WorldWideScience

Sample records for care systems obstacles

  1. Obstacles to TQM success in health care systems.

    Science.gov (United States)

    Mosadeghrad, Ali Mohammad

    2013-01-01

    Many healthcare organisations have found it difficult to implement total quality management (TQM) successfully. The aim of this paper is to explore the barriers to TQM successful implementation in the healthcare sector. This paper reports a literature review exploring the major reasons for the failure of TQM programmes in healthcare organisations. TQM implementation and its impact depend heavily on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in healthcare organisations can be attributed to the strongly departmentalised, bureaucratic and hierarchical structure, professional autonomy, tensions between managers and professionals and the difficulties involved in evaluating healthcare processes and outcomes. Other obstacles to TQM success include lack of consistent managers' and employees' commitment to and involvement in TQM implementation, poor leadership and management, lack of a quality-oriented culture, insufficient training, and inadequate resources. The review was limited to empirical articles written in the English language during the past 30 years (1980-2010). The findings of this article provide policy makers and managers with a practical understanding of the factors that are likely to obstruct TQM implementation in the healthcare sector. Understanding the factors that obstruct TQM implementation would enable managers to develop more effective strategies for implementing TQM successfully in healthcare organisations.

  2. Exploring performance obstacles of intensive care nurses.

    Science.gov (United States)

    Gurses, Ayse P; Carayon, Pascale

    2009-05-01

    High nursing workload, poor patient safety, and poor nursing quality of working life (QWL) are major issues in intensive care units (ICUs). Characteristics of the ICU and performance obstacles may contribute to these issues. The goal of this study was to comprehensively identify the performance obstacles perceived by ICU nurses. We used a qualitative research design and conducted semi-structured interviews with 15 ICU nurses of a medical-surgical ICU. Based on this qualitative study and a previously reported quantitative study, we identified seven main types of performance obstacles experienced by ICU nurses. Obstacles related to the physical environment (e.g., noise, amount of space), family relations (e.g., distractions caused by family, lack of time to spend with family), and equipment (e.g., unavailability, misplacement) were the most frequently experienced performance obstacles. The qualitative interview data provided rich information regarding the factors contributing to the performance obstacles. Overall, ICU nurses experience a variety of performance obstacles in their work on a daily basis. Future research is needed to understand the impact of performance obstacles on nursing workload, nursing QWL, and quality and safety of care.

  3. Obstacle detection system for underground mining vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, P.; Polotski, V.; Piotte, M.; Melamed, F. [Ecole Polytechnique de Montreal, Montreal, PQ (Canada)

    1998-01-01

    A device for detecting obstacles by autonomous vehicles navigating in mine drifts is described. The device is based upon structured lighting and the extraction of relevant features from images of obstacles. The system uses image profile changes, ground and wall irregularities, disturbances of the vehicle`s trajectory, and impaired visibility to detect obstacles, rather than explicit three-dimensional scene reconstruction. 7 refs., 5 figs.

  4. [The federal government discourse during the political decentralization process and the obstacles to implement the Brazilian Public Health Care System].

    Science.gov (United States)

    Pellegrini, Bárbara

    2007-01-01

    A discourse analysis carried out on basic operating standard Norma Operacional Básica do Sistema Unico de Saúde (NOB-SUS 01/96) of the Brazilian public health care system aiming at locating signs that could allow to identify lines of thought which have influenced health care policies prioritized by the federal administration. The author points out a peculiarity in the kind of discourse employed by the ministry directive: its structure is based on isolated aspects of legislation and on ideas advocated by other discourse communities, articulated with redefined legal principles - an effort towards authorizing the official reasoning in favor of the relevance in keeping the decentralization process under the control of the federal administration. The analysis concludes that an infra-legal standard can neither grant state and federal administrations a hierarchical superiority (mediation function) over municipal administrations, nor can it transfer the legal responsibilities pertaining to Health Councils over to inter-administration commissions (Comissões Intergestores) , thus making the former mere decision ratifiers. This study found that granting privileges not contemplated in the legislation to state and federal administrations surfaced again and more strongly so in 2001 in yet another operating standard.

  5. Impact of Performance Obstacles on Intensive Care Nurses‘ Workload, Perceived Quality and Safety of Care, and Quality of Working Life

    Science.gov (United States)

    Gurses, Ayse P; Carayon, Pascale; Wall, Melanie

    2009-01-01

    Objectives To study the impact of performance obstacles on intensive care nurses‘ workload, quality and safety of care, and quality of working life (QWL). Performance obstacles are factors that hinder nurses‘ capacity to perform their job and that are closely associated with their immediate work system. Data Sources/Study Setting Data were collected from 265 nurses in 17 intensive care units (ICUs) between February and August 2004 via a structured questionnaire, yielding a response rate of 80 percent. Study Design A cross-sectional study design was used. Data were analyzed by correlation analyses and structural equation modeling. Principal Findings Performance obstacles were found to affect perceived quality and safety of care and QWL of ICU nurses. Workload mediated the impact of performance obstacles with the exception of equipment-related issues on perceived quality and safety of care as well as QWL. Conclusions Performance obstacles in ICUs are a major determinant of nursing workload, perceived quality and safety of care, and QWL. In general, performance obstacles increase nursing workload, which in turn negatively affect perceived quality and safety of care and QWL. Redesigning the ICU work system to reduce performance obstacles may improve nurses‘ work. PMID:19207589

  6. Obstacles and facilitators of open visiting policy in Intensive Care Units:A qualitative study

    Directory of Open Access Journals (Sweden)

    Shiva Khaleghparast

    2016-07-01

    Full Text Available Open visiting policy in intensive care units is proposed as an essential requirement for patients and their families, so this study is aimed to explain open visiting policy obstacles and facilitators from patients, families and health team members’ viewpoint. This qualitative study implemented in intensive care units of a hospital specialized in cardiology in Tehran-Iran. Patients’, families’, nurses’, doctors’ and guards’ viewpoint was determined regarding open visiting policy obstacles and facilitators by semi-structured interviews. Data analysis method was conventional approach of qualitative content analysis with thematic technique. Data analysis was performed using Max QDA10 software. Two main categories of data regarding open visiting obstacles and facilitators were extracted. Factors related to service systems and visitors derived from open visiting obstacles, and factors related to management system and personnel derived from open visiting facilitators. One of the most important obstacles of open visiting policy implementation is shortage of staff and personnel negative attitude. Regarding open visiting policy facilitators, designing visiting cards for close family and observing specific rules, modification of intensive care unit structure and facilities for families are useful. Finally, what is important as an open visiting policy implementation facilitator is presence of nursing profession as a humanitarian and ethical profession.

  7. Laser Obstacle Detection System Flight Testing

    National Research Council Canada - National Science Library

    Davis, Timothy

    2003-01-01

    ...). The Aviation Applied Technology Directorate (AATD) was contracted to mount the HELLAS sensor on the nose of a UH-60L Blackhawk helicopter and to conduct flight tests to evaluate the HELLAS obstacle detection sensor...

  8. Simulation of Molecular Transport in Systems Containing Mobile Obstacles.

    Science.gov (United States)

    Polanowski, Piotr; Sikorski, Andrzej

    2016-08-04

    In this paper, we investigate the movement of molecules in crowded environments with obstacles undergoing Brownian motion by means of extensive Monte Carlo simulations. Our investigations were performed using the dynamic lattice liquid model, which was based on the cooperative movement concept and allowed to mimic systems at high densities where the motion of all elements (obstacles as well as moving particles) were highly correlated. The crowded environments are modeled on a two-dimensional triangular lattice containing obstacles (particles whose mobility was significantly reduced) moving by a Brownian motion. The subdiffusive motion of both elements in the system was analyzed. It was shown that the percolation transition does not exist in such systems in spite of the cooperative character of the particles' motion. The reduction of the obstacle mobility leads to the longer caging of liquid particles by mobile obstacles.

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

    Science.gov (United States)

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

    2008-02-01

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

  10. Kinect-Based Moving Human Tracking System with Obstacle Avoidance

    Directory of Open Access Journals (Sweden)

    Abdel Mehsen Ahmad

    2017-04-01

    Full Text Available This paper is an extension of work originally presented and published in IEEE International Multidisciplinary Conference on Engineering Technology (IMCET. This work presents a design and implementation of a moving human tracking system with obstacle avoidance. The system scans the environment by using Kinect, a 3D sensor, and tracks the center of mass of a specific user by using Processing, an open source computer programming language. An Arduino microcontroller is used to drive motors enabling it to move towards the tracked user and avoid obstacles hampering the trajectory. The implemented system is tested under different lighting conditions and the performance is analyzed using several generated depth images.

  11. Obstacles to Industrial Implementation of Scanning Systems

    Science.gov (United States)

    Anders Astrom; Olog Broman; John Graffman; Anders Gronlund; Armas Jappinene; Jari Luostarinen; Jan Nystrom; Daniel L. Schmoldt

    1998-01-01

    Initially the group discussed what is meant by scanning systems. An operational definition was adopted to consider scanning system in the current context to be nontraditional scanning. Where, traditional scanning is defined as scanning that has been industrially operational and relatively common for several years-a mature technology. For example,...

  12. Private health care sector investment in Brazil: opportunities and obstacles.

    Science.gov (United States)

    Brandt, Reynaldo

    2003-01-01

    The Brazilian health system is based upon the constitutional right formulated in 1988, according to which health is the peoples' right and duty of the State. So being, it is essentially the government's responsibility, expressed in the so-called Sistema Unico de Saúde--SUS (single health system) Since its creation, however, it admits the existence of a supplementary health system, left to the private sector. In general terms, the public system is considered unsatisfactory in the services it renders. Its resources are distributed heterogeneously, favoring centers of advanced medical practice, to the detriment of basic health care. The supplementary system is considered of better quality, however with great variations and frequent accusations of being essentially profit driven, instead of being driven to the needs of the assisted population. The growing search for health plans is a direct consequence of the image perceived by the population regarding the quality and accessibility of the public services, as well as of the peoples' growing consciousness of their needs, rights and duties as citizens. The need for continuous quality improvement and cost reduction offers numberless opportunities for actions and investments. Initiatives to identify and implement the best medical practices, medical guidelines and actions are essential regarding those illnesses which are most frequent, of higher cost and of greater risk. Health plans and healthcare providers will necessarily have to focus on their common client. Therefore, organizations must be created in order to develop initiatives aimed to the quality of patient care, as well as to the collection and dissemination of data regarding the production and results of the main service providers. Consequently, immense opportunities are being opened for investments in the area of Information Technology, collection, analysis, and data dissemination. This paper analyses the main trends in the Brazilian health sector and from the

  13. Obstacles to Self-Care From The Viewpoint of TypeII Diabetic Patients and Guidelines to Remove Them

    Directory of Open Access Journals (Sweden)

    Khalil Zalak

    2012-10-01

    Full Text Available Background and objective: Little studies using a limited number of questionnaires cannot reflect the depth and complication of diabetic patients about self-care. However, using the qualitative research method, it is possible to find out the depth of patients’ experiences of this illness. The purpose of this study was to find individual and environmental obstacles which affect self-care on these patients and to investigate patients’ viewpoint of this disease.Materials and Methods: In this qualitative study, group interview and case interview have been used. This study was carried out in two phases and at the end of the interview patients were provided with necessary teaching about the principals of self-care.Results: In general, 5 categories of obstacles to self-care in type 2 diabetes were identified which include: physical obstacles, economical obstacles, social obstacles, educational obstacles, and psychic obstacles. Social, educational and psychic obstacles are in latter classes.Conclusion: The results of this study showed that a high percentage of patients with type 2 diabetes face serious obstacles in the way of self-care and the most numerous and important obstacles in their opinion are physical and economical obstacles. Considering that developing countries face a shortage of resources, dealing with physical obstacles can bring satisfaction to patients and on the other hand, dealing with these obstacles requires less cooperation from exterior organizations.

  14. Obstacles to preventive care for individuals with disability: Implications for nurse practitioners.

    Science.gov (United States)

    Marrocco, Anna; Krouse, Helene J

    2017-05-01

    Individuals with disabilities have been identified as a population with a significantly lower usage of preventive services. Nurse practitioners (NPs) provide a key access point in the healthcare delivery system for preventive services for vulnerable populations such as those with disabilities. It is essential to understand existing barriers that prohibit access to effective preventive care for this vulnerable population. Systematic search and review of Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PubMed, Google Scholar, and government reports and World Health Organizations reports. Twenty-six articles were included in the review. This literature review confirmed previous notions that people with disabilities are receiving much fewer preventive services than the general population. The studies reviewed identified four major barriers that contributed to the lack of preventive care. These barriers included physical environment and system, transportation, provider knowledge and attitude, and financial. Recognition of the obstacles that this subpopulation faces in accessing preventive care services is the first step to effectively remedying this problem. Preventive services have been identified as one of the cornerstones to improving health and quality of life. By understanding the circumstances that restrict those with disabilities from accessing preventive services, NPs can provide meaningful and effective solutions. ©2017 American Association of Nurse Practitioners.

  15. Whole-arm obstacle avoidance system conceptual design

    International Nuclear Information System (INIS)

    Wintenberg, A.L.; Butler, P.L.; Babcock, S.M.; Ericson, M.N.; Britton, C.L. Jr.

    1993-04-01

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

  16. Critical Care Nurses' Suggestions to Improve End-of-Life Care Obstacles: Minimal Change Over 17 Years.

    Science.gov (United States)

    Beckstrand, Renea L; Hadley, Kacie Hart; Luthy, Karlen E; Macintosh, Janelle L B

    Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients. The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions asked CCNs for suggestions to improve EOL care. Comparative obstacle size (quantitative) data were previously published. Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse-to-patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared with data gathered 17 years previously, major themes remained the same but in a few cases changed in order and possible causation. Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated that obstacles to providing EOL care to dying intensive care unit patients continue to exist over time.

  17. A comparative study on managers', staffs' and clients' viewpoints about organizational and structural obstacles in family planning counseling in health-care centers in Isfahan in 2012.

    Science.gov (United States)

    Taheri, Safoura; Ehsanpour, Soheila; Kohan, Shahnaz

    2014-03-01

    Organizational and structural obstacles are a group of major obstacles in achievement of appropriate family planning counseling. Detection of these obstacles from the viewpoint of managers, staffs and clients who are key members in health services providing system is a major step toward appropriate planning to modify or delete this group of obstacles. The present study was conducted with the goal of comparing managers', staffs' and clients' viewpoints about organizational and structural obstacles in family planning counseling in health-care centers in Isfahan in 2012. This is a cross-sectional one-step three-group comparative descriptive study conducted on 295 subjects including 59 managers, 110 staffs and 126 clients in medical health-care centers in Isfahan in 2012. Managers and the staffs were selected by census sampling and the clients were recruited through convenient random sampling. The date collection tool was a researcher made questionnaire, which was designed in two sections of fertility and personal characteristics and viewpoint measurement. Descriptive and inferential statistical test were used to analyze the data. The obtained results showed no significant difference between mean scores of viewpoints in three groups of managers, staffs and clients concerning organizational and structural obstacles in family planning counseling (P = 0.677). In addition, most of the managers, staffs and clients reported organizational and structural obstacles as the obstacles in the process of family planning in moderate level. The results showed the necessity of health services managers' planning to modify or delete organizational and structural obstacles especially the agreed obstacles from the viewpoint of managers, staffs and clients.

  18. Can weak-resilience-signals (WRS) reveal obstacles compromising (rail-)system resilience?

    NARCIS (Netherlands)

    Siegel, A.W.; Schraagen, J.M.C.

    2015-01-01

    Analysis of accidents in socio-technical systems frequently reveals unnoticed obstacles, which have grown to become the main cause of incubation and surprise at failure (Dekker, 2011). Thus far, it has proven to be a challenge to identify those unnoticed obstacles upfront among the tremendous number

  19. ASPECTS OF OBSTACLES FOR APPLYING ACTIVITY BASED COSTING (ABC SYSTEM IN EGYPTIAN FIRMS

    Directory of Open Access Journals (Sweden)

    Petru STEFEA

    2013-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Andrés Cela

    2012-12-01

    Full Text Available The aim of this article is focused on the design of an obstacle detection system for assisting visually impaired people. A dense disparity map is computed from the images of a stereo camera carried by the user. By using the dense disparity map, potential obstacles can be detected in 3D in indoor and outdoor scenarios. A ground plane estimation algorithm based on RANSAC plus filtering techniques allows the robust detection of the ground in every frame. A polar grid representation is proposed to account for the potential obstacles in the scene. The design is completed with acoustic feedback to assist visually impaired users while approaching obstacles. Beep sounds with different frequencies and repetitions inform the user about the presence of obstacles. Audio bone conducting technology is employed to play these sounds without interrupting the visually impaired user from hearing other important sounds from its local environment. A user study participated by four visually impaired volunteers supports the proposed system.

  1. A Mobile Robot Sonar System with Obstacle Avoidance.

    Science.gov (United States)

    1994-03-01

    WITH OBSTACLE - AVOIDANCE __ by __ Patrick Gerard Byrne March 1994 Thesis Advisor : Yutaka Kanayama Approved for public release; distribution is...point p is on a line L whose normal has an orientation a and whose distance from the origin is r (Figure 5). This method has an advantage in expressing...sonar(FRONTR); Wine(&pl); while(hitl I >’- 100.0 11 hitl 1 - 0.0 ){ hitl I = sonar(FRONTR); I skipO; line(&p3); gat- robO (&posit 1); while(positl.x

  2. Obstacles to the take-up of mental health-care provision by adult males in rural and remote areas of Australia: A systematic review protocol.

    Science.gov (United States)

    Stroud, Peter; Lockwood, Craig

    ) context is as follows. Research suggests there is a consensus that Australian rural male health is a unique social problem, and there appears to be a possible perception that the state and national health systems may have failed ARRM's. This research also discusses that ARRM's respond differently and uniquely, compared to their international counterparts, and this might be especially true in the case of Australian Indigenous populations. There is a suggestion in the research that the Australian rural health-care environment is unique because of its mix of ARRM's among a population which includes culturally and linguistically diverse populations, local Indigenous people as well as people of Anglo-Saxon descent. Some research suggests that there are unique complexities confronting the ARRM population mix when access to health-care is considered. Research also suggests unique complexities might exist in the mix of care provision, delivery systems, and funding arrangements in the ARRM context. An interesting area of research in terms of social capital, and moral distress, suggests the Australian context might be unique in terms of its formal and informal care structures and arrangements.. Moral distress is believed to represent an issue in the professional delivery of quality health-care Other research considers the notion of structural disadvantage in the provision of, and access to, care services for ARRM's. Structural disadvantage refers to the dearth of asset-based community development opportunities that play a role in health-care provision.A screening search of Pubmed, Cinahl, the Cochrane Library and the JBI Systematic Review Library did not identify published systematic reviews, or active protocols in this topic of research. Therefore this systematic review will help address this gap. Obstacle: A barrier to the utilisation of health-care/mental-health care.Take-up: The accessing of health-care/mental-health care services.Health-care: Services which promote, maintain

  3. Real-Time Obstacle Avoidance for Telerobotic Systems Based on Equipotential Surface

    Directory of Open Access Journals (Sweden)

    Xin Li

    2012-09-01

    Full Text Available Redundant manipulators offer a dual advantage of flexibility and dexterity and can be used in many civilian and military areas. However, operating such systems by teleoperation is challenging because of the redundancy and unstructured task environment, which result in the human operator suffering a huge burden when telemanipulator is facing the complicated obstacles. The existing methods usually use some off-line algorithms to solve the problem of obstacle avoidance. It is difficult for them to meet the requirements of real-time teleoperation in some unknown environment. This paper presents an on-line method for a telerobotic system to take advantage of redundancy to avoid obstacle, which is based on real-time sensor information. With this method, the human operator can focus attention on the end-effector operation regardless of the obstacle avoidance of other parts. The effectiveness and advantage of the method are well demonstrated by experiments.

  4. Generation of spiral waves pinned to obstacles in a simulated excitable system

    Science.gov (United States)

    Phantu, Metinee; Kumchaiseemak, Nakorn; Porjai, Porramain; Sutthiopad, Malee; Müller, Stefan C.; Luengviriya, Chaiya; Luengviriya, Jiraporn

    2017-09-01

    Pinning phenomena emerge in many dynamical systems. They are found to stabilize extreme conditions such as superconductivity and super fluidity. The dynamics of pinned spiral waves, whose tips trace the boundary of obstacles, also play an important role in the human health. In heart, such pinned waves cause longer tachycardia. In this article, we present two methods for generating pinned spiral waves in a simulated excitable system. In method A, an obstacle is set in the system prior to an ignition of a spiral wave. This method may be suitable only for the case of large obstacles since it often fails when used for small obstacles. In method B, a spiral wave is generated before an obstacle is placed at the spiral tip. With this method, a pinned spiral wave is always obtained, regardless the obstacle size. We demonstrate that after a transient interval the dynamics of the pinned spiral waves generated by the methods A and B are identical. The initiation of pinned spiral waves in both two- and three-dimensional systems is illustrated.

  5. Real-Time Obstacle Avoidance for Telerobotic Systems Based on Equipotential Surface

    OpenAIRE

    Xin Li; Aiguo Song; Huijun Li; Wei Lu; Chen Mao

    2012-01-01

    Redundant manipulators offer a dual advantage of flexibility and dexterity and can be used in many civilian and military areas. However, operating such systems by teleoperation is challenging because of the redundancy and unstructured task environment, which result in the human operator suffering a huge burden when telemanipulator is facing the complicated obstacles. The existing methods usually use some off-line algorithms to solve the problem of obstacle avoidance. It is difficult for them ...

  6. A Compact Magnetic Field-Based Obstacle Detection and Avoidance System for Miniature Spherical Robots

    Directory of Open Access Journals (Sweden)

    Fang Wu

    2017-05-01

    Full Text Available Due to their efficient locomotion and natural tolerance to hazardous environments, spherical robots have wide applications in security surveillance, exploration of unknown territory and emergency response. Numerous studies have been conducted on the driving mechanism, motion planning and trajectory tracking methods of spherical robots, yet very limited studies have been conducted regarding the obstacle avoidance capability of spherical robots. Most of the existing spherical robots rely on the “hit and run” technique, which has been argued to be a reasonable strategy because spherical robots have an inherent ability to recover from collisions. Without protruding components, they will not become stuck and can simply roll back after running into bstacles. However, for small scale spherical robots that contain sensitive surveillance sensors and cannot afford to utilize heavy protective shells, the absence of obstacle avoidance solutions would leave the robot at the mercy of potentially dangerous obstacles. In this paper, a compact magnetic field-based obstacle detection and avoidance system has been developed for miniature spherical robots. It utilizes a passive magnetic field so that the system is both compact and power efficient. The proposed system can detect not only the presence, but also the approaching direction of a ferromagnetic obstacle, therefore, an intelligent avoidance behavior can be generated by adapting the trajectory tracking method with the detection information. Design optimization is conducted to enhance the obstacle detection performance and detailed avoidance strategies are devised. Experimental results are also presented for validation purposes.

  7. Obstacle Detection for Intelligent Transportation Systems Using Deep Stacked Autoencoder and k-Nearest Neighbor Scheme

    KAUST Repository

    Dairi, Abdelkader; Harrou, Fouzi; Sun, Ying; Senouci, Mohamed

    2018-01-01

    Obstacle detection is an essential element for the development of intelligent transportation systems so that accidents can be avoided. In this study, we propose a stereovisionbased method for detecting obstacles in urban environment. The proposed method uses a deep stacked auto-encoders (DSA) model that combines the greedy learning features with the dimensionality reduction capacity and employs an unsupervised k-nearest neighbors algorithm (KNN) to accurately and reliably detect the presence of obstacles. We consider obstacle detection as an anomaly detection problem. We evaluated the proposed method by using practical data from three publicly available datasets, the Malaga stereovision urban dataset (MSVUD), the Daimler urban segmentation dataset (DUSD), and Bahnhof dataset. Also, we compared the efficiency of DSA-KNN approach to the deep belief network (DBN)-based clustering schemes. Results show that the DSA-KNN is suitable to visually monitor urban scenes.

  8. Obstacle Detection for Intelligent Transportation Systems Using Deep Stacked Autoencoder and k-Nearest Neighbor Scheme

    KAUST Repository

    Dairi, Abdelkader

    2018-04-30

    Obstacle detection is an essential element for the development of intelligent transportation systems so that accidents can be avoided. In this study, we propose a stereovisionbased method for detecting obstacles in urban environment. The proposed method uses a deep stacked auto-encoders (DSA) model that combines the greedy learning features with the dimensionality reduction capacity and employs an unsupervised k-nearest neighbors algorithm (KNN) to accurately and reliably detect the presence of obstacles. We consider obstacle detection as an anomaly detection problem. We evaluated the proposed method by using practical data from three publicly available datasets, the Malaga stereovision urban dataset (MSVUD), the Daimler urban segmentation dataset (DUSD), and Bahnhof dataset. Also, we compared the efficiency of DSA-KNN approach to the deep belief network (DBN)-based clustering schemes. Results show that the DSA-KNN is suitable to visually monitor urban scenes.

  9. Patient-Centered Care; Physicians’ View of Obstacles against and Ideas for Implementation

    Directory of Open Access Journals (Sweden)

    Faisal Abdullatif Alnasir

    2016-04-01

    Full Text Available To implement proper family medicine practice and to get the best of it, the concept of patient-centered care (PCC has to be put into use. Studies have found that one of the most important advantages of PCC is the increase in the patients' quality of life. PCC has been recognized as a marker of quality in health service delivery with its improvement. However, the physicians’ belief is essential for its implementation. A cross-sectional study was done to find out what family physicians think of PCC and what they believe are the obstacles that block from its use in Bahrain. Twenty-eight family physicians (FPs working in the primary health care centers were arbitrarily culled from a pool of doctors. To all a pre-designed questionnaire was sent that contained three parts; demographic information, type of facilities that they work and whether it is promoting PCC practice and the last was concerned with the physicians’ view about the barrier against its implementation and what they cerebrate that could avail in promoting it. The results showed that the majority of the participants were family physicians working in governmental health centers. More than 85% knew the congruous definition of PCC and 96.4% thought that the most common barrier for not implementing PCC approach is the time constraint while almost 93% thought that the short duration of time of the consultation is another impediment for implementing PCC. Withal, 57.1% and 53.6% of FPs thought that language and the doctor’s communication skills are other barriers respectively. Since the ultimate aim of provision of health care in any country is the optimal health of the population and since PCC practice could fortify and avail in achieving that goal, it is recommended that policy makers and health authorities are required to abstract all obstacles that works against implementing PCC and change the work environment in order to make it facile for the practitioners to apply PCC practice

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

    Science.gov (United States)

    Mohd Zin, Zalhan; Ibrahim, Ratnawati

    2011-06-01

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

  11. Computer usage among nurses in rural health-care facilities in South Africa: obstacles and challenges.

    Science.gov (United States)

    Asah, Flora

    2013-04-01

    This study discusses factors inhibiting computer usage for work-related tasks among computer-literate professional nurses within rural healthcare facilities in South Africa. In the past two decades computer literacy courses have not been part of the nursing curricula. Computer courses are offered by the State Information Technology Agency. Despite this, there seems to be limited use of computers by professional nurses in the rural context. Focus group interviews held with 40 professional nurses from three government hospitals in northern KwaZulu-Natal. Contributing factors were found to be lack of information technology infrastructure, restricted access to computers and deficits in regard to the technical and nursing management support. The physical location of computers within the health-care facilities and lack of relevant software emerged as specific obstacles to usage. Provision of continuous and active support from nursing management could positively influence computer usage among professional nurses. A closer integration of information technology and computer literacy skills into existing nursing curricula would foster a positive attitude towards computer usage through early exposure. Responses indicated that change of mindset may be needed on the part of nursing management so that they begin to actively promote ready access to computers as a means of creating greater professionalism and collegiality. © 2011 Blackwell Publishing Ltd.

  12. Recombinant expression systems: the obstacle to helminth vaccines?

    Science.gov (United States)

    Geldhof, Peter; De Maere, Veerle; Vercruysse, Jozef; Claerebout, Edwin

    2007-11-01

    The need for alternative ways to control helminth parasites has in recent years led to a boost in vaccination experiments with recombinant antigens. Despite the use of different expression systems, only a few recombinants induced high levels of protection against helminths. This is often attributed to the limitations of the current expression systems. Therefore, the need for new systems that can modify and glycosylate the expressed antigens has been advocated. However, analysis of over 100 published vaccine trials with recombinant helminth antigens indicates that it is often not known whether the native parasite antigen itself can induce protection or, if it does, which epitopes are important. This information is vital for a well-thought-out strategy for recombinant production. So, in addition to testing more expression systems, it should be considered that prior evaluation and characterization of the native antigens might help the development of recombinant vaccines against helminths in the long term.

  13. Home Health Care (HHC) Managers Perceptions About Challenges and Obstacles that Hinder HHC Services in Jordan

    Science.gov (United States)

    Ajlouni, Musa T.; Dawani, Hania; Diab, Salah M.

    2015-01-01

    Home care aims at supporting people with various degrees of dependency to remain at home rather than use residential, long-term, or institutional-based nursing care. Demographic, epidemiological, social, and cultural trends in Jordan as in other countries are changing the traditional patterns of care with growing emphasis on home care. The purpose of this study is to highlight the most common challenges related to home health care (HHC) services in Jordan as perceived by the managers of HHC agencies. Methods: a descriptive qualitative design that depends on focus group discussions has been used to collect data from a sample of 18 managers who met the selection criteria and who are willing to participate, the study found that, the main challenges of HHC services as perceived by managers were: shortage of female staff, lack of governance and regulation, poor management, unethical practices, lack of referral systems, and low accessibility of the poor and less privileged as HHC services are not included in health insurance schemes, it concludes also that the home health care industry in Jordan is facing many challenges and problems that may have negative effects on the effectiveness, efficiency, equity and quality of services and should be addressed by health policy makers. PMID:25946949

  14. An obstacle detection system using binocular stereo fisheye lenses for planetary rover navigation

    Science.gov (United States)

    Liu, L.; Jia, J.; Li, L.

    In this paper we present an implementation of an obstacle detection system using binocular stereo fisheye lenses for planetary rover navigation The fisheye lenses can improve image acquisition efficiency and handle minimal clearance recovery problem because they provide a large field of view However the fisheye lens introduces significant distortion in the image and this will make it much more difficult to find a one-to-one correspondence In addition we have to improve the system accuracy and efficiency for robot navigation To compute dense depth maps accurately in real time the following five key issues are considered 1 using lookup tables for a tradeoff between time and space in fisheye distortion correction and correspondence matching 2 using an improved incremental calculation scheme for algorithmic optimization 3 multimedia instruction set MMX implementation 4 consistency check to remove wrong stereo matching problems suffering from occlusions or mismatches 5 constraints of the recovery space To realize obstacle detection robustly we use the following three steps 1 extracting the ground plane parameters using Randomized Hough Transform 2 filtering the ground and background 3 locating the obstacles by using connected region detection Experimental results show the system can run at 3 2fps in 2 0GHz PC with 640X480 pixels

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

    Science.gov (United States)

    Hannes, K; Goedhuys, J; Aertgeerts, B

    2012-01-01

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

  16. Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions.

    Science.gov (United States)

    Laskowski-Jones, Linda; Caudell, Michael J; Hawkins, Seth C; Jones, Lawrence J; Dymond, Chelsea A; Cushing, Tracy; Gupta, Sanjey; Young, David S; Starling, Jennifer M; Bounds, Richard

    2017-10-01

    Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

    International Nuclear Information System (INIS)

    Fujii, Yoshio; Suzuki, Katsuo

    1998-12-01

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

  18. Relay Placement for FSO Multihop DF Systems With Link Obstacles and Infeasible Regions

    KAUST Repository

    Zhu, Bingcheng; Cheng, Julian; Alouini, Mohamed-Slim; Wu, Lenan

    2015-01-01

    Optimal relay placement is studied for free-space optical multihop communication with link obstacles and infeasible regions. An optimal relay placement scheme is proposed to achieve the lowest outage probability, enable the links to bypass obstacles

  19. Healthcare in Equatorial Guinea, West Africa: obstacles and barriers to care.

    Science.gov (United States)

    Reuter, Kim Eleanor; Geysimonyan, Aurora; Molina, Gabriela; Reuter, Peter Robert

    2014-01-01

    The provision of healthcare services in developing countries has received increasing attention, but inequalities persist. One nation with potential inequalities in healthcare services is Equatorial Guinea (Central-West Africa). Mitigating these inequalities is difficult, as the Equatoguinean healthcare system remains relatively understudied. In this study, we interviewed members of the healthcare community in order to: 1) learn which diseases are most common and the most common cause of death from the perspective of healthcare workers; and 2) gain an understanding of the healthcare community in Equatorial Guinea by describing how: a) healthcare workers gain their professional knowledge; b) summarizing ongoing healthcare programs aimed at the general public; c) discussing conflicts within the healthcare community and between the public and healthcare providers; d) and addressing opportunities to improve healthcare delivery. We found that some causes of death, such as serious injuries, may not be currently treatable in country, potentially due to a lack of resources and trauma care facilities. In addition, training and informational programs for both healthcare workers and the general public may not be effectively transmitting information to the intended recipients. This presents hurdles to the healthcare community, both in terms of having professional competence in healthcare delivery and in having a community that is receptive to medical care. Our data also highlight government-facility communication as an opportunity for improvement. Our research is an important first step in understanding the context of healthcare delivery in Equatorial Guinea, a country that is relatively data poor.

  20. Diversity in Defining End of Life Care: An Obstacle or the Way Forward?

    NARCIS (Netherlands)

    Gysels, M.; Evans, N.C.; Menaca, A.; Higginson, I.J.; Harding, R.; Pool, R.

    2013-01-01

    Aim:The terms used to describe care at the end of life (EoL), and its definitions, have evolved over time and reflect the changes in meaning the concept has undergone as the field develops. We explore the remit of EoL care as defined by experts in EoL care, from across Europe and beyond, to

  1. Diversity in defining end of life care: an obstacle or the way forward?

    NARCIS (Netherlands)

    Gysels, M.; Evans, N.; Meñaca, A.; Higginson, I.J.; Harding, R; Pool, R.

    2013-01-01

    Aim: The terms used to describe care at the end of life (EoL), and its definitions, have evolved over time and reflect the changes in meaning the concept has undergone as the field develops. We explore the remit of EoL care as defined by experts in EoL care, from across Europe and beyond, to

  2. Obstacles to comprehensive dental care in patients with sustained limitations of their decision-making abilities: findings from a Delphi study.

    Science.gov (United States)

    Blaizot, Alessandra; Catteau, Céline; Delfosse, Caroline; Hamel, Olivier; Trentesaux, Thomas

    2018-06-01

    The objective of this study was to explore the therapeutic limitations experienced by a panel of special-care dentists in France when treating patients with sustained limitations of their decision-making abilities. We used a Delphi technique conducted in three rounds from 01 June 2014 to 30 September 2015. A first questionnaire comprising open-ended questions was addressed to 72 panellists. A content analysis of the returned questionnaires served to draft a second questionnaire comprising closed-ended questions; this was sent to the 28 panellists who responded in the first round. A third questionnaire was sent to the 20 panellists who responded in the second round to give them an opportunity to reconsider their response in the context of the second-round response group. Sixteen panellists answered the last round. A large majority agreed on the importance of providing comprehensive care, but they encountered obstacles at two time points: (i) when proposing the care; and (ii) when setting it up. The panel put forward recommendations in two main areas: (i) the training of those involved in oral health decisions; and (ii) dental care management and organization of the care system. The study provided a foundation for building future orientations in health care for patients with limited decision-making abilities. © 2018 Eur J Oral Sci.

  3. Obstacles and Challenges to Gender Parity. Political Violence, Electoral System and Interculturalism

    Directory of Open Access Journals (Sweden)

    Laura Albaine

    2015-05-01

    Full Text Available This study is a contribution to the debate about the adoption of gender parity policies in Latin America analyzing particular obstacles and challenges related to the implementation of this principle. Electoral systems tend to either optimize or reduce the impact of such gender parity measures. As well as with quotas, the size of the electoral district and the kind of electoral list system are the two variables that most influence the effective implementation of these measures. At the same time, the socio-cultural context also influences the process of implementation of gender parity measures. In patriarchal societies –with high levels of gender-based violence– electoral processes are often characterized by gender-based harassment and political violence, one of the greatest obstacles for increasing women’s political participation. These situations are further complicated in societies which are also characterized by ethnic and cultural diversity, presenting the challenge of including women who are also discriminated against for their ethno-cultural identity.

  4. Modified bug-1 algorithm based strategy for obstacle avoidance in multi robot system

    Directory of Open Access Journals (Sweden)

    Kandathil Jom J.

    2018-01-01

    Full Text Available One of the primary ability of an intelligent mobile robot system is obstacle avoidance. BUG algorithms are classic examples of the algorithms used for achieving obstacle avoidance. Unlike many other planning algorithms based on global knowledge, BUG algorithms assume only local knowledge of the environment and a global goal. Among the variations of the BUG algorithms that prevail, BUG-0, BUG-1 and BUG-2 are the more prominent versions. The exhaustive search algorithm present in BUG-1 makes it more reliable and safer for practical applications. Overall, this provides a more predictable and dependable performance. Hence, the essential focus in this paper is on implementing the BUG-1 algorithm across a group of robots to move them from a start location to a target location. The results are compared with the results from BUG-1 algorithm implemented on a single robot. The strategy developed in this work reduces the time involved in moving the robots from starting location to the target location. Further, the paper shows that the total distance covered by each robot in a multi robot-system is always lesser than or equal to that travelled by a single robot executing the same problem.

  5. Diversity in Defining End of Life Care: An Obstacle or the Way Forward?

    Science.gov (United States)

    Gysels, Marjolein; Evans, Natalie; Meñaca, Arantza; Higginson, Irene J.; Harding, Richard; Pool, Robert

    2013-01-01

    Aim The terms used to describe care at the end of life (EoL), and its definitions, have evolved over time and reflect the changes in meaning the concept has undergone as the field develops. We explore the remit of EoL care as defined by experts in EoL care, from across Europe and beyond, to understand its current usage and meanings. Method A qualitative survey attached to a call for expertise on cultural issues in EoL care was sent to experts in the field identified through the literature, European EoL care associations, and conferences targeted at EoL care professionals. Respondents were asked to identify further contacts for snowball recruitment.The responses were analysed using content and discourse analysis. Results Responses were received from 167 individuals (33% response rate), mainly from academics (39%) and clinical practitioners working in an academic context (23%) from 19 countries in Europe and beyond. 29% of respondents said explicitly that there was no agreed definition of EoL care in practice and only 14% offered a standard definition (WHO, or local institution). 2% said that the concept of EoL care was not used in their country, and 5% said that there was opposition to the concept for religious or cultural reasons. Two approaches were identified to arrive at an understanding of EoL care: exclusively by drawing boundaries through setting time frames, and inclusively by approaching its scope in an integrative way. This led to reflections about terminology and whether defining EoL care is desirable. Conclusion The global expansion of EoL care contributes to the variety of interpretations of what it means. This complicates the endeavour of defining the field. However, when diversity is taken seriously it can open up new perspectives to underpin the ethical framework of EoL care. PMID:23844145

  6. Navigation integrity monitoring and obstacle detection for enhanced-vision systems

    Science.gov (United States)

    Korn, Bernd; Doehler, Hans-Ullrich; Hecker, Peter

    2001-08-01

    Typically, Enhanced Vision (EV) systems consist of two main parts, sensor vision and synthetic vision. Synthetic vision usually generates a virtual out-the-window view using databases and accurate navigation data, e. g. provided by differential GPS (DGPS). The reliability of the synthetic vision highly depends on both, the accuracy of the used database and the integrity of the navigation data. But especially in GPS based systems, the integrity of the navigation can't be guaranteed. Furthermore, only objects that are stored in the database can be displayed to the pilot. Consequently, unexpected obstacles are invisible and this might cause severe problems. Therefore, additional information has to be extracted from sensor data to overcome these problems. In particular, the sensor data analysis has to identify obstacles and has to monitor the integrity of databases and navigation. Furthermore, if a lack of integrity arises, navigation data, e.g. the relative position of runway and aircraft, has to be extracted directly from the sensor data. The main contribution of this paper is about the realization of these three sensor data analysis tasks within our EV system, which uses the HiVision 35 GHz MMW radar of EADS, Ulm as the primary EV sensor. For the integrity monitoring, objects extracted from radar images are registered with both database objects and objects (e. g. other aircrafts) transmitted via data link. This results in a classification into known and unknown radar image objects and consequently, in a validation of the integrity of database and navigation. Furthermore, special runway structures are searched for in the radar image where they should appear. The outcome of this runway check contributes to the integrity analysis, too. Concurrent to this investigation a radar image based navigation is performed without using neither precision navigation nor detailed database information to determine the aircraft's position relative to the runway. The performance of our

  7. What we have here is a failure to communicate: obstacles to optimal care for preterm birth.

    Science.gov (United States)

    Iams, Jay D; Donovan, Edward F; Rose, Barbara; Prasad, Mona

    2011-09-01

    Obstetricians and pediatricians share the common goal of a healthy beginning for every baby, mother, and family. This article asserts that miscommunication between the specialties, fostered by separate definitions, metrics, and outcomes, is an impediment to optimal care. Solutions are suggested for improving communication and outcomes. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Real-time obstacle and collision avoidance system for fixed wing unmanned aerial systems

    Science.gov (United States)

    Esposito, Julien F.

    The first original contribution of this research is the Advanced Mapping and Waypoint Generator (AMWG), a piece of software which processes publicly available elevation data in order to only retain the information necessary for a given altitude-specific flight mission. The AMWG is what makes systematic offline trajectory possible. The AMWG first creates altitude groups in order to discard elevations points which are not relevant to a specific mission because of the altitude flown at. Those groups referred to as altitude layers can in turn be reused if the original layer becomes unsafe for the altitude range in use, and the other layers are used for altitude re-scheduling in order to update the current altitude layer to a safer layer. Each layer is bounded by a lower and higher altitude, within which terrain contours are considered constant according to a conservative approach involving the principle of natural erosion. The AMWG then proceeds to obstacle contours extraction using threshold and edge detection vision algorithms. A simplification of those obstacle contours and their corresponding free space zones counterparts is performed using a fixed -tolerance Douglas-Peucker algorithm. This simplification allows free space zones to be described by vectors instead of point clouds, which enables UAS point location. The final product of the AWMG is a network of connected free space trapezoidal cells with embedded connectivity information referred to as the Synthetic Terrain Avoidance (STA network). The walls of the trapezoidal cells are then extruded as the AWMG essentially approximates a three-dimensional world by considering it as a stratification of two-dimensional layers, but the real-time phase needs 3D support. Using the graph conceptual view and the depth first search algorithm, all the connected cell sequences joining the departure to the arrival cell can be listed, a capability which is used during aircraft rerouting. By connecting two adjacent cells

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

    Directory of Open Access Journals (Sweden)

    David Zapata

    2013-01-01

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

  10. Obstacle Recognition Based on Machine Learning for On-Chip LiDAR Sensors in a Cyber-Physical System

    Directory of Open Access Journals (Sweden)

    Fernando Castaño

    2017-09-01

    Full Text Available Collision avoidance is an important feature in advanced driver-assistance systems, aimed at providing correct, timely and reliable warnings before an imminent collision (with objects, vehicles, pedestrians, etc.. The obstacle recognition library is designed and implemented to address the design and evaluation of obstacle detection in a transportation cyber-physical system. The library is integrated into a co-simulation framework that is supported on the interaction between SCANeR software and Matlab/Simulink. From the best of the authors’ knowledge, two main contributions are reported in this paper. Firstly, the modelling and simulation of virtual on-chip light detection and ranging sensors in a cyber-physical system, for traffic scenarios, is presented. The cyber-physical system is designed and implemented in SCANeR. Secondly, three specific artificial intelligence-based methods for obstacle recognition libraries are also designed and applied using a sensory information database provided by SCANeR. The computational library has three methods for obstacle detection: a multi-layer perceptron neural network, a self-organization map and a support vector machine. Finally, a comparison among these methods under different weather conditions is presented, with very promising results in terms of accuracy. The best results are achieved using the multi-layer perceptron in sunny and foggy conditions, the support vector machine in rainy conditions and the self-organized map in snowy conditions.

  11. Obstacle Recognition Based on Machine Learning for On-Chip LiDAR Sensors in a Cyber-Physical System.

    Science.gov (United States)

    Castaño, Fernando; Beruvides, Gerardo; Haber, Rodolfo E; Artuñedo, Antonio

    2017-09-14

    Collision avoidance is an important feature in advanced driver-assistance systems, aimed at providing correct, timely and reliable warnings before an imminent collision (with objects, vehicles, pedestrians, etc.). The obstacle recognition library is designed and implemented to address the design and evaluation of obstacle detection in a transportation cyber-physical system. The library is integrated into a co-simulation framework that is supported on the interaction between SCANeR software and Matlab/Simulink. From the best of the authors' knowledge, two main contributions are reported in this paper. Firstly, the modelling and simulation of virtual on-chip light detection and ranging sensors in a cyber-physical system, for traffic scenarios, is presented. The cyber-physical system is designed and implemented in SCANeR. Secondly, three specific artificial intelligence-based methods for obstacle recognition libraries are also designed and applied using a sensory information database provided by SCANeR. The computational library has three methods for obstacle detection: a multi-layer perceptron neural network, a self-organization map and a support vector machine. Finally, a comparison among these methods under different weather conditions is presented, with very promising results in terms of accuracy. The best results are achieved using the multi-layer perceptron in sunny and foggy conditions, the support vector machine in rainy conditions and the self-organized map in snowy conditions.

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

    Directory of Open Access Journals (Sweden)

    Nathan F. Sayre

    2012-12-01

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

  13. An Improved Fast Flocking Algorithm with Obstacle Avoidance for Multiagent Dynamic Systems

    Directory of Open Access Journals (Sweden)

    Jialiang Wang

    2014-01-01

    Full Text Available Flocking behavior is a common phenomenon in nature, such as flocks of birds and groups of fish. In order to make the agents effectively avoid obstacles and fast form flocking towards the direction of destination point, this paper proposes a fast multiagent obstacle avoidance (FMOA algorithm. FMOA is illustrated based on the status of whether the flocking has formed. If flocking has not formed, agents should avoid the obstacles toward the direction of target. If otherwise, these agents have reached the state of lattice and then these agents only need to avoid the obstacles and ignore the direction of target. The experimental results show that the proposed FMOA algorithm has better performance in terms of flocking path length. Furthermore, the proposed FMOA algorithm is applied to the formation flying of quad-rotor helicopters. Compared with other technologies to perform the localization of quad-rotor helicopter, this paper innovatively constructs a smart environment by deploying some wireless sensor network (WSN nodes using the proposed localization algorithm. Finally, the proposed FMOA algorithm is used to conduct the formation flying of these quad-rotor helicopters in the smart environment.

