Servant leadership: enhancing quality of care and staff satisfaction.

PubMed

Neill, Mark W; Saunders, Nena S

2008-09-01

Servant leadership encompasses a powerful skill set that is particularly effective in implementing a team approach to the delivery of nursing practice. This model encourages the professional growth of nurses and simultaneously promotes the improved delivery of healthcare services through a combination of interdisciplinary teamwork, shared decision making, and ethical behavior. The authors describe the case application of servant leadership principles in a Department of Veterans Affairs Medical Intensive Care Unit located in a large urban center.

An evidence synthesis of the international knowledge base for new care models to inform and mobilise knowledge for multispecialty community providers (MCPs).

PubMed

Turner, Alison; Mulla, Abeda; Booth, Andrew; Aldridge, Shiona; Stevens, Sharon; Battye, Fraser; Spilsbury, Peter

2016-10-01

NHS England's Five Year Forward View (NHS England, Five Year Forward View, 2014) formally introduced a strategy for new models of care driven by simultaneous pressures to contain costs, improve care and deliver services closer to home through integrated models. This synthesis focuses on a multispecialty community provider (MCP) model. This new model of care seeks to overcome the limitations in current models of care, often based around single condition-focused pathways, in contrast to patient-focused delivery (Royal College of General Practitioners, The 2022 GP: compendium of evidence, 2012) which offers greater continuity of care in recognition of complex needs and multimorbidity. The synthesis, an innovative combination of best fit framework synthesis and realist synthesis, will develop a "blueprint" which articulates how and why MCP models work, to inform design of future iterations of the MCP model. A systematic search will be conducted to identify research and practice-derived evidence to achieve a balance that captures the historical legacy of MCP models but focuses on contemporary evidence. Sources will include bibliographic databases including MEDLINE, PreMEDLINE, CINAHL, Embase, HMIC and Cochrane Library; and grey literature sources. The Best Fit synthesis methodology will be combined with a synthesis following realist principles which are particularly suited to exploring what works, when, for whom and in what circumstances. The aim of this synthesis is to provide decision makers in health and social care with a practical evidence base relating to the multispecialty community provider (MCP) model of care. PROSPERO CRD42016039552 .

Provider and systems factors in diabetes quality of care.

PubMed

Ghaznavi, Kimia; Malik, Shaista

2012-02-01

A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of care have been targeted at the health systems level and provider organizations. Changes in several domains of care and investment in quality by organizational leaders are needed to make long-lasting improvements. In the studies reviewed, the most effective strategies often have multiple components, whereas the use of one single strategy, such as reminders only or an educational intervention, is less effective. More studies are needed to examine the effect of several care management strategies simultaneously, such as use of clinical information systems, provider financial incentives, and organizational model on processes of care and outcomes.

Addressing care-seeking as well as insurance-seeking selection biases in estimating the impact of health insurance on out-of-pocket expenditure.

PubMed

Ali, Shehzad; Cookson, Richard; Dusheiko, Mark

2017-03-01

Health Insurance (HI) programmes in low-income countries aim to reduce the burden of out-of-pocket (OOP) health care expenditure. However, if the decisions to purchase insurance and to seek care when ill are correlated with the expected health care expenditure, the use of naïve regression models may produce biased estimates of the impact of insurance membership on OOP expenditure. Whilst many studies in the literature have accounted for the endogeneity of the insurance decision, the potential selection bias due to the care-seeking decision has not been taken into account. We extend the Heckman selection model to account simultaneously for both care-seeking and insurance-seeking selection biases in the health care expenditure regression model. The proposed model is illustrated in the context of a Vietnamese HI programme using data from a household survey of 1,192 individuals conducted in 1999. Results were compared with those of alternative econometric models making no or partial allowance for selection bias. In this illustrative example, the impact of insurance membership on reducing OOP expenditures was underestimated by 21 percentage points when selection biases were not taken into account. We believe this is an important methodological contribution that will be relevant to future empirical work. Copyright © 2016 Elsevier Ltd. All rights reserved.

Positive psychological determinants of treatment adherence among primary care patients.

PubMed

Nsamenang, Sheri A; Hirsch, Jameson K

2015-07-01

Patient adherence to medical treatment recommendations can affect disease prognosis, and may be beneficially or deleteriously influenced by psychological factors. Aim We examined the relationships between both adaptive and maladaptive psychological factors and treatment adherence among a sample of primary care patients. One hundred and one rural, primary care patients completed the Life Orientation Test-Revised, Trait Hope Scale, Future Orientation Scale, NEO-FFI Personality Inventory (measuring positive and negative affect), and Medical Outcomes Study General Adherence Scale. In independent models, positive affect, optimism, hope, and future orientation were beneficially associated with treatment adherence, whereas pessimism and negative affect were negatively related to adherence. In multivariate models, only negative affect, optimism and hope remained significant and, in a comparative model, trait hope was most robustly associated with treatment adherence. Therapeutically, addressing negative emotions and expectancies, while simultaneously bolstering motivational and goal-directed attributes, may improve adherence to treatment regimens.

The I-Tribe Community Pharmacy Practice Model: professional pharmacy unshackled.

PubMed

Alston, Greg L; Waitzman, Jennifer A

2013-01-01

To describe a mechanism by which pharmacists could create a disruptive innovation to provide professional primary care services via a Web-based delivery model. Several obstacles have prevented pharmacists from using available technology to develop business models that capitalize on their clinical skills in primary care. Community practice has experienced multiple sustaining innovations that have improved dispensing productivity but have not stimulated sufficient demand for pharmacy services to disrupt the marketplace and provide new opportunities for pharmacists. Pharmacists are in a unique position to bridge the gap between demand for basic primary medical care and access to a competent medical professional. Building on the historic strengths of community pharmacy practice, modern pharmacists could provide a disruptive innovation in the marketplace for primary care by taking advantage of new technology and implementing the I-Tribe Community Pharmacy Practice Model (I-Tribe). This model would directly connect pharmacists to patients through an interactive, secure Web presence that would liberate the relationship from geographic restrictions. The I-Tribe is a disruptive innovation that could become the foundation for a vibrant market in pharmacist professional service offerings. The I-Tribe model could benefit society by expanding access to primary medical care while simultaneously providing a new source of revenue for community practice pharmacists. Entrepreneurial innovation through I-Tribe pharmacy would free pharmacists to become the care providers envisioned by the profession's thought leaders.

A unifying framework of the demand for transnational medical travel.

PubMed

Osterle, August; Johnson, Tricia; Delgado, Jose

2013-01-01

Transnational medical travel has gained attention recently as a strategy for patients to obtain care that is higher quality, costs less, or offers improved access relative to care provided within their home countries. This article examines institutional environments in the European Union and United States that influence transnational medical travel, describes the conceptual model of demand for medical travel, and illustrates individual dimensions in the conceptual model of medical travel using a series of case studies. The conceptual model of medical travel is predicated on Andersen's behavioral model of health services. Transnational medical travel is a heterogeneous phenomenon that is influenced by a number of patient-related factors and by the institutional environment in which the patient resides. While cost, access, and quality are commonly cited factors that influence a patient's decision regarding where to seek care, multiple factors may simultaneously influence the decision about the destination for care, including culture, social factors, and the institutional environment. The conceptual framework addresses the patient-related factors that influence where a patient seeks care. This framework can help researchers and regulatory bodies to evaluate the opportunities and the risks of transnational medical travel and help providers and governments to develop international patient programs.

Information in general medical practices: the information processing model.

PubMed

Crowe, Sarah; Tully, Mary P; Cantrill, Judith A

2010-04-01

The need for effective communication and handling of secondary care information in general practices is paramount. To explore practice processes on receiving secondary care correspondence in a way that integrates the information needs and perceptions of practice staff both clinical and administrative. Qualitative study using semi-structured interviews with a wide range of practice staff (n = 36) in nine practices in the Northwest of England. Analysis was based on the framework approach using N-Vivo software and involved transcription, familiarization, coding, charting, mapping and interpretation. The 'information processing model' was developed to describe the six stages involved in practice processing of secondary care information. These included the amendment or updating of practice records whilst simultaneously or separately actioning secondary care recommendations, using either a 'one-step' or 'two-step' approach, respectively. Many factors were found to influence each stage and impact on the continuum of patient care. The primary purpose of processing secondary care information is to support patient care; this study raises the profile of information flow and usage within practices as an issue requiring further consideration.

Cost-Utility Analysis of Cochlear Implantation in Australian Adults.

PubMed

Foteff, Chris; Kennedy, Steven; Milton, Abul Hasnat; Deger, Melike; Payk, Florian; Sanderson, Georgina

2016-06-01

Sequential and simultaneous bilateral cochlear implants are emerging as appropriate treatment options for Australian adults with sensory deficits in both cochleae. Current funding of Australian public hospitals does not provide for simultaneous bilateral cochlear implantation (CI) as a separate surgical procedure. Previous cost-effectiveness studies of sequential and simultaneous bilateral CI assumed 100% of unilaterally treated patients' transition to a sequential bilateral CI. This assumption does not place cochlear implantation in the context of the generally treated population. When mutually exclusive treatment options exist, such as unilateral CI, sequential bilateral CI, and simultaneous bilateral CI, the mean costs of the treated populations are weighted in the calculation of incremental cost-utility ratios. The objective was to evaluate the cost-utility of bilateral hearing aids (HAs) compared with unilateral, sequential, and simultaneous bilateral CI in Australian adults with bilateral severe to profound sensorineural hearing loss. Cost-utility analysis of secondary sources input to a Markov model. Australian health care perspective, lifetime horizon with costs and outcomes discounted 5% annually. Bilateral HAs as treatment for bilateral severe to profound sensorineural hearing loss compared with unilateral, sequential, and simultaneous bilateral CI. Incremental costs per quality adjusted life year (AUD/QALY). When compared with bilateral hearing aids the incremental cost-utility ratio for the CI treatment population was AUD11,160/QALY. The incremental cost-utility ratio was weighted according to the number of patients treated unilaterally, sequentially, and simultaneously, as these were mutually exclusive treatment options. No peer-reviewed articles have reported the incremental analysis of cochlear implantation in a continuum of care for surgically treated populations with bilateral severe to profound sensorineural hearing loss. Unilateral, sequential, and simultaneous bilateral CI were cost-effective when compared with bilateral hearing aids. Technologies that reduce the total number of visits for a patient could introduce additional cost efficiencies into clinical practice.

ECLIPPx: an innovative model for reflective portfolios in life-long learning.

PubMed

Cheung, C Ronny

2011-03-01

For healthcare professionals, the educational portfolio is the most widely used component of lifelong learning - a vital aspect of modern medical practice. When used effectively, portfolios provide evidence of continuous learning and promote reflective practice. But traditional portfolio models are in danger of becoming outmoded, in the face of changing expectations of healthcare provider competences today. Portfolios in health care have generally focused on competencies in clinical skills. However, many other domains of professional development, such as professionalism and leadership skills, are increasingly important for doctors and health care professionals, and must be addressed in amassing evidence for training and revalidation. There is a need for modern health care learning portfolios to reflect this sea change. A new model for categorising the health care portfolios of professionals is proposed. The ECLIPPx model is based on personal practice, and divides the evidence of ongoing professional learning into four categories: educational development; clinical practice; leadership, innovation and professionalism; and personal experience. The ECLIPPx model offers a new approach for personal reflection and longitudinal learning, one that gives flexibility to the user whilst simultaneously encompassing the many relatively new areas of competence and expertise that are now required of a modern doctor. © Blackwell Publishing Ltd 2011.

Accurate Modeling of Galaxy Clustering on Small Scales: Testing the Standard ΛCDM + Halo Model

NASA Astrophysics Data System (ADS)

Sinha, Manodeep; Berlind, Andreas A.; McBride, Cameron; Scoccimarro, Roman

2015-01-01

The large-scale distribution of galaxies can be explained fairly simply by assuming (i) a cosmological model, which determines the dark matter halo distribution, and (ii) a simple connection between galaxies and the halos they inhabit. This conceptually simple framework, called the halo model, has been remarkably successful at reproducing the clustering of galaxies on all scales, as observed in various galaxy redshift surveys. However, none of these previous studies have carefully modeled the systematics and thus truly tested the halo model in a statistically rigorous sense. We present a new accurate and fully numerical halo model framework and test it against clustering measurements from two luminosity samples of galaxies drawn from the SDSS DR7. We show that the simple ΛCDM cosmology + halo model is not able to simultaneously reproduce the galaxy projected correlation function and the group multiplicity function. In particular, the more luminous sample shows significant tension with theory. We discuss the implications of our findings and how this work paves the way for constraining galaxy formation by accurate simultaneous modeling of multiple galaxy clustering statistics.

PDEMOD: Software for control/structures optimization

NASA Technical Reports Server (NTRS)

Taylor, Lawrence W., Jr.; Zimmerman, David

1991-01-01

Because of the possibility of adverse interaction between the control system and the structural dynamics of large, flexible spacecraft, great care must be taken to ensure stability and system performance. Because of the high cost of insertion of mass into low earth orbit, it is prudent to optimize the roles of structure and control systems simultaneously. Because of the difficulty and the computational burden in modeling and analyzing the control structure system dynamics, the total problem is often split and treated iteratively. It would aid design if the control structure system dynamics could be represented in a single system of equations. With the use of the software PDEMOD (Partial Differential Equation Model), it is now possible to optimize structure and control systems simultaneously. The distributed parameter modeling approach enables embedding the control system dynamics into the same equations for the structural dynamics model. By doing this, the current difficulties involved in model order reduction are avoided. The NASA Mini-MAST truss is used an an example for studying integrated control structure design.

Better Patient Care At High-Quality Hospitals May Save Medicare Money And Bolster Episode-Based Payment Models.

PubMed

Tsai, Thomas C; Greaves, Felix; Zheng, Jie; Orav, E John; Zinner, Michael J; Jha, Ashish K

2016-09-01

US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality. We found that patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions, for both thirty- and ninety-day periods. The difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5 percent of the difference in thirty-day episode spending, and readmissions, which accounted for 19.9 percent. These findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care. Project HOPE—The People-to-People Health Foundation, Inc.

The ABLe change framework: a conceptual and methodological tool for promoting systems change.

PubMed

Foster-Fishman, Pennie G; Watson, Erin R

2012-06-01

This paper presents a new approach to the design and implementation of community change efforts like a System of Care. Called the ABLe Change Framework, the model provides simultaneous attention to the content and process of the work, ensuring effective implementation and the pursuit of systems change. Three key strategies are employed in this model to ensure the integration of content and process efforts and effective mobilization of broad scale systems change: Systemic Action Learning Teams, Simple Rules, and Small Wins. In this paper we describe the ABLe Change Framework and present a case study in which we successfully applied this approach to one system of care effort in Michigan.

Assessment of the quality of primary care for the elderly according to the Chronic Care Model 1

PubMed Central

Silva, Líliam Barbosa; Soares, Sônia Maria; Silva, Patrícia Aparecida Barbosa; Santos, Joseph Fabiano Guimarães; Miranda, Lívia Carvalho Viana; Santos, Raquel Melgaço

2018-01-01

ABSTRACT Objective: to evaluate the quality of care provided to older people with diabetes mellitus and/or hypertension in the Primary Health Care (PHC) according to the Chronic Care Model (CCM) and identify associations with care outcomes. Method: cross-sectional study involving 105 older people with diabetes mellitus and/or hypertension. The Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used to evaluate the quality of care. The total score was compared with care outcomes that included biochemical parameters, body mass index, pressure levels and quality of life. Data analysis was based on descriptive statistics and multiple logistic regression. Results: there was a predominance of females and a median age of 72 years. The median PACIC score was 1.55 (IQ 1.30-2.20). Among the PACIC dimensions, the “delivery system design/decision support” was the one that presented the best result. There was no statistical difference between the medians of the overall PACIC score and individual care outcomes. However, when the quality of life and health satisfaction were simultaneously evaluated, a statistical difference between the medians was observed. Conclusion: the low PACIC scores found indicate that chronic care according to the CCM in the PHC seems still to fall short of its assumptions. PMID:29538582

Assessment of the quality of primary care for the elderly according to the Chronic Care Model.

PubMed

Silva, Líliam Barbosa; Soares, Sônia Maria; Silva, Patrícia Aparecida Barbosa; Santos, Joseph Fabiano Guimarães; Miranda, Lívia Carvalho Viana; Santos, Raquel Melgaço

2018-03-08

to evaluate the quality of care provided to older people with diabetes mellitus and/or hypertension in the Primary Health Care (PHC) according to the Chronic Care Model (CCM) and identify associations with care outcomes. cross-sectional study involving 105 older people with diabetes mellitus and/or hypertension. The Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used to evaluate the quality of care. The total score was compared with care outcomes that included biochemical parameters, body mass index, pressure levels and quality of life. Data analysis was based on descriptive statistics and multiple logistic regression. there was a predominance of females and a median age of 72 years. The median PACIC score was 1.55 (IQ 1.30-2.20). Among the PACIC dimensions, the "delivery system design/decision support" was the one that presented the best result. There was no statistical difference between the medians of the overall PACIC score and individual care outcomes. However, when the quality of life and health satisfaction were simultaneously evaluated, a statistical difference between the medians was observed. the low PACIC scores found indicate that chronic care according to the CCM in the PHC seems still to fall short of its assumptions.

The Effects of Simultaneous Use of Careful Online Planning and Task Repetition on Accuracy, Complexity, and Fluency in EFL Learners' Oral Production

ERIC Educational Resources Information Center

Ahmadian, Mohammad Javad; Tavakoli, Mansoor

2011-01-01

This article reports on a study that was primarily aimed at investigating the effects of simultaneous use of careful online planning and task repetition on accuracy, complexity, and fluency in the oral production of learners of English as a foreign language (EFL). The effects of four planning and task repetition conditions (i.e. careful online…

Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling.

PubMed

Ricci-Cabello, Ignacio; Stevens, Sarah; Dalton, Andrew R H; Griffiths, Robert I; Campbell, John L; Valderas, Jose M

2018-02-01

To study the relationships between the different domains of quality of primary health care for the evaluation of health system performance and for informing policy decision making. A total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012. Cross-sectional study at the practice level. Indicators were allocated to subdomains of processes of care ("quality assurance," "education and training," "medicine management," "access," "clinical management," and "patient-centered care"), health outcomes ("intermediate outcomes" and "patient-reported health status"), and patient satisfaction. The relationships between the subdomains were hypothesized in a conceptual model and subsequently tested using structural equation modeling. The model supported two independent paths. In the first path, "access" was associated with "patient-centered care" (β = 0.63), which in turn was strongly associated with "patient satisfaction" (β = 0.88). In the second path, "education and training" was associated with "clinical management" (β = 0.32), which in turn was associated with "intermediate outcomes" (β = 0.69). "Patient-reported health status" was weakly associated with "patient-centered care" (β = -0.05) and "patient satisfaction" (β = 0.09), and not associated with "clinical management" or "intermediate outcomes." This is the first empirical model to simultaneously provide evidence on the independence of intermediate health care outcomes, patient satisfaction, and health status. The explanatory paths via technical quality clinical management and patient centeredness offer specific opportunities for the development of quality improvement initiatives. © Health Research and Educational Trust.

Testing for the Endogenous Nature between Women's Empowerment and Antenatal Health Care Utilization: Evidence from a Cross-Sectional Study in Egypt

PubMed Central

Hussein, Mohamed Ali

2014-01-01

Women's relative lack of decision-making power and their unequal access to employment, finances, education, basic health care, and other resources are considered to be the root causes of their ill-health and that of their children. The main purpose of this paper is to examine the interactive relation between women's empowerment and the use of maternal health care. Two model specifications are tested. One assumes no correlation between empowerment and antenatal care while the second specification allows for correlation. Both the univariate and the recursive bivariate probit models are tested. The data used in this study is EDHS 2008. Factor Analysis Technique is also used to construct some of the explanatory variables such as the availability and quality of health services indicators. The findings show that women's empowerment and receiving regular antenatal care are simultaneously determined and the recursive bivariate probit is a better approximation to the relationship between them. Women's empowerment has significant and positive impact on receiving regular antenatal care. The availability and quality of health services do significantly increase the likelihood of receiving regular antenatal care. PMID:25140310

A country for old men? Long-term home care utilization in Europe.

PubMed

Balia, Silvia; Brau, Rinaldo

2014-10-01

This paper investigates long-term home care utilization in Europe. Data from the first wave of the Survey on Health, Ageing and Retirement (SHARE) on formal (nursing care and paid domestic help) and informal care (support provided by relatives) are used to study the probability and the quantity of both types of care. The overall process is framed in a fully simultaneous equation system that takes the form of a bivariate two-part model where the reciprocal interaction between formal and informal care is estimated. Endogeneity and unobservable heterogeneity are addressed using a common latent factor approach. The analysis of the relative impact of age and disability on home care utilization is enriched by the use of a proximity to death (PtD) indicator built using the second wave of SHARE. All these indicators are important predictors of home care utilization. In particular, a strong significant effect of PtD is found in the paid domestic help and informal care models. The relationship between formal and informal care moves from substitutability to complementarity depending on the type of care considered, and the estimated effects are small in absolute size. This might call for a reconsideration of the effectiveness of incentives for informal care as instruments to reduce public expenditure for home care services. Copyright © 2013 John Wiley & Sons, Ltd.

Nursing care systematization as a multidimensional and interactive phenomenon.

PubMed

Backes, Dirce Stein; Koerich, Magda Santos; Nascimento, Keyla Cristiane do; Erdmann, Alacoque Lorenzini

2008-01-01

This study aimed to understand the meaning of Nursing Care Systematization (NCS) for multiprofessional health team professionals based on the relationships, interactions and associations of Complex thought. This qualitative study uses Grounded Theory as a methodological reference framework. Data were obtained through interviews with three sample groups, totaling 15 professionals from different institutions. Simultaneous data codification and analysis identified the central theme: 'Glimpsing nursing care systematization as an interactive and multidimensional phenomenon' and the respective reference model. NCS appoints, in addition to interactivity and professional complementarity, the importance of dialog and connection between the academy, health practices and regulatory offices, based on new reference frameworks for the organization of health practices.

WORKING AND CARING: THE SIMULTANEOUS DECISION OF LABOR FORCE PARTICIPATION AND INFORMAL ELDERLY AND CHILD SUPPORT ACT IVITIES IN MEXICO*

PubMed Central

van Gameren, Edwin; Velandia Naranjo, Durfari

2016-01-01

We analyze factors determining women’s decisions to participate in the labor market and provide elderly care and nonfinancial support to their (grand)children. We use data from the Mexican Health and Aging Study, a survey of people aged 50 and over, applying a three-equation, reduced-form SUR model. Results suggest that care needs are the driving force behind caregiving activities. Traditional roles also appear to be relevant in the labor force participation decision: women with a closer labor market connection when they were young are more likely to work. Simulations of demographic changes illustrate potential effects for future caregiving and participation rates. PMID:26924883

Using foresight methods to anticipate future threats: the case of disease management.

PubMed

Ma, Sai; Seid, Michael

2006-01-01

We describe a unique foresight framework for health care managers to use in longer-term planning. This framework uses scenario-building to envision plausible alternate futures of the U.S. health care system and links those broad futures to business-model-specific "load-bearing" assumptions. Because the framework we describe simultaneously addresses very broad and very specific issues, it can be easily applied to a broad range of health care issues by using the broad framework and business-specific assumptions for the particular case at hand. We illustrate this method using the case of disease management, pointing out that although the industry continues to grow rapidly, its future also contains great uncertainties.

Patient loyalty model.

PubMed

Sumaedi, Sik; Bakti, I Gede Mahatma Yuda; Rakhmawati, Tri; Astrini, Nidya Judhi; Yarmen, Medi; Widianti, Tri

2015-07-06

This study aims to investigate the simultaneous effect of subjective norm, perceived behavioral control and trust on patient loyalty. The empirical data were collected through survey. The respondents of the survey are 157 patients of a health-care service institution in Bogor, Indonesia. Multiple regressions analysis was performed to test the conceptual model and the proposed hypotheses. The findings showed that subjective norm and trust influence patient loyalty positively. However, this research also found that perceived behavioral control does not influence patient loyalty significantly. The survey was only conducted at one health-care service institution in Bogor, Indonesia. In addition, convenience sampling method was used. These conditions may cause that the research results can not be generalized to the other contexts. Therefore, replication research is needed to test the stability of the findings in the other contexts. Health-care service institutions need to pay attention to trust and subjective norm to establish patient loyalty. This study is believed to be the first to develop and test patient loyalty model that includes subjective norm, perceived behavioral control and trust.

[Proposing a physiological model for Emergency Department. Operating principles, classification of overcrowding and guidelines for redesign].

PubMed

Herrera Carranza, M; Aguado Correa, F; Padilla Garrido, N; López Camacho, F

2017-04-30

The operation of Emergency Departments (ED) is determined by demand, their own organizational structures and the connection to other medical care levels. When these elements are not simultaneous, it hinders patient flow and decreases capacity, making it necessary to employ a systemic approach to the chain of emergency care as a single operational entity. With this theoretical orientation, we suggest a conceptual model similar to the physiological cardiac output, in which the preload is the demand, the contractile or flow pump is the organizational structure, the afterload is the hospital, the pre-ED valve is primary care and outpatient emergencies, and the post-ED valve is the diagnostic support services and the specialist consultants. Based on this theoretical approach we classify the different types of ED overcrowding and systematise its causes and the different waiting lists that it generates, which can help to redesign the service and avoid its saturation.

Simultaneous pre-concentration and separation on simple paper-based analytical device for protein analysis.

PubMed

Niu, Ji-Cheng; Zhou, Ting; Niu, Li-Li; Xie, Zhen-Sheng; Fang, Fang; Yang, Fu-Quan; Wu, Zhi-Yong

2018-02-01

In this work, fast isoelectric focusing (IEF) was successfully implemented on an open paper fluidic channel for simultaneous concentration and separation of proteins from complex matrix. With this simple device, IEF can be finished in 10 min with a resolution of 0.03 pH units and concentration factor of 10, as estimated by color model proteins by smartphone-based colorimetric detection. Fast detection of albumin from human serum and glycated hemoglobin (HBA1c) from blood cell was demonstrated. In addition, off-line identification of the model proteins from the IEF fractions with matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was also shown. This PAD IEF is potentially useful either for point of care test (POCT) or biomarker analysis as a cost-effective sample pretreatment method.

Current Status of Multidisciplinary Care in Psoriatic Arthritis in Spain: NEXUS 2.0 Project.

PubMed

Queiro, Rubén; Coto, Pablo; Joven, Beatriz; Rivera, Raquel; Navío Marco, Teresa; de la Cueva, Pablo; Alvarez Vega, Jose Luis; Narváez Moreno, Basilio; Rodriguez Martínez, Fernando José; Pardo Sánchez, José; Feced Olmos, Carlos; Pujol, Conrad; Rodríguez, Jesús; Notario, Jaume; Pujol Busquets, Manel; García Font, Mercè; Galindez, Eva; Pérez Barrio, Silvia; Urruticoechea-Arana, Ana; Hergueta, Merce; López Montilla, M Dolores; Vélez García-Nieto, Antonio; Maceiras, Francisco; Rodríguez Pazos, Laura; Rubio Romero, Esteban; Rodríguez Fernandez Freire, Lourdes; Luelmo, Jesús; Gratacós, Jordi

2018-02-26

1) To analyze the implementation of multidisciplinary care models in psoriatic arthritis (PsA) patients, 2) To define minimum and excellent standards of care. A survey was sent to clinicians who already performed multidisciplinary care or were in the process of undertaking it, asking: 1) Type of multidisciplinary care model implemented; 2) Degree, priority and feasibility of the implementation of quality standards in the structure, process and result for care. In 6 regional meetings the results of the survey were presented and discussed, and the ultimate priority of quality standards for care was defined. At a nominal meeting group, 11 experts (rheumatologists and dermatologists) analyzed the results of the survey and the regional meetings. With this information, they defined which standards of care are currently considered as minimum and which are excellent. The simultaneous and parallel models of multidisciplinary care are those most widely implemented, but the implementation of quality standards is highly variable. In terms of structure it ranges from 22% to 74%, in those related to process from 17% to 54% and in the results from 2% to 28%. Of the 25 original quality standards for care, 9 were considered only minimum, 4 were excellent and 12 defined criteria for minimum level and others for excellence. The definition of minimum and excellent quality standards for care will help achieve the goal of multidisciplinary care for patients with PAs, which is the best healthcare possible. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians.

PubMed

Weigl, Matthias; Müller, Andreas; Zupanc, Andrea; Angerer, Peter

2009-06-29

Hospital physicians' time is a critical resource in medical care. Two aspects are of interest. First, the time spent in direct patient contact - a key principle of effective medical care. Second, simultaneous task performance ('multitasking') which may contribute to medical error, impaired safety behaviour, and stress. There is a call for instruments to assess these aspects. A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out. Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested. 35 participant observations of internists and surgeons of a German municipal 300-bed hospital were conducted. Complete day shifts of hospital physicians on wards, emergency ward, intensive care unit, and operating room were continuously observed. Assessed variables of interest were time allocation, share of direct patient contact, and simultaneous activities. Inter-rater agreement of Kappa = .71 points to good reliability of the instrument. Hospital physicians spent 25.5% of their time at work in direct contact with patients. Most time was allocated to documentation and conversation with colleagues and nursing staff. Physicians performed parallel simultaneous activities for 17-20% of their work time. Communication with patients, documentation, and conversation with colleagues and nursing staff were the most frequently observed simultaneous activities. Applying logit-linear analyses, specific primary activities increase the probability of particular simultaneous activities. Patient-related working time in hospitals is limited. The potential detrimental effects of frequently observed simultaneous activities on performance outcomes need further consideration.

Alternative Reimbursement Models: Bundled Payment and Beyond: AOA Critical Issues.

PubMed

Greenwald, A Seth; Bassano, Amy; Wiggins, Stephen; Froimson, Mark I

2016-06-01

The Bundled Payments for Care Improvement (BPCI) initiative was begun in January 2013 by the U.S. Centers for Medicare & Medicaid Services (CMS) through its Innovation Center authority, which was created by the U.S. Patient Protection and Affordable Care Act (PPACA). The BPCI program seeks to improve health-care delivery and to ultimately reduce costs by allowing providers to enter into prenegotiated payment arrangements that include financial and performance accountability for a clinical episode in which a risk-and-reward calculus must be determined. BPCI is a contemporary 3-year experiment designed to test the applicability of episode-based payment models as a viable strategy to transform the CMS payment methodology while improving health outcomes. A summary of the 4 models being evaluated in the BPCI initiative is presented in addition to the awardee types and the number of awardees in each model. Data from one of the BPCI-designated pilot sites demonstrate that strategies do exist for successful implementation of an alternative payment model by keeping patients first while simultaneously improving coordination, alignment of care, and quality and reducing cost. Providers will need to embrace change and their areas of opportunity to gain a competitive advantage. Health-care providers, including orthopaedic surgeons, health-care professionals at post-acute care institutions, and product suppliers, all have a role in determining the strategies for success. Open dialogue between CMS and awardees should be encouraged to arrive at a solution that provides opportunity for gainsharing, as this program continues to gain traction and to evolve. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Educating health care trainees and professionals about suicide prevention in depressed adolescents.

PubMed

Rice, Timothy R; Sher, Leo

2013-01-01

Adolescent depression is a highly prevalent disorder with significant morbidity and suicide mortality. It is simultaneously highly responsive to treatment. Adolescents wish to discuss depression with their providers, and providers routinely receive opportunities to do so. These characteristics of prevalence, morbidity, mortality, responsiveness, and accessibility make adolescent depression an excellent target of care. However, most health care trainees and professionals report low confidence in caring for adolescent depression. As a caregiver community, we fare poorly in routine matters of assessment and management of adolescent depression. All health care professionals are trained within a medical model. In this light, the conceptualization of adolescent depression and suicidality within the medical model may increase provider confidence and performance. Epidemiology and neurobiology are presented with emphasis in this review. Legal concerns also affect health care professionals. For example, providers may deviate from evidence-based medicine owing to anxieties that the identification and treatment of depression may induce suicide and consequent legal culpability. A review of the historical context and relevant outcome trials concerning the increased risk of suicidality in depressed adolescents treated with selective-serotonin reuptake inhibitors may increase provider comfort. Furthermore, increased didactic and experiential training improve provider performance. In this work, proven models were discussed, and the testable hypothesis that education incorporating the views of this article can produce the best care for depressed adolescents.

Noninvasive optical monitoring multiple physiological parameters response to cytokine storm

NASA Astrophysics Data System (ADS)

Li, Zebin; Li, Ting

2018-02-01

Cancer and other disease originated by immune or genetic problems have become a main cause of death. Gene/cell therapy is a highlighted potential method for the treatment of these diseases. However, during the treatment, it always causes cytokine storm, which probably trigger acute respiratory distress syndrome and multiple organ failure. Here we developed a point-of-care device for noninvasive monitoring cytokine storm induced multiple physiological parameters simultaneously. Oxy-hemoglobin, deoxy-hemoglobin, water concentration and deep-tissue/tumor temperature variations were simultaneously measured by extended near infrared spectroscopy. Detection algorithms of symptoms such as shock, edema, deep-tissue fever and tissue fibrosis were developed and included. Based on these measurements, modeling of patient tolerance and cytokine storm intensity were carried out. This custom device was tested on patients experiencing cytokine storm in intensive care unit. The preliminary data indicated the potential of our device in popular and milestone gene/cell therapy, especially, chimeric antigen receptor T-cell immunotherapy (CAR-T).

Advancing renal education: hybrid simulation, using simulated patients to enhance realism in haemodialysis education.

PubMed

Dunbar-Reid, Kylie; Sinclair, Peter M; Hudson, Denis

2015-06-01

Simulation is a well-established and proven teaching method, yet its use in renal education is not widely reported. Criticisms of simulation-based teaching include limited realism and a lack of authentic patient interaction. This paper discusses the benefits and challenges of high-fidelity simulation and suggests hybrid simulation as a complementary model to existing simulation programmes. Through the use of a simulated patient, hybrid simulation can improve the authenticity of renal simulation-based education while simultaneously teaching and assessing technologically enframed caring. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Payment and Care for Hematopoietic Cell Transplantation Patients: Toward a Specialized Medical Home for Complex Care Patients.

PubMed

Gajewski, James L; McClellan, Mark B; Majhail, Navneet S; Hari, Parameswaran N; Bredeson, Christopher N; Maziarz, Richard T; LeMaistre, Charles F; Lill, Michael C; Farnia, Stephanie H; Komanduri, Krishna V; Boo, Michael J

2018-01-01

Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time. Payment is linked to quality measures, including proportion of care delivered according to predefined pathways and demonstrated impact on outcomes. Some medical homes also include opportunities for shared savings by reducing overall costs of care. Recent proposals have suggested expanding the medical home model to specialized populations with complex needs because primary care teams may not have the facilities or the requisite expertise for their unique needs. An example of a successful care model that may provide valuable lessons for those creating specialty medical home models already exists in many hematopoietic cell transplantation (HCT) centers that deliver multidisciplinary, coordinated, and highly specialized care. The integration of care delivery in HCT centers has been driven by the specialty care their patients require and by the payment methodology preferred by the commercial payers, which has included bundling of both inpatient and outpatient care in the peritransplant interval. Commercial payers identify qualified HCT centers based on accreditation status and comparative performance, enabled in part by center-level comparative performance data available within a national outcomes database mandated by the Stem Cell Therapeutic and Research Act of 2005. Standardization across centers has been facilitated via voluntary accreditation implemented by Foundation for the Accreditation of Cell Therapy. Payers have built on these community-established programs and use public outcomes and program accreditation as standards necessary for inclusion in specialty care networks and contracts. Although HCT centers have not been described as medical homes, most HCT providers have already developed the structures that address critical requirements of MACRA for medical homes. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Tactical Firefighter Teams: Pivoting Toward the Fire Service’s Evolving Homeland Security Mission

DTIC Science & Technology

2016-09-01

critical response command C-TECC Committee on Tactical Emergency Casualty Care EMS emergency medical services EMT emergency medical technician ESU...Interagency Tactical Response Model: Integrating Fire and EMS with Law Enforcement to Mitigate Mumbai-Style Terrorist Attacks (New York: FDNY Center...the assailants, several traditional fire and EMS activities must often occur simultaneously to successfully mitigate the threat. Although rare

Next-generation, personalised, model-based critical care medicine: a state-of-the art review of in silico virtual patient models, methods, and cohorts, and how to validation them.

PubMed

Chase, J Geoffrey; Preiser, Jean-Charles; Dickson, Jennifer L; Pironet, Antoine; Chiew, Yeong Shiong; Pretty, Christopher G; Shaw, Geoffrey M; Benyo, Balazs; Moeller, Knut; Safaei, Soroush; Tawhai, Merryn; Hunter, Peter; Desaive, Thomas

2018-02-20

Critical care, like many healthcare areas, is under a dual assault from significantly increasing demographic and economic pressures. Intensive care unit (ICU) patients are highly variable in response to treatment, and increasingly aging populations mean ICUs are under increasing demand and their cohorts are increasingly ill. Equally, patient expectations are growing, while the economic ability to deliver care to all is declining. Better, more productive care is thus the big challenge. One means to that end is personalised care designed to manage the significant inter- and intra-patient variability that makes the ICU patient difficult. Thus, moving from current "one size fits all" protocolised care to adaptive, model-based "one method fits all" personalised care could deliver the required step change in the quality, and simultaneously the productivity and cost, of care. Computer models of human physiology are a unique tool to personalise care, as they can couple clinical data with mathematical methods to create subject-specific models and virtual patients to design new, personalised and more optimal protocols, as well as to guide care in real-time. They rely on identifying time varying patient-specific parameters in the model that capture inter- and intra-patient variability, the difference between patients and the evolution of patient condition. Properly validated, virtual patients represent the real patients, and can be used in silico to test different protocols or interventions, or in real-time to guide care. Hence, the underlying models and methods create the foundation for next generation care, as well as a tool for safely and rapidly developing personalised treatment protocols over large virtual cohorts using virtual trials. This review examines the models and methods used to create virtual patients. Specifically, it presents the models types and structures used and the data required. It then covers how to validate the resulting virtual patients and trials, and how these virtual trials can help design and optimise clinical trial. Links between these models and higher order, more complex physiome models are also discussed. In each section, it explores the progress reported up to date, especially on core ICU therapies in glycemic, circulatory and mechanical ventilation management, where high cost and frequency of occurrence provide a significant opportunity for model-based methods to have measurable clinical and economic impact. The outcomes are readily generalised to other areas of medical care.

A Large-scale Dissemination and Implementation Model for Evidence-based Treatment and Continuing Care

PubMed Central

Garner, Bryan R.; Smith, Jane Ellen; Meyers, Robert J.; Godley, Mark D.

2010-01-01

Multiple evidence-based treatments for adolescents with substance use disorders are available; however, the diffusion of these treatments in practice remains minimal. A dissemination and implementation model incorporating research-based training components for simultaneous implementation across 33 dispersed sites and over 200 clinical staff is described. Key elements for the diffusion of the Adolescent Community Reinforcement Approach and Assertive Continuing Care were: (a) three years of funding to support local implementation; (b) comprehensive training, including a 3.5 day workshop, bi-weekly coaching calls, and ongoing performance feedback facilitated by a web tool; (c) a clinician certification process; (d) a supervisor certification process to promote long-term sustainability; and (e) random fidelity reviews after certification. Process data are summarized for 167 clinicians and 64 supervisors. PMID:21547241

Implementing Innovative Models of Dementia Care: The Healthy Aging Brain Center

PubMed Central

Boustani, Malaz A.; Sachs, Greg A.; Alder, Catherine A.; Munger, Stephanie; Schubert, Cathy C.; Guerriero Austrom, Mary; Hake, Ann; Unverzagt, Frederick W.; Farlow, Martin; Matthews, Brandy R.; Perkins, Anthony J.; Beck, Robin A.; Callahan, Christopher M.

2010-01-01

BACKGROUND Recent randomized controlled trials have demonstrated the effectiveness of the collaborative dementia care model targeting both patients suffering from dementia and their informal caregivers. OBJECTIVE To implement a sustainable collaborative dementia care program in a public health care system in Indianapolis. METHODS We used the framework of Complex Adaptive System and the tool of the Reflective Adaptive Process to translate the results of the dementia care trial into the Healthy Aging Brain Center (HABC). RESULTS Within its first year of operation, the HABC delivered 528 visits to serve 208 patients and 176 informal caregivers. The mean age of HABC patients was 73.8 (SD 9.5), 40% were African Americans, 42% had less than high school education, 14% had normal cognitive status, 39% received a diagnosis of mild cognitive impairment, and 46% were diagnosed with dementia. Within 12 months of the initial HABC visit, 28% of patients had at least one visit to an emergency room (ER) and 14% were hospitalized with a mean length of stay of five days. The rate of a one-week ER revisit was 14% and the 30-day re-hospitalization rate was 11%. Only 5% of HABC patients received an order for neuroleptics and only 16% had simultaneous orders for both definite anticholinergic and anti-dementia drugs. CONCLUSION The tools of “implementation science” can be utilized to translate a health care delivery model developed in the research laboratory to a practical, operational, health care delivery program. PMID:21271387

The Crisis of Capitalism and the Marketisation of Health Care: the Implications for Public Health Professionals

PubMed Central

McKee, Martin; Stuckler, David

2012-01-01

The current economic crisis in Europe has challenged the basis of the economic model that currently prevails in much of the industrialised world. It has revealed a system that is managed not for the benefit of the people but rather for the corporations and the small elite who lead them, and which is clearly unsustainable in its present form. Yet, there is a hidden consequence of this system: an unfolding crisis in health care, driven by the greed of corporations whose profit-seeking model is also failing. Proponents of commodifying healthcare simultaneously argue that the cost of providing care for ageing populations is unaffordable while working to create demand for their health care products among those who are essentially healthy. Will healthcare be the next profit-fuelled investor bubble? In this paper, we call on health professionals to heed the warnings from the economic crisis and, rather than stand by while a crisis unfolds, act now to redirect increasingly market-oriented health systems to serve the common good. PMID:25170470

The crisis of capitalism and the marketisation of health care: the implications for public health professionals.

PubMed

McKee, Martin; Stuckler, David

2012-12-28

The current economic crisis in Europe has challenged the basis of the economic model that currently prevails in much of the industrialised world. It has revealed a system that is managed not for the benefit of the people but rather for the corporations and the small elite who lead them, and which is clearly unsustainable in its present form. Yet, there is a hidden consequence of this system: an unfolding crisis in health care, driven by the greed of corporations whose profit-seeking model is also failing. Proponents of commodifying healthcare simultaneously argue that the cost of providing care for ageing populations is unaffordable while working to create demand for their health care products among those who are essentially healthy. Will healthcare be the next profit-fuelled investor bubble? In this paper, we call on health professionals to heed the warnings from the economic crisis and, rather than stand by while a crisis unfolds, act now to redirect increasingly market-oriented health systems to serve the common good.

Divergent modes of integration: the Canadian way.

PubMed

Jiwani, Izzat; Fleury, Marie-Josée

2011-01-01

The paper highlights key trajectories and outcomes of the recent policy developments toward integrated health care delivery systems in Quebec and Ontario in the primary care sector and in the development of regional networks of health and social services. It particularly explores how policy legacies, interests and cultures may be mitigated to develop and sustain different models of integrated health care that are pertinent to the local contexts. In Quebec, three decades of iterative developments in health and social services evolved in 2005 into integrated centres for health and social services at the local levels (CSSSs). Four integrated university-based health care networks provide ultra-specialised services. Family Medicine Groups and network clinics are designed to enhance access and continuity of care. Ontario's Family Health Teams (2004) constitute an innovative public funding for private delivery model that is set up to enhance the capacity of primary care and to facilitate patient-based care. Ontario's Local Health Integration Networks (LHINs) with autonomous boards of provider organisations are intended to coordinate and integrate care. Integration strategies in Quebec and Ontario yield clinical autonomy and power to physicians while simultaneously making them key partners in change. Contextual factors combined with increased and varied forms of physician remunerations and incentives mitigated some of the challenges from policy legacies, interests and cultures. Virtual partnerships and accountability agreements between providers promise positive but gradual movement toward integrated health service systems.

How Open Data Shapes In Silico Transporter Modeling.

PubMed

Montanari, Floriane; Zdrazil, Barbara

2017-03-07

Chemical compound bioactivity and related data are nowadays easily available from open data sources and the open medicinal chemistry literature for many transmembrane proteins. Computational ligand-based modeling of transporters has therefore experienced a shift from local (quantitative) models to more global, qualitative, predictive models. As the size and heterogeneity of the data set rises, careful data curation becomes even more important. This includes, for example, not only a tailored cutoff setting for the generation of binary classes, but also the proper assessment of the applicability domain. Powerful machine learning algorithms (such as multi-label classification) now allow the simultaneous prediction of multiple related targets. However, the more complex, the less interpretable these models will get. We emphasize that transmembrane transporters are very peculiar, some of which act as off-targets rather than as real drug targets. Thus, careful selection of the right modeling technique is important, as well as cautious interpretation of results. We hope that, as more and more data will become available, we will be able to ameliorate and specify our models, coming closer towards function elucidation and the development of safer medicine.

The relative effectiveness of managed care penetration and the healthcare safety net in reducing avoidable hospitalizations.

PubMed

Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia

2011-01-01

Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. © 2011 National Association for Healthcare Quality.

World Health Organization Public Health Model: A Roadmap for Palliative Care Development.

PubMed

Callaway, Mary V; Connor, Stephen R; Foley, Kathleen M

2018-02-01

The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health-approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made. Copyright © 2017. Published by Elsevier Inc.

Demand for antenatal care in South Africa.

PubMed

Kirigia, J M; Lambo, E; Sambo, L G

2000-01-01

On May,24 1994, the then South African president, Mr. Nelson Mandela, declared that all health care for children under the age of 6 years, and pregnant women would be free. Unfortunately, there has been no significant decrease in maternal, perinatal and infant mortality. Thus, there is a need of research into the factors that influence the demand for antenatal services. The objectives of this paper are to (a) establish the determinants of individual pregnant women's choice to seek antenatal care; and (b) deal with potential endogeneity bias in the relationship between the decision to seek pre-natal care and perceived health status. The joint determination of consumption of antenatal care and pregnant woman's health status requires estimation of a simultaneous system. To help mitigate the simultaneity bias and avoid the inconsistency inherent in the application of Ordinary least Squares (OLS) method to simultaneous equations systems, we used Two-Stage Probit Maximum Likelihood Estimator Method. In the antenatal structural-form equation, the coefficients for TOILET, AGE, OCCUPATION, EMPLOYMENT, SMOKER, METHODS and QUALITY were statistically significant at P

HIT or miss: the application of health care information technology to managing uncertainty in clinical decision making.

PubMed

Kazandjian, Vahé A; Lipitz-Snyderman, Allison

2011-12-01

To discuss the usefulness of health care information technology (HIT) in assisting care providers minimize uncertainty while simultaneously increasing efficiency of the care provided. An ongoing study of HIT, performance measurement (clinical and production efficiency) and their implications to the payment for care represents the design of this study. Since 2006, all Maryland hospitals have embarked on a multi-faceted study of performance measures and HIT adoption surveys, which will shape the health care payment model in Maryland, the last of the all-payor states, in 2011. This paper focuses on the HIT component of the Maryland care payment initiative. While the payment model is still under review and discussion, 'appropriateness' of care has been discussed as an important dimension of measurement. Within this dimension, the 'uncertainty' concept has been identified as associated with variation in care practices. Hence, the methods of this paper define how HIT can assist care providers in addressing the concept of uncertainty, and then provides findings from the first HIT survey in Maryland to infer the readiness of Maryland hospital in addressing uncertainty of care in part through the use of HIT. Maryland hospitals show noteworthy variation in their adoption and use of HIT. While computerized, electronic patient records are not commonly used among and across Maryland hospitals, many of the uses of HIT internally in each hospital could significantly assist in better communication about better practices to minimize uncertainty of care and enhance the efficiency of its production. © 2010 Blackwell Publishing Ltd.

Veterans' informal caregivers in the "sandwich generation": a systematic review toward a resilience model.

PubMed

Smith-Osborne, Alexa; Felderhoff, Brandi

2014-01-01

Social work theory advanced the formulation of the construct of the sandwich generation to apply to the emerging generational cohort of caregivers, most often middle-aged women, who were caring for maturing children and aging parents simultaneously. This systematic review extends that focus by synthesizing the literature on sandwich generation caregivers for the general aging population with dementia and for veterans with dementia and polytrauma. It develops potential protective mechanisms based on empirical literature to support an intervention resilience model for social work practitioners. This theoretical model addresses adaptive coping of sandwich- generation families facing ongoing challenges related to caregiving demands.

Developing measures of educational change for academic health care teams implementing the chronic care model in teaching practices.

PubMed

Bowen, Judith L; Stevens, David P; Sixta, Connie S; Provost, Lloyd; Johnson, Julie K; Woods, Donna M; Wagner, Edward H

2010-09-01

The Chronic Care Model (CCM) is a multidimensional framework designed to improve care for patients with chronic health conditions. The model strives for productive interactions between informed, activated patients and proactive practice teams, resulting in better clinical outcomes and greater satisfaction. While measures for improving care may be clear, measures of residents' competency to provide chronic care do not exist. This report describes the process used to develop educational measures and results from CCM settings that used them to monitor curricular innovations. Twenty-six academic health care teams participating in the national and California Academic Chronic Care Collaboratives. Using successive discussion groups and surveys, participants engaged in an iterative process to identify desirable and feasible educational measures for curricula that addressed educational objectives linked to the CCM. The measures were designed to facilitate residency programs' abilities to address new accreditation requirements and tested with teams actively engaged in redesigning educational programs. Field notes from each discussion and lists from work groups were synthesized using the CCM framework. Descriptive statistics were used to report survey results and measurement performance. Work groups generated educational objectives and 17 associated measurements. Seventeen (65%) teams provided feasibility and desirability ratings for the 17 measures. Two process measures were selected for use by all teams. Teams reported variable success using the measures. Several teams reported use of additional measures, suggesting more extensive curricular change. Using an iterative process in collaboration with program participants, we successfully defined a set of feasible and desirable education measures for academic health care teams using the CCM. These were used variably to measure the results of curricular changes, while simultaneously addressing requirements for residency accreditation.

The Quiet Health Care Revolution.

ERIC Educational Resources Information Center

Herzlinger, Regina

1994-01-01

Discusses how entrepreneurs have helped reduce costs in health care and examines the major changes in the health care system that are simultaneously lowering costs and increasing quality. The author then explains how current reform proposals might affect these entrepreneurial innovations. (GLR)

Variable selection for zero-inflated and overdispersed data with application to health care demand in Germany

PubMed Central

Wang, Zhu; Shuangge, Ma; Wang, Ching-Yun

2017-01-01

In health services and outcome research, count outcomes are frequently encountered and often have a large proportion of zeros. The zero-inflated negative binomial (ZINB) regression model has important applications for this type of data. With many possible candidate risk factors, this paper proposes new variable selection methods for the ZINB model. We consider maximum likelihood function plus a penalty including the least absolute shrinkage and selection operator (LASSO), smoothly clipped absolute deviation (SCAD) and minimax concave penalty (MCP). An EM (expectation-maximization) algorithm is proposed for estimating the model parameters and conducting variable selection simultaneously. This algorithm consists of estimating penalized weighted negative binomial models and penalized logistic models via the coordinated descent algorithm. Furthermore, statistical properties including the standard error formulae are provided. A simulation study shows that the new algorithm not only has more accurate or at least comparable estimation, also is more robust than the traditional stepwise variable selection. The proposed methods are applied to analyze the health care demand in Germany using an open-source R package mpath. PMID:26059498

The practice of neurology: Looking ahead by looking back.

PubMed

Ringel, Steven P

2015-05-19

Over the last 50 years, there have been many improvements in therapy for individuals with neurologic disorders. Simultaneously, the complexity and cost of care have increased. The delivery of neurologic services is inefficient. The needs of both patients and neurologists are not being optimally addressed. Although greater attention is on the quality, safety, and value of the care, there remains a need for fundamental redesign in the way neurologic services are provided. The future practice of neurology will likely be interdisciplinary and provide both easy access and efficient coordination of services. No matter what changes in financing of health care are adopted, focus needs to be on reducing health care costs. Patients seeking neurologic care will expect seamless, innovative, and cost-effective services and to be active participants in their care. The proposed modifications address current demands and advocate for prospective innovative solutions. The changes proposed to improve care for patients will simultaneously make the careers of neurologists more gratifying and less stressful. © 2015 American Academy of Neurology.

The Misapplication of Probability Theory in Quantum Mechanics

NASA Astrophysics Data System (ADS)

Racicot, Ronald

2014-03-01

This article is a revision of two papers submitted to the APS in the past two and a half years. In these papers, arguments and proofs are summarized for the following: (1) The wrong conclusion by EPR that Quantum Mechanics is incomplete, perhaps requiring the addition of ``hidden variables'' for completion. Theorems that assume such ``hidden variables,'' such as Bell's theorem, are also wrong. (2) Quantum entanglement is not a realizable physical phenomenon and is based entirely on assuming a probability superposition model for quantum spin. Such a model directly violates conservation of angular momentum. (3) Simultaneous multiple-paths followed by a quantum particle traveling through space also cannot possibly exist. Besides violating Noether's theorem, the multiple-paths theory is based solely on probability calculations. Probability calculations by themselves cannot possibly represent simultaneous physically real events. None of the reviews of the submitted papers actually refuted the arguments and evidence that was presented. These analyses should therefore be carefully evaluated since the conclusions reached have such important impact in quantum mechanics and quantum information theory.

Simultaneous Prediction of New Morbidity, Mortality, and Survival Without New Morbidity From Pediatric Intensive Care: A New Paradigm for Outcomes Assessment.

PubMed

Pollack, Murray M; Holubkov, Richard; Funai, Tomohiko; Berger, John T; Clark, Amy E; Meert, Kathleen; Berg, Robert A; Carcillo, Joseph; Wessel, David L; Moler, Frank; Dalton, Heidi; Newth, Christopher J L; Shanley, Thomas; Harrison, Rick E; Doctor, Allan; Jenkins, Tammara L; Tamburro, Robert; Dean, J Michael

2015-08-01

Assessments of care including quality assessments adjusted for physiological status should include the development of new morbidities as well as mortalities. We hypothesized that morbidity, like mortality, is associated with physiological dysfunction and could be predicted simultaneously with mortality. Prospective cohort study from December 4, 2011, to April 7, 2013. General and cardiac/cardiovascular PICUs at seven sites. Randomly selected PICU patients from their first PICU admission. None. Among 10,078 admissions, the unadjusted morbidity rates (measured with the Functional Status Scale and defined as an increase of ≥ 3 from preillness to hospital discharge) were 4.6% (site range, 2.6-7.7%) and unadjusted mortality rates were 2.7% (site range, 1.3-5.0%). Morbidity and mortality were significantly (p < 0.001) associated with physiological instability (measured with the Pediatric Risk of Mortality III score) in dichotomous (survival and death) and trichotomous (survival without new morbidity, survival with new morbidity, and death) models without covariate adjustments. Morbidity risk increased with increasing Pediatric Risk of Mortality III scores and then decreased at the highest Pediatric Risk of Mortality III values as potential morbidities became mortalities. The trichotomous model with covariate adjustments included age, admission source, diagnostic factors, baseline Functional Status Scale, and the Pediatric Risk of Mortality III score. The three-level goodness-of-fit test indicated satisfactory performance for the derivation and validation sets (p > 0.20). Predictive ability assessed with the volume under the surface was 0.50 ± 0.019 (derivation) and 0.50 ± 0.034 (validation) (vs chance performance = 0.17). Site-level standardized morbidity ratios were more variable than standardized mortality ratios. New morbidities were associated with physiological status and can be modeled simultaneously with mortality. Trichotomous outcome models including both morbidity and mortality based on physiological status are suitable for research studies and quality and other outcome assessments. This approach may be applicable to other assessments presently based only on mortality.

No child left behind: Enrolling children and adults simultaneously in critical care randomized trials*

PubMed Central

Halpern, Scott D.; Randolph, Adrienne G.; Angus, Derek C.

2010-01-01

Objective Randomized clinical trials of novel critical care interventions are currently tested in children only after documenting their safety in adults. Although this practice may protect children from research risks, it may paradoxically threaten children’s well-being by depriving them of evidence to guide their care. We sought to evaluate the ethical, methodologic, and practical arguments for and against studying critical care interventions in adults and children simultaneously rather than sequentially. Data Source Empirical studies and conceptual arguments germane to the objective were reviewed. Data Extraction and Synthesis Children are traditionally viewed as “participants of last resort” due to their vulnerability and decisional incapacity. However, critically ill adults commonly share similar features. Thus, structured risk assessments used by Institutional Review Boards to determine the adequacy of research protections for critically ill adults can also help protect children. From a methodologic perspective, interventions may be tested simultaneously in children and adults by enrolling children as a prespecified subgroup within a larger adult randomized clinical trial or by enrolling children in a separate trial conducted in parallel. Both approaches raise practical and analytical challenges that can frequently be met. For example, investigators might choose outcome measures that are appropriate for both adults and children. Additionally, using Bayesian approaches to link the estimates of treatment effects in children to the values observed in adults may enhance the statistical power to detect pediatric-specific effects. Finally, centralized Institutional Review Boards and data monitoring centers may alleviate practical concerns with conducting trials among adults and children simultaneously. Conclusions The current standard of testing critical care interventions in adults before children rests on tenuous ethical arguments and is entrenched by the methodologic and logistic barriers encountered with alternative approaches. However, these barriers will frequently be surmountable. We therefore propose that the default paradigm be changed such that interventions are examined routinely in critically ill children and adults simultaneously unless unique reasons exist to the contrary. PMID:19602971

The Problem of Dualism in Modern Western Medicine

PubMed Central

Gendle, Mathew H.

2016-01-01

Dualism is historically important in that it allowed the medical practice to be divorced from church oversight. The reductionist approaches of modern Western medicine facilitate a dispassionate and mechanistic approach to patient care, and dualist views promoted by complementary and alternative medicine are also problematic. Behavioural disorders are multifactorally realizable and emerge apparently chaotically from interactions between internal physiological systems and the patient's environment and experiential history. Conceptualizations of behavioural disorders that are based on dualism deny the primacy of individual physiology in the generation of pathology and distract from therapies that are most likely to produce positive outcomes. Behavioural health professionals should adopt holistic models of patient care, but these models must be based on methodologies that emphasize radical emergence over the artificial separation of the “physical” and “mental.” This will allow for the humanistic practice of medicine while simultaneously maximizing the likelihood of treatment success. PMID:28031628

Enacting Critical Care and Transformative Leadership in Schools Highly Impacted by Poverty: An African-American Principal's Counter Narrative

ERIC Educational Resources Information Center

Wilson, Camille M.

2016-01-01

Critical notions of care and transformative educational leadership are much aligned, yet they are rarely simultaneously addressed in research. This article highlights the benefits of transformative educational leadership that enacts critical care. Critical care involves embracing and exhibiting values, dispositions and behaviours related to…

Using discrete event computer simulation to improve patient flow in a Ghanaian acute care hospital.

PubMed

Best, Allyson M; Dixon, Cinnamon A; Kelton, W David; Lindsell, Christopher J; Ward, Michael J

2014-08-01

Crowding and limited resources have increased the strain on acute care facilities and emergency departments worldwide. These problems are particularly prevalent in developing countries. Discrete event simulation is a computer-based tool that can be used to estimate how changes to complex health care delivery systems such as emergency departments will affect operational performance. Using this modality, our objective was to identify operational interventions that could potentially improve patient throughput of one acute care setting in a developing country. We developed a simulation model of acute care at a district level hospital in Ghana to test the effects of resource-neutral (eg, modified staff start times and roles) and resource-additional (eg, increased staff) operational interventions on patient throughput. Previously captured deidentified time-and-motion data from 487 acute care patients were used to develop and test the model. The primary outcome was the modeled effect of interventions on patient length of stay (LOS). The base-case (no change) scenario had a mean LOS of 292 minutes (95% confidence interval [CI], 291-293). In isolation, adding staffing, changing staff roles, and varying shift times did not affect overall patient LOS. Specifically, adding 2 registration workers, history takers, and physicians resulted in a 23.8-minute (95% CI, 22.3-25.3) LOS decrease. However, when shift start times were coordinated with patient arrival patterns, potential mean LOS was decreased by 96 minutes (95% CI, 94-98), and with the simultaneous combination of staff roles (registration and history taking), there was an overall mean LOS reduction of 152 minutes (95% CI, 150-154). Resource-neutral interventions identified through discrete event simulation modeling have the potential to improve acute care throughput in this Ghanaian municipal hospital. Discrete event simulation offers another approach to identifying potentially effective interventions to improve patient flow in emergency and acute care in resource-limited settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Innovative Use of Service-Learning to Enhance Baccalaureate Nursing Education.

PubMed

Taylor, Wanda; Pruitt, Rosanne; Fasolino, Tracy

2017-09-01

Service-learning is an established pedagogical approach to nursing education found primarily in community nursing. With changing health care landscapes, the expansion of service-learning projects throughout the nursing program provides opportunities to enrich assessment and critical thinking and amplify exposure to determinants of health. Implementing service-learning in foundational nursing courses allows students to be challenged with the application of complex care management within a context of caring, cultural competence, social responsibility, and self-care initiatives. Integrating service-learning throughout the nursing curriculum has the potential to make positive, sustainable changes within a community, while simultaneously preparing students to view clients holistically, think critically, and develop cultural competence. Enhancing nursing curriculum by integrating service-learning opportunities can strengthen the learning experience and foster concepts of caring, social responsibility, cultural competence, and self-care. Working with community leaders from diverse groups can lead to sustainable projects that simultaneously benefit the community and nursing education. [J Nurs Educ. 2017;56(9):560-563.]. Copyright 2017, SLACK Incorporated.

Mechanical Spectroscopy for Epoxy Resins

DTIC Science & Technology

1981-08-01

extensometer into a Hewlett Packard Model 320 two channel recorder with sufficiently high response (DC to 50 cycles at 50 mm peak to peak). A Tinius Olsen...conditioned the signals for simultaneous-recording on a two channel oscillograph. Care was observed in calibration and balancing the output of one gage...off at a greater rate. KVl is also comparable but starts to tail off after only about 10 minutes time at 177 C (350 F). G(t)/G o for variation KV7 at

Evaluating the link between human resource management decisions and patient satisfaction with quality of care.

PubMed

Oppel, Eva-Maria; Winter, Vera; Schreyögg, Jonas

Patient satisfaction with quality of care is becoming increasingly important in the competitive hospital market. Simultaneously, the growing shortage of clinical staff poses a considerable challenge to ensuring a high quality of care. In this context, a question emerges regarding whether and how human resource management (HRM) might serve as a means to reduce staff shortage problems and to increase patient satisfaction. Although considerable efforts have been devoted to understanding the concepts of patient satisfaction and HRM, little is known about the interrelationships between these concepts or about the link between staff shortage problems and patients' satisfaction with quality of care. The aim of this study was to investigate the relationship between strategic human resource management (SHRM), staff shortage problems, and patients' satisfaction with care. Furthermore, we analyze how the HRM decision to fill short-term vacancies through temporary staffing affects patient satisfaction. We differentiate between physicians and nurses. We develop and empirically test a theoretical model. The data (n = 165) are derived from a survey on SHRM that was sent to 732 German hospitals and from a survey on patient satisfaction that comprises 436,848 patient satisfaction ratings. We use a structural equation modeling approach to test the model. The results indicate that SHRM significantly reduces staff shortage problems for both occupational groups. Having fewer physician shortage problems is significantly associated with higher levels of patient satisfaction, whereas this effect is not significant for nurses. Furthermore, the use of temporary staffing considerably reduces patients' satisfaction with care. Hospital managers are advised to consider the effects of HRM decisions on patients' satisfaction with care. In particular, investments in SHRM targeted at physicians have significantly positive effects on patient satisfaction, whereas the temporary staffing of physicians and nurses should be avoided.

Informal Care and Labor Market Outcomes: Evidence From Chinese Married Women.

PubMed

Chen, Lu; Zhao, Na; Fan, Hongli; Coyte, Peter C

2015-10-16

Data were used from the 1991-2009 China Health and Nutrition Survey to examine the influence of informal care on labor market outcomes for married women of working aged, with emphasis on caregiving intensity. After accounting for potential endogeneity between caregiving and labor force participation (LFP) through simultaneous equations modeling, caregivers who provided more than 15 or 20 hr of caregiving per week were 4.5-7.7% less likely to be LFPs. Intensive caregivers who remained working had significantly lower (4.97-7.20) weekly hours of work. The significant positive effect of informal care on LFP only existed in the rural sample, and these women also had much lower hours of work than their urban counterparts. Opportunities exist for policy interventions that target intensive caregivers in order to allow them to balance both work and caregiving. © The Author(s) 2015.

Balancing performance-based expectations with a holistic perspective on coaching: a qualitative study of Swedish women's national football team coaches' practice experiences.

PubMed

Lindgren, Eva-Carin; Barker-Ruchti, Natalie

2017-12-01

The purpose of this study was to explore how an exclusive sample of women's national football team coaches described how they implement careful coaching while facing social and organizational pressure to win medals. To consider coaches' negotiations, we drew on Noddings' concept of caring. Using an interpretive research paradigm, we conducted in-depth interviews with five Swedish women's national football team coaches. An abductive approach was used to simultaneously process the theoretical framework of "ethics of care" and the empirical data. The coaches unanimously adopted a holistic perspective to coaching. The coaching strategies they described included promoting players' development, well-being, and sustainable elite performance; listening to the players' voices and engaging in dialogue; and creating a positive environment and promoting fair play. These findings demonstrate that the women coaches, despite performance pressure, adopt caring coaching in the form of Noddings' pedagogical modelling, dialogue, and confirmation strategies, and provide an example of how coaches can adopt caring, holistic, and athlete-centred coaching while working at the highest level of competitive sport and achieving competitive success.

Mutualism in museums: A model for engaging undergraduates in biodiversity science

PubMed Central

Cicero, Carla; Albe, Monica J.; Barclay, Theresa L. W.; Spencer, Carol L.; Koo, Michelle S.; Bowie, Rauri C. K.; Lacey, Eileen A.

2017-01-01

Museums have an untapped potential to engage students in hands-on learning. Here, we describe the development of a tiered museum-based program at the University of California, Berkeley as a model for engaging undergraduates in biodiversity science. This decade-long effort to increase student participation in collections demonstrates the mutual benefits of undergraduate involvement. Museums benefit from critical help in collections care and an increased intellectual vitality, while students simultaneously gain essential research skills and an unparalleled exposure to biodiversity. Five first steps to creating a program are: dedicate a coordinator, offer credit, diversify participation, create a tiered structure, and build community. PMID:29161253

Multiple social disadvantage does it have an effect on amenable mortality: a brief report.

