WorldWideScience

Sample records for care models guiding

  1. A standardized nutrition care process and language are essential components of a conceptual model to guide and document nutrition care and patient outcomes.

    Science.gov (United States)

    Hakel-Smith, Nancy; Lewis, Nancy M

    2004-12-01

    Documentation of clinical services within health care systems has become increasingly significant because greater amounts of information are now required by accrediting agencies, third-party payers, researchers, and others in their evaluation of patient care and because of the increasing emphasis on patient outcomes. Given the multiple users who depend on health care information in the patient record, it is imperative that clinical nutrition practitioners implement a standardized nutrition care process and language to document comprehensively and communicate meaningful information concerning their role in improving patient outcomes. A body of work has led to the development and adoption of a standardized nutrition care process for the dietetics profession. A standardized nutrition care process consistent with the scientific method and a standardized language are two essential components required to articulate a conceptual model for clinical nutrition practice and documentation and distinguish clinical dietetics' unique body of knowledge. The conceptual model serves as an organizing framework to standardize and guide nutrition practitioners' clinical judgments or critical thinking processes and document information linking nutrition care to patient outcomes.

  2. Health care models guiding mental health policy in Kenya 1965 - 1997

    Directory of Open Access Journals (Sweden)

    Jenkins Rachel

    2010-04-01

    Full Text Available Abstract Background Mental health policy is needed to set the strategy and direction for the provision of mental health services in a country. Policy formulation does not occur in a vacuum, however, but is influenced by local and international factors in the health sector and other sectors. Methods This study was carried out in 1997 to examine the evolution of mental health policy in Kenya between 1965 and 1997 in the context of changing international concepts of health and development. Qualitative content analysis of policy documents was combined with interviews of key policy makers. Results The study showed that during the period 1965-1997 the generic health policy in Kenya changed from one based on the Medical Model in the 1960s and 1970s to one based on the Primary Health Care Model in the late 1970s and the 1980s and finally to one based on the Market Model of health care in the 1990s. The mental health policy, on the other hand, evolved from one based on the Medical Model in the 1960s to one based on the Primary Health Care Model in the 1990s, but did not embrace the Market Model of health care. This resulted in a situation in the 1990s where the mental health policy was rooted in a different conceptual model from that of the generic health policy under which it was supposed to be implemented. This "Model Muddlement" may have impeded the implementation of the mental health policy in Kenya. Conclusions Integration of the national mental health policy with the general health policy and other sector policies would be appropriate and is now underway.

  3. CURRICULUM GUIDE, CHILD CARE CENTERS.

    Science.gov (United States)

    California State Dept. of Education, Sacramento.

    CALIFORNIA CHILD CARE CENTERS WERE ESTABLISHED IN 1943 TO SUPPLY SERVICES TO CHILDREN OF WORKING MOTHERS. THE CHILD CARE PROGRAM PROVIDES, WITHIN NURSERY AND SCHOOLAGE CENTERS, CARE AND EDUCATIONAL SUPERVISION FOR PRESCHOOL AND ELEMENTARY SCHOOL AGE CHILDREN. THE PHILOSOPHY OF THE CHILD CENTER PROGRAM IS BASED UPON THE BELIEF THAT EACH CHILD…

  4. Guide for identifying cultural features in nursing care

    Directory of Open Access Journals (Sweden)

    Gülbu Tanrıverdi

    2009-05-01

    Full Text Available Use of cultural models and guides is useful in accessing cultural data in a more systematical and standardized manner and in increasing information accumulated on inter-cultural nursing field. Thus, nurses know cultural factors underlying health- and disease-related attitudes of individual, whom they provide healthcare, and occurrence of any possible cultural shock between nurse and cared individual is avoided. As a consequence, quality of care provided by nurses to individuals is increased. Although it is not common in our country, models and guides are used in nursing care. However, these are not adequate for collecting cultural data from individuals. In our country, a model of guide is required to remove this deficiency in nursing care. For this purpose, “Guide for Identifying Cultural Features in Nursing Care” is developed. This guide is consisted of four fields identifying cultural features. These are as follows: personal features, communication features, familial and social roles as well as healthcare procedures. Use of this guide in clinics and in the field and also use and development of present guide by other healthcare professionals can be recommended.

  5. The dynamic system of parental work of care for children with special health care needs: A conceptual model to guide quality improvement efforts

    Directory of Open Access Journals (Sweden)

    Hexem Kari R

    2011-10-01

    Full Text Available Abstract Background The work of care for parents of children with complex special health care needs may be increasing, while excessive work demands may erode the quality of care. We sought to summarize knowledge and develop a general conceptual model of the work of care. Methods Systematic review of peer-reviewed journal articles that focused on parents of children with special health care needs and addressed factors related to the physical and emotional work of providing care for these children. From the large pool of eligible articles, we selected articles in a randomized sequence, using qualitative techniques to identify the conceptual components of the work of care and their relationship to the family system. Results The work of care for a child with special health care needs occurs within a dynamic system that comprises 5 core components: (1 performance of tasks such as monitoring symptoms or administering treatments, (2 the occurrence of various events and the pursuit of valued outcomes regarding the child's physical health, the parent's mental health, or other attributes of the child or family, (3 operating with available resources and within certain constraints (4 over the passage of time, (5 while mentally representing or depicting the ever-changing situation and detecting possible problems and opportunities. These components interact, some with simple cause-effect relationships and others with more complex interdependencies. Conclusions The work of care affecting the health of children with special health care needs and their families can best be understood, studied, and managed as a multilevel complex system.

  6. Models of Comprehensive Care

    Science.gov (United States)

    The second plenary of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans reviews the various models for integration of hospice and palliative care into traditional cancer care that have been shown to improve outcomes.

  7. Guide for identifying cultural features in nursing care

    Directory of Open Access Journals (Sweden)

    Gülbu Tanrıverdi

    2009-05-01

    Full Text Available Use of cultural models and guides is useful in accessing cultural data in a more systematical and standardized manner and in increasing information accumulated on inter-cultural nursing field. Thus, nurses know cultural factors underlying health- and disease-related attitudes of individual, whom they provide healthcare, and occurrence of any possible cultural shock between nurse and cared individual is avoided. As a consequence, quality of care provided by nurses to individuals is increased. Although it is not common in our country, models and guides are used in nursing care. However, these are not adequate for collecting cultural data from individuals. In our country, a model of guide is required to remove this deficiency in nursing care. For this purpose, “Guide for Identifying Cultural Features in Nursing Care” is developed. This guide is consisted of four fields identifying cultural features. These are as follows: personal features, communication features, familial and social roles as well as healthcare procedures. Use of this guide in clinics and in the field and also use and development of present guide by other healthcare professionals can be recommended. ÖzetKültürel model ve rehberlerin kullanılması, hemşirelerin bakım verdikleri toplumun kültürel özelliklerini değerlendirmesinde, kültürel verilere daha sistematik ve standardize yollarla ulaşmasında ve kültürlerarası hemşirelik alanında bilgi birikiminin artmasında yararlı olmaktadır. Böylece hemşireler bakım verdikleri bireylerin sağlık ve hastalık davranışları arkasındaki kültürel etmenleri bilir ve bakım verdikleri kişilerle aralarında olası gelişebilecek ve bakıma olumsuz yansıyacak bir algılama ya da davranış yaşanması engellenir. Böylece, hemşirelerin bireylere sunduğu bakımın kalitesi yükselir. Türkiye’de hemşirelik bakımında yaygın olmamakla birlikte model ve rehberler kullanılmaktadır. Bunlar bireyden, k

  8. Guided care: cost and utilization outcomes in a pilot study.

    Science.gov (United States)

    Sylvia, Martha L; Griswold, Michael; Dunbar, Linda; Boyd, Cynthia M; Park, Margaret; Boult, Chad

    2008-02-01

    Guided Care (GC) is an enhancement to primary care that incorporates the operative principles of disease management and chronic care innovations. In a 6-month quasi-experimental study, we compared the cost and utilization patterns of patients assigned to GC and Usual Care (UC). The setting was a community-based general internal medicine practice. The participants were patients of 4 general internists. They were older, chronically ill, community-dwelling patients, members of a capitated health plan, and identified as high risk. Using the Adjusted Clinical Groups Predictive Model (ACG-PM), we identified those at highest risk of future health care utilization. We selected the 75 highest-risk older patients of 2 internists at a primary care practice to receive GC and the 75 highest-risk older patients of 2 other internists in the same practice to receive UC. Insurance data were used to describe the groups' demographics, chronic conditions, insurance expenditures, and utilization. Among our results, at baseline, the GC (all targeted patients) and UC groups were similar in demographics and prevalence of chronic conditions, but the GC group had a higher mean ACG-PM risk score (0.34 vs. 0.20, p insurance expenditures, hospital admissions, hospital days, and emergency department visits (p > 0.05). There were larger differences in insurance expenditures between the GC and UC groups at lower risk levels (at ACG-PM = 0.10, mean difference = $4340; at ACG-PM = 0.6, mean difference = $1304). Thirty-one of the 75 patients assigned to receive GC actually enrolled in the intervention. These results suggest that GC may reduce insurance expenditures for high-risk older adults. If these results are confirmed in larger, randomized studies, GC may help to increase the efficiency of health care for the aging American population. PMID:18279112

  9. An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long-term Care.

    Science.gov (United States)

    Yap, Tracey L; Kennerly, Susan M; Bergstrom, Nancy; Hudak, Sandra L; Horn, Susan D

    2016-01-01

    Pressure ulcers have consistently resisted prevention efforts in long-term care facilities nationwide. Recent research has described cueing innovations that-when selected according to the assumptions and resources of particular facilities-support best practices of pressure ulcer prevention. This article synthesizes that research into a unified, dynamic logic model to facilitate effective staff implementation of a pressure ulcer prevention program.

  10. A Guide to Health Care Reform

    OpenAIRE

    Cutler, David M.

    1994-01-01

    There are four rationales for health care reform: increasing the efficiency of health delivery; reforming the market for health insurance; providing universal coverage; and reducing the federal deficit. These goals are reflected in most reform proposals. Achieving these goals involves several problems, however. Paying for universal coverage may lead to labor supply or demand reductions. In addition, reform involves large federal risks that must be dealt with through deficit financing, reduced...

  11. Improving breast care: providing, guiding, expertise, and leadership.

    Science.gov (United States)

    Granai, Cornelius O; Orr, James W

    2011-03-01

    Optimal healthcare blends timeless doctor-patient values with state-of-the-art medical knowledge. The physician's role varies from delivering therapies to guiding patients through the healthcare maze to their best decisions. Breast care should not be parceling out of anatomic parts, as if biological relationships do not exist. Instead, it should stem from an understanding of the "total woman"--biological and otherwise--and how important that unity is for quality of life, even when confronting breast cancer. Breast fellowships for gynecologic and general surgeons create superior clinicians and better patient advocates -essential in advancing women-centric care and healthcare leadership. PMID:21278506

  12. Improving breast care: providing, guiding, expertise, and leadership.

    Science.gov (United States)

    Granai, Cornelius O; Orr, James W

    2011-03-01

    Optimal healthcare blends timeless doctor-patient values with state-of-the-art medical knowledge. The physician's role varies from delivering therapies to guiding patients through the healthcare maze to their best decisions. Breast care should not be parceling out of anatomic parts, as if biological relationships do not exist. Instead, it should stem from an understanding of the "total woman"--biological and otherwise--and how important that unity is for quality of life, even when confronting breast cancer. Breast fellowships for gynecologic and general surgeons create superior clinicians and better patient advocates -essential in advancing women-centric care and healthcare leadership.

  13. Model Commissioning Plan and Guide Specifications

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    The objectives of Model Commissioning Plan and Guide Specifications are to ensure that the design team applies commissioning concepts to the design and prepares commissioning specifications and a commission plan for inclusion in the bid construction documents.

  14. Guide to APA-Based Models

    Science.gov (United States)

    Robins, Robert E.; Delisi, Donald P.

    2008-01-01

    In Robins and Delisi (2008), a linear decay model, a new IGE model by Sarpkaya (2006), and a series of APA-Based models were scored using data from three airports. This report is a guide to the APA-based models.

  15. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2014-01-01

    this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach......Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good...... outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining...

  16. Guide to Working with Model Providers.

    Science.gov (United States)

    Walter, Katie; Hassel, Bryan C.

    Often a central feature of a school's improvement efforts is the adoption of a Comprehensive School Reform (CSR) model, an externally developed research-based design for school improvement. Adopting a model is only the first step in CSR. Another important step is forging partnerships with developers of CSR models. This guide aims to help schools…

  17. Developing Integrated Care: Towards a development model for integrated care

    OpenAIRE

    Minkman, Mirella M.N

    2012-01-01

    textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated care. Based on a systematic approach in which a literature study, a delphi study, a concept mapping study and questionnaire research are combined, a development model for integrated care is created....

  18. NORTRIP emission model user guide

    Energy Technology Data Exchange (ETDEWEB)

    Denby, Rolstad Bruce

    2012-07-01

    The NORTRIP emission model has been developed at NILU, in conjunction with other Nordic institutes, to model non-exhaust traffic induced emissions. This short summary document explains how to run the NORTRIP model from the MATLAB environment or by using the executable user interface version. It also provides brief information on input files and the model architecture.(Author)

  19. Data Vault Modelling : An Introductory Guide

    OpenAIRE

    Fentaw, Awel Eshetu

    2014-01-01

    The theme of this thesis is to prepare an introductory guide to Data Vault Modelling. The Data Vault is a relatively new method of modelling enterprise data warehouses. The Data Vault uses three core components to model an entire data warehouse. Thus it provides an easy alternate solution for data warehousing. The thesis project was conducted by researching books, scientific journal articles, professional blog posts and professional community discussions. By doing so scattered information...

  20. Using activity-based costing and theory of constraints to guide continuous improvement in managed care.

    Science.gov (United States)

    Roybal, H; Baxendale, S J; Gupta, M

    1999-01-01

    Activity-based costing and the theory of constraints have been applied successfully in many manufacturing organizations. Recently, those concepts have been applied in service organizations. This article describes the application of activity-based costing and the theory of constraints in a managed care mental health and substance abuse organization. One of the unique aspects of this particular application was the integration of activity-based costing and the theory of constraints to guide process improvement efforts. This article describes the activity-based costing model and the application of the theory of constraint's focusing steps with an emphasis on unused capacities of activities in the organization.

  1. Using activity-based costing and theory of constraints to guide continuous improvement in managed care.

    Science.gov (United States)

    Roybal, H; Baxendale, S J; Gupta, M

    1999-01-01

    Activity-based costing and the theory of constraints have been applied successfully in many manufacturing organizations. Recently, those concepts have been applied in service organizations. This article describes the application of activity-based costing and the theory of constraints in a managed care mental health and substance abuse organization. One of the unique aspects of this particular application was the integration of activity-based costing and the theory of constraints to guide process improvement efforts. This article describes the activity-based costing model and the application of the theory of constraint's focusing steps with an emphasis on unused capacities of activities in the organization. PMID:10350791

  2. Developing Integrated Care: Towards a development model for integrated care

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella)

    2012-01-01

    textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated c

  3. Intercultural caring-an abductive model.

    Science.gov (United States)

    Wikberg, Anita; Eriksson, Katie

    2008-09-01

    The aim of this study was to increase the understanding of caring from a transcultural perspective and to develop the first outline of a theory. The theoretical perspective includes Eriksson's theory of caritative caring. Texts on caring by the transcultural theorists, including Campinha-Bacote, Kim-Godwin, Leininger and Ray, are analysed using content analysis. The overall theme that resulted from this analysis was that caring is a complex whole. Three main categories of caring emerged: inner caring, outer caring and the goal of caring. Inner caring consists of caring is a relationship, and caring and culture are seen in different dimensions. Outer caring refers to caring affected by educational, administrative and social and other structures. The goal of caring consists of caring leading to change towards health and well-being. The main categories include categories and subcategories that are compared with Eriksson's theory of caritative caring. A model for intercultural caring is generated abductively. Caring and culture appear in three dimensions: caring as ontology independent of context; caring as a phenomenon emphasised differently in different cultures; caring as nursing care activities is unique. Caring alleviates suffering and leads to health and well-being. This model describes caring from an intercultural perspective as a mutual but asymmetric relationship between the nurse and the patient, including the patient's family and community. The patient's cultural background and acculturation influence caring. The cultural background, cultural competence and organisation of the nurse also influence caring. Caring is seen as a complex whole. This study integrates Campinha-Bacote's, Kim-Godwin's, Leininger's and Ray's views of caring with Eriksson's caritative caring and presents caring from a transcultural perspective in a new way as a model for intercultural caring, which can benefit nursing care, education, research and administration. PMID:18840233

  4. Intercultural caring-an abductive model.

    Science.gov (United States)

    Wikberg, Anita; Eriksson, Katie

    2008-09-01

    The aim of this study was to increase the understanding of caring from a transcultural perspective and to develop the first outline of a theory. The theoretical perspective includes Eriksson's theory of caritative caring. Texts on caring by the transcultural theorists, including Campinha-Bacote, Kim-Godwin, Leininger and Ray, are analysed using content analysis. The overall theme that resulted from this analysis was that caring is a complex whole. Three main categories of caring emerged: inner caring, outer caring and the goal of caring. Inner caring consists of caring is a relationship, and caring and culture are seen in different dimensions. Outer caring refers to caring affected by educational, administrative and social and other structures. The goal of caring consists of caring leading to change towards health and well-being. The main categories include categories and subcategories that are compared with Eriksson's theory of caritative caring. A model for intercultural caring is generated abductively. Caring and culture appear in three dimensions: caring as ontology independent of context; caring as a phenomenon emphasised differently in different cultures; caring as nursing care activities is unique. Caring alleviates suffering and leads to health and well-being. This model describes caring from an intercultural perspective as a mutual but asymmetric relationship between the nurse and the patient, including the patient's family and community. The patient's cultural background and acculturation influence caring. The cultural background, cultural competence and organisation of the nurse also influence caring. Caring is seen as a complex whole. This study integrates Campinha-Bacote's, Kim-Godwin's, Leininger's and Ray's views of caring with Eriksson's caritative caring and presents caring from a transcultural perspective in a new way as a model for intercultural caring, which can benefit nursing care, education, research and administration.

  5. A patient-centered care ethics analysis model for rehabilitation.

    Science.gov (United States)

    Hunt, Matthew R; Ells, Carolyn

    2013-09-01

    There exists a paucity of ethics resources tailored to rehabilitation. To help fill this ethics resource gap, the authors developed an ethics analysis model specifically for use in rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a process model to guide careful moral reasoning for particularly complex or challenging matters in rehabilitation. The Patient-Centered Care Ethics Analysis Model for Rehabilitation was developed over several iterations, with feedback at different stages from rehabilitation professionals and bioethics experts. Development of the model was explicitly informed by the theoretical grounding of patient-centered care and the context of rehabilitation, including the International Classification of Functioning, Disability and Health. Being patient centered, the model encourages (1) shared control of consultations, decisions about interventions, and management of the health problems with the patient and (2) understanding the patient as a whole person who has individual preferences situated within social contexts. Although the major process headings of the Patient-Centered Care Ethics Analysis Model for Rehabilitation resemble typical ethical decision-making and problem-solving models, the probes under those headings direct attention to considerations relevant to rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a suitable tool for rehabilitation professionals to use (in real time, for retrospective review, and for training purposes) to help arrive at ethical outcomes.

  6. Tribes and States Working Together: A Guide to Tribal-State Child Care Coordination

    Science.gov (United States)

    US Department of Health and Human Services, 2005

    2005-01-01

    The purpose of this guide is to increase the understanding of the rationale and benefits of States and Tribes working together to provide quality child care choices and services for the children and families they serve. The guide provides a description of Tribal sovereignty and the government-to-government relationship; an overview of the…

  7. Palliative Care Doula: an innovative model.

    Science.gov (United States)

    Lentz, Judy C

    2014-01-01

    Walking the journey of serious illness is very difficult and stressful for patients and families. A universal principle of palliative care is caring for the patient/ family unit. This article introduces a model for the Palliative Care Doula for experienced and advanced practice palliative care nurses to support patients and families during the traumatic and vulnerable period of end-of-life care.

  8. Investing in Our Future: A Guide to Child Care Financing.

    Science.gov (United States)

    Stoney, Louise; Groginsky, Scott; Poppe, Julie

    This book investigates the innovative ways being used to ensure and finance high quality care for children. Chapter 1, "Introduction," discusses the government's role in helping to structure, build, and finance the system, as well as financing strategies. Chapter 2, "Financing Child Care Supply," addresses center-based child care, supports for…

  9. The Integrated Patient's Self-Care Process Model.

    Science.gov (United States)

    Milavec Kapun, Marija; Šusteršič, Olga; Rajkovič, Vladislav

    2016-01-01

    Long-term care is more efficient and effective when it involves the active participation of the empowered patient and informal caregivers. To achieve this, it is necessary to guide the patient and informal caregivers through the systematic process of self-care. Well-documented observations and assessments are fundamental to plan further interventions of the interdisciplinary team. A systematic literature review revealed that the self-care process and the support of information technology are focused on just one chronic disease. Defined self-care process has a positive impact on the functionality and satisfaction of patients with comorbidity and on their caregivers. The model of the patient's self-care process should be an integral part of the long-term care. PMID:27332172

  10. Children and Stress: Caring Strategies to Guide Children

    OpenAIRE

    Ruffin, Novella J.

    2009-01-01

    Helping children to deal positively with stressful and tension causing events prepares them for healthy emotional and social development. This is an important responsibility of parents, teachers and other caregivers: to effectively guide and help children.

  11. Caring for the Caregiver. A Guide to Living with Alzheimer's Disease.

    Science.gov (United States)

    Warner-Lambert Co., Morris Plains, NJ.

    This book is designed to take caregivers through the basics of patient care and to give them the information needed to guide them through the medical, legal, and financial issues that accompany Alzheimer's disease. The seven chapters of the book cover the following topics: understanding Alzheimer's; caring for a caregiver; medical update; finances…

  12. Implementing the Child Care and Development Block Grant Reauthorization: A Guide for States

    Science.gov (United States)

    Matthews, Hannah; Schulman, Karen; Vogtman, Julie; Johnson-Staub, Christine; Blank, Helen

    2015-01-01

    In November 2014, with broad bipartisan support, Congress reauthorized CCDBG [Child Care and Development Block Grant] (the major federal child care program) for the first time since 1996. The new law strengthens CCDBG's dual role as a major early childhood education program and a work support for low-income families. This implementation guide is…

  13. User's guide to the 'DISPOSALS' model

    International Nuclear Information System (INIS)

    This report provides a User's Guide to the 'DISPOSALS' computer model and includes instructions on how to set up and run a specific problem together with details of the scope, theoretical basis, data requirements and capabilities of the model. The function of the 'DISPOSALS' model is to make assignments of nuclear waste material in an optimum manner to a number of disposal sites each subject to a number of constraints such as limits on the volume and activity. The user is able to vary the number of disposal sites, the range and limits of the constraints to be applied to each disposal site and the objective function for optimisation. The model is based on the Linear Programming technique and uses CAP Scientific's LAMPS and MAGIC packages. Currently the model has been implemented on CAP Scientific's VAX 11/750 minicomputer. (author)

  14. Many diseases, one model of care?

    NARCIS (Netherlands)

    Albreht, T.; Dyakova, M.; Schellevis, F.G.; Broucke, S. van den

    2016-01-01

    Patients with multiple chronic conditions (multimorbidity) have complex and extensive health and social care needs that are not well served by current silo-based models of care. A lack of integration between care providers often leads to fragmented, incomplete, and ineffective care, leaving many pat

  15. Palliative Care Doula: an innovative model.

    Science.gov (United States)

    Lentz, Judy C

    2014-01-01

    Walking the journey of serious illness is very difficult and stressful for patients and families. A universal principle of palliative care is caring for the patient/ family unit. This article introduces a model for the Palliative Care Doula for experienced and advanced practice palliative care nurses to support patients and families during the traumatic and vulnerable period of end-of-life care. PMID:25296488

  16. Guide to providing mouth care for older people.

    Science.gov (United States)

    Bissett, Susan; Preshaw, Philip

    2011-12-01

    The authors provide an overview of oral health, why it is important for older people and how poor oral health can affect nutritional status and quality of life. Practical advice is given on assessment of oral health; cleaning of natural teeth and dentures; and care of oral problems that commonly affect older people. An oral healthcare education session is recommended to provide hands-on advice to caregivers. The article is not intended as an exhaustive reference and the reader should always ask for professional dental advice and assistance if in doubt about any aspect of oral care. PMID:22256725

  17. Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners.

    Science.gov (United States)

    Ohns, Mary Jean; Oliver-McNeil, Sandra; Nantais-Smith, Leanne M; George, Nancy M

    2016-01-01

    Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting.

  18. Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners.

    Science.gov (United States)

    Ohns, Mary Jean; Oliver-McNeil, Sandra; Nantais-Smith, Leanne M; George, Nancy M

    2016-01-01

    Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting. PMID:26489793

  19. Guiding the Forces of the Health Care Revolution.

    Science.gov (United States)

    Califano, Joseph A., Jr.

    1987-01-01

    The author describes his work to help Chrysler Corporation combat high medical care costs. He discusses what the United States must do as a whole to bring costs down. He also predicts that, if his guidelines are followed, within 10 years the number of hospital beds will be cut in half. (CH)

  20. Care ethics for guiding the process of multiple sclerosis diagnosis.

    Science.gov (United States)

    Krahn, Timothy Mark

    2014-12-01

    Multiple sclerosis (MS) is a chronic neurological disorder for which there is no definitive diagnostic test. Uncertainty characterises most of its features with diagnosis reached through a process of elimination. Coping with uncertainty has been recognised as a significant problem for MS patients. Discussions in the literature concerning the ethics of MS diagnosis have focused on an ethics of duty emphasising the rules for disclosure and healthcare professionals' obligations to provide information to patients. This narrow construal of the ethics at stake with MS diagnosis may be driven by a common misperception that diagnosis is an event, or series of events, rather than a process. Scant attention has been given to the dynamic, situated relational space between patient and physician as they journey potentially together (or apart) through the process of diagnosis. The healthcare provider cannot properly judge 'the how, what and when' of MS disclosure merely by applying rules pertaining to general professional duties to tell the truth and patients' rights to know their medical status. Proper disclosure and effective communication require the practice of flexible, caring responsibility and sustained, ongoing attention to the particular relational needs of 'this' patient in her own situational context. Accordingly, this article argues that care ethics is especially useful (but not without certain limitations) for attending to a broader swath of responsibilities (different from minimal duties) and affective components implicated in meeting patients' overall needs for care as the patient and physician cope with uncertainty through the process of establishing an MS diagnosis.

  1. Developing Models of Caring in the Professions.

    Science.gov (United States)

    Noddings, Nel

    Much theoretical work is being done in relational ethics, particularly the ethics of care. Models of human caring are also arising within the professions. This paper discusses feminist contributions to theories of caring, focusing on the shared premises, conflicts, and paradoxes faced by four professions (law, nursing, theology, and education),…

  2. Virtual Models of Long-Term Care

    Science.gov (United States)

    Phenice, Lillian A.; Griffore, Robert J.

    2012-01-01

    Nursing homes, assisted living facilities and home-care organizations, use web sites to describe their services to potential consumers. This virtual ethnographic study developed models representing how potential consumers may understand this information using data from web sites of 69 long-term-care providers. The content of long-term-care web…

  3. On Being in Charge: A Guide for Middle-Level Management in Primary Health Care.

    Science.gov (United States)

    McMahon, Rosemary; And Others

    Intended for middle-level health workers with managerial responsibilities, this guide aims to help improve their efficiency in the support and supervision of community health workers and in the organization and continuous support of primary health care programs. It is a sequel to "The Primary Health Worker," available separately--see note. The…

  4. Home Care for Children with Chronic Illnesses and Severe Disabilities: A Bibliography and Resource Guide.

    Science.gov (United States)

    Wells, Alice; And Others

    The bibliography and resource guide summarizes relevant research and information on home care for children with disabilities and chronic illnesses, including those with such diagnoses as spina bifida, cerebral palsy, severe mental retardation, acquired immune deficiency syndrome (AIDS), hemophilia, sickle cell anemia, autism, or failure-to-thrive…

  5. Dental Care Every Day: A Caregiver's Guide. Practical Oral Care for People with Developmental Disabilities

    Science.gov (United States)

    National Institute of Dental and Craniofacial Research (NIDCR), 2009

    2009-01-01

    Taking care of someone with a developmental disability requires patience and skill. As a caregiver, you know this as well as anyone does. You also know how challenging it is to help that person with dental care. It takes planning, time, and the ability to manage physical, mental, and behavioral problems. Dental care isn't always easy, but you can…

  6. Leading from the heart: caring, love, peace, and values guiding leadership.

    Science.gov (United States)

    Turkel, Marian C

    2014-04-01

    Contemporary transformational leadership focuses on authentic leadership styles, relational caring, meaningful recognition, creativity, building trust, relationships, participative decision making, dialogue with time for reflection, and innovation. The purpose of this paper is to illuminate how concepts from the unitary transformative paradigm and caring science can be integrated within nursing leadership practice, to invite nurse leaders to make these concepts explicit in their own transformational leadership journey, and to offer ways of reframing traditional organizational language. Practice exemplars are presented to highlight how tenets from caring theory are guiding the practice of nursing leadership. PMID:24740954

  7. Model-based decision support in diabetes care.

    Science.gov (United States)

    Salzsieder, E; Vogt, L; Kohnert, K-D; Heinke, P; Augstein, P

    2011-05-01

    The model-based Karlsburg Diabetes Management System (KADIS®) has been developed as a patient-focused decision-support tool to provide evidence-based advice for physicians in their daily efforts to optimize metabolic control in diabetes care of their patients on an individualized basis. For this purpose, KADIS® was established in terms of a personalized, interactive in silico simulation procedure, implemented into a problem-related diabetes health care network and evaluated under different conditions by conducting open-label mono- and polycentric trials, and a case-control study, and last but not least, by application in routine diabetes outpatient care. The trial outcomes clearly show that the recommendations provided to the physicians by KADIS® lead to significant improvement of metabolic control. This model-based decision-support system provides an excellent tool to effectively guide physicians in personalized decision-making to achieve optimal metabolic control for their patients. PMID:20621384

  8. JEDI Marine and Hydrokinetic Model: User Reference Guide

    Energy Technology Data Exchange (ETDEWEB)

    Goldberg, M.; Previsic, M.

    2011-04-01

    The Jobs and Economic Development Impact Model (JEDI) for Marine and Hydrokinetics (MHK) is a user-friendly spreadsheet-based tool designed to demonstrate the economic impacts associated with developing and operating MHK power systems in the United States. The JEDI MHK User Reference Guide was developed to assist users in using and understanding the model. This guide provides information on the model's underlying methodology, as well as the sources and parameters used to develop the cost data utilized in the model. This guide also provides basic instruction on model add-in features, operation of the model, and a discussion of how the results should be interpreted.

  9. Development of a theoretical guide for nursing care in cardiac arrest

    Directory of Open Access Journals (Sweden)

    Aliandra Bittencourt da Silva

    2013-11-01

    Full Text Available This study aimed to identify the knowledge on cardiorespiratory arrest among nurses in a hospital of Vale do Paraíba, São Paulo, Brazil, and develop a theoretical guide for care of this emergency. We prepared an instrument of data collection based on relevant literature and the 2010 AHA Guidelines for CPR, from August to October 2012. The sample consisted of 41 nurses who deliver care activities in various units of the hospital. The study showed that professional participants said they were able to act in cardiopulmonary resuscitation, however, there were limitations of knowledge about the theme. Given the above, we developed a theoretical guide for cardiac arrest care based on scientific literature and covering questions submitted by nurses.

  10. The Gold Coast Integrated Care Model

    OpenAIRE

    Connor, Martin; Cooper, Helen; McMurray, Anne

    2016-01-01

    This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve ...

  11. Models to Guide System Reform for At-Risk Youth

    Science.gov (United States)

    McCarter, Susan A.; Haber, Mason G.; Kazemi, Donna

    2010-01-01

    Policy reform for at-risk youth is complicated by involvement of various service sectors. Issues related to coordinating systems of care in a dynamic policy environment are not new, but surprisingly little has been written to guide practitioners and policymakers in addressing them (Friedman in "Journal of Emotional and Behavioral Disorders"…

  12. Model Year 2012 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2011-11-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles.

  13. Model Year 2011 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2010-11-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles.

  14. Model Year 2013 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2012-12-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles.

  15. 1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease

    DEFF Research Database (Denmark)

    Douglas, Pamela S; De Bruyne, Bernard; Pontone, Gianluca;

    2016-01-01

    BACKGROUND: Coronary computed tomographic angiography (CTA) plus estimation of fractional flow reserve using CTA (FFRCT) safely and effectively guides initial care over 90 days in patients with stable chest pain. Longer-term outcomes are unknown. OBJECTIVES: The study sought to determine the 1-year...... clinical, economic, and quality-of-life (QOL) outcomes of using FFRCT instead of usual care. METHODS: Consecutive patients with stable, new onset chest pain were managed by either usual testing (n = 287) or CTA (n = 297) with selective FFRCT (submitted in 201, analyzed in 177); 581 of 584 (99.5%) completed...... events were infrequent, with 2 in each arm of the planned invasive group and 1 in the planned noninvasive cohort (usual care strategy). In the planned invasive stratum, mean costs were 33% lower with CTA and selective FFRCT ($8,127 vs. $12,145 usual care; p

  16. Children and Residential Experiences: A Comprehensive Strategy for Implementing a Research-Informed Program Model for Residential Care

    Science.gov (United States)

    Holden, Martha J.; Izzo, Charles; Nunno, Michael; Smith, Elliott G.; Endres, Thomas; Holden, Jack C.; Kuhn, Frank

    2010-01-01

    This paper describes an effort to bridge research and practice in residential care through implementing a program model titled Children and Residential Experiences (CARE). The strategy involves consulting at all levels of the organization to guide personnel to incorporate CARE evidence-based principles into daily practice, and fostering an…

  17. The Gold Coast Integrated Care Model

    Directory of Open Access Journals (Sweden)

    Martin Connor

    2016-07-01

    Full Text Available This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve the capacity of specialist outpatients, and decrease planned and unplanned admission rates. Central to the model is a shared care record which is maintained and accessed by staff in the Coordination Centre. We provide a process map outlining the care protocols from initial assessment to care of the patient presenting for emergency care. The model is being evaluated over a pilot three year proof of concept phase to determine economic and process perspectives. If found to be cost-effective, acceptable to patients and professionals and as good as or better than usual care in terms of outcomes, the strategic intent is to scale the programme beyond the local health service.

  18. Many diseases, one model of care?

    Directory of Open Access Journals (Sweden)

    Tit Albreht

    2016-02-01

    Full Text Available Abstract This article has been corrected. See J Comorbidity 2016;6(1:33. http://dx.doi.org/joc.2016.6.78. Patients with multiple chronic conditions (multimorbidity have complex and extensive health and social care needs that are not well served by current silo-based models of care. A lack of integration between care providers often leads to fragmented, incomplete, and ineffective care, leaving many patients overwhelmed and unable to navigate their way towards better health outcomes. In planning for the future, healthcare policies and models of care are required that cater for the complex needs of patients with multimorbidity and that deliver coordinated care that is patient-centred and focused on disease prevention, multidisciplinary teamwork and shared decision-making, and on empowering patients to self-manage. Salient lessons can be learnt from the work undertaken at a European and national level to develop care models in cancer and diabetes – two complex and often co-occurring conditions requiring coordinated long-term care. Innovative work is also underway in many European countries aimed at improving the integration of care for people with multimorbidity, resulting in more efficient and cost-effective health outcomes. This article reviews some of the most innovative programmes that have been initiated across and within Europe with the aim of improving the way care is delivered to people with complex and multiple long-term conditions. This work provides a foundation upon which to build better, more effective models of care for people with multimorbidity. Journal of Comorbidity 2016;6(1:12–20

  19. Subspace model identification of guided wave propagation in metallic plates

    International Nuclear Information System (INIS)

    In this study, a data-driven subspace system identification approach is proposed for modeling guided wave propagation in plate media. In the data-driven approach, the subspace system identification estimates a mathematical model fitted to experimentally measured data, but the black-box model identified captures the dynamics of wave propagation. To demonstrate the versatility of the black-box model, wave motions in various shapes of aluminum plates are investigated in the study. In addition, a waveform predictor and temperature change indicator are proposed as applications of the black-box models, to further promote the modeling approach to guided wave propagation. (paper)

  20. Study of the effect of humanistic nursing care model wards in Children Caring Ward School on the nurses' caring ability

    Institute of Scientific and Technical Information of China (English)

    Jiao He; De-Ying Hu; Yi-Lan Liu; Li-Fen Wu; Lian Liu

    2016-01-01

    Objective: To understand the effect of humanistic nursing care model wards in Children Caring Ward School (CCWS) on the nurses' caring ability. Methods: Questionnaire 25 nurses of humanistic nursing care model wards in CCWS using the Nkongho Caring Ability Inventory (CAI) before and after implement the humanistic nursing care model, including reform the systems of nursing care, introduce humanistic care model, implement the humanistic care, to measure the nurses' caring ability. Results: The nurses' caring ability had significantly developed on total, cognition dimension, courage dimension and patience dimension after all measures considered (p Conclusions: The humanistic nursing care model wards in CCWS has a positive effect on the nurses' caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients' satisfaction.

  1. Automatic generation of computable implementation guides from clinical information models

    OpenAIRE

    Boscá Tomás, Diego; Maldonado Segura, José Alberto; Moner Cano, David; Robles Viejo, Montserrat

    2015-01-01

    Clinical information models are increasingly used to describe the contents of Electronic Health Records. Implementation guides are a common specification mechanism used to define such models. They contain, among other reference materials, all the constraints and rules that clinical information must obey. However, these implementation guides typically are oriented to human-readability, and thus cannot be processed by computers. As a consequence, they must be reinterpreted and trans...

  2. Understanding Business Models in Health Care.

    Science.gov (United States)

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

    2016-05-01

    The increasing focus on the costs of care is forcing health care organizations to critically look at their basic set of processes and activities, to determine what type of value they can deliver. A business model describes the resources, processes, and cost assumptions that an organization makes that will lead to the delivery of a unique value proposition to a customer. As health care organizations are beginning to transform their structure in preparation for a value-based delivery system, understanding business model theory can help in the redesign process. PMID:27018909

  3. Guided crowd dynamics via modified social force model

    Science.gov (United States)

    Yang, Xiaoxia; Dong, Hairong; Wang, Qianling; Chen, Yao; Hu, Xiaoming

    2014-10-01

    Pedestrian dynamics is of great theoretical significance for strategy design of emergency evacuation. Modification of pedestrian dynamics based on the social force model is presented to better reflect pedestrians' behavioral characteristics in emergency. Specifically, the modified model can be used for guided crowd dynamics in large-scale public places such as subway stations and stadiums. This guided crowd model is validated by explicitly comparing its density-speed and density-flow diagrams with fundamental diagrams. Some social phenomena such as gathering, balance and conflicts are clearly observed in simulation, which further illustrate the effectiveness of the proposed modeling method. Also, time delay for pedestrians with time-dependent desired velocities is observed and explained using the established model in this paper. Furthermore, this guided crowd model is applied to the simulation system of Beijing South Railway Station for predictive evacuation experiments.

  4. Implementing Outcome Measures Within an Enhanced Palliative Care Day Care Model.

    LENUS (Irish Health Repository)

    Kilonzo, Isae

    2015-04-23

    Specialist palliative care day care (SPDC) units provide an array of services to patients and their families and can increase continuity of care between inpatient and homecare settings. A multidisciplinary teamwork approach is emphasized, and different models of day care exist. Depending on the emphasis of care, the models can be social, medical, therapeutic, or mixed. We describe our experience of introducing an enhanced therapeutic specialist day care model and using both patient- and carer-rated tools to monitor patient outcomes.

  5. Bedside ultrasound-guided percutaneous cystostomy in an infant in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Yiu Shiobhon Luk

    2015-10-01

    Full Text Available We describe a case of an infant born at 39 weeks of gestation who was in the neonatal intensive care unit for postoperative management of congenital heart disease and underwent bedside ultrasound-guided percutaneous cystostomy to treat an iatrogenic urethral injury. The procedure was uneventful, successful, and no complications were noted. This case demonstrates that this procedure is safe and minimally invasive. Indications, contraindications, techniques, potential complications, and the safety of performing this procedure in a bedside setting are discussed.

  6. A Beginner's Guide to the Solow Model

    Science.gov (United States)

    Stein, Sheldon H.

    2007-01-01

    The Solow model is widely regarded as the workhorse model of the theory of economic growth. Although at one point this model was first encountered in graduate school, it has since filtered down to the intermediate and, occasionally, to the principles of macroeconomics course. Many have commented on how difficult it is to teach the Solow model to…

  7. Model Year 2016 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-11-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles. The vehicles listed have been divided into three classes of cars, three classes of light duty trucks, and three classes of special purpose vehicles.

  8. Model Year 2005 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2004-11-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles. The vehicles listed have been divided into three classes of cars, three classes of light duty trucks, and three classes of special purpose vehicles.

  9. Model Year 2007 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2007-10-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles. The vehicles listed have been divided into three classes of cars, three classes of light duty trucks, and three classes of special purpose vehicles.

  10. Model Year 2008 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2007-10-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles. The vehicles listed have been divided into three classes of cars, three classes of light duty trucks, and three classes of special purpose vehicles.

  11. Model Year 2009 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2008-10-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles. The vehicles listed have been divided into three classes of cars, three classes of light duty trucks, and three classes of special purpose vehicles.

  12. Model Year 2006 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2005-11-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles. The vehicles listed have been divided into three classes of cars, three classes of light duty trucks, and three classes of special purpose vehicles.

  13. Model Year 2014 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-12-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles. The vehicles listed have been divided into three classes of cars, three classes of light duty trucks, and three classes of special purpose vehicles.

  14. Model Year 2015 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2014-12-01

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles. The vehicles listed have been divided into three classes of cars, three classes of light duty trucks, and three classes of special purpose vehicles.

  15. Model Year 2010 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2009-10-14

    The Fuel Economy Guide is published by the U.S. Department of Energy as an aid to consumers considering the purchase of a new vehicle. The Guide lists estimates of miles per gallon (mpg) for each vehicle available for the new model year. These estimates are provided by the U.S. Environmental Protection Agency in compliance with Federal Law. By using this Guide, consumers can estimate the average yearly fuel cost for any vehicle. The Guide is intended to help consumers compare the fuel economy of similarly sized cars, light duty trucks and special purpose vehicles. The vehicles listed have been divided into three classes of cars, three classes of light duty trucks, and three classes of special purpose vehicles.

  16. Automatic generation of computable implementation guides from clinical information models.

    Science.gov (United States)

    Boscá, Diego; Maldonado, José Alberto; Moner, David; Robles, Montserrat

    2015-06-01

    Clinical information models are increasingly used to describe the contents of Electronic Health Records. Implementation guides are a common specification mechanism used to define such models. They contain, among other reference materials, all the constraints and rules that clinical information must obey. However, these implementation guides typically are oriented to human-readability, and thus cannot be processed by computers. As a consequence, they must be reinterpreted and transformed manually into an executable language such as Schematron or Object Constraint Language (OCL). This task can be difficult and error prone due to the big gap between both representations. The challenge is to develop a methodology for the specification of implementation guides in such a way that humans can read and understand easily and at the same time can be processed by computers. In this paper, we propose and describe a novel methodology that uses archetypes as basis for generation of implementation guides. We use archetypes to generate formal rules expressed in Natural Rule Language (NRL) and other reference materials usually included in implementation guides such as sample XML instances. We also generate Schematron rules from NRL rules to be used for the validation of data instances. We have implemented these methods in LinkEHR, an archetype editing platform, and exemplify our approach by generating NRL rules and implementation guides from EN ISO 13606, openEHR, and HL7 CDA archetypes. PMID:25910958

  17. The Island Hospice model of palliative care

    Science.gov (United States)

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals.

  18. Guide to the dynamic biosphere model DECOS (Ed. 1)

    International Nuclear Information System (INIS)

    A dynamic biosphere model, DECOS, has been developed by Associated Nuclear Sevices Ltd for the Department of the Environment. DECOS was written as a 'stand-alone' development code to be interfaced with other assessment models as part of a new probabilistic code, VANDAL. This report provides a guide to the 'stand-alone' version of DECOS. (author)

  19. Procalcitonin-guided antibiotic treatment of respiratory tract infections in a primary care setting

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Jensen, Jens Ulrik Stæhr

    2011-01-01

    Clinical signs of infection do not allow for correct identification of bacterial and viral aetiology in acute respiratory infections. A valid tool to assist the clinician in identifying patients who will benefit from antibiotic therapy, as well as patients with a potentially serious infection, co...... are likely to benefit from antibiotic treatment and to rule out serious infections, and comments on further research to determine a future role for procalcitonin in primary care......., could greatly improve patient care and limit excessive antibiotic prescriptions. Procalcitonin is a new marker of suspected bacterial infection that has shown promise in guiding antibiotic therapy in acute respiratory tract infections in hospitals without compromising patient safety. Procalcitonin...... concentrations in primary care are low and can be used primarily to rule out serious infection. However, procalcitonin measurement should not be used as the sole basis for clinical decisions; clinical skills are prerequisites for the correct use of this new tool in practice. At present there is no point-of-care...

  20. CT-guided percutaneous drainage and fluid aspiration in intensive care patients

    Energy Technology Data Exchange (ETDEWEB)

    Schurawitzki, H.; Karnel, F.; Stiglbauer, R.; Schimmerl, S.; Solomonowitz, E. (Allgemeines Krankenhaus, Vienna (Austria). Dept. of Radiology and MR-Inst.)

    1992-03-01

    Fifty-two intensive care unit (ICU) patients with clinical signs of sepsis who were considered to be at extremely high risk for operation were subjected to CT-guided interventions. Bedside ultrasound (US) had been performed prior to CT in all patients but diagnoses were equivocal or US-guided diagnostic aspiration of fluid collections to rule out infection. Eighteen patients (72%) with abscess formations after surgery or trauma were cured by catheter drainage alone; 4 patients required additional surgery. Out of 8 patients suffering from acute pancreatitis (after several necrosectomies), abscesses could be cured in 5 (62,5%). Three patients with acute necrotizing pancreatitis (no surgery) were not cured by the interventional procedure and all required surgical debridement. Even patients who required additional surgery after drainage improved clinically after the interventional radiologic procedure. Our overall success rate was 64%, emphasizing the need for CT in the case of equivocal US results or if US-guided procedures have failed in ICU patients with signs of sepsis. (orig.).

  1. Global specialized stroke care delivery models.

    Science.gov (United States)

    Theofanidis, Dimitrios; Savopoulos, Christos; Hatzitolios, Apostolos

    2016-03-01

    Stroke services still vary enormously from country to country, with many countries providing no special services at all. The aim of this article is to provide a concise overview of the various types of acute stroke delivery systems at present available and critically describe merits and shortcomings. A systematic literature review was undertaken from 1990 to July 2014. Several models for stroke services have been developed mostly in the past 3 decades, mainly in the Western world. These include state-of-the-art stroke services ranging from highly specialized stroke centers to mobile stroke units for the community. In this light, the recommendations of the structure and organization of stroke units and stroke centers by the European Stroke Organization were recently published. What differentiates the various models of stroke care delivery across the globe is the diversity of services ranging from low key conventional care to highly sophisticated facilities with life saving interventional features via integrated stroke care infrastructure. Effective in-hospital care for stroke should start in the emergency department where a swift and appropriate diagnosis should be made. The role of all brain neuroimaging procedures should have a defined a priori and proper demarcation between actions according to updated stroke care pathways and clinical protocols, which should be followed closely. These essential actions initiated by well-trained staff in the emergency department, should then be carried on in dedicated stroke facilities that is, a stroke unit.

  2. METAPHOR (version 1): Users guide. [performability modeling

    Science.gov (United States)

    Furchtgott, D. G.

    1979-01-01

    General information concerning METAPHOR, an interactive software package to facilitate performability modeling and evaluation, is presented. Example systems are studied and their performabilities are calculated. Each available METAPHOR command and array generator is described. Complete METAPHOR sessions are included.

  3. Sea ice biogeochemistry: a guide for modellers.

    Directory of Open Access Journals (Sweden)

    Letizia Tedesco

    Full Text Available Sea ice is a fundamental component of the climate system and plays a key role in polar trophic food webs. Nonetheless sea ice biogeochemical dynamics at large temporal and spatial scales are still rarely described. Numerical models may potentially contribute integrating among sparse observations, but available models of sea ice biogeochemistry are still scarce, whether their relevance for properly describing the current and future state of the polar oceans has been recently addressed. A general methodology to develop a sea ice biogeochemical model is presented, deriving it from an existing validated model application by extension of generic pelagic biogeochemistry model parameterizations. The described methodology is flexible and considers different levels of ecosystem complexity and vertical representation, while adopting a strategy of coupling that ensures mass conservation. We show how to apply this methodology step by step by building an intermediate complexity model from a published realistic application and applying it to analyze theoretically a typical season of first-year sea ice in the Arctic, the one currently needing the most urgent understanding. The aim is to (1 introduce sea ice biogeochemistry and address its relevance to ocean modelers of polar regions, supporting them in adding a new sea ice component to their modelling framework for a more adequate representation of the sea ice-covered ocean ecosystem as a whole, and (2 extend our knowledge on the relevant controlling factors of sea ice algal production, showing that beyond the light and nutrient availability, the duration of the sea ice season may play a key-role shaping the algal production during the on going and upcoming projected changes.

