WorldWideScience

Sample records for health clinics infrastructure

  1. Rural health clinics infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Olson, K.

    1997-12-01

    The author discusses programs which were directed at the installation of photovoltaic power systems in rural health clinics. The objectives included: vaccine refrigeration; ice pack freezing; lighting; communications; medical appliances; sterilization; water purification; and income generation. The paper discusses two case histories, one in the Dominican Republic and one in Colombia. The author summarizes the results of the programs, both successes and failures, and offers an array of conclusions with regard to the implementation of future programs of this general nature.

  2. Health Care Infrastructure for Financially Sustainable Clinical Genomics.

    Science.gov (United States)

    Lennerz, Jochen K; McLaughlin, Heather M; Baron, Jason M; Rasmussen, David; Sumbada Shin, Meini; Berners-Lee, Nancy; Miller Batten, Julie; Swoboda, Kathryn J; Gala, Manish K; Winter, Harland S; Schmahmann, Jeremy D; Sweetser, David A; Boswell, Marianne; Pacula, Maciej; Stenzinger, Albrecht; Le, Long P; Hynes, William; Rehm, Heidi L; Klibanski, Anne; Black-Schaffer, Stephen W; Golden, Jeffrey A; Louis, David N; Weiss, Scott T; Iafrate, A John

    2016-09-01

    Next-generation sequencing has evolved technically and economically into the method of choice for interrogating the genome in cancer and inherited disorders. The introduction of procedural code sets for whole-exome and genome sequencing is a milestone toward financially sustainable clinical implementation; however, achieving reimbursement is currently a major challenge. As part of a prospective quality-improvement initiative to implement the new code sets, we adopted Agile, a development methodology originally devised in software development. We implemented eight functionally distinct modules (request review, cost estimation, preauthorization, accessioning, prebilling, testing, reporting, and reimbursement consultation) and obtained feedback via an anonymous survey. We managed 50 clinical requests (January to June 2015). The fraction of pursued-to-requested cases (n = 15/50; utilization management fraction, 0.3) aimed for a high rate of preauthorizations. In 13 of 15 patients the insurance plan required preauthorization, which we obtained in 70% and ultimately achieved reimbursement in 50%. Interoperability enabled assessment of 12 different combinations of modules that underline the importance of an adaptive workflow and policy tailoring to achieve higher yields of reimbursement. The survey confirmed a positive attitude toward self-organizing teams. We acknowledge the individuals and their interactions and termed the infrastructure: human pipeline. Nontechnical barriers currently are limiting the scope and availability of clinical genomic sequencing. The presented human pipeline is one approach toward long-term financial sustainability of clinical genomics. Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

  3. Attending unintended transformations of health care infrastructure

    Directory of Open Access Journals (Sweden)

    Helle Wentzer

    2007-11-01

    Full Text Available Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results: This paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. Conclusion and discussion: The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes.

  4. Infrastructure for Clinical Trials in Duchenne Dystrophy

    Science.gov (United States)

    2010-09-13

    A Zimmerman, T Duong, J Florence and the CINRG Investigators. Pulmonary Function Characteristics of Boys with Duchenne and Becker Muscular Dystrophy ...designated CINRG site staff 1. Has the participant been clinically diagnosed with Limb-Girdle or Becker muscular dystrophy ? LGMD BMD 2. Was...Number: W81XWH-09-1-0592 TITLE: CINRG: Infrastructure for Clinical Trials in Duchenne Dystrophy PRINCIPAL INVESTIGATOR: Avital Cnaan, PhD

  5. Attending Unintended Transformations of Health Care Infrastructure

    DEFF Research Database (Denmark)

    Wentzer, Helle; Bygholm, Ann

    2007-01-01

    Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background of theor......Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background...

  6. Green Infrastructure, Ecosystem Services, and Human Health.

    Science.gov (United States)

    Coutts, Christopher; Hahn, Micah

    2015-08-18

    Contemporary ecological models of health prominently feature the natural environment as fundamental to the ecosystem services that support human life, health, and well-being. The natural environment encompasses and permeates all other spheres of influence on health. Reviews of the natural environment and health literature have tended, at times intentionally, to focus on a limited subset of ecosystem services as well as health benefits stemming from the presence, and access and exposure to, green infrastructure. The sweeping influence of green infrastructure on the myriad ecosystem services essential to health has therefore often been underrepresented. This survey of the literature aims to provide a more comprehensive picture-in the form of a primer-of the many simultaneously acting health co-benefits of green infrastructure. It is hoped that a more accurately exhaustive list of benefits will not only instigate further research into the health co-benefits of green infrastructure but also promote consilience in the many fields, including public health, that must be involved in the landscape conservation necessary to protect and improve health and well-being.

  7. Green Infrastructure, Ecosystem Services, and Human Health

    Science.gov (United States)

    Coutts, Christopher; Hahn, Micah

    2015-01-01

    Contemporary ecological models of health prominently feature the natural environment as fundamental to the ecosystem services that support human life, health, and well-being. The natural environment encompasses and permeates all other spheres of influence on health. Reviews of the natural environment and health literature have tended, at times intentionally, to focus on a limited subset of ecosystem services as well as health benefits stemming from the presence, and access and exposure to, green infrastructure. The sweeping influence of green infrastructure on the myriad ecosystem services essential to health has therefore often been underrepresented. This survey of the literature aims to provide a more comprehensive picture—in the form of a primer—of the many simultaneously acting health co-benefits of green infrastructure. It is hoped that a more accurately exhaustive list of benefits will not only instigate further research into the health co-benefits of green infrastructure but also promote consilience in the many fields, including public health, that must be involved in the landscape conservation necessary to protect and improve health and well-being. PMID:26295249

  8. Infrastructure resources for clinical research in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Sherman, Alexander V; Gubitz, Amelie K; Al-Chalabi, Ammar; Bedlack, Richard; Berry, James; Conwit, Robin; Harris, Brent T; Horton, D Kevin; Kaufmann, Petra; Leitner, Melanie L; Miller, Robert; Shefner, Jeremy; Vonsattel, Jean Paul; Mitsumoto, Hiroshi

    2013-05-01

    Clinical trial networks, shared clinical databases, and human biospecimen repositories are examples of infrastructure resources aimed at enhancing and expediting clinical and/or patient oriented research to uncover the etiology and pathogenesis of amyotrophic lateral sclerosis (ALS), a rapidly progressive neurodegenerative disease that leads to the paralysis of voluntary muscles. The current status of such infrastructure resources, as well as opportunities and impediments, were discussed at the second Tarrytown ALS meeting held in September 2011. The discussion focused on resources developed and maintained by ALS clinics and centers in North America and Europe, various clinical trial networks, U.S. government federal agencies including the National Institutes of Health (NIH), the Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC), and several voluntary disease organizations that support ALS research activities. Key recommendations included 1) the establishment of shared databases among individual ALS clinics to enhance the coordination of resources and data analyses; 2) the expansion of quality-controlled human biospecimen banks; and 3) the adoption of uniform data standards, such as the recently developed Common Data Elements (CDEs) for ALS clinical research. The value of clinical trial networks such as the Northeast ALS (NEALS) Consortium and the Western ALS (WALS) Consortium was recognized, and strategies to further enhance and complement these networks and their research resources were discussed.

  9. Health infrastructural challenges to health management information ...

    African Journals Online (AJOL)

    Aim: This study aims to assess health management information systems at the ... workers' ability to practice and use the health data generated at their Primary Health ... Only 2 (5.7%) of the health centres surveyed were capable of operating the ... The government at all levels should ensure collective effort and political will to ...

  10. Towards an affordable public health estate: a review of the 2008 health infrastructure barometer

    CSIR Research Space (South Africa)

    Abbott, G

    2009-05-01

    Full Text Available namely, context and need for health care infrastructure; budget allocations to health infrastructure; health infrastructure delivery, constraints and enabling mechanisms; and lastly, consolidation and recommendations of the future....

  11. FOREWORD: Structural Health Monitoring and Intelligent Infrastructure

    Science.gov (United States)

    Wu, Zhishen; Fujino, Yozo

    2005-06-01

    This special issue collects together 19 papers that were originally presented at the First International Conference on Structural Health Monitoring and Intelligent Infrastructure (SHMII-1'2003), held in Tokyo, Japan, on 13-15 November 2003. This conference was organized by the Japan Society of Civil Engineers (JSCE) with partial financial support from the Japan Society for the Promotion of Science (JSPS) and the Ministry of Education, Culture, Sport, Science and Technology, Japan. Many related organizations supported the conference. A total of 16 keynote papers including six state-of-the-art reports from different counties, six invited papers and 154 contributed papers were presented at the conference. The conference was attended by a diverse group of about 300 people from a variety of disciplines in academia, industry and government from all over the world. Structural health monitoring (SHM) and intelligent materials, structures and systems have been the subject of intense research and development in the last two decades and, in recent years, an increasing range of applications in infrastructure have been discovered both for existing structures and for new constructions. SHMII-1'2003 addressed progress in the development of building, transportation, marine, underground and energy-generating structures, and other civilian infrastructures that are periodically, continuously and/or actively monitored where there is a need to optimize their performance. In order to focus the current needs on SHM and intelligent technologies, the conference theme was set as 'Structures/Infrastructures Sustainability'. We are pleased to have the privilege to edit this special issue on SHM and intelligent infrastructure based on SHMII-1'2003. We invited some of the presenters to submit a revised/extended version of their paper that was included in the SHMII-1'2003 proceedings for possible publication in the special issue. Each paper included in this special issue was edited with the same

  12. the infrastructure supporting hiv vaccine clinical trials

    African Journals Online (AJOL)

    This article describes the infrastructure in global, national and site or regional levels. It concentrates mainly on the ... Research Unit at Chris Hani-Baragwanath Hospital in. Soweto and at the MRC in Durban, as well as two ... and maintenance of CABs, which are required to reduce the perceived power imbalance between ...

  13. Infrastructuring and Ordering Devices in Health Care

    DEFF Research Database (Denmark)

    Bossen, Claus; Markussen, Randi

    2010-01-01

    ) that is part of an electronic health record (EHR), carried out at an endocrinology department. The upgrade led to a temporary breakdown of the EMM, and a return to paper-based medication plans. The breakdown made visible and noticeable the taken-for-granted capabilities of medication plans in their paper......In this paper, we analyse physicians' and nurses' practices of prescribing and administering medication through the use of paper-based, and digitalized medication plans. Our point of departure is an ethnographic study of the implications of upgrading an electronic medication module (EMM......-based and digital versions, and the distribution of functionalities between medication plans and clinicians. We see the case as an opportunity to analyse infrastructuring in health care, the process by which medical practices and artefacts become parts of social and technological networks with longer reaches...

  14. Development of a public health nursing data infrastructure.

    Science.gov (United States)

    Monsen, Karen A; Bekemeier, Betty; P Newhouse, Robin; Scutchfield, F Douglas

    2012-01-01

    An invited group of national public health nursing (PHN) scholars, practitioners, policymakers, and other stakeholders met in October 2010 identifying a critical need for a national PHN data infrastructure to support PHN research. This article summarizes the strengths, limitations, and gaps specific to PHN data and proposes a research agenda for development of a PHN data infrastructure. Future implications are suggested, such as issues related to the development of the proposed PHN data infrastructure and future research possibilities enabled by the infrastructure. Such a data infrastructure has potential to improve accountability and measurement, to demonstrate the value of PHN services, and to improve population health. © 2012 Wiley Periodicals, Inc.

  15. Retooling Institutional Support Infrastructure for Clinical Research

    Science.gov (United States)

    Snyder, Denise C.; Brouwer, Rebecca N.; Ennis, Cory L.; Spangler, Lindsey L.; Ainsworth, Terry L.; Budinger, Susan; Mullen, Catherine; Hawley, Jeffrey; Uhlenbrauck, Gina; Stacy, Mark

    2016-01-01

    Clinical research activities at academic medical centers are challenging to oversee. Without effective research administration, a continually evolving set of regulatory and institutional requirements can detract investigator and study team attention away from a focus on scientific gain, study conduct, and patient safety. However, even when the need for research administration is recognized, there can be struggles over what form it should take. Central research administration may be viewed negatively, with individual groups preferring to maintain autonomy over processes. Conversely, a proliferation of individualized approaches across an institution can create inefficiencies or invite risk. This article describes experiences establishing a unified research support office at the Duke University School of Medicine based on a framework of customer support. The Duke Office of Clinical Research was formed in 2012 with a vision that research administration at academic medical centers should help clinical investigators navigate the complex research environment and operationalize research ideas. The office provides an array of services that have received high satisfaction ratings. The authors describe the ongoing culture change necessary for success of the unified research support office. Lessons learned from implementation of the Duke Office of Clinical Research may serve as a model for other institutions undergoing a transition to unified research support. PMID:27125563

  16. Intelligent Structural Health Management of Civil Infrastructure

    Science.gov (United States)

    2012-10-19

    The collapse of the I-35W Mississippi River Bridge in Minneapolis has spawned a growing interest in the : development of reliable techniques for evaluating the structural integrity of civil infrastructure. Current inspection : techniques tailored to ...

  17. Building the national health information infrastructure for personal health, health care services, public health, and research

    Directory of Open Access Journals (Sweden)

    Detmer Don E

    2003-01-01

    Full Text Available Abstract Background Improving health in our nation requires strengthening four major domains of the health care system: personal health management, health care delivery, public health, and health-related research. Many avoidable shortcomings in the health sector that result in poor quality are due to inaccessible data, information, and knowledge. A national health information infrastructure (NHII offers the connectivity and knowledge management essential to correct these shortcomings. Better health and a better health system are within our reach. Discussion A national health information infrastructure for the United States should address the needs of personal health management, health care delivery, public health, and research. It should also address relevant global dimensions (e.g., standards for sharing data and knowledge across national boundaries. The public and private sectors will need to collaborate to build a robust national health information infrastructure, essentially a 'paperless' health care system, for the United States. The federal government should assume leadership for assuring a national health information infrastructure as recommended by the National Committee on Vital and Health Statistics and the President's Information Technology Advisory Committee. Progress is needed in the areas of funding, incentives, standards, and continued refinement of a privacy (i.e., confidentiality and security framework to facilitate personal identification for health purposes. Particular attention should be paid to NHII leadership and change management challenges. Summary A national health information infrastructure is a necessary step for improved health in the U.S. It will require a concerted, collaborative effort by both public and private sectors. If you cannot measure it, you cannot improve it. Lord Kelvin

  18. Concepts and procedures for mapping food and health research infrastructure

    DEFF Research Database (Denmark)

    Brown, Kerry A.; Timotijević, Lada; Geurts, Marjolein

    2017-01-01

    be achieved in the area of food and health has, to date, been unclear. Scope and approach This commentary paper presents examples of the types of food and health research facilities, resources and services available in Europe. Insights are provided on the challenge of identifying and classifying research...... infrastructure. In addition, suggestions are made for the future direction of food and health research infrastructure in Europe. These views are informed by the EuroDISH project, which mapped research infrastructure in four areas of food and health research: Determinants of dietary behaviour; Intake of foods....../nutrients; Status and functional markers of nutritional health; Health and disease risk of foods/nutrients. Key findings and conclusion There is no objective measure to identify or classify research infrastructure. It is therefore, difficult to operationalise this term. EuroDISH demonstrated specific challenges...

  19. A National Strategy to Develop Pragmatic Clinical Trials Infrastructure

    Science.gov (United States)

    Guise, Jeanne‐Marie; Dolor, Rowena J.; Meissner, Paul; Tunis, Sean; Krishnan, Jerry A.; Pace, Wilson D.; Saltz, Joel; Hersh, William R.; Michener, Lloyd; Carey, Timothy S.

    2014-01-01

    Abstract An important challenge in comparative effectiveness research is the lack of infrastructure to support pragmatic clinical trials, which compare interventions in usual practice settings and subjects. These trials present challenges that differ from those of classical efficacy trials, which are conducted under ideal circumstances, in patients selected for their suitability, and with highly controlled protocols. In 2012, we launched a 1‐year learning network to identify high‐priority pragmatic clinical trials and to deploy research infrastructure through the NIH Clinical and Translational Science Awards Consortium that could be used to launch and sustain them. The network and infrastructure were initiated as a learning ground and shared resource for investigators and communities interested in developing pragmatic clinical trials. We followed a three‐stage process of developing the network, prioritizing proposed trials, and implementing learning exercises that culminated in a 1‐day network meeting at the end of the year. The year‐long project resulted in five recommendations related to developing the network, enhancing community engagement, addressing regulatory challenges, advancing information technology, and developing research methods. The recommendations can be implemented within 24 months and are designed to lead toward a sustained national infrastructure for pragmatic trials. PMID:24472114

  20. Infrastructure for Personalized Medicine at Partners HealthCare

    Directory of Open Access Journals (Sweden)

    Scott T. Weiss

    2016-02-01

    Full Text Available Partners HealthCare Personalized Medicine (PPM is a center within the Partners HealthCare system (founded by Massachusetts General Hospital and Brigham and Women’s Hospital whose mission is to utilize genetics and genomics to improve the care of patients in a cost effective manner. PPM consists of five interconnected components: (1 Laboratory for Molecular Medicine (LMM, a CLIA laboratory performing genetic testing for patients world-wide; (2 Translational Genomics Core (TGC, a core laboratory providing genomic platforms for Partners investigators; (3 Partners Biobank, a biobank of samples (DNA, plasma and serum for 50,000 Consented Partners patients; (4 Biobank Portal, an IT infrastructure and viewer to bring together genotypes, samples, phenotypes (validated diagnoses, radiology, and clinical chemistry from the electronic medical record to Partners investigators. These components are united by (5 a common IT system that brings researchers, clinicians, and patients together for optimal research and patient care.

  1. Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries.

    Science.gov (United States)

    Denburg, Avram; Rodriguez-Galindo, Carlos; Joffe, Steven

    2016-06-01

    Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a "trial effect," however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure-the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research-may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this "infrastructure effect" can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development.

  2. A relational conceptual framework for multidisciplinary health research centre infrastructure

    Directory of Open Access Journals (Sweden)

    Johnson Joy L

    2010-10-01

    Full Text Available Abstract Although multidisciplinary and team-based approaches are increasingly acknowledged as necessary to address some of the most pressing contemporary health challenges, many researchers struggle with a lack of infrastructure to facilitate and formalise the requisite collaborations. Specialised research centres have emerged as an important organisational solution, yet centre productivity and sustainability are frequently dictated by the availability and security of infrastructure funds. Despite being widely cited as a core component of research capacity building, infrastructure as a discrete concept has been rather analytically neglected, often treated as an implicit feature of research environments with little specification or relegated to a narrow category of physical or administrative inputs. The terms research infrastructure, capacity, and culture, among others, are deployed in overlapping and inconsistent ways, further obfuscating the crucial functions of infrastructure specifically and its relationships with associated concepts. The case is made for an expanded conceptualisation of research infrastructure, one that moves beyond conventional 'hardware' notions. Drawing on a case analysis of NEXUS, a multidisciplinary health research centre based at the University of British Columbia, Canada, a conceptual framework is proposed that integrates the tangible and intangible structures that interactively underlie research centre functioning. A relational approach holds potential to allow for more comprehensive accounting of the returns on infrastructure investment. For those developing new research centres or seeking to reinvigorate existing ones, this framework may be a useful guide for both centre design and evaluation.

  3. Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy

    NARCIS (Netherlands)

    Driessen, A.; Schäfer, N.; Albrecht, V.; Schenk, M.; Fröhlich, M.; Stürmer, E. K.; Maegele, M.; Johansson, Pär; Ostrowski, Sisse Rye; Tuovinen, Hannele; Stensballe, Jakob; Goslings, Johann Carel; Juffermans, Nicole; Balvers, Kirsten; Gaarder, Christine; Brohi, Karim; Eaglestone, Simon; Rourke, Claire; Campbell, Helen; Curry, Nicola; Stanworth, Simon; Maegele, Marc; Stürmer, Ewa K.; Schäfer, Nadine; Driessen, Arne; Orr, Adrian; Schubert, Axel

    2015-01-01

    Early detection and management of post-traumatic haemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructures, logistics and clinical strategies may differ. To assess local differences in infrastructure, logistics and clinical management of trauma-associated

  4. Building Connecticut's clinical biodosimetry laboratory surge capacity to mitigate the health consequences of radiological and nuclear disasters: A collaborative approach between the state biodosimetry laboratory and Connecticut's medical infrastructure

    International Nuclear Information System (INIS)

    Albanese, Joseph; Martens, Kelly; Arnold, Jeffrey L.; Kelley, Katherine; Kristie, Virginia; Forte, Elaine; Schneider, Mark; Dainiak, Nicholas

    2007-01-01

    Biodosimetry, based on the analysis of dicentric chromosomes in circulating mononuclear cells, is considered the 'gold standard' for estimating radiation dose and is used to make informed decisions regarding the medical management of irradiated persons. This paper describes the development of biodosimetry laboratory surge capacity for the health consequences of radiological and nuclear disasters in Connecticut, including: (1) establishment of the Biodosimetry Laboratory for the timely assessment of radiation dosage in biodosimetry specimens; (2) identification of clinical laboratories qualified and willing to process biodosimetry specimens from a large number of victims; (3) training of clinical laboratorians in initial biodosimetry specimen processing; and (4) conducting a functional drill that evaluated the effectiveness of these elements. Descriptive information was obtained from: (1) personal observations; (2) a needs assessment of clinical laboratories in Connecticut; (3) records from a training program of clinical laboratorians in biodosimetry specimen processing that was developed and provided by the Yale New Haven Center for Emergency Preparedness and Disaster Response; and (4) records from a statewide functional drill in biodosimetry specimen processing that was developed and conducted by the State of Connecticut Biodosimetry Laboratory. A needs assessment of clinical laboratories in Connecticut identified 30 of 32 clinical laboratories qualified and willing to perform initial biodosimetry specimen processing. Currently, 79 clinical laboratorians in 19 of these qualified clinical laboratories have been trained in biodosimetry specimen processing. A functional exercise was conducted involving 37 of these trained clinical laboratorians in 18 qualified laboratories as well as the Biodosimetry Laboratory. The average turnaround time for biodosimetry specimen processing in this drill was 199 min. Exercise participants provided feedback which will be used to

  5. INFRASTRUCTURE

    CERN Document Server

    A.Gaddi

    2011-01-01

    Between the end of March to June 2011, there has been no detector downtime during proton fills due to CMS Infrastructures failures. This exceptional performance is a clear sign of the high quality work done by the CMS Infrastructures unit and its supporting teams. Powering infrastructure At the end of March, the EN/EL group observed a problem with the CMS 48 V system. The problem was a lack of isolation between the negative (return) terminal and earth. Although at that moment we were not seeing any loss of functionality, in the long term it would have led to severe disruption to the CMS power system. The 48 V system is critical to the operation of CMS: in addition to feeding the anti-panic lights, essential for the safety of the underground areas, it powers all the PLCs (Twidos) that control AC power to the racks and front-end electronics of CMS. A failure of the 48 V system would bring down the whole detector and lead to evacuation of the cavern. EN/EL technicians have made an accurate search of the fault, ...

  6. INFRASTRUCTURE

    CERN Multimedia

    A. Gaddi and P. Tropea

    2011-01-01

    Most of the work relating to Infrastructure has been concentrated in the new CSC and RPC manufactory at building 904, on the Prevessin site. Brand new gas distribution, powering and HVAC infrastructures are being deployed and the production of the first CSC chambers has started. Other activities at the CMS site concern the installation of a new small crane bridge in the Cooling technical room in USC55, in order to facilitate the intervention of the maintenance team in case of major failures of the chilled water pumping units. The laser barrack in USC55 has been also the object of a study, requested by the ECAL community, for the new laser system that shall be delivered in few months. In addition, ordinary maintenance works have been performed during the short machine stops on all the main infrastructures at Point 5 and in preparation to the Year-End Technical Stop (YETS), when most of the systems will be carefully inspected in order to ensure a smooth running through the crucial year 2012. After the incide...

  7. INFRASTRUCTURE

    CERN Multimedia

    A. Gaddi and P. Tropea

    2012-01-01

    The CMS Infrastructures teams are preparing for the LS1 activities. A long list of maintenance, consolidation and upgrade projects for CMS Infrastructures is on the table and is being discussed among Technical Coordination and sub-detector representatives. Apart from the activities concerning the cooling infrastructures (see below), two main projects have started: the refurbishment of the SX5 building, from storage area to RP storage and Muon stations laboratory; and the procurement of a new dry-gas (nitrogen and dry air) plant for inner detector flushing. We briefly present here the work done on the first item, leaving the second one for the next CMS Bulletin issue. The SX5 building is entering its third era, from main assembly building for CMS from 2000 to 2007, to storage building from 2008 to 2012, to RP storage and Muon laboratory during LS1 and beyond. A wall of concrete blocks has been erected to limit the RP zone, while the rest of the surface has been split between the ME1/1 and the CSC/DT laborat...

  8. A knowledge infrastructure for occupational safety and health.

    Science.gov (United States)

    van Dijk, Frank J H; Verbeek, Jos H; Hoving, Jan L; Hulshof, Carel T J

    2010-12-01

    Occupational Safety and Health (OSH) professionals should use scientific evidence to support their decisions in policy and practice. Although examples from practice show that progress has been made in evidence-based decision making, there is a challenge to improve and extend the facilities that support knowledge translation in practice. A knowledge infrastructure that supports OSH practice should include scientific research, systematic reviews, practice guidelines, and other tools for professionals such as well accessible virtual libraries and databases providing knowledge, quality tools, and good learning materials. A good infrastructure connects facilities with each other and with practice. Training and education is needed for OSH professionals in the use of evidence to improve effectiveness and efficiency. New initiatives show that occupational health can profit from intensified international collaboration to establish a good functioning knowledge infrastructure.

  9. Clinical Knowledge Governance Framework for Nationwide Data Infrastructure Projects.

    Science.gov (United States)

    Wulff, Antje; Haarbrandt, Birger; Marschollek, Michael

    2018-01-01

    The availability of semantically-enriched and interoperable clinical information models is crucial for reusing once collected data across institutions like aspired in the German HiGHmed project. Funded by the Federal Ministry of Education and Research, this nationwide data infrastructure project adopts the openEHR approach for semantic modelling. Here, strong governance is required to define high-quality and reusable models. Design of a clinical knowledge governance framework for openEHR modelling in cross-institutional settings like HiGHmed. Analysis of successful practices from international projects, published ideas on archetype governance and own modelling experiences as well as modelling of BPMN processes. We designed a framework by presenting archetype variations, roles and responsibilities, IT support and modelling workflows. Our framework has great potential to make the openEHR modelling efforts manageable. Because practical experiences are rare, prospectively our work will be predestinated to evaluate the benefits of such structured governance approaches.

  10. Primary health care facility infrastructure and services and the ...

    African Journals Online (AJOL)

    ... Research Council ae Currently from Cape Peninsula University of Technology ... Keywords: primary health care facilities; nutritional status; children; caregivers' rural; South Africa ... underlying causes of malnutrition in children, while poor food quality, .... Information on PHC facility infrastructure and services was obtained.

  11. INFRASTRUCTURE

    CERN Multimedia

    A. Gaddi

    2012-01-01

    The CMS Infrastructures teams are constantly ensuring the smooth operation of the different services during this critical period when the detector is taking data at full speed. A single failure would spoil hours of high luminosity beam and everything is put in place to avoid such an eventuality. In the meantime however, the fast approaching LS1 requires that we take a look at the various activities to take place from the end of the year onwards. The list of infrastructures consolidation and upgrade tasks is already long and will touch all the services (cooling, gas, inertion, powering, etc.). The definitive list will be available just before the LS1 start. One activity performed by the CMS cooling team that is worth mentioning is the maintenance of the cooling circuits at the CMS Electronics Integration Centre (EIC) at building 904. The old chiller has been replaced by a three-units cooling plant that also serves the HVAC system for the new CSC and RPC factories. The commissioning of this new plant has tak...

  12. INFRASTRUCTURE

    CERN Multimedia

    Andrea Gaddi

    2010-01-01

    In addition to the intense campaign of replacement of the leaky bushing on the Endcap circuits, other important activities have also been completed, with the aim of enhancing the overall reliability of the cooling infrastructures at CMS. Remaining with the Endcap circuit, the regulating valve that supplies cold water to the primary side of the circuit heat-exchanger, is not well adapted in flow capability and a new part has been ordered, to be installed during a stop of LHC. The instrumentation monitoring of the refilling rate of the circuits has been enhanced and we can now detect leaks as small as 0.5 cc/sec, on circuits that have nominal flow rates of some 20 litres/sec. Another activity starting now that the technical stop is over is the collection of spare parts that are difficult to find on the market. These will be stored at P5 with the aim of reducing down-time in case of component failure. Concerning the ventilation infrastructures, it has been noticed that in winter time the relative humidity leve...

  13. Electronic health record standards, coding systems, frameworks, and infrastructures

    CERN Document Server

    Sinha, Pradeep K; Bendale, Prashant; Mantri, Manisha; Dande, Atreya

    2013-01-01

    Discover How Electronic Health Records Are Built to Drive the Next Generation of Healthcare Delivery The increased role of IT in the healthcare sector has led to the coining of a new phrase ""health informatics,"" which deals with the use of IT for better healthcare services. Health informatics applications often involve maintaining the health records of individuals, in digital form, which is referred to as an Electronic Health Record (EHR). Building and implementing an EHR infrastructure requires an understanding of healthcare standards, coding systems, and frameworks. This book provides an

  14. Importance of clinical microbiologists for U.S. healthcare infrastructure.

    Science.gov (United States)

    Carvalho, John

    2011-01-01

    Clinical microbiologists are highly skilled scientists within national hospitals and reference laboratories who diagnose patients with infections by emerging pathogens. Most advanced training for clinical microbiologists occurs at universities, where an individual can receive certification as a "Medical Laboratory Scientist" (MLS). Unfortunately, many MLS programs have closed in the United States and this has caused a shortage of clinical microbiologists at U.S. hospitals and reference laboratories. This paper explores the present crisis in MLS training and its ramifications for the emergence of antibiotic-resistant bacteria, the economics of hospitals, and the overall health of the nation, and provides resolutions for better public health policy with respect to MLS education.

  15. INFRASTRUCTURE

    CERN Multimedia

    Andrea Gaddi

    With all the technical services running, the attention has moved toward the next shutdown that will be spent to perform those modifications needed to enhance the reliability of CMS Infrastructures. Just to give an example for the cooling circuit, a set of re-circulating bypasses will be installed into the TS/CV area to limit the pressure surge when a circuit is partially shut-off. This problem has affected especially the Endcap Muon cooling circuit in the past. Also the ventilation of the UXC55 has to be revisited, allowing the automatic switching to full extraction in case of magnet quench. (Normally 90% of the cavern air is re-circulated by the ventilation system.) Minor modifications will concern the gas distribution, while the DSS action-matrix has to be refined according to the experience gained with operating the detector for a while. On the powering side, some LV power lines have been doubled and the final schematics of the UPS coverage for the counting rooms have been released. The most relevant inte...

  16. INFRASTRUCTURE

    CERN Multimedia

    A. Gaddi and P. Tropea

    2013-01-01

      Most of the CMS infrastructures at P5 will go through a heavy consolidation-work period during LS1. All systems, from the cryogenic plant of the superconducting magnet to the rack powering in the USC55 counting rooms, from the cooling circuits to the gas distribution, will undergo consolidation work. As announced in the last issue of the CMS Bulletin, we present here one of the consolidation projects of LS1: the installation of a new dry-gas plant for inner detectors inertion. So far the oxygen and humidity suppression inside the CMS Tracker and Pixel volumes were assured by flushing dry nitrogen gas evaporated from a large liquid nitrogen tank. For technical reasons, the maximum flow is limited to less than 100 m3/h and the cost of refilling the tank every two weeks with liquid nitrogen is quite substantial. The new dry-gas plant will supply up to 400 m3/h of dry nitrogen (or the same flow of dry air, during shut-downs) with a comparatively minimal operation cost. It has been evaluated that the...

  17. INFRASTRUCTURE

    CERN Document Server

    Andrea Gaddi

    2010-01-01

    During the last six months, the main activity on the cooling circuit has essentially been preventive maintenance. At each short machine technical stop, a water sample is extracted out of every cooling circuit to measure the induced radioactivity. Soon after, a visual check of the whole detector cooling network is done, looking for water leaks in sensitive locations. Depending on sub-system availability, the main water filters are replaced; the old ones are inspected and sent to the CERN metallurgical lab in case of suspicious sediments. For the coming winter technical stop, a number of corrective maintenance activities and infrastructure consolidation work-packages are foreseen. A few faulty valves, found on the muon system cooling circuit, will be replaced; the cooling gauges for TOTEM and CASTOR, in the CMS Forward region, will be either changed or shielded against the magnetic stray field. The demineralizer cartridges will be replaced as well. New instrumentation will also be installed in the SCX5 PC farm ...

  18. INFRASTRUCTURE

    CERN Multimedia

    Andrea Gaddi.

    The various water-cooling circuits ran smoothly over the summer. The overall performance of the cooling system is satisfactory, even if some improvements are possible, concerning the endcap water-cooling and the C6F14 circuits. In particular for the endcap cooling circuit, we aim to lower the water temperature, to provide more margin for RPC detectors. An expert-on-call piquet has been established during the summer global run, assuring the continuous supervision of the installations. An effort has been made to collect and harmonize the existing documentation on the cooling infrastructures at P5. The last six months have seen minor modifications to the electrical power network at P5. Among these, the racks in USC55 for the Tracker and Sniffer systems, which are backed up by the diesel generator in case of power outage, have been equipped with new control boxes to allow a remote restart. Other interventions have concerned the supply of assured power to those installations that are essential for CMS to run eff...

  19. INFRASTRUCTURE

    CERN Multimedia

    A. Gaddi

    The long winter shut-down allows for modifications that will improve the reliability of the detector infrastructures at P5. The annual maintenance of detector services is taking place as well. This means a full stop of water-cooling circuits from November 24th with a gradual restart from mid January 09. The annual maintenance service includes the cleaning of the two SF5 cooling towers, service of the chiller plants on the surface, and the cryogenic plant serving the CMS Magnet. In addition, the overall site power is reduced from 8MW to 2MW, compatible with the switchover to the Swiss power network in winter. Full power will be available again from end of January. Among the modification works planned, the Low Voltage cabinets are being refurbished; doubling the cable sections and replacing the 40A circuit breakers with 60A types. This will reduce the overheating that has been experienced. Moreover, two new LV transformers will be bought and pre-cabled in order to assure a quick swap in case of failure of any...

  20. INFRASTRUCTURE

    CERN Document Server

    A. Gaddi

    2011-01-01

    During the last winter technical stop, a number of corrective maintenance activities and infrastructure consolidation work-packages were completed. On the surface, the site cooling facility has passed the annual maintenance process that includes the cleaning of the two evaporative cooling towers, the maintenance of the chiller units and the safety checks on the software controls. In parallel, CMS teams, reinforced by PH-DT group personnel, have worked to shield the cooling gauges for TOTEM and CASTOR against the magnetic stray field in the CMS Forward region, to add labels to almost all the valves underground and to clean all the filters in UXC55, USC55 and SCX5. Following the insertion of TOTEM T1 detector, the cooling circuit has been branched off and commissioned. The demineraliser cartridges have been replaced as well, as they were shown to be almost saturated. New instrumentation has been installed in the SCX5 PC farm cooling and ventilation network, in order to monitor the performance of the HVAC system...

  1. Health Clinic Cost Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Independent Rural Health Clinic and Freestanding Federally Qualified Health Center (HCLINIC).This data...

  2. Critical health infrastructure for refugee resettlement in rural Australia: case study of four rural towns.

    Science.gov (United States)

    Sypek, Scott; Clugston, Gregory; Phillips, Christine

    2008-12-01

    To explore the reported impact of regional resettlement of refugees on rural health services, and identify critical health infrastructure for refugee resettlement. Comparative case study, using interviews and situational analysis. Four rural communities in New South Wales, which had been the focus of regional resettlement of refugees since 1999. Refugees, general practitioners, practice managers and volunteer support workers in each town (n = 24). The capacity of health care workers to provide comprehensive care is threatened by low numbers of practitioners, and high levels of turnover of health care staff, which results in attrition of specialised knowledge among health care workers treating refugees. Critical health infrastructure includes general practices with interest and surge capacity, subsidised dental services, mental health support services; clinical support services for rural practitioners; care coordination in the early settlement period; and a supported volunteer network. The need for intensive medical support is greatest in the early resettlement period for 'catch-up' primary health care. The difficulties experienced by rural Australia in securing equitable access to health services are amplified for refugees. While there are economic arguments about resettlement of refugees in regional Australia, the fragility of health services in regional Australia should also be factored into considerations about which towns are best suited to regional resettlement.

  3. Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

    Science.gov (United States)

    Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

    2015-05-01

    Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

  4. Achievable Steps Toward Building a National Health Information Infrastructure in the United States

    OpenAIRE

    Stead, William W.; Kelly, Brian J.; Kolodner, Robert M.

    2005-01-01

    Consensus is growing that a health care information and communication infrastructure is one key to fixing the crisis in the United States in health care quality, cost, and access. The National Health Information Infrastructure (NHII) is an initiative of the Department of Health and Human Services receiving bipartisan support. There are many possible courses toward its objective. Decision makers need to reflect carefully on which approaches are likely to work on a large enough scale to have th...

  5. Green Infrastructure in Context: Public Health and Ecosystem Services

    Science.gov (United States)

    Using interdisciplinary approaches to urban water management strategies can yield benefits for sustainability. While green infrastructure (GI) has primarily been used to increase infiltration/redistribution and reduce runoff in urban areas, the physical siting of GI can provide o...

  6. A centralized informatics infrastructure for the National Institute on Drug Abuse Clinical Trials Network

    Science.gov (United States)

    Pan, Jeng-Jong; Nahm, Meredith; Wakim, Paul; Cushing, Carol; Poole, Lori; Tai, Betty; Pieper, Carl F.

    2009-01-01

    Background Clinical trial networks were created to provide a sustaining infrastructure for the conduct of multisite clinical trials. As such, they must withstand changes in membership. Centralization of infrastructure including knowledge management, portfolio management, information management, process automation, work policies, and procedures in clinical research networks facilitates consistency and ultimately research. Purpose In 2005, the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) transitioned from a distributed data management model to a centralized informatics infrastructure to support the network’s trial activities and administration. We describe the centralized informatics infrastructure and discuss our challenges to inform others considering such an endeavor. Methods During the migration of a clinical trial network from a decentralized to a centralized data center model, descriptive data were captured and are presented here to assess the impact of centralization. Results We present the framework for the informatics infrastructure and evaluative metrics. The network has decreased the time from last patient-last visit to database lock from an average of 7.6 months to 2.8 months. The average database error rate decreased from 0.8% to 0.2%, with a corresponding decrease in the interquartile range from 0.04%–1.0% before centralization to 0.01%–0.27% after centralization. Centralization has provided the CTN with integrated trial status reporting and the first standards-based public data share. A preliminary cost-benefit analysis showed a 50% reduction in data management cost per study participant over the life of a trial. Limitations A single clinical trial network comprising addiction researchers and community treatment programs was assessed. The findings may not be applicable to other research settings. Conclusions The identified informatics components provide the information and infrastructure needed for our clinical trial

  7. STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER.

    Science.gov (United States)

    Freed, Christopher R; Hansberry, Shantisha T; Arrieta, Martha I

    2013-09-01

    To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

  8. Electronic health records to facilitate clinical research.

    Science.gov (United States)

    Cowie, Martin R; Blomster, Juuso I; Curtis, Lesley H; Duclaux, Sylvie; Ford, Ian; Fritz, Fleur; Goldman, Samantha; Janmohamed, Salim; Kreuzer, Jörg; Leenay, Mark; Michel, Alexander; Ong, Seleen; Pell, Jill P; Southworth, Mary Ross; Stough, Wendy Gattis; Thoenes, Martin; Zannad, Faiez; Zalewski, Andrew

    2017-01-01

    Electronic health records (EHRs) provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research. Concerns have been raised about the increasing recruitment challenges in trials, burdensome and obtrusive data collection, and uncertain generalizability of the results. Leveraging electronic health records to counterbalance these trends is an area of intense interest. The initial applications of electronic health records, as the primary data source is envisioned for observational studies, embedded pragmatic or post-marketing registry-based randomized studies, or comparative effectiveness studies. Advancing this approach to randomized clinical trials, electronic health records may potentially be used to assess study feasibility, to facilitate patient recruitment, and streamline data collection at baseline and follow-up. Ensuring data security and privacy, overcoming the challenges associated with linking diverse systems and maintaining infrastructure for repeat use of high quality data, are some of the challenges associated with using electronic health records in clinical research. Collaboration between academia, industry, regulatory bodies, policy makers, patients, and electronic health record vendors is critical for the greater use of electronic health records in clinical research. This manuscript identifies the key steps required to advance the role of electronic health records in cardiovascular clinical research.

  9. CINRG: Infrastructure for Clinical Trials in Duchenne Dystrophy

    Science.gov (United States)

    2013-09-01

    monitoring visit to monitor this study, the PITT0908 clinical trial, a study on facioscapulohumeral muscular dystrophy (FSHD), and PITT0112 Becker natural...height findings manuscript are currently in working stage and circulating among co-authors for editing. 2.3.6 Becker Muscular Dystrophy – A Natural...participants with Becker muscular dystrophy . The study period is 36 months per patient. This project is primarily funded by the National Institutes of

  10. Integrating grey and green infrastructure to improve the health and well-being of urban populations

    Science.gov (United States)

    Erika S. Svendsen; Mary E. Northridge; Sara S. Metcalf

    2012-01-01

    One of the enduring lessons of cities is the essential relationship between grey infrastructure (e.g., streets and buildings) and green infrastructure (e.g., parks and open spaces). The design and management of natural resources to enhance human health and well-being may be traced back thousands of years to the earliest urban civilizations. From the irrigation projects...

  11. Sustainability considerations for health research and analytic data infrastructures.

    Science.gov (United States)

    Wilcox, Adam; Randhawa, Gurvaneet; Embi, Peter; Cao, Hui; Kuperman, Gilad J

    2014-01-01

    The United States has made recent large investments in creating data infrastructures to support the important goals of patient-centered outcomes research (PCOR) and comparative effectiveness research (CER), with still more investment planned. These initial investments, while critical to the creation of the infrastructures, are not expected to sustain them much beyond the initial development. To provide the maximum benefit, the infrastructures need to be sustained through innovative financing models while providing value to PCOR and CER researchers. Based on our experience with creating flexible sustainability strategies (i.e., strategies that are adaptive to the different characteristics and opportunities of a resource or infrastructure), we define specific factors that are important considerations in developing a sustainability strategy. These factors include assets, expansion, complexity, and stakeholders. Each factor is described, with examples of how it is applied. These factors are dimensions of variation in different resources, to which a sustainability strategy should adapt. We also identify specific important considerations for maintaining an infrastructure, so that the long-term intended benefits can be realized. These observations are presented as lessons learned, to be applied to other sustainability efforts. We define the lessons learned, relating them to the defined sustainability factors as interactions between factors. Using perspectives and experiences from a diverse group of experts, we define broad characteristics of sustainability strategies and important observations, which can vary for different projects. Other descriptions of adaptive, flexible, and successful models of collaboration between stakeholders and data infrastructures can expand this framework by identifying other factors for sustainability, and give more concrete directions on how sustainability can be best achieved.

  12. [Access to prenatal care and quality of care in the Family Health Strategy: infrastructure, care, and management].

    Science.gov (United States)

    Guimarães, Wilderi Sidney Gonçalves; Parente, Rosana Cristina Pereira; Guimarães, Thayanne Louzada Ferreira; Garnelo, Luiza

    2018-05-10

    This study focuses on access to prenatal care and quality of care in the Family Health Strategy in Brazil as a whole and in the North region, through evaluation of infrastructure characteristics in the health units, management, and supply of care provided by the teams, from the perspective of regional and state inequalities. A cross-sectional evaluative and normative study was performed, drawing on the external evaluation component of the second round of the Program for Improvement of Access and Quality of Primary Care, in 2013-2014. The results revealed the inadequacy of the primary healthcare network's infrastructure for prenatal care, low adequacy of clinical actions for quality of care, and the teams' low management capacity to guarantee access and quality of care. In the distribution according to geopolitical regions, the findings pertaining to the units' infrastructure indicate a direct relationship between the infrastructure's adequacy and social contexts with higher municipal human development indices and income. For the clinical actions in patient care, the teams in all the regions scored low on adequacy, with slightly better results in the North and South regions of the country. There were important differences between the states of the North, and the states with higher mean income and human development scored higher on adequacy. The results indicate important organizational difficulties in both access and quality of care provided by the health teams, in addition to visible insufficiency in management activities aimed to improve access and quality of prenatal care.

  13. Building research infrastructure in community health centers: a Community Health Applied Research Network (CHARN) report.

    Science.gov (United States)

    Likumahuwa, Sonja; Song, Hui; Singal, Robbie; Weir, Rosy Chang; Crane, Heidi; Muench, John; Sim, Shao-Chee; DeVoe, Jennifer E

    2013-01-01

    This article introduces the Community Health Applied Research Network (CHARN), a practice-based research network of community health centers (CHCs). Established by the Health Resources and Services Administration in 2010, CHARN is a network of 4 community research nodes, each with multiple affiliated CHCs and an academic center. The four nodes (18 individual CHCs and 4 academic partners in 9 states) are supported by a data coordinating center. Here we provide case studies detailing how CHARN is building research infrastructure and capacity in CHCs, with a particular focus on how community practice-academic partnerships were facilitated by the CHARN structure. The examples provided by the CHARN nodes include many of the building blocks of research capacity: communication capacity and "matchmaking" between providers and researchers; technology transfer; research methods tailored to community practice settings; and community institutional review board infrastructure to enable community oversight. We draw lessons learned from these case studies that we hope will serve as examples for other networks, with special relevance for community-based networks seeking to build research infrastructure in primary care settings.

  14. Hospital Adoption of Health Information Technology to Support Public Health Infrastructure.

    Science.gov (United States)

    Walker, Daniel M; Diana, Mark L

    2016-01-01

    Health information technology (IT) has the potential to improve the nation's public health infrastructure. In support of this belief, meaningful use incentives include criteria for hospitals to electronically report to immunization registries, as well as to public health agencies for reportable laboratory results and syndromic surveillance. Electronic reporting can facilitate faster and more appropriate public health response. However, it remains unclear the extent that hospitals have adopted IT for public health efforts. To examine hospital adoption of IT for public health and to compare hospitals capable of using and not using public health IT. Cross-sectional design with data from the 2012 American Hospital Association annual survey matched with data from the 2013 American Hospital Association Information Technology Supplement. Multivariate logistic regression was used to compare hospital characteristics. Inverse probability weights were applied to adjust for selection bias because of survey nonresponse. All acute care general hospitals in the United States that matched across the surveys and had complete data available were included in the analytic sample. Three separate outcome measures were used: whether the hospital could electronically report to immunization registries, whether the hospital could send electronic laboratory results, and whether the hospital can participate in syndromic surveillance. A total of 2841 hospitals met the inclusion criteria. Weighted results show that of these hospitals, 62.7% can electronically submit to immunization registries, 56.6% can electronically report laboratory results, and 54.4% can electronically report syndromic surveillance. Adjusted and weighted results from the multivariate analyses show that small, rural hospitals and hospitals without electronic health record systems lag in the adoption of public health IT capabilities. While a majority of hospitals are using public health IT, the infrastructure still has

  15. IT Infrastructure to Support the Secondary Use of Routinely Acquired Clinical Imaging Data for Research

    NARCIS (Netherlands)

    K.Y.E. Leung (Esther); F. van der Lijn (Fedde); H.A. Vrooman (Henri); M.C.J.M. Sturkenboom (Miriam); W.J. Niessen (Wiro)

    2014-01-01

    textabstractWe propose an infrastructure for the automated anonymization, extraction and processing of image data stored in clinical data repositories to make routinely acquired imaging data available for research purposes. The automated system, which was tested in the context of analyzing routinely

  16. [Public health infrastructure investment difficulties in Chile: concessions and public tenders].

    Science.gov (United States)

    Goyenechea, Matías

    2016-05-12

    This paper seeks to highlight the problems of gaps in health infrastructure in Chile, and to analyze the mechanisms by which it is provided. In Chile this is done in two ways: the first is through competitive bidding or sector-wide modality. The second way is through hospital concessions. Both mechanisms have had difficulties in recent years, which are reported. Finally, we propose ways to improve the provision of health infrastructure in Chile.

  17. Building oral health research infrastructure: the first national oral health survey of Rwanda.

    Science.gov (United States)

    Morgan, John P; Isyagi, Moses; Ntaganira, Joseph; Gatarayiha, Agnes; Pagni, Sarah E; Roomian, Tamar C; Finkelman, Matthew; Steffensen, Jane E M; Barrow, Jane R; Mumena, Chrispinus H; Hackley, Donna M

    2018-01-01

    Oral health affects quality of life and is linked to overall health. Enhanced oral health research is needed in low- and middle-income countries to develop strategies that reduce the burden of oral disease, improve oral health and inform oral health workforce and infrastructure development decisions. To implement the first National Oral Health Survey of Rwanda to assess the oral disease burden and inform oral health promotion strategies. In this cross-sectional study, sample size and site selection were based on the World Health Organization (WHO) Oral Health Surveys Pathfinder stratified cluster methodologies. Randomly selected 15 sites included 2 in the capital city, 2 other urban centers and 11 rural locations representing all provinces and rural/urban population distribution. A minimum of 125 individuals from each of 5 age groups were included at each site. A Computer Assisted Personal Instrument (CAPI) was developed to administer the study instrument. Nearly two-thirds (64.9%) of the 2097 participants had caries experience and 54.3% had untreated caries. Among adults 20 years of age and older, 32.4% had substantial oral debris and 60.0% had calculus. A majority (70.6%) had never visited an oral health provider. Quality-of-life challenges due to oral diseases/conditions including pain, difficulty chewing, self-consciousness, and difficulty participating in usual activities was reported at 63.9%, 42.2% 36.2%, 35.4% respectively. The first National Oral Health Survey of Rwanda was a collaboration of the Ministry of Health of Rwanda, the University of Rwanda Schools of Dentistry and Public Health, the Rwanda Dental Surgeons and Dental (Therapists) Associations, and Tufts University and Harvard University Schools of Dental Medicine. The international effort contributed to building oral health research capacity and resulted in a national oral health database of oral disease burden. This information is essential for developing oral disease prevention and management

  18. Building and measuring infrastructure and capacity for community health assessment and health improvement planning in Florida.

    Science.gov (United States)

    Abarca, Christine; Grigg, C Meade; Steele, Jo Ann; Osgood, Laurie; Keating, Heidi

    2009-01-01

    COMPASS (Comprehensive Assessment, Strategic Success) is the Florida Department of Health's community health assessment and health improvement planning initiative. Since 2002, COMPASS built state and county health department infrastructure to support a comprehensive, systematic, and integrated approach to community health assessment and planning. To assess the capacity of Florida's 67 county health departments (CHDs) to conduct community health assessment and planning and to identify training and technical assistance needs, COMPASS surveyed the CHDs using a Web-based instrument annually from 2004 through 2008. Response rate to the survey was 100 percent annually. In 2007, 96 percent of CHDs reported conducting assessment and planning within the past 3 years; 74 percent used the MAPP (Mobilizing for Action through Planning and Partnerships) framework. Progress was greater for the organizational and assessment phases of the MAPP-based work; only 10 CHDs had identified strategic priorities in 2007, and even fewer had implemented strategies for improving health. In 2007, the most frequently requested types of training were measuring success, developing goals and action plans, and using qualitative data; technical assistance was most frequently requested for program evaluation and writing community health status reports. Florida's CHDs have increased their capacity to conduct community health assessment and planning. Questions remain about sustaining these gains with limited resources.

  19. Leveraging electronic health records for clinical research.

    Science.gov (United States)

    Raman, Sudha R; Curtis, Lesley H; Temple, Robert; Andersson, Tomas; Ezekowitz, Justin; Ford, Ian; James, Stefan; Marsolo, Keith; Mirhaji, Parsa; Rocca, Mitra; Rothman, Russell L; Sethuraman, Barathi; Stockbridge, Norman; Terry, Sharon; Wasserman, Scott M; Peterson, Eric D; Hernandez, Adrian F

    2018-04-30

    Electronic health records (EHRs) can be a major tool in the quest to decrease costs and timelines of clinical trial research, generate better evidence for clinical decision making, and advance health care. Over the past decade, EHRs have increasingly offered opportunities to speed up, streamline, and enhance clinical research. EHRs offer a wide range of possible uses in clinical trials, including assisting with prestudy feasibility assessment, patient recruitment, and data capture in care delivery. To fully appreciate these opportunities, health care stakeholders must come together to face critical challenges in leveraging EHR data, including data quality/completeness, information security, stakeholder engagement, and increasing the scale of research infrastructure and related governance. Leaders from academia, government, industry, and professional societies representing patient, provider, researcher, industry, and regulator perspectives convened the Leveraging EHR for Clinical Research Now! Think Tank in Washington, DC (February 18-19, 2016), to identify barriers to using EHRs in clinical research and to generate potential solutions. Think tank members identified a broad range of issues surrounding the use of EHRs in research and proposed a variety of solutions. Recognizing the challenges, the participants identified the urgent need to look more deeply at previous efforts to use these data, share lessons learned, and develop a multidisciplinary agenda for best practices for using EHRs in clinical research. We report the proceedings from this think tank meeting in the following paper. Copyright © 2018 Elsevier, Inc. All rights reserved.

  20. The Canadian Geospatial Data Infrastructure and health mapping

    DEFF Research Database (Denmark)

    Gao, Sheng; Mioc, Darka; Yi, Xiaolun

    2008-01-01

    such as emergency management, public health, disaster relief, environmental impact assessment, transportation, and land information systems. In this paper, our aims are to use the CGDI and to identify its usability in supporting online health mapping. To identify the usability of the CGDI for health mapping, we...

  1. An open, component-based information infrastructure for integrated health information networks.

    Science.gov (United States)

    Tsiknakis, Manolis; Katehakis, Dimitrios G; Orphanoudakis, Stelios C

    2002-12-18

    A fundamental requirement for achieving continuity of care is the seamless sharing of multimedia clinical information. Different technological approaches can be adopted for enabling the communication and sharing of health record segments. In the context of the emerging global information society, the creation of and access to the integrated electronic health record (I-EHR) of a citizen has been assigned high priority in many countries. This requirement is complementary to an overall requirement for the creation of a health information infrastructure (HII) to support the provision of a variety of health telematics and e-health services. In developing a regional or national HII, the components or building blocks that make up the overall information system ought to be defined and an appropriate component architecture specified. This paper discusses current international priorities and trends in developing the HII. It presents technological challenges and alternative approaches towards the creation of an I-EHR, being the aggregation of health data created during all interactions of an individual with the healthcare system. It also presents results from an ongoing Research and Development (R&D) effort towards the implementation of the HII in HYGEIAnet, the regional health information network of Crete, Greece, using a component-based software engineering approach. Critical design decisions and related trade-offs, involved in the process of component specification and development, are also discussed and the current state of development of an I-EHR service is presented. Finally, Human Computer Interaction (HCI) and security issues, which are important for the deployment and use of any I-EHR service, are considered.

  2. The impact of green stormwater infrastructure installation on surrounding health and safety

    Science.gov (United States)

    Michelle C. Kondo; Sarah C. Low; Jason Henning; Charles C. Branas

    2015-01-01

    We investigated the health and safety effects of urban green stormwater infrastructure (GSI) installments. We conducted a difference-in-differences analysis of the effects of GSI installments on health (e.g., blood pressure, cholesterol and stress levels) and safety (e.g., felonies, nuisance and property crimes, narcotics crimes) outcomes from 2000 to 2012 in...

  3. Regional Disparities in Romania. Contribution of the Regional Operational Program to Health Infrastructure

    Directory of Open Access Journals (Sweden)

    VICTOR PLATON

    2013-01-01

    Full Text Available Health infrastructure is one of the weaknesses of socio-economic development in Romania and in other European states. In order to get a better picture of the Romanian health system issues, this paper analyzes a number of statistical indicators considered representative for the national and European health infrastructure for a 20 years period, between 1990 and 2010. Our paper has three main objectives: (a to identify the main trends for health infrastructure in some of the European Union countries; (b to describe the evolution of the health system in Romania, the comparative situation at the European level as well as regional level indicators dynamics; (c to overview the Regional Operational Program in Romania, how much does it help the regional health infrastructure in our country. At the European level, there is a constant decrease in the number of hospital beds. For this indicator, Romania has slightly higher values than the European average. We must mention that the hospital beds indicator offers limited information on health infrastructure which also includes medical equipment and specific devices and practices. The number of hospitals in Romania increased with 18.9% during the last 20 years (1990-2010. During the observed timeline, the number of hospitals in Romania had a constant positive evolution at regional level. The number of doctors in hospitals has an increasing trend at the local as well as at the international level. Romania has a number of doctors twice lower than the European average (3.6 doctors for one thousand inhabitants. The Regional Operational Program (ROP has a limited influence in achieving the objectives stated in Applicants Guide for Priority Axis 3. Major Intervention Area 3.1. This happens because supporting infrastructure improvements will not create institutional modernization. The financial contribution through ROP will result in the modernization of 11% of the existing hospitals in Romania.

  4. Infrastructures for systems medicine in Iran’s health roadmap

    Directory of Open Access Journals (Sweden)

    Iraj Nabipour

    2014-11-01

    Full Text Available Background: Systems medicine denotes a paradigm shift in medicine that arising from fundamental thoughts in systems biology. Systems medicine looks at health and disease using systems approaches. Systems or holistic approaches to studying the complexities of disease, emerging measurement and visualization molecular technologies to exploring of patient data space, and new computational and mathematical tools are fundamentals for this revolution in medicine. Methods: In order to explore the scientific/technological key objectives for systems medicine in “Iran’s Scientific Map in the Health Sector”, the details of goals, policies and requisites of Iran’s Health Roadmap were compared with horizontal and vertical policies of “National Institutes of Health (NIH Roadmap for Medical Research in U.S.A”. Results: A great attention has been paid on information technology, networking, interdisciplinary approach, innovation and high- risk research in Iran’s Health Roadmap. However, areas of research such as biological pathways (including metabolomics and networks structural biology molecular libraries and imaging bioinformatics and computational biology and human genome have not been adequately addressed. Conclusion: In order to react to waves of systems medicine, as a megatrend in health, Iran’s Scientific Map in the Health Sector should be synthesized to paradigm shift of emerging technologies in biomedicine. A framework for a broad interdisciplinary approach in biomedical research should be addressed to change medicine from reactive to proactive.

  5. A data infrastructure for the assessment of health care performance: lessons from the BRIDGE-health project.

    Science.gov (United States)

    Bernal-Delgado, Enrique; Estupiñán-Romero, Francisco

    2018-01-01

    The integration of different administrative data sources from a number of European countries has been shown useful in the assessment of unwarranted variations in health care performance. This essay describes the procedures used to set up a data infrastructure (e.g., data access and exchange, definition of the minimum common wealth of data required, and the development of the relational logic data model) and, the methods to produce trustworthy healthcare performance measurements (e.g., ontologies standardisation and quality assurance analysis). The paper ends providing some hints on how to use these lessons in an eventual European infrastructure on public health research and monitoring. Although the relational data infrastructure developed has been proven accurate, effective to compare health system performance across different countries, and efficient enough to deal with hundred of millions of episodes, the logic data model might not be responsive if the European infrastructure aims at including electronic health records and carrying out multi-cohort multi-intervention comparative effectiveness research. The deployment of a distributed infrastructure based on semantic interoperability, where individual data remain in-country and open-access scripts for data management and analysis travel around the hubs composing the infrastructure, might be a sensible way forward.

  6. Rigorous Clinical Trial Design in Public Health Emergencies Is Essential

    DEFF Research Database (Denmark)

    Ellenberg, Susan S; Keusch, Gerald T; Babiker, Abdel G

    2018-01-01

    Randomized clinical trials are the most reliable approaches to evaluating the effects of new treatments and vaccines. During the 2014-15 West African Ebola epidemic, many argued that such trials were neither ethical nor feasible in an environment of limited health infrastructure and severe disease...

  7. Clinic Health Awareness Program Subsystem -

    Data.gov (United States)

    Department of Transportation — Clinic Health Awareness Program Subystem (CHAPS) is a comprehensive system for recording, reporting, and analyzing a patient’s medical information and managing an...

  8. National health information infrastructure model: a milestone for health information management education realignment.

    Science.gov (United States)

    Meidani, Zahra; Sadoughi, Farhnaz; Ahmadi, Maryam; Maleki, Mohammad Reza; Zohoor, Alireza; Saddik, Basema

    2012-01-01

    Challenges and drawbacks of the health information management (HIM) curriculum at the Master's degree were examined, including lack of well-established computing sciences and inadequacy to give rise to specific competencies. Information management was condensed to the hospital setting to intensify the indispensability of a well-organized educational campaign. The healthcare information dimensions of a national health information infrastructure (NHII) model present novel requirements for HIM education. Articles related to challenges and barriers to adoption of the personal health record (PHR), the core component of personal health dimension of an NHII, were searched through sources including Science Direct, ProQuest, and PubMed. Through a literature review, concerns about the PHR that are associated with HIM functions and responsibilities were extracted. In the community/public health dimension of the NHII the main components have been specified, and the targeted information was gathered through literature review, e-mail, and navigation of international and national organizations. Again, topics related to HIM were evoked. Using an information system (decision support system, artificial neural network, etc.) to support PHR media and content, patient education, patient-HIM communication skills, consumer health information, conducting a surveillance system in other areas of healthcare such as a risk factor surveillance system, occupational health, using an information system to analyze aggregated data including a geographic information system, data mining, online analytical processing, public health vocabulary and classification system, and emerging automated coding systems pose major knowledge gaps in HIM education. Combining all required skills and expertise to handle personal and public dimensions of healthcare information in a single curriculum is simply impractical. Role expansion and role extension for HIM professionals should be defined based on the essence of

  9. Achievable steps toward building a National Health Information infrastructure in the United States.

    Science.gov (United States)

    Stead, William W; Kelly, Brian J; Kolodner, Robert M

    2005-01-01

    Consensus is growing that a health care information and communication infrastructure is one key to fixing the crisis in the United States in health care quality, cost, and access. The National Health Information Infrastructure (NHII) is an initiative of the Department of Health and Human Services receiving bipartisan support. There are many possible courses toward its objective. Decision makers need to reflect carefully on which approaches are likely to work on a large enough scale to have the intended beneficial national impacts and which are better left to smaller projects within the boundaries of health care organizations. This report provides a primer for use by informatics professionals as they explain aspects of that dividing line to policy makers and to health care leaders and front-line providers. It then identifies short-term, intermediate, and long-term steps that might be taken by the NHII initiative.