PubMed

Manderbacka, Kristiina; Arffman, Martti; Sund, Reijo; Karvonen, Sakari

2014-08-01

Most studies on inequalities in health and health-care focus on single indicators of social position, e.g. income or education. Recent research has suggested that multiple social circumstances need to be analysed simultaneously to disentangle their influence on health. In past decades mortality amenable to health-care, i.e. premature mortality that should not occur given timely and effective health-care, has increasingly been used to study the effect of health-care on health outcomes. This study elaborates the effect of social and regional deprivation and unemployment on the association between income and mortality amenable to health-care in Finland. Individual-level data for deaths were gathered by disease category between 1992 and 2008 for the resident Finnish population aged 25 to 59 years. Differences in amenable mortality and changes over time were assessed using individual-level linked register data. We used gender- and age-standardised rates and Poisson regression models to examine the simultaneous effect of these indicators on amenable mortality. Altogether 22,663 persons aged 25-59 years died from causes amenable to health-care during the study period. An inverse pattern was found in amenable mortality for income. The mortality rate in the lowest income quintile was 98 (93-104) per 100,000 in the period 1991-1996 while in the highest group the figure was 40 (38-42) for the same period. Whereas the level of amenable mortality decreased, mortality differences between income groups steepened and amenable mortality increased in the lowest income group towards the end of the study period. Those in poor labour market position or living alone had significantly larger income differences in amenable mortality. Risk of regional deprivation was not associated with amenable mortality. In order to prevent and treat at an early phase conditions that otherwise may lead to premature and unnecessary deaths more attention should be focused on groups with increased social and economic deprivation risk in municipal health centres with the aim at improving access to primary care. Our results also call for joint action by both health-care and social services, since health services alone cannot deal with the risks posed by accumulating social disadvantage.

Orphan care in Botswana's working households: growing responsibilities in the absence of adequate support.

PubMed

Miller, Candace M; Gruskin, Sofia; Subramanian, S V; Rajaraman, Divya; Heymann, S Jody

2006-08-01

Botswana has one of the world's highest HIV-prevalence rates and the world's highest percentages of orphaned children among its population. We assessed the ability of income-earning households in Botswana to adequately care for orphans. We used data from the Botswana Family Health Needs Study (2002), a sample of 1033 working adults with caregiving responsibilities who used public services, to assess whether households with orphan-care responsibilities encountered financial and other difficulties. Thirty-seven percent of respondents provided orphan care, usually to extended family members. We applied logistic regression models to determine the factors associated with experiencing problems related to orphan caregiving. Nearly half of working households with orphan-care responsibilities reported experiencing financial and other difficulties because of orphan care. Issues of concern included caring for multiple orphans, caring for sick adults and orphans simultaneously, receiving no assistance, and low income. The orphan crisis is impoverishing even working households, where caregivers lack sufficient resources to provide basic needs. Neither the public sector nor communities provide adequate safety nets. International assistance is critical to build capacity within the social welfare infrastructure and to fund community-level activities that support households. Lessons from Botswana's orphan crisis can provide valuable insights to policymakers throughout sub-Saharan Africa.

Modeling Phosphorus Losses through Surface Runoff and Subsurface Drainage Using ICECREAM.

PubMed

Qi, Hongkai; Qi, Zhiming; Zhang, T Q; Tan, C S; Sadhukhan, Debasis

2018-03-01

Modeling soil phosphorus (P) losses by surface and subsurface flow pathways is essential in developing successful strategies for P pollution control. We used the ICECREAM model to simultaneously simulate P losses in surface and subsurface flow, as well as to assess effectiveness of field practices in reducing P losses. Monitoring data from a mineral-P-fertilized clay loam field in southwestern Ontario, Canada, were used for calibration and validation. After careful adjustment of model parameters, ICECREAM was shown to satisfactorily simulate all major processes of surface and subsurface P losses. When the calibrated model was used to assess tillage and fertilizer management scenarios, results point to a 10% reduction in total P losses by shifting autumn tillage to spring, and a 25.4% reduction in total P losses by injecting fertilizer rather than broadcasting. Although the ICECREAM model was effective in simulating surface and subsurface P losses when thoroughly calibrated, further testing is needed to confirm these results with manure P application. As illustrated here, successful use of simulation models requires careful verification of model routines and comprehensive calibration to ensure that site-specific processes are accurately represented. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Political, policy and social barriers to health system interoperability: emerging opportunities of Web 2.0 and 3.0.

PubMed

Juzwishin, Donald W M

2009-01-01

Achieving effective health informatics interoperability in a fragmented and uncoordinated health system is by definition not possible. Interoperability requires the simultaneous integration of health care processes and information across different types and levels of care (systems thinking). The fundamental argument of this paper is that information system interoperability will remain an unfulfilled hope until health reforms effectively address the governance (accountability), structural and process barriers to interoperability of health care delivery. The ascendency of Web 2.0 and 3.0, although still unproven, signals the opportunity to accelerate patients' access to health information and their health record. Policy suggestions for simultaneously advancing health system delivery and information system interoperability are posited.

Simultaneous feature selection and parameter optimisation using an artificial ant colony: case study of melting point prediction.

PubMed

O'Boyle, Noel M; Palmer, David S; Nigsch, Florian; Mitchell, John Bo

2008-10-29

We present a novel feature selection algorithm, Winnowing Artificial Ant Colony (WAAC), that performs simultaneous feature selection and model parameter optimisation for the development of predictive quantitative structure-property relationship (QSPR) models. The WAAC algorithm is an extension of the modified ant colony algorithm of Shen et al. (J Chem Inf Model 2005, 45: 1024-1029). We test the ability of the algorithm to develop a predictive partial least squares model for the Karthikeyan dataset (J Chem Inf Model 2005, 45: 581-590) of melting point values. We also test its ability to perform feature selection on a support vector machine model for the same dataset. Starting from an initial set of 203 descriptors, the WAAC algorithm selected a PLS model with 68 descriptors which has an RMSE on an external test set of 46.6 degrees C and R2 of 0.51. The number of components chosen for the model was 49, which was close to optimal for this feature selection. The selected SVM model has 28 descriptors (cost of 5, epsilon of 0.21) and an RMSE of 45.1 degrees C and R2 of 0.54. This model outperforms a kNN model (RMSE of 48.3 degrees C, R2 of 0.47) for the same data and has similar performance to a Random Forest model (RMSE of 44.5 degrees C, R2 of 0.55). However it is much less prone to bias at the extremes of the range of melting points as shown by the slope of the line through the residuals: -0.43 for WAAC/SVM, -0.53 for Random Forest. With a careful choice of objective function, the WAAC algorithm can be used to optimise machine learning and regression models that suffer from overfitting. Where model parameters also need to be tuned, as is the case with support vector machine and partial least squares models, it can optimise these simultaneously. The moving probabilities used by the algorithm are easily interpreted in terms of the best and current models of the ants, and the winnowing procedure promotes the removal of irrelevant descriptors.

Bayesian assessment of moving group membership: importance of models and prior knowledge

NASA Astrophysics Data System (ADS)

Lee, Jinhee; Song, Inseok

2018-04-01

Young nearby moving groups are important and useful in many fields of astronomy such as studying exoplanets, low-mass stars, and the stellar evolution of the early planetary systems over tens of millions of years, which has led to intensive searches for their members. Identification of members depends on the used models sensitively; therefore, careful examination of the models is required. In this study, we investigate the effects of the models used in moving group membership calculations based on a Bayesian framework (e.g. BANYAN II) focusing on the beta-Pictoris moving group (BPMG). Three improvements for building models are suggested: (1) updating a list of accepted members by re-assessing memberships in terms of position, motion, and age, (2) investigating member distribution functions in XYZ, and (3) exploring field star distribution functions in XYZ and UVW. The effect of each change is investigated, and we suggest using all of these improvements simultaneously in future membership probability calculations. Using this improved MG membership calculation and the careful examination of the age, 57 bona fide members of BPMG are confirmed including 12 new members. We additionally suggest 17 highly probable members.

Variable selection for zero-inflated and overdispersed data with application to health care demand in Germany.

PubMed

Wang, Zhu; Ma, Shuangge; Wang, Ching-Yun

2015-09-01

In health services and outcome research, count outcomes are frequently encountered and often have a large proportion of zeros. The zero-inflated negative binomial (ZINB) regression model has important applications for this type of data. With many possible candidate risk factors, this paper proposes new variable selection methods for the ZINB model. We consider maximum likelihood function plus a penalty including the least absolute shrinkage and selection operator (LASSO), smoothly clipped absolute deviation (SCAD), and minimax concave penalty (MCP). An EM (expectation-maximization) algorithm is proposed for estimating the model parameters and conducting variable selection simultaneously. This algorithm consists of estimating penalized weighted negative binomial models and penalized logistic models via the coordinated descent algorithm. Furthermore, statistical properties including the standard error formulae are provided. A simulation study shows that the new algorithm not only has more accurate or at least comparable estimation, but also is more robust than the traditional stepwise variable selection. The proposed methods are applied to analyze the health care demand in Germany using the open-source R package mpath. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Managing people with diabetes during the cancer palliation in the era of simultaneous care.

PubMed

Ferrari, Pietro; Giardini, Anna; Negri, Enrica Maria; Villani, Giorgio; Preti, Pietro

2017-12-18

Managing people with diabetes and cancer during palliation constitutes a daunting challenge. Cancer, diabetes and treatment toxicity could be seen as a "Bermuda Triangle" for physician and health care professionals in general. Based on literature review, the present paper stresses the distinctive aspects that diabetes and cancer together involve and bring out. Considering the simultaneous care approach as the basement of our perspective, we explore the areas of palliative intervention for which the specific features of persons with diabetes and cancer emerge: pain manifestation and treatment, response to opioids, psychosocial and communication aspects, infection-related susceptibility and complications. The overall impact of suffering that these two diseases in association involve requires new awareness and a cultural attitude towards new network based approaches in order to strengthen the person-centered health care in this field. Copyright © 2017 Elsevier B.V. All rights reserved.

Relationship between pain and post-traumatic stress symptoms in palliative care.

PubMed

Roth, Maya L; St Cyr, Kate; Harle, Ingrid; Katz, Joel D

2013-08-01

Previous research suggests that patients receiving palliative care may simultaneously experience poorly managed pain and post-traumatic stress disorder (PTSD)-related symptoms as a result of their deteriorating health. To: 1) examine predictors of PTSD-related symptoms in patients requiring palliative care; 2) assess whether anxiety, depression, pain catastrophizing, and pain anxiety mediate the relationship between pain interference and PTSD-related symptoms; and 3) evaluate the impact of these variables on pain interference and PTSD-related symptoms. One hundred patients receiving palliative care at one of two palliative care sites in London, ON, Canada, completed the PTSD Checklist-Civilian version (PCL-C), the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), the Brief Pain Inventory-Short Form (BPI-SF), and the Pain Anxiety Symptoms Scale-20 (PASS-20). Hierarchical multiple regressions were used to examine HADS-Anxiety, HADS-Depression, PCS and PASS-20 scores as predictors of PCL-C scores; and mediation analyses were used to test the effect of HADS-Anxiety, HADS-Depression, PCS, and PASS-20 on the relationship between BPI-SF interference and PCL-C. Mediators that significantly affected this relationship in the individual mediator models were entered into a multiple mediator model. Only pain anxiety and pain catastrophizing emerged as significant mediators of the relationship between pain interference and PTSD-related symptoms. After being entered in a multiple mediator model, pain anxiety emerged as the strongest mediator. The findings of the present study reveal that pain and PTSD-related symptoms are important concerns in palliative care, and that pain must be addressed to best meet the needs of this population. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Quasi-Bell inequalities from symmetrized products of noncommuting qubit observables

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gamel, Omar E.; Fleming, Graham R.

Noncommuting observables cannot be simultaneously measured; however, under local hidden variable models, they must simultaneously hold premeasurement values, implying the existence of a joint probability distribution. We study the joint distributions of noncommuting observables on qubits, with possible criteria of positivity and the Fréchet bounds limiting the joint probabilities, concluding that the latter may be negative. We use symmetrization, justified heuristically and then more carefully via the Moyal characteristic function, to find the quantum operator corresponding to the product of noncommuting observables. This is then used to construct Quasi-Bell inequalities, Bell inequalities containing products of noncommuting observables, on two qubits.more » These inequalities place limits on the local hidden variable models that define joint probabilities for noncommuting observables. We also found that the Quasi-Bell inequalities have a quantum to classical violation as high as 3/2 on two qubit, higher than conventional Bell inequalities. Our result demonstrates the theoretical importance of noncommutativity in the nonlocality of quantum mechanics and provides an insightful generalization of Bell inequalities.« less

Quasi-Bell inequalities from symmetrized products of noncommuting qubit observables

DOE PAGES

Gamel, Omar E.; Fleming, Graham R.

2017-05-01

Noncommuting observables cannot be simultaneously measured; however, under local hidden variable models, they must simultaneously hold premeasurement values, implying the existence of a joint probability distribution. We study the joint distributions of noncommuting observables on qubits, with possible criteria of positivity and the Fréchet bounds limiting the joint probabilities, concluding that the latter may be negative. We use symmetrization, justified heuristically and then more carefully via the Moyal characteristic function, to find the quantum operator corresponding to the product of noncommuting observables. This is then used to construct Quasi-Bell inequalities, Bell inequalities containing products of noncommuting observables, on two qubits.more » These inequalities place limits on the local hidden variable models that define joint probabilities for noncommuting observables. We also found that the Quasi-Bell inequalities have a quantum to classical violation as high as 3/2 on two qubit, higher than conventional Bell inequalities. Our result demonstrates the theoretical importance of noncommutativity in the nonlocality of quantum mechanics and provides an insightful generalization of Bell inequalities.« less

Effects of a Problem-Solving Intervention (COPE) on Quality of Life for Patients with Advanced Cancer on Clinical Trials and their Caregivers: Simultaneous Care Educational Intervention (SCEI): Linking Palliation and Clinical Trials

PubMed Central

Carducci, Michael; Loscalzo, Matthew J.; Linder, John; Greasby, Tamara; Beckett, Laurel A.

2011-01-01

Abstract Context Patients on investigational clinical trials and their caregivers experience poor quality of life (QOL), which declines as the disease progresses. Objective To examine the effect of a standardized cognitive–behavioral problem-solving educational intervention on the QOL of patients enrolled on investigational clinical trials and their caregivers. Design Prospective, multi-institution, randomized trial. QOL was measured repeatedly over 6 months. Participants Patients were simultaneously enrolled onto phase 1, 2, or 3 Institutional Review Board (IRB)-approved cancer clinical trials. Intervention Intervention arm dyads participated in three conjoint educational sessions during the first month, learning the COPE problem solving model. Nonintervention arm dyads received usual care. Outcome Measures Global QOL was measured by the City of Hope Quality of Life Instruments for Patients or Caregivers; problem solving skills were measured by the Social Problem Solving Inventory-Revised. Results The results are reported using the CONSORT statement. The analytic data set included 476 dyads including 1596 patient data points and 1576 care giver data points. Patient QOL showed no significant difference in the rate of change between the intervention and usual care arms (p = 0.70). Caregiver QOL scores in the intervention arm declined, but at less than half the rate in the control arm (p = 0.02). Conclusions The COPE intervention enabled the average caregiver to come much closer to stable QOL over the 6-month follow-up. Future studies should enroll subjects much earlier in the cancer illness trajectory, a common patient/caregiver theme. The maximum effect was seen in caregivers who completed the 6-month follow-up, suggesting that the impact may increase over time. PMID:21413846

Using Participatory Action Research to Develop a Working Model That Enhances Psychiatric Nurses' Professionalism: The Architecture of Stability.

PubMed

Salzmann-Erikson, Martin

2017-11-01

Ward rules in psychiatric care aim to promote safety for both patients and staff. Simultaneously, ward rules are associated with increased patient violence, leading to neither a safe work environment nor a safe caring environment. Although ward rules are routinely used, few studies have explicitly accounted for their impact. To describe the process of a team development project considering ward rule issues, and to develop a working model to empower staff in their daily in-patient psychiatric nursing practices. The design of this study is explorative and descriptive. Participatory action research methodology was applied to understand ward rules. Data consists of audio-recorded group discussions, observations and field notes, together creating a data set of 556 text pages. More than 100 specific ward rules were identified. In this process, the word rules was relinquished in favor of adopting the term principles, since rules are inconsistent with a caring ideology. A linguistic transition led to the development of a framework embracing the (1) Principle of Safety, (2) Principle of Structure and (3) Principle of Interplay. The principles were linked to normative guidelines and applied ethical theories: deontology, consequentialism and ethics of care. The work model reminded staff about the principles, empowered their professional decision-making, decreased collegial conflicts because of increased acceptance for individual decisions, and, in general, improved well-being at work. Furthermore, the work model also empowered staff to find support for their decisions based on principles that are grounded in the ethics of totality.

Modeling organizational determinants of hospital mortality.

PubMed Central

al-Haider, A S; Wan, T T

1991-01-01

This study examines hospital characteristics that affect the differential in hospital mortality. Death rates for 1984 Medicare inpatients in acute care hospitals, released by the Health Care Financing Administration in 1986, were analyzed. A confirmatory statistical approach to organizational determinants of hospital mortality was formulated and validated through an empirical examination of 239 hospitals. The findings suggest that the effect of hospital size and specialization on mortality was a spurious one when the effects of other variables were simultaneously controlled. A positive association existed between service intensity and hospital mortality: the more hospital services consumed, the higher the mortality rate. Community attributes accounted for more variance in hospital mortality rates than did organizational attributes. The organizational and community factors studied explained 27 percent of the total variance in hospital mortality. PMID:1869442

Do slums matter? Location and early childhood preventive care choices among urban residents of Bangladesh.

PubMed

Heller, Lauren R

2013-10-01

Upward trends in the relative proportions of slum residents in developing countries have led to widespread concern regarding the impact of slum residency on health behaviors. Measurement of these impacts requires recognizing that unobservable household characteristics that affect the location decision may also affect health care choices and outcomes. To address the potential for bias, this paper models the location decision and the household's demand for maternal and child health services simultaneously using a flexible, semi-parametric approach. It uses a unique urban data set from Bangladesh that incorporates sophisticated geographical mapping techniques to carefully delineate between slum and non-slum areas at a particular point in time. The results suggest that accounting for the endogenous location decision of a family substantially reduces bias in estimated marginal effects of slum residence on preventive care demand. While community infrastructure variables appear correlated with preventive care demand, the causal effect of the availability of primary health care facilities is indistinguishable from zero when unobserved heterogeneity is taken into account. The findings suggest that improvements in community infrastructure in urban areas of developing countries are a more favorable health policy solution at the margin than the construction of additional health care facilities. Copyright © 2013 Elsevier Ltd. All rights reserved.

SMT-Aware Instantaneous Footprint Optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roy, Probir; Liu, Xu; Song, Shuaiwen

Modern architectures employ simultaneous multithreading (SMT) to increase thread-level parallelism. SMT threads share many functional units and the whole memory hierarchy of a physical core. Without a careful code design, SMT threads can easily contend with each other for these shared resources, causing severe performance degradation. Minimizing SMT thread contention for HPC applications running on dedicated platforms is very challenging, because they usually spawn threads within Single Program Multiple Data (SPMD) models. To address this important issue, we introduce a simple scheme for SMT-aware code optimization, which aims to reduce the memory contention across SMT threads.

The relationship between individualized care and the practice environment: an international study.

PubMed

Papastavrou, Evridiki; Acaroglu, Rengin; Sendir, Merdiye; Berg, Agneta; Efstathiou, Georgios; Idvall, Ewa; Kalafati, Maria; Katajisto, Jouko; Leino-Kilpi, Helena; Lemonidou, Chryssoula; da Luz, Maria Deolinda Antunes; Suhonen, Riitta

2015-01-01

Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies. The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries. This study had an international, multisite, prospective, cross-sectional, exploratory survey design. The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey. Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study. Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model. Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care. The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components.

PubMed

Mariko, Mamadou

2003-03-01

The public finance and foreign exchange crisis of the 1980s aggravated the unfavourable economic trends in many developing countries and resulted in budget cuts in the health sector. Policymakers, following the suggestions of World Bank experts, introduced user fees. Economic analysis of the demand for health care in these countries focused on the impact of price and income on health service utilisation. But the lesson to date from experiences in cost recovery is that without visible and fairly immediate improvements in the quality of care, the implementation of user fees will cause service utilisation to drop. For this reason, the role of quality of health care has been recently a subject of investigation in a number of health care demand studies. In spite of using the data from both households and facilities, recent studies are quite limited because they measure quality only by structural attributes (availability of drugs, equipment, number and qualifications of staff, and so on). Structural attributes of quality are necessary but not sufficient conditions for demand. A unique feature of this study is that it also considers the processes followed by practitioners and the outcome of care, to determine simultaneously the respective influence of price and quality on decision making. A nested multinomial logit was used to examine the choice between six alternatives (self-treatment, modern treatment at home, public hospital, public dispensary, for-profit facility and non-profit facility). The estimations are based on data from a statistically representative sample of 1104 patients from 1191 households and the data from a stratified random sample of 42 out of 84 facilities identified. The results indicate that omitting the process quality variables from the demand model produces a bias not only in the estimated coefficient of the "price" variable but also in coefficients of some structural attributes of the quality. The simulations suggest that price has a minor effect on utilisation of health services, and that health authorities can simultaneously double user fees and increase utilisation by emphasising improvement of both the structural and process quality of care in public health facilities.

Experiences of a student-run clinic in primary care: a mixed-method study with students, patients and supervisors.

PubMed

Fröberg, Maria; Leanderson, Charlotte; Fläckman, Birgitta; Hedman-Lagerlöf, Erik; Björklund, Karin; Nilsson, Gunnar H; Stenfors, Terese

2018-03-01

To explore how a student-run clinic (SRC) in primary health care (PHC) was perceived by students, patients and supervisors. A mixed methods study. Clinical learning environment, supervision and nurse teacher evaluation scale (CLES + T) assessed student satisfaction. Client satisfaction questionnaire-8 (CSQ-8) assessed patient satisfaction. Semi-structured interviews were conducted with supervisors. Gustavsberg PHC Center, Stockholm County, Sweden. Students in medicine, nursing, physiotherapy, occupational therapy and psychology and their patients filled in questionnaires. Supervisors in medicine, nursing and physiotherapy were interviewed. Mean values and medians of CLES + T and CSQ-8 were calculated. Interviews were analyzed using content analysis. A majority of 199 out of 227 student respondents reported satisfaction with the pedagogical atmosphere and the supervisory relationship. Most of the 938 patient respondents reported satisfaction with the care given. Interviews with 35 supervisors showed that the organization of the SRC provided time and support to focus on the tutorial assignment. Also, the pedagogical role became more visible and targeted toward the student's individual needs. However, balancing the student's level of autonomy and the own control over care was described as a challenge. Many expressed the need for further pedagogical education. High student and patient satisfaction reported from five disciplines indicate that a SRC in PHC can be adapted for heterogeneous student groups. Supervisors experienced that the SRC facilitated and clarified their pedagogical role. Simultaneously their need for continuous pedagogical education was highlighted. The SRC model has the potential to enhance student-centered tuition in PHC. Key Points Knowledge of student-run clinics (SRCs) as learning environments within standard primary health care (PHC) is limited. We report experiences from the perspectives of students, their patients and supervisors, representing five healthcare disciplines. Students particularly valued the pedagogical atmosphere and the supervisory relationship. Patients expressed high satisfaction with the care provided. Supervisors expressed that the structure of the SRC supported the pedagogical assignment and facilitated student-centered tuition - simultaneously the altered learning environment highlighted the need for further pedagogical education. Student-run clinics in primary health care have great potential for student-regulated learning.

The Development of a Mother’s Internal Working Model of Feeding

PubMed Central

Brown, Lisa F; Griffin, Junyanee; Reyna, Barbara; Lewis, Mary

2012-01-01

Purpose The purpose of the study was to describe changes in a mother’s early internal working model (IWM) of infant feeding. Design & Methods In this qualitative study, 12 maternal responses to the semi-structured IWM interview were audio-recorded; once in the neonatal intensive care unit (NICU) after infants began oral feeding and once 2 weeks post-discharge. Interviews were analyzed using directed content analysis. Results A change between mothers’ early and later nipple feeding experiences was identified. Practice Implications Nurses and other clinicians can help mothers understand the infant’s behaviors and focus on the infant’s nutritional intake while simultaneously developing a relationship with the infant. PMID:23289455

Using a Simultaneous Prompting Procedure to Embed Core Content When Teaching a Potential Employment Skill

ERIC Educational Resources Information Center

Collins, Belva C.; Terrell, Misty; Test, David W.

2017-01-01

This investigation used a multiple-probe-across-participants design to examine the effects of using a simultaneous prompting procedure to teach four secondary students with mild intellectual disabilities the employment task of caring for plants in a greenhouse. The instructor also embedded photosynthesis science content as nontargeted information…

Expansion of the consultation-liaison psychiatry paradigm at a university medical center: integration of diversified clinical and funding models.

PubMed

Bourgeois, James A; Hilty, Donald M; Klein, Sally C; Koike, Alan K; Servis, Mark E; Hales, Robert E

2003-01-01

The perspective of the contemporary Consultation-Liason Service (CLS) psychiatrist is increasingly one of consultant to medical and surgical colleagues in models other than inpatient medical and surgical units. Simultaneously, the need for a clinically and educationally robust inpatient CLS persists despite funding pressures. The University of California, Davis Medical Center Department of Psychiatry has made use of creative organizational and financial models to accomplish the inpatient CLS clinical and educational missions in a fiscally responsible manner. In addition, the department has in recent years expanded the delivery of psychiatry consultation-liaison clinical and educational services to other models of care delivery, broadening the role and influence of the CLS. Several of the initiatives described in this paper parallel an overall evolution of the practice of consultation-liaison psychiatry in response to managed care influences and other systems pressures. This consultation-liaison paradigm expansion with diversified sources of funding support facilitates the development of consultation-liaison psychiatry along additional clinical, administrative, research, and educational dimensions. Other university medical centers may consider adaptation of some of the initiatives described here to their institutions.

Genomic Sequencing: Assessing The Health Care System, Policy, And Big-Data Implications

PubMed Central

Phillips, Kathryn A.; Trosman, Julia; Kelley, Robin K.; Pletcher, Mark J.; Douglas, Michael P.; Weldon, Christine B.

2014-01-01

New genomic sequencing technologies enable the high-speed analysis of multiple genes simultaneously, including all of those in a person's genome. Sequencing is a prominent example of a “big data” technology because of the massive amount of information it produces and its complexity, diversity, and timeliness. Our objective in this article is to provide a policy primer on sequencing and illustrate how it can affect health care system and policy issues. Toward this end, we developed an easily applied classification of sequencing based on inputs, methods, and outputs. We used it to examine the implications of sequencing for three health care system and policy issues: making care more patient-centered, developing coverage and reimbursement policies, and assessing economic value. We conclude that sequencing has great promise but that policy challenges include how to optimize patient engagement as well as privacy, develop coverage policies that distinguish research from clinical uses and account for bioinformatics costs, and determine the economic value of sequencing through complex economic models that take into account multiple findings and downstream costs. PMID:25006153

Genomic sequencing: assessing the health care system, policy, and big-data implications.

PubMed

Phillips, Kathryn A; Trosman, Julia R; Kelley, Robin K; Pletcher, Mark J; Douglas, Michael P; Weldon, Christine B

2014-07-01

New genomic sequencing technologies enable the high-speed analysis of multiple genes simultaneously, including all of those in a person's genome. Sequencing is a prominent example of a "big data" technology because of the massive amount of information it produces and its complexity, diversity, and timeliness. Our objective in this article is to provide a policy primer on sequencing and illustrate how it can affect health care system and policy issues. Toward this end, we developed an easily applied classification of sequencing based on inputs, methods, and outputs. We used it to examine the implications of sequencing for three health care system and policy issues: making care more patient-centered, developing coverage and reimbursement policies, and assessing economic value. We conclude that sequencing has great promise but that policy challenges include how to optimize patient engagement as well as privacy, develop coverage policies that distinguish research from clinical uses and account for bioinformatics costs, and determine the economic value of sequencing through complex economic models that take into account multiple findings and downstream costs. Project HOPE—The People-to-People Health Foundation, Inc.

Early Care and Education Choices, Quality, and Continuity for Low-Income Families: New Findings from the Maryland-Minnesota Child Care Research Partnership. Publication #2015-08

ERIC Educational Resources Information Center

Tout, Kathryn

2015-01-01

Maryland and Minnesota are two states that have been leading innovations across early care and education (ECE) policy and simultaneously investing in research and data infrastructure to ensure that their strategies are informed by evaluation and new evidence in the field. The Maryland-Minnesota Child Care Research Partnership received a grant in…

A revolutionary approach to health care cost control: leveraging the power of Web-enabled employee "consumerism".

PubMed

Rozzi, M V

2001-09-01

The confluence of two trends--health care "consumerism" and employee self-service benefits programs--offers employers a promising opportunity for health care cost control. To take advantage of this opportunity, employers must take a fresh look at the health care cost dilemma and find ways to simultaneously offer employees a new kind of benefit and implement more effective cost-control measures.

Simultaneous Quantification of Dexpanthenol and Resorcinol from Hair Care Formulation Using Liquid Chromatography: Method Development and Validation.

PubMed

De, Amit Kumar; Chowdhury, Partha Pratim; Chattapadhyay, Shyamaprasad

2016-01-01

The current study presents the simultaneous quantification of dexpanthenol and resorcinol from marketed hair care formulation. Dexpanthenol is often present as an active ingredient in personal care products for its beautifying and invigorating properties and restorative and smoothing properties. On the other hand resorcinol is mainly prescribed for the treatment of seborrheic dermatitis of scalp. The toxic side effects of resorcinol limit its use in dermatological preparations. Therefore an accurate quantification technique for the simultaneous estimation of these two components can be helpful for the formulation industries for the accurate analysis of their product quality. In the current study a high performance liquid chromatographic technique has been developed using a C18 column and a mobile phase consisting of phosphate buffer of pH = 2.8 following a gradient elution. The mobile phase flow rate was 0.6 mL per minute and the detection wavelength was 210 nm for dexpanthenol and 280 nm for resorcinol. The linearity study was carried out using five solutions having concentrations ranging between 10.34 μg·mL(-1) and 82.69 μg·mL(-1) (r (2) = 0.999) for resorcinol and 10.44 μg·mL(-1) and 83.50 μg·mL(-1) (r (2) = 0.998) for dexpanthenol. The method has been validated as per ICH Q2(R1) guidelines. The ease of single step sample preparation, accuracy, and precision (intraday and interday) study presents the method suitable for the simultaneous quantification of dexpanthenol and resorcinol from any personal care product and dermatological preparations containing these two ingredients.

Simultaneous Quantification of Dexpanthenol and Resorcinol from Hair Care Formulation Using Liquid Chromatography: Method Development and Validation

PubMed Central

De, Amit Kumar; Chowdhury, Partha Pratim; Chattapadhyay, Shyamaprasad

2016-01-01

The current study presents the simultaneous quantification of dexpanthenol and resorcinol from marketed hair care formulation. Dexpanthenol is often present as an active ingredient in personal care products for its beautifying and invigorating properties and restorative and smoothing properties. On the other hand resorcinol is mainly prescribed for the treatment of seborrheic dermatitis of scalp. The toxic side effects of resorcinol limit its use in dermatological preparations. Therefore an accurate quantification technique for the simultaneous estimation of these two components can be helpful for the formulation industries for the accurate analysis of their product quality. In the current study a high performance liquid chromatographic technique has been developed using a C18 column and a mobile phase consisting of phosphate buffer of pH = 2.8 following a gradient elution. The mobile phase flow rate was 0.6 mL per minute and the detection wavelength was 210 nm for dexpanthenol and 280 nm for resorcinol. The linearity study was carried out using five solutions having concentrations ranging between 10.34 μg·mL−1 and 82.69 μg·mL−1 (r 2 = 0.999) for resorcinol and 10.44 μg·mL−1 and 83.50 μg·mL−1 (r 2 = 0.998) for dexpanthenol. The method has been validated as per ICH Q2(R1) guidelines. The ease of single step sample preparation, accuracy, and precision (intraday and interday) study presents the method suitable for the simultaneous quantification of dexpanthenol and resorcinol from any personal care product and dermatological preparations containing these two ingredients. PMID:27042377

Modeling the value for money of changing clinical practice change: a stochastic application in diabetes care.

PubMed

Hoomans, Ties; Abrams, Keith R; Ament, Andre J H A; Evers, Silvia M A A; Severens, Johan L

2009-10-01

Decision making about resource allocation for guideline implementation to change clinical practice is inevitably undertaken in a context of uncertainty surrounding the cost-effectiveness of both clinical guidelines and implementation strategies. Adopting a total net benefit approach, a model was recently developed to overcome problems with the use of combined ratio statistics when analyzing decision uncertainty. To demonstrate the stochastic application of the model for informing decision making about the adoption of an audit and feedback strategy for implementing a guideline recommending intensive blood glucose control in type 2 diabetes in primary care in the Netherlands. An integrated Bayesian approach to decision modeling and evidence synthesis is adopted, using Markov Chain Monte Carlo simulation in WinBUGs. Data on model parameters is gathered from various sources, with effectiveness of implementation being estimated using pooled, random-effects meta-analysis. Decision uncertainty is illustrated using cost-effectiveness acceptability curves and frontier. Decisions about whether to adopt intensified glycemic control and whether to adopt audit and feedback alter for the maximum values that decision makers are willing to pay for health gain. Through simultaneously incorporating uncertain economic evidence on both guidance and implementation strategy, the cost-effectiveness acceptability curves and cost-effectiveness acceptability frontier show an increase in decision uncertainty concerning guideline implementation. The stochastic application in diabetes care demonstrates that the model provides a simple and useful tool for quantifying and exploring the (combined) uncertainty associated with decision making about adopting guidelines and implementation strategies and, therefore, for informing decisions about efficient resource allocation to change clinical practice.

Mental health care delivery system reform in Belgium: the challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time.

PubMed

Nicaise, Pablo; Dubois, Vincent; Lorant, Vincent

2014-04-01

Most mental health care delivery systems in welfare states currently face two major issues: deinstitutionalisation and fragmentation of care. Belgium is in the process of reforming its mental health care delivery system with the aim of simultaneously strengthening community care and improving integration of care. The new policy model attempts to strike a balance between hospitals and community services, and is based on networks of services. We carried out a content analysis of the policy blueprint for the reform and performed an ex-ante evaluation of its plan of operation, based on the current knowledge of mental health service networks. When we examined the policy's multiple aims, intermediate goals, suggested tools, and their articulation, we found that it was unclear how the new policy could achieve its goals. Indeed, deinstitutionalisation and integration of care require different network structures, and different modes of governance. Furthermore, most of the mechanisms contained within the new policy were not sufficiently detailed. Consequently, three major threats to the effectiveness of the reform were identified. These were: issues concerning the relationship between network structure and purpose, the continued influence of hospitals despite the goal of deinstitutionalisation, and the heterogeneity in the actual implementation of the new policy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The formation, elements of success, and challenges in managing a critical care program: Part I.

PubMed

St Andre, Arthur

2015-04-01

Leaders of critical care programs have significant responsibility to develop and maintain a system of intensive care. At inception, those clinician resources necessary to provide and be available for the expected range of patient illness and injury and throughput are determined. Simultaneously, non-ICU clinical responsibilities and other expectations, such as education of trainees and participation in hospital operations, must be understood. To meet these responsibilities, physicians must be recruited, mentored, and retained. The physician leader may have similar responsibilities for nonphysician practitioners. In concert with other critical care leaders, the service adopts a model of care and assembles an ICU team of physicians, nurses, nonphysician providers, respiratory therapists, and others to provide clinical services. Besides clinician resources, leaders must assure that services such as radiology, pharmacy, the laboratory, and information services are positioned to support the complexities of ICU care. Metrics are developed to report success in meeting process and outcomes goals. Leaders evolve the system of care by reassessing and modifying practice patterns to continually improve safety, efficacy, and efficiency. Major emphasis is placed on the importance of continuity, consistency, and communication by expecting practitioners to adopt similar practices and patterns. Services anticipate and adapt to evolving expectations and resource availability. Effective services will result when skilled practitioners support one another and ascribe to a service philosophy of care.

Pursuing common agendas: a collaborative model for knowledge translation between research and practice in clinical settings.

PubMed

Baumbusch, Jennifer L; Kirkham, Sheryl Reimer; Khan, Koushambhi Basu; McDonald, Heather; Semeniuk, Pat; Tan, Elsie; Anderson, Joan M

2008-04-01

There is an emerging discourse of knowledge translation that advocates a shift away from unidirectional research utilization and evidence-based practice models toward more interactive models of knowledge transfer. In this paper, we describe how our participatory approach to knowledge translation developed during an ongoing program of research concerning equitable care for diverse populations. At the core of our approach is a collaborative relationship between researchers and practitioners, which underpins the knowledge translation cycle, and occurs simultaneously with data collection/analysis/synthesis. We discuss lessons learned including: the complexities of translating knowledge within the political landscape of healthcare delivery, the need to negotiate the agendas of researchers and practitioners in a collaborative approach, and the kinds of resources needed to support this process.

A longitudinal analysis of the impact of hospital service line profitability on the likelihood of readmission.

PubMed

Navathe, Amol S; Volpp, Kevin G; Konetzka, R Tamara; Press, Matthew J; Zhu, Jingsan; Chen, Wei; Lindrooth, Richard C

2012-08-01

Quality of care may be linked to the profitability of admissions in addition to level of reimbursement. Prior policy reforms reduced payments that differentially affected the average profitability of various admission types. The authors estimated a Cox competing risks model, controlling for the simultaneous risk of mortality post discharge, to determine whether the average profitability of hospital service lines to which a patient was admitted was associated with the likelihood of readmission within 30 days. The sample included 12,705,933 Medicare Fee for Service discharges from 2,438 general acute care hospitals during 1997, 2001, and 2005. There was no evidence of an association between changes in average service line profitability and changes in readmission risk, even when controlling for risk of mortality. These findings are reassuring in that the profitability of patients' admissions did not affect readmission rates, and together with other evidence may suggest that readmissions are not an unambiguous quality indicator for in-hospital care.

A qualitative study examining the sustainability of shared care in the delivery of palliative care services in the community.

PubMed

Demiglio, Lily; Williams, Allison M

2013-08-29

This paper focuses on the sustainability of existing palliative care teams that provide home-based care in a shared care model. For the purposes of this study, following Evashwick and Ory (2003), sustainability is understood and approached as the ability to continue the program over time. Understanding factors that influence the sustainability of teams and ways to mitigate these factors is paramount to improving the longevity and quality of service delivery models of this kind. Using qualitative data collected in interviews, the aim of this study is twofold: (1) to explore the factors that affect the sustainability of the teams at three different scales, and; (2) based on the results of this study, to propose a set of recommendations that will contribute to the sustainability of PC teams. Sustainability was conceptualized from two angles: internal and external. An overview of external sustainability was provided and the merging of data from all participant groups showed that the sustainability of teams was largely dependent on actors and organizations at the local (community), regional (Local Health Integration Network or LHIN) and provincial scales. The three scales are not self-contained or singular entities but rather are connected. Integration and collaboration within and between scales is necessary, as community capacity will inevitably reach its threshold without support of the province, which provides funding to the LHIN. While the community continues to advocate for the teams, in the long-term, they will need additional supports from the LHIN and province. The province has the authority and capacity to engrain its support for teams through a formal strategy. The recommendations are presented based on scale to better illustrate how actors and organizations could move forward. This study may inform program and policy specific to strategic ways to improve the provision of team-based palliative home care using a shared care model, while simultaneously providing direction for team-based program delivery and sustainability for other jurisdictions.

A Thematic Analysis of Theoretical Models for Translational Science in Nursing: Mapping the Field

PubMed Central

Mitchell, Sandra A.; Fisher, Cheryl A.; Hastings, Clare E.; Silverman, Leanne B.; Wallen, Gwenyth R.

2010-01-01

Background The quantity and diversity of conceptual models in translational science may complicate rather than advance the use of theory. Purpose This paper offers a comparative thematic analysis of the models available to inform knowledge development, transfer, and utilization. Method Literature searches identified 47 models for knowledge translation. Four thematic areas emerged: (1) evidence-based practice and knowledge transformation processes; (2) strategic change to promote adoption of new knowledge; (3) knowledge exchange and synthesis for application and inquiry; (4) designing and interpreting dissemination research. Discussion This analysis distinguishes the contributions made by leaders and researchers at each phase in the process of discovery, development, and service delivery. It also informs the selection of models to guide activities in knowledge translation. Conclusions A flexible theoretical stance is essential to simultaneously develop new knowledge and accelerate the translation of that knowledge into practice behaviors and programs of care that support optimal patient outcomes. PMID:21074646

Influence of Place of Residence in Access to Specialized Cancer Care for African Americans

ERIC Educational Resources Information Center

Onega, Tracy; Duell, Eric J.; Shi, Xun; Demidenko, Eugene; Goodman, David

2010-01-01

Context: Disparities in cancer care for rural residents and for African Americans have been documented, but the interaction of these factors is not well understood. Purpose: The authors examined the simultaneous influence of race and place of residence on access to and utilization of specialized cancer care in the United States. Methods: Access to…

Children's Mental Health as a Primary Care and Concern

PubMed Central

Tolan, Patrick H.; Dodge, Kenneth A.

2009-01-01

In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country. PMID:16173893

A model for identifying and ranking need for trauma service in nonmetropolitan regions based on injury risk and access to services.

PubMed

Schuurman, Nadine; Bell, Nathaniel; Hameed, Morad S; Simons, Richard

2008-07-01

Timely access to definitive trauma care has been shown to improve survival rates after severe injury. Unfortunately, despite development of sophisticated trauma systems, prompt, definitive trauma care remains unavailable to over 50 million North Americans, particularly in rural areas. Measures to quantify social and geographic isolation may provide important insights for the development of health policy aimed at reducing the burden of injury and improving access to trauma care in presently under serviced populations. Indices of social deprivation based on census data, and spatial analyses of access to trauma centers based on street network files were combined into a single index, the Population Isolation Vulnerability Amplifier (PIVA) to characterize vulnerability to trauma in socioeconomically and geographically diverse rural and urban communities across British Columbia. Regions with a sufficient core population that are more than one hour travel time from existing services were ranked based on their level of socioeconomic vulnerability. Ten regions throughout the province were identified as most in need of trauma services based on population, isolation and vulnerability. Likewise, 10 communities were classified as some of the least isolated areas and were simultaneously classified as least vulnerable populations in province. The model was verified using trauma services utilization data from the British Columbia Trauma Registry. These data indicate that including vulnerability in the model provided superior results to running the model based only on population and road travel time. Using the PIVA model we have shown that across Census Urban Areas there are wide variations in population dependence on and distances to accredited tertiary/district trauma centers throughout British Columbia. Many of the factors that influence access to definitive trauma care can be combined into a single quantifiable model that researchers in the health sector can use to predict where to place new services. The model can also be used to locate optimal locations for any basket of health services.

Controlling images: How awareness of group stereotypes affects Black women's well-being.

PubMed

Jerald, Morgan C; Cole, Elizabeth R; Ward, L Monique; Avery, Lanice R

2017-10-01

This paper presents research exploring how stereotypes that are simultaneously racialized and gendered affect Black women. We investigated the mental and physical health consequences of Black women's awareness that others hold these stereotypes and tested whether this association was moderated by the centrality of racial identity. A structural equation model tested among 609 young Black women revealed that metastereotype awareness (i.e., being aware that others hold negative stereotypes of one's group) predicted negative mental health outcomes (e.g., depression, anxiety, hostility), which, in turn, predicted diminished self-care behaviors and greater drug and alcohol use for coping. High racial centrality exacerbated the negative association between metastereotype awareness and self-care. We discuss implications of the findings for clinical practice and for approaches to research using intersectionality frameworks. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Simultaneous feature selection and parameter optimisation using an artificial ant colony: case study of melting point prediction

PubMed Central

O'Boyle, Noel M; Palmer, David S; Nigsch, Florian; Mitchell, John BO

2008-01-01

Background We present a novel feature selection algorithm, Winnowing Artificial Ant Colony (WAAC), that performs simultaneous feature selection and model parameter optimisation for the development of predictive quantitative structure-property relationship (QSPR) models. The WAAC algorithm is an extension of the modified ant colony algorithm of Shen et al. (J Chem Inf Model 2005, 45: 1024–1029). We test the ability of the algorithm to develop a predictive partial least squares model for the Karthikeyan dataset (J Chem Inf Model 2005, 45: 581–590) of melting point values. We also test its ability to perform feature selection on a support vector machine model for the same dataset. Results Starting from an initial set of 203 descriptors, the WAAC algorithm selected a PLS model with 68 descriptors which has an RMSE on an external test set of 46.6°C and R2 of 0.51. The number of components chosen for the model was 49, which was close to optimal for this feature selection. The selected SVM model has 28 descriptors (cost of 5, ε of 0.21) and an RMSE of 45.1°C and R2 of 0.54. This model outperforms a kNN model (RMSE of 48.3°C, R2 of 0.47) for the same data and has similar performance to a Random Forest model (RMSE of 44.5°C, R2 of 0.55). However it is much less prone to bias at the extremes of the range of melting points as shown by the slope of the line through the residuals: -0.43 for WAAC/SVM, -0.53 for Random Forest. Conclusion With a careful choice of objective function, the WAAC algorithm can be used to optimise machine learning and regression models that suffer from overfitting. Where model parameters also need to be tuned, as is the case with support vector machine and partial least squares models, it can optimise these simultaneously. The moving probabilities used by the algorithm are easily interpreted in terms of the best and current models of the ants, and the winnowing procedure promotes the removal of irrelevant descriptors. PMID:18959785

Modeling efficiency at the process level: an examination of the care planning process in nursing homes.

PubMed

Lee, Robert H; Bott, Marjorie J; Gajewski, Byron; Taunton, Roma Lee

2009-02-01

To examine the efficiency of the care planning process in nursing homes. We collected detailed primary data about the care planning process for a stratified random sample of 107 nursing homes from Kansas and Missouri. We used these data to calculate the average direct cost per care plan and used data on selected deficiencies from the Online Survey Certification and Reporting System to measure the quality of care planning. We then analyzed the efficiency of the assessment process using corrected ordinary least squares (COLS) and data envelopment analysis (DEA). Both approaches suggested that there was considerable inefficiency in the care planning process. The average COLS score was 0.43; the average DEA score was 0.48. The correlation between the two sets of scores was quite high, and there was no indication that lower costs resulted in lower quality. For-profit facilities were significantly more efficient than not-for-profit facilities. Multiple studies of nursing homes have found evidence of inefficiency, but virtually all have had measurement problems that raise questions about the results. This analysis, which focuses on a process with much simpler measurement issues, finds evidence of inefficiency that is largely consistent with earlier studies. Making nursing homes more efficient merits closer attention as a strategy for improving care. Increasing efficiency by adopting well-designed, reliable processes can simultaneously reduce costs and improve quality.

Can a Mediator Moderate? Considering the Role of Time and Change in the Mediator-Moderator Distinction.

PubMed

Karazsia, Bryan T; Berlin, Kristoffer S

2018-01-01

The concepts of mediation and moderation are important for specifying ways in which psychological treatments work and for whom they are most beneficial. Historically, the terms were confused and used interchangeably, so a rich body of scholarly literature makes clear their distinction. Researchers are also becoming increasingly aware that mediation and moderation can be integrated and that such integration can advance theory development and testing. One question that has not received sufficient attention is whether a mediator can simultaneously moderate. We tackle this question in this paper, and in doing so we expand on the MacArthur conceptualizations of mediation and moderation. The result is a presentation of a meta-theoretical model that illustrates how a construct that is initially a mediator can, not simultaneously but over time, evolve into a construct that moderates. When this occurs, a construct that changed for the better as a result of an intervention can later promote more positive change during a later intervention. Various implications of this novel paradigm for future research are discussed, including the importance of this model in the emerging context of managed health care. Copyright © 2017. Published by Elsevier Ltd.

Health-based risk adjustment: is inpatient and outpatient diagnostic information sufficient?

PubMed

Lamers, L M

Adequate risk adjustment is critical to the success of market-oriented health care reforms in many countries. Currently used risk adjusters based on demographic and diagnostic cost groups (DCGs) do not reflect expected costs accurately. This study examines the simultaneous predictive accuracy of inpatient and outpatient morbidity measures and prior costs. DCGs, pharmacy cost groups (PCGs), and prior year's costs improve the predictive accuracy of the demographic model substantially. DCGs and PCGs seem complementary in their ability to predict future costs. However, this study shows that the combination of DCGs and PCGs still leaves room for cream skimming.

[Concept for a department of intensive care].

PubMed

Nierhaus, A; de Heer, G; Kluge, S

2014-10-01

Demographic change and increasing complexity are among the reasons for high-tech critical care playing a major and increasing role in today's hospitals. At the same time, intensive care is one of the most cost-intensive departments in the hospital. To guarantee high-quality care, close cooperation of specialised intensive care staff with specialists of all other medical areas is essential. A network of the intensive care units within the hospital may lead to synergistic effects concerning quality of care, simultaneously optimizing the use of human and technical resources. Notwithstanding any organisational concepts, development and maintenance of the highest possible quality of care should be of overriding importance.

Movement Advocacy, Personal Relationships, and Ending Health Care Disparities

PubMed Central

Chin, Marshall H.

2017-01-01

Deep-rooted structural problems drive health care disparities. Compounding the difficulty of attaining health equity, solutions in clinics and hospitals require the cooperation of clinicians, administrators, patients, and the community. Recent protests over police brutality and racism on campuses across America have opened fresh wounds over how best to end racism, with lessons for achieving health equity. Movement advocacy, the mobilizing of the people to raise awareness of an injustice and to advocate for reform, can break down ingrained structural barriers and policies that impede health equity. However, simultaneously advocates, clinicians, and health care organizations must build trusting relationships and resolve conflict with mutual respect and honesty. Tension is inherent in discussions about racial and ethnic disparities. Yet, tension can be constructive if it forces self-examination and spurs systems change and personal growth. We must simultaneously advocate for policy reform, build personal relationships across diverse groups, and honestly examine our biases. PMID:28259213

Takagi-Sugeno fuzzy model based robust dissipative control for uncertain flexible spacecraft with saturated time-delay input.

PubMed

Xu, Shidong; Sun, Guanghui; Sun, Weichao

2017-01-01

In this paper, the problem of robust dissipative control is investigated for uncertain flexible spacecraft based on Takagi-Sugeno (T-S) fuzzy model with saturated time-delay input. Different from most existing strategies, T-S fuzzy approximation approach is used to model the nonlinear dynamics of flexible spacecraft. Simultaneously, the physical constraints of system, like input delay, input saturation, and parameter uncertainties, are also taken care of in the fuzzy model. By employing Lyapunov-Krasovskii method and convex optimization technique, a novel robust controller is proposed to implement rest-to-rest attitude maneuver for flexible spacecraft, and the guaranteed dissipative performance enables the uncertain closed-loop system to reject the influence of elastic vibrations and external disturbances. Finally, an illustrative design example integrated with simulation results are provided to confirm the applicability and merits of the developed control strategy. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

Endotracheal intubation: application of virtual reality to emergency medical services education.

PubMed

Mayrose, James; Myers, Jeffrey W

2007-01-01

Virtual reality simulation has been identified as an emerging educational tool with significant potential to enhance teaching of residents and students in emergency clinical encounters and procedures. Endotracheal intubation represents a critical procedure for emergency care providers. Current methods of training include working with cadavers and mannequins, which have limitations in their representation of reality, ethical concerns, and overall availability with access, cost, and location of models. This paper will present a human airway simulation model designed for tracheal intubation and discuss the aspects that lend itself to use as an educational tool. This realistic and dynamic model is used to teach routine intubations, while future models will include more difficult airway management scenarios. This work provides a solid foundation for future versions of the intubation simulator, which will incorporate two haptic devices to allow for simultaneous control of the laryngoscope blade and endotracheal tube.

Analysis of modeling cumulative noise from simultaneous flights volume 1 : analysis at four national parks

DOT National Transportation Integrated Search

2012-12-31

This is the first of two volumes of the report on modeling cumulative noise from simultaneous flights. This volume includes: an overview of the time compression algorithms used to model simultaneous aircraft; revised summary of a preliminary study (w...

Use of a hand-held computer observational tool to improve communication for care planning and psychosocial well-being

PubMed Central

Corazzini, Kirsten; Rapp, Carla Gene; McConnell, Eleanor S.; Anderson, Ruth A.

2013-01-01

Staff development nurses in long-term care are challenged to implement training programs that foster quality unlicensed assistive personnel (UAP) care and improve the transfer of their observations to licensed nursing staff for care planning. This study describes the outcomes of a program where UAP recorded behavioral problems of residents to inform care. Findings suggest staff development nurses who aim to improve UAP reporting without simultaneously targeting licensed nursing staff behaviors may worsen nursing staff relationships. PMID:19182546

A Simultaneous Equation Demand Model for Block Rates

NASA Astrophysics Data System (ADS)

Agthe, Donald E.; Billings, R. Bruce; Dobra, John L.; Raffiee, Kambiz

1986-01-01

This paper examines the problem of simultaneous-equations bias in estimation of the water demand function under an increasing block rate structure. The Hausman specification test is used to detect the presence of simultaneous-equations bias arising from correlation of the price measures with the regression error term in the results of a previously published study of water demand in Tucson, Arizona. An alternative simultaneous equation model is proposed for estimating the elasticity of demand in the presence of block rate pricing structures and availability of service charges. This model is used to reestimate the price and rate premium elasticities of demand in Tucson, Arizona for both the usual long-run static model and for a simple short-run demand model. The results from these simultaneous equation models are consistent with a priori expectations and are unbiased.

Dentistry in the 21st century: challenges of a globalising world.

PubMed

Hayashi, Mikako; Haapasalo, Markus; Imazato, Satoshi; Lee, Jae Il; Momoi, Yasuko; Murakami, Shinya; Whelton, Helen; Wilson, Nairn

2014-12-01

Oral health is - literally - vital to good general health, not least because the mouth is the sentinel of the body. Dentistry, the Cinderella of health care, faces immense challenges of globalisation. Governments, having spent freely on everything from defence to social security, face mountains of debts which make budget cutbacks essential. Simultaneously, most developed countries have to pay increasing costs of caring for rapidly ageing populations. Dentistry is being pulled two ways: wealthy members of society demand high-end expensive treatment, much of it cosmetic rather than necessary to deal with disease, whereas many millions of poor people in developing countries cannot afford basic dental treatment and may never see a dentist. Too many governments and dentists persist with the expensive and destructive regime of 'drill and fill (and bill)'. International advances in care may not reach the clinician's chair because treatment guidelines and payments are set locally. An international symposium to celebrate Mikako Hayashi becoming Professor of Restorative Dentistry and Endodontology at Osaka University concluded that dentistry should move from an increasingly un-affordable curative model to a cost-effective evidence-based preventive model. The goal is to help people retain healthy natural teeth throughout their lives, as an essential part of enhancing their general health. © 2014 FDI World Dental Federation.

Successful ingredients in the SMILE study: resident, staff, and management factors influence the effects of humor therapy in residential aged care.

PubMed

Brodaty, Henry; Low, Lee-Fay; Liu, Zhixin; Fletcher, Jennifer; Roast, Joel; Goodenough, Belinda; Chenoweth, Lynn

2014-12-01

To test the hypothesis that individual and institutional-level factors influence the effects of a humor therapy intervention on aged care residents. Data were from the humor therapy group of the Sydney Multisite Intervention of LaughterBosses and ElderClowns, or SMILE, study, a single-blind cluster randomized controlled trial of humor therapy conducted over 12 weeks; assessments were performed at baseline, week 13, and week 26. One hundred eighty-nine individuals from 17 Sydney residential aged care facilities were randomly allocated to the humor therapy intervention. Professional performers called "ElderClowns" provided 9-12 weekly humor therapy 2-hour sessions, augmented by trained staff, called "LaughterBosses." Outcome measures were as follows: Cornell Scale for Depression in Dementia, Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and proxy-rated quality of life in dementia population scale. Facility-level measures were as follows: support of the management for the intervention, commitment levels of LaughterBosses, Environmental Audit Tool scores, and facility level of care provided (high/low). Resident-level measures were engagement, functional ability, disease severity, and time-in-care. Multilevel path analyses simultaneously modeled resident engagement at the individual level (repeated measures) and the effects of management support and staff commitment to humor therapy at the cluster level. Models indicated flow-on effects, whereby management support had positive effects on LaughterBoss commitment, and LaughterBoss commitment increased resident engagement. Higher resident engagement was associated with reduced depression, agitation, and neuropsychiatric scores. Effectiveness of psychosocial programs in residential aged care can be enhanced by management support, staff commitment, and active resident engagement. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

A Rehabilomics framework for personalized and translational rehabilitation research and care for individuals with disabilities: Perspectives and considerations for spinal cord injury

PubMed Central

Wagner, Amy K.

2014-01-01

Despite many people having similar clinical presentation, demographic factors, and clinical care, outcome can differ for those sustaining significant injury such as spinal cord injury (SCI) and traumatic brain injury (TBI). In addition to traditional demographic, social, and clinical factors, variability also may be attributable to innate (including genetic, transcriptomic proteomic, epigenetic) biological variation that individuals bring to recovery and their unique response to their care and environment. Technologies collectively called “-omics” enable simultaneous measurement of an enormous number of biomolecules that can capture many potential biological contributors to heterogeneity of injury/disease course and outcome. Due to the nature of injury and complex disease, and its associations with impairment, disability, and recovery, rehabilitation does not lend itself to a singular “protocolized” plan of therapy. Yet, by nature and by necessity, rehabilitation medicine operates as a functional model of “Personalized Care”. Thus, the challenge for successful programs of translational rehabilitation care and research is to identify viable approaches to examine broad populations, with varied impairments and functional limitations, and to identify effective treatment responses that incorporate personalized protocols to optimize functional recovery. The Rehabilomics framework is a translational model that provides an “-omics” overlay to the scientific study of rehabilitation processes and multidimensional outcomes. Rehabilomics research provides novel opportunities to evaluate the neurobiology of complex injury or chronic disease and can be used to examine methods and treatments for person-centered care among populations with disabilities. Exemplars for application in SCI and other neurorehabilitation populations are discussed. PMID:25029659

Semiquantitative Nucleic Acid Test with Simultaneous Isotachophoretic Extraction and Amplification.

PubMed

Bender, Andrew T; Borysiak, Mark D; Levenson, Amanda M; Lillis, Lorraine; Boyle, David S; Posner, Jonathan D

2018-06-19

Nucleic acid amplification tests (NAATs) provide high diagnostic accuracy for infectious diseases and quantitative results for monitoring viral infections. The majority of NAATs require complex equipment, cold chain dependent reagents, and skilled technicians to perform the tests. This largely confines NAATs to centralized laboratories and can significantly delay appropriate patient care. Low-cost, point-of-care (POC) NAATs are especially needed in low-resource settings to provide patients with diagnosis and treatment planning in a single visit to improve patient care. In this work, we present a rapid POC NAAT with integrated sample preparation and amplification using electrokinetics and paper substrates. We use simultaneous isotachophoresis (ITP) and recombinase polymerase amplification (RPA) to rapidly extract, amplify, and detect target nucleic acids from serum and whole blood in a paper-based format. We demonstrate simultaneous ITP and RPA can consistently detect 5 copies per reaction in buffer and 10 000 copies per milliliter of human serum with no intermediate user steps. We also show preliminary extraction and amplification of DNA from whole blood samples. Our test is rapid (results in less than 20 min) and made from low-cost materials, indicating its potential for detecting infectious diseases and monitoring viral infections at the POC in low resource settings.

Balancing performance-based expectations with a holistic perspective on coaching: a qualitative study of Swedish women’s national football team coaches’ practice experiences

PubMed Central

Lindgren, Eva-Carin; Barker-Ruchti, Natalie

2017-01-01

ABSTRACT Purpose: The purpose of this study was to explore how an exclusive sample of women’s national football team coaches described how they implement careful coaching while facing social and organizational pressure to win medals. Method: To consider coaches’ negotiations, we drew on Noddings’ concept of caring. Using an interpretive research paradigm, we conducted in-depth interviews with five Swedish women’s national football team coaches. An abductive approach was used to simultaneously process the theoretical framework of “ethics of care” and the empirical data. Results: The coaches unanimously adopted a holistic perspective to coaching. The coaching strategies they described included promoting players’ development, well-being, and sustainable elite performance; listening to the players’ voices and engaging in dialogue; and creating a positive environment and promoting fair play. Conclusions: These findings demonstrate that the women coaches, despite performance pressure, adopt caring coaching in the form of Noddings’ pedagogical modelling, dialogue, and confirmation strategies, and provide an example of how coaches can adopt caring, holistic, and athlete-centred coaching while working at the highest level of competitive sport and achieving competitive success. PMID:28812449

A political economic theory of the dental care market.

PubMed Central

Lipscomb, J; Douglass, C W

1982-01-01

A theory of the dental care market is introduced which proposes that the vertically integrated (local/state/national) structure of the profession services as an organizational vehicle both for intra-professional debate and for developing provider-oriented dental care policy. We suggest that a special relationship exists between professionalism and professional regulation. Such regulation has functioned simultaneously to limit competition and to foster a prized consumption commodity for providers: professionalism and professional esteem. The organized pursuit of this commodity inherently dampens competition. Professionalism itself plays a crucial role in: 1) securing for organized dentistry a form of state regulation in which the providers themselves are the principal decision-makers; and 2) influencing provider and consumer market behavior in several significant respects, the net result being the formation of maintenance of a type of "leadership cartel" in the local market. Thus, a political-economic theory of the dental care market formally acknowledges professionalism as valued by established dentists and recent graduates as a central determining influence. Traditional models of pure competition and monopoly emerge as special, extreme cases of the general theory. Hypotheses are offered regarding consumer and provider behavior, market dynamics, and health policy and regulation. PMID:7091455

Experiences of a student-run clinic in primary care: a mixed-method study with students, patients and supervisors

PubMed Central

Fröberg, Maria; Leanderson, Charlotte; Fläckman, Birgitta; Hedman-Lagerlöf, Erik; Björklund, Karin; Nilsson, Gunnar H.; Stenfors, Terese

2018-01-01

Objective To explore how a student-run clinic (SRC) in primary health care (PHC) was perceived by students, patients and supervisors. Design A mixed methods study. Clinical learning environment, supervision and nurse teacher evaluation scale (CLES + T) assessed student satisfaction. Client satisfaction questionnaire-8 (CSQ-8) assessed patient satisfaction. Semi-structured interviews were conducted with supervisors. Setting Gustavsberg PHC Center, Stockholm County, Sweden. Subjects Students in medicine, nursing, physiotherapy, occupational therapy and psychology and their patients filled in questionnaires. Supervisors in medicine, nursing and physiotherapy were interviewed. Main outcome measures Mean values and medians of CLES + T and CSQ-8 were calculated. Interviews were analyzed using content analysis. Results A majority of 199 out of 227 student respondents reported satisfaction with the pedagogical atmosphere and the supervisory relationship. Most of the 938 patient respondents reported satisfaction with the care given. Interviews with 35 supervisors showed that the organization of the SRC provided time and support to focus on the tutorial assignment. Also, the pedagogical role became more visible and targeted toward the student’s individual needs. However, balancing the student’s level of autonomy and the own control over care was described as a challenge. Many expressed the need for further pedagogical education. Conclusions High student and patient satisfaction reported from five disciplines indicate that a SRC in PHC can be adapted for heterogeneous student groups. Supervisors experienced that the SRC facilitated and clarified their pedagogical role. Simultaneously their need for continuous pedagogical education was highlighted. The SRC model has the potential to enhance student-centered tuition in PHC. Key Points Knowledge of student-run clinics (SRCs) as learning environments within standard primary health care (PHC) is limited. We report experiences from the perspectives of students, their patients and supervisors, representing five healthcare disciplines. Students particularly valued the pedagogical atmosphere and the supervisory relationship. Patients expressed high satisfaction with the care provided. Supervisors expressed that the structure of the SRC supported the pedagogical assignment and facilitated student-centered tuition – simultaneously the altered learning environment highlighted the need for further pedagogical education. Student-run clinics in primary health care have great potential for student-regulated learning. PMID:29368978

Understanding the positive role of neighborhood socioeconomic advantage in achievement: the contribution of the home, child care, and school environments.

PubMed

Dupere, Veronique; Leventhal, Tama; Crosnoe, Robert; Dion, Eric

2010-09-01

The goal of this study was to examine the mechanisms underlying associations between neighborhood socioeconomic advantage and children's achievement trajectories between ages 54 months and 15 years. Results of hierarchical linear growth models based on a diverse sample of 1,364 children indicate that neighborhood socioeconomic advantage was nonlinearly associated with youths' initial vocabulary and reading scores, such that the presence of educated, affluent professionals in the neighborhood had a favorable association with children's achievement among those in less advantaged neighborhoods until it leveled off at moderate levels of advantage. A similar tendency was observed for math achievement. The quality of the home and child care environments as well as school advantage partially explained these associations. The findings suggest that multiple environments need to be considered simultaneously for understanding neighborhood-achievement links.

Physio-Environmental Sensing and Live Modeling

PubMed Central

Diaz, Vanessa; Gaggioli, Andrea; Liò, Pietro; Mazzà, Claudia; Merelli, Emanuela; Meskers, Carel G.M; Pappalardo, Francesco; von Ammon, Rainer

2013-01-01

In daily life, humans are constantly interacting with their environment. Evidence is emerging that this interaction is a very important modulator of health and well-being, even more so in our rapidly ageing society. Information and communication technology lies at the heart of the human health care revolution. It cannot remain acceptable to use out of date data analysis and predictive algorithms when superior alternatives exist. Communication network speed, high penetration of home broadband, availability of various mobile network options, together with the available detailed biological data for individuals, are producing promising advances in computerized systems that will turn information on human-environment interactions into actual knowledge with the potential to help make medical and lifestyle decisions. We introduced and discussed a key scenario in which hardware and software technologies capable of simultaneously sensing physiological and environmental signals process health care data in real-time to issue alarms, warnings, or simple recommendations to the patient or carers. PMID:23612245

Understanding the Positive Role of Neighborhood Socioeconomic Advantage in Achievement: The Contribution of the Home, Child Care and School Environments

PubMed Central

Dupéré, Véronique; Leventhal, Tama; Crosnoe, Robert; Dion, Éric

2011-01-01

The goal of this study was to examine the mechanisms underlying associations between neighborhood socioeconomic advantage and children’s achievement trajectories between 54 months and 15 years old. Results of hierarchical linear growth models based on a diverse sample of 1,364 children indicate that neighborhood socioeconomic advantage was non-linearly associated with youths’ initial vocabulary and reading scores, such that the presence of educated, affluent professionals in the neighborhood had a favorable association with children’s achievement among those in less advantaged neighborhoods until it leveled off at moderate levels of advantage. A similar tendency was observed for math achievement. The quality of the home and child care environments as well as school advantage partially explained these associations. The findings suggest that multiple environments need to be considered simultaneously for understanding neighborhood-achievement links. PMID:20822235

Cost-effectiveness of rapid HCV testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs

PubMed Central

Schackman, Bruce R.; Leff, Jared A.; Barter, Devra M.; DiLorenzo, Madeline A.; Feaster, Daniel J.; Metsch, Lisa R.; Freedberg, Kenneth A.; Linas, Benjamin P.