  4. Sea Ice Biogeochemistry: A Guide for Modellers

    Science.gov (United States)

    Tedesco, Letizia; Vichi, Marcello

    2014-01-01

    Sea ice is a fundamental component of the climate system and plays a key role in polar trophic food webs. Nonetheless sea ice biogeochemical dynamics at large temporal and spatial scales are still rarely described. Numerical models may potentially contribute integrating among sparse observations, but available models of sea ice biogeochemistry are still scarce, whether their relevance for properly describing the current and future state of the polar oceans has been recently addressed. A general methodology to develop a sea ice biogeochemical model is presented, deriving it from an existing validated model application by extension of generic pelagic biogeochemistry model parameterizations. The described methodology is flexible and considers different levels of ecosystem complexity and vertical representation, while adopting a strategy of coupling that ensures mass conservation. We show how to apply this methodology step by step by building an intermediate complexity model from a published realistic application and applying it to analyze theoretically a typical season of first-year sea ice in the Arctic, the one currently needing the most urgent understanding. The aim is to (1) introduce sea ice biogeochemistry and address its relevance to ocean modelers of polar regions, supporting them in adding a new sea ice component to their modelling framework for a more adequate representation of the sea ice-covered ocean ecosystem as a whole, and (2) extend our knowledge on the relevant controlling factors of sea ice algal production, showing that beyond the light and nutrient availability, the duration of the sea ice season may play a key-role shaping the algal production during the on going and upcoming projected changes. PMID:24586604

  5. Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians

    Directory of Open Access Journals (Sweden)

    Green M

    2016-05-01

    Full Text Available Margot Green1, Vince Marzano1, I Anne Leditschke2,3, Imogen Mitchell2,3, Bernie Bissett1,4,5 1Physiotherapy Department, Canberra Hospital, Canberra, ACT, Australia; 2Intensive Care Unit, Canberra Hospital, Canberra, ACT, Australia; 3School of Medicine, Australian National University, Canberra, ACT, Australia; 4Discipline of Physiotherapy, University of Canberra, Canberra, ACT, Australia; 5School of Medicine, University of Queensland, Brisbane, QLD, Australia Objectives: To describe our experience and the practical tools we have developed to facilitate early mobilization in the intensive care unit (ICU as a multidisciplinary team.Background: Despite the evidence supporting early mobilization for improving outcomes for ICU patients, recent international point-prevalence studies reveal that few patients are mobilized in the ICU. Existing guidelines rarely address the practical issues faced by multidisciplinary ICU teams attempting to translate evidence into practice. We present a comprehensive strategy for safe mobilization utilized in our ICU, incorporating the combined skills of medical, nursing, and physiotherapy staff to achieve safe outcomes and establish a culture which prioritizes this intervention.Methods: A raft of tools and strategies are described to facilitate mobilization in ICU by the multidisciplinary team. Patients without safe unsupported sitting balance and without ≥3/5 (Oxford scale strength in the lower limbs commence phase 1 mobilization, including training of sitting balance and use of the tilt table. Phase 2 mobilization involves supported or active weight-bearing, incorporating gait harnesses if necessary. The Plan B mnemonic guides safe multidisciplinary mobilization of invasively ventilated patients and emphasizes the importance of a clearly articulated plan in delivering this valuable treatment as a team.Discussion: These tools have been used over the past 5 years in a tertiary ICU with a very low incidence of

  6. Standard guide for use of modeling for passive gamma measurements

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2010-01-01

    1.1 This guide addresses the use of models with passive gamma-ray measurement systems. Mathematical models based on physical principles can be used to assist in calibration of gamma-ray measurement systems and in analysis of measurement data. Some nondestructive assay (NDA) measurement programs involve the assay of a wide variety of item geometries and matrix combinations for which the development of physical standards are not practical. In these situations, modeling may provide a cost-effective means of meeting user’s data quality objectives. 1.2 A scientific knowledge of radiation sources and detectors, calibration procedures, geometry and error analysis is needed for users of this standard. This guide assumes that the user has, at a minimum, a basic understanding of these principles and good NDA practices (see Guide C1592), as defined for an NDA professional in Guide C1490. The user of this standard must have at least a basic understanding of the software used for modeling. Instructions or further train...

  7. Managing mathematical modelling by guiding and monitoring

    NARCIS (Netherlands)

    Scholten, H.; Beulens, A.J.M.

    2006-01-01

    This case study discusses how a knowledge base can be used to solve complex multi-disciplinary problems through a model based approach in the water management sector. We learn how successful execution and completion of multi-disciplinary complex projects can be supported through a knowledge-based sy

  8. A Family Guide to Systems of Care for Children with Mental Health Needs = Guia para la familia de "Systems of Care" para la salud mental de sus hijos.

    Science.gov (United States)

    Dougherty, Janice; Harris, Pam; Hawes, Janet; Shepler, Rick; Tolin, Canice; Truman, Connie

    This bilingual (English-Spanish) guide is intended to assist parents and caregivers in seeking help for children with mental health problems. As part of the system of care, parents and caregivers need to work together to help the child in need. Caregivers and counselors can help families define their strengths, determine the things they want to…

  9. Insider safeguards effectiveness model (ISEM). User's guide

    International Nuclear Information System (INIS)

    A comprehensive presentation of the ISEM computer program is provided. ISEM was designed to evaluate the effectiveness of a fixed-site facility safeguards system in coping with the theft, sabotage, or dispersal of radiological material by a single person who has authorized access to the facility. This insider may be aided by a group of insiders who covertly degrade sensor systems. Each ISEM run evaluates safeguards system performance for a particular scenario specified by the user. The dispatching of guards following alarms and their interaction with the insider are explicitly treated by the model

  10. Macro System Model (MSM) User Guide, Version 1.3

    Energy Technology Data Exchange (ETDEWEB)

    Ruth, M.; Diakov, V.; Sa, T.; Goldsby, M.

    2011-09-01

    This user guide describes the macro system model (MSM). The MSM has been designed to allow users to analyze the financial, environmental, transitional, geographical, and R&D issues associated with the transition to a hydrogen economy. Basic end users can use the MSM to answer cross-cutting questions that were previously difficult to answer in a consistent and timely manner due to various assumptions and methodologies among different models.

  11. Tissue Sampling Guides for Porcine Biomedical Models.

    Science.gov (United States)

    Albl, Barbara; Haesner, Serena; Braun-Reichhart, Christina; Streckel, Elisabeth; Renner, Simone; Seeliger, Frank; Wolf, Eckhard; Wanke, Rüdiger; Blutke, Andreas

    2016-04-01

    This article provides guidelines for organ and tissue sampling adapted to porcine animal models in translational medical research. Detailed protocols for the determination of sampling locations and numbers as well as recommendations on the orientation, size, and trimming direction of samples from ∼50 different porcine organs and tissues are provided in the Supplementary Material. The proposed sampling protocols include the generation of samples suitable for subsequent qualitative and quantitative analyses, including cryohistology, paraffin, and plastic histology; immunohistochemistry;in situhybridization; electron microscopy; and quantitative stereology as well as molecular analyses of DNA, RNA, proteins, metabolites, and electrolytes. With regard to the planned extent of sampling efforts, time, and personnel expenses, and dependent upon the scheduled analyses, different protocols are provided. These protocols are adjusted for (I) routine screenings, as used in general toxicity studies or in analyses of gene expression patterns or histopathological organ alterations, (II) advanced analyses of single organs/tissues, and (III) large-scale sampling procedures to be applied in biobank projects. Providing a robust reference for studies of porcine models, the described protocols will ensure the efficiency of sampling, the systematic recovery of high-quality samples representing the entire organ or tissue as well as the intra-/interstudy comparability and reproducibility of results. PMID:26883152

  12. Disaster medicine. A guide for medical care in case of disasters. 3. rev. ed.

    International Nuclear Information System (INIS)

    This guide was first published in 1982. The 2003 edition takes account of new research, of practical experience in natural disasters, and of the organisational plans of the German civil service units. All factors are considered which are important for successful medical care in case of natural disasters, large-scale accidents, and war. Among the new issues that are considered in this volume is the new European situation with regard to national safety, the new German legislation on civil safety, the hazards of an increasingly technological society, and the options and requirements for protection of the population in case of emergencies. After the Chernobyl accident, the focus in the field of nuclear radiation has shifted to radiation protection problems. There are new chapters on stress management during and after emergency shifts which take account of the experience gained in major disasters. (orig.)

  13. Nursing care for patients with local recurrent rectal cancer after CT-guided 125I seed implantation therapy

    International Nuclear Information System (INIS)

    Objective: To discuss the nursing care strategy for patients with local recurrent rectal cancer who has been treated with CT-guided 125I seed implantation therapy. Methods: Twenty patients with local recurrent rectal cancer received a series of nursing interventions, including comfort care and pain care. The clinical results were observed and analyzed. Results: The therapy was smoothly accomplished in all patients. The pain was remarkably relived and the anxiety was alleviated. No displacement of implanted 125I seed occurred. Conclusion: For patients with local recurrent rectal cancer occurred after CT-guided 125I seed implantation therapy, careful nursing can effectively relieve the pain and anxiety feeling,and the living quality can also be markedly improved. (authors)

  14. The complete guide to blender graphics computer modeling and animation

    CERN Document Server

    Blain, John M

    2014-01-01

    Smoothly Leads Users into the Subject of Computer Graphics through the Blender GUIBlender, the free and open source 3D computer modeling and animation program, allows users to create and animate models and figures in scenes, compile feature movies, and interact with the models and create video games. Reflecting the latest version of Blender, The Complete Guide to Blender Graphics: Computer Modeling & Animation, 2nd Edition helps beginners learn the basics of computer animation using this versatile graphics program. This edition incorporates many new features of Blender, including developments

  15. Image Denoising Using Total Variation Model Guided by Steerable Filter

    OpenAIRE

    Wenxue Zhang; Yongzhen Cao; Rongxin Zhang; Yuanquan Wang

    2014-01-01

    We propose an adaptive total variation (TV) model by introducing the steerable filter into the TV-based diffusion process for image filtering. The local energy measured by the steerable filter can effectively characterize the object edges and ramp regions and guide the TV-based diffusion process so that the new model behaves like the TV model at edges and leads to linear diffusion in flat and ramp regions. This way, the proposed model can provide a better image processing tool which enables n...

  16. Integration of the interaction model of client health behavior and transactional model of stress and coping as a tool for understanding retention in HIV care across the lifespan.

    Science.gov (United States)

    Graham, Lucy J

    2015-01-01

    Retaining people living with HIV (PLWH) in care over the lifespan is critical to quality and longevity of life. Individual health behavior decisions that affect care retention are complicated and multifactorial. Current health behavior theories are inadequate in isolation to guide retention in care research. Two existing models, Cox's Interaction Model of Client Health Behavior, and Lazarus and Folkman's Transactional Model of Stress and Coping have both guided research with PLWH, although not related to retention in care. Integration of these models may more comprehensively inform care retention research and practice across the lifespan as it incorporates not only intra- and inter-personal characteristics and relationships but also the stress and coping experiences inevitable when living with a chronic illness such as HIV.

  17. The Effects of Guided Careful Online Planning on Complexity, Accuracy and Fluency in Intermediate EFL Learners' Oral Production: The Case of English Articles

    Science.gov (United States)

    Ahmadian, Mohammad Javad

    2012-01-01

    The purpose of the study reported in this article was twofold: First, to see whether guided careful online planning assists intermediate learners of English as a foreign language (EFL) in accurate oral production of English articles ("an/a" and "the"); and, second, to see whether guided careful online planning has any effects on global complexity…

  18. A student's guide to Python for physical modeling

    CERN Document Server

    Kinder, Jesse M

    2015-01-01

    Python is a computer programming language that is rapidly gaining popularity throughout the sciences. A Student’s Guide to Python for Physical Modeling aims to help you, the student, teach yourself enough of the Python programming language to get started with physical modeling. You will learn how to install an open-source Python programming environment and use it to accomplish many common scientific computing tasks: importing, exporting, and visualizing data; numerical analysis; and simulation. No prior programming experience is assumed. This tutorial focuses on fundamentals and introduces a wide range of useful techniques, including: Basic Python programming and scripting Numerical arrays Two- and three-dimensional graphics Monte Carlo simulations Numerical methods, including solving ordinary differential equations Image processing Animation Numerous code samples and exercises—with solutions—illustrate new ideas as they are introduced. A website that accompanies this guide provides additional resourc...

  19. Linear mixed models a practical guide using statistical software

    CERN Document Server

    West, Brady T; Galecki, Andrzej T

    2006-01-01

    Simplifying the often confusing array of software programs for fitting linear mixed models (LMMs), Linear Mixed Models: A Practical Guide Using Statistical Software provides a basic introduction to primary concepts, notation, software implementation, model interpretation, and visualization of clustered and longitudinal data. This easy-to-navigate reference details the use of procedures for fitting LMMs in five popular statistical software packages: SAS, SPSS, Stata, R/S-plus, and HLM. The authors introduce basic theoretical concepts, present a heuristic approach to fitting LMMs based on bo

  20. Model Guided Sampling Optimization for Low-dimensional Problems

    OpenAIRE

    Bajer, L. (Lukáš); Holeňa, M. (Martin)

    2015-01-01

    Optimization of very expensive black-box functions requires utilization of maximum information gathered by the process of optimization. Model Guided Sampling Optimization (MGSO) forms a more robust alternative to Jones’ Gaussian-process-based EGO algorithm. Instead of EGO’s maximizing expected improvement, the MGSO uses sampling the probability of improvement which is shown to be helpful against trapping in local minima. Further, the MGSO can reach close-to-optimum solutions faster than stand...

  1. Facilitators and barriers of implementing the chronic care model in primary care: a systematic review

    OpenAIRE

    Kadu, Mudathira K; Stolee, Paul

    2015-01-01

    Background The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identi...

  2. Care production for tuberculosis cases:analysis according to the elements of the Chronic Care Model

    OpenAIRE

    Daiane Medeiros da Silva; Hérika Brito Gomes de Farias; Tereza Cristina Scatena Villa; Lenilde Duarte de Sá; Maria Eugênia Firmino Brunello; Jordana Almeida Nogueira

    2016-01-01

    Abstract OBJECTIVE: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. METHOD: Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum...

  3. Leadership models in health care - a case for servant leadership.

    Science.gov (United States)

    Trastek, Victor F; Hamilton, Neil W; Niles, Emily E

    2014-03-01

    Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients.

  4. Evidence-based models of care for people with epilepsy.

    LENUS (Irish Health Repository)

    Fitzsimons, Mary

    2012-02-01

    Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

  5. Expanded Medical Home Model Works for Children in Foster Care

    Science.gov (United States)

    Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.

    2012-01-01

    The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…

  6. Practitioner's guide to laser pulse propagation models and simulation

    International Nuclear Information System (INIS)

    The purpose of this article is to provide practical introduction into numerical modeling of ultrashort optical pulses in extreme nonlinear regimes. The theoretic background section covers derivation of modern pulse propagation models starting from Maxwell's equations, and includes both envelope-based models and carrier-resolving propagation equations. We then continue with a detailed description of implementation in software of Nonlinear Envelope Equations as an example of a mixed approach which combines finite-difference and spectral techniques. Fully spectral numerical solution methods for the Unidirectional Pulse Propagation Equation are discussed next. The modeling part of this guide concludes with a brief introduction into efficient implementations of nonlinear medium responses. Finally, we include several worked-out simulation examples. These are mini-projects designed to highlight numerical and modeling issues, and to teach numerical-experiment practices. They are also meant to illustrate, first and foremost for a non-specialist, how tools discussed in this guide can be applied in practical numerical modeling. (authors)

  7. Gelatin model for training ultrasound-guided puncture

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2015-09-01

    Full Text Available BACKGROUND: It is indispensable that members of the medical profession receive the technical training needed to enable them to rapidly obtain effective vascular access. Training procedures should be used judiciously to familiarize students with the technique. However, existing models are expensive or ineffective, and models need to be developed that are similar to what will be encountered in real patients.OBJECTIVES: To demonstrate creation and application of a gelatin model for training ultrasound-guided puncture.METHOS: The model was made using a mixture of colorless gelatin and water in a transparent plastic receptacle with two pairs of orifices of different diameters, through which two plastic tubes were inserted, to simulate blood vessels.RESULTS: The model was a close approximation to the real medical procedure in several aspects, since gelatin has a similar consistency to human tissues, providing a more faithful reproduction of the tactile sensation at the moment when the needle reaches the interior of a vessel and its contents are aspirated.CONCLUSIONS: The method proposed here can be used to easily construct a low-cost model using everyday materials that is suitable for large-scale training of ultrasound-guided puncture.

  8. The Guided System Development Framework: Modeling and Verifying Communication Systems

    DEFF Research Database (Denmark)

    Carvalho Quaresma, Jose Nuno; Probst, Christian W.; Nielson, Flemming

    2014-01-01

    In a world that increasingly relies on the Internet to function, application developers rely on the implementations of protocols to guarantee the security of data transferred. Whether a chosen protocol gives the required guarantees, and whether the implementation does the same, is usually unclear....... The Guided System Development framework contributes to more secure communication systems by aiding the development of such systems. The framework features a simple modelling language, step-wise refinement from models to implementation, interfaces to security verification tools, and code generation from...

  9. Endocrine check-up in adolescents and indications for referral: A guide for health care providers

    Directory of Open Access Journals (Sweden)

    Vincenzo De Sanctis

    2014-01-01

    Full Text Available The American Academy of Pediatrics recommends that young people between the ages of 11 and 21 years should be seen annually by their pediatricians, since annual checkups can be an important opportunity for health evaluation and anticipatory guidance. Parents of infants and young children are accustomed to regularly visiting a pediatrician for their child′s checkups. Unfortunately, when children reach the teen years, these annual checkups may decrease in frequency. In routine check-ups and medical office visits, particular attention should be paid to the possibility of a developmental or endocrine disorder. Early diagnosis and treatment may prevent medical complications in adulthood and foster age-appropriate development. Our purpose is to acquaint readers with the concept, based on current scientific understanding, that some endocrine disorders may be associated with a wide range of deleterious health consequences including an increased risk of hypertension and hyperlipidemia, increased risk of coronary artery disease, type 2 diabetes, significant anxiety and lack of self-esteem. Understanding the milestones and developmental stages of adolescence is essential for pediatricians and all other health providers who care for adolescents. Treating adolescents involves knowledge of a variety of medical, social and legal information; in addition, close working relationships must be established within the adolescent′s network to create an effective care system. In summary, we underline the importance of a periodic endocrine checkup in adolescents in order to identify endocrine problems early and develop an approach to treatment for those patients who need help during this time. Indications for endocrine referral for professional and other healthcare providers are also included. These lists are clearly not intended to be comprehensive, but will hopefully serve as a guide for specific clinical circumstances.

  10. Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon's review and perspective (Conference Presentation)

    Science.gov (United States)

    Nehal, Kishwer S.; Rajadhyaksha, Milind

    2016-02-01

    Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon's review and perspective About 350 publications worldwide have reported the ability of reflectance confocal microscopy (RCM) imaging to detect melanocytic skin lesions in vivo with specificity of 84-88% and sensitivity of 71-92%, and non-melanocytic skin lesions with specificity of 85-97% and sensitivity 100-92%. Lentigo maligna melanoma can be detected with sensitivity of 93% and specificity 82%. While the sensitivity is comparable to that of dermoscopy, the specificity is 2X superior, especially for lightly- and non-pigmented lesions. Dermoscopy combined with RCM imaging is proving to be both highly sensitive and highly specific. Recent studies have reported that the ratio of equivocal (i.e., would have been biopsied) lesions to detected melanomas dropped by ~2X when guided by dermoscopy and RCM imaging, compared to that with dermoscopy alone. Dermoscopy combined with RCM imaging is now being implemented to guide noninvasive diagnosis (to rule out malignancy and biopsy) and to also guide treatment, with promising initial impact: thus far, about 3,000 patients have been saved from biopsies of benign lesions. These are currently under follow-up monitoring. With fluorescence confocal microscopy (FCM) mosaicing, residual basal cell carcinomas can be detected in Mohs surgically excised fresh tissue ex vivo, with sensitivity of 94-97% and specificity 89-94%. FCM mosaicing is now being implemented for guiding Mohs surgery. To date, about 600 Mohs procedures have been performed, guided with mosaicing, and with pathology being performed in parallel to confirm the final outcome. These latest advances demonstrate the promising ability of RCM and FCM to guide patient care.

  11. Explanatory model for nursing and care 2007

    OpenAIRE

    Jedid-Jah Jonker; Klarita Sadiraj; Isolde Woittiez; Michiel Ras; Meike Morren

    2007-01-01

    Original title: Verklaringsmodel verpleging en verzorging 2007. Population ageing means the demand for and take-up of care is likely to increase sharply in the coming years. Older people make particularly heavy use of home care, nursing homes and care homes, collectively referred to as 'nursing and care'. The Dutch Ministry of Health, Welfare and Sport is therefore interested in the likely trend in nursing and care in the coming decades. This study presents forecasts of the demand for and tak...

  12. Models for Primary Eye Care Services in India

    Directory of Open Access Journals (Sweden)

    Vasundhra Misra

    2015-01-01

    In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

  13. A guide to Bayesian model selection for ecologists

    Science.gov (United States)

    Hooten, Mevin B.; Hobbs, N.T.

    2015-01-01

    The steady upward trend in the use of model selection and Bayesian methods in ecological research has made it clear that both approaches to inference are important for modern analysis of models and data. However, in teaching Bayesian methods and in working with our research colleagues, we have noticed a general dissatisfaction with the available literature on Bayesian model selection and multimodel inference. Students and researchers new to Bayesian methods quickly find that the published advice on model selection is often preferential in its treatment of options for analysis, frequently advocating one particular method above others. The recent appearance of many articles and textbooks on Bayesian modeling has provided welcome background on relevant approaches to model selection in the Bayesian framework, but most of these are either very narrowly focused in scope or inaccessible to ecologists. Moreover, the methodological details of Bayesian model selection approaches are spread thinly throughout the literature, appearing in journals from many different fields. Our aim with this guide is to condense the large body of literature on Bayesian approaches to model selection and multimodel inference and present it specifically for quantitative ecologists as neutrally as possible. We also bring to light a few important and fundamental concepts relating directly to model selection that seem to have gone unnoticed in the ecological literature. Throughout, we provide only a minimal discussion of philosophy, preferring instead to examine the breadth of approaches as well as their practical advantages and disadvantages. This guide serves as a reference for ecologists using Bayesian methods, so that they can better understand their options and can make an informed choice that is best aligned with their goals for inference.

  14. Symmetry-guided large-scale shell-model theory

    Science.gov (United States)

    Launey, Kristina D.; Dytrych, Tomas; Draayer, Jerry P.

    2016-07-01

    In this review, we present a symmetry-guided strategy that utilizes exact as well as partial symmetries for enabling a deeper understanding of and advancing ab initio studies for determining the microscopic structure of atomic nuclei. These symmetries expose physically relevant degrees of freedom that, for large-scale calculations with QCD-inspired interactions, allow the model space size to be reduced through a very structured selection of the basis states to physically relevant subspaces. This can guide explorations of simple patterns in nuclei and how they emerge from first principles, as well as extensions of the theory beyond current limitations toward heavier nuclei and larger model spaces. This is illustrated for the ab initio symmetry-adapted no-core shell model (SA-NCSM) and two significant underlying symmetries, the symplectic Sp(3 , R) group and its deformation-related SU(3) subgroup. We review the broad scope of nuclei, where these symmetries have been found to play a key role-from the light p-shell systems, such as 6Li, 8B, 8Be, 12C, and 16O, and sd-shell nuclei exemplified by 20Ne, based on first-principle explorations; through the Hoyle state in 12C and enhanced collectivity in intermediate-mass nuclei, within a no-core shell-model perspective; up to strongly deformed species of the rare-earth and actinide regions, as investigated in earlier studies. A complementary picture, driven by symmetries dual to Sp(3 , R) , is also discussed. We briefly review symmetry-guided techniques that prove useful in various nuclear-theory models, such as Elliott model, ab initio SA-NCSM, symplectic model, pseudo- SU(3) and pseudo-symplectic models, ab initio hyperspherical harmonics method, ab initio lattice effective field theory, exact pairing-plus-shell model approaches, and cluster models, including the resonating-group method. Important implications of these approaches that have deepened our understanding of emergent phenomena in nuclei, such as enhanced

  15. Models for Designing Long-Term Care Service Plans and Care Programs for Older People

    Directory of Open Access Journals (Sweden)

    Shogo Kato

    2013-01-01

    Full Text Available The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans and care programs has not been established yet. In this paper, we propose models for designing long-term care service plans and care programs for older people, both by incorporating the technical issues from previous studies and by redesigning the total methodology according to these studies. Our implementation model consists of “Function,” “Knowledge Structure,” and “Action Flow.” In addition, we developed the concrete knowledgebases based on the Knowledge Structure by visualizing, summarizing, and structuring the inherent knowledge of healthcare/welfare professionals. As the results of the workshop and retrospective verification, the adequacy of the models was suggested, while some further issues were pointed. Our models, knowledgebases, and application make it possible to ensure the quality of long-term care for older people.

  16. A better model for care — virtual care coordination

    OpenAIRE

    Herbert, Chris; Medd, Claire

    2012-01-01

    Telehealth is a proven tool for reducing costs, improving quality of life, reducing hospital visits/length of stay and enhancing relationships between patients and community nurses. There have been many trials demonstrating these benefits, and findings have always demonstrated return on investment. However, uptake has been slow—68% of providers have no plans to roll out a telehealth solution in the next 24 months. Through a decade of ethnographic research, Care Innovations has visited 20 coun...

  17. Intervening at the Setting Level to Prevent Behavioral Incidents in Residential Child Care: Efficacy of the CARE Program Model.

    Science.gov (United States)

    Izzo, Charles V; Smith, Elliott G; Holden, Martha J; Norton, Catherine I; Nunno, Michael A; Sellers, Deborah E

    2016-07-01

    The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions.

  18. The implementation of integrated care: the empirical validation of the Development Model for Integrated Care

    OpenAIRE

    Ahaus Kees TB; Vermeulen Robbert P; Minkman Mirella MN; Huijsman Robbert

    2011-01-01

    Abstract Background Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the i...

  19. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

    OpenAIRE

    Stellefson, Michael; Dipnarine, Krishna; Stopka, Christine

    2013-01-01

    Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academi...

  20. [Ultrasonic guided cannulation of the axillary vein in intensive care patients].

    Science.gov (United States)

    Schregel, W; Höer, H; Radtke, J; Cunitz, G

    1994-10-01

    Cannulation of the axillary vein is claimed to be an effective and relatively safe access to the central venous (CV) system [2, 4, 5, 8]. However, anatomical landmarks recommended for venous location (Muskulus pectoralis minor, processus coracoideus) are probably hard to identify in the majority of intensive care (ICU) patients. This investigation evaluated unidirectional 8 MHz Doppler ultrasound (US) in locating the axillary vein. Success rates and complications of this CV access in ICU patients is analysed. METHODS. The experimental design was approved by the local ethical committee (RUB). In 50 patients from our ICU cannulation of the axillary vein was attempted; all were in need of a CV line. Other CV puncture sites (except for the subclavian vein) were associated with contraindications. Patients were placed in a 15 degrees Trendelenburg position (15 exceptions); the arm was abducted to 45 degrees [5, 8]. The course of the axillary vein was located by Doppler US and marked on the skin with a felt pen. Prior to puncture, US intensity was judged by a score ranging from 0 to 4. After skin desinfection, sterile draping, and local anaesthesia, puncture of the axillary vein was attempted. The puncture kit LeaderCath 11,515 (Vygon, Aachen, FRG) was used. When venous blood could be aspirated, the Seldinger guidewire was inserted and the definite catheter placed. The experimental design allowed up to ten punctures, slightly modified in angle and direction of the needle, if puncture of the axillary vein or guide-wire placement failed. The cannulation attempt was classified as unsuccessful in the following cases: malposition, axillary vein not encountered by the puncture needle, guide-wire placement unsuccessful, or if identification and cannulation of the vein lasted more than 20 min. The puncture attempts were evaluated in respect to success rate, time, relation of US intensity to puncture attempts and CV pressure, complications, and malposition. RESULTS. Of the 50

  1. Retinal image registration via feature-guided Gaussian mixture model.

    Science.gov (United States)

    Liu, Chengyin; Ma, Jiayi; Ma, Yong; Huang, Jun

    2016-07-01

    Registration of retinal images taken at different times, from different perspectives, or with different modalities is a critical prerequisite for the diagnoses and treatments of various eye diseases. This problem can be formulated as registration of two sets of sparse feature points extracted from the given images, and it is typically solved by first creating a set of putative correspondences and then removing the false matches as well as estimating the spatial transformation between the image pairs or solved by estimating the correspondence and transformation jointly involving an iteration process. However, the former strategy suffers from missing true correspondences, and the latter strategy does not make full use of local appearance information, which may be problematic for low-quality retinal images due to a lack of reliable features. In this paper, we propose a feature-guided Gaussian mixture model (GMM) to address these issues. We formulate point registration as the estimation of a feature-guided mixture of densities: A GMM is fitted to one point set, such that both the centers and local features of the Gaussian densities are constrained to coincide with the other point set. The problem is solved under a unified maximum-likelihood framework together with an iterative expectation-maximization algorithm initialized by the confident feature correspondences, where the image transformation is modeled by an affine function. Extensive experiments on various retinal images show the robustness of our approach, which consistently outperforms other state-of-the-art methods, especially when the data is badly degraded. PMID:27409682

  2. Modelling Organizational Preservation Goals to Guide Digital Preservation

    Directory of Open Access Journals (Sweden)

    Angela Dappert

    2009-10-01

    Full Text Available This paper is an extended and updated version of the work reported at iPres 2008. Digital preservation activities can only succeed if they go beyond the technical properties of digital objects. They must consider the strategy, policy, goals, and constraints of the institution that undertakes them and take into account the cultural and institutional framework in which data, documents and records are preserved. Furthermore, because organizations differ in many ways, a one-size-fits-all approach cannot be appropriate. Fortunately, organizations involved in digital preservation have created documents describing their policies, strategies, work-flows, plans, and goals to provide guidance. They also have skilled staff who are aware of sometimes unwritten considerations. Within Planets (Farquhar & Hockx-Yu, 2007, a four-year project co-funded by the European Union to address core digital preservation challenges, we have analyzed preservation guiding documents and interviewed staff from libraries, archives, and data centres that are actively engaged in digital preservation. This paper introduces a conceptual model for expressing the core concepts and requirements that appear in preservation guiding documents. It defines a specific vocabulary that institutions can reuse for expressing their own policies and strategies. In addition to providing a conceptual framework, the model and vocabulary support automated preservation planning tools through an XML representation.

  3. Manufacturing Cost Levelization Model – A User’s Guide

    Energy Technology Data Exchange (ETDEWEB)

    Morrow, William R. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Shehabi, Arman [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Smith, Sarah Josephine [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-08-01

    The Manufacturing Cost Levelization Model is a cost-performance techno-economic model that estimates total large-scale manufacturing costs for necessary to produce a given product. It is designed to provide production cost estimates for technology researchers to help guide technology research and development towards an eventual cost-effective product. The model presented in this user’s guide is generic and can be tailored to the manufacturing of any product, including the generation of electricity (as a product). This flexibility, however, requires the user to develop the processes and process efficiencies that represents a full-scale manufacturing facility. The generic model is comprised of several modules that estimate variable costs (material, labor, and operating), fixed costs (capital & maintenance), financing structures (debt and equity financing), and tax implications (taxable income after equipment and building depreciation, debt interest payments, and expenses) of a notional manufacturing plant. A cash-flow method is used to estimate a selling price necessary for the manufacturing plant to recover its total cost of production. A levelized unit sales price ($ per unit of product) is determined by dividing the net-present value of the manufacturing plant’s expenses ($) by the net present value of its product output. A user defined production schedule drives the cash-flow method that determines the levelized unit price. In addition, an analyst can increase the levelized unit price to include a gross profit margin to estimate a product sales price. This model allows an analyst to understand the effect that any input variables could have on the cost of manufacturing a product. In addition, the tool is able to perform sensitivity analysis, which can be used to identify the key variables and assumptions that have the greatest influence on the levelized costs. This component is intended to help technology researchers focus their research attention on tasks

  4. A guide to numerical modelling in systems biology

    CERN Document Server

    Deuflhard, Peter

    2015-01-01

    This book is intended for students of computational systems biology with only a limited background in mathematics. Typical books on systems biology merely mention algorithmic approaches, but without offering a deeper understanding. On the other hand, mathematical books are typically unreadable for computational biologists. The authors of the present book have worked hard to fill this gap. The result is not a book on systems biology, but on computational methods in systems biology. This book originated from courses taught by the authors at Freie Universität Berlin. The guiding idea of the courses was to convey those mathematical insights that are indispensable for systems biology, teaching the necessary mathematical prerequisites by means of many illustrative examples and without any theorems. The three chapters cover the mathematical modelling of biochemical and physiological processes, numerical simulation of the dynamics of biological networks, and identification of model parameters by means of comparisons...

  5. Using Runtime Analysis to Guide Model Checking of Java Programs

    Science.gov (United States)

    Havelund, Klaus; Norvig, Peter (Technical Monitor)

    2001-01-01

    This paper describes how two runtime analysis algorithms, an existing data race detection algorithm and a new deadlock detection algorithm, have been implemented to analyze Java programs. Runtime analysis is based on the idea of executing the program once. and observing the generated run to extract various kinds of information. This information can then be used to predict whether other different runs may violate some properties of interest, in addition of course to demonstrate whether the generated run itself violates such properties. These runtime analyses can be performed stand-alone to generate a set of warnings. It is furthermore demonstrated how these warnings can be used to guide a model checker, thereby reducing the search space. The described techniques have been implemented in the b e grown Java model checker called PathFinder.

  6. Autonomous guided vehicles methods and models for optimal path planning

    CERN Document Server

    Fazlollahtabar, Hamed

    2015-01-01

      This book provides readers with extensive information on path planning optimization for both single and multiple Autonomous Guided Vehicles (AGVs), and discusses practical issues involved in advanced industrial applications of AGVs. After discussing previously published research in the field and highlighting the current gaps, it introduces new models developed by the authors with the goal of reducing costs and increasing productivity and effectiveness in the manufacturing industry. The new models address the increasing complexity of manufacturing networks, due for example to the adoption of flexible manufacturing systems that involve automated material handling systems, robots, numerically controlled machine tools, and automated inspection stations, while also considering the uncertainty and stochastic nature of automated equipment such as AGVs. The book discusses and provides solutions to important issues concerning the use of AGVs in the manufacturing industry, including material flow optimization with A...

  7. Guiding Design: Exposing Librarian and Student Mental Models of Research Guides

    Science.gov (United States)

    Sinkinson, Caroline; Alexander, Stephanie; Hicks, Alison; Kahn, Meredith

    2012-01-01

    This article details an open card sort study administered to undergraduate students, graduate students, and librarians at the University of Colorado at Boulder in order to reveal perceptions of library research guides. The study identifies user group preferences for organization and content of research guides, as well as themes emerging from the…

  8. Interpretation of medical images by model guided analysis

    International Nuclear Information System (INIS)

    Progress in the development of digital pictorial information systems stimulates a growing interest in the use of image analysis techniques in medicine. Especially when precise quantitative information is required the use of fast and reproducable computer analysis may be more appropriate than relying on visual judgement only. Such quantitative information can be valuable, for instance, in diagnostics or in irradiation therapy planning. As medical images are mostly recorded in a prescribed way, human anatomy guarantees a common image structure for each particular type of exam. In this thesis it is investigated how to make use of this a priori knowledge to guide image analysis. For that purpose models are developed which are suited to capture common image structure. The first part of this study is devoted to an analysis of nuclear medicine images of myocardial perfusion. In ch. 2 a model of these images is designed in order to represent characteristic image properties. It is shown that for these relatively simple images a compact symbolic description can be achieved, without significant loss of diagnostically importance of several image properties. Possibilities for automatic interpretation of more complex images is investigated in the following chapters. The central topic is segmentation of organs. Two methods are proposed and tested on a set of abdominal X-ray CT scans. Ch. 3 describes a serial approach based on a semantic network and the use of search areas. Relational constraints are used to guide the image processing and to classify detected image segments. In teh ch.'s 4 and 5 a more general parallel approach is utilized, based on a markov random field image model. A stochastic model used to represent prior knowledge about the spatial arrangement of organs is implemented as an external field. (author). 66 refs.; 27 figs.; 6 tabs

  9. Modeling Market Shares of Competing (e)Care Providers

    Science.gov (United States)

    van Ooteghem, Jan; Tesch, Tom; Verbrugge, Sofie; Ackaert, Ann; Colle, Didier; Pickavet, Mario; Demeester, Piet

    In order to address the increasing costs of providing care to the growing group of elderly, efficiency gains through eCare solutions seem an obvious solution. Unfortunately not many techno-economic business models to evaluate the return of these investments are available. The construction of a business case for care for the elderly as they move through different levels of dependency and the effect of introducing an eCare service, is the intended application of the model. The simulation model presented in this paper allows for modeling evolution of market shares of competing care providers. Four tiers are defined, based on the dependency level of the elderly, for which the market shares are determined. The model takes into account available capacity of the different care providers, in- and outflow distribution between tiers and churn between providers within tiers.

  10. A Purchaser’s Guide to Clinical Preventive Services: A Tool to Improve Health Care Coverage for Prevention

    Directory of Open Access Journals (Sweden)

    Kathryn Phillips Campbell, MPH

    2008-04-01

    Full Text Available IntroductionIn 2005, representatives from the Centers for Disease Control and Prevention partnered with the National Business Group on Health and the Agency for Healthcare Research and Quality to form a work group for developing A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. This guide, designed as a tool for employers, describes recommended clinical preventive services for 46 conditions. The guide includes the scientific evidence and benefits language that employers need to include comprehensive clinical preventive services in their medical benefit plans.MethodsThe work group determined that the guide would address conditions that 1 affected a large percentage of the working population, 2 were costly to control, and 3 had well-defined and accepted recommendations for preventive services. Subject matter experts from the Centers for Disease Control and Prevention, the National Business Group on Health, and the Agency for Healthcare Research and Quality developed or reviewed statements of scientific evidence for 46 diseases and conditions.ResultsThe Purchaser’s Guide, written for an employer audience, includes descriptions for recommended clinical preventive services and their cost savings, syntheses of supporting evidence, strategies for prioritization, and recommendations to improve the delivery and use of preventive services. Twelve hundred copies were sent to more than 275 members of the National Business Group on Health and other purchasers of health care; training sessions on the Guide were held for 228 business leaders, health benefit consultants, and health plan administrators; and an online version was created through the Web sites of the National Business Group on Health and the Centers for Disease Control and Prevention. The online version has received more than 260,000 hits since its release.ConclusionIn 2007, the National Business Group on Health reported that some Fortune 500 companies will be

  11. Hanford Soil Inventory Model (SIM) Rev. 1 Users Guide

    International Nuclear Information System (INIS)

    The focus of the development and application of a soil inventory model as part of the Remediation and Closure Science (RCS) Project managed by PNNL was to develop a probabilistic approach to estimate comprehensive, mass balanced-based contaminant inventories for the Hanford Site post-closure setting. The outcome of this effort was the Hanford Soil Inventory Model (SIM). This document is a user's guide for the Hanford SIM. The principal project requirement for the SIM was to provide comprehensive quantitative estimates of contaminant inventory and its uncertainty for the various liquid waste sites, unplanned releases, and past tank farm leaks as a function of time and location at Hanford. The majority, but not all of these waste sites are in the 200 Areas of Hanford where chemical processing of spent fuel occurred. A computer model capable of performing these calculations and providing satisfactory quantitative output representing a robust description of contaminant inventory and uncertainty for use in other subsequent models was determined to be satisfactory to address the needs of the RCS Project. The ability to use familiar, commercially available software on high-performance personal computers for data input, modeling, and analysis, rather than custom software on a workstation or mainframe computer for modeling, was desired

  12. Adapting chronic care models for diabetes care delivery inlow-and-middle-income countries: A review

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    A contextual review of models for chronic care was doneto develop a context-adapted chronic care model-basedservice delivery model for chronic conditions includingdiabetes. The Philippines was used as the setting ofa low-to-middle-income country. A context-basednarrative review of existing models for chronic carewas conducted. A situational analysis was done at thegrassroots level, involving the leaders and members ofthe community, the patients, the local health system andthe healthcare providers. A second analysis making useof certain organizational theories was done to explore onimproving feasibility and acceptability of organizing carefor chronic conditions. The analyses indicated that carefor chronic conditions may be introduced, consideringthe needs of people with diabetes in particular andthe community in general as recipients of care, andthe issues and factors that may affect the healthcareworkers and the health system as providers of thiscare. The context-adapted chronic care model-basedservice delivery model was constructed accordingly.Key features are incorporation of chronic care in thehealth system's services; assimilation of chronic caredelivery with the other responsibilities of the healthcareworkers but with redistribution of certain tasks; andensuring that the recipients of care experience thewhole spectrum of basic chronic care that includes educationand promotion in the general population, riskidentification, screening, counseling including self-caredevelopment, and clinical management of the chroniccondition and any co-morbidities, regardless of level ofcontrol of the condition. This way, low-to-middle incomecountries can introduce and improve care for chronicconditions without entailing much additional demand ontheir limited resources.

  13. Organizational effectiveness. Primary care and the congruence model.

    Science.gov (United States)

    Eiser, A R; Eiser, B J

    1996-10-01

    The congruence model is a framework used to analyze organizational strengths and weaknesses and pinpoint specific areas for improving effectiveness. This article provides an overview of organizations as open systems, with examples in the primary care arena. It explains and applies the congruence model in the context of primary care issues and functions, including methods by which the model can be used to diagnose organizational problems and generate solutions. Changes needed in primary care due to the managed care environment, and areas of potential problems and sensitivities requiring organizational changes to meet market and regulatory demands now placed on PCOs are examined.

  14. A model for integrating independent physicians into accountable care organizations.

    Science.gov (United States)

    Shields, Mark C; Patel, Pankaj H; Manning, Martin; Sacks, Lee

    2011-01-01

    The Affordable Care Act encourages the formation of accountable care organizations as a new part of Medicare. Pending forthcoming federal regulations, though, it is unclear precisely how these ACOs will be structured. Although large integrated care systems that directly employ physicians may be most likely to evolve into ACOs, few such integrated systems exist in the United States. This paper demonstrates how Advocate Physician Partners in Illinois could serve as a model for a new kind of accountable care organization, by demonstrating how to organize physicians into partnerships with hospitals to improve care, cut costs, and be held accountable for the results. The partnership has signed its first commercial ACO contract effective January 1, 2011, with the largest insurer in Illinois, Blue Cross Blue Shield. Other commercial contracts are expected to follow. In a health care system still dominated by small, independent physician practices, this may constitute a more viable way to push the broader health care system toward accountable care. PMID:21163804

  15. Searching for the Holy Grail of Care Delivery Models.

    Science.gov (United States)

    Mensik, Jennifer

    2016-01-01

    Too often health care executives state the need for more research, knowledge, and information in staffing. Perhaps what we really need is education and support for innovation in operations. In looking for the holy grail of staffing solutions, focused attention will need to be placed on creating innovative care delivery models. Leaders who are tasked with developing innovative care delivery models must have a supportive environment and given time to be successful. PMID:27265951

  16. Towards a model for integrative medicine in Swedish primary care

    OpenAIRE

    Falkenberg Torkel; Warenmark Anders; Halpin Jeremy; Sundberg Tobias

    2007-01-01

    Abstract Background Collaboration between providers of conventional care and complementary therapies (CTs) has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM). The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care. Methods Investigative procedures involved research group and key informant meetings with multiple st...

  17. A Transitional Care Model Using Faith Community Nurses.

    Science.gov (United States)

    Ziebarth, Deborah; Campbell, Katora P

    2016-01-01

    The Medicare mandatory readmission reduction program has hospitals scrambling to reduce 30-day readmissions. A Faith Community Nurse (FCN) Transitional Care Model was developed from systematic literature review of predictive factors of readmission and pre- and postdischarge interventions that decrease readmission. The model presents specific FCN care that occurs pre- and posthospital discharge to support the patient in transitioning from one level of care to another, move toward wholistic health, and avoid unnecessary readmission. PMID:27119808

  18. Choosing a Primary Health Care Provider (PCP): A Guide for Young Women

    Science.gov (United States)

    ... Gynecology Medical Conditions Nutrition & Fitness Emotional Health Choosing a Primary Health Care Provider (PCP): General Information Posted ... taking care of yourself. Why do I need a PCP? You need a PCP so that your ...

  19. Linear mixed models a practical guide using statistical software

    CERN Document Server

    West, Brady T; Galecki, Andrzej T

    2014-01-01

    Highly recommended by JASA, Technometrics, and other journals, the first edition of this bestseller showed how to easily perform complex linear mixed model (LMM) analyses via a variety of software programs. Linear Mixed Models: A Practical Guide Using Statistical Software, Second Edition continues to lead readers step by step through the process of fitting LMMs. This second edition covers additional topics on the application of LMMs that are valuable for data analysts in all fields. It also updates the case studies using the latest versions of the software procedures and provides up-to-date information on the options and features of the software procedures available for fitting LMMs in SAS, SPSS, Stata, R/S-plus, and HLM.New to the Second Edition A new chapter on models with crossed random effects that uses a case study to illustrate software procedures capable of fitting these models Power analysis methods for longitudinal and clustered study designs, including software options for power analyses and suggest...

  20. Imperatives for DUCHENNE MD: a Simplified Guide to Comprehensive Care for Duchenne Muscular Dystrophy

    OpenAIRE

    Kinnett, Kathi; Rodger, Sunil; Vroom, Elizabeth; Furlong, Pat; Aartsma-Rus, Annemieke; Bushby, Kate

    2015-01-01

    Duchenne muscular dystrophy (DMD) is a progressive, life-limiting muscle-wasting disease. Although no curative treatment is yet available, comprehensive multidisciplinary care has increased life expectancy significantly in recent decades. An international consensus care publication in 2010 outlined best-practice care, which includes corticosteroid treatment, respiratory, cardiac, orthopedic and rehabilitative interventions to address disease manifestations. While disease specialists are large...

  1. Diffusion of a collaborative care model in primary care: a longitudinal qualitative study

    OpenAIRE

    Vedel Isabelle; Ghadi Veronique; De Stampa Matthieu; Routelous Christelle; Bergman Howard; Ankri Joel; Lapointe Liette

    2013-01-01

    Background Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs). The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model's diffusion process. Methods We conducted a longitudinal case study based on the Diffusion of Innovations Th...

  2. Creating A Sustainable Model of Spine Care in Underserved Communities

    DEFF Research Database (Denmark)

    Haldeman, Scott; Nordin, Margareta; Outerbridge, Geoff;

    2015-01-01

    The world lacks sustainable models of care to manage spinal disorders in poor and underserved communities. The purpose of this article is to: (1) review the rationale and importance of developing a sustainable evidence-based model of care at low cost for people with spinal disorders in underserved...... leadership, research and a model of care, there is an opportunity to help reduce the burden of the leading cause of disability in the world....... adequate care, World Spine Care (WSC) was established to "improve lives in underserved communities through sustainable, integrated, evidence-based, spinal care." WSC is comprised of volunteers and institutions from 6 continents and several countries, and incorporates a Board of Directors, an executive...

  3. Targeted tissue perfusion versus macrocirculation-guided standard care in patients with septic shock (TARTARE-2S)

    DEFF Research Database (Denmark)

    Pettilä, Ville; Merz, Tobias; Wilkman, Erika;

    2016-01-01

    BACKGROUND: Septic shock has a 90-day mortality risk of up to 50 %. The hemodynamic targets, including mean arterial pressure (MAP) are not based on robust clinical data. Both severe hypotension and high doses of vasopressors may be harmful. Hence, re-evaluation of hemodynamic targets in septic...... important clinical data on treatment targets in septic shock, evaluating the impact of clinical tissue perfusion-guided hemodynamic treatment on a surrogate outcome combining resolution of shock (hyperlactatemia and vasopressors/inotropes), and 30-day mortality. TRIAL REGISTRATION: ClinicalTrials.gov: NCT...... shock is relevant. METHODS/DESIGN: The targeted tissue perfusion versus macrocirculation-guided standard care in patients with septic shock (TARTARE-2S) trial is a prospective, two-parallel-group, randomized, open-label, multicenter trial with assessor-blinded outcome evaluation. We will randomize...

  4. Randomized trial of guiding hypertension management using central aortic blood pressure compared with best-practice care: principal findings of the BP GUIDE study.

    Science.gov (United States)

    Sharman, James E; Marwick, Thomas H; Gilroy, Deborah; Otahal, Petr; Abhayaratna, Walter P; Stowasser, Michael

    2013-12-01

    Arm cuff blood pressure (BP) may overestimate cardiovascular risk. Central aortic BP predicts mortality and could be a better method for patient management. We sought to determine the usefulness of central BP to guide hypertension management. This was a prospective, open-label, blinded-end point study in 286 patients with hypertension randomized to treatment decisions guided by best-practice usual care (n=142; using office, home, and 24-hour ambulatory BP) or, in addition, by central BP intervention (n=144; using SphygmoCor). Therapy was reviewed every 3 months for 12 months, and recommendations were provided to each patient and his/her doctor on antihypertensive medication titration. Outcome measures were as follows: medication quantity (daily defined dose), quality of life, and left ventricular mass (3-dimensional echocardiography). There was 92% compliance with recommendations on medication titration, and quality of life improved in both groups (post hoc P0.10), but with intervention there was a significant stepwise decrease in daily defined dose from baseline to 3 months (P=0.008) and each subsequent visit (all P0.05). We conclude that guidance of hypertension management with central BP results in a significantly different therapeutic pathway than conventional cuff BP, with less use of medication to achieve BP control and no adverse effects on left ventricular mass, aortic stiffness, or quality of life.

  5. A Moral Hazard Model of Parental Care

    OpenAIRE

    Baomin Dong; Tianpeng Zhou

    2013-01-01

    One perplexing observation is that although men and women have different comparative advantages, cooperation is often only seen during child-bearing and rearing periods. One interpretation is that the juvenile offspring serves as an indivisible public goods to facilitate cooperation between opposite sexes of adults. We show that moral hazard in maternal parental care will either force the father to pay the mother a rent in order to induce optimal care (when the child is of intrinsic high qual...

  6. A taxonomy of nursing care organization models in hospitals

    Directory of Open Access Journals (Sweden)

    Dubois Carl-Ardy

    2012-08-01

    Full Text Available Abstract Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs and assistive staff (orderlies to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an

  7. Texture Guided Active Appearance Model Propagation for Prostate Segmentation

    Science.gov (United States)

    Ghose, Soumya; Oliver, Arnau; Martí, Robert; Lladó, Xavier; Freixenet, Jordi; Vilanova, Joan C.; Meriaudeau, Fabrice

    Fusion of Magnetic Resonance Imaging (MRI) and Trans Rectal Ultra Sound (TRUS) images during TRUS guided prostate biopsy improves localization of the malignant tissues. Segmented prostate in TRUS and MRI improve registration accuracy and reduce computational cost of the procedure. However, accurate segmentation of the prostate in TRUS images can be a challenging task due to low signal to noise ratio, heterogeneous intensity distribution inside the prostate, and imaging artifacts like speckle noise and shadow. We propose to use texture features from approximation coefficients of Haar wavelet transform for propagation of a shape and appearance based statistical model to segment the prostate in a multi-resolution framework. A parametric model of the propagating contour is derived from Principal Component Analysis of prior shape and texture informations of the prostate from the training data. The parameters are then modified with prior knowledge of the optimization space to achieve optimal prostate segmentation. The proposed method achieves a mean Dice Similarity Coefficient value of 0.95±0.01, and mean segmentation time of 0.72±0.05 seconds when validated on 25 TRUS images, grabbed from video sequences, in a leave-one-out validation framework. Our proposed model performs computationally efficient accurate prostate segmentation in presence of intensity heterogeneity and imaging artifacts.

  8. Horizontal Violence and the Quality and Safety of Patient Care: A Conceptual Model

    Directory of Open Access Journals (Sweden)

    Christina Purpora

    2012-01-01

    Full Text Available For many years, nurses in international clinical and academic settings have voiced concern about horizontal violence among nurses and its consequences. However, no known framework exists to guide research on the topic to explain these consequences. This paper presents a conceptual model that was developed from four theories to illustrate how the quality and safety of patient care could be affected by horizontal violence. Research is needed to validate the new model and to gather empirical evidence of the consequences of horizontal violence on which to base recommendations for future research, education, and practice.

  9. Children's health care assistance according to their families: a comparison between models of Primary Care

    Directory of Open Access Journals (Sweden)

    Vanessa Bertoglio Comassetto Antunes de Oliveira

    2015-02-01

    Full Text Available OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS with the Family Health Strategy (ESF units for presence and extent of attributes of Primary Health Care (APS, specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care, but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil.