  10. Clinical investigations for SUS, the Brazilian public health system.

    Science.gov (United States)

    Paula, Ana Patrícia de; Giozza, Silvana Pereira; Pereira, Michelle Zanon; Boaventura, Patrícia Souza; Santos, Leonor Maria Pacheco; Sachetti, Camile Giaretta; Tamayo, César Omar Carranza; Kowalski, Clarissa Campos Guaragna; Elias, Flavia Tavares Silva; Serruya, Suzanne Jacob; Guimarães, Reinaldo

    2012-01-01

    Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa), especially with regard to establishing a National Clinical Research Network. The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.

  11. Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy.

    Science.gov (United States)

    Driessen, A; Schäfer, N; Albrecht, V; Schenk, M; Fröhlich, M; Stürmer, E K; Maegele, M

    2015-08-01

    Early detection and management of post-traumatic haemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructures, logistics and clinical strategies may differ. To assess local differences in infrastructure, logistics and clinical management of trauma-associated haemorrhage and coagulopathy, we have conducted a web-based survey amongst the delegates to the 15th European Congress of Trauma and Emergency Surgery (ECTES) and the 2nd World Trauma (WT) Congress held in Frankfurt, Germany, 25-27 May 2014. 446/1,540 delegates completed the questionnaire yielding a response rate of 29%. The majority specified to work as consultants/senior physicians (47.3%) in general (36.1%) or trauma/orthopaedic surgery (44.5%) of level I (70%) or level II (19%) trauma centres. Clinical assessment (>80%) and standard coagulation assays (74.6%) are the most frequently used strategies for early detection and monitoring of bleeding trauma patients with coagulopathy. Only 30% of the respondents declared to use extended coagulation assays to better characterise the bleeding and coagulopathy prompted by more individualised treatment concepts. Most trauma centres (69%) have implemented local protocols based on international and national guidelines using conventional blood products, e.g. packed red blood cell concentrates (93.3%), fresh frozen plasma concentrates (93.3%) and platelet concentrates (83%), and antifibrinolytics (100%). 89% considered the continuous intake of anticoagulants including "new oral anticoagulants" and platelet inhibitors as an increasing threat to bleeding trauma patients. This study confirms differences in infrastructure, logistics and clinical practice for the detection and management of trauma-haemorrhage and trauma-associated coagulopathy amongst international centres. Ongoing work will focus on geographical differences.

  12. A knowledge infrastructure for occupational safety and health.

    NARCIS (Netherlands)

    van Dijk, Frank J. H.; Verbeek, J. H.; Hoving, J. L.; Hulshof, C. T.

    2010-01-01

    Occupational Safety and Health (OSH) professionals should use scientific evidence to support their decisions in policy and practice. Although examples from practice show that progress has been made in evidence-based decision making, there is a challenge to improve and extend the facilities that

  13. Infrastructures for systems medicine in Iran’s health roadmap

    OpenAIRE

    Iraj Nabipour; Majid Assadi

    2014-01-01

    Background: Systems medicine denotes a paradigm shift in medicine that arising from fundamental thoughts in systems biology. Systems medicine looks at health and disease using systems approaches. Systems or holistic approaches to studying the complexities of disease, emerging measurement and visualization molecular technologies to exploring of patient data space, and new computational and mathematical tools are fundamentals for this revolution in medicine. Methods: In order to explore the sci...

  14. Health Impacts of Increased Physical Activity from Changes in Transportation Infrastructure: Quantitative Estimates for Three Communities

    Science.gov (United States)

    2015-01-01

    Recently, two quantitative tools have emerged for predicting the health impacts of projects that change population physical activity: the Health Economic Assessment Tool (HEAT) and Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA). HEAT has been used to support health impact assessments of transportation infrastructure projects, but DYNAMO-HIA has not been previously employed for this purpose nor have the two tools been compared. To demonstrate the use of DYNAMO-HIA for supporting health impact assessments of transportation infrastructure projects, we employed the model in three communities (urban, suburban, and rural) in North Carolina. We also compared DYNAMO-HIA and HEAT predictions in the urban community. Using DYNAMO-HIA, we estimated benefit-cost ratios of 20.2 (95% C.I.: 8.7–30.6), 0.6 (0.3–0.9), and 4.7 (2.1–7.1) for the urban, suburban, and rural projects, respectively. For a 40-year time period, the HEAT predictions of deaths avoided by the urban infrastructure project were three times as high as DYNAMO-HIA's predictions due to HEAT's inability to account for changing population health characteristics over time. Quantitative health impact assessment coupled with economic valuation is a powerful tool for integrating health considerations into transportation decision-making. However, to avoid overestimating benefits, such quantitative HIAs should use dynamic, rather than static, approaches. PMID:26504832

  15. Whole genome sequencing in clinical and public health microbiology.

    Science.gov (United States)

    Kwong, J C; McCallum, N; Sintchenko, V; Howden, B P

    2015-04-01

    Genomics and whole genome sequencing (WGS) have the capacity to greatly enhance knowledge and understanding of infectious diseases and clinical microbiology.The growth and availability of bench-top WGS analysers has facilitated the feasibility of genomics in clinical and public health microbiology.Given current resource and infrastructure limitations, WGS is most applicable to use in public health laboratories, reference laboratories, and hospital infection control-affiliated laboratories.As WGS represents the pinnacle for strain characterisation and epidemiological analyses, it is likely to replace traditional typing methods, resistance gene detection and other sequence-based investigations (e.g., 16S rDNA PCR) in the near future.Although genomic technologies are rapidly evolving, widespread implementation in clinical and public health microbiology laboratories is limited by the need for effective semi-automated pipelines, standardised quality control and data interpretation, bioinformatics expertise, and infrastructure.

  16. The israeli virtual national health record: a robust national health information infrastructure based on a firm foundation of trust.

    Science.gov (United States)

    Saiag, Esther

    2005-01-01

    In many developed countries, a coordinated effort is underway to build national and regional Health Information Infrastructures (HII) for the linking of disparate sites of care, so that an access to a comprehensive Health Record will be feasible when critical medical decisions are made [1]. However, widespread adoption of such national projects is hindered by a series of barriers- regulatory, technical, financial and cultural. Above all, a robust national HII requires a firm foundation of trust: patients must be assured that their confidential health information will not be misused and that there are adequate legal remedies in the event of inappropriate behavior on the part of either authorized or unauthorized parties[2].The Israeli evolving National HII is an innovative state of the art implementation of a wide-range clinical inter-organizational data exchange, based on a unique concept of virtually temporary sharing of information. A logically connection of multiple caregivers and medical organizations creates a patient-centric virtual repository, without centralization. All information remains in its original format, location, system and ownership. On demand, relevant information is instantly integrated and delivered to the point of care. This system, successfully covering more than half of Israel's population, is currently evolving from a voluntary private-public partnership (dbMOTION and CLALIT HMO) to a formal national reality. The governmental leadership, now taking over the process, is essential to achieve a full potential of the health information technology. All partners of the Israeli health system are coordinated in concert with each other, driven with a shared vision - realizing that a secured, private, confidential health information exchange is assured.

  17. 'Two clicks and I'm in!' Patients as co-actors in managing health data through a personal health record infrastructure.

    Science.gov (United States)

    Zanutto, Alberto

    2017-06-01

    One of the most significant changes in the healthcare field in the past 10 years has been the large-scale digitalization of patients' healthcare data, and an increasing emphasis on the importance of patients' roles in cooperating with healthcare professionals through digital infrastructures. A project carried out in the North of Italy with the aim of creating a personal health record has been evaluated over the course of 5 years by means of mixed method fieldwork. Two years after the infrastructure was put into regular service, the way in which patients are represented in the system and patient practices have been studied using surveys and qualitative interviews. The data show that, first, patients have become co-actors in describing their clinical histories; second, that they have become co-actors in the diagnosis process; and finally, they have become co-actors in the management of time and space as regards their specific state of health.

  18. Integration in primary community care networks (PCCNs: examination of governance, clinical, marketing, financial, and information infrastructures in a national demonstration project in Taiwan

    Directory of Open Access Journals (Sweden)

    Lin Blossom Yen-Ju

    2007-06-01

    Full Text Available Abstract Background Taiwan's primary community care network (PCCN demonstration project, funded by the Bureau of National Health Insurance on March 2003, was established to discourage hospital shopping behavior of people and drive the traditional fragmented health care providers into cooperate care models. Between 2003 and 2005, 268 PCCNs were established. This study profiled the individual members in the PCCNs to study the nature and extent to which their network infrastructures have been integrated among the members (clinics and hospitals within individual PCCNs. Methods The thorough questionnaire items, covering the network working infrastructures – governance, clinical, marketing, financial, and information integration in PCCNs, were developed with validity and reliability confirmed. One thousand five hundred and fifty-seven clinics that had belonged to PCCNs for more than one year, based on the 2003–2005 Taiwan Primary Community Care Network List, were surveyed by mail. Nine hundred and twenty-eight clinic members responded to the surveys giving a 59.6 % response rate. Results Overall, the PCCNs' members had higher involvement in the governance infrastructure, which was usually viewed as the most important for establishment of core values in PCCNs' organization design and management at the early integration stage. In addition, it found that there existed a higher extent of integration of clinical, marketing, and information infrastructures among the hospital-clinic member relationship than those among clinic members within individual PCCNs. The financial infrastructure was shown the least integrated relative to other functional infrastructures at the early stage of PCCN formation. Conclusion There was still room for better integrated partnerships, as evidenced by the great variety of relationships and differences in extent of integration in this study. In addition to provide how the network members have done for their initial work at

  19. Education as eHealth Infrastructure: Considerations in Advancing a National Agenda for eHealth

    Science.gov (United States)

    Hilberts, Sonya; Gray, Kathleen

    2014-01-01

    This paper explores the role of education as infrastructure in large-scale ehealth strategies--in theory, in international practice and in one national case study. Education is often invisible in the documentation of ehealth infrastructure. Nevertheless a review of international practice shows that there is significant educational investment made…

  20. Evaluating a Proof-of-Concept Approach of the German Health Telematics Infrastructure in the Context of Discharge Management.

    Science.gov (United States)

    Hübner, Ursula; Schulte, Georg; Sellemann, Björn; Quade, Matthias; Rottmann, Thorsten; Fenske, Matthias; Egbert, Nicole; Kuhlisch, Raik; Rienhoff, Otto

    2015-01-01

    Although national eHealth strategies have existed now for more than a decade in many countries, they have been implemented with varying success. In Germany, the eHealth strategy so far has resulted in a roll out of electronic health cards for all citizens in the statutory health insurance, but in no clinically meaningful IT-applications. The aim of this study was to test the technical and organisation feasibility, usability, and utility of an eDischarge application embedded into a laboratory Health Telematics Infrastructure (TI). The tests embraced the exchange of eDischarge summaries based on the multiprofessional HL7 eNursing Summary standard between a municipal hospital and a nursing home. All in all, 36 transmissions of electronic discharge documents took place. They demonstrated the technical-organisation feasibility and resulted in moderate usability ratings. A comparison between eDischarge and paper-based summaries hinted at higher ratings of utility and information completeness for eDischarges. Despite problems with handling the electronic health card, the proof-of-concept for the first clinically meaningful IT-application in the German Health TI could be regarded as successful.

  1. Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy

    DEFF Research Database (Denmark)

    Driessen, Annemariek; Schäfer, N; Albrecht, V

    2015-01-01

    of trauma-associated haemorrhage and coagulopathy, we have conducted a web-based survey amongst the delegates to the 15th European Congress of Trauma and Emergency Surgery (ECTES) and the 2nd World Trauma (WT) Congress held in Frankfurt, Germany, 25-27 May 2014. RESULTS: 446/1,540 delegates completed...... frequently used strategies for early detection and monitoring of bleeding trauma patients with coagulopathy. Only 30% of the respondents declared to use extended coagulation assays to better characterise the bleeding and coagulopathy prompted by more individualised treatment concepts. Most trauma centres (69...... intake of anticoagulants including "new oral anticoagulants" and platelet inhibitors as an increasing threat to bleeding trauma patients. CONCLUSIONS: This study confirms differences in infrastructure, logistics and clinical practice for the detection and management of trauma-haemorrhage and trauma...

  2. Essential levels of health information in Europe: an action plan for a coherent and sustainable infrastructure.

    Science.gov (United States)

    Carinci, Fabrizio

    2015-04-01

    The European Union needs a common health information infrastructure to support policy and governance on a routine basis. A stream of initiatives conducted in Europe during the last decade resulted into several success stories, but did not specify a unified framework that could be broadly implemented on a continental level. The recent debate raised a potential controversy on the different roles and responsibilities of policy makers vs the public health community in the construction of such a pan-European health information system. While institutional bodies shall clarify the statutory conditions under which such an endeavour is to be carried out, researchers should define a common framework for optimal cross-border information exchange. This paper conceptualizes a general solution emerging from past experiences, introducing a governance structure and overarching framework that can be realized through four main action lines, underpinned by the key principle of "Essential Levels of Health Information" for Europe. The proposed information model is amenable to be applied in a consistent manner at both national and EU level. If realized, the four action lines outlined here will allow developing a EU health information infrastructure that would effectively integrate best practices emerging from EU public health initiatives, including projects and joint actions carried out during the last ten years. The proposed approach adds new content to the ongoing debate on the future activity of the European Commission in the area of health information. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Modifying the Clinical Research Infrastructure at a Dedicated Clinical Trials Unit: Assessment of Trial Development, Activation, and Participant Accrual.

    Science.gov (United States)

    Tang, Chad; Hess, Kenneth R; Sanders, Dwana; Davis, Suzanne E; Buzdar, Aman U; Kurzrock, Razelle; Lee, J Jack; Meric-Bernstam, Funda; Hong, David S

    2017-03-15

    Purpose: Information on processes for trials assessing investigational therapeutics is sparse. We assessed the trial development processes within the Department of Investigational Cancer Therapeutics (ICT) at MD Anderson Cancer Center (Houston, TX) and analyzed their effects on the trial activation timeline and enrolment. Experimental Design: Data were from a prospectively maintained registry that tracks all clinical studies at MD Anderson. From this database, we identified 2,261 activated phase I-III trials; 221 were done at the ICT. ICT trials were matched to trials from other MD Anderson departments by phase, sponsorship, and submission year. Trial performance metrics were compared with paired Wilcoxon signed rank tests. Results: We identified three facets of the ICT research infrastructure: parallel processing of trial approval steps; a physician-led research team; and regular weekly meetings to foster research accountability. Separate analyses were conducted stratified by sponsorship [industry (133 ICT and 133 non-ICT trials) or institutional (68 ICT and 68 non-ICT trials)]. ICT trial development was faster from IRB approval to activation (median difference of 1.1 months for industry-sponsored trials vs. 2.3 months for institutional) and from activation to first enrolment (median difference of 0.3 months for industry vs. 1.2 months for institutional; all matched P infrastructure within a large academic cancer center was associated with efficient trial development and participant accrual. Clin Cancer Res; 23(6); 1407-13. ©2016 AACR . ©2016 American Association for Cancer Research.

  4. Using business intelligence to analyze and share health system infrastructure data in a rural health authority.

    Science.gov (United States)

    Haque, Waqar; Urquhart, Bonnie; Berg, Emery; Dhanoa, Ramandeep

    2014-08-06

    Health care organizations gather large volumes of data, which has been traditionally stored in legacy formats making it difficult to analyze or use effectively. Though recent government-funded initiatives have improved the situation, the quality of most existing data is poor, suffers from inconsistencies, and lacks integrity. Generating reports from such data is generally not considered feasible due to extensive labor, lack of reliability, and time constraints. Advanced data analytics is one way of extracting useful information from such data. The intent of this study was to propose how Business Intelligence (BI) techniques can be applied to health system infrastructure data in order to make this information more accessible and comprehensible for a broader group of people. An integration process was developed to cleanse and integrate data from disparate sources into a data warehouse. An Online Analytical Processing (OLAP) cube was then built to allow slicing along multiple dimensions determined by various key performance indicators (KPIs), representing population and patient profiles, case mix groups, and healthy community indicators. The use of mapping tools, customized shape files, and embedded objects further augment the navigation. Finally, Web forms provide a mechanism for remote uploading of data and transparent processing of the cube. For privileged information, access controls were implemented. Data visualization has eliminated tedious analysis through legacy reports and provided a mechanism for optimally aligning resources with needs. Stakeholders are able to visualize KPIs on a main dashboard, slice-and-dice data, generate ad hoc reports, and quickly find the desired information. In addition, comparison, availability, and service level reports can also be generated on demand. All reports can be drilled down for navigation at a finer granularity. We have demonstrated how BI techniques and tools can be used in the health care environment to make informed

  5. A Disability and Health Institutional Research Capacity Building and Infrastructure Model Evaluation: A Tribal College-Based Case Study

    Science.gov (United States)

    Moore, Corey L.; Manyibe, Edward O.; Sanders, Perry; Aref, Fariborz; Washington, Andre L.; Robertson, Cherjuan Y.

    2017-01-01

    Purpose: The purpose of this multimethod study was to evaluate the institutional research capacity building and infrastructure model (IRCBIM), an emerging innovative and integrated approach designed to build, strengthen, and sustain adequate disability and health research capacity (i.e., research infrastructure and investigators' research skills)…

  6. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN)

    DEFF Research Database (Denmark)

    Kubiak, Christine; de Andres-Trelles, Fernando; Kuchinke, Wolfgang

    2009-01-01

    in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN) developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching...... with cell therapy, etc.); diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.); and epidemiology studies. Our classification...

  7. Structural Health Monitoring of Civil Infrastructure Using Optical Fiber Sensing Technology: A Comprehensive Review

    Science.gov (United States)

    Ye, X. W.; Su, Y. H.; Han, J. P.

    2014-01-01

    In the last two decades, a significant number of innovative sensing systems based on optical fiber sensors have been exploited in the engineering community due to their inherent distinctive advantages such as small size, light weight, immunity to electromagnetic interference (EMI) and corrosion, and embedding capability. A lot of optical fiber sensor-based monitoring systems have been developed for continuous measurement and real-time assessment of diversified engineering structures such as bridges, buildings, tunnels, pipelines, wind turbines, railway infrastructure, and geotechnical structures. The purpose of this review article is devoted to presenting a summary of the basic principles of various optical fiber sensors, innovation in sensing and computational methodologies, development of novel optical fiber sensors, and the practical application status of the optical fiber sensing technology in structural health monitoring (SHM) of civil infrastructure. PMID:25133250

  8. Structural health monitoring of civil infrastructure using optical fiber sensing technology: a comprehensive review.

    Science.gov (United States)

    Ye, X W; Su, Y H; Han, J P

    2014-01-01

    In the last two decades, a significant number of innovative sensing systems based on optical fiber sensors have been exploited in the engineering community due to their inherent distinctive advantages such as small size, light weight, immunity to electromagnetic interference (EMI) and corrosion, and embedding capability. A lot of optical fiber sensor-based monitoring systems have been developed for continuous measurement and real-time assessment of diversified engineering structures such as bridges, buildings, tunnels, pipelines, wind turbines, railway infrastructure, and geotechnical structures. The purpose of this review article is devoted to presenting a summary of the basic principles of various optical fiber sensors, innovation in sensing and computational methodologies, development of novel optical fiber sensors, and the practical application status of the optical fiber sensing technology in structural health monitoring (SHM) of civil infrastructure.

  9. Structural Health Monitoring of Civil Infrastructure Using Optical Fiber Sensing Technology: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    X. W. Ye

    2014-01-01

    Full Text Available In the last two decades, a significant number of innovative sensing systems based on optical fiber sensors have been exploited in the engineering community due to their inherent distinctive advantages such as small size, light weight, immunity to electromagnetic interference (EMI and corrosion, and embedding capability. A lot of optical fiber sensor-based monitoring systems have been developed for continuous measurement and real-time assessment of diversified engineering structures such as bridges, buildings, tunnels, pipelines, wind turbines, railway infrastructure, and geotechnical structures. The purpose of this review article is devoted to presenting a summary of the basic principles of various optical fiber sensors, innovation in sensing and computational methodologies, development of novel optical fiber sensors, and the practical application status of the optical fiber sensing technology in structural health monitoring (SHM of civil infrastructure.

  10. Mental health research in Brazil: policies, infrastructure, financing and human resources

    Directory of Open Access Journals (Sweden)

    Mari Jair de Jesus

    2006-01-01

    Full Text Available The objective of this descriptive study was to map mental health research in Brazil, providing an overview of infrastructure, financing and policies mental health research. As part of the Atlas-Research Project, a WHO initiative to map mental health research in selected low and middle-income countries, this study was carried out between 1998 and 2002. Data collection strategies included evaluation of governmental documents and sites and questionnaires sent to key professionals for providing information about the Brazilian mental health research infrastructure. In the year 2002, the total budget for Health Research was US$101 million, of which US$3.4 million (3.4 was available for Mental Health Research. The main funding sources for mental health research were found to be the São Paulo State Funding Agency (Fapesp, 53.2% and the Ministry of Education (CAPES, 30.2%. The rate of doctors is 1.7 per 1,000 inhabitants, and the rate of psychiatrists is 2.7 per 100,000 inhabitants estimated 2000 census. In 2002, there were 53 postgraduate courses directed to mental health training in Brazil (43 in psychology, six in psychiatry, three in psychobiology and one in psychiatric nursing, with 1,775 students being trained in Brazil and 67 overseas. There were nine programs including psychiatry, neuropsychiatry, psychobiology and mental health, seven of them implemented in Southern states. During the five-year period, 186 students got a doctoral degree (37 per year and 637 articles were published in Institute for Scientic Information (ISI-indexed journals. The investment channeled towards postgraduate and human resource education programs, by means of grants and other forms of research support, has secured the country a modest but continuous insertion in the international knowledge production in the mental health area.

  11. Infrastructural challenges to better health in maternity facilities in rural Kenya: community and healthworker perceptions.

    Science.gov (United States)

    Essendi, Hildah; Johnson, Fiifi Amoako; Madise, Nyovani; Matthews, Zoe; Falkingham, Jane; Bahaj, Abubakr S; James, Patrick; Blunden, Luke

    2015-11-09

    The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. However, in most rural communities in sub-Saharan, access to maternal and newborn care services is still limited and even where services are available they often lack the infrastructural prerequisites to function at the very basic level in providing essential routine health care services, let alone emergency care. Lists of essential interventions for normal and complicated childbirth, do not take into account these prerequisites, thus the needs of most health facilities in rural communities are ignored, although there is enough evidence that maternal and newborn deaths continue to remain unacceptably high in these areas. This study uses data gathered through qualitative interviews in Kitonyoni and Mwania sub-locations of Makueni County in Eastern Kenya to understand community and provider perceptions of the obstacles faced in providing and accessing maternal and newborn care at health facilities in their localities. The study finds that the community perceives various challenges, most of which are infrastructural, including lack of electricity, water and poor roads that adversely impact the provision and access to essential life-saving maternal and newborn care services in the two sub-locations. The findings and recommendations from this study are important for the attention of policy makers and programme managers in order to improve the state of lower-tier health facilities serving rural communities and to strengthen infrastructure with the aim of making basic routine and emergency obstetric and newborn care services more accessible.

  12. Infrastructure and distributed learning methodology for privacy-preserving multi-centric rapid learning health care: euroCAT

    Directory of Open Access Journals (Sweden)

    Timo M. Deist

    2017-06-01

    The euroCAT infrastructure has been successfully implemented in five radiation clinics across three countries. SVM models can be learned on data distributed over all five clinics. Furthermore, the infrastructure provides a general framework to execute learning algorithms on distributed data. The ongoing expansion of the euroCAT network will facilitate machine learning in radiation oncology. The resulting access to larger datasets with sufficient variation will pave the way for generalizable prediction models and personalized medicine.

  13. Clinical investigations for SUS, the Brazilian public health system

    Directory of Open Access Journals (Sweden)

    Ana Patrícia de Paula

    Full Text Available CONTEXT AND OBJECTIVE: Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. DESIGN AND SETTING: Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. METHODS: The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. RESULTS: The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa, especially with regard to establishing a National Clinical Research Network. CONCLUSION: The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.

  14. Including Health in Environmental Assessments of Major Transport Infrastructure Projects: A Documentary Analysis.

    Science.gov (United States)

    Riley, Emily; Harris, Patrick; Kent, Jennifer; Sainsbury, Peter; Lane, Anna; Baum, Fran

    2018-05-10

    Transport policy and practice impacts health. Environmental Impact Assessments (EIAs) are regulated public policy mechanisms that can be used to consider the health impacts of major transport projects before they are approved. The way health is considered in these environmental assessments (EAs) is not well known. This research asked: How and to what extent was human health considered in EAs of four major transport projects in Australia. We developed a comprehensive coding framework to analyse the Environmental Impact Statements (EISs) of four transport infrastructure projects: three road and one light rail. The coding framework was designed to capture how health was directly and indirectly included. We found that health was partially considered in all four EISs. In the three New South Wales (NSW) projects, but not the one South Australian project, this was influenced by the requirements issued to proponents by the government which directed the content of the EIS. Health was assessed using human health risk assessment (HHRA). We found this to be narrow in focus and revealed a need for a broader social determinants of health approach, using multiple methods. The road assessments emphasised air quality and noise risks, concluding these were minimal or predicted to improve. The South Australian project was the only road project not to include health data explicitly. The light rail EIS considered the health benefits of the project whereas the others focused on risk. Only one project considered mental health, although in less detail than air quality or noise. Our findings suggest EIAs lag behind the known evidence linking transport infrastructure to health. If health is to be comprehensively included, a more complete model of health is required, as well as a shift away from health risk assessment as the main method used. This needs to be mandatory for all significant developments. We also found that considering health only at the EIA stage may be a significant

  15. Integrating Urban Infrastructure and Health System Impact Modeling for Disasters and Mass-Casualty Events

    Science.gov (United States)

    Balbus, J. M.; Kirsch, T.; Mitrani-Reiser, J.

    2017-12-01

    Over recent decades, natural disasters and mass-casualty events in United States have repeatedly revealed the serious consequences of health care facility vulnerability and the subsequent ability to deliver care for the affected people. Advances in predictive modeling and vulnerability assessment for health care facility failure, integrated infrastructure, and extreme weather events have now enabled a more rigorous scientific approach to evaluating health care system vulnerability and assessing impacts of natural and human disasters as well as the value of specific interventions. Concurrent advances in computing capacity also allow, for the first time, full integration of these multiple individual models, along with the modeling of population behaviors and mass casualty responses during a disaster. A team of federal and academic investigators led by the National Center for Disaster Medicine and Public Health (NCDMPH) is develoing a platform for integrating extreme event forecasts, health risk/impact assessment and population simulations, critical infrastructure (electrical, water, transportation, communication) impact and response models, health care facility-specific vulnerability and failure assessments, and health system/patient flow responses. The integration of these models is intended to develop much greater understanding of critical tipping points in the vulnerability of health systems during natural and human disasters and build an evidence base for specific interventions. Development of such a modeling platform will greatly facilitate the assessment of potential concurrent or sequential catastrophic events, such as a terrorism act following a severe heat wave or hurricane. This presentation will highlight the development of this modeling platform as well as applications not just for the US health system, but also for international science-based disaster risk reduction efforts, such as the Sendai Framework and the WHO SMART hospital project.

  16. Secure Secondary Use of Clinical Data with Cloud-based NLP Services. Towards a Highly Scalable Research Infrastructure.

    Science.gov (United States)

    Christoph, J; Griebel, L; Leb, I; Engel, I; Köpcke, F; Toddenroth, D; Prokosch, H-U; Laufer, J; Marquardt, K; Sedlmayr, M

    2015-01-01

    The secondary use of clinical data provides large opportunities for clinical and translational research as well as quality assurance projects. For such purposes, it is necessary to provide a flexible and scalable infrastructure that is compliant with privacy requirements. The major goals of the cloud4health project are to define such an architecture, to implement a technical prototype that fulfills these requirements and to evaluate it with three use cases. The architecture provides components for multiple data provider sites such as hospitals to extract free text as well as structured data from local sources and de-identify such data for further anonymous or pseudonymous processing. Free text documentation is analyzed and transformed into structured information by text-mining services, which are provided within a cloud-computing environment. Thus, newly gained annotations can be integrated along with the already available structured data items and the resulting data sets can be uploaded to a central study portal for further analysis. Based on the architecture design, a prototype has been implemented and is under evaluation in three clinical use cases. Data from several hundred patients provided by a University Hospital and a private hospital chain have already been processed. Cloud4health has shown how existing components for secondary use of structured data can be complemented with text-mining in a privacy compliant manner. The cloud-computing paradigm allows a flexible and dynamically adaptable service provision that facilitates the adoption of services by data providers without own investments in respective hardware resources and software tools.

  17. Using tracking infrastructure to support public health programs, policies, and emergency response in New York City.

    Science.gov (United States)

    Jeffery, Nancy Loder; McKelvey, Wendy; Matte, Thomas

    2015-01-01

    To describe how the New York City (NYC) Tracking Program has used nationally mandated Secure Portal infrastructure and staff analytical expertise to support programs and inform policy. The NYC Health Department assesses, investigates, and acts on a wide range of environmental concerns to protect the health of New Yorkers. Specific examples of highly effective policies or initiatives that relied on the NYC Tracking Program are described, including restaurant sanitary grade posting, rat indexing, converting boilers to cleaner-burning fuels, reducing exposure to mercury from fish and contaminated products, and responding to Superstorm Sandy. The NYC Tracking Program supports the Health Department in using inspectional, administrative, and health data to guide operations. Tracking has also allowed internal and external partners to use these data to guide policy development.

  18. Support infrastructure available to Canadian residents completing post-graduate global health electives: current state and future directions

    Directory of Open Access Journals (Sweden)

    Lojan Sivakumaran

    2016-12-01

    Conclusion: Canadian universities are encouraged to continue to send their trainees on global health electives. To address the gaps in infrastructure reported in this study, the authors suggest the development of comprehensive standardized guidelines by post-graduate regulatory/advocacy bodies to better ensure patient and participant safety. We also encourage the centralization of infrastructure management to the universities’ global health departments to aid in resource management.

  19. Real-time health monitoring of civil infrastructure systems in Colombia

    Science.gov (United States)

    Thomson, Peter; Marulanda Casas, Johannio; Marulanda Arbelaez, Johannio; Caicedo, Juan

    2001-08-01

    Colombia's topography, climatic conditions, intense seismic activity and acute social problems place high demands on the nations deteriorating civil infrastructure. Resources that are available for maintenance of the road and railway networks are often misdirected and actual inspection methods are limited to a visual examination. New techniques for inspection and evaluation of safety and serviceability of civil infrastructure, especially bridges, must be developed. Two cases of civil structures with health monitoring systems in Colombia are presented in this paper. Construction of the Pereria-Dos Quebradas Viaduct was completed in 1997 with a total cost of 58 million dollars, including 1.5 million dollars in health monitoring instrumentation provided and installed by foreign companies. This health monitoring system is not yet fully operational due to the lack of training of national personnel in system operation and extremely limited technical documentation. In contrast to the Pereria-Dos Quebradas Viaduct monitoring system, the authors have proposed a relatively low cost health monitoring system via telemetry. This system has been implemented for real-time monitoring of accelerations of El Hormiguero Bridge spanning the Cauca River using the Colombian Southwest Earthquake Observatory telemetry systems. This two span metallic bridge, located along a critical road between the cities of Puerto Tejada and Cali in the Cauca Valley, was constructed approximately 50 years ago. Experiences with this system demonstrate how effective low cost systems can be used to remotely monitor the structural integrity of deteriorating structures that are continuously subject to high loading conditions.

  20. Standardized cardiovascular data for clinical research, registries, and patient care: a report from the Data Standards Workgroup of the National Cardiovascular Research Infrastructure project.

    Science.gov (United States)

    Anderson, H Vernon; Weintraub, William S; Radford, Martha J; Kremers, Mark S; Roe, Matthew T; Shaw, Richard E; Pinchotti, Dana M; Tcheng, James E

    2013-05-07

    Relatively little attention has been focused on standardization of data exchange in clinical research studies and patient care activities. Both are usually managed locally using separate and generally incompatible data systems at individual hospitals or clinics. In the past decade there have been nascent efforts to create data standards for clinical research and patient care data, and to some extent these are helpful in providing a degree of uniformity. Nonetheless, these data standards generally have not been converted into accepted computer-based language structures that could permit reliable data exchange across computer networks. The National Cardiovascular Research Infrastructure (NCRI) project was initiated with a major objective of creating a model framework for standard data exchange in all clinical research, clinical registry, and patient care environments, including all electronic health records. The goal is complete syntactic and semantic interoperability. A Data Standards Workgroup was established to create or identify and then harmonize clinical definitions for a base set of standardized cardiovascular data elements that could be used in this network infrastructure. Recognizing the need for continuity with prior efforts, the Workgroup examined existing data standards sources. A basic set of 353 elements was selected. The NCRI staff then collaborated with the 2 major technical standards organizations in health care, the Clinical Data Interchange Standards Consortium and Health Level Seven International, as well as with staff from the National Cancer Institute Enterprise Vocabulary Services. Modeling and mapping were performed to represent (instantiate) the data elements in appropriate technical computer language structures for endorsement as an accepted data standard for public access and use. Fully implemented, these elements will facilitate clinical research, registry reporting, administrative reporting and regulatory compliance, and patient care

  1. A Model for Sustainable Development of Child Mental Health Infrastructure in the LMIC World: Vietnam as a Case Example.

    Science.gov (United States)

    Weiss, Bahr; Ngo, Victoria Khanh; Dang, Hoang-Minh; Pollack, Amie; Trung, Lam T; Tran, Cong V; Tran, Nam T; Sang, David; Do, Khanh N

    2012-01-01

    Children and adolescents are among the highest need populations in regards to mental health support, especially in low and middle income countries (LMIC). Yet resources in LMIC for prevention and treatment of mental health problems are limited, in particular for children and adolescents. In this paper, we discuss a model for development of child and adolescent mental health (CAMH) resources in LMIC that has guided a ten year initiative focused on development of CAMH treatment and research infrastructure in Vietnam. We first review the need for development of mental health resources for children and adolescents in general, and then in Vietnam. We next present the model that guided our program as it developed, focused on the twin Capacity Development Goals of efficacy and sustainability, and the Capacity Development Targets used to move towards these goals. Finally we discuss our CAMH development initiative in Vietnam, the center of which has been development of a graduate program in clinical psychology at Vietnam National University, linking program activities to this model.

  2. Slovene smart card and IP based health-care information system infrastructure.

    Science.gov (United States)

    Trcek, D; Novak, R; Kandus, G; Suselj, M

    2001-04-01

    Slovenia initiated a nation-wide project to introduce smart cards in the health sector in 1995 and its full-scale deployment started in September 2000. Although the basic aim of the project was to support insurance related procedures, the system was designed in a flexible and open manner to present an infrastructure for the whole health sector. The functionality of the current system is described in this paper along with lessons learned so far. The upgrade of the system is outlined, with emphasis on technical details, the objective being to provide a real-time EDI based environment for a general set of applications in the medical sector, supported by the flexibility and security of modern smart card technologies. Integration with similar systems in other EU countries is discussed.

  3. Enhancing Context Analysis with Intelligence in Providing e-Health Services: Less Infrastructure Dependency in Supporting Cardio-Vascular Patients

    OpenAIRE

    Verbraeck, A.; Widya, I.A.; Shishkov, Boris; Cordeiro, J.; Ranchordas, A.

    2009-01-01

    In Europe, we observe an increasing number of people with health problems, who could theoretically receive care outside of a hospital when their condition could be properly monitored. Not being able to provide this monitoring leads to an increasing pressure on an already overcrowded hospital system and increased costs. Ubiquitous technology on top of a high-quality IT infra-structure has already proven to be able to provide partial solutions. However, such infrastructure is not available thro...

  4. A Multidisciplinary Research Framework on Green Schools: Infrastructure, Social Environment, Occupant Health, and Performance.

    Science.gov (United States)

    Magzamen, Sheryl; Mayer, Adam P; Barr, Stephanie; Bohren, Lenora; Dunbar, Brian; Manning, Dale; Reynolds, Stephen J; Schaeffer, Joshua W; Suter, Jordan; Cross, Jennifer E

    2017-05-01

    Sustainable school buildings hold much promise to reducing operating costs, improve occupant well-being and, ultimately, teacher and student performance. However, there is a scarcity of evidence on the effects of sustainable school buildings on health and performance indicators. We sought to create a framework for a multidisciplinary research agenda that links school facilities, health, and educational outcomes. We conducted a nonsystematic review of peer review publications, government documents, organizational documents, and school climate measurement instruments. We found that studies on the impact of physical environmental factors (air, lighting, and thermal comfort) on health and occupant performance are largely independent of research on the social climate. The current literature precludes the formation of understanding the causal relation among school facilities, social climate, occupant health, and occupant performance. Given the average age of current school facilities in the United States, construction of new school facilities or retrofits of older facilities will be a major infrastructure investment for many municipalities over the next several decades. Multidisciplinary research that seeks to understand the impact of sustainable design on the health and performance of occupants will need to include both an environmental science and social science perspective to inform best practices and quantification of benefits that go beyond general measures of costs savings from energy efficiencies. © 2017, American School Health Association.

  5. Development of a structural health monitoring system for the life assessment of critical transportation infrastructure.

    Energy Technology Data Exchange (ETDEWEB)

    Roach, Dennis Patrick; Jauregui, David Villegas (New Mexico State University, Las Cruces, NM); Daumueller, Andrew Nicholas (New Mexico State University, Las Cruces, NM)

    2012-02-01

    Recent structural failures such as the I-35W Mississippi River Bridge in Minnesota have underscored the urgent need for improved methods and procedures for evaluating our aging transportation infrastructure. This research seeks to develop a basis for a Structural Health Monitoring (SHM) system to provide quantitative information related to the structural integrity of metallic structures to make appropriate management decisions and ensuring public safety. This research employs advanced structural analysis and nondestructive testing (NDT) methods for an accurate fatigue analysis. Metal railroad bridges in New Mexico will be the focus since many of these structures are over 100 years old and classified as fracture-critical. The term fracture-critical indicates that failure of a single component may result in complete collapse of the structure such as the one experienced by the I-35W Bridge. Failure may originate from sources such as loss of section due to corrosion or cracking caused by fatigue loading. Because standard inspection practice is primarily visual, these types of defects can go undetected due to oversight, lack of access to critical areas, or, in riveted members, hidden defects that are beneath fasteners or connection angles. Another issue is that it is difficult to determine the fatigue damage that a structure has experienced and the rate at which damage is accumulating due to uncertain history and load distribution in supporting members. A SHM system has several advantages that can overcome these limitations. SHM allows critical areas of the structure to be monitored more quantitatively under actual loading. The research needed to apply SHM to metallic structures was performed and a case study was carried out to show the potential of SHM-driven fatigue evaluation to assess the condition of critical transportation infrastructure and to guide inspectors to potential problem areas. This project combines the expertise in transportation infrastructure at New

  6. Health care capacity and allocations among South Africa's provinces: infrastructure-inequality traps after the end of apartheid.

    Science.gov (United States)

    Stuckler, David; Basu, Sanjay; McKee, Martin

    2011-01-01

    We assessed the determinants of health care funding allocations among South Africa's provinces and their effects on health care from 1996 through 2007. We performed multivariate regression of funding allocation data against measures of disease burden and health system infrastructure by province. Disease burden was increasingly negatively correlated with funding allocations and explained less than one quarter of the variation in allocations among provinces. Nearly three quarters of the variation in allocations was explained by preexisting hospital infrastructure and health care workers. The density of private hospitals in the preceding year was associated with greater government allocations (b(private) = 0.12; 95% confidence interval [CI] = 0.08, 0.15), but public hospital density in the preceding year was not (b(public) = 0.05; 95% CI = -0.02, 0.11). Greater allocations were associated with a higher number of doctors (b = 0.54; 95% CI = 0.34, 0.75) but fewer nurses (b = -0.37; 95% CI = -0.72,-0.25) in the same year. Regions with a greater capacity to spend funds received more funding and created more infrastructure than those with greater health needs. Historical infrastructure inequalities may have created an infrastructure-inequality trap, in which the distribution of funds to those with greater "absorptive capacity" exacerbates inequalities.

  7. The Mais Médicos (More Doctors) Program, the infrastructure of Primary Health Units and the Municipal Human Development Index.

    Science.gov (United States)

    Soares, Joaquim José; Machado, Maria Helena; Alves, Cecília Brito

    2016-09-01

    The main objective of this article was to examine the context in which professionals working within the Mais Médicos (More Doctors) Program operate. This study used the infrastructure scale of primary health units (PHUs), which was recently developed by Soares Neto and colleagues to provide more information regarding the relationship between the infrastructure of PHUs and the Municipal Human Development Index (MHDI) of municipalities that received Mais Médicos Program doctors. Using exploratory and inferential statistics, the article shows that 65.2% of the PHUs that received Mais Médicos Program doctors had medium-quality infrastructure and only 5.8% of them had low-quality infrastructure. The correlation of 0.50 between the infrastructure indicator and the MHDI points to a moderate tendency for municipalities with low MHDIs to have more precarious PHUs. Using multiple linear regression analysis it can be inferred that the main factor that contributed to the increase in the infrastructure indicator of the PHUs was the average municipal income. On the other hand, the factor that negatively affected the infrastructure of the PHUs was being located in the north or northeast regions.

  8. Outcomes of an investment in administrative data infrastructure: An example of capacity building at the Manitoba Centre for Health Policy.

    Science.gov (United States)

    Orr, Justine; Smith, Mark; Burchill, Charles; Katz, Alan; Fransoo, Randy

    2016-12-27

    Using the Manitoba Centre for Health Policy as an example, this commentary discusses how even small investments in population health data can create a multitude of research benefits. The authors highlight that through infrastructure development such as acquiring databases, facilitating access to data and developing data management practices, new, innovative research can be achieved at relatively low cost.

  9. Sustainable Water Infrastructure

    Science.gov (United States)

    Resources for state and local environmental and public health officials, and water, infrastructure and utility professionals to learn about sustainable water infrastructure, sustainable water and energy practices, and their role.

  10. Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Boulos Maged

    2004-01-01

    Full Text Available Abstract The term "Geographic Information Systems" (GIS has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public; empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS. This paper has the following objectives: (1 to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2 to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3 to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union and global levels.

  11. Communications satellites in the national and global health care information infrastructure: their role, impact, and issues

    Science.gov (United States)

    Zuzek, J. E.; Bhasin, K. B.

    1996-01-01

    Health care services delivered from a distance, known collectively as telemedicine, are being increasingly demonstrated on various transmission media. Telemedicine activities have included diagnosis by a doctor at a remote location, emergency and disaster medical assistance, medical education, and medical informatics. The ability of communications satellites to offer communication channels and bandwidth on demand, connectivity to mobile, remote and under served regions, and global access will afford them a critical role for telemedicine applications within the National and Global Information Infrastructure (NII/GII). The importance that communications satellites will have in telemedicine applications within the NII/GII the differences in requirements for NII vs. GII, the major issues such as interoperability, confidentiality, quality, availability, and costs, and preliminary conclusions for future usability based on the review of several recent trails at national and global levels are presented.

  12. Clinics in Mother and Child Health

    African Journals Online (AJOL)

    Clinics in Mother and Child Health is a bilingual journal and publishes (in ... Health Care Facility in South-South Nigeria: The Need for Middle Level Health Manpower ... Le syndrome des ovaires micropolykystiques chez les femmes infertiles à ...

  13. The impact of green stormwater infrastructure installation on surrounding health and safety.

    Science.gov (United States)

    Kondo, Michelle C; Low, Sarah C; Henning, Jason; Branas, Charles C

    2015-03-01

    We investigated the health and safety effects of urban green stormwater infrastructure (GSI) installments. We conducted a difference-in-differences analysis of the effects of GSI installments on health (e.g., blood pressure, cholesterol and stress levels) and safety (e.g., felonies, nuisance and property crimes, narcotics crimes) outcomes from 2000 to 2012 in Philadelphia, Pennsylvania. We used mixed-effects regression models to compare differences in pre- and posttreatment measures of outcomes for treatment sites (n=52) and randomly chosen, matched control sites (n=186) within multiple geographic extents surrounding GSI sites. Regression-adjusted models showed consistent and statistically significant reductions in narcotics possession (18%-27% less) within 16th-mile, quarter-mile, half-mile (P<.001), and eighth-mile (P<.01) distances from treatment sites and at the census tract level (P<.01). Narcotics manufacture and burglaries were also significantly reduced at multiple scales. Nonsignificant reductions in homicides, assaults, thefts, public drunkenness, and narcotics sales were associated with GSI installation in at least 1 geographic extent. Health and safety considerations should be included in future assessments of GSI programs. Subsequent studies should assess mechanisms of this association.

  14. Assessing needs and assets for building a regional network infrastructure to reduce cancer related health disparities.

    Science.gov (United States)

    Wells, Kristen J; Lima, Diana S; Meade, Cathy D; Muñoz-Antonia, Teresita; Scarinci, Isabel; McGuire, Allison; Gwede, Clement K; Pledger, W Jack; Partridge, Edward; Lipscomb, Joseph; Matthews, Roland; Matta, Jaime; Flores, Idhaliz; Weiner, Roy; Turner, Timothy; Miele, Lucio; Wiese, Thomas E; Fouad, Mona; Moreno, Carlos S; Lacey, Michelle; Christie, Debra W; Price-Haywood, Eboni G; Quinn, Gwendolyn P; Coppola, Domenico; Sodeke, Stephen O; Green, B Lee; Lichtveld, Maureen Y

    2014-06-01

    Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nation-wide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Assessing Needs and Assets for Building a Regional Network Infrastructure to Reduce Cancer Related Health Disparities

    Science.gov (United States)

    Wells, Kristen J.; Lima, Diana S.; Meade, Cathy D.; Muñoz-Antonia, Teresita; Scarinci, Isabel; McGuire, Allison; Gwede, Clement K.; Pledger, W. Jack; Partridge, Edward; Lipscomb, Joseph; Matthews, Roland; Matta, Jaime; Flores, Idhaliz; Weiner, Roy; Turner, Timothy; Miele, Lucio; Wiese, Thomas E.; Fouad, Mona; Moreno, Carlos S.; Lacey, Michelle; Christie, Debra W.; Price-Haywood, Eboni G.; Quinn, Gwendolyn P.; Coppola, Domenico; Sodeke, Stephen O.; Green, B. Lee; Lichtveld, Maureen Y.

    2015-01-01

    Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nationwide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals. PMID:24486917

  16. Toward a new information infrastructure in health technology assessment: communication, design, process, and results.

    Science.gov (United States)

    Neikter, Susanna Allgurin; Rehnqvist, Nina; Rosén, Måns; Dahlgren, Helena

    2009-12-01

    The aim of this study was to facilitate effective internal and external communication of an international network and to explore how to support communication and work processes in health technology assessment (HTA). STRUCTURE AND METHODS: European network for Health Technology Assessment (EUnetHTA) connected sixty-four HTA Partner organizations from thirty-three countries. User needs in the different steps of the HTA process were the starting point for developing an information system. A step-wise, interdisciplinary, creative approach was used in developing practical tools. An Information Platform facilitated the exchange of scientific information between Partners and with external target groups. More than 200 virtual meetings were set up during the project using an e-meeting tool. A Clearinghouse prototype was developed with the intent to offering a single point of access to HTA relevant information. This evolved into a next step not planned from the outset: Developing a running HTA Information System including several Web-based tools to support communication and daily HTA processes. A communication strategy guided the communication effort, focusing on practical tools, creating added value, involving stakeholders, and avoiding duplication of effort. Modern technology enables a new information infrastructure for HTA. The potential of information and communication technology was used as a strategic tool. Several target groups were represented among the Partners, which supported collaboration and made it easier to identify user needs. A distinctive visual identity made it easier to gain and maintain visibility on a limited budget.

  17. Technical challenges for big data in biomedicine and health: data sources, infrastructure, and analytics.

    Science.gov (United States)

    Peek, N; Holmes, J H; Sun, J

    2014-08-15

    To review technical and methodological challenges for big data research in biomedicine and health. We discuss sources of big datasets, survey infrastructures for big data storage and big data processing, and describe the main challenges that arise when analyzing big data. The life and biomedical sciences are massively contributing to the big data revolution through secondary use of data that were collected during routine care and through new data sources such as social media. Efficient processing of big datasets is typically achieved by distributing computation over a cluster of computers. Data analysts should be aware of pitfalls related to big data such as bias in routine care data and the risk of false-positive findings in high-dimensional datasets. The major challenge for the near future is to transform analytical methods that are used in the biomedical and health domain, to fit the distributed storage and processing model that is required to handle big data, while ensuring confidentiality of the data being analyzed.

  18. Internet infrastructures and health care systems: a qualitative comparative analysis on networks and markets in the British National Health Service and Kaiser Permanente.

    Science.gov (United States)

    Séror, Ann C

    2002-12-01

    The Internet and emergent telecommunications infrastructures are transforming the future of health care management. The costs of health care delivery systems, products, and services continue to rise everywhere, but performance of health care delivery is associated with institutional and ideological considerations as well as availability of financial and technological resources. to identify the effects of ideological differences on health care market infrastructures including the Internet and telecommunications technologies by a comparative case analysis of two large health care organizations: the British National Health Service and the California-based Kaiser Permanente health maintenance organization. A qualitative comparative analysis focusing on the British National Health Service and the Kaiser Permanente health maintenance organization to show how system infrastructures vary according to market dynamics dominated by health care institutions ("push") or by consumer demand ("pull"). System control mechanisms may be technologically embedded, institutional, or behavioral. The analysis suggests that telecommunications technologies and the Internet may contribute significantly to health care system performance in a context of ideological diversity. The study offers evidence to validate alternative models of health care governance: the national constitution model, and the enterprise business contract model. This evidence also suggests important questions for health care policy makers as well as researchers in telecommunications, organizational theory, and health care management.

  19. Using GIS to assess priorities of infrastructure and health needs of colonias along the United States-Mexico border

    Science.gov (United States)

    Parcher, J.W.; Humberson, D.G.

    2009-01-01

    Colonias, which are unincorporated border setdements in the United. States, have emerged in rural areas without the governance and services normally provided by local government. Colonia residents live in poverty and lack adequate health care, potable water, and sanitation systems. These conditions create substantial health risks for themselves and surrounding communities. By 2001, more than 1,400 colonias were identified in Texas. Cooperation with several Federal and Texas state agencies has allowed the U.S. Geological Survey (USGS) to improve colonia Geographic Information System (GIS) boundaries and develop the Colonia Health, Infrastructure, and Platting Status tool (CHIPS). Together, the GIS boundaries and CHIPS aid the Texas government in prioritizing the limited funds that are available for infrastructure improvement. CHIPS's report: generator can be tailored, to the needs of the user, providing either broad or specific output. CHIPS is publicly available on the U.S. Geological Survey Border Environmental Health Initiative website at http://borderhealth.cr. usgs.gov.

  20. Development of a Geographical Information System for the monitoring of the health infrastructure in rural areas in Tanzania

    Directory of Open Access Journals (Sweden)

    Jürgen Schweikart

    2008-12-01

    Full Text Available

    Background: Setting up Geographical Information Systems (GIS on the existing health infrastructure and ongoing and planned interventions in public health in Tanzania is still in its infancy. While there are several activities on gathering information and attempts of documentation there does not exist an overall systematic approach of generally capturing all health related facts and bringing them together into a unique information system yet. In order to strengthen the information system in the health sector in general, and to assist Ministry of Health and Social Welfare (MoHSW in better receiving an overview of health related infrastructure and intervention data for management purpose, a first-pilot GIS was built up in the Mbeya Region in cooperation with Tanzanian German Programme to Support Health (TGPSH/Gesellschaft für technische Zusammenarbeit (GTZ.

    Methods: The Health-GIS contains information on all health facilities (HF in the region and their infrastructure. Therefore, personal interviews were conducted in selected HF based on a comprehensive questionnaire. The spatial coordinates of the HF were taken with a Global Positioning System (GPS. In a relational database, the newly coded HF are linked to the gathered information pertaining to them and in a second step are analysed and visualised with help of GIS. Results: First results show newly collected geometry and attribute data for a considerable number of HFs in Mbeya Region, which are then supplemented by information on the street network lately surveyed during the fieldtrip. With the help of a database management system (DBMS all information are stored and maintained within one health database. By their spatial relation, data may be analysed and mapped with a Health-GIS. Because of the targeted cooperation with people and institutions from the local health sector, the way for integrating the Health-GIS into the health

  1. Mass vaccination with a new, less expensive oral cholera vaccine using public health infrastructure in India: the Odisha model.

    Science.gov (United States)

    Kar, Shantanu K; Sah, Binod; Patnaik, Bikash; Kim, Yang Hee; Kerketta, Anna S; Shin, Sunheang; Rath, Shyam Bandhu; Ali, Mohammad; Mogasale, Vittal; Khuntia, Hemant K; Bhattachan, Anuj; You, Young Ae; Puri, Mahesh K; Lopez, Anna Lena; Maskery, Brian; Nair, Gopinath B; Clemens, John D; Wierzba, Thomas F

    2014-02-01

    The substantial morbidity and mortality associated with recent cholera outbreaks in Haiti and Zimbabwe, as well as with cholera endemicity in countries throughout Asia and Africa, make a compelling case for supplementary cholera control measures in addition to existing interventions. Clinical trials conducted in Kolkata, India, have led to World Health Organization (WHO)-prequalification of Shanchol, an oral cholera vaccine (OCV) with a demonstrated 65% efficacy at 5 years post-vaccination. However, before this vaccine is widely used in endemic areas or in areas at risk of outbreaks, as recommended by the WHO, policymakers will require empirical evidence on its implementation and delivery costs in public health programs. The objective of the present report is to describe the organization, vaccine coverage, and delivery costs of mass vaccination with a new, less expensive OCV (Shanchol) using existing public health infrastructure in Odisha, India, as a model. All healthy, non-pregnant residents aged 1 year and above residing in selected villages of the Satyabadi block (Puri district, Odisha, India) were invited to participate in a mass vaccination campaign using two doses of OCV. Prior to the campaign, a de jure census, micro-planning for vaccination and social mobilization activities were implemented. Vaccine coverage for each dose was ascertained as a percentage of the censused population. The direct vaccine delivery costs were estimated by reviewing project expenditure records and by interviewing key personnel. The mass vaccination was conducted during May and June, 2011, in two phases. In each phase, two vaccine doses were given 14 days apart. Sixty-two vaccination booths, staffed by 395 health workers/volunteers, were established in the community. For the censused population, 31,552 persons (61% of the target population) received the first dose and 23,751 (46%) of these completed their second dose, with a drop-out rate of 25% between the two doses. Higher

  2. Developing research and recruitment while fostering stakeholder engagement in a National Institutes of Mental Health-funded Interventions and Practice Research Infrastructure Programs grant for depression.

    Science.gov (United States)

    Stirman, Shannon Wiltsey; Goldstein, Lizabeth A; Wrenn, Glenda; Barrett, Marna; Gibbons, Mary Beth Connolly; Casiano, Delane; Thompson, Donald; Green, Patricia P; Heintz, Laura; Barber, Jacques P; Crits-Christoph, Paul

    2010-01-01

    In the context of a National Institutes of Mental Health-funded Interventions and Practice Research Infrastructure Programs (IP-RISP) grant for the treatment of depression, a partnership was developed between a community mental health organization and a team of researchers. This paper describes the collaborative process, key challenges, and strategies employed to meet the goals of the first phase of the grant, which included development of a working and sustainable partnership and building capacity for recruitment and research. This paper was developed through the use of qualitative interviews and discussion with a variety of IP-RISP partners. Communication with multiple stakeholders through varied channels, feedback from stakeholders on research procedures, and employing a research liaison at the clinic have been key strategies in the first phase of the grant. The strategies we employed allowed multiple stakeholders to contribute to the larger mission of the IP-RISP and helped to establish an ongoing research program within the mental health organization.

  3. Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM - Services data.

    Science.gov (United States)

    Leite, Silvana Nair; Manzini, Fernanda; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mário; Farias, Mareni Rocha

    2017-11-13

    To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2, while in 46.2% these areas were superior to 10m2. Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities.

  4. Making green infrastructure healthier infrastructure

    Directory of Open Access Journals (Sweden)

    Mare Lõhmus

    2015-11-01

    Full Text Available Increasing urban green and blue structure is often pointed out to be critical for sustainable development and climate change adaptation, which has led to the rapid expansion of greening activities in cities throughout the world. This process is likely to have a direct impact on the citizens’ quality of life and public health. However, alongside numerous benefits, green and blue infrastructure also has the potential to create unexpected, undesirable, side-effects for health. This paper considers several potential harmful public health effects that might result from increased urban biodiversity, urban bodies of water, and urban tree cover projects. It does so with the intent of improving awareness and motivating preventive measures when designing and initiating such projects. Although biodiversity has been found to be associated with physiological benefits for humans in several studies, efforts to increase the biodiversity of urban environments may also promote the introduction and survival of vector or host organisms for infectious pathogens with resulting spread of a variety of diseases. In addition, more green connectivity in urban areas may potentiate the role of rats and ticks in the spread of infectious diseases. Bodies of water and wetlands play a crucial role in the urban climate adaptation and mitigation process. However, they also provide habitats for mosquitoes and toxic algal blooms. Finally, increasing urban green space may also adversely affect citizens allergic to pollen. Increased awareness of the potential hazards of urban green and blue infrastructure should not be a reason to stop or scale back projects. Instead, incorporating public health awareness and interventions into urban planning at the earliest stages can help insure that green and blue infrastructure achieves full potential for health promotion.

  5. Making green infrastructure healthier infrastructure.

    Science.gov (United States)

    Lõhmus, Mare; Balbus, John

    2015-01-01

    Increasing urban green and blue structure is often pointed out to be critical for sustainable development and climate change adaptation, which has led to the rapid expansion of greening activities in cities throughout the world. This process is likely to have a direct impact on the citizens' quality of life and public health. However, alongside numerous benefits, green and blue infrastructure also has the potential to create unexpected, undesirable, side-effects for health. This paper considers several potential harmful public health effects that might result from increased urban biodiversity, urban bodies of water, and urban tree cover projects. It does so with the intent of improving awareness and motivating preventive measures when designing and initiating such projects. Although biodiversity has been found to be associated with physiological benefits for humans in several studies, efforts to increase the biodiversity of urban environments may also promote the introduction and survival of vector or host organisms for infectious pathogens with resulting spread of a variety of diseases. In addition, more green connectivity in urban areas may potentiate the role of rats and ticks in the spread of infectious diseases. Bodies of water and wetlands play a crucial role in the urban climate adaptation and mitigation process. However, they also provide habitats for mosquitoes and toxic algal blooms. Finally, increasing urban green space may also adversely affect citizens allergic to pollen. Increased awareness of the potential hazards of urban green and blue infrastructure should not be a reason to stop or scale back projects. Instead, incorporating public health awareness and interventions into urban planning at the earliest stages can help insure that green and blue infrastructure achieves full potential for health promotion.

  6. Electronic health records to facilitate clinical research

    OpenAIRE

    Cowie, Martin R.; Blomster, Juuso I.; Curtis, Lesley H.; Duclaux, Sylvie; Ford, Ian; Fritz, Fleur; Goldman, Samantha; Janmohamed, Salim; Kreuzer, J?rg; Leenay, Mark; Michel, Alexander; Ong, Seleen; Pell, Jill P.; Southworth, Mary Ross; Stough, Wendy Gattis

    2016-01-01

    Electronic health records (EHRs) provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research. Concerns have been raised about the increasing recruitment challenges in trials, burdensome and obtrusive data collection, and uncertain generalizability of the results. Leveraging electronic health records to counterbalance these trends is an area of intense interest. The initial applications of electronic health records, as the pr...

  7. Causal pathways linking environmental change with health behaviour change: Natural experimental study of new transport infrastructure and cycling to work.

    Science.gov (United States)

    Prins, R G; Panter, J; Heinen, E; Griffin, S J; Ogilvie, D B

    2016-06-01

    Mechanisms linking changes to the environment with changes in physical activity are poorly understood. Insights into mechanisms of interventions can help strengthen causal attribution and improve understanding of divergent response patterns. We examined the causal pathways linking exposure to new transport infrastructure with changes in cycling to work. We used baseline (2009) and follow-up (2012) data (N=469) from the Commuting and Health in Cambridge natural experimental study (Cambridge, UK). Exposure to new infrastructure in the form of the Cambridgeshire Guided Busway was defined using residential proximity. Mediators studied were changes in perceptions of the route to work, theory of planned behaviour constructs and self-reported use of the new infrastructure. Outcomes were modelled as an increase, decrease or no change in weekly cycle commuting time. We used regression analyses to identify combinations of mediators forming potential pathways between exposure and outcome. We then tested these pathways in a path model and stratified analyses by baseline level of active commuting. We identified changes in perceptions of the route to work, and use of the cycle path, as potential mediators. Of these potential mediators, only use of the path significantly explained (85%) the effect of the infrastructure in increasing cycling. Path use also explained a decrease in cycling among more active commuters. The findings strengthen the causal argument that changing the environment led to changes in health-related behaviour via use of the new infrastructure, but also show how some commuters may have spent less time cycling as a result. Copyright © 2016. Published by Elsevier Inc.

  8. A national survey of health service infrastructure and policy impacts on access to computerised CBT in Scotland

    Directory of Open Access Journals (Sweden)

    Kenicer David

    2012-09-01

    Full Text Available Abstract Background NICE recommends computerised cognitive behavioural therapy (cCBT for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. Methods A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT. Results Overall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult. Conclusions Conclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks.

  9. eHealth: Towards a Healthcare Service-Oriented Boundary-Less Infrastructure

    Directory of Open Access Journals (Sweden)

    Cristian LELUTIU

    2010-09-01

    Full Text Available The current paper presents several interoperability features applied to a local distributed information system, CardioNET, meant to improve quality of healthcare services, through the use of the latest medical and IT&C technologies. Modern healthcare systems require a patient-centric vision, where patients must receive medical attention or treatment anytime, regardless of their physical location. The eHealth distributed system we present – CardioNET is based on a SOA producer-consumer model taking a patient centric approach where every hardware, software and medical activities become “services”. The system offers tools for remote interactions between patients, doctors, medical entities (e.g. hospitals, labs and authorities. Based on international standards (IDC10, LOINC, HL7, the system assures interoperability and data exchange in widely accepted XML formats. A logical domain bus, called Pervasive Health Service Bus-pHSB, exchanges HL7 compliant data messages between the integrated elements of the platform, through high level protocols (SOAP/HL7. The paper addresses interoperability problems between medical informational platforms proposing an eHealth architecture composed of: - production systems (nodes: General Practitioner, Analysis Laboratories, Clinics, Hospitals, Home Health Care Units (H-HCU;- portal with specialized web services, registries and shared data repositories – distributed, boundary-less environment for decision support, research and educational activities.