2014-01-01

Aims To evaluate the cost-effectiveness of rapid hepatitis C virus (HCV) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs. Design We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer, off-site HCV testing referral, on-site rapid HCV testing offer, and on-site rapid HCV and HIV testing offer. Base case inputs included 11% undetected chronic HCV, 0.4% undetected HIV, 35% HCV co-infection among HIV-infected, 53% linked to HCV care after testing antibody positive, and 67% linked to HIV care. Disease outcomes were estimated from established computer simulation models of HCV (HEP-CE) and HIV (CEPAC). Setting and Participants Data on test acceptance and costs were from a national randomized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the USA. Measurements Lifetime costs (2011 US dollars) and quality-adjusted life years (QALYs) discounted at 3% annually; incremental cost-effectiveness ratios (ICERs) Findings On-site rapid HCV testing had an ICER of $18,300/QALY compared with no testing, and was more efficient than (dominated) off-site HCV testing referral. On-site rapid HCV and HIV testing had an ICER of $64,500/QALY compared with on-site rapid HCV testing alone. In one and two-way sensitivity analyses, the ICER of on-site rapid HCV and HIV testing remained <$100,000/QALY, except when undetected HIV prevalence was <0.1% or when we assumed frequent HIV testing elsewhere. The ICER remained <$100,000/QALY in approximately 90% of probabilistic sensitivity analyses. Conclusions On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a <$100,000/ quality-adjusted life years threshold. PMID:25291977

Whose Culture?: Monolithic Cultures and Subcultures in Early Childhood Settings

ERIC Educational Resources Information Center

Halttunen, Leena

2017-01-01

In Finland, day care centre directors have traditionally led only a single unit, but after the recent merging of many units, most directors simultaneously lead several, physically separate units. These organizations are called distributed organizations. This study was carried out in two distributed day care organizations. The findings are based on…

The Pursuit of Language Appropriate Care: Remote Simultaneous Medical Interpretation Use

ERIC Educational Resources Information Center

Logan, Debra M.

2010-01-01

Background: The U.S. government mandates nurses to deliver linguistically appropriate care to hospital patients. It is difficult for nurses to implement the language mandates because there are 6,912 active living languages spoken in the world. Language barriers appear to place limited English proficient (LEP) patients at increased risk for harm…

Understanding Trust as an Essential Element of Trainee Supervision and Learning in the Workplace

ERIC Educational Resources Information Center

Hauer, Karen E.; ten Cate, Olle; Boscardin, Christy; Irby, David M.; Iobst, William; O'Sullivan, Patricia S.

2014-01-01

Clinical supervision requires that supervisors make decisions about how much independence to allow their trainees for patient care tasks. The simultaneous goals of ensuring quality patient care and affording trainees appropriate and progressively greater responsibility require that the supervising physician trusts the trainee. Trust allows the…

Women's autonomy and reproductive health care utilisation: empirical evidence from Tajikistan.

PubMed

Kamiya, Yusuke

2011-10-01

Women's autonomy is widely considered to be a key to improving maternal health in developing countries, whereas there is no consistent empirical evidence to support this claim. This paper examines whether or not and how women's autonomy within the household affects the use of reproductive health care, using a household survey data from Tajikistan. Estimation is performed by the bivariate probit model whereby woman's use of health services and the level of women's autonomy are recursively and simultaneously determined. The data is from a sample of women aged 15-49 from the Tajikistan Living Standard Measurement Survey 2007. Women's autonomy as measured by women's decision-making on household financial matters increase the likelihood that a woman receives antenatal and delivery care, whilst it has a negative effect on the probability of attending to four or more antenatal consultations. The hypothesis that women's autonomy and reproductive health care utilisation are independently determined is rejected for most of the estimation specifications, indicating the importance of taking into account the endogenous nature of women's autonomy when assessing its effect on health care use. The empirical results reconfirm the assertion that women's status within the household is closely linked to reproductive health care utilisation in developing countries. Policymakers therefore need not only to implement not only direct health interventions but also to focus on broader social policies which address women's empowerment. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Veterans Affairs general surgery service: the last bastion of integrated specialty care.

PubMed

Poteet, Stephen; Tarpley, Margaret; Tarpley, John L; Pearson, A Scott

2011-11-01

In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients. Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to 2009 at the Nashville VA. Over a 5-year span general surgery residents spent an average of 5 months on the VA general surgery service, which includes a postgraduate year (PGY)-5, PGY-3, and 2 PGY-1 residents. Surgeries involved the following specialties: surgical oncology, endocrine, colorectal, hepatobiliary, transplant, gastrointestinal laparoscopy, and elective and emergency general surgery. The surgeries were categorized according to ACGME index requirements. A total of 2,956 surgeries were performed during the 5-year period from 2005 through 2009. Residents participated in an average of 246 surgeries during their experience at the VA; approximately 50 cases are completed during the chief year. On the VA surgery service alone, 100% of the ACGME requirement was met for the following categories: endocrine (8 cases); skin, soft tissue, and breast (33 cases); alimentary tract (78 cases); and abdominal (88 cases). Approximately 50% of the ACGME requirement was met for liver, pancreas, and basic laparoscopic categories. The VA hospital provides an authentic, broad-based, general surgery training experience that integrates complex surgical patients simultaneously. Opportunities for this level of comprehensive care are decreasing or absent in many general surgery training programs. The increasing level of responsibility and simultaneous care of multiple specialty patients through the VA hospital systems offers a crucial experience for those pursuing a career in general surgery. Published by Elsevier Inc.

Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis

PubMed Central

Clark, Christopher E; Taylor, Rod S; Shore, Angela C; Campbell, John L

2016-01-01

Background Various prevalence figures have been reported for inter-arm differences in blood pressure (IAD); variation may be explained by differing population vascular risk and by measurement method. Aim To review the literature to derive robust estimates of IAD prevalence relevant to community populations. Design and setting Systematic review and meta-analysis. Method MEDLINE, Embase, and CINAHL were searched for cross-sectional studies likely to represent general or primary care populations, reporting prevalence of IAD and employing a simultaneous method of measurement. Using study-level data, pooled estimates of mean prevalence of systolic IADs were calculated and compared using a random effects model. Results Eighty IAD studies were identified. Sixteen met inclusion criteria: pooled estimates of prevalence for systolic IAD ≥10 mmHg were 11.2% (95% confidence interval [CI] = 9.1 to 13.6) in hypertension, 7.4% (95% CI = 5.8 to 9.2) in diabetes, and 3.6% (95% CI = 2.3 to 5.0) for a general adult population (P<0.001 for subgroup differences). Differences persisted for higher cut-off values. Prevalences were lower for East Asian than for Western populations and were overestimated by sequential measurement where this could be compared with simultaneous measurement within studies (relative risk for IAD: 2.9 [95% CI = 2.1 to 4.1]). Studies with higher mean absolute systolic pressures had higher prevalences for a systolic IAD ≥10 mmHg (P = 0.04). Conclusion Prevalences of IADs rise in relation to underlying cardiovascular comorbidities of the population studied, and are overestimated threefold when sequential measurement is used. Population-specific variation in prevalences of IAD should be taken into account in delivering clinical care and in planning future studies. PMID:27789511

Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis.

PubMed

Clark, Christopher E; Taylor, Rod S; Shore, Angela C; Campbell, John L

2016-11-01

Various prevalence figures have been reported for inter-arm differences in blood pressure (IAD); variation may be explained by differing population vascular risk and by measurement method. To review the literature to derive robust estimates of IAD prevalence relevant to community populations. Systematic review and meta-analysis. MEDLINE, Embase, and CINAHL were searched for cross-sectional studies likely to represent general or primary care populations, reporting prevalence of IAD and employing a simultaneous method of measurement. Using study-level data, pooled estimates of mean prevalence of systolic IADs were calculated and compared using a random effects model. Eighty IAD studies were identified. Sixteen met inclusion criteria: pooled estimates of prevalence for systolic IAD ≥10 mmHg were 11.2% (95% confidence interval [CI] = 9.1 to 13.6) in hypertension, 7.4% (95% CI = 5.8 to 9.2) in diabetes, and 3.6% (95% CI = 2.3 to 5.0) for a general adult population (P<0.001 for subgroup differences). Differences persisted for higher cut-off values. Prevalences were lower for East Asian than for Western populations and were overestimated by sequential measurement where this could be compared with simultaneous measurement within studies (relative risk for IAD: 2.9 [95% CI = 2.1 to 4.1]). Studies with higher mean absolute systolic pressures had higher prevalences for a systolic IAD ≥10 mmHg (P = 0.04). Prevalences of IADs rise in relation to underlying cardiovascular comorbidities of the population studied, and are overestimated threefold when sequential measurement is used. Population-specific variation in prevalences of IAD should be taken into account in delivering clinical care and in planning future studies. © British Journal of General Practice 2016.

County and organizational predictors of depression symptoms among low-income nursing assistants in the USA.

PubMed

Muntaner, Carles; Li, Yong; Xue, Xiaonan; Thompson, Theresa; Chung, Haejoo; O'Campo, Patricia

2006-09-01

Low-wage workers represent an ever-increasing proportion of the US workforce. A wide spectrum of firms demand low-wage workers, yet just 10 industries account for 70% of all low-paying jobs. The bulk of these jobs are in the services and retail sales industries. In health services, 60% of all workers are low-paid, with nursing aides, orderlies, personal attendants, and home care aides earning an average hourly wage of just 7.97 US dollars--a wage that keeps many of these workers hovering near or below the poverty line. Nursing assistants also tend to work in hazardous and grueling conditions. Work conditions are an important determinant of psychological well-being and mental disorders, particularly depression, in the workplace have important consequences for quality of life, worker productivity, and the utilization and cost of health care. In empirical studies of low-wage workers, county-level variables are of theoretical significance. Multilevel studies have recently provided evidence of a link between county-level variables and poor mental health among low-wage workers. To date, however, no studies have simultaneously considered the effect of county-and workplace-level variables. This study uses a repeated measures design and multilevel modeling to simultaneously test the effect of county-, organizational-, workplace-, and individual-level variables on depression symptoms among low-income nursing assistants employed in US nursing homes. We find that age and emotional strain have a statistically significant association with depression symptoms in this population, yet when controlling for county-level variables of poverty, the organizational-level variables used were no longer statistically significant predictors of depression symptoms. This study also contributes to current research methodology in the field of occupational health by using a cross-classified multilevel model to explicitly account for all variations in this three-level data structure, modeling and testing cross-classifications between nursing homes and counties of residence.

Half-quadratic variational regularization methods for speckle-suppression and edge-enhancement in SAR complex image

NASA Astrophysics Data System (ADS)

Zhao, Xia; Wang, Guang-xin

2008-12-01

Synthetic aperture radar (SAR) is an active remote sensing sensor. It is a coherent imaging system, the speckle is its inherent default, which affects badly the interpretation and recognition of the SAR targets. Conventional methods of removing the speckle is studied usually in real SAR image, which reduce the edges of the images at the same time as depressing the speckle. Morever, Conventional methods lost the information about images phase. Removing the speckle and enhancing the target and edge simultaneously are still a puzzle. To suppress the spckle and enhance the targets and the edges simultaneously, a half-quadratic variational regularization method in complex SAR image is presented, which is based on the prior knowledge of the targets and the edge. Due to the non-quadratic and non- convex quality and the complexity of the cost function, a half-quadratic variational regularization variation is used to construct a new cost function,which is solved by alternate optimization. In the proposed scheme, the construction of the model, the solution of the model and the selection of the model peremeters are studied carefully. In the end, we validate the method using the real SAR data.Theoretic analysis and the experimental results illustrate the the feasibility of the proposed method. Further more, the proposed method can preserve the information about images phase.

Academic medicine: a key partner in strengthening the primary care infrastructure via teaching health centers.

PubMed

Rieselbach, Richard E; Crouse, Byron J; Neuhausen, Katherine; Nasca, Thomas J; Frohna, John G

2013-12-01

In the United States, a worsening shortage of primary care physicians, along with structural deficiencies in their training, threaten the primary care system that is essential to ensuring access to high-quality, cost-effective health care. Community health centers (CHCs) are an underused resource that could facilitate rapid expansion of the primary care workforce and simultaneously prepare trainees for 21st-century practice. The Teaching Health Center Graduate Medical Education (THCGME) program, currently funded by the Affordable Care Act, uses CHCs as training sites for primary-care-focused graduate medical education (GME).The authors propose that the goals of the THCGME program could be amplified by fostering partnerships between CHCs and teaching hospitals (academic medical centers [AMCs]). AMCs would encourage their primary care residency programs to expand by establishing teaching health center (THC) tracks. Modifications to the current THCGME model, facilitated by formal CHC and academic medicine partnerships (CHAMPs), would address the primary care physician shortage, produce physicians prepared for 21st-century practice, expose trainees to interprofessional education in a multidisciplinary environment, and facilitate the rapid expansion of CHC capacity.To succeed, CHAMP THCs require a comprehensive consortium agreement designed to ensure equity between the community and academic partners; conforming with this agreement will provide the high-quality GME necessary to ensure residency accreditation. CHAMP THCs also require a federal mechanism to ensure stable, long-term funding. CHAMP THCs would develop in select CHCs that desire a partnership with AMCs and have capacity for providing a community-based setting for both GME and health services research.

Early Integration of Palliative Care in Oncology Practice: Results of the Italian Association of Medical Oncology (AIOM) Survey.

PubMed

Zagonel, Vittorina; Torta, Riccardo; Franciosi, Vittorio; Brunello, Antonella; Biasco, Guido; Cattaneo, Daniela; Cavanna, Luigi; Corsi, Domenico; Farina, Gabriella; Fioretto, Luisa; Gamucci, Teresa; Lanzetta, Gaetano; Magarotto, Roberto; Maltoni, Marco; Mastromauro, Cataldo; Melotti, Barbara; Meriggi, Fausto; Pavese, Ida; Piva, Erico; Sacco, Cosimo; Tonini, Giuseppe; Trentin, Leonardo; Ermacora, Paola; Varetto, Antonella; Merlin, Federica; Gori, Stefania; Cascinu, Stefano; Pinto, Carmine

2016-01-01

Early integration of palliative care in oncology practice ("simultaneous care", SC) has been shown to provide better care resulting in improved quality-of-life and also survival. We evaluated the opinions of Italian Association of Medical Oncology (AIOM) members. A 37-item questionnaire was delivered to 1119 AIOM members. Main areas covered were: social, ethical, relational aspects of disease and communication, training, research, organizational and management models in SC. Three open questions explored the definition of Quality of Life, Medical Oncologist and Palliative Care. Four hundred and forty-nine (40.1%) medical oncologists returned the questionnaires. Forty-nine percent stated they address non-curability when giving a diagnosis of metastatic tumor, and 43% give the information only to patients who clearly ask for it. Fifty-five percent say the main formative activity in palliative medicine came from attending meetings and 90% agree that specific palliative care training should be part of the core curriculum in oncology. Twenty-two percent stated they consulted guidelines for symptom management, 45% relied upon personal experience and 26% make a referral to a palliative care specialist. Seventy-four percent were in favor of more research in palliative medicine. An integration between Units of Oncology and Palliative Care Services early in the course of advanced disease was advocated by 86%. Diverse and multifaceted definitions were given for the concepts of Quality of Life, Palliative Care and Medical Oncologist. SC is felt as an important task, as well as training of medical oncologists in symptom management and research in this field.

Impact of Integrated Care Model (ICM) on Direct Medical Costs in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

PubMed

Bandurska, Ewa; Damps-Konstańska, Iwona; Popowski, Piotr; Jędrzejczyk, Tadeusz; Janowiak, Piotr; Świętnicka, Katarzyna; Zarzeczna-Baran, Marzena; Jassem, Ewa

2017-06-12

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

The Scorpion An ideal animal model to study long-term microgravity effects on circadian rhythms

NASA Astrophysics Data System (ADS)

Riewe, Pascal C.; Horn, Eberhard R.

2000-01-01

The temporal pattern of light and darkness is basic for the coordination of circadian rhythms and establishment of homoeostasis. The 24th frequency of zeitgebers is probably a function of the Earth's rotation. The only way to eliminate its influence on organisms is to study their behavior in space because the reduced day length during orbiting the Earth might disrupt synchronizing mechanisms based on the 24th rhythm. The stability of microgravity induced disturbances of synchronization as well as the extent of adaptation of different physiological processes to this novel environment can only be studied during long-term exposures to microgravity, i.e., on the International Space Station. Biological studies within the long-term domain on ISS demand the use of experimental models which can be exposed to automatic handling of measurements and which need less or no nutritional care. Scorpions offer these features. We describe a fully automatic recording device for the simultaneous collection of data regarding the sensorimotor system and homoeostatic mechanisms. In particular, we record sensitivity changes of the eyes, motor activity and heart beat and/or respiratory activity. The advantage of the scorpion model is supported by the fact that data can be recorded preflight, inflight and postflight from the same animal. With this animal model, basic insights will be obtained about the de-coupling of circadian rhythms of multiple oscillators and their adaptation to the entraining zeitgeber periodicity during exposure to microgravity for at least three biological parameters recorded simultaneously. .

A primary health care curriculum in action: the lived experience of primary health care nurses in a school of nursing in the Philippines: a phenomenological study.

PubMed

Arthur, David; Drury, John; Sy-Sinda, Maria Teresita; Nakao, Ramonita; Lopez, Arsenia; Gloria, Grace; Turtal, Rowena; Luna, Evelyn

2006-01-01

Primary health care (PHC) nursing is widely practiced in the Philippines yet little is published about the nurses working in this field nor by these nurses. This paper describes a PHC nursing curriculum conducted in an island in the south of the Philippines and examines the experience of nurses working as faculty and simultaneously providing service to the local community. Data were collected from a convenience sample of faculty by interview and analysed using Huserrlian (descriptive) phenomenology and Colaizzi's method of data analysis. From 102 formulated meanings emerged four theme clusters: teaching PHC; external influences; the working reality and practicing PHC, and these are presented with exemplars from the interviews. The data gives a clear impression of the experience of implementing PHC and working with small communities and highlights the educational and clinical issues inherent in this unique model. The insights gained from the analysis of the interviews are contrasted with current literature and recommendations for future research are made.

Bilateral simultaneous femoral neck and shafts fractures - a case report.

PubMed

Sadeghifar, Amirreza; Saied, Alireza

2014-10-01

Simultaneous fractures of the femoral neck and shaft are not common injuries, though they cannot be considered rare. Herein, we report our experience with a patient with bilateral occurance of this injury. Up to the best of our knowkedge this is the first case reported in literature in which correct diagnosis was made initially. Both femurs were fixed using broad 4.5 mm dynamic compression plate and both necks were fixed using 6.5 mm cannulated screws. Femur fixation on one side was converted to retrograde nailing because of plate failure. Both neck fractures healed uneventfully. In spite of rarity of concomitant fractures of femoral neck and shaft, this injury must be approached carefully demanding especial attention and careful device selection.

Cost-effectiveness of simultaneous versus sequential surgery in head and neck reconstruction.

PubMed

Wong, Kevin K; Enepekides, Danny J; Higgins, Kevin M

2011-02-01

To determine whether simultaneous (ablation and reconstruction overlaps by two teams) head and neck reconstruction is cost effective compared to sequentially (ablation followed by reconstruction) performed surgery. Case-controlled study. Tertiary care hospital. Oncology patients undergoing free flap reconstruction of the head and neck. A match paired comparison study was performed with a retrospective chart review examining the total time of surgery for sequential and simultaneous surgery. Nine patients were selected for both the sequential and simultaneous groups. Sequential head and neck reconstruction patients were pair matched with patients who had undergone similar oncologic ablative or reconstructive procedures performed in a simultaneous fashion. A detailed cost analysis using the microcosting method was then undertaken looking at the direct costs of the surgeons, anesthesiologist, operating room, and nursing. On average, simultaneous surgery required 3 hours 15 minutes less operating time, leading to a cost savings of approximately $1200/case when compared to sequential surgery. This represents approximately a 15% reduction in the cost of the entire operation. Simultaneous head and neck reconstruction is more cost effective when compared to sequential surgery.

A discussion of approaches to transforming care: contemporary strategies to improve patient safety.

PubMed

Burston, Sarah; Chaboyer, Wendy; Wallis, Marianne; Stanfield, Jane

2011-11-01

This article presents a discussion of three contemporary approaches to transforming care: Transforming Care at the Bedside, Releasing Time to Care: the Productive Ward and the work of the Studer Group(®). International studies of adverse events in hospitals have highlighted the need to focus on patient safety. The case for transformational change was identified and recently several approaches have been developed to effect this change. Despite limited evaluation, these approaches have spread and have been adopted outside their country of origin and contextual settings. Medline and CINAHL databases were searched for the years 1999-2009. Search terms included derivatives of 'transformation' combined with 'care', 'nursing', 'patient safety', 'Transforming Care at the Bedside', 'the Productive Ward' and 'Studer Group'. A comparison of the three approaches revealed similarities including: the foci of the approaches; interventions employed; and the outcomes measured. Key differences identified are the implementation models used, spread strategies and sustainability of the approaches. The approaches appear to be complementary and a hybrid of the approaches such as a blend of a top-down and bottom-up leadership strategy may offer more sustainable behavioural change. These approaches transform the way nurses do their work, how they work with others and how they view the care they provide to promote patient safety. All the approaches involve the implementation of multiple interventions occurring simultaneously to affect improvements in patient safety. The approaches are complementary and a hybrid approach may offer more sustainable outcomes. © 2011 Blackwell Publishing Ltd.

A descriptive model for a multidisciplinary unit for colorectal and pelvic malformations.

PubMed

Vilanova-Sanchez, Alejandra; Halleran, Devin R; Reck-Burneo, Carlos A; Gasior, Alessandra C; Weaver, Laura; Fisher, Meghan; Wagner, Andrea; Nash, Onnalisa; Booth, Kristina; Peters, Kaleigh; Williams, Charae; Brown, Sarah Mayer; Lu, Peter; Fuchs, Molly; Diefenbach, Karen; Leonard, Jeffrey R; Hewitt, Geri; McCracken, Kate; Di Lorenzo, Carlo; Wood, Richard J; Levitt, Marc A

2018-04-19

Patients with anorectal malformations (ARM), Hirschsprung disease (HD), and colonic motility disorders often require care from specialists across a variety of fields, including colorectal surgery, urology, gynecology, and GI motility. We sought to describe the process of creating a collaborative process for the care of these complex patients. We developed a model of a devoted center for these conditions that includes physicians, psychologists, social workers, nurses, and advanced practice nurses. Our weekly planning strategy includes a meeting with representatives of all specialties to review all patients prior to evaluation in our multidisciplinary clinic, followed by combined exams under anesthesia or surgical intervention as needed. There are 31 people working directly in the Center at present. From the Center's start in 2014 until 2017, 1258 patients were cared for from all 50 United States and 62 countries. 360 patients had an ARM (110 had a cloacal malformation, 11 had cloacal exstrophy), 223 presented with HD, 71 had a spinal malformation or injury causing neurogenic bowel, 321 had severe functional constipation or colonic dysmotility, and 162 had other diagnoses including familial polyposis, Crohn's disease, or ulcerative colitis. We have had 170 multidisciplinary meetings, 170 multispecialty outpatient, and 52 nurse practitioner clinics. In our bowel management program we have seen a total of 514 patients in 36 sessions. This is the first report describing the design of a multidisciplinary team approach for patients with colorectal and complex pelvic malformations. We found that approaching these patients in a collaborative way allows for combined medical and surgical decisions with many providers simultaneously, facilitates therapy, and can potentially improve patient outcomes. We hope that this model will help establish new-devoted centers in other locations to encourage centralized care for these rare malformations. IV. Copyright © 2018. Published by Elsevier Inc.

Increased mortality risk among the visually impaired: the roles of mental well-being and preventive care practices.

PubMed

Zheng, D Diane; Christ, Sharon L; Lam, Byron L; Arheart, Kristopher L; Galor, Anat; Lee, David J

2012-05-14

Mechanisms by which visual impairment (VI) increases mortality risk are poorly understood. We estimated the direct and indirect effects of self-rated VI on risk of mortality through mental well-being and preventive care practice mechanisms. Using complete data from 12,987 adult participants of the 2000 Medical Expenditure Panel Survey with mortality linkage through 2006, we undertook structural equation modeling using two latent variables representing mental well-being and poor preventive care to examine multiple effect pathways of self-rated VI on all-cause mortality. Generalized linear structural equation modeling was used to simultaneously estimate pathways including the latent variables and Cox regression model, with adjustment for controls and the complex sample survey design. VI increased the risk of mortality directly after adjusting for mental well-being and other covariates (hazard ratio [HR] = 1.25 [95% confidence interval: 1.01, 1.55]). Poor preventive care practices were unrelated to VI and to mortality. Mental well-being decreased mortality risk (HR = 0.68 [0.64, 0.74], P < 0.001). VI adversely affected mental well-being (β = -0.54 [-0.65, -0.43]; P < 0.001). VI also increased mortality risk indirectly through mental well-being (HR = 1.23 [1.16, 1.30]). The total effect of VI on mortality including its influence through mental well-being was HR 1.53 [1.24, 1.90]. Similar but slightly stronger patterns of association were found when examining cardiovascular disease-related mortality, but not cancer-related mortality. VI increases the risk of mortality directly and indirectly through its adverse impact on mental well-being. Prevention of disabling ocular conditions remains a public health priority along with more aggressive diagnosis and treatment of depression and other mental health conditions in those living with VI.

A qualitative study examining the sustainability of shared care in the delivery of palliative care services in the community

PubMed Central

2013-01-01

Background This paper focuses on the sustainability of existing palliative care teams that provide home-based care in a shared care model. For the purposes of this study, following Evashwick and Ory (2003), sustainability is understood and approached as the ability to continue the program over time. Understanding factors that influence the sustainability of teams and ways to mitigate these factors is paramount to improving the longevity and quality of service delivery models of this kind. Methods Using qualitative data collected in interviews, the aim of this study is twofold: (1) to explore the factors that affect the sustainability of the teams at three different scales, and; (2) based on the results of this study, to propose a set of recommendations that will contribute to the sustainability of PC teams. Results Sustainability was conceptualized from two angles: internal and external. An overview of external sustainability was provided and the merging of data from all participant groups showed that the sustainability of teams was largely dependent on actors and organizations at the local (community), regional (Local Health Integration Network or LHIN) and provincial scales. The three scales are not self-contained or singular entities but rather are connected. Integration and collaboration within and between scales is necessary, as community capacity will inevitably reach its threshold without support of the province, which provides funding to the LHIN. While the community continues to advocate for the teams, in the long-term, they will need additional supports from the LHIN and province. The province has the authority and capacity to engrain its support for teams through a formal strategy. The recommendations are presented based on scale to better illustrate how actors and organizations could move forward. Conclusions This study may inform program and policy specific to strategic ways to improve the provision of team-based palliative home care using a shared care model, while simultaneously providing direction for team-based program delivery and sustainability for other jurisdictions. PMID:23984638

Nosocomial Transmission and Genetic Diversity of Rhinovirus in a Neonatal Intensive Care Unit.

PubMed

Marcone, Débora Natalia; Carballal, Guadalupe; Irañeta, Mariela; Rubies, Yamile; Vidaurreta, Santiago M; Echavarría, Marcela

2018-02-01

Rhinoviruses were detected as sole pathogens in 6 preterm infants who developed severe respiratory infections while hospitalized in a neonatal intensive care unit. We confirmed 2 nosocomial rhinovirus transmission episodes and describe the genetic diversity of rhinovirus strains that circulated simultaneously during a winter season. Copyright © 2017 Elsevier Inc. All rights reserved.

Unique issues raised by drug benefit design.

PubMed

Berndt, Ernst R

2004-01-01

In this Perspective on the preceding paper by Joseph Newhouse, I point out a number of features of the pharmaceutical industry that differentiate it from other health care sectors. These differences help explain why it has proved to be so very difficult to construct policies that simultaneously contain health care costs, provide patients with high-quality care, and generate continued incentives for innovation. I then summarize Newhouse's preferred Medicare prescription drug benefit program and the issues it raises.

Universal coverage and cost control: the United Kingdom National Health Service.

PubMed

Maynard, A; Bloor, K

1998-01-01

The UK NHS has a number of important strengths. Its costs are relatively low compared to the health care systems of other developed countries due in part to cash limited central budgeting. It is extremely popular with the electorate and surveys show overall satisfaction with the NHS despite some dissatisfaction with waiting lists and a public perception of underfunding. The NHS model of general medical care provided by independent contractors has been acclaimed as "a British success" (General Medical Services Council, 1983). The role of the UK GP combines providing primary care and acting as a gatekeeper to secondary care. This increases equitable access to care for the population and assists in cost containment. As a model, it is currently being emulated in other countries including Sweden and US Health Maintenance Organizations but, as in these countries, the UK primary care model has been evaluated poorly. There are of course continuing weaknesses in the UK health care system. There is insufficient knowledge upon which to base health care services and increase efficiency. In the future, if a knowledge-based health care service is to be created, a considerable amount of research and evaluation is required to identify "what works" in health care (i.e., what is effective) and also the cost effective ways of altering provider behaviour to maximise the amount of health gain which can be achieved using a limited budget. The NHS reforms created a lot of enthusiasm and energy but its effects are difficult to disentangle from the simultaneous increases in funding. There is little evidence from the UK or elsewhere that competition in health care produces efficiency or improvements in resource allocation. Evaluation is required to identify which of the reforms are increasing efficiency. Competition needs to be used with caution and recognised as a mean and not an end in itself. It is remarkable how both clinical practice and health policy reform, in the UK and elsewhere, is poorly evaluated. Medical practice varies substantially locally, regionally, and internationally, e.g., patients with similar age and stage of cancer receive very different levels of radiotherapy across Europe. For most interventions, the appropriate level of treatment may be asserted but is not based on cost effectiveness knowledge. Health policy analysts, like clinicians, make assertions about competition and other health care reforms which are value- rather than knowledge-based. Both groups of decision-makers should be more cautious, informing their choices with research rather than relying on unsubstantiated optimism!

Movement Advocacy, Personal Relationships, and Ending Health Care Disparities.

PubMed

Chin, Marshall H

2017-01-01

Deep-rooted structural problems drive health care disparities. Compounding the difficulty of attaining health equity, solutions in clinics and hospitals require the cooperation of clinicians, administrators, patients, and the community. Recent protests over police brutality and racism on campuses across America have opened fresh wounds over how best to end racism, with lessons for achieving health equity. Movement advocacy, the mobilizing of the people to raise awareness of an injustice and to advocate for reform, can break down ingrained structural barriers and policies that impede health equity. However, simultaneously advocates, clinicians, and health care organizations must build trusting relationships and resolve conflict with mutual respect and honesty. Tension is inherent in discussions about racial and ethnic disparities. Yet, tension can be constructive if it forces self-examination and spurs systems change and personal growth. We must simultaneously advocate for policy reform, build personal relationships across diverse groups, and honestly examine our biases. Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.

[Nursing Care Experiences of Periwound Moisture-Associated Dermatitis After Simultaneous Pancreas-Kidney Transplantation].

PubMed

Yeh, Pei-Ying; Chen, Hsiao-Ping; Wu, Jing-Yi

2018-04-01

Simultaneous pancreas-kidney (SPK) transplantation is the primary surgical treatment for type I diabetes mellitus with end-stage renal disease. However, this transplant surgery has a high-risk of surgical complications, including duodenal anastomotic leakage, which may lead to pancreas transplantation failure if the leakage worsens. This case report describes a patient who suffered from duodenal anastomotic leakage after SPK transplantation. The digestive enzymes eroded the wound and skin around the wound, resulting in periwound moisture-associated dermatitis. During the period of nursing care, the wound-care intervention was determined by interdisciplinary cooperation. In our case report, the periwound moisture-associated dermatitis healed completely under inter-hospital care. In clinical nursing practice, periwound moisture-associated dermatitis should be cared in combination with macerated wounds. We suggest the following: (1) control the moisture source; (2) use advanced dressings as the primary dressing with sterile gauze as a secondary dressing and silver antimicrobial dressings for infected wounds; (3) consider using negative pressure wound therapy for complicated chronic wounds; and (4) use a pH-neutral skin cleanser with non-woven gauze to clean the periwound skin and keep the skin clean and dry. Finally, we suggest isolating and protecting the skin with No Sting Barrier Film and a hydrocolloid dressing. We hope this nursing care experiences serves as a reference for the nursing care of periwound moisture-associated dermatitis resulting from duodenal anastomotic leakage during / after SPK transplantation.

Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis.

PubMed

Park, Claire Su-Yeon

2017-08-01

To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.

Assessing the context of health care utilization in Ecuador: A spatial and multilevel analysis

PubMed Central

2010-01-01

Background There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services. Methods This study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE). Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level. Results Spatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households. Conclusions There are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers) and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform. PMID:20222988

Using the "customer service framework" to successfully implement patient- and family-centered care.

PubMed

Rangachari, Pavani; Bhat, Anita; Seol, Yoon-Ho

2011-01-01

Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.

[Simultaneous determination of 22 typical pharmaceuticals and personal care products in environmental water using ultra performance liquid chromatography- triple quadrupole mass spectrometry].

PubMed

Wu, Chunying; Gu, Feng; Bai, Lu; Lu, Wenlong

2015-08-01

An analytical method for simultaneous determination of 22 typical pharmaceuticals and personal care products (PPCPs) in environmental water samples was developed by ultra performance liquid chromatography-triple quadrupole mass spectrometry (UPLC-MS/MS). An Oasis HLB solid phase extraction cartridge, methanol as washing solution, water containing 0. 1% formic acid-methanol (7:3, v/v) as the mobile phases were selected for sample pretreatment and chromatographic separation. Based on the optimized sample pretreatment procedures and separation condition, the target recoveries ranged from 73% to 125% in water with the relative standard deviations ( RSDs) from 8.8% to 17.5%, and the linear ranges were from 2 to 2 000 µg/L with correlation coefficients (R2) not less than 0.997. The method can be applied to simultaneous determination of the 22 typical PPCPs in environmental water samples because of its low detection limits and high recoveries. It can provide support and help for the related research on water environmental risk assessment and control of the micro-organic pollutants.

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign.

PubMed

Ellsbury, Dan L; Clark, Reese H; Ursprung, Robert; Handler, Darren L; Dodd, Elizabeth D; Spitzer, Alan R

2016-04-01

Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the "100,000 Babies Campaign." Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record-based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program. From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks' gestation) improved. Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record-based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes. Copyright © 2016 by the American Academy of Pediatrics.

In vivo differentiation of complementary contrast media at dual-energy CT.

PubMed

Mongan, John; Rathnayake, Samira; Fu, Yanjun; Wang, Runtang; Jones, Ella F; Gao, Dong-Wei; Yeh, Benjamin M

2012-10-01

To evaluate the feasibility of using a commercially available clinical dual-energy computed tomographic (CT) scanner to differentiate the in vivo enhancement due to two simultaneously administered contrast media with complementary x-ray attenuation ratios. Approval from the institutional animal care and use committee was obtained, and National Institutes of Health guidelines for the care and use of laboratory animals were observed. Dual-energy CT was performed in a set of iodine and tungsten solution phantoms and in a rabbit in which iodinated intravenous and bismuth subsalicylate oral contrast media were administered. In addition, a second rabbit was studied after intravenous administration of iodinated and tungsten cluster contrast media. Images were processed to produce virtual monochromatic images that simulated the appearance of conventional single-energy scans, as well as material decomposition images that separate the attenuation due to each contrast medium. Clear separation of each of the contrast media pairs was seen in the phantom and in both in vivo animal models. Separation of bowel lumen from vascular contrast medium allowed visualization of bowel wall enhancement that was obscured by intraluminal bowel contrast medium on conventional CT scans. Separation of two vascular contrast media in different vascular phases enabled acquisition of a perfectly coregistered CT angiogram and venous phase-enhanced CT scan simultaneously in a single examination. Commercially available clinical dual-energy CT scanners can help differentiate the enhancement of selected pairs of complementary contrast media in vivo. © RSNA, 2012.

In Vivo Differentiation of Complementary Contrast Media at Dual-Energy CT

PubMed Central

Mongan, John; Rathnayake, Samira; Fu, Yanjun; Wang, Runtang; Jones, Ella F.; Gao, Dong-Wei

2012-01-01

Purpose: To evaluate the feasibility of using a commercially available clinical dual-energy computed tomographic (CT) scanner to differentiate the in vivo enhancement due to two simultaneously administered contrast media with complementary x-ray attenuation ratios. Materials and Methods: Approval from the institutional animal care and use committee was obtained, and National Institutes of Health guidelines for the care and use of laboratory animals were observed. Dual-energy CT was performed in a set of iodine and tungsten solution phantoms and in a rabbit in which iodinated intravenous and bismuth subsalicylate oral contrast media were administered. In addition, a second rabbit was studied after intravenous administration of iodinated and tungsten cluster contrast media. Images were processed to produce virtual monochromatic images that simulated the appearance of conventional single-energy scans, as well as material decomposition images that separate the attenuation due to each contrast medium. Results: Clear separation of each of the contrast media pairs was seen in the phantom and in both in vivo animal models. Separation of bowel lumen from vascular contrast medium allowed visualization of bowel wall enhancement that was obscured by intraluminal bowel contrast medium on conventional CT scans. Separation of two vascular contrast media in different vascular phases enabled acquisition of a perfectly coregistered CT angiogram and venous phase–enhanced CT scan simultaneously in a single examination. Conclusion: Commercially available clinical dual-energy CT scanners can help differentiate the enhancement of selected pairs of complementary contrast media in vivo. © RSNA, 2012 PMID:22778447

The cultural production of Bioterapia: psychic healing and the natural medicine movement in Slovakia.

PubMed

Rubens, D; Gyurkovics, D; Hornacek, K

1995-11-01

Despite powerful opposition, natural medicine (NM) has achieved a toe-hold in the state-run biomedical system in the Slovak Republic. The physician-leader of the NM movement hopes to leverage his ministerial post as NM 'supreme expert' and his interlocking NM clinical and research facilities to achieve a complex, unified health care system under control of medical doctors. This health care model simultaneously reinforces biomedical hegemony and decenters classical medicine by substituting a bioenergetical paradigm. NM includes, among other diagnostic and healing modalities, acupuncture, herbal therapies, bee therapy, reflexology, iridology. However, its paradigmatic form is bioterapia, the focus of this paper. Bioterapia is a form of psychic healing or therapeutic touch. According to its practitioners, it is based on bioenergetic and information-processing principles. Conceptually, bioterapia unifies psyche, soma and energy dimensions of the human body and situates the human organism in an extended transpersonal social, physical and cosmological environment. Bioterapia is a scientized and medicalized reconstruction of a folk healing tradition whose appropriation simultaneously secularized and re-sacralized this tradition by re-locating its practice from lay healers to medical doctors, from the religious domain to the venerated scientific domain, from deviant science to normal science. The reconfiguration into bioterapia as part of the creation of an academic secular parapsychology in the former Soviet Bloc in the late 1960s, illustrates the use of the privileged discourse of science for a cultural production that seems to have both supported and subverted the regime.

The National Long Term Care Demonstration: operational issues encountered in developing the research design.

PubMed

Carcagno, G J; Kemper, P

1983-01-01

This paper describes the design of the National Long Term Care Demonstration and its evaluation and discusses a number of operational issues encountered in the design process: simultaneous design of research and operations, identification of the target population, randomization, collection of comparable data, development of an assessment instrument, potential changes in existing programs, and termination planning.

Competitive Reporter Monitored Amplification (CMA) - Quantification of Molecular Targets by Real Time Monitoring of Competitive Reporter Hybridization

PubMed Central

Ullrich, Thomas; Ermantraut, Eugen; Schulz, Torsten; Steinmetzer, Katrin

2012-01-01

Background State of the art molecular diagnostic tests are based on the sensitive detection and quantification of nucleic acids. However, currently established diagnostic tests are characterized by elaborate and expensive technical solutions hindering the development of simple, affordable and compact point-of-care molecular tests. Methodology and Principal Findings The described competitive reporter monitored amplification allows the simultaneous amplification and quantification of multiple nucleic acid targets by polymerase chain reaction. Target quantification is accomplished by real-time detection of amplified nucleic acids utilizing a capture probe array and specific reporter probes. The reporter probes are fluorescently labeled oligonucleotides that are complementary to the respective capture probes on the array and to the respective sites of the target nucleic acids in solution. Capture probes and amplified target compete for reporter probes. Increasing amplicon concentration leads to decreased fluorescence signal at the respective capture probe position on the array which is measured after each cycle of amplification. In order to observe reporter probe hybridization in real-time without any additional washing steps, we have developed a mechanical fluorescence background displacement technique. Conclusions and Significance The system presented in this paper enables simultaneous detection and quantification of multiple targets. Moreover, the presented fluorescence background displacement technique provides a generic solution for real time monitoring of binding events of fluorescently labelled ligands to surface immobilized probes. With the model assay for the detection of human immunodeficiency virus type 1 and 2 (HIV 1/2), we have been able to observe the amplification kinetics of five targets simultaneously and accommodate two additional hybridization controls with a simple instrument set-up. The ability to accommodate multiple controls and targets into a single assay and to perform the assay on simple and robust instrumentation is a prerequisite for the development of novel molecular point of care tests. PMID:22539973

Organizational culture, intersectoral collaboration and mental health care.

PubMed

Mitchell, Penelope Fay; Pattison, Philippa Eleanor

2012-01-01

This study aims to investigate whether and how organizational culture moderates the influence of other organizational capacities on the uptake of new mental health care roles by non-medical primary health and social care services. Using a cross-sectional survey design, data were collected in 2004 from providers in 41 services in Victoria, Australia, recruited using purposeful sampling. Respondents within each service worked as a group to complete a structured interview that collected quantitative and qualitative data simultaneously. Five domains of organizational capacity were analyzed: leadership, moral support and participation; organizational culture; shared concepts, policies, processes and structures; access to resource support; and social model of health. A principal components analysis explored the structure of data about roles and capacities, and multiple regression analysis examined relationships between them. The unit of analysis was the service (n = 41). Organizational culture was directly associated with involvement in two types of mental health care roles and moderated the influence of factors in the inter-organizational environment on role involvement. Congruence between the values embodied in organizational culture, communicated in messages from the environment, and underlying particular mental health care activities may play a critical role in shaping the emergence of intersectoral working and the uptake of new roles. This study is the first to demonstrate the importance of organizational culture to intersectoral collaboration in health care, and one of very few to examine organizational culture as a predictor of performance, compared with other organizational-level factors, in a multivariate analysis. Theory is developed to explain the findings.

Empowerment of Adolescent Girls for Sexual and Reproductive Health Care: A Qualitative Study.

PubMed

Alimoradi, Zainab; Kariman, Nourossadat; Simbar, Masoumeh; Ahmadi, Fazlollah

2017-12-01

Adolescent girls should be empowered to acquire the ability to take care of their sexual and reproductive health. The present study aimed to improve the understanding of the factors affecting the empowerment of Iranian adolescent girls in terms of taking care of their sexual and reproductive health (e.g. pubertal and menstrual health, preventing high risk sexual behaviors, treatment seeking for sexual and reproductive complaints such as dysmenorrhea, genitalia infection). The present qualitative study was performed using conventional content analysis method. Eight key informants were purposively selected and interviewed. Data collection was performed through unstructured and in-depth interviews. The qualitative content was analyzed simultaneously with data collection based on Graneheim and Lundman method using MAXQDA 2010 software. Data analysis led to the emergence of the main theme of empowerment for care with four classes of reinforcing the foundations of sexual and reproductive health, providing services in health system, reinforcing educational institutions, and consolidating the interaction between adolescent and family, as well as thirteen sub-classes. Results of the present study showed the need for inter-sectional interaction and collaboration among authorities of health systems, education systems, and policymaking institutions to achieve a model for empowering adolescent girls via a multi-level and comprehensive approach.

Implementation of health information technology to maximize efficiency of resource utilization in a geographically dispersed prenatal care delivery system.

PubMed

Cochran, Marlo Baker; Snyder, Russell R; Thomas, Elizabeth; Freeman, Daniel H; Hankins, Gary D V

2012-04-01

This study investigated the utilization of health information technology (HIT) to enhance resource utilization in a geographically dispersed tertiary care system with extensive outpatient and delivery services. It was initiated as a result of a systems change implemented after Hurricane Ike devastated southeast Texas. A retrospective database and electronic medical record review was performed, which included data collection from all patients evaluated 18 months prior (epoch I) and 18 months following (epoch II) the landfall of Hurricane Ike. The months immediately following the storm were omitted from the analysis, allowing time to establish a new baseline. We analyzed a total of 21,201 patients evaluated in triage at the University of Texas Medical Branch. Epoch I consisted of 11,280 patients and epoch II consisted of 9922 patients. Using HIT, we were able to decrease the number of visits to triage while simultaneously managing more complex patients in the outpatient setting with no clinically significant change in maternal or fetal outcome. This study developed an innovated model of care using constrained resources while providing quality and safety to our patients without additional cost to the health care delivery system. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Veiled chameleons: Analyzing urban science teachers' epistemological and ontological beliefs on "caring" for urban students' science literacy

NASA Astrophysics Data System (ADS)

Barrett, Channa Nicole

The present study investigated teachers' epistemological and ontological beliefs and how those beliefs influence "caring" for urban students' science literacy. The grounded theory research involved six teacher participants and 18 student participants and collected the data using the following methods: Teacher and student interviews and six weeks of classroom observations. Using critical race theory (CRT) as a lens, the analysis of the data occurred simultaneously with the data collection. The findings revealed seven categories and 16 themes, which emerged from the analysis on "caring" for students' science literacy. From the CRT model tested in the study, the data illustrated a plethora of evidence relating to the themes colorblindness, interest convergence, and microaggressions. A negative effect of teachers who practiced colorblindness in the classroom revealed an assignment of subordinate positions, meaning the teacher assumed the role of the ultimate-knowledge holder in the classroom and the students assumed an academic co-dependency role in the classroom. Such an environment, allowed the teachers to become epistemically privileged while the students became epistemically oppressed. Implications for teaching suggest that there are different "shades" of caring for students' science literacy and that teachers should acknowledge the vast critical race-gendered epistemologies that students bring into the classroom in an effort to move towards a just epistemic environment.

The French health care system: liberal universalism.

PubMed

Steffen, Monika

2010-06-01

This article analyzes the reforms introduced over the last quarter century into the French health care system. A particular public-private combination, rooted in French history and institutionalized through a specific division of the policy field between private doctors and public hospitals, explains the system's core characteristics: universal access, free choice, high quality, and a weak capacity for regulation. The dual architecture of this unique system leads to different reform strategies and outcomes in its two main parts. While the state has leverage in the hospital sector, it has failed repeatedly in attempts to regulate the ambulatory care sector. The first section of this article sets out the main characteristics and historical landmarks that continue to affect policy framing and implementation. Section 2 focuses on the evolution in financing and access, section 3 on management and governance in the (private) ambulatory care sector, and section 4 on the (mainly public) hospital sector. The conclusion compares the French model with those developed in the comparative literature and sets out the terms of the dilemma: a state-run social health insurance that lacks both the legitimacy of Bismarckian systems and the leverages of state-run systems. The French system therefore pursues contradictory policy goals, simultaneously developing universalism and liberalism, which explains both the direct state intervention and its limits.

Impact of Integrated Care Model (ICM) on Direct Medical Costs in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD)

PubMed Central

Bandurska, Ewa; Damps-Konstańska, Iwona; Popowski, Piotr; Jędrzejczyk, Tadeusz; Janowiak, Piotr; Świętnicka, Katarzyna; Zarzeczna-Baran, Marzena; Jassem, Ewa

2017-01-01

Background Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient’s home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. Material/Methods The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. Results Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). Conclusions The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits. PMID:28603270

ACA and the Triple Aim: Musings of a Health Care Actuary.

PubMed

McCarthy, Mac

2015-01-01

In 2008, the Institute for Healthcare Improvement (IHI) promulgated the Triple Aim, which advocates simultaneous improvements in patient experiences, improved population health and lower cost per capita. In 2010, the Patient Protection and Affordable Care Act (ACA) promised quality, affordable health care for all Americans. It's fair to assume that the framers of ACA were aware of the Triple Aim, and it is likely that much of ACA was heavily influenced by IHI's positions. So it is reasonable, from time to time, to assess ACA's impact on health care against the Triple Aim principles.

Simultaneous Liver-Kidney Transplantation: Impact on Liver Transplant Patients and the Kidney Transplant Waiting List.

PubMed

Miles, Clifford D; Westphal, Scott; Liapakis, AnnMarie; Formica, Richard

2018-01-01

The number of simultaneous liver-kidney transplants (SLKT) performed in the USA has been rising. The Organ Procurement and Transplantation Network implemented a new policy governing SLKT that specifies eligibility criteria for candidates to receive a kidney with a liver, and creates a kidney waitlist "safety net" for liver recipients with persistent renal failure after transplant. This review explores potential impacts for liver patients and the kidney waitlist. Factors that have contributed to the rise in SLKT including Model for End-stage Liver Disease (MELD)-based allocation, regional sharing for high MELD candidates, and the rising incidence of non-alcoholic steatohepatitis will continue to increase the number of liver transplant candidates with concurrent renal insufficiency. The effect of center behavior based on the new policy is harder to predict, given wide historic variability in SLKT practice. Continued increase in combined liver/kidney failure is likely, and SLKT and kidney after liver transplant may both increase. Impact of the new policy should be carefully monitored, but influences beyond the policy need to be accounted for.

Tympanic ear thermometer assessment of body temperature among patients with cognitive disturbances. An acceptable and ethically desirable alternative?

PubMed

Aadal, Lena; Fog, Lisbet; Pedersen, Asger Roer

2016-12-01

Investigation of a possible relation between body temperature measurements by the current generation of tympanic ear and rectal thermometers. In Denmark, a national guideline recommends the rectal measurement. Subsequently, the rectal thermometers and tympanic ear devices are the most frequently used and first choice in Danish hospital wards. Cognitive changes constitute challenges with cooperating in rectal temperature assessments. With regard to diagnosing, ethics, safety and the patients' dignity, the tympanic ear thermometer might comprise a desirable alternative to rectal noninvasive measurement of body temperature during in-hospital-based neurorehabilitation. A prospective, descriptive cohort study. Consecutive inclusion of 27 patients. Linear regression models were used to analyse 284 simultaneous temperature measurements. Ethical approval for this study was granted by the Danish Data Protection Agency, and the study was completed in accordance with the Helsinki Declaration 2008. About 284 simultaneous rectal and ear temperature measurements on 27 patients were analysed. The patient-wise variability of measured temperatures was significantly higher for the ear measurements. Patient-wise linear regressions for the 25 patients with at least three pairs of simultaneous ear and rectal temperature measurements showed large interpatient variability of the association. A linear relationship between the rectal body temperature assessment and the temperature assessment employing the tympanic thermometer is weak. Both measuring methods reflect variance in temperature, but ear measurements showed larger variation. © 2016 Nordic College of Caring Science.

Exploring Geographic Variation of Mental Health Risk and Service Utilization of Doctors and Hospitals in Toronto: A Shared Component Spatial Modeling Approach

PubMed Central

Perlman, Christopher

2018-01-01

Mental Health has been known to vary geographically. Different rates of utilization of mental health services in local areas reflect geographic variation of mental health and complexity of health care. Variations and inequalities in how the health care system addresses risks are two critical issues for addressing population mental health. This study examines these issues by analyzing the utilization of mental health services in Toronto at the neighbourhood level. We adopted a shared component spatial modeling approach that allows simultaneous analysis of two main health service utilizations: doctor visits and hospitalizations related to mental health conditions. Our results reflect a geographic variation of both types of mental health service utilization across neighbourhoods in Toronto. We identified hot and cold spots of mental health risks that are common to both or specific to only one type of health service utilization. Based on the evidence found, we discuss intervention strategies, focusing on the hotspots and provision of health services about doctors and hospitals, to improve mental health for the neighbourhoods. Limitations of the study and further research directions are also discussed. PMID:29587426

Moving the Journey Towards Independence: Adolescents Transitioning to Successful Diabetes Self-Management.

PubMed

Babler, Elizabeth; Strickland, Carolyn June

2015-01-01

To gain a greater understanding of adolescent's experiences living with Type 1 diabetes mellitus (T1DM) and create a theoretical paradigm. Grounded theory as described by Glaser was used. Fifteen in-depth interviews were conducted with adolescent's ages 11-15 with T1DM. Symbolic interactionism is the theoretical framework for grounded theory. Data were collected; transcribed, coded, and analyzed simultaneously using constant comparative analysis and findings were grounded in the words of participants. A theoretical model was created with the concept of "normalizing". Normalizing was defined as the ability to integrate diabetes into one's daily life to make diabetes 'part of me'. Phase four of the model, and the focus of this manuscript was "Moving the Journey towards Independence" and included: 1) taking over care, 2) experiencing conflict with parents, and 3) realizing diabetes is hard. The major task for adolescents in this phase was separating from parents to independently manage diabetes. The normalizing task for this phase was: "taking on the burden of care". Adolescents described challenges with independent care and increased parental conflict including: fearing needles, forgetting insulin, feeling embarrassed and believing that diabetes was a burden in their life. Additionally, juggling the multiple responsibilities of home, school and work along with managing a chronic illness during adolescence is challenging. Transitioning to diabetes self-management is a challenge for adolescents. This model advances understanding of the moving processes in adolescents transitioning; additionally, hypotheses are presented that may be used for developing interventions to promote success in self-management. Copyright © 2015 Elsevier Inc. All rights reserved.

A strategy for scaling up access to comprehensive care in adults with Chagas disease in endemic countries: The Bolivian Chagas Platform.

PubMed

Pinazo, Maria-Jesus; Pinto, Jimy; Ortiz, Lourdes; Sánchez, Jareth; García, Wilson; Saravia, Ruth; Cortez, Mirko-R; Moriana, Silvia; Grau, Enric; Lozano, Daniel; Gascon, Joaquim; Torrico, Faustino

2017-08-01

Bolivia has the highest prevalence of Chagas disease (CD) in the world (6.1%), with more than 607,186 people with Trypanosoma cruzi infection, most of them adults. In Bolivia CD has been declared a national priority. In 2009, the Chagas National Program (ChNP) had neither a protocol nor a clear directive for diagnosis and treatment of adults. Although programs had been implemented for congenital transmission and for acute cases, adults remained uncovered. Moreover, health professionals were not aware of treatment recommendations aimed at this population, and research on CD was limited; it was difficult to increase awareness of the disease, understand the challenges it presented, and adapt strategies to cope with it. Simultaneously, migratory flows that led Bolivian patients with CD to Spain and other European countries forced medical staff to look for solutions to an emerging problem. In this context, thanks to a Spanish international cooperation collaboration, the Bolivian platform for the comprehensive care of adults with CD was created in 2009. Based on the establishment of a vertical care system under the umbrella of ChNP general guidelines, six centres specialized in CD management were established in different epidemiological contexts. A common database, standardized clinical forms, a and a protocolized attention to adults patients, together with training activities for health professionals were essential for the model success. With the collaboration and knowledge transfer activities between endemic and non-endemic countries, the platform aims to provide care, train health professionals, and create the basis for a future expansion to the National Health System of a proven model of care for adults with CD. From 2010 to 2015, a total of 26,227 patients were attended by the Platform, 69% (18,316) were diagnosed with T. cruzi, 8,567 initiated anti-parasitic treatment, more than 1,616 health professionals were trained, and more than ten research projects developed. The project helped to increase the number of adults with CD diagnosed and treated, produce evidence-based clinical practice guidelines, and bring about changes in policy that will increase access to comprehensive care among adults with CD. The ChNP is now studying the Platform's health care model to adapt and implement it nationwide. This strategy provides a solution to unmet demands in the care of patients with CD, improving access to diagnosis and treatment. Further scaling up of diagnosis and treatment will be based on the expansion of the model of care to the NHS structures. Its sustainability will be ensured as it will build on existing local resources in Bolivia. Still human trained resources are scarce and the high staff turnover in Bolivia is a limitation of the model. Nevertheless, in a preliminary two-years-experience of scaling up this model, this limitations have been locally solved together with the health local authorities.

A strategy for scaling up access to comprehensive care in adults with Chagas disease in endemic countries: The Bolivian Chagas Platform

PubMed Central

Pinto, Jimy; Ortiz, Lourdes; Sánchez, Jareth; García, Wilson; Saravia, Ruth; Cortez, Mirko-R; Moriana, Silvia; Grau, Enric; Lozano, Daniel; Gascon, Joaquim; Torrico, Faustino

2017-01-01

Background Bolivia has the highest prevalence of Chagas disease (CD) in the world (6.1%), with more than 607,186 people with Trypanosoma cruzi infection, most of them adults. In Bolivia CD has been declared a national priority. In 2009, the Chagas National Program (ChNP) had neither a protocol nor a clear directive for diagnosis and treatment of adults. Although programs had been implemented for congenital transmission and for acute cases, adults remained uncovered. Moreover, health professionals were not aware of treatment recommendations aimed at this population, and research on CD was limited; it was difficult to increase awareness of the disease, understand the challenges it presented, and adapt strategies to cope with it. Simultaneously, migratory flows that led Bolivian patients with CD to Spain and other European countries forced medical staff to look for solutions to an emerging problem. Intervention In this context, thanks to a Spanish international cooperation collaboration, the Bolivian platform for the comprehensive care of adults with CD was created in 2009. Based on the establishment of a vertical care system under the umbrella of ChNP general guidelines, six centres specialized in CD management were established in different epidemiological contexts. A common database, standardized clinical forms, a and a protocolized attention to adults patients, together with training activities for health professionals were essential for the model success. With the collaboration and knowledge transfer activities between endemic and non-endemic countries, the platform aims to provide care, train health professionals, and create the basis for a future expansion to the National Health System of a proven model of care for adults with CD. Results From 2010 to 2015, a total of 26,227 patients were attended by the Platform, 69% (18,316) were diagnosed with T. cruzi, 8,567 initiated anti-parasitic treatment, more than 1,616 health professionals were trained, and more than ten research projects developed. The project helped to increase the number of adults with CD diagnosed and treated, produce evidence-based clinical practice guidelines, and bring about changes in policy that will increase access to comprehensive care among adults with CD. The ChNP is now studying the Platform’s health care model to adapt and implement it nationwide. Conclusions This strategy provides a solution to unmet demands in the care of patients with CD, improving access to diagnosis and treatment. Further scaling up of diagnosis and treatment will be based on the expansion of the model of care to the NHS structures. Its sustainability will be ensured as it will build on existing local resources in Bolivia. Still human trained resources are scarce and the high staff turnover in Bolivia is a limitation of the model. Nevertheless, in a preliminary two-years-experience of scaling up this model, this limitations have been locally solved together with the health local authorities. PMID:28820896

Liminal and invisible long-term care labour: Precarity in the face of austerity.

PubMed

Daly, Tamara; Armstrong, Pat

2016-09-01

Using feminist political economy, this article argues that companions hired privately by families to care for residents in publicly funded long-term care facilities (nursing homes) are a liminal and invisible labour force. A care gap, created by public sector austerity, has resulted in insufficient staff to meet residents' health and social care needs. Families pay to fill this care gap in public funding with companion care, which limits demands on the state to collectively bear the costs of care for older adults. We assess companions' work in light of Vosko's (2015) and Rodgers and Rodgers' (1989) dimensions for precariousness. We discuss how to classify paid care work that overlaps with paid formal and unpaid informal care. Our findings illuminate how companions' labour is simultaneously autonomous and precarious; it fills a care gap and creates one, and can be relational compared with staffs' task-oriented work.

Liminal and invisible long-term care labour: Precarity in the face of austerity

PubMed Central

Daly, Tamara; Armstrong, Pat

2016-01-01

Using feminist political economy, this article argues that companions hired privately by families to care for residents in publicly funded long-term care facilities (nursing homes) are a liminal and invisible labour force. A care gap, created by public sector austerity, has resulted in insufficient staff to meet residents’ health and social care needs. Families pay to fill this care gap in public funding with companion care, which limits demands on the state to collectively bear the costs of care for older adults. We assess companions’ work in light of Vosko’s (2015) and Rodgers and Rodgers’ (1989) dimensions for precariousness. We discuss how to classify paid care work that overlaps with paid formal and unpaid informal care. Our findings illuminate how companions’ labour is simultaneously autonomous and precarious; it fills a care gap and creates one, and can be relational compared with staffs’ task-oriented work. PMID:27840453

Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial

PubMed Central

Abbott, Allan; Schröder, Karin; Enthoven, Paul; Nilsen, Per; Öberg, Birgitta

2018-01-01

Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP. Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context. Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated. Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project. Date and version identifier 13 December 2017, protocol version 3. Trial registration number NCT03147300; Pre-results. PMID:29691246

Analysis of modeling cumulative noise from simultaneous flights volume 2 : supplemental analysis

DOT National Transportation Integrated Search

2012-12-31

This is the second of two volumes of the report on modeling cumulative noise from simultaneous flights. This volume examines the effect of several modeling input cases on Percent Time Audible results calculated by the Integrated Noise Model. The case...

The Effect of Task Planning on L2 Performance and L2 Development in Text-Based Synchronous Computer-Mediated Communication

ERIC Educational Resources Information Center

Hsu, Hsiu-Chen

2017-01-01

This study explored the effect of two planning conditions [the simultaneous use of rehearsal and careful online planning (ROP), and the careful online planning alone (OP)] on L2 production complexity and accuracy and the subsequent development of these two linguistic areas in the context of text-based synchronous computer-mediated communication.…

The business case for quality.

PubMed

Boehler, Richard; Hardesty, Daniel; Gonzales, Eva; Kasnetz, Karen

2009-10-01

Among the lessons St. Joseph Medical Center learned in implementing a diabetes care management program were that: There is a sound business case for quality with such a program. A sound business plan based on a track record of accomplishments by other organizations is key to gaining clinician buy-in. Deploying dwindling resources to simultaneously improve care and the organization's bottom line requires collaboration between clinicians and finance.

Confirmatory Analysis of Simultaneous, Sequential, and Achievement Factors on the K-ABC at 11 Age Levels Ranging from 2 1/2 to 12 1/2 years.

ERIC Educational Resources Information Center

Willson, Victor L.; And Others

1985-01-01

Presents results of confirmatory factor analysis of the Kaufman Assessment Battery for children which is based on the underlying theoretical model of sequential, simultaneous, and achievement factors. Found support for the two-factor, simultaneous and sequential processing model. (MCF)

FlexibleSUSY-A spectrum generator generator for supersymmetric models

NASA Astrophysics Data System (ADS)

Athron, Peter; Park, Jae-hyeon; Stöckinger, Dominik; Voigt, Alexander

2015-05-01

We introduce FlexibleSUSY, a Mathematica and C++ package, which generates a fast, precise C++ spectrum generator for any SUSY model specified by the user. The generated code is designed with both speed and modularity in mind, making it easy to adapt and extend with new features. The model is specified by supplying the superpotential, gauge structure and particle content in a SARAH model file; specific boundary conditions e.g. at the GUT, weak or intermediate scales are defined in a separate FlexibleSUSY model file. From these model files, FlexibleSUSY generates C++ code for self-energies, tadpole corrections, renormalization group equations (RGEs) and electroweak symmetry breaking (EWSB) conditions and combines them with numerical routines for solving the RGEs and EWSB conditions simultaneously. The resulting spectrum generator is then able to solve for the spectrum of the model, including loop-corrected pole masses, consistent with user specified boundary conditions. The modular structure of the generated code allows for individual components to be replaced with an alternative if available. FlexibleSUSY has been carefully designed to grow as alternative solvers and calculators are added. Predefined models include the MSSM, NMSSM, E6SSM, USSM, R-symmetric models and models with right-handed neutrinos.

Advanced medical imaging protocol workflow-a flexible electronic solution to optimize process efficiency, care quality and patient safety in the National VA Enterprise.

PubMed

Medverd, Jonathan R; Cross, Nathan M; Font, Frank; Casertano, Andrew

2013-08-01

Radiologists routinely make decisions with only limited information when assigning protocol instructions for the performance of advanced medical imaging examinations. Opportunity exists to simultaneously improve the safety, quality and efficiency of this workflow through the application of an electronic solution leveraging health system resources to provide concise, tailored information and decision support in real-time. Such a system has been developed using an open source, open standards design for use within the Veterans Health Administration. The Radiology Protocol Tool Recorder (RAPTOR) project identified key process attributes as well as inherent weaknesses of paper processes and electronic emulators of paper processes to guide the development of its optimized electronic solution. The design provides a kernel that can be expanded to create an integrated radiology environment. RAPTOR has implications relevant to the greater health care community, and serves as a case model for modernization of legacy government health information systems.

Objective Assessment of Surgical Technical Skill and Competency in the Operating Room.

PubMed

Vedula, S Swaroop; Ishii, Masaru; Hager, Gregory D

2017-06-21

Training skillful and competent surgeons is critical to ensure high quality of care and to minimize disparities in access to effective care. Traditional models to train surgeons are being challenged by rapid advances in technology, an intensified patient-safety culture, and a need for value-driven health systems. Simultaneously, technological developments are enabling capture and analysis of large amounts of complex surgical data. These developments are motivating a "surgical data science" approach to objective computer-aided technical skill evaluation (OCASE-T) for scalable, accurate assessment; individualized feedback; and automated coaching. We define the problem space for OCASE-T and summarize 45 publications representing recent research in this domain. We find that most studies on OCASE-T are simulation based; very few are in the operating room. The algorithms and validation methodologies used for OCASE-T are highly varied; there is no uniform consensus. Future research should emphasize competency assessment in the operating room, validation against patient outcomes, and effectiveness for surgical training.

Capacity building for critical care training delivery: Development and evaluation of the Network for Improving Critical care Skills Training (NICST) programme in Sri Lanka.

