, tested, and released item banks measuring physical, mental, and social health components. Ongoing efforts continue to add new item banks and further validate existing banks. Discussion PROMIS provides item banks measuring several domains of interest to mental health researchers including emotional distress, social function, and sleep. PROMIS methodology also provides a rigorous standard for the development of new mental health measures. Implications for Health Care Provision Web-based CAT or administration of short forms derived from PROMIS item banks provide efficient and precise dimensional estimates of clinical outcomes that can be utilized to monitor patient progress and assess quality improvement. Implications for Future Research Use of the dimensional PROMIS metrics (and co-calibration of the PROMIS item banks with existing PROs) will allow comparisons of mental health and related health outcomes across disorders and studies. PMID:22345362
Munns, Thomas E.; Kent, Renee M.; Bartolini, Antony; Gause, Charles B.; Borinski, Jason W.; Dietz, Jason; Elster, Jennifer L.; Boyd, Clark; Vicari, Larry; Ray, Asok; Cooper, E. G. (Technical Monitor)
This study established requirements for structural health monitoring systems, identified and characterized a prototype structural sensor system, developed sensor interpretation algorithms, and demonstrated the sensor systems on operationally realistic test articles. Fiber-optic corrosion sensors (i.e., moisture and metal ion sensors) and low-cycle fatigue sensors (i.e., strain and acoustic emission sensors) were evaluated to validate their suitability for monitoring aging degradation; characterize the sensor performance in aircraft environments; and demonstrate placement processes and multiplexing schemes. In addition, a unique micromachined multimeasure and sensor concept was developed and demonstrated. The results show that structural degradation of aircraft materials could be effectively detected and characterized using available and emerging sensors. A key component of the structural health monitoring capability is the ability to interpret the information provided by sensor system in order to characterize the structural condition. Novel deterministic and stochastic fatigue damage development and growth models were developed for this program. These models enable real time characterization and assessment of structural fatigue damage.
Robison, Kevin E.; Watkins, Steve E.; Nicholas, James; Chandrashekhara, K.; Rovey, Joshua L.
A health monitoring approach is investigated for hydrokinetic turbine blade applications. In-service monitoring is critical due to the difficult environment for blade inspection and the cost of inspection downtime. Composite blade designs have advantages that include long life in marine environments and great control over mechanical properties. Experimental strain characteristics are determined for static loads and free-vibration loads. These experiments are designed to simulate the dynamic characteristics of hydrokinetic turbine blades. Carbon/epoxy symmetric composite laminates are manufactured using an autoclave process. Four-layer composite beams, eight-layer composite beams, and two-dimensional eight-layer composite blades are instrumented for strain. Experimental results for strain measurements from electrical resistance gages are validated with theoretical characteristics obtained from in-house finite-element analysis for all sample cases. These preliminary tests on the composite samples show good correlation between experimental and finite-element strain results. A health monitoring system is proposed in which damage to a composite structure, e.g. delamination and fiber breakage, causes changes in the strain signature behavior. The system is based on embedded strain sensors and embedded motes in which strain information is demodulated for wireless transmission.
Russ, Christiana M.; Tran, Tony; Silverman, Melanie; Palfrey, Judith
Background and Objectives: To identify the effects of global health electives over a decade in a pediatric residency program. Methods: This was an anonymous email survey of the Boston Combined Residency alumni funded for global health electives from 2002 to 2011. A test for trend in binomial proportions and logistic regression were used to document associations between elective and participant characteristics and the effects of the electives. Qualitative data were also analyzed. Results: Of the 104 alumni with available email addresses, 69 (66%) responded, describing 94 electives. Elective products included 27 curricula developed, 11 conference presentations, and 7 academic publications. Thirty-two (46%) alumni continued global health work. Previous experience, previous travel to the site, number of global electives, and cumulative global elective time were associated with postresidency work in global health or with the underserved. Conclusions: Resident global electives resulted in significant scholarship and teaching and contributed to long-term career trajectories. PMID:28229096
Featherston, Carol A.; Holford, Karen M.; Pullin, Rhys; Lees, Jonathan; Eaton, Mark; Pearson, Matthew
Combining advanced sensor technologies, with optimised data acquisition and diagnostic and prognostic capability, structural health monitoring (SHM) systems provide real-time assessment of the integrity of bridges, buildings, aircraft, wind turbines, oil pipelines and ships, leading to improved safety and reliability and reduced inspection and maintenance costs. The implementation of power harvesting, using energy scavenged from ambient sources such as thermal gradients and sources of vibration in conjunction with wireless transmission enables truly autonomous systems, reducing the need for batteries and associated maintenance in often inaccessible locations, alongside bulky and expensive wiring looms. The design and implementation of such a system however presents numerous challenges. A suitable energy source or multiple sources capable of meeting the power requirements of the system, over the entire monitoring period, in a location close to the sensor must be identified. Efficient power management techniques must be used to condition the power and deliver it, as required, to enable appropriate measurements to be taken. Energy storage may be necessary, to match a continuously changing supply and demand for a range of different monitoring states including sleep, record and transmit. An appropriate monitoring technique, capable of detecting, locating and characterising damage and delivering reliable information, whilst minimising power consumption, must be selected. Finally a wireless protocol capable of transmitting the levels of information generated at the rate needed in the required operating environment must be chosen. This paper considers solutions to some of these challenges, and in particular examines SHM in the context of the aircraft environment.
Since 1986 Washington Department of Fisheries (WDF) has participated in the Columbia Basin Augmented Fish Health Monitoring Project, funded by Bonneville Power Administration (BPA). This interagency project was developed to provide a standardized level of fish health information from all Agencies rearing fish in the Columbia Basin. Agencies involved in the project are: WDF, Washington Department of Wildlife, Oregon Fish and Wildlife, Idaho Fish and Game, and the US Fish and Wildlife Service. WDF has actively participated in this project, and completed its third year of fish health monitoring, data collection and pathogen inspection during 1989. This report will present data collected from January 1, 1989 to December 31, 1989 and will compare sampling results from screening at spawning for viral pathogens and bacterial kidney disease (BKD), and evaluation of causes of pre-spawning loss. The juvenile analysis will include pre-release examination results, mid-term rearing exam results and evaluation of the Organosomatic Analysis completed on stocks. 2 refs., 4 figs., 15 tabs.
Washington Department of Fisheries has divided the sampling and data collection into three major groups: adult analysis, juvenile analysis and database development. The adult analysis done at spawning includes screening for viral pathogens and Bacterial Kidney Disease (BKD). Pre-spawning mortalities are sampled for the presence of bacterial pathogens and parasites to determine causes of pre-spawning loss. Juvenile analysis involves monthly monitoring; pre-release examinations for viral pathogens, BKD and, where appropriate, whirling disease (M. cerebralis); completion of the Organosomatic analysis on four index stocks, and midterm exams on yearling groups for BKD and M. cerebralis. Database development required constructing fish health monitoring forms and a computer based data entry and retrieval system. We have completed a full year of sampling and data collection, January, 1987 to January, 1988. This report will present and analyze this information.
Park, Gyuhae; Inman, Daniel J
This paper presents an overview and recent advances in impedance-based structural health monitoring. The basic principle behind this technique is to apply high-frequency structural excitations (typically greater than 30kHz) through surface-bonded piezoelectric transducers, and measure the impedance of structures by monitoring the current and voltage applied to the piezoelectric transducers. Changes in impedance indicate changes in the structure, which in turn can indicate that damage has occurred. An experimental study is presented to demonstrate how this technique can be used to detect structural damage in real time. Signal processing methods that address damage classifications and data compression issues associated with the use of the impedance methods are also summarized. Finally, a modified frequency-domain autoregressive model with exogenous inputs (ARX) is described. The frequency-domain ARX model, constructed by measured impedance data, is used to diagnose structural damage with levels of statistical confidence.
Pfleiderer, Klaus; Stoessel, Rainer; Busse, Gerhard
Advanced high performance materials and components such as CFRP, GFRP and Smart Structures require improved testing techniques. The first part of our contribution deals with nonlinear vibrometry as a defect selective non-destructive testing method. This method uses higher harmonics (which are generated only at defects) to locate the defect by scanning across the surface of the sample with a laser interferometer. For input coupling of the elastic wave both an external (like ultrasound welding converters) or internal (integrated piezo actuators) excitation source can be used. The external detection tools are a microphone or a scanning laser vibrometer. With this technique, we characterized Smart Structures made of aerospace materials and composites with embedded piezoelectric actuators. The next part is about health monitoring techniques and diagnostics where integrated elements are used for excitation and detection. Thus, we monitored the transfer function over a large frequency spectrum and especially its changes caused e.g. by defects. Changes in the properties of structures by fatigue, impacts, and thermoplasticity have been successfully observed. Also the changes in reinforced plastics under tensile stress have been monitored. The results were correlated with destructive measurements. For health monitoring we also present the impedance analysis of embedded piezo ceramic sensors. A defect causes changes in the modal response of the hole structure and that effect can be detected using the phase angle of the electric impedance of the piezo element. Additionally some types of defects cause a non-linear behavior of the structure which was verified by extracting higher harmonics as a reaction to sinusoidal single frequency excitation.
Richards, W Lance; Madaras, Eric I.; Prosser, William H.; Studor, George
This presentation provides examples of research and development that has recently or is currently being conducted at NASA, with a special emphasis on the application of structural health monitoring (SHM) of aerospace vehicles. SHM applications on several vehicle programs are highlighted, including Space Shuttle Orbiter, the International Space Station, Uninhabited Aerial Vehicles, and Expendable Launch Vehicles. Examples of current and previous work are presented in the following categories: acoustic emission impact detection, multi-parameter fiber optic strain-based sensing, wireless sensor system development, and distributed leak detection.
Richards, W Lance; Madaras, Eric I.; Prosser, William H.; Studor, George
This presentation provides examples of research and development that has recently or is currently being conducted at NASA, with a special emphasis on the application of structural health monitoring (SHM) of aerospace vehicles. SHM applications on several vehicle programs are highlighted, including Space Shuttle Orbiter, International Space Station, Uninhabited Aerial Vehicles, and Expandable Launch Vehicles. Examples of current and previous work are presented in the following categories: acoustic emission impact detection, multi-parameter fiber optic strain-based sensing, wireless sensor system development, and distributed leak detection.
Watkins, Jr., Kenneth S.; Morris, Shelby J.
An in-situ method for monitoring the health of a composite component utilizes a condition sensor made of electrically conductive particles dispersed in a polymeric matrix. The sensor is bonded or otherwise formed on the matrix surface of the composite material. Age-related shrinkage of the sensor matrix results in a decrease in the resistivity of the condition sensor. Correlation of measured sensor resistivity with data from aged specimens allows indirect determination of mechanical damage and remaining age of the composite component.
Mancoske, Ronald J.; Lewis, Marva L.; Bowers-Stephens, Cheryll; Ford, Almarie
This study describes the relationships between clients' perception of cultural competency of mental health providers and service outcomes. A study was conducted of a public children's mental health program that used a community-based, systems of care approach. Data from a subsample (N = 111) of families with youths (average age 12.3) and primarily…
Abell, M T; Doemeny, L J
To monitor the performance of occupational health laboratories analyzing workplace air, the American Industrial Hygiene Association (AIHA), with assistance from the National Institute for Occupational Safety and Health, has established four national quality assurance programs. They are the Proficiency Analytical Testing (PAT) Program, the AIHA Laboratory Accreditation Program, the Asbestos Analysts Registry, and the Bulk Quality Assurance Program. This paper focuses on the PAT program, a quality audit program that provides samples of asbestos, silica, metals, and solvents to laboratories quarterly. PAT data for asbestos, silica, and lead were examined for trends in precision. Simple graphs of coefficient of variation during the 18-yr history of the program provide evidence of improved agreement among laboratories performing these analyses. The improvement took place in spite of growth in the number of laboratories and decreases in the levels being analyzed. The improvement is attributed to several factors, including improved analytical methods and the very existence of the PAT and AIHA Laboratory Accreditation Programs.
Rush, Brian; Martin, Garth; Corea, Larry; Rotondi, Nooshin Khobzi
We present an example of a collaborative process designed to review models of outcome monitoring for substance abuse services, with a view to assessing the feasibility of different approaches in Ontario, Canada. A conceptual framework that describes the parameters of an outcome monitoring system and four models of outcome monitoring were identified. Consultations were held with stakeholders (managers, directors, researchers, clinicians, and governmental representatives) about the types of information they would like to obtain from an outcome monitoring system. Our process is useful as a model for collaborative research with respect to performance measurement. The study's implications and limitations are noted.
Kuchma, V R
Analysis of population health is necessary for sanitary and epidemiological service. Monitoring scheme is recommended for population health investigation. It includes: measuring--analysis--description--modelling--optimization. Computer system should be developed for analysis of health data.
This report documents the progress of Idaho Department of Fish and Game`s fish health monitoring during the past five years and will serve as a completion report for the Augmented Fish Health Monitoring Project. Anadromous fish at twelve IDFG facilities were monitored for various pathogens and organosomatic analyses were performed to anadromous fish prior to their release. A fish disease database has been developed and data is presently being entered. Alternate funding has been secured to continue fish health monitoring.
Background The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its
Warren, James W.
Augmented Fish Health Monitoring Contract AI79-87BP35585 was implemented on July 20, 1987. Second year activities focused on full implementation of disease surveillance activities and histopathological support services to participating state agencies. Persistent and sometimes severe disease losses were caused by infectious hematopoietic necrosis (IHN) in summer steelhead trout in Idaho and in spring chinook salmon at hatcheries on the lower Columbia River. Diagnostic capability was enhanced by the installation, for field use, of enzyme-linked immunosorbent assay (ELISA) technology at the Dworshak Fish Health Center for the detection and assay of bacterial kidney disease and by a dot-blot'' training session for virus identification at the Lower Columbia Fish Health Center. Complete diagnostic and inspection services were provided to 13 Columbia River basin National Fish hatcheries. Case history data was fully documented in a computerized data base for storage and analysis. This report briefly describes work being done to meet contract requirements for fish disease surveillance at Service facilities in the Columbia River basin. It also summarizes the health status of fish reared at those hatcheries and provides a summary of case history data for calendar year 1988. 2 refs., 4 tabs.
Shanahan, Danielle F; Lin, Brenda B; Bush, Robert; Gaston, Kevin J; Dean, Julie H; Barber, Elizabeth; Fuller, Richard A
There is mounting concern for the health of urban populations as cities expand at an unprecedented rate. Urban green spaces provide settings for a remarkable range of physical and mental health benefits, and pioneering health policy is recognizing nature as a cost-effective tool for planning healthy cities. Despite this, limited information on how specific elements of nature deliver health outcomes restricts its use for enhancing population health. We articulate a framework for identifying direct and indirect causal pathways through which nature delivers health benefits, and highlight current evidence. We see a need for a bold new research agenda founded on testing causality that transcends disciplinary boundaries between ecology and health. This will lead to cost-effective and tailored solutions that could enhance population health and reduce health inequalities.
Bush, Robert; Gaston, Kevin J.; Dean, Julie H.; Barber, Elizabeth; Fuller, Richard A.
There is mounting concern for the health of urban populations as cities expand at an unprecedented rate. Urban green spaces provide settings for a remarkable range of physical and mental health benefits, and pioneering health policy is recognizing nature as a cost-effective tool for planning healthy cities. Despite this, limited information on how specific elements of nature deliver health outcomes restricts its use for enhancing population health. We articulate a framework for identifying direct and indirect causal pathways through which nature delivers health benefits, and highlight current evidence. We see a need for a bold new research agenda founded on testing causality that transcends disciplinary boundaries between ecology and health. This will lead to cost-effective and tailored solutions that could enhance population health and reduce health inequalities. PMID:25602866
Bierman, A S; Lawrence, W F; Haffer, S C; Clancy, C M
OBJECTIVE: the Medicare Health Outcomes Survey (HOS), a new quality measure in the Health Plan Employer Data and Information Set, is designed to assess physical and mental functional health outcomes of Medicare beneficiaries enrolled in Medicare+Choice organizations. We discuss the rationale for the HOS measure together with methodologic challenges in its use and interpretation, using descriptive data from the baseline Medicare HOS to illustrate some of these challenges. DATA SOURCES/STUDY DESIGN: The 1999 Cohort 2 Medicare HOS baseline data were used for a cross-sectional descriptive analysis. A random sample of 1,000 beneficiaries from each health plan with a Medicare+Choice contract was surveyed (N = 156,842; 282 organizations included in these analyses) . PRINCIPAL FINDINGS: The HOS measure is designed to assess a previously unmeasured dimension of quality. Plan-level variation was seen across all baseline measures of sociodemographic characteristics and illness burden. At the individual level socioeconomic position as measured by educational attainment was strongly associated with functional status. The least educated beneficiaries had the highest burden of illness on all measures examined, and there was a consistent and significant gradient in health and functional status across all levels of education. In analyses stratified by race and ethnicity, socioeconomic gradients in f un ct ion persist ed. CONCLUSIONS Despite limitations, by focusing at t en t ion on the need to improve functional health out comes among elderly Medicare beneficiaries enrolled in Medicare+Choice, the HOS can serve as an important new tool to support efforts to improve health care quality. The HOS provides valuable information at the federal, state, and health plan levels that can be used to identify, prioritize, and evaluate quality improvement interventions and monitor progress for the program overall as well as for vulnerable subgroups. To interpret the HOS as a quality measure
Structural Health Monitoring (SHM) is a sought after concept that is expected to advance military maintenance programs, increase platform operational safety and reduce its life cycle cost. Such concept is further considered to constitute a major building block of any Integrated Health Management (IHM) capability. Since 65% to 80% of military assets' Life Cycle Cost (LCC) is devoted to operations and support (O&S), the aerospace industry and military sectors continue to look for opportunities to exploit SHM systems, capability and tools. Over the past several years, countless SHM concepts and technologies have emerged. Among those, fiber optic based systems were identified of significant potential. This paper introduces the elements of an SHM system and investigates key issues impeding the commercial implementation of fiber optic based SHM capability. In particular, this paper presents an experimental study of short gauge, intrinsic, spectrometric-based in-fiber Bragg grating sensors, for potential use as a component of an SHM system. Fiber optic Bragg grating sensors are evaluated against resistance strain gauges for strain monitoring, sensitivity, accuracy, reliability, and fatigue durability. Strain field disturbance is also investigated by "embedding" the sensors under a photoelastic coating in order to illustrate sensor intrusiveness in an embedded configuration.
Rumsey, Mark A.; Paquette, Joshua A.
As electric utility wind turbines increase in size, and correspondingly, increase in initial capital investment cost, there is an increasing need to monitor the health of the structure. Acquiring an early indication of structural or mechanical problems allows operators to better plan for maintenance, possibly operate the machine in a de-rated condition rather than taking the unit off-line, or in the case of an emergency, shut the machine down to avoid further damage. This paper describes several promising structural health monitoring (SHM) techniques that were recently exercised during a fatigue test of a 9 meter glass-epoxy and carbon-epoxy wind turbine blade. The SHM systems were implemented by teams from NASA Kennedy Space Center, Purdue University and Virginia Tech. A commercial off-the-shelf acoustic emission (AE) NDT system gathered blade AE data throughout the test. At a fatigue load cycle rate around 1.2 Hertz, and after more than 4,000,000 fatigue cycles, the blade was diagnostically and visibly failing at the out-board blade spar-cap termination point at 4.5 meters. For safety reasons, the test was stopped just before the blade completely failed. This paper provides an overview of the SHM and NDT system setups and some current test results.
Jensen, Scott L.; Drouant, George J.
The valve monitoring system is a stand alone unit with network capabilities for integration into a higher level health management system. The system is designed for aiding in failure predictions of high-geared ball valves and linearly actuated valves. It performs data tracking and archiving for identifying degraded performance. The data collection types are cryogenic cycles, total cycles, inlet temperature, body temperature torsional strain, linear bonnet strain, preload position, total travel and total directional changes. Events are recorded and time stamped in accordance with the IRIG B True Time. The monitoring system is designed for use in a Class 1 Division II explosive environment. The basic configuration consists of several instrumentation sensor units and a base station. The sensor units are self contained microprocessor controlled and remotely mountable in three by three by two inches. Each unit is potted in a fire retardant substance without any cavities and limited to low operating power for maintaining safe operation in a hydrogen environment. The units are temperature monitored to safeguard against operation outside temperature limitations. Each contains 902-928 MHz band digital transmitters which meet Federal Communication Commission's requirements and are limited to a 35 foot transmission radius for preserving data security. The base-station controller correlates data from the sensor units and generates data event logs on a compact flash memory module for database uploading. The entries are also broadcast over an Ethernet network. Nitrogen purged National Electrical Manufactures Association (NEMA) Class 4 enclosures are used to house the base-station
Ong, Wee Loon; Schouwenburg, Maartje G; van Bommel, Annelotte C M; Stowell, Caleb; Allison, Kim H; Benn, Karen E; Browne, John P; Cooter, Rodney D; Delaney, Geoff P; Duhoux, Francois P; Ganz, Patricia A; Hancock, Patricia; Jagsi, Reshma; Knaul, Felicia M; Knip, Anne M; Koppert, Linetta B; Kuerer, Henry M; McLaughin, Sarah; Mureau, Marc A M; Partridge, Ann H; Reid, Dereesa Purtell; Sheeran, Lisa; Smith, Thomas J; Stoutjesdijk, Mark J; Vrancken Peeters, Marie Jeanne T F D; Wengström, Yvonne; Yip, Cheng-Har; Saunders, Christobel
A major challenge in value-based health care is the lack of standardized health outcomes measurements, hindering optimal monitoring and comparison of the quality of health care across different settings globally. The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary international working group, comprised of 26 health care providers and patient advocates, to develop a standard set of value-based patient-centered outcomes for breast cancer (BC). The working group convened via 8 teleconferences and completed a follow-up survey after each meeting. A modified 2-round Delphi method was used to achieve consensus on the outcomes and case-mix variables to be included. Patient focus group meetings (8 early or metastatic BC patients) and online anonymized surveys of 1225 multinational BC patients and survivors were also conducted to obtain patients' input. The standard set encompasses survival and cancer control, and disutility of care (eg, acute treatment complications) outcomes, to be collected through administrative data and/or clinical records. A combination of multiple patient-reported outcomes measurement (PROM) tools is recommended to capture long-term degree of health outcomes. Selected case-mix factors were recommended to be collected at baseline. The ICHOM will endeavor to achieve wide buy-in of this set and facilitate its implementation in routine clinical practice in various settings and institutions worldwide.
Donovan, Jenny L; Hamdy, Freddie C; Lane, J Athene; Mason, Malcolm; Metcalfe, Chris; Walsh, Eleanor; Blazeby, Jane M; Peters, Tim J; Holding, Peter; Bonnington, Susan; Lennon, Teresa; Bradshaw, Lynne; Cooper, Deborah; Herbert, Phillipa; Howson, Joanne; Jones, Amanda; Lyons, Norma; Salter, Elizabeth; Thompson, Pauline; Tidball, Sarah; Blaikie, Jan; Gray, Catherine; Bollina, Prasad; Catto, James; Doble, Andrew; Doherty, Alan; Gillatt, David; Kockelbergh, Roger; Kynaston, Howard; Paul, Alan; Powell, Philip; Prescott, Stephen; Rosario, Derek J; Rowe, Edward; Davis, Michael; Turner, Emma L; Martin, Richard M; Neal, David E
Background Robust data on patient-reported outcome measures comparing treatments for clinically localized prostate cancer are lacking. We investigated the effects of active monitoring, radical prostatectomy, and radical radiotherapy with hormones on patient-reported outcomes. Methods We compared patient-reported outcomes among 1643 men in the Prostate Testing for Cancer and Treatment (ProtecT) trial who completed questionnaires before diagnosis, at 6 and 12 months after randomization, and annually thereafter. Patients completed validated measures that assessed urinary, bowel, and sexual function and specific effects on quality of life, anxiety and depression, and general health. Cancer-related quality of life was assessed at 5 years. Complete 6-year data were analyzed according to the intention-to-treat principle. Results The rate of questionnaire completion during follow-up was higher than 85% for most measures. Of the three treatments, prostatectomy had the greatest negative effect on sexual function and urinary continence, and although there was some recovery, these outcomes remained worse in the prostatectomy group than in the other groups throughout the trial. The negative effect of radiotherapy on sexual function was greatest at 6 months, but sexual function then recovered somewhat and was stable thereafter; radiotherapy had little effect on urinary continence. Sexual and urinary function declined gradually in the active-monitoring group. Bowel function was worse in the radiotherapy group at 6 months than in the other groups but then recovered somewhat, except for the increasing frequency of bloody stools; bowel function was unchanged in the other groups. Urinary voiding and nocturia were worse in the radiotherapy group at 6 months but then mostly recovered and were similar to the other groups after 12 months. Effects on quality of life mirrored the reported changes in function. No significant differences were observed among the groups in measures of anxiety
Reports describing significant health risks due to inadequate vitamin D status continue to generate considerable interest amongst the medical and lay communities alike. Recent research on the various molecular activities of the vitamin D system, including the nuclear vitamin D receptor and other receptors for 1,25-dihydroxyvitamin D and vitamin D metabolism, provides evidence that the vitamin D system carries out biological activities across a wide range of tissues similar to other nuclear receptor hormones. This knowledge provides physiological plausibility of the various health benefits claimed to be provided by vitamin D and supports the proposals for conducting clinical trials. The vitamin D system plays critical roles in the maintenance of plasma calcium and phosphate and bone mineral homeostasis. Recent evidence confirms that plasma calcium homeostasis is the critical factor modulating vitamin D activity. Vitamin D activities in the skeleton include stimulation or inhibition of bone resorption and inhibition or stimulation of bone formation. The three major bone cell types, which are osteoblasts, osteocytes and osteoclasts, can all respond to vitamin D via the classical nuclear vitamin D receptor and metabolize 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D to activate the vitamin D receptor and modulate gene expression. Dietary calcium intake interacts with vitamin D metabolism at both the renal and bone tissue levels to direct either a catabolic action on the bone through the endocrine system when calcium intake is inadequate or an anabolic action through a bone autocrine or paracrine system when calcium intake is sufficient. PMID:24790904
Lefkowitz, Eva S; Vasilenko, Sara A
Sexual behavior is an important aspect of adolescent development with implications for well-being. These chapters highlight important perspectives on studying sexual health from a normative, developmental perspective, such as viewing a range of sexual behaviors as life events; considering potentially positive physical health, mental health, social health, and identity outcomes; examining both intraindividual and interindividual differences in outcomes; recognizing the romantic relationship context of sexual behavior; and understanding how sexual media may impact sexual health outcomes. We suggest new directions for studying sexual health outcomes, such as studying behaviors beyond vaginal sex and condom use, new methodologies such as latent class analysis, sophisticated longitudinal designs, and collection and analysis of dyadic data. We recommend research on populations underrepresented in sexual health research such as late adolescents who do not attend traditional universities and adolescents from ethnic/racial minorities. Finally, we consider future directions for sexuality education and prevention efforts.
Warren, James W.
Augmented Fish Health Monitoring Contract AI79-87BP35585 was implemented on July 20, 1987. This report briefly describes third-year work being done to meet contract requirements for fish disease surveillance at Service facilities in the Columbia River basin and for histopathological support services provided to participating state agencies. It also summarizes the health status of fish reared at participating Service hatcheries and provides a summary of case history data for calendar year 1989. Items of note included severe disease losses to infectious hematopoietic necrosis (IHN) in summer steelhead trout in Idaho, the detection of IHN virus in juvenile spring chinook salmon at hatcheries on the lower Columbia River, and improved bacterial kidney disease (BKD) detection and adult assay by enzyme-linked immunosorbent assay (ELISA) technology at the Dworshak Fish Health Center. Complete diagnostic and inspection services were provided to 13 Columbia River Basin National Fish Hatcheries. Case history data was fully documented in a computerized data base for storage and analysis and is summarized herein. 2 refs., 1 fig., 4 tabs.
Maantay, Juliana A.; Chakraborty, Jayajit
How living near environmental hazards contributes to poorer health and disproportionate health outcomes is an ongoing concern. We conducted a substantive review and critique of the literature regarding residential proximity to environmental hazards and adverse pregnancy outcomes, childhood cancer, cardiovascular and respiratory illnesses, end-stage renal disease, and diabetes. Several studies have found that living near hazardous wastes sites, industrial sites, cropland with pesticide applications, highly trafficked roads, nuclear power plants, and gas stations or repair shops is related to an increased risk of adverse health outcomes. Government agencies should consider these findings in establishing rules and permitting and enforcement procedures to reduce pollution from environmentally burdensome facilities and land uses. PMID:22028451
Karlsen, Trine; Aamot, Inger-Lise; Haykowsky, Mark; Rognmo, Øivind
Regular physical activity or exercise training are important actions to improve cardiorespiratory fitness and maintain health throughout life. There is solid evidence that exercise is an effective preventative strategy against at least 25 medical conditions, including cardiovascular disease, stroke, hypertension, colon and breast cancer, and type 2 diabetes. Traditionally, endurance exercise training (ET) to improve health related outcomes has consisted of low- to moderate ET intensity. However, a growing body of evidence suggests that higher exercise intensities may be superior to moderate intensity for maximizing health outcomes. The primary objective of this review is to discuss how aerobic high-intensity interval training (HIIT) as compared to moderate continuous training may maximize outcomes, and to provide practical advices for successful clinical and home-based HIIT.
Gopichandran, Vijayaprasad; Indira Krishna, Anil Kumar
Monitoring and evaluation (M&E) is an essential part of public health programmes. Since M&E is the backbone of public health programmes, ethical considerations are important in their conduct. Some of the key ethical considerations are avoiding conflicts of interest, maintaining independence of judgement, maintaining fairness, transparency, full disclosure, privacy and confidentiality, respect, responsibility, accountability, empowerment and sustainability. There are several ethical frameworks in public health, but none focusing on the monitoring and evaluation process. There is a need to institutionalise the ethical review of M&E proposals. A theoretical framework for ethical considerations is proposed in this paper. This proposed theoretical framework can act as the blueprint for building the capacity of ethics committees to review M&E proposals. A case study is discussed in this context. After thorough field testing, this practical and field-based ethical framework can be widely used by donor agencies, M&E teams, institutional review boards and ethics committees.
Annim, Samuel Kobina; Awusabo-Asare, Kofi; Amo-Adjei, Joshua
This study uses three key anthropometric measures of nutritional status among children (stunting, wasting and underweight) to explore the dual effects of household composition and dependency on nutritional outcomes of under-five children in Ghana. The objective is to examine changes in household living arrangements of under-five children to explore the interaction of dependency and nucleation on child health outcomes. The concept of nucleation refers to the changing structure and composition of household living arrangements, from highly extended with its associated socioeconomic system of production and reproduction, social behaviour and values, towards single-family households - especially the nuclear family, containing a husband and wife and their children alone. A negative relationship between levels of dependency, as measured by the number of children in the household, and child health outcomes is premised on the grounds that high dependency depletes resources, both tangible and intangible, to the disadvantage of young children. Data were drawn from the last four rounds of the Ghana Demographic and Health Surveys (GDHSs), from 1993 to 2008, for the first objective - to explore changes in household composition. For the second objective, the study used data from the 2008 GDHS. The results show that, over time, households in Ghana have been changing towards nucleation. The main finding is that in households with the same number of dependent children, in nucleated households children under age 5 have better health outcomes compared with children under age 5 in non-nucleated households. The results also indicate that the effect of dependency on child health outcomes is mediated by household nucleation and wealth status and that, as such, high levels of dependency do not necessarily translate into negative health outcomes for children under age 5, based on anthropometric measures.
Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie-Paule; Wagstaff, Adam
Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries.
Malone, Nolan; Mark, Lauren; Narayan, Krishna
This guide offers educators, program managers, administrators, and researchers a resource for building capacity for monitoring program outcomes. It provides concise definitions of program monitoring components and a framework for assessing program progress. Examples demonstrate the relationships among program components: outcomes, indicators,…
Rust, George; Levine, Robert S.; Fry-Johnson, Yvonne; Baltrus, Peter; Ye, Jiali; Mack, Dominic
U.S. health disparities are real, pervasive, and persistent, despite dramatic improvements in civil rights and economic opportunity for racial and ethnic minority and lower socioeconomic groups in the United States. Change is possible, however. Disparities vary widely from one community to another, suggesting that they are not inevitable. Some communities even show paradoxically good outcomes and relative health equity despite significant social inequities. A few communities have even improved from high disparities to more equitable and optimal health outcomes. These positive-deviance communities show that disparities can be overcome and that health equity is achievable. Research must shift from defining the problem (including causes and risk factors) to testing effective interventions, informed by the natural experiments of what has worked in communities that are already moving toward health equity. At the local level, we need multi-dimensional interventions designed in partnership with communities and continuously improved by rapid-cycle surveillance feedback loops of community-level disparities metrics. Similarly coordinated strategies are needed at state and national levels to take success to scale. We propose ten specific steps to follow on a health equity path toward optimal and equitable health outcomes for all Americans. PMID:22643550
Dixon-Gordon, Katherine L.; Whalen, Diana J.; Layden, Brianne K.; Chapman, Alexander L.
Personality disorders have been associated with a wide swath of adverse health outcomes and correspondingly high costs to healthcare systems. To date, however, there has not been a systematic review of the literature on health conditions among individuals with personality disorders. The primary aim of this article is to review research documenting the associations between personality disorders and health conditions. A systematic review of the literature revealed 78 unique empirical English-language peer-reviewed articles examining the association of personality disorders and health outcomes over the past 15 years. Specifically, we reviewed research examining the association of personality disorders with sleep disturbance, obesity, pain conditions, and other chronic health conditions. In addition, we evaluated research on candidate mechanisms underlying health problems in personality disorders and potential treatments for such disorders. Results underscore numerous deleterious health outcomes associated with PD features and PD diagnoses, and suggest potential biological and behavioural factors that may account for these relations. Guidelines for future research in this area are discussed. PMID:26456998
Wu, Meng-Chou; Winfree, William P.; Moore, Jason P.
A recently developed technique is presented for thermographic detection of flaws in composite materials by performing temperature measurements with fiber optic Bragg gratings. Individual optical fibers with multiple Bragg gratings employed as surface temperature sensors were bonded to the surfaces of composites with subsurface defects. The investigated structures included a 10-ply composite specimen with subsurface delaminations of various sizes and depths. Both during and following the application of a thermal heat flux to the surface, the individual Bragg grating sensors measured the temporal and spatial temperature variations. The data obtained from grating sensors were analyzed with thermal modeling techniques of conventional thermography to reveal particular characteristics of the interested areas. Results were compared with the calculations using numerical simulation techniques. Methods and limitations for performing in-situ structural health monitoring are discussed.
Giurgiutiu, Victor (Inventor); Yu, Lingyu (Inventor); Bottai, Giola Santoni (Inventor)
Disclosed is an apparatus and methodology for structural health monitoring (SHM) in which smart devices interrogate structural components to predict failure, expedite needed repairs, and thus increase the useful life of those components. Piezoelectric wafer active sensors (PWAS) are applied to or integrated with structural components and various data collected there from provide the ability to detect and locate cracking, corrosion, and disbanding through use of pitch-catch, pulse-echo, electro/mechanical impedance, and phased array technology. Stand alone hardware and an associated software program are provided that allow selection of multiple types of SHM investigations as well as multiple types of data analysis to perform a wholesome investigation of a structure.
Jett, J.H.; Martin, J.C.; Saunders, G.C.; Stewart, C.C.
Monitoring the health of space station or lunar base residents will be necessary to provide knowledge of the physiological status of astronauts. Flow cytometric techniques are uniquely capable of providing cellular, chromosome, hormone level and enzyme level information. The use of dyes provides the basis for fluorescently labeling specific cellular components. Laser induced fluorescence from stained cells is quantitated in a flow cytometer to measure cellular components such as DNA, RNA and protein. One major application of a flow cytometer will be to perform a complete blood count including hematocrit, hemoglobin content, and numbers of platelets, erythrocytes, granulocytes, lymphocytes and monocytes. A newly developed flow cytometry based fluoroimmunoassay will be able to measure levels of serum enzymes and hormones. It will also be possible to quantitate radiation exposure and some forms of chromosome damage with flow cytometric measurements. With relatively simple modifications to existing technology, it will be possible to construct a flight rated cytometer. 11 references, 6 figures, 2 tables.
Chang, Feiba; Yin, Jun; Zhang, Hehua; Yan, Lexian; Li, Shuying; Zhou, Deqiang
Wearable health monitoring systems that use wearable biosensors capturing human motion and physiological parameters, to achieve the wearer's movement and health management needs. Wearable health monitoring system is a noninvasive continuous detection of human physiological information, data wireless transmission and real-time processing capabilities of integrated system, can satisfy physiological condition monitoring under the condition of low physiological and psychological load. This paper first describes the wearable health monitoring system structure and the relevant technology applied to wearable health monitoring system, and focuses on the current research work what we have done associated with wearable monitoring that wearable respiration and ECG acquisition and construction of electric multi-parameter body area network. Finally, the wearable monitoring system for the future development direction is put forward a simple expectation.
Butz, Mark G.; Rodriguez, Hector M.
This report presents the results of the NASA contract Propulsion System Health Management for Enhanced Safety performed by General Electric Aircraft Engines (GE AE), General Electric Global Research (GE GR), and Pennsylvania State University Applied Research Laboratory (PSU ARL) under the NASA Aviation Safety Program. This activity supports the overall goal of enhanced civil aviation safety through a reduction in the occurrence of safety-significant propulsion system malfunctions. Specific objectives are to develop and demonstrate vibration diagnostics techniques for the on-line detection of turbine rotor disk cracks, and model-based fault tolerant control techniques for the prevention and mitigation of in-flight engine shutdown, surge/stall, and flameout events. The disk crack detection work was performed by GE GR which focused on a radial-mode vibration monitoring technique, and PSU ARL which focused on a torsional-mode vibration monitoring technique. GE AE performed the Model-Based Fault Tolerant Control work which focused on the development of analytical techniques for detecting, isolating, and accommodating gas-path faults.
Nawaz, Saira; Thomas, Craig; Young, Andrea
We describe an evidence-based framework to define and assess the impact of quality improvement (QI) in public health. Developed to address programmatic and research-identified needs for articulating the value of public health QI in aggregate, this framework proposes a standardized set of measures to monitor and improve the efficiency and effectiveness of public health programs and operations. We reviewed the scientific literature and analyzed QI initiatives implemented through the Centers for Disease Control and Prevention’s National Public Health Improvement Initiative to inform the selection of 5 efficiency and 8 effectiveness measures. This framework provides a model for identifying the types of improvement outcomes targeted by public health QI efforts and a means to understand QI’s impact on the practice of public health. PMID:25689185
Rezvantsev, M V; Kuznetsov, S M; Ivanov, V V; Zakurdaev, V V
The current article is dedicated to some features of the Russian Federation Armed Forces military personnel health monitoring such as legal and informational provision, methodological basis of functioning, historical aspect of formation and development of the social and hygienic monitoring in the Russian Federation Armed Forces. The term "military personnel health monitoring" is defined as an analytical system of constant and long-term observation, analysis, assessment, studying of factors determined the military personnel health, these factors correlations, health risk factors management in order to minimize them. The current state of the military personnel health monitoring allows coming to the conclusion that the military health system does have forces and resources for state policy of establishing the population health monitoring system implementation. The following directions of the militarily personnel health monitoring improvement are proposed: the Russian Federation Armed Forces medical service record and report system reorganization bringing it closer to the civilian one, implementation of the integrated approach to the medical service informatisation, namely, military personnel health status and medical service resources monitoring. The leading means in this direction are development and introduction of a military serviceman individual health status monitoring system on the basis of a serviceman electronic medical record card. Also it is proposed the current Russian Federation Armed Forces social and hygienic monitoring improvement at the expense of informational interaction between the two subsystems on the basis of unified military medical service space.
Abdo, Nour; Khader, Yousef S; Abdelrahman, Mostafa; Graboski-Bauer, Ashley; Malkawi, Mazen; Al-Sharif, Munjed; Elbetieha, Ahmad M
Exposure to air pollution can cause detrimental health and be an economic burden. With newly developed equipment, monitoring of different air pollutants, identifying the sources, types of air pollutants and their corresponding concentrations, and applying mitigation intervention techniques became a crucial step in public health protection. Countries in the Eastern Mediterranean Region (EMR) are highly exposed to dust storms, have high levels of particulate matter (PM) concentrations, and have a unique climatic as well as topographic and socio-economic structure. This is the first study conducted to systemically and qualitatively assess the health impacts of air pollution in the EMR, identify susceptible populations, and ascertain research and knowledge gaps in the literature to better inform decisions by policy makers. We screened relevant papers and reports published between 2000 and 2014 in research databases. A total of 36 published studies met the inclusion criteria. A variety of indoor and outdoor exposures associated with various acute and chronic respiratory health outcomes were included. Respiratory health outcomes ranged in severity, from allergies and general respiratory complaints to lung cancer and mortality. Several adverse health outcomes were positively associated with various indoor/outdoor air pollutants throughout the EMR. However, epidemiological literature concerning the EMR is limited to a few studies in a few countries. More research is needed to elucidate the health outcomes of air pollution. Standardized reliable assessments on the national level for various air pollutants in different regions should be implemented and made publically available for researchers to utilize in their research. Moreover, advancing and utilizing more sound epidemiological designs and studies on the effect of air pollution on the respiratory health outcomes is needed to portray the actual situation in the region.
