The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Human Space Flight Missions

Science.gov (United States)

Kerstman, Eric L.; Minard, Charles; FreiredeCarvalho, Mary H.; Walton, Marlei E.; Myers, Jerry G., Jr.; Saile, Lynn G.; Lopez, Vilma; Butler, Douglas J.; Johnson-Throop, Kathy A.

2011-01-01

This slide presentation reviews the Integrated Medical Model (IMM) and its use as a risk assessment and decision support tool for human space flight missions. The IMM is an integrated, quantified, evidence-based decision support tool useful to NASA crew health and mission planners. It is intended to assist in optimizing crew health, safety and mission success within the constraints of the space flight environment for in-flight operations. It uses ISS data to assist in planning for the Exploration Program and it is not intended to assist in post flight research. The IMM was used to update Probability Risk Assessment (PRA) for the purpose of updating forecasts for the conditions requiring evacuation (EVAC) or Loss of Crew Life (LOC) for the ISS. The IMM validation approach includes comparison with actual events and involves both qualitative and quantitaive approaches. The results of these comparisons are reviewed. Another use of the IMM is to optimize the medical kits taking into consideration the specific mission and the crew profile. An example of the use of the IMM to optimize the medical kits is reviewed.

The Integrated Medical Model - Optimizing In-flight Space Medical Systems to Reduce Crew Health Risk and Mission Impacts

Science.gov (United States)

Kerstman, Eric; Walton, Marlei; Minard, Charles; Saile, Lynn; Myers, Jerry; Butler, Doug; Lyengar, Sriram; Fitts, Mary; Johnson-Throop, Kathy

2009-01-01

The Integrated Medical Model (IMM) is a decision support tool used by medical system planners and designers as they prepare for exploration planning activities of the Constellation program (CxP). IMM provides an evidence-based approach to help optimize the allocation of in-flight medical resources for a specified level of risk within spacecraft operational constraints. Eighty medical conditions and associated resources are represented in IMM. Nine conditions are due to Space Adaptation Syndrome. The IMM helps answer fundamental medical mission planning questions such as What medical conditions can be expected? What type and quantity of medical resources are most likely to be used?", and "What is the probability of crew death or evacuation due to medical events?" For a specified mission and crew profile, the IMM effectively characterizes the sequence of events that could potentially occur should a medical condition happen. The mathematical relationships among mission and crew attributes, medical conditions and incidence data, in-flight medical resources, potential clinical and crew health end states are established to generate end state probabilities. A Monte Carlo computational method is used to determine the probable outcomes and requires up to 25,000 mission trials to reach convergence. For each mission trial, the pharmaceuticals and supplies required to diagnose and treat prevalent medical conditions are tracked and decremented. The uncertainty of patient response to treatment is bounded via a best-case, worst-case, untreated case algorithm. A Crew Health Index (CHI) metric, developed to account for functional impairment due to a medical condition, provides a quantified measure of risk and enables risk comparisons across mission scenarios. The use of historical in-flight medical data, terrestrial surrogate data as appropriate, and space medicine subject matter expertise has enabled the development of a probabilistic, stochastic decision support tool capable of

Individual medication management system (IMMS) as a proposition of obeying the doctor's recommendation with pharmacist cooperation.

Science.gov (United States)

Waszyk-Nowaczyk, Magdalena; Simon, Marek; Matwij, Karolina

2012-01-01

The pharmacist is an expert with the knowledge of drugs, who has a possibility to follow the patient's individual pharmacotherapy, which is the basis of the pharmaceutical care programme. The implementation of the Individual Medication Management System (IMMS) may be one of the proposals which will enable an analysis of the course of pharmacotherapy and elimination of drug problems, which are the chief goals of pharmaceutical care. In order to determine community pharmacy patients' degree of interest in the IMMS and to evaluate the degree of patients' discipline concerning the application of doctors' recommendations they were given an anonymous questionnaire. The research was done from August 2009 to May 2010 on a sample of 179 people selected at random. They were patients of community pharmacies in Poznań, where 70% were women and 30% were men, all of them aged between 20 and 85 years. The individual age groups were: 20-40 years--27.0%, 41-50 years--10.8%, 51-64 years--43.6%, 65 years or more--18.6%. The patients' education was as follows: primary--4.7%, vocational--8.0%, secondary--31.0%, incomplete university--12.0% and university--44.3%. The chi2 and Fisher-Freeman-Halton tests were used for statistical analysis of the results. Each time the level of statistical significance was assumed at p system. However, it was mostly women and respondents with university education that were the most interested in it. More than 50% of the patients aged 20-40 years and those aged over 65 years indicate the purposefulness of the systems. It is mainly the group aged 20-40 years that confirms facilitation in following the doctor's recommendations (p = 0.02). The respondents indicated their interest and confirmed the purposefulness of the IMMS mainly due to the fact that it helps to avoid drug-related problems resulting from omitting doses and helps to keep the dosage time and frequency in a long-term therapy. The research confirms the fact that individualized therapy will

High Radiation Resistance IMM Solar Cell

Science.gov (United States)

Pan, Noren

2015-01-01

Due to high launch costs, weight reduction is a key driver for the development of new solar cell technologies suitable for space applications. This project is developing a unique triple-junction inverted metamorphic multijunction (IMM) technology that enables the manufacture of very lightweight, low-cost InGaAsP-based multijunction solar cells. This IMM technology consists of indium (In) and phosphorous (P) solar cell active materials, which are designed to improve the radiation-resistant properties of the triple-junction solar cell while maintaining high efficiency. The intrinsic radiation hardness of InP materials makes them of great interest for building solar cells suitable for deployment in harsh radiation environments, such as medium Earth orbit and missions to the outer planets. NASA Glenn's recently developed epitaxial lift-off (ELO) process also will be applied to this new structure, which will enable the fabrication of the IMM structure without the substrate.

Sleep Disruption Medical Intervention Forecasting (SDMIF) Module for the Integrated Medical Model

Science.gov (United States)

Lewandowski, Beth; Brooker, John; Mallis, Melissa; Hursh, Steve; Caldwell, Lynn; Myers, Jerry

2011-01-01

The NASA Integrated Medical Model (IMM) assesses the risk, including likelihood and impact of occurrence, of all credible in-flight medical conditions. Fatigue due to sleep disruption is a condition that could lead to operational errors, potentially resulting in loss of mission or crew. Pharmacological consumables are mitigation strategies used to manage the risks associated with sleep deficits. The likelihood of medical intervention due to sleep disruption was estimated with a well validated sleep model and a Monte Carlo computer simulation in an effort to optimize the quantity of consumables. METHODS: The key components of the model are the mission parameter program, the calculation of sleep intensity and the diagnosis and decision module. The mission parameter program was used to create simulated daily sleep/wake schedules for an ISS increment. The hypothetical schedules included critical events such as dockings and extravehicular activities and included actual sleep time and sleep quality. The schedules were used as inputs to the Sleep, Activity, Fatigue and Task Effectiveness (SAFTE) Model (IBR Inc., Baltimore MD), which calculated sleep intensity. Sleep data from an ISS study was used to relate calculated sleep intensity to the probability of sleep medication use, using a generalized linear model for binomial regression. A human yes/no decision process using a binomial random number was also factored into sleep medication use probability. RESULTS: These probability calculations were repeated 5000 times resulting in an estimate of the most likely amount of sleep aids used during an ISS mission and a 95% confidence interval. CONCLUSIONS: These results were transferred to the parent IMM for further weighting and integration with other medical conditions, to help inform operational decisions. This model is a potential planning tool for ensuring adequate sleep during sleep disrupted periods of a mission.

Nonlinear Filtering with IMM Algorithm for Ultra-Tight GPS/INS Integration

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Dah-Jing Jwo

2013-05-01

Full Text Available Abstract This paper conducts a performance evaluation for the ultra-tight integration of a Global positioning system (GPS and an inertial navigation system (INS, using nonlinear filtering approaches with an interacting multiple model (IMM algorithm. An ultra-tight GPS/INS architecture involves the integration of in-phase and quadrature components from the correlator of a GPS receiver with INS data. An unscented Kalman filter (UKF, which employs a set of sigma points by deterministic sampling, avoids the error caused by linearization as in an extended Kalman filter (EKF. Based on the filter structural adaptation for describing various dynamic behaviours, the IMM nonlinear filtering provides an alternative for designing the adaptive filter in the ultra-tight GPS/INS integration. The use of IMM enables tuning of an appropriate value for the process of noise covariance so as to maintain good estimation accuracy and tracking capability. Two examples are provided to illustrate the effectiveness of the design and demonstrate the effective improvement in navigation estimation accuracy. A performance comparison among various filtering methods for ultra-tight integration of GPS and INS is also presented. The IMM based nonlinear filtering approach demonstrates the effectiveness of the algorithm for improved positioning performance.

A Cubature-Principle-Assisted IMM-Adaptive UKF Algorithm for Maneuvering Target Tracking Caused by Sensor Faults

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Huan Zhou

2017-09-01

Full Text Available Aimed at solving the problem of decreased filtering precision while maneuvering target tracking caused by non-Gaussian distribution and sensor faults, we developed an efficient interacting multiple model-unscented Kalman filter (IMM-UKF algorithm. By dividing the IMM-UKF into two links, the algorithm introduces the cubature principle to approximate the probability density of the random variable, after the interaction, by considering the external link of IMM-UKF, which constitutes the cubature-principle-assisted IMM method (CPIMM for solving the non-Gaussian problem, and leads to an adaptive matrix to balance the contribution of the state. The algorithm provides filtering solutions by considering the internal link of IMM-UKF, which is called a new adaptive UKF algorithm (NAUKF to address sensor faults. The proposed CPIMM-NAUKF is evaluated in a numerical simulation and two practical experiments including one navigation experiment and one maneuvering target tracking experiment. The simulation and experiment results show that the proposed CPIMM-NAUKF has greater filtering precision and faster convergence than the existing IMM-UKF. The proposed algorithm achieves a very good tracking performance, and will be effective and applicable in the field of maneuvering target tracking.

Integration of an Evidence Base into a Probabilistic Risk Assessment Model. The Integrated Medical Model Database: An Organized Evidence Base for Assessing In-Flight Crew Health Risk and System Design

Science.gov (United States)

Saile, Lynn; Lopez, Vilma; Bickham, Grandin; FreiredeCarvalho, Mary; Kerstman, Eric; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

2011-01-01

This slide presentation reviews the Integrated Medical Model (IMM) database, which is an organized evidence base for assessing in-flight crew health risk. The database is a relational database accessible to many people. The database quantifies the model inputs by a ranking based on the highest value of the data as Level of Evidence (LOE) and the quality of evidence (QOE) score that provides an assessment of the evidence base for each medical condition. The IMM evidence base has already been able to provide invaluable information for designers, and for other uses.

Comparison of two polymer-based immunohistochemical detection systems: ENVISION+ and ImmPRESS.

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Ramos-Vara, José A; Miller, Margaret A

2006-11-01

The non-specific background reaction produced in avidin-biotin-based immunohistochemistry, particularly after harsh antigen retrieval procedures, has promoted the use of non-avidin-biotin systems, yet there are few reports comparing the performance of non-avidin-biotin, polymer-based methods. In this study we compare two of these methods, ENVISION+trade mark and ImmPRESS, in animal tissues. We examined the immunoreactivity of 18 antigens in formalin-fixed, paraffin-embedded tissues. Antigens were located in the cytoplasmic membrane (CD11d, CD18 and CD79a), cytoplasm (calretinin, COX-1, COX-2, Glut-1, HepPar 1, KIT, Melan A, tryptase and uroplakin III) or nucleus (MUM-1, PGP 9.5 and thyroid transcription factor 1). We also evaluated three infectious agents (Aspergillus, calicivirus and West Nile virus). The staining with ENVISION+ or ImmPRESS was performed simultaneously for each antigen. The intensity of the reaction and background staining were scored. ImmPRESS yielded similar or higher reaction intensity than ENVISION+trade mark in 16/18 antigens. ImmPRESS produced abundant background with the other two antigens (calretinin and COX-2), which hindered interpretation of the specific reaction. The cost of ImmPRESS was 25% lower than for ENVISION+trade mark. Based on these results, ImmPRESS is a good polymer-based detection system for routine immunohistochemistry.

Thin Flexible IMM Solar Array, Phase I

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National Aeronautics and Space Administration — Inverted Metamorphic (IMM) solar cells have achieved high efficiency at very low mass, but integration of the thin crystalline photovoltaic device into a flexible...

High Precision Atomic Mass Measurements: Tests of CVC and IMME

International Nuclear Information System (INIS)

Eronen, Tommi

2011-01-01

Atomic mass is one of the key ingredients in testing the Conserved Vector Current (CVC) hypothesis and Isobaric Mass Multiplet Equation (IMME). With JYFLTRAP Penning trap installation at the University of Jyvaeskylae, Finland, several atomic massses related to these studies have been measured. The performed atomic mass measurements for CVC tests cover almost all the nuclei that are relevant for these studies. To test IMME, masses in two isobaric mass chains (A = 23 and A = 32) have been determined.

High Precision Atomic Mass Measurements: Tests of CVC and IMME

Energy Technology Data Exchange (ETDEWEB)

Eronen, Tommi [Department of Physics, University of Jyvaeskylae, FI-40014 University of Jyvaeskylae (Finland); Collaboration: JYFLTRAP Collaboration

2011-11-30

Atomic mass is one of the key ingredients in testing the Conserved Vector Current (CVC) hypothesis and Isobaric Mass Multiplet Equation (IMME). With JYFLTRAP Penning trap installation at the University of Jyvaeskylae, Finland, several atomic massses related to these studies have been measured. The performed atomic mass measurements for CVC tests cover almost all the nuclei that are relevant for these studies. To test IMME, masses in two isobaric mass chains (A = 23 and A = 32) have been determined.

IMM-H007, a new therapeutic candidate for nonalcoholic fatty liver disease, improves hepatic steatosis in hamsters fed a high-fat diet.

Science.gov (United States)

Shi, Huijie; Wang, Qingchun; Yang, Liu; Xie, Shouxia; Zhu, Haibo

2017-09-01

Nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease in humans, is characterized by the accumulation of triacylglycerols (TGs) in hepatocytes. We tested whether 2',3',5'-tri-acetyl-N6-(3-hydroxylaniline) adenosine (IMM-H007) can eliminate hepatic steatosis in hamsters fed a high-fat diet (HFD), as a model of NAFLD. Compared with HFD-only controls, IMM-H007 treatment significantly lowered serum levels of TG, total cholesterol, and free fatty acids (FFAs) in hamsters fed the HFD, with a prominent decrease in levels of serum transaminases and fasting insulin, without affecting fasting glucose levels. Moreover, 1 H-MRI and histopathological analyses revealed that hepatic lipid accumulation and fibrosis were improved by IMM-H007 treatment. These changes were accompanied by improvement of insulin resistance and oxidative stress, and attenuation of inflammation. IMM-H007 reduced expression of proteins involved in uptake of hepatic fatty acids and lipogenesis, and increased very low density lipoprotein secretion and expression of proteins responsible for fatty acid oxidation and autophagy. In studies in vivo , IMM-H007 inhibited fatty acid import into hepatocytes and liver lipogenesis, and concomitantly stimulated fatty acid oxidation, autophagy, and export of hepatic lipids. These data suggest that IMM-H007 resolves hepatic steatosis in HFD-fed hamsters by the regulation of lipid metabolism. Thus, IMM-H007 has therapeutic potential for NAFLD.

The Immunology Database and Analysis Portal (ImmPort)

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U.S. Department of Health & Human Services — The ImmPort system serves as a long-term, sustainable archive of immunology research data generated by investigators mainly funded through the NIAID/DAIT. The core...

Immucillins ImmA and ImmH Are Effective and Non-toxic in the Treatment of Experimental Visceral Leishmaniasis.

Directory of Open Access Journals (Sweden)

Elisangela Oliveira Freitas

2015-12-01

Full Text Available Immucillins ImmA (IA, ImmH (IH and SerMe-ImmH (SMIH are synthetic deazapurine nucleoside analogues that inhibit Leishmania (L. infantum chagasi and Leishmania (L. amazonensis multiplication in vitro without macrophage toxicity. Immucillins are compared to the Glucantime standard drug in the chemotherapy of Leishmania (L. infantum chagasi infection in mice and hamsters. These agents are tested for toxicity and immune system response.BALB/c mice were infected with 107 amastigotes, treated with IA, IH, SMIH or Glucantime (2.5mg/kg/day and monitored for clinical variables, parasite load, antibody levels and splenocyte IFN-γ, TNF-α, and IL-10 expression. Cytokines and CD4+, CD8+ and CD19+ lymphocyte frequencies were assessed in uninfected controls and in response to immucillins. Urea, creatinine, GOT and GPT levels were monitored in sera. Anti-Leishmania-specific IgG1 antibodies (anti-NH36 increased in untreated animals. IgG2a response, high levels of IFN-γ, TNF-α and lower levels of IL-10 were detected in mice treated with the immucillins and Glucantime. Immucillins permitted normal weight gain, prevented hepato-splenomegaly and cleared the parasite infection (85-89% without renal and hepatic toxicity. Immucillins promoted 35% lower secretion of IFN-γ in uninfected controls than in infected mice. IA and IH increased the CD4+ T and CD19+ B cell frequencies. SMIH increased only the proportion of CD-19 B cells. IA and IH also cured infected hamsters with lower toxicity than Glucantime.Immucillins IA, IH and SMIH were effective in treating leishmaniasis in mice. In hamsters, IA and IH were also effective. The highest therapeutic efficacy was obtained with IA, possibly due to its induction of a TH1 immune response. Low immucillin doses were required and showed no toxicity. Our results disclose the potential use of IA and IH in the therapy of visceral leishmaniasis.

Lightweight IMM Multi-Junction Photovoltaic Flexible Blanket Assembly, Phase II

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National Aeronautics and Space Administration — DSS's recently completed successful NASA SBIR Phase 1 program has established a TRL 3/4 classification for an innovative IMM PV Integrated Modular Blanket Assembly...

An IMM-Aided ZUPT Methodology for an INS/DVL Integrated Navigation System.

Science.gov (United States)

Yao, Yiqing; Xu, Xiaosu; Xu, Xiang

2017-09-05

Inertial navigation system (INS)/Doppler velocity log (DVL) integration is the most common navigation solution for underwater vehicles. Due to the complex underwater environment, the velocity information provided by DVL always contains some errors. To improve navigation accuracy, zero velocity update (ZUPT) technology is considered, which is an effective algorithm for land vehicles to mitigate the navigation error during the pure INS mode. However, in contrast to ground vehicles, the ZUPT solution cannot be used directly for underwater vehicles because of the existence of the water current. In order to leverage the strengths of the ZUPT method and the INS/DVL solution, an interactive multiple model (IMM)-aided ZUPT methodology for the INS/DVL-integrated underwater navigation system is proposed. Both the INS/DVL and INS/ZUPT models are constructed and operated in parallel, with weights calculated according to their innovations and innovation covariance matrices. Simulations are conducted to evaluate the proposed algorithm. The results indicate that the IMM-aided ZUPT solution outperforms both the INS/DVL solution and the INS/ZUPT solution in the underwater environment, which can properly distinguish between the ZUPT and non-ZUPT conditions. In addition, during DVL outage, the effectiveness of the proposed algorithm is also verified.

Alleviation of insulin resistance and liver damage by oral administration of Imm124-E is mediated by increased Tregs and associated with increased serum GLP-1 and adiponectin: results of a phase I/II clinical trial in NASH

Directory of Open Access Journals (Sweden)

Mizrahi M

2012-12-01

Full Text Available Meir Mizrahi,1 Yehudit Shabat,1 Ami Ben Ya'acov,1 Gadi Lalazar,1 Tomer Adar,1 Victor Wong,2 Brian Muller,2 Grant Rawlin,2 Yaron Ilan11Liver Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel; 2Immuron Limited, North Melbourne, AustraliaBackground: Nonalcoholic steatohepatitis (NASH is considered to be part of the nonalcoholic fatty liver disorders and its incidence is increasing. Imm124-E (Immuron Ltd, Melbourne, Australia, containing hyperimmune bovine colostrum, has been shown to exert an immunomodulatory effect and to alleviate target organ damage in animal models of NASH. The aim of our study was to determine the safety and efficacy of oral administration of Imm124-E to patients with insulin resistance and NASH.Methods: In an open-label trial, ten patients with biopsy-proven NASH and insulin resistance were orally treated with Imm124-E for 30 days.Results: Oral administration of Imm124-E was safe, and no side effects were noted. Alleviation of insulin resistance was reflected by significantly improved hemoglobin A1c (HbA1c values in all ten treated patients. For between five and eight responders, the following effects were noted: a decrease in fasting glucose levels; improved oral glucose tolerance test (OGGT and homeostatic model assessment insulin resistance (HOMA scores; and alleviation in lipid profile. These effects were accompanied by increased serum levels of glucagon-like peptide 1 (GLP-1, adiponectin and T regulatory cells.Conclusion: Hyperimmune colostrum alleviates NASH.Keywords: NASH, anti-LPS, diabetes, adipokines, regulatory T cells

Validation of the Instructional Materials Motivation Survey (IMMS) in a self-directed instructional setting aimed at working with technology

NARCIS (Netherlands)

Loorbach, N.R.; Peters, O.; Karreman, Joyce; Steehouder, M.F.

2015-01-01

The ARCS Model of Motivational Design has been used myriad times to design motivational instructions that focus on attention, relevance, confidence and satisfaction in order to motivate students. The Instructional Materials Motivation Survey (IMMS) is a 36-item situational measure of people's

Architecture for Integrated Medical Model Dynamic Probabilistic Risk Assessment

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Jaworske, D. A.; Myers, J. G.; Goodenow, D.; Young, M.; Arellano, J. D.

2016-01-01

Probabilistic Risk Assessment (PRA) is a modeling tool used to predict potential outcomes of a complex system based on a statistical understanding of many initiating events. Utilizing a Monte Carlo method, thousands of instances of the model are considered and outcomes are collected. PRA is considered static, utilizing probabilities alone to calculate outcomes. Dynamic Probabilistic Risk Assessment (dPRA) is an advanced concept where modeling predicts the outcomes of a complex system based not only on the probabilities of many initiating events, but also on a progression of dependencies brought about by progressing down a time line. Events are placed in a single time line, adding each event to a queue, as managed by a planner. Progression down the time line is guided by rules, as managed by a scheduler. The recently developed Integrated Medical Model (IMM) summarizes astronaut health as governed by the probabilities of medical events and mitigation strategies. Managing the software architecture process provides a systematic means of creating, documenting, and communicating a software design early in the development process. The software architecture process begins with establishing requirements and the design is then derived from the requirements.

Characterization and mapping of a novel light-dependent lesion mimic mutant Imm6 in rice （Oryza sativa L.）

Institute of Scientific and Technical Information of China (English)

XIAO Gui-qing[1,2; ZHANG Hal-wen[3; LU Xiang-yang[1,2; HUANG Rong-feng[3

2015-01-01

A novel rice lesion mimic mutant （LMM） was isolated from an ethane methyl sulfonate （EMS）-induced 02428 mutant bank. The mutant, tentatively designated as Imm6, develops necrotic lesions in the whole growth period along with changes in several important agronomic traits. We found that the initiation of the lesions was induced by light and cell death occurred in Imm6 accompanied with accumulation of reactive oxygen species （ROS）. The lower chlorophyll content, soluble protein content and superoxide dismutase （SOD） activity, the higher malondialdehyde （MDA） content were detected in Imm6 than in the wild type （WT）. Moreover, the observation by transmission electronic microscope （TEM） demonstrated that some organelles were damaged and the stroma lamella of chloroplast was irregular and loose in mesophyll cell of Imm6. In addition, Imm6 was more resistant than WT to rice blast fungus Magnaporthe grisea infection, which was consistent with increased expression of four genes involved in the defense-related reaction. Genetic analysis showed that mutant trait of Imm6 is inherited as a monogenic recessive nuclear gene located on the long arm of chromosome 6. Using simple sequence repeat （SSR） markers, the target gene was finally delimited to an interval of 80.8 kb between markers MM2359 and MM2370, containing 7 annotated genes. Taken together, our results provide the information to identify a new gene involved in rice lesion mimic, which will be helpful in clarifying the mechanism of cell death and disease resistance in rice.

Integrated MRSA-Management (IMM with prolonged decolonization treatment after hospital discharge is effective: a single centre, non-randomised open-label trial

Directory of Open Access Journals (Sweden)

Bernhard Jahn

2016-06-01

Full Text Available Abstract Background Guidelines for the control of hospital-acquired MRSA include decolonization measures to end MRSA carrier status in colonized and infected patients. Successful decolonization typically requires up to 22 days of treatment, which is longer than the average hospital length of stay (LOS. Incomplete decolonization is therefore common, with long-term MRSA carriage as a consequence. To overcome this, we developed an integrated MRSA Management (IMM by extending MRSA decolonization to the outpatient and domestic setting. The protocol makes use of polyhexanide-based products, in view of reported qac-mediated resistance to chlorhexidine in S. aureus and MRSA. Methods This is a prospective, single centre, controlled, non-randomized, open-label study to evaluate the efficiency of the IMM concept. The outcome of guideline-approved decolonization during hospital stay only (control group; n = 201 was compared to the outcome following IMM treatment whereby decolonization was continued after discharge in the domestic setting or in a long-term care facility (study group; n = 99. As a secondary outcome, the effect of MRSA-status of skin alterations was assessed. Results The overall decolonization rate was 47 % in the IMM patient group compared to 12 % in the control group (p  0.05. For patients with skin alterations (e.g. wounds and entry sites, decolonization success was 50 % if the skin alterations were MRSA-negative at baseline, compared to 22 % success for patients entering the study with MRSA-positive skin alterations (p < 0.01. Conclusions The IMM strategy offers an MRSA decolonization protocol that is feasible in the domestic setting and is equally effective compared with inpatient decolonization treatment when hospital LOS is long enough to complete the treatment. Moreover, for patients with average LOS, decolonization rates obtained with IMM are significantly higher than for in-hospital treatment. IMM is a promising

Estimated Probability of Traumatic Abdominal Injury During an International Space Station Mission

Science.gov (United States)

Lewandowski, Beth E.; Brooker, John E.; Weavr, Aaron S.; Myers, Jerry G., Jr.; McRae, Michael P.

2013-01-01

The Integrated Medical Model (IMM) is a decision support tool that is useful to spaceflight mission planners and medical system designers when assessing risks and optimizing medical systems. The IMM project maintains a database of medical conditions that could occur during a spaceflight. The IMM project is in the process of assigning an incidence rate, the associated functional impairment, and a best and a worst case end state for each condition. The purpose of this work was to develop the IMM Abdominal Injury Module (AIM). The AIM calculates an incidence rate of traumatic abdominal injury per person-year of spaceflight on the International Space Station (ISS). The AIM was built so that the probability of traumatic abdominal injury during one year on ISS could be predicted. This result will be incorporated into the IMM Abdominal Injury Clinical Finding Form and used within the parent IMM model.

Can We Trust Computational Modeling for Medical Applications?

Science.gov (United States)

Mulugeta, Lealem; Walton, Marlei; Nelson, Emily; Myers, Jerry

2015-01-01

Operations in extreme environments such as spaceflight pose human health risks that are currently not well understood and potentially unanticipated. In addition, there are limited clinical and research data to inform development and implementation of therapeutics for these unique health risks. In this light, NASA's Human Research Program (HRP) is leveraging biomedical computational models and simulations (M&S) to help inform, predict, assess and mitigate spaceflight health and performance risks, and enhance countermeasure development. To ensure that these M&S can be applied with confidence to the space environment, it is imperative to incorporate a rigorous verification, validation and credibility assessment (VV&C) processes to ensure that the computational tools are sufficiently reliable to answer questions within their intended use domain. In this presentation, we will discuss how NASA's Integrated Medical Model (IMM) and Digital Astronaut Project (DAP) have successfully adapted NASA's Standard for Models and Simulations, NASA-STD-7009 (7009) to achieve this goal. These VV&C methods are also being leveraged by organization such as the Food and Drug Administration (FDA), National Institute of Health (NIH) and the American Society of Mechanical Engineers (ASME) to establish new M&S VV&C standards and guidelines for healthcare applications. Similarly, we hope to provide some insight to the greater aerospace medicine community on how to develop and implement M&S with sufficient confidence to augment medical research and operations.

Estimating the Need for Medical Intervention due to Sleep Disruption on the International Space Station

Science.gov (United States)

Myers, Jerry G.; Lewandowski, Beth E.; Brooker, John E.; Hurst, S. R.; Mallis, Melissa M.; Caldwell, J. Lynn

2008-01-01

During ISS and shuttle missions, difficulties with sleep affect more than half of all US crews. Mitigation strategies to help astronauts cope with the challenges of disrupted sleep patterns can negatively impact both mission planning and vehicle design. The methods for addressing known detrimental impacts for some mission scenarios may have a substantial impact on vehicle specific consumable mass or volume or on the mission timeline. As part of the Integrated Medical Model (IMM) task, NASA Glenn Research Center is leading the development of a Monte Carlo based forecasting tool designed to determine the consumables required to address risks related to sleep disruption. The model currently focuses on the International Space Station and uses an algorithm that assembles representative mission schedules and feeds this into a well validated model that predicts relative levels of performance, and need for sleep (SAFTE Model, IBR Inc). Correlation of the resulting output to self-diagnosed needs for hypnotics, stimulants, and other pharmaceutical countermeasures, allows prediction of pharmaceutical use and the uncertainty of the specified prediction. This paper outlines a conceptual model for determining a rate of pharmaceutical utilization that can be used in the IMM model for comparison and optimization of mitigation methods with respect to all other significant medical needs and interventions.

Roux-en-Y Gastric Bypass versus Intensive Medical Management for the Control of Type 2 Diabetes, Hypertension and Hyperlipidemia: An International, Multicenter, Randomized Trial

Science.gov (United States)

Ikramuddin, Sayeed; Korner, Judith; Lee, Wei-Jei; Connett, John E.; Inabnet, William B.; Billington, Charles B.; Thomas, Avis J.; Leslie, Daniel B.; Chong, Keong; Jeffery, Robert W.; Ahmed, Leaque; Vella, Adrian; Chuang, Lee-Ming; Bessler, Marc; Sarr, Michael G.; Swain, James M.; Laqua, Patricia; Jensen, Michael D.; Bantle, John P.

2014-01-01

Context Guideline directed care for diabetes calls for control of glycemia, blood pressure and cholesterol (composite goal). Most patients treated medically do not reach this goal. Objective Determine the efficacy and safety of Roux-en-Y gastric bypass (RYGB) added to lifestyle modification and intensive medical management (LS/IMM) to achieve control of all 3 endpoints. Design Two-arm unblinded randomized clinical trial with 120 participants. The primary endpoint of the composite outcome was assessed at 12 months. The study began in April 2008 and completed one year follow-up in all participants in December 2012. Setting Four academic teaching hospitals in the U.S. and Taiwan, involving five operating surgeons. Participants Inclusion criteria for the Diabetes Surgery Study (DSS) included HbA1c ≥ 8.0%, BMI 30.0-39.9 kg/m2, diagnosis and treatment of type 2 diabetes for at least six months, and stimulated C peptide > 1.0 ng/ml. Interventions All patients received lifestyle intervention modeled after the Look AHEAD study. Medications for hyperglycemia, hypertension, and dyslipidemia were prescribed according to protocol. RYGB techniques were standardized. Main Outcome Measure Attainment of a composite goal: HbA1c < 7.0%, LDL-C < 100 mg/dl, and SBP < 130 mmHg. Results One hundred and twenty participants were randomized with equal probability into LS/IMM or RYGB (60 in each group). Baseline characteristics were similar between groups. Mean BMI was 34.6 kg/m2 (95% CI 29.2 to 40.8 kg/m2) with 71 (59%; 95% CI 50% to 68%) participants having BMI < 35 kg/m2, and mean HbA1c was 9.6% (95% CI 9.4% to 9.8%). At 12 months the followup rate was 95%, and 11 (19%) in the LS/IMM group and 28 (49%) in the RYGB group achieved the primary endpoint (OR = 4.8, 95% CI 1.9 to 11.6). RYGB participants required 3.1 fewer medications than LS/IMM (4.8 versus 1.7, 95% CI -3.6 to -2.3). Weight loss was 7.9% LS/IMM vs. 26.1% RYGB (difference 18.2% 95% CI 14.2% to 20.7%). Regression analyses

Integration of Evidence Base into a Probabilistic Risk Assessment

Science.gov (United States)

Saile, Lyn; Lopez, Vilma; Bickham, Grandin; Kerstman, Eric; FreiredeCarvalho, Mary; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

2011-01-01

INTRODUCTION: A probabilistic decision support model such as the Integrated Medical Model (IMM) utilizes an immense amount of input data that necessitates a systematic, integrated approach for data collection, and management. As a result of this approach, IMM is able to forecasts medical events, resource utilization and crew health during space flight. METHODS: Inflight data is the most desirable input for the Integrated Medical Model. Non-attributable inflight data is collected from the Lifetime Surveillance for Astronaut Health study as well as the engineers, flight surgeons, and astronauts themselves. When inflight data is unavailable cohort studies, other models and Bayesian analyses are used, in addition to subject matters experts input on occasion. To determine the quality of evidence of a medical condition, the data source is categorized and assigned a level of evidence from 1-5; the highest level is one. The collected data reside and are managed in a relational SQL database with a web-based interface for data entry and review. The database is also capable of interfacing with outside applications which expands capabilities within the database itself. Via the public interface, customers can access a formatted Clinical Findings Form (CLiFF) that outlines the model input and evidence base for each medical condition. Changes to the database are tracked using a documented Configuration Management process. DISSCUSSION: This strategic approach provides a comprehensive data management plan for IMM. The IMM Database s structure and architecture has proven to support additional usages. As seen by the resources utilization across medical conditions analysis. In addition, the IMM Database s web-based interface provides a user-friendly format for customers to browse and download the clinical information for medical conditions. It is this type of functionality that will provide Exploratory Medicine Capabilities the evidence base for their medical condition list

Measuring motivational characteristics of courses: applying Keller's instructional materials motivation survey to a web-based course.

Science.gov (United States)

Cook, David A; Beckman, Thomas J; Thomas, Kris G; Thompson, Warren G

2009-11-01

The Instructional Materials Motivation Survey (IMMS) purports to assess the motivational characteristics of instructional materials or courses using the Attention, Relevance, Confidence, and Satisfaction (ARCS) model of motivation. The IMMS has received little use or study in medical education. The authors sought to evaluate the validity of IMMS scores and compare scores between standard and adaptive Web-based learning modules. During the 2005-2006 academic year, 124 internal medicine residents at the Mayo School of Graduate Medical Education (Rochester, Minnesota) were asked to complete the IMMS for two Web-based learning modules. Participants were randomly assigned to use one module that adapted to their prior knowledge of the topic, and one module using a nonadaptive design. IMMS internal structure was evaluated using Cronbach alpha and interdimension score correlations. Relations to other variables were explored through correlation with global module satisfaction and regression with knowledge scores. Of the 124 eligible participants, 79 (64%) completed the IMMS at least once. Cronbach alpha was >or=0.75 for scores from all IMMS dimensions. Interdimension score correlations ranged 0.40 to 0.80, whereas correlations between IMMS scores and global satisfaction ratings ranged 0.40 to 0.63 (Por=.07). IMMS scores were similar between module designs (on a five-point scale, differences ranged from 0.0 to 0.15, P>or=.33). These limited data generally support the validity of IMMS scores. Adaptive and standard Web-based instructional designs were similarly motivating. Cautious use and further study of the IMMS are warranted.

Re-measurement of $^{32}$Ar to test the IMME

CERN Multimedia

The Isobaric Multiplet Mass Equation (IMME) has been subject to extensive studies in the low-mass region. Especially at the A = 32 quintet, the predicted quadratic form could not be confirmed, possible explanations being the insufficient accuracy of input parameters or higher-order interactions within the nucleon. For this quintet, the uncertainty on the mass-excess values of four of the five T = 2 multiplet members is extremely low: 0.6 keV for $^{32}$Cl, 0.3 keV for $^{32}$S, 0.2 keV for $^{32}$P, and 0.7 keV for $^{32}$Si. In the case of $^{32}$Ar, however, the uncertainty is as large as 1.8 keV. State-of-the-art high-precision Penning-trap mass spectrometry makes it possible to decrease this uncertainty. We propose to remeasure the mass of $^{32}$Ar at the Penning-trap mass spectrometer ISOLTRAP thus decreasing the uncertainty by a factor of 3-5. The proposed measurement is part of an experimental collaboration with JYFLTRAP, where the remaining masses of the T = 2 isospin quintet at A = 32 will be remeas...

Problems In Indoor Mapping and Modelling

Science.gov (United States)

Zlatanova, S.; Sithole, G.; Nakagawa, M.; Zhu, Q.

2013-11-01

Research in support of indoor mapping and modelling (IMM) has been active for over thirty years. This research has come in the form of As-Built surveys, Data structuring, Visualisation techniques, Navigation models and so forth. Much of this research is founded on advancements in photogrammetry, computer vision and image analysis, computer graphics, robotics, laser scanning and many others. While IMM used to be the privy of engineers, planners, consultants, contractors, and designers, this is no longer the case as commercial enterprises and individuals are also beginning to apply indoor models in their business process and applications. There are three main reasons for this. Firstly, the last two decades have seen greater use of spatial information by enterprises and the public. Secondly, IMM has been complimented by advancements in mobile computing and internet communications, making it easier than ever to access and interact with spatial information. Thirdly, indoor modelling has been advanced geometrically and semantically, opening doors for developing user-oriented, context-aware applications. This reshaping of the public's attitude and expectations with regards to spatial information has realised new applications and spurred demand for indoor models and the tools to use them. This paper examines the present state of IMM and considers the research areas that deserve attention in the future. In particular the paper considers problems in IMM that are relevant to commercial enterprises and the general public, groups this paper expects will emerge as the greatest users IMM. The subject of indoor modelling and mapping is discussed here in terms of Acquisitions and Sensors, Data Structures and Modelling, Visualisation, Applications, Legal Issues and Standards. Problems are discussed in terms of those that exist and those that are emerging. Existing problems are those that are currently being researched. Emerging problems are those problems or demands that are

Polyfunctional response by ImmTAC (IMCgp100) redirected CD8+ and CD4+ T cells.

Science.gov (United States)

Boudousquie, Caroline; Bossi, Giovanna; Hurst, Jacob M; Rygiel, Karolina A; Jakobsen, Bent K; Hassan, Namir J

2017-11-01

The success of immune system-based cancer therapies depends on a broad immune response engaging a range of effector cells and mechanisms. Immune mobilizing monoclonal T cell receptors (TCRs) against cancer (ImmTAC™ molecules: fusion proteins consisting of a soluble, affinity enhanced TCR and an anti-CD3 scFv antibody) were previously shown to redirect CD8 + and CD4 + T cells against tumours. Here we present evidence that IMCgp100 (ImmTAC recognizing a peptide derived from the melanoma-specific protein, gp100, presented by HLA-A*0201) efficiently redirects and activates effector and memory cells from both CD8 + and CD4 + repertoires. Using isolated subpopulations of T cells, we find that both terminally differentiated and effector memory CD8 + T cells redirected by IMCgp100 are potent killers of melanoma cells. Furthermore, CD4 + effector memory T cells elicit potent cytotoxic activity leading to melanoma cell killing upon redirection by IMCgp100. The majority of T cell subsets belonging to both the CD8 + and CD4 + repertoires secrete key pro-inflammatory cytokines (tumour necrosis factor-α, interferon-γ, interleukin-6) and chemokines (macrophage inflammatory protein-1α-β, interferon-γ-inducible protein-10, monocyte chemoattractant protein-1). At an individual cell level, IMCgp100-redirected T cells display a polyfunctional phenotype, which is a hallmark of a potent anti-cancer response. This study demonstrates that IMCgp100 induces broad immune responses that extend beyond the induction of CD8 + T cell-mediated cytotoxicity. These findings are of particular importance because IMCgp100 is currently undergoing clinical trials as a single agent or in combination with check point inhibitors for patients with malignant melanoma. © 2017 The Authors. Immunology Published by John Wiley & Sons Ltd.

Probabilistic Modeling of the Renal Stone Formation Module

Science.gov (United States)

Best, Lauren M.; Myers, Jerry G.; Goodenow, Debra A.; McRae, Michael P.; Jackson, Travis C.

2013-01-01

The Integrated Medical Model (IMM) is a probabilistic tool, used in mission planning decision making and medical systems risk assessments. The IMM project maintains a database of over 80 medical conditions that could occur during a spaceflight, documenting an incidence rate and end case scenarios for each. In some cases, where observational data are insufficient to adequately define the inflight medical risk, the IMM utilizes external probabilistic modules to model and estimate the event likelihoods. One such medical event of interest is an unpassed renal stone. Due to a high salt diet and high concentrations of calcium in the blood (due to bone depletion caused by unloading in the microgravity environment) astronauts are at a considerable elevated risk for developing renal calculi (nephrolithiasis) while in space. Lack of observed incidences of nephrolithiasis has led HRP to initiate the development of the Renal Stone Formation Module (RSFM) to create a probabilistic simulator capable of estimating the likelihood of symptomatic renal stone presentation in astronauts on exploration missions. The model consists of two major parts. The first is the probabilistic component, which utilizes probability distributions to assess the range of urine electrolyte parameters and a multivariate regression to transform estimated crystal density and size distributions to the likelihood of the presentation of nephrolithiasis symptoms. The second is a deterministic physical and chemical model of renal stone growth in the kidney developed by Kassemi et al. The probabilistic component of the renal stone model couples the input probability distributions describing the urine chemistry, astronaut physiology, and system parameters with the physical and chemical outputs and inputs to the deterministic stone growth model. These two parts of the model are necessary to capture the uncertainty in the likelihood estimate. The model will be driven by Monte Carlo simulations, continuously

Motion Model Employment using interacting Motion Model Algorithm

DEFF Research Database (Denmark)

Hussain, Dil Muhammad Akbar

2006-01-01

The paper presents a simulation study to track a maneuvering target using a selective approach in choosing Interacting Multiple Models (IMM) algorithm to provide a wider coverage to track such targets.  Initially, there are two motion models in the system to track a target.  Probability of each m...

Medical Optimization Network for Space Telemedicine Resources

Science.gov (United States)

Shah, R. V.; Mulcahy, R.; Rubin, D.; Antonsen, E. L.; Kerstman, E. L.; Reyes, D.

2017-01-01

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. NASA recognizes the need to improve capabilities for autonomous care on such missions. As the medical system is developed, it is important to have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources was developed for this reason, and is now a system to gauge the relative importance of medical resources in addressing medical conditions. METHODS: A list of medical conditions of potential concern for an exploration mission was referenced from the Integrated Medical Model, a probabilistic model designed to quantify in-flight medical risk. The diagnostic and treatment modalities required to address best and worst-case scenarios of each medical condition, at the terrestrial standard of care, were entered into a database. This list included tangible assets (e.g. medications) and intangible assets (e.g. clinical skills to perform a procedure). A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program ranked each of the items listed according to its criticality. Data was then obtained from the IMM for the probability of occurrence of the medical conditions, including a breakdown of best case and worst case, during a Mars reference mission. The probability of occurrence information and criticality for each resource were taken into account during analytics performed using Tableau software. RESULTS: A database and weighting system to evaluate all the diagnostic and treatment modalities was created by combining the probability of condition occurrence data with the criticalities assigned by the physician team. DISCUSSION: Exploration Medical Capabilities research at NASA is focused on providing a medical system to

Annual International Meeting on Medical Simulation (5th); Simulating Change Together, Held at the Radisson Miami Florida, on January 13-16, 2005

Science.gov (United States)

2005-02-01

Challenging Superiors in the Healthcare Environment: The Two-Challenge Center for Medical Simulation Rule IMMS Singh Shashank Trauma and Awareness Pen...Rochester * Dallas Rochester MN Rochester NY Dallas TX SMartin Eason MD JD Marc Horowitz MD - Swati Argarwal, MD ETSU University of NM Stanford...Murphy, MD Simluation-based training allows educators in medicine to finally Swati Argarwal, MD address the needs of the adult learner. This high

Short-Term Bus Passenger Demand Prediction Based on Time Series Model and Interactive Multiple Model Approach

Directory of Open Access Journals (Sweden)

Rui Xue

2015-01-01

Full Text Available Although bus passenger demand prediction has attracted increased attention during recent years, limited research has been conducted in the context of short-term passenger demand forecasting. This paper proposes an interactive multiple model (IMM filter algorithm-based model to predict short-term passenger demand. After aggregated in 15 min interval, passenger demand data collected from a busy bus route over four months were used to generate time series. Considering that passenger demand exhibits various characteristics in different time scales, three time series were developed, named weekly, daily, and 15 min time series. After the correlation, periodicity, and stationarity analyses, time series models were constructed. Particularly, the heteroscedasticity of time series was explored to achieve better prediction performance. Finally, IMM filter algorithm was applied to combine individual forecasting models with dynamically predicted passenger demand for next interval. Different error indices were adopted for the analyses of individual and hybrid models. The performance comparison indicates that hybrid model forecasts are superior to individual ones in accuracy. Findings of this study are of theoretical and practical significance in bus scheduling.

A multiple model approach to respiratory motion prediction for real-time IGRT

International Nuclear Information System (INIS)

Putra, Devi; Haas, Olivier C L; Burnham, Keith J; Mills, John A

2008-01-01

Respiration induces significant movement of tumours in the vicinity of thoracic and abdominal structures. Real-time image-guided radiotherapy (IGRT) aims to adapt radiation delivery to tumour motion during irradiation. One of the main problems for achieving this objective is the presence of time lag between the acquisition of tumour position and the radiation delivery. Such time lag causes significant beam positioning errors and affects the dose coverage. A method to solve this problem is to employ an algorithm that is able to predict future tumour positions from available tumour position measurements. This paper presents a multiple model approach to respiratory-induced tumour motion prediction using the interacting multiple model (IMM) filter. A combination of two models, constant velocity (CV) and constant acceleration (CA), is used to capture respiratory-induced tumour motion. A Kalman filter is designed for each of the local models and the IMM filter is applied to combine the predictions of these Kalman filters for obtaining the predicted tumour position. The IMM filter, likewise the Kalman filter, is a recursive algorithm that is suitable for real-time applications. In addition, this paper proposes a confidence interval (CI) criterion to evaluate the performance of tumour motion prediction algorithms for IGRT. The proposed CI criterion provides a relevant measure for the prediction performance in terms of clinical applications and can be used to specify the margin to accommodate prediction errors. The prediction performance of the IMM filter has been evaluated using 110 traces of 4-minute free-breathing motion collected from 24 lung-cancer patients. The simulation study was carried out for prediction time 0.1-0.6 s with sampling rates 3, 5 and 10 Hz. It was found that the prediction of the IMM filter was consistently better than the prediction of the Kalman filter with the CV or CA model. There was no significant difference of prediction errors for the

HRP's Healthcare Spin-Offs Through Computational Modeling and Simulation Practice Methodologies

Science.gov (United States)

Mulugeta, Lealem; Walton, Marlei; Nelson, Emily; Peng, Grace; Morrison, Tina; Erdemir, Ahmet; Myers, Jerry

2014-01-01

Spaceflight missions expose astronauts to novel operational and environmental conditions that pose health risks that are currently not well understood, and perhaps unanticipated. Furthermore, given the limited number of humans that have flown in long duration missions and beyond low Earth-orbit, the amount of research and clinical data necessary to predict and mitigate these health and performance risks are limited. Consequently, NASA's Human Research Program (HRP) conducts research and develops advanced methods and tools to predict, assess, and mitigate potential hazards to the health of astronauts. In this light, NASA has explored the possibility of leveraging computational modeling since the 1970s as a means to elucidate the physiologic risks of spaceflight and develop countermeasures. Since that time, substantial progress has been realized in this arena through a number of HRP funded activates such as the Digital Astronaut Project (DAP) and the Integrated Medical Model (IMM). Much of this success can be attributed to HRP's endeavor to establish rigorous verification, validation, and credibility (VV&C) processes that ensure computational models and simulations (M&S) are sufficiently credible to address issues within their intended scope. This presentation summarizes HRP's activities in credibility of modeling and simulation, in particular through its outreach to the community of modeling and simulation practitioners. METHODS: The HRP requires all M&S that can have moderate to high impact on crew health or mission success must be vetted in accordance to NASA Standard for Models and Simulations, NASA-STD-7009 (7009) [5]. As this standard mostly focuses on engineering systems, the IMM and DAP have invested substantial efforts to adapt the processes established in this standard for their application to biological M&S, which is more prevalent in human health and performance (HHP) and space biomedical research and operations [6,7]. These methods have also generated

A low-complexity interacting multiple model filter for maneuvering target tracking

KAUST Repository

Khalid, Syed Safwan; Abrar, Shafayat

2017-01-01

In this work, we address the target tracking problem for a coordinate-decoupled Markovian jump-mean-acceleration based maneuvering mobility model. A novel low-complexity alternative to the conventional interacting multiple model (IMM) filter is proposed for this class of mobility models. The proposed tracking algorithm utilizes a bank of interacting filters where the interactions are limited to the mixing of the mean estimates, and it exploits a fixed off-line computed Kalman gain matrix for the entire filter bank. Consequently, the proposed filter does not require matrix inversions during on-line operation which significantly reduces its complexity. Simulation results show that the performance of the low-complexity proposed scheme remains comparable to that of the traditional (highly-complex) IMM filter. Furthermore, we derive analytical expressions that iteratively evaluate the transient and steady-state performance of the proposed scheme, and establish the conditions that ensure the stability of the proposed filter. The analytical findings are in close accordance with the simulated results.