  14. Relay Placement for FSO Multihop DF Systems With Link Obstacles and Infeasible Regions

    KAUST Repository

    Zhu, Bingcheng

    2015-05-19

    Optimal relay placement is studied for free-space optical multihop communication with link obstacles and infeasible regions. An optimal relay placement scheme is proposed to achieve the lowest outage probability, enable the links to bypass obstacles of various geometric shapes, and place the relay nodes in specified available regions. When the number of relay nodes is large, the searching space can grow exponentially, and thus, a grouping optimization technique is proposed to reduce the searching time. We numerically demonstrate that the grouping optimization can provide suboptimal solutions close to the optimal solutions, but the average searching time linearly grows with the number of relay nodes. Two useful theorems are presented to reveal insights into the optimal relay locations. Simulation results show that our proposed optimization framework can effectively provide desirable solution to the problem of optimal relay nodes placement. © 2015 IEEE.

  15. Real Time Vision System for Obstacle Detection and Localization on FPGA

    OpenAIRE

    Alhamwi , Ali; Vandeportaele , Bertrand; Piat , Jonathan

    2015-01-01

    International audience; Obstacle detection is a mandatory function for a robot navigating in an indoor environment especially when interaction with humans is done in a cluttered environment. Commonly used vision-based solutions like SLAM (Simultaneous Localization and Mapping) or optical flow tend to be computation intensive and require powerful computation resources to meet low speed real-time constraints. Solutions using LIDAR (Light Detection And Ranging) sensors are more robust but not co...

  16. Health care delivery systems.

    NARCIS (Netherlands)

    Stevens, F.; Zee, J. van der

    2007-01-01

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

  17. Carriageway actual parameters determination system development to form virtual road scene in the authentically recognizable road marking absence and negative obstacle presence

    Science.gov (United States)

    Groshev, A. M.; Groshev, S. M.; Tumasov, A. V.; Romanov, A. D.

    2018-02-01

    This paper presents the development of the carriageway actual parameters determination system to form a virtual road scene in the authentically recognizable road marking absence and negative obstacles presence. The sensors used in defining the vehicle position and the obstacles are given. The developed system will be able to function independently and also work collaboratively with the other ADAS functions increasing the functional quality of the system.

  18. Obstacles in the Utilisation of Maternal Health Care Services in Murarai-II C.D. Block, Birbhum District, West Bengal, India

    Directory of Open Access Journals (Sweden)

    Alokananda Ghosh

    2017-03-01

    Full Text Available Improving maternal health was one of the eight Millennium Development Goals (MDGs and now it is one of the targets of 17 point Sustainable Development Goals (SDGs. The utilisation of Maternal Health Care Services (MHCSs is a complex phenomenon and it is influenced by several factors, like-health care seeking behaviour of the cohorts belonging to different socio-economic and cultural background, distance of the facility centres, type and conditions of the roads including undulating surface, transportation cost, type and availability of transportation mode along with the factors related to the accountability and surveillances of the health care services. Therefore, clear understanding and discussion is needed to draw an association between MHCSs and its influential factors. The objectives of the study are to estimate the impact of accessibility on the underserved status of MHCSs and on the utilisation of MHCSs through paucity index. In addition, the study aims to evaluate the causal relationships between underserved situation and obstacle score with the paucity index of MHCS utilisation. The empirical observation unfolds that the provision and utilisation of MHCSs are strongly dependent on accessibility and distance. The situation is aggravating for proper delivery of services, which is responsible for the increasing obstacle score and paucity index, especially in remote sub- centres of Murarai-II C.D. Block of Birbhum District.

  19. On the obstacles and solutions in the application of Chinese criminal legal aid system

    Directory of Open Access Journals (Sweden)

    Wang Sh.

    2016-06-01

    Full Text Available the article discovers the problem of application of Chinese legal aid system, which is very low. The problem should be solved as below. The author suggests strengthening the education to investigators, changing the way of employing legal aid lawyers and clarify the content of the right informing and applying for legal aid system. These actions application might well improve the situation.

  20. Unsatisfied basic needs of older patients in emergency care environments - obstacles to an active role in decision making.

    Science.gov (United States)

    Nydén, Kristoffer; Petersson, Martin; Nyström, Maria

    2003-03-01

    Little attention is paid in Emergency Care Units (ECUs) in Sweden to the special needs of older people. The aim of this study was thus to analyse older people's basic needs in the emergency care environment. The study was carried out with a life-world interpretative approach, and the theoretical framework for interpretation was Abraham Maslow's theory of motivation and personality. Seven informants aged between 65 and 88 years, with various experiences of being patients with urgent as well as non-urgent health-related problems, were interviewed about their experiences of ECU care. Their basic needs at the lower levels of Maslow's hierarchy were well-represented in the data. Higher needs, such as desire to know and understand, appeared to be totally neglected. Safety needs dominated the whole situation. Our conclusion is that standards of care must be developed in Sweden to make older patients feel safer and more secure in ECUs. Furthermore, the principles of nursing care for older patients need to be defined in order to encourage them to take an active part in their own health process.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-01-01

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

  2. Reflections on Remaining Obstacles in a Primary-Care Oriented Pure PBL Curriculum after Twelve Years of Implementation

    Science.gov (United States)

    D'Ottavio, Alberto Enrique; Bassan, Norberto David

    2014-01-01

    A pioneer primary-care oriented pure PBL curriculum, based on constructivism and adult learning theories combined with Morin's complex thinking, was implemented in our medical school since 2002. Regardless of warnings opportunely made because the basic requirements for its successful implementation could not be fully fulfilled in practice, the…

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

    Czech Academy of Sciences Publication Activity Database

    Eisner, J.; Väth, Martin

    2016-01-01

    Roč. 135, April (2016), s. 158-193 ISSN 0362-546X Institutional support: RVO:67985840 Keywords : reaction-diffusion system * turing instability * global bifurcation Subject RIV: BA - General Mathematics Impact factor: 1.192, year: 2016 http://www.sciencedirect.com/science/article/pii/S0362546X16000146

  4. Nano-scale gene delivery systems; current technology, obstacles, and future directions.

    Science.gov (United States)

    Garcia-Guerra, Antonio; Dunwell, Thomas L; Trigueros, Sonia

    2018-01-07

    Within the different applications of nanomedicine currently being developed, nano-gene delivery is appearing as an exciting new technique with the possibility to overcome recognised hurdles and fulfill several biological and medical needs. The central component of all delivery systems is the requirement for the delivery of genetic material into cells, and for them to eventually reside in the nucleus where their desired function will be exposed. However, genetic material does not passively enter cells; thus, a delivery system is necessary. The emerging field of nano-gene delivery exploits the use of new materials and the properties that arise at the nanometre-scale to produce delivery vectors that can effectively deliver genetic material into a variety of different types of cells. The novel physicochemical properties of the new delivery vectors can be used to address the current challenges existing in nucleic acid delivery in vitro and in vivo. While there is a growing interest in nanostructure-based gene delivery, the field is still in its infancy, and there is yet much to discover about nanostructures and their physicochemical properties in a biological context. We carry out an organized and focused search of bibliographic databases. Our results suggest that despite new breakthroughs in nanostructure synthesis and advanced characterization techniques, we still face many barriers in producing highly efficient and non-toxic delivery systems. In this review, we overview the types of systems currently used for clinical and biomedical research applications along with their advantages and disadvantages, as well as discussing barriers that arise from nano-scale interactions with biological material. In conclusion, we hope that by bringing the far reaching multidisciplinary nature of nano-gene delivery to light, new targeted nanotechnology-bases strategies are developed to overcome the major challenges covered in this review. Copyright© Bentham Science Publishers; For

  5. Cooperation between In-Hospital Psychological Support and Pastoral Care Providers: Obstacles and Opportunities for a Modern Approach.

    Science.gov (United States)

    Proserpio, Tullio; Ferrari, Andrea; Veneroni, Laura; Arice, Carmine; Massimino, Maura; Clerici, Carlo Alfredo

    2017-09-01

    The meaning that patients with cancer attribute to life influences their expectations and their attitudes to the disease and its treatment. Over the centuries, religion has commonly been the answer encoded by the social setting when it came to matters of life and death. The present article analyzes the historical grounds for forms of cooperation between the scientific disciplines that focus on mental health and the approach of religion, centered on the Italian situation. Such cooperation was hard to imagine in the past, but the situation has changed considerably and cooperation is not only possible but extremely desirable. Acknowledgment of their spiritual needs helps patients to battle with their disease. The care of patients should include catering for their spiritual needs by ensuring the constant presence of a chaplain on hospital wards.

  6. The academic story: introducing the clinical nurse leader role in a multifacility health care system.

    Science.gov (United States)

    Moore, Penny

    2013-01-01

    Introducing the clinical nurse leader (CNL) role in a multifacility health care system is an exciting but obstacle-filled journey. This story includes facilitating factors, opportunities, and successes plus suggestions for other academic-practice partners considering implementing the CNL role. A sample course sequence with course descriptions is provided. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. The teaching of French in the French educational system: Obstacle or way to promote the plurilingualism of pupils?

    Directory of Open Access Journals (Sweden)

    Michael Rigolot

    2011-01-01

    Full Text Available This paper proposes an in-depth on the legal and educational linguistic policy of  the state that affect the everyday practice school French students. The allied French academic culture to the  school culture are articulated to serve the construction of republican citizenship. This ideological construction, political and cultural affects students entering the use of  French particularities (phonetic, semiotic or symbolic... of its cultural, social status or family origin. From a historical and legislative perspective the authors address the orientation of the teaching of French in the educational system as an obstacle to the integration of groups of  students who do not fit the narrow linguistic-political patterns that the system imposes. And finally, from an applied perspective, explores the factors that can lead to the breakdown of  monolingual system, moreover, is articulated as a cultural system of segregation and exclusion of class.Este artículo propone una reflexión en profundidad sobre las consecuencias jurídicas y pedagógicas de la política lingüística del estado que afectan en la práctica cotidiana escolar al alumnado francés. La cultura académica francesa aliada con la cultura escolar se articulan al servicio de la construcción de la ciudadanía republicana. Esta construcción ideológica, política y cultural afecta a los estudiantes que incorporan al uso de la lengua francesa particularidades propias (fonéticas, semióticas, simbólicas ... de su entorno cultural, social o de su origen familiar. Desde una perspectiva histórica y legislativa los autores abordan la orientación de la enseñanza de la lengua francesa en el sistema educativo como un obstáculo para la integración de los grupos de alumnado que no se ajustan a los estrechos patrones linguístico-políticos que el sistema impone. Y por último, desde una perspectiva aplicada, exploran los factores que pueden desembocar en la ruptura del

  8. Electromagnetic obstacle detection in close distance

    Science.gov (United States)

    Kurzela, Michał; Burd, Aleksander

    2016-09-01

    The main topic is the electronic system, designed and built to help car drivers during parking. It uses electromagnetism phenomena for making an estimation of arrangement of obstacles. The device works with close distance (about 5-15cm), depending on the material from which the obstacle is made.

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

    Directory of Open Access Journals (Sweden)

    Prabhjot Singh

    2014-01-01

    Full Text Available Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions related to ageing. This paper is based on a qualitative study undertaken in the Australian state of Queensland and explores issues of access to and use of formal services in dementia care from the perspective of the informal family carers. It identifies three critical points at which changes in policy and practice in the formal care system could improve the capability of informal carers to continue to care for their family member with dementia: when symptoms first become apparent and a diagnosis is sought; when the condition of the person with dementia changes resulting in a change to their support needs; and when the burden of informal care being experienced by the carer is so great that some form of transition appears to be immanent in the care arrangement.

  10. [Corruption and health care system].

    Science.gov (United States)

    Marasović Šušnjara, Ivana

    2014-06-01

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

  11. Respiratory care management information systems.

    Science.gov (United States)

    Ford, Richard M

    2004-04-01

    Hospital-wide computerized information systems evolved from the need to capture patient information and perform billing and other financial functions. These systems, however, have fallen short of meeting the needs of respiratory care departments regarding work load assessment, productivity management, and the level of outcome reporting required to support programs such as patient-driven protocols. The respiratory care management information systems (RCMIS) of today offer many advantages over paper-based systems and hospital-wide computer systems. RCMIS are designed to facilitate functions specific to respiratory care, including assessing work demand, assigning and tracking resources, charting, billing, and reporting results. RCMIS incorporate mobile, point-of-care charting and are highly configurable to meet the specific needs of individual respiratory care departments. Important and substantial benefits can be realized with an RCMIS and mobile, wireless charting devices. The initial and ongoing costs of an RCMIS are justified by increased charge capture and reduced costs, by way of improved productivity and efficiency. It is not unusual to recover the total cost of an RCMIS within the first year of its operation. In addition, such systems can facilitate and monitor patient-care protocols and help to efficiently manage the vast amounts of information encountered during the practitioner's workday. Respiratory care departments that invest in RCMIS have an advantage in the provision of quality care and in reducing expenses. A centralized respiratory therapy department with an RCMIS is the most efficient and cost-effective way to monitor work demand and manage the hospital-wide allocation of respiratory care services.

  12. Exploring the Obstacles to Implementing Economic Mechanisms to Stimulate Antibiotic Research and Development: A Multi-Actor and System-Level Analysis.

    Science.gov (United States)

    Baraldi, Enrico; Ciabuschi, Francesco; Leach, Ross; Morel, Chantal M; Waluszewski, Alexandra

    2016-05-01

    This Article examines the potential stakeholder-related obstacles hindering the implementation of mechanisms to re-ignite the development of novel antibiotics. Proposed economic models and incentives to drive such development include: Public Funding of Research and Development ("R&D"), Tax Incentives, Milestone Prizes, End Payments, Intellectual Property ("IP") and Exclusivity Extensions, Pricing and Reimbursement Incentives, Product Development Partnerships ("PDPs"), and the Options Market for Antibiotics model. Drawing on personal experience and understanding of the antibiotic field, as well as stakeholder consultation and numerous expert meetings within the DRIVE-AB project and Uppsala Health Summit 2015, the Authors identify obstacles attributable to the following actors: Universities and Research Institutes, Small and Medium-sized Enterprises ("SMEs"), Large Pharmaceutical Companies, Marketing Approval Regulators, Payors, Healthcare Providers, National Healthcare Authorities, Patients, and Supranational Institutions. The analysis also proposes a characterization and ranking of the difficulty associated with implementing the reviewed mechanisms. Public Funding of R&D, Pricing and Reimbursement Incentives, and PDPs are mechanisms expected to meet highly systemic barriers (i.e., obstacles across the entire antibiotic value chain), imposing greater implementation challenges in that they require convincing and involving several motivationally diverse actors in order to have much effect.

  13. System for measuring the coordinates of tire surfaces in transient conditions when rolling over obstacles: description of the system and performance analysis.

    Science.gov (United States)

    Castellini, Paolo; Di Giuseppe, Andrea

    2008-06-01

    This paper describes the development of a system for measuring surface coordinates (commonly known as "shape measurements") which is able to give the temporal evolution of the position of the tire sidewall in transient conditions (such as during braking, when there are potholes or when the road surface is uneven) which may or may not be reproducible. The system is based on the well-known technique of projecting and observing structured light using a digital camera with an optical axis which is slanted with respect to the axis of the projector. The transient nature of the phenomenon has led to the development of specific innovative solutions as regards image processing algorithms. This paper briefly describes the components which make up the measuring system and presents the results of the measurements carried out on the drum bench. It then analyses the performance of the measuring system and the sources of uncertainty which led to the development of the system for a specific dynamic application: impact with an obstacle (cleat test). The measuring system guaranteed a measurement uncertainty of 0.28 mm along the Z axis (the axial direction of the tire) with a measurement range of 250(X) x 80(Y) x 25(Z) mm(3), with the tire rolling at a speed of up to 30 km/h.

  14. Czechoslovakia's changing health care system.

    Science.gov (United States)

    Raffel, M W; Raffel, N K

    1992-01-01

    Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.

  15. The Chinese Health Care System

    DEFF Research Database (Denmark)

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

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

  16. Trauma care system in Iran

    Directory of Open Access Journals (Sweden)

    Zargar Moussa

    2011-06-01

    Full Text Available 【Abstract】Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to de- scribe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through ex- pert panels and semi-structured interviews with trauma spe- cialists and policy makers. Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of pub- lic education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training stan- dards of the front line medical team and continuing educa- tion and evaluation are yet to be addressed. Trauma regis- try has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources, it is not yet established in our system of trauma care. Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system. Key words: Emergency medical services; Trauma centers; Wounds and injuries

  17. Managed care: employers' influence on the health care system.

    Science.gov (United States)

    Corder, K T; Phoon, J; Barter, M

    1996-01-01

    Health care reform is a complex issue involving many key sectors including providers, consumers, insurers, employers, and the government. System changes must involve all sectors for reform to be effective. Each sector has a responsibility to understand not only its own role in the health care system, but the roles of others as well. The role of business employers is often not apparent to health care providers, especially nurses. Understanding the influence employers have on the health care system is vital if providers want to be proactive change agents ensuring quality care.

  18. Private sector in public health care systems

    OpenAIRE

    Matějusová, Lenka

    2008-01-01

    This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

  19. Obstacle mean-field game problem

    KAUST Repository

    Gomes, Diogo A.; Patrizi, Stefania

    2015-01-01

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

  20. Operation management system evaluation in the central Finland health care district - end users' view of system implementation.

    Science.gov (United States)

    Lemmetty, Kaisa; Häyrinen, Eija

    2005-01-01

    In this paper we evaluate the implementation of the operation management system in the Central Finland Health Care District. The implementation of the operation management system changed the practice of operation management for the surgical clinic and concerned 500 personnel in total. A survey was carried out to investigate the end users' views on the system's usefulness, usability and the training and user support provided. The users' possibilities to accomplish their tasks and the kind of obstacles they face in operation management were explored. The assessment revealed that more end support is needed after the system implementation, even though a generally positive attitude towards the system was manifested among the staff.

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

    Directory of Open Access Journals (Sweden)

    Widodo Budiharto

    2011-03-01

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

  2. Statistics of dislocation pinning at localized obstacles

    Energy Technology Data Exchange (ETDEWEB)

    Dutta, A. [S. N. Bose National Centre for Basic Sciences, Salt Lake, Kolkata 700098 (India); Bhattacharya, M., E-mail: mishreyee@vecc.gov.in; Barat, P. [Variable Energy Cyclotron Centre, 1/AF Bidhannagar, Kolkata 700064 (India)

    2014-10-14

    Pinning of dislocations at nanosized obstacles like precipitates, voids, and bubbles is a crucial mechanism in the context of phenomena like hardening and creep. The interaction between such an obstacle and a dislocation is often studied at fundamental level by means of analytical tools, atomistic simulations, and finite element methods. Nevertheless, the information extracted from such studies cannot be utilized to its maximum extent on account of insufficient information about the underlying statistics of this process comprising a large number of dislocations and obstacles in a system. Here, we propose a new statistical approach, where the statistics of pinning of dislocations by idealized spherical obstacles is explored by taking into account the generalized size-distribution of the obstacles along with the dislocation density within a three-dimensional framework. Starting with a minimal set of material parameters, the framework employs the method of geometrical statistics with a few simple assumptions compatible with the real physical scenario. The application of this approach, in combination with the knowledge of fundamental dislocation-obstacle interactions, has successfully been demonstrated for dislocation pinning at nanovoids in neutron irradiated type 316-stainless steel in regard to the non-conservative motion of dislocations. An interesting phenomenon of transition from rare pinning to multiple pinning regimes with increasing irradiation temperature is revealed.

  3. Current trauma care system and trauma care training in China

    Directory of Open Access Journals (Sweden)

    Lian-Yang Zhang

    2018-04-01

    Full Text Available Trauma is a life-threatening “modern disease”. The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS. Currently, the pre-hospital emergency medical services (EMS has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training. Keywords: Trauma care system, Trauma care training, China

  4. The comparison of spatial accessibility measures between non-obstacle and obstacle oriented based on gravity model

    Science.gov (United States)

    Han, Zhi-Gang; Cui, Cai-Hui

    2009-10-01

    Spatial accessibility denotes the ease with which activities may be reached from a given location using a particular transportation system. There are a number of accessibility measures methods and models, such as time of access to city centre, mean travel costs and opportunity accessibility. But these methods or models ignore the existence of obstacles. In fact, there are many kinds of obstacles in the world, such as rivers, railways, etc. The paper reviews the progress of accessibility measures, and introduces the obstacle to the accessibility measures. Meanwhile, through the analysis of A* algorithm, the advantage of A* algorithm that could avoid obstacles is put forward. Based on the above mentioned, the obstacle oriented accessibility measures based on simple gravity model is discussed in details. Finally, a case study is fulfilled by comparison between the obstacle oriented and non-obstacle accessibility measures.

  5. Reciprocally-Rotating Velocity Obstacles

    KAUST Repository

    Giese, Andrew

    2014-05-01

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

  6. Obstacles to the use of natural gas in electric markets

    International Nuclear Information System (INIS)

    Lynch, M.M.

    1992-01-01

    A brief overview of the New England Electric System (NEES) and its current and planned natural gas fired generation is presented. Some statistics are given that indicate that electric generation is the biggest growth market for natural gas, underscoring the importance of overcoming the obstacles to the use of gas in electric generation markets. What is seen as the major obstacles to gas use in the electric power industry and some ways to overcome these obstacles are reviewed

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

    Czech Academy of Sciences Publication Activity Database

    Eisner, Jan; Kučera, Milan; Väth, Martin

    2016-01-01

    Roč. 61, č. 1 (2016), s. 1-25 ISSN 0862-7940 R&D Projects: GA ČR GA13-12580S Institutional support: RVO:67985904 ; RVO:67985840 Keywords : reaction-diffusion system * unlateral condition * variational inequality Subject RIV: EG - Zoology; BA - General Mathematics (MU-W) Impact factor: 0.618, year: 2016

  8. Reforming the health care system: implications for health care marketers.

    Science.gov (United States)

    Petrochuk, M A; Javalgi, R G

    1996-01-01

    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  9. Obstacles in the Utilisation of Maternal Health Care Services in Murarai-II C.D. Block, Birbhum District, West Bengal, India

    OpenAIRE

    Alokananda Ghosh; Dr.Biswaranjan Mistri

    2017-01-01

    Improving maternal health was one of the eight Millennium Development Goals (MDGs) and now it is one of the targets of 17 point Sustainable Development Goals (SDGs). The utilisation of Maternal Health Care Services (MHCSs) is a complex phenomenon and it is influenced by several factors, like-health care seeking behaviour of the cohorts belonging to different socio-economic and cultural background, distance of the facility centres, type and conditions of the roads including undulating surface,...

  10. Overcoming Obstacles to Drug Repositioning in Japan

    Directory of Open Access Journals (Sweden)

    Yuhei Nishimura

    2017-10-01

    Full Text Available Drug repositioning (DR is the process of identifying new indications for existing drugs. DR usually focuses on drugs that have cleared phase-I safety trials but has yet to show efficacy for the intended indication. Therefore, DR can probably skip the preclinical and phase-I study, which can reduce the cost throughout drug development. However, the expensive phase-II/III trials are required to establish efficacy. The obstacles to DR include identification of new indications with a high success rate in clinical studies, obtaining funding for clinical studies, patent protection, and approval systems. To tackle these obstacles, various approaches have been applied to DR worldwide. In this perspective, we provide representative examples of DR and discuss the ongoing efforts to overcome obstacles to DR in Japan.

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

    Science.gov (United States)

    Dussault, Gilles

    2008-05-01

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

  12. Design of railway obstacle detection prototype

    CSIR Research Space (South Africa)

    Xungu, Sipho A

    2017-11-01

    Full Text Available Survey Inspection Device (SID) test prototype platform to serve as an early warning system for locomotives and was to travel 2km ahead of a locomotive in order to inspect the railway for possible obstacles such as human beings, livestock and collisions...

  13. [Views of health system administrators, professionals, and users concerning the electronic health record and facilitators and obstacles to its implementation].

    Science.gov (United States)

    Costa, Jose Felipe Riani; Portela, Margareth Crisóstomo

    2018-02-05

    The design and deployment of complex technologies like the electronic health record (EHR) involve technical, personal, social, and organizational issues. The Brazilian public and private scenario includes different local and regional initiatives for implementation of the electronic health record. The Brazilian Ministry of Health also has a proposal to develop a national EHR. The current study aimed to provide a comprehensive view of perceptions by health system administrators, professionals, and users concerning their experiences with the electronic health record and their opinions of the possibility of developing a national EHR. This qualitative study involved 28 semi-structured interviews. The results revealed both the diversity of factors that can influence the implementation of an electronic health record and the existence of convergences and aspects that tend to be valued differently according to the different points of view. Key aspects include discussions on the electronic health record's attributes and it impact on healthcare, especially in the case of local electronic health records, concerns over costs and confidentiality and privacy pertaining to electronic health records in general, and the possible implications of centralized versus decentralized data storage in the case of a national EHR. The interviews clearly showed the need to establish more effective communication among the various stakeholders, and that the different perspectives should be considered when drafting and deploying an EHR at the local, regional, and national levels.

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

    Directory of Open Access Journals (Sweden)

    Manuel Rodríguez Palma

    2010-09-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

  16. Multipurpose Health Care Telemedicine System

    National Research Council Canada - National Science Library

    Kyriacou, E

    2001-01-01

    .... Ambulances, Rural Health Centers (RHC) or other remote health location, Ships navigating in wide seas and Airplanes in flight are common examples of possible emergency sites, while critical care telemetry, and telemedicine home follow-ups...

  17. Regional Multiteam Systems in Cancer Care Delivery

    Science.gov (United States)

    Monson, John R.T.; Rizvi, Irfan; Savastano, Ann; Green, James S.A.; Sevdalis, Nick

    2016-01-01

    Teamwork is essential for addressing many of the challenges that arise in the coordination and delivery of cancer care, especially for the problems that are presented by patients who cross geographic boundaries and enter and exit multiple health care systems at various times during their cancer care journeys. The problem of coordinating the care of patients with cancer is further complicated by the growing number of treatment options and modalities, incompatibilities among the vast variety of technology platforms that have recently been adopted by the health care industry, and competing and misaligned incentives for providers and systems. Here we examine the issue of regional care coordination in cancer through the prism of a real patient journey. This article will synthesize and elaborate on existing knowledge about coordination approaches for complex systems, in particular, in general and cancer care multidisciplinary teams; define elements of coordination derived from organizational psychology and human factors research that are applicable to team-based cancer care delivery; and suggest approaches for improving multidisciplinary team coordination in regional cancer care delivery and avenues for future research. The phenomenon of the mobile, multisystem patient represents a growing challenge in cancer care. Paradoxically, development of high-quality, high-volume centers of excellence and the ease of virtual communication and data sharing by using electronic medical records have introduced significant barriers to effective team-based cancer care. These challenges urgently require solutions. PMID:27650833

  18. Psychiatric care in the German prison system.

    Science.gov (United States)

    Lehmann, Marc

    2012-01-01

    The purpose of this paper is to describe the nature of medical care within the German penal system. German prison services provide health care for all inmates, including psychiatric care. The reached level of equivalence of care and ethical problems and resource limitations are discussed and the way of legislation in this field since 2006 reform on federal law is described. The article summarizes basic data on German prison health care for mentally ill inmates. The legislation process and factors of influence are pointed out. A description of how psychiatric care is organized in German prisons follows. It focuses on the actual legal situation including European standards of prison health care and prevention of torture, psychiatric care in German prisons themselves, self harm and addiction. Associated problems such as blood born diseases and tuberculosis are included. The interactions between prison staff and health care personal and ethic aspects are discussed. The legislation process is still going on and there is still a chance to improve psychiatric care. Mental health problems are the major challenge for prison health care. Factors such as special problems of migrants, shortage of professionals and pure statistic data are considered. The paper provides a general overview on psychiatric services in prison and names weak points and strengths of the system.

  19. The Child Health Care System in Italy.

    Science.gov (United States)

    Corsello, Giovanni; Ferrara, Pietro; Chiamenti, Gianpietro; Nigri, Luigi; Campanozzi, Angelo; Pettoello-Mantovani, Massimo

    2016-10-01

    Pediatric care in Italy has been based during the last 40 years on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health and well-being of their children. The pediatric health care system in Italy is part of the national health system. It is made up of 3 main levels of intervention: first access/primary care, secondary care/hospital care, and tertiary care based on specialty hospital care. This overview will also include a brief report on neonatal care, pediatric preventive health care, health service accreditation programs, and postgraduate training in pediatrics. The quality of the Italian child health care system is now considered to be in serious danger because of the restriction of investments in public health caused both by the 2008 global and national economic crisis and by a reduction of the pediatric workforce as a result of progressively insufficient replacement of specialists in pediatrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Obstacle problems in mathematical physics

    CERN Document Server

    Rodrigues, J-F

    1987-01-01

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

  1. Reciprocally-Rotating Velocity Obstacles

    KAUST Repository

    Giese, Andrew; Latypov, Daniel; Amato, Nancy M.

    2014-01-01

    obstacles. One state-of-the-art local collision avoidance technique is Optimal Reciprocal Collision Avoidance (ORCA). Despite being fast and efficient for circular-shaped agents, ORCA may deadlock when polygonal shapes are used. To address this shortcoming

  2. Cognitive systems engineering in health care

    CERN Document Server

    Bisantz, Ann M; Fairbanks, Rollin J

    2014-01-01

    Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    This paper describes an obstacle detection system for a high-speed and agile unmanned surface vehicle (USV), running at speeds up to 30 m/s. The aim is a real-time and high performance obstacle detection system using both radar and vision technologies to detect obstacles within a range of 175 m. ...... performance using sensor fusion of radar and computer vision....

  4. Implementing the learning health care system.

    NARCIS (Netherlands)

    Verheij, R.; Barten, D.J.; Hek, K.; Nielen, M.; Prins, M.; Zwaanswijk, M.; Bakker, D. de

    2014-01-01

    Background: As computerisation of primary care facilities is rapidly increasing, a wealth of data is created in routinely recorded electronic health records (EHRs). This data can be used to create a true learning health care system, in which routinely available data are processed and analysed in

  5. Quality systems in Dutch health care institutions.

    NARCIS (Netherlands)

    Casparie, A.F.; Sluijs, E.M.; Wagner, C.; Bakker, D.H. de

    1997-01-01

    The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived

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

    Directory of Open Access Journals (Sweden)

    Zheping Yan

    2013-01-01

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

  7. Health Care Information System (HCIS) Data File

    Data.gov (United States)

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

  8. Critical care nursing: Embedded complex systems.

    Science.gov (United States)

    Trinier, Ruth; Liske, Lori; Nenadovic, Vera

    2016-01-01

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

  9. Prefrontal cortex activation during obstacle negotiation: What's the effect size and timing?

    Science.gov (United States)

    Maidan, Inbal; Shustak, Shiran; Sharon, Topaz; Bernad-Elazari, Hagar; Geffen, Nimrod; Giladi, Nir; Hausdorff, Jeffrey M; Mirelman, Anat

    2018-04-01

    Obstacle negotiation is a daily activity that requires the integration of sensorimotor and cognitive information. Recent studies provide evidence for the important role of prefrontal cortex during obstacle negotiation. We aimed to explore the effects of obstacle height and available response time on prefrontal activation. Twenty healthy young adults (age: 30.1 ± 1.0 years; 50% women) walked in an obstacle course while negotiating anticipated and unanticipated obstacles at heights of 50 mm and 100 mm. Prefrontal activation was measured using a functional near-infrared spectroscopy system. Kinect cameras measured the obstacle negotiation strategy. Prefrontal activation was defined based on mean level of HbO 2 before, during and after obstacle negotiation and the HbO 2 slope from gait initiation and throughout the task. Changes between types of obstacles were assessed using linear-mix models and partial correlation analyses evaluated the relationship between prefrontal activation and the distance between the feet as the subjects traversed the obstacles. Different obstacle heights showed similar changes in prefrontal activation measures (p > 0.210). However, during unanticipated obstacles, the slope of the HbO 2 response was steeper (p = 0.048), as compared to anticipated obstacles. These changes in prefrontal activation during negotiation of unanticipated obstacles were correlated with greater distance of the leading foot after the obstacles (r = 0.831, p = 0.041). These findings are the first to show that the pattern of prefrontal activation depends on the nature of the obstacle. More specifically, during unanticipated obstacles the recruitment of the prefrontal cortex is faster and greater than during negotiating anticipated obstacles. These results provide evidence of the important role of the prefrontal cortex and the ability of healthy young adults to tailor the activation pattern to different types of obstacles. Copyright © 2018

  10. Nonholonomic feedback control among moving obstacles

    Science.gov (United States)

    Armstrong, Stephen Gregory

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

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

    Science.gov (United States)

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

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

  12. The critical care cascade: a systems approach.

    Science.gov (United States)

    Ghosh, Rishi; Pepe, Paul

    2009-08-01

    To emphasize the evolving body of evidence that supports the need for a more seamless and interconnected continuum of patient care for a growing compendium of critical care conditions, starting in the prehospital and emergency department (ED) phases of management and continuing through ICU and rehabilitation services. The care of critically ill and injured patients has become increasingly complex. It now has been demonstrated that, for a number of such critical care conditions, optimal management not only relies heavily on the talents of highly coordinated, multidisciplinary teams, but it also may require shared responsibilities across a continuum of longitudinal care involving numerous specialties and departments. This continuum usually needs to begin in the prehospital and ED settings with management extending through specialized in-hospital diagnostic and interventional suites to traditional ICU and rehabilitation programs. In recent years, examples of these conditions have included the development of systems of care for trauma, cardiac arrest, myocardial infarction, stroke, sepsis syndromes, toxicology and other critical illnesses. Although the widespread implementation of such multidisciplinary, multispecialty critical care cascades of care has been achieved most commonly in trauma care, current healthcare delivery systems generally tend to employ compartmentalized organization for the majority of other critical care patients. Accordingly, optimal systematic care often breaks down in the management of these complex patients due to barriers such as lack of interoperable communication between teams, disjointed transfers between services, unnecessary time-consuming, re-evaluations and transitional pauses in time-dependent circumstances, deficiencies in cross-disciplinary education and quality assurance loops, and significant variability in patient care practices. Such barriers can lead to adverse outcomes in this fragile patient population. This article discusses

  13. Surface obstacles in pulsatile flow

    Science.gov (United States)

    Carr, Ian A.; Plesniak, Michael W.

    2017-11-01

    Flows past obstacles mounted on flat surfaces have been widely studied due to their ubiquity in nature and engineering. For nearly all of these studies, the freestream flow over the obstacle was steady, i.e., constant velocity, unidirectional flow. Unsteady, pulsatile flows occur frequently in biology, geophysics, biomedical engineering, etc. Our study is aimed at extending the comprehensive knowledge base that exists for steady flows to considerably more complex pulsatile flows. Characterizing the vortex and wake dynamics of flows around surface obstacles embedded in pulsatile flows can provide insights into the underlying physics in all wake and junction flows. In this study, we experimentally investigate the wake of two canonical obstacles: a cube and a circular cylinder with an aspect ratio of unity. Our previous studies of a surface-mounted hemisphere in pulsatile flow are used as a baseline for these two new, more complex geometries. Phase-averaged PIV and hot-wire anemometry are used to characterize the dynamics of coherent structures in the wake and at the windward junction of the obstacles. Complex physics occur during the deceleration phase of the pulsatile inflow. We propose a framework for understanding these physics based on self-induced vortex propagation, similar to the phenomena exhibited by vortex rings.

  14. Obstacles to implementation; Huerden auf dem Weg in die Praxis

    Energy Technology Data Exchange (ETDEWEB)

    Klempert, Oliver

    2010-11-23

    Photovoltaic systems have always promised autonomy to customers. The new German Renewables Act (Erneuerbare-Energien-Gesetz) provides reimbursement for self-consumption of power generated on site. However, there are still many obstacles to overcome. (orig.)

  15. The chinese health care system

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  16. Seeking care as a system.

    Science.gov (United States)

    Berwick, Donald M; Luo, Eva

    2010-01-01

    rise, Kim on top. If it worked, they would cheer. "A miracle," they would shout, in awe that the millions of tiny lines of effort, the millions of tiny lines of cause and effect, from job shops in Ohio and laboratories in Pasadena, criss-crossing through time and space, could converge so magnificently in a massive, gleaming rocket launched exactly right. Perfect. If it failed, they would cry. So would the rocket's makers, who had done their very best. No one wanted it to end this way. Poor Kim. What was the trouble? What went wrong? Why? The lines of cause will converge around Kim in the morning as she wheels toward the operating room. Thousands upon thousands of elements weaving a basket to hold her safely, all hope. No crowd holds its breath tonight; but wouldn't they if they knew? From: Berwick DM. Controlling variation in health care: a consultation from Walter Shewhart. Medical Care 1991; 29: 1212-1225.

  17. Mathematical Models of Smart Obstacles

    Science.gov (United States)

    2006-10-01

    Matematica “G. Castelnuovo” Università di Roma “La Sapienza”, Piazzale Aldo Moro 2 00185 Roma Italy Ph. N. +39-06-49913282, FAX N. +39-06...Dipartimento di Matematica G. Castelnuovo Università di Roma La Sapienza, Piazzale Aldo Moro 2 00185 Roma Italy 8. PERFORMING ORGANIZATION REPORT NUMBER 9... Matematica G. Castelnuovo Università di Roma “La Sapienza” 00185 Roma, Italy 2 Smart (or active) obstacles are obstacles that when illuminated by an

  18. Removing Obstacles to Easy Reading.

    Science.gov (United States)

    Fiske, David

    1994-01-01

    Argues for changes in the way technical communicators design new documentation systems to accommodate readers with impaired vision, mental abilities, and motor control. Recommends use of larger type, careful choice of ink and paper color, use of matte-finish paper, thoughtful page and screen design, and use of contextual aids, priming strategies,…

  19. NGV: an obstacle course

    International Nuclear Information System (INIS)

    Anon.

    1996-01-01

    A colloquium was organized in Paris in 1994 for the promotion of NGV (natural gas for vehicles) and its use in advanced propulsion systems. The French Association of Natural Gas for Vehicles (AFGNV) was created simultaneously and joined together Gaz de France, the car manufacturers (PSA, Peugeot Citroen, Renault, RVI), the IFP (French Petroleum Institute), the French Ministry of Industry and other industrialists and local organizations (public transportation companies). The initial economic objectives were considerably reduced due to the lack of NGV stations and to some technical problems encountered with the design and the adaptation of gas tanks. Also the norms and regulations concerning the NGV pollutants emission are still missing. (J.S.)

  20. Echoic Sensory Substitution Information in a Single Obstacle Circumvention Task.

    Science.gov (United States)

    Kolarik, Andrew J; Scarfe, Amy C; Moore, Brian C J; Pardhan, Shahina

    2016-01-01

    Accurate motor control is required when walking around obstacles in order to avoid collisions. When vision is unavailable, sensory substitution can be used to improve locomotion through the environment. Tactile sensory substitution devices (SSDs) are electronic travel aids, some of which indicate the distance of an obstacle using the rate of vibration of a transducer on the skin. We investigated how accurately such an SSD guided navigation in an obstacle circumvention task. Using an SSD, 12 blindfolded participants navigated around a single flat 0.6 x 2 m obstacle. A 3-dimensional Vicon motion capture system was used to quantify various kinematic indices of human movement. Navigation performance under full vision was used as a baseline for comparison. The obstacle position was varied from trial to trial relative to the participant, being placed at two distances 25 cm to the left, right or directly ahead. Under SSD guidance, participants navigated without collision in 93% of trials. No collisions occurred under visual guidance. Buffer space (clearance between the obstacle and shoulder) was larger by a factor of 2.1 with SSD guidance than with visual guidance, movement times were longer by a factor of 9.4, and numbers of velocity corrections were larger by a factor of 5 (all p<0.05). Participants passed the obstacle on the side affording the most space in the majority of trials for both SSD and visual guidance conditions. The results are consistent with the idea that SSD information can be used to generate a protective envelope during locomotion in order to avoid collisions when navigating around obstacles, and to pass on the side of the obstacle affording the most space in the majority of trials.

  1. Echoic Sensory Substitution Information in a Single Obstacle Circumvention Task.

    Directory of Open Access Journals (Sweden)

    Andrew J Kolarik

    Full Text Available Accurate motor control is required when walking around obstacles in order to avoid collisions. When vision is unavailable, sensory substitution can be used to improve locomotion through the environment. Tactile sensory substitution devices (SSDs are electronic travel aids, some of which indicate the distance of an obstacle using the rate of vibration of a transducer on the skin. We investigated how accurately such an SSD guided navigation in an obstacle circumvention task. Using an SSD, 12 blindfolded participants navigated around a single flat 0.6 x 2 m obstacle. A 3-dimensional Vicon motion capture system was used to quantify various kinematic indices of human movement. Navigation performance under full vision was used as a baseline for comparison. The obstacle position was varied from trial to trial relative to the participant, being placed at two distances 25 cm to the left, right or directly ahead. Under SSD guidance, participants navigated without collision in 93% of trials. No collisions occurred under visual guidance. Buffer space (clearance between the obstacle and shoulder was larger by a factor of 2.1 with SSD guidance than with visual guidance, movement times were longer by a factor of 9.4, and numbers of velocity corrections were larger by a factor of 5 (all p<0.05. Participants passed the obstacle on the side affording the most space in the majority of trials for both SSD and visual guidance conditions. The results are consistent with the idea that SSD information can be used to generate a protective envelope during locomotion in order to avoid collisions when navigating around obstacles, and to pass on the side of the obstacle affording the most space in the majority of trials.

  2. A Hybrid Architecture for Vision-Based Obstacle Avoidance

    Directory of Open Access Journals (Sweden)

    Mehmet Serdar Güzel

    2013-01-01

    Full Text Available This paper proposes a new obstacle avoidance method using a single monocular vision camera as the only sensor which is called as Hybrid Architecture. This architecture integrates a high performance appearance-based obstacle detection method into an optical flow-based navigation system. The hybrid architecture was designed and implemented to run both methods simultaneously and is able to combine the results of each method using a novel arbitration mechanism. The proposed strategy successfully fused two different vision-based obstacle avoidance methods using this arbitration mechanism in order to permit a safer obstacle avoidance system. Accordingly, to establish the adequacy of the design of the obstacle avoidance system, a series of experiments were conducted. The results demonstrate the characteristics of the proposed architecture, and the results prove that its performance is somewhat better than the conventional optical flow-based architecture. Especially, the robot employing Hybrid Architecture avoids lateral obstacles in a more smooth and robust manner than when using the conventional optical flow-based technique.

  3. Child Poverty and the Health Care System.

    Science.gov (United States)

    Racine, Andrew D

    2016-04-01

    The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights

  4. Activity monitoring systems in health care

    NARCIS (Netherlands)

    Kröse, B.; van Oosterhout, T.; van Kasteren, T.; Salah, A.A.; Gevers, T.

    2011-01-01

    This chapter focuses on activity monitoring in a home setting for health care purposes. First the most current sensing systems are described, which consist of wearable and ambient sensors. Then several approaches for the monitoring of simple actions are discussed, like falls or therapies. After

  5. Plant root and shoot dynamics during subsurface obstacle interaction

    Science.gov (United States)

    Conn, Nathaniel; Aguilar, Jeffrey; Benfey, Philip; Goldman, Daniel

    As roots grow, they must navigate complex underground environments to anchor and retrieve water and nutrients. From gravity sensing at the root tip to pressure sensing along the tip and elongation zone, the complex mechanosensory feedback system of the root allows it to bend towards greater depths and avoid obstacles of high impedance by asymmetrically suppressing cell elongation. Here we investigate the mechanical and physiological responses of roots to rigid obstacles. We grow Maize, Zea mays, plants in quasi-2D glass containers (22cm x 17cm x 1.4cm) filled with photoelastic gel and observe that, regardless of obstacle interaction, smaller roots branch off the primary root when the upward growing shoot (which contains the first leaf) reaches an average length of 40 mm, coinciding with when the first leaf emerges. However, prior to branching, contacts with obstacles result in reduced root growth rates. The growth rate of the root relative to the shoot is sensitive to the angle of the obstacle surface, whereby the relative root growth is greatest for horizontally oriented surfaces. We posit that root growth is prioritized when horizontal obstacles are encountered to ensure anchoring and access to nutrients during later stages of development. NSF Physics of Living Systems.

  6. Robust obstacle detection for unmanned surface vehicles

    Science.gov (United States)

    Qin, Yueming; Zhang, Xiuzhi

    2018-03-01

    Obstacle detection is of essential importance for Unmanned Surface Vehicles (USV). Although some obstacles (e.g., ships, islands) can be detected by Radar, there are many other obstacles (e.g., floating pieces of woods, swimmers) which are difficult to be detected via Radar because these obstacles have low radar cross section. Therefore, detecting obstacle from images taken onboard is an effective supplement. In this paper, a robust vision-based obstacle detection method for USVs is developed. The proposed method employs the monocular image sequence captured by the camera on the USVs and detects obstacles on the sea surface from the image sequence. The experiment results show that the proposed scheme is efficient to fulfill the obstacle detection task.

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

    Science.gov (United States)

    Zheng, Li; Yi, Ruan

    2009-11-01

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

  8. A mobile care system with alert mechanism.

    Science.gov (United States)

    Lee, Ren-Guey; Chen, Kuei-Chien; Hsiao, Chun-Chieh; Tseng, Chwan-Lu

    2007-09-01

    Hypertension and arrhythmia are chronic diseases, which can be effectively prevented and controlled only if the physiological parameters of the patient are constantly monitored, along with the full support of the health education and professional medical care. In this paper, a role-based intelligent mobile care system with alert mechanism in chronic care environment is proposed and implemented. The roles in our system include patients, physicians, nurses, and healthcare providers. Each of the roles represents a person that uses a mobile device such as a mobile phone to communicate with the server setup in the care center such that he or she can go around without restrictions. For commercial mobile phones with Bluetooth communication capability attached to chronic patients, we have developed physiological signal recognition algorithms that were implemented and built-in in the mobile phone without affecting its original communication functions. It is thus possible to integrate several front-end mobile care devices with Bluetooth communication capability to extract patients' various physiological parameters [such as blood pressure, pulse, saturation of haemoglobin (SpO2), and electrocardiogram (ECG)], to monitor multiple physiological signals without space limit, and to upload important or abnormal physiological information to healthcare center for storage and analysis or transmit the information to physicians and healthcare providers for further processing. Thus, the physiological signal extraction devices only have to deal with signal extraction and wireless transmission. Since they do not have to do signal processing, their form factor can be further reduced to reach the goal of microminiaturization and power saving. An alert management mechanism has been included in back-end healthcare center to initiate various strategies for automatic emergency alerts after receiving emergency messages or after automatically recognizing emergency messages. Within the time

  9. Capital investment strategies in health care systems.

    Science.gov (United States)

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

    2000-01-01

    Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.