Brownjohn, J M W
Structural health monitoring (SHM) is a term increasingly used in the last decade to describe a range of systems implemented on full-scale civil infrastructures and whose purposes are to assist and inform operators about continued 'fitness for purpose' of structures under gradual or sudden changes to their state, to learn about either or both of the load and response mechanisms. Arguably, various forms of SHM have been employed in civil infrastructure for at least half a century, but it is only in the last decade or two that computer-based systems are being designed for the purpose of assisting owners/operators of ageing infrastructure with timely information for their continued safe and economic operation. This paper describes the motivations for and recent history of SHM applications to various forms of civil infrastructure and provides case studies on specific types of structure. It ends with a discussion of the present state-of-the-art and future developments in terms of instrumentation, data acquisition, communication systems and data mining and presentation procedures for diagnosis of infrastructural 'health'.
Lichtenwalner, Peter F.; White, Edward V.; Baumann, Erwin W.
Structural health monitoring (SHM) technology provides a means to significantly reduce life cycle of aerospace vehicles by eliminating unnecessary inspections, minimizing inspection complexity, and providing accurate diagnostics and prognostics to support vehicle life extension. In order to accomplish this, a comprehensive SHM system will need to acquire data from a wide variety of diverse sensors including strain gages, accelerometers, acoustic emission sensors, crack growth gages, corrosion sensors, and piezoelectric transducers. Significant amounts of computer processing will then be required to convert this raw sensor data into meaningful information which indicates both the diagnostics of the current structural integrity as well as the prognostics necessary for planning and managing the future health of the structure in a cost effective manner. This paper provides a description of the key types of information processing technologies required in an effective SHM system. These include artificial intelligence techniques such as neural networks, expert systems, and fuzzy logic for nonlinear modeling, pattern recognition, and complex decision making; signal processing techniques such as Fourier and wavelet transforms for spectral analysis and feature extraction; statistical algorithms for optimal detection, estimation, prediction, and fusion; and a wide variety of other algorithms for data analysis and visualization. The intent of this paper is to provide an overview of the role of information processing for SHM, discuss various technologies which can contribute to accomplishing this role, and present some example applications of information processing for SHM implemented at the Boeing Company.
Luse, Tina M; Slosek, Jean; Rennix, Christopher
The Department of Defense (DoD) requires service members to complete regular health assessments for identification of deployment-related physical/behavioral issues and environmental/occupational exposures. Compliance among active duty Department of the Navy personnel varies; however, and the impact of incomplete assessments on generalizability of results is unclear. This study examines the differences between Navy and Marine Corps service members who completed both the Post-Deployment Health Assessment and Post-Deployment Health Reassessment (n = 9,452) as compared to service members who never attempted either form (n = 5,603) in fiscal year 2010. Deployment rosters, assessments, and clinical data were analyzed to determine certified assessment completion rates and incidence of certain health conditions in these populations. Only 38.9% of applicable personnel met the completion and certification criteria for the required assessments. Service members who did not complete the forms were distinctly different demographically and at increased risk for psychotropic drug use, post-traumatic stress disorder diagnosis, and traumatic brain injury diagnosis following deployment. The prevailing assumption that the risk of adverse health effects on operational forces can be estimated using the population that completed the required assessments is incorrect, and the true operational impact and medical burden of these conditions may be underestimated.
Lohr, K N
The Boston Working Group on Improving Health Care Outcomes Through Geriatric Rehabilitation was structured around four major themes: (1) defining disability or disablement; (2) the patient's experience of the processes and outcomes of care; (3) the role and value of clinical practice guidelines; and (4) the need for casemix and severity or risk adjustment procedures and measures. These discussions produced opening statements of policy or empiric issues and recommendations about the best means of demonstrating the benefits of geriatric rehabilitation and, in particular, how to measure, ensure, and improve the quality of rehabilitation services, especially for the elderly. This article summarizes the reports from the work groups and identifies some common themes. Critical points include: (1) the need to define and describe geriatric rehabilitation better for nonexperts in the health field and for patients and consumers in general; (2) the need for more research to link rehabilitation processes with measurable and clinically important outcomes; (3) the breadth and depth of domains of processes and outcomes of care that ideally could and should be measured; and (4) the need to reach many audiences with a clear message about the importance of geriatric rehabilitation in ensuring high quality of care and good health status and functional outcomes for all elderly patients.
Connolly, Kathleen Kihmm
The purpose of this research project was to understand, explore and describe the digital divide and the relationship between technology utilization and health outcomes. Diabetes and diabetic eye disease was used as the real-life context for understanding change and exploring the digital divide. As an investigational framework, a telemedicine…
Bonaiuto, Maria M.
Educators and health care professionals alike understand that healthy students are likely to be successful learners. The goal of school nurse case management is to support students so that they are ready to learn. This article describes the outcomes of a 4-year process improvement project designed to show the impact of school nurse case management…
Pedersen, Daphne E.
Objective: Using a stress carry-over perspective, this study examines the relationship between stress stemming from school and family domains and physical and mental health outcomes. Methods: The study sample included 268 undergraduate men and women from a Midwestern university. Participants completed an anonymous online questionnaire. OLS…
Coopman, Stephanie J.
Examines interdisciplinary health care teams, focusing on perceptions of team processes and their relationship to assessments of team performance and individual outcomes. Suggests that hospice interdisciplinary teams are perceived by their members as only somewhat democratic in the practice of decision making. (SG)
Verhaaff, Ashley; Scott, Hannah
Objective: This study examined which individual factors predict mental health court diversion outcome among a sample of persons with mental illness participating in a postcharge diversion program. Method: The study employed secondary analysis of existing program records for 419 persons with mental illness in a court diversion program. Results:…
Torrance, G W
Economic evaluation of health programs consists of the comparative analysis of alternative courses of action in terms of both costs and consequences. The five analytic techniques are cost-consequence analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. Although all techniques have the same objective of informing decision making in the health programs, they come from different theoretic backgrounds and relate differently to the discipline of economics. Cost-utility analysis formally incorporates the measured preferences of individuals for the health outcome consequences of the alternative programs. The individuals may be actual patients who are experiencing or have experienced the outcomes, or they may be a representative sample of the community, many of whom may someday face the outcomes. The health outcomes, at the most general level, consist of changes in the quantity and quality of life; that is, changes in mortality and morbidity. Changes in quantity of life are measured with mortality; changes in quality of life are measured with health-related quality-of-life instruments. Utilities represent a particular approach to the measurement of health-related quality of life that is founded on a well specified theory and provides an interval scale metric. Changes in quantity of life, as measured in years, can be combined with changes in quality of life, as measured in utilities, to determine the number of quality-adjusted life years gained by a particular health program. This can be compared with the incremental cost of the program to determine the cost per quality-adjusted life-year gained. Utilities may be measured directly on patients or other respondents by means of techniques such as visual analog scaling, standard gamble, or time trade-off. Utilities may be determined indirectly by means of a preference-weighted multi-attribute health status classification system such as the health utilities index
Brown, Tyson H.; O'Rand, Angela M.; Adkins, Daniel E.
Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from…
Nelson-Peterman, Jerusha L.; Toof, Robin; Liang, Sidney L.; Grigg-Saito, Dorcas C.
Refugees in the United States have high rates of chronic disease. Both long-term effects of the refugee experience and adjustment to the U.S. health environment may contribute. While there is significant research on health outcomes of newly resettled refugees and long-term mental health experiences of established refugees, there is currently…
“Air Pollution and Health: Bridging the Gap from Sources to Health Outcomes,” an international specialty conference sponsored by the American Association for Aerosol Research, was held to address key uncertainties in our understanding of adverse health effects related to air po...
Allen-Ramey, Felicia C; Gupta, Shaloo; DiBonaventura, Marco daCosta
Background: Recent literature has suggested that emphysema and chronic bronchitis, traditionally considered to be entities overlapping within chronic obstructive pulmonary disease (COPD), may be distinct disorders. Few studies have examined the differences in patient characteristics and health outcomes between these conditions. This study examined whether COPD phenotypes represent distinct patient populations, in a large nationally representative US sample. Methods: Data were obtained from the 2010 US National Health and Wellness Survey (NHWS). NHWS respondents (n = 75,000) were categorized as a COPD phenotype based on their self-reported diagnosis of COPD only (n = 970), emphysema only (n = 399), or chronic bronchitis only (n = 2071). Phenotypes were compared on demographics, health characteristics, treatment patterns, health outcomes, work productivity, and resource use. Variables were compared using Chi-square and analysis of variance tests for categorical and continuous outcomes, respectively. Health outcomes were also examined using regression modeling, controlling for demographic and health characteristic covariates. Results: Patients with chronic bronchitis were significantly younger (51.38 years versus 63.24 years for COPD versus 63.30 years for emphysema, P < 0.05) and more likely to be employed (46.98% versus 23.81% for COPD versus 28.33% for emphysema, P < 0.05). Relative to the other phenotypes, patients with chronic bronchitis were also significantly more likely to be female, nonwhite, and to exercise currently (all P < 0.05), and were significantly less likely to be a current or former smoker (P < 0.05). Controlling for demographic and health characteristics, patients self-identified as having COPD only reported significantly worse physical quality of life (adjusted mean 36.69) and health utilities (adjusted mean 0.65) and significantly more absenteeism (adjusted mean 7.08%), presenteeism (adjusted mean 30.73%), overall work impairment (adjusted mean
Jones, C. E.; Bawden, G. W.; Deverel, S. J.; Dudas, J.; Hensley, S.; Yun, S.
Remote sensing offers the potential to augment current levee monitoring programs by providing rapid and consistent data collection over large areas irrespective of the ground accessibility of the sites of interest, at repeat intervals that are difficult or costly to maintain with ground-based surveys, and in rapid response to emergency situations. While synthetic aperture radar (SAR) has long been used for subsidence measurements over large areas, applying this technique directly to regional levee monitoring is a new endeavor, mainly because it requires both a wide imaging swath and fine spatial resolution to resolve individual levees within the scene, a combination that has not historically been available. Application of SAR remote sensing directly to levee monitoring has only been attempted in a few pilot studies. Here we describe how SAR remote sensing can be used to assess levee conditions, such as seepage, drawing from the results of two levee studies: one of the Sacramento-San Joaquin Delta levees in California that has been ongoing since July 2009 and a second that covered the levees near Vicksburg, Mississippi, during the spring 2011 floods. These studies have both used data acquired with NASA's UAVSAR L-band synthetic aperture radar, which has the spatial resolution needed for this application (1.7 m single-look), sufficiently wide imaging swath (22 km), and the longer wavelength (L-band, 0.238 m) required to maintain phase coherence between repeat collections over levees, an essential requirement for applying differential interferometry (DInSAR) to a time series of repeated collections for levee deformation measurement. We report the development and demonstration of new techniques that employ SAR polarimetry and differential interferometry to successfully assess levee health through the quantitative measurement of deformation on and near levees and through detection of areas experiencing seepage. The Sacramento-San Joaquin Delta levee study, which covers
Baig, Mirza Mansoor; Gholamhosseini, Hamid
Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way health care is currently delivered. Although smart health monitoring systems automate patient monitoring tasks and, thereby improve the patient workflow management, their efficiency in clinical settings is still debatable. This paper presents a review of smart health monitoring systems and an overview of their design and modeling. Furthermore, a critical analysis of the efficiency, clinical acceptability, strategies and recommendations on improving current health monitoring systems will be presented. The main aim is to review current state of the art monitoring systems and to perform extensive and an in-depth analysis of the findings in the area of smart health monitoring systems. In order to achieve this, over fifty different monitoring systems have been selected, categorized, classified and compared. Finally, major advances in the system design level have been discussed, current issues facing health care providers, as well as the potential challenges to health monitoring field will be identified and compared to other similar systems.
Farrar, Charles R; Worden, Keith
The process of implementing a damage identification strategy for aerospace, civil and mechanical engineering infrastructure is referred to as structural health monitoring (SHM). Here, damage is defined as changes to the material and/or geometric properties of these systems, including changes to the boundary conditions and system connectivity, which adversely affect the system's performance. A wide variety of highly effective local non-destructive evaluation tools are available for such monitoring. However, the majority of SHM research conducted over the last 30 years has attempted to identify damage in structures on a more global basis. The past 10 years have seen a rapid increase in the amount of research related to SHM as quantified by the significant escalation in papers published on this subject. The increased interest in SHM and its associated potential for significant life-safety and economic benefits has motivated the need for this theme issue. This introduction begins with a brief history of SHM technology development. Recent research has begun to recognize that the SHM problem is fundamentally one of the statistical pattern recognition (SPR) and a paradigm to address such a problem is described in detail herein as it forms the basis for organization of this theme issue. In the process of providing the historical overview and summarizing the SPR paradigm, the subsequent articles in this theme issue are cited in an effort to show how they fit into this overview of SHM. In conclusion, technical challenges that must be addressed if SHM is to gain wider application are discussed in a general manner.
Puac-Polanco, Victor D.; Lopez-Soto, Victor A.; Kohn, Robert; Xie, Dawei; Richmond, Therese S.
Objectives. We analyzed a probability sample of Guatemalans to determine if a relationship exists between previous violent events and development of mental health outcomes in various sociodemographic groups, as well as during and after the Guatemalan Civil War. Methods. We used regression modeling, an interaction test, and complex survey design adjustments to estimate prevalences and test potential relationships between previous violent events and mental health. Results. Many (20.6%) participants experienced at least 1 previous serious violent event. Witnessing someone severely injured or killed was the most common event. Depression was experienced by 4.2% of participants, with 6.5% experiencing anxiety, 6.4% an alcohol-related disorder, and 1.9% posttraumatic stress disorder (PTSD). Persons who experienced violence during the war had 4.3 times the adjusted odds of alcohol-related disorders (P < .05) and 4.0 times the adjusted odds of PTSD (P < .05) compared with the postwar period. Women, indigenous Maya, and urban dwellers had greater odds of experiencing postviolence mental health outcomes. Conclusions. Violence that began during the civil war and continues today has had a significant effect on the mental health of Guatemalans. However, mental health outcomes resulting from violent events decreased in the postwar period, suggesting a nation in recovery. PMID:25713973
Bowen, Anthony; Casadevall, Arturo
Society makes substantial investments in biomedical research, searching for ways to better human health. The product of this research is principally information published in scientific journals. Continued investment in science relies on society's confidence in the accuracy, honesty, and utility of research results. A recent focus on productivity has dominated the competitive evaluation of scientists, creating incentives to maximize publication numbers, citation counts, and publications in high-impact journals. Some studies have also suggested a decreasing quality in the published literature. The efficiency of society's investments in biomedical research, in terms of improved health outcomes, has not been studied. We show that biomedical research outcomes over the last five decades, as estimated by both life expectancy and New Molecular Entities approved by the Food and Drug Administration, have remained relatively constant despite rising resource inputs and scientific knowledge. Research investments by the National Institutes of Health over this time correlate with publication and author numbers but not with the numerical development of novel therapeutics. We consider several possibilities for the growing input-outcome disparity including the prior elimination of easier research questions, increasing specialization, overreliance on reductionism, a disproportionate emphasis on scientific outputs, and other negative pressures on the scientific enterprise. Monitoring the efficiency of research investments in producing positive societal outcomes may be a useful mechanism for weighing the efficacy of reforms to the scientific enterprise. Understanding the causes of the increasing input-outcome disparity in biomedical research may improve society's confidence in science and provide support for growing future research investments.
You, Sukkyung; Shin, Kyulee
For many years, body dissatisfaction and mental health were thought of as Western phenomena and were studied mostly in Caucasian women. Recent studies, however, suggest that these issues are also present in men and in other ethnic groups. This study examined the association between body dissatisfaction and mental health outcomes, with personality traits and neuroticism playing possible predictive roles, using a Korean sample. A total of 545 college students, from five private universities in South Korea, completed assessment measures for depression, self-esteem, neuroticism, and body esteem scales. After controlling for covariates including body mass index and exercise time, body dissatisfaction was seen to play a mediating role between neuroticism and mental health outcomes. Differences between the sexes were also found in this relationship. For men, body dissatisfaction acted as a mediator between neuroticism and depression. For women, body dissatisfaction acted as a mediator between neuroticism and both depression and self-esteem.
Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel
Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service.
Daugharty, G. D.
To meet our goal of improving health care through more productive use of the data we are collecting about the delivery of health care we need to define our concepts of health and quality. The WHO definition of health allows the design of useful functional outcome criteria which give us measurable standards for the outcome of the health care. By recording, retrieving, and reviewing pertinent information from the structure and the process of health care for a valid comparison with its outcome, the most effective and efficient health care is identified. A practical system is presented which identifies the better methods of management and produces the motivation for change that results in improved care. The successful use of this system in a private practice supports its universal adaptability for health care providers. The initial encouraging results suggest that future trials in other types of practices will be even more encouraging.
Edelstein, Burton L.
The mouth is an obvious portal of entry to the body, and oral health reflects and influences general health and well being. Maternal oral health has significant implications for birth outcomes and infant oral health. Maternal periodontal disease, that is, a chronic infection of the gingiva and supporting tooth structures, has been associated with preterm birth, development of preeclampsia, and delivery of a small-for-gestational age infant. Maternal oral flora is transmitted to the newborn infant, and increased cariogenic flora in the mother predisposes the infant to the development of caries. It is intriguing to consider preconception, pregnancy, or intrapartum treatment of oral health conditions as a mechanism to improve women's oral and general health, pregnancy outcomes, and their children's dental health. However, given the relationship between oral health and general health, oral health care should be a goal in its own right for all individuals. Regardless of the potential for improved oral health to improve pregnancy outcomes, public policies that support comprehensive dental services for vulnerable women of childbearing age should be expanded so that their own oral and general health is safeguarded and their children's risk of caries is reduced. Oral health promotion should include education of women and their health care providers ways to prevent oral disease from occurring, and referral for dental services when disease is present. PMID:16816998
Farrar, Charles; Park, Gyuhae; Angel, Marian; Bement, Matthew; Salvino, Liming
Currently the Office of Naval Research is supporting the development of structural health monitoring (SHM) technology for U.S. Navy ship structures. This application is particularly challenging because of the physical size of these structures, the widely varying and often extreme operational and environmental conditions associated with these ships missions, lack of data from known damage conditions, limited sensing that was not designed specifically for SHM, and the management of the vast amounts of data that can be collected during a mission. This paper will first define a statistical pattern recognition paradigm for SHM by describing the four steps of (1) Operational Evaluation, (2) Data Acquisition, (3) Feature Extraction, and (4) Statistical Classification of Features as they apply to ship structures. Note that inherent in the last three steps of this process are additional tasks of data cleansing, compression, normalization and fusion. The presentation will discuss ship structure SHM challenges in the context of applying various SHM approaches to sea trials data measured on an aluminum multi-hull high-speed ship, the HSV-2 Swift. To conclude, the paper will discuss several outstanding issues that need to be addressed before SHM can make the transition from a research topic to actual field applications on ship structures and suggest approaches for addressing these issues.
Giurgiutiu, Victor; Soutis, Constantinos
This paper discusses the topic of how the integrity of safety-critical structural composites can be enhanced by the use of structural health monitoring (SHM) techniques. The paper starts with a presentation of how the certification of flight-critical composite structures can be achieved within the framework of civil aviation safety authority requirements. Typical composites damage mechanisms, which make this process substantially different from that for metallic materials are discussed. The opportunities presented by the use of SHM techniques in future civil aircraft developments are explained. The paper then focuses on active SHM with piezoelectric wafer active sensors (PWAS). After reviewing the PWAS-based SHM options, the paper follows with a discussion of the specifics of guided wave propagation in composites and PWAS-tuning effects. The paper presents a number of experimental results for damage detection in simple flat unidirectional and quasi-isotropic composite specimens. Calibrated through holes of increasing diameter and impact damage of various energies and velocities are considered. The paper ends with conclusions and suggestions for further work.
Wilcox, Paul D.; Lee, Chee Kin; Scholey, Jonathan J.; Friswell, Michael I.; Wisnom, Michael R.; Drinkwater, Bruce W.
Acoustic emission (AE) testing is potentially a highly suitable technique for structural health monitoring (SHM) applications due to its ability to achieve high sensitivity from a sparse array of sensors. For AE to be deployed as part of an SHM system it is essential that its capability is understood. This is the motivation for developing a forward model, referred to as QAE-Forward, of the complete AE process in real structures which is described in the first part of this paper. QAE-Forward is based around a modular and expandable architecture of frequency domain transfer functions to describe various aspects of the AE process, such as AE signal generation, wave propagation and signal detection. The intention is to build additional functionality into QAE-Forward as further data becomes available, whether this is through new analytic tools, numerical models or experimental measurements. QAE-Forward currently contains functions that implement (1) the excitation of multimodal guided waves by arbitrarily orientated point sources, (2) multi-modal wave propagation through generally anisotropic multi-layered media, and (3) the detection of waves by circular transducers of finite size. Results from the current implementation of QAE-Forward are compared to experimental data obtained from Hsu-Neilson tests on aluminum plate and good agreement is obtained. The paper then describes an experimental technique and a finite element modeling technique to obtain quantitative AE data from fatigue crack growth that will feed into QAE-Forward.
Coleman, P.; Darejeh, H.; Collins, J. J.
Recent work was performed on development optical technology to provide real time monitoring of shaft speed, shaft axial displacement, and shaft orbit of the OTVE hydrostatic bearing tester. Results show shaft axial displacement can be optically measured (at the same time as shaft orbital motion and speed) to within 0.3 mills by two fiber optic deflectometers. The final results of this condition monitoring development effort are presented.
Harrington, Kathleen F; Zhang, Bin; Magruder, Teresa; Bailey, William C; Gerald, Lynn B
Background: Health literacy has been associated with health disparities in many disease outcomes, including children's asthma. Parents are responsible for most of children's healthcare. Therefore, parents' health literacy may impact children's health outcomes, including asthma control. This study sought to determine the association between parent health literacy and children's asthma control among a cohort of predominately minority urban children aged between 6 and 12 years. Methods: This cross-sectional study assessed children with asthma and their parents at a single outpatient visit. English-speaking parents and their children, aged between 6 and 12 years with physician-diagnosed asthma, were eligible for this study. Healthcare providers assessed asthma control and severity, and parents completed demographic, health literacy, asthma control, and asthma knowledge measures. Children completed a pulmonary function test as part of the Asthma Control Questionnaire (ACQ) scoring. Results: A total of 281 parent-child dyads provided data, with the majority of parents being mothers and African American, with a high school level education or less. Lower parent health literacy was associated with worse asthma control as rated both by the provider (p=0.007) and the ACQ (p=0.013), despite only moderate concordance between ratings (ρ=0.408, p<0.0001). Lower parent health literacy also was associated with less asthma knowledge, which was associated with worse asthma control. Conclusions: Higher parent health literacy was associated with more parent asthma knowledge and better child asthma control. Pediatric providers should consider tailoring education or treatment plans or utilizing universal precautions for low health literacy.
Wu, Zhishen; Fujino, Yozo
This special issue collects together 19 papers that were originally presented at the First International Conference on Structural Health Monitoring and Intelligent Infrastructure (SHMII-1'2003), held in Tokyo, Japan, on 13-15 November 2003. This conference was organized by the Japan Society of Civil Engineers (JSCE) with partial financial support from the Japan Society for the Promotion of Science (JSPS) and the Ministry of Education, Culture, Sport, Science and Technology, Japan. Many related organizations supported the conference. A total of 16 keynote papers including six state-of-the-art reports from different counties, six invited papers and 154 contributed papers were presented at the conference. The conference was attended by a diverse group of about 300 people from a variety of disciplines in academia, industry and government from all over the world. Structural health monitoring (SHM) and intelligent materials, structures and systems have been the subject of intense research and development in the last two decades and, in recent years, an increasing range of applications in infrastructure have been discovered both for existing structures and for new constructions. SHMII-1'2003 addressed progress in the development of building, transportation, marine, underground and energy-generating structures, and other civilian infrastructures that are periodically, continuously and/or actively monitored where there is a need to optimize their performance. In order to focus the current needs on SHM and intelligent technologies, the conference theme was set as 'Structures/Infrastructures Sustainability'. We are pleased to have the privilege to edit this special issue on SHM and intelligent infrastructure based on SHMII-1'2003. We invited some of the presenters to submit a revised/extended version of their paper that was included in the SHMII-1'2003 proceedings for possible publication in the special issue. Each paper included in this special issue was edited with the same
Hendriksen, Ingrid J.M.; Snoijer, Mirjam; de Kok, Brenda P.H.; van Vilsteren, Jeroen; Hofstetter, Hedwig
Objective: Evaluation of the effectiveness of a workplace health promotion program on employees’ vitality, health, and work-related outcomes, and exploring the influence of organizational support and the supervisors’ role on these outcomes. Methods: The 5-month intervention included activities at management, team, and individual level targeting self-management to perform healthy behaviors: a kick-off session, vitality training sessions, workshops, individual coaching, and intervision. Outcome measures were collected using questionnaires, health checks, and sickness absence data at baseline, after the intervention and at 10 months follow-up. For analysis linear and generalized mixed models were used. Results: Vitality, work performance, sickness absence, and self-management significantly improved. Good organizational support and involved supervisors were significantly associated with lower sickness absence. Conclusions: Including all organizational levels and focusing on increasing self-management provided promising results for improving vitality, health, and work-related outcomes. PMID:27136605
Brown, Tyson H; O'Rand, Angela M; Adkins, Daniel E
Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories.
de Jong, Kim
Outcome monitoring feedback is a promising intervention to enhance outcomes of clinical practice. However, effective implementation can be tough and research suggests that feedback is not equally effective under all circumstances. In this article, feedback theory, research and experience from clinical practice is used to provide implementation strategies. Factors that moderate the effectiveness of outcome monitoring feedback, including feedback, recipient and organization characteristics are discussed. It is important to pay attention to implementation processes, such as providing sufficient training for clinicians, in order for feedback to be capable of enhancing outcomes.
Holzner, Bernhard; Schauer-Maurer, Gabriele; Stockhammer, Guenter; Muigg, Armin; Hutterer, Markus; Giesinger, Johannes
A computer-based tool for the monitoring of patient-related outcomes, the "Computer-based Health Evaluation System" (CHES) was developed at the medical university of Innsbruck. The software-generated graphic QOL profiles were found to be an important tool for screening patients for clinically relevant problems and were successfully used in oncology, geriatrics, psychiatry, and psychosomatics. The authors report their experience with CHES in 34 patients with recurrent gliomas. The computer-based QoL monitoring was repeated in median 5.4 times per patients and found feasible and well accepted by patients and personnel.
Monsen, Karen A; Fulkerson, Jayne A; Lytton, Amy B; Taft, Lila L; Schwichtenberg, Linda D; Martin, Karen S
To use aggregated data from health informatics systems to identify needs of maternal and child health (MCH) clients served by county public health agencies and to demonstrate outcomes of services provided. Participating agencies developed and implemented a formal standardized classification data comparison process using structured Omaha System data. An exploratory descriptive analysis of the data was performed. Summary reports of aggregated and analyzed data from records of clients served and discharged in 2005 were compared. Client problems and outcomes were found to be similar across agencies, with behavioral, psychosocial, environmental and physiological problems identified and addressed. Differential improvement was noted by problem, outcome measure, and agency; and areas for enhancing intervention strategies were prioritized. Problems with greatest improvement across agencies were Antepartum/postpartum and Family planning, and least improvement across agencies were Neglect and Substance use. Findings demonstrated that public health nurses address many serious health-related problems with low-income high-risk MCH clients. MCH client needs were found to be similar across agencies. Public health nurse home visiting services addressed important health issues with MCH clients, and statistically significant improvement in client health problems occurred consistently across agencies. The data comparison processes developed in this project were useful for MCH programs, and may be applicable to other program areas using structured client data for evaluation purposes. Using informatics tools and data facilitated needs assessment, program evaluation, and outcomes management processes for the agencies, and will continue to play an integral role in directing practice and improving client outcomes.
Woodhouse, Lynn D; Livingood, William C; Toal, Russ; Keene, DeAnna; Hines, Robert B; Tedders, Stuart; Charles, Simone M; Lawrence, Raymona H; Gunn, Laura H; Williams, Natalie; Kellum, Andrea
The challenge of evaluating community asthma management programs is complicated by balancing the emphasis on health outcomes with the need to build community process capacity for conducting and monitoring evidence-based programs. The evaluation of a Georgia Childhood Asthma Management Program, a Healthcare Georgia Foundation-supported initiative for multiple diverse programs and settings, provides an example of an approach and the results that address this challenge. A "developmental evaluation" approach was applied, using mixed methods of quantitative and qualitative data collection and analysis, to assess the progress of community asthma prevention programs in building community within the context of: where the community is starting, community-level systems changes, and the community's progress toward becoming more outcome measurement oriented and evidence based. Initial evaluation efforts revealed extensive mobilization of community assets to manage childhood asthma. However, there were minimal planned efforts to assess health outcomes and systems changes, and the lack of a logic model-based program design linking evidence-based practices to outcomes. Following developmental technical assistance within evaluation efforts, all programs developed logic models, linking practices to outcomes with data collection processes to assess progress toward achieving the selected outcomes. This developmental approach across diverse projects and communities, along with a quality improvement benchmarking approach to outcomes, created a focus on health status outcome improvement. Specifically, this approach complemented an emphasis on an improved community process capacity to identify, implement, and monitor evidence-based asthma practices that could be used within each community setting.
Alwan, Majd; Dalal, Siddharth; Mack, David; Kell, Steven W; Turner, Beverely; Leachtenauer, Jon; Felder, Robin
This paper describes a study designed to assess the acceptance and some psychosocial impacts of monitoring technology in assisted living. Monitoring systems were installed in 22 assisted living units to track the activities of daily living (ADLs) and key alert conditions of residents (15 of whom were nonmemory care residents). Activity reports and alert notifications were sent to professional caregivers who provided care to residents participating in the study. Diagnostic use of the monitoring data was assessed. Nonmemory care residents were surveyed and assessed using the Satisfaction With Life Scale (SWLS) instrument. Pre- and post-installation SWLS scores were compared. Older adult participants accepted monitoring. The results suggest that monitoring technologies could provide care coordination tools that are accepted by residents and may have a positive impact on their quality of life.
Kent, Renee M.; Murphy, Dennis A.
The subject of sensor-based structural health monitoring is very diverse and encompasses a wide range of activities including initiatives and innovations involving the development of advanced sensor, signal processing, data analysis, and actuation and control technologies. In addition, it embraces the consideration of the availability of low-cost, high-quality contributing technologies, computational utilities, and hardware and software resources that enable the operational realization of robust health monitoring technologies. This report presents a detailed analysis of the cost benefit and other logistics and operational considerations associated with the implementation and utilization of sensor-based technologies for use in aerospace structure health monitoring. The scope of this volume is to assess the economic impact, from an end-user perspective, implementation health monitoring technologies on three structures. It specifically focuses on evaluating the impact on maintaining and supporting these structures with and without health monitoring capability.
Scott-Carnell, Lisa A. (Inventor); Siochi, Emilie J. (Inventor)
A method for monitoring the structural health of a structure of interest by coupling one or more electroactive polymer fibers to the structure and monitoring the electroactive responses of the polymer fiber(s). Load changes that are experienced by the structure cause changes in the baseline responses of the polymer fiber(s). A system for monitoring the structural health of the structure is also provided.
Pirkis, Jane E; Burgess, Philip M; Kirk, Pia K; Dodson, Sarity; Coombs, Tim J; Williamson, Michelle K
Background The Health of the Nation Outcome Scales was developed to routinely measure outcomes for adults with mental illness. Comparable instruments were also developed for children and adolescents (the Health of the Nation Outcome Scales for Children and Adolescents) and older people (the Health of the Nation Outcome Scales 65+). All three are being widely used as outcome measures in the United Kingdom, Australia and New Zealand. There is, however, no comprehensive review of these instruments. This paper fills this gap by reviewing the psychometric properties of each. Method Articles and reports relating to the instruments were retrieved, and their findings synthesised to assess the instruments' validity (content, construct, concurrent, predictive), reliability (test-retest, inter-rater), sensitivity to change, and feasibility/utility. Results Mostly, the instruments perform adequately or better on most dimensions, although some of their psychometric properties warrant closer examination. Conclusion Collectively, the Health of the Nation Outcome Scales family of measures can assess outcomes for different groups on a range of mental health-related constructs, and can be regarded as appropriate for routinely monitoring outcomes. PMID:16313678
Continuous monitoring of physiological and biological parameters is expected to improve performance and medical outcomes by assessing overall health status and alerting for life-saving interventions. Continuous monitoring of these parameters requires wearable devices with an appropriate form factor (lightweight, comfortable, low energy consuming and even single-use) to avoid disrupting daily activities thus ensuring operation relevance and user acceptance. Many previous efforts to implement remote and wearable sensors have suffered from high cost and poor performance, as well as low clinical and end-use acceptance. New manufacturing and system level design approaches are needed to make the performance and clinical benefits of these sensors possible while satisfying challenging economic, regulatory, clinical, and user-acceptance criteria. In this talk we will review several recent design and manufacturing efforts aimed at designing and building prototype wearable sensors. We will discuss unique opportunities and challenges provided by additive manufacturing, including 3D printing, to drive innovation through new designs, faster prototyping and manufacturing, distributed networks, and new ecosystems. We will also show alternative hybrid self-assembly based integration techniques for low cost large scale manufacturing of single use wearable devices. Coauthors: Prabhjot Singh and Jeffrey Ashe.
...; National Animal Health Monitoring System; Bison 2014 Study AGENCY: Animal and Plant Health Inspection...: National Animal Health Monitoring System; Bison 2014 Study. OMB Number: 0579-XXXX. Type of Request..., APHIS operates the National Animal Health Monitoring System (NAHMS), which collects...
...; National Animal Health Monitoring System; Cervid 2014 Study AGENCY: Animal and Plant Health Inspection...: National Animal Health Monitoring System; Cervid 2014 Study. OMB Number: 0579-XXXX. Type of Request..., APHIS operates the National Animal Health Monitoring System (NAHMS), which collects...
Hosseinpoor, Ahmad Reza; Bergen, Nicole; Schlotheuber, Anne
Background Health equity is a priority in the post-2015 sustainable development agenda and other major health initiatives. The World Health Organization (WHO) has a history of promoting actions to achieve equity in health, including efforts to encourage the practice of health inequality monitoring. Health inequality monitoring systems use disaggregated data to identify disadvantaged subgroups within populations and inform equity-oriented health policies, programs, and practices. Objective This paper provides an overview of a number of recent and current WHO initiatives related to health inequality monitoring at the global and/or national level. Design We outline the scope, content, and intended uses/application of the following: Health Equity Monitor database and theme page; State of inequality: reproductive, maternal, newborn, and child health report; Handbook on health inequality monitoring: with a focus on low- and middle-income countries; Health inequality monitoring eLearning module; Monitoring health inequality: an essential step for achieving health equity advocacy booklet and accompanying video series; and capacity building workshops conducted in WHO Member States and Regions. Conclusions The paper concludes by considering how the work of the WHO can be expanded upon to promote the establishment of sustainable and robust inequality monitoring systems across a variety of health topics among Member States and at the global level. PMID:26387506
Hosseinpoor, Ahmad Reza; Bergen, Nicole; Schlotheuber, Anne
Background Health equity is a priority in the post-2015 sustainable development agenda and other major health initiatives. The World Health Organization (WHO) has a history of promoting actions to achieve equity in health, including efforts to encourage the practice of health inequality monitoring. Health inequality monitoring systems use disaggregated data to identify disadvantaged subgroups within populations and inform equity-oriented health policies, programs, and practices. Objective This paper provides an overview of a number of recent and current WHO initiatives related to health inequality monitoring at the global and/or national level. Design We outline the scope, content, and intended uses/application of the following: Health Equity Monitor database and theme page; State of inequality: reproductive, maternal, newborn, and child health report; Handbook on health inequality monitoring: with a focus on low- and middle-income countries; Health inequality monitoring eLearning module; Monitoring health inequality: an essential step for achieving health equity advocacy booklet and accompanying video series; and capacity building workshops conducted in WHO Member States and Regions. Conclusions The paper concludes by considering how the work of the WHO can be expanded upon to promote the establishment of sustainable and robust inequality monitoring systems across a variety of health topics among Member States and at the global level.
Background There is increasing attention, globally and in countries, to monitoring and addressing the health systems and human resources inputs, processes and outputs that impede or facilitate progress towards achieving the Millennium Development Goals for maternal and child health. We reviewed the situation of human resources for health (HRH) in 68 low- and middle-income countries that together account for over 95% of all maternal and child deaths. Methods We collected and analysed cross-nationally comparable data on HRH availability, distribution, roles and functions from new and existing sources, and information from country reviews of HRH interventions that are associated with positive impacts on health services delivery and population health outcomes. Results Findings from 68 countries demonstrate availability of doctors, nurses and midwives is positively correlated with coverage of skilled birth attendance. Most (78%) of the target countries face acute shortages of highly skilled health personnel, and large variations persist within and across countries in workforce distribution, skills mix and skills utilization. Too few countries appropriately plan for, authorize and support nurses, midwives and community health workers to deliver essential maternal, newborn and child health-care interventions that could save lives. Conclusions Despite certain limitations of the data and findings, we identify some key areas where governments, international partners and other stakeholders can target efforts to ensure a sufficient, equitably distributed and efficiently utilized health workforce to achieve MDGs 4 and 5. PMID:21702913
John, Juanette; Wright, Caradee Yael; Oosthuizen, Maria Aletta; Steyn, Maronel; Genthe, Bettina; le Roux, Wouter; Albers, Patricia; Oberholster, Paul; Pauw, Christiaan
Potential exposure to water and air pollution and associated health impacts of three low-income communities in the Upper Olifants River Catchment, South Africa, was investigated through a cross-sectional epidemiological study comprising a household survey. Water samples were collected and analysed for microbial indicators and pathogens. Ambient air-monitoring included some of the criteria pollutants, as well as mercury and manganese. Associations between environmental exposure and health outcomes were analysed by means of logistic regression. Despite poor water and air quality episodes, the communities' self-perceived health was good with relatively low prevalence of reported health outcomes. Hygiene practices with respect to water collection and storage were often poor, and most likely contributed to the regularly contaminated water storage containers. Community proximity to the polluted stream was associated with increased prevalence in adverse health outcomes. This paper reports on preliminary results and additional multivariate analyses are necessary to further understand study results.
Poots, Alan J.; Green, Stuart A.; Honeybourne, Emmi; Green, John; Woodcock, Thomas; Barnes, Ruth; Bell, Derek
Objective To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Design Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. Setting A psychological therapy service in Westminster, London, UK. Participants People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. Intervention(s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. Main Outcome Measure(s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Results Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = −6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories. Conclusions QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome. PMID:24521701
Schatz, Bruce R
At the core of the healthcare crisis is fundamental lack of actionable data. Such data could stratify individuals within populations to predict which persons have which outcomes. If baselines existed for all variations of all conditions, then managing health could be improved by matching the measuring of individuals to their cohort in the population. The scale required for complete baselines involves effective National Surveys of Population Health (NSPH). Traditionally, these have been focused upon acute medicine, measuring people to contain the spread of epidemics. In recent decades, the focus has moved to chronic conditions as well, which require smaller measures over longer times. NSPH have long utilized quality of life questionnaires. Mobile Health Monitors, where computing technologies eliminate manual administration, provide richer data sets for health measurement. Older technologies of telephone interviews will be replaced by newer technologies of smartphone sensors to provide deeper individual measures at more frequent timings across larger-sized populations. Such continuous data can provide personal health records, supporting treatment guidelines specialized for population cohorts. Evidence-based medicine will become feasible by leveraging hundreds of millions of persons carrying mobile devices interacting with Internet-scale services for Big Data Analytics.
Schatz, Bruce R.
Abstract At the core of the healthcare crisis is fundamental lack of actionable data. Such data could stratify individuals within populations to predict which persons have which outcomes. If baselines existed for all variations of all conditions, then managing health could be improved by matching the measuring of individuals to their cohort in the population. The scale required for complete baselines involves effective National Surveys of Population Health (NSPH). Traditionally, these have been focused upon acute medicine, measuring people to contain the spread of epidemics. In recent decades, the focus has moved to chronic conditions as well, which require smaller measures over longer times. NSPH have long utilized quality of life questionnaires. Mobile Health Monitors, where computing technologies eliminate manual administration, provide richer data sets for health measurement. Older technologies of telephone interviews will be replaced by newer technologies of smartphone sensors to provide deeper individual measures at more frequent timings across larger-sized populations. Such continuous data can provide personal health records, supporting treatment guidelines specialized for population cohorts. Evidence-based medicine will become feasible by leveraging hundreds of millions of persons carrying mobile devices interacting with Internet-scale services for Big Data Analytics. PMID:26858915
MORALES, LEO S.; LARA, MARIELENA; KINGTON, RAYNARD S.; VALDEZ, ROBERT O.; ESCARCE, JOSÉ J.