  10. A Model for Risk Assessment in Health Care.

    Science.gov (United States)

    Prijatelj, Vesna; Rajkovič, Vladislav; Šušteršič, Olga

    2016-01-01

    The purpose of our research is to reduce risks and hence prevent errors in the health care process. The aim is to design an organizational information model using error prevention methods for risk assessment in a clinical setting. The model is based on selected indicators of quality nursing care, resulting from the world-known theoretical and practical models combined with experience in the Slovenian health care. The proposed organizational information model and software solution has a significant impact on the professional attention, communication and information, critical thinking, experience and knowledge. PMID:27332383

  11. Intervening at the Setting Level to Prevent Behavioral Incidents in Residential Child Care: Efficacy of the CARE Program Model.

    Science.gov (United States)

    Izzo, Charles V; Smith, Elliott G; Holden, Martha J; Norton, Catherine I; Nunno, Michael A; Sellers, Deborah E

    2016-07-01

    The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions. PMID:27138932

  12. Caregiving process and caregiver burden: Conceptual models to guide research and practice

    Directory of Open Access Journals (Sweden)

    Brehaut Jamie

    2004-01-01

    Full Text Available Abstract Background Parental care for a child with a developmental disability is an enormous responsibility, one that can far exceed that of typical parental care. While most parents adapt well to the situation of caring for a child with a disability, some do not. To understand parents' adaptations to their children's disabilities, the complex nature of stress processes must be accounted for and the constructs and factors that play a role in the caregiving must be considered. Discussion Evidence suggests that there is considerable variation in how caregivers adapt to their caregiving demands. Many studies have sought to qualify the association between caregiving and health outcomes of the caregivers. Contextual factors such as SES, child factors such as child behaviour problems and severity of disability, intra-psychic factors such as mastery and self-esteem, coping strategies and social supports have all been associated with psychological and/or physical outcome or parents or primary caregivers. In reviewing these issues, the literature appears to be limited by the use of traditional analytic approaches which examine the relationship between a factor and an outcome. It is clear, however, that changes to single factors, as represented in these studies, occur very rarely even in the experimental context. The literature has also been limited by lack of reliance on specific theoretical frameworks. Summary This conceptual paper documents the state of current knowledge and explores the current theoretical frameworks that have been used to describe the caregiving process from two diverse fields, pediatrics and geriatrics. Integration of these models into one comprehensive model suitable for this population of children with disabilities and their caregivers is proposed. This model may guide future research in this area.

  13. Prostate segmentation with local binary patterns guided active appearance models

    Science.gov (United States)

    Ghose, Soumya; Oliver, Arnau; Martí, Robert; Lladó, Xavier; Freixenet, Jordi; Vilanova, Joan C.; Meriaudeau, Fabrice

    2011-03-01

    Real-time fusion of Magnetic Resonance (MR) and Trans Rectal Ultra Sound (TRUS) images aid in the localization of malignant tissues in TRUS guided prostate biopsy. Registration performed on segmented contours of the prostate reduces computational complexity and improves the multimodal registration accuracy. However, accurate and computationally efficient segmentation of the prostate in TRUS images could be challenging in the presence of heterogeneous intensity distribution inside the prostate gland, and other imaging artifacts like speckle noise, shadow regions and low Signal to Noise Ratio (SNR). In this work, we propose to enhance the texture features of the prostate region using Local Binary Patterns (LBP) for the propagation of a shape and appearance based statistical model to segment the prostate in a multi-resolution framework. A parametric model of the propagating contour is derived from Principal Component Analysis (PCA) of the prior shape and texture information of the prostate from the training data. The estimated parameters are then modified with the prior knowledge of the optimization space to achieve an optimal segmentation. The proposed method achieves a mean Dice Similarity Coefficient (DSC) value of 0.94+/-0.01 and a mean segmentation time of 0.68+/-0.02 seconds when validated with 70 TRUS images of 7 datasets in a leave-one-patient-out validation framework. Our method performs computationally efficient and accurate prostate segmentation in the presence of intensity heterogeneities and imaging artifacts.

  14. Conceptual models used by nurses working in coronary care units--a discussion paper.

    Science.gov (United States)

    Timmins, Fiona

    2006-12-01

    In the UK, Europe and the USA conceptual models of nursing are features of many undergraduate nursing curricula [Alligood MR. The nature of knowledge needed for nursing practice. In Alligood MR, Marriner-Tomey A, editors. Nursing theory utilisation and application. London: Mosby, 2002, Tierney AJ. Nursing models extant or extinct? J Adv Nurs 1998;8(1):77-85] and commonly used in practice. However, UK nurses in practice continue to be dissatisfied with conceptual model use [Griffiths P. An investigation into the description of patients' problems by nurses using two different needs-based nursing models. J Adv Nurs 1998;28(5):969-977, Mason C. Guide to practice or 'load of rubbish'? The influence of care plans on nursing practice in five clinical areas in Northern Ireland. J Adv Nurs 1999;29(2):380-387, Murphy K, Cooney A, Casey D, Connor M, O'Connor J., Dineen B. The Roper, Logan and Tierney Model: perceptions and operationalization of the model in psychiatric nursing within one health board in Ireland. J Adv Nurs 2000;31(6):1333-1341]. An association with increased paperwork and documentation together with a belief that these abstract concepts do not quite fit with the practice setting has resulted in a generalised apathy towards their use in some areas [Timmins F. Critical care nursing in the 21st Century. Intensive Crit Care Nurs 2002;18:118-127]. In an era of concerns about both cost and quality, together with an increased impetus towards multi-professional working patterns and role expansion, alternative models of care, such as critical pathways and care pathways are gaining increased favour in the clinical setting [Johnson S, editor. Pathways of care. Oxford; Blackwell Science 1997]. The aim of this paper is to consider whether or not the traditional conceptual models of nursing are apt for today's practicing coronary care nurse. Specific questions to be addressed are: what is the research evidence that informs conceptual model use in coronary care and what are

  15. Toward population management in an integrated care model.

    Science.gov (United States)

    Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

    2013-01-01

    Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative.

  16. [Guiding patients' family members through an intensive care unit: difficulties of lack of systematization?].

    Science.gov (United States)

    Domingues, C I; Santini, L; da Silva, V E

    1999-03-01

    The purpose of this study was to analyse the problematic situation experienced by nurses at the moment of guiding the relatives of patients in an ICU. Therefore, seven (7) nurses who worked in this unit, which belonged to a general, public and training hospital in the city of São Paulo, were interviewed. The results have shown that the period of guiding brings anxiety and stress to the nurses, originated by the critical patient's condition, as well by the deficiency of conduts and in the systematization of this activity in the unit. Based on the results it was proposed the creation of na assistance plan. That includes the guiding to the family and the elaboration of a written instrument of orientation.

  17. Guiding healthcare technology implementation: a new integrated technology implementation model.

    Science.gov (United States)

    Schoville, Rhonda R; Titler, Marita G

    2015-03-01

    Healthcare technology is used to improve delivery of safe patient care by providing tools for early diagnosis, ongoing monitoring, and treatment of patients. This technology includes bedside physiologic monitors, pulse oximetry devices, electrocardiogram machines, bedside telemetry, infusion pumps, ventilators, and electronic health records. Healthcare costs are a challenge for society, and hospitals are pushed to lower costs by discharging patients sooner. Healthcare technology is being used to facilitate these early discharges. There is little understanding of how healthcare facilities purchase, implement, and adopt technology. There are two areas of theories and models currently used when investigating technology: technology adoption and implementation science. Technology adoption focuses mainly on how the end users adopt technology, whereas implementation science describes methods, interventions, and variables that promote the use of evidence-based practice. These two approaches are not well informed by each other. In addition, amplifying the knowledge gap is the limited conceptualization of healthcare technology implementation frameworks. To bridge this gap, an all-encompassing model is needed. To understand the key technology implementation factors utilized by leading healthcare facilities, the prevailing technology adoption and implementation science theories and models were reviewed. From this review, an integrated technology implementation model will be set forth. PMID:25799235

  18. Guiding healthcare technology implementation: a new integrated technology implementation model.

    Science.gov (United States)

    Schoville, Rhonda R; Titler, Marita G

    2015-03-01

    Healthcare technology is used to improve delivery of safe patient care by providing tools for early diagnosis, ongoing monitoring, and treatment of patients. This technology includes bedside physiologic monitors, pulse oximetry devices, electrocardiogram machines, bedside telemetry, infusion pumps, ventilators, and electronic health records. Healthcare costs are a challenge for society, and hospitals are pushed to lower costs by discharging patients sooner. Healthcare technology is being used to facilitate these early discharges. There is little understanding of how healthcare facilities purchase, implement, and adopt technology. There are two areas of theories and models currently used when investigating technology: technology adoption and implementation science. Technology adoption focuses mainly on how the end users adopt technology, whereas implementation science describes methods, interventions, and variables that promote the use of evidence-based practice. These two approaches are not well informed by each other. In addition, amplifying the knowledge gap is the limited conceptualization of healthcare technology implementation frameworks. To bridge this gap, an all-encompassing model is needed. To understand the key technology implementation factors utilized by leading healthcare facilities, the prevailing technology adoption and implementation science theories and models were reviewed. From this review, an integrated technology implementation model will be set forth.

  19. Improving the Model Guided Sampling Optimization by Model Search and Slice Sampling

    OpenAIRE

    Bajer, L. (Lukáš); Holeňa, M. (Martin); Charypar, V.

    2013-01-01

    Model Guided Sampling Optimization (MGSO) was recently proposed as an alternative for Jones’ Krigingbased EGO algorithm for optimization of expensive blackbox functions. Instead of maximizing a chosen criterion (e.g., expected improvement), MGSO samples probability of improvement of the Gaussian process model forming multiple candidates – a whole population of suggested solutions. This paper further develops this algorithm using slice sampling method and continuous local optimization of the G...

  20. Procalcitonin-guided antibiotic treatment of respiratory tract infections in a primary care setting: are we there yet?

    DEFF Research Database (Denmark)

    Aabenhus, R.; Jensen, J.U.

    2011-01-01

    Clinical signs of infection do not allow for correct identification of bacterial and viral aetiology in acute respiratory infections. A valid tool to assist the clinician in identifying patients who will benefit from antibiotic therapy, as well as patients with a potentially serious infection, co...... are likely to benefit from antibiotic treatment and to rule out serious infections, and comments on further research to determine a future role for procalcitonin in primary care......, could greatly improve patient care and limit excessive antibiotic prescriptions. Procalcitonin is a new marker of suspected bacterial infection that has shown promise in guiding antibiotic therapy in acute respiratory tract infections in hospitals without compromising patient safety. Procalcitonin...... concentrations in primary care are low and can be used primarily to rule out serious infection. However, procalcitonin measurement should not be used as the sole basis for clinical decisions; clinical skills are prerequisites for the correct use of this new tool in practice. At present there is no point-of-care...

  1. Consulting Psychiatry within an Integrated Primary Care Model

    OpenAIRE

    Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L; Serrano, Neftali

    2013-01-01

    After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population.

  2. Modeling ultrasonic NDE and guided wave based structural health monitoring

    Science.gov (United States)

    Ravi, Nitin B.; Rathod, Vivek T.; Chakraborty, Nibir.; Mahapatra, D. R.; Sridaran, Ramanan; Boller, Christian

    2015-04-01

    Structural Health Monitoring (SHM) systems require integration of non-destructive technologies into structural design and operational processes. Modeling and simulation of complex NDE inspection processes are important aspects in the development and deployment of SHM technologies. Ray tracing techniques are vital simulation tools to visualize the wave path inside a material. These techniques also help in optimizing the location of transducers and their orientation with respect to the zone of interrogation. It helps in increasing the chances of detection and identification of a flaw in that zone. While current state-of-the-art techniques such as ray tracing based on geometric principle help in such visualization, other information such as signal losses due to spherical or cylindrical shape of wave front are rarely taken into consideration. The problem becomes a little more complicated in the case of dispersive guided wave propagation and near-field defect scattering. We review the existing models and tools to perform ultrasonic NDE simulation in structural components. As an initial step, we develop a ray-tracing approach, where phase and spectral information are preserved. This enables one to study wave scattering beyond simple time of flight calculation of rays. Challenges in terms of theory and modelling of defects of various kinds are discussed. Various additional considerations such as signal decay and physics of scattering are reviewed and challenges involved in realistic computational implementation are discussed. Potential application of this approach to SHM system design is highlighted and by applying this to complex structural components such as airframe structures, SHM is demonstrated to provide additional value in terms of lighter weight and/or longevity enhancement resulting from an extension of the damage tolerance design principle not compromising safety and reliability.

  3. A guide to the translation of the Global Initiative for Asthma (GINA) strategy into improved care

    DEFF Research Database (Denmark)

    Boulet, Louis-Philippe; FitzGerald, J Mark; Levy, Mark L;

    2012-01-01

    In 1995, the Global Initiative for Asthma (GINA) published an evidence-based workshop report as a guide to clinicians managing asthma patients, and has updated it annually to ensure that recommendations remain current. Although the report has been widely disseminated and influenced clinical pract...

  4. Using Built-In Domain-Specific Modeling Support to Guide Model-Based Test Generation

    CERN Document Server

    Kanstrén, Teemu; 10.4204/EPTCS.80.5

    2012-01-01

    We present a model-based testing approach to support automated test generation with domain-specific concepts. This includes a language expert who is an expert at building test models and domain experts who are experts in the domain of the system under test. First, we provide a framework to support the language expert in building test models using a full (Java) programming language with the help of simple but powerful modeling elements of the framework. Second, based on the model built with this framework, the toolset automatically forms a domain-specific modeling language that can be used to further constrain and guide test generation from these models by a domain expert. This makes it possible to generate a large set of test cases covering the full model, chosen (constrained) parts of the model, or manually define specific test cases on top of the model while using concepts familiar to the domain experts.

  5. Using Built-In Domain-Specific Modeling Support to Guide Model-Based Test Generation

    Directory of Open Access Journals (Sweden)

    Teemu Kanstrén

    2012-02-01

    Full Text Available We present a model-based testing approach to support automated test generation with domain-specific concepts. This includes a language expert who is an expert at building test models and domain experts who are experts in the domain of the system under test. First, we provide a framework to support the language expert in building test models using a full (Java programming language with the help of simple but powerful modeling elements of the framework. Second, based on the model built with this framework, the toolset automatically forms a domain-specific modeling language that can be used to further constrain and guide test generation from these models by a domain expert. This makes it possible to generate a large set of test cases covering the full model, chosen (constrained parts of the model, or manually define specific test cases on top of the model while using concepts familiar to the domain experts.

  6. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality.

    Science.gov (United States)

    Fennell, Mary L; Das, Irene Prabhu; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

    2010-01-01

    Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care.

  7. Two models of primary health care training.

    Science.gov (United States)

    Hill, P; Samisoni, J

    1993-01-01

    In 1991, the Fiji School of Medicine restructured the training of its medical students, dividing the 7-year course into two phases. Students now undertake a 3-year community-oriented primary care practitioners course, after which they may elect to continue practice in a primary health care role, or to undertake further hospital-based training to complete their medical degree. The course responds to the health needs of the South Pacific, and the local patterns of morbidity and mortality, rather than measuring itself against the curricular demands of its more developed neighbours, Australia and New Zealand. At the same time, the Tropical Health Program of the University of Queensland Medical School responded to demands from the Aboriginal and Torres Strait Islander community to develop primary health care training at degree level. This was intended to complement other strategies undertaken by the Aboriginal and Torres Strait Islander Studies Unit such as the recruitment and support of indigenous students through mainstream health professional education. There was a need to address health priorities that are very different to those of the Australian population as a whole, as well as the sociopolitical and cultural context as it affects both students themselves and health issues in their communities. Both institutions have chosen problem-based teaching/learning as appropriate to their courses, and content is also similar, though with emphases that reflect the differing contexts. The two courses are examples of innovative responses by centres with university medical faculties to specific issues in health education. PMID:8433664

  8. A new model for health care delivery

    Directory of Open Access Journals (Sweden)

    Kepros John P

    2009-04-01

    Full Text Available Abstract Background The health care delivery system in the United States is facing cost and quality pressures that will require fundamental changes to remain viable. The optimal structures of the relationships between the hospital, medical school, and physicians have not been determined but are likely to have a large impact on the future of healthcare delivery. Because it is generally agreed that academic medical centers will play a role in the sustainability of this future system, a fundamental understanding of the relative contributions of the stakeholders is important as well as creativity in developing novel strategies to achieve a shared vision. Discussion Core competencies of each of the stakeholders (the hospital, the medical school and the physicians must complement the others and should act synergistically. At the same time, the stakeholders should determine the common core values and should be able to make a meaningful contribution to the delivery of health care. Summary Health care needs to achieve higher quality and lower cost. Therefore, in order for physicians, medical schools, and hospitals to serve the needs of society in a gratifying way, there will need to be change. There needs to be more scientific and social advances. It is obvious that there is a real and urgent need for relationship building among the professionals whose duty it is to provide these services.

  9. Parallel community climate model: Description and user`s guide

    Energy Technology Data Exchange (ETDEWEB)

    Drake, J.B.; Flanery, R.E.; Semeraro, B.D.; Worley, P.H. [and others

    1996-07-15

    This report gives an overview of a parallel version of the NCAR Community Climate Model, CCM2, implemented for MIMD massively parallel computers using a message-passing programming paradigm. The parallel implementation was developed on an Intel iPSC/860 with 128 processors and on the Intel Delta with 512 processors, and the initial target platform for the production version of the code is the Intel Paragon with 2048 processors. Because the implementation uses a standard, portable message-passing libraries, the code has been easily ported to other multiprocessors supporting a message-passing programming paradigm. The parallelization strategy used is to decompose the problem domain into geographical patches and assign each processor the computation associated with a distinct subset of the patches. With this decomposition, the physics calculations involve only grid points and data local to a processor and are performed in parallel. Using parallel algorithms developed for the semi-Lagrangian transport, the fast Fourier transform and the Legendre transform, both physics and dynamics are computed in parallel with minimal data movement and modest change to the original CCM2 source code. Sequential or parallel history tapes are written and input files (in history tape format) are read sequentially by the parallel code to promote compatibility with production use of the model on other computer systems. A validation exercise has been performed with the parallel code and is detailed along with some performance numbers on the Intel Paragon and the IBM SP2. A discussion of reproducibility of results is included. A user`s guide for the PCCM2 version 2.1 on the various parallel machines completes the report. Procedures for compilation, setup and execution are given. A discussion of code internals is included for those who may wish to modify and use the program in their own research.

  10. Roles and responsibilities in the secondary level eye care model

    Directory of Open Access Journals (Sweden)

    Saibaba Saravanan

    2005-12-01

    Full Text Available In any secondary level eye care clinic, a number of tasks must be completed. In different countries and different settings, different people will carry out these tasks. The manager is responsible for ensuring that all the tasks are covered, that people are carefully selected to perform them, and that staff are supported and managed. The International Centre for Advancement of Rural Eye Care (ICARE, within the L.V. Prasad Eye Institute (LVPEI in India, has evolved an eye care team to provide secondary level eye care services to a population of 0.5 to 1 million. The ICARE model emphasises that all cadres of clinical and non-clinical personnel are equally important. Below is a description of the range of jobs at secondary level centres. The tertiary centre at LVPEI manages leadership and training for this model.

  11. Choosing a Primary Health Care Provider (PCP): A Guide for Young Men

    Science.gov (United States)

    ... Health Medical Conditions Nutrition & Fitness Emotional Health Choosing a Primary Health Care Provider (PCP): General Information Posted ... help address your problems. Why do I need a PCP? You need a PCP so that your ...

  12. The health-care manager's guide to managing change in challenging times.

    Science.gov (United States)

    Lombardi, D N

    1996-01-01

    Fifteen years ago, Bill Gates was a college dropout working for a four-member, fledgling company in New Mexico. Today, he is the richest man in America and the head of perhaps the most powerful company in recent corporate history. Ten years ago, managed health care was merely a concept discussed in academic and industry observer circles. Now it is a norm in almost every health-care organization nationally. Five years ago, health-care professionals in every discipline believed the maxim that, ¿as long as people get sick, health-care professionals will have jobs.¿ In 1995, health-care executives have alternately referred to the widescale process of laying off employees as reengineering, rightsizing, downsizing, or RIF (reduction in force). With this massive amount of change, both societally and professionally, health-care managers have been contending with the change management process. Although a breadth of concepts borrowed from other industries and a plethora of conceptual practicums have entered the health-care educational realm, a straightforward, immediately useful approach to managing change is probably more beneficial, as the need to manage change quickly and effectively becomes the paramount criterion for health-care management success in the second half of this decade of change. In this article we will explore the four areas where mistakes are made most frequently by leaders in the change process, and we will provide specific strategies to not only avoid these mistakes but moreover reduce resistance to change, activate positive action, and ultimately improve performance through optimum staff contribution. The four critical areas we will explore are the reasons for resistance to change, the management of the proactive phase of change, creating staff interdependence, and key leadership roles for change management. PMID:10154378

  13. Latent class models for utilisation of health care

    OpenAIRE

    Teresa Bago d’Uva

    2005-01-01

    This paper explores different approaches to econometric modelling of count measures of health care utilisation, with an emphasis on latent class models. A new model is proposed that combines the features of the two most common approaches- the hurdle model and the finite mixture Negative Binomial. Additionally, the panel structure of the data is taken into account. The proposed model is shown to perform better than the existing models for a particular application with data from the RAND Health...

  14. Caring for insiderness”: Phenomenologically informed insights that can guide practice

    Directory of Open Access Journals (Sweden)

    Les Todres

    2014-01-01

    Full Text Available Understanding the “insider” perspective has been a pivotal strength of qualitative research. Further than this, within the more applied fields in which the human activity of “caring” takes place, such understanding of “what it is like” for people from within their lifeworlds has also been acknowledged as the foundational starting point in order for “care” to be caring. But we believe that more attention needs to be paid to this foundational generic phenomenon: what it means to understand the “insiderness” of another, but more importantly, how to act on this in caring ways. We call this human phenomenon “caring for insiderness.” Drawing on existing phenomenological studies of marginal caring situations at the limits of caring capability, and through a process of phenomenologically oriented reflection, we interrogated some existential themes implicit in these publications that could lead to deeper insights for both theoretical and applied purposes. The paper provides direction for practices of caring by highlighting some dangers as well as some remedies along this path.

  15. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    OpenAIRE

    Phillips, Charles D

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

  16. Aquatic Environment, Housing, and Management in the Eighth Edition of the Guide for the Care and Use of Laboratory Animals: Additional Considerations and Recommendations

    OpenAIRE

    Mason, Timothy J.; Matthews, Monte

    2012-01-01

    The eighth edition of the Guide for the Care and Use of Laboratory Animals recognizes the widespread use of aquatic and semiaquatic research animals by including, among other references, an entire section on aquatic animals in its chapter on environment, housing, and management. Recognizing the large number of aquatic and semiaquatic species used in research and the inherent diversity in animal needs, the Guide refers the reader to texts and journal reviews for specific recommendations and su...

  17. Explore Elementary Teachers' Professional Knowledge of Guiding Science Fair Product by Using Different Instruction Model

    Science.gov (United States)

    Lu, Chow-Chin

    2013-01-01

    This research is about using two different instruction models, "theory course combined with sample introduction" and "theory course combined with case method teaching", to instruct elementary teachers on how to guide the science fair product in two courses (16 and 12 teachers in each class) and observe their guiding tactics after the instructed…

  18. Burnout Among Primary Care Physicians: A Test of the Areas of Worklife Model.

    Science.gov (United States)

    Gregory, Sean T; Menser, Terri

    2015-01-01

    Examinations of the current state of the physician workforce, in the United States and globally, indicate a declining overall well-being, and specifically increasing levels of burnout. The consequences of these effects include early retirements or exits from the medical profession, difficulties improving the patient experience, and low levels of provider engagement with clinic-level and system-level initiatives. Such consequences affect physicians, healthcare organizations, and patients. While most research has focused on identifying burnout, cataloging its effects, and creating a case for attending to its impact, relatively few studies have focused on exploring the antecedents of burnout for physicians. The goal of this study was to test an etiological model, the Areas of Worklife Scale (AWS), for practicing primary care physicians. Using the AWS and the Maslach Burnout Inventory, the study used a longitudinal survey research design method to query primary care physicians employed at a large integrated delivery system in the United States. Data collected successfully fit the AWS model for burnout among primary care physicians, supporting our theory that workplace drivers are responsible for burnout. Workload, control, and values congruence are the largest drivers of burnout for practicing primary care physicians. The AWS model provides key insights into the domains of work that cause stress and ultimately burnout for physicians, and these domains can guide physicians and managers to develop interventions to fight the rising incidence of burnout. PMID:26529850

  19. Parenteral Nutrition and Infection Risk in the Intensive Care Unit: A Practical Guide for the Bedside Clinician.

    Science.gov (United States)

    McCleary, Emily J; Tajchman, Sharla

    2016-08-01

    The safety of parenteral nutrition (PN) administration in critically ill patients has been the subject of much controversy. Historically, PN administration has been associated with an increased risk of bacterial and fungal infections, leading to significant morbidity and mortality. Much of the data showing increased infectious complications compared with either no nutrition or enteral nutrition was derived from early studies conducted in the 1980s-2000s. Poor glucose control and hyperalimentation are confounding factors in many early studies, making it difficult to determine the true PN infection risks. While PN studies conducted during the past 10 years have failed to show the same infection rates, these risks continue to be cited as dogma. Potential reasons for such discordant results include improved glycemic control, avoidance of overfeeding, and improved sterility and central venous catheter care. Understanding the true infectious risk of PN administration in the intensive care unit is necessary to optimize patient care, as inappropriately withholding such nutrition is potentially deleterious. This review is meant to serve as a practical guide to the bedside clinician who is evaluating the risks and benefits of initiating PN in a critically ill patient. Each component of PN will be evaluated based on risk of infection, and the potential ways to mitigate risks will be discussed. PMID:27317614

  20. Proposed Reference Model for Guiding Teachers to Perform Ward Round Teaching

    Directory of Open Access Journals (Sweden)

    Luís Alberto Corona Martínez

    2014-06-01

    Full Text Available Ward round teaching is an essential professional medical activity as an organizational form of teaching in undergraduate medical education. Its great importance for shaping a professional "personality" is well recognized by the faculty; as well as its extremely complex implementation and development of the necessary skills. The problem to be solved in this paper is related to the need to help younger clinical teachers in undergraduate medical education to develop the skills to conduct ward round teaching; which would be achieved through appropriate guidance on how to perform this activity. Based on this, the teaching staff in the Department of Clinical Sciences of the Dr. Raúl Dorticós Torrado Faculty of Medical Sciences in Cienfuegos has designed a model or representation of ward round teaching to be used as a guide. The main results include the development of a model with two variants, according to the care provided to a recently admitted patient or an already known patient; and the definition of conditions, both in practical and educational areas, which should be considered for the proper implementation of the activity. The model is not a complete representation of the ward round teaching, thus the proposal is open to review and improvement; and its use is based on its adaptation to the particularities of the different disciplines and learning scenarios.

  1. Chiropractic as spine care: a model for the profession

    Directory of Open Access Journals (Sweden)

    Metz R Douglas

    2005-07-01

    Full Text Available Abstract Background More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. Objective To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. Discussion The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. Conclusion This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.

  2. Venous thromboembolism in Latin America: a review and guide to diagnosis and treatment for primary care.

    Science.gov (United States)

    Ceresetto, Jose Manuel

    2016-01-01

    There are various region-specific challenges to the diagnosis and effective treatment of venous thromboembolism in Latin America. Clear guidance for physicians and patient education could improve adherence to existing guidelines. This review examines available information on the burden of pulmonary embolism and deep vein thrombosis in Latin America and the regional issues surrounding the diagnosis and treatment of pulmonary embolism and deep vein thrombosis. Potential barriers to appropriate care, as well as treatment options and limitations on their use, are discussed. Finally, an algorithmic approach to the diagnosis and treatment of venous thromboembolism in ambulatory patients is proposed and care pathways for patients with pulmonary embolism and deep vein thrombosis are outlined for primary care providers in Latin America.

  3. A practical guide to applying lean tools and management principles to health care improvement projects.

    Science.gov (United States)

    Simon, Ross W; Canacari, Elena G

    2012-01-01

    Manufacturing organizations have used Lean management principles for years to help eliminate waste, streamline processes, and cut costs. This pragmatic approach to structured problem solving can be applied to health care process improvement projects. Health care leaders can use a step-by-step approach to document processes and then identify problems and opportunities for improvement using a value stream process map. Leaders can help a team identify problems and root causes and consider additional problems associated with methods, materials, manpower, machinery, and the environment by using a cause-and-effect diagram. The team then can organize the problems identified into logical groups and prioritize the groups by impact and difficulty. Leaders must manage action items carefully to instill a sense of accountability in those tasked to complete the work. Finally, the team leaders must ensure that a plan is in place to hold the gains.

  4. Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience"

    Directory of Open Access Journals (Sweden)

    Van Royen Paul

    2009-08-01

    Full Text Available Abstract Background Most research publications on Chronic Care Model (CCM implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Belgian healthcare setting, a setting where the organisational framework for chronic care is mainly hospital-centered. Methods Process evaluation of an action research project (2003–2007 guided by the CCM in a well-defined geographical area with 76,826 inhabitants and an estimated number of 2,300 type 2 diabetes patients. In consultation with the region a program for type 2 diabetes patients was developed. The degree of implementation of the CCM in the region was assessed using the Assessment of Chronic Illness Care survey (ACIC. A multimethod approach was used to evaluate the implementation process. The resulting data were triangulated in order to identify the main facilitators and barriers encountered during the implementation process. Results The overall ACIC score improved from 1.45 (limited support at the start of the study to 5.5 (basic support at the end of the study. The establishment of a local steering group and the appointment of a program manager were crucial steps in strengthening primary care. The willingness of a group of well-trained and motivated care providers to invest in quality improvement was an important facilitator. Important barriers were the complexity of the intervention, the lack of quality data, inadequate information technology support, the lack of commitment procedures and the uncertainty about sustainable funding. Conclusion Guided by the CCM, this study highlights the opportunities and the bottlenecks for adapting chronic care

  5. Monte Carlo modeling of ultrasound probes for image guided radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bazalova-Carter, Magdalena, E-mail: bazalova@uvic.ca [Department of Radiation Oncology, Stanford University, Stanford, California 94305 and Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia V8W 2Y2 (Canada); Schlosser, Jeffrey [SoniTrack Systems, Inc., Palo Alto, California 94304 (United States); Chen, Josephine [Department of Radiation Oncology, UCSF, San Francisco, California 94143 (United States); Hristov, Dimitre [Department of Radiation Oncology, Stanford University, Stanford, California 94305 (United States)

    2015-10-15

    X6-1 probe in vertical orientation caused the highest attenuation of the 6 and 15 MV beams, which at 10 cm depth accounted for 33% and 43% decrease compared to the respective (15 × 15) cm{sup 2} open fields. The C5-2 probe in horizontal orientation, on the other hand, caused a dose increase of 10% and 53% for the 6 and 15 MV beams, respectively, in the buildup region at 0.5 cm depth. For the X6-1 probe in vertical orientation, the dose at 5 cm depth for the 3-cm diameter 6 MV and 5-cm diameter 15 MV beams was attenuated compared to the corresponding open fields to a greater degree by 65% and 43%, respectively. Conclusions: MC models of two US probes used for real-time image guidance during radiotherapy have been built. Due to the high beam attenuation of the US probes, the authors generally recommend avoiding delivery of treatment beams that intersect the probe. However, the presented MC models can be effectively integrated into US-guided radiotherapy treatment planning in cases for which beam avoidance is not practical due to anatomy geometry.

  6. Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury

    OpenAIRE

    Bloemen-Vrencken, J.H.A.; de Witte, L.P.; Engels, J.P.G.M.; Van den Heuvel, W.J.A.; Post, M.W.M.

    2005-01-01

    Abstract Purposes The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. Methods The transmural care model was developed in cooperation w...

  7. Modeling Safety Outcomes on Patient Care Units

    Science.gov (United States)

    Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

    In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

  8. Cancer patient-centered home care: a new model for health care in oncology

    Science.gov (United States)

    Tralongo, Paolo; Ferraù, Francesco; Borsellino, Nicolò; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio

    2011-01-01

    Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective. PMID:21941445

  9. A Model for Implementing Integrative Practice in Health Care Agencies

    Directory of Open Access Journals (Sweden)

    Chris Patterson

    2008-01-01

    Full Text Available Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a professional and research development, b health human resource planning, c regulation and legislation and d practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals.

  10. Keeping Kids Safe: A Guide for Safe Food Handling & Sanitation for Child Care Providers.

    Science.gov (United States)

    Food Safety and Inspection Service (USDA), Washington, DC.

    Because children under age 5 are susceptible to food-borne illnesses and children in diapers present special sanitation and health problems, food safety and sanitation are emerging as important issues for child care providers. This booklet is designed to give providers and parents a quick and easy reference for food safety and sanitation. The…

  11. Guided online treatment in routine mental health care: an observational study on uptake, drop-out and effects

    Directory of Open Access Journals (Sweden)

    Kenter Robin

    2013-01-01

    Full Text Available Abstract Background Due to limited resources patients in the Netherlands often have to wait for a minimum of six weeks after registration for mental health care to receive their first treatment session. Offering guided online treatment might be an effective solution to reduce waiting time and to increase patient outcomes at relatively low cost. In this study we report on uptake, drop-out and effects of online problem solving treatment that was implemented in a mental health center. Methods We studied all 104 consecutive patients aged 18–65 years with elevated symptoms of depression, anxiety and/or burnout who registered at the center during the first six months after implementation. They were offered a five week guided online treatment. At baseline, five weeks and twelve weeks we measured depressive (BDI-II, anxiety (HADS-A and burnout symptoms (MBI. Results A total of 55 patients (53% agreed to start with the online treatment. Patients who accepted the online treatment were more often female, younger and lower educated than those who refused. There were no baseline differences in clinical symptoms between the groups. There were large between group effect sizes after five weeks for online treatment for depression (d = 0.94 and anxiety (d = 1.07, but not for burnout (d = −.07. At twelve weeks, when both groups had started regular face-to-face treatments, we no longer found significant differences between the groups, except for anxiety (d = 0.69. Conclusion The results of this study show that the majority of patients prefer online guided online treatment instead of waiting for face-to-face treatment. Furthermore, online PST increases speed of recovery and can therefore be offered as a first step of treatment in mental healthcare.

  12. Genetically Guided Statin Therapy on Statin Perceptions, Adherence, and Cholesterol Lowering: A Pilot Implementation Study in Primary Care Patients

    Directory of Open Access Journals (Sweden)

    Josephine H. Li

    2014-03-01

    Full Text Available Statin adherence is often limited by side effects. The SLCO1B1*5 variant is a risk factor for statin side effects and exhibits statin-specific effects: highest with simvastatin/atorvastatin and lowest with pravastatin/rosuvastatin. The effects of SLCO1B1*5 genotype guided statin therapy (GGST are unknown. Primary care patients (n = 58 who were nonadherent to statins and their providers received SLCO1B1*5 genotyping and guided recommendations via the electronic medical record (EMR. The primary outcome was the change in Beliefs about Medications Questionnaire, which measured patients’ perceived needs for statins and concerns about adverse effects, measured before and after SLCO1B1*5 results. Concurrent controls (n = 59 were identified through the EMR to compare secondary outcomes: new statin prescriptions, statin utilization, and change in LDL-cholesterol (LDL-c. GGST patients had trends (p = 0.2 towards improved statin necessity and concerns. The largest changes were the “need for statin to prevent sickness” (p < 0.001 and “concern for statin to disrupt life” (p = 0.006. GGST patients had more statin prescriptions (p < 0.001, higher statin use (p < 0.001, and greater decrease in LDL-c (p = 0.059 during follow-up. EMR delivery of SLCO1B1*5 results and recommendations is feasible in the primary care setting. This novel intervention may improve patients’ perceptions of statins and physician behaviors that promote higher statin adherence and lower LDL-c.

  13. A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model

    Science.gov (United States)

    2009-01-01

    Abstract Collaborative care models for depression in primary care are effective and cost-effective, but difficult to spread to new sites. Translating Initiatives for Depression into Effective Solutions (TIDES) is an initiative to promote evidence-based collaborative care in the U.S. Veterans Health Administration (VHA). Social marketing applies marketing techniques to promote positive behavior change. Described in this paper, TIDES used a social marketing approach to foster national spread of collaborative care models. TIDES social marketing approach The approach relied on a sequential model of behavior change and explicit attention to audience segmentation. Segments included VHA national leadership, Veterans Integrated Service Network (VISN) regional leadership, facility managers, frontline providers, and veterans. TIDES communications, materials and messages targeted each segment, guided by an overall marketing plan. Results Depression collaborative care based on the TIDES model was adopted by VHA as part of the new Primary Care Mental Health Initiative and associated policies. It is currently in use in more than 50 primary care practices across the United States, and continues to spread, suggesting success for its social marketing-based dissemination strategy. Discussion and conclusion Development, execution and evaluation of the TIDES marketing effort shows that social marketing is a promising approach for promoting implementation of evidence-based interventions in integrated healthcare systems. PMID:19785754

  14. A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model

    Directory of Open Access Journals (Sweden)

    Parker Louise E

    2009-09-01

    Full Text Available Abstract Collaborative care models for depression in primary care are effective and cost-effective, but difficult to spread to new sites. Translating Initiatives for Depression into Effective Solutions (TIDES is an initiative to promote evidence-based collaborative care in the U.S. Veterans Health Administration (VHA. Social marketing applies marketing techniques to promote positive behavior change. Described in this paper, TIDES used a social marketing approach to foster national spread of collaborative care models. TIDES social marketing approach The approach relied on a sequential model of behavior change and explicit attention to audience segmentation. Segments included VHA national leadership, Veterans Integrated Service Network (VISN regional leadership, facility managers, frontline providers, and veterans. TIDES communications, materials and messages targeted each segment, guided by an overall marketing plan. Results Depression collaborative care based on the TIDES model was adopted by VHA as part of the new Primary Care Mental Health Initiative and associated policies. It is currently in use in more than 50 primary care practices across the United States, and continues to spread, suggesting success for its social marketing-based dissemination strategy. Discussion and conclusion Development, execution and evaluation of the TIDES marketing effort shows that social marketing is a promising approach for promoting implementation of evidence-based interventions in integrated healthcare systems.

  15. A Model of Induction for Specialised Residential Care

    OpenAIRE

    Ann McWilliams; Siobhan Quinlan Cooke; Niall Hanlon

    2006-01-01

    The Social Care Education and Training Project at the Dublin Institute of Technology is a four year project funded by the Department of Health and Children. The project has increased the number of students enrolled in social care courses at the Institute and delivers Continued Professional Development courses for workers in the specialised residential units. The article describes an induction model developed and delivered by the project team to new workers in the specialised residential unit...

  16. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model : A Qualitative Study

    NARCIS (Netherlands)

    Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.

    2015-01-01

    Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this stu

  17. Medication Guide

    Science.gov (United States)

    ... Size Small Text Medium Text Large Text Contrast Dark on Light Light on Dark Donate Search Menu Donate What is Glaucoma? Care ... Low Vision Resources Medication Guide Resources on the Web » See All Articles Help the Cause Glaucoma affects ...

  18. ATTEND: Toward a Mindfulness-Based Bereavement Care Model

    Science.gov (United States)

    Cacciatore, Joanne; Flint, Melissa

    2012-01-01

    Few, if any, mindfulness-based bereavement care models exist. The ATTEND (attunement, trust, touch, egalitarianism, nuance, and death education) model is an interdisciplinary paradigm for providers, including physicians, social workers, therapists, nursing staff, and others. Using a case example to enhance the breadth and depth of understanding,…

  19. A GUIDED SWAT MODEL APPLICATION ON SEDIMENT YIELD MODELING IN PANGANI RIVER BASIN: LESSONS LEARNT

    Directory of Open Access Journals (Sweden)

    Preksedis M. Ndomba

    2008-01-01

    Full Text Available The overall objective of this paper is to report on the lessons learnt from applying Soil and Water Assessment Tool (SWAT in a well guided sediment yield modelling study. The study area is the upstream of Pangani River Basin (PRB, the Nyumba Ya Mungu (NYM reservoir catchment, located in the North Eastern part of Tanzania. It should be noted that, previous modeling exercises in the region applied SWAT with preassumption that inter-rill or sheet erosion was the dominant erosion type. In contrast, in this study SWAT model application was guided by results of analysis of high temporal resolution of sediment flow data and hydro-meteorological data. The runoff component of the SWAT model was calibrated from six-years (i.e. 1977¿1982 of historical daily streamflow data. The sediment component of the model was calibrated using one-year (1977-1988 daily sediment loads estimated from one hydrological year sampling programme (between March and November, 2005 rating curve. A long-term period over 37 years (i.e. 1969-2005 simulation results of the SWAT model was validated to downstream NYM reservoir sediment accumulation information. The SWAT model captured 56 percent of the variance (CE and underestimated the observed daily sediment loads by 0.9 percent according to Total Mass Control (TMC performance indices during a normal wet hydrological year, i.e., between November 1, 1977 and October 31, 1978, as the calibration period. SWAT model predicted satisfactorily the long-term sediment catchment yield with a relative error of 2.6 percent. Also, the model has identified erosion sources spatially and has replicated some erosion processes as determined in other studies and field observations in the PRB. This result suggests that for catchments where sheet erosion is dominant SWAT model may substitute the sediment-rating curve. However, the SWAT model could not capture the dynamics of sediment load delivery in some seasons to the catchment outlet.

  20. A GUIDED SWAT MODEL APPLICATION ON SEDIMENT YIELD MODELING IN PANGANI RIVER BASIN: LESSONS LEARNT

    Directory of Open Access Journals (Sweden)

    Preksedis Marco Ndomba

    2008-12-01

    Full Text Available The overall objective of this paper is to report on the lessons learnt from applying Soil and Water Assessment Tool (SWAT in a well guided sediment yield modelling study. The study area is the upstream of Pangani River Basin (PRB, the Nyumba Ya Mungu (NYM reservoir catchment, located in the North Eastern part of Tanzania. It should be noted that, previous modeling exercises in the region applied SWAT with preassumption that inter-rill or sheet erosion was the dominant erosion type. In contrast, in this study SWAT model application was guided by results of analysis of high temporal resolution of sediment flow data and hydro-meteorological data. The runoff component of the SWAT model was calibrated from six-years (i.e. 1977–1982 of historical daily streamflow data. The sediment component of the model was calibrated using one-year (1977–1988 daily sediment loads estimated from one hydrological year sampling programme (between March and November, 2005 rating curve. A long-term period over 37 years (i.e. 1969–2005 simulation results of the SWAT model was validated to downstream NYM reservoir sediment accumulation information. The SWAT model captured 56 percent of the variance (CE and underestimated the observed daily sediment loads by 0.9 percent according to Total Mass Control (TMC performance indices during a normal wet hydrological year, i.e., between November 1, 1977 and October 31, 1978, as the calibration period. SWAT model predicted satisfactorily the long-term sediment catchment yield with a relative error of 2.6 percent. Also, the model has identified erosion sources spatially and has replicated some erosion processes as determined in other studies and field observations in the PRB. This result suggests that for catchments where sheet erosion is dominant SWAT model may substitute the sediment-rating curve. However, the SWAT model could not capture the dynamics of sediment load delivery in some seasons to the catchment outlet.

  1. A Guide For Requirement Specification Of Identity And Access Management In Health Care

    OpenAIRE

    Virkkunen, Sanna

    2014-01-01

    The object of this Master’s thesis was to describe the basic functionalities provided by identity and access management system (IAM) and their suitability for a health care environment. Specifying and defining the IAM project began in the Northern Ostrobothnia Hospital District in 2007. The preliminary work for enabling identity and access management automation has been done ever since. Most of the requirement specification work was done during the autumn 2013 for the IAM SSO project in the N...

  2. Torsional Vibrations at Guide-Vane Shaft of Pump–Turbine Model

    Directory of Open Access Journals (Sweden)

    Andrej Predin

    1997-01-01

    Full Text Available This article focuses on the problem of guide-vane vibrations of reversible pump–turbines, especially, in the pump mode. These vibrations are transmitted to the guide-vane shaft torque. The guide-vane vibrations are caused by the impeller exit flow, which has a turbulent and partly nondeterministic property. Experimentally determined flow velocities at the impeller exit are given. The mathematical models for theoretical torsional vibration prediction formulated using linear and nonlinear differential equations are presented. The results of theoretical calculations are compared with measurement results. The possibility of transferring the parameters from the model to the prototype is discussed.

  3. User's guide to the LIRAQ model: an air pollution model for the San Francisco Bay Area

    International Nuclear Information System (INIS)

    The Livermore Regional Air Quality (LIRAQ) model comprises a set of computer programs that have been integrated into an easily used tool for the air quality planner. To assemble and modify the necessary data files and to direct model execution, a problem formulation program has been developed that makes possible the setup of a wide variety of studies involving perturbation of the emission inventory, changes to the initial and boundary conditions, and different choices of grid size and problem domain. In addition to describing the types of air quality problems for which the LIRAQ model may be used, this User's Guide provides detailed information on how to set up and conduct model simulations. Also included are descriptions of the formats of input data files so that the LIRAQ model may be applied to regions other than the San Francisco Bay Area

  4. Towards a model for integrative medicine in Swedish primary care

    Directory of Open Access Journals (Sweden)

    Falkenberg Torkel

    2007-07-01

    Full Text Available Abstract Background Collaboration between providers of conventional care and complementary therapies (CTs has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM. The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care. Methods Investigative procedures involved research group and key informant meetings with multiple stakeholders including general practitioners, CT providers, medical specialists, primary care administrators and county council representatives. Data collection included meeting notes which were fed back within the research group and used as ongoing working documents. Data analysis was made by immersion/crystallisation and research group consensus. Results were categorised within a public health systems framework of structures, processes and outcomes. Results The outcome was an IM model that aimed for a patient-centered, interdisciplinary, non-hierarchical mix of conventional and complementary medical solutions to individual case management of patients with pain in the lower back and/or neck. The IM model case management adhered to standard clinical practice including active partnership between a gate-keeping general practitioner, collaborating with a team of CT providers in a consensus case conference model of care. CTs with an emerging evidence base included Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong. Conclusion Despite identified barriers such as no formal recognition of CT professions in Sweden, it was possible to develop a model for IM adapted to Swedish primary care. The IM model calls for testing and refinement in a pragmatic randomised controlled trial to explore its clinical effectiveness.

  5. Cancer patient-centered home care: a new model for health care in oncology

    Directory of Open Access Journals (Sweden)

    Tralongo P

    2011-09-01

    Full Text Available Paolo Tralongo1, Francesco Ferraù2, Nicolò Borsellino3, Francesco Verderame4, Michele Caruso5, Dario Giuffrida6, Alfredo Butera7, Vittorio Gebbia81Medical Oncology Unit, Azienda Sanitaria Provinciale, Siracusa; 2Medical Oncology Unit, Ospedale San Vincenzo, Taormina; 3Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo; 4Medical Oncology Unit, Ospedale Giovanni Paolo II, Sciacca; 5Medical Oncology Unit, Istituto Humanitas, Catania; 6Medical Oncology Unit, Istituto Oncologico del Mediterraneo, Catania; 7Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento; 8Medical Oncology Unit, Dipartimento Oncologico, La Maddalena, Università degli Studi, Palermo, ItalyAbstract: Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients' needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients' needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.Keywords: cancer, home care

  6. Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria

    Directory of Open Access Journals (Sweden)

    Karien Jooste

    2013-03-01

    Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n =124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

  7. Jobs and Economic Development Impact (JEDI) Model Geothermal User Reference Guide

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, C.; Augustine, C.; Goldberg, M.

    2012-09-01

    The Geothermal Jobs and Economic Development Impact (JEDI) model, developed through the National Renewable Energy Laboratory (NREL), is an Excel-based user-friendly tools that estimates the economic impacts of constructing and operating hydrothermal and Enhanced Geothermal System (EGS) power generation projects at the local level for a range of conventional and renewable energy technologies. The JEDI Model Geothermal User Reference Guide was developed to assist users in using and understanding the model. This guide provides information on the model's underlying methodology, as well as the parameters and references used to develop the cost data utilized in the model. This guide also provides basic instruction on model add-in features, operation of the model, and a discussion of how the results should be interpreted.

  8. Three-Dimensional Modeling of Guide-Field Magnetic Reconnection

    Science.gov (United States)

    Hesse, Michael

    2005-01-01

    The dissipation mechanism of guide field magnetic reconnection remains a subject of intense scientific interest. On one hand, one set of recent studies have shown that particle inertia-based processes, which include thermal and bulk inertial effects, provide the reconnection electric field in the diffusion region. On the other hand, a second set of studies emphasizes the role of wave-particle interactions in providing anomalous resistivity in the diffusion region. In this presentation, we analyze three-dimensional PIC simulations of guide-field magnetic reconnection. Specific emphasis will be on the question whether thermal-inertia processes, mediated by the electron pressure tensor, remain a viable dissipation mechanism in fully three-dimensional systems.

  9. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial

    DEFF Research Database (Denmark)

    Jensen, Jens U; Hein, Lars; Lundgren, Bettina;

    2011-01-01

    For patients in intensive care units, sepsis is a common and potentially deadly complication and prompt initiation of appropriate antimicrobial therapy improves prognosis. The objective of this trial was to determine whether a strategy of antimicrobial spectrum escalation, guided by daily measure...... measurements of the biomarker procalcitonin, could reduce the time to appropriate therapy, thus improving survival....

  10. Disease management projects and the Chronic Care Model in action: baseline qualitative research

    Directory of Open Access Journals (Sweden)

    Walters Bethany

    2012-05-01

    Full Text Available Abstract Background Disease management programs, especially those based on the Chronic Care Model (CCM, are increasingly common in the Netherlands. While disease management programs have been well-researched quantitatively and economically, less qualitative research has been done. The overall aim of the study is to explore how disease management programs are implemented within primary care settings in the Netherlands; this paper focuses on the early development and implementation stages of five disease management programs in the primary care setting, based on interviews with project leadership teams. Methods Eleven semi-structured interviews were conducted at the five selected sites with sixteen professionals interviewed; all project directors and managers were interviewed. The interviews focused on each project’s chosen chronic illness (diabetes, eating disorders, COPD, multi-morbidity, CVRM and project plan, barriers to development and implementation, the project leaders’ action and reactions, as well as their roles and responsibilities, and disease management strategies. Analysis was inductive and interpretive, based on the content of the interviews. After analysis, the results of this research on disease management programs and the Chronic Care Model are viewed from a traveling technology framework. Results This analysis uncovered four themes that can be mapped to disease management and the Chronic Care Model: (1 changing the health care system, (2 patient-centered care, (3 technological systems and barriers, and (4 integrating projects into the larger system. Project leaders discussed the paths, both direct and indirect, for transforming the health care system to one that addresses chronic illness. Patient-centered care was highlighted as needed and a paradigm shift for many. Challenges with technological systems were pervasive. Project leaders managed the expenses of a traveling technology, including the social, financial, and

  11. Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Christopher Williams

    Full Text Available BACKGROUND: Access to Cognitive behavioural therapy (CBT for depression is limited. One solution is CBT self-help books. Trial Objectives: To assess the impact of a guided self-help CBT book (GSH-CBT on mood, compared to treatment as usual (TAU. HYPOTHESES: GSH-CBT will have improved mood and knowledge of the causes and treatment of depression compared to the control receiving TAUGuided self-help will be acceptable to patients and staff. METHODS AND FINDINGS: PARTICIPANTS: Adults attending seven general practices in Glasgow, UK with a BDI-II score of ≥14. 141 randomised to GSH-CBT and 140 to TAU. INTERVENTIONS: RCT comparing 'Overcoming Depression: A Five Areas Approach' book plus 3-4 short face to face support appointments totalling up to 2 hours of guided support, compared with general practitioner TAU. PRIMARY OUTCOME: The BDI (II score at 4 months. Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome, 117 at 12 months. OUTCOME: Mean BDI-II scores were lower in the GSH-CBT group at 4 months by 5.3 points (2.6 to 7.9, p<0.001. At 4 and 12 months there were also significantly higher proportions of participants achieving a 50% reduction in BDI-II in the GSH-CBT arm. The mean support was 2 sessions with 42.7 minutes for session 1, 41.4 minutes for session 2 and 40.2 minutes of support for session 3. Adverse effects/Harms: Significantly less deterioration in mood in GSH-CBT (2.0% compared to 9.8% in the TAU group for BDI-II category change. LIMITATIONS: Weaknesses: Our follow-up rate of 72.2% at 4 months is better than predicted but is poorer at 12 months (41.6%. In the GSH-CBT arm, around 50% of people attended 2 or fewer sessions. 22% failed to take up treatment. CONCLUSIONS: GSH-CBT is substantially more effective than TAU. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN13475030.