  10. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN

    Directory of Open Access Journals (Sweden)

    Sanz Nuria

    2009-10-01

    Full Text Available Abstract Background Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. Methods In order to summarise the current situation in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching an agreement on a common classification was the initial step in the development of the survey. Results The ECRIN transnational working group on regulation, composed of experts in the field of clinical research from ten European countries, defined seven major categories of clinical research that seem relevant from both the regulatory and the scientific points of view, and correspond to congruent definitions in all countries: clinical trials on medicinal products; clinical trials on medical devices; other therapeutic trials (including surgery trials, transplantation trials, transfusion trials, trials with cell therapy, etc.; diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.; and epidemiology studies. Our classification was essential to develop a survey focused on protocol submission to ethics committees and competent authorities, procedures for amendments, requirements for sponsor and insurance, and adverse event reporting following five main phases: drafting, consensus, data collection, validation, and finalising. Conclusion The list of clinical research categories as used for the survey could serve as a contribution to the, much needed, task of harmonisation and

  11. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN)

    LENUS (Irish Health Repository)

    Kubiak, Christine

    2009-10-16

    Abstract Background Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. Methods In order to summarise the current situation in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN) developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching an agreement on a common classification was the initial step in the development of the survey. Results The ECRIN transnational working group on regulation, composed of experts in the field of clinical research from ten European countries, defined seven major categories of clinical research that seem relevant from both the regulatory and the scientific points of view, and correspond to congruent definitions in all countries: clinical trials on medicinal products; clinical trials on medical devices; other therapeutic trials (including surgery trials, transplantation trials, transfusion trials, trials with cell therapy, etc.); diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.); and epidemiology studies. Our classification was essential to develop a survey focused on protocol submission to ethics committees and competent authorities, procedures for amendments, requirements for sponsor and insurance, and adverse event reporting following five main phases: drafting, consensus, data collection, validation, and finalising. Conclusion The list of clinical research categories as used for the survey could serve as a contribution to the, much needed, task of harmonisation and simplification of the

  12. Assessment of ebola virus disease, health care infrastructure, and preparedness - four counties,Southeastern Liberia, august 2014.

    Science.gov (United States)

    Forrester, Joseph D; Pillai, Satish K; Beer, Karlyn D; Neatherlin, John; Massaquoi, Moses; Nyenswah, Tolbert G; Montgomery, Joel M; De Cock, Kevin

    2014-10-10

    Ebola virus disease (Ebola) is a multisystem disease caused by a virus of the genus Ebolavirus. In late March 2014, Ebola cases were described in Liberia, with epicenters in Lofa County and later in Montserrado County. While information about case burden and health care infrastructure was available for the two epicenters, little information was available about remote counties in southeastern Liberia. Over 9 days, August 6-14, 2014, Ebola case burden, health care infrastructure, and emergency preparedness were assessed in collaboration with the Liberian Ministry of Health and Social Welfare in four counties in southeastern Liberia: Grand Gedeh, Grand Kru, River Gee, and Maryland. Data were collected by health care facility visits to three of the four county referral hospitals and by unstructured interviews with county and district health officials, hospital administrators, physicians, nurses, physician assistants, and health educators in all four counties. Local burial practices were discussed with county officials, but no direct observation of burial practices was conducted. Basic information about Ebola surveillance and epidemiology, case investigation, contact tracing, case management, and infection control was provided to local officials.

  13. [Clinics adjacent to private pharmacies in Mexico: infrastructure and characteristics of the physicians and their remuneration].

    Science.gov (United States)

    Díaz-Portillo, Sandra P; Idrovo, Álvaro J; Dreser, Anahí; Bonilla, Federico R; Matías-Juan, Bonifacia; Wirtz, Veronika J

    2015-01-01

    To analyze and compare the physicians' characteristics, their remuneration, the compliance with regulation and the services offered between clinics adjacent to pharmacies (CAF) and independent medical clinics (CMI). Questionnaire applied to 239 physicians in 18 states including the Federal District, in Mexico in 2012. Physicians in CAF had less professional experience (5 versus 12 years), less postgraduate studies (61.2 versus 81.8%) and lower average monthly salaries (USD 418 versus USD 672) than their peers in CMI. In CAF there was less compliance in relation to medical record keeping and prescribing. The employment situation of physicians in CAF is more precarious than in CMI. It is necessary to strengthen the enforcement of existing regulations and develop policies according to the monitoring of its performance, particularly, but not exclusively, in CAF.

  14. Health record systems that meet clinical needs

    Directory of Open Access Journals (Sweden)

    Gabriella Negrini

    2012-10-01

    Full Text Available Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

  15. Senior health clinics: are they financially viable?

    Science.gov (United States)

    McAtee, Robin E; Crandall, Debra; Wright, Larry D; Beverly, Claudia J

    2009-07-01

    Are hospital-based outpatient interdisciplinary clinics a financially viable alternative for caring for our burgeoning population of older adults in America? Although highly popular, with high patient satisfaction rates among older adults and their families, senior health clinics (SHCs) can be expensive to operate, with limited quantifiable health outcomes. This study analyzed three geriatric hospital-based interdisciplinary clinics in rural Arkansas by examining their patient profiles, revenues, and expenses. It closely examined the effects of the downstream revenue using the multiplier effect and acknowledged other factors that weigh heavily on the success of SHCs and the care of older adults. The findings highlight the similarities and differences in the three clinics' operating and financial structures in addition to the clinics' and providers' productivity. The analysis presents an evidence-based illustration that SHCs can break even or lose large amounts of money.

  16. Greening infrastructure

    CSIR Research Space (South Africa)

    Van Wyk, Llewellyn V

    2014-10-01

    Full Text Available The development and maintenance of infrastructure is crucial to improving economic growth and quality of life (WEF 2013). Urban infrastructure typically includes bulk services such as water, sanitation and energy (typically electricity and gas...

  17. Compassionate use of interventions: results of a European Clinical Research Infrastructures Network (ECRIN) survey of ten European countries

    LENUS (Irish Health Repository)

    Whitfield, Kate

    2010-11-12

    Abstract Background \\'Compassionate use\\' programmes allow medicinal products that are not authorised, but are in the development process, to be made available to patients with a severe disease who have no other satisfactory treatment available to them. We sought to understand how such programmes are regulated in ten European Union countries. Methods The European Clinical Research Infrastructures Network (ECRIN) conducted a comprehensive survey on clinical research regulatory requirements, including questions on regulations of \\'compassionate use\\' programmes. Ten European countries, covering approximately 70% of the EU population, were included in the survey (Austria, Denmark, France, Germany, Hungary, Ireland, Italy, Spain, Sweden, and the UK). Results European Regulation 726\\/2004\\/EC is clear on the intentions of \\'compassionate use\\' programmes and aimed to harmonise them in the European Union. The survey reveals that different countries have adopted different requirements and that \\'compassionate use\\' is not interpreted in the same way across Europe. Four of the ten countries surveyed have no formal regulatory system for the programmes. We discuss the need for \\'compassionate use\\' programmes and their regulation where protection of patients is paramount. Conclusions \\'Compassionate use\\' is a misleading term and should be replaced with \\'expanded access\\'. There is a need for expanded access programmes in order to serve the interests of seriously ill patients who have no other treatment options. To protect these patients, European legislation needs to be more explicit and informative with regard to the regulatory requirements, restrictions, and responsibilities in expanded access programmes.

  18. Compassionate use of interventions: results of a European Clinical Research Infrastructures Network (ECRIN) survey of ten European countries

    Science.gov (United States)

    2010-01-01

    Background 'Compassionate use' programmes allow medicinal products that are not authorised, but are in the development process, to be made available to patients with a severe disease who have no other satisfactory treatment available to them. We sought to understand how such programmes are regulated in ten European Union countries. Methods The European Clinical Research Infrastructures Network (ECRIN) conducted a comprehensive survey on clinical research regulatory requirements, including questions on regulations of 'compassionate use' programmes. Ten European countries, covering approximately 70% of the EU population, were included in the survey (Austria, Denmark, France, Germany, Hungary, Ireland, Italy, Spain, Sweden, and the UK). Results European Regulation 726/2004/EC is clear on the intentions of 'compassionate use' programmes and aimed to harmonise them in the European Union. The survey reveals that different countries have adopted different requirements and that 'compassionate use' is not interpreted in the same way across Europe. Four of the ten countries surveyed have no formal regulatory system for the programmes. We discuss the need for 'compassionate use' programmes and their regulation where protection of patients is paramount. Conclusions 'Compassionate use' is a misleading term and should be replaced with 'expanded access'. There is a need for expanded access programmes in order to serve the interests of seriously ill patients who have no other treatment options. To protect these patients, European legislation needs to be more explicit and informative with regard to the regulatory requirements, restrictions, and responsibilities in expanded access programmes. PMID:21073691

  19. Bike Infrastructures

    DEFF Research Database (Denmark)

    Silva, Victor; Harder, Henrik; Jensen, Ole B.

    Bike Infrastructures aims to identify bicycle infrastructure typologies and design elements that can help promote cycling significantly. It is structured as a case study based research where three cycling infrastructures with distinct typologies were analyzed and compared. The three cases......, the findings of this research project can also support bike friendly design and planning, and cyclist advocacy....

  20. Utilizing an integrated infrastructure for outcomes research: a systematic review.

    Science.gov (United States)

    Dixon, Brian E; Whipple, Elizabeth C; Lajiness, John M; Murray, Michael D

    2016-03-01

    To explore the ability of an integrated health information infrastructure to support outcomes research. A systematic review of articles published from 1983 to 2012 by Regenstrief Institute investigators using data from an integrated electronic health record infrastructure involving multiple provider organisations was performed. Articles were independently assessed and classified by study design, disease and other metadata including bibliometrics. A total of 190 articles were identified. Diseases included cognitive, (16) cardiovascular, (16) infectious, (15) chronic illness (14) and cancer (12). Publications grew steadily (26 in the first decade vs. 100 in the last) as did the number of investigators (from 15 in 1983 to 62 in 2012). The proportion of articles involving non-Regenstrief authors also expanded from 54% in the first decade to 72% in the last decade. During this period, the infrastructure grew from a single health system into a health information exchange network covering more than 6 million patients. Analysis of journal and article metrics reveals high impact for clinical trials and comparative effectiveness research studies that utilised data available in the integrated infrastructure. Integrated information infrastructures support growth in high quality observational studies and diverse collaboration consistent with the goals for the learning health system. More recent publications demonstrate growing external collaborations facilitated by greater access to the infrastructure and improved opportunities to study broader disease and health outcomes. Integrated information infrastructures can stimulate learning from electronic data captured during routine clinical care but require time and collaboration to reach full potential. © 2015 Health Libraries Group.

  1. Evaluating the transport, health and economic impacts of new urban cycling infrastructure in Sydney, Australia - protocol paper.

    Science.gov (United States)

    Rissel, Chris; Greaves, Stephen; Wen, Li Ming; Capon, Anthony; Crane, Melanie; Standen, Chris

    2013-10-17

    There are repeated calls to build better cycling paths in Australian cities if the proportion of people cycling is to increase. Yet the full range of transport, health, environmental and economic impacts of new cycling infrastructure and the extent to which observed changes are sustained is not well understood. The City of Sydney is currently building a new bicycle network, which includes a new bicycle path separated from road traffic in the south Sydney area. This protocol paper describes a comprehensive method to evaluate this new cycling infrastructure. A cohort of residents within two kilometres of the new bicycle path will be surveyed at baseline before a new section of bicycle path is built, and again 12 and 24 months later to assess changes in travel behaviour, sense of community, quality of life and health behaviours. Residents in a comparable area of Sydney that will not get a new separated bike path will act as a comparison group. At baseline a sub-set of residents who volunteer will also take a small GPS device with them for one week to assess travel behaviour. This research should contribute to the advancement in evaluation and appraisal methods for cycling projects.

  2. Infrastructure and Health Care Services in the Niger Delta Region of Nigeria: A Case Study of Physical Amenities in the Primary Health Care System in Delta State

    Directory of Open Access Journals (Sweden)

    Omuta GED

    2016-01-01

    Full Text Available Background: One of the spin-off effects of the urban-based medical services established by the colonial administration was the total neglect of rural communities. Those that existed lacked infrastructure. Even fifty years after independence, this dichotomy has persisted and become more pronounced. The objective of this study is to examine the state of infrastructure in the primary health care centres in Delta State, Nigeria. Methodology: The study was a survey of the infrastructure of all the PHC centres in nine local government areas; three from each of the three senatorial districts. The facilities covered were sources of water supply, sources of electricity, number of functional beds and type of communication facilities. The field date were cleaned up, processed and analysed using SPSS 10.0. Focus group discussions and key informant interviews were also conducted. In order to make the findings policy-relevant, a project steering committee made of researchers and decision makers and a project management committee made of representatives of decision makers, care providers, care seekers and other stakeholders were se up and integrated into the study. Results: There were varying degrees of infrastructural deficiencies. 34.22 per cent of the PHCs had no access to safe water; 51.33 per cent were not connected to the national electricity grid; and 34.22 per cent of the available beds and 40.89 per cent no means of communication whatsoever. Conclusion: Field data and perspectives of stakeholders revealed that the major cause of infrastructural deficiencies was insufficient funding, lopsided allocation of resources and official corruption. Correspondingly, increased and sustained funding; prioritized allocation of resources and targeted upgrading of facilities, were recommended.

  3. From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice

    OpenAIRE

    Fazalullasha, Fatima; Taras, Jillian; Morinis, Julia; Levin, Leo; Karmali, Karima; Neilson, Barbara; Muskat, Barbara; Bloch, Gary; Chan, Kevin; McDonald, Maureen; Makin, Sue; Ford-Jones, E Lee

    2014-01-01

    Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician’s ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider l...

  4. Do knowledge infrastructure facilities support Evidence-Based Practice in occupational health? An exploratory study across countries among occupational physicians enrolled on EBM courses

    NARCIS (Netherlands)

    Hugenholtz, Nathalie I. R.; Nieuwenhuijsen, Karen; Sluiter, Judith K.; van Dijk, Frank J. H.

    2009-01-01

    ABSTRACT: BACKGROUND: Evidence-Based Medicine (EBM) is an important method used by occupational physicians (OPs) to deliver high quality health care. The presence and quality of a knowledge infrastructure is thought to influence the practice of EBM in occupational health care. This study explores

  5. Mobile clinics for women's and children's health.

    Science.gov (United States)

    Abdel-Aleem, Hany; El-Gibaly, Omaima M H; El-Gazzar, Amira F E-S; Al-Attar, Ghada S T

    2016-08-11

    The accessibility of health services is an important factor that affects the health outcomes of populations. A mobile clinic provides a wide range of services but in most countries the main focus is on health services for women and children. It is anticipated that improvement of the accessibility of health services via mobile clinics will improve women's and children's health. To evaluate the impact of mobile clinic services on women's and children's health. For related systematic reviews, we searched the Database of Abstracts of Reviews of Effectiveness (DARE), CRD; Health Technology Assessment Database (HTA), CRD; NHS Economic Evaluation Database (NHS EED), CRD (searched 20 February 2014).For primary studies, we searched ISI Web of Science, for studies that have cited the included studies in this review (searched 18 January 2016); WHO ICTRP, and ClinicalTrials.gov (searched 23 May 2016); Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.cochranelibrary.com (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 7 April 2015); MEDLINE, OvidSP (searched 7 April 2015); Embase, OvidSP (searched 7 April 2015); CINAHL, EbscoHost (searched 7 April 2015); Global Health, OvidSP (searched 8 April 2015); POPLINE, K4Health (searched 8 April 2015); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (searched 8 April 2015); Global Health Library, WHO (searched 8 April 2015); PAHO, VHL (searched 8 April 2015); WHOLIS, WHO (searched 8 April 2015); LILACS, VHL (searched 9 April 2015). We included individual- and cluster-randomised controlled trials (RCTs) and non-RCTs. We included controlled before-and-after (CBA) studies provided they had at least two intervention sites and two control sites. Also, we included interrupted time series (ITS) studies if there was a clearly defined point in time when the intervention occurred and at least three data points

  6. Latvian health care competitiveness in relation to its infrastructure and available resources

    Directory of Open Access Journals (Sweden)

    Kokarevica A.

    2018-01-01

    Full Text Available Resources are one of the essential indicators for the functioning of the health care system. Better health care provision is an essential prerequisite for the export of services. Traditionally a competitive health care system is linked to a number of factors (price, quality, reliability, products and services largely determined by the new technologies, innovations and implementation the new methods. The authors of this article analyzed and collected data from the European Commission Eurostat and OECD data. Current situation in health care in Latvia is characterized by populations’ restricted access to health care services, high out-of-pocket payments and poor health outcomes of the population. More than 10% of Latvian population can’t afford medical care. The ratio of public funding for healthcare in Latvia is among the lowest in EU countries. Latvia spends 5.3% (USD PPP 1217 of GDP on health, lower than the OCED country average of 8.9% (USD PPP 3453. Latvia is facing a dramatic gap between the availability of hospital beds and long term care beds and the lowest prevalence of general medical practitioners among all Baltic States 321.6 per 100 000. These mentioned factors may hinder the development of health care in Latvia and reduce the ability to participate in international health service market.

  7. Implementing Home Health Standards in Clinical Practice.

    Science.gov (United States)

    Gorski, Lisa A

    2016-02-01

    In 1986, the American Nurses Association (ANA) published the first Standards of Home Health Practice. Revised in 1992 and expanded in 1999 to become Home Health Nursing: Scope and Standards of Practice, it was revised in 2008 and again in 2014. In the 2014 edition, there are 6 standards of home healthcare nursing practice and 10 standards of professional performance for home healthcare nursing. The focus of this article is to describe the home healthcare standards and to provide guidance for implementation in clinical practice. It is strongly encouraged that home healthcare administrators, educators, and staff obtain a copy of the standards and fully read this essential home healthcare resource.

  8. Profile-IQ: Web-based data query system for local health department infrastructure and activities.

    Science.gov (United States)

    Shah, Gulzar H; Leep, Carolyn J; Alexander, Dayna

    2014-01-01

    To demonstrate the use of National Association of County & City Health Officials' Profile-IQ, a Web-based data query system, and how policy makers, researchers, the general public, and public health professionals can use the system to generate descriptive statistics on local health departments. This article is a descriptive account of an important health informatics tool based on information from the project charter for Profile-IQ and the authors' experience and knowledge in design and use of this query system. Profile-IQ is a Web-based data query system that is based on open-source software: MySQL 5.5, Google Web Toolkit 2.2.0, Apache Commons Math library, Google Chart API, and Tomcat 6.0 Web server deployed on an Amazon EC2 server. It supports dynamic queries of National Profile of Local Health Departments data on local health department finances, workforce, and activities. Profile-IQ's customizable queries provide a variety of statistics not available in published reports and support the growing information needs of users who do not wish to work directly with data files for lack of staff skills or time, or to avoid a data use agreement. Profile-IQ also meets the growing demand of public health practitioners and policy makers for data to support quality improvement, community health assessment, and other processes associated with voluntary public health accreditation. It represents a step forward in the recent health informatics movement of data liberation and use of open source information technology solutions to promote public health.

  9. Electronic health records improve clinical note quality.

    Science.gov (United States)

    Burke, Harry B; Sessums, Laura L; Hoang, Albert; Becher, Dorothy A; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; O'Malley, Patrick G; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A; Hodge, Joshua A; Kane, Shawn; Magee, Charles; Makary, Zizette R; Mallory, Renee M; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W

    2015-01-01

    The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. A five and a half year longitudinal retrospective multicenter quantitative study comparing the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with type 2 diabetes at three time points: 6 months prior to the introduction of the EHR (before-EHR), 6 months after the introduction of the EHR (after-EHR), and 5 years after the introduction of the EHR (5-year-EHR). QNOTE, a validated quantitative instrument, was used to assess the quality of outpatient clinical notes. Its scores can range from a low of 0 to a high of 100. Sixteen primary care physicians with active practices used QNOTE to determine the quality of the 300 patient notes. The before-EHR, after-EHR, and 5-year-EHR grand mean scores (SD) were 52.0 (18.4), 61.2 (16.3), and 80.4 (8.9), respectively, and the change in scores for before-EHR to after-EHR and before-EHR to 5-year-EHR were 18% (pquality scores significantly improved over the 5-year time interval. The EHR significantly improved the overall quality of the outpatient clinical note and the quality of all its elements, including the core and non-core elements. To our knowledge, this is the first study to demonstrate that the EHR significantly improves the quality of clinical notes. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  10. Implementation of a large-scale hospital information infrastructure for multi-unit health-care services.

    Science.gov (United States)

    Yoo, Sun K; Kim, Dong Keun; Kim, Jung C; Park, Youn Jung; Chang, Byung Chul

    2008-01-01

    With the increase in demand for high quality medical services, the need for an innovative hospital information system has become essential. An improved system has been implemented in all hospital units of the Yonsei University Health System. Interoperability between multi-units required appropriate hardware infrastructure and software architecture. This large-scale hospital information system encompassed PACS (Picture Archiving and Communications Systems), EMR (Electronic Medical Records) and ERP (Enterprise Resource Planning). It involved two tertiary hospitals and 50 community hospitals. The monthly data production rate by the integrated hospital information system is about 1.8 TByte and the total quantity of data produced so far is about 60 TByte. Large scale information exchange and sharing will be particularly useful for telemedicine applications.

  11. Development of a Survey to Assess Local Health Department Organizational Processes and Infrastructure for Supporting Obesity Prevention.

    Science.gov (United States)

    Xiao, Ting; Stamatakis, Katherine A; McVay, Allese B

    Local health departments (LHDs) have an important function in controlling the growing epidemic of obesity in the United States. Data are needed to gain insight into the existence of routine functions and structures of LHDs that support and sustain obesity prevention efforts. The purpose of this study was to develop and examine the reliability of measures to assess foundational LHD organizational processes and functions specific to obesity prevention. Survey measures were developed using a stratified, random sample of US LHDs to assess supportive organizational processes and infrastructure for obesity prevention representing different domains. Data were analyzed using weighted κ and intraclass correlation coefficient for assessing test-retest reliability. Most items and summary indices in the majority of survey domains had moderate/substantial or almost perfect reliability. The overall findings support this survey instrument to be a reliable measurement tool for a large number of processes and functions that comprise obesity prevention-related capacity in LHDs.

  12. Big Data as a Driver for Clinical Decision Support Systems: A Learning Health Systems Perspective

    Directory of Open Access Journals (Sweden)

    Arianna Dagliati

    2018-05-01

    Full Text Available Big data technologies are nowadays providing health care with powerful instruments to gather and analyze large volumes of heterogeneous data collected for different purposes, including clinical care, administration, and research. This makes possible to design IT infrastructures that favor the implementation of the so-called “Learning Healthcare System Cycle,” where healthcare practice and research are part of a unique and synergic process. In this paper we highlight how “Big Data enabled” integrated data collections may support clinical decision-making together with biomedical research. Two effective implementations are reported, concerning decision support in Diabetes and in Inherited Arrhythmogenic Diseases.

  13. Health Information Infrastructure for People with Intellectual and Developmental Disabilities (I/DD) Living in Supported Accommodation: Communication, Co-Ordination and Integration of Health Information.

    Science.gov (United States)

    Dahm, Maria R; Georgiou, Andrew; Balandin, Susan; Hill, Sophie; Hemsley, Bronwyn

    2017-10-25

    People with intellectual and/or developmental disability (I/DD) commonly have complex health care needs, but little is known about how their health information is managed in supported accommodation, and across health services providers. This study aimed to describe the current health information infrastructure (i.e., how data and information are collected, stored, communicated, and used) for people with I/DD living in supported accommodation in Australia. It involved a scoping review and synthesis of research, policies, and health documents relevant in this setting. Iterative database and hand searches were conducted across peer-reviewed articles internationally in English and grey literature in Australia (New South Wales) up to September 2015. Data were extracted from the selected relevant literature and analyzed for content themes. Expert stakeholders were consulted to verify the authors' interpretations of the information and content categories. The included 286 sources (peer-reviewed n = 27; grey literature n = 259) reflect that the health information for people with I/DD in supported accommodation is poorly communicated, coordinated and integrated across isolated systems. 'Work-as-imagined' as outlined in policies, does not align with 'work-as-done' in reality. This gap threatens the quality of care and safety of people with I/DD in these settings. The effectiveness of the health information infrastructure and services for people with I/DD can be improved by integrating the information sources and placing people with I/DD and their supporters at the centre of the information exchange process.

  14. Organizing the public health-clinical health interface: theoretical bases.

    Science.gov (United States)

    St-Pierre, Michèle; Reinharz, Daniel; Gauthier, Jacques-Bernard

    2006-01-01

    This article addresses the issue of the interface between public health and clinical health within the context of the search for networking approaches geared to a more integrated delivery of health services. The articulation of an operative interface is complicated by the fact that the definition of networking modalities involves complex intra- and interdisciplinary and intra- and interorganizational systems across which a new transversal dynamics of intervention practices and exchanges between service structures must be established. A better understanding of the situation is reached by shedding light on the rationale underlying the organizational methods that form the bases of the interface between these two sectors of activity. The Quebec experience demonstrates that neither the structural-functionalist approach, which emphasizes remodelling establishment structures and functions as determinants of integration, nor the structural-constructivist approach, which prioritizes distinct fields of practice in public health and clinical health, adequately serves the purpose of networking and integration. Consequently, a theoretical reframing is imperative. In this regard, structuration theory, which fosters the simultaneous study of methods of inter-structure coordination and inter-actor cooperation, paves the way for a better understanding of the situation and, in turn, to the emergence of new integration possibilities.

  15. Considering virtue: public health and clinical ethics.

    Science.gov (United States)

    Meagher, Karen M

    2011-10-01

    As bioethicists increasingly turn their attention to the profession of public health, many candidate frameworks have been proposed, often with an eye toward articulating the values and foundational concepts that distinguish this practice from curative clinical medicine. First, I will argue that while these suggestions for a distinct ethics of public health are promising, they arise from problems within contemporary bioethics that must be taken into account. Without such cognizance of the impetus for public health ethics, we risk developing a set of ethical resources meant exclusively for public health professionals, thereby neglecting implications for curative medical ethics and the practice of bioethics more broadly. Second, I will present reasons for thinking some of the critiques of dominant contemporary bioethics can be met by a virtue ethics approach. I present a virtue ethics response to criticisms that concern (1) increased rigor in bioethics discourse; (2) the ability of normative theory to accommodate context; and (3) explicit attention to the nature of ethical conflict. I conclude that a virtue ethics approach is a viable avenue for further inquiry, one that leads us away from developing ethics of public health in a vacuum and has the potential for overcoming certain pitfalls of contemporary bioethics discourse. © 2011 Blackwell Publishing Ltd.

  16. A Multidisciplinary Research Framework on Green Schools: Infrastructure, Social Environment, Occupant Health, and Performance

    Science.gov (United States)

    Magzamen, Sheryl; Mayer, Adam P.; Barr, Stephanie; Bohren, Lenora; Dunbar, Brian; Manning, Dale; Reynolds, Stephen J.; Schaeffer, Joshua W.; Suter, Jordan; Cross, Jennifer E.

    2017-01-01

    Background: Sustainable school buildings hold much promise to reducing operating costs, improve occupant well-being and, ultimately, teacher and student performance. However, there is a scarcity of evidence on the effects of sustainable school buildings on health and performance indicators. We sought to create a framework for a multidisciplinary…

  17. Assessing clinical competency in the health sciences

    Science.gov (United States)

    Panzarella, Karen Joanne

    To test the success of integrated curricula in schools of health sciences, meaningful measurements of student performance are required to assess clinical competency. This research project analyzed a new performance assessment tool, the Integrated Standardized Patient Examination (ISPE), for assessing clinical competency: specifically, to assess Doctor of Physical Therapy (DPT) students' clinical competence as the ability to integrate basic science knowledge with clinical communication skills. Thirty-four DPT students performed two ISPE cases, one of a patient who sustained a stroke and the other a patient with a herniated lumbar disc. Cases were portrayed by standardized patients (SPs) in a simulated clinical setting. Each case was scored by an expert evaluator in the exam room and then by one investigator and the students themselves via videotape. The SPs scored each student on an overall encounter rubric. Written feedback was obtained from all participants in the study. Acceptable reliability was demonstrated via inter-rater agreement as well as inter-rater correlations on items that used a dichotomous scale, whereas the items requiring the use of the 4-point rubric were somewhat less reliable. For the entire scale both cases had a significant correlation between the Expert-Investigator pair of raters, for the CVA case r = .547, p performances on the ISPE with other independent estimates of students' competence. The unique integration questions of the ISPE were judged to have good content validity from experts and students, suggestive that integration, a most crucial element of clinical competence, while done in the mind of the student, can be practiced, learned and assessed.

  18. PERSONALIZED MEDICINE AS AN UPDATED MODEL OF NATIONAL HEALTH-CARE SYSTEM.PART 1. STRATEGIC ASPECTS OF INFRASTRUCTURE

    Directory of Open Access Journals (Sweden)

    S. V. Suchkov

    2017-01-01

    Full Text Available The article considers the key problems of the transition of the national health-care system to a new platform of personalized medicine and, in particular, pediatrics. The first part, published in this issue, analyzes the most important of the necessary aspects of the infrastructure of the new model. Evidence is given of the extreme urgency of introducing a new model of predictive, preventive and personalized medicine (PPPM. The result of implementation should be breakthrough success in solving many epidemiological, diagnostic, curative, preventive, social and economic problems. It is emphasized that neonatology and pediatrics are the most important link in this paradigm. When considering the potential architectonics of the model, important characteristics of its main segments are revealed. Diagnostic principles (genotyping, targeting, and dynamic screening of biomarkers and arsenal (genomics, proteomics, metabolomics, mathematical modeling tools, etc. of personalized medicine are presented. Attention is focused on the need to create information (global, regional and target-specific banks that are necessary for monitoring individual health. The need to create a new social decision-making mechanism for selecting a preventive protocol that minimizes the risks of the disease or prevents its development is discussed. Four categories of basic programs of medical and social support of persons from the risk category are considered. The necessary conditions for translating these programs into practice are presented. The main tasks and problems of developing the principles for the preparation of preventive-prophylactic and protocols of medical rehabilitation for personalized medicine were discussed. 

  19. Clinical Trials: A Crucial Key to Human Health Research

    Science.gov (United States)

    ... Past Issues Clinical Trials: A Crucial Key to Human Health Research Past Issues / Summer 2006 Table of Contents ... Javascript on. Photo: PhotoDisc At the forefront of human health research today are clinical trials—studies that use ...

  20. Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations.

    Science.gov (United States)

    T H Wan, Thomas; Masri, Maysoun Dimachkie; Ortiz, Judith

    2014-01-01

    The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective. A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures - 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received. RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis. The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act. Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

  1. Developing a systems framework for sustainable infrastructure technologies (SIT) in the built environment focussing on health facilities: A case for Cape Town

    CSIR Research Space (South Africa)

    Saidi, M

    2007-05-01

    Full Text Available The objective of the study is to develop a systems framework for the implementation and management of sustainable infrastructure technologies in the built environment with specific focus on health facilities. It look at the global trends and drivers...

  2. Factors shaping effective utilization of health information technology in urban safety-net clinics.

    Science.gov (United States)

    George, Sheba; Garth, Belinda; Fish, Allison; Baker, Richard

    2013-09-01

    Urban safety-net clinics are considered prime targets for the adoption of health information technology innovations; however, little is known about their utilization in such safety-net settings. Current scholarship provides limited guidance on the implementation of health information technology into safety-net settings as it typically assumes that adopting institutions have sufficient basic resources. This study addresses this gap by exploring the unique challenges urban resource-poor safety-net clinics must consider when adopting and utilizing health information technology. In-depth interviews (N = 15) were used with key stakeholders (clinic chief executive officers, medical directors, nursing directors, chief financial officers, and information technology directors) from staff at four clinics to explore (a) nonhealth information technology-related clinic needs, (b) how health information technology may provide solutions, and (c) perceptions of and experiences with health information technology. Participants identified several challenges, some of which appear amenable to health information technology solutions. Also identified were requirements for effective utilization of health information technology including physical infrastructural improvements, funding for equipment/training, creation of user groups to share health information technology knowledge/experiences, and specially tailored electronic billing guidelines. We found that despite the potential benefit that can be derived from health information technologies, the unplanned and uninformed introduction of these tools into these settings might actually create more problems than are solved. From these data, we were able to identify a set of factors that should be considered when integrating health information technology into the existing workflows of low-resourced urban safety-net clinics in order to maximize their utilization and enhance the quality of health care in such settings.

  3. From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice.

    Science.gov (United States)

    Fazalullasha, Fatima; Taras, Jillian; Morinis, Julia; Levin, Leo; Karmali, Karima; Neilson, Barbara; Muskat, Barbara; Bloch, Gary; Chan, Kevin; McDonald, Maureen; Makin, Sue; Ford-Jones, E Lee

    2014-04-01

    Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician's ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs.

  4. Care Preferences Among Middle-Aged and Older Adults With Chronic Disease in Europe: Individual Health Care Needs and National Health Care Infrastructure.

    Science.gov (United States)

    Mair, Christine A; Quiñones, Ana R; Pasha, Maha A

    2016-08-01

    The purpose of this study is to expand knowledge of care options for aging populations cross-nationally by examining key individual-level and nation-level predictors of European middle-aged and older adults' preferences for care. Drawing on data from the Survey of Health, Ageing and Retirement in Europe and the Organisation for Economic Co-operation and Development, we analyze old age care preferences of a sample of 6,469 adults aged 50 and older with chronic disease in 14 nations. Using multilevel modeling, we analyze associations between individual-level health care needs and nation-level health care infrastructure and preference for family-based (vs. state-based) personal care. We find that middle-aged and older adults with chronic disease whose health limits their ability to perform paid work, who did not receive personal care from informal sources, and who live in nations with generous long-term care funding are less likely to prefer family-based care and more likely to prefer state-based care. We discuss these findings in light of financial risks in later life and the future role of specialized health support programs, such as long-term care. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. [Clinical bioethics for primary health care].

    Science.gov (United States)

    González-de Paz, L

    2013-01-01

    The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  6. Infrastructural Fractals

    DEFF Research Database (Denmark)

    Bruun Jensen, Casper

    2007-01-01

    . Instead, I outline a fractal approach to the study of space, society, and infrastructure. A fractal orientation requires a number of related conceptual reorientations. It has implications for thinking about scale and perspective, and (sociotechnical) relations, and for considering the role of the social...... and a fractal social theory....

  7. District-level variations in childhood immunizations in India: The role of socio-economic factors and health infrastructure.

    Science.gov (United States)

    Rammohan, Anu; Awofeso, Niyi

    2015-11-01

    Routine childhood immunizations against measles and DPT are part of the World Health Organization's (WHO) Expanded Program on Immunization (EPI) set up in 1974, with the aim of reducing childhood morbidity and mortality. Despite this, immunization rates are sub-optimal in developing countries such as India, with wide heterogeneity observed across districts and socio-economic characteristics. The aim of this paper is to examine district-level variations in the propensity to vaccinate a child in India for measles and DPT3, and analyse the extent to which these immunizations are given age-inappropriately, either prematurely or delayed. The present study uses data from the Indian District Level Household Survey (DLHS-3) collected in 2008, and the final sample contains detailed information on 42157 children aged between 12 and 60 months, across 549 Indian districts for whom we have complete information on immunization history. Our empirical study analyses: (i) the district-level average immunization rates for measles and DPT3, and (ii) the extent to which these immunizations have been given age-appropriately. A key contribution of this paper is that we link the household-level data at the district level to data on availability and proximity to health infrastructure and district-level socio-economic factors. Our results show that after controlling for an array of socio-economic characteristics, across all our models, the district's income per capita is a strong predictor of better immunization outcomes for children. Mother's education level at the district-level has a statistically significant and positive influence on immunization outcomes across all our models. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socio-economic outcomes.

    Science.gov (United States)

    Turley, Ruth; Saith, Ruhi; Bhan, Nandita; Rehfuess, Eva; Carter, Ben

    2013-01-31

    Slums are densely populated, neglected parts of cities where housing and living conditions are exceptionally poor. In situ slum upgrading, at its basic level, involves improving the physical environment of the existing area, such as improving and installing basic infrastructure like water, sanitation, solid waste collection, electricity, storm water drainage, access roads and footpaths, and street lighting, as well as home improvements and securing land tenure. To explore the effects of slum upgrading strategies involving physical environment and infrastructure interventions on the health, quality of life and socio-economic wellbeing of urban slum dwellers in low and middle income countries (LMIC). Where reported, data were collected on the perspectives of slum dwellers regarding their needs, preferences for and satisfaction with interventions received. We searched for published and unpublished studies in 28 bibliographic databases including multidisciplinary (for example Scopus) and specialist databases covering health, social science, urban planning, environment and LMIC topics. Snowballing techniques included searching websites, journal handsearching, contacting authors and reference list checking. Searches were not restricted by language or publication date. We included studies examining the impact of slum upgrading strategies involving physical environment or infrastructure improvements (with or without additional co-interventions) on the health, quality of life and socio-economic wellbeing of LMIC urban slum dwellers. Randomised controlled trials (RCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) were eligible for the main analysis. Controlled studies with only post-intervention data (CPI) and uncontrolled before and after (UBA) studies were included in a separate narrative to examine consistency of results and to supplement evidence gaps in the main analysis. Two authors independently extracted data and assessed risk of bias

  9. Building National Healthcare Infrastructure

    DEFF Research Database (Denmark)

    Jensen, Tina Blegind; Thorseng, Anne

    2017-01-01

    This case chapter is about the evolution of the Danish national e-health portal, sundhed.dk, which provides patient-oriented digital services. We present how the organization behind sundhed.dk succeeded in establishing a national healthcare infrastructure by (1) collating and assembling existing...

  10. Renewable Energy for Rural Health Clinics (Energia Removable para Centros de Salud Rurales); TOPICAL

    International Nuclear Information System (INIS)

    Jimenez, A. C.; Olson, K.

    1998-01-01

    This guide provides a broad understanding of the technical, social, and organizational aspects of health clinic electrification, especially through the use of renewable energy sources. It is intended to be used primarily by decision makers within governments or private agencies to accurately assess their health clinic's needs, select appropriate and cost-effective technologies to meet those needs, and to put into place effective infrastructure to install and maintain the hardware. This is the first in a series of rural applications guidebooks that the National Renewable Energy Laboratory (NREL) Village Power Program is commissioning to couple commercial renewable systems with rural applications. The guidebooks are complemented by NREL's Village Power Program's development activities, international pilot projects, and visiting professionals program. For more information on the NREL Village Power Program, visit the Renewables for Sustainable Village Power web site at http://www.rsvp.nrel .gov/rsvp/

  11. Renewable Energy for Rural Health Clinics (Energia Removable para Centros de Salud Rurales)

    Energy Technology Data Exchange (ETDEWEB)

    Jimenez, A. C.; Olson, K.

    1998-09-01

    This guide provides a broad understanding of the technical, social, and organizational aspects of health clinic electrification, especially through the use of renewable energy sources. It is intended to be used primarily by decision makers within governments or private agencies to accurately assess their health clinic's needs, select appropriate and cost-effective technologies to meet those needs, and to put into place effective infrastructure to install and maintain the hardware. This is the first in a series of rural applications guidebooks that the National Renewable Energy Laboratory (NREL) Village Power Program is commissioning to couple commercial renewable systems with rural applications. The guidebooks are complemented by NREL's Village Power Program's development activities, international pilot projects, and visiting professionals program. For more information on the NREL Village Power Program, visit the Renewables for Sustainable Village Power web site at http://www.rsvp.nrel .gov/rsvp/.

  12. Health Informatics and E-health Curriculum for Clinical Health Profession Degrees.

    Science.gov (United States)

    Gray, Kathleen; Choo, Dawn; Butler-Henderson, Kerryn; Whetton, Sue; Maeder, Anthony

    2015-01-01

    The project reported in this paper models a new approach to making health informatics and e-health education widely available to students in a range of Australian clinical health profession degrees. The development of a Masters level subject uses design-based research to apply educational quality assurance practices which are consistent with university qualification frameworks, and with clinical health profession education standards; at the same time it gives recognition to health informatics as a specialised profession in its own right. The paper presents details of (a) design with reference to the Australian Qualifications Framework and CHIA competencies, (b) peer review within a three-university teaching team, (c) external review by experts from the professions, (d) cross-institutional interprofessional online learning, (e) methods for evaluating student learning experiences and outcomes, and (f) mechanisms for making the curriculum openly available to interested parties. The project has sought and found demand among clinical health professionals for formal health informatics and e-health education that is designed for them. It has helped the educators and organisations involved to understand the need for nuanced and complementary health informatics educational offerings in Australian universities. These insights may aid in further efforts to address substantive and systemic challenges that clinical informatics faces in Australia.

  13. Department of Defense, Deployment Health Clinical Center

    Science.gov (United States)

    ... general public of trends in mental health and mental health care within the Military Health System Get The Numbers Real Warriors Campaign Real Warriors Campaign A multimedia public awareness campaign designed to combat the stigma associated with ...

  14. Health information exchanges--Unfulfilled promise as a data source for clinical research.

    Science.gov (United States)

    Parker, Carol; Weiner, Michael; Reeves, Mathew

    2016-03-01

    research outside of the evaluation of HIEs themselves, as well as the limited number of specific HIEs that are involved in generating published research. Significant barriers exist that prevent HIEs from developing into an invaluable resource for clinical research including technological infrastructure limitations, business processes limiting secondary use of data, and lack of participating provider support. Research to better understand challenges to developing the necessary infrastructure and policies to foster HIE engagement in research would be valuable as HIEs represent an opportunity to engage non-traditional health care provider research partners. Copyright © 2015. Published by Elsevier Ireland Ltd.

  15. Demand response to improved walking infrastructure: A study into the economics of walking and health behaviour change.

    Science.gov (United States)

    Longo, Alberto; Hutchinson, W George; Hunter, Ruth F; Tully, Mark A; Kee, Frank

    2015-10-01

    Walking is the most common form of moderate-intensity physical activity among adults, is widely accessible and especially appealing to obese people. Most often policy makers are interested in valuing the effect on walking of changes in some characteristics of a neighbourhood, the demand response for walking, of infrastructure changes. A positive demand response to improvements in the walking environment could help meet the public health target of 150 min of at least moderate-intensity physical activity per week. We model walking in an individual's local neighbourhood as a 'weak complement' to the characteristics of the neighbourhood itself. Walking is affected by neighbourhood characteristics, substitutes, and individual's characteristics, including their opportunity cost of time. Using compensating variation, we assess the economic benefits of walking and how walking behaviour is affected by improvements to the neighbourhood. Using a sample of 1209 respondents surveyed over a 12 month period (Feb 2010-Jan 2011) in East Belfast, United Kingdom, we find that a policy that increased walkability and people's perception of access to shops and facilities would lead to an increase in walking of about 36 min/person/week, valued at £13.65/person/week. When focussing on inactive residents, a policy that improved the walkability of the area would lead to guidelines for physical activity being reached by only 12.8% of the population who are currently inactive. Additional interventions would therefore be needed to encourage inactive residents to achieve the recommended levels of physical activity, as it appears that interventions that improve the walkability of an area are particularly effective in increasing walking among already active citizens, and, among the inactive ones, the best response is found among healthier, younger and wealthier citizens. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Spontaneous Pneumomediastinum: Case Presentation to a College Student Health Clinic

    Science.gov (United States)

    Spotts, P. Hunter

    2017-01-01

    The author describes a case of spontaneous pneumomediastinum (SPM) in a 19-year-old man presenting to a college student health clinic. The author also provides a review on SPM, including clinical manifestations, diagnostic evaluation, and management.

  17. Platform links clinical data with electronic health records

    Science.gov (United States)

    To make data gathered from patients in clinical trials available for use in standard care, NCI has created a new computer tool to support interoperability between clinical research and electronic health record systems. This new software represents an inno

  18. 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.

  19. Advancing food, nutrition, and health research in Europe by connecting and building research infrastructures in a DISH-RI: Results of the EuroDISH project

    DEFF Research Database (Denmark)

    Snoek, Harriëtte M.; Eijssen, Lars M.T.; Geurts, Marjolein

    2018-01-01

    more effectively. Approach In the EuroDISH project we mapped existing RIs in the food and health area in Europe, identified outstanding needs, and synthesised this into a conceptual design of a pan-European DISH-RI. The DISH model was used to describe and structure the research area: Determinants...... of food choice, Intake of foods and nutrients, Status and functional markers of nutritional health, and Health and disease risk. Key findings The need to develop RIs in the food and health domain clearly emerged from the EuroDISH project. It showed the necessity for a unique interdisciplinary and multi......Background Research infrastructures (RIs) are essential to advance research on the relationship between food, nutrition, and health. RIs will facilitate innovation and allow insights at the systems level which are required to design (public health) strategies that will address societal challenges...

  20. Mobile health clinics in the era of reform.

    Science.gov (United States)

    Hill, Caterina F; Powers, Brian W; Jain, Sachin H; Bennet, Jennifer; Vavasis, Anthony; Oriol, Nancy E

    2014-03-01

    Despite the role of mobile clinics in delivering care to the full spectrum of at-risk populations, the collective impact of mobile clinics has never been assessed. This study characterizes the scope of the mobile clinic sector and its impact on access, costs, and quality. It explores the role of mobile clinics in the era of delivery reform and expanded insurance coverage. A synthesis of observational data collected through Mobile Health Map and published literature related to mobile clinics. Analysis of data from the Mobile Health Map Project, an online platform that aggregates data on mobile health clinics in the United States, supplemented by a comprehensive literature review. Mobile clinics represent an integral component of the healthcare system that serves vulnerable populations and promotes high-quality care at low cost. There are an estimated 1500 mobile clinics receiving 5 million visits nationwide per year. Mobile clinics improve access for vulnerable populations, bolster prevention and chronic disease management, and reduce costs. Expanded coverage and delivery reform increase opportunities for mobile clinics to partner with hospitals, health systems, and insurers to improve care and lower costs. Mobile clinics have a critical role to play in providing high-quality, low-cost care to vulnerable populations. The postreform environment, with increasing accountability for population health management and expanded access among historically underserved populations, should strengthen the ability for mobile clinics to partner with hospitals, health systems, and payers to improve care and lower costs.

  1. Evaluative Infrastructures

    DEFF Research Database (Denmark)

    Kornberger, Martin; Pflueger, Dane; Mouritsen, Jan

    2017-01-01

    Platform organizations such as Uber, eBay and Airbnb represent a growing disruptive phenomenon in contemporary capitalism, transforming economic organization, the nature of work, and the distribution of wealth. This paper investigates the accounting practices that underpin this new form...... of organizing, and in doing so confronts a significant challenge within the accounting literature: the need to escape what Hopwood (1996) describes as its “hierarchical consciousness”. In order to do so, this paper develops the concept of evaluative infrastructure which describes accounting practices...

  2. Ritual Infrastructure

    DEFF Research Database (Denmark)

    Sjørslev, Inger

    2017-01-01

    within urban life. There is a certain parallel between these different locations and the difference in ritual roads to certainty in the two religions. The article draws out connections between different levels of infrastructure – material, spatial and ritual. The comparison between the two religions......This article compares the ways in which two different religions in Brazil generate roads to certainty through objectification, one through gods, the other through banknotes. The Afro-Brazilian religion Candomblé provides a road to certainty based on cosmological ideas about gods whose presence...

  3. Community Mental Health Clinic Cost Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Community Mental Health Center (CMHC). This data was reported on form CMS-2088-92. The data in this...

  4. Typical investigational medicinal products follow relatively uniform regulations in 10 European Clinical Research Infrastructures Network (ECRIN) countries

    DEFF Research Database (Denmark)

    Gluud, Christian; Kubiak, Christine; Whitfield, Kate

    2012-01-01

    In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe.......In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe....

  5. Second generation plant health clinics in Uganda

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Matsiko, Frank; Mutebi, Emmanuel

    coverage, Regularity/timeliness and Quality of plant healthcare. Field work was carried out over 15 months between July 2010 and September 2011 in 13 districts in the eastern, central and western parts of Uganda. A total of 205 plant clinic sessions were held in the period. The plant clinics received 2...... from the clinics to diagnostic laboratories. Although the plant clinics have become part of Ministry policy and districts showed increasing interest and commitment, there are some structural barriers that made it difficult for the districts to institutionalise the clinics and for the Ministry to play...... their leading role. A mismatch between institutional mandates/authority and allocated resources limited the scope of the actions both at district and national level. The plant clinics risk ‘falling between the two chairs’ of extension and pest and disease control. Finding a solid institutional base...

  6. Clinical placements in mental health: a literature review.

    Science.gov (United States)

    Happell, Brenda; Gaskin, Cadeyrn J; Byrne, Louise; Welch, Anthony; Gellion, Stephen

    2015-01-01

    Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students' skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.

  7. Health Literacy Assessment in an Otolaryngology Clinic Population.

    Science.gov (United States)

    Megwalu, Uchechukwu C; Lee, Jennifer Y

    2016-12-01

    To assess health literacy in an adult tertiary care otolaryngology clinic population and to explore potential determinants of inadequate health literacy. Cross-sectional study. Tertiary care otolaryngology clinic. The study population included all adult patients treated at 3 of Stanford University's adult otolaryngology clinic sites between March 1 and 11, 2016. Data were collected via an anonymous questionnaire. Health literacy was assessed with the Brief Health Literacy Screen. Ten percent of patients had inadequate health literacy. White race (odds ratio [OR], 0.23) and having English as the primary language (OR, 0.12) were associated with adequate health literacy, while high school or lower level of education (OR, 3.2) was associated with inadequate health literacy. Age, sex, and Hispanic ethnicity were not associated with health literacy. Our study highlights the need for health literacy screening in the otolaryngology clinic setting and identifies sociodemographic risk factors for inadequate health literacy. Further studies are needed to assess the impact of health literacy on patient outcomes and to test specific interventions to address health literacy and health outcomes. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  8. Health Management Information System in Private Clinics in Ilorin ...

    African Journals Online (AJOL)

    This descriptive survey was conducted among private clinics located in Ilorin, Kwara State, Nigeria to determine the awareness and level of involvement of private clinic operators towards the National Health Management Information System. A total of 37 functional clinics responded to the survey. Structured questionnaire ...

  9. Clinical simulation as an evaluation method in health informatics

    DEFF Research Database (Denmark)

    Jensen, Sanne

    2016-01-01

    Safe work processes and information systems are vital in health care. Methods for design of health IT focusing on patient safety are one of many initiatives trying to prevent adverse events. Possible patient safety hazards need to be investigated before health IT is integrated with local clinical...... work practice including other technology and organizational structure. Clinical simulation is ideal for proactive evaluation of new technology for clinical work practice. Clinical simulations involve real end-users as they simulate the use of technology in realistic environments performing realistic...... tasks. Clinical simulation study assesses effects on clinical workflow and enables identification and evaluation of patient safety hazards before implementation at a hospital. Clinical simulation also offers an opportunity to create a space in which healthcare professionals working in different...

  10. Public Health Investment in Team Care: Increasing Access to Clinical Preventive Services in Los Angeles County

    Directory of Open Access Journals (Sweden)

    Tony Kuo

    2018-02-01

    Full Text Available As part of federal and local efforts to increase access to high quality, clinical preventive services (CPS in underserved populations, the Los Angeles County Department of Public Health (DPH partnered with six local health system and community organization partners to promote the use of team care for CPS delivery. Although these partners were at different stages of organizational capacity, post-program review suggests that each organization advanced team care in their clinical or community environments, potentially affecting >250,000 client visits per year. Despite existing infrastructure and DPH’s funding support of CPS integration, partner efforts faced several challenges. They included lack of sustainable funding for prevention services; limited access to community resources that support disease prevention; and difficulties in changing health-care provider behavior. Although team care can serve as a catalyst or vehicle for delivering CPS, downstream sustainability of this model of practice requires further state and national policy changes that prioritize prevention. Public health is well positioned to facilitate these policy discussions and to assist health system and community organizations in strengthening CPS integration.

  11. Clinical Trials Shed Light on Minority Health

    Science.gov (United States)

    ... Native Hawaiian and Pacific Islander communities. OMH project manager Christine Merenda, M.P.H., R.N. explains ... are disproportionately affected by diabetes. But historically, both women and minorities have been under-represented in clinical ...

  12. Infrastructure to support learning health systems: are we there yet? Innovative solutions and lessons learned from American Recovery and Reinvestment Act CER investments.

    Science.gov (United States)

    Holve, Erin; Segal, Courtney

    2014-11-01

    The 11 big health data networks participating in the AcademyHealth Electronic Data Methods Forum represent cutting-edge efforts to harness the power of big health data for research and quality improvement. This paper is a comparative case study based on site visits conducted with a subset of these large infrastructure grants funded through the Recovery Act, in which four key issues emerge that can inform the evolution of learning health systems, including the importance of acknowledging the challenges of scaling specialized expertise needed to manage and run CER networks; the delicate balance between privacy protections and the utility of distributed networks; emerging community engagement strategies; and the complexities of developing a robust business model for multi-use networks.

  13. Sexual Health Attitudes, Knowledge, and Clinical Behaviors: Implications for Counseling

    Science.gov (United States)

    Russell, Elizabeth B.

    2012-01-01

    This article explores the impact of practitioners' attitudes and knowledge of sexual health on clinical behaviors. Sexual health topics are often areas of concern for clients of any age in counseling. Thus, counselors must be trained and equipped to address sexual health across the life span. This study explored whether child and adolescent…

  14. Building community-engaged health research and discovery infrastructure on the South Side of Chicago: science in service to community priorities.

    Science.gov (United States)

    Lindau, Stacy Tessler; Makelarski, Jennifer A; Chin, Marshall H; Desautels, Shane; Johnson, Daniel; Johnson, Waldo E; Miller, Doriane; Peters, Susan; Robinson, Connie; Schneider, John; Thicklin, Florence; Watson, Natalie P; Wolfe, Marcus; Whitaker, Eric

    2011-01-01

    To describe the roles community members can and should play in, and an asset-based strategy used by Chicago's South Side Health and Vitality Studies for, building sustainable, large-scale community health research infrastructure. The Studies are a family of research efforts aiming to produce actionable knowledge to inform health policy, programming, and investments for the region. Community and university collaborators, using a consensus-based approach, developed shared theoretical perspectives, guiding principles, and a model for collaboration in 2008, which were used to inform an asset-based operational strategy. Ongoing community engagement and relationship-building support the infrastructure and research activities of the studies. Key steps in the asset-based strategy include: 1) continuous community engagement and relationship building, 2) identifying community priorities, 3) identifying community assets, 4) leveraging assets, 5) conducting research, 6) sharing knowledge and 7) informing action. Examples of community member roles, and how these are informed by the Studies' guiding principles, are provided. Community and university collaborators, with shared vision and principles, can effectively work together to plan innovative, large-scale community-based research that serves community needs and priorities. Sustainable, effective models are needed to realize NIH's mandate for meaningful translation of biomedical discovery into improved population health. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. "Tobacco Truths": Health Magazine, Clinical Epidemiology, and the Cigarette Connection.

    Science.gov (United States)

    Wilmshurst, Sara

    2015-01-01

    In the 1950s, Health, a magazine published by the Health League of Canada, was nonchalant about the risks of smoking and largely ignored early epidemiological studies of lung cancer. In the 1960s the magazine stopped accepting cigarette advertising and began to oppose smoking. Health's writers adjusted to new knowledge; the magazine gradually accepted clinical epidemiology as a source of medical knowledge and recognized smoking as a public health risk. As Canada's only devoted health publication for a lay audience at the time, Health provides a unique window into ways that smoking and health were portrayed to its readers.

  16. Using mobile clinics to deliver HIV testing and other basic health services in rural Malawi.

    Science.gov (United States)

    Lindgren, T G; Deutsch, K; Schell, E; Bvumbwe, A; Hart, K B; Laviwa, J; Rankin, S H

    2011-01-01

    The majority of Malawians are impoverished and primarily dependant on subsistence farming, with 85% of the population living in a rural area. The country is highly affected by HIV and under-resourced rural health centers struggle to meet the government's goal of expanding HIV testing, antiretroviral treatment, and other basic services. This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The program was developed by an international non-governmental organization, Global AIDS Interfaith Alliance (GAIA), and the Mulanje District Health Office, with funding from the Elizabeth Taylor HIV/AIDS Foundation. The clinics provide: (1) rapid HIV testing and treatment referral; (2) diagnosis and treatment of malaria; (3) sputum collection for TB screening; (4) diagnosis and treatment of sexually transmitted and opportunistic infections; and (5) pre-natal care. The clinic vehicles provide medical supplies and personnel (a clinical officer, nurse, and nurse aide) to set up clinics in community buildings such as churches or schools. In such a project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. Assessing the impact of healthcare delivery in Malawi is challenging. Although mobile clinic and the government Health Management Information System (HMIS) data were matched, inconsistent variables and gaps in data made direct comparisons difficult. Data collection was compromised by the competing demand of high patient volume; however, rather than reducing the burden on

  17. Perspectives on Clinical Informatics: Integrating Large-Scale Clinical, Genomic, and Health Information for Clinical Care

    Directory of Open Access Journals (Sweden)

    In Young Choi

    2013-12-01

    Full Text Available The advances in electronic medical records (EMRs and bioinformatics (BI represent two significant trends in healthcare. The widespread adoption of EMR systems and the completion of the Human Genome Project developed the technologies for data acquisition, analysis, and visualization in two different domains. The massive amount of data from both clinical and biology domains is expected to provide personalized, preventive, and predictive healthcare services in the near future. The integrated use of EMR and BI data needs to consider four key informatics areas: data modeling, analytics, standardization, and privacy. Bioclinical data warehouses integrating heterogeneous patient-related clinical or omics data should be considered. The representative standardization effort by the Clinical Bioinformatics Ontology (CBO aims to provide uniquely identified concepts to include molecular pathology terminologies. Since individual genome data are easily used to predict current and future health status, different safeguards to ensure confidentiality should be considered. In this paper, we focused on the informatics aspects of integrating the EMR community and BI community by identifying opportunities, challenges, and approaches to provide the best possible care service for our patients and the population.

  18. 42 CFR 405.2462 - Payment for rural health clinic and Federally qualified health center services.

    Science.gov (United States)

    2010-10-01

    ... integral and subordinate part of a hospital, skilled nursing facility or home health agency participating... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for rural health clinic and Federally qualified health center services. 405.2462 Section 405.2462 Public Health CENTERS FOR MEDICARE & MEDICAID...

  19. A review of analytics and clinical informatics in health care.

    Science.gov (United States)

    Simpao, Allan F; Ahumada, Luis M; Gálvez, Jorge A; Rehman, Mohamed A

    2014-04-01

    Federal investment in health information technology has incentivized the adoption of electronic health record systems by physicians and health care organizations; the result has been a massive rise in the collection of patient data in electronic form (i.e. "Big Data"). Health care systems have leveraged Big Data for quality and performance improvements using analytics-the systematic use of data combined with quantitative as well as qualitative analysis to make decisions. Analytics have been utilized in various aspects of health care including predictive risk assessment, clinical decision support, home health monitoring, finance, and resource allocation. Visual analytics is one example of an analytics technique with an array of health care and research applications that are well described in the literature. The proliferation of Big Data and analytics in health care has spawned a growing demand for clinical informatics professionals who can bridge the gap between the medical and information sciences.

  20. Do knowledge infrastructure facilities support Evidence-Based Practice in occupational health? An exploratory study across countries among occupational physicians enrolled on Evidence-Based Medicine courses

    Directory of Open Access Journals (Sweden)

    van Dijk Frank JH

    2009-01-01

    Full Text Available Abstract Background Evidence-Based Medicine (EBM is an important method used by occupational physicians (OPs to deliver high quality health care. The presence and quality of a knowledge infrastructure is thought to influence the practice of EBM in occupational health care. This study explores the facilities in the knowledge infrastructure being used by OPs in different countries, and their perceived importance for EBM practice. Methods Thirty-six OPs from ten countries, planning to attend an EBM course and to a large extent recruited via the European Association of Schools of Occupational Medicine (EASOM, participated in a cross-sectional study. Results Research and development institutes, and knowledge products and tools are used by respectively more than 72% and more than 80% of the OPs and they are rated as being important for EBM practice (more than 65 points (range 0–100. Conventional knowledge access facilities, like traditional libraries, are used often (69% but are rated as less important (46.8 points (range 0–100 compared to the use of more novel facilities, like question-and-answer facilities (25% that are rated as more important (48.9 points (range 0–100. To solve cases, OPs mostly use non evidence-based sources. However, they regard the evidence-based sources that are not often used, e.g. the Cochrane library, as important enablers for practising EBM. The main barriers are lack of time, payment for full-text articles, language barrier (most texts are in English, and lack of skills and support. Conclusion This first exploratory study shows that OPs use many knowledge infrastructure facilities and rate them as being important for their EBM practice. However, they are not used to use evidence-based sources in their practice and face many barriers that are comparable to the barriers physicians face in primary health care.

  1. An electronic health record for infertility clinics

    African Journals Online (AJOL)

    ART [assisted reproductive technology] data monitoring is not a substitute for sound ... Medical history, i.e. a detailed history of the patient's past health/ illnesses .... been done in the North Shore Hospital System on Long Island in. New York[6] ...

  2. Integration of clinical research documentation in electronic health records.

    Science.gov (United States)

    Broach, Debra

    2015-04-01

    Clinical trials of investigational drugs and devices are often conducted within healthcare facilities concurrently with clinical care. With implementation of electronic health records, new communication methods are required to notify nonresearch clinicians of research participation. This article reviews clinical research source documentation, the electronic health record and the medical record, areas in which the research record and electronic health record overlap, and implications for the research nurse coordinator in documentation of the care of the patient/subject. Incorporation of clinical research documentation in the electronic health record will lead to a more complete patient/subject medical record in compliance with both research and medical records regulations. A literature search provided little information about the inclusion of clinical research documentation within the electronic health record. Although regulations and guidelines define both source documentation and the medical record, integration of research documentation in the electronic health record is not clearly defined. At minimum, the signed informed consent(s), investigational drug or device usage, and research team contact information should be documented within the electronic health record. Institutional policies should define a standardized process for this integration in the absence federal guidance. Nurses coordinating clinical trials are in an ideal position to define this integration.

