WorldWideScience

Sample records for merging home health

  1. Private investment purchase and nursing home financial health.

    Science.gov (United States)

    Orfaly Cadigan, Rebecca; Stevenson, David G; Caudry, Daryl J; Grabowski, David C

    2015-02-01

    To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998-2010. Regression specification incorporating facility and time fixed effects. We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company's real estate holdings. Private investment acquired facilities are an important feature of today's nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. © Health Research and Educational Trust.

  2. Private Investment Purchase and Nursing Home Financial Health

    Science.gov (United States)

    Cadigan, Rebecca Orfaly; Stevenson, David G; Caudry, Daryl J; Grabowski, David C

    2015-01-01

    Objective To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Data Sources Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998–2010. Study Design Regression specification incorporating facility and time fixed effects. Principal Findings We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company’s real estate holdings. Conclusions Private investment acquired facilities are an important feature of today’s nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. PMID:25104476

  3. [Home health resource utilization measures using a case-mix adjustor model].

    Science.gov (United States)

    You, Sun-Ju; Chang, Hyun-Sook

    2005-08-01

    The purpose of this study was to measure home health resource utilization using a Case-Mix Adjustor Model developed in the U.S. The subjects of this study were 484 patients who had received home health care more than 4 visits during a 60-day episode at 31 home health care institutions. Data on the 484 patients had to be merged onto a 60-day payment segment. Based on the results, the researcher classified home health resource groups (HHRG). The subjects were classified into 34 HHRGs in Korea. Home health resource utilization according to clinical severity was in order of Minimum (C0) service utilization moderate), and the lowest 97,000 won in group C2F3S1, so the former was 5.82 times higher than the latter. Resource utilization in home health care has become an issue of concern due to rising costs for home health care. The results suggest the need for more analytical attention on the utilization and expenditures for home care using a Case-Mix Adjustor Model.

  4. Home Health Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Home Health Compare has information about the quality of care provided by Medicare-certified home health agencies throughout the nation. Medicare-certified means the...

  5. Home care decision support using an Arden engine--merging smart home and vital signs data.

    Science.gov (United States)

    Marschollek, Michael; Bott, Oliver J; Wolf, Klaus-H; Gietzelt, Matthias; Plischke, Maik; Madiesh, Moaaz; Song, Bianying; Haux, Reinhold

    2009-01-01

    The demographic change with a rising proportion of very old people and diminishing resources leads to an intensification of the use of telemedicine and home care concepts. To provide individualized decision support, data from different sources, e.g. vital signs sensors and home environmental sensors, need to be combined and analyzed together. Furthermore, a standardized decision support approach is necessary. The aim of our research work is to present a laboratory prototype home care architecture that integrates data from different sources and uses a decision support system based on the HL7 standard Arden Syntax for Medical Logical Modules. Data from environmental sensors connected to a home bus system are stored in a data base along with data from wireless medical sensors. All data are analyzed using an Arden engine with the medical knowledge represented in Medical Logic Modules. Multi-modal data from four different sensors in the home environment are stored in a single data base and are analyzed using an HL7 standard conformant decision support system. Individualized home care decision support must be based on all data available, including context data from smart home systems and medical data from electronic health records. Our prototype implementation shows the feasibility of using an Arden engine for decision support in a home setting. Our future work will include the utilization of medical background knowledge for individualized decision support, as there is no one-size-fits-all knowledge base in medicine.

  6. Respiratory Home Health Care

    Science.gov (United States)

    ... Us Home > Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources ... Teenagers Living With Lung Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at ...

  7. The Future of Home Health Care

    Science.gov (United States)

    Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

    2016-01-01

    The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670

  8. Medicare home health utilization as a function of nursing home market factors.

    OpenAIRE

    Swan, J H; Benjamin, A E

    1990-01-01

    Rapid increases in the size and costs of the home health market, unknown impacts of Medicare's DRG hospital reimbursement on the posthospital market, and general lack of knowledge about factors that explain interstate variation in home health utilization all suggest the importance of developing and testing models of Medicare home health use. This article proposes and tests a model of state home health utilization as a function of the nursing home market. This model proposes that home health u...

  9. Home Rx: The Health Benefits of Home Performance

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, Jonathan [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Jacobs, David [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Reddy, Amanda [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Tohn, Ellen [Tohn Environmental Strategies, Wayland, MA (United States); Cohen, Jonathan [Dept. of Energy (DOE), Washington DC (United States); Jacobsohn, Ely [Dept. of Energy (DOE), Washington DC (United States)

    2016-12-01

    Evidence in a new, groundbreaking U.S. Department of Energy report, Home Rx: The Health Benefits of Home Performance, shows that home performance upgrades can improve the quality of a home’s indoor environment by reducing the prevalence of harmful indoor air pollutants and contaminants. Until recently, no systematic review of this evidence had been conducted, limiting full understanding of the link between home performance and health. This new report summarizes current knowledge and identifies research gaps. The design characteristics and results of each of the 40 studies considered in the report are summarized in a searchable matrix.

  10. Health Begins at Home

    Centers for Disease Control (CDC) Podcasts

    2009-03-30

    Clean and well-maintained homes can prevent many illnesses and injuries. This podcast discusses how good health begins at home.  Created: 3/30/2009 by Coordinating Center for Environmental Health and Injury Prevention (CCEHIP).   Date Released: 3/30/2009.

  11. Nursing perception of patient transitions from hospitals to home with home health.

    Science.gov (United States)

    Smith, Shannon Bright; Alexander, Judith W

    2012-01-01

    The study's purpose was to determine nurses' opinions of sending patients from the hospital to home with home health services. The study occurred in the Charleston, South Carolina, Tricounty area (Berkeley, Charleston, and Dorchester counties). Home health agencies and hospitals were invited to participate. The study used a survey design to gather information on nursing perceptions of current practices and needed changes to improve transition of patients. The population was nurses (licensed practical nurses (LPNs) and registered nurses (RNs)) employed at inpatient hospitals or home health agencies in the area. Thirty-four RNs responded with no LPNs respondents. Agency administrators/chief nursing officers agreed for their agencies to participate and distributed the survey using a Research Electronic Data Capture (REDCap) Internet-based survey tool. Using the survey results and information from a literature review, the study developed a list of propositions, which participating administrators reviewed, for improving transitions to home. Both home health and hospital nurses reported a need to improve the process of sending patients from hospital to home with home health services. This study provides hospitals and home health agencies with propositions to facilitate the establishment of a process to communicate effectively patients care needs and streamline the discharging patients from the hospital to home health care; thus, improving patient transition. Case managers and discharge planners will need interagency collaboration along with evidence-based interventions to transition patients from the hospital to home with home health services with various populations. Direct patient care nurses in both hospital and home health settings should share the same accountability as case managers to ensure successful transitions.

  12. Smart homes and home health monitoring technologies for older adults: A systematic review.

    Science.gov (United States)

    Liu, Lili; Stroulia, Eleni; Nikolaidis, Ioanis; Miguel-Cruz, Antonio; Rios Rincon, Adriana

    2016-07-01

    Around the world, populations are aging and there is a growing concern about ways that older adults can maintain their health and well-being while living in their homes. The aim of this paper was to conduct a systematic literature review to determine: (1) the levels of technology readiness among older adults and, (2) evidence for smart homes and home-based health-monitoring technologies that support aging in place for older adults who have complex needs. We identified and analyzed 48 of 1863 relevant papers. Our analyses found that: (1) technology-readiness level for smart homes and home health monitoring technologies is low; (2) the highest level of evidence is 1b (i.e., one randomized controlled trial with a PEDro score ≥6); smart homes and home health monitoring technologies are used to monitor activities of daily living, cognitive decline and mental health, and heart conditions in older adults with complex needs; (3) there is no evidence that smart homes and home health monitoring technologies help address disability prediction and health-related quality of life, or fall prevention; and (4) there is conflicting evidence that smart homes and home health monitoring technologies help address chronic obstructive pulmonary disease. The level of technology readiness for smart homes and home health monitoring technologies is still low. The highest level of evidence found was in a study that supported home health technologies for use in monitoring activities of daily living, cognitive decline, mental health, and heart conditions in older adults with complex needs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Home Health PPS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of...

  14. The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths.

    Science.gov (United States)

    Lister, Cameron; Payne, Hannah; Hanson, Carl L; Barnes, Michael D; Davis, Siena F; Manwaring, Todd

    2017-01-01

    Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM) as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

  15. The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths

    Directory of Open Access Journals (Sweden)

    Cameron Lister

    2017-08-01

    Full Text Available Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

  16. Investigating the incidence of youth mental health problem by merging person register and school level class room survey data

    Directory of Open Access Journals (Sweden)

    Marko Merikukka

    2017-04-01

    It is possible to merge datasets from school level to an individual level register data. The merged big data offers new possibilities to study questions related to the prevalence of mental health problems. The new linked data can be further analyzed to hierarchical model.

  17. Mobile home automation-merging mobile value added services and home automation technologies

    OpenAIRE

    Rosendahl, Andreas; Hampe, Felix J.; Botterweck, Goetz

    2007-01-01

    non-peer-reviewed In this paper we study mobile home automation, a field that emerges from an integration of mobile application platforms and home automation technologies. In a conceptual introduction we first illustrate the need for such applications by introducing a two-dimensional conceptual model of mobility. Subsequently we suggest an architecture and discuss different options of how a user might access a mobile home automation service and the controlled devices. As another contrib...

  18. Home health agency work environments and hospitalizations.

    Science.gov (United States)

    Jarrín, Olga; Flynn, Linda; Lake, Eileen T; Aiken, Linda H

    2014-10-01

    An important goal of home health care is to assist patients to remain in community living arrangements. Yet home care often fails to prevent hospitalizations and to facilitate discharges to community living, thus putting patients at risk of additional health challenges and increasing care costs. To determine the relationship between home health agency work environments and agency-level rates of acute hospitalization and discharges to community living. Analysis of linked Center for Medicare and Medicaid Services Home Health Compare data and nurse survey data from 118 home health agencies. Robust regression models were used to estimate the effect of work environment ratings on between-agency variation in rates of acute hospitalization and community discharge. Home health agencies with good work environments had lower rates of acute hospitalizations and higher rates of patient discharges to community living arrangements compared with home health agencies with poor work environments. Improved work environments in home health agencies hold promise for optimizing patient outcomes and reducing use of expensive hospital and institutional care.

  19. Cost-effectiveness implications based on a comparison of nursing home and home health case mix.

    OpenAIRE

    Kramer, A M; Shaughnessy, P W; Pettigrew, M L

    1985-01-01

    Case-mix differences between 653 home health care patients and 650 nursing home patients, and between 455 Medicare home health patients and 447 Medicare nursing home patients were assessed using random samples selected from 20 home health agencies and 46 nursing homes in 12 states in 1982 and 1983. Home health patients were younger, had shorter lengths of stay, and were less functionally disabled than nursing home patients. Traditional long-term care problems requiring personal care were more...

  20. 42 CFR 440.70 - Home health services.

    Science.gov (United States)

    2010-10-01

    ... an acute illness to avoid the recipient's transfer to a nursing facility. (d) “Home health agency... 42 Public Health 4 2010-10-01 2010-10-01 false Home health services. 440.70 Section 440.70 Public...) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.70 Home health services. (a...

  1. FastStats: Home Health Care

    Science.gov (United States)

    ... this? Submit What's this? Submit Button NCHS Home Home Health Care Recommend on Facebook Tweet Share Compartir Data are ... National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  2. Home Health Care: Services and Cost

    Science.gov (United States)

    Widmer, Geraldine; And Others

    1978-01-01

    Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)

  3. Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization.

    Science.gov (United States)

    Bao, Yuhua; Casalino, Lawrence P; Pincus, Harold Alan

    2013-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.

  4. 42 CFR 441.15 - Home health services.

    Science.gov (United States)

    2010-10-01

    ... Provisions § 441.15 Home health services. With respect to the services defined in § 440.70 of this subchapter, a State plan must provide that— (a) Home health services include, as a minimum— (1) Nursing services... 42 Public Health 4 2010-10-01 2010-10-01 false Home health services. 441.15 Section 441.15 Public...

  5. Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

    Science.gov (United States)

    2016-11-03

    This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

  6. Practices of depression care in home health care: Home health clinician perspectives

    Science.gov (United States)

    Bao, Yuhua; Eggman, Ashley A.; Richardson, Joshua E.; Sheeran, Thomas; Bruce, Martha L.

    2015-01-01

    Objective To assess any gaps between published best practices and real-world practices of treating depression in home health care (HHC), and barriers to closing any gaps. Methods A qualitative study based on semi-structured interviews with HHC nurses and administrators from five home health agencies in five states (n=20). Audio-recorded interviews were transcribed and analyzed by a multi-disciplinary team using grounded theory method to identify themes. Results Routine home health nursing care overlapped with all functional areas of depression care. However, there were reported gaps between best practices and real-world practices. Gaps were associated with perceived scope of practice by HHC nurses, knowledge gaps and low self-efficacy in depression treatment, stigma attached to depression, poor quality of antidepressant management in primary care, and poor communication between HHC and primary care. Conclusions Strategies to close gaps between typical and best practices need to enhance HHC clinician knowledge and self-efficacy with depression treatment and improve the quality of antidepressant management and communication with primary care. PMID:26423098

  7. Marketing in home health care. A practical approach.

    Science.gov (United States)

    Freitag, E M

    1988-06-01

    Home health marketing brings special problems and opportunities. One cannot rely on physical factors such as the physical plant and food service of a hospital or on the durability of a consumer product to judge home health. Opportunities exist within home health to identify activities that carry marketing value. Applying marketing principles to activities such as intake, customer service and public relations allows the home health agency to build referrals by meeting the wants and needs of the market. The home health organization needs to consider different wants and needs of those involved in the home health transaction: the decision maker, the purchaser, and the user. The success of the marketing function in meeting the organization's objectives will be aided by the placement of marketing at the senior management level.

  8. Home Health Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — The instrument-data collection tool used to collect and report performance data by home health agencies is called the Outcome and Assessment Information Set (OASIS)....

  9. Implementing Home Health Standards in Clinical Practice.

    Science.gov (United States)

    Gorski, Lisa A

    2016-02-01

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

  10. Home Health Care Agencies

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of all Home Health Agencies that have been registered with Medicare. The list includes addresses, phone numbers, and quality measure ratings for each agency.

  11. Home Health Compare Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — These are the official datasets used on the Medicare.gov Home Health Compare Website provided by the Centers for Medicare and Medicaid Services. These data allow you...

  12. Home Health PPS - Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Abt Associates July 21, 2010 Analysis of 2000-2008 Home Health Case-mix Change Report estimates the extent to which the observed increases in average case-mix were...

  13. The Future of Home Health project: developing the framework for health care at home.

    Science.gov (United States)

    Lee, Teresa; Schiller, Jennifer

    2015-02-01

    In addition to providing high-quality care to vulnerable patient populations, home healthcare offers the least costly option for patients and the healthcare system, particularly in postacute care. As the baby boom generation ages, policymakers are expressing concerns about rising costs, variation in home healthcare service use, and program integrity. The Alliance for Home Health Quality and Innovation seeks to develop a research-based strategic framework for the future of home healthcare for older Americans and those with disabilities. This article describes the initiative and invites readers to provide comments and suggestions.

  14. Transforming home health nursing with telehealth technology.

    Science.gov (United States)

    Farrar, Francisca Cisneros

    2015-06-01

    Telehealth technology is an evidence-based delivery model tool that can be integrated into the plan of care for mental health patients. Telehealth technology empowers access to health care, can help decrease or prevent hospital readmissions, assist home health nurses provide shared decision making, and focuses on collaborative care. Telehealth and the recovery model have transformed the role of the home health nurse. Nurses need to be proactive and respond to rapidly emerging technologies that are transforming their role in home care. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Comparison of Long-term Care in Nursing Homes Versus Home Health: Costs and Outcomes in Alabama.

    Science.gov (United States)

    Blackburn, Justin; Locher, Julie L; Kilgore, Meredith L

    2016-04-01

    To compare acute care outcomes and costs among nursing home residents with community-dwelling home health recipients. A matched retrospective cohort study of Alabamians aged more than or equal to 65 years admitted to a nursing home or home health between March 31, 2007 and December 31, 2008 (N = 1,291 pairs). Medicare claims were compared up to one year after admission into either setting. Death, emergency department and inpatient visits, inpatient length of stay, and acute care costs were compared using t tests. Medicaid long-term care costs were compared for a subset of matched beneficiaries. After one year, 77.7% of home health beneficiaries were alive compared with 76.2% of nursing home beneficiaries (p Home health beneficiaries averaged 0.2 hospital visits and 0.1 emergency department visits more than nursing home beneficiaries, differences that were statistically significant. Overall acute care costs were not statistically different; home health beneficiaries' costs averaged $31,423, nursing home beneficiaries' $32,239 (p = .5032). Among 426 dual-eligible pairs, Medicaid long-term care costs averaged $4,582 greater for nursing home residents (p nursing home or home health care. Additional research controlling for exogenous factors relating to long-term care decisions is needed. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Home e-health system integration in the Smart Home through a common media server.

    Science.gov (United States)

    Pau, I; Seoane, F; Lindecrantz, K; Valero, M A; Carracedo, J

    2009-01-01

    Home e-health systems and services are revealed as one of the most important challenges to promote Quality of Life related to Health in the Information Society. Leading companies have worked on e-health systems although the majority of them are addressed to hospital or primary care settings. The solution detailed in this paper offers a personal health system to be integrated with Smart Home services platform to support home based e-care. Thus, the home e-health system and architecture detailed in this research work is ready to supply a seamless personal care solution both from the biomedical data analysis, service provision, security guarantee and information management s point of view. The solution is ready to be integrated within the Accessible Digital Home, a living lab managed by Universidad Politécnica de Madrid for R&D activities.

  17. Comparison of home and away-from-home physical activity using accelerometers and cellular network-based tracking devices.

    Science.gov (United States)

    Ramulu, Pradeep Y; Chan, Emilie S; Loyd, Tara L; Ferrucci, Luigi; Friedman, David S

    2012-08-01

    Measuring physical at home and away from home is essential for assessing health and well-being, and could help design interventions to increase physical activity. Here, we describe how physical activity at home and away from home can be quantified by combining information from cellular network-based tracking devices and accelerometers. Thirty-five working adults wore a cellular network-based tracking device and an accelerometer for 6 consecutive days and logged their travel away from home. Performance of the tracking device was determined using the travel log for reference. Tracking device and accelerometer data were merged to compare physical activity at home and away from home. The tracking device detected 98.6% of all away-from-home excursions, accurately measured time away from home and demonstrated few prolonged signal drop-out periods. Most physical activity took place away from home on weekdays, but not on weekends. Subjects were more physically active per unit of time while away from home, particularly on weekends. Cellular network-based tracking devices represent an alternative to global positioning systems for tracking location, and provide information easily integrated with accelerometers to determine where physical activity takes place. Promoting greater time spent away from home may increase physical activity.

  18. Measuring and Assuring the Quality of Home Health Care

    Science.gov (United States)

    Shaughnessy, Peter W.; Crisler, Kathryn S.; Schlenker, Robert E.; Arnold, Angela G.; Kramer, Andrew M.; Powell, Martha C.; Hittle, David F.

    1994-01-01

    The growth in home health care in the United States since 1970, and the exponential increase in the provision of Medicare-covered home health services over the past 5 years, underscores the critical need to assess the effectiveness of home health care in our society. This article presents conceptual and applied topics and approaches involved in assessing effectiveness through measuring the outcomes of home health care. Definitions are provided for a number of terms that relate to quality of care, outcome measures, risk adjustment, and quality assurance (QA) in home health care. The goal is to provide an overview of a potential systemwide approach to outcome-based QA that has its basis in a partnership between the home health industry and payers or regulators. PMID:10140157

  19. Nursing students' attitudes about home health nursing.

    Science.gov (United States)

    Prestia, Mindy; Murphy, Susan; Yoder, Marian

    2008-09-01

    In an effort to address the home care nursing shortage, this pilot study was designed to measure nursing students' attitudes toward home health nursing and to test the Home Health Attitude Questionnaire developed specifically for this study based on the Theory of Planned Behavior. Senior undergraduate nursing students and registered nursing to bachelor of science in nursing students completed the questionnaire.

  20. Assessing Commercially Available Personal Health Records for Home Health: Recommendations for Design.

    Science.gov (United States)

    Kneale, Laura; Choi, Yong; Demiris, George

    2016-01-01

    Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.

  1. Health patterns of cardiac surgery clients using home health care nursing services.

    Science.gov (United States)

    Redeker, N S; Brassard, A B

    1996-12-01

    The purpose of this study was to examine the health patterns of cardiac surgical patients in the home health care population and their relationships to outcomes and duration of home health care using Gordon's Functional Health Pattern framework. Home health care records of 96 cardiac surgical clients were reviewed. Admission health pattern data, reasons for admission, duration and outcomes of home care services, characteristics of hospital experience, and demographic data were analyzed. Dysfunctional health patterns were primarily in the area of activity/exercise. The most common reasons for admission were monitoring of cardiopulmonary status, wound care, and instruction on diet, medications, and cardiac regimen. The mean duration of home care was 28.8 days. Thirty percent of the sample were readmitted to the hospital. Duration of home care was shorter for those who were married and for those who reported weakness, tiredness, or fatigue as a chief complaint. Readmission to the hospital was more likely for those who had complications during their initial hospital stay and those who required at least partial assistance with bathing, dressing, feeding, or toileting. Implications for practice and research are discussed.

  2. Home Health Care: What It Is and What to Expect

    Science.gov (United States)

    ... of care + Share widget - Select to show What’s home health care? What's home health care? Home health care is a wide ... or skilled nursing facility (SNF). Examples of skilled home health services include: Wound care for pressure sores ...

  3. R-2000 home health study : Homeowner health in R-2000 and new conventional homes

    International Nuclear Information System (INIS)

    Parekh, A.

    2002-01-01

    A field study was conducted by Health Canada and Natural Resources Canada (NRCan) to evaluate self-reported health symptoms by residents of R-2000 and conventional homes in Nova Scotia and New Brunswick. It involved 52 energy efficient R-2000 and 50 conventionally built houses. Health Canada collected and analyzed data concerning changes in occupant health after moving into R-2000 houses and similar conventional houses. Definite trends in improvements of respiratory symptoms of occupants in R-2000 houses were revealed, compared to the results obtained for occupants of conventional houses. New occupants of R-2000 houses reported significant improvement in indoor air quality in 94 per cent of cases, while only 77 per cent of conventional homeowners reported similar results. Fifty six per cent of the occupants of R-2000 homes reported a general improvement in their health, compared to 32 per cent in conventional houses. The testing of houses in other regions is being planned by Health Canada. tabs

  4. Home as a health promotion setting for older adults

    DEFF Research Database (Denmark)

    Mahler, Marianne; Sarvimäki, Anneli; Clancy, Anne

    2014-01-01

    promotion care. As official guidelines in the Nordic countries state that home is the best place to grow old, it is essential that older persons keep their health and functional capacity in order to be able to live at home for as long as possible. As current policy emphasises living at home, home care......The number and the proportion of older persons is growing in the Nordic Countries. The growth in the older population has a clear impact on the care system for older persons. One trend is to prioritise home care instead of care in institutions. Another trend is to emphasise preventive and health......, preventive work and health promotion it becomes essential to study the home as a health promotion setting. Objective: The aim of this study was to reach a new understanding of home as a health promotion setting for older persons. Study design: The method used was a literature reflection and analysis...

  5. Implementation of Electronic Health Records in US Nursing Homes.

    Science.gov (United States)

    Bjarnadottir, Ragnhildur I; Herzig, Carolyn T A; Travers, Jasmine L; Castle, Nicholas G; Stone, Patricia W

    2017-08-01

    While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.

  6. Improving Elderly's Dental Hygiene Through Nursing Home Staff's Dental Health Education at the Nursing Home

    OpenAIRE

    Santoso, Bedjo; Eko Ningtyas, Endah Aryati; Fatmasari, Diyah

    2017-01-01

    Stomatitis often occurs in elderly at nursing home. They need nursing home staff assistance to maintain their dental and oral health. Therefore, nursing home staff need dental health education. Lecture or discussion methods, which are more effective to improve knowledge, attitude and skill of nursing home staff was the purpose of this research. The research design was quasi-experiment research and pretest-posttest with control group. The sample was 42 nursing home staffs and 74 elderlies, div...

  7. Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring.

    Science.gov (United States)

    Heeke, Sheila; Wood, Felecia; Schuck, Jennifer

    2014-01-01

    A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template.

  8. The Impact of Certificate-of-Need Laws on Nursing Home and Home Health Care Expenditures.

    Science.gov (United States)

    Rahman, Momotazur; Galarraga, Omar; Zinn, Jacqueline S; Grabowski, David C; Mor, Vincent

    2016-02-01

    Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care. In particular, we observed the slowest growth in community-based care in states with CON for both the nursing home and home health industries. Thus, controlling for other factors, public postacute and long-term care expenditures in CON states have become dominated by nursing homes. © The Author(s) 2015.

  9. Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

    Science.gov (United States)

    Davitt, Joan K.

    2014-01-01

    Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…

  10. Time-varying mixed logit model for vehicle merging behavior in work zone merging areas.

    Science.gov (United States)

    Weng, Jinxian; Du, Gang; Li, Dan; Yu, Yao

    2018-08-01

    This study aims to develop a time-varying mixed logit model for the vehicle merging behavior in work zone merging areas during the merging implementation period from the time of starting a merging maneuver to that of completing the maneuver. From the safety perspective, vehicle crash probability and severity between the merging vehicle and its surrounding vehicles are regarded as major factors influencing vehicle merging decisions. Model results show that the model with the use of vehicle crash risk probability and severity could provide higher prediction accuracy than previous models with the use of vehicle speeds and gap sizes. It is found that lead vehicle type, through lead vehicle type, through lag vehicle type, crash probability of the merging vehicle with respect to the through lag vehicle, crash severities of the merging vehicle with respect to the through lead and lag vehicles could exhibit time-varying effects on the merging behavior. One important finding is that the merging vehicle could become more and more aggressive in order to complete the merging maneuver as quickly as possible over the elapsed time, even if it has high vehicle crash risk with respect to the through lead and lag vehicles. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Green House Adoption and Nursing Home Quality.

    Science.gov (United States)

    Afendulis, Christopher C; Caudry, Daryl J; O'Malley, A James; Kemper, Peter; Grabowski, David C

    2016-02-01

    To evaluate the impact of the Green House (GH) model on nursing home resident-level quality of care measures. Resident-level minimum data set (MDS) assessments merged with Medicare inpatient claims for the period 2005 through 2010. Using a difference-in-differences framework, we compared changes in care quality and outcomes in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nursing homes that had not adopted the GH model. For individuals residing in GH homes, adoption of the model lowered readmissions and several MDS measures of poor quality, including bedfast residents, catheter use, and pressure ulcers, but these results were not present across the entire GH organization, suggesting possible offsetting effects for residents of non-GH "legacy" units within the GH organization. GH adoption led to improvement in rehospitalizations and certain nursing home quality measures for individuals residing in a GH home. The absence of evidence of a decline in other clinical quality measures in GH nursing homes should reassure anyone concerned that GH might have sacrificed clinical quality for improved quality of life. © Health Research and Educational Trust.

  12. Improving the Quality of Home Health Care for Children With Medical Complexity.

    Science.gov (United States)

    Nageswaran, Savithri; Golden, Shannon L

    2017-08-01

    The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery. In this qualitative study, we conducted 20 semistructured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care. There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical care for their children at home and addressing problems with home health care services. There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home care could improve home health care quality. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  13. Nurses' Home Health Experience. Part I: The Practice Setting.

    Science.gov (United States)

    Stulginsky, Maryfran McKenzie

    1993-01-01

    Defines home health nursing as meeting the acute and chronic care needs of patients and their families in the home environment. Offers examples of situations in which home health nurses find themselves and their reactions to them. (JOW)

  14. A multidimensional approach to case mix for home health services

    Science.gov (United States)

    Manton, Kenneth G.; Hausner, Tony

    1987-01-01

    Developing a case-mix methodology for home health services is more difficult than developing one for hospitalization and acute health services, because the determinants of need for home health care are more complex and because of the difficulty in defining episodes of care. To evaluate home health service case mix, a multivariate grouping methodology was applied to records from the 1982 National Long-Term Care Survey linked to Medicare records on home health reimbursements. Using this method, six distinct health and functional status dimensions were identified. These dimensions, combined with factors describing informal care resources and local market conditions, were used to explain significant proportions of the variance (r2 = .45) of individual differences in Medicare home health reimbursements and numbers of visits. Though the data were not collected for that purpose, the high level of prediction strongly suggests the feasibility of developing case-mix strategies for home health services. PMID:10312187

  15. Payment reform will shift home health agency valuation parameters.

    Science.gov (United States)

    Hahn, A D

    1998-12-01

    Changes authorized by the Balanced Budget Act of 1997 have removed many of the payment benefits that motivated past home health agency acquisition activity and temporarily have slowed the rapid pace of acquisitions of home health agencies. The act required that Medicare's cost-based payment system be replaced with a prospective payment system (PPS) and established an interim payment system to provide a framework for home health agencies to make the transition to the PPS. As a consequence, realistic valuations of home health agencies will be determined primarily by cash flows, with consideration given to operational factors, such as quality of patient care, service territory, and information systems capabilities. The limitations imposed by the change in payment mechanism will cause acquisition interest to shift away from home health agencies with higher utilization and revenue expansion to agencies able to control costs and achieve operating leverage.

  16. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

    OpenAIRE

    Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

    2013-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the H...

  17. extramarital affair as correlate of reproductive health and home

    African Journals Online (AJOL)

    Mugumbate

    health and home instability among couples in Ibadan, Nigeria. Descriptive survey ... importance of reproductive health education and home stability to health and general ..... extramarital affair in Nepal due to economic factors such as foreign ...

  18. Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey.

    Science.gov (United States)

    Stone, Robyn; Wilhelm, Jess; Bishop, Christine E; Bryant, Natasha S; Hermer, Linda; Squillace, Marie R

    2017-10-01

    To identify agency policies and workplace characteristics that are associated with intent to leave the job among home health workers employed by certified agencies. Data are from the 2007 National Home and Hospice Care Survey/National Home Health Aide Survey, a nationally representative, linked data set of home health and hospice agencies and their workers. Logistic regression with survey weights was conducted to identify agency and workplace factors associated with intent to leave the job, controlling for worker, agency, and labor market characteristics. Job satisfaction, consistent patient assignment, and provision of health insurance were associated with lower intent to leave the job. By contrast, being assigned insufficient work hours and on-the-job injuries were associated with greater intent to leave the job after controlling for fixed worker, agency, and labor market characteristics. African American workers and workers with a higher household income also expressed greater intent to leave the job. This is the first analysis to use a weighted, nationally representative sample of home health workers linked with agency-level data. The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Home health services in primary care: What can we do?

    Directory of Open Access Journals (Sweden)

    Yasemin Çayır

    2013-01-01

    Full Text Available Home health services is to give examination, diagnosis,treatment, and rehabilitation services to the patients whobedridden, have difficulties to access health facility due toa variety of chronic or malignant disease by professionalhealth care team. Family physicians that providing healthcare in primary care is responsible for to determine whowill need home health care services, and to make homevisit on a regular basis among registered patients in theirpopulations. It is seems that the biggest shortcoming thecontent and scope of this service is not yet a standard. Inthis article, how home health services should be given willbe discussed.Key words: Primary health care, home health care, bedriddenpatient

  20. In-depth analysis of drivers' merging behavior and rear-end crash risks in work zone merging areas.

    Science.gov (United States)

    Weng, Jinxian; Xue, Shan; Yang, Ying; Yan, Xuedong; Qu, Xiaobo

    2015-04-01

    This study investigates the drivers' merging behavior and the rear-end crash risk in work zone merging areas during the entire merging implementation period from the time of starting a merging maneuver to that of completing the maneuver. With the merging traffic data from a work zone site in Singapore, a mixed probit model is developed to describe the merging behavior, and two surrogate safety measures including the time to collision (TTC) and deceleration rate to avoid the crash (DRAC) are adopted to compute the rear-end crash risk between the merging vehicle and its neighboring vehicles. Results show that the merging vehicle has a bigger probability of completing a merging maneuver quickly under one of the following situations: (i) the merging vehicle moves relatively fast; (ii) the merging lead vehicle is a heavy vehicle; and (iii) there is a sizable gap in the adjacent through lane. Results indicate that the rear-end crash risk does not monotonically increase as the merging vehicle speed increases. The merging vehicle's rear-end crash risk is also affected by the vehicle type. There is a biggest increment of rear-end crash risk if the merging lead vehicle belongs to a heavy vehicle. Although the reduced remaining distance to work zone could urge the merging vehicle to complete a merging maneuver quickly, it might lead to an increased rear-end crash risk. Interestingly, it is found that the rear-end crash risk could be generally increased over the elapsed time after the merging maneuver being triggered. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Merging {DBMs} Efficiently

    DEFF Research Database (Denmark)

    David, Alexandre

    2005-01-01

    In this paper we present different algorithms to reduce the number of DBMs in federations by merging them. Federations are unions of DBMs and are used to represent non-convex zones. Inclusion checking between DBMs is a limited technique to reduce the size of federations and how to choose some DBMs...... to merge them into a larger one is a combi-natorial problem. We present a number of simple but efficient techniques to avoid searching the combinations while still being able to merge any number of DBMs...

  2. Merge of terminological resources

    DEFF Research Database (Denmark)

    Henriksen, Lina; Braasch, Anna

    2012-01-01

    In our globalized world, the amount of cross-national communication increases rapidly, which also calls for easy access to multi-lingual high quality terminological resources. Sharing of terminology resources is currently becoming common practice, and efficient strategies for integration...... – or merging – of terminology resources are strongly needed. This paper discusses prerequisites for successful merging with the focus on identification of candidate duplicates of a subject domain found in the resources to be merged, and it describes automatic merging strategies to be applied to such duplicates...... in electronic terminology resources. Further, some perspectives of manual, supplementary assessment methods supporting the automatic procedures are sketched. Our considerations are primarily based on experience gained in the IATE and EuroTermBank projects, as merging was a much discussed issue in both projects....

  3. Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

    Science.gov (United States)

    2017-11-07

    This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.

  4. Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study.

    Science.gov (United States)

    Xiao, Roy; Miller, Jacob A; Zafirau, William J; Gorodeski, Eiran Z; Young, James B

    2018-04-01

    As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population. A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with "self-care" were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates. Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. Automated assessment of cognitive health using smart home technologies.

    Science.gov (United States)

    Dawadi, Prafulla N; Cook, Diane J; Schmitter-Edgecombe, Maureen; Parsey, Carolyn

    2013-01-01

    The goal of this work is to develop intelligent systems to monitor the wellbeing of individuals in their home environments. This paper introduces a machine learning-based method to automatically predict activity quality in smart homes and automatically assess cognitive health based on activity quality. This paper describes an automated framework to extract set of features from smart home sensors data that reflects the activity performance or ability of an individual to complete an activity which can be input to machine learning algorithms. Output from learning algorithms including principal component analysis, support vector machine, and logistic regression algorithms are used to quantify activity quality for a complex set of smart home activities and predict cognitive health of participants. Smart home activity data was gathered from volunteer participants (n=263) who performed a complex set of activities in our smart home testbed. We compare our automated activity quality prediction and cognitive health prediction with direct observation scores and health assessment obtained from neuropsychologists. With all samples included, we obtained statistically significant correlation (r=0.54) between direct observation scores and predicted activity quality. Similarly, using a support vector machine classifier, we obtained reasonable classification accuracy (area under the ROC curve=0.80, g-mean=0.73) in classifying participants into two different cognitive classes, dementia and cognitive healthy. The results suggest that it is possible to automatically quantify the task quality of smart home activities and perform limited assessment of the cognitive health of individual if smart home activities are properly chosen and learning algorithms are appropriately trained.

  6. Home health care nurses' perceptions of empowerment.

    Science.gov (United States)

    Williamson, Kathleen M

    2007-01-01

    This exploratory study involved the triangulation of qualitative (interview and observation) and quantitative methods (Psychological Empowerment Instrument). This study examined the individual home care nurses' perception of empowerment and how it influences decisions in the home clinical setting. Fifteen nurses were self-selected to participate. All completed an interview, and were observed and given Likert Instrument to complete. A framework analysis was performed to identify mutually exclusive and exhaustive emergent themes and patterns within the data. Home care nurses described that enpowerment is in the interaction between nurse and patient, and nurse and health care provider. Empowered is defined as being independent, confident, trusting, and comfortable with providing quality care. Home health care nurses believe that having the ability to practice collaboratively and build professional relationships was essential. Nurses in this study perceived empowerment as having meaning, choice, and competence in their job.

  7. Long-term home care scheduling

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...

  8. Working in clients' homes: the impact on the mental health and well-being of visiting home care workers.

    Science.gov (United States)

    Denton, Margaret A; Zeytinoğlu, Işk Urla; Davies, Sharon

    2002-01-01

    The purpose of this paper is to examine the effects of working in clients' homes on the mental health and well-being of visiting home care workers. This paper reports the results of a survey of 674 visiting staff from three non-profit home care agencies in a medium-sized city in Ontario, Canada. Survey results are also complimented by data from 9 focus groups with 50 employees. For purposes of this study, home care workers include visiting therapists, nurses, and home support workers. Mental health and well-being is measured by three dependent variables: stress; job stress; and intrinsic job satisfaction. Multiple least squared regression analyses show several structural, emotional, physical, and organizational working conditions associated with the health and well-being of visiting home care workers. Overall, results show that workload, difficult clients, clients who take advantage of workers, sexual harassment, safety hazards, a repetitious job, and work-related injuries are associated with poorer health. Being fairly paid, having good benefits, emotional labour, organizational support, control over work, and peer support are associated with better health. Results suggest that policy change is needed to encourage healthier work environments for employees who work in clients' homes.

  9. Preparation for electron ring - plasma ring merging experiments in RECE-MERGE

    International Nuclear Information System (INIS)

    Taggart, D.; Sekiguchi, A.; Fleischmann, H.H.

    1986-01-01

    The formation of a mixed-CT using relativistic electron rings and gun-produced plasma rings by MERGE-ing them axially is simulated. This process is similar to the axial stacking of relativistic electron rings in RECE-Christa. The results of their first plasm production experiment are reported here. After study of the gun-produced plasma's properties is completed, the gun will be mounted at the downstream end of the vacuum tank and the source of relativistic electron rings will be at the upstream end. The two rings, formed at opposite ends of the tank, will be translated axially and merged

  10. Use of Clinical Health Information Technology in Nursing Homes: Nursing Home Characteristics and Quality Measures

    Science.gov (United States)

    Spinelli-Moraski, Carla

    2014-01-01

    This study compares quality measures among nursing homes that have adopted different levels of clinical health information technology (HIT) and examines the perceived barriers and benefits of the adoption of electronic health records as reported by Nursing Home Administrators and Directors of Nursing. A cross-sectional survey distributed online to…

  11. Why healthcare providers merge.

    Science.gov (United States)

    Postma, Jeroen; Roos, Anne-Fleur

    2016-04-01

    In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in the literature by conducting a survey study on mergers among 848 Dutch healthcare executives, of which 35% responded (resulting in a study sample of 239 executives). A total of 65% of the respondents was involved in at least one merger between 2005 and 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increasing competition, more pressure from purchasers, growing financial risks, de-institutionalisation of long-term care and decentralisation of healthcare services to municipalities. Our empirical study shows that healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Also efficiency and financial reasons are important drivers of merger activity in healthcare. We find that motives for merger are related to changes in health policies, in particular to the increasing pressure from competitors, insurers and municipalities.

