WorldWideScience

Sample records for care models guiding

  1. Care 3 model overview and user's guide, first revision

    Science.gov (United States)

    Bavuso, S. J.; Petersen, P. L.

    1985-01-01

    A manual was written to introduce the CARE III (Computer-Aided Reliability Estimation) capability to reliability and design engineers who are interested in predicting the reliability of highly reliable fault-tolerant systems. It was also structured to serve as a quick-look reference manual for more experienced users. The guide covers CARE III modeling and reliability predictions for execution in the CDC CYber 170 series computers, DEC VAX-11/700 series computer, and most machines that compile ANSI Standard FORTRAN 77.

  2. 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.

  3. 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.

  4. Spirit-guided care: Christian nursing for the whole person.

    Science.gov (United States)

    Murphy, Lyn S; Walker, Mark S

    2013-01-01

    Healthcare today is challenged to provide care that goes beyond the medical model of meeting physical needs. Despite a strong historical foundation in spiritual whole person care, nurses struggle with holistic caring. We propose that for the Christian nurse, holistic nursing can be described as Spirit-guided care--removing oneself as the moiatiating force and allowing Christ, in the furm of the Holy Spirit, to flow through and guide the nurse in care of patients and families.

  5. Model-based cost-effectiveness analysis of B-type natriuretic peptide-guided care in patients with heart failure

    Science.gov (United States)

    Mohiuddin, Syed; Reeves, Barnaby; Pufulete, Maria; Maishman, Rachel; Dayer, Mark; Macleod, John; McDonagh, Theresa; Purdy, Sarah; Rogers, Chris; Hollingworth, William

    2016-01-01

    Objective Monitoring B-type natriuretic peptide (BNP) to guide pharmacotherapy might improve survival in patients with heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF). However, the cost-effectiveness of BNP-guided care is uncertain and guidelines do not uniformly recommend it. We assessed the cost-effectiveness of BNP-guided care in patient subgroups defined by age and ejection fraction. Methods We used a Markov model with a 3-month cycle length to estimate the lifetime health service costs, quality-adjusted life years (QALYs) and incremental net monetary benefits (iNMBs) of BNP-guided versus clinically guided care in 3 patient subgroups: (1) HFrEF patients HFpEF patients HFpEF aged ≥75 years. We used individual patient data meta-analyses and linked primary care, hospital and mortality data to inform the key model parameters. We performed probabilistic analysis to assess the uncertainty in model results. Results In younger patients (HFpEF (£3155 (−£10 307 to £11 613)) and older patients (≥75 years) with HFrEF (£2267 (−£1524 to £6074)). BNP-guided care remained cost-effective in the sensitivity analyses, albeit the results were sensitive to assumptions on its sustained effect. Conclusions We found strong evidence that BNP-guided care is a cost-effective alternative to clinically guided care in younger patients with HFrEF. It is potentially cost-effective in younger patients with HFpEF and older patients with HFrEF, but more evidence is required, particularly with respect to the frequency, duration and BNP target for monitoring. Cost-effectiveness results from trials in specialist settings cannot be generalised to primary care. PMID:28031211

  6. Family Day Care Zoning. Local Officials Guide.

    Science.gov (United States)

    Cohen, Abby; And Others

    This guide discusses city planning issues related to family day care zoning. The guide is divided into five sections. The first section discusses child care as a planning issue and focuses on changes in working patterns of families and in residential neighborhoods. The second section describes components of the child care delivery system, which…

  7. 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…

  8. Family Day Care Zoning Advocacy Guide.

    Science.gov (United States)

    Stevenson, Carol; And Others

    Designed to help family day care providers and the agencies that support them reform local zoning laws that make it difficult or impossible to legally care for children in their homes, this guide outlines the process of obtaining a use permit, changing local laws, and strategizing for the passage of state legislation that preempts local laws. A…

  9. 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.

  10. 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.

  11. Exploring Small Animal Care. Teacher's Guide.

    Science.gov (United States)

    Livesey, Dennis W.

    This course guide in small animal care is designed to give students seeking employment in veterinary hospitals, kennels, or pet shops an opportunity to (1) develop basic skills in small animal handling, sanitation of housing, and nutrition, (2) acquire skills in dog and cat grooming, including shop operation, (3) develop attitudes which contribute…

  12. Examining the usefulness of a Family Empowerment Program guided by the Illness Beliefs Model for families caring for a child with thalassemia.

    Science.gov (United States)

    Wacharasin, Chintana; Phaktoop, Maneerat; Sananreangsak, Siriyupa

    2015-05-01

    The purpose of this pilot study was to design, implement, and evaluate a Family Empowerment Program (FEP), guided by the Illness Beliefs Model. Participants included 25 Thai family members who were the primary caregivers of a child with thalassemia. In Phase I, data were collected from participants using individual in-depth interviews and focus groups before involvement in the FEP. In Phase II, 12 hr of FEP sessions were offered to groups of participants. Content analysis of the audiotaped FEP sessions is reported in this article. Family caregivers reported that the FEP helped them share beliefs and experiences related to caring for their child with thalassemia, make decisions related to families' problems/needs and beliefs, provide each other mutual social support, and develop increased ability to manage care for their chronically ill child through sharing information and learning from other family caregivers about family functioning, family management, and family relationships. Future research is needed to examine the FEP intervention under more controlled conditions with measures that include family functioning and child health outcomes.

  13. The Epital Care Model

    DEFF Research Database (Denmark)

    Phanareth, Klaus; Vingtoft, Søren; Christensen, Anders Skovbo

    2017-01-01

    and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports...... the intentions of the World Health Organization (WHO) to have integrated people-centered care. OBJECTIVE: To design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care...... and face-to-face support for COPD management. In step five the initial model was extended with elements that support continuity of care. Beginning in the autumn of 2013, 1102 frail elderly individuals were included and offered two additional services: an outgoing acute medical team and a local subacute bed...

  14. A practical guide to microscope care and maintenance.

    Science.gov (United States)

    Petrak, Lara J; Waters, Jennifer C

    2014-01-01

    Optimal microscope performance requires regular maintenance and quality control testing. This chapter is a practical guide to microscope care with an emphasis on preventing, identifying and troubleshooting common issues.

  15. Could a Computer Someday Guide Breast Cancer Care?

    Science.gov (United States)

    ... medlineplus.gov/news/fullstory_162465.html Could a Computer Someday Guide Breast Cancer Care? 'Watson Oncology' agreed ... Dec. 9, 2016 (HealthDay News) -- An artificially intelligent computer system is making breast cancer treatment recommendations on ...

  16. FORSPAN Model Users Guide

    Science.gov (United States)

    Klett, T.R.; Charpentier, Ronald R.

    2003-01-01

    The USGS FORSPAN model is designed for the assessment of continuous accumulations of crude oil, natural gas, and natural gas liquids (collectively called petroleum). Continuous (also called ?unconventional?) accumulations have large spatial dimensions and lack well defined down-dip petroleum/water contacts. Oil and natural gas therefore are not localized by buoyancy in water in these accumulations. Continuous accumulations include ?tight gas reservoirs,? coalbed gas, oil and gas in shale, oil and gas in chalk, and shallow biogenic gas. The FORSPAN model treats a continuous accumulation as a collection of petroleumcontaining cells for assessment purposes. Each cell is capable of producing oil or gas, but the cells may vary significantly from one another in their production (and thus economic) characteristics. The potential additions to reserves from continuous petroleum resources are calculated by statistically combining probability distributions of the estimated number of untested cells having the potential for additions to reserves with the estimated volume of oil and natural gas that each of the untested cells may potentially produce (total recovery). One such statistical method for combination of number of cells with total recovery, used by the USGS, is called ACCESS.

  17. 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.

  18. Child Care: Almost Ours. An AFL-CIO Guide to Implementing Child Care Laws.

    Science.gov (United States)

    American Federation of Labor and Congress of Industrial Organizations, Washington, DC.

    On October 27, 1990, Congress enacted comprehensive federal child care legislation targeted toward low-income workers and a broad expansion of assistance to parents through the earned income tax credit. This guide alerts union members to the benefits that are now available under the new law: the Omnibus Budget Reconciliation Act of 1990. The guide…

  19. Assessing health centre systems for guiding improvement in diabetes care

    Directory of Open Access Journals (Sweden)

    Robinson Gary

    2005-08-01

    Full Text Available Abstract Background Aboriginal people in Australia experience the highest prevalence of diabetes in the country, an excess of preventable complications and early death. There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to assess the status of systems for chronic illness care in Aboriginal community health centres, and to explore whether more developed systems were associated with better quality of diabetes care. Methods This cross-sectional study was conducted in 12 Aboriginal community health centres in the Northern Territory of Australia. Assessment of Chronic Illness Care scale was adapted to measure system development in health centres, and administered by interview with health centre staff and managers. Based on a random sample of 295 clinical records from attending clients with diagnosed type 2 diabetes, processes of diabetes care were measured by rating of health service delivery against best-practice guidelines. Intermediate outcomes included the control of HbA1c, blood pressure, and total cholesterol. Results Health centre systems were in the low to mid-range of development and had distinct areas of strength and weakness. Four of the six system components were independently associated with quality of diabetes care: an increase of 1 unit of score for organisational influence, community linkages, and clinical information systems, respectively, was associated with 4.3%, 3.8%, and 4.5% improvement in adherence to process standards; likewise, organisational influence, delivery system design and clinical information systems were related to control of HbA1c, blood pressure, and total cholesterol. Conclusion The state of development of health centre systems is reflected in quality of care outcome measures for patients. The health centre systems assessment tool should be useful in assessing and guiding development of systems for improvement of

  20. 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.

  1. 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.

  2. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2014-01-01

    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...... 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...

  3. 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....

  4. Achieving Value in Primary Care: The Primary Care Value Model.

    Science.gov (United States)

    Rollow, William; Cucchiara, Peter

    2016-03-01

    The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM). We advocate for use of patient-centered value when measuring the impact of primary care transformation, recognition, and performance-based payment; for financial support and research and development to better define primary care value-creating activities and their implementation; and for use of the model to support primary care organizations in transformation.

  5. 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.

  6. Error Estimates of Theoretical Models: a Guide

    CERN Document Server

    Dobaczewski, J; Reinhard, P -G

    2014-01-01

    This guide offers suggestions/insights on uncertainty quantification of nuclear structure models. We discuss a simple approach to statistical error estimates, strategies to assess systematic errors, and show how to uncover inter-dependencies by correlation analysis. The basic concepts are illustrated through simple examples. By providing theoretical error bars on predicted quantities and using statistical methods to study correlations between observables, theory can significantly enhance the feedback between experiment and nuclear modeling.

  7. 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

  8. 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.

  9. HEALTH CARE GUIDE TO POLLUTION PREVENTION IMPLEMENTATION THROUGH ENVIRONMENTAL MANAGEMENT SYSTEMS

    Science.gov (United States)

    The Health Care Guide to Pollution Prevention Implementation through Environmental Management Systems provides example EMS procedures and forms used in four ISO 14001 EMS certified hospitals. The latest revisions include more EMS hospital case studies, more compliance resources, ...

  10. 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…

  11. 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.

  12. 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…

  13. 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.

  14. GEOS-5 Chemistry Transport Model User's Guide

    Science.gov (United States)

    Kouatchou, J.; Molod, A.; Nielsen, J. E.; Auer, B.; Putman, W.; Clune, T.

    2015-01-01

    The Goddard Earth Observing System version 5 (GEOS-5) General Circulation Model (GCM) makes use of the Earth System Modeling Framework (ESMF) to enable model configurations with many functions. One of the options of the GEOS-5 GCM is the GEOS-5 Chemistry Transport Model (GEOS-5 CTM), which is an offline simulation of chemistry and constituent transport driven by a specified meteorology and other model output fields. This document describes the basic components of the GEOS-5 CTM, and is a user's guide on to how to obtain and run simulations on the NCCS Discover platform. In addition, we provide information on how to change the model configuration input files to meet users' needs.

  15. 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…

  16. Caring theory as an ethical guide to administrative and clinical practices.

    Science.gov (United States)

    Watson, Jean

    2006-01-01

    This article explores the conventional relationship between caring, economics, and administrative practices that no longer serve patients, practitioners, or systems. A shift toward human caring values and an ethic of authentic healing relationships is required as systems now have to value human resources and life purposes, inner meanings, and processes for workers and patients alike, not just economics alone. This shift requires a professional ethos with renewed attention to practice that is ethics/values-based and theory-guided, alongside evidence and economics. Emergent professional, caring-theory-guided practice options are presented, which are grounded on this deeper ethical-moral and theoretical foundation for transforming the practitioners and the system.

  17. Wake Vortex Inverse Model User's Guide

    Science.gov (United States)

    Lai, David; Delisi, Donald

    2008-01-01

    NorthWest Research Associates (NWRA) has developed an inverse model for inverting landing aircraft vortex data. The data used for the inversion are the time evolution of the lateral transport position and vertical position of both the port and starboard vortices. The inverse model performs iterative forward model runs using various estimates of vortex parameters, vertical crosswind profiles, and vortex circulation as a function of wake age. Forward model predictions of lateral transport and altitude are then compared with the observed data. Differences between the data and model predictions guide the choice of vortex parameter values, crosswind profile and circulation evolution in the next iteration. Iterations are performed until a user-defined criterion is satisfied. Currently, the inverse model is set to stop when the improvement in the rms deviation between the data and model predictions is less than 1 percent for two consecutive iterations. The forward model used in this inverse model is a modified version of the Shear-APA model. A detailed description of this forward model, the inverse model, and its validation are presented in a different report (Lai, Mellman, Robins, and Delisi, 2007). This document is a User's Guide for the Wake Vortex Inverse Model. Section 2 presents an overview of the inverse model program. Execution of the inverse model is described in Section 3. When executing the inverse model, a user is requested to provide the name of an input file which contains the inverse model parameters, the various datasets, and directories needed for the inversion. A detailed description of the list of parameters in the inversion input file is presented in Section 4. A user has an option to save the inversion results of each lidar track in a mat-file (a condensed data file in Matlab format). These saved mat-files can be used for post-inversion analysis. A description of the contents of the saved files is given in Section 5. An example of an inversion input

  18. Business Planning Model Programmer’s Guide

    Science.gov (United States)

    1993-12-01

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  19. Zoning for Day Care (from Models for Day Care Licensing).

    Science.gov (United States)

    Day Care and Child Development Council of America, Inc., Washington, DC.

    Recommendations and regulations regarding the zoning of child development day care programs are discussed. Zoning in general is discussed, as is the treatment of child development day care in zoning ordinance, the background of program planning, modular housing, the impelmentation of zoning, and model provisions regarding characteristics of…

  20. Medicare Care Choices Model Enables Concurrent Palliative and Curative Care.

    Science.gov (United States)

    2015-01-01

    On July 20, 2015, the federal Centers for Medicare & Medicaid Services (CMS) announced hospices that have been selected to participate in the Medicare Care Choices Model. Fewer than half of the Medicare beneficiaries use hospice care for which they are eligible. Current Medicare regulations preclude concurrent palliative and curative care. Under the Medicare Choices Model, dually eligible Medicare beneficiaries may elect to receive supportive care services typically provided by hospice while continuing to receive curative services. This report describes how CMS has expanded the model from an originally anticipated 30 Medicare-certified hospices to over 140 Medicare-certified hospices and extended the duration of the model from 3 to 5 years. Medicare-certified hospice programs that will participate in the model are listed.

  1. 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.

  2. 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)

  3. A Biomechanical Modeling Guided CBCT Estimation Technique.

    Science.gov (United States)

    Zhang, You; Tehrani, Joubin Nasehi; Wang, Jing

    2017-02-01

    Two-dimensional-to-three-dimensional (2D-3D) deformation has emerged as a new technique to estimate cone-beam computed tomography (CBCT) images. The technique is based on deforming a prior high-quality 3D CT/CBCT image to form a new CBCT image, guided by limited-view 2D projections. The accuracy of this intensity-based technique, however, is often limited in low-contrast image regions with subtle intensity differences. The solved deformation vector fields (DVFs) can also be biomechanically unrealistic. To address these problems, we have developed a biomechanical modeling guided CBCT estimation technique (Bio-CBCT-est) by combining 2D-3D deformation with finite element analysis (FEA)-based biomechanical modeling of anatomical structures. Specifically, Bio-CBCT-est first extracts the 2D-3D deformation-generated displacement vectors at the high-contrast anatomical structure boundaries. The extracted surface deformation fields are subsequently used as the boundary conditions to drive structure-based FEA to correct and fine-tune the overall deformation fields, especially those at low-contrast regions within the structure. The resulting FEA-corrected deformation fields are then fed back into 2D-3D deformation to form an iterative loop, combining the benefits of intensity-based deformation and biomechanical modeling for CBCT estimation. Using eleven lung cancer patient cases, the accuracy of the Bio-CBCT-est technique has been compared to that of the 2D-3D deformation technique and the traditional CBCT reconstruction techniques. The accuracy was evaluated in the image domain, and also in the DVF domain through clinician-tracked lung landmarks.

  4. Cost-effectiveness of recurrence risk guided care versus care as usual in women who suffered from early-onset preeclampsia including HELLP syndrome in their previous pregnancy (the PreCare study

    Directory of Open Access Journals (Sweden)

    de Wit-Zuurendonk Laura D

    2010-10-01

    Full Text Available Abstract Background Preeclampsia and HELLP syndrome may have serious consequences for both mother and fetus. Women who have suffered from preeclampsia or the HELLP syndrome, have an increased risk of developing preeclampsia in a subsequent pregnancy. However, most women will develop no or only minor complications. In this study, we intend to determine cost-effectiveness of recurrence risk guided care versus care as usual in pregnant women with a history of early-onset preeclampsia. Methods/design We developed a prediction model to estimate the individual risk of recurrence of early-onset preeclampsia and the HELLP syndrome. In a before-after study, pregnant women with preeclampsia or HELLP syndrome in their previous pregnancy receiving care as usual (before introduction of the prediction model will be compared with women receiving recurrence risk guided care (after introduction of the prediction model. Eligible and pregnant women will be recruited at six university hospitals and seven large non-university tertiary referral hospitals in the Netherlands. The primary outcome measure is the recurrence of early-onset preeclampsia or HELLP syndrome in women allocated to the regular monitoring group. For the economic evaluation, a modelling approach will be used. Costs and effects of recurrence risk guided care with those of care as usual will be compared by means of a decision model. Two incremental cost-effectiveness ratios will be calculated: 1 cost per Quality Adjusted Life Year (mother unit of analysis and 2 cost per live born child (child unit of analysis. Discussion This is, to our knowledge, the first study that evaluates prospectively the efficacy of a multivariable prediction rule for recurrent hypertensive disease in pregnancy. Results of this study could either be integrated into the current guideline on Hypertensive Disorders in Pregnancy, or be used to develop a new guideline.

  5. 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.

  6. Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals with Developmental Disabilities

    Science.gov (United States)

    Kastner, Theodore A.; Walsh, Kevin K.

    2006-01-01

    Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…

  7. 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…

  8. Educators' Curriculum Guide. Quality Assurance and Animal Care: Youth Education Program.

    Science.gov (United States)

    Busboom, Jan R.; Newman, Jerry A.; Shulaw, William P.; Jeffreys, J. Bradford

    This curriculum guide contains a six-unit, two-level program combining animal science and veterinary care for youth club leaders and members in grades three through twelve. The Facilitator and Educator/Leader Introductions describe the program, the goals, and the students who will participate. The six lesson plans contain what the lesson is about,…

  9. Modeling neutron guides using Monte Carlo simulations

    CERN Document Server

    Wang, D Q; Crow, M L; Wang, X L; Lee, W T; Hubbard, C R

    2002-01-01

    Four neutron guide geometries, straight, converging, diverging and curved, were characterized using Monte Carlo ray-tracing simulations. The main areas of interest are the transmission of the guides at various neutron energies and the intrinsic time-of-flight (TOF) peak broadening. Use of a delta-function time pulse from a uniform Lambert neutron source allows one to quantitatively simulate the effect of guides' geometry on the TOF peak broadening. With a converging guide, the intensity and the beam divergence increases while the TOF peak width decreases compared with that of a straight guide. By contrast, use of a diverging guide decreases the intensity and the beam divergence, and broadens the width (in TOF) of the transmitted neutron pulse.

  10. 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…

  11. 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.

  12. 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),…

  13. 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…

  14. Advancing an Ethic of Embodied Relational Sexuality to Guide Decision-Making in Dementia Care.

    Science.gov (United States)

    Grigorovich, Alisa; Kontos, Pia

    2016-12-07

    Sexuality and intimacy are universal needs that transcend age, cognitive decline, and disability; sexuality is a fundamental aspect of the human experience. However, supporting sexuality in long-term residential care presents ethical challenges as this setting is both a home environment for residents and a workplace for health practitioners. This is particularly complex in the case of residents with dementia given the need to balance protection from harm and freedom of self-determination. Despite such complexity, this challenge has received limited critical theoretical attention. The dominant approach advocated to guide ethical reasoning is the bioethical four principles approach. However, the application of this approach in the context of dementia and long-term care may set the bar for practitioners' interference excessively high, restricting assentual (i.e., voluntary) sexual expression. Furthermore, it privileges cognitive and impartial decision-making, while disregarding performative, embodied, and relational aspects of ethical reasoning. With an interest in addressing these limitations, we explicate an alternative ethic of embodied relational sexuality that is grounded in a model of citizenship that recognizes relationality and the agential status of embodied self-expression. This alternative ethic broadens ethical reasoning from the exclusive duty to protect individuals from harm associated with sexual expression, to the duty to also uphold and support their rights to experience the benefits of sexual expression (e.g., pleasure, intimacy). As such it has the potential to inform the development of policies, organizational guidelines, and professional curricula to support the sexuality of persons with dementia, and thereby ensure more humane practices in long-term residential care settings.

  15. 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.

  16. Ecological Modeling Guide for Ecosystem Restoration and Management

    Science.gov (United States)

    2012-08-01

    bioenergetics model into a spatially explicit water quality model : Application to menhaden in Chesapeake Bay. Ecological Modelling 221: 1922-1933...ER D C/ EL T R -1 2 -1 8 Environmental Benefits Analysis Program Ecological Modeling Guide for Ecosystem Restoration and Management E nv...distribution is unlimited. Environmental Benefits Analysis Program ERDC/EL TR-12-18 August 2012 Ecological Modeling Guide for Ecosystem Restoration and

  17. The Attending Nurse Caring Model: integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice.

    Science.gov (United States)

    Watson, Jean; Foster, Roxie

    2003-05-01

    This paper presents a proposed model: The Attending Nursing Caring Model (ANCM) as an exemplar for advancing and transforming nursing practice within a reflective, theoretical and evidence-based context. Watson's theory of human caring is used as a guide for integrating theory, evidence and advanced therapeutics in the area of children's pain. The ANCM is offered as a programme for renewing the profession and its professional practices of caring-healing arts and science, during an era of decline, shortages, and crises in care, safety, and hospital and health reform. The ANCM elevates contemporary nursing's caring values, relationships, therapeutics and responsibilities to a higher/deeper order of caring science and professionalism, intersecting with other professions, while sustaining the finest of its heritage and traditions of healing.

  18. Home-based chronic care. An expanded integrative model for home health professionals.

    Science.gov (United States)

    Suter, Paula; Hennessey, Beth; Harrison, Gregory; Fagan, Martha; Norman, Barbara; Suter, W Newton

    2008-04-01

    The Chronic Care Model (CCM) developed by is an influential and accepted guide for the care of patients with chronic disease. Wagner acknowledges a current healthcare focus on acute care needs that often circumvents chronic care coordination. He identifies the need for a "division of labor" to assist the primary care physician with this neglected function. This article posits that the role of chronic care coordination assistance and disease management fits within the purview of home healthcare and should be central to home health chronic care delivery. An expanded Home-Based Chronic Care Model (HBCCM) is described that builds on Wagner's model and integrates salient theories from fields beyond medicine. The expanded model maximizes the potential for disease self-management success and is intended to provide a foundation for home health's integral role in chronic disease management.

  19. 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.

  20. 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.

  1. Model Year 2017 Fuel Economy Guide: EPA Fuel Economy Estimates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2016-11-01

    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.

  2. 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.

  3. 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

  4. 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…

  5. 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......, 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...

  6. PTSD in Primary Care: A Physician’s Guide to Dealing with War-Induced PTSD

    Science.gov (United States)

    2012-01-01

    with mild TBI and ASD could be effectively treated with a brief CBT protocol designed to prevent development of PTSD . Impaired family functioning...7 PTSD in Primary Care: A Physician’s Guide to Dealing with War-Induced PTSD Jeffrey S. Yarvis1 and Grace D. Landers2 1Department of Psychiatry...stress disorder ( PTSD ), as defined in DSM IV-TR, is the most common and conspicuous psychiatric problem associated with the stress experienced by

  7. Users guide to REGIONAL-1: a regional assessment model

    Energy Technology Data Exchange (ETDEWEB)

    Davis, W.E.; Eadie, W.J.; Powell, D.C.