  10. The medical care system of Hungary.

    Science.gov (United States)

    Raffel, N K; Raffel, M W

    1988-01-01

    Medical care in Hungary has made significant progress since World War II in spite of other social priorities which have limited financial support of the health system. A shortage of hard currency in a high technological era is now having a particularly severe adverse impact on further development. Decentralized administration and local finance have, however, provided some room for progress. Preventive efforts are hampered by a deeply entrenched life style which is not conducive to improving the population's health status.

  11. The Fresenius Medical Care home hemodialysis system.

    Science.gov (United States)

    Schlaeper, Christian; Diaz-Buxo, Jose A

    2004-01-01

    The Fresenius Medical Care home dialysis system consists of a newly designed machine, a central monitoring system, a state-of-the-art reverse osmosis module, ultrapure water, and all the services associated with a successful implementation. The 2008K@home hemodialysis machine has the flexibility to accommodate the changing needs of the home hemodialysis patient and is well suited to deliver short daily or prolonged nocturnal dialysis using a broad range of dialysate flows and concentrates. The intuitive design, large graphic illustrations, and step-by-step tutorial make this equipment very user friendly. Patient safety is assured by the use of hydraulic systems with a long history of reliability, smart alarm algorithms, and advanced electronic monitoring. To further patient comfort with their safety at home, the 2008K@home is enabled to communicate with the newly designed iCare remote monitoring system. The Aquaboss Smart reverse osmosis (RO) system is compact, quiet, highly efficient, and offers an improved hygienic design. The RO module reduces water consumption by monitoring the water flow of the dialysis system and adjusting water production accordingly. The Diasafe Plus filter provides ultrapure water, known for its long-term benefits. This comprehensive approach includes planning, installation, technical and clinical support, and customer service.

  12. Systems biology in critical-care nursing.

    Science.gov (United States)

    Schallom, Lynn; Thimmesch, Amanda R; Pierce, Janet D

    2011-01-01

    Systems biology applies advances in technology and new fields of study including genomics, transcriptomics, proteomics, and metabolomics to the development of new treatments and approaches of care for the critically ill and injured patient. An understanding of systems biology enhances a nurse's ability to implement evidence-based practice and to educate patients and families on novel testing and therapies. Systems biology is an integrated and holistic view of humans in relationship with the environment. Biomarkers are used to measure the presence and severity of disease and are rapidly expanding in systems biology endeavors. A systems biology approach using predictive, preventive, and participatory involvement is being utilized in a plethora of conditions of critical illness and injury including sepsis, cancer, pulmonary disease, and traumatic injuries.

  13. SMART Careplan System for Continuum of Care.

    Science.gov (United States)

    Kim, Young Ah; Jang, Seon Young; Ahn, Meejung; Kim, Kyung Duck; Kim, Sung Soo

    2015-01-01

    This paper describes the integrated Careplan system, designed to manage and utilize the existing Electronic Medical Record (EMR) system; the system also defines key items for interdisciplinary communication and continuity of patient care. We structured the Careplan system to provide effective interdisciplinary communication for healthcare services. The design of the Careplan system architecture proceeded in four steps-defining target datasets; construction of conceptual framework and architecture; screen layout and storyboard creation; screen user interface (UI) design and development, and pilot test and step-by-step deployment. This Careplan system architecture consists of two parts, a server-side and client-side area. On the server-side, it performs the roles of data retrieval and storage from target EMRs. Furthermore, it performs the role of sending push notifications to the client depending on the careplan series. Also, the Careplan system provides various convenient modules to easily enter an individual careplan. Currently, Severance Hospital operates the Careplan system and provides a stable service dealing with dynamic changes (e.g., domestic medical certification, the Joint Commission International guideline) of EMR. The Careplan system should go hand in hand with key items for strengthening interdisciplinary communication and information sharing within the EMR environment. A well-designed Careplan system can enhance user satisfaction and completed performance.

  14. Neuroepigenomics: Resources, Obstacles, and Opportunities.

    Science.gov (United States)

    Satterlee, John S; Beckel-Mitchener, Andrea; Little, Roger; Procaccini, Dena; Rutter, Joni L; Lossie, Amy C

    2015-01-01

    Long-lived post-mitotic cells, such as the majority of human neurons, must respond effectively to ongoing changes in neuronal stimulation or microenvironmental cues through transcriptional and epigenomic regulation of gene expression. The role of epigenomic regulation in neuronal function is of fundamental interest to the neuroscience community, as these types of studies have transformed our understanding of gene regulation in post-mitotic cells. This perspective article highlights many of the resources available to researchers interested in neuroepigenomic investigations and discusses some of the current obstacles and opportunities in neuroepigenomics.

  15. Neuroepigenomics: resources, obstacles, and opportunities

    Directory of Open Access Journals (Sweden)

    John S. Satterlee

    2015-01-01

    Full Text Available Long-lived postmitotic cells, such as most human neurons, must respond effectively to ongoing changes in neuronal stimulation or microenvironmental cues through transcriptional and epigenomic regulation of gene expression. The role of epigenomic regulation in neuronal function is of fundamental interest to the neuroscience community, as these types of studies have transformed our understanding of gene regulation in postmitotic cells. This perspective article highlights many of the resources available to researchers interested in neuroepigenomic investigations and discusses some of the current obstacles and opportunities in neuroepigenomics.

  16. Nuclear power: obstacles and solutions

    International Nuclear Information System (INIS)

    Hart, R.S.

    2002-01-01

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

  17. Nuclear power: obstacles and solutions

    International Nuclear Information System (INIS)

    Hart, R.S.

    2001-01-01

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

  18. Hospital System Readmissions: A Care Cycle Approach

    Directory of Open Access Journals (Sweden)

    Cody Mullen

    2012-01-01

    Full Text Available Hospital readmission rates can be used as an indicator of the quality of health care services and can highlight high-priority research areas to ensure better health. A readmission is defined as when a patient is discharged from an acute care hospital and is admitted back to an acute care hospital in a set amount of days, with 30 days being the current national standard. On average, 19.6% of Medicare patients are readmitted to the hospital within 30 days of discharge and 56.1% within a year (Jencks, Williams, & Coleman, 2009. The hypothesis of this study was that the discharge location, or where a patient went immediately after discharge, would not have a significant effect on readmissions. A data set with all admission records was obtained from a major health provider. These data contain all hospital patients’ demographic and diagnosis information. General, women’s, and children’s hospitals were looked at from a system perspective to study the discharge location of patients as well as the effects of patient demographics on discharge location. By using a z-significance test in Microsoft Excel and SAS 9.2, it was discovered that patients discharged to home have a significantly lower likelihood of readmission. Generally, patients who are discharged to an extended care or intermediate care facility or patients with home health carerelated services had a significantly higher likelihood of being readmitted. The findings may indicate a possible need for an institution-to-institution intervention as well as institution-to-patient intervention. Future work will develop potential interventions in partnership with hospital staff.

  19. VISION BASED OBSTACLE DETECTION IN UAV IMAGING

    Directory of Open Access Journals (Sweden)

    S. Badrloo

    2017-08-01

    Full Text Available Detecting and preventing incidence with obstacles is crucial in UAV navigation and control. Most of the common obstacle detection techniques are currently sensor-based. Small UAVs are not able to carry obstacle detection sensors such as radar; therefore, vision-based methods are considered, which can be divided into stereo-based and mono-based techniques. Mono-based methods are classified into two groups: Foreground-background separation, and brain-inspired methods. Brain-inspired methods are highly efficient in obstacle detection; hence, this research aims to detect obstacles using brain-inspired techniques, which try to enlarge the obstacle by approaching it. A recent research in this field, has concentrated on matching the SIFT points along with, SIFT size-ratio factor and area-ratio of convex hulls in two consecutive frames to detect obstacles. This method is not able to distinguish between near and far obstacles or the obstacles in complex environment, and is sensitive to wrong matched points. In order to solve the above mentioned problems, this research calculates the dist-ratio of matched points. Then, each and every point is investigated for Distinguishing between far and close obstacles. The results demonstrated the high efficiency of the proposed method in complex environments.

  20. CONCERT MANAGEMENT IN CROATIA: OBSTACLES AND CHALLENGES

    Directory of Open Access Journals (Sweden)

    Irina Basara

    2016-12-01

    Full Text Available The concept of concert management in the Republic of Croatia encounters numerous obstacles in any attempt to institutionalize it. Unlike other countries in the European Union, there is no register of the concert stages, venues as well as facilities for the provision of hearing / consumption of music in the form of performances. Process management organization is incomplete, and institutions that are closely associated with such events do not carry out the classification, categorization and analysis of events that are within the concerts' domain. Commercial music, economically far most cost-effective, is completely ignored and within the framework of cultural events not even the slightest attention is given to it. On the contrary, it is considered the music of poor quality and completely irrelevant. This paper tries to frame the mentioned genre, which includes various musical directions that economically bring significant benefits and help the survival of these related activities indirectly, and ultimately have a positive impact on the economy. Comparing global trends it speaks about the position of the Croatian music industry and lists the main obstacles for setting up a solid foundation for the construction of an adequate system of indexation of concert businesses that, as part of the creative industries records a meteoric economic growth.

  1. Individual plant care in cropping systems

    OpenAIRE

    Griepentrog, Hans W.; Nørremark, Michael; Nielsen, Henning; Blackmore, Simon

    2003-01-01

    Individual plant care cropping systems, embodied in precision farming, may lead to new opportunities in agricultural crop management. The objective of the project was to provide high accuracy seed position mapping of a field of sugar beet. An RTK GPS was retrofitted on to a precision seeder to map the seeds as they were planted. The average error between the seed map and the actual plant map was about 32 mm to 59 mm. The results showed that the overall accuracy of the estimated plant position...

  2. Path Generation by Avoiding Obstacles using the Intersection of Bodies

    Directory of Open Access Journals (Sweden)

    Komák Martin

    2018-02-01

    Full Text Available We will discuss the problem of path finding in 3D space with an obstacle. The thesis deals with the problem of searching for the shortest path between the individual points in the space so that this path does not come into collision with an obstacle. A system has been designed to construct paths in cross-sectional planes of the given object representing an obstacle, based on its surface contour. The system solves the issue of loading STL format, creating cross-sectional planes of the object, intersection between geometric shapes, and generation of lines around the contour of the object in 2D. An experiment was performed, in which we have been moving around a model of a jet aircraft and its results are described in the conclusion.

  3. Evolving Systems of Care with Total Clinical Outcomes Management

    Science.gov (United States)

    Lyons, John S.; Epstein, Richard A.; Jordan, Neil

    2010-01-01

    The current article proposes that further specification of the system of care concept is required. Based on the assertions that the system of care concept (a) refers to an ideal as opposed to an observable phenomenon, and (b) is engaged in offering transformational experiences, the authors propose that the system of care definition must be…

  4. Obstacle detectors for automated transit vehicles: A technoeconomic and market analysis

    Science.gov (United States)

    Lockerby, C. E.

    1979-01-01

    A search was conducted to identify the technical and economic characteristics of both NASA and nonNASA obstacle detectors. The findings, along with market information were compiled and analyzed for consideration by DOT and NASA in decisions about any future automated transit vehicle obstacle detector research, development, or applications project. Currently available obstacle detectors and systems under development are identified by type (sonic, capacitance, infrared/optical, guided radar, and probe contact) and compared with the three NASA devices selected as possible improvements or solutions to the problems in existing obstacle detection systems. Cost analyses and market forecasts individually for the AGT and AMTV markets are included.

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  6. Tracked robot controllers for climbing obstacles autonomously

    Science.gov (United States)

    Vincent, Isabelle

    2009-05-01

    Research in mobile robot navigation has demonstrated some success in navigating flat indoor environments while avoiding obstacles. However, the challenge of analyzing complex environments to climb obstacles autonomously has had very little success due to the complexity of the task. Unmanned ground vehicles currently exhibit simple autonomous behaviours compared to the human ability to move in the world. This paper presents the control algorithms designed for a tracked mobile robot to autonomously climb obstacles by varying its tracks configuration. Two control algorithms are proposed to solve the autonomous locomotion problem for climbing obstacles. First, a reactive controller evaluates the appropriate geometric configuration based on terrain and vehicle geometric considerations. Then, a reinforcement learning algorithm finds alternative solutions when the reactive controller gets stuck while climbing an obstacle. The methodology combines reactivity to learning. The controllers have been demonstrated in box and stair climbing simulations. The experiments illustrate the effectiveness of the proposed approach for crossing obstacles.

  7. Obstacle evasion in free-space optical communications utilizing Airy beams

    Science.gov (United States)

    Zhu, Guoxuan; Wen, Yuanhui; Wu, Xiong; Chen, Yujie; Liu, Jie; Yu, Siyuan

    2018-03-01

    A high speed free-space optical communication system capable of self-bending signal transmission around line-of-sight obstacles is proposed and demonstrated. Airy beams are generated and controlled to achieve different propagating trajectories, and the signal transmission characteristics of these beams around the obstacle are investigated. Our results confirm that, by optimising their ballistic trajectories, Airy beams are able to bypass obstacles with more signal energy and thus improve the communication performance compared with normal Gaussian beams.

  8. Interaction of turbulent deflagrations with representative flow obstacles

    International Nuclear Information System (INIS)

    Durst, B.; Ardey, N.; Mayinger, F.

    1997-01-01

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

  9. Care for children with special health care needs in a managed care system: a patient satisfaction survey.

    Science.gov (United States)

    Flynn, J M; Bravo, C J; Reyes, O

    2001-09-01

    In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.

  10. Practice Parameter on Child and Adolescent Mental Health Care in Community Systems of Care

    Science.gov (United States)

    Journal of the American Academy of Child and Adolescent Psychiatry, 2007

    2007-01-01

    This parameter presents overarching principles and practices for child and adolescent mental health care in community systems of care. Community systems of care are defined broadly as comprising the wide array of child-serving agencies, programs, and practitioners (both public and private), in addition to natural community supports such as…

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

    Directory of Open Access Journals (Sweden)

    João Porto de Albuquerque

    2011-01-01

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

  12. The Active Duty Primigravada's Perception of Prenatal Care in the Military Health Care System

    National Research Council Canada - National Science Library

    Brady, Vicki

    1998-01-01

    .... In this study a qualitative descriptive design using the active duty primigravada as the population of interest was used to explore perceptions of and satisfaction with prenatal care in the military health care system...

  13. Guidelines for Psychological Practice in Health Care Delivery Systems

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  15. Factors influencing obstacle crossing performance in patients with Parkinson's disease.

    Directory of Open Access Journals (Sweden)

    Ying-Yi Liao

    Full Text Available BACKGROUND: Tripping over obstacles is the major cause of falls in community-dwelling patients with Parkinson's disease (PD. Understanding the factors associated with the obstacle crossing behavior may help to develop possible training programs for crossing performance. This study aimed to identify the relationships and important factors determining obstacle crossing performance in patients with PD. METHODS: Forty-two idiopathic patients with PD (Hoehn and Yahr stages I to III participated in this study. Obstacle crossing performance was recorded by the Liberty system, a three-dimensional motion capture device. Maximal isometric strength of the lower extremity was measured by a handheld dynamometer. Dynamic balance and sensory integration ability were assessed using the Balance Master system. Movement velocity (MV, maximal excursion (ME, and directional control (DC were obtained during the limits of stability test to quantify dynamic balance. The sum of sensory organization test (SOT scores was used to quantify sensory organization ability. RESULTS: Both crossing stride length and stride velocity correlated significantly with lower extremity muscle strength, dynamic balance control (forward and sideward, and sum of SOT scores. From the regression model, forward DC and ankle dorsiflexor strength were identified as two major determinants for crossing performance (R(2 = .37 to.41 for the crossing stride length, R(2 = .43 to.44 for the crossing stride velocity. CONCLUSIONS: Lower extremity muscle strength, dynamic balance control and sensory integration ability significantly influence obstacle crossing performance. We suggest an emphasis on muscle strengthening exercises (especially ankle dorsiflexors, balance training (especially forward DC, and sensory integration training to improve obstacle crossing performance in patients with PD.

  16. The Child Health Care System of Croatia.

    Science.gov (United States)

    Mestrovic, Julije; Bralic, Irena; Simetin, Ivana Pavic; Mujkic, Aida; Radonić, Marija; Rodin, Urelija; Trošelj, Mario; Stevanović, Ranko; Benjak, Tomislav; Pristaš, Ivan; Mayer, Dijana; Tomić, Branimir

    2016-10-01

    The Republic of Croatia is a Parliamentary Republic with a population of 4.2 million people that sits on the Adriatic coast within Central Europe. Gross domestic product is approximately 60% of the European Union average, which in turn, limits health service spending. The health system is funded through universal health insurance administered by the Croatian Health Insurance Fund based on the principles of social solidarity and reciprocity. The children of Croatia are guaranteed access to universal primary, hospital, and specialist care provided by a network of health institutions. Pediatricians and school medicine specialists provide comprehensive preventive health care for both preschool and school-aged children. Despite the Croatian War of Independence in the late 20th century, indicators of child health and measures of health service delivery to children and families are steadily improving. However, similar to many European countries, Croatia is experiencing a rise in the "new morbidities" and is responding to these new challenges through a whole society approach to promote healthy lifestyles and insure good quality of life for children. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Obstacle avoidance handling and mixed integer predictive control for space robots

    Science.gov (United States)

    Zong, Lijun; Luo, Jianjun; Wang, Mingming; Yuan, Jianping

    2018-04-01

    This paper presents a novel obstacle avoidance constraint and a mixed integer predictive control (MIPC) method for space robots avoiding obstacles and satisfying physical limits during performing tasks. Firstly, a novel kind of obstacle avoidance constraint of space robots, which needs the assumption that the manipulator links and the obstacles can be represented by convex bodies, is proposed by limiting the relative velocity between two closest points which are on the manipulator and the obstacle, respectively. Furthermore, the logical variables are introduced into the obstacle avoidance constraint, which have realized the constraint form is automatically changed to satisfy different obstacle avoidance requirements in different distance intervals between the space robot and the obstacle. Afterwards, the obstacle avoidance constraint and other system physical limits, such as joint angle ranges, the amplitude boundaries of joint velocities and joint torques, are described as inequality constraints of a quadratic programming (QP) problem by using the model predictive control (MPC) method. To guarantee the feasibility of the obtained multi-constraint QP problem, the constraints are treated as soft constraints and assigned levels of priority based on the propositional logic theory, which can realize that the constraints with lower priorities are always firstly violated to recover the feasibility of the QP problem. Since the logical variables have been introduced, the optimization problem including obstacle avoidance and system physical limits as prioritized inequality constraints is termed as MIPC method of space robots, and its computational complexity as well as possible strategies for reducing calculation amount are analyzed. Simulations of the space robot unfolding its manipulator and tracking the end-effector's desired trajectories with the existence of obstacles and physical limits are presented to demonstrate the effectiveness of the proposed obstacle avoidance

  18. Slow maturation of planning in obstacle avoidance in humans

    NARCIS (Netherlands)

    Corporaal, Sharissa H A; Swinnen, Stephan P.; Duysens, Jacques; Bruijn, Sjoerd M.

    2016-01-01

    Complex gait (e.g., obstacle avoidance) requires a higher cognitive load than simple steady-state gait, which is a more automated movement. The higher levels of the central nervous system, responsible for adjusting motor plans to complex gait, develop throughout childhood into adulthood. Therefore,

  19. Budget-makers and health care systems.

    Science.gov (United States)

    White, Joseph

    2013-10-01

    Health programs are shaped by the decisions made in budget processes, so how budget-makers view health programs is an important part of making health policy. Budgeting in any country involves its own policy community, with key players including budgeting professionals and political authorities. This article reviews the typical pressures on and attitudes of these actors when they address health policy choices. The worldview of budget professionals includes attitudes that are congenial to particular policy perspectives, such as the desire to select packages of programs that maximize population health. The pressures on political authorities, however, are very different: most importantly, public demand for health care services is stronger than for virtually any other government activity. The norms and procedures of budgeting also tend to discourage adoption of some of the more enthusiastically promoted health policy reforms. Therefore talk about rationalizing systems is not matched by action; and action is better explained by the need to minimize blame. The budget-maker's perspective provides insight about key controversies in healthcare policy such as decentralization, competition, health service systems as opposed to health insurance systems, and dedicated vs. general revenue finance. It also explains the frequency of various "gaming" behaviors. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Ep for efficient stochastic control with obstacles

    NARCIS (Netherlands)

    Mensink, T.; Verbeek, J.; Kappen, H.J.

    2010-01-01

    Abstract. We address the problem of continuous stochastic optimal control in the presence of hard obstacles. Due to the non-smooth character of the obstacles, the traditional approach using dynamic programming in combination with function approximation tends to fail. We consider a recently

  1. Diversity of primary care systems analysed.

    NARCIS (Netherlands)

    Kringos, D.; Boerma, W.; Bourgueil, Y.; Cartier, T.; Dedeu, T.; Hasvold, T.; Hutchinson, A.; Lember, M.; Oleszczyk, M.; Pavlick, D.R.

    2015-01-01

    This chapter analyses differences between countries and explains why countries differ regarding the structure and process of primary care. The components of primary care strength that are used in the analyses are health policy-making, workforce development and in the care process itself (see Fig.

  2. [Development of child mental health services in Lithuania: achievements and obstacles].

    Science.gov (United States)

    Pūras, Dainius

    2002-01-01

    In 1990, political, economic and social changes in Lithuania introduced the possibility to develop for the first time in nations's history an effective and modern system of child mental health services. During the period between 1990 and 1995 a new model of services was developed in the Department of Social pediatrics and child psychiatry of Vilnius University. The model included development of child and adolescent psychiatric services, as well as early intervention services for infants and preschool children with developmental disabilities. The emphasis, following recommendations of WHO and existing international standards, was made on deinstitutionalization and development of family-oriented and community-based services, which have been ignored by previous system. In the first half of 90's of 20th century, new training programs for professionals were introduced, more than 50 methods of assessment, treatment and rehabilitation, new for Lithuanian clinical practice, were implemented, and a new model of services, including primary, secondary and tertiary level of prevention, was introduced in demonstration sites. However, during next phase of development, in 1997-2001, serious obstacles for replicating new approaches across the country, have been identified, which threatened successful implementation of the new model of services into everyday clinical practice. Analysis of obstacles, which are blocking development of new approaches in the field of child mental health, is presented in the article. The main obstacles, identified during analysis of socioeconomic context, planning and utilization of resources, running of the system of services and evaluation of outcomes, are as follows: lack of intersectorial cooperation between health, education and social welfare systems; strong tradition of discrimination of psychosocial interventions in funding schemes of health services; societal attitudes, which tend to discriminate and stigmatize marginal groups, including

  3. Doctors' health: obstacles and enablers to returning to work.

    Science.gov (United States)

    Cohen, D; Rhydderch, M; Reading, P; Williams, S

    2015-08-01

    For doctors returning to work after absence due to ill-health or performance concerns, the obstacles can seem insurmountable. Doctors' perspectives of these obstacles have been investigated. To support them more effectively, the perspectives of organizations that interact with such doctors should also be considered. To explore the obstacles and enablers to doctors' return to work after long-term absence from the perspective of key organizations involved in assessment and support. We identified organizations operating in the field of doctors' health, well-being and performance. We conducted semi-structured, 30-45 min telephone interviews with representatives of the organizations, exploring problems that they had encountered that were experienced by doctors with health or performance concerns returning to work after absence of a month or longer. We analysed our field notes using theoretical analysis. We conducted 11 telephone interviews. Data analysis identified four key themes of obstacles and enablers to returning to work: 'communication', 'return to work', 'finance and funding' and 'relationships and engagement'. Sub-themes relating to the organization and the individual also emerged. Organizations responsible for supporting doctors back to work reported poor communication as a significant obstacle to doctors returning to work after illness. They also reported differences between specialities, employing organizations, occupational health departments and human resources in terms of knowledge and expertise in supporting doctors with complex issues. Clear communication channels, care pathways and support processes, such as workplace advocates, were perceived as strong enablers to return to work for doctors after long-term absence. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. 3rd International Conference on Health Care Systems Engineering

    CERN Document Server

    Li, Jingshan; Matta, Andrea; Sahin, Evren; Vandaele, Nico; Visintin, Filippo

    2017-01-01

    This book presents statistical processes for health care delivery and covers new ideas, methods and technologies used to improve health care organizations. It gathers the proceedings of the Third International Conference on Health Care Systems Engineering (HCSE 2017), which took place in Florence, Italy from May 29 to 31, 2017. The Conference provided a timely opportunity to address operations research and operations management issues in health care delivery systems. Scientists and practitioners discussed new ideas, methods and technologies for improving the operations of health care systems, developed in close collaborations with clinicians. The topics cover a broad spectrum of concrete problems that pose challenges for researchers and practitioners alike: hospital drug logistics, operating theatre management, home care services, modeling, simulation, process mining and data mining in patient care and health care organizations.

  5. Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

    Science.gov (United States)

    Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

    2017-01-01

    Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

  6. Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant

    Science.gov (United States)

    Power, Thomas J.; Michel, Jeremy; Mayne, Stephanie; Miller, Jeffrey; Blum, Nathan J.; Grundmeier, Robert W.; Guevara, James P.; Fiks, Alexander G.

    2016-01-01

    Perhaps the two principal venues for the delivery of mental health services are schools and primary care practices. Unfortunately, these systems of care are poorly connected, which may result in care that is fragmented and suboptimal. This article describes the development and implementation of an electronic health record portal, known as the ADHD…

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

    International Nuclear Information System (INIS)

    Beheshti, M.T.H.; Tehrani, A.K.

    1999-05-01

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

  8. Women's orgasm obstacles: A qualitative study.

    Science.gov (United States)

    Nekoolaltak, Maryam; Keshavarz, Zohreh; Simbar, Masoumeh; Nazari, Ali Mohammad; Baghestani, Ahmad Reza

    2017-08-01

    Woman's orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is influenced by several factors. The aim of this study is exploring obstacles to orgasm in Iranian married women. This qualitative study with directed content analysis approach was conducted in 2015-2016, on 20 Iranian married women who were individually interviewed at two medical clinics in Tehran, Iran. Orgasm obstacles were explored in one category, 4 subcategories, and 25 codes. The main category was "Multidimensionality of women's orgasm obstacles". Subcategories and some codes included: Physical obstacles (wife's or husband's boredom, vaginal infection, insufficient vaginal lubrication), psychological obstacles (lack of sexual knowledge, shame, lack of concentration on sex due to household and children problems), relational obstacles (husband's hurry, having a dispute and annoyance with spouse) and contextual obstacles (Irregular sleep hours, lack of privacy and inability to separate children's bedroom from their parents, lack of peace at home). For prevention or treatment of female orgasm disorders, attention to physical factors is not enough. Obtaining a comprehensive history about physical, psychological, relational and contextual dimensions of woman's life is necessary.

  9. MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

    Science.gov (United States)

    ROBBINS, JACOB A.

    2015-01-01

    The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

  10. Autonomous Navigation and Obstacle Avoidance of a Micro-Bus

    Directory of Open Access Journals (Sweden)

    Carlos Fernández

    2013-04-01

    Full Text Available At present, the topic of automated vehicles is one of the most promising research areas in the field of Intelligent Transportation Systems (ITS. The use of automated vehicles for public transportation also contributes to reductions in congestion levels and to improvements in traffic flow. Moreover, electrical public autonomous vehicles are environmentally friendly, provide better air quality and contribute to energy conservation. The driverless public transportation systems, which are at present operating in some airports and train stations, are restricted to dedicated roads and exhibit serious trouble dynamically avoiding obstacles in the trajectory. In this paper, an electric autonomous mini-bus is presented. All datasets used in this article were collected during the experiments carried out in the demonstration event of the 2012 IEEE Intelligent Vehicles Symposium that took place in Alcalá de Henares (Spain. The demonstration consisted of a route 725 metres long containing a list of latitude-longitude points (waypoints. The mini-bus was capable of driving autonomously from one waypoint to another using a GPS sensor. Furthermore, the vehicle is provided with a multi-beam Laser Imaging Detection and Ranging (LIDAR sensor for surrounding reconstruction and obstacle detection. When an obstacle is detected in the planned path, the planned route is modified in order to avoid the obstacle and continue its way to the end of the mission. On the demonstration day, a total of 196 attendees had the opportunity to get a ride on the vehicles. A total of 28 laps were successfully completed in full autonomous mode in a private circuit located in the National Institute for Aerospace Research (INTA, Spain. In other words, the system completed 20.3 km of driverless navigation and obstacle avoidance.

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

    Science.gov (United States)

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

    1999-08-01

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

  12. Barriers to Systemic, Effective, and Sustainable Technology Use in High School Classrooms / Obstacles à l’utilisation systémique, efficace et durable de la technologie dans les salles de classe des écoles secondaires

    Directory of Open Access Journals (Sweden)

    Jason Scott Daniels

    2014-01-01

    Full Text Available The purpose of the Technology and High School Success (THSS initiative was to encourage innovative strategies focused on improving provincial high school completion rates, using technology and student-centered learning to engage student interest. The primary purpose of this paper is to report on barriers that impede systemic, effective and sustainable technology integration within schools. Even with teacher and administrative support and commitment for THSS, evaluative research indicated minimal change in system capacity as a result of the initiative. Three primary barriers to program sustainability were: 1 schools and school districts did not leverage the opportunity to revisit their existing vision(s, 2 schools and school districts did not use data to make changes, and 3 limited access to technology. Le but de l’initiative « Technology and High School Success (THSS » était d'encourager des stratégies novatrices visant à améliorer le taux d’achèvement des études secondaires dans la province de l’Alberta en utilisant la technologie et un apprentissage centré sur l'élève afin de susciter l'intérêt des élèves. L'objectif principal de cet article est de rendre compte des obstacles entravant l'intégration systémique, efficace et durable de la technologie dans les écoles. La recherche évaluative a révélé des changements minimes dans la capacité systémique à la suite de l'initiative, et ce, malgré l’appui et l’engagement des enseignants et des administrateurs envers le THSS. Les trois obstacles principaux à la viabilité du programme sont les suivants: 1 les écoles et les districts scolaires n'ont pas profité de l’occasion pour revoir leur(s vision(s, 2 les écoles et les districts scolaires n'ont pas utilisé les données pour effectuer des changements, et 3 l'accès limité à la technologie.

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

    Science.gov (United States)

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

    1998-01-01

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

  14. Automatic Quadcopter Control Avoiding Obstacle Using Camera with Integrated Ultrasonic Sensor

    Science.gov (United States)

    Anis, Hanafi; Haris Indra Fadhillah, Ahmad; Darma, Surya; Soekirno, Santoso

    2018-04-01

    Automatic navigation on the drone is being developed these days, a wide variety of types of drones and its automatic functions. Drones used in this study was an aircraft with four propellers or quadcopter. In this experiment, image processing used to recognize the position of an object and ultrasonic sensor used to detect obstacle distance. The method used to trace an obsctacle in image processing was the Lucas-Kanade-Tomasi Tracker, which had been widely used due to its high accuracy. Ultrasonic sensor used to complement the image processing success rate to be fully detected object. The obstacle avoidance system was to observe at the program decisions from some obstacle conditions read by the camera and ultrasonic sensors. Visual feedback control based PID controllers are used as a control of drones movement. The conclusion of the obstacle avoidance system was to observe at the program decisions from some obstacle conditions read by the camera and ultrasonic sensors.

  15. 2nd International Conference on Health Care Systems Engineering

    CERN Document Server

    Sahin, Evren; Li, Jingshan; Guinet, Alain; Vandaele, Nico

    2016-01-01

    In this volume, scientists and practitioners write about new methods and technologies for improving the operation of health care organizations. Statistical analyses play an important role in these methods with the implications of simulation and modeling applied to the future of health care. Papers are based on work presented at the Second International Conference on Health Care Systems Engineering (HCSE2015) in Lyon, France. The conference was a rare opportunity for scientists and practitioners to share work directly with each other. Each resulting paper received a double blind review. Paper topics include: hospital drug logistics, emergency care, simulation in patient care, and models for home care services. Discusses statistical analysis and operations management for health care delivery systems based on real case studies Papers in this volume received a double blind review Brings together the work of scientists, practitioners, and clinicians to unite research and practice in the future of these systems Top...

  16. Diffusion induced flow on a wedge-shaped obstacle

    International Nuclear Information System (INIS)

    Zagumennyi, Ia V; Dimitrieva, N F

    2016-01-01

    In this paper the problem of evolution of diffusion induced flow on a wedge-shaped obstacle is analyzed numerically. The governing set of fundamental equations is solved using original solvers from the open source OpenFOAM package on supercomputer facilities. Due to breaking of naturally existing diffusion flux of a stratifying agent by the impermeable surface of the wedge a complex multi-level vortex system of compensatory fluid motions is formed around the obstacle. Sharp edges of the obstacle generate extended high-gradient horizontal interfaces which are clearly observed in laboratory experiments by high-resolution Schlieren visualization. Formation of an intensive pressure depression zone in front of the leading vertex of the wedge is responsible for generation of propulsive force resulting in a self-displacement of the obstacle along the neutral buoyancy horizon in a stably stratified environment. The size of the pressure deficiency area near the sharp vertex of a concave wedge is about twice that for a convex one. This demonstrates a more intensive propulsion mechanism in case of the concave wedge and, accordingly, a higher velocity of its self-movement in a continuously stratified medium. (paper)

  17. Open Source, Open Standards, and Health Care Information Systems

    Science.gov (United States)

    2011-01-01

    Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy. PMID:21447469

  18. Optical Flow based Robot Obstacle Avoidance

    Directory of Open Access Journals (Sweden)

    Kahlouche Souhila

    2008-11-01

    Full Text Available In this paper we try to develop an algorithm for visual obstacle avoidance of autonomous mobile robot. The input of the algorithm is an image sequence grabbed by an embedded camera on the B21r robot in motion. Then, the optical flow information is extracted from the image sequence in order to be used in the navigation algorithm. The optical flow provides very important information about the robot environment, like: the obstacles disposition, the robot heading, the time to collision and the depth. The strategy consists in balancing the amount of left and right side flow to avoid obstacles, this technique allows robot navigation without any collision with obstacles. The robustness of the algorithm will be showed by some examples.

  19. Scattering of electromagnetic waves by obstacles

    CERN Document Server

    Kristensson, Gerhard

    2016-01-01

    The main purpose of Scattering of Electromagnetic Waves by Obstacles is to give a theoretical treatment of the scattering phenomena, and to illustrate numerical computations of some canonical scattering problems for different geometries and materials.

  20. Resonances for Obstacles in Hyperbolic Space

    Science.gov (United States)

    Hintz, Peter; Zworski, Maciej

    2017-12-01

    We consider scattering by star-shaped obstacles in hyperbolic space and show that resonances satisfy a universal bound { Im λ ≤ - 1/2 } , which is optimal in dimension 2. In odd dimensions we also show that { Im λ ≤ - μ/ρ } for a universal constant {μ} , where { ρ } is the radius of a ball containing the obstacle; this gives an improvement for small obstacles. In dimensions 3 and higher the proofs follow the classical vector field approach of Morawetz, while in dimension 2 we obtain our bound by working with spaces coming from general relativity. We also show that in odd dimensions resonances of small obstacles are close, in a suitable sense, to Euclidean resonances.

  1. Primary care training and the evolving healthcare system.

    Science.gov (United States)

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

    2012-01-01

    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. © 2012 Mount Sinai School of Medicine.

  2. Social inequalities in the organization of pregnancy care in a universally funded public health care system.

    Science.gov (United States)

    Sutherland, Georgina; Yelland, Jane; Brown, Stephanie

    2012-02-01

    To examine the social organization of pregnancy care and the extent to which socioeconomic factors affect women's experience of care. We consider these data in the global discussion on taking action to reduce health inequalities. This study draws on cross-sectional data from a large population-based survey of Australian women 6 months after giving birth. Only those women reporting to attend publically-funded models of antenatal care (i.e., public clinic, midwife clinic, shared care, primary medical care, primary midwife care) were included in analyses. Results showed a social patterning in the organization and experience of care with clear links between model of care attended in pregnancy and a number of individual-level indicators of social disadvantage. Our findings show model of care is a salient feature in how women view their care. How women from socially disadvantaged backgrounds navigate available care options are important considerations. Pregnancy care is recognized as an opportunity to intervene to give children 'the best start in life.' Our data show the current system of universally accessible pregnancy care in Australia is failing to support the most vulnerable women and families. This information can inform actions to reduce social disparities during this critical period.

  3. Advection endash diffusion around a curved obstacle

    International Nuclear Information System (INIS)

    Ahluwalia, D.S.; Keller, J.B.; Knessl, C.

    1998-01-01

    Advection and diffusion of a substance around a curved obstacle is analyzed when the advection velocity is large compared to the diffusion velocity, i.e., when the Peclet number is large. Asymptotic expressions for the concentration are obtained by the use of boundary layer theory, matched asymptotic expansions, etc. The results supplement and extend previous ones for straight obstacles. They apply to electrophoresis, the flow of ground water, chromatography, sedimentation, etc. copyright 1998 American Institute of Physics

  4. Homogenization of variational inequalities for obstacle problems

    International Nuclear Information System (INIS)

    Sandrakov, G V

    2005-01-01

    Results on the convergence of solutions of variational inequalities for obstacle problems are proved. The variational inequalities are defined by a non-linear monotone operator of the second order with periodic rapidly oscillating coefficients and a sequence of functions characterizing the obstacles. Two-scale and macroscale (homogenized) limiting variational inequalities are obtained. Derivation methods for such inequalities are presented. Connections between the limiting variational inequalities and two-scale and macroscale minimization problems are established in the case of potential operators.

  5. Algorithm for Spatial Clustering with Obstacles

    OpenAIRE

    El-Sharkawi, Mohamed E.; El-Zawawy, Mohamed A.

    2009-01-01

    In this paper, we propose an efficient clustering technique to solve the problem of clustering in the presence of obstacles. The proposed algorithm divides the spatial area into rectangular cells. Each cell is associated with statistical information that enables us to label the cell as dense or non-dense. We also label each cell as obstructed (i.e. intersects any obstacle) or non-obstructed. Then the algorithm finds the regions (clusters) of connected, dense, non-obstructed cells. Finally, th...

  6. Obstacles to nutrition labeling in restaurants.

    Science.gov (United States)

    Almanza, B A; Nelson, D; Chai, S

    1997-02-01

    This study determined the major obstacles that foodservices face regarding nutrition labeling. Survey questionnaire was conducted in May 1994. In addition to demographic questions, the directors were asked questions addressing willingness, current practices, and perceived obstacles related to nutrition labeling. Sixty-eight research and development directors of the largest foodservice corporations as shown in Restaurants & Institutions magazine's list of the top 400 largest foodservices (July 1993). P tests were used to determine significance within a group for the number of foodservices that were currently using nutrition labeling, perceived impact of nutrition labeling on sales, and perceived responsibility to add nutrition labels. Regression analysis was used to determine the importance of factors on willingness to label. Response rate was 45.3%. Most companies were neutral about their willingness to use nutrition labeling. Two thirds of the respondents were not currently using nutrition labels. Only one third thought that it was the foodservice's responsibility to provide such information. Several companies perceived that nutrition labeling would have a potentially negative effect on annual sales volume. Major obstacles were identified as menu or personnel related, rather than cost related. Menu-related obstacles included too many menu variations, limited space on the menu for labeling, and loss of flexibility in changing the menu. Personnel-related obstacles included difficulty in training employees to implement nutrition labeling, and not enough time for foodservice personnel to implement nutrition labeling. Numerous opportunities will be created for dietetics professionals in helping foodservices overcome these menu- or personnel-related obstacles.

  7. Obstacle detection method, obstacle removing method, device and production line for practicing the methods

    International Nuclear Information System (INIS)

    Yoneyama, Takao; Ishimatsu, Tsuneo; Komata, Hisashi; Suzuki, Keisaburo.

    1997-01-01

    The present invention provides techniques for detecting and removing obstacles, which can be applied to pipelines and vessels to be used in structures such as nuclear power structures and electric power generation facilities. Namely, when the pipelines or vessels are in any of the stages, namely, production, installation, before the use after installation and before the reuse after inspection, obstacles remaining in the pipelines and vessels are blown off by using a fluid jetting mechanism (air compressor). Elastic waves generated when the blown off obstacles abut against the pipelines and vessels are detected by using a sensor. As a result, the remaining obstacles can be detected during any one of the stages described above. The blowing is repeated till the absence of the obstacles is confirmed by elastic wave signals detected by the sensor. As a result, the remaining obstacles can be removed. (I.S.)

  8. Canada's health care system: A relevant approach for South Africa ...

    African Journals Online (AJOL)

    Background. While countries such as the USA, South Africa and China debate health reforms to improve access to care while rationalising costs, Canada's health care system has emerged as a notable option. In the USA, meaningful discussion of the advantages and disadvantages of the Canadian system has been ...

  9. Performance analysis of online health care system | Kohli ...

    African Journals Online (AJOL)

    This paper deals with selection of appropriate indexing techniques applied on MySQL database for a health care system and its related performance issues. The proposed Smart Card based Online Health Care System deals with frequent data storage, exchange and retrieval of data from the database servers. Speed and ...

  10. Evaluation of DICE, a terminological system for intensive care

    NARCIS (Netherlands)

    de Keizer, N. F.; Abu-Hanna, A.; Cornet, R.

    2000-01-01

    Evaluative research and the introduction of the Patient Data Management System to support care have increased the need for structured and standardized registration of diagnostic information in Dutch intensive cares (IC). To this end a terminological system to describe diagnoses is needed. A

  11. Sources of project financing in health care systems.

    Science.gov (United States)

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

    2000-01-01

    Through discussions with chief financial officers of leading health care systems, insights are offered on preferences for project financing and development efforts. Data from these same systems provide at least anecdotal evidence in support of pecking-order theory.

  12. A Primary Care System to Improve Health Care Efficiency: Lessons from Ecuador.

    Science.gov (United States)

    Aldulaimi, Sommer; Mora, Francisco E

    2017-01-01

    Ecuador is a country with few resources to spend on health care. Historically, Ecuador has struggled to find a model for health care that is efficient, effective, and available to all people in the country, even those in underserved and rural communities. In 2000, the Ecuador Ministry of Public Health implemented a new system of health care that used primary care as its platform. Since then, Ecuador has been able to increase its health care efficiency, increasing its ranking from 111 of 211 countries worldwide in 2000, to 20 of 211 countries in 2014. This article briefly reviews the new components of the system implemented in Ecuador and examines the tools used to accomplish this. The discussion also compares and contrasts the Ecuador and US systems, and identifies concepts and policies from Ecuador that could improve the US system. © Copyright 2017 by the American Board of Family Medicine.

  13. Interaction of a vacuum arc plasma beam with an obstacle positioned normal to the plasma flow

    International Nuclear Information System (INIS)

    Zarchin, O; Zhitomirsky, V N; Goldsmith, S; Boxman, R L

    2003-01-01

    The effect of an obstacle positioned normal to a plasma jet produced by a vacuum arc plasma source on the radial distribution of ion flux in the vicinity of the obstacle was studied. This study was motivated by interest in the mutual influence of tightly packed substrates on coatings in industrial vacuum arc deposition systems. The experimental system consisted of a vacuum arc plasma source, a straight plasma duct, and a multi-probe consisting of a removable disc obstacle and a set of ring probes for measuring the radial ion flux. A dc arc discharge was ignited in vacuum between a truncated cone-shaped Cu cathode and an annular anode. The plasma jet produced by cathode spots passed through the anode aperture into the straight plasma duct. An axial magnetic field guided the plasma jet in the duct. The multi-probe consisted of a removable disc obstacle and a set of five ring probes for measuring the radial plasma flux as a function of distance from the disc obstacle. The rings and the disc probes were coaxially arranged on the multi-probe assembly and positioned so that plasma from the source passed through the ring probes and then encountered the disc. The influence of the obstacle was determined by measuring the ring ion currents, both in the presence of the obstacle, and when the disc obstacle was removed. The difference between the measured ion currents with and without the obstacle was interpreted to be the contribution of reflected or sputtered particles from the obstacle to the radial ion flux. The ring probes were biased by -60 V with respect to the grounded anode, to collect the saturated ion current. The multi-probe was connected to a movable stem, and positioned at different distances from the plasma source. A plasma density of ∼6 x 10 17 m -3 was estimated in this study based on the ion current to the obstacle. The radial ion flux collected by the ring probes increased by 20-25% due to the presence of the obstacle. As the calculated mean free path for

  14. Transformational change in health care systems: an organizational model.

    Science.gov (United States)

    Lukas, Carol VanDeusen; Holmes, Sally K; Cohen, Alan B; Restuccia, Joseph; Cramer, Irene E; Shwartz, Michael; Charns, Martin P

    2007-01-01

    The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims. This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care. Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care. Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization. The conceptual model holds promise for guiding health care

  15. SMART STICK DESIGN WITH OBSTACLE DETECTION AND NAVIGATION AS THE HELPING TOOL FOR BLIND PEOPLE

    OpenAIRE

    Sumar Hadi*, Susilo Adi Widyanto, Paryanto, Kurnia Chamid, Rachmat Muhamad Andika

    2018-01-01

    Smart stick designed for the blind people, this appliance can help detect obstacles with the use of infrared sensor, ultrasonic and water. The obstacles in a distance of about 3 m can be detected assistance from this sensor. In addition, we use GPS (Global Positioning System) to give the position and navigation on the stick. Using GPS (Global Positioning System) help the blind people reaches its destination. GPS (Global Positioning System) recipients to get the location of the latest and the ...

  16. Study on the functional improvement of the CARE system

    International Nuclear Information System (INIS)

    Han, Seung Jae; Nam, K. W.; Kim, D. I.; Kim, D. S.; Kim, S. H.; Kang, W. S.; Kim, B. H.

