Sample records for care systems obstacles

  1. Primary mental health care: Indications and obstacles

    Y.G. Pillay


    Full Text Available This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the commodification of health to its fruition are seldom addressed.

  2. Obstacle-avoiding navigation system

    Borenstein, Johann; Koren, Yoram; Levine, Simon P.


    A system for guiding an autonomous or semi-autonomous vehicle through a field of operation having obstacles thereon to be avoided employs a memory for containing data which defines an array of grid cells which correspond to respective subfields in the field of operation of the vehicle. Each grid cell in the memory contains a value which is indicative of the likelihood, or probability, that an obstacle is present in the respectively associated subfield. The values in the grid cells are incremented individually in response to each scan of the subfields, and precomputation and use of a look-up table avoids complex trigonometric functions. A further array of grid cells is fixed with respect to the vehicle form a conceptual active window which overlies the incremented grid cells. Thus, when the cells in the active window overly grid cell having values which are indicative of the presence of obstacles, the value therein is used as a multiplier of the precomputed vectorial values. The resulting plurality of vectorial values are summed vectorially in one embodiment of the invention to produce a virtual composite repulsive vector which is then summed vectorially with a target-directed vector for producing a resultant vector for guiding the vehicle. In an alternative embodiment, a plurality of vectors surrounding the vehicle are computed, each having a value corresponding to obstacle density. In such an embodiment, target location information is used to select between alternative directions of travel having low associated obstacle densities.

  3. Obstacle Characterization in a Geocrowdsourced Accessibility System

    Qin, H.; Aburizaiza, A. O.; Rice, R. M.; Paez, F.; Rice, M. T.


    Transitory obstacles - random, short-lived and unpredictable objects - are difficult to capture in any traditional mapping system, yet they have significant negative impacts on the accessibility of mobility- and visually-impaired individuals. These transitory obstacles include sidewalk obstructions, construction detours, and poor surface conditions. To identify these obstacles and assist the navigation of mobility- and visually- impaired individuals, crowdsourced mapping applications have been developed to harvest and analyze the volunteered obstacles reports from local students, faculty, staff, and residents. In this paper, we introduce a training program designed and implemented for recruiting and motivating contributors to participate in our geocrowdsourced accessibility system, and explore the quality of geocrowdsourced data with a comparative analysis methodology.

  4. Obstacles to continuity of care in young mental health service users’ pathways - an explorative study

    Marian Ådnanes


    Full Text Available Background: Users of mental health services often move between different primary and specialised health and care services, depending on their current condition, and this often leads to fragmentation of care. The aim of this study was to map care pathways in the case of young adult mental health service users and to identify key obstacles to continuity of care.Method: Quarterly semi-structured interviews were performed with nine young adults with mental health difficulties, following their pathways in and out of different services in the course of a year.Results: Key obstacles to continuity of care included the mental health system's lack of access to treatment, lack of integration between different specialist services, lack of progress in care and inadequate coordination tools such as ‘Individual Plan’ and case conferences that did not prevent fragmented care pathways.Conclusions: Continuity of care should be more explicitly linked to aspirations for development and progress in the users' care pathways, and how service providers can cooperate with users to actually develop and make progress. Coordination tools such as case conferences and ‘individual plans’ should be upgraded to this end and utilised to the utmost. This may be the most effective way to counteract the system obstacles.

  5. Obstacle penetrating dynamic radar imaging system

    Romero, Carlos E.; Zumstein, James E.; Chang, John T.; Leach, Jr.. Richard R.


    An obstacle penetrating dynamic radar imaging system for the detection, tracking, and imaging of an individual, animal, or object comprising a multiplicity of low power ultra wideband radar units that produce a set of return radar signals from the individual, animal, or object, and a processing system for said set of return radar signals for detection, tracking, and imaging of the individual, animal, or object. The system provides a radar video system for detecting and tracking an individual, animal, or object by producing a set of return radar signals from the individual, animal, or object with a multiplicity of low power ultra wideband radar units, and processing said set of return radar signals for detecting and tracking of the individual, animal, or object.

  6. Wearable Obstacle Detection System for visually impaired People

    Cardin, S; Vexo, F.; Thalmann, D


    This paper presents an obstacle detection system for visually impaired people. User can be alerted of closed obstacles in range while traveling in their environment. The system we propose detects the nearest obstacle via a stereoscopic sonar system and sends back vibro-tactile feedback to inform the user about its localization. The system aims at increasing the mobility of visually impaired people by offering new sensing abilities.

  7. A stereo vision-based obstacle detection system in vehicles

    Huh, Kunsoo; Park, Jaehak; Hwang, Junyeon; Hong, Daegun


    Obstacle detection is a crucial issue for driver assistance systems as well as for autonomous vehicle guidance function and it has to be performed with high reliability to avoid any potential collision with the front vehicle. The vision-based obstacle detection systems are regarded promising for this purpose because they require little infrastructure on a highway. However, the feasibility of these systems in passenger car requires accurate and robust sensing performance. In this paper, an obstacle detection system using stereo vision sensors is developed. This system utilizes feature matching, epipoplar constraint and feature aggregation in order to robustly detect the initial corresponding pairs. After the initial detection, the system executes the tracking algorithm for the obstacles. The proposed system can detect a front obstacle, a leading vehicle and a vehicle cutting into the lane. Then, the position parameters of the obstacles and leading vehicles can be obtained. The proposed obstacle detection system is implemented on a passenger car and its performance is verified experimentally.

  8. Optical Obstacle Avoidance System for Lunar and Mars Landing Project

    National Aeronautics and Space Administration — The systems developed at fibertek for Obstacle-Avoidance has so far all been operated at 1560nm. Such an operation is required due to the required eye-safety...

  9. Formation and obstacle avoidance control for multiagent systems


    This paper considers the problems of formation and obstacle avoidance for multiagent systems.The objective is to design a term of agents that can reach a desired formation while avoiding collision with obstacles.To reduce the amount of information interaction between agents and target,we adopt the leader-follower formation strategy.By using the receding horizon control (RHC),an optimal problem is formulated in terms of cost minimization under constraints.Information on obstacles is incorporated online as se...

  10. Obstacles to continuity of care in young mental health service users' pathways - an explorative study

    Ådnanes, Marian; Steihaug, Sissel


    Background: Users of mental health services often move between different primary and specialised health and care services, depending on their current condition, and this often leads to fragmentation of care. The aim of this study was to map care pathways in the case of young adult mental health service users and to identify key obstacles to continuity of care.Method: Quarterly semi-structured interviews were performed with nine young adults with mental health difficulties, following their pat...

  11. Target Tracking and Obstacle Avoidance for Multi-agent Systems

    Jing Yan; Xin-Ping Guan; Fu-Xiao Tan


    This paper considers the problems of target tracking and obstacle avoidance for multi-agent systems.To solve the problem that multiple agents cannot effectively track the target while avoiding obstacle in dynamic environment,a novel control algorithm based on potential function and behavior rules is proposed.Meanwhile,the interactions among agents are also considered.According to the state whether an agent is within the area of its neighbors' influence,two kinds of potential functions are presented.Meanwhile,the distributed control input of each agent is determined by relative velocities as well as relative positions among agents,target and obstacle.The maximum linear speed of the agents is also discussed.Finally,simulation studies are given to demonstrate the performance of the proposed algorithm.

  12. A Hands-Free Obstacle Detection and Avoidance System

    M. Abdul-Niby


    Full Text Available In this paper, we present a low cost hands-free detection and avoidance system designed to provide mobility assistance for visually impaired people. An ultrasonic sensor is attached to the jacket of the user and detects the obstacles in front. The information obtained is transferred to the user through audio messages and also by a vibration. The range of the detection is user-defined. A text-to-speech module is employed for the voice signal. The proposed obstacle avoidance device is cost effective, easy to use and easily upgraded.

  13. Obstacle detection and warning system for aircraft navigation at airports

    Gallo, Laurent


    This paper speaks about work conducted in 1998 and 1999 by AEROSPATIALE MATRA in development of an obstacle detection system, which has been tested on a demonstrator aircraft in Toulouse. The purpose of this mock- up was to verify the feasibility of a passive technology, and to consider the limits of its use.

  14. The Obstacles against Nurse-Family Communication in Family-Centered Care in Neonatal Intensive Care Unit: a Qualitative Study

    Zahra Hadian Shirazi; Farkhondeh Sharif; Mahnaz Rakhshan; Narjes Pishva; Faezeh Jahanpour


    Introduction: Communication is one of the key principles in Family-Centered Care (FCC). Studies have shown some drawbacks in communication between families and nurses. Therefore, the present study aimed to recognize the obstacles against nurse-family communication in FCC in Neonatal Intensive Care Unit (NICU). Methods: This qualitative study was conducted on 8 staff nurses in 2 NICUs affiliated to Shiraz University of Medical Sciences selected through purposive sampling. The data were collect...

  15. Design of an obstacle avoidance system for automated guided vehicles

    Lockwood, Stephen


    Most Industrial Automated Guided Vehicles CAGV s) follow fixed guide paths embedded in the floor or bonded to the floor surface. Whilst reliable in their basic operation, these AGV systems fail if unexpected obstacles are placed in the vehicle path. This can be a problem particularly in semi-automated factories where men and AGVs share the same environment. The perfonnance of line-guided AGVs may therefore be enhanced with a capability to avoid unexpected obstructions in the guide path. Th...


    Štanclová Tereza


    Full Text Available Main purpose of this article is to find out how is situation of young people leaving residential care institutions and trying to integrate to a usual life after reaching adultery. Using personal interviews with the young people (present clients of residential care, former clients, employees of the caring institutions we try to answer questions how these young people are prepared for a normal life in a society and what are main barriers they have to overcome in order to start a new life without institutional help. Our findings confirm that present system of social services is not effective enough in an effort to help the young people with their integration. We conclude that transformation of the Czech residential care of children from pathological families is inevitable in order to overcome such obstacles as missing emotional help from their biological families and friends, low level of economic independency resulting from low qualification and problems to find a job and an accommodation.

  17. Community mental health care for the elderly--a look at the obstacles.

    Waxman, H M


    Despite the recent attention given to mental disorders in the aged and their higher risk for organic mental disorders, older people rarely receive specialized mental health treatment. This paper reviews recent research on some of the major obstacles to the use of treatment by the elderly. These include claims of "ageism" by health care professionals, the negative attitudes and behaviors of older persons toward mental disorders and their treatment, and the failure of general practice physician...

  18. Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses

    Cho, Ok Min; Kim, Hwasoon; Lee, Young Whee; Cho, Insook


    Objectives The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. Methods Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. On...

  19. Whole-arm obstacle avoidance system conceptual design

    Whole-arm obstacle avoidance is needed for a variety of robotic applications in the Environmental Restoration and Waste Management (ER ampersand WM) Program. Typical industrial applications of robotics involve well-defined workspaces, allowing a predetermined knowledge of collision-free paths for manipulator motion. In the unstructured or poorly defined hazardous environments of the ER ampersand WM Program, the potential for significant problems resulting from collisions between manipulators and the environment in which they are utilized is great. The conceptual design for a sensing system that will provide protection against such collisions is described herein. The whole-arm obstacle avoidance system consists of a set of sensor ''bracelets,'' which cover the surface area of the manipulator links to the maximum extent practical, and a host processor. The host processor accepts commands from the robot control system, controls the operation of the sensors, manipulates data received from the bracelets, and makes the data available to the manipulator control system. The bracelets consist of a subset of the sensors, associated sensor interface electronics, and a bracelet interface. Redundant communications links between the host processor and the bracelets are provided, allowing single-point failure protection. The system allows reporting of 8-bit data from up to 1000 sensors at a minimum of 50 Hz. While the initial prototype implementation of the system utilizes capacitance proximity sensor, the system concept allows multiple types of sensors. These sensors are uniquely addressable, allowing remote calibration, thresholding at the bracelet, and correlation of a sensor measurement with the associated sensor and its location on the manipulator. Variable resolution allows high-speed, single-bit sensing as well as lower-speed higher-resolution sensing, which is necessary for sensor calibration and potentially useful in control

  20. An obstacle information display system with virtual radar

    During teleoperation, when the operator's attention is concentrated in controlling the end-effector motion, it is very difficult to recognize a possible link collision. Such collision may damage the environment or the link seriously, because usually the link has no sensors. In this paper, we propose a so-called 'virtual radar' which displays the collision information considering the whole manipulator at the end-effect level. The computer checks for unreachable areas due to the presence of obstacles and displays the appropriate information mapped in task-space coordinates using a 3D graphical image. This enhances the reliability of the system. However, in the case of a 6 D.O.F. manipulator, collision possibility space must be a 6 dimensional one and hence it is difficult to visualize and understand. To tackle this problem, a deformed sphere and patterns on its surface are employed. We have applied this method to a 6 D.O.F. manipulator and have verified the effectiveness of the proposed approach by experiments with a real telerobotic system. (author)


    Petru STEFEA


    Full Text Available The following investigation aims to determine the aspects of obstacles for applying Activity Based Costing (ABC system in the Egyptian case and the significant differences among the effects of such obstacles . The Study used the survey method to describe and analyze the obstacles in some Egyptian firms. The population of the study is Egyptian manufacturing firms. This survey used the number of 392 questionnaires that were used throughout the total of 23 Egyptian manufacturing firms, during the first half of 2013. Finally, the study found some influencing obstacles for applying this system (ABC and there were significant differences among the aspects of obstacles for applying ABC system in the Egyptian manufacturing firms.

  2. H∞ Formation Control and Obstacle Avoidance for Hybrid Multi-Agent Systems

    Dong Xue


    Full Text Available A new concept of H∞ formation is proposed to handle a group of agents navigating in a free and an obstacle-laden environment while maintaining a desired formation and changing formations when required. With respect to the requirements of changing formation subject to internal or external events, a hybrid multiagent system (HMAS is formulated in this paper. Based on the fact that obstacles impose the negative effect on the formation of HMAS, the H∞ formation is introduced to reflect the above disturbed situation and quantify the attenuation level of obstacle avoidance via the H∞-norm of formation stability. An improved Newtonian potential function and a set of repulsive functions are employed to guarantee the HMAS formation-keeping and collision-avoiding from obstacles in a path planning problem, respectively. Simulation results in this paper show that the proposed formation algorithms can effectively allow the multiagent system to avoid penetration into obstacles while accomplishing prespecified global objective successfully.

  3. An Indoor Obstacle Detection System Using Depth Information and Region Growth

    Hsieh-Chang Huang


    Full Text Available This study proposes an obstacle detection method that uses depth information to allow the visually impaired to avoid obstacles when they move in an unfamiliar environment. The system is composed of three parts: scene detection, obstacle detection and a vocal announcement. This study proposes a new method to remove the ground plane that overcomes the over-segmentation problem. This system addresses the over-segmentation problem by removing the edge and the initial seed position problem for the region growth method using the Connected Component Method (CCM. This system can detect static and dynamic obstacles. The system is simple, robust and efficient. The experimental results show that the proposed system is both robust and convenient.

  4. Development of an Obstacle Detection System for Human Supervisory Control of a UAV in Urban Environments

    Culhane, Andrew Alan


    In order to operate UAVs under human supervisory control in more complex arenas such as urban environments, an obstacle detection system is a requirement to achieve safe navigation. The development of a system capable of meeting these requirements is presented. The first stage of development was sensor selection and initial testing. After this, the sensor was combined with a servomotor to allow it to rotate and provide obstacle detection coverage in front, below, and to both sides of the U...

  5. H∞ Formation Control and Obstacle Avoidance for Hybrid Multi-Agent Systems

    Dong Xue; Jing Yao; Jun Wang


    A new concept of H∞ formation is proposed to handle a group of agents navigating in a free and an obstacle-laden environment while maintaining a desired formation and changing formations when required. With respect to the requirements of changing formation subject to internal or external events, a hybrid multiagent system (HMAS) is formulated in this paper. Based on the fact that obstacles impose the negative effect on the formation of HMAS, the H∞ formation is introduced to reflect the above...

  6. Obstacles to implementing evidence-based practice in Belgium: a context-specific qualitative evidence synthesis including findings from different health care disciplines.

    Hannes, K; Goedhuys, J; Aertgeerts, B


    A number of barriers to the implementation of evidence-based practice have already been inventoried. However, little attention has been given to their context-specific nature. This qualitative evidence synthesis examines commonalities in the obstacles perceived by different groups of health care practitioners working in the Belgian health care system and sets out to discuss potential strategies to bridge some of these barriers. We actively searched for primary studies addressing our topic of interest in international and national databases (1990 to May 2008), consulted experts and screened references of retrieved studies. We opted for the meta-aggregative approach, developed by the Joanna Briggs Institute, to analyse our findings. The findings indicate that (1) evidence might have a limited role in decision-making processes; (2) aspects other than quality of care steer the evidence-based practice agenda; (3) some health care providers benefit less from evidence-based practice than others and (4) there is a lack of competences to put the evidence-based principles in practice. Belgian policy makers might consider health care system characteristics from and strategies developed or suggested by others to respond to country-specific obstacles. Examples include but are not limited to; (a) providing incentives for patient-centred care coordination and patient communication, (b) supporting practitioners interested in applying research-related activities, (c) considering direct access systems and interprofessional learning to respond to the demand for autonomous decision-making from satellite professional groups, (d) systematically involving allied health professionals in important governmental advisory boards, (e) considering pharmaceutical companies perceived as 'the enemy' an ally in filling in research gaps, (f) embedding the evaluation of evidence-based knowledge and skills in examinations (g) moving from (in)formative learning to transformative learning and (h

  7. Vision-based obstacle recognition system for automated lawn mower robot development

    Mohd Zin, Zalhan; Ibrahim, Ratnawati


    Digital image processing techniques (DIP) have been widely used in various types of application recently. Classification and recognition of a specific object using vision system require some challenging tasks in the field of image processing and artificial intelligence. The ability and efficiency of vision system to capture and process the images is very important for any intelligent system such as autonomous robot. This paper gives attention to the development of a vision system that could contribute to the development of an automated vision based lawn mower robot. The works involve on the implementation of DIP techniques to detect and recognize three different types of obstacles that usually exist on a football field. The focus was given on the study on different types and sizes of obstacles, the development of vision based obstacle recognition system and the evaluation of the system's performance. Image processing techniques such as image filtering, segmentation, enhancement and edge detection have been applied in the system. The results have shown that the developed system is able to detect and recognize various types of obstacles on a football field with recognition rate of more 80%.

  8. Assisting the Visually Impaired: Obstacle Detection and Warning System by Acoustic Feedback

    Andrés Cela; Javier Almazán; Bergasa, Luis M.; J. Javier Yebes; Alcantarilla, Pablo F.; Alberto Rodríguez


    The aim of this article is focused on the design of an obstacle detection system for assisting visually impaired people. A dense disparity map is computed from the images of a stereo camera carried by the user. By using the dense disparity map, potential obstacles can be detected in 3D in indoor and outdoor scenarios. A ground plane estimation algorithm based on RANSAC plus filtering techniques allows the robust detection of the ground in every frame. A polar grid representation is proposed t...

  9. Obstacles Faced by Deaf People in the Criminal Justice System

    Vernon, M.; Miller, K.


    Deaf People, especially those who are not well educated, are at risk for serious injustices when they enter the criminal justice system. The present study describes these risks at all stages of the legal process, including arrest, trial, probation, prison, and parole. These dangers are greatest for those who are poorly educated, read at a…

  10. Health care delivery systems.

    Stevens, F; Zee, J. van der


    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective, meaningful, and socially accepted. From a sociological point of view, the analysis of health care delivery systems implies recognition of their distinct history over time, their specific values an...

  11. A salient information processing system for bionic eye with application to obstacle avoidance.

    Stacey, Ashley; Li, Yi; Barnes, Nick


    In this paper we present a visual processing system for bionic eye with a focus on obstacle avoidance. Bionic eye aims at restoring the sense of vision to people living with blindness and low vision. However, current hardware implant technology limits the image resolution of the electrical stimulation device to be very low (e.g., 100 electrode arrays, which is approx. 12 × 9 pixels). Therefore, we need a visual processing unit that extracts salient information in an unknown environment for assisting patients in daily tasks such as obstacle avoidance. We implemented a fully portable system that includes a camera for capturing videos, a laptop for processing information using a state-of-the-art saliency detection algorithm, and a head-mounted display to visualize results. The experimental environment consists of a number of objects, such as shoes, boxes, and foot stands, on a textured ground plane. Our results show that the system efficiently processes the images, effectively identifies the obstacles, and eventually provides useful information for obstacle avoidance. PMID:22255490

  12. Vision System Prototype for UAV Positioning and Sparse Obstacle Detection

    Jaroń, Piotr; Kucharczyk, Mateusz


    For the last few years computer vision due to its low exploitation cost and great capabilities has been experiencing rapid growth. One of the research fields that benefits from it the most is the aircrafts positioning and collision avoidance. Light cameras with low energy consumption are an ideal solution for UAVs (Unmanned Aerial Vehicles) navigation systems. With the new Swedish law – unique to Europe, that allows for civil usage of UAVs that fly on altitudes up to 120 meters, the need for ...