PubMed

Stephens, Tim; De Silva, A Pubudu; Beane, Abi; Welch, John; Sigera, Chathurani; De Alwis, Sunil; Athapattu, Priyantha; Dharmagunawardene, Dilantha; Peiris, Lalitha; Siriwardana, Somalatha; Abeynayaka, Ashoka; Jayasinghe, Kosala Saroj Amarasena; Mahipala, Palitha G; Dondorp, Arjen; Haniffa, Rashan

2017-04-01

To deliver and evaluate a short critical care nurse training course whilst simultaneously building local training capacity. A multi-modal short course for critical care nursing skills was delivered in seven training blocks, from 06/2013-11/2014. Each training block included a Train the Trainer programme. The project was evaluated using Kirkpatrick's Hierarchy of Learning. There was a graded hand over of responsibility for course delivery from overseas to local faculty between 2013 and 2014. Sri Lanka. Participant learning assessed through pre/post course Multi-Choice Questionnaires. A total of 584 nurses and 29 faculty were trained. Participant feedback was consistently positive and each course demonstrated a significant increase (p≤0.0001) in MCQ scores. There was no significant difference MCQ scores (p=0.186) between overseas faculty led and local faculty led courses. In a relatively short period, training with good educational outcomes was delivered to nearly 25% of the critical care nursing population in Sri Lanka whilst simultaneously building a local faculty of trainers. Through use of a structured Train the Trainer programme, course outcomes were maintained following the handover of training responsibility to Sri Lankan faculty. The focus on local capacity building increases the possibility of long term course sustainability. Copyright © 2016 Elsevier Ltd. All rights reserved.

Radiography for intensive care: participatory process analysis in a PACS-equipped and film/screen environment

NASA Astrophysics Data System (ADS)

Peer, Regina; Peer, Siegfried; Sander, Heike; Marsolek, Ingo; Koller, Wolfgang; Pappert, Dirk; Hierholzer, Johannes

2002-05-01

If new technology is introduced into medical practice it must prove to make a difference. However traditional approaches of outcome analysis failed to show a direct benefit of PACS on patient care and economical benefits are still in debate. A participatory process analysis was performed to compare workflow in a film based hospital and a PACS environment. This included direct observation of work processes, interview of involved staff, structural analysis and discussion of observations with staff members. After definition of common structures strong and weak workflow steps were evaluated. With a common workflow structure in both hospitals, benefits of PACS were revealed in workflow steps related to image reporting with simultaneous image access for ICU-physicians and radiologists, archiving of images as well as image and report distribution. However PACS alone is not able to cover the complete process of 'radiography for intensive care' from ordering of an image till provision of the final product equals image + report. Interference of electronic workflow with analogue process steps such as paper based ordering reduces the potential benefits of PACS. In this regard workflow modeling proved to be very helpful for the evaluation of complex work processes linking radiology and the ICU.

Nursing informatics and nursing ethics: addressing their disconnect through an enhanced TIGER-vision.

PubMed

Kaltoft, Mette Kjer

2013-01-01

All healthcare visions, including that of The TIGER (Technology-Informatics-Guiding-Educational-Reform) Initiative envisage a crucial role for nursing. However, its 7 descriptive pillars do not address the disconnect between Nursing Informatics and Nursing Ethics and their distinct communities in the clinical-disciplinary landscape. Each sees itself as providing decision support by way of information inputs and ethical insights, respectively. Both have reasons - ideological, professional, institutional - for their task construction, but this simultaneously disables each from engaging fully in the point-of-(care)-decision. Increased pressure for translating 'evidence-based' research findings into 'ethically-sound', 'value-based' and 'patient-centered' practice requires rethinking the model implicit in conventional knowledge translation and informatics practice in all disciplines, including nursing. The aim is to aid 'how nurses and other health care scientists more clearly identify clinical and other relevant data that can be captured to inform future comparative effectiveness research. 'A prescriptive, theory-based discipline of '(Nursing) Decisionics' expands the Grid for Volunteer Development of TIGER's newly launched virtual learning environment (VLE). This provides an enhanced TIGER-vision for educational reform to deliver ethically coherent, person-centered care transparently.

Modified social learning theory re-examined: correlates of self-management behaviors of persons with Type 2 diabetes.

PubMed

Nugent, Linda E; Wallston, Kenneth A

2016-12-01

Modified social learning theory (MSLT) applied to health predicts that health behavior is a multiplicative function of health value and perceptions of control over health. The self-management behaviors of persons with Type 2 diabetes mellitus, internal diabetes locus of control (IDLC), diabetes self-efficacy (DSE), and health value (HV) were assessed with an index of diabetes self-care activities in 107 patients receiving insulin. Multiple regression analysis showed DSE as the only MSLT construct that correlated with the index of diabetes self-care behaviors (β = .21, p < .05). While the predicted three-way interaction of IDLC × DSE × HV was significant (∆R 2  = 4.5 %, p < .05) in the final step of the hierarchical model, the pattern of the findings only partially supported MSLT. Instead of finding that patients who were simultaneously high on all three predictors scored highest on the behavioral index, we found that patients who were low on all three constructs reported the least amount of diabetes self-care behavior. Implications for further modification of MSLT and its applications to clinical practice are discussed.

Early Integration of Palliative Care in Oncology Practice: Results of the Italian Association of Medical Oncology (AIOM) Survey

PubMed Central

Zagonel, Vittorina; Torta, Riccardo; Franciosi, Vittorio; Brunello, Antonella; Biasco, Guido; Cattaneo, Daniela; Cavanna, Luigi; Corsi, Domenico; Farina, Gabriella; Fioretto, Luisa; Gamucci, Teresa; Lanzetta, Gaetano; Magarotto, Roberto; Maltoni, Marco; Mastromauro, Cataldo; Melotti, Barbara; Meriggi, Fausto; Pavese, Ida; Piva, Erico; Sacco, Cosimo; Tonini, Giuseppe; Trentin, Leonardo; Ermacora, Paola; Varetto, Antonella; Merlin, Federica; Gori, Stefania; Cascinu, Stefano; Pinto, Carmine

2016-01-01

Background: Early integration of palliative care in oncology practice (“simultaneous care”, SC) has been shown to provide better care resulting in improved quality-of-life and also survival. We evaluated the opinions of Italian Association of Medical Oncology (AIOM) members. Patients and methods: A 37-item questionnaire was delivered to 1119 AIOM members. Main areas covered were: social, ethical, relational aspects of disease and communication, training, research, organizational and management models in SC. Three open questions explored the definition of Quality of Life, Medical Oncologist and Palliative Care. Results: Four hundred and forty-nine (40.1%) medical oncologists returned the questionnaires. Forty-nine percent stated they address non-curability when giving a diagnosis of metastatic tumor, and 43% give the information only to patients who clearly ask for it. Fifty-five percent say the main formative activity in palliative medicine came from attending meetings and 90% agree that specific palliative care training should be part of the core curriculum in oncology. Twenty-two percent stated they consulted guidelines for symptom management, 45% relied upon personal experience and 26% make a referral to a palliative care specialist. Seventy-four percent were in favor of more research in palliative medicine. An integration between Units of Oncology and Palliative Care Services early in the course of advanced disease was advocated by 86%. Diverse and multifaceted definitions were given for the concepts of Quality of Life, Palliative Care and Medical Oncologist. Conclusion: SC is felt as an important task, as well as training of medical oncologists in symptom management and research in this field. PMID:27877212

The challenges of primary health care nurse leaders in the wake of New Health Care Reform in Norway.

PubMed

Tingvoll, Wivi-Ann; Sæterstrand, Torill; McClusky, Leon Mendel

2016-01-01

The local municipality, whose management style is largely inspired by the New Public Management (NPM) model, has administrative responsibilities for primary health care in Norway. Those responsible for health care at the local level often find themselves torn between their professional responsibilities and the municipality's market-oriented funding system. The introduction of the new health care reform process known as the Coordination Reform in January 2012 prioritises primary health care while simultaneously promoting a more collaborative and multidisciplinary approach to health care. Nurse leaders experience constant cross-pressure in their roles as members of the municipal executive team, the execution of their professional and administrative duties, and the overall political aims of the new reform. The aim of this article is to illuminate some of the major challenges facing nurse leaders in charge of nursing homes and to draw attention to their professional concerns about the quality of nursing care with the introduction of the new reform and its implementation under NPM-inspired municipal executive leadership. This study employs a qualitative design. In-depth interviews were conducted with 10 nurse leaders in 10 municipalities, with a phenomenological-hermeneutic approach used for data analysis and interpretation. Findings highlighted the increasingly complex challenges facing nurse leaders operating in the context of the municipality's hierarchical NPM management structure, while they are required to exercise collaborative professional interactions as per the guidelines of the new Coordination Reform. The interview findings were interpreted out of three sub-themes 1) importance of support for the nurse leader, 2) concerns about overall service quality, and 3) increased tasks unrelated to nursing leadership. The priorities of municipal senior management and the focus of the municipality's care service need clarification in the light of this reform. The voices of those at the frontlines of the caring services need to be heard as the restructuring of the caring services may have implications both for funding allocation and for the quality of patient care.

A farm-level precision land management framework based on integer programming

PubMed Central

Li, Qi; Hu, Guiping; Jubery, Talukder Zaki; Ganapathysubramanian, Baskar

2017-01-01

Farmland management involves several planning and decision making tasks including seed selection and irrigation management. A farm-level precision farmland management model based on mixed integer linear programming is proposed in this study. Optimal decisions are designed for pre-season planning of crops and irrigation water allocation. The model captures the effect of size and shape of decision scale as well as special irrigation patterns. The authors illustrate the model with a case study on a farm in the state of California in the U.S. and show the model can capture the impact of precision farm management on profitability. The results show that threefold increase of annual net profit for farmers could be achieved by carefully choosing irrigation and seed selection. Although farmers could increase profits by applying precision management to seed or irrigation alone, profit increase is more significant if farmers apply precision management on seed and irrigation simultaneously. The proposed model can also serve as a risk analysis tool for farmers facing seasonal irrigation water limits as well as a quantitative tool to explore the impact of precision agriculture. PMID:28346499

Coupling of the simultaneous heat and water model with a distributed hydrological model and evaluation of the combined model in a cold region watershed

USDA-ARS?s Scientific Manuscript database

To represent the effects of frozen soil on hydrology in cold regions, a new physically based distributed hydrological model has been developed by coupling the simultaneous heat and water model (SHAW) with the geomorphology based distributed hydrological model (GBHM), under the framework of the water...

Hospital positioning: a strategic tool for the 1990s.

PubMed

San Augustine, A J; Long, W J; Pantzallis, J

1992-03-01

The authors extend the process of market positioning in the health care sector by focusing on the simultaneous utilization of traditional research methods and emerging new computer-based adaptive perceptual mapping technologies and techniques.

Patients’ Interactions With Physicians and Complementary and Alternative Medicine Practitioners: Older Women With Breast Cancer and Self-Managed Health Care

PubMed Central

Adler, Shelley R.; Wrubel, Judith; Hughes, Ellen; Beinfield, Harriet

2009-01-01

Older patients are more likely than ever to be under the care of both physicians and complementary and alternative medicine (CAM) practitioners, yet there is little research on older patients’ experience of these different relationships. This article addresses older breast cancer patients’ seeking of concurrent care and examines patients’ understandings of interactions with physicians and CAM practitioners. This is a qualitative study of a random, population-based sample of 44 older women with breast cancer who are simultaneously under the care of at least 1 physician and 1 CAM practitioner. PMID:19147647

Bundling the value of discharge telephone calls and leader rounding.

PubMed

Setia, Nina; Meade, Christine

2009-03-01

Discharge telephone calls made by hospital staff provide invaluable opportunities to prevent adverse events, improve quality of care, and increase patient satisfaction. Similarly, the effect of rounding on patients can improve clinical quality and improve both patient and staff satisfaction. The author discusses how the combination of implementing both nurse leader rounding and discharge telephone calls simultaneously produced powerful positive outcomes in satisfaction and patient quality of care.

The 24-h recall instrument for home nursing to measure the activity profile of home nurses: development and psychometric testing.

PubMed

De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Gosset, Christiane; Heyden, Isabelle; Van Geert, Michel; Moons, Philip

2015-01-01

Home health care today is challenged by a shift from an acute to a chronic health-care model, moving the focus of care from the hospital to home-care setting. This increased focus on care at home emphasizes the need for an efficient, effective, and transparent management of home health care. However, it is not precisely known what home-care nurses do; what kind of care is received by patients; what the performance of home nurses is; and what the impact of the increasing need for home nursing is on the current and future role of home nurses. In this respect, it is necessary to gain a clear insight into the activity profile of home nurses, but there is no gold standard to measure their activities. This study reports on the development and psychometric testing of the '24-hour recall instrument for home nursing' to measure the activity profile of home nurses. Five home nurses in Belgium, simultaneously with the researcher, registered the performed activities in a total of 69 patients, using the 24-h recall instrument for home nursing. The validity and the interrater reliability of this instrument were high: the proportions that observed agreement were very high; the strength of kappa agreement was substantial to almost perfect; the prevalence index showed great variety; and the bias index was low. The findings in this study support the validity evidence based on test content and the interrater reliability of the 24-h recall instrument. This instrument can help to shape practice and policy by making the home nursing profession more transparent: a clear insight into the kind of care that is provided by home nurses and is received by the patients in primary care contributes to the development of a clear definition of the role of home nurses in health care.

Getting more than they realized they needed: a qualitative study of women's experience of group prenatal care

PubMed Central

2012-01-01

Background Pregnant women in Canada have traditionally received prenatal care individually from their physicians, with some women attending prenatal education classes. Group prenatal care is a departure from these practices providing a forum for women to experience medical care and child birth education simultaneously and in a group setting. Although other qualitative studies have described the experience of group prenatal care, this is the first which sought to understand the central meaning or core of the experience. The purpose of this study was to understand the central meaning of the experience of group prenatal care for women who participated in CenteringPregnancy through a maternity clinic in Calgary, Canada. Methods The study used a phenomenological approach. Twelve women participated postpartum in a one-on-one interview and/or a group validation session between June 2009 and July 2010. Results Six themes emerged: (1) "getting more in one place at one time"; (2) "feeling supported"; (3) "learning and gaining meaningful information"; (4) "not feeling alone in the experience"; (5) "connecting"; and (6) "actively participating and taking on ownership of care". These themes contributed to the core phenomenon of women "getting more than they realized they needed". The active sharing among those in the group allowed women to have both their known and subconscious needs met. Conclusions Women's experience of group prenatal care reflected strong elements of social support in that women had different types of needs met and felt supported. The findings also broadened the understanding of some aspects of social support beyond current theories. In a contemporary North American society, the results of this study indicate that women gain from group prenatal care in terms of empowerment, efficiency, social support and education in ways not routinely available through individual care. This model of care could play a key role in addressing women's needs and improving health outcomes. PMID:22436393

SMART DOCS: A New Patient-Centered Outcomes and Coordinated-Care Management Approach for the Future Practice of Sleep Medicine

PubMed Central

Kushida, Clete A.; Nichols, Deborah A.; Holmes, Tyson H.; Miller, Ric; Griffin, Kara; Cardell, Chia-Yu; Hyde, Pamela R.; Cohen, Elyse; Manber, Rachel; Walsh, James K.

2015-01-01

The practice of medicine is currently undergoing a transformation to become more efficient, cost-effective, and patient centered in its delivery of care. The aim of this article is to stimulate discussion within the sleep medicine community in addressing these needs by our approach as well as other approaches to sleep medicine care. The primary goals of the Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS) are: (1) to introduce a new Patient-Centered Outcomes and Coordinated-Care Management (PCCM) approach for the future practice of sleep medicine, and (2) to test the PCCM approach against a Conventional Diagnostic and Treatment Outpatient Medical Care (CONV) approach in a randomized, two-arm, single-center, long-term, comparative effectiveness trial. The PCCM approach is integrated into a novel outpatient care delivery model for patients with sleep disorders that includes the latest technology, allowing providers to obtain more accurate and rapid diagnoses and to make evidence-based treatment recommendations, while simultaneously enabling patients to have access to personalized medical information and reports regarding their diagnosis and treatment so that they can make more informed health care decisions. Additionally, the PCCM approach facilitates better communication between patients, referring primary care physicians, sleep specialists, and allied health professionals so that providers can better assist patients in achieving their preferred outcomes. A total of 1,506 patients 18 y or older will be randomized to either the PCCM or CONV approach and will be followed for at least 1 y with endpoints of improved health care performance, better health, and cost control. Clinical Trials Registration: ClinicalTrials.gov Identifier: NCT02037438. Citation: Kushida CA, Nichols DA, Holmes TH, Miller R, Griffin K, Cardell CY, Hyde PR, Cohen E, Manber R, Walsh JK. SMART DOCS: a new patient-centered outcomes and coordinated-care management approach for the future practice of sleep medicine. SLEEP 2015;38(2):315–326. PMID:25409112

Explanatory models and distress in primary caregivers of patients with acute psychotic presentations: A study from South India.

PubMed

Joy, Deepa S; Manoranjitham, S D; Samuel, P; Jacob, K S

2017-11-01

Emotional distress among caregivers of people with mental illness is common, changes overtime and requires appropriate coping strategies to prevent long-term disability. Explanatory models, which underpin understanding of disease and illness, are crucial to coping. To study the association of explanatory models and distress among caregivers of people with acute psychotic illness. A total of 60 consecutive patients and their primary caregivers who presented to the Department of Psychiatry, Christian Medical College, Vellore, were recruited for the study. Positive and Negative Syndrome Scale (PANSS), Short Explanatory Model Interview (SEMI) and the General Health Questionnaire-12 (GHQ-12) were used to assess severity of psychosis, explanatory models of illness and emotional distress. Standard bivariate and multivariable statistics were employed. Majority of the caregivers simultaneously held multiple models of illness, which included medical and non-medical perspectives. The GHQ-12 score were significantly lower in people who held multiple explanatory models of illness when compared to the caregivers who believed single explanations. Explanatory models affect coping in caregivers of patients with acute psychotic presentations. There is a need to have a broad-based approach to recovery and care.

Platinum nanozymes recover cellular ROS homeostasis in an oxidative stress-mediated disease model

NASA Astrophysics Data System (ADS)

Moglianetti, Mauro; de Luca, Elisa; Pedone, Deborah; Marotta, Roberto; Catelani, Tiziano; Sartori, Barbara; Amenitsch, Heinz; Retta, Saverio Francesco; Pompa, Pier Paolo

2016-02-01

In recent years, the use of nanomaterials as biomimetic enzymes has attracted great interest. In this work, we show the potential of biocompatible platinum nanoparticles (Pt NPs) as antioxidant nanozymes, which combine abundant cellular internalization and efficient scavenging activity of cellular reactive oxygen species (ROS), thus simultaneously integrating the functions of nanocarriers and antioxidant drugs. Careful toxicity assessment and intracellular tracking of Pt NPs proved their cytocompatibility and high cellular uptake, with compartmentalization within the endo/lysosomal vesicles. We have demonstrated that Pt NPs possess strong and broad antioxidant properties, acting as superoxide dismutase, catalase, and peroxidase enzymes, with similar or even superior performance than natural enzymes, along with higher adaptability to the changes in environmental conditions. We then exploited their potent activity as radical scavenging materials in a cellular model of an oxidative stress-related disorder, namely human Cerebral Cavernous Malformation (CCM) disease, which is associated with a significant increase in intracellular ROS levels. Noteworthily, we found that Pt nanozymes can efficiently reduce ROS levels, completely restoring the cellular physiological homeostasis.In recent years, the use of nanomaterials as biomimetic enzymes has attracted great interest. In this work, we show the potential of biocompatible platinum nanoparticles (Pt NPs) as antioxidant nanozymes, which combine abundant cellular internalization and efficient scavenging activity of cellular reactive oxygen species (ROS), thus simultaneously integrating the functions of nanocarriers and antioxidant drugs. Careful toxicity assessment and intracellular tracking of Pt NPs proved their cytocompatibility and high cellular uptake, with compartmentalization within the endo/lysosomal vesicles. We have demonstrated that Pt NPs possess strong and broad antioxidant properties, acting as superoxide dismutase, catalase, and peroxidase enzymes, with similar or even superior performance than natural enzymes, along with higher adaptability to the changes in environmental conditions. We then exploited their potent activity as radical scavenging materials in a cellular model of an oxidative stress-related disorder, namely human Cerebral Cavernous Malformation (CCM) disease, which is associated with a significant increase in intracellular ROS levels. Noteworthily, we found that Pt nanozymes can efficiently reduce ROS levels, completely restoring the cellular physiological homeostasis. Electronic supplementary information (ESI) available. See DOI: 10.1039/c5nr08358c

An institutional staff training and self-management program for developing multiple self-care skills in severely/profoundly retarded individuals.

PubMed Central

Kissel, R C; Whitman, T L; Reid, D H

1983-01-01

Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, haircombing, handwashing), four direct care staff were sequentially taught to use verbal instruction, physical guidance, and contingent reinforcement in the toothbrushing program. During maintenance, staff were simultaneously taught to record, graph, and evaluate resident and their own behavior in the toothbrushing sessions. Staff were taught use of the training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Observer presence and experimenter supervision were gradually decreased during the maintenance condition. Results indicated that during training and maintenance staff: (a) learned to use the training skills appropriately and consistently in the example situation (toothbrushing); (b) applied the skills in the generalization situations (haircombing and handwashing); and thereafter (c) maintained consistent and appropriate use of the skills with infrequent supervision. In addition, important changes in retarded residents' independent self-care responding occurred as staff training skills developed. Results are discussed in terms of their implications for future research and continued development of effective staff training and management programs. PMID:6654771

[Analysis of the web pages of the intensive care units of Spain].

PubMed

Navarro-Arnedo, J M

2009-01-01

In order to determine the Intensive Care Units (ICU) of Spanish hospitals that had a web site, to analyze the information they offered and to know what information they needed to offer according to a sample of ICU nurses, a cross-sectional observational, descriptive study was carried out between January and September 2008. For each ICU website, an analysis was made on the information available on the unit, its care, teaching and research activity on nursing. Simultaneously, based on a sample of intensive care nurses, the information that should be contained on an ICU website was determined. The results, expressed in absolute numbers and percentage, showed that 66 of the 292 hospitals with ICU (22.6%) had a web site; 50.7% of the sites showed the number of beds, 19.7% the activity report, 11.3% the published articles/studies and followed research lines and 9.9% the organized formation courses. 14 webs (19.7%) displayed images of nurses. However, only 1 (1.4%) offered guides on the actions followed. No web site offered a navigation section for nursing, the E-mail of the chief nursing, the nursing documentation used or if any nursing model of their own was used. It is concluded that only one-fourth of the Spanish hospitals with ICU have a web site; number of beds was the data offered by the most sites, whereas information on care, educational and investigating activities was very reduced and that on nursing was practically omitted on the web pages of intensive care units.

Investing in our future: unrealized opportunities for funding graduate psychology training.

PubMed

Reid-Arndt, Stephanie A; Stucky, Kirk; Cheak-Zamora, Nancy; DeLeon, Patrick H; Frank, Robert G

2010-11-01

Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Discovering Structural Regularity in 3D Geometry

PubMed Central

Pauly, Mark; Mitra, Niloy J.; Wallner, Johannes; Pottmann, Helmut; Guibas, Leonidas J.

2010-01-01

We introduce a computational framework for discovering regular or repeated geometric structures in 3D shapes. We describe and classify possible regular structures and present an effective algorithm for detecting such repeated geometric patterns in point- or mesh-based models. Our method assumes no prior knowledge of the geometry or spatial location of the individual elements that define the pattern. Structure discovery is made possible by a careful analysis of pairwise similarity transformations that reveals prominent lattice structures in a suitable model of transformation space. We introduce an optimization method for detecting such uniform grids specifically designed to deal with outliers and missing elements. This yields a robust algorithm that successfully discovers complex regular structures amidst clutter, noise, and missing geometry. The accuracy of the extracted generating transformations is further improved using a novel simultaneous registration method in the spatial domain. We demonstrate the effectiveness of our algorithm on a variety of examples and show applications to compression, model repair, and geometry synthesis. PMID:21170292

The maze and the minotaur: mental health in primary health care.

PubMed

Hirdes, Alice; Scarparo, Helena Beatriz Kochenborger

2015-02-01

The article aims to discuss the issue of integration of mental health in primary care by matrix support in mental health. We point out the main barriers in the use of this work method, as well as the facilitating factors of the matrix support of mental health in primary care. The first are within the scope of epistemological specificities, professional issues and management in the political and ideological dimensions. Among the second, we highlight: the care for people with mental disorders in the territory; the reduction of stigma and discrimination; the development of new skills for professionals in primary care; reduction of costs; simultaneous treatment of physical and mental illness, which often overlap; the possibility of incorporating mental health care in a perspective of extended clinical service using an inter/transdisciplinary approach.

Multitasking simulation: Present application and future directions.

PubMed

Adams, Traci Nicole; Rho, Jason C

2017-02-01

The Accreditation Council for Graduate Medical Education lists multi-tasking as a core competency in several medical specialties due to increasing demands on providers to manage the care of multiple patients simultaneously. Trainees often learn multitasking on the job without any formal curriculum, leading to high error rates. Multitasking simulation training has demonstrated success in reducing error rates among trainees. Studies of multitasking simulation demonstrate that this type of simulation is feasible, does not hinder the acquisition of procedural skill, and leads to better performance during subsequent periods of multitasking. Although some healthcare agencies have discouraged multitasking due to higher error rates among multitasking providers, it cannot be eliminated entirely in settings such as the emergency department in which providers care for more than one patient simultaneously. Simulation can help trainees to identify situations in which multitasking is inappropriate, while preparing them for situations in which multitasking is inevitable.

Creating a high-value delivery system for health care.

PubMed

Teisberg, Elizabeth O; Wallace, Scott

2009-01-01

Health care reform that focuses on improving value enhances both the well-being of patients and the professional satisfaction of physicians. Value in health care is the improvement in health outcomes achieved for patients relative to the money spent. Dramatic and ongoing improvement in the value of health care delivered will require fundamental restructuring of the system. Current efforts to improve safety and reduce waste are truly important but not sufficient. The following three structural changes will drive simultaneous improvement in outcomes and efficiency: (1) reorganizing care delivery into clinically integrated teams defined by patient needs over the full cycle of care; (2) measuring and reporting patient outcomes by clinical teams, across the cycle of care and for identified clusters of medical circumstances; and (3) enabling reimbursement tied to value rather than to quantity of services. Many of these changes require physician leadership. We discuss steps on the journey to value-based care delivery.

Healthcare's Future: Strategic Investment in Technology.

PubMed

Franklin, Michael A

2018-01-01

Recent and rapid advances in the implementation of technology have greatly affected the quality and efficiency of healthcare delivery in the United States. Simultaneously, diverse generational pressures-including the consumerism of millennials and unsustainable growth in the costs of care for baby boomers-have accelerated a revolution in healthcare delivery that was marked in 2010 by the passage of the Affordable Care Act.Against this backdrop, Maryland and the Centers for Medicare & Medicaid Services entered into a partnership in 2014 to modernize the Maryland All-Payer Model. Under this architecture, each Maryland hospital negotiates a global budget revenue agreement with the state's rate-setting agency, limiting the hospital's annual revenue to the budgetary cap established by the state.At Atlantic General Hospital (AGH), leaders had established a disciplined strategic planning process in which the board of trustees, medical staff, and administration annually agree on goals and initiatives to achieve the objectives set forth in its five-year strategic plans. This article describes two initiatives to improve care using technology. In 2006, AGH introduced a service guarantee in the emergency room (ER); the ER 30-Minute Promise assures patients that they will be placed in a bed or receive care within 30 minutes of arrival in the ER. In 2007, several independent hospitals in the state formed Maryland eCare to jointly contract for intensive care unit (ICU) physician coverage via telemedicine. This technology allows clinical staff to continuously monitor ICU patients remotely. The positive results of the ER 30-Minute Promise and Maryland eCare program show that technological advances in an independent, small, rural hospital can make a significant impact on its ability to maintain independence. AGH's strategic investments prepared the organization well for the transition in 2014 to a value-based payment system.

Care for the chronically ill: Nursing home incentive payment experiment

PubMed Central

Weissert, William G.; Scanlon, William J.; Wan, Thomas T. H.; Skinner, Douglas E.

1983-01-01

Nursing home reinbursement systems which do not adjust payment levels to patient care needs lead to access problems for heavy-care patients. Unnecessarily long and costly hospital stays may result. A patient-based nursing home incentive reimbursement system has been designed and is being evaluated in a controlled field experiment in 36 California skilled nursing facilities. Incentives are paid for admitting heavy-care patients, meeting outcome goals on some patients, and discharging and maintaining some patients in the community. This article describes a nursing home reimbursement system which is intended to simultaneously mitigate problems of restricted access, inefficient use of beds, and nonoptimal care. It also discusses the approach to evaluating this broad social intervention by application of a controlled experimental design. PMID:10310528

The Experiences of Reciprocity among Filipino Older Adults in Canada: Intergenerational, Transnational, and Community Considerations.

PubMed

Ferrer, Ilyan; Brotman, Shari; Grenier, Amanda

2017-01-01

This article illustrates the concept of reciprocity in the context of immigrant families. It recommends that definition of reciprocity account for exchanges beyond the immediate family, and render visible the simultaneous location of older people as care recipients and providers, and care arrangements across generations, borders, community, and time. Adopting a critical ethnographic study on the aging and care experiences of older Filipinos in Canada, this article analyzes data from extended observations and in-depth semi-structured interviews with 18 older people, 6 adult children, and 13 community stakeholders. Findings highlight the unique configurations of care among the Filipino community whereby older people engage in care exchange as active participants across intergenerational, transnational, and fictive kin networks.

Privacy in Pharmacogenetics: An End-to-End Case Study of Personalized Warfarin Dosing.

PubMed

Fredrikson, Matthew; Lantz, Eric; Jha, Somesh; Lin, Simon; Page, David; Ristenpart, Thomas

2014-08-01

We initiate the study of privacy in pharmacogenetics, wherein machine learning models are used to guide medical treatments based on a patient's genotype and background. Performing an in-depth case study on privacy in personalized warfarin dosing, we show that suggested models carry privacy risks, in particular because attackers can perform what we call model inversion : an attacker, given the model and some demographic information about a patient, can predict the patient's genetic markers. As differential privacy (DP) is an oft-proposed solution for medical settings such as this, we evaluate its effectiveness for building private versions of pharmacogenetic models. We show that DP mechanisms prevent our model inversion attacks when the privacy budget is carefully selected . We go on to analyze the impact on utility by performing simulated clinical trials with DP dosing models. We find that for privacy budgets effective at preventing attacks, patients would be exposed to increased risk of stroke, bleeding events, and mortality . We conclude that current DP mechanisms do not simultaneously improve genomic privacy while retaining desirable clinical efficacy, highlighting the need for new mechanisms that should be evaluated in situ using the general methodology introduced by our work.

Privacy in Pharmacogenetics: An End-to-End Case Study of Personalized Warfarin Dosing

PubMed Central

Fredrikson, Matthew; Lantz, Eric; Jha, Somesh; Lin, Simon; Page, David; Ristenpart, Thomas

2014-01-01

We initiate the study of privacy in pharmacogenetics, wherein machine learning models are used to guide medical treatments based on a patient’s genotype and background. Performing an in-depth case study on privacy in personalized warfarin dosing, we show that suggested models carry privacy risks, in particular because attackers can perform what we call model inversion: an attacker, given the model and some demographic information about a patient, can predict the patient’s genetic markers. As differential privacy (DP) is an oft-proposed solution for medical settings such as this, we evaluate its effectiveness for building private versions of pharmacogenetic models. We show that DP mechanisms prevent our model inversion attacks when the privacy budget is carefully selected. We go on to analyze the impact on utility by performing simulated clinical trials with DP dosing models. We find that for privacy budgets effective at preventing attacks, patients would be exposed to increased risk of stroke, bleeding events, and mortality. We conclude that current DP mechanisms do not simultaneously improve genomic privacy while retaining desirable clinical efficacy, highlighting the need for new mechanisms that should be evaluated in situ using the general methodology introduced by our work. PMID:27077138

Simultaneous mapping of pan and sentinel lymph nodes for real-time image-guided surgery.

PubMed

Ashitate, Yoshitomo; Hyun, Hoon; Kim, Soon Hee; Lee, Jeong Heon; Henary, Maged; Frangioni, John V; Choi, Hak Soo

2014-01-01

The resection of regional lymph nodes in the basin of a primary tumor is of paramount importance in surgical oncology. Although sentinel lymph node mapping is now the standard of care in breast cancer and melanoma, over 20% of patients require a completion lymphadenectomy. Yet, there is currently no technology available that can image all lymph nodes in the body in real time, or assess both the sentinel node and all nodes simultaneously. In this study, we report an optical fluorescence technology that is capable of simultaneous mapping of pan lymph nodes (PLNs) and sentinel lymph nodes (SLNs) in the same subject. We developed near-infrared fluorophores, which have fluorescence emission maxima either at 700 nm or at 800 nm. One was injected intravenously for identification of all regional lymph nodes in a basin, and the other was injected locally for identification of the SLN. Using the dual-channel FLARE intraoperative imaging system, we could identify and resect all PLNs and SLNs simultaneously. The technology we describe enables simultaneous, real-time visualization of both PLNs and SLNs in the same subject.

Primary care in an unstable security, humanitarian, economic and political context: the Kurdistan Region of Iraq.

PubMed

Shukor, Ali R; Klazinga, Niek S; Kringos, Dionne S

2017-08-23

This study presents a descriptive synthesis of Kurdistan Region of Iraq's (KRI) primary care system, which is undergoing comprehensive primary care reforms within the context of a cross-cutting structural economic adjustment program and protracted security, humanitarian, economic and political crises. The descriptive analysis used a framework operationalizing Starfield's classic primary care model for health services research. A scoping review was performed using relevant sources, and expert consultations were conducted for completing and validating data. The descriptive analysis presents a complex narrative of a primary care system undergoing classical developmental processes of transitioning middle-income countries. The system is simultaneously under tremendous pressure to adapt to the continuously changing, complex and resource-intensive needs of sub-populations exhibiting varying morbidity patterns, within the context of protracted security, humanitarian, economic, and political crises. Despite exhibiting significant resilience in the face of the ongoing crises, the continued influx of IDPs and Syrian refugees, coupled with extremely limited resources and weak governance at policy, organizational and clinical levels threaten the sustainability of KRI's public primary care system. Diverse trajectories to the strengthening and development of primary care are underway by local and international actors, notably the World Bank, RAND Corporation, UN organizations and USAID, focusing on varying imperatives related to the protracted humanitarian and economic crises. The convergence, interaction and outcomes of the diverse initiatives and policy approaches in relation to the development of KRI's primary care system are complex and highly uncertain. A common vision of primary care is required to align resources, initiatives and policies, and to enable synergy between all local and international actors involved in the developmental and humanitarian response. Further research that integrates the knowledge synthesized in this article, and enables actors in KRI to learn from their own experiences and efforts, along with those of other jurisdictions, would be invaluable towards the ongoing development of primary care.

Magnetic immunoassay coupled with inductively coupled plasma mass spectrometry for simultaneous quantification of alpha-fetoprotein and carcinoembryonic antigen in human serum

NASA Astrophysics Data System (ADS)

Zhang, Xing; Chen, Beibei; He, Man; Zhang, Yiwen; Xiao, Guangyang; Hu, Bin

2015-04-01

The absolute quantification of glycoproteins in complex biological samples is a challenge and of great significance. Herein, 4-mercaptophenylboronic acid functionalized magnetic beads were prepared to selectively capture glycoproteins, while antibody conjugated gold and silver nanoparticles were synthesized as element tags to label two different glycoproteins. Based on that, a new approach of magnetic immunoassay-inductively coupled plasma mass spectrometry (ICP-MS) was established for simultaneous quantitative analysis of glycoproteins. Taking biomarkers of alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) as two model glycoproteins, experimental parameters involved in the immunoassay procedure were carefully optimized and analytical performance of the proposed method was evaluated. The limits of detection (LODs) for AFP and CEA were 0.086 μg L- 1 and 0.054 μg L- 1 with the relative standard deviations (RSDs, n = 7, c = 5 μg L- 1) of 6.5% and 6.2% for AFP and CEA, respectively. Linear range for both AFP and CEA was 0.2-50 μg L- 1. To validate the applicability of the proposed method, human serum samples were analyzed, and the obtained results were in good agreement with that obtained by the clinical chemiluminescence immunoassay. The developed method exhibited good selectivity and sensitivity for the simultaneous determination of AFP and CEA, and extended the applicability of metal nanoparticle tags based on ICP-MS methodology in multiple glycoprotein quantifications.

Damage Control Resuscitation Supplemented with Vasopressin in a Severe Polytrauma Model with Traumatic Brain Injury and Uncontrolled Internal Hemorrhage.

PubMed

Dickson, J Michael; Wang, Xu; St John, Alexander E; Lim, Esther B; Stern, Susan A; White, Nathan J

2018-03-14

Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of traumatic death worldwide and particularly on the battlefield. They are especially challenging when present simultaneously (polytrauma), and clear blood pressure end points during fluid resuscitation are not well described for this situation. The goal of this study is to evaluate for any benefit of increasing blood pressure using a vasopressor on brain blood flow during initial fluid resuscitation in a swine polytrauma model. We used a swine polytrauma model with simultaneous TBI, femur fracture, and HS with uncontrolled noncompressible internal bleeding from an aortic tear injury. Five animals were assigned to each of three experimental groups (hydroxyethyl starch only [HES], HES + 0.4 U/kg vasopressin, and no fluid resuscitation [No Fluids]). Fluids were given as two 10 mL/kg boluses according to tactical field care guidelines. Primary outcomes were mean arterial blood pressure (MAP) and brain blood flow at 60 min. Secondary outcomes were blood flows in the heart, intestine, and kidney; arterial blood lactate level; and survival at 6 hr. Organ blood flow was measured using injection of colored microspheres. Five animals were tested in each of the three groups. There was a statistically significant increase in MAP with vasopressin compared with other experimental groups, but no significant increase in brain blood flow during the first 60 min of resuscitation. The vasopressin group also exhibited greater total internal hemorrhage volume and rate. There was no difference in survival at 6 hours. In this experimental swine polytrauma model, increasing blood pressure with vasopressin did not improve brain perfusion, likely due to increased internal hemorrhage. Effective hemostasis should remain the top priority for field treatment of the polytrauma casualty with TBI.

Three-dimensional and multienergy gamma-ray simultaneous imaging by using a Si/CdTe Compton camera.

PubMed

Suzuki, Yoshiyuki; Yamaguchi, Mitsutaka; Odaka, Hirokazu; Shimada, Hirofumi; Yoshida, Yukari; Torikai, Kota; Satoh, Takahiro; Arakawa, Kazuo; Kawachi, Naoki; Watanabe, Shigeki; Takeda, Shin'ichiro; Ishikawa, Shin-nosuke; Aono, Hiroyuki; Watanabe, Shin; Takahashi, Tadayuki; Nakano, Takashi

2013-06-01

To develop a silicon (Si) and cadmium telluride (CdTe) imaging Compton camera for biomedical application on the basis of technologies used for astrophysical observation and to test its capacity to perform three-dimensional (3D) imaging. All animal experiments were performed according to the Animal Care and Experimentation Committee (Gunma University, Maebashi, Japan). Flourine 18 fluorodeoxyglucose (FDG), iodine 131 ((131)I) methylnorcholestenol, and gallium 67 ((67)Ga) citrate, separately compacted into micro tubes, were inserted subcutaneously into a Wistar rat, and the distribution of the radioisotope compounds was determined with 3D imaging by using the Compton camera after the rat was sacrificed (ex vivo model). In a separate experiment, indium 111((111)In) chloride and (131)I-methylnorcholestenol were injected into a rat intravenously, and copper 64 ((64)Cu) chloride was administered into the stomach orally just before imaging. The isotope distributions were determined with 3D imaging after sacrifice by means of the list-mode-expectation-maximizing-maximum-likelihood method. The Si/CdTe Compton camera demonstrated its 3D multinuclear imaging capability by separating out the distributions of FDG, (131)I-methylnorcholestenol, and (67)Ga-citrate clearly in a test-tube-implanted ex vivo model. In the more physiologic model with tail vein injection prior to sacrifice, the distributions of (131)I-methylnorcholestenol and (64)Cu-chloride were demonstrated with 3D imaging, and the difference in distribution of the two isotopes was successfully imaged although the accumulation on the image of (111)In-chloride was difficult to visualize because of blurring at the low-energy region. The Si/CdTe Compton camera clearly resolved the distribution of multiple isotopes in 3D imaging and simultaneously in the ex vivo model.

Sustainable, alternative farming practices as a means to simultaneously secure food production and reduce air pollution in East Asia

NASA Astrophysics Data System (ADS)

Tai, A. P. K.; Fung, K. M.; Yong, T.; Liu, X.

2015-12-01

Proper agricultural land management is essential for securing food supply and minimizing damage to the environment. Among available farming practices, relay strip intercropping and fertilizer application are commonly used, but to study their wider environmental implications and possible feedbacks we require an Earth system modeling framework. In this study, the effectiveness of a maize-soybean relay strip intercropping system and fertilizer reduction is investigated using a multi-model method. The DNDC (DeNitrification-DeComposition) model is used to simulate agricultural activities and their impacts on the environment through nitrogen emissions and changes in soil chemical composition. Crop yield, soil nutrient content and nitrogen emissions to the atmosphere in major agricultural regions of China are predicted under various cultivation scenarios. The GEOS-Chem global chemical transport model is then used to estimate the effects on downwind particle and ozone air pollution. We show that relay strip intercropping and optimal fertilization not only improve crop productivity, but also retain soil nutrients, reduce ammonia emission and mitigate downwind air pollution. By cutting 25% fertilization inputs but cultivating maize and soybean together in a relay strip intercropping system used with field studies, total crop production was improved slightly by 4.4% compared to monoculture with conventional amount of fertilizers. NH3 volatilization decreases by 29%, equivalent to saving the pollution-induced health damage costs by about US$2.5 billion per year. The possible feedback effects from atmospheric nitrogen deposition onto the croplands are also investigated. We show that careful management and better quantitative understanding of alternative farming practices hold huge potential in simultaneously addressing different global change issues including the food crisis, air pollution and climate change, and calls for greater collaboration between scientists, farmers and policy makers concerning these issues.

Breast-Infant Temperature with Twins during Shared Kangaroo Care

PubMed Central

Ludington-Hoe, Susan M.; Lewis, Tina; Cong, Xiaomei; Anderson, Laurie; Morgan, Kathy; Reese, Stacey

2006-01-01

In a case study, two sets of premature twins were held in Shared Kangaroo Care (KC) while maternal breast and infant body temperatures were recorded. Infant temperatures remained warm and increased during KC and each breast appeared to respond to the thermal needs of the infant on that breast. Physiologic explanations for thermal synchrony exist. The data suggests that twins can be simultaneously held in KC without physiologic compromise. PMID:16620248

Simultaneous aortic and tricuspid valve rupture after fall injury

PubMed Central

Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

2013-01-01

Abstract: This case study concerns a patient with disruption of both tricuspid and aortic valves: a previously healthy, adult man, who sustained a 5-meter fall from a building under construction. The mechanism of the injury was acceleration and deceleration, acting in two different phases of the cardiac cycle, i.e. systole and diastole. Simultaneous occurrence of these injuries is exceedingly rare and in a careful literature review, we did not find any such combination of injury. The possible mechanisms of this injury, as well as surgical techniques are discussed. PMID:23511124

Simultaneous aortic and tricuspid valve rupture after fall injury.

PubMed

Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

2013-07-01

This case study concerns a patient with disruption of both tricuspid and aortic valves: a previously healthy, adult man, who sustained a 5-meter fall from a building under construction. The mechanism of the injury was acceleration and deceleration, acting in two different phases of the cardiac cycle, i.e. systole and diastole. Simultaneous occurrence of these injuries is exceedingly rare and in a careful literature review, we did not find any such combination of injury. The possible mechanisms of this injury, as well as surgical techniques are discussed.

Quantitative Detection of Nucleoside Analogues by Multi-enzyme Biosensors using Time-Resolved Kinetic Measurements.

PubMed

Muthu, Pravin; Lutz, Stefan

2016-04-05

Fast, simple and cost-effective methods for detecting and quantifying pharmaceutical agents in patients are highly sought after to replace equipment and labor-intensive analytical procedures. The development of new diagnostic technology including portable detection devices also enables point-of-care by non-specialists in resource-limited environments. We have focused on the detection and dose monitoring of nucleoside analogues used in viral and cancer therapies. Using deoxyribonucleoside kinases (dNKs) as biosensors, our chemometric model compares observed time-resolved kinetics of unknown analytes to known substrate interactions across multiple enzymes. The resulting dataset can simultaneously identify and quantify multiple nucleosides and nucleoside analogues in complex sample mixtures. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs.

PubMed

Cosgrove, Delos M; Fisher, Michael; Gabow, Patricia; Gottlieb, Gary; Halvorson, George C; James, Brent C; Kaplan, Gary S; Perlin, Jonathan B; Petzel, Robert; Steele, Glenn D; Toussaint, John S

2013-02-01

Patient-centeredness--the idea that care should be designed around patients' needs, preferences, circumstances, and well-being--is a central tenet of health care delivery. For CEOs of health care organizations, patient-centered care is also quickly becoming a business imperative, with payments tied to performance on measures of patient satisfaction and engagement. In A CEO Checklist for High-Value Health Care, we, as executives of eleven leading health care delivery institutions, outlined ten key strategies for reducing costs and waste while improving outcomes. In this article we describe how implementation of these strategies benefits both health care organizations and patients. For example, Kaiser Permanente's Healthy Bones Program resulted in a 30 percent reduction in hip fracture rates for at-risk patients. And at Virginia Mason Health System in Seattle, nurses reorganized care patterns and increased the time they spent on direct patient care to 90 percent. Our experiences show that patient-engaged care can be delivered in ways that simultaneously improve quality and reduce costs.

Models of tremor and low-frequency earthquake swarms on Montserrat

NASA Astrophysics Data System (ADS)

Neuberg, J.; Luckett, R.; Baptie, B.; Olsen, K.

2000-08-01

Recent observations from Soufrière Hills volcano in Montserrat reveal a wide variety of low-frequency seismic signals. We discuss similarities and differences between hybrid earthquakes and long-period events, and their role in explosions and rockfall events. These events occur usually in swarms, and occasionally merge into tremor, an observation that can shed further light on the generation and composition of harmonic tremor. We use a 2D finite difference method to model major features of low-frequency seismic signatures and compare them with the observations. A depth-dependent velocity model for a fluid-filled conduit is introduced which accounts for the varying gas-content in the magma, and the impact on the seismic signals is discussed. We carefully analyse episodes of tremor that show shifting spectral lines and model those in terms of changes in the gas content of the magma as well as in terms of a time-dependent triggering mechanism of low-frequency resonances. In this way we explain the simultaneous occurrence of low-frequency events and tremor with a spectral content comprising integer harmonics.

Sound Clocks and Sonic Relativity

NASA Astrophysics Data System (ADS)

Todd, Scott L.; Menicucci, Nicolas C.

2017-10-01

Sound propagation within certain non-relativistic condensed matter models obeys a relativistic wave equation despite such systems admitting entirely non-relativistic descriptions. A natural question that arises upon consideration of this is, "do devices exist that will experience the relativity in these systems?" We describe a thought experiment in which `acoustic observers' possess devices called sound clocks that can be connected to form chains. Careful investigation shows that appropriately constructed chains of stationary and moving sound clocks are perceived by observers on the other chain as undergoing the relativistic phenomena of length contraction and time dilation by the Lorentz factor, γ , with c the speed of sound. Sound clocks within moving chains actually tick less frequently than stationary ones and must be separated by a shorter distance than when stationary to satisfy simultaneity conditions. Stationary sound clocks appear to be length contracted and time dilated to moving observers due to their misunderstanding of their own state of motion with respect to the laboratory. Observers restricted to using sound clocks describe a universe kinematically consistent with the theory of special relativity, despite the preferred frame of their universe in the laboratory. Such devices show promise in further probing analogue relativity models, for example in investigating phenomena that require careful consideration of the proper time elapsed for observers.

A joint data assimilation system (Tan-Tracker) to simultaneously estimate surface CO2 fluxes and 3-D atmospheric CO2 concentrations from observations

NASA Astrophysics Data System (ADS)

Tian, X.; Xie, Z.; Liu, Y.; Cai, Z.; Fu, Y.; Zhang, H.; Feng, L.

2014-12-01

We have developed a novel framework ("Tan-Tracker") for assimilating observations of atmospheric CO2 concentrations, based on the POD-based (proper orthogonal decomposition) ensemble four-dimensional variational data assimilation method (PODEn4DVar). The high flexibility and the high computational efficiency of the PODEn4DVar approach allow us to include both the atmospheric CO2 concentrations and the surface CO2 fluxes as part of the large state vector to be simultaneously estimated from assimilation of atmospheric CO2 observations. Compared to most modern top-down flux inversion approaches, where only surface fluxes are considered as control variables, one major advantage of our joint data assimilation system is that, in principle, no assumption on perfect transport models is needed. In addition, the possibility for Tan-Tracker to use a complete dynamic model to consistently describe the time evolution of CO2 surface fluxes (CFs) and the atmospheric CO2 concentrations represents a better use of observation information for recycling the analyses at each assimilation step in order to improve the forecasts for the following assimilations. An experimental Tan-Tracker system has been built based on a complete augmented dynamical model, where (1) the surface atmosphere CO2 exchanges are prescribed by using a persistent forecasting model for the scaling factors of the first-guess net CO2 surface fluxes and (2) the atmospheric CO2 transport is simulated by using the GEOS-Chem three-dimensional global chemistry transport model. Observing system simulation experiments (OSSEs) for assimilating synthetic in situ observations of surface CO2 concentrations are carefully designed to evaluate the effectiveness of the Tan-Tracker system. In particular, detailed comparisons are made with its simplified version (referred to as TT-S) with only CFs taken as the prognostic variables. It is found that our Tan-Tracker system is capable of outperforming TT-S with higher assimilation precision for both CO2 concentrations and CO2 fluxes, mainly due to the simultaneous estimation of CO2 concentrations and CFs in our Tan-Tracker data assimilation system. A experiment for assimilating the real dry-air column CO2 retrievals (XCO2) from the Japanese Greenhouse Gases Observation Satellite (GOSAT) further demonstrates its potential wide applications.

Health-care users, key community informants and primary health care workers' views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions.

PubMed

Pons-Vigués, Mariona; Berenguera, Anna; Coma-Auli, Núria; Pombo-Ramos, Haizea; March, Sebastià; Asensio-Martínez, Angela; Moreno-Peral, Patricia; Mora-Simón, Sara; Martínez-Andrés, Maria; Pujol-Ribera, Enriqueta

2017-06-13

Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having implemented some change to promote their health. The most powerful motivators to change lifestyles are having a disease, fear of becoming ill and taking care of oneself to maintain health. Health-care users believe that the main difficulties are associated with the physical, social, working and family environment, as well as lack of determination and motivation. They also highlight the need for more information. In relation to the assets and deficits of the neighbourhood, each group identifies those closer to their role. Generally, participants showed a holistic and positive concept of health and a more traditional, individual approach to health promotion. We consider therefore crucial to depart from the model of health services that focuses on the individual and the disease toward a socio-ecological health model that substantially increases the participation of health-care users and emphasizes health promotion, wellbeing and community participation.

The impact of positive and negative intraoperative surgeons' leadership behaviors on surgical team performance.

PubMed

Barling, Julian; Akers, Amy; Beiko, Darren

2018-01-01

The effects of surgeons' leadership on team performance are not well understood. The purpose of this study was to examine the simultaneous effects of transformational, passive, abusive supervision and over-controlling leadership behaviors by surgeons on surgical team performance. Trained observers attended 150 randomly selected operations at a tertiary care teaching hospital. Observers recorded instances of the four leadership behaviors enacted by the surgeon. Postoperatively, team members completed validated questionnaires rating team cohesion and collective efficacy. Multiple regression analyses were computed. Data were analyzed using the complex modeling function in MPlus. Surgeons' abusive supervision was negatively associated with psychological safety (unstandardized B = -0.352, p < 0.01). Both surgeons' abusive supervision (unstandardized B = -0.237, p < 0.01), and over-controlling leadership (unstandardized B = -0.230, p < 0.05) were negatively associated with collective efficacy. This study is the first to assess the simultaneous effects of surgeons' positive and negative leadership behaviors on intraoperative team performance. Significant effects only surfaced for negative leadership behaviors; transformational leadership did not positively influence team performance. Copyright © 2017 Elsevier Inc. All rights reserved.

Precise colloids with tunable interactions for confocal microscopy

PubMed Central

Kodger, Thomas E.; Guerra, Rodrigo E.; Sprakel, Joris

2015-01-01

Model colloidal systems studied with confocal microscopy have led to numerous insights into the physics of condensed matter. Though confocal microscopy is an extremely powerful tool, it requires a careful choice and preparation of the colloid. Uncontrolled or unknown variations in the size, density, and composition of the individual particles and interactions between particles, often influenced by the synthetic route taken to form them, lead to difficulties in interpreting the behavior of the dispersion. Here we describe the straightforward synthesis of copolymer particles which can be refractive index- and density-matched simultaneously to a non-plasticizing mixture of high dielectric solvents. The interactions between particles are accurately tuned by surface grafting of polymer brushes using Atom Transfer Radical Polymerization (ATRP), from hard-sphere-like to long-ranged electrostatic repulsion or mixed charge attraction. We also modify the buoyant density of the particles by altering the copolymer ratio while maintaining their refractive index match to the suspending solution resulting in well controlled sedimentation. The tunability of the inter-particle interactions, the low volatility of the solvents, and the capacity to simultaneously match both the refractive index and density of the particles to the fluid opens up new possibilities for exploring the physics of colloidal systems. PMID:26420044

Biomonitoring polycyclic aromatic hydrocarbons by Salix matsudana leaves: A comparison with the relevant air content and evaluation of environmental parameter effects

NASA Astrophysics Data System (ADS)

Zhao, Xiangai; He, Miao; Shang, Haibo; Yu, Hongling; Wang, Hao; Li, Huijie; Piao, Jingyi; Quinto, Maurizio; Li, Donghao

2018-05-01

Studies on seasonal distribution characteristics of polycyclic aromatic hydrocarbons (PAHs) in Salix matsudana leaves covering its annual life cycle were carried out in order to evaluate plant leaf response sensitivity to air pollution. Salix matsudana leaves were collected throughout different development phases of plant leaf inclusive of bud break to fallen leaves, covering from spring (May) to autumn (November). Simultaneously, particle and gas samples were collected using a high volume air sampler. Seven different PAHs were determined simultaneously in these samples. The temperature dependence of the partitioning of PAHs in air and plant leaves was investigated and the results were incorporated into a mathematical model. The measured plant/air partition coefficients have been found to be exponentially proportional to the reciprocal temperature, in agreement with theoretical expectations. Furthermore, in order to define the influence of different parameters on PAH adsorption on plant leaves, area and lipid leaf content were also measured. Results demonstrated that temperature plays a very important role in PAHs partitioning and that this value should be carefully considered during sampling, in order to obtain the best correlation between PAHs concentration in air and leaves.

Addressing domestic violence through antenatal care in Sri Lanka's plantation estates: Contributions of public health midwives.

PubMed

Infanti, Jennifer J; Lund, Ragnhild; Muzrif, Munas M; Schei, Berit; Wijewardena, Kumudu

2015-11-01

Domestic violence in pregnancy is a significant health concern for women around the world. Globally, much has been written about how the health sector can respond effectively and comprehensively to domestic violence during pregnancy via antenatal services. The evidence from low-income settings is, however, limited. Sri Lanka is internationally acknowledged as a model amongst low-income countries for its maternal and child health statistics. Yet, very little research has considered the perspectives and experiences of the key front line health providers for pregnant women in Sri Lanka, public health midwives (PHMs). We address this gap by consulting PHMs about their experiences identifying and responding to pregnant women affected by domestic violence in an underserved area: the tea estate sector of Badulla district. Over two months in late 2014, our interdisciplinary team of social scientists and medical doctors met with 31 estate PHMs for group interviews and a participatory workshop at health clinics across Badulla district. In the paper, we propose a modified livelihoods model to conceptualise the physical, social and symbolic assets, strategies and constraints that simultaneously enable and limit the effectiveness of community-based health care responses to domestic violence. Our findings also highlight conceptual and practical strategies identified by PHMs to ensure improvements in this complex landscape of care. Such strategies include estate-based counselling services; basic training in family counselling and mediation for PHMs; greater surveillance of abusive men's behaviours by male community leaders; and performance evaluation and incentives for work undertaken to respond to domestic violence. The study contributes to international discussions on the meanings, frameworks, and identities constructed at the local levels of health care delivery in the global challenge to end domestic violence. In turn, such knowledge adds to international debates on the roles and responsibilities of health care professionals in responding to and preventing domestic violence. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Comparative efficacy of simultaneous versus sequential multiple health behavior change interventions among adults: A systematic review of randomised trials.

PubMed

James, Erica; Freund, Megan; Booth, Angela; Duncan, Mitch J; Johnson, Natalie; Short, Camille E; Wolfenden, Luke; Stacey, Fiona G; Kay-Lambkin, Frances; Vandelanotte, Corneel

2016-08-01

Growing evidence points to the benefits of addressing multiple health behaviors rather than single behaviors. This review evaluates the relative effectiveness of simultaneous and sequentially delivered multiple health behavior change (MHBC) interventions. Secondary aims were to identify: a) the most effective spacing of sequentially delivered components; b) differences in efficacy of MHBC interventions for adoption/cessation behaviors and lifestyle/addictive behaviors, and; c) differences in trial retention between simultaneously and sequentially delivered interventions. MHBC intervention trials published up to October 2015 were identified through a systematic search. Eligible trials were randomised controlled trials that directly compared simultaneous and sequential delivery of a MHBC intervention. A narrative synthesis was undertaken. Six trials met the inclusion criteria and across these trials the behaviors targeted were smoking, diet, physical activity, and alcohol consumption. Three trials reported a difference in intervention effect between a sequential and simultaneous approach in at least one behavioral outcome. Of these, two trials favoured a sequential approach on smoking. One trial favoured a simultaneous approach on fat intake. There was no difference in retention between sequential and simultaneous approaches. There is limited evidence regarding the relative effectiveness of sequential and simultaneous approaches. Given only three of the six trials observed a difference in intervention effectiveness for one health behavior outcome, and the relatively consistent finding that the sequential and simultaneous approaches were more effective than a usual/minimal care control condition, it appears that both approaches should be considered equally efficacious. PROSPERO registration number: CRD42015027876. Copyright © 2016 Elsevier Inc. All rights reserved.

Collective Care: Multiple Caregivers and Multiple Care Recipients in Mexican American Families.

PubMed

Evans, Bronwynne C; Coon, David W; Belyea, Michael J; Ume, Ebere

2017-07-01

Specific stressors associated with caregiving in Mexican American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. This article describes these understudied families who are poorly served by contemporary health systems because their characteristics are unknown. Descriptive, multisite, longitudinal mixed-methods study of MA caregiving families. We identified three types of collective caregivers: those providing care for multiple family members simultaneously, those providing care successively to several family members, and/or those needing care themselves during their caregiving of others. Collective caregiving of MA elders warrants further investigation. Exploration of collective caregiving may provide a foundation for tailored family interventions.

Comparative analysis of the expected demands for nursing care services among older people from urban, rural, and institutional environments

PubMed Central

Borowiak, Ewa; Kostka, Joanna; Kostka, Tomasz

2015-01-01

Background Demand for nursing and social services may vary depending on the socio-demographic variables, health status, receipt of formal and informal care provided, and place of residence. Objectives To conduct a comparative analysis of the expectations of older people from urban, rural, and institutional environments concerning nursing care with respect to the care provided and elements of a comprehensive geriatric assessment. Material and methods The study comprised 2,627 individuals above the age of 65 years living in urban (n=935) and rural (n=812) areas as well as nursing homes (n=880). Results Family care was most often expected both in urban (56.6%) and rural (54.7%) environments, followed by care provided simultaneously by a family and nurse (urban – 18.8%; rural – 26.1%) and realized only by a nurse (urban – 24.6%; rural – 19.2%). Not surprisingly, nursing home residents most commonly expected nursing care (57.5%) but 33.1% preferred care provided by family or friends and neighbors. In the whole cohort of people living in the home environment (n=1,718), those living with family demonstrated willingness to use primarily care implemented by the family (62.0%), while respondents living alone more often expected nursing services (30.3%). In the logistic regression model, among the respondents living in the city, only the form of care already received determined the expectations for nursing care. Among the respondents living in the county, the presence of musculoskeletal disorders, better nutritional status, and current care provided by family decreased expectations for nursing care. Higher cognitive functioning, symptoms of depression, and living alone increased the willingness to obtain nursing care. Conclusion Older inhabitants of urban areas, rural areas, and those residing in institutions have different expectations for individual nursing care. Nearly 45% of seniors living in the community expect to obtain nursing care, while only 1.6% do not expect any social or nursing help. While the expectations for the provision of nursing care are significantly increased by living alone, they are decreased by having access to care provided by family. Support for families to take care of elderly relatives would appear to be essential for an effective nursing and social care system. PMID:25673980

Automating quantum dot barcode assays using microfluidics and magnetism for the development of a point-of-care device.

PubMed

Gao, Yali; Lam, Albert W Y; Chan, Warren C W

2013-04-24

The impact of detecting multiple infectious diseases simultaneously at point-of-care with good sensitivity, specificity, and reproducibility would be enormous for containing the spread of diseases in both resource-limited and rich countries. Many barcoding technologies have been introduced for addressing this need as barcodes can be applied to detecting thousands of genetic and protein biomarkers simultaneously. However, the assay process is not automated and is tedious and requires skilled technicians. Barcoding technology is currently limited to use in resource-rich settings. Here we used magnetism and microfluidics technology to automate the multiple steps in a quantum dot barcode assay. The quantum dot-barcoded microbeads are sequentially (a) introduced into the chip, (b) magnetically moved to a stream containing target molecules, (c) moved back to the original stream containing secondary probes, (d) washed, and (e) finally aligned for detection. The assay requires 20 min, has a limit of detection of 1.2 nM, and can detect genetic targets for HIV, hepatitis B, and syphilis. This study provides a simple strategy to automate the entire barcode assay process and moves barcoding technologies one step closer to point-of-care applications.

"Doctor, Why Didn't You Adopt My Baby?" Observant Participation, Care, and the Simultaneous Practice of Medicine and Anthropology.

PubMed

Sufrin, Carolyn

2015-12-01

Medical anthropology has long appreciated the clinical encounter as a rich source of data and a key site for critical inquiry. It is no surprise, then, that a number of physician-anthropologists have used their clinical insights to make important contributions to the field. How does this duality challenge and enhance the moral practice and ethics of care inherent both to ethnography and to medicine? How do bureaucratic and professional obligations of HIPAA and the IRB intersect with aspirations of anthropology to understand human experience and of medicine to heal with compassion? In this paper, I describe my simultaneous fieldwork and clinical practice at an urban women's jail in the United States. In this setting, being a physician facilitates privileged access to people and spaces within, garners easy trust, and enables an insider perspective more akin to observant participation than participant observation. Through experiences of delivering the infants of incarcerated pregnant women and of being with the mothers as they navigate drug addiction, child custody battles, and re-incarceration, the roles of doctor and anthropologist become mutually constitutive and transformative. Moreover, the dual practice reveals congruities and cracks in each discipline's ethics of care. Being an anthropologist among informants who may have been patients reworks expectations of care and necessitates ethical practice informed by the dual roles.

The plaque- and gingivitis-inhibiting capacity of a commercially available essential oil product. A parallel, split-mouth, single blind, randomized, placebo-controlled clinical study.

PubMed

Preus, Hans Ragnar; Koldsland, Odd Carsten; Aass, Anne Merete; Sandvik, Leiv; Hansen, Bjørn Frode

2013-11-01

Studies have reported commercially available essential oils with convincing plaque and gingivitis preventing properties. However, no tests have compared these essential oils, i.e. Listerine(®), against their true vehicle controls. To compare the plaque and gingivitis inhibiting effect of a commercially-available essential oil (Listerine(®) Total Care) to a negative (22% hydro-alcohol solution) and a positive (0.2% chlorhexidine (CHX)) control in an experimental gingivitis model. In three groups of 15 healthy volunteers, experimental gingivitis was induced and monitored over 21 days, simultaneously treated with Listerine(®) Total Care (test), 22% hydro-alcohol solution (negative control) and 0.2% chlorhexidine solution (positive control), respectively. The upper right quadrant of each individual received mouthwash only, whereas the upper left quadrant was subject to both rinses and mechanical oral hygiene. Plaque, gingivitis and side-effects were assessed at day 7, 14 and 21. After 21 days, the chlorhexidine group showed significantly lower average plaque and gingivitis scores than the Listerine(®) and alcohol groups, whereas there was little difference between the two latter. Listerine(®) Total Care had no statistically significant effect on plaque formation as compared to its vehicle control.

Leveraging the private sector for child health: a qualitative examination of caregiver and provider perspectives on private sector care for childhood pneumonia in Uttar Pradesh, India.

PubMed

Brunie, Aurélie; Lenzi, Rachel; Lahiri, Anamika; Izadnegahdar, Rasa

2017-02-22

The private health sector is a primary source of curative care for childhood illnesses in many low- and middle-income countries. Therefore ensuring appropriate private sector care is an important step towards improving outcomes from illnesses like pneumonia, which is the leading infectious cause of childhood mortality worldwide. This study aimed to provide evidence on private sector care for childhood pneumonia in Uttar Pradesh, India, by simultaneously exploring providers' knowledge and practices and caregivers' experiences. We conducted in-depth interviews with a purposive sample of 36 practitioners and 34 caregivers in two districts. Practitioners included allopathic doctors, AYUSH providers, and drug sellers. Caregivers were mothers of children under the age of five with symptoms consistent with pneumonia who had seen one of those practitioners. Interview transcripts were analyzed thematically. Caregivers were generally prompt in seeking care outside the home, but many initially favored local informal providers based on access and cost. Drug sellers were not commonly consulted for treatment. Formal providers had imperfect, but reasonable, knowledge of pneumonia and followed appropriate steps for diagnosis, though some gaps were noticed that were primarily related to lack of (or failure to use) diagnostic tools. Most practitioners prescribed antibiotics and supportive symptomatic treatment. Relational and structural factors encouraged overuse of antibiotics and treatment interruption. Caregivers often had a limited understanding of treatment but wanted rapid symptomatic improvements, frequently leading to sequentially consulting multiple providers and interrupting treatment when symptoms improved. Providers were confronted with these expectations and care-seeking patterns. This study contributes in-depth evidence on private sector care for childhood pneumonia in UP. Achieving appropriate care requires an enriched perspective that simultaneously considers the critical role of provider-caregiver interactions and of the context in which they occur in shaping treatment outcomes.

A task analysis of emergency physician activities in academic and community settings.