Evidence suggests that social and economic factors are important determinants of health. Yet, despite higher poverty rates, less education, and worse access to health care, health outcomes of many Hispanics living in the United States today are equal to, or better than, those of non-Hispanic whites. This paradox is described in the literature as the epidemiological paradox or Hispanic health paradox. In this paper, the authors selectively review data and research supporting the existence of the epidemiological paradox. They find substantial support for the existence of the epidemiological paradox, particularly among Mexican Americans. Census undercounts of Hispanics, misclassification of Hispanic deaths, and emigration of Hispanics do not fully account for the epidemiological paradox. Identifying protective factors underlying the epidemiological paradox, while improving access to care and the economic conditions among Hispanics, are important research and policy implications of this review. PMID:12407964
Morales, Leo S; Lara, Marielena; Kington, Raynard S; Valdez, Robert O; Escarce, José J
Evidence suggests that social and economic factors are important determinants of health. Yet, despite higher porverty rates, less education, and worse access to health care, health outcomes of many Hispanics living in the United States today are equal to, or better than, those of non-Hispanic whites. This paradox is described in the literature as the epidemiological paradox or Hispanic health paradox. In this paper, the authors selectively review data and research supporting the existence of the epidemiological paradox. They find substantial support for the existence of the epidemiological paradox, particularly among Mexican Americans. Census undercounts of Hispanics, misclassification of Hispanic deaths, and emigration of Hispanics do not fully account for the epidemiological paradox. Identifying protective factors underlying the epidemiological paradox, while improving access to care and the economic conditions among Hispanics, are important research and policy implications of this review.
Fendrick, A. Mark
Although medical innovation can reduce morbidity and mortality associated with diseases or their treatments, in most instances new interventions tend to increase the amount of resources expended on health care services. In this era of increasing cost consciousness, there is a perceived tension between the desire to improve health outcomes and the necessity to control the growth of health care costs. The dramatic changes in the organization, financing, and delivery of health care services, make it no longer acceptable to provide any and all services to every individual with only a remote probability of clinical benefit. An incentive structure which rewards the practice of cost-effective medical care is rapidly replacing the 'technological imperative' of decades past. As the expansion towards managed care continues, increasing scrutiny will be paid to the clinical and cost implications of our medical interventions.
Gaab, Jens; Kossowsky, Joe; Hasler, Sebastian; Krummenacher, Peter; Werner, Christoph; Gerger, Heike
Objective To examine whether patients’ trust in the health care professional is associated with health outcomes. Study selection We searched 4 major electronic databases for studies that reported quantitative data on the association between trust in the health care professional and health outcome. We screened the full-texts of 400 publications and included 47 studies in our meta-analysis. Data extraction and data synthesis We conducted random effects meta-analyses and meta-regressions and calculated correlation coefficients with corresponding 95% confidence intervals. Two interdependent researchers assessed the quality of the included studies using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results Overall, we found a small to moderate correlation between trust and health outcomes (r = 0.24, 95% CI: 0.19–0.29). Subgroup analyses revealed a moderate correlation between trust and self-rated subjective health outcomes (r = 0.30, 0.24–0.35). Correlations between trust and objective (r = -0.02, -0.08–0.03) as well as observer-rated outcomes (r = 0.10, -0.16–0.36) were non-significant. Exploratory analyses showed a large correlation between trust and patient satisfaction and somewhat smaller correlations with health behaviours, quality of life and symptom severity. Heterogeneity was small to moderate across the analyses. Conclusions From a clinical perspective, patients reported more beneficial health behaviours, less symptoms and higher quality of life and to be more satisfied with treatment when they had higher trust in their health care professional. There was evidence for upward bias in the summarized results. Prospective studies are required to deepen our understanding of the complex interplay between trust and health outcomes. PMID:28170443
Wright, Michelle L.; Starkweather, Angela R.; York, Timothy P.
It is well established that the environment contributes to health. However, few studies have evaluated environmental exposures in women that may influence future health of their offspring. Knowledge gained may inform nursing how to better advocate for patients and families; and provide individualized interventions and education. Therefore, a more comprehensive investigation of the maternal exposome to uncover mechanistic insight into complex disease in offspring is warranted. To advance understanding of biological mechanisms that contribute to high-risk birth outcomes and offspring predisposition to disease, it will be necessary to measure a range of exposures and biomarkers before and during pregnancy. PMID:27149232
Mauss, Fredrick J.
Pacific Northwest National Laboratory (PNNL) has developed the Captive Carry Health Monitor Unit (HMU) and the Humidity Indicator HMU. Each of these devices provides end users information that can be used to ensure the proper maintenance and performance of the missile. These two efforts have led to the ongoing development and evolution of the next generation Captive Carry HMU and the next generation Humidity Indicator HMU. These next generation efforts are in turn, leading to the future of HMUs. This evolutionary development process inherently allows for direct and indirect impact toward new HMU functionality, operability and performance characteristics by influencing their requirements, testing, communications, data archival, and user interaction. Current designs allow systems to operate in environments outside the limits of typical consumer electronics for up to or exceeding 10 years. These designs are battery powered and typically provided in custom mechanical packages that employ sensors for temperature, shock/vibration, and humidity measurements. The data taken from these sensors is then analyzed onboard using unique algorithms. The algorithms are developed from test data and fielded prototypes. Onboard data analysis provides field users with a simple indication of missile exposure. The HMU provides missile readiness information to the user based on storage and use conditions observed. To continually advance current designs PNNL evaluates the potential for enhancing sensor capabilities by improving performance or power saving features, increasing algorithm and processing abilities, and adding new features. Future work at PNNL includes the utilization of power harvesting, using a defined wireless protocol, and defining a data/information structure. These efforts will lead to improved performance allowing the HMUs to benefit users with direct access to HMUs in the field as well as benefiting those with the ability to make strategic and high-level supply and
Singh, Kavita; Bjerregaard, Peter; Man Chan, Hing
Background Since the 1990s, research has been carried out to monitor environmental contaminants and their effects on human health in the Arctic. Although evidence shows that Arctic indigenous peoples are exposed to higher levels of contaminants and do worse on several dimensions of health compared with other populations, the contribution of such exposures on adverse outcomes is unclear. Objective The purpose of this review is to provide a synopsis of the published epidemiological literature that has examined association between environmental contaminants and health outcomes in Arctic indigenous populations. Design A literature search was conducted in OVID Medline (1946-January 2014) using search terms that combined concepts of contaminant and indigenous populations in the Arctic. No language or date restrictions were applied. The reference lists of review articles were hand-searched. Results Of 559 citations, 60 studies were relevant. The studies fell under the following categories: paediatric (n=18), reproductive health (n=18), obstetrics and gynaecology (n=9), cardiology (n=7), bone health (n=2), oncology (n=2), endocrinology (n=2) and other (n=2). All studies, except one from Arctic Finland, were either from Nunavik or Greenland. Most studies assessed polychlorinated biphenyls (n=43) and organochlorine pesticides (n=29). Fewer studies examined heavy metals, perfluorinated compounds, or polybrominated diphenyl ethers. Details of study results for each health category are provided. Conclusions It is difficult to make conclusive statements about the effects of environmental contaminants on health due to mixed results, small number of studies and studies being restricted to a small number of regions. Meta-analytical synthesis of the evidence should be considered for priority contaminants and health outcomes. The following research gaps should be addressed in future studies: association of contaminants and health in other Arctic regions (i.e. Inuvialuit Settlement
Janik, Donald F.; Gholdston, Edward W.
This paper reports on the work Rocketdyne is performing in the area of power system security monitoring for space-based system health monitoring. The Integrated Power Advisory Controller, which represents a portion of a ground-based system security monitor and uses an object-oriented knowledge design, is discussed. The simulation environment used to develop and test the system is described.
Navy, the smart shirt uses optical fibers to detect bullet and shrapnel wounds, using special interconnected sensors to moni- tor the body’s vital signs ...soldier’s vital signs . The control box receives vital signs from the three-lead EKG monitor- ing system, then forwards sensed data to the SLS—a wearable ...Status Monitor (WPSM). The WPSM will provide commanders and medics with the ability to actively monitor vital signs , core temperatures, and skin
Landale, Nancy S.; Oropesa, R. S.; Llanes, Daniel; Gorman, Bridget K.
Analysis of data from the Puerto Rican Maternal and Infant Health Study found that recent migrants to the U.S. mainland experienced fewer stressful life events and engaged in fewer negative health behaviors during pregnancy than U.S.-born Puerto Rican women. Recent migrants also exhibited better infant health outcomes than childhood migrants or…
Marshall, Grant N.; And Others
Relations between self-assessed health status and satisfaction with health care were examined using two waves of data obtained from participants in the Medical Outcomes Study. Using a multisample covariance modeling framework, separate models were examined for patients with significant symptoms of depression (N=417) and patients with chronic…
Mackenbach, J D; Lakerveld, J; van Lenthe, F J; Kawachi, I; McKee, M; Rutter, H; Glonti, K; Compernolle, S; De Bourdeaudhuij, I; Feuillet, T; Oppert, J-M; Nijpels, G; Brug, J
We compared ecometric neighbourhood scores of social capital (contextual variation) to mean neighbourhood scores (individual and contextual variation), using several health-related outcomes (i.e. self-rated health, weight status and obesity-related behaviours). Data were analysed from 5,900 participants in the European SPOTLIGHT survey. Factor analysis of the 13-item social capital scale revealed two social capital constructs: social networks and social cohesion. The associations of ecometric and mean neighbourhood-level scores of these constructs with self-rated health, weight status and obesity-related behaviours were analysed using multilevel regression analyses, adjusted for key covariates. Analyses using ecometric and mean neighbourhood scores, but not mean neighbourhood scores adjusted for individual scores, yielded similar regression coefficients. Higher levels of social network and social cohesion were not only associated with better self-rated health, lower odds of obesity and higher fruit consumption, but also with prolonged sitting and less transport-related physical activity. Only associations with transport-related physical activity and sedentary behaviours were associated with mean neighbourhood scores adjusted for individual scores. As analyses using ecometric scores generated the same results as using mean neighbourhood scores, but different results when using mean neighbourhood scores adjusted for individual scores, this suggests that the theoretical advantage of the ecometric approach (i.e. teasing out individual and contextual variation) may not be achieved in practice. The different operationalisations of social network and social cohesion were associated with several health outcomes, but the constructs that appeared to represent the contextual variation best were only associated with two of the outcomes.
Orpana, H.; Vachon, J.; Dykxhoorn, J.; McRae, L.; Jayaraman, G.
Abstract Introduction: The Mental Health Strategy for Canada identified a need to enhance the collection of data on mental health in Canada. While surveillance systems on mental illness have been established, a data gap for monitoring positive mental health and its determinants was identified. The goal of this project was to develop a Positive Mental Health Surveillance Indicator Framework, to provide a picture of the state of positive mental health and its determinants in Canada. Data from this surveillance framework will be used to inform programs and policies to improve the mental health of Canadians. Methods: A literature review and environmental scan were conducted to provide the theoretical base for the framework, and to identify potential positive mental health outcomes and risk and protective factors. The Public Health Agency of Canada’s definition of positive mental health was adopted as the conceptual basis for the outcomes of this framework. After identifying a comprehensive list of risk and protective factors, mental health experts, other governmental partners and non-governmental stakeholders were consulted to prioritize these indicators. Subsequently, these groups were consulted to identify the most promising measurement approaches for each indicator. Results: A conceptual framework for surveillance of positive mental health and its determinants has been developed to contain 5 outcome indicators and 25 determinant indicators organized within 4 domains at the individual, family, community and societal level. This indicator framework addresses a data gap identified in Canada’s strategy for mental health and will be used to inform programs and policies to improve the mental health status of Canadians throughout the life course. PMID:26789022
Rojdev, Kristina; Hong, Todd; Hafermalz, Scott; Hunkins, Robert; Valle, Gerald; Toups, Larry
NASA's exploration mission is to send humans to the Moon and Mars, in which the purpose is to learn how to live and work safely in those harsh environments. A critical aspect of living in an extreme environment is habitation, and within that habitation element there are key systems which monitor the habitation environment to provide a safe and comfortable living and working space for humans. Expandable habitats are one of the options currently being considered due to their potential mass and volume efficiencies. This paper discusses a joint project between the National Science Foundation (NSF), ILC Dover, and NASA in which an expandable habitat was deployed in the extreme environment of Antarctica to better understand the performance and operations over a one-year period. This project was conducted through the Innovative Partnership Program (IPP) where the NSF provided the location at McMurdo Station in Antarctica and support at the location, ILC Dover provided the inflatable habitat, and NASA provided the instrumentation and data system for monitoring the habitat. The outcome of this project provided lessons learned in the implementation of an inflatable habitat and the systems that support that habitat. These lessons learned will be used to improve current habitation capabilities and systems to meet the objectives of exploration missions to the moon and Mars.
Honoré, Peggy A; Simoes, Eduardo J; Moonesinghe, Ramal; Kirbey, Harold C; Renner, Meg
A national movement is underway for government agencies and their program implementation partners, such as contractors and grantees, to explicitly demonstrate the benefits acquired from the expenditure of public funds. Given such expectations, agencies have adopted initiatives, such as outcomes-based contracting, as quality improvement tools to facilitate performance improvements and to document results. When using outcomes-based contracting methods, payments are linked to accomplishment of mutually agreed upon results. Outcomes are not defined in terms of what is performed, but on the impact of what has been achieved. This case study documents the implementation of some fundamental principles for outcomes-based contracting in a state health department community partnership program. Results are also presented from an interview of contractors that participated in this new contracting process. Interview objectives were to document the impact of outcomes-based contacting on building collaborations and improving accountability. Results revealed perceptions of a highly collaborative relationship between the agency and contractors where contractors viewed outcomes-based contracting as improving accountability by focusing on results, establishing and monitoring performance targets, and facilitating contractor flexibility. Respondents also indicated strongly that under this contracting method, they utilized the funding more effectively by linking it with other community investments.
Breysse, Jill; Jacobs, David E.; Weber, William; Dixon, Sherry; Kawecki, Carol; Aceti, Susan; Lopez, Jorge
Objective This study sought to determine whether renovating low-income housing using “green” and healthy principles improved resident health and building performance. Methods We investigated resident health and building performance outcomes at baseline and one year after the rehabilitation of low-income housing using Enterprise Green Communities green specifications, which improve ventilation; reduce moisture, mold, pests, and radon; and use sustainable building products and other healthy housing features. We assessed participant health via questionnaire, provided Healthy Homes training to all participants, and measured ventilation, carbon dioxide, and radon. Results Adults reported statistically significant improvements in overall health, asthma, and non-asthma respiratory problems. Adults also reported that their children's overall health improved, with significant improvements in non-asthma respiratory problems. Post-renovation building performance testing indicated that the building envelope was tightened and local exhaust fans performed well. New mechanical ventilation was installed (compared with no ventilation previously), with fresh air being supplied at 70% of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers standard. Radon was <2 picocuries per liter of air following mitigation, and the annual average indoor carbon dioxide level was 982 parts per million. Energy use was reduced by 45% over the one-year post-renovation period. Conclusions We found significant health improvements following low-income housing renovation that complied with green standards. All green building standards should include health requirements. Collaboration of housing, public health, and environmental health professionals through integrated design holds promise for improved health, quality of life, building operation, and energy conservation. PMID:21563714
Bustreo, Flavia; Harding, April; Axelsson, Henrik
The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. This article reviews the available evidence on private sector utilization and quality of care. It provides a framework for analysing the private sector's influence on child health outcomes. This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs). Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. Many governments are experimenting with strategies to engage the private sector to improve child health. The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. Few experiences are clearly described, monitored, and evaluated. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations. PMID:14997241
The Bonneville Power Administration (BPA) initiated the Augmented Fish Health Monitoring project in 1986. This project was a five year interagency project involving fish rearing agencies in the Columbia Basin. Historically, all agencies involved with fish health in the Columbia Basin were conducting various levels of fish health monitoring, pathogen screening and collection. The goals of this project were; to identify, develop and implement a standardized level of fish health methodologies, develop a common data collection and reporting format in the area of artificial production, evaluate and monitor water quality, improve communications between agencies and provide annual evaluation of fish health information for production of healthier smolts. This completion report will contain a project evaluation, review of the goals of the project, evaluation of the specific fish health analyses, an overview of highlights of the project and concluding remarks. 8 refs., 1 fig., 4 tabs.
Guyon, Agnes; Bock, Ariella; Buback, Laura; Knittel, Barbara
ABSTRACT Background: Implementing complex nutrition and other public health projects and tracking nutrition interventions, such as women's diet and supplementation and infant and young child feeding practices, requires reliable routine data to identify potential program gaps and to monitor trends in behaviors in real time. However, current monitoring and evaluation practices generally do not create an environment for this real-time tracking. This article describes the development and application of a mobile-based nutrition and health monitoring system, which collected monitoring data on project activities, women's nutrition, and infant and young child feeding practices in real time. Program Description: The Liberia Agricultural Upgrading Nutrition and Child Health (LAUNCH) project implemented a nutrition and health monitoring system between April 2012 and June 2014. The LAUNCH project analyzed project monitoring and outcome data from the system and shared selected behavioral and programmatic indicators with program managers through a short report, which later evolved into a visual data dashboard, during program-update meetings. The project designed protocols to ensure representativeness of program participants. Findings: LAUNCH made programmatic adjustments in response to findings from the monitoring system; these changes were then reflected in subsequent quarterly trends, indicating that the availability of timely data allowed for the project to react quickly to issues and adapt the program appropriately. Such issues included lack of participation in community groups and insufficient numbers of food distribution points. Likewise, the system captured trends in key outcome indicators such as breastfeeding and complementary feeding practices, linking them to project activities and external factors including seasonal changes and national health campaigns. Conclusion: Digital data collection platforms can play a vital role in improving routine programmatic functions
Meador, K J; Pennell, P B; Harden, C L; Gordon, J C; Tomson, T; Kaplan, P W; Holmes, G L; French, J A; Hauser, W A; Wells, P G; Cramer, J A
Most pregnant women with epilepsy require antiepileptic drug (AED) therapy. Present guidelines recommend optimizing treatment prior to conception, choosing the most effective AED for seizure type and syndrome, using monotherapy and lowest effective dose, and supplementing with folate. The Epilepsy Therapy Project established the international Health Outcomes in Pregnancy and Epilepsy (HOPE) forum to learn more about the impact of AEDs on the developing fetus, particularly the role of pregnancy registries in studying AED teratogenicity. The primary outcome of interest in these registries is the occurrence of major congenital malformations, with some data collected on minor malformations. Cognitive and behavioral outcomes are often beyond the timeframe for follow-up of these registries and require independent study. The HOPE consensus report describes the current state of knowledge and the limitations to interpretations of information from the various sources. Data regarding specific risks for both older and newer AEDs need to be analyzed carefully, considering study designs and confounding factors. There is a critical need for investigations to delineate the underlying mechanisms and explain the variance seen in outcomes across AEDs and within a single AED.
Beyer, Frederike; Sidarus, Nura; Bonicalzi, Sofia; Haggard, Patrick
Diffusion of responsibility across agents has been proposed to underlie decreased helping and increased aggression in group behaviour. However, few studies have directly investigated effects of the presence of other people on how we experience the consequences of our actions. This EEG study investigated whether diffusion of responsibility simply reflects a post-hoc self-serving bias, or rather has direct effects on how we process the outcomes of our actions, and our experience of agency over them. Participants made voluntary actions whose outcomes were more or less negative. Presence of another potential agent reduced participants' sense of agency over those outcomes, even though it was always obvious who caused each outcome. Further, presence of another agent reduced the amplitude of feedback-related negativity evoked by outcome stimuli, suggesting reduced outcome monitoring. The presence of other agents may lead to diffusion of responsibility by weakening the neural linkage between one's actions and their outcomes.
As the nation's healthcare information infrastructure continues to evolve, new technologies promise to provide readily accessible health information that can help people address personal and community health concerns. In particular, wearable and implantable medical sensors and portable computing devices present many opportunities for providing timely health information to health providers, public health professionals, and consumers. Concerns about privacy and information quality, however, may impede the development and deployment of these technologies for remote health monitoring. Patients may fail to apply sensors correctly, device can be stolen or compromised (exposing the medical data therein to a malicious party), low-cost sensors controlled by a capable attacker might generate falsified data, and sensor data sent to the server can be captured in the air by an eavesdropper; there are many opportunities for sensitive health data to be lost, forged, or exposed. In this paper, we design a framework for secure remote health-monitoring systems; we build a realistic risk model for sensor-data quality and propose a new health-monitoring architecture that is secure despite the weaknesses of common personal devices. For evaluation, we plan to implement a proof of concept for secure health monitoring. PMID:22910449
Lyon, Aaron R; Borntrager, Cameo; Nakamura, Brad; Higa-McMillan, Charmaine
Research and practice in school-based mental health (SBMH) typically includes educational variables only as distal outcomes, resulting from improvements in mental health symptoms rather than directly from mental health intervention. Although sometimes appropriate, this approach also has the potential to inhibit the integration of mental health and schools. The current paper applies an existing model of data-driven decision making (Daleiden & Chorpita, 2005) to detail how SBMH can better integrate routine monitoring of school and academic outcomes into four evidence bases: general services research evidence, case histories, local aggregate, and causal mechanisms. The importance of developing new consultation protocols specific to data-driven decision making in SBMH as well as supportive infrastructure (e.g., measurement feedback systems) to support the collection and use of educational data is also described.
Lassiter, John; Engberg, Robert
This viewgraph presentation provides an overview of Structural Health Monitoring (SHM), and profiles piezoelectric sensors useful for SHM of cryogenic structures. The presentation also profiles impedance tests and other SHM tests conducted at Marshall Space Flight Center (MSFC).
Das, Ipsita; Jagger, Pamela; Yeatts, Karin
In sub-Saharan Africa, biomass fuels account for approximately 90% of household energy consumption. Limited evidence exists on the association between different biomass fuels and health outcomes. We report results from a cross-sectional sample of 655 households in Malawi. We calculated odds ratios between hypothesized determinants of household air pollution (HAP) exposure (fuel, stove type, and cooking location) and five categories of health outcomes (cardiopulmonary, respiratory, neurologic, eye health, and burns). Reliance on high- or low-quality firewood or crop residue (vs. charcoal) was associated with significantly higher odds of shortness of breath, difficulty breathing, chest pains, night phlegm, forgetfulness, dizziness, and dry irritated eyes. Use of high-quality firewood was associated with significantly lower odds of persistent phlegm. Cooks in rural areas (vs. urban areas) had significantly higher odds of experiencing shortness of breath, persistent cough, and phlegm, but significantly lower odds of phlegm, forgetfulness, and burns. With deforestation and population pressures increasing reliance on low-quality biomass fuels, prevalence of HAP-related cardiopulmonary and neurologic symptoms will likely increase among cooks. Short- to medium-term strategies are needed to secure access to high-quality biomass fuels given limited potential for scalable transitions to modern energy.
Donaldson, Michael S
While there have been many studies on health outcomes that have included measurements of plasma carotenoids, this data has not been reviewed and assembled into a useful form. In this review sixty-two studies of plasma carotenoids and health outcomes, mostly prospective cohort studies or population-based case-control studies, are analyzed together to establish a carotenoid health index. Five cutoff points are established across the percentiles of carotenoid concentrations in populations, from the tenth to ninetieth percentile. The cutoff points (mean ± standard error of the mean) are 1.11 ± 0.08, 1.47 ± 0.08, 1.89 ± 0.08, 2.52 ± 0.13, and 3.07 ± 0.20 µM. For all cause mortality there seems to be a low threshold effect with protection above every cutoff point but the lowest. But for metabolic syndrome and cancer outcomes there tends to be significant positive health outcomes only above the higher cutoff points, perhaps as a triage effect. Based on this data a carotenoid health index is proposed with risk categories as follows: very high risk: <1 µM, high risk: 1-1.5 µM, moderate risk: 1.5-2.5 µM, low risk: 2.5-4 µM, and very low risk: >4 µM. Over 95 percent of the USA population falls into the moderate or high risk category of the carotenoid health index.
Summers, K H
After a brief analysis of the financial and health care motives that have led to the current boom in disease management (DM) programs, this paper discusses the pragmatic realities of a particular DM program for treating asthma. A model of the institutional structures necessary for DM to work is presented, emphasizing a process of continuous quality improvement in technical, clinical, and managerial processes. Significant differences between the conventions of controlled clinical trials and the realities of actual patient care may lead to unrealistic expectations about DM, making sound managerial practices and effective communication even more important. A "data warehouse" can help health care systems master the intricacies of programwide data collection and analysis, making possible sound decisions regarding treatment regimens and changes in physician and patient behavior. This paper concludes with a discussion of how the Prudential Health Care DM program for asthma makes use of the practices and systems discussed above.
Quality of life is widely used as a measure of individual well-being in developed countries. Social quality (SQ), however, describes how favorable the socioenvironmental components are that impact the life chance of an individual. Despite the associations between SQ, including institutional capacity and citizen capacity, and other community indicators, the impact of SQ on community health status has not been fully examined. This study investigated the interrelationships among institutional capacity, citizen capacity, and their associations with community-level health indicators such as mortality and suicide among 230 local governments in South Korea. Under the principles of conceptual suitability, clarity, reliability, consistency, changeability, and comparability, a total of 81 SQ indicators were collected, and 19 indicators of the 81 indicators were selected. The 19 indicators were transformed by the imputation of missing values, standardization, and geographic information system transformation. It was found that the health outcome of local government was superior as social welfare, political participation, and education were higher. According to the result of the regression analysis based on the regional type, social welfare had the most influence on the health level of local government in both metropolises and small-/medium-sized cities. In addition, education and political participation had a positive effect on the health indicator of local metropolis government. However, SQ indicators did not have any meaningful influence at the county level. Therefore, small- and medium-sized cities need to promote the collective health of the local government through improving social welfare, and metropolises need to consider the complex relationship among other indicators while increasing the level of social welfare and education. Meanwhile, counties need to develop health indicators that reflect aged population characteristics and social environment of rural areas
...; National Animal Health Monitoring System; Equine Herpesvirus Myeloencephalopathy Study AGENCY: Animal and... information collection for a National Animal Health Monitoring System Equine Herpesvirus Myeloencephalopathy...: National Animal Health Monitoring System; Equine Herpesvirus Myeloencephalopathy Study. OMB Number:...
Bent F. Sørensen, Ris National Laboratory 14:45 ~ 15:05 Fundamentals for Remote Condition Monitoring of Offshore Wind Turbine Blades p. 1913...11:20 ~ 11:40 A Novel MEMS Strain Sensor for Structural Health Monitoring Applications under Harsh Environmental Conditions p. 121 Matthew Malkin...Institute for Materials Research and Testing (BAM) 14:25 ~ 14:45 Integrated Monitoring Systems for Offshore Wind Turbines p. 1897 Malcolm McGugan and
De, Debashis; Mukherjee, Anwesha; Sau, Arkaprabha; Bhakta, Ishita
Automated health monitoring and alert system development is a demanding research area today. Most of the currently available monitoring and controlling medical devices are wired which limits freeness of working environment. Wireless sensor network (WSN) is a better alternative in such an environment. Neonatal intensive care unit is used to take care of sick and premature neonates. Hypothermia is an independent risk factor for neonatal mortality and morbidity. To prevent it an automated monitoring system is required. In this Letter, an automated neonatal health monitoring system is designed using sensor mobile cloud computing (SMCC). SMCC is based on WSN and MCC. In the authors' system temperature sensor, acceleration sensor and heart rate measurement sensor are used to monitor body temperature, acceleration due to body movement and heart rate of neonates. The sensor data are stored inside the cloud. The health person continuously monitors and accesses these data through the mobile device using an Android Application for neonatal monitoring. When an abnormal situation arises, an alert is generated in the mobile device of the health person. By alerting health professional using such an automated system, early care is provided to the affected babies and the probability of recovery is increased.
Monitoring and surveillance are seen as statistical procedures that will help health authorities to achieve better health services with the existing resources—monitoring being an integrated system of making observations on health and environmental factors and of scrutinizing, storing, and retrieving those data, and surveillance being a closely associated system for collating and interpreting the data. Monitoring should be an action oriented activity and may encompass a wide range of health activities, for example, communicable and noncommunicable diseases, environmental pollutants, and specific problems in health care delivery systems. Both monitoring and surveillance systems have to be related to control measures, and, since the available resources are usually limited, a scale of priorities has to be developed by the statistician in cooperation with the competent authorities. Monitoring may be performed on either the individual or aggregate level and should be planned to take into account the course of the disease under consideration: it is concerned with monitoring stimuli and events. Collection of data, for example, on exposure to a pollutant, may be continuous and automatically recorded, or regular or irregular through population sampling or registries. The statistical requirements of monitoring and surveillance systems are discussed and a checklist of features to be considered is given in an annex. PMID:310717
36 2.5.1 Histogram .............................................................. 36 2.5.2 Kernel Density Distribution...signals, oil debris, foreign object damage, and other engine health indicators, interpreting the signals and making diagnostic and prognostics decisions...detecting vibration signals, oil debris, foreign object damage, and other engine health indicators, interpreting the signals and making diagnostic and
Bass, Loretta E; Warehime, M Nicole
We use categorical and logistic regression models to investigate the extent that family structure affects children’s health outcomes at age five (i.e., child’s type of health insurance coverage, the use of a routine medical doctor, and report of being in excellent health) using a sample of 4,898 children from the "Fragile Families and Child Well-Being Study." We find that children with married biological parents are most likely to have private health insurance compared with each of three other relationship statuses. With each additional child in the home, a child is less likely to have private insurance compared with no insurance and Medicaid insurance. Children with cohabiting biological parents are less likely to have a routine doctor compared with children of married biological parents, yet having additional children in the household is not associated with having a routine doctor. Children with biological parents who are not romantically involved and those with additional children in the household are less likely to be in excellent health, all else being equal.
Nelson-Peterman, Jerusha L; Toof, Robin; Liang, Sidney L; Grigg-Saito, Dorcas C
Refugees in the United States have high rates of chronic disease. Both long-term effects of the refugee experience and adjustment to the U.S. health environment may contribute. While there is significant research on health outcomes of newly resettled refugees and long-term mental health experiences of established refugees, there is currently little information about how the combined effects of the refugee experience and the U.S. health environment are related to health practices of refugees in the years and decades after resettlement. We examined cross-sectional survey data for Cambodian refugee and immigrant women 35 to 60 years old (n = 160) from an established refugee community in Lowell, Massachusetts, to examine the potential contributors to health behaviors and outcomes among refugees and immigrants postresettlement. In our representative sample, we found that smoking and betel nut use were very low (4% each). Fewer than 50% of respondents walked for at least 10 minutes on 2 or more days/week. Using World Health Organization standards for overweight/obese for Asians, 73% of respondents were overweight/obese and 56% were obese, indicating increased risk of chronic disease. Depression was also high in this sample (41%). In multivariate models, higher acculturation and age were associated with walking more often; lower education and higher acculturation were related to higher weight; and being divorced/separated or widowed and being older were related to higher risk of depression. The interrelated complex of characteristics, health behaviors, and health outcomes of refugees merits a multifaceted approach to health education and health promotion for long-term refugee health.
Pantelopoulos, Alexandros; Bourbakis, Nikolaos
Wearable biosensor systems for health monitoring are an emerging trend and are expected to enable proactive personal health management and better treatment of various medical conditions. These systems, comprising various types of small physiological sensors, transmission modules and processing capabilities, promise to change the future of health care, by providing low-cost wearable unobtrusive solutions for continuous all-day and any-place health, mental and activity status monitoring. This paper presents a comprehensive survey on the research and development done so far on wearable biosensor systems for health-monitoring, by comparing a variety of current system implementations and approaches and identifying their technological shortcomings. A set of significant features, that best describe the functionality and the characteristics of wearable biosensor systems, has been selected to derive a thorough study. The aim of this survey is not to criticize, but to serve as a reference for current achievements and their maturity level and to provide direction for future research improvements.
Schulz, Heiko; Zacher, Hannes; Lippke, Sonia
Occupational health researchers and practitioners have mainly focused on the individual and organizational levels, whereas the team level has been largely neglected. In this study, we define team health climate as employees' shared perceptions of the extent to which their team is concerned, cares, and communicates about health issues. Based on climate, signaling, and social exchange theories, we examined a multilevel model of team health climate and its relationships with five well-established health-related outcomes (i.e., subjective general health, psychosomatic complaints, mental health, work ability, and presenteeism). Results of multilevel analyses of data provided by 6,449 employees in 621 teams of a large organization showed that team health climate is positively related to subjective general health, mental health, and work ability, and negatively related to presenteeism, above and beyond the effects of team size, age, job tenure, job demands, job control, and employees' individual perceptions of health climate. Moreover, additional analyses showed that a positive team health climate buffered the negative relationship between employee age and work ability. Implications for future research on team health climate and suggestions for occupational health interventions in teams are discussed.
Schulz, Heiko; Zacher, Hannes; Lippke, Sonia
Occupational health researchers and practitioners have mainly focused on the individual and organizational levels, whereas the team level has been largely neglected. In this study, we define team health climate as employees’ shared perceptions of the extent to which their team is concerned, cares, and communicates about health issues. Based on climate, signaling, and social exchange theories, we examined a multilevel model of team health climate and its relationships with five well-established health-related outcomes (i.e., subjective general health, psychosomatic complaints, mental health, work ability, and presenteeism). Results of multilevel analyses of data provided by 6,449 employees in 621 teams of a large organization showed that team health climate is positively related to subjective general health, mental health, and work ability, and negatively related to presenteeism, above and beyond the effects of team size, age, job tenure, job demands, job control, and employees’ individual perceptions of health climate. Moreover, additional analyses showed that a positive team health climate buffered the negative relationship between employee age and work ability. Implications for future research on team health climate and suggestions for occupational health interventions in teams are discussed. PMID:28194126
Background The clinical characteristics distinguishing treatable thiamine transporter-2 deficiency (ThTR2) due to SLC19A3 genetic defects from the other devastating causes of Leigh syndrome are sparse. Methods We report the clinical follow-up after thiamine and biotin supplementation in four children with ThTR2 deficiency presenting with Leigh and biotin-thiamine-responsive basal ganglia disease phenotypes. We established whole-blood thiamine reference values in 106 non-neurological affected children and monitored thiamine levels in SLC19A3 patients after the initiation of treatment. We compared our results with those of 69 patients with ThTR2 deficiency after a review of the literature. Results At diagnosis, the patients were aged 1 month to 17 years, and all of them showed signs of acute encephalopathy, generalized dystonia, and brain lesions affecting the dorsal striatum and medial thalami. One patient died of septicemia, while the remaining patients evidenced clinical and radiological improvements shortly after the initiation of thiamine. Upon follow-up, the patients received a combination of thiamine (10–40 mg/kg/day) and biotin (1–2 mg/kg/day) and remained stable with residual dystonia and speech difficulties. After establishing reference values for the different age groups, whole-blood thiamine quantification was a useful method for treatment monitoring. Conclusions ThTR2 deficiency is a reversible cause of acute dystonia and Leigh encephalopathy in the pediatric years. Brain lesions affecting the dorsal striatum and medial thalami may be useful in the differential diagnosis of other causes of Leigh syndrome. Further studies are needed to validate the therapeutic doses of thiamine and how to monitor them in these patients. PMID:24957181
Introduction Based on the knowledge that traumatic brainstem damage often leads to alteration in brainstem functions, including the vestibulo-ocular reflex, the present study is designed to determine whether prediction of outcome in the early phase after severe traumatic brain injury is possible by means of vestibulo-ocular monitoring. Methods Vestibulo-ocular monitoring is based on video-oculographic recording of eye movements during galvanic labyrinth polarization. The integrity of vestibulo-ocular reflex is determined from the eye movement response during vestibular galvanic labyrinth polarization stimulation. Vestibulo-ocular monitoring is performed within three days after traumatic brain injury and the oculomotor response compared to outcome after six months (Glasgow Outcome Score). Results Twenty-seven patients underwent vestibulo-ocular monitoring within three days after severe traumatic brain injury. One patient was excluded from the study. In 16 patients oculomotor response was induced, in the remaining 11 patients no oculomotor response was observed. The patients' outcome was classified as Glasgow Outcome Score 1-2 or as Glasgow Outcome Score 3 to 5. Statistical testing supported the hypothesis that those patients with oculomotor response tended to recover (exact two-sided Fisher-Test (P < 10-3)). Conclusions The results indicate that vestibulo-ocular monitoring with galvanic labyrinth polarization performed during the first days after traumatic brain injury helps to predict favourable or unfavourable outcome. As an indicator of brainstem function, vestibulo-ocular monitoring provides a useful, complementary approach to the identification of brainstem lesions by imaging techniques. PMID:19948056
The experience of poverty during childhood is a potent predictor of a variety of adverse health outcomes during middle and late adulthood. Children who live in poverty are more likely as adults than their peers to develop and die earlier from a range of diseases. These effects are especially strong for cardiovascular disease and type II diabetes. Most disturbingly, these effects appear in large part to be biologically embedded such that later improved life circumstances have only a modest ameliorative effect. Considering these findings and the relatively high rates of child poverty in nations such as Canada, UK, and USA, those concerned with improving the health of citizens should focus their attention on advocating for public policy that will reduce the incidence of child poverty.
Attention-deficit/hyperactivity disorder (ADHD) is defined by extreme levels of inattention–disorganization and/or hyperactivity–impulsivity. In DSM-IV, the diagnostic criteria required impairment in social, academic, or occupational functioning. With DSM-5 publication imminent in 2013, further evaluation of impairment in ADHD is timely. This article reviews the current state of knowledge on health-related impairments of ADHD, including smoking, drug abuse, accidental injury, sleep, obesity, hypertension, diabetes, and suicidal behavior. It concludes by suggesting the need for new avenues of research on mechanisms of association and the potential for ADHD to be an early warning sign for secondary prevention of some poor health outcomes. PMID:23298633
Deola, Claudio; Patel, Ronak B
With urbanisation, cities are increasingly home to greater proportions of the world's population. As this transition has significant implications on human health, the epidemiology of diseases among relatively stable urban populations is growing. As humanitarian crises increasingly drive people to urban centers rather than traditional refugee camps, however, rapid and massive urban displacements will increase in frequency. This paper explores the idea that such urban displacements combine epidemiological features of forced migration, slum conditions and humanitarian disaster contexts. This paper highlights the lack of primary data and the consequent paucity of solid epidemiological literature in the aftermath of rapid massive urban displacements. A framework of health outcomes in urban displacement drawing from the above 3 phenomenon is presented and avenues for improved epidemiologic work described. PMID:28229003
O'Sullivan, Lucia F
New digital technologies are highly responsive to many of the developmental needs of adolescents, including their need for intimate connection and social identity. This chapter explores adolescents' use of web-based sexual information, texting and "sexting," online dating sites, role-playing games, and sexually explicit media, and presents new data comparing the interpersonal and intrapersonal health outcomes among youth who engage in online sexual activities to those who do not. Despite the media-stoked concerns surrounding adolescents' participation in online sexual activities, the ubiquity of online activities and close overlap between online and offline activities indicate that this type of behavior should not be pathologized or used as a metric of problem behavior. The chapter concludes with implications for parents, educators, researchers, counselors, and health care providers, a call to challenge our deep discomfort around adolescent sexuality and to harness these technologies in ways that help promote growth and positive development.
Deola, Claudio; Patel, Ronak B
With urbanisation, cities are increasingly home to greater proportions of the world's population. As this transition has significant implications on human health, the epidemiology of diseases among relatively stable urban populations is growing. As humanitarian crises increasingly drive people to urban centers rather than traditional refugee camps, however, rapid and massive urban displacements will increase in frequency. This paper explores the idea that such urban displacements combine epidemiological features of forced migration, slum conditions and humanitarian disaster contexts. This paper highlights the lack of primary data and the consequent paucity of solid epidemiological literature in the aftermath of rapid massive urban displacements. A framework of health outcomes in urban displacement drawing from the above 3 phenomenon is presented and avenues for improved epidemiologic work described.
Glenn Research Center awarded SBIR funding to Ann Arbor, Michigan-based Evigia Systems to develop a miniaturized accelerometer to account for gravitational effects in space experiments. The company has gone on to implement the technology in its suite of prognostic sensors, which are used to monitor the integrity of industrial machinery. As a result, five employees have been hired.
Based on a land-cover classification from NASA’s MODerate resolution Imaging Spectroradiometer (MODIS), rangelands cover 48% of the Earth’s land surface, not including Antarctica. Nearly all analyses imply the most economical means of monitoring large areas of rangelands worldwide is with remote s...
Chang, Serena; Kohrt, Holbrook; Maecker, Holden T.