    1979-09-01

    A guide was prepared to allow a user to run the PNL long-range transport model, REGIONAL 1. REGIONAL 1 is a computer model set up to run atmospheric assessments on a regional basis. The model has the capability of being run in three modes for a single time period. The three modes are: (1) no deposition, (2) dry deposition, (3) wet and dry deposition. The guide provides the physical and mathematical basis used in the model for calculating transport, diffusion, and deposition for all three modes. Also the guide includes a program listing with an explanation of the listings and an example in the form of a short-term assessment for 48 hours. The purpose of the example is to allow a person who has past experience with programming and meteorology to operate the assessment model and compare his results with the guide results. This comparison will assure the user that the program is operating in a proper fashion.

  8. 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

  9. Improving pain care through implementation of the Stepped Care Model at a multisite community health center

    Science.gov (United States)

    Anderson, Daren R; Zlateva, Ianita; Coman, Emil N; Khatri, Khushbu; Tian, Terrence; Kerns, Robert D

    2016-01-01

    Purpose Treating pain in primary care is challenging. Primary care providers (PCPs) receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM) at a large, multisite Federally Qualified Health Center. Methods The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention) cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009). There was no significant change in opioid prescribing. Conclusion Implementation of the SCM-PM resulted in clinically significant improvements in several quality of pain care outcomes. These findings, if sustained, may translate into improved patient outcomes. PMID:27881926

  10. Aquatic environment, housing, and management in the eighth edition of the Guide for the Care and Use of Laboratory Animals: additional considerations and recommendations.

    Science.gov (United States)

    Mason, Timothy J; Matthews, Monte

    2012-05-01

    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 suggests consultations with persons experienced in caring for aquatic species. Here we present considerations that may add to the basic information presented in the Guide and offer some recommendations that may be useful for aquatic animal model caregivers and researchers.

  11. Review of the Third Edition of the Guide for the Care and Use of Agricultural Animals in Research and Teaching

    OpenAIRE

    Vaughn, Sherry E

    2012-01-01

    The third edition (January 2010) of the Guide for the Care and Use of Agricultural Animals in Research and Teaching (the Ag Guide) was the collaborative effort of a group of 64 authors and provides a science-based reference and performance-based guidelines for institutions that use agricultural species in research and teaching. The adoption of the Ag Guide by the AAALAC Board of Trustees as a primary standard signifies its importance in the AAALAC accreditation process.

  12. Review of the third edition of the Guide for the Care and Use of Agricultural Animals in Research and Teaching.

    Science.gov (United States)

    Vaughn, Sherry E

    2012-05-01

    The third edition (January 2010) of the Guide for the Care and Use of Agricultural Animals in Research and Teaching (the Ag Guide) was the collaborative effort of a group of 64 authors and provides a science-based reference and performance-based guidelines for institutions that use agricultural species in research and teaching. The adoption of the Ag Guide by the AAALAC Board of Trustees as a primary standard signifies its importance in the AAALAC accreditation process.

  13. 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.

  14. 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.

  15. Level-of-care criteria for peer support services: a best-practice guide.

    Science.gov (United States)

    Daniels, Allen S; Cate, Rebecca; Bergeson, Susan; Forquer, Sandra; Niewenhous, Gerard; Epps, Beth

    2013-12-01

    Peer support services (PSS) are an expanding part of the continuum of care provided for behavioral health conditions. These services have been deemed an evidence-based reimbursable model of care by the Centers for Medicare and Medicaid Services. States, counties, employers, and health plans are increasingly covering PSS in benefit plans. Controlled and experimental studies are building the evidence base for these services. Medicaid and the states have not developed level-of-care or medical necessity criteria for PSS, even though these criteria are standards for determining coverage and reimbursement. This review of emerging level-of-care criteria for PSS provides a framework for the further development of these resources.

  16. ACO model should encourage efficient care delivery.

    Science.gov (United States)

    Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M

    2015-09-01

    The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Using trauma informed care as a nursing model of care in an acute inpatient mental health unit: A practice development process.

    Science.gov (United States)

    Isobel, Sophie; Edwards, Clair

    2017-02-01

    Without agreeing on an explicit approach to care, mental health nurses may resort to problem focused, task oriented practice. Defining a model of care is important but there is also a need to consider the philosophical basis of any model. The use of Trauma Informed Care as a guiding philosophy provides a robust framework from which to review nursing practice. This paper describes a nursing workforce practice development process to implement Trauma Informed Care as an inpatient model of mental health nursing care. Trauma Informed Care is an evidence-based approach to care delivery that is applicable to mental health inpatient units; while there are differing strategies for implementation, there is scope for mental health nurses to take on Trauma Informed Care as a guiding philosophy, a model of care or a practice development project within all of their roles and settings in order to ensure that it has considered, relevant and meaningful implementation. The principles of Trauma Informed Care may also offer guidance for managing workforce stress and distress associated with practice change.

  9. Using an age-specific nursing model to tailor care to the adolescent surgical patient.

    Science.gov (United States)

    Monahan, Janean Carter

    2014-06-01

    A surgical experience can be stressful for any patient. When the patient is an adolescent, however, the surgical experience can create significant stress, which is related to normal adolescent development. Perioperative nursing care should address what adolescent patients perceive as stressful and should provide a safe environment so that a successful surgical outcome can be achieved. To accomplish this, a nursing model specific to perioperative nursing practice should be developed to guide nurses when providing care to adolescents. The Adolescent Perioperative System Stability Model based on the Neuman Systems Model provides a framework for defining scope of practice and organizing nursing care that is appropriate for the adolescent during a surgical experience. In addition to guiding nursing practice, this model provides direction and guidance for future studies of adolescents in the perioperative setting.

  10. Guide for Psychological Care of Patients and Families in the Organ Donation and Transplantation Process

    Directory of Open Access Journals (Sweden)

    Teresa Rodríguez Rodríguez

    2015-09-01

    Full Text Available Organ transplants are an expression of the scientific and technological development reached by sciences up to the present, especially in the field of medicine. For a transplant to occur there must be a donation (donor and reception (recipient and the act of donating reflects all the subjectivity of human beings, marked by the culture, environment, education, beliefs, ethical dilemmas and attitudes. This explains why the psychologist is an essential part of the multidisciplinary team. This guide define the steps, psychological techniques for diagnosis and psychological intervention, ethical aspects and other elements of interest to ensure the quality of psychological care in the context of organ donation and transplantation. To achieve this objective, we consulted the existing scientific literature on the subject, including guidelines of the World Health Organization, and the document was created by using the best references found in the review. The guide is a tool to guide the work of the psychologists who are part of the multidisciplinary teams involved in the acquisition and transplant of organs and it is consistent with the guidelines of the World Health Organization and experiences of Cuba and other countries.

  11. Improving pain care through implementation of the Stepped Care Model at a multisite community health center

    Directory of Open Access Journals (Sweden)

    Anderson DR

    2016-11-01

    Full Text Available Daren R Anderson,1 Ianita Zlateva,1 Emil N Coman,2 Khushbu Khatri,1 Terrence Tian,1 Robert D Kerns3 1Weitzman Institute, Community Health Center, Inc., Middletown, 2UCONN Health Disparities Institute, University of Connecticut, Farmington, 3VA Connecticut Healthcare System, West Haven, CT, USA Purpose: Treating pain in primary care is challenging. Primary care providers (PCPs receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM at a large, multisite Federally Qualified Health Center. Methods: The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results: Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009. There was no

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 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...

  18. Field Guide to Plant Model Systems.

    Science.gov (United States)

    Chang, Caren; Bowman, John L; Meyerowitz, Elliot M

    2016-10-06

    For the past several decades, advances in plant development, physiology, cell biology, and genetics have relied heavily on the model (or reference) plant Arabidopsis thaliana. Arabidopsis resembles other plants, including crop plants, in many but by no means all respects. Study of Arabidopsis alone provides little information on the evolutionary history of plants, evolutionary differences between species, plants that survive in different environments, or plants that access nutrients and photosynthesize differently. Empowered by the availability of large-scale sequencing and new technologies for investigating gene function, many new plant models are being proposed and studied.

  19. 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

  20. 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…

  1. C++ Model Developer (CMD) User Guide

    Science.gov (United States)

    2005-04-01

    SIMULATION 66 5 SCALABILITY – BUILDING A 6 DEGREE-OF-FREEDOM (6DOF) SIMULATION One problem with a lot of simulation documentation is that simple...Directorate Aviation and Missile Research, Development, and Engineering Center Ray Sells Michael Fennell DESE Research, Inc. 315 Wynn Drive...C++ Model Developer (CMD) is an open-source C++ source code based environment for building simulations of systems described by time-based

  2. 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.

  3. 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

    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...... the benefits and harms of point-of-care biomarker tests of infection to guide antibiotic treatment in patients presenting with symptoms of acute respiratory infections in primary care settings regardless of age. SEARCH METHODS: We searched CENTRAL (2013, Issue 12), MEDLINE (1946 to January 2014), EMBASE (2010...

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

    Directory of Open Access Journals (Sweden)

    Wenxue Zhang

    2014-01-01

    Full Text Available 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 noise removal, edge-preserving, and staircase suppression.

  5. 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

  6. 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.

  7. A Guide to Education for Children with Osteogenesis Imperfecta. What Is OIF? Care of an Osteogenesis Imperfecta Baby and Child.

    Science.gov (United States)

    Ostegenesis Imperfecta Foundation, Inc., Manchester, NH.

    Three pamphlets provide basic information on the care and education of children with osteogenesis imperfecta (OI) a lifelong liability to fractures due to imperfectly formed "brittle bones." The first brochure, a guide to education for children with OI, addresses the importance of attitudes, the value of early education, public school…

  8. Automated particulate sampler field test model operations guide

    Energy Technology Data Exchange (ETDEWEB)

    Bowyer, S.M.; Miley, H.S.

    1996-10-01

    The Automated Particulate Sampler Field Test Model Operations Guide is a collection of documents which provides a complete picture of the Automated Particulate Sampler (APS) and the Field Test in which it was evaluated. The Pacific Northwest National Laboratory (PNNL) Automated Particulate Sampler was developed for the purpose of radionuclide particulate monitoring for use under the Comprehensive Test Ban Treaty (CTBT). Its design was directed by anticipated requirements of small size, low power consumption, low noise level, fully automatic operation, and most predominantly the sensitivity requirements of the Conference on Disarmament Working Paper 224 (CDWP224). This guide is intended to serve as both a reference document for the APS and to provide detailed instructions on how to operate the sampler. This document provides a complete description of the APS Field Test Model and all the activity related to its evaluation and progression.

  9. 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...

  10. 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

  11. Comprehensive care of amyotrophic lateral sclerosis patients: a care model.

    Science.gov (United States)

    Güell, Maria Rosa; Antón, Antonio; Rojas-García, Ricardo; Puy, Carmen; Pradas, Jesus

    2013-12-01

    Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working.

  12. 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.

  13. NASA AVOSS Fast-Time Wake Prediction Models: User's Guide

    Science.gov (United States)

    Ahmad, Nash'at N.; VanValkenburg, Randal L.; Pruis, Matthew

    2014-01-01

    The National Aeronautics and Space Administration (NASA) is developing and testing fast-time wake transport and decay models to safely enhance the capacity of the National Airspace System (NAS). The fast-time wake models are empirical algorithms used for real-time predictions of wake transport and decay based on aircraft parameters and ambient weather conditions. The aircraft dependent parameters include the initial vortex descent velocity and the vortex pair separation distance. The atmospheric initial conditions include vertical profiles of temperature or potential temperature, eddy dissipation rate, and crosswind. The current distribution includes the latest versions of the APA (3.4) and the TDP (2.1) models. This User's Guide provides detailed information on the model inputs, file formats, and the model output. An example of a model run and a brief description of the Memphis 1995 Wake Vortex Dataset is also provided.

  14. 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.

  15. Expansion of the ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations for three guiding principles.

    Science.gov (United States)

    Nyqvist, Kerstin Hedberg; Häggkvist, Anna-Pia; Hansen, Mette Ness; Kylberg, Elisabeth; Frandsen, Annemi Lyng; Maastrup, Ragnhild; Ezeonodo, Aino; Hannula, Leena; Koskinen, Katja; Haiek, Laura N

    2012-08-01

    The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose, an expert group from the Nordic countries and Quebec, Canada, prepared a draft proposal, which was discussed at an international workshop in Uppsala, Sweden, in September 2011. The expert group suggests the addition of 3 "Guiding Principles" to the Ten Steps to support this vulnerable population of mothers and infants: 1. The staff attitude to the mother must focus on the individual mother and her situation. 2. The facility must provide family-centered care, supported by the environment. 3. The health care system must ensure continuity of care, that is, continuity of pre-, peri-, and postnatal care and post-discharge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care.

  16. Developing a service model that integrates palliative care throughout cancer care: the time is now.

    Science.gov (United States)

    Partridge, Ann H; Seah, Davinia S E; King, Tari; Leighl, Natasha B; Hauke, Ralph; Wollins, Dana S; Von Roenn, Jamie Hayden

    2014-10-10

    Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care; coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships; prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings; and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal.

  17. 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…

  18. 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.

  19. Survival model construction guided by fit and predictive strength.

    Science.gov (United States)

    Chauvel, Cécile; O'Quigley, John

    2016-10-05

    Survival model construction can be guided by goodness-of-fit techniques as well as measures of predictive strength. Here, we aim to bring together these distinct techniques within the context of a single framework. The goal is how to best characterize and code the effects of the variables, in particular time dependencies, when taken either singly or in combination with other related covariates. Simple graphical techniques can provide an immediate visual indication as to the goodness-of-fit but, in cases of departure from model assumptions, will point in the direction of a more involved and richer alternative model. These techniques appear to be intuitive. This intuition is backed up by formal theorems that underlie the process of building richer models from simpler ones. Measures of predictive strength are used in conjunction with these goodness-of-fit techniques and, again, formal theorems show that these measures can be used to help identify models closest to the unknown non-proportional hazards mechanism that we can suppose generates the observations. Illustrations from studies in breast cancer show how these tools can be of help in guiding the practical problem of efficient model construction for survival data.

  20. Pain management standards in the eighth edition of the Guide for the Care and Use of Laboratory Animals.

    Science.gov (United States)

    Carbone, Larry

    2012-05-01

    The eighth edition Guide for the Care and Use of Laboratory Animals sets standards for diverse laboratory animal care and use practices. It frames its standards as performance, engineering, and practice standards, with a strong emphasis on performance standards, allowing for multiple routes to clearly defined outcomes. Standards intended to be upheld rigorously are indicated through the use of must in the description, and those accommodating more flexibility are indicated through may and should statements. With respect to pain management standards, a fourth type of standard-the jurisdictional standard-has been prevalent through all 8 editions of the Guide. Under jurisdictional standards, specific methods and outcomes for measuring, preventing, or alleviating pain are not detailed, but the various jurisdictions of veterinarian, investigator, and IACUC are elaborated. Although data on pain management in laboratory animals has expanded greatly since the 1996 Guide, the eighth (2011) edition does not contain major new standards or guidance regarding animal pain management. Requirements for veterinary and IACUC involvement remain as in prior editions, and the duty of veterinarians and scientists to stay abreast of new developments is expected to drive refinement of animal pain management institution by institution. The current article details selected specific pain management standards in the 2011 Guide, lists topics in pain management for which the Guide does not set clear standards, and suggests possible standards for those topics.

  1. 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...

  2. 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.

  3. 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.

  4. 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.

  5. Fully Coupled Electromechanical Elastodynamic Model for Guided Wave Propagation Analysis

    CERN Document Server

    Borkowski, Luke; Chattopadhyay, Aditi

    2013-01-01

    Physics-based computational models play a key role in the study of wave propagation for structural health monitoring (SHM) and the development of improved damage detection methodologies. Due to the complex nature of guided waves, accurate and efficient computation tools are necessary to investigate the mechanisms responsible for dispersion, coupling, and interaction with damage. In this paper, a fully coupled electromechanical elastodynamic model for wave propagation in a heterogeneous, anisotropic material system is developed. The final framework provides the full three dimensional displacement and electrical potential fields for arbitrary plate and transducer geometries and excitation waveform and frequency. The model is validated theoretically and proven computationally efficient. Studies are performed with surface bonded piezoelectric sensors to gain insight into the physics of experimental techniques used for SHM. Collocated actuation of the fundamental Lamb wave modes is modeled over a range of frequenc...

  6. 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.

  7. Select agent and toxin regulations: beyond the eighth edition of the Guide for the Care and Use of Laboratory Animals.

    Science.gov (United States)

    Kastenmayer, Robin J; Moore, Rashida M; Bright, Allison L; Torres-Cruz, Rafael; Elkins, William R

    2012-05-01

    In the interval between the publication of the seventh and eighth editions of the Guide for the Care and Use of Laboratory Animals (Guide), much has changed with regard to the regulation and funding of highly pathogenic biologic agents and toxins (Select Agents). Funding of research involving highly pathogenic agents has increased dramatically during this time, thus increasing the demand for facilities capable of supporting this work. The eighth edition of the Guide briefly mentions Select Agents and provides a limited set of references. Here we provide some background information regarding the relevant laws and regulations, as well as an overview of the programmatic requirements pertaining to the use of Select Agents, with a focus on use in animals.

  8. [Primary care practices in Germany: a model for the future].

    Science.gov (United States)

    Beyer, Martin; Gerlach, Ferdinand M; Erler, Antje

    2011-01-01

    In its 2009 report the Federal Advisory Council on the Assessment of Developments in the Health Care System developed a model of Primary Care Practices for future general practice-based primary care. This article presents the theoretical background of the model. Primary care practices are seen as developed organisations requiring changes at all system levels (interaction, organisation, and health system) to ensure sustainability of primary care functions in the future. Developments of the elements comprising the health care system may be compared to the developments and proposals observed in other countries. In Germany, however, the pace of these developments is relatively slow.

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

    Directory of Open Access Journals (Sweden)

    Noël Polly H

    2011-02-01

    Full Text Available 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 the health care literature, but may be related to the ability of primary care practices to improve the care they deliver. To better understand learning in primary care settings by developing a scale of learning in primary care clinics based on the literature related to learning across disciplines, and to examine the association between scale responses and chronic care model implementation as measured by the Assessment of Chronic Illness Care (ACIC scale. Methods Development of a scale of learning in primary care setting and administration of the learning and ACIC scales to primary care clinic members as part of the baseline assessment in the ABC Intervention Study. All clinic clinicians and staff in forty small primary care clinics in South Texas participated in the survey. Results We developed a twenty-two item learning scale, and identified a five-item subscale measuring the construct of reciprocal learning (Cronbach alpha 0.79. Reciprocal learning was significantly associated with ACIC total and sub-scale scores, even after adjustment for clustering effects. Conclusions Reciprocal learning appears to be an important attribute of learning in primary care clinics, and its presence relates to the degree of chronic care model implementation. Interventions to improve reciprocal learning among clinic members may lead to improved care of patients with chronic disease and may be relevant to improving overall clinic performance.

  10. A survey of financial planning models for health care organizations.

    Science.gov (United States)

    Coleman, J R; Kaminsky, F C; McGee, F

    1978-01-01

    This paper describes "what if?" financial planning models developed for health care administrators and financial managers to study and evaluate the economic impact of changes in a health care organization's charge structure, operating policies, reimbursement plans, and services and resources. Models for inpatient and outpatient care systems are presented. The models are described in terms of input, output, and application. An assessment of the state of the art of financial planning and prospects for the future of what if?models are given.

  11. [Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units].

    Science.gov (United States)

    Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura

    2014-01-01

    Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.

  12. [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

  13. An ultrasound image-guided surgical workflow model

    Science.gov (United States)

    Guo, Bing; Lemke, Heinz; Liu, Brent; Huang, H. K.; Grant, Edward G.

    2006-03-01

    A 2003 report in the Journal of Annual Surgery predicted an increase in demand for surgical services to be as high as 14 to 47% in the workload of all surgical fields by 2020. Medical difficulties which are already now apparent in the surgical OR (Operation Room) will be amplified in the near future and it is necessary to address this problem and develop strategies to handle the workload. Workflow issues are central to the efficiency of the OR and in response to today's continuing workforce shortages and escalating costs. Among them include: Inefficient and redundant processes, System Inflexibility, Ergonomic deficiencies, Scattered Data, Lack of Guidelines, Standards, and Organization. The objective of this research is to validate the hypothesis that a workflow model does improve the efficiency and quality of surgical procedure. We chose to study the image-guided surgical workflow for US as a first proof of concept by minimizing the OR workflow issues. We developed, and implemented deformable workflow models using existing and projected future clinical environment data as well as a customized ICT system with seamless integration and real-time availability. An ultrasound (US) image-guided surgical workflow (IG SWF) for a specific surgical procedure, the US IG Liver Biopsy, was researched to find out the inefficient and redundant processes, scattered data in clinical systems, and improve the overall quality of surgical procedures to the patient.

  14. 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.

  15. 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

  16. Transitions: A Guide to Teens Getting Older and Changing Health Care Providers

    Science.gov (United States)

    ... have By age 17 or 18, you should: Work on managing your health care Learn about your health insurance ... health care to in an adult setting Actively work with your health care team to ensure that you receive optimal care Update ...

  17. 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...

  18. 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...

  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

    (e.g., environment). By combining regressions of vital rates, an IPM provides mechanistic insight into emergent ecological patterns such as population dynamics, species geographic distributions, or life history strategies. Here, we review important resources for building IPMs and provide......Integral Projection Models (IPMs) use information on how an individual's state influences its vital rates - survival, growth and reproduction - to make population projections. IPMs are constructed from regression models predicting vital rates from state variables (e.g., size or age) and covariates...... a comprehensive guide, with extensive R code, for their construction. IPMs can be applied to any stage-structured population; here we illustrate IPMs for a series of plant life histories of increasing complexity and biological realism, highlighting the utility of various regression methods for capturing...

  20. 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.

  1. 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

  2. H2A Production Model, Version 2 User Guide

    Energy Technology Data Exchange (ETDEWEB)

    Steward, D.; Ramsden, T.; Zuboy, J.

    2008-09-01

    The H2A Production Model analyzes the technical and economic aspects of central and forecourt hydrogen production technologies. Using a standard discounted cash flow rate of return methodology, it determines the minimum hydrogen selling price, including a specified after-tax internal rate of return from the production technology. Users have the option of accepting default technology input values--such as capital costs, operating costs, and capacity factor--from established H2A production technology cases or entering custom values. Users can also modify the model's financial inputs. This new version of the H2A Production Model features enhanced usability and functionality. Input fields are consolidated and simplified. New capabilities include performing sensitivity analyses and scaling analyses to various plant sizes. This User Guide helps users already familiar with the basic tenets of H2A hydrogen production cost analysis get started using the new version of the model. It introduces the basic elements of the model then describes the function and use of each of its worksheets.

  3. A Conceptual Model for Episodes of Acute, Unscheduled Care.

    Science.gov (United States)

    Pines, Jesse M; Lotrecchiano, Gaetano R; Zocchi, Mark S; Lazar, Danielle; Leedekerken, Jacob B; Margolis, Gregg S; Carr, Brendan G

    2016-10-01

    We engaged in a 1-year process to develop a conceptual model representing an episode of acute, unscheduled care. Acute, unscheduled care includes acute illnesses (eg, nausea and vomiting), injuries, or exacerbations of chronic conditions (eg, worsening dyspnea in congestive heart failure) and is delivered in emergency departments, urgent care centers, and physicians' offices, as well as through telemedicine. We began with a literature search to define an acute episode of care and to identify existing conceptual models used in health care. In accordance with this information, we then drafted a preliminary conceptual model and collected stakeholder feedback, using online focus groups and concept mapping. Two technical expert panels reviewed the draft model, examined the stakeholder feedback, and discussed ways the model could be improved. After integrating the experts' comments, we solicited public comment on the model and made final revisions. The final conceptual model includes social and individual determinants of health that influence the incidence of acute illness and injury, factors that affect care-seeking decisions, specific delivery settings where acute care is provided, and outcomes and costs associated with the acute care system. We end with recommendations for how researchers, policymakers, payers, patients, and providers can use the model to identify and prioritize ways to improve acute care delivery.

  4. 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 ...

  5. 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.

  6. Methodology of the Access to Care and Timing Simulation Model for Traumatic Spinal Cord Injury Care.

    Science.gov (United States)

    Santos, Argelio; Fallah, Nader; Lewis, Rachel; Dvorak, Marcel F; Fehlings, Michael G; Burns, Anthony Scott; Noonan, Vanessa K; Cheng, Christiana L; Chan, Elaine; Singh, Anoushka; Belanger, Lise M; Atkins, Derek

    2017-03-12

    Despite the relatively low incidence, the management and care of persons with traumatic spinal cord injury (tSCI) can be resource intensive and complex, spanning multiple phases of care and disciplines. Using a simulation model built with a system level view of the healthcare system allows for prediction of the impact of interventions on patient and system outcomes from injury through to community reintegration after tSCI. The Access to Care and Timing (ACT) project developed a simulation model for tSCI care using techniques from operations research and its development has been described previously. The objective of this article is to briefly describe the methodology and the application of the ACT Model as it was used in several of the articles in this focus issue. The approaches employed in this model provide a framework to look into the complexity of interactions both within and among the different SCI programs, sites and phases of care.

  7. 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...