PubMed

Chisholm, Carey D; Weaver, Christopher S; Whenmouth, Laura; Giles, Beverly

2011-08-01

We characterize and compare the work activities, including peak patient loads, associated with the workplace in the academic and community emergency department (ED) settings. This allows assessment of the effect of future ED system operational changes and identifies potential sources contributing to medical error. This was an observational, time-motion study. Trained observers shadowed physicians, recording activities. Data included total interactions, distances walked, time sitting, patients concurrently treated, interruptions, break in tasks, physical contact with patients, hand washing, diagnostic tests ordered, and therapies rendered. Activities were classified as direct patient care, indirect patient care, or personal time with a priori definitions. There were 203 2-hour observation periods of 85 physicians at 2 academic EDs with 100,000 visits per year at each (N=160) and 2 community EDs with annual visits of 19,000 and 21,000 (N=43). Reported data present the median and minimum-maximum values per 2-hour period. Emergency physicians spent the majority of time on indirect care activities (academic 64 minutes, 29 to 91 minutes; community 55 min, 25 to 95 minutes), followed by direct care activities (academic 36 minutes, 6 to 79 minutes; community 41 minutes, 5 to 60 minutes). Personal time differed by location type (academic 6 minutes, 0 to 66 minutes; community 13 minutes, 0 to 69 minutes). All physicians simultaneously cared for multiple patients, with a median number of patients greater than 5 (academic 7 patients, 2 to 16 patients; community 6 patients, 2 to 12 patients). Emergency physicians spend the majority of their time involved in indirect patient care activities. They are frequently interrupted and interact with a large number of individuals. They care for a wide range of patients simultaneously, with surges in multiple patient care responsibilities. Physicians working in academic settings are interrupted at twice the rate of their community counterparts. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Multi-target QSPR modeling for simultaneous prediction of multiple gas-phase kinetic rate constants of diverse chemicals

NASA Astrophysics Data System (ADS)

Basant, Nikita; Gupta, Shikha

2018-03-01

The reactions of molecular ozone (O3), hydroxyl (•OH) and nitrate (NO3) radicals are among the major pathways of removal of volatile organic compounds (VOCs) in the atmospheric environment. The gas-phase kinetic rate constants (kO3, kOH, kNO3) are thus, important in assessing the ultimate fate and exposure risk of atmospheric VOCs. Experimental data for rate constants are not available for many emerging VOCs and the computational methods reported so far address a single target modeling only. In this study, we have developed a multi-target (mt) QSPR model for simultaneous prediction of multiple kinetic rate constants (kO3, kOH, kNO3) of diverse organic chemicals considering an experimental data set of VOCs for which values of all the three rate constants are available. The mt-QSPR model identified and used five descriptors related to the molecular size, degree of saturation and electron density in a molecule, which were mechanistically interpretable. These descriptors successfully predicted three rate constants simultaneously. The model yielded high correlations (R2 = 0.874-0.924) between the experimental and simultaneously predicted endpoint rate constant (kO3, kOH, kNO3) values in test arrays for all the three systems. The model also passed all the stringent statistical validation tests for external predictivity. The proposed multi-target QSPR model can be successfully used for predicting reactivity of new VOCs simultaneously for their exposure risk assessment.

Generalized Path Analysis and Generalized Simultaneous Equations Model for Recursive Systems with Responses of Mixed Types

ERIC Educational Resources Information Center

Tsai, Tien-Lung; Shau, Wen-Yi; Hu, Fu-Chang

2006-01-01

This article generalizes linear path analysis (PA) and simultaneous equations models (SiEM) to deal with mixed responses of different types in a recursive or triangular system. An efficient instrumental variable (IV) method for estimating the structural coefficients of a 2-equation partially recursive generalized path analysis (GPA) model and…

Mixture Item Response Theory-MIMIC Model: Simultaneous Estimation of Differential Item Functioning for Manifest Groups and Latent Classes

ERIC Educational Resources Information Center

Bilir, Mustafa Kuzey

2009-01-01

This study uses a new psychometric model (mixture item response theory-MIMIC model) that simultaneously estimates differential item functioning (DIF) across manifest groups and latent classes. Current DIF detection methods investigate DIF from only one side, either across manifest groups (e.g., gender, ethnicity, etc.), or across latent classes…

Caring for the Elderly at Work and Home: Can a Randomized Organizational Intervention Improve Psychological Health?

PubMed

Kossek, Ellen Ernst; Thompson, Rebecca J; Lawson, Katie M; Bodner, Todd; Perrigino, Matthew B; Hammer, Leslie B; Buxton, Orfeu M; Almeida, David M; Moen, Phyllis; Hurtado, David A; Wipfli, Brad; Berkman, Lisa F; Bray, Jeremy W

2017-12-07

Although job stress models suggest that changing the work social environment to increase job resources improves psychological health, many intervention studies have weak designs and overlook influences of family caregiving demands. We tested the effects of an organizational intervention designed to increase supervisor social support for work and nonwork roles, and job control in a results-oriented work environment on the stress and psychological distress of health care employees who care for the elderly, while simultaneously considering their own family caregiving responsibilities. Using a group-randomized organizational field trial with an intent-to-treat design, 420 caregivers in 15 intervention extended-care nursing facilities were compared with 511 caregivers in 15 control facilities at 4 measurement times: preintervention and 6, 12, and 18 months. There were no main intervention effects showing improvements in stress and psychological distress when comparing intervention with control sites. Moderation analyses indicate that the intervention was more effective in reducing stress and psychological distress for caregivers who were also caring for other family members off the job (those with elders and those "sandwiched" with both child and elder caregiving responsibilities) compared with employees without caregiving demands. These findings extend previous studies by showing that the effect of organizational interventions designed to increase job resources to improve psychological health varies according to differences in nonwork caregiving demands. This research suggests that caregivers, especially those with "double-duty" elder caregiving at home and work and "triple-duty" responsibilities, including child care, may benefit from interventions designed to increase work-nonwork social support and job control. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Sports and exercise cardiology in the United States: cardiovascular specialists as members of the athlete healthcare team.

PubMed

Lawless, Christine E; Olshansky, Brian; Washington, Reginald L; Baggish, Aaron L; Daniels, Curt J; Lawrence, Silvana M; Sullivan, Renee M; Kovacs, Richard J; Bove, Alfred A

2014-04-22

In recent years, athletic participation has more than doubled in all major demographic groups, while simultaneously, children and adults with established heart disease desire participation in sports and exercise. Despite conferring favorable long-term effects on well-being and survival, exercise can be associated with risk of adverse events in the short term. Complex individual cardiovascular (CV) demands and adaptations imposed by exercise present distinct challenges to the cardiologist asked to evaluate athletes. Here, we describe the evolution of sports and exercise cardiology as a unique discipline within the continuum of CV specialties, provide the rationale for tailoring of CV care to athletes and exercising individuals, define the role of the CV specialist within the athlete care team, and lay the foundation for the development of Sports and Exercise Cardiology in the United States. In 2011, the American College of Cardiology launched the Section of Sports and Exercise Cardiology. Membership has grown from 150 to over 4,000 members in just 2 short years, indicating marked interest from the CV community to advance the integration of sports and exercise cardiology into mainstream CV care. Although the current athlete CV care model has distinct limitations, here, we have outlined a new paradigm of care for the American athlete and exercising individual. By practicing and promoting this new paradigm, we believe we will enhance the CV care of athletes of all ages, and serve the greater athletic community and our nation as a whole, by allowing safest participation in sports and physical activity for all individuals who seek this lifestyle. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Examination of the utility of the promoting action on research implementation in health services framework for implementation of evidence based practice in residential aged care settings.

PubMed

Perry, Lin; Bellchambers, Helen; Howie, Andrew; Moxey, Annette; Parkinson, Lynne; Capra, Sandra; Byles, Julie

2011-10-01

This study examined the relevance and fit of the PARiHS framework (Promoting Action on Research Implementation in Health Services) as an explanatory model for practice change in residential aged care. Translation of research knowledge into routine practice is a complex matter in health and social care environments. Examination of the environment may identify factors likely to support and hinder practice change, inform strategy development, predict and explain successful uptake of new ways of working. Frameworks to enable this have been described but none has been tested in residential aged care. This paper reports preliminary qualitative analyses from the Encouraging Best Practice in Residential Aged Care Nutrition and Hydration project conducted in New South Wales in 2007-2009. We examined congruence with the PARiHS framework of factors staff described as influential for practice change during 29 digitally recorded and transcribed staff interviews and meetings at three facilities. Unique features of the setting were flagged, with facilities simultaneously filling the roles of residents' home, staff's workplace and businesses. Participants discussed many of the same characteristics identified by the PARiHS framework, but in addition temporal dimensions of practice change were flagged. Overall factors described by staff as important for practice change in aged care settings showed good fit with those of the PARiHS framework. This framework can be recommended for use in this setting. Widespread adoption will enable cross-project and international synthesis of findings, a major step towards building a cumulative science of knowledge translation and practice change. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings--insights from South Africa.

PubMed

Levitt, Naomi S; Steyn, Krisela; Dave, Joel; Bradshaw, Debbie

2011-12-01

Sub-Saharan Africa is experiencing a multiple disease burden. Noncommunicable diseases (NCDs) are emerging, and their risk factors are becoming more common as lifestyles change and rates of urbanization increase. Simultaneously, epidemics of infectious diseases persist, and HIV/AIDS has taken hold in the region, although recent data indicate a decrease in new HIV infection rates. With the use of diabetes as a marker for NCDs, it was estimated that the number of people with diabetes would rise between 2000 and 2010 despite the HIV/AIDS epidemic, largely because of the aging of the population and the increase in risk factors for diabetes in South Africa. These numbers are likely to increase further, given the declining HIV/AIDS mortality rates and longer life expectancy due to the up-scaling of antiretroviral therapy (ART), with its concomitant metabolic complications. Given that treated HIV/AIDS has become a chronic disease, and the health care needs of people on ART resemble those of people with NCDs, and given that vertical programs are difficult to sustain when health systems are underresourced and strained, there is a powerful argument to integrate the primary level care for people with chronic diseases, whether they be NCDs or infectious diseases. Pilot studies are required to test the feasibility of an integrated service that extends from health facilities into the community in a reciprocal manner based on the WHO Innovative Care for Chronic Conditions model of care. These will begin to provide the evidence that policy makers need to change the mode of health care delivery.

[Study on correction of data bias caused by different missing mechanisms in survey of medical expenditure among students enrolling in Urban Resident Basic Medical Insurance].

PubMed

Zhang, Haixia; Zhao, Junkang; Gu, Caijiao; Cui, Yan; Rong, Huiying; Meng, Fanlong; Wang, Tong

2015-05-01

The study of the medical expenditure and its influencing factors among the students enrolling in Urban Resident Basic Medical Insurance (URBMI) in Taiyuan indicated that non response bias and selection bias coexist in dependent variable of the survey data. Unlike previous studies only focused on one missing mechanism, a two-stage method to deal with two missing mechanisms simultaneously was suggested in this study, combining multiple imputation with sample selection model. A total of 1 190 questionnaires were returned by the students (or their parents) selected in child care settings, schools and universities in Taiyuan by stratified cluster random sampling in 2012. In the returned questionnaires, 2.52% existed not missing at random (NMAR) of dependent variable and 7.14% existed missing at random (MAR) of dependent variable. First, multiple imputation was conducted for MAR by using completed data, then sample selection model was used to correct NMAR in multiple imputation, and a multi influencing factor analysis model was established. Based on 1 000 times resampling, the best scheme of filling the random missing values is the predictive mean matching (PMM) method under the missing proportion. With this optimal scheme, a two stage survey was conducted. Finally, it was found that the influencing factors on annual medical expenditure among the students enrolling in URBMI in Taiyuan included population group, annual household gross income, affordability of medical insurance expenditure, chronic disease, seeking medical care in hospital, seeking medical care in community health center or private clinic, hospitalization, hospitalization canceled due to certain reason, self medication and acceptable proportion of self-paid medical expenditure. The two-stage method combining multiple imputation with sample selection model can deal with non response bias and selection bias effectively in dependent variable of the survey data.

Effects of Depression Alleviation on ART Adherence and HIV Clinic Attendance in Uganda, and the Mediating Roles of Self-Efficacy and Motivation

PubMed Central

Wagner, Glenn J.; Ghosh-Dastidar, Bonnie; Robinson, Eric; Ngo, Victoria K.; Glick, Peter; Mukasa, Barbara; Musisi, Seggane; Akena, Dickens

2016-01-01

With depression known to impede HIV care adherence and retention, we examined whether depression alleviation improves these disease management behaviors. A sample of 1028 depressed HIV clients in Uganda enrolled in a cluster randomized controlled trial of two depression care models, and were surveyed over 12 months. Serial regression analyses examined whether depression alleviation was associated with self-reported antiretroviral therapy (ART) adherence and clinic attendance at month 12, and whether these relationships were mediated by self-efficacy and motivation. Among those with major depression, depression alleviation was associated with better ART adherence and clinic attendance at month 12; these relationships were fully mediated by self-efficacy at month 12, while adherence motivation partially mediated the relationship between depression alleviation and ART adherence. When both mediators were entered simultaneously, only self-efficacy was a significant predictor and still fully mediated the relationship between depression alleviation and adherence. These findings suggest that depression alleviation benefits both ART adherence and clinic attendance, in large part through improved confidence and motivation to engage in these disease management behaviors. PMID:27438460

Effects of Depression Alleviation on ART Adherence and HIV Clinic Attendance in Uganda, and the Mediating Roles of Self-Efficacy and Motivation.

PubMed

Wagner, Glenn J; Ghosh-Dastidar, Bonnie; Robinson, Eric; Ngo, Victoria K; Glick, Peter; Mukasa, Barbara; Musisi, Seggane; Akena, Dickens

2017-06-01

With depression known to impede HIV care adherence and retention, we examined whether depression alleviation improves these disease management behaviors. A sample of 1028 depressed HIV clients in Uganda enrolled in a cluster randomized controlled trial of two depression care models, and were surveyed over 12 months. Serial regression analyses examined whether depression alleviation was associated with self-reported antiretroviral therapy (ART) adherence and clinic attendance at month 12, and whether these relationships were mediated by self-efficacy and motivation. Among those with major depression, depression alleviation was associated with better ART adherence and clinic attendance at month 12; these relationships were fully mediated by self-efficacy at month 12, while adherence motivation partially mediated the relationship between depression alleviation and ART adherence. When both mediators were entered simultaneously, only self-efficacy was a significant predictor and still fully mediated the relationship between depression alleviation and adherence. These findings suggest that depression alleviation benefits both ART adherence and clinic attendance, in large part through improved confidence and motivation to engage in these disease management behaviors.

Next-generation healthcare: a strategic appraisal.

PubMed

Montague, Terrence

2009-01-01

Successful next-generation healthcare must deliver timely access and quality for an aging population, while simultaneously promoting disease prevention and managing costs. The key factors for sustained success are a culture with aligned goals and values; coordinated team care that especially engages with physicians and patients; practical information that is collected and communicated reliably; and education in the theory and methods of collaboration, measurement and leadership. Currently, optimal population health is challenged by a high prevalence of chronic disease, with large gaps between best and usual care, a scarcity of health human resources - particularly with the skills, attitudes and training for coordinated team care - and the absence of flexible, reliable clinical measurement systems. However, to make things better, institutional models and supporting technologies are available. In the short term, a first step is to enhance the awareness of the practical opportunities to improve, including the expansion of proven community-based disease management programs that communicate knowledge, competencies and clinical measurements among professional and patient partners, leading to reduced care gaps and improved clinical and economic outcomes. Longer-term success requires two additional steps. One is formal inter-professional training to provide, on an ongoing basis, the polyvalent human resource skills and foster the culture of working with others to improve the care of whole populations. The other is the adoption of reliable information systems, including electronic health records, to allow useful and timely measurement and effective communication of clinical information in real-world settings. A better health future can commence immediately, within existing resources, and be sustained with feasible innovations in provider and patient education and information systems. The future is now.

Striatal and Hippocampal Entropy and Recognition Signals in Category Learning: Simultaneous Processes Revealed by Model-Based fMRI

PubMed Central

Davis, Tyler; Love, Bradley C.; Preston, Alison R.

2012-01-01

Category learning is a complex phenomenon that engages multiple cognitive processes, many of which occur simultaneously and unfold dynamically over time. For example, as people encounter objects in the world, they simultaneously engage processes to determine their fit with current knowledge structures, gather new information about the objects, and adjust their representations to support behavior in future encounters. Many techniques that are available to understand the neural basis of category learning assume that the multiple processes that subserve it can be neatly separated between different trials of an experiment. Model-based functional magnetic resonance imaging offers a promising tool to separate multiple, simultaneously occurring processes and bring the analysis of neuroimaging data more in line with category learning’s dynamic and multifaceted nature. We use model-based imaging to explore the neural basis of recognition and entropy signals in the medial temporal lobe and striatum that are engaged while participants learn to categorize novel stimuli. Consistent with theories suggesting a role for the anterior hippocampus and ventral striatum in motivated learning in response to uncertainty, we find that activation in both regions correlates with a model-based measure of entropy. Simultaneously, separate subregions of the hippocampus and striatum exhibit activation correlated with a model-based recognition strength measure. Our results suggest that model-based analyses are exceptionally useful for extracting information about cognitive processes from neuroimaging data. Models provide a basis for identifying the multiple neural processes that contribute to behavior, and neuroimaging data can provide a powerful test bed for constraining and testing model predictions. PMID:22746951

Motivational pathways of occupational and organizational turnover intention among newly registered nurses in Canada.

PubMed

Fernet, Claude; Trépanier, Sarah-Geneviève; Demers, Mireille; Austin, Stéphanie

Staff turnover is a major issue for health care systems. In a time of labor shortage, it is critical to understand the motivational factors that underlie turnover intention in newly licensed nurses. To examine whether different forms of motivation (the reasons for which nurses engage in their work) predict intention to quit the occupation and organization through distinct forms (affective and continuance) and targets (occupation and organization) of commitment. Cross-sectional data were collected from a sample of 572 French-Canadian newly registered nurses working in public health care in the province of Quebec, Canada. The hypothesized model was tested by structural equation modeling. Autonomous motivation (nurses accomplish their work primarily out of a sense of pleasure and satisfaction or because they personally endorse the importance or value of their work) negatively predicts intention to quit the profession and organization through target-specific affective commitment. However, although controlled motivation (nurses accomplish their work mainly because of internal or external pressure) is positively associated with continuance commitment to the occupation and organization, it directly predicts, positively so, intention to quit the occupation and organization. These results highlight the complexity of the motivational processes at play in the turnover intention of novice nurses, revealing distinct forms of commitment that explain how motivation quality is related simultaneously to intention to quit the occupation and organization. Health care organizations are advised to promote autonomous over controlled motivation to retain newly recruited nurses and sustain the future of the nursing workforce. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Duplicate Federal Payments for Dual Enrollees in Medicare Advantage Plans and the Veterans Affairs Health Care System

PubMed Central

Trivedi, Amal N.; Grebla, Regina C.; Jiang, Lan; Yoon, Jean; Mor, Vincent; Kizer, Kenneth W.

2013-01-01

Context Some veterans are eligible to enroll simultaneously in a Medicare Advantage (MA) plan and the Veterans Affairs health care system (VA). This scenario produces the potential for redundant federal spending because MA plans would receive payments to insure veterans who receive care from the VA, another taxpayer-funded health plan. Objective To quantify the prevalence of dual enrollment in VA and MA, the concurrent use of health services in each setting, and the estimated costs of VA care provided to MA enrollees. Design Retrospective analysis of 1 245 657 veterans simultaneously enrolled in the VA and an MA plan between 2004–2009. Main Outcome Measures Use of health services and inflation-adjusted estimated VA health care costs. Results Among individuals who were eligible to enroll in the VA and in an MA plan, the number of persons dually enrolled increased from 485 651 in 2004 to 924 792 in 2009. In 2009, 8.3% of the MA population was enrolled in the VA and 5.0% of MA beneficiaries were VA users. The estimated VA health care costs for MA enrollees totaled $13.0 billion over 6 years, increasing from $1.3 billion in 2004 to $3.2 billion in 2009. Among dual enrollees, 10% exclusively used the VA for outpatient and acute inpatient services, 35% exclusively used the MA plan, 50% used both the VA and MA, and 4% received no services during the calendar year. The VA financed 44% of all outpatient visits (n=21 353 841), 15% of all acute medical and surgical admissions (n=177 663), and 18% of all acute medical and surgical inpatient days (n=1 106 284) for this dually enrolled population. In 2009, the VA billed private insurers $52.3 million to reimburse care provided to MA enrollees and collected $9.4 million (18% of the billed amount; 0.3% of the total cost of care). Conclusions The federal government spends a substantial and increasing amount of potentially duplicative funds in 2 separate managed care programs for the care of same individuals. PMID:22735360

Diagnostic test accuracy and prevalence inferences based on joint and sequential testing with finite population sampling.

PubMed

Su, Chun-Lung; Gardner, Ian A; Johnson, Wesley O

2004-07-30

The two-test two-population model, originally formulated by Hui and Walter, for estimation of test accuracy and prevalence estimation assumes conditionally independent tests, constant accuracy across populations and binomial sampling. The binomial assumption is incorrect if all individuals in a population e.g. child-care centre, village in Africa, or a cattle herd are sampled or if the sample size is large relative to population size. In this paper, we develop statistical methods for evaluating diagnostic test accuracy and prevalence estimation based on finite sample data in the absence of a gold standard. Moreover, two tests are often applied simultaneously for the purpose of obtaining a 'joint' testing strategy that has either higher overall sensitivity or specificity than either of the two tests considered singly. Sequential versions of such strategies are often applied in order to reduce the cost of testing. We thus discuss joint (simultaneous and sequential) testing strategies and inference for them. Using the developed methods, we analyse two real and one simulated data sets, and we compare 'hypergeometric' and 'binomial-based' inferences. Our findings indicate that the posterior standard deviations for prevalence (but not sensitivity and specificity) based on finite population sampling tend to be smaller than their counterparts for infinite population sampling. Finally, we make recommendations about how small the sample size should be relative to the population size to warrant use of the binomial model for prevalence estimation. Copyright 2004 John Wiley & Sons, Ltd.

Simultaneous travel time tomography for updating both velocity and reflector geometry in triangular/tetrahedral cell model

NASA Astrophysics Data System (ADS)

Bai, Chao-ying; He, Lei-yu; Li, Xing-wang; Sun, Jia-yu

2018-05-01

To conduct forward and simultaneous inversion in a complex geological model, including an irregular topography (or irregular reflector or velocity anomaly), we in this paper combined our previous multiphase arrival tracking method (referred as triangular shortest-path method, TSPM) in triangular (2D) or tetrahedral (3D) cell model and a linearized inversion solver (referred to as damped minimum norms and constrained least squares problem solved using the conjugate gradient method, DMNCLS-CG) to formulate a simultaneous travel time inversion method for updating both velocity and reflector geometry by using multiphase arrival times. In the triangular/tetrahedral cells, we deduced the partial derivative of velocity variation with respective to the depth change of reflector. The numerical simulation results show that the computational accuracy can be tuned to a high precision in forward modeling and the irregular velocity anomaly and reflector geometry can be accurately captured in the simultaneous inversion, because the triangular/tetrahedral cell can be easily used to stitch the irregular topography or subsurface interface.

Simultaneous travel time tomography for updating both velocity and reflector geometry in triangular/tetrahedral cell model

NASA Astrophysics Data System (ADS)

Bai, Chao-ying; He, Lei-yu; Li, Xing-wang; Sun, Jia-yu

2017-12-01

To conduct forward and simultaneous inversion in a complex geological model, including an irregular topography (or irregular reflector or velocity anomaly), we in this paper combined our previous multiphase arrival tracking method (referred as triangular shortest-path method, TSPM) in triangular (2D) or tetrahedral (3D) cell model and a linearized inversion solver (referred to as damped minimum norms and constrained least squares problem solved using the conjugate gradient method, DMNCLS-CG) to formulate a simultaneous travel time inversion method for updating both velocity and reflector geometry by using multiphase arrival times. In the triangular/tetrahedral cells, we deduced the partial derivative of velocity variation with respective to the depth change of reflector. The numerical simulation results show that the computational accuracy can be tuned to a high precision in forward modeling and the irregular velocity anomaly and reflector geometry can be accurately captured in the simultaneous inversion, because the triangular/tetrahedral cell can be easily used to stitch the irregular topography or subsurface interface.

Effects of ferumoxytol on quantitative PET measurements in simultaneous PET/MR whole-body imaging: a pilot study in a baboon model.

PubMed

Borra, Ronald Jh; Cho, Hoon-Sung; Bowen, Spencer L; Attenberger, Ulrike; Arabasz, Grae; Catana, Ciprian; Josephson, Lee; Rosen, Bruce R; Guimaraes, Alexander R; Hooker, Jacob M

2015-12-01

Simultaneous PET/MR imaging depends on MR-derived attenuation maps (mu-maps) for accurate attenuation correction of PET data. Currently, these maps are derived from gradient-echo-based MR sequences, which are sensitive to susceptibility changes. Iron oxide magnetic nanoparticles have been used in the measurement of blood volume, tumor microvasculature, tumor-associated macrophages, and characterizing lymph nodes. Our aim in this study was to assess whether the susceptibility effects associated with iron oxide nanoparticles can potentially affect measured (18)F-FDG PET standardized uptake values (SUV) through effects on MR-derived attenuation maps. The study protocol was approved by the Institutional Animal Care and Use Committee. Using a Siemens Biograph mMR PET/MR scanner, we evaluated the effects of increasing concentrations of ferumoxytol and ferumoxytol aggregates on MR-derived mu-maps using an agarose phantom. In addition, we performed a baboon experiment evaluating the effects of a single i.v. ferumoxytol dose (10 mg/kg) on the liver, spleen, and pancreas (18)F-FDG SUV at baseline (ferumoxytol-naïve), within the first hour and at 1, 3, 5, and 11 weeks. Phantom experiments showed mu-map artifacts starting at ferumoxytol aggregate concentrations of 10 to 20 mg/kg. The in vivo baboon data demonstrated a 53% decrease of observed (18)F-FDG SUV compared to baseline within the first hour in the liver, persisting at least 11 weeks. A single ferumoxytol dose can affect measured SUV for at least 3 months, which should be taken into account when administrating ferumoxytol in patients needing sequential PET/MR scans. Advances in knowledge 1. Ferumoxytol aggregates, but not ferumoxytol alone, produce significant artifacts in MR-derived attenuation correction maps at approximate clinical dose levels of 10 mg/kg. 2. When performing simultaneous whole-body (18)F-FDG PET/MR, a single dose of ferumoxytol can result in observed SUV decreases up to 53%, depending on the amount of ferumoxytol aggregates in the studied tissue. Implications for patient care Administration of a single, clinically relevant, dose of ferumoxytol can potentially result in changes in observed SUV for a prolonged period of time in the setting of simultaneous PET/MR. These potential changes should be considered in particular when administering ferumoxytol to patients with expected future PET/MR studies, as ferumoxytol-induced SUV changes might interfere with therapy assessment.

Design for life-cycle profit with simultaneous consideration of initial manufacturing and end-of-life remanufacturing

NASA Astrophysics Data System (ADS)

Kwak, Minjung; Kim, Harrison

2015-01-01

Remanufacturing is emerging as a promising solution for achieving green, profitable businesses. This article considers a manufacturer that produces new products and also remanufactured versions of the new products that become available at the end of their life cycle. For such a manufacturer, design decisions at the initial design stage determine both the current profit from manufacturing and future profit from remanufacturing. To maximize the total profit, design decisions must carefully consider both ends of product life cycle, i.e. manufacturing and end-of-life stages. This article proposes a decision-support model for the life-cycle design using mixed-integer nonlinear programming. With an aim to maximize the total life-cycle profit, the proposed model searches for an (at least locally) optimal product design (i.e. design specifications and the selling price) for the new and remanufactured products. It optimizes both the initial design and design upgrades at the end-of-life stage and also provides corresponding production strategies, including production quantities and take-back rate. The model is extended to a multi-objective model that maximizes both economic profit and environmental-impact saving. To illustrate, the developed model is demonstrated with an example of a desktop computer.

Changes in quality of care and costs induced by implementation of a diabetes program in a social security entity of Argentina.

PubMed

González, Lorena; Elgart, Jorge F; Calvo, Héctor; Gagliardino, Juan J

2013-01-01

To measure the impact of a diabetes and cardiovascular risk factors program implemented in a social security institution upon short- and long-term clinical/metabolic outcomes and costs of care. Observational longitudinal cohort analysis of clinical/metabolic data and resource use of 300 adult male and female program participants with diabetes before (baseline) and 1 and 3 years after implementation of the program. Data were obtained from clinical records (Qualidiab) and the administration's database. The implementation of the program in "real world" conditions resulted in an immediate and sustainable improvement of the quality of care provided to people with diabetes incorporated therein. We also recorded a more appropriate oral therapy prescription for hyperglycemia and cardiovascular risk factors (CVRFs), as well as a decrease of events related to chronic complications. This improvement was associated with an increased use of diagnostic and therapeutic resources, particularly those related to pharmacy prescriptions, not specifically used for the control of hyperglycemia and other CVRFs. The implementation of a diabetes program in real-world conditions results in a significant short- and long-term improvement of the quality of care provided to people with diabetes and other CVRFs, but simultaneously increased the use of resources and the cost of diagnostic and therapeutic practices. Since controlled studies have shown improvement in quality of care without increasing costs, our results suggest the need to include management-control strategies in these programs for appropriate medical and administrative feedback to ensure the simultaneous improvement of clinical outcomes and optimization of the use of resources.

Routine programs of health care systems as an opportunity toward communication skills training for family physicians: A randomized field trial

PubMed Central

Zamani, Ahmad Reza; Motamedi, Narges; Farajzadegan, Ziba

2015-01-01

Background: To have high-quality primary health care services, an adequate doctor–patient communication is necessary. Because of time restrictions and limited budget in health system, an effective, feasible, and continuous training approach is important. The aim of this study is to assess the appropriateness of a communication skills training program simultaneously with routine programs of health care system. Materials and Methods: It was a randomized field trial in two health network settings during 2013. Twenty-eight family physicians through simple random sampling and 140 patients through convenience sampling participated as intervention and control group. The physicians in the intervention group (n = 14) attended six educational sessions, simultaneous organization meeting, with case discussion and peer education method. In both the groups, physicians completed communication skills knowledge and attitude questionnaires, and patients completed patient satisfaction of medical interview questionnaire at baseline, immediately after intervention, and four months postintervention. Physicians and health network administrators (stakeholders), completed a set of program evaluation forms. Descriptive statistics and Chi-square test, t-test, and repeated measure analysis of variance were used to analyze the data. Results: Use of routine program as a strategy of training was rated by stakeholders highly on “feasibility” (80.5%), “acceptability” (93.5%), “educational content and method appropriateness” (80.75%), and “ability to integrating in the health system programs” (approximate 60%). Significant improvements were found in physicians’ knowledge (P < 0.001), attitude (P < 0.001), and patients’ satisfaction (P = 0.002) in intervention group. Conclusions: Communication skills training program, simultaneous organization meeting was successfully implemented and well received by stakeholders, without considering extra time and manpower. Therefore it can be a valuable opportunity toward communication skills training. PMID:27462613

'Heated political dynamics exist ...': examining the politics of palliative care in rural British Columbia, Canada.

PubMed

Crooks, Valorie A; Castleden, Heather; Hanlon, Neil; Schuurman, Nadine

2011-01-01

Palliative care is delivered by a number of professional groups and informal providers across a range of settings. This arrangement works well in that it maximizes avenues for providing care, but may also bring about complicated 'politics' due to struggles over control and decision-making power. Thirty-one interviews conducted with formal and informal palliative care providers in a rural region of British Columbia, Canada, are drawn upon as a case study. Three types of politics impacting on palliative care provision are identified: inter-community, inter-site, and inter-professional. Three themes crosscut these politics: ownership, entitlement, and administration. The politics revealed by the interviews, and heretofore underexplored in the palliative literature, have implications for the delivery of palliative care. For example, the outcomes of the politics simultaneously facilitate (e.g. by promoting advocacy for local services) and serve as a barrier to (e.g. by privileging certain communities/care sites/provider) palliative care provision.

Unsettling care: Troubling transnational itineraries of care in feminist health practices.

PubMed

Murphy, Michelle

2015-10-01

Responding to the call by Maria Puig de la Bellacasa for Science and Technology Studies to take up 'matters of care', this article cautions against equating care with positive feelings and, in contrast, argues for the importance of grappling with the non-innocent histories in which the politics of care already circulates, particularly in transnational couplings of feminism and health. The article highlights these histories by tracing multiple versions of the politics of care in a select set of feminist engagements with the pap smear and cervical cancer. Drawing on postcolonial and indigenous feminist commitments, as well as amplifying Donna Haraway's call to 'stay with the trouble', the article seeks to disturb hegemonic histories and arrangements of race, colonialism, and political economy, while simultaneously valuing divergent multi-local itineraries as relevant to technoscientific matters of care. This call for a politics of 'unsettling' care strives to stir up and put into motion what is sedimented, while embracing the generativity of discomfort, critique, and non-innocence.

Shifting patterns of practice: nurse practitioners in a managed care environment.

PubMed

Johnson, Rosemary

2005-01-01

The purpose of this qualitative study was to uncover patterns across nurse practitioner (NP) experiences that contribute to understanding their perceptions of managed care, how it affects daily practice, and how NPs respond to a changing managed care workplace. In-depth interviews were conducted with 14 NPs representing primary care, specialty, and independent practices. Over an 18-month period, data collection and analysis occurred simultaneously using standard methods of purposive sampling, constant comparison, memoing, and member checks. This study illuminates the tension NPs experience between a business and a professional ethic and the strategies they use to reconcile this difference with core nursing values. Type of setting, workplace dynamics, and length of time in practice contributed to variation in NP perspectives.

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association.

PubMed

Maddox, Thomas M; Albert, Nancy M; Borden, William B; Curtis, Lesley H; Ferguson, T Bruce; Kao, David P; Marcus, Gregory M; Peterson, Eric D; Redberg, Rita; Rumsfeld, John S; Shah, Nilay D; Tcheng, James E

2017-04-04

The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented. © 2017 American Heart Association, Inc.

Network meta-analysis of diagnostic test accuracy studies identifies and ranks the optimal diagnostic tests and thresholds for health care policy and decision-making.

PubMed

Owen, Rhiannon K; Cooper, Nicola J; Quinn, Terence J; Lees, Rosalind; Sutton, Alex J

2018-07-01

Network meta-analyses (NMA) have extensively been used to compare the effectiveness of multiple interventions for health care policy and decision-making. However, methods for evaluating the performance of multiple diagnostic tests are less established. In a decision-making context, we are often interested in comparing and ranking the performance of multiple diagnostic tests, at varying levels of test thresholds, in one simultaneous analysis. Motivated by an example of cognitive impairment diagnosis following stroke, we synthesized data from 13 studies assessing the efficiency of two diagnostic tests: Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), at two test thresholds: MMSE <25/30 and <27/30, and MoCA <22/30 and <26/30. Using Markov chain Monte Carlo (MCMC) methods, we fitted a bivariate network meta-analysis model incorporating constraints on increasing test threshold, and accounting for the correlations between multiple test accuracy measures from the same study. We developed and successfully fitted a model comparing multiple tests/threshold combinations while imposing threshold constraints. Using this model, we found that MoCA at threshold <26/30 appeared to have the best true positive rate, whereas MMSE at threshold <25/30 appeared to have the best true negative rate. The combined analysis of multiple tests at multiple thresholds allowed for more rigorous comparisons between competing diagnostics tests for decision making. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

A homecare application based on the ASTM E2369-05 Standard Specification for Continuity of Care Record.

PubMed

Botsivaly, M; Spyropoulos, B; Koutsourakis, K; Mertika, K

2006-01-01

The purpose of this study is the presentation of a system appropriate to be used upon the transition of a patient from hospital to homecare. The developed system is structured according to the ASTM E2369-05 Standard Specification for Continuity of Care Record and its function is based upon the creation of a structured subset of data, containing the patient's most relevant clinical information, enabling simultaneously the planning and the optimal documentation of the provided homecare.

Caught in the competitive crossfire: safety-net providers balance margin and mission in a profit-driven health care market.

PubMed

Cunningham, Peter J; Bazzoli, Gloria J; Katz, Aaron

2008-01-01

This paper describes how intensifying competitive pressures in the health system are simultaneously driving increased demand for safety-net care and taxing safety-net providers' ability to maintain the mission of serving all, regardless of ability to pay. Although safety-net providers adapted to previous challenges arising from managed care, health system pressures have been more intense and more generalized across different sectors in recent years than in the past. Providers are adopting some of the same strategies being used in the private sector to attract higher-paying patients and changing their "image" as a safety-net provider.

Quality of nurses' work life: strategies for enhancement.

PubMed

Davis, B; Thorburn, B

1999-01-01

The radical transformation resulting from health care reform, with its emphasis on restructuring, reorganizing and downsizing, has impacted on the nursing profession and has profoundly effected the quality of nurses' work life. The Health Care Corporation of St. John's experienced the stress associated with change when it simultaneously merged eight health care sites and introduced a programmed-based management structure. This article reviews the strategies developed in response to this transition by the Nurses' Quality of Worklife Team, to help reduce stress and enhance the quality of nurses' work life. In particular, it highlights the development and implementation of a professional support network called the Nursing Peer Support Program.

Managing interorganizational dependencies in the new health care marketplace.

PubMed

Pointer, D D; Begun, J W; Luke, R D

1988-01-01

To survive, let alone thrive, in an increasingly competitive and threatening environment, health care organizations must skillfully manage their dependencies. Such dependencies traditionally have been managed through marketplace exchanges (buying and selling) and ownership relationships (acquisition, merger, and business development). An alternative strategy for designing and managing interorganizational relationships, the quasi-firm, is introduced. The quasi-firm is a hybrid market/ownership arrangement that allows participating organizations to pursue strategically important purposes while simultaneously preserving a high degree of functional and legal autonomy. We suggest that this distinctive interorganizational form is particularly well suited to the features of the new health care marketplace.

Response Styles in Rating Scales: Simultaneous Modeling of Content-Related Effects and the Tendency to Middle or Extreme Categories

ERIC Educational Resources Information Center

Tutz, Gerhard; Berger, Moritz

2016-01-01

Heterogeneity in response styles can affect the conclusions drawn from rating scale data. In particular, biased estimates can be expected if one ignores a tendency to middle categories or to extreme categories. An adjacent categories model is proposed that simultaneously models the content-related effects and the heterogeneity in response styles.…

Information Processing and Human Abilities

ERIC Educational Resources Information Center

Kirby, John R.; Das, J. P.

1978-01-01

The simultaneous and successive processing model of cognitive abilities was compared to a traditional primary mental abilities model. Simultaneous processing was found to be primarily related to spatial ability; and to a lesser extent, to memory and inductive reasoning. Subjects were 104 fourth-grade urban males. (Author/GD C)

Simultaneous and Successive Processing in Children with Reading Disability.

ERIC Educational Resources Information Center

Das, J. P.

1984-01-01

Considered are implications for learning disabled students of the simultaneous, successive, and planning (SSP) model, a model of information integration that emphasizes processes rather than ability. Remedial training guidelines are offered, including assessment of learning potential and determination of the nature of the weakness and its…

Does centralisation of acute obstetric care reduce intrapartum and first-week mortality? An empirical study of over 1 million births in the Netherlands.

PubMed

Poeran, Jashvant; Borsboom, Gerard J J M; de Graaf, Johanna P; Birnie, Erwin; Steegers, Eric A P; Mackenbach, Johan P; Bonsel, Gouke J

2014-07-01

In this hypothetical analysis with retrospective cohort data (1,160,708 hospital births) we estimated outcome of centralisation of acute obstetric care, i.e., closure of 10 hospitals (out of 99) in The Netherlands. The main outcome was predicted intrapartum and first-week mortality (further referred to as neonatal mortality) for several subgroups of patients affected by two centralisation scenarios: (1) closure of the 10 smallest hospitals; (2) closure of the 10 smallest hospitals, but avoiding adjacent closures. Predictions followed from regression coefficients from a multilevel logistic regression model. Scenario 1 resulted in doubled travel time, and 10% increased mortality (210 [0.34%] to 231 [0.38%] cases). Scenario 2 showed less effect on mortality (268 [0.33%] to 259 [0.32%] cases) and travel time. Heterogeneity in hospital organisational features caused simultaneous improvement and deterioration of predicted neonatal mortality. Consequences vary for subgroups. We demonstrate that (in The Netherlands) centralisation of acute obstetric care according to the 'closure-of-the-smallest-rule' yields suboptimal outcomes. In order to develop an optimal strategy one would need to consider all positive and negative effects, e.g., organisational heterogeneity of closing and surviving hospitals, differential effects for patient subgroups, increased travel time, and financial aspects. The provided framework may be beneficial for other countries considering centralisation of acute obstetric care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Addressing dual agency: getting specific about the expectations of professionalism.

PubMed

Tilburt, Jon C

2014-01-01

Professionalism requires that physicians uphold the best interests of patients while simultaneously insuring just use of health care resources. Current articulations of these obligations like the American Board of Internal Medicine (ABIM) Foundation's Physician Charter do not reconcile how these obligations fit together when they conflict. This is the problem of dual agency. The most common ways of dealing with dual agency: "bunkering"--physicians act as though societal cost issues are not their problem; "bailing"--physicians assume that they are merely agents of society and deliver care typically based on a strongly consequentialist public health ethic; or "balancing"--a vaguely specified attempt to uphold both patient welfare and societal need for judicious resource use simultaneously--all fail. Here I propose how the problem of dual agency might begin to be addressed with rigor and consistency. Without dealing with the dual agency problem and getting more specific about how to reconcile its norms when they conflict, the expectations of professionalism risk being written off as cute, nonbinding aphorisms from the medical profession.

Simultaneous activation of parallel sensory pathways promotes a grooming sequence in Drosophila

PubMed Central

Hampel, Stefanie; McKellar, Claire E

2017-01-01

A central model that describes how behavioral sequences are produced features a neural architecture that readies different movements simultaneously, and a mechanism where prioritized suppression between the movements determines their sequential performance. We previously described a model whereby suppression drives a Drosophila grooming sequence that is induced by simultaneous activation of different sensory pathways that each elicit a distinct movement (Seeds et al., 2014). Here, we confirm this model using transgenic expression to identify and optogenetically activate sensory neurons that elicit specific grooming movements. Simultaneous activation of different sensory pathways elicits a grooming sequence that resembles the naturally induced sequence. Moreover, the sequence proceeds after the sensory excitation is terminated, indicating that a persistent trace of this excitation induces the next grooming movement once the previous one is performed. This reveals a mechanism whereby parallel sensory inputs can be integrated and stored to elicit a delayed and sequential grooming response. PMID:28887878

Simultaneous hand-held contact color fundus and SD-OCT imaging for pediatric retinal diseases (Conference Presentation)

NASA Astrophysics Data System (ADS)

Ruggeri, Marco; Hernandez, Victor; De Freitas, Carolina; Relhan, Nidhi; Silgado, Juan; Manns, Fabrice; Parel, Jean-Marie

2016-03-01

Hand-held wide-field contact color fundus photography is currently the standard method to acquire diagnostic images of children during examination under anesthesia and in the neonatal intensive care unit. The recent development of portable non-contact hand-held OCT retinal imaging systems has proved that OCT is of tremendous help to complement fundus photography in the management of pediatric patients. Currently, there is no commercial or research system that combines color wide-field digital fundus and OCT imaging in a contact-fashion. The contact of the probe with the cornea has the advantages of reducing motion experienced by the photographer during the imaging and providing fundus and OCT images with wider field of view that includes the periphery of the retina. In this study we produce proof of concept for a contact-type hand-held unit for simultaneous color fundus and OCT live view of the retina of pediatric patients. The front piece of the hand-held unit consists of a contact ophthalmoscopy lens integrating a circular light guide that was recovered from a digital fundus camera for pediatric imaging. The custom-made rear piece consists of the optics to: 1) fold the visible aerial image of the fundus generated by the ophthalmoscopy lens on a miniaturized level board digital color camera; 2) conjugate the eye pupil to the galvanometric scanning mirrors of an OCT delivery system. Wide-field color fundus and OCT images were simultaneously obtained in an eye model and sequentially obtained on the eye of a conscious 25 year-old human subject with healthy retina.

Oncotripsy: Targeting cancer cells selectively via resonant harmonic excitation

NASA Astrophysics Data System (ADS)

Heyden, S.; Ortiz, M.

2016-07-01

We investigate a method of selectively targeting cancer cells by means of ultrasound harmonic excitation at their resonance frequency, which we refer to as oncotripsy. The geometric model of the cells takes into account the cytoplasm, nucleus and nucleolus, as well as the plasma membrane and nuclear envelope. Material properties are varied within a pathophysiologically-relevant range. A first modal analysis reveals the existence of a spectral gap between the natural frequencies and, most importantly, resonant growth rates of healthy and cancerous cells. The results of the modal analysis are verified by simulating the fully-nonlinear transient response of healthy and cancerous cells at resonance. The fully nonlinear analysis confirms that cancerous cells can be selectively taken to lysis by the application of carefully tuned ultrasound harmonic excitation while simultaneously leaving healthy cells intact.

Cooling the Martian atmosphere: The spectral overlap of the C02 15 micrometers band and dust

NASA Technical Reports Server (NTRS)

Lindner, Bernhard Lee

1994-01-01

Careful consideration must be given to the simultaneous treatment of the radiative transfer of the CO2 15 micron band and dust calculations for the Martian winter polar region show that a simple sum of separately calculated CO2 cooling rates and dust cooling rates can easily result a 30 percent error in the net cooling particularly near the surface. CO2 and dust hinder each others ability to cool the atmosphere. Even during periods of low dust opacity, dust still reduces the efficacy of CO2 at cooling the atmosphere. At the other extreme, when dust storms occur, CO2 still significantly impedes the ability of dust to cool the atmosphere. Hence, both CO2 and dust must be considered in radiative transfer models.

Sensitivity of decomposition rates of soil organic matter with respect to simultaneous changes in temperature and moisture

NASA Astrophysics Data System (ADS)

Sierra, Carlos A.; Trumbore, Susan E.; Davidson, Eric A.; Vicca, Sara; Janssens, I.

2015-03-01

The sensitivity of soil organic matter decomposition to global environmental change is a topic of prominent relevance for the global carbon cycle. Decomposition depends on multiple factors that are being altered simultaneously as a result of global environmental change; therefore, it is important to study the sensitivity of the rates of soil organic matter decomposition with respect to multiple and interacting drivers. In this manuscript, we present an analysis of the potential response of decomposition rates to simultaneous changes in temperature and moisture. To address this problem, we first present a theoretical framework to study the sensitivity of soil organic matter decomposition when multiple driving factors change simultaneously. We then apply this framework to models and data at different levels of abstraction: (1) to a mechanistic model that addresses the limitation of enzyme activity by simultaneous effects of temperature and soil water content, the latter controlling substrate supply and oxygen concentration for microbial activity; (2) to different mathematical functions used to represent temperature and moisture effects on decomposition in biogeochemical models. To contrast model predictions at these two levels of organization, we compiled different data sets of observed responses in field and laboratory studies. Then we applied our conceptual framework to: (3) observations of heterotrophic respiration at the ecosystem level; (4) laboratory experiments looking at the response of heterotrophic respiration to independent changes in moisture and temperature; and (5) ecosystem-level experiments manipulating soil temperature and water content simultaneously.

Airframe Noise Prediction of a Full Aircraft in Model and Full Scale Using a Lattice Boltzmann Approach

NASA Technical Reports Server (NTRS)

Fares, Ehab; Duda, Benjamin; Khorrami, Mehdi R.

2016-01-01

Unsteady flow computations are presented for a Gulfstream aircraft model in landing configuration, i.e., flap deflected 39deg and main landing gear deployed. The simulations employ the lattice Boltzmann solver PowerFLOW(Trademark) to simultaneously capture the flow physics and acoustics in the near field. Sound propagation to the far field is obtained using a Ffowcs Williams and Hawkings acoustic analogy approach. Two geometry representations of the same aircraft are analyzed: an 18% scale, high-fidelity, semi-span model at wind tunnel Reynolds number and a full-scale, full-span model at half-flight Reynolds number. Previously published and newly generated model-scale results are presented; all full-scale data are disclosed here for the first time. Reynolds number and geometrical fidelity effects are carefully examined to discern aerodynamic and aeroacoustic trends with a special focus on the scaling of surface pressure fluctuations and farfield noise. An additional study of the effects of geometrical detail on farfield noise is also documented. The present investigation reveals that, overall, the model-scale and full-scale aeroacoustic results compare rather well. Nevertheless, the study also highlights that finer geometrical details that are typically not captured at model scales can have a non-negligible contribution to the farfield noise signature.

Dual-energy X-ray analysis using synchrotron computed tomography at 35 and 60 keV for the estimation of photon interaction coefficients describing attenuation and energy absorption.

PubMed

Midgley, Stewart; Schleich, Nanette

2015-05-01

A novel method for dual-energy X-ray analysis (DEXA) is tested using measurements of the X-ray linear attenuation coefficient μ. The key is a mathematical model that describes elemental cross sections using a polynomial in atomic number. The model is combined with the mixture rule to describe μ for materials, using the same polynomial coefficients. Materials are characterized by their electron density Ne and statistical moments Rk describing their distribution of elements, analogous to the concept of effective atomic number. In an experiment with materials of known density and composition, measurements of μ are written as a system of linear simultaneous equations, which is solved for the polynomial coefficients. DEXA itself involves computed tomography (CT) scans at two energies to provide a system of non-linear simultaneous equations that are solved for Ne and the fourth statistical moment R4. Results are presented for phantoms containing dilute salt solutions and for a biological specimen. The experiment identifies 1% systematic errors in the CT measurements, arising from third-harmonic radiation, and 20-30% noise, which is reduced to 3-5% by pre-processing with the median filter and careful choice of reconstruction parameters. DEXA accuracy is quantified for the phantom as the mean absolute differences for Ne and R4: 0.8% and 1.0% for soft tissue and 1.2% and 0.8% for bone-like samples, respectively. The DEXA results for the biological specimen are combined with model coefficients obtained from the tabulations to predict μ and the mass energy absorption coefficient at energies of 10 keV to 20 MeV.

The Relationship between Simultaneous-Successive Processing and Academic Achievement.

ERIC Educational Resources Information Center

Merritt, Frank M.; McCallum, Steve

The Luria-Das Information Processing Model of human learning holds that information is analysed and coded within the brain in either a simultaneous or a successive fashion. Simultaneous integration refers to the synthesis of separate elements into groups, often with spatial characteristics; successive integration means that information is…

Policy insights from the nutritional food market transformation model: the case of obesity prevention.

PubMed

Struben, Jeroen; Chan, Derek; Dubé, Laurette

2014-12-01

This paper presents a system dynamics policy model of nutritional food market transformation, tracing over-time interactions between the nutritional quality of supply, consumer food choice, population health, and governmental policy. Applied to the Canadian context and with body mass index as the primary outcome, we examine policy portfolios for obesity prevention, including (1) industry self-regulation efforts, (2) health- and nutrition-sensitive governmental policy, and (3) efforts to foster health- and nutrition-sensitive innovation. This work provides novel theoretical and practical insights on drivers of nutritional market transformations, highlighting the importance of integrative policy portfolios to simultaneously shift food demand and supply for successful and self-sustaining nutrition and health sensitivity. We discuss model extensions for deeper and more comprehensive linkages of nutritional food market transformation with supply, demand, and policy in agrifood and health/health care. These aim toward system design and policy that can proactively, and with greater impact, scale, and resilience, address single as well as double malnutrition in varying country settings. © 2014 New York Academy of Sciences.

Multiscale Analysis of Head Impacts in Contact Sports

NASA Astrophysics Data System (ADS)

Guttag, Mark; Sett, Subham; Franck, Jennifer; McNamara, Kyle; Bar-Kochba, Eyal; Crisco, Joseph; Blume, Janet; Franck, Christian

2012-02-01

Traumatic brain injury (TBI) is one of the world's major causes of death and disability. To aid companies in designing safer and improved protective gear and to aid the medical community in producing improved quantitative TBI diagnosis and assessment tools, a multiscale finite element model of the human brain, head and neck is being developed. Recorded impact data from football and hockey helmets instrumented with accelerometers are compared to simulated impact data in the laboratory. Using data from these carefully constructed laboratory experiments, we can quantify impact location, magnitude, and linear and angular accelerations of the head. The resultant forces and accelerations are applied to a fully meshed head-form created from MRI data by Simpleware. With appropriate material properties for each region of the head-form, the Abaqus finite element model can determine the stresses, strains, and deformations in the brain. Simultaneously, an in-vitro cellular TBI criterion is being developed to be incorporated into Abaqus models for the brain. The cell-based injury criterion functions the same way that damage criteria for metals and other materials are used to predict failure in structural materials.

Collective Care: Multiple Caregivers and Multiple Care Recipients in Mexican American Families

PubMed Central

Evans, Bronwynne C.; Coon, David W.; Belyea, Michael J.; Ume, Ebere

2016-01-01

Purpose Specific stressors associated with caregiving in Mexican-American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. Such families are both understudied and poorly served by contemporary health systems because their characteristics are unknown. Design Descriptive, multi-site, longitudinal mixed-methods study of MA caregiving families. Findings We identified three types of collective caregivers: those providing care for multiple family members simultaneously; those providing care successively to several family members, and/or those finding themselves obliged to accept care during their caregiving of others. Discussion and Conclusions Collective caregiving of MA elders warrants further investigation. Implications for Practice Exploration of collective caregiving may provide a foundation for tailored family interventions. PMID:27389911

45 CFR 150.459 - Judicial review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS CMS...) Simultaneously sending a copy of the notice of appeal by registered mail to CMS. (b) Certification of administrative record. CMS promptly certifies and files with the court the record upon which the penalty was...

Correction of a liquid lens for 3D imaging systems

NASA Astrophysics Data System (ADS)

Bower, Andrew J.; Bunch, Robert M.; Leisher, Paul O.; Li, Weixu; Christopher, Lauren A.

2012-06-01

3D imaging systems are currently being developed using liquid lens technology for use in medical devices as well as in consumer electronics. Liquid lenses operate on the principle of electrowetting to control the curvature of a buried surface, allowing for a voltage-controlled change in focal length. Imaging systems which utilize a liquid lens allow extraction of depth information from the object field through a controlled introduction of defocus into the system. The design of such a system must be carefully considered in order to simultaneously deliver good image quality and meet the depth of field requirements for image processing. In this work a corrective model has been designed for use with the Varioptic Arctic 316 liquid lens. The design is able to be optimized for depth of field while minimizing aberrations for a 3D imaging application. The modeled performance is compared to the measured performance of the corrected system over a large range of focal lengths.

Gender Differences in Spousal Caregiving in Japan

PubMed Central

Ito, Mikiko; Kutsumi, Masami; Mikami, Hiroshi

2009-01-01

Background Gender differences in spousal caregivers and their relationship to care experiences, social demographics, and caregivers’ depression were examined. Methods A stratified random sample of 2,020 users of public long-term care insurance in a city of Osaka prefecture, Japan, participated in this study. Responses from 308 spouses (56.2% wives, 43.8% husbands) were analyzed. Variables relating to care experiences, social demographics, and caregivers’ depression were compared by conducting simultaneous analyses of multiple populations. Results Wives caring for husbands had higher depression scores than husbands caring for wives. Wives tended to adopt “emotional support seeking” and “willing commitment” as coping strategies for their caregiving experience. Husband caregivers used more home-care services; however, increased service use had no effect on husbands’ depression. The availability of secondary caregivers reduced depression for caregivers, regardless of gender. Conclusions The effects on depression differed related to the caregiver's gender. Husbands relied more on family or home-care services when caring for their wives, whereas wives provided higher levels of care, positively accepted their role, and did not seek to share caregiving, but sought emotional support. PMID:19176486

Gender differences in spousal caregiving in Japan.

PubMed

Sugiura, Keiko; Ito, Mikiko; Kutsumi, Masami; Mikami, Hiroshi

2009-01-01

Gender differences in spousal caregivers and their relationship to care experiences, social demographics, and caregivers' depression were examined. A stratified random sample of 2,020 users of public long-term care insurance in a city of Osaka prefecture, Japan, participated in this study. Responses from 308 spouses (56.2% wives, 43.8% husbands) were analyzed. Variables relating to care experiences, social demographics, and caregivers' depression were compared by conducting simultaneous analyses of multiple populations. Wives caring for husbands had higher depression scores than husbands caring for wives. Wives tended to adopt "emotional support seeking" and "willing commitment" as coping strategies for their caregiving experience. Husband caregivers used more home-care services; however, increased service use had no effect on husbands' depression. The availability of secondary caregivers reduced depression for caregivers, regardless of gender. The effects on depression differed related to the caregiver's gender. Husbands relied more on family or home-care services when caring for their wives, whereas wives provided higher levels of care, positively accepted their role, and did not seek to share caregiving, but sought emotional support.

Development and validation of a whole-exome sequencing test for simultaneous detection of point mutations, indels and copy-number alterations for precision cancer care

PubMed Central

Rennert, Hanna; Eng, Kenneth; Zhang, Tuo; Tan, Adrian; Xiang, Jenny; Romanel, Alessandro; Kim, Robert; Tam, Wayne; Liu, Yen-Chun; Bhinder, Bhavneet; Cyrta, Joanna; Beltran, Himisha; Robinson, Brian; Mosquera, Juan Miguel; Fernandes, Helen; Demichelis, Francesca; Sboner, Andrea; Kluk, Michael; Rubin, Mark A; Elemento, Olivier

2016-01-01

We describe Exome Cancer Test v1.0 (EXaCT-1), the first New York State-Department of Health-approved whole-exome sequencing (WES)-based test for precision cancer care. EXaCT-1 uses HaloPlex (Agilent) target enrichment followed by next-generation sequencing (Illumina) of tumour and matched constitutional control DNA. We present a detailed clinical development and validation pipeline suitable for simultaneous detection of somatic point/indel mutations and copy-number alterations (CNAs). A computational framework for data analysis, reporting and sign-out is also presented. For the validation, we tested EXaCT-1 on 57 tumours covering five distinct clinically relevant mutations. Results demonstrated elevated and uniform coverage compatible with clinical testing as well as complete concordance in variant quality metrics between formalin-fixed paraffin embedded and fresh-frozen tumours. Extensive sensitivity studies identified limits of detection threshold for point/indel mutations and CNAs. Prospective analysis of 337 cancer cases revealed mutations in clinically relevant genes in 82% of tumours, demonstrating that EXaCT-1 is an accurate and sensitive method for identifying actionable mutations, with reasonable costs and time, greatly expanding its utility for advanced cancer care. PMID:28781886

The combining of multiple hemispheric resources in learning-disabled and skilled readers' recall of words: a test of three information-processing models.

PubMed

Swanson, H L

1987-01-01

Three theoretical models (additive, independence, maximum rule) that characterize and predict the influence of independent hemispheric resources on learning-disabled and skilled readers' simultaneous processing were tested. Predictions related to word recall performance during simultaneous encoding conditions (dichotic listening task) were made from unilateral (dichotic listening task) presentations. The maximum rule model best characterized both ability groups in that simultaneous encoding produced no better recall than unilateral presentations. While the results support the hypothesis that both ability groups use similar processes in the combining of hemispheric resources (i.e., weak/dominant processing), ability group differences do occur in the coordination of such resources.

Efficient simultaneous reverse Monte Carlo modeling of pair-distribution functions and extended x-ray-absorption fine structure spectra of crystalline disordered materials.

PubMed

Németh, Károly; Chapman, Karena W; Balasubramanian, Mahalingam; Shyam, Badri; Chupas, Peter J; Heald, Steve M; Newville, Matt; Klingler, Robert J; Winans, Randall E; Almer, Jonathan D; Sandi, Giselle; Srajer, George

2012-02-21

An efficient implementation of simultaneous reverse Monte Carlo (RMC) modeling of pair distribution function (PDF) and EXAFS spectra is reported. This implementation is an extension of the technique established by Krayzman et al. [J. Appl. Cryst. 42, 867 (2009)] in the sense that it enables simultaneous real-space fitting of x-ray PDF with accurate treatment of Q-dependence of the scattering cross-sections and EXAFS with multiple photoelectron scattering included. The extension also allows for atom swaps during EXAFS fits thereby enabling modeling the effects of chemical disorder, such as migrating atoms and vacancies. Significant acceleration of EXAFS computation is achieved via discretization of effective path lengths and subsequent reduction of operation counts. The validity and accuracy of the approach is illustrated on small atomic clusters and on 5500-9000 atom models of bcc-Fe and α-Fe(2)O(3). The accuracy gains of combined simultaneous EXAFS and PDF fits are pointed out against PDF-only and EXAFS-only RMC fits. Our modeling approach may be widely used in PDF and EXAFS based investigations of disordered materials. © 2012 American Institute of Physics

Innovating in Health Care Management Education: Development of an Accelerated MBA and MPH Degree Program at Yale

PubMed Central

Forman, Howard P.; Pistell, Anne F.; Nembhard, Ingrid M.

2015-01-01

Increasingly, there is recognition of the need for individuals with expertise in both management and public health to help health care organizations deliver high-quality and cost-effective care. The Yale School of Public Health and Yale School of Management began offering an accelerated Master of Business Administration (MBA) and Master of Public Health (MPH) joint degree program in the summer of 2014. This new program enables students to earn MBA and MPH degrees simultaneously from 2 fully accredited schools in 22 months. Students will graduate with the knowledge and skills needed to become innovative leaders of health care organizations. We discuss the rationale for the program, the developmental process, the curriculum, benefits of the program, and potential challenges. PMID:25706023

Personal review and justice analysis of nursing experiences in Haiti.

PubMed

Emmott, Helen

2008-08-01

Health care providers frequently struggle to develop wise applications of theoretical knowledge. As a nurse studying traditional approaches in ethics while simultaneously volunteering in Haiti, I wrestled with the notion of justice in the midst of radical material inequities. Paul Farmer, physician and anthropologist, provides an analytic perspective for health care providers who work in poor and underserved countries by expanding the liberation theology of the 1970s to include social applications. Analyzing my past experiences in Haiti using Farmer's methodology provided insight into my successes and failures and prompted me to search for personal and professional reasons to provide care for the poor in the future. This type of reflection is essential for health care providers who work with the underserved, regardless of their religion or the country in which they work.

Innovating in health care management education: development of an accelerated MBA and MPH degree program at Yale.

PubMed

Pettigrew, Melinda M; Forman, Howard P; Pistell, Anne F; Nembhard, Ingrid M

2015-03-01

Increasingly, there is recognition of the need for individuals with expertise in both management and public health to help health care organizations deliver high-quality and cost-effective care. The Yale School of Public Health and Yale School of Management began offering an accelerated Master of Business Administration (MBA) and Master of Public Health (MPH) joint degree program in the summer of 2014. This new program enables students to earn MBA and MPH degrees simultaneously from 2 fully accredited schools in 22 months. Students will graduate with the knowledge and skills needed to become innovative leaders of health care organizations. We discuss the rationale for the program, the developmental process, the curriculum, benefits of the program, and potential challenges.

Physicians in training as quality managers: survival strategy for academic health centers.

PubMed

Wofford, J L; Moran, W P; Cohen, S J; Simon, R C

1997-12-01

Being responsible for medical education places academic health centers at a disadvantage in competing for managed care contracts. Although many suggestions have been made for changing medical education to produce physicians who are better prepared for the managed care environment, few studies have shown how physicians in training can actually contribute to the competitiveness of an academic health center. We present three examples of engaging trainees in projects with a population-based perspective that demonstrate how quality improvement for the academic health center can be operationalized and even led by physicians in training. In addition to gaining experience in a managed care skill that is increasingly important for future employment, physicians in training can simultaneously improve the quality of care delivered through the academic health center.

Simultaneous surgeries in a split forward surgical team: a case study.

PubMed

Vanfosson, Christopher A; Seery, Jason M

2011-12-01

The 541st Forward Surgical Team performed split-based operations, with one site in the city of Pol-e-Khumri. One evening, the 10-person team received two pediatric patients simultaneously and conducted simultaneous surgeries. The 3-year-old female sustained severe injuries to bilateral lower extremities and a puncture wound to her right forearm. The 13-year-old sustained fragmentary wounds to her left hand, left foot, right medial calf, and evisceration to her left lower quadrant. The patients presented in extremis after being taken to a civilian hospital initially, spending approximately 1.5 hours receiving no resuscitative therapy. The 3-year-old underwent amputations of bilateral lower extremities and a fasciotomy of the right forearm. The 13-year-old survived an exploratory laparotomy and irrigation and debridement of intra-abdominal wounds. The successful completion of simultaneous surgeries, by a split forward surgical team at a remote location, for two critically ill patients is possible. It should not become the standard of care. Prior planning made this occurrence feasible and safer, but such situations put the patients at risk for complications.

Simultaneous deblending and interpolation using structure-oriented filters

NASA Astrophysics Data System (ADS)

Zhou, Yatong; Li, Song

2018-03-01

Simultaneous source shooting is a modern marine acquisition technology that accelerates field acquisition tremendously. However, we need to carefully remove the spike-like noise in the recorded seismic data, the process of which is called deblending. Considering the field obstacles, the recorded data may also contain missing traces. In this paper, we propose a very efficient way to simultaneously remove the spike-like noise to separate simultaneous sources and fill the data gaps in the recorded data. We propose to apply structure-oriented median and mean filters to reject the spike-like noise and restore the missing data. The commonly used median and mean filters guarantee the efficiency and convenience of the proposed algorithm framework. We use a robust slope estimation method to calculate the local slope of the structure patterns in the seismic data. Both synthetic and field data examples demonstrate the successful performance of the proposed algorithm. When compared with the state-of-the-art FK transform based projection onto convex sets (POCS) method, the presented method can obtain better performance with much less computational cost.

Simultaneous visualization of transonic buffet on a rocket faring model using unsteady PSP measurement and Schlieren method

NASA Astrophysics Data System (ADS)

Nakakita, K.

2017-02-01

Simultaneous visualization technique of the combination of the unsteady Pressure-Sensitive Paint and the Schlieren measurement was introduced. It was applied to a wind tunnel test of a rocket faring model at the JAXA 2mx2m transonic wind tunnel. Quantitative unsteady pressure field was acquired by the unsteady PSP measurement, which consisted of a high-speed camera, high-power laser diode, and so on. Qualitative flow structure was acquired by the Schlieren measurement using a high-speed camera and Xenon lamp with a blue optical filter. Simultaneous visualization was achieved 1.6 kfps frame rate and it gave the detailed structure of unsteady flow fields caused by the unsteady shock wave oscillation due to shock-wave/boundary-layer interaction around the juncture between cone and cylinder on the model. Simultaneous measurement results were merged into a movie including surface pressure distribution on the rocket faring and spatial structure of shock wave system concerning to transonic buffet. Constructed movie gave a timeseries and global information of transonic buffet flow field on the rocket faring model visually.

Image Search Reranking With Hierarchical Topic Awareness.