  13. Viscosity Solutions of Systems of PDEs with Interconnected Obstacles and Switching Problem

    Hamadene, S., E-mail:; Morlais, M. A., E-mail: [Universite du Maine, LMM (France)


    This paper deals with existence and uniqueness of a solution in viscosity sense, for a system of m variational partial differential inequalities with inter-connected obstacles. A particular case is the Hamilton-Jacobi-Bellmann system of the Markovian stochastic optimal m-states switching problem. The switching cost functions depend on (t,x). The main tool is the notion of systems of reflected backward stochastic differential equations with oblique reflection.

  14. Health care delivery systems.

    Stevens, F.; Zee, J. van der


    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

  15. Real-Time Obstacle Detection System in Indoor Environment for the Visually Impaired Using Microsoft Kinect Sensor

    Huy-Hieu Pham


    Full Text Available Any mobility aid for the visually impaired people should be able to accurately detect and warn about nearly obstacles. In this paper, we present a method for support system to detect obstacle in indoor environment based on Kinect sensor and 3D-image processing. Color-Depth data of the scene in front of the user is collected using the Kinect with the support of the standard framework for 3D sensing OpenNI and processed by PCL library to extract accurate 3D information of the obstacles. The experiments have been performed with the dataset in multiple indoor scenarios and in different lighting conditions. Results showed that our system is able to accurately detect the four types of obstacle: walls, doors, stairs, and a residual class that covers loose obstacles on the floor. Precisely, walls and loose obstacles on the floor are detected in practically all cases, whereas doors are detected in 90.69% out of 43 positive image samples. For the step detection, we have correctly detected the upstairs in 97.33% out of 75 positive images while the correct rate of downstairs detection is lower with 89.47% from 38 positive images. Our method further allows the computation of the distance between the user and the obstacles.

  16. Obstacle avoidance test using a sensor-based autonomous robotic system

    From a viewpoint of reducing personnel radiation exposure of plant staffs working in the high radiation area of nuclear facilities, it is often said to be necessary to develop remote robotic systems, which have great potential of performing various tasks in nuclear facilities. Hence, we developed an advanced remote robotic system, consisting of redundant manipulator and environment-sensing systems, which can be applied to complicated handling tasks under unstructured environment. In the robotic system, various types of sensors for environment-sensing are mounted on the redundant manipulator and sensor-based autonomous capabilities are incorporated. This report describes the results of autonomous obstacle avoidance test which was carried out as follows: manipulating valves at the rear-side of wall, through a narrow window of the wall, with the redundant manipulator mounted on an x-axis driving mechanism. From this test, it is confirmed that the developed robotic system can autonomously achieve handling tasks in limited space as avoiding obstacles, which is supposed to be difficult by a non-redundant manipulator. (author)

  17. Provision of Palliative Care in Low- and Middle-Income Countries: Overcoming Obstacles for Effective Treatment Delivery.

    Hannon, Breffni; Zimmermann, Camilla; Knaul, Felicia M; Powell, Richard A; Mwangi-Powell, Faith N; Rodin, Gary


    Despite being declared a basic human right, access to adult and pediatric palliative care for millions of individuals in need in low- and middle-income countries (LMICs) continues to be limited or absent. The requirement to make palliative care available to patients with cancer is increasingly urgent because global cancer case prevalence is anticipated to double over the next two decades. Fifty percent of these cancers are expected to occur in LMICs, where mortality figures are disproportionately greater as a result of late detection of disease and insufficient access to appropriate treatment options. Notable initiatives in many LMICs have greatly improved access to palliative care. These can serve as development models for service scale-up in these regions, based on rigorous evaluation in the context of specific health systems. However, a multipronged public health approach is needed to fulfill the humane and ethical obligation to make palliative care universally available. This includes health policy that supports the integration of palliative care and investment in systems of health care delivery; changes in legislation and regulation that inappropriately restrict access to opioid medications for individuals with life-limiting illnesses; education and training of health professionals; development of a methodologically rigorous data and research base specific to LMICs that encompasses health systems and clinical care; and shifts in societal and health professional attitudes to palliative and end-of-life care. International partnerships are valuable to achieve these goals, particularly in education and research, but leadership and health systems stewardship within LMICs are critical factors that will drive and implement change. PMID:26578612


    Nik Mohd Ramli Nik Yusoff


    Full Text Available The shortest path routing is one of the well-known network analysis techniques implemented in road management systems. Pg Routing as an extension of Postgre SQL/Post GIS database is an open source library that implements the Dijkstra shortest path algorithm. However, the functionality to avoid obstacles in that analysis is still limited. Therefore, this study was conducted to enable obstacle avoidance function in the existing pgRouting algorithm using OpenStreetMap road network. By implementing this function, it enhances the Dijkstra algorithm ability in network analysis. In this study a dynamic restriction feature is added at the program level to represent the obstacles on the road. With this modification the algorithm is now able to generate an alternative route by avoiding the existence of obstacles on the roads. By using OpenLayers and PHP a web-based GIS platform was developed to ease the system’s usability.

  19. Awareness and Detection of Traffic and Obstacles Using Synthetic and Enhanced Vision Systems

    Bailey, Randall E.


    Research literature are reviewed and summarized to evaluate the awareness and detection of traffic and obstacles when using Synthetic Vision Systems (SVS) and Enhanced Vision Systems (EVS). The study identifies the critical issues influencing the time required, accuracy, and pilot workload associated with recognizing and reacting to potential collisions or conflicts with other aircraft, vehicles and obstructions during approach, landing, and surface operations. This work considers the effect of head-down display and head-up display implementations of SVS and EVS as well as the influence of single and dual pilot operations. The influences and strategies of adding traffic information and cockpit alerting with SVS and EVS were also included. Based on this review, a knowledge gap assessment was made with recommendations for ground and flight testing to fill these gaps and hence, promote the safe and effective implementation of SVS/EVS technologies for the Next Generation Air Transportation System

  20. An Aerial-Ground Robotic System for Navigation and Obstacle Mapping in Large Outdoor Areas

    David Zapata


    Full Text Available There are many outdoor robotic applications where a robot must reach a goal position or explore an area without previous knowledge of the environment around it. Additionally, other applications (like path planning require the use of known maps or previous information of the environment. This work presents a system composed by a terrestrial and an aerial robot that cooperate and share sensor information in order to address those requirements. The ground robot is able to navigate in an unknown large environment aided by visual feedback from a camera on board the aerial robot. At the same time, the obstacles are mapped in real-time by putting together the information from the camera and the positioning system of the ground robot. A set of experiments were carried out with the purpose of verifying the system applicability. The experiments were performed in a simulation environment and outdoor with a medium-sized ground robot and a mini quad-rotor. The proposed robotic system shows outstanding results in simultaneous navigation and mapping applications in large outdoor environments.




    Full Text Available In this paper the Detection of Moving obstacle and remote video monitoring and extracting the key frames from the captured video system based on high performance SAMSUNG S5PV210 CORTEX-A8 processor core is build and expanding peripheral devices using embedded Linux as the operating system. Today monitoring systems are either webcam based or simple motion detection based. Here we have interfaced both webcam and PIR sensor to the embedded system so that the user can get an immediate alert message and can take necessary steps. This system is based on the kernel of Cortex board with the GSM module being triggered by a Pyroelectric Infrared Sensor (PIR, which senses changes in the external temperature, especially in this case when an invader enters in to remote location and send SMS to the user. At the same time, by using a smart device or a PC, the user can link to the video streaming server constructed on the embedded board via the internet and browse the webpage to monitor the surveillance area, here the UVC driver and V4L programming is used to interface USB camera to the board to capture video information and then board will do two parallel works first one is transmits the processed captured video information using wireless network, which will be collected and monitored at client side using wireless network connection through the wireless device, second one is extracts the key frames from captured video using OpenCV and served on a server, the both provides an advantage to surveillance monitoring system.

  2. The Role of Rangelands in Diversified Farming Systems: Innovations, Obstacles, and Opportunities in the USA

    Liz Carlisle


    Full Text Available Discussions of diversified farming systems (DFS rarely mention rangelands: the grasslands, shrublands, and savannas that make up roughly one-third of Earth's ice-free terrestrial area, including some 312 million ha of the United States. Although ranching has been criticized by environmentalists for decades, it is probably the most ecologically sustainable segment of the U.S. meat industry, and it exemplifies many of the defining characteristics of DFS: it relies on the functional diversity of natural ecological processes of plant and animal (reproduction at multiple scales, based on ecosystem services generated and regenerated on site rather than imported, often nonrenewable, inputs. Rangelands also provide other ecosystem services, including watershed, wildlife habitat, recreation, and tourism. Even where non-native or invasive plants have encroached on or replaced native species, rangelands retain unusually high levels of plant diversity compared with croplands or plantation forests. Innovations in management, marketing, incentives, and easement programs that augment ranch income, creative land tenure arrangements, and collaborations among ranchers all support diversification. Some obstacles include rapid landownership turnover, lack of accessible U.S. Department of Agriculture certified processing facilities, tenure uncertainty, fragmentation of rangelands, and low and variable income, especially relative to land costs. Taking advantage of rancher knowledge and stewardship, and aligning incentives with production of diverse goods and services, will support the sustainability of ranching and its associated public benefits. The creation of positive feedbacks between economic and ecological diversity should be the ultimate goal.

  3. Systems architecture for integrated care


    Introduction Telehealth and telecare projects do not always pay enough attention to the wider information systems architecture required to deliver integrated care. They often focus on technologies to support specific diseases or social care problems which can result in information silos that impede integrated care of the patient. While these technologies can deliver discrete benefits, they could potentially generate unintended disbenefits in terms of creating data silos which may cause patien...

  4. [Corruption and health care system].

    Marasović Šušnjara, Ivana


    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions. PMID:26016214


    Štanclová Tereza; Kotrusová Miriam


    Main purpose of this article is to find out how is situation of young people leaving residential care institutions and trying to integrate to a usual life after reaching adultery. Using personal interviews with the young people (present clients of residential care, former clients, employees of the caring institutions) we try to answer questions how these young people are prepared for a normal life in a society and what are main barriers they have to overcome in order to start a new life witho...

  6. Obstacles to the prevention of overweight and obesity in the context of child health care in Sweden

    Isma, Gabriella; Bramhagen, Ann-Cathrine; Ahlström, Gerd; Ostman, Margareta; Dykes, Anna-Karin


    Background: Overweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care. Method: A qualitative study, based on open-ended interviews, involving 18 CHC-nurses strategically selected fr...

  7. Trauma care system in Iran

    Moussa Zargar; Sarah Ganji; Mahmoud Khodabandeh; Shahab Abdollahi Far; Morteza Abdollahi; Mohammad Reza Zarei; Seyed Mohammad Reza Kalantar Motamedi; Mojgan Karbakhsh; Seyed Mohammad Ghodsi; Vafa Rahimi-Movaghar; Farzad Panahi; Soheil Saadat; Ali Khaji; Seyed Mahdi Davachi


    Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries,but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement,hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance,financial resources), it is not yet established in our system of trauma care.Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

  8. The Chinese Health Care System

    Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi

    In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...

  9. 矿井机车防撞系统障碍物识别方法%Obstacle Recognition Method of Anti-collision System of Mine Locomotive



    分析了矿井机车防撞系统中车载摄像头获取的机车运行前方障碍物图像的特征,提出了近、中、远距离下的障碍物识别方法及实现流程.测试结果表明,该方法能够有效获取障碍物特征并快速识别出障碍物.%The paper analyzed characteristics of images of obstacle in front of running locomotive obtained by camera of anti-collision system of mine locomotive, and proposed recognition methods of obstacle away from the locomotive with short, middle and long distances and their realization flows. Thetesting result showed the method can obtain characteristics of obstacles validly and recognize the obstacles quickly.

  10. Reforms of health care system in Romania

    Bara, AC; Van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.


    Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of the health care system. Results. The reforms of the health care system in Romania have been realized in a rather difficult context of scarcity of financial and human resources. The Gross Domestic Pro...

  11. Dementia Care: Intersecting Informal Family Care and Formal Care Systems

    Prabhjot Singh; Rafat Hussain; Adeel Khan; Lyn Irwin; Roslyn Foskey


    Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions rel...

  12. [Female migrants in the health care system. Health care utilisation, access barriers and health promotion strategies].

    Wimmer-Puchinger, B; Wolf, H; Engleder, A


    Due to the evident interaction between social factors and health, migrants are exposed to specific risk factors and access barriers to health services. Some examples are the lower education level, the low social position and/or the insufficient language skills. This concept is further elaborated in the multi-factorial impacts of health literacy. Female migrants often experience additional discrimination because of their gender. Despite the lack of representative data, consistent studies show that female migrants do not regularly take advantage of health care prevention and present themselves with higher degrees of stress. The current "inadequate health care" manifests itself in a lack of care in the areas of prevention and health education and an abundance in the context of medication and diagnostic procedures. To meet these demands and to further reduce barriers, in particular language barriers, specific strategies for this target group involving both politics and the health care system have to be developed. Besides the employment of interpreters with a native cultural background and the distribution of information booklets, it is an important strategy to reduce structural obstacles such as cultural diversity. To contact these women in their living environment should help to increase their self-determined health promotion. Selected models of good practice in Austria with regard to the themes of FGM (female genital mutilation), violence, heart disease and breast cancer are presented to highlight the specific health situation and risk factors of female migrants as well as successful strategies to confront them. PMID:16927035

  13. An Electronic System for Home Care Protocols

    Saba, Virginia K.; Irwin, Ruth Galten


    This is demonstration of an Electronic Tracking System being implemented in several Home Health Agencies in the US. It uses the Home Health Care Classification (HHCC) System, a standardized terminology designed and developed to document patient care. The goal it to take the coded data to design the Electronic Tracking System as a method for predicting resource requirements, tracking care needs, and measuring the outcomes of the care.

  14. [The most important obstacles of the development of Hungarian psychiatry].

    Kalmár, Sándor


    A quarter of a century ago the change of the political system in Hungary precipitated a serious value-crisis and caused a lot of harmful effects in nurturing and the development of psychiatry. The author establishes that the attack against psychiatry is more intensive than previously but neither the education and health management nor the psychiatric leadership could cope with these difficulties. It can't be denied that the foundation of lifelong mental health begins in the early life years and about 75% of the first Mental Disorder manifests in adolescence and youth. We are not able to ensure the special rights of every child according to the Hungarian Constitution and the Declaration of the Rights of the Child by the United Nations. The large inequalities within the country, the lack of paramount mental education and nurturing, the lack of essential, consistent eternal values, the lack of required psychiatric care system are huge obstacles of the development of healthy individual and leads to self-destructive behaviour and several, serious physical and mental disorders. The purpose of the author is to call psychiatrists' attention to the main obstacles of the development of Hungarian Psychiatric Care System. The main obstacles of the present psychiatric care system: 1. Unclarified notions, confusion of ideas. 2. Somatic, neurologic, mental, cultural-social and spiritual ignorance. 3. Lack of organization in Mental Education and Psychiatric Care System. 4. Value-crisis in our society despite the fact that the "Council of Wise Men" created a "Scale of the Essential Consistent Eternal Values" for the Hungarian Education System in 2008. 5. Lack of mental health prevention both in education system and health care system. There is no teaching of hygiene lessons in the Hungarian schools. 6. Negligence and selfishness among the population. 7. Disinterest among competent authorities. 8. Leaving the most important possibilities out of consideration. The author establishes

  15. The Spanish distribution system for oil products: an obstacle to competition?

    Contin, I. [Universidad Publica de Navarra (Spain). Dpto. Gestion de Empresas; University of Njimegen (Netherlands). International Political Economy Centre; Correlje, A. [University of Rotterdam (Netherlands). Dept. of General Economy; Huerta, E. [Universidad Publica de Navarra (Spain). Dpto. Gestion de Empresas


    This paper examines why the formal liberalization of the Spanish market for automotive fuels did not introduce competition in the sector. Against the background of the transformation of the country's oil industry, it is shown how the Spanish distribution system emerged as the essential facility within the formally liberalized oil products market. 'Light-handed' regulation, in combination with the prevailing ownership structure turned the system into an impediment to newcomers' activities and to competition. This suggests that an evaluation of regulatory options for distribution systems in specific markets should take into due account crucial market characteristics like concentration and specific ownership/control relationships. (author)

  16. Trauma care systems in Spain.

    Queipo de Llano, E; Mantero Ruiz, A; Sanchez Vicioso, P; Bosca Crespo, A; Carpintero Avellaneda, J L; de la Torre Prado, M V


    Trauma care systems in Spain are provided by the Nacional Health Service in a decentralized way by the seventeen autonomous communities whose process of decentralization was completed in January 2002. Its organisation is similar in all of them. Public sector companies of sanitary emergencies look after the health of citizens in relation to medical and trauma emergencies with a wide range of up to date resources both technical and human. In the following piece there is a description of the emergency response teams divided into ground and air that are responsible for the on site care of the patients in coordination with other public services. They also elaborate the prehospital clinical history that is going to be a valuable piece of information for the teams that receive the patient in the Emergency Hospital Unit (EHU). From 1980 to 1996 the mortality rate per 10.000 vehicles and the deaths per 1.000 accidents dropped significantly: in 1980 6.4 and 96.19% and in 1996, 2.8 and 64.06% respectively. In the intrahospital organisation there are two differentiated areas to receive trauma patients the casualty department and the EHU. In the EHU the severe and multiple injured patients are treated by the emergency hospital doctors; first in the triage or resuscitation areas and after when stabilised they are passed too the observation area or to the Intensive Care Unit (ICU) and from there the EHU or ICU doctors call the appropriate specialists. There is a close collaboration and coordination between the orthopaedic surgeon the EHU doctors and the other specialists surgeons in order to comply with treatment prioritization protocols. Once the patient has been transferred an entire process of assistance continuity is developed based on interdisciplinary teams formed in the hospital from the services areas involved in trauma assistance and usually coordinated by the ICU doctors. There is also mentioned the assistance registry of trauma patients, the ICU professional training

  17. Degree, instability and bifurcation of reaction-diffusion systems with obstacles near certain hyperbolas

    Eisner, J.; Väth, Martin


    Roč. 135, April (2016), s. 158-193. ISSN 0362-546X Institutional support: RVO:67985840 Keywords : reaction-diffusion system * turing instability * global bifurcation Subject RIV: BA - General Mathematics Impact factor: 1.327, year: 2014 http://www. science science /article/pii/S0362546X16000146

  18. Reforms of health care system in Romania

    Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.


    Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of th

  19. [A Maternal Health Care System Based on Mobile Health Care].

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai


    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals. PMID:27382731

  20. Quality systems in Dutch health care institutions.

    Casparie, Anton; Sluijs, Emmy; Wagner, Cordula; de Bakker, Dinny


    The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived from the European Quality Award-was sent to 1594 health care institutions; the response was 74%. The results showed that in 13% of the institutions a coherent quality system had been implemented. These ...

  1. Health care system in bangladesh

    Dibyajyoti Saha


    Full Text Available Pharmacists are healthcare professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use. The role of pharmacist has shifted from the classical “lick, stick and pour” dispensary role, to being an integrated member of the health care team directly involved in patient care. But, in our country pharmacists are mainly engaged with manufacturing of drugs, which is secondary responsibility of pharmacist.

  2. Health care system in bangladesh

    Dibyajyoti Saha,


    Pharmacists are healthcare professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use. The role of pharmacist has shifted from the classical “lick, stick and pour” dispensary role, to being an integrated member of the health care team directly involved in patient care. But, in our country pharmacists are mainly engaged with manufacturing of drugs, which is secondary responsibility of pharmacist.

  3. Optimal obstacle control problem

    ZHU Li; LI Xiu-hua; GUO Xing-ming


    In the paper we discuss some properties of the state operators of the optimal obstacle control problem for elliptic variational inequality. Existence, uniqueness and regularity of the optimal control problem are established. In addition, the approximation of the optimal obstacle problem is also studied.