  3. Managing risk: clinical decision-making in mental health services.

    Science.gov (United States)

    Muir-Cochrane, Eimear; Gerace, Adam; Mosel, Krista; O'Kane, Debra; Barkway, Patricia; Curren, David; Oster, Candice

    2011-01-01

    Risk assessment and management is a major component of contemporary mental health practice. Risk assessment in health care exists within contemporary perspectives of management and risk aversive practices in health care. This has led to much discussion about the best approach to assessing possible risks posed by people with mental health problems. In addition, researchers and commentators have expressed concern that clinical practice is being dominated by managerial models of risk management at the expense of meeting the patient's health and social care needs. The purpose of the present study is to investigate the risk assessment practices of a multidisciplinary mental health service. Findings indicate that mental health professionals draw on both managerial and therapeutic approaches to risk management, integrating these approaches into their clinical practice. Rather than being dominated by managerial concerns regarding risk, the participants demonstrate professional autonomy and concern for the needs of their clients.

  4. Clinical genomics in the world of the electronic health record.

    Science.gov (United States)

    Marsolo, Keith; Spooner, S Andrew

    2013-10-01

    The widespread adoption of electronic health records presents a number of benefits to the field of clinical genomics. They include the ability to return results to the practitioner, to use genetic findings in clinical decision support, and to have data collected in the electronic health record that serve as a source of phenotypic information for analysis purposes. Not all electronic health records are created equal, however. They differ in their features, capabilities, and ease of use. Therefore, to understand the potential of the electronic health record, it is first necessary to understand its capabilities and the impact that implementation strategy has on usability. Specifically, we focus on the following areas: (i) how the electronic health record is used to capture data in clinical practice settings; (ii) how the implementation and configuration of the electronic health record affect the quality and availability of data; (iii) the management of clinical genetic test results and the feasibility of electronic health record integration; and (iv) the challenges of implementing an electronic health record in a research-intensive environment. This is followed by a discussion of the minimum functional requirements that an electronic health record must meet to enable the satisfactory integration of genomic results as well as the open issues that remain.

  5. Do Physical Proximity and Availability of Adequate Infrastructure at Public Health Facility Increase Institutional Delivery? A Three Level Hierarchical Model Approach.

    Science.gov (United States)

    Patel, Rachana; Ladusingh, Laishram

    2015-01-01

    This study aims to examine the inter-district and inter-village variation of utilization of health services for institutional births in EAG states in presence of rural health program and availability of infrastructures. District Level Household Survey-III (2007-08) data on delivery care and facility information was used for the purpose. Bivariate results examined the utilization pattern by states in presence of correlates of women related while a three-level hierarchical multilevel model illustrates the effect of accessibility, availability of health facility and community health program variables on the utilization of health services for institutional births. The study found a satisfactory improvement in state Rajasthan, Madhya Pradesh and Orissa, importantly, in Bihar and Uttaranchal. The study showed that increasing distance from health facility discouraged institutional births and there was a rapid decline of more than 50% for institutional delivery as the distance to public health facility exceeded 10 km. Additionally, skilled female health worker (ANM) and observed improved public health facility led to significantly increase the probability of utilization as compared to non-skilled ANM and not-improved health centers. Adequacy of essential equipment/laboratory services required for maternal care significantly encouraged deliveries at public health facility. District/village variables neighborhood poverty was negatively related to institutional delivery while higher education levels in the village and women's residing in more urbanized districts increased the utilization. "Inter-district" variation was 14 percent whereas "between-villages" variation for the utilization was 11 percent variation once controlled for all the three-level variables in the model. This study suggests that the mere availability of health facilities is necessary but not sufficient condition to promote utilization until the quality of service is inadequate and inaccessible considering

  6. Do Physical Proximity and Availability of Adequate Infrastructure at Public Health Facility Increase Institutional Delivery? A Three Level Hierarchical Model Approach.

    Directory of Open Access Journals (Sweden)

    Rachana Patel

    Full Text Available This study aims to examine the inter-district and inter-village variation of utilization of health services for institutional births in EAG states in presence of rural health program and availability of infrastructures. District Level Household Survey-III (2007-08 data on delivery care and facility information was used for the purpose. Bivariate results examined the utilization pattern by states in presence of correlates of women related while a three-level hierarchical multilevel model illustrates the effect of accessibility, availability of health facility and community health program variables on the utilization of health services for institutional births. The study found a satisfactory improvement in state Rajasthan, Madhya Pradesh and Orissa, importantly, in Bihar and Uttaranchal. The study showed that increasing distance from health facility discouraged institutional births and there was a rapid decline of more than 50% for institutional delivery as the distance to public health facility exceeded 10 km. Additionally, skilled female health worker (ANM and observed improved public health facility led to significantly increase the probability of utilization as compared to non-skilled ANM and not-improved health centers. Adequacy of essential equipment/laboratory services required for maternal care significantly encouraged deliveries at public health facility. District/village variables neighborhood poverty was negatively related to institutional delivery while higher education levels in the village and women's residing in more urbanized districts increased the utilization. "Inter-district" variation was 14 percent whereas "between-villages" variation for the utilization was 11 percent variation once controlled for all the three-level variables in the model. This study suggests that the mere availability of health facilities is necessary but not sufficient condition to promote utilization until the quality of service is inadequate and

  7. Technology transfer for the implementation of a clinical trials network on drug abuse and mental health treatment in Mexico.

    Science.gov (United States)

    Horigian, Viviana E; Marín-Navarrete, Rodrigo A; Verdeja, Rosa E; Alonso, Elizabeth; Perez, María A; Fernández-Mondragón, José; Berlanga, Carlos; Medina-Mora, María Elena; Szapocznik, José

    2015-09-01

    Low- and middle-income countries (LMIC) lack the research infrastructure and capacity to conduct rigorous substance abuse and mental health effectiveness clinical trials to guide clinical practice. A partnership between the Florida Node Alliance of the United States National Drug Abuse Treatment Clinical Trials Network and the National Institute of Psychiatry in Mexico was established in 2011 to improve substance abuse practice in Mexico. The purpose of this partnership was to develop a Mexican national clinical trials network of substance abuse researchers and providers capable of implementing effectiveness randomized clinical trials in community-based settings. A technology transfer model was implemented and ran from 2011-2013. The Florida Node Alliance shared the "know how" for the development of the research infrastructure to implement randomized clinical trials in community programs through core and specific training modules, role-specific coaching, pairings, modeling, monitoring, and feedback. The technology transfer process was bi-directional in nature in that it was informed by feedback on feasibility and cultural appropriateness for the context in which practices were implemented. The Institute, in turn, led the effort to create the national network of researchers and practitioners in Mexico and the implementation of the first trial. A collaborative model of technology transfer was useful in creating a Mexican researcher-provider network that is capable of changing national practice in substance abuse research and treatment. Key considerations for transnational technology transfer are presented.

  8. Health literacy and usability of clinical trial search engines.

    Science.gov (United States)

    Utami, Dina; Bickmore, Timothy W; Barry, Barbara; Paasche-Orlow, Michael K

    2014-01-01

    Several web-based search engines have been developed to assist individuals to find clinical trials for which they may be interested in volunteering. However, these search engines may be difficult for individuals with low health and computer literacy to navigate. The authors present findings from a usability evaluation of clinical trial search tools with 41 participants across the health and computer literacy spectrum. The study consisted of 3 parts: (a) a usability study of an existing web-based clinical trial search tool; (b) a usability study of a keyword-based clinical trial search tool; and (c) an exploratory study investigating users' information needs when deciding among 2 or more candidate clinical trials. From the first 2 studies, the authors found that users with low health literacy have difficulty forming queries using keywords and have significantly more difficulty using a standard web-based clinical trial search tool compared with users with adequate health literacy. From the third study, the authors identified the search factors most important to individuals searching for clinical trials and how these varied by health literacy level.

  9. An electronic health record for infertility clinics | Coetsee | South ...

    African Journals Online (AJOL)

    Objective. To design a user-friendly electronic health record system for infertility clinics (EHRIC) to capture quality data that will allow advanced audit and practice analysis, and to use the captured data for the South African Register of Assisted Reproductive Techniques (SARA) database and as a clinical research function.

  10. Clinical trial registration in oral health journals.

    Science.gov (United States)

    Smaïl-Faugeron, V; Fron-Chabouis, H; Durieux, P

    2015-03-01

    Prospective registration of randomized controlled trials (RCTs) represents the best solution to reporting bias. The extent to which oral health journals have endorsed and complied with RCT registration is unknown. We identified journals publishing RCTs in dentistry, oral surgery, and medicine in the Journal Citation Reports. We classified journals into 3 groups: journals requiring or recommending trial registration, journals referring indirectly to registration, and journals providing no reference to registration. For the 5 journals with the highest 2012 impact factors in each group, we assessed whether RCTs with results published in 2013 had been registered. Of 78 journals examined, 32 (41%) required or recommended trial registration, 19 (24%) referred indirectly to registration, and 27 (35%) provided no reference to registration. We identified 317 RCTs with results published in the 15 selected journals in 2013. Overall, 73 (23%) were registered in a trial registry. Among those, 91% were registered retrospectively and 32% did not report trial registration in the published article. The proportion of trials registered was not significantly associated with editorial policies: 29% with results in journals that required or recommended registration, 15% in those that referred indirectly to registration, and 21% in those providing no reference to registration (P = 0.05). Less than one-quarter of RCTs with results published in a sample of oral health journals were registered with a public registry. Improvements are needed with respect to how journals inform and require their authors to register their trials. © International & American Associations for Dental Research.

  11. Clinical, classroom, or personal education: attitudes about health literacy.

    Science.gov (United States)

    Logan, Robert A

    2007-04-01

    This study explores how diverse attitudes about health literacy are assessed by medical librarians and other health care professionals. An online survey of thirty-six items was conducted using Q methodology in two phases in spring 2005 and winter 2006. Respondents (n = 51) were nonrandomly self-selected from a convenience sample of members of the Medical Library Association and a group of environmental health consultants to the National Library of Medicine. Three factors were identified. Factor 1 is optimistic and supportive of health literacy's transformative sociocultural and professional potential, if clinical settings become a launching point for health literacy activities. Factor 2 is less optimistic about health literacy's potential to improve clinical or patient outcomes and prefers to focus health literacy initiatives on classroom education settings. Factor 3 supports improving the nation's health literacy but tends to support health literacy initiatives when people privately interact with health information materials. Each factor's attitudes about the appropriate educational venue to initiate health literacy activities are different and somewhat mutually exclusive. This suggests that health literacy is seen through different perceptual frameworks that represent a possible source of professional disagreement.

  12. Central Region Green Infrastructure

    Data.gov (United States)

    Minnesota Department of Natural Resources — This Green Infrastructure data is comprised of 3 similar ecological corridor data layers ? Metro Conservation Corridors, green infrastructure analysis in counties...

  13. Armenia - Irrigation Infrastructure

    Data.gov (United States)

    Millennium Challenge Corporation — This study evaluates irrigation infrastructure rehabilitation in Armenia. The study separately examines the impacts of tertiary canals and other large infrastructure...

  14. Strategies for Improving Nursing Students' Mental Health Clinical Rotation.

    Science.gov (United States)

    Kroning, Maureen

    2016-01-01

    Mental illness is a huge problem many people face in the U.S. and around the world. The American Psychiatric Nurses Association indicates there is a shortage of nurses in every level and role in psychiatric-mental health nursing. Raising up a generation of nurses who want to work with the mentally ill is a challenge for nurse educators. The use of role playing and simulation in the learning lab prior to entering the clinical setting and reflective journaling in the clinical rotation can improve undergraduate nursing students' mental health clinical experience.

  15. Understanding the infrastructure of European Research Infrastructures

    DEFF Research Database (Denmark)

    Lindstrøm, Maria Duclos; Kropp, Kristoffer

    2017-01-01

    European Research Infrastructure Consortia (ERIC) are a new form of legal and financial framework for the establishment and operation of research infrastructures in Europe. Despite their scope, ambition, and novelty, the topic has received limited scholarly attention. This article analyses one ER....... It is also a promising theoretical framework for addressing the relationship between the ERIC construct and the large diversity of European Research Infrastructures.......European Research Infrastructure Consortia (ERIC) are a new form of legal and financial framework for the establishment and operation of research infrastructures in Europe. Despite their scope, ambition, and novelty, the topic has received limited scholarly attention. This article analyses one ERIC...... became an ERIC using the Bowker and Star’s sociology of infrastructures. We conclude that focusing on ERICs as a European standard for organising and funding research collaboration gives new insights into the problems of membership, durability, and standardisation faced by research infrastructures...

  16. Collaborative learning of clinical skills in health professions education

    DEFF Research Database (Denmark)

    Tolsgaard, Martin G.; Kulasegaram, Kulamakan M.; Ringsted, Charlotte V

    2016-01-01

    Objectives: This study is designed to provide an overview of why, how, when and for whom collaborative learning of clinical skills may work in health professions education. Why: Collaborative learning of clinical skills may influence learning positively according to the non-medical literature...... suggests that learning is dependent on cognitive co-construction, shared knowledge and reduced cognitive load. When and for whom: The literature on the collaborative learning of clinical skills in health science education is reviewed to support or contradict the hypotheses provided by the theories outlined...... above. Collaborative learning of clinical skills leads to improvements in self-efficacy, confidence and performance when task processing is observable or communicable. However, the effects of collaborative learning of clinical skills may decrease over time as benefits in terms of shared cognition...

  17. Characteristics of Health Educators Desired by Inner-City Health Clinic Patients: A Case Study

    Science.gov (United States)

    Price, James; Sidani, Jaime

    2007-01-01

    A group (n = 170) of inner-city, predominantly African American, health clinic patients were asked to identify the characteristics they desired in a new clinic health educator. A plurality (44%) of the patients perceived a bachelor's degree would be a sufficient level of education. The vast majority of patients claimed the sex of the health…

  18. Building Infrastructure to Accelerate Transfer of Basic Research in Spinal Cord Injury (SCI) to Clinical Practice: North American Clinical Trials Network

    Science.gov (United States)

    2013-08-01

    that may emerge and longer term lifestyle and caregiving issues). A recent Lancet publication (Freund et al) reports on the use of MRI to track the...hours of injury. Riluzole, 50 mg, was administered enterally ( tablet form) every 12 hours for 14 days. At the successful conclusion of the Riluzole...report. • Michael Fehlings, MD, PhD, University Health Network (University of Toronto) (NOA5-2011-MF) for “The use of MRI characteristics to predict

  19. Mayo Clinic Care Network: A Collaborative Health Care Model.

    Science.gov (United States)

    Wald, John T; Lowery-Schrandt, Sherri; Hayes, David L; Kotsenas, Amy L

    2018-01-01

    By leveraging its experience and expertise as a consultative clinical partner, the Mayo Clinic developed an innovative, scalable care model to accomplish several strategic goals: (1) create and sustain high-value relationships that benefit patients and providers, (2) foster relationships with like-minded partners to act as a strategy against the development of narrow health care networks, and (3) increase national and international brand awareness of Mayo Clinic. The result was the Mayo Clinic Care Network. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. Awareness and using of medical students about mobile health technology in clinical areas.

    Science.gov (United States)

    Ehteshami, Asghar; Hachesu, Peyman Rezaei; Esfahani, Mahtab Kasayi; Rezazadeh, Esmaeil

    2013-01-01

    NONE DECLARED. Necessity of data transmission and getting contact with specialists is so evident in impassable regions. In order to solve such problems, there are different solutions one of which is mobile health technology. Being small and user-friendly, easy to enter data and having low expense are some of its advantages. This study aims to define the association between awareness of medical students in clinical stage about mobile health technology application and the rate of their using this technology in educational hospital of Isfahan in 2011. The study is a cross-sectional analytical application research. Sixty medical students were selected as samples from a society of 240 medical students. A researcher-made questionnaire was used. The questionnaire included 21 multiple choice and 15 yes no questions, which were corrected to reach a score. A researcher-made checklist with 5-fold Likert scale was used to define the rate of applying such technology. The reliability of questionnaire was confirmed through a test-retest. The collected data were analyzed with the help of SPSS software in descriptive and deductive statistics level. The highest percentage of awareness about mobile health technology among medical students in the clinical stage of Azzahra educational hospital is 45.6 in nature areas, and their lowest percentage of awareness is 17.8 in the infrastructure area. In addition, their mean awareness of all areas is 54.4. The highest percentage of using mobile health technology by medical students is 14.6 in the education area, and their lowest percentage of usage is 6.8 in the treatment area. Their mean usage of all areas is 9.4 as well. The rate of awareness and application of mobile health technology is not favorable. Except for treatment, there is no significant association between the rate of awareness and application of mobile health technology.

  1. Awareness and Using of Medical Students About Mobile Health Technology in Clinical Areas

    Science.gov (United States)

    Ehteshami, Asghar; Hachesu, Peyman Rezaei; Esfahani, Mahtab Kasayi

    2013-01-01

    CONFLICT OF INTEREST: NONE DECLARED Introduction Necessity of data transmission and getting contact with specialists is so evident in impassable regions. In order to solve such problems, there are different solutions one of which is mobile health technology. Being small and user-friendly, easy to enter data and having low expense are some of its advantages. This study aims to define the association between awareness of medical students in clinical stage about mobile health technology application and the rate of their using this technology in educational hospital of Isfahan in 2011. Method The study is a cross-sectional analytical application research. Sixty medical students were selected as samples from a society of 240 medical students. A researcher-made questionnaire was used. The questionnaire included 21 multiple choice and 15 yes no questions, which were corrected to reach a score. A researcher-made checklist with 5-fold Likert scale was used to define the rate of applying such technology. The reliability of questionnaire was confirmed through a test–retest. The collected data were analyzed with the help of SPSS software in descriptive and deductive statistics level. Findings The highest percentage of awareness about mobile health technology among medical students in the clinical stage of Azzahra educational hospital is 45.6 in nature areas, and their lowest percentage of awareness is 17.8 in the infrastructure area. In addition, their mean awareness of all areas is 54.4. The highest percentage of using mobile health technology by medical students is 14.6 in the education area, and their lowest percentage of usage is 6.8 in the treatment area. Their mean usage of all areas is 9.4 as well. Conclusion The rate of awareness and application of mobile health technology is not favorable. Except for treatment, there is no significant association between the rate of awareness and application of mobile health technology. PMID:24058250

  2. Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery.

    Science.gov (United States)

    Birx, Deborah; de Souza, Mark; Nkengasong, John N

    2009-06-01

    Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment.

  3. Cost analysis of public health influenza vaccine clinics in Ontario.

    Science.gov (United States)

    Mercer, Nicola J

    2009-01-01

    Public health in Ontario delivers, promotes and provides each fall the universal influenza immunization program. This paper addresses the question of whether Ontario public health agencies are able to provide the influenza immunization program within the Ministry of Health fiscal funding envelope of $5 per dose. Actual program delivery data from the 2006 influenza season of Wellington-Dufferin-Guelph Public Health (WDGPH) were used to create a model template for influenza clinics capturing all variable costs. Promotional and administrative costs were separated from clinic costs. Maximum staff workloads were estimated. Vaccine clinics were delivered by public health staff in accordance with standard vaccine administration practices. The most significant economic variables for influenza clinics are labour costs and number of vaccines given per nurse per hour. The cost of facility rental was the only other significant cost driver. The ability of influenza clinics to break even depended on the ability to manage these cost drivers. At WDGPH, weekday flu clinics required the number of vaccines per nurse per hour to exceed 15, and for weekend flu clinics this number was greater than 21. We estimate that 20 vaccines per hour is at the limit of a safe workload over several hours. Managing cost then depends on minimizing hourly labour costs. The results of this analysis suggest that by managing the labour costs along with planning the volume of patients and avoiding expensive facilities, flu clinics can just break even. However, any increased costs, including negotiated wage increases or the move to safety needles, with a fixed revenue of $5.00 per dose will negate this conclusion.

  4. Health claims on foods: challenge for clinical research companies

    Directory of Open Access Journals (Sweden)

    Essi Sarkkinen

    2012-06-01

    Full Text Available Background The Nutrition and Health Claim Regulation 1924/2006/EC, together with EFSA guidances on the scientific requirements for different type of health claims, is setting the basis for health claim substantiation in the EU. Aim The aim of this presentation is to bring up the key challenges that the food industry and clinical research organizations are facing when meeting these requirements. Results and discussion Key issues in clinical research planning to meet the requirements set for the health claim substantiation are: (1 Selection of right outcome markers since the selection of outcome marker defines actually the formulation of the health claim to be used on food or food ingredient. (2 Selection of right target population since that determines the target consumer group for the food with a health claim. (3 Selection of dose regime and food matrices used since these largely determine the conditions set for the use of the health claim. One of the major challenges in health claim substantiation is the deviant approach to risk factors or biomarkers. From the regulation point of view, a single risk factor approach is emphasized, but from the clinical and scientific point of view the pattern of different risk markers or biomarkers could, in some cases, be a more relevant choice to reflect the final health outcome. This is especially the case in the nutrition and health area because we are often dealing with weak but multiple health effects of certain food items or ingredients. Also the lack of validated well-established biomarkers potent to be affected by diet is a challenge in health claim substantiation.The selection of right target population is often a compromise between choosing a more potential target group to obtain efficacy (i.e. risk factors elevated vs. patient groups and choosing a rationale to generalize the results to wider population (target consumer group.The selection of optimal dosing regime and matrices for a clinical study is

  5. INFRASTRUCTURING DESIGN

    DEFF Research Database (Denmark)

    Ertner, Sara Marie

    The fact that the average citizen in Western societies is aging has significant implications for national welfare models. What some call ’the grey tsunami’ has resulted in suggestions for, and experiments in, re-designing healthcare systems and elderly care. In Denmark, one attempted solution...... that are imagined as the target group for welfare technology, and where are they located? Based on ethnographic explorations of ’welfare technology’ and related figures that include not only ’the elderly’, but also ’prototypes’ and ’partnership’ the dissertation analyses the processes and socio...... for collaborative design to happen. The implication of this is that technological design should not be imagined as the foundation for shaping more effective health care practices and better welfare. Instead, possibilities for improving practices through welfare technology emerge out of heterogeneous assemblages...

  6. Employee Health in the Mental Health Workplace: Clinical, Administrative, and Organizational Perspectives.

    Science.gov (United States)

    Shah, Jai L; Kapoor, Reena; Cole, Robert; Steiner, Jeanne L

    2016-04-01

    Issues of mental health and employee health have risen to increasing prominence in recent years. However, there have been few explorations of the clinical and administrative challenges that these issues raise, particularly in settings that are themselves mental health workplaces. In order to identify and understand such challenges, a brief case of acute employee illness in a mental health workplace is described followed by a discussion of salient clinical, administrative, and organizational considerations. The case raises questions about medicolegal responsibilities and relationships between clinicians and patients in mental health settings, illuminates tensions between clinical staff and human resources processes, and draws attention to the need for illness prevention and mental health promotion initiatives in the workplace. Increased awareness of these issues, complications, and potential solutions would benefit clinicians, administrators, and mental health institutions.

  7. Support for Offering Sexual Health Services through School-Based Health Clinics

    Science.gov (United States)

    Moore, Michele Johnson; Barr, Elissa; Wilson, Kristina; Griner, Stacey

    2016-01-01

    Background: Numerous studies document support for sexuality education in the schools. However, there is a dearth of research assessing support for sexual health services offered through school-based health clinics (SBHCs). The purpose of this study was to assess voter support for offering 3 sexual health services (STI/HIV testing, STI/HIV…

  8. Machine learning methods for clinical forms analysis in mental health.

    Science.gov (United States)

    Strauss, John; Peguero, Arturo Martinez; Hirst, Graeme

    2013-01-01

    In preparation for a clinical information system implementation, the Centre for Addiction and Mental Health (CAMH) Clinical Information Transformation project completed multiple preparation steps. An automated process was desired to supplement the onerous task of manual analysis of clinical forms. We used natural language processing (NLP) and machine learning (ML) methods for a series of 266 separate clinical forms. For the investigation, documents were represented by feature vectors. We used four ML algorithms for our examination of the forms: cluster analysis, k-nearest neigh-bours (kNN), decision trees and support vector machines (SVM). Parameters for each algorithm were optimized. SVM had the best performance with a precision of 64.6%. Though we did not find any method sufficiently accurate for practical use, to our knowledge this approach to forms has not been used previously in mental health.

  9. Federally qualified health center dental clinics: financial information.

    Science.gov (United States)

    Bailit, Howard L; Devitto, Judy; Myne-Joslin, Ronnie; Beazoglou, Tryfon; McGowan, Taegan

    2013-01-01

    Federally Qualified Health Center (FQHC) dental clinics are a major component of the dental safety net system, providing care to 3.75 million patients annually. This study describes the financial and clinical operations of a sample of FQHCs. In cooperation with the National Network for Oral Health Access, FQHC dental clinics that could provide 12 months of electronic dental record information were asked to participate in the study. Based on data from 28 dental clinics (14 FQHCs), 50 percent of patients were under 21 years of age. The primary payers were Medicaid (72.4 percent) and sliding-scale/self-pay patients (17.5 percent). Sites averaged 3.1 operatories, 0.66 dental hygienists, and 1.9 other staff per dentist. Annually, each FTE dentist and hygienist provided 2,801 and 2,073 patient visits, respectively. Eighty percent of services were diagnostic, preventive, and restorative. Patient care accounted for 82 percent of revenues, and personnel (64.2 percent) and central administration (13.4 percent) accounted for most expenses. Based on a small convenience sample of FQHC dental clinics, this study presents descriptive data on their clinical and financial operations. Compared with data from the UDS (Uniform Data System) report, study FQHCs were larger in terms of space, staff, and patients served. However, there was substantial variation among clinics for almost all measures. As the number and size of FQHC dental clinics increase, the Health Resources and Services Administration needs to provide them access to comparative data that they can use to benchmark their operations. © 2013 American Association of Public Health Dentistry.

  10. mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review.

    Science.gov (United States)

    Adepoju, Ibukun-Oluwa Omolade; Albersen, Bregje Joanna Antonia; De Brouwere, Vincent; van Roosmalen, Jos; Zweekhorst, Marjolein

    2017-03-23

    In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established. The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa. A scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA. We retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training. The use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings. ©Ibukun-Oluwa Omolade Adepoju, Bregje Joanna Antonia

  11. Successful introduction of an underutilized elderly pneumococcal vaccine in a national immunization program by integrating the pre-existing public health infrastructure.

    Science.gov (United States)

    Yang, Tae Un; Kim, Eunsung; Park, Young-Joon; Kim, Dongwook; Kwon, Yoon Hyung; Shin, Jae Kyong; Park, Ok

    2016-03-18

    Although pneumococcal vaccines had been recommended for the elderly population in South Korea for a considerable period of time, the coverage has been well below the optimal level. To increase the vaccination rate with integrating the pre-existing public health infrastructure and governmental funding, the Korean government introduced an elderly pneumococcal vaccination into the national immunization program with a 23-valent pneumococcal polysaccharide vaccine in May 2013. The aim of this study was to assess the performance of the program in increasing the vaccine coverage rate and maintaining stable vaccine supply and safe vaccination during the 20 months of the program. We qualitatively and quantitatively analyzed the process of introducing and the outcomes of the program in terms of the systematic organization, efficiency, and stability at the national level. A staggered introduction during the first year utilizing the public sector, with a target coverage of 60%, was implemented based on the public demand for an elderly pneumococcal vaccination, vaccine supply capacity, vaccine delivery capacity, safety, and sustainability. During the 20-month program period, the pneumococcal vaccine coverage rate among the population aged ≥65 years increased from 5.0% to 57.3% without a noticeable vaccine shortage or safety issues. A web-based integrated immunization information system, which includes the immunization registry, vaccine supply chain management, and surveillance of adverse events following immunization, reduced programmatic errors and harmonized the overall performance of the program. Introduction of an elderly pneumococcal vaccination in the national immunization program based on strong government commitment, meticulous preparation, financial support, and the pre-existing public health infrastructure resulted in an efficient, stable, and sustainable increase in vaccination coverage. Copyright © 2016. Published by Elsevier Ltd.

  12. Methodology for Analyzing and Developing Information Management Infrastructure to Support Telerehabilitation

    Directory of Open Access Journals (Sweden)

    Andi Saptono

    2009-09-01

    Full Text Available The proliferation of advanced technologies led researchers within the Rehabilitation Engineering Research Center on Telerehabilitation (RERC-TR to devise an integrated infrastructure for clinical services using the University of Pittsburgh (PITT model. This model describes five required characteristics for a telerehabilitation (TR infrastructure: openness, extensibility, scalability, cost-effectiveness, and security. The infrastructure is to deliver clinical services over distance to improve access to health services for people living in underserved or remote areas. The methodological approach to design, develop, and employ this infrastructure is explained and detailed for the remote wheelchair prescription project, a research task within the RERC-TR. The availability of this specific clinical service and personnel outside of metropolitan areas is limited due to the lack of specialty expertise and access to resources. The infrastructure is used to deliver expertise in wheeled mobility and seating through teleconsultation to remote clinics, and has been successfully deployed to five rural clinics in Western Pennsylvania. Keywords: Telerehabilitation, Information Management, Infrastructure Development Methodology, Videoconferencing, Online Portal, Database

  13. Emerging uses of patient generated health data in clinical research.

    Science.gov (United States)

    Wood, William A; Bennett, Antonia V; Basch, Ethan

    2015-05-01

    Recent advancements in consumer directed personal computing technology have led to the generation of biomedically-relevant data streams with potential health applications. This has catalyzed international interest in Patient Generated Health Data (PGHD), defined as "health-related data - including health history, symptoms, biometric data, treatment history, lifestyle choices, and other information-created, recorded, gathered, or inferred by or from patients or their designees (i.e. care partners or those who assist them) to help address a health concern."(Shapiro et al., 2012) PGHD offers several opportunities to improve the efficiency and output of clinical trials, particularly within oncology. These range from using PGHD to understand mechanisms of action of therapeutic strategies, to understanding and predicting treatment-related toxicity, to designing interventions to improve adherence and clinical outcomes. To facilitate the optimal use of PGHD, methodological research around considerations related to feasibility, validation, measure selection, and modeling of PGHD streams is needed. With successful integration, PGHD can catalyze the application of "big data" to cancer clinical research, creating both "n of 1" and population-level observations, and generating new insights into the nature of health and disease. Copyright © 2014 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

  14. Multi-sensor sheets based on large-area electronics for advanced structural health monitoring of civil infrastructure.

    Science.gov (United States)

    2014-09-01

    Structural Health Monitoring has a great potential to provide valuable information about the actual structural : condition and can help optimize the management activities. However, few eective and robust monitoring technology exist which hinders a...

  15. Clinical quality performance in U.S. health centers.

    Science.gov (United States)

    Shi, Leiyu; Lebrun, Lydie A; Zhu, Jinsheng; Hayashi, Arthur S; Sharma, Ravi; Daly, Charles A; Sripipatana, Alek; Ngo-Metzger, Quyen

    2012-12-01

    To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. National data from the 2009 Uniform Data System. Health centers reviewed patient records and reported aggregate data to the Uniform Data System. Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients. © Health Research and Educational Trust.

  16. Integrative Mental Health (IMH): paradigm, research, and clinical practice.

    Science.gov (United States)

    Lake, James; Helgason, Chanel; Sarris, Jerome

    2012-01-01

    This paper provides an overview of the rapidly evolving paradigm of "Integrative Mental Health (IMH)." The paradigm of contemporary biomedical psychiatry and its contrast to non-allopathic systems of medicine is initially reviewed, followed by an exploration of the emerging paradigm of IMH, which aims to reconcile the bio-psycho-socio-spiritual model with evidence-based methods from traditional healing practices. IMH is rapidly transforming conventional understandings of mental illness and has significant positive implications for the day-to-day practice of mental health care. IMH incorporates mainstream interventions such as pharmacologic treatments, psychotherapy, and psychosocial interventions, as well as alternative therapies such as acupuncture, herbal and nutritional medicine, dietary modification, meditation, etc. Two recent international conferences in Europe and the United States show that interest in integrative mental health care is growing rapidly. In response, the International Network of Integrative Mental Health (INIMH: www.INIMH.org) was established in 2010 with the objective of creating an international network of clinicians, researchers, and public health advocates to advance a global agenda for research, education, and clinical practice of evidence-based integrative mental health care. The paper concludes with a discussion of emerging opportunities for research in IMH, and an exploration of potential clinical applications of integrative mental health care. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Public health importance of lassa fever epidemiology, clinical ...

    African Journals Online (AJOL)

    The public health importance of Lassa fever can not be over emphasized if one considers the high infectivity and mortality rates associated with the disease. This study dealt extensively on the epidemiology, clinical features and current management of Lassa fever through literature review. The aim of this study is to sensitise ...

  18. Using Clinical Decision Support Software in Health Insurance Company

    Science.gov (United States)

    Konovalov, R.; Kumlander, Deniss

    This paper proposes the idea to use Clinical Decision Support software in Health Insurance Company as a tool to reduce the expenses related to Medication Errors. As a prove that this class of software will help insurance companies reducing the expenses, the research was conducted in eight hospitals in United Arab Emirates to analyze the amount of preventable common Medication Errors in drug prescription.

  19. Uses of cancer registries for public health and clinical research in Europe: Results of the European Network of Cancer Registries survey among 161 population-based cancer registries during 2010–2012

    NARCIS (Netherlands)

    Siesling, Sabine; Louwman, W.J.; Kwast, A.; van den Hurk, C.J.G.; O'Callaghan, M.; Rosso, S.; Zanetti, R.; Storm, H.; Comber, H.; Steliarova-Foucher, E.; Coebergh, J.W.W.

    2015-01-01

    Aim To provide insight into cancer registration coverage, data access and use in Europe. This contributes to data and infrastructure harmonisation and will foster a more prominent role of cancer registries (CRs) within public health, clinical policy and cancer research, whether within or outside the

  20. Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators.

    Science.gov (United States)

    Delany, Clare; Golding, Clinton

    2014-01-30

    Clinical reasoning is fundamental to all forms of professional health practice, however it is also difficult to teach and learn because it is complex, tacit, and effectively invisible for students. In this paper we present an approach for teaching clinical reasoning based on making expert thinking visible and accessible to students. Twenty-one experienced allied health clinical educators from three tertiary Australian hospitals attended up to seven action research discussion sessions, where they developed a tentative heuristic of their own clinical reasoning, trialled it with students, evaluated if it helped their students to reason clinically, and then refined it so the heuristic was targeted to developing each student's reasoning skills. Data included participants' written descriptions of the thinking routines they developed and trialed with their students and the transcribed action research discussion sessions. Content analysis was used to summarise this data and categorise themes about teaching and learning clinical reasoning. Two overriding themes emerged from participants' reports about using the 'making thinking visible approach'. The first was a specific focus by participating educators on students' understanding of the reasoning process and the second was heightened awareness of personal teaching styles and approaches to teaching clinical reasoning. We suggest that the making thinking visible approach has potential to assist educators to become more reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own expert reasoning and for students to access and use.

  1. Self-Esteem, Oral Health Behaviours, and Clinical Oral Health Status in Chinese Adults: An Exploratory Study

    Science.gov (United States)

    Chin, Luzy Siu-Hei; Chan, Joanne Chung-Yan

    2013-01-01

    Objectives: This is an exploratory study to examine the relations among self-esteem, oral health behaviours and clinical oral health status in Chinese adults. In addition, gender differences in clinical oral health status and oral health behaviours were explored. Methods: Participants were 192 patients from a private dental clinic in Hong Kong…

  2. Enhancing Context Analysis with Intelligence in Providing e-Health Services: Less Infrastructure Dependency in Supporting Cardio-Vascular Patients

    NARCIS (Netherlands)

    Verbraeck, A.; Widya, I.A.; Shishkov, Boris; Cordeiro, J.; Ranchordas, A.

    2009-01-01

    In Europe, we observe an increasing number of people with health problems, who could theoretically receive care outside of a hospital when their condition could be properly monitored. Not being able to provide this monitoring leads to an increasing pressure on an already overcrowded hospital system

  3. Mobile phone based clinical microscopy for global health applications.

    Directory of Open Access Journals (Sweden)

    David N Breslauer

    Full Text Available Light microscopy provides a simple, cost-effective, and vital method for the diagnosis and screening of hematologic and infectious diseases. In many regions of the world, however, the required equipment is either unavailable or insufficiently portable, and operators may not possess adequate training to make full use of the images obtained. Counterintuitively, these same regions are often well served by mobile phone networks, suggesting the possibility of leveraging portable, camera-enabled mobile phones for diagnostic imaging and telemedicine. Toward this end we have built a mobile phone-mounted light microscope and demonstrated its potential for clinical use by imaging P. falciparum-infected and sickle red blood cells in brightfield and M. tuberculosis-infected sputum samples in fluorescence with LED excitation. In all cases resolution exceeded that necessary to detect blood cell and microorganism morphology, and with the tuberculosis samples we took further advantage of the digitized images to demonstrate automated bacillus counting via image analysis software. We expect such a telemedicine system for global healthcare via mobile phone -- offering inexpensive brightfield and fluorescence microscopy integrated with automated image analysis -- to provide an important tool for disease diagnosis and screening, particularly in the developing world and rural areas where laboratory facilities are scarce but mobile phone infrastructure is extensive.

  4. Identifying the barriers to conducting outcomes research in integrative health care clinic settings - a qualitative study

    Directory of Open Access Journals (Sweden)

    Findlay-Reece Barbara

    2010-01-01

    Full Text Available Abstract Background Integrative health care (IHC is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a further study in 2008, to explore the reasons why IHC clinics are not conducting outcomes research and to identify strategies for conducting successful in-house outcomes research programs. The results of the latter study are reported here. Methods A total of 25 qualitative interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews. Results Barriers identified by participants fell into four categories: organizational culture, organizational resources, organizational environment and logistical challenges. Cultural challenges relate to the philosophy of IHC, organizational leadership and practitioner attitudes and beliefs. Participants also identified significant issues relating to their organization's lack of resources such as funding, compensation, infrastructure and partnerships/linkages. Environmental challenges such as the nature of a clinic's patient population and logistical issues such as the actual implementation of a research program and the applicability of research data also posed challenges to the conduct of research. Embedded research leadership, integration of personal and professional values about research, alignment of research activities and clinical workflow processes are some of the factors identified by participants that support IHC clinics' ability to conduct outcomes research. Conclusions Assessing and enhancing the broader

  5. Effects of dry period length on clinical mastitis and other major clinical health disorders

    DEFF Research Database (Denmark)

    Enevoldsen, Carsten; Sørensen, J.T.

    1992-01-01

    Four, 7-, and 10-wk dry periods were randomly assigned to 366 dairy cows in eight herds. A multiple polytomous logistic regression analysis was conducted with the objective to reveal possible important effects of the dry period on the risk of contracting major clinical health disorders. Several...... complex statistical interactions were revealed. Complications around and after drying off occurred least frequently at 7-wk dry periods. There was little evidence of an effect of the dry period on the risk of clinical mastitis and other severe clinical disorders around and after calving. With short...... like milk yield at drying off and previous mastitis are much more important predisposing factors....

  6. Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK.

    Science.gov (United States)

    Vecchi, Veronica; Hellowell, Mark; Gatti, Stefano

    2013-05-01

    This paper is concerned with the cost-efficiency of Private Finance Initiatives (PFIs) in the delivery of hospital facilities in the UK. We outline a methodology for identifying the "fair" return on equity, based on the Weighted Average Cost of Capital (WACC) of each investor. We apply this method to assess the expected returns on a sample of 77 contracts signed between 1997 and 2011 by health care provider organisations in the UK. We show that expected returns are in general in excess of the WACC benchmarks. The findings highlight significant problems in current procurement practices and the methodologies by which bids are assessed. To minimise the financial impact of hospital investments on health care systems, a regulatory regime must ensure that expected returns are set at the "fair" rate. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. G20 action on the digital economy: Addressing market failures to improve the health of the digital infrastructure

    OpenAIRE

    Twomey, Paul

    2017-01-01

    Market failures are resulting in network operators and device manufacturers not being incentivized to ensure improved cyber security practices in their operations. The result is a large global base of vulnerable computers, modems/routers and Internet of Things devices which can be manipulated by Cyber criminals. Practical recommendations are made as to how governments could address these market failures (with low-cost to government) and significantly improve the health of the cyber ecosystem.

  8. Green(ing) infrastructure

    CSIR Research Space (South Africa)

    Van Wyk, Llewellyn V

    2014-03-01

    Full Text Available the generation of electricity from renewable sources such as wind, water and solar. Grey infrastructure – In the context of storm water management, grey infrastructure can be thought of as the hard, engineered systems to capture and convey runoff..., pumps, and treatment plants.  Green infrastructure reduces energy demand by reducing the need to collect and transport storm water to a suitable discharge location. In addition, green infrastructure such as green roofs, street trees and increased...

  9. Building a learning health system using clinical registers: a non-technical introduction.

    Science.gov (United States)

    Ovretveit, John; Nelson, Eugene; James, Brent

    2016-10-10

    Purpose The purpose of this paper is to describe how clinical registers were designed and used to serve multiple purposes in three health systems, in order to contribute practical experience for building learning healthcare systems. Design/methodology/approach Case description and comparison of the development and use of clinical registries, drawing on participants' experience and published and unpublished research. Findings Clinical registers and new software systems enable fact-based decisions by patients, clinicians, and managers about better care, as well as new and more economical research. Designing systems to present the data for users' daily work appears to be the key to effective use of the potential afforded by digital data. Research limitations/implications The case descriptions draw on the experience of the authors who were involved in the development of the registers, as well as on published and unpublished research. There is limited data about outcomes for patients or cost-effectiveness. Practical implications The cases show the significant investments which are needed to make effective use of clinical register data. There are limited skills to design and apply the digital systems to make the best use of the systems and to reduce their disadvantages. More use can be made of digital data for quality improvement, patient empowerment and support, and for research. Social implications Patients can use their data combined with other data to self-manage their chronic conditions. There are challenges in designing and using systems so that those with lower health and computer literacy and incomes also benefit from these systems, otherwise the digital revolution may increase health inequalities. Originality/value The paper shows three real examples of clinical registers which have been developed as part of their host health systems' strategies to develop learning healthcare systems. The paper gives a simple non-technical introduction and overview for

  10. The normativity of clinical health care: perspectives on moral realism.

    Science.gov (United States)

    Nortvedt, Per

    2012-06-01

    The paper argues that a particular version of moral realism constitutes an important basis for ethics in medicine and health care. Moral realism is the position that moral value is a part of the fabric of relational and interpersonal reality. But even though moral values are subject to human interpretations, they are not themselves the sole product of these interpretations. Moral values are not invented but discovered by the subject. Moral realism argues that values are open to perception and experience and that moral subjectivity must be portrayed in how moral values are discovered and perceived by the human subject. Moral values may exist independent of the particular subject's interpretative evaluations as a part of reality. This epistemological point about normativity is particularly significant in medical care and in health care. The clinician perceives moral value in the clinical encounter in a way that is important for competent clinical understanding. Clinical understanding in medical care and health care bears on the encounter with moral values in the direct and embodied relations to patients, with their experiences of illness and their vulnerabilities. Good clinical care is then partly conditioned upon adequate understanding of such moral realities.

  11. Precautions used by occupational health nursing students during clinical placements

    Directory of Open Access Journals (Sweden)

    T.M.M. Maja

    2009-09-01

    Full Text Available Protection of health care workers including students from being infected when caring for high risk patients is a major cause for concern to all promoting occupational health. Safety of every employee is mandatory. Furthermore, universal guidelines for precautions must be used by all interacting with high risk patients and clients to protect themselves and prevent the spread of infection. The aim of this paper was to ascertain the availability of universal guidelines for precautions against the spread of infection in clinical settings and determine the precautions used by OHN students during their clinical placements. To realise these objectives, a quantitative and descriptive design was followed. A purposive sampling method was used to select 45 Occupational health nursing students who participated in the study. Data was collected with the use of a structured questionnaire and the results revealed that: most units where OHN students were placed for clinical experience had guidelines for universal precautions although these were not always accessible to them; regarding compliance to universal precautions, OHN students were reportedly aware of the hazards of failure to comply although in some emergencies and where personal protective material was not available, they had to provide care without using protective equipments. Recommendations made include that employers and staff at all occupational settings must ensure that updated guidelines for universal precautions are available and accessible to every body interacting with high risk patients; health care providers and students must be fully informed about and should always adhere to universal precautions.

  12. Health profiles of foreigners attending primary care clinics in Malaysia.

    Science.gov (United States)

    Ab Rahman, Norazida; Sivasampu, Sheamini; Mohamad Noh, Kamaliah; Khoo, Ee Ming

    2016-06-14

    The world population has become more globalised with increasing number of people residing in another country for work or other reasons. Little is known about the health profiles of foreign population in Malaysia. The aim of this study was to provide a detailed description of the health problems presented by foreigners attending primary care clinics in Malaysia. Data were derived from the 2012 National Medical Care Survey (NMCS), a cross sectional survey of primary care encounters from public and private primary care clinics sampled from five regions in Malaysia. Patients with foreign nationality were identified and analysed for demographic profiles, reasons for encounter (RFEs), diagnosis, and provision of care. Foreigners accounted for 7.7 % (10,830) of all patient encounters from NMCS. Most encounters were from private clinics (90.2 %). Median age was 28 years (IQR: 24.0, 34.8) and 69.9 % were male. Most visits to the primary care clinics were for symptom-based complaints (69.5 %), followed by procedures (23.0 %) and follow-up visit (7.4 %). The commonest diagnosis in public clinics was antenatal care (21.8 %), followed by high risk pregnancies (7.5 %) and upper respiratory tract infection (URTI) (6.8 %). Private clinics had more cases for general medical examination (13.5 %), URTI (13.1 %) and fever (3.9 %). Medications were prescribed to 76.5 % of these encounters. More foreigners were seeking primary medical care from private clinics and the encounters were for general medical examinations and acute minor ailments. Those who sought care from public clinics were for obstetric problems and chronic diseases. Medications were prescribed to two-thirds of the encounters while other interventions: laboratory investigations, medical procedures and follow-up appointment had lower rates in private clinics. Foreigners are generally of young working group and are expected to have mandatory medical checks. The preponderance of obstetrics seen in public

  13. US Public Sexually Transmitted Disease Clinical Services in an Era of Declining Public Health Funding: 2013-14.

    Science.gov (United States)

    Leichliter, Jami S; Heyer, Kate; Peterman, Thomas A; Habel, Melissa A; Brookmeyer, Kathryn A; Arnold Pang, Stephanie S; Stenger, Mark R; Weiss, Gretchen; Gift, Thomas L

    2017-08-01

    We examined the infrastructure for US public sexually transmitted disease (STD) clinical services. In 2013 to 2014, we surveyed 331 of 1225 local health departments (LHDs) who either reported providing STD testing/treatment in the 2010 National Profile of Local Health Departments survey or were the 50 local areas with the highest STD cases or rates. The sample was stratified by jurisdiction population size. We examined the primary referral clinics for STDs, the services offered and the impact of budget cuts (limited to government funding only). Data were analyzed using SAS, and analyses were weighted for nonresponse. Twenty-two percent of LHDs cited a specialty STD clinic as their primary referral for STD services; this increased to 53.5% of LHDs when combination STD-family planning clinics were included. The majority of LHDs (62.8%) referred to clinics providing same-day services. Sexually transmitted disease clinics more frequently offered extragenital testing for chlamydia and/or gonorrhea (74.7%) and gonorrhea culture (68.5%) than other clinics (52.9%, 46.2%, respectively; P < 0.05). The majority of LHDs (61.5%) reported recent budget cuts. Of those with decreased budgets, the most common impacts were fewer clinic hours (42.8%; 95% confidence interval [CI], 24.4-61.2), reduced routine screening (40.2%; 95% CI, 21.7-58.8) and reductions in partner services (42.1%; 95% CI, 23.6-60.7). One quarter of those with reduced STD budgets increased fees or copays for clients. Findings demonstrate gaps and reductions in US public STD services including clinical services that play an important role in reducing disease transmission. Furthermore, STD clinics tended to offer more specialized STD services than other public clinics.

  14. The critical success factor approach to strategic alignment: seeking a trail from a health organization's goals to its management information infrastructure.

    Science.gov (United States)

    Tan, J K

    1999-11-01

    The critical success factor (CSF) approach is a technique that will aid health administrators, planners and managers to identify, specify and sort among the most relevant and critical factors determining an organization's survival and success. Following a top-down management perspective, this paper discusses the CSF methodology as a strategic information management process comprising several important phases: (i) understanding the external factors such as the organization's industry, market and environment; (ii) achieving strong support and championship from top management; (iii) encouraging the proactive involvement of management and staff in generic CSF identification; (iv) educating and directing the participation of staff members in CSF verification and further refinement of generic CSFs into specific CSFs; and (v) aggregating, prioritizing and translating activity-related CSFs into organizational information requirements for the design of the organization's management information infrastructure. The implementation of this CSF approach is illustrated in the context of a British Columbia community hospital, with insights provided into key issues for future health researchers and practitioners.

  15. A Framework to Support the Sharing and Reuse of Computable Phenotype Definitions Across Health Care Delivery and Clinical Research Applications.

    Science.gov (United States)

    Richesson, Rachel L; Smerek, Michelle M; Blake Cameron, C

    2016-01-01

    The ability to reproducibly identify clinically equivalent patient populations is critical to the vision of learning health care systems that implement and evaluate evidence-based treatments. The use of common or semantically equivalent phenotype definitions across research and health care use cases will support this aim. Currently, there is no single consolidated repository for computable phenotype definitions, making it difficult to find all definitions that already exist, and also hindering the sharing of definitions between user groups. Drawing from our experience in an academic medical center that supports a number of multisite research projects and quality improvement studies, we articulate a framework that will support the sharing of phenotype definitions across research and health care use cases, and highlight gaps and areas that need attention and collaborative solutions. An infrastructure for re-using computable phenotype definitions and sharing experience across health care delivery and clinical research applications includes: access to a collection of existing phenotype definitions, information to evaluate their appropriateness for particular applications, a knowledge base of implementation guidance, supporting tools that are user-friendly and intuitive, and a willingness to use them. We encourage prospective researchers and health administrators to re-use existing EHR-based condition definitions where appropriate and share their results with others to support a national culture of learning health care. There are a number of federally funded resources to support these activities, and research sponsors should encourage their use.

  16. Health information technology: integration of clinical workflow into meaningful use of electronic health records.

    Science.gov (United States)

    Bowens, Felicia M; Frye, Patricia A; Jones, Warren A

    2010-10-01

    This article examines the role that clinical workflow plays in successful implementation and meaningful use of electronic health record (EHR) technology in ambulatory care. The benefits and barriers of implementing EHRs in ambulatory care settings are discussed. The researchers conclude that widespread adoption and meaningful use of EHR technology rely on the successful integration of health information technology (HIT) into clinical workflow. Without successful integration of HIT into clinical workflow, clinicians in today's ambulatory care settings will continue to resist adoption and implementation of EHR technology.

  17. Implementation of an Electronic Health Records System in a Small Clinic: The Viewpoint of Clinic Staff

    Science.gov (United States)

    Carayon, Pascale; Smith, Paul; Hundt, Ann Schoofs; Kuruchittham, Vipat; Li, Qian

    2009-01-01

    In this study, we examined the implementation of an electronic health records (EHR) system in a small family practice clinic. We used three data collection instruments to evaluate user experience, work pattern changes, and organisational changes related to the implementation and use of the EHR system: (1) an EHR user survey, (2) interviews with…

  18. Infrastructure for the Geospatial Web

    Science.gov (United States)

    Lake, Ron; Farley, Jim

    Geospatial data and geoprocessing techniques are now directly linked to business processes in many areas. Commerce, transportation and logistics, planning, defense, emergency response, health care, asset management and many other domains leverage geospatial information and the ability to model these data to achieve increased efficiencies and to develop better, more comprehensive decisions. However, the ability to deliver geospatial data and the capacity to process geospatial information effectively in these domains are dependent on infrastructure technology that facilitates basic operations such as locating data, publishing data, keeping data current and notifying subscribers and others whose applications and decisions are dependent on this information when changes are made. This chapter introduces the notion of infrastructure technology for the Geospatial Web. Specifically, the Geography Markup Language (GML) and registry technology developed using the ebRIM specification delivered from the OASIS consortium are presented as atomic infrastructure components in a working Geospatial Web.

  19. The infrastructure of telecare

    DEFF Research Database (Denmark)

    Nickelsen, Niels Christian Mossfeldt

    2018-01-01

    . The analysis demonstrates and proposes that, in telecare, greater accountability, discretion and responsibility are imposed on the nurse, but that they also have less access to the means of clinical decision-making, i.e. doctors. The article explores how relational infrastructures ascribe the professions......Telecare can offer a unique experience of trust in patient-nurse relationships, embracing new standards for professional discretion among nurses, but also reflects an increasingly complicated relationship between nurses and doctors. The study uses ethnographic methodology in relation to a large 5...... million euro project at four hospitals caring for 120 patients with COPD. Twenty screen-mediated conferences were observed and two workshops, centring on nurses’ photo elucidation of the practice of telecare, were conducted with a focus on shifting tasks, professional discretion, responsibility...

  20. Adolescent health care maintenance in a teen-friendly clinic.

    Science.gov (United States)

    Chaisson, Nicole; Shore, William B

    2014-09-01

    Adolescence is marked by complex physical, cognitive, social, and emotional development, which can be stressful for families and adolescents. Before the onset of puberty, providers should clearly lay the groundwork for clinical care and office visits during the adolescent years. This article addresses the guidelines and current legal standards for confidentiality in adolescent care, the most frequently used psychosocial screening tools, and current recommendations for preventive health services and immunizations. Through the creation of teen-friendly clinics, primary care providers are well positioned to offer guidance and support to teens and their parents during this time of transition and growth. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Developing a manual for strengthening mental health nurses' clinical supervision

    DEFF Research Database (Denmark)

    Buus, Niels; Cassedy, Paul; Gonge, Henrik

    2013-01-01

    In this article, we report findings from a study aimed at developing the content and implementation of a manual for a research-based intervention on clinical supervision of mental health nursing staff. The intervention was designed to strengthen already existing supervision practices through...... educational preparation for supervision and systematic reflection on supervision. The intervention consists of three sessions and was implemented on two groups of mental health hospital staff. We present an outline of the manual and explain how the trial sessions made us adjust the preliminary manual....... The effects of implementing the manual will subsequently be analysed in an independent randomised controlled trial....

  2. CLINICAL PSYCHOLOGY – ACTUAL DIRECTION IN GROUNDING OF HEALTH MANPOWER

    Directory of Open Access Journals (Sweden)

    M.G. Kucherov

    2007-09-01

    Full Text Available In 90-ies years of last century in our country happened the crash of the system of values with transition to the standards of capitalistic society, and it lead to the formation of chronicle psychosocial stress of high and medium levels. Medics of all directions started to face functional psychosomatic diseases. Raised the necessity in grounding of health manpower in discipline of clinical psychology, with the learning of psychophisiological bases of diseases and possibilities if their correction. This direction of development of soviet medical education and health service in general seems progressive and prospective.

  3. The Union Health Center: a working model of clinical care linked to preventive occupational health services.

    Science.gov (United States)

    Herbert, R; Plattus, B; Kellogg, L; Luo, J; Marcus, M; Mascolo, A; Landrigan, P J

    1997-03-01

    As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having field a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success

  4. Cultural politics and clinical competence in Australian health services.

    Science.gov (United States)

    Manderson, Lenore; Allotey, Pascale

    2003-01-01

    Medical competence is demonstrated in multiple ways in clinical settings, and includes technical competence, both in terms of diagnosis and management, and cultural competence, as demonstrated in communication between providers and clients. In cross-cultural contexts, such communication is complicated by interpersonal communication and the social and cultural context. To illustrate this, we present four case studies that illustrate the themes from interviews with immigrant women and refugees from Middle Eastern and Sahel African backgrounds, conducted as part of a study of their reproductive health. In our analysis, we highlight the limitations of conventional models of communication. We illustrate the need for health providers to appreciate the possible barriers of education, ethnicity, religion and gender that can impede communication, and the need to be mindful of broader structural, institutional and inter-cultural factors that affect the quality of the clinical encounter.

  5. Sleep Health Issues for Children with FASD: Clinical Considerations

    OpenAIRE

    Jan, James E.; Asante, Kwadwo O.; Conry, Julianne L.; Fast, Diane K.; Bax, Martin C. O.; Ipsiroglu, Osman S.; Bredberg, Elizabeth; Loock, Christine A.; Wasdell, Michael B.

    2010-01-01

    This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniqu...

  6. Evidence-based health care: its place within clinical governance.

    Science.gov (United States)

    McSherry, R; Haddock, J

    This article explores the principles of evidence-based practice and its role in achieving quality improvements within the clinical governance framework advocated by the recent White Papers 'The New NHS: Modern, Dependable' (Department of Health (DoH), 1997) and 'A First Class Service: Quality in the New NHS' (DoH, 1998a). Within these White Papers there is an emphasis on improving quality of care, treatment and services through employing the principles of clinical governance. A major feature of clinical governance is guaranteeing quality to the public and the NHS, and ensuring that clinical, managerial and educational practice is based on scientific evidence. This article also examines what evidence-based practice is and what processes are required to promote effective healthcare interventions. The authors also look at how clinical governance relates to other methods/systems involved in clinical effectiveness. Finally, the importance for nurses and other healthcare professionals of familiarizing themselves with the development of critical appraisal skills, and their implications for developing evidence-based practice, is emphasized.

  7. Role of pharmacogenetics in public health and clinical health care: a SWOT analysis.

    Science.gov (United States)

    Kapoor, Ritika; Tan-Koi, Wei Chuen; Teo, Yik-Ying

    2016-12-01

    Pharmacogenomics has been lauded as an important innovation in clinical medicine as a result of advances in genomic science. As one of the cornerstones in precision medicine, the vision to determine the right medication in the right dosage for the right treatment with the use of genetic information has not exactly materialised, and few genetic tests have been implemented as the standard of care in health systems worldwide. Here we review the findings from a SWOT analysis to examine the strengths, weaknesses, opportunities and threats around the role of pharmacogenetics in public health and clinical health care, at the micro, meso and macro levels corresponding to the perspectives of the individuals (scientists, patients and physicians), the health-care institutions and the health systems, respectively.

  8. Clinical working postures of bachelor of oral health students.

    Science.gov (United States)

    Horton, S J; Johnstone, C L; Hutchinson, C M W; Taylor, P A; Wade, K J

    2011-09-01

    To observe and describe the clinical working postures of final-year Bachelor of Oral Health (BOH) students. Pilot observational study. The University of Otago Faculty of Dentistry and School of Physiotherapy. Eight final-year BOH students voluntarily participated in this study, where postural data were collected using a digital video camera during a standard clinical treatment session. The postural data were analysed using 3D Match biomechanical software. Final-year BOH students who work in the seated position are exposed to neck flexion of greater than 35 degrees, together with trunk flexion greater than 20 degrees and bilateral elbow flexion greater than 90 degrees. The findings of this study agree with the findings of previous postural studies of dental professionals. Dental hygiene students, together with their clinical supervisors, need to be aware of the importance of good working posture early in their careers, and pay particular attention to the degree of neck flexion occurring for prolonged periods.

  9. Clinical interdisciplinary health team care: an educational experiment.

    Science.gov (United States)

    Mazur, H; Beeston, J J; Yerxa, E J

    1979-09-01

    With increasing concern for teamwork in clinical practice in health care settings, the need to identify the concepts, methods, and learning processes for improving interdisciplinary team skills is apparent. This paper describes patient-centered, clinical-research-demonstration programs for teams of students, preceptors, and faculty members from six disciplines who provided patient care in a long-term rehabilitation setting. The teams were involved in the theory and practice of team-building, including weekly sessions on leadership styles, communication, group decision-making, and team effectiveness assessment. Objective and subjective measurements were administered throughout the program. The results indicate that task-oriented patient care favors the learning of team skills, especially when all levels of administration support and participate in the processes. Question are raised concerning the effect of clinical teams on the quality of patient care, their cost-effectiveness, and the low priority given to teaching interdisciplinary team skills in professional education.

  10. A Health-Based Metric for Evaluating the Effectiveness of Noise Barrier Mitigation Associated With Transport Infrastructure Noise

    Directory of Open Access Journals (Sweden)

    Geoffrey P Prendergast

    2017-01-01

    Full Text Available Introduction: This study examines the use of the number of night-time sleep disturbances as a health-based metric to assess the cost effectiveness of rail noise mitigation strategies for situations, wherein high-intensity noises dominate such as freight train pass-bys and wheel squeal. Materials and Methods: Twenty residential properties adjacent to the existing and proposed rail tracks in a noise catchment area of the Epping to Thornleigh Third Track project were used as a case study. Awakening probabilities were calculated for individual’s awakening 1, 3 and 5 times a night when subjected to 10 independent freight train pass-by noise events using internal maximum sound pressure levels (LAFmax. Results: Awakenings were predicted using a random intercept multivariate logistic regression model. With source mitigation in place, the majority of the residents were still predicted to be awoken at least once per night (median 88.0%, although substantial reductions in the median probabilities of awakening three and five times per night from 50.9 to 29.4% and 9.2 to 2.7%, respectively, were predicted. This resulted in a cost-effective estimate of 7.6–8.8 less people being awoken at least three times per night per A$1 million spent on noise barriers. Conclusion: The study demonstrates that an easily understood metric can be readily used to assist making decisions related to noise mitigation for large-scale transport projects.

  11. Computer-assisted self interviewing in sexual health clinics.

    Science.gov (United States)

    Fairley, Christopher K; Sze, Jun Kit; Vodstrcil, Lenka A; Chen, Marcus Y

    2010-11-01

    This review describes the published information on what constitutes the elements of a core sexual history and the use of computer-assisted self interviewing (CASI) within sexually transmitted disease clinics. We searched OVID Medline from 1990 to February 2010 using the terms "computer assisted interviewing" and "sex," and to identify published articles on a core sexual history, we used the term "core sexual history." Since 1990, 3 published articles used a combination of expert consensus, formal clinician surveys, and the Delphi technique to decide on what questions form a core sexual health history. Sexual health histories from 4 countries mostly ask about the sex of the partners, the number of partners (although the time period varies), the types of sex (oral, anal, and vaginal) and condom use, pregnancy intent, and contraceptive methods. Five published studies in the United States, Australia, and the United Kingdom compared CASI with in person interviews in sexually transmitted disease clinics. In general, CASI identified higher risk behavior more commonly than clinician interviews, although there were substantial differences between studies. CASI was found to be highly acceptable and individuals felt it allowed more honest reporting. Currently, there are insufficient data to determine whether CASI results in differences in sexually transmitted infection testing, diagnosis, or treatment or if CASI improves the quality of sexual health care or its efficiency. The potential public health advantages of the widespread use of CASI are discussed.