A low-complexity interacting multiple model filter for maneuvering target tracking

KAUST Repository

Khalid, Syed Safwan

2017-01-22

In this work, we address the target tracking problem for a coordinate-decoupled Markovian jump-mean-acceleration based maneuvering mobility model. A novel low-complexity alternative to the conventional interacting multiple model (IMM) filter is proposed for this class of mobility models. The proposed tracking algorithm utilizes a bank of interacting filters where the interactions are limited to the mixing of the mean estimates, and it exploits a fixed off-line computed Kalman gain matrix for the entire filter bank. Consequently, the proposed filter does not require matrix inversions during on-line operation which significantly reduces its complexity. Simulation results show that the performance of the low-complexity proposed scheme remains comparable to that of the traditional (highly-complex) IMM filter. Furthermore, we derive analytical expressions that iteratively evaluate the transient and steady-state performance of the proposed scheme, and establish the conditions that ensure the stability of the proposed filter. The analytical findings are in close accordance with the simulated results.

Analytical modeling of worldwide medical radiation use

International Nuclear Information System (INIS)

Mettler, F.A. Jr.; Davis, M.; Kelsey, C.A.; Rosenberg, R.; Williams, A.

1987-01-01

An analytical model was developed to estimate the availability and frequency of medical radiation use on a worldwide basis. This model includes medical and dental x-ray, nuclear medicine, and radiation therapy. The development of an analytical model is necessary as the first step in estimating the radiation dose to the world's population from this source. Since there is no data about the frequency of medical radiation use in more than half the countries in the world and only fragmentary data in an additional one-fourth of the world's countries, such a model can be used to predict the uses of medical radiation in these countries. The model indicates that there are approximately 400,000 medical x-ray machines worldwide and that approximately 1.2 billion diagnostic medical x-ray examinations are performed annually. Dental x-ray examinations are estimated at 315 million annually and approximately 22 million in-vivo diagnostic nuclear medicine examinations. Approximately 4 million radiation therapy procedures or courses of treatment are undertaken annually

Defending the Counseling Model and Its Eventual Synthesis with the Medical Model.

Science.gov (United States)

Farrell, Madison, III

This paper explores the strengths and weaknesses of the medical model in an effort to promote a counseling perspective that embraces some of the medical models strengths. Through inclusion, rather than exclusion, it is believed that the counseling model will eventually infiltrate the medical model by way of its own documentation system. With its…

Dose reconstruction modeling for medical radiation workers

International Nuclear Information System (INIS)

Choi, Yeong Chull; Cha, Eun Shil; Lee, Won Jin

2017-01-01

Exposure information is a crucial element for the assessment of health risk due to radiation. Radiation doses received by medical radiation workers have been collected and maintained by public registry since 1996. Since exposure levels in the remote past are greater concern, it is essential to reconstruct unmeasured doses in the past using known information. We developed retrodiction models for different groups of medical radiation workers and estimate individual past doses before 1996. Reconstruction models for past radiation doses received by medical radiation workers were developed, and the past doses were estimated. Using these estimates, organ doses should be calculated which, in turn, will be used to explore a wide range of health risks of medical occupational radiation exposure. Reconstruction models for past radiation doses received by medical radiation workers were developed, and the past doses were estimated. Using these estimates, organ doses should be calculated which, in turn, will be used to explore a wide range of health risks of medical occupational radiation exposure.

Dose reconstruction modeling for medical radiation workers

Energy Technology Data Exchange (ETDEWEB)

Choi, Yeong Chull; Cha, Eun Shil; Lee, Won Jin [Dept. of Preventive Medicine, Korea University, Seoul (Korea, Republic of)

2017-04-15

Exposure information is a crucial element for the assessment of health risk due to radiation. Radiation doses received by medical radiation workers have been collected and maintained by public registry since 1996. Since exposure levels in the remote past are greater concern, it is essential to reconstruct unmeasured doses in the past using known information. We developed retrodiction models for different groups of medical radiation workers and estimate individual past doses before 1996. Reconstruction models for past radiation doses received by medical radiation workers were developed, and the past doses were estimated. Using these estimates, organ doses should be calculated which, in turn, will be used to explore a wide range of health risks of medical occupational radiation exposure. Reconstruction models for past radiation doses received by medical radiation workers were developed, and the past doses were estimated. Using these estimates, organ doses should be calculated which, in turn, will be used to explore a wide range of health risks of medical occupational radiation exposure.

Investigation of sliding DNA clamp dynamics by single-molecule fluorescence, mass spectrometry and structure-based modeling

Science.gov (United States)

Gadkari, Varun V; Harvey, Sophie R; Raper, Austin T; Chu, Wen-Ting; Wang, Jin; Wysocki, Vicki H; Suo, Zucai

2018-01-01

Abstract Proliferating cell nuclear antigen (PCNA) is a trimeric ring-shaped clamp protein that encircles DNA and interacts with many proteins involved in DNA replication and repair. Despite extensive structural work to characterize the monomeric, dimeric, and trimeric forms of PCNA alone and in complex with interacting proteins, no structure of PCNA in a ring-open conformation has been published. Here, we use a multidisciplinary approach, including single-molecule Förster resonance energy transfer (smFRET), native ion mobility-mass spectrometry (IM-MS), and structure-based computational modeling, to explore the conformational dynamics of a model PCNA from Sulfolobus solfataricus (Sso), an archaeon. We found that Sso PCNA samples ring-open and ring-closed conformations even in the absence of its clamp loader complex, replication factor C, and transition to the ring-open conformation is modulated by the ionic strength of the solution. The IM-MS results corroborate the smFRET findings suggesting that PCNA dynamics are maintained in the gas phase and further establishing IM-MS as a reliable strategy to investigate macromolecular motions. Our molecular dynamic simulations agree with the experimental data and reveal that ring-open PCNA often adopts an out-of-plane left-hand geometry. Collectively, these results implore future studies to define the roles of PCNA dynamics in DNA loading and other PCNA-mediated interactions. PMID:29529283

Methods of Medical Guidelines Modelling in GLIF.

Czech Academy of Sciences Publication Activity Database

Buchtela, David; Anger, Z.; Peleška, Jan (ed.); Tomečková, Marie; Veselý, Arnošt; Zvárová, Jana

2005-01-01

Roč. 11, - (2005), s. 1529-1532 ISSN 1727-1983. [EMBEC'05. European Medical and Biomedical Conference /3./. Prague, 20.11.2005-25.11.2005] Institutional research plan: CEZ:AV0Z10300504 Keywords : medical guidelines * knowledge modelling * GLIF model Subject RIV: BD - Theory of Information

Economic consequence of local control with radiotherapy: Cost analysis of internal mammary and medial supraclavicular lymph node radiotherapy in breast cancer

International Nuclear Information System (INIS)

Lievens, Yolande; Kesteloot, Katrien; Bogaert, Walter van den

2005-01-01

Purpose: To investigate the financial implications of radiotherapy (RT) to the internal mammary and medial supraclavicular lymph node chain (IM-MS) in postoperative breast cancer. Methods and Materials: A cost-effectiveness and cost-utility analysis were performed, using Markov models, comparing the early and delayed costs and effects of IM-MS during a 20-year time span from a societal viewpoint. The outcome estimates were based on Level I evidence from postoperative RT literature and the cost estimates on the standard practice of the Leuven University Hospitals, with the RT costs derived from an activity-based costing program developed in the department. Results: On the basis of the assumptions of the model and seen during a 20-year time span, primary treatment including IM-MS RT results in a cost savings (approximately EURO 10,000) compared with a strategy without RT. Because IM-MS RT also results in better clinical effectiveness and greater quality of life, the treatment with IM-MS dominates the approach without IM-MS. Sensitivity analyses confirmed the robustness of these results in all tested circumstances. Although threshold values were found for the cost of IM-MS, the cost at relapse, and the quality of life after treatment, these were substantially different from the baseline estimates, indicating that it is very unlikely that omitting IM-MS would become superior. Conclusion: This ex-ante cost evaluation of IM-MS RT showed that the upfront costs of locoregional RT are easily compensated for by avoiding the costs of treating locoregional and distant relapse at a later stage. The cost-sparing effect of RT should, however, be evaluated for a sufficiently long time span and is most specifically found in tumors with a rather slow natural history and a multitude of available systemic treatments at relapse, such as breast cancer

Spatially adaptive mixture modeling for analysis of FMRI time series.

Science.gov (United States)

Vincent, Thomas; Risser, Laurent; Ciuciu, Philippe

2010-04-01

Within-subject analysis in fMRI essentially addresses two problems, the detection of brain regions eliciting evoked activity and the estimation of the underlying dynamics. In Makni et aL, 2005 and Makni et aL, 2008, a detection-estimation framework has been proposed to tackle these problems jointly, since they are connected to one another. In the Bayesian formalism, detection is achieved by modeling activating and nonactivating voxels through independent mixture models (IMM) within each region while hemodynamic response estimation is performed at a regional scale in a nonparametric way. Instead of IMMs, in this paper we take advantage of spatial mixture models (SMM) for their nonlinear spatial regularizing properties. The proposed method is unsupervised and spatially adaptive in the sense that the amount of spatial correlation is automatically tuned from the data and this setting automatically varies across brain regions. In addition, the level of regularization is specific to each experimental condition since both the signal-to-noise ratio and the activation pattern may vary across stimulus types in a given brain region. These aspects require the precise estimation of multiple partition functions of underlying Ising fields. This is addressed efficiently using first path sampling for a small subset of fields and then using a recently developed fast extrapolation technique for the large remaining set. Simulation results emphasize that detection relying on supervised SMM outperforms its IMM counterpart and that unsupervised spatial mixture models achieve similar results without any hand-tuning of the correlation parameter. On real datasets, the gain is illustrated in a localizer fMRI experiment: brain activations appear more spatially resolved using SMM in comparison with classical general linear model (GLM)-based approaches, while estimating a specific parcel-based HRF shape. Our approach therefore validates the treatment of unsmoothed fMRI data without fixed GLM

Commentary: discovering a different model of medical student education.

Science.gov (United States)

Watson, Robert T

2012-12-01

Traditional medical schools in modern academic health centers make discoveries, create new knowledge and technology, provide innovative care to the sickest patients, and educate future academic and practicing physicians. Unfortunately, the growth of the research and clinical care missions has sometimes resulted in a loss of emphasis on the general professional education of medical students. The author concludes that it may not be practical for many established medical schools to functionally return to the reason they were created: for the education of medical students.He had the opportunity to discover a different model of medical student education at the first new MD-granting medical school created in the United States in 25 years (in 2000), the Florida State University College of Medicine. He was initially skeptical about how its distributed regional campuses model, using practicing primary care physicians to help medical students learn in mainly ambulatory settings, could be effective. But his experience as a faculty member at the school convinced him that the model works very well.He proposes a better alignment of form and function for many established medical schools and an extension of the regional community-based model to the formation of community-based primary care graduate medical education programs determined by physician workforce needs and available resources.

Development of a career coaching model for medical students.

Science.gov (United States)

Hur, Yera

2016-03-01

Deciding on a future career path or choosing a career specialty is an important academic decision for medical students. The purpose of this study is to develop a career coaching model for medical students. This research was carried out in three steps. The first step was systematic review of previous studies. The second step was a need assessment of medical students. The third step was a career coaching model using the results acquired from the researched literature and the survey. The career coaching stages were defined as three big phases: The career coaching stages were defined as the "crystallization" period (Pre-medical year 1 and 2), "specification" period (medical year 1 and 2), and "implementation" period (medical year 3 and 4). The career coaching model for medical students can be used in programming career coaching contents and also in identifying the outcomes of career coaching programs at an institutional level.

[New business model for medical specialists].

Science.gov (United States)

Houwen, L G H J Louis

2013-01-01

The reforms in the field of medical specialist care have important implications for the professional practice of medical specialists and their working relationship with the hospital. This leads to a considerable amount of pressure placed upon the way physicians have traditionally practiced their liberal professions, which is by forming partnerships and practicing from within the hospitals based on an admission agreement. As of 2015, the tax benefits for entrepreneurs will be abolished and the formation of regional partnerships will be discouraged. These developments not only pose threats but also offer opportunities for both the entrepreneurial medical specialist and the innovative hospital. In this article, the prospect of a future business model for specialist medical care will be outlined and explored by proposing three new organizational forms. The central vision of this model is that physicians who wish to retain their status of liberal professional practitioners in the twenty-first century should be more involved in the ownership structure of hospitals. The social importance of responsible patient care remains paramount.

Development of a career coaching model for medical students

Directory of Open Access Journals (Sweden)

Yera Hur

2016-03-01

Full Text Available Purpose: Deciding on a future career path or choosing a career specialty is an important academic decision for medical students. The purpose of this study is to develop a career coaching model for medical students. Methods: This research was carried out in three steps. The first step was systematic review of previous studies. The second step was a need assessment of medical students. The third step was a career coaching model using the results acquired from the researched literature and the survey. Results: The career coaching stages were defined as three big phases: The career coaching stages were defined as the “crystallization” period (Pre-medical year 1 and 2, “specification” period (medical year 1 and 2, and “implementation” period (medical year 3 and 4. Conclusion: The career coaching model for medical students can be used in programming career coaching contents and also in identifying the outcomes of career coaching programs at an institutional level.

Multi-sensor fusion with interacting multiple model filter for improved aircraft position accuracy.

Science.gov (United States)

Cho, Taehwan; Lee, Changho; Choi, Sangbang

2013-03-27

The International Civil Aviation Organization (ICAO) has decided to adopt Communications, Navigation, and Surveillance/Air Traffic Management (CNS/ATM) as the 21st century standard for navigation. Accordingly, ICAO members have provided an impetus to develop related technology and build sufficient infrastructure. For aviation surveillance with CNS/ATM, Ground-Based Augmentation System (GBAS), Automatic Dependent Surveillance-Broadcast (ADS-B), multilateration (MLAT) and wide-area multilateration (WAM) systems are being established. These sensors can track aircraft positions more accurately than existing radar and can compensate for the blind spots in aircraft surveillance. In this paper, we applied a novel sensor fusion method with Interacting Multiple Model (IMM) filter to GBAS, ADS-B, MLAT, and WAM data in order to improve the reliability of the aircraft position. Results of performance analysis show that the position accuracy is improved by the proposed sensor fusion method with the IMM filter.

Clinical Outcome Metrics for Optimization of Robust Training

Science.gov (United States)

Ebert, D.; Byrne, V. E.; McGuire, K. M.; Hurst, V. W., IV; Kerstman, E. L.; Cole, R. W.; Sargsyan, A. E.; Garcia, K. M.; Reyes, D.; Young, M.

2016-01-01

Introduction: The emphasis of this research is on the Human Research Program (HRP) Exploration Medical Capability's (ExMC) "Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-Flight Medical Capabilities." Specifically, this project aims to contribute to the closure of gap ExMC 2.02: We do not know how the inclusion of a physician crew medical officer quantitatively impacts clinical outcomes during exploration missions. The experiments are specifically designed to address clinical outcome differences between physician and non-physician cohorts in both near-term and longer-term (mission impacting) outcomes. Methods: Medical simulations will systematically compare success of individual diagnostic and therapeutic procedure simulations performed by physician and non-physician crew medical officer (CMO) analogs using clearly defined short-term (individual procedure) outcome metrics. In the subsequent step of the project, the procedure simulation outcomes will be used as input to a modified version of the NASA Integrated Medical Model (IMM) to analyze the effect of the outcome (degree of success) of individual procedures (including successful, imperfectly performed, and failed procedures) on overall long-term clinical outcomes and the consequent mission impacts. The procedures to be simulated are endotracheal intubation, fundoscopic examination, kidney/urinary ultrasound, ultrasound-guided intravenous catheter insertion, and a differential diagnosis exercise. Multiple assessment techniques will be used, centered on medical procedure simulation studies occurring at 3, 6, and 12 months after initial training (as depicted in the following flow diagram of the experiment design). Discussion: Analysis of procedure outcomes in the physician and non-physician groups and their subsets (tested at different elapsed times post training) will allow the team to 1) define differences between physician and non-physician CMOs in terms of both procedure performance

Dual processing model of medical decision-making

Science.gov (United States)

2012-01-01

Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical

Dual processing model of medical decision-making.

Science.gov (United States)

Djulbegovic, Benjamin; Hozo, Iztok; Beckstead, Jason; Tsalatsanis, Athanasios; Pauker, Stephen G

2012-09-03

Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. We show that physician's beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker's threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the

Modeling Medical Services with Mobile Health Applications

Directory of Open Access Journals (Sweden)

Zhenfei Wang

2018-01-01

Full Text Available The rapid development of mobile health technology (m-Health provides unprecedented opportunities for improving health services. As the bridge between doctors and patients, mobile health applications enable patients to communicate with doctors through their smartphones, which is becoming more and more popular among people. To evaluate the influence of m-Health applications on the medical service market, we propose a medical service equilibrium model. The model can balance the supply of doctors and demand of patients and reflect possible options for both doctors and patients with or without m-Health applications in the medical service market. In the meantime, we analyze the behavior of patients and the activities of doctors to minimize patients’ full costs of healthcare and doctors’ futility. Then, we provide a resolution algorithm through mathematical reasoning. Lastly, based on artificially generated dataset, experiments are conducted to evaluate the medical services of m-Health applications.

The IMM Frontal Face Database

DEFF Research Database (Denmark)

Fagertun, Jens; Stegmann, Mikkel Bille

2005-01-01

This note describes a data set consisting of 120 annotated monocular images of 12 different frontal human faces. Points of correspondence are placed on each image so the data set can be readily used for building statistical models of shape. Format specifications and terms of use are also given...

A Proposed Conceptual Model of Military Medical Readiness

National Research Council Canada - National Science Library

Van Hall, Brian M

2007-01-01

.... The purpose of this research is to consolidate existing literature on the latent variable of medical readiness, and to propose a composite theoretical model of medical readiness that may provide...

Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model.

Science.gov (United States)

De Leeuw, R A; Westerman, Michiel; Nelson, E; Ket, J C F; Scheele, F

2016-07-08

E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.

Dual processing model of medical decision-making

Directory of Open Access Journals (Sweden)

Djulbegovic Benjamin

2012-09-01

Full Text Available Abstract Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I and/or an analytical, deliberative (system II processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to

A flexible model for correlated medical costs, with application to medical expenditure panel survey data.

Science.gov (United States)

Chen, Jinsong; Liu, Lei; Shih, Ya-Chen T; Zhang, Daowen; Severini, Thomas A

2016-03-15

We propose a flexible model for correlated medical cost data with several appealing features. First, the mean function is partially linear. Second, the distributional form for the response is not specified. Third, the covariance structure of correlated medical costs has a semiparametric form. We use extended generalized estimating equations to simultaneously estimate all parameters of interest. B-splines are used to estimate unknown functions, and a modification to Akaike information criterion is proposed for selecting knots in spline bases. We apply the model to correlated medical costs in the Medical Expenditure Panel Survey dataset. Simulation studies are conducted to assess the performance of our method. Copyright © 2015 John Wiley & Sons, Ltd.

Semantic concept-enriched dependence model for medical information retrieval.

Science.gov (United States)

Choi, Sungbin; Choi, Jinwook; Yoo, Sooyoung; Kim, Heechun; Lee, Youngho

2014-02-01

In medical information retrieval research, semantic resources have been mostly used by expanding the original query terms or estimating the concept importance weight. However, implicit term-dependency information contained in semantic concept terms has been overlooked or at least underused in most previous studies. In this study, we incorporate a semantic concept-based term-dependence feature into a formal retrieval model to improve its ranking performance. Standardized medical concept terms used by medical professionals were assumed to have implicit dependency within the same concept. We hypothesized that, by elaborately revising the ranking algorithms to favor documents that preserve those implicit dependencies, the ranking performance could be improved. The implicit dependence features are harvested from the original query using MetaMap. These semantic concept-based dependence features were incorporated into a semantic concept-enriched dependence model (SCDM). We designed four different variants of the model, with each variant having distinct characteristics in the feature formulation method. We performed leave-one-out cross validations on both a clinical document corpus (TREC Medical records track) and a medical literature corpus (OHSUMED), which are representative test collections in medical information retrieval research. Our semantic concept-enriched dependence model consistently outperformed other state-of-the-art retrieval methods. Analysis shows that the performance gain has occurred independently of the concept's explicit importance in the query. By capturing implicit knowledge with regard to the query term relationships and incorporating them into a ranking model, we could build a more robust and effective retrieval model, independent of the concept importance. Copyright © 2013 Elsevier Inc. All rights reserved.

Model-based engineering for medical-device software.

Science.gov (United States)

Ray, Arnab; Jetley, Raoul; Jones, Paul L; Zhang, Yi

2010-01-01

This paper demonstrates the benefits of adopting model-based design techniques for engineering medical device software. By using a patient-controlled analgesic (PCA) infusion pump as a candidate medical device, the authors show how using models to capture design information allows for i) fast and efficient construction of executable device prototypes ii) creation of a standard, reusable baseline software architecture for a particular device family, iii) formal verification of the design against safety requirements, and iv) creation of a safety framework that reduces verification costs for future versions of the device software. 1.

Dialect topic modeling for improved consumer medical search.

Science.gov (United States)

Crain, Steven P; Yang, Shuang-Hong; Zha, Hongyuan; Jiao, Yu

2010-11-13

Access to health information by consumers is hampered by a fundamental language gap. Current attempts to close the gap leverage consumer oriented health information, which does not, however, have good coverage of slang medical terminology. In this paper, we present a Bayesian model to automatically align documents with different dialects (slang, common and technical) while extracting their semantic topics. The proposed diaTM model enables effective information retrieval, even when the query contains slang words, by explicitly modeling the mixtures of dialects in documents and the joint influence of dialects and topics on word selection. Simulations using consumer questions to retrieve medical information from a corpus of medical documents show that diaTM achieves a 25% improvement in information retrieval relevance by nDCG@5 over an LDA baseline.

Dialect Topic Modeling for Improved Consumer Medical Search

Energy Technology Data Exchange (ETDEWEB)

Crain, Steven P. [Georgia Institute of Technology; Yang, Shuang-Hong [Georgia Institute of Technology; Zha, Hongyuan [Georgia Institute of Technology; Jiao, Yu [ORNL

2010-01-01

Access to health information by consumers is ham- pered by a fundamental language gap. Current attempts to close the gap leverage consumer oriented health information, which does not, however, have good coverage of slang medical terminology. In this paper, we present a Bayesian model to automatically align documents with different dialects (slang, com- mon and technical) while extracting their semantic topics. The proposed diaTM model enables effective information retrieval, even when the query contains slang words, by explicitly modeling the mixtures of dialects in documents and the joint influence of dialects and topics on word selection. Simulations us- ing consumer questions to retrieve medical information from a corpus of medical documents show that diaTM achieves a 25% improvement in information retrieval relevance by nDCG@5 over an LDA baseline.

Medical Writing Competency Model - Section 1: Functions, Tasks, and Activities.

Science.gov (United States)

Clemow, David B; Wagner, Bertil; Marshallsay, Christopher; Benau, Dan; L'Heureux, Darryl; Brown, David H; Dasgupta, Devjani Ghosh; Girten, Eileen; Hubbard, Frank; Gawrylewski, Helle-Mai; Ebina, Hiroko; Stoltenborg, Janet; York, J P; Green, Kim; Wood, Linda Fossati; Toth, Lisa; Mihm, Michael; Katz, Nancy R; Vasconcelos, Nina-Maria; Sakiyama, Norihisa; Whitsell, Robin; Gopalakrishnan, Shobha; Bairnsfather, Susan; Wanderer, Tatyana; Schindler, Thomas M; Mikyas, Yeshi; Aoyama, Yumiko

2018-01-01

This article provides Section 1 of the 2017 Edition 2 Medical Writing Competency Model that describes the core work functions and associated tasks and activities related to professional medical writing within the life sciences industry. The functions in the Model are scientific communication strategy; document preparation, development, and finalization; document project management; document template, standard, format, and style development and maintenance; outsourcing, alliance partner, and client management; knowledge, skill, ability, and behavior development and sharing; and process improvement. The full Model also includes Section 2, which covers the knowledge, skills, abilities, and behaviors needed for medical writers to be effective in their roles; Section 2 is presented in a companion article. Regulatory, publication, and other scientific writing as well as management of writing activities are covered. The Model was developed to aid medical writers and managers within the life sciences industry regarding medical writing hiring, training, expectation and goal setting, performance evaluation, career development, retention, and role value sharing to cross-functional partners.

A smart medication recommendation model for the electronic prescription.

Science.gov (United States)

Syed-Abdul, Shabbir; Nguyen, Alex; Huang, Frank; Jian, Wen-Shan; Iqbal, Usman; Yang, Vivian; Hsu, Min-Huei; Li, Yu-Chuan

2014-11-01

The report from the Institute of Medicine, To Err Is Human: Building a Safer Health System in 1999 drew a special attention towards preventable medical errors and patient safety. The American Reinvestment and Recovery Act of 2009 and federal criteria of 'Meaningful use' stage 1 mandated e-prescribing to be used by eligible providers in order to access Medicaid and Medicare incentive payments. Inappropriate prescribing has been identified as a preventable cause of at least 20% of drug-related adverse events. A few studies reported system-related errors and have offered targeted recommendations on improving and enhancing e-prescribing system. This study aims to enhance efficiency of the e-prescribing system by shortening the medication list, reducing the risk of inappropriate selection of medication, as well as in reducing the prescribing time of physicians. 103.48 million prescriptions from Taiwan's national health insurance claim data were used to compute Diagnosis-Medication association. Furthermore, 100,000 prescriptions were randomly selected to develop a smart medication recommendation model by using association rules of data mining. The important contribution of this model is to introduce a new concept called Mean Prescription Rank (MPR) of prescriptions and Coverage Rate (CR) of prescriptions. A proactive medication list (PML) was computed using MPR and CR. With this model the medication drop-down menu is significantly shortened, thereby reducing medication selection errors and prescription times. The physicians will still select relevant medications even in the case of inappropriate (unintentional) selection. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Model medication management process in Australian nursing homes using business process modeling.

Science.gov (United States)

Qian, Siyu; Yu, Ping

2013-01-01

One of the reasons for end user avoidance or rejection to use health information systems is poor alignment of the system with healthcare workflow, likely causing by system designers' lack of thorough understanding about healthcare process. Therefore, understanding the healthcare workflow is the essential first step for the design of optimal technologies that will enable care staff to complete the intended tasks faster and better. The often use of multiple or "high risk" medicines by older people in nursing homes has the potential to increase medication error rate. To facilitate the design of information systems with most potential to improve patient safety, this study aims to understand medication management process in nursing homes using business process modeling method. The paper presents study design and preliminary findings from interviewing two registered nurses, who were team leaders in two nursing homes. Although there were subtle differences in medication management between the two homes, major medication management activities were similar. Further field observation will be conducted. Based on the data collected from observations, an as-is process model for medication management will be developed.

Medical Professionals Designing Hospital Management Models

DEFF Research Database (Denmark)

Byg, Vibeke

Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals...... especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research literature on the topic of reforming hospital management models. Lacking from the literature, however......, is insight into how we can understand and explain how medical professionals adapt hospital management over time in relation to changing hospital management models that are global in their influence in hospital organizations. The aim of this dissertation is to understand and explain how medical professionals...

Bearings-Only Tracking of Manoeuvring Targets Using Particle Filters

Directory of Open Access Journals (Sweden)

M. Sanjeev Arulampalam

2004-11-01

Full Text Available We investigate the problem of bearings-only tracking of manoeuvring targets using particle filters (PFs. Three different (PFs are proposed for this problem which is formulated as a multiple model tracking problem in a jump Markov system (JMS framework. The proposed filters are (i multiple model PF (MMPF, (ii auxiliary MMPF (AUX-MMPF, and (iii jump Markov system PF (JMS-PF. The performance of these filters is compared with that of standard interacting multiple model (IMM-based trackers such as IMM-EKF and IMM-UKF for three separate cases: (i single-sensor case, (ii multisensor case, and (iii tracking with hard constraints. A conservative CRLB applicable for this problem is also derived and compared with the RMS error performance of the filters. The results confirm the superiority of the PFs for this difficult nonlinear tracking problem.

Wanted: role models - medical students’ perceptions of professionalism

Directory of Open Access Journals (Sweden)

Byszewski Anna

2012-11-01

Full Text Available Abstract Background Transformation of medical students to become medical professionals is a core competency required for physicians in the 21st century. Role modeling was traditionally the key method of transmitting this skill. Medical schools are developing medical curricula which are explicit in ensuring students develop the professional competency and understand the values and attributes of this role. The purpose of this study was to determine student perception of professionalism at the University of Ottawa and gain insights for improvement in promotion of professionalism in undergraduate medical education. Methods Survey on student perception of professionalism in general, the curriculum and learning environment at the University of Ottawa, and the perception of student behaviors, was developed by faculty and students and sent electronically to all University of Ottawa medical students. The survey included both quantitative items including an adapted Pritzker list and qualitative responses to eight open ended questions on professionalism at the Faculty of Medicine, University of Ottawa. All analyses were performed using SAS version 9.1 (SAS Institute Inc. Cary, NC, USA. Chi-square and Fischer’s exact test (for cell count less than 5 were used to derive p-values for categorical variables by level of student learning. Results The response rate was 45.6% (255 of 559 students for all four years of the curriculum. 63% of the responses were from students in years 1 and 2 (preclerkship. Students identified role modeling as the single most important aspect of professionalism. The strongest curricular recommendations included faculty-led case scenario sessions, enhancing interprofessional interactions and the creation of special awards to staff and students to “celebrate” professionalism. Current evaluation systems were considered least effective. The importance of role modeling and information on how to report lapses and breaches was

[Research progress of multi-model medical image fusion and recognition].

Science.gov (United States)

Zhou, Tao; Lu, Huiling; Chen, Zhiqiang; Ma, Jingxian

2013-10-01

Medical image fusion and recognition has a wide range of applications, such as focal location, cancer staging and treatment effect assessment. Multi-model medical image fusion and recognition are analyzed and summarized in this paper. Firstly, the question of multi-model medical image fusion and recognition is discussed, and its advantage and key steps are discussed. Secondly, three fusion strategies are reviewed from the point of algorithm, and four fusion recognition structures are discussed. Thirdly, difficulties, challenges and possible future research direction are discussed.

Using A Model-Based Systems Engineering Approach For Exploration Medical System Development

Science.gov (United States)

Hanson, A.; Mindock, J.; McGuire, K.; Reilly, J.; Cerro, J.; Othon, W.; Rubin, D.; Urbina, M.; Canga, M.

2017-01-01

NASA's Human Research Program's Exploration Medical Capabilities (ExMC) element is defining the medical system needs for exploration class missions. ExMC's Systems Engineering (SE) team will play a critical role in successful design and implementation of the medical system into exploration vehicles. The team's mission is to "Define, develop, validate, and manage the technical system design needed to implement exploration medical capabilities for Mars and test the design in a progression of proving grounds." Development of the medical system is being conducted in parallel with exploration mission architecture and vehicle design development. Successful implementation of the medical system in this environment will require a robust systems engineering approach to enable technical communication across communities to create a common mental model of the emergent engineering and medical systems. Model-Based Systems Engineering (MBSE) improves shared understanding of system needs and constraints between stakeholders and offers a common language for analysis. The ExMC SE team is using MBSE techniques to define operational needs, decompose requirements and architecture, and identify medical capabilities needed to support human exploration. Systems Modeling Language (SysML) is the specific language the SE team is utilizing, within an MBSE approach, to model the medical system functional needs, requirements, and architecture. Modeling methods are being developed through the practice of MBSE within the team, and tools are being selected to support meta-data exchange as integration points to other system models are identified. Use of MBSE is supporting the development of relationships across disciplines and NASA Centers to build trust and enable teamwork, enhance visibility of team goals, foster a culture of unbiased learning and serving, and be responsive to customer needs. The MBSE approach to medical system design offers a paradigm shift toward greater integration between

From medical imaging data to 3D printed anatomical models.

Directory of Open Access Journals (Sweden)

Thore M Bücking

Full Text Available Anatomical models are important training and teaching tools in the clinical environment and are routinely used in medical imaging research. Advances in segmentation algorithms and increased availability of three-dimensional (3D printers have made it possible to create cost-efficient patient-specific models without expert knowledge. We introduce a general workflow that can be used to convert volumetric medical imaging data (as generated by Computer Tomography (CT to 3D printed physical models. This process is broken up into three steps: image segmentation, mesh refinement and 3D printing. To lower the barrier to entry and provide the best options when aiming to 3D print an anatomical model from medical images, we provide an overview of relevant free and open-source image segmentation tools as well as 3D printing technologies. We demonstrate the utility of this streamlined workflow by creating models of ribs, liver, and lung using a Fused Deposition Modelling 3D printer.

Image analysis and modeling in medical image computing. Recent developments and advances.

Science.gov (United States)

Handels, H; Deserno, T M; Meinzer, H-P; Tolxdorff, T

2012-01-01

Medical image computing is of growing importance in medical diagnostics and image-guided therapy. Nowadays, image analysis systems integrating advanced image computing methods are used in practice e.g. to extract quantitative image parameters or to support the surgeon during a navigated intervention. However, the grade of automation, accuracy, reproducibility and robustness of medical image computing methods has to be increased to meet the requirements in clinical routine. In the focus theme, recent developments and advances in the field of modeling and model-based image analysis are described. The introduction of models in the image analysis process enables improvements of image analysis algorithms in terms of automation, accuracy, reproducibility and robustness. Furthermore, model-based image computing techniques open up new perspectives for prediction of organ changes and risk analysis of patients. Selected contributions are assembled to present latest advances in the field. The authors were invited to present their recent work and results based on their outstanding contributions to the Conference on Medical Image Computing BVM 2011 held at the University of Lübeck, Germany. All manuscripts had to pass a comprehensive peer review. Modeling approaches and model-based image analysis methods showing new trends and perspectives in model-based medical image computing are described. Complex models are used in different medical applications and medical images like radiographic images, dual-energy CT images, MR images, diffusion tensor images as well as microscopic images are analyzed. The applications emphasize the high potential and the wide application range of these methods. The use of model-based image analysis methods can improve segmentation quality as well as the accuracy and reproducibility of quantitative image analysis. Furthermore, image-based models enable new insights and can lead to a deeper understanding of complex dynamic mechanisms in the human body

[New model of doctor-nurse communication based on electronic medical advice platform].

Science.gov (United States)

Cao, Yang; Ding, Aimin; Wang, Yan

2012-01-01

This article introduces a new model of the communication between doctors and nurses, with the aid of the electronic medical advice platform. This model has achieved good results in improving doctor and nurse's co-working efficiency, treating patients safely, preventing medical accidents, reducing medical errors and so on.

The benefits of 3D modelling and animation in medical teaching.

Science.gov (United States)

Vernon, Tim; Peckham, Daniel

2002-12-01

Three-dimensional models created using materials such as wax, bronze and ivory, have been used in the teaching of medicine for many centuries. Today, computer technology allows medical illustrators to create virtual three-dimensional medical models. This paper considers the benefits of using still and animated output from computer-generated models in the teaching of medicine, and examines how three-dimensional models are made.

[Chinese constitution research and the practice of 4P medical model].

Science.gov (United States)

Wang, Ji; Wang, Qi

2012-05-01

The aim of modern medicine is transforming from disease to health. Thus the medical model of 4P was proposed in recent years. 4P includes preventive, predictive, personalized, and participatory medical model. In constitution theory of Chinese medicine, there are three main ideas. The first one is: constitutions can be divided to nine types in the Chinese population. Prevention and treatment of disease can be divided according to the constitutional type. This reflects personalized or individualized of 4P. The second one is: certain constitution is correlated to certain disease. So constitution differentiation can be used to predict the occurrence of any kind disease. The third one is: Disease can be prevented through regulating correlated constitutions. And during the course of constitution differentiation, the object of service or patients can participate in the whole course. In summary, the research of Chinese medical constitution embodies the application and practice of 4P medical model. And it provided reference for studying and developing other subjects under the present medical model.

Modelling Cooperative Work at a Medical Department

DEFF Research Database (Denmark)

Christensen, Lars Rune; Hildebrandt, Thomas

2017-01-01

Based on ethnographic fieldwork, and the modelling of work processes at a medical department, this paper considers some of the opportunities and challenges involved in working with models in a complex work setting. The paper introduces a flexible modelling tool to CSCW, called the DCR Portal......, and considers how it may be used to model complex work settings collaboratively. Further, the paper discusses how models created with the DCR portal may potentially play a key role in making a cooperative work ensemble appreciate, discuss and coordinate key interdependencies inherent to their cooperative work...

Ontological Model-Based Transparent Access To Information In A Medical Multi-Agent System

Directory of Open Access Journals (Sweden)

Felicia GÎZĂ-BELCIUG

2012-01-01

Full Text Available Getting the full electronic medical record of a patient is an important step in providing a quality medical service. But the degree of heterogeneity of data from health unit informational systems is very high, because each unit can have a different model for storing patients’ medical data. In order to achieve the interoperability and integration of data from various medical units that store partial patient medical information, this paper proposes a multi-agent systems and ontology based approach. Therefore, we present an ontological model for describing the particular structure of the data integration process. The system is to be used for centralizing the information from a patient’s partial medical records. The main advantage of the proposed model is the low ratio between the complexity of the model and the amount of information that can be retrieved in order to generate the complete medical history of a patient.

Constructing an Urban Population Model for Medical Insurance Scheme Using Microsimulation Techniques

Directory of Open Access Journals (Sweden)

Linping Xiong

2012-01-01

Full Text Available China launched a pilot project of medical insurance reform in 79 cities in 2007 to cover urban nonworking residents. An urban population model was created in this paper for China’s medical insurance scheme using microsimulation model techniques. The model made it clear for the policy makers the population distributions of different groups of people, the potential urban residents entering the medical insurance scheme. The income trends of units of individuals and families were also obtained. These factors are essential in making the challenging policy decisions when considering to balance the long-term financial sustainability of the medical insurance scheme.

Higher Referrals for Diabetes Education in a Medical Home Model of Care.

Science.gov (United States)

Manard, William T; Syberg, Kevin; Behera, Anit; Salas, Joanne; Schneider, F David; Armbrecht, Eric; Hooks-Anderson, Denise; Crannage, Erica; Scherrer, Jeffrey

2016-01-01

The medical home model has been gaining attention from the health care community as a strategy for improved outcomes for management of chronic disease, including diabetes. The purpose of this study was to compare referrals for diabetes education among patients receiving care from a medical home model versus a traditional practice. Data were obtained from a large, university-affiliated primary care patient data registry. All patients (age 18-96 years) with a diagnosis of prediabetes or diabetes and seen by a physician at least twice during 2011 to 2013 were selected for inclusion. Multivariate regression models measuring the association between medical home status and referral to diabetes education were computed before and after adjusting for covariates. A significantly (P patients in a medical home than without a medical home (23.9% vs 13.5%) received a referral for diabetes education. After adjusting for covariates, medical home patients were 2.7 times more likely to receive a referral for diabetes education (odds ratio, 2.70; 95% confidence interval, 1.69-4.35). Patients in a medical home model were more likely to receive referrals for diabetes education than patients in a standard university-affiliated family medicine practice. Future longitudinal designs that match characteristics of patients with a medical home with those of patients without one will provide strong evidence to determine whether referral to diabetes education is a result of the medical home model of care independent of confounding factors. © Copyright 2016 by the American Board of Family Medicine.

Beating Heart Motion Accurate Prediction Method Based on Interactive Multiple Model: An Information Fusion Approach

Science.gov (United States)

Xie, Weihong; Yu, Yang

2017-01-01

Robot-assisted motion compensated beating heart surgery has the advantage over the conventional Coronary Artery Bypass Graft (CABG) in terms of reduced trauma to the surrounding structures that leads to shortened recovery time. The severe nonlinear and diverse nature of irregular heart rhythm causes enormous difficulty for the robot to realize the clinic requirements, especially under arrhythmias. In this paper, we propose a fusion prediction framework based on Interactive Multiple Model (IMM) estimator, allowing each model to cover a distinguishing feature of the heart motion in underlying dynamics. We find that, at normal state, the nonlinearity of the heart motion with slow time-variant changing dominates the beating process. When an arrhythmia occurs, the irregularity mode, the fast uncertainties with random patterns become the leading factor of the heart motion. We deal with prediction problem in the case of arrhythmias by estimating the state with two behavior modes which can adaptively “switch” from one to the other. Also, we employed the signal quality index to adaptively determine the switch transition probability in the framework of IMM. We conduct comparative experiments to evaluate the proposed approach with four distinguished datasets. The test results indicate that the new proposed approach reduces prediction errors significantly. PMID:29124062

Beating Heart Motion Accurate Prediction Method Based on Interactive Multiple Model: An Information Fusion Approach

Directory of Open Access Journals (Sweden)

Fan Liang

2017-01-01

Full Text Available Robot-assisted motion compensated beating heart surgery has the advantage over the conventional Coronary Artery Bypass Graft (CABG in terms of reduced trauma to the surrounding structures that leads to shortened recovery time. The severe nonlinear and diverse nature of irregular heart rhythm causes enormous difficulty for the robot to realize the clinic requirements, especially under arrhythmias. In this paper, we propose a fusion prediction framework based on Interactive Multiple Model (IMM estimator, allowing each model to cover a distinguishing feature of the heart motion in underlying dynamics. We find that, at normal state, the nonlinearity of the heart motion with slow time-variant changing dominates the beating process. When an arrhythmia occurs, the irregularity mode, the fast uncertainties with random patterns become the leading factor of the heart motion. We deal with prediction problem in the case of arrhythmias by estimating the state with two behavior modes which can adaptively “switch” from one to the other. Also, we employed the signal quality index to adaptively determine the switch transition probability in the framework of IMM. We conduct comparative experiments to evaluate the proposed approach with four distinguished datasets. The test results indicate that the new proposed approach reduces prediction errors significantly.

Description of a practice model for pharmacist medication review in a general practice setting

DEFF Research Database (Denmark)

Brandt, Mette; Hallas, Jesper; Hansen, Trine Graabæk

2014-01-01

BACKGROUND: Practical descriptions of procedures used for pharmacists' medication reviews are sparse. OBJECTIVE: To describe a model for medication review by pharmacists tailored to a general practice setting. METHODS: A stepwise model is described. The model is based on data from the medical chart...... no indication (n=47, 23%). Most interventions were aimed at cardiovascular drugs. CONCLUSION: We have provided a detailed description of a practical approach to pharmacists' medication review in a GP setting. The model was tested and found to be usable, and to deliver a medication review with high acceptance...

Medical applications of model-based dynamic thermography

Science.gov (United States)

Nowakowski, Antoni; Kaczmarek, Mariusz; Ruminski, Jacek; Hryciuk, Marcin; Renkielska, Alicja; Grudzinski, Jacek; Siebert, Janusz; Jagielak, Dariusz; Rogowski, Jan; Roszak, Krzysztof; Stojek, Wojciech

2001-03-01

The proposal to use active thermography in medical diagnostics is promising in some applications concerning investigation of directly accessible parts of the human body. The combination of dynamic thermograms with thermal models of investigated structures gives attractive possibility to make internal structure reconstruction basing on different thermal properties of biological tissues. Measurements of temperature distribution synchronized with external light excitation allow registration of dynamic changes of local temperature dependent on heat exchange conditions. Preliminary results of active thermography applications in medicine are discussed. For skin and under- skin tissues an equivalent thermal model may be determined. For the assumed model its effective parameters may be reconstructed basing on the results of transient thermal processes. For known thermal diffusivity and conductivity of specific tissues the local thickness of a two or three layer structure may be calculated. Results of some medical cases as well as reference data of in vivo study on animals are presented. The method was also applied to evaluate the state of the human heart during the open chest cardio-surgical interventions. Reference studies of evoked heart infarct in pigs are referred, too. We see the proposed new in medical applications technique as a promising diagnostic tool. It is a fully non-invasive, clean, handy, fast and affordable method giving not only qualitative view of investigated surfaces but also an objective quantitative measurement result, accurate enough for many applications including fast screening of affected tissues.

Beyond the standard of care: a new model to judge medical negligence.

Science.gov (United States)

Brenner, Lawrence H; Brenner, Alison Tytell; Awerbuch, Eric J; Horwitz, Daniel

2012-05-01

The term "standard of care" has been used in law and medicine to determine whether medical care is negligent. However, the precise meaning of this concept is often unclear for both medical and legal professionals. Our purposes are to (1) examine the limitations of using standard of care as a measure of negligence, (2) propose the use of the legal concepts of justification and excuse in developing a new model of examining medical conduct, and (3) outline the framework of this model. We applied the principles of tort liability set forth in the clinical and legal literature to describe the difficulty in applying standard of care in medical negligence cases. Using the concepts of justification and excuse, we propose a judicial model that may promote fair and just jury verdicts in medical negligence cases. Contrary to conventional understanding, medical negligence is not simply nonconformity to norms. Two additional concepts of legal liability, ie, justification and excuse, must also be considered to properly judge medical conduct. Medical conduct is justified when the benefits outweigh the risks; the law sanctions the conduct and encourages future conduct under similar circumstances. Excuse, on the other hand, relieves a doctor of legal liability under specific circumstances even though his/her conduct was not justified. Standard of care is an inaccurate measure of medical negligence because it is premised on the faulty notion of conformity to norms. An alternative judicial model to determine medical negligence would (1) eliminate standard of care in medical malpractice law, (2) reframe the court instruction to jurors, and (3) establish an ongoing consensus committee on orthopaedic principles of negligence.

SPD-based Logistics Management Model of Medical Consumables in Hospitals

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LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei; YANG, Shanlin

2016-01-01

Background: With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. Methods: We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. Results: We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. Conclusion: The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China. PMID:27957435

SPD-based Logistics Management Model of Medical Consumables in Hospitals.

Science.gov (United States)

Liu, Tongzhu; Shen, Aizong; Hu, Xiaojian; Tong, Guixian; Gu, Wei; Yang, Shanlin

2016-10-01

With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China.

Function-based payment model for inpatient medical rehabilitation: an evaluation.

Science.gov (United States)

Sutton, J P; DeJong, G; Wilkerson, D

1996-07-01

To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diagnosis-related groups (DRGs), to evaluate this model in relation to stakeholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, creates an incentive for provides to maximize functional outcomes. This article describes a conceptual model, involving no data collection or data synthesis. The basic payment model described parallels DRGs. Information on the potential impact of this model on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated against the results of a Delphi Survey of rehabilitation providers, consumers, policymakers, and researchers previously conducted by members of the research team. The major shortcoming of a function-based prospective payment model for inpatient medical rehabilitation is that it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a "quality of care" pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outcomes are attained, may be one strategy for maximizing outcome goals.

Modeling and Simulation of Handover Scheme in Integrated EPON-WiMAX Networks

DEFF Research Database (Denmark)

Yan, Ying; Dittmann, Lars

2011-01-01

In this paper, we tackle the seamless handover problem in integrated optical wireless networks. Our model applies for the convergence network of EPON and WiMAX and a mobilityaware signaling protocol is proposed. The proposed handover scheme, Integrated Mobility Management Scheme (IMMS), is assisted...... by enhancing the traditional MPCP signaling protocol, which cooperatively collects mobility information from the front-end wireless network and makes centralized bandwidth allocation decisions in the backhaul optical network. The integrated network architecture and the joint handover scheme are simulated using...... OPNET modeler. Results show validation of the protocol, i.e., integrated handover scheme gains better network performances....

Funding medical education: should we follow a different model to general higher education?

Directory of Open Access Journals (Sweden)

Kieran Walsh

2015-09-01

Full Text Available ISSUE. There has been much recent discussion on the funding of medical education. There has also been much discussion about the funding of higher education more generally. EVIDENCE. The topics of discussion have included the rising costs of education; who should pay; the various potential models of funding; and how best to ensure maximum returns from investment. IMPLICATIONS. Medical education has largely followed the emerging models of funding for higher education. However there are important reasons why the funding models for higher education may not suit medical education. These reasons include the fact that medical education is as important to the public as it is to the learner; the range of funding sources available to medical schools; the strict regulation of medical education; and the fact that the privatisation and commercialisation of higher education may not been in keeping with the social goals of medical schools and the agenda of diversification within the medical student population.