A new era of cancer immunotherapy has brought not only successful cancer vaccines but also immunomodulators, such as those that target checkpoint blockade in order to induce endogenous host immune responses. However, the immune system of cancer patients can be compromised through multiple means, including immune suppression by the tumor and by prior therapies such as chemotherapy and radiation. Therefore, a comprehensive means of assessing patient immunocompetence would seem helpful for determining whether patients are ready to benefit from immunotherapy, and perhaps even which immunotherapy might be most appropriate for them. Unfortunately, there are no standardized tests for immune competence, nor is there agreement on what to measure and what will be predictive of outcome. In this review, we will discuss the technologies and assays that might be most useful for this purpose. We argue for a comprehensive approach that should maximize the chances of developing predictive biomarkers for eventual clinical use. PMID:24487923
Bowen, Anthony; Casadevall, Arturo
Society makes substantial investments in biomedical research, searching for ways to better human health. The product of this research is principally information published in scientific journals. Continued investment in science relies on society’s confidence in the accuracy, honesty, and utility of research results. A recent focus on productivity has dominated the competitive evaluation of scientists, creating incentives to maximize publication numbers, citation counts, and publications in high-impact journals. Some studies have also suggested a decreasing quality in the published literature. The efficiency of society’s investments in biomedical research, in terms of improved health outcomes, has not been studied. We show that biomedical research outcomes over the last five decades, as estimated by both life expectancy and New Molecular Entities approved by the Food and Drug Administration, have remained relatively constant despite rising resource inputs and scientific knowledge. Research investments by the National Institutes of Health over this time correlate with publication and author numbers but not with the numerical development of novel therapeutics. We consider several possibilities for the growing input-outcome disparity including the prior elimination of easier research questions, increasing specialization, overreliance on reductionism, a disproportionate emphasis on scientific outputs, and other negative pressures on the scientific enterprise. Monitoring the efficiency of research investments in producing positive societal outcomes may be a useful mechanism for weighing the efficacy of reforms to the scientific enterprise. Understanding the causes of the increasing input-outcome disparity in biomedical research may improve society’s confidence in science and provide support for growing future research investments. PMID:26283360
Frank, John; Haw, Sally
Context In this article we present “best practice” guidelines for monitoring socioeconomic inequalities in health status in the general population, using routinely collected data. Methods First, we constructed a set of critical appraisal criteria to assess the utility of routinely collected outcomes for monitoring socioeconomic inequalities in population health status, using epidemiological principles to measure health status and quantify health inequalities. We then selected as case studies three recent “cutting-edge” reports on health inequalities from the Scottish government and assessed the extent to which each of the following outcomes met our critical appraisal criteria: natality (low birth weight rate, LBW), adult mortality (all-cause, coronary heart disease [CHD], alcohol-related, cancer, and healthy life expectancy at birth), cancer incidence, and mental health and well-being. Findings The critical appraisal criteria we derived were “completeness and accuracy of reporting”; “reversibility and sensitivity to intervention”; “avoidance of reverse causation”; and “statistical appropriateness.” Of these, the most commonly unmet criterion across the routinely collected outcomes was “reversibility and sensitivity to intervention.” The reasons were that most mortality events occur in later life and that the LBW rate has now become obsolete as a sole indicator of perinatal health. Other outcomes were also judged to fail other criteria, notably alcohol-related mortality after midlife (“avoidance of reverse causation”); all cancer sites’ incidence and mortality (statistical appropriateness due largely to heterogeneity of SEP gradients across different cancer sites, as well as long latency); and mental health and well-being (“uncertain reversibility and sensitivity to intervention”). Conclusions We conclude that even state-of-the-art data reports on health inequalities by SEP have only limited usefulness for most health and social
Love, Thomas E.; Jehi, Lara E.; Ferguson, Lisa; Yardi, Ruta; Najm, Imad; Bingaman, William; Gonzalez-Martinez, Jorge
Objectives: The objective of this cohort study was to compare neuropsychological outcomes following left temporal lobe resection (TLR) in patients with epilepsy who had or had not undergone prior invasive monitoring. Methods: Data were obtained from an institutional review board–approved, neuropsychology registry for patients who underwent epilepsy surgery at Cleveland Clinic between 1997 and 2013. A total of 176 patients (45 with and 131 without invasive EEG) met inclusion criteria. Primary outcome measures were verbal memory and language scores. Other cognitive outcomes were also examined. Outcomes were assessed using difference in scores from before to after surgery and by presence/absence of clinically meaningful decline using reliable change indices (RCIs). Effect of invasive EEG on cognitive outcomes was estimated using weighting and propensity score adjustment to account for differences in baseline characteristics. Linear and logistic regression models compared surgical groups on all cognitive outcomes. Results: Patients with invasive monitoring showed greater declines in confrontation naming; however, when RCIs were used to assess clinically meaningful change, there was no significant treatment effect on naming performance. No difference in verbal memory was observed, regardless of how the outcome was measured. In secondary outcomes, patients with invasive monitoring showed greater declines in working memory, which were no longer apparent using RCIs to define change. There were no outcome differences on other cognitive measures. Conclusions: Results suggest that invasive EEG monitoring conducted prior to left TLR is not associated with greater cognitive morbidity than left TLR alone. This information is important when counseling patients regarding cognitive risks associated with this elective surgery. PMID:26408491
Kenning, Cassandra; Coventry, Peter A; Gibbons, Chris; Bee, Penny; Fisher, Louise; Bower, Peter
Background. There is a need to better understand the mechanisms which lead to poor outcomes in patients with multimorbidity, especially those factors that might be amenable to intervention. Objective. This research aims to explore what factors predict self-management behaviour and health outcomes in patients with multimorbidity in primary care in the UK. Methods. A prospective study design was used. Questionnaires were mailed out to 1460 patients with multimorbidity. Patients were asked to complete a range of self-report measures including measures of multimorbidity, measures of their experience of multimorbidity and service delivery and outcomes (three measures of self-management: behaviours, Self-monitoring and Insight and medication adherence; and a measure of self-reported health). Results. In total, 36% (n = 499) of patients responded to the baseline survey and 80% of those respondents completed follow-up. Self-management behaviour at 4 months was predicted by illness perceptions around the consequences of individual conditions. Self-monitoring and Insight at 4 months was predicted by patient experience of ‘Hassles’ in health services. Self-reported medication adherence at 4 months was predicted by health status, Self-monitoring and Insight and ‘Hassles’ in health services. Perceived health status at 4 months was predicted by age and patient experience of multimorbidity. Conclusions. This research shows that different factors, particularly around patients’ experiences of health care and control over their treatment, impact on various types of self-management. Patient experience of multimorbidity was not a critical predictor of self-management but did predict health status in the short term. The findings can help to develop and target interventions that might improve outcomes in patients with multimorbidity. PMID:25715962
Currie, Janet; Stabile, Mark; Manivong, Phongsack; Roos, Leslie L.
Previous research has shown a strong connection between birth weight and future child outcomes. But this research has not asked how insults to child health after birth affect long-term outcomes, whether health at birth matters primarily because it predicts future health or through some other mechanism, or whether health insults matter more at some…
Boerma, Ties; AbouZahr, Carla; Evans, David; Evans, Tim
Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of
Gruszfeld, Dariusz; Socha, Piotr
Maternal diet, nutritional status during pregnancy, and the early diet of the offspring play an important role in later health. The short- and long-term outcomes of early nutrition have been extensively studied in recent decades. One of the most commonly investigated nutritional interventions is breastfeeding, which is associated with a number of positive short- and long-term outcomes. A short-term effect of breastfeeding is reduced morbidity and mortality in children from poor living conditions and in preterm infants. Breastfeeding is associated with better cognitive development and also has a long-term protective effect on obesity risk, prevalence of type 2 diabetes, and a lowering effect on blood pressure. Selected nutrients have undergone extensive investigation to show their role in disease prevention or improved development, e.g. protein intake in infancy seems to be associated with a later risk of obesity or docosahexaenoic acid supplementation has a positive impact on cognitive function. Another consideration is the fast catch-up growth in small for gestational age infants as an important factor associated with adult risk of cardiovascular problems. On the other hand, high protein and energy intake seems to be positively associated with some indicators of cognitive development. Most of the evidence comes from observational studies that cannot exclude potential confounders. Animal studies demonstrate causality but should not be directly extrapolated to humans. The number of randomized controlled studies is increasing but long-term follow-ups are necessary to obtain convincing results. The majority of these trials compare different infant formula compositions and macro- or micronutrient supplementation. One of the major questions is to define a critical (or opportunity) window and a mechanism of nutritional influence on several health outcomes.
Santi, L. Michael; Sowers, T. Shane; Aguilar, Robert B.
Sensor data are the basis for performance and health assessment of most complex systems. Careful selection and implementation of sensors is critical to enable high fidelity system health assessment. A model-based procedure that systematically selects an optimal sensor suite for overall health assessment of a designated host system is described. This procedure, termed the Systematic Sensor Selection Strategy (S4), was developed at NASA John H. Glenn Research Center in order to enhance design phase planning and preparations for in-space propulsion health management systems (HMS). Information and capabilities required to utilize the S4 approach in support of design phase development of robust health diagnostics are outlined. A merit metric that quantifies diagnostic performance and overall risk reduction potential of individual sensor suites is introduced. The conceptual foundation for this merit metric is presented and the algorithmic organization of the S4 optimization process is described. Representative results from S4 analyses of a boost stage rocket engine previously under development as part of NASA's Next Generation Launch Technology (NGLT) program are presented.
Background Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables. Methods A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index. Results The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant. Conclusions Despite the adverse contextual conditions and the limitations imposed by the Colombian health
Avey, Holly; Matheny, Kenneth B.; Robbins, Anna; Jacobson, Terry A.
In order to assess health care providers' training, perceptions, and practices regarding stress and health outcomes, a survey was administered to primary care providers in the outpatient medical clinics of a southeastern urban hospital serving a predominantly African-American indigent population. One-hundred-fifty-one of 210 providers (72%) responded. Forty-two percent of respondents reported receiving no instruction regarding stress and health outcomes during their medical/professional education. While 90% believed stress management was "very" or "somewhat" effective in improving health outcomes, 45% "rarely" or "never" discussed stress management with their patients. Respondents were twice as likely to believe that counseling patients about smoking, nutrition, or exercise was more important than counseling them about stress. Seventy-six percent lacked confidence in their ability to counsel patients about stress. The majority of respondents (57%) "rarely" or "never" practiced stress reduction techniques themselves. Belief in the importance of stress counseling, its effectiveness in improving health, and confidence in one's ability to teach relaxation techniques were all related to the probability that providers would counsel patients regarding stress. There is a need for curriculum reform that emphasizes new knowledge about stress and disease, new skills in stress reduction, and more positive beliefs about mind/body medicine and its integration into the existing health care structure. PMID:14527051
de Jong, Kaz; Ariti, Cono; van der Kam, Saskia; Mooren, Trudy; Shanks, Leslie; Pintaldi, Giovanni; Kleber, Rolf
Existing tools for evaluating psychosocial interventions (un-validated self-reporting questionnaires) are not ideal for use in non-Western conflict settings. We implement a generic method of treatment evaluation, using client and counsellor feedback, in 18 projects in non-Western humanitarian settings. We discuss our findings from the perspective of validity and suggestions for future research. A retrospective analysis is executed using data gathered from psychosocial projects. Clients (n = 7,058) complete two (complaints and functioning) rating scales each session and counsellors rate the client’s status at exit. The client-completed pre- and post-intervention rating scales show substantial changes. Counsellor evaluation of the clients’ status shows a similar trend in improvement. All three multivariable models for each separate scale have similar associations between the scales and the investigated variables despite different cultural settings. The validity is good. Limitations are: ratings give only a general impression and clinical risk factors are not measured. Potential ceiling effects may influence change of scales. The intra and inter-rater reliability of the counsellors’ rating is not assessed. The focus on client and counsellor perspectives to evaluate treatment outcome seems a strong alternative for evaluation instruments frequently used in psychosocial programming. The session client rated scales helps client and counsellor to set mutual treatment objectives and reduce drop-out risk. Further research should test the scales against a cross-cultural valid gold standard to obtain insight into their clinical relevance. PMID:27315263
Ports, Katie A; Reddy, Diane M; Barnack-Tavlaris, Jessica L
Research in primary care medicine demonstrates that health care providers' communication varies depending on their sex, and that these sex differences in communication can influence patients' health outcomes. The present study aimed to examine the extent to which sex differences in primary care providers' communication extend to the sensitive context of gynecological care for genital herpes and whether these potential sex differences in communication influence patients' herpes transmission prevention behaviors and herpes-related quality of life. Women (N = 123) from the United States recently diagnosed with genital herpes anonymously completed established measures in which they rated (a) their health care providers' communication, (b) their herpes transmission prevention behaviors, and (c) their herpes-related quality of life. The authors found significant sex differences in health care providers' communication; this finding supports that sex differences in primary care providers' communication extend to gynecological care for herpes. Specifically, patients with female health care providers indicated that their providers engaged in more patient-centered communication and were more satisfied with their providers' communication. However, health care providers' sex did not predict women's quality of life, a finding that suggests that health care providers' sex alone is of little importance in patients' health outcomes. Patient-centered communication was significantly associated with greater quality-of-life scores and may provide a promising avenue for intervention.
Brown, Tyson H.; O’Rand, Angela M.; Adkins, Daniel E.
Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories. PMID:22940814
Hamdy, Freddie C; Donovan, Jenny L; Lane, J Athene; Mason, Malcolm; Metcalfe, Chris; Holding, Peter; Davis, Michael; Peters, Tim J; Turner, Emma L; Martin, Richard M; Oxley, Jon; Robinson, Mary; Staffurth, John; Walsh, Eleanor; Bollina, Prasad; Catto, James; Doble, Andrew; Doherty, Alan; Gillatt, David; Kockelbergh, Roger; Kynaston, Howard; Paul, Alan; Powell, Philip; Prescott, Stephen; Rosario, Derek J; Rowe, Edward; Neal, David E
Background The comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain. Methods We compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths. Results There were 17 prostate-cancer-specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P=0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P=0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P=0.004 for the overall comparison). Higher rates of disease progression were seen in the active-monitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7 to 12.0) (P<0
de Rezende, Leandro Fornias Machado; Rodrigues Lopes, Maurício; Rey-López, Juan Pablo; Matsudo, Victor Keihan Rodrigues; Luiz, Olinda do Carmo
Objective 1) To synthesize the current observational evidence for the association between sedentary behavior and health outcomes using information from systematic reviews. 2) To assess the methodological quality of the systematic reviews found. Methodology/Principal Findings Medline; Excerpta Medica (Embase); PsycINFO; and Web of Science were searched for reviews published up to September 2013. Additional publications were provided by Sedentary Behaviour Research Network members. The methodological quality of the systematic reviews was evaluated using recommended standard criteria from AMSTAR. For each review, improper use of causal language in the description of their main results/conclusion was evaluated. Altogether, 1,044 review titles were identified, 144 were read in their entirety, and 27 were included. Based on the systematic reviews with the best methodological quality, we found in children and adolescents, strong evidence of a relationship between time spent in sedentary behavior and obesity. Moreover, moderate evidence was observed for blood pressure and total cholesterol, self-esteem, social behavior problems, physical fitness and academic achievement. In adults, we found strong evidence of a relationship between sedentary behavior and all-cause mortality, fatal and non-fatal cardiovascular disease, type 2 diabetes and metabolic syndrome. In addition, there is moderate evidence for incidence rates of ovarian, colon and endometrial cancers. Conclusions This overview based on the best available systematics reviews, shows that sedentary behavior may be an important determinant of health, independently of physical activity. However, the relationship is complex because it depends on the type of sedentary behavior and the age group studied. The relationship between sedentary behavior and many health outcomes remains uncertain; thus, further studies are warranted. PMID:25144686
CPI's spinoff from miniaturized pace circuitry is the new heart-assist device, the AID implantable automatic pulse generator. AID pulse generator monitors the heart continuously, recognizes onset of fibrillation, then administers a corrective electrical shock. A mini- computer, a power source, and two electrodes which sense heart activity are included in the unit. An associated system was also developed. It includes an external recorder to be worn by AID patients and a physician's console to display the data stored by the recorder. System provides a record of fibrillation occurrences and the ensuing defibrillation.
Cohen, Beth E.; Maguen, Shira; Bertenthal, Daniel; Shi, Ying; Jacoby, Vanessa; Seal, Karen H.
Background An increasing number of women serve in the military and are exposed to trauma during service that can lead to mental health problems. Understanding how these mental health problems affect reproductive and physical health outcomes will inform interventions to improve care for women veterans. Methods We analyzed national VA data from women Iraq and Afghanistan veterans who were new users of VA healthcare from 10/7/2001 through 12/31/2010 (N=71,504). We used ICD-9 codes to categorize veterans into 5 groups by mental health diagnoses (MH Dx), those with: no MH Dx, PTSD, depression, comorbid PTSD and depression, and MH Dx other than PTSD and depression. We determined the association between mental health category and reproductive and other physical health outcomes defined by ICD-9 codes. Categories included sexually transmitted infections, other infections (e.g. urinary tract infections), pain-related conditions (e.g. dysmenorrhea and dsypareunia), and other conditions (e.g. polycystic ovarian syndrome, infertility, sexual dysfunction). Models were adjusted for sociodemographics and military service factors. Results 31,481 (44%) received at least one mental health diagnosis. Women veterans with any mental health diagnosis had significantly higher prevalences of nearly all categories of reproductive and physical disease diagnoses (p <.0001 for adjusted prevalences). There was a trend of increasing prevalence of disease outcomes in women with PTSD, depression, and comorbid PTSD and depression (p for trend <.0001 for all outcomes). Conclusions Iraq and Afghanistan women veterans with mental health diagnoses had significantly greater prevalences of several important reproductive and physical health diagnoses. These results provide support for VA initiatives to address mental and physical health concerns and improve comprehensive care for women veterans. PMID:22944901
Sun, L. M.; Yu, G.
The recent engineering implementation of health monitoring system for long span bridges show difficulties for precisely assessing structural physical condition as well as for accurately alarming on structural damages, although hundreds of sensors were installed on a structure and a great amount of data were collected from the monitoring system. The allocation of sensors and the alarming algorithm are still two of the most important tasks to be considered when designing the structural health monitoring system. Vulnerability, in its original meaning, is the system susceptibility to local damage. For a structural system, the vulnerability can thus be regarded as structural performance susceptibility to local damage of structure. The purpose of this study is to propose concepts and methods of structural vulnerability for determining monitoring components which are more vulnerable than others and the corresponding warning threshold once the damages occur. The structural vulnerability performances to various damage scenarios depend upon structural geometrical topology, loading pattern on the structure and the degradation of component performance. A two-parameters structural vulnerability evaluation method is proposed in this paper. The parameters are the damage consequence and the relative magnitude of the damage scenarios to the structural system, respectively. Structural vulnerability to various damage scenarios can be regarded as the tradeoff between the two parameters. Based on the results of structural vulnerability analysis, the limited structural information from health monitoring can be utilized efficiently. The approach of the design of bridge health monitoring system is illustrated for a cable-stayed bridge.
Nevers, Meredith B.; Byappanahalli, Muruleedhara N.; Whitman, Richard L.
With the recent release of new recreational water quality monitoring criteria, there are more options for regulatory agencies seeking to protect beachgoers from waterborne pathogens. Included are methods that can reduce analytical time, providing timelier estimates of water quality, but the application of these methods has not been examined at most beaches for expectation of health risk and management decisions. In this analysis, we explore health and monitoring outcomes expected at Lake Michigan beaches using protocols for indicator bacteria including culturable Escherichia coli (E. coli; EC), culturable enterococci (ENT), and enterococci as analyzed by qPCR (QENT). Correlations between method results were generally high, except at beaches with historically high concentrations of EC. The “beach action value” was exceeded most often when using EC or ENT as the target indicator; QENT exceeded the limit far less frequently. Measured water quality between years was varied. Although methods with equivalent health expectation have been established, the lack of relationship among method outcomes and annual changes in mean indicator bacteria concentrations complicates the decision-making process. The monitoring approach selected by beach managers may be a combination of available tools that maximizes timely health protection, cost efficiency, and collaboration among beach jurisdictions.
Hashemian, H. M.; Shumaker, B. D.; McCulley, J. R.; Morton, G. W.
Based on such criteria as safety and mission success, programmatic risk, affordability, and extensibility/flexibility, the National Aeronautics and Space Administration (NASA) has chosen fission surface power (FSP) as the primary energy source for building a sustained human presence on the Moon, exploring Mars, and extremely long-duration space missions. The current benchmark FSP system has a mission life of at least 8 years during which time there is no opportunity for repair, sensor calibrations, or periodic maintenance tasks that are normally performed on terrestrial-based nuclear power plants during scheduled outages. Current technology relies heavily on real-time human interaction, monitoring and control. However; due to the long communication times between the Earth and Moon, or Mars, real-time human control is not possible, resulting in a critical need to develop autonomous health monitoring technology for FSP systems.This paper describes the design and development of an autonomous health monitoring system that will (1) provide on-line calibration monitoring, (2) reduce uncertainties in sensor measurements, and (3) provide sensor validation and fault detection capabilities for the control systems of various FSP subsystems. The health monitoring system design integrates a number of signal processing algorithms and techniques such as cross-calibration, empirical modeling using neural networks, and physical modeling under a modular signal processing platform that will enable robust sensor and system monitoring without the need for human interaction. Prototypes of the health monitoring system have been tested and validated on data acquired from preliminary subsystem testing of NASA's FSP Technology Demonstration Unit (TDU) as well as simulated laboratory data. Results from this testing have demonstrated the utility and benefits that such autonomous health monitoring systems can provide to FSP subsystems and other potential applications within NASA such as launch
Abdul-Aziz, Ali; Woike, Mark R.; Abumeri, G.; Lekki, John D.; Baaklini, George Y.
Rotor health monitoring and on-line damage detection have been increasingly gaining interest to manufacturers of aircraft engines, primarily to increase safety of operation and lower the high maintenance costs. But health monitoring in the presence of scatter in the loading conditions, crack size, disk geometry, and material property is rather challenging. However, detection factors that cause fractures and hidden internal cracks can be implemented via noninvasive types of health monitoring and or nondestructive evaluation techniques. These evaluations go further to inspect materials discontinuities and other anomalies that have grown to become critical defects that can lead to failure. To address the bulk of these concerning issues and understand the technical aspects leading to these outcomes, a combined analytical and experimental study is being thought. Results produced from the experiments such as blade tip displacement and other data collected from tests conducted at the NASA Glenn Research Center's Rotordynamics Laboratory, a high precision spin rig, are evaluated, discussed and compared with data predicted from finite element analysis simulating the engine rotor disk spinning at various rotational speeds. Further computations using the progressive failure analysis (PFA) approach with GENOA code  to additionally assess the structural response, damage initiation, propagation, and failure criterion are also performed. This study presents an inclusive evaluation of an on-line health monitoring of a rotating disk and an examination for the capability of the in-house spin system in support of ongoing research under the NASA Integrated Vehicle Health Management (IVHM) program.
Johnson, Owen A; Hall, Peter S; Hulme, Claire
Many healthcare organizations are now making good use of electronic health record (EHR) systems to record clinical information about their patients and the details of their healthcare. Electronic data in EHRs is generated by people engaged in complex processes within complex environments, and their human input, albeit shaped by computer systems, is compromised by many human factors. These data are potentially valuable to health economists and outcomes researchers but are sufficiently large and complex enough to be considered part of the new frontier of 'big data'. This paper describes emerging methods that draw together data mining, process modelling, activity-based costing and dynamic simulation models. Our research infrastructure includes safe links to Leeds hospital's EHRs with 3 million secondary and tertiary care patients. We created a multidisciplinary team of health economists, clinical specialists, and data and computer scientists, and developed a dynamic simulation tool called NETIMIS (Network Tools for Intervention Modelling with Intelligent Simulation; http://www.netimis.com ) suitable for visualization of both human-designed and data-mined processes which can then be used for 'what-if' analysis by stakeholders interested in costing, designing and evaluating healthcare interventions. We present two examples of model development to illustrate how dynamic simulation can be informed by big data from an EHR. We found the tool provided a focal point for multidisciplinary team work to help them iteratively and collaboratively 'deep dive' into big data.
Guerrero, Erick G.; Aarons, Gregory; Grella, Christine; Garner, Bryan R.; Cook, Benjamin; Vega, William A.
We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010–2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed. PMID:25450596
Zhao, Mingjie; Kim, Yang-Seon; Srebric, Jelena
Indoor Environmental Quality (IEQ) in commercial buildings, such as retail stores, can affect employee satisfaction, productivity, and health. This study administered an IEQ survey to retail employees and found correlations between measured IEQ parameters and the survey responses. The survey included 611 employees in 14 retail stores located in Pennsylvania (climate zone 5A) and Texas (climate zone 2A). The survey questionnaire featured ratings of different aspects of IEQ, including thermal comfort, lighting and noise level, indoor smells, overall cleanness, and environmental quality. Simultaneously with the survey, on-site physical measurements were taken to collect data of relative humidity levels, air exchange rates, dry bulb temperatures, and contaminant concentrations. This data was analyzed using multinomial logit regression with independent variables being the measured IEQ parameters, employees’ gender, and age. This study found that employee perception of stuffy smells is related to formaldehyde and PM10 concentrations. Furthermore, the survey also asked the employees to report an annual frequency of common colds as a health indicator. The regression analysis showed that the cold frequency statistically correlates with the measured air exchange rates, outdoor temperatures, and indoor PM concentrations. Overall, the air exchange rate is the most influential parameter on the employee perception of the overall environmental quality and self-reported health outcome.
Becker, Kimberly D.; Brandt, Nicole Evangelista; Stephan, Sharon H.; Chorpita, Bruce F.
We examined the measurement of educational outcomes related to children's mental health treatments. A total of 85 papers describing 88 randomized controlled trials that included at least one educational outcome and one mental health outcome were included in these analyses. Forty-five different measures were identified as the primary educational…
Grodstein, Francine; Stampfer, Meir J.; Willett, Walter C.; Hu, Frank B.; Manson, JoAnn E.
Objectives. To review the contribution of the Nurses’ Health Study (NHS) to our understanding of the complex relationship between exogenous hormones and health outcomes in women. Methods. We performed a narrative review of the publications of the NHS and NHS II from 1976 to 2016. Results. Oral contraceptive and postmenopausal hormone use were studied in relation to major health outcomes, including cardiovascular disease and cancer. Current or recent oral contraceptive use is associated with a higher risk of cardiovascular disease (mainly among smokers), melanoma, and breast cancer, and a lower risk of colorectal and ovarian cancer. Although hormone therapy is not indicated primarily for chronic disease prevention, findings from the NHS and a recent analysis of the Women’s Health Initiative indicate that younger women who are closer to menopause onset have a more favorable risk–benefit profile than do older women from use of hormone therapy for relief of vasomotor symptoms. Conclusions. With updated information on hormone use, lifestyle factors, and other variables, the NHS and NHS II continue to contribute to our understanding of the complex relationship between exogenous hormones and health outcomes in women. PMID:27459451
Aggarwal, Neelum T; Everson-Rose, Susan A; Evans, Denis A
The broad spectrum of economic and cultural diversity in the U.S. population correlates with and affects the study of behavioral aspects of health. The purpose of this article is to provide a selective overview of research findings from the Chicago Health and Aging Project (CHAP), which covers a socio-demographically diverse population in Chicago, with a focus on role-related psychosocial factors and observed racial/ethnic differences in aging outcomes. CHAP is a longitudinal, epidemiological study of common chronic conditions of aging with an emphasis on medical, psychosocial, and environmental risk factors for the decline in cognitive function across the older adult lifespan. We briefly summarize the study design and methods used in the CHAP study and characterize the study population and describe the psychosocial data, noting black-white associations as they relate to three common brain health outcomes: cognitive function and Alzheimer's Disease, stroke, and subclinical vascular disease as noted on neuroimaging.
Heijnen, Marieke; Cumming, Oliver; Peletz, Rachel; Chan, Gabrielle Ka-Seen; Brown, Joe; Baker, Kelly; Clasen, Thomas
Background More than 761 million people rely on shared sanitation facilities. These have historically been excluded from international sanitation targets, regardless of the service level, due to concerns about acceptability, hygiene and access. In connection with a proposed change in such policy, we undertook this review to identify and summarize existing evidence that compares health outcomes associated with shared sanitation versus individual household latrines. Methods and Findings Shared sanitation included any type of facilities intended for the containment of human faeces and used by more than one household, but excluded public facilities. Health outcomes included diarrhoea, helminth infections, enteric fevers, other faecal-oral diseases, trachoma and adverse maternal or birth outcomes. Studies were included regardless of design, location, language or publication status. Studies were assessed for methodological quality using the STROBE guidelines. Twenty-two studies conducted in 21 countries met the inclusion criteria. Studies show a pattern of increased risk of adverse health outcomes associated with shared sanitation compared to individual household latrines. A meta-analysis of 12 studies reporting on diarrhoea found increased odds of disease associated with reliance on shared sanitation (odds ratio (OR) 1.44, 95% CI: 1.18–1.76). Conclusion Evidence to date does not support a change of existing policy of excluding shared sanitation from the definition of improved sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines. PMID:24743336
Lodhi, Muhammad K.; Stifter, Janet; Yao, Yingwei; Ansari, Rashid; Kee-nan, Gail M.; Wilkie, Diana J.; Khokhar, Ashfaq A.
Electronic health record (EHR) systems are being widely used in the healthcare industry nowadays, mostly for monitoring the progress of the patients. EHR data analysis has become a big data problem as data is growing rapidly. Using a nursing EHR system, we built predictive models for determining what factors influence pain in end-of-life (EOL) patients. Utilizing different modeling techniques, we developed coarse-grained and fine-grained models to predict patient pain outcomes. The coarse-grained models help predict the outcome at the end of each hospitalization, whereas fine-grained models help predict the outcome at the end of each shift, thus providing a trajectory of predicted outcomes over the entire hospitalization. These models can help in determining effective treatments for individuals and groups of patients and support standardization of care where appropriate. Using these models may also lower the cost and increase the quality of end-of-life care. Results from these techniques show significantly accurate predictions. PMID:27500287
Cooper, S. A.; Morrison, J.; Melville, C.; Finlayson, J.; Allan, L.; Martin, G.; Robinson, N.
Background: People with intellectual disabilities (IDs) have a higher level of health needs, a higher level of which is unmet, compared with the general population. Health screening can detect unmet health needs, but it is unknown whether it effects beneficial health outcomes in the longer term. People with IDs are reliant on health management by…
Donaldson, Michael S.
While there have been many studies on health outcomes that have included measurements of plasma carotenoids, this data has not been reviewed and assembled into a useful form. In this review sixty-two studies of plasma carotenoids and health outcomes, mostly prospective cohort studies or population-based case-control studies, are analyzed together to establish a carotenoid health index. Five cutoff points are established across the percentiles of carotenoid concentrations in populations, from the tenth to ninetieth percentile. The cutoff points (mean ± standard error of the mean) are 1.11 ± 0.08, 1.47 ± 0.08, 1.89 ± 0.08, 2.52 ± 0.13, and 3.07 ± 0.20 µM. For all cause mortality there seems to be a low threshold effect with protection above every cutoff point but the lowest. But for metabolic syndrome and cancer outcomes there tends to be significant positive health outcomes only above the higher cutoff points, perhaps as a triage effect. Based on this data a carotenoid health index is proposed with risk categories as follows: very high risk: <1 µM, high risk: 1-1.5 µM, moderate risk: 1.5-2.5 µM, low risk: 2.5-4 µM, and very low risk: >4 µM. Over 95 percent of the USA population falls into the moderate or high risk category of the carotenoid health index. PMID:22292108
Background The early years are the period of growth for which we know the least about the impact of physical activity. In contrast, we know that more than 90 % of school-aged Canadian children, for example, are not meeting physical activity recommendations. Such an activity crisis is a major contributor to recent trends in childhood obesity, to which preschoolers are not immune. The World Health Organization estimated that more than 42 million children under the age of 5 years were overweight world-wide in 2010. If an activity crisis exists during the preschool years, we should also be concerned about its broader impact on health. Unfortunately, the relationship between physical activity and health during the early years is poorly understood. The goal of the Health Outcomes and Physical activity in Preschoolers (HOPP) study is to describe how the prevalence and patterns of physical activity in preschoolers are associated with indices of health. Methods The HOPP study is a prospective cohort study. We aim to recruit 400 3- to 5-year-old children (equal number of boys and girls) and test them once per year for 3 years. Each annual assessment involves 2 laboratory visits and 7 consecutive days of physical activity monitoring with protocols developed in our pilot work. At visit 1, we assess body composition, aerobic fitness, short-term muscle power, motor skills, and have the parents complete a series of questionnaires related to their child’s physical activity, health-related quality of life and general behaviour. Over 7 consecutive days each child wears an accelerometer on his/her waist to objectively monitor physical activity. The accelerometer is programmed to record movement every 3 s, which is needed to accurately capture the intensity of physical activity. At visit 2, we assess vascular structure and function using ultrasound. To assess the associations between physical activity and health outcomes, our primary analysis will involve mixed-effects models for
Zunino, James L., III; Iqbal, Zafar
Thermochromic semiconductive polymers that change color in response to external stimuli, such as heat and radiation, can be utilized to monitor the temperature range and elapsed time profiles of stored and prepositioned munitions. These polymers are being tailored to create paints and coatings that will alert Army logistic staff of dangerous temperature exposures. Irreversible indication via color change in multiple thermal bands, 145 F - 164 F (63o-73°C), 165 F - 184 F (74° - 84° C) and over 185 F (>85°C) are possible with these thermochromic polymers. The resulting active coating can be visually inspected to determine if safe temperatures were exceeded. More detailed information, including cumulative time of exposure in certain temperature bands through changes in optical chromaticity describing the vividness or dullness of a color, can be assessed using a hand-held optical densitometer.
Wilde, Elizabeth Ty
The introduction of technology aimed at reducing the response times of emergency medical services has been one of the principal innovations in crisis care over the last several decades. These substantial investments have typically been justified by an assumed link between shorter response times and improved health outcomes. However, current medical research does not generally show a relationship between response time and mortality. In this study, we explain the discrepancy between conventional wisdom and mortality; existing medical research fails to account for the endogeneity of incident severity and response times. Analyzing detailed call-level information from the state of Utah's Bureau of Emergency Medical Services, we measure the impact of response time on mortality and hospital utilization using the distance of the incident from the nearest EMS agency headquarters as an instrument for response time. We find that response times significantly affect mortality and the likelihood of being admitted to the hospital, but not procedures or utilization within the hospital.
Philipson, Tomas; Linthicum, Mark T; Snider, Julia Thornton
As healthcare costs climb around the world, public and private payers alike are demanding evidence of a treatment's value to support approval and reimbursement decisions. Health economics and outcomes research, or HEOR, offers tools to answer questions about a treatment's value, as well as its real-world effects and cost-effectiveness. Given that nutrition interventions have to compete for space in budgets along with biopharmaceutical products and devices, nutrition is now increasingly coming to be evaluated through HEOR. This tutorial introduces the discipline of HEOR and motivates its relevance for nutrition. We first define HEOR and explain its role and relevance in relation to randomized controlled trials. Common HEOR study types--including burden of illness, effectiveness studies, cost-effectiveness analysis, and valuation studies--are presented, with applications to nutrition. Tips for critically reading HEOR studies are provided, along with suggestions on how to use HEOR to improve patient care. Directions for future research are discussed.
Dutta, Mousumi; Husain, Zakir
In this paper, we examine the relationship between socio-economic status (SES) and the usage of in-patient services, and analyze the impact of introducing health insurance in India - a major developing country with poor health outcomes. In contrast to results of similar works undertaken for developed countries, our results reveal that the positive relation between usage of in-patient services and SES persists even in the presence of health insurance. This implies that health insurance is unable to eliminate the inequities in accessing healthcare services that stem from disparities in SES. In fact, insurance aggravates inequity in the healthcare market. The study is based on unit-level data from the 2005-06 Morbidity and Health Care Survey undertaken by National Sample Survey Organization.
Centers for Disease Control and Prevention, 2011
The national Youth Risk Behavior Survey (YRBS) monitors priority health risk behaviors that contribute to the leading causes of death, disability, and social problems among youth and adults in the United States. The national YRBS is conducted every two years during the spring semester and provides data representative of 9th through 12th grade…
Munns, Thomas E.; Beard, Richard E.; Culp, Aubrey M.; Murphy, Dennis A.; Kent, Renee M.; Cooper, Eric G. (Technical Monitor)
The purpose of this study was to assess the connection between current FAA regulations and the incorporation of Health Management (HM) systems into commercial aircraft. To address the overall objectives ARINC: (1) investigated FAA regulatory guidance, (2) investigated airline maintenance practices, (3) systematically identified regulations and practices that would be affected or could act as barriers to the introduction of HM technology, and (4) assessed regulatory and operational tradeoffs that should be considered for implementation. The assessment procedure was validated on a postulated structural HM capability for the B757 horizontal stabilizer.
Suh, Kangho; Gabriel, Susan; Adams, Michelle A; Arcona, Steve
The guidelines for health economics and outcomes research (HEOR) fellowship training programs devised by the American College of Clinical Pharmacy (ACCP) and the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) suggest that continuous improvements are made to ensure that postgraduate training through didactic and professional experiences prepare fellows for HEOR research careers. The HEOR Fellowship Program at Novartis Pharmaceuticals Corporation was standardized to enhance the fellows' HEOR research understanding and align professional skill sets with the ACCP-ISPOR Fellowship Program Guidelines. Based on feedback from an internal task force comprised of HEOR employees and current and former fellows, the HEOR Fellowship Program was normatively and qualitatively assessed to evaluate the current curricular program. Fellowship program activities were instituted to ensure that the suggested minimum level requirements established by the guidelines were being met. Research opportunities enabling fellows to work hand-in-hand with other fellows and HEOR professionals were emphasized. Curricular enhancements in research methodology and professional training and development, and materials for a structured journal club focusing on specific methodological and HEOR research topics were developed. A seminar series (e.g., creating SMART Goals, StrengthsFinder 2.0) and professional courses (e.g., ISPOR short courses, statistics.com) were included to enhance the fellows' short- and long-term professional experience. Additional program attributes include an online reference library developed to enrich the current research facilities and a Statistical Analysis Software training program. Continuously assessing and updating HEOR fellowship programs keeps programs up-to-date in the latest HEOR concepts and approaches used to evaluate health care, both professionally and educationally.
Hill, Tom R; Aspray, Terence J; Francis, Roger M
The aim of this review is to summarise the evidence linking vitamin D to bone health outcomes in older adults. A plethora of scientific evidence globally suggests that large proportions of people have vitamin D deficiency and are not meeting recommended intakes. Older adults are at particular risk of the consequences of vitamin D deficiency owing to a combination of physiological and behavioural factors. Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism. There seems to be inconsistent evidence for a protective role of vitamin D supplementation alone on bone mass. However, it is generally accepted that vitamin D (17·5 μg/d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects. Evidence for a benefit of vitamin D supplementation alone on reducing fracture risk is varied. According to a recent Agency for Healthcare Research and Quality review in the USA the evidence base shows mixed results for a beneficial effect of vitamin D on decreasing overall fracture risk. Limitations such as poor compliance with treatment, incomplete assessment of vitamin D status and large drop-out rates however, have been highlighted within some studies. In conclusion, it is generally accepted that vitamin D in combination with Ca reduces the risk of non-vertebral fractures particularly those in institutional care. The lack of data on vitamin D and bone health outcomes in certain population groups such as diverse racial groups warrants attention.
Verret, Catherine; Jutand, Mathe-Aline; De Vigan, Catherine; Bégassat, Marion; Bensefa-Colas, Lynda; Brochard, Patrick; Salamon, Roger
Background Since 1993, many studies on the health of Persian Gulf War veterans (PGWVs) have been undertaken. Some authors have concluded that an association exists between Gulf War service and reported infertility or miscarriage, but that effects on PGWV's children were limited. The present study's objective was to describe the reproductive outcome and health of offspring of French Gulf War veterans. Methods The French Study on the Persian Gulf War (PGW) and its Health Consequences is an exhaustive cross-sectional study on all French PGWVs conducted from 2002 to 2004. Data were collected by postal self-administered questionnaire. A case-control study nested in this cohort was conducted to evaluate the link between PGW-related exposures and fathering a child with a birth defect. Results In the present study, 9% of the 5,666 Gulf veterans who participated reported fertility disorders, and 12% of male veterans reported at least one miscarriage among their partners after the PGW. Overall, 4.2% of fathers reported at least one child with a birth defect conceived after the mission. No PGW-related exposure was associated with any birth defect in children fathered after the PGW mission. Concerning the reported health of children born after the PGW, 1.0% of children presented a pre-term delivery and 2.7% a birth defect. The main birth defects reported were musculoskeletal malformations (0.5%) and urinary system malformations (0.3%). Birth defect incidence in PGWV children conceived after the mission was similar to birth defect incidence described by the Paris Registry of Congenital Malformations, except for Down syndrome (PGWV children incidence was lower than Registry incidence). Conclusion This study did not highlight a high frequency of fertility disorders or miscarriage among French PGW veterans. We found no evidence for a link between paternal exposure during the Gulf War and increased risk of birth defects among French PGWV children. PMID:18442369
French, C. E.; Hedegaard, B.; Shield, C. K.; Stolarski, H.
During evening rush hour traffic on August 1, 2007, the major interstate highway bridge carrying I35W over the Mississippi River in Minneapolis catastrophically failed, tragically taking the lives of thirteen people and injuring many more. The steel truss bridge, constructed in 1967, was undergoing deck reconstruction during the collapse, and was estimated to carry more than 140,000 vehicles daily. This tragedy generated great interest in employment of structural health monitoring systems. The I35W St. Anthony Falls Bridge, a post-tensioned concrete box bridge constructed to replace the collapsed steel truss bridge, contains over 500 instruments to monitor the structural behavior. Numerical models of the bridge are being developed and calibrated to the collected data obtained from truck load tests and thermal effects. The data obtained over the first few years of monitoring are being correlated with the calibrated models and used to develop the baseline bridge behavior. This information is being used to develop a system to monitor and interpret the long-term behavior of the bridge. This paper describes the instrumentation, preliminary results from the data and model calibration, the plan for developing long-term monitoring capabilities, and the challenges associated with structural health monitoring of bridge systems. In addition, opportunities and directions for future research required to fully realize the objectives of structural health monitoring are described.