  12. Triadic split-merge sampler

    Science.gov (United States)

    van Rossum, Anne C.; Lin, Hai Xiang; Dubbeldam, Johan; van der Herik, H. Jaap

    2018-04-01

    In machine vision typical heuristic methods to extract parameterized objects out of raw data points are the Hough transform and RANSAC. Bayesian models carry the promise to optimally extract such parameterized objects given a correct definition of the model and the type of noise at hand. A category of solvers for Bayesian models are Markov chain Monte Carlo methods. Naive implementations of MCMC methods suffer from slow convergence in machine vision due to the complexity of the parameter space. Towards this blocked Gibbs and split-merge samplers have been developed that assign multiple data points to clusters at once. In this paper we introduce a new split-merge sampler, the triadic split-merge sampler, that perform steps between two and three randomly chosen clusters. This has two advantages. First, it reduces the asymmetry between the split and merge steps. Second, it is able to propose a new cluster that is composed out of data points from two different clusters. Both advantages speed up convergence which we demonstrate on a line extraction problem. We show that the triadic split-merge sampler outperforms the conventional split-merge sampler. Although this new MCMC sampler is demonstrated in this machine vision context, its application extend to the very general domain of statistical inference.

  13. Comparing Sleep Quality and General Health Among the Elderly Living at Home and at Nursing Home

    Directory of Open Access Journals (Sweden)

    Mansour Beyrami

    2014-01-01

    Full Text Available Objectives: Survey about the issues and problems related to elderly in order to improve their quality of life of this increasing population has become a universal concern.This study was performed by the purpose of comparing the sleep quality and general health among the Elderly Residing at Home and Old People's Homes. Methods & Materials: This study is descriptive-analytic type. Population of this investigation consisted of elderly men and women (upper than 60 years old living at personal home and at nursing home in Tabriz. Sample group composed of 100 elderly (50 men and 50 women 50 living at home and 50 living at nursing home who were selected through available sampling method. For collecting data, Goldberg General Health Questionnaire and Pittsburgh Sleep Quality Index were used. Data were analyzed by Multivariate analysis of variance (MANOVA. Results: Findings showed that In terms of general health and its components (Physical symptoms, anxiety, social dysfunction and depression and Sleep quality and its components (Subjective quality of sleep, time for sleep, total sleep time, sleep efficiency, routine, sleep disorders, sleep medications and daily dysfunction there were significant differences between nursing home residents and elderly residents in nursing homes (P=0.001. Conclusion: Findings indicated that elderly residents in nursing home are experiencing more symptoms of anxiety, depression, physical symptoms and social dysfunction Compared with the elderly whom resident at home. Also the results showed that the elderly residents of nursing homes have poor sleep quality than ones whom residents at home. On the other hand Future development of elderly care institution is inevitable. Therefore, more attention to the living conditions of elderly residents of institutions seems necessary.

  14. How Home Health Nurses Plan Their Work Schedules: A Qualitative Descriptive Study.

    Science.gov (United States)

    Irani, Elliane; Hirschman, Karen B; Cacchione, Pamela Z; Bowles, Kathryn H

    2018-06-12

    To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process. Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face within the dynamic home health setting. Qualitative descriptive design. Semi-structured interviews were conducted with 20 registered nurses who had greater than 2 years of experience in home health and were employed by one of the three participating home health agencies in the mid-Atlantic region of the United States. Data were analyzed using conventional content analysis. Four themes emerged about planning work schedules and daily itineraries: identifying patient needs to prioritize visits accordingly, partnering with patients to accommodate their preferences, coordinating visit timing with other providers to avoid overwhelming patients, and working within agency standards to meet productivity requirements. Scheduling challenges included readjusting the schedule based on patient needs and staffing availability, anticipating longer visits, and maintaining continuity of care with patients. Home health nurses make autonomous decisions regarding their work schedules while considering specific patient and agency factors, and overcome challenges related to the unpredictable nature of providing care in a home health setting. Future research is needed to further explore nurse productivity in home health and improve home health work environments. Home health nurses plan their work schedules to provide high quality care that is patient-centered and timely. The findings also highlight organizational priorities to facilitate continuity of care and support nurses while alleviating the burnout

  15. Nursing home staffing requirements and input substitution: effects on housekeeping, food service, and activities staff.

    Science.gov (United States)

    Bowblis, John R; Hyer, Kathryn

    2013-08-01

    To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. OSCAR surveys from 1999 to 2004. Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. © Health Research and Educational Trust.

  16. Primary Caregivers Satisfaction and its Related Factors in Home Health Care Services

    Directory of Open Access Journals (Sweden)

    Shu-Ping Wei

    2011-06-01

    Conclusion: This study showed that the overall perceived performance is higher than expectation for home health care service provided. The primary caregiver who was older than 30 years, who had lower education level, and other than siblings showed higher satisfaction. The four items that need improving included “home health care nurses will provide detailed description of services,” “home health care nurses will provide knowledge of illness,” “home health care nurses can complete the promised tasks,” and “home health care nurses will actively inquire patient’s conditions and needs.”

  17. Validity analysis on merged and averaged data using within and between analysis: focus on effect of qualitative social capital on self-rated health.

    Science.gov (United States)

    Shin, Sang Soo; Shin, Young-Jeon

    2016-01-01

    With an increasing number of studies highlighting regional social capital (SC) as a determinant of health, many studies are using multi-level analysis with merged and averaged scores of community residents' survey responses calculated from community SC data. Sufficient examination is required to validate if the merged and averaged data can represent the community. Therefore, this study analyzes the validity of the selected indicators and their applicability in multi-level analysis. Within and between analysis (WABA) was performed after creating community variables using merged and averaged data of community residents' responses from the 2013 Community Health Survey in Korea, using subjective self-rated health assessment as a dependent variable. Further analysis was performed following the model suggested by WABA result. Both E-test results (1) and WABA results (2) revealed that single-level analysis needs to be performed using qualitative SC variable with cluster mean centering. Through single-level multivariate regression analysis, qualitative SC with cluster mean centering showed positive effect on self-rated health (0.054, panalysis using SC variables without cluster mean centering or multi-level analysis. As modification in qualitative SC was larger within the community than between communities, we validate that relational analysis of individual self-rated health can be performed within the group, using cluster mean centering. Other tests besides the WABA can be performed in the future to confirm the validity of using community variables and their applicability in multi-level analysis.

  18. Research supporting the congruence between rehabilitation principles and home health nursing practice.

    Science.gov (United States)

    Neal, L J

    1999-01-01

    A grounded-theory study of 30 home health nurses conducted in the Washington, DC, metropolitan area used unstructured audiotaped interviews to elicit data as to how home health nurses define their practice. The purpose of the study was to develop a beginning substantive research-based theory of home health nursing practice. The model that emerged consists of three stages by which nurses attain autonomy in their practice. Adaptation was found to be the core category, in that nurses cannot function effectively or successfully in the home health arena unless they are or learn to be adaptable. Data also revealed that home health nurses either knowingly or unknowingly use rehabilitation nursing principles in their practice, thereby lending credence to the supposition that home health nursing practice is congruent with rehabilitation nursing principles.

  19. National Trends and Geographic Variation in Availability of Home Health Care: 2002-2015.

    Science.gov (United States)

    Wang, Yun; Leifheit-Limson, Erica C; Fine, Jonathan; Pandolfi, Michelle M; Gao, Yan; Liu, Fanglin; Eckenrode, Sheila; Lichtman, Judith H

    2017-07-01

    To evaluate national trends and geographic variation in the availability of home health care from 2002 to 2015 and identify county-specific characteristics associated with home health care. Observational study. All counties in the United States. All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002-2003 and 2014-2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. The availability of home health care increased nationwide during the study period, but there was much geographic variation. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  20. The home health workforce: a distinction between worker categories.

    Science.gov (United States)

    Stone, Robyn; Sutton, Janet P; Bryant, Natasha; Adams, Annelise; Squillace, Marie

    2013-01-01

    The demand for home health aides is expected to rise, despite concerns about the sustainability of this workforce. Home health workers receive low wages and little training and have high turnover. It is difficult to recruit and retain workers to improve clinical outcomes. This study presents national estimates to examine how home health workers and the subgroup of workers differ in terms of sociodemographic characteristics, compensation, benefits, satisfaction, and retention. Hospice aides fare better than other categories of workers and are less likely to leave their job. Policymakers should consider strategies to increase the quality and stability of this workforce.

  1. Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees.

    Science.gov (United States)

    Li, Qijuan; Keohane, Laura M; Thomas, Kali; Lee, Yoojin; Trivedi, Amal N

    2017-07-01

    Several policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy. To determine the association of home health copayments with use of home health services. A difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans. Introduction of copayments for home health care between 2007 and 2011. Proportion of enrollees receiving home health care, annual numbers of home health episodes, and days receiving home health care. Copayments for home health visits ranged from $5 to $20 per visit, which were estimated to be associated with $165 (interquartile range [IQR], $45-$180) to $660 (IQR, $180-$720) in out-of-pocket spending for the average user of home health care. The increased copayment for home health care was not associated with the proportion of enrollees receiving home health care (adjusted difference-in-differences, -0.15 percentage points; 95% CI, -0.38 to 0.09), the number of home health episodes per user (adjusted difference-in-differences, 0.01; 95% CI, -0.01 to 0.03), and home health days per user (adjusted difference-in-differences, -0.19; 95% CI, -3.02 to 2.64). In both intervention and control plans and across all levels of copayments, we observed higher disenrollment rates among enrollees with greater baseline use of home health care. We found no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. The findings raise questions about the potential effectiveness of this cost-containment strategy.

  2. An eMERGE Clinical Center at Partners Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Jordan W. Smoller

    2016-01-01

    Full Text Available The integration of electronic medical records (EMRs and genomic research has become a major component of efforts to advance personalized and precision medicine. The Electronic Medical Records and Genomics (eMERGE network, initiated in 2007, is an NIH-funded consortium devoted to genomic discovery and implementation research by leveraging biorepositories linked to EMRs. In its most recent phase, eMERGE III, the network is focused on facilitating implementation of genomic medicine by detecting and disclosing rare pathogenic variants in clinically relevant genes. Partners Personalized Medicine (PPM is a center dedicated to translating personalized medicine into clinical practice within Partners HealthCare. One component of the PPM is the Partners Healthcare Biobank, a biorepository comprising broadly consented DNA samples linked to the Partners longitudinal EMR. In 2015, PPM joined the eMERGE Phase III network. Here we describe the elements of the eMERGE clinical center at PPM, including plans for genomic discovery using EMR phenotypes, evaluation of rare variant penetrance and pleiotropy, and a novel randomized trial of the impact of returning genetic results to patients and clinicians.

  3. Medicare Provider Payment Data - Home Health Agencies

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standard payment), and submitted charges organized by CMS Certification...

  4. A theoretical model of job retention for home health care nurses.

    Science.gov (United States)

    Ellenbecker, Carol Hall

    2004-08-01

    Predicted severe nursing shortages and an increasing demand for home health care services have made the retention of experienced, qualified nursing staff a priority for health care organizations. The purpose of this paper is to describe a theoretical model of job retention for home health care nurses. The theoretical model is an integration of the findings of empirical research related to intent to stay and retention, components of Neal's theory of home health care nursing practice and findings from earlier work to develop an instrument to measure home health care nurses' job satisfaction. The theoretical model identifies antecedents to job satisfaction of home health care nurses. The antecedents are intrinsic and extrinsic job characteristics. The model also proposes that job satisfaction is directly related to retention and indirectly related to retention though intent to stay. Individual nurse characteristics are indirectly related to retention through intent to stay. The individual characteristic of tenure is indirectly related to retention through autonomy, as an intrinsic characteristic of job satisfaction, and intent to stay. The proposed model can be used to guide research that explores gaps in knowledge about intent to stay and retention among home health care nurses.

  5. Smart Health Caring Home: A Systematic Review of Smart Home Care for Elders and Chronic Disease Patients.

    Science.gov (United States)

    Moraitou, Marina; Pateli, Adamantia; Fotiou, Sotiris

    2017-01-01

    As access to health care is important to people's health especially for vulnerable groups that need nursing for a long period of time, new studies in the human sciences argue that the health of the population depend less on the quality of the health care, or on the amount of spending that goes into health care, and more heavily on the quality of everyday life. Smart home applications are designed to "sense" and monitor the health conditions of its residents through the use of a wide range of technological components (motion sensors, video cameras, wearable devices etc.), and web-based services that support their wish to stay at home. In this work, we provide a review of the main technological, psychosocial/ethical and economic challenges that the implementation of a Smart Health Caring Home raises.

  6. Caring for Depression in Older Home Health Patients.

    Science.gov (United States)

    Bruce, Martha L

    2015-11-01

    Depression is common in older home health patients and increases their risk of adverse outcomes. Depression screening is required by Medicare's Outcome and Assessment Information Set. The Depression Care for Patients at Home (CAREPATH) was developed as a feasible strategy for home health nurses to manage depression in their patients. The protocol builds on nurses' existing clinical skills and is designed to fit within routine home visits. Major components include ongoing clinical assessment, care coordination, medication management, education, and goal setting. In a randomized trial, Depression CAREPATH patients had greater improvement in depressive symptoms compared to usual care. The difference between groups was significant at 3 months, growing larger and more clinically meaningful over 1 year. The intervention had no impact on patient length of stay, number of home visits, or duration of visits. Thus, nurses can play a pivotal role in the long-term course and outcomes of patients with depression. Copyright 2015, SLACK Incorporated.

  7. A tangent subsolar merging line

    International Nuclear Information System (INIS)

    Crooker, N.U.; Siscoe, G.L.; Toffoletto, F.R.

    1990-01-01

    The authors describe a global magnetospheric model with a single subsolar merging line whose position is determined neither locally by the relative orientations and strengths of the merging fields nor globally by the orientation of a separator line--the governing parameters of most previous models--but by the condition of tangential contact between the external field and the magnetopause. As in previous models, the tilt of the merging line varies with IMF orientation, but here it also depends upon the ratio of Earth's magnetic flux that leaks out of the magnetopause to IMF flux that penetrates in. In the limiting case treated by Alekseyev and Belen'kaya, with no leakage of Earth's field and total IMF penetration, the merging line forms a great circle around a spherical magnetosphere where undeviated IMF lines lie tangent to its surface. This tangent merging line lies perpendicular to the IMF. They extend their work to the case of finite leakage and partial penetration, which distort the IMF into a draped pattern, thus changing the locus of tangency to the sphere. In the special case where the penetrating IMF flux is balanced by an equal amount of Earth flux leakage, the tangent merging line bisects the angle between the IMF and Earth's northward subsolar field. This result is identical to the local merging line model result for merging fields with equal magnitude. Here a global flux balance condition replaces the local equal magnitude condition

  8. Use of mental health services by nursing home residents after hurricanes.

    Science.gov (United States)

    Brown, Lisa M; Hyer, Kathryn; Schinka, John A; Mando, Ahed; Frazier, Darvis; Polivka-West, Lumarie

    2010-01-01

    A growing body of research supports the value of mental health intervention to treat people affected by disasters. This study used a mixed-methods approach to evaluate pre- and posthurricane mental health service use in Florida nursing homes. A questionnaire was administered to 258 directors of nursing, administrators, and owners of nursing homes, representing two-thirds of Florida's counties, to identify residents' mental health needs and service use. In four subsequent focus group meetings with 22 nursing home administrators, underlying factors influencing residents' use of services were evaluated. Although most nursing homes provided some type of mental health care during normal operations, disaster-related mental health services were not routinely provided to residents. Receiving facilities were more likely than evacuating facilities to provide treatment to evacuated residents. Nursing home staff should be trained to deliver disaster-related mental health intervention and in procedures for making referrals for follow-up evaluation and formal intervention.

  9. Merging By Decentralized Eventual Consistency Algorithms

    Directory of Open Access Journals (Sweden)

    Ahmed-Nacer Mehdi

    2015-12-01

    Full Text Available Merging mechanism is an essential operation for version control systems. When each member of collaborative development works on an individual copy of the project, software merging allows to reconcile modifications made concurrently as well as managing software change through branching. The collaborative system is in charge to propose a merge result that includes user’s modifications. Theusers now have to check and adapt this result. The adaptation should be as effort-less as possible, otherwise, the users may get frustrated and will quit the collaboration. This paper aims to reduce the conflicts during the collaboration and im prove the productivity. It has three objectives: study the users’ behavior during the collaboration, evaluate the quality of textual merging results produced by specific algorithms and propose a solution to improve the r esult quality produced by the default merge tool of distributed version control systems. Through a study of eight open-source repositories totaling more than 3 million lines of code, we observe the behavior of the concurrent modifications during t he merge p rocedure. We i dentified when th e ex isting merge techniques under-perform, and we propose solutions to improve the quality of the merge. We finally compare with the traditional merge tool through a large corpus of collaborative editing.

  10. Home-based carers’ perceptions of health promotion on sexual health communication in Vhembe District

    Directory of Open Access Journals (Sweden)

    Dorah U. Ramathuba

    2015-05-01

    Full Text Available Background: The introduction of home-based care in rural communities in the 1980s contributed immensely toward the upliftment of the personal and environmental health of communities. Women’s groups provided health promotion skills and health education to communities and made a difference in health-related behaviour change. Objective: The purpose of the study was to explore and describe the home-based carers’ perception regarding health promotion concerning sexual health communication in Vhembe district, in the context of HIV, amongst communities still rooted in their culture. Method: A qualitative, explorative and descriptive design was used in order to understand home-based carers’ perceptions regarding health promotion on sexual health communication amongst rural communities which may adversely impact on health promotion practices. The population were home-based organisations in Vhembe. The sample was purposive and randomly selected and data were gathered through semi-structured face-to-face interviews and focus groups which determined data saturation. Open coding was used for analysis of data. Results: The results indicated that sexual communication was absent in most relationships and was not seen as necessary amongst married couples. Socioeconomic conditions, power inequity and emotional dependence had a negative impact on decision making and sexual communication. Conclusion: This study, therefore, recommends that educational and outreach efforts should focus on motivating change by improving the knowledge base of home-based carers. Since they are health promoters, they should be able to change the perceptions of the communities toward sexually-transmitted infections and HIV by promoting sexual health communication.

  11. Population Health and Tailored Medical Care in the Home: the Roles of Home-Based Primary Care and Home-Based Palliative Care.

    Science.gov (United States)

    Ritchie, Christine S; Leff, Bruce

    2018-03-01

    With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. Home-based medical care services have two flavors that are related to historical context and specialty background-home-based primary care (HBPC) and home-based palliative care (HBPalC). Although the type of services provided by HBPC and HBPalC (together termed "home-based medical care") overlap, HBPC tends to encompass longitudinal and preventive care, while HBPalC often provides services for shorter durations focused more on distress management and goals of care clarification. Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  12. Health Information Technology and Nursing Homes

    Science.gov (United States)

    Liu, Darren

    2009-01-01

    Nursing homes are considered lagging behind in adopting health information technology (HIT). Many studies have highlighted the use of HIT as a means of improving health care quality. However, these studies overwhelmingly do not provide empirical information proving that HIT can actually achieve these improvements. The main research goal of this…

  13. Competition and quality in home health care markets.

    Science.gov (United States)

    Jung, Kyoungrae; Polsky, Daniel

    2014-03-01

    Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients' homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition. Copyright © 2013 John Wiley & Sons, Ltd.

  14. COMPETITION AND QUALITY IN HOME HEALTH CARE MARKETS†

    Science.gov (United States)

    JUNG, KYOUNGRAE; POLSKY, DANIEL

    2013-01-01

    SUMMARY Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients’ homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition. PMID:23670849

  15. Montessori-based training makes a difference for home health workers & their clients.

    Science.gov (United States)

    Gorzelle, Gregg J; Kaiser, Kathy; Camp, Cameron J

    2003-01-01

    Home care visits can last several hours. Home care workers are often at a loss on how to fill time spent in homes of clients. The challenge is how to use this time in ways that are productive and engaging for both clients and home health workers. The authors trained home health aides to implement Montessori-based activities while interacting with clients who have dementia. The results were amazing. Among other positive results, the authors found a statistically significant increase in the amount of pleasure displayed by clients after health workers received training.

  16. Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes

    Science.gov (United States)

    Molony, Sheila L.; Evans, Lois K.; Jeon, Sangchoon; Rabig, Judith; Straka, Leslie A.

    2011-01-01

    Background: Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. Purpose: To compare and contrast trajectories of at-homeness and health over…

  17. Home health nursing care services in Greece during an economic crisis.

    Science.gov (United States)

    Adamakidou, T; Kalokerinou-Anagnostopoulou, A

    2017-03-01

    The purpose of this review was to describe public home healthcare nursing services in Greece. The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided. © 2016 International Council of Nurses.

  18. Mapping the literature of home health nursing.

    Science.gov (United States)

    Friedman, Yelena

    2006-04-01

    The purpose of this study was to identify core journals in home health nursing and to determine how well these journals were covered by indexing and abstracting services. The study was part of the project for mapping the nursing literature of the Medical Library Association's Nursing and Allied Health Resource Section. A citation analysis of two core journals was done to determine distribution of references by format types and age of citations and dispersion of the literature, according to Bradford's Law of Scattering. The analysis of indexing coverage for Zone 1 and 2 was also provided. The study showed that 64.2% of citations came from journals, versus 22.9% from books and 12.9% from other publications. PubMed/ MEDLINE rated highest in average indexing coverage of Zone 1 and 2 journals, followed by CINAHL. PsycINFO, SocioAbstracts, and EBSCO Health Business FullTEXT showed practically no coverage for the home health nursing literature. As expected, journal articles were found to be the primary source for referencing and books, the secondary source. In regard to bibliographic control, no databases provided full coverage of the journals in the field of home health nursing. PubMed/MEDLINE and CINAHL gave better results in combination, because CINAHL tended to cover more nursing journals, while PubMed/MEDLINE did better with medical titles.

  19. Dayside merging and cusp geometry

    International Nuclear Information System (INIS)

    Crooker, N.U.

    1979-01-01

    Geometrical considerations are presented to show that dayside magnetic merging when constrained to act only where the fields are antiparallel results in lines of merging that converge at the polar cusps. An important consequence of this geometry is that no accelerated flows are predicted across the dayside magnetopause. Acceleration owing to merging acts in opposition to the magnetosheath flow at the merging point and produces the variably directed, slower-than-magnetosheath flows observed in the entry layer. Another consequence of the merging geometry is that much of the time closed field lines constitute the subsolar region of the magnetopause. The manner in which the polar cap convection patterns predicted by the proposed geometry change as the interplanetary field is rotated through 360 0 provides a unifying description of how the observed single circular vortex and the crescent-shaped double vortex patterns mutually evolve under the influence of a single operating principle

  20. Use of the Home Safety Self-Assessment Tool (HSSAT) within Community Health Education to Improve Home Safety.

    Science.gov (United States)

    Horowitz, Beverly P; Almonte, Tiffany; Vasil, Andrea

    2016-10-01

    This exploratory research examined the benefits of a health education program utilizing the Home Safety Self-Assessment Tool (HSSAT) to increase perceived knowledge of home safety, recognition of unsafe activities, ability to safely perform activities, and develop home safety plans of 47 older adults. Focus groups in two senior centers explored social workers' perspectives on use of the HSSAT in community practice. Results for the health education program found significant differences between reported knowledge of home safety (p = .02), ability to recognize unsafe activities (p = .01), safely perform activities (p = .04), and develop a safety plan (p = .002). Social workers identified home safety as a major concern and the HSSAT a promising assessment tool. Research has implications for reducing environmental fall risks.

  1. Exploring the activity profile of health care assistants and nurses in home nursing.

    Science.gov (United States)

    De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Moons, Philip

    2015-12-01

    Are home nurses (also known as community nurses) ready for their changing role in primary care? A quantitative study was performed in home nursing in Flanders, Belgium, to explore the activity profile of home nurses and health care assistants, using the 24-hour recall instrument for home nursing. Seven dates were determined, covering each day of the week and the weekend, on which data collection would take place. All the home nurses and health care assistants from the participating organisations across Flanders were invited to participate in the study. All data were measured at nominal level. A total of 2478 home nurses and 277 health care assistants registered 336 128 (47 977 patients) and 36 905 (4558 patients) activities, respectively. Home nurses and health care assistants mainly perform 'self-care facilitation' activities in combination with 'psychosocial care' activities. Health care assistants also support home nurses in the 'selfcare facilitation' of patients who do not have a specific nursing indication.

  2. Applying the International Classification of Functioning, Disability and Health to guide home health care services planning and delivery in Thailand.

    Science.gov (United States)

    Pimdee, Atipong; Nualnetr, Nomjit

    2017-01-01

    Home health care is an essential service for home-bound patients in Thailand. In this action research study, we used the International Classification of Functioning, Disability and Health (ICF) framework to modify home health care services provided by a university hospital. Staff responsible for delivering the services (physical therapist, nurses, and Thai traditional medicine practitioners) participated in the development of an ICF-based assessment tool and home health care service procedure. After an 8-month trial of implementing these changes, professional satisfaction and empowerment were high among the home health care team members. Patients and their caregivers were also satisfied with the services. In conclusion, the ICF is an effective means of guiding home health care.

  3. Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health.

    Science.gov (United States)

    Lindley, Lisa C; Mixer, Sandra J; Mack, Jennifer W

    2016-01-01

    Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.

  4. Team-level flexibility, work–home spillover, and health behavior

    Science.gov (United States)

    Moen, Phyllis; Fan, Wen; Kelly, Erin L.

    2013-01-01

    Drawing on two waves of survey data conducted six months apart in 2006, this study examined the impacts of a team-level flexibility initiative (ROWE – Results Only Work Environment) on changes in the work-home spillover and health behavior of employees at the Midwest headquarters of a large US corporation. Using cluster analysis, we identified three distinct baseline spillover constellations: employees with high negative spillover, high positive spillover, and low overall spillover. Within-team spillover measures were highly intercorrelated, suggesting that work teams as well as individuals have identifiable patterns of spillover. Multilevel analyses showed ROWE reduced individual- and team-level negative work-home spillover but not positive work-home spillover or spillover from home-to-work. ROWE also promoted employees’ health behaviors: increasing the odds of quitting smoking, decreasing smoking frequency, and promoting perceptions of adequate time for healthy meals. Trends suggest that ROWE also decreased the odds of excessive drinking and improved sleep adequacy and exercise frequency. Some health behavior effects were mediated via reduced individual-level negative work-home spillover (exercise frequency, adequate time for sleep) and reduced team-level negative work-home spillover (smoking frequency, exercise frequency, and adequate time for sleep). While we found no moderating effects of gender, ROWE especially improved the exercise frequency of singles and reduced the smoking frequency of employees with low overall spillover at baseline. PMID:23517706

  5. Home Health Compare: Find a Home Health Agency

    Science.gov (United States)

    ... page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with " ... widget - Select to show Back to top Footer Home A federal government website managed and paid for ...

  6. Evidence-Based Health Promotion in Nursing Homes: A Pilot Intervention to Improve Oral Health

    Science.gov (United States)

    Cadet, Tamara J.; Berrett-Abebe, Julie; Burke, Shanna L.; Bakk, Louanne; Kalenderian, Elsbeth; Maramaldi, Peter

    2016-01-01

    Nursing home residents over the age of 65 years are at high risk for poor oral health and related complications such as pneumonia and adverse diabetes outcomes. A preliminary study found that Massachusetts' nursing homes generally lack the training and resources needed to provide adequate oral health care to residents. In this study, an…

  7. Smart home technologies for health and social care support.

    Science.gov (United States)

    Martin, Suzanne; Kelly, Greg; Kernohan, W George; McCreight, Bernadette; Nugent, Christopher

    2008-10-08

    The integration of smart home technology to support health and social care is acquiring an increasing global significance. Provision is framed within the context of a rapidly changing population profile, which is impacting on the number of people requiring health and social care, workforce availability and the funding of healthcare systems. To explore the effectiveness of smart home technologies as an intervention for people with physical disability, cognitive impairment or learning disability, who are living at home, and to consider the impact on the individual's health status and on the financial resources of health care. We searched the following databases for primary studies: (a) the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register, (b) the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, issue 1, 2007), and (c) bibliographic databases, including MEDLINE (1966 to March 2007), EMBASE (1980 to March 2007) and CINAHL (1982 to March 2007). We also searched the Database of Abstracts of Reviews of Effectiveness (DARE). We searched the electronic databases using a strategy developed by the EPOC Trials Search Co-ordinator. We included randomised controlled trials (RCTs), quasi-experimental studies, controlled before and after studies (CBAs) and interrupted time series analyses (ITS). Participants included adults over the age of 18, living in their home in a community setting. Participants with a physical disability, dementia or a learning disability were included. The included interventions were social alarms, electronic assistive devices, telecare social alert platforms, environmental control systems, automated home environments and 'ubiquitous homes'. Outcome measures included any objective measure that records an impact on a participant's quality of life, healthcare professional workload, economic outcomes, costs to healthcare provider or costs to participant. We included measures of service satisfaction

  8. Home births in the context of free health care: The case of Kaya health district in Burkina Faso.

    Science.gov (United States)

    Kouanda, Seni; Bado, Aristide; Meda, Ivlabèhiré Bertrand; Yameogo, Gisèle S; Coulibaly, Abou; Haddad, Slim

    2016-11-01

    To identify the factors associated with home births in the Kaya health district in Burkina Faso, where child delivery was free of charge between 2007 and 2011. Both qualitative and quantitative data were collected from the Kaya Health and Demographic Surveillance System (Kaya HDSS) among women who delivered at home or in a health facility between January 2008 and December 2010. Multilevel logistic regression was applied to quantitative data, while the qualitative data were analyzed thematically based on emerging themes, subthemes, and patterns across group and individual cases. The findings indicate that 12% (n=311) of childbirths occurred at home (n=2560). Key factors associated with home birth were age, distance from the household to the primary health center, and prenatal visits. The qualitative analysis showed that immediate child delivery, previous experience of giving birth at home, negative experiences with health centers, fear of cesarean delivery, and lack of transport are key predictors of home births. Though relevant, addressing the financial barrier to health care is not enough. Additional measures are necessary to further reduce the rate of home births. Copyright © 2016. Published by Elsevier Ireland Ltd.

  9. Morphology of magnetic merging at the magnetopause

    International Nuclear Information System (INIS)

    Crooker, N.U.

    1990-01-01

    To illustrate the basic features of magnetospheric topology, the development of a global model is traced from the superposition of dipole and uniform fields to the effects of adding, in turn, diffusion regions, surface currents, and a magnetic field component normal to the magnetopause. The subsolar, antiparallel, tearing, and patchy merging geometries proposed in the past all emerge under various conditions, but models tht deduce merging geometry from global boundary conditions are lacking. An exception is a model in which the external field merges wherever it falls tangent to the magnetopause. The result is a subsolar merging line that has all the characteristics of early sketches based on local arguments. Magnetosheath plasma beta affects magnetospheric topology and, consequently, merging geometry. Low, high, and variable beta favor subsolar, tearing, and patchy merging, respectively. Proposed flux transfer event models of burst reconnection from a single merging line, flux ropes from multiple merging lines, and flux tube elbows from patches can also be categorized by plasma beta in the same respective order. The topological modeling reviewed here may prove to be most useful for interpreting merging results from MHD simulations. (author)

  10. Mental health services for homebound elders from home health nursing agencies and home care agencies.

    Science.gov (United States)

    Zeltzer, Barry B; Kohn, Robert

    2006-04-01

    This study examined the practices of home care agencies and home health nursing agencies in the management and treatment of homebound clients with behavioral problems, dementia, and undiagnosed mental illnesses. A survey was mailed to all 54 directors of agencies in Rhode Island in 2003; 53 responded, either by mail or telephone. Data indicated a lack of psychiatric services, a reluctance to address behavioral problems, and a failure to identify undiagnosed disorders. There was also a bias against accepting individuals with primary psychiatric disorders. Although the population of homebound elders with mental illness is increasing, their needs are not being met by these agencies.

  11. Work-home interference among nurses: reciprocal relationships with job demands and health.

    Science.gov (United States)

    van der Heijden, Beatrice I J M; Demerouti, Evangelia; Bakker, Arnold B

    2008-06-01

    This paper is a report of a study with three aims: (i) to investigate whether emotional, quantitative and physical demands have a causal, negative impact on nurses' health; (ii) to examine whether work-home interference can explain this effect, by playing a mediating role; and (iii) to test the so-called loss spiral hypothesis claiming that nurses' health problems lead to even higher job demands and more work-home interference over time. While many scholars have thought in terms of the stressor-->work-home interference-->strain model, the validity of a model that includes opposite pathways needs to be tested. A questionnaire was completed twice, with a 1-year time interval by 753 (63.4%) Registered Nurses working in hospitals, 183 (15.4%) working in nursing homes, and 251 (21.1%) working in home care institutions. The first measurement took place between October 2002 and June 2003. Our findings strongly support the idea of cross-lagged, reciprocal relationships between job demands and general health over time. The reciprocal model with work-home interference as an intervening variable (including reciprocal relationships between job demands, work-home interference and general health) showed a good fit to the data, and proved to be superior to both the causality and reversed causation models. The higher nurses' job demands, the higher is their level of work-home interference and the more likely is a general health deterioration over time, in turn giving rise to higher job demands and work-home interference, which may even aggravate the nurses' general health, and so on.

  12. Health and Safety Guide for Home Performance Contractors

    Energy Technology Data Exchange (ETDEWEB)

    Stratton, Chris [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Walker, Iain S. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2012-02-15

    This report is intended to provide home performance contractor trainers with a resource to keep both their workers and home residents safe and healthy. This document is an attempt to describe what we currently believe is safe, what we believe is unsafe, and what we’re unsure about. It is intended to identify health and safety issues and provide historical context and current understanding of both risks and mitigation strategies. In addition, it provides links to more in-depth resources for each issue. When we tighten the thermal envelope of a house to improve comfort and reduce energy use, we have to be sure that we are not compromising the indoor air quality of the home. This means identifying and mitigating or eliminating pollution sources before and after you make changes to the home. These sources can include materials and finishes in the home, exhaust gasses from combustion appliances, soil gasses such as radon, and moisture from a bathroom, kitchen, or unvented clothes dryer. Our first responsibility is to do no harm — this applies both to our clients and to our employees. Currently, there are many new products that are widely used but whose health effects are not well understood. Our in ability to have perfect information means the directive to do no harm can be difficult to obey. Each home is a little bit different, and in the face of a situation you’ve never encountered, it’s important to have a solid grasp of the fundamental concepts of building science when the hard and fast rules don’t apply . The home performance industry is gaining momentum, and has the potential to expand greatly as energy costs continue to rise. It is imperative that we remain vigilant about protecting the health and safety of our workers and our customers. It only takes a few news stories about a family that got sick after their home was tightened by a home performance contractor to scare off potential customers and taint the reputation of the entire industry. Good

  13. Useful tool for general practitioners, home health care nurses and social workers in assessing determinants of the health status and treatment of patients visited in their homes

    Directory of Open Access Journals (Sweden)

    Andrzej Brodziak

    2012-09-01

    Full Text Available The necessity is emphasized to distinguish between the traditional model of data acquisition reported by a patient in doctor’s office and the more valuable and desired model to become acquainted with the core of the problem by going to a patient’s domicile. In the desired model it is possible to come across various determinants of health during home visits. Family members can be approached and there is a possibility to evaluate the relationships between the patient and his loved ones. One can visually assess one’s living conditions and predictable environmental hazard. For several years, the desired model has been put into practice by general practitioners and home health care nurses. Recently this model is also promoted by “health care therapists” who are members of “teams of home health care”. The authors, being convinced of the merits of “home and environmental model” of practical medicine, have developed a method of recording and illustrating data collected during visits in patient’s home. The elaborated tool helps to communicate and exchange information among general practitioners, home health care nurses, social workers of primary health care centers and specialists. The method improves the formulation of the plan of further therapeutic steps and remedial interventions in psycho-social relations and living conditions of patients.

  14. Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

    Science.gov (United States)

    2015-11-05

    This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

  15. The home care teaching and learning process in undergraduate health care degree courses.

    Science.gov (United States)

    Hermann, Ana Paula; Lacerda, Maria Ribeiro; Maftum, Mariluci Alves; Bernardino, Elizabeth; Mello, Ana Lúcia Schaefer Ferreira de

    2017-07-01

    Home care, one of the services provided by the health system, requires health practitioners who are capable of understanding its specificities. This study aimed to build a substantive theory that describes experiences of home care teaching and learning during undergraduate degree courses in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy. A qualitative analysis was performed using the grounded theory approach based on the results of 63 semistructured interviews conducted with final year students, professors who taught subjects related to home care, and recent graduates working with home care, all participants in the above courses. The data was analyzed in three stages - open coding, axial coding and selective coding - resulting in the phenomenon Experiences of home care teaching and learning during the undergraduate health care degree courses. Its causes were described in the category Articulating knowledge of home care, strategies in the category Experiencing the unique nature of home care, intervening conditions in the category Understanding the multidimensional characteristics of home care, consequences in the category Changing thinking about home care training, and context in the category Understanding home care in the health system. Home care contributes towards the decentralization of hospital care.

  16. Merging Electronic Health Record Data and Genomics for Cardiovascular Research: A Science Advisory From the American Heart Association.

    Science.gov (United States)

    Hall, Jennifer L; Ryan, John J; Bray, Bruce E; Brown, Candice; Lanfear, David; Newby, L Kristin; Relling, Mary V; Risch, Neil J; Roden, Dan M; Shaw, Stanley Y; Tcheng, James E; Tenenbaum, Jessica; Wang, Thomas N; Weintraub, William S

    2016-04-01

    The process of scientific discovery is rapidly evolving. The funding climate has influenced a favorable shift in scientific discovery toward the use of existing resources such as the electronic health record. The electronic health record enables long-term outlooks on human health and disease, in conjunction with multidimensional phenotypes that include laboratory data, images, vital signs, and other clinical information. Initial work has confirmed the utility of the electronic health record for understanding mechanisms and patterns of variability in disease susceptibility, disease evolution, and drug responses. The addition of biobanks and genomic data to the information contained in the electronic health record has been demonstrated. The purpose of this statement is to discuss the current challenges in and the potential for merging electronic health record data and genomics for cardiovascular research. © 2016 American Heart Association, Inc.