  12. Clinical contributions to addressing the social determinants of health.

    Science.gov (United States)

    Patel, Kiran C R; Spilsbury, Peter; Shukla, Rashmi

    2010-04-01

    The drive to address social determinants of health is gaining momentum. Appreciating that health outcomes are only partly affected by healthcare, clinicians and clinical communities can play a significant role in this crusade by action at local, regional, national and global levels. A concerted and systematic focus on integrating and industrialising upstream interventions at every healthcare encounter is essential to prevent future illness, thus enabling a paradigm shift in the healthcare service from being one of illness management to health preservation. The evidence base demonstrates the cost efficacy of upstream interventions. The challenge is how this evidence is utilised to implement these interventions in everyday healthcare. Today, with a global economic crisis and challenged public sector funding, the need to address prevention has never been more pressing. Clinical engagement at all levels, from the front line to the boardroom is vital. Clinicians must address access, communication, strategy and commissioning to fulfil a professional responsibility to become and remain the corporate memory of a health service focused on preventing illness while simultaneously delivering cost-effective healthcare.

  13. Evaluation of a pharmacist-managed asthma clinic in an Indian Health Service clinic.

    Science.gov (United States)

    Pett, Ryan G; Nye, Shane

    2016-01-01

    To observe whether American Indian and Alaskan Native (AI/AN) patients at the Yakama Indian Health Service seen at the pharmacist-managed asthma clinic improved asthma outcomes. Retrospective chart review, single group, preintervention and postintervention. Pharmacist-managed asthma clinic at an Indian Health Service ambulatory care clinic. Sixty-one AI/AN patients who were seen at least once in the asthma clinic from 2010 to 2014. Pharmacist-provided asthma education and medication management. Asthma-related hospitalizations and emergency department or urgent care (ED) visits. The total number of asthma-related hospitalizations and ED visits between the 12-month periods preceding and following the initial asthma clinic visit were 11 versus 2 hospitalizations (P = 0.02) and 43 versus 25 ED visits (P = 0.02), respectively. Over the same period, asthma-related oral corticosteroid use showed a nonsignificant decrease in the number of prescriptions filled (n = 59, P = 0.08). In contrast, inhaled corticosteroid prescription fills significantly increased (n = 42, P = 0.01). A reduction of asthma-related hospitalizations and ED visits were observed during the course of the intervention. Increased access to formal asthma education and appropriate asthma care benefit the Yakama AI/AN people. A controlled trial is needed to confirm that the intervention causes the intended effect. Published by Elsevier Inc.

  14. A Comparison of Medical Birth Register Outcomes between Maternity Health Clinics and Integrated Maternity and Child Health Clinics in Southwest Finland.

    Science.gov (United States)

    Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Mäkinen, Juha; Rautava, Päivi

    2016-07-08

    Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.

  15. An exploration of clinical decision making in mental health triage.

    Science.gov (United States)

    Sands, Natisha

    2009-08-01

    Mental health (MH) triage is a specialist area of clinical nursing practice that involves complex decision making. The discussion in this article draws on the findings of a Ph.D. study that involved a statewide investigation of the scope of MH triage nursing practice in Victoria, Australia. Although the original Ph.D. study investigated a number of core practices in MH triage, the focus of the discussion in this article is specifically on the findings related to clinical decision making in MH triage, which have not previously been published. The study employed an exploratory descriptive research design that used mixed data collection methods including a survey questionnaire (n = 139) and semistructured interviews (n = 21). The study findings related to decision making revealed a lack of empirically tested evidence-based decision-making frameworks currently in use to support MH triage nursing practice. MH triage clinicians in Australia rely heavily on clinical experience to underpin decision making and have little of knowledge of theoretical models for practice, such as methodologies for rating urgency. A key recommendation arising from the study is the need to develop evidence-based decision-making frameworks such as clinical guidelines to inform and support MH triage clinical decision making.

  16. Models for Clinical Education Accompanying in Mental Health and Psychiatry

    Directory of Open Access Journals (Sweden)

    Lino Ramos

    2017-08-01

    Full Text Available Objective: To analyze the available scientific literature on the follow-up models in Clinical Teaching in Mental Health, carrying out a systematic review of the literature with re- search in the electronic databases PubMed, B-On, EBSCO platform and Scielo, as well as the Open Access scientific repositories of Portugal. Methodology: The present work consists of a systematic literature review (RSL. Keyword databases were searched first, the results were filtered according to exclusion and inclusion criteria and only selected the most appropriate references to answer the research question that were subsequently submitted to an evaluation by CASPe. The final sample includes 11 articles. Results: In the last decades, the training of nursing students has been the subject of several changes and transformations, once it is agreed that the training takes place in moments of theoretical training and moments of practical training in clinical teaching. Clinical teaching is a privileged space for the learning of nursing students. This is where they have the possibility to develop and mobilize skills and build knowledge The orientation of nursing students in clinical education has been the subject of numerous investigations in recent years; the area of Mental Health and Psychiatry (MHP shows a significant role in the development and construction of the identity of the nursing professional future. in the follow-up of students in clinical teaching, several actors stand out: the student, the teacher and the nurse orientate, who take special importance in the process of personal and professional development of the student, having a pedagogical, social and professional responsibility. The provision of care in MHP Clinical Teaching requires a wide range that allows the student to develop several aspects, namely creativity, therapeutic communication, sensitivity to care, listening, empathy, and interpersonal relationship capacity with the person, multi- disciplinary

  17. [Ethics in clinical practice and in health care].

    Science.gov (United States)

    Pintor, S; Mennuni, G; Fontana, M; Nocchi, S; Giarrusso, P; Serio, A; Fraioli, A

    2015-01-01

    The clinical ethics is the identification, analysis and solution of moral problems that can arise during the care of a patient. Given that when dealing with ethical issues in health care some risks will be encountered (talking about ethics in general, or as a problem overlapped with others in this area, or by delegation to legislative determinations) in the text certain important aspects of the topic are examined. First of all ethics as human quality of the relationship between people for the common good, especially in health services where there are serious problems like the life and the health. It is also necessary a "humanizing relationship" between those who work in these services in order to achieve quality and efficiency in this business. It is important a proper training of health professionals, especially doctors, so that they can identify the real needs and means of intervention. It is also important that scientific research must respect fundamental ethical assumptions. In conclusion, ethics in health care is not a simple matter of "cookbook" rules, but involves the responsibility and consciousness of individual operators.

  18. Timing of Clinical Billing Reimbursement for a Local Health Department.

    Science.gov (United States)

    McCullough, J Mac

    2016-01-01

    A major responsibility of a local health department (LHD) is to assure public health service availability throughout its jurisdiction. Many LHDs face expanded service needs and declining budgets, making billing for services an increasingly important strategy for sustaining public health service provision. Yet, little practice-based data exist to guide practitioners on what to expect financially, especially regarding timing of reimbursement receipt. This study provides results from one LHD on the lag from service delivery to reimbursement receipt. Reimbursement records for all transactions at Maricopa County Department of Public Health immunization clinics from January 2013 through June 2014 were compiled and analyzed to determine the duration between service and reimbursement. Outcomes included daily and cumulative revenues received. Time to reimbursement for Medicaid and private payers was also compared. Reimbursement for immunization services was received a median of 68 days after service. Payments were sometimes taken back by payers through credit transactions that occurred a median of 333 days from service. No differences in time to reimbursement between Medicaid and private payers were found. Billing represents an important financial opportunity for LHDs to continue to sustainably assure population health. Yet, the lag from service provision to reimbursement may complicate budgeting, especially in initial years of new billing activities. Special consideration may be necessary to establish flexibility in the budget-setting processes for services with clinical billing revenues, because funds for services delivered in one budget period may not be received in the same period. LHDs may also benefit from exploring strategies used by other delivery organizations to streamline billing processes.

  19. Health Professionals Facing Suicidal Patients: What Are Their Clinical Practices?

    Directory of Open Access Journals (Sweden)

    Inês Rothes

    2018-06-01

    Full Text Available Clinical work with suicidal people is a demanding area. Little is known about health professionals’ practices when faced with suicidal patients. The aims of this study were to: (1 describe the practices most likely to be adopted by professionals facing a suicidal patient and (2 analyze the differences according to professional characteristics (group, specific training on suicide, and experience with suicidal patients. A self-report questionnaire that was developed for this study was filled out by 239 participants. Participants were psychologists, psychiatrists, and general practitioners who work in different contexts: hospitals, public health centres, schools or colleges, and community centres. Principal components analysis, analyses of variance, and t-tests were used. Four components were identified: (1 Comprehensive risk assessment; (2 protocols, psychotherapy and connectedness; (3 multidisciplinary clinical approach; and, (4 family, explaining a total of variance of 44%. Positive associations between suicide-related variables (training and experience and practices were found. In general, health professionals’ practices are evidence-based, however a relevant percentage of professionals can benefit from training and improve their practices.

  20. Clinical and Para Clinical Information Needs of Infertility Electronic Health Records in Iran: A Delphi Study.

    Science.gov (United States)

    Farzandipour, Mehrdad; Jeddi, Fateme Rangraz; Gilasi, Hamid Reza; Shirzadi, Diana

    2017-09-01

    infertility is referred to the person's inability to conceive pregnancy after one year of intercourse without using protection. This study paves the ground for creating a complete, united, and coherent source of patients' medical information. this is an applied research of descriptive-cross sectional type which has been carried out through qualitative - quantitative methods. The sample of the present study was 50 specialists in the field of infertility which has been chosen based on purposive sampling method. Designing the questionnaire was done based on library studies and Gathering experts' views was done based on Delphi technique. 261 items from clinical and Para clinical information of infertile patients' electronic health records were subjected to an opinion poll by experts. During this process 223 items were accepted and 38 items have been rejected after two sessions of surveys by infertility experts. Para clinical information section consisted of 57 items that all of them have been accepted by the experts. Also, clinical information section consisted of 242 items from which 204 items were accepted and 38 items were rejected by the experts. existence of a structured electronic record system of infertile patients' information leads to the integration of patients' information, improvement of health care services and a decrease in treatment costs: all working to increase information safety. Furthermore, only essential and relevant information would be provided for the specialists and it will facilitate and direct the future infertility related studies due to the coherence, unity and relevance of the information.

  1. A model linking clinical workforce skill mix planning to health and health care dynamics

    Directory of Open Access Journals (Sweden)

    McDonnell Geoff

    2010-04-01

    Full Text Available Abstract Background In an attempt to devise a simpler computable tool to assist workforce planners in determining what might be an appropriate mix of health service skills, our discussion led us to consider the implications of skill mixing and workforce composition beyond the 'stock and flow' approach of much workforce planning activity. Methods Taking a dynamic systems approach, we were able to address the interactions, delays and feedbacks that influence the balance between the major components of health and health care. Results We linked clinical workforce requirements to clinical workforce workload, taking into account the requisite facilities, technologies, other material resources and their funding to support clinical care microsystems; gave recognition to productivity and quality issues; took cognisance of policies, governance and power concerns in the establishment and operation of the health care system; and, going back to the individual, gave due attention to personal behaviour and biology within the socio-political family environment. Conclusion We have produced the broad endogenous systems model of health and health care which will enable human resource planners to operate within real world variables. We are now considering the development of simple, computable national versions of this model.

  2. A model linking clinical workforce skill mix planning to health and health care dynamics.

    Science.gov (United States)

    Masnick, Keith; McDonnell, Geoff

    2010-04-30

    In an attempt to devise a simpler computable tool to assist workforce planners in determining what might be an appropriate mix of health service skills, our discussion led us to consider the implications of skill mixing and workforce composition beyond the 'stock and flow' approach of much workforce planning activity. Taking a dynamic systems approach, we were able to address the interactions, delays and feedbacks that influence the balance between the major components of health and health care. We linked clinical workforce requirements to clinical workforce workload, taking into account the requisite facilities, technologies, other material resources and their funding to support clinical care microsystems; gave recognition to productivity and quality issues; took cognisance of policies, governance and power concerns in the establishment and operation of the health care system; and, going back to the individual, gave due attention to personal behaviour and biology within the socio-political family environment. We have produced the broad endogenous systems model of health and health care which will enable human resource planners to operate within real world variables. We are now considering the development of simple, computable national versions of this model.

  3. Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices.

    Science.gov (United States)

    Weinstein, Ronald S; Krupinski, Elizabeth A; Doarn, Charles R

    2018-05-01

    Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Structures and infrastructures series

    National Research Council Canada - National Science Library

    2008-01-01

    "Research, developments, and applications...on the most advanced techonologies for analyzing, predicting, and optimizing the performance of structures and infrastructures such as buildings, bridges, dams...

  5. Global information infrastructure.

    Science.gov (United States)

    Lindberg, D A

    1994-01-01

    The High Performance Computing and Communications Program (HPCC) is a multiagency federal initiative under the leadership of the White House Office of Science and Technology Policy, established by the High Performance Computing Act of 1991. It has been assigned a critical role in supporting the international collaboration essential to science and to health care. Goals of the HPCC are to extend USA leadership in high performance computing and networking technologies; to improve technology transfer for economic competitiveness, education, and national security; and to provide a key part of the foundation for the National Information Infrastructure. The first component of the National Institutes of Health to participate in the HPCC, the National Library of Medicine (NLM), recently issued a solicitation for proposals to address a range of issues, from privacy to 'testbed' networks, 'virtual reality,' and more. These efforts will build upon the NLM's extensive outreach program and other initiatives, including the Unified Medical Language System (UMLS), MEDLARS, and Grateful Med. New Internet search tools are emerging, such as Gopher and 'Knowbots'. Medicine will succeed in developing future intelligent agents to assist in utilizing computer networks. Our ability to serve patients is so often restricted by lack of information and knowledge at the time and place of medical decision-making. The new technologies, properly employed, will also greatly enhance our ability to serve the patient.

  6. Sleep Health Issues for Children with FASD: Clinical Considerations

    Directory of Open Access Journals (Sweden)

    James E. Jan

    2010-01-01

    Full Text Available This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniques used for typical children are less suitable for children with FASD who need individually designed interventions. The types, causes, and adverse effects of sleep disorders, the modification of environment, scheduling and preparation for sleep, and sleep health for their caregivers are discussed. It is our hope that parents and also researchers, who are interested in the sleep disorders of children with FASD, will benefit from this presentation and that this discussion will stimulate much needed evidence-based research.

  7. Sleep Health Issues for Children with FASD: Clinical Considerations.

    Science.gov (United States)

    Jan, James E; Asante, Kwadwo O; Conry, Julianne L; Fast, Diane K; Bax, Martin C O; Ipsiroglu, Osman S; Bredberg, Elizabeth; Loock, Christine A; Wasdell, Michael B

    2010-01-01

    This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniques used for typical children are less suitable for children with FASD who need individually designed interventions. The types, causes, and adverse effects of sleep disorders, the modification of environment, scheduling and preparation for sleep, and sleep health for their caregivers are discussed. It is our hope that parents and also researchers, who are interested in the sleep disorders of children with FASD, will benefit from this presentation and that this discussion will stimulate much needed evidence-based research.

  8. NON-COMMUNICABLE DISEASE PROGRAM IN AMPANGAN HEALTH CLINIC

    Directory of Open Access Journals (Sweden)

    MASTURA I

    2010-01-01

    Full Text Available Non-communicable diseases (NCDs represent among the most common and debilitating conditions seen in primary care. Patients’ care will often involves multiple providers and follow-up requires persistence by patients and clinicians alike, therefore ideal outcomes are often difficult to achieve. The need for better disease management policies and practice is growing. This is due to the changing demographic profile of the population, the increasing cost of managing people in acute care hospitals and the availability of new technologies and services. All these changes enable a different care paradigm which is more cost effective and provides people with chronic conditions an improved quality of life. Management of the NCDs therefore offers an excellent opportunity to practice chronic disease management - a systems approach designed to ensure excellent care. The NCD team has developed a comprehensive approach to chronic disease care. We would like to describe the NCD Program in Ampangan Health Clinic which represents many typical government health clinics in Malaysia and the processes by which it was developed. Included are specific examples of the tools and how they can be used by individual clinicians incaring for patients. The integration of Chronic Disease Management Services into health care systems is the direction being undertaken to tackle the burden of chronic disease. Disease management supports the shift in healthcare from an emphasis on managing the acute episode to managing the entire disease course, highlighting both prevention and maintenance of wellbeing for patients with chronic diseases. Disease management promotes better integration and coordination of care across all aspects of the health sector.

  9. eHealth in cardiovascular medicine: A clinical update.

    Science.gov (United States)

    Saner, Hugo; van der Velde, Enno

    2016-10-01

    Demographic changes, progress in medicine technology and regional problems in providing healthcare to low density populations are posing great challenges to our healthcare systems. Rapid progress in computer sciences and information technologies have a great impact on the way healthcare will be delivered in the near future. This article describes opportunities and challenges of eHealth and telemedicine in the framework of our health systems and, in particular, in the context of today's cardiology services. The most promising applications of eHealth and telemedicine include: (a) prevention and lifestyle interventions; (b) chronic disease management including hypertension, diabetes and heart failure; (c) arrhythmia detection including early detection of atrial fibrillation and telemonitoring of devices such as pacemaker, internal cardioverter defibrillators and implantable rhythm monitoring devices; (d) telerehabilitation. Major obstacles to the integration of eHealth and telemedicine into daily clinical practice include limited large-scale evidence, in particular, for cost-effectiveness, as well as lack of interoperability, inadequate or fragmented legal frameworks and lack of reimbursement. An important challenge for those involved in these new technologies will be to keep the main focus on patient's individual needs and to carefully evaluate the evidence behind the practice. © The European Society of Cardiology 2016.

  10. Site Support Program Plan Infrastructure Program

    International Nuclear Information System (INIS)

    1995-01-01

    The Fiscal Year 1996 Infrastructure Program Site Support Program Plan addresses the mission objectives, workscope, work breakdown structures (WBS), management approach, and resource requirements for the Infrastructure Program. Attached to the plan are appendices that provide more detailed information associated with scope definition. The Hanford Site's infrastructure has served the Site for nearly 50 years during defense materials production. Now with the challenges of the new environmental cleanup mission, Hanford's infrastructure must meet current and future mission needs in a constrained budget environment, while complying with more stringent environmental, safety, and health regulations. The infrastructure requires upgrading, streamlining, and enhancement in order to successfully support the site mission of cleaning up the Site, research and development, and economic transition

  11. Site Support Program Plan Infrastructure Program

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-09-26

    The Fiscal Year 1996 Infrastructure Program Site Support Program Plan addresses the mission objectives, workscope, work breakdown structures (WBS), management approach, and resource requirements for the Infrastructure Program. Attached to the plan are appendices that provide more detailed information associated with scope definition. The Hanford Site`s infrastructure has served the Site for nearly 50 years during defense materials production. Now with the challenges of the new environmental cleanup mission, Hanford`s infrastructure must meet current and future mission needs in a constrained budget environment, while complying with more stringent environmental, safety, and health regulations. The infrastructure requires upgrading, streamlining, and enhancement in order to successfully support the site mission of cleaning up the Site, research and development, and economic transition.

  12. Prioritizing Infrastructure Investments in Panama : Pilot Application of the World Bank Infrastructure Prioritization Framework

    OpenAIRE

    Marcelo, Darwin; Mandri-Perrott, Cledan; House, Schuyler

    2016-01-01

    Infrastructure services are significant determinants of economic development, social welfare, trade, and public health. As such, they typically feature strongly in national development plans. While governments may receive many infrastructure project proposals, however, resources are often insufficient to finance the full set of proposals in the short term. Leading up to 2020, an estimated US$836 ...

  13. Diet and Sleep Physiology: Public Health and Clinical Implications

    Directory of Open Access Journals (Sweden)

    Sarah Frank

    2017-08-01

    Full Text Available This mini-review examines the complex relationship between diet and sleep and explores the clinical and public health implications of the current evidence. Dietary quality and intake of specific nutrients can impact regulatory hormonal pathways to alter sleep quantity and quality. Sleep, in turn, affects the intake of total energy, as well as of specific foods and nutrients, through biological and behavioral mechanisms. Initial research in this field focused primarily on the effects of short sleep duration on nutritional quality. However, more recent studies have explored the dynamic relationship between long sleep duration and diet. Current evidence suggests that extremes of sleep duration alter sleep patterns, hormonal levels, and circadian rhythms, which contribute to weight-related outcomes and obesity, and other risk factors for the development of chronic disease such as type 2 diabetes and cardiovascular disease. These patterns may begin as early as childhood and have impacts throughout the life course. Given that non-communicable diseases are among the leading causes of death globally, deeper understanding of the interactions between sleep and nutrition has implications for both public health and clinical practice.

  14. Communication between hospitals and isolated aboriginal community health clinics.

    Science.gov (United States)

    Mackenzie, G; Currie, B J

    1999-04-01

    This study described the communication dynamics, identified problems and recommended changes to improve patient follow-up and communication between Royal Darwin Hospital (RDH) and isolated Aboriginal community health clinics (CHC) in the Northern Territory (NT). In 1995, staff interviews were conducted and an audit of isolated Aboriginal patients' RDH discharge summaries (DS). Eighteen per cent of RDH DSs never arrived in CHCs. DSs were often prepared late and more likely to be in CHC records if written on time and if the referral source was specified. Interviews revealed discontent between CHCs and RDH regarding: communication, DS documentation, the supply of discharge medication, as well as different hospital and community perceptions of Aboriginies' reliability to carry a DS and CHC desire for patients to be given DSs at discharge. Aboriginal patients should be given a DS at discharge and resident medical officers should be educated as to the function and importance of the DS. In 18 months following this study, RDH appointed unit-based Aboriginal health workers and a policy was produced for written communication between hospital and CHCs, as well as a discharge planning manual for Aboriginal communities. Projects investigating communication between hospitals and isolated Aboriginal clinics and patient follow-up may result in significant policy changes concerning these processes.

  15. Building an evaluation infrastructure

    DEFF Research Database (Denmark)

    Brandrup, Morten; Østergaard, Kija Lin

    Infrastructuring does not happen by itself; it must be supported. In this paper, we present a feedback mechanism implemented as a smartphone-based application, inspired by the concept of infrastructure probes, which supports the in situ elicitation of feedback. This is incorporated within an eval...

  16. Physical resources and infrastructure

    NARCIS (Netherlands)

    Foeken, D.W.J.; Hoorweg, J.; Foeken, D.W.J.; Obudho, R.A.

    2000-01-01

    This chapter describes the main physical characteristics as well as the main physical and social infrastructure features of Kenya's coastal region. Physical resources include relief, soils, rainfall, agro-ecological zones and natural resources. Aspects of the physical infrastructure discussed are

  17. Transport Infrastructure Slot Allocation

    NARCIS (Netherlands)

    Koolstra, K.

    2005-01-01

    In this thesis, transport infrastructure slot allocation has been studied, focusing on selection slot allocation, i.e. on longer-term slot allocation decisions determining the traffic patterns served by infrastructure bottlenecks, rather than timetable-related slot allocation problems. The

  18. Telecom infrastructure leasing

    International Nuclear Information System (INIS)

    Henley, R.

    1995-01-01

    Slides to accompany a discussion about leasing telecommunications infrastructure, including radio/microwave tower space, radio control buildings, paging systems and communications circuits, were presented. The structure of Alberta Power Limited was described within the ATCO group of companies. Corporate goals and management practices and priorities were summarized. Lessons and experiences in the infrastructure leasing business were reviewed

  19. Infrastructures for healthcare

    DEFF Research Database (Denmark)

    Langhoff, Tue Odd; Amstrup, Mikkel Hvid; Mørck, Peter

    2018-01-01

    The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classif...... synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare....

  20. Clinical guideline implementation strategies for common mental health disorders.

    Science.gov (United States)

    Moreno, Eliana María; Moriana, Juan Antonio

    2016-01-01

    There has been a considerable proliferation of clinical guidelines recently, but their practical application is low, and organisations do not always implement their own ones. The aim of this study is to analyse and describe key elements of strategies and resources designed by the National Institute for Health and Care Excellence for the implementation of guidelines for common mental health disorders in adults, which are some of the most prevalent worldwide. A systematic review was performed following PRISMA model. Resources, tools and implementation materials where included and categorised considering type, objectives, target and scope. A total of 212 elements were analysed, of which 33.5 and 24.5% are related to the implementation of generalized anxiety and depression guidelines, respectively. Applied tools designed to estimate costs and assess the feasibility of the setting up at local level are the most frequent type of resource. The study highlights the important variety of available materials, classified into 3 main strategies: tools targeting the professionals (30.6%), structural (26.4%), and organizational (24%). Developing guidelines is not enough; it is also necessary to promote their implementation in order to encourage their application. The resources and strategies described in this study may be potentially applicable to other contexts, and helpful to public health managers and professionals in the design of programmes and in the process of informed decision making to help increase access to efficient treatments. Copyright © 2015. Published by Elsevier España.

  1. After the clinic? Researching sexual health technology in context.

    Science.gov (United States)

    Davis, Mark

    2015-01-01

    There is great interest in what testing, pharmaceutical, information and social media technology can do for sexual health. Much programmatic and research activity is focused on assessing how these technologies can be used to best effect. Less obvious are analyses that place technology into historical, political and real-world settings. Developing an 'in-context' analysis of sexual health technology, this paper draws on interviews with leading community advocates, researchers and clinicians in Australia, Canada and the UK and looks across examples, including social media, rapid HIV testing, pre-Exposure Prophylaxis for HIV and polymerase chain reaction Chlamydia testing. The analysis is framed by studies of techno-society and the dialectics of sex-affirmative advocacy with biomedical authority and attends to: the rationalistic and affective dimensions of the imaginary associated with technology; the role of technology in the re-spatialisation and re-temporalisation of the sexual health clinic; and the re-invention of technology in its real-world contexts. This in-context approach is important for: the effective implementation of new technology; strengthening the social science contribution to the field; and enriching social theory in general on life in techno-societies.

  2. The Fountain of Health: Bringing Seniors’ Mental Health Promotion into Clinical Practice

    Science.gov (United States)

    Thoo, Vanessa; Freer, Janya; Cassidy, Keri-Leigh

    2015-01-01

    Background The Fountain of Health (FoH) initiative offers valuable evidence-based mental health knowledge and provides clinicians with evaluated tools for translating knowledge into practice, in order to reduce seniors’ risks of mental disorders, including dementia. Methods A presentation on mental health promotion and educational materials were disseminated to mental health clinicians including physicians and other allied health professionals either in-person or via tele-education through a provincial seniors’ mental health network. Measures included: 1) a tele-education quality evaluation form, 2) a knowledge transfer questionnaire, 3) a knowledge translation-to-practice evaluation tool, and 4) a quality assurance questionnaire. Results A total of 74 mental health clinicians received the FoH education session. There was a highly significant (p < .0001) difference in clinicians’ knowledge transfer questionnaire scores pre- and post-educational session. At a two-month follow-up, 19 (25.7%) participants completed a quality assurance questionnaire, with all 19 (100%) of respondents stating they would positively recommend the FoH information to colleagues and patients. Eleven (20.4%) translation-to-practice forms were also collected at this interval, tracking clinician use of the educational materials. Conclusions The use of a formalized network for knowledge transfer allows for education and evaluation of health-care practitioners in both acquisition of practical knowledge and subsequent clinical behavior change. PMID:26740830

  3. Health status measurement in COPD: the minimal clinically important difference of the clinical COPD questionnaire

    Directory of Open Access Journals (Sweden)

    van den Berg JWK

    2006-04-01

    Full Text Available Abstract Background Patient-reported outcomes (PRO questionnaires are being increasingly used in COPD clinical studies. The challenge facing investigators is to determine what change is significant, ie what is the minimal clinically important difference (MCID. This study aimed to identify the MCID for the clinical COPD questionnaire (CCQ in terms of patient referencing, criterion referencing, and by the standard error of measurement (SEM. Methods Patients were ≥40 years of age, diagnosed with COPD, had a smoking history of >10 pack-years, and were participating in a randomized, controlled clinical trial comparing intravenous and oral prednisolone in patients admitted with an acute exacerbation of COPD. The CCQ was completed on Days 1–7 and 42. A Global Rating of Change (GRC assessment was taken to establish the MCID by patient referencing. For criterion referencing, health events during a period of 1 year after Day 42 were included in this analysis. Results 210 patients were recruited, 168 completed the CCQ questionnaire on Day42. The MCID of the CCQ total score, as indicated by patient referencing in terms of the GRC, was 0.44. The MCID of the CCQ in terms of criterion referencing for the major outcomes was 0.39, and calculation of the SEM resulted in a value of 0.21. Conclusion This investigation, which is the first to determine the MCID of a PRO questionnaire via more than one approach, indicates that the MCID of the CCQ total score is 0.4.

  4. Clinical reasoning and population health: decision making for an emerging paradigm of health care.

    Science.gov (United States)

    Edwards, Ian; Richardson, Barbara

    2008-01-01

    Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners' understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community.

  5. 42 CFR 440.20 - Outpatient hospital services and rural health clinic services.

    Science.gov (United States)

    2010-10-01

    ... Definitions § 440.20 Outpatient hospital services and rural health clinic services. (a) Outpatient hospital... services that are not generally furnished by most hospitals in the State. (b) Rural health clinic services... 42 Public Health 4 2010-10-01 2010-10-01 false Outpatient hospital services and rural health...

  6. Barriers to Providing Health Education During Primary Care Visits at Community Health Centers: Clinical Staff Insights.

    Science.gov (United States)

    Alicea-Planas, Jessica; Pose, Alix; Smith, Linda

    2016-04-01

    The rapid increase of diverse patients living in the US has created a different set of needs in healthcare, with the persistence of health disparities continuing to challenge the current system. Chronic disease management has been discussed as a way to improve health outcomes, with quality patient education being a key component. Using a community based participatory research framework, this study utilized a web-based survey and explored clinical staff perceptions of barriers to providing patient education during primary care visits. With a response rate of nearly 42 %, appointment time allotment seemed to be one of the most critical factors related to the delivery of health education and should be considered key. The importance of team-based care and staff training were also significant. Various suggestions were made in order to improve the delivery of quality patient education at community health centers located in underserved areas.

  7. Security infrastructure for dynamically provisioned cloud infrastructure services

    NARCIS (Netherlands)

    Demchenko, Y.; Ngo, C.; de Laat, C.; Lopez, D.R.; Morales, A.; García-Espín, J.A.; Pearson, S.; Yee, G.

    2013-01-01

    This chapter discusses conceptual issues, basic requirements and practical suggestions for designing dynamically configured security infrastructure provisioned on demand as part of the cloud-based infrastructure. This chapter describes general use cases for provisioning cloud infrastructure services

  8. Information infrastructure(s) boundaries, ecologies, multiplicity

    CERN Document Server

    Mongili, Alessandro

    2014-01-01

    This book marks an important contribution to the fascinating debate on the role that information infrastructures and boundary objects play in contemporary life, bringing to the fore the concern of how cooperation across different groups is enabled, but also constrained, by the material and immaterial objects connecting them. As such, the book itself is situated at the crossroads of various paths and genealogies, all focusing on the problem of the intersection between different levels of scale...

  9. Chef infrastructure automation cookbook

    CERN Document Server

    Marschall, Matthias

    2013-01-01

    Chef Infrastructure Automation Cookbook contains practical recipes on everything you will need to automate your infrastructure using Chef. The book is packed with illustrated code examples to automate your server and cloud infrastructure.The book first shows you the simplest way to achieve a certain task. Then it explains every step in detail, so that you can build your knowledge about how things work. Eventually, the book shows you additional things to consider for each approach. That way, you can learn step-by-step and build profound knowledge on how to go about your configuration management

  10. Characterizing implicit mental health associations across clinical domains.

    Science.gov (United States)

    Werntz, Alexandra J; Steinman, Shari A; Glenn, Jeffrey J; Nock, Matthew K; Teachman, Bethany A

    2016-09-01

    Implicit associations are relatively uncontrollable associations between concepts in memory. The current investigation focuses on implicit associations in four mental health domains (alcohol use, anxiety, depression, and eating disorders) and how these implicit associations: a) relate to explicit associations and b) self-reported clinical symptoms within the same domains, and c) vary based on demographic characteristics (age, gender, race, ethnicity, and education). Participants (volunteers over age 18 to a research website) completed implicit association (Implicit Association Tests), explicit association (self + psychopathology or attitudes toward food, using semantic differential items), and symptom measures at the Project Implicit Mental Health website tied to: alcohol use (N = 12,387), anxiety (N = 21,304), depression (N = 24,126), or eating disorders (N = 10,115). Within each domain, implicit associations showed small to moderate associations with explicit associations and symptoms, and predicted self-reported symptoms beyond explicit associations. In general, implicit association strength varied little by race and ethnicity, but showed small ties to age, gender, and education. This research was conducted on a public research and education website, where participants could take more than one of the studies. Among a large and diverse sample, implicit associations in the four domains are congruent with explicit associations and self-reported symptoms, and also add to our prediction of self-reported symptoms over and above explicit associations, pointing to the potential future clinical utility and validity of using implicit association measures with diverse populations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. The European Research Infrastructures of the ESFRI Roadmap in Biological and Medical Sciences: status and perspectives

    Directory of Open Access Journals (Sweden)

    Alessia Calzolari

    2014-06-01

    Full Text Available INTRODUCTION. Since 2002, the European Strategy Forum on Research Infrastructures identified the needs for Research Infrastructures (RIs in Europe in priority fields of scientific research and drafted a strategic document, the ESFRI Roadmap, defining the specific RIs essential to foster European research and economy. The Biological and Medical Sciences RIs (BMS RIs were developed thanks to the active participation of many institutions in different European member states associated to address the emerging needs in biomedicine and, among these, the Italian National Institute of Health (ISS, in virtue of its role in public health and research, has been specifically involved in the national development and implementation of three RIs: the Biobanking and Biomolecular Resources Research Infrastructure (BBMRI, the European Advanced Translational Research Infrastructure in Medicine (EATRIS and the European Clinical Research Infrastructures Network (ECRIN. AIM. This article outlines the design and development of these RIs up to the recent achievement of the ERIC status, their importance in the Horizon 2020 programme and their societal and economic potential impact, with special attention to their development and significance in Italy. CONCLUSIONS. The ISS plays a unique role in fostering a coordinated participation of excellence Italian institutes/facilities to different European biomedical RIs, thus contributing to health innovation, healthcare optimization, and healthcare cost containment.

  12. Next generation terminology infrastructure to support interprofessional care planning.

    Science.gov (United States)

    Collins, Sarah; Klinkenberg-Ramirez, Stephanie; Tsivkin, Kira; Mar, Perry L; Iskhakova, Dina; Nandigam, Hari; Samal, Lipika; Rocha, Roberto A

    2017-11-01

    Develop a prototype of an interprofessional terminology and information model infrastructure that can enable care planning applications to facilitate patient-centered care, learn care plan linkages and associations, provide decision support, and enable automated, prospective analytics. The study steps included a 3 step approach: (1) Process model and clinical scenario development, and (2) Requirements analysis, and (3) Development and validation of information and terminology models. Components of the terminology model include: Health Concerns, Goals, Decisions, Interventions, Assessments, and Evaluations. A terminology infrastructure should: (A) Include discrete care plan concepts; (B) Include sets of profession-specific concerns, decisions, and interventions; (C) Communicate rationales, anticipatory guidance, and guidelines that inform decisions among the care team; (D) Define semantic linkages across clinical events and professions; (E) Define sets of shared patient goals and sub-goals, including patient stated goals; (F) Capture evaluation toward achievement of goals. These requirements were mapped to AHRQ Care Coordination Measures Framework. This study used a constrained set of clinician-validated clinical scenarios. Terminology models for goals and decisions are unavailable in SNOMED CT, limiting the ability to evaluate these aspects of the proposed infrastructure. Defining and linking subsets of care planning concepts appears to be feasible, but also essential to model interprofessional care planning for common co-occurring conditions and chronic diseases. We recommend the creation of goal dynamics and decision concepts in SNOMED CT to further enable the necessary models. Systems with flexible terminology management infrastructure may enable intelligent decision support to identify conflicting and aligned concerns, goals, decisions, and interventions in shared care plans, ultimately decreasing documentation effort and cognitive burden for clinicians and

  13. [Clinical governance and patient safety culture in clinical laboratories in the Spanish National Health System].

    Science.gov (United States)

    Giménez-Marín, Á; Rivas-Ruiz, F

    To conduct a situational analysis of patient safety culture in public laboratories in the Spanish National Health System and to determine the clinical governance variables that most strongly influence patient safety. A descriptive cross-sectional study was carried out, in which a Survey of Patient Safety in Clinical Laboratories was addressed to workers in 26 participating laboratories. In this survey, which consisted of 45 items grouped into 6 areas, scores were assigned on a scale from 0 to 100 (where 0 is the lowest perception of patient safety). Laboratory managers were asked specific questions about quality management systems and technology. The mean scores for the 26 participating hospitals were evaluated, and the following results observed: in 4of the 6areas, the mean score was higher than 70 points. In the third area (equipment and resources) and the fourth area (working conditions), the scores were lower than 60 points. Every hospital had a digital medical record system. This 100% level of provision was followed by that of an electronic request management system, which was implemented in 82.6% of the hospitals. The results obtained show that the culture of security is homogeneous and of high quality in health service laboratories, probably due to the steady improvement observed. However, in terms of clinical governance, there is still some way to go, as shown by the presence of weaknesses in crucial dimensions of safety culture, together with variable levels of implementation of fail-safe technologies and quality management systems. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Complementary therapy use by women's health clinic clients.

    Science.gov (United States)

    Pettigrew, Amy C; King, Margaret O'Brien; McGee, Karen; Rudolph, Connie

    2004-01-01

    While it is known that more women than men use complementary and alternative therapies, it is important to look at women who are pregnant or possibly receiving hormonal therapy, as side effects and consequences of these therapies may have a significant effect on their health status. To assess women's knowledge, perceived effectiveness and use of 20 complementary and alternative therapies. Descriptive four-page questionnaire to obtain data on the use, reason for use, knowledge, perceived effectiveness, and sources of information of twenty complementary and alternative therapies. Women's Health Center at a large Midwestern hospital. A convenience sample of 250 women waiting to be seen by either a nurse midwife or obstetrician/gynecologist at an outpatient clinic. Sixty-nine percent of the participants used one or more complementary therapy. The most frequently used therapies included prayer, vitamins, massage, diet, and aromatherapy. The best predictor of use of each therapy was the participant's knowledge of the therapy. Participants generally rated the efficacy of the therapies higher than their knowledge level. Frequently cited sources of information were popular media and family. The least common information sources were nurse-midwives, drug stores, Internet, and other professional healthcare providers. Women in this setting use complementary therapies at a rate greater than the general population. The participants obtained a great deal of their information about the therapies from popular press, media, friends, and family members rather than from licensed healthcare providers.

  15. Evaluation of specialist referrals at a rural health care clinic.

    Science.gov (United States)

    Biggerstaff, Mary Ellen; Short, Nancy

    2017-07-01

    Transition to a value-based care system involves reducing costs improving population health and enhancing the patient experience. Many rural hospitals must rely on specialist referrals because of a lack of an internal system of specialists on staff. This evaluation of the existing specialist referrals from primary care was conducted to better understand and improve the referral process and address costs, population health, and the patient experience. A 6-month retrospective chart review was conducted to evaluate quality and outcomes of specialty referrals submitted by 10 primary care providers. During a 6-month period in 2015, there was a total of 13,601 primary care patient visits and 3814 referrals, a referral rate of approximately 27%. The most striking result of this review was that nearly 50% of referred patients were not making the prescribed specialist appointment. Rather than finding a large number of unnecessary referrals, we found overall referral rates higher than expected, and a large percentage of our patients were not completing their referrals. The data and patterns emerging from this investigation would guide the development of referral protocols for a newly formed accountable care organization and lead to further quality improvement projects: a LEAN effort, dissemination of results to clinical and executive staff, protocols for orthopedic and neurosurgical referrals, and recommendations for future process improvements. ©2017 American Association of Nurse Practitioners.

  16. A numerical similarity approach for using retired Current Procedural Terminology (CPT) codes for electronic phenotyping in the Scalable Collaborative Infrastructure for a Learning Health System (SCILHS).

    Science.gov (United States)

    Klann, Jeffrey G; Phillips, Lori C; Turchin, Alexander; Weiler, Sarah; Mandl, Kenneth D; Murphy, Shawn N

    2015-12-11

    Interoperable phenotyping algorithms, needed to identify patient cohorts meeting eligibility criteria for observational studies or clinical trials, require medical data in a consistent structured, coded format. Data heterogeneity limits such algorithms' applicability. Existing approaches are often: not widely interoperable; or, have low sensitivity due to reliance on the lowest common denominator (ICD-9 diagnoses). In the Scalable Collaborative Infrastructure for a Learning Healthcare System (SCILHS) we endeavor to use the widely-available Current Procedural Terminology (CPT) procedure codes with ICD-9. Unfortunately, CPT changes drastically year-to-year - codes are retired/replaced. Longitudinal analysis requires grouping retired and current codes. BioPortal provides a navigable CPT hierarchy, which we imported into the Informatics for Integrating Biology and the Bedside (i2b2) data warehouse and analytics platform. However, this hierarchy does not include retired codes. We compared BioPortal's 2014AA CPT hierarchy with Partners Healthcare's SCILHS datamart, comprising three-million patients' data over 15 years. 573 CPT codes were not present in 2014AA (6.5 million occurrences). No existing terminology provided hierarchical linkages for these missing codes, so we developed a method that automatically places missing codes in the most specific "grouper" category, using the numerical similarity of CPT codes. Two informaticians reviewed the results. We incorporated the final table into our i2b2 SCILHS/PCORnet ontology, deployed it at seven sites, and performed a gap analysis and an evaluation against several phenotyping algorithms. The reviewers found the method placed the code correctly with 97 % precision when considering only miscategorizations ("correctness precision") and 52 % precision using a gold-standard of optimal placement ("optimality precision"). High correctness precision meant that codes were placed in a reasonable hierarchal position that a reviewer

  17. Infrastructure Area Simplification Plan

    CERN Document Server

    Field, L.

    2011-01-01

    The infrastructure area simplification plan was presented at the 3rd EMI All Hands Meeting in Padova. This plan only affects the information and accounting systems as the other areas are new in EMI and hence do not require simplification.

  18. IPHE Infrastructure Workshop Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    None

    2010-02-01

    This proceedings contains information from the IPHE Infrastructure Workshop, a two-day interactive workshop held on February 25-26, 2010, to explore the market implementation needs for hydrogen fueling station development.

  19. EV Charging Infrastructure Roadmap

    Energy Technology Data Exchange (ETDEWEB)

    Karner, Donald [Electric Transportation Inc., Rogers, AR (United States); Garetson, Thomas [Electric Transportation Inc., Rogers, AR (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2016-08-01

    As highlighted in the U.S. Department of Energy’s EV Everywhere Grand Challenge, vehicle technology is advancing toward an objective to “… produce plug-in electric vehicles that are as affordable and convenient for the average American family as today’s gasoline-powered vehicles …” [1] by developing more efficient drivetrains, greater battery energy storage per dollar, and lighter-weight vehicle components and construction. With this technology advancement and improved vehicle performance, the objective for charging infrastructure is to promote vehicle adoption and maximize the number of electric miles driven. The EV Everywhere Charging Infrastructure Roadmap (hereafter referred to as Roadmap) looks forward and assumes that the technical challenges and vehicle performance improvements set forth in the EV Everywhere Grand Challenge will be met. The Roadmap identifies and prioritizes deployment of charging infrastructure in support of this charging infrastructure objective for the EV Everywhere Grand Challenge

  20. Pennsylvania Reaches Infrastructure Milestone

    Science.gov (United States)

    With a series of “aye” votes, the Pennsylvania agency that turns EPA funding and state financing into water infrastructure projects crossed a key threshold recently – $8 billion in investment over nearly three decades

  1. EV Charging Infrastructure Roadmap

    International Nuclear Information System (INIS)

    Karner, Donald; Garetson, Thomas; Francfort, Jim

    2016-01-01

    As highlighted in the U.S. Department of Energy's EV Everywhere Grand Challenge, vehicle technology is advancing toward an objective to ''... produce plug-in electric vehicles that are as affordable and convenient for the average American family as today's gasoline-powered vehicles ...'' [1] by developing more efficient drivetrains, greater battery energy storage per dollar, and lighter-weight vehicle components and construction. With this technology advancement and improved vehicle performance, the objective for charging infrastructure is to promote vehicle adoption and maximize the number of electric miles driven. The EV Everywhere Charging Infrastructure Roadmap (hereafter referred to as Roadmap) looks forward and assumes that the technical challenges and vehicle performance improvements set forth in the EV Everywhere Grand Challenge will be met. The Roadmap identifies and prioritizes deployment of charging infrastructure in support of this charging infrastructure objective for the EV Everywhere Grand Challenge

  2. Green Infrastructure Modeling Toolkit

    Science.gov (United States)

    Green infrastructure, such as rain gardens, green roofs, porous pavement, cisterns, and constructed wetlands, is becoming an increasingly attractive way to recharge aquifers and reduce the amount of stormwater runoff that flows into wastewater treatment plants or into waterbodies...

  3. Acceptability of health information technology aimed at environmental health education in a prenatal clinic.

    Science.gov (United States)

    Rosas, Lisa G; Trujillo, Celina; Camacho, Jose; Madrigal, Daniel; Bradman, Asa; Eskenazi, Brenda

    2014-11-01

    To describe the acceptability of an interactive computer kiosk that provides environmental health education to low-income Latina prenatal patients. A mixed-methods approach was used to assess the acceptability of the Prenatal Environmental Health Kiosk pregnant Latina women in Salinas, CA (n=152). The kiosk is a low literacy, interactive touch-screen computer program with an audio component and includes graphics and an interactive game. The majority had never used a kiosk before. Over 90% of women reported that they learned something new while using the kiosk. Prior to using the kiosk, 22% of women reported their preference of receiving health education from a kiosk over a pamphlet or video compared with 57% after using the kiosk (peducation; and (3) popularity of the interactive game. The Prenatal Environmental Health Kiosk is an innovative patient health education modality that was shown to be acceptable among a population of low-income Latino pregnant women in a prenatal care clinic. This pilot study demonstrated that a health education kiosk was an acceptable strategy for providing Latina prenatal patients with information on pertinent environmental exposures. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Clarkesville Green Infrastructure Implementation Strategy

    Science.gov (United States)

    The report outlines the 2012 technical assistance for Clarkesville, GA to develop a Green Infrastructure Implementation Strategy, which provides the basic building blocks for a green infrastructure plan:

  5. Optimally Reorganizing Navy Shore Infrastructure

    National Research Council Canada - National Science Library

    Kerman, Mitchell

    1997-01-01

    ...), but infrastructure reductions continue to lag force structure reductions. The United States Navy's recent initiatives to reduce its shore infrastructure costs include "regionalization", "outsourcing," and "homebasing...

  6. Infrastructure Engineering and Deployment Division

    Data.gov (United States)

    Federal Laboratory Consortium — Volpe's Infrastructure Engineering and Deployment Division advances transportation innovation by being leaders in infrastructure technology, including vehicles and...

  7. MFC Communications Infrastructure Study

    Energy Technology Data Exchange (ETDEWEB)

    Michael Cannon; Terry Barney; Gary Cook; George Danklefsen, Jr.; Paul Fairbourn; Susan Gihring; Lisa Stearns

    2012-01-01

    Unprecedented growth of required telecommunications services and telecommunications applications change the way the INL does business today. High speed connectivity compiled with a high demand for telephony and network services requires a robust communications infrastructure.   The current state of the MFC communication infrastructure limits growth opportunities of current and future communication infrastructure services. This limitation is largely due to equipment capacity issues, aging cabling infrastructure (external/internal fiber and copper cable) and inadequate space for telecommunication equipment. While some communication infrastructure improvements have been implemented over time projects, it has been completed without a clear overall plan and technology standard.   This document identifies critical deficiencies with the current state of the communication infrastructure in operation at the MFC facilities and provides an analysis to identify needs and deficiencies to be addressed in order to achieve target architectural standards as defined in STD-170. The intent of STD-170 is to provide a robust, flexible, long-term solution to make communications capabilities align with the INL mission and fit the various programmatic growth and expansion needs.

  8. Building safeguards infrastructure

    International Nuclear Information System (INIS)

    Stevens, Rebecca S.; McClelland-Kerr, John

    2009-01-01

    Much has been written in recent years about the nuclear renaissance - the rebirth of nuclear power as a clean and safe source of electricity around the world. Those who question the nuclear renaissance often cite the risk of proliferation, accidents or an attack on a facility as concerns, all of which merit serious consideration. The integration of these three areas - sometimes referred to as 3S, for safety, security and safeguards - is essential to supporting the growth of nuclear power, and the infrastructure that supports them should be strengthened. The focus of this paper will be on the role safeguards plays in the 3S concept and how to support the development of the infrastructure necessary to support safeguards. The objective of this paper has been to provide a working definition of safeguards infrastructure, and to discuss xamples of how building safeguards infrastructure is presented in several models. The guidelines outlined in the milestones document provide a clear path for establishing both the safeguards and the related infrastructures needed to support the development of nuclear power. The model employed by the INSEP program of engaging with partner states on safeguards-related topics that are of current interest to the level of nuclear development in that state provides another way of approaching the concept of building safeguards infrastructure. The Next Generation Safeguards Initiative is yet another approach that underscored five principal areas for growth, and the United States commitment to working with partners to promote this growth both at home and abroad.

  9. Are our subcenters equipped enough to provide primary health care to the community: A study to explore the gaps in workforce and infrastructure in the subcenters from North India

    Directory of Open Access Journals (Sweden)

    M A Bashar

    2017-01-01

    Full Text Available Background: A Sub-Centre (SC is most peripheral and first point of contact between the primary healthcare system and the community in the rural areas. The success of any nationwide program largely depends on well-functioning SCs providing services of acceptable standards to people. Indian Public Health Standards (IPHS for SCs was prepared keeping in view the minimum standards required to provide quality and need sensitive health care to the community. Materials and Methods: A cross-sectional study was conducted in Ambala District of Haryana to assess the availability of physical infrastructure, manpower, drugs and equipment in the SCs. A total of 30 SCs from a rural block was selected. The data was statistically analyzed using Microsoft Excel. The deficiencies in the availability of health workers male and female were found to be 66.6% and 50%, respectively. The residential facility for health workers was available only in 33.3% SCs but none being utilized. Although labour room with labour table was present in half of the Sub Centers, the deliveries were found to be conducted in none of those. Only 40% and 26.6% of SCs had stethoscope and functional B.P apparatus. The availability of essential drugs and equipment was also poor. Conclusion: The physical infrastructure and manpower availability at the SCs needs considerable improvement as per the Indian Public Health Standard (IPHS. Poor availability of essential drugs and equipment needs to be addressed at the earliest.

  10. Building and strengthening infrastructure for data exchange: lessons from the beacon communities.

    Science.gov (United States)

    Torres, Gretchen W; Swietek, Karen; Ubri, Petry S; Singer, Rachel F; Lowell, Kristina H; Miller, Wilhelmine

    2014-01-01

    The Beacon Community Cooperative Agreement Program supports interventions, including care-delivery innovations, provider performance measurement and feedback initiatives, and tools for providers and consumers to enhance care. Using a learning health system framework, we examine the Beacon Communities' processes in building and strengthening health IT (HIT) infrastructures, specifically successes and challenges in sharing patient information to improve clinical care. In 2010, the Office of the National Coordinator for Health Information Technology (ONC) launched the three-year program, which provided $250 million to 17 Beacon Communities to invest in HIT and health information exchange (HIE) infrastructure. Beacon Communities used this funding to develop and disseminate HIT-enabled quality improvement practices found effective in particular community and practice environments. NORC conducted 7 site visits, November 2012-March 2013, selecting Communities to represent diverse program features. From August-October 2013, NORC held discussions with the remaining 10 Communities. Following each visit or discussion, NORC summarized the information gathered, including transcripts, team observations, and other documents the Community provided, to facilitate a within-Community analysis of context and stakeholders, intervention strategies, enabling factors, and challenges. Although each Community designed and implemented data-sharing strategies in a unique environment, similar challenges and enabling factors emerged across the Beacons. From a learning health system perspective, their strategies to build and strengthen data-sharing infrastructures address the following crosscutting priorities: promoting technical advances and innovations by helping providers adapt EHRs for data exchange and performance measurement with customizable IT and offering technical support to smaller, independent providers; engaging key stakeholders; and fostering transparent governance and stewardship

  11. The Emerging Business Models and Value Proposition of Mobile Health Clinics.

    Science.gov (United States)

    Aung, Khin-Kyemon; Hill, Caterina; Bennet, Jennifer; Song, Zirui; Oriol, Nancy E

    2015-12-01

    Mobile health clinics are increasingly used to deliver healthcare to urban and rural populations. An estimated 2000 vehicles in the United States are now delivering between 5 and 6 million visits annually; however, despite this growth, mobile health clinics represent an underutilized resource that could transform the way healthcare is delivered, especially in underserved areas. Preliminary research has shown that mobile health clinics have the potential to reduce costs and improve health outcomes. Their value lies primarily in their mobility, their ability to be flexibly deployed and customized to fit the evolving needs of populations and health systems, and their ability to link clinical and community settings. Few studies have identified how mobile health clinics can be sustainably utilized. We discuss the value proposition of mobile health clinics and propose 3 potential business models for them-adoption by accountable care organizations, payers, and employers.

  12. Demographic and Mental Health Characteristics of Individuals Who Present to Community Health Clinics With Substance Misuse

    Directory of Open Access Journals (Sweden)

    Praise O. Iyiewuare

    2017-10-01

    Full Text Available Introduction: Community health clinics (CHCs are an opportune setting to identify and treat substance misuse. This study assessed the characteristics of patients who presented to a CHC with substance misuse. Methods: Personnel at a large CHC administered a 5-question screener to patients between June 3, 2014, and January 15, 2016, to assess past 3-month alcohol use, prescription opioid misuse, or illicit drug use. We stratified screen-positive patients into 4 diagnostic groups: (1 probable alcohol use disorder (AUD and no comorbid opioid use disorder (OUD; (2 probable heroin use disorder; (3 probable prescription OUD, with or without comorbid AUD; and (4 no probable substance use disorder. We describe substance use and mental health characteristics of screen-positive patients and compare the characteristics of patients in the diagnostic groups. Results: Compared to the clinic population, screen-positive patients (N = 733 included more males ( P < .0001 and had a higher prevalence of probable bipolar disorder ( P < .0001 and schizophrenia ( P < .0001. Eighty-seven percent of screen-positive patients had probable AUD or OUD; only 7% were currently receiving substance use treatment. The prescription opioid and heroin groups had higher rates of past bipolar disorder and consequences of mental health conditions than the alcohol only or no diagnosis groups ( P < .0001. Conclusions: Patients presenting to CHCs who screen positive for alcohol or opioid misuse have a high likelihood of having an AUD or OUD, with or without a comorbid serious mental illness. Community health clinics offering substance use treatment may be an important resource for addressing unmet need for substance use treatment and comorbid mental illness.

  13. A Return to "The Clinic" for Community Psychology: Lessons from a Clinical Ethnography in Urban American Indian Behavioral Health.

    Science.gov (United States)

    Hartmann, William E; St Arnault, Denise M; Gone, Joseph P

    2018-03-01

    Community psychology (CP) abandoned the clinic and disengaged from movements for community mental health (CMH) to escape clinical convention and pursue growing aspirations as an independent field of context-oriented, community-engaged, and values-driven research and action. In doing so, however, CP positioned itself on the sidelines of influential contemporary movements that promote potentially harmful, reductionist biomedical narratives in mental health. We advocate for a return to the clinic-the seat of institutional power in mental health-using critical clinic-based inquiry to open sites for clinical-community dialogue that can instigate transformative change locally and nationally. To inform such works within the collaborative and emancipatory traditions of CP, we detail a recently completed clinical ethnography and offer "lessons learned" regarding challenges likely to re-emerge in similar efforts. Conducted with an urban American Indian community behavioral health clinic, this ethnography examined how culture and culture concepts (e.g., cultural competence) shaped clinical practice with socio-political implications for American Indian peoples and the pursuit of transformative change in CMH. Lessons learned identify exceptional clinicians versed in ecological thinking and contextualist discourses of human suffering as ideal partners for this work; encourage intense contextualization and constraining critique to areas of mutual interest; and support relational approaches to clinic collaborations. © Society for Community Research and Action 2017.

  14. Pharmacists' Perception of the Sale of Non-Clinically Proven Health ...

    African Journals Online (AJOL)

    Pharmacists' Perception of the Sale of Non-Clinically Proven Health Supplements in Penang, Malaysia. ... A total of 10.7 % respondents indicated that the sale of non-clinically proven products result in high profit. Only 25.0 % of the pharmacists ... Keywords: Perception, Health promotion, Urban poor, Health supplements.

  15. New infrastructures, new landscapes

    Directory of Open Access Journals (Sweden)

    Chiara Nifosì

    2014-06-01

    Full Text Available New infrastructures, new landscapes AbstractThe paper will discuss one recent Italian project that share a common background: the relevance of the existing maritime landscape as a non negotiable value. The studies will be discussed in details a feasibility study for the new port in Monfalcone. National infrastructural policies emphasize competitiveness and connection as a central issue incultural, economic and political development of communities . Based on networks and system development along passageways that make up the European infrastructural armor; the two are considered at the meantime as cause and effect of "territorialisation”. These two views are obviously mutually dependent. It's hard to think about a strong attractiveness out of the network, and to be part of the latter encourages competitiveness. Nonetheless this has proved to be conflictual when landscape values and the related attractiveness are considered.The presented case study project, is pursuing the ambition to promote a new approach in realizing large infrastructures; its double role is to improve connectivity and to generate lasting and positive impact on the local regions. It deal with issues of inter-modality and the construction of nodes and lines which connects Europe, and its markets.Reverting the usual approach which consider landscape project as as a way to mitigate or to compensate for the infrastructure, the goal is to succeed in realizing large infrastructural works by conceiving them as an occasion to reinterpret a region or, as extraordinary opportunities, to build new landscapes.The strategy proposed consists in achieving structural images based on the reinforcement of the environmental and historical-landscape systems. Starting from the reinterpretation of local maritime context and resources it is possible not just to preserve the attractiveness of a specific landscape but also to conceive infrastructure in a more efficient way. 

  16. Burnout in Veterans Health Administration Mental Health Providers in Posttraumatic Stress Clinics

    Science.gov (United States)

    Garcia, Hector A.; McGeary, Cindy A.; McGeary, Donald D.; Finley, Erin P.; Peterson, Alan L.

    2015-01-01

    The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.2). Recruitment was directed through VHA PTSD Clinical Teams (PCT) throughout the United States based on a nationwide mailing list of PCT Clinic Directors. Participants completed an electronic survey that assessed demographics, organizational work factors, absenteeism, and burnout (assessed through the Maslach Burnout Inventory-General Survey, MBI-GS). Twelve percent of the sample reported low Professional Efficacy, 50% reported high levels of Exhaustion, and 47% reported high levels of Cynicism as determined by the MBI-GS cut-off scores. Only workplace characteristics were significantly associated with provider scores on all 3 scales. Exhaustion and Cynicism were most impacted by perceptions of organizational politics/bureaucracy, increased clinical workload and control over how work is done. Organizational factors were also significantly associated with provider absenteeism and intent to leave his/her job. Findings suggest that providers in VHA specialty PTSD care settings may benefit from programs or supports aimed at preventing and/or ameliorating burnout. PMID:24564443

  17. IBM’s Health Analytics and Clinical Decision Support

    Science.gov (United States)

    Sun, J.; Knoop, S.; Shabo, A.; Carmeli, B.; Sow, D.; Syed-Mahmood, T.; Rapp, W.

    2014-01-01

    Summary Objectives This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Methods Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. Results There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Conclusion Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation. PMID:25123736

  18. INNOVATIVE INFRASTRUCTURE OF ENTREPRENEURSHIP DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    O. Mykytyuk

    2014-06-01

    Full Text Available Practical realization of sustainable development general conception is passing to the organic production, that allows to satisfy society problems, not putting health and future generations' existence under a threat. At this entrepreneurs, which work in the consumer products' field, must displace accents from economic oriented to social oriented entrepreneurship. The article is dedicated to research negative and positive factors that influence on social oriented Ukrainian enterprises in the sphere of organic goods production. The special attention is attended to the analysis of foodstuffs producers' activity, the results of which have considerable direct influence on consumers' health. The value of informative influences on consumers and producers is analyzed. State support directions of organic goods production, creation of internal market ecologically safe products infrastructure are defined. Recommendations are given according to research results in relation to stimulation social responsibility of businessmen and model forming, which combines interests of consumers and producers, environmental preservation, population health refinement and ecological situation improvement.

  19. Clinical Simulation and Workflow by use of two Clinical Information Systems, the Electronic Health Record and Digital Dictation

    DEFF Research Database (Denmark)

    Schou Jensen, Iben; Koldby, Sven

    2013-01-01

    digital dictation and the EHR (electronic health record) were simulated in realistic and controlled clinical environments. Useful information dealing with workflow and patient safety were obtained. The clinical simulation demonstrated that the EHR locks during use of the integration of digital dictation......Clinical information systems do not always support clinician workflows. An increasing number of unintended clinical inci-dents might be related to implementation of clinical infor-mation systems and to a new registration praxis of unin-tended clinical incidents. Evidence of performing clinical...... simulations before implementation of new clinical information systems provides the basis for use of this method. The intention has been to evaluate patient safety issues, functionality, workflow, and usefulness of a new solution before implementation in the hospitals. Use of a solution which integrates...