  8. Simultaneous Semi-Distributed Model Calibration Guided by ...

    Science.gov (United States)

    Modelling approaches to transfer hydrologically-relevant information from locations with streamflow measurements to locations without such measurements continues to be an active field of research for hydrologists. The Pacific Northwest Hydrologic Landscapes (PNW HL) provide a solid conceptual classification framework based on our understanding of dominant processes. A Hydrologic Landscape code (5 letter descriptor based on physical and climatic properties) describes each assessment unit area, and these units average area 60km2. The core function of these HL codes is to relate and transfer hydrologically meaningful information between watersheds without the need for streamflow time series. We present a novel approach based on the HL framework to answer the question “How can we calibrate models across separate watersheds simultaneously, guided by our understanding of dominant processes?“. We should be able to apply the same parameterizations to assessment units of common HL codes if 1) the Hydrologic Landscapes contain hydrologic information transferable between watersheds at a sub-watershed-scale and 2) we use a conceptual hydrologic model and parameters that reflect the hydrologic behavior of a watershed. In this study, This work specifically tests the ability or inability to use HL-codes to inform and share model parameters across watersheds in the Pacific Northwest. EPA’s Western Ecology Division has published and is refining a framework for defining la

  9. 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.

  10. The shifting landscape of health care: toward a model of health care empowerment.

    Science.gov (United States)

    Johnson, Mallory O

    2011-02-01

    In a rapidly changing world of health care information access and patients' rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities.

  11. Workforce Transition Modeling Environment user`s guide

    Energy Technology Data Exchange (ETDEWEB)

    Stahlman, E.J.; Oens, M.A.; Lewis, R.E.

    1993-10-01

    The Pacific Northwest Laboratory (PNL) was tasked by the US Department of Energy Albuquerque Field Office (DOE-AL) to develop a workforce assessment and transition planning tool to support integrated decision making at a single DOE installation. The planning tool permits coordinated, integrated workforce planning to manage growth, decline, or transition within a DOE installation. The tool enhances the links and provides commonality between strategic, programmatic, and operations planners and human resources. Successful development and subsequent complex-wide implementation of the model also will facilitate planning at the national level by enforcing a consistent format on data that are now collected by installations in corporate-specific formats that are not amenable to national-level analyses. The workforce assessment and transition planning tool, the Workforce Transition Modeling Environment (WFTME), consists of two components: the Workforce Transition Model and the Workforce Budget Constraint Model. The Workforce Transition Model, the preponderant of the two, assists decision makers identify and evaluate alternatives for transitioning the current workforce to meet the skills required to support projected workforce requirements. The Workforce Budget Constraint Model helps estimate the number of personnel that will be affected by a given workforce budget increase or decrease and assists in identifying how the corresponding hirings or layoffs should be distributed across the Common Occupation Classification System (COCS) occupations. This user`s guide describes the use and operation of the WFTME. This includes the functions of modifying data and running models, interpreting output reports, and an approach for using the WFTME to evaluate various workforce transition scenarios.

  12. 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.

  13. Counseling People Living in Poverty: The CARE Model

    Science.gov (United States)

    Foss, Louisa L.; Generali, Margaret M.; Kress, Victoria E.

    2011-01-01

    Counselors frequently counsel clients who live in poverty. The authors describe the new CARE model that addresses the influence of multiple systems on poor clients' experiences. A social justice, humanistic intervention, the CARE model emphasizes cultivating a positive counseling relationship with poor clients, empathizing with their unique…

  14. Correction, improvement and model verification of CARE 3, version 3

    Science.gov (United States)

    Rose, D. M.; Manke, J. W.; Altschul, R. E.; Nelson, D. L.

    1987-01-01

    An independent verification of the CARE 3 mathematical model and computer code was conducted and reported in NASA Contractor Report 166096, Review and Verification of CARE 3 Mathematical Model and Code: Interim Report. The study uncovered some implementation errors that were corrected and are reported in this document. The corrected CARE 3 program is called version 4. Thus the document, correction. improvement, and model verification of CARE 3, version 3 was written in April 1984. It is being published now as it has been determined to contain a more accurate representation of CARE 3 than the preceding document of April 1983. This edition supercedes NASA-CR-166122 entitled, 'Correction and Improvement of CARE 3,' version 3, April 1983.

  15. 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...

  16. 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.

  17. ORGANIZATION AND PROCEDURES GUIDE FOR PERFORMING MAJOR AMBULATORY AND SHORT-STAY SURGERY IN COORDINATION WITH THE PRIMARY HEALTH CARE TEAM

    Directory of Open Access Journals (Sweden)

    Javier Cruz Rodríguez

    2015-11-01

    Full Text Available Currently, there are constraints on coordination between the primary and secondary levels of care, and we lack a regulatory document for surgical activity in major ambulatory and short-stay surgery, which affects the quality of this modality of care. Such reasons led to the design of the “Organization and Procedures Guide for Performing Major Ambulatory and Short-stay Surgery in Coordination with the Primary Health Care Team". The guide was assessed by 90 experts with experience in the primary and secondary levels of care, who endorsed the quality and relevance of the proposal. It contains recommendations to help primary and secondary care professionals involved in surgical care to select the most appropriate approach to conditions treated by means of ambulatory or short-stay surgery. The recommendations are based on the latest available scientific evidence supporting the use of ambulatory surgery, short-stay surgery and home hospitalization.

  18. Nurses' Use of a Web-Based National Guide for Child Health Care.

    Science.gov (United States)

    Tell, Johanna; Olander, Ewy; Anderberg, Peter; Berglund, Johan Sanmartin

    2016-05-01

    Rikshandboken i Barnhälsovård is a Swedish Web-based guide for child healthcare, providing quality-ensured guidelines and support contributing to equality in child healthcare among all children. In 2015, a new child healthcare program was implemented and made available in this Web-based guide. The aim of this study was to investigate how child healthcare nurses use Rikshandboken i Barnhälsovård and factors affecting its use. The study was a comprehensive Web survey of 2376 child healthcare nurses in Sweden answered by 1309. Statistical processing was performed using descriptive and analytical methods. Rikshandboken i Barnhälsovård was widely used by the respondents, but regional differences and number of years in the profession affected the use. Almost all nurses were satisfied with the usability, content, and design and felt that a national guide for child healthcare is important. This indicates that an established Web-based national guide is an appropriate setting when a new national program is implemented. In order to achieve an equal and equitable child healthcare, it is essential that all nurses use the national guide to provide evidence-based practice. The value of main child healthcare units as regional facilitators in the innovation process of Rikshandboken i Barnhälsovård should not be underestimated.

  19. 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.

  20. 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.

  1. [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.

  2. Nurses’ Use of a Web-Based National Guide for Child Health Care

    OpenAIRE

    Tell, Johanna; Olander, Ewy; Anderberg, Peter; Berglund, Johan Sanmartin

    2016-01-01

    Rikshandboken i Barnhälsovård is a Swedish Web-based guide for child healthcare, providing quality-ensured guidelines and support contributing to equality in child healthcare among all children. In 2015, a new child healthcare program was implemented and made available in this Web-based guide. The aim of this study was to investigate how child healthcare nurses use Rikshandboken i Barnhälsovård and factors affecting its use. The study was a comprehensive Web survey of 2376 child healthcare nu...

  3. 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.

  4. Prehospital care and new models of regionalization.

    Science.gov (United States)

    Cone, David C; Brooke Lerner, E; Band, Roger A; Renjilian, Chris; Bobrow, Bentley J; Crawford Mechem, C; Carter, Alix J E; Kupas, Douglas F; Spaite, Daniel W

    2010-12-01

    This article summarizes the discussions of the emergency medical services (EMS) breakout session at the June 2010 Academic Emergency Medicine consensus conference "Beyond Regionalization: Integrated Networks of Emergency Care." The group focused on prehospital issues such as the identification of patients by EMS personnel, protocol-driven destination selection, bypassing closer nondesignated centers to transport patients directly to more distant designated specialty centers, and the modes of transport to be used as they relate to the regionalization of emergency care. It is our hope that the proposed research agenda will be advanced in a way that begins to rigorously approach the unanswered research questions and that these answers, in turn, will lead to an evidence-based, cohesive, comprehensive, and more uniform set of guidelines that govern the delivery and practice of prehospital emergency care.

  5. 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.

  6. The Cure PSP Care Guide: A Telephonic Nursing Intervention for Individuals and Families Living With Progressive Supranuclear Palsy.

    Science.gov (United States)

    Dunlop, Susan Rebecca; Kent, Vicky P; Lashley, Mary; Caruana, Trish

    2016-04-01

    Progressive supranuclear palsy (PSP) is a rare, progressive, and terminal neurodegenerative disease characterized by problems with ambulation, balance, mobility, vision, speech, swallowing, and behavior during the 7- to 10-year course of the illness. Substantial evidence in the nursing literature supports the benefits of patient education, self-management, chronic disease management, telehealth, and nurse navigation programs, which enhance patient and caregiver knowledge, improve day-to-day management by developing an awareness of resources, decrease dependence on services, and address caregiver needs. The Cure PSP Care Guide is a targeted telehealth nursing intervention aimed at providing knowledge, guidance, and resources to the vulnerable individuals and families living with PSP; identifying local resources; and building community. During the course of two telephone calls, individuals and their caregivers are assessed to develop a Cure PSP Care Guide designed to provide guidance along the trajectory. A knowledge assessment, self-efficacy scale, and Caregiver Strain Index are administered before and after the intervention to determine the program intervention effect. Caregiver knowledge assessments improved after the intervention, whereas strain scores were static. Qualitative data show the ability of the intervention to address caregiver needs for knowledge and support, daily management tips, and resource identification. The preliminary quantitative and qualitative data collected on this pilot project justify further exploration of the use of telehealth to remotely deliver nurse case management to the vulnerable individuals and families living with PSP.

  7. Queer Choreographies of Care: A Guided Tour of an Arts and Social Welfare Initiative in Manchester

    Science.gov (United States)

    Hughes, Jenny

    2013-01-01

    This article presents a guided tour of the Men's Room, an arts and social welfare project that works with young men with experiences of homelessness, sex work and the criminal justice system. Focusing on three "dwelling moments" that capture how the project occupies space and time, the article describes how a queer spatial practice…

  8. 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...

  9. Feasibility of guided cognitive behaviour therapy (CBT) self-help for childhood anxiety disorders in primary care.

    Science.gov (United States)

    Creswell, Cathy; Hentges, Francoise; Parkinson, Monika; Sheffield, Paul; Willetts, Lucy; Cooper, Peter

    2010-03-01

    Anxiety disorders in childhood are common, disabling and run a chronic course. Cognitive behaviour therapy (CBT) is effective but expensive and trained therapists are scarce. Guided self-help treatments may be a means of widening access to treatment. This study aimed to examine the feasibility of guided CBT self-help in primary care for childhood anxiety disorders, specifically in terms of therapist adherence, patient and therapist satisfaction and clinical gain.Participants were children aged between five and 12 years referred to two primary child and adolescent mental health services (PCAMHSs) in Oxfordshire, UK, who met diagnostic criteria for a primary anxiety disorder. Of the 52 eligible children, 41 anxious children were assessed for anxiety severity and interference before and after receiving CBT self-help delivered via a parent (total therapy time = five hours) by primary mental health workers (PMHWs). Therapy sessions were rated for treatment adherence and parents and PMHWs completed satisfaction questionnaires after treatment completion. Over 80% of therapy sessions were rated at a high level of treatment adherence. Parents and PMHWs reported high satisfaction with the treatment. Sixty-one percent of the children assessed no longer met the criteria for their primary anxiety disorder diagnosis following treatment, and 76% were rated as 'much'/'very much' improved on the Clinical Global Impression-Improvement (CGI-I) scale. There were significant reductions on parent and child report measures of anxiety symptoms, interference and depression. Preliminary exploration indicated that parental anxiety was associated with child treatment outcome. The findings suggest that guided CBT self-help represents a promising treatment for childhood anxiety in primary care.

  10. 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.

  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. 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.

  13. 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.

  14. 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.

  15. Guided reflection as a tool to deal with the theory– practice gap in critical care nursing students

    Directory of Open Access Journals (Sweden)

    Heleen S. du Toit

    2012-02-01

    Full Text Available Critical care nursing students experience inconsistencies between the theoretical content they have learnt and what is expected from them in practice, which retards the learning process. This has been described as the theory–practice gap. There seems to be no single solution to address the integration of theory and practice. In an attempt to bridge this gap, a study was done to establish the influence of guided reflection on critical care nursing students in dealing with their theoretical and practical experiences. A qualitative, explorative, descriptive and contextual design was followed. An instrument for guided reflection was designed which was used during semi-structured interviews during the data collection process. Field notes and narrative descriptions were also used as means to collect data. Themes that emerged from the data included a description of incidents experienced, critical analysis of knowledge, critical analysis of feelings and changed perspective experienced. Theory–practice integration occurred to an extent in some of the categories; conversely, the inability to apply theory to practice evoked responses such as feelings of guilt and incompetence. Guided reflection appeared to have assisted the participants in clarifying theoretical and practical experiences, and in reaching a changed perspective by understanding the link between theory and practice. Guided reflection ought to be incorporated in the education of nurses from their basic training in theory and practice so that student nurses will be aware of their own competencies in order to provide optimal patient care.

    Opsomming

    Kritiekesorgverpleegstudente ervaar teenstrydighede ten opsigte van dit wat hul geleer word en wat van hul in die praktyk verwag word wat weer die leerproses vertraag. Dit word as die teorie–praktykgaping beskryf. Daar blyk geen enkelvoudige oplossing te wees vir die integrasie van teorie en praktyk nie. In ’n poging

  16. 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.

  17. A new model for health care delivery

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    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.

  18. Fluid-structure coupling in the guide vanes cascade of a pump-turbine scale model

    Energy Technology Data Exchange (ETDEWEB)

    Roth, S; Hasmatuchi, V; Botero, F; Farhat, M; Avellan, F, E-mail: steven.roth@epfl.c [Laboratory for Hydraulic Machines, Ecole Polytechnique Federale de Lausanne Av. de Cour 33bis, Lausanne, 1007 (Switzerland)

    2010-08-15

    The present study concerns fluid-structure coupling phenomena occurring in a guide vane cascade of a pump-turbine scale model placed in the EPFL PF3 test rig. An advanced instrument set is used to monitor both vibrating structures and the surrounding flow. The paper highlights the interaction between vibrating guide vanes and the flow behavior. The pressure fluctuations in the stay vanes region are found to be strongly influenced by the amplitude of the vibrating guide vanes. Moreover, the flow induces different hydrodynamic damping on the vibrating guide vanes depending on the operating point of the pump-turbine.

  19. The Cardiovascular Intensive Care Unit-An Evolving Model for Health Care Delivery.

    Science.gov (United States)

    Loughran, John; Puthawala, Tauqir; Sutton, Brad S; Brown, Lorrel E; Pronovost, Peter J; DeFilippis, Andrew P

    2017-02-01

    Prior to the advent of the coronary care unit (CCU), patients having an acute myocardial infarction (AMI) were managed on the general medicine wards with reported mortality rates of greater than 30%. The first CCUs are believed to be responsible for reducing mortality attributed to AMI by as much as 40%. This drastic improvement can be attributed to both advances in medical technology and in the process of health care delivery. Evolving considerably since the 1960s, the CCU is now more appropriately labeled as a cardiac intensive care unit (CICU) and represents a comprehensive system designed for the care of patients with an array of advanced cardiovascular disease, an entity that reaches far beyond its early association with AMI. Grouping of patients by diagnosis to a common physical space, dedicated teams of health care providers, as well as the development and implementation of evidence-based treatment algorithms have resulted in the delivery of safer, more efficient care, and most importantly better patient outcomes. The CICU serves as a platform for an integrated, team-based patient care delivery system that addresses a broad spectrum of patient needs. Lessons learned from this model can be broadly applied to address the urgent need to improve outcomes and efficiency in a variety of health care settings.

  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. 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.

  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. Models of helping and coping in cancer care.

    Science.gov (United States)

    Northouse, L L; Wortman, C B

    1990-02-01

    This paper provides a theoretical analysis of four models of helping and coping as they relate to cancer care. The four conceptual models focus on the issue of whether or not patients should be viewed as responsible for the cause or the treatment of their cancer. The moral model, characterized by the holistic health movement, holds patients responsible for both causing and resolving health problems. The compensatory model, exemplified by cancer education programs, attributes low responsibility to patients for causing health problems but high responsibility for resolving them. The medical model views patients as neither responsible for causing nor for resolving health problems. The enlightenment model, typified by the healing movement, holds people responsible for causing their health problems, but not for resolving them. An attempt is made to examine existing programs in cancer care in light of these models. The present analysis addresses the following questions. Why is each of these models appealing? Why are they sometimes embraced by patients or health care providers? What are the benefits and disadvantages of using each of these models with cancer patients? What happens when the health care provider and patient hold different models regarding the patient's responsibility or participation in the cause of the disease or its treatment? Further research is needed to determine the conditions under which a particular model results in better health outcomes for patients, and to assess how factors such as extent of disease or type of cancer influence the patient's choice of a model.

  4. A service model for delivering care closer to home.

    Science.gov (United States)

    Dodd, Joanna; Taylor, Charlotte Elizabeth; Bunyan, Paul; White, Philippa Mary; Thomas, Siân Myra; Upton, Dominic

    2011-04-01

    Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects.

  5. 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

    NARCIS (Netherlands)

    W.M. Looman (Willemijn); I.N. Fabbricotti (Isabelle); R. Huijsman (Robbert)

    2014-01-01

    markdownabstract__Abstract__ 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 w

  6. Kansas Primary Care Weighs In: A Pilot Randomized Trial of a Chronic Care Model Program for Obesity in 3 Rural Kansas Primary Care Practices

    Science.gov (United States)

    Ely, Andrea C.; Banitt, Angela; Befort, Christie; Hou, Qing; Rhode, Paula C.; Grund, Chrysanne; Greiner, Allen; Jeffries, Shawn; Ellerbeck, Edward

    2008-01-01

    Context: Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. Purpose: To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary…

  7. 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.

  8. 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

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

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    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.

  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. The ENDOCARE questionnaire guides European endometriosis clinics to improve the patient-centeredness of their care

    NARCIS (Netherlands)

    Dancet, E.A.; Apers, S.; Kluivers, K.B.; Kremer, J.A.M.; Sermeus, W.; Devriendt, C.; Nelen, W.L.D.M.; D'Hooghe, T.M.

    2012-01-01

    STUDY QUESTION: How patient-centered are two included specialized endometriosis clinics relative to each other and how can they improve the patient-centeredness of their care? SUMMARY ANSWER: The validated ENDOCARE questionnaire (ECQ) reliably concluded that the adjusted overall patient-centeredness

  12. Putting a face and context on pediatric surgery cancelations: The development of parent personas to guide equitable surgical care.

    Science.gov (United States)

    Vaughn, Lisa M; DeJonckheere, Melissa; Pratap, Jayant Nick

    2016-06-09

    Last-minute cancelation of planned surgery can have substantial psychological, social, and economic effects for patients/families and also leads to wastage of expensive health-care resources. In order to have a deeper understanding of the contextual, psychological, practical, and behavioral factors that potentially impact pediatric surgery cancelation, we conducted a qualitative study to create 'personas' or fictional portraits of parents who are likely to cancel surgery. We conducted in-depth qualitative interviews with 21 parents of children who were considered 'at risk' for surgical cancelation and whose scheduled surgery was canceled at late notice. From the themes, patterns, and associated descriptive phrases in the data, we developed and validated five different personas of typical scenarios reflecting parent experiences with surgery and surgery cancelations. The personas are being employed to guide contextualized development of interventions tailored to prototypical families as they prepare and attend for surgery.

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

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    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.

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

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    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.

  15. 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).

  16. 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.

  17. 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

  18. 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.

  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. 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

  1. Animal models of chronic wound care

    DEFF Research Database (Denmark)

    Trostrup, Hannah; Thomsen, Kim; Calum, Henrik

    2016-01-01

    . An inhibiting effect of bacterial biofilms on wound healing is gaining significant clinical attention over the last few years. There is still a paucity of suitable animal models to recapitulate human chronic wounds. The etiology of the wound (venous insufficiency, ischemia, diabetes, pressure) has to be taken...... on nonhealing wounds. Relevant hypotheses based on clinical or in vitro observations can be tested in representative animal models, which provide crucial tools to uncover the pathophysiology of cutaneous skin repair in infectious environments. Disposing factors, species of the infectious agent(s), and time...... of establishment of the infection are well defined in suitable animal models. In addition, several endpoints can be involved for evaluation. Animals do not display chronic wounds in the way that humans do. However, in many cases, animal models can mirror the pathological conditions observed in humans, although...

  2. 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

    2013-01-01

    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.

  3. 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,…

  4. 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...

  5. 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.

  6. 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.

  7. A practical guide about biosimilar data for health care providers treating inflammatory diseases

    OpenAIRE

    Markenson J; Alvarez DF; Jacobs I; Kirchhoff C

    2017-01-01

    Joseph Markenson,1,2 Daniel F Alvarez,3 Ira Jacobs,4 Carol Kirchhoff5 1Department of Rheumatology, 2Department of Medicine, Hospital for Special Surgery, New York, NY, 3Pfizer Inc, Collegeville, PA, 4Pfizer Inc, New York, NY, 5Pfizer Inc, Chesterfield, MO, USA Abstract: To make informed decisions about the safety, efficacy, and clinical utility of a biosimilar, health care providers should understand the types and be able to analyze data generated from a biosimilar development program. T...

  8. 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.

  9. 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

  10. System dynamics modeling on health care : supply and demand of dementia care

    NARCIS (Netherlands)

    Rouwette, E.A.J.A.

    2006-01-01

    This presentation will address the use of system dynamics models to analyze complex problems in health care. System dynamics has been used on health related issues since at least the 1960s and in the Netherlands since the 1980s. In this approach a group of experts and stakeholders participates in de

  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. HETEAC: The Aerosol Classification Model for EarthCARE

    Directory of Open Access Journals (Sweden)

    Wandinger Ulla

    2016-01-01

    Full Text Available We introduce the Hybrid End-To-End Aerosol Classification (HETEAC model for the upcoming EarthCARE mission. The model serves as the common baseline for development, evaluation, and implementation of EarthCARE algorithms. It shall ensure the consistency of different aerosol products from the multi-instrument platform as well as facilitate the conform specification of broad-band optical properties necessary for the EarthCARE radiative closure efforts. The hybrid approach ensures the theoretical description of aerosol microphysics consistent with the optical properties of various aerosol types known from observations. The end-to-end model permits the uniform representation of aerosol types in terms of microphysical, optical and radiative properties.

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

    DEFF Research Database (Denmark)

    Winther, Jonas; Hillersdal, Line

    and technologies herein lead to the emergence of what we propose to be local models of obesity. Describing the emergence of local models of obesity we show how a specific model is being cared for, calibrated and embodied by research staff as well as research subjects and how interdisciplinary obesity research...... 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....... highlighted as such a problem. Within research communities disparate explanatory models of obesity exist (Ulijaszek 2008) and some of these models of obesity are brought together in the Copenhagen-based interdisciplinary research initiative; Governing Obesity (GO) with the aim of addressing the causes...

  14. Optimal administrative scale for planning public services: a social cost model applied to Flemish hospital care.

    Science.gov (United States)

    Blank, Jos L T; van Hulst, Bart

    2015-01-01

    In choosing the scale of public services, such as hospitals, both economic and public administrative considerations play important roles. The scale and the corresponding spatial distribution of public institutions have consequences for social costs, defined as the institutions' operating costs and the users' travel costs (which include the money and time costs). Insight into the relationship between scale and spatial distribution and social costs provides a practical guide for the best possible administrative planning level. This article presents a purely economic model that is suitable for deriving the optimal scale for public services. The model also reveals the corresponding optimal administrative planning level from an economic perspective. We applied this model to hospital care in Flanders for three different types of care. For its application, we examined the social costs of hospital services at different levels of administrative planning. The outcomes show that the social costs of rehabilitation in Flanders with planning at the urban level (38 areas) are 11% higher than those at the provincial level (five provinces). At the regional level (18 areas), the social costs of rehabilitation are virtually equal to those at the provincial level. For radiotherapy, there is a difference of 88% in the social costs between the urban and the provincial level. For general care, there are hardly any cost differences between the three administrative levels. Thus, purely from the perspective of social costs, rehabilitation should preferably be planned at the regional level, general services at the urban level and radiotherapy at the provincial level.

  15. Behavior modification in primary care: the pressure system model.

    Science.gov (United States)

    Katz, D L

    2001-01-01

    The leading causes of death in the United States are predominantly attributable to modifiable behaviors. Patients with behavioral risk factors for premature death and disability, including dietary practices; sexual practices; level of physical activity; motor vehi cle use patterns; and tobacco, alcohol, and illicit sub stance use, are seen far more consistently by primary care providers than by mental health specialists. Yet models of behavior modification are reported, debated, and revised almost exclusively in the psychology literature. While the Stages of Change Model, or Transtheo retical Model, has won application in a broadening array of clinical settings, its application in the primary care setting is apparently quite limited despite evidence of its utility [Prochaska J, Velicer W. Am J Health Promot 1997;12:38-48]. The lack of a rigorous behavioral model developed for application in the primary care setting is an impediment to the accomplishment of public health goals specified in the Healthy People objectives and in the reports of the U.S. Preventive Services Task Force. The Pressure System Model reported here synthesizes elements of established behavior modification theories for specific application under the constraints of the primary care setting. Use of the model in both clinical and research settings, with outcome evaluation, is encouraged as part of an effort to advance public health.