PubMed

Tian, Xinmei; Yang, Linjun; Lu, Yijuan; Tian, Qi; Tao, Dacheng

2015-10-01

With much attention from both academia and industrial communities, visual search reranking has recently been proposed to refine image search results obtained from text-based image search engines. Most of the traditional reranking methods cannot capture both relevance and diversity of the search results at the same time. Or they ignore the hierarchical topic structure of search result. Each topic is treated equally and independently. However, in real applications, images returned for certain queries are naturally in hierarchical organization, rather than simple parallel relation. In this paper, a new reranking method "topic-aware reranking (TARerank)" is proposed. TARerank describes the hierarchical topic structure of search results in one model, and seamlessly captures both relevance and diversity of the image search results simultaneously. Through a structured learning framework, relevance and diversity are modeled in TARerank by a set of carefully designed features, and then the model is learned from human-labeled training samples. The learned model is expected to predict reranking results with high relevance and diversity for testing queries. To verify the effectiveness of the proposed method, we collect an image search dataset and conduct comparison experiments on it. The experimental results demonstrate that the proposed TARerank outperforms the existing relevance-based and diversified reranking methods.

The Changing Landscape of Afterschool Programs

ERIC Educational Resources Information Center

Hynes, Kathryn; Sanders, Felicia

2010-01-01

In the past 15 years, the need for quality school-age child care has combined with concerns about children's academic performance, delinquency, and safety to create tremendous momentum around out-of-school time (OST) programming. Public funding for programs has simultaneously increased, bringing greater demand from policymakers and private funders…

Emotional Labour and Governmentality: Productive Power in Childcare

ERIC Educational Resources Information Center

Monrad, Merete

2017-01-01

This article examines the interplay between governance and cost-containment efforts in the public sector and the emotional labour and well-being of childcare workers. Care-work researchers have highlighted the complexities of power in emotional labour, such as the fact that emotional labour may simultaneously benefit the individual worker and…

Managing and Resolving Organizational Conflict in School-University Partnerships through Sound Planning and Design

ERIC Educational Resources Information Center

Reaves, William E.; Narvaez, Jeanette G.

2006-01-01

Partnerships and collaborative projects among public schools and universities have become increasingly prominent in the educational landscape. Properly structured and carefully managed school-university initiatives can enrich educational opportunities and contribute to simultaneous and continual quality improvement of the partnering entities. In…

Intervention as Workplace Learning

ERIC Educational Resources Information Center

Elkjaer, Bente; Nickelsen, Niels Christian Mossfeldt

2016-01-01

Purpose: The purpose of this paper is to illustrate how workplace interventions may benefit from a simultaneous focus on individuals' learning and knowledge and on the situatedness of workplaces in the wider world of changing professional knowledge regimes. This is illustrated by the demand for evidence-based practice in health care.…

The Videocassette Challenge: Strategies for the Foreign Language Teacher.

ERIC Educational Resources Information Center

Mount, Richard Terry; And Others

Foreign language teachers can tap the appeal of video successfully and enjoyably in the foreign language classroom. Potential difficulties include length of feature films and difficulty in understanding the language and story simultaneously. The instructor must select materials and equipment carefully and commit considerable time and energy to…

Thermogravimetric and differential thermal analysis of potassium bicarbonate contaminated cellulose

Treesearch

A. Broido

1966-01-01

When samples undergo a complicated set of simultaneous and sequential reactions, as cellulose does on heating, results of thermogravimetric and differential thermal analyses are difficult to interpret. Nevertheless, careful comparison of pure and contaminated samples, pyrolyzed under identical conditions, can yield useful information. In these experiments TGA and DTA...

A Training Program for Unlicensed Assistive Personnel

ERIC Educational Resources Information Center

Gursky, Beverly S.; Ryser, Barbara J.

2007-01-01

In many school districts, school nurses are assigned multiple schools with responsibility for the health care needs of all students at those schools. Because they cannot be physically present at all sites simultaneously, it is necessary to delegate tasks to unlicensed assistive personnel (UAP). Educating and supervising UAP are critical steps in…

A STRINGENT COMPARISON OF SAMPLING AND ANALYSIS METHODS FOR VOCS IN AMBIENT AIR

EPA Science Inventory

A carefully designed study was conducted during the summer of 1998 to simultaneously collect samples of ambient air by canisters and compare the analysis results to direct sorbent preconcentration results taken at the time of sample collection. A total of 32 1-h sample sets we...

Health economics in clinical research.

PubMed

Manns, Braden J

2015-01-01

The pressure for health care systems to provide more resource intensive health care and newer, more costly, therapies is significant, despite limited health care budgets. As such, demonstration that a new therapy is effective is no longer sufficient to ensure that it is funded within publicly funded health care systems. The impact of a therapy on health care costs is also an important consideration for decision-makers who must allocate scarce resources. The clinical benefits and costs of a new therapy can be estimated simultaneously using economic evaluation, the strengths and limitations of which are discussed herein. In addition, this chapter includes discussion of the important economic outcomes that can be collected within a clinical trial (alongside the clinical outcome data) enabling consideration of the impact of the therapy on overall resource use, thus enabling performance of an economic evaluation, if the therapy is shown to be effective.

Collaborative care for depression and anxiety disorders in patients with recent cardiac events: the Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized clinical trial.

PubMed

Huffman, Jeff C; Mastromauro, Carol A; Beach, Scott R; Celano, Christopher M; DuBois, Christina M; Healy, Brian C; Suarez, Laura; Rollman, Bruce L; Januzzi, James L

2014-06-01

Depression and anxiety are associated with adverse cardiovascular outcomes in patients with recent acute cardiac events. There has been minimal study of collaborative care (CC) management models for mental health disorders in high-risk cardiac inpatients, and no prior CC intervention has simultaneously managed depression and anxiety disorders. To determine the impact of a low-intensity CC intervention for depression, generalized anxiety disorder, and panic disorder among patients hospitalized for an acute cardiac illness. Single-blind randomized clinical trial, with study assessors blind to group assignment, from September 2010 through July 2013 of 183 patients admitted to inpatient cardiac units in an urban academic general hospital for acute coronary syndrome, arrhythmia, or heart failure and found to have clinical depression, generalized anxiety disorder, or panic disorder on structured assessment. Participants were randomized to 24 weeks of a low-intensity telephone-based multicomponent CC intervention targeting depression and anxiety disorders (n = 92) or to enhanced usual care (serial notification of primary medical providers; n = 91). The CC intervention used a social work care manager to coordinate assessment and stepped care of psychiatric conditions and to provide support and therapeutic interventions as appropriate. Improvement in mental health-related quality of life (Short Form-12 Mental Component Score [SF-12 MCS]) at 24 weeks, compared between groups using a random-effects model in an intent-to-treat analysis. Patients randomized to CC had significantly greater estimated mean improvements in SF-12 MCS at 24 weeks (11.21 points [from 34.21 to 45.42] in the CC group vs 5.53 points [from 36.30 to 41.83] in the control group; estimated mean difference, 5.68 points [95% CI, 2.14-9.22]; P = .002; effect size, 0.61). Patients receiving CC also had significant improvements in depressive symptoms and general functioning, and higher rates of treatment of a mental health disorder; anxiety scores, rates of disorder response, and adherence did not differ between groups. A novel telephone-based, low-intensity model to concurrently manage cardiac patients with depression and/or anxiety disorders was effective for improving mental health-related quality of life in a 24-week trial. clinicaltrials.gov Identifier: NCT01201967.

Office-Based Tools and Primary Care Visit Communication, Length, and Preventive Service Delivery.

PubMed

Lafata, Jennifer Elston; Shay, L Aubree; Brown, Richard; Street, Richard L

2016-04-01

The use of physician office-based tools such as electronic health records (EHRs), health risk appraisal (HRA) instruments, and written patient reminder lists is encouraged to support efficient, high-quality, patient-centered care. We evaluate the association of exam room use of EHRs, HRA instruments, and self-generated written patient reminder lists with patient-physician communication behaviors, recommended preventive health service delivery, and visit length. Observational study of 485 office visits with 64 primary care physicians practicing in a health system serving the Detroit metropolitan area. Study data were obtained from patient surveys, direct observation, office visit audio-recordings, and automated health system records. Outcome measures included visit length in minutes, patient use of active communication behaviors, physician use of supportive talk and partnership-building communication behaviors, and percentage of delivered guideline-recommended preventive health services for which patients are eligible and due. Simultaneous linear regression models were used to evaluate associations between tool use and outcomes. Adjusted models controlled for patient characteristics, physician characteristics, characteristics of the relationship between the patient and physician, and characteristics of the environment in which the visit took place. Prior to adjusting for other factors, visits in which the EHR was used on average were significantly (p < .05) longer (27.6 vs. 23.8 minutes) and contained fewer preventive services for which patients were eligible and due (56.5 percent vs. 62.7 percent) compared to those without EHR use. Patient written reminder lists were also significantly associated with longer visits (30.0 vs. 26.5 minutes), and less use of physician communication behaviors facilitating patient involvement (2.1 vs. 2.6 occurrences), but more use of active patient communication behaviors (4.4 vs. 2.6). Likewise, HRA use was significantly associated with increased preventive services delivery (62.1 percent vs. 57.0 percent). All relationships remained significant (p > .05) in adjusted models with the exception of that between HRA use and preventive service delivery. Office-based tools intended to facilitate the implementation of desired primary care practice redesign are associated with both positive and negative cost and quality outcomes. Findings highlight the need for monitoring both intended and unintended consequences of office-based tools commonly used in primary care practice redesign. © Health Research and Educational Trust.

Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions.

PubMed

Aantjes, Carolien J; Quinlan, Tim K C; Bunders, Joske F G

2014-07-08

The rapid evolution in disease burdens in low- and middle income countries is forcing policy makers to re-orient their health system towards a system which has the capability to simultaneously address infectious and non-communicable diseases. This paper draws on two different but overlapping studies which examined how actors in the Zambian health system are re-directing their policies, strategies and service structures to include the provision of health care for people with chronic conditions. Study methods in both studies included semi-structured interviews with government health officials at national level, and governmental and non-governmental health practitioners operating from community-, primary health care to hospital facility level. Focus group discussions were conducted with staff, stakeholders and caregivers of programmes providing care and support at community- and household levels. Study settings included urban and rural sites. A series of adaptations transformed the HIV programme from an emergency response into the first large chronic care programme in the country. There are clear indications that the Zambian government is intending to expand this reach to patients with non-communicable diseases. Challenges to do this effectively include a lack of proper NCD prevalence data for planning, a concentration of technology and skills to detect and treat NCDs at secondary and tertiary levels in the health system and limited interest by donor agencies to support this transition. The reorientation of Zambia's health system is in full swing and uses the foundation of a decentralised health system and presence of local models for HIV chronic care which actively involve community partners, patients and their families. There are early warning signs which could cause this transition to stall, one of which is the financial capability to resource this process.

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors.

PubMed

Lentine, Krista L; Kasiske, Bertram L; Levey, Andrew S; Adams, Patricia L; Alberú, Josefina; Bakr, Mohamed A; Gallon, Lorenzo; Garvey, Catherine A; Guleria, Sandeep; Li, Philip Kam-Tao; Segev, Dorry L; Taler, Sandra J; Tanabe, Kazunari; Wright, Linda; Zeier, Martin G; Cheung, Michael; Garg, Amit X

2017-08-01

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.

Zero inflation in ordinal data: Incorporating susceptibility to response through the use of a mixture model

PubMed Central

Kelley, Mary E.; Anderson, Stewart J.

2008-01-01

Summary The aim of the paper is to produce a methodology that will allow users of ordinal scale data to more accurately model the distribution of ordinal outcomes in which some subjects are susceptible to exhibiting the response and some are not (i.e., the dependent variable exhibits zero inflation). This situation occurs with ordinal scales in which there is an anchor that represents the absence of the symptom or activity, such as “none”, “never” or “normal”, and is particularly common when measuring abnormal behavior, symptoms, and side effects. Due to the unusually large number of zeros, traditional statistical tests of association can be non-informative. We propose a mixture model for ordinal data with a built-in probability of non-response that allows modeling of the range (e.g., severity) of the scale, while simultaneously modeling the presence/absence of the symptom. Simulations show that the model is well behaved and a likelihood ratio test can be used to choose between the zero-inflated and the traditional proportional odds model. The model, however, does have minor restrictions on the nature of the covariates that must be satisfied in order for the model to be identifiable. The method is particularly relevant for public health research such as large epidemiological surveys where more careful documentation of the reasons for response may be difficult. PMID:18351711

ICONS: Managing Care and Costs: The Sustained Cost Impact of Reduced Hospitalizations in a Partnership-Measurement Model of Disease Management.

PubMed

Paradis, Pierre Emmanuel; Nemis-White, Joanna; Meilleur, Marie-Claude; Ginn, Marissa; Cox, Jafna; Montague, Terrence

2010-01-01

Improving Cardiovascular Outcomes in Nova Scotia (ICONS) was a multidisciplinary-partnership, measurement-driven disease management project designed to improve the care and outcomes of patients with acute and chronic heart diseases in Nova Scotia. Previous analyses demonstrated beneficial clinical and macroeconomic end points at the population and system levels, including heightened awareness of the value of team care, increased use of proven therapies, decreased re-hospitalizations and a positive dollar return on investment for the economies of Nova Scotia and Canada. This article analyzes the additional cost-reduction benefits resulting from the reduced re-hospitalizations that occurred among patient populations with heart attacks and heart failure. Over the five-year course of ICONS, one-year readmissions and readmission rates fell continuously for both index disease states. Despite a general inflationary rise in real hospital costs, the per-event cost of readmissions expressed in constant 2002 dollars also decreased: from $10,377 in 1997 to $9,022 in 2002 for the heart attack patient population; and from $9,020 to $8,697 for patients with heart failure. Total real yearly costs for heart attack readmissions fell from $7.4 million in 1997 to $6.4 million in 2002, a 14% decrease; for heart failure, yearly costs decreased by 26%, from $9.2 million to $6.8 million. These microeconomic data supplement the previously reported improvements in patient care and the positive macroeconomic impact of ICONS. Overall, ICONS demonstrated that quality and cost of healthcare could be simultaneously and successfully managed over a sustained period of time for whole patient populations in a real-world setting. ICONS offers strong evidence of the value of the partnership-measurement model of disease management and prevention as a reproducible and desirable template for next-generation healthcare in Canada.

The complex and quaternionic quantum bit from relativity of simultaneity on an interferometer

NASA Astrophysics Data System (ADS)

Garner, Andrew J. P.; Müller, Markus P.; Dahlsten, Oscar C. O.

2017-12-01

The patterns of fringes produced by an interferometer have long been important testbeds for our best contemporary theories of physics. Historically, interference has been used to contrast quantum mechanics with classical physics, but recently experiments have been performed that test quantum theory against even more exotic alternatives. A physically motivated family of theories are those where the state space of a two-level system is given by a sphere of arbitrary dimension. This includes classical bits, and real, complex and quaternionic quantum theory. In this paper, we consider relativity of simultaneity (i.e. that observers may disagree about the order of events at different locations) as applied to a two-armed interferometer, and show that this forbids most interference phenomena more complicated than those of complex quantum theory. If interference must depend on some relational property of the setting (such as path difference), then relativity of simultaneity will limit state spaces to standard complex quantum theory, or a subspace thereof. If this relational assumption is relaxed, we find one additional theory compatible with relativity of simultaneity: quaternionic quantum theory. Our results have consequences for current laboratory interference experiments: they have to be designed carefully to avoid rendering beyond-quantum effects invisible by relativity of simultaneity.

Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure.

PubMed

Pagenstert, Geert; Hintermann, Beat

2011-10-13

Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.

The complex and quaternionic quantum bit from relativity of simultaneity on an interferometer.

PubMed

Garner, Andrew J P; Müller, Markus P; Dahlsten, Oscar C O

2017-12-01

The patterns of fringes produced by an interferometer have long been important testbeds for our best contemporary theories of physics. Historically, interference has been used to contrast quantum mechanics with classical physics, but recently experiments have been performed that test quantum theory against even more exotic alternatives. A physically motivated family of theories are those where the state space of a two-level system is given by a sphere of arbitrary dimension. This includes classical bits, and real, complex and quaternionic quantum theory. In this paper, we consider relativity of simultaneity (i.e. that observers may disagree about the order of events at different locations) as applied to a two-armed interferometer, and show that this forbids most interference phenomena more complicated than those of complex quantum theory. If interference must depend on some relational property of the setting (such as path difference), then relativity of simultaneity will limit state spaces to standard complex quantum theory, or a subspace thereof. If this relational assumption is relaxed, we find one additional theory compatible with relativity of simultaneity: quaternionic quantum theory. Our results have consequences for current laboratory interference experiments: they have to be designed carefully to avoid rendering beyond-quantum effects invisible by relativity of simultaneity.

Babies Need Healthy Moms: an innovative postpartum screening and education class for women who had gestational diabetes mellitus.

PubMed

Frazzitta, Marie A; Anderson, Michele; Egan, Elizabeth

2013-01-01

Healthy Babies Need Healthy Moms (HBNHM) is an innovative education program that combines the recommended 2-hour postpartum oral glucose tolerance test (OGTT) with diabetes prevention education for women who had gestational diabetes mellitus. During the class, the 2-hour OGTT is performed, and in the time between venipunctures, the women participate in group education focused on evidence-based diabetes prevention strategies that promote healthy family nutrition and lifestyle behavior, importance of preconception care for subsequent pregnancies, and the need for follow-up care for women who screen positive for abnormal glucose levels. The purpose of this article is to describe this model to encourage replication in other diabetes programs. The HBNHM program is a low-budget education program that provides postpartum OGTT screening for women who had gestational diabetes mellitus during their pregnancies while simultaneously offering education designed to improve future outcomes. For those women whose screening is positive for overt diabetes or prediabetes, the educational strategies are directed at encouraging follow-up care. For those patients who have normal screening results, the program is designed to help the patient prevent the future development of type 2 diabetes. Preconception counseling is included in an effort to improve outcomes in future pregnancies and provide patients with the tools needed to help enhance the health of their families.

Navigating the field of temporally framed care in the Danish home care sector.

PubMed

Tufte, Pernille; Dahl, Hanne Marlene

2016-01-01

The organisational and temporal framing of elderly care in Europe has changed in the wake of new public management reforms and standardised care services, the strict measurement of time and work schedules have become central aspects of care work. The article investigates the crafting of care in this framing: how care workers approach the services specified in their rotas and navigate between needs, demands and opportunities in the daily performance of duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two Danish municipalities. Data are derived predominantly from participant observation. The article identifies two overarching temporal dilemmas in different home care situations: one where process time prevails over clock time and another where the care workers balance the two. Focusing on how care workers respond to these dilemmas in practice, the article identifies various navigation tactics, including leaving time outside, individualised routinisation, working on different paths simultaneously and postponing tasks. By assessing care workers' performance in the temporal framing of work and focusing on care workers' mediation between different time logics, this study provides an in-depth perspective on the broader feminist literature on the dilemmas of care. © 2015 Foundation for the Sociology of Health & Illness.

A Homecare Application based on the ASTM E2369-05 Standard Specification for Continuity of Care Record

PubMed Central

Botsivaly, M.; Spyropoulos, B.; Koutsourakis, K.; Mertika, K.

2006-01-01

The purpose of this study is the presentation of a system appropriate to be used upon the transition of a patient from hospital to homecare. The developed system is structured according to the ASTM E2369-05 Standard Specification for Continuity of Care Record and its function is based upon the creation of a structured subset of data, containing the patient’s most relevant clinical information, enabling simultaneously the planning and the optimal documentation of the provided homecare. PMID:17238479

Man-machine interfaces in health care

NASA Technical Reports Server (NTRS)

Charles, Steve; Williams, Roy E.

1991-01-01

The surgeon, like the pilot, is confronted with an ever increasing volume of voice, data, and image input. Simultaneously, the surgeon must control a rapidly growing number of devices to deliver care to the patient. The broad disciplines of man-machine interface design, systems integration, and teleoperation will play a role in the operating room of the future. The purpose of this communication is to report the incorporation of these design concepts into new surgical and laser delivery systems. A review of each general problem area and the systems under development to solve the problems are presented.

Sustainability in medicine.

PubMed

George, Ruth; Coffin, Janis; George, Sierra

2013-01-01

Given the current state of the U.S. healthcare system, with increasingly complicated regulations and paperwork and decreasing reimbursements, the question arises: Is it possible to provide safe, high-quality healthcare and reduce costs? Furthermore, is it possible to care for the health of your patients while simultaneously caring for the financial health of your practice and promoting improvement in the overall health of the planet? This article will review some steps currently being taken by various companies and hopefully stimulate ideas for changes you may want to consider for your own practice, hospital, or institution.

Impact analysis of air gap motion with respect to parameters of mooring system for floating platform

NASA Astrophysics Data System (ADS)

Shen, Zhong-xiang; Huo, Fa-li; Nie, Yan; Liu, Yin-dong

2017-04-01

In this paper, the impact analysis of air gap concerning the parameters of mooring system for the semi-submersible platform is conducted. It is challenging to simulate the wave, current and wind loads of a platform based on a model test simultaneously. Furthermore, the dynamic equivalence between the truncated and full-depth mooring system is still a tuff work. However, the wind and current loads can be tested accurately in wind tunnel model. Furthermore, the wave can be simulated accurately in wave tank test. The full-scale mooring system and the all environment loads can be simulated accurately by using the numerical model based on the model tests simultaneously. In this paper, the air gap response of a floating platform is calculated based on the results of tunnel test and wave tank. Meanwhile, full-scale mooring system, the wind, wave and current load can be considered simultaneously. In addition, a numerical model of the platform is tuned and validated by ANSYS AQWA according to the model test results. With the support of the tuned numerical model, seventeen simulation cases about the presented platform are considered to study the wave, wind, and current loads simultaneously. Then, the impact analysis studies of air gap motion regarding the length, elasticity, and type of the mooring line are performed in the time domain under the beam wave, head wave, and oblique wave conditions.

Simultaneous confidence sets for several effective doses.

PubMed

Tompsett, Daniel M; Biedermann, Stefanie; Liu, Wei

2018-04-03

Construction of simultaneous confidence sets for several effective doses currently relies on inverting the Scheffé type simultaneous confidence band, which is known to be conservative. We develop novel methodology to make the simultaneous coverage closer to its nominal level, for both two-sided and one-sided simultaneous confidence sets. Our approach is shown to be considerably less conservative than the current method, and is illustrated with an example on modeling the effect of smoking status and serum triglyceride level on the probability of the recurrence of a myocardial infarction. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Nurse moral distress: A survey identifying predictors and potential interventions.

PubMed

Rathert, Cheryl; May, Douglas R; Chung, Hye Sook

2016-01-01

Ethical dilemmas and conflicts are inherent in today's health care organizations and may lead to moral distress, which is often associated with physical and psychological symptoms. Although the existence of moral distress has been observed by scholars for decades, most of the research has been descriptive and has examined what types of health care conflicts lead to distress. This study tested a comprehensive model, underpinned by Social Cognitive Theory, that examined work environment and intrapersonal variables that may influence moral distress. We surveyed nursing staff employed in a U.S. acute care hospital (response rate=45%; n=290). More than half of the respondents reported they experience ethical dilemmas and conflicts from several times a month to daily, and nearly half reported they experience moral distress at least several times a month. Structural equation modeling analysis simultaneously examined the effects of five independent variables on moral distress and moral voice: (a) frequency of ethical dilemmas and conflicts; (b) moral efficacy; (c) ethics communication; (d) ethical environment; and (e) organizational ethics support. Results revealed significant independent effects of the frequency of ethics issues and organizational ethics support on moral distress. Bootstrapping analysis indicated that voice fully mediated the relationship between moral efficacy and moral distress, and partially mediated the relationship between organizational ethics support and distress. Supplemental analysis revealed that organizational ethics support moderated the moral efficacy-voice-moral distress relationship such that when organizational support was low, moral efficacy was negatively related to moral distress via voice. Although it may be impossible to eliminate all ethical dilemmas and conflicts, leaders and organizations may wish to help improve nurses' moral efficacy, which appears to give rise to voice, and reduced moral distress. Increasing organizational ethics support may be a key approach. Copyright © 2015 Elsevier Ltd. All rights reserved.

Direct reciprocity stabilizes simultaneous hermaphroditism at high mating rates: A model of sex allocation with egg trading.

PubMed

Henshaw, Jonathan M; Kokko, Hanna; Jennions, Michael D

2015-08-01

Simultaneous hermaphroditism is predicted to be unstable at high mating rates given an associated increase in sperm competition. The existence of reciprocal egg trading, which requires both hermaphroditism and high mating rates to evolve, is consequently hard to explain. We show using mathematical models that the presence of a trading economy creates an additional fitness benefit to egg production, which selects for traders to bias their sex allocation toward the female function. This female-biased sex allocation prevents pure females from invading a trading population, thereby allowing simultaneous hermaphroditism to persist stably at much higher levels of sperm competition than would otherwise be expected. More generally, our model highlights that simultaneous hermaphroditism can persist stably when mating opportunities are abundant, as long as sperm competition remains low. It also predicts that reciprocity will select for heavier investment in the traded resource. © 2015 The Author(s). Evolution © 2015 The Society for the Study of Evolution.

Striatal and Hippocampal Entropy and Recognition Signals in Category Learning: Simultaneous Processes Revealed by Model-Based fMRI

ERIC Educational Resources Information Center

Davis, Tyler; Love, Bradley C.; Preston, Alison R.

2012-01-01

Category learning is a complex phenomenon that engages multiple cognitive processes, many of which occur simultaneously and unfold dynamically over time. For example, as people encounter objects in the world, they simultaneously engage processes to determine their fit with current knowledge structures, gather new information about the objects, and…

A Model of Parental Distress and Factors that Mediate its Link with Parental Monitoring of Youth Diabetes Care, Adherence, and Glycemic Control

PubMed Central

Robinson, Elizabeth M.; Weaver, Patrick; Chen, Rusan; Streisand, Randi; Holmes, Clarissa S.

2016-01-01

Objective Parental monitoring of adolescents’ diabetes self-care is associated with better adherence and glycemic control (A1c). A number of parent-level factors are associated with higher levels of parental monitoring, including lower levels of parental distress (depressive symptoms, stress, anxiety), as well as higher levels of parental self-efficacy for diabetes management and authoritative parenting. Often studied in isolation, these factors may be best considered simultaneously as they are interrelated and are associated with parental monitoring and youth adherence. Methods Structural equation modeling with a cross-sectional sample of 257 parent/youth (aged 11-14) dyads: 1) examined a broad model of parental factors (i.e., parental distress, parental diabetes self-efficacy, authoritative parenting) and 2) assessed their relation to parental monitoring, youth adherence, and A1c. Post-hoc ANOVAs evaluated clinical implications of daily parental monitoring. Results Parental distress was not related directly to parental monitoring. Instead less distress related indirectly to more monitoring via higher parental self-efficacy and more authoritative parenting which in turn related to better adherence and A1c. Higher parental self-efficacy also related directly to better youth adherence and then to better A1c. Clinically, more parental monitoring related to more daily blood glucose checks and to better A1c (8.48% v. 9.17%). Conclusions A broad model of parent-level factors revealed more parental distress was linked only indirectly to less monitoring via lower parental self-efficacy and less authoritative parenting. Behaviorally, more parental monitoring related to better adherence and to clinically better A1c in adolescents. Further study of parent-level factors that relate to parental distress and monitoring of adherence appears warranted. PMID:27513476

SSCC TD: A Serial and Simultaneous Configural-Cue Compound Stimuli Representation for Temporal Difference Learning

PubMed Central

Mondragón, Esther; Gray, Jonathan; Alonso, Eduardo; Bonardi, Charlotte; Jennings, Dómhnall J.

2014-01-01

This paper presents a novel representational framework for the Temporal Difference (TD) model of learning, which allows the computation of configural stimuli – cumulative compounds of stimuli that generate perceptual emergents known as configural cues. This Simultaneous and Serial Configural-cue Compound Stimuli Temporal Difference model (SSCC TD) can model both simultaneous and serial stimulus compounds, as well as compounds including the experimental context. This modification significantly broadens the range of phenomena which the TD paradigm can explain, and allows it to predict phenomena which traditional TD solutions cannot, particularly effects that depend on compound stimuli functioning as a whole, such as pattern learning and serial structural discriminations, and context-related effects. PMID:25054799

Simultaneous Optical and Meteor Head Echo Measurements Using the Middle Atmosphere Alomar Radar System (MAARSY)

NASA Technical Reports Server (NTRS)

Cooke, W. J.; Brown, P. G.; Stober, G.; Schult, C.; Krzeminski, Z.; Chau, J. L.

2017-01-01

We describe a two year campaign of simultaneous automated meteor optical and head echo radar measurements conducted with the Middle Atmosphere Alomar Radar System (MAARSY). This campaign was established with the following goals: Compare trajectories as measured by MAARSY and the two optical stations for a range of meteoroid masses. Compare photometric and dynamic mass measured optically with radar-derived masses (inter-calibration of mass scales). Use the best observed simultaneous events to fuse all metric, photometric and ionization estimates together and apply different ablation models to self-consistently model these highest quality events.

Simultaneous Excitation of Multiple-Input Multiple-Output CFD-Based Unsteady Aerodynamic Systems

NASA Technical Reports Server (NTRS)

Silva, Walter A.

2008-01-01

A significant improvement to the development of CFD-based unsteady aerodynamic reduced-order models (ROMs) is presented. This improvement involves the simultaneous excitation of the structural modes of the CFD-based unsteady aerodynamic system that enables the computation of the unsteady aerodynamic state-space model using a single CFD execution, independent of the number of structural modes. Four different types of inputs are presented that can be used for the simultaneous excitation of the structural modes. Results are presented for a flexible, supersonic semi-span configuration using the CFL3Dv6.4 code.

Simultaneous Excitation of Multiple-Input Multiple-Output CFD-Based Unsteady Aerodynamic Systems

NASA Technical Reports Server (NTRS)

Silva, Walter A.

2007-01-01

A significant improvement to the development of CFD-based unsteady aerodynamic reduced-order models (ROMs) is presented. This improvement involves the simultaneous excitation of the structural modes of the CFD-based unsteady aerodynamic system that enables the computation of the unsteady aerodynamic state-space model using a single CFD execution, independent of the number of structural modes. Four different types of inputs are presented that can be used for the simultaneous excitation of the structural modes. Results are presented for a flexible, supersonic semi-span configuration using the CFL3Dv6.4 code.

The hepatitis C cascade of care: identifying priorities to improve clinical outcomes.

PubMed

Linas, Benjamin P; Barter, Devra M; Leff, Jared A; Assoumou, Sabrina A; Salomon, Joshua A; Weinstein, Milton C; Kim, Arthur Y; Schackman, Bruce R

2014-01-01

As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them. We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation. Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs). We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals. We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost-effective. Priority should be given to developing and evaluating interventions addressing multiple points along the cascade rather than options focusing solely on single points.

The Hepatitis C Cascade of Care: Identifying Priorities to Improve Clinical Outcomes

PubMed Central

Linas, Benjamin P.; Barter, Devra M.; Leff, Jared A.; Assoumou, Sabrina A.; Salomon, Joshua A.; Weinstein, Milton C.; Kim, Arthur Y.; Schackman, Bruce R.

2014-01-01

Background As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them. Methods We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation. Main measures Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs). Results We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals. Conclusions We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost-effective. Priority should be given to developing and evaluating interventions addressing multiple points along the cascade rather than options focusing solely on single points. PMID:24842841

Mathematical model and metaheuristics for simultaneous balancing and sequencing of a robotic mixed-model assembly line

NASA Astrophysics Data System (ADS)

Li, Zixiang; Janardhanan, Mukund Nilakantan; Tang, Qiuhua; Nielsen, Peter

2018-05-01

This article presents the first method to simultaneously balance and sequence robotic mixed-model assembly lines (RMALB/S), which involves three sub-problems: task assignment, model sequencing and robot allocation. A new mixed-integer programming model is developed to minimize makespan and, using CPLEX solver, small-size problems are solved for optimality. Two metaheuristics, the restarted simulated annealing algorithm and co-evolutionary algorithm, are developed and improved to address this NP-hard problem. The restarted simulated annealing method replaces the current temperature with a new temperature to restart the search process. The co-evolutionary method uses a restart mechanism to generate a new population by modifying several vectors simultaneously. The proposed algorithms are tested on a set of benchmark problems and compared with five other high-performing metaheuristics. The proposed algorithms outperform their original editions and the benchmarked methods. The proposed algorithms are able to solve the balancing and sequencing problem of a robotic mixed-model assembly line effectively and efficiently.

"I find the term customer offensive".

PubMed

Clarke, D; Yarrow, D

1997-01-01

Explores the tensions between cost and quality, need and market, and the effects on patient care and service providers within today's NHS. Builds on research carried out in two hospitals during 1993 to 1995, focusing on perceptions of quality and its management in the context of the nursing discipline. Indicates a divergence of perspectives on "customer requirements" and the emergence of a cultural divide within the total care process. Identifies and illustrates the significant potential for cost savings in health care, which may be achievable while simultaneously improving quality, and suggests that the "prize" for bridging the cultural divide might include a substantial financial gain as well as improved standards of care. In the context of health care, need, expectation, and finite resources are inextricably linked. A shared understanding of the interdependence between the three, and of the balance to be struck, is essential in health care provision today and into the twenty-first century. Suggests that there is some way to go.

Illness perception, risk perception and health promotion self-care behaviors among Chinese patient with type 2 diabetes: A cross-sectional survey.

PubMed

Nie, Rong; Han, Yanhong; Xu, Jiaqi; Huang, Qiao; Mao, Jing

2018-02-01

To explore illness perception and perceived risk of developing diabetes complications in relation to health-promoting self-care behaviors among Chinese patients with type 2 diabetes. Illness and risk perceptions are important determinants of various health behaviors. However, few studies have simultaneously examined the impacts of these two constructs on self-care among diabetic patients. Data were collected on participants' characteristics, illness perception, risk perception, and health-promoting self-care behaviors over 6months among 304 subjects from three general hospitals. Significant associations between illness perception and risk perception were observed. Illness perception and/or risk perception explained an independent, small but significant proportion of the variance in each health-promoting self-care behavior. One's perceptions of illness and future risk might be influential in understanding health-promoting self-care among diabetic patients. It may be useful to improve self-management by tailoring intervention content to individuals' illness-related perceptions. Copyright © 2017 Elsevier Inc. All rights reserved.

Working under pressure: a pilot study of nurse work in a postoperative setting.

PubMed

Willis, Karen; Brown, Claire R; Sahlin, Ingrid; Svensson, Björn; Arnetz, Bengt B; Arnetz, Judith E

2005-01-01

Postoperative services provide an excellent setting to study nursing work due to the patients' needing highly technical, yet highly comforting, care. The current study examined nursing work in postoperative services in an attempt to discern how nursing work is structured. Observations of nursing interactions in a 14-bed postoperative unit of a large Swedish university hospital found that nursing work in this setting is highly intensive and multidimensional. The need to provide nursing interactions that are caring and respectful of patients, while at the same time ensuring a high level of technical capacity, was obvious throughout all stages of patient stays in this unit. Furthermore, although each interaction is necessarily time-limited there is a caring relationship sustained with each patient. There is a pattern of caring that emerges that can be encapsulated as a "contingent routine." Nursing work cannot be broken down into "dimensions of caring." The work is high-pressure and involves, by necessity, multitasking. There are many dimensions of nursing care, but, usually, these are supplied simultaneously.

Moving the journey towards independence: Adolescents transitioning to successful diabetes self-management

PubMed Central

Strickland, C. June

2016-01-01

Purpose To gain a greater understanding of adolescent’s experiences living with Type 1 diabetes mellitus (T1DM) and create a theoretical paradigm. Methods Grounded theory as described by Glaser was used. Fifteen in-depth interviews were conducted with adolescent’s ages 11 to 15 with T1DM. Symbolic interactionism is the theoretical framework for grounded theory. Data were collected; transcribed, coded, and analyzed simultaneously using constant comparative analysis and findings were grounded in the words of participants. Results A theoretical model was created with the concept of “normalizing”. Normalizing was defined as the ability to integrate diabetes into one’s daily life to make diabetes ‘part of me’. Phase four of the model, and the focus of this manuscript was “Moving the Journey towards Independence” and included: 1) taking over care, 2) experiencing conflict with parents, and 3) realizing diabetes is hard. The major task for adolescents in this phase was separating from parents to independently manage diabetes. The normalizing task for this phase was: “taking on the burden of care”. Adolescents described challenges with independent care and increased parental conflict including: fearing needles, forgetting insulin, feeling embarrassed and believing that diabetes was a burden in their life. Additionally, juggling the multiple responsibilities of home, school and work along with managing a chronic illness during adolescence is challenging. Conclusions Transitioning to diabetes self-management is a challenge for adolescents. This model advances understanding of the moving processes in adolescents transitioning; additionally, hypotheses are presented that may be used for developing interventions to promote success in self-management. PMID:26190456

Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial.

PubMed

Cully, Jeffrey A; Breland, Jessica Y; Robertson, Suzanne; Utech, Anne E; Hundt, Natalie; Kunik, Mark E; Petersen, Nancy J; Masozera, Nicholas; Rao, Radha; Naik, Aanand D

2014-04-28

Depression and diabetes cause significant burden for patients and the healthcare system and, when co-occurring, result in poorer self-care behaviors and worse glycemic control than for either condition alone. However, the clinical management of these comorbid conditions is complicated by a host of patient, provider, and system-level barriers that are especially problematic for patients in rural locations. Patient-centered medical homes provide an opportunity to integrate mental and physical health care to address the multifaceted needs of complex comorbid conditions. Presently, there is a need to not only develop robust clinical interventions for complex medically ill patients but also to find feasible ways to embed these interventions into the frontlines of existing primary care practices. This randomized controlled trial uses a hybrid effectiveness-implementation design to evaluate the Healthy Outcomes through Patient Empowerment (HOPE) intervention, which seeks to simultaneously address diabetes and depression for rural veterans in Southeast Texas. A total of 242 Veterans with uncontrolled diabetes and comorbid symptoms of depression will be recruited and randomized to either the HOPE intervention or to a usual-care arm. Participants will be evaluated on a host of diabetes and depression-related measures at baseline and 6- and 12-month follow-up. The trial has two primary goals: 1) to examine the effectiveness of the intervention on both physical (diabetes) and emotional health (depression) outcomes and 2) to simultaneously pilot test a multifaceted implementation strategy designed to increase fidelity and utilization of the intervention by coaches interfacing within the primary care setting. This ongoing blended effectiveness-implementation design holds the potential to advance the science and practice of caring for complex medically ill patients within the constraints of a busy patient-centered medical home. Behavioral Activation Therapy for Rural Veterans with Diabetes and Depression: NCT01572389.

Simultaneous repair of abdominal aortic aneurysm and resection of unexpected, associated abdominal malignancies.

PubMed

Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Lorusso, Riccardo; Ceccanei, Gianluca; Vietri, Francesco

2004-12-15

The management of unexpected intra-abdominal malignancy, discovered at laparotomy for elective treatment of an abdominal aortic aneurysm (AAA), is controversial. It is still unclear whether both conditions should be treated simultaneously or a staged approach is to be preferred. To contribute in improving treatment guidelines, we retrospectively reviewed the records of patients undergoing laparotomy for elective AAA repair. From January 1994 to March 2003, 253 patients underwent elective, trans-peritoneal repair of an AAA. In four patients (1.6%), an associated, unexpected neoplasm was detected at abdominal exploration, consisting of one renal, one gastric, one ileal carcinoid, and one ascending colon tumor. All of them were treated at the same operation, after aortic repair and careful isolation of the prosthetic graft. The whole series' operative mortality was 3.6%. None of the patients simultaneously treated for AAA and tumor resection died in the postoperative period. No graft-related infections were observed. Simultaneous treatment of AAA and tumor did not prolong significantly the mean length of stay in the hospital, compared to standard treatment of AAA alone. Except for malignancies of organs requiring major surgical resections, simultaneous AAA repair and resection of an associated, unexpected abdominal neoplasm can be safely performed, in most of the patients, sparing the need for a second procedure. Endovascular grafting of the AAA can be a valuable tool in simplifying simultaneous treatment, or in staging the procedures with a very short delay.

Discharge documentation of patients discharged to subacute facilities: a three-year quality improvement process across an integrated health care system.

PubMed

Gandara, Esteban; Ungar, Jonathan; Lee, Jason; Chan-Macrae, Myrna; O'Malley, Terrence; Schnipper, Jeffrey L

2010-06-01

Effective communication among physicians during hospital discharge is critical to patient care. Partners Healthcare (Boston) has been engaged in a multi-year process to measure and improve the quality of documentation of all patients discharged from its five acute care hospitals to subacute facilities. Partners first engaged stakeholders to develop a consensus set of 12 required data elements for all discharges to subacute facilities. A measurement process was established and later refined. Quality improvement interventions were then initiated to address measured deficiencies and included education of physicians and nurses, improvements in information technology, creation of or improvements in discharge documentation templates, training of hospitalists to serve as role models, feedback to physicians and their service chiefs regarding reviewed cases, and case manager review of documentation before discharge. To measure improvement in quality as a result of these efforts, rates of simultaneous inclusion of all 12 applicable data elements ("defect-free rate") were analyzed over time. Some 3,101 discharge documentation packets of patients discharged to subacute facilities from January 1, 2006, through September 2008 were retrospectively studied. During the 11 monitored quarters, the defect-free rate increased from 65% to 96% (p < .001 for trend). The largest improvements were seen in documentation of preadmission medication lists, allergies, follow-up, and warfarin information. Institution of rigorous measurement, feedback, and multidisciplinary, multimodal quality improvement processes improved the inclusion of data elements in discharge documentation required for safe hospital discharge across a large integrated health care system.

Dietitians employed by health care facilities preferred a HACCP system over irradiation or chemical rinses for reducing risk of foodborne disease.

PubMed

Giamalva, J N; Redfern, M; Bailey, W C

1998-08-01

To survey dietitians in health care facilities about the acceptability of alternative meat and poultry processing methods designed to reduce the risk of foodborne disease and their willingness to pay for these processes. A geographically representative sample of 600 members of The American Dietetic Association who work in health care facilities. The response rate was 250 completed questionnaires from 592 eligible subjects (42%). A mail survey was used to gather information on the acceptability of a Hazard Analysis and Critical Control Point (HACCP) system, chemical rinses, and irradiation for increasing the safety of food. Discrete choice contingent valuation was used to determine the acceptability at current prices and at 5, 10, and 25 cents per pound above current prices. Logistic regression was used to estimate mean willingness to pay (the maximum amount respondents are willing to pay) for each process. A simultaneous equations regression model was used to estimate the effects of other variables on acceptability. Respondents expressed a high level of concern for food safety in health care facilities. The estimated mean willingness to pay was highest for a HACCP system and lowest for chemical rinses. The successful adoption of alternative methods to increase food safety depends on their acceptance by foodservice professionals. The professionals sampled were most accepting of a HACCP system, somewhat less accepting of irradiation, and least accepting of new chemical rinses. Poultry and beef processors and government agencies concerned with food safety may want to take into account the attitudes of foodservice professionals.

Public reporting helped drive quality improvement in outpatient diabetes care among Wisconsin physician groups

PubMed Central

Smith, Maureen A.; Wright, Alexandra; Queram, Christopher; Lamb, Geoffrey C.

2012-01-01

Public reporting on the quality of ambulatory health care is growing, but knowledge of how physician groups respond to such reporting has not kept pace. We examined responses to public reporting on the quality of diabetes care in 409 primary care clinics within seventeen large, multispecialty physician groups. We determined that a focus on publicly reported metrics, along with participation in large or externally sponsored projects, increased a clinic’s implementation of diabetes improvement interventions. Clinics were also more likely to implement interventions in more recent years. Public reporting helped drive both early implementation of a single intervention and ongoing implementation of multiple simultaneous interventions. To fully engage physician groups, accountability metrics should be structured to capture incremental improvements in quality, thereby rewarding both early and ongoing improvement activities. PMID:22392668

From Nonclinical Research to Clinical Trials and Patient-registries: Challenges and Opportunities in Biomedical Research

PubMed Central

de la Torre Hernández, José M.; Edelman, Elazer R.

2018-01-01

The most important challenge faced by human beings is health. The only way to provide better solutions for health care is innovation, true innovation. The only source of true innovation is research, good research indeed. The pathway from a basic science study to a randomized clinical trial is long and not free of bumps and even landmines. These are all the obstacles and barriers that limit the availability of resources, entangle administrative-regulatory processes, and restrain investigators’ initiatives. There is increasing demand for evidence to guide clinical practice but, paradoxically, biomedical research has become increasingly complex, expensive, and difficult to integrate into clinical care with increased barriers to performing the practical aspects of investigation. We face the challenge of increasing the volume of biomedical research and simultaneously improving the efficiency and output of this research. In this article, we review the main stages and methods of biomedical research, from nonclinical studies with animal and computational models to randomized trials and clinical registries, focusing on their limitations and challenges, but also providing alternative solutions to overcome them. Fortunately, challenges are always opportunities in disguise. PMID:28838647

Sequential and simultaneous choices: testing the diet selection and sequential choice models.

PubMed

Freidin, Esteban; Aw, Justine; Kacelnik, Alex

2009-03-01

We investigate simultaneous and sequential choices in starlings, using Charnov's Diet Choice Model (DCM) and Shapiro, Siller and Kacelnik's Sequential Choice Model (SCM) to integrate function and mechanism. During a training phase, starlings encountered one food-related option per trial (A, B or R) in random sequence and with equal probability. A and B delivered food rewards after programmed delays (shorter for A), while R ('rejection') moved directly to the next trial without reward. In this phase we measured latencies to respond. In a later, choice, phase, birds encountered the pairs A-B, A-R and B-R, the first implementing a simultaneous choice and the second and third sequential choices. The DCM predicts when R should be chosen to maximize intake rate, and SCM uses latencies of the training phase to predict choices between any pair of options in the choice phase. The predictions of both models coincided, and both successfully predicted the birds' preferences. The DCM does not deal with partial preferences, while the SCM does, and experimental results were strongly correlated to this model's predictions. We believe that the SCM may expose a very general mechanism of animal choice, and that its wider domain of success reflects the greater ecological significance of sequential over simultaneous choices.

Health care professionals' perspectives of the experiences of family caregivers during in-patient cancer care.

PubMed

Ekstedt, Mirjam; Stenberg, Una; Olsson, Mariann; Ruland, Cornelia M

2014-11-01

Being a family member of a patient who is being treated in an acute care setting for cancer often involves a number of challenges. Our study describes Norwegian cancer care health professionals' perceptions of family members who served as family caregivers (FCs) and their need for support during the in-hospital cancer treatment of their ill family member. Focus group discussions were conducted with a multidisciplinary team of 24 experienced social workers, physicians, and nurses who were closely involved in the patients' in-hospital cancer treatment and care. Drawing on qualitative hermeneutic analysis, four main themes describe health professionals' perceptions of FCs during the patient's in-hospital cancer care: an asset and additional burden, infinitely strong and struggling with helplessness, being an outsider in the center of care, and being in different temporalities. We conclude that it is a challenge for health care professionals to support the family and create room for FC's needs in acute cancer care. System changes are needed in health care, so that the patient/FC dyad is viewed as a unit of care in a dual process of caregiving, which would enable FCs to be given space and inclusion in care, with their own needs simultaneously considered alongside those of the patient. © The Author(s) 2014.

Semantic Connection or Visual Connection: Investigating the True Source of Confusion

ERIC Educational Resources Information Center

Ishii, Tomoko

2015-01-01

It has been repeatedly argued among vocabulary researchers that semantically related words should not be taught simultaneously because they can interfere with each other. However, the question of what types of relatedness cause interference has rarely been examined carefully. In addition, there are disagreements among the past studies that have…

Pros in Parks: Integrated Programming for Reaching Our Urban Park Operations Audience

ERIC Educational Resources Information Center

Miller, Laura M.; Walker, Jamie Rae

2016-01-01

In addition to regular job duties, such as tree care, mulching, irrigation, and pesticide management, urban park workers have faced environmental changes due to drought, wildfires, and West Nile virus. They simultaneously have endured expectations to manage growing, diversifying park usage and limitations on career development. An integrated…

Developing High School Students' Creativity by Teaching Them To Take Risks and Defer Judgment.

ERIC Educational Resources Information Center

Israel, Elfie

A practicum was designed to help high school students become more creative by encouraging them to be audacious, divergent thinkers capable of entertaining several contradictory ideas simultaneously. Tolerating paradox and ambiguity are vital components in developing creativity. These goals were achieved by developing a nurturing, caring, accepting…

Family-Centred Care: A Critical Perspective

ERIC Educational Resources Information Center

Hjorngaard, Tina

2011-01-01

This commentary is informed by the author's multiple perspectives as a parent of a 12-year-old girl with cerebral palsy, as a social worker, and as a critical disability advocate and activist. While the author occupies these subject positions simultaneously, they are not necessarily always confluent with one another. She struggles with, and is, at…

[Spending and financing in health care: situation and trends].

PubMed

Molina, R; Pinto, M; Henderson, P; Vieira, C

2000-01-01

Being knowledgeable about national health expenditures and sources of financing is essential for decision-making. This awareness also makes it possible to evaluate the equity of allocation and the efficiency of utilization of these resources. Changes in financing have been a substantial component of health sector reform in the Americas. The goal has shifted from merely one of financial sustainability to simultaneously seeking equitable access to quality services. In this article the Pan American Health Organization (PAHO) presents a proposal for analyzing and designing a policy on health financing. The aim of the policy is to identify the mix of financing mechanisms most likely to simultaneously produce financial sustainability, equity, access, and efficiency. The PAHO proposal combines traditional mechanisms for generating resources (public funds from taxes, as well as private health insurance, national health insurance, and user fees) with complementary subsidy mechanisms for vulnerable groups. Health financing strategies ought to explicitly consider the financing both of care for individuals and of health interventions for the general public good, for which public financing is the most equitable and efficient approach.

Block-suffix shifting: fast, simultaneous medical concept set identification in large medical record corpora.

PubMed

Liu, Ying; Lita, Lucian Vlad; Niculescu, Radu Stefan; Mitra, Prasenjit; Giles, C Lee

2008-11-06

Owing to new advances in computer hardware, large text databases have become more prevalent than ever.Automatically mining information from these databases proves to be a challenge due to slow pattern/string matching techniques. In this paper we present a new, fast multi-string pattern matching method based on the well known Aho-Chorasick algorithm. Advantages of our algorithm include:the ability to exploit the natural structure of text, the ability to perform significant character shifting, avoiding backtracking jumps that are not useful, efficiency in terms of matching time and avoiding the typical "sub-string" false positive errors.Our algorithm is applicable to many fields with free text, such as the health care domain and the scientific document field. In this paper, we apply the BSS algorithm to health care data and mine hundreds of thousands of medical concepts from a large Electronic Medical Record (EMR) corpora simultaneously and efficiently. Experimental results show the superiority of our algorithm when compared with the top of the line multi-string matching algorithms.

Effects of Video Modeling on the Instructional Efficiency of Simultaneous Prompting among Preschoolers with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Genc-Tosun, Derya; Kurt, Onur

2017-01-01

The purpose of the present study was to compare the effectiveness and efficiency of simultaneous prompting with and without video modeling in teaching food preparation skills to four participants with autism spectrum disorder, whose ages ranged from 5 to 6 years old. An adapted alternating treatment single-case experimental design was used to…

A simple model to predict the biodiesel blend density as simultaneous function of blend percent and temperature.

PubMed

Gaonkar, Narayan; Vaidya, R G

2016-05-01

A simple method to estimate the density of biodiesel blend as simultaneous function of temperature and volume percent of biodiesel is proposed. Employing the Kay's mixing rule, we developed a model and investigated theoretically the density of different vegetable oil biodiesel blends as a simultaneous function of temperature and volume percent of biodiesel. Key advantage of the proposed model is that it requires only a single set of density values of components of biodiesel blends at any two different temperatures. We notice that the density of blend linearly decreases with increase in temperature and increases with increase in volume percent of the biodiesel. The lower values of standard estimate of error (SEE = 0.0003-0.0022) and absolute average deviation (AAD = 0.03-0.15 %) obtained using the proposed model indicate the predictive capability. The predicted values found good agreement with the recent available experimental data.

A Heckman selection model for the safety analysis of signalized intersections

PubMed Central

Wong, S. C.; Zhu, Feng; Pei, Xin; Huang, Helai; Liu, Youjun

2017-01-01

Purpose The objective of this paper is to provide a new method for estimating crash rate and severity simultaneously. Methods This study explores a Heckman selection model of the crash rate and severity simultaneously at different levels and a two-step procedure is used to investigate the crash rate and severity levels. The first step uses a probit regression model to determine the sample selection process, and the second step develops a multiple regression model to simultaneously evaluate the crash rate and severity for slight injury/kill or serious injury (KSI), respectively. The model uses 555 observations from 262 signalized intersections in the Hong Kong metropolitan area, integrated with information on the traffic flow, geometric road design, road environment, traffic control and any crashes that occurred during two years. Results The results of the proposed two-step Heckman selection model illustrate the necessity of different crash rates for different crash severity levels. Conclusions A comparison with the existing approaches suggests that the Heckman selection model offers an efficient and convenient alternative method for evaluating the safety performance at signalized intersections. PMID:28732050

Evaluation of a Wake Vortex Upset Model Based on Simultaneous Measurements of Wake Velocities and Probe-Aircraft Accelerations

NASA Technical Reports Server (NTRS)

Short, B. J.; Jacobsen, R. A.

1979-01-01

Simultaneous measurements were made of the upset responses experienced and the wake velocities encountered by an instrumented Learjet probe aircraft behind a Boeing 747 vortex-generating aircraft. The vortex-induced angular accelerations experienced could be predicted within 30% by a mathematical upset response model when the characteristics of the wake were well represented by the vortex model. The vortex model used in the present study adequately represented the wake flow field when the vortices dissipated symmetrically and only one vortex pair existed in the wake.

Comment on 'All quantum observables in a hidden-variable model must commute simultaneously'

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nagata, Koji

Malley discussed [Phys. Rev. A 69, 022118 (2004)] that all quantum observables in a hidden-variable model for quantum events must commute simultaneously. In this comment, we discuss that Malley's theorem is indeed valid for the hidden-variable theoretical assumptions, which were introduced by Kochen and Specker. However, we give an example that the local hidden-variable (LHV) model for quantum events preserves noncommutativity of quantum observables. It turns out that Malley's theorem is not related to the LHV model for quantum events, in general.

The impact of fillers on lineup performance.

PubMed

Wetmore, Stacy A; McAdoo, Ryan M; Gronlund, Scott D; Neuschatz, Jeffrey S

2017-01-01

Filler siphoning theory posits that the presence of fillers (known innocents) in a lineup protects an innocent suspect from being chosen by siphoning choices away from that innocent suspect. This mechanism has been proposed as an explanation for why simultaneous lineups (viewing all lineup members at once) induces better performance than showups (one-person identification procedures). We implemented filler siphoning in a computational model (WITNESS, Clark, Applied Cognitive Psychology 17:629-654, 2003), and explored the impact of the number of fillers (lineup size) and filler quality on simultaneous and sequential lineups (viewing lineups members in sequence), and compared both to showups. In limited situations, we found that filler siphoning can produce a simultaneous lineup performance advantage, but one that is insufficient in magnitude to explain empirical data. However, the magnitude of the empirical simultaneous lineup advantage can be approximated once criterial variability is added to the model. But this modification works by negatively impacting showups rather than promoting more filler siphoning. In sequential lineups, fillers were found to harm performance. Filler siphoning fails to clarify the relationship between simultaneous lineups and sequential lineups or showups. By incorporating constructs like filler siphoning and criterial variability into a computational model, and trying to approximate empirical data, we can sort through explanations of eyewitness decision-making, a prerequisite for policy recommendations.

Simultaneous point-of-care detection of anemia and sickle cell disease in Tanzania: the RAPID study.

PubMed

Smart, Luke R; Ambrose, Emmanuela E; Raphael, Kevin C; Hokororo, Adolfine; Kamugisha, Erasmus; Tyburski, Erika A; Lam, Wilbur A; Ware, Russell E; McGann, Patrick T

2018-02-01

Both anemia and sickle cell disease (SCD) are highly prevalent across sub-Saharan Africa, and limited resources exist to diagnose these conditions quickly and accurately. The development of simple, inexpensive, and accurate point-of-care (POC) assays represents an important advance for global hematology, one that could facilitate timely and life-saving medical interventions. In this prospective study, Robust Assays for Point-of-care Identification of Disease (RAPID), we simultaneously evaluated a POC immunoassay (Sickle SCAN™) to diagnose SCD and a first-generation POC color-based assay to detect anemia. Performed at Bugando Medical Center in Mwanza, Tanzania, RAPID tested 752 participants (age 1 day to 20 years) in four busy clinical locations. With minimally trained medical staff, the SCD POC assay diagnosed SCD with 98.1% sensitivity and 91.1% specificity. The hemoglobin POC assay had 83.2% sensitivity and 74.5% specificity for detection of severe anemia (Hb ≤ 7 g/dL). Interobserver agreement was excellent for both POC assays (r = 0.95-0.96). Results for the hemoglobin POC assay have informed the second-generation assay design to be more suitable for low-resource settings. RAPID provides practical feasibility data regarding two novel POC assays for the diagnosis of anemia and SCD in real-world field evaluations and documents the utility and potential impact of these POC assays for sub-Saharan Africa.

Hospital stay for healthy term newborns.

PubMed

2010-02-01

The hospital stay of the mother and her healthy term newborn infant should be long enough to allow identification of early problems and to ensure that the family is able and prepared to care for the infant at home. The length of stay should also accommodate the unique characteristics of each mother-infant dyad, including the health of the mother, the health and stability of the infant, the ability and confidence of the mother to care for her infant, the adequacy of support systems at home, and access to appropriate follow-up care. Input from the mother and her obstetrician should be considered before a decision to discharge a newborn is made, and all efforts should be made to keep mothers and infants together to promote simultaneous discharge.

Synchronous occurrence of breast cancer and pulmonary sclerosing hemangioma: management and review of the literature.

PubMed

Salemis, Nikolaos S; Seretis, Charalampos; Nakos, Georgios; Kantounakis, Ioannis; Stoumpos, Charalampos; Spiliopoulos, Kyriakos

2013-01-01

Pulmonary sclerosing hemangioma (PSH) is a rare tumor accounting for 0.2-1% of all primary lung tumors. Simultaneous occurrence of PSH with breast cancer has very rarely been reported in the literature. We describe here a case of simultaneous occurrence of PSH with breast cancer. A pathological diagnosis of PSH was confirmed by computed tomography (CT)-guided biopsy. Due to the patient's poor performance status and the benign nature of PSH, surgical excision was not considered and the patient was managed conservatively with regular follow-up. Although surgical excision is the preferred treatment for PSH, conservative management may be a reasonable option in carefully selected patients.

Kinetic modeling of multi-feed simultaneous saccharification and co-fermentation of pretreated birch to ethanol.

PubMed

Wang, Ruifei; Koppram, Rakesh; Olsson, Lisbeth; Franzén, Carl Johan

2014-11-01

Fed-batch simultaneous saccharification and fermentation (SSF) is a feasible option for bioethanol production from lignocellulosic raw materials at high substrate concentrations. In this work, a segregated kinetic model was developed for simulation of fed-batch simultaneous saccharification and co-fermentation (SSCF) of steam-pretreated birch, using substrate, enzymes and cell feeds. The model takes into account the dynamics of the cellulase-cellulose system and the cell population during SSCF, and the effects of pre-cultivation of yeast cells on fermentation performance. The model was cross-validated against experiments using different feed schemes. It could predict fermentation performance and explain observed differences between measured total yeast cells and dividing cells very well. The reproducibility of the experiments and the cell viability were significantly better in fed-batch than in batch SSCF at 15% and 20% total WIS contents. The model can be used for simulation of fed-batch SSCF and optimization of feed profiles. Copyright © 2014 Elsevier Ltd. All rights reserved.

Two field trials for deblending of simultaneous source surveys: Why we failed and why we succeeded?

NASA Astrophysics Data System (ADS)

Zu, Shaohuan; Zhou, Hui; Chen, Haolin; Zheng, Hao; Chen, Yangkang

2017-08-01

Currently, deblending is the main strategy for dealing with the intense interference problem of simultaneous source data. Most deblending methods are based on the property that useful signal is coherent while the interference is incoherent in some domains other than common shot domain. In this paper, two simultaneous source field trials were studied in detail. In the first trial, the simultaneous source survey was not optimal, as the dithering code had strong coherency and the minimum distance between the two vessels was also small. The chosen marine shot scheduling and vessel deployment made it difficult to deblend the simultaneous source data, and result was an unexpected failure. Next, we tested different parameters (the dithering code and the minimum distance between vessels) of the simultaneous source survey using the simulated blended data and got some useful insights. Then, we carried out the second field trial with a carefully designed survey that was much different from the first trial. The deblended results in common receiver gather, common shot gather or the final stacked profile were encouraging. We obtained a complete success in the second field trial, which gave us confidence in the further test (such as a full three dimensional acquisition test or a high-resolution acquisition test with denser spatial sampling). Remembering that failures with simultaneous sourcing seldom reported, in this paper, our contribution is the discussion in detail about both our failed and successful field experiments and the lessons we have learned from them with the hope that the experience gained from this study can be very useful to other researchers in the same field.

Providing primary health care through integrated microfinance and health services in Latin America.

PubMed

Geissler, Kimberley H; Leatherman, Sheila

2015-05-01

The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. The poor are at particular risk, with lower access to health care and higher rates of avoidable mortality. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs. Using a conceptual model of health services access, we examine supply- and demand-side factors in a microfinance client population receiving integrated services. We conduct a case study using data from 2010 to 2012 of the design of a universal screening program and primary care services provided in conjunction with microfinance loans by Pro Mujer, a women's development organization in Latin America. The program operates in Argentina, Bolivia, Mexico, Nicaragua, and Peru. We analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. We find provision of preventive care is substantial, with an average of 13% of Pro Mujer clients being screened for cervical cancer each year, 21% receiving breast exams, 16% having a blood glucose measurement, 39% receiving a blood pressure measurement, and 46% having their body mass index calculated. This population, with more than half of those screened being overweight or obese and 9% of those screened having elevated glucose measures, has major risk factors for diabetes, high blood pressure, and cardiovascular disease without intervention. The components of the Pro Mujer health program address four dimensions of healthcare access: geographic accessibility, availability, affordability, and acceptability. Significant progress has been made to meet basic health needs, but challenges remain to ensure that health care provided is of reliable quality to predictably improve health outcomes over time. Copyright © 2015 Elsevier Ltd. All rights reserved.

The influence of work characteristics, emotional display rules and affectivity on burnout and job satisfaction: A survey among geriatric care workers.

PubMed

Rouxel, Géraldine; Michinov, Estelle; Dodeler, Virginie

2016-10-01

Previous studies have demonstrated that geriatric care employees are exposed to a large number of factors that can affect their levels of job satisfaction and occupational stress. Although working with elderly people is emotionally demanding, little research has been done on the role played by perceptions of emotional display rules, alongside more traditional work characteristics and individual factors, in the prediction of geriatric care employees' wellbeing. The aim of the present study was to examine the role played by work characteristics (job demands, job control, emotional display rules) and individual (affectivity) factors to predict job satisfaction and burnout among French geriatric care nurses. Questionnaires were sent to 891 employees working in 32 geriatric care centers in France. A total of 371 valid questionnaires (response rate: 41.60%) were analyzed using structural equation modeling techniques. Results revealed two main processes of burnout and job satisfaction among women geriatric care workers, namely a salutogenic process and a pathogenic process. As expected, negative affectivity, low job status, perceived negative display rules and job demands are involved in the pathogenic process; while positive affectivity, perceived positive display rules and job control are implied in the salutogenic one. More specifically, as expected, negative affectivity is a positive predictor of burnout, both directly and indirectly through its impact on perceived negative display rules and job demands. Moreover, negative affectivity was negatively related to job satisfaction. Simultaneously, positive affectivity can predict job satisfaction, both directly and indirectly through its impact on perceived positive display rules and job control. Positive affectivity is also a negative predictor of burnout. Practical implications are discussed to support intervention programs that develop healthy workplaces, and also to inform nurses about how to manage emotional display rules in retirement homes. Copyright © 2016 Elsevier Ltd. All rights reserved.

"Spiral-Cap" ileocystoplasty for bladder augmentation and ureteric reimplant.

PubMed

Sawant, S Ajit; Tamhankar, Ashwin Sunil; Kumar, Vikash; Prakash, W Pawar; Gaurav, V Kasat; Bansal, Sumit

2016-01-01

To demonstrate the new technique of Spiral-cap ileocystoplasty for bladder augmentation and simultaneous ureteric reimplant. Seven patients with small capacity bladder and simultaneous lower ureteric involvement operated in single tertiary care institute over the last 5 years were included in this study. Spiral-cap ileocystoplasty was used in all the patients for bladder augmentation. Proximal part of the same ileal loop was used in isoperistaltic manner for ureteric reimplantation. Distal end of this ileal loop was intussuscepted into the pouch to decrease the incidence of reflux. Detubularized distal portion of the loop was reconfigured in spiral manner to augment the native bladder. Patients were analyzed for upper tract changes, serum creatinine, bladder capacity, and requirement of clean intermittent self-catheterization in follow-up over 5 years. There was no evidence of any urinary or bowel leak in the postoperative period. Recovery was equivalent with those treated with other methods of bladder augmentation. Follow-up ultrasonography showed good capacity bladder. Upper tracts were well preserved in follow-up. Urinary bladder and lower ureter pathologies were addressed simultaneously. Spiral-cap ileocystoplasty is a useful technique in patients who require simultaneous bladder augmentation and ureteric reimplant.

Patient Perceptions of Whom is Most Involved in Their Care with Successive Duty Hour Limits.

PubMed

Arora, Vineet M; Prochaska, Micah T; Farnan, Jeanne M; Meltzer, David O

2015-09-01

Although direct patient care is necessary for experiential learning during residency, inpatient perceptions of the roles of resident and attending physicians in their care may have changed with residency duty hours. We aimed to assess if patients' perceptions of who is most involved in their care changed with residency duty hours. This was a prospective observational study over 12 years at a single institution. Participants were 22,408 inpatients admitted to the general medicine teaching service from 2001 to 2013, who completed a 1-month follow-up phone interview. Percentage of inpatients who reported an attending, resident, or intern as most involved in their care by duty hour period (pre-2003, post-2003-pre-2011, post-2011). With successive duty hour limits, the percentage of patients who reported the attending as most involved in their care increased (pre-2003 20 %, post-2003-pre-2011 29 %, post-2011 37 %, p < 0.001). Simultaneously, fewer patients reported a housestaff physician (resident or intern) as most involved in their care (pre-2003 20 %, post-2003-pre-2011 17 %, post-2011 12 %, p < 0.001). In multinomial regression models controlling for patient age, race, gender and hospitalist as teaching attending, the relative risk ratio of naming the resident versus the attending was higher in the pre-2003 period (1.44, 95 % CI 1.28-1.62, p < 0.001) than the post-2003-pre-2011 (reference group). In contrast, the relative risk ratio for naming the resident versus the attending was lower in the post-2011 period (0.79, 95 % CI 0.68-0.93, p = 0.004) compared to the reference group. After successive residency duty hours limits, hospitalized patients were more likely to report the attending physician and less likely to report the resident or intern as most involved in their hospital care. Given the importance of experiential learning to the formation of clinical judgment for independent practice, further study on the implications of these trends for resident education and patient safety is warranted.