  17. 77 FR 60128 - Noncompetitive Supplements to Nursing Assistant and Home Health Aide Program Grantees

    Science.gov (United States)

    2012-10-02

    ... Noncompetitive Supplements to Nursing Assistant and Home Health Aide Program Grantees AGENCY: Health Resources... expansion supplements of $100,000 to 10 Nursing Assistant and Home Health Aide (NAHHA) Program grantees to... Management; Care Coordination and Follow Up; and Behavioral Health and Social Support for Home Health Aides...

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

    Directory of Open Access Journals (Sweden)

    Grace Haeson Park

    2014-03-01

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

  19. Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30- and 60-Day Hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial.

    Science.gov (United States)

    Bruce, Martha L; Lohman, Matthew C; Greenberg, Rebecca L; Bao, Yuhua; Raue, Patrick J

    2016-11-01

    To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306). The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks. Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments. The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants. Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  20. Numerical Investigation of Merged and Non-merged Flame of a Twin Cavity Annular Trapped Vortex Combustor

    Directory of Open Access Journals (Sweden)

    Pravendra Kumar

    2016-09-01

    Full Text Available : The present work is focused to characterize numerically the merged and non-merged flame emanating from the cavities in downstream of twin cavity Annular Trapped Vortex Combustor (ATVC.The isotherm corresponding to the auto-ignition temperature is used to locate the merging point of the flame in the mainstream region along the combustor length. In present study, the cavity flame is said to be merged only if this isotherm corresponding to self-ignition temperature of methane is located within 20 percentage of the combustor length from aft wall of cavities. It is interesting to note that on increasing the power loading parameter (PLP in mainstream for a constant power loading parameter ratio (outer to inner cavity, the merging point gets shifted towards the cavity aft-wall. This leads to the reduction of combustor length and subsequent reduction in overall weight of the gas turbine engine.

  1. Team-level flexibility, work-home spillover, and health behavior.

    Science.gov (United States)

    Moen, Phyllis; Fan, Wen; Kelly, Erin L

    2013-05-01

    Drawing on two waves of survey data conducted six months apart in 2006, this study examined the impacts of a team-level flexibility initiative (ROWE--results only work environment) on changes in the work-home spillover and health behavior of employees at the Midwest headquarters of a large U.S. corporation. Using cluster analysis, we identified three distinct baseline spillover constellations: employees with high negative spillover, high positive spillover, and low overall spillover. Within-team spillover measures were highly intercorrelated, suggesting that work teams as well as individuals have identifiable patterns of spillover. Multilevel analyses showed ROWE reduced individual- and team-level negative work-home spillover but not positive work-home spillover or spillover from home-to-work. ROWE also promoted employees' health behaviors: increasing the odds of quitting smoking, decreasing smoking frequency, and promoting perceptions of adequate time for healthy meals. Trends suggest that ROWE also decreased the odds of excessive drinking and improved sleep adequacy and exercise frequency. Some health behavior effects were mediated via reduced individual-level negative work-home spillover (exercise frequency, adequate time for sleep) and reduced team-level negative work-home spillover (smoking frequency, exercise frequency, and adequate time for sleep). While we found no moderating effects of gender, ROWE especially improved the exercise frequency of singles and reduced the smoking frequency of employees with low overall spillover at baseline. Copyright © 2013. Published by Elsevier Ltd.

  2. Home Health Agency Performance in the United States: 2011-15.

    Science.gov (United States)

    Wang, Yun; Spatz, Erica S; Tariq, Maliha; Angraal, Suveen; Krumholz, Harlan M

    2017-12-01

    To evaluate home health agency quality performance. Observational study. Home health agencies. All Medicare-certified agencies with at least 6 months of data from 2011 to 2015. Twenty-two quality indicators, five patient survey indicators, and their composite scores. The study included 11,462 Medicare-certified home health agencies that served 92.4% of all ZIP codes nationwide, accounting for 315.2 million people. The mean composite scores were 409.1 ± 22.7 out of 500 with the patient survey indicators and 492.3 ± 21.7 out of 600 without the patient survey indicators. Home health agency performance on 27 quality indicators varied, with the coefficients of dispersion ranging from 4.9 to 62.8. Categorization of agencies into performance quartiles revealed that 3,179 (27.7%) were in the low-performing group (below 25th percentile) at least one time during the period from 2011-12 to 2014-15 and that 493 were in the low-performing group throughout the study period. Geographic variation in agency performance was observed. Agencies with longer Medicare-certified years were more likely to have high-performing scores; agencies providing partial services, with proprietary ownership, and those with long travel distances to reach patients had lower performance. Agencies serving low-income counties and counties with lower proportions of women and senior residences and greater proportions of Hispanic residents were more likely to attain lower performance scores. Home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance. Still, there is a need to improve the quality of care of all agencies. Many parts of the United States, particularly lower-income areas and areas with more Hispanic residents, are more likely to receive lower quality home health care. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  3. Medicare and Medicaid programs; CY 2015 Home Health Prospective Payment System rate update; Home Health Quality Reporting Requirements; and survey and enforcement requirements for home health agencies. Final rule.

    Science.gov (United States)

    2014-11-06

    This final rule updates Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2015. As required by the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule provides information on our efforts to monitor the potential impacts of the rebasing adjustments and the Affordable Care Act mandated face-to-face encounter requirement. This rule also implements: Changes to simplify the face-to-face encounter regulatory requirements; changes to the HH PPS case-mix weights; changes to the home health quality reporting program requirements; changes to simplify the therapy reassessment timeframes; a revision to the Speech-Language Pathology (SLP) personnel qualifications; minor technical regulations text changes; and limitations on the reviewability of the civil monetary penalty provisions. Finally, this rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and a HH value-based purchasing (HH VBP) model.

  4. Environmental Health and Safety Hazards Experienced by Home Health Care Providers: A Room-by-Room Analysis.

    Science.gov (United States)

    Polivka, Barbara J; Wills, Celia E; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

    2015-11-01

    The number of personnel providing in-home health care services is increasing substantially. The unique configuration of environmental hazards in individual client homes has a significant impact on the safety and health of home health care providers (HHPs). This mixed-methods study used data from a standardized questionnaire, focus groups, and individual interviews to explore environmental health and safety hazards encountered by HHPs in client homes. The participant sample (N = 68) included nurses, aides, therapists, and owners/managers from a variety of geographic locations. The most often-reported hazards were trip/slip/lift hazards, biohazards, and hazards from poor air quality, allergens, pests and rodents, and fire and burns. Frequency of identified key hazards varied by room, that is, kitchen (e.g., throw rugs, water on floor), bathroom (e.g., tight spaces for client handling), bedroom (e.g., bed too low), living room (e.g., animal waste), and hallway (e.g., clutter). Findings indicate the need for broader training to enable HHPs to identify and address hazards they encounter in client homes. © 2015 The Author(s).

  5. Can the care transitions measure predict rehospitalization risk or home health nursing use of home healthcare patients?

    Science.gov (United States)

    Ryvicker, Miriam; McDonald, Margaret V; Trachtenberg, Melissa; Peng, Timothy R; Sridharan, Sridevi; Feldman, Penny H

    2013-01-01

    The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits. The CTM was administered to 495 home healthcare patients shortly after hospital discharge and home healthcare admission. Follow-up interviews were completed 30 and 60 days post hospital discharge. Interview data were supplemented with agency assessment and service use data. We did not find evidence that the CTM could predict home healthcare patients having an elevated risk for emergent care, rehospitalization, or higher home health nursing use. Because Medicare/Medicaid-certified home healthcare providers already use a comprehensive, mandated start of care assessment, the CTM may not provide them additional crucial information. Process and outcome measurement is increasingly becoming part of usual care. Selection of measures appropriate for each service setting requires thorough site-specific evaluation. In light of our findings, we cannot recommend the CTM as an additional measure in the home healthcare setting. © 2013 National Association for Healthcare Quality.

  6. Association Between Race, Neighborhood, and Medicaid Enrollment and Outcomes in Medicare Home Health Care.

    Science.gov (United States)

    Joynt Maddox, Karen E; Chen, Lena M; Zuckerman, Rachael; Epstein, Arnold M

    2018-02-01

    More than 3 million Medicare beneficiaries use home health care annually, yet little is known about how vulnerable beneficiaries fare in the home health setting. This is particularly important given the recent launch of Medicare's Home Health Value-Based Purchasing model. The objective of this study was to determine odds of adverse clinical outcomes associated with dual enrollment in Medicaid and Medicare as a marker of individual poverty, residence in a low-income ZIP code tabulation area (ZCTA), and black race. Retrospective observational study using individuals-level logistic regression. Home health care. Fee-for-service Medicare beneficiaries from 2012 to 2014. Thirty- and 60-day clinical outcomes, including readmissions, admissions, and emergency department (ED) use. Home health agencies serving a high proportion of dually enrolled, low-income ZCTA, or black beneficiaries were less often high-quality. Dually-enrolled, low-income ZCTA, and Black beneficiaries receiving home health care after hospitalization had higher risk-adjusted odds of 30-day readmission (odds ratio [OR] = 1.08, P home health care without preceding hospitalization had higher 60-day admission (OR = 1.06, P home health services who are dually enrolled, live in a low-income neighborhood, or are black have higher rates of adverse clinical outcomes. These populations may be an important target for quality improvement under Home Health Value-Based Purchasing. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  7. Merged neutral beams

    Energy Technology Data Exchange (ETDEWEB)

    Osterwalder, Andreas [Ecole Polytechnique Federale de Lausanne (EPFL), Institute for Chemical Sciences and Engineering, Lausanne (Switzerland)

    2015-12-15

    A detailed description of a merged beam apparatus for the study of low energy molecular scattering is given. This review is intended to guide any scientist who plans to construct a similar experiment, and to provide some inspiration in describing the approach we chose to our goal. In our experiment a supersonic expansion of paramagnetic particles is merged with one of polar molecules. A magnetic and an electric multipole guide are used to bend the two beams onto the same axis. We here describe in detail how the apparatus is designed, characterised, and operated. (orig.)

  8. Does information matter? Competition, quality, and the impact of nursing home report cards.

    Science.gov (United States)

    Grabowski, David C; Town, Robert J

    2011-12-01

    We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. © Health Research and Educational Trust.

  9. Meaning creation and employee engagement in home health caregivers.

    Science.gov (United States)

    Nielsen, Mette Strange; Jørgensen, Frances

    2016-03-01

    The purpose of this study is to contribute to an understanding on how home health caregivers experience engagement in their work, and specifically, how aspects of home healthcare work create meaning associated with employee engagement. Although much research on engagement has been conducted, little has addressed how individual differences such as worker orientation influence engagement, or how engagement is experienced within a caregiving context. The study is based on a qualitative study in two home homecare organisations in Denmark using a think-aloud data technique, interviews and observations. The analysis suggests caregivers experience meaning in three relatively distinct ways, depending on their work orientation. Specifically, the nature of engagement varies across caregivers oriented towards being 'nurturers', 'professionals', or 'workers', and the sources of engagement differ for each of these types of caregivers. The article contributes by (i) advancing our theoretical understanding of employee engagement by emphasising meaning creation and (ii) identifying factors that influence meaning creation and engagement of home health caregivers, which should consequently affect the quality of services provided home healthcare patients. © 2015 Nordic College of Caring Science.

  10. Flooded homes, broken bonds, the meaning of home, psychological processes and their impact on psychological health in a disaster.

    Science.gov (United States)

    Carroll, Bob; Morbey, Hazel; Balogh, Ruth; Araoz, Gonzalo

    2009-06-01

    In 2005, Carlisle suffered severe flooding and 1600 houses were affected. A qualitative research project to study the social and health impacts was undertaken. People whose homes had been flooded and workers who had supported them were interviewed. The findings showed that there was severe disruption to people's lives and severe damage to their homes, and many suffered from psychological health issues. Phenomenological and transactional perspectives are utilised to analyse the psychological processes (identity, attachment, alienation and dialectics) underlying the meaning of home and their impact on psychological health. Proposals for policy and practice are made.

  11. Mapping the literature of home health nursing

    OpenAIRE

    Friedman, Yelena

    2006-01-01

    Objectives: The purpose of this study was to identify core journals in home health nursing and to determine how well these journals were covered by indexing and abstracting services. The study was part of the project for mapping the nursing literature of the Medical Library Association's Nursing and Allied Health Resource Section.

  12. [Oral and dental health and oral and dental support of home patients--role of dental hygienist in the home service nursing station].

    Science.gov (United States)

    Hayashi, T; Kimura, M; Tamura, N; Hirata, S; Yabunaka, T; Kamimura, Y

    1999-12-01

    Home patients have few chances for going out, so communication with their family means a lot. Talking and eating are particular pleasures. Therefore, oral and dental health and oral and dental support are very important for home patients. A dental hygienist from our clinic visits and offers oral and dental health (oral care) and oral and dental support (oral rehabilitation) to home patients as part of a care plan with home care nurses. Moreover, as general conditions are closely related with oral function, maintaining oral and dental health and regular oral and dental support are very important in order to improve the quality of life (QOL) of home patients.

  13. Bouncing and Merging of Liquid Jets

    Science.gov (United States)

    Saha, Abhishek; Li, Minglei; Law, Chung K.

    2014-11-01

    Collision of two fluid jets is a technique that is utilized in many industrial applications, such as in rocket engines, to achieve controlled mixing, atomization and sometimes liquid phase reactions. Thus, the dynamics of colliding jets have direct impact on the performance, efficiency and reliability of such applications. In analogy with the dynamics of droplet-droplet collision, in this work we have experimentally demonstrated, for n-alkane hydrocarbons as well as water, that with increasing impact inertia obliquely colliding jets also exhibit the same nonmonotonic responses of merging, bouncing, merging again, and merging followed by disintegration; and that the continuous entrainment of the boundary layer air over the jet surface into the colliding interfacial region leads to two distinguishing features of jet collision, namely: there exists a maximum impact angle beyond which merging is always possible, and that merging is inhibited and then promoted with increasing pressure. These distinct response regimes were mapped and explained on the bases of impact inertia, deformation of the jet surface, viscous loss within the jet interior, and the thickness and pressure build-up within the interfacial region in order to activate the attractive surface van der Waals force to effect merging.

  14. [Clinical evaluation of bedridden patients with pneumonia receiving home health care].

    Science.gov (United States)

    Fukuyama, Hajime; Ishida, Tadashi; Tachibana, Hiromasa; Iga, Chiya; Nakagawa, Hiroaki; Ito, Akihiro; Ubukata, Satoshi; Yoshioka, Hiroshige; Arita, Machiko; Hashimoto, Toru

    2010-12-01

    Pneumonia which develops in patients while living in their own home is categorized as community-acquired pneumonia (CAP), even if these patients are bedridden and receiving home health care. However, because of the differences in patient backgrounds, we speculated that the clinical outcomes and pathogens of bedridden patients with pneumonia who are receiving home health care would be different from those of CAP. We conducted a prospective study of patients with CAP who were hospitalized at our hospital from April 2007 through September 2009. We compared home health care bedridden pneumonia (performance status 4, PS4-CAP) with non-PS4-CAP in a total of 505 enrolled patients in this study. Among these, 66 had PS4-CAP, mostly associated with aspiration. Severity scores, mortality rate, recurrence rate and length of hospital stay of those with PS4-CAP were significantly higher than those with non-PS4-CAP. Drug resistant pathogens were more frequently isolated from patients with PS4-CAP than from those of non-PS4-CAP. The results of patients with PS4-CAP were in agreement with those of previous health care-associated pneumonia (HCAP) reports. The present study suggested home health care bedridden pneumonia should be categorized as HCAP, not CAP.

  15. Home birth integration into the health care systems of eleven international jurisdictions.

    Science.gov (United States)

    Comeau, Amanda; Hutton, Eileen K; Simioni, Julia; Anvari, Ella; Bowen, Megan; Kruegar, Samantha; Darling, Elizabeth K

    2018-02-13

    The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta-analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer-reviewed, non-peer-reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences. © 2018 Wiley Periodicals, Inc.

  16. Adapting heart failure guidelines for nursing care in home health settings: challenges and solutions.

    Science.gov (United States)

    Radhakrishnan, Kavita; Topaz, Maxim; Masterson Creber, Ruth

    2014-07-01

    Nurses provide most of home health services for patients with heart failure, and yet there are no evidence-based practice guidelines developed for home health nurses. The purpose of this article was to review the challenges and solutions for adapting generally available HF clinical practice guidelines to home health nursing. Appropriate HF guidelines were identified and home health nursing-relevant guidelines were extracted by the research team. In addition, a team of nursing academic and practice experts evaluated the extracted guidelines and reached consensus through Delphi rounds. We identified 172 recommendations relevant to home health nursing from the American Heart Association and Heart Failure Society of America guidelines. The recommendations were divided into 5 groups (generic, minority populations, normal ejection fraction, reduced ejection fraction, and comorbidities) and further subgroups. Experts agreed that 87% of the recommendations selected by the research team were relevant to home health nursing and rejected 6% of the selected recommendations. Experts' opinions were split on 7% of guideline recommendations. Experts mostly disagreed on recommendations related to HF medication and laboratory prescription as well as HF patient assessment. These disagreements were due to lack of patient information available to home health nurses as well as unclear understanding of scope of practice regulations for home health nursing. After 2 Delphi rounds over 8 months, we achieved 100% agreement on the recommendations. The finalized guideline included 153 recommendations. Guideline adaptation projects should include a broad scope of nursing practice recommendations from which home health agencies can customize relevant recommendations in accordance with available information and state and agency regulations.

  17. Home and Health in the Third Age — Methodological Background and Descriptive Findings

    Directory of Open Access Journals (Sweden)

    Maya Kylén

    2014-07-01

    Full Text Available Background: The understanding of the complex relationship between the home environment, well-being and daily functioning in the third age is currently weak. The aim of this paper is to present the methodological background of the Home and Health in the Third Age Study, and describe a sample of men and women in relation to their home and health situation. Methods and Design: The study sample included 371 people aged 67–70, living in ordinary housing in the south of Sweden. Structured interviews and observations were conducted to collect data about objective and perceived aspects of home and health. Results: The majority of the participants were in good health and had few functional limitations. Women had more functional limitations and reported more symptoms than men. Environmental barriers were found in every home investigated; the most were found in the kitchen and hygiene area. Environmental barriers were more common in multi-family than in one-family dwellings. Discussion: This study will increase our knowledge on home and health dynamics among people in the third age. The results have potential to contribute to societal planning related to housing provision, home care and social services for senior citizens.

  18. Home and Health in the Third Age — Methodological Background and Descriptive Findings

    Science.gov (United States)

    Kylén, Maya; Ekström, Henrik; Haak, Maria; Elmståhl, Sölve; Iwarsson, Susanne

    2014-01-01

    Background: The understanding of the complex relationship between the home environment, well-being and daily functioning in the third age is currently weak. The aim of this paper is to present the methodological background of the Home and Health in the Third Age Study, and describe a sample of men and women in relation to their home and health situation. Methods and Design: The study sample included 371 people aged 67–70, living in ordinary housing in the south of Sweden. Structured interviews and observations were conducted to collect data about objective and perceived aspects of home and health. Results: The majority of the participants were in good health and had few functional limitations. Women had more functional limitations and reported more symptoms than men. Environmental barriers were found in every home investigated; the most were found in the kitchen and hygiene area. Environmental barriers were more common in multi-family than in one-family dwellings. Discussion: This study will increase our knowledge on home and health dynamics among people in the third age. The results have potential to contribute to societal planning related to housing provision, home care and social services for senior citizens. PMID:25019267

  19. Automatic generation of data merging program codes.

    OpenAIRE

    Hyensook, Kim; Oussena, Samia; Zhang, Ying; Clark, Tony

    2010-01-01

    Data merging is an essential part of ETL (Extract-Transform-Load) processes to build a data warehouse system. To avoid rewheeling merging techniques, we propose a Data Merging Meta-model (DMM) and its transformation into executable program codes in the manner of model driven engineering. DMM allows defining relationships of different model entities and their merging types in conceptual level. Our formalized transformation described using ATL (ATLAS Transformation Language) enables automatic g...

  20. The medical home and integrated behavioral health: advancing the policy agenda.

    Science.gov (United States)

    Ader, Jeremy; Stille, Christopher J; Keller, David; Miller, Benjamin F; Barr, Michael S; Perrin, James M

    2015-05-01

    There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patient-centered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health. In this article we present these recommendations: Build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models, and develop population-based measures to evaluate integration. Copyright © 2015 by the American Academy of Pediatrics.

  1. Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients.

    Science.gov (United States)

    Lohman, Matthew C; Cotton, Brandi P; Zagaria, Alexandra B; Bao, Yuhua; Greenberg, Rebecca L; Fortuna, Karen L; Bruce, Martha L

    2017-12-01

    Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. Cross-sectional analysis using data from 132 home health agencies in the US. Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780). Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes

  2. Nursing staff intentions towards managing deteriorating health in nursing homes: A convergent parallel mixed-methods study using the theory of planned behaviour.

    Science.gov (United States)

    O'Neill, Barbara J; Dwyer, Trudy; Reid-Searl, Kerry; Parkinson, Lynne

    2018-03-01

    To predict the factors that are most important in explaining nursing staff intentions towards early detection of the deteriorating health of a resident and providing subacute care in the nursing home setting. Nursing staff play a pivotal role in managing the deteriorating resident and determining whether the resident needs to be transferred to hospital or remain in the nursing home; however, there is a dearth of literature that explains the factors that influence their intentions. This information is needed to underpin hospital avoidance programs that aim to enhance nursing confidence and skills in this area. A convergent parallel mixed-methods study, using the theory of planned behaviour as a framework. Surveys and focus groups were conducted with nursing staff (n = 75) at a 94-bed nursing home at two points in time, prior to and following the implementation of a hospital avoidance program. The quantitative and qualitative data were analysed separately and merged during final analysis. Nursing staff had strong intentions, a positive attitude that became significantly more positive with the hospital avoidance program in place, and a reasonable sense of control; however, the influence of important referents was the strongest predictor of intention towards managing residents with deteriorating health. Support from a hospital avoidance program empowered staff and increased confidence to intervene. The theory of planned behaviour served as an effective framework for identifying the strong influence referents had on nursing staff intentions around managing residents with deteriorating health. Although nursing staff had a reasonable sense of control over this area of their work, they believed they benefitted from a hospital avoidance program initiated by the nursing home. Managers implementing hospital avoidance programs should consider the role of referents, appraise the known barriers and facilitators and take steps to identify those unique to their local situation

  3. Changes in thunderstorm characteristics due to feeder cloud merging

    Science.gov (United States)

    Sinkevich, Andrei A.; Krauss, Terrence W.

    2014-06-01

    Cumulus cloud merging is a complex dynamical and microphysical process in which two convective cells merge into a single cell. Previous radar observations and numerical simulations have shown a substantial increase in the maximum area, maximum echo top and maximum reflectivity as a result of the merging process. Although the qualitative aspects of merging have been well documented, the quantitative effects on storm properties remain less defined. Therefore, a statistical assessment of changes in storm characteristics due to merging is of importance. Further investigation into the effects of cloud merging on precipitation flux (Pflux) in a statistical manner provided the motivation for this study in the Asir region of Saudi Arabia. It was confirmed that merging has a strong effect on storm development in this region. The data analysis shows that an increase in the median of the distribution of maximum reflectivity was observed just after merging and was equal to 3.9 dBZ. A detailed analysis of the individual merge cases compared the merged storm Pflux and mass to the sum of the individual Feeder and Storm portions just before merging for each case. The merged storm Pflux increased an average of 106% over the 20-min period after merging, and the mass increased on average 143%. The merged storm clearly became larger and more severe than the sum of the two parts prior to merging. One consequence of this study is that any attempts to evaluate the precipitation enhancement effects of cloud seeding must also include the issue of cloud mergers because merging can have a significant effect on the results.

  4. DETECTION OF FLUX EMERGENCE, SPLITTING, MERGING, AND CANCELLATION OF NETWORK FIELD. I. SPLITTING AND MERGING

    Energy Technology Data Exchange (ETDEWEB)

    Iida, Y.; Yokoyama, T. [Department of Earth and Planetary Science, University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan); Hagenaar, H. J. [Lockheed Martin Advanced Technology Center, Org. ADBS, Building 252, 3251 Hanover Street, Palo Alto, CA 94304 (United States)

    2012-06-20

    Frequencies of magnetic patch processes on the supergranule boundary, namely, flux emergence, splitting, merging, and cancellation, are investigated through automatic detection. We use a set of line-of-sight magnetograms taken by the Solar Optical Telescope (SOT) on board the Hinode satellite. We found 1636 positive patches and 1637 negative patches in the data set, whose time duration is 3.5 hr and field of view is 112'' Multiplication-Sign 112''. The total numbers of magnetic processes are as follows: 493 positive and 482 negative splittings, 536 positive and 535 negative mergings, 86 cancellations, and 3 emergences. The total numbers of emergence and cancellation are significantly smaller than those of splitting and merging. Further, the frequency dependence of the merging and splitting processes on the flux content are investigated. Merging has a weak dependence on the flux content with a power-law index of only 0.28. The timescale for splitting is found to be independent of the parent flux content before splitting, which corresponds to {approx}33 minutes. It is also found that patches split into any flux contents with the same probability. This splitting has a power-law distribution of the flux content with an index of -2 as a time-independent solution. These results support that the frequency distribution of the flux content in the analyzed flux range is rapidly maintained by merging and splitting, namely, surface processes. We suggest a model for frequency distributions of cancellation and emergence based on this idea.

  5. Privacy, boundaries and smart homes for health: An ethnographic study.

    Science.gov (United States)

    Burrows, Alison; Coyle, David; Gooberman-Hill, Rachael

    2018-03-01

    This article explores how people negotiate borders and boundaries within the home, in the context of health and the introduction of new technologies. We draw on an ethnographic study involving a socially diverse group of people, which included people with experience of telecare or smart home energy systems. Participants engaged in various strategies to regulate the borders of their home, even though new technologies have begun to change the nature of these borders. Participants managed health conditions but also their use of technology through boundary work that permitted devices to be more or less visible and integrated within the home. Findings highlight that if smart healthcare technologies are to be accepted in the home then there is a need for mechanisms that allow people to control the interpretation of data and flow of information generated about them and their households. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Home Health Care for California's Injured Workers: Options for Implementing a Fee Schedule.

    Science.gov (United States)

    Wynn, Barbara O; Boustead, Anne

    2015-07-15

    The California Department of Industrial Relations/Division of Worker's Compensation asked RAND to provide technical assistance in developing a fee schedule for home health services provided to injured workers. The fee schedule needs to address the full spectrum of home health services ranging from skilled nursing and therapy services to unskilled personal care or chore services that may be provided by family members. RAND researchers consulted with stakeholders in the California workers' compensation system to outline issues the fee schedule should address, reviewed home health fee schedules used by other payers, and conducted interviews with WC administrators from other jurisdictions to elicit their experiences. California stakeholders identified unskilled attendant services as most problematic in determining need and payment rates, particularly services furnished by family members. RAND researchers concentrated on fee schedule options that would result in a single fee schedule covering the full range of home health care services furnished to injured workers and made three sets of recommendations. The first set pertains to obtaining additional information that would highlight the policy issues likely to occur with the implementation of the fee schedule and alternatives for assessing an injured worker's home health care needs. Another approach conforms most closely with the Labor Code requirements. It would integrate the fee schedules used by Medicare, In-Home Health Supportive Services, and the federal Office of Workers' Compensation. The third approach would base the home health fee schedule on rules used by the federal Office of Workers' Compensation.

  7. Evaluation of an oral health education session for Early Head Start home visitors.

    Science.gov (United States)

    Glatt, Kevin; Okunseri, Christopher; Flanagan, Diane; Simpson, Pippa; Cao, Yumei; Willis, Earnestine

    2016-06-01

    Home visiting programs promote the education and health of Early Head Start (EHS) children and pregnant women. However, EHS's oral health component is unevenly implemented. We conducted an educational intervention to improve oral health knowledge and motivational interviewing techniques among Wisconsin EHS home visitors. A questionnaire assessing oral health-related knowledge and confidence was administered to home visitors before and after an educational session. Changes between pre/post-responses were analyzed with McNemar's test and Wilcoxon Signed Rank test. After the intervention there were increases in both knowledge and confidence related to oral health communication. Knowledge increases were observed in such topics as fluoridation, dental caries, and caregivers' role in assisting and supervising children's tooth brushing. A brief educational intervention was associated with increased home visitor knowledge and confidence in communicating oral health messages to EHS caregivers and pregnant women. © 2016 American Association of Public Health Dentistry.

  8. A community-wide school health project for the promotion of smoke-free homes.

    Science.gov (United States)

    Loke, Alice Yuen; Mak, Y W

    2015-11-26

    A community-wide school health project for the promotion of smoke-free homes was launched in June 2010 with the aim of promoting the benefits of smoke-free homes to all school-aged children (aged 6-18), and indirectly to their parents and family members. The 1-year project included health talks on a smoke-free life; the distribution of educational leaflets; slogan and visual art competitions; and a health fair held in June 2011. Two sets of questionnaires were developed to solicit a resolution and action from the participants regarding the establishment of a smoke-free home, and their decision to stay smoke-free. This is a paper to report on the activities of this project, the attempts to reach out to school-aged children, and their indications of agreement with, support for, and commitment to promoting smoke-free homes. The project reached an estimated 12,800 school-aged children in Hong Kong. A large proportion of those received educational leaflets (69.6-88.2 %). Of those who participated in the health fair, 69.7-87.6 % agreed to promote the concept of smoke-free homes to friends and family. More primary than secondary students pledged to not take up smoking (90.8 vs 85.8 %). About 82 % of those who had experimented with smoking pledged to stop. A small proportion of them reported already having established a smoke-free policy at home (14.9 %), placed a 'No Smoking' sign at home (16.4 %), informed visitors of their smoke-free policy at home (12.9 %), and asked visitors to dispose of lit cigarettes before entering their home (15.9 %). This community-wide school health project on the benefits of smoke-free homes reached a large number of students, and indirectly to family members, and home visitors. Public health efforts of this kind should be continued to reach younger generations and the general public.

  9. Designing Smart Health Care Technology into the Home of the Future

    Energy Technology Data Exchange (ETDEWEB)

    Warren, S.; Craft, R.L.; Bosma, J.T.

    1999-04-07

    The US health care industry is experiencing a substantial paradigm shift with regard to home care due to the convergence of several technology areas. Increasingly-capable telehealth systems and the internet are not only moving the point of care closer to the patient, but the patient can now assume a more active role in his or her own care. These technologies, coupled with (1) the migration of the health care industry to electronic patient records and (2) the emergence of a growing number of enabling health care technologies (e.g., novel biosensors, wearable devices, and intelligent software agents), demonstrate unprecedented potential for delivering highly automated, intelligent health care in the home. This editorial paper presents a vision for the implementation of intelligent health care technology in the home of the future, focusing on areas of research that have the highest potential payoff given targeted government funding over the next ten years. Here, intelligent health care technology means smart devices and systems that are aware of their context and can therefore assimilate information to support care decisions. A systems perspective is used to describe a framework under which devices can interact with one another in a plug-and-play manner. Within this infrastructure, traditionally passive sensors and devices will have read/write access to appropriate portions of an individual's electronic medical record. Through intelligent software agents, plug-and-play mechanisms, messaging standards, and user authentication tools, these smart home-based medical devices will be aware of their own capabilities, their relationship to the other devices in the home system, and the identity of the individual(s) from whom they acquire data. Information surety technology will be essential to maintain the confidentiality of patient-identifiable medical information and to protect the integrity of geographically dispersed electronic medical records with which each home

  10. Content and Design Features of Academic Health Sciences Libraries' Home Pages.

    Science.gov (United States)

    McConnaughy, Rozalynd P; Wilson, Steven P

    2018-01-01

    The goal of this content analysis was to identify commonly used content and design features of academic health sciences library home pages. After developing a checklist, data were collected from 135 academic health sciences library home pages. The core components of these library home pages included a contact phone number, a contact email address, an Ask-a-Librarian feature, the physical address listed, a feedback/suggestions link, subject guides, a discovery tool or database-specific search box, multimedia, social media, a site search option, a responsive web design, and a copyright year or update date.

  11. A Remote Health Monitoring System for the Elderly Based on Smart Home Gateway

    Directory of Open Access Journals (Sweden)

    Kai Guan

    2017-01-01

    Full Text Available This paper proposed a remote health monitoring system for the elderly based on smart home gateway. The proposed system consists of three parts: the smart clothing, the smart home gateway, and the health care server. The smart clothing collects the elderly’s electrocardiogram (ECG and motion signals. The home gateway is used for data transmission. The health care server provides services of data storage and user information management; it is constructed on the Windows-Apache-MySQL-PHP (WAMP platform and is tested on the Ali Cloud platform. To resolve the issues of data overload and network congestion of the home gateway, an ECG compression algorithm is applied. System demonstration shows that the ECG signals and motion signals of the elderly can be monitored. Evaluation of the compression algorithm shows that it has a high compression ratio and low distortion and consumes little time, which is suitable for home gateways. The proposed system has good scalability, and it is simple to operate. It has the potential to provide long-term and continuous home health monitoring services for the elderly.

  12. A Remote Health Monitoring System for the Elderly Based on Smart Home Gateway.

    Science.gov (United States)

    Guan, Kai; Shao, Minggang; Wu, Shuicai

    2017-01-01

    This paper proposed a remote health monitoring system for the elderly based on smart home gateway. The proposed system consists of three parts: the smart clothing, the smart home gateway, and the health care server. The smart clothing collects the elderly's electrocardiogram (ECG) and motion signals. The home gateway is used for data transmission. The health care server provides services of data storage and user information management; it is constructed on the Windows-Apache-MySQL-PHP (WAMP) platform and is tested on the Ali Cloud platform. To resolve the issues of data overload and network congestion of the home gateway, an ECG compression algorithm is applied. System demonstration shows that the ECG signals and motion signals of the elderly can be monitored. Evaluation of the compression algorithm shows that it has a high compression ratio and low distortion and consumes little time, which is suitable for home gateways. The proposed system has good scalability, and it is simple to operate. It has the potential to provide long-term and continuous home health monitoring services for the elderly.

  13. A Remote Health Monitoring System for the Elderly Based on Smart Home Gateway

    Science.gov (United States)

    Shao, Minggang

    2017-01-01

    This paper proposed a remote health monitoring system for the elderly based on smart home gateway. The proposed system consists of three parts: the smart clothing, the smart home gateway, and the health care server. The smart clothing collects the elderly's electrocardiogram (ECG) and motion signals. The home gateway is used for data transmission. The health care server provides services of data storage and user information management; it is constructed on the Windows-Apache-MySQL-PHP (WAMP) platform and is tested on the Ali Cloud platform. To resolve the issues of data overload and network congestion of the home gateway, an ECG compression algorithm is applied. System demonstration shows that the ECG signals and motion signals of the elderly can be monitored. Evaluation of the compression algorithm shows that it has a high compression ratio and low distortion and consumes little time, which is suitable for home gateways. The proposed system has good scalability, and it is simple to operate. It has the potential to provide long-term and continuous home health monitoring services for the elderly. PMID:29204258

  14. Clients' outcomes of home health nursing in Taiwan.

    Science.gov (United States)

    Yeh, L; Wen, M J

    2001-09-01

    The home health nursing movement is expanding rapidly. Home health nursing agencies (HHNAs) are expected to demonstrate that the care provided does make a difference for the client receiving the services. The purpose of this study was to explore client outcomes from home health nursing. Outcome indicators include: Services utilized (emergency services, re-hospitalization), physiological status (catheter indwelling status, consciousness level, wound severity-number and wound stages) and functional status (reflected by Barthel Index). A prospective research design was used to collect the results. Five hospital-based HHNAs were invited to participate in this research. Clients newly admitted to HHNAs and diagnosed as non-cancer patients were recruited, and the researchers gathered outcome indicators over a six-month period. Data were analyzed using SPSS 8.0 computer software. There were 75 clients in this study. Results showed that most of the clients (64.0%) received service for more than 180 days. The client characteristics were dominated by elderly (66.6% age above 70), female (53.3%) and married (74.7%). The three leading care needs were NG tubing service (84.0%), Foley tubing service (45.3%) and wound care (38.7%). The Kruscal Wallis Test revealed that there was no difference in emergency service frequency and re-hospitalization between clients who received service for more than 180 days and those who received service for less than 180 days. The Wilcoxon Sign rank test showed that within one half-year, catheter indwelling status, functional status, and wound severity were not significantly different, with the exception only of conscious level (p = .001). The results of this study can be viewed as preliminary data to assist in shaping home health nursing services in Taiwan.

  15. Analysis of Home Health Sensor Data

    NARCIS (Netherlands)

    Kröse, B.; van Hoof, J.; Demiris, G.; Wouters, E.J.M.

    2014-01-01

    This chapter focuses on the analysis of data that is collected from sensors in the home environment. First we discuss the need for a good model that relates sensor data (or features derived from the data) to indicators of health and well-being. Then we present several methods for model building. We

  16. Home Gardening and the Health and Well-Being of Adolescents.

    Science.gov (United States)

    van Lier, Laila E; Utter, Jennifer; Denny, Simon; Lucassen, Mathijs; Dyson, Ben; Clark, Terryann

    2016-10-19

    The current article explores the associations between home gardening and dietary behaviors, physical activity, mental health, and social relationships among secondary school students in New Zealand. Data were drawn from a national youth health and well-being survey, conducted in 2012. In total, 8,500 randomly selected students from 91 randomly selected secondary schools completed the survey. Two thirds of students had a vegetable garden at home and one quarter of all students participated in home gardening. Students participating in gardening were most likely to be male, of a Pacific Island ethnicity, of younger age, and living in a rural area. Gardening was positively associated with healthy dietary habits among students, such as greater fruit and vegetable consumption. Gardening was also positively associated with physical activity and improved mental health and well-being. Students who participate in gardening report slightly lower levels of depressive symptoms and enhanced emotional well-being and experience higher family connection than students who do not participate in gardening. Gardening may make a difference for health and nutrition behaviors and may contribute to adolescents' health and well-being in a positive manner. Health promoters should be encouraged to include gardening in future interventions for young people. © 2016 Society for Public Health Education.

  17. A Remote Health Monitoring System for the Elderly Based on Smart Home Gateway

    OpenAIRE

    Guan, Kai; Shao, Minggang; Wu, Shuicai

    2017-01-01

    This paper proposed a remote health monitoring system for the elderly based on smart home gateway. The proposed system consists of three parts: the smart clothing, the smart home gateway, and the health care server. The smart clothing collects the elderly's electrocardiogram (ECG) and motion signals. The home gateway is used for data transmission. The health care server provides services of data storage and user information management; it is constructed on the Windows-Apache-MySQL-PHP (WAMP) ...