Prediction of peptide drift time in ion mobility mass spectrometry from sequence-based features

KAUST Repository

Wang, Bing; Zhang, Jun; Chen, Peng; Ji, Zhiwei; Deng, Shuping; Li, Chi

2013-01-01

Background: Ion mobility-mass spectrometry (IMMS), an analytical technique which combines the features of ion mobility spectrometry (IMS) and mass spectrometry (MS), can rapidly separates ions on a millisecond time-scale. IMMS becomes a powerful tool to analyzing complex mixtures, especially for the analysis of peptides in proteomics. The high-throughput nature of this technique provides a challenge for the identification of peptides in complex biological samples. As an important parameter, peptide drift time can be used for enhancing downstream data analysis in IMMS-based proteomics.Results: In this paper, a model is presented based on least square support vectors regression (LS-SVR) method to predict peptide ion drift time in IMMS from the sequence-based features of peptide. Four descriptors were extracted from peptide sequence to represent peptide ions by a 34-component vector. The parameters of LS-SVR were selected by a grid searching strategy, and a 10-fold cross-validation approach was employed for the model training and testing. Our proposed method was tested on three datasets with different charge states. The high prediction performance achieve demonstrate the effectiveness and efficiency of the prediction model.Conclusions: Our proposed LS-SVR model can predict peptide drift time from sequence information in relative high prediction accuracy by a test on a dataset of 595 peptides. This work can enhance the confidence of protein identification by combining with current protein searching techniques. 2013 Wang et al.; licensee BioMed Central Ltd.

Prediction of peptide drift time in ion mobility mass spectrometry from sequence-based features

KAUST Repository

Wang, Bing

2013-05-09

Background: Ion mobility-mass spectrometry (IMMS), an analytical technique which combines the features of ion mobility spectrometry (IMS) and mass spectrometry (MS), can rapidly separates ions on a millisecond time-scale. IMMS becomes a powerful tool to analyzing complex mixtures, especially for the analysis of peptides in proteomics. The high-throughput nature of this technique provides a challenge for the identification of peptides in complex biological samples. As an important parameter, peptide drift time can be used for enhancing downstream data analysis in IMMS-based proteomics.Results: In this paper, a model is presented based on least square support vectors regression (LS-SVR) method to predict peptide ion drift time in IMMS from the sequence-based features of peptide. Four descriptors were extracted from peptide sequence to represent peptide ions by a 34-component vector. The parameters of LS-SVR were selected by a grid searching strategy, and a 10-fold cross-validation approach was employed for the model training and testing. Our proposed method was tested on three datasets with different charge states. The high prediction performance achieve demonstrate the effectiveness and efficiency of the prediction model.Conclusions: Our proposed LS-SVR model can predict peptide drift time from sequence information in relative high prediction accuracy by a test on a dataset of 595 peptides. This work can enhance the confidence of protein identification by combining with current protein searching techniques. 2013 Wang et al.; licensee BioMed Central Ltd.

Inhibition and Structure of Trichomonas vaginalis Purine Nucleoside Phosphorylase with Picomolar Transition State Analogues

Energy Technology Data Exchange (ETDEWEB)

Rinaldo-Matthis,A.; Wing, C.; Ghanem, M.; Deng, H.; Wu, P.; Gupta, A.; Tyler, P.; Evans, G.; Furneaux, R.; et al.

2007-01-01

Trichomonas vaginalis is a parasitic protozoan purine auxotroph possessing a unique purine salvage pathway consisting of a bacterial type purine nucleoside phosphorylase (PNP) and a purine nucleoside kinase. Thus, T. vaginalis PNP (TvPNP) functions in the reverse direction relative to the PNPs in other organisms. Immucillin-A (ImmA) and DADMe-Immucillin-A (DADMe-ImmA) are transition stte mimics of adenosine with geometric and electrostatic features that resemble early and late transition states of adenosine at the transition state stabilized by TvPNP. ImmA demonstrates slow-onset tight-binding inhibition with TvPNP, to give an equilibrium dissociation constant of 87 pM, an inhibitor release half-time of 17.2 min, and a K{sub m}/K{sub d} ratio of 70,100. DADMe-ImmA resembles a late ribooxacarbenium ion transition state for TvPNP to give a dissociation constant of 30 pM, an inhibitor release half-time of 64 min, and a K{sub m}/K{sub d} ratio of 203,300. The tight binding of DADMe-ImmA supports a late S{sub N}1 transition state. Despite their tight binding to TvPNP, ImmA and DADMe-ImmA are weak inhibitors of human and P. falciparum PNPs. The crystal structures of the TvPNP-ImmA{center_dot}PO{sub 4} and TvPNP{center_dot}DADMe-ImmA{center_dot}PO{sub 4} ternary complexes differ from previous structures with substrate anologues. The tight binding with DADMe-ImmA is in part due to a 2.7 {angstrom} ionic interaction between a PO{sub 4} oxygen and the N1 cation of the hydroxypyrrolidine and is weaker in the TvPNP{center_dot}ImmA{center_dot}PO{sub 4} structure at 3.5 {angstrom}. However, the TvPNP{center_dot}ImmA{center_dot}PO{sub 4} structure includes hydrogen bonds between the 2'-hydroxyl and the protein that are not present in TvPNP{center_dot}DADMe-ImmA{center_dot}PO{sub 4}. These structures explain why DADMe-ImmA binds tighter than ImmA. Immucillin-H is a 12 nM inhibitor of TvPNP but a 56 pM inhibitor of human PNP. And this difference is explained by isotope

Multilevel Modeling and Policy Development: Guidelines and Applications to Medical Travel

Science.gov (United States)

Garcia-Garzon, Eduardo; Zhukovsky, Peter; Haller, Elisa; Plakolm, Sara; Fink, David; Petrova, Dafina; Mahalingam, Vaishali; Menezes, Igor G.; Ruggeri, Kai

2016-01-01

Medical travel has expanded rapidly in recent years, resulting in new markets and increased access to medical care. Whereas several studies investigated the motives of individuals seeking healthcare abroad, the conventional analytical approach is limited by substantial caveats. Classical techniques as found in the literature cannot provide sufficient insight due to the nested nature of data generated. The application of adequate analytical techniques, specifically multilevel modeling, is scarce to non-existent in the context of medical travel. This study introduces the guidelines for application of multilevel techniques in public health research by presenting an application of multilevel modeling in analyzing the decision-making patterns of potential medical travelers. Benefits and potential limitations are discussed. PMID:27252672

Multilevel Modeling and Policy Development: Guidelines and Applications to Medical Travel.

Science.gov (United States)

Garcia-Garzon, Eduardo; Zhukovsky, Peter; Haller, Elisa; Plakolm, Sara; Fink, David; Petrova, Dafina; Mahalingam, Vaishali; Menezes, Igor G; Ruggeri, Kai

2016-01-01

Medical travel has expanded rapidly in recent years, resulting in new markets and increased access to medical care. Whereas several studies investigated the motives of individuals seeking healthcare abroad, the conventional analytical approach is limited by substantial caveats. Classical techniques as found in the literature cannot provide sufficient insight due to the nested nature of data generated. The application of adequate analytical techniques, specifically multilevel modeling, is scarce to non-existent in the context of medical travel. This study introduces the guidelines for application of multilevel techniques in public health research by presenting an application of multilevel modeling in analyzing the decision-making patterns of potential medical travelers. Benefits and potential limitations are discussed.

Models and Algorithms for Tracking Target with Coordinated Turn Motion

Directory of Open Access Journals (Sweden)

Xianghui Yuan

2014-01-01

Full Text Available Tracking target with coordinated turn (CT motion is highly dependent on the models and algorithms. First, the widely used models are compared in this paper—coordinated turn (CT model with known turn rate, augmented coordinated turn (ACT model with Cartesian velocity, ACT model with polar velocity, CT model using a kinematic constraint, and maneuver centered circular motion model. Then, in the single model tracking framework, the tracking algorithms for the last four models are compared and the suggestions on the choice of models for different practical target tracking problems are given. Finally, in the multiple models (MM framework, the algorithm based on expectation maximization (EM algorithm is derived, including both the batch form and the recursive form. Compared with the widely used interacting multiple model (IMM algorithm, the EM algorithm shows its effectiveness.

Dual processing model of medical decision-making

OpenAIRE

Djulbegovic, Benjamin; Hozo, Iztok; Beckstead, Jason; Tsalatsanis, Athanasios; Pauker, Stephen G

2012-01-01

Abstract Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administe...

Model construction by students within an integrated medical curriculum.

Science.gov (United States)

Barling, Peter M; Ramasamy, Perumal

2011-03-01

This paper presents our experience of running a special study module (SSM) in the second semester of the first year of our 5-year medical programme, worth 10 per cent of that semester's assessment, in which each student constructs an individually selected model illustrating a specific aspect of the teaching course. Each student conceptualises and develops his or her model, to clarify a specific aspect of medical teaching. The use of non-traditional materials in construction is strongly encouraged. Six weeks later, each student presents their model for assessment by four first-year academic teaching staff. The student is quizzed about the concepts that he or she presents, the mode of construction and the materials used. The students' projects broadly cover the disciplines of physiology, biochemistry and anatomy, but are somewhat biased towards anatomy. Students spend on average about 14 hours planning and building their models, at a time when they are busy with other teaching activities. The marks awarded for the projects closely follow a normal distribution. A survey suggests that most students enjoy the exercise and feel that it has enhanced their learning and understanding. It is clear from the wide variety of different topics, models and materials that students are highly resourceful in their modelling. Creative activity does not generally play a substantial part in medical education, but is of considerable importance. The development of their models stimulates, informs and educates the constructors, and provides a teaching resource for later use in didactic teaching. © Blackwell Publishing Ltd 2011.

The GRAIL concept modelling language for medical terminology.

Science.gov (United States)

Rector, A L; Bechhofer, S; Goble, C A; Horrocks, I; Nowlan, W A; Solomon, W D

1997-02-01

The GALEN representation and integration language (GRAIL) has been developed to support effective clinical user interfaces and extensible re-usable models of medical terminology. It has been used successfully to develop the prototype GALEN common reference (CORE) model for medical terminology and for a series of projects in clinical user interfaces within the GALEN and PEN&PAD projects. GRAIL is a description logic or frame language with novel features to support part-whole and other transitive relations and to support the GALEN modelling style aimed at re-use and application independence. GRAIL began as an experimental language. However, it has clarified many requirements for an effective knowledge representation language for clinical concepts. It still has numerous limitations despite its practical successes. The GRAIL experience is expected to form the basis for future languages which meet the same requirements but have greater expressiveness and more soundly based semantics. This paper provides a description and motivation for the GRAIL language and gives examples of the modelling paradigm which it supports.

Application of Computer Simulation Modeling to Medication Administration Process Redesign

Directory of Open Access Journals (Sweden)

Nathan Huynh

2012-01-01

Full Text Available The medication administration process (MAP is one of the most high-risk processes in health care. MAP workflow redesign can precipitate both unanticipated and unintended consequences that can lead to new medication safety risks and workflow inefficiencies. Thus, it is necessary to have a tool to evaluate the impact of redesign approaches in advance of their clinical implementation. This paper discusses the development of an agent-based MAP computer simulation model that can be used to assess the impact of MAP workflow redesign on MAP performance. The agent-based approach is adopted in order to capture Registered Nurse medication administration performance. The process of designing, developing, validating, and testing such a model is explained. Work is underway to collect MAP data in a hospital setting to provide more complex MAP observations to extend development of the model to better represent the complexity of MAP.

Evaluation of the efficacy of intramuscular versus intramammary treatment of subclinical Streptococcus agalactiae mastitis in dairy cows in Colombia.

Science.gov (United States)

Reyes, J; Chaffer, M; Sanchez, J; Torres, G; Macias, D; Jaramillo, M; Duque, P C; Ceballos, A; Keefe, G P

2015-08-01

A randomized controlled trial was performed in 17 Colombian dairy herds to determine the cure risk among cows subclinically infected with Streptococcus agalactiae exposed to 2 antibiotic therapies. Composite milk samples were collected before milking at the onset of the trial (pretreatment) and 2 subsequent times over a period of approximately 63 d. The intramammary application (IMM) of ampicillin-cloxacillin was compared with the intramuscular application (IM) of penethamate hydriodide, and cure risks after an initial and retreatment application were assessed. Cure risk after the initial treatment was higher (82.4%) for the IMM treatment than for IM therapy (65.8%). However, no difference was observed in the cure risk of refractory cases after retreatment (IMM=52.6% vs. IM=51.2%). The cumulative cure risk (both initial and retreatment) was 90.4 and 82.9% for the IMM and IM products, respectively. A 2-level random effects logistic model that controlled for pretreatment cow-level somatic cell count, indicated that IM treatment (odds ratio=0.37) had a lower cure risk than IMM and a tendency for a lower cure risk with increasing baseline somatic cell count. Our findings suggest that both products and administration routes can reduce the prevalence of S. agalactiae in affected herds, but the IMM product had a better efficacy in curing the infection. In addition to the treatment protocol, the cow somatic cell count should be considered when making management decisions for cows infected with S. agalactiae. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Review of early assessment models of innovative medical technologies

DEFF Research Database (Denmark)

Fasterholdt, Iben; Krahn, Murray D; Kidholm, Kristian

2017-01-01

INTRODUCTION: Hospitals increasingly make decisions regarding the early development of and investment in technologies, but a formal evaluation model for assisting hospitals early on in assessing the potential of innovative medical technologies is lacking. This article provides an overview of models...

Predicting medical complications after spine surgery: a validated model using a prospective surgical registry.

Science.gov (United States)

Lee, Michael J; Cizik, Amy M; Hamilton, Deven; Chapman, Jens R

2014-02-01

The possibility and likelihood of a postoperative medical complication after spine surgery undoubtedly play a major role in the decision making of the surgeon and patient alike. Although prior study has determined relative risk and odds ratio values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of medical complication, rather than relative risk or odds ratio values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. The purpose of this study was to create and validate a predictive model for the risk of medical complication during and after spine surgery. Statistical analysis using a prospective surgical spine registry that recorded extensive demographic, surgical, and complication data. Outcomes examined are medical complications that were specifically defined a priori. This analysis is a continuation of statistical analysis of our previously published report. Using a prospectively collected surgical registry of more than 1,476 patients with extensive demographic, comorbidity, surgical, and complication detail recorded for 2 years after surgery, we previously identified several risk factor for medical complications. Using the beta coefficients from those log binomial regression analyses, we created a model to predict the occurrence of medical complication after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created two predictive models: one predicting the occurrence of any medical complication and the other predicting the occurrence of a major medical complication. The final predictive model for any medical complications had a receiver operator curve characteristic of 0.76, considered to be a fair measure. The final predictive model for any major medical complications had

A Discussion of Virtual Reality As a New Tool for Training Healthcare Professionals

OpenAIRE

Caroline Fertleman; Caroline Fertleman; Phoebe Aubugeau-Williams; Carmel Sher; Carmel Sher; Ai-Nee Lim; Sophie Lumley; Sylvie Delacroix; Xueni Pan

2018-01-01

BackgroundVirtual reality technology is an exciting and emerging field with vast applications. Our study sets out the viewpoint that virtual reality software could be a new focus of direction in the development of training tools in medical education. We carried out a panel discussion at the Center for Behavior Change 3rd Annual Conference, prompted by the study, “The Responses of Medical General Practitioners to Unreasonable Patient Demand for Antibiotics––A Study of Medical Ethics Using Imme...

Magnetically-driven medical robots: An analytical magnetic model for endoscopic capsules design

Science.gov (United States)

Li, Jing; Barjuei, Erfan Shojaei; Ciuti, Gastone; Hao, Yang; Zhang, Peisen; Menciassi, Arianna; Huang, Qiang; Dario, Paolo

2018-04-01

Magnetic-based approaches are highly promising to provide innovative solutions for the design of medical devices for diagnostic and therapeutic procedures, such as in the endoluminal districts. Due to the intrinsic magnetic properties (no current needed) and the high strength-to-size ratio compared with electromagnetic solutions, permanent magnets are usually embedded in medical devices. In this paper, a set of analytical formulas have been derived to model the magnetic forces and torques which are exerted by an arbitrary external magnetic field on a permanent magnetic source embedded in a medical robot. In particular, the authors modelled cylindrical permanent magnets as general solution often used and embedded in magnetically-driven medical devices. The analytical model can be applied to axially and diametrically magnetized, solid and annular cylindrical permanent magnets in the absence of the severe calculation complexity. Using a cylindrical permanent magnet as a selected solution, the model has been applied to a robotic endoscopic capsule as a pilot study in the design of magnetically-driven robots.

Reengineering Real-Time Software Systems

Science.gov (United States)

1993-09-09

Advisor : Yutaka Kanayama Approved for public release; distribution is unlimited. 93-29769 93 12 6 098 Form Appmoved REPORT DOCUMENTATION PAGE 1o No. PI rep...line...and~parabola() Queue.c inc...getinst() Queue.c readjinst() Queue.c se~_insto ImmCmd.c accO0) ImmCmd.c getjineO() ImmCmd.c get robO () ImmCmd.c

Proposing a Model of Co-Regulated Learning for Graduate Medical Education.

Science.gov (United States)

Rich, Jessica V

2017-08-01

Primarily grounded in Zimmerman's social cognitive model of self-regulation, graduate medical education is guided by principles that self-regulated learning takes place within social context and influence, and that the social context and physical environment reciprocally influence persons and their cognition, behavior, and development. However, contemporary perspectives on self-regulation are moving beyond Zimmerman's triadic reciprocal orientation to models that consider social transactions as the central core of regulated learning. Such co-regulated learning models emphasize shared control of learning and the role more advanced others play in scaffolding novices' metacognitive engagement.Models of co-regulated learning describe social transactions as periods of distributed regulation among individuals, which instrumentally promote or inhibit the capacity for individuals to independently self-regulate. Social transactions with other regulators, including attending physicians, more experienced residents, and allied health care professionals, are known to mediate residents' learning and to support or hamper the development of their self-regulated learning competence. Given that social transactions are at the heart of learning-oriented assessment and entrustment decisions, an appreciation for co-regulated learning is likely important for advancing medical education research and practice-especially given the momentum of new innovations such as entrustable professional activities.In this article, the author explains why graduate medical educators should consider adopting a model of co-regulated learning to complement and extend Zimmerman's models of self-regulated learning. In doing so, the author suggests a model of co-regulated learning and provides practical examples of how the model is relevant to graduate medical education research and practice.

Experiences of building a medical data acquisition system based on two-level modeling.

Science.gov (United States)

Li, Bei; Li, Jianbin; Lan, Xiaoyun; An, Ying; Gao, Wuqiang; Jiang, Yuqiao

2018-04-01

Compared to traditional software development strategies, the two-level modeling approach is more flexible and applicable to build an information system in the medical domain. However, the standards of two-level modeling such as openEHR appear complex to medical professionals. This study aims to investigate, implement, and improve the two-level modeling approach, and discusses the experience of building a unified data acquisition system for four affiliated university hospitals based on this approach. After the investigation, we simplified the approach of archetype modeling and developed a medical data acquisition system where medical experts can define the metadata for their own specialties by using a visual easy-to-use tool. The medical data acquisition system for multiple centers, clinical specialties, and diseases has been developed, and integrates the functions of metadata modeling, form design, and data acquisition. To date, 93,353 data items and 6,017 categories for 285 specific diseases have been created by medical experts, and over 25,000 patients' information has been collected. OpenEHR is an advanced two-level modeling method for medical data, but its idea to separate domain knowledge and technical concern is not easy to realize. Moreover, it is difficult to reach an agreement on archetype definition. Therefore, we adopted simpler metadata modeling, and employed What-You-See-Is-What-You-Get (WYSIWYG) tools to further improve the usability of the system. Compared with the archetype definition, our approach lowers the difficulty. Nevertheless, to build such a system, every participant should have some knowledge in both medicine and information technology domains, as these interdisciplinary talents are necessary. Copyright © 2018 Elsevier B.V. All rights reserved.

Role modelling in medical education: the importance of teaching skills.

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Burgess, Annette; Oates, Kim; Goulston, Kerry

2016-04-01

By observation of role models, and participation in activities, students develop their attitudes, values and professional competencies. Literature suggests that clinical skills and knowledge, personality, and teaching skills are three main areas that students consider central to the identification of positive role models. The aim of this study was to explore junior medical students' opinions of the ideal attributes of a good role model in clinical tutors. The study was conducted with one cohort (n = 301) of students who had completed year 1 of the medical programme in 2013. All students were asked to complete a questionnaire regarding the ideal attributes of a good role model in a clinical tutor. The questionnaire consisted of seven closed items and one open-ended question. The response rate to the questionnaire was 265/301 (88%). Although students found all three key areas important in a good role model, students emphasised the importance of excellence in teaching skills. Specifically, students see good role models as being able to provide a constructive learning environment, a good understanding of the curriculum and an ability to cater to the learning needs of all students. Students see good role models as being able to provide a constructive learning environment While acknowledging the importance of a patient-centred approach, as well as clinical knowledge and skills, our findings reinforce the importance of the actual teaching abilities of role models within medical education. © 2015 John Wiley & Sons Ltd.

Funding medical education: should we follow a different model to general higher education? Commentary.

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Walsh, Kieran

2015-01-01

There has been much recent discussion on the funding of medical education. There has also been much discussion about the funding of higher education more generally. The topics of discussion have included the rising costs of education; who should pay; the various potential models of funding; and how best to ensure maximum returns from investment. Medical education has largely followed the emerging models of funding for higher education. However there are important reasons why the funding models for higher education may not suit medical education. These reasons include the fact that medical education is as important to the public as it is to the learner; the range of funding sources available to medical schools; the strict regulation of medical education; and the fact that the privatisation and commercialisation of higher education may not been in keeping with the social goals of medical schools and the agenda of diversification within the medical student population.

Wind farm production prediction - The Zephyr model

Energy Technology Data Exchange (ETDEWEB)

Landberg, L. [Risoe National Lab., Wind Energy Dept., Roskilde (Denmark); Giebel, G. [Risoe National Lab., Wind Energy Dept., Roskilde (Denmark); Madsen, H. [IMM (DTU), Kgs. Lyngby (Denmark); Nielsen, T.S. [IMM (DTU), Kgs. Lyngby (Denmark); Joergensen, J.U. [Danish Meteorologisk Inst., Copenhagen (Denmark); Lauersen, L. [Danish Meteorologisk Inst., Copenhagen (Denmark); Toefting, J. [Elsam, Fredericia (DK); Christensen, H.S. [Eltra, Fredericia (Denmark); Bjerge, C. [SEAS, Haslev (Denmark)

2002-06-01

This report describes a project - funded by the Danish Ministry of Energy and the Environment - which developed a next generation prediction system called Zephyr. The Zephyr system is a merging between two state-of-the-art prediction systems: Prediktor of Risoe National Laboratory and WPPT of IMM at the Danish Technical University. The numerical weather predictions were generated by DMI's HIRLAM model. Due to technical difficulties programming the system, only the computational core and a very simple version of the originally very complex system were developed. The project partners were: Risoe, DMU, DMI, Elsam, Eltra, Elkraft System, SEAS and E2. (au)

The Application of Use Case Modeling in Designing Medical Imaging Information Systems

International Nuclear Information System (INIS)

Safdari, Reza; Farzi, Jebraeil; Ghazisaeidi, Marjan; Mirzaee, Mahboobeh; Goodini, Azadeh

2013-01-01

Introduction. The essay at hand is aimed at examining the application of use case modeling in analyzing and designing information systems to support Medical Imaging services. Methods. The application of use case modeling in analyzing and designing health information systems was examined using electronic databases (Pubmed, Google scholar) resources and the characteristics of the modeling system and its effect on the development and design of the health information systems were analyzed. Results. Analyzing the subject indicated that Provident modeling of health information systems should provide for quick access to many health data resources in a way that patients' data can be used in order to expand distant services and comprehensive Medical Imaging advices. Also these experiences show that progress in the infrastructure development stages through gradual and repeated evolution process of user requirements is stronger and this can lead to a decline in the cycle of requirements engineering process in the design of Medical Imaging information systems. Conclusion. Use case modeling approach can be effective in directing the problems of health and Medical Imaging information systems towards understanding, focusing on the start and analysis, better planning, repetition, and control

A Baseline Patient Model to Support Testing of Medical Cyber-Physical Systems.

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Silva, Lenardo C; Perkusich, Mirko; Almeida, Hyggo O; Perkusich, Angelo; Lima, Mateus A M; Gorgônio, Kyller C

2015-01-01

Medical Cyber-Physical Systems (MCPS) are currently a trending topic of research. The main challenges are related to the integration and interoperability of connected medical devices, patient safety, physiologic closed-loop control, and the verification and validation of these systems. In this paper, we focus on patient safety and MCPS validation. We present a formal patient model to be used in health care systems validation without jeopardizing the patient's health. To determine the basic patient conditions, our model considers the four main vital signs: heart rate, respiratory rate, blood pressure and body temperature. To generate the vital signs we used regression models based on statistical analysis of a clinical database. Our solution should be used as a starting point for a behavioral patient model and adapted to specific clinical scenarios. We present the modeling process of the baseline patient model and show its evaluation. The conception process may be used to build different patient models. The results show the feasibility of the proposed model as an alternative to the immediate need for clinical trials to test these medical systems.

Modelling degradation of bioresorbable polymeric medical devices

CERN Document Server

Pan, J

2015-01-01

The use of bioresorbable polymers in stents, fixation devices and tissue engineering is revolutionising medicine. Both industry and academic researchers are interested in using computer modelling to replace some experiments which are costly and time consuming. This book provides readers with a comprehensive review of modelling polymers and polymeric medical devices as an alternative to practical experiments. Chapters in part one provide readers with an overview of the fundamentals of biodegradation. Part two looks at a wide range of degradation theories for bioresorbable polymers and devices.

Trust and risk: a model for medical education.

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Damodaran, Arvin; Shulruf, Boaz; Jones, Philip

2017-09-01

Health care delivery, and therefore medical education, is an inherently risky business. Although control mechanisms, such as external audit and accreditation, are designed to manage risk in clinical settings, another approach is 'trust'. The use of entrustable professional activities (EPAs) represents a deliberate way in which this is operationalised as a workplace-based assessment. Once engaged with the concept, clinical teachers and medical educators may have further questions about trust. This narrative overview of the trust literature explores how risk, trust and control intersect with current thinking in medical education, and makes suggestions for potential directions of enquiry. Beyond EPAs, the importance of trust in health care and medical education is reviewed, followed by a brief history of trust research in the wider literature. Interpersonal and organisational levels of trust and a model of trust from the management literature are used to provide the framework with which to decipher trust decisions in health care and medical education, in which risk and vulnerability are inherent. In workplace learning and assessment, the language of 'trust' may offer a more authentic and practical vocabulary than that of 'competency' because clinical and professional risks are explicitly considered. There are many other trust relationships in health care and medical education. At the most basic level, it is helpful to clearly delineate who is the trustor, the trustee, and for what task. Each relationship has interpersonal and organisational elements. Understanding and considered utilisation of trust and control mechanisms in health care and medical education may lead to systems that maturely manage risk while actively encouraging trust and empowerment. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Discourse in Action: Parents' use of medical and social models to resist disability stigma.

Science.gov (United States)

Manago, Bianca; Davis, Jenny L; Goar, Carla

2017-07-01

For parents of children with disabilities, stigmatization is part of everyday life. To resist the negative social and emotional consequences of stigma, parents both challenge and deflect social devaluations. Challenges work to upend the stigmatizing structure, while deflections maintain the interaction order. We examine how parents of children with disabilities deploy deflections and challenges, and how their stigma resistance strategies combine with available models of disability discourse. Disability discourse falls into two broad categories: medical and social. The medical model emphasizes diagnostic labels and treats impairment as an individual deficit, while the social model centralizes unaccommodating social structures. The social model's activist underpinnings make it a logical frame for parents to use as they challenge disability stigma. In turn, the medical model's focus on individual "improvement" seems to most closely align with stigma deflections. However, the relationship between stigma resistance strategies and models of disability is an empirical question not yet addressed in the literature. In this study, we examine 117 instances of stigmatization from 40 interviews with 43 parents, and document how parents respond. We find that challenges and deflections do not map cleanly onto the social or medical models. Rather, parents invoke medical and social meanings in ways that serve diverse ends, sometimes centralizing a medical label to challenge stigma, and sometimes recognizing disabling social structures, but deflecting stigma nonetheless. Copyright © 2017 Elsevier Ltd. All rights reserved.

Optical mathematical model of medical tourism village at Euan Mousa

International Nuclear Information System (INIS)

Faten H Fahmy

2006-01-01

This paper describes a computer simulation model of the main components of the designed photovoltaic energy system to feed the suggested whole load of the presented medical village. The main topic of this paper is to serve a medical services for special patients who need benefits of natural water spots, and special sand that exist in Euan Mousa, Safaga, South of Sinai. For that, a healthy PV medical tourism village contains all the necessary requirements for these patients and tourists is designed. Also, it presents full hospitality for tourists. The energy flow through the photovoltaic system is determined as time-integrated value of power being produced during each hour. The energy balance model, which governs the behaviour of the different components (array, battery and load), is obtained by considering the energy flow at each component of the system

Motivation in computer-assisted instruction.

Science.gov (United States)

Hu, Amanda; Shewokis, Patricia A; Ting, Kimberly; Fung, Kevin

2016-08-01

Computer-aided instruction (CAI) is defined as instruction in which computers play a central role as the means of information delivery and direct interaction with learners. Computer-aided instruction has become mainstream in medical school curricula. For example, a three-dimensional (3D) computer module of the larynx has been created to teach laryngeal anatomy. Although the novelty and educational potential of CAI has garnered much attention, these new technologies have been plagued with low utilization rates. Several experts attribute this problem to lack of motivation in students. Motivation is defined as the desire and action toward goal-oriented behavior. Psychologist Dr. John Keller developed the ARCS theory of motivational learning, which proposed four components: attention (A), relevance (R), concentration (C), and satisfaction (S). Keller believed that motivation is not only an innate characteristic of the pupil; it can also be influenced by external factors, such as the instructional design of the curriculum. Thus, understanding motivation is an important step to designing CAI appropriately. Keller also developed a 36-item validated instrument called the Instructional Materials Motivation Survey (IMMS) to measure motivation. The objective of this study was to study motivation in CAI. Medical students learning anatomy with the 3D computer module will have higher laryngeal anatomy test scores and higher IMMS motivation scores. Higher anatomy test scores will be positively associated with higher IMMS scores. Prospective, randomized, controlled trial. After obtaining institutional review board approval, 100 medical students (mean age 25.5 ± 2.5, 49% male) were randomized to either the 3D computer module (n = 49) or written text (n = 51). Information content was identical in both arms. Students were given 30 minutes to study laryngeal anatomy and then completed the laryngeal anatomy test and IMMS. Students were categorized as either junior (year 1

A model of user engagement in medical device development.

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Grocott, Patricia; Weir, Heather; Ram, Mala Bridgelal

2007-01-01

The purpose of this paper is to address three topical themes: user involvement in health services research; determining the value of new medical technologies in patient care pathways, furthering knowledge related to quality in health and social care; and knowledge exchange between manufacturers, health service supply chain networks and device users. The model is being validated in a case study in progress. The latter is a "proving ground" study for a translational research company. Medical devices play a pivotal role in the management of chronic diseases, across all care settings. Failure to engage users in device development inevitably affects the quality of clinical outcomes. A model of user engagement is presented, turning unmet needs for medical devices into viable commercial propositions. A case study investigating the perceptions of individuals with Epidermolysis Bullosa (EB), their lay and professional carers into unmet needs. EB is an inherited condition affecting the skin and mucosal linings that leads to blistering and wounds. Qualitative data are being collected to generate understanding of unmet needs and wound care products. These needs are being translated into new design concepts and prototypes. Prototypes will be evaluated in an n = 1 experimental design, generating quantitative outcomes data. There are generalisations from the case study, and the model outlined. New products for managing EB wounds can logically benefit other groups. The model is transferable to other clinical problems, which can benefit from research and technological advances that are integral to clinical needs and care.

The Advantage of Using International Multimodel Ensemble for Seasonal Precipitation Forecast over Israel

Directory of Open Access Journals (Sweden)

Amir Givati

2017-01-01

Full Text Available This study analyzes the results of monthly and seasonal precipitation forecasting from seven different global climate forecast models for major basins in Israel within October–April 1982–2010. The six National Multimodel Ensemble (NMME models and the ECMWF seasonal model were used to calculate an International Multimodel Ensemble (IMME. The study presents the performance of both monthly and seasonal predictions of precipitation accumulated over three months, with respect to different lead times for the ensemble mean values, one per individual model. Additionally, we analyzed the performance of different combinations of models. We present verification of seasonal forecasting using real forecasts, focusing on a small domain characterized by complex terrain, high annual precipitation variability, and a sharp precipitation gradient from west to east as well as from south to north. The results in this study show that, in general, the monthly analysis does not provide very accurate results, even when using the IMME for one-month lead time. We found that the IMME outperformed any single model prediction. Our analysis indicates that the optimal combinations with the high correlation values contain at least three models. Moreover, prediction with larger number of models in the ensemble produces more robust predictions. The results obtained in this study highlight the advantages of using an ensemble of global models over single models for small domain.

Improving the Efficiency of Medical Services Systems: A New Integrated Mathematical Modeling Approach

Directory of Open Access Journals (Sweden)

Davood Shishebori

2013-01-01

Full Text Available Nowadays, the efficient design of medical service systems plays a critical role in improving the performance and efficiency of medical services provided by governments. Accordingly, health care planners in countries especially with a system based on a National Health Service (NHS try to make decisions on where to locate and how to organize medical services regarding several conditions in different residence areas, so as to improve the geographic equity of comfortable access in the delivery of medical services while accounting for efficiency and cost issues especially in crucial situations. Therefore, optimally locating of such services and also suitable allocating demands them, can help to enhance the performance and responsiveness of medical services system. In this paper, a multiobjective mixed integer nonlinear programming model is proposed to decide locations of new medical system centers, link roads that should be constructed or improved, and also urban residence centers covered by these medical service centers and link roads under investment budget constraint in order to both minimize the total transportation cost of the overall system and minimize the total failure cost (i.e., maximize the system reliability of medical service centers under unforeseen situations. Then, the proposed model is linearized by suitable techniques. Moreover, a practical case study is presented in detail to illustrate the application of the proposed mathematical model. Finally, a sensitivity analysis is done to provide an insight into the behavior of the proposed model in response to changes of key parameters of the problem.

Information Governance: A Model for Security in Medical Practice

Directory of Open Access Journals (Sweden)

Patricia A.H. Williams

2007-03-01

Full Text Available Information governance is becoming an important aspect of organisational accountability. In consideration that information is an integral asset of most organisations, the protection of this asset will increasingly rely on organisational capabilities in security.  In the medical arena this information is primarily sensitive patient-based information. Previous research has shown that application of security measures is a low priority for primary care medical practice and that awareness of the risks are seriously underestimated. Consequently, information security governance will be a key issue for medical practice in the future. Information security governance is a relatively new term and there is little existing research into how to meet governance requirements. The limited research that exists describes information security governance frameworks at a strategic level. However, since medical practice is already lagging in the implementation of appropriate security, such definition may not be practical although it is obviously desirable. This paper describes an on-going action research project undertaken in the area of medical information security, and presents a tactical approach model aimed at addressing information security governance and the protection of medical data. 

Topic modeling for cluster analysis of large biological and medical datasets.

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Zhao, Weizhong; Zou, Wen; Chen, James J

2014-01-01

The big data moniker is nowhere better deserved than to describe the ever-increasing prodigiousness and complexity of biological and medical datasets. New methods are needed to generate and test hypotheses, foster biological interpretation, and build validated predictors. Although multivariate techniques such as cluster analysis may allow researchers to identify groups, or clusters, of related variables, the accuracies and effectiveness of traditional clustering methods diminish for large and hyper dimensional datasets. Topic modeling is an active research field in machine learning and has been mainly used as an analytical tool to structure large textual corpora for data mining. Its ability to reduce high dimensionality to a small number of latent variables makes it suitable as a means for clustering or overcoming clustering difficulties in large biological and medical datasets. In this study, three topic model-derived clustering methods, highest probable topic assignment, feature selection and feature extraction, are proposed and tested on the cluster analysis of three large datasets: Salmonella pulsed-field gel electrophoresis (PFGE) dataset, lung cancer dataset, and breast cancer dataset, which represent various types of large biological or medical datasets. All three various methods are shown to improve the efficacy/effectiveness of clustering results on the three datasets in comparison to traditional methods. A preferable cluster analysis method emerged for each of the three datasets on the basis of replicating known biological truths. Topic modeling could be advantageously applied to the large datasets of biological or medical research. The three proposed topic model-derived clustering methods, highest probable topic assignment, feature selection and feature extraction, yield clustering improvements for the three different data types. Clusters more efficaciously represent truthful groupings and subgroupings in the data than traditional methods, suggesting

The approach of Bayesian model indicates media awareness of medical errors

Science.gov (United States)

Ravichandran, K.; Arulchelvan, S.

2016-06-01

This research study brings out the factors behind the increase in medical malpractices in the Indian subcontinent in the present day environment and impacts of television media awareness towards it. Increased media reporting of medical malpractices and errors lead to hospitals taking corrective action and improve the quality of medical services that they provide. The model of Cultivation Theory can be used to measure the influence of media in creating awareness of medical errors. The patient's perceptions of various errors rendered by the medical industry from different parts of India were taken up for this study. Bayesian method was used for data analysis and it gives absolute values to indicate satisfaction of the recommended values. To find out the impact of maintaining medical records of a family online by the family doctor in reducing medical malpractices which creates the importance of service quality in medical industry through the ICT.

The theory of planned behaviour in medical education: a model for integrating professionalism training.

Science.gov (United States)

Archer, Ray; Elder, William; Hustedde, Carol; Milam, Andrea; Joyce, Jennifer

2008-08-01

Teaching and evaluating professionalism remain important issues in medical education. However, two factors hinder attempts to integrate curricular elements addressing professionalism into medical school training: there is no common definition of medical professionalism used across medical education, and there is no commonly accepted theoretical model upon which to integrate professionalism into the curriculum. This paper proposes a definition of professionalism, examines this definition in the context of some of the previous definitions of professionalism and connects this definition to the attitudinal roots of professionalism. The problems described above bring uncertainty about the best content and methods with which to teach professionalism in medical education. Although various aspects of professionalism have been incorporated into medical school curricula, content, teaching and evaluation remain controversial. We suggest that intervening variables, which may augment or interfere with medical students' implementation of professionalism knowledge, skills and, therefore, attitudes, may go unaddressed. We offer a model based on the theory of planned behaviour (TPB), which describes the relationships of attitudes, social norms and perceived behavioural control with behaviour. It has been used to predict a wide range of behaviours, including doctor professional behaviours. Therefore, we propose an educational model that expands the TPB as an organisational framework that can integrate professionalism training into medical education. We conclude with a discussion about the implications of using this model to transform medical school curricula to develop positive professionalism attitudes, alter the professionalism social norms of the medical school and increase students' perceived control over their behaviours.

Role modelling of clinical tutors: a focus group study among medical students.

Science.gov (United States)

Burgess, Annette; Goulston, Kerry; Oates, Kim

2015-02-14

Role modelling by clinicians assists in development of medical students' professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students' perceptions of their bedside clinical tutors as role models during the first year of a medical program. The study was conducted with one cohort (n = 301) of students who had completed Year 1 of the Sydney Medical Program in 2013. A total of nine focus groups (n = 59) were conducted with medical students following completion of Year 1. Data were transcribed verbatim. Thematic analysis was used to code and categorise data into themes. Students identified both positive and negative characteristics and behaviour displayed by their clinical tutors. Characteristics and behaviour that students would like to emulate as medical practitioners in the future included: 1) Clinical attributes: a good knowledge base; articulate history taking skills; the ability to explain and demonstrate skills at the appropriate level for students; and empathy, respect and genuine compassion for patients. 2) Teaching skills: development of a rapport with students; provision of time towards the growth of students academically and professionally; provision of a positive learning environment; an understanding of the student curriculum and assessment requirements; immediate and useful feedback; and provision of patient interaction. 3) Personal qualities: respectful interprofessional staff interactions; preparedness for tutorials; demonstration of a passion for teaching; and demonstration of a passion for their career choice. Excellence in role modelling entails demonstration of excellent clinical care, teaching skills and personal characteristics. Our findings reinforce the important function of clinical bedside tutors as role models, which has implications for faculty development and

Medical Device Integration Model Based on the Internet of Things

Science.gov (United States)

Hao, Aiyu; Wang, Ling

2015-01-01

At present, hospitals in our country have basically established the HIS system, which manages registration, treatment, and charge, among many others, of patients. During treatment, patients need to use medical devices repeatedly to acquire all sorts of inspection data. Currently, the output data of the medical devices are often manually input into information system, which is easy to get wrong or easy to cause mismatches between inspection reports and patients. For some small hospitals of which information construction is still relatively weak, the information generated by the devices is still presented in the form of paper reports. When doctors or patients want to have access to the data at a given time again, they can only look at the paper files. Data integration between medical devices has long been a difficult problem for the medical information system, because the data from medical devices are lack of mandatory unified global standards and have outstanding heterogeneity of devices. In order to protect their own interests, manufacturers use special protocols, etc., thus causing medical decices to still be the "lonely island" of hospital information system. Besides, unfocused application of the data will lead to failure to achieve a reasonable distribution of medical resources. With the deepening of IT construction in hospitals, medical information systems will be bound to develop towards mobile applications, intelligent analysis, and interconnection and interworking, on the premise that there is an effective medical device integration (MDI) technology. To this end, this paper presents a MDI model based on the Internet of Things (IoT). Through abstract classification, this model is able to extract the common characteristics of the devices, resolve the heterogeneous differences between them, and employ a unified protocol to integrate data between devices. And by the IoT technology, it realizes interconnection network of devices and conducts associate matching

[Self-Determination in Medical Rehabilitation - Development of a Conceptual Model for Further Theoretical Discussion].

Science.gov (United States)

Senin, Tatjana; Meyer, Thorsten

2018-01-22

Aim was to gather theoretical knowledge about self-determination and to develop a conceptual model for medical rehabilitation- which serves as a basis for discussion. We performed a literature research in electronic databases. Various theories and research results were adopted and transferred to the context of medical rehabilitation and into a conceptual model. The conceptual model of self-determination reflects on a continuum which forms of self-determination may be present in situations of medical rehabilitation treatments. The location on the continuum depends theoretically on the manifestation of certain internal and external factors that may influence each other. The model provides a first conceptualization of self-determination focusing on medical rehabilitation which should be further refined and tested empirically. © Georg Thieme Verlag KG Stuttgart · New York.

Support for medical students with mental health problems: a conceptual model.

Science.gov (United States)

Grant, Andrew; Rix, Andrew; Winter, Peter; Mattick, Karen; Jones, Debbie

2015-02-01

Medical students experience higher prevalence of mental illness than age-matched controls and are less likely to access appropriate help when this happens. The aim of this study was to determine the range of strategies deployed by medical schools to support medical students with mental health concerns and to use this to identify distinct categories. Websites and documents relating to all 32 UK medical schools were looked at, as were reports for quality assurance visits carried out by the General Medical Council (UK). A structured telephone interview was carried out with medical schools. Support services were examined by tracing the path that might be taken by a hypothetical student with mental health concerns of varying severity, seeing what was required and what was available at each stage. A range of support strategies is available to most medical students both from their medical school and from generic services in the university. Medical students will usually first contact a personal tutor or a senior member of faculty or be contacted by them as a result of concerns raised either via performance issues or by another student. While individual support interventions are mostly based on evidence of effectiveness, there is no unifying theory in terms of what constitutes effective support. To enable analysis of support interventions and comparison across providers, a six-stage conceptual model of prevention was developed. The six stages are the following: prevention, identification, referral, escalation, treatment, and reintegration. The staged model, derived from analysis of existing interventions, provides a framework for evaluation of current provision and comparison of different methods of delivery. Moreover, it provides a framework for future research.

Predicting Urban Medical Services Demand in China: An Improved Grey Markov Chain Model by Taylor Approximation.

Science.gov (United States)

Duan, Jinli; Jiao, Feng; Zhang, Qishan; Lin, Zhibin

2017-08-06

The sharp increase of the aging population has raised the pressure on the current limited medical resources in China. To better allocate resources, a more accurate prediction on medical service demand is very urgently needed. This study aims to improve the prediction on medical services demand in China. To achieve this aim, the study combines Taylor Approximation into the Grey Markov Chain model, and develops a new model named Taylor-Markov Chain GM (1,1) (T-MCGM (1,1)). The new model has been tested by adopting the historical data, which includes the medical service on treatment of diabetes, heart disease, and cerebrovascular disease from 1997 to 2015 in China. The model provides a predication on medical service demand of these three types of disease up to 2022. The results reveal an enormous growth of urban medical service demand in the future. The findings provide practical implications for the Health Administrative Department to allocate medical resources, and help hospitals to manage investments on medical facilities.

Advancing the large-scale CCS database for metabolomics and lipidomics at the machine-learning era.

Science.gov (United States)

Zhou, Zhiwei; Tu, Jia; Zhu, Zheng-Jiang

2018-02-01

Metabolomics and lipidomics aim to comprehensively measure the dynamic changes of all metabolites and lipids that are present in biological systems. The use of ion mobility-mass spectrometry (IM-MS) for metabolomics and lipidomics has facilitated the separation and the identification of metabolites and lipids in complex biological samples. The collision cross-section (CCS) value derived from IM-MS is a valuable physiochemical property for the unambiguous identification of metabolites and lipids. However, CCS values obtained from experimental measurement and computational modeling are limited available, which significantly restricts the application of IM-MS. In this review, we will discuss the recently developed machine-learning based prediction approach, which could efficiently generate precise CCS databases in a large scale. We will also highlight the applications of CCS databases to support metabolomics and lipidomics. Copyright © 2017 Elsevier Ltd. All rights reserved.

Models for integrating medical acupuncture into practice: an exploratory qualitative study of physicians' experiences.

Science.gov (United States)

Crumley, Ellen T

2016-08-01

Internationally, physicians are integrating medical acupuncture into their practice. Although there are some informative surveys and reviews, there are few international, exploratory studies detailing how physicians have accommodated medical acupuncture (eg, by modifying schedules, space and processes). To examine how physicians integrate medical acupuncture into their practice. Semi-structured interviews and participant observations of physicians practising medical acupuncture were conducted using convenience and snowball sampling. Data were analysed in NVivo and themes were developed. Despite variation, three principal models were developed to summarise the different ways that physicians integrated medical acupuncture into their practice, using the core concept of 'helping'. Quotes were used to illustrate each model and its corresponding themes. There were 25 participants from 11 countries: 21 agreed to be interviewed and four engaged in participant observations. Seventy-two per cent were general practitioners. The three models were: (1) appointments (44%); (2) clinics (44%); and (3) full-time practice (24%). Some physicians held both appointments and regular clinics (models 1 and 2). Most full-time physicians initially tried appointments and/or clinics. Some physicians charged to offset administration costs or compensate for their time. Despite variation within each category, the three models encapsulated how physicians described their integration of medical acupuncture. Physicians varied in how often they administered medical acupuncture and the amount of time they spent with patients. Although 24% of physicians surveyed administered medical acupuncture full-time, most practised it part-time. Each individual physician incorporated medical acupuncture in the way that worked best for their practice. 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/

A basket two-part model to analyze medical expenditure on interdependent multiple sectors.

Science.gov (United States)

Sugawara, Shinya; Wu, Tianyi; Yamanishi, Kenji

2018-05-01

This study proposes a novel statistical methodology to analyze expenditure on multiple medical sectors using consumer data. Conventionally, medical expenditure has been analyzed by two-part models, which separately consider purchase decision and amount of expenditure. We extend the traditional two-part models by adding the step of basket analysis for dimension reduction. This new step enables us to analyze complicated interdependence between multiple sectors without an identification problem. As an empirical application for the proposed method, we analyze data of 13 medical sectors from the Medical Expenditure Panel Survey. In comparison with the results of previous studies that analyzed the multiple sector independently, our method provides more detailed implications of the impacts of individual socioeconomic status on the composition of joint purchases from multiple medical sectors; our method has a better prediction performance.

Evaluation of HVS models in the application of medical image quality assessment

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Zhang, L.; Cavaro-Menard, C.; Le Callet, P.