  16. [Citizen constitution and social representations: reflecting about health care models].

    Science.gov (United States)

    da Silva, Sílvio Eder Dias; Ramos, Flávia Regina Souza; Martins, Cleusa Rios; Padilha, Maria Itayra; Vasconcelos, Esleane Vilela

    2010-12-01

    This article presents a reflection on the meaning of the terms citizenship and health, addressing the Theory of Social Representations as a strategy for implementing and evaluating health care models in Brazil. First, a brief history about the concept of citizenship is presented; then the article addresses the principles of freedom and equality according to Kant; the third section of the article shows that health is as a right of the citizen and a duty of the state. Finally, the Theory of Social Representations is emphasized as a strategy to evaluate and implement the health services provided to citizens by the current health care models in Brazil.

  17. [Leadership strategies--the Bible as a guide to management in the health care system].

    Science.gov (United States)

    Kudlacek, Stefan; Meran, Johannes G

    2006-06-01

    Management and leadership are an integral part of any organisation, to optimise procedures and increase efficiency. Aims, ideals and structures first need to be defined for tasks to be carried out successfully, particularly in difficult times. A good example for the way communities can effectively and with conviction pass on their values and standpoints from generation to generation, grow in strength and also influence their surroundings is provided by religion. This paper focuses leadership provided by charismatic personalities within the Jewish and Christian religions. Monasteries have run hospitals without governmental support ever since the Middle Ages. Leadership within today's health care system calls for a variety of strategies in the different phases of development. In times of limited resources and multifarious societies, leadership implies both a scientific as well as an ethical challenge.

  18. A practical guide about biosimilar data for health care providers treating inflammatory diseases

    Science.gov (United States)

    Markenson, Joseph; Alvarez, Daniel F; Jacobs, Ira; Kirchhoff, Carol

    2017-01-01

    To make informed decisions about the safety, efficacy, and clinical utility of a biosimilar, health care providers should understand the types and be able to analyze data generated from a biosimilar development program. This article reviews the biosimilar guidelines, the biosimilar development process to provide education and context about biosimilarity, and uses examples from infliximab biosimilars to review the terminology and potential types of analyses that may be used to compare potential biosimilars to the originator biologic. A biosimilar is a biologic product that is highly similar to an approved (originator) biologic, notwithstanding minor differences in clinically inactive components, and with no clinically meaningful differences in terms of the safety, purity, and potency of the product. Due to their complex nature and production in living systems, it is not possible to exactly duplicate the approved originator biologic. To ensure biosimilars provide consistent, safe, and effective treatment comparable to the originator biologic, extensive analyses of the potential biosimilar are conducted, including side-by-side analytical, nonclinical, and clinical comparisons. A key goal is to determine whether there are sufficient relevant similarities in chemical composition, biologic activity, and pharmacokinetic aspects between the potential biosimilar and the originator. Regulatory approvals and marketing authorizations for biosimilars are made on a case-by-case and agency-by-agency basis after evaluating the totality of the evidence generated from the entire development program. Understanding how regulatory agencies review data for approval can help health care providers make appropriate decisions when biosimilars become available for use in the treatment of inflammatory diseases, and therefore they should review the literature to gain further information about specific biosimilars. PMID:28280299

  19. A practical guide about biosimilar data for health care providers treating inflammatory diseases

    Directory of Open Access Journals (Sweden)

    Markenson J

    2017-02-01

    Full Text Available Joseph Markenson,1,2 Daniel F Alvarez,3 Ira Jacobs,4 Carol Kirchhoff5 1Department of Rheumatology, 2Department of Medicine, Hospital for Special Surgery, New York, NY, 3Pfizer Inc, Collegeville, PA, 4Pfizer Inc, New York, NY, 5Pfizer Inc, Chesterfield, MO, USA Abstract: To make informed decisions about the safety, efficacy, and clinical utility of a biosimilar, health care providers should understand the types and be able to analyze data generated from a biosimilar development program. This article reviews the biosimilar guidelines, the biosimilar development process to provide education and context about biosimilarity, and uses examples from infliximab biosimilars to review the terminology and potential types of analyses that may be used to compare potential biosimilars to the originator biologic. A biosimilar is a biologic product that is highly similar to an approved (originator biologic, notwithstanding minor differences in clinically inactive components, and with no clinically meaningful differences in terms of the safety, purity, and potency of the product. Due to their complex nature and production in living systems, it is not possible to exactly duplicate the approved originator biologic. To ensure biosimilars provide consistent, safe, and effective treatment comparable to the originator biologic, extensive analyses of the potential biosimilar are conducted, including side-by-side analytical, nonclinical, and clinical comparisons. A key goal is to determine whether there are sufficient relevant similarities in chemical composition, biologic activity, and pharmacokinetic aspects between the potential biosimilar and the originator. Regulatory approvals and marketing authorizations for biosimilars are made on a case-by-case and agency-by-agency basis after evaluating the totality of the evidence generated from the entire development program. Understanding how regulatory agencies review data for approval can help health care providers make

  20. Incidence of sepsis following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon

    Directory of Open Access Journals (Sweden)

    Mohammed Shahait

    2016-02-01

    Full Text Available ABSTRACT Background Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in areas with high prevalence of resistant strains or patients presenting risk factors is lacking. Objectives The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. Materials and Methods We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients’ hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. Results In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independent predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88–1.00, p-value=0.03, and hypertension comorbidity with an OR=3.25 (95% CI: 1.19–8.85, p-value=0.02. Conclusion We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy.

  1. The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive Care Unit

    Science.gov (United States)

    2016-04-01

    AWARD NUMBER: W81XWH-13-2-0011 TITLE: The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive...2016 4. TITLE AND SUBTITLE “The Phase of Illness Paradigm: A Checklist Centric Model to 5a. CONTRACT NUMBER Improve Patient Care in the Burn...shared mental model of patient care amongst clinicians in the BICU and thus enhance distributed cognition (Hutchins 2000) and assist the work of the

  2. 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.

  3. 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.

  4. 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

  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. The Performance of Academic Identity as Pedagogical Model and Guide in/through Lecture Discourse

    Science.gov (United States)

    McInnes, David

    2013-01-01

    This article argues that lecture discourse has the capacity to support students in their transition into modes of social critique and that the lecturer, through an enactment of an academic identity in lecture discourse, plays a crucial role as both model and guide. Certain crucial phases and sub-phases of lectures are used to model an engagement…

  7. Analysing empowerment-oriented email consultation for parents : Development of the Guiding the Empowerment Process model

    NARCIS (Netherlands)

    Nieuwboer, C.C.; Fukkink, R.G.; Hermanns, J.M.A.

    2017-01-01

    Online consultation is increasingly offered by parenting practitioners, but it is not clear if it is feasible to provide empowerment-oriented support in a single session email consultation. Based on the empowerment theory, we developed the Guiding the Empowerment Process model (GEP model) to evaluat

  8. Digital Avionics Information System (DAIS): Training Requirements Analysis Model Users Guide. Final Report.

    Science.gov (United States)

    Czuchry, Andrew J.; And Others

    This user's guide describes the functions, logical operations and subroutines, input data requirements, and available outputs of the Training Requirements Analysis Model (TRAMOD), a computerized analytical life cycle cost modeling system for use in the early stages of system design. Operable in a stand-alone mode, TRAMOD can be used for the…

  9. 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...

  10. Medical care transition planning and dental care use for youth with special health care needs during the transition from adolescence to young adulthood: a preliminary explanatory model.

    Science.gov (United States)

    Chi, Donald L

    2014-05-01

    The aims of the study were to test the hypotheses that youth with special health care needs (YSHCN) with a medical care transition plan are more likely to use dental care during the transition from adolescence to young adulthood and that different factors are associated with dental utilization for YSHCN with and YSHCN without functional limitations. National Survey of CSHCN (2001) and Survey of Adult Transition and Health (2007) data were analyzed (N = 1,746). The main predictor variable was having a medical care transition plan, defined as having discussed with a doctor how health care needs might change with age and having developed a transition plan. The outcome variable was dental care use in 2001 (adolescence) and 2007 (young adulthood). Multiple variable Poisson regression models with robust standard errors were used to estimate covariate-adjusted relative risks (RR). About 63 % of YSHCN had a medical care transition plan and 73.5 % utilized dental care. YSHCN with a medical care transition plan had a 9 % greater RR of utilizing dental care than YSHCN without a medical care transition plan (RR 1.09; 95 % CI 1.03-1.16). In the models stratified by functional limitation status, having a medical care transition plan was significantly associated with dental care use, but only for YSHCN without functional limitations (RR 1.11; 95 % CI 1.04-1.18). Having a medical care transition plan is significantly associated with dental care use, but only for YSHCN with no functional limitation. Dental care should be an integral part of the comprehensive health care transition planning process for all YSHCN.

  11. The Arkansas AHEC model of community-oriented primary care.

    Science.gov (United States)

    Hartwig, M S; Landis, B J

    1999-07-01

    This article explicates the Arkansas Area Health Education Center (AHEC) model of community-oriented primary care (COPC) and the role of the family nurse practitioner (FNP) in its implementation. The AHECs collaborate with local agencies to provide comprehensive, accessible, quality health care to specific patient populations, and offer learning opportunities to a wide variety of health professions students. The FNP demonstrates organizational and role competencies that include directing patient care, providing professional leadership, and developing the advanced practice nursing role. Two case studies are used to illustrate the FNPs' approach to COPC: (1) selection of interdisciplinary, multidisciplinary, and transdisciplinary approaches to management of a patient with chronic illnesses, and (2) the Sexual Assault Nurse Examiners Training Project.

  12. 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.

  13. 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.

  14. The Preventable Admissions Care Team (PACT): A Social Work-Led Model of Transitional Care.

    Science.gov (United States)

    Basso Lipani, Maria; Holster, Kathleen; Bussey, Sarah

    2015-10-01

    In 2010, the Preventable Admissions Care Team (PACT), a social work-led transitional care model, was developed at Mount Sinai to reduce 30-day readmissions among high-risk patients. PACT begins with a comprehensive bedside assessment to identify the psychosocial drivers of readmission. In partnership with the patient and family, a patient-centered action plan is developed and carried out through phone calls, accompaniments, navigations and home visits, as needed, in the first 30 days following discharge. 620 patients were enrolled during the pilot from September 2010-August 2012. Outcomes demonstrated a 43% reduction in inpatient utilization and a 54% reduction in emergency department visits among enrollees. In addition, 93% of patients had a follow-up appointment within 7-10 days of discharge and 90% of patients attended the appointment. The success of PACT has led to additional funding from the Centers for Medicare and Medicaid Services under the Community-based Care Transitions Program and several managed care companies seeking population health management interventions for high risk members.

  15. 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

  16. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yimin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Goldberg, Marshall [MRG and Associates, Nevada City, CA (United States)

    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.

  18. Pediatric Oncology Clinic Care Model: Achieving Better Continuity of Care for Patients in a Medium-sized Program.

    Science.gov (United States)

    Johnston, Donna L; Halton, Jacqueline; Bassal, Mylène; Klaassen, Robert J; Mandel, Karen; Ramphal, Raveena; Simpson, Ewurabena; Peckan, Li

    2016-10-25

    Providing the best care in both the inpatient and outpatient settings to pediatric oncology patients is all programs goal. Using continuous improvement methodologies, we changed from a solely team-based physician care model to a hybrid model. All patients were assigned a dedicated oncologist. There would then be 2 types of weeks of outpatient clinical service. A "Doc of the Day" week where each oncologist would have a specific day in clinic when their assigned patients would be scheduled, and then a "Doc of the Week" week where one physician would cover clinic for the week. Patient satisfaction surveys done before and 14 months after changing the model of care showed that patients were very satisfied with the care they received in both models. A questionnaire to staff 14 months after changing showed that the biggest effect was increased continuity of care, followed by more efficient clinic workflow and increased consistency of care. Staff felt it provided better planning and delivery of care. A hybrid model of care with a primary physician for each patient and assigned clinic days, alternating with weeks of single physician coverage is a feasible model of care for a medium-sized pediatric oncology program.

  19. Designing a Care Pathway Model – A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway

    Directory of Open Access Journals (Sweden)

    Robin I. Oosterholt

    2017-03-01

    Full Text Available Introduction: Although the clinical attributes of total hip arthroplasty (THA care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. Theory: The outpatient THA care pathway enables patients to be discharged on the day of surgery, short- ening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. Methods: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi- structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. Results: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1 and mobilisation & discharge (4. The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. Conclusion: The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1, radiologist (1, anaesthetist (1, nurse specialist (1, pharmacist (1, orthopaedic surgeon (1,4, physiotherapist (1,4, nurse (4, doctor (4 and patient applica- tion (1,4. The critical value exchanges include patient preparation (mental and practical, patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

  20. 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.

  1. 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.

  2. 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.

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

    OpenAIRE

    Veinot Paula; MacKay Crystal; Badley Elizabeth M

    2008-01-01

    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 provide...

  4. Performance Improvement/HPT Model: Guiding the Process

    Science.gov (United States)

    Dessinger, Joan Conway; Moseley, James L.; Van Tiem, Darlene M.

    2012-01-01

    This commentary is part of an ongoing dialogue that began in the October 2011 special issue of "Performance Improvement"--Exploring a Universal Performance Model for HPT: Notes From the Field. The performance improvement/HPT (human performance technology) model represents a unifying process that helps accomplish successful change, create…

  5. 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.

  6. 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.

  7. A model for ubiquitous care of noncommunicable diseases.

    Science.gov (United States)

    Vianna, Henrique Damasceno; Barbosa, Jorge Luis Victória

    2014-09-01

    The ubiquitous computing, or ubicomp, is a promising technology to help chronic diseases patients managing activities, offering support to them anytime, anywhere. Hence, ubicomp can aid community and health organizations to continuously communicate with patients and to offer useful resources for their self-management activities. Communication is prioritized in works of ubiquitous health for noncommunicable diseases care, but the management of resources is not commonly employed. We propose the UDuctor, a model for ubiquitous care of noncommunicable diseases. UDuctor focuses the resources offering, without losing self-management and communication supports. We implemented a system and applied it in two practical experiments. First, ten chronic patients tried the system and filled out a questionnaire based on the technology acceptance model. After this initial evaluation, an alpha test was done. The system was used daily for one month and a half by a chronic patient. The results were encouraging and show potential for implementing UDuctor in real-life situations.

  8. 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.

  9. 78 FR 29139 - Medicare Program; Bundled Payments for Care Improvement Model 1 Open Period

    Science.gov (United States)

    2013-05-17

    ... participation in Model 1 of the Bundled Payments for Care Improvement initiative. DATES: Model 1 of the Bundled Payments for Care Improvement Deadline: Interested organizations must submit a Model 1 Open Period... regarding Model 1 of the Bundled Payments for Care Improvement initiative. For additional information...

  10. Mathematically guided approaches to distinguish models of periodic patterning

    OpenAIRE

    2015-01-01

    How periodic patterns are generated is an open question. A number of mechanisms have been proposed – most famously, Turing's reaction-diffusion model. However, many theoretical and experimental studies focus on the Turing mechanism while ignoring other possible mechanisms. Here, we use a general model of periodic patterning to show that different types of mechanism (molecular, cellular, mechanical) can generate qualitatively similar final patterns. Observation of final patterns is therefore n...

  11. Subject-specific models for image-guided cardiac surgery

    Science.gov (United States)

    Wierzbicki, Marcin; Moore, John; Drangova, Maria; Peters, Terry

    2008-10-01

    Three-dimensional visualization for planning and guidance is still not routinely available for minimally invasive cardiac surgery (MICS). This can be addressed by providing the surgeon with subject-specific geometric models derived from 3D preoperative images for planning of port locations or to rehearse the procedure. For guidance purposes, these models can also be registered to the subject using intraoperative images. In this paper, we present a method for extracting subject-specific heart geometry from preoperative MR images. The main obstacle we face is the low quality of clinical data in terms of resolution, signal-to-noise ratio, and presence of artefacts. Instead of using these images directly, we approach the problem in three steps: (1) generate a high quality template model, (2) register the template with the preoperative data, and (3) animate the result over the cardiac cycle. Validation of this approach showed that dynamic subject-specific models can be generated with a mean error of 3.6 ± 1.1 mm from low resolution target images (6 mm slices). Thus, the models are sufficiently accurate for MICS training and procedure planning. In terms of guidance, we also demonstrate how the resulting models may be adapted to the operating room using intraoperative ultrasound imaging.

  12. 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.

  13. 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…

  14. Health care policy development: a critical analysis model.

    Science.gov (United States)

    Logan, Jean E; Pauling, Carolyn D; Franzen, Debra B

    2011-01-01

    This article describes a phased approach for teaching baccalaureate nursing students critical analysis of health care policy, including refinement of existing policy or the foundation to create new policy. Central to this approach is the application of an innovative framework, the Grand View Critical Analysis Model, which was designed to provide a conceptual base for the authentic learning experience. Students come to know the interconnectedness and the importance of the model, which includes issue selection and four phases: policy focus, colleagueship analysis, evidence-based practice analysis, and policy analysis and development.

  15. 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

  16. A computational fluid dynamics modeling study of guide walls for downstream fish passage

    Science.gov (United States)

    Mulligan, Kevin; Towler, Brett; Haro, Alexander J.; Ahlfeld, David P.

    2017-01-01

    A partial-depth, impermeable guidance structure (or guide wall) for downstream fish passage is typically constructed as a series of panels attached to a floating boom and anchored across a water body (e.g. river channel, reservoir, or power canal). The downstream terminus of the wall is generally located nearby to a fish bypass structure. If guidance is successful, the fish will avoid entrainment in a dangerous intake structure (i.e. turbine intakes) while passing from the headpond to the tailwater of a hydroelectric facility through a safer passage route (i.e. the bypass). The goal of this study is to determine the combination of guide wall design parameters that will most likely increase the chance of surface-oriented fish being successfully guided to the bypass. To evaluate the flow field immediately upstream of a guide wall, a parameterized computational fluid dynamics model of an idealized power canal was constructed in © ANSYS Fluent v 14.5 (ANSYS Inc., 2012). The design parameters investigated were the angle and depth of the guide wall and the average approach velocity in the power canal. Results call attention to the importance of the downward to sweeping flow ratio and demonstrate how a change in guide wall depth and angle can affect this important hydraulic cue to out-migrating fish. The key findings indicate that a guide wall set at a small angle (15° is the minimum in this study) and deep enough such that sweeping flow dominant conditions prevail within the expected vertical distribution of fish approaching the structure will produce hydraulic conditions that are more likely to result in effective passage.

  17. 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...

  18. 76 FR 33306 - Medicare Program; Pioneer Accountable Care Organization Model, Request for Applications; Correction

    Science.gov (United States)

    2011-06-08

    ... Care Organization Model: Request for Applications.'' FOR FURTHER INFORMATION CONTACT: Maria Alexander... http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco... HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program; Pioneer Accountable...

  19. Guiding Principles for Language Assessment Reform: A Model for Collaboration

    Science.gov (United States)

    Green, Brent A.; Andrade, Maureen Snow

    2010-01-01

    Traditionally, practitioners interested in language test reform have focused on the qualities within an examination which result in either positive or negative impacts on participants, institutions, and society. Recent views suggest a multifaceted interaction among factors affecting language test reform. We introduce a model for test reform that…

  20. 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

  1. 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…

  2. 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

  3. 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

  4. Finite element modeling of guided wave scattering at delaminations in composite panels

    Science.gov (United States)

    Murat, B. I. S.; Fromme, P.

    2016-04-01

    Carbon fiber laminate composites, consisting of layers of polymer matrix reinforced with high strength carbon fibers, are increasingly employed for aerospace structures. They offer advantages for aerospace applications, e.g., good strength to weight ratio. However, impact during the operation and servicing of the aircraft can lead to barely visible and difficult to detect damage. Depending on the severity of the impact, delaminations can occur, reducing the load carrying capacity of the structure. Efficient structural health monitoring of composite panels can be achieved using guided ultrasonic waves propagating along the structure. The guided ultrasonic wave (A0 Lamb wave mode) scattering at delaminations was modelled using full three-dimensional Finite Element (FE) simulations. The influence of the delamination size was systematically investigated from a parameter study. The angular dependency of the scattered guided wave amplitude was calculated using a baseline subtraction method. A significant influence of the delamination width on the guided wave scattering was found. The sensitivity of guided waves for the detection of barely visible impact damage in composite panels has been predicted.

  5. Unidirectional cell crawling model guided by extracellular cues.

    Science.gov (United States)

    Wang, Zhanjiang; Geng, Yuxu

    2015-03-01

    Cell migration is a highly regulated and complex cellular process to maintain proper homeostasis for various biological processes. Extracellular environment was identified as the main affecting factors determining the direction of cell crawling. It was observed experimentally that the cell prefers migrating to the area with denser or stiffer array of microposts. In this article, an integrated unidirectional cell crawling model was developed to investigate the spatiotemporal dynamics of unidirectional cell migration, which incorporates the dominating intracellular biochemical processes, biomechanical processes and the properties of extracellular micropost arrays. The interpost spacing and the stiffness of microposts are taken into account, respectively, to study the mechanism of unidirectional cell locomotion and the guidance of extracellular influence cues on the direction of unidirectional cell crawling. The model can explain adequately the unidirectional crawling phenomena observed in experiments such as "spatiotaxis" and "durotaxis," which allows us to obtain further insights into cell migration.

  6. [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.

  7. 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.

  8. 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.

  9. 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...

  10. Aircraft/Air Traffic Management Functional Analysis Model. Version 2.0; User's Guide

    Science.gov (United States)

    Etheridge, Melvin; Plugge, Joana; Retina, Nusrat

    1998-01-01

    The Aircraft/Air Traffic Management Functional Analysis Model, Version 2.0 (FAM 2.0), is a discrete event simulation model designed to support analysis of alternative concepts in air traffic management and control. FAM 2.0 was developed by the Logistics Management Institute (LMI) a National Aeronautics and Space Administration (NASA) contract. This document provides a guide for using the model in analysis. Those interested in making enhancements or modification to the model should consult the companion document, Aircraft/Air Traffic Management Functional Analysis Model, Version 2.0 Technical Description.

  11. 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.

  12. 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 required

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. Improved analytical model for the field of index-guiding microstructured optical fibers

    Science.gov (United States)

    Sharma, Dinesh Kumar; Sharma, Anurag

    2016-05-01

    We present an improved version of our earlier developed analytical field model for the fundamental mode of index-guiding microstructured optical fibers (MOFs), to obtain better accuracy in the simulated results. Using this improved field model, we have studied the splice losses between an MOF and a traditional step-index single-mode fiber (SMF). Comparisons with available experimental and numerical simulation results have also been included.

  18. Novel Modeling Framework To Guide Design of Optimal Dosing Strategies for β-Lactamase Inhibitors

    OpenAIRE

    Bhagunde, Pratik; Chang, Kai-Tai; Hirsch, Elizabeth B.; Ledesma, Kimberly R.; Nikolaou, Michael; Tam, Vincent H.

    2012-01-01

    The scarcity of new antibiotics against drug-resistant bacteria has led to the development of inhibitors targeting specific resistance mechanisms, which aim to restore the effectiveness of existing agents. However, there are few guidelines for the optimal dosing of inhibitors. Extending the utility of mathematical modeling, which has been used as a decision support tool for antibiotic dosing regimen design, we developed a novel mathematical modeling framework to guide optimal dosing strategie...

  19. 75 FR 2562 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Science.gov (United States)

    2010-01-15

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care Continuation... document announces the availability of the model health care continuation coverage notices required by...

  20. 75 FR 26276 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Science.gov (United States)

    2010-05-11

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care Continuation... announces the availability of the model health care continuation coverage notices required by ARRA,...

  1. 76 FR 29249 - Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications

    Science.gov (United States)

    2011-05-20

    ... participate in the Pioneer Accountable Care Organization Model for a period beginning in 2011 and ending...://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco . Application Submission... Accountable Care Organization Model or the application process. SUPPLEMENTARY INFORMATION: I. Background...

  2. 75 FR 13595 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Science.gov (United States)

    2010-03-22

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the availability of the Model Health Care Continuation... document announces the availability of the model health care continuation coverage notices required by...

  3. 78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

    Science.gov (United States)

    2013-02-06

    ... Disease Care Model Announcement AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION... the testing of the Comprehensive End- Stage Renal Disease (ESRD) Care Model, a new initiative from the... (CHIP) beneficiaries. We are interested in identifying models designed to improve care for...

  4. 76 FR 34712 - Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission...

    Science.gov (United States)

    2011-06-14

    ...: This notice extends the deadlines for the submission of the Pioneer Accountable Care Organization Model...-coordinated-care-models/pioneer-aco . Application Submission Deadline: Applications must be postmarked on or before August 19, 2011. The Pioneer Accountable Care Organization Model ] Application is available...