  4. Care credits in the British pension system

    Vlachantoni, Athina


    The paper is a brief outline of the first stage of a comparative research project in the role and adequacy of care credits in the British and German pension systems. The provision of care credits has been an essential part of pension reforms around Europe, which significantly changes the prospects of carers to accumulate adequate pension contributions through their life course. But although the policy significance of care credits is due to rise in line with an increasing demand...

  5. Financial management in leading health care systems.

    Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L


    To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. In this introduction, we present an overview of the project and summary responses on corporate financial structures and strategic challenges facing CFOs. PMID:10845383

  6. Critical care nursing: Embedded complex systems.

    Trinier, Ruth; Liske, Lori; Nenadovic, Vera


    Variability in parameters such as heart rate, respiratory rate and blood pressure defines healthy physiology and the ability of the person to adequately respond to stressors. Critically ill patients have lost this variability and require highly specialized nursing care to support life and monitor changes in condition. The critical care environment is a dynamic system through which information flows. The critical care unit is typically designed as a tree structure with generally one attending physician and multiple nurses and allied health care professionals. Information flow through the system allows for identification of deteriorating patient status and timely interventionfor rescue from further deleterious effects. Nurses provide the majority of direct patient care in the critical care setting in 2:1, 1:1 or 1:2 nurse-to-patient ratios. The bedside nurse-critically ill patient relationship represents the primary, real-time feedback loop of information exchange, monitoring and treatment. Variables that enhance information flow through this loop and support timely nursing intervention can improve patient outcomes, while barriers can lead to errors and adverse events. Examining patient information flow in the critical care environment from a dynamic systems perspective provides insights into how nurses deliver effective patient care and prevent adverse events. PMID:27047997

  7. Health Care Information System (HCIS) Data File

    U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...

  8. Laser-Based Obstacle Detection at Railway Level Crossings

    Vítor Amaral; Francisco Marques; André Lourenço; José Barata; Pedro Santana


    This paper presents a system for obstacle detection in railway level crossings from 3D point clouds acquired with tilting 2D laser scanners. Although large obstacles in railway level crossings are detectable with current solutions, the detection of small obstacles remains an open problem. By relying on a tilting laser scanner, the proposed system is able to acquire highly dense and accurate point clouds, enabling the detection of small obstacles, like rocks laying near the rail. During an off...

  9. Trauma care systems in India - An overview

    Joshipura M


    Full Text Available Trauma-care systems in India are at a nascent stage of development. Industrialized cities, rural towns and villages coexist, with variety of health care facilities and almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints and lack of appropriate health infrastructure. There is no national lead agency to coordinate various components of a trauma system. No mechanism for accreditation of trauma centres and professionals exists. Education in trauma life-support skills has only recently become available. A nationwide survey encompassing various facilities has demonstrated significant deficiencies in current trauma systems. Although injury is a major public-health problem, the government, medical fraternity and the society are yet to recognize it as a growing challenge.

  10. Challenges for the German Health Care System.

    Dietrich, C F; Riemer-Hommel, P


    The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate. PMID:22660990

  11. A telemedicine health care delivery system

    Sanders, Jay H.


    The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.

  12. Compétences en santé déficientes: obstacle à une prise en charge optimale [Low health literacy: barrier to optimal care].

    Zenklusen S.; Bischoff T.; Panese F.; Bodenmann P.


    Les carences en compétences en santé touchent principalement certaines populations à risques en limitant l'accès aux soins, l'interaction avec les soignants et l'autoprise en charge. L'utilisation systématique d'instruments de dépistage n'est pas recommandée et les interventions préconisées en pratique consistent plutôt à diminuer les obstacles entravant la communication patient-soignant. Il s'agit d'intégrer non seulement les compétences de la population en matière de santé mais aussi les co...

  13. Permanency and the Foster Care System.

    Lockwood, Katie K; Friedman, Susan; Christian, Cindy W


    Each year over 20,000 youth age out of the child welfare system without reaching a permanent placement in a family. Certain children, such as those spending extended time in foster care, with a diagnosed disability, or adolescents, are at the highest risk for aging out. As young adults, this population is at and increased risk of incarceration; food, housing, and income insecurity; unemployment; educational deficits; receipt of public assistance; and mental health disorders. We reviewed the literature on foster care legislation, permanency, outcomes, and interventions. The outcomes of children who age out of the child welfare system are poor. Interventions to increase permanency include training programs for youth and foster parents, age extension for foster care and insurance coverage, an adoption tax credit, and specialized services and programs that support youth preparing for their transition to adulthood. Future ideas include expanding mentoring, educational support, mental health services, and post-permanency services to foster stability in foster care placements and encourage permanency planning. Children in the child welfare system are at a high risk for physical, mental, and emotional health problems that can lead to placement instability and create barriers to achieving permanency. Failure to reach the permanency of a family leads to poor outcomes, which have negative effects on the individual and society. Supporting youth in foster care throughout transitions may mediate the negative outcomes that have historically followed placement in out-of-home care. PMID:26403649

  14. The chinese health care system

    Hougaard, Jens Leth; Østerdal, Lars Peter Raahave; Yu, Yi


    We describe the structure and present situation of the Chinese healthcare system and discuss its primary problems and challenges. We discuss problems with inefficient burden sharing, adverse provider incentives and huge inequities, and seek explanations in the structural features of the Chinese h...

  15. Barriers of Referral System to Health Care Provision in Rural Societies in Iran

    Manijeh Eskandari


    Full Text Available Introduction: Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. This study aimed to describe barriers of health care process in rural societies in Iran. Methods: In this qualitative study, 26 participants (21 rural health care providers and five rural patients were selected through purposive sampling. The data was collected via semi-structured individual interviews and small focus group discussions. Data was analyzed with qualitative content analysis.Results: One category, “ineffective referral system”, and five subcategories, i.e. being far from the ideal referral system, lack of adequate governmental referral system, lack of connection between different levels of the referral system, self-referential and bypassing the referral system, and insufficient knowledge about the referral system, were found. Conclusion: Considering the obstacles to the referral system, improvements in its structure are necessary to promote the quality of health care in rural areas. Such changes require coordination between the three levels of the referral system, strengthening the public sector of the system, increasing public awareness about the referral system, and prevention of self-referential.

  16. [Informatics in the Croatian health care system].

    Kern, Josipa; Strnad, Marija


    Informatization process of the Croatian health care system started relatively early. Computer processing of data of persons not covered by health insurance started in 1968 in Zagreb. Remetinec Health Center served as a model of computer data processing (CDP) in primary health care and Sveti Duh General Hospital in inpatient CDP, whereas hospital administration and health service were first introduced to Zagreb University Hospital Center and Sestre Milosrdnice University Hospital. At Varazdin Medical Center CDP for health care services started in 1970. Several registries of chronic diseases have been established: cancer, psychosis, alcoholism, and hospital registries as well as pilot registries of lung tuberculosis patients and diabetics. Health statistics reports on healthcare services, work accidents and sick-leaves as well as on hospital mortality started to be produced by CDP in 1977. Besides alphanumeric data, the modern information technology (IT) can give digital images and signals. Communication in health care system demands a standardized format of all information, especially for telemedicine. In 2000, Technical Committee for Standardization in Medical Informatics was founded in Croatia, in order to monitor the activities of the International Standardization Organization (ISO) and Comite Européen de Normalisation (CEN), and to implement their international standards in the Croatian standardization procedure. The HL7 Croatia has also been founded to monitor developments in the communication standard HL7. So far, the Republic of Croatia has a number of acts regulating informatization in general and consequently the informatization of the health care system (Act on Personal Data Confidentiality, Act on Digital Signature, Act of Standardization) enacted. The ethical aspect of data security and data protection has been covered by the Code of Ethics for medical informaticians. It has been established by the International Medical Informatics Association (IMIA

  17. Evaluation of Ambulatory Care Information Systems

    Simborg, Donald W.; Whiting-O'Keefe, Quinn E.


    The central purpose of an ambulatory care information system is to communicate information to the practitioner to facilitate clinical decision making. The clinical decision can be considered the dependent output variable in a process having the information system, the patient, clinician characteristics, and the environment as the independent input variables. Evaluation approaches using patient outcomes are problematic because of the indirect relationship between the information system and pat...

  18. Application of database systems in diabetes care.

    Kopelman, P G; Sanderson, A J


    The St Vincent Declaration includes a commitment to continuous quality improvement in diabetes care. This necessitates the collection of appropriate information to ensure that diabetes services are efficient, effective and equitable. The quantity of information, and the need for rapid access, means that this must be computer-based. The choice of architecture and the design of a database for diabetes care must take into account available equipment and operational requirements. Hardware topology may be determined by the operating system and/or netware software. An effective database system will include: user-friendliness, rapid but secure access to data, a facility for multiple selections for analysis and audit, the ability to be used as part of the patient consultation process, the ability to interface or integrate with other applications, and cost efficiency. An example of a clinical information database for diabetes care, Diamond, is described. PMID:9244825

  19. Obstacle mean-field game problem

    Gomes, Diogo A.


    In this paper, we introduce and study a first-order mean-field game obstacle problem. We examine the case of local dependence on the measure under assumptions that include both the logarithmic case and power-like nonlinearities. Since the obstacle operator is not differentiable, the equations for first-order mean field game problems have to be discussed carefully. Hence, we begin by considering a penalized problem. We prove this problem admits a unique solution satisfying uniform bounds. These bounds serve to pass to the limit in the penalized problem and to characterize the limiting equations. Finally, we prove uniqueness of solutions. © European Mathematical Society 2015.

  20. Child Poverty and the Health Care System.

    Racine, Andrew D


    The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty. PMID:27044708

  1. Apparatus for obstacle traversion

    Borenstein, Johann


    An apparatus for traversing obstacles having an elongated, round, flexible body that includes a plurality of drive track assemblies. The plurality of drive track assemblies cooperate to provide forward propulsion wherever a propulsion member is in contact with any feature of the environment, regardless of how many or which ones of the plurality of drive track assemblies make contact with such environmental feature.

  2. Opportunities Outweigh Obstacles

    Rozum, Betty; Thoms, Becky L.; Bates, Scott C.; Barandiaran, Danielle M


    Student research is an untapped commodity. A survey of 238 Institutional Repositories in 2013 indicated that only 38% collect student research other than theses and dissertations. We think student research is a potential goldmine. Do other librarians agree? What about stake holders outside of the library? And, what are the obstacles preventing more robust collection of student research?

  3. Obstacles to Laser Safety

    Barat, K


    The growth of laser development & technology has been remarkable. Unfortunately, a number of traps or obstacles to laser safety have also developed with that growth. The goal of this article is to highlight those traps, in the hope that an aware laser user will avoid them. These traps have been the cause or contributing factor of many a preventable laser accident.

  4. La gestión de úlceras por presión en residencias de mayores: Obstáculos y facilitadores The management of pressure ulcers in nursing home care: Obstacles and facilitators

    Manuel Rodríguez Palma


    Full Text Available Introducción y objetivos: las úlceras por presión (UPP son un problema que repercute negativamente en la calidad de vida del anciano, contribuyendo a la morbilidad y mortalidad de la población institucionalizada. La heterogénea realidad de la asistencia y la variabilidad epidemiológica de estas lesiones dificultan su abordaje en las instituciones socio-sanitarias. Intentaremos conocer la gestión de las UPP en las residencias de mayores y los obstáculos que impiden su adecuado manejo, planteando estrategias para optimizar los cuidados. Método: revisión bibliográfica en bases de datos nacionales e internacionales. Resultados: la adopción e implementación de las mejores directrices de prevención y tratamiento de UPP ofrece una elevada variabilidad. Se detectan obstáculos a nivel de dirección e instituciones, costes económicos y materiales, formación, actitudes y motivaciones del personal, implantación y cuidados. Conclusiones: el uso de programas adaptados a los centros, el compromiso mantenido de la institución, planes globales y multidimensionales, formación interdisciplinar y evaluación continua serían algunas de las recomendaciones para la mejora de los cuidados de prevención y tratamiento de ancianos con UPP.Introduction and aims: the PU is a problem that adversely affects the quality of life among the elderly, contributing to morbidity and mortality in the institutionalized population. The heterogeneous reality of care and epidemiological variability of these injuries make it difficult to approach in socio-sanitary institutions. Knowing the management of pressure ulcers in nursing homes and obstacles to its proper management, raising strategies to optimize care. Method: literature review on the basis of national and international data. Results: the adoption and implementation of best practice guidelines for prevention and treatment of PU offers a high variability. Obstacles are detected at the managerial and

  5. Consumer-Centered, Collaborative, and Comprehensive Care: The Core Essentials of Recovery-Oriented System of Care.

    DiClemente, Carlo C; Norwood, Amber E Q; Gregory, W Henry; Travaglini, Letitia; Graydon, Meagan M; Corno, Catherine M


    Recovery from substance abuse and mental health disorders represents a journey through which individuals move beyond treatment of provider-identified problems toward a path of achieving wellness and productive lives. Overcoming obstacles and barriers encountered along the recovery process, individuals reveal their own strengths and resilience necessary to cope, survive, and thrive in the face of adversity. Recovery-oriented system of care (ROSC) is a framework designed to address the multidimensional nature of recovery by creating a system for coordinating multiple systems, services, and supports that are person centered and build on the strengths and resiliencies of individuals, families, and communities. As is common knowledge among substance abuse and mental health providers, consumers often present with high rates of comorbidity, which complicates care. In addition, behavioral health consumers engage in risky health behaviors (e.g., smoking) at a disproportionate rate, which places them at increased risk for developing noncommunicable diseases. ROSCs are ideal for addressing the complicated and varied needs of consumers as they progress toward wellness. The challenges of creating an ROSC framework that is effective, efficient, and acceptable to consumers is formidable. It requires change on the part of agencies, organizations, providers, and consumers. The importance of comprehensive, integrated screening is highlighted as a critical component of ROSC. Key suggestions for initiating ROSC are offered. PMID:27272993

  6. Highly Oscillating Thin Obstacles

    Lee, Ki-ahm; Yoo, Minha


    The focus of this paper is on a thin obstacle problem where the obstacle is defined on the intersection between a hyper-plane $\\Gamma$ in $\\mathbb{R}^n$ and a periodic perforation $\\mathcal{T}_\\varepsilon$ of $\\mathbb{R}^n$, depending on a small parameter $\\varepsilon>0$. As $\\varepsilon\\to 0$, it is crucial to estimate the frequency of intersections and to determine this number locally. This is done using strong tools from uniform distribution. By employing classical estimates for the discrepancy of sequences of type $\\{k\\alpha\\}_{k=1}^\\infty$, $\\alpha\\in\\R$, we are able to extract rather precise information about the set $\\Gamma\\cap\\mathcal{T}_\\varepsilon$. As $\\varepsilon\\to0$, we determine the limit $u$ of the solution $u_\\varepsilon$ to the obstacle problem in the perforated domain, in terms of a limit equation it solves. We obtain the typical "strange term" behaviour for the limit problem, but with a different constant taking into account the contribution of all different intersections, that we call the...

  7. A Robust Obstacle Avoidance for Service Robot Using Bayesian Approach

    Widodo Budiharto


    Full Text Available The objective of this paper is to propose a robust obstacle avoidance method for service robot in indoor environment. The method for obstacles avoidance uses information about static obstacles on the landmark using edge detection. Speed and direction of people that walks as moving obstacle obtained by single camera using tracking and recognition system and distance measurement using 3 ultrasonic sensors. A new geometrical model and maneuvering method for moving obstacle avoidance introduced and combined with Bayesian approach for state estimation. The obstacle avoidance problem is formulated using decision theory, prior and posterior distribution and loss function to determine an optimal response based on inaccurate sensor data. Algorithms for moving obstacles avoidance method proposed and experiment results implemented to service robot also presented. Various experiments show that our proposed method very fast, robust and successfully implemented to service robot called Srikandi II that equipped with 4 DOF arm robot developed in our laboratory.

  8. Redundant Robot Can Avoid Obstacles

    Homayoun, Seraji; Colbaugh, Richard; Glass, Kristin


    Simple and direct control scheme enables redundant robot to avoid obstacles in workspace. In proposed scheme, called "configuration control", degrees of freedom used to configure robot to satisfy set of inequality constraints representing avoidance of obstacles, while simultaneously making end effector follow desired trajectory. Provides capability to avoid obstacles in dynamically varying environment where apriori planning of tasks not feasible.

  9. Developing a web 2.0 diabetes care support system with evaluation from care provider perspectives.

    Lin, Yung-Hsiu; Chen, Rong-Rong; Guo, Sophie Huey-Ming; Chang, Hui-Yu; Chang, Her-Kun


    Diabetes is a life-long illness condition that many diabetic patients end up with related complications resulted largely from lacking of proper supports. The success of diabetes care relies mainly on patient's daily self-care activities and care providers' continuous support. However, the self-care activities are socially bounded with patient's everyday schedules that can easily be forgotten or neglected and the care support from providers has yet been fully implemented. This study develops a Web 2.0 diabetes care support system for patients to integrate required self-care activities with different context in order to enhance patient's care knowledge and behavior adherence. The system also supports care managers in a health service center to conduct patient management through collecting patient's daily physiological information, sharing care information, and maintaining patient-provider relationships. After the development, we evaluate the acceptance of the system through a group of nursing staffs. PMID:21369781

  10. Introducing variable-step topography (VST) coordinates within dynamically constrained nonhydrostatic modeling system (NMS). Part 2: VST performance on orthodox obstacle flows

    Tripoli, Gregory J.; Smith, Eric A.


    In this second part of a two-part sequence of papers, the performance metrics and quantitative advantages of a new VST surface coordinate system, implemented within a dynamically constrained, nonhydrostatic, cloud mesoscale atmospheric model, are evaluated in conjunction with seven orthodox obstacle flow problems. [The first part presented a full formulation of the VST model, prefaced by a description of the framework of the newly re-tooled nonhydrostatic modeling system (NMS) operating within integral constraints based on the conservation of the foremost quantities of mass, energy and circulation.] The intent behind VST is to create a vertical surface coordinate system boundary underpinning a nonhydrostatic atmosphere capable of reliable simulations of flows over both smooth and steep terrain without sacrificing dynamical integrity over either type of surface. Model simulation results are analyzed for six classical fluid dynamics problems involving flows relative to obstacles with known analytical or laboratory-simulated solutions, as well as for a seventh noteworthy mountain wave breaking problem that has well-studied numerical solutions. For cases when topography becomes excessively severe or poorly resolved numerically, atmospheric models using transform (terrain-following) coordinates produce noteworthy errors rendering a stable integration only if the topography is smoothed. For cases when topography is slowly varying (smooth or subtle), models using discrete-step coordinates also produce noteworthy errors relative to known solutions. Alternatively, the VST model demonstrates that both limitations of the two conventional approaches, for the entire range of slope severities, can be overcome. This means that VST is ideally suited for a scalable, nonhydrostatic atmospheric model, safeguarded with physically realistic dynamical constraints.

  11. Toward a 21st-century health care system: Recommendations for health care reform

    K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)


    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project ( held a

  12. Systems modelling for improving health care

    Pitt, Martin; Monks, Thomas; Allen, Michael


    The growing complexity of health care coupled with the ever-increasing pressures to ensure efficient and effective use of limited resources have encouraged policy makers to turn to system modelling solutions. Such techniques have been available for decades, but despite ample research which demonstrates potential, their application in health services to date is limited. This presentation surveys the breadth of approaches available to support delivery and design across many areas and levels of ...

  13. Visual navigation for the blind: path and obstacle detection

    José, João; Rodrigues, J. M. F.; du Buf, J. M. H.


    We present a real-time vision system to assist blind and visually impaired persons. This system complements the white cane, and it can be used both indoor and outdoor. It detects borders of paths and corridors, obstacles within the borders, and it provides guidance for centering and obstacle avoidance. Typical obstacles are backpacks, trash cans, trees, light poles, holes, branches, stones and other objects at a distance of 2 to 5 meters from the camera position. Walkable paths ar...