  20. Service quality in public health clinics: perceptions of users and health professionals.

    Science.gov (United States)

    Campos, Domingos Fernandes; Negromonte Filho, Rinaldo Bezerra; Castro, Felipe Nalon

    2017-10-09

    Purpose The purpose of this paper is to investigate the expectations and quality gaps in services provided at city public health clinics in the city of Natal, Brazil, from the perspective of patients and healthcare service providers. Design/methodology/approach The research sample consisted of 1,200 patients who used public health services and 265 providers - doctors, nutritionists, physiotherapists, psychologists, pharmacists and managers at three health clinics in the city of Natal, Brazil. A scale with 25 health service attributes was used in data collection. Summary statistics and t-test were used to analyze the data. Findings The results show that the providers think that users have lower levels of expectations than those indicated by the users in all attributes. Providers and users have the most approximate insights into what attributes are considered most important: explanations, level of knowledge and attention dispensed by health professionals. Users and providers perceived similar quality gaps for most of the attributes. The gaps were statistically the same, when comparing the mean quality shortcomings by means of a Student's test, considering a significance level of 5 percent, obtained independently by the manifestation of users and providers. Research limitations/implications The results reveal only a photograph of the moment. The study did not consider the differences that may exist between groups with different income levels, genders or age groups. A qualitative study could improve the understanding of the differences and coincidences of the diverse points of views. A more advanced research could even study possibilities so that health managers could promote changes in the service, some of them low cost, as the health professionals training for contact with patients. Practical implications The evaluation of the service quality complemented by the matrix of opportunities, importance × quality gaps generates information to help make decisions in the

  1. Effect of immersive workplace experience on undergraduate nurses' mental health clinical confidence.

    Science.gov (United States)

    Patterson, Christopher; Moxham, Lorna; Taylor, Ellie K; Perlman, Dana; Brighton, Renee; Sumskis, Susan; Heffernan, Tim; Lee-Bates, Benjamin

    2017-12-01

    Preregistration education needs to ensure that student nurses are properly trained with the required skills and knowledge, and have the confidence to work with people who have a mental illness. With increased attention on non-traditional mental health clinical placements, further research is required to determine the effects of non-traditional mental health clinical placements on mental health clinical confidence. The aim of the present study was to investigate the impact of a non-traditional mental health clinical placement on mental health nursing clinical confidence compared to nursing students undergoing traditional clinical placements. Using the Mental Health Nursing Clinical Confidence Scale, the study investigated the relative effects of two placement programmes on the mental health clinical confidence of 79 nursing students. The two placement programmes included a non-traditional clinical placement of Recovery Camp and a comparison group that attended traditional clinical placements. Overall, the results indicated that, for both groups, mental health placement had a significant effect on improving mean mental health clinical confidence, both immediately upon conclusion of placement and at the 3-month follow up. Students who attended Recovery Camp reported a significant positive difference, compared to the comparison group, for ratings related to communicating effectively with clients with a mental illness, having a basic knowledge of antipsychotic medications and their side-effects, and providing client education regarding the effects and side-effects of medications. The findings suggest that a unique clinical placement, such as Recovery Camp, can improve and maintain facets of mental health clinical confidence for students of nursing. © 2017 Australian College of Mental Health Nurses Inc.

  2. Railway infrastructure security

    CERN Document Server

    Sforza, Antonio; Vittorini, Valeria; Pragliola, Concetta

    2015-01-01

    This comprehensive monograph addresses crucial issues in the protection of railway systems, with the objective of enhancing the understanding of railway infrastructure security. Based on analyses by academics, technology providers, and railway operators, it explains how to assess terrorist and criminal threats, design countermeasures, and implement effective security strategies. In so doing, it draws upon a range of experiences from different countries in Europe and beyond. The book is the first to be devoted entirely to this subject. It will serve as a timely reminder of the attractiveness of the railway infrastructure system as a target for criminals and terrorists and, more importantly, as a valuable resource for stakeholders and professionals in the railway security field aiming to develop effective security based on a mix of methodological, technological, and organizational tools. Besides researchers and decision makers in the field, the book will appeal to students interested in critical infrastructur...

  3. Building safeguards infrastructure

    International Nuclear Information System (INIS)

    McClelland-Kerr, J.; Stevens, J.

    2010-01-01

    Much has been written in recent years about the nuclear renaissance - the rebirth of nuclear power as a clean and safe source of electricity around the world. Those who question the nuclear renaissance often cite the risk of proliferation, accidents or an attack on a facility as concerns, all of which merit serious consideration. The integration of three areas - sometimes referred to as 3S, for safety, security and safeguards - is essential to supporting the clean and safe growth of nuclear power, and the infrastructure that supports these three areas should be robust. The focus of this paper will be on the development of the infrastructure necessary to support safeguards, and the integration of safeguards infrastructure with other elements critical to ensuring nuclear energy security

  4. Internationalization of infrastructure companies

    Directory of Open Access Journals (Sweden)

    Frederico Araujo Turolla

    2009-03-01

    Full Text Available The decision of infrastructure firms to go international is not a simple one. Differently from firms from most of the sectors, investment requires large amounts of capital, there are significant transaction costs and also involves issues that are specific to the destiny country. In spite of the risks, several infrastructure groups have been investing abroad and have widened the foreign part in the share of the receipts. The study herein proposed is a refinement of the established theory of international business, with support from the industrial organization theory, namely on infrastructure economics. The methodology is theoretical empirical since it starts from two existing theories. Hypotheses relate the degree of internationalization (GI to a set of determinants of internationalization. As of conclusions, with the exception of the economies of density and scale, which did not show as relevant, all other variables behaved as expected.

  5. Travel characteristics and health practices among travellers at the travellers' health and vaccination clinic in Singapore.

    Science.gov (United States)

    Lee, Vernon J; Wilder-Smith, Annelies

    2006-10-01

    Singapore has a fast-growing travel industry, but few studies have been done on travel characteristics and travel health practices. This study describes the profile and healthseeking behaviour of travellers attending a travel health clinic in Singapore. A cross-sectional survey was conducted on travellers attending the Traveller's Health and Vaccination Centre (THVC) between September and November 2002 using a standardised questionnaire. Information obtained included individual demographic and medical information, travel patterns, vaccination status and travel health practices. Four hundred and ninetyfive (74%) eligible travellers seen at THVC responded to the questionnaire. Their mean age was 36 years; 77% were professionals, managers, executives, and businessmen, students, and white collar workers. Asia was the main travel destination, and most travelled for leisure and resided in hotels or hostels. The median duration of travel was 16 days. Although >90% had previously travelled overseas, only 20% had previously sought pre-travel advice. Malays were significantly underrepresented (P travel advice compared with Chinese, Indians and Malays. Factors associated with seeking pre-travel advice included travel outside of Asia, especially Africa and South America. Singaporean travellers travel more often to cities rather than rural areas, compared with non-Asian travellers. Asia is the preferred destination, and travel outside of Asia is perceived as more risky and is associated with seeking pre-travel advice and vaccinations. Travel patterns and behaviours need to be taken into account when developing evidence-based travel medicine in Asia.

  6. Impact of environmental chemicals, sociodemographic variables, depression, and clinical indicators of health and nutrition on self-reported health status

    Science.gov (United States)

    Public health researchers ideally integrate social, environmental, and clinical measures to identify predictors of poor health. Chemicals measured in human tissues are often evaluated in relation to intangible or rare health outcomes, or are studied one chemical at a time. Using ...

  7. Health providers' perceptions of clinical trials : lessons from Ghana, Kenya and Burkina Faso

    NARCIS (Netherlands)

    Angwenyi, Vibian; Asante, Kwaku-Poku; Traoré, Abdoulaye; Febir, Lawrence Gyabaa; Tawiah, Charlotte; Kwarteng, Anthony; Ouédraogo, Alphonse; Sirima, Sodiomon Bienvenue; Owusu-Agyei, Seth; Imoukhuede, Egeruan Babatunde; Webster, Jayne; Chandramohan, Daniel; Molyneux, Sassy; Jones, Caroline

    2015-01-01

    BACKGROUND: Clinical trials conducted in Africa often require substantial investments to support trial centres and public health facilities. Trial resources could potentially generate benefits for routine health service delivery but may have unintended consequences. Strengthening ethical practice

  8. The ATLAS Simulation Infrastructure

    CERN Document Server

    Aad, G.; Abdallah, J.; Abdelalim, A.A.; Abdesselam, A.; Abdinov, O.; Abi, B.; Abolins, M.; Abramowicz, H.; Abreu, H.; Acharya, B.S.; Adams, D.L.; Addy, T.N.; Adelman, J.; Adorisio, C.; Adragna, P.; Adye, T.; Aefsky, S.; Aguilar-Saavedra, J.A.; Aharrouche, M.; Ahlen, S.P.; Ahles, F.; Ahmad, A.; Ahmed, H.; Ahsan, M.; Aielli, G.; Akdogan, T.; Akesson, T.P.A.; Akimoto, G.; Akimov, A.V.; Aktas, A.; Alam, M.S.; Alam, M.A.; Albrand, S.; Aleksa, M.; Aleksandrov, I.N.; Alexa, C.; Alexander, G.; Alexandre, G.; Alexopoulos, T.; Alhroob, M.; Aliev, M.; Alimonti, G.; Alison, J.; Aliyev, M.; Allport, P.P.; Allwood-Spiers, S.E.; Almond, J.; Aloisio, A.; Alon, R.; Alonso, A.; Alviggi, M.G.; Amako, K.; Amelung, C.; Amorim, A.; Amoros, G.; Amram, N.; Anastopoulos, C.; Andeen, T.; Anders, C.F.; Anderson, K.J.; Andreazza, A.; Andrei, V.; Anduaga, X.S.; Angerami, A.; Anghinolfi, F.; Anjos, N.; Annovi, A.; Antonaki, A.; Antonelli, M.; Antonelli, S.; Antos, J.; Antunovic, B.; Anulli, F.; Aoun, S.; Arabidze, G.; Aracena, I.; Arai, Y.; Arce, A.T.H.; Archambault, J.P.; Arfaoui, S.; Arguin, J-F.; Argyropoulos, T.; Arik, M.; Armbruster, A.J.; Arnaez, O.; Arnault, C.; Artamonov, A.; Arutinov, D.; Asai, M.; Asai, S.; Asfandiyarov, R.; Ask, S.; Asman, B.; Asner, D.; Asquith, L.; Assamagan, K.; Astbury, A.; Astvatsatourov, A.; Atoian, G.; Auerbach, B.; Augsten, K.; Aurousseau, M.; Austin, N.; Avolio, G.; Avramidou, R.; Axen, D.; Ay, C.; Azuelos, G.; Azuma, Y.; Baak, M.A.; Bach, A.M.; Bachacou, H.; Bachas, K.; Backes, M.; Badescu, E.; Bagnaia, P.; Bai, Y.; Bain, T.; Baines, J.T.; Baker, O.K.; Baker, M.D.; Baker, S; Baltasar Dos Santos Pedrosa, F.; Banas, E.; Banerjee, P.; Banerjee, S.; Banfi, D.; Bangert, A.; Bansal, V.; Baranov, S.P.; Baranov, S.; Barashkou, A.; Barber, T.; Barberio, E.L.; Barberis, D.; Barbero, M.; Bardin, D.Y.; Barillari, T.; Barisonzi, M.; Barklow, T.; Barlow, N.; Barnett, B.M.; Barnett, R.M.; Baroncelli, A.; Barr, A.J.; Barreiro, F.; Barreiro Guimaraes da Costa, J.; Barrillon, P.; Bartoldus, R.; Bartsch, D.; Bates, R.L.; Batkova, L.; Batley, J.R.; Battaglia, A.; Battistin, M.; Bauer, F.; Bawa, H.S.; Bazalova, M.; Beare, B.; Beau, T.; Beauchemin, P.H.; Beccherle, R.; Becerici, N.; Bechtle, P.; Beck, G.A.; Beck, H.P.; Beckingham, M.; Becks, K.H.; Beddall, A.J.; Beddall, A.; Bednyakov, V.A.; Bee, C.; Begel, M.; Behar Harpaz, S.; Behera, P.K.; Beimforde, M.; Belanger-Champagne, C.; Bell, P.J.; Bell, W.H.; Bella, G.; Bellagamba, L.; Bellina, F.; Bellomo, M.; Belloni, A.; Belotskiy, K.; Beltramello, O.; Ben Ami, S.; Benary, O.; Benchekroun, D.; Bendel, M.; Benedict, B.H.; Benekos, N.; Benhammou, Y.; Benincasa, G.P.; Benjamin, D.P.; Benoit, M.; Bensinger, J.R.; Benslama, K.; Bentvelsen, S.; Beretta, M.; Berge, D.; Bergeaas Kuutmann, E.; Berger, N.; Berghaus, F.; Berglund, E.; Beringer, J.; Bernat, P.; Bernhard, R.; Bernius, C.; Berry, T.; Bertin, A.; Besana, M.I.; Besson, N.; Bethke, S.; Bianchi, R.M.; Bianco, M.; Biebel, O.; Biesiada, J.; Biglietti, M.; Bilokon, H.; Bindi, M.; Binet, S.; Bingul, A.; Bini, C.; Biscarat, C.; Bitenc, U.; Black, K.M.; Blair, R.E.; Blanchard, J-B; Blanchot, G.; Blocker, C.; Blondel, A.; Blum, W.; Blumenschein, U.; Bobbink, G.J.; Bocci, A.; Boehler, M.; Boek, J.; Boelaert, N.; Boser, S.; Bogaerts, J.A.; Bogouch, A.; Bohm, C.; Bohm, J.; Boisvert, V.; Bold, T.; Boldea, V.; Bondarenko, V.G.; Bondioli, M.; Boonekamp, M.; Bordoni, S.; Borer, C.; Borisov, A.; Borissov, G.; Borjanovic, I.; Borroni, S.; Bos, K.; Boscherini, D.; Bosman, M.; Boterenbrood, H.; Bouchami, J.; Boudreau, J.; Bouhova-Thacker, E.V.; Boulahouache, C.; Bourdarios, C.; Boveia, A.; Boyd, J.; Boyko, I.R.; Bozovic-Jelisavcic, I.; Bracinik, J.; Braem, A.; Branchini, P.; Brandenburg, G.W.; Brandt, A.; Brandt, G.; Brandt, O.; Bratzler, U.; Brau, B.; Brau, J.E.; Braun, H.M.; Brelier, B.; Bremer, J.; Brenner, R.; Bressler, S.; Britton, D.; Brochu, F.M.; Brock, I.; Brock, R.; Brodet, E.; Bromberg, C.; Brooijmans, G.; Brooks, W.K.; Brown, G.; Bruckman de Renstrom, P.A.; Bruncko, D.; Bruneliere, R.; Brunet, S.; Bruni, A.; Bruni, G.; Bruschi, M.; Bucci, F.; Buchanan, J.; Buchholz, P.; Buckley, A.G.; Budagov, I.A.; Budick, B.; Buscher, V.; Bugge, L.; Bulekov, O.; Bunse, M.; Buran, T.; Burckhart, H.; Burdin, S.; Burgess, T.; Burke, S.; Busato, E.; Bussey, P.; Buszello, C.P.; Butin, F.; Butler, B.; Butler, J.M.; Buttar, C.M.; Butterworth, J.M.; Byatt, T.; Caballero, J.; Cabrera Urban, S.; Caforio, D.; Cakir, O.; Calafiura, P.; Calderini, G.; Calfayan, P.; Calkins, R.; Caloba, L.P.; Calvet, D.; Camarri, P.; Cameron, D.; Campana, S.; Campanelli, M.; Canale, V.; Canelli, F.; Canepa, A.; Cantero, J.; Capasso, L.; Capeans Garrido, M.D.M.; Caprini, I.; Caprini, M.; Capua, M.; Caputo, R.; Caramarcu, C.; Cardarelli, R.; Carli, T.; Carlino, G.; Carminati, L.; Caron, B.; Caron, S.; Carrillo Montoya, G.D.; Carron Montero, S.; Carter, A.A.; Carter, J.R.; Carvalho, J.; Casadei, D.; Casado, M.P.; Cascella, M.; Castaneda Hernandez, A.M.; Castaneda-Miranda, E.; Castillo Gimenez, V.; Castro, N.F.; Cataldi, G.; Catinaccio, A.; Catmore, J.R.; Cattai, A.; Cattani, G.; Caughron, S.; Cauz, D.; Cavalleri, P.; Cavalli, D.; Cavalli-Sforza, M.; Cavasinni, V.; Ceradini, F.; Cerqueira, A.S.; Cerri, A.; Cerrito, L.; Cerutti, F.; Cetin, S.A.; Chafaq, A.; Chakraborty, D.; Chan, K.; Chapman, J.D.; Chapman, J.W.; Chareyre, E.; Charlton, D.G.; Chavda, V.; Cheatham, S.; Chekanov, S.; Chekulaev, S.V.; Chelkov, G.A.; Chen, H.; Chen, S.; Chen, X.; Cheplakov, A.; Chepurnov, V.F.; Cherkaoui El Moursli, R.; Tcherniatine, V.; Chesneanu, D.; Cheu, E.; Cheung, S.L.; Chevalier, L.; Chevallier, F.; Chiarella, V.; Chiefari, G.; Chikovani, L.; Childers, J.T.; Chilingarov, A.; Chiodini, G.; Chizhov, V.; Choudalakis, G.; Chouridou, S.; Christidi, I.A.; Christov, A.; Chromek-Burckhart, D.; Chu, M.L.; Chudoba, J.; Ciapetti, G.; Ciftci, A.K.; Ciftci, R.; Cinca, D.; Cindro, V.; Ciobotaru, M.D.; Ciocca, C.; Ciocio, A.; Cirilli, M.; Citterio, M.; Clark, A.; Clark, P.J.; Cleland, W.; Clemens, J.C.; Clement, B.; Clement, C.; Coadou, Y.; Cobal, M.; Coccaro, A.; Cochran, J.; Coggeshall, J.; Cogneras, E.; Colijn, A.P.; Collard, C.; Collins, N.J.; Collins-Tooth, C.; Collot, J.; Colon, G.; Conde Muino, P.; Coniavitis, E.; Consonni, M.; Constantinescu, S.; Conta, C.; Conventi, F.; Cooke, M.; Cooper, B.D.; Cooper-Sarkar, A.M.; Cooper-Smith, N.J.; Copic, K.; Cornelissen, T.; Corradi, M.; Corriveau, F.; Corso-Radu, A.; Cortes-Gonzalez, A.; Cortiana, G.; Costa, G.; Costa, M.J.; Costanzo, D.; Costin, T.; Cote, D.; Coura Torres, R.; Courneyea, L.; Cowan, G.; Cowden, C.; Cox, B.E.; Cranmer, K.; Cranshaw, J.; Cristinziani, M.; Crosetti, G.; Crupi, R.; Crepe-Renaudin, S.; Cuenca Almenar, C.; Cuhadar Donszelmann, T.; Curatolo, M.; Curtis, C.J.; Cwetanski, P.; Czyczula, Z.; D'Auria, S.; D'Onofrio, M.; D'Orazio, A.; Da Via, C; Dabrowski, W.; Dai, T.; Dallapiccola, C.; Dallison, S.J.; Daly, C.H.; Dam, M.; Danielsson, H.O.; Dannheim, D.; Dao, V.; Darbo, G.; Darlea, G.L.; Davey, W.; Davidek, T.; Davidson, N.; Davidson, R.; Davies, M.; Davison, A.R.; Dawson, I.; Daya, R.K.; De, K.; de Asmundis, R.; De Castro, S.; De Castro Faria Salgado, P.E.; De Cecco, S.; de Graat, J.; De Groot, N.; de Jong, P.; De Mora, L.; De Oliveira Branco, M.; De Pedis, D.; De Salvo, A.; De Sanctis, U.; De Santo, A.; De Vivie De Regie, J.B.; De Zorzi, G.; Dean, S.; Dedovich, D.V.; Degenhardt, J.; Dehchar, M.; Del Papa, C.; Del Peso, J.; Del Prete, T.; Dell'Acqua, A.; Dell'Asta, L.; Della Pietra, M.; della Volpe, D.; Delmastro, M.; Delsart, P.A.; Deluca, C.; Demers, S.; Demichev, M.; Demirkoz, B.; Deng, J.; Deng, W.; Denisov, S.P.; Derkaoui, J.E.; Derue, F.; Dervan, P.; Desch, K.; Deviveiros, P.O.; Dewhurst, A.; DeWilde, B.; Dhaliwal, S.; Dhullipudi, R.; Di Ciaccio, A.; Di Ciaccio, L.; Di Domenico, A.; Di Girolamo, A.; Di Girolamo, B.; Di Luise, S.; Di Mattia, A.; Di Nardo, R.; Di Simone, A.; Di Sipio, R.; Diaz, M.A.; Diblen, F.; Diehl, E.B.; Dietrich, J.; Dietzsch, T.A.; Diglio, S.; Dindar Yagci, K.; Dingfelder, J.; Dionisi, C.; Dita, P.; Dita, S.; Dittus, F.; Djama, F.; Djilkibaev, R.; Djobava, T.; do Vale, M.A.B.; Do Valle Wemans, A.; Doan, T.K.O.; Dobos, D.; Dobson, E.; Dobson, M.; Doglioni, C.; Doherty, T.; Dolejsi, J.; Dolenc, I.; Dolezal, Z.; Dolgoshein, B.A.; Dohmae, T.; Donega, M.; Donini, J.; Dopke, J.; Doria, A.; Dos Anjos, A.; Dotti, A.; Dova, M.T.; Doxiadis, A.; Doyle, A.T.; Drasal, Z.; Dris, M.; Dubbert, J.; Duchovni, E.; Duckeck, G.; Dudarev, A.; Dudziak, F.; Duhrssen, M.; Duflot, L.; Dufour, M-A.; Dunford, M.; Duran Yildiz, H.; Dushkin, A.; Duxfield, R.; Dwuznik, M.; Duren, M.; Ebenstein, W.L.; Ebke, J.; Eckweiler, S.; Edmonds, K.; Edwards, C.A.; Egorov, K.; Ehrenfeld, W.; Ehrich, T.; Eifert, T.; Eigen, G.; Einsweiler, K.; Eisenhandler, E.; Ekelof, T.; El Kacimi, M.; Ellert, M.; Elles, S.; Ellinghaus, F.; Ellis, K.; Ellis, N.; Elmsheuser, J.; Elsing, M.; Emeliyanov, D.; Engelmann, R.; Engl, A.; Epp, B.; Eppig, A.; Erdmann, J.; Ereditato, A.; Eriksson, D.; Ermoline, I.; Ernst, J.; Ernst, M.; Ernwein, J.; Errede, D.; Errede, S.; Ertel, E.; Escalier, M.; Escobar, C.; Espinal Curull, X.; Esposito, B.; Etienvre, A.I.; Etzion, E.; Evans, H.; Fabbri, L.; Fabre, C.; Facius, K.; Fakhrutdinov, R.M.; Falciano, S.; Fang, Y.; Fanti, M.; Farbin, A.; Farilla, A.; Farley, J.; Farooque, T.; Farrington, S.M.; Farthouat, P.; Fassnacht, P.; Fassouliotis, D.; Fatholahzadeh, B.; Fayard, L.; Fayette, F.; Febbraro, R.; Federic, P.; Fedin, O.L.; Fedorko, W.; Feligioni, L.; Felzmann, C.U.; Feng, C.; Feng, E.J.; Fenyuk, A.B.; Ferencei, J.; Ferland, J.; Fernandes, B.; Fernando, W.; Ferrag, S.; Ferrando, J.; Ferrara, V.; Ferrari, A.; Ferrari, P.; Ferrari, R.; Ferrer, A.; Ferrer, M.L.; Ferrere, D.; Ferretti, C.; Fiascaris, M.; Fiedler, F.; Filipcic, A.; Filippas, A.; Filthaut, F.; Fincke-Keeler, M.; Fiolhais, M.C.N.; Fiorini, L.; Firan, A.; Fischer, G.; Fisher, M.J.; Flechl, M.; Fleck, I.; Fleckner, J.; Fleischmann, P.; Fleischmann, S.; Flick, T.; Flores Castillo, L.R.; Flowerdew, M.J.; Fonseca Martin, T.; Formica, A.; Forti, A.; Fortin, D.; Fournier, D.; Fowler, A.J.; Fowler, K.; Fox, H.; Francavilla, P.; Franchino, S.; Francis, D.; Franklin, M.; Franz, S.; Fraternali, M.; Fratina, S.; Freestone, J.; French, S.T.; Froeschl, R.; Froidevaux, D.; Frost, J.A.; Fukunaga, C.; Fullana Torregrosa, E.; Fuster, J.; Gabaldon, C.; Gabizon, O.; Gadfort, T.; Gadomski, S.; Gagliardi, G.; Gagnon, P.; Galea, C.; Gallas, E.J.; Gallo, V.; Gallop, B.J.; Gallus, P.; Galyaev, E.; Gan, K.K.; Gao, Y.S.; Gaponenko, A.; Garcia-Sciveres, M.; Garcia, C.; Garcia Navarro, J.E.; Gardner, R.W.; Garelli, N.; Garitaonandia, H.; Garonne, V.; Gatti, C.; Gaudio, G.; Gautard, V.; Gauzzi, P.; Gavrilenko, I.L.; Gay, C.; Gaycken, G.; Gazis, E.N.; Ge, P.; Gee, C.N.P.; Geich-Gimbel, Ch.; Gellerstedt, K.; Gemme, C.; Genest, M.H.; Gentile, S.; Georgatos, F.; George, S.; Gershon, A.; Ghazlane, H.; Ghodbane, N.; Giacobbe, B.; Giagu, S.; Giakoumopoulou, V.; Giangiobbe, V.; Gianotti, F.; Gibbard, B.; Gibson, A.; Gibson, S.M.; Gilbert, L.M.; Gilchriese, M.; Gilewsky, V.; Gingrich, D.M.; Ginzburg, J.; Giokaris, N.; Giordani, M.P.; Giordano, R.; Giorgi, F.M.; Giovannini, P.; Giraud, P.F.; Girtler, P.; Giugni, D.; Giusti, P.; Gjelsten, B.K.; Gladilin, L.K.; Glasman, C.; Glazov, A.; Glitza, K.W.; Glonti, G.L.; Godfrey, J.; Godlewski, J.; Goebel, M.; Gopfert, T.; Goeringer, C.; Gossling, C.; Gottfert, T.; Goggi, V.; Goldfarb, S.; Goldin, D.; Golling, T.; Gomes, A.; Gomez Fajardo, L.S.; Goncalo, R.; Gonella, L.; Gong, C.; Gonzalez de la Hoz, S.; Gonzalez Silva, M.L.; Gonzalez-Sevilla, S.; Goodson, J.J.; Goossens, L.; Gordon, H.A.; Gorelov, I.; Gorfine, G.; Gorini, B.; Gorini, E.; Gorisek, A.; Gornicki, E.; Gosdzik, B.; Gosselink, M.; Gostkin, M.I.; Gough Eschrich, I.; Gouighri, M.; Goujdami, D.; Goulette, M.P.; Goussiou, A.G.; Goy, C.; Grabowska-Bold, I.; Grafstrom, P.; Grahn, K-J.; Grancagnolo, S.; Grassi, V.; Gratchev, V.; Grau, N.; Gray, H.M.; Gray, J.A.; Graziani, E.; Green, B.; Greenshaw, T.; Greenwood, Z.D.; Gregor, I.M.; Grenier, P.; Griesmayer, E.; Griffiths, J.; Grigalashvili, N.; Grillo, A.A.; Grimm, K.; Grinstein, S.; Grishkevich, Y.V.; Groh, M.; Groll, M.; Gross, E.; Grosse-Knetter, J.; Groth-Jensen, J.; Grybel, K.; Guicheney, C.; Guida, A.; Guillemin, T.; Guler, H.; Gunther, J.; Guo, B.; Gupta, A.; Gusakov, Y.; Gutierrez, A.; Gutierrez, P.; Guttman, N.; Gutzwiller, O.; Guyot, C.; Gwenlan, C.; Gwilliam, C.B.; Haas, A.; Haas, S.; Haber, C.; Hadavand, H.K.; Hadley, D.R.; Haefner, P.; Hartel, R.; Hajduk, Z.; Hakobyan, H.; Haller, J.; Hamacher, K.; Hamilton, A.; Hamilton, S.; Han, L.; Hanagaki, K.; Hance, M.; Handel, C.; Hanke, P.; Hansen, J.R.; Hansen, J.B.; Hansen, J.D.; Hansen, P.H.; Hansl-Kozanecka, T.; Hansson, P.; Hara, K.; Hare, G.A.; Harenberg, T.; Harrington, R.D.; Harris, O.M.; Harrison, K; Hartert, J.; Hartjes, F.; Harvey, A.; Hasegawa, S.; Hasegawa, Y.; Hashemi, K.; Hassani, S.; Haug, S.; Hauschild, M.; Hauser, R.; Havranek, M.; Hawkes, C.M.; Hawkings, R.J.; Hayakawa, T.; Hayward, H.S.; Haywood, S.J.; Head, S.J.; Hedberg, V.; Heelan, L.; Heim, S.; Heinemann, B.; Heisterkamp, S.; Helary, L.; Heller, M.; Hellman, S.; Helsens, C.; Hemperek, T.; Henderson, R.C.W.; Henke, M.; Henrichs, A.; Henriques Correia, A.M.; Henrot-Versille, S.; Hensel, C.; Henss, T.; Hernandez Jimenez, Y.; Hershenhorn, A.D.; Herten, G.; Hertenberger, R.; Hervas, L.; Hessey, N.P.; Higon-Rodriguez, E.; Hill, J.C.; Hiller, K.H.; Hillert, S.; Hillier, S.J.; Hinchliffe, I.; Hines, E.; Hirose, M.; Hirsch, F.; Hirschbuehl, D.; Hobbs, J.; Hod, N.; Hodgkinson, M.C.; Hodgson, P.; Hoecker, A.; Hoeferkamp, M.R.; Hoffman, J.; Hoffmann, D.; Hohlfeld, M.; Holy, T.; Holzbauer, J.L.; Homma, Y.; Horazdovsky, T.; Hori, T.; Horn, C.; Horner, S.; Horvat, S.; Hostachy, J-Y.; Hou, S.; Hoummada, A.; Howe, T.; Hrivnac, J.; Hryn'ova, T.; Hsu, P.J.; Hsu, S.C.; Huang, G.S.; Hubacek, Z.; Hubaut, F.; Huegging, F.; Hughes, E.W.; Hughes, G.; Hurwitz, M.; Husemann, U.; Huseynov, N.; Huston, J.; Huth, J.; Iacobucci, G.; Iakovidis, G.; Ibragimov, I.; Iconomidou-Fayard, L.; Idarraga, J.; Iengo, P.; Igonkina, O.; Ikegami, Y.; Ikeno, M.; Ilchenko, Y.; Iliadis, D.; Ince, T.; Ioannou, P.; Iodice, M.; Irles Quiles, A.; Ishikawa, A.; Ishino, M.; Ishmukhametov, R.; Isobe, T.; Issakov, V.; Issever, C.; Istin, S.; Itoh, Y.; Ivashin, A.V.; Iwanski, W.; Iwasaki, H.; Izen, J.M.; Izzo, V.; Jackson, B.; Jackson, J.N.; Jackson, P.; Jaekel, M.R.; Jain, V.; Jakobs, K.; Jakobsen, S.; Jakubek, J.; Jana, D.K.; Jansen, E.; Jantsch, A.; Janus, M.; Jared, R.C.; Jarlskog, G.; Jeanty, L.; Jen-La Plante, I.; Jenni, P.; Jez, P.; Jezequel, S.; Ji, W.; Jia, J.; Jiang, Y.; Jimenez Belenguer, M.; Jin, S.; Jinnouchi, O.; Joffe, D.; Johansen, M.; Johansson, K.E.; Johansson, P.; Johnert, S; Johns, K.A.; Jon-And, K.; Jones, G.; Jones, R.W.L.; Jones, T.J.; Jorge, P.M.; Joseph, J.; Juranek, V.; Jussel, P.; Kabachenko, V.V.; Kaci, M.; Kaczmarska, A.; Kado, M.; Kagan, H.; Kagan, M.; Kaiser, S.; Kajomovitz, E.; Kalinin, S.; Kalinovskaya, L.V.; Kalinowski, A.; Kama, S.; Kanaya, N.; Kaneda, M.; Kantserov, V.A.; Kanzaki, J.; Kaplan, B.; Kapliy, A.; Kaplon, J.; Kar, D.; Karagounis, M.; Karagoz Unel, M.; Kartvelishvili, V.; Karyukhin, A.N.; Kashif, L.; Kasmi, A.; Kass, R.D.; Kastanas, A.; Kastoryano, M.; Kataoka, M.; Kataoka, Y.; Katsoufis, E.; Katzy, J.; Kaushik, V.; Kawagoe, K.; Kawamoto, T.; Kawamura, G.; Kayl, M.S.; Kayumov, F.; Kazanin, V.A.; Kazarinov, M.Y.; Keates, J.R.; Keeler, R.; Keener, P.T.; Kehoe, R.; Keil, M.; Kekelidze, G.D.; Kelly, M.; Kenyon, M.; Kepka, O.; Kerschen, N.; Kersevan, B.P.; Kersten, S.; Kessoku, K.; Khakzad, M.; Khalil-zada, F.; Khandanyan, H.; Khanov, A.; Kharchenko, D.; Khodinov, A.; Khomich, A.; Khoriauli, G.; Khovanskiy, N.; Khovanskiy, V.; Khramov, E.; Khubua, J.; Kim, H.; Kim, M.S.; Kim, P.C.; Kim, S.H.; Kind, O.; Kind, P.; King, B.T.; Kirk, J.; Kirsch, G.P.; Kirsch, L.E.; Kiryunin, A.E.; Kisielewska, D.; Kittelmann, T.; Kiyamura, H.; Kladiva, E.; Klein, M.; Klein, U.; Kleinknecht, K.; Klemetti, M.; Klier, A.; Klimentov, A.; Klingenberg, R.; Klinkby, E.B.; Klioutchnikova, T.; Klok, P.F.; Klous, S.; Kluge, E.E.; Kluge, T.; Kluit, P.; Klute, M.; Kluth, S.; Knecht, N.S.; Kneringer, E.; Ko, B.R.; Kobayashi, T.; Kobel, M.; Koblitz, B.; Kocian, M.; Kocnar, A.; Kodys, P.; Koneke, K.; Konig, A.C.; Koenig, S.; Kopke, L.; Koetsveld, F.; Koevesarki, P.; Koffas, T.; Koffeman, E.; Kohn, F.; Kohout, Z.; Kohriki, T.; Kolanoski, H.; Kolesnikov, V.; Koletsou, I.; Koll, J.; Kollar, D.; Kolos, S.; Kolya, S.D.; Komar, A.A.; Komaragiri, J.R.; Kondo, T.; Kono, T.; Konoplich, R.; Konovalov, S.P.; Konstantinidis, N.; Koperny, S.; Korcyl, K.; Kordas, K.; Korn, A.; Korolkov, I.; Korolkova, E.V.; Korotkov, V.A.; Kortner, O.; Kostka, P.; Kostyukhin, V.V.; Kotov, S.; Kotov, V.M.; Kotov, K.Y.; Kourkoumelis, C.; Koutsman, A.; Kowalewski, R.; Kowalski, H.; Kowalski, T.Z.; Kozanecki, W.; Kozhin, A.S.; Kral, V.; Kramarenko, V.A.; Kramberger, G.; Krasny, M.W.; Krasznahorkay, A.; Kreisel, A.; Krejci, F.; Kretzschmar, J.; Krieger, N.; Krieger, P.; Kroeninger, K.; Kroha, H.; Kroll, J.; Kroseberg, J.; Krstic, J.; Kruchonak, U.; Kruger, H.; Krumshteyn, Z.V.; Kubota, T.; Kuehn, S.; Kugel, A.; Kuhl, T.; Kuhn, D.; Kukhtin, V.; Kulchitsky, Y.; Kuleshov, S.; Kummer, C.; Kuna, M.; Kunkle, J.; Kupco, A.; Kurashige, H.; Kurata, M.; Kurchaninov, L.L.; Kurochkin, Y.A.; Kus, V.; Kwee, R.; La Rotonda, L.; Labbe, J.; Lacasta, C.; Lacava, F.; Lacker, H.; Lacour, D.; Lacuesta, V.R.; Ladygin, E.; Lafaye, R.; Laforge, B.; Lagouri, T.; Lai, S.; Lamanna, M.; Lampen, C.L.; Lampl, W.; Lancon, E.; Landgraf, U.; Landon, M.P.J.; Lane, J.L.; Lankford, A.J.; Lanni, F.; Lantzsch, K.; Lanza, A.; Laplace, S.; Lapoire, C.; Laporte, J.F.; Lari, T.; Larner, A.; Lassnig, M.; Laurelli, P.; Lavrijsen, W.; Laycock, P.; Lazarev, A.B.; Lazzaro, A.; Le Dortz, O.; Le Guirriec, E.; Le Menedeu, E.; Le Vine, M.; Lebedev, A.; Lebel, C.; LeCompte, T.; Ledroit-Guillon, F.; Lee, H.; Lee, J.S.H.; Lee, S.C.; Lefebvre, M.; Legendre, M.; LeGeyt, B.C.; Legger, F.; Leggett, C.; Lehmacher, M.; Lehmann Miotto, G.; Lei, X.; Leitner, R.; Lellouch, D.; Lellouch, J.; Lendermann, V.; Leney, K.J.C.; Lenz, T.; Lenzen, G.; Lenzi, B.; Leonhardt, K.; Leroy, C.; Lessard, J-R.; Lester, C.G.; Leung Fook Cheong, A.; Leveque, J.; Levin, D.; Levinson, L.J.; Leyton, M.; Li, H.; Li, S.; Li, X.; Liang, Z.; Liang, Z.; Liberti, B.; Lichard, P.; Lichtnecker, M.; Lie, K.; Liebig, W.; Lilley, J.N.; Lim, H.; Limosani, A.; Limper, M.; Lin, S.C.; Linnemann, J.T.; Lipeles, E.; Lipinsky, L.; Lipniacka, A.; Liss, T.M.; Lissauer, D.; Lister, A.; Litke, A.M.; Liu, C.; Liu, D.; Liu, H.; Liu, J.B.; Liu, M.; Liu, T.; Liu, Y.; Livan, M.; Lleres, A.; Lloyd, S.L.; Lobodzinska, E.; Loch, P.; Lockman, W.S.; Lockwitz, S.; Loddenkoetter, T.; Loebinger, F.K.; Loginov, A.; Loh, C.W.; Lohse, T.; Lohwasser, K.; Lokajicek, M.; Long, R.E.; Lopes, L.; Lopez Mateos, D.; Losada, M.; Loscutoff, P.; Lou, X.; Lounis, A.; Loureiro, K.F.; Lovas, L.; Love, J.; Love, P.A.; Lowe, A.J.; Lu, F.; Lubatti, H.J.; Luci, C.; Lucotte, A.; Ludwig, A.; Ludwig, D.; Ludwig, I.; Luehring, F.; Luisa, L.; Lumb, D.; Luminari, L.; Lund, E.; Lund-Jensen, B.; Lundberg, B.; Lundberg, J.; Lundquist, J.; Lynn, D.; Lys, J.; Lytken, E.; Ma, H.; Ma, L.L.; Macana Goia, J.A.; Maccarrone, G.; Macchiolo, A.; Macek, B.; Machado Miguens, J.; Mackeprang, R.; Madaras, R.J.; Mader, W.F.; Maenner, R.; Maeno, T.; Mattig, P.; Mattig, S.; Magalhaes Martins, P.J.; Magradze, E.; Mahalalel, Y.; Mahboubi, K.; Mahmood, A.; Maiani, C.; Maidantchik, C.; Maio, A.; Majewski, S.; Makida, Y.; Makouski, M.; Makovec, N.; Malecki, Pa.; Malecki, P.; Maleev, V.P.; Malek, F.; Mallik, U.; Malon, D.; Maltezos, S.; Malyshev, V.; Malyukov, S.; Mambelli, M.; Mameghani, R.; Mamuzic, J.; Mandelli, L.; Mandic, I.; Mandrysch, R.; Maneira, J.; Mangeard, P.S.; Manjavidze, I.D.; Manning, P.M.; Manousakis-Katsikakis, A.; Mansoulie, B.; Mapelli, A.; Mapelli, L.; March, L.; Marchand, J.F.; Marchese, F.; Marchiori, G.; Marcisovsky, M.; Marino, C.P.; Marroquim, F.; Marshall, Z.; Marti-Garcia, S.; Martin, A.J.; Martin, A.J.; Martin, B.; Martin, B.; Martin, F.F.; Martin, J.P.; Martin, T.A.; Martin dit Latour, B.; Martinez, M.; Martinez Outschoorn, V.; Martini, A.; Martyniuk, A.C.; Marzano, F.; Marzin, A.; Masetti, L.; Mashimo, T.; Mashinistov, R.; Masik, J.; Maslennikov, A.L.; Massa, I.; Massol, N.; Mastroberardino, A.; Masubuchi, T.; Matricon, P.; Matsunaga, H.; Matsushita, T.; Mattravers, C.; Maxfield, S.J.; Mayne, A.; Mazini, R.; Mazur, M.; Mazzanti, M.; Mc Donald, J.; Mc Kee, S.P.; McCarn, A.; McCarthy, R.L.; McCubbin, N.A.; McFarlane, K.W.; McGlone, H.; Mchedlidze, G.; McMahon, S.J.; McPherson, R.A.; Meade, A.; Mechnich, J.; Mechtel, M.; Medinnis, M.; Meera-Lebbai, R.; Meguro, T.M.; Mehlhase, S.; Mehta, A.; Meier, K.; Meirose, B.; Melachrinos, C.; Mellado Garcia, B.R.; Mendoza Navas, L.; Meng, Z.; Menke, S.; Meoni, E.; Mermod, P.; Merola, L.; Meroni, C.; Merritt, F.S.; Messina, A.M.; Metcalfe, J.; Mete, A.S.; Meyer, J-P.; Meyer, J.; Meyer, J.; Meyer, T.C.; Meyer, W.T.; Miao, J.; Michal, S.; Micu, L.; Middleton, R.P.; Migas, S.; Mijovic, L.; Mikenberg, G.; Mikestikova, M.; Mikuz, M.; Miller, D.W.; Mills, W.J.; Mills, C.M.; Milov, A.; Milstead, D.A.; Milstein, D.; Minaenko, A.A.; Minano, M.; Minashvili, I.A.; Mincer, A.I.; Mindur, B.; Mineev, M.; Ming, Y.; Mir, L.M.; Mirabelli, G.; Misawa, S.; Miscetti, S.; Misiejuk, A.; Mitrevski, J.; Mitsou, V.A.; Miyagawa, P.S.; Mjornmark, J.U.; Mladenov, D.; Moa, T.; Moed, S.; Moeller, V.; Monig, K.; Moser, N.; Mohr, W.; Mohrdieck-Mock, S.; Moles-Valls, R.; Molina-Perez, J.; Monk, J.; Monnier, E.; Montesano, S.; Monticelli, F.; Moore, R.W.; Mora Herrera, C.; Moraes, A.; Morais, A.; Morel, J.; Morello, G.; Moreno, D.; Moreno Llacer, M.; Morettini, P.; Morii, M.; Morley, A.K.; Mornacchi, G.; Morozov, S.V.; Morris, J.D.; Moser, H.G.; Mosidze, M.; Moss, J.; Mount, R.; Mountricha, E.; Mouraviev, S.V.; Moyse, E.J.W.; Mudrinic, M.; Mueller, F.; Mueller, J.; Mueller, K.; Muller, T.A.; Muenstermann, D.; Muir, A.; Munwes, Y.; Murillo Garcia, R.; Murray, W.J.; Mussche, I.; Musto, E.; Myagkov, A.G.; Myska, M.; Nadal, J.; Nagai, K.; Nagano, K.; Nagasaka, Y.; Nairz, A.M.; Nakamura, K.; Nakano, I.; Nakatsuka, H.; Nanava, G.; Napier, A.; Nash, M.; Nation, N.R.; Nattermann, T.; Naumann, T.; Navarro, G.; Nderitu, S.K.; Neal, H.A.; Nebot, E.; Nechaeva, P.; Negri, A.; Negri, G.; Nelson, A.; Nelson, T.K.; Nemecek, S.; Nemethy, P.; Nepomuceno, A.A.; Nessi, M.; Neubauer, M.S.; Neusiedl, A.; Neves, R.N.; Nevski, P.; Newcomer, F.M.; Nickerson, R.B.; Nicolaidou, R.; Nicolas, L.; Nicoletti, G.; Nicquevert, B.; Niedercorn, F.; Nielsen, J.; Nikiforov, A.; Nikolaev, K.; Nikolic-Audit, I.; Nikolopoulos, K.; Nilsen, H.; Nilsson, P.; Nisati, A.; Nishiyama, T.; Nisius, R.; Nodulman, L.; Nomachi, M.; Nomidis, I.; Nordberg, M.; Nordkvist, B.; Notz, D.; Novakova, J.; Nozaki, M.; Nozicka, M.; Nugent, I.M.; Nuncio-Quiroz, A.E.; Nunes Hanninger, G.; Nunnemann, T.; Nurse, E.; O'Neil, D.C.; O'Shea, V.; Oakham, F.G.; Oberlack, H.; Ochi, A.; Oda, S.; Odaka, S.; Odier, J.; Ogren, H.; Oh, A.; Oh, S.H.; Ohm, C.C.; Ohshima, T.; Ohshita, H.; Ohsugi, T.; Okada, S.; Okawa, H.; Okumura, Y.; Okuyama, T.; Olchevski, A.G.; Oliveira, M.; Oliveira Damazio, D.; Oliver, J.; Oliver Garcia, E.; Olivito, D.; Olszewski, A.; Olszowska, J.; Omachi, C.; Onofre, A.; Onyisi, P.U.E.; Oram, C.J.; Oreglia, M.J.; Oren, Y.; Orestano, D.; Orlov, I.; Oropeza Barrera, C.; Orr, R.S.; Ortega, E.O.; Osculati, B.; Ospanov, R.; Osuna, C.; Ottersbach, J.P; Ould-Saada, F.; Ouraou, A.; Ouyang, Q.; Owen, M.; Owen, S.; Oyarzun, A; Ozcan, V.E.; Ozone, K.; Ozturk, N.; Pacheco Pages, A.; Padilla Aranda, C.; Paganis, E.; Pahl, C.; Paige, F.; Pajchel, K.; Palestini, S.; Pallin, D.; Palma, A.; Palmer, J.D.; Pan, Y.B.; Panagiotopoulou, E.; Panes, B.; Panikashvili, N.; Panitkin, S.; Pantea, D.; Panuskova, M.; Paolone, V.; Papadopoulou, Th.D.; Park, S.J.; Park, W.; Parker, M.A.; Parker, S.I.; Parodi, F.; Parsons, J.A.; Parzefall, U.; Pasqualucci, E.; Passeri, A.; Pastore, F.; Pastore, Fr.; Pasztor, G.; Pataraia, S.; Pater, J.R.; Patricelli, S.; Patwa, A.; Pauly, T.; Peak, L.S.; Pecsy, M.; Pedraza Morales, M.I.; Peleganchuk, S.V.; Peng, H.; Penson, A.; Penwell, J.; Perantoni, M.; Perez, K.; Perez Codina, E.; Perez Garcia-Estan, M.T.; Perez Reale, V.; Perini, L.; Pernegger, H.; Perrino, R.; Persembe, S.; Perus, P.; Peshekhonov, V.D.; Petersen, B.A.; Petersen, T.C.; Petit, E.; Petridou, C.; Petrolo, E.; Petrucci, F.; Petschull, D; Petteni, M.; Pezoa, R.; Phan, A.; Phillips, A.W.; Piacquadio, G.; Piccinini, M.; Piegaia, R.; Pilcher, J.E.; Pilkington, A.D.; Pina, J.; Pinamonti, M.; Pinfold, J.L.; Pinto, B.; Pizio, C.; Placakyte, R.; Plamondon, M.; Pleier, M.A.; Poblaguev, A.; Poddar, S.; Podlyski, F.; Poffenberger, P.; Poggioli, L.; Pohl, M.; Polci, F.; Polesello, G.; Policicchio, A.; Polini, A.; Poll, J.; Polychronakos, V.; Pomeroy, D.; Pommes, K.; Ponsot, P.; Pontecorvo, L.; Pope, B.G.; Popeneciu, G.A.; Popovic, D.S.; Poppleton, A.; Popule, J.; Portell Bueso, X.; Porter, R.; Pospelov, G.E.; Pospisil, S.; Potekhin, M.; Potrap, I.N.; Potter, C.J.; Potter, C.T.; Potter, K.P.; Poulard, G.; Poveda, J.; Prabhu, R.; Pralavorio, P.; Prasad, S.; Pravahan, R.; Pribyl, L.; Price, D.; Price, L.E.; Prichard, P.M.; Prieur, D.; Primavera, M.; Prokofiev, K.; Prokoshin, F.; Protopopescu, S.; Proudfoot, J.; Prudent, X.; Przysiezniak, H.; Psoroulas, S.; Ptacek, E.; Puigdengoles, C.; Purdham, J.; Purohit, M.; Puzo, P.; Pylypchenko, Y.; Qi, M.; Qian, J.; Qian, W.; Qin, Z.; Quadt, A.; Quarrie, D.R.; Quayle, W.B.; Quinonez, F.; Raas, M.; Radeka, V.; Radescu, V.; Radics, B.; Rador, T.; Ragusa, F.; Rahal, G.; Rahimi, A.M.; Rajagopalan, S.; Rammensee, M.; Rammes, M.; Rauscher, F.; Rauter, E.; Raymond, M.; Read, A.L.; Rebuzzi, D.M.; Redelbach, A.; Redlinger, G.; Reece, R.; Reeves, K.; Reinherz-Aronis, E.; Reinsch, A; Reisinger, I.; Reljic, D.; Rembser, C.; Ren, Z.L.; Renkel, P.; Rescia, S.; Rescigno, M.; Resconi, S.; Resende, B.; Reznicek, P.; Rezvani, R.; Richards, A.; Richards, R.A.; Richter, R.; Richter-Was, E.; Ridel, M.; Rijpstra, M.; Rijssenbeek, M.; Rimoldi, A.; Rinaldi, L.; Rios, R.R.; Riu, I.; Rizatdinova, F.; Rizvi, E.; Roa Romero, D.A.; Robertson, S.H.; Robichaud-Veronneau, A.; Robinson, D.; Robinson, JEM; Robinson, M.; Robson, A.; Rocha de Lima, J.G.; Roda, C.; Roda Dos Santos, D.; Rodriguez, D.; Rodriguez Garcia, Y.; Roe, S.; Rohne, O.; Rojo, V.; Rolli, S.; Romaniouk, A.; Romanov, V.M.; Romeo, G.; Romero Maltrana, D.; Roos, L.; Ros, E.; Rosati, S.; Rosenbaum, G.A.; Rosselet, L.; Rossetti, V.; Rossi, L.P.; Rotaru, M.; Rothberg, J.; Rousseau, D.; Royon, C.R.; Rozanov, A.; Rozen, Y.; Ruan, X.; Ruckert, B.; Ruckstuhl, N.; Rud, V.I.; Rudolph, G.; Ruhr, F.; Ruggieri, F.; Ruiz-Martinez, A.; Rumyantsev, L.; Rurikova, Z.; Rusakovich, N.A.; Rutherfoord, J.P.; Ruwiedel, C.; Ruzicka, P.; Ryabov, Y.F.; Ryan, P.; Rybkin, G.; Rzaeva, S.; Saavedra, A.F.; Sadrozinski, H.F-W.; Sadykov, R.; Sakamoto, H.; Salamanna, G.; Salamon, A.; Saleem, M.S.; Salihagic, D.; Salnikov, A.; Salt, J.; Salvachua Ferrando, B.M.; Salvatore, D.; Salvatore, F.; Salvucci, A.; Salzburger, A.; Sampsonidis, D.; Samset, B.H.; Sandaker, H.; Sander, H.G.; Sanders, M.P.; Sandhoff, M.; Sandhu, P.; Sandstroem, R.; Sandvoss, S.; Sankey, D.P.C.; Sanny, B.; Sansoni, A.; Santamarina Rios, C.; Santoni, C.; Santonico, R.; Saraiva, J.G.; Sarangi, T.; Sarkisyan-Grinbaum, E.; Sarri, F.; Sasaki, O.; Sasao, N.; Satsounkevitch, I.; Sauvage, G.; Savard, P.; Savine, A.Y.; Savinov, V.; Sawyer, L.; Saxon, D.H.; Says, L.P.; Sbarra, C.; Sbrizzi, A.; Scannicchio, D.A.; Schaarschmidt, J.; Schacht, P.; Schafer, U.; Schaetzel, S.; Schaffer, A.C.; Schaile, D.; Schamberger, R.D.; Schamov, A.G.; Schegelsky, V.A.; Scheirich, D.; Schernau, M.; Scherzer, M.I.; Schiavi, C.; Schieck, J.; Schioppa, M.; Schlenker, S.; Schmidt, E.; Schmieden, K.; Schmitt, C.; Schmitz, M.; Schott, M.; Schouten, D.; Schovancova, J.; Schram, M.; Schreiner, A.; Schroeder, C.; Schroer, N.; Schroers, M.; Schultes, J.; Schultz-Coulon, H.C.; Schumacher, J.W.; Schumacher, M.; Schumm, B.A.; Schune, Ph.; Schwanenberger, C.; Schwartzman, A.; Schwemling, Ph.; Schwienhorst, R.; Schwierz, R.; Schwindling, J.; Scott, W.G.; Searcy, J.; Sedykh, E.; Segura, E.; Seidel, S.C.; Seiden, A.; Seifert, F.; Seixas, J.M.; Sekhniaidze, G.; Seliverstov, D.M.; Sellden, B.; Semprini-Cesari, N.; Serfon, C.; Serin, L.; Seuster, R.; Severini, H.; Sevior, M.E.; Sfyrla, A.; Shabalina, E.; Shamim, M.; Shan, L.Y.; Shank, J.T.; Shao, Q.T.; Shapiro, M.; Shatalov, P.B.; Shaw, K.; Sherman, D.; Sherwood, P.; Shibata, A.; Shimojima, M.; Shin, T.; Shmeleva, A.; Shochet, M.J.; Shupe, M.A.; Sicho, P.; Sidoti, A.; Siegert, F; Siegrist, J.; Sijacki, Dj.; Silbert, O.; Silva, J.; Silver, Y.; Silverstein, D.; Silverstein, S.B.; Simak, V.; Simic, Lj.; Simion, S.; Simmons, B.; Simonyan, M.; Sinervo, P.; Sinev, N.B.; Sipica, V.; Siragusa, G.; Sisakyan, A.N.; Sivoklokov, S.Yu.; Sjoelin, J.; Sjursen, T.B.; Skovpen, K.; Skubic, P.; Slater, M.; Slavicek, T.; Sliwa, K.; Sloper, J.; Sluka, T.; Smakhtin, V.; Smirnov, S.Yu.; Smirnov, Y.; Smirnova, L.N.; Smirnova, O.; Smith, B.C.; Smith, D.; Smith, K.M.; Smizanska, M.; Smolek, K.; Snesarev, A.A.; Snow, S.W.; Snow, J.; Snuverink, J.; Snyder, S.; Soares, M.; Sobie, R.; Sodomka, J.; Soffer, A.; Solans, C.A.; Solar, M.; Solc, J.; Solfaroli Camillocci, E.; Solodkov, A.A.; Solovyanov, O.V.; Soluk, R.; Sondericker, J.; Sopko, V.; Sopko, B.; Sosebee, M.; Soukharev, A.; Spagnolo, S.; Spano, F.; Spencer, E.; Spighi, R.; Spigo, G.; Spila, F.; Spiwoks, R.; Spousta, M.; Spreitzer, T.; Spurlock, B.; St. Denis, R.D.; Stahl, T.; Stahlman, J.; Stamen, R.; Stancu, S.N.; Stanecka, E.; Stanek, R.W.; Stanescu, C.; Stapnes, S.; Starchenko, E.A.; Stark, J.; Staroba, P.; Starovoitov, P.; Stastny, J.; Stavina, P.; Steele, G.; Steinbach, P.; Steinberg, P.; Stekl, I.; Stelzer, B.; Stelzer, H.J.; Stelzer-Chilton, O.; Stenzel, H.; Stevenson, K.; Stewart, G.A.; Stockton, M.C.; Stoerig, K.; Stoicea, G.; Stonjek, S.; Strachota, P.; Stradling, A.R.; Straessner, A.; Strandberg, J.; Strandberg, S.; Strandlie, A.; Strauss, M.; Strizenec, P.; Strohmer, R.; Strom, D.M.; Stroynowski, R.; Strube, J.; Stugu, B.; Soh, D.A.; Su, D.; Sugaya, Y.; Sugimoto, T.; Suhr, C.; Suk, M.; Sulin, V.V.; Sultansoy, S.; Sumida, T.; Sun, X.H.; Sundermann, J.E.; Suruliz, K.; Sushkov, S.; Susinno, G.; Sutton, M.R.; Suzuki, T.; Suzuki, Y.; Sykora, I.; Sykora, T.; Szymocha, T.; Sanchez, J.; Ta, D.; Tackmann, K.; Taffard, A.; Tafirout, R.; Taga, A.; Takahashi, Y.; Takai, H.; Takashima, R.; Takeda, H.; Takeshita, T.; Talby, M.; Talyshev, A.; Tamsett, M.C.; Tanaka, J.; Tanaka, R.; Tanaka, S.; Tanaka, S.; Tapprogge, S.; Tardif, D.; Tarem, S.; Tarrade, F.; Tartarelli, G.F.; Tas, P.; Tasevsky, M.; Tassi, E.; Tatarkhanov, M.; Taylor, C.; Taylor, F.E.; Taylor, G.N.; Taylor, R.P.; Taylor, W.; Teixeira-Dias, P.; Ten Kate, H.; Teng, P.K.; Tennenbaum-Katan, Y.D.; Terada, S.; Terashi, K.; Terron, J.; Terwort, M.; Testa, M.; Teuscher, R.J.; Thioye, M.; Thoma, S.; Thomas, J.P.; Thompson, E.N.; Thompson, P.D.; Thompson, P.D.; Thompson, R.J.; Thompson, A.S.; Thomson, E.; Thun, R.P.; Tic, T.; Tikhomirov, V.O.; Tikhonov, Y.A.; Tipton, P.; Tique Aires Viegas, F.J.; Tisserant, S.; Toczek, B.; Todorov, T.; Todorova-Nova, S.; Toggerson, B.; Tojo, J.; Tokar, S.; Tokushuku, K.; Tollefson, K.; Tomasek, L.; Tomasek, M.; Tomoto, M.; Tompkins, L.; Toms, K.; Tonoyan, A.; Topfel, C.; Topilin, N.D.; Torrence, E.; Torro Pastor, E.; Toth, J.; Touchard, F.; Tovey, D.R.; Trefzger, T.; Tremblet, L.; Tricoli, A.; Trigger, I.M.; Trincaz-Duvoid, S.; Trinh, T.N.; Tripiana, M.F.; Triplett, N.; Trischuk, W.; Trivedi, A.; Trocme, B.; Troncon, C.; Trzupek, A.; Tsarouchas, C.; Tseng, J.C-L.; Tsiakiris, M.; Tsiareshka, P.V.; Tsionou, D.; Tsipolitis, G.; Tsiskaridze, V.; Tskhadadze, E.G.; Tsukerman, I.I.; Tsulaia, V.; Tsung, J.W.; Tsuno, S.; Tsybychev, D.; Tuggle, J.M.; Turecek, D.; Turk Cakir, I.; Turlay, E.; Tuts, P.M.; Twomey, M.S.; Tylmad, M.; Tyndel, M.; Uchida, K.; Ueda, I.; Ugland, M.; Uhlenbrock, M.; Uhrmacher, M.; Ukegawa, F.; Unal, G.; Undrus, A.; Unel, G.; Unno, Y.; Urbaniec, D.; Urkovsky, E.; Urquijo, P.; Urrejola, P.; Usai, G.; Uslenghi, M.; Vacavant, L.; Vacek, V.; Vachon, B.; Vahsen, S.; Valente, P.; Valentinetti, S.; Valkar, S.; Valladolid Gallego, E.; Vallecorsa, S.; Valls Ferrer, J.A.; Van Berg, R.; van der Graaf, H.; van der Kraaij, E.; van der Poel, E.; van der Ster, D.; van Eldik, N.; van Gemmeren, P.; van Kesteren, Z.; van Vulpen, I.; Vandelli, W.; Vaniachine, A.; Vankov, P.; Vannucci, F.; Vari, R.; Varnes, E.W.; Varouchas, D.; Vartapetian, A.; Varvell, K.E.; Vasilyeva, L.; Vassilakopoulos, V.I.; Vazeille, F.; Vellidis, C.; Veloso, F.; Veneziano, S.; Ventura, A.; Ventura, D.; Venturi, M.; Venturi, N.; Vercesi, V.; Verducci, M.; Verkerke, W.; Vermeulen, J.C.; Vetterli, M.C.; Vichou, I.; Vickey, T.; Viehhauser, G.H.A.; Villa, M.; Villani, E.G.; Villaplana Perez, M.; Vilucchi, E.; Vincter, M.G.; Vinek, E.; Vinogradov, V.B.; Viret, S.; Virzi, J.; Vitale, A.; Vitells, O.; Vivarelli, I.; Vives Vaque, F.; Vlachos, S.; Vlasak, M.; Vlasov, N.; Vogel, A.; Vokac, P.; Volpi, M.; von der Schmitt, H.; von Loeben, J.; von Radziewski, H.; von Toerne, E.; Vorobel, V.; Vorwerk, V.; Vos, M.; Voss, R.; Voss, T.T.; Vossebeld, J.H.; Vranjes, N.; Vranjes Milosavljevic, M.; Vrba, V.; Vreeswijk, M.; Vu Anh, T.; Vudragovic, D.; Vuillermet, R.; Vukotic, I.; Wagner, P.; Walbersloh, J.; Walder, J.; Walker, R.; Walkowiak, W.; Wall, R.; Wang, C.; Wang, H.; Wang, J.; Wang, S.M.; Warburton, A.; Ward, C.P.; Warsinsky, M.; Wastie, R.; Watkins, P.M.; Watson, A.T.; Watson, M.F.; Watts, G.; Watts, S.; Waugh, A.T.; Waugh, B.M.; Weber, M.D.; Weber, M.; Weber, M.S.; Weber, P.; Weidberg, A.R.; Weingarten, J.; Weiser, C.; Wellenstein, H.; Wells, P.S.; Wen, M.; Wenaus, T.; Wendler, S.; Wengler, T.; Wenig, S.; Wermes, N.; Werner, M.; Werner, P.; Werth, M.; Werthenbach, U.; Wessels, M.; Whalen, K.; White, A.; White, M.J.; White, S.; Whitehead, S.R.; Whiteson, D.; Whittington, D.; Wicek, F.; Wicke, D.; Wickens, F.J.; Wiedenmann, W.; Wielers, M.; Wienemann, P.; Wiglesworth, C.; Wiik, L.A.M.; Wildauer, A.; Wildt, M.A.; Wilkens, H.G.; Williams, E.; Williams, H.H.; Willocq, S.; Wilson, J.A.; Wilson, M.G.; Wilson, A.; Wingerter-Seez, I.; Winklmeier, F.; Wittgen, M.; Wolter, M.W.; Wolters, H.; Wosiek, B.K.; Wotschack, J.; Woudstra, M.J.; Wraight, K.; Wright, C.; Wright, D.; Wrona, B.; Wu, S.L.; Wu, X.; Wulf, E.; Wynne, B.M.; Xaplanteris, L.; Xella, S.; Xie, S.; Xu, D.; Xu, N.; Yamada, M.; Yamamoto, A.; Yamamoto, K.; Yamamoto, S.; Yamamura, T.; Yamaoka, J.; Yamazaki, T.; Yamazaki, Y.; Yan, Z.; Yang, H.; Yang, U.K.; Yang, Z.; Yao, W-M.; Yao, Y.; Yasu, Y.; Ye, J.; Ye, S.; Yilmaz, M.; Yoosoofmiya, R.; Yorita, K.; Yoshida, R.; Young, C.; Youssef, S.P.; Yu, D.; Yu, J.; Yuan, L.; Yurkewicz, A.; Zaidan, R.; Zaitsev, A.M.; Zajacova, Z.; Zambrano, V.; Zanello, L.; Zaytsev, A.; Zeitnitz, C.; Zeller, M.; Zemla, A.; Zendler, C.; Zenin, O.; Zenis, T.; Zenonos, Z.; Zenz, S.; Zerwas, D.; Zevi della Porta, G.; Zhan, Z.; Zhang, H.; Zhang, J.; Zhang, Q.; Zhang, X.; Zhao, L.; Zhao, T.; Zhao, Z.; Zhemchugov, A.; Zhong, J.; Zhou, B.; Zhou, N.; Zhou, Y.; Zhu, C.G.; Zhu, H.; Zhu, Y.; Zhuang, X.; Zhuravlov, V.; Zimmermann, R.; Zimmermann, S.; Zimmermann, S.; Ziolkowski, M.; Zivkovic, L.; Zobernig, G.; Zoccoli, A.; zur Nedden, M.; Zutshi, V.