  5. 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

  6. Adjoint Methods for Guiding Adaptive Mesh Refinement in Tsunami Modeling

    Science.gov (United States)

    Davis, B. N.; LeVeque, R. J.

    2016-12-01

    One difficulty in developing numerical methods for tsunami modeling is the fact that solutions contain time-varying regions where much higher resolution is required than elsewhere in the domain, particularly when tracking a tsunami propagating across the ocean. The open source GeoClaw software deals with this issue by using block-structured adaptive mesh refinement to selectively refine around propagating waves. For problems where only a target area of the total solution is of interest (e.g., one coastal community), a method that allows identifying and refining the grid only in regions that influence this target area would significantly reduce the computational cost of finding a solution. In this work, we show that solving the time-dependent adjoint equation and using a suitable inner product with the forward solution allows more precise refinement of the relevant waves. We present the adjoint methodology first in one space dimension for illustration and in a broad context since it could also be used in other adaptive software, and potentially for other tsunami applications beyond adaptive refinement. We then show how this adjoint method has been integrated into the adaptive mesh refinement strategy of the open source GeoClaw software and present tsunami modeling results showing that the accuracy of the solution is maintained and the computational time required is significantly reduced through the integration of the adjoint method into adaptive mesh refinement.

  7. 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

  8. 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.

  9. 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…

  10. EPEC-O for African Americans - Plenary 2 AA - 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.

  11. A Clinic Model: Post-Intensive Care Syndrome and Post-Intensive Care Syndrome-Family.

    Science.gov (United States)

    Huggins, Elizabeth L; Bloom, Sarah L; Stollings, Joanna L; Camp, Mildred; Sevin, Carla M; Jackson, James C

    2016-01-01

    The number of patients surviving critical illness in the United States has increased with advancements in medicine. Post-intensive care syndrome and post-intensive care syndrome-family are terms developed by the Society of Critical Care Medicine in order to address the cognitive, psychological, and physical sequelae emerging in patients and their families after discharge from the intensive care unit. In the United Kingdom and Europe, intensive care unit follow-up clinics have been used to address the complications of post-intensive care syndrome for some time. However, the interprofessional clinic at Vanderbilt University Medical Center is among the first in the United States to address the wide variety of problems experienced by intensive care survivors and to provide patients and their families with care after discharge from the intensive care unit.

  12. 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

  13. An agent-based simulation model of patient choice of health care providers in accountable care organizations.

    Science.gov (United States)

    Alibrahim, Abdullah; Wu, Shinyi

    2016-10-04

    Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

  14. Spider silk as guiding biomaterial for human model neurons.

    Science.gov (United States)

    Roloff, Frank; Strauß, Sarah; Vogt, Peter M; Bicker, Gerd; Radtke, Christine

    2014-01-01

    Over the last years, a number of therapeutic strategies have emerged to promote axonal regeneration. An attractive strategy is the implantation of biodegradable and nonimmunogenic artificial scaffolds into injured peripheral nerves. In previous studies, transplantation of decellularized veins filled with spider silk for bridging critical size nerve defects resulted in axonal regeneration and remyelination by invading endogenous Schwann cells. Detailed interaction of elongating neurons and the spider silk as guidance material is unknown. To visualize direct cellular interactions between spider silk and neurons in vitro, we developed an in vitro crossed silk fiber array. Here, we describe in detail for the first time that human (NT2) model neurons attach to silk scaffolds. Extending neurites can bridge gaps between single silk fibers and elongate afterwards on the neighboring fiber. Culturing human neurons on the silk arrays led to an increasing migration and adhesion of neuronal cell bodies to the spider silk fibers. Within three to four weeks, clustered somata and extending neurites formed ganglion-like cell structures. Microscopic imaging of human neurons on the crossed fiber arrays in vitro will allow for a more efficient development of methods to maximize cell adhesion and neurite growth on spider silk prior to transplantation studies.

  15. Spider Silk as Guiding Biomaterial for Human Model Neurons

    Directory of Open Access Journals (Sweden)

    Frank Roloff

    2014-01-01

    Full Text Available Over the last years, a number of therapeutic strategies have emerged to promote axonal regeneration. An attractive strategy is the implantation of biodegradable and nonimmunogenic artificial scaffolds into injured peripheral nerves. In previous studies, transplantation of decellularized veins filled with spider silk for bridging critical size nerve defects resulted in axonal regeneration and remyelination by invading endogenous Schwann cells. Detailed interaction of elongating neurons and the spider silk as guidance material is unknown. To visualize direct cellular interactions between spider silk and neurons in vitro, we developed an in vitro crossed silk fiber array. Here, we describe in detail for the first time that human (NT2 model neurons attach to silk scaffolds. Extending neurites can bridge gaps between single silk fibers and elongate afterwards on the neighboring fiber. Culturing human neurons on the silk arrays led to an increasing migration and adhesion of neuronal cell bodies to the spider silk fibers. Within three to four weeks, clustered somata and extending neurites formed ganglion-like cell structures. Microscopic imaging of human neurons on the crossed fiber arrays in vitro will allow for a more efficient development of methods to maximize cell adhesion and neurite growth on spider silk prior to transplantation studies.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. Erratum to: Many diseases, one model of care?

    Directory of Open Access Journals (Sweden)

    Tit Albreht

    2016-02-01

    Full Text Available Abstract Erratum to: Albreht T, Dyakova M, Schellevis FG, Van den Broucke S. Many diseases, one model of care? J Comorbidity 2016;6(1:12−20. doi: 10.15256/joc.2016.6.73. The received and accepted dates for this article were incorrectly published as Jan 4, 2015 and Jan 25, 2015, respectively, instead of Jan 4, 2016 and Jan 25, 2016, respectively. The original article has now been updated to reflect the correct submission and acceptance dates. Journal of Comorbidity 2016;6(1:34 The original article can be found at: http://dx.doi.org/10.15256/joc.2016.6.73

  3. Providing surgical care in Somalia: A model of task shifting

    Directory of Open Access Journals (Sweden)

    Ford Nathan P

    2011-07-01

    Full Text Available Abstract Background Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. Methods In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Results Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65% were male and the median age was 22 (interquartile range, 17-30. 1460 (70% of interventions were emergent. Trauma accounted for 76% (1585 of all surgical pathology; gunshot wounds accounted for 89% (584 of violent injuries. Operative mortality (0.5% of all surgical interventions was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. Conclusions The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully

  4. 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.

  5. Testing cost-benefit models of parental care evolution using lizard populations differing in the expression of maternal care.

    Directory of Open Access Journals (Sweden)

    Wen-San Huang

    Full Text Available Parents are expected to evolve tactics to care for eggs or offspring when providing such care increases fitness above the costs incurred by this behavior. Costs to the parent include the energetic demands of protecting offspring, delaying future fecundity, and increased risk of predation. We used cost-benefit models to test the ecological conditions favoring the evolution of parental care, using lizard populations that differ in whether or not they express maternal care. We found that predators play an important role in the evolution of maternal care because: (1 evolving maternal care is unlikely when care increases predation pressure on the parents; (2 maternal care cannot evolve under low levels of predation pressure on both parents and offspring; and (3 maternal care evolves only when parents are able to successfully defend offspring from predators without increasing predation risk to themselves. Our studies of one of the only known vertebrate species to exhibit interpopulation differences in the expression of maternal care provide clear support for some of the hypothesized circumstances under which maternal care should evolve (e.g., when nests are in exposed locations, parents are able to defend the eggs from predators, and egg incubation periods are brief, but do not support others (e.g., when nest-sites are scarce, life history strategies are "risky", reproductive frequency is low, and environmental conditions are harsh. We conclude that multiple pathways can lead to the evolution of parental care from a non-caring state, even in a single population of a widespread species.

  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. [Advantages of midwife-led continuity model of care

    NARCIS (Netherlands)

    Prins, M.; Dillen, J. van; Jonge, A de

    2014-01-01

    In the Dutch maternity care system women at low risk of complications in pregnancy and birth are distinguished from women at an increased risk. Primary care midwives are responsible for the care in the low-risk group, whereas obstetricians are responsible for care when the risk is increased. Most pr

  8. 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.

  9. 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

  10. 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

  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. 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

  13. [Fusing empowerment concept into patient-centered collaborative care model].

    Science.gov (United States)

    Wu, Chia-Chen; Lin, Chiu-Chu

    2014-12-01

    Chronic diseases are incurable, long-term illnesses. To improve quality of life, patients with chronic diseases must adjust their own personal lifestyle to cope with their diseases and eventually learn to achieve a balance between disease control and daily life. Therefore, self-management necessarily plays a key role in chronic disease management. Different from physician-centered healthcare, the self-management practiced by chronic disease patients is more patient-centered with a greater emphasis on active patient participation. The main goal of this article is to elucidate the essence of the empowerment concept. An example of diabetes care, this article introduces a detailed five-step application as a basic model for incorporating the empowerment concept into the healthcare of patients with chronic disease. The author suggests that healthcare providers apply the empowerment model in clinical practice to assist patients to maintain an optimal balance between their health status and personal lives.

  14. 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.

  15. Goals and Characteristics of Long-Term Care Programs: An Analytic Model.

    Science.gov (United States)

    Braun, Kathryn L.; Rose, Charles L.

    1989-01-01

    Used medico-social analytic model to compare five long-term care programs: Skilled Nursing Facility-Intermediate Care Facility (SNF-ICF) homes, ICF homes, foster homes, day hospitals, and home care. Identified similarities and differences among programs. Preliminary findings suggest that model is useful in the evaluation and design of long-term…

  16. 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.

  17. 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.

  18. 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.)

  19. Development and testing of a Hyperlearning Model for design of an online critical care course.

    Science.gov (United States)

    Jeffries, Pamela R

    2005-08-01

    Many U.S. colleges and universities are discovering innovative and exciting ways of using information technology to promote the process of teaching and learning and to extend education to new populations of students. Nurse educators in academia and service settings are developing interactive e-learning programs or courses to meet this need, and to either enhance practice concepts and basic skills or orient new associates to the clinical organization. In continuing education programs, students need flexibility and convenience to concurrently meet their personal and academic goals, and consumer demand for online instruction is increasing. The challenge is to prepare a comprehensive, high-quality, cost-effective e-learning course to meet educational standards and competencies. To meet this challenge, an instructional design model, the Hyperlearning Model, was developed based on Chickering and Gamson's principles of best practices in undergraduate education, to guide the development of an online course for basic critical care content. In this article, I describe the creation and testing of an instructional design model for developing content in this online course.

  20. 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.

  1. 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

  2. Evaluating the Quality of the Learning Outcome in Healthcare Sector: The Expero4care Model

    Science.gov (United States)

    Cervai, Sara; Polo, Federica

    2015-01-01

    Purpose: This paper aims to present the Expero4care model. Considering the growing need for a training evaluation model that does not simply fix processes, the Expero4care model represents the first attempt of a "quality model" dedicated to the learning outcomes of healthcare trainings. Design/Methodology/Approach: Created as development…

  3. 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.

  4. 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.

  5. Manual-guided cognitive-behavioural therapy for insomnia delivered by ordinary primary care personnel in general medical practice: a randomized controlled effectiveness trial.

    Science.gov (United States)

    Bothelius, Kristoffer; Kyhle, Kicki; Espie, Colin A; Broman, Jan-Erik

    2013-12-01

    Chronic insomnia is a prevalent problem in primary health care and tends to be more serious than insomnia in the general population. These patients often obtain little benefit from hypnotics, and are frequently open to exploring various options for medical treatment. However, most general practitioners (GPs) are unable to provide such options. Several meta-analyses have shown that cognitive-behavioural therapy (CBT) for insomnia results in solid improvements on sleep parameters, and a few studies have demonstrated promising results for nurse-administered CBT in primary care. The aim of this randomized controlled study was to investigate the clinical effectiveness of manual-guided CBT for insomnia delivered by ordinary primary care personnel in general medical practice with unselected patients. Sixty-six primary care patients with insomnia were randomized to CBT or a waiting-list control group. The CBT group improved significantly more than the control group using the Insomnia Severity Index as the outcome. The effect size was high. Sleep diaries showed a significant, medium-sized treatment effect for sleep onset latency and wake time after sleep onset. However, for all measures there is a marked deterioration at follow-up assessments. Almost half of the treated subjects (47%) reported a clinically relevant treatment effect directly after treatment. It is concluded that this way of delivering treatment may be cost-effective.

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

    Energy Technology Data Exchange (ETDEWEB)

    Couairon, A. [Centre de Physique Theorique, CNRS, Ecole Polytechnique, 91128 Palaiseau (France); Brambilla, E.; Corti, T. [Department of Physics and Mathematics, University of Insubria, via Vallegio 11, 22100 Como (Italy); Majus, D. [Department of Quantum Electronics, Vilnius University, Sauletekio Avenue 9, Bldg. 3, 10222 Vilnius (Lithuania); Ramirez-Congora, O. de [Departamento de Ciencias Naturales y Matematicas, Pontificia Universidad Javeriana-Cali, Avenida Canas Gordas no 118-250 Cali (Colombia); Kolesik, M. [College of Optical Sciences, Tucson 85721 AZ (United States); Department of Physics, Constantine the Philosopher Uninversity, Nitra (Slovakia)

    2011-11-15

    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. 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)

  8. Evaluation of Health Care System Model Based on Collaborative Algorithms

    OpenAIRE

    2015-01-01

    The rapid development and use of information and communication technologies in the last two decades has influenced a dramatic transformation of public health and health care, changing the roles of the health care support systems and services. Recent trends in health care support systems are focused on developing patient-centric pervasive environments and the use of mobile devices and technologies in medical monitoring and health care systems [1].

  9. 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.

  10. 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.

  11. Diabetes Care as an Active Learning Model of Postgraduate Education and Training for Pharmaceutical Care.

    Science.gov (United States)

    Koda-Kimble, Mary Anne; Batz, Forrest R.

    1994-01-01

    In a University of California continuing pharmacy education course in diabetes care, practicing pharmacists lived as patients with diabetes for two days and role-played in small groups. One year later, participants reported making changes in their diabetes care-related practice, suggesting its effectiveness in improving practitioners' skill…

  12. 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…

  13. Formative evaluation of practice changes for managing depression within a Shared Care model in primary care.

    Science.gov (United States)

    Beaulac, Julie; Edwards, Jeanette; Steele, Angus

    2017-01-01

    Aim To investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba.

  14. Intracranial pressure monitoring, cerebral perfusion pressure estimation, and ICP/CPP-guided therapy: a standard of care or optional extra after brain injury?

    Science.gov (United States)

    Kirkman, M A; Smith, M

    2014-01-01

    Measurement of intracranial pressure (ICP) and mean arterial pressure (MAP) is used to derive cerebral perfusion pressure (CPP) and to guide targeted therapy of acute brain injury (ABI) during neurointensive care. Here we provide a narrative review of the evidence for ICP monitoring, CPP estimation, and ICP/CPP-guided therapy after ABI. Despite its widespread use, there is currently no class I evidence that ICP/CPP-guided therapy for any cerebral pathology improves outcomes; indeed some evidence suggests that it makes no difference, and some that it may worsen outcomes. Similarly, no class I evidence can currently advise the ideal CPP for any form of ABI. 'Optimal' CPP is likely patient-, time-, and pathology-specific. Further, CPP estimation requires correct referencing (at the level of the foramen of Monro as opposed to the level of the heart) for MAP measurement to avoid CPP over-estimation and adverse patient outcomes. Evidence is emerging for the role of other monitors of cerebral well-being that enable the clinician to employ an individualized multimodality monitoring approach in patients with ABI, and these are briefly reviewed. While acknowledging difficulties in conducting robust prospective randomized studies in this area, such high-quality evidence for the utility of ICP/CPP-directed therapy in ABI is urgently required. So, too, is the wider adoption of multimodality neuromonitoring to guide optimal management of ICP and CPP, and a greater understanding of the underlying pathophysiology of the different forms of ABI and what exactly the different monitoring tools used actually represent.

  15. 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…

  16. Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care

    OpenAIRE

    Symon, A; J. Pringle; Cheyne, H.; Downe, S.; Hundley, Vanora; Lee, E; Lynn, F; McFadden, A.; McNeill, J.; Renfrew, M. J.; Ross-Davie, M.; Van Teijlingen, Edwin; Whitford, H.; Alderdice, F.

    2016-01-01

    Background: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportu...

  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. 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

  19. 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

  20. ANALYTICAL MODEL OF CALCULUS FOR INFLUENCE THE TRANSLATION GUIDE WEAR OVER THE MACHINING ACCURACY ON THE MACHINE TOOL

    Directory of Open Access Journals (Sweden)

    Ivona PETRE

    2010-10-01

    Full Text Available The wear of machine tools guides influences favorably to vibrations. As a result of guides wear, the initial trajectory of cutting tools motion will be modified, the generating dimensional accuracy discrepancies and deviations of geometrical shape of the work pieces. As it has already been known, the wear of mobile and rigid guides is determined by many parameters (pressure, velocity, friction length, lubrication, material. The choice of one or another analytic model and/or the experimental model of the wear is depending by the working conditions, assuming that the coupling material is known.The present work’s goal is to establish an analytic model of calculus showing the influence of the translation guides wear over the machining accuracy on machine-tools.

  1. 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.

  2. Image-guided radiotherapy platform using single nodule conditional lung cancer mouse models.

    Science.gov (United States)

    Herter-Sprie, Grit S; Korideck, Houari; Christensen, Camilla L; Herter, Jan M; Rhee, Kevin; Berbeco, Ross I; Bennett, David G; Akbay, Esra A; Kozono, David; Mak, Raymond H; Mike Makrigiorgos, G; Kimmelman, Alec C; Wong, Kwok-Kin

    2014-12-18

    Close resemblance of murine and human trials is essential to achieve the best predictive value of animal-based translational cancer research. Kras-driven genetically engineered mouse models of non-small-cell lung cancer faithfully predict the response of human lung cancers to systemic chemotherapy. Owing to development of multifocal disease, however, these models have not been usable in studies of outcomes following focal radiotherapy (RT). We report the development of a preclinical platform to deliver state-of-the-art image-guided RT in these models. Presence of a single tumour as usually diagnosed in patients is modelled by confined injection of adenoviral Cre recombinase. Furthermore, three-dimensional conformal planning and state-of-the-art image-guided dose delivery are performed as in humans. We evaluate treatment efficacies of two different radiation regimens and find that Kras-driven tumours can temporarily be stabilized upon RT, whereas additional loss of either Lkb1 or p53 renders these lesions less responsive to RT.

  3. 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

  4. Generalized poroviscoelastic model based on effective Biot theory and its application to borehole guided wave analysis

    Science.gov (United States)

    Liu, Xu; Greenhalgh, Stewart; Zhou, Bing; Heinson, Graham

    2016-12-01

    A method using modified attenuation factor function is suggested to determine the parameters of the generalized Zener model approximating the attenuation factor function. This method is applied to constitute the poroviscoelastic model based on the effective Biot theory which considers the attenuative solid frame of reservoir. In the poroviscoelastic model, frequency-dependent bulk modulus and shear modulus of solid frame are represented by generalized Zener models. As an application, the borehole logging dispersion equations from Biot theory are extended to include effects from the intrinsic body attenuation in formation media in full-frequency range. The velocity dispersions of borehole guided waves are calculated to investigate the influence from attenuative bore fluid, attenuative solid frame of the formation and impermeable bore wall.

  5. 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.

  6. 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.

  7. Technical elements, demonstration projects, and fiscal models in Medicaid managed care for people with developmental disabilities.

    Science.gov (United States)

    Kastner, T A; Walsh, K K; Criscione, T

    1997-08-01

    We presented a general model of the structure and functioning of managed care and described elements (provider networks, fiscal elements, risk estimation, case-mix, management information systems, practice parameters, and quality improvement) critical to service delivery for people with developmental disabilities. A number of technical elements of managed care systems were delineated and reviewed in relation to the inclusion of people with developmental disabilities. Several managed care demonstration projects were described and, finally, a multi-year hypothetical budget model, including long-term care, was presented as a framework for considering how managed care affects specific service structures. Implications for people with developmental disabilities were discussed.

  8. 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.

  9. 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...

  10. 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.

  11. Improving Web Learning through model Optimization using Bootstrap for a Tour-Guide Robot

    Directory of Open Access Journals (Sweden)

    Rafael León

    2012-09-01

    Full Text Available We perform a review of Web Mining techniques and we describe a Bootstrap Statistics methodology applied to pattern model classifier optimization and verification for Supervised Learning for Tour-Guide Robot knowledge repository management. It is virtually impossible to test thoroughly Web Page Classifiers and many other Internet Applications with pure empirical data, due to the need for human intervention to generate training sets and test sets. We propose using the computer-based Bootstrap paradigm to design a test environment where they are checked with better reliability

  12. Efficient methods to model the scattering of ultrasonic guided waves in 3D

    Science.gov (United States)

    Moreau, L.; Velichko, A.; Wilcox, P. D.

    2010-03-01

    The propagation of ultrasonic guided waves and their interaction with a defect is of interest to the nondestructive testing community. There is no general solution to the scattering problem and it is still an ongoing research topic. Due to the complexity of guided wave scattering problems, most existing models are related to the 2D case. However, thanks to the increase in computer calculation power, specific 3D problems can also be studied, with the help of numerical or semi-analytical methods. This paper describes two efficient methods aimed at modeling 3D scattering problems. The first method is the use of the Huygens' principle to reduce the size of finite element models. This principle allows the area of interest to be restricted to the very near field of the defect, for both the generation of the incident field and the modal decomposition of the scattered field. The second method consists of separating the 3D problem into two 2D problems for which the solutions are calculated and used to approximate the 3D solution. This can be used at low frequency-thickness products, where Lamb waves have a similar behavior to bulk waves. These two methods are presented briefly and compared on simple scattering cases.

  13. 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.

  14. 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.

  15. 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...

  16. 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.

  17. 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.

  18. Dynamic Model for Hydro-Turbine Generator Units Based on a Database Method for Guide Bearings

    Directory of Open Access Journals (Sweden)

    Yong Xu

    2013-01-01

    Full Text Available A suitable dynamic model of rotor system is of great significance not only for supplying knowledge of the fault mechanism, but also for assisting in machine health monitoring research. Many techniques have been developed for properly modeling the radial vibration of large hydro-turbine generator units. However, an applicable dynamic model has not yet been reported in literature due to the complexity of the boundary conditions and exciting forces. In this paper, a finite element (FE rotor dynamic model of radial vibration taking account of operating conditions is proposed. A brief and practical database method is employed to model the guide bearing. Taking advantage of the method, rotating speed and bearing clearance can be considered in the model. A novel algorithm, which can take account of both transient and steady-state analysis, is proposed to solve the model. Dynamic response for rotor model of 125 MW hydro-turbine generator units in Gezhouba Power Station is simulated. Field data from Optimal Maintenance Information System for Hydro power plants (HOMIS are analyzed compared with the simulation. Results illustrate the application value of the model in providing knowledge of the fault mechanism and in failure diagnosis.

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

    DEFF Research Database (Denmark)

    Madsen, Jens

    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...... 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 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 radius effects on the radial transport of isolated plasma filaments (blobs) in the scrape-off region of fusion plasmas...

  20. Model Guided Design and Development Process for an Electronic Health Record Training Program.

    Science.gov (United States)

    He, Ze; Marquard, Jenna; Henneman, Elizabeth

    2016-01-01

    Effective user training is important to ensure electronic health record (EHR) implementation success. Though many previous studies report best practice principles and success and failure stories, current EHR training is largely empirically-based and often lacks theoretical guidance. In addition, the process of training development is underemphasized and underreported. A white paper by the American Medical Informatics Association called for models of user training for clinical information system implementation; existing instructional development models from learning theory provide a basis to meet this call. We describe in this paper our experiences and lessons learned as we adapted several instructional development models to guide our development of EHR user training. Specifically, we focus on two key aspects of this training development: training content and training process.

  1. Eatwell Guide: modelling the dietary and cost implications of incorporating new sugar and fibre guidelines

    DEFF Research Database (Denmark)

    Scarborough, Peter; Kaur, Asha; Cobiac, Linda

    2016-01-01

    adult per day, very similar to the cost of the current diet: £6.02 (£5.96 to £6.08). The optimised diet would result in increased consumption of n-3 fatty acids and most micronutrients (including iron and folate), but decreased consumption of zinc and small decreases in consumption of calcium......Objectives To model food group consumption and price of diet associated with achieving UK dietary recommendations while deviating as little as possible from the current UK diet, in order to support the redevelopment of the UK food-based dietary guidelines (now called the Eatwell Guide). Design...... Optimisation modelling, minimising an objective function of the difference between population mean modelled and current consumption of 125 food groups, and constraints of nutrient and food-based recommendations. Setting The UK. Population Adults aged 19 years and above from the National Diet and Nutrition...

  2. 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…

  3. 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.

  4. 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.

  5. How To Start a Family Day Care = Como Iniciar una Guarderia en El Hogar. [Videotape and Viewer's Guide].

    Science.gov (United States)

    Raphael, Doris; Weisman, Douglas

    Being a family day care provider is work that requires professional responsibilities and attention to the physical, emotional, and educational well-being of children; listening and responding to parents; and running a business. This videotape, in English- and Spanish-language versions, explores the elements involved in starting up a family day…

  6. [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.