  14. Bellco Formula Domus Home Care System.

    Trewin, Elizabeth


    There are certain characteristics in a dialysis machine that would be desirable for use in home and limited care environments. These features relate to safety, ease of use, consideration of physical space, and reliability. The Bellco Formula Domus Home Care System was designed to meet all these requirements. Bellco's philosophy of patient treatment centers on global biocompatibility. This is evident in the design of the Formula Domus Home Care System. It has the smallest hydraulic fluid pathway of any dialysis machine on the market. Formula is capable of preparing ultrapure dialysate. The ultrafiltration measurement mechanism, the patented Coriolis flow meter, measures the mass of the dialysate, not the volume. For this reason it is the only dialysis machine that detects actual backfiltration, not just the theoretical possibility of it based on transmembrane pressure. The Coriolis flow meter also ensures that dialysate flow is a true single pass. The operator interface is a single window operating control. It is possible to select up to 14 different languages. There is an online help key to assist patients with troubleshooting. Programmable start-up and shutdown times save time for the patient. Formula is the only dialysis machine to offer a backup battery feature. Formula is capable of communicating with any software available. The focus on global biocompatibility ensures the best quality dialysis treatments for a population of patients who will likely remain on dialysis for a longer period of time than conventional dialysis patients. PMID:15043621

  15. Seamless health care for chronic diseases in a dual health care system: managed care and the role of family physicians.

    Lee, A


    Neither private nor state run health care systems are perfect. Although there is increasing evidence that Health Maintenance Organizations (HMOs) provide comparable care at lower cost, HMOs tend to select healthy patients. The dual health care system in Hong Kong spends about 3.9 per cent of GDP, with health indices among the best in the world. Hong Kong still faces the problem of escalating health care expenditure. One should take advantage of the dual health care system to evolve a new paradigm for a primary-led seamless health care service. The Diabetes Centre of a university teaching hospital together with the University of Community and Family Medicine has started a structured shared care programme in diabetes mellitus, involving general practitioners in both the private and public sectors integrating the primary and secondary care, and the private and public sectors. This programme starts to develop an infrastructure for providing quality care at an affordable cost for a large pool of patients with chronic disease. Unlike other "managed care schemes", this one is not run by profit-oriented companies, but by health professionals with an interest in providing best possible care at an affordable cost. The "disease management" approach needs a care delivery system without traditional boundaries; and a continuous improvement process which develops and refines the knowledge base, guidelines and delivery system. PMID:10351265

  16. The Taiwanese health care system under efficiency scrutiny

    Schreyögg, Jonas


    This thesis describes the status quo of the Taiwanese health care system in the year 2000, 5 years after the reforms, analyses the economic efficiency of single components of the new health care system and searches for possible solutions to solve uncovered problems. For a better understanding of the Taiwanese health care system, the economic, political and demographic environment is described first of all. Although the Taiwanese economy developed rapidly, the health care system was still look...

  17. [Justice in health care systems from an economic perspective].

    Schreyögg, J


    Due to rising health care expenditures international comparisons of health care systems are recently gaining more importance. These benchmarks can provide interesting information for improving health care systems. Many of these comparisons implicitly assume that countries have a universal understanding of justice. But this assumption is rather questionable. With regard to the existing cultural differences in the understanding of justice the transferability of elements of health care systems is not always assured. A transfer usually requires a thorough examination of the judicial systems in each country. This article analyses the influence of different judicial systems applying to health care. In this context theories of justice by Rawls, Nozick and Confucius representing the possible understanding of justice in different cultures are described and analysed with regards to their influence on health care systems. The example of financing health care shows that the three theories of justice have very different consequences for designing health care systems especially concerning the role of governments. PMID:14767785

  18. Corruption in health-care systems and its effect on cancer care in Africa.

    Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan


    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. PMID:26248847

  19. Reciprocally-Rotating Velocity Obstacles

    Giese, Andrew


    © 2014 IEEE. Modern multi-agent systems frequently use highlevel planners to extract basic paths for agents, and then rely on local collision avoidance to ensure that the agents reach their destinations without colliding with one another or dynamic obstacles. One state-of-the-art local collision avoidance technique is Optimal Reciprocal Collision Avoidance (ORCA). Despite being fast and efficient for circular-shaped agents, ORCA may deadlock when polygonal shapes are used. To address this shortcoming, we introduce Reciprocally-Rotating Velocity Obstacles (RRVO). RRVO generalizes ORCA by introducing a notion of rotation for polygonally-shaped agents. This generalization permits more realistic motion than ORCA and does not suffer from as much deadlock. In this paper, we present the theory of RRVO and show empirically that it does not suffer from the deadlock issue ORCA has, permits agents to reach goals faster, and has a comparable collision rate at the cost of performance overhead quadratic in the (typically small) user-defined parameter δ.

  20. [Health care systems and impossibility theorems].

    Penchas, Shmuel


    Health care systems, amongst the most complicated systems that serve mankind, have been in turmoil for many years. They are characterized by widespread dissatisfaction, repeated reforms and a general perception of failure. Is it possible that this abominable situation derives from underlying causes, which are inherent to the most basic elements of these systems? Those elements compromise the use of words and definitions in the formulation of their principles and their way of action, in their logical structure as well as in the social order in which they exist. An in-depth investigation of these elements raises findings that may negate the basic feasibility of the success of such complex systems, as currently known in the western world. One of the main elements of the democratic regime is its system of decision/choice making, i.e. the majority vote. But, already in the nineteenth century, it was discovered that a majority was an intransitive ordering and did not produce a consistent definition of a preference. The Marquis of Condorcet in his famous 1785 "Essai sur l'application de l'analyse a la probabilite des decisions rendues a la plurite des voix", clearly demonstrated that majority decisions might lead to intransitivity and an indeterminancy in social choices. On the basis of his discoveries, it was later shown that legislative rules may lead to the choice of a proposal that is actually opposed by the majority, or to a deadlock and therefore, to socially undesirable implications. Subsequent to these theories of Condorcet, which became known as "The Paradox of Condorcet", many papers were published in the 19th and 20th centuries regarding the issue of problems dealing with individual preferences leading to social order--a complex procedure of, amongst others, aggregation in a defined axiomatic framework. During the twentieth century it became astoundingly manifest that certain issues, although correctly attacked logically, could not be resolved. Two such famous

  1. [Differences and similarities of Primary Care in the German and Spanish Health Care Systems].

    Salvador Comino, María Rosa; Krane, Sibylla; Schelling, Jörg; Regife García, Víctor


    An efficient primary care is of particular importance for any countries' health care system. Many differences exist on how distinctive countries try to obtain the goal of an efficient, cost-effective primary care for its population. In this article we conducted a selective literature review, which includes both scientific and socio-political publications. The findings are complemented with the experience of a Spanish physician from Seville in her last year of training in family medicine, who completed a four months long rotation in the German health care system. We highlighted different features by comparing both countries, including their health care expenditure, the relation between primary and secondary care, the organization in the academic field and the training of future primary care physicians. It is clear that primary care in both countries plays a central role, have to deal with shortcomings, and in some points one system can learn from the other. PMID:26363955

  2. Antimicrobial stewardship programs in health care systems.

    MacDougall, Conan; Polk, Ron E


    Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources. PMID:16223951

  3. Midwives and obstetric nurses in the Brazilian Unified Health System and Primary Health Care: for a systemic and progressive incorporation

    Armando Henrique Norman


    Full Text Available The objective of this paper is to present a proposal for a gradual and systemic incorporation of midwives and obstetric nurses into the Brazilian Unified Health System (SUS and Primary Health Care (PHC. The proposal was born from contact with the British experience, based on midwives, which is briefly described. In Brazil, these professionals would progressively take over the prenatal, delivery and postpartum care for pregnant women of usual risk in a region, in partnership with the PHC teams. This creates a specific niche for practicing, monitoring and evaluating the pregnancy care, based on the specific life cycle continued care with the user closely linked to the PHC team. There are technical and institutional conditions favorable to the development of this type of proposal, but there is a need to overcome the political obstacles. Its realization is a powerful strategy to reduce the high rates of obstetric violence, especially the significant cesarean rates in Brazil, contributing to humanization of childbirth in the SUS.

  4. Ambivalent implications of health care information systems: a study in the Brazilian public health care system

    João Porto de Albuquerque


    Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

  5. Guidelines for Psychological Practice in Health Care Delivery Systems

    American Psychologist, 2013


    Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

  6. Measuring the strength of primary care systems in Europe.

    Kringos, D.S.; Boerma, W.G.W.


    Background: The investment in primary care (PC) reforms to improve the overall performance of health care systems has been substantial in Europe. There is however a lack of up to date comparable information to evaluate the development and strength of PC systems. This EU-funded Primary Health Care A

  7. Health Care System Responses to Children Exposed to Domestic Violence.

    Culross, Patti L.


    Summarizes health care approaches to identifying and treating child and adult victims of domestic violence. Describes innovative programs that tie children's well-being to that of their mothers and proposes strategies for improving current health care system responses. (SLD)

  8. A variational approach to bifurcation points of a reaction-diffusion system with obstacles and neumann boundary conditions

    Eisner, Jan; Kučera, Milan; Väth, Martin


    Roč. 61, č. 1 (2016), s. 1-25. ISSN 0862-7940 R&D Projects: GA ČR GA13-12580S Institutional support: RVO:67985904 ; RVO:67985840 Keywords : reaction-diffusion system * unlateral condition * variational inequality Subject RIV: EG - Zoology; BA - General Mathematics (MU-W) Impact factor: 0.400, year: 2014

  9. Organizational Fragmentation and Care Quality in the U.S. Health Care System

    Randall D. Cebul; James B. Rebitzer; Taylor, Lowell J.; Mark Votruba


    Many goods and services can be readily provided through a series of unconnected transactions, but in health care close coordination over time and within care episodes improves both health outcomes and efficiency. Close coordination is problematic in the US health care system because the financing and delivery of care is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations and capabilities. These fragmented organizational structures l...

  10. Toward a 21st-century health care system: Recommendations for health care reform

    Arrow, Kenneth; Auerbach, Alan; Bertko, John; Casalino, Lawrence Peter; Crosson, Francis; Enthoven, Alain; Falcone, E.; Feldman, R.C.; Fuchs, Victor; Garber, Alan; Gold, Marthe Rachel; Goldman, D A; Hadfield, Gillian; Hall, Mark Ann; Horwitz, Ralph


    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project ( held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspective...

  11. An enhanced MMW and SMMW/THz imaging system performance prediction and analysis tool for concealed weapon detection and pilotage obstacle avoidance

    Murrill, Steven R.; Jacobs, Eddie L.; Franck, Charmaine C.; Petkie, Douglas T.; De Lucia, Frank C.


    The U.S. Army Research Laboratory (ARL) has continued to develop and enhance a millimeter-wave (MMW) and submillimeter- wave (SMMW)/terahertz (THz)-band imaging system performance prediction and analysis tool for both the detection and identification of concealed weaponry, and for pilotage obstacle avoidance. The details of the MATLAB-based model which accounts for the effects of all critical sensor and display components, for the effects of atmospheric attenuation, concealment material attenuation, and active illumination, were reported on at the 2005 SPIE Europe Security and Defence Symposium (Brugge). An advanced version of the base model that accounts for both the dramatic impact that target and background orientation can have on target observability as related to specular and Lambertian reflections captured by an active-illumination-based imaging system, and for the impact of target and background thermal emission, was reported on at the 2007 SPIE Defense and Security Symposium (Orlando). Further development of this tool that includes a MODTRAN-based atmospheric attenuation calculator and advanced system architecture configuration inputs that allow for straightforward performance analysis of active or passive systems based on scanning (single- or line-array detector element(s)) or staring (focal-plane-array detector elements) imaging architectures was reported on at the 2011 SPIE Europe Security and Defence Symposium (Prague). This paper provides a comprehensive review of a newly enhanced MMW and SMMW/THz imaging system analysis and design tool that now includes an improved noise sub-model for more accurate and reliable performance predictions, the capability to account for postcapture image contrast enhancement, and the capability to account for concealment material backscatter with active-illumination- based systems. Present plans for additional expansion of the model's predictive capabilities are also outlined.

  12. Obstacle Avoidance Through Visual Teleoperation

    Muhammad Usman Keerio


    Full Text Available This paper presents a novel controlling approach forHumanoid Robot to work safely in critical situations like badlight environment using Visual Teleoperation. In this regardmodeling environments for Humanoid Teleoperation Systemis developed. Here virtual reality modeling environmentincludes development of virtual Humanoid BHR-2, andvirtual objects like table etc. The main goal of this work is toenhance our visual teleoperation system for BHR-2 in orderto avoid any collision during real time operation. SoftwareMaya is used for modeling and simulations. Maya plug-insin VC++ provides efficient modeling rule, real timeinteraction, and time saving rendering approach in a virtualenvironment. In this paper the validity of proposed scheme isshown by conducting experiments using offline step overtrajectory to avoid obstacle in bad light environment.

  13. [Costs of maternal-infant care in an institutionalized health care system].

    Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L


    Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities. PMID:9528219

  14. Health disparities and health care financing: restructuring the American health care system.

    Diggs, Schnequa N


    For more than seven decades there has been a systematic disregard for the health needs of certain groups of individuals. Discrepancies in treatment and privilege based on race/ethnicity, gender, sexual orientation, class, and socio-economic status have been significant players in any portrait of American health care and have helped frame considerations of those who deserve and those undeserving of quality health care. Continuous incidences of inequitable health care practices strongly suggest a need for drastic changes in our current health care system. Although growing interest in social inequalities in health preside, health policy makers struggle to find appropriate intervention strategies to alleviate health disparities. The purpose of this article is to depict a clearer portrait of the American health care system within the context of health disparities and recognize intervention strategies to reduce/eliminate health care disparities. This article concludes with suggestions on how to refinance the American health care system based on equality principles. PMID:22894023

  15. The health professions and the performance of future health systems in low-income countries: support or obstacle?

    Dussault, Gilles


    This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role. PMID:18336977

  16. Health-Care Waste Management System

    T. Subramani


    Full Text Available The main purpose of this paper is to give A view of the hospital waste management and environmental problem in india. The objective of this study is to analyze the health care waste management system, including practices and compliances. Most countries of the world, especially the developing countries, are facing the grim situation arising out of environmental pollution due to pathological waste arising from increasing populations and the consequent rapid growth in the number of hospital units. In india, there are about 6 lakhs hospital beds, over 23,000 primary health centers, more than 15,000 small and private hospitals. In india, the biomedical waste (management and handling rules 1998 make it mandatory for hospitals, clinics, and other medical and veterinary institutes to dispose of bio medical wastes strictly according to the rules.

  17. "Differences" are the Biggest Obstacle



    China has the greatest numbers of both teachers and students worldwide ,who teach and learn English. Therefore ,to analyze the obstacles of learning English for Chinese is necessary. This article gives the idea of differences between Chinese and English mainly in languages and cultures fields. Through these we can see deafly that "differences" are the biggest obstacle in language learning.

  18. CHINs in the context of an evolving health care system.

    Duncan, K. A.


    Community Health Information Network (CHIN) developments have slowed, due to the chaotic change in the health care system and stakeholders' attendant short-sighted focus. CHINs are a long-term investment that is necessary for the health care system's evolution to maturity. Several arenas of essential CHIN activity are given that would be characteristic of a mature, goal-directed health care system Lack of enterprise-wide computer-based patient record systems is a major barrier. Even in the sh...

  19. Obstacle dropping detection device for nuclear power plant

    The present invention provides a device for monitoring dropping of obstacles to a reactor well, cavity or spent fuel pool during periodical inspection to detect/display the position when obstacles are dropped. Namely, an optical detection means has a light emitting portion and a light receiving portion, and detects dropping of obstacles by the interruption of the light when obstacles pass through between them. The optical detection means are disposed each by one system to at least two intersecting directions while having an opening face of the pool defined as a retrieving area. An acoustic monitoring means has at least a set of three microphones and detect a time difference of the sounds of the obstacles arriving on water which is detected by each of the microphones to detect the position of the obstacles arriving on the water. The acoustic monitoring means is disposed while having the water surface of the pool as an area for retrieving. The obstacle dropping detection device always monitor the dropping of obstacles, and can determine the position when they are dropped. Accordingly, information can be provided, which is quite effective for the recovery of obstacles which is performed separately. (I.S.)

  20. Obstacle detection during day and night conditions using stereo vision

    Dubbelman, G.; Mark, W. van der; Heuvel, J.C. van den; Groen, F.C.A.


    We have developed a stereo vision based obstacle detection (OD) system that can be used to detect obstacles in off-road terrain during both day and night conditions. In order to acquire enough depth estimates for reliable OD during low visibility conditions, we propose a stereo disparity (depth) est

  1. Preventive health care and payment systems

    Martínez Giralt, Xavier; Barros, Pedro Pita


    Prevention has been a main issue of recent policy orientations in health care. This renews the interest on how different organizational designs and the definition of payment schemes to providers may affect the incentives to provide preventive health care. We focus on the externality resulting from referral decisions from primary to acute care providers. This makes our analysis complementary to most works in the literature allowing to address in a more direct way the issue of preventive health...

  2. Dynamic Obstacle Avoidance for an Omnidirectional Mobile Robot

    Robert L. Williams


    Full Text Available We have established a novel method of obstacle-avoidance motion planning for mobile robots in dynamic environments, wherein the obstacles are moving with general velocities and accelerations, and their motion profiles are not preknown. A hybrid system is presented in which a global deliberate approach is applied to determine the motion in the desired path line (DPL, and a local reactive approach is used for moving obstacle avoidance. A machine vision system is required to sense obstacle motion. Through theoretical analysis, simulation, and experimental validation applied to the Ohio University RoboCup robot, we show the method is effective to avoid collisions with moving obstacles in a dynamic environment.

  3. Clogging and Jamming Transitions in Granular Matter Flowing Through Obstacles

    Reichhardt, Cynthia Olson; Reichhardt, Charles


    We consider a two-dimensional system of bidisperse disks driven through a landscape of fixed obstacles. In the limit of a single obstacle, the disks cease moving when the disk density is increased to the jamming density. The threshold density value decreases as the number of obstacles increases, but we also observe a change in the nature of the frozen state. At low obstacle density we find a homogeneous jammed state, but for higher obstacle density we instead find a heterogeneous clogged state containing void areas and possessing a memory of the driving direction. The transition to the clogged state is strongly stochastic and we observe large fluctuations in clogging time both for clogging in the original driving direction and for transverse clogging when the drive is suddenly rotated by 90 degrees. We find evidence for a diverging clogging transition time at a critical disk density well below the jamming density in a clean system.

  4. A decision technology system for health care electronic commerce.

    Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R


    Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice. PMID:10539421

  5. Fostering the coexistence of caring philosophy and economics in today's health care system.

    Cara, Chantal M; Nyberg, Jan J; Brousseau, Sylvain


    For the past decade, several health care systems are undergoing continuous administrative restructuring, whose main objective is cost reduction. These changes often result in the patients' needs not being met because nurses are continuously affected by widespread budget cuts and staff downsizing. Have we reached a point, where we are setting aside our prime directive of patient well-being for the sake of finances? If so, are we at risk of forsaking our professional identity as nurses? The authors believe that caring management and economical constraints can coexist while promoting quality patient care. The purpose of this article is to show how nurse managers and administrators can facilitate caring practices while maintaining their financial responsibilities within the health care organization. This article suggests several strategies for assisting nurse managers in promoting caring in the health care environment. PMID:21157259

  6. Optimal obstacle placement with disambiguations

    Ceyhan, Elvan; Aksakalli, Vural


    arXiv:1201.5076v3 [stat.AP] 14 Jan 2013 The Annals of Applied Statistics 2012, Vol. 6, No. 4, 1730–1774 DOI: 10.1214/12-AOAS556 c Institute of Mathematical Statistics, 2012 OPTIMAL OBSTACLE PLACEMENT WITH DISAMBIGUATIONS By Vural Aksakalli and Elvan Ceyhan Istanbul S¸ehir University and Ko¸c University We introduce the optimal obstacle placement with disambigua-tions problem wherein the goal is to place true obstacles in an en-vironment cluttered with false obst...

  7. Primary care training and the evolving healthcare system.

    Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V


    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. PMID:22786734

  8. [A theoretical analysis of coordination in the field of health care: application to coordinated care systems].

    Sebai, Jihane


    Various organizational, functional or structural issues have led to a review of the foundations of the former health care system based on a traditional market segmentation between general practice and hospital medicine, and between health and social sectors and marked by competition between private and public sectors. The current reconfiguration of the health care system has resulted in “new” levers explained by the development of a new organizational reconfiguration of the primary health care model. Coordinated care structures (SSC) have been developed in this context by making coordination the cornerstone of relations between professionals to ensure global, continuous and quality health care. This article highlights the contributions of various theoretical approaches to the understanding of the concept of coordination in the analysis of the current specificity of health care. PMID:27392057

  9. Directional Preconditioner for High Frequency Obstacle Scattering

    Ying, Lexing


    The boundary integral method is an efficient approach for solving time-harmonic obstacle scattering problems by a bounded scatterer. This paper presents the directional preconditioner for the iterative solution of linear systems of the boundary integral method. This new preconditioner builds a data-sparse approximation of the integral operator, transforms it into a sparse linear system, and computes an approximate inverse with efficient sparse and hierarchical linear algebra algorithms. This ...