    2010-01-01

    The simulation software for the ATLAS Experiment at the Large Hadron Collider is being used for large-scale production of events on the LHC Computing Grid. This simulation requires many components, from the generators that simulate particle collisions, through packages simulating the response of the various detectors and triggers. All of these components come together under the ATLAS simulation infrastructure. In this paper, that infrastructure is discussed, including that supporting the detector description, interfacing the event generation, and combining the GEANT4 simulation of the response of the individual detectors. Also described are the tools allowing the software validation, performance testing, and the validation of the simulated output against known physics processes.

  9. Making Energy Infrastructure

    DEFF Research Database (Denmark)

    Schick, Lea; Winthereik, Brit Ross

    2016-01-01

    in a pragmatic present and in an unprecedented future; between being tied to the specific site of the competition and belonging to no place in particular; and not least between being predominantly an art project and primarily an infrastructure project. Remarkable differences between cosmopolitics and smooth...... politics appear here, especially compared to the literature analysing the roles played by art and design when imagining new ways of living with energy. Oscillation between smooth politics and cosmopolitics may provide a generative way forward for actors wishing to engage in the infrastructuring...

  10. Transformation of technical infrastructure

    DEFF Research Database (Denmark)

    Nielsen, Susanne Balslev

    , the evolution of large technological systems and theories about organisational and technological transformationprocesses. The empirical work consist of three analysis at three different levels: socio-technical descriptions of each sector, an envestigation of one municipality and envestigations of one workshop......The scope of the project is to investigate the possibillities of - and the barriers for a transformation of technical infrastructure conserning energy, water and waste. It focus on urban ecology as a transformation strategy. The theoretical background of the project is theories about infrastructure...

  11. VADMC: The Infrastructure

    Directory of Open Access Journals (Sweden)

    Le Sidaner Pierre

    2012-09-01

    Full Text Available The Virtual Atomic and Molecular Data Centre (VAMDC; http://www.vamdc.eu is a European-Union-funded collaboration between several groups involved in the generation, evaluation, and use of atomic and molecular data. VAMDC aims at building a secure, documented, flexible and interoperable e-Science environment-based interface to existing atomic and molecular databases. The global infrastructure of this project uses technologies derived from the International Virtual Observatory Alliance (IVOA. The infrastructure, as well as the first database prototypes will be described.

  12. Indonesian infrastructure development

    International Nuclear Information System (INIS)

    Djojohadikusumo, H.S.

    1991-01-01

    It is with the achievement of a competitive advantage as a motivating factor that the Indonesian coal industry is engaged in infrastructure development including both small regionally trade-based terminals and high capacity capesize bulk terminals to support large scale coal exports. The unique characteristics of Indonesian coal quality, low production costs and the optimization of transport economics in accordance with vessel size provides great incentives for the European and U.S. market. This paper reports on the infrastructure development, Indonesian coal resources, and coal exports

  13. Evaluating Faculty Clinical Excellence in the Academic Health Sciences Center.

    Science.gov (United States)

    Carey, Robert M.; And Others

    1993-01-01

    Evaluation of the clinical competence of medical faculty in teaching hospitals is discussed. Different approaches to clinical assessment and theoretical and practical problems in assessing clinical faculty's performance are discussed. A University of Virginia medical school system for evaluation that combines objective and subjective assessment is…

  14. mHealth for Clinical Decision-Making in Sub-Saharan Africa : A Scoping Review

    NARCIS (Netherlands)

    Adepoju, Ibukun-Oluwa Omolade; Albersen, Bregje Joanna Antonia; De Brouwere, Vincent; van Roosmalen, Jos; Zweekhorst, M.B.M.

    2017-01-01

    BACKGROUND: In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for

  15. [Health care activity in a headache-specific clinic].

    Science.gov (United States)

    Garcia-Escrivà, A; Asensio-Asensio, M; López-Hernández, N; González-Aznar, O J; Oliver-Navarrete, C; Alvarez-Saúco, M; Pampliega-Pérez, A

    It is reckoned that headaches affect, at least once a year, around 90% of the population. The socioeconomic repercussion occasioned by this malady justifies the appearance in recent years of headache units. To conduct a descriptive epidemiological and health care study of the activity carried out in a headache-specific clinic. All the relevant points from the histories of patients who visited our surgery over a period of two years were collected prospectively and consecutively. The different types of headaches were classified according to the 1988 IHS criteria. Both the symptomatic and the preventive treatment were analysed. In all, a total of 866 patients were found; 691 (79.8%) were females and the mean age was 39.8 +/- 15.9 years (range: 6-90 years); 208 (24%) had a history of migraine in the family; 399 (49.9%) were diagnosed as suffering from migraine: 256 (64.2%) had migraine without aura, 152 (19%) were diagnosed as having tension-type headache, and 218 (27.3%) presented chronic daily headache (CDH). The most frequently used symptomatic treatments were NSAI drugs (36.7%) and triptanes (28.4%). Amitriptyline (47.7%), beta-blockers (14.5%) and calcium antagonists (11.3%) were the main drugs used as preventive treatment. After several years' operation of our Headache Unit, we thought there was a need to analyse the population seen in the visits. The fact that the majority of our patients were middle-aged females matched our expectations. Although most of the patients were diagnosed as suffering from M, we also want to highlight the high proportion of cases of CDH, above all associated with the abuse of analgesics.

  16. Aluminium in Infrastructures

    NARCIS (Netherlands)

    Maljaars, J.

    2016-01-01

    Aluminium alloys are used in infrastructures such as pedestrian bridges or parts of it such as handrail. This paper demonstrates that aluminium alloys are in principle also suited for heavy loaded structures, such as decks of traffic bridges and helicopter landing platforms. Recent developments in

  17. CERN printing infrastructure

    International Nuclear Information System (INIS)

    Otto, R; Sucik, J

    2008-01-01

    For many years CERN had a very sophisticated print server infrastructure [13] which supported several different protocols (AppleTalk, IPX and TCP/IP) and many different printing standards. Today's situation differs a lot: we have a much more homogenous network infrastructure, where TCP/IP is used everywhere and we have less printer models, which almost all work using current standards (i.e. they all provide PostScript drivers). This change gave us the possibility to review the printing architecture aiming at simplifying the infrastructure in order to achieve full automation of the service. The new infrastructure offers both: LPD service exposing print queues to Linux and Mac OS X computers and native printing for Windows based clients. The printer driver distribution is automatic and native on Windows and automated by custom mechanisms on Linux, where the appropriate Foomatic drivers are configured. Also the process of printer registration and queue creation is completely automated following the printer registration in the network database. At the end of 2006 we have moved all (∼1200) CERN printers and all users' connections at CERN to the new service. This paper will describe the new architecture and summarize the process of migration

  18. CERN printing infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Otto, R; Sucik, J [CERN, Geneva (Switzerland)], E-mail: Rafal.Otto@cern.ch, E-mail: Juraj.Sucik@cern.ch

    2008-07-15

    For many years CERN had a very sophisticated print server infrastructure [13] which supported several different protocols (AppleTalk, IPX and TCP/IP) and many different printing standards. Today's situation differs a lot: we have a much more homogenous network infrastructure, where TCP/IP is used everywhere and we have less printer models, which almost all work using current standards (i.e. they all provide PostScript drivers). This change gave us the possibility to review the printing architecture aiming at simplifying the infrastructure in order to achieve full automation of the service. The new infrastructure offers both: LPD service exposing print queues to Linux and Mac OS X computers and native printing for Windows based clients. The printer driver distribution is automatic and native on Windows and automated by custom mechanisms on Linux, where the appropriate Foomatic drivers are configured. Also the process of printer registration and queue creation is completely automated following the printer registration in the network database. At the end of 2006 we have moved all ({approx}1200) CERN printers and all users' connections at CERN to the new service. This paper will describe the new architecture and summarize the process of migration.

  19. Language Convergence Infrastructure

    NARCIS (Netherlands)

    V. Zaytsev (Vadim); J.M. Fernandes; R. Lämmel (Ralf); J.M.W. Visser (Joost); J. Saraiva

    2011-01-01

    htmlabstractThe process of grammar convergence involves grammar extraction and transformation for structural equivalence and contains a range of technical challenges. These need to be addressed in order for the method to deliver useful results. The paper describes a DSL and the infrastructure behind

  20. Documentation of Infrastructure

    DEFF Research Database (Denmark)

    Workspace

    2003-01-01

    This report describes the software infrastructure developed within the WorkSPACE  project, both from a software architectural point of view and from a user point of  view. We first give an overview of the system architecture, then go on to present the  more prominent features of the 3D graphical...

  1. Serial private infrastructures

    NARCIS (Netherlands)

    van den Berg, V.A.C.

    2013-01-01

    This paper investigates private supply of two congestible infrastructures that are serial, where the consumer has to use both in order to consume. Four market structures are analysed: a monopoly and 3 duopolies that differ in how firms interact. It is well known that private supply leads too high

  2. Enabling professional development in mental health nursing: the role of clinical leadership.

    Science.gov (United States)

    Ennis, G; Happell, B; Reid-Searl, K

    2015-10-01

    Clinical leadership is acknowledged as important to the nursing profession. While studies continue to identify its significance in contributing to positive outcomes for consumers, the role that clinical leadership has in enabling and supporting professional development in mental health nursing is poorly understood. This study utilized a grounded theory methodology to explore the characteristics clinicians consider important for clinical leadership and its significance for mental health nursing in day-to-day clinical practice. Individual face-to-face, semi-structured interviews were conducted with nurses working in mental health settings. Participants described the important role that clinical leaders play in enabling professional development of others through role modelling and clinical teaching. They describe how nurses, whom they perceive as clinical leaders, use role modelling and clinical teaching to influence the professional development of nursing staff and undergraduate nursing students. Attributes such as professionalism and honesty were seen, by participants, as enablers for clinical leaders in effectively and positively supporting the professional development of junior staff and undergraduate nurses in mental health nursing. This paper examines clinical leadership from the perspective of mental health nurses delivering care, and highlights the important role of clinical leaders in supporting professional development in mental health nursing. © 2015 John Wiley & Sons Ltd.

  3. The effectiveness of clinical teaching of mental health courses in nursing using clinical supervision and Kirkpatrick's model.

    Science.gov (United States)

    Maddineshat, Maryam; Hashemi, Mitra; Besharati, Reza; Gholami, Sepideh; Ghavidel, Fatemeh

    2018-01-01

    Clinical experience associated with the fear and anxiety of nursing students in the psychiatric unit. Mental health nursing instructors find it challenging to teach nursing students to deal with patients with mental disorders in an environment where they need to provide patient teaching and clinical decision-making based on evidence and new technology. To measure the effectiveness of clinical teaching of mental health courses in nursing using clinical supervision and Kirkpatrick's model evaluation in the psychiatry unit of Imam Reza Hospital, Bojnurd, Iran. This cross-sectional study was carried out from 2011 to 2016 on 76 nursing students from a university as part of a clinical mental health course in two semesters. The students were selected by a non-probable convenient sampling method. After completing their clinical education, each student responded to checklist questions based on the four-level Kirkpatrick's model evaluation and open questions relating to clinical supervision. Finally, all data was analyzed using the SPSS version 16. The students have evaluated clinical supervision as a useful approach, and appreciated the instructor's supportive behavior during teaching and imparting clinical skills. This has made them feel relaxed at the end of the clinical teaching course. In addition, in the evaluation through Kirkpatrick's model, more than 70% of the students have been satisfied with the method of conducting the teaching and average score of nursing students' attitude toward mental health students: Their mean self-confidence score was 18.33±1.69, and the mean score of their performance in the study was evaluated to be 93.74±5.3 from 100 points. The results of clinical mental health teaching through clinical supervision and Kirkpatrick's model evaluation show that the satisfaction, self-esteem, attitude, and skill of nursing students are excellent, thereby portraying the effectiveness of clinical teaching. But this program still needs to be reformed. To

  4. Emergent Risks In Critical Infrastructures

    Science.gov (United States)

    Dynes, Scott

    Firms cannot function successfully without managing a host of internal and external organizational and process interdependencies. Part of this involves business continuity planning, which directly aects how resilient arm and its business sector are in the face of disruptions. This paper presents the results of eld studies related to information risk management practices in the health care and retail sectors. The studies explore information risk management coordinating signals within and across rms in these sectors as well as the potential eects of cyber disruptions on the rms as stand-alone entities and as part of a critical infrastructure. The health care case study investigates the impact of the Zotob worm on the ability to deliver medical care and treatment. The retail study examines the resilience of certain elements of the food supply chain to cyber disruptions.

  5. PACS infrastructure supporting e-learning

    International Nuclear Information System (INIS)

    Mildenberger, Peter; Brueggemann, Kerstin; Roesner, Freya; Koch, Katja; Ahlers, Christopher

    2011-01-01

    Digital imaging is becoming predominant in radiology. This has implications for teaching support, because conventional film-based concepts are now obsolete. The IHE Teaching File and Clinical Study Export (TCE) profile provides an excellent platform to enhance PACS infrastructure with educational functionality. This can be supplemented with dedicated e-learning tools.

  6. PACS infrastructure supporting e-learning

    Energy Technology Data Exchange (ETDEWEB)

    Mildenberger, Peter, E-mail: milden@radiologie.klinik.uni-mainz.de [University Medicine Mainz, Johannes Gutenberg-University Mainz, Langenbeckstr 1, Mainz (Germany); Brueggemann, Kerstin; Roesner, Freya; Koch, Katja; Ahlers, Christopher [University Medicine Mainz, Johannes Gutenberg-University Mainz, Langenbeckstr 1, Mainz (Germany)

    2011-05-15

    Digital imaging is becoming predominant in radiology. This has implications for teaching support, because conventional film-based concepts are now obsolete. The IHE Teaching File and Clinical Study Export (TCE) profile provides an excellent platform to enhance PACS infrastructure with educational functionality. This can be supplemented with dedicated e-learning tools.

  7. Preventative health, diversity, and inclusion: a qualitative study of client experience aboard a mobile health clinic in Boston, Massachusetts.

    Science.gov (United States)

    Bouchelle, Zoe; Rawlins, Yasmin; Hill, Caterina; Bennet, Jennifer; Perez, Leonor Xochitl; Oriol, Nancy

    2017-11-03

    There are approximately 2000 mobile health clinics operating in the United States. While researchers have established that mobile health clinics can be cost effective and improve outcomes, there is scant research examining the healthcare experience on a mobile health clinic from patients' perspectives. Data were gathered from interviews with 25 clients receiving care on a Boston-based mobile health clinic and analyzed using grounded theory methodology. Emerging patterns in the data revealed three relational and three structural factors most significant to participants' experience of care on The Family Van. Relational factors include providers who 1) Communicate understandably, 2) Create a culture of respect and inclusivity, and 3) Are diverse with knowledge of the community. Structural factors include 1) A focus on preventative health and managing chronic disease, 2) Expeditious, free, and multiple services, and 3) Location. The participant accounts in this report serve to expand on prior research exploring mobile health clinics' role in patients' healthcare, to more clearly define the most salient aspects of the mobile health clinic model for the patients they serve, and to give voice to patients too seldom heard in the academic literature.

  8. Mental health and clinical correlates in lesbian, gay, bisexual, and queer young adults

    DEFF Research Database (Denmark)

    Grant, Jon E; Odlaug, Brian Lawrence; Derbyshire, Katherine

    2014-01-01

    This study examined the prevalence of mental health disorders and their clinical correlates in a university sample of lesbian, gay, bisexual, and queer (LGBQ) students.......This study examined the prevalence of mental health disorders and their clinical correlates in a university sample of lesbian, gay, bisexual, and queer (LGBQ) students....

  9. Frontline health care can be improved by bringing research into the clinic

    DEFF Research Database (Denmark)

    Steinhausen, Kirsten; Berghmans, Stephane; Højgaard, Liselotte

    2011-01-01

    Progress in clinical research has played a huge role in the great improvements in frontline health care achieved over the last 50 years, both in general practice and in hospitals.......Progress in clinical research has played a huge role in the great improvements in frontline health care achieved over the last 50 years, both in general practice and in hospitals....

  10. Investigation Clinical Competence and Its Relationship with Professional Ethics and Spiritual Health in Nurses

    Directory of Open Access Journals (Sweden)

    Elahe Ramezanzade Tabriz

    2017-03-01

    Full Text Available Abstract Background and Objectives: Study of clinical competence in nursing helps determine the quality of health care delivered to patients. Given the priority of observance of principles over caretaking and necessity of spirituality existence at the core of health care provision, this study was conducted to investigate clinical competence and its relationship with professional ethics and spiritual health in nurses. Methods: In this cross-sectional, descriptive, and correlational study, 281 nurses were enrolled by consensus sampling. Sampling was conducted from February, 2016 till June, 2016. The data were gathered by a demographics questionnaire, a self-assessment scale of clinical competence, a nursing ethics questionnaire, and a spiritual health questionnaire, and analyzed by descriptive statistics and t-test, Pearson's correlation coefficient, ANOVA, and linear regression analysis in SPSS 21. Results: The total scores for self-assessment scale of nurses' clinical competence, professional ethics, and spiritual health were moderate. In the light of the results of Spearman's correlation coefficient, there was a significant and positive correlation between clinical competence and spiritual health. Moreover, a significant positive correlation was observed between professional ethics and spiritual health but there was no correlation between professional ethics and clinical competence. Conclusion: Managers' and personnel's Knowledge about the level of nurses clinical competence, professional ethics, and spiritual health in teaching health care centers provides valuable information to develop in-service and efficacious education programs and ultimately to improve the quality of nursing services.

  11. DETAILED CLINICAL MODELS AND THEIR RELATION WITH ELECTRONIC HEALTH RECORDS.

    OpenAIRE

    Boscá Tomás, Diego

    2016-01-01

    [EN] Healthcare domain produces and consumes big quantities of people's health data. Although data exchange is the norm rather than the exception, being able to access to all patient data is still far from achieved. Current developments such as personal health records will introduce even more data and complexity to the Electronic Health Records (EHR). Achieving semantic interoperability is one of the biggest challenges to overcome in order to benefit from all the information contained in the ...

  12. Oral health literacy in adult dental patients - A clinical study

    OpenAIRE

    Stein, Linda

    2015-01-01

    The papers II and III of this thesis are not available in Munin. Paper II: Stein, L., Bergdahl, M., Pettersen, K. S., Bergdahl, J.: “The association between oral health literacy and alexithymia: Implications for patient-clinician communication”. (Manuscript). Published version with title “Exploring the association between oral health literacy and alexithymia” available in Community Dental Health 2015, 32(3):143 - 147. Paper III: Stein, L., Bergdahl, M., Pettersen, K. S., Bergdahl...

  13. Sex differences in health research and clinical guideline development

    NARCIS (Netherlands)

    Keuken, D.G.

    2008-01-01

    In current medical practice, research based evidence is an important foundation for clinical decision making. Clinical practice guidelines are a major instrument for keeping physicians up-to-date about this evidence. In order to provide optimal care to both men and women, it is important that sex

  14. Distribution of green infrastructure along walkable roads

    Science.gov (United States)

    Low-income and minority neighborhoods frequently lack healthful resources to which wealthier communities have access. Though important, the addition of facilities such as recreation centers can be costly and take time to implement. Urban green infrastructure, such as street trees...

  15. Security infrastructure for on-demand provisioned Cloud infrastructure services

    NARCIS (Netherlands)

    Demchenko, Y.; Ngo, C.; de Laat, C.; Wlodarczyk, T.W.; Rong, C.; Ziegler, W.

    2011-01-01

    Providing consistent security services in on-demand provisioned Cloud infrastructure services is of primary importance due to multi-tenant and potentially multi-provider nature of Clouds Infrastructure as a Service (IaaS) environment. Cloud security infrastructure should address two aspects of the

  16. Clinical Correlates of Health Preference and Generic Health-Related Quality of Life in Patients with Colorectal Neoplasms

    OpenAIRE

    Wong, Carlos K. H.; Lam, Cindy L. K.; Poon, Jensen T. C.; Kwong, Dora L. W.

    2013-01-01

    BACKGROUND: The aims of the study were to assess the health preference and health-related quality of life (HRQOL) in patients with colorectal neoplasms (CRN), and to determine the clinical correlates that significantly influence the HRQOL of patients. METHODS: Five hundred and fifty-four CRN patients, inclusive of colorectal polyp or cancer, who attended the colorectal specialist outpatient clinic at Queen Mary Hospital in Hong Kong between October 2009 and July 2010, were included. Patients ...

  17. Religion, Spirituality, and Health: The Research and Clinical Implications

    Science.gov (United States)

    Koenig, Harold G.

    2012-01-01

    This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard. PMID:23762764

  18. Role of Forensic Pathology in Clinical Practice and Public Health ...

    African Journals Online (AJOL)

    The request for and performance of autopsy have been on the decline despite its obvious merits to medical practice, the patients and public health. Several surveys have exposed some reasons for this decline. Method: This work is a review of the role of forensic pathology to medical practice and public health. The author ...

  19. School-Located Influenza Vaccination Clinics: Local Health Department Perspectives

    Science.gov (United States)

    Ransom, James

    2009-01-01

    Universal childhood influenza vaccination presents challenges and opportunities for health care and public health systems to vaccinate the children who fall under the new recommendation. Advisory Committee on Immunization Practices (ACIP) recommendations and guidelines are helpful, but they do not provide strategies on how to deliver immunization…

  20. Clinical leadership in mental health nursing: the importance of a calm and confident approach.

    Science.gov (United States)

    Ennis, Gary; Happell, Brenda; Reid-Searl, Kerry

    2015-01-01

    Explore the perceptions of nurses working in mental health of effective clinical leadership. In-depth interviews were conducted with registered nurses employed in a mental health setting. Qualitative research using grounded theory. Remaining calm and confident in times of crisis and uncertainty was identified as one attribute of clinical leadership. Participants noted clinical leaders' demeanor during stressful or crisis situations, and their ability to manage unpredictable or unexpected clinical situations as contributing positively to clinical practice. Understanding these characteristics and how they can influence positive outcomes for clients is crucial in addressing the recruitment and retention challenges for the nursing workforce. © 2014 Wiley Periodicals, Inc.

  1. The importance of communication for clinical leaders in mental health nursing: the perspective of nurses working in mental health.

    Science.gov (United States)

    Ennis, Gary; Happell, Brenda; Broadbent, Marc; Reid-Searl, Kerry

    2013-11-01

    Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.

  2. Understanding Clinician Information Demands and Synthesis of Clinical Documents in Electronic Health Record Systems

    Science.gov (United States)

    Farri, Oladimeji Feyisetan

    2012-01-01

    Large quantities of redundant clinical data are usually transferred from one clinical document to another, making the review of such documents cognitively burdensome and potentially error-prone. Inadequate designs of electronic health record (EHR) clinical document user interfaces probably contribute to the difficulties clinicians experience while…

  3. Automated Methods to Extract Patient New Information from Clinical Notes in Electronic Health Record Systems

    Science.gov (United States)

    Zhang, Rui

    2013-01-01

    The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…

  4. Consumer health information technology in an adult public health primary care clinic: a heart health education feasibility study.

    Science.gov (United States)

    Gleason-Comstock, Julie A; Streater, Alicia; Jen, Kai-Lin Catherine; Artinian, Nancy T; Timmins, Jessica; Baker, Suzanne; Joshua, Bosede; Paranjpe, Aniruddha

    2013-12-01

    To explore the feasibility and short term outcomes of using an interactive kiosk integrated into office flow to deliver health information in a primary care clinic. Fifty-one adults with BMI ≥25 were randomly assigned to use a kiosk with attached devices to receive a six-week healthy eating/weight monitoring (intervention) or general health/BP monitoring (attention-control) program. Outcomes were measured at baseline, 8 weeks (post) and three month follow-up. Participants completed an average of 2.73 weekly sessions, with transportation and time given as limiting factors. They found the kiosk easy to use (97%), liked the touchscreen (94%), and would use the kiosk again (81%). Although there were no differences between groups, the 27 completing all assessments showed reduced weight (p=.02), and decreased systolic (p=.01) and diastolic BP (pinformation and self-monitoring. Multi-session educational content can provide beneficial short-term outcomes in overweight adults. A kiosk with attached peripherals in a clinic setting is a viable adjunct to provider education, particularly in medically underserved areas. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  5. The Gap in Knowledge of Clinical Practice Guidelines by Mental Health Residents in Buenos Aires (Argentina

    Directory of Open Access Journals (Sweden)

    Javier Fabrissin

    2014-05-01

    Full Text Available The aim of this pilot study was to evaluate if the residents of psychiatry and clinical psychology from the city of Buenos Aires knew any of the existing mental health Clinical Practice and Treatment Guidelines (CPTGs. We asked residents their opinion about CPTGs and, also, if they followed their recommendations in clinical practice. We asked 59 mental health residents (28 physicians and 29 psychologists with different years of clinical training to fill a questionnaire to know their opinion about CPTGs and also if they follow the CPTG recommendations in their clinical practice. We found that 79.31% of residents did not know any CPTG. Eighty percent of the residents who did know any CPTG have a positive opinion about CPTGs. Finally, the American Psychiatric Association Guidelines were the most known CPTGs. The authors emphasize the need for a clinical guidelines diffusion policy in Buenos Aires city and particularly as a clinical and training resource for mental health residents.

  6. Infrastructuring for Quality

    DEFF Research Database (Denmark)

    Bossen, Claus; Danholt, Peter; Ubbesen, Morten Bonde

    2015-01-01

    Reimbursement and budgeting constitutes a central infrastructural element in most secondary healthcare sectors. In Denmark, Diagnose-Related Groups (DRG) function as the core element for budgeting and encouraging increase in activity and effectivity. However, DRG is known to potentially have...... indicators for quality in treatment to guide and govern their performance, in order to investigate whether this may generate a new performance measurement infrastructure that will improve quality of healthcare. The project is entitled: “New governance in the patient’s perspective”....... adverse effects by encouraging hospitals to maximize reimbursement at the expense of patients. To counter this, one Danish region has initiated an experiment involving nine hospital departments whose normal budgeting and reimbursement based on DRG is put on hold. Instead, they have been asked to develop...

  7. Flowscapes : Designing infrastructure as landscape

    NARCIS (Netherlands)

    Nijhuis, S.; Jauslin, D.T.; Van der Hoeven, F.D.

    2015-01-01

    Social, cultural and technological developments of our society are demanding a fundamental review of the planning and design of its landscapes and infrastructures, in particular in relation to environmental issues and sustainability. Transportation, green and water infrastructures are important

  8. Sustainable Bridge Infrastructure Procurement

    DEFF Research Database (Denmark)

    Safi, Mohammed; Du, Guangli; Simonsson, Peter

    2016-01-01

    The lack of a flexible but systematic approach for integrating lifecycle aspects into bridge investment decisions is a major obstacle hindering the procurement of sustainable bridge infrastructures. This paper addresses this obstacle by introducing a holistic approach that agencies could use...... to procure the most “sustainable” (lifecycle-efficient) bridge through a fair design-build (D-B) tendering process, considering all the main aspects: life-cycle cost (LCC), service life-span, aesthetic demands and environmental impacts (LCA)....

  9. Cloud Infrastructure Security

    OpenAIRE

    Velev , Dimiter; Zlateva , Plamena

    2010-01-01

    Part 4: Security for Clouds; International audience; Cloud computing can help companies accomplish more by eliminating the physical bonds between an IT infrastructure and its users. Users can purchase services from a cloud environment that could allow them to save money and focus on their core business. At the same time certain concerns have emerged as potential barriers to rapid adoption of cloud services such as security, privacy and reliability. Usually the information security professiona...

  10. Chef infrastructure automation cookbook

    CERN Document Server

    Marschall, Matthias

    2015-01-01

    This book is for system engineers and administrators who have a fundamental understanding of information management systems and infrastructure. It helps if you've already played around with Chef; however, this book covers all the important topics you will need to know. If you don't want to dig through a whole book before you can get started, this book is for you, as it features a set of independent recipes you can try out immediately.

  11. Durability of critical infrastructures

    OpenAIRE

    Raluca Pascu; Ramiro Sofronie

    2011-01-01

    The paper deals with those infrastructures by which world society, under the pressure ofdemographic explosion, self-survives. The main threatening comes not from terrorist attacks, but fromthe great natural catastrophes and global climate change. It’s not for the first time in history when suchmeasures of self-protection are built up. First objective of this paper is to present the background fordurability analysis. Then, with the aid of these mathematical tools the absolute durability of thr...

  12. IP Infrastructure Geolocation

    Science.gov (United States)

    2015-03-01

    by non-commercial enti- ties. HostiP is a community-driven geolocation service. It provides an Application Pro- gramming Interface ( API ) for...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS IP INFRASTRUCTURE GEOLOCATION Thesis Advisor: Second Reader: by Guan Yan Cai March...FUNDING NUMBERS IP INFRASTRUCfURE GEOLOCATION N66001-2250-59231 6. AUTHOR(S) Guan Yan Cai 7. PERFORMING ORGANIZATION NAME(S) AND AOORESS(ES) 9

  13. Critical infrastructure protection

    Energy Technology Data Exchange (ETDEWEB)

    Bradley, F. [Canadian Electricity Association, Toronto, ON (Canada)

    2003-04-01

    The need to protect critical electrical infrastructure from terrorist attacks, or other physical damage, including weather related events, or the potential impact of computer viruses and other attacks on IT resources are discussed. Activities of the North American Electric Reliability Council (NERC) are highlighted which seek to safeguard the North American bulk electric power system principally through the Information Sharing and Analysis Sector (ES-ISAC). ES-ISAC serves the electricity sector by facilitating communication between electric sector participants, federal government and other critical infrastructure industries by disseminating threat indications, analyses and warnings, together with interpretations, to assist the industry in taking infrastructure protection actions. Attention is drawn to the numerous cyber incidents in recent years, which although resulted in no loss of service to electricity customers so far, in at least one instance (the January 25th SOL-Slammer worm incident) resulted in degradation of service in a number of sectors, including financial, transportation and telecommunication services. The increasing frequency of cyber-based attacks, coupled with the industry's growing dependence on e-commerce and electronic controls, are good reasons to believe that critical infrastructure protection (CIP) poses a serious challenge to the industry's risk management practices. The Canadian Electricity Association (CEA) is an active participant in ES-ISAC and works cooperatively with a range of partners, such as the Edison Electric Institute and the American Public Power Association to ensure coordination and effective protection program delivery for the electric power sector. The Early Warning System (EWS) developed by the CIP Working Group is one of the results of this cooperation. EWS uses the Internet, e-mail, web-enabled cell phones and Blackberry hand-held devices to deliver real-time threat information to members on a 24/7 basis. EWS

  14. 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.

  15. Injection safety knowledge and practices among clinical health care ...

    African Journals Online (AJOL)

    Injection safety is therefore critical in preventing occupational exposure and infection from blood borne pathogens, hence prevention is a vital part of any ... safety among clinical healthcare workers at the Garissa Provincial General Hospital.

  16. Oral Health Status and Behaviour of Mauritians Visiting Private Dental Clinics

    Science.gov (United States)

    Gunsam, P. Pugo; Banka, S.

    2011-01-01

    Purpose: This paper seeks to assess the oral health status and behaviour of a sample of the Mauritian population visiting private dental clinics. Design/methodology/approach: Oral health status was determined using the World Health Organization (Decayed, Missing, Filled Teeth (DMFT) index indicating the prevalence of caries, and factors associated…

  17. Healthcare information technology infrastructures in Turkey.

    Science.gov (United States)

    Dogac, A; Yuksel, M; Ertürkmen, G L; Kabak, Y; Namli, T; Yıldız, M H; Ay, Y; Ceyhan, B; Hülür, U; Oztürk, H; Atbakan, E

    2014-05-22

    The objective of this paper is to describe some of the major healthcare information technology (IT) infrastructures in Turkey, namely, Sağlık-Net (Turkish for "Health-Net"), the Centralized Hospital Appointment System, the Basic Health Statistics Module, the Core Resources Management System, and the e-prescription system of the Social Security Institution. International collaboration projects that are integrated with Sağlık-Net are also briefly summarized. The authors provide a survey of the some of the major healthcare IT infrastructures in Turkey. Sağlık-Net has two main components: the National Health Information System (NHIS) and the Family Medicine Information System (FMIS). The NHIS is a nation-wide infrastructure for sharing patients' Electronic Health Records (EHRs). So far, EHRs of 78.9 million people have been created in the NHIS. Similarly, family medicine is operational in the whole country via FMIS. Centralized Hospital Appointment System enables the citizens to easily make appointments in healthcare providers. Basic Health Statistics Module is used for collecting information about the health status, risks and indicators across the country. Core Resources Management System speeds up the flow of information between the headquarters and Provincial Health Directorates. The e-prescription system is linked with Sağlık-Net and seamlessly integrated with the healthcare provider information systems. Finally, Turkey is involved in several international projects for experience sharing and disseminating national developments. With the introduction of the "Health Transformation Program" in 2003, a number of successful healthcare IT infrastructures have been developed in Turkey. Currently, work is going on to enhance and further improve their functionality.

  18. California Hydrogen Infrastructure Project

    Energy Technology Data Exchange (ETDEWEB)

    Heydorn, Edward C

    2013-03-12

    Air Products and Chemicals, Inc. has completed a comprehensive, multiyear project to demonstrate a hydrogen infrastructure in California. The specific primary objective of the project was to demonstrate a model of a real-world retail hydrogen infrastructure and acquire sufficient data within the project to assess the feasibility of achieving the nation's hydrogen infrastructure goals. The project helped to advance hydrogen station technology, including the vehicle-to-station fueling interface, through consumer experiences and feedback. By encompassing a variety of fuel cell vehicles, customer profiles and fueling experiences, this project was able to obtain a complete portrait of real market needs. The project also opened its stations to other qualified vehicle providers at the appropriate time to promote widespread use and gain even broader public understanding of a hydrogen infrastructure. The project engaged major energy companies to provide a fueling experience similar to traditional gasoline station sites to foster public acceptance of hydrogen. Work over the course of the project was focused in multiple areas. With respect to the equipment needed, technical design specifications (including both safety and operational considerations) were written, reviewed, and finalized. After finalizing individual equipment designs, complete station designs were started including process flow diagrams and systems safety reviews. Material quotes were obtained, and in some cases, depending on the project status and the lead time, equipment was placed on order and fabrication began. Consideration was given for expected vehicle usage and station capacity, standard features needed, and the ability to upgrade the station at a later date. In parallel with work on the equipment, discussions were started with various vehicle manufacturers to identify vehicle demand (short- and long-term needs). Discussions included identifying potential areas most suited for hydrogen fueling

  19. Simplified Clinical Tools and Educational Outreach for Health Workers

    International Development Research Centre (IDRC) Digital Library (Canada)

    The training will focus on mid-level healthcare workers, that is, nurses, medical ... Registered Trustees of the Research for Equity and Community Health ... Call for new OWSD Fellowships for Early Career Women Scientists now open.

  20. The National Health Insurance, the decentralised clinical training ...

    African Journals Online (AJOL)

    studies, particularly those from Australia, Canada, and SA.[1-6] ... Gluckman's principles; therefore it is imperative to keep these in the forefront .... Digby A. Evidence, encounters and effects of South Africa's reforming Gluckman National Health.

  1. Engineering economics and finance for transportation infrastructure

    CERN Document Server

    Prassas, Elena S

    2013-01-01

    Transportation infrastructure is often referred to as society’s bloodstream.  It allows for the movement of people and goods to provide the ability to optimize the production and distribution of goods in an effective and efficient manner, and to provide personal opportunities for employment, recreation, education, health care, and other vital activities.   At the same time, the costs to provide, maintain, and operate this complex infrastructure are enormous.  Because so much of the economic resources to be invested come from public funds, it is critical that expenditures are made in a manner that provides society with the best possible return on the investment.  Further, it is important that sufficient investment is made available, and the costs of the investment are equitably borne by taxpayers.   This textbook provides a fundamental overview of the application of engineering economic principles to transportation infrastructure investments.  Basic theory is presented and illustrated with examples spe...

  2. Evaluation of services of the integrative health clinic in Hong Kong.

    Science.gov (United States)

    Chung, Joanne W Y; Chung, Louisa M Y; Kwok, Nedra W L; Wong, Thomas K S

    2008-10-01

    (i) To provide a profile of the clients who have used the Integrative Health Clinic's services, (ii) to determine the clients' extent of satisfaction with the services received and (iii) to assess whether integrative therapies can/should be recommended to other clinics. Based on the integration of various health paradigms and the use of health promotion strategies, our Integrative Health Clinic in Hong Kong provides a range of different therapies for integrated symptom management. The integrative therapies are derived from conventional, complementary and alternative medicine. Design. Postal survey, followed by routine data analysis. Hong Kong Chinese clients attending a residential community health clinic were surveyed about health status and satisfaction towards the services received. A total of 489 clients (30.8% were male and 69.2% female) were registered with the clinic during the study period. The mean age (SD) was 47.8 (15.4) years. The customer satisfaction survey found that traditional Chinese medicine consultation was the most frequently used modality of the Integrative Health Clinic, followed by pain management. Out of the 489 clients, those who attended the Integrative Health Clinic only once in the study period for an annual health assessment and those who died during the period were excluded from the survey, giving a total of 276 eligible clients. Out of the 276 clients, 52.5% (128) responded to the survey that asked them to evaluate their satisfaction with the services received at the clinic and the performance of the clinic's practitioners who interacted with them. For practitioner performance, the percentage of respondents who gave a rating of satisfaction was found to range between 86.3-64.3%, while the percentage of respondents who gave a rating of dissatisfaction ranged from 13.7-35.7%. Overall, the survey found that most aspects of the Integrative Health Clinic's services were rated as satisfactory. The overwhelming satisfaction of clients with

  3. Clinical diagnosis of syphilis: a ten-year retrospective analysis in a South Australian urban sexual health clinic.

    Science.gov (United States)

    Forrest, C E; Ward, A

    2016-12-01

    National notifications for infectious syphilis in Australia have increased in recent years. Outside of sexual health clinics, junior clinicians seldom encounter this disease in its infectious stage (primary, secondary and early latent). With such a variable clinical presentation, textbook teaching is no substitute for real-life experience. The importance of accurate classification and staging of disease is relevant to the risk of transmission and determines treatment duration. In this article, the authors review the clinical presentation of syphilis over ten years in an urban sexual health clinic with a focus on the clinical presentation and diagnosis of infectious syphilis, in particular secondary syphilis, compared with that outlined in the Australian National Notifiable Diseases Surveillance System guidelines. This retrospective review of all patients diagnosed with syphilis at an urban sexual health clinic showed that between 2005 and 2015, 226 cases of syphilis were diagnosed. Documentation of impression of clinical staging of disease was present in 46% of the cases. Seventeen of these cases were recorded as secondary syphilis. The criteria used by clinicians to diagnose the secondary syphilis cases were consistent with criteria defined by the Australian National Notifiable Diseases Surveillance System. All cases of secondary syphilis had at least one cutaneous manifestation of disease. The demographic of the cohort of syphilis cases was consistent with that recorded in the literature. This review showed that the clinician's diagnosis of secondary syphilis in this service is consistent with the National Notifiable Diseases Surveillance System guidelines. Continuing education of junior medical staff is important to facilitate diagnosis and improve documentation of clinical staging, minimise disease transmission and ensure appropriate treatment. © The Author(s) 2016.

  4. The Interplay between socioeconomic inequalities and clinical oral health.

    Science.gov (United States)

    Steele, J; Shen, J; Tsakos, G; Fuller, E; Morris, S; Watt, R; Guarnizo-Herreño, C; Wildman, J

    2015-01-01

    Oral health inequalities associated with socioeconomic status are widely observed but may depend on the way that both oral health and socioeconomic status are measured. Our aim was to investigate inequalities using diverse indicators of oral health and 4 socioeconomic determinants, in the context of age and cohort. Multiple linear or logistic regressions were estimated for 7 oral health measures representing very different outcomes (2 caries prevalence measures, decayed/missing/filled teeth, 6-mm pockets, number of teeth, anterior spaces, and excellent oral health) against 4 socioeconomic measures (income, education, Index of Multiple Deprivation, and occupational social class) for adults aged ≥21 y in the 2009 UK Adult Dental Health Survey data set. Confounders were adjusted and marginal effects calculated. The results showed highly variable relationships for the different combinations of variables and that age group was critical, with different relationships at different ages. There were significant income inequalities in caries prevalence in the youngest age group, marginal effects of 0.10 to 0.18, representing a 10- to 18-percentage point increase in the probability of caries between the wealthiest and every other quintile, but there was not a clear gradient across the quintiles. With number of teeth as an outcome, there were significant income gradients after adjustment in older groups, up to 4.5 teeth (95% confidence interval, 2.2-6.8) between richest and poorest but none for the younger groups. For periodontal disease, income inequalities were mediated by other socioeconomic variables and smoking, while for anterior spaces, the relationships were age dependent and complex. In conclusion, oral health inequalities manifest in different ways in different age groups, representing age and cohort effects. Income sometimes has an independent relationship, but education and area of residence are also contributory. Appropriate choices of measures in relation to age

  5. [Conflicts of interests in clinical research in primary health care].

    Science.gov (United States)

    González-de Paz, L; Navarro-Rubio, M D; Sisó-Almirall, A

    2014-03-01

    Conflicts of interests between professionals and patients in biomedical research, is an ethical problem. None of the laws in Spain mention whether the clinical researcher has to clarify to participants the reasons why it proposes them to participate in a clinical trial. In this article, conflicts of interests in research are discussed in the context of primary healthcare. In this area conflicts of interests might alter the confidence between patients and healthcare professionals. Finally, we suggest some practical strategies that can help participants make the decision to participate in a clinical trial more willingly and freely. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  6. Health status measurement in COPD : the minimal clinically important difference of the clinical COPD questionnaire

    NARCIS (Netherlands)

    Kocks, J. W. H.; Tuinenga, M. G.; Uil, S. M.; van den Berg, J. W. K.; Stahl, E.; van der Molen, T.

    2006-01-01

    Background: Patient-reported outcomes ( PRO) questionnaires are being increasingly used in COPD clinical studies. The challenge facing investigators is to determine what change is significant, ie what is the minimal clinically important difference (MCID). This study aimed to identify the MCID for

  7. Electronic health record tools' support of nurses' clinical judgment and team communication.

    Science.gov (United States)

    Kossman, Susan P; Bonney, Leigh Ann; Kim, Myoung Jin

    2013-11-01

    Nurses need to quickly process information to form clinical judgments, communicate with the healthcare team, and guide optimal patient care. Electronic health records not only offer potential for enhanced care but also introduce unintended consequences through changes in workflow, clinical judgment, and communication. We investigated nurses' use of improvised (self-made) and electronic health record-generated cognitive artifacts on clinical judgment and team communication. Tanner's Clinical Judgment Model provided a framework and basis for questions in an online survey and focus group interviews. Findings indicated that (1) nurses rated self-made work lists and medication administration records highest for both clinical judgment and communication, (2) tools aided different dimensions of clinical judgment, and (3) interdisciplinary tools enhance team communication. Implications are that electronic health record tool redesign could better support nursing work.

  8. Infrastructure: concept, types and value

    Directory of Open Access Journals (Sweden)

    Alexander E. Lantsov

    2013-01-01

    Full Text Available Researches of influence of infrastructure on the economic growth and development of the countries gained currency. However the majority of authors drop the problem of definition of accurate concept of studied object and its criteria out. In the given article various approaches in the definition of «infrastructure» concept, criterion and the characteristics of infrastructure distinguishing it from other capital assets are presented. Such types of infrastructure, as personal, institutional, material, production, social, etc. are considered. Author’s definition of infrastructure is given.

  9. Infrastructure needs for waste management

    International Nuclear Information System (INIS)

    Takahashi, M.

    2001-01-01

    National infrastructures are needed to safely and economically manage radioactive wastes. Considerable experience has been accumulated in industrialized countries for predisposal management of radioactive wastes, and legal, regulatory and technical infrastructures are in place. Drawing on this experience, international organizations can assist in transferring this knowledge to developing countries to build their waste management infrastructures. Infrastructure needs for disposal of long lived radioactive waste are more complex, due to the long time scale that must be considered. Challenges and infrastructure needs, particularly for countries developing geologic repositories for disposal of high level wastes, are discussed in this paper. (author)

  10. A Study of Children's Geographic Access to Health Services (Health Care Centers and Clinical Laboratories in Kermanshah City, Iran

    Directory of Open Access Journals (Sweden)

    Sohyla Reshadat

    2018-02-01

    Full Text Available Background Given that the protection of children's health is of special importance due to their special age and physical conditions, the present study aimed to investigate the condition of children's Geographic access to health services (Health Centers and Clinical Laboratories in Kermanshah city, Iran. Materials and Methods: In this applied study, the research approach was descriptive-analytic using quantitative models in Geographic information system (GIS environment. The statistical population was the whole population of young girls aged 0-14 years old in Kermanshah, Iran. Moreover, to evaluate the spatial deployment pattern of health services and the correct and true access of this groupto such services, all data and information were collected through the Iranian Statistics Center and evaluated using the Arc-GIS Software. The latest published population statistics on the Population and Housing Census in 2011 were considered the basis for the analyses. Results: The results of the present study demonstrated that more than 40% and 60% of the young girls aged 0-14 years old in Kermanshah were deprived of proper access to health centers and clinical laboratories, respectively. In terms of the status of children’s access in the Second Scenario (access to health services by vehicles and during 5, 10, and 15 minutes, about 5.53%, 93.1% and 15.1% lacked access to health centers, respectively. In addition, in terms of the status of children’s access to clinical laboratories during 5, 10, and 15 minutes, 17.26%, 65.4% and 51% lacked access to clinical laboratories, respectively. Conclusion: The access of young girls aged 0-14 years old to health services in Kermanshah was undesirable in the access to health services through walking. Additionally, the access of this groupto health services in the access to health services by vehicles was far better than the first one.

  11. Laboratory-based surveillance in the molecular era: the TYPENED model, a joint data-sharing platform for clinical and public health laboratories.

    Science.gov (United States)

    Niesters, H G; Rossen, J W; van der Avoort, H; Baas, D; Benschop, K; Claas, E C; Kroneman, A; van Maarseveen, N; Pas, S; van Pelt, W; Rahamat-Langendoen, J C; Schuurman, R; Vennema, H; Verhoef, L; Wolthers, K; Koopmans, M

    2013-01-24

    Laboratory-based surveillance, one of the pillars of monitoring infectious disease trends, relies on data produced in clinical and/or public health laboratories. Currently, diagnostic laboratories worldwide submit strains or samples to a relatively small number of reference laboratories for characterisation and typing. However, with the introduction of molecular diagnostic methods and sequencing in most of the larger diagnostic and university hospital centres in high-income countries, the distinction between diagnostic and reference/public health laboratory functions has become less clear-cut. Given these developments, new ways of networking and data sharing are needed. Assuming that clinical and public health laboratories may be able to use the same data for their own purposes when sequence-based testing and typing are used, we explored ways to develop a collaborative approach and a jointly owned database (TYPENED) in the Netherlands. The rationale was that sequence data - whether produced to support clinical care or for surveillance -can be aggregated to meet both needs. Here we describe the development of the TYPENED approach and supporting infrastructure, and the implementation of a pilot laboratory network sharing enterovirus sequences and metadata.

  12. Willingness to Use Health Insurance at a Sexually Transmitted Disease Clinic: A Survey of Patients at 21 US Clinics.

    Science.gov (United States)

    Pearson, William S; Cramer, Ryan; Tao, Guoyu; Leichliter, Jami S; Gift, Thomas L; Hoover, Karen W

    2016-08-01

    To survey patients of publicly funded sexually transmitted disease (STD) clinics across the United States about their willingness to use health insurance for their visit. In 2013, we identified STD clinics in 21 US metropolitan statistical areas with the highest rates of chlamydia, gonorrhea, and syphilis according to Centers for Disease Control and Prevention surveillance reports. Patients attending the identified STD clinics completed a total of 4364 surveys (response rate = 86.6%). Nearly half of the insured patients were willing to use their health insurance. Patients covered by government insurance were more likely to be willing to use their health insurance compared with those covered by private insurance (odds ratio [OR] =  3.60; 95% confidence interval [CI] = 2.79, 4.65), and patients covered by their parents' insurance were less likely to be willing to use their insurance compared with those covered by private insurance (OR = 0.72; 95% CI = 0.52, 1.00). Reasons for unwillingness to use insurance were privacy and out-of-pocket cost. Before full implementation of the Affordable Care Act, privacy and cost were barriers to using health insurance for STD services. Barriers to using health insurance for STD services could be reduced through addressing issues of stigma associated with STD care and considering alternative payment sources for STD services.

  13. Ecosystem Health Disorders - changing perspectives in clinical medicine and nutrition.

    Science.gov (United States)

    Wahlqvist, Mark L

    2014-01-01

    The inseparability of people from their ecosystem without biological change is increasingly clear. The discrete species concept is becoming more an approximation as the interconnectedness of all things, animate and inanimate, becomes more apparent. Yet this was evident even to our earliest Homo Sapiens sapiens ancestors as they hunted and gathered from one locality to another and migrated across the globe. During a rather short 150-200,000 years of ancestral history, we have changed the aeons-old planet and our ecology with dubious sustainability. As we have changed the ecosystems of which we are a part, with their opportunities for shelter, rest, ambulation, discourse, food, recreation and their sensory inputs, we have changed our shared biology and our health prospects. The rate of ecosystem change has increased quantitatively and qualitatively and so will that of our health patterns, depending on our resilience and how linear, non-linear or fractal-like the linkage. Our health-associated ecosystem trajectories are uncertain. The interfaces between us and our environment are blurred, but comprise time, biorhythms, prokaryotic organisms, sensory (auditory, visual, tactile, taste and smell), conjoint movement, endocrine with various external hormonal through food and contaminants, the reflection of soil and rock composition in the microbes, plants, insects and animals that we eat (our biogeology) and much more. We have sought ways to optimise our health through highly anthropocentric means, which have proven inadequate. Accumulated ecosystem change may now overwhelm our health. On these accounts, more integrative approaches and partnerships for health care practice are required.

  14. Factor Structure of the WPPSI in Mental Health Clinic Settings.

    Science.gov (United States)

    Haynes, Jack P.; Atkinson, David

    1984-01-01

    Factor-analyzed the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) scores of emotionally disturbed children (N=181). The results suggested that the structure of intelligence for emotionally disturbed children is similar to that for normal children. WPPSI profile analysis that uses subtest scores may be invalid in clinical settings.…

  15. Surrogate end points in clinical research: hazardous to your health.

    Science.gov (United States)

    Grimes, David A; Schulz, Kenneth F

    2005-05-01

    Surrogate end points in clinical research pose real danger. A surrogate end point is an outcome measure, commonly a laboratory test, that substitutes for a clinical event of true importance. Resistance to activated protein C, for example, has been used as a surrogate for venous thrombosis in women using oral contraceptives. Other examples of inappropriate surrogate end points in contraception include the postcoital test instead of pregnancy to evaluate new spermicides, breakage and slippage instead of pregnancy to evaluate condoms, and bone mineral density instead of fracture to assess the safety of depo-medroxyprogesterone acetate. None of these markers captures the effect of the treatment on the true outcome. A valid surrogate end point must both correlate with and accurately predict the outcome of interest. Although many surrogate markers correlate with an outcome, few have been shown to capture the effect of a treatment (for example, oral contraceptives) on the outcome (venous thrombosis). As a result, thousands of useless and misleading reports on surrogate end points litter the medical literature. New drugs have been shown to benefit a surrogate marker, but, paradoxically, triple the risk of death. Thousands of patients have died needlessly because of reliance on invalid surrogate markers. Researchers should avoid surrogate end points unless they have been validated; that requires at least one well done trial using both the surrogate and true outcome. The clinical maxim that "a difference to be a difference must make a difference" applies to research as well. Clinical research should focus on outcomes that matter.

  16. Experiences of health science students during clinical placements at ...

    African Journals Online (AJOL)

    Inadequate supervision and inappropriate behaviours by supervisors were some of the challenges faced. Almost 89% used stress-relieving strategies such as focusing on why they were doing the clinical placement and the importance of successful completion. Ninety-one per cent had never used cannabis/mbanje but 41% ...

  17. Developing a Clinical Approach to Air Pollution and Cardiovascular Health.

    Science.gov (United States)

    Hadley, Michael B; Baumgartner, Jill; Vedanthan, Rajesh

    2018-02-13

    Nearly 3 billion people are exposed to household air pollution emitted from inefficient cooking and heating stoves, and almost the entire global population is exposed to detectable levels of outdoor air pollution from traffic, industry, and other sources. Over 3 million people die annually of ischemic heart disease or stroke attributed to air pollution, more than from traditional cardiac risk factors such as obesity, diabetes mellitus, or smoking. Clinicians have a role to play in reducing the burden of pollution-attributable cardiovascular disease. However, there currently exists no clear clinical approach to this problem. Here, we provide a blueprint for an evidence-based clinical approach to assessing and mitigating cardiovascular risk from exposure to air pollution. We begin with a discussion of the global burden of pollution-attributable cardiovascular disease, including a review of the mechanisms by which particulate matter air pollution leads to cardiovascular outcomes. Next, we offer a simple patient-screening tool using known risk factors for pollution exposure. We then discuss approaches to quantifying air pollution exposures and cardiovascular risk, including the development of risk maps for clinical catchment areas. We review a collection of interventions for household and outdoor air pollution, which clinicians can tailor to patients and populations at risk. Finally, we identify future research needed to quantify pollution exposures and validate clinical interventions. Overall, we demonstrate that clinicians can be empowered to mitigate the global burden of cardiovascular disease attributable to air pollution. © 2018 American Heart Association, Inc.

  18. Competence of maternal and child health clinic workers in detecting ...

    African Journals Online (AJOL)

    Background: The MCH clinic workers in Somalia receive formal and in-service training to perform their professional duties. Their competence in the field was never examined. This study assessed their competencies in detecting malnourished children 5 years and below in Beledweyne. Objective: To assess the competence ...

  19. Adoption of health information technologies by physicians for clinical practice

    DEFF Research Database (Denmark)

    Villalba-Mora, Elena; Casas, Isabel; Lupiañez-Villanueva, Francisco

    2015-01-01

    OBJECTIVES: We investigated the level of adoption of Health Information Technologies (HIT) services, and the factors that influence this, amongst specialised and primary care physicians; in Andalusia, Spain. METHODS: We analysed the physicians' responses to an online survey. First, we performed...... Technologies: Electronic Health Records (EHR), ePrescription and patient management and telemedicine services. Results from an ordered logit model showed that the frequency of use of HIT is associated with the physicians' perceived usefulness. Lack of financing appeared as a common barrier to the adoption...

  20. Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic.

    Science.gov (United States)

    Maslow, Gary R; Banny, Adrienne; Pollock, McLean; Stefureac, Kristen; Rosa, Kendra; Walter, Barbara Keith; Hobbs Knutson, Katherine; Lucas, Joseph; Heilbron, Nicole

    2017-10-01

    An estimated 1 in 5 children in the United States meet criteria for a diagnosable mental disorder, yet fewer than 20% receive mental health services. Unmet need for psychiatric treatment may contribute to patterns of increasing use of the emergency department. This article describes an integrated pediatric evaluation center designed to prevent the need for treatment in emergency settings by increasing access to timely and appropriate care for emergent and critical mental health needs. Preliminary results showed that the center provided rapid access to assessment and treatment services for children and adolescents presenting with a wide range of psychiatric concerns. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Regulation of gas infrastructure expansion

    International Nuclear Information System (INIS)

    De Joode, J.

    2012-01-01

    The topic of this dissertation is the regulation of gas infrastructure expansion in the European Union (EU). While the gas market has been liberalised, the gas infrastructure has largely remained in the regulated domain. However, not necessarily all gas infrastructure facilities - such as gas storage facilities, LNG import terminals and certain gas transmission pipelines - need to be regulated, as there may be scope for competition. In practice, the choice of regulation of gas infrastructure expansion varies among different types of gas infrastructure facilities and across EU Member States. Based on a review of economic literature and on a series of in-depth case studies, this study explains these differences in choices of regulation from differences in policy objectives, differences in local circumstances and differences in the intrinsic characteristics of the infrastructure projects. An important conclusion is that there is potential for a larger role for competition in gas infrastructure expansion.

  2. Growing the Blockchain information infrastructure

    DEFF Research Database (Denmark)

    Jabbar, Karim; Bjørn, Pernille

    2017-01-01

    In this paper, we present ethnographic data that unpacks the everyday work of some of the many infrastructuring agents who contribute to creating, sustaining and growing the Blockchain information infrastructure. We argue that this infrastructuring work takes the form of entrepreneurial actions......, which are self-initiated and primarily directed at sustaining or increasing the initiator’s stake in the emerging information infrastructure. These entrepreneurial actions wrestle against the affordances of the installed base of the Blockchain infrastructure, and take the shape of engaging...... or circumventing activities. These activities purposefully aim at either influencing or working around the enablers and constraints afforded by the Blockchain information infrastructure, as its installed base is gaining inertia. This study contributes to our understanding of the purpose of infrastructuring, seen...

  3. Agile infrastructure monitoring

    International Nuclear Information System (INIS)

    Andrade, P; Ascenso, J; Fedorko, I; Fiorini, B; Paladin, M; Pigueiras, L; Santos, M

    2014-01-01

    At the present time, data centres are facing a massive rise in virtualisation and cloud computing. The Agile Infrastructure (AI) project is working to deliver new solutions to ease the management of CERN data centres. Part of the solution consists in a new 'shared monitoring architecture' which collects and manages monitoring data from all data centre resources. In this article, we present the building blocks of this new monitoring architecture, the different open source technologies selected for each architecture layer, and how we are building a community around this common effort.

  4. Subsea Infrastructure Inspection

    DEFF Research Database (Denmark)

    Mai, Christian; Pedersen, Simon; Hansen, Leif

    2016-01-01

    Due to the increasing energy demands, the offshore energy business has boomed in recent decades. Sub-sea pipeline and power transmission cable installations are commonly applied worldwide. Any potential breakages can cause equipment damage and also damage the environment. The majority...... (S-AUVs) can significantly change the inspections of infrastructure, as these vehicles could be much cheaper to deploy. S-AUVs can potentially conduct faster data collection and provide higher inspection data quality. However, there are still some technical challenges related to: underwater wireless...

  5. CERN Infrastructure Evolution

    CERN Document Server

    Bell, Tim

    2012-01-01

    The CERN Computer Centre is reviewing strategies for optimizing the use of the existing infrastructure in the future, and in the likely scenario that any extension will be remote from CERN, and in the light of the way other large facilities are today being operated. Over the past six months, CERN has been investigating modern and widely-used tools and procedures used for virtualisation, clouds and fabric management in order to reduce operational effort, increase agility and support unattended remote computer centres. This presentation will give the details on the project’s motivations, current status and areas for future investigation.

  6. Infrastructural politics on Facebook

    DEFF Research Database (Denmark)

    Birkbak, Andreas

    If Twitter started as a device for reporting one’s everyday comings and goings, it has in recent years come to be seen also as a resource for understanding and problematizing things like revolutions, disasters and politics (Rogers 2013). In this paper, I raise the question of whether a similar...... broadening of the avenues of possible inquiry could be timely in relation to Facebook. What can we learn from Facebook as a venue for organizing in emergencies or around public issues? In order start answering this question I examine a recent controversy over plans to build a new road-pricing infrastructure...

  7. Fractal actors and infrastructures

    DEFF Research Database (Denmark)

    Bøge, Ask Risom

    2011-01-01

    -network-theory (ANT) into surveillance studies (Ball 2002, Adey 2004, Gad & Lauritsen 2009). In this paper, I further explore the potential of this connection by experimenting with Marilyn Strathern’s concept of the fractal (1991), which has been discussed in newer ANT literature (Law 2002; Law 2004; Jensen 2007). I...... under surveillance. Based on fieldwork conducted in 2008 and 2011 in relation to my Master’s thesis and PhD respectively, I illustrate fractal concepts by describing the acts, actors and infrastructure that make up the ‘DNA surveillance’ conducted by the Danish police....