Mickens, T.; Schulz, M.; Sundaresan, M.; Ghoshal, A.; Naser, A. S.; Reichmeider, R.
A major concern with ageing aircraft is the deterioration of structural components in the form of fatigue cracks at fastener holes, loose rivets and debonding of joints. These faults in conjunction with corrosion can lead to multiple-site damage and pose a hazard to flight. Developing a simple vibration-based method of damage detection for monitoring ageing structures is considered in this paper. The method is intended to detect damage during operation of the vehicle before the damage can propagate and cause catastrophic failure of aircraft components. It is typical that only a limited number of sensors could be used on the structure and damage can occur anywhere on the surface or inside the structure. The research performed was to investigate use of the chirp vibration responses of an aircraft wing tip to detect, locate and approximately quantify damage. The technique uses four piezoelectric patches alternatively as actuators and sensors to send and receive vibration diagnostic signals.Loosening of selected screws simulated damage to the wing tip. The results obtained from the testing led to the concept of a sensor tape to detect damage at joints in an aircraft structure.
Yehia, Baligh R.; Stephens-Shield, Alisa J.; Momplaisir, Florence; Taylor, Lynne; Gross, Robert; Dubé, Benoit; Glanz, Karen; Brady, Kathleen A.
Improving outcomes for people with HIV and mental illness will be critical to meeting the goals of the US National HIV/AIDS Strategy. In a retrospective analysis of the 2008–2010 cycles of the locally representative Philadelphia Medical Monitoring Project, we compared the proportions of HIV-infected adults with and without mental illness: (1) retained in care (≥2 primary HIV visits separated by ≥90 days in a 12-month period); (2) prescribed antiretroviral therapy (ART) at any point in a 12-month period; and (3) virally suppressed (HIV-1 RNA ≤200 copies/mL at the last measure in the 12-month period). Multivariable regression assessed associations between mental illness and the outcomes, adjusting for age, gender, race/ethnicity, insurance, alcohol abuse, injection drug use, CD4 count, and calendar year. Of 730 HIV-infected persons, representative of 9409 persons in care for HIV in Philadelphia, 49.0 % had mental illness. In adjusted analyses, there were no significant differences in retention (91.3 vs. 90.3 %; AOR 1.30, 95 % CI 0.63–2.56) and prescription of ART (83.2 vs. 88.7 %; AOR 0.79, 95 % CI 0.49–1.25) between those with and without mental illness. However, mentally ill patients were less likely to achieve viral suppression than those without mental illness (65.9 vs. 74.4 %; AOR 0.64, 95 % CI 0.46–0.90). These findings argue for the need to optimize ART adherence in this population. PMID:25931243
Yap, Keng C.
This viewgraph presentation reviews Structural Health Monitoring Analysis for the Orbiter Wing Leading Edge. The Wing Leading Edge Impact Detection System (WLE IDS) and the Impact Analysis Process are also described to monitor WLE debris threats. The contents include: 1) Risk Management via SHM; 2) Hardware Overview; 3) Instrumentation; 4) Sensor Configuration; 5) Debris Hazard Monitoring; 6) Ascent Response Summary; 7) Response Signal; 8) Distribution of Flight Indications; 9) Probabilistic Risk Analysis (PRA); 10) Model Correlation; 11) Impact Tests; 12) Wing Leading Edge Modeling; 13) Ascent Debris PRA Results; and 14) MM/OD PRA Results.
Zheng, Shijie; Naik, Gautam; Chen, Zhongbi; Zhu, Yinian; Krishnaswamy, Sridhar
The emerging concept of structural health management relies on extensive onboard diagnostic sensors that can provide near real-time information about the state of a structure so that informed prognostic assessment can be made of the continuing reliability of the structure. In this paper, we will discuss two types of sensing platforms that can provide valuable information about the state of a structure: 1D fiber-optic sensors and 2D thin-film sensors. Both fiber-optic and thin film sensors are easily integrated with structures, and can offer local and/or distributed sensing capabilities. Parameters that can be sensed include: static and dynamic strain, acoustic emission, vibration, corrosion products, moisture ingression etc. We will first describe some recent developments in dynamic strain sensing using optical fiber Bragg grating (FBG) sensors. Applications to detection of acoustic emission and impact will be described. In the area of chemical sensing, we will describe a nanofilm-coated photonic crystal fiber (PCF) long-period grating (LPG) sensing platform. PCF-LPG sensors can be designed to provide greater interaction between the analyte of interest and the light propagating in the fiber, thereby increasing the sensitivity of detection. Applications to humidity sensing will be described. Finally, 2D thin-film sensors on polymer substrates will be discussed. One type of sensor we have been fabricating is based on reduced graphene oxide for large-area chemical sensing applications. It is expected that these 1D and 2D sensing platforms will form part of a suite of sensors that can provide diagnostic structural health information.
Ahnn, Jong Hoon; Potkonjak, Miodrag
Although mobile health monitoring where mobile sensors continuously gather, process, and update sensor readings (e.g. vital signals) from patient's sensors is emerging, little effort has been investigated in an energy-efficient management of sensor information gathering and processing. Mobile health monitoring with the focus of energy consumption may instead be holistically analyzed and systematically designed as a global solution to optimization subproblems. This paper presents an attempt to decompose the very complex mobile health monitoring system whose layer in the system corresponds to decomposed subproblems, and interfaces between them are quantified as functions of the optimization variables in order to orchestrate the subproblems. We propose a distributed and energy-saving mobile health platform, called mHealthMon where mobile users publish/access sensor data via a cloud computing-based distributed P2P overlay network. The key objective is to satisfy the mobile health monitoring application's quality of service requirements by modeling each subsystem: mobile clients with medical sensors, wireless network medium, and distributed cloud services. By simulations based on experimental data, we present the proposed system can achieve up to 10.1 times more energy-efficient and 20.2 times faster compared to a standalone mobile health monitoring application, in various mobile health monitoring scenarios applying a realistic mobility model.
Hadi, Tamer A; Fleshler, Keren
Social media monitoring for public health emergency response and recovery is an essential response capability for any health department. The value of social media for emergency response lies not only in the capacity to rapidly communicate official and critical incident information, but as a rich source of incoming data that can be gathered to inform leadership decision-making. Social media monitoring is a function that can be formally integrated into the Incident Command System of any response agency. The approach to planning and required resources, such as staffing, logistics, and technology, is flexible and adaptable based on the needs of the agency and size and scope of the emergency. The New York City Department of Health and Mental Hygiene has successfully used its Social Media Monitoring Team during public health emergency responses and planned events including major Ebola and Legionnaires' disease responses. The concepts and implementations described can be applied by any agency, large or small, interested in building a social media monitoring capacity. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).
The key health issues for women tend to be primarily associated with the female reproductive system. There are also other gender priorities and consequences associated with ageing, which require effective interventions. Acupuncture is used worldwide and its evidence base is increasing on both mechanisms of action and its effectiveness in clinical care. Although acupuncture may be a valuable addition to healthcare for some conditions, it is rarely fully integrated into mainstream Western medicine clinical practice. Inadequate design and poor reporting of clinical trials have been barriers. Additionally systematic reviews and meta-analyses have tended to be equivocal and have reported that there is insufficient evidence for its recommendation. Future research should focus on ensuring good trial design including cost effectiveness and qualitative data and using a more pragmatic stance which reflects acupuncture in clinical practice. Undoubtedly, effective interventions are always needed to ensure the best health outcomes and address preventable deaths, morbidities, and disabilities among women but integration will be compromised unless underpinned by good evidence. PMID:28271658
McCague, Anna-Binney; Cox-Ganser, Jean M.; Harney, Joshua M.; Alwis, K. Udeni; Blount, Benjamin C.; Cummings, Kristin J.; Edwards, Nicole; Kreiss, Kathleen
Background Health risks of using styrene to manufacture windblades for the green energy sector are unknown. Methods Using data collected from 355 (73%) current windblade workers and regression analysis, we investigated associations between health outcomes and styrene exposure estimates derived from urinary styrene metabolites. Results The median current styrene exposure was 53.6 mg/g creatinine (interquartile range: 19.5–94.4). Color blindness in men and women (standardized morbidity ratios 2.3 and 16.6, respectively) was not associated with exposure estimates, but was the type previously reported with styrene. Visual contrast sensitivity decreased and chest tightness increased (odds ratio 2.9) with increasing current exposure. Decreases in spirometric parameters and FeNO, and increases in the odds of wheeze and asthma-like symptoms (odds ratios 1.3 and 1.2, respectively) occurred with increasing cumulative exposure. Conclusions Despite styrene exposures below the recommended 400 mg/g creatinine, visual and respiratory effects indicate the need for additional preventative measures in this industry. PMID:26305283
Optimizing Population Health and Economic Outcomes: Innovative Treatment for Benign Prostatic Hyperplasia (BPH) Transcribed and adapted for publication by Janice L. Clarke, RN, BBA Editorial: David B. Nash, MD, MBA S-2 Introduction S-2 Benign Prostatic Hyperplasia (BPH) S-3 • Overview S-3• Current BPH Treatment Paradigm S-4• BPH Continuum of Care: Bladder Health S-5 New Treatment Option for BPH S-5 • The UroLift® System S-6• Positioning of UroLift® in BPH Treatment Paradigm S-7 New Value Proposition S-8 • Addressing Bladder Health: Breaking the Cycle S-8• Cost Benefit Analysis: The Big Picture S-8 Patient and Family Engagement S-10 Summary S-11 PMID:22823180
Stahre, Mandy; VanEenwyk, Juliet; Siegel, Paul; Njai, Rashid
Few studies of associations between housing and health have focused on housing insecurity and health risk behaviors and outcomes. We measured the association between housing insecurity and selected health risk behaviors and outcomes, adjusted for socioeconomic measures, among 8,415 respondents to the 2011 Washington State Behavioral Risk Factor Surveillance System. Housing insecure respondents were about twice as likely as those who were not housing insecure to report poor or fair health status or delay doctor visits because of costs. This analysis supports a call to action among public health practitioners who address disparities to focus on social determinants of health risk behaviors and outcomes.
process performance, remove existing sources of natural and unnatural variability, and identify any new sources of variability . Control charts are SPC...can be used and refined over time . The causes of any Phase I points outside the established control limits should be investigated. If the cause is...U.S. Army Public Health Command Statistical Process Control Charts for Public Health Monitoring PHR No. S.0023112 General Medical: 500A, Public
Firestone, M; Smylie, J; Maracle, S; Spiller, M; O'Campo, P
Objective Population-based health information on urban Aboriginal populations in Canada is limited due to challenges with the identification of Aboriginal persons in existing health data sets. The main objective of the Our Health Counts (OHC) project was to work in partnership with Aboriginal stakeholders to generate a culturally relevant, representative baseline health data set for three urban Aboriginal communities in Ontario, Canada. Design Respondent-driven sampling (RDS). Setting Hamilton, Ontario, Canada. Participants The OHC study, in partnership with the De dwa da dehs ney >s Aboriginal Health Access Centre (DAHC), recruited 554 First Nations adults living in Hamilton using RDS. Results Among First Nations adults living in Hamilton, 78% earned less than $20 000 per year and 70% lived in the lowest income quartile neighbourhoods. Mobility and crowded living conditions were also highly prevalent. Common chronic diseases included arthritis, hypertension, diabetes and chronic obstructive pulmonary disease and rates of emergency room access were elevated. Conclusions RDS is an effective sampling method in urban Aboriginal contexts as it builds on existing social networks and successfully identified a population-based cohort. The findings illustrate striking disparities in health determinants and health outcomes between urban First Nations individuals and the general population which have important implications for health services delivery, programming and policy development. PMID:25011988
Benjamins, Maureen R; Whitman, Steven
Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23% of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57-3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28-0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers.
Phillips, David E; AbouZahr, Carla; Lopez, Alan D; Mikkelsen, Lene; de Savigny, Don; Lozano, Rafael; Wilmoth, John; Setel, Philip W
In this Series paper, we examine whether well functioning civil registration and vital statistics (CRVS) systems are associated with improved population health outcomes. We present a conceptual model connecting CRVS to wellbeing, and describe an ecological association between CRVS and health outcomes. The conceptual model posits that the legal identity that civil registration provides to individuals is key to access entitlements and services. Vital statistics produced by CRVS systems provide essential information for public health policy and prevention. These outcomes benefit individuals and societies, including improved health. We use marginal linear models and lag-lead analysis to measure ecological associations between a composite metric of CRVS performance and three health outcomes. Results are consistent with the conceptual model: improved CRVS performance coincides with improved health outcomes worldwide in a temporally consistent manner. Investment to strengthen CRVS systems is not only an important goal for individuals and societies, but also a development imperative that is good for health.
Lönnroth, Knut; Glaziou, Philippe; Weil, Diana; Floyd, Katherine; Uplekar, Mukund; Raviglione, Mario
Tuberculosis (TB) remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC) and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.
Rutherford, A. C.; Park, G. H.; Sohn, H.; Farrar, C. R.
The impedance-based structural health monitoring technique, which utilizes electromechanical coupling properties of piezoelectric materials, has shown feasibility for use in a variety of structural health monitoring applications. Relying on high frequency local excitations (typically > 30 kHz), this technique is very sensitive to minor changes in structural integrity in the near field of piezoelectric sensors. Several damage sensitive features have been identified and used coupled with the impedance methods. Most of these methods are, however, limited to linearity assumptions of a structure. This paper presents the use of experimentally identified nonlinear features, combined with impedance methods, for structural health monitoring. Their applicability to damage detection in various frequency ranges is demonstrated using actual impedance signals measured from a portal frame structure. The performance of the nonlinear feature is compared with those of conventional impedance methods. This paper reinforces the utility of nonlinear features in structural health monitoring and suggests that their varying sensitivity in different frequency ranges may be leveraged for certain applications.
Shih, Hui-Ru; Walters, Wilbur L.; Zheng, Wei; Everett, Jessica
Structural Health Monitoring (SHM) is an emerging technology that has multiple applications. SHM emerged from the wide field of smart structures, and it also encompasses disciplines such as structural dynamics, materials and structures, nondestructive testing, sensors and actuators, data acquisition, signal processing, and possibly much more. To…
Lissenden, Cliff J.; Puthillath, Padma K.; Blackshire, James L.
The actuation of ultrasonic guided waves in a carbon fiber reinforced polymer plate from embedded metal core piezoelectric fibers is studied for structural health monitoring applications. A linear array of fibers embedded at the midplane can generate guided waves transverse to the fiber direction. Finite element simulations show that a significant source influence is associated with the small diameter piezoelectric fibers.
Selhub, Jacob; Rosenberg, Irwin H
The recent increase in the intake of folic acid by the general public through fortified foods and supplements, has raised safety concern based on early reports of adverse health outcome in elderly with low B12 status who took high doses of folic acid. These safety concerns are contrary to the 2015 WHO statement that "high folic acid intake has not reliably been shown to be associated with negative healeffects". In the folic acid post-fortification era, we have shown that in elderly participants in NHANES 1999-2002, high plasma folate level is associated with exacerbation of both clinical (anemia and cognitive impairment) and biochemical (high MMA and high Hcy plasma levels) signs of vitamin B12 deficiency. Adverse clinical outcomes in association with high folate intake were also seen among elderly with low plasma B12 levels from the Framingham Original Cohort and in a study from Australia which combined three elderly cohorts. Relation between high folate and adverse biochemical outcomes were also seen in the Sacramento Area Latino Study on Aging (High Hcy, high MMA and lower TC2) and at an outpatient clinic at Yale University where high folate is associated with higher MMA in the elderly but not in the young. Potential detrimental effects of high folic acid intake may not be limited to the elderly nor to those with B12 deficiency. A study from India linked maternal high RBC folate to increased insulin resistance in offspring. Our study suggested that excessive folic acid intake is associated with lower natural killer cells activity in elderly women. In a recent study we found that the risk for unilateral retinoblastoma in offspring is 4 fold higher in women that are homozygotes for the 19 bp deletion in the DHFR gene and took folic acid supplement during pregnancy. In the elderly this polymorphism is associated with lower memory and executive scores, both being significantly worse in those with high plasma folate. These and other data strongly imply that
Antunes, Paulo; Travanca, Rui; Rodrigues, Hugo; Melo, José; Jara, José; Varum, Humberto; André, Paulo
In this paper we summarize the research activities at the Instituto de Telecomunicações—Pólo de Aveiro and University of Aveiro, in the field of fiber Bragg grating based sensors and their applications in dynamic measurements for Structural Health Monitoring of slender structures such as towers. In this work we describe the implementation of an optical biaxial accelerometer based on fiber Bragg gratings inscribed on optical fibers. The proof-of-concept was done with the dynamic monitoring of a reinforced concrete structure and a slender metallic telecommunication tower. Those structures were found to be suitable to demonstrate the feasibility of FBG accelerometers to obtain the structures' natural frequencies, which are the key parameters in Structural Health Monitoring and in the calibration of numerical models used to simulate the structure behavior. PMID:22778661
Antunes, Paulo; Travanca, Rui; Rodrigues, Hugo; Melo, José; Jara, José; Varum, Humberto; André, Paulo
In this paper we summarize the research activities at the Instituto de Telecomunicações--Pólo de Aveiro and University of Aveiro, in the field of fiber Bragg grating based sensors and their applications in dynamic measurements for Structural Health Monitoring of slender structures such as towers. In this work we describe the implementation of an optical biaxial accelerometer based on fiber Bragg gratings inscribed on optical fibers. The proof-of-concept was done with the dynamic monitoring of a reinforced concrete structure and a slender metallic telecommunication tower. Those structures were found to be suitable to demonstrate the feasibility of FBG accelerometers to obtain the structures' natural frequencies, which are the key parameters in Structural Health Monitoring and in the calibration of numerical models used to simulate the structure behavior.
Delgado, Irebert R.; Dempsey, Paula J.; Simon, Donald L.
A brief review is presented on the state-of-the-art in rotorcraft engine health monitoring technologies including summaries on current practices in the area of sensors, data acquisition, monitoring and analysis. Also, presented are guidelines for verification and validation of Health Usage Monitoring System (HUMS) and specifically for maintenance credits to extend part life. Finally, a number of new efforts in HUMS are summarized as well as lessons learned and future challenges. In particular, gaps are identified to supporting maintenance credits to extend rotorcraft engine part life. A number of data sources were consulted and include results from a survey from the HUMS community, Society of Automotive Engineers (SAE) documents, American Helicopter Society (AHS) papers, as well as references from Defence Science & Technology Organization (DSTO), Civil Aviation Authority (CAA), and Federal Aviation Administration (FAA).
McPheeters, Melissa L; Sathe, Nila A; Jerome, Rebecca N; Carnahan, Ryan M
This report provides an overview of methods used to conduct systematic reviews for the US Food and Drug Administration (FDA) Mini-Sentinel project, which is designed to inform the development of safety monitoring tools for FDA-regulated products including vaccines. The objective of these reviews was to summarize the literature describing algorithms (e.g., diagnosis or procedure codes) to identify health outcomes in administrative and claims data. A particular focus was the validity of the algorithms when compared to reference standards such as diagnoses in medical records. The overarching goal was to identify algorithms that can accurately identify the health outcomes for safety surveillance. We searched the MEDLINE database via PubMed and required dual review of full text articles and of data extracted from studies. We also extracted data on each study's methods for case validation. We reviewed over 5600 abstracts/full text studies across 15 health outcomes of interest. Nearly 260 studies met our initial criteria (conducted in the US or Canada, used an administrative database, reported case-finding algorithm). Few studies (N=45), however, reported validation of case-finding algorithms (sensitivity, specificity, positive or negative predictive value). Among these, the most common approach to validation was to calculate positive predictive values, based on a review of medical records as the reference standard. Of the studies reporting validation, the ease with which a given clinical condition could be identified in administrative records varied substantially, both by the clinical condition and by other factors such as the clinical setting, which relates to the disease prevalence.
Bayati, Mohsen; Feyzabadi, Vahid Yazdi; Rashidian, Arash
Background: Women's health is a key factor affecting the health of the whole population. Tackling inequality in determinants of health is recognized as the main path toward reducing the inequality in health outcomes. This study aimed to analyze the provincial inequality in determinants of women's health and health care in Iran. Methods: Using the Moss's model (2002) as a comprehensive framework of determinants of women's health, including “geopolitical environment,” “culture, norms, sanctions,” “women's roles in reproduction and production,” “health-related mediators,” and “health outcome” categories, we chose 13 indicators. Afterward, using data sources including the Iranian Multiple Indicators of Demographics and Health Survey, the National Organization for Civil Registration, and Statistics Centre of Iran, we analyzed provincial inequality in these indicators in Iran (2011). Gini coefficient and Lorenz curve were used for measuring inequality. Results: Gini coefficients calculated as follows; life satisfaction level (0.027), literate women (0.398), women with proper knowledge about HIV/AIDS prevention (0.483), unemployed women (0.380), women without an income (0.384), women who use at least one type of mass media (0.389), women who used computer or internet (0.467), women who had received pregnancy care from a skill birth attendant (SBA) (0.420), women who had delivered with the help of an SBA (0.426), women who currently smoke cigarettes (0.603), women who currently consume hookah (0.561), women with at least one chronic disease (0.438), and women's deaths in 2010 and 2011 (0.393 and 0.359, respectively). Conclusions: We found large provincial disparities in determinants of women's health in Iran. Determinants such as lifestyle, health behavior, health knowledge, and health-care services availability should be considered by health policymakers in addressing the inequality in women's health at a provincial level. PMID:28348721
DeVries, Aaron; Talley, Pamela; Sweet, Kristin; Kline, Susan; Stinchfield, Patricia; Tosh, Pritish; Danila, Richard
Background In October 2014, the United States began actively monitoring all persons who had traveled from Guinea, Liberia, and Sierra Leone in the previous 21 days. State public health departments were responsible for monitoring all travelers; Minnesota has the largest Liberian population in the United States. The MDH Ebola Clinical Team (ECT) was established to assess travelers with symptoms of concern for Ebola virus disease (EVD), coordinate access to healthcare at appropriate facilities including Ebola Assessment and Treatment Units (EATU), and provide guidance to clinicians. Methods Minnesota Department of Health (MDH) began receiving traveler information collected by U.S. Customs and Border Control and Centers for Disease Control and Prevention staff on October 21, 2014 via encrypted electronic communication. All travelers returning from Liberia, Sierra Leone, and Guinea during 10/21/14–5/15/15 were monitored by MDH staff in the manner recommended by CDC based on the traveler’s risk categorization as “low (but not zero)”, “some” and “high” risk. When a traveler reported symptoms or a temperature ≥100.4° F at any time during their 21-day monitoring period, an ECT member would speak to the traveler and perform a clinical assessment by telephone or via video-chat. Based on the assessment the ECT member would recommend 1) continued clinical monitoring while at home with frequent telephone follow-up by the ECT member, 2) outpatient clinical evaluation at an outpatient site agreed upon by all parties, or 3) inpatient clinical evaluation at one of four Minnesota EATUs. ECT members assessed and approved testing for Ebola virus infection at MDH. Traveler data, calls to the ECT and clinical outcomes were logged on a secure server at MDH. Results During 10/21/14–5/15/15, a total of 783 travelers were monitored; 729 (93%) traveled from Liberia, 30 (4%) Sierra Leone, and 24 (3%) Guinea. The median number monitored per week was 59 (range 45–143). The
Isham, George J; Zimmerman, Donna J; Kindig, David A; Hornseth, Gary W
Clinical care contributes only 20 percent to overall health outcomes, according to a population health model developed at the University of Wisconsin. Factors contributing to the remainder include lifestyle behaviors, the physical environment, and social and economic forces--all generally considered outside the realm of care. In 2010 Minnesota-based HealthPartners decided to target nonclinical community health factors as a formal part of its strategic business plan to improve public health in the Twin Cities area. The strategy included creating partnerships with businesses and institutions that are generally unaccustomed to working together or considering how their actions could help improve community health. This article describes efforts to promote healthy eating in schools, reduce the stigma of mental illness, improve end-of-life decision making, and strengthen an inner-city neighborhood. Although still in their early stages, the partnerships can serve as encouragement for organizations inside and outside health care that are considering undertaking similar efforts in their markets.
Jo, Hongki; Spencer, B. F.
ABSTRACT The inspection and maintenance of bridges of all types is critical to the public safety and often critical to the economy of a region. Recent advanced sensor technologies provide accurate and easy-to-deploy means for structural health monitoring and, if the critical locations are known a priori, can be monitored by direct measurements. However, for today's complex civil infrastructure, the critical locations are numerous and often difficult to identify. This paper presents an innovative framework for structural monitoring at arbitrary locations on the structure combining computational models and limited physical sensor information. The use of multi-metric measurements is advocated to improve the accuracy of the approach. A numerical example is provided to illustrate the proposed hybrid monitoring framework, particularly focusing on fatigue life assessment of steel structures.
Lynch, Wendy D; Sherman, Bruce W
When corporate health researchers examine the effects of health on business outcomes or the effect of health interventions on health and business outcomes, results will necessarily be confounded by the corporate environment(s) in which they are studied. In this research setting, most studies control for factors traditionally identified in public health, such as demographics and health status. Nevertheless, often overlooked is the extent to which company policies can also independently impact health care cost, work attendance, and productivity outcomes. With changes in employment and benefits practices resulting from health care reform, including incentives and plan design options, consideration of these largely neglected variables in research design has become increasingly important. This commentary summarizes existing knowledge regarding the implications of policy variations in research outcomes and provides a framework for incorporating them into future employer-based research.
Warren, James W.
Augmented Fish Health Monitoring Contract DE-AI79-87BP35585 was implemented on July 20, 1987. First year highlights included remodeling of the Olympia (WA) Fish Health Center to provide laboratory space for histopathological support services to participating state agencies, acquisition of gas monitoring equipment for hatchery water systems, expanded disease detection work for bacterial kidney disease and erythrocytic inclusion body syndrome in fish stocks at 13 Columbia River Basin National Fish Hatcheries and advancements in computerized case history data storage and analysis. This report summarizes the health status of fish reared at Service facilities in the Columbia River basin, briefly describes work being done to meet contract requirements for fish disease surveillance at those hatcheries and provides a summary of case history data for calendar years 1984, 1985, 1986 and 1987. 1 ref.
Daigle, Matthew J.; Kulkarni, Chetan Shrikant
Batteries have seen an increased use in electric ground and air vehicles for commercial, military, and space applications as the primary energy source. An important aspect of using batteries in such contexts is battery health monitoring. Batteries must be carefully monitored such that the battery health can be determined, and end of discharge and end of usable life events may be accurately predicted. For planetary rovers, battery health estimation and prediction is critical to mission planning and decision-making. We develop a model-based approach utilizing computaitonally efficient and accurate electrochemistry models of batteries. An unscented Kalman filter yields state estimates, which are then used to predict the future behavior of the batteries and, specifically, end of discharge. The prediction algorithm accounts for possible future power demands on the rover batteries in order to provide meaningful results and an accurate representation of prediction uncertainty. The framework is demonstrated on a set of lithium-ion batteries powering a rover at NASA.
Maleka, Elma Nelisiwe
There are number of Non-Governmental Organisations (NGOs) in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA). Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour. The selected
Woodart, Stanley E.; Woodman, Keith L.; Coffey, Neil C.; Taylor, Bryant D.
Aircraft and other vehicles are often kept in service beyond their original design lives. As they age, they become susceptible to system malfunctions and fatigue. Unlike future aircraft that will include health-monitoring capabilities as integral parts in their designs, older aircraft have not been so equipped. The Adaptable Vehicle Health and Usage Monitoring System is designed to be retrofitted into a preexisting fleet of military and commercial aircraft, ships, or ground vehicles to provide them with state-of-the-art health- and usage-monitoring capabilities. The monitoring system is self-contained, and the integration of it into existing systems entails limited intrusion. In essence, it has bolt-on/ bolt-off simplicity that makes it easy to install on any preexisting vehicle or structure. Because the system is completely independent of the vehicle, it can be certified for airworthiness as an independent system. The purpose served by the health-monitoring system is to reduce vehicle operating costs and to increase safety and reliability. The monitoring system is a means to identify damage to, or deterioration of, vehicle subsystems, before such damage or deterioration becomes costly and/or disastrous. Frequent monitoring of a vehicle enables identification of the embryonic stages of damage or deterioration. The knowledge thus gained can be used to correct anomalies while they are still somewhat minor. Maintenance can be performed as needed, instead of having the need for maintenance identified during cyclic inspections that take vehicles off duty even when there are no maintenance problems. Measurements and analyses acquired by the health-monitoring system also can be used to analyze mishaps. Overall, vehicles can be made more reliable and kept on duty for longer times. Figure 1 schematically depicts the system as applied to a fleet of n vehicles. The system has three operational levels. All communication between system components is by use of wireless
Objectives. I investigated whether the introduction of health and health care provisions in US state constitutions can make health systems more equitable and improve health outcomes by urging state policymakers and administrative agencies to uphold their human rights obligations at state level. Methods. I constructed a panel of infant mortality rates from 50 US states over the period 1929 through 2000 to examine their association with the timing and details of introducing a constitutional right to health and health care provisions. Results. The introduction of a stronger constitutional commitment that obligates state legislature to provide health care was associated with a subsequent reduction in the infant mortality rate of approximately 7.8%. The introduction of provisions explicitly targeting the poor was also associated with a reduction in the infant mortality rate of 6.5%. These health benefits are primarily evident in non-White populations. Conclusions. This empirical result supports Elizabeth Leonard’s view that although state constitutional rights have been poorly enforced through the judiciary, a constitutional expression of health care duties has fueled the political and social process, ultimately allowing states to identify the best way to address citizens’ health inequality concerns. PMID:25905857
Andrews, M L; Sánchez, V; Carrillo, C; Allen-Ananins, B; Cruz, Y B
We present the collaborative development of a web-based data collection and monitoring plan for thirty-two county councils within New Mexico's health council system. The monitoring plan, a key component in our multiyear participatory statewide evaluation process, was co-developed with the end users: representatives of the health councils. Guided by the Institute of Medicine's Community, Health Improvement Process framework, we first developed a logic model that delineated processes and intermediate systems-level outcomes in council development, planning, and community action. Through the online system, health councils reported data on intermediate outcomes, including policy changes and funds leveraged. The system captured data that were common across the health council system, yet was also flexible so that councils could report their unique accomplishments at the county level. A main benefit of the online system was that it provided the ability to assess intermediate, outcomes across the health council system. Developing the system was not without challenges, including creating processes to ensure participation across a large rural state; creating shared understanding of intermediate outcomes and indicators; and overcoming technological issues. Even through the challenges, however, the benefits of committing to using participatory processes far outweighed the challenges.
Zawada, Edward T; Kapaska, David; Herr, Pat; Aaronson, Michael; Bennett, Joann; Hurley, Brian; Bishop, Donald; Dagher, Hikmat; Kovaleski, David; Melanson, Tina; Burdge, Kelly; Johnson, Thomas
APACHE (Acute Physiology and Chronic Health Evaluation) mortality predictions and other outcomes are reported after the initiation of a telemedicine intensivist staffing program to monitor the intensive care unit patients of a rural health system. Mortality, length of ICU stay, and length of hospital stay were significantly less than predicted. Length of stay was identical to one year previously in the largest hospital reported, but the case mix index of severity had increased. More severely ill patients were being treated without increase in length of stay.
Tamrat, Tigest; Kachnowski, Stan
Mobile health (mHealth) encompasses the use of mobile telecommunication and multimedia into increasingly mobile and wireless health care delivery systems and has the potential to improve tens of thousands of lives each year. The ubiquity and penetration of mobile phones presents the opportunity to leverage mHealth for maternal and newborn care, particularly in under-resourced health ecosystems. Moreover, the slow progress and funding constraints in attaining the Millennium Development Goals for child and maternal health encourage harnessing innovative measures, such as mHealth, to address these public health priorities. This literature review provides a schematic overview of the outcomes, barriers, and strategies of integrating mHealth to improve prenatal and neonatal health outcomes. Six electronic databases were methodically searched using predetermined search terms. Retrieved articles were then categorized according to themes identified in previous studies. A total of 34 articles and reports contributed to the findings with information about the use and limitations of mHealth for prenatal and neonatal healthcare access and delivery. Health systems have implemented mHealth programs to facilitate emergency medical responses, point-of-care support, health promotion and data collection. However, the policy infrastructure for funding, coordinating and guiding the sustainable adoption of prenatal and neonatal mHealth services remains under-developed. The integration of mobile health for prenatal and newborn health services has demonstrated positive outcomes, but the sustainability and scalability of operations requires further feedback from and evaluation of ongoing programs.
Friedel, Jonathan E.; DeHart, William B.; Frye, Charles C. J.; Rung, Jillian M.; Odum, Amy L.
In delay discounting, temporally remote outcomes have less value. Cigarette smoking is associated with steeper discounting of money and consumable outcomes. It is presently unclear whether smokers discount health outcomes more than non-smokers. We sought to establish the generality of steep discounting for different types of health outcomes in cigarette smokers. Seventy participants (38 smokers and 32 non-smokers) completed four hypothetical outcome delay-discounting tasks: a gain of $500, a loss of $500, a temporary boost in health, and temporary cure from a debilitating disease. Participants reported the duration of each health outcome that would be equivalent to $500; these durations were then used in the respective discounting tasks. Delays ranged from 1 week to 25 years. Smokers’ indifference points for monetary gains, boosts in health, and temporary cures were lower than indifference points from non-smokers. Indifference points of one outcome were correlated with indifference points of other outcomes. Smokers demonstrate steeper discounting across a range of delayed outcomes. How a person discounts one outcome predicts how they will discount other outcomes. These two findings support our assertion that delay discounting is in part a trait. PMID:26691848
Sriram, Janani; Shin, Minho; Kotz, David; Rajan, Anand; Sastry, Manoj; Yarvis, Mark
Wearable, portable, and implantable medical sensors have ushered in a new paradigm for healthcare in which patients can take greater responsibility and caregivers can make well-informed, timely decisions. Health-monitoring systems built on such sensors have huge potential benefit to the quality of healthcare and quality of life for many people, such as patients with chronic medical conditions (such as blood-sugar sensors for diabetics), people seeking to change unhealthy behavior (such as losing weight or quitting smoking), or athletes wishing to monitor their condition and performance. To be effective, however, these systems must provide assurances about the quality of the sensor data. The sensors must be applied to the patient by a human, and the sensor data may be transported across multiple networks and devices before it is presented to the medical team. While no system can guarantee data quality, we anticipate that it will help for the system to annotate data with some measure of confidence. In this paper, we take a deeper look at potential health-monitoring usage scenarios and highlight research challenges required to ensure and assess quality of sensor data in health-monitoring systems.
Kamdar, Maulik R; Wu, Michelle J
Neuropsychiatric disorders are the leading cause of disability worldwide and there is no gold standard currently available for the measurement of mental health. This issue is exacerbated by the fact that the information physicians use to diagnose these disorders is episodic and often subjective. Current methods to monitor mental health involve the use of subjective DSM-5 guidelines, and advances in EEG and video monitoring technologies have not been widely adopted due to invasiveness and inconvenience. Wearable technologies have surfaced as a ubiquitous and unobtrusive method for providing continuous, quantitative data about a patient. Here, we introduce PRISM-Passive, Real-time Information for Sensing Mental Health. This platform integrates motion, light and heart rate data from a smart watch application with user interactions and text entries from a web application. We have demonstrated a proof of concept by collecting preliminary data through a pilot study of 13 subjects. We have engineered appropriate features and applied both unsupervised and supervised learning to develop models that are predictive of user-reported ratings of their emotional state, demonstrating that the data has the potential to be useful for evaluating mental health. This platform could allow patients and clinicians to leverage continuous streams of passive data for early and accurate diagnosis as well as constant monitoring of patients suffering from mental disorders.
James, G.H. III
Today`s society depends upon many structures (such as aircraft, bridges, wind turbines, offshore platforms, buildings, and nuclear weapons) which are nearing the end of their design lifetime. Since these structures cannot be economically replaced, techniques for structural health monitoring must be developed and implemented. Modal and structural dynamics measurements hold promise for the global non-destructive inspection of a variety of structures since surface measurements of a vibrating structure can provide information about the health of the internal members without costly (or impossible) dismantling of the structure. In order to develop structural health monitoring for application to operational structures, developments in four areas have been undertaken within this project: operational evaluation, diagnostic measurements, information condensation, and damage identification. The developments in each of these four aspects of structural health monitoring have been exercised on a broad range of experimental data. This experimental data has been extracted from structures from several application areas which include aging aircraft, wind energy, aging bridges, offshore structures, structural supports, and mechanical parts. As a result of these advances, Sandia National Laboratories is in a position to perform further advanced development, operational implementation, and technical consulting for a broad class of the nation`s aging infrastructure problems.
Millis, Marc G.; Binder, Michael P.
NASA is reviewing various propulsion technologies for exploring space. The requirements are examined for one enabling propulsion technology: Integrated Controls and Health Monitoring (ICHM) for Chemical Transfer Propulsion (CTP). Functional requirements for a CTP-ICHM system are proposed from tentative mission scenarios, vehicle configurations, CTP specifications, and technical feasibility. These CTP-ICHM requirements go beyond traditional reliable operation and emergency shutoff control to include: (1) enhanced mission flexibility; (2) continuously variable throttling; (3) tank-head start control; (4) automated prestart and post-shutoff engine check; (5) monitoring of space exposure degradation; and (6) product evolution flexibility. Technology development plans are also discussed.
Lee, Chi Chung; Hung, Kevin; Chan, Wai-Man; Wu, Y. K.; Choy, Sheung-On; Kwok, Paul
In this paper, a wearable physiologic monitoring system using FBG sensors is investigated. The FBG sensors with the capability of sensing temperature, movement, and respiration are connected to the wireless transceiver, microcontroller and server for wireless and long distance physiologic monitoring and analysis. Biosignals recorded experimentally are analyzed and compared with the data obtained in the traditional medical data acquisition system. The system investigated in this paper can be used in an m-health shirt, which has the capability to measure and wirelessly transmit electrocardiogram, respiration, movement, and body temperature signal to a remote station, with other plug-in modules.
Warren, Jared S.; Nelson, Philip L.; Mondragon, Sasha A.; Baldwin, Scott A.; Burlingame, Gary M.
Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome…
Carrico, Ruth M; Sorrells, Nikka; Westhusing, Kelly; Wiemken, Timothy
Recent studies have identified concerns with various elements of health care personnel immunization programs, including the handling and management of the vaccine. The purpose of this study was to assess monitoring processes that support evaluation of the care of vaccines in health care settings. An 11-question survey instrument was developed for use in scripted telephone surveys. State health departments in all 50 states in the United States and the District of Columbia were the target audience for the surveys. Data from a total of 47 states were obtained and analyzed. No states reported an existing monitoring process for evaluation of health care personnel immunization programs in their states. Our assessment indicates that vaccine evaluation processes for health care facilities are rare to nonexistent in the United States. Identifying existing practice gaps and resultant opportunities for improvements may be an important safety initiative that protects patients and health care personnel.
Gee, Susan B.; Croucher, Matthew J.; Beveridge, John
The Health of the Nation Outcome Scales (HoNOS) family of measures is routinely used in mental health services in the New Zealand, Australia, and the United Kingdom. However, the psychometric properties of the HoNOS65+ for elderly people have not been extensively evaluated. The aim of the present study was to examine the validity, reliability, and…
Tan, Yee-Yong; Chung, Wan-Young
Promising development in the light emitting diode (LED) technology has spurred the interest to adapt LED for both illumination and data transmission. This has fostered the growth of interest in visible light communication (VLC), with on-going research to utilize VLC in various applications. This paper presents a mobile-health monitoring system, where healthcare information such as biomedical signals and patient information are transmitted via the LED lighting. A small and portable receiver module is designed and developed to be attached to the mobile device, providing a seamless monitoring environment. Three different healthcare information including ECG, PPG signals and HL7 text information is transmitted simultaneously, using a single channel VLC. This allows for a more precise and accurate monitoring and diagnosis. The data packet size is carefully designed, to transmit information in a minimal packet error rate. A comprehensive monitoring application is designed and developed through the use of a tablet computer in our study. Monitoring and evaluation such as heart rate and arterial blood pressure measurement can be performed concurrently. Real-time monitoring is demonstrated through experiment, where non-hazardous transmission method can be implemented alongside a portable device for better and safer healthcare service.