  10. Obstacles, strenghts and weaknesses

    Akinyemi, Okoro Monday


    In drawing a conclusion for this study, care must be taken in generalizing findings since the population of students and teachers investigated were limited to certain levels in the different schools and countries. This study recognized some complexity of the factors underlying the status of school gardening instruction and activities in Germany, Nigeria and the U.S. as inadequate time for decision-making in the process of gardening, motivation of teachers and students. This was seen as the ma...

  11. Validity Assessment of Referral Decisions at a VA Health Care System Polytrauma System of Care.

    Chung, Joyce; Aguila, Fatima; Harris, Odette


    There has been intensive interest to ensure equitable and appropriate access to the specialized rehabilitative services of the VA Polytrauma System of Care (PSC) for patients sustaining polytrauma and traumatic brain injuries (TBI). A retrospective cohort study with prospective data acquisition was conducted to assess validity and objectivity of the acceptance decision algorithm to the VA Palo Alto Health Care System (VAPAHCS) PSC. Our hypotheses are (1) VAPAHCS PSC referral decisions were appropriate and without bias and (2) the identified needs of redirected referrals were addressed. This analysis included 1,025 referrals (906 patients); 813 patients (89.7%) were accepted, and 93 (10.3%) were redirected. Redirected cases were older, were more often active duty service members, and were not from the West Coast. There were more females redirected due to concomitant spinal cord injury. These are rationale differences. In redirected patients, the most commonly identified rehabilitation needs were psychological support, mobility/physical therapy, and communication/speech services; >75% of patients had these services offered elsewhere outside of the PSC resources. While balancing financial stewardship and meeting our mission to provide outstanding rehabilitative care to veterans and service members, we demonstrated that acceptance decisions were valid and without bias, and redirected patients received appropriate alternate resources. PMID:26180664

  12. Princeton HealthCare System name reflects comprehensive services. New brand identity focuses on 'Redefining Care'.

    Botvin, Judith D


    The Medical Center at Princeton, Princeton, N.J., introduced its new name last June, both to its community and its internal stakeholders. It is now known as Princeton HealthCare System, a name chosen to reflect its growth and diversity. It's being branded as a unique institution that combines the sensitive, caring serice of a community hospital with the sophisticated care of a teaching hospital. PMID:15162577

  13. Obstacle detection of mobile robot based on data fusion

    YUAN Xin; SU Li; SUN Li-ning


    To study the problem of obstacle detection based on multi-sensors data fusion, the multi-target track-ing theory and techniques are introduced into obstacle detection systems, and the exact position of obstacle can be determined. Data fusion problems are discussed directly based on achievable data from some sensors without considering the specific structure of each individual sensor. With respect to normal linear systems and nonlinear systems, the corresponding algorithms are proposed. The validity of the method is confirmed by simulation re-suits.

  14. Obstacle problems in mathematical physics

    Rodrigues, J-F


    The aim of this research monograph is to present a general account of the applicability of elliptic variational inequalities to the important class of free boundary problems of obstacle type from a unifying point of view of classical Mathematical Physics.The first part of the volume introduces some obstacle type problems which can be reduced to variational inequalities. Part II presents some of the main aspects of the theory of elliptic variational inequalities, from the abstract hilbertian framework to the smoothness of the variational solution, discussing in general the properties of the free boundary and including some results on the obstacle Plateau problem. The last part examines the application to free boundary problems, namely the lubrication-cavitation problem, the elastoplastic problem, the Signorini (or the boundary obstacle) problem, the dam problem, the continuous casting problem, the electrochemical machining problem and the problem of the flow with wake in a channel past a profile.

  15. The next pandemic: anticipating an overwhelmed health care system.

    Duley, Mary Grace Keating


    INTRODUCTION: In September 2005, an overview of current health care system planning efforts was presented to the audience at the Yale University Ethics Symposium on Avian and Pandemic Influenza. The speaker, also the author of this article, provided the audience with a summary of what was being undertaken with the use of federal preparedness funds to improve the overall infrastructure of the health care system. All of Connecticut's 31 acute care hospitals, the Veteran's Administration Hospita...

  16. Mean curvature flow with obstacles

    Almeida, Luís; Novaga, Matteo


    We consider the evolution of fronts by mean curvature in the presence of obstacles. We construct a weak solution to the flow by means of a variational method, corresponding to an implicit time-discretization scheme. Assuming the regularity of the obstacles, in the two-dimensional case we show existence and uniqueness of a regular solution before the onset of singularities. Finally, we discuss an application of this result to the positive mean curvature flow.

  17. Obstacle Avoidance for Unmanned Undersea Vehicle in Unknown Unstructured Environment

    Zheping Yan


    Full Text Available To avoid obstacle in the unknown environment for unmanned undersea vehicle (UUV, an obstacle avoiding system based on improved vector field histogram (VFH is designed. Forward looking sonar is used to detect the environment, and the divisional sonar modal is applied to deal with the measure uncertainty. To adapt to the VFH, rolling occupancy grids are used for the map building, and high accuracy details of local environment are obtained. The threshold is adaptively adjusted by the statistic of obstacles to solve the problem that VFH is sensitive to threshold. To improve the environment adaptability, the hybrid-behaviors strategy is proposed, which selects the optimal avoidance command according to the motion status and environment character. The simulation shows that UUV could avoid the obstacles fast and escape from the U shape obstacles.

  18. Setting goals and targets for performance standards within the Swedish health care system.

    Axelsson, L; Svensson, P G


    The development of any health care system towards setting goals and targets and intended outcomes--with national guidelines, a legislative framework, limited resources, consumer influence and competitive forces--makes great demands on the control mechanisms required. The Swedish health care system has no tradition of goal formulation of this type. Hence, the purpose of this article is to clarify the goal-setting process of performance standards, and to examine whether goal setting is a relevant method within the organization of a Swedish county council. Goal setting can be seen partly as a control method and partly as an administrative process. The approach used is a combination of qualitative and quantitative methods. Data have been collected from interviews, observations, notes taken in the field and available performance statistics. The analysis shows that working towards a goal is made easier through a common and simple concept. It 'stands and falls' with the management of the work and its manager. Good communications and information are important prerequisites if goal formulation, through dialogue, is to succeed. This process takes time and can be described as an iterative process, in which a common behaviour pattern develops a 'we-feeling' which spreads among the staff. It is important that the goal is relevant and directly related to the basic objects of the work. It is also crucial that the goal is realistic and reflects a priority. Goal formulation relating to performance standards can be a contributing factor to staff's experience of job satisfaction through increased engagement and motivation, and to the satisfaction of patients/relatives with the care given. It is difficult to formulate performance standards; there are many problems and obstacles. If goal formulation as a control method within the health care system in Sweden is to work, clearer manifestations of political will are necessary and also better measuring methods in order to guage

  19. Foster Care and College: The Educational Aspirations and Expectations of Youth in the Foster Care System

    Kirk, Chris M.; Lewis, Rhonda K.; Nilsen, Corinne; Colvin, Deltha Q.


    Despite an overall increase in college attendance, low-income youth and particularly those in the foster care system are less likely to attend college (Wolanin, 2005). Although youth in foster care report high educational aspirations, as little as 4% obtain a 4-year college degree (Nixon & Jones, 2007). The purpose of this study is to explore…

  20. Research on UAV Intelligent Obstacle Avoidance Technology During Inspection of Transmission Line

    Wei, Chuanhu; Zhang, Fei; Yin, Chaoyuan; Liu, Yue; Liu, Liang; Li, Zongyu; Wang, Wanguo

    Autonomous obstacle avoidance of unmanned aerial vehicle (hereinafter referred to as UAV) in electric power line inspection process has important significance for operation safety and economy for UAV intelligent inspection system of transmission line as main content of UAV intelligent inspection system on transmission line. In the paper, principles of UAV inspection obstacle avoidance technology of transmission line are introduced. UAV inspection obstacle avoidance technology based on particle swarm global optimization algorithm is proposed after common obstacle avoidance technologies are studied. Stimulation comparison is implemented with traditional UAV inspection obstacle avoidance technology which adopts artificial potential field method. Results show that UAV inspection strategy of particle swarm optimization algorithm, adopted in the paper, is prominently better than UAV inspection strategy of artificial potential field method in the aspects of obstacle avoidance effect and the ability of returning to preset inspection track after passing through the obstacle. An effective method is provided for UAV inspection obstacle avoidance of transmission line.

  1. New systems of care for substance use disorders: treatment, finance, and technology under health care reform.

    Pating, David R; Miller, Michael M; Goplerud, Eric; Martin, Judith; Ziedonis, Douglas M


    This article outlined ways in which persons with addiction are currently underserved by our current health care system. However, with the coming broad scale reforms to our health care system, the access to and availability of high-quality care for substance use disorders will increase. Addiction treatments will continue to be offered through traditional substance abuse care systems, but these will be more integrated with primary care, and less separated as treatment facilities leverage opportunities to blend services, financing mechanisms, and health information systems under federally driven incentive programs. To further these reforms, vigilance will be needed by consumers, clinicians, and policy makers to assure that the unmet treatment needs of individuals with addiction are addressed. Embedded in this article are essential recommendations to facilitate the improvement of care for substance use disorders under health care reform. Ultimately, as addiction care acquires more of the “look and feel” of mainstream medicine, it is important to be mindful of preexisting trends in health care delivery overall that are reflected in recent health reform legislation. Within the world of addiction care, clinicians must move beyond their self-imposed “stigmatization” and sequestration of specialty addiction treatment. The problem for addiction care, as it becomes more “mainstream,” is to not comfortably feel that general slogans like “Treatment Works,” as promoted by Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment during its annual Recovery Month celebrations, will meet the expectations of stakeholders outside the specialty addiction treatment community. Rather, the problem is to show exactly how addiction treatment works, and to what extent it works-there have to be metrics showing changes in symptom level or functional outcome, changes in health care utilization, improvements in workplace attendance and

  2. Novel approaches to helicopter obstacle warning

    Seidel, Christian; Samuelis, Christian; Wegner, Matthias; Münsterer, Thomas; Rumpf, Thomas; Schwartz, Ingo


    EADS Germany is the world market leader in commercial Helicopter Laser Radar (HELLAS) Obstacle Warning Systems. The HELLAS-Warning System has been introduced into the market in 2000, is in service at German Border Control (Bundespolizei) and Royal Thai Airforce and is successfully evaluated by the Foreign Comparative Test Program (FCT) of the USSOCOM. Currently the successor system HELLAS-Awareness is in development. It will have extended sensor performance, enhanced realtime data processing capabilities and advanced HMI features. We will give an outline of the new sensor unit concerning detection technology and helicopter integration aspects. The system provides a widespread field of view with additional dynamic line of sight steering and a large detection range in combination with a high frame rate of 3Hz. The workflow of the data processing will be presented with focus on novel filter techniques and obstacle classification methods. As commonly known the former are indispensable due to unavoidable statistical measuring errors and solarisation. The amount of information in the filtered raw data is further reduced by ground segmentation. The remaining raised objects are extracted and classified in several stages into different obstacle classes. We will show the prioritization function which orders the obstacles concerning to their threat potential to the helicopter taking into account the actual flight dynamics. The priority of an object determines the display and provision of warnings to the pilot. Possible HMI representation includes video or FLIR overlay on multifunction displays, audio warnings and visualization of information on helmet mounted displays and digital maps. Different concepts will be presented.

  3. Nonholonomic feedback control among moving obstacles

    Armstrong, Stephen Gregory

    A feedback controller is developed for navigating a nonholonomic vehicle in an area with multiple stationary and possibly moving obstacles. Among other applications the developed algorithms can be used for automatic parking of a passenger car in a parking lot with complex configuration or a ground robot in cluttered environment. Several approaches are explored which combine nonholonomic systems control based on sliding modes and potential field methods.

  4. Catastrophic disasters and the design of disaster medical care systems.

    Mahoney, L E; Reutershan, T P


    The National Disaster Medical System (NDMS) is aimed at medical care needs resulting from catastrophic earthquakes, which may cause thousands of deaths and injuries. Other geophysical events may cause great mortality, but leave few injured survivors. Weather incidents, technological disasters, and common mass casualty incidents cause much less mortality and morbidity. Catastrophic disasters overwhelm the local medical care system. Supplemental care is provided by disaster relief forces; this care should be adapted to prevalent types of injuries. Most care should be provided at the disaster scene through supplemental medical facilities, while some can be provided by evacuating patients to distant hospitals. Medical response teams capable of stabilizing, sorting, and holding victims should staff supplemental medical facilities. The NDMS program includes hospital facilities, evacuation assets, and medical response teams. The structure and capabilities of these elements are determined by the medical care needs of the catastrophic disaster situation. PMID:3631673

  5. Large-System Transformation in Health Care: A Realist Review

    Best, Allan; Greenhalgh, Trisha; Lewis, Stephen; Saul, Jessie E.; Carroll, Simon; Bitz, Jennifer


    Context: An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait l...

  6. Obstacles, levers and impacts of organic farming development in Camargue

    Delmotte, Sylvestre; Lacombe, C.; Couderc, Vincent; Mailly, F; Mouret, J.C.; Lopez-Ridaura, S; Barbier, J.M.


    We are presenting an analysis of the obstacles and levers for the development of organic cropping systems in Camargue, documented with a multicriteria analysis of scenarios of organic farming (OF) development. This communication is built using results from on-farm agronomic monitoring, stakeholders and farmers’ interviews and the use of models for integrated assessment of scenarios. At the farm level, the obstacles are related to identification of profitable cropping systems and rotations tha...

  7. Characterizing emergency departments to improve understanding of emergency care systems

    Steptoe, Anne P; Corel, Blanka; Sullivan, Ashley F; Camargo, Carlos A.


    International emergency medicine aims to understand different systems of emergency care across the globe. To date, however, international emergency medicine lacks common descriptors that can encompass the wide variety of emergency care systems in different countries. The frequent use of general, system-wide indicators (e.g. the status of emergency medicine as a medical specialty or the presence of emergency medicine training programs) does not account for the diverse methods that contribute t...

  8. Effects of Quality Improvement System for Child Care Centers

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace


    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  9. Physician leadership: a health-care system's investment in the future of quality care.

    Orlando, Rocco; Haytaian, Marcia


    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system. PMID:23248866

  10. Teaching Evidence-Based Practice to Undergraduate Nursing Students: Overcoming Obstacles

    Martin, Sharon D.


    Evidence-based practice is highly valued in health care literature at this time. But research suggests that U.S. RNs face many obstacles when implementing evidence-based practice including a lack of value for research in practice (Pravikoff et al, 2005). Additional obstacles may exist for traditional U.S. BSN nursing students who may not value the…

  11. Antimicrobial Stewardship Programs in Health Care Systems

    MacDougall, Conan; Polk, Ron E.


    Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based o...

  12. Medicaid Managed Care in an Integrated Health Care Delivery System: Lessons from Geisinger's Early Experience.

    Maeng, Daniel D; Snyder, Susan R; Baumgart, Charles; Minnich, Amy L; Tomcavage, Janet F; Graf, Thomas R


    Many states in the United States, including Pennsylvania, have opted to rely on private managed care organizations to provide health insurance coverage for their Medicaid population in recent years. Geisinger Health System has been one such organization since 2013. Based on its existing care management model involving data-driven population management, advanced patient-centered medical homes, and targeted case management, Geisinger's Medicaid management efforts have been redesigned specifically to accommodate those with complex health care issues and social service needs to facilitate early intervention, effective and efficient care support, and ultimately, a positive impact on health care outcomes. An analysis of Geisinger's claims data suggests that during the first 19 months since beginning Medicaid member enrollment, Geisinger's Medicaid members, particularly those eligible for the supplemental security income benefits, have incurred lower inpatient, outpatient, and professional costs of care compared to expected levels. However, the total cost savings were partially offset by the higher prescription drug costs. These early data suggest that an integrated Medicaid care management effort may achieve significant cost of care savings. (Population Health Management 2016;19:257-263). PMID:26565693

  13. 脑卒中吞咽障碍患者对人性化护理需求的研究%Stroke patients with swallow obstacle to the study of humanized care needs

    胡玮琳; 李保兰; 陈海; 冯丽华; 卢琦


    Objective:To investigate in stroke patients with swallow obstacle to the characteristics of the needs of the humanized nursing and analyze its influencing factors, and provide a theoretical basis for improve the humanized nursing measures. Methods The questionnaire was designed by, through the pre - experiments verify the reliability and validity of the questionnaire. Formal investigation using cluster sampling, 90 effective questionnaires were recovered, will investigate data entry SPSS13.0 to internal consistency check descriptive analysis, correlation analysis and exploratory factor analysis. Results Pre - survey two score each item there was no statistically significant difference (P > 0.05). Questionnaire total Cronbach's alpha coefficient is 0.85 the factors Cronbach 's alpha coefficients is greater than 0.76, the relevance of the project and its subordinate factors is stronger, principal component analysis after extraction of five male factor, the cumulated variance contribution rate reached 63.47% . Conclusion Initially formed including the five dimensions of 18 items "swallowing disorder in patients with cerebral apoplexy humanized care needs questionnaire the questionnaire has good representativeness.%目的:调查住院脑卒中吞咽障碍患者对人性化护理需求的特点并分析其影响因素,为改进人性化护理措施提供理论依据.方法:采用自行设计的调查表,通过预实验检验调查表的信度、效度.正式调查采用整群抽样,共收回90份有效问卷,将调查数据录入SPSS13.0进行内部一致性检验、相关性分析和探索性因子分析以及描述性分析结果预调查两次评分各条目差异无统计学意义(P>0.05).调查表总Cronbach's α系数为0.85各因素Cronbach's α系数均大于0.76,各项目与其所属因素的相关性较强,主成分分析后共提取5个公因子,其累积方差贡献率达到63.47%.结论:初步形成了包括5个维度18个条目的“脑卒中吞咽障

  14. The POIS (Parkland On-Line Information System) Implementation of the IBM Health Care Support/Patient Care System

    Mishelevich, David J.; Hudson, Betty G.; Van Slyke, Donald; Mize, Elaine I.; Robinson, Anna L.; Brieden, Helen C.; Atkinson, Jack; Robertson, James


    The installation of major components of a comprehensive Hospital Information System (HIS) called POIS, the Parkland On-line Information System, including identified success factors is described for the Dallas County Hospital District (DCHD) known also as the Parkland Memorial Hospital. Installation of the on-line IBM Health Care Support (HCS) Registration and Admissions Packages occurred in 1976 and implementation of the HCS Patient Care System (PCS) began in 1977 which includes on-line suppo...

  15. Would you care for some integrated care in your fragmented health system? A participatory action research to improve integration between levels of care in a Belgian urban setting.

    Belche, Jean; Duchesnes, Christiane; Darras, Christian; Van der Vennet, Jean; Monet, Francis; Unger, Jean-Pierre; Giet, Didier


    Integration between levels of care is not facilitated by the Belgian health system. Indeed, patients have uninhibited access to every level of care, there is no gatekeeping system, and no structural coordination between levels of care. Meanwhile, on one hand, the occurrence of more complex care situations in the ambulatory setting is enhancing the need for coordination while on the other hand, hospitals face financial constraints to provide care in the community. The aim of the research ...

  16. Obstacle negotiation control for a mobile robot suspended on overhead ground wires by optoelectronic sensors

    Zheng, Li; Yi, Ruan


    Power line inspection and maintenance already benefit from developments in mobile robotics. This paper presents mobile robots capable of crossing obstacles on overhead ground wires. A teleoperated robot realizes inspection and maintenance tasks on power transmission line equipment. The inspection robot is driven by 11 motor with two arms, two wheels and two claws. The inspection robot is designed to realize the function of observation, grasp, walk, rolling, turn, rise, and decline. This paper is oriented toward 100% reliable obstacle detection and identification, and sensor fusion to increase the autonomy level. An embedded computer based on PC/104 bus is chosen as the core of control system. Visible light camera and thermal infrared Camera are both installed in a programmable pan-and-tilt camera (PPTC) unit. High-quality visual feedback rapidly becomes crucial for human-in-the-loop control and effective teleoperation. The communication system between the robot and the ground station is based on Mesh wireless networks by 700 MHz bands. An expert system programmed with Visual C++ is developed to implement the automatic control. Optoelectronic laser sensors and laser range scanner were installed in robot for obstacle-navigation control to grasp the overhead ground wires. A novel prototype with careful considerations on mobility was designed to inspect the 500KV power transmission lines. Results of experiments demonstrate that the robot can be applied to execute the navigation and inspection tasks.