  18. Automated Cognitive Health Assessment Using Smart Home Monitoring of Complex Tasks.

    Science.gov (United States)

    Dawadi, Prafulla N; Cook, Diane J; Schmitter-Edgecombe, Maureen

    2013-11-01

    One of the many services that intelligent systems can provide is the automated assessment of resident well-being. We hypothesize that the functional health of individuals, or ability of individuals to perform activities independently without assistance, can be estimated by tracking their activities using smart home technologies. In this paper, we introduce a machine learning-based method for assessing activity quality in smart homes. To validate our approach we quantify activity quality for 179 volunteer participants who performed a complex, interweaved set of activities in our smart home apartment. We observed a statistically significant correlation (r=0.79) between automated assessment of task quality and direct observation scores. Using machine learning techniques to predict the cognitive health of the participants based on task quality is accomplished with an AUC value of 0.64. We believe that this capability is an important step in understanding everyday functional health of individuals in their home environments.

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

    Science.gov (United States)

    Phillips, Charles D.

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

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

    Science.gov (United States)

    Phillips, Charles D

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

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

    Directory of Open Access Journals (Sweden)

    Charles D. Phillips

    2015-01-01

    Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

  2. Immigrant Families, Children With Special Health Care Needs, and the Medical Home.

    Science.gov (United States)

    Kan, Kristin; Choi, Hwajung; Davis, Matthew

    2016-01-01

    Immigrant children in the United States historically experience lower-quality health care. Such disparities areconcerning for immigrant children with special health care needs (CSHCNs). Our study assesses the medical home presence for CSHCN by immigrant family type and evaluates which medical home components are associated with disparities. We used the 2011 National Survey of Children's Health, comparing the prevalence and odds of a parent-reported medical home and 5 specific medical home components by immigrant family types using bivariate and multivariate logistic regression. Foreign-born CSHCNs were less likely than CSHCNs with US-born parents to have a medical home (adjusted odds ratio = 0.40, 95% confidence interval 0.19-0.85). The adjusted prevalence of having a medical home was 28% among foreign-born CSHCNs (P special needs also had a lower odds of a medical home, compared with children with US-born parents (adjusted odds ratio = 0.62, 0.46-0.83). The medical home component most frequently absent for immigrant children without special needs and CSHCNs with a foreign-born parent was family-centered care. In contrast, foreign-born CSHCNs most often lacked care coordination (adjusted prevalence = 37% versus 56% for CSHCNs with US-born parents; P < .05). Disparities in medical home presence for CSHCNs appear to be exacerbated by immigrant family type. Efforts focused on improving family-centered care and care coordination may provide the greatest benefit for immigrant CSHCNs. Copyright © 2016 by the American Academy of Pediatrics.

  3. Design and operation of the national home health aide survey: 2007-2008.

    Science.gov (United States)

    Bercovitz, Anita; Moss, Abigail J; Sengupta, Manisha; Harris-Kojetin, Lauren D; Squillace, Marie R; Emily, Rosenoff; Branden, Laura

    2010-03-01

    This report provides an overview of the National Home Health Aide Survey (NHHAS), the first national probability survey of home health aides. NHHAS was designed to provide national estimates of home health aides who provided assistance in activities of daily living (ADLs) and were directly employed by agencies that provide home health and/or hospice care. This report discusses the need for and objectives of the survey, the design process, the survey methods, and data availability. METHODS NHHAS, a multistage probability sample survey, was conducted as a supplement to the 2007 National Home and Hospice Care Survey (NHHCS). Agencies providing home health and/or hospice care were sampled, and then aides employed by these agencies were sampled and interviewed by telephone. Survey topics included recruitment, training, job history, family life, client relations, work-related injuries, and demographics. NHHAS was virtually identical to the 2004 National Nursing Assistant Survey of certified nursing assistants employed in sampled nursing homes with minor changes to account for differences in workplace environment and responsibilities. RESULTS From September 2007 to April 2008, interviews were completed with 3,416 aides. A public-use data file that contains the interview responses, sampling weights, and design variables is available. The NHHAS overall response rate weighted by the inverse of the probability of selection was 41 percent. This rate is the product of the weighted first-stage agency response rate of 57 percent (i.e., weighted response rate of 59 percent for agency participation in NHHCS times the weighted response rate of 97 percent for agencies participating in NHHCS that also participated in NHHAS) and the weighted second-stage aide response rate of 72 percent to NHHAS.

  4. Socioeconomic disparities in home health care service access and utilization: a scoping review.

    Science.gov (United States)

    Goodridge, Donna; Hawranik, Pamela; Duncan, Vicky; Turner, Hollie

    2012-10-01

    Home health care services are expanding at a rapid pace in order to meet the needs of the growing population of older adults and those with chronic illnesses. Because of current restrictions on home health care as an insured service in some countries, individuals may be required to pay for some or all of their home care services out of pocket. These payments may potentially limit access to needed home care services for persons in the lowest socioeconomic strata. Previous research demonstrates a clear socioeconomic gradient in access to acute and primary care services, where those most in need of services are the most disadvantaged and under-serviced. There has been little attention paid thus far, however, to the way in which socioeconomic status may affect the receipt of home health care services. To determine what is known from existing literature about socioeconomic disparities in home health care access and utilization. A scoping review was used to map the extent and nature of the literature in this area. A search of the databases CINAHL, Medline, SocIndex and Sociological Abstracts as well as Dissertations International. A total of 206 potentially relevant articles were published between 2000 and April 2011. Two reviewers independently reviewed the articles, leaving 15 research articles to be included in the scoping review. The majority of articles reported secondary analyses of administrative datasets related to utilization of home health care. Several studies examined access and utilization using qualitative approaches. The distinction between professional and supportive home care services was not always clear in the articles. Individual and composite measures of socioeconomic status were reported, with the most frequently used indicator being income. Several studies used more complex composite ecological indicators of socieconomic status. There was general agreement that utilization of home health services favored persons with greater economic disadvantage

  5. The impact of oral health on the quality of life of nursing home residents

    OpenAIRE

    Porter, Jessie; Ntouva, Antiopi; Read, Andrew; Murdoch, Mandy; Ola, Dennis; Tsakos, Georgios

    2015-01-01

    Background Good oral health in older residents of nursing homes is important for general health and quality of life. Very few studies have assessed how oral symptoms affect residents? quality of life. Objective To assess the clinical and subjective oral health, including oral health related quality of life (OHRQoL), and the association of oral symptoms with OHRQoL in older people residing in nursing homes in Islington, London. Method Overall, 325 residents from nine nursing homes were clinica...

  6. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

    Science.gov (United States)

    2011-11-21

    ... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing... to ``RIN 2900-AN98--Payment for home health and services and hospice care by non-VA providers...

  7. Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review.

    Science.gov (United States)

    Reeder, Blaine; Meyer, Ellen; Lazar, Amanda; Chaudhuri, Shomir; Thompson, Hilaire J; Demiris, George

    2013-07-01

    There is a critical need for public health interventions to support the independence of older adults as the world's population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions. We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology. One thousand, six hundred and thirty-nine candidate articles were identified. Thirty-one studies from the years 1998-2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier). The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of them used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults; social support; and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Merged ozone profiles from four MIPAS processors

    Science.gov (United States)

    Laeng, Alexandra; von Clarmann, Thomas; Stiller, Gabriele; Dinelli, Bianca Maria; Dudhia, Anu; Raspollini, Piera; Glatthor, Norbert; Grabowski, Udo; Sofieva, Viktoria; Froidevaux, Lucien; Walker, Kaley A.; Zehner, Claus

    2017-04-01

    The Michelson Interferometer for Passive Atmospheric Sounding (MIPAS) was an infrared (IR) limb emission spectrometer on the Envisat platform. Currently, there are four MIPAS ozone data products, including the operational Level-2 ozone product processed at ESA, with the scientific prototype processor being operated at IFAC Florence, and three independent research products developed by the Istituto di Fisica Applicata Nello Carrara (ISAC-CNR)/University of Bologna, Oxford University, and the Karlsruhe Institute of Technology-Institute of Meteorology and Climate Research/Instituto de Astrofísica de Andalucía (KIT-IMK/IAA). Here we present a dataset of ozone vertical profiles obtained by merging ozone retrievals from four independent Level-2 MIPAS processors. We also discuss the advantages and the shortcomings of this merged product. As the four processors retrieve ozone in different parts of the spectra (microwindows), the source measurements can be considered as nearly independent with respect to measurement noise. Hence, the information content of the merged product is greater and the precision is better than those of any parent (source) dataset. The merging is performed on a profile per profile basis. Parent ozone profiles are weighted based on the corresponding error covariance matrices; the error correlations between different profile levels are taken into account. The intercorrelations between the processors' errors are evaluated statistically and are used in the merging. The height range of the merged product is 20-55 km, and error covariance matrices are provided as diagnostics. Validation of the merged dataset is performed by comparison with ozone profiles from ACE-FTS (Atmospheric Chemistry Experiment-Fourier Transform Spectrometer) and MLS (Microwave Limb Sounder). Even though the merging is not supposed to remove the biases of the parent datasets, around the ozone volume mixing ratio peak the merged product is found to have a smaller (up to 0.1 ppmv

  9. A systematic review of integrated working between care homes and health care services

    Science.gov (United States)

    2011-01-01

    Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in

  10. Merging history of three bimodal clusters

    Science.gov (United States)

    Maurogordato, S.; Sauvageot, J. L.; Bourdin, H.; Cappi, A.; Benoist, C.; Ferrari, C.; Mars, G.; Houairi, K.

    2011-01-01

    We present a combined X-ray and optical analysis of three bimodal galaxy clusters selected as merging candidates at z ~ 0.1. These targets are part of MUSIC (MUlti-Wavelength Sample of Interacting Clusters), which is a general project designed to study the physics of merging clusters by means of multi-wavelength observations. Observations include spectro-imaging with XMM-Newton EPIC camera, multi-object spectroscopy (260 new redshifts), and wide-field imaging at the ESO 3.6 m and 2.2 m telescopes. We build a global picture of these clusters using X-ray luminosity and temperature maps together with galaxy density and velocity distributions. Idealized numerical simulations were used to constrain the merging scenario for each system. We show that A2933 is very likely an equal-mass advanced pre-merger ~200 Myr before the core collapse, while A2440 and A2384 are post-merger systems (~450 Myr and ~1.5 Gyr after core collapse, respectively). In the case of A2384, we detect a spectacular filament of galaxies and gas spreading over more than 1 h-1 Mpc, which we infer to have been stripped during the previous collision. The analysis of the MUSIC sample allows us to outline some general properties of merging clusters: a strong luminosity segregation of galaxies in recent post-mergers; the existence of preferential axes - corresponding to the merging directions - along which the BCGs and structures on various scales are aligned; the concomitance, in most major merger cases, of secondary merging or accretion events, with groups infalling onto the main cluster, and in some cases the evidence of previous merging episodes in one of the main components. These results are in good agreement with the hierarchical scenario of structure formation, in which clusters are expected to form by successive merging events, and matter is accreted along large-scale filaments. Based on data obtained with the European Southern Observatory, Chile (programs 072.A-0595, 075.A-0264, and 079.A-0425

  11. Patient Health Goals Elicited During Home Care Admission: A Categorization.

    Science.gov (United States)

    Sockolow, Paulina; Radhakrishnan, Kavita; Chou, Edgar Y; Wojciechowicz, Christine

    2017-11-01

    Home care agencies are initiating "patient health goal elicitation" activities as part of home care admission planning. We categorized elicited goals and identified "clinically informative" goals at a home care agency. We examined patient goals that admitting clinicians documented in the point-of-care electronic health record; conducted content analysis on patient goal data to develop a coding scheme; grouped goal themes into codes; assigned codes to each goal; and identified goals that were in the patient voice. Of the 1,763 patient records, 16% lacked a goal; only 15 goals were in a patient's voice. Nurse and physician experts identified 12 of the 20 codes as clinically important accounting for 82% of goal occurrences. The most frequent goal documented was safety/falls (23%). Training and consistent communication of the intent and operationalization of patient goal elicitation may address the absence of patient voice and the less than universal recording of home care patients' goals.

  12. Training of Home Health Aides and Nurse Aides: Findings from National Data

    Science.gov (United States)

    Sengupta, Manisha; Ejaz, Farida K.; Harris-Kojetin, Lauren D.

    2012-01-01

    Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 home health aides (HHAs) from the National Home Health Aide Survey conducted in 2004 and 2007, respectively. This article focuses on the…

  13. Scoring the home falls and accidents screening tool for health professionals (HOME FAST-HP): Evidence from one epidemiological study.

    Science.gov (United States)

    Mackenzie, Lynette; Byles, Julie

    2018-03-30

    Falls in older people are a major public health concern. To target falls prevention interventions, screening tools need to be able to identify older people at greater risk of falling. This study aimed to investigate the screening capacity of the Home Falls and Accidents Screening Tool for health professionals (HOME FAST-HP), and to identify the best cut-off score to identify older people at higher risk of falls using the HOME FAST-HP. The study used cross-sectional data from a random sample of 650 women from the 1921 to 1926 cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Selected women were sent a postal survey including the HOME FAST-HP, falls history, and other health factors. Scores on the home fast were calculated and the cut-point for optimal sensitivity and specificity of the HOME FAST-HP in relation to falls was assessed using a Receiver Operating Characteristic curve. A total of 567 older women participated (response rate 87%). The mean age of participants was 77.5 yrs (95% CI 77.31-77.70). A total of 153 participants (27%) reported a fall in the previous six months. The mean number of hazards using the HOME FAST-HP was 9.74 (95% CI 9.48-10.01), range 2-22. Non-fallers had a mean of 9.6 hazards (95% CI 9.32-9.91) and fallers had a mean of 10.63 hazards (95% CI 10.08-11.19) which was a significant difference (t = 3.41, P = 0.001). The area under the receiver operator curve (AUC) was 0.58 (95% CI 0.53-0.64). A HOME FAST-HP cut-off score of 9 was associated with the optimal sensitivity for falls (73.9%), with specificity (37.9%), and positive predictive value was 30.6% and negative predictive value was 79.7%. The HOME FAST-HP can be used as a screening tool to identify fallers with a cut-off score of nine indicating a higher risk of falling. © 2018 Occupational Therapy Australia.

  14. Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries With Rehabilitation-Sensitive Conditions.

    Science.gov (United States)

    Mroz, Tracy M; Meadow, Ann; Colantuoni, Elizabeth; Leff, Bruce; Wolff, Jennifer L

    2018-06-01

    To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely. Retrospective analysis. Home health agencies. Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009. Not applicable. Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge. Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88-.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77-.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18-1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10-1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70-.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03-1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07-1.28). As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation. Copyright © 2017

  15. The availability of allied health care in Dutch nursing homes.

    NARCIS (Netherlands)

    Boer, M.E. de; Leemrijse, C.J.; Ende, C.H.M. van den; Ribbe, M.W.; Dekker, J.

    2007-01-01

    Purpose. To determine the availability of allied health care in nursing homes in the Netherlands, and its dependency on characteristics of the nursing home. Methods. Structured surveys by telephone were carried out in a sample of 100 from a country total of 286 somatic (for somatic patients only)

  16. How State-Funded Home Care Programs Respond to Changes in Medicare Home Health Care: Resource Allocation Decisions on the Front Line

    Science.gov (United States)

    Corazzini, Kirsten

    2003-01-01

    Objective To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. Data Sources/Study Setting Primary data collected on 355 case managers and 26 agency directors employed in June 1999 by 26 of the 27 regional agencies administering the Massachusetts Home Care Program for low-income elders. Study Design Data were collected in a cross-sectional survey study design. A case manager survey included measures of work environment, demographics, and factorial survey vignette clients (N=2,054), for which case managers assessed service eligibility levels. An agency director survey included measures of management practices. Data Collection/Extraction Methods Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and care plan levels while controlling for case-mix differences in agencies' clients. Principal Findings Case managers did not supplement extant Medicare home health services, but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. This finding persisted when controlling for case mix and did not vary by work environment. Work environment affected overall care plan levels. Conclusions Study findings indicate systematic patterns of frontline resource allocation shaping the relationships among community-based long-term care payment sources. Further, results illustrate how nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics. PMID:14596390

  17. Security And Privacy Issues in Health Monitoring Systems: eCare@Home Case Study

    DEFF Research Database (Denmark)

    Wearing, Thomas; Dragoni, Nicola

    2016-01-01

    Automated systems for monitoring elderly people in their home are becoming more and more common. Indeed, an increasing number of home sensor networks for healthcare can be found in the recent literature, indicating a clear research direction in smart homes for health-care. Although the huge amount...... of sensitive data these systems deal with and expose to the external world, security and privacy issues are surpris-ingly not taken into consideration. The aim of this paper is to raise some key security and privacy issues that home health monitor systems should face with. The analysis is based on a real world...... monitoring sensor network for healthcare built in the context of the eCare@Home project....

  18. Antidepressant Medication Management among Older Patients Receiving Home Health Care

    Science.gov (United States)

    Bao, Yuhua; Shao, Huibo; Bruce, Martha L.; Press, Matthew J.

    2014-01-01

    Objective Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay. Methods Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients 65 or older who received HHC in 2006–7 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (vs. discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy. Results About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10–20 percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change. Conclusions Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions. PMID:25158915

  19. The 2003 Merged Model for Vietnam

    DEFF Research Database (Denmark)

    Jensen, Henning Tarp; Tarp, Finn

    This monograph documents the 2003 Merged Model for Vietnam. The initialization and calibration of the model is based on a financial 2003 SAM framework and an auxiliary 2002-3 data set. The recursive nature of the solution of the Merged Model is discussed with reference to the four main sectors...

  20. Merging startup experiments on the UTST spherical tokamak

    International Nuclear Information System (INIS)

    Yamada, Takuma; Kamio, Shuji; Imazawa, Ryota

    2010-01-01

    The University of Tokyo Spherical Tokamak (UTST) was constructed to explore the formation of ultrahigh-beta spherical tokamak (ST) plasmas using double null plasma merging. The main feature of the UTST is that the poloidal field coils are located outside the vacuum vessel to demonstrate startup in a reactor-relevant situation. Initial operations used partially completed power supplies to investigate the appropriate conditions for plasma merging. The plasma current of the merged ST reached 100 kA when the central solenoid coil was used to assist plasma formation. Merging of two ST plasmas through magnetic reconnection was successfully observed using two-dimensional pickup coil arrays, which directly measure the toroidal and axial magnetic fields inside the UTST vacuum vessel. The resistivity of the current sheet was found to be anomalously high during merging. (author)

  1. Using data from ambient assisted living and smart homes in electronic health records.

    Science.gov (United States)

    Knaup, P; Schöpe, L

    2014-01-01

    This editorial is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records". To increase efficiency in the health care of the future, data from innovative technology like it is used for ambient assisted living (AAL) or smart homes should be available for individual health decisions. Integrating and aggregating data from different medical devices and health records enables a comprehensive view on health data. The objective of this paper is to present examples of the state of the art in research on information management that leads to a sustainable use and long-term storage of health data provided by innovative assistive technologies in daily living. Current research deals with the perceived usefulness of sensor data, the participatory design of visual displays for presenting monitoring data, and communication architectures for integrating sensor data from home health care environments with health care providers either via a regional health record bank or via a telemedical center. Integrating data from AAL systems and smart homes with data from electronic patient or health records is still in an early stage. Several projects are in an advanced conceptual phase, some of them exploring feasibility with the help of prototypes. General comprehensive solutions are hardly available and should become a major issue of medical informatics research in the near future.

  2. Health centre versus home presumptive diagnosis of malaria in southern Ghana: implications for home-based care policy.

    Science.gov (United States)

    Dunyo, S K; Afari, E A; Koram, K A; Ahorlu, C K; Abubakar, I; Nkrumah, F K

    2000-01-01

    A study was conducted in 1997 to compare the accuracy of presumptive diagnosis of malaria in children aged 1-9 years performed by caretakers of the children to that of health centre staff in 2 ecological zones in southern Ghana. Similar symptoms were reported in the children at home and at the health centre. In the home setting, symptoms were reported the same day that they occurred, 77.6% of the children with a report of fever were febrile (axillary temperature > or = 37.5 degrees C) and 64.7% of the reports of malaria were parasitologically confirmed. In the health centre, the median duration of symptoms before a child was seen was 3 days (range 1-14 days), 58.5% of the children with a report of fever were febrile and 62.6% of the clinically diagnosed cases were parasitologically confirmed. In the 2 settings almost all the infections were due to Plasmodium falciparum. Parasite density was 3 times higher in the health centre cases compared to the home-diagnosed cases. Early and appropriate treatment of malaria detected in children by caretakers may prevent complications that arise as a result of persistence of symptoms and attainment of high parasitaemic levels.

  3. An examination of interventions to reduce respiratory health and injury hazards in homes of low-income families

    International Nuclear Information System (INIS)

    Dixon, Sherry L.; Fowler, Cecile; Harris, Judy; Moffat, Sally; Martinez, Yolanda; Walton, Heather; Ruiz, Bernice; Jacobs, David E.

    2009-01-01

    We evaluated whether combining asthma trigger reduction with housing structural repairs, device disbursement and education in low-income households with children would improve self-reported respiratory health and reduce housing-related respiratory health and injury hazards (convenience sample of n=67 homes with 63 asthmatic and 121 non-asthmatic children). At baseline, a visual assessment of the home environment and a structured occupant interview were used to examine 29 potential injury hazards and 7 potential respiratory health hazards. A home-specific intervention was designed to provide the children's parents or caretakers with the knowledge, skills, motivation, supplies, equipment, and minimum housing conditions necessary for a healthy and safe home. The enrolled households were primarily Hispanic and owned their homes. On average, 8 injury hazards were observed in the homes at baseline. Four months following intervention, the average declined to 2.2 hazards per home (p<0.001), with 97% of the parents reporting that their homes were safer following the interventions. An average of 3.3 respiratory health hazards were observed in the homes at baseline. Four months following intervention, the average declined to 0.9 hazards per home (p<0.001), with 96% of parents reporting that the respiratory health of their asthmatic children improved. A tailored healthy homes improvement package significantly improves self-reported respiratory health and safety, reduces respiratory health and injury hazards, and can be implemented in concert with a mobile clinical setting

  4. Modeling cooperative driving behavior in freeway merges.

    Science.gov (United States)

    2011-11-01

    Merging locations are major sources of freeway bottlenecks and are therefore important for freeway operations analysis. Microscopic simulation tools have been successfully used to analyze merging bottlenecks and to design optimum geometric configurat...

  5. Why Hospitals and Payers are Recommending Home Care Upon Discharge Instead of SNF or Traditional Home Health Services--Alternative Payment Model Hospital Incentives Aligning with Patient Choice.

    Science.gov (United States)

    Luke, Josh

    2016-01-01

    Seniors and other hospital patients in the United States have traditionally had the option of being discharged to a skilled nursing facility (convalescent home) for post-acute services, or home with nursing and therapy services provided in the home setting. Traditionally, these home based services have been referred to as "home health." As more Americans have retired, home health services have expanded and are readily accessible. This growth put tremendous stress on the Medicare fund which pays for senior care services. However, "Home Care," which traditionally has been viewed as non-medical home based services, has also become a booming industry for the cost conscious in recent years as more Americans reach retirement age. With the passing of the Affordable Care Act in 2010, providers and payers are now finding themselves responsible for post-acute care and continuous patient health, so cost efficient solutions for post-acute care are thriving. For the first time in history, American hospitals and Insurers are recognizing Home Care as an effective model that achieves the Triple Aim of Health Care reform. Home Care, which is no longer completely non-medical services, has proven to be an integral part of the care continuum for seniors in recent years and is now becoming a viable solution for keeping patients well, while still honoring their desire to age and heal at home. This paper analyzes the benefits and risks of home care and provides a clear understanding as to why American hospitals are emphasizing SNF Avoidance and skipping home health, opting instead to refer patients directly to home care as the preferred discharge solution in a value based model.

  6. Access to patient-centered medical home among Ohio's Children with Special Health Care Needs.

    Science.gov (United States)

    Conrey, Elizabeth J; Seidu, Dazar; Ryan, Norma J; Chapman, Dj Sam

    2013-06-01

    Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005-2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination.

  7. A randomized controlled study about the use of eHealth in the home health care of premature infants

    Directory of Open Access Journals (Sweden)

    Gund Anna

    2013-02-01

    Full Text Available Abstract Background One area where the use of information and communication technology (ICT, or eHealth, could be developed is the home health care of premature infants. The aim of this randomized controlled study was to investigate whether the use of video conferencing or a web application improves parents’ satisfaction in taking care of a premature infant at home and decreases the need of home visits. In addition, nurses’ attitudes regarding the use of these tools were examined. Method Thirty-four families were randomized to one of three groups before their premature infant was discharged from the hospital to home health care: a control group receiving standard home health care (13 families; a web group receiving home health care supplemented with the use of a web application (12 families; a video group with home health care supplemented with video conferencing using Skype (9 families. Families and nursing staff answered questionnaires about the usefulness of ICT. In addition, semi-structured interviews were conducted with 16 families. Results All the parents in the web group found the web application easy to use. 83% of the families thought it was good to have access to their child’s data through the application. All the families in the video group found Skype easy to use and were satisfied with the video calls. 88% of the families thought that video calls were better than ordinary phone calls. 33% of the families in the web group and 75% of those in the video group thought the need for home visits was decreased by the web application or Skype. 50% of the families in the web group and 100% of those in the video group thought the web application or the video calls had helped them feel more confident in caring for their child. Most of the nurses were motivated to use ICT but some were reluctant and avoided using the web application and video conferencing. Conclusion The families were satisfied with both the web application and video

  8. A randomized controlled study about the use of eHealth in the home health care of premature infants.

    Science.gov (United States)

    Gund, Anna; Sjöqvist, Bengt Arne; Wigert, Helena; Hentz, Elisabet; Lindecrantz, Kaj; Bry, Kristina

    2013-02-09

    One area where the use of information and communication technology (ICT), or eHealth, could be developed is the home health care of premature infants. The aim of this randomized controlled study was to investigate whether the use of video conferencing or a web application improves parents' satisfaction in taking care of a premature infant at home and decreases the need of home visits. In addition, nurses' attitudes regarding the use of these tools were examined. Thirty-four families were randomized to one of three groups before their premature infant was discharged from the hospital to home health care: a control group receiving standard home health care (13 families); a web group receiving home health care supplemented with the use of a web application (12 families); a video group with home health care supplemented with video conferencing using Skype (9 families). Families and nursing staff answered questionnaires about the usefulness of ICT. In addition, semi-structured interviews were conducted with 16 families. All the parents in the web group found the web application easy to use. 83% of the families thought it was good to have access to their child's data through the application. All the families in the video group found Skype easy to use and were satisfied with the video calls. 88% of the families thought that video calls were better than ordinary phone calls. 33% of the families in the web group and 75% of those in the video group thought the need for home visits was decreased by the web application or Skype. 50% of the families in the web group and 100% of those in the video group thought the web application or the video calls had helped them feel more confident in caring for their child. Most of the nurses were motivated to use ICT but some were reluctant and avoided using the web application and video conferencing. The families were satisfied with both the web application and video conferencing. The families readily embraced the use of ICT, whereas

  9. Virtual Visits in Home Health Care for Older Adults

    Directory of Open Access Journals (Sweden)

    Anne Marie Lunde Husebø

    2014-01-01

    Full Text Available Background. This review identifies the content of virtual visits in community nursing services to older adults and explores the manner in which service users and the nurses use virtual visits. Design. An integrative literature review. Method. Data collection comprised a literature search in three databases: Cinahl, Medline, and PubMed. In addition, a manual search of reference lists and expert consultation were performed. A total of 12 articles met the inclusion criteria. The articles were reviewed in terms of study characteristics, service content and utilization, and patient and health care provider experience. Results. Our review shows that in most studies the service is delivered on a daily basis and in combination with in-person visits. The findings suggest that older home-dwelling patients can benefit from virtual visits in terms of enhanced social inclusion and medication compliance. Service users and their nurses found virtual visits satisfactory and suitable for care delivery in home care to the elderly. Evidence for cost-saving benefits of virtual visits was not found. Conclusions. The findings can inform the planning of virtual visits in home health care as a complementary service to in-person visits, in order to meet the increasingly complex needs of older adults living at home.

  10. On-the Fly Merging of Attitude Solutions

    DEFF Research Database (Denmark)

    Jørgensen, Peter Siegbjørn; Jørgensen, John Leif; Denver, Troelz

    2008-01-01

    Recent advances in autonomous attitude determination instrumentation enable even small satellites flying fully autonomous multi head star trackers providing full accurate and robust attitude information. Each sensor provides the full attitude information but for robustness and optimal usage...... of the available information, i.e. optimal accuracy, methods for merging such data should be investigated. The need for and desirability of attitude merging depends on the mission objective and available resources. To enable real-time attitude control and reduce requirements on download budget, on-board merging...... of attitude data will often be advantageous. This should be weighted against the need for post observation reconstruction of attitudes, especially needed when end products are sensitive to optimal attitude reconstruction. Instrument integrated merging algorithms will reduce the complexity of on-board AOCS...

  11. Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy.

    Science.gov (United States)

    Chen, Chia-Ching; Yamada, Tetsuji; Nakashima, Taeko; Chiu, I-Ming

    2017-01-01

    The purposes of this study are: (1) to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC) service use; (2) to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3) to investigate health outcome disparity based on substitutability. The methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR), which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly. There exists a complement relationship between the informal home care (IHC) and community-based FHC services, and the elasticity's ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH) services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services. Policy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

  12. Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy

    Directory of Open Access Journals (Sweden)

    Chia-Ching Chen

    2017-11-01

    Full Text Available ObjectivesThe purposes of this study are: (1 to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC service use; (2 to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3 to investigate health outcome disparity based on substitutability.Methodology and dataThe methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR, which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly.ResultsThere exists a complement relationship between the informal home care (IHC and community-based FHC services, and the elasticity’s ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services.ConclusionPolicy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

  13. The Japan Home-health Apparatus Industrial Association: investigation of home-use electronic sphygmomanometers.

    Science.gov (United States)

    Shirasaki, O; Terada, H; Niwano, K; Nakanishi, T; Kanai, M; Miyawaki, Y; Souma, T; Tanaka, T; Kusunoki, T

    2001-12-01

    The Japanese Home-health Apparatus Industrial Association is an official independent organization comprising ten departments. That concerned with home electronic sphygmomanometers, which has seven participants from different Japanese manufacturers, has already undertaken and is currently involved in various activities related to voluntary standards for performance validation and quality assurance. Because Japanese companies form a large proportion of manufacturers, these activities are important in terms of autonomic regulation. Although many improvements have been made to home electronic sphygmomanometers, some problems still remain unresolved, especially in terms of measurement reliability and easy operation by lay people. Another aspect of the department's work relates to making proposals on major validation standards, such as those of the Association for the Advancement of Medical Instrumentation, the British Hypertension Society and Comité Européen de Normalisation (CEN). Clinical validation should be discussed in order to define a more accurate standard method of measurement using auscultation and more appropriate criteria that are unaffected by primary blood pressure variation.

  14. Handbook of Home Health Standards - Fifth edition Marrelli Tina M Handbook of Home Health Standards - Fifth edition 688pp Elsevier 9780323052245 032305224X [Formula: see text].

    Science.gov (United States)

    2009-06-03

    Home care is different from other forms of health care. Clinicians are guests in patients' homes and may be the only healthcare providers patients see on a particular day or week, so they should feel comfortable working independently, but recognise they are part of a larger healthcare team.

  15. Health-illness transition among persons using advanced medical technology at home.

    Science.gov (United States)

    Fex, Angelika; Flensner, Gullvi; Ek, Anna-Christina; Söderhamn, Olle

    2011-06-01

    This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive attitude towards technology at home facilitates the transition. © 2010 The Authors. Scandinavian Journal of

  16. Testing an app for reporting health concerns-Experiences from older people and home care nurses.

    Science.gov (United States)

    Göransson, Carina; Eriksson, Irene; Ziegert, Kristina; Wengström, Yvonne; Langius-Eklöf, Ann; Brovall, Maria; Kihlgren, Annica; Blomberg, Karin

    2017-12-05

    To explore the experiences of using an app among older people with home-based health care and their nurses. Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. Explorative qualitative design. For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care. © 2017 John Wiley & Sons Ltd.

  17. Determination of Onramp Weaving Length for Resolving Merging Dilemma

    Directory of Open Access Journals (Sweden)

    Chiu Liu

    2012-03-01

    Full Text Available It is physically known that onramp merging may turn out to be difficult if the onramp (weaving/merging length is too short because a driver under certain driving circumstances may find that either merging ahead or merging behind a neighboring vehicle on the adjacent highway lane cannot be completed. Various existing guidelines or design manuals provide no clear physical understanding and explanations to the design onramp weaving length but often based on evolved empirical experiences. By integrating human factors, vehicle dynamic characteristics, roadway surface condition, and the onramp weaving design into a single unified analytic framework, the onramp length required for a driver to merge into the highway traffic successfully is determined exactly with formulas and physical solutions to avoid the merging dilemma and enhance driving safety at highway interchanges. The design onramp weaving length is examined and evaluated with various foreseeable merging scenarios and physical examples. This analytic framework sheds light on the understanding of the onramp weaving the first time strictly on a physical human-vehicle-roadway interaction setting. Practitioners can easily apply these user friendly formulae and equations derived from the unified framework to calculate the onramp weaving length to resolve the merging dilemma and enhance driving safety for any highway interchanges.

  18. 42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.

    Science.gov (United States)

    2010-10-01

    ... Services of Residents § 415.204 Services of residents in skilled nursing facilities and home health... 42 Public Health 3 2010-10-01 2010-10-01 false Services of residents in skilled nursing facilities and home health agencies. 415.204 Section 415.204 Public Health CENTERS FOR MEDICARE & MEDICAID...

  19. Practical guide on home health in heart failure patients

    DEFF Research Database (Denmark)

    Jaarsma, T.; Larsen, Torben; Stromberg, A.

    2013-01-01

    in this population and specialised heart failure care can save costs and improve the quality of care. However, only a few European countries have implemented specialised home care and offered this to a larger number of patients with heart failure. Method: We developed a guide on Home Health in Heart Failure patients...... from a literature review, a survey of heart failure management programs, the opinion of researchers and practitioners, data from clinical trials and a reflection of an international expert meeting. Results: In integrated home care for heart failure patients, it is advised to consider the following...... components: integrated multidisciplinary care, patient and partner participation, care plans with clear goals of care, patient education, self-care management, appropriate access to care and optimised treatment. Discussion: We summarised the state of the art of home-based care for heart failure patients...

  20. ESO's Two Observatories Merge

    Science.gov (United States)

    2005-02-01

    astronomical technology and is one of the premier facilities in the world for optical and near-infrared observations. In addition to the state-of-the-art Very Large Telescope and the four Auxiliary Telescopes of 1.8-m diameter which can move to relocate in up to 30 different locations feeding the interferometer, Paranal will also be home to the 2.6-m VLT Survey telescope (VST) and the 4.2-m VISTA IR survey telescope. Both Paranal and La Silla have a proven record of their unique ability to address most current issues in observational astronomy. In 2004 alone, each observatory provided data for the publication of about 350 peer-reviewed journal articles, more than any other ground-based observatory. With the present merging of these top-ranking astronomical observatories, fostering synergies and harmonizing the many diverse activities, ESO and the entire community of European astronomers will profit even more from these highly efficient research facilities. Images of ESO's observatories and telescopes are available in the ESO gallery.

  1. The half-wave rectifier response of the magnetosphere and antiparallel merging

    Science.gov (United States)

    Crooker, N. U.

    1980-01-01

    In some ways the magnetosphere behaves as if merging occurs only when the interplanetary magnetic field (IMF) is southward, and in other ways it behaves as if merging occurs for all IMF orientations. An explanation of this duality is offered in terms of a geometrical antiparallel merging model which predicts merging for all IMF orientations but magnetic flux transfer to the tail only for southward IMF. This is in contrast to previous models of component merging, where merging and flux transfer occur together for nearly all IMF orientations. That the problematic duality can be explained by the model is compelling evidence that antiparallel merging should be seriously considered in constructing theories of the merging process.

  2. Mental status of the elderly receiving home health services and the associated stress of home helpers.

    Science.gov (United States)

    Nagatomo, I; Takigawa, M

    1998-01-01

    One hundred and ninety elderly people receiving home health service were investigated. The intellectual levels, depressive state evaluated by the Cornell scale for depression in dementia (CSDD) scale, abnormal behaviors evaluated by the dementia behavior disturbance (DBD) scale, and activities of daily living (ADL) were examined. These assessments were performed by 72 skilled home helpers who also assessed the severity of their own level of stress using the Burnout scale. The intellectual level and mood-related signs, based on the CSDD scale, of the elderly living with families or with a spouse were diminished significantly as compared to the elderly living alone. The elderly living with families also performed worse on all ADL categories except for visual acuity as compared to the elderly living with a spouse or living alone. There was no significant correlation between the Burnout scale score and age or frequency of working as a home helper. These results suggest that elderly people living with families as compared to the elderly living with a spouse or living alone have greater mental health needs as well as more profound physical limitations.

  3. The effect of vortex merging and non-merging on the transfer of modal turbulent kinetic energy content

    Science.gov (United States)

    Ground, Cody; Vergine, Fabrizio; Maddalena, Luca

    2016-08-01

    A defining feature of the turbulent free shear layer is that its growth is hindered by compressibility effects, thus limiting its potential to sufficiently mix the injected fuel and surrounding airstream at the supersonic Mach numbers intrinsic to the combustor of air-breathing hypersonic vehicles. The introduction of streamwise vorticity is often proposed in an attempt to counteract these undesired effects. This fact makes the strategy of introducing multiple streamwise vortices and imposing upon them certain modes of mutual interaction in order to potentially enhance mixing an intriguing concept. However, many underlying fundamental characteristics of the flowfields in the presence such interactions are not yet well understood; therefore, the fundamental physics of these flowfields should be independently investigated before the explicit mixing performance is characterized. In this work, experimental measurements are taken with the stereoscopic particle image velocimetry technique on two specifically targeted modes of vortex interaction—the merging and non-merging of two corotating vortices. The fluctuating velocity fields are analyzed utilizing the proper orthogonal decomposition (POD) in order to identify the content, organization, and distribution of the modal turbulent kinetic energy content of the fluctuating velocity eigenmodes. The effects of the two modes of vortex interaction are revealed by the POD analysis which shows distinct differences in the modal features of the two cases. When comparing the low-order eigenmodes of the two cases, the size of the structures contained within the first ten modes is seen to increase as the flow progresses downstream for the merging case, whereas the opposite is true for the non-merging case. Additionally, the relative modal energy contribution of the first ten eigenmodes increases as the vortices evolve downstream for the merging case, whereas in the non-merging case the relative modal energy contribution decreases

  4. Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation.

    Science.gov (United States)

    Scammon, Debra L; Tomoaia-Cotisel, Andrada; Day, Rachel L; Day, Julie; Kim, Jaewhan; Waitzman, Norman J; Farrell, Timothy W; Magill, Michael K

    2013-12-01

    To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived. An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design, its version of the Patient Centered Medical Home. Convergent case study mixed methods design. Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semistructured interviews, focus groups, Centers for Medicare and Medicaid Services database, and the Utah All Payer Claims Database. Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence. © Health Research and Educational Trust.