    2003-12-01

    The CARE system was developed in order to protect the public during nuclear emergency in Korea by KINS staffs with cooperation of other concerned organizations. In this study, some improvements to be considered for effective operation of CARE system were drawn. In 2002, Emergency Technical Advisory Center was constructed. Following the function of this center, the CARE system should be enforced for effective analysis of the nuclear power plant operation and the severe accident as well as for another areas such as radiological accidents and physical protection. The modules in this system shall be expanded to analysis of broader radiological accidents by long-range consequences modelling and so on

  17. Induced vibrations facilitate traversal of cluttered obstacles

    Science.gov (United States)

    Thoms, George; Yu, Siyuan; Kang, Yucheng; Li, Chen

    When negotiating cluttered terrains such as grass-like beams, cockroaches and legged robots with rounded body shapes most often rolled their bodies to traverse narrow gaps between beams. Recent locomotion energy landscape modeling suggests that this locomotor pathway overcomes the lowest potential energy barriers. Here, we tested the hypothesis that body vibrations induced by intermittent leg-ground contact facilitate obstacle traversal by allowing exploration of locomotion energy landscape to find this lowest barrier pathway. To mimic a cockroach / legged robot pushing against two adjacent blades of grass, we developed an automated robotic system to move an ellipsoidal body into two adjacent beams, and varied body vibrations by controlling an oscillation actuator. A novel gyroscope mechanism allowed the body to freely rotate in response to interaction with the beams, and an IMU and cameras recorded the motion of the body and beams. We discovered that body vibrations facilitated body rolling, significantly increasing traversal probability and reducing traversal time (P locomotor pathways in complex 3-D terrains.

  18. Do Danes enjoy a high performing chronic care system?

    DEFF Research Database (Denmark)

    Hernández-Quevedo, Christina; Olejaz, Maria; Juul, Annegrete

    2012-01-01

    The trends in population health in Denmark are similar to those in most Western European countries. Major health issues include, among others, the high prevalence of chronic illnesses and lifestyle related risk factors such as obesity, tobacco, physical inactivity and alcohol. This has pressed...... the health system towards a model of provision of care based on the management of chronic care conditions. While the Chronic Care Model was introduced in 2005, the Danish health system does not fulfil the ten key preconditions that would characterise a high-performing chronic care system. As revealed...... in a recent report, the fragmented structure of the Danish health system poses challenges in providing effectively coordinated care to patients with chronic diseases....

  19. The Obstacles Facing the Flow of the Electronic Information in the Arab World

    Directory of Open Access Journals (Sweden)

    Samir Yahya Umri

    2006-12-01

    Full Text Available This research views the most important obstacles facing the flow of electronic information in Arab world; with an illustration about the effect of each obstacle on the flowing of the information, and the special recommendation to overcome it. the research states 4 main obstacles; they are: number of internet users and the weakness of the infrastructure in our Arab world, the spam e-mails, the Bugs and vulnerabilities in the operating systems that allow hackers to attack the information systems, and the spread of the electronic pornography on the internet

  20. Effect of a provincial system of stroke care delivery on stroke care and outcomes

    Science.gov (United States)

    Kapral, Moira K.; Fang, Jiming; Silver, Frank L.; Hall, Ruth; Stamplecoski, Melissa; O’Callaghan, Christina; Tu, Jack V.

    2013-01-01

    Background: Systems of stroke care delivery have been promoted as a means of improving the quality of stroke care, but little is known about their effectiveness. We assessed the effect of the Ontario Stroke System, a province-wide strategy of regionalized stroke care delivery, on stroke care and outcomes in Ontario, Canada. Methods: We used population-based provincial administrative databases to identify all emergency department visits and hospital admissions for acute stroke and transient ischemic attack from Jan. 1, 2001, to Dec. 31, 2010. Using piecewise regression analyses, we assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centres, and on rates of discharge to long-term care facilities and 30-day mortality after stroke. Results: We included 243 287 visits by patients with acute stroke or transient ischemic attack. The full implementation of the Ontario Stroke System in 2005 was associated with an increase in rates of care at stroke centres (before implementation: 40.0%; after implementation: 46.5%), decreased rates of discharge to long-term care facilities (before implementation: 16.9%; after implementation: 14.8%) and decreased 30-day mortality for hemorrhagic (before implementation: 38.3%; after implementation: 34.4%) and ischemic stroke (before implementation: 16.3%; after implementation: 15.7%). The system’s implementation was also associated with marked increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit and antithrombotic therapy. Interpretation: The implementation of an organized system of stroke care delivery was associated with improved processes of care and outcomes after stroke. PMID:23713072

  1. Electronic consultation system demonstrates educational benefit for primary care providers.

    Science.gov (United States)

    Kwok, Jonas; Olayiwola, J Nwando; Knox, Margae; Murphy, Elizabeth J; Tuot, Delphine S

    2017-01-01

    Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse

  2. Intuitive Robot Tasks with Augmented Reality and Virtual Obstacles

    OpenAIRE

    Gaschler, Andre;Springer, Maximilian;Rickert, Markus;Knoll, Alois

    2017-01-01

    Today's industrial robots require expert knowledge and are not profitable for small and medium sized enterprises with their small lot sizes. It is our strong belief that more intuitive robot programming in an augmented reality robot work cell can dramatically simplify re-programming and leverage robotics technology in short production cycles. In this paper, we present a novel augmented reality system for defining virtual obstacles, specifying tool positions, and specifying robot tasks. We eva...

  3. Policy choices in dementia care-An exploratory analysis of the Alberta continuing care system (ACCS) using system dynamics.

    Science.gov (United States)

    Cepoiu-Martin, Monica; Bischak, Diane P

    2018-02-01

    The increase in the incidence of dementia in the aging population and the decrease in the availability of informal caregivers put pressure on continuing care systems to care for a growing number of people with disabilities. Policy changes in the continuing care system need to address this shift in the population structure. One of the most effective tools for assessing policies in complex systems is system dynamics. Nevertheless, this method is underused in continuing care capacity planning. A system dynamics model of the Alberta Continuing Care System was developed using stylized data. Sensitivity analyses and policy evaluations were conducted to demonstrate the use of system dynamics modelling in this area of public health planning. We focused our policy exploration on introducing staff/resident benchmarks in both supportive living and long-term care (LTC). The sensitivity analyses presented in this paper help identify leverage points in the system that need to be acknowledged when policy decisions are made. Our policy explorations showed that the deficits of staff increase dramatically when benchmarks are introduced, as expected, but at the end of the simulation period, the difference in deficits of both nurses and health care aids are similar between the 2 scenarios tested. Modifying the benchmarks in LTC only versus in both supportive living and LTC has similar effects on staff deficits in long term, under the assumptions of this particular model. The continuing care system dynamics model can be used to test various policy scenarios, allowing decision makers to visualize the effect of a certain policy choice on different system variables and to compare different policy options. Our exploration illustrates the use of system dynamics models for policy making in complex health care systems. © 2017 John Wiley & Sons, Ltd.

  4. Managed Care Approaches to Children's Services within Public Systems of Care.

    Science.gov (United States)

    Pumariega, Andres; Fallon, Theodore, Jr.

    This report presents two discussions of conceptual and infrastructure issues that state mental health systems serving children with emotional disturbances must consider to make an effective transition towards a managed care organization of services under Medicaid. The first discussion, "Clinical Experiences in Managed Care Implementation for…

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2015-08-01

    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Transition to Motherhood as an Immigrant: Risks and Obstacles

    Directory of Open Access Journals (Sweden)

    Ruveyde Aydin

    2017-09-01

    Full Text Available The process of transition to motherhood that brings along a number of vital changes may be full of risks and difficulties for immigrant mothers. Poverty, being unfamiliar with the language of the country that the mother migrated, inability of healthcare policies in covering healthcare expenses of immigrants, insufficiency of social assistance and loneliness may negatively affect health of mother and infant. Postpartum immigrant mothers are seen depression, anxiety, stress and social isolation because of these obstacles. Therefore, health care professionals, who provide care to immigrant mothers, should clarify immigrant mothers' religious, cultural beliefs and attitudes. Procurement of peer support is important by developing care programs special to immigrant mothers and ensuring immigrant women to come together. Increase in the number of translators in hospitals and prepara-tion of education materials in native language of mothers will improve the level of benefiting from healthcare services. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2017; 9(3.000: 250-262

  8. Declining amenable mortality: a reflection of health care systems?

    Science.gov (United States)

    Gianino, Maria Michela; Lenzi, Jacopo; Fantini, Maria Pia; Ricciardi, Walter; Damiani, Gianfranco

    2017-11-15

    Some studies have analyzed the association of health care systems variables, such as health service resources or expenditures, with amenable mortality, but the association of types of health care systems with the decline of amenable mortality has yet to be studied. The present study examines whether specific health care system types are associated with different time trend declines in amenable mortality from 2000 to 2014 in 22 European OECD countries. A time trend analysis was performed. Using Nolte and McKee's list, age-standardized amenable mortality rates (SDRs) were calculated as the annual number of deaths over the population aged 0-74 years per 100,000 inhabitants. We classified health care systems according to a deductively generated classification by Böhm. This classification identifies three dimensions that are not entirely independent of each other but follow a clear order: the regulation dimension is first, followed by the financing dimension and finally service provision. We performed a hierarchical semi-log polynomial regression analysis on the annual SDRs to determine whether specific health care systems were associated with different SDR trajectories over time. The results showed a clear decline in SDRs in all 22 health care systems between 2000 and 2014 although at different annual changes (slopes). Regression analysis showed that there was a significant difference among the slopes according to provision dimension. Health care systems with a private provision exhibited a slowdown in the decline of amenable mortality over time. It therefore seems that ownership is the most relevant dimension in determining a different pattern of decline in mortality. All countries experienced decreases in amenable mortality between 2000 and 2014; this decline seems to be partially a reflection of health care systems, especially when affected by the provision dimension. If the private ownership is maintained or promoted by health systems, these findings might be

  9. Primary health care in Canada: systems in motion.

    Science.gov (United States)

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

    2011-06-01

    During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

  10. Supersonic flows past an obstacle in Yukawa liquids

    Science.gov (United States)

    Charan, Harish; Ganesh, Rajaraman

    2018-04-01

    Shock formation, when a supersonic flow passes a stationary obstacle, is ubiquitous in nature. Considering particles mediating via a Yukawa-type interaction as a prototype for a strongly coupled complex plasma, characterized by coupling strength (Γ, ratio of the average potential to kinetic energy per particle) and screening parameter (κ, ratio of the mean inter-particle distance to the shielding length), we address the fundamental problem of supersonic fluid flow U0, past a stationary obstacle immersed in this strongly coupled system. We here report the results on the bow shocks formed in Yukawa liquids when the liquid flows at speeds larger than the speed of sound in the system. Depending on the values of Mach number MC L=U/0 CL , where CL is the longitudinal speed of sound in the system, the bow shocks are found to be either traveling or localized. We find that for the transonic flows (0.8 ≲ MC L≲ 1.2), the bow shocks travel in the upstream direction opposite to the incoming fluid. The phase velocity of the traveling bow shocks is found to be a non-monotonous function of κ, varying as ∝1 /k1.11 at a fixed value of Γ, and is found to be independent of Γ at a fixed value of κ. It is observed that for the flow values with MC L>1.5 , the shock waves do not travel in the upstream direction but instead form a stationary arc like structure around the obstacle. For the fluid flows with 1 ≲ MC L≲ 2.6 , secondary bow shocks are seen to emerge behind the stationary obstacle which travel in the downstream direction, and the phase velocity of these secondary bow shocks is found to be equal to that of the primary bow shocks.

  11. Strategic management of health care information systems: nurse managers' perceptions.

    Science.gov (United States)

    Lammintakanen, Johanna; Kivinen, Tuula; Saranto, Kaija; Kinnunen, Juha

    2009-01-01

    The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.

  12. Effects of Quality Improvement System for Child Care Centers

    Science.gov (United States)

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

    2011-01-01

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

  13. Localization of small obstacles in Stokes flow

    International Nuclear Information System (INIS)

    Caubet, Fabien; Dambrine, Marc

    2012-01-01

    We want to detect small obstacles immersed in a fluid flowing in a larger bounded domain Ω in the three-dimensional case. We assume that the fluid motion is governed by the steady-state Stokes equations. We make a measurement on a part of the exterior boundary ∂Ω and then take a Kohn–Vogelius approach to locate these obstacles. We use here the notion of the topological derivative in order to determine the number of objects and their rough locations. Thus we first establish an asymptotic expansion of the solution of the Stokes equations in Ω when we add small obstacles inside. Then, we use it to find a topological asymptotic expansion of the considered Kohn–Vogelius functional which gives us the formula of its topological gradient. Finally, we make some numerical simulations exploring the efficiency and the limits of this method. (paper)

  14. Unsupervised obstacle detection in driving environments using deep-learning-based stereovision

    KAUST Repository

    Dairi, Abdelkader; Harrou, Fouzi; Senouci, Mohamed; Sun, Ying

    2017-01-01

    A vision-based obstacle detection system is a key enabler for the development of autonomous robots and vehicles and intelligent transportation systems. This paper addresses the problem of urban scene monitoring and tracking of obstacles based on unsupervised, deep-learning approaches. Here, we design an innovative hybrid encoder that integrates deep Boltzmann machines (DBM) and auto-encoders (AE). This hybrid auto-encode (HAE) model combines the greedy learning features of DBM with the dimensionality reduction capacity of AE to accurately and reliably detect the presence of obstacles. We combine the proposed hybrid model with the one-class support vector machines (OCSVM) to visually monitor an urban scene. We also propose an efficient approach to estimating obstacles location and track their positions via scene densities. Specifically, we address obstacle detection as an anomaly detection problem. If an obstacle is detected by the OCSVM algorithm, then localization and tracking algorithm is executed. We validated the effectiveness of our approach by using experimental data from two publicly available dataset, the Malaga stereovision urban dataset (MSVUD) and the Daimler urban segmentation dataset (DUSD). Results show the capacity of the proposed approach to reliably detect obstacles.

  15. Unsupervised obstacle detection in driving environments using deep-learning-based stereovision

    KAUST Repository

    Dairi, Abdelkader

    2017-12-06

    A vision-based obstacle detection system is a key enabler for the development of autonomous robots and vehicles and intelligent transportation systems. This paper addresses the problem of urban scene monitoring and tracking of obstacles based on unsupervised, deep-learning approaches. Here, we design an innovative hybrid encoder that integrates deep Boltzmann machines (DBM) and auto-encoders (AE). This hybrid auto-encode (HAE) model combines the greedy learning features of DBM with the dimensionality reduction capacity of AE to accurately and reliably detect the presence of obstacles. We combine the proposed hybrid model with the one-class support vector machines (OCSVM) to visually monitor an urban scene. We also propose an efficient approach to estimating obstacles location and track their positions via scene densities. Specifically, we address obstacle detection as an anomaly detection problem. If an obstacle is detected by the OCSVM algorithm, then localization and tracking algorithm is executed. We validated the effectiveness of our approach by using experimental data from two publicly available dataset, the Malaga stereovision urban dataset (MSVUD) and the Daimler urban segmentation dataset (DUSD). Results show the capacity of the proposed approach to reliably detect obstacles.

  16. Overcoming obstacles against effective solar lighting interventions in South Asia

    International Nuclear Information System (INIS)

    Wong, Sam

    2012-01-01

    Basing on our devised World Bank’s ‘Design Principles’ for effective renewable energy projects in developing countries and an in-depth analysis of our two solar lighting projects in Bangladesh and India, this paper explores three key obstacles that constrain poor people from obtaining solar lighting: financial exclusion, weak governance, and passive NGO and customer participation. The low take-up rate has a social and psychological impact. This paper recommends creating easy access to credit, establishing a robust complaint system, and developing strategic partnership to overcome the obstacles. - Research Highlights: ► To provide a critical analysis of the World Bank's 'Design Principles' for renewable energy policies in developing countries. ► To explain why some solar lighting projects do not work and how the barriers can be overcome. ► To highlight the roles of poverty, governance and technical support in solar lighting design.

  17. Obstacle-avoiding robot with IR and PIR motion sensors

    Science.gov (United States)

    Ismail, R.; Omar, Z.; Suaibun, S.

    2016-10-01

    Obstacle avoiding robot was designed, constructed and programmed which may be potentially used for educational and research purposes. The developed robot will move in a particular direction once the infrared (IR) and the PIR passive infrared (PIR) sensors sense a signal while avoiding the obstacles in its path. The robot can also perform desired tasks in unstructured environments without continuous human guidance. The hardware was integrated in one application board as embedded system design. The software was developed using C++ and compiled by Arduino IDE 1.6.5. The main objective of this project is to provide simple guidelines to the polytechnic students and beginners who are interested in this type of research. It is hoped that this robot could benefit students who wish to carry out research on IR and PIR sensors.

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

    Science.gov (United States)

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

    2012-06-01

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

  19. TB case detection in Tajikistan – analysis of existing obstacles

    Directory of Open Access Journals (Sweden)

    Alexei Korobitsyn

    2013-10-01

    Full Text Available Background: Tajikistan National TB Control ProgramObjective: (1 To identify the main obstacles to increasing TB Detection in Tajikistan. (2 To identify interventions that improve TB detection.Methods: Review of the available original research data, health normative base, health systems performance and national economic data, following WHO framework for detection of TB cases, which is based on three scenarios of why incident cases of TB may not be notified.Results: Data analysis revealed that some aspects of TB case detection are more problematic than others and that there are gaps in the knowledge of specific obstacles to TB case detection. The phenomenon of “initial default” in Tajikistan has been documented; however, it needs to be studied further. The laboratory services detect infectious TB cases effectively; however, referrals of appropriate suspects for TB diagnosis may lag behind. The knowledge about TB in the general population has improved. Yet, the problem of TB related stigma persists, thus being an obstacle for effective TB detection. High economic cost of health services driven by under-the-table payments was identified as another barrier for access to health services.Conclusion: Health system strengthening should become a primary intervention to improve case detection in Tajikistan. More research on reasons contributing to the failure to register TB cases, as well as factors underlying stigma is needed.

  20. Student Obstacles in Solving Algebraic Thinking Problems

    Science.gov (United States)

    Andini, W.; Suryadi, D.

    2017-09-01

    The aim of this research is to analize the student obstacles on solving algebraic thinking problems in low grades elementary school. This research is a preliminary qualitative research, and involved 66 students of grade 3 elementary school. From the analysis student test results, most of student experience difficulty in solving algebraic thinking problems. The main obstacle is the student’s difficulty in understanding the problem of generalizing the pattern because the students are not accustomed to see the rules that exist in generalize the pattern.

  1. Wide-Baseline Stereo-Based Obstacle Mapping for Unmanned Surface Vehicles

    Science.gov (United States)

    Mou, Xiaozheng; Wang, Han

    2018-01-01

    This paper proposes a wide-baseline stereo-based static obstacle mapping approach for unmanned surface vehicles (USVs). The proposed approach eliminates the complicated calibration work and the bulky rig in our previous binocular stereo system, and raises the ranging ability from 500 to 1000 m with a even larger baseline obtained from the motion of USVs. Integrating a monocular camera with GPS and compass information in this proposed system, the world locations of the detected static obstacles are reconstructed while the USV is traveling, and an obstacle map is then built. To achieve more accurate and robust performance, multiple pairs of frames are leveraged to synthesize the final reconstruction results in a weighting model. Experimental results based on our own dataset demonstrate the high efficiency of our system. To the best of our knowledge, we are the first to address the task of wide-baseline stereo-based obstacle mapping in a maritime environment. PMID:29617293

  2. Adaptive Tracking and Obstacle Avoidance Control for Mobile Robots with Unknown Sliding

    Directory of Open Access Journals (Sweden)

    Mingyue Cui

    2012-11-01

    Full Text Available An adaptive control approach is proposed for trajectory tracking and obstacle avoidance for mobile robots with consideration given to unknown sliding. A kinematic model of mobile robots is established in this paper, in which both longitudinal and lateral sliding are considered and processed as three time-varying parameters. A sliding model observer is introduced to estimate the sliding parameters online. A stable tracking control law for this nonholonomic system is proposed to compensate the unknown sliding effect. From Lyapunov-stability analysis, it is proved, regardless of unknown sliding, that tracking errors of the controlled closed-loop system are asymptotically stable, the tracking errors converge to zero outside the obstacle detection region and obstacle avoidance is guaranteed inside the obstacle detection region. The efficiency and robustness of the proposed control system are verified by simulation results.

  3. Efficiency performance of China's health care delivery system.

    Science.gov (United States)

    Zhang, Luyu; Cheng, Gang; Song, Suhang; Yuan, Beibei; Zhu, Weiming; He, Li; Ma, Xiaochen; Meng, Qingyue

    2017-07-01

    Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system. Copyright © 2017 John Wiley & Sons, Ltd.

  4. Health care system in Sudan: review and analysis of Strength ...

    African Journals Online (AJOL)

    Health care system in Sudan: review and analysis of Strength, Weakness, Opportunity, and Threats (SWOT Analysis). Ebrahim M.A. Ebrahim, Luam Ghebrehiwot, Tasneem Abdalgfar, Muhammad Hanafiah Juni ...

  5. Corruption in the health care system: the circumstantial evidence.

    Science.gov (United States)

    Ibrahim, Joseph; Majoor, Jennifer

    2002-01-01

    Health care systems are under intense scrutiny, and there is an increasing emphasis on patient safety and quality of care in general. Evidence continues to emerge demonstrating that health systems are performing at sub-optimal levels. The evidence includes the under-use, over-use and mis-use of health care services; new standards asking for respect, dignity, honesty and transparency; the corporatization of health; and the existing inequalities in power and health outcomes. Recommendations for improving health care often refer to increasing the level of collaboration and consultation. These strategies are unlikely to remedy the root causes of our ailing health systems if we accept the circumstantial evidence that suggests the system is rotten.

  6. Requirements Engineering for a Pervasive Health Care System

    DEFF Research Database (Denmark)

    Jørgensen, Jens Bæk; Bossen, Claus

    2003-01-01

    We describe requirements engineering for a new pervasive health care system for hospitals in Denmark. The chosen requirements engineering approach composes iterative prototyping and explicit environment description in terms of workflow modelling. New work processes and their proposed computer...

  7. Systems modeling and simulation applications for critical care medicine

    Science.gov (United States)

    2012-01-01

    Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area. PMID:22703718

  8. Systems modeling and simulation applications for critical care medicine.

    Science.gov (United States)

    Dong, Yue; Chbat, Nicolas W; Gupta, Ashish; Hadzikadic, Mirsad; Gajic, Ognjen

    2012-06-15

    Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area.

  9. Enhancing Health-Care Services with Mixed Reality Systems

    Science.gov (United States)

    Stantchev, Vladimir

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

  10. HEALTH CARE SYSTEM AS AN OBJECT OF STATISTICAL RESEARCH

    Directory of Open Access Journals (Sweden)

    Pavel A. Smelov

    2015-01-01

    Full Text Available The article describes the health care system of the Russian Federation as anobject of statistical analysis. The features of accounting of the health system in Russia. The article highlights the key aspects of the health system, which is characterized as fully as possible the object of study.

  11. Audit Trail Management System in Community Health Care Information Network.

    Science.gov (United States)

    Nakamura, Naoki; Nakayama, Masaharu; Nakaya, Jun; Tominaga, Teiji; Suganuma, Takuo; Shiratori, Norio

    2015-01-01

    After the Great East Japan Earthquake we constructed a community health care information network system. Focusing on the authentication server and portal server capable of SAML&ID-WSF, we proposed an audit trail management system to look over audit events in a comprehensive manner. Through implementation and experimentation, we verified the effectiveness of our proposed audit trail management system.

  12. Development and innovation of system resources to optimize patient care.

    Science.gov (United States)

    Johnson, Thomas J; Brownlee, Michael J

    2018-04-01

    Various incremental and disruptive healthcare innovations that are occurring or may occur are discussed, with insights on how multihospital health systems can prepare for the future and optimize the continuity of patient care provided. Innovation in patient care is occurring at an ever-increasing rate, and this is especially true relative to the transition of patients through the care continuum. Health systems must leverage their ability to standardize and develop electronic health record (EHR) systems and other infrastructure necessary to support patient care and optimize outcomes; examples include 3D printing of patient-specific medication dosage forms to enhance precision medicine, the use of drones for medication delivery, and the expansion of telehealth capabilities to improve patient access to the services of pharmacists and other healthcare team members. Disruptive innovations in pharmacy services and delivery will alter how medications are prescribed and delivered to patients now and in the future. Further, technology may also fundamentally alter how and where pharmacists and pharmacy technicians care for patients. This article explores the various innovations that are occurring and that will likely occur in the future, particularly as they apply to multihospital health systems and patient continuity of care. Pharmacy departments that anticipate and are prepared to adapt to incremental and disruptive innovations can demonstrate value in the multihospital health system through strategies such as optimizing the EHR, identifying telehealth opportunities, supporting infrastructure, and integrating services. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  13. A clinician-driven home care delivery system.

    Science.gov (United States)

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

    1993-12-01

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

  14. Implementation of Obstacle-Avoidance Control for an Autonomous Omni-Directional Mobile Robot Based on Extension Theory

    Directory of Open Access Journals (Sweden)

    Yi-Chung Lai

    2012-10-01

    Full Text Available The paper demonstrates a following robot with omni-directional wheels, which is able to take action to avoid obstacles. The robot design is based on both fuzzy and extension theory. Fuzzy theory was applied to tune the PMW signal of the motor revolution, and correct path deviation issues encountered when the robot is moving. Extension theory was used to build a robot obstacle-avoidance model. Various mobile models were developed to handle different types of obstacles. The ultrasonic distance sensors mounted on the robot were used to estimate the distance to obstacles. If an obstacle is encountered, the correlation function is evaluated and the robot avoids the obstacle autonomously using the most appropriate mode. The effectiveness of the proposed approach was verified through several tracking experiments, which demonstrates the feasibility of a fuzzy path tracker as well as the extensible collision avoidance system.

  15. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

    Science.gov (United States)

    Monroe, C Douglas; Chin, Karen Y

    2013-05-01

    The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

  16. Dynamic Obstacle Avoidance for Unmanned Underwater Vehicles Based on an Improved Velocity Obstacle Method

    Directory of Open Access Journals (Sweden)

    Wei Zhang

    2017-11-01

    Full Text Available In view of a dynamic obstacle environment with motion uncertainty, we present a dynamic collision avoidance method based on the collision risk assessment and improved velocity obstacle method. First, through the fusion optimization of forward-looking sonar data, the redundancy of the data is reduced and the position, size and velocity information of the obstacles are obtained, which can provide an accurate decision-making basis for next-step collision avoidance. Second, according to minimum meeting time and the minimum distance between the obstacle and unmanned underwater vehicle (UUV, this paper establishes the collision risk assessment model, and screens key obstacles to avoid collision. Finally, the optimization objective function is established based on the improved velocity obstacle method, and a UUV motion characteristic is used to calculate the reachable velocity sets. The optimal collision speed of UUV is searched in velocity space. The corresponding heading and speed commands are calculated, and outputted to the motion control module. The above is the complete dynamic obstacle avoidance process. The simulation results show that the proposed method can obtain a better collision avoidance effect in the dynamic environment, and has good adaptability to the unknown dynamic environment.

  17. An assessment of auditory-guided locomotion in an obstacle circumvention task.

    Science.gov (United States)

    Kolarik, Andrew J; Scarfe, Amy C; Moore, Brian C J; Pardhan, Shahina

    2016-06-01

    This study investigated how effectively audition can be used to guide navigation around an obstacle. Ten blindfolded normally sighted participants navigated around a 0.6 × 2 m obstacle while producing self-generated mouth click sounds. Objective movement performance was measured using a Vicon motion capture system. Performance with full vision without generating sound was used as a baseline for comparison. The obstacle's location was varied randomly from trial to trial: it was either straight ahead or 25 cm to the left or right relative to the participant. Although audition provided sufficient information to detect the obstacle and guide participants around it without collision in the majority of trials, buffer space (clearance between the shoulder and obstacle), overall movement times, and number of velocity corrections were significantly (p < 0.05) greater with auditory guidance than visual guidance. Collisions sometime occurred under auditory guidance, suggesting that audition did not always provide an accurate estimate of the space between the participant and obstacle. Unlike visual guidance, participants did not always walk around the side that afforded the most space during auditory guidance. Mean buffer space was 1.8 times higher under auditory than under visual guidance. Results suggest that sound can be used to generate buffer space when vision is unavailable, allowing navigation around an obstacle without collision in the majority of trials.

  18. A novel artificial immune algorithm for spatial clustering with obstacle constraint and its applications.

    Science.gov (United States)

    Sun, Liping; Luo, Yonglong; Ding, Xintao; Zhang, Ji

    2014-01-01

    An important component of a spatial clustering algorithm is the distance measure between sample points in object space. In this paper, the traditional Euclidean distance measure is replaced with innovative obstacle distance measure for spatial clustering under obstacle constraints. Firstly, we present a path searching algorithm to approximate the obstacle distance between two points for dealing with obstacles and facilitators. Taking obstacle distance as similarity metric, we subsequently propose the artificial immune clustering with obstacle entity (AICOE) algorithm for clustering spatial point data in the presence of obstacles and facilitators. Finally, the paper presents a comparative analysis of AICOE algorithm and the classical clustering algorithms. Our clustering model based on artificial immune system is also applied to the case of public facility location problem in order to establish the practical applicability of our approach. By using the clone selection principle and updating the cluster centers based on the elite antibodies, the AICOE algorithm is able to achieve the global optimum and better clustering effect.

  19. A Novel Artificial Immune Algorithm for Spatial Clustering with Obstacle Constraint and Its Applications

    Directory of Open Access Journals (Sweden)

    Liping Sun

    2014-01-01

    Full Text Available An important component of a spatial clustering algorithm is the distance measure between sample points in object space. In this paper, the traditional Euclidean distance measure is replaced with innovative obstacle distance measure for spatial clustering under obstacle constraints. Firstly, we present a path searching algorithm to approximate the obstacle distance between two points for dealing with obstacles and facilitators. Taking obstacle distance as similarity metric, we subsequently propose the artificial immune clustering with obstacle entity (AICOE algorithm for clustering spatial point data in the presence of obstacles and facilitators. Finally, the paper presents a comparative analysis of AICOE algorithm and the classical clustering algorithms. Our clustering model based on artificial immune system is also applied to the case of public facility location problem in order to establish the practical applicability of our approach. By using the clone selection principle and updating the cluster centers based on the elite antibodies, the AICOE algorithm is able to achieve the global optimum and better clustering effect.

  20. [Obstacles perceived by nurses for evidence-based practice: a qualitative study].

    Science.gov (United States)

    Sánchez-García, Inmaculada; López-Medina, Isabel M; Pancorbo-Hidalgo, Pedro L

    2013-01-01

    To examine the obstacles perceived by nurses to implement an evidence-based clinical practice. A qualitative study through semi-structured interviews conducted in 2010-2011 including 11 nurses purposively selected from public hospitals and community centres in Jaén and Córdoba (Spain). A content analysis was performed, using Miles and Huberman as a reference and comprising the following steps: data reduction, data presentation, and data conclusion/verification. Data saturation was reached in these categories (obstacles). The obstacles perceived by nurses to introduce an evidence-based clinical practice (EBCP) were grouped into 3 major categories: obstacles related with professionals (routine-based practice, unwilling and stagnant attitudes, and lack of training in EBCP), obstacles related to the social context (reluctance from other professionals and from patients or families), and obstacles related to the organization (obsolete cultures that do not promote innovation in nursing care). This study highlights the persistence of various factors that hinder the use of research findings in clinical practice. The results underline the need to change the culture of healthcare organizations, to motivate professionals, and to break some of the resistance attitudes that hinder the implementation of evidence-based practice. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  1. Care and Conversing in Dialogical Systems

    DEFF Research Database (Denmark)

    Steffensen, Sune Vork

    2012-01-01

    positions, a theory of dialogical systems is developed, on the basis of current thinking within the enactive program (e.g. De Jaegher and Di Paolo, 2007), the distributed language movement (e.g. Cowley, 2011b), and values-realizing theory (e.g. Hodges, 2009). Dialogical systems are systems of co......This article promotes a point of view on human interaction in terms of dialogical systems. The approach draws on recent, so-called third wave, developments in cognitive science. After an introduction to three waves in cognitive science, and their counterparts in linguistics, the article is placed......-present human beings engaged in interactivity that bring forth situated behavioural coordination (or a communicative, structural coupling). Dialogical systems, however, have emergent properties irreducible to individual actions or microsocial norms. Among the emergent properties one find a tendency to establish...

  2. Visualizing news: obstacles, challenges, and solutions

    NARCIS (Netherlands)

    Dr. Piet Bakker; Gerard Smit; Yael de Haan; Laura Buijs

    2013-01-01

    Depicting news graphically is considered an apt way to deal with challenges of modern journalism: to disclose big data, and present news attractively, visually, and fast to grasp. This study delves into reported obstacles and challenges for the production of news visualizations. It focuses on the

  3. Obstacles to Gender Parity in Engineering Education

    Science.gov (United States)

    Rohatynskyj, Marta; Davidson, Valerie; Stiver, Warren; Hayward, Maren

    2008-01-01

    Low rates of women's enrolment in engineering programs has been identified as a global problem within the general concern to enable women to attain parity in education in all areas. A Western women in engineering meta-narrative is identified which contains a complex of obstacles that typify the situation of Western women. The question is asked…

  4. Recovering an obstacle using integral equations

    KAUST Repository

    Rundell, William

    2009-01-01

    . It is assumed that the physical situation is modelled by harmonic functions and the boundary condition on the obstacle is one of Dirichlet type. The purpose of this paper is to answer some of the questions raised in a recent paper that introduced a nonlinear

  5. Learn to Avoid or Overcome Leadership Obstacles

    Science.gov (United States)

    D'Auria, John

    2015-01-01

    Leadership is increasingly recognized as an important factor in moving schools forward, yet we have been relatively random in how we prepare and support them. Four obstacles often block or diminish their effectiveness. Avoiding or overcoming each of these requires an underlying set of skills and knowledge that we believe can be learned and…

  6. Simple Obstacle Avoidance Algorithm for Rehabilitation Robots

    NARCIS (Netherlands)

    Stuyt, Floran H.A.; Römer, GertWillem R.B.E.; Stuyt, Harry .J.A.

    2007-01-01

    The efficiency of a rehabilitation robot is improved by offering record-and-replay to operate the robot. While automatically moving to a stored target (replay) collisions of the robot with obstacles in its work space must be avoided. A simple, though effective, generic and deterministic algorithm

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

    Directory of Open Access Journals (Sweden)

    Menizibeya Osain Welcome

    2011-01-01

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

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

    Science.gov (United States)

    Orlando, Rocco; Haytaian, Marcia

    2012-08-01

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

  9. Western impressions of the Hong Kong health care system.

    Science.gov (United States)

    Bennett, C L; Pei, G K; Ultmann, J E

    1996-01-01

    Hong Kong, Taiwan, Singapore, and Malaysia are initiating health care reform to meet the changing demands of populations with improved socioeconomic status and access to modern technologies and who are living longer than in previous generations. Hong Kong, in particular, is facing a unique set of circumstances as its people prepare for the transition in 1997 from a British colony to a Special Administrative Region of China. While spending only 4% of its gross domestic product on health care, it has a large and regulated public hospital system for most inpatient medical care and a separate, loosely regulated private health care system for most outpatient medical care. In 1993 the Secretary for Health and Welfare of Hong Kong initiated a year-long process to debate the pros and cons of 5 fundamental programs for health care reform. After a year of open consultation, options were chosen. We describe the Hong Kong health care system, the fundamental changes that have been adopted, and lessons for reformers in the United States.

  10. System care improves trauma outcome: patient care errors dominate reduced preventable death rate.

    Science.gov (United States)

    Thoburn, E; Norris, P; Flores, R; Goode, S; Rodriguez, E; Adams, V; Campbell, S; Albrink, M; Rosemurgy, A

    1993-01-01

    A review of 452 trauma deaths in Hillsborough County, Florida, in 1984 documented that 23% of non-CNS trauma deaths were preventable and occurred because of inadequate resuscitation or delay in proper surgical care. In late 1988 Hillsborough County organized a County Trauma Agency (HCTA) to coordinate trauma care among prehospital providers and state-designated trauma centers. The purpose of this study was to review county trauma deaths after the inception of the HCTA to determine the frequency of preventable deaths. 504 trauma deaths occurring between October 1989 and April 1991 were reviewed. Through committee review, 10 deaths were deemed preventable; 2 occurred outside the trauma system. Of the 10 deaths, 5 preventable deaths occurred late in severely injured patients. The preventable death rate has decreased to 7.0% with system care. The causes of preventable deaths have changed from delayed or inadequate intervention to postoperative care errors.

  11. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System

    Science.gov (United States)

    Durant, Anne Foss; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California’s Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes. PMID:26828076

  12. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System.

    Science.gov (United States)

    Foss Durant, Anne; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.

  13. 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

  14. Experimental Investigation on the Detection of Obstacles by a Mobile Robot

    Directory of Open Access Journals (Sweden)

    Zoltan-Iosif Korka

    2017-06-01

    Full Text Available The paper presents an experimental investigation regarding the detection of obstacles in the workspace of a mobile robot. The traveling time of mobile robot on wheels, while moving on four with same length routes but with different shapes, was investigated. In this context, the average time to avoid an obstacle was determined, concluding with regard to the sensorial system of the robot.

  15. Caring for the Patient With Limited Systemic Scleroderma.

    Science.gov (United States)

    Lachner, Kelly Denise

    2016-01-01

    Systemic scleroderma (systemic sclerosis) is a rare, autoimmune, collagen-vascular disease of unknown etiology that affects the connective tissues of the skin, internal organs, as well as the small blood vessels. There are 3 subclasses of systemic scleroderma: limited cutaneous, diffuse cutaneous, and sine scleroderma. Prognosis depends on the extent of organ involvement. Complications of systemic scleroderma can involve the cardiovascular, pulmonary, gastrointestinal, renal, integumentary, and the skeletal-muscular systems. Because systemic scleroderma is not common, many orthopaedic nurses may be unfamiliar with how to best provide care. This article provides information about the complexity of the different types of this disease and the basic nursing care of the patient with the most common subclass of systemic scleroderma, limited cutaneous systemic scleroderma.

  16. From Diabetes Care to Diabetes Cure—The Integration of Systems Biology, eHealth, and Behavioral Change

    Directory of Open Access Journals (Sweden)

    Ben van Ommen

    2018-01-01

    Full Text Available From a biological view, most of the processes involved in insulin resistance, which drives the pathobiology of type 2 diabetes, are reversible. This theoretically makes the disease reversible and curable by changing dietary habits and physical activity, particularly when adopted early in the disease process. Yet, this is not fully implemented and exploited in health care due to numerous obstacles. This article reviews the state of the art in all areas involved in a diabetes cure-focused therapy and discusses the scientific and technological advancements that need to be integrated into a systems approach sustainable lifestyle-based healthcare system and economy. The implementation of lifestyle as cure necessitates personalized and sustained lifestyle adaptations, which can only be established by a systems approach, including all relevant aspects (personalized diagnosis and diet, physical activity and stress management, self-empowerment, motivation, participation and health literacy, all facilitated by blended care and ehealth. Introduction of such a systems approach in type 2 diabetes therapy not only requires a concerted action of many stakeholders but also a change in healthcare economy, with new winners and losers. A “call for action” is put forward to actually initiate this transition. The solution provided for type 2 diabetes is translatable to other lifestyle-related disorders.

  17. Studying integrated health care systems with a structurationist approach

    Science.gov (United States)

    Demers, Louis; Arseneault, Stéphane; Couturier, Yves

    2010-01-01

    Introduction To implement an integrated health care system is not an easy task and to ensure its sustainability is yet more difficult. Aim Discuss how a structurationist approach can shed light on the stakes of these processes and guide the managers of such endeavours. Theory and method Structuration theory [1] has been used by numerous authors to cast new light on complex organizational phenomena. One of the central tenets of this theory is that social systems, such as integrated health care systems, are recurrent social practices across time-space and are characterized by structural properties which simultaneously constrain and enable the constitutive social actors who reproduce and transform the system through their practices. We will illustrate our theoretical standpoint with empirical material gathered during the study of an integrated health care system for the frail elderly in Quebec, Canada. This system has been implemented in 1997 and is still working well in 2010. Results and conclusion To implement an integrated health care system that is both effective and sustainable, its managers must shrewdly allow for the existing system and progressively introduce changes in the way managers and practitioners at work in the system view their role and act on a daily basis.

  18. Closed-loop strategies for patient care systems.

    Science.gov (United States)

    Pauldine, Ronald; Beck, George; Salinas, Jose; Kaczka, David W

    2008-04-01

    Military operations, mass casualty events, and remote work sites present unique challenges to providers of immediate medical care, who may lack the necessary skills for optimal clinical management. Moreover, the number of patients in these scenarios may overwhelm available health care resources. Recent applications of closed-loop control (CLC) techniques to critical care medicine may offer possible solutions for such environments. Here, feedback of a monitored variable or group of variables is used to control the state or output of a dynamic system. Some potential advantages of CLC in patient management include limiting task saturation when there is simultaneous demand for cognitive and active clinical intervention, improving quality of care through optimization of the titration of medications, conserving limited consumable supplies, preventing secondary insults in traumatic brain injury, shortening the duration of mechanical ventilation, and achieving appropriate goal-directed resuscitation. The uses of CLC systems in critical care medicine have been increasingly explored across a wide range of therapeutic modalities. This review will provide an overview of control system theory as applied to critical care medicine that must be considered in the design of autonomous CLC systems, and introduce a number of clinical applications under development in the context of deployment of such applications to austere environments.

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

    Science.gov (United States)

    Barsanti, Sara; Nuti, Sabina

    2014-01-01

    The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the 'equity process' by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups. Copyright © 2013 John Wiley & Sons, Ltd.

  20. Automatic guidance and control laws for helicopter obstacle avoidance

    Science.gov (United States)

    Cheng, Victor H. L.; Lam, T.

    1992-01-01

    The authors describe the implementation of a full-function guidance and control system for automatic obstacle avoidance in helicopter nap-of-the-earth (NOE) flight. The guidance function assumes that the helicopter is sufficiently responsive so that the flight path can be readily adjusted at NOE speeds. The controller, basically an autopilot for following the derived flight path, was implemented with parameter values to control a generic helicopter model used in the simulation. Evaluation of the guidance and control system with a 3-dimensional graphical helicopter simulation suggests that the guidance has the potential for providing good and meaningful flight trajectories.

  1. [Information system for supporting the Nursing Care Systematization].

    Science.gov (United States)

    Malucelli, Andreia; Otemaier, Kelly Rafaela; Bonnet, Marcel; Cubas, Marcia Regina; Garcia, Telma Ribeiro

    2010-01-01

    It is an unquestionable fact, the importance, relevance and necessity of implementing the Nursing Care Systematization in the different environments of professional practice. Considering it as a principle, emerged the motivation for the development of an information system to support the Nursing Care Systematization, based on Nursing Process steps and Human Needs, using the diagnoses language, nursing interventions and outcomes for professional practice documentation. This paper describes the methodological steps and results of the information system development - requirements elicitation, modeling, object-relational mapping, implementation and system validation.

  2. Provider and systems factors in diabetes quality of care.

    Science.gov (United States)

    Ghaznavi, Kimia; Malik, Shaista

    2012-02-01

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

  3. Transitioning from learning healthcare systems to learning health care communities.

    Science.gov (United States)

    Mullins, C Daniel; Wingate, La'Marcus T; Edwards, Hillary A; Tofade, Toyin; Wutoh, Anthony

    2018-02-26

    The learning healthcare system (LHS) model framework has three core, foundational components. These include an infrastructure for health-related data capture, care improvement targets and a supportive policy environment. Despite progress in advancing and implementing LHS approaches, low levels of participation from patients and the public have hampered the transformational potential of the LHS model. An enhanced vision of a community-engaged LHS redesign would focus on the provision of health care from the patient and community perspective to complement the healthcare system as the entity that provides the environment for care. Addressing the LHS framework implementation challenges and utilizing community levers are requisite components of a learning health care community model, version two of the LHS archetype.

  4. Guidelines for Management Information Systems in Canadian Health Care Facilities

    Science.gov (United States)

    Thompson, Larry E.

    1987-01-01

    The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations. The MIS Guidelines were produced by the Management Information Systems (MIS) Project, a cooperative effort of the federal and provincial governments, provincial hospital/health associations, under the authority of the Canadian Federal/Provincial Advisory Committee on Institutional and Medical Services. The Guidelines are currently being implemented on a “test” basis in ten health care facilities across Canada and portions integrated in government reporting as finalized.

  5. Apparent motion perception in lower limb amputees with phantom sensations: "obstacle shunning" and "obstacle tolerance".

    Science.gov (United States)

    Saetta, Gianluca; Grond, Ilva; Brugger, Peter; Lenggenhager, Bigna; Tsay, Anthony J; Giummarra, Melita J

    2018-03-21

    Phantom limbs are the phenomenal persistence of postural and sensorimotor features of an amputated limb. Although immaterial, their characteristics can be modulated by the presence of physical matter. For instance, the phantom may disappear when its phenomenal space is invaded by objects ("obstacle shunning"). Alternatively, "obstacle tolerance" occurs when the phantom is not limited by the law of impenetrability and co-exists with physical objects. Here we examined the link between this under-investigated aspect of phantom limbs and apparent motion perception. The illusion of apparent motion of human limbs involves the perception that a limb moves through or around an object, depending on the stimulus onset asynchrony (SOA) for the two images. Participants included 12 unilateral lower limb amputees matched for obstacle shunning (n = 6) and obstacle tolerance (n = 6) experiences, and 14 non-amputees. Using multilevel linear models, we replicated robust biases for short perceived trajectories for short SOA (moving through the object), and long trajectories (circumventing the object) for long SOAs in both groups. Importantly, however, amputees with obstacle shunning perceived leg stimuli to predominantly move through the object, whereas amputees with obstacle tolerance perceived leg stimuli to predominantly move around the object. That is, in people who experience obstacle shunning, apparent motion perception of lower limbs was not constrained to the laws of impenetrability (as the phantom disappears when invaded by objects), and legs can therefore move through physical objects. Amputees who experience obstacle tolerance, however, had stronger solidity constraints for lower limb apparent motion, perhaps because they must avoid co-location of the phantom with physical objects. Phantom limb experience does, therefore, appear to be modulated by intuitive physics, but not in the same way for everyone. This may have important implications for limb experience post

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

    Science.gov (United States)

    Gunn, Jane M; Palmer, Victoria J; Dowrick, Christopher F; Herrman, Helen E; Griffiths, Frances E; Kokanovic, Renata; Blashki, Grant A; Hegarty, Kelsey L; Johnson, Caroline L; Potiriadis, Maria; May, Carl R

    2010-08-06

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

  7. Outlining a preventive oral health care system for China.

    Science.gov (United States)

    Saekel, Rüdiger

    2015-01-01

    The most recent Chinese health care reform, scheduled to run until 2020, has been underway for a number of years. Oral health care has not been explicitly mentioned in the context of this reform. However, oral health is an integral part of general health and the under-servicing of the Chinese population in the area of dental care is particularly high. The article describes how this problem could be addressed. Based on present scientific knowledge,specifically on evidence-based strategies and long-term empirical experience from Western industrialised countries, as well as findings from Chinese pilot studies, the author outlines a preventive oral health care system tailored specifically to the conditions prevailing in China. He describes the background and rationale for a clearly structured, preventive system and summarises the scientific cornerstones on which this concept is founded. The single steps of this model, that are adapted specifically to China, are presented so as to facilitate a critical discussion on the pros and cons of the approach. The author concludes that, by implementing preventive oral care, China could gradually reduce the under-servicing of great parts of the population with dental care that largely avoids dental disease and preserves teeth at a price that is affordable to both public health and patients. This approach would minimise the danger of starting a cycle of re-restorations, owing to outdated treatment methods. The proposal would both fit in well with and add to the current blueprint for Chinese health care reform.