  17. Diabetes care for emerging adults: transition from pediatric to adult diabetes care systems

    Lee, Young Ah


    With the increasing prevalence of diabetes mellitus in children, transitioning patients from childhood to adulthood are increasing. High-risk behaviors and poor glycemic control during the transition period increase the risk for hypoglycemia and hyperglycemia as well as chronic microvascular and macrovascular complications. Discussions regarding complications and preparations for transition must take place before the actual transition to adult care systems. Pediatric care providers should foc...

  18. Embedding effective depression care: using theory for primary care organisational and systems change

    Gunn Jane M


    , which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences. Conclusions Ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depression.

  19. Uncovering the systemic issues that reside in home care

    Giannasi, Wynona


    This video clip comprises the Keynote Address: “Uncovering the systemic issues that reside in home care” held at the 21st Annual John K. Friesen Conference, "Innovations in Home Care: A Public Policy Perspective," MAY 16-17, 2012, Vancouver, BC. Presented by Wynona Giannasi, Partner, Howegroup – Public Sector Consultants, Vancouver BC. It is well known that jurisdictions with more comprehensive and integrated home care delivery systems are able to extend independent living for older p...

  20. Using Electronic Health Record Systems in Diabetes Care: Emerging Practices.

    Veinot, Tiffany C; Zheng, Kai; Lowery, Julie C; Souden, Maria; Keith, Rosalind


    While there has been considerable attention devoted to the deployment of electronic health record (EHR) systems, there has been far less attention given to their appropriation for use in clinical encounters - particularly in the context of complex, chronic illness. The Department of Veterans' Affairs (VA) has been at the forefront of EHR adoption and, as such, provides a unique opportunity to examine a mature EHR system in widespread use. Moreover, with a high prevalence of diabetes in its patient population, the VA provides a useful platform for examining EHR use in the context of chronic disease care. We conducted a sequential, exploratory qualitative study at two VA Medical Centers in the Midwest. First, we conducted observations of 64 clinical consultations with diabetes patients. These observations involved 31 different health care providers. Second, using insights from these observations, we conducted in-depth, semi-structured interviews with 39 health care providers focusing on their use of information in diabetes patient care. Field notes and interview transcripts were analyzed using a grounded theory approach. Our analysis generated several categories of EHR use in clinical encounters: priming, structuring, assessing, informing, and continuing. We also outline some mismatches between EHR system design and VA diabetes care practices. We conclude by discussing implications of these emergent system uses for improving the software design of EHRs to better support chronic disease care, as well as for our understanding of the integration of technologies in health care. PMID:25264545

  1. Five Obstacles to Grading Reform

    Guskey, Thomas R.


    Educators seeking to reform grading must combat five long-held traditions that stand as formidable obstacles to change: (1) Grades should provide the basis for differentiating students; (2) grade distributions should resemble a bell-shaped curve; (3) grades should be based on students' standing among classmates; (4) poor grades prompt students to…

  2. Obstacle detection using thermal imaging sensors for large passenger airplane

    Shi, Jie


    This thesis addresses the issue of ground collision in poor weather conditions. As bad weather is an adverse factor when airplanes are taxiing, an obstacle detection system based on thermal vision is proposed to enhance the awareness of pilots during taxiing in poor weather conditions. Two infrared cameras are employed to detect the objects and estimate the distance of the obstacle. The distance is computed by stereo vision technology. A warning will be given if the distance is less than the ...

  3. Obstacles to Rural Residents' Consumption in China and the Countermeasures

    Huang, Yi


    On the basis of relevant statistical data, this paper analyzes the obstacles to rural residents' consumption in China as follows, the consumption structure is restricted critically; the consumption environment cannot meet the need of social development; the traditional consumption concept has not yet been changed; the social security system is not sound; the support of rural finance is short. Pointed countermeasures for eliminating the obstacles to rural residents' consumption are put forward...

  4. A clinician-driven home care delivery system.

    August, D A; Faubion, W C; Ryan, M L; Haggerty, R H; Wesley, J R


    The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal. PMID:8242586

  5. Enhancing Health-Care Services with Mixed Reality Systems

    Stantchev, Vladimir

    This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

  6. Passive detection of subpixel obstacles for flight safety

    Nixon, Matthew D.; Loveland, Rohan C.


    Military aircraft fly below 100 ft. above ground level in support of their missions. These aircraft include fixed and rotary wing and may be manned or unmanned. Flying at these low altitudes presents a safety hazard to the aircrew and aircraft, due to the occurrences of obstacles within the aircraft's flight path. The pilot must rely on eyesight and in some cases, infrared sensors to see obstacles. Many conditions can exacerbate visibility creating a situation in which obstacles are essentially invisible, creating a safety hazard, even to an alerted aircrew. Numerous catastrophic accidents have occurred in which aircraft have collided with undetected obstacles. Accidents of this type continue to be a problem for low flying military and commercial aircraft. Unmanned Aerial Vehicles (UAVs) have the same problem, whether operating autonomously or under control of a ground operator. Boeing-SVS has designed a passive, small, low- cost (under $100k) gimbaled, infrared imaging based system with advanced obstacle detection algorithms. Obstacles are detected in the infrared band, and linear features are analyzed by innovative cellular automata based software. These algorithms perform detection and location of sub-pixel linear features. The detection of the obstacles is performed on a frame by frame basis, in real time. Processed images are presented to the aircrew on their display as color enhanced features. The system has been designed such that the detected obstacles are displayed to the aircrew in sufficient time to react and maneuver the aircraft to safety. A patent for this system is on file with the US patent office, and all material herein should be treated accordingly.

  7. 40 CFR 792.43 - Test system care facilities.


    ... CONTROL ACT (CONTINUED) GOOD LABORATORY PRACTICE STANDARDS Facilities § 792.43 Test system care facilities. (a) A testing facility shall have a sufficient number of animal rooms or other test system areas, as... different tests. (b) A testing facility shall have a number of animal rooms or other test system...

  8. [President Obama's health care reform: lessons to and from the Israeli health care system].

    Balicer, Ran D; Shadmi, Efrat


    In March 2010 the United States enacted the most significant health care reform in several decades. The Patient Protection and Affordable Care Act, amongst other provisions, addresses two of the main current shortcomings of the U.S. health system: the large portion of the population that are uninsured and the high percentage of hsealth expenditures (mostly private] which amounts to about 16% of the GDP. Changes to the current structure and financing of the U.S. health system will have implications for other health systems, for science (e.g., through enhanced federal funding for comparative effectiveness research), and for technological advance (e.g., through accelerated development and use of electronic health records). There are several lessons from the reform, and the factors leading to its implementation, for the Israeli health system. Firstly, the basic principles of the Israeli health system are a source of pride, and undermining its main values can have deleterious effects. Overreliance on private, out-of-pocket, spending and lack of support for public practice of medicine (in community and hospital settings) will weaken the public sector, strengthen the private sector, and could result in a tiered lower quality and less accessible public system with greater widening of gaps in health and health care utilization. This paper reviews the main provisions of the U.S. health care reform and the potential implications for the IsraeLi health system. PMID:21939111

  9. Design and Realization of Dynamic Obstacle on URWPSSim2D

    Xiao Chen


    Full Text Available Simulation system is charged with the strategy validation and dual team meets, and as the 2-dimensional simulation platform for underwater robotic fish game, URWPGSim2D is the assigned platform for Chinese underwater robot contest and Robot cup underwater program. By now on URWPGSim2D, there is only static obstacles,thus short of changeableness. In order to improve the changeableness and innovation of robotic fish contest, to extend the space for the programming of contest strategy, and to increase the interest, this paper study the design of dynamic obstacles on URWPGSim2D, and design and implement two kinds of dynamic obstacles, which are the evadible dynamic obstacle and the forcing dribbling obstacle.  

  10. A robot arm controller with obstacle avoidance using fuzzy logic

    This study is devoted to the development of a lower level robot arm control system, which allows obstacles to be avoided using a relatively rough path and without precise map information. To achieve autonomous arm movements, the overall arm motion is divided into an obstacle avoidance component and a target point adjustment component, and movement is selected with regard to the distance between the arm and the obstacle by a higher control unit. A fuzzy rule is used for mode selection in order to maintain continuous change of control mode. The control method applied to two degrees of freedom in two dimensional space was examined by numerical simulations. The simulations verified the autonomous obstacle avoidance capability and the ability to continuously control joint angles using fuzzy logic. (author)

  11. Structuring Community Care using Multi-Agent Systems

    Beer, Martin D.

    Community care is a complex operation that requires the interaction of large numbers of dedicated individuals, managed by an equally wide range of organisations. They are also by their nature highly mobile and flexible, moving between clients in whatever order person receiving care is that they receive what they expect regularly, reliably and when they expect to receive it. Current systems are heavily provider focused on providing the scheduled care with as high apparent cost effectiveness as possible. Unfortunately, the lack of focus on the client often leads to inflexibility with expensive services being provided when they are not needed, large scale duplication of effort or inadequate flexibility to change the care regime to meet changing circumstances. Add to this the problems associated with the lack of integration of emergency and routing care and the extensive support given by friends and family and many opportunities exist to improve both the levels of support and the efficiency of care. The move towards Individual Care Plans requires much closer monitoring to ensure that the care specified for each individual is actually delivered and when linked with smart home technology in conjunction with appropriate sensors allows a much richer range of services to be offered which can be customised to meet the needs of each individual, giving them the assurance to continue to live independently.

  12. Managed care in four managed competition OECD health systems.

    Shmueli, Amir; Stam, Piet; Wasem, Jürgen; Trottmann, Maria


    Managed care emerged in the American health system in the 1980s as a way to manage suppliers' induced demand and to contain insurers' costs. While in Israel the health insurers have always been managed care organizations, owning health care facilities, employing medical personnel or contracting selectively with independent providers, European insurers have been much more passive, submitting themselves to collective agreements between insurers' and providers' associations, accompanied by extensive government regulation of prices, quantities, and budgets. With the 1990s reforms, and the introduction of risk-adjusted "managed competition", a growing pressure to allow the European insurers to manage their own care - including selective contracting with providers - has emerged, with varying speed of the introduction of policy changes across the individual countries. This paper compares experiences with managed care in Israel, The Netherlands, Germany and Switzerland since the 1990s. After a brief description of the health insurance markets in the four countries, we focus comparatively on the emergence of managed care in the markets for ambulatory care and inpatient market care. We conclude with an evaluation of the current situation and a discussion of selected health policy issues. PMID:25776034

  13. Global and local obstacle avoidance technique for an autonomous vehicle

    Gray, Keith W.; Saunders, Kevin S.


    The Center for Self-Organizing and Intelligent Systems (CSOIS) is engaged in developing autonomous ground vehicles. A significant problem for such vehicles is obstacle detection and avoidance. After studying various methods of detection, a scanning laser system was chosen that can detect objects at a distance of up to thirty feet while traveling between five and ten miles per hour. Once an object is detected, the vehicle must avoid it. The project employs a mission-level path planner that predetermines the path of a vehicle. One avoidance scheme is to inform the path planner of the obstacle and then let it re-plan the path. This is the global approach to the problem, which allows the use of existing software for maneuvering the vehicle. However, replanning is time consuming and lacks knowledge of the entire obstacle. An alternative approach is to use local avoidance, whereby a vehicle determines how to get by an obstacle without help from the path planner. This approach offers faster response without requiring the computing resource of the path planner. The disadvantage is that during local avoidance the vehicle ignores the global map of known obstacles and does not know to turn control back to the path planner if mission efficiency is adversely affected. This paper will describe a method for combining the current global path planner with a local obstacle avoidance technique to efficiently complete required tasks in a partially unknown environment.

  14. Collaborative Decision Support Systems for Primary Health care Managers

    Gunjan Pahuja


    Full Text Available In this paper, a collaborative DSS Model for health care systems and results obtained are described. The proposed framework [1] embeds expert knowledge within DSS to provide intelligent decision support, and implements the intelligent DSS using collaboration technologies. The problem space contains several Hub and Spoke networks. Information about such networks is dynamically captured and represented in a Meta-data table. This master table enables collaboration between any two networks in the problem space, through load transfer, between them. In order to show the collaboration the sample database of 15 health care centers is taken assuming that there are 5 health care centers in one network.

  15. Systems and processes that ensure high quality care.

    Bassett, Sally; Westmore, Kathryn


    This is the second in a series of articles examining the components of good corporate governance. It considers how the structures and processes for quality governance can affect an organisation's ability to be assured about the quality of care. Complex information systems and procedures can lead to poor quality care, but sound structures and processes alone are insufficient to ensure good governance, and behavioural factors play a significant part in making sure that staff are enabled to provide good quality care. The next article in this series looks at how the information reporting of an organisation can affect its governance. PMID:23252087

  16. The equity lens in the health care performance evaluation system.

    Barsanti, Sara; Nuti, Sabina


    The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the 'equity process' by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups. PMID:23722829

  17. The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems

    Menizibeya Osain Welcome


    Full Text Available Objectives : As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance. Materials and Methods : Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria. Results : Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries. Conclusion : The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine

  18. Organisational Culture Matters for System Integration in Health Care

    Munir, Samina K.; Kay, Stephen


    This paper illustrates the importance of organisational culture for Clinical Information Systems (CIS) integration. The study is based on data collected in intensive care units in the UK and Denmark. Data were collected using qualitative methods, i.e., observations, interviews and shadowing of health care providers, together with a questionnaire at each site. The data are analysed to extract salient variables for CIS integration, and it is shown that these variables can be separated into two ...

  19. Time based management in health care system: The chosen aspects

    Joanna Kobza; Magdalena Syrkiewicz-Świtała


    Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011) have be...

  20. [The Chilean Health Care System: the task ahead].

    Goic, Alejandro


    The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%. From 1952 to 2014, public health care policies made possible a remarkable improvement in Chile's health indexes: downward trends in infant mortality rate (from 117.8 to 7.2 x 1,000 live births), maternal mortality (from 276 to 18.5 x 100,000), undernourished children schooling, and years of primary school education, were significantly improved as well. Nevertheless, compared with OECD countries, Chile has a relatively low public investment in health (45.7% of total national investment), a deficit in the number of physicians (1.7 x 1,000 inhabitants) and nurses (4.8 x 1,000), in the number of hospital beds (2.1 x 1,000), and in the availability of generic drugs in the market (30%). Chile and the USA are the two OECD countries with the lowest public investment in health. A generalized dissatisfaction with the current Chilean health care model and the need of the vast majority of the population for timely access to acceptable quality medical care are powerful arguments which point to the need for a universal public health care system. The significant increase in public expenditure on health care which such a system would demand requires a sustainable growth of the Chilean economy. PMID:26230561

  1. Obstacle crossing in lower limb amputees

    Vrieling, A.H.; van Keeken, H.G.; Schoppen, Tanneke; Otten, Egbert; Halbertsma, J.P.; Hof, A.L.; Postema, K.


    Objective: To study limitations in function and adjustment strategies in lower limb amputees during obstacle crossing. Design: Observational cohort study. Subjects: Transfemoral and transtibial amputees and able-bodied control subjects. Methods: In a motion analysis laboratory unimpeded and obstacle

  2. Reviewing Security and Privacy Aspects in Combined Mobile Information System (CMIS) for health care systems

    Kunwar, Ramesh; Al-Leddawi, Mustafa


    Medical area has been benefited by the use of ICT (Information and Communication Technology) in recent days. CMIS (Combined Mobile Information System), our proposed model system, is such a system targeted for health care system. IMIS (Integrated Mobile Information System), a system for diabetic healthcare, which is being developed in Blekinge Institute of Technology will be taken as a case study for our proposed system. CMIS is a multi-role system with core service being medical-care related ...

  3. Care and Conversing in Dialogical Systems

    Steffensen, Sune Vork


    positions, a theory of dialogical systems is developed, on the basis of current thinking within the enactive program (e.g. De Jaegher and Di Paolo, 2007), the distributed language movement (e.g. Cowley, 2011b), and values-realizing theory (e.g. Hodges, 2009). Dialogical systems are systems of co...... in a tradition that is ecological, embodied and distributed. Its specific take on human interaction pursues these perspectives by claiming that language can neither be reduced to social rules in the micro-sociological domain, nor to biological properties of the individual being. As an alternative to these two...

  4. Fresnel diffraction by spherical obstacles

    Hovenac, Edward A.


    Lommel functions were used to solve the Fresnel-Kirchhoff diffraction integral for the case of a spherical obstacle. Comparisons were made between Fresnel diffraction theory and Mie scattering theory. Fresnel theory is then compared to experimental data. Experiment and theory typically deviated from one another by less than 10 percent. A unique experimental setup using mercury spheres suspended in a viscous fluid significantly reduced optical noise. The major source of error was due to the Gaussian-shaped laser beam.

  5. The Durham Family Initiative: A Preventive System of Care

    Dodge, Kenneth A.; Berlin, Lisa J.; Epstein, Matthew; Spitz-Roth, Adele; O'Donnell, Karen; Kaufman, Martha; Amaya-Jackson, Lisa; Rosch, Joel; Christopoulos, Christina


    This article describes the Durham Family Initiative (DFI), an innovative effort to bring together child welfare and juvenile justice systems to reach DFI's goal of reducing the child abuse rate in Durham, North Carolina, by 50% within the next 10 years. DFI will follow principles of a preventive system of care (PSoC), which focuses on nurturing…

  6. 40 CFR 160.43 - Test system care facilities.


    ... GOOD LABORATORY PRACTICE STANDARDS Facilities § 160.43 Test system care facilities. (a) A testing... testing facility shall have a number of animal rooms or other test system areas separate from those... sanitary storage of waste before removal from the testing facility. Disposal facilities shall be...

  7. The Role of Education in Systems of Care.

    Liberton, Cindy J., Ed.; And Others

    Eight papers presented at a March 1993 conference address the role of education in systems of care for children's mental health. Papers have the following titles and authors: (1) "Interagency Collaboration through a School-Based Wraparound Approach: A Systems Analysis Summary of Project WRAP" (Lucille Eber and Carol Stieper); (2) "Baseline…

  8. Evidence Based Order Sets as a Nursing Care Planning System

    LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria


    The process for developing the nursing care planning (NCP) function for integration into a clinical information system (CIS) will be described. This NCP system uses evidence based order sets or interventions that are specific to a problem with associated patient focused goals or outcomes. The problem, order set, goal framework will eventually be used by all disciplines in the patient focused record.

  9. Motivation Driven Multiagent Systems Coordination in Health Care

    Zhang, Peng; Bai, Guohua


    This paper explores MultiAgent Systems coordination from a socio-psychological point of view. Activity Theory is introduced to explain the coordination among intelligent agents. The hierarchy and motivation thinking from Activity Theory is used to define the motivation driven MultiAgent Systems coordination mechanism. Finally, we apply this mechanism into a health care scenario.

  10. Laser-Based Obstacle Detection at Railway Level Crossings

    Vítor Amaral


    Full Text Available This paper presents a system for obstacle detection in railway level crossings from 3D point clouds acquired with tilting 2D laser scanners. Although large obstacles in railway level crossings are detectable with current solutions, the detection of small obstacles remains an open problem. By relying on a tilting laser scanner, the proposed system is able to acquire highly dense and accurate point clouds, enabling the detection of small obstacles, like rocks laying near the rail. During an offline training phase, the system learns a background model of the level crossing from a set of point clouds. Then, online, obstacles are detected as occupied space contrasting with the background model. To reduce the need for manual on-site calibration, the system automatically estimates the pose of the level crossing and railway with respect to the laser scanner. Experimental results show the ability of the system to successfully perform on a set of 41 point clouds acquired in an operational one-lane level crossing.

  11. Difficulties reporting system in intensive care

    Claudio Bianchin


    Full Text Available In 2005, Belluno Health Authority’s Resuscitation Unit took part in a regional project coordinated by Veneto Regional Health and Social Services to test an incident re p o rting system. The main aims were to experiment an electronic incident rep o rting sheet and the relative computerised procedure for data e n t ry and analysis with the aim of developing an incident rep o rting system. The Australian Incident Monitoring System (AIMS was designed to obtain information about the event, the context and concomitant causes. We observed 58 anonymous incident reports over a six-month period. The main incidents include issues relating to the management of medication, the a i rways, catheters and equipment. Most incidents had modest consequences or led to temporary disability and they often caused longer hospitalisation or further treatment and investigations. Communication problems, inadequate superv i s i o n , poor teamwork and difficulties in applying procedures and protocols were the contributory factors most frequently identified as the concomitant causes of the incidents. The report sheet and experience as a whole were evaluated favourably by the operators involved. This reporting system does not provide the real frequency of the adverse events, but it does provide useful information for improving patient safety.