  5. A remote data access architecture for home-monitoring health-care applications.

    Science.gov (United States)

    Lin, Chao-Hung; Young, Shuenn-Tsong; Kuo, Te-Son

    2007-03-01

    With the aging of the population and the increasing patient preference for receiving care in their own homes, remote home care is one of the fastest growing areas of health care in Taiwan and many other countries. Many remote home-monitoring applications have been developed and implemented to enable both formal and informal caregivers to have remote access to patient data so that they can respond instantly to any abnormalities of in-home patients. The aim of this technology is to give both patients and relatives better control of the health care, reduce the burden on informal caregivers and reduce visits to hospitals and thus result in a better quality of life for both the patient and his/her family. To facilitate their widespread adoption, remote home-monitoring systems take advantage of the low-cost features and popularity of the Internet and PCs, but are inherently exposed to several security risks, such as virus and denial-of-service (DoS) attacks. These security threats exist as long as the in-home PC is directly accessible by remote-monitoring users over the Internet. The purpose of the study reported in this paper was to improve the security of such systems, with the proposed architecture aimed at increasing the system availability and confidentiality of patient information. A broker server is introduced between the remote-monitoring devices and the in-home PCs. This topology removes direct access to the in-home PC, and a firewall can be configured to deny all inbound connections while the remote home-monitoring application is operating. This architecture helps to transfer the security risks from the in-home PC to the managed broker server, on which more advanced security measures can be implemented. The pros and cons of this novel architecture design are also discussed and summarized.

  6. Automated Cognitive Health Assessment From Smart Home-Based Behavior Data.

    Science.gov (United States)

    Dawadi, Prafulla Nath; Cook, Diane Joyce; Schmitter-Edgecombe, Maureen

    2016-07-01

    Smart home technologies offer potential benefits for assisting clinicians by automating health monitoring and well-being assessment. In this paper, we examine the actual benefits of smart home-based analysis by monitoring daily behavior in the home and predicting clinical scores of the residents. To accomplish this goal, we propose a clinical assessment using activity behavior (CAAB) approach to model a smart home resident's daily behavior and predict the corresponding clinical scores. CAAB uses statistical features that describe characteristics of a resident's daily activity performance to train machine learning algorithms that predict the clinical scores. We evaluate the performance of CAAB utilizing smart home sensor data collected from 18 smart homes over two years. We obtain a statistically significant correlation ( r=0.72) between CAAB-predicted and clinician-provided cognitive scores and a statistically significant correlation ( r=0.45) between CAAB-predicted and clinician-provided mobility scores. These prediction results suggest that it is feasible to predict clinical scores using smart home sensor data and learning-based data analysis.

  7. The home-based maternal record: a tool for family involvement in health care.

    Science.gov (United States)

    Shah, P M; Shah, K P; Belsey, M A

    1988-04-01

    The home-based maternal record offers an opportunity for family involvement in health care. Home-based records of maternal health have been used in several developing countries, and have led to increased detection and monitoring of women at high risk for complications during pregnancy. Home-based cards that include menstrual information remind health workers to educate and motivate women for family planning, and serve as a source of health statistics. Records that use pictures and symbols have been used by illiterate traditional birth attendants, and had an accurate completion rate of over 90%. The WHO has prepared a prototype record and guidelines for local adaptation. The objectives were to provide continuity of care throughout pregnancy, ensure recognition of at-risk women, encourage family participation in health care, an provide data on maternal health, breastfeeding, and family planning. The guidelines have been evaluated and results show that the records have improved the coverage, acceptability, and quality of MCH/FP care. The records have also led to an increase in diagnosis and referral of at-risk women and newborns, and the use of family planning and tetanus toxoid immunization has increased in the 13 centers where the reports are being used. Focus group discussions have shown that mothers, community members, primary health workers, and doctors and nurses liked the records. It is important to adapt criteria for high-risk conditions to the local areas where the records will be used to ensure the relevance of risk diagnosis. The evidence shows that home-based maternal and child records can be an important tool in the promotion of self-reliance and family participation in health care. In addition, home-based records can be used for the implementation of primary health care at the local level, and serve as a resource for data collection.

  8. Association of Individual and Neighborhood Factors with Home Food Availability: Evidence from the National Health and Nutrition Examination Survey.

    Science.gov (United States)

    Chai, Weiwen; Fan, Jessie X; Wen, Ming

    2018-05-01

    Accumulating evidence suggests the important role of the home food environment in an individual's dietary intake. This study examined the associations of individual and neighborhood-level factors with the availability of healthy and unhealthy foods in the home using a nationally representative sample from the 2007 to 2008 and 2009 to 2010 National Health and Nutrition Examination Surveys (NHANES). A cross-sectional study design was used with NHANES merged with the 2000 census data. Food availability was measured through self-report questionnaire regarding the frequency of foods or drinks available in the home. The analysis included 8,975 participants aged 19 to 65 years. Associations of individual and neighborhood factors with home food availability (always or most of the time available) were assessed using logistic regression modeling accounting for NHANES' complex survey design and weights. Individual-level and neighborhood-level factors were simultaneously included in the analysis. Family income-to-needs ratio was positively associated with the availability of dark green vegetables (odds ratio [OR]=1.07; 95% CI=1.00 to 1.13), fat-free or low-fat milk (OR=1.16; 95% CI=1.07 to 1.25), and salty snacks (OR=1.12; 95% CI=1.04 to 1.20) in the home. College graduates were more likely to have fruits (OR=1.96, 95% CI=1.48 to 2.60), vegetables (OR=1.48; 95% CI=1.16 to 1.88), and fat-free or low-fat milk (OR=1.81; 95% CI=1.55 to 2.12) and less likely to have salty snacks (OR=0.77; 95% CI=0.63 to 0.95) and sugary drinks (OR=0.46, 95% CI=0.37 to 0.57) available compared with non-college graduates. Tract socioeconomic status (SES) scores were positively associated with fruit (OR=1.15; 95% CI=1.02 to 1.29), vegetable (OR=1.14; 95% CI=1.03 to 1.26), and fat-free or low-fat milk (OR=1.25; 95% CI=1.10 to 1.42) availability. Urban residents were associated with greater availability of fruits (OR=1.47; 95% CI=1.05 to 2.08) and fat-free or low-fat milk (OR=1.33; 95% CI=1.02 to 1

  9. Experiments on CT plasma merging in the CTCC-1

    International Nuclear Information System (INIS)

    Watanabe, K.; Ikegami, K.; Nishikawa, M.; Ozaki, A.; Satomi, N.; Uyama, T.

    1982-01-01

    A compact toroid (CT) plasma merging experiment has been tried preliminarily in the CTCC-1 experiment as a method for further-heating of CT, on producing two CT plasmas in the flux conserver successively. Two CT plasmas were observed really to merge with each other in the flux conserver. In the merging process, it is found that the field reconnection of surface magnetic field lines of CT is completed until 30 μs after the second CT injection, but magnetic field lines around the center of CT merge slowly, taking about 100 μs. Experimental results indicate that merging of CT results in doubled addition of toroidal fluxes and no-addition of poloidal fluxes

  10. The relationship between advertising, price, and nursing home quality.

    Science.gov (United States)

    Kash, Bita A; Miller, Thomas R

    2009-01-01

    Theoretically, nursing homes should engage in advertising for the following two reasons: (a) to improve awareness of the services offered in a particular market and (b) to signal high-quality services. In this study, we build upon results from prior studies of nursing home advertising activity, market competition, and quality. The purpose of this study was to examine the association between advertising expenses, price, and quality. We focused on answering the question: Do nursing homes use advertising and price to signal superior quality? The Texas Nursing Facilities Medicaid Cost Report, the Texas Quality Reporting System, and the Area Resource File were merged for the year 2003. We used three alternative measures of quality to improve the robustness of this exploratory analysis. Quality measures were examined using Bonferroni correlation coefficient analysis. Associations between advertising expenses and quality were evaluated using three regression models predicting quality. We also examined the association of the price of a private bed per day with quality. Advertising expenses were not associated with better nursing home quality as measured by three quality scales. The average price customers pay for one private bed per day was associated with better quality only in one of the three quality regression models. The price of nursing home care might be a better indicator of quality and necessary to increase as quality of care is improved in the nursing homes sector. Because more advertising expenditures are not necessarily associated with better quality, consumers could be mislead by advertisements and choose poor quality nursing homes. Nursing home administrators should focus on customer relationship management tools instead of expensive advertising. Relationship management tools are proven marketing techniques for the health services sector, usually less expensive than advertising, and help with staff retention and quality outcomes.

  11. Economic evaluation of home-based telebehavioural health care compared to in-person treatment delivery for depression.

    Science.gov (United States)

    Bounthavong, Mark; Pruitt, Larry D; Smolenski, Derek J; Gahm, Gregory A; Bansal, Aasthaa; Hansen, Ryan N

    2018-02-01

    Introduction Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care and in-person care for depression among current and former US service members. Methods We performed trial-based cost-minimisation and cost-utility analyses to assess the economic impact of home-based telebehavioural health care versus in-person behavioural care for depression. Our analyses focused on the payer perspective (Department of Defense and Department of Veterans Affairs) at three months. We also performed a scenario analysis where all patients possessed video-conferencing technology that was approved by these agencies. The cost-utility analysis evaluated the impact of different depression categories on the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model assumptions. Results In the base case analysis the total direct cost of home-based telebehavioural health care was higher than in-person care (US$71,974 versus US$20,322). Assuming that patients possessed government-approved video-conferencing technology, home-based telebehavioural health care was less costly compared to in-person care (US$19,177 versus US$20,322). In one-way sensitivity analyses, the proportion of patients possessing personal computers was a major driver of direct costs. In the cost-utility analysis, home-based telebehavioural health care was dominant when patients possessed video-conferencing technology. Results from probabilistic sensitivity analyses did not differ substantially from base case results. Discussion Home-based telebehavioural health care is dependent on the cost of supplying video-conferencing technology to patients but offers the opportunity to

  12. [Current status of costs and utilizations of hospital based home health nursing care in Korea].

    Science.gov (United States)

    Ryu, Hosihn

    2006-12-01

    The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won ( approximately 48 $, 1 $=960 Won). The costs ranged from 74,523 Won ( approximately 78 $, loss of chronic kidney function, N18) to 32,270 Won ( approximately 34 $, other cerebrovascular diseases, I67). Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.

  13. Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands.

    Science.gov (United States)

    Peters, Velibor P J M; de Rijk, Angelique E; Boumans, Nicolle P G

    2009-12-01

    This paper is a report of a study conducted to determine if satisfaction with irregular working hours that are a form of shiftwork operates as a mediator between work and home characteristics and health problems. Shiftwork contributes to health problems, decreased well-being and poorer health habits. It also affects employees' decisions to leave the healthcare sector. Although many nurses voluntarily work shifts, there have been few studies of their satisfaction with irregular working hours when these are a form of shiftwork. A survey was carried out with 144 nurses working in three nursing homes and one care home in the Netherlands. Questionnaires were distributed in 2003 to 233 nurses who worked shifts (response rate 60%). The questionnaire contained items on work and home characteristics, satisfaction with irregular working hours that are a form of shiftwork and health. A new scale to measure satisfaction with irregular working hours was constructed. All work characteristics, but no home characteristics, were associated with satisfaction with irregular working hours. The work characteristics 'job demands' and the home characteristics 'autonomy at home' and 'home demands' were associated with health. Satisfaction with irregular working hours did not mediate between work/home characteristics and health. Those reporting more social support, lower job demands and more job autonomy were more satisfied with their irregular working times that were a form of shiftwork. Satisfaction with irregular working hours is a useful construct that requires further longitudinal study. The results also underline the importance of considering home characteristics when predicting health outcomes.

  14. Convolutional Neural Network-Based Embarrassing Situation Detection under Camera for Social Robot in Smart Homes.

    Science.gov (United States)

    Yang, Guanci; Yang, Jing; Sheng, Weihua; Junior, Francisco Erivaldo Fernandes; Li, Shaobo

    2018-05-12

    Recent research has shown that the ubiquitous use of cameras and voice monitoring equipment in a home environment can raise privacy concerns and affect human mental health. This can be a major obstacle to the deployment of smart home systems for elderly or disabled care. This study uses a social robot to detect embarrassing situations. Firstly, we designed an improved neural network structure based on the You Only Look Once (YOLO) model to obtain feature information. By focusing on reducing area redundancy and computation time, we proposed a bounding-box merging algorithm based on region proposal networks (B-RPN), to merge the areas that have similar features and determine the borders of the bounding box. Thereafter, we designed a feature extraction algorithm based on our improved YOLO and B-RPN, called F-YOLO, for our training datasets, and then proposed a real-time object detection algorithm based on F-YOLO (RODA-FY). We implemented RODA-FY and compared models on our MAT social robot. Secondly, we considered six types of situations in smart homes, and developed training and validation datasets, containing 2580 and 360 images, respectively. Meanwhile, we designed three types of experiments with four types of test datasets composed of 960 sample images. Thirdly, we analyzed how a different number of training iterations affects our prediction estimation, and then we explored the relationship between recognition accuracy and learning rates. Our results show that our proposed privacy detection system can recognize designed situations in the smart home with an acceptable recognition accuracy of 94.48%. Finally, we compared the results among RODA-FY, Inception V3, and YOLO, which indicate that our proposed RODA-FY outperforms the other comparison models in recognition accuracy.

  15. Home Monitoring and Personal Health Management Services in a Regional Health Telematics Network

    National Research Council Canada - National Science Library

    Traganitis, A

    2001-01-01

    ...), the R&D issues involved in the design, development and implementation of a modular and configurable Home Care Platform that supports different health and social care domains, and the results of the clinical...

  16. Effects of home-based long-term care services on caregiver health according to age.

    Science.gov (United States)

    Chen, Ming-Chun; Kao, Chi-Wen; Chiu, Yu-Lung; Lin, Tzu-Ying; Tsai, Yu-Ting; Jian, Yi-Ting Zhang; Tzeng, Ya-Mei; Lin, Fu-Gong; Hwang, Shu-Ling; Li, Shan-Ru; Kao, Senyeong

    2017-10-23

    Caregiver health is a crucial public health concern due to the increasing number of elderly people with disabilities. Elderly caregivers are more likely to have poorer health and be a care recipient than younger caregivers. The Taiwan government offers home-based long-term care (LTC) services to provide formal care and decrease the burden of caregivers. This study examined the effects of home-based LTC services on caregiver health according to caregiver age. This cross-sectional study included a simple random sample of care recipients and their caregivers. The care recipients had used LTC services under the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. Data were collected through self-administered questionnaires from September 2012 to January 2013. The following variables were assessed for caregivers: health, sex, marital status, education level, relationship with care recipient, quality of relationship with care recipient, job, household monthly income, family income spent on caring for the care recipient (%) and caregiving period. Furthermore, the following factors were assessed for care recipients: age, sex, marital status, education level, living alone, number of family members living with the care recipient, quality of relationship with family and dependency level. The health of the caregivers and care recipients was measured using a self-rated question (self-rated health [SRH] was rated as very poor, poor, fair, good and very good). The study revealed that home nursing care was significantly associated with the health of caregivers aged 65 years or older; however, caregivers aged less than 65 who had used home nursing care, rehabilitation or respite care had poorer health than those who had not used these services. In addition, the following variables significantly improved the health of caregivers aged 65 years or older: caregiver employment, 20% or less of family income spent on caregiving than 81%-100% and higher care recipient health. The

  17. 42 CFR 403.764 - Basis and purpose of religious nonmedical health care institutions providing home service.

    Science.gov (United States)

    2010-10-01

    ... care institutions providing home service. 403.764 Section 403.764 Public Health CENTERS FOR MEDICARE... Basis and purpose of religious nonmedical health care institutions providing home service. (a) Basis... and 1878 of the Act regarding Medicare payment for items and services provided in the home setting...

  18. Resource utilization in home health care: results of a prospective study.

    Science.gov (United States)

    Trisolini, M G; Thomas, C P; Cashman, S B; Payne, S M

    1994-01-01

    Resource utilization in home health care has become an issue of concern due to rising costs and recent initiatives to develop prospective payment systems for home health care. A number of issues remain unresolved for the development of prospective reimbursement in this sector, including the types of variables to be included as payment variables and appropriate measures of resource use. This study supplements previous work on home health case-mix by analyzing the factors affecting one aspect of resource use for skilled nursing visits--visit length--and explores the usefulness of several specially collected variables which are not routinely available in administrative records. A data collection instrument was developed with a focus group of skilled nurses, identifying a range of variables hypothesized to affect visit length. Five categories of variables were studied using multiple regression analysis: provider-related; patient's socio-economic status; patient's clinical status; patient's support services; and visit-specific. The final regression model identifies 9 variables which significantly affect visit time. Five of the 9 are visit-specific variables, a significant finding since these are not routinely collected. Case-mix systems which include visit time as a measure of resource use will need to investigate visit-specific variables, as this study indicates they could have the largest influence on visit time. Two other types of resources used in home health care, supplies and security drivers, were also investigated in less detail.

  19. A university-sponsored home health nursing program in Karachi, Pakistan.

    Science.gov (United States)

    Smego, Raymond A; Khan, Mohammad Aslam; Khowaja, Khurshid; Rafique, Rozina; Datoo, Farida

    2005-11-01

    This article describes a university-sponsored home health nursing program in a large urban center in Pakistan and details the essential elements needed in implementing such a program in a developing country. Compared to in-hospital treatment, home healthcare reduced hospital stay from 12.8 days to 3.9 days, and resulted in a net savings of Pakistani rupees (PRs) 5,374,135 (USD 89,569). A cost-effective home treatment program in a resource-limited country can be successfully implemented by using the hospital pharmacy as the central point for the preparation and distribution of medications and specialty nursing services.

  20. The Home Independence Program with non-health professionals as care managers: an evaluation

    Directory of Open Access Journals (Sweden)

    Lewin G

    2016-06-01

    Full Text Available Gill Lewin,1 Karyn Concanen,2 David Youens3 1School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia; 2Silver Chain Group, Osborne Park, WA, Australia; 3Faculty of Health Science, Curtin University, Perth, WA, Australia Abstract: The Home Independence Program (HIP, an Australian restorative home care/reablement service for older adults, has been shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday activities, and quality of life. These gains were found to translate into a reduced need for ongoing care services and reduced health and aged care costs over time. Despite these positive outcomes, few Australian home care agencies have adopted the service model – a key reason being that few Australian providers employ health professionals, who act as care managers under the HIP service model. A call for proposals from Health Workforce Australia for projects to expand the scope of practice of health/aged care staff then provided the opportunity to develop, implement, and evaluate a service delivery model, in which nonprofessionals replaced the health professionals as Care Managers in the HIP service. Seventy older people who received the HIP Coordinator (HIPC service participated in the outcomes evaluation. On a range of personal outcome measures, the group showed statistically significant improvement at 3 and 12 months compared to baseline. On each outcome, the improvement observed was larger than that observed in a previous trial in which the service was delivered by health professionals. However, differences in the timing of data collection between the two studies mean that a direct comparison cannot be made. Clients in both studies showed a similarly reduced need for ongoing home care services at both follow-up points. The outcomes achieved by HIPC, with non-health professionals as Care Managers, were positive and can be considered to compare favorably

  1. Human rights dimensions of food, health and care in children's homes in Kampala, Uganda - a qualitative study.

    Science.gov (United States)

    Vogt, Line Erikstad; Rukooko, Byaruhanga; Iversen, Per Ole; Eide, Wenche Barth

    2016-03-18

    More than 14 % of Ugandan children are orphaned and many live in children's homes. Ugandan authorities have targeted adolescent girls as a priority group for nutrition interventions as safeguarding nutritional health before pregnancy can reduce the chance of passing on malnutrition to the offspring and thus future generations. Ugandan authorities have obligations under international human rights law to progressively realise the rights to adequate food, health and care for all Ugandan children. Two objectives guided this study in children's homes: (a) To examine female adolescent residents' experiences, attitudes and views regarding: (i) eating patterns and food, (ii) health conditions, and (iii) care practices; and (b) to consider if the conditions in the homes comply with human rights standards and principles for the promotion of the rights to adequate food, health and care. A human rights-based approach guided the planning and conduct of this study. Five children's homes in Kampala were included where focus group discussions were held with girls aged 12-14 and 15-17 years. These discussions were analysed through a phenomenological approach. The conditions of food, health and care as experienced by the girls, were compared with international standards for the realisation of the human rights to adequate food, health and care. Food, health and care conditions varied greatly across the five homes. In some of these the girls consumed only one meal per day and had no access to clean drinking water, soap, toilet paper and sanitary napkins. The realisation of the right to adequate food for the girls was not met in three homes, the realisation of the right to health was not met in two homes, and the realisation of the right to care was not met in one home. In three of the selected children's homes human rights standards for food, health or care were not met. Care in the children's homes was an important contributing factor for whether standards for the rights to adequate

  2. Seamless-merging-oriented parallel inverse lithography technology

    International Nuclear Information System (INIS)

    Yang Yiwei; Shi Zheng; Shen Shanhu

    2009-01-01

    Inverse lithography technology (ILT), a promising resolution enhancement technology (RET) used in next generations of IC manufacture, has the capability to push lithography to its limit. However, the existing methods of ILT are either time-consuming due to the large layout in a single process, or not accurate enough due to simply block merging in the parallel process. The seamless-merging-oriented parallel ILT method proposed in this paper is fast because of the parallel process; and most importantly, convergence enhancement penalty terms (CEPT) introduced in the parallel ILT optimization process take the environment into consideration as well as environmental change through target updating. This method increases the similarity of the overlapped area between guard-bands and work units, makes the merging process approach seamless and hence reduces hot-spots. The experimental results show that seamless-merging-oriented parallel ILT not only accelerates the optimization process, but also significantly improves the quality of ILT.

  3. Promoting Health of People with Intellectual Disabilities: Views of Professionals Working in Group Homes

    Science.gov (United States)

    Wahlström, Lina; Bergström, Helena; Marttila, Anneli

    2014-01-01

    Deinstitutionalisation has influenced the life situation for people with intellectual disabilities, whilst the experiences of health promotion in group homes now are limited. This study aimed to explore aspects important to consider when promoting health amongst persons with intellectual disabilities in group homes, from the perspective of…

  4. 75 FR 81138 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2010-12-27

    ... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in... Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home...

  5. Exploration of the administrative aspects of the delivery of home health care services: a qualitative study.

    Science.gov (United States)

    Shahsavari, Hooman; Nasrabadi, Alireza Nikbakht; Almasian, Mohammad; Heydari, Heshmatolah; Hazini, Abdolrahim

    2018-01-01

    Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task. The purpose of this study was to explore the administrative aspects of the delivery of home health care services. This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method. 23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories. Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.

  6. Home health nurses: stress, self-esteem, social intimacy, and job satisfaction.

    Science.gov (United States)

    Moore, S; Lindquist, S; Katz, B

    1997-06-01

    A survey of 253 home health care nurses' perceptions of work-related stress, self-esteem, social intimacy, and job satisfaction found that stress has a negative correlation with self-esteem, social intimacy, and job satisfaction. A positive correlation, however, was found between self-esteem and social intimacy and job satisfaction. Health system administrators, owners, and directors had significantly higher levels of self-esteem, nurses with 5 years or more in their home health nursing position had significantly higher levels of self-esteem. The survey found that nurses with less than a baccalaureate degree possessed significantly lower levels of sociability than those with a graduate or baccalaureate degree. Administrators and managers scored significantly higher on sociability than head nurses.

  7. Home visits during pregnancy: consequences on pregnancy outcome, use of health services, and women's situations.

    Science.gov (United States)

    Blondel, B; Bréart, G

    1995-08-01

    This review of eight randomized controlled trials assessed two different types of home visits during pregnancy: (1) those offering social support to high-risk women; and (2) those providing medical care to women with complications. In both categories, pregnancy outcome was not improved when women received home visits. The summary odds ratio for preterm delivery (better integration of hospital and home services might allow a more rational use of health services for women with complications. In addition, we need to define more precisely the content of home visits providing social support. For this, further research is required on how emotional support, health education, and advice influence the health of women and infants and mother-child interactions.

  8. [Chronic home-care patients and their primary health care environment].

    Science.gov (United States)

    Bilbao Curiel, I; Gastaminza Santacoloma, A M; García García, J A; Quindimil Vázquez, J A; López Rivas, J L; Huidobro Fernández, L

    1994-03-15

    Describing the primary level of attention to chronic home patients (CHP), their quality or life and the one of their home carers. Descriptive transverse study. Teaching Unit of Family of Sestao (Vizcaya) urban environment. 197 CHP patients with subacute, chronic illnesses or in terminal stages or handicapped, that is to say, people who cannot attend the Medical Centre and needing constant home care (longer than 4 weeks) although they do not need to be in hospital at the moment. A questionnaire made up by the researching group. April-June 1992. The clinical histories and home interviews. Mean age (78 +/- 23) years old; 70% were women; average of health problems of patients (4.2 +/- 4); average of drug consumption by patients (3.6 +/- 4); average of one visit to each patient per two months; 75% did not need derivation. The average age of people looking after them was (58 +/- 28) years old and 77.3% of them were women. Their average QL index was (9 +/- 2.4) out of 10, 9.2% had a QL index between 4 and 7 although there was nobody under 3. We have found an old population, mostly women with an average of health problems of (4.24 +/- 4) and who are polymedicated. 9.4 of them are not looked after by anybody. Generally their homes are habitable enough. In 77.3% of the cases the carers are women and 65.6% do not receive any domiciliary help.

  9. Home births in the Mosvold health ward of KwaZulu | Buchman ...

    African Journals Online (AJOL)

    A community survey was carried out to determine the frequency and the methods of home deliveries in the Mosvold health ward in northern KwaZulu. Of a sample of 210 mothers interviewed 46% had given birth at home, and of these 48% were delivered by traditional birth attendants; 84% gave birth in a kneeling or sitting ...

  10. Physical Restraint Initiation in Nursing Homes and Subsequent Resident Health

    Science.gov (United States)

    Engberg, John; Castle, Nicholas G.; McCaffrey, Daniel

    2008-01-01

    Purpose: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental…

  11. A Numerical Study of Vortex and Precipitating Cloud Merging in Middle Latitudes

    Institute of Scientific and Technical Information of China (English)

    PING Fan; LUO Zhe-Xian; JU Jian-Hua

    2006-01-01

    @@ We mainly focus on the study of precipitating cloud merging associated with vortex merging. The vortex and precipitating cloud merging are simulated by the cloud resolving model from 0000 21 to 1800 23 July 2003. The results show that the model well simulates vortex circulation associated with precipitating clouds. It is also proven that the vortex merging follows the precipitating cloud merging although vortices show the spatial and temporal differences. The convection vorticity vector is introduced to describe the merging processes. Two merging cases are identified during the 42-h simulation and are studied.

  12. Exploring partners' perspectives on participation in heart failure home care: a mixed-method design.

    Science.gov (United States)

    Näsström, Lena; Luttik, Marie Louise; Idvall, Ewa; Strömberg, Anna

    2017-05-01

    To describe the partners' perspectives on participation in the care for patients with heart failure receiving home care. Partners are often involved in care of patients with heart failure and have an important role in improving patients' well-being and self-care. Partners have described both negative and positive experiences of involvement, but knowledge of how partners of patients with heart failure view participation in care when the patient receives home care is lacking. A convergent parallel mixed-method design was used, including data from interviews and questionnaires. A purposeful sample of 15 partners was used. Data collection lasted between February 2010 - December 2011. Interviews were analysed with content analysis and data from questionnaires (participation, caregiving, health-related quality of life, depressive symptoms) were analysed statistically. Finally, results were merged, interpreted and labelled as comparable and convergent or as being inconsistent. Partners were satisfied with most aspects of participation, information and contact. Qualitative findings revealed four different aspects of participation: adapting to the caring needs and illness trajectory, coping with caregiving demands, interacting with healthcare providers and need for knowledge to comprehend the health situation. Results showed confirmatory results that were convergent and expanded knowledge that gave a broader understanding of partner participation in this context. The results revealed different levels of partner participation. Heart failure home care included good opportunities for both participation and contact during home visits, necessary to meet partners' ongoing need for information to comprehend the situation. © 2016 John Wiley & Sons Ltd.

  13. Health status of UK care home residents: a cohort study.

    Science.gov (United States)

    Gordon, Adam Lee; Franklin, Matthew; Bradshaw, Lucy; Logan, Pip; Elliott, Rachel; Gladman, John R F

    2014-01-01

    UK care home residents are often poorly served by existing healthcare arrangements. Published descriptions of residents' health status have been limited by lack of detail and use of data derived from surveys drawn from social, rather than health, care records. to describe in detail the health status and healthcare resource use of UK care home residents a 180-day longitudinal cohort study of 227 residents across 11 UK care homes, 5 nursing and 6 residential, selected to be representative for nursing/residential status and dementia registration. Barthel index (BI), Mini-mental state examination (MMSE), Neuropsychiatric index (NPI), Mini-nutritional index (MNA), EuroQoL-5D (EQ-5D), 12-item General Health Questionnaire (GHQ-12), diagnoses and medications were recorded at baseline and BI, NPI, GHQ-12 and EQ-5D at follow-up after 180 days. National Health Service (NHS) resource use data were collected from databases of local healthcare providers. out of a total of 323, 227 residents were recruited. The median BI was 9 (IQR: 2.5-15.5), MMSE 13 (4-22) and number of medications 8 (5.5-10.5). The mean number of diagnoses per resident was 6.2 (SD: 4). Thirty per cent were malnourished, 66% had evidence of behavioural disturbance. Residents had contact with the NHS on average once per month. residents from both residential and nursing settings are dependent, cognitively impaired, have mild frequent behavioural symptoms, multimorbidity, polypharmacy and frequently use NHS resources. Effective care for such a cohort requires broad expertise from multiple disciplines delivered in a co-ordinated and managed way.

  14. The effect of early postpartum home visits by health visitors: a natural experiment

    DEFF Research Database (Denmark)

    Kronborg, Hanne; Væth, Michael; Kristensen, Ingeborg

    2012-01-01

    Objective: To assess if the absence of early home visits influenced the mothers’ breastfeeding duration and use of medical services. Design: Data from mothers who had given birth during a strike period were compared to data from a reference period with usual work practice. Sample: The study...... included 3834 newborn and 375 health visitors, 75 of whom worked during the strike period. Intervention: All families were offered non- standardized home visits after discharge in the reference period. During the strike, the service was based on individual risk assessment. Results: Overall, no difference....... The mothers’ needs for postnatal visits differed depending on parity: primiparae underlined uncertainty, multiparae underlined previous breastfeeding experience. Mothers had missed out on guidance on all areas of the health visitors’ service. Conclusion: Non-standardized home visits by health visitors were...

  15. The oral health condition and treatment needs assessment of nursing home residents in Flanders (Belgium).

    Science.gov (United States)

    Janssens, B; Vanobbergen, J; Petrovic, M; Jacquet, W; Schols, J M G A; De Visschere, L

    2017-09-01

    A study was conducted of nursing home residents with limited access to regular oral health care services to evaluate their oral health status, to perform an assessment of the need for oral treatment and to determine the possible predicting value of age, gender, care dependency and income level on their oral health status and treatment needs. Three experienced dentists collected clinical oral health data with a mobile dental unit in 23 nursing homes. Socio-demographic data were extracted from the residents' records in the nursing home. Besides the descriptive and bivariate analysis, a general linear mixed model analysis was also performed with the nursing home as random effect. The study sample consisted of 1,226 residents with a mean age of 83.9 years, of which 41.9% were edentulous. The mean D₃MFt in the dentate group was 24.5 and 77% needed extractions or fillings. In the group of residents wearing removable dentures, 36.9% needed repair, rebasing or renewal of the denture. The mixed model analysis demonstrated that with each year a resident gets older, the oral health outcomes get worse and that men have worse oral health and higher treatment needs than women. However, the level of income and care dependency had a less extensive role in predicting the oral health outcomes. The nursing home residents presented a poor overall oral health status and high dental and prosthetic treatment needs. Gender and age were important predicting variables for the oral health outcomes. Copyright© 2017 Dennis Barber Ltd.

  16. 75 FR 76293 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2010-12-08

    ... [CMS-1510-CN] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification... effective as if they had been included in the Medicare Program; Home Health Prospective Payment System Rate...

  17. Changes in the Medicare home health care market: the impact of reimbursement policy.

    Science.gov (United States)

    Choi, Sunha; Davitt, Joan K

    2009-03-01

    The Balanced Budget Act of 1997 introduced 2 new reimbursement structures, the Interim Payment System (IPS, 1997-2000) and the Prospective Payment System (PPS, begun October 2000) for Medicare home health agencies (HHAs) under the fee-for-service program. This article describes and compares the impact of these changes on the Medicare home health market from a period before the BBA through the IPS and PPS in relation to agency characteristics. A secondary analysis of 1996, 1999, and 2002 Provider of Services data was conducted on all Medicare-certified HHAs. Frequencies and rates of change were calculated by agency characteristics to describe changes in the number of active agencies through those years. Logistic regression models were used to compare factors associated with market exits under different payment systems. The results indicate dramatic but disproportional changes in response to the IPS and the PPS among Medicare home health care agencies. Agency closures were greater and market entries fewer during the IPS, but more branch offices/subunits were closed during the PPS. Proprietary and freestanding agencies experienced greater volatility throughout, with the greatest number of closures seen in Region VI (Dallas). These results demonstrate the direct impact of policy changes on the home health care market and highlight the need to evaluate policy changes to understand both intended and unintended impacts on health markets. Future research should analyze the effect of these policy changes on other healthcare providers and systems and their impact on health outcomes for Medicare beneficiaries.

  18. A branch-and-price algorithm for the long-term home care scheduling problem

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    2012-01-01

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans such that a high quality of service is maintained, the work hours of the employees are respected, and the overall cost is kept as low as possible. We...... propose a branchand-price algorithm for the long-term home care scheduling problem. The pricing problem generates a one-day plan for an employee, and the master problem merges the plans with respect to regularity constraints. The method is capable of generating plans with up to 44 visits during one week....

  19. Home Economics/Health Grades 6-12. Program Evaluation.

    Science.gov (United States)

    Des Moines Public Schools, IA. Teaching and Learning Div.

    Home economics programs are offered to students in grades 6-12 in the Des Moines INdependent Community School District (Iowa). Programs at the middle school level are exploratory, leading to occupational training in family and consumer science, child care, food service, and textile and fashion arts at the high school level. Health education…

  20. Benefits of Medical Home Care Reaching Beyond Chronically Ill Teens: Exploring Parent Health-Related Quality of Life.

    Science.gov (United States)

    Chavez, Laura J; Grannis, Connor; Dolce, Millie; Chisolm, Deena J

    2018-03-15

    Caring for teens with special health care needs places physical and mental health burdens on parents, which can be exacerbated by the stresses of transitions to independence. Medical homes can improve teen transitions to greater self-management and reduce health care-related time and financial burdens for families. We examined the association between parent-reported teen medical home status and caregiver health-related quality of life (HRQOL). The study sample included parents or caregivers of teens with special health care needs aged 15 to 18 recruited from a pediatric Medicaid accountable care organization who participated in a survey (response rate, 40.5%). The primary outcome was parent HRQOL scores (0-100 points) measured using the Pediatric Quality of Life Inventory Family Impact Module. Medical home status was based on parent report of teen's health care meeting medical home criteria. Linear regression models were used to estimate HRQOL scores, adjusted for demographic characteristics, health literacy, and teen functional limitation. Among 488 parents, 27% reported their teen received care consistent with a medical home. Adjusted parent HRQOL scores were significantly higher among those whose teens had a medical home (74.40; 95% confidence interval, 71.31-77.48), relative to those whose teens did not (65.78; 95% confidence interval, 63.92-67.65). Medical home subscale analyses showed HRQOL scores had significant positive associations with family-centered care and coordinated care, but not other subscales. Teen medical home status was positively associated with caregiver HRQOL, suggesting that the medical home may benefit overall caregiver well-being. In particular, receiving care that was family centered and coordinated appeared to be the most beneficial. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  1. Filtered Rayleigh scattering mixing measurements of merging and non-merging streamwise vortex interactions in supersonic flow

    Science.gov (United States)

    Ground, Cody R.; Gopal, Vijay; Maddalena, Luca

    2018-04-01

    By introducing large-scale streamwise vortices into a supersonic flow it is possible to enhance the rate of mixing between two fluid streams. However, increased vorticity content alone does not explicitly serve as a predictor of mixing enhancement. Additional factors, particularly the mutual interactions occurring between neighboring vortical structures, affect the underlying fundamental physics that influence the rate at which the fluids mix. As part of a larger systematic study on supersonic streamwise vortex interactions, this work experimentally quantifies the average rate of mixing of helium and air in the presence of two separate modes of vortex interaction, the merging and non-merging of a pair of co-rotating vortices. In these experiments vortex-generating expansion ramps are placed on a strut injector. The freestream Mach number is set at 2.5 and helium is injected as a passive scalar. Average injectant mole fractions at selected flow planes downstream of the injector are measured utilizing the filtered Rayleigh scattering technique. The filtered Rayleigh scattering measurements reveal that, in the domain surveyed, the merging vortex interaction strongly displaces the plume from its initial horizontal orientation while the non-merging vortex interaction more rapidly mixes the helium and air. The results of the current experiments are consistent with associated knowledge derived from previous analyses of the two studied configurations which have included the detailed experimental characterization of entrainment, turbulent kinetic energy, and vorticity of both modes of vortex interaction.

  2. Cluster Physics with Merging Galaxy Clusters

    Directory of Open Access Journals (Sweden)

    Sandor M. Molnar

    2016-02-01

    Full Text Available Collisions between galaxy clusters provide a unique opportunity to study matter in a parameter space which cannot be explored in our laboratories on Earth. In the standard LCDM model, where the total density is dominated by the cosmological constant ($Lambda$ and the matter density by cold dark matter (CDM, structure formation is hierarchical, and clusters grow mostly by merging.Mergers of two massive clusters are the most energetic events in the universe after the Big Bang,hence they provide a unique laboratory to study cluster physics.The two main mass components in clusters behave differently during collisions:the dark matter is nearly collisionless, responding only to gravity, while the gas is subject to pressure forces and dissipation, and shocks and turbulenceare developed during collisions. In the present contribution we review the different methods used to derive the physical properties of merging clusters. Different physical processes leave their signatures on different wavelengths, thusour review is based on a multifrequency analysis. In principle, the best way to analyze multifrequency observations of merging clustersis to model them using N-body/HYDRO numerical simulations. We discuss the results of such detailed analyses.New high spatial and spectral resolution ground and space based telescopeswill come online in the near future. Motivated by these new opportunities,we briefly discuss methods which will be feasible in the near future in studying merging clusters.