  12. Comprehensive School Reform Models: A Study Guide for Comparing CSR Models (and How Well They Meet Minnesota's Learning Standards).

    Science.gov (United States)

    St. John, Edward P.; Loescher, Siri; Jacob, Stacy; Cekic, Osman; Kupersmith, Leigh; Musoba, Glenda Droogsma

    A growing number of schools are exploring the prospect of applying for funding to implement a Comprehensive School Reform (CSR) model. But the process of selecting a CSR model can be complicated because it frequently involves self-study and a review of models to determine which models best meet the needs of the school. This study guide is intended…

  13. Technologies of birth and models of midwifery care

    Directory of Open Access Journals (Sweden)

    Christine McCourt

    2014-08-01

    Full Text Available This article is based on a study of a reform in the organisation of maternity services in the United Kingdom, which aimed towards developing a more woman-centred model of care. After decades of fragmentation and depersonalisation of care, associated with the shift of birth to a hospital setting, pressure by midwives and mothers prompted government review and a relatively radical turnaround in policy. However, the emergent model of care has been profoundly influenced by concepts and technologies of monitoring. The use of such technologies as ultrasound scans, electronic foetal monitoring and oxytocic augmentation of labour, generally supported by epidural anaesthesia for pain relief, have accompanied the development of a particular ecological model of birth – often called active management –, which is oriented towards the idea of an obstetric norm. Drawing on analysis of women’s narrative accounts of labour and birth, this article discusses the impact on women’s embodiment in birth, and the sources of information they use about the status of their own bodies, their labour and that of the child. It also illustrates how the impact on women’s experiences of birth may be mediated by a relational model of support, through the provision of caseload midwifery care.

  14. Pathology service line: a model for accountable care organizations at an academic medical center.

    Science.gov (United States)

    Sussman, Ira; Prystowsky, Michael B

    2012-05-01

    Accountable care is designed to manage the health of patients using a capitated cost model rather than fee for service. Pay for performance is an attempt to use quality and not service reduction as the way to decrease costs. Pathologists will have to demonstrate value to the system. This value will include (1) working with clinical colleagues to optimize testing protocols, (2) reducing unnecessary testing in both clinical and anatomic pathology, (3) guiding treatment by helping to personalize therapy, (4) designing laboratory information technology solutions that will promote and facilitate accurate, complete data mining, and (5) administering efficient cost-effective laboratories. The pathology service line was established to improve the efficiency of delivering pathology services and to provide more effective support of medical center programs. We have used this model effectively at the Montefiore Medical Center for the past 14 years. PMID:22333926

  15. Nursing care for elderly lung cancer patients treated with CT-guided permanent interstitial co-implantation of 125I seeds and slow-released fluorouracil

    International Nuclear Information System (INIS)

    Objective: To investigate the specific measures and effect of the nursing care for elderly lung cancer patients who were receiving the treatment of CT-guided permanent interstitial co-implantation of 125I seeds and slow-released fluorouracil. Methods: Active care, including adequate preoperative preparation, proper support during operation and postoperative nursing,was carried out for fifty-three elderly patients with lung cancer during their treatment course of CT-guided permanent interstitial brachytherapy with co-implantation of 125I seeds and slow-released fluorouracil. Results: In order to ensure accurate puncture and the smooth particle implantation, the possible conditions which might happen after the procedure were informed to the patients before the surgery and useful advice was given to patients to guide their daily activities. All 53 patients showed no obvious fear before surgery and made good cooperation during the procedure, moreover, they well responded to the therapy and recovered pretty soon. Conclusion: CT-guided permanent interstitial co-implantation of 125I seeds and slow-released fluorouracil is a safe, minimally-invasive and newly-developed technique with reliable effect, which is especially suitable for aged patients. Active and adequate nursing care is essential during the whole therapeutic course. (authors)

  16. Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury

    Directory of Open Access Journals (Sweden)

    J.H.A. Bloemen-Vrencken

    2005-06-01

    Full Text Available Purposes: The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. Methods: The transmural care model was developed in cooperation with the Dutch Association of Spinal Cord Injured Patients, community nurses, general practitioners, rehabilitation nurses, rehabilitation managers, physiatrists and researchers. The core component of the care model consists of a transmural nurse, who ‘liaises’ between people with SCI living in the community, professional primary care professionals and the rehabilitation centre. The transmural care model provides a job description containing activities to support people with SCI and their family/partners and activities to promote continuity of care. The transmural care model was implemented in two Dutch rehabilitation centres. The following three aspects, as experienced by the transmural nurses, were evaluated: the extent to which the care model was implemented; enabling factors and barriers for implementation; strength and weakness of the care model. Results: The transmural care model was not implemented in all its details, with a clear difference between the two rehabilitation centres. Enabling factors and barriers for implementation were found at three levels: 1. the level of the individual professional (e.g. competencies, attitude and motivation, 2. the organisational and financing level (e.g. availability of facilities and finances, and 3. the social context (the opinion of colleagues, managers and other professionals involved with the care. The most important weakness experienced was that there was not enough time to put all the activities into practice

  17. Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use.

    Science.gov (United States)

    Culyer, Anthony J

    2016-10-01

    There is misunderstanding about both the meaning and the role of cost-effectiveness thresholds in policy decision making. This article dissects the main issues by use of a bookshelf metaphor. Its main conclusions are as follows: it must be possible to compare interventions in terms of their impact on a common measure of health; mere effectiveness is not a persuasive case for inclusion in public insurance plans; public health advocates need to address issues of relative effectiveness; a 'first best' benchmark or threshold ratio of health gain to expenditure identifies the least effective intervention that should be included in a public insurance plan; the reciprocal of this ratio - the 'first best' cost-effectiveness threshold - will rise or fall as the health budget rises or falls (ceteris paribus); setting thresholds too high or too low costs lives; failure to set any cost-effectiveness threshold at all also involves avertable deaths and morbidity; the threshold cannot be set independently of the health budget; the threshold can be approached from either the demand side or the supply side - the two are equivalent only in a health-maximising equilibrium; the supply-side approach generates an estimate of a 'second best' cost-effectiveness threshold that is higher than the 'first best'; the second best threshold is the one generally to be preferred in decisions about adding or subtracting interventions in an established public insurance package; multiple thresholds are implied by systems having distinct and separable health budgets; disinvestment involves eliminating effective technologies from the insured bundle; differential weighting of beneficiaries' health gains may affect the threshold; anonymity and identity are factors that may affect the interpretation of the threshold; the true opportunity cost of health care in a community, where the effectiveness of interventions is determined by their impact on health, is not to be measured in money - but in health

  18. Systematic reviews: A guide for radiographers and other health care professionals

    Energy Technology Data Exchange (ETDEWEB)

    Marshall, Gill, E-mail: gill.marshall@cumbria.ac.u [Chair in Medical Imaging Education, Research Development Lead, School of Medical Imaging Sciences, Faculty of Health, Medical Sciences and Social Care, University of Cumbria, Lancaster, LA1 3JD (United Kingdom); Sykes, Anne E., E-mail: a.e.sykes@salford.ac.u [Directorate of Radiography School of Health, Sport and Rehabilitation Sciences, University of Salford Frederick Road, M6 6PU (United Kingdom)

    2011-05-15

    This paper offers guidance on performing systematic reviews to help up-skill radiographers and other health care professionals. It considers why systematic review is critically important to Radiography. Using a relevant example i.e. to investigate adverse effects related to MRI contrast agents it then examines the features of a systematic review and explains how diagnostic research evidence within a systematic review is evaluated. The paper then discusses the threats to validity of systematic reviews on a step by step basis. Five key steps are considered: Step 1: define the purpose of the review via a well-structured question. Step 2: determine the parameters (eligibility criteria) for a comprehensive systematic literature review that will address the research question. It is the wide range of material reviewed in this way that makes the work a systematic review, rather than an analysis of papers you happen to have. Step 3: Assess the quality of the literature you have found. Generally peer-reviewed papers published on a database such as Medline, which in the example given was established as an eligibility criterion, are considered to be high quality, but the actual impact factor/SCOPUS score of each journal is variable and should be considered. Step 4: Synthesise what the literature has revealed; appropriately extract data and summarise it; identifying any study differences. This requires the use of suitable methods for agreeing and summarising the results. This may involve a meta-analysis to collate the results from several studies. Step 5: interpret the findings to draw inferences from the resulting review and from the results of a meta-analysis if undertaken. This paper then provides a check list for guidance of those involved in writing systematic reviews and finally summarises the paper. A glossary of terms appears at the end of this paper.

  19. A Model of Induction for Specialised Residential Care

    Directory of Open Access Journals (Sweden)

    Ann McWilliams

    2006-01-01

    Full Text Available The Social Care Education and Training Project at the Dublin Institute of Technology is a four year project funded by the Department of Health and Children. The project has increased the number of students enrolled in social care courses at the Institute and delivers Continued Professional Development courses for workers in the specialised residential units. The article describes an induction model developed and delivered by the project team to new workers in the specialised residential units in the Dublin region although the course is suitable for all residential care settings. The evaluation suggests that the majority of participants found the induction module worthwhile because it had a positive effect on their professional practice and increased their self confidence. This supports the need for formal induction training for all new workers to ensure they perform their professional duties effectively as possible in their new working environment.

  20. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    Directory of Open Access Journals (Sweden)

    Marc Carreras

    2016-08-01

    Full Text Available Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care. Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain for the year 2012 (N = 92,498 individuals. A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG patient classification system. Results: Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained. Conclusion: The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

  1. Evaluation of the integrated community based home care model

    Directory of Open Access Journals (Sweden)

    LR Uys

    2001-09-01

    Full Text Available In 1999-2000 the Integrated Community-Based Home Care model for the care of people with AIDS in communities were implemented in seven sites across the country. The post-implementation evaluation showed that most respondents felt that the model could be replicated if a functioning and informed network including all partners, and a strong management team were in place. The effects of the project were mainly positive for all stakeholders (hospice, clinic, hospital, PWA and their carers, professionals and other community members. Hospitals and community- based services became more aware of and involved in the needs of PWA and felt that the model enabled them to address these needs. PWA and their carers felt supported and respected.

  2. Impact Of Training On The Knowledge Of Community Health Guides In Some Selected Areas Of Primary Health Care

    Directory of Open Access Journals (Sweden)

    Dwivedi R. R

    1989-01-01

    Full Text Available In the present study conducted in Kashi Vidyapeeth Block of Varanasi District, 20 Community Health Guides (CHGs were trained in order to strengthen their knowledge in some selected areas of Primary Health Care. Of the total score of 235, the mean score in pre-training was 115.65 (49.21%. During the first post-training assessment done after 3 months the mean score increased by 61.50 (26.17% which was statistically significant During the third post-training assessment after 9 months of training, the mean score increased significantly from the pre-training assessment by 38 (16.17%. Separate analysis for each item revealed significant improvements in the knowledge of CHGs after training. Age had no significant influence in the gain of knowledge. The increase in knowledge was significantly greater in CHGs with higher formal education. The “practitioner” group of CHGs could gain and retain more knowledge compared to the “non-practitioner” group.

  3. Data-driven modelling of structured populations a practical guide to the integral projection model

    CERN Document Server

    Ellner, Stephen P; Rees, Mark

    2016-01-01

    This book is a “How To” guide for modeling population dynamics using Integral Projection Models (IPM) starting from observational data. It is written by a leading research team in this area and includes code in the R language (in the text and online) to carry out all computations. The intended audience are ecologists, evolutionary biologists, and mathematical biologists interested in developing data-driven models for animal and plant populations. IPMs may seem hard as they involve integrals. The aim of this book is to demystify IPMs, so they become the model of choice for populations structured by size or other continuously varying traits. The book uses real examples of increasing complexity to show how the life-cycle of the study organism naturally leads to the appropriate statistical analysis, which leads directly to the IPM itself. A wide range of model types and analyses are presented, including model construction, computational methods, and the underlying theory, with the more technical material in B...

  4. Guiding-center models for edge plasmas and numerical simulations of isolated plasma filaments

    DEFF Research Database (Denmark)

    Madsen, Jens

    models are presented that overcome some of the difficulties associated with the development of reduced dynamical models applicable to the edge. Second order guiding-center coordinates are derived using the phasespace Lie transform method. Using a variational principle the corresponding Vlasov...

  5. Methods to construct a step-by-step beginner’s guide to decision analytic cost-effectiveness modeling

    Science.gov (United States)

    Rautenberg, Tamlyn; Hulme, Claire; Edlin, Richard

    2016-01-01

    Background Although guidance on good research practice in health economic modeling is widely available, there is still a need for a simpler instructive resource which could guide a beginner modeler alongside modeling for the first time. Aim To develop a beginner’s guide to be used as a handheld guide contemporaneous to the model development process. Methods A systematic review of best practice guidelines was used to construct a framework of steps undertaken during the model development process. Focused methods review supplemented this framework. Consensus was obtained among a group of model developers to review and finalize the content of the preliminary beginner’s guide. The final beginner’s guide was used to develop cost-effectiveness models. Results Thirty-two best practice guidelines were data extracted, synthesized, and critically evaluated to identify steps for model development, which formed a framework for the beginner’s guide. Within five phases of model development, eight broad submethods were identified and 19 methodological reviews were conducted to develop the content of the draft beginner’s guide. Two rounds of consensus agreement were undertaken to reach agreement on the final beginner’s guide. To assess fitness for purpose (ease of use and completeness), models were developed independently and by the researcher using the beginner’s guide. Conclusion A combination of systematic review, methods reviews, consensus agreement, and validation was used to construct a step-by-step beginner’s guide for developing decision analytical cost-effectiveness models. The final beginner’s guide is a step-by-step resource to accompany the model development process from understanding the problem to be modeled, model conceptualization, model implementation, and model checking through to reporting of the model results. PMID:27785080

  6. Information structure design for databases a practical guide to data modelling

    CERN Document Server

    Mortimer, Andrew J

    2014-01-01

    Computer Weekly Professional Series: Information Structure Design for Databases: A Practical Guide to Data modeling focuses on practical data modeling covering business and information systems. The publication first offers information on data and information, business analysis, and entity relationship model basics. Discussions cover degree of relationship symbols, relationship rules, membership markers, types of information systems, data driven systems, cost and value of information, importance of data modeling, and quality of information. The book then takes a look at entity relationship mode

  7. Return on Roller Coasters: A Model to Guide Investments in Theme Park Attractions

    OpenAIRE

    VAN OEST, Rutger D.; Heerde, Harald J. van; Dekimpe, Marnik G.

    2010-01-01

    Despite the economic significance of the theme park industry and the huge investments needed to set up new attractions, no marketing models exist to guide these investment decisions. This study addresses this gap in the literature by estimating a response model for theme park attendance. The model not only determines the contribution of each attraction to attendance, but also how this contribution is distributed within and across years. The model accommodates saturation effects, which imply t...

  8. Jobs and Economic Development Impact (JEDI) User Reference Guide: Fast Pyrolysis Biorefinery Model

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Y.; Goldberg, M.

    2015-02-01

    This guide -- the JEDI Fast Pyrolysis Biorefinery Model User Reference Guide -- was developed to assist users in operating and understanding the JEDI Fast Pyrolysis Biorefinery Model. The guide provides information on the model's underlying methodology, as well as the parameters and data sources used to develop the cost data utilized in the model. This guide also provides basic instruction on model add-in features and a discussion of how the results should be interpreted. Based on project-specific inputs from the user, the JEDI Fast Pyrolysis Biorefinery Model estimates local (e.g., county- or state-level) job creation, earnings, and output from total economic activity for a given fast pyrolysis biorefinery. These estimates include the direct, indirect and induced economic impacts to the local economy associated with the construction and operation phases of biorefinery projects.Local revenue and supply chain impacts as well as induced impacts are estimated using economic multipliers derived from the IMPLAN software program. By determining the local economic impacts and job creation for a proposed biorefinery, the JEDI Fast Pyrolysis Biorefinery Model can be used to field questions about the added value biorefineries might bring to a local community.

  9. Interprofessional Education and Practice Guide No. 6: Developing practice-based interprofessional learning using a short placement model.

    Science.gov (United States)

    Anderson, Elizabeth Susan; Ford, Jenny; Kinnair, Daniel James

    2016-07-01

    Offering undergraduate and post-qualified learners opportunities to take part in, and reflect on, the nature of interprofessional working when in practice remains an important goal for interprofessional educators. There are a plethora of opportunities within hospital and community care for learners to actively participate in health and social care delivery where collaborative practice prevails. However, it remains challenging to know how to establish and sustain meaningful interprofessional practice-based learning. This is because profession-specific teaching is prioritised and many teams are under-resourced, leaving little time for additional teaching activities. In some instances, practitioners lack the knowledge concerning how to design meaningful interprofessional learning and often feel unprepared for this teaching because of limited interprofessional faculty development. Others are simply unaware of the presence of the different students within their practice area. This guide offers key lessons developed over many years for setting up practice-based interprofessional education. The learning model has been adapted and adopted in different settings and countries and offers a method for engaging clinical front-line practitioners in learning with, and from learners who can help support and in some instances advance care delivery. PMID:27269042

  10. A New Long-Term Care Facilities Model in Nova Scotia, Canada: Protocol for a Mixed Methods Study of Care by Design

    OpenAIRE

    Marshall, Emily Gard; Boudreau, Michelle Anne; Jensen, Jan L; Edgecombe, Nancy; Clarke, Barry; Burge, Frederick; Archibald, Greg; Taylor, Anthony; Andrew, Melissa K.

    2013-01-01

    Background Prior to the implementation of a new model of care in long-term care facilities in the Capital District Health Authority, Halifax, Nova Scotia, residents entering long-term care were responsible for finding their own family physician. As a result, care was provided by many family physicians responsible for a few residents leading to care coordination and continuity challenges. In 2009, Capital District Health Authority (CDHA) implemented a new model of long-term care called “Care b...

  11. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities.

    Science.gov (United States)

    Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen

    2015-01-01

    Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. PMID:25499658

  12. A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP

    Directory of Open Access Journals (Sweden)

    Francis Rebecca

    2010-01-01

    Full Text Available Abstract Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT. Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR with number ACTRN12609000251224.

  13. Incorporating positive body image into the treatment of eating disorders: A model for attunement and mindful self-care.

    Science.gov (United States)

    Cook-Cottone, Catherine P

    2015-06-01

    This article provides a model for understanding the role positive body image can play in the treatment of eating disorders and methods for guiding patients away from symptoms and toward flourishing. The Attuned Representational Model of Self (Cook-Cottone, 2006) and a conceptual model detailing flourishing in the context of body image and eating behavior (Cook-Cottone et al., 2013) are discussed. The flourishing inherent in positive body image comes hand-in-hand with two critical ways of being: (a) having healthy, embodied awareness of the internal and external aspects of self (i.e., attunement) and (b) engaging in mindful self-care. Attunement and mindful self-care thus are considered as potential targets of actionable therapeutic work in the cultivation of positive body image among those with disordered eating. For context, best-practices in eating disorder treatment are also reviewed. Limitations in current research are detailed and directions for future research are explicated.

  14. Solar Advisor Model User Guide for Version 2.0

    Energy Technology Data Exchange (ETDEWEB)

    Gilman, P.; Blair, N.; Mehos, M.; Christensen, C.; Janzou, S.; Cameron, C.

    2008-08-01

    The Solar Advisor Model (SAM) provides a consistent framework for analyzing and comparing power system costs and performance across the range of solar technologies and markets, from photovoltaic systems for residential and commercial markets to concentrating solar power and large photovoltaic systems for utility markets. This manual describes Version 2.0 of the software, which can model photovoltaic and concentrating solar power technologies for electric applications for several markets. The current version of the Solar Advisor Model does not model solar heating and lighting technologies.

  15. 13A. Integrative Cancer Care: The Life Over Cancer Model

    OpenAIRE

    Block, Keith; Block, Penny; Gyllenhaal, Charlotte; Shoham, Jacob

    2013-01-01

    Focus Areas: Integrative Algorithms of Care Integrative cancer treatment fully blends conventional cancer treatment with integrative therapies such as diet, supplements, exercise and biobehavioral approaches. The Life Over Cancer model comprises three spheres of intervention: improving lifestyle, improving biochemical environment (terrain), and improving tolerance of conventional treatment. These levels are applied within the context of a life-affirming approach to cancer patients and treatme...

  16. Monks' Health: Holistic Health Care Model by Community Participation

    OpenAIRE

    Decha Buates; Songkoon Chantachon; Kosit Paengsoi; Anongrit Kangrang

    2010-01-01

    Problem statement: Monks health tended to be a continuous increased problem. They were groups who had limitations to access health services due to their monastic disciplines and their most importance for Buddhist institution. Without urgent solution, their normal way of life would have been affected. Approach: This research aimed to study current conditions and to develop monks holistic health care models by community participation in central region of Thailand. The study ...

  17. Embodying, calibrating and caring for a local model of obesity

    DEFF Research Database (Denmark)

    Winther, Jonas; Hillersdal, Line

    Interdisciplinary research collaborations are increasingly made a mandatory 'standard' within strategic research grants. Collaborations between the natural, social and humanistic sciences are conceptualized as uniquely suited to study pressing societal problems. The obesity epidemic has been...... is an ongoing process of configuring but also extending beyond already established models of obesity. We argue that an articulation of such practices of local care, embodiment and calibration are crucial for the appreciation, evaluation and transferability of interdisciplinary obesity research....

  18. Attitudes of Doctors and Nurses toward the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Rolando Bonal Ruiz

    2015-06-01

    Full Text Available Background: the fact that chronic diseases replace traditional causes of morbidity and mortality in a country, or are on a par with major common health problems, demands the development of new strategies to address them. Objective: to explore attitudes of doctors and nurses from the Rolando López Peña Polyclinic toward the Chronic Care Model. Methods: a quantitative and qualitative cross-sectional study was conducted including the 22 family physicians and 26 nurses who provide care to patients with chronic diseases and were at the polyclinic at the time of the study. All were administered a 5 point Likert scale and a focus group interview, which was taped, transcribed and analyzed. Results: the attitudinal results correspond with the actions assessed in each component of the model, being the most common barriers: the lack of awareness and training on the new approaches to care of these patients, work overload created by other programs such as the maternal-child and vector control programs, uncertainties on the effectiveness of patient education and ignorance of the practice guidelines. Conclusions: favorable attitudes toward the introduction of the model to the practice of the family physician and nurse predominated as long as organizational changes are made and the suggestions of these service providers are put into practice with the support of the decision makers of the health sector.

  19. Advancing population ecology with integral projection models: a practical guide

    DEFF Research Database (Denmark)

    Merow, Cory; Dahlgren, Johan; Metcall, C. Jessica E.;

    2014-01-01

    of regression models. Many subtleties arise when scaling from vital rate regressions to population-level patterns, so we provide a set of diagnostics and guidelines to ensure that models are biologically plausible. Moreover, IPMs can exploit a large existing suite of analytical tools developed for Matrix...

  20. The redefinition of the familialist home care model in France: the complex formalization of care through cash payment.

    Science.gov (United States)

    Le Bihan, Blanche

    2012-05-01

    This article investigates the impact of policy measures on the organisation of home-based care for older people in France, by examining the balance between formal and informal care and the redefinition of the initial familialist model. It focuses on the specific cash for care scheme (the Allocation personnalisée d'autonomie - Personalised allowance for autonomy) which is at the core of the French home-based care policy. The author argues that in a redefined context of 'welfare mix', the French public strategy for supporting home-based care in France is articulated around two major objectives, which can appear contradictory. It aims to formalise a professional care sector, with respect to the employment policy while allowing the development of new forms of informal care, which cannot be considered to be formal employment. The data collection is two-fold. Firstly, a detailed analysis was made of different policy documents and public reports, together with a systematic review of existing studies. Secondly, statistical analysis on home-based care resources were collected, which was not easy, as home-care services for older people in France are part of a larger sector of activity, 'personal services' (services à la personne). The article exposes three main findings. First, it highlights the complexity of the formalisation process related to the introduction of the French care allowance and demonstrates that formalisation, which facilitates the recognition of care as work, does not necessarily mean professionalisation. Second, it outlines the diversity of the resources available: heterogeneous professional care, semi-formal forms of care work with the possibility to employ a relative and informal family care. Finally, the analysis outlines the importance of the regulation of cash payments on the reshaping of formal and informal care and comments on its impact on the redefinition of informal caring activities.

  1. Guided Inquiry and Consensus-Building Used to Construct Cellular Models

    Directory of Open Access Journals (Sweden)

    Joel I. Cohen

    2015-02-01

    Full Text Available Using models helps students learn from a “whole systems” perspective when studying the cell. This paper describes a model that employs guided inquiry and requires consensus building among students for its completion. The model is interactive, meaning that it expands upon a static model which, once completed, cannot be altered and additionally relates various levels of biological organization (molecular, organelle, and cellular to define cell and organelle function and interaction. Learning goals are assessed using data summed from final grades and from images of the student’s final cell model (plant, bacteria, and yeast taken from diverse seventh grade classes. Instructional figures showing consensus-building pathways and seating arrangements are discussed. Results suggest that the model leads to a high rate of participation, facilitates guided inquiry, and fosters group and individual exploration by challenging student understanding of the living cell.

  2. Petroleum Refinery Jobs and Economic Development Impact (JEDI) Model User Reference Guide

    Energy Technology Data Exchange (ETDEWEB)

    Goldberg, M.

    2013-12-31

    The Jobs and Economic Development Impact (JEDI) models, developed through the National Renewable Energy Laboratory (NREL), are user-friendly tools utilized to estimate the economic impacts at the local level of constructing and operating fuel and power generation projects for a range of conventional and renewable energy technologies. The JEDI Petroleum Refinery Model User Reference Guide was developed to assist users in employing and understanding the model. This guide provides information on the model's underlying methodology, as well as the parameters and references used to develop the cost data utilized in the model. This guide also provides basic instruction on model add-in features, operation of the model, and a discussion of how the results should be interpreted. Based on project-specific inputs from the user, the model estimates job creation, earning and output (total economic activity) for a given petroleum refinery. This includes the direct, indirect and induced economic impacts to the local economy associated with the refinery's construction and operation phases. Project cost and job data used in the model are derived from the most current cost estimations available. Local direct and indirect economic impacts are estimated using economic multipliers derived from IMPLAN software. By determining the regional economic impacts and job creation for a proposed refinery, the JEDI Petroleum Refinery model can be used to field questions about the added value refineries may bring to the local community.

  3. Hybrid empirical/analytical modeling of guided wave generation by circular piezoceramics

    International Nuclear Information System (INIS)

    Classical piezoceramic transducer design methods in structural health monitoring based on guided wave propagation rely mostly on the use of the pin-force model, assuming that a piezoelectric actuator can be modelled as a constant shear stress applied at its circumference, whatever the frequency generated. However, the assumptions of this model are only valid for thin piezoelectric elements, weak coupling between the host structure and the transducer, and when the wavelength of the generated guided wave is above the size of the transducer. In order to overcome those limitations, this paper presents an axisymmetric analysis of guided wave generation by a circular piezoceramic, considering the complex shear and normal interfacial stress profiles between the transducer and the host structure. The excitation terms are estimated empirically using a best-fit model and a function derived from measured admittance. The validity of the approach is assessed numerically and experimentally, and the influence of piezoceramic thickness on guided wave generation is accurately modeled for frequencies below the second electro–mechanical resonance frequency. (paper)

  4. Real-time Social Internet Data to Guide Forecasting Models

    Energy Technology Data Exchange (ETDEWEB)

    Del Valle, Sara Y. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-09-20

    Our goal is to improve decision support by monitoring and forecasting events using social media, mathematical models, and quantifying model uncertainty. Our approach is real-time, data-driven forecasts with quantified uncertainty: Not just for weather anymore. Information flow from human observations of events through an Internet system and classification algorithms is used to produce quantitatively uncertain forecast. In summary, we want to develop new tools to extract useful information from Internet data streams, develop new approaches to assimilate real-time information into predictive models, validate approaches by forecasting events, and our ultimate goal is to develop an event forecasting system using mathematical approaches and heterogeneous data streams.

  5. Models for Designing Long-Term Care Service Plans and Care Programs for Older People

    OpenAIRE

    Shogo Kato; Satoko Tsuru; Yoshinori Iizuka

    2013-01-01

    The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans a...

  6. User guide: The FACEPA model software (costs of production: FADN)

    OpenAIRE

    Butault, Jean-Pierre; Zardet, Guillaume; Mathias, Loïc; Delame, Nathalie; Desbois, Dominique; Rousselle, Jean-Marc; Kleinhanss, Werner; Offermann, Frank

    2011-01-01

    This report describes the different potential uses of the software programmed with the SAS package command language, implementing the input/output FACEPA model aimed to estimate the agricultural production cost on the emprical basis of the European FADN.

  7. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    OpenAIRE

    Carreras, Marc; Sánchez-Pérez, Inma; Ibern, Pere; Coderch, Jordi; Inoriza, José María

    2016-01-01

    Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care.Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain) for the year 2012 (N = 92,498 individuals). A set of individual cost models as a function of sex, age and morbidity burd...

  8. Patients in a depression collaborative care model of care: comparison of 6-month cost utilization data with usual care.

    Science.gov (United States)

    Angstman, Kurt B; Williams, Mark D

    2010-04-01

    A collaborative care model (CCM) has been implemented for management of depression. This paper studies the impact that the CCM had on cost measures for the period of six months after initial diagnosis of depression compared to patients receiving usual care (UC). There was a significant increase in the CPT costs for the six months following diagnosis in the CCM group ($451.35 vs. $323.50, P < 0.001). The average CPT cost rank and CPT cost differential were also significantly increased in the CCM group. The adjusted means of the CPT costs were (when controlling for prior utilization) $452.11 for the CCM group and $322.09 for UC (P < 0.001). In the CCM group; there were 161 patients (73.5%) that achieved a clinical response for their depression compared to the UC group, which had a 15.1% (18/119) response rate (P < 0.001). There also was a significant difference between the groups in those who were symptoms free of their depression (PHQ-9 score < 5), with the CCM having 59.4% of the patients symptom-free compared to 10.9% of the UC group (P < 0.001). In this group of patients, CCM is associated with markedly improved clinical outcomes for depression, however with a modest short-term increase in CPT costs. PMID:23804062

  9. PENGEMBANGAN PERANGKAT PEMBELAJARAN MENGGUNAKAN MODEL PEMBELAJARAN GUIDE INQUIRY BERBASIS “QAIT” PADA MATA KULIAH STRUKTUR ALJABAR I MATERI GRUPOIDA

    OpenAIRE

    Lusiana, Restu; Andari, Tri

    2015-01-01

    The aims of this research is to create a good learning tools of Algebra Stucture towards “QAIT”based Guide Inquiry. Algebra Stucture as basic subject in mathematics. This conditions is essensials for students to comprehend the materials. The using of “QAIT” based Learning Model Guide Inquiry is one of the ways to incrase motivation student on learning. “QAIT” based Learning Model Guide Inquiry will increase the active learning of the students. This developmental research was applying Thiagara...

  10. Controlled trial of a collaborative primary care team model for patients with diabetes and depression: Rationale and design for a comprehensive evaluation

    Directory of Open Access Journals (Sweden)

    Johnson Jeffrey A

    2012-08-01

    Full Text Available Abstract Background When depression accompanies diabetes, it complicates treatment, portends worse outcomes and increases health care costs. A collaborative care case-management model, previously tested in an urban managed care organization in the US, achieved significant reduction of depressive symptoms, improved diabetes disease control and patient-reported outcomes, and saved money. While impressive, these findings need to be replicated and extended to other healthcare settings. Our objective is to comprehensively evaluate a collaborative care model for comorbid depression and type 2 diabetes within a Canadian primary care setting. Methods/design We initiated the TeamCare model in four Primary Care Networks in Northern Alberta. The intervention involves a nurse care manager guiding patient-centered care with family physicians and consultant physician specialists to monitor progress and develop tailored care plans. Patients eligible for the intervention will be identified using the Patient Health Questionnaire-9 as a screen for depressive symptoms. Care managers will then guide patients through three phases: 1 improving depressive symptoms, 2 improving blood glucose, blood pressure and cholesterol, and 3 improving lifestyle behaviors. We will employ the RE-AIM framework for a comprehensive and mixed-methods approach to our evaluation. Effectiveness will be assessed using a controlled “on-off” trial design, whereby eligible patients would be alternately enrolled in the TeamCare intervention or usual care on a monthly basis. All patients will be assessed at baseline, 6 and 12 months. Our primary analyses will be based on changes in two outcomes: depressive symptoms, and a multivariable, scaled marginal model for the combined outcome of global disease control (i.e., A1c, systolic blood pressure, LDL cholesterol. Our planned enrolment of 168 patients will provide greater than 80% power to observe clinically important improvements in all

  11. Transmission Line Jobs and Economic Development Impact (JEDI) Model User Reference Guide

    Energy Technology Data Exchange (ETDEWEB)

    Goldberg, M.; Keyser, D.

    2013-10-01

    The Jobs and Economic Development Impact (JEDI) models, developed through the National Renewable Energy Laboratory (NREL), are freely available, user-friendly tools that estimate the potential economic impacts of constructing and operating power generation projects for a range of conventional and renewable energy technologies. The Transmission Line JEDI model can be used to field questions about the economic impacts of transmission lines in a given state, region, or local community. This Transmission Line JEDI User Reference Guide was developed to provide basic instruction on operating the model and understanding the results. This guide also provides information on the model's underlying methodology, as well as the parameters and references used to develop the cost data contained in the model.

  12. Developing a Total Quality Management Model for Health Care Systems

    Directory of Open Access Journals (Sweden)

    AM Mosadegh Rad

    2005-10-01

    Full Text Available Background: Total quality management (TQM is a managerial practice to improve the effectiveness, efficiency, flexibility, and competitiveness of a business as a whole. However, in practice, these TQM benefits are not easy to achieve. Despite its theoretical promise and the enthusiastic response to TQM, recent evidence suggests that attempts to implement it are often unsuccessful. Many of these TQM programmes have been cancelled, or are in the process of being cancelled, as a result of the negative impact on profits. Therefore, there is a pressing need for a clinical approach to establishing TQM. Method: The aim of this article is therefore: “To identify the strengths and weakness of TQM, the logical steps towards TQM, and to develop a model so that health care organizations aiming at using TQM to achieve excellence can follow through easily”. Based on the research questions proposed in this study, the research strategies of a literature review, a questionnaire survey, semi-structured interviews, and a participatory action research were adopted in this study. For determining the success and barriers of TQM in health care organizations, a questionnaire survey has done in 90 health acre organizations in Isfahan Province, which implement TQM. The results of this survey were used for introducing a new model of TQM. This model will be developed via a semi-structured interview with at minimum 10 health care and quality managers. Then, through a participatory action research, this model will be implemented in 3 sites. At this time, the questionnaire survey has done and the model is introduced. Therefore, developing the model and its implementation will be done later. Results: In this survey, the mean score of TQM success was 3.48±0.68 (medium from 5 credits. Implementation of TQM was very low, low, medium, high and very high successful respectively in 3.6, 10.9, 21.8, 56.4 and 7.3 percent of health care organizations. TQM had the most effect on

  13. Modeling the transmission of curved neutron guides with non-perfect reflectivity

    Energy Technology Data Exchange (ETDEWEB)

    Mildner, D.F.R., E-mail: david.mildner@nist.gov [National Institute of Standards and Technology Center for Neutron Research, Gaithersburg, MD 20899 (United States)

    2011-11-11

    Analytic expressions for the transmission of a curved neutron guide including reflection losses are contrasted. The expressions are derived by considering the distribution of the number of reflections as a function of grazing angle at the outer surface. The results of different analytic expressions are compared with simulation results to find the model that best fits the simulations.

  14. Guided-Inquiry Experiments for Physical Chemistry: The POGIL-PCL Model

    Science.gov (United States)

    Hunnicutt, Sally S.; Grushow, Alexander; Whitnell, Robert

    2015-01-01

    The POGIL-PCL project implements the principles of process-oriented, guided-inquiry learning (POGIL) in order to improve student learning in the physical chemistry laboratory (PCL) course. The inquiry-based physical chemistry experiments being developed emphasize modeling of chemical phenomena. In each experiment, students work through at least…

  15. Family Day Care Check-In Program: After-School Care for Children Aged 10-14. [Introduction and Guide to Operation.

    Science.gov (United States)

    Osborne, Linda B., Ed.

    The Family Day Care Check-In Program is designed to offer working parents convenient, affordable after school care for their children aged 10 to 14. It provides children with flexible supervision by caring, trained adults and gives them opportunities to grow into responsible, independent teens by planning and participating in activities on their…

  16. [An Experience Promoting the Interdisciplinary Care Model for Dengue Fever].

    Science.gov (United States)

    Kuo, Wen-Fu; Ke, Ya-Ting

    2016-08-01

    Emergency departments represent the first line in facing major healthcare events. During major epidemic outbreaks, patients crowding into the emergency departments increase the wait time for patients and overload the staffs that are on duty. The dengue fever outbreak in southern Taiwan during the summer 2015 presented a huge management challenge for physicians and nurses in local hospitals. We responded to this challenge by integrating resources from different hospital departments. This strategy successfully increased group cohesiveness among the medical team, ensuring that they could not only ultimately cope with the outbreak together but also effectively provide patient-centered care. This interdisciplinary care model may serve as a reference for medical professionals for the management of future epidemics and similar events. PMID:27492305

  17. A rehabilitation model as key to comprehensive care in the era of HIV as a chronic disease in South Africa.

    Science.gov (United States)

    Chetty, Verusia; Hanass-Hancock, Jill

    2016-01-01

    In the era of widespread access to antiretroviral therapy, people living with HIV survive; however, this comes with new experiences of comorbidities and HIV-related disability posing new challenges to rehabilitation professionals and an already fragile health system in Southern Africa. Public health approaches to HIV need to include not only prevention, treatment and support but also rehabilitation. While some well-resourced countries have developed rehabilitation approaches for HIV, resource-poor settings of Southern Africa lack a model of care that includes rehabilitation approaches providing accessible and comprehensive care for people living with HIV. In this study, a learning in action approach was used to conceptualize a comprehensive model of care that addresses HIV-related disability and a feasible rehabilitation framework for resource-poor settings. The study used qualitative methods in the form of a focus group discussion with thirty participants including people living with HIV, the multidisciplinary healthcare team and community outreach partners at a semi-rural health facility in South Africa. The discussion focused on barriers and enablers of access to rehabilitation. Participants identified barriers at various levels, including transport, physical access, financial constraints and poor multi-stakeholder team interaction. The results of the group discussions informed the design of an inclusive model of HIV care. This model was further informed by established integrated rehabilitation models. Participants emphasized that objectives need to respond to policy, improve access to patient-centered care and maintain a multidisciplinary team approach. They proposed that guiding principles should include efficient communication, collaboration of all stakeholders and leadership in teams to enable staff to implement the model. Training of professional staff and lay personnel within task-shifting approaches was seen as an essential enabler to implementation. The

  18. Patient-specific Deformation Modelling via Elastography: Application to Image-guided Prostate Interventions.

    Science.gov (United States)

    Wang, Yi; Ni, Dong; Qin, Jing; Xu, Ming; Xie, Xiaoyan; Heng, Pheng-Ann

    2016-01-01

    Image-guided prostate interventions often require the registration of preoperative magnetic resonance (MR) images to real-time transrectal ultrasound (TRUS) images to provide high-quality guidance. One of the main challenges for registering MR images to TRUS images is how to estimate the TRUS-probe-induced prostate deformation that occurs during TRUS imaging. The combined statistical and biomechanical modeling approach shows promise for the adequate estimation of prostate deformation. However, the right setting of the biomechanical parameters is very crucial for realistic deformation modeling. We propose a patient-specific deformation model equipped with personalized biomechanical parameters obtained from shear wave elastography to reliably predict the prostate deformation during image-guided interventions. Using data acquired from a prostate phantom and twelve patients with suspected prostate cancer, we compared the prostate deformation model with and without patient-specific biomechanical parameters in terms of deformation estimation accuracy. The results show that the patient-specific deformation model possesses favorable model ability, and outperforms the model without patient-specific biomechanical parameters. The employment of the patient-specific biomechanical parameters obtained from elastography for deformation modeling shows promise for providing more precise deformation estimation in applications that use computer-assisted image-guided intervention systems. PMID:27272239

  19. Toolkit for Conceptual Modeling (TCM): User's Guide and Reference

    NARCIS (Netherlands)

    Dehne, F.; Wieringa, R.J.

    1997-01-01

    The Toolkit for Conceptual Modeling (TCM) is a suite of graphical editors for a number of graphical notation systems that are used in software specification methods. The notations can be used to represent the conceptual structure of the software - hence the name of the suite. This manual describes

  20. Guiding and Modelling Quality Improvement in Higher Education Institutions

    Science.gov (United States)

    Little, Daniel

    2015-01-01

    The article considers the process of creating quality improvement in higher education institutions from the point of view of current organisational theory and social-science modelling techniques. The author considers the higher education institution as a functioning complex of rules, norms and other organisational features and reviews the social…

  1. Acting Locally: A Guide to Model, Community and Demonstration Forests.

    Science.gov (United States)

    Keen, Debbie Pella

    1993-01-01

    Describes Canada's efforts in sustainable forestry, which refers to management practices that ensure long-term health of forest ecosystems so that they can continue to provide environmental, social, and economic benefits. Describes model forests, community forests, and demonstration forests and lists contacts for each of the projects. (KS)

  2. Do telemonitoring projects of heart failure fit the Chronic Care Model?

    OpenAIRE

    Willemse, Evi; Adriaenssens, Jef; Dilles, Tinne; Remmen, Roy

    2014-01-01

    This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner.Background: The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation.Methods: This...

  3. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program

    OpenAIRE

    RAMOS-GOMEZ, FRANCISCO J.

    2014-01-01

    The Affordable Care Act (ACA) mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP) in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0–5 and their ca...

  4. Modeling low order aberrations in laser guide star adaptive optics systems

    OpenAIRE

    Clare, Richard M.; Van Dam, Marcos A.; Bouchez, Antonin H.

    2007-01-01

    When using a laser guide star (LGS) adaptive optics (AO) system, quasi-static aberrations are observed between the measured wavefronts from the LGS wavefront sensor (WFS) and the natural guide star (NGS) WFS. These LGS aberrations, which can be as much as 1200 nm RMS on the Keck II LGS AO system, arise due to the finite height and structure of the sodium layer. The LGS aberrations vary significantly between nights due to the difference in sodium structure. In this paper, we successfully model...

  5. A framework to support team-based models of primary care within the Australian health care system.

    Science.gov (United States)

    Naccarella, Lucio; Greenstock, Louise N; Brooks, Peter M

    2013-09-01

    Health systems with strong primary care orientations are known to be associated with improved equity, better access for patients to appropriate services at lower costs, and improved population health. Team-based models of primary care have emerged in response to health system challenges due to complex patient profiles, patient expectations and health system demands. Successful team-based models of primary care require a combination of interprofessional education and learning; organisational and management policies and systems; and practice support systems. To ensure evidence is put into practice, we propose a framework comprising five domains (theory, implementation, infrastructure, sustainability and evaluation) to assist policymakers, educators, researchers, managers and health professionals in supporting team-based models of primary care within the Australian health care system. PMID:25370088

  6. A framework to support team-based models of primary care within the Australian health care system.

    Science.gov (United States)

    Naccarella, Lucio; Greenstock, Louise N; Brooks, Peter M

    2013-09-01

    Health systems with strong primary care orientations are known to be associated with improved equity, better access for patients to appropriate services at lower costs, and improved population health. Team-based models of primary care have emerged in response to health system challenges due to complex patient profiles, patient expectations and health system demands. Successful team-based models of primary care require a combination of interprofessional education and learning; organisational and management policies and systems; and practice support systems. To ensure evidence is put into practice, we propose a framework comprising five domains (theory, implementation, infrastructure, sustainability and evaluation) to assist policymakers, educators, researchers, managers and health professionals in supporting team-based models of primary care within the Australian health care system.

  7. National Foster Care and Adoption Directory Search

    Science.gov (United States)

    ... Directory National Foster Care & Adoption Directory App State Guides & Manuals State Related Organizations Lists Adoption Assistance by State Child Welfare Workload Compendium More Tools & Resources Logic Model Builders Related Organizations Learning Center ...

  8. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is

  9. A dynamic model of how feature cues guide spatial attention

    OpenAIRE

    Hamker, Fred H.

    2004-01-01

    We will describe a computational model of attention which explains the guidance of spatial attention by feedback within a distributed network. We hypothesize that feedback within the ventral pathway transfers the target template from prefrontal areas into intermediate areas like V4. The oculomotor circuit consisting of FEF, LIP and superior colliculus picks up this distributed activity and provides a continuous spatial reentry signal from premotor cells. In order to test this hypothesis, we s...

  10. A Constraint Guided Progressive Sequential Mining Waterfall Model for CRM

    OpenAIRE

    Mallick, Bhawna; Garg, Deepak; Grover, P. S.

    2014-01-01

    CRM has been realized as a core for the growth of any enterprise. This requires both the customer satisfaction and fulfillment of customer requirement, which can only be achieved by analyzing consumer behaviors. The data mining has become an effective tool since often the organizations have large databases of information on customers. However, the traditional data mining techniques have no relevant mechanism to provide guidance for business understanding, model selection and dynamic changes m...

  11. Modelling the shape hierarchy for visually guided grasping

    Directory of Open Access Journals (Sweden)

    Omid eRezai

    2014-10-01

    Full Text Available The monkey anterior intraparietal area (AIP encodes visual information about three-dimensional object shape that is used to shape the hand for grasping. We modelled shape tuning in visual AIP neurons and its relationship with curvature and gradient information from the caudal intraparietal area (CIP. The main goal was to gain insight into the kinds of shape parameterizations that can account for AIP tuning and that are consistent with both the inputs to AIP and the role of AIP in grasping. We first experimented with superquadric shape parameters. We considered superquadrics because they occupy a role in robotics that is similar to AIP, in that superquadric fits are derived from visual input and used for grasp planning. We also experimented with an alternative shape parameterization that was based on an Isomap dimension reduction of spatial derivatives of depth (i.e. distance from the observer to the object surface. We considered an Isomap-based model because its parameters lacked discontinuities between similar shapes. When we matched the dimension of the Isomap to the number of superquadric parameters, the superquadric model fit the AIP data somewhat more closely. However, higher-dimensional Isomaps provided excellent fits. Also, we found that the Isomap parameters could be approximated much more accurately than superquadric parameters by feedforward neural networks with CIP-like inputs. We conclude that Isomaps, or perhaps alternative dimension reductions of visual inputs to AIP, provide a promising model of AIP electrophysiology data. However (in contrast with superquadrics further work is needed to test whether such shape parameterizations actually provide an effective basis for grasp control.

  12. Care plans and care planning in long term conditions: a conceptual model

    OpenAIRE

    Burt, J.; J. Rick; Blakeman, T; Protheroe, J; Roland, M; Bower, P.

    2013-01-01

    The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planni...

  13. Shape coexistence in the microscopically guided interacting boson model

    CERN Document Server

    Nomura, K; Van Isacker, P

    2015-01-01

    Shape coexistence has been a subject of great interest in nuclear physics for many decades. In the context of the nuclear shell model, intruder excitations may give rise to remarkably low-lying excited $0^+$ states associated with different intrinsic shapes. In heavy open-shell nuclei, the dimension of the shell-model configuration space that includes such intruder excitations becomes exceedingly large, thus requiring a drastic truncation scheme. Such a framework has been provided by the interacting boson model (IBM). In this article we address the phenomenon of shape coexistence and its relevant spectroscopy from the point of view of the IBM. A special focus is placed on the method developed recently which makes use of the link between the IBM and the self-consistent mean-field approach based on the nuclear energy density functional. The method is extended to deal with various intruder configurations associated with different equilibrium shapes. We assess the predictive power of the method and suggest possib...

  14. Cross-link guided molecular modeling with ROSETTA.

    Directory of Open Access Journals (Sweden)

    Abdullah Kahraman

    Full Text Available Chemical cross-links identified by mass spectrometry generate distance restraints that reveal low-resolution structural information on proteins and protein complexes. The technology to reliably generate such data has become mature and robust enough to shift the focus to the question of how these distance restraints can be best integrated into molecular modeling calculations. Here, we introduce three workflows for incorporating distance restraints generated by chemical cross-linking and mass spectrometry into ROSETTA protocols for comparative and de novo modeling and protein-protein docking. We demonstrate that the cross-link validation and visualization software Xwalk facilitates successful cross-link data integration. Besides the protocols we introduce XLdb, a database of chemical cross-links from 14 different publications with 506 intra-protein and 62 inter-protein cross-links, where each cross-link can be mapped on an experimental structure from the Protein Data Bank. Finally, we demonstrate on a protein-protein docking reference data set the impact of virtual cross-links on protein docking calculations and show that an inter-protein cross-link can reduce on average the RMSD of a docking prediction by 5.0 Å. The methods and results presented here provide guidelines for the effective integration of chemical cross-link data in molecular modeling calculations and should advance the structural analysis of particularly large and transient protein complexes via hybrid structural biology methods.

  15. The capillary hysteresis model HYSTR: User`s guide

    Energy Technology Data Exchange (ETDEWEB)

    Niemi, A.; Bodvarsson, G.S.

    1991-11-01

    The potential disposal of nuclear waste in the unsaturated zone at Yucca Mountain, Nevada, has generated increased interest in the study of fluid flow through unsaturated media. In the near future, large-scale field tests will be conducted at the Yucca Mountain site, and work is now being done to design and analyze these tests. As part of these efforts a capillary hysteresis model has been developed. A computer program to calculate the hysteretic relationship between capillary pressure {phi} and liquid saturation (S{sub 1}) has been written that is designed to be easily incorporated into any numerical unsaturated flow simulator that computes capillary pressure as a function of liquid saturation. This report gives a detailed description of the model along with information on how it can be interfaced with a transport code. Although the model was developed specifically for calculations related to nuclear waste disposal, it should be applicable to any capillary hysteresis problem for which the secondary and higher order scanning curves can be approximated from the first order scanning curves. HYSTR is a set of subroutines to calculate capillary pressure for a given liquid saturation under hysteretic conditions.