  12. Effectively marketing prepaid medical care with decision support systems.

    Forgionne, G A


    The paper reports a decision support system (DSS) that enables health plan administrators to quickly and easily: (1) manage relevant medical care market (consumer preference and competitors' program) information and (2) convert the information into appropriate medical care delivery and/or payment policies. As the paper demonstrates, the DSS enables providers to design cost efficient and market effective medical care programs. The DSS provides knowledge about subscriber preferences, customer desires, and the program offerings of the competition. It then helps administrators structure a medical care plan in a way that best meets consumer needs in view of the competition. This market effective plan has the potential to generate substantial amounts of additional revenue for the program. Since the system's data base consists mainly of the provider's records, routine transactions, and other readily available documents, the DSS can be implemented at a nominal incremental cost. The paper also evaluates the impact of the information system on the general financial performance of existing dental and mental health plans. In addition, the paper examines how the system can help contain the cost of providing medical care while providing better services to more potential beneficiaries than current approaches. PMID:10111964

  13. Exposure management systems in emergencies as comprehensive medical care

    The emergency management of nuclear hazards relies on a comprehensive medical care system that includes accident prevention administration, environmental monitoring, a health physics organization, and a medical institution. In this paper, the care organization involved in the criticality accident at Tokai-mura is described, and the problems that need to be examined are pointed out. In that incident, even the expert was initially utterly confused and was unable to take appropriate measures. The author concluded that the members of the care organization were all untrained for dealing with nuclear hazards and radiation accidents. The education and training of personnel at the job site are important, and they are even more so for the leaders. Revisions of the regional disaster prevention plans and care manual are needed. (K.H.)

  14. Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

    Powers, Sharon; Bacon, Cynthia Thornton


    The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges. PMID:27259130

  15. Unfinished nursing care: An important performance measure for nursing care systems.

    VanFosson, Christopher A; Jones, Terry L; Yoder, Linda H


    Performance measurement is a core administrative function and an essential component of organizational quality programs. The prevalence of performance measurement initiatives increased significantly after the release of the Institute of Medicine series on quality. Nursing performance measures are limited in their scope, resulting in an underrepresentation of process measures. Development of performance indicators that reflect how effectively organizational units actually transform nursing resources into nursing services should be a high priority. Unfinished nursing care is a nursing process performance measure that reflects the complexity of the nursing care environment and can be useful in comparing process performance across systems and organizations. Unfinished nursing care is congruent with many of the National Quality Forum requirements for endorsement and warrants further refinement as an important nurse-sensitive performance measure. PMID:26850334

  16. Infection control and changing health-care delivery systems.

    Jarvis, W. R.


    In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly. The home-care industry and managed care have become major providers of health ca...

  17. Managing health care system in small island countries: Palau.

    Kuartei, Stevenson


    Managing health systems in small island countries carry with it challenges that are common with other small communities around the world but also articulates for unique challenges that are intrinsically that of small island countries. Sustainability of economies and the small population in small island countries in the Pacific dictates how health care services align and organize to meet the needs of their population. This paper is an attempt to outline possible strategies that could be implemented in view of the ever decreasing meager resources. It will outline a step approach toward realignment and reengineering a viable health care system that is hopefully both cost effective and outcome oriented. PMID:18181405

  18. An intelligent partner system for improving chronic illness care

    Tibor Deutsch


    Full Text Available Chronic care consists of a sequence of actions to treat a specific clinical disorder over time as a function of the ways in which illness progresses and patients respond to management actions. Outcomes depend on physicians' skills to select the actions best suited for their patients and competent self-management. This paper presents the architecture of an intelligent partner system (IPS, which helps to provide doctors with relevant data and skills and empowers chronically ill patients with the information and confidence to manage their health wisely. The services of this intelligent system are presented as 'therapies' for the information-processing 'pathologies' associated with traditional chronic illness care.

  19. What is Clinical Safety in Electronic Health Care Record Systems?

    Davies, George

    There is mounting public awareness of an increasing number of adverse clinical incidents within the National Health Service (NHS), but at the same time, large health care projects like the National Programme for IT (NPFIT) are claiming that safer care is one of the benefits of the project and that health software systems in particular have the potential to reduce the likelihood of accidental or unintentional harm to patients. This paper outlines the approach to clinical safety management taken by CSC, a major supplier to NPFIT; discusses acceptable levels of risk and clinical safety as an end-to-end concept; and touches on the future for clinical safety in health systems software.

  20. Digital remote viewing system for coronary care unit

    A digital remote viewing system developed for the coronary care unit at the UCLA Medical Center has been in clinical operation since March 1, 1987. The present system consists of three 512-line monitors, VAX 11/750, Gould IP8500 image processor and a broad-band communication system. The patients' images are acquired with a computed radiography system and are transmitted to the coronary care unit, which is five floors above the radiology department. This exhibit presents the architecture and the performance characteristics of the system. Also, the second-generation system, which consists of an intelligent local work station with three 1,024-line monitors and a fast digital communication network, will be introduced

  1. Reconfigurable point-of-care systems designed with interoperability standards.

    Warren, Steve; Yao, Jianchu; Schmitz, Ryan; Lebak, Jeff


    Interoperability standards, if properly applied to medical system design, have the potential to decrease the cost of point-of-care monitoring systems while better matching systems to patient needs. This paper presents a brief editorial overview of future monitoring environments, followed by a short listing of smart-home and wearable-device efforts. This is followed by a summary of recent efforts in the Medical Component Design Laboratory at Kansas State University to address interoperability issues in point-of-care systems by incorporating the Bluetooth Host Controller Interface, the IEEE 1073 Medical Information Bus, and Health Level 7 (HL7) into a monitoring system that hosts wearable or nearby wireless devices. This wireless demonstration system includes a wearable electrocardiogram, wearable pulse oximeter, wearable data logger, weight scale, and LabVIEW base station. Data are exchanged between local and remote MySQL databases using the HL7 standard for medical information exchange. PMID:17270979

  2. Systemic racism and U.S. health care.

    Feagin, Joe; Bennefield, Zinobia


    This article draws upon a major social science theoretical approach-systemic racism theory-to assess decades of empirical research on racial dimensions of U.S. health care and public health institutions. From the 1600s, the oppression of Americans of color has been systemic and rationalized using a white racial framing-with its constituent racist stereotypes, ideologies, images, narratives, and emotions. We review historical literature on racially exploitative medical and public health practices that helped generate and sustain this racial framing and related structural discrimination targeting Americans of color. We examine contemporary research on racial differentials in medical practices, white clinicians' racial framing, and views of patients and physicians of color to demonstrate the continuing reality of systemic racism throughout health care and public health institutions. We conclude from research that institutionalized white socioeconomic resources, discrimination, and racialized framing from centuries of slavery, segregation, and contemporary white oppression severely limit and restrict access of many Americans of color to adequate socioeconomic resources-and to adequate health care and health outcomes. Dealing justly with continuing racial "disparities" in health and health care requires a conceptual paradigm that realistically assesses U.S. society's white-racist roots and contemporary racist realities. We conclude briefly with examples of successful public policies that have brought structural changes in racial and class differentials in health care and public health in the U.S. and other countries. PMID:24507906

  3. New uses of legacy systems: examples in perinatal care.

    Margolis, A; Vázquez, R.; Mendoza, G.; Zignago, A.; López, A.; Lucián, H.


    In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dyna...

  4. Architecture of a prehospital emergency patient care report system (PEPRS).

    Majeed, Raphael W; Stöhr, Mark R; Röhrig, Rainer


    In recent years, prehospital emergency care adapted to the technology shift towards tablet computers and mobile computing. In particular, electronic patient care report (e-PCR) systems gained considerable attention and adoption in prehospital emergency medicine [1]. On the other hand, hospital information systems are already widely adopted. Yet, there is no universal solution for integrating prehospital emergency reports into electronic medical records of hospital information systems. Previous projects either relied on proprietary viewing workstations or examined and transferred only data for specific diseases (e.g. stroke patients[2]). Using requirements engineering and a three step software engineering approach, this project presents a generic architecture for integrating prehospital emergency care reports into hospital information systems. Aim of this project is to describe a generic architecture which can be used to implement data transfer and integration of pre hospital emergency care reports to hospital information systems. In summary, the prototype was able to integrate data in a standardized manner. The devised methods can be used design generic software for prehospital to hospital data integration. PMID:23920925

  5. Health Care Performance Indicators for Health Information Systems.

    Hyppönen, Hannele; Ronchi, Elettra; Adler-Milstein, Julia


    Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators. PMID:27198102

  6. Nuclear power: obstacles and solutions

    Nuclear power has a history extending over more than 50 years; it has been pursued both for military power applications (primarily aircraft carrier and submarine propulsion) and for commercial power applications. Nuclear power has benefited from many hundreds of billions of dollars in research, development, design, construction, and operations expenditures, and has received substantial attention and support world-wide, having being implemented by most developed countries, including all of the G-7 countries, and several developing countries (for example, India, China, and Republic of Korea). In spite of this long history, massive development effort, and unprecedented financial commitment, nuclear power has failed to achieve commercial success, having captured less than 5% of the world's primary energy supply market. There are many factors contributing to the stagnation/decline of the commercial nuclear power business. These factors include: non competitive economics, lengthy construction schedules, large and demanding human resource requirements, safety concerns, proliferation concerns, waste management concerns, the high degree of government financial and political involvement necessary, and the incompatibility of the available nuclear power plant designs with most process heat applications due to their temperature limitations and/or large heat output. An examination of the obstacles to deployment of nuclear power plants of current design suggest a set of requirements for new nuclear power plants, which may overcome or circumvent these obstacles. These requirements include: inherent characteristics that will achieve reactor shutdown under any postulated accident condition; the removal of decay heat by natural and passive means; no safety dependence on operator actions and tolerant to operator error, and malicious or incompetent operator action; and, economic viability in relatively small unit sizes. Many innovative reactor technologies and concepts are under

  7. The Danish health care system from a British perspective.

    Hurst, Jeremy


    The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weakness, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a one-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. The dominance of tax financing helps to achieve control over the level of health care expenditure, as well as securing equity in financing the services. The reliance on local government for financing and running health care has both advantages and disadvantages, and the split between county and municipal responsibility leads to problems of co-ordination. The remuneration of general practitioners by a mix of capitation payment and fee for services has the advantage of capping expenditure whilst leaving the GPs with an incentive to compete for patients by providing them with good services. The GP service is remarkably economical. The hospital sector displays much strength, but there seem to be problems with respect to: (i) perceived lack of resources and waiting lists; (ii) impersonal care, lack of continuity of care and failures in communication between patients and staff; (iii) management problems and sometimes demotivated staff. The relationship between patients and providers is facilitated by free access to GPs and absence of any charges for hospital treatment. The biggest threat is continuation of avoidable illness caused by poor health habits in the population. The biggest opportunity is to strengthen public health measures to tackle these poor health habits. PMID:11755995

  8. Rationing and competition in the Dutch health-care system.

    Schut, Frederik T; Van de Ven, Wynand P M M


    In this paper we examine the goals and effects of health-care policy in the Netherlands over the period 1980--2000. During this period Dutch health-care policy is marked by a peculiar combination of increasingly stringent cost-containment policies alongside a persistent pursuit of market-oriented reforms. The main goal of cost containment was to keep labour costs down under the restriction of universal equal access to health care. Supply and price control policies were quite successful in achieving cost containment, but in due course prolonged quantity rationing began to jeopardise universal physical access to health services. The main goal of market-oriented health-care reforms is to increase the system's efficiency and its responsiveness to patient's needs, while maintaining equal access. The feasibility of the reforms crucially hinges on the realisation of adequate methods of risk adjustment, product classification and quality measurement, an appropriate consumer information system and an effective competition policy. Realising these preconditions requires a lengthy and cautious implementation process. Although considerable progress has been made in setting the appropriate stage for regulated competition in Dutch health care, the role of the market is still limited. PMID:16161190

  9. Regionalized trauma care: a methodological proposal from the system dynamics

    Piedad Roldán J


    Full Text Available Studies relating to trauma are mainly multicausal, but when we observe the impact of interventions on their causes, there is no clarity about the best way for prevention and control. Objective: To approach the problem of trauma from an integral point of view that facilitates understanding the phenomenon from its complex interrelationships. Methodology: using the system dynamics raised by Forrester to propose a dynamic model capable of predicting situations related to prevention and care, to raise public policies towards reducing the incidence and mortality. The process included six steps of the dynamics of systems to deliver a model for the analysis of existing and potential scenarios in their care, based on simulations of the behavior of the trauma, including the incidence and prevention of variables in interaction with prehospital care and hospitable. Results: the proposal was ideal in the care of trauma described in the dynamic scenario put “appropriate care of the patient described in the appropriate institution, is guaranteed to reduce the mortality for trauma”.

  10. Quality improvement and accountability in the Danish health care system.

    Mainz, Jan; Kristensen, Solvejg; Bartels, Paul


    Denmark has unique opportunities for quality measurement and benchmarking since Denmark has well-developed health registries and unique patient identifier that allow all registries to include patient-level data and combine data into sophisticated quality performance monitoring. Over decades, Denmark has developed and implemented national quality and patient safety initiatives in the healthcare system in terms of national clinical guidelines, performance and outcome measurement integrated in clinical databases for important diseases and clinical conditions, measurement of patient experiences, reporting of adverse events, national handling of patient complaints, national accreditation and public disclosure of all data on the quality of care. Over the years, Denmark has worked up a progressive and transparent just culture in quality management; the different actors at the different levels of the healthcare system are mutually attentive and responsive in a coordinated effort for quality of the healthcare services. At national, regional, local and hospital level, it is mandatory to participate in the quality initiatives and to use data and results for quality management, quality improvement, transparency in health care and accountability. To further develop the Danish governance model, it is important to expand the model to the primary care sector. Furthermore, a national quality health programme 2015-18 recently launched by the government supports a new development in health care focusing upon delivering high-quality health care-high quality is defined by results of value to the patients. PMID:26443814

  11. Primary Health Care in Canada: Systems in Motion

    Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie


    Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged.

  12. The Changing Medical Care System: Some Implications for Medical Education.

    Foreman, Spencer


    The medical care system is undergoing widespread and significant changes. Individual hospitals may be disappearing as mergers, acquisitions, and a variety of multi-institutional arrangements become the dominant form and as a host of free-standing medical enterprises spread out into the community. (MLW)

  13. Medical Information Management System (MIMS) CareWindows.

    Stiphout, R. M.; Schiffman, R. M.; Christner, M. F.; Ward, R.; Purves, T. M.


    The demonstration of MIMS/CareWindows will include: (1) a review of the application environment and development history, (2) a demonstration of a very large, comprehensive clinical information system with a cost effective graphic user server and communications interface. PMID:1807755

  14. Indonesia health care system and Asean economic community

    Joko Gunawan


    However, AEC, by looking at this challenges, is expected to improve health care system and service in Indonesia, and close the gap by collaborating among ten ASEAN member countries through 4 modes of AEC consisting of cross border supply, consumption abroad, commercial presence, and movement of natural persons. [Int J Res Med Sci 2015; 3(7.000: 1571-1577

  15. 用于避障研究的微型仿生机器鱼3维仿真系统%3D simulation system of micro robotic fish for obstacle avoidance research

    叶秀芬; 关红玲; 张哲会; 杨博文


    基于VC++6.0开发环境和OpenGL(open graphics library)国际图形标准,在Windows系统下开发了微型仿生机器鱼3维仿真系统.该系统可以降低用实体机器鱼进行机器鱼避障能力研究的成本和减少在研究过程中对实体机器鱼造成的损害.采用多边形建模的方法构建了虚拟微型仿生机器鱼模型,模拟了鱼类尾鳍的摆动.提出了一种模拟红外传感器探测障碍物的虚拟射线方法.并采用实时模糊决策算法设计了基于多传感器信息的复合模糊控制器,决策微型仿生机器鱼的避障行为.仿真实验表明,复合模糊控制器实时性好、效率高;无论是单个任意形状的障碍物还是多个连续障碍物,复合模糊控制器都能有效地引导仿生机器鱼避开障碍物,到达目标点.微型仿生机器鱼3维仿真系统为研究仿生机器鱼的自主避障能力提供了可靠、逼真、便利的平台.%A 3D simulation system of micro robotic fish was developed in windows operation system with VC++ 6.0developing environment and OpenGL international graphic standard, in order to reduce the cost of obstacle avoidance research using real robotic fish and reduce the damage to the real robotic fish. A virtual robotic fish was built using polygon modeling method and the swing of fish tail was simulated. A virtual ray method which simulated infrared sensor detecting obstacles was proposed. Based on the information of multiple sensors, a composite fuzzy controller using real time fuzzy control algorithm was designed to decide the avoidance behavior of micro robotic fish. The simulation results demonstrate the composite fuzzy controller is of real-time and has high efficienly. Micro robotic fish was efficiently conducted by the composite fuzzy controller to avoid both single arbitrary shape obstacle and multiple continuous obstacles and achieved the targeting result. A reliable, realistic and convenient platform was provided for researching the

  16. [Major obstacles in the development of child and adolescent psychiatry in Hungary].

    Kalmar, Sandor


    The author ascertains that healthy personality development faces increasingly serious obstacles and consequently the number of children in need of mental healthcare is on the rise. Child and adolescent psychiatry has drawn increasing appreciation, however, it is only formal and deficient in Hungary today and cannot assure optimal mental care according to the principles of evidence-based medicine. The author emphasizes that 75% of the first manifestation of the psychiatric disorders occurs during adolescence and young adulthood. In spite of legal regulation, several deficiencies hinder the development of children into healthy adults. The author analyses the most important obstacles in the development of child and adolescent Psychiatry. The author emphasizes the role of keypersons, describes the situation of and problems faced by Hungarian child psychiatric care. The author lists in detail the most important contradictions, deficiencies and obstacles and outlines suggestions for resolving the present crisis. The author emphasizes (1) the responsibility of institutions, and people dealing with society and children, and the disinterest of competent authorities. (2) The somatic, mental, cultural and spiritual ignorance/illiteracy among parents, teachers, healthcare workers, and the general population partly related to crises among the pedagogues. (3) The lack of holistic approach to treatment of children suffering from mental disorder. (4) The importance and the lack of knowledge concerning central nervous system function in child psychiatry. (5) Application of evidence-based medicine in child and adolescent psychiatry based on understanding the relationship between central nervous system alterations and mental functions. (6) Respecting keypersons' competence limits. (7) Immediate development of inpatient and outpatient child and adolescent psychiatry in the whole country. (8) Reform of child psychiatry board exam. (9) Development of currently missing textbooks and

  17. Can casemix-systems be applied in Danish primary care?

    Halling, Anders; Kristensen, Troels

    Data", which covers the collection, storage, analysis, processing and interpretation of large amounts of data can via a casemix system provide new and insightful information about the morbidity burden of populations in terms of co-morbidity in addition to index conditions/multi-morbidity and related......Background: New technology in terms of IT systems, better data infrastructure and improved registrations of health data provide new opportunities for health care systems to improve the care experience of individual patients, improve public health and reduce healthcare costs. Application of "Big...... resource consumption. . Aim: The objective of this study was to conduct a preliminary analysis of the usefulness of the ACG casemix system in Denmark. This includes presenting the results for a region of Denmark and assessment of the usefulness and quality of the results. Methods and Data: This cross...

  18. Obstacles to Rural Residents’ Consumption in China and the Countermeasures


    On the basis of relevant statistical data, this paper analyzes the obstacles to rural residents’ consumption in China as follows: the consumption structure is restricted critically; the consumption environment cannot meet the need of social development; the traditional consumption concept has not yet been changed; the social security system is not sound; the support of rural finance is short. Pointed countermeasures for eliminating the obstacles to rural residents’ consumption are put forward as follows: first, adopt effective measures to elevate the level of farmers’ income; second, strengthen the credit support of rural finance; third, quicken the pace of modernized development in rural areas; fourth, construct perfect rural social security system.