  8. Social Workers' Role in the Canadian Mental Health Care System

    Science.gov (United States)

    Towns, Ashley M.; Schwartz, Karen

    2012-01-01

    Objective: Using Canadian survey data this research provides social workers in Canada with a better understanding of their role in the Canadian mental health care system. Methods: By analyzing data from the Canadian Community Health Survey, Cycle 1.2 Mental Health and Well-being, the role of social workers in the Canadian mental health system was…

  9. Structuring Community Care using Multi-Agent Systems

    Science.gov (United States)

    Beer, Martin D.

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

  10. Systems and processes that ensure high quality care.

    Science.gov (United States)

    Bassett, Sally; Westmore, Kathryn

    2012-10-01

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

  11. Systemic Inflammatory Reaction in Operative Gynecological Care

    Directory of Open Access Journals (Sweden)

    A. V. Pronoza

    2008-01-01

    Full Text Available Objective: to evaluate the impact of various methods of anesthesia and treatment on the development of a systemic inflammatory reaction (SIR in gynecological patients. Subjects and methods. The manifestations of SIR were studied in 426 patients who had undergone standard operations on the uterine appendages via traditional laparoscopic access. Ninety-seven women had unoptimized anesthetic maintenance and postoperative preventive antibacterial therapy (Group 1; 95 women had unop-timized anesthetic maintenance and pre- and postoperative massive antibacterial therapy (Group 2; 103 women had optimized anesthetic maintenance and preventive antibacterial therapy (Group 3; 131 women had optimized anesthetic maintenance and massive antibacterial therapy (Group 4. Results. Antibacterial therapy was not found to affect the manifestations of SIR significantly. The optimized anesthetic maintenance that differed from the unoptimized one in higher nociceptive defense had a considerable impact on the manifestation of SIR. Low molecular-weight heparins and preoperative hyperv-olemic hemodilution with hydroxyethyl starch preparations positively affected the study indices. The observed SIR belonged to the second stage of release of the small amount of mediators into systemic circulation. The transition of SIR to the third stage of inflammatory reaction generalization was suggested by changes in other monitored parameters, simultaneously informing about this or that degree of multiple organ dysfunction. Conclusion. Laparoscopic surgical intervention, multicom-ponent preoperative sedation, preventive preoperative analgesia with nonsteroidal anti-inflammatory drugs, prevention of microcirculatory disorders with low molecular-weight heparins, preoperative hypervolemic hemodilution with hydroxyethyl starch, and use of the loading doses of opioids in the period of induction to anesthesia in combination with propofol lower the level of a systemic inflammatory response

  12. Assessing the role of GPs in Nordic health care systems.

    Science.gov (United States)

    Quaye, Randolph K

    2016-05-03

    Purpose This paper examines the changing role of general practitioners (GPs) in Nordic countries of Sweden, Norway and Denmark. It aims to explore the "gate keeping" role of GPs in the face of current changes in the health care delivery systems in these countries. Design/methodology/approach Data were collected from existing literature, interviews with GPs, hospital specialists and representatives of Danish regions and Norwegian Medical Association. Findings The paper contends that in all these changes, the position of the GPs in the medical division of labor has been strengthened, and patients now have increased and broadened access to choice. Research limitations/implications Health care cost and high cancer mortality rates have forced Nordic countries of Sweden, Norway and Denmark to rethink their health care systems. Several attempts have been made to reduce health care cost through market reform and by strenghtening the position of GPs. The evidence suggests that in Norway and Denmark, right incentives are in place to achieve this goal. Sweden is not far behind. The paper has limitations of a small sample size and an exclusive focus on GPs. Practical implications Anecdotal evidence suggests that physicians are becoming extremely unhappy. Understanding the changing status of primary care physicians will yield valuable information for assessing the effectiveness of Nordic health care delivery systems. Social implications This study has wider implications of how GPs see their role as potential gatekeepers in the Nordic health care systems. The role of GPs is changing as a result of recent health care reforms. Originality/value This paper contends that in Norway and Denmark, right incentives are in place to strengthen the position of GPs.

  13. Mittag–Leffler's function, Vekua transform and an inverse obstacle scattering problem

    International Nuclear Information System (INIS)

    Ikehata, Masaru

    2010-01-01

    This paper studies a prototype of inverse obstacle scattering problems whose governing equation is the Helmholtz equation in two dimensions. An explicit method to extract information about the location and shape of unknown obstacles from the far-field operator with a fixed wave number is given. The method is based on an explicit construction of a modification of Mittag–Leffler's function via the Vekua transform and the study of the asymptotic behaviour; an explicit density in the Herglotz wavefunction that approximates the modification of Mittag–Leffler's function in the bounded domain surrounding unknown obstacles; a system of inequalities derived from Kirsch's factorization formula of the far-field operator. Then an indicator function which can be calculated from the far-field operator acting on the density is introduced. It is shown that the asymptotic behaviour of the indicator function yields information about the visible part of the exterior of the obstacles

  14. The Cuban health care system and factors currently undermining it.

    Science.gov (United States)

    Nayeri, K

    1995-08-01

    This paper explores the dynamics of health and health care in Cuba during a period of severe crisis by placing it within its economic, social, and political context using a comparative historical approach. It outlines Cuban achievements in health care as a consequence of the socialist transformations since 1959, noting the full commitment by the Cuban state, the planned economy, mass participation, and a self-critical, working class perspective as crucial factors. The roles of two external factors, the U.S. economic embargo and the Council of Mutual Economic Cooperation (CMEA), are explored in shaping the Cuban society and economy, including its health care system. It is argued that the former has hindered health efforts in Cuba. The role of the latter is more complex. While the CMEA was an important source for economic growth, Cuban relations with the Soviet bloc had a damaging effect on the development of socialism in Cuba. The adoption of the Soviet model of economic development fostered bureaucracy and demoralization of Cuban workers. As such, it contributed to two internal factors that have undermined further social progress including in health care: low productivity of labor and the growth of bureaucracy. While the health care system is still consistently supported by public policy and its structure is sound, economic crisis undermines its material and moral foundations and threatens its achievements. The future of the current Cuban health care system is intertwined with the potentials for its socialist development.

  15. The Influence of Topographic Obstacles on Basaltic Lava Flow Morphologies

    Science.gov (United States)

    von Meerscheidt, H. C.; Brand, B. D.; deWet, A. P.; Bleacher, J. E.; Hamilton, C. W.; Samuels, R.

    2014-12-01

    Smooth pāhoehoe and jagged ´áā represent two end-members of a textural spectrum that reflects the emplacement characteristics of basaltic lava flows. However, many additional textures (e.g., rubbly and slabby pāhoehoe) reflect a range of different process due to lava flow dynamics or interaction with topography. Unfortunately the influence of topography on the distribution of textures in basaltic lava flows is not well-understood. The 18 ± 1.0 ka Twin Craters lava flow in the Zuni-Bandera field (New Mexico, USA) provides an excellent site to study the morphological changes of a lava flow that encountered topographic obstacles. The flow field is 0.2-3.8 km wide with a prominent central tube system that intersects and wraps around a 1000 m long ridge, oriented perpendicular to flow. Upstream of the ridge, the flow has low-relief inflation features extending out and around the ridge. This area includes mildly to heavily disrupted pāhoehoe with interdispersed agglutinated masses, irregularly shaped rubble and lava balls. Breakouts of ´áā and collapse features are also common. These observations suggest crustal disruption due to flow-thickening upstream from the ridge and the movement of lava out and around the obstacle. While the ridge influenced the path of the tube, which wraps around the southern end of the ridge, the series of collapse features and breakouts of ´áā along the tube system are more likely a result of changes in flux throughout the tube system because these features are found both upstream and downstream of the obstacle. This work demonstrates that topography can significantly influence the formation history and surface disruption of a flow field, and in some cases the influence of topography can be separated from the influences of changes in flux along a tube system.

  16. Comparative effectiveness of the SNaP™ Wound Care System.

    Science.gov (United States)

    Hutton, David W; Sheehan, Peter

    2011-04-01

    Diabetic lower extremity wounds cause substantial burden to healthcare systems, costing tens of thousands of dollars per episode. Negative pressure wound therapy (NPWT) devices have been shown to be cost-effective at treating these wounds, but the traditional devices use bulky electrical pumps that require a durable medical equipment rental-based procurement process. The Spiracur SNaP™ Wound Care System is an ultraportable NPWT system that does not use an electric pump and is fully disposable. It has superior healing compared to standard of care with modern dressings and comparable healing to traditional NPWT devices while giving patients greater mobility and giving clinicians a simpler procurement process. We used a mathematical model to analyse the costs of the SNaP™ system and compare them to standard of care and electrically powered NPWT devices. When compared to standard of care, the SNaP™ system saves over $9000 per wound treated and more than doubles the number of patients healed. The SNaP system has similar healing time to powered NPWT devices, but saves $2300 in Medicare payments or $2800 for private payers per wound treated. Our analysis shows that the SNaP™ system could save substantial treatment costs in addition to allowing patients greater freedom and mobility. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  17. Impact Of Health Care Delivery System Innovations On Total Cost Of Care.

    Science.gov (United States)

    Smith, Kevin W; Bir, Anupa; Freeman, Nikki L B; Koethe, Benjamin C; Cohen, Julia; Day, Timothy J

    2017-03-01

    Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation's Health Care Innovations Awards. The innovations' impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information technology or community health workers achieved the greatest cost savings. Savings were also relatively large in programs that targeted clinically fragile patients-clinically complex populations at risk for disease progression. While the magnitude of these effects was often substantial, none achieved conventional levels of significance in our analyses. Meta-analyses of a larger number of delivery system innovations are needed to more clearly establish their potential for patient care cost savings. Project HOPE—The People-to-People Health Foundation, Inc.

  18. Bi-stability in cooperative transport by ants in the presence of obstacles.

    Directory of Open Access Journals (Sweden)

    Jonathan E Ron

    2018-05-01

    Full Text Available To cooperatively carry large food items to the nest, individual ants conform their efforts and coordinate their motion. Throughout this expedition, collective motion is driven both by internal interactions between the carrying ants and a response to newly arrived informed ants that orient the cargo towards the nest. During the transport process, the carrying group must overcome obstacles that block their path to the nest. Here, we investigate the dynamics of cooperative transport, when the motion of the ants is frustrated by a linear obstacle that obstructs the motion of the cargo. The obstacle contains a narrow opening that serves as the only available passage to the nest, and through which single ants can pass but not with the cargo. We provide an analytical model for the ant-cargo system in the constrained environment that predicts a bi-stable dynamic behavior between an oscillatory mode of motion along the obstacle and a convergent mode of motion near the opening. Using both experiments and simulations, we show how for small cargo sizes, the system exhibits spontaneous transitions between these two modes of motion due to fluctuations in the applied force on the cargo. The bi-stability provides two possible problem solving strategies for overcoming the obstacle, either by attempting to pass through the opening, or take large excursions to circumvent the obstacle.

  19. Digital remote viewing system for coronary care unit

    International Nuclear Information System (INIS)

    Cho, P.S.; Tillisch, J.; Huang, H.K.

    1987-01-01

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

  20. Co-Creating an Expansive Health Care Learning System.

    Science.gov (United States)

    Cribb, Alan; Owens, John; Singh, Guddi

    2017-11-01

    How should practices of co-creation be integrated into health professions education? Although co-creation permits a variety of interpretations, we argue that realizing a transformative vision of co-creation-one that invites professionals to genuinely reconsider the purposes, relationships, norms, and priorities of health care systems through new forms of collaborative thought and practice-will require radically rethinking existing approaches to professional education. The meaningful enactment of co-creative roles and practices requires health professionals and students to negotiate competing traditions, pressures, and expectations. We therefore suggest that the development of what we call an "expansive health care learning system" is crucial for supporting learners in meeting the challenges of establishing genuinely co-creative health care systems. © 2017 American Medical Association. All Rights Reserved.

  1. Anthropometric record to be used in Centers for Family Health Support: possibilities and obstacles

    Directory of Open Access Journals (Sweden)

    Camila Fabiana Rossi Squarcini

    2015-02-01

    Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2015v17n2p248   A model of an anthropometric record to be used in the Núcleos de Apoio à Saúde da Família (Centers for Family Health Support in Brazil has been proposed in the literature, showing the logistics of use. The aim of this study was to discuss the anthropometric record, showing the potential and obstacles of its use. It was observed that, for adults, the screening measures (body mass index and waist circumference for the determination of the risk of cardiovascular and metabolic diseases can be considered promising, although the Basic Health Care network already uses these measures. Nevertheless, the supplementary assessment (skinfold thickness and body circumferences could be another potential possibility, except for the time spent to perform this assessment and the lack of studies of the cost-benefit of these anthropometric techniques. It was concluded that the anthropometric record proposed is an important instrument for improving the quality of the service provided to users of the Basic Health Care System; however, some adjustments, such as the removal of skinfold measurements as part of primary care, should be taken into consideration.

  2. Obstacles Facing the Iranian Basketball Academy

    OpenAIRE

    Hamta Hadian; Mohamad Reza Boroumand; Saeed Amirnejad; Masoud Najafi

    2016-01-01

    This study, which is a strategic study with a mixed research approach aimed to identify obstacles facing the academies of Iranian Basketball Federation. The population comprises board of directors and committees responsible for Education and Talent Spotting Association, academy administrators, physical education instructors, qualified experts, professors, coaches, referees and heads of delegations who were asked via interviews and questionnaire (exploratory manner) to state internal and exter...

  3. Clustering with Obstacles in Spatial Databases

    OpenAIRE

    El-Zawawy, Mohamed A.; El-Sharkawi, Mohamed E.

    2009-01-01

    Clustering large spatial databases is an important problem, which tries to find the densely populated regions in a spatial area to be used in data mining, knowledge discovery, or efficient information retrieval. However most algorithms have ignored the fact that physical obstacles such as rivers, lakes, and highways exist in the real world and could thus affect the result of the clustering. In this paper, we propose CPO, an efficient clustering technique to solve the problem of clustering in ...

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

    Science.gov (United States)

    Forgionne, G A

    1991-01-01

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

  5. Obstacle detection and avoiding of quadcopter

    Science.gov (United States)

    Wang, Dizhong; Lin, Jiajian

    2017-10-01

    Recent years, the flight control technology over quadcopter has been boosted vigorously and acquired the comprehensive application in a variety of industries. However, it is prominent for there to be problems existed in the stable and secure flight with the development of its autonomous flight. Through comparing with the characteristics of ultrasonic ranging and laser Time-of-Flight(abbreviated to ToF) distance as well as vision measurement and its related sensors, the obstacle detection and identification sensors need to be installed in order to effectively enhance the safety flying for aircraft, which is essential for avoiding the dangers around the surroundings. That the major sensors applied to objects perception at present are distance measuring instruments which based on the principle and application of non-contact detection technology . Prior to acknowledging the general principles of flight and obstacle avoiding, the aerodynamics modeling of the quadcopter and its object detection means has been initially determined on this paper. Based on such premise, this article emphasized on describing and analyzing the research on obstacle avoiding technology and its application status, and making an expectation for the trend of its development after analyzing the primary existing problems concerning its accuracy object avoidance.

  6. Assessing the contribution of the dental care delivery system to oral health care disparities.

    Science.gov (United States)

    Pourat, Nadereh; Andersen, Ronald M; Marcus, Marvin

    2015-01-01

    Existing studies of disparities in access to oral health care for underserved populations often focus on supply measures such as number of dentists. This approach overlooks the importance of other aspects of the dental care delivery system, such as personal and practice characteristics of dentists, that determine the capacity to provide care. This study aims to assess the role of such characteristics in access to care of underserved populations. We merged data from the 2003 California Health Interview Survey and a 2003 survey of California dentists in their Medical Study Service Areas (MSSAs). We examined the role of overall supply and other characteristics of dentists in income and racial/ethnic disparities in access, which was measured by annual dental visits and unmet need for dental care due to costs. We found that some characteristics of MSSAs, including higher proportions of dentists who were older, white, busy or overworked, and did not accept public insurance or discounted fees, inhibited access for low-income and minority populations. These findings highlight the importance of monitoring characteristics of dentists in addition to traditional measures of supply such as licensed-dentist-to-population ratios. The findings identify specific aspects of the delivery system such as dentists' participation in Medicaid, provision of discounted care, busyness, age, race/ethnicity, and gender that should be regularly monitored. These data will provide a better understanding of how the dental care delivery system is organized and how this knowledge can be used to develop more narrowly targeted policies to alleviate disparities. © 2014 American Association of Public Health Dentistry.

  7. PALLIATIVE CARE – ITS ROLE IN HEALTHCARE SYSTEMS

    Directory of Open Access Journals (Sweden)

    Urška Lunder

    2003-11-01

    Full Text Available Background. In the last decades a palliative care has been well established in the majority of West European countries. However, majority of these countries are not able to follow needs for palliative care because of demographic changes (older population, changes of morbidity pattern (increase of chronic progressive diseases and social changes (disability of families to care for their relatives at their homes. Research is showing evidence on palliative care effectiveness at end of life and in bereavement. There is still a great need for healthcare professionals’ change in their attitudes, knowledge and skills. In many National strategic plans (United Kingdom, Ireland, Sweden, Australia, New Zealand and Canada palliative care becomes a priority in the national public health. New organizational planning supports establishement of palliative care departments in hospitals and other healthcare settings and consultant teams at all levels of healthcare system. Hospices, caritative and independent organizations, will remain as a source of good clinical practice and philosophy of care at the end of life also in the future.

  8. Four proposals for market-based health care system reform.

    Science.gov (United States)

    Sumner, W

    1994-08-01

    A perfectly free, competitive medical market would not meet many social goals, such as universal access to health care. Micromanagement of interactions between patients and providers does not guarantee quality care and frequently undermines that relationship, to the frustration of all involved. Furthermore, while some North American health care plans are less expensive than others, none have reduced the medical inflation rate to equal the general inflation rate. Markets have always fixed uneven inflation rates in other domains. The suggested reforms could make elective interactions between patients and providers work more like a free market than did any preceding system. The health and life insurance plan creates cost-sensitive consumers, informed by a corporation with significant research incentives and abilities. The FFEB proposal encourages context-sensitive pricing, established by negotiation processes that weigh labor and benefit. Publication of providers' expected outcomes further enriches the information available to consumers and may reduce defensive medicine incentives. A medical career ladder would ease entry and exit from medical professions. These and complementary reforms do not specifically cap spending yet could have a deflationary impact on elective health care prices, while providing incentives to maintain quality. They accomplish these ends by giving more responsibility, information, incentives, and choice to citizens. We could provide most health care in a marketlike environment. We can incorporate these reforms in any convenient order and allow them to compete with alternative schemes. Our next challenge is to design, implement, and evaluate marketlike health care systems.

  9. An intelligent partner system for improving chronic illness care

    Directory of Open Access Journals (Sweden)

    Tibor Deutsch

    2003-02-01

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

  10. [Interpretation in the Danish health-care system].

    Science.gov (United States)

    Lund Hansen, Marianne Taulo; Nielsen, Signe Smith

    2013-03-04

    Communication between health professional and patient is central for treatment and patient safety in the health-care system. This systematic review examines the last ten years of specialist literature concerning interpretation in the Danish health-care system. Structural search in two databases, screening of references and recommended literature from two scientists led to identification of seven relevant articles. The review showed that professional interpreters were not used consistently when needed. Family members were also used as interpreters. These results were supported by international investigations.

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

    Science.gov (United States)

    Davies, George

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

  12. Exposure management systems in emergencies as comprehensive medical care

    International Nuclear Information System (INIS)

    Shinohara, Teruhiko

    2000-01-01

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

  13. Patient Experienced Continuity of Care in the Psychiatric Healthcare System

    DEFF Research Database (Denmark)

    Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne

    2014-01-01

    Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse...... migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry......, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups...

  14. Intelligent Surveillance Robot with Obstacle Avoidance Capabilities Using Neural Network

    Directory of Open Access Journals (Sweden)

    Widodo Budiharto

    2015-01-01

    Full Text Available For specific purpose, vision-based surveillance robot that can be run autonomously and able to acquire images from its dynamic environment is very important, for example, in rescuing disaster victims in Indonesia. In this paper, we propose architecture for intelligent surveillance robot that is able to avoid obstacles using 3 ultrasonic distance sensors based on backpropagation neural network and a camera for face recognition. 2.4 GHz transmitter for transmitting video is used by the operator/user to direct the robot to the desired area. Results show the effectiveness of our method and we evaluate the performance of the system.

  15. Obstacle Avoidance of a Mobile Robot with Hierarchical Structure

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Gyu [Yeungnam College of Science and Technolgy, Taegu (Korea)

    2001-06-01

    This paper proposed a new hierarchical fuzzy-neural network algorithm for navigation of a mobile robot within unknown dynamic environment. Proposed navigation algorithm used the learning ability of the neural network and the feasibility of control highly nonlinear system of fuzzy theory. The proposed navigation algorithm used fuzzy algorithm for goal approach and fuzzy-network for effective collision avoidance. Some computer simulation results for a mobile robot equipped with ultrasonic range sensors show that the suggested navigation algorithm is very effective to escape in stationary and moving obstacles environment. (author). 11 refs., 14 figs., 2 tabs.

  16. [Perceptions of primary care physicians in Madrid on the austerity measures in the health care system].

    Science.gov (United States)

    Heras-Mosteiro, Julio; Otero-García, Laura; Sanz-Barbero, Belén; Aranaz-Andrés, Jesús María

    2016-01-01

    To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

  17. Scaling Lean in primary care: impacts on system performance.

    Science.gov (United States)

    Hung, Dorothy Y; Harrison, Michael I; Martinez, Meghan C; Luft, Harold S

    2017-03-01

    We examined a wide range of performance outcomes after Lean methodology-a leading strategy to enhance efficiency and patient value-was implemented and scaled across all primary care clinics in a nonprofit, ambulatory care delivery system. Using a stepped wedge approach, we assessed changes associated with the phased introduction of Lean-based redesigns across 46 primary care departments in 17 different clinic locations. Longitudinal analysis of operational metrics included: workflow efficiency, physician productivity, operating expenses, clinical quality, and satisfaction among patients, physicians, and staff. We used interrupted time series analysis with generalized linear mixed models to estimate Lean impacts over time. Projected outcomes in the absence of changes (ie, counterfactuals) were compared with observed outcomes after Lean redesigns were implemented, and mean differences were assessed using 95% bias-corrected bootstrap confidence intervals (CIs). We observed systemwide improvements in workflow efficiencies (eg, 95% CI, 5.8-10.4) and physician productivity (95% CI, 3.9-27.2), with no adverse effects on clinical quality. Patient satisfaction increased with respect to access to care (95% CI, 15.2-20.7), handling of personal issues (95% CI, 2.1-6.9), and overall experience of care (95% CI, 11.0-17.0), but decreased with respect to interactions with care providers (95% CI, -13.4 to -5.7). Departmental operating costs decreased, and annual staff and physician satisfaction scores increased particularly among early adopters, with key improvements in employee engagement, connection to purpose, relationships with staff, and physician time spent working. Lean redesigns can benefit primary care patients, physicians, and staff without negatively impacting the quality of clinical care. Study results may lead other delivery system leaders to innovate using Lean techniques and may further enhance support for Lean learning among public and private payers.

  18. Obstacles: their impact on thinking and beyond thinking

    NARCIS (Netherlands)

    Marguc, J.; van Kleef, G.A.; Förster, J.; Contreras, D.A.

    2010-01-01

    People encounter myriads of obstacles throughout their lives. Those can be big or small, such as a fallen tree blocking the road to work or life circumstances that make it hard for an adolescent to obtain a university degree. What are the effects of such obstacles? Could it be that obstacles have an

  19. Pressures on the dental care system in the United States.

    Science.gov (United States)

    Wotman, S; Goldman, H

    1982-07-01

    A number of significant pressures are creating tensions in the dental profession and the dental care delivery system. These pressures may be categorized in five major areas: 1) regulation and deregulation pressures involve changes in the state dental practice acts, court decisions concerning antitrust and advertising, and the inclusion of consumers on State professional regulatory boards; 2) cost of services includes factors involving the out-of-pocket cost of dental care and the growth of dental insurance; 3) dentist-related factors include the increased number of dentists and the indebtedness of dental graduates; 4) the pressures of changes in the American populations include the decline in population growth and the increase in proportion of elderly people; 5) changes in the distribution of dental care are based on new epidemiologic data concerning dental caries and progress in the prevention of periodontal disease. Many of these pressures are inducing competition in the dental care system. It is clear that the dental care system is in the process of change as it responds to these complex pressures.

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

    Science.gov (United States)

    Feagin, Joe; Bennefield, Zinobia

    2014-02-01

    This article draws upon a major social science theoretical approach-systemic racism theory-to assess decades of empirical research on racial dimensions of U.S. health care and public health institutions. From the 1600s, the oppression of Americans of color has been systemic and rationalized using a white racial framing-with its constituent racist stereotypes, ideologies, images, narratives, and emotions. We review historical literature on racially exploitative medical and public health practices that helped generate and sustain this racial framing and related structural discrimination targeting Americans of color. We examine contemporary research on racial differentials in medical practices, white clinicians' racial framing, and views of patients and physicians of color to demonstrate the continuing reality of systemic racism throughout health care and public health institutions. We conclude from research that institutionalized white socioeconomic resources, discrimination, and racialized framing from centuries of slavery, segregation, and contemporary white oppression severely limit and restrict access of many Americans of color to adequate socioeconomic resources-and to adequate health care and health outcomes. Dealing justly with continuing racial "disparities" in health and health care requires a conceptual paradigm that realistically assesses U.S. society's white-racist roots and contemporary racist realities. We conclude briefly with examples of successful public policies that have brought structural changes in racial and class differentials in health care and public health in the U.S. and other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. A computerized decision support system for depression in primary care.

    Science.gov (United States)

    Kurian, Benji T; Trivedi, Madhukar H; Grannemann, Bruce D; Claassen, Cynthia A; Daly, Ella J; Sunderajan, Prabha

    2009-01-01

    In 2004, results from The Texas Medication Algorithm Project (TMAP) showed better clinical outcomes for patients whose physicians adhered to a paper-and-pencil algorithm compared to patients who received standard clinical treatment for major depressive disorder (MDD). However, implementation of and fidelity to the treatment algorithm among various providers was observed to be inadequate. A computerized decision support system (CDSS) for the implementation of the TMAP algorithm for depression has since been developed to improve fidelity and adherence to the algorithm. This was a 2-group, parallel design, clinical trial (one patient group receiving MDD treatment from physicians using the CDSS and the other patient group receiving usual care) conducted at 2 separate primary care clinics in Texas from March 2005 through June 2006. Fifty-five patients with MDD (DSM-IV criteria) with no significant difference in disease characteristics were enrolled, 32 of whom were treated by physicians using CDSS and 23 were treated by physicians using usual care. The study's objective was to evaluate the feasibility and efficacy of implementing a CDSS to assist physicians acutely treating patients with MDD compared to usual care in primary care. Primary efficacy outcomes for depression symptom severity were based on the 17-item Hamilton Depression Rating Scale (HDRS(17)) evaluated by an independent rater. Patients treated by physicians employing CDSS had significantly greater symptom reduction, based on the HDRS(17), than patients treated with usual care (P < .001). The CDSS algorithm, utilizing measurement-based care, was superior to usual care for patients with MDD in primary care settings. Larger randomized controlled trials are needed to confirm these findings. clinicaltrials.gov Identifier: NCT00551083.

  2. Towards systemic sustainable performance of TBI care systems: emergency leadership frontiers.

    Science.gov (United States)

    Caro, Denis H J

    2010-11-10

    Traumatic brain injuries (TBIs) continue as a twenty-first century subterranean and almost invisible scourge internationally. TBI care systems provide a safety net for survival, recovery, and reintegration into social communities from this scourge, particularly in Canada, the European Union, and the USA. This paper examines the underlying issues of systemic performance and sustainability of TBI care systems, in the light of decreasing care resources and increasing demands for services. This paper reviews the extant literature on TBI care systems, systems reengineering, and emergency leadership literature. This paper presents a seven care layer paradigm, which forms the essence of systemic performance in the care of patients with TBIs. It also identifies five key strategic drivers that hold promise for the future systemic sustainability of TBI care systems. Transformational leadership and engagement from the international emergency medical community is the key to generating positive change. The sustainability/performance care framework is relevant and pertinent for consideration internationally and in the context of other emergency medical populations.

  3. Health system strategies supporting transition to adult care.

    Science.gov (United States)

    Hepburn, Charlotte Moore; Cohen, Eyal; Bhawra, Jasmin; Weiser, Natalie; Hayeems, Robin Z; Guttmann, Astrid

    2015-06-01

    The transition from paediatric to adult care is associated with poor clinical outcomes, increased costs and low patient and family satisfaction. However, little is known about health system strategies to streamline and safeguard care for youth transitioning to adult services. Moreover, the needs of children and youth are often excluded from broader health system reform discussions, leaving this population especially vulnerable to system 'disintegration'. (1) To explore the international policy profile of paediatric-to-adult care transitions, and (2) to document policy objectives, initiatives and outcomes for jurisdictions publicly committed to addressing transition issues. An international policy scoping review of all publicly available government documents detailing transition-related strategies was completed using a web-based search. Our analysis included a comparable cohort of nine wealthy Organisation for Economic Co-operation and Development (OECD) jurisdictions with Beveridge-style healthcare systems (deemed those most likely to benefit from system-level transition strategies). Few jurisdictions address transition of care issues in either health or broader social policy documents. While many jurisdictions refer to standardised practice guidelines, a few report the intention to use powerful policy levers (including physician remuneration and non-physician investments) to facilitate the uptake of best practice. Most jurisdictions do not address the policy infrastructure required to support successful transitions, and rigorous evaluations of transition strategies are rare. Despite the well-documented risks and costs associated with a poor transition from paediatric to adult care, little policy attention has been paid to this issue. We recommend that healthcare providers engage health system planners in the design and evaluation of system-level, policy-sensitive transition strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not

  4. Integrated Health Care Systems and Indigenous Medicine: Reflections from the Sub-Sahara African Region

    Directory of Open Access Journals (Sweden)

    Beth Maina Ahlberg

    2017-09-01

    Full Text Available Indigenous or traditional medicine has, since the 1970s, been widely regarded as a resource likely to contribute to strengthening the health care systems in low income countries. This paper examines the state of traditional medicine using evidence from three case studies in Central Kenya. While the cases are too few to represent the broad diversity of cultures and related healing systems in the Sub-Sahara African Region, the way they seem to refute the main assumptions in the integration discourse is important, also because studies from other countries in the region report perspectives, similar to the case studies in Kenya. It is often argued that people continue to use traditional medicine because it is affordable, available, and culturally familiar. Its integration into the health care system would therefore promote cultural familiarity. The case studies however point to the loss of essential cultural elements central to traditional medicine in this particular area while users travel long distances to reach the healers. In addition, there are significant paradigm differences that may present obstacles to integration of the two systems. More problematic however is that integration is, as in many development interventions, a top-down policy that is rarely based on contextual realities and conditions. Instead, integration is often defined and dominated by biomedical professionals and health planners who may be unfamiliar or even hostile to some aspects of traditional medicine. Furthermore, integration efforts have tended to embrace selected components mostly herbal medicine. This has led to isolating herbal medicine from spiritualism, which may in turn affect the holistic perspective of traditional medicine. While familiarity and relevance may explain the continued use of traditional medicine, its services may not be as readily available, accessible, or even affordable as is often asserted. Globalization set in motion through colonization and

  5. Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems.

    Science.gov (United States)

    2014-05-01

    Understanding a care coordination framework, its functions, and its effects on children and families is critical for patients and families themselves, as well as for pediatricians, pediatric medical subspecialists/surgical specialists, and anyone providing services to children and families. Care coordination is an essential element of a transformed American health care delivery system that emphasizes optimal quality and cost outcomes, addresses family-centered care, and calls for partnership across various settings and communities. High-quality, cost-effective health care requires that the delivery system include elements for the provision of services supporting the coordination of care across settings and professionals. This requirement of supporting coordination of care is generally true for health systems providing care for all children and youth but especially for those with special health care needs. At the foundation of an efficient and effective system of care delivery is the patient-/family-centered medical home. From its inception, the medical home has had care coordination as a core element. In general, optimal outcomes for children and youth, especially those with special health care needs, require interfacing among multiple care systems and individuals, including the following: medical, social, and behavioral professionals; the educational system; payers; medical equipment providers; home care agencies; advocacy groups; needed supportive therapies/services; and families. Coordination of care across settings permits an integration of services that is centered on the comprehensive needs of the patient and family, leading to decreased health care costs, reduction in fragmented care, and improvement in the patient/family experience of care. Copyright © 2014 by the American Academy of Pediatrics.

  6. Role of curvatures in determining the characteristics of a string vibrating against a doubly curved obstacle

    Science.gov (United States)

    Singh, Harkirat; Wahi, Pankaj

    2017-08-01

    The motion of a string in the presence of a doubly curved obstacle is investigated. A mathematical model has been developed for a general shape of the obstacle. However, detailed analysis has been performed for a shape relevant to the Indian stringed musical instruments like Tanpura and Sitar. In particular, we explore the effect of obstacle's curvature in the plane perpendicular to the string axis on its motion. This geometrical feature of the obstacle introduces a coupling between motions in mutually perpendicular directions over and above the coupling due to the stretching nonlinearity. We find that only one planar motion is possible for our system. Small amplitude planar motions are stable to perturbations in the perpendicular direction resulting in non-whirling motions while large amplitude oscillations lead to whirling motions. The critical amplitude of oscillations, across which there is a transition in the qualitative behavior of the non-planar trajectories, is determined using Floquet theory. Our analysis reveals that a small obstacle curvature in a direction perpendicular to the string axis leads to a considerable reduction in the critical amplitudes required for initiation of whirling motions. Hence, this obstacle curvature has a destabilizing effect on the planar motions in contrast to the curvature along the string axis which stabilizes planar motions.

  7. Monte Carlo simulations of protein micropatterning in biomembranes: effects of immobile sticky obstacles

    International Nuclear Information System (INIS)

    Arnold, Andreas M; Sevcsik, Eva; Schütz, Gerhard J

    2016-01-01

    Single molecule trajectories of lipids and proteins can yield valuable information about the nanoscopic organization of the plasma membrane itself. The interpretation of such trajectories, however, is complicated, as the mobility of molecules can be affected by the presence of immobile obstacles, and the transient binding of the tracers to these obstacles. We have previously developed a micropatterning approach that allows for immobilizing a plasma membrane protein and probing the diffusional behavior of a putative interaction partner in living cells. Here, we provide guidelines on how this micropatterning approach can be extended to quantify interaction parameters between plasma membrane constituents in their natural environment. We simulated a patterned membrane system and evaluated the effect of different surface densities of patterned immobile obstacles on the relative mobility as well as the surface density of diffusing tracers. In the case of inert obstacles, the size of the obstacle can be assessed from its surface density at the percolation threshold, which in turn can be extracted from the diffusion behavior of the tracer. For sticky obstacles, 2D dissociation constants can be determined from the tracer diffusion or surface density. (paper)

  8. 78 FR 38679 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-06-27

    ... Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... regarding MS-DRG classifications and new technology add-on payments. Eva Fung (410) 786-7539, for...

  9. 77 FR 4908 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-02-01

    ... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal... the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates...

  10. 77 FR 65495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-10-29

    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...

  11. 78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-03-13

    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals...

  12. Investigation of obstacles against effective crisis management in earthquake

    Directory of Open Access Journals (Sweden)

    Mahmood Nekoei-Moghadam

    2016-03-01

    Full Text Available Floods, hurricanes, landslides, hurricanes, tornadoes, earthquakes are events that a large group of people on earth are affected. In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city. The purpose of this study was to investigate obstacles against effective crisis management with considering service received by individuals in the Bam earthquake. In this study, domestic journals, foreign dissertations in Persian bases such as Google scholar, Magiran, IranMedex, SID and in English bases such as PubMed, Web of Science, Google scholar were used. The results of this study showed that there were many problems in various aspects of planning including: lack of coherent programs, lack of attention to the needs of health care, poor coordination between agencies and organizations and lack of appropriate training of volunteers and people.

  13. A SUSTAINABLE HEALTH CARE SYSTEM REQUIRES MANAGEMENT TRANSFORMATION

    Directory of Open Access Journals (Sweden)

    Kanellopoulos Dimitros

    2011-12-01

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

  14. Patient care information systems and physicians: the transition from technology icon to health care instrument.

    Science.gov (United States)

    Bria, W F

    1993-11-01

    We have discussed several important transitions now occurring in PCIS that promise to improve the utility and availability of these systems for the average physician. Charles Babbage developed the first computers as "thinking machines" so that we may extend our ability to grapple with more and more complex problems. If current trends continue, we will finally witness the evolution of patient care computing from information icons of the few to clinical instruments improving the quality of medical decision making and care for all patients.

  15. Evaluation of health care system reform in Hubei Province, China.

    Science.gov (United States)

    Sang, Shuping; Wang, Zhenkun; Yu, Chuanhua

    2014-02-21

    This study established a set of indicators for and evaluated the effects of health care system reform in Hubei Province (China) from 2009 to 2011 with the purpose of providing guidance to policy-makers regarding health care system reform. The resulting indicators are based on the "Result Chain" logic model and include the following four domains: Inputs and Processes, Outputs, Outcomes and Impact. Health care system reform was evaluated using the weighted TOPSIS and weighted Rank Sum Ratio methods. Ultimately, the study established a set of indicators including four grade-1 indicators, 16 grade-2 indicators and 76 grade-3 indicators. The effects of the reforms increased year by year from 2009 to 2011 in Hubei Province. The health status of urban and rural populations and the accessibility, equity and quality of health services in Hubei Province were improved after the reforms. This sub-national case can be considered an example of a useful approach to the evaluation of the effects of health care system reform, one that could potentially be applied in other provinces or nationally.

  16. ORIGINAL ARTICLES Canada's health care system: A relevant ...

    African Journals Online (AJOL)

    Canada's universal health care system, named Medicare, was fully in place. While this universal .... through lotteries and 'sin taxes' on alcohol and cigarettes. Since 2004, the federal portion of ..... Himmelstein DU, Thorne D, Warren E, Woolhandler S. Medical bankruptcy in the United. States, 2007: results of a national study.

  17. Prevention Service System Transformation Using "Communities That Care"

    Science.gov (United States)

    Brown, Eric C.; Hawkins, J. David; Arthur, Michael W.; Briney, John S.; Fagan, Abigail A.

    2011-01-01

    This study examines prevention system transformation as part of a community-randomized controlled trial of Communities That Care (CTC). Using data from surveys of community leaders, we examine differences between CTC and control communities 4.5 years after CTC implementation. Significantly higher levels of adopting a science-based approach to…

  18. Using systems science for population health management in primary care.

    Science.gov (United States)

    Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

    2014-10-01

    Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

  19. Systems Health Care: daily measurement and lifestyle change

    Science.gov (United States)

    Nakajima, Hiroshi; Tsuchiya, Naoki; Shiga, Toshikazu; Hata, Yutaka

    2012-06-01

    Health is quite important to be realized in our daily life. However, its idea covers wide area and has individual dependency. Activities in health care have been widely developed by medical, drag, insurance, food, and other types of industries mainly centering diseases. In this article, systems approach named Systems Health Care is introduced and discussed to generate new and precious values based on measurements in daily life to change lifestyle habits for realizing each health. Firstly, issues related to health such as its definitions are introduced and discussed by centering health rather than disease. In response to the discussions on health, Home and Medical Care is continuously introduced to point out the important role causality between life style and vital signal such as exercise and blood pressure based on detailed sampling time. Systems approaches of Systems Health Care are discussed from various points of views. Real applications of devices and services are used to make the studies and discussions deeper on the subjects of the article.

  20. Medical Information Management System (MIMS) CareWindows.

    Science.gov (United States)

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

    1991-01-01

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

  1. Internet of Things Framework for Home Care Systems

    Directory of Open Access Journals (Sweden)

    Biljana Risteska Stojkoska

    2017-01-01

    Full Text Available The increasing average age of the population in most industrialized countries imposes a necessity for developing advanced and practical services using state-of-the-art technologies, dedicated to personal living spaces. In this paper, we introduce a hierarchical distributed approach for home care systems based on a new paradigm known as Internet of Things (IoT. The proposed generic framework is supported by a three-level data management model composed of dew computing, fog computing, and cloud computing for efficient data flow in IoT based home care systems. We examine the proposed model through a real case scenario of an early fire detection system using a distributed fuzzy logic approach. The obtained results prove that such implementation of dew and fog computing provides high accuracy in fire detection IoT systems, while achieving minimum data latency.

  2. Health Care Performance Indicators for Health Information Systems.

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Hurst, Jeremy

    2002-02-01

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

  4. WHAT CAN TANZANIA'S HEALTH CARE SYSTEM LEARN FROM OECD COUNTRIES?

    OpenAIRE

    Kajuna, Dezidery Theobard

    2014-01-01

    Abstract Healthcare systems around the world have different shapes that are largely affected by socio-economic and political situations of a particular country. It is essential for the population to have better health services which requires the country to have better health policies, enough funding for health care sector, and a well structured delivery system. Tanzania like any other developing countries continue to face different challenges in healthcare sector greatly influenced by poor ec...

  5. Organizing and managing care in a changing health system.

    Science.gov (United States)

    Kohn, L T

    2000-04-01

    To examine ways in which the management and organization of medical care is changing in response to the shifting incentives created by managed care. Site visits conducted in 12 randomly selected communities in 1996/ 1997. Approximately 35-60 interviews were conducted per site with key informants in healthcare and community organizations; about half were with providers. A standardized interview protocol was implemented across all sites, enabling cross-site comparisons. Multiple respondents were interviewed on each issue. A great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from the more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant was the rapid formation of intermediary organizations, such as independent practice arrangements (IPAs), physician-hospital organizations (PHOs), or management services organizations (MSOs), for contracting with managed care organizations. Managed care appears to have only a modest effect on how healthcare organizations deliver medical care, despite the profound effect that managed care has on how providers are organized. Rather than improving the efficiency of healthcare organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity. It is not clear if new organizational arrangements will help providers manage the changing incentives they face, or if their intent is to blunt the effects of the incentives by forming larger organizations to improve their bargaining power and resist change.

  6. Application of a smartphone nurse call system for nursing care.

    Science.gov (United States)

    Chuang, Shu-Ting; Liu, Yi-Fang; Fu, Zi-Xuan; Liu, Kuang-Chung; Chien, Sou-Hsin; Lin, Chin-Lon; Lin, Pi-Yu

    2015-02-01

    Traditionally, a patient presses the nurse call button and alerts the central nursing station. This system cannot reach the primary care nurse directly. The aim of this study was to apply a new smartphone system through the cloud system and information technology that linked a smartphone and a mobile nursing station for nursing care service. A smartphone and mobile nursing station were integrated into a smartphone nurse call system through the cloud and information technology for better nursing care. Waiting time for a patient to contact the most responsible nurse was reduced from 3.8 min to 6 s. The average time for pharmacists to locate the nurse for medication problem was reduced from 4.2 min to 1.8 min by the new system. After implementation of the smartphone nurse call system, patients received a more rapid response. This improved patients' satisfaction and reduced the number of complaints about longer waiting time due to the shortage of nurses.

  7. Do characteristics of a stationary obstacle lead to adjustments in obstacle stepping strategies?

    Science.gov (United States)

    Worden, Timothy A; De Jong, Audrey F; Vallis, Lori Ann

    2016-01-01

    Navigating cluttered and complex environments increases the risk of falling. To decrease this risk, it is important to understand the influence of obstacle visual cues on stepping parameters, however the specific obstacle characteristics that have the greatest influence on avoidance strategies is still under debate. The purpose of the current work is to provide further insight on the relationship between obstacle appearance in the environment and modulation of stepping parameters. Healthy young adults (N=8) first stepped over an obstacle with one visible top edge ("floating"; 8 trials) followed by trials where experimenters randomly altered the location of a ground reference object to one of 7 different positions (8 trials per location), which ranged from 6cm in front of, directly under, or up to 6cm behind the floating obstacle (at 2cm intervals). Mean take-off and landing distance as well as minimum foot clearance values were unchanged across different positions of the ground reference object; a consistent stepping trajectory was observed for all experimental conditions. Contrary to our hypotheses, results of this study indicate that ground based visual cues are not essential for the planning of stepping and clearance strategies. The simultaneous presentation of both floating and ground based objects may have provided critical information that lead to the adoption of a consistent strategy for clearing the top edge of the obstacle. The invariant foot placement observed here may be an appropriate stepping strategy for young adults, however this may not be the case across the lifespan or in special populations. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. APPLICATION OF DSM IN OBSTACLE CLEARANCE SURVEYING OF AERODROME

    Directory of Open Access Journals (Sweden)

    X. Qiao

    2016-06-01

    Full Text Available Compared to the wide use of digital elevation model (DEM, digital surface model (DSM receives less attention because that it is composed by not only terrain surface, but also vegetations and man-made objects which are usually regarded as useless information. Nevertheless, these objects are useful for the identification of obstacles around an aerodrome. The primary objective of the study was to determine the applicability of DSM in obstacle clearance surveying of aerodrome. According to the requirements of obstacle clearance surveying at QT airport, aerial and satellite imagery were used to generate DSM, by means of photogrammetry, which was spatially analyzed with the hypothetical 3D obstacle limitation surfaces (OLS to identify the potential obstacles. Field surveying was then carried out to retrieve the accurate horizontal position and height of the obstacles. The results proved that the application of DSM could make considerable improvement in the efficiency of obstacle clearance surveying of aerodrome.