Velocity analysis of simultaneous-source data using high-resolution semblance—coping with the strong noise

NASA Astrophysics Data System (ADS)

Gan, Shuwei; Wang, Shoudong; Chen, Yangkang; Qu, Shan; Zu, Shaohuan

2016-02-01

Direct imaging of simultaneous-source (or blended) data, without the need of deblending, requires a precise subsurface velocity model. In this paper, we focus on the velocity analysis of simultaneous-source data using the normal moveout-based velocity picking approach.We demonstrate that it is possible to obtain a precise velocity model directly from the blended data in the common-midpoint domain. The similarity-weighted semblance can help us obtain much better velocity spectrum with higher resolution and higher reliability compared with the traditional semblance. The similarity-weighted semblance enforces an inherent noise attenuation solely in the semblance calculation stage, thus it is not sensitive to the intense interference. We use both simulated synthetic and field data examples to demonstrate the performance of the similarity-weighted semblance in obtaining reliable subsurface velocity model for direct migration of simultaneous-source data. The migrated image of blended field data using prestack Kirchhoff time migration approach based on the picked velocity from the similarity-weighted semblance is very close to the migrated image of unblended data.

Towards Accurate Modelling of Galaxy Clustering on Small Scales: Testing the Standard ΛCDM + Halo Model

NASA Astrophysics Data System (ADS)

Sinha, Manodeep; Berlind, Andreas A.; McBride, Cameron K.; Scoccimarro, Roman; Piscionere, Jennifer A.; Wibking, Benjamin D.

2018-04-01

Interpreting the small-scale clustering of galaxies with halo models can elucidate the connection between galaxies and dark matter halos. Unfortunately, the modelling is typically not sufficiently accurate for ruling out models statistically. It is thus difficult to use the information encoded in small scales to test cosmological models or probe subtle features of the galaxy-halo connection. In this paper, we attempt to push halo modelling into the "accurate" regime with a fully numerical mock-based methodology and careful treatment of statistical and systematic errors. With our forward-modelling approach, we can incorporate clustering statistics beyond the traditional two-point statistics. We use this modelling methodology to test the standard ΛCDM + halo model against the clustering of SDSS DR7 galaxies. Specifically, we use the projected correlation function, group multiplicity function and galaxy number density as constraints. We find that while the model fits each statistic separately, it struggles to fit them simultaneously. Adding group statistics leads to a more stringent test of the model and significantly tighter constraints on model parameters. We explore the impact of varying the adopted halo definition and cosmological model and find that changing the cosmology makes a significant difference. The most successful model we tried (Planck cosmology with Mvir halos) matches the clustering of low luminosity galaxies, but exhibits a 2.3σ tension with the clustering of luminous galaxies, thus providing evidence that the "standard" halo model needs to be extended. This work opens the door to adding interesting freedom to the halo model and including additional clustering statistics as constraints.

The long view: how the financial downturn will change health care.

PubMed

Moore, Keith; Coddington, Dean; Byrne, Deirdre

2009-01-01

There are five reasons that today's economic downturn will have a much broader impact on U.S. health care than did past recessions: This downturn is likely to be more severe and last longer. Healthcare organizations are experiencing problems from several directions simultaneously. Healthcare organizations entered this downturn more heavily leveraged and more vulnerable. This downturn is notjust a recession, but a major realignment for financing practices. As the realignment occurs and the new financing order sorts itself out, healthcare organizations are not likely to receive the favorable treatment they had in the past.

Pediatric lung transplantation and end of life care in cystic fibrosis: Barriers and successful strategies.

PubMed

Dellon, Elisabeth; Goldfarb, Samuel B; Hayes, Don; Sawicki, Gregory S; Wolfe, Joanne; Boyer, Debra

2017-11-01

Pediatric lung transplantation has advanced over the years, providing a potential life-prolonging therapy to patients with cystic fibrosis. Despite this, many challenges in lung transplantation remain and result in worse outcomes than other solid organ transplants. As CF lung disease progresses, children and their caregivers are often simultaneously preparing for lung transplantation and end of life. In this article, we will discuss the current barriers to success in pediatric CF lung transplantation as well as approaches to end of life care in this population. © 2017 Wiley Periodicals, Inc.

Deformation of red blood cells using acoustic radiation forces

PubMed Central

Mishra, Puja; Hill, Martyn; Glynne-Jones, Peter

2014-01-01

Acoustic radiation forces have been used to manipulate cells and bacteria in a number of recent microfluidic applications. The net force on a cell has been subject to careful investigation over a number of decades. We demonstrate that the radiation forces also act to deform cells. An ultrasonic standing wave field is created in a 0.1 mm glass capillary at a frequency of 7.9 MHz. Using osmotically swollen red-blood cells, we show observable deformations up to an aspect ratio of 1.35, comparable to deformations created by optical tweezing. In contrast to optical technologies, ultrasonic devices are potentially capable of deforming thousands of cells simultaneously. We create a finite element model that includes both the acoustic environment of the cell, and a model of the cell membrane subject to forces resulting from the non-linear aspects of the acoustic field. The model is found to give reasonable agreement with the experimental results, and shows that the deformation is the result of variation in an acoustic force that is directed outwards at all points on the cell membrane. We foresee applications in diagnostic devices, and in the possibility of mechanically stimulating cells to promote differentiation and physiological effects. PMID:25379070

Financial effect of instituting Deficit Reduction Act documentation requirements in family planning clinics in Oregon.

PubMed

Rodriguez, Maria Isabel; Angus, Lisa; Elman, Emily; Darney, Philip D; Caughey, Aaron B

2011-06-01

The study was conducted to estimate the long-term costs for implementing citizenship documentation requirements in a Medicaid expansion program for family planning services in Oregon. A decision-analytic model was developed using two perspectives: the state and society. Our primary outcome was future reproductive health care costs due to pregnancy in the next 5 years. A Markov structure was utilized to capture multiple future pregnancies. Model inputs were retrieved from the existing literature and local hospital and Medicaid data related to reimbursements. One-way and multi-way sensitivity analyses were conducted. A Monte Carlo simulation was performed to simultaneously incorporate uncertainty from all of the model inputs. Screening for citizenship results in a loss of $3119 over 5 years ($39,382 vs. $42,501) for the state and $4209 for society ($63,391 compared to $59,182) for adult women. Among adolescents, requiring proof of identity and citizenship results in a loss of $3123 for the state ($39,378 versus $42,501) and $4214 for society ($63,391 instead of $59,177). Screening for citizenship status in publicly funded family planning clinics leads to financial losses for the state and society. Copyright © 2011 Elsevier Inc. All rights reserved.

Mapping the Moral Domain

PubMed Central

Graham, Jesse; Nosek, Brian A.; Haidt, Jonathan; Iyer, Ravi; Koleva, Spassena; Ditto, Peter H.

2010-01-01

The moral domain is broader than the empathy and justice concerns assessed by existing measures of moral competence, and it is not just a subset of the values assessed by value inventories. To fill the need for reliable and theoretically-grounded measurement of the full range of moral concerns, we developed the Moral Foundations Questionnaire (MFQ) based on a theoretical model of five universally available (but variably developed) sets of moral intuitions: Harm/care, Fairness/reciprocity, Ingroup/loyalty, Authority/respect, and Purity/sanctity. We present evidence for the internal and external validity of the scale and the model, and in doing so present new findings about morality: 1. Comparative model fitting of confirmatory factor analyses provides empirical justification for a five-factor structure of moral concerns. 2. Convergent/discriminant validity evidence suggests that moral concerns predict personality features and social group attitudes not previously considered morally relevant. 3. We establish pragmatic validity of the measure in providing new knowledge and research opportunities concerning demographic and cultural differences in moral intuitions. These analyses provide evidence for the usefulness of Moral Foundations Theory in simultaneously increasing the scope and sharpening the resolution of psychological views of morality. PMID:21244182

Models of the electrically stimulated binaural system: A review.

PubMed

Dietz, Mathias

2016-01-01

In an increasing number of countries, the standard treatment for deaf individuals is moving toward the implantation of two cochlear implants. Today's device technology and fitting procedure, however, appears as if the two implants would serve two independent ears and brains. Many experimental studies have demonstrated that after careful matching and balancing of left and right stimulation in controlled laboratory studies most patients have almost normal sensitivity to interaural level differences and some sensitivity to interaural time differences (ITDs). Mechanisms underlying the limited ITD sensitivity are still poorly understood and many different aspects may contribute. Recent pioneering computational approaches identified some of the functional implications the electric input imposes on the neural brainstem circuits. Simultaneously these studies have raised new questions and certainly demonstrated that further refinement of the model stages is necessary. They join the experimental study's conclusions that binaural device technology, binaural fitting, specific speech coding strategies, and binaural signal processing algorithms are obviously missing components to maximize the benefit of bilateral implantation. Within this review, the existing models of the electrically stimulated binaural system are explained, compared, and discussed from a viewpoint of a "CI device with auditory system" and from that of neurophysiological research.

Evaluating the Effects of Emission Reductions on Multiple Pollutants Simultaneously

EPA Science Inventory

Modeling studies over the Philadelphia metropolitan area have examined how emission control strategies might affect several types of air pollutants simultaneously. This study supports considering effects of multiple pollutants in determining optimum pollution control strategies. ...

Disparities in urban/rural environmental quality

EPA Science Inventory

Individuals experience simultaneous exposure to many pollutants and social factors, which cluster to affect human health outcomes. Because the optimal approach to combining these factors is unknown, we developed a method to model simultaneous exposure using criteria air pollutant...

A study on the impact of prioritising emergency department arrivals on the patient waiting time.

PubMed

Van Bockstal, Ellen; Maenhout, Broos

2018-05-03

In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern. We determine the personnel staffing requirements and the design of the shifts based on the patient arrival rates per acuity class such that the resource staffing cost and the weighted patient waiting time are minimised. In order to solve this multi-objective optimisation problem, we construct a Pareto set of optimal solutions via the -constraints method. For a particular staffing composition, the proposed model minimises the patient waiting time subject to upper bounds on the staffing size using the Sample Average Approximation Method. In our computational experiments, we discern the impact of prioritising the emergency department arrivals. Triaging results in lower patient waiting times for higher priority acuity classes and to a higher waiting time for the lowest priority class, which does not require immediate care. Moreover, we perform a sensitivity analysis to verify the impact of the arrival and service pattern characteristics, the prioritisation weights between different acuity classes and the incorporated shift flexibility in the model.

The impact of system of care support in adherence to wraparound principles in Child and Family Teams in child welfare in North Carolina.

PubMed

Snyder, Elizabeth H; Lawrence, C Nicole; Dodge, Kenneth A

2012-04-01

North Carolina is one of a growing number of states to implement family meeting models in child welfare as a way to engage families, while simultaneously addressing complex familial needs and child safety issues. However, much is still unknown regarding how family meetings actually operate in child welfare, underscoring a clear need for further evaluation of this process. Utilizing direct observational data of Child and Family Team (CFT) meetings, collected as part of two separate evaluations of the North Carolina Division of Social Service's Multiple Response System (MRS) and System of Care (SOC) initiatives, the purpose of the current study was to examine whether the support provided by SOC improved fidelity to the CFT model in child welfare. The observations were conducted using the Team Observation Measure consisting of 78 indicators that measure adherence to ten domains associated with high quality family team meetings (e.g., collaborative, individualized, natural supports, outcomes based, strengths-based). Findings indicate that receiving SOC support in child welfare leads to a more collaborative and individualized decision-making process with families. Meeting facilitators in SOC counties were better prepared for CFTs, and had greater ability to lead a more robust and creative brainstorming process to develop a family-driven case plan. The current study also provides a much needed description of the CFT meeting process within child welfare using a direct observational measure.

[Normative prenatal evaluation at a philanthropic maternity hospital in São Paulo].

PubMed

Corrêa, Claudia Regina Hostim; Bonadio, Isabel Cristina; Tsunechiro, Maria Alice

2011-12-01

This cross-sectional study counted with the participation of 301 pregnant women seen in 2009 at a philanthropic maternity hospital in the city of São Paulo (a prenatal support program named Pré-Natal do Amparo Maternal - PN-AM). The objectives of this study were to evaluate the prenatal care according to the initial gestational age, the number of appointments that were held, the continuity of the assistance, and relate the appropriateness with the socio-demographic, obstetric and local variables of the initial prenatal care. The analysis criteria used was initiating prenatal care before 120 days of gestation and attending at least six appointments. The relationship between the variables was analyzed using the Chi-Square Test. Results showed that 41.5% of the pregnant women initiated prenatal care at another health care service and transferred spontaneously to the PN-AM; 74.1% initiated the prenatal care early and 80.4% attended at least six appointments; 63.1% met both criteria simultaneously. Appropriate prenatal care showed a statistically significant difference for mother's age, steady partner, employment, place of residence, having a companion during the appointment and place where prenatal care was initiated.

Effects of health insurance on non-working married women’s medical care use and bed days at home

PubMed Central

2013-01-01

Background This study examines whether bed days are alternative methods to medical care use for treating a particular illness. If bed days at home are considered as an alternative to medical treatment, then medical care use and bed days at home should be influenced by an individual’s health insurance status. Method This study uses data from the 2003 Medical Expenditure Panel Survey (MEPS) on medical care use and bed days at home for each contracted illness of non-working married women. Results The results suggest that the health insurance status of non-working married women has considerable influence on their choice between medical care use and bed days at home. In addition, those with health insurance are more likely to use medical care and less likely to use bed days at home, but they tend to avoid the simultaneous use of medical care and bed days at home. Conclusions In contrast to previous studies’ findings indicating that absences from work and medical care use among working males may be complements, this study’s results for non-working married women without health insurance suggest that they use rest and medical treatment as substitutes, not complements. PMID:23816313

Extending emotion and decision-making beyond the laboratory: The promise of palliative care contexts.

PubMed

Ferrer, Rebecca A; Padgett, Lynne; Ellis, Erin M

2016-08-01

Although laboratory-based research on emotion and decision-making holds the distinct advantage of rigorous experimental control conditions that allow causal inferences, the question of how findings in a laboratory generalize to real-world settings remains. Identifying ecologically valid, real-world opportunities to extend laboratory findings is a valuable means of advancing this field. Palliative care-or care intended to provide relief from serious illness and aging-related complications during treatment or at the end of life-provides a particularly rich opportunity for such work. Here, we present an overview of palliative care, summarize existing research on emotion and palliative care decision-making, highlight challenges associated with conducting such research, outline examples of collaborative projects leveraging palliative care as a context for generating fundamental knowledge about emotion and decision-making, and describe the resources and collaborations necessary to conduct this type of research. In sum, palliative care holds unique promise as an emotionally laden context in which to answer fundamental questions about emotion and decision-making that extends our theoretical understanding of the role of emotion in high-stakes decision-making while simultaneously generating knowledge that can improve palliative care implementation. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Effects of health insurance on non-working married women's medical care use and bed days at home.

PubMed

Lee, Changwoo; Shin, Euichul

2013-07-01

This study examines whether bed days are alternative methods to medical care use for treating a particular illness. If bed days at home are considered as an alternative to medical treatment, then medical care use and bed days at home should be influenced by an individual's health insurance status. This study uses data from the 2003 Medical Expenditure Panel Survey (MEPS) on medical care use and bed days at home for each contracted illness of non-working married women. The results suggest that the health insurance status of non-working married women has considerable influence on their choice between medical care use and bed days at home. In addition, those with health insurance are more likely to use medical care and less likely to use bed days at home, but they tend to avoid the simultaneous use of medical care and bed days at home. In contrast to previous studies' findings indicating that absences from work and medical care use among working males may be complements, this study's results for non-working married women without health insurance suggest that they use rest and medical treatment as substitutes, not complements.

Nursing care in a high-technological environment: Experiences of critical care nurses.

PubMed

Tunlind, Adam; Granström, John; Engström, Åsa

2015-04-01

Management of technical equipment, such as ventilators, infusion pumps, monitors and dialysis, makes health care in an intensive care setting more complex. Technology can be defined as items, machinery and equipment that are connected to knowledge and management to maximise efficiency. Technology is not only the equipment itself, but also the knowledge of how to use it and the ability to convert it into nursing care. The aim of this study is to describe critical care nurses' experience of performing nursing care in a high technology healthcare environment. Qualitative, personal interviews were conducted during 2012 with eight critical care nurses in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis. Three themes with six categories emerged. The technology was described as a security that could facilitate nursing care, but also one that could sometimes present obstacles. The importance of using the clinical gaze was highlighted. Nursing care in a high technological environment must be seen as multi-faceted when it comes to how it affects CCNs' experience. The advanced care conducted in an ICU could not function without high-tech equipment, nor could care operate without skilled interpersonal interaction and maintenance of basal nursing. That technology is seen as a major tool and simultaneously as a barrier to patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Simultaneous construction of PCR-DGGE-based predictive models of Listeria monocytogenes and Vibrio parahaemolyticus on cooked shrimps.

PubMed

Liao, C; Peng, Z Y; Li, J B; Cui, X W; Zhang, Z H; Malakar, P K; Zhang, W J; Pan, Y J; Zhao, Y

2015-03-01

The aim of this study was to simultaneously construct PCR-DGGE-based predictive models of Listeria monocytogenes and Vibrio parahaemolyticus on cooked shrimps at 4 and 10°C. Calibration curves were established to correlate peak density of DGGE bands with microbial counts. Microbial counts derived from PCR-DGGE and plate methods were fitted by Baranyi model to obtain molecular and traditional predictive models. For L. monocytogenes, growing at 4 and 10°C, molecular predictive models were constructed. It showed good evaluations of correlation coefficients (R(2) > 0.92), bias factors (Bf ) and accuracy factors (Af ) (1.0 ≤ Bf ≤ Af ≤ 1.1). Moreover, no significant difference was found between molecular and traditional predictive models when analysed on lag phase (λ), maximum growth rate (μmax ) and growth data (P > 0.05). But for V. parahaemolyticus, inactivated at 4 and 10°C, molecular models show significant difference when compared with traditional models. Taken together, these results suggest that PCR-DGGE based on DNA can be used to construct growth models, but it is inappropriate for inactivation models yet. This is the first report of developing PCR-DGGE to simultaneously construct multiple molecular models. It has been known for a long time that microbial predictive models based on traditional plate methods are time-consuming and labour-intensive. Denaturing gradient gel electrophoresis (DGGE) has been widely used as a semiquantitative method to describe complex microbial community. In our study, we developed DGGE to quantify bacterial counts and simultaneously established two molecular predictive models to describe the growth and survival of two bacteria (Listeria monocytogenes and Vibrio parahaemolyticus) at 4 and 10°C. We demonstrated that PCR-DGGE could be used to construct growth models. This work provides a new approach to construct molecular predictive models and thereby facilitates predictive microbiology and QMRA (Quantitative Microbial Risk Assessment). © 2014 The Society for Applied Microbiology.

Enhancing Continuity in Care: An Implemantation of the ASTM E2369-05 Standard Specification for Continuity of Care Record in a Homecare Application

PubMed Central

Botsivaly, M.; Spyropoulos, B.; Koutsourakis, K.; Mertika, K.

2006-01-01

Sharing of healthcare related information among the different healthcare providers is a crucial aspect for the continuity of the provided care The purpose of this study is the presentation of a system appropriate to be used upon the transition or the referral of a patient, and especially in transition from hospital to homecare. The function of the developed system is based upon the creation of a structured subset of data, concerning the most relevant facts about a patient’s healthcare, organized and transportable, in order to be employed during the post-discharge homecare period, enabling simultaneously the planning and the optimal documentation of the provided homecare. The structure and the content of the created data sets are complying with the ASTM E2369-0 Standard, Specification for Continuity of Care Record. PMID:17238304

Enhancing continuity in care: an implemantation of the ASTM E2369-05 Standard Specification for Continuity of Care Record in a homecare application.

PubMed

Botsivaly, M; Spyropoulos, B; Koutsourakis, K; Mertika, K

2006-01-01

Sharing of healthcare related information among the different healthcare providers is a crucial aspect for the continuity of the provided care The purpose of this study is the presentation of a system appropriate to be used upon the transition or the referral of a patient, and especially in transition from hospital to homecare. The function of the developed system is based upon the creation of a structured subset of data, concerning the most relevant facts about a patient's healthcare, organized and transportable, in order to be employed during the post-discharge homecare period, enabling simultaneously the planning and the optimal documentation of the provided homecare. The structure and the content of the created data sets are complying with the ASTM E2369-0 Standard, Specification for Continuity of Care Record.

Subacute care, Medicare benefits, and nursing home behavior.

PubMed

Aaronson, W E; Zinn, J S; Rosko, M D

1995-09-01

Two policy changes in 1988, one administrative and one legislative, allowed greater Medicare coverage of subacute care in skilled nursing facilities (SNFs). The Medicare Catastrophic Coverage Act (MCCA) of 1988, in conjunction with an administrative directive, or transmittal, from the Health Care Financing Administration (HCFA), changed the Medicare SNF benefit structure substantially. In this study, we specified a simultaneous equation system to explain the effects of the benefit changes on Medicare use. The results suggest that the two policy changes increased Medicare use in Pennsylvania SNFs substantially; however, the increase was associated with facility and case mix characteristics, which suggest that the increase was largely attributable to reclassification of current patients from other payer categories, Medicaid and self-pay, rather than new admissions. The effects of the MCCA and the HCFA transmittal on increased Medicare use were unanticipated and have important implications for the way in which subacute care is defined and financed in future benefit discussions.

Evidence-based decision making in health care settings: from theory to practice.

PubMed

Kohn, Melanie Kazman; Berta, Whitney; Langley, Ann; Davis, David

2011-01-01

The relatively recent attention that evidence-based decision making has received in health care management has been at least in part due to the profound influence of evidence-based medicine. The result has been several comparisons in the literature between the use of evidence in health care management decisions and the use of evidence in medical decision making. Direct comparison, however, may be problematic, given the differences between medicine and management as they relate to (1) the nature of evidence that is brought to bear on decision making; (2) the maturity of empirical research in each field (in particular, studies that have substantiated whether or not and how evidence-based decision making is enacted); and (3) the context within which evidence-based decisions are made. By simultaneously reviewing evidence-based medicine and management, this chapter aims to inform future theorizing and empirical research on evidence-based decision making in health care settings.

The new frontiers of multimodality and multi-isotope imaging

NASA Astrophysics Data System (ADS)

Behnam Azad, Babak; Nimmagadda, Sridhar

2014-06-01

Technological advances in imaging systems and the development of target specific imaging tracers has been rapidly growing over the past two decades. Recent progress in "all-in-one" imaging systems that allow for automated image coregistration has significantly added to the growth of this field. These developments include ultra high resolution PET and SPECT scanners that can be integrated with CT or MR resulting in PET/CT, SPECT/CT, SPECT/PET and PET/MRI scanners for simultaneous high resolution high sensitivity anatomical and functional imaging. These technological developments have also resulted in drastic enhancements in image quality and acquisition time while eliminating cross compatibility issues between modalities. Furthermore, the most cutting edge technology, though mostly preclinical, also allows for simultaneous multimodality multi-isotope image acquisition and image reconstruction based on radioisotope decay characteristics. These scientific advances, in conjunction with the explosion in the development of highly specific multimodality molecular imaging agents, may aid in realizing simultaneous imaging of multiple biological processes and pave the way towards more efficient diagnosis and improved patient care.

The unexpected but understandable dynamics of mating, paternity and paternal care in the ocellated wrasse

PubMed Central

Alonzo, Suzanne H.; Heckman, Kellie L.

2010-01-01

Although theory generally predicts that males should reduce paternal care in response to cues that predict increased sperm competition and decreased paternity, empirical patterns are equivocal. Some studies have found the predicted decrease in male care with increased sperm competition, while even more studies report no effect of paternity or sperm competition on male care. Here, we report the first example, to our knowledge, of paternal care increasing with the risk and intensity of sperm competition, in the ocellated wrasse (Symphodus ocellatus). Theory also predicts that if paternal care varies and is important to female fitness, female choice among males and male indicators traits of expected paternal care should evolve. Despite a non-random distribution of mating success among nests, we found no evidence for female choice among parental males. Finally, we document the highest published levels of extra-pair paternity for a species with exclusive and obligate male care: genetic paternity analyses revealed cuckoldry at 100 per cent of nests and 28 per cent of all offspring were not sired by the male caring for them. While not predicted by any existing theory, these unexpected reproductive patterns become understandable if we consider how male and female mating and parental care interact simultaneously in this and probably many other species. PMID:19812085

Eliciting health care priorities in developing countries: experimental evidence from Guatemala.

PubMed

Font, Joan Costa; Forns, Joan Rovira; Sato, Azusa

2016-02-01

Although some methods for eliciting preferences to assist participatory priority setting in health care in developed countries are available, the same is not true for poor communities in developing countries whose preferences are neglected in health policy making. Existing methods grounded on self-interested, monetary valuations that may be inappropriate for developing country settings where community care is provided through 'social allocation' mechanisms. This paper proposes and examines an alternative methodology for eliciting preferences for health care programmes specifically catered for rural and less literate populations but which is still applicable in urban communities. Specifically, the method simulates a realistic collective budget allocation experiment, to be implemented in both rural and urban communities in Guatemala. We report evidence revealing that participatory budget-like experiments are incentive compatible mechanisms suitable for revealing collective preferences, while simultaneously having the advantage of involving communities in health care reform processes. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

[Social medicine and dental health].

PubMed

Grünfeld, B

1976-03-01

Some socio-medical aspects of preventive and curative dental care. Preventive and early curative dental care is considered as an integral part of general health behavior in the individual. Different variables possibly determining such behavior are discussed. Demographic factors as age, sex, place of residence, as well as family and educational background, income and vocation seem to be of importance. A dental health delivery system free of charge to everyone in the age group 6-18, eventually up to 21 years has been available for several years in Norway. We assume that this has had a great impact upon the motivations for a positive atitude towards preventive care, particularly since economic barriers have been reduced simultaneously with shift in the popular value aspects of having good dental health status. Plans for a future incorporation of dental care into a total national health service, comprising the entire population, in order to make the delivery system feasible for everyone, will probably stimulate a still wider interest and motivation for preventive and early dental care.

Gendered Expectations? Reconsidering Single Fathers' Child-Care Time

ERIC Educational Resources Information Center

Hook, Jennifer L.; Chalasani, Satvika

2008-01-01

We take a fresh look at an important question in the sociology of gender and family: Do single fathers "mother"? We add to the theoretical debate by proposing that single fathers face competing interactional pressures, to simultaneously act like mothers and men. Using nationally representative data from the American Time Use Survey 2003-2006 (N =…

CASAWORKS for Families: A Promising Approach to Welfare Reform and Substance-Abusing Women. A CASA White Paper.

ERIC Educational Resources Information Center

Columbia Univ., New York, NY. National Center on Addiction and Substance Abuse.

CASAWORKS for Families is the first national demonstration program to provide simultaneously drug and alcohol treatment; literacy, job, parenting, and social skills training; family violence prevention; and health care to help substance-abusing welfare parents recover. Its mission is to help women on welfare with substance abuse problems achieve…

Quantification of the enhanced effectiveness of NOx control from simultaneous reductions of VOC and NH3 for reducing air pollution in the Beijing-Tianjin-Hebei region, China

NASA Astrophysics Data System (ADS)

Xing, Jia; Ding, Dian; Wang, Shuxiao; Zhao, Bin; Jang, Carey; Wu, Wenjing; Zhang, Fenfen; Zhu, Yun; Hao, Jiming

2018-06-01

As one common precursor for both PM2.5 and O3 pollution, NOx gains great attention because its controls can be beneficial for reducing both PM2.5 and O3. However, the effectiveness of NOx controls for reducing PM2.5 and O3 are largely influenced by the ambient levels of NH3 and VOC, exhibiting strong nonlinearities characterized as NH3-limited/NH3-poor and NOx-/VOC-limited conditions, respectively. Quantification of such nonlinearities is a prerequisite for making suitable policy decisions but limitations of existing methods were recognized. In this study, a new method was developed by fitting multiple simulations of a chemical transport model (i.e., Community Multiscale Air Quality Modeling System, CMAQ) with a set of polynomial functions (denoted as pf-RSM) to quantify responses of ambient PM2.5 and O3 concentrations to changes in precursor emissions. The accuracy of the pf-RSM is carefully examined to meet the criteria of a mean normalized error within 2 % and a maximal normalized error within 10 % by using 40 training samples with marginal processing. An advantage of the pf-RSM method is that the nonlinearity in PM2.5 and O3 responses to precursor emission changes can be characterized by quantitative indicators, including (1) a peak ratio (denoted as PR) representing VOC-limited or NOx-limited conditions, (2) a suggested ratio of VOC reduction to NOx reduction to avoid increasing O3 under VOC-limited conditions, (3) a flex ratio (denoted as FR) representing NH3-poor or NH3-rich conditions, and (4) enhanced benefits in PM2.5 reductions from simultaneous reduction of NH3 with the same reduction rate of NOx. A case study in the Beijing-Tianjin-Hebei region suggested that most urban areas present strong VOC-limited conditions with a PR from 0.4 to 0.8 in July, implying that the NOx emission reduction rate needs to be greater than 20-60 % to pass the transition from VOC-limited to NOx-limited conditions. A simultaneous VOC control (the ratio of VOC reduction to NOx reduction is about 0.5-1.2) can avoid increasing O3 during the transition. For PM2.5, most urban areas present strong NH3-rich conditions with a PR from 0.75 to 0.95, implying that NH3 is sufficiently abundant to neutralize extra nitric acid produced by an additional 5-35 % of NOx emissions. Enhanced benefits in PM2.5 reductions from simultaneous reduction of NH3 were estimated to be 0.04-0.15 µg m-3 PM2.5 per 1 % reduction of NH3 along with NOx, with greater benefits in July when the NH3-rich conditions are not as strong as in January. Thus, the newly developed pf-RSM model has successfully quantified the enhanced effectiveness of NOx control, and simultaneous reduction of VOC and NH3 with NOx can assure the control effectiveness of PM2.5 and O3.

Sequential vs simultaneous revascularization in patients undergoing liver transplantation: A meta-analysis.

PubMed

Wang, Jia-Zhong; Liu, Yang; Wang, Jin-Long; Lu, Le; Zhang, Ya-Fei; Lu, Hong-Wei; Li, Yi-Ming

2015-06-14

We undertook this meta-analysis to investigate the relationship between revascularization and outcomes after liver transplantation. A literature search was performed using MeSH and key words. The quality of the included studies was assessed using the Jadad Score and the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the χ(2) and I (2) tests. The risk of publication bias was assessed using a funnel plot and Egger's test, and the risk of bias was assessed using a domain-based assessment tool. A sensitivity analysis was conducted by reanalyzing the data using different statistical approaches. Six studies with a total of 467 patients were included. Ischemic-type biliary lesions were significantly reduced in the simultaneous revascularization group compared with the sequential revascularization group (OR = 4.97, 95%CI: 2.45-10.07; P < 0.00001), and intensive care unit (ICU) days were decreased (MD = 2.00, 95%CI: 0.55-3.45; P = 0.007) in the simultaneous revascularization group. Although warm ischemia time was prolonged in simultaneous revascularization group (MD = -25.84, 95%CI: -29.28-22.40; P < 0.00001), there were no significant differences in other outcomes between sequential and simultaneous revascularization groups. Assessment of the risk of bias showed that the methods of random sequence generation and blinding might have been a source of bias. The sensitivity analysis strengthened the reliability of the results of this meta-analysis. The results of this study indicate that simultaneous revascularization in liver transplantation may reduce the incidence of ischemic-type biliary lesions and length of stay of patients in the ICU.

Strategies of experiment standardization and response optimization in a rat model of hemorrhagic shock and chronic hypertension.

PubMed

Reynolds, Penny S; Tamariz, Francisco J; Barbee, Robert Wayne

2010-04-01

Exploratory pilot studies are crucial to best practice in research but are frequently conducted without a systematic method for maximizing the amount and quality of information obtained. We describe the use of response surface regression models and simultaneous optimization methods to develop a rat model of hemorrhagic shock in the context of chronic hypertension, a clinically relevant comorbidity. Response surface regression model was applied to determine optimal levels of two inputs--dietary NaCl concentration (0.49%, 4%, and 8%) and time on the diet (4, 6, 8 weeks)--to achieve clinically realistic and stable target measures of systolic blood pressure while simultaneously maximizing critical oxygen delivery (a measure of vulnerability to hemorrhagic shock) and body mass M. Simultaneous optimization of the three response variables was performed though a dimensionality reduction strategy involving calculation of a single aggregate measure, the "desirability" function. Optimal conditions for inducing systolic blood pressure of 208 mmHg, critical oxygen delivery of 4.03 mL/min, and M of 290 g were determined to be 4% [NaCl] for 5 weeks. Rats on the 8% diet did not survive past 7 weeks. Response surface regression model and simultaneous optimization method techniques are commonly used in process engineering but have found little application to date in animal pilot studies. These methods will ensure both the scientific and ethical integrity of experimental trials involving animals and provide powerful tools for the development of novel models of clinically interacting comorbidities with shock.

Geomechanical Assessments of Simultaneous Operation in the Case of Transition from Open Pit to Underground Mine in Vietnam

NASA Astrophysics Data System (ADS)

Niedbalski, Zbigniew; Nguyen, Phu Minh Vuong; Widzyk-Capehart, Eleonora

2018-03-01

Nowadays, for a number of reasons, many open pit mines are considering a transition from Open Pit (OP) to Underground (UG) to remain competitive. In OP-UG transition, UG operation is operated simultaneously with the OP operation for a certain period of time. Guidelines for the simultaneous operation of OP and UG are very difficult to establish, as there are very few case studies available. Yet, because of the OP-UG interactions; the operation has a higher safety, technical and management requirements than the OP or UG methods when considered separately. In Vietnam, Cao Son is one of many OP mines, which decided to change the operational system from OP to UG. Simultaneous operation started in 2015 and will be conducted until 2030 when the OP mine Cao Son ends its mining activities. In this paper, selected geomechanical considerations of the simultaneous operation are presented. A number of numerical modelling calculations using finitedifference software with code FLAC were carried out for calibration process, slope stability analysis and the OP-UG interaction analysis for the Cao Son - Khe Cham II-IV mine. Based on the results obtained from numerical modelling, the geomechanical assessments of simultaneous operation Cao Son - Khe Cham II-IV are discussed in this paper.

Assessing environmental quality: the implications for social justice

EPA Science Inventory

Individuals experience simultaneous exposure to pollutants and social factors, which cluster to affect human health outcomes. The optimal approach to combining these factors is unknown, therefore we developed a method to model simultaneous exposure using criteria air pollutants, ...

SimWIND: A Geospatial Infrastructure Model for Wind Energy Production and Transmission

NASA Astrophysics Data System (ADS)

Middleton, R. S.; Phillips, B. R.; Bielicki, J. M.

2009-12-01

Wind is a clean, enduring energy resource with a capacity to satisfy 20% or more of the electricity needs in the United States. A chief obstacle to realizing this potential is the general paucity of electrical transmission lines between promising wind resources and primary load centers. Successful exploitation of this resource will therefore require carefully planned enhancements to the electric grid. To this end, we present the model SimWIND for self-consistent optimization of the geospatial arrangement and cost of wind energy production and transmission infrastructure. Given a set of wind farm sites that satisfy meteorological viability and stakeholder interest, our model simultaneously determines where and how much electricity to produce, where to build new transmission infrastructure and with what capacity, and where to use existing infrastructure in order to minimize the cost for delivering a given amount of electricity to key markets. Costs and routing of transmission line construction take into account geographic and social factors, as well as connection and delivery expenses (transformers, substations, etc.). We apply our model to Texas and consider how findings complement the 2008 Electric Reliability Council of Texas (ERCOT) Competitive Renewable Energy Zones (CREZ) Transmission Optimization Study. Results suggest that integrated optimization of wind energy infrastructure and cost using SimWIND could play a critical role in wind energy planning efforts.

Pabon Lasso and Data Envelopment Analysis: A Complementary Approach to Hospital Performance Measurement

PubMed Central

Mehrtak, Mohammad; Yusefzadeh, Hasan; Jaafaripooyan, Ebrahim

2014-01-01

Background: Performance measurement is essential to the management of health care organizations to which efficiency is per se a vital indicator. Present study accordingly aims to measure the efficiency of hospitals employing two distinct methods. Methods: Data Envelopment Analysis and Pabon Lasso Model were jointly applied to calculate the efficiency of all general hospitals located in Iranian Eastern Azerbijan Province. Data was collected using hospitals’ monthly performance forms and analyzed and displayed by MS Visio and DEAP software. Results: In accord with Pabon Lasso model, 44.5% of the hospitals were entirely efficient, whilst DEA revealed 61% to be efficient. As such, 39% of the hospitals, by the Pabon Lasso, were wholly inefficient; based on DEA though; the relevant figure was only 22.2%. Finally, 16.5% of hospitals as calculated by Pabon Lasso and 16.7% by DEA were relatively efficient. DEA appeared to show more hospitals as efficient as opposed to the Pabon Lasso model. Conclusion: Simultaneous use of two models rendered complementary and corroborative results as both evidently reveal efficient hospitals. However, their results should be compared with prudence. Whilst the Pabon Lasso inefficient zone is fully clear, DEA does not provide such a crystal clear limit for inefficiency. PMID:24999147

The outcomes of simultaneous liver and kidney transplantation using donation after cardiac death organs.

PubMed

Alhamad, Tarek; Spatz, Christin; Uemura, Tadahiro; Lehman, Eric; Farooq, Umar

2014-12-15

There has been a remarkable increase in simultaneous liver and kidney transplantations (SLK). As organ demand has increased, so has the use of donation after cardiac death (DCD). However, little is known about the outcomes of DCD in SLK. We performed a retrospective analysis using the United Network for Organ Sharing database to compare the outcomes of DCD SLK to donation after brain death (DBD) and determine the impact of donor and recipient factors on allograft and patient survival. Between 2002 and 2011, a total of 3,026 subjects received SLK from DBD and 98 from DCD. Kidney, liver, and patient survival from DCD donors were inferior to DBD at 1, 3, and 5 years (P=0.0056, P=0.0035, and P=0.0205, respectively). With the use of the Cox model, DCD was a significant risk factor for kidney and liver allograft failure and patient mortality. Recipient factors that were associated with worse allograft and patient outcomes included black race, diabetes, being on a ventilator, hospitalization, delayed graft function, hepatocellular carcinoma, and intensive care unit stay. Older age of the donor was also associated with worse outcomes. Despite the decreased allograft and patient survival compared with DBD, DCD SLK provides an acceptable option for SLK, with a survival probability of more than 50% at 5 years.

Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units.

PubMed

van Nieuwenhoven, Christianne A; Buskens, Erik; Bergmans, Dennis C; van Tiel, Frank H; Ramsay, Graham; Bonten, Marc J M

2004-01-01

Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not show significant cost reductions. Based on actual cost data of 181 individual patients included in a former randomized clinical trial, cost-effectiveness of prevention of VAP was determined using a decision model and univariate sensitivity analyses, and bootstrapping was used to assess the impact of variability in the various outcomes. Published data on prevention of VAP by oropharyngeal decontamination, which resulted in a relative risk for VAP of 0.45, with a baseline rate of VAP of 29% among control patients. The mean costs of the intervention were 351 dollars per patient (32 dollars per patient per day). All other costs were derived from the hospital administrative database for all individual patients. Prevention of VAP led to mean total costs of 16,119 dollars and 18,268 dollars for patients without preventive measures administered. Thus, costs were saved and instances of VAP were prevented. Similar results were observed in terms of overall survival. Prevention of VAP remains cost-saving if the relative risk for VAP because of intervention is <0.923, the costs of the intervention are less than 2,500 dollars, and the prevalence of VAP without intervention is >4%. Bootstrapping confirmed that, with about 80% certainty, oropharyngeal decontamination results in prevention of VAP and simultaneously saves costs. In terms of a survival benefit, the results are less evident; the results indicate that with only about 60% certainty can we confirm that oropharyngeal decontamination would result in a survival benefit and simultaneously save costs. This study provides strong evidence that prevention of VAP by means of oropharyngeal decontamination is cost-effective.

Employment through Lifelong Learning. A Project Demonstrating Long-Term Simultaneous Training in Academic, Vocational, and Self-Awareness Skills. Final Report. Project Operation Dates: January 1, 1980 to September 30, 1980.

ERIC Educational Resources Information Center

Conti, Gary J.; Giles, Wayne E.

This project, conducted by Spoon River College (Canton, Illinois), demonstrated the feasibility of a theoretical model developed by Wayne Giles and Gary Conti for training Comprehensive Employment and Training Act (CETA) clients. The model proposed the interfacing of long-term simultaneous training in academic skills, vocational skills, and…

Parachute Drag Model

NASA Technical Reports Server (NTRS)

Cuthbert, Peter

2010-01-01

DTV-SIM is a computer program that implements a mathematical model of the flight dynamics of a missile-shaped drop test vehicle (DTV) equipped with a multistage parachute system that includes two simultaneously deployed drogue parachutes and three main parachutes deployed subsequently and simultaneously by use of pilot parachutes. DTV-SIM was written to support air-drop tests of the DTV/parachute system, which serves a simplified prototype of a proposed crew capsule/parachute landing system.

Timing of Gestures: Gestures Anticipating or Simultaneous with Speech as Indexes of Text Comprehension in Children and Adults

ERIC Educational Resources Information Center

Ianì, Francesco; Cutica, Ilaria; Bucciarelli, Monica

2017-01-01

The deep comprehension of a text is tantamount to the construction of an articulated mental model of that text. The number of correct recollections is an index of a learner's mental model of a text. We assume that another index of comprehension is the timing of the gestures produced during text recall; gestures are simultaneous with speech when…

Divided attention in computer game play: analysis utilizing unobtrusive health monitoring.

PubMed

McKanna, James A; Jimison, Holly; Pavel, Misha

2009-01-01

Divided attention is a vital cognitive ability used in important daily activities (e.g., driving), which tends to deteriorate with age. As with Alzheimer's and other neural degenerative conditions, treatment for divided attention problems is likely to be more effective the earlier it is detected. Thus, it is important that a method be found to detect changes in divided attention early on in the process, for both safety and health care reasons. We present here a new method for detecting divided attention unobtrusively, using performance on a computer game designed to force players to attend to different dimensions simultaneously in order to succeed. Should this model prove to predict scores on a standard test for divided attention, it could help to detect cognitive decline earlier in our increasingly computer-involved aging population, providing treatment efficacy benefits to those who will experience cognitive decline.

It Is a Brave New World: Alternative Payment Models and Value Creation in Total Joint Arthroplasty: Creating Value for TJR, Quality and Cost-Effectiveness Programs.

PubMed

Chen, Kevin K; Harty, Jonathan H; Bosco, Joseph A

2017-06-01

The increasing cost of our country's healthcare is not sustainable. To address this crisis, the federal government is transiting healthcare reimbursement from the traditional volume-based system to a value-based system. As such, increasing healthcare value has become an essential point of discussion for all healthcare stakeholders. The purpose of this study is to discuss the importance of healthcare value as a means to achieve this goal of value-based medicine and 3 methods to create value in total joint arthroplasty. These methods are to: (1) improve outcomes greater than the increased costs to achieve this improvement, (2) decrease costs without affecting outcomes, and (3) decrease costs while simultaneously improving outcomes. Following these guidelines will help practitioners thrive in a bundled care environment. Copyright © 2017 Elsevier Inc. All rights reserved.

Tuberculosis and mental health in the Asia-Pacific.

PubMed

Mason, Paul H; Sweetland, Annika C; Fox, Greg J; Halovic, Shaun; Nguyen, Thu Anh; Marks, Guy B

2016-12-01

This opinion piece encourages mental health researchers and clinicians to engage with mental health issues among tuberculosis patients in the Asia-Pacific region in a culturally appropriate and ethical manner. The diversity of cultural contexts and the high burden of tuberculosis throughout the Asia-Pacific presents significant challenges. Research into tuberculosis and mental illness in this region is an opportunity to develop more nuanced models of mental illness and treatment, while simultaneously contributing meaningfully to regional tuberculosis care and prevention. We overview key issues in tuberculosis and mental illness co-morbidity, highlight ethical concerns and advocate for a regional approach to tuberculosis and mental health that is consistent with the transnational challenges presented by this airborne infectious disease. Integrating tuberculosis and mental health services will go a long way to addressing the needs of vulnerable populations and stopping the transmission of one of the world's biggest infectious killers. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Toward Implementing Patient Flow in a Cancer Treatment Center to Reduce Patient Waiting Time and Improve Efficiency.

PubMed

Suss, Samuel; Bhuiyan, Nadia; Demirli, Kudret; Batist, Gerald

2017-06-01

Outpatient cancer treatment centers can be considered as complex systems in which several types of medical professionals and administrative staff must coordinate their work to achieve the overall goals of providing quality patient care within budgetary constraints. In this article, we use analytical methods that have been successfully employed for other complex systems to show how a clinic can simultaneously reduce patient waiting times and non-value added staff work in a process that has a series of steps, more than one of which involves a scarce resource. The article describes the system model and the key elements in the operation that lead to staff rework and patient queuing. We propose solutions to the problems and provide a framework to evaluate clinic performance. At the time of this report, the proposals are in the process of implementation at a cancer treatment clinic in a major metropolitan hospital in Montreal, Canada.

BOND: A quantum of solace for nebular abundance determinations

NASA Astrophysics Data System (ADS)

Vale Asari, N.; Stasińska, G.; Morisset, C.; Cid Fernandes, R.

2017-11-01

The abundances of chemical elements other than hydrogen and helium in a galaxy are the fossil record of its star formation history. Empirical relations such as mass-metallicity relation are thus seen as guides for studies on the history and chemical evolution of galaxies. Those relations usually rely on nebular metallicities measured with strong-line methods, which assume that H II regions are a one- (or at most two-) parameter family where the oxygen abundance is the driving quantity. Nature is however much more complex than that, and metallicities from strong lines may be strongly biased. We have developed the method BOND (Bayesian Oxygen and Nitrogen abundance Determinations) to simultaneously derive oxygen and nitrogen abundances in giant H II regions by comparing strong and semi-strong observed emission lines to a carefully-defined, finely-meshed grid of photoionization models. Our code and results are public and available at http://bond.ufsc.br.

Working Sandwich Generation Women Utilize Strategies within and between Roles to Achieve Role Balance.

PubMed

Evans, Kiah L; Millsteed, Jeannine; Richmond, Janet E; Falkmer, Marita; Falkmer, Torbjorn; Girdler, Sonya J

2016-01-01

Increasingly, women simultaneously balance the roles of mother, parental carer and worker. However, individual role balance strategies among these working 'sandwich' generation women have not been thoroughly explored. Eighteen women combining these three roles were interviewed about their individual role balance strategies. Findings were identified through the framework analysis technique, underpinned by the Model of Juggling Occupations. Achieving and maintaining role balance was explained as a complex process accomplished through a range of strategies. Findings revealed the women used six within-role balance strategies: living with integrity, being the best you can, doing what you love, loving what you do, remembering why and searching for signs of success. The women also described six between-role balance strategies: maintaining health and wellbeing, repressing perfectionism, managing time and energy, releasing responsibility, nurturing social connection and reciprocating. These findings provide a basis for health care providers to understand and potentially support working 'sandwich' generation women.

Application of double-hybrid density functionals to charge transfer in N-substituted pentacenequinones.

PubMed

Sancho-García, J C

2012-05-07

A set of N-heteroquinones, deriving from oligoacenes, have been recently proposed as n-type organic semiconductors with high electron mobilities in thin-film transistors. Generally speaking, this class of compounds self-assembles in neighboring π-stacks linked by weak hydrogen bonds. We aim at theoretically characterizing here the sequential charge transport (hopping) process expected to take place across these arrays of molecules. To do so, we need to accurately address the preferred packing of these materials simultaneously to single-molecule properties related to charge-transfer events, carefully employing dispersion-corrected density functional theory methods to accurately extract the key molecular parameters governing this phenomenon at the nanoscale. This study confirms the great deal of interest around these compounds, since controlled functionalization of model molecules (i.e., pentacene) allows to efficiently tune the corresponding charge mobilities, and the capacity of modern quantum-chemical methods to predict it after rationalizing the underlying structure-property relationships.

Gender policy developments and policy regimes in 22 OECD countries, 1979-2008.

PubMed

Backhans, Mona C; Burström, Bo; Marklund, Staffan

2011-01-01

This study investigates trends and clustering of gender policy in 22 OECD (Organization for Economic Cooperation and Development) countries during 1979-2008. The starting point was Sainsbury's gender policy regime framework, and the study included indicators reflecting the male bread-winner, individual earner-carer, and separate gender roles regimes. The indicators were followed over seven time points for mean, range, and distribution. Cluster analyses were performed for the years 1979, 1989, 1999, and 2004. In accordance with previous studies, the authors found a Nordic cluster of earner-carer countries, while several Southern European countries and the United States were marked by their low generosity and high pension requirements. Though aspects of the separate gender roles regime have become more widespread, no country could be classified as fully belonging to this regime type. The two aspects of the model--compensatory measures in the pension system, and benefits for caring activities--were never present simultaneously.

Influence of flow constraints on the properties of the critical endpoint of symmetric nuclear matter

NASA Astrophysics Data System (ADS)

Ivanytskyi, A. I.; Bugaev, K. A.; Sagun, V. V.; Bravina, L. V.; Zabrodin, E. E.

2018-06-01

We propose a novel family of equations of state for symmetric nuclear matter based on the induced surface tension concept for the hard-core repulsion. It is shown that having only four adjustable parameters the suggested equations of state can, simultaneously, reproduce not only the main properties of the nuclear matter ground state, but the proton flow constraint up its maximal particle number densities. Varying the model parameters we carefully examine the range of values of incompressibility constant of normal nuclear matter and its critical temperature, which are consistent with the proton flow constraint. This analysis allows us to show that the physically most justified value of nuclear matter critical temperature is 15.5-18 MeV, the incompressibility constant is 270-315 MeV and the hard-core radius of nucleons is less than 0.4 fm.

Controlling the motion of multiple objects on a Chladni plate

NASA Astrophysics Data System (ADS)

Zhou, Quan; Sariola, Veikko; Latifi, Kourosh; Liimatainen, Ville

2016-09-01

The origin of the idea of moving objects by acoustic vibration can be traced back to 1787, when Ernst Chladni reported the first detailed studies on the aggregation of sand onto nodal lines of a vibrating plate. Since then and to this date, the prevailing view has been that the particle motion out of nodal lines is random, implying uncontrollability. But how random really is the out-of-nodal-lines motion on a Chladni plate? Here we show that the motion is sufficiently regular to be statistically modelled, predicted and controlled. By playing carefully selected musical notes, we can control the position of multiple objects simultaneously and independently using a single acoustic actuator. Our method allows independent trajectory following, pattern transformation and sorting of multiple miniature objects in a wide range of materials, including electronic components, water droplets loaded on solid carriers, plant seeds, candy balls and metal parts.

Data warehousing methods and processing infrastructure for brain recovery research.

PubMed

Gee, T; Kenny, S; Price, C J; Seghier, M L; Small, S L; Leff, A P; Pacurar, A; Strother, S C

2010-09-01

In order to accelerate translational neuroscience with the goal of improving clinical care it has become important to support rapid accumulation and analysis of large, heterogeneous neuroimaging samples and their metadata from both normal control and patient groups. We propose a multi-centre, multinational approach to accelerate the data mining of large samples and facilitate data-led clinical translation of neuroimaging results in stroke. Such data-driven approaches are likely to have an early impact on clinically relevant brain recovery while we simultaneously pursue the much more challenging model-based approaches that depend on a deep understanding of the complex neural circuitry and physiological processes that support brain function and recovery. We present a brief overview of three (potentially converging) approaches to neuroimaging data warehousing and processing that aim to support these diverse methods for facilitating prediction of cognitive and behavioral recovery after stroke, or other types of brain injury or disease.

Enhanced recovery programmes: do these have a role in gynaecology?

PubMed

Bell, A; Relph, S; Sivashanmugarajan, V; Yoong, W

2013-08-01

Enhanced recovery (ER) has become increasingly ubiquitous in most surgical specialities and its use is gathering pace. It has been proven to be a safe and effective means of managing patients perioperatively, while also improving patient outcomes, and its use in gynaecology has recently been supported by the Royal College of Obstetricians and Gynaecologists (RCOG). ER is gaining popularity, despite being a diversion from the traditional surgical approach, demanding an orchestration of primary, secondary, social and auxillary care teams to work effectively. ER has been heralded as improving clinical outcomes and patient satisfaction, while simultaneously allowing increased patient turnover. This has potentially massive impacts on service provision within the NHS and is likely to become a proof of concept that the NHS can adapt. ER can be championed as a flexible and contemporary healthcare model, which can be improved as patients' needs and NHS resources change.

Poisson's Ratio of a Hyperelastic Foam Under Quasi-static and Dynamic Loading

DOE PAGES

Sanborn, Brett; Song, Bo

2018-06-03

Poisson's ratio is a material constant representing compressibility of material volume. However, when soft, hyperelastic materials such as silicone foam are subjected to large deformation into densification, the Poisson's ratio may rather significantly change, which warrants careful consideration in modeling and simulation of impact/shock mitigation scenarios where foams are used as isolators. The evolution of Poisson's ratio of silicone foam materials has not yet been characterized, particularly under dynamic loading. In this study, radial and axial measurements of specimen strain are conducted simultaneously during quasi-static and dynamic compression tests to determine the Poisson's ratio of silicone foam. The Poisson's ratiomore » of silicone foam exhibited a transition from compressible to nearly incompressible at a threshold strain that coincided with the onset of densification in the material. Poisson's ratio as a function of engineering strain was different at quasi-static and dynamic rates. Here, the Poisson's ratio behavior is presented and can be used to improve constitutive modeling of silicone foams subjected to a broad range of mechanical loading.« less

Poisson's Ratio of a Hyperelastic Foam Under Quasi-static and Dynamic Loading

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sanborn, Brett; Song, Bo

Poisson's ratio is a material constant representing compressibility of material volume. However, when soft, hyperelastic materials such as silicone foam are subjected to large deformation into densification, the Poisson's ratio may rather significantly change, which warrants careful consideration in modeling and simulation of impact/shock mitigation scenarios where foams are used as isolators. The evolution of Poisson's ratio of silicone foam materials has not yet been characterized, particularly under dynamic loading. In this study, radial and axial measurements of specimen strain are conducted simultaneously during quasi-static and dynamic compression tests to determine the Poisson's ratio of silicone foam. The Poisson's ratiomore » of silicone foam exhibited a transition from compressible to nearly incompressible at a threshold strain that coincided with the onset of densification in the material. Poisson's ratio as a function of engineering strain was different at quasi-static and dynamic rates. Here, the Poisson's ratio behavior is presented and can be used to improve constitutive modeling of silicone foams subjected to a broad range of mechanical loading.« less

Network-based modeling and intelligent data mining of social media for improving care.

PubMed

Akay, Altug; Dragomir, Andrei; Erlandsson, Bjorn-Erik

2015-01-01

Intelligently extracting knowledge from social media has recently attracted great interest from the Biomedical and Health Informatics community to simultaneously improve healthcare outcomes and reduce costs using consumer-generated opinion. We propose a two-step analysis framework that focuses on positive and negative sentiment, as well as the side effects of treatment, in users' forum posts, and identifies user communities (modules) and influential users for the purpose of ascertaining user opinion of cancer treatment. We used a self-organizing map to analyze word frequency data derived from users' forum posts. We then introduced a novel network-based approach for modeling users' forum interactions and employed a network partitioning method based on optimizing a stability quality measure. This allowed us to determine consumer opinion and identify influential users within the retrieved modules using information derived from both word-frequency data and network-based properties. Our approach can expand research into intelligently mining social media data for consumer opinion of various treatments to provide rapid, up-to-date information for the pharmaceutical industry, hospitals, and medical staff, on the effectiveness (or ineffectiveness) of future treatments.

Clinical and financial analysis of an acute palliative care unit in an oncological department.

PubMed

Mercadante, S; Intravaia, G; Villari, P; Ferrera, P; David, F; Casuccio, A; Mangione, S

2008-09-01

The aim of this article is to describe the clinical activity and medical intervention of an acute model of palliative care unit (APC), as well as the reimbursement procedures and economic viability. A sample of 504 patients admitted at an APC in 1 year was surveyed. Indications for admission, pain and symptom intensity, analgesic treatments, procedures, instrumental examinations and modalities of discharge were recorded. For each patient, tariff for reimbursement was calculated according to the existent disease related grouping (DRG) system. The mean age was 62 years, and 246 patients were males. The mean hospital stay was 5.4 days. Pain control was the most frequent indication for admission. All patients had laboratory tests and several instrumental examinations. Almost all patients were prescribed one or more opioids at significant doses, and different routes of administration, as well as medication as needed. 59 patients received blood cell transfusions and 34 interventional procedures. Only 40 patients died in the unit, 11 of them being sedated at the end of life. Treatment efficacy was considered optimal and mild in 264 and 226 patients respectively. A mean of 3019 euros for admission was reimbursed by the Health Care System. APCs are of paramount importance within an oncological department, as they provide effective and intensive treatments during the entire course of disease, providing a simultaneous and integrated approach. Our findings also suggest both a cost and quality incentive for oncological departments to develop APC.

Making Residents Part of the Safety Culture: Improving Error Reporting and Reducing Harms.

PubMed

Fox, Michael D; Bump, Gregory M; Butler, Gabriella A; Chen, Ling-Wan; Buchert, Andrew R

2017-01-30

Reporting medical errors is a focus of the patient safety movement. As frontline physicians, residents are optimally positioned to recognize errors and flaws in systems of care. Previous work highlights the difficulty of engaging residents in identification and/or reduction of medical errors and in integrating these trainees into their institutions' cultures of safety. The authors describe the implementation of a longitudinal, discipline-based, multifaceted curriculum to enhance the reporting of errors by pediatric residents at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center. The key elements of this curriculum included providing the necessary education to identify medical errors with an emphasis on systems-based causes, modeling of error reporting by faculty, and integrating error reporting and discussion into the residents' daily activities. The authors tracked monthly error reporting rates by residents and other health care professionals, in addition to serious harm event rates at the institution. The interventions resulted in significant increases in error reports filed by residents, from 3.6 to 37.8 per month over 4 years (P < 0.0001). This increase in resident error reporting correlated with a decline in serious harm events, from 15.0 to 8.1 per month over 4 years (P = 0.01). Integrating patient safety into the everyday resident responsibilities encourages frequent reporting and discussion of medical errors and leads to improvements in patient care. Multiple simultaneous interventions are essential to making residents part of the safety culture of their training hospitals.

Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal.

PubMed

Citrin, David; Thapa, Poshan; Nirola, Isha; Pandey, Sachit; Kunwar, Lal Bahadur; Tenpa, Jasmine; Acharya, Bibhav; Rayamazi, Hari; Thapa, Aradhana; Maru, Sheela; Raut, Anant; Poudel, Sanjaya; Timilsina, Diwash; Dhungana, Santosh Kumar; Adhikari, Mukesh; Khanal, Mukti Nath; Pratap Kc, Naresh; Acharya, Bhim; Karki, Khem Bahadur; Singh, Dipendra Raman; Bangura, Alex Harsha; Wacksman, Jeremy; Storisteanu, Daniel; Halliday, Scott; Schwarz, Ryan; Schwarz, Dan; Choudhury, Nandini; Kumar, Anirudh; Wu, Wan-Ju; Kalaunee, S P; Chaudhari, Pushpa; Maru, Duncan

2018-06-04

Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems. Copyright © 2018 Elsevier Inc. All rights reserved.

Economic and other determinants of infant and child mortality in small developing countries: the case of Central America and the Caribbean.

PubMed

Hojman, D E

1996-03-01

This analysis involves empirically testing a theoretical model among 22 Central American and Caribbean countries during the 1990s that explains differences in infant and child mortality. Explanatory measures capture demographic, economic, health care, and educational characteristics. The model is expected to allow for an assessment of the potential impact of structural adjustment and external debt. It is pointed out that birth rates and child mortality rates followed similar patterns over time and between countries. In this study's regression analyses all variables in the three models that explain infant mortality are exogenous: low birth weight, immunization, gross domestic product per capita, years of schooling for women, population/nurse, and debt as a proportion of gross national product. As nations became richer, infant mortality declined. Infant mortality was lower in countries with high external debt. In models for explaining the birth rate and the child mortality rate, the best fit included variables for debt, real public expenditure on health care, water supply, and malnutrition. Analysis in a simultaneous model for 10 countries revealed that the birth rate and the child mortality rate were more responsive to shocks in exogenous variables in Barbados than in the Dominican Republic, and more responsive in the Dominican Republic than in Guatemala. The impact of each exogenous variable varied by country. In Barbados education was four times more effective in explaining the birth rate than water. In Guatemala, the most effective exogenous variable was malnutrition. Child mortality rates were affected more by multiplier effects. In richer countries, the most important impact on child survival was improved access to safe water, and the most important impact on the birth rate was increased real public expenditure on education per capita. For the poorest countries, findings suggest first improvement in malnutrition and then improvement in safe water supplies. Structural adjustment variables were found to have small impacts on the birth rate or limited impacts on child survival in poorer countries.

Treating childhood pneumonia in hard-to-reach areas: a model-based comparison of mobile clinics and community-based care.

PubMed

Pitt, Catherine; Roberts, Bayard; Checchi, Francesco

2012-01-10

Where hard-to-access populations (such as those living in insecure areas) lack access to basic health services, relief agencies, donors, and ministries of health face a dilemma in selecting the most effective intervention strategy. This paper uses a decision mathematical model to estimate the relative effectiveness of two alternative strategies, mobile clinics and fixed community-based health services, for antibiotic treatment of childhood pneumonia, the world's leading cause of child mortality. A "Markov cycle tree" cohort model was developed in Excel with Visual Basic to compare the number of deaths from pneumonia in children aged 1 to 59 months expected under three scenarios: 1) No curative services available, 2) Curative services provided by a highly-skilled but intermittent mobile clinic, and 3) Curative services provided by a low-skilled community health post. Parameter values were informed by literature and expert interviews. Probabilistic sensitivity analyses were conducted for several plausible scenarios. We estimated median pneumonia-specific under-5 mortality rates of 0.51 (95% credible interval: 0.49 to 0.541) deaths per 10,000 child-days without treatment, 0.45 (95% CI: 0.43 to 0.48) with weekly mobile clinics, and 0.31 (95% CI: 0.29 to 0.32) with CHWs in fixed health posts. Sensitivity analyses found the fixed strategy superior, except when mobile clinics visited communities daily, where rates of care-seeking were substantially higher at mobile clinics than fixed posts, or where several variables simultaneously differed substantially from our baseline assumptions. Current evidence does not support the hypothesis that mobile clinics are more effective than CHWs. A CHW strategy therefore warrants consideration in high-mortality, hard-to-access areas. Uncertainty remains, and parameter values may vary across contexts, but the model allows preliminary findings to be updated as new or context-specific evidence becomes available. Decision analytic modelling can guide needed field-based research efforts in hard-to-access areas and offer evidence-based insights for decision-makers.

A microfluidic device for simultaneous measurement of viscosity and flow rate of blood in a complex fluidic network

PubMed Central

Jun Kang, Yang; Yeom, Eunseop; Lee, Sang-Joon

2013-01-01

Blood viscosity has been considered as one of important biophysical parameters for effectively monitoring variations in physiological and pathological conditions of circulatory disorders. Standard previous methods make it difficult to evaluate variations of blood viscosity under cardiopulmonary bypass procedures or hemodialysis. In this study, we proposed a unique microfluidic device for simultaneously measuring viscosity and flow rate of whole blood circulating in a complex fluidic network including a rat, a reservoir, a pinch valve, and a peristaltic pump. To demonstrate the proposed method, a twin-shaped microfluidic device, which is composed of two half-circular chambers, two side channels with multiple indicating channels, and one bridge channel, was carefully designed. Based on the microfluidic device, three sequential flow controls were applied to identify viscosity and flow rate of blood, with label-free and sensorless detection. The half-circular chamber was employed to achieve mechanical membrane compliance for flow stabilization in the microfluidic device. To quantify the effect of flow stabilization on flow fluctuations, a formula of pulsation index (PI) was analytically derived using a discrete fluidic circuit model. Using the PI formula, the time constant contributed by the half-circular chamber is estimated to be 8 s. Furthermore, flow fluctuations resulting from the peristaltic pumps are completely removed, especially under periodic flow conditions within short periods (T < 10 s). For performance demonstrations, the proposed method was applied to evaluate blood viscosity with respect to varying flow rate conditions [(a) known blood flow rate via a syringe pump, (b) unknown blood flow rate via a peristaltic pump]. As a result, the flow rate and viscosity of blood can be simultaneously measured with satisfactory accuracy. In addition, the proposed method was successfully applied to identify the viscosity of rat blood, which circulates in a complex fluidic network. These observations confirm that the proposed method can be used for simultaneous measurement of viscosity and flow rate of whole blood circulating in the complex fluid network, with sensorless and label-free detection. Furthermore, the proposed method will be used in evaluating variations in the viscosity of human blood during cardiopulmonary bypass procedures or hemodialysis. PMID:24404074

A microfluidic device for simultaneous measurement of viscosity and flow rate of blood in a complex fluidic network.

PubMed

Jun Kang, Yang; Yeom, Eunseop; Lee, Sang-Joon

2013-01-01

Blood viscosity has been considered as one of important biophysical parameters for effectively monitoring variations in physiological and pathological conditions of circulatory disorders. Standard previous methods make it difficult to evaluate variations of blood viscosity under cardiopulmonary bypass procedures or hemodialysis. In this study, we proposed a unique microfluidic device for simultaneously measuring viscosity and flow rate of whole blood circulating in a complex fluidic network including a rat, a reservoir, a pinch valve, and a peristaltic pump. To demonstrate the proposed method, a twin-shaped microfluidic device, which is composed of two half-circular chambers, two side channels with multiple indicating channels, and one bridge channel, was carefully designed. Based on the microfluidic device, three sequential flow controls were applied to identify viscosity and flow rate of blood, with label-free and sensorless detection. The half-circular chamber was employed to achieve mechanical membrane compliance for flow stabilization in the microfluidic device. To quantify the effect of flow stabilization on flow fluctuations, a formula of pulsation index (PI) was analytically derived using a discrete fluidic circuit model. Using the PI formula, the time constant contributed by the half-circular chamber is estimated to be 8 s. Furthermore, flow fluctuations resulting from the peristaltic pumps are completely removed, especially under periodic flow conditions within short periods (T < 10 s). For performance demonstrations, the proposed method was applied to evaluate blood viscosity with respect to varying flow rate conditions [(a) known blood flow rate via a syringe pump, (b) unknown blood flow rate via a peristaltic pump]. As a result, the flow rate and viscosity of blood can be simultaneously measured with satisfactory accuracy. In addition, the proposed method was successfully applied to identify the viscosity of rat blood, which circulates in a complex fluidic network. These observations confirm that the proposed method can be used for simultaneous measurement of viscosity and flow rate of whole blood circulating in the complex fluid network, with sensorless and label-free detection. Furthermore, the proposed method will be used in evaluating variations in the viscosity of human blood during cardiopulmonary bypass procedures or hemodialysis.