2012-03-01

In this study, four of the most widely used Human Visual System (HVS) models are applied on Magnetic Resonance (MR) images for signal detection task. Their performances are evaluated against gold standard derived from radiologists' majority decision. The task-based image quality assessment requires taking into account the human perception specificities, for which various HVS models have been proposed. However to our knowledge, no work was conducted to evaluate and compare the suitability of these models with respect to the assessment of medical image qualities. This pioneering study investigates the performances of different HVS models on medical images in terms of approximation to radiologist performance. We propose to score the performance of each HVS model using the AUC (Area Under the receiver operating characteristic Curve) and its variance estimate as the figure of merit. The radiologists' majority decision is used as gold standard so that the estimated AUC measures the distance between the HVS model and the radiologist perception. To calculate the variance estimate of AUC, we adopted the one-shot method that is independent of the HVS model's output range. The results of this study will help to provide arguments to the application of some HVS model on our future medical image quality assessment metric.

A model for flexible tools used in minimally invasive medical virtual environments.

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Soler, Francisco; Luzon, M Victoria; Pop, Serban R; Hughes, Chris J; John, Nigel W; Torres, Juan Carlos

2011-01-01

Within the limits of current technology, many applications of a virtual environment will trade-off accuracy for speed. This is not an acceptable compromise in a medical training application where both are essential. Efficient algorithms must therefore be developed. The purpose of this project is the development and validation of a novel physics-based real time tool manipulation model, which is easy to integrate into any medical virtual environment that requires support for the insertion of long flexible tools into complex geometries. This encompasses medical specialities such as vascular interventional radiology, endoscopy, and laparoscopy, where training, prototyping of new instruments/tools and mission rehearsal can all be facilitated by using an immersive medical virtual environment. Our model recognises and uses accurately patient specific data and adapts to the geometrical complexity of the vessel in real time.

An Empirical Assessment of a Technology Acceptance Model for Apps in Medical Education.

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Briz-Ponce, Laura; García-Peñalvo, Francisco José

2015-11-01

The evolution and the growth of mobile applications ("apps") in our society is a reality. This general trend is still upward and the app use has also penetrated the medical education community. However, there is a lot of unawareness of the students' and professionals' point of view about introducing "apps" within Medical School curriculum. The aim of this research is to design, implement and verify that the Technology Acceptance Model (TAM) can be employed to measure and explain the acceptance of mobile technology and "apps" within Medical Education. The methodology was based on a survey distributed to students and medical professionals from University of Salamanca. This model explains 46.7% of behavioral intention to use mobile devise or "apps" for learning and will help us to justify and understand the current situation of introducing "apps" into the Medical School curriculum.

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

Science.gov (United States)

2013-01-01

Background Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication management involves key recurrent activities (determine need, prescribe, dispense, administer, and monitor/evaluate) with information communicated within and between each. Despite its importance, there is a lack of conceptual models that explore medication communication specifically across roles and settings. This research seeks to address that gap. Methods The Circle of Care Modeling (CCM) approach was used to build a model of medication communication activities across the circle of care. CCM positions the patient in the centre of his or her own healthcare system; providers and other roles are then modeled around the patient as a web of relationships. Recurrent medication communication activities were mapped to the medication management framework. The research occurred in three iterations, to test and revise the model: Iteration 1 consisted of a literature review and internal team discussion, Iteration 2 consisted of interviews, observation, and a discussion group at a Community Health Centre, and Iteration 3 consisted of interviews and a discussion group in the larger community. Results Each iteration provided further detail to the Circle of Care medication communication model. Specific medication communication activities were mapped along each communication pathway between roles and to the medication management framework. We could not map all medication communication activities to the medication management framework; we added Coordinate as a separate and distinct recurrent activity

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

Science.gov (United States)

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

2013-10-17

Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication management involves key recurrent activities (determine need, prescribe, dispense, administer, and monitor/evaluate) with information communicated within and between each. Despite its importance, there is a lack of conceptual models that explore medication communication specifically across roles and settings. This research seeks to address that gap. The Circle of Care Modeling (CCM) approach was used to build a model of medication communication activities across the circle of care. CCM positions the patient in the centre of his or her own healthcare system; providers and other roles are then modeled around the patient as a web of relationships. Recurrent medication communication activities were mapped to the medication management framework. The research occurred in three iterations, to test and revise the model: Iteration 1 consisted of a literature review and internal team discussion, Iteration 2 consisted of interviews, observation, and a discussion group at a Community Health Centre, and Iteration 3 consisted of interviews and a discussion group in the larger community. Each iteration provided further detail to the Circle of Care medication communication model. Specific medication communication activities were mapped along each communication pathway between roles and to the medication management framework. We could not map all medication communication activities to the medication management framework; we added Coordinate as a separate and distinct recurrent activity. We saw many examples of

Is a Three-Dimensional Printing Model Better Than a Traditional Cardiac Model for Medical Education? A Pilot Randomized Controlled Study.

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Wang, Zhongmin; Liu, Yuhao; Luo, Hongxing; Gao, Chuanyu; Zhang, Jing; Dai, Yuya

2017-11-01

Three-dimensional (3D) printing is a newly-emerged technology converting a series of two-dimensional images to a touchable 3D model, but no studies have investigated whether or not a 3D printing model is better than a traditional cardiac model for medical education. A 3D printing cardiac model was generated using multi-slice computed tomography datasets. Thirty-four medical students were randomized to either the 3D Printing Group taught with the aid of a 3D printing cardiac model or the Traditional Model Group with a commonly used plastic cardiac model. Questionnaires with 10 medical questions and 3 evaluative questions were filled in by the students. A 3D printing cardiac model was successfully generated. Students in the 3D Printing Group were slightly quicker to answer all questions when compared with the Traditional Model Group (224.53 ± 44.13 s vs. 238.71 ± 68.46 s, p = 0.09), but the total score was not significantly different (6.24 ± 1.30 vs. 7.18 ± 1.70, p = 0.12). Neither the students'satisfaction (p = 0.48) nor their understanding of cardiac structures (p = 0.24) was significantly different between two groups. More students in the 3D Printing Group believed that they had understood at least 90% of teaching content (6 vs. 1). Both groups had 12 (70.6%) students who preferred a 3D printing model for medical education. A 3D printing model was not significantly superior to a traditional model in teaching cardiac diseases in our pilot randomized controlled study, yet more studies may be conducted to validate the real effect of 3D printing on medical education.

Patient-centered medical home model: do school-based health centers fit the model?

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Larson, Satu A; Chapman, Susan A

2013-01-01

School-based health centers (SBHCs) are an important component of health care reform. The SBHC model of care offers accessible, continuous, comprehensive, family-centered, coordinated, and compassionate care to infants, children, and adolescents. These same elements comprise the patient-centered medical home (PCMH) model of care being promoted by the Affordable Care Act with the hope of lowering health care costs by rewarding clinicians for primary care services. PCMH survey tools have been developed to help payers determine whether a clinician/site serves as a PCMH. Our concern is that current survey tools will be unable to capture how a SBHC may provide a medical home and therefore be denied needed funding. This article describes how SBHCs might meet the requirements of one PCMH tool. SBHC stakeholders need to advocate for the creation or modification of existing survey tools that allow the unique characteristics of SBHCs to qualify as PCMHs.

The Medical Home Model and Pediatric Asthma Symptom Severity: Evidence from a National Health Survey.

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Rojanasarot, Sirikan; Carlson, Angeline M

2018-04-01

The objective was to investigate the association between receiving care under the medical home model and parental assessment of the severity of asthma symptoms. It was hypothesized that parents of children who received care under the medical home model reported less severe asthma symptoms compared with their counterparts, whose care did not meet the medical home criteria. Secondary analyses were conducted using cross-sectional data from the 2011-2012 National Survey of Children's Health. Children with asthma aged 0-17 years were included and classified as receiving care from the medical home if their care contained 5 components: a personal doctor, a usual source of sick care, family-centered care, no problems getting referrals, and effective care coordination. Ordinal logistic regression was used to examine the relationship between parent-rated severity of asthma symptoms (mild, moderate, and severe symptoms) and the medical home. Approximately 52% of 8229 children who reported having asthma received care from the medical home. Only 30.8% of children with severe asthma symptoms received care that met the medical home criteria, compared to 55.7% of children with mild symptoms. After accounting for confounding factors, obtaining care under the medical home model decreased the odds of parent-reported severe asthma symptoms by 31% (adjusted odds ratio 0.69; 95% CI, 0.56-0.85). Study results suggest that the medical home model can reduce parent-rated severity of asthma symptoms. The findings highlight the importance of providing medical home care to children with asthma to improve the outcomes that matter most to children and their families.

Developing a Model of Tuition Fee Calculation for Universities of Medical Sciences

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Seyed Amir Mohsen Ziaee

2018-01-01

Full Text Available Background: The aim of our study was to introduce and evaluate a practicable model for tuition fee calculation of each medical field in universities of medical sciences in Iran.Methods: Fifty experts in 11 panels were interviewed to identify variables that affect tuition fee calculation. This led to key points including total budgets, expenses of the universities, different fields’ attractiveness, universities’ attractiveness, and education quality. Tuition fees were calculated for different levels of education, such as post-diploma, Bachelor, Master, and Doctor of Philosophy (Ph.D degrees, Medical specialty, and Fellowship. After tuition fee calculation, the model was tested during 2013-2015. Since then, a questionnaire including 20 questions was prepared. All Universities’ financial and educational managers were asked to respond to the questions regarding the model’s reliability and effectiveness.Results: According to the results, fields’ attractiveness, universities’ attractiveness, zone distinction and education quality were selected as effective variables for tuition fee calculation. In this model, tuition fees per student were calculated for the year 2013, and, therefore, the inflation rate of the same year was used. Testing of the model showed that there is a 92% of satisfaction. This model is used by medical science universities in Iran.Conclusion: Education quality, zone coefficient, fields’ attractiveness, universities’ attractiveness, inflation rate, and portion of each level of education were the most important variables affecting tuition fee calculation.Keywords: TUITION FEES, FIELD’S ATTRACTIVENESS, UNIVERSITIES’ ATTRACTIVENESS, ZONE DISTINCTION, EDUCATION QUALITY

Empathy in Medical Students: Exploring the Impact of a Longitudinal Integrated Clerkship Model

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Bergstresser, Kara

2017-01-01

Empathy is considered a significant factor in the physician-patient relationship. The current study examined the impact of a Longitudinal Integrated Clerkship (LIC) model on empathy and patient-centered attitude in medical students. Archival data were examined from 186 medical students at a medical college in the mid-Atlantic region of the United…

EURADOS intercomparison exercise on Monte Carlo modelling of a medical linear accelerator.

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Caccia, Barbara; Le Roy, Maïwenn; Blideanu, Valentin; Andenna, Claudio; Arun, Chairmadurai; Czarnecki, Damian; El Bardouni, Tarek; Gschwind, Régine; Huot, Nicolas; Martin, Eric; Zink, Klemens; Zoubair, Mariam; Price, Robert; de Carlan, Loïc

2017-01-01

In radiotherapy, Monte Carlo (MC) methods are considered a gold standard to calculate accurate dose distributions, particularly in heterogeneous tissues. EURADOS organized an international comparison with six participants applying different MC models to a real medical linear accelerator and to one homogeneous and four heterogeneous dosimetric phantoms. The aim of this exercise was to identify, by comparison of different MC models with a complete experimental dataset, critical aspects useful for MC users to build and calibrate a simulation and perform a dosimetric analysis. Results show on average a good agreement between simulated and experimental data. However, some significant differences have been observed especially in presence of heterogeneities. Moreover, the results are critically dependent on the different choices of the initial electron source parameters. This intercomparison allowed the participants to identify some critical issues in MC modelling of a medical linear accelerator. Therefore, the complete experimental dataset assembled for this intercomparison will be available to all the MC users, thus providing them an opportunity to build and calibrate a model for a real medical linear accelerator.

Supervised variational model with statistical inference and its application in medical image segmentation.

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Li, Changyang; Wang, Xiuying; Eberl, Stefan; Fulham, Michael; Yin, Yong; Dagan Feng, David

2015-01-01

Automated and general medical image segmentation can be challenging because the foreground and the background may have complicated and overlapping density distributions in medical imaging. Conventional region-based level set algorithms often assume piecewise constant or piecewise smooth for segments, which are implausible for general medical image segmentation. Furthermore, low contrast and noise make identification of the boundaries between foreground and background difficult for edge-based level set algorithms. Thus, to address these problems, we suggest a supervised variational level set segmentation model to harness the statistical region energy functional with a weighted probability approximation. Our approach models the region density distributions by using the mixture-of-mixtures Gaussian model to better approximate real intensity distributions and distinguish statistical intensity differences between foreground and background. The region-based statistical model in our algorithm can intuitively provide better performance on noisy images. We constructed a weighted probability map on graphs to incorporate spatial indications from user input with a contextual constraint based on the minimization of contextual graphs energy functional. We measured the performance of our approach on ten noisy synthetic images and 58 medical datasets with heterogeneous intensities and ill-defined boundaries and compared our technique to the Chan-Vese region-based level set model, the geodesic active contour model with distance regularization, and the random walker model. Our method consistently achieved the highest Dice similarity coefficient when compared to the other methods.

Application of Computer Simulation Modeling to Medication Administration Process Redesign

OpenAIRE

Huynh, Nathan; Snyder, Rita; Vidal, Jose M.; Tavakoli, Abbas S.; Cai, Bo

2012-01-01

The medication administration process (MAP) is one of the most high-risk processes in health care. MAP workflow redesign can precipitate both unanticipated and unintended consequences that can lead to new medication safety risks and workflow inefficiencies. Thus, it is necessary to have a tool to evaluate the impact of redesign approaches in advance of their clinical implementation. This paper discusses the development of an agent-based MAP computer simulation model that can be used to assess...

Simulation Modeling of a Check-in and Medication Reconciliation Ambulatory Clinic Kiosk

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Blake Lesselroth

2011-01-01

Full Text Available Gaps in information about patient medication adherence may contribute to preventable adverse drug events and patient harm. Hence, health-quality advocacy groups, including the Joint Commission, have called for the implementation of standardized processes to collect and compare patient medication lists. This manuscript describes the implementation of a self-service patient kiosk intended to check in patients for a clinic appointment and collect a medication adherence history, which is then available through the electronic health record. We used business process engineering and simulation modeling to analyze existing workflow, evaluate technology impact on clinic throughput, and predict future infrastructure needs. Our empiric data indicated that a multi-function healthcare kiosk offers a feasible platform to collect medical history data. Furthermore, our simulation model showed a non-linear association between patient arrival rate, kiosk number, and estimated patient wait times. This study provides important data to help administrators and healthcare executives predict infrastructure needs when considering the use of self-service kiosks.

Automating the segmentation of medical images for the production of voxel tomographic computational models

International Nuclear Information System (INIS)

Caon, M.

2001-01-01

Radiation dosimetry for the diagnostic medical imaging procedures performed on humans requires anatomically accurate, computational models. These may be constructed from medical images as voxel-based tomographic models. However, they are time consuming to produce and as a consequence, there are few available. This paper discusses the emergence of semi-automatic segmentation techniques and describes an application (iRAD) written in Microsoft Visual Basic that allows the bitmap of a medical image to be segmented interactively and semi-automatically while displayed in Microsoft Excel. iRAD will decrease the time required to construct voxel models. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

A Dual Hesitant Fuzzy Multigranulation Rough Set over Two-Universe Model for Medical Diagnoses

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Zhang, Chao; Li, Deyu; Yan, Yan

2015-01-01

In medical science, disease diagnosis is one of the difficult tasks for medical experts who are confronted with challenges in dealing with a lot of uncertain medical information. And different medical experts might express their own thought about the medical knowledge base which slightly differs from other medical experts. Thus, to solve the problems of uncertain data analysis and group decision making in disease diagnoses, we propose a new rough set model called dual hesitant fuzzy multigranulation rough set over two universes by combining the dual hesitant fuzzy set and multigranulation rough set theories. In the framework of our study, both the definition and some basic properties of the proposed model are presented. Finally, we give a general approach which is applied to a decision making problem in disease diagnoses, and the effectiveness of the approach is demonstrated by a numerical example. PMID:26858772

The "medication interest model": an integrative clinical interviewing approach for improving medication adherence-part 2: implications for teaching and research.

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Shea, Shawn Christopher

2009-01-01

Over the past several decades, exciting advances have been made in the art and science of teaching clinical interviewing, which are supported by an ever-growing evidence base documenting their effectiveness. In this second article in a 2-part series, the training and research implications of an innovative approach to improving medication adherence based on these educational advances--the medication interest model (MIM)--are described. The objective is to provide an "insider's view" of how to creatively teach the MIM to case managers, as well as design state-of-the-art courses and research platforms dedicated to improving medication adherence through improved clinical interviewing skills in both nursing and medical student education. The teaching and research design concepts are applicable to all primary care settings as well as specialty areas from endocrinology and cardiology to psychiatry. Evidence-based advances in the teaching of clinical interviewing skills such as response-mode research, facilic supervision, microtraining, and macrotraining lend a distinctive quality and integrative power to the MIM. The model delineates several new platforms for training and research regarding the enhancement of medication adherence including an approach for collecting individual interviewing techniques into manageable "learning modules" amenable to competency evaluation and potential certification.

Religious views of the 'medical' rehabilitation model: a pilot qualitative study.

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Yamey, Gavin; Greenwood, Richard

2004-04-22

To explore the religious beliefs that patients may bring to the rehabilitation process, and the hypothesis that these beliefs may diverge from the medical model of rehabilitation. Qualitative semi-structured interviews with representatives of six major religions--Islam, Buddhism, Christianity, Judaism, Sikhism, and Hinduism. Representatives were either health care professionals or religious leaders, all with an interest in how their religion approached health issues. There were three recurrent themes in the interviews: religious explanations for injury and illness; beliefs about recovery; religious duties of care towards family members. The Buddhist, Sikh, and Hindu interviewees described beliefs about karma--unfortunate events happening due to a person's former deeds. Fatalistic ideas, involving God having control over an individual's recovery, were expressed by the Muslim, Jewish, and Christian interviewees. All interviewees expressed the fundamental importance of a family's religious duty of care towards ill or injured relatives, and all expressed some views that were compatible with the medical model of rehabilitation. Religious beliefs may both diverge from and resonate with the medical rehabilitation model. Understanding these beliefs may be valuable in facilitating the rehabilitation of diverse religious groups.

Lessons learned from a pharmacy practice model change at an academic medical center.

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Knoer, Scott J; Pastor, John D; Phelps, Pamela K

2010-11-01

The development and implementation of a new pharmacy practice model at an academic medical center are described. Before the model change, decentralized pharmacists responsible for order entry and verification and clinical specialists were both present on the care units. Staff pharmacists were responsible for medication distribution and sterile product preparation. The decentralized pharmacists handling orders were not able to use their clinical training, the practice model was inefficient, and few clinical services were available during evenings and weekends. A task force representing all pharmacy department roles developed a process and guiding principles for the model change, collected data, and decided on a model. Teams consisting of decentralized pharmacists, decentralized pharmacy technicians, and team leaders now work together to meet patients' pharmacy needs and further departmental safety, quality, and cost-saving goals. Decentralized service hours have been expanded through operational efficiencies, including use of automation (e.g., computerized provider order entry, wireless computers on wheels used during rounds with physician teams). Nine clinical specialist positions were replaced by five team leader positions and four pharmacists functioning in decentralized roles. Additional staff pharmacist positions were shifted into decentralized roles, and the hospital was divided into areas served by teams including five to eight pharmacists. Technicians are directly responsible for medication distribution. No individual's job was eliminated. The new practice model allowed better alignment of staff with departmental goals, expanded pharmacy hours and services, more efficient medication distribution, improved employee engagement, and a staff succession plan.

Conversion of a Surface Model of a Structure of Interest into a Volume Model for Medical Image Retrieval

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Sarmad ISTEPHAN

2015-06-01

Full Text Available Volumetric medical image datasets contain vital information for noninvasive diagnosis, treatment planning and prognosis. However, direct and unlimited query of such datasets is hindered due to the unstructured nature of the imaging data. This study is a step towards the unlimited query of medical image datasets by focusing on specific Structures of Interest (SOI. A requirement in achieving this objective is having both the surface and volume models of the SOI. However, typically, only the surface model is available. Therefore, this study focuses on creating a fast method to convert a surface model to a volume model. Three methods (1D, 2D and 3D are proposed and evaluated using simulated and real data of Deep Perisylvian Area (DPSA within the human brain. The 1D method takes 80 msec for DPSA model; about 4 times faster than 2D method and 7.4 fold faster than 3D method, with over 97% accuracy. The proposed 1D method is feasible for surface to volume conversion in computer aided diagnosis, treatment planning and prognosis systems containing large amounts of unstructured medical images.

Medical mitigation model: quantifying the benefits of the public health response to a chemical terrorism attack.

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Good, Kevin; Winkel, David; VonNiederhausern, Michael; Hawkins, Brian; Cox, Jessica; Gooding, Rachel; Whitmire, Mark

2013-06-01

The Chemical Terrorism Risk Assessment (CTRA) and Chemical Infrastructure Risk Assessment (CIRA) are programs that estimate the risk of chemical terrorism attacks to help inform and improve the US defense posture against such events. One aspect of these programs is the development and advancement of a Medical Mitigation Model-a mathematical model that simulates the medical response to a chemical terrorism attack and estimates the resulting number of saved or benefited victims. At the foundation of the CTRA/CIRA Medical Mitigation Model is the concept of stock-and-flow modeling; "stocks" are states that individuals progress through during the event, while "flows" permit and govern movement from one stock to another. Using this approach, the model is able to simulate and track individual victims as they progress from exposure to an end state. Some of the considerations in the model include chemical used, type of attack, route and severity of exposure, response-related delays, detailed treatment regimens with efficacy defined as a function of time, medical system capacity, the influx of worried well individuals, and medical countermeasure availability. As will be demonstrated, the output of the CTRA/CIRA Medical Mitigation Model makes it possible to assess the effectiveness of the existing public health response system and develop and examine potential improvement strategies. Such a modeling and analysis capability can be used to inform first-responder actions/training, guide policy decisions, justify resource allocation, and direct knowledge-gap studies.

A crowdsourcing model for creating preclinical medical education study tools.

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Bow, Hansen C; Dattilo, Jonathan R; Jonas, Andrea M; Lehmann, Christoph U

2013-06-01

During their preclinical course work, medical students must memorize and recall substantial amounts of information. Recent trends in medical education emphasize collaboration through team-based learning. In the technology world, the trend toward collaboration has been characterized by the crowdsourcing movement. In 2011, the authors developed an innovative approach to team-based learning that combined students' use of flashcards to master large volumes of content with a crowdsourcing model, using a simple informatics system to enable those students to share in the effort of generating concise, high-yield study materials. The authors used Google Drive and developed a simple Java software program that enabled students to simultaneously access and edit sets of questions and answers in the form of flashcards. Through this crowdsourcing model, medical students in the class of 2014 at the Johns Hopkins University School of Medicine created a database of over 16,000 questions that corresponded to the Genes to Society basic science curriculum. An analysis of exam scores revealed that students in the class of 2014 outperformed those in the class of 2013, who did not have access to the flashcard system, and a survey of students demonstrated that users were generally satisfied with the system and found it a valuable study tool. In this article, the authors describe the development and implementation of their crowdsourcing model for creating study materials, emphasize its simplicity and user-friendliness, describe its impact on students' exam performance, and discuss how students in any educational discipline could implement a similar model of collaborative learning.

Medical staff involvement in nursing homes: development of a conceptual model and research agenda.

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Shield, Renée; Rosenthal, Marsha; Wetle, Terrie; Tyler, Denise; Clark, Melissa; Intrator, Orna

2014-02-01

Medical staff (physicians, nurse practitioners, physicians' assistants) involvement in nursing homes (NH) is limited by professional guidelines, government policies, regulations, and reimbursements, creating bureaucratic burden. The conceptual NH Medical Staff Involvement Model, based on our mixed-methods research, applies the Donabedian "structure-process-outcomes" framework to the NH, identifying measures for a coordinated research agenda. Quantitative surveys and qualitative interviews conducted with medical directors, administrators and directors of nursing, other experts, residents and family members and Minimum Data Set, the Online Certification and Reporting System and Medicare Part B claims data related to NH structure, process, and outcomes were analyzed. NH control of medical staff, or structure, affects medical staff involvement in care processes and is associated with better outcomes (e.g., symptom management, appropriate transitions, satisfaction). The model identifies measures clarifying the impact of NH medical staff involvement on care processes and resident outcomes and has strong potential to inform regulatory policies.

Two Models for Implementing Senior Mentor Programs in Academic Medical Settings

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Corwin, Sara J.; Bates, Tovah; Cohan, Mary; Bragg, Dawn S.; Roberts, Ellen

2007-01-01

This paper compares two models of undergraduate geriatric medical education utilizing senior mentoring programs. Descriptive, comparative multiple-case study was employed analyzing program documents, archival records, and focus group data. Themes were compared for similarities and differences between the two program models. Findings indicate that…

The Impact of Health Literacy Status on the Comparative Validity and Sensitivity of an Interactive Multimedia Beverage Intake Questionnaire

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Lucy P. Hooper

2016-12-01

Full Text Available Self-reported dietary assessment methods can be challenging to validate, and reporting errors for those with lower health literacy (HL may be augmented. Interactive multimedia (IMM based questionnaires could help overcome these limitations. The objectives of this investigation are to assess the comparative validity and sensitivity to change of an IMM beverage intake questionnaire (IMM-BEVQ as compared to dietary recalls and determine the impact of HL. Adults completed three 24-h dietary recalls and the IMM-BEVQ at baseline and after a six-month intervention targeting either sugar-sweetened beverages (SSB or physical activity. Correlations and paired-samples t-tests are presented. For validity (n = 273, intake of SSB (mean difference = 10.6 fl oz and total beverage consumption (mean difference = 16.0 fl oz were significantly different (p ≤ 0.001 at baseline between the IMM-BEVQ and dietary recalls for all participants. However, the differences in intake were generally greater in low HL participants than in adequate HL participants. For sensitivity (n = 162, change in SSB intake (mean difference = 7.2 fl oz was significantly different (p ≤ 0.01 between pre-/post-IMM-BEVQ and pre-/post-dietary recalls, but not total beverage intake (mean difference = 7.6 fl oz for all participants. Changes in SSB and total beverage intake were not significantly different for those with adequate HL. The IMM-BEVQ is a valid dietary assessment tool that is as responsive to detecting changes in beverage intake as dietary recalls. However, adults with lower HL may need additional guidance when completing the IMM-BEVQ.

Exploration of a leadership competency model for medical school faculties in Korea.

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Lee, Yong Seok; Oh, Dong Keun; Kim, Myungun; Lee, Yoon Seong; Shin, Jwa Seop

2010-12-01

To adapt to rapid and turbulent changes in the field of medicine, education, and society, medical school faculties need appropriate leadership. To develop leadership competencies through education, coaching, and mentoring, we need a leadership competency model. The purpose of this study was to develop a new leadership competency model that is suitable for medical school faculties in Korea. To collect behavioral episodes with regard to leadership, we interviewed 54 subjects (faculties, residents, nurses) and surveyed 41 faculties with open-ended questionnaires. We classified the behavioral episodes based on Quinn and Cameron's leadership competency model and developed a Likert scale questionnaire to perform a confirmatory factor analysis. Two hundred seven medical school faculties responded to the questionnaire. The competency clusters that were identified by factor analysis were professionalism, citizenship, leadership, and membership to an organization. Accordingly, each cluster was linked with a dimension: self, society, team (that he/she is leading), and organization (to which he/she belongs). The clusters of competencies were: professional ability, ethics/morality, self-management, self-development, and passion; public interest, networking, social participation, and active service; motivating, caring, promoting teamwork, nurturing, conflict management, directing, performance management, and systems thinking; organizational orientation, collaboration, voluntary participation, and cost-benefit orientation. This competency model that fits medical school faculties in Korea can be used to design and develop selection plans, education programs, feedback tools, diagnostic evaluation tools, and career plan support programs.

DEVELOPMENT OF CLINICAL SCENARIO’S INFORMATION MODEL IN THE MEDICAL SIMULATION CENTER

Directory of Open Access Journals (Sweden)

I. V. Tolmachyov

2014-01-01

Full Text Available There is the big issue in medical education which is students don’t have enough skills. Often even with theoretical knowledge graduate medical students need to improve their skills by working with patients. Obviously it can be a risk for patients and takes quite long time. This situation could be changed with applying simulation technologies in medical education. Medical education with virtual simulators allows reducing the time of skills development and improving the quality of training. The aims of this work are developing informational model and creating clinical scenarios of emergency states in the Medical Simulation Center.Objectives:– to analyze the process of scenario conducting;– to create clinical scenarios of emergency states (anaphylactic shock, hypovolemic shock, obstructive shock with specialist’s help.The scenarios consist of sections such as main aim, skills, required mannequins, preparation of the mannequins, preparation of medical equipment and instruments for the scenario, preparation of special materials, scenario description, guide for operator, information for trainees.By analyzing the process of scenario conducting the key participants were defined who are operator, assistant, trainer, trainees. Also the main scenario stages were defined. Based on the stages diagram of variants of scenario conducting was designed.As an example there are fragments of scenario “Obstructive shock – a pulmonary embolism” in this article. Learn skills are cognitive, technical, social ones.Results. This paper presents an analysis of the clinical scenario conducting. Information model was developed which based on object-oriented decomposition. The model is the diagram of variants of scenario conducting. Scenario’s structure for emergency states was formulated. The scenarios are anaphylactic shock, hypovolemic shock, obstructive shock (pulmonary embolism, tension pneumothorax, pulmonary edema, hypertensive crisis, respiratory

Medical students on the value of role models for developing 'soft skills'

African Journals Online (AJOL)

Adele

of medical students, especially their doctor-patient interaction skills and .... how they adapted their own personalities with patients…] ... students learning from role models. Students .... Role models and the learning environment: essential elements in ... Paice E, Heard S, Moss F. How important are role models in making.

The role of Patient Health Engagement Model (PHE-model in affecting patient activation and medication adherence: A structural equation model.

Directory of Open Access Journals (Sweden)

Guendalina Graffigna

Full Text Available Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed.To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model in this pathway.This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i patient activation (Patient Activation Measure 13 -short form; ii Patient Health Engagement model (Patient Health Engagement Scale; iii patient adherence (4 item-Morinsky Medication Adherence Scale; iv the quality of the patients' emotional feelings (Manikin Self Assessment Scale; v the quality of the patient/doctor relationship (Health Care Climate Questionnaire. Structural equation modeling was used to test the hypotheses proposed.According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis.Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in

The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model.

Science.gov (United States)

Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea

2017-01-01

Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed. To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model) in this pathway. This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i) patient activation (Patient Activation Measure 13 -short form); ii) Patient Health Engagement model (Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky Medication Adherence Scale); iv) the quality of the patients' emotional feelings (Manikin Self Assessment Scale); v) the quality of the patient/doctor relationship (Health Care Climate Questionnaire). Structural equation modeling was used to test the hypotheses proposed. According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis. Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in enhancing

The NASA Human Research Wiki - An Online Collaboration Tool

Science.gov (United States)

Barr, Yael; Rasbury, Jack; Johnson, Jordan; Barstend, Kristina; Saile, Lynn; Watkins, Sharmi

2012-01-01

The Exploration Medical Capability (ExMC) element is one of six elements of the Human Research Program (HRP). ExMC is charged with decreasing the risk of: "Inability to adequately recognize or treat an ill or injured crew member" for exploration-class missions In preparation for exploration-class missions, ExMC has compiled a large evidence base, previously available only to persons within the NASA community. ExMC has developed the "NASA Human Research Wiki" in an effort to make the ExMC information available to the general public and increase collaboration within and outside of NASA. The ExMC evidence base is comprised of several types of data, including: (1)Information on more than 80 medical conditions which could occur during space flight (a)Derived from several sources (b)Including data on incidence and potential outcomes, as captured in the Integrated Medical Model s (IMM) Clinical Finding Forms (CliFFs). (2)Approximately 25 gap reports (a)Identify any "gaps" in knowledge and/or technology that would need to be addressed in order to provide adequate medical support for these novel missions.

Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education.

Science.gov (United States)

Miller, Ryan; Ho, Hang; Ng, Vivienne; Tran, Melissa; Rappaport, Douglas; Rappaport, William J A; Dandorf, Stewart J; Dunleavy, James; Viscusi, Rebecca; Amini, Richard

2016-05-01

Over the past decade, medical students have witnessed a decline in the opportunities to perform technical skills during their clinical years. Ultrasound-guided central venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine, anesthesia, and general surgery residents, often during their first month of residency. However, the acquisition of skills required to safely perform this procedure is often deficient upon graduation from medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have been introduced into undergraduate medical education to train venous access skills. Criticisms of simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical variances when compared to living patients. The purpose of our investigation was to design and evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver. This was a cross-sectional study at an urban academic medical center. An 18-point procedural knowledge tool and an 18-point procedural skill evaluation tool were administered during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver lab, procedure naïve third-year medical students were trained on how to perform ultrasound-guided central venous access of the femoral and internal jugular vessels. Preparation of the fresh cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the femoral and internal jugular vein respectively. Fifty-six third-year medical students participated in this study during their surgical clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12 (pcadaver model prevented extravasation of fluid, maintained ultrasound-imaging quality, and proved to be an effective educational model allowing third-year medical

Transfer of the lambdadv plasmid to new bacterial hosts

International Nuclear Information System (INIS)

Kellenberger-Gujer, G.; Boy de la Tour, E.; Berg, D.E.

1974-01-01

Lambda dv, which was derived from bacteriophage lambda, replicates autonomously as a plasmid in Escherichia coli and consists of only the immunity region (imm/sup lambda/) and DNA replication genes (O, P) of the ancestral phage. Addition phages (lambda imm 21 --lambda dv) carry the lambda dv fragment inserted as a tandem duplication in their genome (sequence A imm 21 O P imm/sup lambda/ O P R) are formed as recombinants after lambda imm 21 infection of strains carrying lambda dv. Addition phages were used to transfer lambda dv to new bacterial hosts. Lambda dv transfer by excision of the lambda dv segment from the addition phage genome requires a bacterial Rec or a phage Red recombination system. Successful transfer is stimulated by uv irradiation of the addition phage before infection. Some properties of the newly transferred lambda dv plasmids are described. (U.S.)

Theoretical Biology and Medical Modelling: ensuring continued growth and future leadership.

Science.gov (United States)

Nishiura, Hiroshi; Rietman, Edward A; Wu, Rongling

2013-07-11

Theoretical biology encompasses a broad range of biological disciplines ranging from mathematical biology and biomathematics to philosophy of biology. Adopting a broad definition of "biology", Theoretical Biology and Medical Modelling, an open access journal, considers original research studies that focus on theoretical ideas and models associated with developments in biology and medicine.

Overcoming barriers to development of cooperative medical decision support models.

Science.gov (United States)

Hudson, Donna L; Cohen, Maurice E

2012-01-01

Attempts to automate the medical decision making process have been underway for the at least fifty years, beginning with data-based approaches that relied chiefly on statistically-based methods. Approaches expanded to include knowledge-based systems, both linear and non-linear neural networks, agent-based systems, and hybrid methods. While some of these models produced excellent results none have been used extensively in medical practice. In order to move these methods forward into practical use, a number of obstacles must be overcome, including validation of existing systems on large data sets, development of methods for including new knowledge as it becomes available, construction of a broad range of decision models, and development of non-intrusive methods that allow the physician to use these decision aids in conjunction with, not instead of, his or her own medical knowledge. None of these four requirements will come easily. A cooperative effort among researchers, including practicing MDs, is vital, particularly as more information on diseases and their contributing factors continues to expand resulting in more parameters than the human decision maker can process effectively. In this article some of the basic structures that are necessary to facilitate the use of an automated decision support system are discussed, along with potential methods for overcoming existing barriers.

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

Science.gov (United States)

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

2009-01-01

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

Multi-object segmentation framework using deformable models for medical imaging analysis.

Science.gov (United States)

Namías, Rafael; D'Amato, Juan Pablo; Del Fresno, Mariana; Vénere, Marcelo; Pirró, Nicola; Bellemare, Marc-Emmanuel

2016-08-01

Segmenting structures of interest in medical images is an important step in different tasks such as visualization, quantitative analysis, simulation, and image-guided surgery, among several other clinical applications. Numerous segmentation methods have been developed in the past three decades for extraction of anatomical or functional structures on medical imaging. Deformable models, which include the active contour models or snakes, are among the most popular methods for image segmentation combining several desirable features such as inherent connectivity and smoothness. Even though different approaches have been proposed and significant work has been dedicated to the improvement of such algorithms, there are still challenging research directions as the simultaneous extraction of multiple objects and the integration of individual techniques. This paper presents a novel open-source framework called deformable model array (DMA) for the segmentation of multiple and complex structures of interest in different imaging modalities. While most active contour algorithms can extract one region at a time, DMA allows integrating several deformable models to deal with multiple segmentation scenarios. Moreover, it is possible to consider any existing explicit deformable model formulation and even to incorporate new active contour methods, allowing to select a suitable combination in different conditions. The framework also introduces a control module that coordinates the cooperative evolution of the snakes and is able to solve interaction issues toward the segmentation goal. Thus, DMA can implement complex object and multi-object segmentations in both 2D and 3D using the contextual information derived from the model interaction. These are important features for several medical image analysis tasks in which different but related objects need to be simultaneously extracted. Experimental results on both computed tomography and magnetic resonance imaging show that the proposed

Medical Models and Bayesian Networks

DEFF Research Database (Denmark)

Olesen, Kristian Grønborg

1999-01-01

Proc. of a Workshop Held during the Joint European Conf. on Artificial Intelligence in Medicine and Medical Decision Making : AIMDM'99, Aalborg, Denmark, June 1999......Proc. of a Workshop Held during the Joint European Conf. on Artificial Intelligence in Medicine and Medical Decision Making : AIMDM'99, Aalborg, Denmark, June 1999...

A Cellular Automata Model of Infection Control on Medical Implants

Science.gov (United States)

Prieto-Langarica, Alicia; Kojouharov, Hristo; Chen-Charpentier, Benito; Tang, Liping

2011-01-01

S. epidermidis infections on medically implanted devices are a common problem in modern medicine due to the abundance of the bacteria. Once inside the body, S. epidermidis gather in communities called biofilms and can become extremely hard to eradicate, causing the patient serious complications. We simulate the complex S. epidermidis-Neutrophils interactions in order to determine the optimum conditions for the immune system to be able to contain the infection and avoid implant rejection. Our cellular automata model can also be used as a tool for determining the optimal amount of antibiotics for combating biofilm formation on medical implants. PMID:23543851

Forecasting the need for medical specialists in Spain: application of a system dynamics model

Science.gov (United States)

2010-01-01

Background Spain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities. Methods We created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method. Results In the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology. Conclusions The model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America. PMID:21034458

Medical students' emotional development in early clinical experience : a model

NARCIS (Netherlands)

Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Dornan, Tim; Koopmans, Raymond

Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others.

Development of a mission-based funding model for undergraduate medical education: incorporation of quality.

Science.gov (United States)

Stagnaro-Green, Alex; Roe, David; Soto-Greene, Maria; Joffe, Russell

2008-01-01

Increasing financial pressures, along with a desire to realign resources with institutional priorities, has resulted in the adoption of mission-based funding (MBF) at many medical schools. The lack of inclusion of quality and the time and expense in developing and implementing mission based funding are major deficiencies in the models reported to date. In academic year 2002-2003 New Jersey Medical School developed a model that included both quantity and quality in the education metric and that was departmentally based. Eighty percent of the undergraduate medical education allocation was based on the quantity of undergraduate medical education taught by the department ($7.35 million), and 20% ($1.89 million) was allocated based on the quality of the education delivered. Quality determinations were made by the educational leadership based on student evaluations and departmental compliance with educational administrative requirements. Evolution of the model has included the development of a faculty oversight committee and the integration of peer evaluation in the determination of educational quality. Six departments had a documented increase in quality over time, and one department had a transient decrease in quality. The MBF model has been well accepted by chairs, educational leaders, and faculty and has been instrumental in enhancing the stature of education at our institution.

Enhanced risk prediction model for emergency department use and hospitalizations in patients in a primary care medical home.

Science.gov (United States)

Takahashi, Paul Y; Heien, Herbert C; Sangaralingham, Lindsey R; Shah, Nilay D; Naessens, James M

2016-07-01

With the advent of healthcare payment reform, identifying high-risk populations has become more important to providers. Existing risk-prediction models often focus on chronic conditions. This study sought to better understand other factors to improve identification of the highest risk population. A retrospective cohort study of a paneled primary care population utilizing 2010 data to calibrate a risk prediction model of hospital and emergency department (ED) use in 2011. Data were randomly split into development and validation data sets. We compared the enhanced model containing the additional risk predictors with the Minnesota medical tiering model. The study was conducted in the primary care practice of an integrated delivery system at an academic medical center in Rochester, Minnesota. The study focus was primary care medical home patients in 2010 and 2011 (n = 84,752), with the primary outcome of subsequent hospitalization or ED visit. A total of 42,384 individuals derived the enhanced risk-prediction model and 42,368 individuals validated the model. Predictors included Adjusted Clinical Groups-based Minnesota medical tiering, patient demographics, insurance status, and prior year healthcare utilization. Additional variables included specific mental and medical conditions, use of high-risk medications, and body mass index. The area under the curve in the enhanced model was 0.705 (95% CI, 0.698-0.712) compared with 0.662 (95% CI, 0.656-0.669) in the Minnesota medical tiering-only model. New high-risk patients in the enhanced model were more likely to have lack of health insurance, presence of Medicaid, diagnosed depression, and prior ED utilization. An enhanced model including additional healthcare-related factors improved the prediction of risk of hospitalization or ED visit.

A systematic review of the effect of different models of after-hours primary medical care services on clinical outcome, medical workload, and patient and GP satisfaction.

Science.gov (United States)

Leibowitz, Ruth; Day, Susan; Dunt, David

2003-06-01

The organization of after-hours primary medical care services is changing in many countries. Increasing demand, economic considerations and changes in doctors' attitudes are fueling these changes. Information for policy makers in this field is needed. However, a comprehensive review of the international literature that compares the effects of one model of after-hours care with another is lacking. The aim of this study was to carry out a systematic review of the international literature to determine what evidence exists about the effect of different models of out-of-hours primary medical care service on outcome. Original studies and systematic reviews written since 1976 on the subject of 'after-hours primary medical care services' were identified. Databases searched were Medline/Premedline, CINAHL, HealthSTAR, Current Contents, Cochrane Reviews, DARE, EBM Reviews and EconLit. For each paper where the optimal design would have been an interventional study, the 'level' of evidence was assessed as described in the National Health and Medical Research Council Handbook. 'Comparative' studies (levels I, II, III and IV pre-/post-test studies) were included in this review. Six main models of after-hours primary care services (not mutually exclusive) were identified: practice-based services, deputizing services, emergency departments, co-operatives, primary care centres, and telephone triage and advice services. Outcomes were divided into the following categories: clinical outcomes, medical workload, and patient and GP satisfaction. The results indicate that the introduction of a telephone triage and advice service for after-hours primary medical care may reduce the immediate medical workload. Deputizing services increase immediate medical workload because of the low use of telephone advice and the high home visiting rate. Co-operatives, which use telephone triage and primary care centres and have a low home visiting rate, reduce immediate medical workload. There is little

Medical simulation: Overview, and application to wound modelling and management

Directory of Open Access Journals (Sweden)

Dinker R Pai

2012-01-01

Full Text Available Simulation in medical education is progressing in leaps and bounds. The need for simulation in medical education and training is increasing because of a overall increase in the number of medical students vis-à-vis the availability of patients; b increasing awareness among patients of their rights and consequent increase in litigations and c tremendous improvement in simulation technology which makes simulation more and more realistic. Simulation in wound care can be divided into use of simulation in wound modelling (to test the effect of projectiles on the body and simulation for training in wound management. Though this science is still in its infancy, more and more researchers are now devising both low-technology and high-technology (virtual reality simulators in this field. It is believed that simulator training will eventually translate into better wound care in real patients, though this will be the subject of further research.

Medical simulation: Overview, and application to wound modelling and management.

Science.gov (United States)

Pai, Dinker R; Singh, Simerjit

2012-05-01

Simulation in medical education is progressing in leaps and bounds. The need for simulation in medical education and training is increasing because of a) overall increase in the number of medical students vis-à-vis the availability of patients; b) increasing awareness among patients of their rights and consequent increase in litigations and c) tremendous improvement in simulation technology which makes simulation more and more realistic. Simulation in wound care can be divided into use of simulation in wound modelling (to test the effect of projectiles on the body) and simulation for training in wound management. Though this science is still in its infancy, more and more researchers are now devising both low-technology and high-technology (virtual reality) simulators in this field. It is believed that simulator training will eventually translate into better wound care in real patients, though this will be the subject of further research.

Empirical validation of the information-motivation-behavioral skills model of diabetes medication adherence: a framework for intervention.

Science.gov (United States)

Mayberry, Lindsay S; Osborn, Chandra Y

2014-01-01

Suboptimal adherence to diabetes medications is prevalent and associated with unfavorable health outcomes, but it remains unclear what intervention content is necessary to effectively promote medication adherence in diabetes. In other disease contexts, the Information-Motivation-Behavioral skills (IMB) model has effectively explained and promoted medication adherence and thus may have utility in explaining and promoting adherence to diabetes medications. We tested the IMB model's hypotheses in a sample of adults with type 2 diabetes. Participants (N = 314) completed an interviewer-administered survey and A1C test. Structural equation models tested the effects of diabetes medication adherence-related information, motivation, and behavioral skills on medication adherence and the effect of medication adherence on A1C. The IMB elements explained 41% of the variance in adherence, and adherence explained 9% of the variance in A1C. As predicted, behavioral skills had a direct effect on adherence (β = 0.59; P information (indirect effect 0.08 [0.01-0.15]) and motivation (indirect effect 0.12 [0.05-0.20]) on adherence. Medication adherence significantly predicted glycemic control (β = -0.30; P information, motivation, and behavioral skills and assessing the degree to which change in these determinants leads to changes in medication adherence behavior.

Virtual medical plant modeling based on L-system | Ding | African ...

African Journals Online (AJOL)

... aid of graphics and PlantVR, we implemented the plant shape and 3-D structure's reconstruction. Conclusion: Three-dimensional structure virtual plant growth model based on time- controlled L-system has been successfully established. Keywords: Drug R&D, toxicity, medical plants, fractals; L-system; quasi binary-trees.

A Latent Growth Model Suggests that Empathy of Medical Students Does Not Decline over Time

Science.gov (United States)

Costa, Patrício; Magalhães, Eunice; Costa, Manuel João

2013-01-01

Empathy is a relevant attribute in the context of patient care. However, a decline in empathy throughout medical education has been reported in North-American medical schools, particularly, in the transition to clinical training. The present study aims to longitudinally model empathy during medical school at three time points: at the entrance,…

A Pathophysiological Model-Driven Communication for Dynamic Distributed Medical Best Practice Guidance Systems.

Science.gov (United States)

Hosseini, Mohammad; Jiang, Yu; Wu, Poliang; Berlin, Richard B; Ren, Shangping; Sha, Lui

2016-11-01

There is a great divide between rural and urban areas, particularly in medical emergency care. Although medical best practice guidelines exist and are in hospital handbooks, they are often lengthy and difficult to apply clinically. The challenges are exaggerated for doctors in rural areas and emergency medical technicians (EMT) during patient transport. In this paper, we propose the concept of distributed executable medical best practice guidance systems to assist adherence to best practice from the time that a patient first presents at a rural hospital, through diagnosis and ambulance transfer to arrival and treatment at a regional tertiary hospital center. We codify complex medical knowledge in the form of simplified distributed executable disease automata, from the thin automata at rural hospitals to the rich automata in the regional center hospitals. However, a main challenge is how to efficiently and safely synchronize distributed best practice models as the communication among medical facilities, devices, and professionals generates a large number of messages. This complex problem of patient diagnosis and transport from rural to center facility is also fraught with many uncertainties and changes resulting in a high degree of dynamism. A critically ill patient's medical conditions can change abruptly in addition to changes in the wireless bandwidth during the ambulance transfer. Such dynamics have yet to be addressed in existing literature on telemedicine. To address this situation, we propose a pathophysiological model-driven message exchange communication architecture that ensures the real-time and dynamic requirements of synchronization among distributed emergency best practice models are met in a reliable and safe manner. Taking the signs, symptoms, and progress of stroke patients transported across a geographically distributed healthcare network as the motivating use case, we implement our communication system and apply it to our developed best practice

A proteomic study of memory after imprinting in the domestic chick

Directory of Open Access Journals (Sweden)

Maia eMeparishvili

2015-11-01

Full Text Available The intermediate and medial mesopallium (IMM of the domestic chick forebrain has previously been shown to be a memory system for visual imprinting. Learning-related changes occur in certain plasma membrane and mitochondrial proteins in the IMM. Two-dimensional gel electrophoresis/mass spectrometry has been employed to identify more comprehensively learning-related expression of proteins in the membrane-mitochondrial fraction of the IMM 24 h after training. We inquired whether amounts of these proteins in the IMM and a control region (posterior pole of the nidopallium, PPN are correlated with a behavioural estimate of memory for the imprinting stimulus. Learning-related increases in amounts of the following proteins were found in the left IMM, but not the right IMM or the left or right PPN: (i membrane cognin; (ii a protein resembling the P32 subunit of splicing factor SF2; (iii voltage-dependent anionic channel-1; (iv dynamin-1; (v heterogeneous nuclear ribonucleoprotein A2/B1. Learning-related increases in some transcription factors involved in mitochondrial biogenesis were also found, without significant change in mitochondrial DNA copy number. The results indicate that the molecular processes involved in learning and memory underlying imprinting include protein stabilization, increased mRNA trafficking, synaptic vesicle recycling and specific changes in the mitochondrial proteome.