  3. A Consumer Health Information System to Assist Patients Select Quality Home Health Services

    Directory of Open Access Journals (Sweden)

    Dimitrios Zikos

    2017-11-01

    Full Text Available Patients evaluate the quality of home health agencies (HHAs using the Health Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey. This paper describes a prototype community health information system to help patients select appropriate and quality HHAs, according to the location, proprietary status, type of service, and year of HHA establishment. Five HCAHPS indicators were selected: “summary rating”, “quality of care”, “professional care”, “communication”, and “recommend agency”. Independent t-test analysis showed that agencies offering Speech Pathology, Medical-Social, or Home Health Aide services, receive significantly worse HCAHPS ratings, while mean ratings vary significantly across different US states. Multiple comparisons with post hoc ANOVA revealed differences between and within HHAs of different proprietary status (p < 0.001: governmental HHAs receiving higher ratings than private HHAs. Finally, there was observed a relationship between all five quality rating variables and the HHA year of establishment (Pearson, p < 0.001. The older the agency is, the better the HCAPS summary ratings. Findings provided the knowledge to design of a consumer health information system, to provide rankings filtered according to user criteria, comparing the quality rankings of eligible HHAs. Users can also see how a specific agency is ranked against eligible HHAs. Ultimately, the system aims to support the patient community with contextually realistic comparisons in an effort to choose optimal HH service.

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

    OpenAIRE

    Phillips, Charles D.

    2015-01-01

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

  5. Individual Subjective Initiative Merge Model Based on Cellular Automaton

    Directory of Open Access Journals (Sweden)

    Yin-Jie Xu

    2013-01-01

    Full Text Available The merge control models proposed for work zones are classified into two types (Hard Control Merge (HCM model and Soft Control Merge (SCM model according to their own control intensity and are compared with a new model, called Individual Subjective Initiative Merge (ISIM model, which is based on the linear lane-changing probability strategy in the merging area. The attention of this paper is paid to the positive impact of the individual subjective initiative for the whole traffic system. Three models (ISIM, HCM, and SCM are established and compared with each other by two order parameters, that is, system output and average vehicle travel time. Finally, numerical results show that both ISIM and SCM perform better than HCM. Compared with SCM, the output of ISIM is 20 vehicles per hour higher under the symmetric input condition and is more stable under the asymmetric input condition. Meanwhile, the average travel time of ISIM is 2000 time steps less under the oversaturated input condition.

  6. Children's Home Environments: Understanding the Role of Family Structure Changes

    Science.gov (United States)

    Kowaleski-Jones, Lori; Dunifon, Rachel

    2004-01-01

    Using data from the 1996 National Longitudinal Survey of Youth (NLSY79) merged mother-child sample, we investigate the impact of two family events, parental divorce and the birth of a sibling, on the cognitive stimulation and emotional support provided to children in the home. We use fixed-effect regression techniques to control for unmeasured…

  7. Satellite and gauge rainfall merging using geographically weighted regression

    Directory of Open Access Journals (Sweden)

    Q. Hu

    2015-05-01

    Full Text Available A residual-based rainfall merging scheme using geographically weighted regression (GWR has been proposed. This method is capable of simultaneously blending various satellite rainfall data with gauge measurements and could describe the non-stationary influences of geographical and terrain factors on rainfall spatial distribution. Using this new method, an experimental study on merging daily rainfall from the Climate Prediction Center Morphing dataset (CMOROH and gauge measurements was conducted for the Ganjiang River basin, in Southeast China. We investigated the capability of the merging scheme for daily rainfall estimation under different gauge density. Results showed that under the condition of sparse gauge density the merging rainfall scheme is remarkably superior to the interpolation using just gauge data.

  8. Objectness Supervised Merging Algorithm for Color Image Segmentation

    Directory of Open Access Journals (Sweden)

    Haifeng Sima

    2016-01-01

    Full Text Available Ideal color image segmentation needs both low-level cues and high-level semantic features. This paper proposes a two-hierarchy segmentation model based on merging homogeneous superpixels. First, a region growing strategy is designed for producing homogenous and compact superpixels in different partitions. Total variation smoothing features are adopted in the growing procedure for locating real boundaries. Before merging, we define a combined color-texture histogram feature for superpixels description and, meanwhile, a novel objectness feature is proposed to supervise the region merging procedure for reliable segmentation. Both color-texture histograms and objectness are computed to measure regional similarities between region pairs, and the mixed standard deviation of the union features is exploited to make stop criteria for merging process. Experimental results on the popular benchmark dataset demonstrate the better segmentation performance of the proposed model compared to other well-known segmentation algorithms.

  9. Designing Smart Health Care Technology into the Home of the Future

    Energy Technology Data Exchange (ETDEWEB)

    Craft, R.L.; Warren, S.

    1999-04-20

    This editorial paper presents a vision for intelligent health care in the home of the future, focusing on technologies with the highest potential payoff given targeted government funding over the next ten years. A secure, plug-and-play information framework provides the starting point for identifying technologies that must be developed before home-based devices can know their context and assimilate information to support care decisions.

  10. Gender inequality at home is associated with poorer health for women.

    Science.gov (United States)

    Eek, Frida; Axmon, Anna

    2015-03-01

    As more women have joined the work force, the difference in employment rate between men and women has decreased, in Sweden as well as many other countries. Despite this, traditional gender patterns regarding, for example, responsibility for household duties still remain. Women are on sick leave more often than men, and previous studies have indicated that an unequal split of household responsibilities and perceived gender inequality could be associated with negative health outcomes. The aim of the present study was to explore whether an unequal distribution of responsibilities in the home was related to various health related outcomes among women. A sample consisting of 837 women living in a relationship, and working at least 50% of full time, responded to a questionnaire including information about division of responsibilities at home as well as various psychological and physiological health related outcomes. The results showed that women living in relationships with perceived more unequal distribution of responsibility for house hold duties showed significantly higher levels of perceived stress, fatigue, physical/psychosomatic symptoms, and work family conflict compared with women living in more equal relationships. They also had significantly increased odds for insufficient time for various forms of recovery, which may further contribute to an increased risk of poor health. Although an increasing employment rate among women is valuable for both society and individuals, it is important to work towards greater gender equality at home to maintain this development without it having a negative effect on women's health and well-being. © 2014 the Nordic Societies of Public Health.

  11. HIV/aids related home based care practices among primary health care workers in Ogun state, Nigeria

    Directory of Open Access Journals (Sweden)

    E Amoran

    2012-05-01

    Full Text Available Abstract Background HIV/AIDS is fast becoming a chronic disease with the advent of antiretroviral drugs, therefore making home based care key in the management of chronically ill HIV/AIDS patient. The objective of this study was to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria. Methods This study is an analytical cross-sectional study. A multistage cluster sampling technique was used to obtain a representative sample of the primary health care workers in Ogun state. An interviewer administered structured questionnaire was administered by trained health workers to elicit the required information. Result A total of 350 health care workers were interviewed, 70% of the respondents could adequately describe the components of home based care. Only 38.7% were aware of the National guideline on home based care practices and 17.1% believe that home based care will not significantly improve the prognosis of PLWAs. Few 19.1% had ever been trained or ever involved 16.6% in home based care practices. Only 20 [5.7%] are involved on a weekly basis, 16 [4.6%] monthly and 22 [6.3%] quarterly. Reasons given for non implementation of home based care are inadequate number of healthcare workers 45%, lack of political will 24.4%, lack of implementation by facility managers 14% and inadequate funds 16.6%. Factors that were significantly associated with the practice of home based care were perception of its relevance in improving prognosis [OR = 54.21, C.I = 23.22-129.52] and presence of a support group in the facility [OR = 4.80, C.I = 2.40-9.57]. There was however no statistically significant relationship between adequate knowledge of home based care [OR = 0.78, C.I = 0.39-1.54] and previous training on home based care (OR = 1.43, C.I = 0.66-3.06]. Conclusion The practice of home based care for HIV/AIDS among the study population is low

  12. Effects of a training program for home health care workers on the provision of preventive activities and on the health-related behavior of their clients: A quasi-experimental study.

    Science.gov (United States)

    Walters, Maaike E; Reijneveld, Sijmen A; van der Meulen, Anja; Dijkstra, Arie; de Winter, Andrea F

    2017-09-01

    Because home health care workers repeatedly visit the same older adults, they are in an excellent position to improve the health-related behavior of older adults, their clients, by providing preventive activities. The objective of this study was to determine the short- and medium term effects of an intervention to support workers in providing preventive activities for older adults. To do this, the number of activities undertaken by workers and the health-related behavior of their clients were assessed. A quasi-experimental study was performed with a pre-post design and inclusion of one control group. The study took place in a deprived, semi-rural area in The Netherlands (2011-2013). Data in three districts served by one home health care organization were gathered. The participants were home health care workers (registered nurses and nurse aides) and home health care clients aged 55 and over (community-dwelling, dependent older adults receiving home health care). 205 home health care workers participated in the study, 97 of them in the first effect measurement; and 83 of them in the second effect measurement. A total of 304 home health care clients participated, 214 of them in the first effect measurement; and 186 of them in the second effect measurement. Differences in change were determined in health-related behavior between groups of older adults as a result of training home health care workers in preventive activities RESULTS: In the control group of home health care professionals a significant increase was found regarding the provision of preventive activities for the domain 'weight' (partial eta squared: 0.05 and 0.08 at first and second effect measurements, respectively). We found preventive activities performed by home health care professionals to have no significant effects on older adult-reported health-related behavior, but observed in the intervention group a non-significant trend in improvement of physical activity of, respectively, 85 and 207min for

  13. Merging Children's Oncology Group Data with an External Administrative Database Using Indirect Patient Identifiers: A Report from the Children's Oncology Group.

    Directory of Open Access Journals (Sweden)

    Yimei Li

    Full Text Available Clinical trials data from National Cancer Institute (NCI-funded cooperative oncology group trials could be enhanced by merging with external data sources. Merging without direct patient identifiers would provide additional patient privacy protections. We sought to develop and validate a matching algorithm that uses only indirect patient identifiers.We merged the data from two Phase III Children's Oncology Group (COG trials for de novo acute myeloid leukemia (AML with the Pediatric Health Information Systems (PHIS. We developed a stepwise matching algorithm that used indirect identifiers including treatment site, gender, birth year, birth month, enrollment year and enrollment month. Results from the stepwise algorithm were compared against the direct merge method that used date of birth, treatment site, and gender. The indirect merge algorithm was developed on AAML0531 and validated on AAML1031.Of 415 patients enrolled on the AAML0531 trial at PHIS centers, we successfully matched 378 (91.1% patients using the indirect stepwise algorithm. Comparison to the direct merge result suggested that 362 (95.7% matches identified by the indirect merge algorithm were concordant with the direct merge result. When validating the indirect stepwise algorithm using the AAML1031 trial, we successfully matched 157 out of 165 patients (95.2% and 150 (95.5% of the indirectly merged matches were concordant with the directly merged matches.These data demonstrate that patients enrolled on COG clinical trials can be successfully merged with PHIS administrative data using a stepwise algorithm based on indirect patient identifiers. The merged data sets can be used as a platform for comparative effectiveness and cost effectiveness studies.

  14. Parents as Teachers Health Literacy Demonstration project: integrating an empowerment model of health literacy promotion into home-based parent education.

    Science.gov (United States)

    Carroll, Lauren N; Smith, Sandra A; Thomson, Nicole R

    2015-03-01

    The Parents as Teachers (PAT) Health Literacy Demonstration project assessed the impact of integrating data-driven reflective practices into the PAT home visitation model to promote maternal health literacy. PAT is a federally approved Maternal, Infant, Early Childhood Home Visiting program with the goal of promoting school readiness and healthy child development. This 2-year demonstration project used an open-cohort longitudinal design to promote parents' interactive and reflective skills, enhance health education, and provide direct assistance to personalize and act on information by integrating an empowerment paradigm into PAT's parent education model. Eight parent educators used the Life Skills Progression instrument to tailor the intervention to each of 103 parent-child dyads. Repeated-measures analysis of variance, paired t tests, and logistic regression combined with qualitative data demonstrated that mothers achieved overall significant improvements in health literacy, and that home visitors are important catalysts for these improvements. These findings support the use of an empowerment model of health education, skill building, and direct information support to enable parents to better manage personal and child health and health care. © 2014 Society for Public Health Education.

  15. Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment

    Directory of Open Access Journals (Sweden)

    Naoko Muramatsu

    2017-04-01

    Full Text Available Home care aides (HCAs, predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise (p = 0.027. Almost all (98% HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs.

  16. Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment.

    Science.gov (United States)

    Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti

    2017-04-05

    Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients' homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs' work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) ( p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs' job is feasible and can effectively promote HCAs' health, especially among older HCAs.

  17. The influence of a mental health home visit service partnership intervention on the caregivers' home visit service satisfaction and care burden.

    Science.gov (United States)

    Cheng, Jui-Fen; Huang, Xuan-Yi; Lin, Mei-Jue; Wang, Ya-Hui; Yeh, Tzu-Pei

    2018-02-01

    To investigate a community-based and hospital-based home visit partnership intervention in improving caregivers' satisfaction with home service and reducing caregiver burden. The community-oriented mental healthcare model prevails internationally. After patients return to the community, family caregivers are the patients' main support system and they also take the most of the burden of caring for patients. It is important to assist these caregivers by building good community healthcare models. A longitudinal quasi-experimental quantitative design. The experimental group (n = 109) involved "partnership" intervention, and the control group (n = 101) maintained routine home visits. The results were measured before the intervention, 6 and 12 months after the partnership intervention. Six months after the partnership intervention, the satisfaction of the experimental group was higher than the control group for several aspects of care. Although the care burden was reduced in the experimental group, there was no significant difference between the two groups. This study confirms that the partnership intervention can significantly improve caregiver satisfaction with home services, without reducing the care burden. The community-based and hospital-based mental health home visit service partnership programme could improve the main caregiver's satisfaction with the mental health home visit services, while the reduction in care burden may need government policies for the provision of more individual and comprehensive assistance. © 2017 John Wiley & Sons Ltd.

  18. Home treatment for mental health problems: a systematic review.

    Science.gov (United States)

    Burns, T; Knapp, M; Catty, J; Healey, A; Henderson, J; Watt, H; Wright, C

    2001-01-01

    This review investigates the effectiveness of 'home treatment' for mental health problems in terms of hospitalisation and cost-effectiveness. For the purposes of this review, 'home treatment' is defined as a service that enables the patient to be treated outside hospital as far as possible and remain in their usual place of residence. METHODS - SYSTEMATIC LITERATURE SEARCH: 'Home treatment' excluded studies focused on day, residential and foster care. The review was based on Cochrane methodology, but non-randomised studies were included if they compared two services; these were only analysed if they provided evidence of the groups' baseline clinical comparability. METHODS - REVIEW OF ECONOMIC EVALUATIONS: Economic evaluations among the studies found were reviewed against established criteria. METHODS - IDENTIFICATION OF SERVICE COMPONENTS: A three-round Delphi exercise ascertained the degree of consensus among expert psychiatrists concerning the important components of community-based services that enable them to treat patients outside hospital. The identified components were used to construct the follow-up questionnaire. METHODS - FOLLOW-UP OF AUTHORS: As a supplement to the information available in the papers, authors of all the studies were followed up for data on service components, sustainability of programmes and service utilisation. METHODS - DATA ANALYSIS: The outcome measure was mean days in hospital per patient per month over the follow-up period. (1) Comparative analysis - compared experimental to control services. It analysed all studies with available data, divided into 'inpatient-control' and 'community-control' studies, and tested for associations between service components and difference in hospital days. (2) Experimental services analysis - analysed only experimental service data and tested for associations between service components and hospital days. RESULTS - SYSTEMATIC LITERATURE SEARCH: A total of 91 studies were found, conducted over a 30

  19. Family Support in Nursing Homes Serving Residents with a Mental Health History

    Science.gov (United States)

    Frahm, Kathryn; Gammonley, Denise; Zhang, Ning Jackie; Paek, Seung Chun

    2010-01-01

    Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were…

  20. Postpartum home care and its effects on mothers' health: A clinical trial

    Directory of Open Access Journals (Sweden)

    Hourieh Shamshiri Milani

    2017-01-01

    Full Text Available Background: Postpartum home care plays an important role in prevention of postpartum complications. Regular visits of mothers during this period are imperative. This study aimed to provide postpartum home care for mothers to assess its effects on mothers' health in Iran. Materials and Methods: This study was carried out in two phases. First, a comprehensive postpartum home care program was compiled by performing a comparative study, using the available guidelines in this regard in different countries and based on the opinions of the experts. Next, a clinical trial was carried out on 276 women who gave birth in the university hospitals affiliated to Shahid Beheshti University of Medical Sciences. There were 92 mothers in the intervention and 184 in the control group. The intervention group mothers were provided with postpartum home care service while the control group did not receive such a service. Results: Outcome assessment at 60 days' postpartum revealed a significant difference between the two groups in terms of the use of supplements, birth control methods, postpartum depression, breastfeeding problems, constipation, and fatigue (P 0.05. Conclusion: The postpartum home care program had a positive effect on some aspects of the mothers' health status and their satisfaction in our society.

  1. Perceptions of health and risk management among home care workers in Sweden.

    Science.gov (United States)

    Larsson, A; Karlqvist, L; Westerberg, M; Gard, G

    2013-10-01

    Municipal home care workers provide high-quality services to an increasing proportion of elderly people living in private homes. The work environments and working conditions of these workers vary to a great extent, implying rapid priority-making among both employers and employees to ensure that the work can be performed in a safe way. This study aims to examine home care workers' perceptions of health, risks, working conditions, and risk management within their organization. The study was based on cross-sectional data collected from home care service staff in a municipality in the north of Sweden. Nursing assistants and care aides ( n  = 133) replied to a self-administered questionnaire. Descriptive statistics and between-group differences were analysed. Home care work was perceived to require high levels of professional skill and ingenuity, a good psychosocial work situation, but required a high physical workload. The general health, the capacity and self-efficacy of the staff in relation to work were good. Difficulty in performing risk assessments and following safety regulations due to lack of time, equipment, and information were identified. There is a need to increase participation in risk assessments among the staff, improve management support, structures, and cooperation with other divisions of the social services and the medical care organizations.

  2. Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

    Science.gov (United States)

    Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

    2008-01-01

    Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…

  3. [Pilot-experience in home care: bedridden aged patients of a basic health unit, Porto Alegre, Brazil].

    Science.gov (United States)

    Marques, Giselda Quintana; Freitas, Ivani Bueno de Almeida

    2009-12-01

    The objectives of this study were to describe the development of a pilot-project in home care to bedridden aged patients at a Basic Health Unit, and identify demographic, social and health aspects of these patients, as well as relevant aspects reported by the health team that implemented the home care. The study had descriptive and evaluative characteristics. The patients' enrollment forms and health records and the project's records were analyzed. The pilot-experience permitted to develop the team's skills, in addition to being enriching and of great responsibility for the professionals and caregivers involved. The results indicated the need for continuous home care and adjustments in its organization with the purpose of increasing the areas for health care and improving the population's quality of life.

  4. Modeling merging behavior at lane drops : [tech transfer summary].

    Science.gov (United States)

    2015-02-01

    A better understanding of the merging behavior of drivers will lead : to the development of better lane-drop traffic-control plans and : strategies, which will provide better guidance to drivers for safer : merging.

  5. 78 FR 68364 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date

    Science.gov (United States)

    2013-11-14

    ... providers of home health services and hospice care. The preamble of that final rule stated the effective... 17.56, applicable to non-VA home health services and hospice care. Section 17.56 provides, among... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and...

  6. 78 FR 41013 - Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014...

    Science.gov (United States)

    2013-07-09

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 431 [CMS-1450-CN] RIN 0938-AR52 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate... period titled ``Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY...

  7. Home Health Chains and Practice Patterns: Evidence of 2008 Medicare Reimbursement Revision.

    Science.gov (United States)

    Huang, Sean Shenghsiu; Kim, Hyunjee

    2017-10-01

    Home health agencies (HHAs) are known to exploit the Medicare reimbursement schedule by targeting a specific number of therapy visits. These targeting behaviors cause unnecessary medical spending. The Centers for Medicare & Medicaid Services estimates that during fiscal year 2015, Medicare made more than $10 billion in improper payments to HHAs. Better understanding of heterogeneous gaming behaviors among HHAs can inform policy makers to more effectively oversee the home health care industry. This article aims to study how home health chains adjust and adopt new targeting behaviors as compared to independent agencies under the new reimbursement schedule. The analytic data are constructed from: (1) 5% randomly sampled Medicare home health claim data, and (2) HHA chain information extracted from the Medicare Cost Report. The study period spans from 2007 to 2010, and the sample includes 7800 unique HHAs and 380,118 treatment episodes. A multivariate regression model is used to determine whether chain and independent agencies change their practice patterns and adopt different targeting strategies after the revision of the reimbursement schedule in 2008. This study finds that independent agencies are more likely to target 6 and 14 visits, while chain agencies are more likely to target 20 visits. Such a change of practice patterns is more significant among for-profit HHAs. The authors expect these findings to inform policy makers that organizational structures, especially the combination of for-profit status and chain affiliation, should be taken into the consideration when detecting medical fraud and designing the reimbursement schedule.

  8. Home care assistants’ perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity

    Directory of Open Access Journals (Sweden)

    Grundberg Å

    2016-02-01

    Full Text Available Åke Grundberg,1,2 Anna Hansson,2 Dorota Religa,1 Pernilla Hillerås1,2 1Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, 2Sophiahemmet University, Stockholm, Sweden Introduction: Elderly people with multiple chronic conditions, or multimorbidity, are at risk of developing poor mental health. These seniors often remain in their homes with support from home care assistants (HCAs. Mental health promotion by HCAs needs to be studied further because they may be among the first to observe changes in clients’ mental health status. Aim: To describe HCAs’ perspectives on detecting mental health problems and promoting mental health among homebound seniors with multimorbidity. Methods: We applied a descriptive qualitative study design using semi-structured interviews. Content analyses were performed on five focus group interviews conducted in 2014 with 26 HCAs. Results: Most HCAs stated that they were experienced in caring for clients with mental health problems such as anxiety, depression, sleep problems, and high alcohol consumption. The HCAs mentioned as causes, or risk factors, multiple chronic conditions, feelings of loneliness, and social isolation. The findings reveal that continuity of care and seniors’ own thoughts and perceptions were essential to detecting mental health problems. Observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health. Conclusion: The HCAs had knowledge of risk factors, but they seemed insecure about which health professionals had the primary responsibility for mental health. They also seemed to have detected early signs of mental health problems, even though good personal knowledge of the client and continuity in home visits were crucial to do so. When it came to mental health promotion, the suggestions related to the aim of ending social isolation, decreasing feelings of

  9. The study protocol of women′s education to create smoke-free home on the basis of family ties in Isfahan, Iran

    Directory of Open Access Journals (Sweden)

    Ahmadreza Zamani

    2013-01-01

    Full Text Available Background: Tobacco smoke is the leading cause of preventable death world-wide. Unfortunately, the risk is not limited to smokers. It is dangerous for non-smokers particularly women, kids and elderly. Despite the remarkable reduction of tobacco exposure in public places, it is still continuing at homes as the most common places. Interventions to create a smoke-free home are needed, but little is known about them. The aim of this study is to explain the field randomized controlled trial that is designed to examine the role of non-smoker women to create a smoke-free home through establishing complete agreement on ban smoking at home. Methods: In this field randomized controlled trial, the effectiveness of women′s education will be evaluated in primary health-care centers. A total of 136 non-smoker women who exposed to second-hand smoke by their husbands at home will be included (68 intervention/non-intervention group. The intervention arm will receive an educational package including a consultation visit individually, a peer group session, a booklet, a "no smoking" sign. The primary outcome is the frequency of smoke-free home (no exposure to second-hand smoke at home. Mediator outcomes include a complete agreement to ban smoking at home, second-hand smoke exposure rate and self-assertiveness rate. All measurements will be conducted on baseline, 1 and 3 months after intervention. Conclusions: Outcomes will present the effects of implementing multi-component women′s education intervention program to ban smoking at home. If the effectiveness of the trial is confirmed, it will be suggested to merge this package to routine care in primary health-care centers.

  10. Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.

    Science.gov (United States)

    Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

    2014-03-01

    Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The home health interim payment system in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health prospective payment system in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Qualitative analysis and conceptual mapping of patient experiences in home health care.

    Science.gov (United States)

    Lines, Lisa M; Anderson, Wayne L; Blackmon, Brian D; Pronier, Cristalle R; Allen, Rachael W; Kenyon, Anne E

    2018-01-01

    This study explored patient experiences in home health care through a literature review, focus groups, and interviews. Our goal was to develop a conceptual map of home health care patient experience domains. The conceptual map identifies technical and personal spheres of care, relating prior studies to new focus group and interview findings and identifying the most important domains of care. Study participants (n = 35) most frequently reported the most important domain as staff who are caring, supportive, patient, empathetic, respectful, and considerate (endorsed by 29% of participants). The conceptual map includes 114 discrete domains.

  12. Socioeconomic Differences in and Predictors of Home-Based Palliative Care Health Service Use in Ontario, Canada.

    Science.gov (United States)

    Cai, Jiaoli; Guerriere, Denise N; Zhao, Hongzhong; Coyte, Peter C

    2017-07-18

    The use of health services may vary across people with different socioeconomic statuses, and may be determined by many factors. The purposes of this study were (i) to examine the socioeconomic differences in the propensity and intensity of use for three main home-based health services, that is, home-based palliative care physician visits, nurse visits and personal support worker (PSW) hours; and (ii) to explore the determinants of the use of home-based palliative care services. A prospective cohort study was employed. A total of 181 caregivers were interviewed biweekly over the course of the palliative care trajectory, yielding a total of 994 interviews. The propensity and intensity of health service use were examined using logistic regression and negative binomial regression, respectively. The results demonstrated that both the propensity and intensity of home-based nurse and PSW visits fell with socioeconomic status. The use of home-based palliative care services was not concentrated in high socioeconomic status groups. The common predictors of health service use in the three service categories were patient age, the Palliative Performance Scale (PPS) score and place of death. These findings may assist health service planners in the appropriate allocation of resources and service packages to meet the complex needs of palliative care populations.

  13. Application studies of spherical tokamak plasma merging

    International Nuclear Information System (INIS)

    Ono, Yasushi; Inomoto, Michiaki

    2012-01-01

    The experiment of plasma merging and heating has long history in compact torus studies since Wells. The study of spherical tokamak (ST), starting from TS-3 plasma merging experiment of Tokyo University in the late 1980s, is followed by START of Culham laboratory in the 1900s, TS-4 and UTST of Tokyo University and MAST of Culham laboratory in the 2000s, and last year by VEST of Soul University. ST has the following advantages: 1) plasma heating by magnetic reconnection at a MW-GW level, 2) rapid start-up of high beta plasma, 3) current drive/flux multiplication and distribution control of ST plasma, 4) fueling and helium-ash exhaust. In the present article, we emphasize that magnetic reconnection and plasma merging phenomena are important in ST plasma study as well as in plasma physics. (author)

  14. The impact of oral health on the quality of life of nursing home residents.

    Science.gov (United States)

    Porter, Jessie; Ntouva, Antiopi; Read, Andrew; Murdoch, Mandy; Ola, Dennis; Tsakos, Georgios

    2015-07-15

    Good oral health in older residents of nursing homes is important for general health and quality of life. Very few studies have assessed how oral symptoms affect residents' quality of life. To assess the clinical and subjective oral health, including oral health related quality of life (OHRQoL), and the association of oral symptoms with OHRQoL in older people residing in nursing homes in Islington, London. Overall, 325 residents from nine nursing homes were clinically examined and 180 residents were interviewed to assess their oral symptoms and their OHRQoL using the OIDP measure. Managers and carers working in the homes were also interviewed. Almost two thirds of the sample were dentate (64.5%). 61.3% of dentate and 50.9% of edentate residents reported problems such as dry mouth, sore cracked lips, broken teeth and toothache and ill-fitting dentures. Oral health impacted considerably upon resident's OHRQoL; 20.2% of dentate and 30.9% of edentate reported at least one oral impact in the past 6 months. Sensitive teeth, toothache, bleeding gums, dry mouth and loose natural teeth among the dentate and loose or ill-fitting dentures among the edentate were strongly associated with higher prevalence of oral impacts even after adjusting for demographic and socio-economic factors, and for the number of teeth (dentate only). The burden of oral conditions was considerable. Oral symptoms were very common and were strongly associated with residents' worse OHRQoL. Health promotion programmes are important to help residents maintain an acceptable level of oral health and function.

  15. "Willing but unwilling": attitudinal barriers to adoption of home-based health information technology among older adults.

    Science.gov (United States)

    Young, Rachel; Willis, Erin; Cameron, Glen; Geana, Mugur

    2014-06-01

    While much research focuses on adoption of electronic health-care records and other information technology among health-care providers, less research explores patient attitudes. This qualitative study examines barriers to adoption of home-based health information technology, particularly personal electronic health records, among older adults. We conducted in-depth interviews (30-90 min duration) with 35 American adults, aged 46-72 years, to determine their perceptions of and attitudes toward home-based health information technology. Analysis of interview data revealed that most barriers to adoption fell under four themes: technological discomfort, privacy or security concerns, lack of relative advantage, and perceived distance from the user representation. Based on our findings, systems to promote home-based health information technology should incorporate familiar computer applications, alleviate privacy and security concerns, and align with older adults' active and engaged self-image.

  16. Oral health educational interventions for nursing home staff and residents.

    Science.gov (United States)

    Albrecht, Martina; Kupfer, Ramona; Reissmann, Daniel R; Mühlhauser, Ingrid; Köpke, Sascha

    2016-09-30

    Associations between nursing home residents' oral health status and quality of life, respiratory tract infections, and nutritional status have been reported. Educational interventions for nurses or residents, or both, focusing on knowledge and skills related to oral health management may have the potential to improve residents' oral health. To assess the effects of oral health educational interventions for nursing home staff or residents, or both, to maintain or improve the oral health of nursing home residents. We searched the Cochrane Oral Health Trials Register (to 18 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 12), MEDLINE Ovid (1946 to 18 January 2016), Embase Ovid (1980 to 18 January 2016), CINAHL EBSCO (1937 to 18 January 2016), and Web of Science Conference Proceedings (1990 to 18 January 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 18 January 2016. In addition, we searched reference lists of identified articles and contacted experts in the field. We placed no restrictions on language or date of publication when searching the electronic databases. Randomised controlled trials (RCTs) and cluster-RCTs comparing oral health educational programmes for nursing staff or residents, or both with usual care or any other oral healthcare intervention. Two review authors independently screened articles retrieved from the searches for relevance, extracted data from included studies, assessed risk of bias for each included study, and evaluated the overall quality of the evidence. We retrieved data about the development and evaluation processes of complex interventions on the basis of the Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). We contacted authors of relevant studies for additional information. We included nine RCTs involving

  17. Genetics Home Reference

    Science.gov (United States)

    ... Page Search Home Health Conditions Genes Chromosomes & mtDNA Resources Help Me Understand Genetics Share: Email Facebook Twitter Genetics Home Reference provides consumer-friendly information about the effects of genetic variation on human health. Health Conditions More than 1,200 health ...

  18. Effects of health insurance on non-working married women's medical care use and bed days at home.

    Science.gov (United States)

    Lee, Changwoo; Shin, Euichul

    2013-07-01

    This study examines whether bed days are alternative methods to medical care use for treating a particular illness. If bed days at home are considered as an alternative to medical treatment, then medical care use and bed days at home should be influenced by an individual's health insurance status. This study uses data from the 2003 Medical Expenditure Panel Survey (MEPS) on medical care use and bed days at home for each contracted illness of non-working married women. The results suggest that the health insurance status of non-working married women has considerable influence on their choice between medical care use and bed days at home. In addition, those with health insurance are more likely to use medical care and less likely to use bed days at home, but they tend to avoid the simultaneous use of medical care and bed days at home. In contrast to previous studies' findings indicating that absences from work and medical care use among working males may be complements, this study's results for non-working married women without health insurance suggest that they use rest and medical treatment as substitutes, not complements.

  19. Home foreclosure, health, and mental health: a systematic review of individual, aggregate, and contextual associations.

    Directory of Open Access Journals (Sweden)

    Alexander C Tsai

    Full Text Available The U.S. foreclosure crisis intensified markedly during the Great Recession of 2007-09, and currently an estimated five percent of U.S. residential properties are more than 90 days past due or in the process of foreclosure. Yet there has been no systematic assessment of the effects of foreclosure on health and mental health.I applied systematic search terms to PubMed and PsycINFO to identify quantitative or qualitative studies about the relationship between home foreclosure and health or mental health. After screening the titles and abstracts of 930 publications and reviewing the full text of 76 articles, dissertations, and other reports, I identified 42 publications representing 35 unique studies about foreclosure, health, and mental health. The majority of studies (32 [91%] concluded that foreclosure had adverse effects on health or mental health, while three studies yielded null or mixed findings. Only two studies examined the extent to which foreclosure may have disproportionate impacts on ethnic or racial minority populations.Home foreclosure adversely affects health and mental health through channels operating at multiple levels: at the individual level, the stress of personally experiencing foreclosure was associated with worsened mental health and adverse health behaviors, which were in turn linked to poorer health status; at the community level, increasing degradation of the neighborhood environment had indirect, cross-level adverse effects on health and mental health. Early intervention may be able to prevent acute economic shocks from eventually developing into the chronic stress of foreclosure, with all of the attendant benefits this implies for health and mental health status. Programs designed to encourage early return of foreclosed properties back into productive use may have similar health and mental health benefits.

  20. Characteristics of workplace violence prevention training and violent events among home health and hospice care providers.

    Science.gov (United States)

    Vladutiu, Catherine J; Casteel, Carri; Nocera, Maryalice; Harrison, Robert; Peek-Asa, Corinne

    2016-01-01

    In the rapidly growing home health and hospice industry, little is known about workplace violence prevention (WVP) training and violent events. We examined the characteristics of WVP training and estimated violent event rates among 191 home health and hospice care providers from six agencies in California. Training characteristics were identified from the Occupational Safety and Health Administration guidelines. Rates were estimated as the number of violent events divided by the total number of home visit hours. Between 2008 and 2009, 66.5% (n = 127) of providers reported receiving WVP training when newly hired or as recurrent training. On average, providers rated the quality of their training as 5.7 (1 = poor to 10 = excellent). Among all providers, there was an overall rate of 17.1 violent events per 1,000 visit-hours. Efforts to increase the number of home health care workers who receive WVP training and to improve training quality are needed. © 2015 Wiley Periodicals, Inc.

  1. Handbook of smart homes, health care and well-being

    CERN Document Server

    Demiris, George; Wouters, Eveline

    2017-01-01

    Smart homes, home automation and ambient-assisted living are terms used to describe technological systems that enrich our living environment and provide means to support care, facilitate well-being and improve comfort. This handbook provides an overview of the domain from the perspective of health care and technology.  In Part 1, we set out to describe the demographic changes in society, including ageing, and diseases and impairments which lead to the needs for technological solutions. In Part 2, we describe the technological solutions, ranging from sensor-based networks, components, to communication protocols that are used in the design of smart homes. We also deal will biomedical features which can be measured, and services that can be delivered to end-users as well as the use of social robots.  In Part 3, we present best practices in the field. These best practices mainly focus on existing projects in Europe, the USA and Asia, in which people receive help through dedicated technological solutions being p...

  2. Local adaptations to a global health initiative: penalties for home births in Zambia.

    Science.gov (United States)

    Greeson, Dana; Sacks, Emma; Masvawure, Tsitsi B; Austin-Evelyn, Katherine; Kruk, Margaret E; Macwan'gi, Mubiana; Grépin, Karen A

    2016-11-01

    Global health initiatives (GHIs) are implemented across a variety of geographies and cultures. Those targeting maternal health often prioritise increasing facility delivery rates. Pressure on local implementers to meet GHI goals may lead to unintended programme features that could negatively impact women. This study investigates penalties for home births imposed by traditional leaders on women during the implementation of Saving Mothers, Giving Life (SMGL) in Zambia. Forty focus group discussions (FGDs) were conducted across four rural districts to assess community experiences of SMGL at the conclusion of its first year. Participants included women who recently delivered at home (3 FGDs/district), women who recently delivered in a health facility (3 FGDs/district), community health workers (2 FGDs/district) and local leaders (2 FGDs/district). Findings indicate that community leaders in some districts-independently of formal programme directive-used fines to penalise women who delivered at home rather than in a facility. Participants in nearly all focus groups reported hearing about the imposition of penalties following programme implementation. Some women reported experiencing penalties firsthand, including cash and livestock fines, or fees for child health cards that are typically free. Many women who delivered at home reported their intention to deliver in a facility in the future to avoid penalties. While communities largely supported the use of penalties to promote facility delivery, the penalties effectively introduced a new tax on poor rural women and may have deterred their utilization of postnatal and child health care services. The imposition of penalties is thus a punitive adaptation that can impose new financial burdens on vulnerable women and contribute to widening health, economic and gender inequities in communities. Health initiatives that aim to increase demand for health services should monitor local efforts to achieve programme targets in order

  3. Can double-peaked lines indicate merging effects in AGNs?

    Directory of Open Access Journals (Sweden)

    Popović L.Č.

    2000-01-01

    Full Text Available The influence of merging effects in the central part of an Active Galactic Nucleus (AGN on the emission spectral line shapes are discussed. We present a model of close binary Broad Line Region. The numerical experiments show that the merging effects can explain double peaked lines. The merging effects may also be present in the center of AGNs, although they emit slightly asymmetric as well as symmetric and relatively stable (in profile shape spectral lines. Depending on the black hole masses and their orbit elements such model may explain some of the line profile shapes observed in AGNs. This work shows that if one is looking for the merging effects in the central region as well as in the wide field structure of AGNs, he should first pay attention to objects which have double peaked lines.

  4. Family involvement in timely detection of changes in health of nursing homes residents: A qualitative exploratory study.

    Science.gov (United States)

    Powell, Catherine; Blighe, Alan; Froggatt, Katherine; McCormack, Brendan; Woodward-Carlton, Barbara; Young, John; Robinson, Louise; Downs, Murna

    2018-01-01

    To explore family perspectives on their involvement in the timely detection of changes in their relatives' health in UK nursing homes. Increasingly, policy attention is being paid to the need to reduce hospitalisations for conditions that, if detected and treated in time, could be managed in the community. We know that family continue to be involved in the care of their family members once they have moved into a nursing home. Little is known, however, about family involvement in the timely detection of changes in health in nursing home residents. Qualitative exploratory study with thematic analysis. A purposive sampling strategy was applied. Fourteen semi-structured one-to-one interviews with family members of people living in 13 different UK nursing homes. Data were collected from November 2015-March 2016. Families were involved in the timely detection of changes in health in three key ways: noticing signs of changes in health, informing care staff about what they noticed and educating care staff about their family members' changes in health. Families suggested they could be supported to detect timely changes in health by developing effective working practices with care staff. Families can provide a special contribution to the process of timely detection in nursing homes. Their involvement needs to be negotiated, better supported, as well as given more legitimacy and structure within the nursing home. Families could provide much needed support to nursing home nurses, care assistants and managers in timely detection of changes in health. This may be achieved through communication about their preferred involvement on a case-by-case basis as well as providing appropriate support or services. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

  5. Improving Chronic Disease Self-Management by Older Home Health Patients through Community Health Coaching

    Directory of Open Access Journals (Sweden)

    Cheryl Dye

    2018-04-01

    Full Text Available The purpose of the study was to pilot test a model to reduce hospital readmissions and emergency department use of rural, older adults with chronic diseases discharged from home health services (HHS through the use of volunteers. The study’s priority population consistently experiences poorer health outcomes than their urban counterparts due in part to lower socioeconomic status, reduced access to health services, and incidence of chronic diseases. When they are hospitalized for complications due to poorly managed chronic diseases, they are frequently readmitted for the same conditions. This pilot study examines the use of volunteer community members who were trained as Health Coaches to mentor discharged HHS patients in following the self-care plan developed by their HHS RN; improving chronic disease self-management behaviors; reducing risk of falls, pneumonia, and flu; and accessing community resources. Program participants increased their ability to monitor and track their chronic health conditions, make positive lifestyle changes, and reduce incidents of falls, pneumonia and flu. Although differences in the ED and hospital admission rates after discharge from HHS between the treatment and comparison group (matched for gender, age, and chronic condition were not statistically significant, the treatment group’s rate was less than the comparison group thus suggesting a promising impact of the HC program (90 day: 263 comparison vs. 129 treatment; p = 0.65; 180 day 666.67 vs. 290.32; p = 0.19. The community health coach model offers a potential approach for improving the ability of discharged older home health patients to manage chronic conditions and ultimately reduce emergent care.