  7. Residential Care

    Science.gov (United States)

    ... Last name: Email: * Zip: * *required We will not sell or share your name. Residential Care Tweet Bookmark ... for the future. Use Alzheimer's Navigator ™ - our free online tool - to guide you as you map out ...

  8. [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.

  9. A computational model of the hippocampus that represents environmental structure and goal location, and guides movement.

    Science.gov (United States)

    Matsumoto, Jumpei; Makino, Yoshinari; Miura, Haruki; Yano, Masafumi

    2011-08-01

    Hippocampal place cells (PCs) are believed to represent environmental structure. However, it is unclear how and which brain regions represent goals and guide movements. Recently, another type of cells that fire around a goal was found in rat hippocampus (we designate these cells as goal place cells, GPCs). This suggests that the hippocampus is also involved in goal representation. Assuming that the activities of GPCs depend on the distance to a goal, we propose an adaptive navigation model. By monitoring the population activity of GPCs, the model navigates to shorten the distance to the goal. To achieve the distance-dependent activities of GPCs, plastic connections are assumed between PCs and GPCs, which are modified depending on two reward-triggered activities: activity propagation through PC-PC network representing the topological environmental structure, and the activity of GPCs with different durations. The former activity propagation is regarded as a computational interpretation of "reverse replay" phenomenon found in rat hippocampus. Simulation results confirm that after reaching a goal only once, the model can navigate to the goal along almost the shortest path from arbitrary places in the environment. This indicates that the hippocampus might play a primary role in the representation of not only the environmental structure but also the goal, in addition to guiding the movement. This navigation strategy using the population activity of GPCs is equivalent to the taxis strategy, the simplest and most basic for biological systems. Our model is unique because this simple strategy allows the model to follow the shortest path in the topological map of the environment.

  10. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

    Science.gov (United States)

    Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

    2014-07-01

    Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  11. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    Directory of Open Access Journals (Sweden)

    Daniel Alyeshmerni

    2014-07-01

    Full Text Available Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA, and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  12. 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…

  13. 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

  14. Embedding Care and Unpaid Work in Macroeconomic Modeling: A Structuralist Approach

    NARCIS (Netherlands)

    E. Braunstein (Elissa); I.P. van Staveren (Irene); D. Tavani (Daniele)

    2011-01-01

    textabstractThis study embeds paid and unpaid care work in a structuralist macroeconomic model. Care work is formally modeled as a gendered input into the market production process via its impact on the current and future labor force, with altruistic motivations determining both how much support peo

  15. 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.

  16. 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.

  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. 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

  19. 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

    2016-10-01

    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.

  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. 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.

  2. A microstructure-guided constitutive modeling approach for random heterogeneous materials: Application to structural binders

    Energy Technology Data Exchange (ETDEWEB)

    Das, Sumanta; Maroli, Amit; Singh, Sudhanshu S.; Stannard, Tyler; Xiao, Xianghui; Chawla, Nikhilesh; Neithalath, Narayanan

    2016-06-01

    This paper presents a microstructure-guided modeling approach to predict the effective elastic response of heterogeneous materials, and demonstrates its application toward two highly heterogeneous, uncon- ventional structural binders, i.e., iron carbonate and fly ash geopolymer. Microstructural information from synchrotron X-ray tomography (XRT) and intrinsic elastic properties of component solid phases from statistical nanoindentation are used as the primary inputs. The virtual periodic 3D microstructure reconstructed using XRT, along with periodic boundary conditions is used as a basis for strain- controlled numerical simulation scheme in the linear elastic range to predict the elastic modulus as well as the stresses in the microstructural phases. The elastic modulus of the composite material predicted from the microstructure-based constitutive modeling approach correlates very well with experimental measurements for both the materials considered. This technique efficiently links the microstructure to mechanical properties of interest and helps develop material design guidelines for novel heterogeneous composites

  3. Two-mode model for metal-dielectric guided-mode resonance filters.

    Science.gov (United States)

    Tuambilangana, Christelle; Pardo, Fabrice; Sakat, Emilie; Bouchon, Patrick; Pelouard, Jean-Luc; Haïdar, Riad

    2015-12-14

    Symmetric metal-dielectric guided-mode resonators (GMR) can operate as infrared band-pass filters, thanks to high-transmission resonant peaks and good rejection ratio. Starting from matrix formalism, we show that the behavior of the system can be described by a two-mode model. This model reduces to a scalar formula and the GMR is described as the combination of two independent Fabry-Perot resonators. The formalism has then been applied to the case of asymmetric GMR, in order to restore the properties of the symmetric system. This result allows designing GMR-on-substrate as efficient as free-standing systems, the same high transmission maximum value and high quality factor being conserved.

  4. 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.

  5. 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.

  6. Comparative Effects of Dexmedetomidine and Propofol on US-Guided Radiofrequency Ablation of Hepatic Neoplasm Under Monitored Anesthesia Care

    OpenAIRE

    2015-01-01

    Abstract Percutaneous radiofrequency ablation (RFA) is a useful and safe procedure for treating hepatic neoplasm. However, liver RFA causes severe pain, which thereby increases the demand for monitored anesthesia care (MAC). Here, we compared the efficacy and safety of propofol and dexmedetomidine, which are commonly administered during MAC when performing RFA to assess hepatic neoplasm. In this randomized controlled trial, 40 patients were randomly allocated to 2 groups for elective RFA. Pat...

  7. 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.

  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. 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.

  10. 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.

  11. 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.

  12. Conformity of pediatric/adolescent HIV clinics to the patient-centered medical home care model.

    Science.gov (United States)

    Yehia, Baligh R; Agwu, Allison L; Schranz, Asher; Korthuis, P Todd; Gaur, Aditya H; Rutstein, Richard; Sharp, Victoria; Spector, Stephen A; Berry, Stephen A; Gebo, Kelly A

    2013-05-01

    The patient-centered medical home (PCMH) has been introduced as a model for providing high-quality, comprehensive, patient-centered care that is both accessible and coordinated, and may provide a framework for optimizing the care of youth living with HIV (YLH). We surveyed six pediatric/adolescent HIV clinics caring for 578 patients (median age 19 years, 51% male, and 82% black) in July 2011 to assess conformity to the PCMH. Clinics completed a 50-item survey covering the six domains of the PCMH: (1) comprehensive care, (2) patient-centered care, (3) coordinated care, (4) accessible services, (5) quality and safety, and (6) health information technology. To determine conformity to the PCMH, a novel point-based scoring system was devised. Points were tabulated across clinics by domain to obtain an aggregate assessment of PCMH conformity. All six clinics responded. Overall, clinics attained a mean 75.8% [95% CI, 63.3-88.3%] on PCMH measures-scoring highest on patient-centered care (94.7%), coordinated care (83.3%), and quality and safety measures (76.7%), and lowest on health information technology (70.0%), accessible services (69.1%), and comprehensive care (61.1%). Clinics moderately conformed to the PCMH model. Areas for improvement include access to care, comprehensive care, and health information technology. Future studies are warranted to determine whether greater clinic PCMH conformity improves clinical outcomes and cost savings for YLH.

  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. 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.

  16. Rethinking prenatal care within a social model of health: an exploratory study in Northern Ireland.

    Science.gov (United States)

    McNeill, Jenny A; Reiger, Kerreen M

    2015-01-01

    Implementation of maternity reform agendas remains limited by the dominance of a medical rather than social model of health. This article considers group prenatal care as a complex health intervention and explores its potential in the socially divided, postconflict communities of Northern Ireland. Using qualitative inquiry strategies, we sought key informants' views on existing prenatal care provision and on an innovative group care model (CenteringPregnancy®) as a social health initiative. We argue that taking account of the locally specific context is critical to introducing maternity care interventions to improve the health of women and their families and to contribute to community development.

  17. 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.

  18. Modelling of resource allocation to health care authorities in Stockholm county

    DEFF Research Database (Denmark)

    Andersson, Paula; Varde, E; Diderichsen, Finn

    2000-01-01

    Since the Stockholm County Council introduced a system of purchasers and providers there has been a quest for population-based resource allocation models to allocate monies to purchasers of health care. In contrast to models used in Britain, Swedish models have been based on individual level data....... 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...

  19. 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...

  20. Digital Avionics Information System (DAIS): Reliability and Maintainability Model Users Guide. Final Report, May 1975-July 1977.

    Science.gov (United States)

    Czuchry, Andrew J.; And Others

    This report provides a complete guide to the stand alone mode operation of the reliability and maintenance (R&M) model, which was developed to facilitate the performance of design versus cost trade-offs within the digital avionics information system (DAIS) acquisition process. The features and structure of the model, its input data…

  1. 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.

  2. 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.

  3. 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.

  4. Adapting Gel Wax into an Ultrasound-Guided Pericardiocentesis Model at Low Cost.

    Science.gov (United States)

    Daly, Robert; Planas, Jason H; Edens, Mary Ann

    2017-01-01

    Cardiac tamponade is a life-threatening emergency for which pericardiocentesis may be required. Real-time bedside ultrasound has obviated the need for routine blind procedures in cardiac arrest, and the number of pericardiocenteses being performed has declined. Despite this fact, pericardiocentesis remains an essential skill in emergency medicine. While commercially available training models exist, cost, durability, and lack of anatomical landmarks limit their usefulness. We sought to create a pericardiocentesis model that is realistic, simple to build, reusable, and cost efficient. We constructed the model using a red dye-filled ping pong ball (simulating the right ventricle) and a 250cc normal saline bag (simulating the effusion) encased in an artificial rib cage and held in place by gel wax. The inner saline bag was connected to a 1L saline bag outside of the main assembly to act as a fluid reservoir for repeat uses. The entire construction process takes approximately 16-20 hours, most of which is attributed to cooling of the gel wax. Actual construction time is approximately four hours at a cost of less than $200. The model was introduced to emergency medicine residents and medical students during a procedure simulation lab and compared to a model previously described by dell'Orto.1 The learners performed ultrasound-guided pericardiocentesis using both models. Learners who completed a survey comparing realism of the two models felt our model was more realistic than the previously described model. On a scale of 1-9, with 9 being very realistic, the previous model was rated a 4.5. Our model was rated a 7.8. There was also a marked improvement in the perceived recognition of the pericardium, the heart, and the pericardial sac. Additionally, 100% of the students were successful at performing the procedure using our model. In simulation, our model provided both palpable and ultrasound landmarks and held up to several months of repeated use. It was less expensive

  5. 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.

  6. Perceptions of a Primary Nursing Care Model in a Pediatric Hematology/Oncology Unit.

    Science.gov (United States)

    Nadeau, Katie; Pinner, Kerri; Murphy, Katie; Belderson, Kristin M

    2016-02-22

    The primary nursing care model optimizes relationship-based care. Despite using a primary nursing model on a pediatric hematology/oncology inpatient unit, it was hypothesized patients and nurses were dissatisfied with the structure of primary care teams and inconsistency of primary assignments. The purpose of this study was to evaluate patient/family and nurse perceptions of our current care model through assessing gaps in its operationalization and satisfaction. This study used a descriptive cross-sectional design featuring patient/family and nurse surveys. Of the 59 patient/family respondents, 93.2% prefer to have a primary nurse care for them and 85% are satisfied with how often they are assigned a primary care team member. Similarly, 63% of the 57 nurse respondents are satisfied with the current implementation of our primary nursing model and 61% state the model reflects good continuity of care. Yet 80.7% of nurses believe safety would improve for a patient whose nurse works shifts consecutively even if not a primary nurse. Overall, patients, families, and nurses value care continuity and meaningful nurse-patient relationships, which is fundamental to primary nursing.

  7. 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

  8. A Porcine Liver Model for Validation of Registration Accuracy in Image-Guided Surgery

    Science.gov (United States)

    Peterhans, Matthias; Dagon, Benoît; Berg, Anne Vom; Inderbitzin, Daniel; Baur, Charles; Weber, Stefan

    Correct registration between pre-operative high-resolution images and intra-operative data of lower detail is a fundamental requirement in image-guided liver surgery. We propose a multi modality liver model for measuring the accuracy of such registration methods. A freshly explanted porcine liver is artificially perfused by a peristaltic pump and liver motion is simulated by means of inflatable objects positioned around the liver. Co-registered ultrasound and CT data sets are acquired in different deformation scenarios and allow compar-ing registration outcomes with a CT data set serving as ground truth. The pre-sent work describes the experimental setup and summarizes the results from ultrasound and CT imaging.

  9. 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.

  10. 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.

  11. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    Directory of Open Access Journals (Sweden)

    Grace Haeson Park

    2014-03-01

    Full Text Available Background: A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. Description of integrated practice: An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. Early results: The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased. Conclusion: Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

  12. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    Directory of Open Access Journals (Sweden)

    Grace Haeson Park

    2014-03-01

    Full Text Available Background: A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions.Description of integrated practice: An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues.Early results: The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased.Conclusion: Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

  13. What is Patient-Centered Care? A Typology of Models and Missions.

    Science.gov (United States)

    Tanenbaum, Sandra J

    2015-09-01

    Recently adopted health care practices and policies describe themselves as "patient-centered care." The meaning of the term, however, remains contested and obscure. This paper offers a typology of "patient-centered care" models that aims to contribute to greater clarity about, continuing discussion of, and further advances in patient-centered care. The paper imposes an original analytic framework on extensive material covering mostly US health care and health policy topics over several decades. It finds that four models of patient-centered care emphasize: patients versus their parts; patients versus providers; patients/providers/states versus "the system"; and patients and providers as persons. Each type is distinguishable along three dimensions: epistemological orientations, practical accommodations, and policy tools. Based on this analysis, the paper recommends that four questions be asked of any proposal that claims to provide patient-centered care: Is this care a means to an end or an end in itself? Are patients here subjects or objects? Are patients here individuals or aggregates? How do we know what patients want and need? The typology reveals that models are neither entirely compatible nor entirely incompatible and may be usefully combined in certain practices and policies. In other instances, internal contradictions may jeopardize the realization of coherent patient-centered care.

  14. 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.

  15. Forecasting the use of elderly care: a static micro-simulation model.

    Science.gov (United States)

    Eggink, Evelien; Woittiez, Isolde; Ras, Michiel

    2016-07-01

    This paper describes a model suitable for forecasting the use of publicly funded long-term elderly care, taking into account both ageing and changes in the health status of the population. In addition, the impact of socioeconomic factors on care use is included in the forecasts. The model is also suitable for the simulation of possible implications of some specific policy measures. The model is a static micro-simulation model, consisting of an explanatory model and a population model. The explanatory model statistically relates care use to individual characteristics. The population model mimics the composition of the population at future points in time. The forecasts of care use are driven by changes in the composition of the population in terms of relevant characteristics instead of dynamics at the individual level. The results show that a further 37 % increase in the use of elderly care (from 7 to 9 % of the Dutch 30-plus population) between 2008 and 2030 can be expected due to a further ageing of the population. However, the use of care is expected to increase less than if it were based on the increasing number of elderly only (+70 %), due to decreasing disability levels and increasing levels of education. As an application of the model, we simulated the effects of restricting access to residential care to elderly people with severe physical disabilities. The result was a lower growth of residential care use (32 % instead of 57 %), but a somewhat faster growth in the use of home care (35 % instead of 32 %).

  16. User's guide for simulation of waste treatment (SWAT) model

    Energy Technology Data Exchange (ETDEWEB)

    Macal, C.M.

    1979-04-01

    This document is a user's guide for the Simulation of Waste Treatment (SWAT) model computer code. (A detailed description of the logic and assumptions of the model was published previously.) A flow diagram depicting the logic of the SWAT computer code is included. Several river basins or regions can be simulated in a single computer run, with each region having numerous treatment plants. Treatment plants are simulated sequentially to reduce computer storage requirements. All input to the model is in the form of cards and all output is to a line printer. The code is written in FORTRAN IV and consists of approximately 3000 statements. Using the IBM 370/195 under OS, a Gl compiler requires a region of 220K. Execution time is under two minutes for a typical run for a river basin with 23 treatment plants, with each plant having an average of one technology modification over a simulation period of 25 years. In the first section of this report a brief description of the subroutines in the model is given along with an explanation of how the subroutines function in the context of the whole program. The third section indicates formatting for input data; sample input data for a test problem are also presented. Section 4 describes the output resulting from the sample input data. A program listing appears in the appendix.

  17. Use of narrative as an awareness strategy for a Family-Centered Care model

    Directory of Open Access Journals (Sweden)

    Daniela Doulavince Amador

    Full Text Available The aim of this study was to comprehend the meaning of using illness narratives to raise awareness among nursing students and healthcare professionals toward the family-centred care model. The adopted methodological framework was Qualitative Content Analysis based on the philosophy of Family-Centered Care. Data were collected by means of assessments provided by 29 participants at an event in 2013, in São Paulo. The resulting analytical category was "transformed by the family narrative", which consisted of three sub-categories: Favours a better understanding of the family's experience; facilitates learning of family issues; and triggers thought on family-centered care. Results showed that hearing the family narrative on experiences with illness and hospitalization raises awareness among nursing students and healthcare professionals toward the family-centered care model, and facilitates learning of this model of care.

  18. Shared care is a model for patients with stable prostate cancer

    DEFF Research Database (Denmark)

    Lund, Lars; Jønler, Morten; Graversen, Hans Peder

    2013-01-01

    general practitioners (GPs) can handle follow-up. MATERIAL AND METHODS: A Steering Committee was established in collaboration with health-care professionals to devise a strategy for a shared care model. An action plan was designed that included 1) the development of a shared care model for follow......-up and treatment, 2) implementation of the shared care model in cooperation between the parties involved, 3) design of procedures for re-referral, and 4) evaluation of effect, change processes and contextual factors. RESULTS: A total of 2,585 patients with PC were included in the study: 1,172 had disseminated...... to follow-up with a GP and 2,055 were not transferred to their GP. The main reason why patients were considered not suitable for transfer to primary health care was the patients' own desire (33%), followed by clinical or biochemical disease progression (33%). The evaluation found that 96% of the patients...

  19. Model of learning for practitioners in dementia care with music therapy as the joint focal point

    DEFF Research Database (Denmark)

    Ottesen, Aase Marie

    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...... 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...... care, which has music therapy as the joint focal point and focus on the relational meeting.Through development of a cross-disciplinary cooperation between the music therapist and the care providers in connection with a course of music therapy, will following areas be elucidated: How can the musical...

  20. 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

    Directory of Open Access Journals (Sweden)

    Fransina J. de Jong

    2009-06-01

    Full Text Available 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, information sheets from professional associations. Results: Factors facilitating the implementation of the collaborative care model are continuous supervision of the care managers by the consultant psychiatrist and the trainers, a supportive web-based tracking system and the new reimbursement system that allows for introduction of a mental health care-practice nurse (MHC-PN in the general practices and coverage of the treatment costs. Impeding factors might be the relatively high percentage of solo-primary care practices, the small percentage of professionals that are located in the same building, unfamiliarity with the concept of collaboration as required for collaborative care, the reimbursement system that demands regular negotiations between each health care provider and the insurance companies and the reluctance general practitioners might feel to expand their responsibility for their depressed patients. Conclusion: Implementation of the collaborative care model in the Netherlands requires extensive training and supervision on micro level, facilitation of reimbursement on meso- and macro level and structural effort to change the treatment culture for chronic mental disorders in the primary care setting.

  1. Disruptive innovation in health care delivery: a framework for business-model innovation.

    Science.gov (United States)

    Hwang, Jason; Christensen, Clayton M

    2008-01-01

    Disruptive innovation has brought affordability and convenience to customers in a variety of industries. However, health care remains expensive and inaccessible to many because of the lack of business-model innovation. This paper explains the theory of disruptive innovation and describes how disruptive technologies must be matched with innovative business models. The authors present a framework for categorizing and developing business models in health care, followed by a discussion of some of the reasons why disruptive innovation in health care delivery has been slow.

  2. Partnership and empowerment program: a model for patient-centered, comprehensive, and cost-effective care.

    Science.gov (United States)

    Brown, Corinne; Bornstein, Elizabeth; Wilcox, Catina

    2012-02-01

    The Partnership and Empowerment Program model offers a comprehensive, patient-centered, and cost-effective template for coordinating care for underinsured and uninsured patients with cancer. Attention to effective coordination, including use of internal and external resources, may result in decreased costs of care and improved patient compliance and health outcomes.

  3. A theoretical model to address organizational human conflict and disruptive behavior in health care organizations.

    Science.gov (United States)

    Piper, Llewellyn E

    2006-01-01

    This article proposes a theoretical model for leaders to use to address organizational human conflict and disruptive behavior in health care organizations. Leadership is needed to improve interpersonal relationships within the workforce. A workforce with a culture of internal conflict will be unable to achieve its full potential to delivery quality patient care.

  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. 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…

  6. 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…

  7. Archimedes: a new model for simulating health care systems--the mathematical formulation.

    Science.gov (United States)

    Schlessinger, Leonard; Eddy, David M

    2002-02-01

    This paper designs an object-oriented, continuous-time, full simulation model for addressing a wide range of clinical, procedural, administrative, and financial decisions in health care at a high level of biological, clinical, and administrative detail. The full model has two main parts, which with some simplification can be designated "physiology models" and "models of care processes." The models of care processes, although highly detailed, are mathematically straightforward. However, the mathematics that describes human biology, diseases, and the effects of interventions are more difficult. This paper describes the mathematical formulation and methods for deriving equations, for a variety of different sources of data. Although Archimedes was originally designed for health care applications, the formulation, and equations are general and can be applied to many natural systems.

  8. 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

  9. 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.

  10. Stepped care model of pain management and quality of pain care in long-term opioid therapy.

    Science.gov (United States)

    Moore, Brent A; Anderson, Daren; Dorflinger, Lindsey; Zlateva, Ianita; Lee, Allison; Gilliam, Wesley; Tian, Terrence; Khatri, Khushbu; Ruser, Christopher B; Kerns, Robert D

    2016-01-01

    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.

  11. Health promotion interventions and policies addressing excessive alcohol use: A systematic review of national and global evidence as a guide to health-care reform in China

    Science.gov (United States)

    Li, Qing; Babor, Thomas F.; Zeigler, Donald; Xuan, Ziming; Morisky, Donald; Hovell, Melbourne F.; Nelson, Toben F.; Shen, Weixing; Li, Bing

    2014-01-01

    Aims Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiologic transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. Methods We searched in Chinese and English language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the WHO Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. Results In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of ten in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, workplaces, the health sector, and taxation. Conclusions China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy, and health reform experience in Russia, Australia, Mexico, and the USA, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems, and the implementation of effective alcohol control strategies. PMID:25533866

  12. Research on the Model of Reflexive Hospice Care%临终反向关怀模式探析

    Institute of Scientific and Technical Information of China (English)

    康宗林; 王京娥; 黎莹; 李梦倩

    2015-01-01

    在中国重生轻死的传统文化中,社会将临终者视为弱者、问题者或患者,强调给予关怀与照顾,临终者处于被动接受的处境。因此,当前的临终关怀模式视临终关怀团队及照顾者为主体,临终者为客体。提出将临终者视为主体,是临终关怀的主要参与者。旨在探讨临终反向关怀模式的内涵及干预模式。从心理学“知情意行”的视角梳理临终反向关怀模式,并将临终反向关怀划分为主我、立言、立功、立德四个层面七个等分,引导临终者从言语、行为、物品及精神层面实施反向关怀,以达到临终反向关怀“立言、立功、立德”的三个不同层次。%Due to our traditional culture in which the life is valued more than death ,the community tends to take the terminally ill persons as the vulnerable ones ,people with difficulties or patients .In the current hospice care system ,the hospice care providers are the subjects considering patients as passive care receivers . This article appealed for taking terminally ill patients as the subjects and active participants ,focusing on the connotation and intervening model of reflexive hospice care ,which is analyzed with the cognition ,emotion ,volition and practice from the psychological perspective . Meanwhile ,the authors further divided reflexive hospice care into four levels ,in order to guide the patients at the end of their lives to implement the care in communication ,behavior ,object and spirit .Finally ,the paper argued that the reflexive hospice care could eventually deliver the patients’ thoughts ,memorize their contributions and exemplify their moralities .

  13. Influence of Role Models and Hospital Design on the Hand Hygiene of Health-Care Workers

    OpenAIRE

    2003-01-01

    We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) we...

  14. From 'solution shop' model to 'focused factory' in hospital surgery: increasing care value and predictability.

    Science.gov (United States)

    Cook, David; Thompson, Jeffrey E; Habermann, Elizabeth B; Visscher, Sue L; Dearani, Joseph A; Roger, Veronique L; Borah, Bijan J

    2014-05-01

    The full-service US hospital has been described organizationally as a "solution shop," in which medical problems are assumed to be unstructured and to require expert physicians to determine each course of care. If universally applied, this model contributes to unwarranted variation in care, which leads to lower quality and higher costs. We purposely disrupted the adult cardiac surgical practice that we led at Mayo Clinic, in Rochester, Minnesota, by creating a "focused factory" model (characterized by a uniform approach to delivering a limited set of high-quality products) within the practice's solution shop. Key elements of implementing the new model were mapping the care process, segmenting the patient population, using information technology to communicate clearly defined expectations, and empowering nonphysician providers at the bedside. Using a set of criteria, we determined that the focused-factory model was appropriate for 67 percent of cardiac surgical patients. We found that implementation of the model reduced resource use, length-of-stay, and cost. Variation was markedly reduced, and outcomes were improved. Assigning patients to different care models increases care value and the predictability of care process, outcomes, and costs while preserving (in a lesser clinical footprint) the strengths of the solution shop. We conclude that creating a focused-factory model within a solution shop, by applying industrial engineering principles and health information technology tools and changing the model of work, is very effective in both improving quality and reducing costs.