  16. Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury

    NARCIS (Netherlands)

    Bloemen-Vrencken, J.H.A.; De Witte, L.P.; Engels, J.P.G.M.; Van den Heuvel, W.J.A.; Post, M.W.M.

    2005-01-01

    Purposes: The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purp

  17. Characteristics of evolving models of care for arthritis: A key informant study

    Directory of Open Access Journals (Sweden)

    Veinot Paula

    2008-07-01

    Full Text Available Abstract Background The burden of arthritis is increasing in the face of diminishing health human resources to deliver care. In response, innovative models of care delivery are developing to facilitate access to quality care. Most models have developed in response to local needs with limited evaluation. The primary objective of this study is to a examine the range of models of care that deliver specialist services using a medical/surgical specialist and at least one other health care provider and b document the strengths and challenges of the identified models. A secondary objective is to identify key elements of best practice models of care for arthritis. Methods Semi-structured interviews were conducted with a sample of key informants with expertise in arthritis from jurisdictions with primarily publicly-funded health care systems. Qualitative data were analyzed using a constant comparative approach to identify common types of models of care, strengths and challenges of models, and key components of arthritis care. Results Seventy-four key informants were interviewed from six countries. Five main types of models of care emerged. 1 Specialized arthritis programs deliver comprehensive, multidisciplinary team care for arthritis. Two models were identified using health care providers (e.g. nurses or physiotherapists in expanded clinical roles: 2 triage of patients with musculoskeletal conditions to the appropriate services including specialists; and 3 ongoing management in collaboration with a specialist. Two models promoting rural access were 4 rural consultation support and 5 telemedicine. Key informants described important components of models of care including knowledgeable health professionals and patients. Conclusion A range of models of care for arthritis have been developed. This classification can be used as a framework for discussing care delivery. Areas for development include integration of care across the continuum, including primary

  18. Brief introductory guide to agent-based modeling and an illustration from urban health research.

    Science.gov (United States)

    Auchincloss, Amy H; Garcia, Leandro Martin Totaro

    2015-11-01

    There is growing interest among urban health researchers in addressing complex problems using conceptual and computation models from the field of complex systems. Agent-based modeling (ABM) is one computational modeling tool that has received a lot of interest. However, many researchers remain unfamiliar with developing and carrying out an ABM, hindering the understanding and application of it. This paper first presents a brief introductory guide to carrying out a simple agent-based model. Then, the method is illustrated by discussing a previously developed agent-based model, which explored inequalities in diet in the context of urban residential segregation. PMID:26648364

  19. Brief introductory guide to agent-based modeling and an illustration from urban health research

    Directory of Open Access Journals (Sweden)

    Amy H. Auchincloss

    2015-11-01

    Full Text Available Abstract There is growing interest among urban health researchers in addressing complex problems using conceptual and computation models from the field of complex systems. Agent-based modeling (ABM is one computational modeling tool that has received a lot of interest. However, many researchers remain unfamiliar with developing and carrying out an ABM, hindering the understanding and application of it. This paper first presents a brief introductory guide to carrying out a simple agent-based model. Then, the method is illustrated by discussing a previously developed agent-based model, which explored inequalities in diet in the context of urban residential segregation.

  20. Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition)

    OpenAIRE

    Muntinga Maaike E; Hoogendijk Emiel O; van Leeuwen Karen M; van Hout Hein PJ; Twisk Jos WR; van der Horst Henriette E; Nijpels Giel; Jansen Aaltje PD

    2012-01-01

    Abstract Background Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling...

  1. Challenges of Change: A Qualitative Study of Chronic Care Model Implementation

    OpenAIRE

    Hroscikoski, Mary C.; Solberg, Leif I.; Sperl-Hillen, JoAnn M.; Harper, Peter G.; McGrail, Michael P.; Crabtree, Benjamin F.

    2006-01-01

    PURPOSE The Chronic Care Model (CCM) provides a conceptual framework for transforming health care for patients with chronic conditions; however, little is known about how to best design and implement its specifics. One large health care organization that tried to implement the CCM in primary care provided an opportunity to study these issues.

  2. Efficiency of a Care Coordination Model: A Randomized Study with Stroke Patients

    Science.gov (United States)

    Claiborne, Nancy

    2006-01-01

    Objectives: This study investigated the efficiency of a social work care coordination model for stroke patients. Care coordination addresses patient care and treatment resources across the health care system to reduce risk, improve clinical outcomes, and maximize efficiency. Method: A randomly assigned, pre-post experimental design measured…

  3. Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life

    OpenAIRE

    Christine Ritchie; Robin Andersen; Jessica Eng; Garrigues, Sarah K.; Gina Intinarelli; Helen Kao; Suzanne Kawahara; Kanan Patel; Lisa Sapiro; Anne Thibault; Erika Tunick; Barnes, Deborah E.

    2016-01-01

    Introduction The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers. Aims To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center. Setting 152 high-risk patients (≥5 ED visits or ≥2 hosp...

  4. Using the Unified Modelling Language (UML) to guide the systemic description of biological processes and systems.

    Science.gov (United States)

    Roux-Rouquié, Magali; Caritey, Nicolas; Gaubert, Laurent; Rosenthal-Sabroux, Camille

    2004-07-01

    One of the main issues in Systems Biology is to deal with semantic data integration. Previously, we examined the requirements for a reference conceptual model to guide semantic integration based on the systemic principles. In the present paper, we examine the usefulness of the Unified Modelling Language (UML) to describe and specify biological systems and processes. This makes unambiguous representations of biological systems, which would be suitable for translation into mathematical and computational formalisms, enabling analysis, simulation and prediction of these systems behaviours.

  5. Constructing Teaching Model for Training English Guides of Stone In-scription Relics

    Institute of Scientific and Technical Information of China (English)

    李慧

    2016-01-01

    A teaching model based on constructivism is proposed in this paper. The model contains five teaching steps, e.g. inter-pretation teaching, questioning-dialogue, knowledge and skills teaching, discussion-collaboration and field training. Practice proves that it can effectively improve the training efficiency of the training of English guides of stone inscription relics and en-hance their interpretation quality and English skills.

  6. Jobs and Economic Development Impact (JEDI) Model: Offshore Wind User Reference Guide

    Energy Technology Data Exchange (ETDEWEB)

    Lantz, E.; Goldberg, M.; Keyser, D.

    2013-06-01

    The Offshore Wind Jobs and Economic Development Impact (JEDI) model, developed by NREL and MRG & Associates, is a spreadsheet based input-output tool. JEDI is meant to be a user friendly and transparent tool to estimate potential economic impacts supported by the development and operation of offshore wind projects. This guide describes how to use the model as well as technical information such as methodology, limitations, and data sources.

  7. Top-down guided eye movements: peripheral model

    Science.gov (United States)

    Chernyak, Dimitri A.; Stark, Lawrence W.

    2001-06-01

    Eye movements are an important aspect of human visual behavior. The temporal and space-variant nature of sampling a visual scenes requires frequent attentional gaze shifts, saccades, to fixate onto different parts of an image. Fixations are often directed towards the most informative regions in the visual scene. We introduce a model and its simulation that can select such regions based on prior knowledge of similar scenes. Having representations of scene categories as probabilistic combination of hypothetical objects, i.e., prototypical regions with certain properties, it is possible to assess the likely contribution of each image region to the successive recognition process. The regions are obtained by segmenting low-resolution images using the normalized cut algorithm. Based on low-level features, such as average color, size, position, regions are clustered into a small set of hypothetical objects. Using conditions probabilities for each object given the scene category, the model can then predict the informative value of the corresponding region and initiate a sequential spatial information-gathering algorithm analogous to an eye movement saccade to a new fixation. The article demonstrates how the initial hypothesis determines the next region of interest to visit and how these scene hypotheses are affected by sequentially visiting each new image region.

  8. A model for 'reverse innovation' in health care.

    Science.gov (United States)

    Depasse, Jacqueline W; Lee, Patrick T

    2013-01-01

    'Reverse innovation,' a principle well established in the business world, describes the flow of ideas from emerging to more developed economies. There is strong and growing interest in applying this concept to health care, yet there is currently no framework for describing the stages of reverse innovation or identifying opportunities to accelerate the development process. This paper combines the business concept of reverse innovation with diffusion of innovation theory to propose a model for reverse innovation as a way to innovate in health care. Our model includes the following steps: (1) identifying a problem common to lower- and higher-income countries; (2) innovation and spread in the low-income country (LIC); (3) crossover to the higher-income country (HIC); and (4) innovation and spread in the HIC. The crucial populations in this pathway, drawing from diffusion of innovation theory, are LIC innovators, LIC early adopters, and HIC innovators. We illustrate the model with three examples of current reverse innovations. We then propose four sets of specific actions that forward-looking policymakers, entrepreneurs, health system leaders, and researchers may take to accelerate the movement of promising solutions through the reverse innovation pipeline: (1) identify high-priority problems shared by HICs and LICs; (2) create slack for change, especially for LIC innovators, LIC early adopters, and HIC innovators; (3) create spannable social distances between LIC early adopters and HIC innovators; and (4) measure reverse innovation activity globally. PMID:24001367

  9. A model for 'reverse innovation' in health care.

    Science.gov (United States)

    Depasse, Jacqueline W; Lee, Patrick T

    2013-08-30

    'Reverse innovation,' a principle well established in the business world, describes the flow of ideas from emerging to more developed economies. There is strong and growing interest in applying this concept to health care, yet there is currently no framework for describing the stages of reverse innovation or identifying opportunities to accelerate the development process. This paper combines the business concept of reverse innovation with diffusion of innovation theory to propose a model for reverse innovation as a way to innovate in health care. Our model includes the following steps: (1) identifying a problem common to lower- and higher-income countries; (2) innovation and spread in the low-income country (LIC); (3) crossover to the higher-income country (HIC); and (4) innovation and spread in the HIC. The crucial populations in this pathway, drawing from diffusion of innovation theory, are LIC innovators, LIC early adopters, and HIC innovators. We illustrate the model with three examples of current reverse innovations. We then propose four sets of specific actions that forward-looking policymakers, entrepreneurs, health system leaders, and researchers may take to accelerate the movement of promising solutions through the reverse innovation pipeline: (1) identify high-priority problems shared by HICs and LICs; (2) create slack for change, especially for LIC innovators, LIC early adopters, and HIC innovators; (3) create spannable social distances between LIC early adopters and HIC innovators; and (4) measure reverse innovation activity globally.

  10. GCFM Users Guide Revision for Model Version 5.0

    Energy Technology Data Exchange (ETDEWEB)

    Keimig, Mark A.; Blake, Coleman

    1981-08-10

    This paper documents alterations made to the MITRE/DOE Geothermal Cash Flow Model (GCFM) in the period of September 1980 through September 1981. Version 4.0 of GCFM was installed on the computer at the DOE San Francisco Operations Office in August 1980. This Version has also been distributed to about a dozen geothermal industry firms, for examination and potential use. During late 1980 and 1981, a few errors detected in the Version 4.0 code were corrected, resulting in Version 4.1. If you are currently using GCFM Version 4.0, it is suggested that you make the changes to your code that are described in Section 2.0. User's manual changes listed in Section 3.0 and Section 4.0 should then also be made.

  11. Molecular modelling guided experimental study for isotopic enrichment of Gadolinium

    International Nuclear Information System (INIS)

    Molecular modelling and experimental studies were performed to predict the feasibility of Gd isotope separation using crown ether grafted resin. BP and B3LYP functional - based DFT calculations foretell the complexation stability order of Gd3+ ion as DCH18C6>B15C5>DB18C6 as observed in the experiment. The calculated isotopic separation factor shows that DB18C6 is the promising candidate. Hence, CMPS grafted DB18C6 resin was chosen for the isotope separation of Gd. The adsorption capacity of the resin for Gd3+ ion was found to be 1mg/g. The separation coefficients (ε ×103) were found to be 6.3, 3.4, 9.7 and 11.1 for the isotopic pair of 155/158, 157/158, 155/160 and 157/160 respectively and shows promise for future study. (author)

  12. Diffusion of a collaborative care model in primary care: a longitudinal qualitative study

    Directory of Open Access Journals (Sweden)

    Vedel Isabelle

    2013-01-01

    Full Text Available Background Although collaborative team models (CTM improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs. The objectives of this study are to understand: (1 how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2 the model's diffusion process. Methods We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 PCPs and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics. Results Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM's diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM's compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices. Opinion leaders played a key role in the diffusion of the CTM among PCPs. Conclusion CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians.

  13. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  14. The Norrtaelje model: a unique model for integrated health and social care in Sweden

    Directory of Open Access Journals (Sweden)

    Monica Andersson Bäck

    2015-09-01

    Full Text Available Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This “top-down” approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system.

  15. The Norrtaelje model: a unique model for integrated health and social care in Sweden.

    Science.gov (United States)

    Bäck, Monica Andersson; Calltorp, Johan

    2015-01-01

    Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This "top-down" approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system. PMID:26528093

  16. A systematic review of contemporary models of shared HIV care and HIV in primary care in high-income settings.

    Science.gov (United States)

    Mapp, Fiona; Hutchinson, Jane; Estcourt, Claudia

    2015-12-01

    HIV shared care is uncommon in the UK although shared care could be a beneficial model of care. We review the literature on HIV shared care to determine current practice and clinical, economic and patient satisfaction outcomes. We searched MEDLINE, EMBASE, NICE Evidence, Cochrane collaboration, Google and websites of the British HIV Association, Aidsmap, Public Health England, World Health Organization and Terrence Higgins Trust using relevant search terms in August 2014. Studies published after 2000, from healthcare settings comparable to the UK that described links between primary care and specialised HIV services were included and compared using principles of the Critical Appraisal Skills Programme and Authority, Accuracy, Coverage, Objectivity, Date, Significance frameworks. Three of the nine included models reported clinical or patient satisfaction outcomes but data collection and analyses were inadequate. None reported economic outcomes although some provided financial costings. Facilitators of shared care included robust clinical protocols, training and timely communication. Few published examples of HIV shared care exist and quality of evidence is poor. There is no consistent association with improved clinical outcomes, cost effectiveness or acceptability. Models are context specific, driven by local need, although some generalisable features could inform novel service delivery. Further evaluative research is needed to determine optimal components of shared HIV care. PMID:25804421

  17. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Jensen, Jens Ulrik Stæhr; Jørgensen, Karsten Juhl;

    2014-01-01

    of the observed heterogeneity.There was no difference between using a C-reactive protein point-of-care test and standard care in clinical recovery (defined as at least substantial improvement at day 7 and 28 or need for re-consultations day 28). However, we noted an increase in hospitalisations in the C......BACKGROUND: Acute respiratory infections (ARIs) are by far the most common reason for prescribing an antibiotic in primary care, even though the majority of ARIs are of viral or non-severe bacterial aetiology. Unnecessary antibiotic use will, in many cases, not be beneficial to the patients...... and renders patients at risk of future ineffective treatments, in turn increasing morbidity and mortality from infectious diseases. One strategy aiming to reduce antibiotic use in primary care is the guidance of antibiotic treatment by use of a point-of-care biomarker. A point-of-care biomarker of infection...

  18. Short guide to direct gravitational field modelling with Hotine's equations

    Science.gov (United States)

    Sebera, Josef; Wagner, Carl A.; Bezděk, Aleš; Klokočník, Jaroslav

    2013-03-01

    This paper presents a unified approach to the least squares spherical harmonic analysis of the acceleration vector and Eötvös tensor (gravitational gradients) in an arbitrary orientation. The Jacobian matrices are based on Hotine's equations that hold in the Earth-fixed Cartesian frame and do not need any derivatives of the associated Legendre functions. The implementation was confirmed through closed-loop tests in which the simulated input is inverted in the least square sense using the rotated Hotine's equations. The precision achieved is at the level of rounding error with RMS about 10^{-12}{-}10^{-14} m in terms of the height anomaly. The second validation of the linear model is done with help from the standard ellipsoidal correction for the gravity disturbance that can be computed with an analytic expression as well as with the rotated equations. Although the analytic expression for this correction is only of a limited accuracy at the submillimeter level, it was used for an independent validation. Finally, the equivalent of the ellipsoidal correction, called the effect of the normal, has been numerically obtained also for other gravitational functionals and some of their combinations. Most of the numerical investigations are provided up to spherical harmonic degree 70, with degree 80 for the computation time comparison using real GRACE data. The relevant Matlab source codes for the design matrices are provided.

  19. An ecological model of workplace bullying: a guide for intervention and research.

    Science.gov (United States)

    Johnson, Susan L

    2011-01-01

    The origins and outcomes of workplace bullying can be understood through the use of a conceptual model which is based on the ecological perspective. This model portrays the work environment as a series of nested, interconnected layers that exist within society as a whole. These layers are society (macrosystem), the corporation (exosystem), the co-workers and managers of the bully and target (mesosystem), and the bully and target (microsystem). Workplace bullying does not occur in isolation. Elements at each of these levels serve as antecedents to bullying, and the outcomes of bullying are manifested at each of these levels. These antecedents and outcomes need to be considered when developing interventions that target workplace bullying. The model can be used as a theoretical framework to guide intervention planning and evaluation, and can also be used to guide the formulation of questions for empirical research. PMID:21517878

  20. Methods to construct a step-by-step beginner’s guide to decision analytic cost-effectiveness modeling

    Directory of Open Access Journals (Sweden)

    Rautenberg T

    2016-10-01

    Full Text Available Tamlyn Rautenberg,1 Claire Hulme,2 Richard Edlin,3 1Health Economics and HIV/AIDS Research Division (HEARD, University of Kwazulu Natal, KwaZulu Natal, South Africa; 2Leeds Institute of Health Sciences (LIHS, Academic Unit of Health Economics (AUHE, University of Leeds, West Yorkshire, United Kingdom; 3Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand Background: Although guidance on good research practice in health economic modeling is widely available, there is still a need for a simpler instructive resource which could guide a beginner modeler alongside modeling for the first time. Aim: To develop a beginner’s guide to be used as a handheld guide contemporaneous to the model development process. Methods: A systematic review of best practice guidelines was used to construct a framework of steps undertaken during the model development process. Focused methods review supplemented this framework. Consensus was obtained among a group of model developers to review and finalize the content of the preliminary beginner’s guide. The final beginner’s guide was used to develop cost-effectiveness models. Results: Thirty-two best practice guidelines were data extracted, synthesized, and critically evaluated to identify steps for model development, which formed a framework for the beginner’s guide. Within five phases of model development, eight broad submethods were identified and 19 methodological reviews were conducted to develop the content of the draft beginner’s guide. Two rounds of consensus agreement were undertaken to reach agreement on the final beginner’s guide. To assess fitness for purpose (ease of use and completeness, models were developed independently and by the researcher using the beginner’s guide. Conclusion: A combination of systematic review, methods reviews, consensus agreement, and validation was used to construct a step-by-step beginner’s guide for developing decision analytical

  1. Modelling catchment areas for secondary care providers: a case study.

    Science.gov (United States)

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

    2011-09-01

    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

  2. Victoria BGY palliative care model--a new model for the 1990s.

    Science.gov (United States)

    Downing, G M; Braithwaite, D L; Wilde, J M

    1993-01-01

    If, as palliative care practitioners, we ensure that distressing symptoms such as pain, vomiting, dyspnea, confusion, and pre-death restlessness are fully controlled (note "fully"), then most people are deeply appreciative and continue to live until they die, confident that whatever happens, their worth, desires, and comfort are secure. Credibility (Latin, fides dignus) is remaining true and reliable to what was agreed. Patients registering with palliative care generally desire comfort, which can only occur when palliative care physicians and programs are capable and willing to apply all three types of palliation discussed here--the BGY model. PMID:7510798

  3. On the choice of calibration periods and objective functions: A practical guide to model parameter identification

    Science.gov (United States)

    Romanowicz, Renata; Osuch, Marzena; Grabowiecka, Magdalena

    2013-12-01

    Despite the development of new measuring techniques, monitoring systems and advances in computer technology, rainfall-flow modelling is still a challenge. The reasons are multiple and fairly well known. They include the distributed, heterogeneous nature of the environmental variables affecting flow from the catchment. These are precipitation, evapotranspiration and in some seasons and catchments in Poland, snow melt also. This paper presents a review of work done on the calibration and validation of rainfall-runoff modelling, with a focus on the conceptual HBV model. We give a synthesis of the problems and propose a practical guide to the calibration and validation of rainfall-runoff models.

  4. A beginner's guide to writing the nursing conceptual model-based theoretical rationale.

    Science.gov (United States)

    Gigliotti, Eileen; Manister, Nancy N

    2012-10-01

    Writing the theoretical rationale for a study can be a daunting prospect for novice researchers. Nursing's conceptual models provide excellent frameworks for placement of study variables, but moving from the very abstract concepts of the nursing model to the less abstract concepts of the study variables is difficult. Similar to the five-paragraph essay used by writing teachers to assist beginning writers to construct a logical thesis, the authors of this column present guidelines that beginners can follow to construct their theoretical rationale. This guide can be used with any nursing conceptual model but Neuman's model was chosen here as the exemplar.

  5. Reciprocal learning and chronic care model implementation in primary care: results from a new scale of learning in primary care

    OpenAIRE

    Noël Polly H; Jordan Michelle; McDaniel Reuben R; Lanham Holly; Palmer Ray; Leykum Luci K; Parchman Michael

    2011-01-01

    Abstract Background Efforts to improve the care of patients with chronic disease in primary care settings have been mixed. Application of a complex adaptive systems framework suggests that this may be because implementation efforts often focus on education or decision support of individual providers, and not on the dynamic system as a whole. We believe that learning among clinic group members is a particularly important attribute of a primary care clinic that has not yet been well-studied in ...

  6. Monks' Health: Holistic Health Care Model by Community Participation

    Directory of Open Access Journals (Sweden)

    Decha Buates

    2010-01-01

    Full Text Available Problem statement: Monks’ health tended to be a continuous increased problem. They were groups who had limitations to access health services due to their monastic disciplines and their most importance for Buddhist institution. Without urgent solution, their normal way of life would have been affected. Approach: This research aimed to study current conditions and to develop monks’ holistic health care models by community participation in central region of Thailand. The study was a qualitative research conducted in 9 temples; 3 temples in urban area, 3 in semi-urban area and 3 in rural area. Samples were 224 persons; consisted of monks, public health officers from Department of Religious Affairs, local administrative organizations and people; selected by purposive sampling method. Observation form, survey form, interview form, focus group discussion and workshop were used as research tools while data was analyzed by descriptive research. Results: The result founded that in former time culture of monks’ health care was leaned on community, social, culture and tradition. People spoke in style of central Thai language and were in agricultural sector as well as had their belief in merit, sin and elder respect. Relation in communities was in form of generosity and living as similar as relatives. When some monk got sick, they would visit, take care and give foods and medicines. Most of medicines were household remedy and Thai herbal medicine that bought from drug stores in local market or grocery stores in village and monks were sent to hospital in case of severe illness. Temple was a part of community, so they had close relation. Nowadays people increasingly worked in manufactories that caused conflicts and alienations among them. Monks leaned on local markets for receiving foods offering and most of foods were cooked from flour, sugar, coconut milk and fat. These caused three-fourth of monks having chronic disease as diabetes

  7. The utility of the model for end-stage liver disease score: a reliable guide for liver transplant candidacy and, for select patients, simultaneous hospice referral.

    Science.gov (United States)

    Medici, Valentina; Rossaro, Lorenzo; Wegelin, Jacob A; Kamboj, Amit; Nakai, Junko; Fisher, Kelli; Meyers, Frederick J

    2008-08-01

    Patients with chronic liver disease are referred late to hospice or never referred. There are several barriers to timely referral. First, liver transplantation (LT) and hospice care have always been perceived as mutually exclusive. Yet the criteria for hospice referral and for LT are more similar than different (for example, advanced liver disease and imminent death). Second, physicians, patients, and families have not had a reliable metric to guide referral. However, many patients wait for transplantation but never receive an organ. We hypothesized that the Model for End-Stage Liver Disease (MELD) score already in use to prioritize LT could be used in selected patients for concurrent hospice referral. Furthermore, we hypothesized that patients awaiting LT can receive hospice care and remain eligible for transplantation. Patients with advanced or end-stage liver disease were referred to the University of California Davis Health System hospice program. We correlated the MELD score at admission to length of stay (LOS) in hospice. A total of 157 end-stage liver disease patients were admitted to the hospice service. At the time of hospice admission the mean MELD score was 21 (range, 6-45). The mean length of hospice stay was 38 days (range, 1-329 days). A significant correlation was observed between hospice LOS and MELD score at hospice admission (P < 0.01). Six patients were offered a liver graft while on the combined (LT and hospice) program. MELD can be used to guide clinician recommendation to families about hospice care, achieving one of the national benchmark goals of increasing hospice care duration beyond the current median of 2-3 weeks. A higher MELD score might augment physician judgment as to hospice referral. Hospice care for selected patients may be an effective strategy to improve the care of end-stage liver disease patients waiting for LT. PMID:18668666

  8. The implementation of integrated care: The empirical validation of the development model for integrated care

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella); R.P. Vermeulen (Robert); C.T.B. Ahaus (Kees); R. Huijsman (Robbert)

    2011-01-01

    textabstractBackground: Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be

  9. The implementation of integrated care : The empirical validation of the development model for integrated care

    NARCIS (Netherlands)

    Minkman, M.M.N.; Vermeulen, Robbert; Ahaus, C.T.B.; Huijsman, R.

    2011-01-01

    Background: Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented

  10. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Sophie L W Spoorenberg

    Full Text Available Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs.Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach.Responses of participants concerned two focus areas: 1 Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2 Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system.The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

  11. Cost analysis of prenatal care using the activity-based costing model: a pilot study.

    Science.gov (United States)

    Gesse, T; Golembeski, S; Potter, J

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.

  12. Cost Analysis of Prenatal Care Using the Activity-Based Costing Model: A Pilot Study

    OpenAIRE

    Gesse, Theresa; Golembeski, Susan; Potter, Jonell

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.

  13. Do new and traditional models of primary care differ with regard to access?

    Science.gov (United States)

    Miedema, Baukje; Easley, Julie; Thompson, Ashley E.; Boivin, Antoine; Aubrey-Bassler, Kris; Katz, Alan; Hogg, William E.; Breton, Mylaine; Francoeur, Danièle; Wong, Sabrina T.; Wodchis, Walter P.

    2016-01-01

    Abstract Objective To examine access to primary care in new and traditional models using 2 dimensions of the concept of patient-centred access. Design An international survey examining the quality and costs of primary health care (the QUALICOPC study) was conducted in 2013 in Canada. This study adopted a descriptive cross-sectional survey method using data from practices across Canada. Each participating practice filled out the Family Physician Survey and the Practice Survey, and patients in each participating practice were asked to complete the Patient Experiences Survey. Setting All 10 Canadian provinces. Participants A total of 759 practices and 7172 patients. Main outcome measures Independent t tests were conducted to examine differences between new and traditional models of care in terms of availability and accommodation, and affordability of care. Results Of the 759 practices, 407 were identified as having new models of care and 352 were identified as traditional. New models of care were distinct with respect to payment structure, opening hours, and having an interdisciplinary work force. Most participating practices were from large cities or suburban areas. There were few differences between new and traditional models of care regarding accessibility and accommodation in primary care. Patients under new models of care reported easier access to other physicians in the same practice, while patients from traditional models reported seeing their regular family physicians more frequently. There was no difference between the new and traditional models of care with regard to affordability of primary care. Patients attending clinics with new models of care reported that their physicians were more involved with them as a whole person than patients attending clinics based on traditional models did. Conclusion Primary care access issues do not differ strongly between traditional and new models of care; however, patients in the new models of care believed that their

  14. Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians

    OpenAIRE

    Sanjeev Bhoi; Tej P Sinha; Mahaveer Rodha; Amit Bhasin; Radhakrishna Ramchandani; Sagar Galwankar

    2012-01-01

    Background: Patients require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US) guided peripheral nerve block is a safe alternative. Aim: Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED). Setting and Design: Prospective observational study conducted in ED. Materials and Methods: Patients above five years requiring analgesia for management of limb emergencies were ...

  15. A Web-Based Model for Diabetes Education and Decision Support for the Home Care Nurse

    OpenAIRE

    Hill, Michelle; Kirby, Judy

    1998-01-01

    Diabetes education for the home care population requires expert knowledge to be available at the point-of-care, the patient's home. This poster displays a model for Web-based diabetes education and decision support for the home care nurse. The system utilizes the line of reasoning (LOR) model to organize and represent expert decision-making thought processes.

  16. Generic precise augmented reality guiding system and its calibration method based on 3D virtual model.

    Science.gov (United States)

    Liu, Miao; Yang, Shourui; Wang, Zhangying; Huang, Shujun; Liu, Yue; Niu, Zhenqi; Zhang, Xiaoxuan; Zhu, Jigui; Zhang, Zonghua

    2016-05-30

    Augmented reality system can be applied to provide precise guidance for various kinds of manual works. The adaptability and guiding accuracy of such systems are decided by the computational model and the corresponding calibration method. In this paper, a novel type of augmented reality guiding system and the corresponding designing scheme are proposed. Guided by external positioning equipment, the proposed system can achieve high relative indication accuracy in a large working space. Meanwhile, the proposed system is realized with a digital projector and the general back projection model is derived with geometry relationship between digitized 3D model and the projector in free space. The corresponding calibration method is also designed for the proposed system to obtain the parameters of projector. To validate the proposed back projection model, the coordinate data collected by a 3D positioning equipment is used to calculate and optimize the extrinsic parameters. The final projecting indication accuracy of the system is verified with subpixel pattern projecting technique. PMID:27410124

  17. Users guide for the hydroacoustic coverage assessment model (HydroCAM)

    Energy Technology Data Exchange (ETDEWEB)

    Farrell, T., LLNL

    1997-12-01

    A model for predicting the detection and localization performance of hydroacoustic monitoring networks has been developed. The model accounts for major factors affecting global-scale acoustic propagation in the ocean. including horizontal refraction, travel time variability due to spatial and temporal fluctuations in the ocean, and detailed characteristics of the source. Graphical user interfaces are provided to setup the models and visualize the results. The model produces maps of network detection coverage and localization area of uncertainty, as well as intermediate results such as predicted path amplitudes, travel time and travel time variance. This Users Guide for the model is organized into three sections. First a summary of functionality available in the model is presented, including example output products. The second section provides detailed descriptions of each of models contained in the system. The last section describes how to run the model, including a summary of each data input form in the user interface.

  18. ACEEE's green book: The environmental guide to cars and trucks, Model year 2000

    Energy Technology Data Exchange (ETDEWEB)

    DeCicco, J.; Kliesch, J.; Thomas, M.

    2000-07-01

    This pathbreaking guide ranks cars and trucks according to environmental friendliness. Buyers can compare cars, vans, pickups, and sport utility vehicles by their environmental impacts, including air pollution, global warming, and fuel efficiency. Inside the guide: how to buy the cleanest and most efficient vehicle that meets your needs; Green Scores for all 2000 makes and models, listed by class--compact, mid-size, and large cars, vans, pickups, and sport utilities; Best of 2000 section featuring the greenest models in each class; Green by Design chapter highlighting advanced technologies and what makes some vehicles greener than others; listings for electric and other alternative fuel vehicles in addition to gasoline and diesel vehicles; tips on keeping your vehicle running cleanly and efficiently; and the environmental impacts of vehicles, including global warming and the health effects of vehicle pollution.

  19. Processing system of jaws tomograms for pathology identification and surgical guide modeling

    Energy Technology Data Exchange (ETDEWEB)

    Putrik, M. B., E-mail: pmb-88@mail.ru; Ivanov, V. Yu. [Ural Federal University named after the first President of Russia B.N. Yeltsin, Yekaterinburg (Russian Federation); Lavrentyeva, Yu. E. [Private dental clinic «Uraldent», Yekaterinburg (Russian Federation)

    2015-11-17

    The aim of the study is to create an image processing system, which allows dentists to find pathological resorption and to build surgical guide surface automatically. X-rays images of jaws from cone beam tomography or spiral computed tomography are the initial data for processing. One patient’s examination always includes up to 600 images (or tomograms), that’s why the development of processing system for fast automation search of pathologies is necessary. X-rays images can be useful not for only illness diagnostic but for treatment planning too. We have studied the case of dental implantation – for successful surgical manipulations surgical guides are used. We have created a processing system that automatically builds jaw and teeth boundaries on the x-ray image. After this step, obtained teeth boundaries used for surgical guide surface modeling and jaw boundaries limit the area for further pathologies search. Criterion for the presence of pathological resorption zones inside the limited area is based on statistical investigation. After described actions, it is possible to manufacture surgical guide using 3D printer and apply it in surgical operation.

  20. Processing system of jaws tomograms for pathology identification and surgical guide modeling

    Science.gov (United States)

    Putrik, M. B.; Lavrentyeva, Yu. E.; Ivanov, V. Yu.

    2015-11-01

    The aim of the study is to create an image processing system, which allows dentists to find pathological resorption and to build surgical guide surface automatically. X-rays images of jaws from cone beam tomography or spiral computed tomography are the initial data for processing. One patient's examination always includes up to 600 images (or tomograms), that's why the development of processing system for fast automation search of pathologies is necessary. X-rays images can be useful not for only illness diagnostic but for treatment planning too. We have studied the case of dental implantation - for successful surgical manipulations surgical guides are used. We have created a processing system that automatically builds jaw and teeth boundaries on the x-ray image. After this step, obtained teeth boundaries used for surgical guide surface modeling and jaw boundaries limit the area for further pathologies search. Criterion for the presence of pathological resorption zones inside the limited area is based on statistical investigation. After described actions, it is possible to manufacture surgical guide using 3D printer and apply it in surgical operation.

  1. Processing system of jaws tomograms for pathology identification and surgical guide modeling

    International Nuclear Information System (INIS)

    The aim of the study is to create an image processing system, which allows dentists to find pathological resorption and to build surgical guide surface automatically. X-rays images of jaws from cone beam tomography or spiral computed tomography are the initial data for processing. One patient’s examination always includes up to 600 images (or tomograms), that’s why the development of processing system for fast automation search of pathologies is necessary. X-rays images can be useful not for only illness diagnostic but for treatment planning too. We have studied the case of dental implantation – for successful surgical manipulations surgical guides are used. We have created a processing system that automatically builds jaw and teeth boundaries on the x-ray image. After this step, obtained teeth boundaries used for surgical guide surface modeling and jaw boundaries limit the area for further pathologies search. Criterion for the presence of pathological resorption zones inside the limited area is based on statistical investigation. After described actions, it is possible to manufacture surgical guide using 3D printer and apply it in surgical operation

  2. Surface water management: a user's guide to calculate a water balance using the CREAMS model

    International Nuclear Information System (INIS)

    The hydrologic component of the CREAMS model is described and discussed in terms of calculating a surface water balance for shallow land burial systems used for waste disposal. Parameter estimates and estimation procedures are presented in detail in the form of a user's guide. Use of the model is illustrated with three examples based on analysis of data from Los Alamos, New Mexico and Rock Valley, Nevada. Use of the model in design of trench caps for shallow land burial systems is illustrated with the example applications at Los Alamos

  3. FACSIM/MRS [Monitored Retrievable Storage]-2: Storage and shipping model documentation and user's guide

    International Nuclear Information System (INIS)

    The Pacific Northwest Laboratory (PNL) has developed a stochastic computer model, FACSIM/MRS, to assist in assessing the operational performance of the Monitored Retrievable Storage (MRS) waste-handling facility. This report provides the documentation and user's guide for FACSIM/MRS-2, which is also referred to as the back-end model. The FACSIM/MRS-2 model simulates the MRS storage and shipping operations, which include handling canistered spent fuel and secondary waste in the shielded canyon cells, in onsite yard storage, and in repository shipping cask loading areas

  4. Familial hypercholesterolaemia: a model of care for Australasia.

    Science.gov (United States)

    Watts, Gerald F; Sullivan, David R; Poplawski, Nicola; van Bockxmeer, Frank; Hamilton-Craig, Ian; Clifton, Peter M; O'Brien, Richard; Bishop, Warrick; George, Peter; Barter, Phillip J; Bates, Timothy; Burnett, John R; Coakley, John; Davidson, Patricia; Emery, Jon; Martin, Andrew; Farid, Waleed; Freeman, Lucinda; Geelhoed, Elizabeth; Juniper, Amanda; Kidd, Alexa; Kostner, Karam; Krass, Ines; Livingston, Michael; Maxwell, Suzy; O'Leary, Peter; Owaimrin, Amal; Redgrave, Trevor G; Reid, Nicola; Southwell, Lynda; Suthers, Graeme; Tonkin, Andrew; Towler, Simon; Trent, Ronald

    2011-10-01

    Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that causes marked elevation in plasma cholesterol and premature coronary heart disease. There are at least 45,000 people with FH in Australia and New Zealand, but the vast majority remains undetected and those diagnosed with the condition are inadequately treated. To bridge this major gap in coronary prevention the FH Australasia Network (Australian Atherosclerosis Society) has developed a consensus model of care (MoC) for FH. The MoC is based on clinical experience, expert opinion, published evidence and consultations with a wide spectrum of stakeholders, and has been developed for use primarily by specialist centres intending starting a clinical service for FH. This MoC aims to provide a standardised, high-quality and cost-effective system of care that is likely to have the highest impact on patient outcomes. The MoC for FH is presented as a series of recommendations and algorithms focusing on the standards required for the detection, diagnosis, assessment and management of FH in adults and children. The process involved in cascade screening and risk notification, the backbone for detecting new cases of FH, is detailed. Guidance on treatment is based on risk stratifying patients, management of non-cholesterol risk factors, safe and effective use of statins, and a rational approach to follow-up of patients. Clinical and laboratory recommendations are given for genetic testing. An integrative system for providing best clinical care is described. This MoC for FH is not prescriptive and needs to be complemented by good clinical judgment and adjusted for local needs and resources. After initial implementation, the MoC will require critical evaluation, development and appropriate modification. PMID:21917530

  5. Hydro-economic modeling of conjunctive ground and surface water use to guide sustainable basin management

    OpenAIRE

    Kahil, Mohamed Taher; Ward, Frank A.; Albiac Murillo, José; Eggleston, Jack; Sanz, David

    2016-01-01

    Water demands for irrigation, urban and environmental uses in arid and semiarid regions continue to grow, while freshwater supplies from surface and groundwater resources are becoming scarce and are expected to decline with climate change. Policymakers in these regions face hard choices on water management and policies. Hydro-economic modeling is the state-of-the art tool that could be used to guide the design and implementation of sustainable water management policies in basins. ...

  6. Systems-based guiding principles for risk modeling, planning, assessment, management, and communication.

    Science.gov (United States)

    Haimes, Yacov Y

    2012-09-01

    This article is grounded on the premise that the complex process of risk assessment, management, and communication, when applied to systems of systems, should be guided by universal systems-based principles. It is written from the perspective of systems engineering with the hope and expectation that the principles introduced here will be supplemented and complemented by principles from the perspectives of other disciplines. Indeed, there is no claim that the following 10 guiding principles constitute a complete set; rather, the intent is to initiate a discussion on this important subject that will incrementally lead us to a more complete set of guiding principles. The 10 principles are as follows: First Principle: Holism is the common denominator that bridges risk analysis and systems engineering. Second Principle: The process of risk modeling, assessment, management, and communication must be systemic and integrated. Third Principle: Models and state variables are central to quantitative risk analysis. Fourth Principle: Multiple models are required to represent the essence of the multiple perspectives of complex systems of systems. Fifth Principle: Meta-modeling and subsystems integration must be derived from the intrinsic states of the system of systems. Sixth Principle: Multiple conflicting and competing objectives are inherent in risk management. Seventh Principle: Risk analysis must account for epistemic and aleatory uncertainties. Eighth Principle: Risk analysis must account for risks of low probability with extreme consequences. Ninth Principle: The time frame is central to quantitative risk analysis. Tenth Principle: Risk analysis must be holistic, adaptive, incremental, and sustainable, and it must be supported with appropriate data collection, metrics with which to measure efficacious progress, and criteria on the basis of which to act. The relevance and efficacy of each guiding principle is demonstrated by applying it to the U.S. Federal Aviation

  7. Introduction of a team-based care model in a general medical unit

    OpenAIRE

    Hastings, Stephanie E.; Suter, Esther; Bloom, Judy; Sharma, Krishna

    2016-01-01

    Background Alberta Health Services is a provincial health authority responsible for healthcare for more than four million people. The organization recognized a need to change its care delivery model to make care more patient- and family-centred and use its health human resources more effectively by enhancing collaborative practice. A new care model including changes to how providers deliver care and skill mix changes to support the new processes was piloted on a medical unit in a large urban ...

  8. Task-role-based Access Control Model in Smart Health-care System

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

    As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

  9. User's Guide for the Agricultural Non-Point Source (AGNPS) Pollution Model Data Generator

    Science.gov (United States)

    Finn, Michael P.; Scheidt, Douglas J.; Jaromack, Gregory M.

    2003-01-01

    BACKGROUND Throughout this user guide, we refer to datasets that we used in conjunction with developing of this software for supporting cartographic research and producing the datasets to conduct research. However, this software can be used with these datasets or with more 'generic' versions of data of the appropriate type. For example, throughout the guide, we refer to national land cover data (NLCD) and digital elevation model (DEM) data from the U.S. Geological Survey (USGS) at a 30-m resolution, but any digital terrain model or land cover data at any appropriate resolution will produce results. Another key point to keep in mind is to use a consistent data resolution for all the datasets per model run. The U.S. Department of Agriculture (USDA) developed the Agricultural Nonpoint Source (AGNPS) pollution model of watershed hydrology in response to the complex problem of managing nonpoint sources of pollution. AGNPS simulates the behavior of runoff, sediment, and nutrient transport from watersheds that have agriculture as their prime use. The model operates on a cell basis and is a distributed parameter, event-based model. The model requires 22 input parameters. Output parameters are grouped primarily by hydrology, sediment, and chemical output (Young and others, 1995.) Elevation, land cover, and soil are the base data from which to extract the 22 input parameters required by the AGNPS. For automatic parameter extraction, follow the general process described in this guide of extraction from the geospatial data through the AGNPS Data Generator to generate input parameters required by the pollution model (Finn and others, 2002.)

  10. Affordance-based perception-action dynamics: A model of visually guided braking.

    Science.gov (United States)

    Harrison, Henry S; Turvey, Michael T; Frank, Till D

    2016-04-01

    Behavioral dynamics is a framework for understanding adaptive behavior as arising from the self-organizing interaction between animal and environment. The methods of nonlinear dynamics provide a language for describing behavior that is both stable and flexible. Behavioral dynamics has been criticized for ignoring the animal's sensitivity to its own capabilities, leading to the development of an alternative framework: affordance-based control. Although it is theoretically sound and empirically motivated, affordance-based control has resisted characterization in terms of nonlinear dynamics. Here, we provide a dynamical description of affordance-based control, extending behavioral dynamics to meet its criticisms. We propose a general modeling strategy consistent with both theories. We use visually guided braking as a representative behavior and construct a novel dynamical model. This model demonstrates the possibility of understanding visually guided action as respecting the limits of the actor's capabilities, while still being guided by informational variables associated with desired states of affairs. In addition to such "hard" constraints on behavior, our framework allows for the influence of "soft" constraints such as preference and comfort, opening a new area of inquiry in perception-action dynamics. PMID:26881694

  11. National Utility Financial Statement model (NUFS). Volume II of III: user's guide. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1981-10-29

    This volume is a User's Guide for the National Utility Financial Statement Model (NUFS). This is the second of three volumes describing NUFS provided by ICF Incorporated under contract DEAC01-79EI10579. The three volumes are entitled: Model Overview and Description; User's Guide; and Software Description. This volume describes each necessary input file, discusses user options, and describes the job stream necessary to run the model.

  12. Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians

    Directory of Open Access Journals (Sweden)

    Sanjeev Bhoi

    2012-01-01

    Full Text Available Background: Patients require procedural sedation and analgesia (PSA for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US guided peripheral nerve block is a safe alternative. Aim: Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED. Setting and Design: Prospective observational study conducted in ED. Materials and Methods: Patients above five years requiring analgesia for management of limb emergencies were recruited. Emergency Physicians trained in US guided nerve blocks performed the procedure. Statistical analysis: Effectiveness of pain control, using visual analogue scale was assessed at baseline and at 15 and 60 minutes after the procedure. Paired t test was used for comparison. Results: Fifty US guided nerve blocks were sciatic- 4 (8%, femoral-7 (14%, brachial- 29 (58%, median -6 (12%, and radial 2 (4% nerves. No patients required rescue PSA. Initial median VAS score was 9 (Inter Quartile Range [IQR] 7-10 and at 1 hour was 2(IQR 0-4. Median reduction in VAS score was 7.44 (IQR 8-10(75%, 1-2(25% (P=0.0001. Median procedure time was 9 minutes (IQR 3, 12 minutes and median time to reduction of pain was 5 minutes (IQR 1,15 minutes. No immediate or late complications noticed at 3 months. Conclusion: Ultrasound-guided nerve blocks can be safely and effectively performed for upper and lower limb emergencies by emergency physicians with adequate training.

  13. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection. Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  14. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency.Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model.Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection.Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  15. Transient modeling of ultrasonic guided waves in circular viscoelastic waveguides for inverse material characterization

    International Nuclear Information System (INIS)

    In this contribution, we present an efficient approach for the transient and time-causal modeling of guided waves in viscoelastic cylindrical waveguides in the context of ultrasonic material characterization. We use the scaled boundary finite element method (SBFEM) for efficient computation of the phase velocity dispersion. Regarding the viscoelastic behavior of the materials under consideration, we propose a decomposition approach that considers the real-valued frequency dependence of the (visco-)elastic moduli and, separately, of their attenuation. The modal expansion approach is utilized to take the transmitting and receiving transducers into account and to propagate the excited waveguide modes through a waveguide of finite length. The effectiveness of the proposed simulation model is shown by comparison with a standard transient FEM simulation as well as simulation results based on the exact solution of the complex-valued viscoelastic guided wave problem. Two material models are discussed, namely the fractional Zener model and the anti-Zener model; we re-interpret the latter in terms of the Rayleigh damping model. Measurements are taken on a polypropylene sample and the proposed transient simulation model is used for inverse material characterization. The extracted material properties may then be used in computer-aided design of ultrasonic systems. (paper)

  16. Vouchers for Day Care of Children: Evaluating a Program Model.

    Science.gov (United States)

    Parker, Michael D.

    1989-01-01

    Examined effects of a pilot voucher program on the price, supply, and quality of day care. Findings offered no conclusive evidence concerning expected benefits. Discusses vouchers' potential for easing the day care crisis. (RJC)

  17. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

    Directory of Open Access Journals (Sweden)

    Murray JR

    2015-11-01

    Full Text Available Julia R Murray,1,2 Helen A McNair,2 David P Dearnaley1,2 1Academic Urology Unit, Institute of Cancer Research, London, 2Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK Abstract: The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion. Keywords: radiotherapy, prostate cancer, post-prostatectomy, image-guided radiation therapy

  18. Perspective: A new model of leadership performance in health care.

    Science.gov (United States)

    Souba, Wiley

    2011-10-01

    Current leadership models are based largely on concepts and explanations, which provide limited access to the being and actions of an effective leader in health care. Rather than teaching leadership from a theoretical vantage point, the ontological perspective teaches leadership as it is lived and experienced. When one exercises leadership "as lived," concurrently informed by theories, one performs at one's best. A distinctive feature of the ontological approach resides in its capacity to disclose human ways of being and acting that limit our freedom to lead effectively as our natural self-expression. Ontological leadership maintains that our worldviews and mental maps affect the way we lead and are shaped by and accessible through language--hence, to lead more effectively, mastery of a new conversational domain of leadership is required. This emerging model of leadership performance reveals that (1) our actions as leaders are correlated with the way in which the leadership situation we are dealing with occurs for us, and (2) this "occurring" is shaped by the context we bring to that situation. Master leaders use language to recontextualize their leadership challenges so that their naturally correlated ways of being and acting can emerge, resulting in effective leadership. When leaders linguistically unveil limiting contexts, they are freed up to create new contexts that shift the way leadership challenges occur for them. This provides leaders--physicians, scientists, educators, executives--with new opportunity sets (previously unavailable) for exercising exemplary leadership. The ontological approach to leadership offers a powerful framework for tackling health care's toughest challenges. PMID:21869664

  19. Promoting health behavior change using appreciative inquiry: moving from deficit models to affirmation models of care.

    Science.gov (United States)

    Moore, Shirley M; Charvat, Jacqueline

    2007-01-01

    This article describes a new theoretical approach to health promotion and behavior change that may be especially suited to underserved women. Appreciative inquiry (AI), an organizational development process that focuses on the positive and creative as a force for an improved future, is described and adapted for use as an intervention to achieve health behavior change at the individual level. Guiding principles for its use with clients are provided, and an example of its application is illustrated in a hypothetical case study of an African American woman of low-socioeconomic resources who is attempting to increase lifestyle exercise following a cardiac event. AI is contrasted with the more traditional problem-solving approaches to the provision of care. The advantages, challenges, and issues associated with the use of AI as a health behavior change strategy are discussed. PMID:17159634

  20. Selection of terrestrial transfer factors for radioecological assessment models and regulatory guides

    International Nuclear Information System (INIS)

    A parameter value for a radioecological assessment model is not a single value but a distribution of values about a central value. The sources that contribute to the variability of transfer factors to predict foodchain transport of radionuclides are enumerated. Knowledge of these sources, judgement in interpreting the available data, consideration of collateral information, and established criteria that specify the desired level of conservatism in the resulting predictions are essential elements when selecting appropriate parameter values for radioecological assessment models and regulatory guides. 39 references, 4 figures, 5 tables

  1. Edmonton, Canada: a regional model of palliative care development.

    Science.gov (United States)

    Fainsinger, Robin L; Brenneis, Carleen; Fassbender, Konrad

    2007-05-01

    Palliative care developed unevenly in Edmonton in the 1980s and early 1990s. Health care budget cuts created an opportunity for innovative redesign of palliative care service delivery. This report describes the components that were developed to build an integrated comprehensive palliative care program, the use of common clinical assessments and outcome evaluation that has been key to establishing credibility and ongoing support. Our program has continued to develop and grow with an ongoing focus on the core areas of clinical care, education, and research. PMID:17482060

  2. Pressley Ridge Treatment Foster Care: The Model of Care Thirty Years Later

    Science.gov (United States)

    Trunzo, Annette C.; Bishop-Fitzpatrick, Lauren; Strickler, Amy; Doncaster, James

    2012-01-01

    Since the early 1950s, trends in children's mental health have moved care from residential and office-based treatment to community-based interventions. The Pressley Ridge Treatment Foster Care (PRTFC) program was developed in 1981 in response to these trends. Currently, Pressley Ridge provides PR-TFC treatment in 15 programs in six states and the…

  3. [Family-centered care: A model for approaching dementia care in the community].