Application of the SEIPS Model to Analyze Medication Safety in a Crisis Residential Center.

Science.gov (United States)

Steele, Maria L; Talley, Brenda; Frith, Karen H

2018-02-01

Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices. The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework to analyze factors affecting medication safety. The model approach analyzes the work system concepts of technology, tasks, persons, environment, and organization to guide the collection of data. In the study, the Lean methodology tools were used to identify vulnerabilities in the system that could be targeted later for improvement activities. The project director completed face-to-face interviews, asked nurses to record disruptions in a log, and administered a questionnaire to nursing staff. The project director also conducted medication chart reviews and recorded medication errors using a standardized taxonomy for errors that allowed categorization of the prevalent types of medication errors. Results of the study revealed disruptions during the medication process, pharmacology training needs, and documentation processes as the primary opportunities for improvement. The project engaged nurses to identify sustainable quality improvement strategies to improve patient safety. The mental health setting carries challenges for safe medication administration practices. Through analysis of the structure, process, and outcomes of medication administration, opportunities for quality improvement and sustainable interventions were identified, including minimizing the number of distractions during medication administration, training nurses on psychotropic medications, and improving the documentation

Implementing the patient-centered medical home model for chronic disease care in small medical practices: practice group characteristics and physician understanding.

Science.gov (United States)

Baxter, Louisa; Nash, David B

2013-01-01

Strengthening primary care may improve health outcomes and restrain spending. The patient-centered medical home (PCMH) model is endorsed as a tool to achieve this. Early evaluations in large group practices demonstrate improvements in some health outcomes. Evidence is lacking from small medical practices that deliver the majority of primary health care. This was a national survey of 200 physicians that explored perceptions of PCMH. There was considerable interest in adoption of the model; however, providing PCMH care was seen as an extension of traditional roles that requires additional reimbursement. No differentiation was made among a variety of payment models to do this. All joint principle components of the model were identified as important: extending access and information technology were the most contentious. There was consensus that PCMH might improve the quality of primary care; however, tension between wider societal benefits and rising costs for individual practices was a challenge to implementation.

The Research on Influencing Factors of Medical Logistics Cost Based on ISM Model

Directory of Open Access Journals (Sweden)

Zhai Yunkai

2017-01-01

Full Text Available The reason why medical logistics cost remains high is a system problem, this paper analyzes the system through the ISM model. The result presents that medical logistics cost factors have four levels of relationship, primary factor is the national policies, secondary factors are the talent construction and pharmaceutical enterprise scale, Intermediate factors are medical information management system and inventory cost, the key factors are transportation cost and distribution center location. Finally, according to the four levels of relationship, this paper put forward specific suggestions to reduce logistics cost.

Modeling the acceptance of clinical information systems among hospital medical staff: an extended TAM model.

Science.gov (United States)

Melas, Christos D; Zampetakis, Leonidas A; Dimopoulou, Anastasia; Moustakis, Vassilis

2011-08-01

Recent empirical research has utilized the Technology Acceptance Model (TAM) to advance the understanding of doctors' and nurses' technology acceptance in the workplace. However, the majority of the reported studies are either qualitative in nature or use small convenience samples of medical staff. Additionally, in very few studies moderators are either used or assessed despite their importance in TAM based research. The present study focuses on the application of TAM in order to explain the intention to use clinical information systems, in a random sample of 604 medical staff (534 physicians) working in 14 hospitals in Greece. We introduce physicians' specialty as a moderator in TAM and test medical staff's information and communication technology (ICT) knowledge and ICT feature demands, as external variables. The results show that TAM predicts a substantial proportion of the intention to use clinical information systems. Findings make a contribution to the literature by replicating, explaining and advancing the TAM, whereas theory is benefited by the addition of external variables and medical specialty as a moderator. Recommendations for further research are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

Pedestrian Path Prediction with Recursive Bayesian Filters: A Comparative Study

NARCIS (Netherlands)

Schneider, N.; Gavrila, D.M.

2013-01-01

In the context of intelligent vehicles, we perform a comparative study on recursive Bayesian filters for pedestrian path prediction at short time horizons (< 2s). We consider Extended Kalman Filters (EKF) based on single dynamical models and Interacting Multiple Models (IMM) combining several such

Mediatized Business Models impairing the Professional Autonomy of Medical Professions

DEFF Research Database (Denmark)

Pfadenhauer, Michaela; Kirschner, Heiko

2018-01-01

With the emergence and spread of digital media, more business models foster and empower client participation in medical professions. With services and products ranging from rating platforms to apps targeting self-diagnosis, these businesses transform the client–practitioner relationship yet risk...... undermining a central pillar of professions – autonomy. Practitioners have to take legal actions against these business models, making visible the frictional interplay among the involved actors. This development calls for an analytical understanding of how this technology-induced cultural change affects...

Simulation modelling of a patient surge in an emergency department under disaster conditions

Directory of Open Access Journals (Sweden)

Muhammet Gul

2015-10-01

Full Text Available The efficiency of emergency departments (EDs in handling patient surges during disaster times using the available resources is very important. Many EDs require additional resources to overcome the bottlenecks in emergency systems. The assumption is that EDs consider the option of temporary staff dispatching, among other options, in order to respond to an increased demand or even the hiring temporarily non-hospital medical staff. Discrete event simulation (DES, a well-known simulation method and based on the idea of process modeling, is used for establishing ED operations and management related models. In this study, a DES model is developed to investigate and analyze an ED under normal conditions and an ED in a disaster scenario which takes into consideration an increased influx of disaster victims-patients. This will allow early preparedness of emergency departments in terms of physical and human resources. The studied ED is located in an earthquake zone in Istanbul. The report on Istanbul’s disaster preparedness presented by the Japan International Cooperation Agency (JICA and Istanbul Metropolitan Municipality (IMM, asserts that the district where the ED is located is estimated to have the highest injury rate. Based on real case study information, the study aims to suggest a model on pre-planning of ED resources for disasters. The results indicate that in times of a possible disaster, when the percentage of red patient arrivals exceeds 20% of total patient arrivals, the number of red area nurses and the available space for red area patients will be insufficient for the department to operate effectively. A methodological improvement presented a different distribution function that was tested for service time of the treatment areas. The conclusion is that the Weibull distribution function used in service process of injection room fits the model better than the Gamma distribution function.

The Four-Tier Continuum of Academic and Behavioral Support (4T-CABS) Model: An Integrated Model for Medical Student Success.

Science.gov (United States)

Stegers-Jager, Karen M; Cohen-Schotanus, Janke; Themmen, Axel P N

2017-11-01

Not all students cope successfully with the demands of medical school, and students' struggles may result in study delay or dropout. To prevent these outcomes, medical schools need to identify students who are experiencing academic difficul ties and provide them with timely interventions through access to support programs. Although the importance of early identification and intervention is well recognized, less is known about successful strategies for identifying and supporting struggling students.Building on the literature and their own empirical findings, the authors propose an integrated, school-wide model for medical student success comprising a continuum of academic and behavioral support. This Four-Tier Continuum of Academic and Behavioral Support (4T-CABS) model focuses on improving both academic and behavioral outcomes by offering support for students at four levels, which range from adequate instruction for all, to targeted small-group interventions, to individualized support, and also include exit support for students who might be better off in another degree program. Additionally, medical schools should provide both academic and behavioral support; set high, yet realistic expectations and clearly communicate these to students; and intervene early, which requires timely identification of at-risk students who would benefit from the different types and tiers of support. Finally, interventions should be evidence based and fit the needs of the identified groups of students. The authors argue that adopting the core principles of the 4T-CABS model will enable medical schools to maximize academic engagement and performance for all students.

Organizational models of educational technology in U.S. and Canadian medical schools.

Science.gov (United States)

Souza, Kevin H; Kamin, Carol; O'Sullivan, Patricia; Moses, Anna; Heestand, Diane

2008-07-01

To examine the organizational structure of educational technology units within U.S. and Canadian medical schools in order to (1) identify organization models that support educational technology, (2) describe key attributes of these models, and (3) discuss the strengths and challenges associated with these models. The authors distributed a survey to 88 schools that had previously provided information on their educational technology services and infrastructure. The authors developed the survey through a series of pilots and, then, from the data for each respondent school, created concept maps, which were used to identify organizational models. The authors conducted analyses to determine differences among models. The authors coded the comments about organizational models and identified themes. The authors received adequate data for analysis from 61 schools (69%). Four models for educational technology organizations emerged: (1) centralized units located in the school of medicine, (2) centralized units located at the health science center, (3) centralized units at the comprehensive university, and (4) no centralized unit (Dispersed Model). The majority (75%) of schools relied on some type of centralized organization. Whereas few organization attributes proved to be statistically significant, the centralized models have more resources devoted to educational technology and a closer alignment with the academic mission than the Dispersed Model. Medical schools primarily use central models. The authors recommend that schools structuring their educational technology resources consider exploration of a central model because of its focused use of resources to improve teaching and learning.

Project EASE: a study to test a psychosocial model of epilepsy medication managment.

Science.gov (United States)

DiIorio, Collen; Shafer, Patricia Osborne; Letz, Richard; Henry, Thomas R; Schomer, Donal L; Yeager, Kate

2004-12-01

The purpose of this study was to test a psychosocial model of medication self-management among people with epilepsy. This model was based primarily on social cognitive theory and included personal (self-efficacy, outcome expectations, goals, stigma, and depressive symptoms), social (social support), and provider (patient satisfaction and desire for control) variables. Participants for the study were enrolled at research sites in Atlanta, Georgia, and Boston, Massachusetts and completed computer-based assessments that included measures of the study variables listed above. The mean age of the 317 participants was 43.3 years; about 50% were female, and 81%white. Self-efficacy and patient satisfaction explained the most variance in medication management. Social support was related to self-efficacy; stigma to self-efficacy and depressive symptoms; and self-efficacy to outcome expectations and depressive symptoms. Findings reinforce that medication-taking behavior is affected by a complex set of interactions among psychosocial variables.

A new model to understand the career choice and practice location decisions of medical graduates.

Science.gov (United States)

Stagg, P; Greenhill, J; Worley, P S

2009-01-01

places is influencing both urban- and rural-origin graduates to practise in urban locations. Further analysis of graduates' career pathway choices (rural or urban) and geographic background (rural or urban) was conducted. This resulted in the development of a new model, 'The Four Qs Model'. This model consists of four quadrants derived from the variables career pathway choice (rural or urban) and geographic background (rural or urban). Clustering of consistent demographic and qualitative trends unique to each quadrant was demonstrated. The distinctive clustering that emerged from the data resulted in the quadrants being renamed 'The True Believers', 'The Convertibles' 'The Frustrated' and 'The Metro Docs'. The PRCC is influencing graduates to choose a rural career path. The PRCC program affirms the career preferences of rural origin students while graduates with little rural exposure prior to the PRCC report being positively influenced to pursue a rural career path. The Four Qs Model is a useful model in that it demonstrates consistent themes in the characteristics of PRCC graduates and assists understanding of why they choose a rural medical career. This could be relevant to the selection of medical students into rural medical education programs and in the construction of rural curricula. The model also offers a useful framework for further research in this field.

Simulation-based rhomboid flap skills training during medical education: comparing low- and high-fidelity bench models.

Science.gov (United States)

Denadai, Rafael; Saad-Hossne, Rogerio; Raposo-Amaral, Cassio Eduardo

2014-11-01

To assess if the bench model fidelity interferes in the acquisition of rhomboid flap skills by medical students. Sixty novice medical students were randomly assigned to 5 practice conditions with instructor-directed Limberg rhomboid flap skills training: didactic materials (control group 1), low-fidelity rubberized line (group 2) or ethylene-vinyl acetate (group 3) bench models; high-fidelity chicken leg skin (group 4) or pig foot skin (group 5) bench models. Pretests and posttests were applied, and Global Rating Scale, effect size, and self-perceived confidence were used to evaluate all flap performances. Medical students from groups 2 to 5 showed better flap performances based on the Global Rating Scale (all P 0.05). The magnitude of the effect was considered large (>0.80) in all measurements. There was acquisition of rhomboid flap skills regardless of bench model fidelity.

Evaluation of Medical Education virtual Program: P3 model.

Science.gov (United States)

Rezaee, Rita; Shokrpour, Nasrin; Boroumand, Maryam

2016-10-01

In e-learning, people get involved in a process and create the content (product) and make it available for virtual learners. The present study was carried out in order to evaluate the first virtual master program in medical education at Shiraz University of Medical Sciences according to P3 Model. This is an evaluation research study with post single group design used to determine how effective this program was. All students 60 who participated more than one year in this virtual program and 21 experts including teachers and directors participated in this evaluation project. Based on the P3 e-learning model, an evaluation tool with 5-point Likert rating scale was designed and applied to collect the descriptive data. Students reported storyboard and course design as the most desirable element of learning environment (2.30±0.76), but they declared technical support as the less desirable part (1.17±1.23). Presence of such framework in this regard and using it within the format of appropriate tools for evaluation of e-learning in universities and higher education institutes, which present e-learning curricula in the country, may contribute to implementation of the present and future e-learning curricula efficiently and guarantee its implementation in an appropriate way.

New medical diagnoses and length of stay of acutely unwell older patients: Implications for funding models.

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Basic, David; Khoo, Angela

2015-09-01

To examine the relationship between newly made medical diagnoses and length of stay (LOS) of acutely unwell older patients. Consecutive patients admitted under the care of four geriatricians were randomly allocated to a model development sample (n = 937) or a model validation sample (n = 855). Cox regression was used to model LOS. Variables considered for inclusion in the development model were established risk factors for LOS and univariate predictors from our dataset. Variables selected in the development sample were tested in the validation sample. A median of five new medical diagnoses were made during a median LOS of 10 days. New diagnoses predicted an increased LOS (hazard ratio 0.90, 95% confidence interval 0.88-0.92). Other significant predictors of increased LOS in both samples were malnutrition and frailty. Identification of new medical diagnoses may have implications for Diagnosis Related Groups-based funding models and may improve the care of older people. © 2015 AJA Inc.

A Structural Equation Model of HIV-related Symptoms, Depressive Symptoms, and Medication Adherence.

Science.gov (United States)

Yoo-Jeong, Moka; Waldrop-Valverde, Drenna; McCoy, Katryna; Ownby, Raymond L

2016-05-01

Adherence to combined antiretroviral therapy (cART) remains critical in management of HIV infection. This study evaluated depression as a potential mechanism by which HIV-related symptoms affect medication adherence and explored if particular clusters of HIV symptoms are susceptible to this mechanism. Baseline data from a multi-visit intervention study were analyzed among 124 persons living with HIV (PLWH). A bifactor model showed two clusters of HIV-related symptom distress: general HIV-related symptoms and gastrointestinal (GI) symptoms. Structural equation modeling showed that both general HIV-related symptoms and GI symptoms were related to higher levels of depressive symptoms, and higher levels of depressive symptoms were related to lower levels of medication adherence. Although general HIV-related symptoms and GI symptoms were not directly related to adherence, they were indirectly associated with adherence via depression. The findings highlight the importance of early recognition and evaluation of symptoms of depression, as well as the underlying physical symptoms that might cause depression, to improve medication adherence.

Sparse Principal Component Analysis in Medical Shape Modeling

DEFF Research Database (Denmark)

Sjöstrand, Karl; Stegmann, Mikkel Bille; Larsen, Rasmus

2006-01-01

Principal component analysis (PCA) is a widely used tool in medical image analysis for data reduction, model building, and data understanding and exploration. While PCA is a holistic approach where each new variable is a linear combination of all original variables, sparse PCA (SPCA) aims...... analysis in medicine. Results for three different data sets are given in relation to standard PCA and sparse PCA by simple thresholding of sufficiently small loadings. Focus is on a recent algorithm for computing sparse principal components, but a review of other approaches is supplied as well. The SPCA...

Imprinting.

Science.gov (United States)

McCabe, Brian J

2013-07-01

Imprinting is a type of learning by which an animal restricts its social preferences to an object after exposure to that object. Filial imprinting occurs shortly after birth or hatching and sexual imprinting, around the onset of sexual maturity; both have sensitive periods. This review is concerned mainly with filial imprinting. Filial imprinting in the domestic chick is an effective experimental system for investigating mechanisms underlying learning and memory. Extensive evidence implicates a restricted part of the chick forebrain, the intermediate and medial mesopallium (IMM), as a memory store for visual imprinting. After imprinting to a visual stimulus, neuronal responsiveness in IMM is specifically biased toward the imprinting stimulus. Both this bias and the strength of imprinting measured behaviorally depend on uninterrupted sleep shortly after training. When learning-related changes in IMM are lateralized they occur predominantly or completely on the left side. Ablation experiments indicate that the left IMM is responsible for long-term storage of information about the imprinting stimulus; the right side is also a store but additionally is necessary for extra storage outside IMM, in a region necessary for flexible use of information acquired through imprinting. Auditory imprinting gives rise to biochemical, neuroanatomical, and electrophysiological changes in the medio-rostral nidopallium/mesopallium, anterior to IMM. Auditory imprinting has not been shown to produce learning-related changes in IMM. Imprinting may be facilitated by predispositions. Similar predispositions for faces and biological motion occur in domestic chicks and human infants. WIREs Cogn Sci 2013, 4:375-390. doi: 10.1002/wcs.1231 For further resources related to this article, please visit the WIREs website. Copyright © 2013 John Wiley & Sons, Ltd.

A risk stratification model for antihypertensive medication non-adherence among Chinese immigrants

Directory of Open Access Journals (Sweden)

Wen-Wen Li

2016-12-01

Full Text Available The purpose of this study was to establish a risk stratification model for identifying Chinese immigrants at risk for non-adherence to antihypertensive medications. Questionnaires were self-administered to 200 Chinese immigrants in San Francisco, USA. Questionnaires included demographics, culture factors (e.g., Perceived Susceptibility in General, Perceived Benefits of Western Medication, Perceived Benefits of Chinese Herbs, and Health-Related Social Support, and medications adherence. Participants' mean age was 70.6 (±10.3 years. Three stratification factors were identified for non-adherence: Lower Perceived Susceptibility in General, lower Perceived Benefit of Western Medications, and longer Length of Stay in the United States. The probability of non-adherence was 77%, 62%, and 57% for lower perceived susceptibility, longer stay in the United States, and lower perceived benefits of Western medications, respectively. A combination of lower perceived susceptibility and lower perceived benefits of medication predicted 81% non-adherence and lower perceived susceptibility with longer stay in the United States predicted at 84%. All three factors combined predicted nearly 90%. Patients with all three factors had the highest risk for non-adherence. The second priority groups are patients with lower perceived susceptibility and those with lower perceived susceptibility combined with any of the other two factors. In the clinical setting, these three groups are a high priority for education on the importance of medication adherence.

How to interpret the results of medical time series data analysis: Classical statistical approaches versus dynamic Bayesian network modeling.

Science.gov (United States)

Onisko, Agnieszka; Druzdzel, Marek J; Austin, R Marshall

2016-01-01

Classical statistics is a well-established approach in the analysis of medical data. While the medical community seems to be familiar with the concept of a statistical analysis and its interpretation, the Bayesian approach, argued by many of its proponents to be superior to the classical frequentist approach, is still not well-recognized in the analysis of medical data. The goal of this study is to encourage data analysts to use the Bayesian approach, such as modeling with graphical probabilistic networks, as an insightful alternative to classical statistical analysis of medical data. This paper offers a comparison of two approaches to analysis of medical time series data: (1) classical statistical approach, such as the Kaplan-Meier estimator and the Cox proportional hazards regression model, and (2) dynamic Bayesian network modeling. Our comparison is based on time series cervical cancer screening data collected at Magee-Womens Hospital, University of Pittsburgh Medical Center over 10 years. The main outcomes of our comparison are cervical cancer risk assessments produced by the three approaches. However, our analysis discusses also several aspects of the comparison, such as modeling assumptions, model building, dealing with incomplete data, individualized risk assessment, results interpretation, and model validation. Our study shows that the Bayesian approach is (1) much more flexible in terms of modeling effort, and (2) it offers an individualized risk assessment, which is more cumbersome for classical statistical approaches.

Modeling of bubble dynamics in relation to medical applications

Energy Technology Data Exchange (ETDEWEB)

Amendt, P.A.; London, R.A. [Lawrence Livermore National Lab., CA (United States); Strauss, M. [California Univ., Davis, CA (United States)]|[Israel Atomic Energy Commission, Beersheba (Israel). Nuclear Research Center-Negev] [and others

1997-03-12

In various pulsed-laser medical applications, strong stress transients can be generated in advance of vapor bubble formation. To better understand the evolution of stress transients and subsequent formation of vapor bubbles, two-dimensional simulations are presented in channel or cylindrical geometry with the LATIS (LAser TISsue) computer code. Differences with one-dimensional modeling are explored, and simulated experimental conditions for vapor bubble generation are presented and compared with data. 22 refs., 8 figs.

Modeling of bubble dynamics in relation to medical applications

International Nuclear Information System (INIS)

Amendt, P.A.; London, R.A.; Strauss, M.; Israel Atomic Energy Commission, Beersheba

1997-01-01

In various pulsed-laser medical applications, strong stress transients can be generated in advance of vapor bubble formation. To better understand the evolution of stress transients and subsequent formation of vapor bubbles, two-dimensional simulations are presented in channel or cylindrical geometry with the LATIS (LAser TISsue) computer code. Differences with one-dimensional modeling are explored, and simulated experimental conditions for vapor bubble generation are presented and compared with data. 22 refs., 8 figs

How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model.

Science.gov (United States)

Meyer-Zehnder, Barbara; Albisser Schleger, Heidi; Tanner, Sabine; Schnurrer, Valentin; Vogt, Deborah R; Reiter-Theil, Stella; Pargger, Hans

2017-02-23

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing (explicit) ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and

The medical simulation markup language - simplifying the biomechanical modeling workflow.

Science.gov (United States)

Suwelack, Stefan; Stoll, Markus; Schalck, Sebastian; Schoch, Nicolai; Dillmann, Rüdiger; Bendl, Rolf; Heuveline, Vincent; Speidel, Stefanie

2014-01-01

Modeling and simulation of the human body by means of continuum mechanics has become an important tool in diagnostics, computer-assisted interventions and training. This modeling approach seeks to construct patient-specific biomechanical models from tomographic data. Usually many different tools such as segmentation and meshing algorithms are involved in this workflow. In this paper we present a generalized and flexible description for biomechanical models. The unique feature of the new modeling language is that it not only describes the final biomechanical simulation, but also the workflow how the biomechanical model is constructed from tomographic data. In this way, the MSML can act as a middleware between all tools used in the modeling pipeline. The MSML thus greatly facilitates the prototyping of medical simulation workflows for clinical and research purposes. In this paper, we not only detail the XML-based modeling scheme, but also present a concrete implementation. Different examples highlight the flexibility, robustness and ease-of-use of the approach.

Modeling the economic impact of medication adherence in type 2 diabetes: a theoretical approach

Directory of Open Access Journals (Sweden)

David S Cobden

2010-08-01

Full Text Available David S Cobden1, Louis W Niessen2, Frans FH Rutten1, W Ken Redekop11Department of Health Policy and Management, Section of Health Economics – Medical Technology Assessment (HE-MTA, Erasmus MC, Erasmus University Rotterdam, The Netherlands; 2Department of International Health, Johns Hopkins University School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, USAAims: While strong correlations exist between medication adherence and health economic outcomes in type 2 diabetes, current economic analyses do not adequately consider them. We propose a new approach to incorporate adherence in cost-effectiveness analysis.Methods: We describe a theoretical approach to incorporating the effect of adherence when estimating the long-term costs and effectiveness of an antidiabetic medication. This approach was applied in a Markov model which includes common diabetic health states. We compared two treatments using hypothetical patient cohorts: injectable insulin (IDM and oral (OAD medications. Two analyses were performed, one which ignored adherence (analysis 1 and one which incorporated it (analysis 2. Results from the two analyses were then compared to explore the extent to which adherence may impact incremental cost-effectiveness ratios.Results: In both analyses, IDM was more costly and more effective than OAD. When adherence was ignored, IDM generated an incremental cost-effectiveness of $12,097 per quality-adjusted life-year (QALY gained versus OAD. Incorporation of adherence resulted in a slightly higher ratio ($16,241/QALY. This increase was primarily due to better adherence with OAD than with IDM, and the higher direct medical costs for IDM.Conclusions: Incorporating medication adherence into economic analyses can meaningfully influence the estimated cost-effectiveness of type 2 diabetes treatments, and should therefore be ­considered in health care decision-making. Future work on the impact of adherence on health �

A unified framework for data modeling on medical information systems.

Science.gov (United States)

Neves, J; Cortez, P; Rocha, M; Abelha, A; Machado, J; Alves, V; Basto, S; Botelho, H; Neves, J

1999-01-01

Medical Information Systems (MIS) are seen as a way of optimizing the use of existing health-care infrastructure, without resorting to new and costly hospital (re)construction. The qualitative (re)design of such an environment requires a basic understanding of patient and doctors related characteristics and capabilities. Patient care, patient education, medical education, and clinical research need to be considered to meet the basic requirements on the level of services desirable, determined on the basis of the patient's length of stay; i.e., used for modeling the significant entities of such a world. The aim is to extract conclusions for the level of services provided to the users. One's concept will capture, as well as will integrate, the basic design principles under which MIS may be set.

Structural-functional model of medical students’ professional-applied physical training

Directory of Open Access Journals (Sweden)

A.V. Petryshyn

2016-10-01

Full Text Available Purpose: to work out and experimentally prove model of professional-applied physical training of medical higher educational establishments’ students. Material: in the research 80 students participated. In questioning physical education instructors of medical higher education establishments (n=20 participated. Results: influence of students’ professionally important characteristics on general physical fitness indicators and functional state has been shown. Directions of students’ physical fitness parameters’ individual diagnostic and control over physical education effectiveness have been offered. Volumes of physical exercises in the structure of training have been found: special training (15-20% and competition exercises (20-30%. Conclusions: the need in raising the level of professionally important for students’ abilities has been noted: speed power, static power endurance, power endurance, coordination of arms’ movements, static balance.

Testing a Mediational Model of Communication Among Medical Staff and Families of Cancer Patients

Science.gov (United States)

Gionta, Dana A.; Harlow, Lisa L.; Loitman, Jane E.; Leeman, Joanne M.

2005-01-01

Three structural equation models of communication between family members and medical staff were examined to understand relations among staff accessibility, inhibitory family attitudes, getting communication needs met, perceived stress, and satisfaction with communication. Compared to full and direct models, a mediational model fit best in which…

A structural model of stress, motivation, and academic performance in medical students.

Science.gov (United States)

Park, Jangho; Chung, Seockhoon; An, Hoyoung; Park, Seungjin; Lee, Chul; Kim, Seong Yoon; Lee, Jae-Dam; Kim, Ki-Soo

2012-06-01

The purpose of the present study was 1) to identify factors that may influence academic stress in medical students and 2) to investigate the causal relationships among these variables with path analysis. One hundred sixty medical students participated in the present study. Psychological parameters were assessed with the Medical Stress Scale, Minnesota Multiphasic Personality Inventory, Hamilton Depression Scale, Beck Depression Inventory, and Academic Motivation Scale. Linear regression and path analysis were used to examine the relationships among variables. Significant correlations were noted between several factors and Medical Stress scores. Specifically, Hamilton Depression Scale scores (β=0.26, p=0.03) and amotivation (β=0.20, p=0.01) and extrinsically identified regulation (β=0.27, pAcademic Motivation Scale had independent and significant influences on Medical Stress Scale scores. A path analysis model indicated that stress, motivation, and academic performance formed a triangular feedback loop. Moreover, depression was associated with both stress and motivation, and personality was associated with motivation. The triangular feedback-loop structure in the present study indicated that actions that promote motivation benefit from interventions against stress and depression. Moreover, stress management increases motivation in students. Therefore, strategies designed to reduce academic pressures in medical students should consider these factors. Additional studies should focus on the relationship between motivation and depression.

CoMIC, the hidden dynamics of mitochondrial inner compartments.

Science.gov (United States)

Cho, Bongki; Sun, Woong

2017-12-01

Mitochondria have evolutionarily, functionally and structurally distinct outer- (OMM) and inner-membranes (IMM). Thus, mitochondrial morphology is controlled by independent but coordinated activity of fission and fusion of the OMM and IMM. Constriction and division of the OMM are mediated by endocytosis-like machineries, which include dynamin-related protein 1 with additional cytosolic vesicle scissoring machineries such as actin filament and Dynamin 2. However, structural alteration of the IMM during mitochondrial division has been poorly understood. Recently, we found that the IMM and the inner compartments undergo transient and reversible constriction prior to the OMM division, which we termed CoMIC, Constriction of Mitochondrial Inner Compartment. In this short review, we further discuss the evolutionary perspective and the regulatory mechanism of CoMIC during mitochondrial division. [BMB Reports 2017; 50(12): 597-598].

Using 3D Printing (Additive Manufacturing) to Produce Low-Cost Simulation Models for Medical Training.

Science.gov (United States)

Lichtenberger, John P; Tatum, Peter S; Gada, Satyen; Wyn, Mark; Ho, Vincent B; Liacouras, Peter

2018-03-01

This work describes customized, task-specific simulation models derived from 3D printing in clinical settings and medical professional training programs. Simulation models/task trainers have an array of purposes and desired achievements for the trainee, defining that these are the first step in the production process. After this purpose is defined, computer-aided design and 3D printing (additive manufacturing) are used to create a customized anatomical model. Simulation models then undergo initial in-house testing by medical specialists followed by a larger scale beta testing. Feedback is acquired, via surveys, to validate effectiveness and to guide or determine if any future modifications and/or improvements are necessary. Numerous custom simulation models have been successfully completed with resulting task trainers designed for procedures, including removal of ocular foreign bodies, ultrasound-guided joint injections, nerve block injections, and various suturing and reconstruction procedures. These task trainers have been frequently utilized in the delivery of simulation-based training with increasing demand. 3D printing has been integral to the production of limited-quantity, low-cost simulation models across a variety of medical specialties. In general, production cost is a small fraction of a commercial, generic simulation model, if available. These simulation and training models are customized to the educational need and serve an integral role in the education of our military health professionals.

Non-bilayer structures in mitochondrial membranes regulate ATP synthase activity.

Science.gov (United States)

Gasanov, Sardar E; Kim, Aleksandr A; Yaguzhinsky, Lev S; Dagda, Ruben K

2018-02-01

Cardiolipin (CL) is an anionic phospholipid at the inner mitochondrial membrane (IMM) that facilitates the formation of transient non-bilayer (non-lamellar) structures to maintain mitochondrial integrity. CL modulates mitochondrial functions including ATP synthesis. However, the biophysical mechanisms by which CL generates non-lamellar structures and the extent to which these structures contribute to ATP synthesis remain unknown. We hypothesized that CL and ATP synthase facilitate the formation of non-bilayer structures at the IMM to stimulate ATP synthesis. By using 1 H NMR and 31 P NMR techniques, we observed that increasing the temperature (8°C to 37°C), lowering the pH (3.0), or incubating intact mitochondria with CTII - an IMM-targeted toxin that increases the formation of immobilized non-bilayer structures - elevated the formation of non-bilayer structures to stimulate ATP synthesis. The F 0 sector of the ATP synthase complex can facilitate the formation of non-bilayer structures as incubating model membranes enriched with IMM-specific phospholipids with exogenous DCCD-binding protein of the F 0 sector (DCCD-BPF) elevated the formation of immobilized non-bilayer structures to a similar manner as CTII. Native PAGE assays revealed that CL, but not other anionic phospholipids, specifically binds to DCCD-BPF to promote the formation of stable lipid-protein complexes. Mechanistically, molecular docking studies identified two lipid binding sites for CL in DCCD-BPF. We propose a new model of ATP synthase regulation in which CL mediates the formation of non-bilayer structures that serve to cluster protons and ATP synthase complexes as a mechanism to enhance proton translocation to the F 0 sector, and thereby increase ATP synthesis. Copyright © 2017 Elsevier B.V. All rights reserved.

Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

Science.gov (United States)

Akinci, Fevzi; Patel, Poonam M

2014-01-01

Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

The National Center for Collaboration in Medical Modeling and Simulation

Science.gov (United States)

2005-05-01

being developed that addressed specific procedures including knee surgery, ophthalmology , and sinus surgery (Satava, 2001). One of the important factors...Nirona, 1990). In fact, the general picture for Vietnam data suggested that the prevalence of some types of disease may decrease during wartime...physical models with limited functionality. However, the current breed of medical simulators is quite sophisticated and many have impressive levels

The Ambulatory Integration of the Medical and Social (AIMS) model: A retrospective evaluation.

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Rowe, Jeannine M; Rizzo, Victoria M; Shier Kricke, Gayle; Krajci, Kate; Rodriguez-Morales, Grisel; Newman, Michelle; Golden, Robyn

2016-01-01

An exploratory, retrospective evaluation of Ambulatory Integration of the Medical and Social (AIMS), a care coordination model designed to integrate medical and non-medical needs of patients and delivered exclusively by social workers was conducted to examine mean utilization of costly health care services for older adult patients. Results reveal mean utilization of 30-day hospital readmissions, emergency department (ED) visits, and hospital admissions are significantly lower for the study sample compared to the larger patient population. Comparisons with national population statistics reveal significantly lower mean utilization of 30-day admissions and ED visits for the study sample. The findings offer preliminary support regarding the value of AIMS.

The migraine ACE model: evaluating the impact on time lost and medical resource Use.

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Caro, J J; Caro, G; Getsios, D; Raggio, G; Burrows, M; Black, L

2000-04-01

To describe the Migraine Adaptive Cost-Effectiveness Model in the context of an analysis of a simulated population of Canadian patients with migraine. The high prevalence of migraine and its substantial impact on patients' ability to function normally present a significant economic burden to society. In light of the recent availability of improved pharmaceutical treatments, a model was developed to assess their economic impact. The Migraine Adaptive Cost-Effectiveness Model incorporates the costs of time lost from both work and nonwork activities, as well as medical resource and medication use. Using Monte Carlo techniques, the model simulates the experience of a population of patients with migraine over the course of 1 year. As an example, analyses of a Canadian population were carried out using data from a multinational trial, surveys, national statistics, and the available literature. Using customary therapy, mean productivity losses (amounting to 84 hours of paid work time, 48 hours of unpaid work time, and 113 hours of leisure time lost) were estimated to cost $1949 (in 1997 Canadian dollars) per patient, with medical expenditures adding an average of $280 to the cost of illness. With customary treatment patterns, the costs of migraine associated with reduced functional capacity are substantial. The migraine model represents a flexible tool for the economic evaluation of different migraine treatments in various populations.

A Course Evaluation Tool Based on SPICES Model, and its Application to Evaluation of Medical Pharmacology Course

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Tahereh Changiz

2009-02-01

Full Text Available Background and purpose: The SPICES model has been proposed to be used both as a framework for quality improvement in medical education and as a guide for evaluation of curricula. The six strategies of SPICES are representatives of innovative approaches to medical education, and each one has been considered as a continuum. The present study models a theory-based questionnaire, based on SPICES, to be used as a course evaluation tool, through developing a conceptual model for eachcontinuum of the six.Methods: At the first step, operational definition and questionnaire development was performed as an extensive literature review and consensus building in a focus groups of experts .The content andface validity of questionnaire was confirmed. In the second phase-as a pilot -, the questionnaire was used for evaluation of Medical Pharmacology course at Isfahan University of Medical Sciences.Results: The results showed that Medical Pharmacology course located in the traditional end of SPICES continua according to the most aspects of the course.Conclusion: The pilot study showed that the questionnaire scale should be changed. Also it may be more feasible and valid if an item bank is prepared based on the proposed matrix and appropriate items are selected according to the general situation of the curriculum.Keywords: SPICES MODEL, EVALUATION

The social structure of the medical model of madness and the physician's role.

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Fernandez, G

1981-08-01

In this paper the origins of the medical model of madness are traced in the sociohistorical context of institutional and professional development. The paper establishes the emergence of the three primary conditions necessary for the medical model to exist: (a) the view that madness is a separate ontological reality which can be differentiated from the insane person; (b) the concept that insane people do not have a completely free will and therefore cannot be held responsible for their actions; and (c) the creation of specific criteria to classify the disease into empirically derived nosologies. These conditions and their acceptance as an explanatory paradigm of insanity result from the political economy of the late Middle Ages and are reflected in the institutional arrangement for insane persons of the 17th and 18th centuries. Finally, the role of the physician-psychiatrist is explained in terms of an ability to (a) serve as a technician for the new political forces, and (b) dislodge the moral entrepreneurs and become the only profession able to offer a proper scientific and secular treatment of madness. The psychiatrist is presented as a by-product of the dominance of the medical model rather than as the agent who created it.

Development of a patient-doctor communication skills model for medical students.

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Lee, Young Hee; Lee, Young-Mee

2010-09-01

Communication is a core clinical skill that can be taught and learned. The authors intended to develop a patient-doctor communication model for teaching and assessing undergraduate medical students in Korea. To develop a model, literature reviews and an iterative process of discussion between faculty members of a communication skills course for second year medical students were conducted. The authors extracted common communication skill competencies by comparing the Kalamazoo Consensus Statement, SEGUE framework communication skills, the Calgary Cambridge Observation Guides, and previous communication skills lists that have been used by the authors. The content validity, with regard to clinical importance and feasibility, was surveyed by both faculty physicians and students. The first version of the model consisted of 36 items under 7 categories: initiating the session (8 items), building a relationship (6), gathering information (8), understanding a patient's perspectives (4), sharing information (4), reaching an agreement (3), and closing the session (3). It was used as a guide for both students and teachers in an actual communication skills course. At the end of the course, student performance was assessed using two 7-minute standardized patient interviews with a 34-item checklist. This assessment tool was modified from the first version of the model to reflect the case specificity of the scenarios. A patient-doctor communication model, which can be taught to those with limited patient care experience, was finally developed. We recommended a patient-doctor communication skills model that can be used for teaching and evaluating preclinical and clinical students. Further studies are needed to verify its validity and reliability.

Structural characterisation of medically relevant protein assemblies by integrating mass spectrometry with computational modelling.

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Politis, Argyris; Schmidt, Carla

2018-03-20

Structural mass spectrometry with its various techniques is a powerful tool for the structural elucidation of medically relevant protein assemblies. It delivers information on the composition, stoichiometries, interactions and topologies of these assemblies. Most importantly it can deal with heterogeneous mixtures and assemblies which makes it universal among the conventional structural techniques. In this review we summarise recent advances and challenges in structural mass spectrometric techniques. We describe how the combination of the different mass spectrometry-based methods with computational strategies enable structural models at molecular levels of resolution. These models hold significant potential for helping us in characterizing the function of protein assemblies related to human health and disease. In this review we summarise the techniques of structural mass spectrometry often applied when studying protein-ligand complexes. We exemplify these techniques through recent examples from literature that helped in the understanding of medically relevant protein assemblies. We further provide a detailed introduction into various computational approaches that can be integrated with these mass spectrometric techniques. Last but not least we discuss case studies that integrated mass spectrometry and computational modelling approaches and yielded models of medically important protein assembly states such as fibrils and amyloids. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Modeling manipulation in medical education.

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Dailey, Jason I

2010-05-01

As residents and medical students progress through their medical training, they are presented with multiple instances in which they feel they must manipulate the healthcare system and deceive others in order to efficiently treat their patients. This, however, creates a culture of manipulation resulting in untoward effects on trainees' ethical and professional development. Yet manipulation need not be a skill necessary to practice medicine, and steps should be taken by both individuals and institutions to combat the view that the way medicine must be practiced "in the real world" is somehow different from what one's affective moral sense implores.

Empirical Validation of the Information–Motivation–Behavioral Skills Model of Diabetes Medication Adherence: A Framework for Intervention

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Mayberry, Lindsay S.; Osborn, Chandra Y.

2014-01-01

OBJECTIVE Suboptimal adherence to diabetes medications is prevalent and associated with unfavorable health outcomes, but it remains unclear what intervention content is necessary to effectively promote medication adherence in diabetes. In other disease contexts, the Information–Motivation–Behavioral skills (IMB) model has effectively explained and promoted medication adherence and thus may have utility in explaining and promoting adherence to diabetes medications. We tested the IMB model’s hypotheses in a sample of adults with type 2 diabetes. RESEARCH DESIGN AND METHODS Participants (N = 314) completed an interviewer-administered survey and A1C test. Structural equation models tested the effects of diabetes medication adherence-related information, motivation, and behavioral skills on medication adherence and the effect of medication adherence on A1C. RESULTS The IMB elements explained 41% of the variance in adherence, and adherence explained 9% of the variance in A1C. As predicted, behavioral skills had a direct effect on adherence (β = 0.59; P motivation (indirect effect 0.12 [0.05–0.20]) on adherence. Medication adherence significantly predicted glycemic control (β = −0.30; P motivation, and behavioral skills and assessing the degree to which change in these determinants leads to changes in medication adherence behavior. PMID:24598245

Organization-and-technological model of medical care delivered to patients with arterial hypertension

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Kiselev A.R.

2014-09-01

Full Text Available Organization-and-technological model of medical care delivered to patients with arterial hypertension based on IDEF0 methodology and corresponded with clinical guidelines is presented.

Modeled occupational exposures to gas-phase medical laser-generated air contaminants.

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Lippert, Julia F; Lacey, Steven E; Jones, Rachael M

2014-01-01

Exposure monitoring data indicate the potential for substantive exposure to laser-generated air contaminants (LGAC); however the diversity of medical lasers and their applications limit generalization from direct workplace monitoring. Emission rates of seven previously reported gas-phase constituents of medical laser-generated air contaminants (LGAC) were determined experimentally and used in a semi-empirical two-zone model to estimate a range of plausible occupational exposures to health care staff. Single-source emission rates were generated in an emission chamber as a one-compartment mass balance model at steady-state. Clinical facility parameters such as room size and ventilation rate were based on standard ventilation and environmental conditions required for a laser surgical facility in compliance with regulatory agencies. All input variables in the model including point source emission rates were varied over an appropriate distribution in a Monte Carlo simulation to generate a range of time-weighted average (TWA) concentrations in the near and far field zones of the room in a conservative approach inclusive of all contributing factors to inform future predictive models. The concentrations were assessed for risk and the highest values were shown to be at least three orders of magnitude lower than the relevant occupational exposure limits (OELs). Estimated values do not appear to present a significant exposure hazard within the conditions of our emission rate estimates.

"No-fault" compensation for victims of medical injuries. Ten years of implementing the French model.

Science.gov (United States)

Barbot, Janine; Parizot, Isabelle; Winance, Myriam

2014-02-01

For decades and in many countries, the issue of compensation for victims of medical injuries has led to lively debates. In 2002, a law set up a new model for compensation in France - based on the creation of a "no fault" compensation scheme and of an out-of-court settlement mechanism. This is one of the most recent models to have been adopted in European countries. This article analyses the choices made by the law and discusses the key figures of its ten years of implementation. We conducted (1) a study of debates regarding compensation for victims of medical injuries in France; (2) a comparative analysis of the different models of compensation which had already been adopted in different countries; (3) a study of primary sources provided by the bodies in charge of the French new out-of-court settlement mechanism; and (4) a statistical analysis of the exhaustive list of 18,258 claims filed between 2003 and 2009. The article highlights the context which led to the adoption of the 2002 law on the quality of care and patients' rights. It analyses, from a comparative standpoint, the specificities of the new compensation model set up by the law. It shows how the opportunities for victims of medical injuries to be compensated had improved in France. Finally, we discuss the limits of the new model and what the next step might be to improve access to compensation for victims of medical injuries. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Survey of using GPU CUDA programming model in medical image analysis

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T. Kalaiselvi

2017-01-01

Full Text Available With the technology development of medical industry, processing data is expanding rapidly and computation time also increases due to many factors like 3D, 4D treatment planning, the increasing sophistication of MRI pulse sequences and the growing complexity of algorithms. Graphics processing unit (GPU addresses these problems and gives the solutions for using their features such as, high computation throughput, high memory bandwidth, support for floating-point arithmetic and low cost. Compute unified device architecture (CUDA is a popular GPU programming model introduced by NVIDIA for parallel computing. This review paper briefly discusses the need of GPU CUDA computing in the medical image analysis. The GPU performances of existing algorithms are analyzed and the computational gain is discussed. A few open issues, hardware configurations and optimization principles of existing methods are discussed. This survey concludes the few optimization techniques with the medical imaging algorithms on GPU. Finally, limitation and future scope of GPU programming are discussed.

Medication Reconciliation: Work Domain Ontology, prototype development, and a predictive model.

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Markowitz, Eliz; Bernstam, Elmer V; Herskovic, Jorge; Zhang, Jiajie; Shneiderman, Ben; Plaisant, Catherine; Johnson, Todd R

2011-01-01

Medication errors can result from administration inaccuracies at any point of care and are a major cause for concern. To develop a successful Medication Reconciliation (MR) tool, we believe it necessary to build a Work Domain Ontology (WDO) for the MR process. A WDO defines the explicit, abstract, implementation-independent description of the task by separating the task from work context, application technology, and cognitive architecture. We developed a prototype based upon the WDO and designed to adhere to standard principles of interface design. The prototype was compared to Legacy Health System's and Pre-Admission Medication List Builder MR tools via a Keystroke-Level Model analysis for three MR tasks. The analysis found the prototype requires the fewest mental operations, completes tasks in the fewest steps, and completes tasks in the least amount of time. Accordingly, we believe that developing a MR tool, based upon the WDO and user interface guidelines, improves user efficiency and reduces cognitive load.

Effects of drift gas on collision cross sections of a protein standard in linear drift tube and traveling wave ion mobility mass spectrometry.

Science.gov (United States)

Jurneczko, Ewa; Kalapothakis, Jason; Campuzano, Iain D G; Morris, Michael; Barran, Perdita E

2012-10-16

There has been a significant increase in the use of ion mobility mass spectrometry (IM-MS) to investigate conformations of proteins and protein complexes following electrospray ionization. Investigations which employ traveling wave ion mobility mass spectrometry (TW IM-MS) instrumentation rely on the use of calibrants to convert the arrival times of ions to collision cross sections (CCS) providing "hard numbers" of use to structural biology. It is common to use nitrogen as the buffer gas in TW IM-MS instruments and to calibrate by extrapolating from CCS measured in helium via drift tube (DT) IM-MS. In this work, both DT and TW IM-MS instruments are used to investigate the effects of different drift gases (helium, neon, nitrogen, and argon) on the transport of multiply charged ions of the protein myoglobin, frequently used as a standard in TW IM-MS studies. Irrespective of the drift gas used, recorded mass spectra are found to be highly similar. In contrast, the recorded arrival time distributions and the derived CCS differ greatly. At low charge states (7 ≤ z ≤ 11) where the protein is compact, the CCS scale with the polarizability of the gas; this is also the case for higher charge states (12 ≤ z ≤ 22) where the protein is more unfolded for the heavy gases (neon, argon, and nitrogen) but not the case for helium. This is here interpreted as a different conformational landscape being sampled by the lighter gas and potentially attributable to increased field heating by helium. Under nanoelectrospray ionization (nESI) conditions, where myoglobin is sprayed from an aqueous solution buffered to pH 6.8 with 20 mM ammonium acetate, in the DT IM-MS instrument, each buffer gas can yield a different arrival time distribution (ATD) for any given charge state.

Evaluation of medical education virtual program: P3 model

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RITA REZAEE

2016-10-01

Full Text Available Introduction: In e-learning, people get involved in a process and create the content (product and make it available for virtual learners. The present study was carried out in order to evaluate the first virtual master program in medical education at Shiraz University of Medical Sciences according to P3 Model. Methods: This is an evaluation research study with post single group design used to determine how effective this program was. All students 60 who participated more than one year in this virtual program and 21 experts including teachers and directors participated in this evaluation project. Based on the P3 e-learning model, an evaluation tool with 5-point Likert rating scale was designed and applied to collect the descriptive data. Results: Students reported storyboard and course design as the most desirable element of learning environment (2.30±0.76, but they declared technical support as the less desirable part (1.17±1.23. Conclusion: Presence of such framework in this regard and using it within the format of appropriate tools for evaluation of e-learning in universities and higher education institutes, which present e-learning curricula in the country, may contribute to implementation of the present and future e-learning curricula efficiently and guarantee its implementation in an appropriate way.