Managed competition that works.

PubMed

Caper, P

1993-05-19

President Clinton has advocated managed competition within a global budget as a long-term strategy for simultaneously controlling health care costs and expanding access to medical care to all Americans. This proposal is intended to show how these two seemingly conflicting goals can be simultaneously accomplished. Managed competition, as it has been conceptualized to date, is primarily a strategy for reforming the system of providing health services. To work, it must be joined with a strategy for reforming our system of financing and paying for those services and of limiting overall system capacity. "Managed Competition That Works" is a proposal that would create a single trust-funded national system of health insurance, implemented through a system of vouchers to individuals. Global budgeting would be accomplished through establishment of the voucher's value each year. The trust fund would pay health plans for all medical care by capitation, but health plans would be free to negotiate a variety of payment arrangements with physicians, hospitals, and other providers. All plans would be required to offer a standard package of benefits, but would have great flexibility in offering benefits beyond the scope of the standard package, if those benefits replace high-cost with lower-cost services or permit the plan to compete more effectively for market share. This proposal would establish firm but acceptable national budget limits; provide universal, comprehensive, and uniform insurance coverage; eliminate cost shifting; encourage competition; reward efficiency-improving innovation; greatly reduce the need for centralized micromanagement of medical care; and retain local determination and a somewhat reduced level of consumer choice. Although this proposal is written as a national plan, trust funds could be implemented at the state level, if problems associated with portability of benefits among states could be solved.

Simultaneous Risk Factor Control Using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study: Protocol and baseline characteristics of a randomized controlled trial.

PubMed

Diamantidis, Clarissa J; Bosworth, Hayden B; Oakes, Megan M; Davenport, Clemontina A; Pendergast, Jane F; Patel, Sejal; Moaddeb, Jivan; Barnhart, Huiman X; Merrill, Peter D; Baloch, Khaula; Crowley, Matthew J; Patel, Uptal D

2018-06-01

Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease (ESKD) in the United States. Multiple risk factors contribute to DKD development, yet few interventions target more than a single DKD risk factor at a time. This manuscript describes the study protocol, recruitment, and baseline participant characteristics for the Simultaneous Risk Factor Control Using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study. The STOP-DKD study is a randomized controlled trial designed to evaluate the effectiveness of a multifactorial behavioral and medication management intervention to mitigate kidney function decline at 3 years compared to usual care. The intervention consists of up to 36 monthly educational modules delivered via telephone by a study pharmacist, home blood pressure monitoring, and medication management recommendations delivered electronically to primary care physicians. Patients seen at seven primary care clinics in North Carolina, with diabetes and [1] uncontrolled hypertension and [2] evidence of kidney dysfunction (albuminuria or reduced estimated glomerular filtration rate [eGFR]) were eligible to participate. Study recruitment completed in December 2014. Of the 281 participants randomized, mean age at baseline was 61.9; 52% were male, 56% were Black, and most were high school graduates (89%). Baseline co-morbidity was high- mean blood pressure was 134/76 mmHg, mean body mass index was 35.7 kg/m 2 , mean eGFR was 80.7 ml/min/1.73 m 2 , and mean glycated hemoglobin was 8.0%. Experiences of recruiting and implementing a comprehensive DKD program to individuals at high risk seen in the primary care setting are provided. NCT01829256. Copyright © 2018 Elsevier Inc. All rights reserved.

Modern Estimates of Global Water Cycle Fluxes

NASA Astrophysics Data System (ADS)

Rodell, M.; Beaudoing, H. K.; L'Ecuyer, T. S.; Olson, W. S.

2014-12-01

The goal of the first phase of the NASA Energy and Water Cycle Study (NEWS) Water and Energy Cycle Climatology project was to develop "state of the global water cycle" and "state of the global energy cycle" assessments based on data from modern ground and space based observing systems and data integrating models. Here we describe results of the water cycle assessment, including mean annual and monthly fluxes over continents and ocean basins during the first decade of the millennium. To the extent possible, the water flux estimates are based on (1) satellite measurements and (2) data-integrating models. A careful accounting of uncertainty in each flux was applied within a routine that enforced multiple water and energy budget constraints simultaneously in a variational framework, in order to produce objectively-determined, optimized estimates. Simultaneous closure of the water and energy budgets caused the ocean evaporation and precipitation terms to increase by about 10% and 5% relative to the original estimates, mainly because the energy budget required turbulent heat fluxes to be substantially larger in order to balance net radiation. In the majority of cases, the observed annual, surface and atmospheric water budgets over the continents and oceans close with much less than 10% residual. Observed residuals and optimized uncertainty estimates are considerably larger for monthly surface and atmospheric water budget closure, often nearing or exceeding 20% in North America, Eurasia, Australia and neighboring islands, and the Arctic and South Atlantic Oceans. The residuals in South America and Africa tend to be smaller, possibly because cold land processes are a non-issue. Fluxes are poorly observed over the Arctic Ocean, certain seas, Antarctica, and the Australasian and Indonesian Islands, leading to reliance on atmospheric analysis estimates. Other details of the study and future directions will be discussed.

On demand manufacturing of patient-specific liquid capsules via co-ordinated 3D printing and liquid dispensing.

PubMed

Okwuosa, Tochukwu C; Soares, Cindy; Gollwitzer, Verena; Habashy, Rober; Timmins, Peter; Alhnan, Mohamed A

2018-06-15

A method for the production of liquid capsules with the potential of modifying drug dose and release is presented. For the first time, the co-ordinated use of fused deposition modelling (FDM), 3D printing and liquid dispensing to fabricate individualised dosage form on demand in a fully automated fashion has been demonstrated. Polymethacrylate shells (Eudragit EPO and RL) for immediate and extended release were fabricated using FDM 3D printing and simultaneously filled using a computer-controlled liquid dispenser loaded with model drug solution (theophylline) or suspension (dipyridamole). The impact of printing modes: simultaneous shell printing and filling (single-phase) or sequential 3D printing of shell bottom, filling and shell cap (multi-phase), nozzle size, syringe volume, and shell structure has been reported. The use of shell thickness of 1.6 mm, and concentric architecture allowed successful containment of liquid core whilst maintaining the release properties of the 3D printed liquid capsule. The linear relationship between the theoretical and the actual volumes from the dispenser reflected its potential for accurate dosing (R 2  = 0.9985). Modifying the shell thickness of Eudragit RL capsule allowed a controlled extended drug release without the need for formulation change. Owing to its low cost and versatility, this approach can be adapted to wide spectrum of liquid formulations such as small and large molecule solutions and obviate the need for compatibility with the high temperature of FDM 3D printing process. In a clinical setting, health care staff will be able to instantly manufacture in small volumes liquid capsules with individualised dose contents and release pattern in response to specific patient's needs. Copyright © 2018 Elsevier B.V. All rights reserved.

A new modal-based approach for modelling the bump foil structure in the simultaneous solution of foil-air bearing rotor dynamic problems

NASA Astrophysics Data System (ADS)

Bin Hassan, M. F.; Bonello, P.

2017-05-01

Recently-proposed techniques for the simultaneous solution of foil-air bearing (FAB) rotor dynamic problems have been limited to a simple bump foil model in which the individual bumps were modelled as independent spring-damper (ISD) subsystems. The present paper addresses this limitation by introducing a modal model of the bump foil structure into the simultaneous solution scheme. The dynamics of the corrugated bump foil structure are first studied using the finite element (FE) technique. This study is experimentally validated using a purpose-made corrugated foil structure. Based on the findings of this study, it is proposed that the dynamics of the full foil structure, including bump interaction and foil inertia, can be represented by a modal model comprising a limited number of modes. This full foil structure modal model (FFSMM) is then adapted into the rotordynamic FAB problem solution scheme, instead of the ISD model. Preliminary results using the FFSMM under static and unbalance excitation conditions are proven to be reliable by comparison against the corresponding ISD foil model results and by cross-correlating different methods for computing the deflection of the full foil structure. The rotor-bearing model is also validated against experimental and theoretical results in the literature.

Pediatric Care Coordination: Lessons Learned and Future Priorities.

PubMed

Cady, Rhonda G; Looman, Wendy S; Lindeke, Linda L; LaPlante, Bonnie; Lundeen, Barbara; Seeley, Amanda; Kautto, Mary E

2015-09-30

A fundamental component of the medical home model is care coordination. In Minnesota, this model informed design and implementation of the state's health care home (HCH) model, a key element of statewide healthcare reform legislation. Children with medical complexity (CMC) often require care from multiple specialists and community resources. Coordinating this multi-faceted care within the HCH is challenging. This article describes the need for specialized models of care coordination for CMC. Two models of care coordination for CMC were developed to address this challenge. The TeleFamilies Model of Pediatric Care Coordination uses an advanced practice registered nurse care (APRN) coordinator embedded within an established HCH. The PRoSPer Model of Pediatric Care Coordination uses a registered nurse/social worker care coordinator team embedded within a specialty care system. We describe key findings from implementation of these models, and conclude with lessons learned. Replication of the models is encouraged to increase the evidence base for care coordination for the growing population of children with medical complexities.

Knowledge management as a mediator for the efficacy of transformational leadership and quality management initiatives in U.S. health care.

PubMed

Gowen, Charles R; Henagan, Stephanie C; McFadden, Kathleen L

2009-01-01

The health care industry has become one of the largest sectors of the U.S. economy and provides the greatest job growth of any industry. With such growth, effective leadership, knowledge management, and quality programs can ameliorate patient safety outcomes and improve organizational performance. This exploratory study examines the efficacy of transformational leadership, knowledge management, and quality initiatives, each of which has been proven effective in health care organizations. The literature has neglected the relationships among these three types of programs, although they are increasingly implemented simultaneously now. This research tests the degree to which knowledge management could act as a mediator of the effects transformational leadership and quality management have on organizational performance for hospitals. Our survey of U.S. hospitals utilizes validated scales from the literature. By calling and e-mailing quality and other department directors, the data set includes responses from all 50 states in our sample of 370 U.S. hospitals. Statistical tests confirmed acceptable regional distribution, interrater reliability, and control variable characteristics for our sample. Structural equation modeling is used to test the research hypotheses. These preliminary results reveal that transformational leadership and quality management improve knowledge management. In addition, transformational leadership is fully mediated by knowledge responsiveness and quality management is partially mediated by knowledge responsiveness for their effects on organizational performance. The unique contribution of this study includes the suggestion that greater transformational leadership skills are important for health care executives to motivate successful knowledge management initiatives. Secondly, continuous improvements in quality management programs have significant positive impacts on knowledge management and organizational outcomes in hospitals. Finally, successful knowledge management initiatives are more closely tied to patient and organizational outcomes through the enhancement of knowledge responsiveness than by knowledge acquisition and dissemination alone.

Observational study using the tools of lean six sigma to improve the efficiency of the resident rounding process.

PubMed

Chand, David V

2011-06-01

Recent focus on resident work hours has challenged residency programs to modify their curricula to meet established duty hour restrictions and fulfill their mission to develop the next generation of clinicians. Simultaneously, health care systems strive to deliver efficient, high-quality care to patients and families. The primary goal of this observational study was to use a data-driven approach to eliminate examples of waste and variation identified in resident rounding using Lean Six Sigma methodology. A secondary goal was to improve the efficiency of the rounding process, as measured by the reduction in nonvalue-added time. We used the "DMAIC" methodology: define, measure, analyze, improve, and control. Pediatric and family medicine residents rotating on the pediatric hospitalist team participated in the observation phase. Residents, nurses, hospitalists, and parents of patients completed surveys to gauge their attitudes toward rounds. The Mann-Whitney test was used to test for differences in the median times measured during the preimprovement and postimprovement phases, and the Student t test was used for comparison of survey data. Collaborative, family-centered rounding with elimination of the "prerounding" process, as well as standard work instructions and pacing the process to meet customer demand (takt time), were implemented. Nonvalue-added time per patient was reduced by 64% (P  =  .005). Survey data suggested that team members preferred the collaborative, family-centered approach to the traditional model of rounding. Lean Six Sigma provides tools, a philosophy, and a structured, data-driven approach to address a problem. In our case this facilitated an effort to adhere to duty hour restrictions while promoting education and quality care. Such approaches will become increasingly useful as health care delivery and education continue to transform.

Heterogeneity in health status and the influence of patient characteristics across patients seeking musculoskeletal orthopaedic care - a cross-sectional study.

PubMed

Perruccio, Anthony V; Gandhi, Rajiv; Rampersaud, Y Raja

2013-03-07

Health status is an important predictor of patient outcomes. Consequently, identifying patient predictors of health status is essential. In musculoskeletal orthopaedic care, the majority of work examining the association between patient characteristics and health status has been undertaken among hip/knee cohorts. We investigate these associations comparing findings across four musculoskeletal cohorts (hip/knee; foot/ankle; neck/back; elbow/shoulder). Patients seeking elective musculoskeletal orthopaedic care were recruited prior to consultation. Questionnaires captured health domain status (bodily pain, physical functioning, and mental and general health) and covariates: demographics; socioeconomic characteristics; and comorbidity. Scores were compared across cohorts. Two path regression analyses were undertaken. First, domain scores were simultaneously examined as dependent variables in the overall sample. Subsequently, the model was assessed stratified by cohort. 1,948 patients: 454 neck/back, 767 hip/knee, 378 shoulder/elbow, 349 foot/ankle. From stratified analyses, significant variability in covariate effects was observed. Worse bodily pain scores were associated with increasing age and female sex among hip/knee, low income among foot/ankle, and overweight/obese for foot/ankle and hip/knee. Worse mental health scores were associated with low income across cohorts except elbow/shoulder, low education within neck/back, and compared to Whites, Blacks had significantly worse scores among foot/ankle, better scores among hip/knee. Worse general health scores were observed for Asians among hip/knee, Blacks among foot/ankle, and South-Asians among elbow/shoulder and neck/back. The substantial heterogeneity across musculoskeletal cohorts suggests that patient- and cohort-specific approaches to patient counsel and care may be more effective for achieving optimal health and outcomes.

Observational Study Using the Tools of Lean Six Sigma to Improve the Efficiency of the Resident Rounding Process

PubMed Central

Chand, David V.

2011-01-01

Background Recent focus on resident work hours has challenged residency programs to modify their curricula to meet established duty hour restrictions and fulfill their mission to develop the next generation of clinicians. Simultaneously, health care systems strive to deliver efficient, high-quality care to patients and families. The primary goal of this observational study was to use a data-driven approach to eliminate examples of waste and variation identified in resident rounding using Lean Six Sigma methodology. A secondary goal was to improve the efficiency of the rounding process, as measured by the reduction in nonvalue-added time. Methods We used the “DMAIC” methodology: define, measure, analyze, improve, and control. Pediatric and family medicine residents rotating on the pediatric hospitalist team participated in the observation phase. Residents, nurses, hospitalists, and parents of patients completed surveys to gauge their attitudes toward rounds. The Mann-Whitney test was used to test for differences in the median times measured during the preimprovement and postimprovement phases, and the Student t test was used for comparison of survey data. Results and Discussion Collaborative, family-centered rounding with elimination of the “prerounding” process, as well as standard work instructions and pacing the process to meet customer demand (takt time), were implemented. Nonvalue-added time per patient was reduced by 64% (P  =  .005). Survey data suggested that team members preferred the collaborative, family-centered approach to the traditional model of rounding. Conclusions Lean Six Sigma provides tools, a philosophy, and a structured, data-driven approach to address a problem. In our case this facilitated an effort to adhere to duty hour restrictions while promoting education and quality care. Such approaches will become increasingly useful as health care delivery and education continue to transform. PMID:22655134

Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial.

PubMed

Meropol, Sharon B; Schiltz, Nicholas K; Sattar, Abdus; Stange, Kurt C; Nevar, Ann H; Davey, Christina; Ferretti, Gerald A; Howell, Diana E; Strosaker, Robyn; Vavrek, Pamela; Bader, Samantha; Ruhe, Mary C; Cuttler, Leona

2014-06-01

Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need. Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care. Copyright © 2014 by the American Academy of Pediatrics.

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

PubMed Central

Schiltz, Nicholas K.; Sattar, Abdus; Stange, Kurt C.; Nevar, Ann H.; Davey, Christina; Ferretti, Gerald A.; Howell, Diana E.; Strosaker, Robyn; Vavrek, Pamela; Bader, Samantha; Ruhe, Mary C.; Cuttler, Leona

2014-01-01

OBJECTIVE: Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. METHODS: In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS: Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices’ control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need. CONCLUSIONS: Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care. PMID:24799539

Cancer patients' experiences with nature: Normalizing dichotomous realities.

PubMed

Blaschke, Sarah; O'Callaghan, Clare C; Schofield, Penelope; Salander, Pär

2017-01-01

To explore cancer patients' subjective experiences with nature in order to examine the relevance of nature-based care opportunities in cancer care contexts. The rationale was to describe the underlying mechanisms of this interaction and produce translatable knowledge. Qualitative research design informed by grounded theory. Sampling was initially convenience and then theoretical. Competent adults with any cancer diagnosis were eligible to participate in a semi-structured interview exploring views about the role of nature in their lives. Audio-recorded and transcribed interviews were analyzed using inductive, cyclic, and constant comparative analysis. Twenty cancer patients (9 female) reported detailed description about their experiences with nature from which a typology of five common nature interactions emerged. A theory model was generated constituting a core category and two inter-related themes explaining a normalization process in which patients negotiate their shifting realities (Core Category). Nature functioned as a support structure and nurtured patients' inner and outer capacities to respond and connect more effectively (Theme A). Once enabled and comforted, patients could engage survival and reconstructive maneuvers and explore the consequences of cancer (Theme B). A dynamic relationship was evident between moving away while, simultaneously, advancing towards the cancer reality in order to accept a shifting normality. From a place of comfort and safety, patients felt supported to deal differently and more creatively with the threat and demands of cancer diagnosis, treatment and outlook. New understanding about nature's role in cancer patients' lives calls attention to recognizing additional forms of psychosocial care that encourage patients' own coping and creative processes to deal with their strain and, in some cases, reconstruct everyday lives. Further research is required to determine how nature opportunities can be feasibly delivered in the cancer care setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Strategic uses of information technology in health care: a state-of-the-art survey.

PubMed

Raghupathi, W; Tan, J

1999-08-01

The general perception that the use of information technology (IT) in health care is ten to fifteen years behind IT in other industrial sectors such as banking, manufacturing, and airline is rapidly changing. Health care providers, faced with an unprecedented era of competition and managed care, are now exploring the opportunities for using IT to improve the quality while simultaneously reducing the cost of health care. A revolution is taking place in the health care industry, with IT playing an increasingly important role in its delivery. In recent years, for example, the industry spent approximately $12 billion to $14 billion a year on IT. Further exponential growth is expected as the health care industry implements electronic medical records, upgrades hospital information systems, sets up intranets for sharing information among key stakeholders, and uses public networks, such as the Internet, for distributing health-related information and for providing remote diagnostics. Along with these drastic changes and the new approach to health care, the field of health/medical informatics and telematics has also experienced significant growth in the last few years. This article identifies and surveys the critical information technologies that are being adopted to provide strategic benefits to the various health care constituencies including hospitals and health maintenance organizations (HMOs).

Organic UV filters in personal care products in Switzerland: a survey of occurrence and concentrations.

PubMed

Manová, Eva; von Goetz, Natalie; Hauri, Urs; Bogdal, Christian; Hungerbühler, Konrad

2013-07-01

Organic ultraviolet (UV) filters are a group of compounds designed to absorb UV radiation and hence protect our skin against UV-induced damage. Apart from traditional sunscreens, they can be found in many other categories of personal care products (PCPs). These include skin care, facial makeup and lip care products, which are often used simultaneously, and on a regular basis. The frequency of occurrence as well as concentrations of organic UV filters contained in PCPs change over time. Furthermore, in Switzerland the exact UV filter concentrations are confidential. To date, only limited data are available for the levels of organic UV filters in PCPs, and these data refer mainly to sunscreens. In this paper, we provide an up-to-date frequency of occurrence and concentrations of organic UV filters in PCPs, including for the first time PCPs used in everyday life. A total of 116 PCPs was selected on the basis of a product-use questionnaire and distributed among seven PCP categories: lip care products, lipsticks, face creams, liquid makeup foundations, aftershaves, hand creams, and sunscreens. Concentrations of 22 organic UV filters were measured in the selected PCPs. The most frequently occurring UV filters were butyl methoxydibenzoylmethane (BMBM) detected in 82 products (71%), ethylhexyl methoxycinnamate (EHMC) in 59 products (51%) and octocrylene (OCT) in 50 products (43%). BMBM, EHMC and OCT concentrations averaged 2.6%, 4.0%, and 6.0%, respectively. Overall, UV filter concentrations in PCPs applied regularly throughout the year can be as high as those in sunscreens that are primarily used for sun protection and hence applied only on selected days. PCPs that are used on a regular basis, and often simultaneously, thus represent an important and, as yet, unquantified source of UV filter exposure. This study provides essential information for aggregate exposure assessments that combine data on concentrations of individual UV filters widely used in a variety of PCP categories. Copyright © 2012 Elsevier GmbH. All rights reserved.

Costs of health care across primary care models in Ontario.

PubMed

Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

2017-08-01

The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the traditional FFS model, despite higher primary care costs in some models.

More than a name: Heterogeneity in characteristics of models of maternity care reported from the Australian Maternity Care Classification System validation study.

PubMed

Donnolley, Natasha R; Chambers, Georgina M; Butler-Henderson, Kerryn A; Chapman, Michael G; Sullivan, Elizabeth A

2017-08-01

Without a standard terminology to classify models of maternity care, it is problematic to compare and evaluate clinical outcomes across different models. The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics and an overarching broad model descriptor (Major Model Category). This study aimed to assess the extent of variability in the defining characteristics of models of care grouped to the same Major Model Category, using the Maternity Care Classification System. All public hospital maternity services in New South Wales, Australia, were invited to complete a web-based survey classifying two local models of care using the Maternity Care Classification System. A descriptive analysis of the variation in 15 attributes of models of care was conducted to evaluate the level of heterogeneity within and across Major Model Categories. Sixty-nine out of seventy hospitals responded, classifying 129 models of care. There was wide variation in a number of important attributes of models classified to the same Major Model Category. The category of 'Public hospital maternity care' contained the most variation across all characteristics. This study demonstrated that although models of care can be grouped into a distinct set of Major Model Categories, there are significant variations in models of the same type. This could result in seemingly 'like' models of care being incorrectly compared if grouped only by the Major Model Category. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

SIMULTANEOUS MULTISLICE MAGNETIC RESONANCE FINGERPRINTING WITH LOW-RANK AND SUBSPACE MODELING

PubMed Central

Zhao, Bo; Bilgic, Berkin; Adalsteinsson, Elfar; Griswold, Mark A.; Wald, Lawrence L.; Setsompop, Kawin

2018-01-01

Magnetic resonance fingerprinting (MRF) is a new quantitative imaging paradigm that enables simultaneous acquisition of multiple magnetic resonance tissue parameters (e.g., T1, T2, and spin density). Recently, MRF has been integrated with simultaneous multislice (SMS) acquisitions to enable volumetric imaging with faster scan time. In this paper, we present a new image reconstruction method based on low-rank and subspace modeling for improved SMS-MRF. Here the low-rank model exploits strong spatiotemporal correlation among contrast-weighted images, while the subspace model captures the temporal evolution of magnetization dynamics. With the proposed model, the image reconstruction problem is formulated as a convex optimization problem, for which we develop an algorithm based on variable splitting and the alternating direction method of multipliers. The performance of the proposed method has been evaluated by numerical experiments, and the results demonstrate that the proposed method leads to improved accuracy over the conventional approach. Practically, the proposed method has a potential to allow for a 3x speedup with minimal reconstruction error, resulting in less than 5 sec imaging time per slice. PMID:29060594

Interaction of cadmium with phosphate on goethite

DOE Office of Scientific and Technical Information (OSTI.GOV)

Venema, P.; Hiemstra, T.; Riemsdijk, W.H. van

1997-08-01

Interactions between different ions are of importance in understanding chemical processes in natural systems. In this study simultaneous adsorption of phosphate and cadmium on goethite is studied in detail. The charge distribution (CD)-multisite complexation (MUSIC) model has been successful in describing extended data sets of cadmium adsorption and phosphate adsorption on goethite. In this study, the parameters of this model for these two data sets were combined to describe a new data set of simultaneous adsorption of cadmium and phosphate on goethite. Attention is focused on the surface speciation of cadmium. With the extra information that can be obtained frommore » the interaction experiments, the cadmium adsorption model is refined. For a perfect description of the data, the singly coordinated surface groups at the 110 face of goethite were assumed to form both monodentate and bidentate surface species with cadmium. The CD-MUSIC model is able to describe data sets of both simultaneous and single adsorption of cadmium and phosphate with the same parameters. The model calculations confirmed the idea that only singly coordinated surface groups are reactive for specific ion binding.« less

Simultaneous multislice magnetic resonance fingerprinting with low-rank and subspace modeling.

PubMed

Bo Zhao; Bilgic, Berkin; Adalsteinsson, Elfar; Griswold, Mark A; Wald, Lawrence L; Setsompop, Kawin

2017-07-01

Magnetic resonance fingerprinting (MRF) is a new quantitative imaging paradigm that enables simultaneous acquisition of multiple magnetic resonance tissue parameters (e.g., T 1 , T 2 , and spin density). Recently, MRF has been integrated with simultaneous multislice (SMS) acquisitions to enable volumetric imaging with faster scan time. In this paper, we present a new image reconstruction method based on low-rank and subspace modeling for improved SMS-MRF. Here the low-rank model exploits strong spatiotemporal correlation among contrast-weighted images, while the subspace model captures the temporal evolution of magnetization dynamics. With the proposed model, the image reconstruction problem is formulated as a convex optimization problem, for which we develop an algorithm based on variable splitting and the alternating direction method of multipliers. The performance of the proposed method has been evaluated by numerical experiments, and the results demonstrate that the proposed method leads to improved accuracy over the conventional approach. Practically, the proposed method has a potential to allow for a 3× speedup with minimal reconstruction error, resulting in less than 5 sec imaging time per slice.

Microwave ablation with multiple simultaneously powered small-gauge triaxial antennas: results from an in vivo swine liver model.

PubMed

Brace, Christopher L; Laeseke, Paul F; Sampson, Lisa A; Frey, Tina M; van der Weide, Daniel W; Lee, Fred T

2007-07-01

To prospectively investigate the ability of a single generator to power multiple small-diameter antennas and create large zones of ablation in an in vivo swine liver model. Thirteen female domestic swine (mean weight, 70 kg) were used for the study as approved by the animal care and use committee. A single generator was used to simultaneously power three triaxial antennas at 55 W per antenna for 10 minutes in three groups: a control group where antennas were spaced to eliminate ablation zone overlap (n=6; 18 individual zones of ablation) and experimental groups where antennas were spaced 2.5 cm (n=7) or 3.0 cm (n=5) apart. Animals were euthanized after ablation, and ablation zones were sectioned and measured. A mixed linear model was used to test for differences in size and circularity among groups. Mean (+/-standard deviation) cross-sectional areas of multiple-antenna zones of ablation at 2.5- and 3.0-cm spacing (26.6 cm(2) +/- 9.7 and 32.2 cm(2) +/- 8.1, respectively) were significantly larger than individual ablation zones created with single antennas (6.76 cm(2) +/- 2.8, P<.001) and were 31% (2.5-cm spacing group: multiple antenna mean area, 26.6 cm(2); 3 x single antenna mean area, 20.28 cm(2)) to 59% (3.0-cm spacing group: multiple antenna mean area, 32.2 cm(2); 3 x single antenna mean area, 20.28 cm(2)) larger than 3 times the mean area of the single-antenna zones. Zones of ablation were found to be very circular, and vessels as large as 1.1 cm were completely coagulated with multiple antennas. A single generator may effectively deliver microwave power to multiple antennas. Large volumes of tissue may be ablated and large vessels coagulated with multiple-antenna ablation in the same time as single-antenna ablation. (c) RSNA, 2007.

Combining Formal and Informal Caregiving Roles: The Psychosocial Implications of Double- and Triple-Duty Care

PubMed Central

Davis, Kelly D.; Zarit, Steven H.; Moen, Phyllis; Hammer, Leslie B.; Almeida, David M.

2016-01-01

Objectives. Women who combine formal and informal caregiving roles represent a unique, understudied population. In the literature, healthcare employees who simultaneously provide unpaid elder care at home have been referred to as double-duty caregivers. The present study broadens this perspective by examining the psychosocial implications of double-duty child care (child care only), double-duty elder care (elder care only), and triple-duty care (both child care and elder care or “sandwiched” care). Method. Drawing from the Work, Family, and Health Study, we focus on a large sample of women working in nursing homes in the United States (n = 1,399). We use multiple regression analysis and analysis of covariance tests to examine a range of psychosocial implications associated with double- and triple-duty care. Results. Compared with nonfamily caregivers, double-duty child caregivers indicated greater family-to-work conflict and poorer partner relationship quality. Double-duty elder caregivers reported more family-to-work conflict, perceived stress, and psychological distress, whereas triple-duty caregivers indicated poorer psychosocial functioning overall. Discussion. Relative to their counterparts without family caregiving roles, women with combined caregiving roles reported poorer psychosocial well-being. Additional research on women with combined caregiving roles, especially triple-duty caregivers, should be a priority amidst an aging population, older workforce, and growing number of working caregivers. PMID:25271309

Supply Rate and Equilibrium Inventory of Air Force Enlisted Personnel: A Simultaneous Model of the Accession and Retention Markets Incorporating Force Level Constraints. Final Report for Period July 1969-June 1976.

ERIC Educational Resources Information Center

DeVany, Arthur S.; And Others

This research was designed to develop and test a model of the Air Force manpower market. The study indicates that previous manpower supply studies failed to account for simultaneous determination of enlistments and retentions and misinterpreted regressions as supply equations. They are, instead, reduced form equations resulting from joint…

In vivo comparison of simultaneous versus sequential injection technique for thermochemical ablation in a porcine model.

PubMed

Cressman, Erik N K; Shenoi, Mithun M; Edelman, Theresa L; Geeslin, Matthew G; Hennings, Leah J; Zhang, Yan; Iaizzo, Paul A; Bischof, John C

2012-01-01

To investigate simultaneous and sequential injection thermochemical ablation in a porcine model, and compare them to sham and acid-only ablation. This IACUC-approved study involved 11 pigs in an acute setting. Ultrasound was used to guide placement of a thermocouple probe and coaxial device designed for thermochemical ablation. Solutions of 10 M acetic acid and NaOH were used in the study. Four injections per pig were performed in identical order at a total rate of 4 mL/min: saline sham, simultaneous, sequential, and acid only. Volume and sphericity of zones of coagulation were measured. Fixed specimens were examined by H&E stain. Average coagulation volumes were 11.2 mL (simultaneous), 19.0 mL (sequential) and 4.4 mL (acid). The highest temperature, 81.3°C, was obtained with simultaneous injection. Average temperatures were 61.1°C (simultaneous), 47.7°C (sequential) and 39.5°C (acid only). Sphericity coefficients (0.83-0.89) had no statistically significant difference among conditions. Thermochemical ablation produced substantial volumes of coagulated tissues relative to the amounts of reagents injected, considerably greater than acid alone in either technique employed. The largest volumes were obtained with sequential injection, yet this came at a price in one case of cardiac arrest. Simultaneous injection yielded the highest recorded temperatures and may be tolerated as well as or better than acid injection alone. Although this pilot study did not show a clear advantage for either sequential or simultaneous methods, the results indicate that thermochemical ablation is attractive for further investigation with regard to both safety and efficacy.

A balanced motor primitive framework can simultaneously explain motor learning in unimanual and bimanual movements.

PubMed

Takiyama, Ken; Sakai, Yutaka

2017-02-01

Certain theoretical frameworks have successfully explained motor learning in either unimanual or bimanual movements. However, no single theoretical framework can comprehensively explain motor learning in both types of movement because the relationship between these two types of movement remains unclear. Although our recent model of a balanced motor primitive framework attempted to simultaneously explain motor learning in unimanual and bimanual movements, this model focused only on a limited subset of bimanual movements and therefore did not elucidate the relationships between unimanual movements and various bimanual movements. Here, we extend the balanced motor primitive framework to simultaneously explain motor learning in unimanual and various bimanual movements as well as the transfer of learning effects between unimanual and various bimanual movements; these phenomena can be simultaneously explained if the mean activity of each primitive for various unimanual movements is balanced with the corresponding mean activity for various bimanual movements. Using this balanced condition, we can reproduce the results of prior behavioral and neurophysiological experiments. Furthermore, we demonstrate that the balanced condition can be implemented in a simple neural network model. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Fulfilling Multiple Missions Concurrently: An Ethnographic Study of a Campus Children's Center's Trials and Triumphs in Serving Six Populations

ERIC Educational Resources Information Center

Calica, Corinna Dy-Liacco

2017-01-01

The study is a comprehensive ethnographic investigation into how a campus children's center and laboratory school site can simultaneously serve six major population groups (i.e., parents, college students, teachers, faculty, administrators, and researchers) while maintaining program operations. The study carefully examines the converging and…

The Caring Performance and the "Blooming Student": Exploring the Emotional Labour of Further Education Lecturers in Scotland

ERIC Educational Resources Information Center

Chowdhry, Sushila

2014-01-01

The British further education (FE) sector has experienced almost continual restructuring as it adapts to simultaneously meet the evolving needs of industry and to tackle social injustice. Studies examining the work of FE lecturers suggest that they have become alienated and stressed by loss of autonomy and work intensification. This paper…

Joint two-dimensional inversion of magnetotelluric and gravity data using correspondence maps

NASA Astrophysics Data System (ADS)

Carrillo, Jonathan; Gallardo, Luis A.

2018-05-01

An accurate characterization of subsurface targets relies on the interpretation of multiple geophysical properties and their relationships. There are mainly two links to jointly invert different geophysical parameters: structural and petrophysical relationships. Structural approaches aim at minimizing topological differences and are widely popular since they need only a few assumptions about models. Conversely, methods based on petrophysical links rely mostly on the property values themselves and can provide a strong coupling between models, but they need to be treated carefully because specific direct relationship must be known or assumed. While some petrophysical relationships are widely accepted, it remains the question whether we may be able to detect them directly from the geophysical data. Currently, there is no reported development that takes full advantage of the flexibility of jointly estimating in-situ empirical relationships and geophysical models for a given geological scenario. We thus developed an algorithm for the two dimensional joint inversion of gravity and magnetotelluric data that seeks simultaneously for a density-resistivity relationship optimal for each studied site described trough a polynomial function. The iterative two-dimensional scheme is tested using synthetic and field data from Cerro Prieto, Mexico. The resulting models show an enhanced resolution with an increased structural and petrophysical correlation. We show that by fitting a functional relationship we increased significantly the coupled geological sense of the models at a little cost in terms of data misfit.

Simultaneous Tensor Decomposition and Completion Using Factor Priors.

PubMed

Chen, Yi-Lei; Hsu, Chiou-Ting Candy; Liao, Hong-Yuan Mark

2013-08-27

Tensor completion, which is a high-order extension of matrix completion, has generated a great deal of research interest in recent years. Given a tensor with incomplete entries, existing methods use either factorization or completion schemes to recover the missing parts. However, as the number of missing entries increases, factorization schemes may overfit the model because of incorrectly predefined ranks, while completion schemes may fail to interpret the model factors. In this paper, we introduce a novel concept: complete the missing entries and simultaneously capture the underlying model structure. To this end, we propose a method called Simultaneous Tensor Decomposition and Completion (STDC) that combines a rank minimization technique with Tucker model decomposition. Moreover, as the model structure is implicitly included in the Tucker model, we use factor priors, which are usually known a priori in real-world tensor objects, to characterize the underlying joint-manifold drawn from the model factors. We conducted experiments to empirically verify the convergence of our algorithm on synthetic data, and evaluate its effectiveness on various kinds of real-world data. The results demonstrate the efficacy of the proposed method and its potential usage in tensor-based applications. It also outperforms state-of-the-art methods on multilinear model analysis and visual data completion tasks.

Diabetes induction by total pancreatectomy in minipigs with simultaneous splenectomy: a feasible approach for advanced diabetes research.

PubMed

Heinke, Sophie; Ludwig, Barbara; Schubert, Undine; Schmid, Janine; Kiss, Thomas; Steffen, Anja; Bornstein, Stefan; Ludwig, Stefan

2016-09-01

Safe and reliable diabetes models are a key prerequisite for advanced preclinical studies on diabetes. Chemical induction is the standard model of diabetes in rodents and also widely used in large animal models of non-human primates and minipigs. However, uncertain efficacy, the potential of beta-cell regeneration, and relevant side effects are debatable aspects particularly in large animals. Therefore, we aimed to evaluate a surgical approach of total pancreatectomy combined with splenectomy for diabetes induction in an exploratory study in Goettingen minipigs. Total pancreatectomy was performed in Goettingen minipigs (n = 4) under general anesthesia and endotracheal intubation. Prior to surgery, a central venous line was established for drug application and blood sampling. After median laparotomy, splenectomy was performed and the lobular pancreas was carefully dissected with particular attention to the duodenal vascular arcade. Close monitoring of blood glucose was initiated immediately after surgery by standard glucometer measurement or continuous glucose monitoring systems (CGMS). Exogenous insulin was given by multiple daily subcutaneous (s.c.) injections or via insulin pump systems (CSII). Complete endogenous insulin deficiency was confirmed by intravenous glucose tolerance test (ivGTT) and measurement of c-peptide. For establishing a suitable regimen for diabetes management, the animals were followed for 4-6 weeks. Following pancreatectomy and splenectomy, the animals showed a quick recovery from surgery and initial analgetic medication and volume substitution could be terminated within 24 h. A rapid increase in blood glucose was observed immediately following pancreatectomy necessitating insulin therapy. The induced exocrine insufficiency did not cause any clinical symptoms. Complete insulin deficiency could be confirmed in all animals by determination of negative c-peptide during glucose challenge. The two regimen of insulin treatment (multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII)) were both feasible with respect to acceptable glycemic control whereas CSII was considerably advantageous in comfort and popularity for both animals and care takers. Surgical pancreatectomy in combination with splenectomy to facilitate access to the pancreas is a feasible model for efficient diabetes induction in minipigs. The procedure itself and postoperative animal care could be performed without complications in this exploratory study. Nevertheless, this approach requires well-equipped infrastructure, experienced and skilled surgeons and anesthesiologists and dedicated animal care takers. The impact of total pancreatectomy in combination with splenectomy on the digestive and immune system must be considered in the design and definition of end points of experimental diabetes and transplantation studies. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A control-theory model for human decision-making

NASA Technical Reports Server (NTRS)

Levison, W. H.; Tanner, R. B.

1971-01-01

A model for human decision making is an adaptation of an optimal control model for pilot/vehicle systems. The models for decision and control both contain concepts of time delay, observation noise, optimal prediction, and optimal estimation. The decision making model was intended for situations in which the human bases his decision on his estimate of the state of a linear plant. Experiments are described for the following task situations: (a) single decision tasks, (b) two-decision tasks, and (c) simultaneous manual control and decision making. Using fixed values for model parameters, single-task and two-task decision performance can be predicted to within an accuracy of 10 percent. Agreement is less good for the simultaneous decision and control situation.

The clinical, operational, and financial worlds of neonatal palliative care: A focused ethnography.

PubMed

Williams-Reade, Jackie; Lamson, Angela L; Knight, Sharon M; White, Mark B; Ballard, Sharon M; Desai, Priti P

2015-04-01

Due to multiple issues, integrated interdisciplinary palliative care teams in a neonatal intensive care unit (NICU) may be difficult to access, sometimes fail to be implemented, or provide inconsistent or poorly coordinated care. When implementing an effective institution-specific neonatal palliative care program, it is critical to include stakeholders from the clinical, operational, and financial worlds of healthcare. In this study, researchers sought to gain a multidisciplinary perspective into issues that may impact the implementation of a formal neonatal palliative care program at a tertiary regional academic medical center. In this focused ethnography, the primary researcher conducted semistructured interviews that explored the perspectives of healthcare administrators, finance officers, and clinicians about neonatal palliative care. The perspectives of 39 study participants informed the identification of institutional, financial, and clinical issues that impact the implementation of neonatal palliative care services at the medical center and the planning process for a formal palliative care program on behalf of neonates and their families. Healthcare professionals described experiences that influenced their views on neonatal palliative care. Key themes included: (a) uniqueness of neonatal palliative care, (b) communication and conflict among providers, (c) policy and protocol discrepancies, and (d) lack of administrative support. The present study highlighted several areas that are challenging in the provision of neonatal palliative care. Our findings underscored the importance of recognizing and procuring resources needed simultaneously from the clinical, operational, and financial worlds in order to implement and sustain a successful neonatal palliative care program.

Current densities in a pregnant woman model induced by simultaneous ELF electric and magnetic field exposure

NASA Astrophysics Data System (ADS)

Cech, R.; Leitgeb, N.; Pediaditis, M.

2008-01-01

The pregnant woman model SILVY was studied to ascertain to what extent the electric current densities induced by 50 Hz homogeneous electric and magnetic fields increase in the case of simultaneous exposure. By vectorial addition of the electric current densities, it could be shown that under worst case conditions the basic restrictions recommended by ICNIRP (International Commission on Non-Ionizing Radiation Protection) guidelines are exceeded within the central nervous system (CNS) of the mother, whereas in sole field exposure they are not. However, within the foetus the induced current densities do not comply with basic restrictions, either from single reference-level electric fields or from simultaneous exposure to electric and magnetic fields. Basic limits were considerably exceeded.

Lessons from bad general practice *

PubMed Central

Wilkes, Eric

1975-01-01

The paucity of resources for general practice correlates well with high losses through emigration and questions the expensive over-production of doctors now being undertaken. The variable quality of community care and the absence of a structure yet providing real planning or capital, leads to the uneconomic abuse of hospital facilities and to an excessive emphasis on institutionalisation. Medicine is becoming depersonalised because unrealistic expectations lead to an overloading of the service. Simultaneously we allocate a low priority to education in the use of the service, have little training in the sociological aspects of medical care, and even less in how best to use the skills of our non-medical professional colleagues. PMID:1177214

HNET - A National Computerized Health Network

PubMed Central

Casey, Mark; Hamilton, Richard

1988-01-01

The HNET system demonstrated conceptually and technically a national text (and limited bit mapped graphics) computer network for use between innovative members of the health care industry. The HNET configuration of a leased high speed national packet switching network connecting any number of mainframe, mini, and micro computers was unique in it's relatively low capital costs and freedom from obsolescence. With multiple simultaneous conferences, databases, bulletin boards, calendars, and advanced electronic mail and surveys, it is marketable to innovative hospitals, clinics, physicians, health care associations and societies, nurses, multisite research projects libraries, etc.. Electronic publishing and education capabilities along with integrated voice and video transmission are identified as future enhancements.

Management of nosocomial scabies, an outbreak of occupational disease.

PubMed

Jungbauer, Frank H W; Veenstra-Kyuchukova, Yanka K; Koeze, Jacqueline; KruijtSpanjer, Martijn R; Kardaun, Sylvia H

2015-05-01

The optimal approach to managing institutional scabies outbreaks has yet to be defined. We report on outbreak managements are needed. We report on a large outbreak of scabies in three acute care wards in a tertiary university teaching hospital in the Netherlands. The outbreak potentially effected 460 patients and 185 health care workers who had been exposed to the index patient. Containment of an outbreak relies on a quick and strict implementation of appropriate infection control measures and should include simultaneous treatment of all infested persons and exposed contacts to prevent secondary spread and prolonged post-intervention surveillance. © 2015 Wiley Periodicals, Inc.

E-commerce. Point, click, purchase.

PubMed

Menduno, M

1999-10-01

Many in health care may still be technology-shy, but there are big savings to be found in business-to-business e-commerce. Some experts estimate that electronic purchasing can trim 18 to 45 percent of costs out of the health care supply chain. That could revolutionize the $140 billion supply industry--but only if buyers and sellers can get on the same page. A whole host of companies are springing up to make that link. It won't be easy. "Anyone can do online ordering," says Joseph Miccio of NCI Consulting. "The real challenge for these vendors is to simultaneously connect all the players in the supply chain through a common database."

Holistic self-management education and support: a proposed public health model for improving women's health in Zimbabwe.

PubMed

Kanchense, Jane Handina Murigwa

2006-08-01

The primary health care model of public health has been implemented in many countries around the globe since the Declaration of Alma Ata in 1978, without pilot testing the primary health care model. Therefore, many public health researchers have sought methods of improving primary health care by creating evidence-based models. Many of these researchers recognize the role of behavioral models in public health. These offshoots of primary health care include the ecological, care, central human capabilities, and the SPECIES models. Holistic self-management education and support is a capacity-building philosophy that ensures active involvement of consumers of health care in the planning and implementation and evaluation of health care services. It helps consumers of health care to achieve the desired improved quality of health and life in managing and sustaining their health at the grassroots level. The care model addresses disease management ideals of the in the original primary health care model. The SPECIES model addresses those aspects of the primary health care model that include the cultural and social factors, as well as individual health education and support in the original primary health care model. The ecological model offers an improvement of the socioeconomic ideal in the original primary health care model. Improving the health of individuals will prevent illness, thereby reducing health care costs and lessening the current strain on an overburdened health care system in Zimbabwe. Holistic self-management education and support links health care delivery systems with social processes. It is a best practices model that could better serve Zimbabwean girls and women by contributing positively to the national challenges in health care, thereby meeting the Zimbabwean primary health care and safe motherhood goals. It is here recommended that holistic self-management education and support must be pilot tested before being adopted as the most appropriate model for ensuring population health.

RVxK2: Simultaneous PRV Program with Kepler/K2 Campaign 16

NASA Astrophysics Data System (ADS)

Xuesong Wang, Sharon; RVxK2 team

2018-01-01

Introducing the RVxK2 program: simultaneous precise radial velocity (PRV) observations with Kepler/K2 Campaign 16, from Dec 7 2017 through Feb 26 2018 (website: rvxk2.com). K2 will provide short cadence photometric data on five carefully selected stars, including the brightest M dwarf in C16 field, a solar analog, and three bright G/K subgiants. K2 will also provide long cadence data on the next three brightest K or M dwarfs in the C16 field. Our campaign includes several precise RV instruments around the globe, including Keck/HIRES, APF, IRTF/iSHELL, SONG, MINERVA, PARAS, representing the first organized, extensive, simultaneous RV campaign with space photometry. Our primary science goal is to characterize and understand stellar jitter and stellar activity. This RV+K2 campaign will provide the community with an unprecedented dataset of RV spectra and precise photometry to study stellar jitter on a broad range of time scales, from minutes to 80 days. We will gather the first ever RV+photometry dataset aiming at characterizing stellar granulation, the most poorly understood term among all astrophysical sources of stellar jitter. This project will also enable the first asteroseismic studies with simultaneous precise RVs and photometry, while searching for planets in the brightest nearby G to M dwarfs in the field.

Simultaneous sequential monitoring of efficacy and safety led to masking of effects.

PubMed

van Eekelen, Rik; de Hoop, Esther; van der Tweel, Ingeborg

2016-08-01

Usually, sequential designs for clinical trials are applied on the primary (=efficacy) outcome. In practice, other outcomes (e.g., safety) will also be monitored and influence the decision whether to stop a trial early. Implications of simultaneous monitoring on trial decision making are yet unclear. This study examines what happens to the type I error, power, and required sample sizes when one efficacy outcome and one correlated safety outcome are monitored simultaneously using sequential designs. We conducted a simulation study in the framework of a two-arm parallel clinical trial. Interim analyses on two outcomes were performed independently and simultaneously on the same data sets using four sequential monitoring designs, including O'Brien-Fleming and Triangular Test boundaries. Simulations differed in values for correlations and true effect sizes. When an effect was present in both outcomes, competition was introduced, which decreased power (e.g., from 80% to 60%). Futility boundaries for the efficacy outcome reduced overall type I errors as well as power for the safety outcome. Monitoring two correlated outcomes, given that both are essential for early trial termination, leads to masking of true effects. Careful consideration of scenarios must be taken into account when designing sequential trials. Simulation results can help guide trial design. Copyright © 2016 Elsevier Inc. All rights reserved.

Assessing Spurious Interaction Effects in Structural Equation Modeling

ERIC Educational Resources Information Center

Harring, Jeffrey R.; Weiss, Brandi A.; Li, Ming

2015-01-01

Several studies have stressed the importance of simultaneously estimating interaction and quadratic effects in multiple regression analyses, even if theory only suggests an interaction effect should be present. Specifically, past studies suggested that failing to simultaneously include quadratic effects when testing for interaction effects could…

[Mandibular-driven simultaneous maxillo-mandibular distraction for hemifacial microsomia with rapid prototyping technology].

PubMed

Gao, Quan-Wen; Song, Hui-Feng; Xu, Ming-Huo; Liu, Chun-Ming; Chai, Jia-Ke

2013-11-01

To explore the clinical application of mandibular-driven simultaneous maxillo-mandihular distraction to correct hemifacial microsomia with rapid prototyping technology. The patient' s skull resin model was manufactured with rapid prototyping technology. The osteotomy was designed on skull resin model. According to the preoperative design, the patients underwent Le Fort I osteotomy and mandibular ramus osteotomy. The internal mandible distractor was embedded onto the osteotomy position. The occlusal titanium pin was implanted. Distraction were carried out by mandibular-driven simultaneous maxillo-mandihular distraction 5 days after operation. The distraction in five patients was complete as designed. No infection and dysosteogenesis happened. The longest distance of distraction was 28 mm, and the shortest distance was 16 mm. The facial asymmetry deformity was significantly improved at the end of distraction. The ocelusal plane of patients obviously improved. Rapid prototyping technology is helpful to design precisely osteotomy before operation. Mandibular-driven simultaneous maxillo-mandibular distraction can correct hemifacial microsomia. It is worth to clinical application.

Medical student appraisal: applications for bedside patient education.

PubMed

Markman, T M; Sampognaro, P J; Mitchell, S L; Weeks, S R; Khalifian, S; Dattilo, J R

2013-01-01

Medical students are often afforded the privilege of counselling patients. In the past resources were limited to pen and paper or anatomic models. The evolution of mobile applications allows for limitless access to resources that facilitate bedside patient education. To evaluate the utility of six applications in patient education and promote awareness of implementing mobile resources in clinical care. Six medical students rotating on various clerkships evaluated a total of six mobile applications. Strengths, limitations, and suggested uses in clinical care were identified. Applications included Meditoons™, VisiblePatient™, DrawMD™, CardioTeach™, Visual Anatomy™, and 360° Patient Education Suite™. Data was generated from narrative responses supplied by each student during their evaluation period. Bedside teaching was enhanced by professional illustrations and animations depicting anatomy and pathophysiology. Impromptu teaching was facilitated, as resources were conveniently available on a student's smartphone or tablet. The ability to annotate and modify images and subsequently email to patients was an extraordinary improvement in provider-patient communication. Universal limitations included small smartphone screens and the novelty of new technology. Mobile applications have the potential to greatly enhance patient education and simultaneously build rapport. Endless opportunities exist for their integration in clinical practice, particularly for new diagnoses, consent for procedures, and at time of discharge. Providers should be encouraged to try new applications and utilize them with patients.

A partial test of a hospital behavioral model.

PubMed

Hornbrook, M C; Goldfarb, M G

1983-01-01

The influence of hospital and community characteristics on the behavior of five dimensions of hospital output is examined in this article. These dimensions are the level of emergency stand-by capacity, total admissions, the diagnosis-mix of admissions and the hospital's 'style of practice' with regard to ancillary services and length of stay. A simultaneous equations model is estimated with data from a sample of 63 New England short-term general hospitals for 1970. The findings suggest that various types of short-term general hospitals have distinctive preferences for emergency capacity, volume, case mix and style of practice, and that style of practice may be more appropriately viewed as a rate of resource use per day. Specific findings of interest include the positive interdependence between protection against running out of emergency beds and length of stay, and between length of stay and ancillary service use. Hospitals that admit greater numbers of patients tend to treat more severely ill patients, and sicker patients tend to go to larger hospitals. Hospitals that provide more ancillary services tend to attract the more acutely ill patients. Relationships among other elements of the hospital's utility function represent trade-offs, i.e. substitution, in a constrained world. Among the exogenous factors, patient preferences and ability to pay have strong associations with the types of care provided by hospitals. Highly educated, high income communities, for example, tend to prefer risk averse, service intensive hospital output. Teaching hospitals are shown to prefer higher protection levels, service-intensive patterns of care, and higher admissions levels. Self-paying patients tend to be admitted for more discretionary types of diagnoses and to receive longer diagnosis-specific lengths of stay. A relatively greater supply of physician specialists in the market area is associated with increased use of ancillary services in the hospital. If replicated, these results have significant policy implications for reimbursing teaching hospitals; for defining accessibility of hospital care for the uninsured; for identifying the practice of 'skimming' by proprietary hospitals; and for specifying the role of community preferences in determining hospital performance, especially with respect to quality of care and level of emergency stand-by capacity.

Pathways to Lung Cancer Diagnosis: A Qualitative Study of Patients and General Practitioners about Diagnostic and Pretreatment Intervals.

PubMed

Rankin, Nicole M; York, Sarah; Stone, Emily; Barnes, David; McGregor, Deborah; Lai, Michelle; Shaw, Tim; Butow, Phyllis N

2017-05-01

Pathways to lung cancer diagnosis and treatment are complex. International evidence shows significant variations in pathways. Qualitative research investigating pathways to lung cancer diagnosis rarely considers both patient and general practitioner views simultaneously. To describe the lung cancer diagnostic pathway, focusing on the perspective of patients and general practitioners about diagnostic and pretreatment intervals. This qualitative study of patients with lung cancer and general practitioners in Australia used qualitative interviews or a focus group in which participants responded to a semistructured questionnaire designed to explore experiences of the diagnostic pathway. The Model of Pathways to Treatment (the Model) was used as a framework for analysis, with data organized into (1) events, (2) processes, and (3) contributing factors for variations in diagnostic and pretreatment intervals. Thirty participants (19 patients with lung cancer and 11 general practitioners) took part. Nine themes were identified during analysis. For the diagnostic interval, these were: (1) taking patient concerns seriously, (2) a sense of urgency, (3) advocacy that is doctor-driven or self-motivated, and (4) referral: "knowing who to refer to." For the pretreatment interval, themes were: (5) uncertainty, (6) psychosocial support for the patient and family before treatment, and (7) communication among the multidisciplinary team and general practitioners. Two cross-cutting themes were: (8) coordination of care and "handing over" the patient, and (9) general practitioner knowledge about lung cancer. Events were perceived as complex, with diagnosis often being revealed over time, rather than as a single event. Contributing factors at patient, system, and disease levels are described for both intervals. Patients and general practitioners expressed similar themes across the diagnostic and pretreatment intervals. Significant improvements could be made to health systems to facilitate better patient and general practitioner experiences of the diagnostic pathway. This novel presentation of patient and general practitioner perspectives indicates that systemic interventions have a role in timely and appropriate referrals to specialist care and coordination of investigations. Systemic interventions may alleviate concerns about urgency of diagnostic workup, communication, and coordination of care as patients transition from primary to specialist care.

Simultaneous resection for colorectal cancer with synchronous liver metastases is a safe procedure: Outcomes at a single center in Turkey.

PubMed

Dulundu, Ender; Attaallah, Wafi; Tilki, Metin; Yegen, Cumhur; Coskun, Safak; Coskun, Mumin; Erdim, Aylin; Tanrikulu, Eda; Yardimci, Samet; Gunal, Omer

2017-05-23

The optimal surgical strategy for treating colorectal cancer with synchronous liver metastases is subject to debate. The current study sought to evaluate the outcomes of simultaneous colorectal cancer and liver metastases resection in a single center. Prospectively collected data on all patients with synchronous colorectal liver metastases who underwent simultaneous resection with curative intent were analyzed retrospectively. Patient outcomes were compared depending on the primary tumor location and type of liver resection (major or minor). Between January 2005 and August 2016, 108 patients underwent simultaneous resection of primary colorectal cancer and liver metastases. The tumor was localized to the right side of the colon in 24 patients (22%), to the left side in 40 (37%), and to the rectum in 44 (41%). Perioperative mortality occurred in 3 patients (3%). Postoperative complications were noted in 32 patients (30%), and most of these complications (75%) were grade 1 to 3 according to the Clavien-Dindo classification. Neither perioperative mortality nor the rate of postoperative complications after simultaneous resection differed among patients with cancer of the right side of the colon, those with cancer of the left side of the colon, and those with rectal cancer (4%, 2.5%, and 2%, respectively, p = 0.89) and (17%, 33%, and 34%, respectively; p = 0.29)]. The 5-year overall survival of the entire sample was 54% and the 3-year overall survival was 67 %. In conclusion, simultaneous resection for primary colorectal cancer and liver metastases is a safe procedure and can be performed without excess morbidity in carefully selected patients regardless of the location of the primary tumor and type of hepatectomy.

Sequential vs simultaneous revascularization in patients undergoing liver transplantation: A meta-analysis

PubMed Central

Wang, Jia-Zhong; Liu, Yang; Wang, Jin-Long; Lu, Le; Zhang, Ya-Fei; Lu, Hong-Wei; Li, Yi-Ming

2015-01-01

AIM: We undertook this meta-analysis to investigate the relationship between revascularization and outcomes after liver transplantation. METHODS: A literature search was performed using MeSH and key words. The quality of the included studies was assessed using the Jadad Score and the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the χ2 and I2 tests. The risk of publication bias was assessed using a funnel plot and Egger’s test, and the risk of bias was assessed using a domain-based assessment tool. A sensitivity analysis was conducted by reanalyzing the data using different statistical approaches. RESULTS: Six studies with a total of 467 patients were included. Ischemic-type biliary lesions were significantly reduced in the simultaneous revascularization group compared with the sequential revascularization group (OR = 4.97, 95%CI: 2.45-10.07; P < 0.00001), and intensive care unit (ICU) days were decreased (MD = 2.00, 95%CI: 0.55-3.45; P = 0.007) in the simultaneous revascularization group. Although warm ischemia time was prolonged in simultaneous revascularization group (MD = -25.84, 95%CI: -29.28-22.40; P < 0.00001), there were no significant differences in other outcomes between sequential and simultaneous revascularization groups. Assessment of the risk of bias showed that the methods of random sequence generation and blinding might have been a source of bias. The sensitivity analysis strengthened the reliability of the results of this meta-analysis. CONCLUSION: The results of this study indicate that simultaneous revascularization in liver transplantation may reduce the incidence of ischemic-type biliary lesions and length of stay of patients in the ICU. PMID:26078582

The SPACE 1.0 model: a Landlab component for 2-D calculation of sediment transport, bedrock erosion, and landscape evolution

NASA Astrophysics Data System (ADS)

Shobe, Charles M.; Tucker, Gregory E.; Barnhart, Katherine R.

2017-12-01

Models of landscape evolution by river erosion are often either transport-limited (sediment is always available but may or may not be transportable) or detachment-limited (sediment must be detached from the bed but is then always transportable). While several models incorporate elements of, or transition between, transport-limited and detachment-limited behavior, most require that either sediment or bedrock, but not both, are eroded at any given time. Modeling landscape evolution over large spatial and temporal scales requires a model that can (1) transition freely between transport-limited and detachment-limited behavior, (2) simultaneously treat sediment transport and bedrock erosion, and (3) run in 2-D over large grids and be coupled with other surface process models. We present SPACE (stream power with alluvium conservation and entrainment) 1.0, a new model for simultaneous evolution of an alluvium layer and a bedrock bed based on conservation of sediment mass both on the bed and in the water column. The model treats sediment transport and bedrock erosion simultaneously, embracing the reality that many rivers (even those commonly defined as bedrock rivers) flow over a partially alluviated bed. SPACE improves on previous models of bedrock-alluvial rivers by explicitly calculating sediment erosion and deposition rather than relying on a flux-divergence (Exner) approach. The SPACE model is a component of the Landlab modeling toolkit, a Python-language library used to create models of Earth surface processes. Landlab allows efficient coupling between the SPACE model and components simulating basin hydrology, hillslope evolution, weathering, lithospheric flexure, and other surface processes. Here, we first derive the governing equations of the SPACE model from existing sediment transport and bedrock erosion formulations and explore the behavior of local analytical solutions for sediment flux and alluvium thickness. We derive steady-state analytical solutions for channel slope, alluvium thickness, and sediment flux, and show that SPACE matches predicted behavior in detachment-limited, transport-limited, and mixed conditions. We provide an example of landscape evolution modeling in which SPACE is coupled with hillslope diffusion, and demonstrate that SPACE provides an effective framework for simultaneously modeling 2-D sediment transport and bedrock erosion.

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

PubMed Central

Lentine, Krista L.; Kasiske, Bertram L.; Levey, Andrew S.; Adams, Patricia L.; Alberú, Josefina; Bakr, Mohamed A.; Gallon, Lorenzo; Garvey, Catherine A.; Guleria, Sandeep; Li, Philip Kam-Tao; Segev, Dorry L.; Taler, Sandra J.; Tanabe, Kazunari; Wright, Linda; Zeier, Martin G.; Cheung, Michael; Garg, Amit X.

2017-01-01

Abstract The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a “proof-in-concept” risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided. In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1–S109. PMID:28742762

Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis.

PubMed

van der Feltz-Cornelis, Christina M; Nuyen, Jasper; Stoop, Corinne; Chan, Juliana; Jacobson, Alan M; Katon, Wayne; Snoek, Frank; Sartorius, Norman

2010-01-01

Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown. This systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes. PubMed, Psycinfo, Embase and Cochrane library. Study eligibility criteria, participants, interventions: randomized controlled trials (RCTs) evaluating the outcome of treatment by psychotherapy, pharmacotherapy or collaborative care of depression in persons with Type 1 and Type 2 diabetes mellitus. risk of bias assessment; data extraction. Synthesis methods: data synthesis, random model meta analysis and publication bias analysis. Meta analysis of 14 RCTs with a total of 1724 patients show that treatment is effective in terms of reduction of depressive symptoms: -0.512; 95% CI -0.633 to -0.390. The combined effect of all interventions on clinical impact is moderate, -0.370; 95% CI -0.470 to -0.271; it is large for psychotherapeutic interventions that are often combined with diabetes self management: -0.581; 95% CI -0.770 to -0.391, n=310 and moderate for pharmacological treatment: -0.467; 95% CI -0.665 to -0.270, n=281. Delivery of collaborative care, which provided a stepped care intervention with a choice of starting with psychotherapy or pharmacotherapy, to a primary care population, yielded an effect size of -0.292; 95% CI -0.429 to -0.155, n=1133; indicating the effect size that can be attained on a population scale. Pharmacotherapy and collaborative care aimed at and succeeded in the reduction of depressive symptoms but, apart from sertraline, had no effect on glycemic control. amongst others, the number of RCTs is small. The treatment of depression in people with diabetes is a necessary step, but improvement of the general medical condition including glycemic control is likely to require simultaneous attention to both conditions. Further research is needed. Copyright 2010 Elsevier Inc. All rights reserved.

Towards accurate modelling of galaxy clustering on small scales: testing the standard ΛCDM + halo model

NASA Astrophysics Data System (ADS)

Sinha, Manodeep; Berlind, Andreas A.; McBride, Cameron K.; Scoccimarro, Roman; Piscionere, Jennifer A.; Wibking, Benjamin D.

2018-07-01

Interpreting the small-scale clustering of galaxies with halo models can elucidate the connection between galaxies and dark matter haloes. Unfortunately, the modelling is typically not sufficiently accurate for ruling out models statistically. It is thus difficult to use the information encoded in small scales to test cosmological models or probe subtle features of the galaxy-halo connection. In this paper, we attempt to push halo modelling into the `accurate' regime with a fully numerical mock-based methodology and careful treatment of statistical and systematic errors. With our forward-modelling approach, we can incorporate clustering statistics beyond the traditional two-point statistics. We use this modelling methodology to test the standard Λ cold dark matter (ΛCDM) + halo model against the clustering of Sloan Digital Sky Survey (SDSS) seventh data release (DR7) galaxies. Specifically, we use the projected correlation function, group multiplicity function, and galaxy number density as constraints. We find that while the model fits each statistic separately, it struggles to fit them simultaneously. Adding group statistics leads to a more stringent test of the model and significantly tighter constraints on model parameters. We explore the impact of varying the adopted halo definition and cosmological model and find that changing the cosmology makes a significant difference. The most successful model we tried (Planck cosmology with Mvir haloes) matches the clustering of low-luminosity galaxies, but exhibits a 2.3σ tension with the clustering of luminous galaxies, thus providing evidence that the `standard' halo model needs to be extended. This work opens the door to adding interesting freedom to the halo model and including additional clustering statistics as constraints.

[Quality evaluation of rhubarb dispensing granules based on multi-component simultaneous quantitative analysis and bioassay].

PubMed

Tan, Peng; Zhang, Hai-Zhu; Zhang, Ding-Kun; Wu, Shan-Na; Niu, Ming; Wang, Jia-Bo; Xiao, Xiao-He

2017-07-01

This study attempts to evaluate the quality of Chinese formula granules by combined use of multi-component simultaneous quantitative analysis and bioassay. The rhubarb dispensing granules were used as the model drug for demonstrative study. The ultra-high performance liquid chromatography (UPLC) method was adopted for simultaneously quantitative determination of the 10 anthraquinone derivatives (such as aloe emodin-8-O-β-D-glucoside) in rhubarb dispensing granules; purgative biopotency of different batches of rhubarb dispensing granules was determined based on compound diphenoxylate tablets-induced mouse constipation model; blood activating biopotency of different batches of rhubarb dispensing granules was determined based on in vitro rat antiplatelet aggregation model; SPSS 22.0 statistical software was used for correlation analysis between 10 anthraquinone derivatives and purgative biopotency, blood activating biopotency. The results of multi-components simultaneous quantitative analysisshowed that there was a great difference in chemical characterizationand certain differences inpurgative biopotency and blood activating biopotency among 10 batches of rhubarb dispensing granules. The correlation analysis showed that the intensity of purgative biopotency was significantly correlated with the content of conjugated anthraquinone glycosides (P<0.01), and the intensity of blood activating biopotency was significantly correlated with the content of free anthraquinone (P<0.01). In summary, the combined use of multi-component simultaneous quantitative analysis and bioassay can achieve objective quantification and more comprehensive reflection on overall quality difference among different batches of rhubarb dispensing granules. Copyright© by the Chinese Pharmaceutical Association.