    Science.gov (United States)

    Esandi, Nuria; Canga, Ana

    2016-04-01

    Along with ageing population, there has been an increase in the prevalence and incidence of chronic and debilitating conditions, such as dementia which, in turn, has increased the demands for long term care in the community. This is challenging current health care systems that wish to provide an appropriate response whilst intensify its efforts to contain costs. This paper, through a critical reflection, argues for an integrative, positive, and systemic care approach, focused not only on the person with dementia but also on the entire family unit. For this purpose, it approaches the impact that dementia has for the family, and therefore for Primary Health Care professional. In addition care strategies aimed at strengthening the whole family system are suggested. PMID:26968688

  4. Aerodynamic Performance of Scale-Model Turbofan Outlet Guide Vanes Designed for Low Noise

    Science.gov (United States)

    Hughes, Christopher E.

    2001-01-01

    The design of effective new technologies to reduce aircraft propulsion noise is dependent on an understanding of the noise sources and noise generation mechanisms in the modern turbofan engine. In order to more fully understand the physics of noise in a turbofan engine, a comprehensive aeroacoustic wind tunnel test programs was conducted called the 'Source Diagnostic Test.' The text was cooperative effort between NASA and General Electric Aircraft Engines, as part of the NASA Advanced Subsonic Technology Noise Reduction Program. A 1/5-scale model simulator representing the bypass stage of a current technology high bypass ratio turbofan engine was used in the test. The test article consisted of the bypass fan and outlet guide vanes in a flight-type nacelle. The fan used was a medium pressure ratio design with 22 individual, wide chord blades. Three outlet guide vane design configurations were investigated, representing a 54-vane radial Baseline configuration, a 26-vane radial, wide chord Low Count configuration and a 26-vane, wide chord Low Noise configuration with 30 deg of aft sweep. The test was conducted in the NASA Glenn Research Center 9 by 15-Foot Low Speed Wind Tunnel at velocities simulating the takeoff and approach phases of the aircraft flight envelope. The Source Diagnostic Test had several acoustic and aerodynamic technical objectives: (1) establish the performance of a scale model fan selected to represent the current technology turbofan product; (2) assess the performance of the fan stage with each of the three distinct outlet guide vane designs; (3) determine the effect of the outlet guide vane configuration on the fan baseline performance; and (4) conduct detailed flowfield diagnostic surveys, both acoustic and aerodynamic, to characterize and understand the noise generation mechanisms in a turbofan engine. This paper addresses the fan and stage aerodynamic performance results from the Source Diagnostic Test.

  5. Application of Orem self-care model for oral care in patients with indwelling stomach tube%Orem自理模式对留置胃管期间患者口腔护理的应用体会

    Institute of Scientific and Technical Information of China (English)

    张忠顺

    2011-01-01

    目的 探讨应用Orem自理理论指导留置胃管期间患者自行刷牙进行自我口腔护理的可行性.方法选择60例留置胃管患者,指导其自行刷牙进行口腔护理,观察口腔护理后口腔的舒适度、心理状态等效果.结果进行自我口腔护理患者感觉口腔舒适,心理放松,对康复充满信心,同时节省了医疗费用和护理工作时间.结论Orem自理模式可激发患者的主观能动性,增加患者的舒适度,有利于提高护理质量及患者的舒适度.%Objective To evaluate the Orem self - care theory in guiding patients' self - oral care with brushing their own teeth during indwelling stomach tube period. Methods Sixty patients with indwelling stomach tube were chosen, who were guided with self - oral care brushing their own teeth. The effects such as oral comfort and psychological condition were observed. Results The patients with Orem self - care felt comfortable, mental relaxed, and had more confidence in rehabilitation, while caring time and medical costs were saved. Conclusion Orem self- care model can stimulate the initiative of patients, increase patients comfort, and help improving the quality of care.

  6. Health Insurance, Medical Care, and Health Outcomes: A Model of Elderly Health Dynamics

    Science.gov (United States)

    Yang, Zhou; Gilleskie, Donna B.; Norton, Edward C.

    2009-01-01

    Prescription drug coverage creates a change in medical care consumption, beyond standard moral hazard, arising both from the differential cost-sharing and the relative effectiveness of different types of care. We model the dynamic supplemental health insurance decisions of Medicare beneficiaries, their medical care demand, and subsequent health…

  7. Using a guided inquiry and modeling instructional framework (EIMA) to support preservice K-8 science teaching

    Science.gov (United States)

    Schwarz, Christina V.; Gwekwerere, Yovita N.

    2007-01-01

    This paper presents results from a study aimed at helping preservice elementary and middle school teachers incorporate model-centered scientific inquiry into their science teaching practices. Specifically, the authors studied the effect of using a guided inquiry and modeling instructional framework (EIMA) and accompanying science methods instruction on preservice elementary teachers' science lesson design skills, scientific model use, and teaching orientations. Analysis of preservice teachers' pre-posttests, classroom artifacts, peer interviews, and lesson plans throughout the semester indicates that the framework successfully built on preservice teachers' prior instructional ideas, and that the majority of preservice teachers learned and used the framework in their lesson plans and teaching. Additionally, analysis of pre-posttest differences indicates an increase in posttest lesson plans that focused on engaging students in scientific inquiry using several kinds of models. Most importantly, the framework and accompanying instruction enabled two thirds of the class to move their teaching orientations away from discovery or didactic approaches toward reform-based approaches such as conceptual change, inquiry, and guided inquiry. Results from this study show that using instructional frameworks such as EIMA can enable preservice teachers to socially construct, synthesize, and apply their knowledge for enacting reform-oriented science teaching approaches such as model-centered scientific inquiry.

  8. Clinical outcomes of HIV care delivery models in the US: a systematic review.

    Science.gov (United States)

    Kimmel, April D; Martin, Erika G; Galadima, Hadiza; Bono, Rose S; Tehrani, Ali Bonakdar; Cyrus, John W; Henderson, Margaret; Freedberg, Kenneth A; Krist, Alexander H

    2016-10-01

    With over 1 million people living with HIV, the US faces national challenges in HIV care delivery due to an inadequate HIV specialist workforce and the increasing role of non-communicable chronic diseases in driving morbidity and mortality in HIV-infected patients. Alternative HIV care delivery models, which include substantial roles for advanced practitioners and/or coordination between specialty and primary care settings in managing HIV-infected patients, may address these needs. We aimed to systematically review the evidence on patient-level HIV-specific and primary care health outcomes for HIV-infected adults receiving outpatient care across HIV care delivery models. We identified randomized trials and observational studies from bibliographic and other databases through March 2016. Eligible studies met pre-specified eligibility criteria including on care delivery models and patient-level health outcomes. We considered all available evidence, including non-experimental studies, and evaluated studies for risk of bias. We identified 3605 studies, of which 13 met eligibility criteria. Of the 13 eligible studies, the majority evaluated specialty-based care (9 studies). Across all studies and care delivery models, eligible studies primarily reported mortality and antiretroviral use, with specialty-based care associated with mortality reductions at the clinician and practice levels and with increased antiretroviral initiation or use at the clinician level but not the practice level. Limited and heterogeneous outcomes were reported for other patient-level HIV-specific outcomes (e.g., viral suppression) as well as for primary care health outcomes across all care delivery models. No studies addressed chronic care outcomes related to aging. Limited evidence was available across geographic settings and key populations. As re-design of care delivery in the US continues to evolve, better understanding of patient-level HIV-related and primary care health outcomes, especially

  9. FACSIM/MRS-1: Cask receiving and consolidation model documentation and user's guide

    International Nuclear Information System (INIS)

    The Pacific Northwest Laboratory (PNL) has developed a stochastic computer model, FACSIM/MRS, to assist in assessing the operational performance of the Monitored Retrievable Storage (MRS) waste-handling facility. This report provides the documentation and user's guide for the component FACSIM/MRS-1, which is also referred to as the front-end model. The FACSIM/MRS-1 model simulates the MRS cask-receiving and spent-fuel consolidation activities. The results of the assessment of the operational performance of these activities are contained in a second report, FACSIM/MRS-1: Cask Receiving and Consolidation Performance Assessment (Lotz and Shay 1987). The model of MRS canister storage and shipping operations is presented in FACSIM/MRS-2: Storage and Shipping Model Documentation and User's Guide (Huber et al. 1987). The FACSIM/MRS model uses the commercially available FORTRAN-based SIMAN (SIMulation ANalysis language) simulation package (Pegden 1982). SIMAN provides a set of FORTRAN-coded commands, called block operations, which are used to build detailed models of continuous or discrete events that make up the operations of any process, such as the operation of an MRS facility. The FACSIM models were designed to run on either an IBM-PC or a VAX minicomputer. The FACSIM/MRS-1 model is flexible enough to collect statistics concerning almost any aspect of the cask receiving and consolidation operations of an MRS facility. The MRS model presently collects statistics on 51 quantities of interest during the simulation. SIMAN reports the statistics with two forms of output: a SIMAN simulation summary and an optional set of SIMAN output files containing data for use by more detailed post processors and report generators

  10. Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life.

    Directory of Open Access Journals (Sweden)

    Christine Ritchie

    Full Text Available The Geriatric Resources for the Assessment and Care of Elders (GRACE program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers.To describe adaptation of the GRACE model to include adults of all ages (named Care Support and to evaluate the process and impact of Care Support implementation at an urban academic medical center.152 high-risk patients (≥5 ED visits or ≥2 hospitalizations in the past 12 months enrolled from four medical clinics from 4/29/2013 to 5/31/2014.Patients received a comprehensive in-home assessment by a nurse practitioner/social worker (NP/SW team, who then met with a larger interdisciplinary team to develop an individualized care plan. In consultation with the primary care team, standardized care protocols were activated to address relevant key issues as needed.A process evaluation based on the Consolidated Framework for Implementation Research identified key adaptations of the original model, which included streamlining of standardized protocols, augmenting mental health interventions and performing some assessments in the clinic. A summative evaluation found a significant decline in the median number of ED visits (5.5 to 0, p = 0.015 and hospitalizations (5.5 to 0, p<0.001 6 months before enrollment in Care Support compared to 6 months after enrollment. In addition, the percent of patients reporting better self-rated health increased from 31% at enrollment to 64% at 9 months (p = 0.002. Semi-structured interviews with Care Support team members identified patients with multiple, complex conditions; little community support; and mild anxiety as those who appeared to benefit the most from the program.It was feasible to implement GRACE/Care Support at an academic medical center by making adaptations based on local needs. Care Support patients experienced significant reductions in acute care utilization and significant improvements

  11. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Stewart Allison

    2008-05-01

    Full Text Available Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1 organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2 community linkages – facilitated by working together with community organisations (e.g. local stores and running community-based programs (e.g. "health week", but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3 self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4 decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5 delivery system

  12. The internationalization of health care: the UZ Brussel model for international partnerships.

    Science.gov (United States)

    Noppen, Marc

    2012-01-01

    Globalization of health care, flat medicine, cross-boarder health care, medical tourism, are all terms describing some, but not all, aspects of a growing trend: patients seeking health care provision abroad, and health care providers travelling abroad for temporary or permanent health care delivery services. This trend is a complex, bilateral and multifaceted phenomenon, which in our opinion, cannot be sustained in a single, comprehensive description. Individual hospitals have the unique opportunity to develop a model for appropriate action. The specific model created by the university hospital UZ Brussel is presented here. PMID:23484427

  13. The internationalization of health care: the UZ Brussel model for international partnerships.

    Science.gov (United States)

    Noppen, Marc

    2012-01-01

    Globalization of health care, flat medicine, cross-boarder health care, medical tourism, are all terms describing some, but not all, aspects of a growing trend: patients seeking health care provision abroad, and health care providers travelling abroad for temporary or permanent health care delivery services. This trend is a complex, bilateral and multifaceted phenomenon, which in our opinion, cannot be sustained in a single, comprehensive description. Individual hospitals have the unique opportunity to develop a model for appropriate action. The specific model created by the university hospital UZ Brussel is presented here.

  14. Respecting your rights : a guide to the rights of people living in British Columbia long term care facilities

    OpenAIRE

    Spencer, Charmaine; Beck, Mary

    2003-01-01

    This booklet answers common questions about living in care facilities (including intermediate-, multi-level-, private-, and extended care facilities).Table of Contents: Introduction. 1. Your Right to Be Treated with Dignity and Respect: Your right to be treated as an adult; Your right to be treated with respect; Your right to be treated as a person capable of making your own decisions. 2. Your Right to Personal Choices: Your right to personal lifestyle choices; Your right to choices about you...

  15. Modelling the landscape of palliative care for people with dementia: a European mixed methods study

    OpenAIRE

    Iliffe, Steve; Davies, Nathan; Vernooij-Dassen, Myrra; van Riet Paap, Jasper; Sommerbakk, Ragni; Mariani, Elena; Jaspers, Birgit; Radbruch, Lukas; Manthorpe, Jill; Maio, Laura; Haugen, Dagny; Engels, Yvonne

    2013-01-01

    BACKGROUND: Palliative care for people with dementia is often sub-optimal. This is partly because of the challenging nature of dementia itself, and partly because of system failings that are particularly salient in primary care and community services. There is a need to systematize palliative care for people with dementia, to clarify where changes in practice could be made.To develop a model of palliative care for people with dementia that captures commonalities and differences across Europe,...

  16. Site-specific induction of lymphatic malformations in a rat model for image-guided therapy

    International Nuclear Information System (INIS)

    Lymphatic malformation is a common benign mass in children and adults and is representative of a derangement in lymphangiogenesis. These lesions have high recurrence rates and significant morbidity associated with surgery. Several sclerotherapy regimens have been developed clinically to treat lymphatic malformations; however, an animal model has not been developed that is adequate to test the efficacy of image-guided therapeutic interventions. To develop an animal model suitable for evaluation of percutaneous treatments of lymphatic malformations. Male Harlan Sprague-Dawley rats (n = 9) received two US-guided injections of Incomplete Freund's Adjuvant (IFA) over a 2-week period. All nine rats were injected twice into the peritoneum (IP); a subgroup (n = 3) received additional injections into the neck. Three animals that received IP injections of saline were used as controls. The injection sites were monitored for the development of lesions by high-resolution ultrasonography at 2-week intervals for 100 days. High-resolution (4.7 Tesla) magnetic resonance imaging was then performed on two animals noted to have developed masses. The rats were sacrificed and histologic examination of the identified lesions was performed, including immunohistochemical staining for vascular (CD31) and lymphatic (Flt-4 and Prox-1) endothelium. All animals injected with IFA developed cystic lesions. The three animals injected at dual sites were noted to have both microcystic and macrocystic malformations in the neck and microcystic plaque-like lesions in the peritoneum. The macrocystic malformations (≥5 mm) in the neck were detected by ultrasonography and grossly later during necropsy. Histopathologic analysis revealed the cystic spaces to be lined by lymphatic endothelium supported by a connective tissue stroma. Control animals did not exhibit detectable lesions with either ultrasonography or necropsy. This model represents a promising tool for translational development of image-guided

  17. Methods for Using Ground-Water Model Predictions to Guide Hydrogeologic Data Collection, with Applications to the Death Valley Regional Ground-Water Flow System

    Energy Technology Data Exchange (ETDEWEB)

    Claire R. Tiedeman; M.C. Hill; F.A. D' Agnese; C.C. Faunt

    2001-07-31

    Calibrated models of ground-water systems can provide substantial information for guiding data collection. This work considers using such models to guide hydrogeologic data collection for improving model predictions, by identifying model parameters that are most important to the predictions. Identification of these important parameters can help guide collection of field data about parameter values and associated flow-system features that can lead to improved predictions. Methods for identifying parameters important to predictions include prediction scaled sensitivities (PSS), which account for uncertainty on individual parameters as well as prediction sensitivity to parameters, and a new ''value of improved information'' (VOII) method, which includes the effects of parameter correlation in addition to individual parameter uncertainty and prediction sensitivity. The PSS and VOII methods are demonstrated using a model of the Death Valley regional ground-water flow system. The predictions of interest are advective-transport paths originating at sites of past underground nuclear testing. Results show that for two paths evaluated, the most important parameters include a subset of five or six of the 23 defined model parameters. Some of the parameters identified as most important are associated with flow-system attributes that do not lie in the immediate vicinity of the paths. Results also indicate that the PSS and VOII methods can identify different important parameters. Because the methods emphasize somewhat different criteria for parameter importance, it is suggested that parameters identified by both methods be carefully considered in subsequent data collection efforts aimed at improving model predictions.

  18. MR-guided coil embolisation of renal arteries in an animal model

    International Nuclear Information System (INIS)

    Purpose: To test the feasibility of MR-guided coil embolization with passive visualization in an animal model. Materials and Methods: All experiments were performed on a 1.5 T interventional MR-scanner (Gyroscan ACS-NT, Philips, Netherlands). A gradient echo sequence was combined with radial k-space acquisition and sliding window reconstruction technique to calculate the raw data with a specially designed back projector, yielding a frame rate of 20 images per second. The images were directly displayed on LCD-screens next to the MR scanner. A multipurpose catheter with dysprosium markers was placed into the renal arteries of two pigs under MR guidance, and a nitinol coil and platinum coil each were deployed. The position of the coils was verified with magnetic resonance angiography and conventional angiography. Results: MR-guided catheterization of renal arteries with subsequent coil embolization was successfully carried out but the configuration of the coils could not be visualized on the MR images. Conclusion: MR-guided coil embolization of renal arteries is feasible. Exact guidance of coil deployment is not attainable with passive visualization. (orig.)

  19. Do telemonitoring projects of heart failure fit the Chronic Care Model?

    Directory of Open Access Journals (Sweden)

    Evi Willemse

    2014-07-01

    Full Text Available This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner.Background: The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation.Methods: This qualitative study describes seven non-invasive home-care telemonitoring projects in patients with heart failure in Belgium. A qualitative design, including interviews and literature review, was used to describe the correspondence of these home-care telemonitoring projects with the dimensions of the Chronic Care Model.Results: The projects were situated in primary and secondary health care. Their primary goal was to reduce the number of readmissions for chronic heart failure. None of these projects succeeded in a final implementation of telemonitoring in home care after the pilot phase. Not all the projects were initiated to accomplish all of the dimensions of the Chronic Care Model. A central role for the patient was sparse.Conclusion: Limited financial resources hampered continuation after the pilot phase. Cooperation and coordination in telemonitoring appears to be major barriers but are, within primary care as well as between the lines of care, important links in follow-up. This discrepancy can be prohibitive for deployment of good chronic care. Chronic Care Model is recommended as basis for future.

  20. Do telemonitoring projects of heart failure fit the Chronic Care Model?

    Directory of Open Access Journals (Sweden)

    Evi Willemse

    2014-07-01

    Full Text Available This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner. Background: The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation. Methods: This qualitative study describes seven non-invasive home-care telemonitoring projects in patients with heart failure in Belgium. A qualitative design, including interviews and literature review, was used to describe the correspondence of these home-care telemonitoring projects with the dimensions of the Chronic Care Model. Results: The projects were situated in primary and secondary health care. Their primary goal was to reduce the number of readmissions for chronic heart failure. None of these projects succeeded in a final implementation of telemonitoring in home care after the pilot phase. Not all the projects were initiated to accomplish all of the dimensions of the Chronic Care Model. A central role for the patient was sparse. Conclusion: Limited financial resources hampered continuation after the pilot phase. Cooperation and coordination in telemonitoring appears to be major barriers but are, within primary care as well as between the lines of care, important links in follow-up. This discrepancy can be prohibitive for deployment of good chronic care. Chronic Care Model is recommended as basis for future.

  1. Personality, personal model beliefs, and self-care in adolescents and young adults with type 1 diabetes

    OpenAIRE

    Skinner, TC; Hampson, SE; Fife-Schaw, CR

    2002-01-01

    This study compared 3 models of association between personality, personal model beliefs, and self-care in a cross-sectional design. These models were as follows: (a) Emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness is a direct predictor of self-care; (b) emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness moderates the association between beliefs and self-care; (c) both emotional sta...

  2. Hybrid local FEM/global LISA modeling of damped guided wave propagation in complex composite structures

    Science.gov (United States)

    Shen, Yanfeng; Cesnik, Carlos E. S.

    2016-09-01

    This paper presents a new hybrid modeling technique for the efficient simulation of guided wave generation, propagation, and interaction with damage in complex composite structures. A local finite element model is deployed to capture the piezoelectric effects and actuation dynamics of the transmitter, while the global domain wave propagation and interaction with structural complexity (structure features and damage) are solved utilizing a local interaction simulation approach (LISA). This hybrid approach allows the accurate modeling of the local dynamics of the transducers and keeping the LISA formulation in an explicit format, which facilitates its readiness for parallel computing. The global LISA framework was extended through the 3D Kelvin–Voigt viscoelasticity theory to include anisotropic damping effects for composite structures, as an improvement over the existing LISA formulation. The global LISA framework was implemented using the compute unified device architecture running on graphic processing units. A commercial preprocessor is integrated seamlessly with the computational framework for grid generation and material property allocation to handle complex structures. The excitability and damping effects are successfully captured by this hybrid model, with experimental validation using the scanning laser doppler vibrometry. To demonstrate the capability of our hybrid approach for complex structures, guided wave propagation and interaction with a delamination in a composite panel with stiffeners is presented.

  3. Hybrid local FEM/global LISA modeling of damped guided wave propagation in complex composite structures

    Science.gov (United States)

    Shen, Yanfeng; Cesnik, Carlos E. S.

    2016-09-01

    This paper presents a new hybrid modeling technique for the efficient simulation of guided wave generation, propagation, and interaction with damage in complex composite structures. A local finite element model is deployed to capture the piezoelectric effects and actuation dynamics of the transmitter, while the global domain wave propagation and interaction with structural complexity (structure features and damage) are solved utilizing a local interaction simulation approach (LISA). This hybrid approach allows the accurate modeling of the local dynamics of the transducers and keeping the LISA formulation in an explicit format, which facilitates its readiness for parallel computing. The global LISA framework was extended through the 3D Kelvin-Voigt viscoelasticity theory to include anisotropic damping effects for composite structures, as an improvement over the existing LISA formulation. The global LISA framework was implemented using the compute unified device architecture running on graphic processing units. A commercial preprocessor is integrated seamlessly with the computational framework for grid generation and material property allocation to handle complex structures. The excitability and damping effects are successfully captured by this hybrid model, with experimental validation using the scanning laser doppler vibrometry. To demonstrate the capability of our hybrid approach for complex structures, guided wave propagation and interaction with a delamination in a composite panel with stiffeners is presented.

  4. A simple method for EEG guided transcranial electrical stimulation without models

    Science.gov (United States)

    Cancelli, Andrea; Cottone, Carlo; Tecchio, Franca; Truong, Dennis Q.; Dmochowski, Jacek; Bikson, Marom

    2016-06-01

    Objective. There is longstanding interest in using EEG measurements to inform transcranial Electrical Stimulation (tES) but adoption is lacking because users need a simple and adaptable recipe. The conventional approach is to use anatomical head-models for both source localization (the EEG inverse problem) and current flow modeling (the tES forward model), but this approach is computationally demanding, requires an anatomical MRI, and strict assumptions about the target brain regions. We evaluate techniques whereby tES dose is derived from EEG without the need for an anatomical head model, target assumptions, difficult case-by-case conjecture, or many stimulation electrodes. Approach. We developed a simple two-step approach to EEG-guided tES that based on the topography of the EEG: (1) selects locations to be used for stimulation; (2) determines current applied to each electrode. Each step is performed based solely on the EEG with no need for head models or source localization. Cortical dipoles represent idealized brain targets. EEG-guided tES strategies are verified using a finite element method simulation of the EEG generated by a dipole, oriented either tangential or radial to the scalp surface, and then simulating the tES-generated electric field produced by each model-free technique. These model-free approaches are compared to a ‘gold standard’ numerically optimized dose of tES that assumes perfect understanding of the dipole location and head anatomy. We vary the number of electrodes from a few to over three hundred, with focality or intensity as optimization criterion. Main results. Model-free approaches evaluated include (1) voltage-to-voltage, (2) voltage-to-current; (3) Laplacian; and two Ad-Hoc techniques (4) dipole sink-to-sink; and (5) sink to concentric. Our results demonstrate that simple ad hoc approaches can achieve reasonable targeting for the case of a cortical dipole, remarkably with only 2–8 electrodes and no need for a model of the head

  5. A simple method for EEG guided transcranial electrical stimulation without models

    Science.gov (United States)

    Cancelli, Andrea; Cottone, Carlo; Tecchio, Franca; Truong, Dennis Q.; Dmochowski, Jacek; Bikson, Marom

    2016-06-01

    Objective. There is longstanding interest in using EEG measurements to inform transcranial Electrical Stimulation (tES) but adoption is lacking because users need a simple and adaptable recipe. The conventional approach is to use anatomical head-models for both source localization (the EEG inverse problem) and current flow modeling (the tES forward model), but this approach is computationally demanding, requires an anatomical MRI, and strict assumptions about the target brain regions. We evaluate techniques whereby tES dose is derived from EEG without the need for an anatomical head model, target assumptions, difficult case-by-case conjecture, or many stimulation electrodes. Approach. We developed a simple two-step approach to EEG-guided tES that based on the topography of the EEG: (1) selects locations to be used for stimulation; (2) determines current applied to each electrode. Each step is performed based solely on the EEG with no need for head models or source localization. Cortical dipoles represent idealized brain targets. EEG-guided tES strategies are verified using a finite element method simulation of the EEG generated by a dipole, oriented either tangential or radial to the scalp surface, and then simulating the tES-generated electric field produced by each model-free technique. These model-free approaches are compared to a ‘gold standard’ numerically optimized dose of tES that assumes perfect understanding of the dipole location and head anatomy. We vary the number of electrodes from a few to over three hundred, with focality or intensity as optimization criterion. Main results. Model-free approaches evaluated include (1) voltage-to-voltage, (2) voltage-to-current; (3) Laplacian; and two Ad-Hoc techniques (4) dipole sink-to-sink; and (5) sink to concentric. Our results demonstrate that simple ad hoc approaches can achieve reasonable targeting for the case of a cortical dipole, remarkably with only 2-8 electrodes and no need for a model of the head

  6. Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

    Science.gov (United States)

    Wallace, Cara L

    2016-08-01

    This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care. PMID:27332743

  7. Mathematical modelling of translational motion of rail-guided cart with suspended payload

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    In this paper modelling of the translational motion of transportation rail-guided cart with rope suspended payload is considered. The linearly moving cart, driven by a travel mechanism, is modelled as a discrete six degrees of freedom (DOF) dynamic system. The hoisting mechanism for lowering and lifting the payload is considered and is included in the dynamic model as one DOF system. Differential equations of motion of the cart elements are derived using Lagrangian dynamics and are solved for a set of real-life constant parameters of the cart. A two-sided interaction was observed between the swinging payload and the travel mechanism. Results for kinematical and force parameters of the system are obtained. A verification of the proposed model was conducted.

  8. Dynamic energy conservation model REDUCE. Extension with experience curves, energy efficiency indicators and user's guide

    International Nuclear Information System (INIS)

    The main objective of the energy conservation model REDUCE (Reduction of Energy Demand by Utilization of Conservation of Energy) is the evaluation of the effectiveness of economical, financial, institutional, and regulatory measures for improving the rational use of energy in end-use sectors. This report presents the results of additional model development activities, partly based on the first experiences in a previous project. Energy efficiency indicators have been added as an extra tool for output analysis in REDUCE. The methodology is described and some examples are given. The model has been extended with a method for modelling the effects of technical development on production costs, by means of an experience curve. Finally, the report provides a 'users guide', by describing in more detail the input data specification as well as all menus and buttons. 19 refs

  9. Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach

    OpenAIRE

    Kitson, Nicole A; Price, Morgan; Lau, Francis Y; Showler, Grey

    2013-01-01

    Background Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication managemen...

  10. NASA Handbook for Models and Simulations: An Implementation Guide for NASA-STD-7009

    Science.gov (United States)

    Steele, Martin J.

    2013-01-01

    The purpose of this Handbook is to provide technical information, clarification, examples, processes, and techniques to help institute good modeling and simulation practices in the National Aeronautics and Space Administration (NASA). As a companion guide to NASA-STD- 7009, Standard for Models and Simulations, this Handbook provides a broader scope of information than may be included in a Standard and promotes good practices in the production, use, and consumption of NASA modeling and simulation products. NASA-STD-7009 specifies what a modeling and simulation activity shall or should do (in the requirements) but does not prescribe how the requirements are to be met, which varies with the specific engineering discipline, or who is responsible for complying with the requirements, which depends on the size and type of project. A guidance document, which is not constrained by the requirements of a Standard, is better suited to address these additional aspects and provide necessary clarification. This Handbook stems from the Space Shuttle Columbia Accident Investigation (2003), which called for Agency-wide improvements in the "development, documentation, and operation of models and simulations"' that subsequently elicited additional guidance from the NASA Office of the Chief Engineer to include "a standard method to assess the credibility of the models and simulations."2 General methods applicable across the broad spectrum of model and simulation (M&S) disciplines were sought to help guide the modeling and simulation processes within NASA and to provide for consistent reporting ofM&S activities and analysis results. From this, the standardized process for the M&S activity was developed. The major contents of this Handbook are the implementation details of the general M&S requirements ofNASA-STD-7009, including explanations, examples, and suggestions for improving the credibility assessment of an M&S-based analysis.

  11. Explicit simulations of stream networks to guide hydrological modelling in ungauged basins

    Directory of Open Access Journals (Sweden)

    S. Stoll

    2010-08-01

    Full Text Available Rainfall-runoff modelling in ungauged basins is still one of the greatest challenges in hydrological research. The lack of discharge data necessitates the establishment of new innovative approaches to guide hydrological modelling in ungauged basins. Besides the transfer of calibrated parameters from similar gauged catchments, the application of distributed data as a hydrological response in addition to discharge seems to be promising. A new approach to guide hydrological modelling based on explicit simulation of the spatial stream network was tested in four different catchments in Germany. In a first step we used a simplified version of the process-based model Hill-Vi together with regional climate normals to simulate stream networks. The calculation of gravity driven lateral subsurface and groundwater flow is used to identify patterns of stream cells, which were compared to reference stream networks and their degree of spatial agreement was evaluated. Significant differences between good and poor simulations could be distinguished and the corresponding parameter sets relate well with the hydrogeological properties of the catchments. The optimized parameters were subsequently used to simulate daily discharge using an observed time series of precipitation and air temperature. The performance was evaluated against observed discharge and water balance. This approach shows some promising results but also some limitations. Although the model's parsimonious model structure could be further improved regarding discharge recession and evapotranspiration, the performance was similar to regionalisation methods. Stream network modelling, which has minimal data requirements, seems to be a reasonable alternative for model development and parameter evaluation in ungauged basins.

  12. Differences in referral rates to specialised health care from four primary health care models in Klaipeda, Lithuania

    Science.gov (United States)

    Zielinski, Andrzej; Håkansson, Anders; Jurgutis, Arnoldas; Ovhed, Ingvar; Halling, Anders

    2008-01-01

    Background Lithuanian primary health care (PHC) is undergoing changes from the systems prevalent under the Soviet Union, which ensured free access to specialised health care. Currently four different PHC models work in parallel, which offers the opportunity to study their respective effect on referral rates. Our aim was to investigate whether there were differences in referrals rates from different Lithuanian PHC models in Klaipeda after adjustment for co-morbidity. Methods The population listed with 18 PHC practices serving inhabitants in Klaipeda city and region (250 070 inhabitants). Four PHC models: rural state-owned family medicine practices, urban privately owned family medicine practices, state-owned polyclinics and privately owned polyclinics. Information on listed patients and referrals during 2005 from each PHC practice in Klaipeda was obtained from the Lithuanian State Sickness Fund database. The database records included information on age, gender, PHC model, referrals and ICD 10 diagnoses. The Johns Hopkins ACG Case-Mix system was used to study co-morbidity. Referral rates from different PHC models were studied using Poisson regression models. Results Patients listed with rural state-owned family medicine practices had a significantly lower referral rate to specialised health care than those in the other three PHC models. An increasing co-morbidity level correlated with a higher physician- to self-referral ratio. Conclusion Family medicine practices located in rural-, but not in urban areas had significantly lower referral rates to specialised health care. It could not be established whether this was due to organisation, training of physicians or financing, but suggests there is room for improving primary health care in urban areas. Patient's place of residence and co morbidity level were the most important factors for referral rate. We also found that gatekeeping had an effect on the referral pattern with respect to co-morbidity level, so that those

  13. Optimization of an Image-Guided Laser-Induced Choroidal Neovascularization Model in Mice.

    Directory of Open Access Journals (Sweden)

    Yan Gong

    Full Text Available The mouse model of laser-induced choroidal neovascularization (CNV has been used in studies of the exudative form of age-related macular degeneration using both the conventional slit lamp and a new image-guided laser system. A standardized protocol is needed for consistent results using this model, which has been lacking. We optimized details of laser-induced CNV using the image-guided laser photocoagulation system. Four lesions with similar size were consistently applied per eye at approximately double the disc diameter away from the optic nerve, using different laser power levels, and mice of various ages and genders. After 7 days, the mice were sacrificed and retinal pigment epithelium/choroid/sclera was flat-mounted, stained with Isolectin B4, and imaged. Quantification of the area of the laser-induced lesions was performed using an established and constant threshold. Exclusion criteria are described that were necessary for reliable data analysis of the laser-induced CNV lesions. The CNV lesion area was proportional to the laser power levels. Mice at 12-16 weeks of age developed more severe CNV than those at 6-8 weeks of age, and the gender difference was only significant in mice at 12-16 weeks of age, but not in those at 6-8 weeks of age. Dietary intake of omega-3 long-chain polyunsaturated fatty acid reduced laser-induced CNV in mice. Taken together, laser-induced CNV lesions can be easily and consistently applied using the image-guided laser platform. Mice at 6-8 weeks of age are ideal for the laser-induced CNV model.

  14. Activity Diagrams for DEVS Models: A Case Study Modeling Health Care Behavior

    Energy Technology Data Exchange (ETDEWEB)

    Ozmen, Ozgur [ORNL; Nutaro, James J [ORNL

    2015-01-01

    Discrete Event Systems Specification (DEVS) is a widely used formalism for modeling and simulation of discrete and continuous systems. While DEVS provides a sound mathematical representation of discrete systems, its practical use can suffer when models become complex. Five main functions, which construct the core of atomic modules in DEVS, can realize the behaviors that modelers want to represent. The integration of these functions is handled by the simulation routine, however modelers can implement each function in various ways. Therefore, there is a need for graphical representations of complex models to simplify their implementation and facilitate their reproduction. In this work, we illustrate the use of activity diagrams for this purpose in the context of a health care behavior model, which is developed with an agent-based modeling paradigm.

  15. Peer Collaboration: A Model to Support Counsellor Self-Care

    Science.gov (United States)

    Barlow, Constance A.; Phelan, Anne M.

    2007-01-01

    In the context of a larger case study on how continuous learning in the workplace could be achieved through the implementation of peer collaboration, the process of how counsellors engaged in self-care within a large health care organization became clearer. This article is based on data derived from a qualitative analysis of nine transcribed…

  16. User's guide to the LIRAQ model: an air pollution model for the San Francisco Bay Area

    Energy Technology Data Exchange (ETDEWEB)

    MacCracken, M.C.

    1975-12-19

    The Livermore Regional Air Quality (LIRAQ) model comprises a set of computer programs that have been integrated into an easily used tool for the air quality planner. To assemble and modify the necessary data files and to direct model execution, a problem formulation program has been developed that makes possible the setup of a wide variety of studies involving perturbation of the emission inventory, changes to the initial and boundary conditions, and different choices of grid size and problem domain. In addition to describing the types of air quality problems for which the LIRAQ model may be used, this User's Guide provides detailed information on how to set up and conduct model simulations. Also included are descriptions of the formats of input data files so that the LIRAQ model may be applied to regions other than the San Francisco Bay Area.

  17. Hydro-economic modeling with aquifer-river interactions to guide sustainable basin management

    Science.gov (United States)

    Kahil, Mohamed Taher; Ward, Frank A.; Albiac, Jose; Eggleston, Jack; Sanz, David

    2016-08-01

    Policymakers in arid and semiarid basins face hard choices on water policies needed for adaptation to climate change. Hydro-economic modeling is a state-of-the art approach that can be used to guide the design and implementation of these policies in basins. A major gap in developments of hydro-economic modeling to date has been the weak integration of physically-based representations of water sources and uses such as the interaction between ground and surface water resources, to inform complex basin scale policy choices. This paper presents an integrated hydro-economic modeling framework to address this gap with application to an important and complex river basin in Spain, the Jucar basin, for the assessment of a range of climate change scenarios and policy choices. Results indicate that in absence of adequate policies protecting water resources and natural ecosystems, water users will strategically deplete reservoirs, aquifers and river flows for short-term adaptation to climate change, disregarding the impacts on the environment and future human activities. These impacts can be addressed by implementing sustainable management policies. However, these policies could have disproportionate costs for some stakeholders groups, and their opposition may undermine attempts at sustainable policy. These tradeoffs among water policy choices are important guides to the design of policies aimed at basin-wide adaptation to climate change.

  18. The Women's Health Care Empowerment Model as a Catalyst for Change in Developing Countries.

    Science.gov (United States)

    Mitroi, Lavinia R; Sahak, Medina; Sherzai, Ayesha Z; Sherzai, Dean

    2016-01-01

    Women's empowerment has been attempted through a number of different fields including the realms of politics, finance, and education, yet none of these domains are as promising as health care. Here we review preliminary work in this domain and introduce a model for women's empowerment through involvement in health care, titled the "women's health care empowerment model." Principles upon which our model is built include: acknowledging the appropriate definition of empowerment within the cultural context, creating a women's network for communication, integrating local culture and tradition into training women, and increasing the capability of women to care for their children and other women. PMID:24945243

  19. Program Implementation in the Prison System: An Organizational Study of the Chronic Care Model Program

    OpenAIRE

    Robinson, Greg

    2013-01-01

    This study provides evidence of a successful implementation of a not-for-profit operational model within a public setting. The federal government placed a receiver in charge of improving health care within the California Department of Corrections and Rehabilitation. To achieve the receivership's goals, a chronic care model from the not-for-profit sector was selected and implemented to improve the delivery of health care to inmates. The data suggest that operational programs developed outsi...

  20. Parameter-free methods distinguish Wnt pathway models and guide design of experiments

    KAUST Repository

    MacLean, Adam L.

    2015-02-17

    The canonical Wnt signaling pathway, mediated by β-catenin, is crucially involved in development, adult stem cell tissue maintenance, and a host of diseases including cancer. We analyze existing mathematical models of Wnt and compare them to a new Wnt signaling model that targets spatial localization; our aim is to distinguish between the models and distill biological insight from them. Using Bayesian methods we infer parameters for each model from mammalian Wnt signaling data and find that all models can fit this time course. We appeal to algebraic methods (concepts from chemical reaction network theory and matroid theory) to analyze the models without recourse to specific parameter values. These approaches provide insight into aspects of Wnt regulation: the new model, via control of shuttling and degradation parameters, permits multiple stable steady states corresponding to stem-like vs. committed cell states in the differentiation hierarchy. Our analysis also identifies groups of variables that should be measured to fully characterize and discriminate between competing models, and thus serves as a guide for performing minimal experiments for model comparison.

  1. Explicit simulations of stream networks to guide hydrological modelling in ungauged basins

    Directory of Open Access Journals (Sweden)

    S. Stoll

    2010-01-01

    Full Text Available Rainfall-runoff modelling in ungauged basins is still one of the greatest challenges in recent hydrological research. The lack of discharge data necessitates the establishment of new innovative approaches to guide hydrological modelling in ungauged basins. Besides the transfer of calibrated parameters from similar gauged catchments, the application of distributed data as a hydrological response in addition to discharge seems to be promising. A new approach for model and parameter evaluation based on explicit simulation of the spatial stream network was tested in four different catchments in Germany. In a first step, spatial explicit modelling of stream networks was performed using a simplified version of the process-based model Hill-Vi together with regional climate normals. The simulated networks were compared to mapped stream networks and their degree of spatial agreement was evaluated. Significant differences between good and poor simulations could be distinguished and the corresponding parameter sets relate well with the hydrogeological properties of the catchments. The optimized parameters were subsequently used to simulate daily discharge using an observed time series of precipitation and air temperature. The performance was evaluated against observed discharge and water balance. This approach shows some promising results but also some limitations. Although the model's parsimonious model structure should to be further improved regarding discharge recession and evapotranspiration, the performance was similar to the regionalisation methods. Stream network modelling, which has minimal data requirements, seems to be a reasonable alternative for model development and parameter evaluation in ungauged basins.

  2. 76 FR 46330 - NUREG-1934, Nuclear Power Plant Fire Modeling Application Guide (NPP FIRE MAG); Second Draft...

    Science.gov (United States)

    2011-08-02

    ... COMMISSION NUREG-1934, Nuclear Power Plant Fire Modeling Application Guide (NPP FIRE MAG); Second Draft... for public comment a document entitled, NUREG-1934 (EPRI 1023259), ``Nuclear Power Plant Fire Modeling... pdr.resource@nrc.gov . NUREG-1934 (EPRI 1023259), ``Nuclear Power Plant Fire Modeling...

  3. [Models of care and classification of "Children with special health care needs-CSHCN": Recommendations from the CSHCN Committee, Chilean Paediatric Society].

    Science.gov (United States)

    Flores Cano, Juan Carlos; Lizama Calvo, Macarena; Rodríguez Zamora, Natalie; Ávalos Anguita, María Eugenia; Galanti De La Paz, Mónica; Barja Yañez, Salesa; Becerra Flores, Carlos; Sanhueza Sepúlveda, Carolina; Cabezas Tamayo, Ana María; Orellana Welch, Jorge; Zillmann Geerdts, Gisela; Antilef, Rosa María; Cox Melane, Alfonso; Valle Maluenda, Marcelo; Vargas Catalán, Nelson

    2016-01-01

    "Children with special health care needs" (CSHCN) is an emerging and heterogeneous group of paediatric patients, with a wide variety of medical conditions and with different uses of health care services. There is consensus on how to classify and assess these patients according to their needs, but not for their specific diagnosis. Needs are classified into 6 areas: a) specialised medical care; b) use or need of prescription medication; c) special nutrition; d) dependence on technology; e) rehabilitation therapy for functional limitation; and f) special education services. From the evaluation of each area, a classification for CSHCN is proposed according to low, medium, or high complexity health needs, to guide and distribute their care at an appropriate level of the health care system. Low complexity CSHCN should be incorporated into Primary Care services, to improve benefits for patients and families at this level. It is critical to train health care professionals in taking care of CSHCN, promoting a coordinated, dynamic and communicated work between different levels of the health care system. Compliance with these guidelines will achieve a high quality and integrated care for this vulnerable group of children.

  4. WFR-2D: an analytical model for PWAS-generated 2D ultrasonic guided wave propagation

    Science.gov (United States)

    Shen, Yanfeng; Giurgiutiu, Victor

    2014-03-01

    This paper presents WaveFormRevealer 2-D (WFR-2D), an analytical predictive tool for the simulation of 2-D ultrasonic guided wave propagation and interaction with damage. The design of structural health monitoring (SHM) systems and self-aware smart structures requires the exploration of a wide range of parameters to achieve best detection and quantification of certain types of damage. Such need for parameter exploration on sensor dimension, location, guided wave characteristics (mode type, frequency, wavelength, etc.) can be best satisfied with analytical models which are fast and efficient. The analytical model was constructed based on the exact 2-D Lamb wave solution using Bessel and Hankel functions. Damage effects were inserted in the model by considering the damage as a secondary wave source with complex-valued directivity scattering coefficients containing both amplitude and phase information from wave-damage interaction. The analytical procedure was coded with MATLAB, and a predictive simulation tool called WaveFormRevealer 2-D was developed. The wave-damage interaction coefficients (WDICs) were extracted from harmonic analysis of local finite element model (FEM) with artificial non-reflective boundaries (NRB). The WFR-2D analytical simulation results were compared and verified with full scale multiphysics finite element models and experiments with scanning laser vibrometer. First, Lamb wave propagation in a pristine aluminum plate was simulated with WFR-2D, compared with finite element results, and verified by experiments. Then, an inhomogeneity was machined into the plate to represent damage. Analytical modeling was carried out, and verified by finite element simulation and experiments. This paper finishes with conclusions and suggestions for future work.

  5. The Model Standards Project: Creating Inclusive Systems for LGBT Youth in Out-of-Home Care

    Science.gov (United States)

    Wilber, Shannan; Reyes, Carolyn; Marksamer, Jody

    2006-01-01

    This article describes the Model Standards Project (MSP), a collaboration of Legal Services for Children and the National Center for Lesbian Rights. The MSP developed a set of model professional standards governing the care of lesbian, gay, bisexual and transgender (LGBT) youth in out-of-home care. This article provides an overview of the…

  6. A quality management model for integrated care: results of a Delphi and Concept Mapping study

    NARCIS (Netherlands)

    M. Minkman; K. Ahaus; I. Fabbricotti; U. Nabitz; R. Huijsman

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

  7. A quality management model for integrated care : results of a Delphi and Concept Mapping study

    NARCIS (Netherlands)

    Minkman, Mirella; Ahaus, Kees; Fabbricotti, Isabelle; Nabitz, Udo; Huijsman, Robbert

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

  8. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staffdagger

    NARCIS (Netherlands)

    Gameiro, S.; Boivin, J.; Dancet, E.; Klerk, C. de; Emery, M.; Lewis-Jones, C.; Thorn, P.; Broeck, U. Van den; Venetis, C.; Verhaak, C.M.; Wischmann, T.; Vermeulen, N.

    2015-01-01

    STUDY QUESTION: Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? SUMMARY ANSWER: Using the structured methodology of the Manual for the European Society of Human Repro

  9. Le «Chronic care model» en médecine de famille en Suisse

    OpenAIRE

    Steurer-Stey, C.; Frei, A; Rosemann, T

    2010-01-01

    The Chronic care model in Swiss primary care The care of patients with chronic disease is one of the most urgent medical challenges of actual society. The chronic care model (CCM) is an organizational, proactive approach for chronic disease in primary care. The system creates practical, supportive, evidence-based interactions between an informed, activated patient and a proactive practice team. CCM identifies six essential elements of high-quality health care : community ; heal...

  10. Challenges faced in Latin America for the implementation of an ideal health-care model for rheumatoid arthritis patients: are we ready?

    Science.gov (United States)

    Rodríguez Jaillier, Juan Carlos; Posada Arango, Ana María; Martínez Pérez, David Antonio

    2015-03-01

    Rheumatoid arthritis (RA) is a chronic, inflammatory, progressive disease characterized by inflammation of the synovial tissue. It results in the severe functional deterioration of the joints involved and the incapacity to work. Our main aim is to determine the characteristics of the current health-care models used in treating rheumatoid arthritis patients in Latin America. We want to analyze the details, using them as the foundation to create an ideal health-care model that is focused on the patient. We have revised documents, including guides to clinical practice, monitoring models and health-care models according to the current policies and resources available in various Latin American countries. Based on this information, the qualities and deficiencies of the current models will be analyzed, in order to use this as a basis on which to construct a proposed health-care model that covers the specific needs of rheumatoid arthritis patients, considering the resources of each population. Despite the collapse seen in many health systems throughout history, we can learn from them and should develop a new model starting from the path pursued, capitalizing on our experiences, teachings, and errors committed. However, in most cases, the obstacles to the success of the systems do not lie in the fundamental structure or the "spirit of the legislator" but rather in the day-to-day development within the community and the special interest of each agent in a system.

  11. Nurse Work Engagement Impacts Job Outcome and Nurse-Assessed Quality of Care: Model Testing with Nurse Practice Environment and Nurse Work Characteristics as Predictors

    Directory of Open Access Journals (Sweden)

    Peter Mathieu Van Bogaert

    2014-11-01

    Full Text Available Key words: burnout,job satisfaction, nurse retention, nurse practice environment,quality of care, acute health care,structural equation modelling. Aim:To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption.Background: Understanding to support and guide the practice community in their daily effort to answer most accurate complex care demands along with a stable nurse workforce are challenging.Design: Cross-sectional survey.Method:Based on previous empirical findings,a structural equation model designed with valid measurement instruments was tested.The study population was registered acute care hospital nurses(N = 1201 in twoindependent hospitals and one hospital group with six hospitals in Belgium.Results: Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care.Analyses were consistent with features of nurses’ work characteristics including perceived workload,decision latitude,and social capital,as well as three dimension of work engagement playing mediating roles between nurse practice environment and outcomes.A revised model adjusted using various fit measures explained 60 % and 47 % of job outcomes and nurse - assessed quality of care,respectively.Conclusion: Study findings show that aspects of nurse work characteristics such as workload,decision latitude and social capital along with nurse work engagement(e.g.vigor, dedication and absorption play a role between how various stakeholders such as executives,nurse managers and physicians will organize care and how nurses perceive job outcomes and quality of care.

  12. International care models for chronic kidney disease: methods and economics--United States.

    Science.gov (United States)

    Crooks, Peter

    2004-01-01

    In the United States, there is a major chronic kidney disease (CKD) problem with over 8 million adults having stage 3 or 4 CKD. There is good medical evidence that many of these patients can benefit from focused interventions. And while there are strong theoretical reasons to believe these interventions are cost-effective, there are little published data to back up this assertion. However, despite the lack of financial data proving cost-effectiveness and against the background of a disorganized health care system in the US, some models of CKD care are being employed. At the present time, the most comprehensive models of care in the US are emerging in vertically integrated health care programs. Other models of care are developing in the setting of managed care health plans that employ CKD disease management programs, either developed internally or in partnership with renal disease management companies.

  13. [A guide to good practice for information security in the handling of personal health data by health personnel in ambulatory care facilities].

    Science.gov (United States)

    Sánchez-Henarejos, Ana; Fernández-Alemán, José Luis; Toval, Ambrosio; Hernández-Hernández, Isabel; Sánchez-García, Ana Belén; Carrillo de Gea, Juan Manuel

    2014-04-01

    The appearance of electronic health records has led to the need to strengthen the security of personal health data in order to ensure privacy. Despite the large number of technical security measures and recommendations that exist to protect the security of health data, there is an increase in violations of the privacy of patients' personal data in healthcare organizations, which is in many cases caused by the mistakes or oversights of healthcare professionals. In this paper, we present a guide to good practice for information security in the handling of personal health data by health personnel, drawn from recommendations, regulations and national and international standards. The material presented in this paper can be used in the security audit of health professionals, or as a part of continuing education programs in ambulatory care facilities.