Silvey, Kerry; Stock, Jacquie; Hasegawa, Lianne E; Au, Sylvia Mann
Third party payers, funding agencies, and lawmakers often require clinicians and public health agencies to justify programs and services by documenting results. This article describes two assessment tools--"Defining Genetics Services Framework" and "Genetics Services Outcomes Menu," created to assist public health professionals, clinicians, family advocates, and researchers to plan, evaluate, and demonstrate the effectiveness of genetics services. The tools were developed by a work group of the Western States Genetics Services Collaborative (WSGSC) consisting of public health genetics and newborn screening professionals, family representatives, a medical geneticist, and genetic counselors from Alaska, California, Hawaii, Idaho, Oregon, and Washington. The work group created both tools by an iterative process of combining their ideas with findings from a literature and World Wide Web review. The Defining Genetics Services Framework reflects the diversity of work group members. Three over-lapping areas of genetics services from public health core functions to population screening to clinical genetics services are depicted. The Genetics Services Outcomes Menu lists sample long-term outcomes of genetics services. Menu outcomes are classified under impact areas of Knowledge and Information; Financing; Screening and Identification; Diagnosis, Treatment, and Management; and Population Health. The WSGSC incorporated aspects of both tools into their Regional Genetics Plan.
assessment of "outcome". Stroke , 13, 873-876. 63. Ferguson, G. H., Hildman, T., & Nichols, B. (1987). The effect of nursing care planning systems on patient...Outcome assessment. (1987). New England Journal of Medicine, 317(4), 251-252. 177. Partridge, C. J. (1982). The outcome of physiotherapy and its...measurement. Physiotherapy , 68(11), 362-363. 178. Penckofer, S. H., & Holm, K. (1984). Early appraisal of coronary revascularization on quality of life
Shaw, Ryan J; Zullig, Leah L; Crowley, Matthew J; Grambow, Steven C; Lindquist, Jennifer H; Shah, Bimal R; Peterson, Eric; Bosworth, Hayden B
We describe the computer use characteristics of 406 post-myocardial infarction (MI) patients and their willingness to engage online for health communication and monitoring. Most participants were computer users (n = 259; 63.8%) and half (n = 209; 51.5%) read health information online at least monthly. However, most participants did not go online to track health conditions (n = 283; 69.7%), look at medical records (n = 287; 70.7%), or e-mail doctors (n = 351; 86.5%). Most participants would consider using a Web site to e-mail doctors (n = 275; 67.7%), share medical information with doctors (n = 302; 74.4%), send biological data to their doctor (n = 308; 75.9%), look at medical records (n = 321; 79.1%), track health conditions (n = 331; 81.5%), and read about health conditions (n = 332; 81.8%). Sharing health information online with family members (n = 181; 44.6%) or for support groups (n = 223; 54.9%) was not of much interest. Most post-MI participants reported they were interested in communicating with their provider and tracking their health conditions online. Because patients with a history of MI tend to be older and are disproportionately minority, researchers and clinicians must be careful to design interventions that embrace post-MI patients of diverse backgrounds that both improve their access to care and health outcomes.
Kolena, B; Petrovičová, I; Šidlovská, M; Pilka, T; Neuschlová, M; Valentová, I; Rybanský, L'; Trnovec, T
We studied occupational exposure to phthalates from first-morning-void urine sample of hairdressing apprentices by HPLC-MS/MS analyses and association with health status. Metabolites of mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono ethyl phthalate (MEP), mono-n-butyl phthalate (MnBP) and mono-iso-butyl phthalate (MiBP) were detected in all urine samples, followed by metabolites mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono(2-etylhexyl) phthalate (MEHP) occurring in 97.06% and 86.76% of samples, respectively. Positive associations for females were observed between MnBP and fat-free mass index (FFMI) and age; negative associations were found between MEHP, MEOHP, MEHHP, sum of MEHP, MEHHP, MEOHP and vital capacity and also between MEHP and forced vital capacity (FVC of predicted value (PV)). Lengths of exposure were associated to MnBP, MEHHP, and MEP. We also documented positive associations between anthropometry (body mass index, waist-to-height ratio (WHtR), FFMI, fat mass index) and pulmonary function FVC% of PV for females and negative associations between WHtR, waist-to-hip ratio, FFMI and ratio of forced expiratory volume in 1 s (FEV1) to FVC (FEV1/FVC). We assume that factors of occupational environment of hairdressing apprentices are affected by phthalates and resulted in negative outcomes in breathing mechanism and influence of body composition. Adipose tissue could play role as confounding factor in urine excretion of phthalates because of their lipid solubility and accumulation.
Musyimi, Christine W; Mutiso, Victoria; Ndetei, David M; Henderson, David C; Bunders, Joske
Task-shifting in mental health such as engaging Traditional Health Practitioners (THPs) in appropriate management of mental disorders is crucial in reducing global mental health challenges. This study aims to determine the outcomes of using evidence-based mental health Global Action Programme Intervention guide (mhGAP-IG) to provide psychosocial interventions among depressed patients seeking care from THPs. THPs were trained to deliver psychosocial interventions to their patients screening positive for mild to severe depression on Beck's Depression Inventory (BDI). Assessments were conducted at 0, 6 and 12 weeks and Analysis of Variance (ANOVA) performed to determine the change in depression scores over the three time period. BDI mean score was 26.52 before intervention and reduced significantly at 6 (13%) and 12 (35%) weeks after intervention. 58 and 78% of patients showed reduction in symptoms of depression at 6 and 12 weeks. It is therefore crucial to engage THPs in the care of patients with depression and the need for inclusion of training packages; and other mental disorders in order to establish and maintain collaboration between THPs and conventional health workers and promote evidence-based care among marginalized populations. Moreover, further research on randomized control trials of mhGAP-IG intervention versus usual care is required.
Nancarrow, Susan A
For over a decade, organizations have attempted to include the measurement and reporting of health outcome data in contractual agreements between funders and health service providers, but few have succeeded. This research explores the utility of collecting health outcomes data that could be included in funding contracts for an Australian Community Care Organisation (CCO). An action-research methodology was used to trial the implementation of outcome measurement in six diverse projects within the CCO using a taxonomy of interventions based on the International Classification of Function. The findings from the six projects are presented as vignettes to illustrate the issues around the routine collection of health outcomes in each case. Data collection and analyses were structured around Donabedian’s structure–process–outcome triad. Health outcomes are commonly defined as a change in health status that is attributable to an intervention. This definition assumes that a change in health status can be defined and measured objectively; the intervention can be defined; the change in health status is attributable to the intervention; and that the health outcomes data are accessible. This study found flaws with all of these assumptions that seriously undermine the ability of community-based organizations to introduce routine health outcome measurement. Challenges were identified across all stages of the Donabedian triad, including poor adherence to minimum dataset requirements; difficulties standardizing processes or defining interventions; low rates of use of outcome tools; lack of value of the tools to the service provider; difficulties defining or identifying the end point of an intervention; technical and ethical barriers to accessing data; a lack of standardized processes; and time lags for the collection of data. In no case was the use of outcome measures sustained by any of the teams, although some quality-assurance measures were introduced as a result of the
Nevers, Meredith B.; Whitman, Richard L.
Efforts to improve public health protection in recreational swimming waters have focused on obtaining real-time estimates of water quality. Current monitoring techniques rely on the time-intensive culturing of fecal indicator bacteria (FIB) from water samples, but rapidly changing FIB concentrations result in management errors that lead to the public being exposed to high FIB concentrations (type II error) or beaches being closed despite acceptable water quality (type I error). Empirical predictive models may provide a rapid solution, but their effectiveness at improving health protection has not been adequately assessed. We sought to determine if emerging monitoring approaches could effectively reduce risk of illness exposure by minimizing management errors. We examined four monitoring approaches (inactive, current protocol, a single predictive model for all beaches, and individual models for each beach) with increasing refinement at 14 Chicago beaches using historical monitoring and hydrometeorological data and compared management outcomes using different standards for decision-making. Predictability (R2) of FIB concentration improved with model refinement at all beaches but one. Predictive models did not always reduce the number of management errors and therefore the overall illness burden. Use of a Chicago-specific single-sample standard-rather than the default 235 E. coli CFU/100 ml widely used-together with predictive modeling resulted in the greatest number of open beach days without any increase in public health risk. These results emphasize that emerging monitoring approaches such as empirical models are not equally applicable at all beaches, and combining monitoring approaches may expand beach access.
Nevers, Meredith B; Whitman, Richard L
Efforts to improve public health protection in recreational swimming waters have focused on obtaining real-time estimates of water quality. Current monitoring techniques rely on the time-intensive culturing of fecal indicator bacteria (FIB) from water samples, but rapidly changing FIB concentrations result in management errors that lead to the public being exposed to high FIB concentrations (type II error) or beaches being closed despite acceptable water quality (type I error). Empirical predictive models may provide a rapid solution, but their effectiveness at improving health protection has not been adequately assessed. We sought to determine if emerging monitoring approaches could effectively reduce risk of illness exposure by minimizing management errors. We examined four monitoring approaches (inactive, current protocol, a single predictive model for all beaches, and individual models for each beach) with increasing refinement at 14 Chicago beaches using historical monitoring and hydrometeorological data and compared management outcomes using different standards for decision-making. Predictability (R(2)) of FIB concentration improved with model refinement at all beaches but one. Predictive models did not always reduce the number of management errors and therefore the overall illness burden. Use of a Chicago-specific single-sample standard-rather than the default 235 E. coli CFU/100 ml widely used-together with predictive modeling resulted in the greatest number of open beach days without any increase in public health risk. These results emphasize that emerging monitoring approaches such as empirical models are not equally applicable at all beaches, and combining monitoring approaches may expand beach access.
Eager, C A
To determine the type and quality of documentation in home health care agencies in the United States, a 15-question survey was sent to 500 agencies. The returned surveys revealed the following: (1) narrative notes were the most consistently used documentation tool; (2) 74% of agencies take photographs of the wound as part of their documentation; (3) 87% of agencies stage pressure ulcers according to the National Pressure Ulcer Advisory Panel (NPUAP) staging system; (4) 7% use reverse staging to document improvement in wounds; (5) 32% use standard protocols to treat different types of wounds; (6) 96% to 98% monitored healing by measuring length times width, as well as drainage and wound bed changes. The results indicate that most home health care agencies use the NPUAP staging system but do not track healing in a consistent way. They do not follow a consistent documentation standard, nor do their wound assessments bring together all the monitored factors indicative of healing progress.
Salmanpour, Mohammad Saleh; Sharif Khodaei, Zahra; Aliabadi, Mohammad Hossein
This paper investigates the robustness of permanently mounted transducers used in airborne structural health monitoring systems, when exposed to the operational environment. Typical airliners operate in a range of conditions, hence, structural health monitoring (SHM) transducer robustness and integrity must be demonstrated for these environments. A set of extreme temperature, altitude and vibration environment test profiles are developed using the existing Radio Technical Commission for Aeronautics (RTCA)/DO-160 test methods. Commercially available transducers and manufactured versions bonded to carbon fibre reinforced polymer (CFRP) composite materials are tested. It was found that the DuraAct transducer is robust to environmental conditions tested, while the other transducer types degrade under the same conditions.
Kostyk, Chris; Richards, Lance; Hudston, Larry; Prosser, William
Progress in the development of new thermal protection systems (TPS) is reported. New approaches use embedded lightweight, sensitive, fiber optic strain and temperature sensors within the TPS. Goals of the program are to develop and demonstrate a prototype TPS health monitoring system, develop a thermal-based damage detection algorithm, characterize limits of sensor/system performance, and develop ea methodology transferable to new designs of TPS health monitoring systems. Tasks completed during the project helped establish confidence in understanding of both test setup and the model and validated system/sensor performance in a simple TPS structure. Other progress included complete initial system testing, commencement of the algorithm development effort, generation of a damaged thermal response characteristics database, initial development of a test plan for integration testing of proven FBG sensors in simple TPS structure, and development of partnerships to apply the technology.
Dodson, J C; Inman, D J
One of the drawbacks of the current Lamb wave structural health monitoring methods are the false positives due to changing environmental conditions such as temperature. To create an environmental insensitive damage detection scheme, the physics of thermal effects on Lamb waves must be understood. Dispersion and thermal sensitivity curves for an isotropic plate with thermal stress and thermally varying elastic modulus are presented. The thermal sensitivity of dispersion curves is analytically developed and validated by experimental measurements. The group velocity thermal sensitivity highlights temperature insensitive features at two critical frequencies. The thermal sensitivity gives us insight to how temperature affects Lamb wave speeds in different frequency ranges and will help those developing structural health monitoring algorithms.
Vincze, Johanna E.; Sauer, Richard L.
One of the unique aspects of the Space Station is that it will be a totally encapsulated environment and the air and water supplies will be reclaimed for reuse. The Environmental Health System, a subsystem of CHeCS (Crew Health Care System), must monitor the air and water on board the Space Station Freedom to verify that the quality is adequate for crew safety. Specifically, the Water Quality Subsystem will analyze the potable and hygiene water supplies regularly for organic, inorganic, particulate, and microbial contamination. The equipment selected to perform these analyses will be commercially available instruments which will be converted for use on board the Space Station Freedom. Therefore, the commercial hardware will be analyzed to identify the gravity dependent functions and modified to eliminate them. The selection, analysis, and conversion of the off-the-shelf equipment for monitoring the Space Station reclaimed water creates a challenging project for the Water Quality engineers and scientists.
Salmanpour, Mohammad Saleh; Sharif Khodaei, Zahra; Aliabadi, Mohammad Hossein
This paper investigates the robustness of permanently mounted transducers used in airborne structural health monitoring systems, when exposed to the operational environment. Typical airliners operate in a range of conditions, hence, structural health monitoring (SHM) transducer robustness and integrity must be demonstrated for these environments. A set of extreme temperature, altitude and vibration environment test profiles are developed using the existing Radio Technical Commission for Aeronautics (RTCA)/DO-160 test methods. Commercially available transducers and manufactured versions bonded to carbon fibre reinforced polymer (CFRP) composite materials are tested. It was found that the DuraAct transducer is robust to environmental conditions tested, while the other transducer types degrade under the same conditions. PMID:27973450
Jones, Cathleen E.
Radar remote sensing offers great potential for high resolution monitoring of ground surface changes over large areas at one time to detect movement on and near levees and for location of seepage through levees. Our NASA-funded projects to monitor levees in the Sacramento Delta and the Mississippi River have developed and demonstrated methods to use radar remote sensing to measure quantities relevant to levee health and of great value to emergency response. The DHS-funded project will enable us is to define how to optimally monitor levees in this new way and set the stage for transition to using satellite SAR (synthetic aperture radar) imaging for better temporal and spatial coverage at lower cost to the end users.
Thompson, Larry D.; Westermo, Bruce D.
Fiber-reinforced composite materials are beginning to be employed in applications related to retrofit and repair of large-scale civil structures. This paper discusses the utilization of a passive, pea, strain monitoring technology to the damage and health assessment of composite structures. Applications considered include epoxy-matrix composite materials reinforced with chopped glass, continuous glass fibers, carbon-fiber mat as well as continuous carbon-fiber. The advantages of the various material applications are discussed as they apply to large civil structures with peak strain monitoring data presented to illustrate how the systems can be field monitored. Full-scale structural component testing as well as subscale laboratory testing results will be presented and discussed. Recommendations are provided to guide the engineering community in such composite applications and to provide a design framework for the inclusion of simple and reliable sensor systems to detect both short-term and long-term damage.
Lie, Penny; Mowry, Mychelle; Nettle, Jeremy
Wireless technology enables clinicians to continuously monitor their patients' conditions remotely. This allows doctors to leverage data to make informed decisions and interventions with immediacy, thereby reducing or eliminating hospital stays, driving down costs and improving outcomes. Remote monitoring initiatives rely on a sophisticated end-to-end IT infrastructure that encompasses wireless sensors and mobile telecommunications devices as well as middleware and business intelligence capabilities to provide a faster response loop, greater visibility and an extensible and scalable framework. This article explores the potential of wireless remote monitoring to improve care and reduce the cost of chronic disease management in an aging and mobile population. The article will also discuss the IT infrastructure and operational requirements needed to ensure that data from remote sensors can be quickly translated into actionable information.
AFRL-AFOSR-VA-TR-2016-0094 Bayesian Computational Sensor Networks for Aircraft Structural Health Monitoring. Thomas Henderson UNIVERSITY OF UTAH SALT...The major goal of this work was to provide rigorous Bayesian Computational Sensor Networks to quantify uncertainty in (1) model-based state...estimates incorporating sensor data, (2) model parameters (e.g., diffusion coefficients), (3) sensor node model parameter values (e.g., location, bias
Liew, Oi Wah; Chong, Pek Ching Jenny; Li, Bingqing; Asundi, Anand K.
Optical technologies can be developed as practical tools for monitoring plant health by providing unique spectral signatures that can be related to specific plant stresses. Signatures from thermal and fluorescence imaging have been used successfully to track pathogen invasion before visual symptoms are observed. Another approach for non-invasive plant health monitoring involves elucidating the manner with which light interacts with the plant leaf and being able to identify changes in spectral characteristics in response to specific stresses. To achieve this, an important step is to understand the biochemical and anatomical features governing leaf reflectance, transmission and absorption. Many studies have opened up possibilities that subtle changes in leaf reflectance spectra can be analyzed in a plethora of ways for discriminating nutrient and water stress, but with limited success. There has also been interest in developing transgenic phytosensors to elucidate plant status in relation to environmental conditions. This approach involves unambiguous signal creation whereby genetic modification to generate reporter plants has resulted in distinct optical signals emitted in response to specific stressors. Most of these studies are limited to laboratory or controlled greenhouse environments at leaf level. The practical translation of spectral cues for application under field conditions at canopy and regional levels by remote aerial sensing remains a challenge. The movement towards technology development is well exemplified by the Controlled Ecological Life Support System under development by NASA which brings together technologies for monitoring plant status concomitantly with instrumentation for environmental monitoring and feedback control. PMID:27879874
Pitarma, Rui; Marques, Gonçalo; Ferreira, Bárbara Roque
Indoor environments are characterized by several pollutant sources. Because people spend more than 90% of their time in indoor environments, several studies have pointed out the impact of indoor air quality on the etiopathogenesis of a wide number of non-specific symptoms which characterizes the "Sick Building Syndrome", involving the skin, the upper and lower respiratory tract, the eyes and the nervous system, as well as many building related diseases. Thus, indoor air quality (IAQ) is recognized as an important factor to be controlled for the occupants' health and comfort. The majority of the monitoring systems presently available is very expensive and only allow to collect random samples. This work describes the system (iAQ), a low-cost indoor air quality monitoring wireless sensor network system, developed using Arduino, XBee modules and micro sensors, for storage and availability of monitoring data on a web portal in real time. Five micro sensors of environmental parameters (air temperature, humidity, carbon monoxide, carbon dioxide and luminosity) were used. Other sensors can be added for monitoring specific pollutants. The results reveal that the system can provide an effective indoor air quality assessment to prevent exposure risk. In fact, the indoor air quality may be extremely different compared to what is expected for a quality living environment. Systems like this would have benefit as public health interventions to reduce the burden of symptoms and diseases related to "sick buildings".
Marinkovic, Stevan; Popovici, Emanuel
In recent years there is growing pressure on the medical sector to reduce costs while maintaining or even improving the quality of care. A potential solution to this problem is real time and/or remote patient monitoring by using mobile devices. To achieve this, medical sensors with wireless communication, computational and energy harvesting capabilities are networked on, or in, the human body forming what is commonly called a Wireless Body Area Network (WBAN). We present the implementation of a novel Wake Up Receiver (WUR) in the context of standardised wireless protocols, in a signal-oriented WBAN environment and present a novel protocol intended for wireless health monitoring (WhMAC). WhMAC is a TDMA-based protocol with very low power consumption. It utilises WBAN-specific features and a novel ultra low power wake up receiver technology, to achieve flexible and at the same time very low power wireless data transfer of physiological signals. As the main application is in the medical domain, or personal health monitoring, the protocol caters for different types of medical sensors. We define four sensor modes, in which the sensors can transmit data, depending on the sensor type and emergency level. A full power dissipation model is provided for the protocol, with individual hardware and application parameters. Finally, an example application shows the reduction in the power consumption for different data monitoring scenarios.
Chilles, James; Croxford, Anthony; Bond, Ian
This study demonstrates the capability of inductively coupled piezoelectric sensors to monitor the state of health throughout the lifetime of composite structures. A single sensor which generated guided elastic waves was embedded into the stacking sequence of a large glass fiber reinforced plastic plate. The progress of cure was monitored by measuring variations in the amplitude and velocity of the waveforms reflected from the plate's edges. Baseline subtraction techniques were then implemented to detect barely visible impact damage (BVID) created by a 10 Joule impact, at a distance of 350 mm from the sensor embedded in the cured plate. To investigate the influence of mechanical loading on sensor performance, a single sensor was embedded within a glass fiber panel and subjected to tensile load. The panel was loaded up to a maximum strain of 1%, in increments of 0.1% strain. Guided wave measurements were recorded by the embedded sensor before testing, when the panel was under load, and after testing. The ultrasonic measurements showed a strong dependence on the applied load. Upon removal of the mechanical load the guided wave measurements returned to their original values recorded before testing. The results in this work show that embedded piezoelectric sensors can be used to monitor the state of health throughout the life-cycle of composite parts, even when subjected to relatively large strains. However the influence of load on guided wave measurements has implications for online monitoring using embedded piezoelectric transducers.
Yu, Lingyu; Giurgiutiu, Victor; Ziehl, Paul; Ozevin, Didem
rent routine inspection practices for bridge health monitoring are not sufficient for the timely identification of areas of concern or to provide enough information to bridge owners to make informed decisions for maintenance prioritization. Continuous monitoring is needed for long term evaluation from an integrated sensing system that would act as a monitoring and early warning alarm system and be able to communicate the information from the bridge directly to the bridge owners for potential and immediate action. To address this urgent highway bridge health monitoring need, a joint venture research has been initiated by incorporating novel and promising sensing approach based on piezoelectricity together with energy harvesting to reduce the dramatic uncertainty inherent into any inspection and maintenance plan. In the system, the damage detection and classification is focused on the use of piezoelectric wafer active sensors (PWAS) at both active (Lamb wave interrogation) mode and passive (acoustic emission) mode on steel bridge. For efficient energy usage, the active mode will be triggered when acoustic emission caused by the structural change is detected. In the active sensing mode, computed array imaging will be used to detect the presence of crack and to track its growth. To further quantify the crack growth, damage physics based damage indicator will be defined and used to trace the crack growth as well.
Brown, Timothy; Wood, Karen; Childers, Brooks; Cano, Roberto; Jensen, Brian; Rogowski, Robert
Fiber optic sensors are being developed for health monitoring of future aircraft. Aircraft health monitoring involves the use of strain, temperature, vibration and chemical sensors. These sensors will measure load and vibration signatures that will be used to infer structural integrity. Sine the aircraft morphing program assumes that future aircraft will be aerodynamically reconfigurable there is also a requirement for pressure, flow and shape sensors. In some cases a single fiber may be used for measuring several different parameters. The objective of the current program is to develop techniques for using optical fibers to monitor composite cure in real time during manufacture and to monitor in-service structural integrity of the composite structure. Graphite-epoxy panels were fabricated with integrated optical fibers of various types. The panels were mechanically and thermally tested to evaluate composite strength and sensor durability. Finally the performance of the fiber optic sensors was determined. Experimental results are presented evaluating the performance of embedded and surface mounted optical fibers for measuring strain, temperature and chemical composition. The performance of the fiber optic sensors was determined by direct comparison with results from more conventional instrumentation. The facilities for fabricating optical fiber and associated sensors and methods of demodulating Bragg gratings for strain measurement will be described.
This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children.
Bao, James; Rodriguez, Daniela C; Paina, Ligia; Ozawa, Sachiko; Bennett, Sara
Purpose: Donors are increasingly interested in the transition and sustainability of global health programs as priorities shift and external funding declines. Systematic and high-quality monitoring and evaluation (M&E) of such processes is rare. We propose a framework and related guiding questions to systematize the M&E of global health program transitions. Methods: We conducted stakeholder interviews, searched the peer-reviewed and gray literature, gathered feedback from key informants, and reflected on author experiences to build a framework on M&E of transition and to develop guiding questions. Findings: The conceptual framework models transition as a process spanning pre-transition and transition itself and extending into sustained services and outcomes. Key transition domains include leadership, financing, programming, and service delivery, and relevant activities that drive the transition in these domains forward include sustaining a supportive policy environment, creating financial sustainability, developing local stakeholder capacity, communicating to all stakeholders, and aligning programs. Ideally transition monitoring would begin prior to transition processes being implemented and continue for some time after transition has been completed. As no set of indicators will be applicable across all types of health program transitions, we instead propose guiding questions and illustrative quantitative and qualitative indicators to be considered and adapted based on the transition domains identified as most important to the particular health program transition. The M&E of transition faces new and unique challenges, requiring measuring constructs to which evaluators may not be accustomed. Many domains hinge on measuring “intangibles” such as the management of relationships. Monitoring these constructs may require a compromise between rigorous data collection and the involvement of key stakeholders. Conclusion: Monitoring and evaluating transitions in global
Hunter, G W; Xu, J C; Biaggi-Labiosa, A M; Laskowski, D; Dutta, P K; Mondal, S P; Ward, B J; Makel, D B; Liu, C C; Chang, C W; Dweik, R A
Breath analysis techniques offer a potential revolution in health care diagnostics, especially if these techniques can be brought into standard use in the clinic and at home. The advent of microsensors combined with smart sensor system technology enables a new generation of sensor systems with significantly enhanced capabilities and minimal size, weight and power consumption. This paper discusses the microsensor/smart sensor system approach and provides a summary of efforts to migrate this technology into human health breath monitoring applications. First, the basic capability of this approach to measure exhaled breath associated with exercise physiology is demonstrated. Building from this foundation, the development of a system for a portable asthma home health care system is described. A solid-state nitric oxide (NO) sensor for asthma monitoring has been identified, and efforts are underway to miniaturize this NO sensor technology and integrate it into a smart sensor system. It is concluded that base platform microsensor technology combined with smart sensor systems can address the needs of a range of breath monitoring applications and enable new capabilities for healthcare.
Mukkamala, Ravi; Sixto, S. L. (Technical Monitor)
During the two-year project period, we have worked on several aspects of Health Usage and Monitoring Systems for structural health monitoring. In particular, we have made contributions in the following areas. 1. Reference HUMS architecture: We developed a high-level architecture for health monitoring and usage systems (HUMS). The proposed reference architecture is shown. It is compatible with the Generic Open Architecture (GOA) proposed as a standard for avionics systems. 2. HUMS kernel: One of the critical layers of HUMS reference architecture is the HUMS kernel. We developed a detailed design of a kernel to implement the high level architecture.3. Prototype implementation of HUMS kernel: We have implemented a preliminary version of the HUMS kernel on a Unix platform.We have implemented both a centralized system version and a distributed version. 4. SCRAMNet and HUMS: SCRAMNet (Shared Common Random Access Memory Network) is a system that is found to be suitable to implement HUMS. For this reason, we have conducted a simulation study to determine its stability in handling the input data rates in HUMS. 5. Architectural specification.
Background Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research). Methods With the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013. Results The findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user. Conclusions The findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers. PMID:24139139
Background Recent studies show several health-related behaviors to cluster in adolescents. This has important implications for public health. Interrelated behaviors have been shown to be most effectively targeted by multimodal interventions addressing wider-ranging improvements in lifestyle instead of via separate interventions targeting individual behaviors. However, few previous studies have taken into account a broad, multi-disciplinary range of health-related behaviors and connected these behavioral patterns to health-related outcomes. This paper presents an analysis of the clustering of a broad range of health-related behaviors with relevant demographic factors and several health-related outcomes in adolescents. Methods Self-report questionnaire data were collected from a sample of 2,690 Dutch high school adolescents. Behavioral patterns were deducted via Principal Components Analysis. Subsequently a Two-Step Cluster Analysis was used to identify groups of adolescents with similar behavioral patterns and health-related outcomes. Results Four distinct behavioral patterns describe the analyzed individual behaviors: 1- risk-prone behavior, 2- bully behavior, 3- problematic screen time use, and 4- sedentary behavior. Subsequent cluster analysis identified four clusters of adolescents. Multi-problem behavior was associated with problematic physical and psychosocial health outcomes, as opposed to those exerting relatively few unhealthy behaviors. These associations were relatively independent of demographics such as ethnicity, gender and socio-economic status. Conclusions The results show that health-related behaviors tend to cluster, indicating that specific behavioral patterns underlie individual health behaviors. In addition, specific patterns of health-related behaviors were associated with specific health outcomes and demographic factors. In general, unhealthy behavior on account of multiple health-related behaviors was associated with both poor psychosocial
Kimball, J. C.
The performance monitoring aspect of maintenance, characteristic of the engine health monitoring system are discussed. An overview of the system activities is presented and a summary of programs for improved monitoring in the 1980's are discussed.
von Treuer, Kathryn; Fuller-Tyszkiewicz, Matthew; Little, Glenn
Shift workers have a higher rate of negative health outcomes than day shift workers. Few studies however, have examined the role of difference in workplace environment between shifts itself on such health measures. This study investigated variation in organizational climate across different types of shift work and health outcomes in nurses. Participants (n = 142) were nursing staff from a metropolitan Melbourne hospital. Demographic items elicited the type of shift worked, while the Work Environment Scale and the General Health Questionnaire measured organizational climate and health respectively. Analysis supported the hypotheses that different organizational climates occurred across different shifts, and that different organizational climate factors predicted poor health outcomes. Shift work alone was not found to predict health outcomes. Specifically, permanent night shift workers had significantly lower coworker cohesion scores compared with rotating day and evening shift workers and significantly higher managerial control scores compared with day shift workers. Further, coworker cohesion and involvement were found to be significant predictors of somatic problems. These findings suggest that differences in organizational climate between shifts accounts for the variation in health outcomes associated with shift work. Therefore, increased workplace cohesion and involvement, and decreased work pressure, may mitigate the negative health outcomes of shift workers.
Li, Ian W; Awofeso, Niyi
Little information is available on the public health workforce. This study contributes to the gap in the literature and examines the demographic characteristics, career destinations and earnings of Masters in Public Health (MPH) graduates in Australia, using data from the 1999-2009 waves of the Graduate Destination Survey. It was found that public health graduates had a high amount of female representation and very low proportions of indigenous representation. Public health graduates experienced a relatively low unemployment rate and 85% were employed within 120 days of graduation. However, close to half of the graduates did not work in the health industry or in health-related roles. The mean salaries of public health graduates working in public health roles were relatively low compared to those in other occupations, but they had a range comparable to that observed for public health professionals in the USA and were higher than those of other Masters graduates in some other health fields. The results indicate strong demand and positive employment prospects for public health graduates in Australia. Strategies to target recruitment and/or retention of female or indigenous graduates in the public health workforce should be a priority. Mapping of public health graduate destinations and employment prospects should might be prioritised, given its strong potential to facilitate workforce planning and provide potential public health workers with more comprehensive career trajectories.
Swindell, Paul; Doyle, Jon; Roach, Dennis
The Federal Aviation Administration (FAA) started a research program in structural health monitoring (SHM) in 2011. The program's goal was to understand the technical gaps of implementing SHM on commercial aircraft and the potential effects on FAA regulations and guidance. The program evolved into a demonstration program consisting of a team from Sandia National Labs Airworthiness Assurance NDI Center (AANC), the Boeing Corporation, Delta Air Lines, Structural Monitoring Systems (SMS), Anodyne Electronics Manufacturing Corp (AEM) and the FAA. This paper will discuss the program from the selection of the inspection problem, the SHM system (Comparative Vacuum Monitoring-CVM) that was selected as the inspection solution and the testing completed to provide sufficient data to gain the first approved use of an SHM system for routine maintenance on commercial US aircraft.
Finlayson, Richard D.; Luzio, Marco A.; Miller, Ronnie K.; Pollock, Adrian A.
With the increasing use of advanced composite materials in aircraft, automobiles, military hardware, and aerospace composites (such as rocket motorcases) a sizable need for composite health assessment measures exist, particularly where there is risk of failure due to high mechanical and thermal stresses. For most epoxy-based laminate composites, even low-momentum impacts can lead to "barely visible impact damage" (BVD), corresponding to a significant weakening of the composite. This weakening can lead to sudden and catastrophic failure when the material is subjected to normal operating loads. Following the explosion of Delta 241 (IIR-1) on Jaunary 17th, 1997, the failure investigation board concluded that an entire fleet of Graphite Epoxy Motorcases (GEMs) should be instrumented with a health monitoring system. This system would provide continuous structural health data on the GEM from initial acceptance testing through final erection on the launch pad. The result presented here contribute significantly to the understanding of the acoustic properties of the GEM casing, and make a substantial advancement in the theoretical phase of the source location algorithm development. When the system is complete it will continuously monitor the structural health of the GEMs, communicate wirelessly with base stations, operate autonomously for extended periods, and fit unobtrusively on the GEM itself.
Ng, Marie; Fullman, Nancy; Dieleman, Joseph L; Flaxman, Abraham D; Murray, Christopher J L; Lim, Stephen S
A major challenge in monitoring universal health coverage (UHC) is identifying an indicator that can adequately capture the multiple components underlying the UHC initiative. Effective coverage, which unites individual and intervention characteristics into a single metric, offers a direct and flexible means to measure health system performance at different levels. We view effective coverage as a relevant and actionable metric for tracking progress towards achieving UHC. In this paper, we review the concept of effective coverage and delineate the three components of the metric - need, use, and quality - using several examples. Further, we explain how the metric can be used for monitoring interventions at both local and global levels. We also discuss the ways that current health information systems can support generating estimates of effective coverage. We conclude by recognizing some of the challenges associated with producing estimates of effective coverage. Despite these challenges, effective coverage is a powerful metric that can provide a more nuanced understanding of whether, and how well, a health system is delivering services to its populations.
da Silva, Isis Tande; de Almeida-Pititto, Bianca; Ferreira, Sandra Roberta G
Introduction Non-communicable chronic diseases (NCCDs) represent a burden for public health. Alongside the established cardiometabolic risk factors such as high blood pressure and disorders of glucose and lipid metabolism, living habits and nutritional status at different stages of life are seen as contributors to this scenario. Gut microbiota composition and subclinical inflammation have been pointed out as underlying mechanisms of NCCDs. Studies involving health professionals have brought relevant contributions to the knowledge about risk factors. Technological advances facilitate data collection and analysis for big samples. A web-based survey addressed to collect data from a cohort study, which is able to identify NCCDs risk factors, is highly desirable. The objective of the Brazilian Nutritionists’ Health Study (NutriHS) is to gather online information on early life events, daily habits, emergent cardiometabolic risk factors and health outcomes of a specific subset of the Brazilian population. Methods and analysis NutriHS, developed at the School of Public Health—University of Sao Paulo, Brazil, is a research initiative that enrols undergraduates of nutrition courses from Brazilian universities and graduated volunteers. A web-based self-administered system was designed to collect health-related data. After fulfilling online questionnaires (socioeconomic, early life events and lifestyle data), participants are invited to a clinical visit for physical examination and laboratory procedures (blood sampling, faeces collection and body composition). At a 3-year interval, they will be invited to repeat similar procedures. Ethics and dissemination The NutriHS research protocol was approved by the Institutional Ethics Committee and is providing promising data which contribute to the understanding of pathophysiological links between early life events, body composition, gut microbiota, and inflammatory and metabolic risk profile. The combination of a friendly tool
Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group
Wissig, Stephanie; van Maasakkers, Lisa; Stowell, Caleb; Ackerman, Ilana; Ayers, David; Barber, Thomas; Benzakour, Thami; Bozic, Kevin; Budhiparama, Nicolaas; Caillouette, James; Conaghan, Philip G.; Dahlberg, Leif; Dunn, Jennifer; Grady‐Benson, John; Ibrahim, Said A.; Lewis, Sally; Malchau, Henrik; Manzary, Mojieb; March, Lyn; Nassif, Nader; Nelissen, Rob; Smith, Noel; Franklin, Patricia D.
Objective To define a minimum Standard Set of outcome measures and case‐mix factors for monitoring, comparing, and improving health care for patients with clinically diagnosed hip or knee osteoarthritis (OA), with a focus on defining the outcomes that matter most to patients. Methods An international working group of patients, arthroplasty register experts, orthopedic surgeons, primary care physicians, rheumatologists, and physiotherapists representing 10 countries was assembled to review existing literature and practices for assessing outcomes of pharmacologic and nonpharmacologic OA therapies, including surgery. A series of 8 teleconferences, incorporating a modified Delphi process, were held to reach consensus. Results The working group reached consensus on a concise set of outcome measures to evaluate patients’ joint pain, physical functioning, health‐related quality of life, work status, mortality, reoperations, readmissions, and overall satisfaction with treatment result. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were defined. Annual outcome measurement is recommended for all patients. Conclusion We have defined a Standard Set of outcome measures for monitoring the care of people with clinically diagnosed hip or knee OA that is appropriate for use across all treatment and care settings. We believe this Standard Set provides meaningful, comparable, and easy to interpret measures ready to implement in clinics and/or registries globally. We view this set as an initial step that, when combined with cost data, will facilitate value‐based health care improvements in the treatment of hip and knee OA. PMID:26881821
George, Melissa W; Trumpeter, Nevelyn N; Wilson, Dawn K; McDaniel, Heather L; Schiele, Bryn; Prinz, Ron; Weist, Mark D
The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program.
George, Melissa W.; Trumpeter, Nevelyn N.; Wilson, Dawn K.; McDaniel, Heather L.; Schiele, Bryn; Prinz, Ron; Weist, Mark D.
The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program. PMID:24297005
Qing, Xinlin P.; Anton, Steven R.; Zhang, David; Kumar, Amrita; Inman, Daniel J.; Ooi, Teng K.
Structural health monitoring technology is perceived as a revolutionary method of determining the integrity of structures involving the use of multidisciplinary fields including sensors, materials, system integration, signal processing and interpretation. The core of the technology is the development of self-sufficient systems for the continuous monitoring, inspection and damage detection of structures with minimal labor involvement. A major drawback of the existing technology for real-time structural health monitoring is the requirement for external electrical power input. For some applications, such as missiles or combat vehicles in the field, this factor can drastically limit the use of the technology. Having an on-board electrical power source that is independent of the vehicle power system can greatly enhance the SHM system and make it a completely self-contained system. In this paper, using the SMART layer technology as a basis, an Autonomous Self-powered (ASP) Structural Health Monitoring (SHM) system has been developed to solve the major challenge facing the transition of SHM systems into field applications. The architecture of the self-powered SHM system was first designed. There are four major components included in the SHM system: SMART Layer with sensor network, low power consumption diagnostic hardware, rechargeable battery with energy harvesting device, and host computer with supporting software. A prototype of the integrated self-powered active SHM system was built for performance and functionality testing. Results from the evaluation tests demonstrated that a fully charged battery system is capable of powering the SHM system for active scanning up to 10 hours.
Schulz, Mark J.
Large composite material structures such as aircraft and Reusable Launch Vehicles (RLVS) operate in severe environments comprised of vehicle dynamic loads, aerodynamic loads, engine vibration, foreign object impact, lightning strikes, corrosion, and moisture absorption. These structures are susceptible to damage such as delamination, fiber breaking/pullout, matrix cracking, and hygrothermal strain. To ensure human safety and load-bearing integrity, these structures must be inspected to detect and locate often invisible damage and faults before becoming catastrophic. Moreover, nearly all future structures will need some type of in-service inspection technique to increase their useful life and reduce maintenance and overall costs. Possible techniques for monitoring the health and indicating damage on composite structures include: c-scan, thermography, acoustic emissions using piezoceramic actuators or fiber-optic wires with gratings, laser ultrasound, shearography, holography, x-ray, and others. These techniques have limitations in detecting damage that is beneath the surface of the structure, far away from a sensor location, or during operation of the vehicle. The objective of this project is to develop a more global method for damage detection that is based on structural dynamics principles, and can inspect for damage when the structure is subjected to vibratory loads to expose faults that may not be evident by static inspection. A Transmittance Function Monitoring (TFM) method is being developed in this project for ground-based inspection and operational health monitoring of large composite structures as a RLV. A comparison of the features of existing health monitoring approaches and the proposed TFM method is given.
Yang, Zhou; Gilleskie, Donna B.; Norton, Edward C.
Prescription drug coverage creates a change in medical care consumption, beyond standard moral hazard, arising both from the differential cost-sharing and the relative effectiveness of different types of care. We model the dynamic supplemental health insurance decisions of Medicare beneficiaries, their medical care demand, and subsequent health…
Finlayson, Richard D.; Schaafsma, David T.; Shen, H. Warren; Carlos, Mark F.; Miller, Ronnie K.; Shepherd, Brent
Following the explosion of Delta 241 (IIR-1) on January 17th, 1997, the failure investigation board concluded that the Graphite Epoxy Motorcases (GEM's) should be inspected for damage just prior to launch. Subsequent investigations and feedback from industry led to an Aerospace Corporation proposal to instrument the entire fleet of GEM's with a continuous health monitoring system. The period of monitoring would extend from the initial acceptance testing through final erection on the launch pad. As this proposal demonstrates, (along with the increasing use of advanced composite materials in aircraft, automobiles, military hardware, and aerospace components such as rocket motorcases) a sizable need for composite health assessment measures exist. Particularly where continuous monitoring is required for the detection of damage from impacts and other sources of high mechanical and thermal stresses. Even low-momentum impacts can lead to barely visible impact damage (BVID), corresponding to a significant weakening of the composite. This damage, undetectable by visual inspection, can in turn lead to sudden and catastrophic failure when the material is subjected to a normal operating load. There is perhaps no system with as much potential for truly catastrophic failure as a rocket motor. We will present an update on our ongoing efforts with the United States Air Force Delta II Program Office, and The Aerospace Corporation. This will cover the development of a local, portable, surface-mounted, fiberoptic sensor based impact damage monitor designed to operate on a Delta II GEM during transport, storage, and handling. This system is designed to continuously monitor the GEMs, to communicate wirelessly with base stations and maintenance personnel, to operate autonomously for extended periods, and to fit unobtrusively on the GEM itself.