SEM Model Medical Solid Waste Hospital Management In Medan City

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Simarmata, Verawaty; Pandia, Setiaty; Mawengkang, Herman

2018-01-01

In daily activities, hospitals, as one of the important health care unit, generate both medical solid waste and non-medical solid waste. The occurrence of medical solid waste could be from the results of treatment activities, such as, in the treatment room for a hospital inpatient, general clinic, a dental clinic, a mother and child clinic, laboratories and pharmacies. Most of the medical solid waste contains infectious and hazardous materials. Therefore it should be managed properly, otherwise it could be a source of new infectious for the community around the hospital as well as for health workers themselves. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. One of the efforts that need to be done in improving the quality of the environment is to undertake waste management activities, because with proper waste management is the most important in order to achieve an optimal degree of human health. Health development in Indonesian aims to achieve a future in which the Indonesian people live in a healthy environment, its people behave clean and healthy, able to reach quality health services, fair and equitable, so as to have optimal health status, health development paradigm anchored to the healthy. The healthy condition of the individual and society can be influenced by the environment. Poor environmental quality is a cause of various health problems. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. This paper proposes a model for managing the medical solid waste in hospitals in Medan city, in order to create healthy environment around hospitals.

A Structural Model of Stress, Motivation, and Academic Performance in Medical Students

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Park, Jangho; An, Hoyoung; Park, Seungjin; Lee, Chul; Kim, Seong Yoon; Lee, Jae-Dam; Kim, Ki-Soo

2012-01-01

Objective The purpose of the present study was 1) to identify factors that may influence academic stress in medical students and 2) to investigate the causal relationships among these variables with path analysis. Methods One hundred sixty medical students participated in the present study. Psychological parameters were assessed with the Medical Stress Scale, Minnesota Multiphasic Personality Inventory, Hamilton Depression Scale, Beck Depression Inventory, and Academic Motivation Scale. Linear regression and path analysis were used to examine the relationships among variables. Results Significant correlations were noted between several factors and Medical Stress scores. Specifically, Hamilton Depression Scale scores (β=0.26, p=0.03) and amotivation (β=0.20, p=0.01) and extrinsically identified regulation (β=0.27, p<0.01) response categories on the Academic Motivation Scale had independent and significant influences on Medical Stress Scale scores. A path analysis model indicated that stress, motivation, and academic performance formed a triangular feedback loop. Moreover, depression was associated with both stress and motivation, and personality was associated with motivation. Conclusion The triangular feedback-loop structure in the present study indicated that actions that promote motivation benefit from interventions against stress and depression. Moreover, stress management increases motivation in students. Therefore, strategies designed to reduce academic pressures in medical students should consider these factors. Additional studies should focus on the relationship between motivation and depression. PMID:22707964

Review of early assessment models of innovative medical technologies.

Science.gov (United States)

Fasterholdt, Iben; Krahn, Murray; Kidholm, Kristian; Yderstræde, Knud Bonnet; Pedersen, Kjeld Møller

2017-08-01

Hospitals increasingly make decisions regarding the early development of and investment in technologies, but a formal evaluation model for assisting hospitals early on in assessing the potential of innovative medical technologies is lacking. This article provides an overview of models for early assessment in different health organisations and discusses which models hold most promise for hospital decision makers. A scoping review of published studies between 1996 and 2015 was performed using nine databases. The following information was collected: decision context, decision problem, and a description of the early assessment model. 2362 articles were identified and 12 studies fulfilled the inclusion criteria. An additional 12 studies were identified and included in the review by searching reference lists. The majority of the 24 early assessment studies were variants of traditional cost-effectiveness analysis. Around one fourth of the studies presented an evaluation model with a broader focus than cost-effectiveness. Uncertainty was mostly handled by simple sensitivity or scenario analysis. This review shows that evaluation models using known methods assessing cost-effectiveness are most prevalent in early assessment, but seems ill-suited for early assessment in hospitals. Four models provided some usable elements for the development of a hospital-based model. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Postdependent state in rats as a model for medication development in alcoholism.

Science.gov (United States)

Meinhardt, Marcus W; Sommer, Wolfgang H

2015-01-01

Rational development of novel therapeutic strategies for alcoholism requires understanding of its underlying neurobiology and pathophysiology. Obtaining this knowledge largely relies on animal studies. Thus, choosing the appropriate animal model is one of the most critical steps in pre-clinical medication development. Among the range of animal models that have been used to investigate excessive alcohol consumption in rodents, the postdependent model stands out. It was specifically developed to test the role of negative affect as a key driving force in a perpetuating addiction cycle for alcoholism. Here, we will describe our approach to make rats dependent via chronic intermittent exposure to alcohol, discuss the validity of this model, and compare it with other commonly used animal models of alcoholism. We will summarize evidence that postdependent rats fulfill several criteria of a 'Diagnostic and Statistical Manual of Mental Disorders IV/V-like' diagnostic system. Importantly, these animals show long-lasting excessive consumption of and increased motivation for alcohol, and evidence for loss of control over alcohol intake. Our conclusion that postdependent rats are an excellent model for medication development for alcoholism is underscored by a summary of more than two dozen pharmacological tests aimed at reversing these abnormal alcohol responses. We will end with open questions on the use of this model. In the tradition of the Sanchis-Segura and Spanagel review, we provide comic strips that illustrate the postdependent procedure and relevant phenotypes in this review. © 2014 Society for the Study of Addiction.

Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach.

Science.gov (United States)

De Las Cuevas, Carlos; de Leon, Jose; Peñate, Wenceslao; Betancort, Moisés

2017-01-01

To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients' adherence to psychopharmacological medications. A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. Structural equation modeling demonstrated that psychiatric patients' treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients' trust in their psychiatrists (doctors' subscale), 3) negatively with patients' belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients' adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients' psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models.

Science.gov (United States)

Eason, Christianne M; Mazerolle, Stephanie M; Goodman, Ashley

2017-01-01

 Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models.  To investigate the perceived benefits of and barriers in the medical and academic models.  Qualitative study.  National Collegiate Athletic Association Divisions I, II, and III.  A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models.  We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility.  In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative).  The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties.

77 FR 52977 - Regulatory Capital Rules: Advanced Approaches Risk-Based Capital Rule; Market Risk Capital Rule

Science.gov (United States)

2012-08-30

...-weighted assets for residential mortgages, securitization exposures, and counterparty credit risk. The.... Risk-Weighted Assets--Proposed Modifications to the Advanced Approaches Rules A. Counterparty Credit... Margin Period of Risk 3. Changes to the Internal Models Methodology (IMM) 4. Credit Valuation Adjustments...

A Nursing Management Model to Increase Medication Adherence and Nutritional Status of Patients with Pulmonary TB

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Eka Mishbahatul Mar’ah Has

2015-04-01

Full Text Available Introduction: High dropout rate, inadequate treatment, and resistance to medication, still become an obstacle in the treatment of pulmonary TB. Pulmonary TB patient care management at home can be done actively through telenursing. N-SMSI (Ners-Short Message Service Intervention is one of community nursing intervention, in which community nurses send short messages to remind patients to take medication and nutrition. The aim of this study was to analyze the effect of nursing management model N-SMSI to increased medication adherence and nutritional status of patients with pulmonary TB. Method: This study was used prospective design. The populations were new pulmonary TB patient at intensive phase, at Puskesmas Pegirian Surabaya. Samples were taken by purposive sampling technique; consist of 30 people, divided into treatment and control groups. The independent variable was N-SMSI. The dependent variables were medication adherence collected by using questionnaire and nutritional status by using measurement of body weight (kg. The data were then analyzed by using Wilcoxon Signed Rank Test, Mann Whitney, and Independent t-test with α ≤ 0.05 Result: The results of wilcoxon signed rank test had showed difference in the nutritional status of the treatment group before and after intervention, with p = 0.001. It’s similar with the control group, with p = 0.002. Mann whitney test results had showed no signifi cant difference in nutritional status between treatment and control group, as indicated by the value of p=0.589. While independent t-test had showed difference in compliance between treatment and control group, with p=0.031. Conslusion: N-SMSI can improve medication adherence of patient with Pulmonary TB. This model can be developed by nurse as alternative methods to improve medication adherence in patients with Pulmonary TB. Further research should modify nursing management model which can improve the nutritional status of patient with Pulmonary

Are Clinical Trial Experiences Utilized?: A Differentiated Model of Medical Sites’ Information Transfer Ability

DEFF Research Database (Denmark)

Smed, Marie; Schultz, Carsten; Getz, Kenneth A.

2015-01-01

The collaboration with medical professionals in pharmaceutical clinical trials facilitates opportunities to gain valuable market information concerning product functionality issues, as well as issues related to market implementation and adoption. However, previous research on trial management lacks......’ information transfer ability, their methods of communicating, are included. The model is studied on a unique dataset of 395 medical site representatives by applying Rasch scale modeling to differentiate the stickiness of the heterogenic information issues. The results reveal that economic measures...... a differentiated perspective on the potential for information transfer from site to producer. An exploration of the variation in stickiness of information, and therefore the complexity of information transfer in clinical trials, is the main aim of this study. To further enrich the model of the dispersed sites...

Using medical history embedded in biometrics medical card for user identity authentication: privacy preserving authentication model by features matching.

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Fong, Simon; Zhuang, Yan

2012-01-01

Many forms of biometrics have been proposed and studied for biometrics authentication. Recently researchers are looking into longitudinal pattern matching that based on more than just a singular biometrics; data from user's activities are used to characterise the identity of a user. In this paper we advocate a novel type of authentication by using a user's medical history which can be electronically stored in a biometric security card. This is a sequel paper from our previous work about defining abstract format of medical data to be queried and tested upon authentication. The challenge to overcome is preserving the user's privacy by choosing only the useful features from the medical data for use in authentication. The features should contain less sensitive elements and they are implicitly related to the target illness. Therefore exchanging questions and answers about a few carefully chosen features in an open channel would not easily or directly expose the illness, but yet it can verify by inference whether the user has a record of it stored in his smart card. The design of a privacy preserving model by backward inference is introduced in this paper. Some live medical data are used in experiments for validation and demonstration.

Using Medical History Embedded in Biometrics Medical Card for User Identity Authentication: Privacy Preserving Authentication Model by Features Matching

Directory of Open Access Journals (Sweden)

Simon Fong

2012-01-01

Full Text Available Many forms of biometrics have been proposed and studied for biometrics authentication. Recently researchers are looking into longitudinal pattern matching that based on more than just a singular biometrics; data from user’s activities are used to characterise the identity of a user. In this paper we advocate a novel type of authentication by using a user’s medical history which can be electronically stored in a biometric security card. This is a sequel paper from our previous work about defining abstract format of medical data to be queried and tested upon authentication. The challenge to overcome is preserving the user’s privacy by choosing only the useful features from the medical data for use in authentication. The features should contain less sensitive elements and they are implicitly related to the target illness. Therefore exchanging questions and answers about a few carefully chosen features in an open channel would not easily or directly expose the illness, but yet it can verify by inference whether the user has a record of it stored in his smart card. The design of a privacy preserving model by backward inference is introduced in this paper. Some live medical data are used in experiments for validation and demonstration.

An antenatal prediction model for adverse birth outcomes in an urban population: The contribution of medical and non-medical risks.

Science.gov (United States)

Posthumus, A G; Birnie, E; van Veen, M J; Steegers, E A P; Bonsel, G J

2016-07-01

in the Netherlands the perinatal mortality rate is high compared to other European countries. Around eighty percent of perinatal mortality cases is preceded by being small for gestational age (SGA), preterm birth and/or having a low Apgar-score at 5 minutes after birth. Current risk detection in pregnancy focusses primarily on medical risks. However, non-medical risk factors may be relevant too. Both non-medical and medical risk factors are incorporated in the Rotterdam Reproductive Risk Reduction (R4U) scorecard. We investigated the associations between R4U risk factors and preterm birth, SGA and a low Apgar score. a prospective cohort study under routine practice conditions. six midwifery practices and two hospitals in Rotterdam, the Netherlands. 836 pregnant women. the R4U scorecard was filled out at the booking visit. after birth, the follow-up data on pregnancy outcomes were collected. Multivariate logistic regression was used to fit models for the prediction of any adverse outcome (preterm birth, SGA and/or a low Apgar score), stratified for ethnicity and socio-economic status (SES). factors predicting any adverse outcome for Western women were smoking during the first trimester and over-the-counter medication. For non-Western women risk factors were teenage pregnancy, advanced maternal age and an obstetric history of SGA. Risk factors for high SES women were low family income, no daily intake of vegetables and a history of preterm birth. For low SES women risk factors appeared to be low family income, non-Western ethnicity, smoking during the first trimester and a history of SGA. the presence of both medical and non-medical risk factors early in pregnancy predict the occurrence of adverse outcomes at birth. Furthermore the risk profiles for adverse outcomes differed according to SES and ethnicity. to optimise effective risk selection, both medical and non-medical risk factors should be taken into account in midwifery and obstetric care at the booking visit

Predicción a escala genómica de Componentes de Saccharomyces cerevisiae mediante Análisis de Balance de Flujos

Directory of Open Access Journals (Sweden)

César Augusto Vargas García

2012-01-01

Full Text Available Título en ingles: Prediction of genome scale  of Saccharomyces cerevisiae by flux balance analysis Resumen: El microorganismo Saccharomyces cerevisiae cuenta con gran número de modelos biológicos conocidos como reconstrucciones, las cuales pueden ser a escala genómica. De estas reconstrucciones a escala genómica provienen los modelos matemáticos, también llamados modelos estequiométricos. Una de las técnicas más usadas para estudiar estos modelos es el Análisis de Balance de Flujos (FBA. El proposito del FBA es predecir el crecimiento del microorganismo bajo estudio, y la producción y consumo de componentes como el etanol, CO2 glicerol, sucinato, acetato y piruvato. Para determinar si las predicciones obtenidas mediante FBA son únicas se utiliza la técnica de Análisis de Variabilidad Flujos (FVA. El presente trabajo muestra los resultados de aplicar el FBA a la reconstrucción reciente del microorganismo S. cerevisiae, la denominada iMM904 y los compara con un conjunto de datos experimentales presente en la literatura. Este trabajo también estudia la existencia de múltiples predicciones FBA utilizando la técnica FVA. Los resultados ilustran que es posible predecir el crecimiento del microorganimo S. cerevisiae, con errores entre el 11% y 28%;  la producción de CO2, con errores entre el 0.3% y 4.5% y la producción de etanol, con errores entre el 11% y 13%. Palabras clave: analisis de balance de flujos, reconstrucción a escala genómica, iMM904, S. cerevisiae. Abstract: Several biological models, named reconstructions, are used for the study of the S. cerevisiae microorganism. The reconstructions can be genomic scaled. Mathematical models are generated from the reconstructions and they are called stoichiometric models. The flux balance analysis (FBA is one of the tools used for the analysis of these models. The FBA attempts to predict the evolution of the microorganism and the consumption and production of components like

On a turbulent wall model to predict hemolysis numerically in medical devices

Science.gov (United States)

Lee, Seunghun; Chang, Minwook; Kang, Seongwon; Hur, Nahmkeon; Kim, Wonjung

2017-11-01

Analyzing degradation of red blood cells is very important for medical devices with blood flows. The blood shear stress has been recognized as the most dominant factor for hemolysis in medical devices. Compared to laminar flows, turbulent flows have higher shear stress values in the regions near the wall. In case of predicting hemolysis numerically, this phenomenon can require a very fine mesh and large computational resources. In order to resolve this issue, the purpose of this study is to develop a turbulent wall model to predict the hemolysis more efficiently. In order to decrease the numerical error of hemolysis prediction in a coarse grid resolution, we divided the computational domain into two regions and applied different approaches to each region. In the near-wall region with a steep velocity gradient, an analytic approach using modeled velocity profile is applied to reduce a numerical error to allow a coarse grid resolution. We adopt the Van Driest law as a model for the mean velocity profile. In a region far from the wall, a regular numerical discretization is applied. The proposed turbulent wall model is evaluated for a few turbulent flows inside a cannula and centrifugal pumps. The results present that the proposed turbulent wall model for hemolysis improves the computational efficiency significantly for engineering applications. Corresponding author.

Mobile Laser Scanning for Indoor Modelling

Directory of Open Access Journals (Sweden)

C. Thomson

2013-10-01

Full Text Available The process of capturing and modelling buildings has gained increased focus in recent years with the rise of Building Information Modelling (BIM. At the heart of BIM is a process change for the construction and facilities management industries whereby a BIM aids more collaborative working through better information exchange, and as a part of the process Geomatic/Land Surveyors are not immune from the changes. Terrestrial laser scanning has been proscribed as the preferred method for rapidly capturing buildings for BIM geometry. This is a process change from a traditional measured building survey just with a total station and is aided by the increasing acceptance of point cloud data being integrated with parametric building models in BIM tools such as Autodesk Revit or Bentley Architecture. Pilot projects carried out previously by the authors to investigate the geometry capture and modelling of BIM confirmed the view of others that the process of data capture with static laser scan setups is slow and very involved requiring at least two people for efficiency. Indoor Mobile Mapping Systems (IMMS present a possible solution to these issues especially in time saved. Therefore this paper investigates their application as a capture device for BIM geometry creation over traditional static methods through a fit-for-purpose test.

Mobile Laser Scanning for Indoor Modelling

Science.gov (United States)

Thomson, C.; Apostolopoulos, G.; Backes, D.; Boehm, J.

2013-10-01

The process of capturing and modelling buildings has gained increased focus in recent years with the rise of Building Information Modelling (BIM). At the heart of BIM is a process change for the construction and facilities management industries whereby a BIM aids more collaborative working through better information exchange, and as a part of the process Geomatic/Land Surveyors are not immune from the changes. Terrestrial laser scanning has been proscribed as the preferred method for rapidly capturing buildings for BIM geometry. This is a process change from a traditional measured building survey just with a total station and is aided by the increasing acceptance of point cloud data being integrated with parametric building models in BIM tools such as Autodesk Revit or Bentley Architecture. Pilot projects carried out previously by the authors to investigate the geometry capture and modelling of BIM confirmed the view of others that the process of data capture with static laser scan setups is slow and very involved requiring at least two people for efficiency. Indoor Mobile Mapping Systems (IMMS) present a possible solution to these issues especially in time saved. Therefore this paper investigates their application as a capture device for BIM geometry creation over traditional static methods through a fit-for-purpose test.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models

Science.gov (United States)

Eason, Christianne M.; Mazerolle, Stephanie M.; Goodman, Ashley

2017-01-01

Context: Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models. Objective: To investigate the perceived benefits of and barriers in the medical and academic models. Design: Qualitative study. Setting: National Collegiate Athletic Association Divisions I, II, and III. Patients or Other Participants: A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models. Data Collection and Analysis: We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility. Results: In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative). Conclusions: The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties. PMID:27977302

Predictive Analytics In Healthcare: Medications as a Predictor of Medical Complexity.

Science.gov (United States)

Higdon, Roger; Stewart, Elizabeth; Roach, Jared C; Dombrowski, Caroline; Stanberry, Larissa; Clifton, Holly; Kolker, Natali; van Belle, Gerald; Del Beccaro, Mark A; Kolker, Eugene

2013-12-01

Children with special healthcare needs (CSHCN) require health and related services that exceed those required by most hospitalized children. A small but growing and important subset of the CSHCN group includes medically complex children (MCCs). MCCs typically have comorbidities and disproportionately consume healthcare resources. To enable strategic planning for the needs of MCCs, simple screens to identify potential MCCs rapidly in a hospital setting are needed. We assessed whether the number of medications used and the class of those medications correlated with MCC status. Retrospective analysis of medication data from the inpatients at Seattle Children's Hospital found that the numbers of inpatient and outpatient medications significantly correlated with MCC status. Numerous variables based on counts of medications, use of individual medications, and use of combinations of medications were considered, resulting in a simple model based on three different counts of medications: outpatient and inpatient drug classes and individual inpatient drug names. The combined model was used to rank the patient population for medical complexity. As a result, simple, objective admission screens for predicting the complexity of patients based on the number and type of medications were implemented.

Benzodiazepines and antipsychotic medications for treatment of acute cocaine toxicity in animal models--a systematic review and meta-analysis.

Science.gov (United States)

Heard, Kennon; Cleveland, Nathan R; Krier, Shay

2011-11-01

There are no controlled human studies to determine the efficacy of benzodiazepines or antipsychotic medications for prevention or treatment of acute cocaine toxicity. The only available controlled data are from animal models and these studies have reported inconsistent benefits. The objective of this study was to quantify the reported efficacy of benzodiazepines and antipsychotic medication for the prevention of mortality due to cocaine poisoning. We conducted a systematic review to identify English language articles describing experiments that compared a benzodiazepine or antipsychotic medication to placebo for the prevention of acute cocaine toxicity in an animal model. We then used these articles in a meta-analysis with a random-effects model to quantify the absolute risk reduction observed in these experiments. We found 10 articles evaluating antipsychotic medications and 15 articles evaluating benzodiazepines. Antipsychotic medications reduced the risk of death by 27% (95% CI, 15.2%-38.7%) compared to placebo and benzodiazepines reduced the risk of death by 52% (42.8%-60.7%) compared to placebo. Both treatments showed evidence of a dose-response effect, and no experiment found a statistically significant increase in risk of death. We conclude that both benzodiazepines and antipsychotic medications are effective for the prevention of lethality from cocaine toxicity in animal models.

Application of object modeling technique to medical image retrieval system

International Nuclear Information System (INIS)

Teshima, Fumiaki; Abe, Takeshi

1993-01-01

This report describes the results of discussions on the object-oriented analysis methodology, which is one of the object-oriented paradigms. In particular, we considered application of the object modeling technique (OMT) to the analysis of a medical image retrieval system. The object-oriented methodology places emphasis on the construction of an abstract model from real-world entities. The effectiveness of and future improvements to OMT are discussed from the standpoint of the system's expandability. These discussions have elucidated that the methodology is sufficiently well-organized and practical to be applied to commercial products, provided that it is applied to the appropriate problem domain. (author)

Modeling the economic impact of medication adherence in type 2 diabetes: a theoretical approach.

Science.gov (United States)

Cobden, David S; Niessen, Louis W; Rutten, Frans Fh; Redekop, W Ken

2010-09-07

While strong correlations exist between medication adherence and health economic outcomes in type 2 diabetes, current economic analyses do not adequately consider them. We propose a new approach to incorporate adherence in cost-effectiveness analysis. We describe a theoretical approach to incorporating the effect of adherence when estimating the long-term costs and effectiveness of an antidiabetic medication. This approach was applied in a Markov model which includes common diabetic health states. We compared two treatments using hypothetical patient cohorts: injectable insulin (IDM) and oral (OAD) medications. Two analyses were performed, one which ignored adherence (analysis 1) and one which incorporated it (analysis 2). Results from the two analyses were then compared to explore the extent to which adherence may impact incremental cost-effectiveness ratios. In both analyses, IDM was more costly and more effective than OAD. When adherence was ignored, IDM generated an incremental cost-effectiveness of $12,097 per quality-adjusted life-year (QALY) gained versus OAD. Incorporation of adherence resulted in a slightly higher ratio ($16,241/QALY). This increase was primarily due to better adherence with OAD than with IDM, and the higher direct medical costs for IDM. Incorporating medication adherence into economic analyses can meaningfully influence the estimated cost-effectiveness of type 2 diabetes treatments, and should therefore be considered in health care decision-making. Future work on the impact of adherence on health economic outcomes, and validation of different approaches to modeling adherence, is warranted.

A System Model for Personalized Medication Management (MyMediMan—The Consumers’ Point of View

Directory of Open Access Journals (Sweden)

Elena Vlahu-Gjorgievska

2018-03-01

Full Text Available In this paper, we propose a design for a personalized medication management system model MyMediMan that provides medication information for different stakeholders. The focus of the paper is on the system’s features and personalized information provided for the consumers as primary users of the proposed solution. The presented design introduces the consumers to different aspects of the medications they take and their overall health condition. The personalized information should increase the consumers’ awareness about the positive benefits of taking the medications as well as the consequences that particular medication can have on their health condition. By obtaining this information, the consumers will be aware of various medications’ characteristics and different ways to improve their health, and thus be more actively involved in their healthcare.

Adding Live-Streaming to Recorded Lectures in a Non-Distributed Pre-Clerkship Medical Education Model.

Science.gov (United States)

Sandhu, Amanjot; Fliker, Aviva; Leitao, Darren; Jones, Jodi; Gooi, Adrian

2017-01-01

Live-streaming video has had increasing uses in medical education, especially in distributed education models. The literature on the impact of live-streaming in non-distributed education models, however, is scarce. To determine the attitudes towards live-streaming and recorded lectures as a resource to pre-clerkship medical students in a non-distributed medical education model. First and second year medical students were sent a voluntary cross-sectional survey by email, and were asked questions on live-streaming, recorded lectures and in person lectures using a 5-point Likert and open answers. Of the 118 responses (54% response rate), the data suggested that both watching recorded lectures (Likert 4.55) and live-streaming lectures (4.09) were perceived to be more educationally valuable than face-to-face attendance of lectures (3.60). While responses indicated a statistically significant increase in anticipated classroom attendance if both live-streaming and recorded lectures were removed (from 63% attendance to 76%, p =0.002), there was no significant difference in attendance if live-streaming lectures were removed but recorded lectures were maintained (from 63% to 66%, p=0.76). The addition of live-streaming lectures in the pre-clerkship setting was perceived to be value added to the students. The data also suggests that the removal of live-streaming lectures would not lead to a statistically significant increase in classroom attendance by pre-clerkship students.

Smart Grid Interoperability Maturity Model

Energy Technology Data Exchange (ETDEWEB)

Widergren, Steven E.; Levinson, Alex; Mater, J.; Drummond, R.

2010-04-28

The integration of automation associated with electricity resources (including transmission and distribution automation and demand-side resources operated by end-users) is key to supporting greater efficiencies and incorporating variable renewable resources and electric vehicles into the power system. The integration problems faced by this community are analogous to those faced in the health industry, emergency services, and other complex communities with many stakeholders. To highlight this issue and encourage communication and the development of a smart grid interoperability community, the GridWise Architecture Council (GWAC) created an Interoperability Context-Setting Framework. This "conceptual model" has been helpful to explain the importance of organizational alignment in addition to technical and informational interface specifications for "smart grid" devices and systems. As a next step to building a community sensitive to interoperability, the GWAC is investigating an interoperability maturity model (IMM) based on work done by others to address similar circumstances. The objective is to create a tool or set of tools that encourages a culture of interoperability in this emerging community. The tools would measure status and progress, analyze gaps, and prioritize efforts to improve the situation.

The Arabian Gulf University College of Medicine and Medical Sciences: a successful model of a multinational medical school.

Science.gov (United States)

Hamdy, Hossam; Anderson, M Brownell

2006-12-01

In the late 1970s, leaders of the Arabian [corrected] Gulf countries proposed a novel idea of a joint educational and cultural venture: establishing a new regional university based in the Kingdom of Bahrain that would be managed as a multinational consortium of Gulf countries including Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain. It was intended to promote higher education and research in the Gulf region; to serve the development needs of the region; to reflect the unique economic, social, and cultural attributes of the Gulf communities and their environments; and to respond to the health care needs of the member countries. Since its inception in 1982, the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU) has adopted the educational philosophy of problem-based learning (PBL) and self-directed, student-centered education. The curriculum is integrated, with early introduction of education to foster clinical skills and professional competencies. The strategic alliance with the health care systems in Bahrain and other Gulf regions has created a successful model of efficient and effective initialization of health care resources in the community. The experience that has accumulated at the AGU-CMMS from introducing innovative medical education has allowed it to take a leadership position in medical education in the Gulf region. The original goals of this unique experiment have been realized along with unanticipated outcomes of spearheading changes in medical education in the Gulf region. Old and new medical schools have adopted several characteristics of the AGU educational program. Several elements contributed to its success: a clear vision of providing quality medical education and realizing and sustaining this vision by a supportive leadership at the university and college levels; an alliance with the regional health care systems; a dedicated faculty who have been able to work as a team while continually

Co-occurrence of medical conditions: Exposing patterns through probabilistic topic modeling of snomed codes.

Science.gov (United States)

Bhattacharya, Moumita; Jurkovitz, Claudine; Shatkay, Hagit

2018-04-12

Patients associated with multiple co-occurring health conditions often face aggravated complications and less favorable outcomes. Co-occurring conditions are especially prevalent among individuals suffering from kidney disease, an increasingly widespread condition affecting 13% of the general population in the US. This study aims to identify and characterize patterns of co-occurring medical conditions in patients employing a probabilistic framework. Specifically, we apply topic modeling in a non-traditional way to find associations across SNOMED-CT codes assigned and recorded in the EHRs of >13,000 patients diagnosed with kidney disease. Unlike most prior work on topic modeling, we apply the method to codes rather than to natural language. Moreover, we quantitatively evaluate the topics, assessing their tightness and distinctiveness, and also assess the medical validity of our results. Our experiments show that each topic is succinctly characterized by a few highly probable and unique disease codes, indicating that the topics are tight. Furthermore, inter-topic distance between each pair of topics is typically high, illustrating distinctiveness. Last, most coded conditions grouped together within a topic, are indeed reported to co-occur in the medical literature. Notably, our results uncover a few indirect associations among conditions that have hitherto not been reported as correlated in the medical literature. Copyright © 2018. Published by Elsevier Inc.

Integrating bioethics into postgraduate medical education: the University of Toronto model.

Science.gov (United States)

Howard, Frazer; McKneally, Martin F; Levin, Alex V

2010-06-01

Bioethics training is a vital component of postgraduate medical education and required by accreditation organizations in Canada and the United States. Residency program ethics curricula should ensure trainees develop core knowledge, skills, and competencies, and should encourage lifelong learning and teaching of bioethics. Many physician-teachers, however, feel unprepared to teach bioethics and face challenges in developing and implementing specialty-specific bioethics curricula. The authors present, as one model, the innovative strategies employed by the University of Toronto Joint Centre for Bioethics. They postulate that centralized support is a key component to ensure the success of specialty-specific bioethics teaching, to reinforce the importance of ethics in medical training, and to ensure it is not overshadowed by other educational concerns.

Evaluation of a Danish pharmacist student-physician medication review collaboration model

DEFF Research Database (Denmark)

Kaae, Susanne; Sørensen, Ellen Westh; Nørgaard, Lotte Stig

2014-01-01

Background Interprofessional collaboration between pharmacists and physicians to conduct joint home medication reviews (HMR) is important for optimizing the medical treatment of patients suffering from chronic illnesses. However, collaboration has proved difficult to achieve. The HMR programme...... "Medisam" was launched in 2009 at the University of Copenhagen with the aim of "developing, implementing and evaluating a collaboration model for HMRs and medicine reconciliations in Denmark". The Medisam programme involves patients, pharmacy internship students, the (pharmacist) supervisor of the pharmacy...... students and physicians. Objective To explore if it was possible through the Medisam programme to obtain a fruitful HMR collaboration between pharmacy internship students and physicians as a means to develop HMR collaboration between trained pharmacists and physicians further. Setting Ten matching pairs...

MO-DE-BRA-05: Developing Effective Medical Physics Knowledge Structures: Models and Methods

International Nuclear Information System (INIS)

Sprawls, P

2015-01-01

Purpose: Develop a method and supporting online resources to be used by medical physics educators for teaching medical imaging professionals and trainees so they develop highly-effective physics knowledge structures that can contribute to improved diagnostic image quality on a global basis. Methods: The different types of mental knowledge structures were analyzed and modeled with respect to both the learning and teaching process for their development and the functions or tasks that can be performed with the knowledge. While symbolic verbal and mathematical knowledge structures are very important in medical physics for many purposes, the tasks of applying physics in clinical imaging--especially to optimize image quality and diagnostic accuracy--requires a sensory conceptual knowledge structure, specifically, an interconnected network of visually based concepts. This type of knowledge supports tasks such as analysis, evaluation, problem solving, interacting, and creating solutions. Traditional educational methods including lectures, online modules, and many texts are serial procedures and limited with respect to developing interconnected conceptual networks. A method consisting of the synergistic combination of on-site medical physics teachers and the online resource, CONET (Concept network developer), has been developed and made available for the topic Radiographic Image Quality. This was selected as the inaugural topic, others to follow, because it can be used by medical physicists teaching the large population of medical imaging professionals, such as radiology residents, who can apply the knowledge. Results: Tutorials for medical physics educators on developing effective knowledge structures are being presented and published and CONET is available with open access for all to use. Conclusion: An adjunct to traditional medical physics educational methods with the added focus on sensory concept development provides opportunities for medical physics teachers to share

MO-DE-BRA-05: Developing Effective Medical Physics Knowledge Structures: Models and Methods

Energy Technology Data Exchange (ETDEWEB)

Sprawls, P [Sprawls Educational Foundation, Montreat, NC (United States)

2015-06-15

Purpose: Develop a method and supporting online resources to be used by medical physics educators for teaching medical imaging professionals and trainees so they develop highly-effective physics knowledge structures that can contribute to improved diagnostic image quality on a global basis. Methods: The different types of mental knowledge structures were analyzed and modeled with respect to both the learning and teaching process for their development and the functions or tasks that can be performed with the knowledge. While symbolic verbal and mathematical knowledge structures are very important in medical physics for many purposes, the tasks of applying physics in clinical imaging--especially to optimize image quality and diagnostic accuracy--requires a sensory conceptual knowledge structure, specifically, an interconnected network of visually based concepts. This type of knowledge supports tasks such as analysis, evaluation, problem solving, interacting, and creating solutions. Traditional educational methods including lectures, online modules, and many texts are serial procedures and limited with respect to developing interconnected conceptual networks. A method consisting of the synergistic combination of on-site medical physics teachers and the online resource, CONET (Concept network developer), has been developed and made available for the topic Radiographic Image Quality. This was selected as the inaugural topic, others to follow, because it can be used by medical physicists teaching the large population of medical imaging professionals, such as radiology residents, who can apply the knowledge. Results: Tutorials for medical physics educators on developing effective knowledge structures are being presented and published and CONET is available with open access for all to use. Conclusion: An adjunct to traditional medical physics educational methods with the added focus on sensory concept development provides opportunities for medical physics teachers to share

[MEDICAL SOCIAL MODELING TECHNOLOGIES FOR ACTIVE AGING IN KAZAKHSTAN].

Science.gov (United States)

Benberin, V V; Akhetov, A A; Tanbaeva, G Z

2015-01-01

The article discusses a new model for active ageing in Republic of Kazakhstan with participation the state, population and medical social services. Achieving active longevity will lead to positive trends in the development of human capital of the state, because it enables to use experience and knowledge of senior generation in enhancing the effectiveness of socio-economic transformation in health care. The study was carried out on the base of the Central clinical hospital of the President's affairs administration in Republic of Kazakhstan, with the participation of 147 admitted patients of elderly and senile age.

Using Probablilistic Risk Assessment to Model Medication System Failures in Long-Term Care Facilities

National Research Council Canada - National Science Library

Comden, Sharon C; Marx, David; Murphy-Carley, Margaret; Hale, Misti

2005-01-01

.... Discussion: The models provide contextual maps of the errors and behaviors that lead to medication delivery system failures, including unanticipated risks associated with regulatory practices and common...

Work Stress and Alcohol Use: Developing and Testing a Biphasic Self-Medication Model

OpenAIRE

Frone, Michael R.

2016-01-01

This study developed and tested a moderated-mediation model of work stress and alcohol use, based on the biphasic (stimulant and sedative) effects of alcohol and the self-medication and stress-vulnerability models of alcohol use. The model proposes that exposure to work stressors can increase both negative affect and work fatigue, and that these two sources of strain can subsequently motivate the use of alcohol. However, the relations of negative affect and work fatigue to a...

Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis: implications for intervention.

Science.gov (United States)

Drake, Richard J; Nordentoft, Merete; Haddock, Gillian; Arango, Celso; Fleischhacker, W Wolfgang; Glenthøj, Birte; Leboyer, Marion; Leucht, Stefan; Leweke, Markus; McGuire, Phillip; Meyer-Lindenberg, Andreas; Rujescu, Dan; Sommer, Iris E; Kahn, René S; Lewis, Shon W

2015-05-01

We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures' and DAI's predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For

Diagnostic Machine Learning Models for Acute Abdominal Pain: Towards an e-Learning Tool for Medical Students.

Science.gov (United States)

Khumrin, Piyapong; Ryan, Anna; Judd, Terry; Verspoor, Karin

2017-01-01

Computer-aided learning systems (e-learning systems) can help medical students gain more experience with diagnostic reasoning and decision making. Within this context, providing feedback that matches students' needs (i.e. personalised feedback) is both critical and challenging. In this paper, we describe the development of a machine learning model to support medical students' diagnostic decisions. Machine learning models were trained on 208 clinical cases presenting with abdominal pain, to predict five diagnoses. We assessed which of these models are likely to be most effective for use in an e-learning tool that allows students to interact with a virtual patient. The broader goal is to utilise these models to generate personalised feedback based on the specific patient information requested by students and their active diagnostic hypotheses.

Designing and redesigning medical telecare services: a forces-oriented model.

Science.gov (United States)

Gortzis, L G

2007-01-01

Medical telecare services' designing and redesigning still remains a challenging issue since it often depends on how a number of socio-technological issues are framed. This work has two key objectives; the former is to theoretically analyze the nature of a telecare environment by developing a model that reveals potential areas of analysis and the latter is to support designing and redesigning medical telecare services by formulating a strategy as well as a number of 'state of the art' guidelines. We have extended Leavitt's diamond to develop a model capable of accurately reflecting the telecare environment building dimensions as well as their interactions. This model depends on the i) technology, ii) collaborators, iii) tasks, iv) structure, v) social forces, and the vi) procedure dimensions. Taking this model as a core element we have proposed a service designing and redesigning strategy formulating, in parallel, six scalable dimension-oriented guidelines. During the two-year period (2003-2005) an enormous amount of data was collected (by active participating in two EU projects, by conducting semistructured interviews, by performing onsite observations as well as by reviewing 78 previous projects) and classified, structuring six guidelines. These guidelines can be considered as the 'state of the art' to support future services' design and redesign. This work considering the telecare environment as a multi-dimensional, operational organization has put the focus on accurate telecare services' design and redesign. The parameters are not limited, by any means, and are drawn from experience of designing services in a variety of telecare domains. The optimal parameter combination must be chosen according to the aim of each telecare procedure. Further research is needed to determine the minimum parameters to support telecare service design.

Specialty choice preference of medical students according to personality traits by Five-Factor Model.

Science.gov (United States)

Kwon, Oh Young; Park, So Youn

2016-03-01

The purpose of this study was to determine the relationship between personality traits, using the Five-Factor Model, and characteristics and motivational factors affecting specialty choice in Korean medical students. A questionnaire survey of Year 4 medical students (n=110) in July 2015 was administered. We evaluated the personality traits of Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness by using the Korean version of Big Five Inventory. Questions about general characteristics, medical specialties most preferred as a career, motivational factors in determining specialty choice were included. Data between five personality traits and general characteristics and motivational factors affecting specialty choice were analyzed using Student t-test, Mann-Whitney test and analysis of variance. Of the 110 eligible medical students, 105 (95.4% response rate) completed the questionnaire. More Agreeableness students preferred clinical medicine to basic medicine (p=0.010) and more Openness students preferred medical departments to others (p=0.031). Personal interest was the significant motivational factors in more Openness students (p=0.003) and Conscientiousness students (p=0.003). Medical students with more Agreeableness were more likely to prefer clinical medicine and those with more Openness preferred medical departments. Personal interest was a significant influential factor determining specialty choice in more Openness and Conscientiousness students. These findings may be helpful to medical educators or career counselors in the specialty choice process.

Specialty choice preference of medical students according to personality traits by Five-Factor Model

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Oh Young Kwon

2016-03-01

Full Text Available Purpose: The purpose of this study was to determine the relationship between personality traits, using the Five-Factor Model, and characteristics and motivational factors affecting specialty choice in Korean medical students. Methods: A questionnaire survey of Year 4 medical students (n=110 in July 2015 was administered. We evaluated the personality traits of Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness by using the Korean version of Big Five Inventory. Questions about general characteristics, medical specialties most preferred as a career, motivational factors in determining specialty choice were included. Data between five personality traits and general characteristics and motivational factors affecting specialty choice were analyzed using Student t-test, Mann-Whitney test and analysis of variance. Results: Of the 110 eligible medical students, 105 (95.4% response rate completed the questionnaire. More Agreeableness students preferred clinical medicine to basic medicine (p=0.010 and more Openness students preferred medical departments to others (p=0.031. Personal interest was the significant motivational factors in more Openness students (p=0.003 and Conscientiousness students (p=0.003. Conclusion: Medical students with more Agreeableness were more likely to prefer clinical medicine and those with more Openness preferred medical departments. Personal interest was a significant influential factor determining specialty choice in more Openness and Conscientiousness students. These findings may be helpful to medical educators or career counselors in the specialty choice process.

Modeling nurses' attitude toward using automated unit-based medication storage and distribution systems: an extension of the technology acceptance model.

Science.gov (United States)

Escobar-Rodríguez, Tomás; Romero-Alonso, María Mercedes

2013-05-01

This article analyzes the attitude of nurses toward the use of automated unit-based medication storage and distribution systems and identifies influencing factors. Understanding these factors provides an opportunity to explore actions that might be taken to boost adoption by potential users. The theoretical grounding for this research is the Technology Acceptance Model. The Technology Acceptance Model specifies the causal relationships between perceived usefulness, perceived ease of use, attitude toward using, and actual usage behavior. The research model has six constructs, and nine hypotheses were generated from connections between these six constructs. These constructs include perceived risks, experience level, and training. The findings indicate that these three external variables are related to the perceived ease of use and perceived usefulness of automated unit-based medication storage and distribution systems, and therefore, they have a significant influence on attitude toward the use of these systems.

Organization-and-technological model of medical care delivered to patients with chronic heart failure

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Kiselev A.R.

2014-09-01

Full Text Available Organization-and-technological model of medical care delivered to patients with chronic heart failure based on IDEF0 methodology and corresponded with clinical guidelines is presented.

Organization-and-technological model of medical care delivered to patients with coronary heart disease

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Popova Y.V.

2014-09-01

Full Text Available Organization-and-technological model of medical care delivered to patients with coronary heart disease based on IDEF0 methodology and corresponded with clinical guidelines is presented.

Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach

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De las Cuevas C

2017-03-01

Full Text Available Carlos De las Cuevas,1 Jose de Leon,2–4 Wenceslao Peñate,5 Moisés Betancort5 1Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, Canary Islands, Spain; 2Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; 3Psychiatry and Neurosciences Research Group (CTS-549, Institute of Neurosciences, University of Granada, Granada, Spain; 4Biomedical Research Center in Mental Health Net (CIBERSAM, Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain; 5Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad de La Laguna, Canary Islands, Spain Purpose: To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients’ adherence to psychopharmacological medications.Method: A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education, clinical (diagnoses, drug treatment, and treatment duration, attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making, perception of control over health (health locus of control, self-efficacy, and psychological reactance, and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables.Results: Structural equation modeling demonstrated that psychiatric patients’ treatment adherence was associated: 1 negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased, 2 positively with patients’ trust in their psychiatrists (doctors’ subscale, 3 negatively with patients’ belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale, and 4

An Overview of Mechanical Properties and Material Modeling of Polylactide (PLA) for Medical Applications.

Science.gov (United States)

Bergström, Jörgen S; Hayman, Danika

2016-02-01

This article provides an overview of the connection between the microstructural state and the mechanical response of various bioresorbable polylactide (PLA) devices for medical applications. PLLA is currently the most commonly used material for bioresorbable stents and sutures, and its use is increasing in many other medical applications. The non-linear mechanical response of PLLA, due in part to its low glass transition temperature (T g ≈ 60 °C), is highly sensitive to the molecular weight and molecular orientation field, the degree of crystallinity, and the physical aging time. These microstructural parameters can be tailored for specific applications using different resin formulations and processing conditions. The stress-strain, deformation, and degradation response of a bioresorbable medical device is also strongly dependent on the time history of applied loads and boundary conditions. All of these factors can be incorporated into a suitable constitutive model that captures the multiple physics that are involved in the device response. Currently developed constitutive models already provide powerful computations simulation tools, and more progress in this area is expected to occur in the coming years.

Relationships between beliefs about medications and nonadherence to prescribed chronic medications.

Science.gov (United States)

Phatak, Hemant M; Thomas, Joseph

2006-10-01

Medication beliefs of patients with a specific medical condition have been associated with nonadherence to drugs used to treat that condition. However, associations between medication beliefs and nonadherence of individuals on chronic, multiple medications have not been studied. To investigate associations between patients' medication beliefs and nonadherence to chronic drug therapy. A cross-sectional, self-administered survey of patients waiting to see pharmacists at an outpatient pharmacy in a primary care clinic was conducted. Participants' medication beliefs were assessed using the Beliefs about Medicines Questionnaire, and nonadherence was assessed using the Morisky Medication Adherence Scale. Pearson correlation analysis was used to assess bivariate associations between medication beliefs and nonadherence. Regression was used to assess relative strength of associations between various medication beliefs and nonadherence and also to assess the significance of the interactions between those beliefs and nonadherence. There were positive bivariate associations between specific concerns about medications (p harmful effects of medications (p belief and nonadherence was assessed, while controlling for other medication beliefs, specific-necessity (p = 0.02) and specific-concerns (p = 0.01) exhibited significant negative and positive associations with nonadherence, respectively. All two-way interactions between variables in the model were insignificant. A model consisting of age, total number of drugs used, and medication beliefs, that is, specific-necessity, specific-concerns, general-overuse, and general-harm, accounted for 26.5% of variance. Medication beliefs alone explained 22.4% of variation in nonadherence to chronic drug therapy. Patients' medication beliefs explained a significant portion of variation in medication nonadherence.

Predicting adherence to prophylactic medication in adolescents with asthma: an application of the ASE-model

NARCIS (Netherlands)

van Es, S.M.; Kaptein, A.A.; Bezemer, P.D.; Nagelkerke, A.F.; Colland, V.T.; Bouter, L.M.

2002-01-01

An explanatory framework, referred to as the attitude/social influence/self-efficacy-model (ASE-model), was utilised to explain future self-reported adherence of adolescents to daily inhaled prophylactic asthma medication. The objective was to investigate the long-term influence of these earlier

Predicting adherence to prophylactic medication in adolescents with asthma : an application of the ASE-model

NARCIS (Netherlands)

van Es, Saskia M; Kaptein, Adrian A; Bezemer, P Dick; Nagelkerke, Ad F; Colland, Vivian T; Bouter, Lex M

An explanatory framework, referred to as the attitude/social influence/self-efficacy-model (ASE-model), was utilised to explain future self-reported adherence of adolescents to daily inhaled prophylactic asthma medication. The objective was to investigate the long-term influence of these earlier

Discussion on the Implementation of the Patient Centred Medical Home model - Experiences from Australia

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Safa Majidi Rahbar

2017-07-01

Full Text Available Introduction: Different practitioners and academics have been working on the application of the Patient Centred Medical Home (PCMH model within the Australian context for many years. In early 2016, the Commonwealth government of Australia announced plans to establish Health Care Homes throughout the country based off the PCMH model, beginning with trial sites focused on the bundling of payments. As a result, the number of Primary Health Networks, policy makers and general practices receptive to establishing Health Care Homes is growing rapidly. The time is ripe to identify how best the elements of the model translate into the Australian context and how to implement its elements with success. As a contribution to the opportunity for a widespread implementation, the North Coast Primary Health Network is engaged in a project to build capacity in general practices to transition into Health Care Homes. The main outcomes of this project include: 1. Preparing “The Australian Handbook for Transitioning to Health Care Homes” A resource which will provide a rationale for transitioning to a HCH, milestones for transitioning along a continuum and tools for practice and practice support for establishing the model in general practice. Thus developing capacity to train ‘change facilitators’ to work to accompany transitioning practices. 2. Establishment of a National Network of Patient Centred HCH Collaborators Made up of PHN representatives, experts and policy makers working in the PCMH development space. Focused on improving advocacy effectiveness, knowledge sharing and keeping stakeholders up to date with unfolding developments. 3. Increasing local preparedness and interest for establishing HCHs Focused on propagation of development of interest locally for transitioning practices into HCHs. A local network of practitioners and collaborators informed of project updates and HCH learning and development opportunities in the region. 4. Local trial and

A Cost-Effective Tracking Algorithm for Hypersonic Glide Vehicle Maneuver Based on Modified Aerodynamic Model

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Yu Fan

2016-10-01

Full Text Available In order to defend the hypersonic glide vehicle (HGV, a cost-effective single-model tracking algorithm using Cubature Kalman filter (CKF is proposed in this paper based on modified aerodynamic model (MAM as process equation and radar measurement model as measurement equation. In the existing aerodynamic model, the two control variables attack angle and bank angle cannot be measured by the existing radar equipment and their control laws cannot be known by defenders. To establish the process equation, the MAM for HGV tracking is proposed by using additive white noise to model the rates of change of the two control variables. For the ease of comparison several multiple model algorithms based on CKF are presented, including interacting multiple model (IMM algorithm, adaptive grid interacting multiple model (AGIMM algorithm and hybrid grid multiple model (HGMM algorithm. The performances of these algorithms are compared and analyzed according to the simulation results. The simulation results indicate that the proposed tracking algorithm based on modified aerodynamic model has the best tracking performance with the best accuracy and least computational cost among all tracking algorithms in this paper. The proposed algorithm is cost-effective for HGV tracking.