  6. 76 FR 68525 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012

    Science.gov (United States)

    2011-11-04

    ... Prospective Payment System Rate Update for Calendar Year 2012; Final Rule #0;#0;Federal Register / Vol. 76, No... 0938-AQ30 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012... sets forth updates to the home health prospective payment system (HH PPS) rates, including: the...

  7. 76 FR 9502 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2011-02-18

    ... [CMS-1510-F2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... set forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: The... the Medicare prospective payment system for HHAs. This correcting amendment corrects a technical error...

  8. Multilevel examination of facility characteristics, social integration, and health for older adults living in nursing homes.

    Science.gov (United States)

    Leedahl, Skye N; Chapin, Rosemary K; Little, Todd D

    2015-01-01

    Testing a model based on past research and theory, this study assessed relationships between facility characteristics (i.e., culture change efforts, social workers) and residents' social networks and social support across nursing homes; and examined relationships between multiple aspects of social integration (i.e., social networks, social capital, social engagement, social support) and mental and functional health for older adults in nursing homes. Data were collected at nursing homes using a planned missing data design with random sampling techniques. Data collection occurred at the individual-level through in-person structured interviews with older adult nursing home residents (N = 140) and at the facility-level (N = 30) with nursing home staff. The best fitting multilevel structural equation model indicated that the culture change subscale for relationships significantly predicted differences in residents' social networks. Additionally, social networks had a positive indirect relationship with mental and functional health among residents primarily via social engagement. Social capital had a positive direct relationship with both health outcomes. To predict better social integration and mental and functional health outcomes for nursing homes residents, study findings support prioritizing that close relationships exist among staff, residents, and the community as well as increased resident social engagement and social trust. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Heating properties of merging/reconnection startup of high-beta ST

    International Nuclear Information System (INIS)

    Ono, Yasushi

    2005-01-01

    The high-power reconnection heating of spherical tokamak (ST) has been studied in the TS-3 experiment by use of axial merging of two STs. In this method, the merging/magnetic reconnection transformed a part of magnetic energy of merging STs into their thermal energy within short reconnection time. Our present low-field merging (0.3-0.5kG, R∼0.2m) attained the maximum heating power of 4-10MW and increased the beta-values of STs by factor 2-3 transiently. The ion heating energy was found to increase inversely with the q-value (B t component) of two STs. The most probable cause for this dependence is fast reconnection speed/ outflow speed due to large anomalous resistivity of current sheet in low-q state. After merging startup, decrease in beta was observed especially in low-q STs, indicating that the final beta value of ST increased with the q-value. (author)

  10. Considerations for the design of safe and effective consumer health IT applications in the home.

    Science.gov (United States)

    Zayas-Cabán, Teresa; Dixon, Brian E

    2010-10-01

    Consumer health IT applications have the potential to improve quality, safety and efficiency of consumers' interactions with the healthcare system. Yet little attention has been paid to human factors and ergonomics in the design of consumer health IT, potentially limiting the ability of health IT to achieve these goals. This paper presents the results of an analysis of human factors and ergonomics issues encountered by five projects during the design and implementation of home-based consumer health IT applications. Agency for Healthcare Research and Quality-funded consumer health IT research projects, where patients used the IT applications in their homes, were reviewed. Project documents and discussions with project teams were analysed to identify human factors and ergonomic issues considered or addressed by project teams. The analysis focused on system design and design processes used as well as training, implementation and use of the IT intervention. A broad range of consumer health IT applications and diverse set of human factors and ergonomics issues were identified. The design and implementation processes used resulted in poor fit with some patients' healthcare tasks and the home environment and, in some cases, resulted in lack of use. Clinician interaction with patients and the information provided through health IT applications appeared to positively influence adoption and use. Consumer health IT application design would benefit from the use of human factors and ergonomics design and evaluation methods. Considering the context in which home-based consumer health IT applications are used will likely affect the ability of these applications to positively impact the quality, safety and efficiency of patient care.

  11. Cosmic ray modulation and merged interaction regions

    International Nuclear Information System (INIS)

    Burlaga, L.F.; Goldstein, M.L.; Mcdonald, F.B.

    1985-01-01

    Beyond several AU, interactions among shocks and streams give rise to merged interaction regions in which the magnetic field is turbulent. The integral intensity of . 75 MeV/Nuc cosmic rays at Voyager is generally observed to decrease when a merged interaction region moves past the spacecraft and to increase during the passage of a rarefaction region. When the separation between interaction regions is relatively large, the cosmic ray intensity tends to increase on a scale of a few months. This was the case at Voyager 1 from July 1, 1983 to May 1, 1984, when the spacecraft moved from 16.7 to 19.6 AU. Changes in cosmic ray intensity were related to the magnetic field strength in a simple way. It is estimated that the diffusion coefficient in merged interaction regions at this distance is similar to 0.6 x 10 to the 22nd power sq cm/s

  12. Reconnection and merging of positive streamers in air

    Energy Technology Data Exchange (ETDEWEB)

    Nijdam, S; Geurts, C G C; Van Veldhuizen, E M; Ebert, U, E-mail: s.nijdam@tue.n [Department of Applied Physics, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven (Netherlands)

    2009-02-21

    Pictures show that streamer or sprite discharge channels emerging from the same electrode sometimes seem to reconnect or merge though their heads carry electric charge of the same polarity; one might therefore suspect that reconnections are an artefact of the two-dimensional projection in the pictures. Here we use stereo photography to investigate the full three-dimensional structure of such events. We analyse reconnection, possibly an electrostatic effect in which a late thin streamer reconnects to an earlier thick streamer channel, and merging, a suggested photoionization effect in which two simultaneously propagating streamer heads merge into one new streamer. We use four different anode geometries (one tip, two tips, two asymmetric protrusions in a plate and a wire), placed 40 mm above a flat cathode plate in ambient air. A positive high voltage pulse is applied to the anode, creating a positive corona discharge. This discharge is studied with a fast ICCD camera, in many cases combined with optics to enable stereoscopic imaging. We find that reconnections as defined above occur frequently. Merging on the other hand was only observed at a pressure of 25 mbar and a tip separation of 2 mm, i.e. for a reduced tip distance of p{center_dot}d = 50 {mu}m bar. In this case the full width at half maximum of the streamer channel is more than 10 times as large as the tip separation. At higher pressures or with a wire anode, merging was not observed.

  13. Reconnection and merging of positive streamers in air

    International Nuclear Information System (INIS)

    Nijdam, S; Geurts, C G C; Van Veldhuizen, E M; Ebert, U

    2009-01-01

    Pictures show that streamer or sprite discharge channels emerging from the same electrode sometimes seem to reconnect or merge though their heads carry electric charge of the same polarity; one might therefore suspect that reconnections are an artefact of the two-dimensional projection in the pictures. Here we use stereo photography to investigate the full three-dimensional structure of such events. We analyse reconnection, possibly an electrostatic effect in which a late thin streamer reconnects to an earlier thick streamer channel, and merging, a suggested photoionization effect in which two simultaneously propagating streamer heads merge into one new streamer. We use four different anode geometries (one tip, two tips, two asymmetric protrusions in a plate and a wire), placed 40 mm above a flat cathode plate in ambient air. A positive high voltage pulse is applied to the anode, creating a positive corona discharge. This discharge is studied with a fast ICCD camera, in many cases combined with optics to enable stereoscopic imaging. We find that reconnections as defined above occur frequently. Merging on the other hand was only observed at a pressure of 25 mbar and a tip separation of 2 mm, i.e. for a reduced tip distance of p·d = 50 μm bar. In this case the full width at half maximum of the streamer channel is more than 10 times as large as the tip separation. At higher pressures or with a wire anode, merging was not observed.

  14. Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls.

    Science.gov (United States)

    Cull, Brooke J; Rosenkranz, Sara K; Dzewaltowski, David A; Teeman, Colby S; Knutson, Cassandra K; Rosenkranz, Richard R

    2016-01-01

    Childhood obesity is a major public health problem, with one third of America's children classified as either overweight or obese. Obesity prevention and health promotion programs using components such as wellness coaching and home-based interventions have shown promise, but there is a lack of published research evaluating the impact of a combined home-based and wellness coaching intervention for obesity prevention and health promotion in young girls. The main objective of this study is to test the feasibility of such an intervention on metrics related to recruitment, intervention delivery, and health-related outcome assessments. The secondary outcome is to evaluate the possibility of change in health-related psychosocial, behavioral, and biomedical outcomes in our sample of participants. Forty girls who are overweight or obese (aged 8-13 years) will be recruited from a Midwestern college town. Participants will be recruited through posted flyers, newspaper advertisements, email, and social media. The volunteer convenience sample of girls will be randomized to one of two home-based wellness coaching interventions: a general health education condition or a healthy eating physical activity skills condition. Trained female wellness coaches will conduct weekly hour-long home visits for 12 consecutive weeks. Assessments will occur at baseline, post-intervention (3 months after baseline), and follow-up (6 months after baseline) and will include height, weight, waist circumference, body composition, pulmonary function, blood pressure, systemic inflammation, physical activity (Actical accelerometer), and self-reported survey measures (relevant to fruit and vegetable consumption, physical activity, and quality of life). This study will evaluate the feasibility of home-based wellness coaching interventions for overweight and obese girls and secondarily assess the preliminary impact on health-related psychosocial, behavioral, and biomedical outcomes. Results will provide

  15. Health-related profile and quality of life among nursing home residents: does pain matter?

    Science.gov (United States)

    Tse, Mimi M Y; Wan, Vanessa T C; Vong, Sinfia K S

    2013-12-01

    The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents' demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents' physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p nursing home residents' pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  16. Examining trust in health professionals among family caregivers of nursing home residents with advanced dementia.

    Science.gov (United States)

    Boogaard, Jannie A; Werner, Perla; Zisberg, Anna; van der Steen, Jenny T

    2017-12-01

    In a context of increasing emphasis on shared decision-making and palliative care in dementia, research on family caregivers' trust in health professionals in advanced dementia is surprisingly scant. The aim of the present study was to assess trust in nursing home health professionals of family caregivers of nursing home residents with advanced dementia, and possible correlates, such as family caregivers' satisfaction, involvement in care, care burden and patients' symptom burden. A cross-sectional study was carried out using structured questionnaires administered through the telephone. Generalized estimating equation analyses with adjustment for nursing home clustering were applied to assess the most important associations with family caregivers' trust. A total of 214 family caregivers of persons with dementia residing in 25 nursing homes participated in the study. The majority of the participants (67%) were women and adult children (75%). The majority of the family caregivers trusted physicians, nurses and nurses' aides at a moderate-to-high level. Approximately half to one-third reported moderate-to-low levels of trust. Higher levels of trust were associated with more positive care outcomes, such as higher family satisfaction with care and more positive evaluations of physician-family communication. The present study showed the importance of family caregivers trusting nursing home health professionals for their experiences as caregivers. Although causation cannot be established, increased family caregivers' trust in nursing home health professionals by improving communication and exchange of information might provide a good basis for providing optimal palliative care in advanced dementia. Geriatr Gerontol Int 2017; 17: 2466-2471. © 2017 Japan Geriatrics Society.

  17. Office home care workers' occupational health: associations with workplace flexibility and worker insecurity.

    Science.gov (United States)

    Zeytinoglu, Isik U; Denton, Margaret; Davies, Sharon; Plenderleith, Jennifer Millen

    2009-05-01

    Office home care workers provide support to visiting staff, although their work tends to be invisible in many respects. This paper focuses on managers, supervisors, coor dinators, case managers and office administrative staff in home care. We examine the effects of workplace flexibility and worker insecurity on office home care workers' occupational health, particularly their self-reported stress and musculoskeletal disorders. Data come from our survey of 300 home care office staff in a mid-sized city in Ontario. Results show that workers' perceptions of insecurity are positively associated with musculoskeletal disorders but not workplace flexibility measures. We recommend that managers and other decision-makers in the home care field pay attention to the perceptions of workers' insecurity in initiating workplace flexibility measures.

  18. Integrity mechanism for eHealth tele-monitoring system in smart home environment.

    Science.gov (United States)

    Mantas, Georgios; Lymberopoulos, Dimitrios; Komninos, Nikos

    2009-01-01

    During the past few years, a lot of effort has been invested in research and development of eHealth tele-monitoring systems that will provide many benefits for healthcare delivery from the healthcare provider to the patient's home. However, there is a plethora of security requirements in eHealth tele-monitoring systems. Data integrity of the transferred medical data is one of the most important security requirements that should be satisfied in these systems, since medical information is extremely sensitive information, and even sometimes life threatening information. In this paper, we present a data integrity mechanism for eHealth tele-monitoring system that operates in a smart home environment. Agent technology is applied to achieve data integrity with the use of cryptographic smart cards. Furthermore, the overall security infrastructure and its various components are described.

  19. How do race and Hispanic ethnicity affect nursing home admission? Evidence from the Health and Retirement Study.

    Science.gov (United States)

    Thomeer, Mieke Beth; Mudrazija, Stipica; Angel, Jacqueline L

    2015-07-01

    This study investigates how health- and disability-based need factors and enabling factors (e.g., socioeconomic and family-based resources) relate to nursing home admission among 3 different racial and ethnic groups. We use Cox proportional hazard models to estimate differences in nursing home admission for non-Hispanic whites, non-Hispanic blacks, and Hispanics from 1998 to 2010 in the Health and Retirement Study (N = 18,952). Racial-ethnic differences in nursing home admission are magnified after controlling for health- and disability-based need factors and enabling factors. Additionally, the degree to which specific factors contribute to risk of nursing home admission varies significantly across racial-ethnic groups. Our findings indicate that substantial racial and ethnic variations in nursing home admission continue to exist and that Hispanic use is particularly low. We argue that these differences may demonstrate a significant underuse of nursing homes for racial and ethnic minorities. Alternatively, they could signify different preferences for nursing home care, perhaps due to unmeasured cultural factors or structural obstacles. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Plan Merging : Experimental results

    NARCIS (Netherlands)

    De Weerdt, M.M.; Van der Krogt, R.P.J.; Zutt, J.

    2003-01-01

    In this paper we discuss the results of a plan merging algorithm. This algorithm coordinates the plans of multiple, autonomous agents, each able to independently find a plan. This algorithm is evaluated using realistic data from a taxi company. We show that when we allow passengers to be a few

  1. Factors related to home health-care transition in trisomy 13.

    Science.gov (United States)

    Kitase, Yuma; Hayakawa, Masahiro; Kondo, Taiki; Saito, Akiko; Tachibana, Takashi; Oshiro, Makoto; Ieda, Kuniko; Kato, Eiko; Kato, Yuichi; Hattori, Tetsuo; Hayashi, Seiji; Ito, Masatoki; Hyodo, Reina; Muramatsu, Yukako; Sato, Yoshiaki

    2017-10-01

    Trisomy 13 (T13) is accompanied by severe complications, and it can be challenging to achieve long-term survival without aggressive treatment. However, recently, some patients with T13 have been receiving home care. We conducted this study to investigate factors related to home health-care transition for patients with T13.We studied 28 patients with T13 born between January 2000 and December 2014. We retrospectively compared nine home care transition patients (the home care group) and 19 patients that died during hospitalization (the discharge at death group). The median gestational age of the patients was 36.6 weeks, with a median birth weight of 2,047 g. Currently, three patients (11%) have survived, and 25 (89%) have died. The home care group exhibited a significantly longer gestational age (38.9 vs. 36.3 weeks, p = 0.039) and significantly larger occipitofrontal circumference Z score (-0.04 vs. -0.09, p = 0.019). Congenital heart defects (CHD) was more frequent in the discharge at death group, with six patients in the home care group and 18 patients in the discharge at death group (67% vs. 95%, p = 0.047), respectively. Survival time was significantly longer in the home care group than in the discharge at death group (171 vs. 19 days, p = 0.012). This study has shown that gestational age, occipitofrontal circumference Z score at birth, and the presence of CHD are helpful prognostic factors for determining treatment strategy in patients with T13. © 2017 Wiley Periodicals, Inc.

  2. Home care assistants’ perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity

    Science.gov (United States)

    Grundberg, Åke; Hansson, Anna; Religa, Dorota; Hillerås, Pernilla

    2016-01-01

    Introduction Elderly people with multiple chronic conditions, or multimorbidity, are at risk of developing poor mental health. These seniors often remain in their homes with support from home care assistants (HCAs). Mental health promotion by HCAs needs to be studied further because they may be among the first to observe changes in clients’ mental health status. Aim To describe HCAs’ perspectives on detecting mental health problems and promoting mental health among homebound seniors with multimorbidity. Methods We applied a descriptive qualitative study design using semi-structured interviews. Content analyses were performed on five focus group interviews conducted in 2014 with 26 HCAs. Results Most HCAs stated that they were experienced in caring for clients with mental health problems such as anxiety, depression, sleep problems, and high alcohol consumption. The HCAs mentioned as causes, or risk factors, multiple chronic conditions, feelings of loneliness, and social isolation. The findings reveal that continuity of care and seniors’ own thoughts and perceptions were essential to detecting mental health problems. Observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health. Conclusion The HCAs had knowledge of risk factors, but they seemed insecure about which health professionals had the primary responsibility for mental health. They also seemed to have detected early signs of mental health problems, even though good personal knowledge of the client and continuity in home visits were crucial to do so. When it came to mental health promotion, the suggestions related to the aim of ending social isolation, decreasing feelings of loneliness, and increasing physical activity. The results indicate that the HCAs seemed dependent on supervision by district nurses and on care managers’ decisions to support the needed care, to schedule assignments related to the detection of mental health

  3. The Environmental Health/Home Safety Education Project: a successful and practical U.S.-Mexico border initiative.

    Science.gov (United States)

    Forster-Cox, Susan C; Mangadu, Thenral; Jacquez, Benjamín; Fullerton, Lynne

    2010-05-01

    The Environmental Health/Home Safety Education Project (Proyecto de Salud Ambiental y Seguridad en el Hogar) has been developed in response to a wide array of severe and often preventable environmental health issues occurring in and around homes on the U.S.-Mexico border. Utilizing well-trained community members, called promotoras , homes are visited and assessed for potential environmental hazards, including home fire and food safety issues. Data analyzed from project years 2002 to 2005 shows a significant impact in knowledge levels and initial behavior change among targeted participants as it relates to fire and food safety issues. Since the initiation of the project in 1999, hundreds of participants have improved their quality of life by making their homes safer. The project has proven to be sustainable, replicable, flexible, and attractive to funders.

  4. Effects of intensive home visiting programs for older people with poor health status: a systematic review.

    NARCIS (Netherlands)

    Bouman, A.; Rossum, E. van; Nelemans, P.; Kempen, G.I.J.M.; Knipschild, P.

    2008-01-01

    BACKGROUND: Home visiting programs have been developed aimed at improving the health and independent functioning of older people. Also, they intend to reduce hospital and nursing home admission and associated cost. A substantial number of studies have examined the effects of preventive home visiting

  5. Health needs of regional Australian children in out-of-home care.

    Science.gov (United States)

    Arora, Nitin; Kaltner, Melissa; Williams, Judy

    2014-10-01

    This study aims to identify the health needs of children placed in out-of-home care in regional Queensland and to compare them with the needs of similar children in metropolitan Queensland. Retrospective chart review and subsequent analysis of data from the first assessments of the children placed in care from January 2005 to April 2011. Health needs based on assessment recommendations were then compared with needs and recommendations from a similar clinic in metropolitan Brisbane. Two hundred thirty-nine first assessments were reviewed. The average number of health referrals arising out of each assessment was 2. 72% children were between 2 and 12 years of age and accounted for 76% of the health referrals made. The 10-13% of the children needed referrals for medical and surgical specialties, audiology, speech pathology, dental, and ophthalmology/optometry, each. A percentage of 30 needed ongoing paediatric care. The 15% needed immunisation catch up, 35% counselling and behaviour management, and 15% formal mental health referrals. These were comparable to the health needs identified in out-of-home care children residing in metropolitan Queensland. Children in care who live in a regional setting have similar health-care needs compared with urban children. Given restricted health services in regional settings, there is difficulty in accessing services to meet these needs. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  6. Provision and perceived quality of mental health services for older care home residents in England: a national survey.

    Science.gov (United States)

    Stewart, Karen; Hargreaves, Claire; Jasper, Rowan; Challis, David; Tucker, Sue; Wilberforce, Mark

    2018-02-01

    This study examined the nature, extent and perceived quality of the support provided by community mental health teams for older people (CMHTsOP) to care home residents. A postal survey was sent to all CMHTsOP in England. Information was collected about teams' staffing and their involvement in case finding, assessment, medication reviews, care planning and training as well as team managers' rating of the perceived quality of the service they provided for care home residents. Data were analysed using chi-squared tests of association and ordinal regression. Responses were received from 225 (54%) CMHTsOP. Only 18 per cent of these teams contained staff with allocated time for care home work. Services for care home residents varied considerably between teams. Two-fifths of teams provided formal training to care home staff. Team managers were more likely to perceive the quality of their service to care homes as good if they had a systematic process in place for reviewing antipsychotic drugs or routine mental health reviews, including contact with a GP. The findings suggested that more evidence is needed on the best approach for supporting care home residents with mental health needs. Areas to consider are the potential benefits of training to care home staff and regular mental health reviews, utilising links between GPs and CMHTsOP. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  7. The structure, processes, and outcomes of Banner Health's corporate-wide strategy to improve health care quality.

    Science.gov (United States)

    Kirkman-Liff, Bradford

    2004-01-01

    Banner Health consists of 19 hospitals, 6 long-term care centers and a number of family health clinics, home care programs, and home medical equipment providers in 9 Western and Midwestern states. Banner Health has developed an integrated organization-wide effort called Care Management to simultaneously address quality and safety, reduce patient errors, and measure and report performance, outcomes, and patient satisfaction, while controlling costs through utilization management, care coordination, and performance improvement. Eleven functional areas were identified and more than 36 cross-functional and cross-facility work groups have been created. These work groups use a deliberate process in which knowledge is created, reviewed, synthesized, distributed, taught, and implemented within the system. Key lessons after the first 2 years of this effort are as follows: information sharing and collegial support can be established within newly merged organizations; there must be continued enhancement of both the accuracy and timeliness of data; the ability of health care professionals to understand and use sophisticated statistical tools has increased; a variety of methods should be used to distribute the knowledge products; and the strategy to have functional teams and work groups develop systemwide policies and toolkits but leave implementation to facility employees has worked relatively well.

  8. Workplace violence prevention policies in home health and hospice care agencies.

    Science.gov (United States)

    Gross, Nathan; Peek-Asa, Corinne; Nocera, Maryalice; Casteel, Carri

    2013-01-31

    Workplace violence in the home health industry is a growing concern, but little is known about the content of existing workplace violence prevention programs. The authors present the methods for this study that examined workplace violence prevention programs in a sample of 40 California home health and hospice agencies. Data was collected through surveys that were completed by the branch managers of participating facilities. Programs were scored in six different areas, including general workplace violence prevention components; management commitment and employee involvement; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation. The results and discussion sections consider these six areas and the important gaps that were found in existing programs. For example, although most agencies offered workplace violence training, not every worker performing patient care was required to receive the training. Similarly, not all programs were written or reviewed and updated regularly. Few program differences were observed between agency characteristics, but nonetheless several striking gaps were found.

  9. The impact of living in a care home on the health and wellbeing of spinal cord injured people.

    Science.gov (United States)

    Smith, Brett; Caddick, Nick

    2015-04-15

    In the UK, 20% of people with spinal cord injury (SCI) are discharged from rehabilitation into an elderly care home. Despite this, and knowledge that the home is central to health and wellbeing, little research has examined the impact of being in care homes on the health and wellbeing of people with SCI. The purpose of this study was to address this gap. Twenty adults who lived in care homes or had done so recently for over two years were interviewed in-depth. Qualitative data were analyzed using inductive thematic analysis. Analyses revealed that living in a care home environment severely damages quality of life, physical health and psychological wellbeing in the short and long-term. Reasons why quality of life, health, and wellbeing were damaged are identified. These included a lack of freedom, control, and flexibility, inability to participate in community life, inability to sustain relationships, safety problems, restricted participation in work and leisure time physical activity, lack of meaning, self-expression, and a future, loneliness, difficulties with the re-housing process, depression, and suicidal thoughts and actions. It is concluded that for people with SCI, the care home environment violates social dignity, is oppressive, and denies human rights. Implications for housing and health care policies are also offered.

  10. Smart Cities - Smart Homes and Smart Home Technology

    OpenAIRE

    Faanes, Erlend Kydland

    2014-01-01

    This master’s thesis consists of two articles where the first article is theoretical and the second is the empirical study. Article I The purpose with this paper is to explore and illuminate how smart home and smart home technology can contribute to enhance health and Quality of Life in elderly citizens and allow them to live longer in their home. The paper provides a brief introduction to health promotion and highlights the thesis theoretical framework and foundation of Aaron Antonov...

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

    Science.gov (United States)

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

    2015-01-01

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

  12. Starting a hospital-based home health agency: Part II--Key success factors.

    Science.gov (United States)

    Montgomery, P

    1993-09-01

    In Part II of a three-part series, the financial, technological and legislative issues of a hospital-based home health-agency are discussed. Beginning a home healthcare service requires intensive research to answer key environmental and operational questions--need, competition, financial projections, initial start-up costs and the impact of delayed depreciation. Assessments involving technology, staffing, legislative and regulatory issues can help project service volume, productivity and cost-control.

  13. Health and social determinants and outcomes of home cooking: A systematic review of observational studies.

    Science.gov (United States)

    Mills, Susanna; White, Martin; Brown, Heather; Wrieden, Wendy; Kwasnicka, Dominika; Halligan, Joel; Robalino, Shannon; Adams, Jean

    2017-04-01

    Many dietary interventions assume a positive influence of home cooking on diet, health and social outcomes, but evidence remains inconsistent. We aimed to systematically review health and social determinants and outcomes of home cooking. Given the absence of a widely accepted, established definition, we defined home cooking as the actions required for preparing hot or cold foods at home, including combining, mixing and often heating ingredients. Nineteen electronic databases were searched for relevant literature. Peer-reviewed studies in English were included if they focussed mainly on home cooking, and presented post 19 th century observational or qualitative data on participants from high/very high human development index countries. Interventional study designs, which have previously been reviewed, were excluded. Themes were summarised using narrative synthesis. From 13,341 unique records, 38 studies - primarily cross-sectional in design - met the inclusion criteria. A conceptual model was developed, mapping determinants of home cooking to layers of influence including non-modifiable, individual, community and cultural factors. Key determinants included female gender, greater time availability and employment, close personal relationships, and culture and ethnic background. Putative outcomes were mostly at an individual level and focused on potential dietary benefits. Findings show that determinants of home cooking are more complex than simply possessing cooking skills, and that potential positive associations between cooking, diet and health require further confirmation. Current evidence is limited by reliance on cross-sectional studies and authors' conceptualisation of determinants and outcomes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  14. Epidemiological Criminology: Contextualization of HIV/AIDS Health Care for Female Inmates.

    Science.gov (United States)

    Lanier, Mark M; Zaitzow, Barbara H; Farrell, C Thomas

    2015-04-01

    Worldwide, women are increasingly being incarcerated. One unintended consequence is the increase in unhealthy female offenders. Among the more serious health concerns are HIV and AIDS. Challenges associated with caring for women with HIV/AIDS impacts not only disease management and infection control within correctional facilities but also the prisoners' home communities where they will need health care, drug and alcohol rehabilitation, housing assistance, and employment opportunities. No bridging theory has been presented that links prison and community health concerns with criminal justice policy. This article not only presents recommendations for effective HIV/AIDS policy but also suggests epidemiological criminology as a means of explicit merging of health with justice issues and consequently provides a bridging framework. © The Author(s) 2015.

  15. Differences in health-related quality of life between older nursing home residents without cognitive impairment and the general population of Norway.

    Science.gov (United States)

    Drageset, Jorunn; Natvig, Gerd Karin; Eide, Geir Egil; Clipp, Elizabeth C; Bondevik, Margareth; Nortvedt, Monica W; Nygaard, Harald A

    2008-05-01

    To advance the understanding of health-related quality of life among older nursing home residents by assessing their health-related quality of life and comparing this with norms from the general population. The study used a two-group cross-sectional comparative design. The samples comprised 227 nursing home residents aged 65-102 years with at least six months' residence and a representative population sample of 1137 Norwegian citizens aged 65-102 years. All nursing home residents had a Clinical Dementia Rating Scale score > or =0.5 and were capable of conversing. The respondents provided demographic information and were surveyed using the SF-36 Health Survey. We used univariate and multivariate linear models to identify possible differences in health-related quality of life between the nursing home residents and the general population, controlled for age, sex, marital status and education. After adjustment for age, group, sex, marital status and education, the nursing home residents scored significantly higher on bodily pain and on physical and emotional role limitation and significantly lower on the other SF-36 subscales, except social functioning, with the largest differences for physical functioning (mean nursing home 23.2 and mean general population 62.9). The general population scores on all subscales generally increased with increasing education but not among the nursing home residents. The mean SF-36 scale scores differed markedly between the nursing home residents and the general population, with the nursing home residents generally scoring lower. The association with background variables known to be related to health-related quality of life differed between the groups. Healthcare professionals should increase attention to health-related quality of life among nursing home residents, periodically assess health-related quality of life and consider interventions that may improve health-related quality of life in older institutionalised populations. This study

  16. Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30 and 60 Day Hospitalization: The Depression CAREPATH Cluster-Randomized Trial

    Science.gov (United States)

    Bruce, Martha L.; Lohman, Matthew C.; Greenberg, Rebecca L.; Bao, Yuhua; Raue, Patrick J.

    2016-01-01

    OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services. PMID:27739067

  17. Effects of health insurance on non-working married women’s medical care use and bed days at home

    Science.gov (United States)

    2013-01-01

    Background This study examines whether bed days are alternative methods to medical care use for treating a particular illness. If bed days at home are considered as an alternative to medical treatment, then medical care use and bed days at home should be influenced by an individual’s health insurance status. Method This study uses data from the 2003 Medical Expenditure Panel Survey (MEPS) on medical care use and bed days at home for each contracted illness of non-working married women. Results The results suggest that the health insurance status of non-working married women has considerable influence on their choice between medical care use and bed days at home. In addition, those with health insurance are more likely to use medical care and less likely to use bed days at home, but they tend to avoid the simultaneous use of medical care and bed days at home. Conclusions In contrast to previous studies’ findings indicating that absences from work and medical care use among working males may be complements, this study’s results for non-working married women without health insurance suggest that they use rest and medical treatment as substitutes, not complements. PMID:23816313

  18. Nursing Homes

    Science.gov (United States)

    ... Home › Aging & Health A to Z › Nursing Homes Font size A A A Print Share Glossary Basic ... Reason For Living in A Nursing Home Some type of disability with activities of daily living (ADLs) ...

  19. Behavioral health service utilization and preferences of older adults receiving home-based aging services.

    Science.gov (United States)

    Gum, Amber M; Iser, Lindsay; Petkus, Andrew

    2010-06-01

    To examine use of behavioral health services, treatment preferences, and facilitators and barriers to service use in older adults receiving home-based services within the aging network. Cross-sectional survey. Interviews were conducted in participants' homes. One hundred forty-two clients receiving home-based aging services. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; Brief Symptom Inventory-18; Discrimination-Devaluation Scale; utilization of behavioral health services; and preferences, facilitators, and barriers for behavioral health services. Use of psychotropic medication was high (54.2%), primarily received in primary care settings (58.8%), with a few visits a year (54.0%). Participants were more likely to be taking psychotropic medication if they were younger and white. Approximately one-third of participants on antidepressant or antianxiety medication still met criteria for an Axis I disorder. Twenty-one participants (14.8%) reported receiving counseling within the past year, with a few visits or less a year for most (57.1%). Almost all were willing to see at least one professional (97.2%) and try prescribed medications or counseling (90.1%). The most common barriers to service use were practical: affordability (71.8%), difficulty traveling (62.7%), and lack of transportation (45.8%). Aging network clients receiving home-based services have ready access to psychotropic medications but receive very few specialty behavioral health services and medication monitoring visits. They are willing to use a variety of behavioral health services and perceive mainly practical barriers to using services. The aging network has significant potential to enhance access to service utilization; strategies for integrating behavioral health services in the aging network are discussed.

  20. Mental health issues in Australian nursing homes.

    Science.gov (United States)

    Lie, David

    2003-07-01

    Mental illness is common, under detected and often poorly managed in residential aged care facilities. These concerns have achieved greater prominence as the worldwide population ages. Over 80% of people in nursing home care fulfill criteria for one or more psychiatric disorders in an environment that often presents significant difficulties for assessment and treatment. This article aims to provide an overview of the important mental health issues involved in providing medical care for patients with behavioural and psychological problems in residential aged care facilities. Recent developments in education and training, service development and assessment and treatment strategies show some promise of improving the outcome for aged care residents with mental health problems. This is of especial relevance for primary care physicians who continue to provide the bulk of medical care for this population.

  1. The Effectiveness of Hands-on Health Informatics Skills Exercises in the Multidisciplinary Smart Home Healthcare and Health Informatics Training Laboratories.

    Science.gov (United States)

    Sapci, A H; Sapci, H A

    2017-10-01

    This article aimed to evaluate the effectiveness of newly established innovative smart home healthcare and health informatics laboratories, and a novel laboratory course that focuses on experiential health informatics training, and determine students' self-confidence to operate wireless home health monitoring devices before and after the hands-on laboratory course. Two web-based pretraining and posttraining questionnaires were sent to 64 students who received hands-on training with wireless remote patient monitoring devices in smart home healthcare and health informatics laboratories. All 64 students completed the pretraining survey (100% response rate), and 49 students completed the posttraining survey (76% response rate). The quantitative data analysis showed that 95% of students had an interest in taking more hands-on laboratory courses. Sixty-seven percent of students had no prior experience with medical image, physiological data acquisition, storage, and transmission protocols. After the hands-on training session, 75.51% of students expressed improved confidence about training patients to measure blood pressure monitor using wireless devices. Ninety percent of students preferred to use a similar experiential approach in their future learning experience. Additionally, the qualitative data analysis demonstrated that students were expecting to have more courses with hands-on exercises and integration of technology-enabled delivery and patient monitoring concepts into the curriculum. This study demonstrated that the multidisciplinary smart home healthcare and health informatics training laboratories and the hands-on exercises improved students' technology adoption rates and their self-confidence in using wireless patient monitoring devices. Schattauer GmbH Stuttgart.

  2. Bringing home the health humanities: narrative humility, structural competency, and engaged pedagogy.

    Science.gov (United States)

    Tsevat, Rebecca K; Sinha, Anoushka A; Gutierrez, Kevin J; DasGupta, Sayantani

    2015-11-01

    As health humanities programs grow and thrive across the country, encouraging medical students to read, write, and become more reflective about their professional roles, educators must bring a sense of self-reflexivity to the discipline itself. In the health humanities, novels, patient histories, and pieces of reflective writing are often treated as architectural spaces or "homes" that one can enter and examine. Yet, narrative-based learning in health care settings does not always allow its participants to feel "at home"; when not taught with a critical attention to power and pedagogy, the health humanities can be unsettling and even dangerous. Educators can mitigate these risks by considering not only what they teach but also how they teach it.In this essay, the authors present three pedagogical pillars that educators can use to invite learners to engage more fully, develop critical awareness of medical narratives, and feel "at home" in the health humanities. These pedagogical pillars are narrative humility (an awareness of one's prejudices, expectations, and frames of listening), structural competency (attention to sources of power and privilege), and engaged pedagogy (the protection of students' security and well-being). Incorporating these concepts into pedagogical practices can create safe and productive classroom spaces for all, including those most vulnerable and at risk of being "unhomed" by conventional hierarchies and oppressive social structures. This model then can be translated through a parallel process from classroom to clinic, such that empowered, engaged, and cared-for learners become empowering, engaging, and caring clinicians.

  3. Project CHERISH (Children in Home Environments: Regulation To Improve Safety and Health). Final Report.

    Science.gov (United States)

    Grubb, Paul Dallas

    In 1990, Project CHERISH (Children in Home Environments: Regulation to Increase Safety and Health) enabled the Texas Department of Human Services to implement and evaluate several innovative strategies to strengthen regulation of family day care homes. This report contains descriptions of those strategies, an evaluation of their efficacy, and…

  4. Exploring the relationship between nursing home financial performance and management entrepreneurial attributes.

    Science.gov (United States)

    Davis, Jullet A; Marino, Louis D; Vecchiarini, Mariangela

    2013-01-01

    This paper explores the relationship between entrepreneurial orientation (EO) (i.e., their innovativeness, proactiveness and risk-taking) and financial performance in nursing homes. We hypothesize that nursing homes that are more proactive will report better short-term financial performance, while when firms with higher propensities for innovativeness and risk-taking will experience poorer financial performance in the short period due to the high costs associated with the initial adoption of innovation and with pursuing high-risks ventures. In 2004, a survey was developed and mailed to a population of 670 nursing homes in the state of Florida who were listed in the Florida Nursing Home Guide of the Agency for Health Care Administration. The final sample for this study included 104 respondents. The data from these surveys were merged with additional variables gathered from the 2004 Online Survey Certification and Reporting (OSCAR) system and the 2004/2005 Medicare Cost Reports (MCR). EO was operationalized using a nine-item scale adapted from Covin and Slevin (1989), and financial performance was assessed using total profit margin. The overall findings suggest partial support for the hypotheses. Support was found for the negative relationship between innovativeness and short-term financial performance, but only partial support was found for the relationship between performance and risk-taking. Our results demonstrated that the various aspects of entrepreneurial behaviors have a differential effect on firm performance. From a managerial perspective, nursing home administrators may continue to seek ways to be entrepreneurial while understanding that some activities may only lead to short-term profitability. These findings should not dissuade administrators from innovative behaviors. They do suggest, however, that innovative administrators should prepare for some initial decrease in profitability following new service implementation. Findings suggest that to varying

  5. Health Related Quality of Life in Elderly of Nursing Homes, Medellin-Colombia, 2012

    Directory of Open Access Journals (Sweden)

    Jaiberth Antonio Cardona Arias

    2014-05-01

    Full Text Available Introduction: Elderly in Medellin present conditions of economic, social, environmental and gen-eral health vulnerability; in nursing homes shows further deterioration of health related quality of life (HRQOL. Objective: To compare the profile of HRQOL of adults over public and private nursing homes in Medellin. Materials and methods: Across-sectional correlational study in 220 elderly selected using probability sampling. WHOQOL-BREF was used and the clinical data of each individual. We assessed scale reliability using Cronbach’s alpha, internal consistency and discriminant validity using Pearson correlations, analyzes of HRQOL were based on summaries measures and frequencies, non-parametric and parametric tests and lineal regression. Results: We found 50 % hypertension, 23.6 % diabetes mellitus, dislipidemia 22.3 % and 15 % osteoporosis. The WHOQOL-BREF showed excellent reliability, internal consistency and discriminant validity, the best score was the psychological health and worst in social relationships. We found no differ¬ences in HRQOL by type of nursing home. The main factors related to HRQL were satisfaction with family support and participation in social groups. Conclusion: We identified some determinants of HRQOL, this demonstrated its multidimensionality; relevant information for further research and for the implementation of public health policies and clinical actions.