  15. 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

  16. A microelectronic portal imaging device for image guided conformal microirradiation of murine cancer models.

    Science.gov (United States)

    Price, Samantha G; Silvius, Alexander A; Izaguirre, Enrique W

    2014-01-01

    Image guided conformal small animal orthovoltage microirradiators are currently under development to perform radiobiological experiments with preclinical cancer models. An important component of these instruments is the treatment delivery image guidance system, a microelectronic portal imaging device (μEPID). Here, we present the design and implementation of a μEPID, specifically designed and constructed for small animal orthovoltage microirradiators. The μEPID can acquire images in the range of 60 kVp to 320 kVp x-ray photon energies and can endure high doses from orthovoltage beams without radiation damage. The μEPID can acquire 200 μm resolution images at a rate of 17 frames per second for online in vivo co-registration between irradiation beams and small animal anatomy. An exposure with less than 1% of a 2 Gy treatment field is required for imaging, which is an adequate ratio between imaging dose and treatment dose to avoid undesired irradiation of healthy tissue or alteration of the preclinical cancer model. The μEPID was calibrated for microdosimetry with a precision of 4.1% with respect to an ion chamber, used as a gold standard. To validate the in vivo device performance, irradiations of lung, brain, and xenograft breast cancer preclinical models were performed and analyzed.

  17. 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.

  18. Hospital-in-the-Home — essential to an integrated model of paediatric care

    LENUS (Irish Health Repository)

    Hensey, CC

    2017-01-01

    The National Clinical Programme for Paediatrics and Neonatology is proposing a model of care that will determine the future delivery of children’s health services in Ireland1. The focus is on the provision of an integrated service with improved co-ordination between primary, secondary, and tertiary level facilities. A parallel goal is improvements in chronic care and medical care in the home. An expanded role for ambulatory care and hospital at home schemes with a reduced reliance on inpatient care is proposed in line with international best practice. Achieving these goals requires a paradigm shift in delivery of children’s health care, and reconfiguration of current services to deliver multidisciplinary care in hospital and at home. The recently approved planning application for the new children’s hospital provides an opportunity and heralds a change in the structure of paediatric services in Ireland. It will act as the nexus of paediatric care throughout Ireland; supporting paediatric services nationally through outreach programmes, and ensuring children are treated as close to home as possible. A Hospital-in-the-Home (HITH) program would help meet these objectives; and could provide home based acute paediatric care, leading to economic benefits, and the delivery of quality family-centred care.

  19. 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

  20. [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.

  1. Understanding the health care business model: the financial analysts' point of view.

    Science.gov (United States)

    Bukh, Per Nikolaj; Nielsen, Christian

    2010-01-01

    This study focuses on how financial analysts understand the strategy of a health care company and which elements, from such a strategy perspective, they perceive as constituting the cornerstone of a health care company's business model. The empirical part of this study is based on semi-structured interviews with analysts following a large health care company listed on the Copenhagen Stock Exchange. The authors analyse how the financial analysts view strategy and value creation within the framework of a business model. Further, the authors analyze whether the characteristics emerging from a comprehensive literature review are reflected in the financial analysts' perceptions of which information is decision-relevant and important to communicate to the financial markets. Among the conclusions of the study is the importance of distinguishing between the health care companies' business model and the model by which the payment of revenues are allocated between end users and reimbursing organizations.

  2. The Integrated Medical Model: A Decision Support Tool for In-flight Crew Health Care

    Science.gov (United States)

    Butler, Doug

    2009-01-01

    This viewgraph presentation reviews the development of an Integrated Medical Model (IMM) decision support tool for in-flight crew health care safety. Clinical methods, resources, and case scenarios are also addressed.

  3. Implementing integrated models of care: the importance of the macro-level context.

    Science.gov (United States)

    Ashton, Toni

    2015-01-01

    Reports of how different countries are responding to the need to develop more integrated health and social care services for older adults can provide useful lessons for other health systems. However an understanding of how the wider structural, political, economic and cultural context affects implementation of these models of care is essential when considering the potential for models to be scaled up or transferred to other jurisdictions.

  4. 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.

  5. Understanding Spiritual Care: The Faith-Hope-Love Model of Spiritual Wellness.

    Science.gov (United States)

    Christman, Sharon K; Mueller, Julia R

    Spiritual care has been associated with positive patient outcomes. Although nurses want to provide spiritual care, many have difficulty conceptualizing spiritual care outside of religion and religious activities. The Faith-Hope-Love Model of Spiritual Wellness, a theoretical model of spirituality and spiritual well-being, grounded in Christian theology and biblical text, can help nurses provide spiritual support to patients and families from multiple faith traditions or those without a faith background. Spirituality concepts are discussed, and description of how spirituality is related to finding meaning and purpose in life along with a summary of the spiritual needs identified from healthcare literature and the Bible, are provided.

  6. Collaborative care for depression: a literature review and a model for implementation in developing countries.

    Science.gov (United States)

    Farooq, Saeed

    2013-03-01

    Depression will soon be the leading cause of disability in developing countries but effective treatments are not widely available. There is compelling evidence for the effectiveness and cost-effectiveness of the multicondition collaborative care (MCC) model for depression in developing and developed countries. In the MCC model integrated care for depression is provided along with care for different non-communicable disorders. MCC has been shown to reduce hyperglycaemia and hyperlipidaemia and can lead to depression-free days when integrated care for depression and diabetes is provided. However, due to limited resources, it is not possible to make this effective model of care available at the population level. It is suggested that a public health intervention based on the MCC model can lead to better care for depression in developing countries. A public health programme of MCC which provides treatment for depression, diabetes and hypertension in a collaborative care programme will be a cost-effective way of providing treatment for depression in developing countries. This will cater for the leading cause of disability (unipolar depression) and the leading projected causes of mortality (ischaemic heart disease and cerebrovascular disease) in low-income and middle-income countries.

  7. 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.

  8. 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.

  9. 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

  10. Model-guided ligation strategy for optimal assembly of DNA libraries.

    Science.gov (United States)

    Ng, Daphne T W; Sarkar, Casim A

    2012-10-01

    DNA ligation is essential to many molecular biology manipulations, but this reaction is often carried out by following generic guidelines or by trial and error. Maximizing the desired ligation product is especially important in DNA library construction for directed evolution experiments since library diversity is directly affected by ligation efficiency. Here, we suggest that display vectors that rely on Type IIP restriction sites for cloning should be redesigned to utilize Type IIS restriction sites instead because ligation yield is significantly improved: we observed up to 15- and 2.6-fold increases in desired products for circular and linear ligation reactions, respectively. To guide ligation optimization more rationally, we developed an easily parameterized thermodynamic model that predicts product distributions based on input DNA concentrations and free energies of the ligation events. We applied this model to study ligation reactions using a ribosome display vector redesigned with Type IIS restriction sites (pRDV2). We computationally predicted and experimentally validated the relative abundance of various products in three-piece linear ligations as well as the extent of transformation from vector-insert circular ligations. Based on our results, we provide general insights into ligation and we outline guidelines for optimizing this reaction for both in vivo and in vitro display methodologies.

  11. 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

    2016-03-15

    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.

  12. Evolutionary Synthesis Models as a Tool and Guide Towards the First Galaxies

    Science.gov (United States)

    Schaerer, Daniel

    We summarize the principles and fundamental ingredients of evolutionary synthesis models, which are stellar evolution, stellar atmospheres, the IMF, star-formation histories, nebular emission, and also attenuation from the ISM and IGM. The chapter focusses in particular on issues of importance for predictions of metal-poor and Population III dominated galaxies.We review recent predictions for the main physical properties and related observables of star-forming galaxies based on up-to-date inputs. The predicted metallicity dependence of these quantities and their physical causes are discussed. The predicted observables include in particular the restframe UV-to-optical domain with continuum emission from stars and the ionized ISM, as well as emission lines from H, He, and metals.Based on these predictions we summarize the main observational signatures (emission line strengths, colors etc.), which can be used to distinguish "normal" stellar populations from very metal-poor objects or even Pop III.Evolutionary synthesis models provide an important and fundamental tool for studies of galaxy formation and evolution, from the nearby Universe back to first galaxies. They are used in many applications to interpret existing observations, to predict and guide future missions/instruments, and to allow direct comparisons between state-of-the-art galaxy simulations and observations.

  13. Guiding heat in laser ablation of metals on ultrafast timescales: an adaptive modeling approach on aluminum

    Science.gov (United States)

    Colombier, J. P.; Combis, P.; Audouard, E.; Stoian, R.

    2012-01-01

    Using an optimal control hydrodynamic modeling approach and irradiation adaptive time-design, we indicate excitation channels maximizing heat load in laser ablated aluminum at low energy costs. The primary relaxation paths leading to an emerging plasma are particularly affected. With impulsive pulses on ps pedestals, thermodynamic trajectories are preferentially guided in ionized domains where variations in ionization degree occur. This impinges on the gas-transformation mechanisms and triggers a positive bremsstrahlung absorption feedback. The highest temperatures are thus obtained in the expanding ionized matter after a final impulsive excitation, as the electronic energy relaxes recombinatively. The drive relies on transitions to weakly coupled front plasmas at the critical optical density, favoring energy confinement with low mechanical work. Alternatively, robust collisional heating occurs in denser regions above the critical point. This impacts the nature, the excitation degree and the energy content of the ablated matter. Adaptive modeling can therefore provide optimal strategies with information on physical variables not readily accessible and, as experimentally confirmed, databases for pulse shapes with interest in remote spectroscopy, laser-induced matter transfer, laser material processing and development of secondary sources.

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. Radiology as the Point of Cancer Patient and Care Team Engagement: Applying the 4R Model at a Patient's Breast Cancer Care Initiation.

    Science.gov (United States)

    Weldon, Christine B; Friedewald, Sarah M; Kulkarni, Swati A; Simon, Melissa A; Carlos, Ruth C; Strauss, Jonathan B; Bunce, Mikele M; Small, Art; Trosman, Julia R

    2016-12-01

    Radiologists aspire to improve patient experience and engagement, as part of the Triple Aim of health reform. Patient engagement requires active partnerships among health providers and patients, and rigorous teamwork provides a mechanism for this. Patient and care team engagement are crucial at the time of cancer diagnosis and care initiation but are complicated by the necessity to orchestrate many interdependent consultations and care events in a short time. Radiology often serves as the patient entry point into the cancer care system, especially for breast cancer. It is uniquely positioned to play the value-adding role of facilitating patient and team engagement during cancer care initiation. The 4R approach (Right Information and Right Care to the Right Patient at the Right Time), previously proposed for optimizing teamwork and care delivery during cancer treatment, could be applied at the time of diagnosis. The 4R approach considers care for every patient with cancer as a project, using project management to plan and manage care interdependencies, assign clear responsibilities, and designate a quarterback function. The authors propose that radiology assume the quarterback function during breast cancer care initiation, developing the care initiation sequence, as a project care plan for newly diagnosed patients, and engaging patients and their care teams in timely, coordinated activities. After initial consultations and treatment plan development, the quarterback function is transitioned to surgery or medical oncology. This model provides radiologists with opportunities to offer value-added services and solidifies radiology's relevance in the evolving health care environment. To implement 4R at cancer care initiation, it will be necessary to change the radiology practice model to incorporate patient interaction and teamwork, develop 4R content and local adaption approaches, and enrich radiology training with relevant clinical knowledge, patient interaction

  19. Transition Planning Guide for Parents of Special Education Students. DISD Community Transition Model.

    Science.gov (United States)

    Quinones, Bill; Ozmun, Ellie

    This transition planning guide is intended as a resource for parents of severely handicapped students approaching or at the legal age for leaving public school services and entering community services. The guide was developed after a 2-year transition project, Project Impact, revealed common concerns and questions which parents and teachers…

  20. 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…

  1. 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.

  2. Novel modeling framework to guide design of optimal dosing strategies for β-lactamase inhibitors.

    Science.gov (United States)

    Bhagunde, Pratik; Chang, Kai-Tai; Hirsch, Elizabeth B; Ledesma, Kimberly R; Nikolaou, Michael; Tam, Vincent H

    2012-05-01

    The scarcity of new antibiotics against drug-resistant bacteria has led to the development of inhibitors targeting specific resistance mechanisms, which aim to restore the effectiveness of existing agents. However, there are few guidelines for the optimal dosing of inhibitors. Extending the utility of mathematical modeling, which has been used as a decision support tool for antibiotic dosing regimen design, we developed a novel mathematical modeling framework to guide optimal dosing strategies for a beta-lactamase inhibitor. To illustrate our approach, MK-7655 was used in combination with imipenem against a clinical isolate of Klebsiella pneumoniae known to produce KPC-2. A theoretical concept capturing fluctuating susceptibility over time was used to define a novel pharmacodynamic index (time above instantaneous MIC [T>MIC(i)]). The MK-7655 concentration-dependent MIC reduction was characterized by using a modified sigmoid maximum effect (E(max))-type model. Various dosing regimens of MK-7655 were simulated to achieve escalating T>MIC(i) values in the presence of a clinical dose of imipenem (500 mg every 6 h). The effectiveness of these dosing exposures was subsequently validated by using a hollow-fiber infection model (HFIM). An apparent trend in the bacterial response was observed in the HFIM with increasing T>MIC(i) values. In addition, different dosing regimens of MK-7655 achieving a similar T>MIC(i) (69%) resulted in comparable bacterial killing over 48 h. The proposed framework was reasonable in predicting the in vitro activity of a novel beta-lactamase inhibitor, and its utility warrants further investigations.

  3. Integrating the Chronic Care Model into a Novel Medical Student Course

    Science.gov (United States)

    Block, Robert C.; Tran, Bill; McIntosh, Scott

    2011-01-01

    Objective: To determine whether integration of the Chronic Care Model into undergraduate medical education is associated with anticipated use of the Model and whether student perceptions match actual integration of the Model into their community projects. Design: This was a cross-sectional study using qualitative and quantitative data. Setting: A…

  4. 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.

  5. 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.

  6. Proactive intervention dentistry: a model for oral care through life.

    Science.gov (United States)

    Goldstep, Fay

    2012-06-01

    Tools and techniques are available to oral care providers that have been found to be effective in reversing and controlling the caries process. In addition to fluoride, these tools include new remineralization therapies that can be incorporated into solutions, creams, and dentifrices, and bioactive restorative materials that work effectively with dental hard tissues. By incorporating such "proactive interventions" into their practice and educating patients on maintaining a daily oral hygiene regimen, clinicians can inhibit the multifactorial disease process of demineralization and caries before more extensive treatment becomes necessary.

  7. 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.

  8. Exporting the Buyers Health Care Action Group purchasing model: lessons from other communities.

    Science.gov (United States)

    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 expected to be supportive. This experience underscores several difficulties that appear to be inherent in implementing purchasing models based on competing care systems. It also, once again, suggests caution in drawing lessons from community-level experiments in purchasing health care.

  9. 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.

  10. Application of the expanded Creme RIFM consumer exposure model to fragrance ingredients in cosmetic, personal care and air care products.

    Science.gov (United States)

    Safford, B; Api, A M; Barratt, C; Comiskey, D; Ellis, G; McNamara, C; O'Mahony, C; Robison, S; Rose, J; Smith, B; Tozer, S

    2017-02-28

    As part of a joint project between the Research Institute for Fragrance Materials (RIFM) and Creme Global, a Monte Carlo model (here named the Creme RIFM model) has been developed to estimate consumer exposure to ingredients in personal care products. Details of the model produced in Phase 1 of the project have already been published. Further data on habits and practises have been collected which enable the model to estimate consumer exposure from dermal, oral and inhalation routes for 25 product types. . In addition, more accurate concentration data have been obtained which allow levels of fragrance ingredients in these product types to be modelled. Described is the use of this expanded model to estimate aggregate systemic exposure for eight fragrance ingredients. Results are shown for simulated systemic exposure (expressed as μg/kg bw/day) for each fragrance ingredient in each product type, along with simulated aggregate exposure. Highest fragrance exposure generally occurred from use of body lotions, body sprays and hydroalcoholic products. For the fragrances investigated, aggregate exposure calculated using this model was 11.5-25 fold lower than that calculated using deterministic methodology. The Creme RIFM model offers a very comprehensive and powerful tool for estimating aggregate exposure to fragrance ingredients.

  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. 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.

  13. 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.

  14. Concept mapping as an approach for expert-guided model building: The example of health literacy.

    Science.gov (United States)

    Soellner, Renate; Lenartz, Norbert; Rudinger, Georg

    2017-02-01

    Concept mapping served as the starting point for the aim of capturing the comprehensive structure of the construct of 'health literacy.' Ideas about health literacy were generated by 99 experts and resulted in 105 statements that were subsequently organized by 27 experts in an unstructured card sorting. Multidimensional scaling was applied to the sorting data and a two and three-dimensional solution was computed. The three dimensional solution was used in subsequent cluster analysis and resulted in a concept map of nine "clusters": (1) self-regulation, (2) self-perception, (3) proactive approach to health, (4) basic literacy and numeracy skills, (5) information appraisal, (6) information search, (7) health care system knowledge and acting, (8) communication and cooperation, and (9) beneficial personality traits. Subsequently, this concept map served as a starting point for developing a "qualitative" structural model of health literacy and a questionnaire for the measurement of health literacy. On the basis of questionnaire data, a "quantitative" structural model was created by first applying exploratory factor analyses (EFA) and then cross-validating the model with confirmatory factor analyses (CFA). Concept mapping proved to be a highly valuable tool for the process of model building up to translational research in the "real world".

  15. A situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance (sIMB-CIM): an IMB model based approach to understanding and intervening in engagement in care for chronic medical conditions.

    Science.gov (United States)

    Rivet Amico, K

    2011-10-01

    A sizable portion of adults living with chronic medical conditions (CMCs) delay initiation of care or maintain it inconsistently, which has tremendous personal and public costs. However, few explanatory models with high yield for intervention development and implementation have been proposed to date that would help to characterize and support care use for CMCs. A situated Information, Motivation, Behavioral Skills model of Care Initiation and Maintenance (sIMB-CIM) is presented here as an application of the IMB model to medical care use for CMCs. An example of a sIMB model for characterizing and intervening to support maintenance in HIV-care is provided.

  16. Identification, control and visually-guided behavior for a model helicopter

    Science.gov (United States)

    Saripalli, Srikanth

    Research on unmanned aerial vehicles is motivated by applications where human intervention is impossible, risky or expensive e.g. hazardous material recovery, traffic monitoring, disaster relief support, military operations etc. Due to its vertical take-off, landing and hover capabilities, a helicopter is an attractive platform for such applications. There are significant challenges to building an autonomous robotic helicopter - these span the areas of system identification, low-level control, state estimation, and planning. Towards the goal of fully-autonomous helicopters this thesis makes the following contributions. A continuous-discrete extended Kalman filter has been developed that combines inertial data with GPS and compass data to provide estimates of the 6DOF state of the helicopter. Using this filter a model for the helicopter has been identified based on frequency response techniques. The model has been validated in flight tests on a small helicopter testbed (1.6 m rotor diameter) at speeds upto 5 m/s. Based on evidence from this model a decoupled low-level controller has been developed which is embedded in a control architecture suitable for visually-guided navigation. As a novel application, we show how such a controller can be used to perform trajectory following on the helicopter where the desired trajectories are typical spacecraft landing trajectories, and the only controls available are thrusters. This in effect, produces a low-cost testbed for testing spacecraft landing and hazard avoidance on a planetary surface. Finally, we develop and extensively experimentally characterize algorithms for vision-based autonomous landing, object tracking, and sensor deployment.

  17. 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.

  18. [Home treatment--a treatment model of integrated care in Hamburg].

    Science.gov (United States)

    Schöttle, Daniel; Ruppelt, Friederike; Karow, Anne; Lambert, Martin

    2015-03-01

    Treatment models like "Crisis Resolution and Hometreatment (CRHT)" or "Assertive Community Treatment" (ACT), were found to be effective, enhancing the qualitative level of treatment for patients with severe mental disorders. In Germany, these are implemented only sporadically until today, often as part of a cross-sectoral Integrated Care (IC) treatment system. We will present the implementation of an "Assertive Community Treatment" embedded into an IC-treatment model in Hamburg and discuss the 3-year-outcomes. The IC-treatment model has been designed for severe mentally ill patients with psychotic disorders. Since May 2007 the model is financed by different health insurances as a managed-care "capitation-model" and its effectiveness gets continuously evaluated. The model proved to be effective in earlier studies were compared with standard care low rates of service disengagement were found as well as significantly improved psychopathology, psychosocial functioning, quality of life, satisfaction with care and adherence, while being cost effective. The rates of involuntary admissions declined to 10% in comparison to the years before. In 2011 the model was specified to the indication "first-episode adolescents and young adults in the age of 12-29" in a government-funded study "Integrated Care in Early Psychosis, ICEP Study". In this study an interdisciplinary team of child, adolescent and adult psychiatrists was implemented and since 2012 it is financed by the involved health insurances throughout an expansion of the §140 SGB V agreement.

  19. Improving glycaemic control and life skills in adolescents with type 1 diabetes: A randomised, controlled intervention study using the Guided Self-Determination-Young method in triads of adolescents, parents and health care providers integrated into routine paediatric outpatient clinics

    DEFF Research Database (Denmark)

    Thorsteinsson, Birger; Esbensen, Bente Appel; Hommel, Eva

    2011-01-01

    a barrier for health care providers (HCPs) to overcome in their attempts to involve both adolescents and parents in improvement of glycaemic control. Evidence-based interventions that involve all three parties (i.e., adolescents, parents and HCPs) and are integrated into routine outpatient clinic visits...... are lacking. The Guided Self-Determination method is proven effective in adult care and has been adapted to adolescents and parents (Guided Self-Determination-Young (GSD-Y)) for use in paediatric diabetes outpatient clinics. Our objective is to test whether GSD-Y used in routine paediatric outpatient clinic...... and analysed qualitatively together with individual interviews carried out after follow-up. DISCUSSION: This study will provide evidence of the effectiveness of using a GSD-Y intervention with three parties on HbA1c and life skills and the feasibility of integrating the intervention into routine outpatient...

  20. CRISPR RNA-guided FokI nucleases repair a PAH variant in a phenylketonuria model

    Science.gov (United States)

    Pan, Yi; Shen, Nan; Jung-Klawitter, Sabine; Betzen, Christian; Hoffmann, Georg F.; Hoheisel, Jörg D.; Blau, Nenad

    2016-01-01

    The CRISPR/Cas9 system is a recently developed genome editing technique. In this study, we used a modified CRISPR system, which employs the fusion of inactive Cas9 (dCas9) and the FokI endonuclease (FokI-dCas9) to correct the most common variant (allele frequency 21.4%) in the phenylalanine hydroxylase (PAH) gene - c.1222C>T (p.Arg408Trp) - as an approach toward curing phenylketonuria (PKU). PKU is the most common inherited diseases in amino acid metabolism. It leads to severe neurological and neuropsychological symptoms if untreated or late diagnosed. Correction of the disease-causing variants could rescue residual PAH activity and restore normal function. Co-expression of a single guide RNA plasmid, a FokI-dCas9-zsGreen1 plasmid, and the presence of a single-stranded oligodeoxynucleotide in PAH_c.1222C>T COS-7 cells – an in vitro model for PKU – corrected the PAH variant and restored PAH activity. Also in this system, the HDR enhancer RS-1 improved correction efficiency. This proof-of-concept indicates the potential of the FokI-dCas9 system for precision medicine, in particular for targeting PKU and other monogenic metabolic diseases. PMID:27786189

  1. Conditions for NIR fluorescence-guided tumor resectioning in preclinical lung cancer model (Conference Presentation)

    Science.gov (United States)

    Kim, Minji; Quan, Yuhua; Choi, Byeong Hyun; Choi, Yeonho; Kim, Hyun Koo; Kim, Beop-Min

    2016-03-01

    Pulmonary nodule could be identified by intraoperative fluorescence imaging system from systemic injection of indocyanine green (ICG) which achieves enhanced permeability and retention (EPR) effects. This study was performed to evaluate optimal injection time of ICG for detecting cancer during surgery in rabbit lung cancer model. VX2 carcinoma cell was injected in rabbit lung under fluoroscopic computed tomography-guidance. Solitary lung cancer was confirmed on positron emitting tomography with CT (PET/CT) 2 weeks after inoculation. ICG was administered intravenously and fluorescent intensity of lung tumor was measured using the custom-built intraoperative color and fluorescence merged imaging system (ICFIS) for 15 hours. Solitary lung cancer was resected through thoracoscopic version of ICFIS. ICG was observed in all animals. Because Lung has fast blood pulmonary circulation, Fluorescent signal showed maximum intensity earlier than previous studies in other organs. Fluorescent intensity showed maximum intensity within 6-9 hours in rabbit lung cancer. Overall, Fluorescent intensity decreased with increasing time, however, all tumors were detectable using fluorescent images until 12 hours. In conclusion, while there had been studies in other organs showed that optimal injection time was at least 24 hours before operation, this study showed shorter optimal injection time at lung cancer. Since fluorescent signal showed the maximum intensity within 6-9 hours, cancer resection could be performed during this time. This data informed us that optimal injection time of ICG should be evaluated in each different solid organ tumor for fluorescent image guided surgery.