Improved Medical Student Perception of Ultrasound Using a Paired Anatomy Teaching Assistant and Clinician Teaching Model

Science.gov (United States)

Smith, Jacob P.; Kendall, John L.; Royer, Danielle F.

2018-01-01

This study describes a new teaching model for ultrasound (US) training, and evaluates its effect on medical student attitudes toward US. First year medical students participated in hands-on US during human gross anatomy (2014 N = 183; 2015 N = 182). The sessions were facilitated by clinicians alone in 2014, and by anatomy teaching assistant…

Analysis of the Service Quality of Medical Centers Using Servqual Model (Case:Shaheed Rahnemoon Hospital

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H Zare Ahmadabadi

2007-07-01

Full Text Available Introduction: Many organizations, especially service oriented ones, relative to their goals and mission, have a special view towards quality phenomena and its management. Methods: This paper analyzes medical service quality in one case; The internal section of Shaheed Rahnemoon Hospital Based on the basis of gap analysis model and Servqual technique. A questionnaire was designed and applied to measure expectations and perceptions of patients and personnel of the hospital. Results: On application of non-parametric statistical tests, we propose certain recommendations. These tests drive on five conceptual dimensions of service quality including intangibility, responsiveness, reliability, assurance and empathy. Results show that patients in this section were satisfied from the service provider’s responsiveness, but there are significant differences between expectations and perceptions in other dimensions. Conclusion: The service quality analysis models are useful for managers of medical centers to distinguish gaps between the two sides of service representation; patients and medical centers personnel. Ultimately, they can reinforce strengths and control weaknesses.

Development of the ultrasonography learning model for undergraduate medical students: A case study of the Faculty of Medicine, Burapha University

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Sornsupha Limchareon

2016-08-01

Conclusion: By adding hands-on ultrasound experience using live patients proctored by radiologists for final year medical students, in the space of 2 weeks, an effective ultrasound learning model for undergraduate medical students can be provided. This model should be considered in the curricular design.

Explanatory models of depression and treatment adherence to antidepressant medication

DEFF Research Database (Denmark)

Buus, Niels; Johannessen, Helle; Stage, Kurt Bjerregaard

2012-01-01

and medicine were not central. However, taking antidepressant medication was a meaningful part of being admitted to hospital, and the adoption of the rhetoric and practices of biomedicine strengthened patients' sense of control and hope for recovery. If medicine was ineffective, the explanatory models...... legitimised alternative strategies towards recovery, including non-adherence. CONCLUSIONS: The patients' reasons for adhering to antidepressants included a range of diverse psychosocial issues, and could be regarded as a central part of their common sense illness management....

Students' medical ethics rounds: a combinatorial program for medical ethics education.

Science.gov (United States)

Beigy, Maani; Pishgahi, Ghasem; Moghaddas, Fateme; Maghbouli, Nastaran; Shirbache, Kamran; Asghari, Fariba; Abolfat-H Zadeh, Navid

2016-01-01

It has long been a common goal for both medical educators and ethicists to develop effective methods or programs for medical ethics education. The current lecture-based courses of medical ethics programs in medical schools are demonstrated as insufficient models for training "good doctors''. In this study, we introduce an innovative program for medical ethics education in an extra-curricular student-based design named Students' Medical Ethics Rounds (SMER). In SMER, a combination of educational methods, including theater-based case presentation, large group discussion, expert opinions, role playing and role modeling were employed. The pretest-posttest experimental design was used to assess the impact of interventions on the participants' knowledge and attitude regarding selected ethical topics. A total of 335 students participated in this study and 86.57% of them filled the pretest and posttest forms. We observed significant improvements in the knowledge (P educational methods were reported as helpful. We found that SMER might be an effective method of teaching medical ethics. We highly recommend the investigation of the advantages of SMER in larger studies and interdisciplinary settings.

On the Effect of Sphere-Overlap on Super Coarse-Grained Models of Protein Assemblies

Science.gov (United States)

Degiacomi, Matteo T.

2018-05-01

Ion mobility mass spectrometry (IM/MS) can provide structural information on intact protein complexes. Such data, including connectivity and collision cross sections (CCS) of assemblies' subunits, can in turn be used as a guide to produce representative super coarse-grained models. These models are constituted by ensembles of overlapping spheres, each representing a protein subunit. A model is considered plausible if the CCS and sphere-overlap levels of its subunits fall within predetermined confidence intervals. While the first is determined by experimental error, the latter is based on a statistical analysis on a range of protein dimers. Here, we first propose a new expression to describe the overlap between two spheres. Then we analyze the effect of specific overlap cutoff choices on the precision and accuracy of super coarse-grained models. Finally, we propose a method to determine overlap cutoff levels on a per-case scenario, based on collected CCS data, and show that it can be applied to the characterization of the assembly topology of symmetrical homo-multimers. [Figure not available: see fulltext.

Use of System Dynamics Modeling in Medical Education and Research Projects.

Science.gov (United States)

Bozikov, Jadranka; Relic, Danko; Dezelic, Gjuro

2018-01-01

The paper reviews experiences and accomplishments in application of system dynamics modeling in education, training and research projects at the Andrija Stampar School of Public Health, a branch of the Zagreb University School of Medicine, Croatia. A number of simulation models developed over the past 40 years are briefly described with regard to real problems concerned, objectives and modeling methods and techniques used. Many of them have been developed as the individual students' projects as a part of their graduation, MSc or PhD theses and subsequently published in journals or conference proceedings. Some of them were later used in teaching and simulation training. System dynamics modeling proved to be not only powerful method for research and decision making but also a useful tool in medical and nursing education enabling better understanding of dynamic systems' behavior.

Statistical Modeling of the Trends Concerning the Number of Hospitals and Medical Centres in Romania

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Gabriela OPAIT

2017-04-01

Full Text Available This study reveals the technique for to achive the shapes of the mathematical models which put in evidence the distributions of the values concerning the number of Hospitals, respectively Medical Centres, in our country, in the time horizon 2005-2014. In the same time, we can to observe the algorithm applied for to construct forecasts about the evolutions regarding the number of Hospitals and Medical Centres in Romania.

Telemedicine and distributed medical intelligence.

Science.gov (United States)

Warner, D; Tichenor, J M; Balch, D C

1996-01-01

Recent trends in health care informatics and telemedicine indicate that systems are being developed with a primary focus on technology and business, not on the process of medicine itself. The authors present a new model of health care information, distributed medical intelligence, which promotes the development of an integrative medical communication system addressing the process of providing expert medical knowledge to the point of need. The model incorporates audio, video, high-resolution still images, and virtual reality applications into an integrated medical communications network. Three components of the model (care portals, Docking Station, and the bridge) are described. The implementation of this model at the East Carolina University School of Medicine is also outlined.

Designing a model for critical thinking development in AJA University of Medical Sciences

Science.gov (United States)

MAFAKHERI LALEH, MAHYAR; MOHAMMADIMEHR, MOJGAN; ZARGAR BALAYE JAME, SANAZ

2016-01-01

Introduction: In the new concept of medical education, creativity development is an important goal. The aim of this research was to identify a model for developing critical thinking among students with the special focus on learning environment and learning style. Methods: This applied and cross-sectional study was conducted among all students studying in undergraduate and professional doctorate programs in Fall Semester 2013-2014 in AJA University of Medical Sciences (N=777). The sample consisted of 257 students selected based on the proportional stratified random sampling method. To collect data, three questionnaires including Critical Thinking, Perception of Learning Environment and Learning Style were employed. The data were analyzed using Pearson's correlation statistical test, and one-sample t-test. The Structural Equation Model (SEM) was used to test the research model. SPSS software, version 14 and the LISREL software were used for data analysis. Results: The results showed that students had significantly assessed the teaching-learning environment and two components of "perception of teachers" and "perception of emotional-psychological climate" at the desirable level (pcritical thinking among students in terms of components of "commitment", "creativity" and "cognitive maturity" was at the relatively desirable level (pcritical thinking through learning style. Conclusion: One of the factors which can significantly impact the quality improvement of the teaching and learning process in AJA University of Medical Sciences is to develop critical thinking among learners. This issue requires providing the proper situation for teaching and learning critical thinking in the educational environment. PMID:27795968

[Medical human resources planning in Europe: A literature review of the forecasting models].

Science.gov (United States)

Benahmed, N; Deliège, D; De Wever, A; Pirson, M

2018-02-01

Healthcare is a labor-intensive sector in which half of the expenses are dedicated to human resources. Therefore, policy makers, at national and internal levels, attend to the number of practicing professionals and the skill mix. This paper aims to analyze the European forecasting model for supply and demand of physicians. To describe the forecasting tools used for physician planning in Europe, a grey literature search was done in the OECD, WHO, and European Union libraries. Electronic databases such as Pubmed, Medine, Embase and Econlit were also searched. Quantitative methods for forecasting medical supply rely mainly on stock-and-flow simulations and less often on systemic dynamics. Parameters included in forecasting models exhibit wide variability for data availability and quality. The forecasting of physician needs is limited to healthcare consumption and rarely considers overall needs and service targets. Besides quantitative methods, horizon scanning enables an evaluation of the changes in supply and demand in an uncertain future based on qualitative techniques such as semi-structured interviews, Delphi Panels, or focus groups. Finally, supply and demand forecasting models should be regularly updated. Moreover, post-hoc analyze is also needed but too rarely implemented. Medical human resource planning in Europe is inconsistent. Political implementation of the results of forecasting projections is essential to insure efficient planning. However, crucial elements such as mobility data between Member States are poorly understood, impairing medical supply regulation policies. These policies are commonly limited to training regulations, while horizontal and vertical substitution is less frequently taken into consideration. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Current trends in medical ethics education in Japanese medical schools.

Science.gov (United States)

Kurosu, Mitsuyasu

2012-09-01

The Japanese medical education program has radically improved during the last 10 years. In 1999, the Task Force Committee on Innovation of Medical Education for the 21st Century proposed a tutorial education system, a core curriculum, and a medical student evaluation system for clinical clerkship. In 2001, the Model Core Curriculum of medical education was instituted, in which medical ethics became part of the core material. Since 2005, a nationwide medical student evaluation system has been applied for entrance to clinical clerkship. Within the Japan Society for Medical Education, the Working Group of Medical Ethics proposed a medical ethics education curriculum in 2001. In line with this, the Japanese Association for Philosophical and Ethical Research in Medicine has begun to address the standardization of the curriculum of medical ethics. A medical philosophy curriculum should also be included in considering illness, health, life, death, the body, and human welfare.

Cox4i2, Ifit2, and Prdm11 Mutant Mice

DEFF Research Database (Denmark)

Horsch, Marion; Aguilar-Pimentel, Juan Antonio; Bönisch, Clemens

2015-01-01

We established a selection strategy to identify new models for an altered airway inflammatory response from a large compendium of mutant mouse lines that were systemically phenotyped in the German Mouse Clinic (GMC). As selection criteria we included published gene functional data, as well as imm...

A Diverging View of Role Modeling in Medical Education

Directory of Open Access Journals (Sweden)

Gurjit Sandhu

2015-03-01

Full Text Available Research in the area of role modeling has primarily focused on the qualities and attributes of exceptional role models, and less attention has been given to the act of role modeling itself (Elzubeir & Rizk, 2001; Jochemsen-van der Leeuw, van Dijk, van Etten-Jamaludin, & Wieringa-de Waard, 2013; Wright, 1996; Wright, Wong, & Newill, 1997. A standardized understanding of role modeling in medical education remains elusive (Kenny, Mann, & MacLeod, 2003. This is problematic given that role modeling is pervasively documented as an approach to teaching (Reuler & Nardone, 1994. Our study attempts to fill a void in this body of research by looking at what faculty are thinking, saying, and doing when they say they are role modeling. Individual semi-structured interviews with faculty members were conducted in the Department of General Surgery at Queen’s University, Kingston, Ontario, Canada. Interviews were recorded, transcribed, and analyzed using qualitative methods for themes surrounding teaching and role modeling. Three major themes emerged from the data: (1 faculty members think they are teaching when they are acting professionally; (2 faculty members become aware of teaching opportunities and act on them; and (3 faculty members employ evidence-based teaching methods, but they are incorrectly labeling them as “role modeling.” As a whole, our findings should help distinguish between role modeling as roles and responsibilities enacted while doing one’s job well, and teaching as facilitated instruction that helps connect knowledge with action (Clayton, 2006; Fassbinder, 2007. Contributing to a better understanding of how teaching is separate from role modeling has the potential to improve the scope and quality of teaching, ultimately enhancing the learning experience for trainees.

Food Safety Education Using an Interactive Multimedia Kiosk in a WIC Setting: Correlates of Client Satisfaction and Practical Issues

Science.gov (United States)

Trepka, Mary Jo; Newman, Frederick L.; Huffman, Fatma G.; Dixon, Zisca

2010-01-01

Objective: To assess acceptability of food safety education delivered by interactive multimedia (IMM) in a Supplemental Nutrition Program for Women, Infants and Children Program (WIC) clinic. Methods: Female clients or caregivers (n = 176) completed the food-handling survey; then an IMM food safety education program on a computer kiosk.…

Testing the Grossman model of medical spending determinants with macroeconomic panel data.

Science.gov (United States)

Hartwig, Jochen; Sturm, Jan-Egbert

2018-02-16

Michael Grossman's human capital model of the demand for health has been argued to be one of the major achievements in theoretical health economics. Attempts to test this model empirically have been sparse, however, and with mixed results. These attempts so far relied on using-mostly cross-sectional-micro data from household surveys. For the first time in the literature, we bring in macroeconomic panel data for 29 OECD countries over the period 1970-2010 to test the model. To check the robustness of the results for the determinants of medical spending identified by the model, we include additional covariates in an extreme bounds analysis (EBA) framework. The preferred model specifications (including the robust covariates) do not lend much empirical support to the Grossman model. This is in line with the mixed results of earlier studies.

Constrained State Estimation for Individual Localization in Wireless Body Sensor Networks

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Xiaoxue Feng

2014-11-01

Full Text Available Wireless body sensor networks based on ultra-wideband radio have recently received much research attention due to its wide applications in health-care, security, sports and entertainment. Accurate localization is a fundamental problem to realize the development of effective location-aware applications above. In this paper the problem of constrained state estimation for individual localization in wireless body sensor networks is addressed. Priori knowledge about geometry among the on-body nodes as additional constraint is incorporated into the traditional filtering system. The analytical expression of state estimation with linear constraint to exploit the additional information is derived. Furthermore, for nonlinear constraint, first-order and second-order linearizations via Taylor series expansion are proposed to transform the nonlinear constraint to the linear case. Examples between the first-order and second-order nonlinear constrained filters based on interacting multiple model extended kalman filter (IMM-EKF show that the second-order solution for higher order nonlinearity as present in this paper outperforms the first-order solution, and constrained IMM-EKF obtains superior estimation than IMM-EKF without constraint. Another brownian motion individual localization example also illustrates the effectiveness of constrained nonlinear iterative least square (NILS, which gets better filtering performance than NILS without constraint.

Constrained State Estimation for Individual Localization in Wireless Body Sensor Networks

Science.gov (United States)

Feng, Xiaoxue; Snoussi, Hichem; Liang, Yan; Jiao, Lianmeng

2014-01-01

Wireless body sensor networks based on ultra-wideband radio have recently received much research attention due to its wide applications in health-care, security, sports and entertainment. Accurate localization is a fundamental problem to realize the development of effective location-aware applications above. In this paper the problem of constrained state estimation for individual localization in wireless body sensor networks is addressed. Priori knowledge about geometry among the on-body nodes as additional constraint is incorporated into the traditional filtering system. The analytical expression of state estimation with linear constraint to exploit the additional information is derived. Furthermore, for nonlinear constraint, first-order and second-order linearizations via Taylor series expansion are proposed to transform the nonlinear constraint to the linear case. Examples between the first-order and second-order nonlinear constrained filters based on interacting multiple model extended kalman filter (IMM-EKF) show that the second-order solution for higher order nonlinearity as present in this paper outperforms the first-order solution, and constrained IMM-EKF obtains superior estimation than IMM-EKF without constraint. Another brownian motion individual localization example also illustrates the effectiveness of constrained nonlinear iterative least square (NILS), which gets better filtering performance than NILS without constraint. PMID:25390408

Constrained state estimation for individual localization in wireless body sensor networks.

Science.gov (United States)

Feng, Xiaoxue; Snoussi, Hichem; Liang, Yan; Jiao, Lianmeng

2014-11-10

Wireless body sensor networks based on ultra-wideband radio have recently received much research attention due to its wide applications in health-care, security, sports and entertainment. Accurate localization is a fundamental problem to realize the development of effective location-aware applications above. In this paper the problem of constrained state estimation for individual localization in wireless body sensor networks is addressed. Priori knowledge about geometry among the on-body nodes as additional constraint is incorporated into the traditional filtering system. The analytical expression of state estimation with linear constraint to exploit the additional information is derived. Furthermore, for nonlinear constraint, first-order and second-order linearizations via Taylor series expansion are proposed to transform the nonlinear constraint to the linear case. Examples between the first-order and second-order nonlinear constrained filters based on interacting multiple model extended kalman filter (IMM-EKF) show that the second-order solution for higher order nonlinearity as present in this paper outperforms the first-order solution, and constrained IMM-EKF obtains superior estimation than IMM-EKF without constraint. Another brownian motion individual localization example also illustrates the effectiveness of constrained nonlinear iterative least square (NILS), which gets better filtering performance than NILS without constraint.

Exploring the possibility for business model innovation in Laerdal Medical using Virtual Reality

OpenAIRE

Ullestad, Freddie; Søndenaa, Thomas

2017-01-01

Master's thesis in Business administration: Executive MBA The purpose of this paper is to check how Virtual Reality patient simulation as a disruptive technology may give opportunities for established companies, such as Laerdal Medical, to create innovative business models in the nursing and healthcare education market. The goal of the new and innovative business model would be to maintain and further strengthen existing business, when faced with threats from established and potential new ...

Clinical evaluation of a Mucorales-specific real-time PCR assay in tissue and serum samples.

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Springer, Jan; Lackner, Michaela; Ensinger, Christian; Risslegger, Brigitte; Morton, Charles Oliver; Nachbaur, David; Lass-Flörl, Cornelia; Einsele, Hermann; Heinz, Werner J; Loeffler, Juergen

2016-12-01

Molecular diagnostic assays can accelerate the diagnosis of fungal infections and subsequently improve patient outcomes. In particular, the detection of infections due to Mucorales is still challenging for laboratories and physicians. The aim of this study was to evaluate a probe-based Mucorales-specific real-time PCR assay (Muc18S) using tissue and serum samples from patients suffering from invasive mucormycosis (IMM). This assay can detect a broad range of clinically relevant Mucorales species and can be used to complement existing diagnostic tests or to screen high-risk patients. An advantage of the Muc18S assay is that it exclusively detects Mucorales species allowing the diagnosis of Mucorales DNA without sequencing within a few hours. In paraffin-embedded tissue samples this PCR-based method allowed rapid identification of Mucorales in comparison with standard methods and showed 91 % sensitivity in the IMM tissue samples. We also evaluated serum samples, an easily accessible material, from patients at risk from IMM. Mucorales DNA was detected in all patients with probable/proven IMM (100 %) and in 29 % of the possible cases. Detection of IMM in serum could enable an earlier diagnosis (up to 21 days) than current methods including tissue samples, which were gained mainly post-mortem. A screening strategy for high-risk patients, which would enable targeted treatment to improve patient outcomes, is therefore possible.

Developing a semantic web model for medical differential diagnosis recommendation.

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Mohammed, Osama; Benlamri, Rachid

2014-10-01

In this paper we describe a novel model for differential diagnosis designed to make recommendations by utilizing semantic web technologies. The model is a response to a number of requirements, ranging from incorporating essential clinical diagnostic semantics to the integration of data mining for the process of identifying candidate diseases that best explain a set of clinical features. We introduce two major components, which we find essential to the construction of an integral differential diagnosis recommendation model: the evidence-based recommender component and the proximity-based recommender component. Both approaches are driven by disease diagnosis ontologies designed specifically to enable the process of generating diagnostic recommendations. These ontologies are the disease symptom ontology and the patient ontology. The evidence-based diagnosis process develops dynamic rules based on standardized clinical pathways. The proximity-based component employs data mining to provide clinicians with diagnosis predictions, as well as generates new diagnosis rules from provided training datasets. This article describes the integration between these two components along with the developed diagnosis ontologies to form a novel medical differential diagnosis recommendation model. This article also provides test cases from the implementation of the overall model, which shows quite promising diagnostic recommendation results.

Integration of soft tissue model and open haptic device for medical training simulator

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Akasum, G. F.; Ramdhania, L. N.; Suprijanto; Widyotriatmo, A.

2016-03-01

Minimally Invasive Surgery (MIS) has been widely used to perform any surgical procedures nowadays. Currently, MIS has been applied in some cases in Indonesia. Needle insertion is one of simple MIS procedure that can be used for some purposes. Before the needle insertion technique used in the real situation, it essential to train this type of medical student skills. The research has developed an open platform of needle insertion simulator with haptic feedback that providing the medical student a realistic feel encountered during the actual procedures. There are three main steps in build the training simulator, which are configure hardware system, develop a program to create soft tissue model and the integration of hardware and software. For evaluating its performance, haptic simulator was tested by 24 volunteers on a scenario of soft tissue model. Each volunteer must insert the needle on simulator until rearch the target point with visual feedback that visualized on the monitor. From the result it can concluded that the soft tissue model can bring the sensation of touch through the perceived force feedback on haptic actuator by looking at the different force in accordance with different stiffness in each layer.

Medical imaging education in biomedical engineering curriculum: courseware development and application through a hybrid teaching model.

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Zhao, Weizhao; Li, Xiping; Chen, Hairong; Manns, Fabrice

2012-01-01

Medical Imaging is a key training component in Biomedical Engineering programs. Medical imaging education is interdisciplinary training, involving physics, mathematics, chemistry, electrical engineering, computer engineering, and applications in biology and medicine. Seeking an efficient teaching method for instructors and an effective learning environment for students has long been a goal for medical imaging education. By the support of NSF grants, we developed the medical imaging teaching software (MITS) and associated dynamic assessment tracking system (DATS). The MITS/DATS system has been applied to junior and senior medical imaging classes through a hybrid teaching model. The results show that student's learning gain improved, particularly in concept understanding and simulation project completion. The results also indicate disparities in subjective perception between junior and senior classes. Three institutions are collaborating to expand the courseware system and plan to apply it to different class settings.

The REEME project: a cooperative model for sharing international medical education materials.

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Iserson, Kenneth V

2008-07-01

Although the Internet has become an excellent source of medical education materials, in many specialties, including Emergency Medicine (EM), most of the information is in English. Few international EM practitioners can attend costly specialty conferences, importing foreign experts to teach at these conferences is costly and, even then, these experts are available for a limited time to relatively few people. Countries with minimal health care or medical education budgets find providing even basic materials for professional medical education difficult. An exciting international project now freely distributes Spanish language educational programs to health care professionals on topics relating to EM. The Recursos Educacionales en Español para Medicina de Emergencia (REEME; Educational Resources in Spanish for EM) Project (www.reeme.arizona.edu) was developed to overcome some of these problems by providing language-specific specialty information and widespread international availability, and by promoting international cooperation among professional health care educators. It also provides a ready source of Spanish medical vocabulary for those trying to learn the language. With computer support from the University of Arizona's Learning and Technology Center, REEME first went "live" on November 1, 2004. Three years later, as of November 1, 2007, the site had 575 programs from 411 donors representing 19 countries and the United Nations. There are currently about 645 downloads per month to users in 73 countries. The REEME Project demonstrates the power of the Internet as a means to achieve international cooperation in medical education, and can serve as a model for similar projects in other specialties and languages.

Critical elements of culturally competent communication in the medical encounter: a review and model.

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Teal, Cayla R; Street, Richard L

2009-02-01

Increasing the cultural competence of physicians is one means of responding to demographic changes in the USA, as well as reducing health disparities. However, in spite of the development and implementation of cultural competence training programs, little is known about the ways cultural competence manifests itself in medical encounters. This paper will present a model of culturally competent communication that offers a framework of studying cultural competence 'in action.' First, we describe four critical elements of culturally competent communication in the medical encounter--communication repertoire, situational awareness, adaptability, and knowledge about core cultural issues. We present a model of culturally competent physician communication that integrates existing frameworks for cultural competence in patient care with models of effective patient-centered communication. The culturally competent communication model includes five communication skills that are depicted as elements of a set in which acquisition of more skills corresponds to increasing complexity and culturally competent communication. The culturally competent communication model utilizes each of the four critical elements to fully develop each skill and apply increasingly sophisticated, contextually appropriate communication behaviors to engage with culturally different patients in complex interactions. It is designed to foster maximum physician sensitivity to cultural variation in patients as the foundation of physician-communication competence in interacting with patients.

Medina (Medical Instant Pashmina) Hijab for Medical Personnel

OpenAIRE

Limita, Sandrarizka Yuvike; Dinarsari, Fairuz Febrita; Rona, Tiga Putu; Halimi, Achmad Aunul

2017-01-01

MEDINA (Medical Instant Pashmina) is a hijab made for medical personnel. MEDINA hijab is a hijab in instantpashmina model with a small hole near the ears but it cannot be seen from outside and the function is to makeusing stetoskop easier. The purpose of making our product is to make MEDINA as medical personnel's hijabwhich has funct ion to easily use stethoscope and still look syar'i. It is convenient with our motto: “Beauty inSyari, Luxury in Simplicit y”. There are three stages in running ...

Dynamic sensor tasking and IMM EKF estimation for tracking impulsively maneuvering satellites

Science.gov (United States)

Lace, Arthur A.

In order to efficiently maintain space situational awareness, care must be taken to optimally allocate expensive observation resources. In most situations the available sensors capable of tracking spacecraft have their time split between many different monitoring responsibilities. Tracking maneuvering spacecraft can be especially difficult as the schedule of maneuvers may not be known and will often throw off previous orbital models. Effectively solving this tasking problem is an ongoing focus of research in the area of space situational awareness. Most methods of automated tasking do not make use of interacting multiple model extended Kalman filter techniques to better track satellites during maneuvers. This paper proposes a modification to a Fisher information gain and estimated state covariance based sensor tasking method to take maneuver probability and multiple model dynamics into account. By incorporating the probabilistic maneuvering model, sensor tasking can be improved during satellite maneuvers using constrained resources. The proposed methods are verified through the use of numerical simulations with multiple maneuvering satellites and both orbital and ground-based sensors.

Sadhana | Indian Academy of Sciences

Indian Academy of Sciences (India)

The interacting multiple model (IMM) algorithm has proved to be useful in tracking maneuvering targets. Tracking accuracy can be further improved using data fusion. Tracking of multiple targets using multiple sensors and fusing them at a central site using centralized architecture involves communication of large volumes of ...

Evolving models for medical physics education and training: a global perspective.

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Sprawls, P

2008-01-01

There is a significant need for high-quality medical physics education and training in all countries to support effective and safe use of modern medical technology for both diagnostic and treatment purposes. This is, and will continue to be, achieved using appropriate technology to increase both the effectiveness and efficiency of educational activities everywhere in the world. While the applications of technology to education and training are relatively new, the successful applications are based on theories and principles of the learning process developed by two pioneers in the field, Robert Gagne and Edgar Dale.The work of Gagne defines the different levels of learning that can occur and is used to show the types and levels of learning that are required for the application of physics and engineering principles to achieve appropriate diagnostic and therapeutic results from modern technology. The learning outcomes are determined by the effectiveness of the learning activity or experience. The extensive work of Dale as formulated in his Cone of Experience relates the effectiveness to the efficiency of educational activities. A major challenge in education is the development and conduction of learning activities (classroom discussions, laboratory and applied experiences, individual study, etc) that provide an optimum balance between effectiveness and efficiency. New and evolving models of the educational process use technology as the infrastructure to support education that is both more effective and efficient.The goal is to use technology to enhance human performance for both learners (students) and learning facilitators (teachers). A major contribution to global education is the trend in the development of shared educational resources. Two models of programs to support this effort with open and free shared resources are Physical Principles of Medical Imaging Online (http://www.sprawls.org/resources) and AAPM Continuing Education Courses (http://www.aapm.org/international).

Discovering subgroups using descriptive models of adverse outcomes in medical care.

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Stiglic, Gregor; Kokol, P

2012-01-01

Hospital discharge databases store hundreds of thousands of patients. These datasets are usually used by health insurance companies to process claims from hospitals, but they also represent a rich source of information about the patterns of medical care. The proposed subgroup discovery method aims to improve the efficiency of detecting interpretable subgroups in data. Supervised descriptive rule discovery techniques can prove inefficient in cases when target class samples represent only an extremely small amount of all available samples. Our approach aims to balance the number of samples in target and control groups prior to subgroup discovery process. Additionally, we introduce some improvements to an existing subgroup discovery algorithm enhancing the user experience and making the descriptive data mining process and visualization of rules more user friendly. Instance-based subspace subgroup discovery introduced in this paper is demonstrated on hospital discharge data with focus on medical errors. In general, the number of patients with a recorded diagnosis related to a medical error is relatively small in comparison to patients where medical errors did not occur. The ability to produce comprehensible and simple models with high degree of confidence, support, and predictive power using the proposed method is demonstrated. This paper introduces a subspace subgroup discovery process that can be applied in all settings where a large number of samples with relatively small number of target class samples are present. The proposed method is implemented in Weka machine learning environment and is available at http://ri.fzv.uni-mb.si/ssd.

Evaluation of a task-based community oriented teaching model in family medicine for undergraduate medical students in Iraq

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Al-Taee Waleed G

2005-08-01

Full Text Available Abstract Background The inclusion of family medicine in medical school curricula is essential for producing competent general practitioners. The aim of this study is to evaluate a task-based, community oriented teaching model of family medicine for undergraduate students in Iraqi medical schools. Methods An innovative training model in family medicine was developed based upon tasks regularly performed by family physicians providing health care services at the Primary Health Care Centre (PHCC in Mosul, Iraq. Participants were medical students enrolled in their final clinical year. Students were assigned to one of two groups. The implementation group (28 students was exposed to the experimental model and the control group (56 students received the standard teaching curriculum. The study took place at the Mosul College of Medicine and at the Al-Hadba PHCC in Mosul, Iraq, during the academic year 1999–2000. Pre- and post-exposure evaluations comparing the intervention group with the control group were conducted using a variety of assessment tools. Results The primary endpoints were improvement in knowledge of family medicine and development of essential performance skills. Results showed that the implementation group experienced a significant increase in knowledge and performance skills after exposure to the model and in comparison with the control group. Assessment of the model by participating students revealed a high degree of satisfaction with the planning, organization, and implementation of the intervention activities. Students also highly rated the relevancy of the intervention for future work. Conclusion A model on PHCC training in family medicine is essential for all Iraqi medical schools. The model is to be implemented by various relevant departments until Departments of Family medicine are established.

Predictive Modeling of Physician-Patient Dynamics That Influence Sleep Medication Prescriptions and Clinical Decision-Making

Science.gov (United States)

Beam, Andrew L.; Kartoun, Uri; Pai, Jennifer K.; Chatterjee, Arnaub K.; Fitzgerald, Timothy P.; Shaw, Stanley Y.; Kohane, Isaac S.

2017-02-01

Insomnia remains under-diagnosed and poorly treated despite its high economic and social costs. Though previous work has examined how patient characteristics affect sleep medication prescriptions, the role of physician characteristics that influence this clinical decision remains unclear. We sought to understand patient and physician factors that influence sleep medication prescribing patterns by analyzing Electronic Medical Records (EMRs) including the narrative clinical notes as well as codified data. Zolpidem and trazodone were the most widely prescribed initial sleep medication in a cohort of 1,105 patients. Some providers showed a historical preference for one medication, which was highly predictive of their future prescribing behavior. Using a predictive model (AUC = 0.77), physician preference largely determined which medication a patient received (OR = 3.13 p = 3 × 10-37). In addition to the dominant effect of empirically determined physician preference, discussion of depression in a patient’s note was found to have a statistically significant association with receiving a prescription for trazodone (OR = 1.38, p = 0.04). EMR data can yield insights into physician prescribing behavior based on real-world physician-patient interactions.

Creating a Common Data Model for Comparative Effectiveness with the Observational Medical Outcomes Partnership.

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FitzHenry, F; Resnic, F S; Robbins, S L; Denton, J; Nookala, L; Meeker, D; Ohno-Machado, L; Matheny, M E

2015-01-01

Adoption of a common data model across health systems is a key infrastructure requirement to allow large scale distributed comparative effectiveness analyses. There are a growing number of common data models (CDM), such as Mini-Sentinel, and the Observational Medical Outcomes Partnership (OMOP) CDMs. In this case study, we describe the challenges and opportunities of a study specific use of the OMOP CDM by two health systems and describe three comparative effectiveness use cases developed from the CDM. The project transformed two health system databases (using crosswalks provided) into the OMOP CDM. Cohorts were developed from the transformed CDMs for three comparative effectiveness use case examples. Administrative/billing, demographic, order history, medication, and laboratory were included in the CDM transformation and cohort development rules. Record counts per person month are presented for the eligible cohorts, highlighting differences between the civilian and federal datasets, e.g. the federal data set had more outpatient visits per person month (6.44 vs. 2.05 per person month). The count of medications per person month reflected the fact that one system's medications were extracted from orders while the other system had pharmacy fills and medication administration records. The federal system also had a higher prevalence of the conditions in all three use cases. Both systems required manual coding of some types of data to convert to the CDM. The data transformation to the CDM was time consuming and resources required were substantial, beyond requirements for collecting native source data. The need to manually code subsets of data limited the conversion. However, once the native data was converted to the CDM, both systems were then able to use the same queries to identify cohorts. Thus, the CDM minimized the effort to develop cohorts and analyze the results across the sites.

Neurocognition, insight and medication nonadherence in schizophrenia: a structural equation modeling approach.

Directory of Open Access Journals (Sweden)

Laurent Boyer

Full Text Available OBJECTIVE: The aim of this study was to examine the complex relationships among neurocognition, insight and nonadherence in patients with schizophrenia. METHODS: DESIGN: Cross-sectional study. INCLUSION CRITERIA: Diagnosis of schizophrenia according to the DSM-IV-TR criteria. DATA COLLECTION: Neurocognition was assessed using a global approach that addressed memory, attention, and executive functions; insight was analyzed using the multidimensional 'Scale to assess Unawareness of Mental Disorder;' and nonadherence was measured using the multidimensional 'Medication Adherence Rating Scale.' ANALYSIS: Structural equation modeling (SEM was applied to examine the non-straightforward relationships among the following latent variables: neurocognition, 'awareness of positive symptoms' and 'negative symptoms', 'awareness of mental disorder' and nonadherence. RESULTS: One hundred and sixty-nine patients were enrolled. The final testing model showed good fit, with normed χ(2 = 1.67, RMSEA = 0.063, CFI = 0.94, and SRMR = 0.092. The SEM revealed significant associations between (1 neurocognition and 'awareness of symptoms,' (2 'awareness of symptoms' and 'awareness of mental disorder' and (3 'awareness of mental disorder' and nonadherence, mainly in the 'attitude toward taking medication' dimension. In contrast, there were no significant links between neurocognition and nonadherence, neurocognition and 'awareness of mental disorder,' and 'awareness of symptoms' and nonadherence. CONCLUSIONS: Our findings support the hypothesis that neurocognition influences 'awareness of symptoms,' which must be integrated into a higher level of insight (i.e., the 'awareness of mental disorder' to have an impact on nonadherence. These findings have important implications for the development of effective strategies to enhance medication adherence.

Separating Business Logic from Medical Knowledge in Digital Clinical Workflows Using Business Process Model and Notation and Arden Syntax.

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de Bruin, Jeroen S; Adlassnig, Klaus-Peter; Leitich, Harald; Rappelsberger, Andrea

2018-01-01

Evidence-based clinical guidelines have a major positive effect on the physician's decision-making process. Computer-executable clinical guidelines allow for automated guideline marshalling during a clinical diagnostic process, thus improving the decision-making process. Implementation of a digital clinical guideline for the prevention of mother-to-child transmission of hepatitis B as a computerized workflow, thereby separating business logic from medical knowledge and decision-making. We used the Business Process Model and Notation language system Activiti for business logic and workflow modeling. Medical decision-making was performed by an Arden-Syntax-based medical rule engine, which is part of the ARDENSUITE software. We succeeded in creating an electronic clinical workflow for the prevention of mother-to-child transmission of hepatitis B, where institution-specific medical decision-making processes could be adapted without modifying the workflow business logic. Separation of business logic and medical decision-making results in more easily reusable electronic clinical workflows.

A flexible model for the mean and variance functions, with application to medical cost data.

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Chen, Jinsong; Liu, Lei; Zhang, Daowen; Shih, Ya-Chen T

2013-10-30

Medical cost data are often skewed to the right and heteroscedastic, having a nonlinear relation with covariates. To tackle these issues, we consider an extension to generalized linear models by assuming nonlinear associations of covariates in the mean function and allowing the variance to be an unknown but smooth function of the mean. We make no further assumption on the distributional form. The unknown functions are described by penalized splines, and the estimation is carried out using nonparametric quasi-likelihood. Simulation studies show the flexibility and advantages of our approach. We apply the model to the annual medical costs of heart failure patients in the clinical data repository at the University of Virginia Hospital System. Copyright © 2013 John Wiley & Sons, Ltd.

An information model to support user-centered design of medical devices.

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Hagedorn, Thomas J; Krishnamurty, Sundar; Grosse, Ian R

2016-08-01

The process of engineering design requires the product development team to balance the needs and limitations of many stakeholders, including those of the user, regulatory organizations, and the designing institution. This is particularly true in medical device design, where additional consideration must be given for a much more complex user-base that can only be accessed on a limited basis. Given this inherent challenge, few projects exist that consider design domain concepts, such as aspects of a detailed design, a detailed view of various stakeholders and their capabilities, along with the user-needs simultaneously. In this paper, we present a novel information model approach that combines a detailed model of design elements with a model of the design itself, customer requirements, and of the capabilities of the customer themselves. The information model is used to facilitate knowledge capture and automated reasoning across domains with a minimal set of rules by adopting a terminology that treats customer and design specific factors identically, thus enabling straightforward assessments. A uniqueness of this approach is that it systematically provides an integrated perspective on the key usability information that drive design decisions towards more universal or effective outcomes with the very design information impacted by the usability information. This can lead to cost-efficient optimal designs based on a direct inclusion of the needs of customers alongside those of business, marketing, and engineering requirements. Two case studies are presented to show the method's potential as a more effective knowledge management tool with built-in automated inferences that provide design insight, as well as its overall effectiveness as a platform to develop and execute medical device design from a holistic perspective. Copyright © 2016 Elsevier Inc. All rights reserved.

Renal Transplant Recipients: The Factors Related to Immunosuppressive Medication Adherence Based on the Health Belief Model.

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Kung, Pen-Chen; Yeh, Mei Chang; Lai, Ming-Kuen; Liu, Hsueh-Erh

2017-10-01

Kidney transplant failures are caused primarily by lack of adherence to immunosuppressive medication regimens by patients after transplantation. A number of studies have indicated that health-related beliefs are an effective predictor of health-related behavior. The aim of this study is to understand the influence of the personal characteristics and health-related beliefs of patients on adherence to treatment with immunosuppressive medication based on the Health Belief Model. This cross-sectional study distributed questionnaires to patients who had been recruited via purposive sampling at one medical center in Taipei. All of the potential participants had undergone kidney transplantation at least 6 months previously. The self-developed questionnaire collected data in three areas: personal characteristics, health-related beliefs regarding transplant rejection, and adherence to the immunosuppressive medication regimen. One hundred twenty-two valid questionnaires were received. The collected data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Pearson's correlation, and multiple regression. Participants who had received dialysis treatment or had experienced rejection perceived susceptibility to rejection more strongly than those who had not. Participants who had undergone transplantation in Taiwan, had experienced more drug-related symptoms, or had contracted severe to extremely severe infections in the past showed lower rates of adherence to treatment with immunosuppressive medication. Adherence to medication regimens correlated negatively with length of time since transplantation. Length of time since transplantation, drug-related symptoms, perceived susceptibility to rejection, and perceived benefits of treatment were identified as major predictors of adherence to immunosuppressive medication regimens. The results partially conformed to the concepts of the Health Belief Model. Perceived susceptibility to rejection and

Teaching leadership: the medical student society model.

Science.gov (United States)

Matthews, Jacob H; Morley, Gabriella L; Crossley, Eleanor; Bhanderi, Shivam

2018-04-01

All health care professionals in the UK are expected to have the medical leadership and management (MLM) skills necessary for improving patient care, as stipulated by the UK General Medical Council (GMC). Newly graduated doctors reported insufficient knowledge about leadership and quality improvement skills, despite all UK medical schools reporting that MLM is taught within their curriculum. A medical student society organised a series of extracurricular educational events focusing on leadership topics. The society recognised that the events needed to be useful and interesting to attract audiences. Therefore, clinical leaders in exciting fields were invited to talk about their experiences and case studies of personal leadership challenges. The emphasis on personal stories, from respected leaders, was a deliberate strategy to attract students and enhance learning. Evaluation data were collected from the audiences to improve the quality of the events and to support a business case for an intercalated degree in MLM. When leadership and management concepts are taught through personal stories, students find it interesting and are prepared to give up their leisure time to engage with the subject. Students appear to recognise the importance of MLM knowledge to their future careers, and are able to organise their own, and their peers', learning and development. Organising these events and collecting feedback can provide students with opportunities to practise leadership, management and quality improvement skills. These extracurricular events, delivered through a student society, allow for subjects to be discussed in more depth and can complement an already crowded undergraduate curriculum. Newly graduated doctors reported insufficient knowledge about leadership and quality improvement skills. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Machine medical ethics

CERN Document Server

Pontier, Matthijs

2015-01-01

The essays in this book, written by researchers from both humanities and sciences, describe various theoretical and experimental approaches to adding medical ethics to a machine in medical settings. Medical machines are in close proximity with human beings, and getting closer: with patients who are in vulnerable states of health, who have disabilities of various kinds, with the very young or very old, and with medical professionals. In such contexts, machines are undertaking important medical tasks that require emotional sensitivity, knowledge of medical codes, human dignity, and privacy. As machine technology advances, ethical concerns become more urgent: should medical machines be programmed to follow a code of medical ethics? What theory or theories should constrain medical machine conduct? What design features are required? Should machines share responsibility with humans for the ethical consequences of medical actions? How ought clinical relationships involving machines to be modeled? Is a capacity for e...

The isobaric multiplet mass equation for A≤71 revisited

Energy Technology Data Exchange (ETDEWEB)

Lam, Yi Hua, E-mail: lamyihua@gmail.com [CENBG (UMR 5797 — Université Bordeaux 1 — CNRS/IN2P3), Chemin du Solarium, Le Haut Vigneau, BP 120, 33175 Gradignan Cedex (France); Blank, Bertram, E-mail: blank@cenbg.in2p3.fr [CENBG (UMR 5797 — Université Bordeaux 1 — CNRS/IN2P3), Chemin du Solarium, Le Haut Vigneau, BP 120, 33175 Gradignan Cedex (France); Smirnova, Nadezda A. [CENBG (UMR 5797 — Université Bordeaux 1 — CNRS/IN2P3), Chemin du Solarium, Le Haut Vigneau, BP 120, 33175 Gradignan Cedex (France); Bueb, Jean Bernard; Antony, Maria Susai [IPHC, Université de Strasbourg, CNRS/UMR7178, 23 Rue du Loess, 67037 Strasbourg Cedex (France)

2013-11-15

Accurate mass determination of short-lived nuclides by Penning-trap spectrometers and progress in the spectroscopy of proton-rich nuclei have triggered renewed interest in the isobaric multiplet mass equation (IMME). The energy levels of the members of T=1/2,1,3/2, and 2 multiplets and the coefficients of the IMME are tabulated for A≤71. The new compilation is based on the most recent mass evaluation (AME2011) and it includes the experimental results on energies of the states evaluated up to end of 2011. Taking into account the error bars, a significant deviation from the quadratic form of the IMME for the A=9,35 quartets and the A=32 quintet is observed.

[The regional model of three-level system of of medical social monitoring of children and adolescents: the pilot project in the Republic of Tatarstan].

Science.gov (United States)

Al'bitskii, V Iu; Ustinova, N V; Farrakhov, A Z; Shavaliev, R F; Kulikov O V; Plaksina, L V

2014-01-01

The absence of system of medical social monitoring of children being in difficult life situations is one of main causes of preventable losses of health and life of children and adolescents. The plan of activities of the working group No3 under the Coordination council under the President of the Russian Federation of the national strategy realization of actions in interest of children for 2012-2017 includes a point: "The development and implementation of standard model of medical social monitoring of children and adolescents in the subjects of the Russian Federation". The implementation of this task is assigned to the Department of social pediatrics of The research center of children health of Moscow and the Ministry of Health of the Republic of Tatarstan. The research methods included analysis and generalization of advanced experience of medical social monitoring of children population; expertise technique; modeling. The regional model of three-level system of medical social monitoring of children population is developed and implemented. The model includes level I (consulting rooms of medical social care of children polyclinics, feldsher obstetric stations, first-aid centers), level II--inter-municipal (departments of medical social monitoring in central district hospitals, medical institutions, clinical diagnostic centers) and level III--regional (the Republican center of medical social monitoring of children and adolescents). The immediate tasks necessary for effective functioning of system of medical social monitoring were determined. Within the framework of implementation of the pilot project the legal and normative legislative acts were developed to regulate functioning of regional model of three-level system of medical social care. The other documents necessary for effective functioning of this system were elaborated. The practical significance of this system is in the implementation of effective three-level model of medical social monitoring of children and

Mentoring for junior medical faculty: Existing models and suggestions for low-resource settings.

Science.gov (United States)

Menon, Vikas; Muraleedharan, Aparna; Bhat, Ballambhattu Vishnu

2016-02-01

Globally, there is increasing recognition about the positive benefits and impact of mentoring on faculty retention rates, career satisfaction and scholarly output. However, emphasis on research and practice of mentoring is comparatively meagre in low and middle income countries. In this commentary, we critically examine two existing models of mentorship for medical faculty and offer few suggestions for an integrated hybrid model that can be adapted for use in low resource settings. Copyright © 2016 Elsevier B.V. All rights reserved.

Expansion of the consultation-liaison psychiatry paradigm at a university medical center: integration of diversified clinical and funding models.

Science.gov (United States)

Bourgeois, James A; Hilty, Donald M; Klein, Sally C; Koike, Alan K; Servis, Mark E; Hales, Robert E

2003-01-01

The perspective of the contemporary Consultation-Liason Service (CLS) psychiatrist is increasingly one of consultant to medical and surgical colleagues in models other than inpatient medical and surgical units. Simultaneously, the need for a clinically and educationally robust inpatient CLS persists despite funding pressures. The University of California, Davis Medical Center Department of Psychiatry has made use of creative organizational and financial models to accomplish the inpatient CLS clinical and educational missions in a fiscally responsible manner. In addition, the department has in recent years expanded the delivery of psychiatry consultation-liaison clinical and educational services to other models of care delivery, broadening the role and influence of the CLS. Several of the initiatives described in this paper parallel an overall evolution of the practice of consultation-liaison psychiatry in response to managed care influences and other systems pressures. This consultation-liaison paradigm expansion with diversified sources of funding support facilitates the development of consultation-liaison psychiatry along additional clinical, administrative, research, and educational dimensions. Other university medical centers may consider adaptation of some of the initiatives described here to their institutions.

Putting patients first: a novel patient-centered model for medical enterprise success.

Science.gov (United States)

Dhawan, Naveen

2014-01-01

This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise.

Emphasizing humanities in medical education: Promoting the integration of medical scientific spirit and medical humanistic spirit.