  19. Smart Sensor Based Obstacle Detection for High-Speed Unmanned Surface Vehicle

    Hermann, Dan; Galeazzi, Roberto; Andersen, Jens Christian;


    This paper describes an obstacle detection system for a high-speed and agile unmanned surface vehicle (USV), running at speeds up to 30 m/s. The aim is a real-time and high performance obstacle detection system using both radar and vision technologies to detect obstacles within a range of 175 m. A...... computer vision horizon detector enables a highly accurate attitude estimation despite large and sudden vehicle accelerations. This further facilitates the reduction of sea clutter by utilising a attitude based statistical measure. Full scale sea trials show a significant increase in obstacle tracking...

  20. Vermont STep Ahead Recognition System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    Child Trends, 2010


    This paper presents a profile of Vermont's STep Ahead Recognition System (STARS) prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for All Child Care Programs;…

  1. The Durham Family Initiative: A Preventive System of Care

    Dodge, Kenneth A.; Lisa J. Berlin; Epstein, Matthew; Spitz-Roth, Adele; O’Donnell, Karen; Kaufman, Martha; Amaya-Jackson, Lisa; Rosch, Joel; Christopoulos, Christina


    This article describes the Durham Family Initiative (DFI), an innovative effort to bring together child welfare and juvenile justice systems to reach DFI’s goal of reducing the child abuse rate in Durham, North Carolina, by 50% within the next 10 years. DFI will follow principles of a preventive system of care (PSoC), which focuses on nurturing the healthy parent-child relationship. A community collaborative of government agency directors has signed a memorandum of agreement to implement the ...

  2. HTRAK, a computerized health maintenance tracking system for primary care.

    Frame, P. S.; Werth, P. L.


    This presentation describes a computerized health maintenance tracking system for primary care designed to be linked to the practice billing system. Providers enter health maintenance data along with billing data on an encounter form. Physician and patient reminders are generated once a year for all patients regardless of appointment status. Multiple entry options are available and the frequency of procedures can be varied for individual patients. Summary reports are generated to assist compl...

  3. Health Care Professionals Devise Ways to Get Around Using Electronic Health Record Systems

    ... Task Force Improving Primary Care Practice Health IT Integration Health Care/System Redesign Clinical-Community Linkages Care Coordination Capacity Building Behavioral and Mental Health Self-Management Support Resources Clinical Community Relationships ...


    Kanellopoulos Dimitros


    Full Text Available In order to be the health care system sustainable , management transformations must be based on very precise diagnostic analysis that includes complete and current information. It is necessary to implement an information system that collects information in real time, that watches the parameters that significantly influence the sustainability of the system. Such an information system should point out a radiography(a scan of the system at some time under following aspects:: 1. An overview of system; 2 An overview of the economic situation; 3 A technical presentation ;4. A legal overview; 5. A social overview ; 6. A management overview .Based on these Xrays of the health system, it outlines a series of conclusions and recommendations together with a SWOT analysis that highlights the potential internal (strengths and weaknesses and external potential (opportunities and threats. Based on this analysis and recommendations, the management is going to redesign the system in order to be adapted to the changing environmental requirements. Management transformation is recommended to be by following steps. :1. The development of a new management system that would make a positive change in the health care system 2. Implementation of the new management system 3. Assessment of the changes

  5. Darwinian drift: Effects of Wake Vortices and Multiple Obstacles

    Melkoumian, Sergei; Protas, Bartosz


    When a body passes through an unbounded fluid, it induces a net displacement of fluid particles. The difference between the initial and final positions of a fluid particle is defined as the Darwinian drift and plays an important role in the characterization of the stirring occurring in multiphase flows and in the context of biogenic mixing. Traditional studies of drift have mainly focused on single obstacles moving in a potential flow. In the present investigation we consider the effect of wake vorticity, represented by a pair of Föppl point vortices, and the combined effect of multiple obstacles. The drift in various configurations is determined using methods of complex analysis and careful numerical computations. It is demonstrated that, while the total drift increases with the size of the wake for large vortex strengths, it is actually decreased for small circulation values. We also discuss how the interaction of two obstacles affects the drift in comparison to the case of two isolated obstacles. In particular, we identify the lower and upper bound on the drift due to two identical cylinders. In certain cases our results are supported by asymptotic analysis. A physical explanation of the observed affects is offered in terms of the trajectories of individual particles.

  6. Exploring the Perceived Obstacles to E-administration by Faculty Members of Eastern Mediterranean University

    Rachel George, Malipula


    This thesis aims to explore the obstacles that hinder the application and implementation of E-administration as perceived by faculty members at Eastern Mediterranean University, North Cyprus. This study examined the degree of the Human Obstacles such as the human nature, the culture of closed doors, the lack of confidence in the protection, confidentiality and security of personal transactions; and Organizational obstacles such as the nature of organizational structure and the lack of systems...

  7. Algorithms for High-Performance Networking in the Presence of Obstacles

    Lozev, Kamen


    This work develops novel algorithms for high-performance networking in the presence of obstacles based on a method for communicating via ultrasonic rays reflected at the obstacles. The rays are curves determined by the variable speed of sound and initial conditions and we develop ultrasonic ray models based on a system of differential equations. We present new parallel algorithms and software for shape and trajectory reconstruction of moving obstacles and show how the reconstructed reflection...

  8. Time based management in health care system: The chosen aspects

    Joanna Kobza


    Full Text Available Time-based management (TBM is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms. Over the past two decades a systematic review of Polish literature (since 1990 and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011 have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary

  9. 基于dsPIC30f4012的越障小车控制系统设计%Design of Obstacle-Navigation Car and Controlling System Based on dsPIC30f4012

    黄金虎; 卢刚; 王俊


    According to the performance requirements of obstacle-navigation car, the characteristics of the motion control system were analyzed, and the distributed motor control system based on CAN bus was used. The car's main controller and controller unit of the drive wheel were designed. The digital signal controller dsPIC30f4012 with higher cost performance was selected as the master and slave controller processor. The communication between the main controller and each joint movement was achieved through the CAN bus. Tests proved that the system design was reasonable with good response and control accuracy, and the operation requirements of the obstacle-navigation car were met.%根据越障小车的性能要求,分析其运动控制系统的特点,采用基于CAN总线的分布式电机控制系统,设计了监控云台的主控制器和驱动轮的单元控制器.选用了性价比较高的数字信号控制器dsPIC30f4012在作为主、从控制器的处理器,通过CAN总线实现了主控制器和各个运动关节的驱动控制器之间的通讯.试验证明该系统设计合理,具有良好的响应速度和控制精度,可以满足越障小车运行要求.

  10. Open architecture for health care systems: the European RICHE experience.

    Frandji, B


    Groupe RICHE is bringing to the market of health IT the Open Systems approach allowing a new generation of health information systems to arise with benefit for patients, health care professionals, hospital managers, agencies and citizens. Groupe RICHE is a forum for exchanging information, expertise around open systems in health care. It is open to any organisation interested by open systems in health care and wanting to participate and influence the work done by its user, marketing and technical committees. The Technical Committee is in charge of the maintenance of the architecture and impact the results of industrial experiences on new releases. Any Groupe RICHE member is entitled to participate to this process. This unique approach in Europe allows health care professionals to benefit from applications supporting their business processes, including providing a cooperative working environment, a shared electronic record, in an integrated system where the information is entered only once, customised according to the user needs and available to the administrative applications. This allows Hospital managers to satisfy their health care professionals, to smoothly migrate from their existing environment (protecting their investment), to choose products in a competitive environment, being able to mix and match system components and services from different suppliers, being free to change suppliers without having to replace their existing system (minimising risk), in line with national and regional strategies. For suppliers, this means being able to commercialise products well fitted to their field of competence in a large market, reducing investments and increasing returns. The RICHE approach also allows agencies to define a strategy, allowing to create a supporting infrastructure, organising the market leaving enough freedom to health care organisations and suppliers. Such an approach is based on the definition of an open standard architecture. The RICHE esprit project

  11. Applying principles of health system strengthening to eye care

    Karl Blanchet


    Full Text Available Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.

  12. Applying principles of health system strengthening to eye care

    Blanchet, Karl; Patel, Daksha


    Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries) often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions. PMID:22944762

  13. Virtual reshaping and invisibility in obstacle scattering

    We consider reshaping an obstacle virtually by using transformation optics in acoustic and electromagnetic scattering. Among the general virtual reshaping results, the virtual minification and virtual magnification in particular are studied. Stability estimates are derived for scattering amplitude in terms of the diameter of a small obstacle, which implies that the limiting case for minification corresponds to a perfect cloaking, i.e., the obstacle is invisible to detection

  14. Interaction of turbulent deflagrations with representative flow obstacles

    Durst, B.; Ardey, N.; Mayinger, F. [Lehrstul a fuer Thermodynamik, Technische Universitat Munchen (Germany)


    In the case of a gradual release of hydrogen in the course of an assumed, severe accident in a light water reactor, the combustion will normally start out as a slow deflagration. Acceleration of an initially slow flame due to interactions of chemical kinetics and turbulent heat and mass transfer can result in very high flame speeds. Therefore, in order to assess hydrogen mitigation techniques, detailed knowledge about flame acceleration and interaction of flames with obstacles is required. The reported investigations are aimed at the investigation of the mechanisms responsible for turbulent flame acceleration and improving present correlations for estimates and models for numerical simulations of hydrogen combustion processes. A medium-scale square cross-section setup is employed, using flow obstacles with shapes representative for reactor containments. The global flame speed is deduced from measurements using thermocouples, pressure transducers and photodiodes. Measurements using a two-component LDA-system are being carried through in order to correlate global flame spread and local turbulence parameters. Results indicate that low blockage-ratio obstacles only marginally influence the flame, as disturbances which are induced remain local to the vicinity of the obstacle and die out very quickly downstream thereof. Flow visualizations by means of a Schlieren setup indicate very complex flow structures in the vicinity of obstacles. The results are being used to validate turbulent reaction models. A model based on probability density functions (pdf) of assumed shape has been developed and initial calculations are presented. (author)

  15. Obstacle Avoidance in Groping Locomotion of a Humanoid Robot

    Masahiro Ohka


    Full Text Available This paper describes the development of an autonomous obstacle-avoidance method that operates in conjunction with groping locomotion on the humanoid robot Bonten-Maru II. Present studies on groping locomotion consist of basic research in which humanoid robot recognizes its surroundings by touching and groping with its arm on the flat surface of a wall. The robot responds to the surroundings by performing corrections to its orientation and locomotion direction. During groping locomotion, however, the existence of obstacles within the correction area creates the possibility of collisions. The objective of this paper is to develop an autonomous method to avoid obstacles in the correction area by applying suitable algorithms to the humanoid robot's control system. In order to recognize its surroundings, six-axis force sensors were attached to both robotic arms as end effectors for force control. The proposed algorithm refers to the rotation angle of the humanoid robot's leg joints due to trajectory generation. The algorithm relates to the groping locomotion via the measured groping angle and motions of arms. Using Bonten-Maru II, groping experiments were conducted on a wall's surface to obtain wall orientation data. By employing these data, the humanoid robot performed the proposed method autonomously to avoid an obstacle present in the correction area. Results indicate that the humanoid robot can recognize the existence of an obstacle and avoid it by generating suitable trajectories in its legs.

  16. The French Health Care System: What Can We Learn?

    El Taguri A


    Full Text Available All public systems look for the best organizational structure to funnel part of their national income into healthcare services. Appropriate policies may differ widely across country settings. Most healthcare systems fall under one of two broad categories, either Bismark or Beveridge systems. There is no simple ideal model for the organization of health services, but most healthcare systems that follow the Beveridge healthcare model are poor performers. The Libyan Health system is a low responsive, inefficient and underperforming system that lacks goals and/or SMART. (Specific, Measurable, Achievable, Realistic, Time specific objectives. A look at different organization models in the world would reinforce efforts to reorganize and improve the performance of the Libyan National Healthcare services.The French Health Care System (FHCS ranked first according to the WHO and the European Health Consumer Powerhouse. The FHCS was described to have a technically efficient, generous healthcare system that provides the best overall health care. This makes the FHCS a practical model of organization having many of the essential aspects of a modern national health service. In this review, we describe the main features of the FHCS, current challenges and future trends with particular attention paid to aspects that could be of importance to the Libyan Healthcare System.

  17. Constructing target product profiles (TPPs) to help vaccines overcome post-approval obstacles.

    Lee, Bruce Y; Burke, Donald S


    As history has demonstrated, post-approval obstacles can impede a vaccine's use and potentially lead to its withdrawal. Addressing these potential obstacles when changes in a vaccine's technology can still be easily made may improve a vaccine's chances of success. Augmented vaccine target product profiles (TPPs) can help vaccine scientists better understand and anticipate these obstacles and galvanize conversations among various vaccine stakeholders (e.g., scientists, marketers, business development managers, policy makers, public health officials, health care workers, third party payors, etc.) earlier in a vaccine's development. PMID:19782109

  18. Obstacle avoidance for kinematically redundant robots using an adaptive fuzzy logic algorithm

    In this paper the Adaptive Fuzzy Logic approach for solving the inverse kinematics of redundant robots in an environment with obstacles is presented. The obstacles are modeled as convex bodies. A fuzzy rule base that is updated via an adaptive law is used to solve the inverse kinematic problem. Additional rules have been introduced to take care of the obstacles avoidance problem. The proposed method has advantages such as high accuracy, simplicity of computations and generality for all redundant robots. Simulation results illustrate much better tracking performance than the dynamic base solution for a given trajectory in cartesian space, while guaranteeing a collision-free trajectory and observation of a mechanical joint limit

  19. [The revised system of hospitalization for medical care and protection].

    Fukuo, Yasuhisa


    The Act to Partially Amend the Act on Mental Health and Welfare for the Mentally Disabled was passed on June 13, 2013. Major amendments regarding hospitalization for medical care and protection include the points listed below. The guardianship system will be abolished. Consent by a guardian will no longer be required in the case of hospitalization for medical care and protection. In the case of hospitalization for medical care and protection, the administrators of the psychiatric hospital are required to obtain the consent of one of the following persons: spouse, person with parental authority, person responsible for support, legal custodian, or curator. If no qualified person is available, consent must be obtained from the mayor, etc. of the municipality. The following three obligations are imposed on psychiatric hospital administrators. (1) Assignment of a person, such as a psychiatric social worker, to provide guidance and counseling to patients hospitalized for medical care and protection regarding their postdischarge living environment. (2) Collaboration with community support entities that consult with and provide information as necessary to the person hospitalized, their spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. (3) Organizational improvements to promote hospital discharge. With regard to requests for discharge, the revised law stipulates that, in addition to the person hospitalized with a mental disorder, others who may file a request for discharge with the psychiatric review board include: the person's spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. If none of the above persons are available, or if none of them are able to express their wishes, the mayor, etc. of the municipality having jurisdiction over the place of residence of the person hospitalized may request a discharge. In order to promote transition to life in the


    罗青; 李智军; 吕恬生


    In the context of robot soccer, the robots have to select actions to achieve individual and team goals in the dynamic environment. It is important for a robot to acquire navigation behaviors for avoiding other robots and obstacles in the real-time environment. This paper suggested an efficient approach to collision-avoidance in multirobot system. This approach is based on velocity information of moving objects and the distance between robot and obstacle in three specified directions. The main contribution of this paper is that it provides a method for robots with decreased-computational cost and makes the robot navigate without collision with each other in a complicated environment.

  1. Preparing a health care delivery system for Space Station

    Logan, J. S.; Stewart, G. R.


    NASA's Space Station is viewed as the beginning of man's permanent presence in space. This paper presents the guidelines being developed by NASA's medical community in preparing a quality, permanent health care delivery system for Space Station. The guidelines will be driven by unique Space Station requirements such as mission duration, crew size, orbit altitude and inclination, EVA frequency and rescue capability. The approach will emphasize developing a health care system that is modular and flexible. It will also incorporate NASA's requirements for growth capability, commonality, maintainability, and advanced technology development. Goals include preventing unnecessary rescue attempts, as well as maintaining the health and safety of the crew. Proper planning will determine the levels of prevention, diagnosis, and treatment necessary to achieve these goals.

  2. Organisational culture matters for system integration in health care.

    Munir, Samina K; Kay, Stephen


    This paper illustrates the importance of organisational culture for Clinical Information Systems (CIS) integration. The study is based on data collected in intensive care units in the UK and Denmark. Data were collected using qualitative methods, i.e., observations, interviews and shadowing of health care providers, together with a questionnaire at each site. The data are analysed to extract salient variables for CIS integration, and it is shown that these variables can be separated into two categories that describe the 'Actual Usefulness' of the system and the 'Organisational Culture'. This model is then extended to show that CIS integration directly affects the work processes of the organisation, forming an iterative process of change as a CIS is introduced and integrated. PMID:14728220

  3. Provider's Constraints and Difficulties in Primary Health Care System

    Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Anu


    Background: The contractualization of human resource in recent years has resulted into various human resource management issues. Objective: To explore the administrative and management issues of contractual model of human resource under primary health care system in Delhi. Materials and Methods: Comparative study was conducted on randomly selected sample of 333, comprised of Medical Officers, ANMs, Pharmacist and Laboratory Assistants and Technicians, both regular and contractual cadre. The d...

  4. A Systems Approach to Improving Rural Care in Ethiopia

    Bradley, Elizabeth H.; Byam, Patrick; Alpern, Rachelle; Thompson, Jennifer W.; Zerihun, Abraham; Abeb, Yigeremu; Leslie A Curry


    Background Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation i...

  5. The meaning of integrated care: a systems approach

    Edgren, Lars


    Introduction In all well developed societies, such as those that we live in, there tend to be strong borders or barriers between different organisations and different professions. People with different kinds of knowledge are kept well apart. So how can we—should we—manage health and social services that are located in different organisations? If we are to improve the capability of a health care organisation to function as an integrated part of a locally driven health and social service system...

  6. Quality systems in health care: A sociotechnical approach

    Harteloh, Peter


    textabstractIn this paper, we explore a sociotechnical approach to construct quality systems as an alternative to the traditional, ISO orientated approach. A sociotechnical approach is characterised as bottom-up, incremental, information technology facilitated and indicator driven. Its purpose is to ground quality assurance in medical practice and to provide meaning to those directly involved (patients, health care providers and medical professionals). Meaning depends on information. Accordin...

  7. Health care system reform. Ontario family physicians' reactions.


    OBJECTIVE: To determine the effect on a cohort of family physicians of health care system reforms in Ontario and the relationship of reforms to their career satisfaction. DESIGN: Follow-up survey in 1999 of a cohort initially studied in 1993, posing many of the original questions along with some new ones. Four focus groups of other Ontario family physicians. SETTING: Family practices in Ontario. PARTICIPANTS: All family physicians who had received certification after completing a family medic...

  8. The Swedish health care system--an economist's view.

    Blomqvist, A G


    This article compares the organization of the Swedish health care system with that in three other countries, the U.S., the U.K., and Canada, focussing on three main areas: (1) the provision and financing (public or private) of health insurance, including the question of the quality of the insurance protection offered; (2) the organization of the production of health services, and the economic incentives on the system's decision-makers (doctors, hospital managers, politicians, etc.). Possible answers are suggested to the question why one country (the U.K.) is able to provide health care to its population at an average cost considerably below that of the others: Differences in the quality of the insurance protection and health services; in the incentives on the system managers to exercise cost control; and in the incentives on service providers such as physicians, to consider cost-effectiveness when making treatment decisions. An attempt is made to suggest lessons for health care reform in Sweden and elsewhere. PMID:10119959

  9. Robot vision: obstacle-avoidance techniques for unmanned aerial vehicles

    Carloni, Raffaella; Lippiello, Vincenzo; D'auria, Massimo; Fumagalli, Matteo; Mersha, Abeje Y.; Stramigioli, Stefano; Sicilano, Bruno


    In this article, a vision-based technique for obstacle avoidance and target identification is combined with haptic feedback to develop a new teleoperated navigation system for underactuated aerial vehicles in unknown environments. A three-dimensional (3-D) map of the surrounding environment is built

  10. Toward a 21st Century Quality-Measurement System for Managed-Care Organizations

    Armstead, Rodney C.; Elstein, Paul; Gorman, John


    As the Nation's largest managed-care purchaser, the Health Care Financing Administration (HCFA) is working to develop a uniform data and performance-measurement system for all enrollees in managed-care plans. This effort will ultimately hold managed-care plans accountable for continuous improvement in the quality of care they provide and will provide information to consumers and purchasers to make responsible managed-care choices. The effort entails overhauling peer review organization (PRO) ...