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

    Science.gov (United States)

    Goic, Alejandro

    2015-06-01

    The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%. From 1952 to 2014, public health care policies made possible a remarkable improvement in Chile's health indexes: downward trends in infant mortality rate (from 117.8 to 7.2 x 1,000 live births), maternal mortality (from 276 to 18.5 x 100,000), undernourished children purchasing power parity increased from US$ 3,827 to US$ 20,894 and poverty decreased from 60% to 14.4% of the population. Related indexes such as illiteracy, average schooling, and years of primary school education, were significantly improved as well. Nevertheless, compared with OECD countries, Chile has a relatively low public investment in health (45.7% of total national investment), a deficit in the number of physicians (1.7 x 1,000 inhabitants) and nurses (4.8 x 1,000), in the number of hospital beds (2.1 x 1,000), and in the availability of generic drugs in the market (30%). Chile and the USA are the two OECD countries with the lowest public investment in health. A generalized dissatisfaction with the current Chilean health care model and the need of the vast majority of the population for timely access to acceptable quality medical care are powerful arguments which point to the need for a universal public health care system. The significant increase in public expenditure on health care

  10. Mediating Systems of Care: Emergency Calls to Long-Term Care Facilities at Life's End.

    Science.gov (United States)

    Waldrop, Deborah P; McGinley, Jacqueline M; Clemency, Brian

    2018-04-09

    Nursing home (NH) residents account for over 2.2 million emergency department visits yearly; the majority are cared for and transported by prehospital providers (emergency medical technicians and paramedics). The purpose of this study was to investigate prehospital providers' perceptions of emergency calls at life's end. This article focuses on perceptions of end-of-life calls in long-term care (LTC). This pilot study employed a descriptive cross-sectional design. Concepts from the symbolic interaction theory guided the exploration of perceptions and interpretations of emergency calls in LTC facilities. A purposeful sample of prehospital providers was developed from one agency in a small northeastern U.S. city. Semistructured interviews were conducted with 43 prehospital providers to explore their perceptions of factors that trigger emergency end-of-life calls in LTC facilities. Qualitative data analysis involved iterative coding in an inductive process that included open, systematic, focused, and axial coding. Interview themes illustrated the contributing factors as follows: care crises; dying-related turmoil; staffing ratios; and organizational protocols. Distress was crosscutting and present in all four themes. The findings illuminate how prehospital providers become mediators between NHs and emergency departments by managing tension, conflict, and challenges in patient care between these systems and suggest the importance of further exploration of interactions between LTC staff, prehospital providers, and emergency departments. Enhanced communication between LTC facilities and prehospital providers is important to address potentially inappropriate calls and transport requests and to identify means for collaboration in the care of sick frail residents.

  11. Obstacles using amorphous materials for volume applications

    Energy Technology Data Exchange (ETDEWEB)

    Kiessling, Albert [Festo AG and Co. KG, 73734, Esslingen (Germany); Reininger, Thomas, E-mail: drn@de.festo.com [Festo AG and Co. KG, 73734, Esslingen (Germany)

    2012-10-15

    This contribution is especially focussed on the attempt to use amorphous or nanocrystalline metals in position sensor applications and to describe the difficulties and obstacles encountered in coherence with the development of appropriate industrial high volume series products in conjunction with the related quality requirements. The main motivation to do these investigations was to beat the generally known sensors especially silicon based Hall-sensors as well as AMR- and GMR-sensors - well known from mobile phones and electronic storage devices like hard discs and others - in terms of cost-effectiveness and functionality.

  12. Recovering an obstacle using integral equations

    KAUST Repository

    Rundell, William

    2009-05-01

    We consider the inverse problem of recovering the shape, location and surface properties of an object where the surrounding medium is both conductive and homogeneous and we measure Cauchy data on an accessible part of the exterior boundary. It is assumed that the physical situation is modelled by harmonic functions and the boundary condition on the obstacle is one of Dirichlet type. The purpose of this paper is to answer some of the questions raised in a recent paper that introduced a nonlinear integral equation approach for the solution of this type of problem.

  13. Error identities for variational problems with obstacles

    Czech Academy of Sciences Publication Activity Database

    Repin, S.; Valdman, Jan

    2018-01-01

    Roč. 98, č. 4 (2018), s. 635-658 ISSN 0044-2267 R&D Projects: GA ČR(CZ) GF16-34894L; GA ČR GA17-04301S; GA MŠk(CZ) 7AMB16AT015 Institutional support: RVO:67985556 Keywords : variational problems with obstacles * coincidence set * convex functionals * error identities Subject RIV: BA - General Mathematics OBOR OECD: Pure mathematics Impact factor: 1.332, year: 2016 http://library.utia.cas.cz/separaty/2017/MTR/valdman-0483574.pdf

  14. Supporting Active Patient and Health Care Collaboration: A Prototype for Future Health Care Information Systems.

    Science.gov (United States)

    Åhlfeldt, Rose-Mharie; Persson, Anne; Rexhepi, Hanife; Wåhlander, Kalle

    2016-12-01

    This article presents and illustrates the main features of a proposed process-oriented approach for patient information distribution in future health care information systems, by using a prototype of a process support system. The development of the prototype was based on the Visuera method, which includes five defined steps. The results indicate that a visualized prototype is a suitable tool for illustrating both the opportunities and constraints of future ideas and solutions in e-Health. The main challenges for developing and implementing a fully functional process support system concern both technical and organizational/management aspects. © The Author(s) 2015.

  15. Health care financing and the sustainability of health systems.

    Science.gov (United States)

    Liaropoulos, Lycourgos; Goranitis, Ilias

    2015-09-15

    The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.

  16. The Oral Health Care Delivery System in 2040: Executive Summary.

    Science.gov (United States)

    Bailit, Howard L

    2017-09-01

    This executive summary for Section 4 of the "Advancing Dental Education in the 21 st Century" project examines the projected oral health care delivery system in 2040 and the likely impact of system changes on dental education. Dental care is at an early stage of major changes with the decline in solo practice and increase in large group practices. These groups are not consolidated at the state level, but further consolidation is expected as they try to increase their negotiating leverage with dental insurers. At this time, there is limited integration of medical and dental care in terms of financing, regulation, education, and delivery. This pattern may change as health maintenance organizations and integrated medical systems begin to offer dental care to their members. By 2040, it is expected that many dentists will be employed in large group practices and working with allied dental staff with expanded duties and other health professionals, and more dental graduates will seek formal postdoctoral training to obtain better positions in group practices.

  17. Emergent oscillations assist obstacle negotiation during ant cooperative transport

    Science.gov (United States)

    Gelblum, Aviram; Pinkoviezky, Itai; Fonio, Ehud; Gov, Nir S.; Feinerman, Ofer

    2016-01-01

    Collective motion by animal groups is affected by internal interactions, external constraints, and the influx of information. A quantitative understanding of how these different factors give rise to different modes of collective motion is, at present, lacking. Here, we study how ants that cooperatively transport a large food item react to an obstacle blocking their path. Combining experiments with a statistical physics model of mechanically coupled active agents, we show that the constraint induces a deterministic collective oscillatory mode that facilitates obstacle circumvention. We provide direct experimental evidence, backed by theory, that this motion is an emergent group effect that does not require any behavioral changes at the individual level. We trace these relaxation oscillations to the interplay between two forces; informed ants pull the load toward the nest whereas uninformed ants contribute to the motion’s persistence along the tangential direction. The model’s predictions that oscillations appear above a critical system size, that the group can spontaneously transition into its ordered phase, and that the system can exhibit complete rotations are all verified experimentally. We expect that similar oscillatory modes emerge in collective motion scenarios where the structure of the environment imposes conflicts between individually held information and the group’s tendency for cohesiveness. PMID:27930304

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

    Directory of Open Access Journals (Sweden)

    El Taguri A

    2008-01-01

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

  19. Effects of an Integrated Care System on quality of care and satisfaction for children with special health care needs.

    Science.gov (United States)

    Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth

    2012-04-01

    To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide.

  20. Care and pedagogical production: integration of Public Health System scenarios

    Directory of Open Access Journals (Sweden)

    Túlio Batista Franco

    2007-01-01

    Full Text Available Throughout Brazilian Public Health System's (Centralized Health System - SUS construction history there has been a reasonable investment in the education for the sector. However, it has been frequently noticed by health professionals and managers the fact that this investment in educational programs has not converted into change of healthcare practices. Assuming that education can be used as a tool for changes in health, the text suggests that the pedagogical practices should be directed towards the production of individuals implied with the care production. Hence it proposes to work on a field of subjectivity in addition to cognition. This work reveals the management of the Brazilian public health system and its flows of permanent education, focusing "micromanagement" to think about the context on which they structuralize the diverse scenarios of care production, treating them as Pedagogical Production Units where it would be possible to develop entailed educational methodologies to a general idea of permanent education in health.

  1. Applying principles of health system strengthening to eye care

    Directory of Open Access Journals (Sweden)

    Karl Blanchet

    2012-01-01

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

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

    Science.gov (United States)

    Frandji, B

    1997-01-01

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

  3. Public trust in the Spanish health‐care system

    Science.gov (United States)

    Jovell, Albert; Blendon, Robert J.; Navarro, Maria Dolors; Fleischfresser, Channtal; Benson, John M.; DesRoches, Catherine M.; Weldon, Kathleen J.

    2007-01-01

    Abstract Background  Fifteen years ago, public opinion surveys in Spain showed substantial dissatisfaction with the health‐care system. Since that time, health‐care in Spain has undergone significant changes, including a decentralization of the system, an increase in spending and a change in the way the system is financed. Objective  This study examines how Spanish citizens rate the performance of their health system today, both as compared with other sectors of society and as compared with earlier time periods. Methods  Data are drawn from nationally representative telephone surveys of the non‐institutionalized adult Spanish population (age 18 years and over). The study was carried out in two phases: October–November 2005 (n = 3010) and January 2006 (n = 2101). Results  The majority of the Spanish population thinks the health system needs to be changed. The problems cited relate mostly to long wait times to get health‐care. Nevertheless, over the last 15 years, the proportion of people who have very negative views about the health system has decreased by half. The majority believes that not enough money is spent on health‐care, but few people would support an increase in taxes to provide additional funding. The survey finds the National Health System’s institutions and health professionals to be more highly trusted than other institutions and professional groups in the country. Conclusions  Government policy‐makers in Spain face a dilemma: the public wants more health spending to decrease wait times, but there is substantial resistance to increasing taxes as a means to finance improvements in the system’s capacity. PMID:17986071

  4. Multi-Modal Detection and Mapping of Static and Dynamic Obstacles in Agriculture for Process Evaluation

    Directory of Open Access Journals (Sweden)

    Timo Korthals

    2018-03-01

    Full Text Available Today, agricultural vehicles are available that can automatically perform tasks such as weed detection and spraying, mowing, and sowing while being steered automatically. However, for such systems to be fully autonomous and self-driven, not only their specific agricultural tasks must be automated. An accurate and robust perception system automatically detecting and avoiding all obstacles must also be realized to ensure safety of humans, animals, and other surroundings. In this paper, we present a multi-modal obstacle and environment detection and recognition approach for process evaluation in agricultural fields. The proposed pipeline detects and maps static and dynamic obstacles globally, while providing process-relevant information along the traversed trajectory. Detection algorithms are introduced for a variety of sensor technologies, including range sensors (lidar and radar and cameras (stereo and thermal. Detection information is mapped globally into semantical occupancy grid maps and fused across all sensors with late fusion, resulting in accurate traversability assessment and semantical mapping of process-relevant categories (e.g., crop, ground, and obstacles. Finally, a decoding step uses a Hidden Markov model to extract relevant process-specific parameters along the trajectory of the vehicle, thus informing a potential control system of unexpected structures in the planned path. The method is evaluated on a public dataset for multi-modal obstacle detection in agricultural fields. Results show that a combination of multiple sensor modalities increases detection performance and that different fusion strategies must be applied between algorithms detecting similar and dissimilar classes.

  5. StereoBox: A Robust and Efficient Solution for Automotive Short-Range Obstacle Detection

    Directory of Open Access Journals (Sweden)

    Alberto Broggi

    2007-07-01

    Full Text Available This paper presents a robust method for close-range obstacle detection with arbitrarily aligned stereo cameras. System calibration is performed by means of a dense grid to remove perspective and lens distortion after a direct mapping between image pixels and world points. Obstacle detection is based on the differences between left and right images after transformation phase and with a polar histogram, it is possible to detect vertical structures and to reject noise and small objects. Found objects' world coordinates are transmitted via CAN bus; the driver can also be warned through an audio interface. The proposed algorithm can be useful in different automotive applications, requiring real-time segmentation without any assumption on background. Experimental results proved the system to be robust in several envitonmental conditions. In particular, the system has been tested to investigate presence of obstacles in blind spot areas around heavy goods vehicles (HGVs and has been mounted on three different prototypes at different heights.

  6. StereoBox: A Robust and Efficient Solution for Automotive Short-Range Obstacle Detection

    Directory of Open Access Journals (Sweden)

    Broggi Alberto

    2007-01-01

    Full Text Available This paper presents a robust method for close-range obstacle detection with arbitrarily aligned stereo cameras. System calibration is performed by means of a dense grid to remove perspective and lens distortion after a direct mapping between image pixels and world points. Obstacle detection is based on the differences between left and right images after transformation phase and with a polar histogram, it is possible to detect vertical structures and to reject noise and small objects. Found objects' world coordinates are transmitted via CAN bus; the driver can also be warned through an audio interface. The proposed algorithm can be useful in different automotive applications, requiring real-time segmentation without any assumption on background. Experimental results proved the system to be robust in several envitonmental conditions. In particular, the system has been tested to investigate presence of obstacles in blind spot areas around heavy goods vehicles (HGVs and has been mounted on three different prototypes at different heights.

  7. The Military Health Care System May Have the Potential to Prevent Health Care Disparities.

    Science.gov (United States)

    Pierre-Louis, Bosny J; Moore, Angelo D; Hamilton, Jill B

    2015-09-01

    The existence of health disparities in military populations has become an important topic of research. However, to our knowledge, this is the first study to examine health disparities, as related to access to care and health status, among active duty soldiers and their families. Specifically, the purpose of this analysis was to evaluate whether health disparities exist in access to care and health outcomes of patient satisfaction, physical health status, and mental health status according to race, gender, and sponsor rank in the population of active duty soldiers and their family members. In this cross-sectional study, active duty army soldiers and family members were recruited from either one particular army health clinic where they received their health care or from an adjacent shopping center frequented by eligible participants. Data were collected using validated measures to assess concepts of access to care and health status. Statistical analysis, including one-way analysis of variance (ANOVA) was performed to investigate differences in study outcome measures across four key demographic subgroups: race, gender, sponsor rank, and component (active soldier or family member). A total of 200 participants completed the study questionnaires. The sample consisted of 45.5 % soldiers and 54.5 % family members, with 88.5 % reporting a sponsor rank in the category of junior or senior enlisted rank. Mean scores for access to care did not differ significantly for the groups race/ethnicity (p = 0.53), gender (p = 0.14), and sponsor rank (p = 0.10). Furthermore, no significant differences were observed whether respondents were active soldiers or their family members (p = 0.36). Similarly, there were no statistically significant subgroup (race/ethnicity, gender, sponsor rank, or component) differences in mean patient satisfaction, physical health, and mental health scores. In a health equity system of care such as the military health care system, active duty

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

    Directory of Open Access Journals (Sweden)

    Joanna Kobza

    2014-08-01

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

  9. [Time based management in health care system: the chosen aspects].

    Science.gov (United States)

    Kobza, Joanna; Syrkiewicz-Świtała, Magdalena

    2014-01-01

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

  10. The importance of management information systems in a managed care environment.

    Science.gov (United States)

    Porro, M R; Brill, K R

    1995-06-01

    Keys to successful information systems for home care providers are planning and control. With managed care's emphasis on data, agencies need to have information systems that can handle the demands managed care puts on agencies today--planning before hurrying to install a system will ensure control as the managed care contracts add up.

  11. 75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2010-10-01

    ...; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...

  12. 75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Science.gov (United States)

    2010-06-17

    ... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010 Rates... Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care...

  13. Bowel management systems in critical care: a service evaluation.

    Science.gov (United States)

    Ritzema, Jennifer

    2017-01-25

    Aim Many patients who are critically ill develop faecal incontinence associated with diarrhoea, and require a bowel management system (BMS) to prevent skin excoriation. Following guidelines produced by the National Institute for Health and Care Excellence, early rehabilitation has resulted in a reduction in the number of days that patients receive mechanical ventilation. However, patients with a BMS are potentially mechanically ventilated for longer because they are cared for in bed. The aim of this evaluation was to investigate whether patients with a BMS are mechanically ventilated for longer than those without a BMS. Method This was a retrospective service evaluation, in which a database search was conducted to identify patients admitted to the critical care department in one healthcare organisation during 2013. The search was narrowed to identify patients admitted to the critical care department who had received advanced respiratory support (mechanical ventilation), to compare the mean number of mechanically ventilated days between patients with and without a BMS (n = 122). Data were analysed using the Mann-Whitney U test. Results There was a significant difference in the number of mechanically ventilated days (Pcritically ill patients with a BMS are placed in a sitting position for short periods of time. Further research should explore alternative bowel care options for patients who are critically ill.

  14. Obstacles to HIV prevention, treatment and care in selected public ...

    African Journals Online (AJOL)

    South Africa, like the rest of Southern Africa, is ravaged by AIDS. Higher education in South Africa has a significant role to play in the fight against the spread of HIV and AIDS. This article reports the factors contributing to the spread of HIV and AIDS in three selected public universities in South Africa. To achieve the stated ...

  15. Zika virus: Vaccine initiatives and obstacles

    Directory of Open Access Journals (Sweden)

    Reema Mukherjee

    2017-01-01

    Full Text Available Over 130,000 humans in Brazil are infected with Zika virus (ZIKV since March 2015, and presently 29 countries in Americas have reported local autochthonous ZIKV transmission. Besides the associated clinical features, Brazil has also reported a temporal and spatial association of ZIKV with Guillain-Barre syndrome (GBS and Zika fetal syndrome. ZIKV vaccine approaches include purified inactivated virus, nucleic acid-based vaccines (DNA, RNA, live vector vaccines, subunit vaccines, virus-like particle technologies, and live recombinant vaccines similar to the technologies used against other human flaviviruses. At present, 15 commercial entities are involved in the development of ZIKV vaccine. Vaccines developed through different approaches would have their own inherent advantages and disadvantages. The presentation of disease in different populations and lack of clarity on the pathogenesis and complications is the most important obstacle. Second, Zika belongs to a genus that is notorious for the antibody-mediated enhancement of infection, which proved to be a stumbling block during the development of the dengue vaccine. Identifying large naive and yet uninfected at-risk populations may be an obstacle to demonstrating efficacy. Next, the association of Zika with GBS is being researched since the vaccine may have the potential to provoke similar neuropathophysiologic mechanisms. Zika's association with adverse fetal outcomes necessitates that pregnant women and women of childbearing age are considered for evaluating vaccines, which form a vulnerable group for vaccine trials.

  16. Obstacles in the climate policy arena

    International Nuclear Information System (INIS)

    Manders, T.; Tang, P.

    2001-01-01

    Implementing climate policy is not a straightforward matter. International negotiations during the recent climate conference in The Hague ended in disagreement. With the present position of the United States chances to reach an agreement are even slimmer than ever. One of the obstacles is to what extent trade in emission rights should be allowed. Economically speaking, there are strong arguments for allowing as much flexibility as possible. Ironically, our analysis shows that the party favouring restrictions on emissions trade, the European Union, suffers most from curtailing flexibility. Another obstacle which comes up when addressing more ambitious goals in climate policy is the involvement of developing countries. A treaty should aim at emissions reductions in developing countries as well. If the potentially serious consequences of the greenhouse effect are to be avoided, that is even essential. To induce these reductions, the developed countries could consider to compensate the developing countries. For industrialised countries compensation has the effect to raise the costs of climate policy considerably

  17. Interaction of debris with a solid obstacle: Numerical analysis

    International Nuclear Information System (INIS)

    Kosinska, Anna

    2010-01-01

    The subject of this research is the propagation of a cloud of solid particles formed from an explosion-damaged construction. The main objective is the interaction of the cloud (debris) with a solid beam located at some distance from the explosion. The mathematical model involves the flow of the gas using standard conservation equations, and this part of the model is solved numerically. The solid particles are treated as a system of solid points (so-called Lagrangian approach), whose motion is the result of the flowing gas as well as collisions with obstacles. These two issues are described respectively by Newton's second law and the hard-sphere model. The model is used to simulate various cases where the influence of different parameters like the value of the pressure of the explosion, the particle size, the number of particles and the obstacle location are investigated. The results are presented as snapshots of particle location, and also as the particle total momentum during collision with the beam.

  18. Interaction of debris with a solid obstacle: numerical analysis.

    Science.gov (United States)

    Kosinska, Anna

    2010-05-15

    The subject of this research is the propagation of a cloud of solid particles formed from an explosion-damaged construction. The main objective is the interaction of the cloud (debris) with a solid beam located at some distance from the explosion. The mathematical model involves the flow of the gas using standard conservation equations, and this part of the model is solved numerically. The solid particles are treated as a system of solid points (so-called Lagrangian approach), whose motion is the result of the flowing gas as well as collisions with obstacles. These two issues are described respectively by Newton's second law and the hard-sphere model. The model is used to simulate various cases where the influence of different parameters like the value of the pressure of the explosion, the particle size, the number of particles and the obstacle location are investigated. The results are presented as snapshots of particle location, and also as the particle total momentum during collision with the beam. Copyright (c) 2009 Elsevier B.V. All rights reserved.

  19. Structural Obstacles against Order of Law in Safavid Iran

    Directory of Open Access Journals (Sweden)

    Hamid Ebadollahi

    2010-04-01

    Full Text Available While focusing on the teleological matters, most of the studies about the roots of disorder and anarchy in Iran attempt to explain the “present” obstacles against order of law; the present study aims to analyze the structural-historical conditions affecting the “possibility and impossibility of the order of law in Iran”. In the former studies, “Iran’s history” is inversely applied in order to explain the present situation of society. Instead of interpreting the determining social structures in the history, such studies attempts to understand “contemporary Iran”. Furthermore, applying comparative-fundamentalist method, they base their analysis on the economic or political conditions of the matter. However, the present study claims that the general theory of social transformation –either the Marxian or Weberian- -that is produced approaching western medieval societies- could not explain roots of disorder and anarchy in Iran. Instead, applying a structuralist model, and focusing on “articulation” in analysis, the present study aims to explore the historical obstacles against the order of law in the history of Iran (rather than western medieval history. Thus, it claims that the main root of “disorder in the history of Iran” is the governing system of political, martial, and economic management in Iran.

  20. Helping Children and Youth with Attention-Deficit/Hyperactivity Disorder: Systems of Care

    Science.gov (United States)

    ... is why only qualified health care or mental health care providers can diagnose ADHD, and why it is important that supports be in place to bridge differences in language and culture. The Core Values of Systems of Care Although ...

  1. Optimizing nursing care delivery systems in the Army: back to basics with care teams and peer feedback.

    Science.gov (United States)

    Prue-Owens, Kathy; Watkins, Miko; Wolgast, Kelly A

    2011-01-01

    The Patient CaringTouch System emerged from a comprehensive assessment and gap analysis of clinical nursing capabilities in the Army. The Patient CaringTouch System now provides the framework and set of standards by which we drive excellence in quality nursing care for our patients and excellence in quality of life for our nurses in Army Medicine. As part of this enterprise transformation, we placed particular emphasis on the delivery of nursing care at the bedside as well as the integration of a formal professional peer feedback process in support of individual nurse practice enhancement. The Warrior Care Imperative Action Team was chartered to define and establish the standards for care teams in the clinical settings and the process by which we established formal peer feedback for our professional nurses. This back-to-basics approach is a cornerstone of the Patient CaringTouch System implementation and sustainment.

  2. Path planning for first responders in the presence of moving obstacles

    Directory of Open Access Journals (Sweden)

    Zhiyong Wang

    2015-06-01

    Full Text Available Navigation services have gained much importance for all kinds of human activities ranging from tourist navigation to support of rescue teams in disaster management. However, despite the considerable amount of route guidance research that has been performed, many issues that are related to navigation for first responders still need to be addressed. During disasters, emergencies can result in different types of moving obstacles (e.g., fires, plumes, floods, which make some parts of the road network temporarily unavailable. After such incidents occur, responders have to go to different destinations to perform their tasks in the environment affected by the disaster. Therefore they need a path planner that is capable of dealing with such moving obstacles, as well as generating and coordinating their routes quickly and efficiently. During the past decades, more and more hazard simulations, which can modify the models with incorporation of dynamic data from the field, have been developed. These hazard simulations use methods such as data assimilation, stochastic estimation, and adaptive measurement techniques, and are able to generate more reliable results of hazards. This would allow the hazard simulation models to provide valuable information regarding the state of road networks affected by hazards, which supports path planning for first responders among the moving obstacles. The objective of this research is to develop an integrated navigation system for first responders in the presence of moving obstacles. Such system should be able to navigate one or more responders to one or multiple destinations avoiding the moving obstacles, using the predicted information of the moving obstacles generated from by hazard simulations. In this dissertation, the objective we have is expressed as the following research question: How do we safely and efficiently navigate one or more first responders to one or more destinations avoiding moving obstacles? To address

  3. Organisational Culture Matters for System Integration in Health Care

    Science.gov (United States)

    Munir, Samina K.; Kay, Stephen

    2003-01-01

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

  4. Study on Korean Radiological Emergency System-Care System- and National Nuclear Emergency Preparedness System Development

    International Nuclear Information System (INIS)

    Akhmad Khusyairi; Yudi Pramono

    2008-01-01

    Care system; Radiological Emergency Supporting System. Environmental radiology level is the main aspect that should be concerned deal with the utilization of nuclear energy. The usage of informational technology in nuclear area gives significant contribution to anticipate and to protect human and environment. Since 1960, South Korea has developed environment monitoring system as the effort to protect the human and environment in the radiological emergency condition. Indonesia has possessed several nuclear installations and planned to build and operate nuclear power plants (PLTN) in the future. Therefore, Indonesia has to prepare the integrated system, technically enables to overcome the radiological emergency. Learning from the practice in South Korea, the system on the radiological emergency should be prepared and applied in Indonesia. However, the government regulation draft on National Radiological Emergency System, under construction, only touches the management aspect, not the technical matters. Consequently, when the regulation is implemented, it will need an additional regulation on technical aspect including the consideration on the system (TSS), the organization of operator and the preparation of human resources development of involved institution. For that purpose, BAPETEN should have a typical independence system in regulatory frame work. (author)

  5. Image-guided neurosurgery. Global concept of a surgical tele-assistance using obstacle detection robotics

    International Nuclear Information System (INIS)

    Desgeorges, M.; Bellegou, N.; Faillot, Th.; Cordoliani, Y.S.; Dutertre, G.; Blondet, E.; Soultrait, F. de; Boissy, J.M.

    2000-01-01

    Surgical tele-assistance significantly increases accuracy of surgical gestures, especially in the case of brain tumor neurosurgery. The robotic device is tele-operated through a microscope and the surgeon's gestures are guided by real-time overlaying of the X-ray imagery in the microscope. During the device's progression inside the brain, the focus is ensured by the microscope auto-focus feature. The surgeon can thus constantly check his position on the field workstation. Obstacles to avoid or dangerous areas can be previewed in the operation field. This system is routinely used for 5 years in the neurosurgery division of the Val de Grace hospital. More than 400 brain surgery operations have been done using it. An adaptation is used for rachis surgery. Other military hospitals begin to be equipped with similar systems. It will be possible to link them for data transfer. When it will be operational, such a network it will show what could be, in the future, a medical/surgical remote-assistance system designed to take care of wounded/critical conditions people, including assistance to surgical gestures. (authors)

  6. Intelligence-Based Multi-Resolution 3D Visual Modeling, Registration And Obstacle Avoidance Capabilities For Unmanned Vehicles, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — The use of truly autonomous vehicles (UV) has been hampered by a lack of sophisticated and resource efficient obstacle avoidance systems. Current approaches have...

  7. Educational potential of a virtual patient system for caring for traumatized patients in primary care.

    Science.gov (United States)

    Ekblad, Solvig; Mollica, Richard F; Fors, Uno; Pantziaras, Ioannis; Lavelle, James

    2013-08-19

    Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC). A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system's usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data. Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results. Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on improving clinical diagnosis and

  8. Enhancing systems to improve the management of acute, unscheduled care.

    Science.gov (United States)

    Braithwaite, Sabina A; Pines, Jesse M; Asplin, Brent R; Epstein, Stephen K

    2011-06-01

    For acutely ill patients, health care services are available in many different settings, including hospital-based emergency departments (EDs), retail clinics, federally qualified health centers, and outpatient clinics. Certain conditions are the sole domain of particular settings: stabilization of critically ill patients can typically only be provided in EDs. By contrast, many conditions that do not require hospital resources, such as advanced radiography, admission, and same-day consultation can often be managed in clinic settings. Because clinics are generally not open nights, and often not on weekends or holidays, the ED remains the only option for face-to-face medical care during these times. For patients who can be managed in either setting, there are many open research questions about which is the best setting, because these venues differ in terms of access, costs of care, and potentially, quality. Consideration of these patients must be risk-adjusted, as patients may self-select a venue for care based upon perceived acuity. We present a research agenda for acute, unscheduled care in the United States developed in conjunction with an Agency for Healthcare Research and Quality-funded conference hosted by the American College of Emergency Physicians in October 2009, titled "Improving the Quality and Efficiency of Emergency Care Across the Continuum: A Systems Approach." Given the possible increase in ED utilization over the next several years as more people become insured, understanding differences in cost, quality, and access for conditions that may be treated in EDs or clinic settings will be vital in guiding national health policy. © 2011 by the Society for Academic Emergency Medicine.

  9. China's health care system reform: Progress and prospects.

    Science.gov (United States)

    Li, Ling; Fu, Hongqiao

    2017-07-01

    This paper discusses the progress and prospects of China's complex health care reform beginning in 2009. The Chinese government's undertaking of systemic reform has achieved laudable achievements, including the expansion of social health insurance, the reform of public hospitals, and the strengthening of primary care. An innovative policy tool in China, policy experimentation under hierarchy, played an important role in facilitating these achievements. However, China still faces gaps and challenges in creating a single payer system, restructuring the public hospitals, and establishing an integrated delivery system. Recently, China issued the 13th 5-year plan for medical reform, setting forth the goals, policy priorities, and strategies for health reform in the following 5 years. Moreover, the Chinese government announced the "Healthy China 2030" blueprint in October 2016, which has the goals of providing universal health security for all citizens by 2030. By examining these policy priorities against the existing gaps and challenges, we conclude that China's health care reform is heading in the right direction. To effectively implement these policies, we recommend that China should take advantage of policy experimentation to mobilize bottom-up initiatives and encourage innovations. Copyright © 2017 John Wiley & Sons, Ltd.

  10. Service Line Management: A New Paradigm in Health Care System

    Directory of Open Access Journals (Sweden)

    Rafat Rezapour Nasrabad

    2016-12-01

    Full Text Available Health care organizations are required to implement modern management practices and approaches due to the importance of improving quality and increasing efficiency of health care services. Service line management of healthcare services is one of the new approaches that managers of health sectors are interested in. The “service line” approach will organize the management of inpatient and outpatient in clinical services focusing on patient diagnostic clusters. Services specific in each patient diagnostic cluster will be offered by a multidisciplinary team including nurses, physicians, and so no. Accordingly, the present study aims to evaluate the features, process and benefits of service line management approach in the provision of health services. In this descriptive study, internal and external scientific database have been reviewed and the necessary data have been extracted from the latest research projects and related scientific documents. The results showed that the new management approach is based on a paradigm shift from traditional health care system management to healthcare service line management with a focus on managers’ competencies. Four specific manager’s competencies in this new management model are: conceptual, collaborative, interpersonal, and leadership competencies. Theses competencies should be developed in health system managers so as to lead to organizational excellency and improvement of health service quality. The health sector managers should strengthen these four key competencies and act on them. Then they will become effective leaders and managers in the health system.

  11. A change of direction in the Dutch health care system?

    Science.gov (United States)

    Lapré, R M

    1988-08-01

    The Dutch health care system seems to be undergoing a clear change of direction. The publication of the Report of the Committee of the Structure and Financing of the Health Care System is a prominent document which marks the emergence of a new trend. After an analysis of the characteristics of the Dutch health care system in the periods 1960-1975 and 1975-1985, an account is given of the most important proposals of the committee. The proposals clearly alter the trend towards more governmental involvement. They envisage a more market-oriented approach and freedom of operation while at the same time paying attention to aspects such as solidarity and social justice. The Committee's suggestions include the introduction of a basic insurance scheme for every citizen with a coverage determined by law, and in addition a voluntary supplementary insurance scheme in which the insured can decide what coverage he requires and that the insurer is obliged to accept him. The fact that there is a certain amount of agreement, at least over the direction that the strategy for change should take, justifies the expectation that many of the committee's proposals will be implemented.

  12. A system for intelligent home care ECG upload and priorisation.

    Science.gov (United States)

    D'Angelo, Lorenzo T; Tarita, Eugeniu; Zywietz, Tosja K; Lueth, Tim C

    2010-01-01

    In this contribution, a system for internet based, automated home care ECG upload and priorisation is presented for the first time. It unifies the advantages of existing telemonitoring ECG systems adding functionalities such as automated priorisation and usability for home care. Chronic cardiac diseases are a big group in the geriatric field. Most of them can be easily diagnosed with help of an electrocardiogram. A frequent or long-term ECG analysis allows early diagnosis of e.g. a cardiac infarction. Nevertheless, patients often aren't willing to visit a doctor for prophylactic purposes. Possible solutions of this problem are home care devices, which are used to investigate patients at home without the presence of a doctor on site. As the diffusion of such systems leads to a huge amount of data which has to be managed and evaluated, the presented approach focuses on an easy to use software for ECG upload from home, a web based management application and an algorithm for ECG preanalysis and priorisation.

  13. Simulating changes to emergency care resources to compare system effectiveness.

    Science.gov (United States)

    Branas, Charles C; Wolff, Catherine S; Williams, Justin; Margolis, Gregg; Carr, Brendan G

    2013-08-01

    To apply systems optimization methods to simulate and compare the most effective locations for emergency care resources as measured by access to care. This study was an optimization analysis of the locations of trauma centers (TCs), helicopter depots (HDs), and severely injured patients in need of time-critical care in select US states. Access was defined as the percentage of injured patients who could reach a level I/II TC within 45 or 60 minutes. Optimal locations were determined by a search algorithm that considered all candidate sites within a set of existing hospitals and airports in finding the best solutions that maximized access. Across a dozen states, existing access to TCs within 60 minutes ranged from 31.1% to 95.6%, with a mean of 71.5%. Access increased from 0.8% to 35.0% after optimal addition of one or two TCs. Access increased from 1.0% to 15.3% after optimal addition of one or two HDs. Relocation of TCs and HDs (optimal removal followed by optimal addition) produced similar results. Optimal changes to TCs produced greater increases in access to care than optimal changes to HDs although these results varied across states. Systems optimization methods can be used to compare the impacts of different resource configurations and their possible effects on access to care. These methods to determine optimal resource allocation can be applied to many domains, including comparative effectiveness and patient-centered outcomes research. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Validation of Surgical Intensive Care-Infection Registry: a medical informatics system for intensive care unit research, quality of care improvement, and daily patient care.

    Science.gov (United States)

    Golob, Joseph F; Fadlalla, Adam M A; Kan, Justin A; Patel, Nilam P; Yowler, Charles J; Claridge, Jeffrey A

    2008-08-01

    We developed a prototype electronic clinical information system called the Surgical Intensive Care-Infection Registry (SIC-IR) to prospectively study infectious complications and monitor quality of care improvement programs in the surgical and trauma intensive care unit. The objective of this study was to validate SIC-IR as a successful health information technology with an accurate clinical data repository. Using the DeLone and McLean Model of Information Systems Success as a framework, we evaluated SIC-IR in a 3-month prospective crossover study of physician use in one of our two surgical and trauma intensive care units (SIC-IR unit versus non SIC-IR unit). Three simultaneous research methodologies were used: a user survey study, a pair of time-motion studies, and an accuracy study of SIC-IR's clinical data repository. The SIC-IR user survey results were positive for system reliability, graphic user interface, efficiency, and overall benefit to patient care. There was a significant decrease in prerounding time of nearly 4 minutes per patient on the SIC-IR unit compared with the non SIC-IR unit. The SIC-IR documentation and data archiving was accurate 74% to 100% of the time depending on the data entry method used. This accuracy was significantly improved compared with normal hand-written documentation on the non SIC-IR unit. SIC-IR proved to be a useful application both at individual user and organizational levels and will serve as an accurate tool to conduct prospective research and monitor quality of care improvement programs.

  15. QUANTITATIVE СHARACTERISTICS OF COMPLEMENTARY INTEGRATED HEALTH CARE SYSTEM AND INTEGRATED MEDICATION MANAGEMENT INFORMATION SYSTEM

    Directory of Open Access Journals (Sweden)

    L. Yu. Babintseva

    2015-05-01

    i mportant elements of state regulation of the pharmaceutical sector health. For the first time creation of two information systems: integrated medication management infor mation system and integrated health care system in an integrated medical infor mation area, operating based on th e principle of complementarity was justified. Global and technological coefficients of these systems’ functioning were introduced.

  16. Coordination of care in the Chinese health care systems: a gap analysis of service delivery from a provider perspective.

    Science.gov (United States)

    Wang, Xin; Birch, Stephen; Zhu, Weiming; Ma, Huifen; Embrett, Mark; Meng, Qingyue

    2016-10-12

    Increases in health care utilization and costs, resulting from the rising prevalence of chronic conditions related to the aging population, is exacerbated by a high level of fragmentation that characterizes health care systems in China. There have been several pilot studies in China, aimed at system-level care coordination and its impact on the full integration of health care system, but little is known about their practical effects. Huangzhong County is one of the pilot study sites that introduced organizational integration (a dimension of integrated care) among health care institutions as a means to improve system-level care coordination. The purposes of this study are to examine the effect of organizational integration on system-level care coordination and to identify factors influencing care coordination and hence full integration of county health care systems in rural China. We chose Huangzhong and Hualong counties in Qinghai province as study sites, with only Huangzhong having implemented organizational integration. A mixed methods approach was used based on (1) document analysis and expert consultation to develop Best Practice intervention packages; (2) doctor questionnaires, identifying care coordination from the perspective of service provision. We measured service provision with gap index, overlap index and over-provision index, by comparing observed performance with Best Practice; (3) semi-structured interviews with Chiefs of Medicine in each institution to identify barriers to system-level care coordination. Twenty-nine institutions (11 at county-level, 6 at township-level and 12 at village-level) were selected producing surveys with a total of 19 schizophrenia doctors, 23 diabetes doctors and 29 Chiefs of Medicine. There were more care discontinuities for both diabetes and schizophrenia in Huangzhong than in Hualong. Overall, all three index scores (measuring service gaps, overlaps and over-provision) showed similar tendencies for the two conditions

  17. Giving up nuclear energy. Obstacles, conditions, consequences

    International Nuclear Information System (INIS)

    Koegel-Dorfs, H.

    1990-01-01

    Life on this earth is not possible without using energy. The resources of the energies used so far are limited and their utilization carries certain risks which have now become obvious: climatic problems on the one hand, safety problems on the other. Chernobyl, Wackersdorf, tornados and population growth are issues mentioned all the time in the fight for the best solution. Even church synodes have spoken up and demanded to give up nuclear energy. The energy issue, however, has become a question of survival. This study, worked out by a group of scientists (natural science, energy science, lawyers, theologians) analyses the obstacles, conditions and consequences of such a step. The possible solution of rational energy utilization and substitution of energy services and regenerative energies is discussed in depth. The book concludes that problems can only be coped with if there is a feeling of joint responsibility and global social consensus. (orig./HP) [de

  18. Investing in CIS: obstacles and strategies

    International Nuclear Information System (INIS)

    Anon.

    1996-01-01

    The CIS (Community of Independent States) needs the help of foreign investments to develop its huge hydrocarbon potentialities. Because of the uncertainties concerning the legal and fiscal context of their activities, the role of the international oil companies has remained limited so far. These problems were discussed in May 1996 during an important ''General Session'' of the OTC 96 congress. Proven and explored onshore oil reserves in Russia are enormous, in particular in Western and Eastern Siberia. However, the economically most interesting resources are located in the offshore zones of the Barents, Pechora and Kara seas and of Eastern Siberia and Okhotsk. This paper describes the last years decay of oil production in CIS and its causes, in particular the obstacles to foreign investments (exportation and transport taxes), the recent contracts and joint-ventures with American major companies (Exxon, Amoco..), and the situation of the Russian industry in petroleum engineering and field exploitation materials. (J.S.)

  19. The meaning of integrated care: a systems approach

    Directory of Open Access Journals (Sweden)

    Lars Edgren

    2008-10-01

    Full Text Available Introduction: Organizations can be regarded as systems. The traditional model of systems views them as machines. This seems to be insufficient when it comes to understanding and organizing complex tasks. To better understand integrated care we should approach organizations as constantly changing living organisms, where many agents are interconnected in so-called Complex Adaptive Systems (CAS. Theory and discussion: The term “complex” emphasizes that the necessary competence to perform a task is not owned by any one part, but comes as a result of co-operation within the system. “Adaptive” means that system change occurs through successive adaptations. A CAS consists of several subsystems called agents, which act in dependence of one another. Examples would be the ant-hill, the human immune defence, the financial market and the surgical operating theatre team. Studying a CAS, the focus is on the interaction and communication between agents. Although these thoughts are not new, the CAS-approach has not yet been widely applied to the management of integrated care. This helps the management to understand why the traditional top down way of managing, following the machine model thinking, may meet with problems in interdependent organizations with complex tasks. Conclusion: When we perceive health and social services as CASs we should gain more insight into the processes that go on within and between organizations and how top management, for example within a hospital, in fact executes its steering function.

  20. International Cooperation in Physics - Opportunities and Obstacles

    Science.gov (United States)

    Vary, James P.

    2000-03-01

    The rapid advances in high speed digital communications are making new scientific achievements feasible. This presents a new opportunity for all scientists, especially those in developing countries, to participate in world-class science at a reasonable cost. ``Virtual Laboratories" or ``Collaboratories" provide promising mechanisms to bridge geographical boundaries and infrastructure disparities. While science and technology are recognized as engines of economic development, they are also keys to addressing societal problems and fostering peace. Following the historical precedent of CERN founded after World War II, an initiative organized by UNESCO to create a world-class research institute in the Middle East is underway. A synchrotron light-source is being offered by Germany as the key experimental facility. This project called ``Synchrotron Light for Experimental Science and Applications in the Middle East" or ``SESAME" offers a special opportunity for basic and applied science in the Arab nations of the Middle East to take a giant leap forward. I will review the current status of this initiative and indicate the opportunities and challenges for countries of the Middle East. An emerging mega-science project in Astronomy is the ``Southern Africa Large Telescope" or ``SALT" which, when completed, will be the Southern Hemisphere's largest single telescope. University partners in the US are pledging support for SALT’s construction and operation. SALT promises to become a focal point of world-class basic science in Sub-Saharan Africa. The primary obstacles to international cooperation involving scientists in developing countries stem from scarce financial resources needed to allow potential collaborators to meet and explore where the win-win opportunities reside. Follow up support is a second major obstacle.

  1. Directed cell migration in the presence of obstacles

    Directory of Open Access Journals (Sweden)

    Grima Ramon

    2007-01-01

    Full Text Available Abstract Background Chemotactic movement is a common feature of many cells and microscopic organisms. In vivo, chemotactic cells have to follow a chemotactic gradient and simultaneously avoid the numerous obstacles present in their migratory path towards the chemotactic source. It is not clear how cells detect and avoid obstacles, in particular whether they need a specialized biological mechanism to do so. Results We propose that cells can sense the presence of obstacles and avoid them because obstacles interfere with the chemical field. We build a model to test this hypothesis and find that this naturally enables efficient at-a-distance sensing to be achieved with no need for a specific and active obstacle-sensing mechanism. We find that (i the efficiency of obstacle avoidance depends strongly on whether the chemotactic chemical reacts or remains unabsorbed at the obstacle surface. In particular, it is found that chemotactic cells generally avoid absorbing barriers much more easily than non-absorbing ones. (ii The typically low noise in a cell's motion hinders the ability to avoid obstacles. We also derive an expression estimating the typical distance traveled by chemotactic cells in a 3D random distribution of obstacles before capture; this is a measure of the distance over which chemotaxis is viable as a means of directing cells from one point to another in vivo. Conclusion Chemotactic cells, in many cases, can avoid obstacles by simply following the spatially perturbed chemical gradients around obstacles. It is thus unlikely that they have developed specialized mechanisms to cope with environments having low to moderate concentrations of obstacles.

  2. DEVELOPMENT OF FRANCHISING IN CROATIA OBSTACLES AND POLICY RECOMMENDATIONS

    OpenAIRE

    Alpeza, Mirela; Erceg, Aleksandar; Oberman Peterka, Sunčica

    2015-01-01

    Franchising is very popular growth model but despite the wide application of franchising in the developed countries of the world, its impact on the Croatian economy is still marginal. The purpose of this research is to identify the obstacles and challenges to a wider application of franchising in Croatia and generate policy recommendations for removing the identified obstacles. Obstacles and recommendations are identified on the basis of a conducted longitudinal qualitative research, the firs...

  3. On cylindrically converging shock waves shaped by obstacles

    Energy Technology Data Exchange (ETDEWEB)

    Eliasson, V; Henshaw, W D; Appelo, D

    2007-07-16

    Motivated by recent experiments, numerical simulations were performed of cylindrically converging shock waves. The converging shocks impinged upon a set of zero to sixteen regularly space obstacles. For more than two obstacles the resulting diffracted shock fronts formed polygonal shaped patterns near the point of focus. The maximum pressure and temperature as a function of number of obstacles were studied. The self-similar behavior of cylindrical, triangular and square-shaped shocks were also investigated.