Ide, Hiroshi; Abdi, Frank; Miraj, Rashid; Dang, Chau; Takahashi, Tatsuya; Sauer, Bruce
A compact cell phone size radio frequency (ZigBee) wireless strain measurement sensor system to measure the structural strain deformation was developed. The developed system provides an accurate strain measurement data stream to the Internet for further Diagnostic and Prognostic (DPS) correlation. Existing methods of structural measurement by strain sensors (gauges) do not completely satisfy problems posed by continuous structural health monitoring. The need for efficient health monitoring methods with real-time requirements to bidirectional data flow from sensors and to a commanding device is becoming critical for keeping our daily life safety. The use of full-field strain measurement techniques could reduce costly experimental programs through better understanding of material behavior. Wireless sensor-network technology is a monitoring method that is estimated to grow rapidly providing potential for cost savings over traditional wired sensors. The many of currently available wireless monitoring methods have: the proactive and constant data rate character of the data streams rather than traditional reactive, event-driven data delivery; mostly static node placement on structures with limited number of nodes. Alpha STAR Electronics' wireless sensor network system, ASWN, addresses some of these deficiencies, making the system easier to operate. The ASWN strain measurement system utilizes off-the-shelf sensors, namely strain gauges, with an analog-to-digital converter/amplifier and ZigBee radio chips to keep cost lower. Strain data is captured by the sensor, converted to digital form and delivered to the ZigBee radio chip, which in turn broadcasts the information using wireless protocols to a Personal Data Assistant (PDA) or Laptop/Desktop computers. From here, data is forwarded to remote computers for higher-level analysis and feedback using traditional cellular and satellite communication or the Ethernet infrastructure. This system offers a compact size, lower cost
Saganowski, Stanisław; Misiaszek, Andrzej; Bródka, Piotr; Andreasson, Anna; Curcin, Vasa; Delaney, Brendan; Frączkowski, Kazimierz
Patient Recorded Outcome Measures (PROMs) are an essential part of quality of life monitoring, clinical trials, improvement studies and other medical tasks. Recently, web and mobile technologies have been explored as means of improving the response rates and quality of data collected. Despite the potential benefit of this approach, there are currently no widely accepted standards for developing or implementing PROMs in CER (Comparative Effectiveness Research). Within the European Union project Transform (Translational Research and Patient Safety in Europe) an eHealth solution for quality of life monitoring has been developed and validated. This paper presents the overall architecture of the system as well as a detailed description of the mobile and web applications. PMID:27570677
Saganowski, Stanisław; Misiaszek, Andrzej; Bródka, Piotr; Andreasson, Anna; Curcin, Vasa; Delaney, Brendan; Frączkowski, Kazimierz
Patient Recorded Outcome Measures (PROMs) are an essential part of quality of life monitoring, clinical trials, improvement studies and other medical tasks. Recently, web and mobile technologies have been explored as means of improving the response rates and quality of data collected. Despite the potential benefit of this approach, there are currently no widely accepted standards for developing or implementing PROMs in CER (Comparative Effectiveness Research). Within the European Union project Transform (Translational Research and Patient Safety in Europe) an eHealth solution for quality of life monitoring has been developed and validated. This paper presents the overall architecture of the system as well as a detailed description of the mobile and web applications.
This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. The term monitoring is commonly used to describe the process of systematically collecting data to inform policymakers, managers and other stakeholders whether a new policy or programme is being implemented in accordance with their expectations. Indicators are used for monitoring purposes to judge, for example, if objectives are being achieved, or if allocated funds are being spent appropriately. Sometimes the term evaluation is used interchangeably with the term monitoring, but the former usually suggests a stronger focus on the achievement of results. When the term impact evaluation is used, this usually implies that there is a specific attempt to try to determine whether the observed changes in outcomes can be attributed to a particular policy or programme. In this article, we suggest four questions that can be used to guide the monitoring and evaluation of policy or programme options. These are: 1. Is monitoring necessary? 2. What should be measured? 3. Should an impact evaluation be conducted? 4. How should the impact evaluation be done? PMID:20018108
Sharma, P; Busby, M; Chapple, L; Matthews, R; Chapple, I
.Conclusion The current study has demonstrated that patient reported general health and risk factors were negatively associated with an overall composite oral health score outcome in a large population of over 37,000 patients examined by 493 dentists. While the clinical significance of some of the reported associations is unknown, the data lend support to the growing body of evidence linking the oral and systemic health of individuals. Therefore, GDPs may be in a unique position to influence the lifestyle and general health of patients as part of their specific remit to attain and maintain optimal oral health.
Kaspin, Lisa C; Gorman, Kathleen M; Miller, Ross M
This review determines the characteristics and health-related and economic outcomes of employer-sponsored wellness programs and identifies possible reasons for their success. PubMed, ABI/Inform, and Business Source Premier databases, and Corporate Wellness Magazine were searched. English-language articles published from 2005 to 2011 that reported characteristics of employer-sponsored wellness programs and their impact on health-related and economic outcomes among US employees were accepted. Data were abstracted, synthesized, and interpreted. Twenty references were accepted. Wellness interventions were classified into health assessments, lifestyle management, and behavioral health. Improved economic outcomes were reported (health care costs, return on investment, absenteeism, productivity, workers' compensation, utilization) as well as decreased health risks. Programs associated with favorable outcomes had several characteristics in common. First, the corporate culture encouraged wellness to improve employees' lives, not only to reduce costs. Second, employees and leadership were strongly motivated to support the wellness programs and to improve their health in general. Third, employees were motivated by a participation-friendly corporate policy and physical environment. Fourth, successful programs adapted to the changing needs of the employees. Fifth, community health organizations provided support, education, and treatment. Sixth, successful wellness programs utilized technology to facilitate health risk assessments and wellness education. Improved health-related and economic outcomes were associated with employer-sponsored wellness programs. Companies with successful programs tended to include wellness as part of their corporate culture and supported employee participation in several key ways.
Pai, Devdas M.; Tatum, Paul; Pace, Rachel
As with most elements of infrastructure, electrical wiring is innocuous; usually hidden away and unnoticed until it fails. Failure of infrastructure, however, sometimes leads to serious health and safety hazards. Electrical wiring fails when the polymeric (usually rubber) insulation material that sheathes the conductor gets embrittled with age from exposure to pressure, temperature or radiation cycling or when the insulation gets removed by the chafing of wires against each other. Miles of such wiring can be found in typical aircraft, with significant lengths of the wiring immersed in aviation fuel - a recipe for an explosion if a spark were to occur. Diagnosing the health of wiring is thus an important aspect of monitoring the health of aging aircraft. Stress wave propagation through wiring affords a quick and non-invasive method for health monitoring. The extent to which a stress wave propagating through the cable core gets attenuated depends on the condition of the surrounding insulation. When the insulation is in good condition - supple and pliable, there is more damping or attenuation of the waveform. As the insulation gets embrittled and cracked, the attenuation is likely to reduce and the waveform of the propagating stress wave is likely to change. The monitoring of these changes provides a potential tool to evaluate wiring or cabling in service that is not accessible for visual inspection. This experiment has been designed for use in an introductory mechanical or materials engineering instrumentation lab. Initial setup (after procuring all the materials) should take the lab instructor about 4 hours. A single measurement can be initiated and saved to disk in less than 3 minutes, allowing for all the students in a typical lab section to take their own data rather than share a single set of data for the entire class.
Doyle, Eva I.; Caro, Carla M.; Lysoby, Linda; Auld, M. Elaine; Smith, Becky J.; Muenzen, Patricia M.
The National Health Educator Job Analysis 2010 was conducted to update the competencies model for entry- and advanced-level health educators. Qualitative and quantitative methods were used. Structured interviews, focus groups, and a modified Delphi technique were implemented to engage 59 health educators from diverse work settings and experience…
Steinfeld, Bradley; Franklin, Allie; Mercer, Brian; Fraynt, Rebecca; Simon, Greg
Progress monitoring implementation in an integrated health care system is a complex process that must address factors such as measurement, technology, delivery system care processes, patient needs and provider requirements. This article will describe how one organization faced these challenges by identifying the key decision points (choice of measure, process for completing rating scale, interface with electronic medical record and clinician engagement) critical to implementation. Qualitative and quantitative data will be presented describing customer and stakeholder satisfaction with the mental health progress monitoring tool (MHPMT) as well as organizational performance with key measurement targets.
Background Providing remote health monitoring to specific groups of patients represents an issue of great relevance for the national health systems, because of the costs related to moving health operators, the time spent to reach remote sites, and the high number of people needing health assistance. At the same time, some assistance activities, like those related to chronical diseases, may be satisfied through a remote interaction with the patient, without a direct medical examination. Methods Moving from this considerations, our paper proposes a system architecture for the provisioning of remote health assistance to older adults, based on a blind management of a network of wireless medical devices, and an interactive TV Set Top Box for accessing health related data. The selection of TV as the interface between the user and the system is specifically targeted to older adults. Due to the private nature of the information exchanged, a certified procedure is implemented for data delivery, through the use of non conditional smart cards. All these functions may be accomplished through a proper design of the system management, and a suitable interactive application. Results The interactive application acting as the interface between the user and the system on the TV monitor has been evaluated able to help readability and clear understanding of the contents and functions proposed. Thanks to the limited amount of data to transfer, even a Set Top Box equipped with a traditional PSTN modem may be used to support the proposed service at a basic level; more advanced features, like audio/video connection, may be activated if the Set Top Box enables a broadband connection (e.g. ADSL). Conclusions The proposed layered architecture for a remote health monitoring system can be tailored to address a wide range of needs, according with each patient’s conditions and capabilities. The system exploits the potentialities offered by Digital Television receivers, a friendly MHP interface
Aranguren, G; Monje, P M; Cokonaj, Valerijan; Barrera, Eduardo; Ruiz, Mariano
Piezoelectric sensors and actuators are the bridge between electronic and mechanical systems in structures. This type of sensor is a key element in the integrity monitoring of aeronautic structures, bridges, pressure vessels, wind turbine blades, and gas pipelines. In this paper, an all-in-one system for Structural Health Monitoring (SHM) based on ultrasonic waves is presented, called Phased Array Monitoring for Enhanced Life Assessment. This integrated instrument is able to generate excitation signals that are sent through piezoelectric actuators, acquire the received signals in the piezoelectric sensors, and carry out signal processing to check the health of structures. To accomplish this task, the instrument uses a piezoelectric phased-array transducer that performs the actuation and sensing of the signals. The flexibility and strength of the instrument allow the user to develop and implement a substantial part of the SHM technique using Lamb waves. The entire system is controlled using configuration software and has been validated through functional, electrical loading, mechanical loading, and thermal loading resistance tests.
Bansal, Ayush; Kumar, Sunil; Bajpai, Anurag; Tiwari, Vijay N; Nayak, Mithun; Venkatesan, Shankar; Narayanan, Rangavittal
Remote health monitoring system with clinical decision support system as a key component could potentially quicken the response of medical specialists to critical health emergencies experienced by their patients. A monitoring system, specifically designed for cardiac care with electrocardiogram (ECG) signal analysis as the core diagnostic technique, could play a vital role in early detection of a wide range of cardiac ailments, from a simple arrhythmia to life threatening conditions such as myocardial infarction. The system that the authors have developed consists of three major components, namely, (a) mobile gateway, deployed on patient's mobile device, that receives 12-lead ECG signals from any ECG sensor, (b) remote server component that hosts algorithms for accurate annotation and analysis of the ECG signal and (c) point of care device of the doctor to receive a diagnostic report from the server based on the analysis of ECG signals. In the present study, their focus has been toward developing a system capable of detecting critical cardiac events well in advance using an advanced remote monitoring system. A system of this kind is expected to have applications ranging from tracking wellness/fitness to detection of symptoms leading to fatal cardiac events.
Arshad, Atika; Fadzil Ismail, Ahmad; Khan, Sheroz; Zahirul Alam, A. H. M.; Tasnim, Rumana; Samnan Haider, Syed; Shobaki, Mohammed M.; Shahid, Zeeshan
A proliferating interest has been being observed over the past years in accurate wireless system development in order to monitor incessant human activities in health care centres. Furthermore because of the swelling number of elderly population and the inadequate number of competent staffs for nursing homes there is a big market petition for health care monitoring system. In order to detect human researchers developed different methods namely which include Field Identification technique, Visual Sensor Network, radar detection, e-mobile techniques and so on. An all-encompassing overview of the non-wired human detection application advancement is presented in this paper. Inductive links are used for human detection application while wiring an electronic system has become impractical in recent times. Keeping in mind the shortcomings, an Inductive Intelligent Sensor (IIS) has been proposed as a novel human monitoring system for future implementation. The proposed sensor works towards exploring the signature signals of human body movement and size. This proposed sensor is fundamentally based on inductive loop that senses the presence and a passing human resulting an inductive change.
Aranguren, G.; Monje, P. M.; Cokonaj, Valerijan; Barrera, Eduardo; Ruiz, Mariano
Piezoelectric sensors and actuators are the bridge between electronic and mechanical systems in structures. This type of sensor is a key element in the integrity monitoring of aeronautic structures, bridges, pressure vessels, wind turbine blades, and gas pipelines. In this paper, an all-in-one system for Structural Health Monitoring (SHM) based on ultrasonic waves is presented, called Phased Array Monitoring for Enhanced Life Assessment. This integrated instrument is able to generate excitation signals that are sent through piezoelectric actuators, acquire the received signals in the piezoelectric sensors, and carry out signal processing to check the health of structures. To accomplish this task, the instrument uses a piezoelectric phased-array transducer that performs the actuation and sensing of the signals. The flexibility and strength of the instrument allow the user to develop and implement a substantial part of the SHM technique using Lamb waves. The entire system is controlled using configuration software and has been validated through functional, electrical loading, mechanical loading, and thermal loading resistance tests.
Aranguren, G.; Monje, P. M.; Cokonaj, Valerijan; Barrera, Eduardo; Ruiz, Mariano
Piezoelectric sensors and actuators are the bridge between electronic and mechanical systems in structures. This type of sensor is a key element in the integrity monitoring of aeronautic structures, bridges, pressure vessels, wind turbine blades, and gas pipelines. In this paper, an all-in-one system for Structural Health Monitoring (SHM) based on ultrasonic waves is presented, called Phased Array Monitoring for Enhanced Life Assessment. This integrated instrument is able to generate excitation signals that are sent through piezoelectric actuators, acquire the received signals in the piezoelectric sensors, and carry out signal processing to check the health of structures. To accomplish this task, the instrument uses a piezoelectric phased-array transducer that performs the actuation and sensing of the signals. The flexibility and strength of the instrument allow the user to develop and implement a substantial part of the SHM technique using Lamb waves. The entire system is controlled using configuration software and has been validated through functional, electrical loading, mechanical loading, and thermal loading resistance tests.
Peairs, Daniel M.; Park, Gyuhae; Inman, Daniel J.
This paper presents the current research on impedance-based structural health monitoring technique at the Center for Intelligent Material Systems and Structures. The basic principle behind this technique is to apply high frequency structural excitations (typically higher than 30 kHz) through the surface-bonded piezoelectric transducers, and measure the impedance of structures by monitoring the current and voltage applied to the piezoelectric transducers. Changes in impedance indicate changes in the structure, which in turn can indicate that damage has occurred. Three examples, including a bolted joint, gas pipeline and composite structure, are presented to illustrate the effectiveness of this health monitoring technique to the wide variety of practical field applications. Although many proof-of-concept experiments have been performed using the impedance methods, the impedance-measuring device (HP4194A) is still bulky and expensive. Therefore, we have developed an operational amplifier-based turnkey device that can measure and record the electric impedance of a PZT. The performance of this miniaturized and portable device has been compared to our previous results and its effectiveness has been demonstrated. This paper summarizes the experimental setup, procedures, considerations needed to implement the device in field applications.
Woike, Mark R.; Abdul-Aziz, Ali; Bencic, Timothy J.
Microwave sensor technology is being investigated by the NASA Glenn Research Center as a means of making non-contact structural health measurements in the hot sections of gas turbine engines. This type of sensor technology is beneficial in that it is accurate, it has the ability to operate at extremely high temperatures, and is unaffected by contaminants that are present in turbine engines. It is specifically being targeted for use in the High Pressure Turbine (HPT) and High Pressure Compressor (HPC) sections to monitor the structural health of the rotating components. It is intended to use blade tip clearance to monitor blade growth and wear and blade tip timing to monitor blade vibration and deflection. The use of microwave sensors for this application is an emerging concept. Techniques on their use and calibration needed to be developed. As a means of better understanding the issues associated with the microwave sensors, a series of experiments have been conducted to evaluate their performance for aero engine applications. This paper presents the results of these experiments.
Chourasia, Vijay S; Tiwari, Anil Kumar
Continuous foetal monitoring of physiological signals is of particular importance for early detection of complexities related to the foetus or the mother's health. The available conventional methods of monitoring mostly perform off-line analysis and restrict the mobility of subjects within a hospital or a room. Hence, the aim of this paper is to develop a foetal e-health monitoring system using mobile phones and wireless sensors for providing advanced healthcare services in the home environment. The system is tested by recording the real-time Foetal Phonocardiography (fPCG) signals from 15 subjects with different gestational periods. The performance of the developed system is compared with the existing ultrasound based Doppler shift technique, ensuring an overall accuracy of 98% of the developed system. The developed framework is non-invasive, cost-effective and simple enough to be used in home care application. It offers advanced healthcare facilities even to the pregnant women living in rural areas and avoids their unnecessary visits at the healthcare centres.
Prociow, Pawel A; Crowe, John A
Managing bipolar disorder is an important health issue that can strongly affect the patient's quality of life during occurrences of depressive or manic episodes and is therefore a growing burden to healthcare systems. A widely practised method of monitoring the course of the disorder is by mood and general mental health questionnaires, which are nowadays often implemented on mobile electronic devices.Detecting changes to daily routine and behaviour is of crucial importance as they can be symptomatic of an ongoing episode, or in the case of an external cause, may trigger such an episode.Current mobile phones and geospatial technology provide a means of monitoring aspects of daily routine and lifestyle which may be valuable in facilitating self-management of the condition.This manuscript introduces a methodology for analysing data obtained from a simple wearable system based on a mid-range mobile phone, along with trial results from a control group of three participants with no history of Bipolar Disorder. It is suggested that such an approach offers an unobtrusive, acceptable and low cost means of monitoring bipolar disorder patients that could significantly improve their care.
Krause, James S; Broderick, Lynne E; Saladin, Lisa K; Broyles, Joy
Objective: The purpose of this study was to investigate heath disparities as a function of race and gender and the extent to which socioeconomic factors mediate disparities among participants with spinal cord injury. Design: Survey methodology. Cross-sectional data. Setting: A large Southeastern specialty hospital. Participants: There were 1,342 participants in the current analysis, all of whom were identified from patient records. There were 3 inclusion criteria: (a) traumatic SCI, (b) at least 18 years of age at the time of study, and (c) injury duration of more than 1 year. Main outcome measures: Six outcomes were measured, including 3 general outcomes (self-ratings, days impacted by poor health, days impacted by poor mental health) and 3 that reflect utilization of services (hospitalizations, days hospitalized, and nonroutine physician visits in the past 2 years). Results: Results of multivariate analysis of variance (MANOVA) indicated significant main effects for both race and gender. Follow-up tests identified racial disparities on 3 of the 6 outcomes, whereas gender disparities were observed for a single outcome. Years of education and household income mediated interrelationships between race and health (but not gender) as racial disparities disappeared after consideration of these factors. Conclusions: These findings suggest the need to work more diligently to promote better health outcomes among African Americans and to further investigate how socioeconomic factors and access to health care related to diminished health outcomes among African Americans with spinal cord injury. PMID:16572561
Mostofsky, Elizabeth; Mukamal, Kenneth J.; Giovannucci, Ed L.; Stampfer, Meir J.
Objectives. To review critical contributions from the Nurses’ Health Study (NHS) on alcohol consumption and health outcomes. Methods. We performed a narrative review of NHS (1980–2012) and NHS II (1989–2011) publications. Results. Using detailed information on self-reported alcohol drinking patterns obtained approximately every 4 years combined with extensive information on diet, lifestyle habits, and physician-diagnosed health conditions, NHS investigators have prospectively examined the risks and benefits associated with alcohol consumption. Moderate intake, defined as up to 1 drink a day, is associated with a lower risk of hypertension, myocardial infarction, stroke, sudden cardiac death, gallstones, cognitive decline, and all-cause mortality. However, even moderate intake places women at higher risk for breast cancer and bone fractures, and higher intake increases risk for colon polyps and colon cancer. Conclusions. Regular alcohol intake has both risks and benefits. In analyses using repeated assessments of alcohol over time and deaths from all causes, women with low to moderate intake and regular frequency (> 3 days/week) had the lowest risk of mortality compared with abstainers and women who consumed substantially more than 1 drink per day. PMID:27459455
Birbas, M.; Petrellis, N.; Gioulekas, F.
Aging population can benefit from health care systems that allow their health and daily life to be monitored by expert medical staff. Blood pressure, temperature measurements or more advanced tests like Electrocardiograms (ECG) can be ordered through such a healthcare system while urgent situations can be detected and alleviated on time. The results of these tests can be stored with security in a remote cloud or database. Such systems are often used to monitor non-life threatening patient health problems and their advantage in lowering the cost of the healthcare services is obvious. A low cost commercial medical sensor kit has been used in the present work, trying to improve the accuracy and stability of the sensor measurements, the power consumption, etc. This Sensor Controller communicates with a Gateway installed in the patient's residence and a tablet or smart phone used for giving instructions to the patient through a comprehensive user interface. A flexible communication protocol has been defined supporting any short or long term sensor sampling scenario. The experimental results show that it is possible to achieve low power consumption by applying apropriate sleep intervals to the Sensor Controller and by deactivating periodically some of its functionality.
Pinto, Gino A.; Ventres, C. S.; Ginty, Carol A.; Chamis, Christos C.
The aerospace industry is witnessing a vast utilization of composites in critical structural applications and anticipates even more use of them in future aircraft. Therefore, a definite need exists for a composite health monitoring expert system to meet today's current needs and tomorrow's future demands. The primary goal for this conceptual health monitoring system is functional reliably for in-service operation in the environments of various composite structures. The underlying philosophy of this system is to utilize proven vibration techniques to assess the structural integrity of a fibrous composite. Statistical methods are used to determine if the variances in the measured data are acceptable for making a reliable decision on the health status of the composite. The flexible system allows for algorithms describing any composite fatigue or damage behavior characteristic to be provided as an input to the system. Alert thresholds and variances can also be provided as an input to this system and may be updated to allow for future changes/refinements in the composite's structural integrity behavior.
Mahadevan, Sankaran; Agarwal, Vivek; Cai, Guowei; Nath, Paromita; Bao, Yanqing; Bru Brea, Jose Maria; Koester, David; Adams, Douglas; Kosson, David
Assessment and management of aging concrete structures in nuclear power plants require a more systematic approach than simple reliance on existing code margins of safety. Structural health monitoring of concrete structures aims to understand the current health condition of a structure based on heterogeneous measurements to produce high confidence actionable information regarding structural integrity that supports operational and maintenance decisions. This ongoing research project is seeking to develop a probabilistic framework for health diagnosis and prognosis of aging concrete structures in a nuclear power plant subjected to physical, chemical, environment, and mechanical degradation. The proposed framework consists of four elements—damage modeling, monitoring, data analytics, and uncertainty quantification. This report describes a proof-of-concept example on a small concrete slab subjected to a freeze-thaw experiment that explores techniques in each of the four elements of the framework and their integration. An experimental set-up at Vanderbilt University’s Laboratory for Systems Integrity and Reliability is used to research effective combination of full-field techniques that include infrared thermography, digital image correlation, and ultrasonic measurement. The measured data are linked to the probabilistic framework: the thermography, digital image correlation data, and ultrasonic measurement data are used for Bayesian calibration of model parameters, for diagnosis of damage, and for prognosis of future damage. The proof-of-concept demonstration presented in this report highlights the significance of each element of the framework and their integration.
Mbuagbaw, Lawrence; Medley, Nancy; Darzi, Andrea J; Richardson, Marty; Habiba Garga, Kesso; Ongolo-Zogo, Pierre
Background The World Health Organization (WHO) recommends at least four antenatal care (ANC) visits for all pregnant women. Almost half of pregnant women worldwide, and especially in developing countries do not receive this amount of care. Poor attendance of ANC is associated with delivery of low birthweight babies and more neonatal deaths. ANC may include education on nutrition, potential problems with pregnancy or childbirth, child care and prevention or detection of disease during pregnancy. This review focused on community-based interventions and health systems-related interventions. Objectives To assess the effects of health system and community interventions for improving coverage of antenatal care and other perinatal health outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2015) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials (RCTs), quasi-randomised trials and cluster-randomised trials. Trials of any interventions to improve ANC coverage were eligible for inclusion. Trials were also eligible if they targeted specific and related outcomes, such as maternal or perinatal death, but also reported ANC coverage. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results We included 34 trials involving approximately 400,000 women. Some trials tested community-based interventions to improve uptake of antenatal care (media campaigns, education or financial incentives for pregnant women), while other trials looked at health systems interventions (home visits for pregnant women or equipment for clinics). Most trials took place in low- and middle-income countries, and 29 of the 34 trials used a cluster-randomised design. We assessed 30 of the 34 trials as of low or unclear overall risk of bias. Comparison 1: One intervention versus no intervention We
Feuer, S K; Camarano, L; Rinaudo, P F
Since the birth of the first IVF-conceived child in 1978, the use of assisted reproductive technologies (ART) has grown dramatically, contributing to the successful birth of 5 million individuals worldwide. However, there are several reported associations of ART with pregnancy complications, such as low birthweight (LBW), preterm birth, birth defects, epigenetic disorders, cancer and poor metabolic health. Whether this is attributed to ART procedures or to the subset of the population seeking ART remains a controversy, but the most relevant question today concerns the potential long-term implications of assisted conception. Recent evidence has emerged suggesting that ART-conceived children have distinct metabolic profiles that may predispose to cardiovascular pathologies in adulthood. Because the eldest IVF individuals are still too young to exhibit components of chronic middle-aged syndromes, the use of animal models has become particularly useful in describing the effects of unusual or stressful preimplantation experiences on adult fitness. Elucidating the molecular mechanisms by which embryos integrate environmental signals into development and metabolic gene expression programs will be essential for optimizing ART procedures such as in vitro culture conditions, embryo selection and transfer. In the future, additional animal studies to identify mechanisms underlying unfavorable ART outcomes, as well as more epidemiological reviews to monitor the long-term health of ART children are required, given that ART procedures have become routine medical practice.
Feuer, S.K.; Camarano, L.; Rinaudo, P.F.
Since the birth of the first IVF-conceived child in 1978, the use of assisted reproductive technologies (ART) has grown dramatically, contributing to the successful birth of 5 million individuals worldwide. However, there are several reported associations of ART with pregnancy complications, such as low birthweight (LBW), preterm birth, birth defects, epigenetic disorders, cancer and poor metabolic health. Whether this is attributed to ART procedures or to the subset of the population seeking ART remains a controversy, but the most relevant question today concerns the potential long-term implications of assisted conception. Recent evidence has emerged suggesting that ART-conceived children have distinct metabolic profiles that may predispose to cardiovascular pathologies in adulthood. Because the eldest IVF individuals are still too young to exhibit components of chronic middle-aged syndromes, the use of animal models has become particularly useful in describing the effects of unusual or stressful preimplantation experiences on adult fitness. Elucidating the molecular mechanisms by which embryos integrate environmental signals into development and metabolic gene expression programs will be essential for optimizing ART procedures such as in vitro culture conditions, embryo selection and transfer. In the future, additional animal studies to identify mechanisms underlying unfavorable ART outcomes, as well as more epidemiological reviews to monitor the long-term health of ART children are required, given that ART procedures have become routine medical practice. PMID:23264495
Tulpule, S.; Galinaitis, W. S.
A Health Monitoring System (HMS) Framework for the Space Shuttle Main Engine (SSME) has been developed by United Technologies Corporation (UTC) for the NASA Lewis Research Center. As part of this effort, fault detection algorithms have been developed to detect the SSME faults with sufficient time to shutdown the engine. These algorithms have been designed to provide monitoring coverage during the startup, mainstage and shutdown phases of the SSME operation. The algorithms have the capability to detect multiple SSME faults, and are based on time series, regression and clustering techniques. This paper presents a discussion of candidate algorithms suitable for fault detection followed by a description of the algorithms selected for implementation in the HMS and the results of testing these algorithms with the SSME test stand data.
García, Iker; Zubia, Joseba; Durana, Gaizka; Aldabaldetreku, Gotzon; Illarramendi, María Asunción; Villatoro, Joel
Aircraft structures require periodic and scheduled inspection and maintenance operations due to their special operating conditions and the principles of design employed to develop them. Therefore, structural health monitoring has a great potential to reduce the costs related to these operations. Optical fiber sensors applied to the monitoring of aircraft structures provide some advantages over traditional sensors. Several practical applications for structures and engines we have been working on are reported in this article. Fiber Bragg gratings have been analyzed in detail, because they have proved to constitute the most promising technology in this field, and two different alternatives for strain measurements are also described. With regard to engine condition evaluation, we present some results obtained with a reflected intensity-modulated optical fiber sensor for tip clearance and tip timing measurements in a turbine assembled in a wind tunnel. PMID:26134107
García, Iker; Zubia, Joseba; Durana, Gaizka; Aldabaldetreku, Gotzon; Illarramendi, María Asunción; Villatoro, Joel
Aircraft structures require periodic and scheduled inspection and maintenance operations due to their special operating conditions and the principles of design employed to develop them. Therefore, structural health monitoring has a great potential to reduce the costs related to these operations. Optical fiber sensors applied to the monitoring of aircraft structures provide some advantages over traditional sensors. Several practical applications for structures and engines we have been working on are reported in this article. Fiber Bragg gratings have been analyzed in detail, because they have proved to constitute the most promising technology in this field, and two different alternatives for strain measurements are also described. With regard to engine condition evaluation, we present some results obtained with a reflected intensity-modulated optical fiber sensor for tip clearance and tip timing measurements in a turbine assembled in a wind tunnel.
Guo, Honglei; Xiao, Gaozhi; Mrad, Nezih; Yao, Jianping
Aircraft operators are faced with increasing requirements to extend the service life of air platforms beyond their designed life cycles, resulting in heavy maintenance and inspection burdens as well as economic pressure. Structural health monitoring (SHM) based on advanced sensor technology is potentially a cost-effective approach to meet operational requirements, and to reduce maintenance costs. Fiber optic sensor technology is being developed to provide existing and future aircrafts with SHM capability due to its unique superior characteristics. This review paper covers the aerospace SHM requirements and an overview of the fiber optic sensor technologies. In particular, fiber Bragg grating (FBG) sensor technology is evaluated as the most promising tool for load monitoring and damage detection, the two critical SHM aspects of air platforms. At last, recommendations on the implementation and integration of FBG sensors into an SHM system are provided.
Guo, Honglei; Xiao, Gaozhi; Mrad, Nezih; Yao, Jianping
Aircraft operators are faced with increasing requirements to extend the service life of air platforms beyond their designed life cycles, resulting in heavy maintenance and inspection burdens as well as economic pressure. Structural health monitoring (SHM) based on advanced sensor technology is potentially a cost-effective approach to meet operational requirements, and to reduce maintenance costs. Fiber optic sensor technology is being developed to provide existing and future aircrafts with SHM capability due to its unique superior characteristics. This review paper covers the aerospace SHM requirements and an overview of the fiber optic sensor technologies. In particular, fiber Bragg grating (FBG) sensor technology is evaluated as the most promising tool for load monitoring and damage detection, the two critical SHM aspects of air platforms. At last, recommendations on the implementation and integration of FBG sensors into an SHM system are provided. PMID:22163816
Kumberg, T.; Kokert, J.; Younesi, V.; Koenig, S.; Reindl, L. M.
In this article we present a wireless sensor network to monitor the structural health of a large-scale highway bridge in Germany. The wireless sensor network consists of several sensor nodes that use wake-up receivers to realize latency free and low-power communication. The sensor nodes are either equipped with very accurate tilt sensor developed by Northrop Grumman LITEF GmbH or with a Novatel OEM615 GNSS receiver. Relay nodes are required to forward measurement data to a base station located on the bridge. The base station is a gateway that transmits the local measurement data to a remote server where it can be further analyzed and processed. Further on, we present an energy harvesting system to supply the energy demanding GNSS sensor nodes to realize long term monitoring.
Yap, Keng C.; Macias, Jesus; Kaouk, Mohamed; Gafka, Tammy L.; Kerr, Justin H.
A structural health monitoring (SHM) system can contribute to the risk management of a structure operating under hazardous conditions. An example is the Wing Leading Edge Impact Detection System (WLEIDS) that monitors the debris hazards to the Space Shuttle Orbiter s Reinforced Carbon-Carbon (RCC) panels. Since Return-to-Flight (RTF) after the Columbia accident, WLEIDS was developed and subsequently deployed on board the Orbiter to detect ascent and on-orbit debris impacts, so as to support the assessment of wing leading edge structural integrity prior to Orbiter re-entry. As SHM is inherently an inverse problem, the analyses involved, including those performed for WLEIDS, tend to be associated with significant uncertainty. The use of probabilistic approaches to handle the uncertainty has resulted in the successful implementation of many development and application milestones.
This report details the progress made on the ASCR funded project Performance Health Monitoring for Large Scale Systems. A large-scale application may not achieve its full performance potential due to degraded performance of even a single subsystem. Detecting performance faults, isolating them, and taking remedial action is critical for the scale of systems on the horizon. PHM aims to develop techniques and tools that can be used to identify and mitigate such performance problems. We accomplish this through two main aspects. The PHM framework encompasses diagnostics, system monitoring, fault isolation, and performance evaluation capabilities that indicates when a performance fault has been detected, either due to an anomaly present in the system itself or due to contention for shared resources between concurrently executing jobs. Software components called the PHM Control system then build upon the capabilities provided by the PHM framework to mitigate degradation caused by performance problems.
Black, Richard J.; Faridian, Ferey; Moslehi, Behzad; Sotoudeh, Vahid
Structural health monitoring (SHM) is one of the most important tools available for the maintenance, safety, and integrity of aerospace structural systems. Lightweight, electromagnetic-interference- immune, fiber-optic sensor-based SHM will play an increasing role in more secure air transportation systems. Manufacturers and maintenance personnel have pressing needs for significantly improving safety and reliability while providing for lower inspection and maintenance costs. Undetected or untreated damage may grow and lead to catastrophic structural failure. Damage can originate from the strain/stress history of the material, imperfections of domain boundaries in metals, delamination in multi-layer materials, or the impact of machine tools in the manufacturing process. Damage can likewise develop during service life from wear and tear, or under extraordinary circumstances such as with unusual forces, temperature cycling, or impact of flying objects. Monitoring and early detection are key to preventing a catastrophic failure of structures, especially when these are expected to perform near their limit conditions.
Pegan, Jonathan D; Zhang, Jasmine; Chu, Michael; Nguyen, Thao; Park, Sun-Jun; Paul, Akshay; Kim, Joshua; Bachman, Mark; Khine, Michelle
This work presents a wrinkled Platinum (wPt) strain sensor with tunable strain sensitivity for applications in wearable health monitoring. These stretchable sensors show a dynamic range of up to 185% strain and gauge factor (GF) of 42. This is believed to be the highest reported GF of any metal thin film strain sensor over a physiologically relevant dynamic range to date. Importantly, sensitivity and dynamic range are tunable to the application by adjusting wPt film thickness. Performance is reliable over 1000 cycles with low hysteresis after sensor conditioning. The possibility of using such a sensor for real-time respiratory monitoring by measuring chest wall displacement and correlating with lung volume is demonstrated.
Shi, H.; Worden, K.; Cross, E. J.
One major obstacle to the implementation of structural health monitoring (SHM) is the effect of operational and environmental variabilities, which may corrupt the signal of structural degradation. Recently, an approach inspired from the community of econometrics, called cointegration, has been employed to eliminate the adverse influence from operational and environmental changes and still maintain sensitivity to structural damage. However, the linear nature of cointegration may limit its application when confronting nonlinear relations between system responses. This paper proposes a nonlinear cointegration method based on Gaussian process regression (GPR); the method is constructed under the Engle-Granger framework, and tests for unit root processes are conducted both before and after the GPR is applied. The proposed approach is examined with real engineering data from the monitoring of the Z24 Bridge.
Li, Xu; Dorvash, Siavash; Cheng, Liang; Pakzad, Shamim
Application of wireless sensor network (WSN) for structural health monitoring (SHM), is becoming widespread due to its implementation ease and economic advantage over traditional sensor networks. Beside advantages that have made wireless network preferable, there are some concerns regarding their performance in some applications. In long-span Bridge monitoring the need to transfer data over long distance causes some challenges in design of WSN platforms. Due to the geometry of bridge structures, using multi-hop data transfer between remote nodes and base station is essential. This paper focuses on the performances of pipelining algorithms. We summarize several prevent pipelining approaches, discuss their performances, and propose a new pipelining algorithm, which gives consideration to both boosting of channel usage and the simplicity in deployment.
Clithero, Amy; Ross, Simone Jacquelyn; Middleton, Lyn; Reeve, Carole; Neusy, Andre-Jacques
Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement. PMID:28289678
Clithero, Amy; Ross, Simone Jacquelyn; Middleton, Lyn; Reeve, Carole; Neusy, Andre-Jacques
Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.
The sugar maple, Acer saccharum, is projected to decline and die in 88 to 100 percent of its current range in the United States. An iconic symbol of the northeastern temperate forest and a dominant species in this forest, the sugar maple is identified as the most sensitive tree in its ecosystem to rising temperatures and a warming climate. This study measures the health of sugar maples on 12 privately owned forests and at three schools in New Hampshire. Laboratory quantitative analyses of leaves, buds and sap as well as qualitative measures of leaf and bud indicate that record high beat in 2012 stressed the sugar maple. The study identifies several laboratory and qualitative tests of health which seem most sensitive and capable of identifying stress early when intervention in forest management or public policy change might counter decline of the species. The study presents evidence of an unusual atmospheric pollution event which defoliated sugar maples in 2010. The study examines the work of citizen scientists in Forest Watch, a K-12 school program in which students monitor the impacts of ozone on white pine, Pinus strobus, another keystone species in New Hampshire's forest. Finally, the study examines three simple measurements of bud, leaf and the tree's acclimation to light. The findings of these tests illuminate findings in the first study. And they present examples of what citizen scientists might contribute to long-term monitoring of maples. A partnership between science and citizens is proposed to begin long-term monitoring and to report on the health of sugar maples.
Hall, William J.; Lee, Kent M.; Merino, Yesenia M.; Thomas, Tainayah W.; Payne, B. Keith; Eng, Eugenia; Day, Steven H.; Coyne-Beasley, Tamera
Background. In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition. Objectives. We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes. Search Methods. To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique. Selection Criteria. We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English. Data Collection and Analysis. We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings. Main Results. Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias
Prosser, W. H.; Wu, M. C.; Allison, S. G.; DeHaven, S. L.; Ghoshal, A.
NASA is applying considerable effort on the development of sensor technology for structural health monitoring (SHM). This research is targeted toward increasing the safety and reliability of aerospace vehicles, while reducing operating and maintenance costs. Research programs are focused on applications to both aircraft and space vehicles. Sensor technologies under development span a wide range including fiber-optic sensing, active and passive acoustic sensors, electromagnetic sensors, wireless sensing systems, MEMS, and nanosensors. Because of their numerous advantages for aerospace applications, fiber-optic sensors are one of the leading candidates and are the major focus of this presentation. In addition, recent advances in active and passive acoustic sensing will also be discussed.
Arria, Amelia M.; Caldeira, Kimberly M.; Bugbee, Brittany A.; Vincent, Kathryn B.; O’Grady, Kevin E.