  14. LAPAROSCOPIC APPENDECTOMY AS A CARE MODEL OF "FAST TRACK SURGERY"

    Directory of Open Access Journals (Sweden)

    F. Ferrara

    2012-01-01

    Full Text Available "Fast track surgery" is a model of care pathway that is gradually replacing and incorporating all the other models so far applied in surgery. In particular, this is possible thanks to minimally invasive procedures widely disseminated for the several benefits they offer. The authors present a preliminary study of laparoscopic appendectomy using endo-GIA as a model of fast track surgery. At the Department of Pediatric Surgery of the University of Siena, from December 2008 to May 2009 were carried out 10 surgery procedures of laparoscopic appendectomy. Patients were subjected to emergency surgery for acute appendicitis diagnosed by clinical examination, laboratory tests and ultrasound study. The mean age was 10.8 years (range 7-14 years. All procedures were performed under general anesthesia with the patient in supine decubitus and using three trocars. The first 12 mm, was introduced through the umbilical incision with "open" approach, the second, 12 mm in the left iliac fossa and the third, 5 mm, in sovrapubic seat. In each patient the appendectomy was carried out with endo-GIA (a linear stapling device that can be used for the section of appendix and vessels. Results: Any patient needed to convert to “open surgery”. The duration of surgery procedure was in mean 80 minutes (range 60-90 minutes. In any case intraoperative complications were observed. In 1 patient (10% further surgery procedure with technique "open" was necessary due to presence of purulent exudate in peritoneal cavity, depending to severity of endo-abdominal infection. The hospitalization was in mean 4.3 days (range 3-10 days with intestinal canalization on the 1st post-operative day. Laparoscopic appendectomy is a feasible and safe method with advantages for patients such as lower incidence of septic complications (better toilet of peritoneal cavity and possible placement of drainage, reduced time of hospitalization and convalescence, better control of postoperative pain, and

  15. The Key Variables for the Development of a Care Model for Stroke

    Directory of Open Access Journals (Sweden)

    Stavrianopoulos T.

    2011-10-01

    Full Text Available Introduction Stroke is a major cause of death, threatened and reduced health, and a patient’s dependence on support after the acute phase. The increase in knowledge of neurological recovery after a stroke has led to new treatment strategies, where the importance of the physical environment and rehabilitation is on par with the importance of the medical treatment. It is crucial that the whole stroke team is involved in assessing, planning, and evaluating the care provided. Aim The presentation of the variables that are needed for the development of a general model of care for stroke. Material and Methods Method was used is to search electronic databases (MEDLINE, CINAHL for a review of international literature to 2009 and became selection of books, articles and studies from libraries. The search was done the December of 2010. Results The key variables to develop a model of care are: the care planning, the team culture, the care culture, the professional knowledge, the quality of space, the observation and assessment, the patient participation and the inter-professional teamwork. Conclusions The model presents stroke care as a complex system, with many feedback relationships between key variables for care. The development of the model, with the contributions of existing literature, enables further tests in practice and improvements in stroke care and further refinement of variables which include the model of care.

  16. Staged diabetes management. Toward an integrated model of diabetes care.

    Science.gov (United States)

    Mazze, R S; Etzwiler, D D; Strock, E; Peterson, K; McClave, C R; Meszaros, J F; Leigh, C; Owens, L W; Deeb, L C; Peterson, A

    1994-06-01

    This paper introduces a new and innovative approach to diabetes management in the primary-care setting. Staged diabetes management (SDM) represents a four-year effort to develop and test a data-based approach to diabetes management that could be easily adapted to a variety of health-care settings in which diabetes management is principally under the direction of primary-care physicians was limited access to specialists. After testing under controlled circumstances at the International Diabetes Center (Minneapolis, MN), SDM was subjected to substantial field trials under conditions that represent the scope and variety of primary-care practices in diabetes. The following represents the work of several investigators who independently undertook a review of SDM.

  17. Sea-level rise modeling handbook: Resource guide for coastal land managers, engineers, and scientists

    Science.gov (United States)

    Doyle, Thomas W.; Chivoiu, Bogdan; Enwright, Nicholas M.

    2015-08-24

    Global sea level is rising and may accelerate with continued fossil fuel consumption from industrial and population growth. In 2012, the U.S. Geological Survey conducted more than 30 training and feedback sessions with Federal, State, and nongovernmental organization (NGO) coastal managers and planners across the northern Gulf of Mexico coast to evaluate user needs, potential benefits, current scientific understanding, and utilization of resource aids and modeling tools focused on sea-level rise. In response to the findings from the sessions, this sea-level rise modeling handbook has been designed as a guide to the science and simulation models for understanding the dynamics and impacts of sea-level rise on coastal ecosystems. The review herein of decision-support tools and predictive models was compiled from the training sessions, from online research, and from publications. The purpose of this guide is to describe and categorize the suite of data, methods, and models and their design, structure, and application for hindcasting and forecasting the potential impacts of sea-level rise in coastal ecosystems. The data and models cover a broad spectrum of disciplines involving different designs and scales of spatial and temporal complexity for predicting environmental change and ecosystem response. These data and models have not heretofore been synthesized, nor have appraisals been made of their utility or limitations. Some models are demonstration tools for non-experts, whereas others require more expert capacity to apply for any given park, refuge, or regional application. A simplified tabular context has been developed to list and contrast a host of decision-support tools and models from the ecological, geological, and hydrological perspectives. Criteria were established to distinguish the source, scale, and quality of information input and geographic datasets; physical and biological constraints and relations; datum characteristics of water and land components

  18. Accelerating a Network Model of Care: Taking a Social Innovation to Scale

    Directory of Open Access Journals (Sweden)

    Kerry Byrne

    2012-07-01

    Full Text Available Government-funded systems of health and social care are facing enormous fiscal and human-resource challenges. The space for innovation in care is wide open and new disruptive patterns are emerging. These include self-management and personal budgets, participatory and integrated care, supported decision making and a renewed focus on prevention. Taking these disruptive patterns to scale can be accelerated by a technologically enabled shift to a network model of care to co-create the best outcomes for individuals, family caregivers, and health and social care organizations. The connections, relationships, and activities within an individual’s personal network lay the foundation for care that health and social care systems/policy must simultaneously support and draw on for positive outcomes. Practical tools, adequate information, and tangible resources are required to coordinate and sustain care. Tyze Personal Networks is a social venture that uses technology to engage and inform the individual, their personal networks, and their care providers to co-create the best outcomes. In this article, we demonstrate how Tyze contributes to a shift to a network model of care by strengthening our networks and enhancing partnerships between care providers, individuals, and family and friends.

  19. Object Segmentation Methods for Online Model Acquisition to Guide Robotic Grasping

    Science.gov (United States)

    Ignakov, Dmitri

    A vision system is an integral component of many autonomous robots. It enables the robot to perform essential tasks such as mapping, localization, or path planning. A vision system also assists with guiding the robot's grasping and manipulation tasks. As an increased demand is placed on service robots to operate in uncontrolled environments, advanced vision systems must be created that can function effectively in visually complex and cluttered settings. This thesis presents the development of segmentation algorithms to assist in online model acquisition for guiding robotic manipulation tasks. Specifically, the focus is placed on localizing door handles to assist in robotic door opening, and on acquiring partial object models to guide robotic grasping. First, a method for localizing a door handle of unknown geometry based on a proposed 3D segmentation method is presented. Following segmentation, localization is performed by fitting a simple box model to the segmented handle. The proposed method functions without requiring assumptions about the appearance of the handle or the door, and without a geometric model of the handle. Next, an object segmentation algorithm is developed, which combines multiple appearance (intensity and texture) and geometric (depth and curvature) cues. The algorithm is able to segment objects without utilizing any a priori appearance or geometric information in visually complex and cluttered environments. The segmentation method is based on the Conditional Random Fields (CRF) framework, and the graph cuts energy minimization technique. A simple and efficient method for initializing the proposed algorithm which overcomes graph cuts' reliance on user interaction is also developed. Finally, an improved segmentation algorithm is developed which incorporates a distance metric learning (DML) step as a means of weighing various appearance and geometric segmentation cues, allowing the method to better adapt to the available data. The improved method

  20. Knowledge-guided fuzzy logic modeling to infer cellular signaling networks from proteomic data

    Science.gov (United States)

    Liu, Hui; Zhang, Fan; Mishra, Shital Kumar; Zhou, Shuigeng; Zheng, Jie

    2016-01-01

    Modeling of signaling pathways is crucial for understanding and predicting cellular responses to drug treatments. However, canonical signaling pathways curated from literature are seldom context-specific and thus can hardly predict cell type-specific response to external perturbations; purely data-driven methods also have drawbacks such as limited biological interpretability. Therefore, hybrid methods that can integrate prior knowledge and real data for network inference are highly desirable. In this paper, we propose a knowledge-guided fuzzy logic network model to infer signaling pathways by exploiting both prior knowledge and time-series data. In particular, the dynamic time warping algorithm is employed to measure the goodness of fit between experimental and predicted data, so that our method can model temporally-ordered experimental observations. We evaluated the proposed method on a synthetic dataset and two real phosphoproteomic datasets. The experimental results demonstrate that our model can uncover drug-induced alterations in signaling pathways in cancer cells. Compared with existing hybrid models, our method can model feedback loops so that the dynamical mechanisms of signaling networks can be uncovered from time-series data. By calibrating generic models of signaling pathways against real data, our method supports precise predictions of context-specific anticancer drug effects, which is an important step towards precision medicine. PMID:27774993

  1. Health care policy reform: a microanalytic model for comparing hospitals in the United States and Germany.

    Science.gov (United States)

    Parsons, R J; Woller, G M; Neubauer, G; Rothaemel, F T; Zelle, B

    1999-01-01

    Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available, and these were similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.

  2. Systematic coarse graining flowing polymer melts: thermodynamically guided simulations and resulting constitutive model.

    Science.gov (United States)

    Iig, Patrick

    2011-01-01

    Complex fluids, such as polymers, colloids, liquid-crystals etc., show intriguing viscoelastic properties, due to the complicated interplay between flow-induced structure formation and dynamical behavior. Starting from microscopic models of complex fluids, a systematic coarse-graining method is presented that allows us to derive closed-form and thermodynamically consistent constitutive equations for such fluids. Essential ingredients of the proposed approach are thermodynamically guided simulations within a consistent coarse-graining scheme. In addition to this new type of multiscale simulations, we reconstruct the building blocks that constitute the thermodynamically consistent coarse-grained model. We illustrate the method for low-molecular polymer melts, which are subject to different imposed flow fields like planar shear and different elongational flows. The constitutive equation for general flow conditions we obtain shows rheological behavior including shear thinning, normal stress differences, and elongational viscosities in good agreement with reference results. PMID:21678766

  3. Expert-Guided Generative Topographical Modeling with Visual to Parametric Interaction.

    Science.gov (United States)

    Han, Chao; House, Leanna; Leman, Scotland C

    2016-01-01

    Introduced by Bishop et al. in 1996, Generative Topographic Mapping (GTM) is a powerful nonlinear latent variable modeling approach for visualizing high-dimensional data. It has shown useful when typical linear methods fail. However, GTM still suffers from drawbacks. Its complex parameterization of data make GTM hard to fit and sensitive to slight changes in the model. For this reason, we extend GTM to a visual analytics framework so that users may guide the parameterization and assess the data from multiple GTM perspectives. Specifically, we develop the theory and methods for Visual to Parametric Interaction (V2PI) with data using GTM visualizations. The result is a dynamic version of GTM that fosters data exploration. We refer to the new version as V2PI-GTM. In this paper, we develop V2PI-GTM in stages and demonstrate its benefits within the context of a text mining case study.

  4. Expert-Guided Generative Topographical Modeling with Visual to Parametric Interaction.

    Directory of Open Access Journals (Sweden)

    Chao Han

    Full Text Available Introduced by Bishop et al. in 1996, Generative Topographic Mapping (GTM is a powerful nonlinear latent variable modeling approach for visualizing high-dimensional data. It has shown useful when typical linear methods fail. However, GTM still suffers from drawbacks. Its complex parameterization of data make GTM hard to fit and sensitive to slight changes in the model. For this reason, we extend GTM to a visual analytics framework so that users may guide the parameterization and assess the data from multiple GTM perspectives. Specifically, we develop the theory and methods for Visual to Parametric Interaction (V2PI with data using GTM visualizations. The result is a dynamic version of GTM that fosters data exploration. We refer to the new version as V2PI-GTM. In this paper, we develop V2PI-GTM in stages and demonstrate its benefits within the context of a text mining case study.

  5. Laser generated guided waves and finite element modeling for the thickness gauging of thin layers

    International Nuclear Information System (INIS)

    In this paper, nondestructive testing has been performed on a thin gold layer deposited on a 2 in. silicon wafer. Guided waves were generated and studied using a laser ultrasonic setup and a two-dimensional fast Fourier transform technique was employed to obtain the dispersion curves. A gold layer thickness of 1.33 μm has been determined with a ±5% margin of error using the shape of the two first propagating modes, assuming for the substrate and the layer an uncertainty on the elastic parameters of ±2.5%. A finite element model has been implemented to validate the data post-treatment and the experimental results. A good agreement between the numerical simulation, the analytical modeling and the experimentations has been observed. This method was considered suitable for thickness layer higher than 0.7 μm.

  6. A roller chain drive model including contact with guide-bars

    DEFF Research Database (Denmark)

    Pedersen, Sine Leergaard; Hansen, John Michael; Ambrósio, J. A. C.

    2004-01-01

    and continuous force methods, respectively. In the unilateral constraint methodology the kinematic constraints are introduced in the system anytime a contact between the rollers and the sprockets is detected. The condition for the constraint addition is based on the relative distance between the roller centre....... The methodology is implemented in a computational code to study the dynamics of the drive, including the chain flexibility, transversal and longitudinal vibrations and contact forces between the chain and sprockets. The models proposed effectively represent the polygonal effect, always present in this type...... of drives, and therefore, all vibration dynamics associated to it. The inclusion of the guide-bars allows the usage of the chain drive model in situations relevant for implementation of the real diesel engines in large maritime vessels....

  7. Expert-Guided Generative Topographical Modeling with Visual to Parametric Interaction.

    Science.gov (United States)

    Han, Chao; House, Leanna; Leman, Scotland C

    2016-01-01

    Introduced by Bishop et al. in 1996, Generative Topographic Mapping (GTM) is a powerful nonlinear latent variable modeling approach for visualizing high-dimensional data. It has shown useful when typical linear methods fail. However, GTM still suffers from drawbacks. Its complex parameterization of data make GTM hard to fit and sensitive to slight changes in the model. For this reason, we extend GTM to a visual analytics framework so that users may guide the parameterization and assess the data from multiple GTM perspectives. Specifically, we develop the theory and methods for Visual to Parametric Interaction (V2PI) with data using GTM visualizations. The result is a dynamic version of GTM that fosters data exploration. We refer to the new version as V2PI-GTM. In this paper, we develop V2PI-GTM in stages and demonstrate its benefits within the context of a text mining case study. PMID:26905728

  8. Vision-guided ocular growth in a mutant chicken model with diminished visual acuity.

    Science.gov (United States)

    Ritchey, Eric R; Zelinka, Christopher; Tang, Junhua; Liu, Jun; Code, Kimberly A; Petersen-Jones, Simon; Fischer, Andy J

    2012-09-01

    Visual experience is known to guide ocular growth. We tested the hypothesis that vision-guided ocular growth is disrupted in a model system with diminished visual acuity. We examine whether ocular elongation is influenced by form-deprivation (FD) and lens-imposed defocus in the Retinopathy, Globe Enlarged (RGE) chicken. Young RGE chicks have poor visual acuity, without significant retinal pathology, resulting from a mutation in guanine nucleotide-binding protein β3 (GNB3), also known as transducin β3 or Gβ3. The mutation in GNB3 destabilizes the protein and causes a loss of Gβ3 from photoreceptors and ON-bipolar cells (Ritchey et al., 2010). FD increased ocular elongation in RGE eyes in a manner similar to that seen in wild-type (WT) eyes. By comparison, the excessive ocular elongation that results from hyperopic defocus was increased, whereas myopic defocus failed to significantly decrease ocular elongation in RGE eyes. Brief daily periods of unrestricted vision interrupting FD prevented ocular elongation in RGE chicks in a manner similar to that seen in WT chicks. Glucagonergic amacrine cells differentially expressed the immediate early gene Egr1 in response to growth-guiding stimuli in RGE retinas, but the defocus-dependent up-regulation of Egr1 was lesser in RGE retinas compared to that of WT retinas. We conclude that high visual acuity, and the retinal signaling mediated by Gβ3, is not required for emmetropization and the excessive ocular elongation caused by FD and hyperopic defocus. However, the loss of acuity and Gβ3 from RGE retinas causes enhanced responses to hyperopic defocus and diminished responses to myopic defocus.

  9. iGuide to plastic surgery: iPhone apps, the plastic surgeon, and the health care environment.

    Science.gov (United States)

    Mohan, Anita Tanniru; Branford, Olivier Alexandre

    2012-07-01

    The growth in the adoption of smartphones among clinicians has been phenomenal. The demand for medical applications, or "apps," downloaded by smartphone users has led to the development of practical and educational apps for clinicians, medical students, and patients. In addition to being a valuable resource for the clinician, mobile technologies are revolutionizing the nature and delivery of health care services. This article summarizes the current trends in the smartphone market and explores the medical apps that are currently available. PMID:22628896

  10. iGuide to plastic surgery: iPhone apps, the plastic surgeon, and the health care environment.

    Science.gov (United States)

    Mohan, Anita Tanniru; Branford, Olivier Alexandre

    2012-07-01

    The growth in the adoption of smartphones among clinicians has been phenomenal. The demand for medical applications, or "apps," downloaded by smartphone users has led to the development of practical and educational apps for clinicians, medical students, and patients. In addition to being a valuable resource for the clinician, mobile technologies are revolutionizing the nature and delivery of health care services. This article summarizes the current trends in the smartphone market and explores the medical apps that are currently available.

  11. NHF-McMaster Guideline on Care Models for Haemophilia Management.

    Science.gov (United States)

    Pai, M; Key, N S; Skinner, M; Curtis, R; Feinstein, M; Kessler, C; Lane, S J; Makris, M; Riker, E; Santesso, N; Soucie, J M; Yeung, C H T; Iorio, A; Schünemann, H J

    2016-07-01

    This guideline was developed to identify evidence-based best practices in haemophilia care delivery, and discuss the range of care providers and services that are most important to optimize outcomes for persons with haemophilia (PWH) across the United States. The guideline was developed following specific methods described in detail in this supplement and based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation approach). Direct evidence from published literature and the haemophilia community, as well as indirect evidence from other chronic diseases, were reviewed, synthesized and applied to create evidence-based recommendations. The Guideline panel suggests that the integrated care model be used over non-integrated care models for PWH (conditional recommendation, moderate certainty in the evidence). For PWH with inhibitors and those at high risk for inhibitor development, the same recommendation was graded as strong, with moderate certainty in the evidence. The panel suggests that a haematologist, a specialized haemophilia nurse, a physical therapist, a social worker and round-the-clock access to a specialized coagulation laboratory be part of the integrated care team, over an integrated care team that does not include all of these components (conditional recommendation, very low certainty in the evidence). Based on available evidence, the integrated model of care in its current structure, is suggested for optimal care of PWH. There is a need for further appropriately designed studies that address unanswered questions about specific outcomes and the optimal structure of the integrated care delivery model in haemophilia. PMID:27348396

  12. Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care.

    Science.gov (United States)

    Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S

    2015-07-01

    In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided. PMID:25803647

  13. A finite state model for respiratory motion analysis in image guided radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Wu Huanmei [College of Computer and Information Science, Northeastern University, Boston, MA 02115 (United States); Sharp, Gregory C [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States); Salzberg, Betty [College of Computer and Information Science, Northeastern University, Boston, MA 02115 (United States); Kaeli, David [Department of Electrical and Computer Engineering, Northeastern University, Boston, MA 02115 (United States); Shirato, Hiroki [Department of Radiation Medicine, Hokkaido University School of Medicine, Sapporo (Japan); Jiang, Steve B [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)

    2004-12-07

    Effective image guided radiation treatment of a moving tumour requires adequate information on respiratory motion characteristics. For margin expansion, beam tracking and respiratory gating, the tumour motion must be quantified for pretreatment planning and monitored on-line. We propose a finite state model for respiratory motion analysis that captures our natural understanding of breathing stages. In this model, a regular breathing cycle is represented by three line segments, exhale, end-of-exhale and inhale, while abnormal breathing is represented by an irregular breathing state. In addition, we describe an on-line implementation of this model in one dimension. We found this model can accurately characterize a wide variety of patient breathing patterns. This model was used to describe the respiratory motion for 23 patients with peak-to-peak motion greater than 7 mm. The average root mean square error over all patients was less than 1 mm and no patient has an error worse than 1.5 mm. Our model provides a convenient tool to quantify respiratory motion characteristics, such as patterns of frequency changes and amplitude changes, and can be applied to internal or external motion, including internal tumour position, abdominal surface, diaphragm, spirometry and other surrogates.

  14. Hydro-economic modeling of conjunctive ground and surface water use to guide sustainable basin management

    Science.gov (United States)

    Taher Kahil, Mohamed; Ward, Frank A.; Albiac, Jose; Eggleston, Jack; Sanz, David

    2016-04-01

    Water demands for irrigation, urban and environmental uses in arid and semiarid regions continue to grow, while freshwater supplies from surface and groundwater resources are becoming scarce and are expected to decline with climate change. Policymakers in these regions face hard choices on water management and policies. Hydro-economic modeling is the state-of-the art tool that could be used to guide the design and implementation of sustainable water management policies in basins. The strength of hydro-economic modeling lies in its capacity to integrate key biophysical and socio-economic components within a unified framework. A major gap in developments on hydro-economic modeling to date has been the weak integration of surface and groundwater flows, based on the theoretically correct Darcy equations used by the hydrogeological community. The modeling approach taken here is integrated, avoiding the single-tank aquifer assumption, avoiding simplified assumptions on aquifer-river linkages, and bypassing iterations among separate hydrological and economic models. The groundwater flow formulation used in this paper harnesses the standard finite difference expressions for groundwater flow and groundwater-surface water exchange developed in the USGS MODFLOW groundwater model. The methodological contribution to previous modeling efforts is the explicit specification of aquifer-river interactions, important when aquifer systems make a sizable contribution to basin resources. The modeling framework is solved completely, and information among the economic and hydrological components over all periods and locations are jointly and simultaneously determined. This novel framework is applied to the Jucar basin (Spain), which is a good experimental region for an integrated basin scale analysis. The framework is used for assessing the impacts of a range of climate change scenarios and policy choices, especially the hydrologic, land use, and economic outcomes. The modeling framework

  15. Three-dimensional finite element modeling of guided ultrasound wave propagation in intact and healing long bones.

    Science.gov (United States)

    Protopappas, Vasilios C; Kourtis, Iraklis C; Kourtis, Lampros C; Malizos, Konstantinos N; Massalas, Christos V; Fotiadis, Dimitrios I

    2007-06-01

    The use of guided waves has recently drawn significant interest in the ultrasonic characterization of bone aiming at supplementing the information provided by traditional velocity measurements. This work presents a three-dimensional finite element study of guided wave propagation in intact and healing bones. A model of the fracture callus was constructed and the healing course was simulated as a three-stage process. The dispersion of guided modes generated by a broadband 1-MHz excitation was represented in the time-frequency domain. Wave propagation in the intact bone model was first investigated and comparisons were then made with a simplified geometry using analytical dispersion curves of the tube modes. Then, the effect of callus consolidation on the propagation characteristics was examined. It was shown that the dispersion of guided waves was significantly influenced by the irregularity and anisotropy of the bone. Also, guided waves were sensitive to material and geometrical changes that take place during healing. Conversely, when the first-arriving signal at the receiver corresponded to a nondispersive lateral wave, its propagation velocity was almost unaffected by the elastic symmetry and geometry of the bone and also could not characterize the callus tissue throughout its thickness. In conclusion, guided waves can enhance the capabilities of ultrasonic evaluation. PMID:17552737

  16. Image-Guided Cryoablation of the Spine in a Swine Model: Clinical, Radiological, and Pathological Findings with Light and Electron Microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Freitas, Ricardo Miguel Costa de, E-mail: ricardomcfreitas@gmail.com; Andrade, Celi Santos, E-mail: celis.andrade@hotmail.com; Caldas, José Guilherme Mendes Pereira, E-mail: jgmpcaldas@uol.com.br [Faculdade de Medicina da Universidade de São Paulo, Department of Radiology, Interventional Radiology Unit of the Instituto de Radiologia (Brazil); Tsunemi, Miriam Harumi, E-mail: miharumi@gmail.com [Universidade Estadual Paulista Júlio de Mesquita Filho, Department of Biostatistics, Biosciences Institute (Brazil); Ferreira, Lorraine Braga, E-mail: lorraine.braga@gmail.com; Arana-Chavez, Victor Elias, E-mail: vearana@usp.br [Faculdade de Odontologia da Universidade de São Paulo, Department of Oral Pathology (Brazil); Cury, Patrícia Maluf, E-mail: pmcury@hotmail.com [Faculdade de Medicina de São José do Rio Preto, Department of Pathology and Forensic Medicine (Brazil)

    2015-10-15

    PurposeThis study was designed to present the feasibility of an in vivo image-guided percutaneous cryoablation of the porcine vertebral body.MethodsThe institutional animal care committee approved this study. Cone-beam computed tomography (CBCT)-guided vertebral cryoablations (n = 22) were performed in eight pigs with short, 2-min, single or double-freezing protocols. Protective measures to nerves included dioxide carbon (CO{sub 2}) epidural injections and spinal canal temperature monitoring. Clinical, radiological, and pathological data with light (n = 20) or transmission electron (n = 2) microscopic analyses were evaluated after 6 days of clinical follow-up and euthanasia.ResultsCBCT/fluoroscopic-guided transpedicular vertebral body cryoprobe positioning and CO{sub 2} epidural injection were successful in all procedures. No major complications were observed in seven animals (87.5 %, n = 8). A minor complication was observed in one pig (12.5 %, n = 1). Logistic regression model analysis showed the cryoprobe-spinal canal (Cp-Sc) distance as the most efficient parameter to categorize spinal canal temperatures lower than 19 °C (p < 0.004), with a significant Pearson’s correlation test (p < 0.041) between the Cp-Sc distance and the lowest spinal canal temperatures. Ablation zones encompassed pedicles and the posterior wall of the vertebral bodies with an inflammatory rim, although no inflammatory infiltrate was depicted in the surrounding neural structures at light microscopy. Ultrastructural analyses evidenced myelin sheath disruption in some large nerve fibers, although neurological deficits were not observed.ConclusionsCBCT-guided vertebral cryoablation of the porcine spine is feasible under a combination of a short freezing protocol and protective measures to the surrounding nerves. Ultrastructural analyses may be helpful assess the early modifications of the nerve fibers.

  17. Image-Guided Cryoablation of the Spine in a Swine Model: Clinical, Radiological, and Pathological Findings with Light and Electron Microscopy

    International Nuclear Information System (INIS)

    PurposeThis study was designed to present the feasibility of an in vivo image-guided percutaneous cryoablation of the porcine vertebral body.MethodsThe institutional animal care committee approved this study. Cone-beam computed tomography (CBCT)-guided vertebral cryoablations (n = 22) were performed in eight pigs with short, 2-min, single or double-freezing protocols. Protective measures to nerves included dioxide carbon (CO2) epidural injections and spinal canal temperature monitoring. Clinical, radiological, and pathological data with light (n = 20) or transmission electron (n = 2) microscopic analyses were evaluated after 6 days of clinical follow-up and euthanasia.ResultsCBCT/fluoroscopic-guided transpedicular vertebral body cryoprobe positioning and CO2 epidural injection were successful in all procedures. No major complications were observed in seven animals (87.5 %, n = 8). A minor complication was observed in one pig (12.5 %, n = 1). Logistic regression model analysis showed the cryoprobe-spinal canal (Cp-Sc) distance as the most efficient parameter to categorize spinal canal temperatures lower than 19 °C (p < 0.004), with a significant Pearson’s correlation test (p < 0.041) between the Cp-Sc distance and the lowest spinal canal temperatures. Ablation zones encompassed pedicles and the posterior wall of the vertebral bodies with an inflammatory rim, although no inflammatory infiltrate was depicted in the surrounding neural structures at light microscopy. Ultrastructural analyses evidenced myelin sheath disruption in some large nerve fibers, although neurological deficits were not observed.ConclusionsCBCT-guided vertebral cryoablation of the porcine spine is feasible under a combination of a short freezing protocol and protective measures to the surrounding nerves. Ultrastructural analyses may be helpful assess the early modifications of the nerve fibers

  18. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    Science.gov (United States)

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  19. Implementing a stepped-care approach in primary care: results of a qualitative study.

    NARCIS (Netherlands)

    Franx, G.C.; Oud, M.; Lange, J.; Wensing, M.J.; Grol, R.P.

    2012-01-01

    BACKGROUND: Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC) was initiated in t

  20. PREDICTING ATTENUATION OF VIRUSES DURING PERCOLATION IN SOILS: 2. USER'S GUIDE TO THE VIRULO 1.0 COMPUTER MODEL

    Science.gov (United States)

    In the EPA document Predicting Attenuation of Viruses During Percolation in Soils 1. Probabilistic Model the conceptual, theoretical, and mathematical foundations for a predictive screening model were presented. In this current volume we present a User's Guide for the computer mo...

  1. Analysis on pressure characteristics of pump turbine guide bearing rotating sump based on VOF model

    International Nuclear Information System (INIS)

    With the technology of Computational Fluid Dynamics (CFD), this paper conducts a 3D numerical simulation for the oil and gas flow field in the Pump turbine guide bearing rotating sump. VOF model is adopted in this simulation. This study calculates distribution of the oil-air phase and characteristics of the pressure. The influence of sump rotating speed, oil level and oil viscosity on the pressure at the inlet of oil-immersion plate are discussed. The results demonstrate that the static pressure at the inlet is roughly proportional to oil level. Too low level may result in the separation between lubrication oil and supply hole on the oil-immersion plate, which then disables the oil supply. The static pressure at the inlet increases parabola as the sump rotating speed increases. To ensure the supply pressure, the unit is not suitable for long time operation under low rotating speed. The temperature-viscosity effect of the lubricant oil has little influence on the oil pressure at the supply hole. This paper provides a theoretical base for the safe design and operation of the pump turbine rotating sump, and offers the inlet boundary condition for the analysis of the oil film dynamic characteristics of the turbine guide bearing

  2. Paying for Primary Care: The Factors Associated with Physician Self-selection into Payment Models.

    Science.gov (United States)

    Rudoler, David; Deber, Raisa; Barnsley, Janet; Glazier, Richard H; Dass, Adrian Rohit; Laporte, Audrey

    2015-09-01

    To determine the factors associated with primary care physician self-selection into different payment models, we used a panel of eight waves of administrative data for all primary care physicians who practiced in Ontario between 2003/2004 and 2010/2011. We used a mixed effects logistic regression model to estimate physicians' choice of three alternative payment models: fee for service, enhanced fee for service, and blended capitation. We found that primary care physicians self-selected into payment models based on existing practice characteristics. Physicians with more complex patient populations were less likely to switch into capitation-based payment models where higher levels of effort were not financially rewarded. These findings suggested that investigations aimed at assessing the impact of different primary care reimbursement models on outcomes, including costs and access, should first account for potential selection effects. PMID:26190516

  3. Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions

    OpenAIRE

    Leppin, Aaron L; Victor M Montori; Gionfriddo, Michael R

    2015-01-01

    An increasing proportion of healthcare resources in the United States are directed toward an expanding group of complex and multimorbid patients. Federal stakeholders have called for new models of care to meet the needs of these patients. Minimally Disruptive Medicine (MDM) is a theory-based, patient-centered, and context-sensitive approach to care that focuses on achieving patient goals for life and health while imposing the smallest possible treatment burden on patients’ lives. The MDM Care...

  4. Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

    OpenAIRE

    Shantanu Nundy; Jonathan J. Dick; Goddu, Anna P.; Patrick Hogan; Lu, Chen-Yuan E.; Solomon, Marla C; Arnell Bussie; Chin, Marshall H; Peek, Monica E.

    2012-01-01

    Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot...

  5. Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: 'the Belgian experience'

    OpenAIRE

    Van Royen Paul; Vermeire Etienne; Wens Johan; Nobels Frank; Snauwaert Boris; Feyen Luc; Bastiaens Hilde; Sunaert Patricia; De Maeseneer Jan; De Sutter An; Willems Sara

    2009-01-01

    Abstract Background Most research publications on Chronic Care Model (CCM) implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Bel...

  6. A new model of care collaboration for community-dwelling elders: findings and lessons learned from the NORC-health care linkage evaluation

    OpenAIRE

    Kyriacou, Corinne

    2009-01-01

    Purpose Providing care for older individuals with chronic illnesses in the community requires a model of service delivery that takes into account both physical health and social health needs. However, packaging care in this way does not fit into existing service or reimbursement structures in the US, and there are few financial incentives that encourage service coordination. Lack of coordinated care can negatively affect access to high quality, appropriate care, putting seniors' physical and ...

  7. A Prospective Validation Study of a Rainbow Model of Integrated Care Measurement Tool in Singapore

    Directory of Open Access Journals (Sweden)

    Milawaty Nurjono

    2016-01-01

    Full Text Available Introduction: The conceptual ambiguity of the integrated care concept precludes a full understanding of what constitutes a well-integrated health system, posing a significant challenge in measuring the level of integrated care. Most available measures have been developed from a disease-specific perspective and only measure certain aspects of integrated care. Based on the Rainbow Model of Integrated Care, which provides a detailed description of the complex concept of integrated care, a measurement tool has been developed to assess integrated care within a care system as a whole gathered from healthcare providers’ and managerial perspectives. This paper describes the methodology of a study seeking to validate the Rainbow Model of Integrated Care measurement tool within and across the Singapore Regional Health System. The Singapore Regional Health System is a recent national strategy developed to provide a better-integrated health system to deliver seamless and person-focused care to patients through a network of providers within a specified geographical region. Methods: The validation process includes the assessment of the content of the measure and its psychometric properties. Conclusion: If the measure is deemed to be valid, the study will provide the first opportunity to measure integrated care within Singapore Regional Health System with the results allowing insights in making recommendations for improving the Regional Health System and supporting international comparison.

  8. The Development of a National Curriculum Guide for Persian: Themes, Genres, Standards-based Goals, and Models

    Directory of Open Access Journals (Sweden)

    Nicole Mills

    2014-08-01

    Full Text Available Wang (2009 has challenged foreign language scholars to “engage in rigorous discussions to develop language-specific examples and performance indicators to guide program development and decision-making for less commonly taught language (LCTL instructors” (p. 284. The 2011-2012 STARTALK programs in Persian aimed to encourage such rigorous discussion through the development of a National Curriculum Guide in Persian. Persian professionals explored current theories in second language acquisition, examined curricular resources and models, and shared successful teaching materials. This article describes the rationale, procedures, and outcomes of a series of faculty development events that aimed to create a model for curriculum development for the LCTLs and, perhaps, also for other language programs in the context of higher education. The final curriculum guide produced by the program participants includes overarching themes and genres, Standards-based goals, strategies for authentic assessment, and model unit plans.

  9. User Guide for the International Jobs and Economic Development Impacts Model

    Energy Technology Data Exchange (ETDEWEB)

    Keyser, David [National Renewable Energy Lab. (NREL), Golden, CO (United States); Flores-Espino, Francisco [National Renewable Energy Lab. (NREL), Golden, CO (United States); Uriarte, Caroline [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cox, Sadie [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-09-01

    The International Jobs and Economic Development Impacts (I-JEDI) model is a freely available economic model that estimates gross economic impacts from wind, solar, and geothermal energy projects for several different countries. Building on the original JEDI model, which was developed for the United States, I-JEDI was developed under the USAID Enhancing Capacity for Low Emission Development Strategies (EC-LEDS) program to support countries in assessing economic impacts of LEDS actions in the energy sector. I-JEDI estimates economic impacts by characterizing the construction and operation of energy projects in terms of expenditures and the portion of these expenditures made within the country of analysis. These data are then used in a country-specific input-output (I-O) model to estimate employment, earnings, gross domestic product (GDP), and gross output impacts. Total economic impacts are presented as well as impacts by industry. This user guide presents general information about how to use I-JEDI and interpret results as well as detailed information about methodology and model limitations.

  10. Repository Integration Program: RIP performance assessment and strategy evaluation model theory manual and user's guide

    International Nuclear Information System (INIS)

    This report describes the theory and capabilities of RIP (Repository Integration Program). RIP is a powerful and flexible computational tool for carrying out probabilistic integrated total system performance assessments for geologic repositories. The primary purpose of RIP is to provide a management tool for guiding system design and site characterization. In addition, the performance assessment model (and the process of eliciting model input) can act as a mechanism for integrating the large amount of available information into a meaningful whole (in a sense, allowing one to keep the ''big picture'' and the ultimate aims of the project clearly in focus). Such an integration is useful both for project managers and project scientists. RIP is based on a '' top down'' approach to performance assessment that concentrates on the integration of the entire system, and utilizes relatively high-level descriptive models and parameters. The key point in the application of such a ''top down'' approach is that the simplified models and associated high-level parameters must incorporate an accurate representation of their uncertainty. RIP is designed in a very flexible manner such that details can be readily added to various components of the model without modifying the computer code. Uncertainty is also handled in a very flexible manner, and both parameter and model (process) uncertainty can be explicitly considered. Uncertainty is propagated through the integrated PA model using an enhanced Monte Carlo method. RIP must rely heavily on subjective assessment (expert opinion) for much of its input. The process of eliciting the high-level input parameters required for RIP is critical to its successful application. As a result, in order for any project to successfully apply a tool such as RIP, an enormous amount of communication and cooperation must exist between the data collectors, the process modelers, and the performance. assessment modelers

  11. Understanding the implementation of complex interventions in health care: the normalization process model

    OpenAIRE

    Rogers Anne; Rapley Tim; Murray Elizabeth; MacFarlane Anne; Gask Linda; Eccles Martin; Dowrick Christopher; Ballini Luciana; Mair Frances; Finch Tracy; May Carl; Treweek Shaun; Wallace Paul; Anderson George; Burns Jo

    2007-01-01

    Abstract Background The Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice. Methods A formal theory structure is used to define the model, and its in...

  12. Exploring implementation and sustainability of models of care: can theory help?

    OpenAIRE

    Forster Della A; Newton Michelle; McLachlan Helen L; Willis Karen

    2011-01-01

    Abstract Objective Research on new models of care in health service provision is complex, as is the introduction and embedding of such models, and positive research findings are only one factor in whether a new model of care will be implemented. In order to understand why this is the case, research design must not only take account of proposed changes in the clinical encounter, but the organisational context that must sustain and normalise any changed practices. We use two case studies where ...

  13. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program

    Directory of Open Access Journals (Sweden)

    Francisco J. Ramos-Gomez

    2014-01-01

    Full Text Available The Affordable Care Act (ACA mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0–5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC, and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance “in health” not in “disease modality”. IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the “age-one visit”. This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children.

  14. Model of learning for practitioners in dementia care with music therapy as the joint focal point

    DEFF Research Database (Denmark)

    Ottesen, Aase Marie

    of tangible tools from the musical activities? And further: What impact does the emphasis on development of the care provider’s musical and interpersonal competencies have on quality of life and well-being among persons suffering from dementia? The model of learning includes using the Dementia Care Mapping...... results indicate that the care providers are able to develop and transfer new knowledge and acquired skills to the daily nursing and care through the application of tangible tools from the musical activities, which has an effect on quality of life and wellbeing for persons suffering from dementia.......Abstract to the 21st Nordic Congress of Gerontology in June 10th - 13th, 2012 Title Model of learning for practitioners in dementia care with music therapy as the joint focal point The project is a PhD research in progress, which aims to develop a model of learning for practitioners in dementia...

  15. Community Land Model Version 3.0 (CLM3.0) Developer's Guide

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, FM

    2004-12-21

    This document describes the guidelines adopted for software development of the Community Land Model (CLM) and serves as a reference to the entire code base of the released version of the model. The version of the code described here is Version 3.0 which was released in the summer of 2004. This document, the Community Land Model Version 3.0 (CLM3.0) User's Guide (Vertenstein et al., 2004), the Technical Description of the Community Land Model (CLM) (Oleson et al., 2004), and the Community Land Model's Dynamic Global Vegetation Model (CLM-DGVM): Technical Description and User's Guide (Levis et al., 2004) provide the developer, user, or researcher with details of implementation, instructions for using the model, a scientific description of the model, and a scientific description of the Dynamic Global Vegetation Model integrated with CLM respectively. The CLM is a single column (snow-soil-vegetation) biogeophysical model of the land surface which can be run serially (on a laptop or personal computer) or in parallel (using distributed or shared memory processors or both) on both vector and scalar computer architectures. Written in Fortran 90, CLM can be run offline (i.e., run in isolation using stored atmospheric forcing data), coupled to an atmospheric model (e.g., the Community Atmosphere Model (CAM)), or coupled to a climate system model (e.g., the Community Climate System Model Version 3 (CCSM3)) through a flux coupler (e.g., Coupler 6 (CPL6)). When coupled, CLM exchanges fluxes of energy, water, and momentum with the atmosphere. The horizontal land surface heterogeneity is represented by a nested subgrid hierarchy composed of gridcells, landunits, columns, and plant functional types (PFTs). This hierarchical representation is reflected in the data structures used by the model code. Biophysical processes are simulated for each subgrid unit (landunit, column, and PFT) independently, and prognostic variables are maintained for each subgrid unit

  16. Compassionate Accountability in Residential Care: A Trauma Informed Model

    Science.gov (United States)

    Cimmarusti, Rocco A.; Gamero, Soe L.

    2009-01-01

    This article examines techniques for holding youth in residential care accountable for their behavior. Based on the use of trauma treatment theory, the authors believe that holding one accountable can actually be conceptualized and put into practice as a nurturing operation. For traumatized individuals, more traditional approaches to…

  17. A GPU-accelerated cortical neural network model for visually guided robot navigation.

    Science.gov (United States)

    Beyeler, Michael; Oros, Nicolas; Dutt, Nikil; Krichmar, Jeffrey L

    2015-12-01

    Humans and other terrestrial animals use vision to traverse novel cluttered environments with apparent ease. On one hand, although much is known about the behavioral dynamics of steering in humans, it remains unclear how relevant perceptual variables might be represented in the brain. On the other hand, although a wealth of data exists about the neural circuitry that is concerned with the perception of self-motion variables such as the current direction of travel, little research has been devoted to investigating how this neural circuitry may relate to active steering control. Here we present a cortical neural network model for visually guided navigation that has been embodied on a physical robot exploring a real-world environment. The model includes a rate based motion energy model for area V1, and a spiking neural network model for cortical area MT. The model generates a cortical representation of optic flow, determines the position of objects based on motion discontinuities, and combines these signals with the representation of a goal location to produce motor commands that successfully steer the robot around obstacles toward the goal. The model produces robot trajectories that closely match human behavioral data. This study demonstrates how neural signals in a model of cortical area MT might provide sufficient motion information to steer a physical robot on human-like paths around obstacles in a real-world environment, and exemplifies the importance of embodiment, as behavior is deeply coupled not only with the underlying model of brain function, but also with the anatomical constraints of the physical body it controls. PMID:26494281

  18. A GPU-accelerated cortical neural network model for visually guided robot navigation.

    Science.gov (United States)

    Beyeler, Michael; Oros, Nicolas; Dutt, Nikil; Krichmar, Jeffrey L

    2015-12-01

    Humans and other terrestrial animals use vision to traverse novel cluttered environments with apparent ease. On one hand, although much is known about the behavioral dynamics of steering in humans, it remains unclear how relevant perceptual variables might be represented in the brain. On the other hand, although a wealth of data exists about the neural circuitry that is concerned with the perception of self-motion variables such as the current direction of travel, little research has been devoted to investigating how this neural circuitry may relate to active steering control. Here we present a cortical neural network model for visually guided navigation that has been embodied on a physical robot exploring a real-world environment. The model includes a rate based motion energy model for area V1, and a spiking neural network model for cortical area MT. The model generates a cortical representation of optic flow, determines the position of objects based on motion discontinuities, and combines these signals with the representation of a goal location to produce motor commands that successfully steer the robot around obstacles toward the goal. The model produces robot trajectories that closely match human behavioral data. This study demonstrates how neural signals in a model of cortical area MT might provide sufficient motion information to steer a physical robot on human-like paths around obstacles in a real-world environment, and exemplifies the importance of embodiment, as behavior is deeply coupled not only with the underlying model of brain function, but also with the anatomical constraints of the physical body it controls.

  19. Modeling of pulsed laser guide stars for the Thirty Meter Telescope project

    CERN Document Server

    Rochester, S M; Boyer, C; Budker, D; Ellerbroek, B; Holzlöhner, R; Wang, L

    2012-01-01

    The Thirty Meter Telescope (TMT) has been designed to include an adaptive optics system and associated laser guide star (LGS) facility to correct for the image distortion due to Earth's atmospheric turbulence and achieve diffraction-limited imaging. We have calculated the response of mesospheric sodium atoms to a pulsed laser that has been proposed for use in the LGS facility, including modeling of the atomic physics, the light-atom interactions, and the effect of the geomagnetic field and atomic collisions. This particular pulsed laser format is shown to provide comparable photon return to a continuous-wave (cw) laser of the same average power; both the cw and pulsed lasers have the potential to satisfy the TMT design requirements for photon return flux.

  20. Rainfall-runoff modelling in northern Australia: A guide to modelling strategies in the tropics

    Science.gov (United States)

    Petheram, C.; Rustomji, P.; Chiew, F. H. S.; Vleeshouwer, J.

    2012-09-01

    SummaryA prolonged drought across southern Australia has led to renewed interest in water resource development of northern Australia, and to increased demand for runoff predictions from ungauged catchments in Australia's tropics. In contrast to more temperate settings where there is a plethora of rainfall-runoff modelling studies, the world's tropical regions, including those of Australia, have received little attention and thus the predictive skill of various rainfall-runoff models and methods in tropical basins is less known. Using data from 105 catchments in tropical Australia, five daily rainfall-runoff models and three methods of regionalising model parameters were compared. When locally calibrated, the more complex rainfall-runoff models performed best. However, when the models were used to predict streamflow in 'ungauged' catchments the differences in model performance was negligible. The adoption of multiple criteria to select an optimal parameter set resulted in an improved ability to simulate low-flows with no loss in predictive capacity for higher flows. An 'informed' transposition of parameter sets from gauged to ungauged catchments was better than random assignment of intact parameter sets for medium to high-flows, but not for low-flows. Assigning model parameters on the basis of spatial proximity outperformed physical similarity methods, particular with respect to model bias. The use of spatially distributed rainfall data did not improve model performance over the use of catchment average rainfall data. When models were locally calibrated there was a weak inverse correlation between catchment area and model performance. However, constraining donor-target parameter allocation by similar catchment area did not improve predictive capability in ungauged catchments. Although model performance was not as good as that reported for southern Australia and other temperate regions of the world, this study confirmed that modelling strategies similar to those

  1. A Dual-Driver Model of Retention and Turnover in the Direct Care Workforce

    Science.gov (United States)

    Mittal, Vikas; Rosen, Jules; Leana, Carrie

    2009-01-01

    Purpose: The purpose of this study was to understand the factors associated with turnover and retention of direct care workers. We hypothesize that a dual-driver model that includes individual factors, on-the-job factors, off-the-job factors, and contextual factors can be used to distinguish between reasons for direct care workforces (DCWs)…

  2. The System-of-Care Model: Implementation in Twenty-Seven Communities.

    Science.gov (United States)

    Vinson, Nina B.; Brannan, Ana Maria; Baughman, Lela N.; Wilce, Maureen; Gawron, Timothy

    2001-01-01

    A 4-year study of 27 system-of-care sites designed to provides mental health services to children and adolescents, found that despite many changes in each local service system, no site was able to fully implement all 16 key attributes comprising an ideal system-of-care model (including sites with previous system-building experience). (Contains…

  3. Opening the Black Box of Clinical Collaboration in Integrated Care Models for Frail, Elderly Patients

    Science.gov (United States)

    de Stampa, Matthieu; Vedel, Isabelle; Bergman, Howard; Novella, Jean-Luc; Lechowski, Laurent; Ankri, Joel; Lapointe, Liette

    2013-01-01

    Purpose: The purpose of the study was to understand better the clinical collaboration process among primary care physicians (PCPs), case managers (CMs), and geriatricians in integrated models of care. Methods: We conducted a qualitative study with semistructured interviews. A purposive sample of 35 PCPs, 7 CMs, and 4 geriatricians was selected in…

  4. Filipino Nursing Students' Behavioral Intentions toward Geriatric Care: A Structural Equation Model (SEM)

    Science.gov (United States)

    de Guzman, Allan B.; Jimenez, Benito Christian B.; Jocson, Kathlyn P.; Junio, Aileen R.; Junio, Drazen E.; Jurado, Jasper Benjamin N.; Justiniano, Angela Bianca F.

    2013-01-01

    Anchored on the key constucts of Ajzen's Theory of Planned Behavior (1985), this paper seeks to test a model that explores the influence of knowledge, attitude, and caring behavior on nursing students' behavioral intention toward geriatric care. A five-part survey-questionnaire was administered to 839 third and fourth year nursing students from a…

  5. Teaching Wound Care Management: A Model for the Budget Conscious Educator

    Science.gov (United States)

    Berry, David C.

    2012-01-01

    For the author, the concept of wound care has always been a challenging topic to demonstrate. How to teach the concept without having a student in need of wound care or without having to spend money to buy another simulation manikin/model? The author has recently created a simulation to demonstrate and practice the cleaning, closing, and dressing…

  6. Stepped care model for pain management and quality of pain care in long-term opioid therapy

    Directory of Open Access Journals (Sweden)

    Brent A. Moore, PhD

    2016-02-01

    Full Text Available Successful organizational improvement processes depend on application of reliable metrics to establish targets and to monitor progress. This study examined the utility of the Pain Care Quality (PCQ extraction tool in evaluating implementation of the Stepped Care Model for Pain Management at one Veterans Health Administration (VHA healthcare system over 4 yr and in a non-VHA Federally qualified health center (FQHC over 2 yr. Two hundred progress notes per year from VHA and 150 notes per year from FQHC primary care prescribers of long-term opioid therapy (>90 consecutive days were randomly sampled. Each note was coded for the presence or absence of key dimensions of PCQ (i.e., pain assessment, treatment plans, pain reassessment/outcomes, patient education. General estimating equations controlling for provider and facility were used to examine changes in PCQ items over time. Improvements in the VHA were noted in pain reassessment and patient education, with trends in positive directions for all dimensions. Results suggest that the PCQ extraction tool is feasible and may be responsive to efforts to promote organizational improvements in pain care. Future research is indicated to improve the reliability of the PCQ extraction tool and enhance its usability.

  7. Management and Treatment of Hepatitis B Virus in Patients with Hiv Infection: A Practical Guide for Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Marina B. Klein

    2011-01-01

    Full Text Available The management and treatment of HIV and hepatitis B virus (HBV-coinfected patients present specific challenges for clinicians. The morbidity and mortality related to these concomitant infections are growing concerns, while the use of antiviral drugs effective against both viruses complicates therapeutic decision making. The present document provides guidelines for physicians regarding care and treatment of patients coinfected with HIV and HBV. Primary prevention of HBV in HIV-positive patients is achieved through appropriate vaccination schedules. Follow-up before treatment of HBV may include liver biopsy, screening for hepatocellular carcinoma and testing for esophageal varicies in cases of cirrhosis. In HBV-infected patients requiring treatment, recommendations regarding initiation, duration and choice of first-line drugs are made. Finally, in the case of resistance, appropriate alternative therapies are necessary.