  4. Educational potential of a virtual patient system for caring for traumatized patients in primary care

    Science.gov (United States)

    2013-01-01

    Background Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC). Methods A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system’s usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data. Results Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results. Conclusions Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on

  5. 40 CFR 792.90 - Animal and other test system care.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Animal and other test system care. 792... Animal and other test system care. (a) There shall be standard operating procedures for the housing, feeding, handling, and care of animals and other test systems. (b) All newly received test systems from...

  6. Controlled drug delivery systems towards new frontiers in patient care

    CERN Document Server

    Rossi, Filippo; Masi, Maurizio

    2016-01-01

    This book offers a state-of-the-art overview of controlled drug delivery systems, covering the most important innovative applications. The principles of controlled drug release and the mechanisms involved in controlled release are clearly explained. The various existing polymeric drug delivery systems are reviewed, and new frontiers in material design are examined in detail, covering a wide range of polymer modification techniques. The concluding chapter is a case study focusing on use of a drug-eluting stent. The book is designed to provide the reader with a complete understanding of the mechanisms and design of controlled drug delivery systems, and to this end includes numerous step-by-step tutorials. It illustrates how chemical engineers can advance medical care by designing polymeric delivery systems that achieve either temporal or spatial control of drug delivery and thus ensure more effective therapy that eliminates the potential for both under-and overdosing.

  7. Teaching medical ethics to meet the realities of a changing health care system.

    Science.gov (United States)

    Millstone, Michael

    2014-06-01

    The changing context of medical practice--bureaucratic, political, or economic--demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.

  8. Blindness enhances auditory obstacle circumvention: Assessing echolocation, sensory substitution, and visual-based navigation.

    Science.gov (United States)

    Kolarik, Andrew J; Scarfe, Amy C; Moore, Brian C J; Pardhan, Shahina

    2017-01-01

    Performance for an obstacle circumvention task was assessed under conditions of visual, auditory only (using echolocation) and tactile (using a sensory substitution device, SSD) guidance. A Vicon motion capture system was used to measure human movement kinematics objectively. Ten normally sighted participants, 8 blind non-echolocators, and 1 blind expert echolocator navigated around a 0.6 x 2 m obstacle that was varied in position across trials, at the midline of the participant or 25 cm to the right or left. Although visual guidance was the most effective, participants successfully circumvented the obstacle in the majority of trials under auditory or SSD guidance. Using audition, blind non-echolocators navigated more effectively than blindfolded sighted individuals with fewer collisions, lower movement times, fewer velocity corrections and greater obstacle detection ranges. The blind expert echolocator displayed performance similar to or better than that for the other groups using audition, but was comparable to that for the other groups using the SSD. The generally better performance of blind than of sighted participants is consistent with the perceptual enhancement hypothesis that individuals with severe visual deficits develop improved auditory abilities to compensate for visual loss, here shown by faster, more fluid, and more accurate navigation around obstacles using sound.

  9. Blindness enhances auditory obstacle circumvention: Assessing echolocation, sensory substitution, and visual-based navigation.

    Directory of Open Access Journals (Sweden)

    Andrew J Kolarik

    Full Text Available Performance for an obstacle circumvention task was assessed under conditions of visual, auditory only (using echolocation and tactile (using a sensory substitution device, SSD guidance. A Vicon motion capture system was used to measure human movement kinematics objectively. Ten normally sighted participants, 8 blind non-echolocators, and 1 blind expert echolocator navigated around a 0.6 x 2 m obstacle that was varied in position across trials, at the midline of the participant or 25 cm to the right or left. Although visual guidance was the most effective, participants successfully circumvented the obstacle in the majority of trials under auditory or SSD guidance. Using audition, blind non-echolocators navigated more effectively than blindfolded sighted individuals with fewer collisions, lower movement times, fewer velocity corrections and greater obstacle detection ranges. The blind expert echolocator displayed performance similar to or better than that for the other groups using audition, but was comparable to that for the other groups using the SSD. The generally better performance of blind than of sighted participants is consistent with the perceptual enhancement hypothesis that individuals with severe visual deficits develop improved auditory abilities to compensate for visual loss, here shown by faster, more fluid, and more accurate navigation around obstacles using sound.

  10. Construction of Fisheye Lens Inverse Perspective Mapping Model and Its Applications of Obstacle Detection

    Directory of Open Access Journals (Sweden)

    Chin-Teng Lin

    2010-01-01

    Full Text Available In this paper, we develop a vision based obstacle detection system by utilizing our proposed fisheye lens inverse perspective mapping (FLIPM method. The new mapping equations are derived to transform the images captured by the fisheye lens camera into the undistorted remapped ones under practical circumstances. In the obstacle detection, we make use of the features of vertical edges on objects from remapped images to indicate the relative positions of obstacles. The static information of remapped images in the current frame is referred to determining the features of source images in the searching stage from either the profile or temporal IPM difference image. The profile image can be acquired by several processes such as sharpening, edge detection, morphological operation, and modified thinning algorithms on the remapped image. The temporal IPM difference image can be obtained by a spatial shift on the remapped image in the previous frame. Moreover, the polar histogram and its post-processing procedures will be used to indicate the position and length of feature vectors and to remove noises as well. Our obstacle detection can give drivers the warning signals within a limited distance from nearby vehicles while the detected obstacles are even with the quasi-vertical edges.

  11. Analysis of the obstacles related to treatment entry, adherence and drop-out among alcoholic patients.

    Science.gov (United States)

    Fonsi Elbreder, Márcia; Carvalho De Humerez, Dorisdaia; Laranjeira, Ronaldo

    2009-01-01

    Alcoholism is a complex syndrome involving social, psychological and individual factors in addition to a series of obstacles regarding treatment entry, adherence, and drop-out. These obstacles contribute negatively to both clinical evolution and prognosis of the patients, affecting their quality of life and raising the social costs. This is a bibliographical study in which we address this theme as well as other experiences observed in our daily practice in the Alcohol and Drug Research Unit (UNIAD) based at the Federal University of São Paulo (UNIFESP). The analysis of the obstacles related to treatment entry, attendance, and drop-out among alcoholic patients shows that systemic, social, cultural, and individual factors are all involved, including the structural ones. Women have more obstacles compared to men, and what is thought to be a barrier to one patient may be a factor motivating another patient to search for help. We conclude that several factors at different levels exist that prevent the patient from overcoming these treatment obstacles.

  12. Obstacle detection by stereo vision of fast correlation matching

    International Nuclear Information System (INIS)

    Jeon, Seung Hoon; Kim, Byung Kook

    1997-01-01

    Mobile robot navigation needs acquiring positions of obstacles in real time. A common method for performing this sensing is through stereo vision. In this paper, indoor images are acquired by binocular vision, which contains various shapes of obstacles. From these stereo image data, in order to obtain distances to obstacles, we must deal with the correspondence problem, or get the region in the other image corresponding to the projection of the same surface region. We present an improved correlation matching method enhancing the speed of arbitrary obstacle detection. The results are faster, simple matching, robustness to noise, and improvement of precision. Experimental results under actual surroundings are presented to reveal the performance. (author)

  13. Effect of form of obstacle on speed of crowd evacuation

    Science.gov (United States)

    Yano, Ryosuke

    2018-03-01

    This paper investigates the effect of the form of an obstacle on the time that a crowd takes to evacuate a room, using a toy model. Pedestrians are modeled as active soft matter moving toward a point with intended velocities. An obstacle is placed in front of the exit, and it has one of four shapes: a cylindrical column, a triangular prism, a quadratic prism, or a diamond prism. Numerical results indicate that the evacuation-completion time depends on the shape of the obstacle. Obstacles with a circular cylinder (C.C.) shape yield the shortest evacuation-completion time in the proposed model.

  14. Selecting, adapting, and sustaining programs in health care systems

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-04-01

    Full Text Available Leah L Zullig,1,2 Hayden B Bosworth1–4 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University Medical Center, Durham, NC, USA; 3School of Nursing, 4Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA Abstract: Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities. Keywords: program sustainability, diffusion of innovation, information dissemination, health services research, intervention studies 

  15. A systems approach to improving rural care in Ethiopia.

    Directory of Open Access Journals (Sweden)

    Elizabeth H Bradley

    Full Text Available BACKGROUND: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI, we identified PHCUs with consistently higher performance (n = 2, most improved performance (n = 3, or consistently lower performance (n = 2 in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51, we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1 managerial problem solving capacity, 2 relationship with the woreda (district health office, and 3 community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. CONCLUSIONS/SIGNIFICANCE: Effective health strengthening efforts may require intensive

  16. A systems approach to improving rural care in Ethiopia.

    Science.gov (United States)

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

    2012-01-01

    Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. Effective health strengthening efforts may require intensive development of managerial problem solving skills, strong relationships with

  17. Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction.

    Science.gov (United States)

    Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel

    2011-01-01

    Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

  18. Evaluation of Community Care Network (CCN) system in a rural health care setting.

    Science.gov (United States)

    Galfalvy, H C; Reddy, S M; Niewiadomska-Bugaj, M; Friedman, S; Merkin, B

    1995-01-01

    Concurrent Engineering Research Center (CERC), under the sponsorship of NLM (National Library of Medicine) is in the process of developing a computerized patient record system for a clinical environment distributed in rural West Virginia. This realization of the CCN (Community Care Network), besides providing computer-based patient records accessible from a chain of clinics and one hospital, supports collaborative health care processes like referral and consulting. To evaluate the effectiveness of the system, a study was designed and is in the process of being executed. Three surveys were designed to provide subjective measures, and four experiments for collecting objective data. Data collection is taking place in several phases: baseline data are collected before the system is deployed; the process is repeated with minimal changes three, then six months later or as often as new versions of the system are installed. Results are then to be compared, using whenever possible matching techniques (i.e. the preliminary data collected on a provider will be matched with the data collected later on the same provider). Surveys are conducted through questionnaires distributed to providers and nurses and person-to-person interviews of the patients. The time spent on patient-chart related activities is measured by work-sampling, aided by a computer application running on a laptop PC. Information about missing patient record parts is collected by the providers, the frequency by which new features of the computerized system are used will be logged by the system itself and clinical outcome measures will be studied from the results of the clinics' own patient chart audits. Preliminary results of the surveys and plans for the immediate and distant future are discussed at the end of the paper.

  19. Development of an allergy management support system in primary care

    Directory of Open Access Journals (Sweden)

    Flokstra - de Blok BMJ

    2017-03-01

    Full Text Available Bertine MJ Flokstra - de Blok,1,2 Thys van der Molen,1,2 Wianda A Christoffers,3 Janwillem WH Kocks,1,2 Richard L Oei,4 Joanne NG Oude Elberink,2,4 Emmy M Roerdink,5 Marie Louise Schuttelaar,3 Jantina L van der Velde,1,2 Thecla M Brakel,1,6 Anthony EJ Dubois2,5 1Department of General Practice, 2GRIAC Research Institute, 3Department of Dermatology, 4Department of Allergology, 5Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, 6Teaching Unit, Department of Social Psychology, University of Groningen, Groningen, The Netherlands Background: Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS for primary care. Methods: Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard and AMSS diagnostic categories. Results: The two-page patient-completed AMSS questionnaire consists of 12 (mainly multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other

  20. A dashboard-based system for supporting diabetes care.

    Science.gov (United States)

    Dagliati, Arianna; Sacchi, Lucia; Tibollo, Valentina; Cogni, Giulia; Teliti, Marsida; Martinez-Millana, Antonio; Traver, Vicente; Segagni, Daniele; Posada, Jorge; Ottaviano, Manuel; Fico, Giuseppe; Arredondo, Maria Teresa; De Cata, Pasquale; Chiovato, Luca; Bellazzi, Riccardo

    2018-05-01

    To describe the development, as part of the European Union MOSAIC (Models and Simulation Techniques for Discovering Diabetes Influence Factors) project, of a dashboard-based system for the management of type 2 diabetes and assess its impact on clinical practice. The MOSAIC dashboard system is based on predictive modeling, longitudinal data analytics, and the reuse and integration of data from hospitals and public health repositories. Data are merged into an i2b2 data warehouse, which feeds a set of advanced temporal analytic models, including temporal abstractions, care-flow mining, drug exposure pattern detection, and risk-prediction models for type 2 diabetes complications. The dashboard has 2 components, designed for (1) clinical decision support during follow-up consultations and (2) outcome assessment on populations of interest. To assess the impact of the clinical decision support component, a pre-post study was conducted considering visit duration, number of screening examinations, and lifestyle interventions. A pilot sample of 700 Italian patients was investigated. Judgments on the outcome assessment component were obtained via focus groups with clinicians and health care managers. The use of the decision support component in clinical activities produced a reduction in visit duration (P ≪ .01) and an increase in the number of screening exams for complications (P < .01). We also observed a relevant, although nonstatistically significant, increase in the proportion of patients receiving lifestyle interventions (from 69% to 77%). Regarding the outcome assessment component, focus groups highlighted the system's capability of identifying and understanding the characteristics of patient subgroups treated at the center. Our study demonstrates that decision support tools based on the integration of multiple-source data and visual and predictive analytics do improve the management of a chronic disease such as type 2 diabetes by enacting a successful

  1. UAV formation control design with obstacle avoidance in dynamic three-dimensional environment.

    Science.gov (United States)

    Chang, Kai; Xia, Yuanqing; Huang, Kaoli

    2016-01-01

    This paper considers the artificial potential field method combined with rotational vectors for a general problem of multi-unmanned aerial vehicle (UAV) systems tracking a moving target in dynamic three-dimensional environment. An attractive potential field is generated between the leader and the target. It drives the leader to track the target based on the relative position of them. The other UAVs in the formation are controlled to follow the leader by the attractive control force. The repulsive force affects among the UAVs to avoid collisions and distribute the UAVs evenly on the spherical surface whose center is the leader-UAV. Specific orders or positions of the UAVs are not required. The trajectories of avoidance obstacle can be obtained through two kinds of potential field with rotation vectors. Every UAV can choose the optimal trajectory to avoid the obstacle and reconfigure the formation after passing the obstacle. Simulations study on UAV are presented to demonstrate the effectiveness of proposed method.

  2. Cooperative fusion for multi-obstacles detection with use of stereovision and laser scanner

    OpenAIRE

    LABAYRADE, R; ROYERE, C; GRUYER, D; AUBERT, D

    2003-01-01

    The authors propose in this paper a new cooperative fusion approach between stereovision and laser scanner in order to take advantage of the best features of these two sensors to perform robust, accurate and real-time detection of multi-obstacles in the automotive context. The proposed system is able to estimate the position and the height, width and depth of generic obstacles at video frame rate (25 frames per second). The vehicle pitch, estimated by stereovision, is used to filter laser sca...

  3. Cooperative fusion for multi-obstacles detection with use of stereovision and laser scanner

    OpenAIRE

    LABAYRADE, R; ROYERE, C; GRUYER, D; AUBERT, D

    2005-01-01

    We propose a new cooperative fusion approach between stereovision and laser scanner in order to take advantage of the best features and cope with the drawbacks of these two sensors to perform robust, accurate and real time-detection of multi-obstacles in the automotive context. The proposed system is able to estimate the position and the height, width and depth of generic obstacles at video frame rate (25 frames per second). The vehicle pitch, estimated by stereovision, is used to filter lase...

  4. Comparative analysis of organizational obstacles to CHP/DH

    Energy Technology Data Exchange (ETDEWEB)

    Ruedig, W.

    1986-04-01

    An explanation is given of the vast differences between the countries of Western Europe in the adoption of combined heat and power (CHP) for district heating (DH). The history of this technology in FR Germany and the UK is analysed in detail, and experiences of other countries are reviewed. It is concluded that the over centralization of the electricity supply industry is a major obstacle in the widespread adoption of combined heat and power and district heating. Significant improvements of energy efficiency would thus require organizational reforms giving greater powers to local energy organizations. This, however, should not imply total decentralization of energy supply. Instead, a two-tier system is proposed in which central organizations remain responsible for bulk supply but where local or regional bodies are in charge of all gas, electricity and heat supplies to the final user.

  5. Locomotor circumvention strategies are altered by stroke: I. Obstacle clearance.

    Science.gov (United States)

    Darekar, Anuja; Lamontagne, Anouk; Fung, Joyce

    2017-06-15

    Functional locomotion requires the ability to adapt to environmental challenges such as the presence of stationary or moving obstacles. Difficulties in obstacle circumvention often lead to restricted community ambulation in individuals with stroke. The objective of this study was to contrast obstacle circumvention strategies between post-stroke (n = 12) and healthy individuals (n = 12) performing locomotor and perceptuomotor (joystick navigation) tasks with different obstacle approaches. Participants walked and navigated with a joystick towards a central target, in a virtual environment simulating a large room, while avoiding an obstacle that either remained stationary at the pre-determined point of intersection or moved from head-on or diagonally 30° left/right. The outcome measures included dynamic clearance (DC), instantaneous distance from obstacle at crossing (IDC), number of collisions and preferred side of circumvention. These measures were compared between groups (stroke vs. healthy), obstacle parameter (stationary vs. moving head-on) and direction of approach (left/paretic vs. right/non-paretic). DC was significantly larger when circumventing a moving obstacle that approached head-on as compared to a stationary obstacle for both groups during both tasks, while not significantly different in either diagonal approach in either group. IDC was smaller in the stroke group while walking and larger in both groups during joystick navigation when avoiding moving as compared to stationary obstacle. IDC was significantly larger in the stroke group compared to controls for diagonal approaches during walking, wherein two different strategies emerged amongst individuals with stroke: circumventing to the same (V same n = 6) or opposite (V opp n = 4) side of obstacle approach. This behavior was not seen in the perceptuomotor task, wherein post-stroke participants circumvented to opposite side of the obstacle approach as seen in healthy participants. In the

  6. A computational study for investigating acoustic streaming and tissue heating during high intensity focused ultrasound through blood vessel with an obstacle

    Science.gov (United States)

    Parvin, Salma; Sultana, Aysha

    2017-06-01

    The influence of High Intensity Focused Ultrasound (HIFU) on the obstacle through blood vessel is studied numerically. A three-dimensional acoustics-thermal-fluid coupling model is employed to compute the temperature field around the obstacle through blood vessel. The model construction is based on the linear Westervelt and conjugate heat transfer equations for the obstacle through blood vessel. The system of equations is solved using Finite Element Method (FEM). We found from this three-dimensional numerical study that the rate of heat transfer is increasing from the obstacle and both the convective cooling and acoustic streaming can considerably change the temperature field.

  7. Care delivery for Filipino Americans using the Neuman systems model.

    Science.gov (United States)

    Angosta, Alona D; Ceria-Ulep, Clementina D; Tse, Alice M

    2014-04-01

    Filipino Americans are at risk of coronary heart disease due to the presence of multiple cardiometabolic factors. Selecting a framework that addresses the factors leading to coronary heart disease is vital when providing care for this population. The Neuman systems model is a comprehensive and wholistic framework that offers an innovative method of viewing clients, their families, and the healthcare system across multiple dimensions. Using the Neuman systems model, advanced practice nurses can develop and implement interventions that will help reduce the potential cardiovascular problems of clients with multiple risk factors. The authors in this article provides insight into the cardiovascular health of Filipino Americans and has implications for nurses and other healthcare providers working with various Southeast Asian groups in the United States.

  8. Health, Health Care, and Systems Science: Emerging Paradigm.

    Science.gov (United States)

    Janecka, Ivo

    2017-02-15

    Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public's health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite of

  9. Patient perspectives of care in a regionalised trauma system: lessons from the Victorian State Trauma System.

    Science.gov (United States)

    Gabbe, Belinda J; Sleney, Jude S; Gosling, Cameron M; Wilson, Krystle; Hart, Melissa J; Sutherland, Ann M; Christie, Nicola

    2013-02-18

    To explore injured patients' experiences of trauma care to identify areas for improvement in service delivery. Qualitative study using in-depth, semi-structured interviews, conducted from 1 April 2011 to 31 January 2012, with 120 trauma patients registered by the Victorian State Trauma Registry and the Victorian Orthopaedic Trauma Outcomes Registry and managed at the major adult trauma services (MTS) in Victoria. Emergent themes from patients' experiences of acute, rehabilitation and post-discharge care in the Victorian State Trauma System (VSTS). Patients perceived their acute hospital care as high quality, although 3s with communication and surgical management delays were common. Discharge from hospital was perceived as stressful, and many felt ill prepared for discharge. A consistent emerging theme was the sense of a lack of coordination of post-discharge care, and the absence of a consistent point of contact for ongoing management. Most patients' primary point of contact after discharge was outpatient clinics at the MTS, which were widely criticised because of substantial delays in receiving an appointment, prolonged waiting times, limited time with clinicians, lack of continuity of care and inability to see senior clinicians. This study highlights perceived 3s in the patient care pathway in the VSTS, especially those relating to communication, information provision and post-discharge care. Trauma patients perceived the need for a single point of contact for coordination of post-discharge care.

  10. Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

    Science.gov (United States)

    Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

    2012-04-01

    This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

  11. Options for Improving the Military Child Care System

    National Research Council Canada - National Science Library

    Zellman, Gail L; Gates, Susan M; Cho, Michelle; Shaw, Rebecca

    2008-01-01

    .... Care in Child Development Centers (CDCs) is quite costly for DoD to provide; care for the youngest children is particularly expensive since parent fees are based on family income and not on the cost of care...

  12. 78 FR 25304 - Siemens Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology), Including On...

    Science.gov (United States)

    2013-04-30

    ..., USA, Inc., Oncology Care Systems (Radiation Oncology), Including On-Site Leased Workers From Source... Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology), including on- site leased... of February 2013, Siemens Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology...

  13. 76 FR 59167 - Siemens Medical Solutions USA, Inc., Oncology Care Systems Division, Concord, CA; Siemens Medical...

    Science.gov (United States)

    2011-09-23

    ... Medical Solutions USA, Inc., Oncology Care Systems Division, Concord, CA; Siemens Medical Solutions USA... Solutions USA, Inc. (Siemens), Oncology Care Systems Division, Concord, California (subject firm). The...., Oncology Care Systems Division, Concord, California (TA-W-73,158) and Siemens Medical Solutions USA, Inc...

  14. System impact research - increasing public health and health care system performance.

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Interventions directed to system features of public health and health care should increase health and welfare of patients and population. To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. System Impact Research - creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population. Key messages The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features. SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services. SIR creates the

  15. System impact research – increasing public health and health care system performance

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Abstract Background Interventions directed to system features of public health and health care should increase health and welfare of patients and population. Aims To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). Methods The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. Results The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. Conclusions System Impact Research – creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population.Key messagesThe new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features.SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency

  16. [Artificial intelligence in medicine: limits and obstacles.

    Science.gov (United States)

    Santoro, Eugenio

    2017-12-01

    Data scientists and physicians are starting to use artificial intelligence (AI) even in the medical field in order to better understand the relationships among the huge amount of data coming from the great number of sources today available. Through the data interpretation methods made available by the recent AI tools, researchers and AI companies have focused on the development of models allowing to predict the risk of suffering from a specific disease, to make a diagnosis, and to recommend a treatment that is based on the best and most updated scientific evidence. Even if AI is used to perform unimaginable tasks until a few years ago, the awareness about the ongoing revolution has not yet spread through the medical community for several reasons including the lack of evidence about safety, reliability and effectiveness of these tools, the lack of regulation accompanying hospitals in the use of AI by health care providers, the difficult attribution of liability in case of errors and malfunctions of these systems, and the ethical and privacy questions that they raise and that, as of today, are still unanswered.

  17. Performance characteristics of solar air heater with surface mounted obstacles

    International Nuclear Information System (INIS)

    Bekele, Adisu; Mishra, Manish; Dutta, Sushanta

    2014-01-01

    Highlights: • Solar air heater with delta shaped obstacles have been studied. • Obstacle angle of incidence strongly affects the thermo-hydraulic performance. • Thermal performance of obstacle mounted collectors is superior to smooth collectors. • Thermo-hydraulic performance of the present SAH is higher than those in previous studies. - Abstract: The performance of conventional solar air heaters (SAHs) can be improved by providing obstacles on the heated wall (i.e. on the absorber plate). Experiments have been performed to collect heat transfer and flow-friction data from an air heater duct with delta-shaped obstacles mounted on the absorber surface and having an aspect ratio 6:1 resembling the conditions close to the solar air heaters. This study encompassed for the range of Reynolds number (Re) from 2100 to 30,000, relative obstacle height (e/H) from 0.25 to 0.75, relative obstacle longitudinal pitch (P l /e) from 3/2 to 11/2, relative obstacle transverse pitch (P t /b) from 1 to 7/3 and the angle of incidence (α) varied from 30° to 90°. The thermo-hydraulic performance characteristics of SAH have been compared with the previous published works and the optimum range of the geometries have been explored for the better performance of such air-heaters compared to the other designs of solar air heaters

  18. Getting to Darwin: Obstacles to Accepting Evolution by Natural Selection

    Science.gov (United States)

    Thagard, Paul; Findlay, Scott

    2010-01-01

    Darwin's theory of evolution by natural selection is central to modern biology, but is resisted by many people. This paper discusses the major psychological obstacles to accepting Darwin's theory. Cognitive obstacles to adopting evolution by natural selection include conceptual difficulties, methodological issues, and coherence problems that…

  19. Foot strike patterns after obstacle clearance during running.

    Science.gov (United States)

    Scholten, Shane D; Stergiou, Nicholas; Hreljac, Alan; Houser, Jeremy; Blanke, Daniel; Alberts, L Russell

    2002-01-01

    Running over obstacles of sufficient height requires heel strike (HS) runners to make a transition in landing strategy to a forefoot (FF) strike, resulting in similar ground reaction force patterns to those observed while landing from a jump. Identification of the biomechanical variables that distinguish between the landing strategies may offer some insight into the reasons that the transition occurs. The purpose of this study was to investigate the difference in foot strike patterns and kinetic parameters of heel strike runners between level running and running over obstacles of various heights. Ten heel strike subjects ran at their self-selected pace under seven different conditions: unperturbed running (no obstacle) and over obstacles of six different heights (10%, 12.5%, 15%, 17.5%, 20%, and 22.5% of their standing height). The obstacle was placed directly before a Kistler force platform. Repeated measures ANOVAs were performed on the subject means of selected kinetic parameters. The statistical analysis revealed significant differences (P strike patterns were affected by the increased obstacle height. Between the 12.5% and 15% obstacle conditions, the group response changed from a heel strike to a forefoot strike pattern. At height > 15%, the pattern was more closely related to the foot strike patterns found in jumping activities. This strategy change may represent a gait transition effected as a mechanism to protect against increased impact forces. Greater involvement of the ankle and the calf muscles could have assisted in attenuating the increased impact forces while maintaining speed after clearing the obstacle.

  20. Biologically-Inspired Adaptive Obstacle Negotiation Behavior of Hexapod Robots

    Directory of Open Access Journals (Sweden)

    Dennis eGoldschmidt

    2014-01-01

    Full Text Available Neurobiological studies have shown that insects are able to adapt leg movements and posture for obstacle negotiation in changing environments. Moreover, the distance to an obstacle where an insect begins to climb is found to be a major parameter for successful obstacle negotiation. Inspired by these findings, we present an adaptive neural control mechanism for obstacle negotiation behavior in hexapod robots. It combines locomotion control, backbone joint control, local leg reflexes, and neural learning. While the first three components generate locomotion including walking and climbing, the neural learning mechanism allows the robot to adapt its behavior for obstacle negotiation with respect to changing conditions, e.g., variable obstacle heights and different walking gaits. By successfully learning the association of an early, predictive signal (conditioned stimulus, CS and a late, reflex signal (unconditioned stimulus, UCS, both provided by ultrasonic sensors at the front of the robot, the robot can autonomously find an appropriate distance from an obstacle to initiate climbing. The adaptive neural control was developed and tested first on a physical robot simulation, and was then successfully transferred to a real hexapod robot, called AMOS II. The results show that the robot can efficiently negotiate obstacles with a height up to 85% of the robot's leg length in simulation and 75% in a real environment.

  1. Minimum-link paths among obstacles in the plane

    NARCIS (Netherlands)

    Mitchell, J.S.B.; Rote, G.; Woeginger, G.J.

    1992-01-01

    Given a set of nonintersecting polygonal obstacles in the plane, thelink distance between two pointss andt is the minimum number of edges required to form a polygonal path connectings tot that avoids all obstacles. We present an algorithm that computes the link distance (and a corresponding

  2. Swarm Robotics with Circular Formation Motion Including Obstacles Avoidance

    Directory of Open Access Journals (Sweden)

    Nabil M. Hewahi

    2017-07-01

    Full Text Available The robots science has been developed over the past few years, where robots have become used to accomplish difficult, repetitive or accurate tasks, which are very hard for humans to carry out. In this paper, we propose an algorithm to control the motion of a swarm of robots and make them able to avoid obstacles. The proposed solution is based on forming the robots in circular fashion. A group set of robots consists of multiple groups of robots, each group of robots consists of robots forming a circular shape and each group set is a circular form of robots. The proposed algorithm is concerned with first locating the randomly generated robots in groups and secondly with the swarm robot motion and finally with the swarm obstacle avoidance and swarm reorganization after crossing the obstacle. The proposed algorithm has been simulated with five different obstacles with various numbers of randomly generated robots. The results show that the swarm in the circular form can deal with the obstacles very effectively by passing the obstacles smoothly. The proposed algorithm has been compared with flocking algorithm and it is shown that the circular formation algorithm does not need extensive computation after obstacle avoidance whereas the flocking algorithm needs extensive computation. In addition, the circular formation algorithm maintains every robot in its group after avoiding the obstacles whereas with flocking algorithm does not.

  3. Sensor network infrastructure for a home care monitoring system.

    Science.gov (United States)

    Palumbo, Filippo; Ullberg, Jonas; Stimec, Ales; Furfari, Francesco; Karlsson, Lars; Coradeschi, Silvia

    2014-02-25

    This paper presents the sensor network infrastructure for a home care system that allows long-term monitoring of physiological data and everyday activities. The aim of the proposed system is to allow the elderly to live longer in their home without compromising safety and ensuring the detection of health problems. The system offers the possibility of a virtual visit via a teleoperated robot. During the visit, physiological data and activities occurring during a period of time can be discussed. These data are collected from physiological sensors (e.g., temperature, blood pressure, glucose) and environmental sensors (e.g., motion, bed/chair occupancy, electrical usage). The system can also give alarms if sudden problems occur, like a fall, and warnings based on more long-term trends, such as the deterioration of health being detected. It has been implemented and tested in a test environment and has been deployed in six real homes for a year-long evaluation. The key contribution of the paper is the presentation of an implemented system for ambient assisted living (AAL) tested in a real environment, combining the acquisition of sensor data, a flexible and adaptable middleware compliant with the OSGistandard and a context recognition application. The system has been developed in a European project called GiraffPlus.

  4. Logical obstacles in learning planetary motion

    Science.gov (United States)

    Dileep, V.; Sathe, D. V.

    Daniel Schaffer wrote now-a-days scientists and particularly theoretical physicists are not held in unquestioned esteem in his editorial This became the starting point of my presentation which was dedicated to the memory of Abdus Salam 1 Had he survived to witness the IYP he would have become surprised on knowing that Frank Wilczek had maximum trouble in learning classical mechanics 2 These facts require us to restudy learning O level physics from the logical point of view - in order to attract promising young students to take up challenges of physics and astronomy of the 21 st century Newton s laws of motion are known for more than 300 years and so there should not be any problems in learning and teaching these laws now in the 21 st century But findings of educators reported in the last 30 years show that there are some serious and global problems I have shown that there are some logical obstacles which make adverse effect on the comprehension of circular motion and related topics 3 In this presentation relevant aspects are discussed References begin enumerate item D V Sathe August 2001 Chemical Education International http www iupac org publications cei vol2 0201x0026 html item Frank Wilczek October 2004 Physics Today p 11 item D V Sathe December 2001 COSPAR Info Bulletin 152 p 53 end enumerate

  5. Decision support system for health care resources allocation.

    Science.gov (United States)

    Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

    2017-06-01

    A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff.

  6. Turbidity current flow over an erodible obstacle and phases of sediment wave generation

    Science.gov (United States)

    Strauss, Moshe; Glinsky, Michael E.

    2012-06-01

    We study the flow of particle-laden turbidity currents down a slope and over an obstacle. A high-resolution 2-D computer simulation model is used, based on the Navier-Stokes equations. It includes poly-disperse particle grain sizes in the current and substrate. Particular attention is paid to the erosion and deposition of the substrate particles, including application of an active layer model. Multiple flows are modeled from a lock release that can show the development of sediment waves (SW). These are stream-wise waves that are triggered by the increasing slope on the downstream side of the obstacle. The initial obstacle is completely erased by the resuspension after a few flows leading to self consistent and self generated SW that are weakly dependant on the initial obstacle. The growth of these waves is directly related to the turbidity current being self sustaining, that is, the net erosion is more than the net deposition. Four system parameters are found to influence the SW growth: (1) slope, (2) current lock height, (3) grain lock concentration, and (4) particle diameters. Three phases are discovered for the system: (1) "no SW," (2) "SW buildup," and (3) "SW growth". The second phase consists of a soliton-like SW structure with a preserved shape. The phase diagram of the system is defined by isolating regions divided by critical slope angles as functions of current lock height, grain lock concentration, and particle diameters.

  7. Can learning health systems help organisations deliver personalised care?

    Science.gov (United States)

    Nwaru, Bright I; Friedman, Charles; Halamka, John; Sheikh, Aziz

    2017-10-02

    There is increasing international policy and clinical interest in developing learning health systems and delivering precision medicine, which it is hoped will help reduce variation in the quality and safety of care, improve efficiency, and lead to increasing the personalisation of healthcare. Although reliant on similar policies, informatics tools, and data science and implementation research capabilities, these two major initiatives have thus far largely progressed in parallel. In this opinion piece, we argue that they should be considered as complementary, synergistic initiatives whereby the creation of learning health systems infrastructure can support and catalyse the delivery of precision medicine that maximises the benefits and minimises the risks associated with treatments for individual patients. We illustrate this synergy by considering the example of treatments for asthma, which is now recognised as an umbrella term for a heterogeneous group of related conditions.

  8. A conceptual data model for a primary health care patient-centric electronic medical record system

    CSIR Research Space (South Africa)

    Kotzé, P

    2014-09-01

    Full Text Available regarding continuity of care, typical healthcare protocols, a study of public healthcare district hospital information systems and both public and private primary healthcare information systems....

  9. Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management.

    Science.gov (United States)

    Lam, Nguyet-Cam Vu; Ghetu, Maria V; Bieniek, Marzena L

    2016-08-15

    Systemic lupus erythematosus is an autoimmune disease that affects many systems, including the skin, musculoskeletal, renal, neuropsychiatric, hematologic, cardiovascular, pulmonary, and reproductive systems. Family physicians should be familiar with the manifestations of lupus to aid in early diagnosis, monitoring patients with mild disease, recognizing warning signs that require referral to a rheumatologist, and helping to monitor disease activity and treatment in patients with moderate to severe disease. The American College of Rheumatology has 11 classification criteria for lupus. If a patient meets at least four criteria, lupus can be diagnosed with 95% specificity and 85% sensitivity. All patients with lupus should receive education, counseling, and support. Hydroxychloroquine is the cornerstone of treatment because it reduces disease flares and other constitutional symptoms. Low-dose glucocorticoids can be used to treat most manifestations of lupus. The use of immunosuppressive and cytotoxic agents depends on the body systems affected. Patients with mild disease that does not involve major organ systems can be monitored by their family physician. Patients with increased disease activity, complications, or adverse effects from treatment should be referred to a rheumatologist. To optimize treatment, it is important that a rheumatologist coordinate closely with the patient's family physician to improve chronic care as well as preventive health services.

  10. In place of fear: aligning health care planning with system objectives to achieve financial sustainability.

    Science.gov (United States)

    Birch, Stephen; Murphy, Gail Tomblin; MacKenzie, Adrian; Cumming, Jackie

    2015-04-01

    The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  11. National Child Care Regulatory, Monitoring and Evaluation Systems Model.

    Science.gov (United States)

    Fiene, Richard

    The relation between compliance with child care regulations and the quality of day care programs is discussed, and predictors of child care compliance are identified. Substantial compliance (90-97 percent, but not a full 100 percent compliance with state day care regulations) positively affects children. Low compliance (below 85 percent…

  12. Rapid Business Transformations in Health Care: A Systems Approach

    Science.gov (United States)

    Shulaiba, Refaat A.

    2011-01-01

    The top two priorities of health care business leaders are to constantly improve the quality of health care while striving to contain and reduce the high cost of health care. The Health Care industry, similar to all businesses, is motivated to deliver innovative solutions that accelerate business transformation and increase business capabilities. …

  13. Innovating Responsibly in ICT for Ageing: Drivers, Obstacles and Implementation

    Directory of Open Access Journals (Sweden)

    Kate Chatfield

    2017-06-01

    Full Text Available Responsible research and innovation (RRI is a nascent concept, promoted actively by the European Union and other policy makers around the world. Hitherto, this concept has been associated primarily with publicly funded activities but given the considerable proportion of research and innovation that is undertaken in the private sector, RRI will be rendered irrelevant unless it is adopted by industry. This paper introduces a private sector perspective of RRI, specifically that of the information and communication technology (ICT industry, working in the field of healthy ageing. Drawing upon empirical data from 30 in-depth interviews with key industry representatives from across Europe, it explores: (a the level of awareness of RRI; (b the drivers and obstacles influencing its implementation; and (c the factors deemed vital for facilitation of RRI in industry. The findings paint a varied picture, including significant concerns about adoption of RRI in an industry environment where the economic implications of all activities must be considered carefully. However, some companies have found their own ways to balance financial and altruistic goals, suggesting that there is both a willingness and a place for an RRI-type governance framework within the private sector.

  14. Research on the Obstacle Negotiation Strategy for the Heavy-duty Six-legged Robot based on Force Control

    Directory of Open Access Journals (Sweden)

    Li Mantian

    2017-01-01

    Full Text Available To make heavy-duty six-legged robots without environment reconstruction system negotiate obstacles after the earthquake successfully, an obstacle negotiation strategy is described in this paper. The reflection strategy is generated by the information of plantar force sensors and Bezier Curve is used to plan trajectory. As the heavy-duty six-legged robot has a large inertia, force controller is necessary to ensure the robot not to lose stability while negotiating obstacles. Impedance control is applied to reduce the impact of collision and active force control is applied to adjust the pose of the robot. The robot can walk through zones that are filled with obstacles automatically because of force control. Finally, the algorithm is verified in a simulation environment.

  15. Grounds of necessity to carry out reforms in health care system in Ukraine: historical aspect

    Directory of Open Access Journals (Sweden)

    I. P. Krynychna

    2015-03-01

    Full Text Available The article studies the historical experience of reforming the health care system in Ukraine, which allow clearing up the basic problems of public administration. Thus, the health care legislation is characterized as a fragmentary and complex thing with common overlaps and vaguely defined areas of accountability of financial and material resources and a significant deficit of funding. In turn, there is an urgent need for a fundamental change in strategy of the state policy concerning the restructuring of the health care system, which would involve fundamentally new mechanisms of public administration that must be adapted to the specific social problems and opportunities, particularly in conditions of limited resources. It is determined that reforming the health care systems of the former Soviet Union countries has similar nature with Ukraine, namely: the lack of government funding, poor quality of medical care, high level of medical services payment by citizens, the low level of wages of health care employees, and, as a consequence, the limited availability of the population to qualitative health services. On the basis of the results of the analysis of existing and not solved problems of the health care system it is proved the necessity to introduce new mechanisms of control in this field: the development of a system of compulsory medical insurance; the combination of budget and insurance sources of financing the health care system; the growing funding for the health care system; the development of initial care; adjustment of the state guarantees, according to the state financial opportunities; increasing the wages of health care employees; search for new organizational forms of health care institutions; increase the efficiency of health care resources; privatization and improvement of the structure of the medical care system . Keywords: public administration, health care reform, health insurance, initial care, medical care, medical services

  16. Anesthesia information management systems

    OpenAIRE

    Feri Štivan; Janez Benedik; Tomaž Lužar

    2014-01-01

    Introduction: The use of anesthesia information management systems (AIMS) is on the increase. This is particularly true for academic anesthesia departments. The main reasons for slow adoption of these systems in the past are financial barriers associated with implementation of these systems and their not so traditionally obvious potential to improve patient care. In addition, a major obstacle to acceptance of this technology is the concern of users over the impact of the electronic anesthesia...

  17. FOREWORD: Special section on electromagnetic characterization of buried obstacles

    Science.gov (United States)

    Lesselier, Dominique; Chew, Weng Cho

    2004-12-01

    laboratory data that emulate buried objects in the ocean and where the data are very limited and the environment is highly attenuative. The forward model is employed with an integral equation approach. The inverse scattering algorithm uses the level set method as well as a binary specialized contrast source method. Though computationally intensive these approaches are expected to be effective whenever linearization of the inversion fails. Two types of antennae were tested out in the experiment, a small one and a larger one. It is found, in particular, that the smaller antenna reproduces the modelled result better than the larger one. • X Feng and M Sato, in `Pre-stack migration applied to GPR for landmine detection', investigate the testing of a ground penetrating radar with synthetic aperture, acquiring mid-point multi-offset data in the demanding situations (strong clutter) of inhomogeneous soil and rough ground and/or of steeply oblique landmines. This is done in practice with experimental data, and is thoroughly illustrated by numerical experiments in the framework of migration techniques. These techniques are tailored to provide an approximate but robust solution to the highly involved three-dimensional vector wave-field inversion problem which is relevant here. • A Kirsch, in `The factorization method for Maxwell's equations', shows how the theory of the recently introduced and much considered factorization method can be developed in a sound theoretical fashion for the time-harmonic three-dimensional Maxwell system when far-field scattering patterns are known—by constructing a binary criterion which tells whether, if a given point lies inside or outside an unknown obstacle, the shape of which is to be retrieved. The vector nature of the electromagnetic field is fully considered in this paper. This is investigated in depth both for a lossy obstacle (with lower-bounded imaginary part of the dielectric permittivity) and for a lossless one (albeit with smoothly

  18. The research of autonomous obstacle avoidance of mobile robot based on multi-sensor integration

    Science.gov (United States)

    Zhao, Ming; Han, Baoling

    2016-11-01

    The object of this study is the bionic quadruped mobile robot. The study has proposed a system design plan for mobile robot obstacle avoidance with the binocular stereo visual sensor and the self-control 3D Lidar integrated with modified ant colony optimization path planning to realize the reconstruction of the environmental map. Because the working condition of a mobile robot is complex, the result of the 3D reconstruction with a single binocular sensor is undesirable when feature points are few and the light condition is poor. Therefore, this system integrates the stereo vision sensor blumblebee2 and the Lidar sensor together to detect the cloud information of 3D points of environmental obstacles. This paper proposes the sensor information fusion technology to rebuild the environment map. Firstly, according to the Lidar data and visual data on obstacle detection respectively, and then consider two methods respectively to detect the distribution of obstacles. Finally fusing the data to get the more complete, more accurate distribution of obstacles in the scene. Then the thesis introduces ant colony algorithm. It has analyzed advantages and disadvantages of the ant colony optimization and its formation cause deeply, and then improved the system with the help of the ant colony optimization to increase the rate of convergence and precision of the algorithm in robot path planning. Such improvements and integrations overcome the shortcomings of the ant colony optimization like involving into the local optimal solution easily, slow search speed and poor search results. This experiment deals with images and programs the motor drive under the compiling environment of Matlab and Visual Studio and establishes the visual 2.5D grid map. Finally it plans a global path for the mobile robot according to the ant colony algorithm. The feasibility and effectiveness of the system are confirmed by ROS and simulation platform of Linux.

  19. Racial disparities in cancer care in the Veterans Affairs health care system and the role of site of care.

    Science.gov (United States)

    Samuel, Cleo A; Landrum, Mary Beth; McNeil, Barbara J; Bozeman, Samuel R; Williams, Christina D; Keating, Nancy L

    2014-09-01

    We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12,897), lung (n = 25,608), or prostate (n = 38,202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences. Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10). Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.

  20. The Healthcare Administrator's Desk Reference: A Managed Care and Health Care Contracting Dictionary for the Military Health System

    National Research Council Canada - National Science Library

    Korody-Colwell, Carol

    1998-01-01

    .... Specifically, a thorough knowledge of the language, terminology, and acronyms is fundamental to understanding today s health care delivery processes both in the civilian sector and the military health system...

  1. 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

  2. System requirements for a computerised patient record information system at a busy primary health care clinic

    Directory of Open Access Journals (Sweden)

    PJ Blignaut

    2001-09-01

    Full Text Available A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.

  3. United States and Canadian approaches to justice in health care: a comparative analysis of health care systems and values.

    Science.gov (United States)

    Jecker, N S; Meslin, E M

    1994-06-01

    The purpose of this study is to compare and contrast the basic ethical values underpinning national health care policies in the United States and Canada. We use the framework of ethical theory to name and elaborate ethical values and to facilitate moral reflection about health care reform. Section one describes historical and contemporary social contract theories and clarifies the ethical values associated with them. Sections two and three show that health care debates and health care systems in both countries reflect the values of this tradition; however, each nation interprets the tradition differently. In the U.S., standards of justice for health care are conceived as a voluntary agreement reached by self-interested parties. Canadians, by contrast, interpret the same justice tradition as placing greater emphasis on concern for others and for the community. The final section draws out the implications of these differences for future U.S. and Canadian health care reforms.

  4. Investigation of administrative obstacles to family physician program in urban areas of Iran

    Directory of Open Access Journals (Sweden)

    Javad Javan noughabi

    2017-06-01

    Full Text Available Health is regarded as one of the basic rights of each person in society; so governments are obligated to provide it equally for everyone. The best way to achieve this goal is the establishment of health insurance with the orientation of family physician and the strategic referral system. Yet, such programs will not be successful without encouraging people to participate and changing social behaviors. The aim of the present study was to investigate the administrative obstacles and problems to family physician program in urban areas of Iran. This study was a qualitative research conducted. A purposive sampling method was employed and the data were gathered via semi-structured interview with open-ended questions and document examination. All the interviews were recorded digitally and immediately transcribed verbatim. They were finally analyzed based on framework analysis. The participants' detailed descriptions showed that systemic, environmental, and human related factors were the main obstacles to the implementation of family physician plan. Since the success and performance of each program effectively cannot be obtained without people’s acceptance and collaboration, the necessity of training and giving information rapidly and timely to the residents in urban areas is felt more than ever. Also, making authorities aware of the obstacles expressed by people can be helpful in harmonizing the program with people’s requests; and can result in overcoming the challenges and obstacles facing the program.