Background Several studies have linked marijuana use with a variety of health outcomes among young adults. Information about marijuana’s long-term health effects is critically needed. Methods Data are from a ten-year study of 1,253 young adults originally recruited as first-year college students and assessed annually thereafter. Six trajectories of marijuana use during college (Non-Use, Low-Stable, Early-Decline, College-Peak, Late-Increase, Chronic) were previously derived using latent variable growth mixture modeling. Nine health outcomes assessed in Year 10 (modal age 27) were regressed on a group membership variable for the six group trajectories, holding constant demographics, baseline health status, and alcohol and tobacco trajectory group membership. Results Marijuana trajectory groups differed significantly on seven of the nine outcomes (functional impairment due to injury, illness, or emotional problems; psychological distress; subjective well-being; and mental and physical health service utilization; all ps<.001), but not on general health rating or body mass index. Non-Users fared better than the Late-Increase and Chronic groups on most physical and mental health outcomes. The declining groups (Early-Decline, College-Peak) fared better than the Chronic group on mental health outcomes. The Late-Increase group fared significantly worse than the stable groups (Non-Use, Low-Stable, Chronic) on both physical and mental health outcomes. Conclusions Even occasional or time-limited marijuana use might have adverse effects on physical and mental health, perhaps enduring after several years of moderation or abstinence. Reducing marijuana use frequency might mitigate such effects. Individuals who escalate their marijuana use in their early twenties might be at especially high risk for adverse outcomes. PMID:26778758
There is a dearth of knowledge about the health outcomes of resilience during adolescence, making the study of health-related outcomes of resilience important. The purpose of this study was to develop a theory-based just-identified model and to test the direct and indirect effects of resilience on hope, well-being, and health-promoting lifestyle in middle adolescents. The study used a correlational design. The final sample consisted of 311 middle adolescents, aged 15 to 17, who were recruited from a public high school. Participants responded to instrument packets in classroom settings. The structural equation model was tested with the LISREL 8.80 software program. All seven hypotheses were supported at a statistically significant level (p < .001). The results supported the theoretical propositions and the previous empirical findings that were used to create the theoretical model of health-related outcomes of resilience. Alternate models of outcomes of resilience need to be tested on adolescents.
Zendjidjian, Xavier Y; Boyer, Laurent
Patient-reported outcomes (PROs) are increasingly important in health care and mental health research. Furthermore, caregivers become partners in care for patients with mental disorders, and health workers are more attentive to the expectations and needs of caregivers. A number of outcomes for caregivers are measured and used in daily practice in order to promote actions to improve health care systems and progress in research on the impact of mental disorders on their caregivers. This paper proposes an inventory of the different outcomes and different measurement tools used to assess the impact of disorders, raising a number of methodological and conceptual issues that limit the relevance of measurement tools and complicate their use. Finally, we propose some recommendations promoting the development of relevant outcome measures for caregivers and their integration into current systems of care.
Huybrechts, Krista F.; Choudhry, Niteesh K.; Fulchino, Lisa A.; Isaman, Danielle L.; Kowal, Mary K.; Brennan, Troyen A.
Previous reviews have shown that changes in prescription drug insurance benefits can affect medication use and adherence. We conducted a systematic review of the literature to identify studies addressing the association between prescription drug coverage and health outcomes. Studies were included if they collected empirical data on expansions or restrictions of prescription drug coverage and if they reported clinical outcomes. We found 23 studies demonstrating that broader prescription drug insurance reduces use of other health care services and has a positive impact on patient outcomes. Coverage gaps or caps on drug insurance generally led to worse outcomes. States should consider implementing the Affordable Care Act expansions in drug coverage to improve the health of low-income patients receiving state-based health insurance. PMID:25521879
Robinson, Jeffrey C; Abbott, Cheryl; Meadows, Christina A; Roach, Robert C; Honigman, Benjamin; Bull, Todd M
Robinson, Jeffrey C., Cheryl Abbott, Christina A. Meadows, Robert C. Roach, Benjamin Honigman, and Todd M. Bull. Long-term health outcomes in high-altitude pulmonary hypertension. High Alt Med Biol. 18:61-66, 2017.
Murphy, J. Michael; Guzmán, Javier; McCarthy, Alyssa; Squicciarini, Ana María; George, Myriam; Canenguez, Katia; Dunn, Erin C.; Baer, Lee; Simonsohn, Ariela; Smoller, Jordan W.; Jellinek, Michael
The world’s largest school-based mental health program, Habilidades para la Vida [Skills for Life, SFL], has been operating at a national scale in Chile for fifteen years. SFL’s activities include using standardized measures to screen elementary school students and providing preventive workshops to students at risk for mental health problems. This paper used SFL’s data on 37,397 students who were in first grade in 2009 and third grade in 2011 to ascertain whether first grade mental health predicted subsequent academic achievement and whether remission of mental health problems predicted improved academic outcomes. Results showed that mental health was a significant predictor of future academic performance and that, overall, students whose mental health improved between first and third grade made better academic progress than students whose mental health did not improve or worsened. Our findings suggest that school-based mental health programs like SFL may help improve students’ academic outcomes. PMID:24771270
Murphy, J Michael; Guzmán, Javier; McCarthy, Alyssa E; Squicciarini, Ana María; George, Myriam; Canenguez, Katia M; Dunn, Erin C; Baer, Lee; Simonsohn, Ariela; Smoller, Jordan W; Jellinek, Michael S
The world's largest school-based mental health program, Habilidades para la Vida [Skills for Life (SFL)], has been operating on a national scale in Chile for 15 years. SFL's activities include using standardized measures to screen elementary school students and providing preventive workshops to students at risk for mental health problems. This paper used SFL's data on 37,397 students who were in first grade in 2009 and third grade in 2011 to ascertain whether first grade mental health predicted subsequent academic achievement and whether remission of mental health problems predicted improved academic outcomes. Results showed that mental health was a significant predictor of future academic performance and that, overall, students whose mental health improved between first and third grade made better academic progress than students whose mental health did not improve or worsened. Our findings suggest that school-based mental health programs like SFL may help improve students' academic outcomes.
sexual violence defined as violence within one’s personal (dating or marital) relationships. The common thread through these negative health outcomes is...personal sexual violence . This research also seeks to establish the best training practices for educating young troops about health issues that impact
sexual violence defined as violence within one’s personal (dating or marital) relationships. The common thread through these negative health outcomes is...personal sexual violence . This research also seeks to establish the best training practices for educating young troops about health issues that impact
Pantalone, David W.; Hessler, Danielle M.; Simoni, Jane M.
Objective: We examined mental health pathways between interpersonal violence (IPV) and health-related outcomes in HIV-positive sexual minority men engaged with medical care. Method: HIV-positive gay and bisexual men (N = 178) were recruited for this cross-sectional study from 2 public HIV primary care clinics that treated outpatients in an urban…
Metzner, Jeffrey L
Class action litigation has been instrumental in jail and prison reform over the past four decades. This article provides a very brief introduction underlying the legal basis for such litigation. It focuses on the role of the mental health expert in monitoring a correctional mental health care system as a result of class action litigation including issues related to selection of the expert, development of the remedial plan, and monitoring of the implementation of the remedial plan. The importance of policies and procedures and a quality improvement process is emphasized. Essential elements of the monitoring process, prior to and during the site assessment, are described. Inmates and correctional staff alike have benefited substantially from such litigation in the form of increased resources and positive changes in institutional culture.
Madkour, Aubrey S.; Xie, Yiqiong; Harville, Emily W.
Background: Adverse birth outcomes are more common among adolescent versus adult mothers, but little is known about school-based services that may improve birth outcomes in this group. Methods: Data from Waves I and IV of the National Longitudinal Study of Adolescent Health were analyzed. Girls and women who gave birth to singleton live infants…
Roberts, Sean D.; Stroud, Daniel; Hoag, Matthew J.; Combs, Katie M.
A lack of clarity exists regarding how different clients respond to outdoor behavioral health care (OBH). In this study, specific client and treatment characteristics were assessed for 186 young adults completing an OBH therapeutic wilderness program. Clinical outcomes were measured with the Outcome Questionnaire-45.2. Hierarchical linear modeling…
Pillemer, Karl; Fuller-Rowell, Thomas E.; Reid, M. C.; Wells, Nancy M.
Purpose: This study tested the hypothesis that volunteering in environmental organizations in midlife is associated with greater physical activity and improved mental and physical health over a 20-year period. Design and Methods: The study used data from two waves (1974 and 1994) of the Alameda County Study, a longitudinal study of health and…
The full benefits of connected health cannot be achieved unless everyone in the United States who wants to participate and the organizations that support health and deliver healthcare have adequate access to high-speed Internet service. Access depends both on the availability of broadband service and the resources needed to obtain and maintain service.
Boscarino, Joseph A; Hoffman, Stuart N; Kirchner, H Lester; Erlich, Porat M; Adams, Richard E; Figley, Charles R; Solhkhah, Ramon
On October 29, 2012, Hurricane Sandy made landfall in the most densely populated region in the US. In New Jersey, thousands of families were made homeless and entire communities were destroyed in the worst disaster in the history of the state. The economic impact of Sandy was huge, comparable to Hurricane Katrina. The areas that sustained the most damage were the small- to medium-sized beach communities along New Jersey's Atlantic coastline. Six months following the hurricane, we conducted a random telephone survey of 200 adults residing in 18 beach communities located in Monmouth County. We found that 14.5% (95% CI = 9.9-20.2) of these residents screened positive for PTSD and 6.0% (95% CI = 3.1-10.2) met criteria for major depression. Altogether 13.5% (95% CI = 9.1-19.0) received mental health counseling and 20.5% (95% CI = 15.1-26.8) sought some type of mental health support in person or online, rates similar to those reported in New York after the World Trade Center disaster In multivariate analyses, the best predictors of mental health status and service use were having high hurricane exposure levels, having physical health limitations, and having environmental health concerns. Research is needed to assess the mental health status and service use of Jersey Shore residents over time, to evaluate environmental health concerns, and to better understand the storm's impact among those with physical health limitations.
Atkinson, David J.; James, Mark L.; Martin, R. Gaius
Briefly discussed here are the spacecraft and ground systems monitoring process at the Jet Propulsion Laboratory (JPL). Some of the difficulties associated with the existing technology used in mission operations are highlighted. A new automated system based on artificial intelligence technology is described which seeks to overcome many of these limitations. The system, called the Spacecraft Health Automated Reasoning Prototype (SHARP), is designed to automate health and status analysis for multi-mission spacecraft and ground data systems operations. The system has proved to be effective for detecting and analyzing potential spacecraft and ground systems problems by performing real-time analysis of spacecraft and ground data systems engineering telemetry. Telecommunications link analysis of the Voyager 2 spacecraft was the initial focus for evaluation of the system in real-time operations during the Voyager spacecraft encounter with Neptune in August 1989.
Chen, Ding-Geng(Din); Lin, Feng; Chen, Xinguang (Jim); Tang, Wan; Kitzman, Harriet
Background Although health outcomes may have fundamentally nonlinearly relationships with relevant behavioral, psychological, cognitively, or biological predictors, most analytical models assume a linear relationship. Further, some health outcomes may have multimodal distributions but most statistical models in commun use assume a unimodal, normal distribution. Suitable nonlinear models should be developed to explain health outcomes. Objective The aim of this study is to provide an overview of a cusp catastrophe model for examining health outcomes, and to present an example using grip strength as an indicator of a physical functioning outcome to illustrate how the technique may be used. Results using linear regression, nonlinear logistic model and the cusp catastrophe model were compared. Methods Data from 935 participants from the Survey of Midlife Development in the United States (MIDUS) were analyzed. The outcome was grip strength; executive function (EF) and the inflammatory cytokine interleukin-6 (IL-6) were predictor variables. Results Grip strength was bimodally distributed. Based on fit and model selection criteria, the cusp model was superior to the linear model and the nonlinear logistic regression model. The cusp catastrophe model identified IL-6 as a significant asymmetry factor and EF as a significant bifurcation factor. Conclusion The cusp catastrophe model is a useful alternative for for explaining the nonlinear relationships commonly seen between health outcome and its predictors. Considerations for the use of cusp catastrophe model in nursing research are discussed and recommended. PMID:24785249
Wagner, E H; Wickizer, T M; Cheadle, A; Psaty, B M; Koepsell, T D; Diehr, P; Curry, S J; Von Korff, M; Anderman, C; Beery, W L; Pearson, D C; Perrin, E B
OBJECTIVES: To present results from an outcome evaluation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grants Program (CHPGP) in the West, which represented a major community-based initiative designed to promote improved health by changing community norms, environmental conditions, and individual behavior in 11 western communities. METHODS: The evaluation design: 14 randomly assigned intervention and control communities, 4 intervention communities selected on special merit, and 4 matched controls. Data for the outcome evaluation were obtained from surveys, administered every two years at three points in time, of community leaders and representative adults and adolescents, and from specially designed surveys of grocery stores. Outcomes for each of the 11 intervention communities were compared with outcomes in control communities. RESULTS: With the exception of two intervention communities-a largely Hispanic community and a Native American reservation-we found little evidence of positive changes in the outcomes targeted by the 11 intervention communities. The programs that demonstrated positive outcomes targeted dietary behavior and adolescent substance abuse. CONCLUSIONS: Improvement of health through community-based interventions remains a critical public health challenge. The CHPGP, like other prominent community-based initiatives, generally failed to produce measurable changes in the targeted health outcomes. Efforts should focus on developing theories and methods that can improve the design and evaluation of community-based interventions. PMID:10966086
Lavallee, Danielle C; Chenok, Kate E; Love, Rebecca M; Petersen, Carolyn; Holve, Erin; Segal, Courtney D; Franklin, Patricia D
The provision of patient-centered care requires a health care environment that fosters engagement between patients and their health care team. One way to encourage patient-centered care is to incorporate patient-reported outcomes into clinical settings. Collecting these outcomes in routine care ensures that important information only the patient can provide is captured. This provides insights into patients' experiences of symptoms, quality of life, and functioning; values and preferences; and goals for health care. Previously embraced in the research realm, patient-reported outcomes have started to play a role in successful shared decision making, which can enhance the safe and effective delivery of health care. We examine the opportunities for using patient-reported outcomes to enhance care delivery and outcomes as health care information needs and technology platforms change. We highlight emerging practices in which patient-reported outcomes provide value to patients and clinicians and improve care delivery. Finally, we examine present and future challenges to maximizing the use of patient-reported outcomes in the clinic.
Takei, Kuniharu; Honda, Wataru; Harada, Shingo; Arie, Takayuki; Akita, Seiji
This Progress Report introduces flexible wearable health-monitoring devices that interact with a person by detecting from and stimulating the body. Interactive health-monitoring devices should be highly flexible and attach to the body without awareness like a bandage. This type of wearable health-monitoring device will realize a new class of electronics, which will be applicable not only to health monitoring, but also to other electrical devices. However, to realize wearable health-monitoring devices, many obstacles must be overcome to economically form the active electrical components on a flexible substrate using macroscale fabrication processes. In particular, health-monitoring sensors and curing functions need to be integrated. Here recent developments and advancements toward flexible health-monitoring devices are presented, including conceptual designs of human-interactive devices.
Pedrana, Leo; Pamponet, Marina; Walker, Ruth; Costa, Federico; Rasella, Davide
Background The strategic importance of monitoring social determinants of health (SDH) and health equity and inequity has been a central focus in global discussions around the 2011 Rio Political Declaration on SDH and the Millennium Development Goals. This study is part of the World Health Organization (WHO) equity-oriented analysis of linkages between health and other sectors (EQuAL) project, which aims to define a framework for monitoring SDH and health equity. Objectives This review provides a global summary and analysis of the domains and indicators that have been used in recent studies covering the SDH. These studies are considered here within the context of indicators proposed by the WHO EQuAL project. The objectives are as follows: to describe the range of international and national studies and the types of indicators most frequently used; report how they are used in causal explanation of the SDH; and identify key priorities and challenges reported in current research for national monitoring of the SDH. Design We conducted a scoping review of published SDH studies in the PubMed® database to obtain evidence of socio-economic indicators. We evaluated, selected, and extracted data from national scale studies published from 2004 to 2014. The research included papers published in English, Italian, French, Portuguese, and Spanish. Results The final sample consisted of 96 articles. SDH monitoring is well reported in the scientific literature independent of the economic level of the country and magnitude of deprivation in population groups. The research methods were mostly quantitative and many papers used multilevel and multivariable statistical analyses and indexes to measure health inequalities and SDH. In addition to the usual economic indicators, a high number of socio-economic indicators were used. The indicators covered a broad range of social dimensions, which were given consideration within and across different social groups. Many indicators included in the
Pedrana, Leo; Pamponet, Marina; Walker, Ruth; Costa, Federico; Rasella, Davide
Background The strategic importance of monitoring social determinants of health (SDH) and health equity and inequity has been a central focus in global discussions around the 2011 Rio Political Declaration on SDH and the Millennium Development Goals. This study is part of the World Health Organization (WHO) equity-oriented analysis of linkages between health and other sectors (EQuAL) project, which aims to define a framework for monitoring SDH and health equity. Objectives This review provides a global summary and analysis of the domains and indicators that have been used in recent studies covering the SDH. These studies are considered here within the context of indicators proposed by the WHO EQuAL project. The objectives are as follows: to describe the range of international and national studies and the types of indicators most frequently used; report how they are used in causal explanation of the SDH; and identify key priorities and challenges reported in current research for national monitoring of the SDH. Design We conducted a scoping review of published SDH studies in the PubMed(®) database to obtain evidence of socio-economic indicators. We evaluated, selected, and extracted data from national scale studies published from 2004 to 2014. The research included papers published in English, Italian, French, Portuguese, and Spanish. Results The final sample consisted of 96 articles. SDH monitoring is well reported in the scientific literature independent of the economic level of the country and magnitude of deprivation in population groups. The research methods were mostly quantitative and many papers used multilevel and multivariable statistical analyses and indexes to measure health inequalities and SDH. In addition to the usual economic indicators, a high number of socio-economic indicators were used. The indicators covered a broad range of social dimensions, which were given consideration within and across different social groups. Many indicators included in
Parmar, Divya; Ioannidis, John P A
Objective To systematically identify, critically appraise, and synthesise empirical studies about the impact of the 2008 financial crisis in Europe on health outcomes. Design Systematic literature review. Data sources Structural searches of key databases, healthcare journals, and organisation based websites. Review methods Empirical studies reporting on the impact of the financial crisis on health outcomes in Europe, published from January 2008 to December 2015, were included. All selected studies were assessed for risk of bias. Owing to the heterogeneity of studies in terms of study design and analysis and the use of overlapping datasets across studies, studies were analysed thematically per outcome, and the evidence was synthesised on different health outcomes without formal meta-analysis. Results 41 studies met the inclusion criteria, and focused on suicide, mental health, self rated health, mortality, and other health outcomes. Of those studies, 30 (73%) were deemed to be at high risk of bias, nine (22%) at moderate risk of bias, and only two (5%) at low risk of bias, limiting the conclusions that can be drawn. Although there were differences across countries and groups, there was some indication that suicides increased and mental health deteriorated during the crisis. The crisis did not seem to reverse the trend of decreasing overall mortality. Evidence on self rated health and other indicators was mixed. Conclusions Most published studies on the impact of financial crisis on health in Europe had a substantial risk of bias; therefore, results need to be cautiously interpreted. Overall, the financial crisis in Europe seemed to have had heterogeneous effects on health outcomes, with the evidence being most consistent for suicides and mental health. There is a need for better empirical studies, especially those focused on identifying mechanisms that can mitigate the adverse effects of the crisis. PMID:27601477
Moura, Erly Catarina de; Lima, Aline Maria Peixoto; Urdaneta, Margarita
This article presents and discusses the initial actions of Brazilian National Men's Health Policy (PNAISH) concerning indicators used for monitoring promotion and assistance actions of men's health. This multiple case study was developed among five Brazilian cities which had implanted the PNAISH: (Goiânia (GO), Joinville (SC), Petrolina (PE), Rio Branco (AC) and Rio de Janeiro (RJ). A questionnaire was applied to verify the use of data and information required to calculate the indicators recommended by the PNAISH, concerning health's promotion, implementation and expansion of the men's health assistance system, according to the planned goals contained in the cities' local action plans. The results revealed a critical situation concerning monitoring of the activities through the proposed indicators taking into account the lack of standardized procedures to calculate them. Another specific limitation encountered was the limited access to or availability of data by age and sex in the health information systems. These results point out a lack of necessary indicators to define a base line situation, which weakens the systematic monitoring and future evaluation of the actions.
Jozkowski, Kristen N; Sanders, Stephanie A
Previous research has linked women's history of experiencing sexual assault with negative health outcomes; however, much of this research is over a decade old. Furthermore, little research has examined the relationship between sexual assault and women's sexuality. In the current study the authors aimed to assess the relation of experiencing sexual assault to women's health and sexuality and the relation of repeat victimization by multiple different perpetrators to such outcomes. Data were collected from a convenience sample of 2,915 women using an online questionnaire. Nearly half (n = 1,394, 47.8%) indicated having experienced forced or coercive sex. Women who had experienced forced or coercive sex were more likely to report negative health outcomes (Adj. OR = 1.56; 95% CI: 1.35-1.82, p < .001) and some negative sexual outcomes compared to women without a history of forced or coercive sex. Similarly, women who experienced repeat victimizations by multiple different perpetrators were even more likely to report negative health outcomes (Adj. OR = 1.43; 95% CI: 1.28-1.59, p < .001) as well as some negative sexual outcomes. Healthcare providers should be aware of the relation of sexual assault to health and sexuality and continue to address health and sexuality issues associated with sexual assault for their patients.
Cibulskis, R. E.; Hiawalyer, G.
This paper describes (i). how a national health information System was designed, tested and implemented in Papua New Guinea, (ii). how the system was integrated with other management information systems, and (iii). how information has been used to support decision-making. It concludes that central coordination of systems design is essential to make sure that information systems are aligned with government priorities and can deliver the information required by managers. While there is often scope for improving the performance of existing information systems, too much emphasis can be placed on revising data collection procedures and creating the perfect information system. Data analysis, even from imperfect systems, can stimulate greater interest in information, which can improve the quality and completeness of reporting and encourage a more methodical approach to planning and monitoring services. Our experience suggests that senior decision-makers and political leaders can play an important role in creating a culture of information use. By demanding health information, using it to formulate policy, and disseminating it through the channels open to them, they can exert greater influence in negotiations with donors and other government departments, encourage a more rational approach to decision-making that will improve the operation of health services, and stimulate greater use of information at lower levels of the health system. The ability of information systems to deliver these benefits is critical to their sustainability. PMID:12378295
Lewandowski, Jacek; Arochena, Hisbel E; Naguib, Raouf N G; Chao, Kuo-Ming; Garcia-Perez, Alexeis
One of the key points to maintain and boost research and development in the area of smart wearable systems (SWS) is the development of integrated architectures for intelligent services, as well as wearable systems and devices for health and wellness management. This paper presents such a generic architecture for multiparametric, intelligent and ubiquitous wireless sensing platforms. It is a transparent, smartphone-based sensing framework with customizable wireless interfaces and plug'n'play capability to easily interconnect third party sensor devices. It caters to wireless body, personal, and near-me area networks. A pivotal part of the platform is the integrated inference engine/runtime environment that allows the mobile device to serve as a user-adaptable personal health assistant. The novelty of this system lays in a rapid visual development and remote deployment model. The complementary visual Inference Engine Editor that comes with the package enables artificial intelligence specialists, alongside with medical experts, to build data processing models by assembling different components and instantly deploying them (remotely) on patient mobile devices. In this paper, the new logic-centered software architecture for ubiquitous health monitoring applications is described, followed by a discussion as to how it helps to shift focus from software and hardware development, to medical and health process-centered design of new SWS applications.
van der Pol, Marjon; Ruggeri, Matteo
The aim of this study is to examine whether individuals' risk attitude for life years differ from their risk attitude for quality of life. The study also investigates two different framing effects, an order and sequence effect, and the interaction between risk attitude and time preferences. The results showed that individuals tended to be risk averse with respect to the gamble involving risk of immediate death and risk seeking with respect to the other health gambles. Varying the order of the questions or the sequence of full health and ill-health did not seem to systematically bias the estimates.
Background One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. Methods This study uses a unique dataset, based on the ‘ActiZ Benchmark in Healthcare’, a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. Results It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the ‘black box’ between HRM and performance. Conclusion The results underscore the importance of HRM in the health care sector, especially for HR and
Croxson, B; Hanney, S; Buxton, M
Increasing attention is being directed to measuring and monitoring the use of health-related R&D funding, partly to justify this expenditure and partly to ensure that R&D effort is directed to achieving the paybacks desired by funders. These paybacks include contributing to knowledge, contributing to R&D capacity, political benefits, benefits to the health service and to patients, and more general economic benefits. This paper addresses the issues that must be considered when designing a routine performance management system for health R&D. Conventional methods of routine performance management are often rendered inappropriate in this context by the intangible and unpredictable outcomes of research, which are heterogeneous across projects and programmes and which can be hard to attribute to particular R&D support. Instead, to be effective in this context, a routine system must combine quantitative and qualitative indicators, utilising information from a number of different sources. The system must achieve acceptable levels (defined by the funder) on each of the following criteria: it must measure those dimensions of payback that are valued by the funder; it must be decision-relevant; it must be consistent with truthful compliance; it must minimise perverse incentives; and it must have acceptable net costs. It is vitally important that the system itself generates a positive payback. We illustrate these issues by outlining a system that might be used to monitor the payback from government-funded R&D.
Walker, William P; Bhatia, Dinesh K
Obesity is a global epidemic that imposes a financial burden and increased risk for a myriad of chronic diseases. Presented here is an overview of a prototype automated ingestion detection (AID) process implemented in a health monitoring system (HMS). The automated detection of ingestion supports personal record keeping which is essential during obesity management. Personal record keeping allows the care provider to monitor the therapeutic progress of a patient. The AID-HMS determines the levels of ingestion activity from sounds captured by an external throat microphone. Features are extracted from the sound recording and presented to machine learning classifiers, where a simple voting procedure is employed to determine instances of ingestion. Using a dataset acquired from seven individuals consisting of consumption of liquid and solid, speech, and miscellaneous sounds, > 94% of ingestion sounds are correctly identified with false positive rates around 9% based on 10-fold cross validation. The detected levels of ingestion activity are transmitted and stored on a remote web server, where information is displayed through a web application operating in a web browser. This information allows remote users (health provider) determine meal lengths and levels of ingestion activity during the meal. The AID-HMS also provides a basis for automated reinforcement for the patient.
Lieske, U.; Dietrich, A.; Schubert, L.; Frankenstein, B.
Structural health monitoring systems are increasingly used for comprehensive fatigue tests and surveillance of large scale structures. In this paper we describe the development and validation of a wireless system for SHM application based on Lamb-waves. The system is based on a wireless sensor network and focuses especially on low power measurement, signal processing and communication. The sensor nodes were realized by compact, sensor near signal processing structures containing components for analog preprocessing of acoustic signals, their digitization and network communication. The core component is a digital microprocessor ARM Cortex-M3 von STMicroelectronics, which performs the basic algorithms necessary for data acquisition synchronization and filtering. The system provides network discovery and multi-hop and self-healing mechanisms. If the distance between two communicating devices is too big for direct radio transmission, packets are routed over intermediate devices automatically. The system represents a low-power and low-cost active structural health monitoring solution. As a first application, the system was installed on a CFRP structure.
Bravo, Viria; Rodríguez, Teresa; van Wendel de Joode, Berna; Canto, Nonato; Calderón, Gloria Ruth; Turcios, Miguel; Menéndez, Luis Armando; Mejía, Winston; Tatis, Anabel; Abrego, Federico Z; de la Cruz, Elba; Wesseling, Catharina
We established methods for monitoring pesticide use and associated health hazards in Central America. With import data from Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama for 2000-2004, we constructed quantitative indicators (kg active ingredient) for general pesticide use, associated health hazards, and compliance with international regulations. Central America imported 33 million kg active ingredient per year. Imports increased 33% during 2000-2004. Of 403 pesticides, 13 comprised 77% of the total pesticides imported. High volumes of hazardous pesticides are used; 22% highly/extremely acutely toxic, 33% moderately/severely irritant or sensitizing, and 30% had multiple chronic toxicities. Of the 41 pesticides included in the Stockholm Convention on Persistent Organic Pollutants (POPs), the Rotterdam Convention on Prior Informed Consent (PIC), the Montreal Protocol on Substances that Deplete the Ozone Layer, the Pesticide Action Network (PAN) Dirty Dozen, and the Central American Dirty Dozen, 16 (17% total volume) were imported, four being among the 13 most imported pesticides. Costa Rica is by far the biggest consumer. Pesticide import data are good indicators of use trends and an informative source to monitor hazards and, potentially, the effectiveness of interventions.
Li, Jingcheng; Jang, Shinae; Tang, Jiong
With development of wireless sensor technology, wireless sensor network has shown a great potential for railway health monitoring. However, how to supply continuous power to the wireless sensor nodes is one of the critical issues in long-term full-scale deployment of the wireless smart sensors. Some energy harvesting methodologies have been available including solar, vibration, wind, etc; among them, vibration-based energy harvester using piezoelectric material showed the potential for converting ambient vibration energy to electric energy in railway health monitoring even for underground subway systems. However, the piezoelectric energy harvester has two major problems including that it could only generate small amount of energy, and that it should match the exact narrow band natural frequency with the excitation frequency. To overcome these problems, a wide band piezoelectric energy harvester, which could generate more power on various frequencies regions, has been designed and validated with experimental test. Then it was applied to a full-scale field test using actual railway train. The power generation of the wide band piezoelectric array has been compared to a narrow-band, resonant-based, piezoelectric energy harvester.
Lee, Malrey; Gatton, Thomas M
Ubiquitous home healthcare systems have been playing an increasingly significant role in the treatment and management of chronic diseases, such as diabetes and hypertension, but progress has been hampered by the lack of standardization in the exchange of medical health care information. In an effort to establish standardization, this paper proposes a home healthcare monitoring system data exchange scheme between the HL7 standard and the IEEE1451 standard. IEEE1451 is a standard for special sensor networks, such as industrial control and smart homes, and defines a suite of interfaces that communicate among heterogeneous networks. HL7 is the standard for medical information exchange among medical organizations and medical personnel. While it provides a flexible data exchange in health care domains, it does not provide for data exchange with sensors. Thus, it is necessary to develop a data exchange schema to convert data between the HL7 and the IEEE1451 standard. This paper proposes a schema that can exchange data between HL7 devices and the monitoring device, and conforms to the IEEE 1451 standard. The experimental results and conclusions of this approach are presented and show the feasibility of the proposed exchange schema.
Forth, Scott C.; Staroselsky, Alexander
A new hybrid surface-integral-finite-element numerical scheme has been developed to model a three-dimensional crack propagating through a thin, multi-layered coating. The finite element method was used to model the physical state of the coating (far field), and the surface integral method was used to model the fatigue crack growth. The two formulations are coupled through the need to satisfy boundary conditions on the crack surface and the external boundary. The coupling is sufficiently weak that the surface integral mesh of the crack surface and the finite element mesh of the uncracked volume can be set up independently. Thus when modeling crack growth, the finite element mesh can remain fixed for the duration of the simulation as the crack mesh is advanced. This method was implemented to evaluate the feasibility of fabricating a structural health monitoring system for real-time detection of surface cracks propagating in engine components. In this work, the authors formulate the hybrid surface-integral-finite-element method and discuss the mechanical issues of implementing a structural health monitoring system in an aircraft engine environment.
Amaddeo, Carmen; Benzoni, Gianmario; D'Amore, Enzo
After natural events like the 1994 Northridge (USA), the 1995 Kobe (Japan), the 1999 Chi-Chi (Taiwan) and the 1999 Duzce (Turkey) earthquakes it became evident that the demand for bridge structures could greatly benefit from the application of isolation/energy dissipation techniques. Despite the level of maturity achieved in the field of seismic isolation, open questions still remain on the durability of seismic response modification devices (SRMD) under working conditions. The option of removal of sample devices from the bridge structure to verify their performance characteristics involves a significant economical effort, particularly if associated to disruption of the regular traffic. It provides also a device response verification difficult to correlate to the global structural performance. Health monitoring techniques offer a valuable alternative. The main objective of this research is the definition of an effective health monitoring approach to be applied to bridges protected with the most common seismic response modification devices (SRMD). The proposed methodology was validated with the use of records from a bridge equipped with viscous dampers. The record were obtained before and after damage occurred. The procedure proved to be accurate in detecting early degradations of the device characteristics as well as of the structural elements directly connected to the devices.
Kulkarni, Chetan S.; Celaya, Jose Ramon; Biswas, Gautam; Goebel, Kai
This paper discusses experimental setups for health monitoring and prognostics of electrolytic capacitors under nominal operation and accelerated aging conditions. Electrolytic capacitors have higher failure rates than other components in electronic systems like power drives, power converters etc. Our current work focuses on developing first-principles-based degradation models for electrolytic capacitors under varying electrical and thermal stress conditions. Prognostics and health management for electronic systems aims to predict the onset of faults, study causes for system degradation, and accurately compute remaining useful life. Accelerated life test methods are often used in prognostics research as a way to model multiple causes and assess the effects of the degradation process through time. It also allows for the identification and study of different failure mechanisms and their relationships under different operating conditions. Experiments are designed for aging of the capacitors such that the degradation pattern induced by the aging can be monitored and analyzed. Experimental setups and data collection methods are presented to demonstrate this approach.
Perry, John G.
Degradation mechanisms and sensor identification/selection resulted in a list of degradation modes and a list of sensors that are utilized in the diagnosis of these degradation modes. The sensor list is divided into primary and secondary indicators of the corresponding degradation modes. The signal conditioning requirements are discussed, describing the methods of producing the Space Shuttle Main Engine (SSME) post-hot-fire test data to be utilized by the Health Monitoring System. Development of the diagnostic logic and algorithms is also presented. The knowledge engineering approach, as utilized, includes the knowledge acquisition effort, characterization of the expert's problem solving strategy, conceptually defining the form of the applicable knowledge base, and rule base, and identifying an appropriate inferencing mechanism for the problem domain. The resulting logic flow graphs detail the diagnosis/prognosis procedure as followed by the experts. The nature and content of required support data and databases is also presented. The distinction between deep and shallow types of knowledge is identified. Computer coding of the Health Monitoring System is shown to follow the logical inferencing of the logic flow graphs/algorithms.
Harvey, Dustin Y.; Todd, Michael D.
Structural health monitoring (SHM) systems provide real-time damage and performance information for civil, aerospace, and other high-capital or life-safety critical structures. Conventional data processing involves pre-processing and extraction of low-dimensional features from in situ time series measurements. The features are then input to a statistical pattern recognition algorithm to perform the relevant classification or regression task necessary to facilitate decisions by the SHM system. Traditional design of signal processing and feature extraction algorithms can be an expensive and time-consuming process requiring extensive system knowledge and domain expertise. Genetic programming, a heuristic program search method from evolutionary computation, was recently adapted by the authors to perform automated, data-driven design of signal processing and feature extraction algorithms for statistical pattern recognition applications. The proposed method, called Autofead, is particularly suitable to handle the challenges inherent in algorithm design for SHM problems where the manifestation of damage in structural response measurements is often unclear or unknown. Autofead mines a training database of response measurements to discover information-rich features specific to the problem at hand. This study provides experimental validation on three SHM applications including ultrasonic damage detection, bearing damage classification for rotating machinery, and vibration-based structural health monitoring. Performance comparisons with common feature choices for each problem area are provided demonstrating the versatility of Autofead to produce significant algorithm improvements on a wide range of problems.
Wincheski, Russell; Jordan, Jeffrey; Oglesby, Donald; Watkins, Anthony; Patry, JoAnne; Smits, Jan; Williams, Phillip
Carbon nanotube (CNT)-based sensors for structural health monitoring (SHM) can be embedded in structures of all geometries to monitor conditions both inside and at the surface of the structure to continuously sense changes. These CNTs can be manipulated into specific orientations to create small, powerful, and flexible sensors. One of the sensors is a highly flexible sensor for crack growth detection and strain field mapping that features a very dense and highly ordered array of single-walled CNTs. CNT structural health sensors can be mass-produced, are inexpensive, can be packaged in small sizes (0.5 micron(sup 2)), require less power than electronic or piezoelectric transducers, and produce less waste heat per square centimeter than electronic or piezoelectric transducers. Chemically functionalized lithographic patterns are used to deposit and align the CNTs onto metallic electrodes. This method consistently produces aligned CNTs in the defined locations. Using photo- and electron-beam lithography, simple Cr/Au thin-film circuits are patterned onto oxidized silicon substrates. The samples are then re-patterned with a CNT-attracting, self-assembled monolayer of 3-aminopropyltriethoxysilane (APTES) to delineate the desired CNT locations between electrodes. During the deposition of the solution-suspended single- wall CNTs, the application of an electric field to the metallic contacts causes alignment of the CNTs along the field direction. This innovation is a prime candidate for smart skin technologies with applications ranging from military, to aerospace, to private industry.
Michalopoulou, Georgia; Falzarano, Pamela; Butkus, Michael; Zeman, Lori; Vershave, Judy; Arfken, Cynthia
Minorities in the United States have well-documented health disparities. Cultural barriers and biases by health care providers may contribute to lower quality of services which may contribute to these disparities. However, evidence linking cultural competency and health outcomes is lacking. This study, part of an ongoing quality improvement effort, tested the mediation hypothesis that patients' perception of provider cultural competency indirectly influences patients' health outcomes through process of care. Data were from patient satisfaction surveys collected in seven mental health clinics (n=94 minority patients). Consistent with our hypothesis, patients' perception of clinicians' cultural competency was indirectly associated with patients' self-reported improvements in social interactions, improvements in performance at work or school, and improvements in managing life problems through the patients' experience of respect, trust, and communication with the clinician. These findings indicate that process of care characteristics during the clinical encounter influence patients' perceptions of clinicians' cultural competency and affect functional outcomes.
Westlake, Cheryl; Sethares, Kristen; Davidson, Patricia
Health literacy is discussed in papers from 25 countries where findings suggest that approximately a third up to one half of the people in developed countries have low health literacy. Specifically, health literacy is the mechanism by which individuals obtain and use health information to make health decisions about individual treatments in the home, access care in the community, promote provider-patient interactions, structure self-care, and navigate health care programs both locally and nationally. Further, health literacy is a key determinant of health and a critical dimension for assessing individuals' needs, and, importantly, their capacity for self-care. Poorer health knowledge/status, more medication errors, costs, and higher rates of morbidity, readmissions, emergency room visits, and mortality among patients with health illiteracy have been demonstrated. Individuals at high risk for low health literacy include the elderly, disabled, Blacks, those with a poverty-level income, some or less high school education, either no insurance or Medicare or Medicaid, and those for whom English is a second language. As a consequence, health literacy is a complex, multifaceted, and evolving construct including aspects of social, psychological, cultural and economic circumstances. The purpose of this paper is to describe the mechanisms and consequences of health illiteracy. Specifically, the prevalence, associated demographics, and models of health literacy are described. The mechanism of health illiteracy's influence on outcomes in heart failure is proposed. Tools for health literacy assessment are described and compared. Finally, the health outcomes and general interventions to enhance the health outcomes in heart failure are discussed.
Lynch, Jerome Peter
Wireless monitoring has emerged in recent years as a promising technology that could greatly impact the field of structural monitoring and infrastructure asset management. This paper is a summary of research efforts that have resulted in the design of numerous wireless sensing unit prototypes explicitly intended for implementation in civil structures. Wireless sensing units integrate wireless communications and mobile computing with sensors to deliver a relatively inexpensive sensor platform. A key design feature of wireless sensing units is the collocation of computational power and sensors; the tight integration of computing with a wireless sensing unit provides sensors with the opportunity to self-interrogate measurement data. In particular, there is strong interest in using wireless sensing units to build structural health monitoring systems that interrogate structural data for signs of damage. After the hardware and the software designs of wireless sensing units are completed, the Alamosa Canyon Bridge in New Mexico is utilized to validate their accuracy and reliability. To improve the ability of low-cost wireless sensing units to detect the onset of structural damage, the wireless sensing unit paradigm is extended to include the capability to command actuators and active sensors.
Lorgelly, Paula; Yamabhai, Inthira
Abstract Public health programmes tend to be complex and may combine social strategies with aspects of empowerment, capacity building and knowledge across sectors. The nature of the programmes means that some effects are likely to occur outside the healthcare sector; this breadth impacts on the choice of health and non‐health outcomes to measure and value in an economic evaluation. Employing conventional outcome measures in evaluations of public health has been questioned. There are concerns that such measures are too narrow, overlook important dimensions of programme effect and, thus, lead to such interventions being undervalued. This issue is of particular importance for low‐income and middle‐income countries, which face considerable budget constraints, yet deliver a large proportion of health activities within public health programmes. The need to develop outcome measures, which include broader measures of quality of life, has given impetus to the development of a variety of new, holistic approaches, including Sen's capability framework and measures of subjective wellbeing. Despite their promise, these approaches have not yet been widely applied, perhaps because they present significant methodological challenges. This paper outlines the methodological challenges for the identification and measurement of broader outcomes of public health interventions in economic evaluation in low‐income and middle‐income countries. PMID:26804360
Greco, Giulia; Lorgelly, Paula; Yamabhai, Inthira
Public health programmes tend to be complex and may combine social strategies with aspects of empowerment, capacity building and knowledge across sectors. The nature of the programmes means that some effects are likely to occur outside the healthcare sector; this breadth impacts on the choice of health and non-health outcomes to measure and value in an economic evaluation. Employing conventional outcome measures in evaluations of public health has been questioned. There are concerns that such measures are too narrow, overlook important dimensions of programme effect and, thus, lead to such interventions being undervalued. This issue is of particular importance for low-income and middle-income countries, which face considerable budget constraints, yet deliver a large proportion of health activities within public health programmes. The need to develop outcome measures, which include broader measures of quality of life, has given impetus to the development of a variety of new, holistic approaches, including Sen's capability framework and measures of subjective wellbeing. Despite their promise, these approaches have not yet been widely applied, perhaps because they present significant methodological challenges. This paper outlines the methodological ch