Science.gov (United States)

Song, Peipei; Tang, Wei

2017-05-23

In the era of the biological-psychological-social medicine model, an ideal of modern medicine is to enhance the humanities in medical education, to foster medical talents with humanistic spirit, and to promote the integration of scientific spirit and humanistic spirit in medicine. Throughout the United States (US), United Kingdom (UK), other Western countries, and some Asian countries like Japan, many medical universities have already integrated the learning of medical humanities in their curricula and recognized their value. While in China, although medical education reform over the past decade has emphasized the topic of medical humanities to increase the professionalism of future physicians, the integration of medical humanity courses in medical universities has lagged behind the pace in Western countries. In addition, current courses in medical humanities were arbitrarily established due to a lack of organizational independence. For various reasons like a shortage of instructors, medical universities have failed to pay sufficient attention to medical humanities education given the urgent needs of society. The medical problems in contemporary Chinese society are not solely the purview of biomedical technology; what matters more is enhancing the humanities in medical education and fostering medical talents with humanistic spirit. Emphasizing the humanities in medical education and promoting the integration of medical scientific spirit and medical humanistic spirit have become one of the most pressing issues China must address. Greater attention should be paid to reasonable integration of humanities into the medical curriculum, creation of medical courses related to humanities and optimization of the curriculum, and actively allocating abundant teaching resources and exploring better methods of instruction.

Identification of a potential fibromyalgia diagnosis using random forest modeling applied to electronic medical records

OpenAIRE

Masters, Elizabeth T.; Emir,Birol; Mardekian,Jack; Clair,Andrew; Kuhn,Max; Silverman,Stuart

2015-01-01

Birol Emir,1 Elizabeth T Masters,1 Jack Mardekian,1 Andrew Clair,1 Max Kuhn,2 Stuart L Silverman,3 1Pfizer Inc., New York, NY, 2Pfizer Inc., Groton, CT, 3Cedars-Sinai Medical Center, Los Angeles, CA, USA Background: Diagnosis of fibromyalgia (FM), a chronic musculoskeletal condition characterized by widespread pain and a constellation of symptoms, remains challenging and is often delayed. Methods: Random forest modeling of electronic medical records was used to identify variables that may fa...

Hybrid 3D pregnant woman and fetus modeling from medical imaging for dosimetry studies

Energy Technology Data Exchange (ETDEWEB)

Bibin, Lazar; Anquez, Jeremie; Angelini, Elsa; Bloch, Isabelle [Telecom ParisTech, CNRS UMR 5141 LTCI, Institut TELECOM, Paris (France)

2010-01-15

Numerical simulations studying the interactions between radiations and biological tissues require the use of three-dimensional models of the human anatomy at various ages and in various positions. Several detailed and flexible models exist for adults and children and have been extensively used for dosimetry. On the other hand, progress of simulation studies focusing on pregnant women and the fetus have been limited by the fact that only a small number of models exist with rather coarse anatomical details and a poor representation of the anatomical variability of the fetus shape and its position over the entire gestation. In this paper, we propose a new computational framework to generate 3D hybrid models of pregnant women, composed of fetus shapes segmented from medical images and a generic maternal body envelope representing a synthetic woman scaled to the dimension of the uterus. The computational framework includes the following tasks: image segmentation, contour regularization, mesh-based surface reconstruction, and model integration. A series of models was created to represent pregnant women at different gestational stages and with the fetus in different positions, all including detailed tissues of the fetus and the utero-fetal unit, which play an important role in dosimetry. These models were anatomically validated by clinical obstetricians and radiologists who verified the accuracy and representativeness of the anatomical details, and the positioning of the fetus inside the maternal body. The computational framework enables the creation of detailed, realistic, and representative fetus models from medical images, directly exploitable for dosimetry simulations. (orig.)

Hybrid 3D pregnant woman and fetus modeling from medical imaging for dosimetry studies

International Nuclear Information System (INIS)

Bibin, Lazar; Anquez, Jeremie; Angelini, Elsa; Bloch, Isabelle

2010-01-01

Numerical simulations studying the interactions between radiations and biological tissues require the use of three-dimensional models of the human anatomy at various ages and in various positions. Several detailed and flexible models exist for adults and children and have been extensively used for dosimetry. On the other hand, progress of simulation studies focusing on pregnant women and the fetus have been limited by the fact that only a small number of models exist with rather coarse anatomical details and a poor representation of the anatomical variability of the fetus shape and its position over the entire gestation. In this paper, we propose a new computational framework to generate 3D hybrid models of pregnant women, composed of fetus shapes segmented from medical images and a generic maternal body envelope representing a synthetic woman scaled to the dimension of the uterus. The computational framework includes the following tasks: image segmentation, contour regularization, mesh-based surface reconstruction, and model integration. A series of models was created to represent pregnant women at different gestational stages and with the fetus in different positions, all including detailed tissues of the fetus and the utero-fetal unit, which play an important role in dosimetry. These models were anatomically validated by clinical obstetricians and radiologists who verified the accuracy and representativeness of the anatomical details, and the positioning of the fetus inside the maternal body. The computational framework enables the creation of detailed, realistic, and representative fetus models from medical images, directly exploitable for dosimetry simulations. (orig.)

Attachment in medical care: A review of the interpersonal model in chronic disease management.

Science.gov (United States)

Jimenez, Xavier F

2017-03-01

Objective Patient-physician interaction is continually examined in an era prioritizing patient-centered approaches, yet elaboration beyond aspects of communication and empathy is lacking. Major chronic conditions would benefit tremendously from understanding interpersonal aspects of patient-physician encounters. This review intends to provide a concise introduction to the interpersonal model of attachment theory and how it informs both the patient-physician interaction and medical outcomes in chronic care. Methods A narrative review of the theoretical, neurobiological, epidemiological, investigational, and clinical literature on attachment theory and its impact on medical outcomes was conducted, utilizing a variety of key words as searched on PubMed database. Studies and reviews included were of a variety of sources, including textbooks and peer-reviewed journals. Reports in languages other than English were excluded. Results Measurable, discrete attachment styles and behavioral patterns correlate with poor medical outcomes, including nonadherence in insecure dismissing attachment and care overutilization in insecure preoccupied attachment. Furthermore, insecure dismissing attachment is associated with significant mortality. These variables can be easily assessed, and their effects are reversible, as evidenced by collaborative care outcome data. Discussion Attachment theory is useful a model with application in clinical and investigational aspects of chronic illness care. Implications and guidelines are explored.

Motion and deformation estimation from medical imagery by modeling sub-structure interaction and constraints

KAUST Repository

Sundaramoorthi, Ganesh

2012-09-13

This paper presents a novel medical image registration algorithm that explicitly models the physical constraints imposed by objects or sub-structures of objects that have differing material composition and border each other, which is the case in most medical registration applications. Typical medical image registration algorithms ignore these constraints and therefore are not physically viable, and to incorporate these constraints would require prior segmentation of the image into regions of differing material composition, which is a difficult problem in itself. We present a mathematical model and algorithm for incorporating these physical constraints into registration / motion and deformation estimation that does not require a segmentation of different material regions. Our algorithm is a joint estimation of different material regions and the motion/deformation within these regions. Therefore, the segmentation of different material regions is automatically provided in addition to the image registration satisfying the physical constraints. The algorithm identifies differing material regions (sub-structures or objects) as regions where the deformation has different characteristics. We demonstrate the effectiveness of our method on the analysis of cardiac MRI which includes the detection of the left ventricle boundary and its deformation. The experimental results indicate the potential of the algorithm as an assistant tool for the quantitative analysis of cardiac functions in the diagnosis of heart disease.

Association between Perceived Value and Self-Medication with Antibiotics: An Observational Study Based on Health Belief Model Theory

Directory of Open Access Journals (Sweden)

Annisa N. Insany

2015-06-01

Full Text Available High prevalence of self medication with antibiotics can increase the probability of irrational use of antibiotics which may lead antibiotics resistance. Thus, shifting of behavior is required to minimize the irrational use of antibiotics. This study was aimed to determine the association between public perceived value and self-medication with antibiotics which can be used to develop an intervention model in order to reduce the practice of self-medication with antibiotics. An observational study was conducted during the period of November–December 2014.The subjects were patients who visit primary health care facilities in Bandung. A structured-interview that has been validated was used to investigate the association between perceived value and self-medication behavior based on the Health Belief Model theory (perceived susceptibility, benefits, barrier, and cues to action. Approximately 506 respondents were drawn randomly from 43 community healthcare centers and 8 pharmacies. Data was analyzed by using descriptive statistics and logistic regression (CI 95%, α = 5%. Validity and reliability of the questionnaire were shown with a correlation coefficient of >0.3 and a cronbach-alpha value of 0.719, respectively. We found that 29.45% of respondents practiced self-medication with antibiotics over the last six months. Additionally, there was no significant association between the perceived susceptibility, benefits, barrier, and cues to action with self-medication behavior (p>0.05. Easiness to access antibiotics without prescription was presumed as a factor that contribute to self-medication with antibiotics, therefore strict regulation in antibiotics use is very needed as a basic intervention to decrease self-medication with antibiotic.

Investigating the Relationships among Metacognitive Strategy Training, Willingness to Read English Medical Texts, and Reading Comprehension Ability Using Structural Equation Modeling

Science.gov (United States)

Hassanpour, Masoumeh; Ghonsooly, Behzad; Nooghabi, Mehdi Jabbari; Shafiee, Mohammad Naser

2017-01-01

This quasi-experimental study examined the relationship between students' metacognitive awareness and willingness to read English medical texts. So, a model was proposed and tested using structural equation modeling (SEM) with R software. Participants included 98 medical students of two classes. One class was assigned as the control group and the…

Behind the scenes of GS: health in the workplace

CERN Multimedia

CERN Bulletin

2014-01-01

CERN has had its own Medical Service since 1965. Open to members of the personnel, users and visitors, the team offers care and advice with professionalism and commitment.   The Medical Service team, currently consisting of three doctors, four nurses, a lab technician, a psychologist and two administrative assistants, provides an ever-increasing number of consultations. In 2013, around 7800 people were seen by the Medical Service, mainly at walk-in consultations, and more than 6665 further tests were performed (e.g. electrocardiograms, hearing tests, lung function tests, urine tests, blood tests). While its chief objective is to monitor the health of the CERN community in relation to their work through regular medical check-ups, the Medical Service also performs an important primary care function: “More than 10,000 people work in CERN’s offices, workshops, tunnels and worksites every day. As in any community of that size, sometimes certain situations arise that demand imme...

Collidoscope: An Improved Tool for Computing Collisional Cross-Sections with the Trajectory Method

Science.gov (United States)

Ewing, Simon A.; Donor, Micah T.; Wilson, Jesse W.; Prell, James S.

2017-04-01

Ion mobility-mass spectrometry (IM-MS) can be a powerful tool for determining structural information about ions in the gas phase, from small covalent analytes to large, native-like or denatured proteins and complexes. For large biomolecular ions, which may have a wide variety of possible gas-phase conformations and multiple charge sites, quantitative, physically explicit modeling of collisional cross sections (CCSs) for comparison to IMS data can be challenging and time-consuming. We present a "trajectory method" (TM) based CCS calculator, named "Collidoscope," which utilizes parallel processing and optimized trajectory sampling, and implements both He and N2 as collision gas options. Also included is a charge-placement algorithm for determining probable charge site configurations for protonated protein ions given an input geometry in pdb file format. Results from Collidoscope are compared with those from the current state-of-the-art CCS simulation suite, IMoS. Collidoscope CCSs are within 4% of IMoS values for ions with masses from 18 Da to 800 kDa. Collidoscope CCSs using X-ray crystal geometries are typically within a few percent of IM-MS experimental values for ions with mass up to 3.5 kDa (melittin), and discrepancies for larger ions up to 800 kDa (GroEL) are attributed in large part to changes in ion structure during and after the electrospray process. Due to its physically explicit modeling of scattering, computational efficiency, and accuracy, Collidoscope can be a valuable tool for IM-MS research, especially for large biomolecular ions.

Modelo de competencias del profesor de medicina Competencies model of medical teacher

Directory of Open Access Journals (Sweden)

A. Martínez-González

2008-09-01

Full Text Available Objetivo. Generar el modelo de competencias del profesor para ejercer la docencia de alto nivel en Medicina. Materiales y métodos. Para generar el modelo se analizó la bibliografía, el propósito del plan de estudio por competencias y se utilizó el método Developing a Curriculum (DACUM, con la participación de 35 expertos que integraron mediante consenso el trabajo que debe realizar un docente de medicina para cumplir con éxito el propósito del plan de estudio. Resultados. Se identificaron las funciones básicas de los profesores de medicina, así como las actividades para su cumplimiento. Se conformó el modelo con seis competencias: disciplinaria, de investigación, psicopedagógica, de comunicación, académico-administrativa y humanística. Conclusiones. El modelo pretende guiar las acciones de los profesores que actualmente participan en el programa y aquellos que aspiran a formar parte del proceso educativo; elaborar programas para la formación de profesores que favorezcan el desarrollo de competencias académicas; identificar elementos que se deben considerar para la evaluación del desempeño docente; orientar el diseño de indicadores útiles para otorgar reconocimientos y estímulos a los profesores cuyo desempeño académico sea excepcional; orientar al estudiante, en la relación profesor-alumno, sobre las funciones y actividades que puede esperar del profesor.Aim. To create a competency model for the medical professor in order to exert teaching at its highest level. Materials and methods. To create such model, we analyzed current literature on teaching, the aim of the curricula for competencies and we used the DACUM method whose letters stand for Developing a Curriculum. 35 experts who participated in this project reached a consensus regarding the duties that have to be carried out by a medical professor in order to successfully fulfill the aim of the curricula. Results. We identified the basic functions of medical

A Social Accountable Model for Medical Education System in Iran: A Grounded-Theory

Directory of Open Access Journals (Sweden)

Mohammadreza Abdolmaleki

2017-10-01

Full Text Available Social accountability has been increasingly discussed over the past three decades in various fields providing service to the community and has been expressed as a goal for various areas. In medical education system, like other social accountability areas, it is considered as one of the main objectives globally. The aim of this study was to seek a social accountability theory in the medical education system that is capable of identifying all the standards, norms, and conditions within the country related to the study subject and recognize their relationship. In this study, a total of eight experts in the field of social accountability in medical education system with executive or study experience were interviewedpersonally. After analysis of interviews, 379 codes, 59 secondary categories, 16 subcategories, and 9 main categories were obtained. The resulting data was collected and analyzed at three levels of open coding, axial coding, and selective coding in the form of grounded theory study of “Accountability model of medical education in Iran”, which can be used in education system’s policies and planning for social accountability, given that almost all effective components of social accountability in highereducation health system with causal and facilitator associations were determined.Keywords: SOCIAL ACCOUNTABILITY, COMMUNITY–ORIENTED MEDICINE, COMMUNITY MEDICINE, EDUCATION SYSTEM, GROUNDED THEORY

Developing a funding model for an after-hours primary medical care service in a rural town.

Science.gov (United States)

O'Meara, P; Hall, R H; Strasser, R; Speck, V

1998-01-01

The study described in this paper aimed to determine a funding model for an after-hours primary medical care service in the rural town of Moe, a socioeconomically disadvantaged area of Victoria suffering the rigours of industry restructuring and privatisation. It has 12.5 equivalent full-time general practitioners servicing 21,966 persons. A break-even analysis of the financial viability compared the expected costs of providing the service with the anticipated income. A mixed funding model is recommended. This would incorporate a general practitioner incentive scheme and State Government underwriting of infrastructure and basic non-medical staffing costs during the business development phase to supplement the income from the Health Insurance Commission.

Computer model for the cardiovascular system: development of an e-learning tool for teaching of medical students.

Science.gov (United States)

Warriner, David Roy; Bayley, Martin; Shi, Yubing; Lawford, Patricia Victoria; Narracott, Andrew; Fenner, John

2017-11-21

This study combined themes in cardiovascular modelling, clinical cardiology and e-learning to create an on-line environment that would assist undergraduate medical students in understanding key physiological and pathophysiological processes in the cardiovascular system. An interactive on-line environment was developed incorporating a lumped-parameter mathematical model of the human cardiovascular system. The model outputs were used to characterise the progression of key disease processes and allowed students to classify disease severity with the aim of improving their understanding of abnormal physiology in a clinical context. Access to the on-line environment was offered to students at all stages of undergraduate training as an adjunct to routine lectures and tutorials in cardiac pathophysiology. Student feedback was collected on this novel on-line material in the course of routine audits of teaching delivery. Medical students, irrespective of their stage of undergraduate training, reported that they found the models and the environment interesting and a positive experience. After exposure to the environment, there was a statistically significant improvement in student performance on a series of 6 questions based on cardiovascular medicine, with a 33% and 22% increase in the number of questions answered correctly, p < 0.0001 and p < 0.001 respectively. Considerable improvement was found in students' knowledge and understanding during assessment after exposure to the e-learning environment. Opportunities exist for development of similar environments in other fields of medicine, refinement of the existing environment and further engagement with student cohorts. This work combines some exciting and developing fields in medical education, but routine adoption of these types of tool will be possible only with the engagement of all stake-holders, from educationalists, clinicians, modellers to, most importantly, medical students.

Computer model for the cardiovascular system: development of an e-learning tool for teaching of medical students

Directory of Open Access Journals (Sweden)

David Roy Warriner

2017-11-01

Full Text Available Abstract Background This study combined themes in cardiovascular modelling, clinical cardiology and e-learning to create an on-line environment that would assist undergraduate medical students in understanding key physiological and pathophysiological processes in the cardiovascular system. Methods An interactive on-line environment was developed incorporating a lumped-parameter mathematical model of the human cardiovascular system. The model outputs were used to characterise the progression of key disease processes and allowed students to classify disease severity with the aim of improving their understanding of abnormal physiology in a clinical context. Access to the on-line environment was offered to students at all stages of undergraduate training as an adjunct to routine lectures and tutorials in cardiac pathophysiology. Student feedback was collected on this novel on-line material in the course of routine audits of teaching delivery. Results Medical students, irrespective of their stage of undergraduate training, reported that they found the models and the environment interesting and a positive experience. After exposure to the environment, there was a statistically significant improvement in student performance on a series of 6 questions based on cardiovascular medicine, with a 33% and 22% increase in the number of questions answered correctly, p < 0.0001 and p < 0.001 respectively. Conclusions Considerable improvement was found in students’ knowledge and understanding during assessment after exposure to the e-learning environment. Opportunities exist for development of similar environments in other fields of medicine, refinement of the existing environment and further engagement with student cohorts. This work combines some exciting and developing fields in medical education, but routine adoption of these types of tool will be possible only with the engagement of all stake-holders, from educationalists, clinicians, modellers to

Factors Affecting the Choice of Professors as a Role Model from the Viewpoint of Medical Students

Directory of Open Access Journals (Sweden)

Masome Rahimi

2018-01-01

Full Text Available The role of professors as a model can have a beneficial impact on the mental, psychological and educational conditions of medical students. This also plays an important role in improving professionalism and academic achievements among medical students. Therefore, the present study was aimed at evaluating the standpoint of students on factors influencing the selection of professors as a role model. This descriptive cross-sectional study was conducted on the students of different disciplines studying in Jahrom University of Medical Sciences in 2016. A randomized sampling method was conducted on 217 students. Their viewpoints were collected using a 30- question researcher-made questionnaire. The questionnaire consisted of three parts, each containing ten items. In addition, this questionnaire was distributed among 20 people (as a pilot survey, the alpha coefficient of which was equal to 0.88; and its measurement was based on Likert scale "from very low to very high". Data were analyzed using SPSS 18 and descriptive statistics. Most respondents were nursing students and the highest influence of professors as a role model was associated with their role as a research leader (future specialized courses in the clinical choices and selection of future specialized fields. The factors influencing the selection of professors as a role model included their respectful attitude toward students, and the high level of their knowledge and skills. On the other hand, the most important factors that caused professors not to be regarded as a role model included their inappropriate relationship with the students and refusing to listen to them. Role model professors can have a beneficial impact on the future of students and scientific communities, as far as the science and education is concerned. Therefore, it is necessary for professors to pay particular attention to strengthening their role as a model at universities.

Model-based formalization of medical knowledge for context-aware assistance in laparoscopic surgery

Science.gov (United States)

Katić, Darko; Wekerle, Anna-Laura; Gärtner, Fabian; Kenngott, Hannes G.; Müller-Stich, Beat P.; Dillmann, Rüdiger; Speidel, Stefanie

2014-03-01

The increase of technological complexity in surgery has created a need for novel man-machine interaction techniques. Specifically, context-aware systems which automatically adapt themselves to the current circumstances in the OR have great potential in this regard. To create such systems, models of surgical procedures are vital, as they allow analyzing the current situation and assessing the context. For this purpose, we have developed a Surgical Process Model based on Description Logics. It incorporates general medical background knowledge as well as intraoperatively observed situational knowledge. The representation consists of three parts: the Background Knowledge Model, the Preoperative Process Model and the Integrated Intraoperative Process Model. All models depend on each other and create a concise view on the surgery. As a proof of concept, we applied the system to a specific intervention, the laparoscopic distal pancreatectomy.

Influence of the medication environment on the unsafe medication behavior of nurses: A path analysis.

Science.gov (United States)

Yu, Xi; Li, Ce; Gao, Xueqin; Liu, Furong; Lin, Ping

2018-04-20

To explore the relationship between the medication environment and the unsafe medication behavior of nurses and to analyze its influence path. Unsafe medication behavior is the direct cause of medication error. The organizational environment is the foundation of and plays a guiding role in work behavior. Whether the medication environment correlates with the unsafe medication behavior of nurses remains unclear. This study used a correlative design with self-administered questionnaires, and the SHEL model, an acronym of its elements of software, hardware, environment, and liveware, was used as the framework for the medication environment. A survey was conducted among 1012 clinical nurses from five tertiary hospitals in China using the nurse unsafe medication behavior scale (NUMBS) and the nurses' perceptions of the medication environment scale (NPMES). Data were collected from January to February 2017. Path analyses were used to examine the hypothesized model. The medication environment correlated negatively with unsafe medication behavior (r=-0.48, pbehavior. Software, hardware and the environment indirectly influenced unsafe medication behavior, and nurses' personal factors played a mediating role in the relationships of unsafe medication behavior with software, hardware, and the environment. The unsafe medication behavior of nurses should be further improved. The medication environment was a predictor of unsafe medication behavior. Care managers should actively improve the medication environment to reduce the incidence of unsafe medication behaviors. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

MO-C-9A-01: Effective Medical Physics Educational Activities: Models and Methods

Energy Technology Data Exchange (ETDEWEB)

Sprawls, P [Sprawls Educational Foundation, Montreat, NC (United States)

2014-06-15

Medical physics is learned in a combination of activities including classroom sessions, individual study, small-group collaborative problem solving, and direct experience in the laboratory or clinical environment. Each type of learning activity is characterized by its effectiveness in producing the desired knowledge for the learner and the cost in terms of resources and human effort required providing it. While learning and teaching is a human activity, modern technology provides a variety of tools that can be used to enhance human performance. The class or conference room is the common setting for educational sessions in both academic institutions and continuing education conferences and programs such as those sponsored by the AAPM. A major value of a class/conference room program is efficiency by bringing a group of learners together to share in a common learning experience under the guidance of one or more experienced learning facilitators (lecturers or presenters). A major challenge is that the class/conference room is separated from the real world of medical physics. The design of an educational activity needs to take into consideration the desired outcomes with respect to what the learners should be able to do. The distinction is that of being able to apply the knowledge to perform specific physics functions rather than just knowing and being able to recall facts, and perhaps do well on written examinations. These are different types of knowledge structures within the human brain and distinctly different learning activities to develop each. Much of medical physics education, especially at the post-graduate and continuing education level, is for the purpose of enhancing the ability of physicists and other related professionals to perform applied procedures and tasks and requires specific types of knowledge.In this session we will analyze various learning activity models, the values and limitations of each, and how they can be used in medical physics education

MO-C-9A-01: Effective Medical Physics Educational Activities: Models and Methods

International Nuclear Information System (INIS)

Sprawls, P

2014-01-01

Medical physics is learned in a combination of activities including classroom sessions, individual study, small-group collaborative problem solving, and direct experience in the laboratory or clinical environment. Each type of learning activity is characterized by its effectiveness in producing the desired knowledge for the learner and the cost in terms of resources and human effort required providing it. While learning and teaching is a human activity, modern technology provides a variety of tools that can be used to enhance human performance. The class or conference room is the common setting for educational sessions in both academic institutions and continuing education conferences and programs such as those sponsored by the AAPM. A major value of a class/conference room program is efficiency by bringing a group of learners together to share in a common learning experience under the guidance of one or more experienced learning facilitators (lecturers or presenters). A major challenge is that the class/conference room is separated from the real world of medical physics. The design of an educational activity needs to take into consideration the desired outcomes with respect to what the learners should be able to do. The distinction is that of being able to apply the knowledge to perform specific physics functions rather than just knowing and being able to recall facts, and perhaps do well on written examinations. These are different types of knowledge structures within the human brain and distinctly different learning activities to develop each. Much of medical physics education, especially at the post-graduate and continuing education level, is for the purpose of enhancing the ability of physicists and other related professionals to perform applied procedures and tasks and requires specific types of knowledge.In this session we will analyze various learning activity models, the values and limitations of each, and how they can be used in medical physics education

Role of Travel Motivations, Perceived Risks and Travel Constraints on Destination Image and Visit Intention in Medical Tourism: Theoretical model.

Science.gov (United States)

Khan, Mohammad J; Chelliah, Shankar; Haron, Mahmod S; Ahmed, Sahrish

2017-02-01

Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation.

A comprehensive model for diagnosing the causes of individual medical performance problems: skills, knowledge, internal, past and external factors (SKIPE).

Science.gov (United States)

Norfolk, Tim; Siriwardena, A Niroshan

2013-01-01

This discussion paper describes a new and comprehensive model for diagnosing the causes of individual medical performance problems: SKIPE (skills, knowledge, internal, past and external factors). This builds on a previous paper describing a unifying theory of clinical practice, the RDM-p model, which captures the primary skill sets required for effective medical performance (relationship, diagnostics and management), and the professionalism that needs to underpin them. The SKIPE model is currently being used, in conjunction with the RDM-p model, for the in-depth assessment and management of doctors whose performance is a cause for concern.

[Information technology in medical education].

Science.gov (United States)

Ramić, A

1999-01-01

The role of information technology in educational models of under-graduate and post-graduate medical education is growing in 1980's influenced by PC's break-in in medical practice and creating relevant data basis, and, particularly, in 1990's by integration of information technology on international level, development of international network, Internet, Telemedicin, etc. The development of new educational information technology is evident, proving that information in transfer of medical knowledge, medical informatics and communication systems represent the base of medical practice, medical education and research in medical sciences. In relation to the traditional approaches in concept, contents and techniques of medical education, new models of education in training of health professionals, using new information technology, offer a number of benefits, such as: decentralization and access to relevant data sources, collecting and updating of data, multidisciplinary approach in solving problems and effective decision-making, and affirmation of team work within medical and non-medical disciplines. Without regard to the dynamics of change and progressive reform orientation within health sector, the development of modern medical education is inevitable for all systems a in which information technology and available data basis, as a base of effective and scientifically based medical education of health care providers, give guarantees for efficient health care and improvement of health of population.

Telemedicine as an innovative model for rebuilding medical systems in developing countries through multipartnership collaboration: the case of Albania.

Science.gov (United States)

Latifi, Rifat; Dasho, Erion; Shatri, Zhaneta; Tilley, Elizabeth; Osmani, Kalterina L; Doarn, Charles R; Dogjani, Agron; Olldashi, Fatos; Koçiraj, Agim; Merrell, Ronald C

2015-06-01

The U.S. Government and other developed nations provide billions of dollars annually in relief assistance to countries around the world. The long-term benefits of this aid, however, are often difficult to elucidate. The aim of this article is to present a model of a multipartnership collaboration among U.S. governmental, nongovernmental organizations, and academia to rebuild medical systems using telemedicine as a sustainable model of foreign aid. The International Virtual e-Hospital implemented the "initiate-build-operate-transfer" strategy to establish an effective telemedicine system in Albania that includes the National Telemedicine Center and 12 regional telemedicine centers. This nationwide telemedicine network has active clinical programs, virtual educational programs, and an electronic library that has substantially improved the access to care while advancing medical education. We propose that telemedicine is an optimal, sustainable, low-cost model for rebuilding medical systems of developing countries when implemented through a multipartnership approach.

Applying the International Medical Graduate Program Model to Alleviate the Supply Shortage of Accounting Doctoral Faculty

Science.gov (United States)

HassabElnaby, Hassan R.; Dobrzykowski, David D.; Tran, Oanh Thikie

2012-01-01

Accounting has been faced with a severe shortage in the supply of qualified doctoral faculty. Drawing upon the international mobility of foreign scholars and the spirit of the international medical graduate program, this article suggests a model to fill the demand in accounting doctoral faculty. The underlying assumption of the suggested model is…

The inadequacy of role models for educating medical students in ethics with some reflections on virtue theory.

Science.gov (United States)

Erde, E L

1997-01-01

Persons concerned with medical education sometimes argued that medical students need no formal education in ethics. They contended that if admissions were restricted to persons of good character and those students were exposed to good role models, the ethics of medicine would take care of itself. However, no one seems to give much philosophic attention to the ideas of model or role model. In this essay, I undertake such an analysis and add an analysis of role. I show the weakness in relying on role models exclusively and draw implications from these for appeals to virtue theory. Furthermore, I indicate some of the problems about how virtue theory is invoked as the ethical theory that would most closely be associated to the role model rhetoric and consider some of the problems with virtue theory. Although Socrates was interested in the character of the (young) persons with whom he spoke, Socratic education is much more than what role modeling and virtue theory endorse. It-that is, philosophy-is invaluable for ethics education.

The effectiveness of an interactive 3-dimensional computer graphics model for medical education.

Science.gov (United States)

Battulga, Bayanmunkh; Konishi, Takeshi; Tamura, Yoko; Moriguchi, Hiroki

2012-07-09

Medical students often have difficulty achieving a conceptual understanding of 3-dimensional (3D) anatomy, such as bone alignment, muscles, and complex movements, from 2-dimensional (2D) images. To this end, animated and interactive 3-dimensional computer graphics (3DCG) can provide better visual information to users. In medical fields, research on the advantages of 3DCG in medical education is relatively new. To determine the educational effectiveness of interactive 3DCG. We divided 100 participants (27 men, mean (SD) age 17.9 (0.6) years, and 73 women, mean (SD) age 18.1 (1.1) years) from the Health Sciences University of Mongolia (HSUM) into 3DCG (n = 50) and textbook-only (control) (n = 50) groups. The control group used a textbook and 2D images, while the 3DCG group was trained to use the interactive 3DCG shoulder model in addition to a textbook. We conducted a questionnaire survey via an encrypted satellite network between HSUM and Tokushima University. The questionnaire was scored on a 5-point Likert scale from strongly disagree (score 1) to strongly agree (score 5). Interactive 3DCG was effective in undergraduate medical education. Specifically, there was a significant difference in mean (SD) scores between the 3DCG and control groups in their response to questionnaire items regarding content (4.26 (0.69) vs 3.85 (0.68), P = .001) and teaching methods (4.33 (0.65) vs 3.74 (0.79), P < .001), but no significant difference in the Web category. Participants also provided meaningful comments on the advantages of interactive 3DCG. Interactive 3DCG materials have positive effects on medical education when properly integrated into conventional education. In particular, our results suggest that interactive 3DCG is more efficient than textbooks alone in medical education and can motivate students to understand complex anatomical structures.

Identifying the Basal Ganglia network model markers for medication-induced impulsivity in Parkinson's disease patients.

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Pragathi Priyadharsini Balasubramani

Full Text Available Impulsivity, i.e. irresistibility in the execution of actions, may be prominent in Parkinson's disease (PD patients who are treated with dopamine precursors or dopamine receptor agonists. In this study, we combine clinical investigations with computational modeling to explore whether impulsivity in PD patients on medication may arise as a result of abnormalities in risk, reward and punishment learning. In order to empirically assess learning outcomes involving risk, reward and punishment, four subject groups were examined: healthy controls, ON medication PD patients with impulse control disorder (PD-ON ICD or without ICD (PD-ON non-ICD, and OFF medication PD patients (PD-OFF. A neural network model of the Basal Ganglia (BG that has the capacity to predict the dysfunction of both the dopaminergic (DA and the serotonergic (5HT neuromodulator systems was developed and used to facilitate the interpretation of experimental results. In the model, the BG action selection dynamics were mimicked using a utility function based decision making framework, with DA controlling reward prediction and 5HT controlling punishment and risk predictions. The striatal model included three pools of Medium Spiny Neurons (MSNs, with D1 receptor (R alone, D2R alone and co-expressing D1R-D2R. Empirical studies showed that reward optimality was increased in PD-ON ICD patients while punishment optimality was increased in PD-OFF patients. Empirical studies also revealed that PD-ON ICD subjects had lower reaction times (RT compared to that of the PD-ON non-ICD patients. Computational modeling suggested that PD-OFF patients have higher punishment sensitivity, while healthy controls showed comparatively higher risk sensitivity. A significant decrease in sensitivity to punishment and risk was crucial for explaining behavioral changes observed in PD-ON ICD patients. Our results highlight the power of computational modelling for identifying neuronal circuitry implicated in learning

Identifying the Basal Ganglia network model markers for medication-induced impulsivity in Parkinson's disease patients.

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Balasubramani, Pragathi Priyadharsini; Chakravarthy, V Srinivasa; Ali, Manal; Ravindran, Balaraman; Moustafa, Ahmed A

2015-01-01

Impulsivity, i.e. irresistibility in the execution of actions, may be prominent in Parkinson's disease (PD) patients who are treated with dopamine precursors or dopamine receptor agonists. In this study, we combine clinical investigations with computational modeling to explore whether impulsivity in PD patients on medication may arise as a result of abnormalities in risk, reward and punishment learning. In order to empirically assess learning outcomes involving risk, reward and punishment, four subject groups were examined: healthy controls, ON medication PD patients with impulse control disorder (PD-ON ICD) or without ICD (PD-ON non-ICD), and OFF medication PD patients (PD-OFF). A neural network model of the Basal Ganglia (BG) that has the capacity to predict the dysfunction of both the dopaminergic (DA) and the serotonergic (5HT) neuromodulator systems was developed and used to facilitate the interpretation of experimental results. In the model, the BG action selection dynamics were mimicked using a utility function based decision making framework, with DA controlling reward prediction and 5HT controlling punishment and risk predictions. The striatal model included three pools of Medium Spiny Neurons (MSNs), with D1 receptor (R) alone, D2R alone and co-expressing D1R-D2R. Empirical studies showed that reward optimality was increased in PD-ON ICD patients while punishment optimality was increased in PD-OFF patients. Empirical studies also revealed that PD-ON ICD subjects had lower reaction times (RT) compared to that of the PD-ON non-ICD patients. Computational modeling suggested that PD-OFF patients have higher punishment sensitivity, while healthy controls showed comparatively higher risk sensitivity. A significant decrease in sensitivity to punishment and risk was crucial for explaining behavioral changes observed in PD-ON ICD patients. Our results highlight the power of computational modelling for identifying neuronal circuitry implicated in learning, and its

Twelve Tips for teaching medical professionalism at all levels of medical education.

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Al-Eraky, Mohamed Mostafa

2015-01-01

Review of studies published in medical education journals over the last decade reveals that teaching medical professionalism is essential, yet challenging. According to a recent Best Evidence in Medical Education (BEME) guide, there is no consensus on a theoretical or practical model to integrate the teaching of professionalism into medical education. The aim of this article is to outline a practical manual for teaching professionalism at all levels of medical education. Drawing from research literature and author's experience, Twelve Tips are listed and organised in four clusters with relevance to (1) the context, (2) the teachers, (3) the curriculum, and (4) the networking. With a better understanding of the guiding educational principles for teaching medical professionalism, medical educators will be able to teach one of the most challenging constructs in medical education.

A Trial and Perceptions Assessment of APP-Based Flipped Classroom Teaching Model for Medical Students in Learning Immunology in China

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Xingming Ma

2018-04-01

Full Text Available The application-based flipped classroom (APP-FC is an innovative teaching-learning model that has not been applied and assessed in basic medical curricula teaching in China. The aim of this investigation is to assess students’ perceptions to the APP-based flipped classroom (APP-FC teaching model in an immunology course. The data of this study were collected from second-year medical students (n = 92 at Lanzhou University. One class (n = 50, as a control group, was offered lecture-based learning (LBL, while the other class (n = 42, as the APP-FC group, was given lecture-based instruction and the APP-FC teaching model during September–November 2017. Afterward, the perceptions of students on APP-FC teaching model were evaluated using questionnaires. Students responded that APP-FC improves their motivation (83% and interest in learning immunology (81%, as well as their self-directed learning skills (81%. Compared to the traditional lecture-based instruction, the APP-FC noticeably improved students’ motivation in learning (P = 0.011, self-directed learn skills (P = 0.001, memory abilities (P = 0.009, and problem-solving abilities (P = 0.010. Most medical students’ scores (60% in the final examination were more than 80 points after implementing an APP-FC model as compared to the control group (40%. The majority of students (70% preferred the APP-FC teaching approach over traditional lecture-based pedagogy. The implementation of the APP-FC teaching model could improve students’ learning motivation, self-directed learn skills, and problem-solving abilities, which is a preferable teaching model for medical immunology courses in China.

Professional identity in medical students: pedagogical challenges to medical education.

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Wilson, Ian; Cowin, Leanne S; Johnson, Maree; Young, Helen

2013-01-01

Professional identity, or how a doctor thinks of himself or herself as a doctor, is considered to be as critical to medical education as the acquisition of skills and knowledge relevant to patient care. This article examines contemporary literature on the development of professional identity within medicine. Relevant theories of identity construction are explored and their application to medical education and pedagogical approaches to enhancing students' professional identity are proposed. The influence of communities of practice, role models, and narrative reflection within curricula are examined. Medical education needs to be responsive to changes in professional identity being generated from factors within medical student experiences and within contemporary society.

Development of the ultrasonography learning model for undergraduate medical students: A case study of the Faculty of Medicine, Burapha University.

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Limchareon, Sornsupha; Asawaworarit, Nattawat; Klinwichit, Wethaka; Dinchuthai, Pakaphun

2016-08-01

Ultrasound technology is generally considered to be reliable and widely used by physicians today. Therefore, given the efficacy and popularity of the technology, the need for quality ultrasound education is evident. Ultrasound training for undergraduate medical students has been increasingly incorporated into school curriculums, but the teaching methods can vary significantly among medical schools. Among many different choices, one effective teaching model was proposed which added hands-on ultrasound experience on live patients that was supervised by radiologists in the last clinical year. A 2-week radiology elective course was offered for 6(th)-year medical students at Burapha University Hospital, Chonburi, Thailand in the academic year 2014. Fourteen medical students participated in the elective course. Additionally, students who chose radiology as their elective were provided an ultrasound experience on live patients in real-life clinical settings. All 6(th)-year medical students then completed a 25-ultrasound image quiz, and completed a questionnaire at the end of the academic year. The ultrasound test scores were compared between the elective and nonelective students. The students' background characteristics were determined by a grade point average and the ultrasound experience was determined by the number of scans. These were collected, and analyzed to establish their relationship with the ultrasound test scores. The students' opinions were also surveyed. Fourteen medical students participated in the elective course. The ultrasound test scores in the elective group were significantly higher than those in the nonelective group (p=0.013). The students' background characteristics and ultrasound experience had no significant relationship with the ultrasound test scores. By adding hands-on ultrasound experience using live patients proctored by radiologists for final year medical students, in the space of 2 weeks, an effective ultrasound learning model for

A new model for graduate education and innovation in medical technology.

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Yazdi, Youseph; Acharya, Soumyadipta

2013-09-01

We describe a new model of graduate education in bioengineering innovation and design- a year long Master's degree program that educates engineers in the process of healthcare technology innovation for both advanced and low-resource global markets. Students are trained in an iterative "Spiral Innovation" approach that ensures early, staged, and repeated examination of all key elements of a successful medical device. This includes clinical immersion based problem identification and assessment (at Johns Hopkins Medicine and abroad), team based concept and business model development, and project planning based on iterative technical and business plan de-risking. The experiential, project based learning process is closely supported by several core courses in business, design, and engineering. Students in the program work on two team based projects, one focused on addressing healthcare needs in advanced markets and a second focused on low-resource settings. The program recently completed its fourth year of existence, and has graduated 61 students, who have continued on to industry or startups (one half), additional graduate education, or medical school (one third), or our own Global Health Innovation Fellowships. Over the 4 years, the program has sponsored 10 global health teams and 14 domestic/advanced market medtech teams, and launched 5 startups, of which 4 are still active. Projects have attracted over US$2.5M in follow-on awards and grants, that are supporting the continued development of over a dozen projects.

Improving Education in Medical Statistics: Implementing a Blended Learning Model in the Existing Curriculum

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Milic, Natasa M.; Trajkovic, Goran Z.; Bukumiric, Zoran M.; Cirkovic, Andja; Nikolic, Ivan M.; Milin, Jelena S.; Milic, Nikola V.; Savic, Marko D.; Corac, Aleksandar M.; Marinkovic, Jelena M.; Stanisavljevic, Dejana M.

2016-01-01

Background Although recent studies report on the benefits of blended learning in improving medical student education, there is still no empirical evidence on the relative effectiveness of blended over traditional learning approaches in medical statistics. We implemented blended along with on-site (i.e. face-to-face) learning to further assess the potential value of web-based learning in medical statistics. Methods This was a prospective study conducted with third year medical undergraduate students attending the Faculty of Medicine, University of Belgrade, who passed (440 of 545) the final exam of the obligatory introductory statistics course during 2013–14. Student statistics achievements were stratified based on the two methods of education delivery: blended learning and on-site learning. Blended learning included a combination of face-to-face and distance learning methodologies integrated into a single course. Results Mean exam scores for the blended learning student group were higher than for the on-site student group for both final statistics score (89.36±6.60 vs. 86.06±8.48; p = 0.001) and knowledge test score (7.88±1.30 vs. 7.51±1.36; p = 0.023) with a medium effect size. There were no differences in sex or study duration between the groups. Current grade point average (GPA) was higher in the blended group. In a multivariable regression model, current GPA and knowledge test scores were associated with the final statistics score after adjusting for study duration and learning modality (plearning environments for teaching medical statistics to undergraduate medical students. Blended and on-site training formats led to similar knowledge acquisition; however, students with higher GPA preferred the technology assisted learning format. Implementation of blended learning approaches can be considered an attractive, cost-effective, and efficient alternative to traditional classroom training in medical statistics. PMID:26859832

Role of Travel Motivations, Perceived Risks and Travel Constraints on Destination Image and Visit Intention in Medical Tourism; Theoretical model

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Mohammad J. Khan

2017-03-01

Full Text Available Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation.

Interpretation of medical images by model guided analysis

International Nuclear Information System (INIS)

Karssemeijer, N.

1989-01-01

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

A Technology Acceptance Model for Inter-Organisational Electronic Medical Records Systems

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Jocelyn Handy

2001-11-01

Full Text Available This article reports the findings of the first stage of an ongoing, longitudinal study into the implementation of an interorganisational electronic medical records (EMR system. The study adapted and expanded Davis' (1993 technology acceptance model (TAM to investigate the attitudes of primary care practitioners towards a proposed system for maternity patients. All doctors and midwives holding maternity care contracts with a large urban hospital in New Zealand were sent a questionnaire soliciting their views on a planned EMR system linking the hospital and the primary care sectors. The results showed that whilst Davis' two key factors of perceived ease of use and perceived usefulness were important to medical professionals, another key factor, perceived system acceptability, which concerns control and management of information is vitally important to the acceptance of the system. The study also showed that the two groups of professionals had differing requirements due to different levels of experience and practice computerisation. Finally, the research highlights a number of wider organisational issues particularly relevant to the use of inter organisational systems in general and healthcare systems in particular.

Medical talent management: a model for physician deployment.

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Brightman, Baird

2007-01-01

This article aims to provide a focused cost-effective method for triaging physicians into appropriate non-clinical roles to benefit both doctors and healthcare organizations. Reviews a validated career-planning process and customize it for medical talent management. A structured career assessment can differentiate between different physician work styles and direct medical talent into best-fit positions. This allows healthcare organizations to create a more finely tuned career ladder than the familiar "in or out" binary choice. PRACTICAL IMPLICATIONS--Healthcare organizations can invest in cost-effective processes for the optimal utilization of their medical talent. Provides a new use for a well-validated career assessment and planning system. The actual value of this approach should be studied using best-practices in ROI research.

Medical sociology as a heuristic instrument for medical tourism and cross-border healthcare

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Mainil, Tomas

2015-01-01

In this commentary, we establish a relationship between medical sociology and the study of medical tourism and cross-border healthcare by introducing Ronald Andersen’s behavioral model of healthcare use, and linking this model to the recent empirical study of Kovacs et al. on patients travelling to Hungary for orthopedic treatment. Finally, we plead for more measurement in the field of patient mobility. PMID:25844386

Modeling and simulation of multi-physics multi-scale transport phenomenain bio-medical applications

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Kenjereš, Saša

2014-08-01

We present a short overview of some of our most recent work that combines the mathematical modeling, advanced computer simulations and state-of-the-art experimental techniques of physical transport phenomena in various bio-medical applications. In the first example, we tackle predictions of complex blood flow patterns in the patient-specific vascular system (carotid artery bifurcation) and transfer of the so-called "bad" cholesterol (low-density lipoprotein, LDL) within the multi-layered artery wall. This two-way coupling between the blood flow and corresponding mass transfer of LDL within the artery wall is essential for predictions of regions where atherosclerosis can develop. It is demonstrated that a recently developed mathematical model, which takes into account the complex multi-layer arterial-wall structure, produced LDL profiles within the artery wall in good agreement with in-vivo experiments in rabbits, and it can be used for predictions of locations where the initial stage of development of atherosclerosis may take place. The second example includes a combination of pulsating blood flow and medical drug delivery and deposition controlled by external magnetic field gradients in the patient specific carotid artery bifurcation. The results of numerical simulations are compared with own PIV (Particle Image Velocimetry) and MRI (Magnetic Resonance Imaging) in the PDMS (silicon-based organic polymer) phantom. A very good agreement between simulations and experiments is obtained for different stages of the pulsating cycle. Application of the magnetic drug targeting resulted in an increase of up to ten fold in the efficiency of local deposition of the medical drug at desired locations. Finally, the LES (Large Eddy Simulation) of the aerosol distribution within the human respiratory system that includes up to eight bronchial generations is performed. A very good agreement between simulations and MRV (Magnetic Resonance Velocimetry) measurements is obtained

Modeling and simulation of multi-physics multi-scale transport phenomenain bio-medical applications

International Nuclear Information System (INIS)

Kenjereš, Saša

2014-01-01

We present a short overview of some of our most recent work that combines the mathematical modeling, advanced computer simulations and state-of-the-art experimental techniques of physical transport phenomena in various bio-medical applications. In the first example, we tackle predictions of complex blood flow patterns in the patient-specific vascular system (carotid artery bifurcation) and transfer of the so-called 'bad' cholesterol (low-density lipoprotein, LDL) within the multi-layered artery wall. This two-way coupling between the blood flow and corresponding mass transfer of LDL within the artery wall is essential for predictions of regions where atherosclerosis can develop. It is demonstrated that a recently developed mathematical model, which takes into account the complex multi-layer arterial-wall structure, produced LDL profiles within the artery wall in good agreement with in-vivo experiments in rabbits, and it can be used for predictions of locations where the initial stage of development of atherosclerosis may take place. The second example includes a combination of pulsating blood flow and medical drug delivery and deposition controlled by external magnetic field gradients in the patient specific carotid artery bifurcation. The results of numerical simulations are compared with own PIV (Particle Image Velocimetry) and MRI (Magnetic Resonance Imaging) in the PDMS (silicon-based organic polymer) phantom. A very good agreement between simulations and experiments is obtained for different stages of the pulsating cycle. Application of the magnetic drug targeting resulted in an increase of up to ten fold in the efficiency of local deposition of the medical drug at desired locations. Finally, the LES (Large Eddy Simulation) of the aerosol distribution within the human respiratory system that includes up to eight bronchial generations is performed. A very good agreement between simulations and MRV (Magnetic Resonance Velocimetry) measurements is

Building New Education Model to Enhance the Comprehensive Competence of the Medical Students The exploration of PRICE Education Model in School of Medicine, Shanghai Jiao Tong University

Institute of Scientific and Technical Information of China (English)

Gang Huang; Bingjie Lu; Jifeng Fu; Yanping Zhang; Wenhan Mei; Yan Li; Yifei Wang

2014-01-01

To enhance the competence of medical students, Shanghai Jiao Tong University School of Medicine innovates the new PRICE education model, through Problem-based Learning(P) and Research-based learning(R), guides the students to give full play to the active learning; break the traditional discipline-centered teaching model by an integrated curriculum(I),combines with clinical practice-based learning(C) to solve the disjointed question between the basic theory and clinical practice in medical education, uses the comprehensive evaluation system(E) to assess the learning effect of the students and the quality of the teaching. The PRICE education model is verified by our educational practice.

The research and practice based on the full-time visitation model in clinical medical education

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