  5. Using the ecological framework to identify barriers and enablers to implementing Namaste Care in Canada's long-term care system.

    Science.gov (United States)

    Hunter, Paulette V; Kaasalainen, Sharon; Froggatt, Katherine A; Ploeg, Jenny; Dolovich, Lisa; Simard, Joyce; Salsali, Mahvash

    2017-10-01

    Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care. Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach. We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force. We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.

  6. Obstacles to and motivation for successful breast-feeding

    Directory of Open Access Journals (Sweden)

    A-M Bergh

    1993-03-01

    Full Text Available This study determined obstetric physiotherapists' perceptions about major obstacles to and methods of motivation for successful breast-feeding by means of the Friedman non-parametric procedure for the two-way analysis of variance. Three categories of obstacles were identified: maternal obstacles, health professionals and society. Maternal obstacles mentioned most were insufficient motivation (25% and knowledge (24%, anxiety (14%, fatigue (14%, and employment (14%. Obstacles related to health professionals included tack of support for mothers (20%, inappropriate lactation management (19%, lack of knowledge (15%, negative attitudes (5% and staff shortages (5%. With regard to society, lack of support (27% and life-styles (29% were identified as significant obstacles. The two most significantly important methods of motivation were information and education (53% and contact with other breast-feeders (27%. It is concluded that breast-feeding education efforts can be improved by identifying obstacles to breast-feeding and methods of motivation and that the Friedman test may be a statistical procedure to consider for determining priorities.

  7. Multiple Moving Obstacles Avoidance of Service Robot using Stereo Vision

    Directory of Open Access Journals (Sweden)

    Achmad Jazidie

    2011-12-01

    Full Text Available In this paper, we propose a multiple moving obstacles avoidance using stereo vision for service robots in indoor environments. We assume that this model of service robot is used to deliver a cup to the recognized customer from the starting point to the destination. The contribution of this research is a new method for multiple moving obstacle avoidance with Bayesian approach using stereo camera. We have developed and introduced 3 main modules to recognize faces, to identify multiple moving obstacles and to maneuver of robot. A group of people who is walking will be tracked as a multiple moving obstacle, and the speed, direction, and distance of the moving obstacles is estimated by a stereo camera in order that the robot can maneuver to avoid the collision. To overcome the inaccuracies of vision sensor, Bayesian approach is used for estimate the absense and direction of obstacles. We present the results of the experiment of the service robot called Srikandi III which uses our proposed method and we also evaluate its performance. Experiments shown that our proposed method working well, and Bayesian approach proved increasing the estimation perform for absence and direction of moving obstacle.

  8. Capturing the complexity of European primary care systems in a European monitoring instrument.

    NARCIS (Netherlands)

    Kringos, D.; Boerma, W.

    2009-01-01

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

  9. A System for Planning and Achieving Comprehensive Health Care in Residential Institutions for the Mentally Retarded.

    Science.gov (United States)

    Decker, Harold A.

    Based on a view of health care intertwining medicine intimately with other components of institutional care, the monograph presents a system of concepts and operating techniques for providing comprehensive health care to institutionalized retardates. Background of the system is explained in terms of its research basis (two studies by the author of…

  10. Holistic System of Care: a ten-year perspective.

    Science.gov (United States)

    Nebelkopf, Ethan; Wright, Serena

    2011-01-01

    The Holistic System of Care for Native Americans in an Urban Environment is a community-focused intervention that provides behavioral health care, promotes health, and prevents disease. This approach is based on a community strategic planning process that honored Native American culture and relationships. Substance abuse, mental illness, homelessness, poverty, crime, physical illness, and violence are symptoms of historical trauma, family dysfunction, and spiritual imbalance. The holistic model links treatment, prevention, and recovery. The link between prevention and treatment is early intervention. Peer support is the link between treatment and recovery. Recovering individuals serve as role models linking recovery to prevention. Culture and spirituality build a strong and resilient foundation for recovery. This article documents the effectiveness of the holistic model over a ten-year period that it has been implemented at the Family & Child Guidance Clinic of the Native American Health Center in the San Francisco Bay Area. The holistic model has produced statistically significant reductions in substance abuse among adult Native American women, men, reentry, and homeless populations; reductions in substance abuse among Native American adolescents; reductions in HIV/AIDS high-risk behavior among Native American men, women, and adolescents; and decreases in acting out behavior among Native American severely emotionally disturbed children.

  11. Making the CARE Comprehensive Geriatric Assessment as the Core of a Total Mobile Long Term Care Support System in China.

    Science.gov (United States)

    Cui, Yanyan; Gong, Dongwei; Yang, Bo; Chen, Hua; Tu, Ming-Hsiang; Zhang, Chaonan; Li, Huan; Liang, Naiwen; Jiang, Liping; Chang, Polun

    2018-01-01

    Comprehensive Geriatric Assessments (CGAs) have been recommended to be used for better monitoring the health status of elder residents and providing quality care. This study reported how our nurses perceived the usability of CGA component of a mobile integrated-care long term care support system developed in China. We used the Continuity Assessment Record and Evaluation (CARE), developed in the US, as the core CGA component of our Android-based support system, in which apps were designed for all key stakeholders for delivering quality long term care. A convenience sample of 18 subjects from local long term care facilities in Shanghai, China were invited to assess the CGA assessment component in terms of Technology Acceptance Model for Mobile based on real field trial assessment. All (100%) were satisfied with the mobile CGA component. 88.9% perceived the system was easy to learn and use. 99.4% showed their willingness to use for their work. We concluded it is technically feasible to implement a CGA-based mobile integrated care support system in China.

  12. Using Thermal Radiation in Detection of Negative Obstacles

    Science.gov (United States)

    Rankin, Arturo L.; Matthies, Larry H.

    2009-01-01

    A method of automated detection of negative obstacles (potholes, ditches, and the like) ahead of ground vehicles at night involves processing of imagery from thermal-infrared cameras aimed at the terrain ahead of the vehicles. The method is being developed as part of an overall obstacle-avoidance scheme for autonomous and semi-autonomous offroad robotic vehicles. The method could also be applied to help human drivers of cars and trucks avoid negative obstacles -- a development that may entail only modest additional cost inasmuch as some commercially available passenger cars are already equipped with infrared cameras as aids for nighttime operation.

  13. Getting to Darwin: Obstacles to Accepting Evolution by Natural Selection

    Science.gov (United States)

    Thagard, Paul; Findlay, Scott

    2010-06-01

    Darwin’s theory of evolution by natural selection is central to modern biology, but is resisted by many people. This paper discusses the major psychological obstacles to accepting Darwin’s theory. Cognitive obstacles to adopting evolution by natural selection include conceptual difficulties, methodological issues, and coherence problems that derive from the intuitiveness of alternative theories. The main emotional obstacles to accepting evolution are its apparent conflict with valued beliefs about God, souls, and morality. We draw on the philosophy of science and on a psychological theory of cognitive and emotional belief revision to make suggestions about what can be done to improve acceptance of Darwinian ideas.

  14. Carolina Care at University of North Carolina Health Care: Implementing a Theory-Driven Care Delivery Model Across a Healthcare System.

    Science.gov (United States)

    Tonges, Mary; Ray, Joel D; Herman, Suzanne; McCann, Meghan

    2018-04-01

    Patient satisfaction is a key component of healthcare organizations' performance. Providing a consistent, positive patient experience across a system can be challenging. This article describes an organization's approach to achieving this goal by implementing a successful model developed at the flagship academic healthcare center across an 8-hospital system. The Carolina Care at University of North Carolina Health Care initiative has resulted in substantive qualitative and quantitative benefits including higher patient experience scores for both overall rating and nurse communication.

  15. Evaluating the effectiveness of care integration strategies in different healthcare systems in Latin America: the EQUITY-LA II quasi-experimental study protocol.

    Science.gov (United States)

    Vázquez, María-Luisa; Vargas, Ingrid; Unger, Jean-Pierre; De Paepe, Pierre; Mogollón-Pérez, Amparo Susana; Samico, Isabella; Albuquerque, Paulette; Eguiguren, Pamela; Cisneros, Angelica Ivonne; Rovere, Mario; Bertolotto, Fernando

    2015-07-31

    Although fragmentation in the provision of healthcare is considered an important obstacle to effective care, there is scant evidence on best practices in care coordination in Latin America. The aim is to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America. A controlled before and after quasi-experimental study taking a participatory action research approach. In each country, two comparable healthcare networks were selected--intervention and control. The study contains four phases: (1) A baseline study to establish network performance in care coordination and continuity across care levels, using (A) qualitative methods: semi-structured interviews and focus groups with a criterion sample of health managers, professionals and users; and (B) quantitative methods: two questionnaire surveys with samples of 174 primary and secondary care physicians and 392 users with chronic conditions per network. Sample size was calculated to detect a proportion difference of 15% and 10%, before and after intervention (α=0.05; β=0.2 in a two-sided test); (2) a bottom-up participatory design and implementation of shared care strategies involving micro-level care coordination interventions to improve the adequacy of patient referral and information transfer. Strategies are selected through a participatory process by the local steering committee (local policymakers, health care network professionals, managers, users and researchers), supported by appropriate training; (3) Evaluation of the effectiveness of interventions by measuring changes in levels of care coordination and continuity 18 months after implementation, applying the same design as in the baseline study; (4) Cross-country comparative analysis. This study complies with international and national legal stipulations on ethics. Conditions of the study procedure

  16. Evaluating the effectiveness of care integration strategies in different healthcare systems in Latin America: the EQUITY-LA II quasi-experimental study protocol

    Science.gov (United States)

    Vázquez, María-Luisa; Vargas, Ingrid; Unger, Jean-Pierre; De Paepe, Pierre; Mogollón-Pérez, Amparo Susana; Samico, Isabella; Albuquerque, Paulette; Eguiguren, Pamela; Cisneros, Angelica Ivonne; Rovere, Mario; Bertolotto, Fernando

    2015-01-01

    Introduction Although fragmentation in the provision of healthcare is considered an important obstacle to effective care, there is scant evidence on best practices in care coordination in Latin America. The aim is to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America. Methods and analysis A controlled before and after quasi-experimental study taking a participatory action research approach. In each country, two comparable healthcare networks were selected—intervention and control. The study contains four phases: (1) A baseline study to establish network performance in care coordination and continuity across care levels, using (A) qualitative methods: semi-structured interviews and focus groups with a criterion sample of health managers, professionals and users; and (B) quantitative methods: two questionnaire surveys with samples of 174 primary and secondary care physicians and 392 users with chronic conditions per network. Sample size was calculated to detect a proportion difference of 15% and 10%, before and after intervention (α=0.05; β=0.2 in a two-sided test); (2) a bottom-up participatory design and implementation of shared care strategies involving micro-level care coordination interventions to improve the adequacy of patient referral and information transfer. Strategies are selected through a participatory process by the local steering committee (local policymakers, health care network professionals, managers, users and researchers), supported by appropriate training; (3) Evaluation of the effectiveness of interventions by measuring changes in levels of care coordination and continuity 18 months after implementation, applying the same design as in the baseline study; (4) Cross-country comparative analysis. Ethics and dissemination This study complies with international and national legal

  17. TRICARE: Transformation of the Military Health Care System - Demystifying Military Medicine and the Mission Impossible

    National Research Council Canada - National Science Library

    Zeliff, Barbara

    2004-01-01

    The Department of Defense's military health care system, entitled TRICARE, brings together the direct health care resources of the Department of Defense and supplements this capability through the use...

  18. Procurement performance measurement system in the health care industry.

    Science.gov (United States)

    Kumar, Arun; Ozdamar, Linet; Ng, Chai Peng

    2005-01-01

    The rising operating cost of providing healthcare is of concern to health care providers. As such, measurement of procurement performance will enable competitive advantage and provide a framework for continuous improvement. The objective of this paper is to develop a procurement performance measurement system. The paper reviews the existing literature in procurement performance measurement to identify the key areas of purchasing performance. By studying the three components in the supply chain collectively with the resources, procedures and output, a model is been developed. Additionally, a balanced scorecard is proposed by establishing a set of generic measures and six perspectives. A case study conducted at the Singapore Hospital applies the conceptual model to describe the purchasing department and the activities within and outside the department. The results indicate that the material management department has already made a good start in measuring the procurement process through the implementation of the balanced scorecard. There are many data that are collected but not properly collated and utilized. Areas lacking measurement include cycle time of delivery, order processing time, effectiveness, efficiency and reliability. Though a lot of hard work was involved, the advantages of establishing a measurement system outweigh the costs and efforts involved in its implementation. Results of balanced scorecard measurements provide decision-makers with critical information on efficiency and effectiveness of the purchasing department's work. The measurement model developed could be used for any hospital procurement system.

  19. Health Care System for Children and Adolescents in Slovenia.

    Science.gov (United States)

    Juričič, Mojca; Truden Dobrin, Polonca; Paulin, Sonja; Seher Zupančič, Margareta; Bratina, Nataša

    2016-10-01

    Slovenia's health system is financed by a Bismarckian type of social insurance system with a single insurer for a statutory health insurance, which is fully regulated by national legislation and administered by the Health Insurance Institute of Slovenia. The health insurance system is mandatory, providing almost universal coverage (98.5% of the population). Children and adolescents have the right to compulsory health insurance as family members of an insured person until the end of their regular education. Slovenia has a lower number of physicians per capita than both the European Union and the Central and Eastern Europe countries. Slovenia is facing a workforce crisis, as the number of health professionals retiring is not adequately being replaced by new trainees. There is also a net deficit of nurses with university and college degrees. Physicians working with children and adolescents in primary level have a 5-year specialization in pediatrics. Slovenia tends to be in line with the goals for the development of pediatric health care on a primary level in European countries, which are to maintain the achieved level of quality, better and equitable access, and delivery of services, aiming to reduce inequalities in health of children and adolescents and provide for every child and adolescent in the best way possible. Copyright © 2016. Published by Elsevier Inc.

  20. Leadership Perspectives on Operationalizing the Learning Health Care System in an Integrated Delivery System.

    Science.gov (United States)

    Psek, Wayne; Davis, F Daniel; Gerrity, Gloria; Stametz, Rebecca; Bailey-Davis, Lisa; Henninger, Debra; Sellers, Dorothy; Darer, Jonathan

    2016-01-01

    Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders' perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders' perspectives on the LHS and learning activities in an integrated delivery system. A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders' responses were categorized into themes. Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals. Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed. Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery.

  1. TRICARE: transformation of the military health care system : demystifying military medicine and the mission impossible

    OpenAIRE

    Zeliff, Barbara Hundley.

    2004-01-01

    The Department of Defense's military health care system, entitled TRICARE, brings together the direct health care resources of the Department of Defense and supplements this capability through the use of managed care support services contracts and purchased care. This blended system is charged with providing a comprehensive health benefit to approximately 8.9 million beneficiaries, including active duty and retired uniformed services members, their families, and survivors, while also providin...

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

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

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

  3. The efficient presentation - obstacles, strategies, success

    Directory of Open Access Journals (Sweden)

    Daniela-Elena Radu

    2007-12-01

    Full Text Available The making of presentations has become an omnipresent act of communication in the companies practice, but also in the didactic one. The notoriety and the increase of the importance of an efficient presentation lie in the transformations felt by a society of knowledge, communication being the answer in front of a constant information wave.Business people look in fear at the preparation of a presentation, the interaction with the audience andtheir feedback, all these leading to a low efficiency in transmitting the message.The speaker must overcome a group of obstacles, the most important being the reduced human capacityto capture the information transmitted orally; in this respect, he has available a group of visual instruments and strategies to capture the attention. In order to achieve efficiency one needs mental and emotional preparation, knowing the audience and the presentation’s objective and eliminating the old listing format in PowerPoint, for focusing the communication of the audience’s necessities. The present essay aims to analyze the verbal, non-verbal and para-verbal communication act that constitutes the base of any presentation, the reasons that lead to failure and the ways to increase efficiency, in order to succeed in transmitting a well structured and easy to remember message.Many researchers and practice workers within the communication, economic but also IT fields, have tried to find the solution for organizing and transmitting the message during a presentation, in accordance with the new technologies. In elaborating the present paper, we have used our personal experience and data obtained through 30 in-depth interviews,with managers in companies such Bostina Asociatii Skoda, Petrom etc.; we have used in our research articles of honored professors in social sciences from the Harvard and Stanford Universities , researches of the Minnesota and Ulster Universities, as well as works of specialists in marketing and information

  4. 76 FR 4061 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2011-01-24

    ..., Randolph County, Takeoff Minimums and Obstacle DP, Orig El Dorado, KS, Captain Jack Thomas/El Dorado... Minimums and Obstacle DP, Amdt 3 Cook, MN, Cook Muni, Takeoff Minimums and Obstacle DP, Orig Duluth, MN...

  5. Regional differences analysis of land use efficiency and obstacle degree in Xianning-Yueyang-Jiujiang area

    Directory of Open Access Journals (Sweden)

    Chengshun Song

    2017-03-01

    Full Text Available This paper established an evaluation index system for the land use efficiency from social, economic, ecological and environmental aspects, and adopted the variation coefficient TOPSIS method and obstacle degree model to analyze the regional differences of land use efficiency and obstacle degree in Xianning, Yueyang and Jiujiang. The results showed that: (1 During 2000-2010, the land use efficiency in these regions had an increasing tendency and the regional differences were small. In Yueyang and Jiujiang, there were four stages, that is low, moderate, good and excellent; while in Xianning, there were only three stages, that is low, moderate and good; (2 The economic level was the greatest obstacle factor affecting the land use efficiency in these regions, followed by the environmental quality, ecological status, social development, and the regional differences in these aspects were not so obvious; (3 Per area financial revenue, the output of comprehensive utilization of “three wastes” and per capita GDP were the top three obstacle factors and the regional differences in these aspects were not so obvious.

  6. The Integrated Nordic End-User Electricity Market - Feasibility and identified obstacles

    International Nuclear Information System (INIS)

    2006-02-01

    The report identifies the various obstacles that currently exist which prevent the formation of a truly integrated Nordic electricity end-user market. The obstacles have been divided into three categories: technical, regulatory and commercial. NordREG proposes that to further integrate the Nordic end-user electricity markets, a number of differences of technical, legal and market nature ought to be gradually harmonized in order to facilitate market entry and cross-border trade. Technical obstacles: Especially the following problems related to the data and metering systems should be solved: Transferred messages, information and message timing should be harmonised; Message format should be decided; A common data transmission protocol should be specified. New solutions like web-based solutions should be studied; The identification of the final customers' metering point should be harmonised. Regulatory obstacles: The identified regulatory obstacles relate to three areas, namely the division of tasks between monopoly and competitive activities, the operation and duties of distribution network operators including how these are regulated, and the legal framework to provide protection for small end users. On the basis of the review of regulatory obstacles, the following recommendations are made: The principles of neutrality and the way these principles are being supervised by the regulator is a key issue to improve the functioning of the Nordic end-user market. Regulators should seek to harmonise regulation on neutrality and put it high on the agenda in a forthcoming process of market integration; The procedures for switching supplier should be as smooth, easy and quick as possible. It is also important that suppliers, especially the new market entrants, can participate in reliable, transparent and fluent switching practices, since this lowers the threshold for entering other than domestic electricity market. The switching model should be harmonised for the Nordic end

  7. The Integrated Nordic End-User Electricity Market - Feasibility and identified obstacles

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-02-15

    The report identifies the various obstacles that currently exist which prevent the formation of a truly integrated Nordic electricity end-user market. The obstacles have been divided into three categories: technical, regulatory and commercial. NordREG proposes that to further integrate the Nordic end-user electricity markets, a number of differences of technical, legal and market nature ought to be gradually harmonized in order to facilitate market entry and cross-border trade. Technical obstacles: Especially the following problems related to the data and metering systems should be solved: Transferred messages, information and message timing should be harmonised; Message format should be decided; A common data transmission protocol should be specified. New solutions like web-based solutions should be studied; The identification of the final customers' metering point should be harmonised. Regulatory obstacles: The identified regulatory obstacles relate to three areas, namely the division of tasks between monopoly and competitive activities, the operation and duties of distribution network operators including how these are regulated, and the legal framework to provide protection for small end users. On the basis of the review of regulatory obstacles, the following recommendations are made: The principles of neutrality and the way these principles are being supervised by the regulator is a key issue to improve the functioning of the Nordic end-user market. Regulators should seek to harmonise regulation on neutrality and put it high on the agenda in a forthcoming process of market integration; The procedures for switching supplier should be as smooth, easy and quick as possible. It is also important that suppliers, especially the new market entrants, can participate in reliable, transparent and fluent switching practices, since this lowers the threshold for entering other than domestic electricity market. The switching model should be harmonised for the Nordic end

  8. Prospects for regulated competition in the health care system: what can China learn from Russia's experience?

    Science.gov (United States)

    Xu, Weiwei; Sheiman, Igor; van de Ven, Wynand P M M; Zhang, Wei

    2011-05-01

    As China explores new directions to reform its health care system, regulated competition among both insurers and providers of care might be one potential model. The Russian Federation in 1993 implemented legislation intended to stimulate such regulated competition in the health care sector. The subsequent progress and lessons learned over these 17 years can shed light on and inform the future evolution of the Chinese system. In this paper, we list the necessary pre-conditions for reaping the benefits of regulated competition in the health care sector. We indicate to what extent these conditions are being fulfilled in the post-reform Russian and current Chinese health care systems. We draw lessons from the Russian experience for the Chinese health care system, which shares a similar economic and political background with the pre-reform Russian health care system in terms of the starting point of the reform, and analyse the prospects for regulated competition in China.

  9. Sedimentation control in the reservoirs by using an obstacle

    Indian Academy of Sciences (India)

    2Faculty of Water Sciences Engineering, Shahid Chamran University, Ahwaz, Iran. 3Department of ... some experiments were carried out without an obstacle. Results showed ..... Design and management of dams, reservoirs and watersheds ...

  10. UOBPRM: A uniformly distributed obstacle-based PRM

    KAUST Repository

    Yeh, Hsin-Yi; Thomas, Shawna; Eppstein, David; Amato, Nancy M.

    2012-01-01

    This paper presents a new sampling method for motion planning that can generate configurations more uniformly distributed on C-obstacle surfaces than prior approaches. Here, roadmap nodes are generated from the intersections between C

  11. Biologically-Inspired Adaptive Obstacle Negotiation Behavior of Hexapod Robots

    DEFF Research Database (Denmark)

    Goldschmidt, Dennis; Wörgötter, Florentin; Manoonpong, Poramate

    2014-01-01

    by these findings, we present an adaptive neural control mechanism for obstacle negotiation behavior in hexapod robots. It combines locomotion control, backbone joint control, local leg reflexes, and neural learning. While the first three components generate locomotion including walking and climbing, the neural...... learning mechanism allows the robot to adapt its behavior for obstacle negotiation with respect to changing conditions, e.g., variable obstacle heights and different walking gaits. By successfully learning the association of an early, predictive signal (conditioned stimulus, CS) and a late, reflex signal...... (unconditioned stimulus, UCS), both provided by ultrasonic sensors at the front of the robot, the robot can autonomously find an appropriate distance from an obstacle to initiate climbing. The adaptive neural control was developed and tested first on a physical robot simulation, and was then successfully...

  12. Understanding Obstacles to Peace: Actors, Interests, and Strategies ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2011-02-24

    Feb 24, 2011 ... Understanding Obstacles to Peace: Actors, Interests, and Strategies in Africa's ... The case studies all employ methods of “thick description” process tracing ... Addressing Africa's unmet need for family planning by intensifying ...

  13. Surrounding Moving Obstacle Detection for Autonomous Driving Using Stereo Vision

    Directory of Open Access Journals (Sweden)

    Hao Sun

    2013-06-01

    Full Text Available Detection and tracking surrounding moving obstacles such as vehicles and pedestrians are crucial for the safety of mobile robotics and autonomous vehicles. This is especially the case in urban driving scenarios. This paper presents a novel framework for surrounding moving obstacles detection using binocular stereo vision. The contributions of our work are threefold. Firstly, a multiview feature matching scheme is presented for simultaneous stereo correspondence and motion correspondence searching. Secondly, the multiview geometry constraint derived from the relative camera positions in pairs of consecutive stereo views is exploited for surrounding moving obstacles detection. Thirdly, an adaptive particle filter is proposed for tracking of multiple moving obstacles in surrounding areas. Experimental results from real-world driving sequences demonstrate the effectiveness and robustness of the proposed framework.

  14. Overcoming the Obstacles to Establishing a Democratic State in Afghanistan

    National Research Council Canada - National Science Library

    Young, Dennis O

    2007-01-01

    .... This project looks at several of those obstacles to democracy in Afghanistan, to include the absence of a democratic history and tradition, an endemic culture of corruption, a pervasive narcotics...

  15. OBSTACLES IN THE APPLICATION OF MICROENCAPSULATION IN ISLET TRANSPLANTATION

    NARCIS (Netherlands)

    DEVOS, P; WOLTERS, GHJ; FRITSCHY, WM; VANSCHILFGAARDE, R

    Several factors stand in the way of successful clinical transplantation of alginate-polylysine-alginate microencapsulated pancreatic islets. These obstacles can be classified into three categories. The first regards the technical aspects of the production process. Limiting factors are the

  16. Excavating obstacles and enablers to internationalization at home

    NARCIS (Netherlands)

    Beelen, Jos; Woldegiyorgis, Ayenachew A.; Rumbley, Laura E.; de Wit, Hans

    2017-01-01

    Gives an overview of my research as a visiting scholar at The Boston College Center for International Higher Education. This research classifies these obstacles and enablers in four categories: disciplinary, external, internal and personal.

  17. UOBPRM: A uniformly distributed obstacle-based PRM

    KAUST Repository

    Yeh, Hsin-Yi

    2012-10-01

    This paper presents a new sampling method for motion planning that can generate configurations more uniformly distributed on C-obstacle surfaces than prior approaches. Here, roadmap nodes are generated from the intersections between C-obstacles and a set of uniformly distributed fixed-length segments in C-space. The results show that this new sampling method yields samples that are more uniformly distributed than previous obstacle-based methods such as OBPRM, Gaussian sampling, and Bridge test sampling. UOBPRM is shown to have nodes more uniformly distributed near C-obstacle surfaces and also requires the fewest nodes and edges to solve challenging motion planning problems with varying narrow passages. © 2012 IEEE.

  18. Advancing Army Women as Senior Leaders - Understanding the Obstacles

    National Research Council Canada - National Science Library

    Ellefson, Kristi

    1998-01-01

    This paper examined through research, whether any evidence exists which indicates that, army women are confronted with inherent obstacles as they try to advance through the ranks to senior level positions...

  19. A Learning Health Care System Using Computer-Aided Diagnosis.

    Science.gov (United States)

    Cahan, Amos; Cimino, James J

    2017-03-08

    Physicians intuitively apply pattern recognition when evaluating a patient. Rational diagnosis making requires that clinical patterns be put in the context of disease prior probability, yet physicians often exhibit flawed probabilistic reasoning. Difficulties in making a diagnosis are reflected in the high rates of deadly and costly diagnostic errors. Introduced 6 decades ago, computerized diagnosis support systems are still not widely used by internists. These systems cannot efficiently recognize patterns and are unable to consider the base rate of potential diagnoses. We review the limitations of current computer-aided diagnosis support systems. We then portray future diagnosis support systems and provide a conceptual framework for their development. We argue for capturing physician knowledge using a novel knowledge representation model of the clinical picture. This model (based on structured patient presentation patterns) holds not only symptoms and signs but also their temporal and semantic interrelations. We call for the collection of crowdsourced, automatically deidentified, structured patient patterns as means to support distributed knowledge accumulation and maintenance. In this approach, each structured patient pattern adds to a self-growing and -maintaining knowledge base, sharing the experience of physicians worldwide. Besides supporting diagnosis by relating the symptoms and signs with the final diagnosis recorded, the collective pattern map can also provide disease base-rate estimates and real-time surveillance for early detection of outbreaks. We explain how health care in resource-limited settings can benefit from using this approach and how it can be applied to provide feedback-rich medical education for both students and practitioners. ©Amos Cahan, James J Cimino. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.03.2017.

  20. Pluralist social constraints on the development of a health care system: the case of Israel.

    Science.gov (United States)

    Palley, H A; Yishai, Y; Ever-Hadani, P

    1983-01-01

    The effectiveness of Israel's health care system is hindered by pluralism, in terms both of its many separate health service institutions and of the particularism of those institutions. Although the health care system provides modern health care to a widely insured population, it does so inefficiently and at unnecessary expense. The lack of vertical and horizontal integration of the health care system has led to problems of fragmentation, duplication, and lack of coordination of services. Because of its limited resources, Israel must work to surmount this pluralism and achieve integrated planning if it is to succeed in providing the efficient and cost-effective care its population needs.

  1. Dynamic Obstacle Clearing for Real-time Character Animation

    OpenAIRE

    Glardon, Pascal; Boulic, Ronan; Thalmann, Daniel

    2006-01-01

    This paper proposes a novel method to control virtual characters in dynamic environments. A virtual character is animated by a locomotion and jumping engine, enabling production of continuous parameterized motions. At any time during runtime, flat obstacles (e.g. a puddle of water) can be created and placed in front of a character. The method first decides whether the character is able to get around or jump over the obstacle. Then the motion parameters are accordingly modified. The transition...

  2. On Robust Methodologies for Managing Public Health Care Systems

    Directory of Open Access Journals (Sweden)

    Shastri L. Nimmagadda

    2014-01-01

    Full Text Available Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems.

  3. Building a comprehensive geriatric health care system: a case study.

    Science.gov (United States)

    Bleiweiss, L; Simson, S

    1976-01-01

    This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.

  4. Population aging and its impacts: strategies of the health-care system in Taipei.

    Science.gov (United States)

    Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung

    2010-11-01

    Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities. Copyright © 2010 Elsevier B.V. All rights reserved.

  5. DEVELOPMENT OF FRANCHISING IN CROATIA OBSTACLES AND POLICY RECOMMENDATIONS

    Directory of Open Access Journals (Sweden)

    Mirela Alpeza

    2015-11-01

    Full Text Available Franchising is very popular growth model but despite the wide application of franchising in the developed countries of the world, its impact on the Croatian economy is still marginal. The purpose of this research is to identify the obstacles and challenges to a wider application of franchising in Croatia and generate policy recommendations for removing the identified obstacles. Obstacles and recommendations are identified on the basis of a conducted longitudinal qualitative research, the first phase of which was conducted in 2006, and second in 2014. The overall results of this research were presented in a form of PEST analysis and compared with the results of the 2006 research aiming to detect changes (improvements/ deterioration in individual areas of the research political, economic, legal and technologic factors of influence on the development of franchising in Croatia. Based on the detected changes, conclusions and policy recommendations were identified.The obstacles can be divided in two categories: franchising specific barriers and general business related obstacles for doing business in Croatia. Without removing most of these obstacles, it is unrealistic to expect high growth of franchising activities in Croatia in near future.

  6. Women’s orgasm obstacles: A qualitative study

    Science.gov (United States)

    Nekoolaltak, Maryam; Keshavarz, Zohreh; Simbar, Masoumeh; Nazari, Ali Mohammad; Baghestani, Ahmad Reza

    2017-01-01

    Background: Woman’s orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is influenced by several factors. Objective: The aim of this study is exploring obstacles to orgasm in Iranian married women. Materials and Methods: This qualitative study with directed content analysis approach was conducted in 2015-2016, on 20 Iranian married women who were individually interviewed at two medical clinics in Tehran, Iran. Results: Orgasm obstacles were explored in one category, 4 subcategories, and 25 codes. The main category was “Multidimensionality of women’s orgasm obstacles”. Subcategories and some codes included: Physical obstacles (wife’s or husband’s boredom, vaginal infection, insufficient vaginal lubrication), psychological obstacles (lack of sexual knowledge, shame, lack of concentration on sex due to household and children problems), relational obstacles (husband’s hurry, having a dispute and annoyance with spouse) and contextual obstacles (Irregular sleep hours, lack of privacy and inability to separate children’s bedroom from their parents, lack of peace at home). Conclusion: For prevention or treatment of female orgasm disorders, attention to physical factors is not enough. Obtaining a comprehensive history about physical, psychological, relational and contextual dimensions of woman’s life is necessary. PMID:29082366

  7. The influence of roughness and obstacle on wind power map

    International Nuclear Information System (INIS)

    Abas Ab Wahab; Mohd Fadhil Abas; Mohd Hafiz Ismail

    2006-01-01

    In the development of wind energy in Malaysia, the need for wind power map of Peninsular Malaysia has aroused. The map is needed to help in determining the potential areas where low wind speed wind turbines could operate optimally. In establishing the wind power map the effects of roughness and obstacles have been investigated. Wind data from 24 meteorological stations around the country have been utilized in conjunction with the respective local roughness and obstacles. Two sets of wind power maps have been developed i.e. the wind power maps with and without roughness and obstacles. These two sets of wind power maps exhibit great significant amount of difference in the wind power values especially in the inland areas where the wind power map without roughness and obstacles gives much lower values than those with roughness and obstacles. This paper outlines the process of establishing the two sets of wind power map as well as discussing the influence of roughness and obstacles based on the results obtained

  8. Gendered Obstacles Faced by Historical Women in Physics and Astronomy

    Science.gov (United States)

    Jones, Kristen M.

    2007-12-01

    A gender gap still exists in modern science; this is especially evident in the fields of physics and astronomy. The cause of such a gap is the center of debate. Is this discrepancy the result of inherent ability or socialization? Most studies have focused on modern issues and how women are socialized today. The role of historical gender perspectives and social opinions in creating the field of modern science and any discrepancies within it has not yet been explored in depth. This project investigates the obstacles faced by historical women in physics and astronomy that stem from the officialized gender biases that accompanied the establishment of modern science. Such obstacles are both formal and informal. Four women were chosen to span the three hundred year period between the standardization of the field and the modern day: Laura Bassi, Mary Somerville, Lise Meitner, and Jocelyn Bell Burnell. The investigation reveals that formal obstacles significantly decreased over the time period, while informal obstacles eroded more gradually. Obstacles also reflected historical events such as the World Wars and the Enlightenment. Trends in obstacles faced by four prominent women physicists indicate that education, finances, support networks, and social opinion played a large role in determining success in the field. The applicability to modern day physics issues and the gender gap is discussed. Many thanks to the Pathways Scholars Program and the Ronald E. McNair Post-Baccalaureate Achievement Program for funding for this project.

  9. Women’s orgasm obstacles: A qualitative study

    Directory of Open Access Journals (Sweden)

    Maryam Nekoolaltak

    2017-09-01

    Full Text Available Background: Woman’s orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is influenced by several factors. Objective: The aim of this study is exploring obstacles to orgasm in Iranian married women. Materials and Methods: This qualitative study with directed content analysis approach was conducted in 2015-2016, on 20 Iranian married women who were individually interviewed at two medical clinics in Tehran, Iran. Results: Orgasm obstacles were explored in one category, 4 subcategories, and 25 codes. The main category was “Multidimensionality of women’s orgasm obstacles”. Subcategories and some codes included: Physical obstacles (wife’s or husband’s boredom, vaginal infection, insufficient vaginal lubrication, psychological obstacles (lack of sexual knowledge, shame, lack of concentration on sex due to household and children problems, relational obstacles (husband’s hurry, having a dispute and annoyance with spouse and contextual obstacles (Irregular sleep hours, lack of privacy and inability to separate children’s bedroom from their parents, lack of peace at home. Conclusion: For prevention or treatment of female orgasm disorders, attention to physical factors is not enough. Obtaining a comprehensive history about physical, psychological, relational and contextual dimensions of woman’s life is necessary.

  10. Cellular neural networks for motion estimation and obstacle detection

    Directory of Open Access Journals (Sweden)

    D. Feiden

    2003-01-01

    Full Text Available Obstacle detection is an important part of Video Processing because it is indispensable for a collision prevention of autonomously navigating moving objects. For example, vehicles driving without human guidance need a robust prediction of potential obstacles, like other vehicles or pedestrians. Most of the common approaches of obstacle detection so far use analytical and statistical methods like motion estimation or generation of maps. In the first part of this contribution a statistical algorithm for obstacle detection in monocular video sequences is presented. The proposed procedure is based on a motion estimation and a planar world model which is appropriate to traffic scenes. The different processing steps of the statistical procedure are a feature extraction, a subsequent displacement vector estimation and a robust estimation of the motion parameters. Since the proposed procedure is composed of several processing steps, the error propagation of the successive steps often leads to inaccurate results. In the second part of this contribution it is demonstrated, that the above mentioned problems can be efficiently overcome by using Cellular Neural Networks (CNN. It will be shown, that a direct obstacle detection algorithm can be easily performed, based only on CNN processing of the input images. Beside the enormous computing power of programmable CNN based devices, the proposed method is also very robust in comparison to the statistical method, because is shows much less sensibility to noisy inputs. Using the proposed approach of obstacle detection in planar worlds, a real time processing of large input images has been made possible.

  11. Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014.

    Directory of Open Access Journals (Sweden)

    Shalini Rudra

    Full Text Available AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy represents the alternative systems of medicine recognized by the Government of India. Understanding the patterns of utilization of AYUSH care has been important for various reasons including an increased focus on its mainstreaming and integration with biomedicine-based health care system. Based on a nationally representative health survey 2014, we present an analysis to understand utilization of AYUSH care across socioeconomic and demographic groups in India. Overall, 6.9% of all patients seeking outpatient care in the reference period of last two weeks have used AYUSH services without any significant differentials across rural and urban India. Importantly, public health facilities play a key role in provisioning of AYUSH care in rural areas with higher utilization in Chhattisgarh, Kerala and West Bengal. Use of AYUSH among middle-income households is lower when compared with poorer and richer households. We also find that low-income households display a greater tendency for AYUSH self-medication. AYUSH care utilization is higher among patients with chronic diseases and also for treating skin-related and musculo-skeletal ailments. Although the overall share of AYUSH prescription drugs in total medical expenditure is only about 6% but the average expenditure for drugs on AYUSH and allopathy did not differ hugely. The discussion compares our estimates and findings with other studies and also highlights major policy issues around mainstreaming of AYUSH care.

  12. Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

    Science.gov (United States)

    2017-01-01

    AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy represents the alternative systems of medicine recognized by the Government of India. Understanding the patterns of utilization of AYUSH care has been important for various reasons including an increased focus on its mainstreaming and integration with biomedicine-based health care system. Based on a nationally representative health survey 2014, we present an analysis to understand utilization of AYUSH care across socioeconomic and demographic groups in India. Overall, 6.9% of all patients seeking outpatient care in the reference period of last two weeks have used AYUSH services without any significant differentials across rural and urban India. Importantly, public health facilities play a key role in provisioning of AYUSH care in rural areas with higher utilization in Chhattisgarh, Kerala and West Bengal. Use of AYUSH among middle-income households is lower when compared with poorer and richer households. We also find that low-income households display a greater tendency for AYUSH self-medication. AYUSH care utilization is higher among patients with chronic diseases and also for treating skin-related and musculo-skeletal ailments. Although the overall share of AYUSH prescription drugs in total medical expenditure is only about 6% but the average expenditure for drugs on AYUSH and allopathy did not differ hugely. The discussion compares our estimates and findings with other studies and also highlights major policy issues around mainstreaming of AYUSH care. PMID:28472197

  13. Point-of-care, portable microfluidic blood analyzer system

    Science.gov (United States)

    Maleki, Teimour; Fricke, Todd; Quesenberry, J. T.; Todd, Paul W.; Leary, James F.

    2012-03-01

    Recent advances in MEMS technology have provided an opportunity to develop microfluidic devices with enormous potential for portable, point-of-care, low-cost medical diagnostic tools. Hand-held flow cytometers will soon be used in disease diagnosis and monitoring. Despite much interest in miniaturizing commercially available cytometers, they remain costly, bulky, and require expert operation. In this article, we report progress on the development of a battery-powered handheld blood analyzer that will quickly and automatically process a drop of whole human blood by real-time, on-chip magnetic separation of white blood cells (WBCs), fluorescence analysis of labeled WBC subsets, and counting a reproducible fraction of the red blood cells (RBCs) by light scattering. The whole blood (WB) analyzer is composed of a micro-mixer, a special branching/separation system, an optical detection system, and electronic readout circuitry. A droplet of un-processed blood is mixed with the reagents, i.e. magnetic beads and fluorescent stain in the micro-mixer. Valve-less sorting is achieved by magnetic deflection of magnetic microparticle-labeled WBC. LED excitation in combination with an avalanche photodiode (APD) detection system is used for counting fluorescent WBC subsets using several colors of immune-Qdots, while counting a reproducible fraction of red blood cells (RBC) is performed using a laser light scatting measurement with a photodiode. Optimized branching/channel width is achieved using Comsol Multi-Physics™ simulation. To accommodate full portability, all required power supplies (40v, +/-10V, and +3V) are provided via step-up voltage converters from one battery. A simple onboard lock-in amplifier is used to increase the sensitivity/resolution of the pulse counting circuitry.

  14. Obstacles to early career psychiatrists practicing psychotherapy.

    Science.gov (United States)

    Clemens, Norman A; Plakun, Eric M; Lazar, Susan G; Mellman, Lisa

    2014-09-01

    Though psychiatric residents are expected to be competent psychotherapists on graduation, further growth in skill and versatility requires continued experience in their ongoing career. Maturity as a psychotherapist is essential because a psychiatrist is the only mental health provider who, as a physician, can assume full responsibility for biopsychosocial patient care and roles as supervisor, consultant, and team leader. Graduating residents face an environment in which surveys show a steady and alarming decline in practice of psychotherapy by psychiatrists, along with a decline in job satisfaction. High educational debts, practice structures, intrusive management, and reimbursement policies that devalue psychotherapy discourage early career psychiatrists from a practice style that enables providing it. For the early-career psychiatrist there is thus the serious risk of being unable to develop a critical mass of experience or a secure identity as a psychiatric psychotherapist. Implementation of parity laws and the Affordable Care Act (ACA) will affect the situation in unpredictable ways that call for vigilance and active response. Additional service and administrative demands may result from the ACA, creating ethical dilemmas about meeting urgent patient needs versus biopsychosocial standards of care. The authors recommend 1) vigorous advocacy for better payment levels for psychotherapy and freedom from disruptive management; 2) aggressive action against violations of the parity act, 3) active preparation of psychiatric residents for dealing with career choices and the environment for providing psychotherapy in their practice, and 4) post-graduate training in psychotherapy through supervision/consultation, continuing education courses, computer instruction, and distance learning.

  15. Curing a meagre health care system by lean methods--translating 'chains of care' in the Swedish health care sector.

    Science.gov (United States)

    Trägårdh, Björn; Lindberg, Kajsa

    2004-01-01

    The purpose of this article is to discuss what happens when work embedded in a 'meagre' organizational context is changed by lean production-related methods. The article is based on studies of seven lean production-inspired projects in the Swedish health care sector, a sector already poor due to organizational slack. The projects were directed to develop 'health care chains', an organizational concept regarded as a way to rationalize health care organizations as well as to develop them, i.e. increase productivity, quality from a customer perspective and quality of working conditions. The article analyses the projects from an interpretative perspective and discusses how modem management models with ambitions to concurrently rationalize and develop organizations--e.g. lean production and health care chains--are used in a 'meagre' organizational field. As an outcome, a model is presented that explores what is beyond simple imitations and unique translations of ideas when a new concept is implemented in local organizations.

  16. Exploring information systems outsourcing in U.S. hospital-based health care delivery systems.

    Science.gov (United States)

    Diana, Mark L

    2009-12-01

    The purpose of this study is to explore the factors associated with outsourcing of information systems (IS) in hospital-based health care delivery systems, and to determine if there is a difference in IS outsourcing activity based on the strategic value of the outsourced functions. IS sourcing behavior is conceptualized as a case of vertical integration. A synthesis of strategic management theory (SMT) and transaction cost economics (TCE) serves as the theoretical framework. The sample consists of 1,365 hospital-based health care delivery systems that own 3,452 hospitals operating in 2004. The findings indicate that neither TCE nor SMT predicted outsourcing better than the other did. The findings also suggest that health care delivery system managers may not be considering significant factors when making sourcing decisions, including the relative strategic value of the functions they are outsourcing. It is consistent with previous literature to suggest that the high cost of IS may be the main factor driving the outsourcing decision.

  17. Key elements of successful care process of patients with heart symptoms in an emergency care - could an ERP system help?

    Science.gov (United States)

    Kontio, Elina; Korvenranta, Heikki; Lundgren-Laine, Heljä; Salanterä, Sanna

    2009-01-01

    The aim of the study was to identify key elements of successful care process of patients with heart symptoms from the nursing management viewpoint in an emergency care. Through these descriptions, we aimed at identifying possibilities for using enterprise resource planning (ERP) systems to support decision making in emergency care. Hospitals are increasingly moving to process-based workings and at the same time new information system in healthcare are developed and therefore it is essential to understand the strengths and weaknesses of current processes better. A qualitative descriptive design using critical incident technique was employed. Critical Incidents were collected with an open-ended questionnaire. The sample (n=50), 13 head nurses and 37 registered nurses, was purposeful selected from three acute hospitals in southern Finland. The process of patients with heart symptoms in emergency care was described. We identified three competence categories where special focus should be placed to achieve successful process of patients with heart symptoms: process-oriented competencies, personal/management competencies and logistics oriented competencies. Improvement of decision making requires that the care processes are defined and modeled. The research showed that there are several happenings in emergency care where an ERP system could help and support decision making. These happenings can be categorized in two groups: 1) administrative related happenings and 2) patient processes related happenings.

  18. Using management information systems to enhance health care quality assurance.

    Science.gov (United States)

    Rosser, L H; Kleiner, B H

    1995-01-01

    Examines how computers and quality assurance are being used to improve the quality of health care delivery. Traditional quality assurance methods have been limited in their ability to effectively manage the high volume of data generated by the health care process. Computers on the other hand are able to handle large volumes of data as well as monitor patient care activities in both the acute care and ambulatory care settings. Discusses the use of computers to collect and analyse patient data so that changes and problems can be identified. In addition, computer models for reminding physicians to order appropriate preventive health measures for their patients are presented. Concludes that the use of computers to augment quality improvement is essential if the quality of patient care and health promotion are to be improved.

  19. 77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-10-17

    ... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates..., 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for...

  20. 40 CFR 160.90 - Animal and other test system care.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Animal and other test system care. 160... PROGRAMS GOOD LABORATORY PRACTICE STANDARDS Testing Facilities Operation § 160.90 Animal and other test... care of animals and other test systems. (b) All newly received test systems from outside sources shall...