  8. The prostate health index selectively identifies clinically significant prostate cancer

    NARCIS (Netherlands)

    S. Loeb (Stacy); M.G. Sanda (Martin G.); D.L. Broyles (Dennis L.); S.S. Shin (Sanghyuk S.); C.H. Bangma (Chris); J.T. Wei (John T.); A.W. Partin (Alan W.); G.G. Klee (George); K.M. Slawin (Kevin M.); L.S. Marks (Leonard S.); R.H.N. van Schaik (Ron); D.W. Chan (Daniel); L. Sokoll (Lori); A.B. Cruz (Amabelle B.); I.A. Mizrahi (Isaac A.); W.J. Catalona (William)

    2015-01-01

    textabstractPurpose The Prostate Health Index (phi) is a new test combining total, free and [-2]proPSA into a single score. It was recently approved by the FDA and is now commercially available in the U.S., Europe and Australia. We investigate whether phi improves specificity for detecting

  9. Clinical Perspective Qualitative adolescent health research — focus ...

    African Journals Online (AJOL)

    This paper introduces nine steps that are recommended in conducting focus group discussions in rural communities and gives an example of how they can appropriately and fruitfully be employed in adolescent health behavioural research. The paper also reviewed issues related to methods of data collection, data analysis, ...

  10. Appointment Template Redesign in a Women's Health Clinic Using Clinical Constraints to Improve Service Quality and Efficiency.

    Science.gov (United States)

    Huang, Y; Verduzco, S

    2015-01-01

    Patient wait time is a critical element of access to care that has long been recognized as a major problem in modern outpatient health care delivery systems. It impacts patient and medical staff productivity, stress, quality and efficiency of medical care, as well as health-care cost and availability. This study was conducted in a Women's Health Clinic. The objective was to improve clinic service quality by redesigning patient appointment template using the clinical constraints. The proposed scheduling template consisted of two key elements: the redesign of appointment types and the determination of the length of time slots using defined constraints. The re-classification technique was used for the redesign of appointment visit types to capture service variation for scheduling purposes. Then, the appointment length was determined by incorporating clinic constraints or goals, such as patient wait time, physician idle time, overtime, finish time, lunch hours, when the last appointment was scheduled, and the desired number of appointment slots, to converge the optimal length of appointment slots for each visit type. The redesigned template was implemented and the results indicated a 73% reduction in average patient waiting from the reported 40 to 11 minutes. The patient no-show rate was reduced by 4% from 24% to 20%. The morning section on average finished about 11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was estimated to be about 5 minutes, which can be used for charting/documenting patients. This study provided an alternative method of redesigning appointment scheduling templates using only the clinical constraints rather than the traditional way that required an objective function. This paper also documented the employed methods step by step in a real clinic setting. The implementation results concluded a significant improvement on patient wait time and no-show rate.

  11. What are the effective ways to translate clinical leadership into health care quality improvement?

    Directory of Open Access Journals (Sweden)

    McSherry R

    2016-02-01

    Full Text Available Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks. Keywords: governance

  12. A system architecture for sharing de-identified, research-ready brain scans and health information across clinical imaging centers.

    Science.gov (United States)

    Chervenak, Ann L; van Erp, Theo G M; Kesselman, Carl; D'Arcy, Mike; Sobell, Janet; Keator, David; Dahm, Lisa; Murry, Jim; Law, Meng; Hasso, Anton; Ames, Joseph; Macciardi, Fabio; Potkin, Steven G

    2012-01-01

    Progress in our understanding of brain disorders increasingly relies on the costly collection of large standardized brain magnetic resonance imaging (MRI) data sets. Moreover, the clinical interpretation of brain scans benefits from compare and contrast analyses of scans from patients with similar, and sometimes rare, demographic, diagnostic, and treatment status. A solution to both needs is to acquire standardized, research-ready clinical brain scans and to build the information technology infrastructure to share such scans, along with other pertinent information, across hospitals. This paper describes the design, deployment, and operation of a federated imaging system that captures and shares standardized, de-identified clinical brain images in a federation across multiple institutions. In addition to describing innovative aspects of the system architecture and our initial testing of the deployed infrastructure, we also describe the Standardized Imaging Protocol (SIP) developed for the project and our interactions with the Institutional Review Board (IRB) regarding handling patient data in the federated environment.

  13. Innovation in Rehabilitation Services and Clinical Programs for Health Care

    Directory of Open Access Journals (Sweden)

    Asghar Dadkhah

    2014-06-01

    Full Text Available Rehabilitation program is a critical piece of clinical care strategy in order to accelerate healing and improve quality of life to the fullest extent possible. An innovated program should have 3 inspiring concepts: Seek inspire and Advance. Seeking and evaluating is a breakthrough technology, innovative methodology and emerging trend in the healthcare industry. The program should inspire clinicians to critically evaluate and implement the highest standards of care. Also an innovated program should advance clinical program development to maximize opportunities for first to market positioning and community partnerships. The scope of program can be from psycho-rehabilitation to predictor in addiction (1-3, Cognitive and motor rehabilitation researchers are quite concerned about system wide biases that may impair development of innovative rehabilitation techniques. In this issue ....

  14. Transforming rural health systems through clinical academic leadership: lessons from South Africa.

    Science.gov (United States)

    Doherty, J E; Couper, I D; Campbell, D; Walker, J

    2013-01-01

    Under-resourced and poorly managed rural health systems challenge the achievement of universal health coverage, and require innovative strategies worldwide to attract healthcare staff to rural areas. One such strategy is rural health training programs for health professionals. In addition, clinical leadership (for all categories of health professional) is a recognised prerequisite for substantial improvements in the quality of care in rural settings. Rural health training programs have been slow to develop in low- and middle-income countries (LMICs); and the impact of clinical leadership is under-researched in such settings. A 2012 conference in South Africa, with expert input from South Africa, Canada and Australia, discussed these issues and produced recommendations for change that will also be relevant in other LMICs. The two underpinning principles were that: rural clinical leadership (both academic and non-academic) is essential to developing and expanding rural training programs and improving care in LMICs; and leadership can be learned and should be taught. The three main sets of recommendations focused on supporting local rural clinical academic leaders; training health professionals for leadership roles in rural settings; and advancing the clinical academic leadership agenda through advocacy and research. By adopting the detailed recommendations, South Africa and other LMICs could energise management strategies, improve quality of care in rural settings and impact positively on rural health outcomes.

  15. Preceptors' perspectives of an integrated clinical learning model in a mental health environment.

    Science.gov (United States)

    Boardman, Gayelene; Lawrence, Karen; Polacsek, Meg

    2018-02-14

    Supervised clinical practice is an essential component of undergraduate nursing students' learning and development. In the mental health setting, nursing students traditionally undertake four-week block placements. An integrated clinical learning model, where preceptors mentor students on an individual basis, has been used successfully in the clinical learning environment. This flexible model provides the opportunity for students to work across morning, afternoon, night and weekend shifts. There is a need to improve the evidence base for a flexible model for students undertaking a mental health placement. The aim of this study was to understand preceptors' experience of, and satisfaction with, a mental health integrated clinical learning model. Focus groups were used to elicit the views of preceptors from a mental health service. Findings highlight the advantages and disadvantages of an integrated clinical learning model in the mental health setting. Participants suggested that students may benefit from flexible work arrangements, a variety of experiences and a more realistic experience of working in a mental health service. However, they found it challenging to mentor and evaluate students under this model. Most also agreed that the model impeded students' ability to engage with consumers and develop rapport with staff. The findings indicate the need to develop a placement model that meets the unique needs of the mental health setting. © 2018 Australian College of Mental Health Nurses Inc.

  16. Terrorism and Security Issues Facing the Water Infrastructure Sector

    National Research Council Canada - National Science Library

    Copeland, Claudia; Cody, Betsy

    2005-01-01

    Damage to or destruction of the nation's water supply and water quality infrastructure by terrorist attack could disrupt the delivery of vital human services in this country, threatening public health...

  17. Terrorism and Security Issues Facing the Water Infrastructure Sector

    National Research Council Canada - National Science Library

    Copeland, Claudia; Cody, Betsy A

    2006-01-01

    Damage to or destruction of the nation's water supply and water quality infrastructure by a terrorist attack could disrupt the delivery of vital human services in this country, threaten public health...

  18. Center for Reinventing Aging Infrastructure for Nutrient Management

    Data.gov (United States)

    Federal Laboratory Consortium — The mission of RAINmgt is to achieve sustainable and cost-effective health and environmental outcomes by re-imagining aging coastal urban infrastructure communities....

  19. Health self-perception by dementia family caregivers: sociodemographic and clinical factors

    Directory of Open Access Journals (Sweden)

    Letice Ericeira Valente

    2011-10-01

    Full Text Available Caring for a demented family member has been associated with burden. Studies concerning health self-perception of family caregivers are still scarce. OBJECTIVE: To investigate caregivers perceived health and to look into relationships with patients and caregivers' sociodemographic and clinical data. METHOD: Dyads of dementia outpatients and family caregivers (n=137 were assessed with Mini Mental State Examination, Functional Activities Questionnaire, Neuropsychiatric Inventory and Clinical Dementia Rating. Caregivers answered Sociodemographic Questionnaire, Beck Depression and Anxiety Inventories, Zarit Burden Interview and Maslach Burnout Inventory. RESULTS: Caregivers poor perceived health was associated with emotional exhaustion, burden, depression and anxiety. Logistic regression analyses revealed caregivers' age, anxiety and physical problem as the main predictors of health self-perception. CONCLUSION: Aged family caregivers with anxiety who also report physical problem characterize a group at risk for poor self-perceived health. Evaluation of health self-perception may be useful for designing interventions to improve anxiety and physical health.

  20. Patients' Positive and Negative Responses to Reading Mental Health Clinical Notes Online.

    Science.gov (United States)

    Denneson, Lauren M; Chen, Jason I; Pisciotta, Maura; Tuepker, Anais; Dobscha, Steven K

    2018-05-01

    This study describes responses to OpenNotes, clinical notes available online, among patients receiving mental health care and explores whether responses vary by patient demographic or clinical characteristics. Survey data from 178 veterans receiving mental health treatment at a large Veterans Affairs medical center included patient-reported health self-efficacy, health knowledge, alliance with clinicians, and negative emotional responses after reading OpenNotes. Health care data were extracted from the patient care database. Reading OpenNotes helped many participants feel in control of their health care (49%) and have more trust in clinicians (45%), although a few (8%) frequently felt upset after reading their notes. In multivariate models, posttraumatic stress disorder was associated with increased patient-clinician alliance (p=.046) but also with negative emotional responses (p<.01). Patients receiving mental health care frequently reported benefits from reading OpenNotes, yet some experienced negative responses.

  1. Ethics and the electronic health record in dental school clinics.

    Science.gov (United States)

    Cederberg, Robert A; Valenza, John A

    2012-05-01

    Electronic health records (EHRs) are a major development in the practice of dentistry, and dental schools and dental curricula have benefitted from this technology. Patient data entry, storage, retrieval, transmission, and archiving have been streamlined, and the potential for teledentistry and improvement in epidemiological research is beginning to be realized. However, maintaining patient health information in an electronic form has also changed the environment in dental education, setting up potential ethical dilemmas for students and faculty members. The purpose of this article is to explore some of the ethical issues related to EHRs, the advantages and concerns related to the use of computers in the dental operatory, the impact of the EHR on the doctor-patient relationship, the introduction of web-based EHRs, the link between technology and ethics, and potential solutions for the management of ethical concerns related to EHRs in dental schools.

  2. Nuclear hybrid energy infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Agarwal, Vivek; Tawfik, Magdy S.

    2015-02-01

    The nuclear hybrid energy concept is becoming a reality for the US energy infrastructure where combinations of the various potential energy sources (nuclear, wind, solar, biomass, and so on) are integrated in a hybrid energy system. This paper focuses on challenges facing a hybrid system with a Small Modular Reactor at its core. The core of the paper will discuss efforts required to develop supervisory control center that collects data, supports decision-making, and serves as an information hub for supervisory control center. Such a center will also be a model for integrating future technologies and controls. In addition, advanced operations research, thermal cycle analysis, energy conversion analysis, control engineering, and human factors engineering will be part of the supervisory control center. Nuclear hybrid energy infrastructure would allow operators to optimize the cost of energy production by providing appropriate means of integrating different energy sources. The data needs to be stored, processed, analyzed, trended, and projected at right time to right operator to integrate different energy sources.

  3. A Health Science Process Framework for Comprehensive Clinical Functional Assessment

    Science.gov (United States)

    2014-02-01

    Adaptability Inventory-4 • Rancho Los Amigos Cognitive Scale - Inpatient • Rancho Los Amigos Cognitive Scale - Outpatient • Satisfaction with Life...and policies e580 Health services, systems and policies e585 Education and training services, systems and policies e590 Labour and employment services...consistently reported a high degree of satisfaction with the process, and demonstrated a high level of interest in the exercise. In conjunction with the

  4. A method of teaching clinical problem-solving skills to primary health ...

    African Journals Online (AJOL)

    2009-03-14

    Mar 14, 2009 ... was named the Diploma in Clinical Nursing Science, Health Assessment,. Treatment and ... Seeks relevant and discriminating physical signs to help confirm or refute working .... related to allergies e.g. pets, pollens, smoke.

  5. How to estimate the health benefits of additional research and changing clinical practice

    OpenAIRE

    Claxton, Karl; Griffin, Susan; Koffijberg, Hendrik; McKenna, Claire

    2015-01-01

    A simple extension of standard meta-analysis can provide quantitative estimates of the potential health benefits of further research and of implementing the findings of existing research, which can help inform research prioritisation and efforts to change clinical practice

  6. How to estimate the health benefits of additional research and changing clinical practice

    OpenAIRE

    Claxton, Karl; Griffin, Susan; Koffijberg, Hendrik; McKenna, Claire

    2015-01-01

    A simple extension of standard metaanalysis can provide quantitative estimates of the potential health benefits of further research and of implementing the findings of existing research, which can help inform research prioritisation and efforts to change clinical practice

  7. Addiction Competencies in the 2009 CACREP Clinical Mental Health Counseling Program Standards

    Science.gov (United States)

    Lee, Tiffany K.; Craig, Stephen E.; Fetherson, Bianca T. L.; Simpson, C. Dennis

    2013-01-01

    The Council for Accreditation of Counseling and Related Educational Programs developed addiction competencies for clinical mental health counseling students. This article highlights these competencies, provides an overview of current addiction training, and describes methods to integrate addiction education into curricula.

  8. Evaluating Integrative Cancer Clinics With the Claim Assessment Profile: An Example With the InspireHealth Clinic.

    Science.gov (United States)

    Hilton, Lara; Elfenbaum, Pamela; Jain, Shamini; Sprengel, Meredith; Jonas, Wayne B

    2018-03-01

    The evaluation of freestanding integrative cancer clinical programs is challenging and is rarely done. We have developed an approach called the Claim Assessment Profile (CAP) to identify whether evaluation of a practice is justified, feasible, and likely to provide useful information. A CAP was performed in order to (1) clarify the healing claims at InspireHealth, an integrative oncology treatment program, by defining the most important impacts on its clients; (2) gather information about current research capacity at the clinic; and (3) create a program theory and path model for use in prospective research. This case study design incorporates methods from a variety of rapid assessment approaches. Procedures included site visits to observe the program, structured qualitative interviews with 26 providers and staff, surveys to capture descriptive data about the program, and observational data on program implementation. The InspireHealth program is a well-established, multi-site, thriving integrative oncology clinical practice that focuses on patient support, motivation, and health behavior engagement. It delivers patient-centered care via a standardized treatment protocol. There arehigh levels of research interest from staff and resources by which to conduct research. This analysis provides the primary descriptive and claims clarification of an integrative oncology treatment program, an evaluation readiness report, a detailed logic model explicating program theory, and a clinical outcomes path model for conducting prospective research. Prospective evaluation of this program would be feasible and valuable, adding to our knowledge base of integrative cancer therapies.

  9. What would it take? Stakeholders' views and preferences for implementing a health care manager program in community mental health clinics under health care reform.

    Science.gov (United States)

    Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto

    2015-02-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. © The Author(s) 2014.

  10. Service quality and clinical outcomes: an example from mental health rehabilitation services in England.

    Science.gov (United States)

    Killaspy, Helen; Marston, Louise; Omar, Rumana Z; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, Frank; Craig, Tom; Leavey, Gerard; King, Michael

    2013-01-01

    Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

  11. What are the effective ways to translate clinical leadership into health care quality improvement?

    Science.gov (United States)

    McSherry, Robert; Pearce, Paddy

    2016-01-01

    The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks.

  12. Bronx Teens Connection's Clinic Linkage Model: Connecting Youth to Quality Sexual and Reproductive Health Care.

    Science.gov (United States)

    O'Uhuru, Deborah J; Santiago, Vivian; Murray, Lauren E; Travers, Madeline; Bedell, Jane F

    2017-03-01

    Teen pregnancy and birth rates in the Bronx have been higher than in New York City, representing a longstanding health disparity. The New York City Department of Health and Mental Hygiene implemented a community-wide, multicomponent intervention to reduce unintended teen pregnancy, the Bronx Teens Connection. The Bronx Teens Connection Clinic Linkage Model sought to increase teens' access to and use of sexual and reproductive health care by increasing community partner capacity to link neighborhood clinics to youth-serving organizations, including schools. The Bronx Teens Connection Clinic Linkage Model used needs assessments, delineated the criteria for linkages, clarified roles and responsibilities of partners and staff, established trainings to support the staff engaged in linkage activities, and developed and used process evaluation methods. Early results demonstrated the strength and feasibility of the model over a 4-year period, with 31 linkages developed and maintained, over 11,300 contacts between clinic health educators and teens completed, and increasing adherence to the Centers for Disease Control and Prevention-defined clinical best practices for adolescent reproductive health. For those eight clinics that were able to provide data, there was a 25% increase in the number of teen clients seen over 4 years. There are many factors that relate to an increase in clinic utilization; some of this increase may have been a result of the linkages between schools and clinics. The Bronx Teens Connection Clinic Linkage Model is an explicit framework for clinical and youth-serving organizations seeking to establish formal linkage relationships that may be useful for other municipalities or organizations. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  13. Using the diffusion of innovations theory to assess socio-technical factors in planning the implementation of an electronic health record alert across multiple primary care clinics.

    Science.gov (United States)

    Lin, Ching-Pin; Guirguis-Blake, Janelle; Keppel, Gina A; Dobie, Sharon; Osborn, Justin; Cole, Allison M; Baldwin, Laura-Mae

    2016-04-15

    Adverse drug events (ADEs) are a leading cause of death in the United States. Patients with stage 3 and 4 chronic kidney disease (CKD) are at particular risk because many medications are cleared by the kidneys. Alerts in the electronic health record (EHR) about drug appropriateness and dosing at the time of prescription have been shown to reduce ADEs for patients with stage 3 and 4 CKD in inpatient settings, but more research is needed about the implementation and effectiveness of such alerts in outpatient settings.  To explore factors that might inform the implementation of an electronic drug-disease alert for patients with CKD in primary care clinics, using Rogers' diffusion of innovations theory as an analytic framework. Interviews were conducted with key informants in four diverse clinics using various EHR systems. Interviews were audio recorded and transcribed. results Although all clinics had a current method for calculating glomerular filtration rate (GFR), clinics were heterogeneous with regard to current electronic decision support practices, quality improvement resources, and organizational culture and structure. Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.

  14. Women in Free Clinics: An Assessment of Health-Related Quality of Life for Prevention and Health Education.

    Science.gov (United States)

    Kamimura, Akiko; Myers, Kyl; Ashby, Jeanie; Trinh, Ha Ngoc; Nourian, Maziar M; Reel, Justine J

    2015-08-01

    Understanding gender influences on health-related quality of life (HRQoL) is important to improve women's health when considering diseases that afflict women specifically. The target population of this study was uninsured female free clinic patients who are low socio-economic status and lack access to healthcare resources. Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. While approximately half of free clinic patients are women, there is a paucity of comprehensive health-related data for female free clinic patients. US born English, non-US born English, and Spanish speaking female free clinic patients completed a self-administered survey using a standardized women's HRQoL measure in Fall 2014 (N = 389). Female free clinic patients reported lower HRQoL on all aspects of women's health compared to the US baseline scores, and were less likely to utilize preventive care including: mammograms, Pap smear, and HPV vaccination compared to the US general population. Spanish speakers reported a higher percentage of having had mammography and Pap smear, and heard about HPV compared to the other two groups. US born English speakers reported lower levels of HRQoL in vasomotor symptoms and sleep symptoms, and the lowest percentage of breast health and Pap smear screenings compared to non-US born English and Spanish speakers. Non-US born English speakers reported higher preference for female physician compared to US born English speakers and Spanish speakers. Free clinic female patients need preventative interventions and educational opportunities to improve their overall HRQoL.

  15. Seniors' perspectives on care: a case study of the Alex Seniors health clinic, Calgary.

    Science.gov (United States)

    Shaw, Marta; Rypien, Candace; Drummond, Neil; Harasym, Patricia; Nixon, Lara

    2015-02-25

    Primary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to their stated health needs. Themes reflected participants' perspectives on factors impacting their health needs as vulnerable seniors as well as on the measures that the Alex Seniors Clinic has taken to meet those needs. Factors impacting health included: the nature of their relationships to the physical environment in which they lived, the nature of the relationships they had to others in that environment, and independence and autonomy. Participants identified accessibility, respect and support, and advocacy as the ways in which the clinic was working to address those health needs. While respect and support, as well as advocacy, effectively addressed some patient needs, participants felt that accessibility problems continue to be health-related barriers for clinic patients. This may be due to the fact that issues of accessibility reflect larger community and social problems. Nevertheless, it is only through engaging the patient community for input on clinic approaches that an understanding can be gained of how closely a clinic's care goals are currently aligning with patient perspectives of the care and services they receive.

  16. Radiometric system for clinical applications in the National Health System

    International Nuclear Information System (INIS)

    Mesa Perez, G.; Arteche Diaz, R.; Camejo Batista, A.; Fonfria Bragado, C.

    2013-01-01

    In this paper it is presented the radiometric detection system SRNIC-02, manufactured at CEADEN. The system has three major components: a well-type Nal(TI) scintillator detector with its collimator, a measurement module, and the application software, which allows fixing the working parameters of the system, as well as the acquisition and processing of data. The system has two main applications in the National Health System, one for the quality control in Radiopharmacy, and in RIA/IRMA blood tests. There are 16 systems installed, in 13 provinces of the country up to this date. (Author)

  17. Clinical Trials in Dentistry: A Cross-sectional Analysis of World Health Organization-International Clinical Trial Registry Platform.

    Science.gov (United States)

    Sivaramakrishnan, Gowri; Sridharan, Kannan

    2016-06-01

    Clinical trials are the back bone for evidence-based practice (EBP) and recently EBP has been considered the best source of treatment strategies available. Clinical trial registries serve as databases of clinical trials. As regards to dentistry in specific data on the number of clinical trials and their quality is lacking. Hence, the present study was envisaged. Clinical trials registered in WHO-ICTRP (http://apps.who.int/trialsearch/AdvSearch.aspx) in dental specialties were considered. The details assessed from the collected trials include: Type of sponsors; Health condition; Recruitment status; Study design; randomization, method of randomization and allocation concealment; Single or multi-centric; Retrospective or prospective registration; and Publication status in case of completed studies. A total of 197 trials were identified. Maximum trials were from United States (n = 30) and United Kingdom (n = 38). Seventy six trials were registered in Clinical Trials.gov, 54 from International Standards of Reporting Clinical Trials, 13 each from Australia and New Zealand Trial Register and Iranian Registry of Clinical Trials, 10 from German Clinical Trial Registry, eight each from Brazilian Clinical Trial Registry and Nederland's Trial Register, seven from Japan Clinical Trial Registry, six from Clinical Trial Registry of India and two from Hong Kong Clinical Trial Registry. A total of 78.7% studies were investigator-initiated and 64% were completed while 3% were terminated. Nearly four-fifths of the registered trials (81.7%) were interventional studies of which randomized were the large majority (94.4%) with 63.2% being open label, 20.4% using single blinding technique and 16.4% were doubled blinded. The number, methodology and the characteristics of clinical trials in dentistry have been noted to be poor especially in terms of being conducted multi-centrically, employing blinding and the method for randomization and allocation concealment. More emphasis has to be

  18. Using a plant health system framework to assess plant clinic performance in Uganda

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Matsiko, Frank B.

    2016-01-01

    and expand, new analytical frameworks and tools are needed to identify factors influencing performance of services and systems in specific contexts, and to guide interventions. In this paper we apply a plant health system framework to assess plant clinic performance, using Uganda as a case study...... factors, influenced by basic operational and financial concerns, inter-institutional relations and public sector policies. Overall, there was a fairly close match between the plant health system attributes and plant clinic performance, suggesting that the framework can help explain system functioning....... A comparative study of plant clinics was carried out between July 2010 and September 2011 in the 12 districts where plant clinics were operating at that time. The framework enabled us to organise multiple issues and identify key features that affected the plant clinics. Clinic performance was, among other...

  19. Wiki Activities in Blended Learning for Health Professional Students: Enhancing Critical Thinking and Clinical Reasoning Skills

    Science.gov (United States)

    Snodgrass, Suzanne

    2011-01-01

    Health professionals use critical thinking, a key problem solving skill, for clinical reasoning which is defined as the use of knowledge and reflective inquiry to diagnose a clinical problem. Teaching these skills in traditional settings with growing class sizes is challenging, and students increasingly expect learning that is flexible and…

  20. A decade of the International Journal of Clinical and Health Psychology (2001-2010

    Directory of Open Access Journals (Sweden)

    Izabela Zych

    2011-01-01

    and that the journal has published works of authors from 29 different countries. The highest percentages were found for ex post facto studies, works on test validation and adaptation and adult clinical samples. These results are in agreement with the journal's mission of promoting advancement in clinical and health psychology and show that it is a truly international journal.

  1. Financial Analysis of Behavioral Health Services in a Pediatric Endocrinology Clinic.

    Science.gov (United States)

    Yarbro, Jessica L; Mehlenbeck, Robyn

    2016-09-01

    This article addresses a current need in psychological practice by describing a financially feasible model that moves toward integrated care of behavioral health services in a pediatric endocrinology clinic. Financial information (costs and revenue associated with behavioral health services) for the clinic, over an 18-month period (July 2012 to December 2013), was obtained through the hospital's financial department. The clinic meets one half day per week. Over the 18-month period, the behavioral health services generated a net gain of $3661.45 in the favor of the clinic. We determined that the psychologist and clinical psychology residents needed to see a total of four patients per half-day clinic for the clinic to "break-even." We describe one financially feasible way of integrating behavioral health services into a pediatric endocrinology clinic in the hope that this will be generalizable to other medical settings. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    Science.gov (United States)

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  3. Michigan E85 Infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Sandstrom, Matthew M.

    2012-03-30

    This is the final report for a grant-funded project to financially assist and otherwise provide support to projects that increase E85 infrastructure in Michigan at retail fueling locations. Over the two-year project timeframe, nine E85 and/or flex-fuel pumps were installed around the State of Michigan at locations currently lacking E85 infrastructure. A total of five stations installed the nine pumps, all providing cost share toward the project. By using cost sharing by station partners, the $200,000 provided by the Department of Energy facilitated a total project worth $746,332.85. This project was completed over a two-year timetable (eight quarters). The first quarter of the project focused on project outreach to station owners about the incentive on the installation and/or conversion of E85 compatible fueling equipment including fueling pumps, tanks, and all necessary electrical and plumbing connections. Utilizing Clean Energy Coalition (CEC) extensive knowledge of gasoline/ethanol infrastructure throughout Michigan, CEC strategically placed these pumps in locations to strengthen the broad availability of E85 in Michigan. During the first and second quarters, CEC staff approved projects for funding and secured contracts with station owners; the second through eighth quarters were spent working with fueling station owners to complete projects; the third through eighth quarters included time spent promoting projects; and beginning in the second quarter and running for the duration of the project was spent performing project reporting and evaluation to the US DOE. A total of 9 pumps were installed (four in Elkton, two in Sebewaing, one in East Lansing, one in Howell, and one in Whitmore Lake). At these combined station locations, a total of 192,445 gallons of E85, 10,786 gallons of E50, and 19,159 gallons of E30 were sold in all reporting quarters for 2011. Overall, the project has successfully displaced 162,611 gallons (2,663 barrels) of petroleum, and reduced

  4. Identifying mental health services in clinical genetic settings.

    Science.gov (United States)

    Cappelli, M; Esplen, M J; Wilson, B J; Dorval, M; Bottorff, J L; Ly, M; Carroll, J C; Allanson, J; Humphreys, E; Rayson, D

    2009-10-01

    The purpose of this study was to examine the mental health needs of individuals at risk for adult onset hereditary disorder (AOHD) from the perspective of their genetic service providers, as it is unknown to what extent psychosocial services are required and being met. A mail-out survey was sent to 281 providers on the membership lists of the Canadian Association of Genetic Counsellors and the Canadian College of Medical Geneticists. The survey assessed psychosocial issues that were most commonly observed by geneticists, genetic counsellors (GCs), and nurses as well as availability and types of psychosocial services offered. Of the 129 respondents, half of genetic service providers reported observing signs of depression and anxiety, while 44% noted patients' concerns regarding relationships with family and friends. In terms of providing counselling to patients, as the level of psychological risk increased, confidence in dealing with these issues decreased. In addition, significantly more GCs reported that further training in psychosocial issues would be most beneficial to them if resources were available. As a feature of patient care, it is recommended that gene-based predictive testing include an integrative model of psychosocial services as well as training for genetic service providers in specific areas of AOHD mental health.

  5. The future of infrastructure security :

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Pablo; Turnley, Jessica Glicken; Parrott, Lori K.

    2013-05-01

    Sandia National Laboratories hosted a workshop on the future of infrastructure security on February 27-28, 2013, in Albuquerque, NM. The 17 participants came from backgrounds as diverse as federal policy, the insurance industry, infrastructure management, and technology development. The purpose of the workshop was to surface key issues, identify directions forward, and lay groundwork for cross-sectoral and cross-disciplinary collaborations. The workshop addressed issues such as the problem space (what is included in infrastructure problems?), the general types of threats to infrastructure (such as acute or chronic, system-inherent or exogenously imposed) and definitions of secure and resilient infrastructures. The workshop concluded with a consideration of stakeholders and players in the infrastructure world, and identification of specific activities that could be undertaken by the Department of Homeland Security (DHS) and other players.

  6. School-Based Health Clinics: An Analysis of the Johns Hopkins Study. Research Developments.

    Science.gov (United States)

    Demsko, Tobin W.

    School-based health clinics, adolescent pregnancy prevention programs offering comprehensive health services, represent the latest initiative to reduce the incidence of teenage pregnancy. Researchers at Johns Hopkins University designed and administered a pregnancy prevention program which offered sexuality education and family planning services…

  7. 75 FR 47310 - Solicitation for Nominations for New Clinical Preventive Health Topics To Be Considered for...

    Science.gov (United States)

    2010-08-05

    ... following set of criteria: Public health importance (burden of suffering, potential of preventive service to.../gynecology). c. Public health importance (burden of disease/suffering, potential of preventive service to... accomplishes these goals through scientific research and promotion of improvements in clinical practice...

  8. Use of Clinical Health Information Technology in Nursing Homes: Nursing Home Characteristics and Quality Measures

    Science.gov (United States)

    Spinelli-Moraski, Carla

    2014-01-01

    This study compares quality measures among nursing homes that have adopted different levels of clinical health information technology (HIT) and examines the perceived barriers and benefits of the adoption of electronic health records as reported by Nursing Home Administrators and Directors of Nursing. A cross-sectional survey distributed online to…

  9. Incidence of dog bite injuries and clinical rabies in a tertiary health ...

    African Journals Online (AJOL)

    Background: It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority. This study aimed at determining the incidence of dog bite injuries and clinical rabies in a tertiary health care centre.

  10. Public health nurses perception of clinical leadership in Ireland: narrative descriptions.

    Science.gov (United States)

    Carney, Marie

    2009-05-01

    The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery. Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles. Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery. Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective. Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor. RELEVANCE TO NURSE MANAGERS: Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.

  11. Obstacles to Successful Implementation of eHealth Applications into Clinical Practice.

    Science.gov (United States)

    Voogt, Marianne P; Opmeer, Brent C; Kastelein, Arnoud W; Jaspers, Monique W M; Peute, Linda W

    2018-01-01

    eHealth can improve healthcare worldwide, and scientific research should provide evidence on the efficacy, safety and added value of such interventions. For successful implementation of eHealth interventions into clinical practice, barriers need to be anticipated. We identified seven barriers by interviewing health professionals in the Dutch healthcare system. These barriers covered three topics: financing, human factors and organizational factors. This paper discusses their potential impact on eHealth uptake. Bridging the gap between studies to assess effective eHealth interventions and their value-based implementation in healthcare is much needed.

  12. Flowscapes: Designing infrastructure as landscape

    OpenAIRE

    Nijhuis, S.; Jauslin, D.T.; Van der Hoeven, F.D.

    2015-01-01

    Social, cultural and technological developments of our society are demanding a fundamental review of the planning and design of its landscapes and infrastructures, in particular in relation to environmental issues and sustainability. Transportation, green and water infrastructures are important agents that facilitate processes that shape the built environment and its contemporary landscapes. With movement and flows at the core, these landscape infrastructures facilitate aesthetic, functional,...

  13. Hanford Site Infrastructure Plan

    International Nuclear Information System (INIS)

    1990-01-01

    The Hanford Site Infrastructure Plan (HIP) has been prepared as an overview of the facilities, utilities, systems, and services that support all activities on the Hanford Site. Its purpose is three-fold: to examine in detail the existing condition of the Hanford Site's aging utility systems, transportation systems, Site services and general-purpose facilities; to evaluate the ability of these systems to meet present and forecasted Site missions; to identify maintenance and upgrade projects necessary to ensure continued safe and cost-effective support to Hanford Site programs well into the twenty-first century. The HIP is intended to be a dynamic document that will be updated accordingly as Site activities, conditions, and requirements change. 35 figs., 25 tabs

  14. Energy Transmission and Infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Mathison, Jane

    2012-12-31

    The objective of Energy Transmission and Infrastructure Northern Ohio (OH) was to lay the conceptual and analytical foundation for an energy economy in northern Ohio that will: • improve the efficiency with which energy is used in the residential, commercial, industrial, agricultural, and transportation sectors for Oberlin, Ohio as a district-wide model for Congressional District OH-09; • identify the potential to deploy wind and solar technologies and the most effective configuration for the regional energy system (i.e., the ratio of distributed or centralized power generation); • analyze the potential within the district to utilize farm wastes to produce biofuels; • enhance long-term energy security by identifying ways to deploy local resources and building Ohio-based enterprises; • identify the policy, regulatory, and financial barriers impeding development of a new energy system; and • improve energy infrastructure within Congressional District OH-09. This objective of laying the foundation for a renewable energy system in Ohio was achieved through four primary areas of activity: 1. district-wide energy infrastructure assessments and alternative-energy transmission studies; 2. energy infrastructure improvement projects undertaken by American Municipal Power (AMP) affiliates in the northern Ohio communities of Elmore, Oak Harbor, and Wellington; 3. Oberlin, OH-area energy assessment initiatives; and 4. a district-wide conference held in September 2011 to disseminate year-one findings. The grant supported 17 research studies by leading energy, policy, and financial specialists, including studies on: current energy use in the district and the Oberlin area; regional potential for energy generation from renewable sources such as solar power, wind, and farm-waste; energy and transportation strategies for transitioning the City of Oberlin entirely to renewable resources and considering pedestrians, bicyclists, and public transportation as well as drivers

  15. Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study.

    Science.gov (United States)

    Woods, Susan S; Schwartz, Erin; Tuepker, Anais; Press, Nancy A; Nazi, Kim M; Turvey, Carolyn L; Nichol, W Paul

    2013-03-27

    Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health record, including clinical notes, laboratory tests, and imaging reports. A qualitative study with purposeful sampling sought to examine patients' views and experiences with reading their health records, including their clinical notes, online. Five focus group sessions were conducted with patients and family members who enrolled in the My HealtheVet Pilot at the Portland Veterans Administration Medical Center, Oregon. A total of 30 patients enrolled in the My HealtheVet Pilot, and 6 family members who had accessed and viewed their electronic health records participated in the sessions. Four themes characterized patient experiences with reading the full complement of their health information. Patients felt that seeing their records positively affected communication with providers and the health system, enhanced knowledge of their health and improved self-care, and allowed for greater participation in the quality of their care such as follow-up of abnormal test results or decision-making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits. Patients and their delegates had predominantly positive experiences with health record transparency and the open sharing of notes and test results. Viewing their records appears to empower patients and enhance their contributions to care, calling into question common provider concerns about the effect of full record access on patient well-being. While shared

  16. Infant oral health care: An invaluable clinical intervention

    Directory of Open Access Journals (Sweden)

    Kanika Singh Dhull

    2016-01-01

    Full Text Available Dental assessments and evaluations for children during their 1st year of life have been recommended by the American Academy of Pediatric Dentistry and the American Association of Pediatrics. Early dental intervention evaluates a child's risk status based on parental interviews and oral examinations. These early screenings present an opportunity to educate parents about the medical, dental, and cost benefits of preventive rather than restorative care and may be more effective in reducing early childhood caries than traditional infectious disease models. A comprehensive infant oral care program includes: (1 risk assessments at regularly scheduled dental visits, (2 preventive treatments such as fluoride varnishes or sealants, (3 parental education on the correct methods to clean the baby's mouth, and (4 establishment of dental home and use of anticipatory guidance. The present article highlights the important guidelines of infant oral health care.

  17. Medical image informatics infrastructure design and applications.

    Science.gov (United States)

    Huang, H K; Wong, S T; Pietka, E

    1997-01-01

    Picture archiving and communication systems (PACS) is a system integration of multimodality images and health information systems designed for improving the operation of a radiology department. As it evolves, PACS becomes a hospital image document management system with a voluminous image and related data file repository. A medical image informatics infrastructure can be designed to take advantage of existing data, providing PACS with add-on value for health care service, research, and education. A medical image informatics infrastructure (MIII) consists of the following components: medical images and associated data (including PACS database), image processing, data/knowledge base management, visualization, graphic user interface, communication networking, and application oriented software. This paper describes these components and their logical connection, and illustrates some applications based on the concept of the MIII.

  18. Adolescent postabortion groups: risk reduction in a school-based health clinic.

    Science.gov (United States)

    Daly, Joan Ziegler; Ziegler, Robert; Goldstein, Donna J

    2004-10-01

    A short-term postabortion group for adolescents was developed. Three groups were conducted in an adolescent mental health clinic within an urban high school-based health clinic. The clinical group experiences offered the adolescents an opportunity to integrate the experience of pregnancy and the abortion decision into their lives. At follow up, adolescents who participated in th postabortion counseling group indicated that they chose and used a method of birth control, did not repeat an unplanned pregnancy, and remained in high school.

  19. An ethnography of clinic "noise" in a community-based, promotora-centered mental health intervention.

    Science.gov (United States)

    Getrich, Christina; Heying, Shirley; Willging, Cathleen; Waitzkin, Howard

    2007-07-01

    Community-based health interventions have emerged as a growing focus for anthropological research. The application of ethnographic approaches in clinical practice settings reveals that community-based interventions must grapple with "noise," or unanticipated factors such as patients' own perceptions of illness and treatment, primary care providers' non-adherence to guidelines-based treatment, the social dynamics of the clinic site itself, and incomplete understanding and acceptance of an intervention by a clinic's staff members. Such noise can influence the implementation and quality of treatment. Thus, identifying clinic-based noise is critical in assessments of fidelity to intervention protocols as well as outcomes of community-based interventions. This paper highlights findings from an evaluation of a mental health intervention focusing on the role of promotoras (briefly trained, non-professional community health workers) as mental health practitioners in two urban New Mexico, USA, community health centers. Our research identified three areas of clinic-based noise: the clinics' physical ability to "absorb" the intervention, the challenges of co-worker instability and interpersonal relationships, and balancing extra workplace demands. The findings demonstrate the value of ethnographic approaches in community-based intervention research.

  20. Self-esteem, stress and self-rated health in family planning clinic patients

    Directory of Open Access Journals (Sweden)

    Young Rodney

    2004-06-01

    Full Text Available Abstract Background The independent effects of stress on the health of primary care patients might be different for different types of clinic populations. This study examines these relationships in a low-income female population of patients attending a family planning clinic. Methods This study investigated the relevance of different sources of personal stress and social support to self-rated health, adjusting for mental health, health behavior and demographic characteristics of subjects. Five hundred women who attended family planning clinics were surveyed and 345 completed the form for a response rate of 72 percent. Results Multiple logistic regression analysis revealed that liking oneself was related to good self-rated health (Odds ratio = 7.11, but stress or support from children, parents, friends, churches or spouses were not significant. White non-Hispanic and non-white non-Hispanic respondents had lower odds of reporting good self-rated health than Hispanic respondents (odds ratios were 2.87 and 2.81, respectively. Exercising five or more days per week also was related to good self-rated health. Smoking 20 or more cigarettes per day, and obese III were negatively related to good self-rated health (odds ratios were .19 and .22, respectively with corresponding p-values equal to .0043 and .0332. Conclusions Among younger low-income women, addressing low self-esteem might improve health status.

  1. Private prayer associations with depression, anxiety and other health conditions: an analytical review of clinical studies.

    Science.gov (United States)

    Anderson, James W; Nunnelley, Paige A

    2016-09-01

    To critically analyze appropriate clinical studies to assess the relationship between health conditions and the frequency of private prayer. Private prayer is defined as individuals praying for themselves. Using PubMed and other search engines, we identified over 300 articles reporting relationships between prayer and health conditions. We identified 41 observational clinical studies that evaluated the relationship between private prayer and health conditions. Prayer scores of 5 to 1 were assigned to studies, with 5 being private prayer for health and 1 being prayer in combination with meditation or Bible study. Frequency scores ranged from 3 to 1 with 3 being twice daily or more and 0 when frequency was not assessed. Studies were ranked from 8 to 1 based on the sum of Prayer and Frequency Scores. Twenty-one studies had Prayer-Frequency scores of 5 to 8, indicating that they evaluated private prayer (praying for one's own health) of suitable frequency in association with health conditions. Nine of 11 studies indicated that private prayer was associated with a significantly lower prevalence of depression (P value, prayer in four studies (P value, P prayer (P prayer did not have a significant effect on physical health or blood pressure. The reported observational studies suggest that frequent private prayer is associated with a significant benefit for depression, optimism, coping, and other mental health conditions such as anxiety. Controlled clinical trials are required to critically assess the associations of private prayer and health conditions.

  2. Evaluation of a hand hygiene campaign in outpatient health care clinics.

    Science.gov (United States)

    Kukanich, Kate Stenske; Kaur, Ramandeep; Freeman, Lisa C; Powell, Douglas A

    2013-03-01

    To improve hand hygiene in two outpatient health care clinics through the introduction of a gel sanitizer and an informational poster. In this interventional study, health care workers at two outpatient clinics were observed for frequency of hand hygiene (attempts versus opportunities). Gel sanitizer and informational posters were introduced together as an intervention. Direct observation of the frequency of hand hygiene was performed during baseline, intervention, and follow-up. A poststudy survey of health care workers was also distributed and collected. In both clinics, the frequency of hand hygiene was poor at baseline (11% and 21%) but improved significantly after intervention (36% and 54%) and was maintained through the follow-up period (32% and 51%). Throughout the study, postcontact hand hygiene was observed significantly more often than precontact hand hygiene. In both clinics, health care workers reported a preference for soap and water; yet observations showed that when the intervention made gel sanitizer available, sanitizer use predominated. Fifty percent of the surveyed health care workers considered the introduction of gel sanitizer to be an effective motivating tool for improving hand hygiene. Hand hygiene performance by health care workers in outpatient clinics may be improved through promoting the use of gel sanitizer and using informational posters. Compared with surveys, direct observation by trained observers may provide more accurate information about worker preferences for hand hygiene tools.

  3. National infrastructure maintenance strategy for South Africa

    CSIR Research Space (South Africa)

    Wall, K

    2009-05-01

    Full Text Available Conference, Addis Ababa, Ethiopia, 2009 WATER, SANITATION AND HYGIENE: SUSTAINABLE DEVELOPMENT AND MULTISECTORAL APPROACHES A National Infrastructure Maintenance Strategy for South Africa Kevin Wall, South Africa [OFFICE USE ONLY: REVIEWED...; − effects on human health and economic growth; − lack of effective countermeasures in the event of failure of the service; and − the risk generally to government's growth objectives. Wastewater treatment works are often problematic, as are water...

  4. Infrastructures and Necessary Actions Parallel to Reforms of Medical Service Tariffs to Improve Health System Performance in Iran: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Alireza Jabbari

    2017-09-01

    Conclusion: First, it seems that various issues and aspects related to tariff determination should be considered. Furthermore, some preliminaries should be provided before tariffs' reformation or some actions should be taken in line with that for the success of tariff reformation process. These measures and reformations  are related to the Ministry of Health, insurances, and the government.

  5. Experience from mental health clinics held during medical service camps in Fiji.

    Science.gov (United States)

    Sivakumaran, Hemalatha; George, Kuruvilla; Naker, Gunu; Nadanachandran, Kathir

    2015-12-01

    We aim to describe the experience and findings of mental health clinics held during medical service camps in the rural settings of Fiji. Descriptive data collated at the end of the medical camps across 2011-2014 are used to highlight the main findings. The exposure to mental health assessments and brief interventions at these camps was a validating experience for both individuals and medical students attending the clinics. The most common presentations can be categorised under symptoms of depression, anxiety and relationship problems. The accessibility of mental health support services is a challenge in Fiji. Medical service camps can form an important pathway in promoting mental health awareness, especially amongst the rural communities of Fiji, and a useful platform for medical students to acquire some clinical exposure. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  6. Is it just religious practice? Exploring patients' reasons for choosing a faith-based primary health clinic over their local public sector primary health clinic.

    Science.gov (United States)

    Porter, James D; Bresick, Graham

    2017-06-29

    Person-centred, re-engineered primary health care (PHC) is a national and global priority. Faith-based health care is a significant provider of PHC in sub-Saharan Africa, but there is limited published data on the reasons for patient choice of faith-based health care, particularly in South Africa. The primary objective was to determine and explore the reasons for patient choice of a faith-based primary care clinic over their local public sector primary care clinic, and secondarily to determine to what extent these reasons were influenced by demography. The study was conducted at Jubilee Health Centre (JHC), a faith-based primary care clinic attached to Jubilee Community Church in Cape Town, South Africa. Focus groups, using the nominal group technique, were conducted with JHC patients and used to generate ranked reasons for attending the clinic. These were collated into the top 15 reasons and incorporated into a quantitative questionnaire which was administered to adult patients attending JHC. A total of 164 patients were surveyed (a response rate of 92.4%) of which 68.3% were female and 57.9% from the Democratic Republic of the Congo (DRC). Of patients surveyed, 98.2% chose to attend JHC because 'the staff treat me with respect', 96.3% because 'the staff are friendly' and 96.3% because 'the staff take time to listen to me'. The reason 'it is a Christian clinic' was chosen by 70.1% of patients. 'The staff speak my home language' was given as a reason by 61.1% of DRC patients and 37.1% of South African patients. 'The clinic is close to me' was chosen by 66.6% of Muslims and 40.8% of Christians. Patients chose to attend JHC (a faith-based primary care clinic) because of the quality of care received. They emphasised the staff-patient relationship and patient-centredness rather than the clinic's religious practices (prayer with patients). These findings may be important in informing efforts to improve public sector primary care.

  7. Federated querying architecture with clinical & translational health IT application.

    Science.gov (United States)

    Livne, Oren E; Schultz, N Dustin; Narus, Scott P

    2011-10-01

    We present a software architecture that federates data from multiple heterogeneous health informatics data sources owned by multiple organizations. The architecture builds upon state-of-the-art open-source Java and XML frameworks in innovative ways. It consists of (a) federated query engine, which manages federated queries and result set aggregation via a patient identification service; and (b) data source facades, which translate the physical data models into a common model on-the-fly and handle large result set streaming. System modules are connected via reusable Apache Camel integration routes and deployed to an OSGi enterprise service bus. We present an application of our architecture that allows users to construct queries via the i2b2 web front-end, and federates patient data from the University of Utah Enterprise Data Warehouse and the Utah Population database. Our system can be easily adopted, extended and integrated with existing SOA Healthcare and HL7 frameworks such as i2b2 and caGrid.

  8. The gut microbiota and host health: a new clinical frontier.

    Science.gov (United States)

    Marchesi, Julian R; Adams, David H; Fava, Francesca; Hermes, Gerben D A; Hirschfield, Gideon M; Hold, Georgina; Quraishi, Mohammed Nabil; Kinross, James; Smidt, Hauke; Tuohy, Kieran M; Thomas, Linda V; Zoetendal, Erwin G; Hart, Ailsa

    2016-02-01

    Over the last 10-15 years, our understanding of the composition and functions of the human gut microbiota has increased exponentially. To a large extent, this has been due to new 'omic' technologies that have facilitated large-scale analysis of the genetic and metabolic profile of this microbial community, revealing it to be comparable in influence to a new organ in the body and offering the possibility of a new route for therapeutic intervention. Moreover, it might be more accurate to think of it like an immune system: a collection of cells that work in unison with the host and that can promote health but sometimes initiate disease. This review gives an update on the current knowledge in the area of gut disorders, in particular metabolic syndrome and obesity-related disease, liver disease, IBD and colorectal cancer. The potential of manipulating the gut microbiota in these disorders is assessed, with an examination of the latest and most relevant evidence relating to antibiotics, probiotics, prebiotics, polyphenols and faecal microbiota transplantation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. Intentional Modelling: A Process for Clinical Leadership Development in Mental Health Nursing.

    Science.gov (United States)

    Ennis, Gary; Happell, Brenda; Reid-Searl, Kerry

    2016-05-01

    Clinical leadership is becoming more relevant for nurses, as the positive impact that it can have on the quality of care and outcomes for consumers is better understood and more clearly articulated in the literature. As clinical leadership continues to become more relevant, the need to gain an understanding of how clinical leaders in nursing develop will become increasingly important. While the attributes associated with effective clinical leadership are recognized in current literature there remains a paucity of research on how clinical leaders develop these attributes. This study utilized a grounded theory methodology to generate new insights into the experiences of peer identified clinical leaders in mental health nursing and the process of developing clinical leadership skills. Participants in this study were nurses working in a mental health setting who were identified as clinical leaders by their peers as opposed to identifying them by their role or organizational position. A process of intentional modeling emerged as the substantive theory identified in this study. Intentional modeling was described by participants in this study as a process that enabled them to purposefully identify models that assisted them in developing the characteristics of effective clinical leaders as well as allowing them to model these characteristics to others. Reflection on practice is an important contributor to intentional modelling. Intentional modelling could be developed as a framework for promoting knowledge and skill development in the area of clinical leadership.

  10. Towards integration of health economics into medical education and clinical practice in Saudi Arabia.

    Science.gov (United States)

    Da'ar, Omar B; Al Shehri, Ali M

    2015-04-01

    In an era of expanding health sectors and rising costs, doctors are expected to have a working knowledge of health economics to better use resources and improve outcomes and quality of health care. This article recognizes the dearth of knowledge and application of economic analyses in medical education and clinical practice in Saudi Arabia. In particular, it highlights the desirability of knowledge of health economics in ensuring certain competencies in medical education and the rationale for inviting doctors to apply knowledge of economics in Saudi Arabia. In addition, the article discusses challenges that hinder integrating health economics into clinical practice. Furthermore, the article typifies some of the important economic phenomena that physicians need to discern. Besides, the article provides implications for incorporating economic analysis into medical education and clinical practice in Saudi Arabia. Finally, the article concludes by demonstrating how health economics can enhance doctors' knowledge and recommends the country to move towards integrating health economics into medical education and clinical practice for best practice.

  11. Impact and user satisfaction of a clinical information portal embedded in an electronic health record.

    Science.gov (United States)

    Tannery, Nancy H; Epstein, Barbara A; Wessel, Charles B; Yarger, Frances; LaDue, John; Klem, Mary Lou

    2011-01-01

    In 2008, a clinical information tool was developed and embedded in the electronic health record system of an academic medical center. In 2009, the initial information tool, Clinical-e, was superseded by a portal called Clinical Focus, with a single search box enabling a federated search of selected online information resources. To measure the usefulness and impact of Clinical Focus, a survey was used to gather feedback about users' experience with this clinical resource. The survey determined what type of clinicians were using this tool and assessed user satisfaction and perceived impact on patient care decision making. Initial survey results suggest the majority of respondents found Clinical Focus easy to navigate, the content easy to read, and the retrieved information relevant and complete. The majority would recommend Clinical Focus to their colleagues. Results indicate that this tool is a promising area for future development.

  12. Feasibility of Automatic Extraction of Electronic Health Data to Evaluate a Status Epilepticus Clinical Protocol.

    Science.gov (United States)

    Hafeez, Baria; Paolicchi, Juliann; Pon, Steven; Howell, Joy D; Grinspan, Zachary M

    2016-05-01

    Status epilepticus is a common neurologic emergency in children. Pediatric medical centers often develop protocols to standardize care. Widespread adoption of electronic health records by hospitals affords the opportunity for clinicians to rapidly, and electronically evaluate protocol adherence. We reviewed the clinical data of a small sample of 7 children with status epilepticus, in order to (1) qualitatively determine the feasibility of automated data extraction and (2) demonstrate a timeline-style visualization of each patient's first 24 hours of care. Qualitatively, our observations indicate that most clinical data are well labeled in structured fields within the electronic health record, though some important information, particularly electroencephalography (EEG) data, may require manual abstraction. We conclude that a visualization that clarifies a patient's clinical course can be automatically created using the patient's electronic clinical data, supplemented with some manually abstracted data. Future work could use this timeline to evaluate adherence to status epilepticus clinical protocols. © The Author(s) 2015.

  13. "The family is the clinic, the community is the hospital": community mental health in Timor-Leste.

    Science.gov (United States)

    Hawkins, Zoe; Tilman, Teofilo

    2011-07-01

    This paper describes the history and recent development of mental health services in Timor-Leste, a small developing country recovering from conflict. Challenges to effective service delivery are discussed as well as plans for future development. Timor-Leste's mental health service began just over a decade ago. Unlike many other low and middle income countries where hospital-based services predominate, the mental health model in Timor-Leste is entirely community based. However, challenges to effective mental health care delivery are similar to most developing countries and include a lack of sufficient financial resources, human resources, and mental health infrastructure. Addressing these issues successfully requires political will, a greater prioritization of mental health services, close coordination between stakeholders, as well as developments in the area of education, training and infrastructure. Greater understanding and education about the links between mental and physical health would benefit the overall health of the population, and integration of these respective policies may prove a successful method of more equitably redistributing finances and resources.

  14. Acupuncture and women's health: an overview of the role of acupuncture and its clinical management in women's reproductive health

    Directory of Open Access Journals (Sweden)

    Cochrane S

    2014-03-01

    Full Text Available Suzanne Cochrane,1 Caroline A Smith,2 Alphia Possamai-Inesedy,3 Alan Bensoussan2 1School of Science and Health, 2Centre for Complementary Medicine Research, 3School of Social Sciences and Psychology, University of Western Sydney – Campbelltown Campus, Penrith, NSW, Australia Background: Acupuncture and other modalities of Chinese/East Asian medicine have been used to treat women's health for many centuries. Gynecology specialties focus particularly on menstrual and reproductive disorders. Both the adoption of the use of acupuncture outside Asia, and the incorporation of scientific analysis in Asia have challenged biomedical conceptions of what can be achieved with this treatment method. The scale of research activity in relation to acupuncture and women's health has increased over the last 20 years. Objective: This review aims to explore the research evidence in relation to acupuncture use for women's reproductive disorders, focusing on both clinical findings and experimental research on acupuncture's mechanisms of action in relation to women's health. Methods: A narrative literature search was undertaken using searches of electronic databases and manual searches of journals and textbooks. The search included all literature published prior to June 2013. The literature was assessed as to the nature of the study it was reporting and findings synthesized into a commentary. Results: For acupuncture's mechanism of action the search resulted in 114 relevant documents; in relation to clinical reports on the use of acupuncture for women's health 204 documents were found and assessed. Conclusion: There is preliminary data indicating acupuncture may improve menstrual health and coping for women experiencing delays falling pregnant. There is experimental data showing that acupuncture can influence female reproductive functioning, although the actual mechanisms involved are not yet clarified. Further well-conducted clinical research would benefit our

  15. Digital health promotion in sexual health clinics: results of a feasibility trial of the Men’s Safer Sex website

    Directory of Open Access Journals (Sweden)

    Julia V Bailey

    2015-10-01

    The best way to assess the impact of the MenSS website was by recording STI diagnoses from clinical records. Response rates for the online questionnaire were poor despite offers of incentives. There were many challenges to conducting an online trial of a sexual health website including ethical committee concerns about email content, poor reliability of trial-related software, balancing data protection and security protocols against ease of access for participants, barriers to patient access to IT in NHS clinics, and trying to ensure that participants engage with a digital intervention for long enough. Whilst digital interventions have great potential for health promotion, we encountered significant obstacles to online research, and to implementation of an IDI in an NHS clinical setting.

  16. Health status in routine clinical practice: validity of the clinical COPD questionnaire at the individual patient level

    Directory of Open Access Journals (Sweden)

    de Vos Barbara

    2010-11-01

    Full Text Available Abstract Background There is a growing interest to use health status or disease control questionnaires in routine clinical practice. However, the validity of most questionnaires is established using techniques developed for group level validation. This study examines a new method, using patient interviews, to validate a short health status questionnaire, the Clinical COPD Questionnaire (CCQ, at the individual patient level. Methods Patients with COPD who visited an outpatient clinic completed the CCQ before the consultation, and the specialist physician completed it after the consultation. After the consultation all patients had a semi-structured in-depth interview. The patients' CCQ scores were compared with those of the treating clinician, and with mean scores from 5 clinicians from a pool of 20 who scored the CCQ after reading the transcript of the in-depth interviews only. Agreement was assessed using Lin's concordance correlation coefficient (CCC, and Blant and Altman plots. Interviews with patients with low agreement were reviewed for possible explanations. Results A total of 44 COPD patients (32 male, mean age 66 years, FEV1 45% of predicted participated. Agreement between the patients' CCQ scores and those of the treating clinicians (CCC = 0.87 and the mean score of the reviewing clinicians (CCC = 0.86 was very high. No systematic error was detected. No explanation for individuals with low agreement was found. Conclusion The validity of the CCQ on the individual patient level, as assessed by these methods, is good. Individual health status assessment with the CCQ is therefore sufficiently accurate to be used in routine clinical practice.

  17. Implications of Nursing Clinical Practice to The Student’s Spiritual Health

    Directory of Open Access Journals (Sweden)

    Bhandesa Asthadi Mahendra

    2018-01-01

    Full Text Available This study aimed to clarify the implications of Nursing Clinical Practice (PLKK to the spiritual health of STIKES Bali students. This study employed purposive sampling method to determine the number of respondents. To conduct this study, the fourth grade of nursing students were recruited as the sample with total number 136 respondents. A questionnaire about spirituality from World Health Organization (WHO was used in this study as the instrument. In addition, the data were analysed by using quantitative descriptive technique. The result showed that 50.0% of students had a very good spiritual health, 42.6% had good spiritual health, 6.6% had moderate spiritual health, and 0.7 % had poor spiritual health. It can be interpreted that spiritual health of nursing students of STIKES Bali is good after conducting Nursing Clinical Practice. Thus, this study can be concluded that Nursing Clinical Practice has implication to the ability of students to love themselves and others meaningfully as the evidence of students’ spiritual health.

  18. Socioeconomic and clinical factors associated with caregivers' perceptions of children's oral health in Brazil.

    Science.gov (United States)

    Piovesan, Chaiana; Marquezan, Macela; Kramer, Paulo F; Bönecker, Marcelo; Ardenghi, Thiago M

    2011-06-01

    We assessed how socioeconomic and clinical conditions could affect parents' perceptions of their child's oral health. A cross-sectional study was conducted in a sample of 455 children, aged 1-5 years, representative of Santa Maria, a southern city in Brazil. Participants were randomly selected among children attending a National Day of Children's Vaccination. Clinical examinations provided information on the prevalence of caries, dental trauma, and occlusion. The caregivers' perception of children's oral health and socioeconomic status were assessed by means of a questionnaire. A Poisson regression model using robust variance (Prevalence ratio: PR; 95% CI, P ≤ 0.05) was performed to assess the association between the predictor variables and outcomes. Parents were more likely to rate their child's oral health as 'poor' if the former earned a lower income and the latter had anterior open bite and dental caries. Parents of black children with anterior open bite and dental caries were more likely to rate their child's oral health as 'worse than that of other children'. Clinical and socioeconomic characteristics are significantly associated with parents' perceptions of their child's oral health. Understanding the caregivers' perceptions of children's oral health and the factors affecting this could be useful in the planning of public health polices, in view of the inequity in the oral health pattern. © 2010 John Wiley & Sons A/S.

  19. Assessment of volatile organic compounds and particulate matter in a dental clinic and health risks to clinic personnel.

    Science.gov (United States)

    Hong, Yu-Jue; Huang, Yen-Ching; Lee, I-Long; Chiang, Che-Ming; Lin, Chitsan; Jeng, Hueiwang Anna

    2015-01-01

    This study was conducted to assess (1) levels of volatile organic compounds (VOCs) and particulate matter (PM) in a dental clinic in southern Taiwan and (2) dental care personnel's health risks associated with due to chronic exposure to VOCs. An automatic, continuous sampling system and a multi-gas monitor were employed to quantify the air pollutants, along with environmental comfort factors, including temperature, CO2, and relative humidity at six sampling sites in the clinic over eight days. Specific VOC compounds were identified and their concentrations were quantified. Both non-carcinogenic and carcinogenic VOC compounds were assessed based on the US Environmental Protection Agency's Principles of Health Risk Assessment in terms of whether those indoor air pollutants increased health risks for the full-time dental care professionals at the clinic. Increased levels of VOCs were recorded during business hours and exceeded limits recommended by the Taiwan Environmental Protection Agency. A total of 68 VOC compounds were identified in the study area. Methylene methacrylate (2.8 ppm) and acetone (0.176 ppm) were the only two non-carcinogenic compounds that posed increased risks for human health, yielding hazard indexes of 16.4 and 4.1, respectively. None of the carcinogenic compounds increased cancer risk. All detected PM10 levels ranged from 20 to 150 μg/m(3), which met the Taiwan EPA and international limits. The average PM10 level during business hours was significantly higher than that during non-business hours (P = 0.04). Improved ventilation capacity in the air conditioning system was recommended to reduce VOCs and PM levels.

  20. Cyberwarfare on the Electricity Infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Murarka, N.; Ramesh, V.C.

    2000-03-20

    The report analyzes the possibility of cyberwarfare on the electricity infrastructure. The ongoing deregulation of the electricity industry makes the power grid all the more vulnerable to cyber attacks. The report models the power system information system components, models potential threats and protective measures. It therefore offers a framework for infrastructure protection.