  2. Homology models guide discovery of diverse enzyme specificities among dipeptide epimerases in the enolase superfamily

    Science.gov (United States)

    Lukk, Tiit; Sakai, Ayano; Kalyanaraman, Chakrapani; Brown, Shoshana D.; Imker, Heidi J.; Song, Ling; Fedorov, Alexander A.; Fedorov, Elena V.; Toro, Rafael; Hillerich, Brandan; Seidel, Ronald; Patskovsky, Yury; Vetting, Matthew W.; Nair, Satish K.; Babbitt, Patricia C.; Almo, Steven C.; Gerlt, John A.; Jacobson, Matthew P.

    2012-01-01

    The rapid advance in genome sequencing presents substantial challenges for protein functional assignment, with half or more of new protein sequences inferred from these genomes having uncertain assignments. The assignment of enzyme function in functionally diverse superfamilies represents a particular challenge, which we address through a combination of computational predictions, enzymology, and structural biology. Here we describe the results of a focused investigation of a group of enzymes in the enolase superfamily that are involved in epimerizing dipeptides. The first members of this group to be functionally characterized were Ala-Glu epimerases in Eschericiha coli and Bacillus subtilis, based on the operon context and enzymological studies; these enzymes are presumed to be involved in peptidoglycan recycling. We have subsequently studied more than 65 related enzymes by computational methods, including homology modeling and metabolite docking, which suggested that many would have divergent specificities;, i.e., they are likely to have different (unknown) biological roles. In addition to the Ala-Phe epimerase specificity reported previously, we describe the prediction and experimental verification of: (i) a new group of presumed Ala-Glu epimerases; (ii) several enzymes with specificity for hydrophobic dipeptides, including one from Cytophaga hutchinsonii that epimerizes D-Ala-D-Ala; and (iii) a small group of enzymes that epimerize cationic dipeptides. Crystal structures for certain of these enzymes further elucidate the structural basis of the specificities. The results highlight the potential of computational methods to guide experimental characterization of enzymes in an automated, large-scale fashion. PMID:22392983

  3. Preface: Monitoring and modelling to guide coastal adaptation to extreme storm events in a changing climate

    Science.gov (United States)

    Brown, J. M.; Ciavola, P.; Masselink, G.; McCall, R.; Plater, A. J.

    2016-02-01

    Storms across the globe and their associated consequences in coastal zones (flooding and erosion), combined with the long-term geomorphic evolution of our coastlines, are a threat to life and assets, both socioeconomic and environmental. In a changing climate, with a rising global sea level, potentially changing patterns in storm tracks and storminess, and rising population density and pressures on the coastal zone, the future risk of coastal storm impacts is likely to increase. Coastal managers and policy makers therefore need to make effective and timely decisions on the use of resources for the immediate and longer Research focused on "monitoring and modelling to guide coastal adaptation to extreme storm events in a changing climate" is becoming more common; its goal is to provide science-based decision support for effective adaptation to the consequences of storm impacts, both now and under future climate scenarios at the coast. The growing transfer of information between the science community and end-users is enabling leading research to have a greater impact on the socioeconomic resilience of coastal communities. This special issue covers recent research activities relating to coastal hazard mapping in response to extreme events, economic impacts of long-term change, coastal processes influencing management decisions and the development of online decision support tools.

  4. Simplified analytical model of penetration with lateral loading -- User`s guide

    Energy Technology Data Exchange (ETDEWEB)

    Young, C.W.

    1998-05-01

    The SAMPLL (Simplified Analytical Model of Penetration with Lateral Loading) computer code was originally developed in 1984 to realistically yet economically predict penetrator/target interactions. Since the code`s inception, its use has spread throughout the conventional and nuclear penetrating weapons community. During the penetrator/target interaction, the resistance of the material being penetrated imparts both lateral and axial loads on the penetrator. These loads cause changes to the penetrator`s motion (kinematics). SAMPLL uses empirically based algorithms, formulated from an extensive experimental data base, to replicate the loads the penetrator experiences during penetration. The lateral loads resulting from angle of attack and trajectory angle of the penetrator are explicitly treated in SAMPLL. The loads are summed and the kinematics calculated at each time step. SAMPLL has been continually improved, and the current version, Version 6.0, can handle cratering and spall effects, multiple target layers, penetrator damage/failure, and complex penetrator shapes. Version 6 uses the latest empirical penetration equations, and also automatically adjusts the penetrability index for certain target layers to account for layer thickness and confinement. This report describes the SAMPLL code, including assumptions and limitations, and includes a user`s guide.

  5. CRISPR RNA-guided FokI nucleases repair a PAH variant in a phenylketonuria model.

    Science.gov (United States)

    Pan, Yi; Shen, Nan; Jung-Klawitter, Sabine; Betzen, Christian; Hoffmann, Georg F; Hoheisel, Jörg D; Blau, Nenad

    2016-10-27

    The CRISPR/Cas9 system is a recently developed genome editing technique. In this study, we used a modified CRISPR system, which employs the fusion of inactive Cas9 (dCas9) and the FokI endonuclease (FokI-dCas9) to correct the most common variant (allele frequency 21.4%) in the phenylalanine hydroxylase (PAH) gene - c.1222C>T (p.Arg408Trp) - as an approach toward curing phenylketonuria (PKU). PKU is the most common inherited diseases in amino acid metabolism. It leads to severe neurological and neuropsychological symptoms if untreated or late diagnosed. Correction of the disease-causing variants could rescue residual PAH activity and restore normal function. Co-expression of a single guide RNA plasmid, a FokI-dCas9-zsGreen1 plasmid, and the presence of a single-stranded oligodeoxynucleotide in PAH_c.1222C>T COS-7 cells - an in vitro model for PKU - corrected the PAH variant and restored PAH activity. Also in this system, the HDR enhancer RS-1 improved correction efficiency. This proof-of-concept indicates the potential of the FokI-dCas9 system for precision medicine, in particular for targeting PKU and other monogenic metabolic diseases.

  6. Sodium vapor cell laser guide star experiments for continuous wave model validation

    Science.gov (United States)

    Pedreros Bustos, Felipe; Holzlöhner, Ronald; Budker, Dmitry; Lewis, Steffan; Rochester, Simon

    2016-07-01

    Recent numerical simulations and experiments on sodium Laser Guide Star (LGS) have shown that a continuous wave (CW) laser with circular polarization and re-pumping should maximize the fluorescent photon return flux to the wavefront sensor for adaptive optics applications. The orientation and strength of the geomagnetic field in the sodium layer also play an important role affecting the LGS return ux. Field measurements of the LGS return flux show agreement with the CW LGS model, however, fluctuations in the sodium column abundance and geomagnetic field intensity, as well as atmospheric turbulence, induce experimental uncertainties. We describe a laboratory experiment to measure the photon return flux from a sodium vapor cell illuminated with a 589 nm CW laser beam, designed to approximately emulate a LGS under controlled conditions. Return flux measurements are carried out controlling polarization, power density, re-pumping, laser linewidth, and magnetic field intensity and orientation. Comparison with the numerical CW simulation package Atomic Density Matrix are presented and discussed.

  7. Radiation-Guided Peptide Delivery in a Mouse Model of Nasopharyngeal Carcinoma

    Directory of Open Access Journals (Sweden)

    Pei-cheng Lin

    2016-01-01

    Full Text Available Purpose. This study aimed to evaluate the characteristics of the HVGGSSV peptide, exploring radiation-guided delivery in a mouse model of nasopharyngeal carcinoma. Methods. Mice with CNE-1 nasopharyngeal carcinoma were assigned to two different groups treated with Cy7-NHS and Cy7-HVGGSSV, respectively. Meanwhile, each mouse received a single dose of 3 Gy radiation. Biological distribution of the recombinant peptide was assessed on an in vivo small animal imaging system. Results. The experimental group showed maximum fluorescence intensity in irradiated tumors treated with Cy7-labeled HVGGSSV, while untreated (0 Gy control tumors showed lower intensity levels. Fluorescence intensities of tumors in the right hind limbs of experimental animals were 7.84×107±1.13×107, 1.35×108±2.66×107, 4.05×108±1.75×107, 5.57×108±3.47×107, and 9.26×107±1.73×107 photons/s/cm2 higher compared with left hind limb values at 1, 2, 15, 24, and 48 h, respectively. Fluorescence intensities of tumor in the right hind limbs of the experimental group were 1.66×108±1.71×107, 1.51×108±3.23×107, 5.38×108±1.96×107, 5.89×108±3.57×107, and 1.62×108±1.69×107 photons/s/cm2 higher compared with control group values at 1, 2, 15, 24, and 48 h, respectively. Fluorescence was not specifically distributed in the control group. Compared with low fluorescence intensity in the heart, lungs, and tumors, high fluorescence distribution was found in the liver and kidney at 48 h. Conclusions. HVGGSSV was selectively bound to irradiated nasopharyngeal carcinoma, acting as a targeting transport carrier for radiation-guided drugs that are mainly metabolized in the kidney and liver.

  8. Radiation-Guided Peptide Delivery in a Mouse Model of Nasopharyngeal Carcinoma

    Science.gov (United States)

    Lin, Pei-cheng; He, Jun-yan; Le, Yu-yin; Du, Kai-xin; Zhu, Wei-feng; Peng, Qing-qin; Dong, Ya-ping

    2016-01-01

    Purpose. This study aimed to evaluate the characteristics of the HVGGSSV peptide, exploring radiation-guided delivery in a mouse model of nasopharyngeal carcinoma. Methods. Mice with CNE-1 nasopharyngeal carcinoma were assigned to two different groups treated with Cy7-NHS and Cy7-HVGGSSV, respectively. Meanwhile, each mouse received a single dose of 3 Gy radiation. Biological distribution of the recombinant peptide was assessed on an in vivo small animal imaging system. Results. The experimental group showed maximum fluorescence intensity in irradiated tumors treated with Cy7-labeled HVGGSSV, while untreated (0 Gy) control tumors showed lower intensity levels. Fluorescence intensities of tumors in the right hind limbs of experimental animals were 7.84 × 107 ± 1.13 × 107, 1.35 × 108 ± 2.66 × 107, 4.05 × 108 ± 1.75 × 107, 5.57 × 108 ± 3.47 × 107, and 9.26 × 107 ± 1.73 × 107 photons/s/cm2 higher compared with left hind limb values at 1, 2, 15, 24, and 48 h, respectively. Fluorescence intensities of tumor in the right hind limbs of the experimental group were 1.66 × 108 ± 1.71 × 107, 1.51 × 108 ± 3.23 × 107, 5.38 × 108 ± 1.96 × 107, 5.89 × 108 ± 3.57 × 107, and 1.62 × 108 ± 1.69 × 107 photons/s/cm2 higher compared with control group values at 1, 2, 15, 24, and 48 h, respectively. Fluorescence was not specifically distributed in the control group. Compared with low fluorescence intensity in the heart, lungs, and tumors, high fluorescence distribution was found in the liver and kidney at 48 h. Conclusions. HVGGSSV was selectively bound to irradiated nasopharyngeal carcinoma, acting as a targeting transport carrier for radiation-guided drugs that are mainly metabolized in the kidney and liver.

  9. Hybrid local FEM/global LISA modeling of guided wave propagation and interaction with damage in composite structures

    Science.gov (United States)

    Shen, Yanfeng; Cesnik, Carlos E. S.

    2015-03-01

    This paper presents a hybrid modeling technique for the efficient simulation of guided wave propagation and interaction with damage in composite structures. This hybrid approach uses a local finite element model (FEM) to compute the excitability of guided waves generated by piezoelectric transducers, while the global domain wave propagation, wave-damage interaction, and boundary reflections are modeled with the local interaction simulation approach (LISA). A small-size multi-physics FEM with non-reflective boundaries (NRB) was built to obtain the excitability information of guided waves generated by the transmitter. Frequency-domain harmonic analysis was carried out to obtain the solution for all the frequencies of interest. Fourier and inverse Fourier transform and frequency domain convolution techniques are used to obtain the time domain 3-D displacement field underneath the transmitter under an arbitrary excitation. This 3-D displacement field is then fed into the highly efficient time domain LISA simulation module to compute guided wave propagation, interaction with damage, and reflections at structural boundaries. The damping effect of composite materials was considered in the modified LISA formulation. The grids for complex structures were generated using commercial FEM preprocessors and converted to LISA connectivity format. Parallelization of the global LISA solution was achieved through Compute Unified Design Architecture (CUDA) running on Graphical Processing Unit (GPU). The multi-physics local FEM can reliably capture the detailed dimensions and local dynamics of the piezoelectric transducers. The global domain LISA can accurately solve the 3-D elastodynamic wave equations in a highly efficient manner. By combining the local FEM with global LISA, the efficient and accurate simulation of guided wave structural health monitoring procedure is achieved. Two numerical case studies are presented: (1) wave propagation in a unidirectional CFRP composite plate

  10. What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model

    Directory of Open Access Journals (Sweden)

    Lankshear Annette J

    2010-02-01

    Full Text Available Abstract Background There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy. Methods Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression. Results Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so. Conclusions The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.

  11. Research on Model of Guiding Rural Residents’ Relatively Centralized Residence——A Case Study of Chongqing City

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    On the basis of expounding the status quo of rural residents’ residence, the thesis notes that influenced by the weak foundation of rural economy, the characteristic of mountain landscape, smallholder consciousness, shortage of capital and other factors, the rural residents in Chongqing City mainly live scattered. In addition to opportunities of the expansion and drive of city, rural market development, rural resources development, rural industrial development, and rural ecological migration, the model of urban development promotion, the model of market development drive, the model of land development drive, the model of rural industry construction and the model of resettlement and reconstruction are advocated in order to guide the rural residents to adopt relative centralized residence. The suggestions concerning guiding rural residents’ relative centralized residence are put forward as follows: firstly, act according to circumstances and conduct scientific planning and design; secondly, propagate extensively and activate famers’ willingness; thirdly, first experiment and exert the exemplary guide; fourthly, perfect policy and guarantee farmers’ benefit; fifthly, strengthen leadership and decrease the risk of centralized residence; sixthly, boost gradually and realize moderate centralized residence.

  12. In vivo models for cancer stem cell research: a practical guide for frequently used animal models and available biomarkers.

    Science.gov (United States)

    Skidan, I; Steiniger, S C J

    2014-04-01

    The identification of a rare population of cancer stem cells whose presence in tumors is believed to determine their growth and metastatic activity, has provided a novel approach for targeted anti-cancer therapy. At the in vivo stage of the development of new therapeutic approaches for killing cancer stem cells, the most significant issues are the appropriate choice of rational animal models that offer the option to select animal species, strains and substrains, essential techniques for the inoculation of tumors, and methods of tumor detection in animals. The identification and validation of various types of cancer stem cell markers, which could serve as potential marker(s) of therapeutic efficacy of applied drugs, is a considerable challenge. The aim of this review is to provide a guide for the in vivo study of novel therapeutics that target cancer stem cells. This review describes frequently used mouse solid tumor models and evaluates their usefulness for cancer stem cell research. The classification of existing compounds that are used in today's experimental anti-cancer stem cell therapy and examples of exploratory first-in-human studies using these compounds for selective elimination of cancer stem cells will also be discussed. Finally, this review will examine the current status of available cancer stem cell markers, and highlight several important cancer stem cell properties that are still not well understood, but could influence the anti-cancer drug development process.

  13. Shared Care of Young Children: Alternative Models to Monotropism.

    Science.gov (United States)

    Smith, Peter K.

    1980-01-01

    Reviews evidence for assertions related to the monotropism hypothesis and examines causal factors that might constrain the number of satisfactory caretaker relationships provided for young children. Two models of constraint derived from the earlier work of Bowlby and others are rejected; two models based on more recent theory are considered worth…

  14. Durability-Based Design Guide for an Automotive Structural Composite: Part 2. Background Data and Models

    Energy Technology Data Exchange (ETDEWEB)

    Corum, J.M. [ORNL; Battiste, R.L. [ORNL; Brinkman, C.R. [ORNL; Ren, W. [ORNL; Ruggles, M.B. [ORNL; Weitsman, Y.J. [ORNL; Yahr, G.T. [ORNL

    1998-02-01

    This background report is a companion to the document entitled ''Durability-Based Design Criteria for an Automotive Structural Composite: Part 1. Design Rules'' (ORNL-6930). The rules and the supporting material characterization and modeling efforts described here are the result of a U.S. Department of Energy Advanced Automotive Materials project entitled ''Durability of Lightweight Composite Structures.'' The overall goal of the project is to develop experimentally based, durability-driven design guidelines for automotive structural composites. The project is closely coordinated with the Automotive Composites Consortium (ACC). The initial reference material addressed by the rules and this background report was chosen and supplied by ACC. The material is a structural reaction injection-molded isocyanurate (urethane), reinforced with continuous-strand, swirl-mat, E-glass fibers. This report consists of 16 position papers, each summarizing the observations and results of a key area of investigation carried out to provide the basis for the durability-based design guide. The durability issues addressed include the effects of cyclic and sustained loadings, temperature, automotive fluids, vibrations, and low-energy impacts (e.g., tool drops and roadway kickups) on deformation, strength, and stiffness. The position papers cover these durability issues. Topics include (1) tensile, compressive, shear, and flexural properties; (2) creep and creep rupture; (3) cyclic fatigue; (4) the effects of temperature, environment, and prior loadings; (5) a multiaxial strength criterion; (6) impact damage and damage tolerance design; (7) stress concentrations; (8) a damage-based predictive model for time-dependent deformations; (9) confirmatory subscale component tests; and (10) damage development and growth observations.

  15. Image-driven, model-based 3D abdominal motion estimation for MR-guided radiotherapy

    Science.gov (United States)

    Stemkens, Bjorn; Tijssen, Rob H. N.; de Senneville, Baudouin Denis; Lagendijk, Jan J. W.; van den Berg, Cornelis A. T.

    2016-07-01

    Respiratory motion introduces substantial uncertainties in abdominal radiotherapy for which traditionally large margins are used. The MR-Linac will open up the opportunity to acquire high resolution MR images just prior to radiation and during treatment. However, volumetric MRI time series are not able to characterize 3D tumor and organ-at-risk motion with sufficient temporal resolution. In this study we propose a method to estimate 3D deformation vector fields (DVFs) with high spatial and temporal resolution based on fast 2D imaging and a subject-specific motion model based on respiratory correlated MRI. In a pre-beam phase, a retrospectively sorted 4D-MRI is acquired, from which the motion is parameterized using a principal component analysis. This motion model is used in combination with fast 2D cine-MR images, which are acquired during radiation, to generate full field-of-view 3D DVFs with a temporal resolution of 476 ms. The geometrical accuracies of the input data (4D-MRI and 2D multi-slice acquisitions) and the fitting procedure were determined using an MR-compatible motion phantom and found to be 1.0-1.5 mm on average. The framework was tested on seven healthy volunteers for both the pancreas and the kidney. The calculated motion was independently validated using one of the 2D slices, with an average error of 1.45 mm. The calculated 3D DVFs can be used retrospectively for treatment simulations, plan evaluations, or to determine the accumulated dose for both the tumor and organs-at-risk on a subject-specific basis in MR-guided radiotherapy.

  16. Computational fluid dynamics modeling of rope-guided conveyances in two typical kinds of shaft layouts.

    Directory of Open Access Journals (Sweden)

    Renyuan Wu

    Full Text Available The behavior of rope-guided conveyances is so complicated that the rope-guided hoisting system hasn't been understood thoroughly so far. In this paper, with user-defined functions loaded, ANSYS FLUENT 14.5 was employed to simulate lateral motion of rope-guided conveyances in two typical kinds of shaft layouts. With rope-guided mine elevator and mine cages taken into account, results show that the lateral aerodynamic buffeting force is much larger than the Coriolis force, and the side aerodynamic force have the same order of magnitude as the Coriolis force. The lateral aerodynamic buffeting forces should also be considered especially when the conveyance moves along the ventilation air direction. The simulation shows that the closer size of the conveyances can weaken the transverse aerodynamic buffeting effect.

  17. Electromagnetic ultrasonic guided waves

    CERN Document Server

    Huang, Songling; Li, Weibin; Wang, Qing

    2016-01-01

    This book introduces the fundamental theory of electromagnetic ultrasonic guided waves, together with its applications. It includes the dispersion characteristics and matching theory of guided waves; the mechanism of production and theoretical model of electromagnetic ultrasonic guided waves; the effect mechanism between guided waves and defects; the simulation method for the entire process of electromagnetic ultrasonic guided wave propagation; electromagnetic ultrasonic thickness measurement; pipeline axial guided wave defect detection; and electromagnetic ultrasonic guided wave detection of gas pipeline cracks. This theory and findings on applications draw on the author’s intensive research over the past eight years. The book can be used for nondestructive testing technology and as an engineering reference work. The specific implementation of the electromagnetic ultrasonic guided wave system presented here will also be of value for other nondestructive test developers.

  18. Open and closed models of intensive care unit have different influences on infectious complications in a tertiary care center: A retrospective data analysis.

    Science.gov (United States)

    El-Kersh, Karim; Guardiola, Juan; Cavallazzi, Rodrigo; Wiemken, Timothy L; Roman, Jesse; Saad, Mohamed

    2016-12-01

    Infectious complications in the intensive care unit (ICU) are associated with higher morbidity, mortality, and increased health care use. Here, we report the results of implementing 2 different models (open vs closed) on infectious complications in the ICU. The closed ICU model was associated with 52% reduction in ventilator-associated pneumonia rate (P = .038) and 25% reduction in central line-associated bloodstream infection rate (P = .631). We speculate that a closed ICU model allows clinical leadership centralization that further facilitates standardized care delivery that translates into fewer infectious complications.

  19. A comprehensive model for intimate partner violence in South African primary care: action research

    Directory of Open Access Journals (Sweden)

    Joyner Kate

    2012-11-01

    Full Text Available Abstract Background Despite extensive evidence on the magnitude of intimate partner violence (IPV as a public health problem worldwide, insubstantial progress has been made in the development and implementation of sufficiently comprehensive health services. This study aimed to implement, evaluate and adapt a published protocol for the screening and management of IPV and to recommend a model of care that could be taken to scale in our underdeveloped South African primary health care system. Methods Professional action research utilised a co-operative inquiry group that consisted of four nurses, one doctor and a qualitative researcher. The inquiry group implemented the protocol in two urban and three rural primary care facilities. Over a period of 14 months the group reflected on their experience, modified the protocol and developed recommendations on a practical but comprehensive model of care. Results The original protocol had to be adapted in terms of its expectations of the primary care providers, overly forensic orientation, lack of depth in terms of mental health, validity of the danger assessment and safety planning process, and need for ongoing empowerment and support. A three-tier model resulted: case finding and clinical care provision by primary care providers; psychological, social and legal assistance by ‘IPV champions’ followed by a group empowerment process; and then ongoing community-based support groups. Conclusion The inquiry process led to a model of comprehensive and intersectoral care that is integrated at the facility level and which is now being piloted in the Western Cape, South Africa.

  20. Integral model of oral health care in Pachacútec, Callao

    OpenAIRE

    Madrid Chumacero, Marco Tulio; Dpto. Académico Estomatología Preventiva y Social. Facultad de Odontología. Universidad Nacional Mayor de San Marcos.; Castro Rodriguez, Antonia; Dpto. Académico Estomatología Preventiva y Social. Facultad de Odontología. Universidad Nacional Mayor de San Marcos.; Echeandía Arellano, Juana; Facultad de Medicina. Universidad Nacional Mayor de San Marcos.; Chein Villacampa, Sylvia; Dpto. Académico Estomatología Preventiva y Social. Facultad de Odontología. Universidad Nacional Mayor de San Marcos.; Villavicencio Gastelú, Jorge; Dpto. Académico Médico Quirúrgico. Facultad de Odontología. Universidad Nacional Mayor de San Marcos.; Cuentas Robles, Adelmo; Dpto. Académico Médico Quirúrgico. Facultad de Odontología. Universidad Nacional Mayor de San Marcos.; Vásquez Olivares, Ricardo; Dpto. Académico Estomatología Preventiva y Social. Facultad de Odontología. Universidad Nacional Mayor de San Marcos.

    2014-01-01

    The principal aim of the model was to raise the quality of dental care through comprehensive measures for promotion, prevention and healing in the community. Specific aims were to increase the healthy population through promotion of health and reduce the morbidity of oral diseases by preventive actions and first class welfare care. A cross-sectional descriptive study. Revised Health Situation Analysis (HSA) of the Microgrid 03, the modified tab WHO oral health assessment is applied and oral e...