  8. Aligning health information technologies with effective service delivery models to improve chronic disease care

    Science.gov (United States)

    Bauer, Amy M.; Thielke, Stephen M.; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-01-01

    Objective Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. Method A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Results Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. Conclusion HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. PMID:24963895

  9. Guiding-center models for edge plasmas and numerical simulations of isolated plasma filaments

    Energy Technology Data Exchange (ETDEWEB)

    Madsen, Jens

    2010-09-15

    The work presented in this thesis falls into two categories: development of reduced dynamical models applicable to edge turbulence in magnetically confined fusion plasmas and numerical simulations of isolated plasma filaments in the scrape-off layer region investigating the influence of finite Larmor radius effects on the radial plasma transport. The coexistence of low-frequency fluctuations, having length scales comparable to the ion gyroradius, steep pressure gradients and strong E x B flows in the edge region of fusion plasmas violates the standard gyrokinetic ordering. In this thesis two models are presented that overcome some of the difficulties associated with the development of reduced dynamical models applicable to the edge. Second order guiding-center coordinates are derived using the phasespace Lie transform method. Using a variational principle the corresponding Vlasov-Maxwell equations expressed in guiding-center coordinates are derived including a local energy theorem. The second order terms describe lowest order finite Larmor radius effects. This set of equations might be relevant for edge plasmas due to the capability of capturing strong E x B flows and lowest order finite Larmor radius effects self-consistently. Next, an extension of the existing gyrokinetic formalism with strong flows is presented. In this work the background electric fields is dynamical, whereas earlier contributions did only incorporate a stationary electric field. In an ordering relevant for edge plasma turbulence, fully electromagnetic second order gyrokinetic coordinates and the corresponding gyrokinetic Vlasov-Maxwell equations are derived, including a local energy theorem. By taking the polarization and magnetization densities in the drift kinetic limit, we present the gyrokinetic Vlasov-Maxwell equations in a more tractable form, which could be relevant for direct numerical simulations of edge plasma turbulence. Finally, an investigation of the influence of finite Larmor

  10. Multi-level model of missed nursing care in the context of hospital merger.

    Science.gov (United States)

    Castner, Jessica; Wu, Yow-Wu B; Dean-Baar, Susan

    2015-04-01

    The aim of this study was to delineate the multi-level relationships of individual registered nurse (RN) and nursing unit factors on missed nursing care. This was a quantitative model-building study using a descriptive, cross-sectional design. Surveys (N = 553) and administrative unit records from nurses in one hospital system undergoing merger were included. The results showed that 36% of the variation in missed nursing care is due to the unit context, with a corresponding 64% due to individual nurse differences. At the unit level, workload, skill mix, and critical unit type affected the amount of missed nursing care. At the individual nurse level, more experience, supplies problems, communication problems, and involvement in errors of commission all increased the perception of the amount of missed nursing care. Education level was not related to the amount of missed nursing care. The findings highlight the importance of unit- and individual-level interventions to redesign hospital nursing care.

  11. The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands

    OpenAIRE

    de Jong, Fransina J.; van Steenbergen-Weijenburg, Kirsten M; Huijbregts, Klaas M.L.; Vlasveld, Moniek C; van Marwijk, Harm W. J.; Beekman, Aartjan T.F.; van der Feltz-Cornelis, Christina M

    2009-01-01

    Background: In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands. Aim: Description of a collaborative care model for major depressive disorder (MDD) and of the factors influencing its implementation in the primary care setting in the Netherlands. Data sources: Data collected during the preparation phase of the CC:DIP trial of the Depression Initiative, literature, policy documents, in...

  12. [The permanence of access to health care: a tradition of hospitality and innovative organizational model].

    Science.gov (United States)

    Georges-Tarragano, C

    2015-01-01

    The PASS ("Permanence d'Accès aux Soins de Santé") are hospital-based units providing primary care services to patients who lack health care coverage. Using a "whole person" approach and providing a combination of health and social care, the PASS offer an appropriately adapted response to complex health problems within a context of marked social vulnerability and contribute to reducing health inequalities. The PASS are an example of an interdisciplinary approach to health care which contrasts with the segmentary approach typical of conventional hospital departments. Operating at the interface between primary and secondary care, the PASS have the potential to become key players in developing models of patient pathways. Their presence reduces inappropriate emergency attendances and hospitalisation by offering medical care in a timely fashion, in an outpatient-type setting. The PASS can provide a resource for research into optimum models of health care, where the social context of health needs are fully recognized and inform medical treatment appropriately. According to their potential development, PASS are living labs of an innovative organizational model of care.

  13. Adapting health care competencies to a formal competency model

    OpenAIRE

    Sitthisak, Onjira; Gilbert, Lester; Davis, Hugh C.; Gobbi, Mary

    2007-01-01

    Health professions education has moved away from process-based curricula to competency-based curricula. Machine readable and processable health care competencies are still embryonic, pending the emergence of appropriate standards. The IMS Reusable Definition of Competency or Educational Objective specification and the HR-XML competency standard are introduced, compared, and their problems identified in the implementation of exemplar competencies from the UK...

  14. Interior Ballistics Two-Phase Reactive Flow Model Applied to Large Caliber Guided Projectile-Gun System

    OpenAIRE

    Mahmoud Rashad; XiaoBing Zhang; Hazem El Sadek

    2014-01-01

    Transient complex phenomena take place in a gun during interior ballistic cycle. Understanding these phenomena clearly and describing the mathematical models accurately are crucial to predict the behavior of gun system considering firing safety and performance. A mathematical model based on Eulerian-Eulerian approach for reactive gas-solid flow arising during interior ballistic cycle inside large caliber naval gun guided projectile system was developed. The model included the governing equati...

  15. Life cycle of the marine alga Phaeocystis: A conceptual model to summarize literature and guide research

    Science.gov (United States)

    Whipple, Stuart J.; Patten, Bernard C.; Verity, Peter G.

    2005-08-01

    This paper reviews literature on the life cycle of the marine algal genus Phaeocystis, and organizes existing information in the form of a qualitative conceptual model of life-cycle stages, stage transitions, ecosystem inputs and outputs, and internal and external controlling factors. Conceptualization is the first phase of modeling, typically continued in later quantitative phases by mathematical formulation, calibration of parameters, dynamic simulation, and different forms of systems analysis. Qualitative conceptualization can also promote multidisciplinary interactions and structure early stages of scientific inquiry. To exploit the qualitative benefits of conceptual modeling, the goals of this paper are to: (1) review the literature of Phaeocystis life-cycle biology and ecology; (2) from the material of this review, construct, a conceptual life-cycle model covering all Phaeocystis species; and (3) show how this model, a platform for further quantitative development, is also used as a qualitative tool to guide empirical research. The conceptual model includes known and putative life-cycle stages, colony size classes, and genetic, physiological, semiotic, and ecological information expressed or potentially expressed across the genus. It consists of 15 compartments. Seven are single-celled: Solitary Diploid Flagellates ( x1), Solitary Diploid Non-flagellates ( x2), Benthic Solitary Diploid Non-Flagellates ( x3), Solitary Diploid Flagellated Macrozoospores ( x8), Solitary Haploid Flagellated Microzoospores ( x9), Solitary Haploid Microflagellates ( x10), and Solitary Haploid Mesoflagellates ( x11). The remaining eight compartments represent the New stage, and Small, Medium, and Large size classes of Healthy/Growing Colonies ( x4- x7), and Senescent/Declining Colonies ( x12- x15). Six flow types interconnect the compartments: (a) physical transport, (b) solitary cell transformations, (c) solitary cell↔colony transitions, (d) colony growth and differentiation, (e

  16. Constructing a folding model for protein S6 guided by native fluctuations deduced from NMR structures

    Energy Technology Data Exchange (ETDEWEB)

    Lammert, Heiko; Noel, Jeffrey K.; Haglund, Ellinor; Onuchic, José N., E-mail: jonuchic@rice.edu [Center for Theoretical Biological Physics and Department of Physics, Rice University, Houston, Texas 77005 (United States); Schug, Alexander [Steinbuch Centre for Computing, Karlsruhe Institute of Technology, Karlsruhe (Germany)

    2015-12-28

    The diversity in a set of protein nuclear magnetic resonance (NMR) structures provides an estimate of native state fluctuations that can be used to refine and enrich structure-based protein models (SBMs). Dynamics are an essential part of a protein’s functional native state. The dynamics in the native state are controlled by the same funneled energy landscape that guides the entire folding process. SBMs apply the principle of minimal frustration, drawn from energy landscape theory, to construct a funneled folding landscape for a given protein using only information from the native structure. On an energy landscape smoothed by evolution towards minimal frustration, geometrical constraints, imposed by the native structure, control the folding mechanism and shape the native dynamics revealed by the model. Native-state fluctuations can alternatively be estimated directly from the diversity in the set of NMR structures for a protein. Based on this information, we identify a highly flexible loop in the ribosomal protein S6 and modify the contact map in a SBM to accommodate the inferred dynamics. By taking into account the probable native state dynamics, the experimental transition state is recovered in the model, and the correct order of folding events is restored. Our study highlights how the shared energy landscape connects folding and function by showing that a better description of the native basin improves the prediction of the folding mechanism.

  17. Constructing a folding model for protein S6 guided by native fluctuations deduced from NMR structures

    Science.gov (United States)

    Lammert, Heiko; Noel, Jeffrey K.; Haglund, Ellinor; Schug, Alexander; Onuchic, José N.

    2015-12-01

    The diversity in a set of protein nuclear magnetic resonance (NMR) structures provides an estimate of native state fluctuations that can be used to refine and enrich structure-based protein models (SBMs). Dynamics are an essential part of a protein's functional native state. The dynamics in the native state are controlled by the same funneled energy landscape that guides the entire folding process. SBMs apply the principle of minimal frustration, drawn from energy landscape theory, to construct a funneled folding landscape for a given protein using only information from the native structure. On an energy landscape smoothed by evolution towards minimal frustration, geometrical constraints, imposed by the native structure, control the folding mechanism and shape the native dynamics revealed by the model. Native-state fluctuations can alternatively be estimated directly from the diversity in the set of NMR structures for a protein. Based on this information, we identify a highly flexible loop in the ribosomal protein S6 and modify the contact map in a SBM to accommodate the inferred dynamics. By taking into account the probable native state dynamics, the experimental transition state is recovered in the model, and the correct order of folding events is restored. Our study highlights how the shared energy landscape connects folding and function by showing that a better description of the native basin improves the prediction of the folding mechanism.

  18. Constructing a folding model for protein S6 guided by native fluctuations deduced from NMR structures

    International Nuclear Information System (INIS)

    The diversity in a set of protein nuclear magnetic resonance (NMR) structures provides an estimate of native state fluctuations that can be used to refine and enrich structure-based protein models (SBMs). Dynamics are an essential part of a protein’s functional native state. The dynamics in the native state are controlled by the same funneled energy landscape that guides the entire folding process. SBMs apply the principle of minimal frustration, drawn from energy landscape theory, to construct a funneled folding landscape for a given protein using only information from the native structure. On an energy landscape smoothed by evolution towards minimal frustration, geometrical constraints, imposed by the native structure, control the folding mechanism and shape the native dynamics revealed by the model. Native-state fluctuations can alternatively be estimated directly from the diversity in the set of NMR structures for a protein. Based on this information, we identify a highly flexible loop in the ribosomal protein S6 and modify the contact map in a SBM to accommodate the inferred dynamics. By taking into account the probable native state dynamics, the experimental transition state is recovered in the model, and the correct order of folding events is restored. Our study highlights how the shared energy landscape connects folding and function by showing that a better description of the native basin improves the prediction of the folding mechanism

  19. A case study: the clinical application of quadrangular dialogue--a caring in nursing teaching model.

    Science.gov (United States)

    Sumner, Jane F

    2004-01-01

    Teaching caring in nursing is expected of nursing faculty, but the practical application is rarely explained. It has been regarded as the moral responsibility of faculty to teach in a caring way. This case study relates how one faculty applied the concepts to quadrangular dialogue a caring model of nursing education to the experience of baccalaureate student nurses in their first clinical rotation. The components of quadrangular dialogue will be described, and applied to a specific patient who was cared for by students in one semester. This model is developed from Habermas' (1995) Theory of Communicative Action and Moral Consciousness, Bishop and Scudder's (1990) Triadic Dialogue and a caring in nursing paradigm developed by this author. It explains how the patient, nursing student and nursing faculty are all first person in the interaction, while the illness is object. By acknowledging the humanness of participants, validation and fulfillment for each follow. PMID:16646898

  20. A Cost-Effective Model for Increasing Access to Mental Health Care at the Primary Care Level in Nigeria.

    Science.gov (United States)

    Omigbodun, Olayinka O.

    2001-09-01

    BACKGROUND: Although effective treatment modalities for mental health problems currently exist in Nigeria, they remain irrelevant to the 70% of Nigeria's 120 million people who have no access to modern mental health care services. The nation's Health Ministry has adopted mental health as the 9th component of Primary Health Care (PHC) but ten years later, very little has been done to put this policy into practice. Mental Health is part of the training curriculum of PHC workers, but this appears to be money down the drain. AIMS OF THE STUDY: To review the weaknesses and problems with existing mode of mental health training for PHC workers with a view to developing a cost-effective model for integration. METHODS: A review and analysis of current training methods and their impact on the provision of mental health services in PHC in a rural and an urban local government area in Nigeria were done. An analysis of tested approaches for integrating mental health into PHC was carried out and a cost-effective model for the Nigerian situation based on these approaches and the local circumstances was derived. RESULTS: Virtually no mental health services are being provided at the PHC levels in the two local government areas studied. Current training is not effective and virtually none of what was learnt appears to be used by PHC workers in the field. Two models for integrating mental health into PHC emerged from the literature. Enhancement, which refers to the training of PHC personnel to carry out mental health care independently is not effective on its own and needs to be accompanied by supervision of PHC staff. Linkage, which occurs when mental health professionals leave their hospital bases to provide mental health care in PHC settings, requires a large number of skilled staff who are unavailable in Nigeria. In view of past experiences in Nigeria and other countries, a mixed enhancement-linkage model for mental health in PHC appears to be the most cost-effective approach for

  1. The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands

    NARCIS (Netherlands)

    Jong, de F.J.; Steenbergen-Weijenburg, van K.M.; Huijbregts, K.M.L.; Vlasveld, M.C.; Marwijk, van H.W.J.; Beekman, A.T.F.; Feltz - Cornelis, van der C.M.

    2009-01-01

    BACKGROUND: In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands. AIM: Description of a collaborative care model for major depressive disorder (MDD) and of the factors influencing its implemen

  2. User Guide for VISION 3.4.7 (Verifiable Fuel Cycle Simulation) Model

    Energy Technology Data Exchange (ETDEWEB)

    Jacob J. Jacobson; Robert F. Jeffers; Gretchen E. Matthern; Steven J. Piet; Wendell D. Hintze

    2011-07-01

    The purpose of this document is to provide a guide for using the current version of the Verifiable Fuel Cycle Simulation (VISION) model. This is a complex model with many parameters and options; the user is strongly encouraged to read this user guide before attempting to run the model. This model is an R&D work in progress and may contain errors and omissions. It is based upon numerous assumptions. This model is intended to assist in evaluating 'what if' scenarios and in comparing fuel, reactor, and fuel processing alternatives at a systems level. The model is not intended as a tool for process flow and design modeling of specific facilities nor for tracking individual units of fuel or other material through the system. The model is intended to examine the interactions among the components of a fuel system as a function of time varying system parameters; this model represents a dynamic rather than steady-state approximation of the nuclear fuel system. VISION models the nuclear cycle at the system level, not individual facilities, e.g., 'reactor types' not individual reactors and 'separation types' not individual separation plants. Natural uranium can be enriched, which produces enriched uranium, which goes into fuel fabrication, and depleted uranium (DU), which goes into storage. Fuel is transformed (transmuted) in reactors and then goes into a storage buffer. Used fuel can be pulled from storage into either separation or disposal. If sent to separations, fuel is transformed (partitioned) into fuel products, recovered uranium, and various categories of waste. Recycled material is stored until used by its assigned reactor type. VISION is comprised of several Microsoft Excel input files, a Powersim Studio core, and several Microsoft Excel output files. All must be co-located in the same folder on a PC to function. You must use Powersim Studio 8 or better. We have tested VISION with the Studio 8 Expert, Executive, and Education versions

  3. Efficiency and functionality of an internal purchaser-provider model in public specialized health care services

    OpenAIRE

    Iso-Mustajärvi, Anni

    2016-01-01

    There is an increasing demand to find solutions for improving cost-efficiency in health care. The demand for services continues to increase and there is a need to control the increasing resource requirements. Market-oriented organization models and management methods have been seen as one way to address the challenge and as an alternative to traditional hierarchical organization models in health care. Researchers highlight the importance of investigating how different kinds of changes actuall...

  4. Implementation of a Diabetes Educator Care Model to Reduce Paediatric Admission for Diabetic Ketoacidosis

    OpenAIRE

    Asma Deeb; Hana Yousef; Layla Abdelrahman; Mary Tomy; Shaker Suliman; Salima Attia; Hana Al Suwaidi

    2016-01-01

    Introduction. Diabetic Ketoacidosis (DKA) is a serious complication that can be life-threatening. Management of DKA needs admission in a specialized center and imposes major constraints on hospital resources. Aim. We plan to study the impact of adapting a diabetes-educator care model on reducing the frequency of hospital admission of children and adolescents presenting with DKA. Method. We have proposed a model of care led by diabetes educators for children and adolescents with diabetes. The ...

  5. Exporting the Buyers Health Care Action Group Purchasing Model: Lessons from Other Communities

    OpenAIRE

    Christianson, Jon B; Feldman, Roger

    2005-01-01

    When first implemented in Minneapolis and St. Paul, Minnesota, the Buyers Health Care Action Group's (BHCAG) purchasing approach received considerable attention as an employer-managed, consumer-driven health care model embodying many of the principles of managed competition. First BHCAG and, later, a for-profit management company attempted to export this model to other communities. Their efforts were met with resistance from local hospitals and, in many cases, apathy by employers who were exp...

  6. Developing and Implementing Diagnostic Prediction Models for Vestibular Diseases in Primary Care.

    Science.gov (United States)

    Grill, Eva; Groezinger, Michael; Feil, Katharina; Strupp, Michael

    2016-01-01

    Diagnosing patients with vertigo and dizziness is a challenge in primary care settings where laboratory examinations are often not available. This study uses data from patients with confirmed diagnoses of vestibular syndromes to develop and validate simple diagnostic prediction models for the primary care physician. We describe the implementation of these models into an application that may assist the practitioners with their clinical decisions. PMID:27577483

  7. Mortality, fertility and old age care in a two-sex growth model

    OpenAIRE

    Andreassen, Leif

    2004-01-01

    Abstract: The paper discusses the importance of decreasing mortality in explaining demographic change over the last century. A two-sex overlapping generations model is used where care both for children and the elderly is modeled. Assuming that the main costs of care are tied to time use (and thereby fairly invariant to income changes), the paper illustrates how exogenous changes in mortality, the cost of children and the bargaining power of women can explain fluctuations in bot...

  8. Modeling Motivational Deficits in Mouse Models of Schizophrenia: Behavior Analysis as a Guide for Neuroscience

    OpenAIRE

    Ryan D Ward; Simpson, Eleanor H.; Kandel, Eric R.; Balsam, Peter D.

    2011-01-01

    In recent years it has become possible to develop animal models of psychiatric disease in genetically modified mice. While great strides have been made in the development of genetic and neurobiological tools with which to model psychiatric disease, elucidation of neural and molecular mechanisms thought to underlie behavioral phenotypes has been hindered by an inadequate analysis of behavior. This is unfortunate given the fact that the experimental analysis of behavior has created powerful met...

  9. JERM model of care: an in-principle model for dental health policy.

    Science.gov (United States)

    Lam, Raymond; Kruger, Estie; Tennant, Marc

    2014-01-01

    Oral diseases are the most prevalent conditions in the community. Their economic burden is high and their impact on quality of life is profound. There is an increasing body of evidence indicating that oral diseases have wider implications beyond the confines of the mouth. The importance of oral health has not been unnoticed by the government. The Commonwealth (Federal) government under the Howard-led Coalition in 2004 had broken tradition by placing dentistry in its universal health insurance scheme, Medicare. Known as the Chronic Disease Dental Scheme (CDDS), the program aimed to manage patients with chronic conditions as part of the Enhanced Primary Care initiative. This scheme was a landmark policy for several reasons. Besides being the first major dental policy under Medicare, the program proved to be the most expensive and controversial. Unfortunately, cost containment and problems with service provision led to its cessation in 2012 by the Gillard Labor Government. Despite being seen as a failure, the CDDS provided a unique opportunity to assess national policy in practice. By analysing the policy-relevant effects of the CDDS, important lessons can be learnt for policy development. This paper discusses these lessons and has formulated a set of principles recommended for effective oral health policy. The JERM model represents the principles of a justified, economical and research-based model of care. PMID:23927886

  10. Interprofessional education for students of the health professions: the "Seamless Care" model.

    Science.gov (United States)

    Mann, K V; Mcfetridge-Durdle, J; Martin-Misener, R; Clovis, J; Rowe, R; Beanlands, H; Sarria, M

    2009-05-01

    "Seamless Care" was one of 21 grants awarded by Health Canada to inform policymakers of the effectiveness of interprofessional education in promoting collaborative patient-centred practice among health professionals. The "Seamless Care" model of interprofessional education was designed with input from three Faculties at Dalhousie University (Medicine, Dentistry and Health Professions). The design was grounded in relevant learning theories--Social Cognitive Theory, Self-efficacy, Situated Learning theory and Constructivism. The intervention was informed by principles of active learning, problem-based learning, reflection and role modeling. The primary goal of Seamless Care was to develop students' interprofessional patient-centred collaborative skills through experiential learning. Fourteen student teams, each including one student from medicine, nursing, pharmacy, dentistry and dental hygiene, learned with, from and about each other while they were mentored in the collaborative care of patients transitioning from acute care to the community. Student teams providing collaborative care assisted patients experiencing a chronic illness to become more active in managing their health through development of self-management and decision-making skills. This paper describes the Seamless Care model of interprofessional education and discusses the theoretical underpinnings of this experiential model of interprofessional education designed to extend classroom-based interprofessional education to the clinical setting.

  11. Care episode retrieval: distributional semantic models for information retrieval in the clinical domain.

    Science.gov (United States)

    Moen, Hans; Ginter, Filip; Marsi, Erwin; Peltonen, Laura-Maria; Salakoski, Tapio; Salanterä, Sanna

    2015-01-01

    Patients' health related information is stored in electronic health records (EHRs) by health service providers. These records include sequential documentation of care episodes in the form of clinical notes. EHRs are used throughout the health care sector by professionals, administrators and patients, primarily for clinical purposes, but also for secondary purposes such as decision support and research. The vast amounts of information in EHR systems complicate information management and increase the risk of information overload. Therefore, clinicians and researchers need new tools to manage the information stored in the EHRs. A common use case is, given a--possibly unfinished--care episode, to retrieve the most similar care episodes among the records. This paper presents several methods for information retrieval, focusing on care episode retrieval, based on textual similarity, where similarity is measured through domain-specific modelling of the distributional semantics of words. Models include variants of random indexing and the semantic neural network model word2vec. Two novel methods are introduced that utilize the ICD-10 codes attached to care episodes to better induce domain-specificity in the semantic model. We report on experimental evaluation of care episode retrieval that circumvents the lack of human judgements regarding episode relevance. Results suggest that several of the methods proposed outperform a state-of-the art search engine (Lucene) on the retrieval task.

  12. Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

    Directory of Open Access Journals (Sweden)

    Hogg William

    2011-10-01

    Full Text Available Abstract Background Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. Methods This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. Results The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69% than in fee-for-service (45% practices (Adjusted Odds Ratio (AOR = 2.4 [95% CI 1.4-4.2], p = 0.001. Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006, and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007. Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices

  13. Task-role-based Access Control Model in Smart Health-care System

    Directory of Open Access Journals (Sweden)

    Wang Peng

    2015-01-01

    Full Text Available As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for the medical health-care environment, task-role-based access control model, which overcomes the disadvantages of traditional access control models. The task-role-based access control (T-RBAC model introduces a task concept, dividing tasks into four categories. It also supports supervision role hierarchy. T-RBAC is a proper access control model for Smart Health-care System, and it improves the management of access rights. This paper also proposes an implementation of T-RBAC, a binary two-key-lock pair access control scheme using prime factorization.

  14. Family Models for Earning and Caring: Implications for Child Care and for Family Policy

    Directory of Open Access Journals (Sweden)

    Ravanera, Zenaida

    2009-01-01

    Full Text Available AbstractCanadian families have changed, in part due to an economy that provides more work opportunities for women, and a cultural orientation that values equal opportunity and diversity infamilies. In spite of the change, both quantitative and qualitative evidence suggest a continued preference for mothers to spend considerable time with children, especially in the infant andtoddler years. Thus, in an average couple, the presence of young children in the home brings wives to reduce their paid work and husbands to increase their paid work. Our reading of parentalpreferences suggests an interest in more services for young children in the form of early childhood education and child care, but also an interest in policies that would allow parents to spend more time with children through parental leaves, part-time work with good benefits, and subsidies that supplement market income. Many options available to two-parent families are often less feasible for lone parents, giving a higher priority to child care.RésuméLa famille canadiennes a changé, dû en partie à une économie qui offre plus de possibilités d’emploi pour les femmes, et à une tendance culturelle qui valorise l’égalité des chances et la diversité dans les familles. En dépit de ces changements, les preuves quantitatives et qualitatives suggèrent une préférence continue pour les mères de passer plus de temps avec les enfants, particulièrement quand il s’agit de nouveau-nés ou d’enfants en bas âge. Donc, pour un couple moyen, la présence de jeunes enfants au foyer pousse les femmes à réduire leurs emplois rémunérés et les maris à augmenter les leurs. Notre étude des préférences parentales suggère un intérêt pour un accroissement des services pour jeunes enfants sous la forme d’éducation préscolaire et de garde d’enfants, et aussi un intérêt pour des politiques qui permettraient aux parents de passer plus de temps avec leurs enfants tels que cong

  15. Effects of magnetic resonance-guided high-intensity focused ultrasound ablation on bone mechanical properties and modeling

    NARCIS (Netherlands)

    Yeo, Sin Yuin; Arias Moreno, Andrés J; van Rietbergen, Bert; Ter Hoeve, Natalie D; van Diest, Paul J; Grüll, Holger

    2015-01-01

    BACKGROUND: Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a promising technique for palliative treatment of bone pain. In this study, the effects of MR-HIFU ablation on bone mechanics and modeling were investigated. METHODS: A total of 12 healthy rat femurs were ablated us

  16. Models for intensive care training. A European perspective.

    Science.gov (United States)

    Bion, Julian; Rothen, Hans U

    2014-02-01

    The diversity of European culture is reflected in its healthcare training programs. In intensive care medicine (ICM), the differences in national training programs were so marked that it was unlikely that they could produce specialists of equivalent skills. The Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) program was established in 2003 as a Europe-based worldwide collaboration of national training organizations to create core competencies for ICM using consensus methodologies to establish common ground. The group's professional and research ethos created a social identity that facilitated change. The program was easily adaptable to different training structures and incorporated the voice of patients and relatives. The CoBaTrICE program has now been adopted by 15 European countries, with another 12 countries planning to adopt the training program, and is currently available in nine languages, including English. ICM is now recognized as a primary specialty in Spain, Switzerland, and the UK. There are still wide variations in structures and processes of training in ICM across Europe, although there has been agreement on a set of common program standards. The combination of a common "product specification" for an intensivist, combined with persisting variation in the educational context in which competencies are delivered, provides a rich source of research inquiry. Pedagogic research in ICM could usefully focus on the interplay between educational interventions, healthcare systems and delivery, and patient outcomes, such as including whether competency-based program are associated with lower error rates, whether communication skills training is associated with greater patient and family satisfaction, how multisource feedback might best be used to improve reflective learning and teamworking, or whether increasing the proportion of specialists trained in acute care in the hospital at weekends results in better patient outcomes. PMID

  17. Modelling of resource allocation to health care authorities in Stockholm county

    DEFF Research Database (Denmark)

    Andersson, Paula; Varde, E; Diderichsen, Finn

    2000-01-01

    . This paper presents recent developments in the model used in Stockholm for all care except primary care, testing new statistical methods for compression and clustering of the matrices used and the effect of introducing diagnostic information in addition to the demographic and socio-economic information used...... ahead. Moreover, two calibration methods are compared: Cross-sectional modelling, based on data for one year only, versus prospective modelling, using population characteristics for one year and registered health-care costs for a following year. While models including diagnostic information are deemed...... before. We also show the effect of using more current data sources by replacing existing census variables with data from annually updated registers. Since the aim is to use the resource allocation models for prospective budgeting we test and evaluate the predictive power of the models one to two years...

  18. Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

    Directory of Open Access Journals (Sweden)

    Shantanu Nundy

    2012-01-01

    Full Text Available Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time. Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral. Conclusion. Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.

  19. Prerequisites for sustainable care improvement using the reflective team as a work model.

    Science.gov (United States)

    Jonasson, Lise-Lotte; Carlsson, Gunilla; Nyström, Maria

    2014-01-01

    Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

  20. The Joint Venture Model of Knowledge Utilization: a guide for change in nursing.

    Science.gov (United States)

    Edgar, Linda; Herbert, Rosemary; Lambert, Sylvie; MacDonald, Jo-Ann; Dubois, Sylvie; Latimer, Margot

    2006-05-01

    Knowledge utilization (KU) is an essential component of today's nursing practice and healthcare system. Despite advances in knowledge generation, the gap in knowledge transfer from research to practice continues. KU models have moved beyond factors affecting the individual nurse to a broader perspective that includes the practice environment and the socio-political context. This paper proposes one such theoretical model the Joint Venture Model of Knowledge Utilization (JVMKU). Key components of the JVMKU that emerged from an extensive multidisciplinary review of the literature include leadership, emotional intelligence, person, message, empowered workplace and the socio-political environment. The model has a broad and practical application and is not specific to one type of KU or one population. This paper provides a description of the JVMKU, its development and suggested uses at both local and organizational levels. Nurses in both leadership and point-of-care positions will recognize the concepts identified and will be able to apply this model for KU in their own workplace for assessment of areas requiring strengthening and support.

  1. A Guide RNA Sequence Design Platform for the CRISPR/Cas9 System for Model Organism Genomes

    Directory of Open Access Journals (Sweden)

    Ming Ma

    2013-01-01

    Full Text Available Cas9/CRISPR has been reported to efficiently induce targeted gene disruption and homologous recombination in both prokaryotic and eukaryotic cells. Thus, we developed a Guide RNA Sequence Design Platform for the Cas9/CRISPR silencing system for model organisms. The platform is easy to use for gRNA design with input query sequences. It finds potential targets by PAM and ranks them according to factors including uniqueness, SNP, RNA secondary structure, and AT content. The platform allows users to upload and share their experimental results. In addition, most guide RNA sequences from published papers have been put into our database.

  2. On Sequence Learning Models: Open-loop Control Not Strictly Guided by Hick’s Law

    Science.gov (United States)

    Pavão, Rodrigo; Savietto, Joice P.; Sato, João R.; Xavier, Gilberto F.; Helene, André F.

    2016-01-01

    According to the Hick’s law, reaction times increase linearly with the uncertainty of target stimuli. We tested the generality of this law by measuring reaction times in a human sequence learning protocol involving serial target locations which differed in transition probability and global entropy. Our results showed that sigmoid functions better describe the relationship between reaction times and uncertainty when compared to linear functions. Sequence predictability was estimated by distinct statistical predictors: conditional probability, conditional entropy, joint probability and joint entropy measures. Conditional predictors relate to closed-loop control models describing that performance is guided by on-line access to past sequence structure to predict next location. Differently, joint predictors relate to open-loop control models assuming global access of sequence structure, requiring no constant monitoring. We tested which of these predictors better describe performance on the sequence learning protocol. Results suggest that joint predictors are more accurate than conditional predictors to track performance. In conclusion, sequence learning is better described as an open-loop process which is not precisely predicted by Hick’s law. PMID:26975409

  3. Optimization of magnetophoretic-guided drug delivery to the olfactory region in a human nose model.

    Science.gov (United States)

    Xi, Jinxiang; Zhang, Ze; Si, Xiuhua April; Yang, Jing; Deng, Wu

    2016-08-01

    Magnetophoretic-guided delivery has been shown to be able to improve the olfactory doses. However, due to the complex nasal structure and quick decay of magnetic intensity, precise control of particle motion in the human nose remains a challenge. In this study, an optimization model was developed for magnetophoretic olfactory delivery systems. The performance of the model was evaluated using a baseline device design in an MRI-based human nose geometry. Three key components of the delivery system were examined, which included the particle release position, the front magnet to minimize nasal valve depositions, and the top magnet to attract particles into the olfactory region. Results show that the magnetophoretic olfactory delivery device can be significantly improved by optimizing the product and operational parameters. The olfactory delivery efficiency was increased by 1.5-fold compared to the baseline design. The top magnet height and strength were shown to be the most influential factor in olfactory delivery, followed by the drug release position and the front magnet strength. The optimization framework developed in this study can be easily adapted for the optimization of intranasal drug delivery to other regions such as paranasal sinuses. PMID:26386567

  4. On Sequence Learning Models: Open-loop Control Not Strictly Guided by Hick's Law.

    Science.gov (United States)

    Pavão, Rodrigo; Savietto, Joice P; Sato, João R; Xavier, Gilberto F; Helene, André F

    2016-01-01

    According to the Hick's law, reaction times increase linearly with the uncertainty of target stimuli. We tested the generality of this law by measuring reaction times in a human sequence learning protocol involving serial target locations which differed in transition probability and global entropy. Our results showed that sigmoid functions better describe the relationship between reaction times and uncertainty when compared to linear functions. Sequence predictability was estimated by distinct statistical predictors: conditional probability, conditional entropy, joint probability and joint entropy measures. Conditional predictors relate to closed-loop control models describing that performance is guided by on-line access to past sequence structure to predict next location. Differently, joint predictors relate to open-loop control models assuming global access of sequence structure, requiring no constant monitoring. We tested which of these predictors better describe performance on the sequence learning protocol. Results suggest that joint predictors are more accurate than conditional predictors to track performance. In conclusion, sequence learning is better described as an open-loop process which is not precisely predicted by Hick's law. PMID:26975409

  5. An Instructional Model for Guiding Reflection and Research in the Classroom: The Educational Situation Quality Model

    Science.gov (United States)

    Domenech-Betoret, Fernando

    2013-01-01

    The purpose of this work is to present an instructional model entitled the "Modelo de Calidad de Situacion Educativa" (MCSE) and how teachers can use it to reflect and investigate in a formal educational setting. It is a theoretical framework which treat to explain the functioning of an educational setting by organizing and relating the…

  6. CenteringParenting: an innovative dyad model for group mother-infant care.

    Science.gov (United States)

    Bloomfield, Joanna; Rising, Sharon Schindler

    2013-01-01

    CenteringParenting is a group model that brings a cohort of 6 to 7 mothers and infants together for care during the first year of life. During 9 group sessions the clinician provides well-baby care and also attends to the health, development, and safety issues of the mother. Ideally, CenteringParenting provides continuity of care for a cohort of women who have received care in CenteringPregnancy, group prenatal care that is 10 sessions throughout the entire pregnancy and that leads to community building, better health outcomes, and increased satisfaction with prenatal care. The postpartum year affects the entire family, but especially the mother, who is redefining herself and her own personal goals. Issues of weight/body image, breastfeeding, depression, contraception, and relationship issues all may surface. In traditional care, health resources for support and intervention are frequently lacking or unavailable. Women's health clinicians also note the loss of contact with women they have followed during the prenatal period, often not seeing a woman again until she returns for another pregnancy. CenteringParenting recognizes that the health of the mother is tied to the health of the infant and that assessment and interventions are more appropriate and efficient when done in a dyad context. Facilitative leadership, rather than didactic education, encourages women to fully engage in their care, to raise issues of importance to them, and to discuss concerns within an atmosphere that allows for the surfacing of culturally appropriate values and beliefs. Implementing the model calls for system changes that are often significant. It also requires the building of a substantial team relationship among care providers. This overview describes the CenteringParenting mother-infant dyad care model with special focus on the mother and reviews the perspectives and experiences of staff from several practice sites.

  7. A research model of health-care competition and customer satisfaction.

    Science.gov (United States)

    Asoh, Derek A; Rivers, Patrick A

    2007-11-01

    In all industries, competition among businesses has long been encouraged as a mechanism to increase value for customers. In other words, competition ensures the provision of better products and services to satisfy the needs of customers. Various perspectives of competition, the nature of service quality, health-care system costs and customer satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts customer satisfaction as an outcome measure directly dependent on competition. Quality of care and health-care system costs, while also directly dependent on competition, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research. PMID:17958970

  8. Teacher's Guide for Earthworms.

    Science.gov (United States)

    Bruno, Merle S.; And Others

    This teacher's guide on earthworms includes four major sections: (1) introduction, (2) caring for earthworms in the classroom, (3) classroom activities, and (4) the appendix. The introduction includes information concerning grade level, scheduling, materials, obtaining earthworms, field study, classroom clean-up, and records. Caring for earthworms…

  9. A Teacher's Guide to Studying the Local Community Through Models, Games and Simulation.

    Science.gov (United States)

    Heilman, James M.; Freund, John Dean

    This teacher's guide grew out of an environmental education project involving personnel from the Ohio State School for the Deaf, the Worthington (Ohio) Outdoor Education Department, and teachers and pupils in one of the Worthington elementary schools. The guide is divided into four parts: Background Information, Strategies (for involving students…

  10. Implementing a continuum of care model for older people - results from a Swedish case study

    Directory of Open Access Journals (Sweden)

    Anna Duner

    2011-11-01

    Full Text Available Introduction: There is a need for integrated care and smooth collaboration between care-providing organisations and professions to create a continuum of care for frail older people. However, collaboration between organisations and professions is often problematic. The aim of this study was to examine the process of implementing a new continuum of care model in a complex organisational context, and illuminate some of the challenges involved. The introduced model strived to connect three organisations responsible for delivering health and social care to older people: the regional hospital, primary health care and municipal eldercare.Methods: The actions of the actors involved in the process of implementing the model were understood to be shaped by the actors' understanding, commitment and ability. This article is based on 44 qualitative interviews performed on four occasions with 26 key actors at three organisational levels within these three organisations.Results and conclusions: The results point to the importance of paying regard to the different cultures of the organisations when implementing a new model. The role of upper management emerged as very important. Furthermore, to be accepted, the model has to be experienced as effectively dealing with real problems in the everyday practice of the actors in the organisations, from the bottom to the top.

  11. Nurses Improving the Care of Healthsystem Elders: creating a sustainable business model to improve care of hospitalized older adults.

    Science.gov (United States)

    Capezuti, Elizabeth A; Bricoli, Barbara; Briccoli, Barbara; Boltz, Marie P

    2013-08-01

    The Nurses Improving the Care of Healthsystem Elders (NICHE) program helps its more than 450 member sites to build the leadership capabilities to enact system-level change that targets the unique needs of older adults and embeds evidence-based geriatrics knowledge into practice. NICHE received expansion funding to establish a sustainable business model for operations while positioning the program to continue as a leader in innovative senior care programs. The expansion program focused on developing an internal business infrastructure, expanding NICHE-specific resources, creating a Web platform, increasing the number of participating NICHE hospitals, enhancing and expanding the NICHE benchmarking service, supporting research that generates evidence-based practices, fostering interorganizational collaboration, developing sufficient diversified revenue sources, and increasing the penetration and level of activity of current NICHE sites. These activities (improved services, Web-based tools, better benchmarking) added value and made it feasible to charge hospitals an annual fee for access and participation. NICHE does not stipulate how institutions should modify geriatric care; rather, NICHE principles and tools are meant to be adapted to each site's unique institutional culture. This article describes the historical context, the rationale, and the business plan that has resulted in successful organizational outcomes, including financial sustainability of the business operations of NICHE.

  12. Model assisted probability of detection for a guided waves based SHM technique

    Science.gov (United States)

    Memmolo, V.; Ricci, F.; Maio, L.; Boffa, N. D.; Monaco, E.

    2016-04-01

    Guided wave (GW) Structural Health Monitoring (SHM) allows to assess the health of aerostructures thanks to the great sensitivity to delamination and/or debondings appearance. Due to the several complexities affecting wave propagation in composites, an efficient GW SHM system requires its effective quantification associated to a rigorous statistical evaluation procedure. Probability of Detection (POD) approach is a commonly accepted measurement method to quantify NDI results and it can be effectively extended to an SHM context. However, it requires a very complex setup arrangement and many coupons. When a rigorous correlation with measurements is adopted, Model Assisted POD (MAPOD) is an efficient alternative to classic methods. This paper is concerned with the identification of small emerging delaminations in composite structural components. An ultrasonic GW tomography focused to impact damage detection in composite plate-like structures recently developed by authors is investigated, getting the bases for a more complex MAPOD analysis. Experimental tests carried out on a typical wing composite structure demonstrated the effectiveness of modeling approach in order to detect damages with the tomographic algorithm. Environmental disturbances, which affect signal waveforms and consequently damage detection, are considered simulating a mathematical noise in the modeling stage. A statistical method is used for an effective making decision procedure. A Damage Index approach is implemented as metric to interpret the signals collected from a distributed sensor network and a subsequent graphic interpolation is carried out to reconstruct the damage appearance. A model validation and first reliability assessment results are provided, in view of performance system quantification and its optimization as well.

  13. 加强药学服务,指导儿童合理用药%Strengthening pharmaceutical care and guide the rational use of drugs for children

    Institute of Scientific and Technical Information of China (English)

    严晗

    2012-01-01

    Children are at the stage of growth and development, liver and kidney function and gastrointestinal function and endocrine system, the central nervous system and the development is not perfect, the pharmacokinetics and Pharmacodynamics and adult difference is more significant, thus strengthening the rational use of drugs for children of far - reaching significance, this article from the use of drugs, drug dose to prevent antibiotics abuse and drug analysis of the special storage, strengthen pharmaceutical care and guide the rational use of drugs for children, reduce the occurrence of adverse reactions.%儿童都处于生长发育的阶段,肝肾功能、胃肠道功能、内分泌系统、中枢神经系统和发育都未健全,其药动学和药效学与成人差异更为显著,因此加强儿童合理用药,意义深远,本文从药物的使用方法、药物的使用剂量、杜绝滥用抗生素以及药物的特殊的贮存进行分析,加强药学服务,指导儿童合理用药,减少不良反应的发生.

  14. Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care.

    Science.gov (United States)

    Mitchell, Robert A; Stanger, Dylan; Shuster, Constantin; Telford, Jennifer; Lam, Eric; Enns, Robert

    2016-01-01

    Background. There is a high incidence of inconclusive cytopathology at initial EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) for suspected malignant pancreatic lesions. To obtain appropriate preoperative or palliative chemotherapy for pancreatic cancer, definitive cytopathology is often required. The utility of repeat EUS-FNA is not well established. Methods. A retrospective cohort study was conducted evaluating the yield of repeat EUS-FNA in determining a cytological diagnosis in patients who had undergone a prior EUS-FNA for diagnosis of suspected malignant pancreatic lesions with inconclusive cytopathology. The wait times to the second procedure and to decisions regarding therapy were calculated. Results. Overall, 45 repeat EUS-FNA procedures were performed over seven years for suspected malignant pancreatic lesions. Cytopathological class (I to IV) changed between first and second EUS-FNA in 32 patients (71%). Of 34 patients with an initially nonconclusive diagnosis, 20 had a conclusive diagnosis (59%) on repeat EUS-FNA. The cumulative yield after repeat EUS-FNA for definite pancreatic adenocarcinoma was 7 (16%). The median time interval between first and second EUS-FNA was 31 (7-175) days. Conclusions. A substantial number of patients had a definitive diagnosis of adenocarcinoma on repeat FNA and were, therefore, subsequently able to access appropriate care. PMID:27648440

  15. New calculation of derived limits for the 1960 radiation protection guides reflecting updated models for dosimetry and biological transport

    International Nuclear Information System (INIS)

    This report presents revised values for the radioactivity concentration guides (RCGs), based on the 1960 primary radiation protection guides (RPGs) for occupational exposure (FRC 1960) and for underground uranium miners (EPA 1971a) using the updated dosimetric models developed to prepare ICRP Publication 30. Unlike the derived quantities presented in Publication 30, which are based on limitation of the weighted sum of doses to all irradiated tissues, these RCGs are based on the ''critical organ'' approach of the 1960 guidance, which was a single limit for the most critically irradiated organ or tissue. This report provides revised guides for the 1960 Federal guidance which are consistent with current dosimetric relationships. 2 figs., 4 tabs

  16. Integration of modeling and simulation into hospital-based decision support systems guiding pediatric pharmacotherapy

    Directory of Open Access Journals (Sweden)

    Vijayakumar Kalpana

    2008-01-01

    Full Text Available Abstract Background Decision analysis in hospital-based settings is becoming more common place. The application of modeling and simulation approaches has likewise become more prevalent in order to support decision analytics. With respect to clinical decision making at the level of the patient, modeling and simulation approaches have been used to study and forecast treatment options, examine and rate caregiver performance and assign resources (staffing, beds, patient throughput. There us a great need to facilitate pharmacotherapeutic decision making in pediatrics given the often limited data available to guide dosing and manage patient response. We have employed nonlinear mixed effect models and Bayesian forecasting algorithms coupled with data summary and visualization tools to create drug-specific decision support systems that utilize individualized patient data from our electronic medical records systems. Methods Pharmacokinetic and pharmacodynamic nonlinear mixed-effect models of specific drugs are generated based on historical data in relevant pediatric populations or from adults when no pediatric data is available. These models are re-executed with individual patient data allowing for patient-specific guidance via a Bayesian forecasting approach. The models are called and executed in an interactive manner through our web-based dashboard environment which interfaces to the hospital's electronic medical records system. Results The methotrexate dashboard utilizes a two-compartment, population-based, PK mixed-effect model to project patient response to specific dosing events. Projected plasma concentrations are viewable against protocol-specific nomograms to provide dosing guidance for potential rescue therapy with leucovorin. These data are also viewable against common biomarkers used to assess patient safety (e.g., vital signs and plasma creatinine levels. As additional data become available via therapeutic drug monitoring, the model is re

  17. Midwife-led Care Model for Reducing Caesarean Rate: A Novel Concept for Worldwide Birth units where Standard Obstetric Care Still Dominates

    Directory of Open Access Journals (Sweden)

    Hong Zhou

    2012-01-01

    Full Text Available Caesarean rate has been increasing year by year in China and other countries in the world. In fact, caesarean section is associated with increased risk of maternal mortality and serious foetal pulmonary morbidity. To reduce caesarean rate, obstetricians in physician-based birth units get used to take early intervention for any delay in labour progress that could cause dystocia. However, standard obstetric care enhanced by obstetric power has not consistently been shown to reduce rate of caesarean delivery. Other than physician-based model, midwife-led model of care is aiming to promote normal birth by use of midwives’ skills as well as continuous support rather than augmentation of labour through excessive medical treatment. Midwife-led care model is novel to worldwide birth units where standard obstetric care still dominates. It has made some headway in efforts to reduce caesarean rate. The fact that standard obstetric care of childbirth have not consistently reduced rate of caesarean delivery encourages us for creating the hypotheses that midwife-led care model satisfying puerpera with care and support could minimise unnecessary obstetric intervention and facilitate vaginal birth, and finally reduces caesarean rate. This hypothesis, if confirmed, might have the potential to be disseminated elsewhere in the world, where most women still take standard obstetric care. Moreover, it has political implications for the national health-care policymaking.

  18. Feasibility of telecytopathology for rapid preliminary diagnosis of ultrasound-guided fine needle aspiration of axillary lymph nodes in a remote breast care center

    Directory of Open Access Journals (Sweden)

    Kamal K Khurana

    2012-01-01

    Full Text Available Background: In the recent years, the advances in digital methods in pathology have resulted in the use of telecytology in the immediate assessment of fine needle aspiration (FNA specimens. However, there is a need for organ-based and body site-specific studies on the use of telecytology for the immediate assessment of FNA to evaluate its pitfalls and limitations. We present our experience with the use of telecytology for on-site evaluation of ultrasound-guided FNA (USG-FNA of axillary lymph nodes in a remote breast care center. Materials and Methods: Real-time images of Diff-Quik-stained cytology smears were obtained with an Olympus digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a pathologist who rendered preliminary diagnosis while communicating with the on-site cytotechnologist over the Vocera system. The accuracy of the preliminary diagnosis was compared with the final diagnosis, retrospectively. Results: A total of 39 female patients (mean age: 50.5 years seen at the breast care center underwent USG-FNA of 44 axillary nodes. Preliminary diagnoses of benign, suspicious/malignant, and unsatisfactory were 41, 52, and 7%, respectively. Only one of the 23 cases that were initially interpreted as benign was reclassified as suspicious on final cytologic diagnosis. Seventeen of 18 suspicious/malignant cases on initial cytology corresponded with a malignant diagnosis on final cytology. One suspicious case was reclassified as benign on final cytologic diagnosis. All unsatisfactory cases remained inadequate for final cytologic interpretation. The presence of additional material in the cell block and interpretative error were the main reasons for discrepancy, accounting for the two discrepant cases. Conclusions: This retrospective study demonstrates that the on-site telecytology evaluation of USG-FNA of axillary lymph nodes in patients at a remote breast care center was highly accurate

  19. Development of the Transitional Care Model for nursing care in Mainland China: A literature review

    Directory of Open Access Journals (Sweden)

    Zeng-Jie Ye

    2016-03-01

    Conclusion: Despite the potential of this nursing model to have a successful and beneficial impact in Mainland China, it remains an under-researched topic. Further research on education and training as well as premium policies for nurses under the TCM are needed.

  20. PENGARUH MODEL PEMBELAJARAN OPEN INQUIRY DAN GUIDED INQUIRY TERHADAP SIKAP ILMIAH SISWA SMP PADA TEMA SUHU DAN PERUBAHAN

    Directory of Open Access Journals (Sweden)

    Dwi Indah Suryani

    2016-03-01

    Full Text Available Tujuan penelitian ini adalah untuk menganalisis perbedaan sikap ilmiah antara siswa yang menggunakan model pembelajaran Open Inquiry dengan siswa yang menggunakan model pembelajaran Guided Inquiry pada tema suhu dan perubahan. Penelitian ini menggunakan metode Quasi Eksperiment dengan desain penelitian Matching Only Pretest-Posttest Control Group Design. Sampel penelitian terdiri dari 56 orang siswa kelas VII dari salah satu SMP N di Kota Palembang. Teknik pengambilan sampel yang digunakan adalah Cluster Random Sampling. Teknik pengumpulan data yaitu menggunakan skala sikap ilmiah. Teknik analisis data menggunakan uji Normalitas, uji Homogenitas, dan uji Independent Samples Test dengan menggunakan program IBM SPSS Statistics 22 dan Microsoft Excel. Diperoleh dari data peningkatan sikap ilmiah untuk siswa yang menggunakan model pembelajaran Open Inquiry sebesar 0,30 dengan kategori sedang dan untuk siswa yang menggunakan model pembelajaran Guided Inquiry sebesar 0,21 dengan kategori rendah. Hasil uji hipotesis penelitian menunjukkan nilai signifikansi (2-Tailed sebesar 0,031 < α (0,05 yang berarti H0 ditolak dan H1 diterima. Dapat disimpulkan bahwa terdapat perbedaan yang signifikan sikap ilmiah siswa yang menggunakan model pembelajaran Open Inquiry dengan siswa yang menggunakan model pembelajaran Guided Inquiry pada tema suhu dan perubahan.