  6. Merged reality for everyone

    OpenAIRE

    Carvalho, Fausto de; Morgado, Leonel

    2017-01-01

    This article addresses some interesting challenges and business opportunities within the promising merged reality ecosystem, which offers the vision of bringing together virtual, augmented and physical realities, seamlessly. The article also links the current status of this field with exploratory research and development work carried out by Altice Labs. Altice Labs info:eu-repo/semantics/publishedVersion

  7. The Medical Home

    Science.gov (United States)

    ... Videos for Educators Search English Español The Medical Home KidsHealth / For Parents / The Medical Home What's in ... for your child. What Does the Term "Medical Home" Mean? A medical home isn't a place ...

  8. Interpreting quantum discord through quantum state merging

    International Nuclear Information System (INIS)

    Madhok, Vaibhav; Datta, Animesh

    2011-01-01

    We present an operational interpretation of quantum discord based on the quantum state merging protocol. Quantum discord is the markup in the cost of quantum communication in the process of quantum state merging, if one discards relevant prior information. Our interpretation has an intuitive explanation based on the strong subadditivity of von Neumann entropy. We use our result to provide operational interpretations of other quantities like the local purity and quantum deficit. Finally, we discuss in brief some instances where our interpretation is valid in the single-copy scenario.

  9. Collaborating for oral health in support of vulnerable older people: co-production of oral health training in care homes.

    Science.gov (United States)

    Patel, Rakhee; Robertson, Claire; Gallagher, Jennifer E

    2017-11-23

    In recent years, the value of co-production has become embedded in the social care agenda. Care home residents are at significantly higher risk of dental diseases and often rely on the care team for support. It is therefore vital that staff are trained and confident in delivering evidence based oral care to their clients. Three London care homes co-produced a pilot oral health training programme, informed by in-depth interviews and group discussions. The initiative was evaluated using pre/post-questionnaires of carers and semi-structured interviews of managers and the dental teams. Two care homes were available for delivery of the programme, which resulted in training of 64% (n = 87) of care staff. The training programme involved videos and resources and was delivered flexibly with the support of an oral health educator and a dental therapist. There was an improvement in knowledge and self-reported confidence post-training; however, only 54% (n = 45) completed the post-training questionnaire. This study suggests that co-production of an oral care training package for care home staff, is possible and welcome, but challenging in this complex and changing environment. Further work is needed to explore the feasibility, sustainability and impact of doing so. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  10. Observations in the Earth's magnetotail relating to magnetic merging

    International Nuclear Information System (INIS)

    Hones, E.W. Jr.

    1976-01-01

    For more than a decade there has been growing conviction that the burst of energy from a solar flare is first stored in magnetic fields and is then released rapidly by magnetic field annihilation (magnetic merging). There has also been recognition that magnetic merging may be responsible for the energy release manifested in auroral phenomena at the Earth. The most substantial evidence that magnetic merging does indeed occur in the Earth's magnetosphere and causes the auroral phenomena is provided by recent observations, in the magnetotail, of very rapid (approximately 500 km s -1 ) tailward, then earthward, flow of plasma during magnetospheric substorms. The observations, made with the Vela and IMP satellites, reveal also that the component of the tail magnetic field perpendicular to the tail neutral sheet changes polarity at the time of the reversal of plasma flow. These features are interpreted as indicative of passage of a magnetic neutral line, at which magnetic merging is proceeding, past the observing satellite. This paper describes an example of such observations made with IMP 6. It is anticipated that such systematic measurements of the plasma, energetic particles and magnetic field in the neighborhood of the passing neutral line on many such occasions will provide a general understanding of the magnetic merging process which can be applied to studies of solar flares and other astrophysical phenomena. (Auth.)

  11. Advertising expenditures in the nursing home sector: evaluating the need for and purpose of advertising.

    Science.gov (United States)

    Kash, Bita A; Boyer, Gregory J

    2008-01-01

    Marketing and advertising activities in the nursing home sector have increased in recent years, following the example of hospitals and health systems. The reasons for this trend may be related to the growth in competition but are not clearly identified yet. Theoretically, advertising becomes necessary to gain an advantage over the competition. The purpose of this study was to identify the reasons for the variation in advertising expenditures among nursing homes in Texas. For this study, we merged 2003 data from the Texas Medicaid Nursing Facility Cost Report, the Texas Nursing Home Quality Reporting System, and the Area Resource File for Texas. Using the Herfindahl-Hirschman Index, we then examined the correlations between advertising expenses and the level of market concentration. We evaluated the association between advertising expenditures and market competition using two logistic and four linear regression models. Total advertising expenses in Texas nursing homes ranged from $0 to $165,000 per year. Higher advertising expenditures were associated with larger facilities, higher occupancy, and high Medicare census. Market competition, however, was not a significant predictor of such expenses. Advertising seems to be more resource-driven than market-driven. Therefore, some advertising expenditures may be unnecessary, may lack impact, and may even be wasteful. Reducing unnecessary advertising costs could free up resources, which may be allocated to necessary resident care activities.

  12. A Research Agenda on Assessing and Remediating Home Dampness and Mold to Reduce Dampness-Related Health Effects

    Energy Technology Data Exchange (ETDEWEB)

    Mendell, Mark J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Computational Cosmology Center

    2015-05-28

    This report briefly summarizes, based on recent review articles and selected more recent research reports, current scientific knowledge on two topics: assessing unhealthy levels of indoor D/M in homes and remediating home dampness-related problems to protect health. Based on a comparison of current scientific knowledge to that required to support effective, evidence-based, health-protective policies on home D/M, gaps in knowledge are highlighted, prior questions and research questions specified, and necessary research activities and approaches recommended.

  13. A Research Agenda on Assessing and Remediating Home Dampness and Mold to Reduce Dampness-Related Health Effects

    Energy Technology Data Exchange (ETDEWEB)

    Mendell, Mark J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-06-01

    This report briefly summarizes, based on recent review articles and selected more recent research reports, current scientific knowledge on two topics: assessing unhealthy levels of indoor D/M in homes and remediating home dampness-related problems to protect health. Based on a comparison of current scientific knowledge to that required to support effective, evidence-based, health-protective policies on home D/M, gaps in knowledge are highlighted, prior questions and research questions specified, and necessary research activities and approaches recommended.

  14. Advances in ATLAS@Home towards a major ATLAS computing resource

    CERN Document Server

    Cameron, David; The ATLAS collaboration

    2018-01-01

    The volunteer computing project ATLAS@Home has been providing a stable computing resource for the ATLAS experiment since 2013. It has recently undergone some significant developments and as a result has become one of the largest resources contributing to ATLAS computing, by expanding its scope beyond traditional volunteers and into exploitation of idle computing power in ATLAS data centres. Removing the need for virtualization on Linux and instead using container technology has made the entry barrier significantly lower data centre participation and in this paper, we describe the implementation and results of this change. We also present other recent changes and improvements in the project. In early 2017 the ATLAS@Home project was merged into a combined LHC@Home platform, providing a unified gateway to all CERN-related volunteer computing projects. The ATLAS Event Service shifts data processing from file-level to event-level and we describe how ATLAS@Home was incorporated into this new paradigm. The finishing...

  15. Home health nursing care agenda based on health policy in Korea.

    Science.gov (United States)

    Ryu, Hosihn; An, Jiyoung; Koabyashi, Mia

    2005-06-01

    Home health nursing care (HHNC) in Korea has taken on an important role under the mandate of the national health care system since 2000. This program was developed to verify the possibility of early discharge of hospitalized patients and cost containment through a research and development project that was conducted with the government from 1994 to 1999. The process of development of HHNC provided an opportunity to realize the advancement and changes in the system into a consumer-focused structure. This is an important turning point for the Korean health care system that suggests certain possibilities for building a foundation for further changes in the service delivery structure. The structure, which had been limited to a supplier-oriented model, is moving to a consumer-oriented structure. Accordingly, the major function and role of nursing policy makers in Korea is to develop an agenda and alternatives for policy-making in a systematic manner and to present implementation strategies clearly.

  16. Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney disease.

    Science.gov (United States)

    Harwood, Lori; Clark, Alexander M

    2012-03-01

    Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney disease This paper examines home-dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education for self-management to delay the progression of kidney disease and the preparation and support for renal replacement therapy e.g.) dialysis and transplantation. Home-dialysis has clear health, societal and economic benefits yet service usage is low despite efforts to realign resources and educate individuals. Current research on the determinants of modality selection is superficial and insufficient to capture the complexities embedded in the process of dialysis modality selection. Predictors of home-dialysis selection and the effect of chronic kidney disease educational programmes provide a limited explanation of this experience. A re-conceptualization of the problem is required in order to fully understand this process. The epistemology and ontology of critical realism guides our knowledge and methodology particularly suited for examination of these complexities. This approach examines the deeper mechanisms and wider determinants associated with modality decision making, specifically who chooses home dialysis and under what circumstances. Until more is known regarding dialysis modality decision making service usage of home dialysis will remain low as interventions will be based on inadequate epistemology. © 2011 Blackwell Publishing Ltd.

  17. Controlling inclusive cross sections in parton shower + matrix element merging

    Energy Technology Data Exchange (ETDEWEB)

    Plaetzer, Simon

    2012-11-15

    We propose an extension of matrix element plus parton shower merging at tree level to preserve inclusive cross sections obtained from the merged and showered sample. Implementing this constraint generates approximate next-to-leading order (NLO) contributions similar to the LoopSim approach. We then show how full NLO, or in principle even higher order, corrections can be added consistently, including constraints on inclusive cross sections to account for yet missing parton shower accuracy at higher logarithmic order. We also show how NLO accuracy below the merging scale can be obtained.

  18. Controlling inclusive cross sections in parton shower + matrix element merging

    International Nuclear Information System (INIS)

    Plaetzer, Simon

    2012-11-01

    We propose an extension of matrix element plus parton shower merging at tree level to preserve inclusive cross sections obtained from the merged and showered sample. Implementing this constraint generates approximate next-to-leading order (NLO) contributions similar to the LoopSim approach. We then show how full NLO, or in principle even higher order, corrections can be added consistently, including constraints on inclusive cross sections to account for yet missing parton shower accuracy at higher logarithmic order. We also show how NLO accuracy below the merging scale can be obtained.

  19. Spheromak Merging Experiments on SSX

    Science.gov (United States)

    Brown, M. R.; Kornack, T. W.; Sollins, P. K.; Luh, W. J.

    1997-11-01

    Spheromak merging experiments are underway at the Swarthmore Spheromak Experiment (SSX) at Swarthmore College. The spheromaks are formed by identical magnetized plasma guns and equilibrium is established in close fitting 0.5 m diameter copper flux conservers. Partial merging is achieved through openings in the back wall. We observe the formation of a reconnection boundary layer at the interface of the two spheromaks using a linear probe array. The characteristic scale of the flux reversal is about 1 cm (consistent with the diffusion scale δ_diff, the ion Larmor radius ρi and the ion inertial length c/ω_pi). Movies of the formation and evolution of the layer will be presented. Correlations between reconnection events and pulses of soft x-rays and energetic particles will be presented if available. Plans for 2D and 3D imaging of the layer will also be discussed.

  20. Facilitating out-of-home caregiving through health information technology: survey of informal caregivers' current practices, interests, and perceived barriers.

    Science.gov (United States)

    Zulman, Donna M; Piette, John D; Jenchura, Emily C; Asch, Steven M; Rosland, Ann-Marie

    2013-07-10

    Many patients with chronic conditions are supported by out-of-home informal caregivers-family members, friends, and other individuals who provide care and support without pay-who, if armed with effective consumer health information technology, could inexpensively facilitate their care. We sought to understand caregivers' use of, interest in, and perceived barriers to health information technology for out-of-home caregiving. We conducted 2 sequential Web-based surveys with a national sample of individuals who provide out-of-home caregiving to an adult family member or friend with a chronic illness. We queried respondents about their use of health information technology for out-of-home caregiving and used multivariable regression to investigate caregiver and care-recipient characteristics associated with caregivers' technology use for caregiving. Among 316 out-of-home caregiver respondents, 34.5% (109/316) reported using health information technology for caregiving activities. The likelihood of a caregiver using technology increased significantly with intensity of caregiving (as measured by number of out-of-home caregiving activities). Compared with very low intensity caregivers, the adjusted odds ratio (OR) of technology use was 1.88 (95% CI 1.01-3.50) for low intensity caregivers, 2.39 (95% CI 1.11-5.15) for moderate intensity caregivers, and 3.70 (95% CI 1.62-8.45) for high intensity caregivers. Over 70% (149/207) of technology nonusers reported interest in using technology in the future to support caregiving. The most commonly cited barriers to technology use for caregiving were health system privacy rules that restrict access to care-recipients' health information and lack of familiarity with programs or websites that facilitate out-of-home caregiving. Health information technology use for out-of-home caregiving is common, especially among individuals who provide more intense caregiving. Health care systems can address the mismatch between caregivers' interest

  1. Structure-preservingness, internal merge, and the strict locality of triads

    NARCIS (Netherlands)

    Koster, J.; Karimi, S.; Samiian, V.; Wilkins, W.

    2007-01-01

    This paper examines Emonds’ Structure Preserving Hypothesis, and suggests that the insight behind this hypothesis survives reformulation in terms of recent minimalist theory: each structure created by internal merge can also, independently, be created by external merge. As before, this makes

  2. Eldercare at Home: Choosing a Nursing Home

    Science.gov (United States)

    ... required, these services can be provided by a separate home health agency as directed by a doctor or ... complaints made by or on behalf of nursing home residents and work to resolve the problems. If they are unable ...

  3. Correlation order, merging and diversification

    NARCIS (Netherlands)

    Dhaene, J.; Denuit, M.; Vanduffel, S.

    2009-01-01

    We investigate the influence of the dependence between random losses on the shortfall and on the diversification benefit that arises from merging these losses. We prove that increasing the dependence between losses, expressed in terms of correlation order, has an increasing effect on the shortfall,

  4. Job demands-resources predicting burnout and work engagement among Belgian home health care nurses: A cross-sectional study.

    Science.gov (United States)

    Vander Elst, Tinne; Cavents, Carolien; Daneels, Katrien; Johannik, Kristien; Baillien, Elfi; Van den Broeck, Anja; Godderis, Lode

    A better knowledge of the job aspects that may predict home health care nurses' burnout and work engagement is important in view of stress prevention and health promotion. The Job Demands-Resources model predicts that job demands and resources relate to burnout and work engagement but has not previously been tested in the specific context of home health care nursing. The present study offers a comprehensive test of the Job-Demands Resources model in home health care nursing. We investigate the main and interaction effects of distinctive job demands (workload, emotional demands and aggression) and resources (autonomy, social support and learning opportunities) on burnout and work engagement. Analyses were conducted using cross-sectional data from 675 Belgian home health care nurses, who participated in a voluntary and anonymous survey. The results show that workload and emotional demands were positively associated with burnout, whereas aggression was unrelated to burnout. All job resources were associated with higher levels of work engagement and lower levels of burnout. In addition, social support buffered the positive relationship between workload and burnout. Home health care organizations should invest in dealing with workload and emotional demands and stimulating the job resources under study to reduce the risk of burnout and increase their nurses' work engagement. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. OPTICAL-NEAR-INFRARED COLOR GRADIENTS AND MERGING HISTORY OF ELLIPTICAL GALAXIES

    International Nuclear Information System (INIS)

    Kim, Duho; Im, Myungshin

    2013-01-01

    It has been suggested that merging plays an important role in the formation and the evolution of elliptical galaxies. While gas dissipation by star formation is believed to steepen metallicity and color gradients of the merger products, mixing of stars through dissipation-less merging (dry merging) is believed to flatten them. In order to understand the past merging history of elliptical galaxies, we studied the optical-near-infrared (NIR) color gradients of 204 elliptical galaxies. These galaxies are selected from the overlap region of the Sloan Digital Sky Survey (SDSS) Stripe 82 and the UKIRT Infrared Deep Sky Survey (UKIDSS) Large Area Survey (LAS). The use of optical and NIR data (g, r, and K) provides large wavelength baselines, and breaks the age-metallicity degeneracy, allowing us to derive age and metallicity gradients. The use of the deep SDSS Stripe 82 images makes it possible for us to examine how the color/age/metallicity gradients are related to merging features. We find that the optical-NIR color and the age/metallicity gradients of elliptical galaxies with tidal features are consistent with those of relaxed ellipticals, suggesting that the two populations underwent a similar merging history on average and that mixing of stars was more or less completed before the tidal features disappeared. Elliptical galaxies with dust features have steeper color gradients than the other two types, even after masking out dust features during the analysis, which can be due to a process involving wet merging. More importantly, we find that the scatter in the color/age/metallicity gradients of the relaxed and merging feature types decreases as their luminosities (or masses) increase at M > 10 11.4 M ☉ but stays large at lower luminosities. Mean metallicity gradients appear nearly constant over the explored mass range, but a possible flattening is observed at the massive end. According to our toy model that predicts how the distribution of metallicity gradients

  6. Innovation in a Learning Health Care System: Veteran-Directed Home- and Community-Based Services.

    Science.gov (United States)

    Garrido, Melissa M; Allman, Richard M; Pizer, Steven D; Rudolph, James L; Thomas, Kali S; Sperber, Nina R; Van Houtven, Courtney H; Frakt, Austin B

    2017-11-01

    A path-breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administration's (VHA's) planned roll-out of a program for providing participant-directed home- and community-based services to veterans with cognitive and functional limitations. We describe the design of a large-scale, stepped-wedge, cluster-randomized trial of the Veteran-Directed Home- and Community-Based Services (VD-HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD-HCBS to veterans at risk of nursing home placement. Services will be provided to community-dwelling participants with support from Aging and Disability Network Agencies. The VHA Partnered Evidence-based Policy Resource Center (PEPReC) is coordinating the evaluation, which includes collaboration from operational stakeholders from the VHA and Administration for Community Living and interdisciplinary researchers from the Center of Innovation in Long-Term Services and Supports and the Center for Health Services Research in Primary Care. For older veterans with functional limitations who are eligible for VD-HCBS, we will evaluate health outcomes (hospitalizations, emergency department visits, nursing home admissions, days at home) and healthcare costs associated with VD-HCBS availability. Learning healthcare systems facilitate diffusion of innovation while enabling rigorous evaluation of effects on patient outcomes. The VHA's randomized rollout of VD-HCBS to veterans at risk of nursing home placement is an example of how to achieve these goals simultaneously. PEPReC's experience designing an evaluation with researchers and operations stakeholders may serve as a framework for others seeking to develop rapid, rigorous, large-scale evaluations of delivery system innovations targeted to older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  7. The Astrophysics of Merging Black Holes

    Science.gov (United States)

    Schnittman, Jeremy D.

    2011-01-01

    When two supermassive black holes (SMBHs) approach within 1-10 mpc, gravitational wave (GW) losses begin to dominate the evolution of the binary, pushing the system to merge in a relatively small time. During this final inspiral regime, the system will emit copious energy in GWs, which should be directly detectable by pulsar timing arrays and space-based interferometers. At the same time, any gas or stars in the immediate vicinity of the merging 5MBHs can get heated and produce bright electromagnetic (EM) counterparts to the GW signals. We present here a number of possible mechanisms by which simultaneous EM and GW signals will yield valuable new information about galaxy evolution, accretion disk dynamics, and fundamental physics in the most extreme gravitational fields.

  8. Why is housing tenure associated with a lower risk of admission to a nursing or residential home? Wealth, health and the incentive to keep 'my home'.

    Science.gov (United States)

    McCann, Mark; Grundy, Emily; O'Reilly, Dermot

    2012-02-01

    Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors. To analyse the probability of admission to residential and nursing home care according to housing tenure and house value. Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of ≈28% of the population of Northern Ireland. Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters. The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers.

  9. Development of a Health Care Information System for the Elderly at Home

    Directory of Open Access Journals (Sweden)

    Wang Dong

    2016-01-01

    Full Text Available The growing population aging is a serious social problem in the world today. Accidental death at home is increasing because abnormal conditions can not be discovered in time, especially to the elderly who live alone. Besides, according to statistics, over 80 percent of the elderly need the service of home care in China. A health care information system for the elderly at home is developed to monitor the real–time state of the elderly remotely in this thesis. The system can show the current positions of the elderly in the house and judge whether they are in dangerous locations or have dangerous activities. In the case of emergency, the elderly can press the emergency button. The system also provides some help for the elderly’s daily life. The system offers the advantage for living at home more safely and more comfortably, and has better application prospect

  10. Care workers health in Swiss nursing homes and its association with psychosocial work environment: A cross-sectional study.

    Science.gov (United States)

    Dhaini, Suzanne R; Zúñiga, Franziska; Ausserhofer, Dietmar; Simon, Michael; Kunz, Regina; De Geest, Sabina; Schwendimann, Rene

    2016-01-01

    Previous studies have demonstrated poor health of care workers in nursing homes. Yet, little is known about the prevalence of physical and mental health outcomes, and their associations with the psychosocial work environment in nursing homes. (1) To explore the prevalence of physical and mental health outcomes of care workers in Swiss nursing homes, (2) their association with psychosocial work environment. This is a secondary data analysis of the cross-sectional Swiss Nursing Home Human Resources Project (SHURP). We used survey data on socio-demographic characteristics and work environment factors from care workers (N=3471) working in Swiss nursing homes (N=155), collected between May 2012 and April 2013. GEE logistic regression models were used to estimate the relationship between psychosocial work environment and physical and mental health outcomes, taking into account care workers' age. Back pain (19.0%) and emotional exhaustion (24.2%) were the most frequent self-reported physical and mental health. Back pain was associated with increased workload (odds ratios (OR) 1.52, confidence interval (CI) 1.29-1.79), conflict with other health professionals and lack of recognition (OR 1.72, CI 1.40-2.11), and frequent verbal aggression by residents (OR 1.36, CI 1.06-1.74), and inversely associated with staffing adequacy (OR 0.69, CI 0.56-0.84); emotional exhaustion was associated with increased workload (OR 1.96, CI 1.65-2.34), lack of job preparation (OR 1.41, CI 1.14-1.73), and conflict with other health professionals and lack of recognition (OR 1.68, CI 1.37-2.06), and inversely associated with leadership (OR 0.70, CI 0.56-0.87). Physical and mental health among care workers in Swiss nursing homes is of concern. Modifying psychosocial work environment factors offer promising strategies to improve health. Longitudinal studies are needed to conduct targeted assessments of care workers health status, taking into account their age, along with the exposure to all four

  11. The labor impacts of policy change in health care: how federal policy transformed home health organizations and their labor practices.

    Science.gov (United States)

    Szasz, A

    1990-01-01

    Health care organizations are highly labor-intensive; policies designed to stimulate organizational change are likely to have labor impacts. This paper examines the labor effects of policy change in home health care. Major federal home care policy trends since 1980 have spurred the evolution of the typical home care provider toward greater organizational and market rationality. Greater managerial sophistication has introduced changes in management/labor relations. Survey data from the 1986 DRG Impact Study are used to show how the pressure of cost-containment policies has pushed agencies to cut labor costs by increasing workloads, managerial supervision, and control of the work process. Research on the effects of recent policy change in health care has to date focused primarily on potential client effects. Labor impacts are rarely examined and are poorly understood at the time that policy is made. Findings in this article suggest that these issues deserve greater, more systematic attention, because unanticipated labor impacts may prove to be significant impediments to the realization of intended policy goals.

  12. Health Economic Evaluation of Home and Hospital-Based Care in T2D Patients on Insulin Therapy.

    Science.gov (United States)

    Janati, Ali; Sarabchian, Mohamad Ali; Mohaghegh, Bahram; Aghmohamadzadeh, Naser; Seyedin, Hesam; Gholizadeh, Masumeh; Hasanpoor, Edris

    2017-11-01

    Type 2 Diabetes is a main concern of public health in contemporary world with remarkable mortality, delayed complications and health costs. Governments are obliged to improve the quality of health care and consider appropriate strategies to reduce the costs. An alternative strategy for hospital services is care at home. Therefore, this study was aimed to evaluate the cost-effectiveness of home-based and hospital-based diabetes care. A quasi-experimental, pre-test and post-test design was conducted in Northwest Iran. Sixty subjects who were eligible insulin-treatment type 2 diabetes mellitus were randomly assigned into two equal groups to receive home-based or conventional hospital-based care. Data on glycosylated hemoglobin (HbA1c), hypoglycemia episodes, time needed to achieve glycemic control level, diabetes treatment satisfaction, diabetes knowledge and costs during three months were collected. The cost of home-based care in insulin therapy diabetes was 61% less compared with the hospital-based methods. The former strategy was cost-effective in terms of reduction in HbA1C and the time needed to achieve glycemic control. The patients in home care group were more satisfied and knowledgeable. The care at home approach for type 2 diabetic patients can be introduced and supported as a cost-effective care method in the country.

  13. Bridging the gap: a virtual health record for integrated home care

    Directory of Open Access Journals (Sweden)

    Maria Hägglund

    2007-06-01

    Full Text Available Introduction: The coexistence of different information systems that are unable to communicate is a persistent problem in healthcare and in integrated home care in particular. Theory and methods: Physically federated integration is used for design of the underlying technical architecture to implement a mobile virtual health record for integrated home care. A user centered system development approach is followed during design and development of the system. Results: A technical platform based on a service-oriented approach where database functionality and services are separated has been developed. This guarantees flexibility with regard to changed functional demands and allows third party systems to interact with the platform in a standardized way. A physically federated integration enables point-of-care documentation, integrated presentation of information from different feeder systems, and offline access to data on handheld devices. Feeder systems deliver information in XML-files that are mapped against an ideal XML schema, published as an interface for integration with the information broker, and inserted into the mediator database. Conclusions: A seamless flow of information between both different care professionals involved in integrated home care and patients and relatives is provided through mobile information access and interaction with different feeder systems using the virtual health record.

  14. A Water-Damaged Home and Health of Occupants: A Case Study

    International Nuclear Information System (INIS)

    Thrasher, J.D.; Gray, M.R.; Kilburn, K.H.; Kilburn, K.H.; Dennis, D.P.; Yu, A.

    2012-01-01

    A family of five and pet dog who rented a water-damaged home and developed multiple health problems. The home was analyzed for species of mold and bacteria. The diagnostics included MRI for chronic sinusitis with ENT and sinus surgery, and neurological testing for neuro cognitive deficits. Bulk samples from the home, tissue from the sinuses, urine, nasal secretions, placenta, umbilical cord, and breast milk were tested for the presence of trichothecene, aflatoxins, and Ochratoxin A. The family had the following diagnosed conditions: chronic sinusitis, neurological deficits, coughing with wheeze, nose bleeds, and fatigue among other symptoms. An infant was born with a total body flare, developed multiple Cafe-au-Lait pigmented skin spots and diagnoses with NF1 at age 2. The mycotoxins were detected in bulk samples, urine and nasal secretions, breast milk, placenta, and umbilical cord. Pseudomonas aueroginosa, Acinetobacter, Penicillium, and Aspergillus fumigatus were cultured from nasal secretions (father and daughter). RT-PCR revealed A. fumigatus DNA in sinus tissues of the daughter. The dog had 72 skin lesions (sebaceous glands and lipomas) from which trichothecene and ochratoxin A. were detected. The health of the family is discussed in relation to the most recent published literature regarding microbial contamination and toxic by-products present in water-damaged buildings.

  15. A Water-Damaged Home and Health of Occupants: A Case Study

    Directory of Open Access Journals (Sweden)

    Jack Dwayne Thrasher

    2012-01-01

    Full Text Available A family of five and pet dog who rented a water-damaged home and developed multiple health problems. The home was analyzed for species of mold and bacteria. The diagnostics included MRI for chronic sinusitis with ENT and sinus surgery, and neurological testing for neurocognitive deficits. Bulk samples from the home, tissue from the sinuses, urine, nasal secretions, placenta, umbilical cord, and breast milk were tested for the presence of trichothecenes, aflatoxins, and Ochratoxin A. The family had the following diagnosed conditions: chronic sinusitis, neurological deficits, coughing with wheeze, nose bleeds, and fatigue among other symptoms. An infant was born with a total body flare, developed multiple Cafe-au-Lait pigmented skin spots and diagnoses with NF1 at age 2. The mycotoxins were detected in bulk samples, urine and nasal secretions, breast milk, placenta, and umbilical cord. Pseudomonas aueroginosa, Acinetobacter, Penicillium, and Aspergillus fumigatus were cultured from nasal secretions (father and daughter. RT-PCR revealed A. fumigatus DNA in sinus tissues of the daughter. The dog had 72 skin lesions (sebaceous glands and lipomas from which trichothecenes and ochratoxin A. were detected. The health of the family is discussed in relation to the most recent published literature regarding microbial contamination and toxic by-products present in water-damaged buildings.

  16. Capacity of Freeway Merge Areas with Different On-Ramp Traffic Flow

    Directory of Open Access Journals (Sweden)

    Jinxing Shen

    2015-06-01

    Full Text Available This paper is aimed at investigating the influence of different types of traffic flows on the capacity of freeway merge areas. Based on the classical gap-acceptance model, two calculating models were established specifically considering randomly arriving vehicles and individual difference in driving behaviours. Monte-Carlo simulation was implemented to reproduce the maximum traffic volume on the designed freeway merge area under different situations. The results demonstrated that the proposed calculating models have better performance than the conventional gap-acceptance theory on accurately predicting the capacity of freeway merge areas. The findings of research could be helpful to improve the microscopic traffic flow simulation model from a more practical perspective and support the designing of freeway merge areas as well.

  17. Can survival prediction be improved by merging gene expression data sets?

    Directory of Open Access Journals (Sweden)

    Haleh Yasrebi

    Full Text Available BACKGROUND: High-throughput gene expression profiling technologies generating a wealth of data, are increasingly used for characterization of tumor biopsies for clinical trials. By applying machine learning algorithms to such clinically documented data sets, one hopes to improve tumor diagnosis, prognosis, as well as prediction of treatment response. However, the limited number of patients enrolled in a single trial study limits the power of machine learning approaches due to over-fitting. One could partially overcome this limitation by merging data from different studies. Nevertheless, such data sets differ from each other with regard to technical biases, patient selection criteria and follow-up treatment. It is therefore not clear at all whether the advantage of increased sample size outweighs the disadvantage of higher heterogeneity of merged data sets. Here, we present a systematic study to answer this question specifically for breast cancer data sets. We use survival prediction based on Cox regression as an assay to measure the added value of merged data sets. RESULTS: Using time-dependent Receiver Operating Characteristic-Area Under the Curve (ROC-AUC and hazard ratio as performance measures, we see in overall no significant improvement or deterioration of survival prediction with merged data sets as compared to individual data sets. This apparently was due to the fact that a few genes with strong prognostic power were not available on all microarray platforms and thus were not retained in the merged data sets. Surprisingly, we found that the overall best performance was achieved with a single-gene predictor consisting of CYB5D1. CONCLUSIONS: Merging did not deteriorate performance on average despite (a The diversity of microarray platforms used. (b The heterogeneity of patients cohorts. (c The heterogeneity of breast cancer disease. (d Substantial variation of time to death or relapse. (e The reduced number of genes in the merged data

  18. Modelling of lane-changing behaviour integrating with merging effect before a city road bottleneck

    Science.gov (United States)

    Lv, Wei; Song, Wei-guo; Fang, Zhi-ming; Ma, Jian

    2013-10-01

    Merging behaviour is a compulsive action in a discretionary lane-changing traffic system, especially in a system with a bottleneck. This paper aims to investigate the generic lane-changing behaviour considering the merging effect before a city road bottleneck. Thus firstly the merging behaviour is distinguished from other generic lane-changing behaviour. Combining discretionary lane-changing and compulsive merging, we developed an integrative traffic model, in which a method to calculate the lane-changing probability and the merging probability was proposed. A simulation scenario derived from real life was conducted to validate the proposed programming algorithm. Finally, a discussion on the simulation findings shows that the merging influence can be expanded and the merging behaviour can increase the probability of local traffic jamming in its affected area of the adjacent lane. The distribution of the merging distance provides fundamental insights for actual traffic management. The result of the clearance time implies the position of the incident point has a significant effect on the clearing time and it is important to ensure the end (exit) of the road is unimpeded in traffic evacuation.

  19. Preventing home health nursing assistant back and shoulder injuries.

    Science.gov (United States)

    Leff, E W; Hagenbach, G L; Marn, K K

    2000-10-01

    Franklin County Home Health Agency (St Albans, Vermont) undertook a performance improvement project in 1996 to reduce employee injuries. A review of recent injuries led to the prevention of licensed nursing assistants' (LNAs') back and shoulder injuries as the first priority. Root causes of injuries were agency communication, employee training, patient home environment, nursing assistant body mechanics, and failure to use safety measures. Given that injury causality is complex and multifactorial, a variety of improvement strategies were implemented over the following two to three years. IMPLEMENTATION OF POTENTIAL SOLUTIONS: Short-term (a few months), mid-term (six months), and long-term (one year) potential solutions to the LNA back and shoulder injury problem were charted. Safety and health training was the major focus of the team's short-term plan. Risk management forms were to be used to identify and follow up on hazardous situations. Project plans that were successfully implemented included revision of LNA plans of care, standardization of the return-to-work process after injury, development of guidelines for identifying unsafe patient lifts and transfers, improved follow-up of employee reports of injury-risk situations in patient homes, improved body mechanics screening of new employees, and a stronger injury-prevention training program for current employees. A less successful initiative was aimed at collecting more data about injuries and causal factors. Employee injuries were gradually reduced from 4-10 per quarter to 0-3 per quarter. Injury prevention requires commitment, persistence, and patience--but not expensive improvements. Multiple interventions increase the chances of success when there are many root causes and lack of evidence regarding the effectiveness of various approaches.

  20. Exercise at Home

    Science.gov (United States)

    ... Home Health Insights Exercise & Weight Exercise at Home Exercise at Home Make an Appointment Ask a Question ... with the movement and contact your provider. Posture Exercises Better posture means better breathing and movement. Axial ...

  1. Automatic assessment of functional health decline in older adults based on smart home data.

    Science.gov (United States)

    Alberdi Aramendi, Ane; Weakley, Alyssa; Aztiria Goenaga, Asier; Schmitter-Edgecombe, Maureen; Cook, Diane J

    2018-05-01

    In the context of an aging population, tools to help elderly to live independently must be developed. The goal of this paper is to evaluate the possibility of using unobtrusively collected activity-aware smart home behavioral data to automatically detect one of the most common consequences of aging: functional health decline. After gathering the longitudinal smart home data of 29 older adults for an average of >2 years, we automatically labeled the data with corresponding activity classes and extracted time-series statistics containing 10 behavioral features. Using this data, we created regression models to predict absolute and standardized functional health scores, as well as classification models to detect reliable absolute change and positive and negative fluctuations in everyday functioning. Functional health was assessed every six months by means of the Instrumental Activities of Daily Living-Compensation (IADL-C) scale. Results show that total IADL-C score and subscores can be predicted by means of activity-aware smart home data, as well as a reliable change in these scores. Positive and negative fluctuations in everyday functioning are harder to detect using in-home behavioral data, yet changes in social skills have shown to be predictable. Future work must focus on improving the sensitivity of the presented models and performing an in-depth feature selection to improve overall accuracy. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. Optimization approaches to mpi and area merging-based parallel buffer algorithm

    Directory of Open Access Journals (Sweden)

    Junfu Fan

    Full Text Available On buffer zone construction, the rasterization-based dilation method inevitably introduces errors, and the double-sided parallel line method involves a series of complex operations. In this paper, we proposed a parallel buffer algorithm based on area merging and MPI (Message Passing Interface to improve the performances of buffer analyses on processing large datasets. Experimental results reveal that there are three major performance bottlenecks which significantly impact the serial and parallel buffer construction efficiencies, including the area merging strategy, the task load balance method and the MPI inter-process results merging strategy. Corresponding optimization approaches involving tree-like area merging strategy, the vertex number oriented parallel task partition method and the inter-process results merging strategy were suggested to overcome these bottlenecks. Experiments were carried out to examine the performance efficiency of the optimized parallel algorithm. The estimation results suggested that the optimization approaches could provide high performance and processing ability for buffer construction in a cluster parallel environment. Our method could provide insights into the parallelization of spatial analysis algorithm.

  3. Learning to merge search results for efficient Distributed Information Retrieval

    NARCIS (Netherlands)

    Tjin-Kam-Jet, Kien; Hiemstra, Djoerd

    2010-01-01

    Merging search results from different servers is a major problem in Distributed Information Retrieval. We used Regression-SVM and Ranking-SVM which would learn a function that merges results based on information that is readily available: i.e. the ranks, titles, summaries and URLs contained in the

  4. The political economy of a public health case management program's transition into medical homes.

    Science.gov (United States)

    Wells, Rebecca; Cilenti, Dorothy; Issel, L Michele

    2015-11-01

    Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent. Published by Elsevier Ltd.

  5. Merging Mixture Components for Cell Population Identification in Flow Cytometry

    Directory of Open Access Journals (Sweden)

    Greg Finak

    2009-01-01

    Full Text Available We present a framework for the identification of cell subpopulations in flow cytometry data based on merging mixture components using the flowClust methodology. We show that the cluster merging algorithm under our framework improves model fit and provides a better estimate of the number of distinct cell subpopulations than either Gaussian mixture models or flowClust, especially for complicated flow cytometry data distributions. Our framework allows the automated selection of the number of distinct cell subpopulations and we are able to identify cases where the algorithm fails, thus making it suitable for application in a high throughput FCM analysis pipeline. Furthermore, we demonstrate a method for summarizing complex merged cell subpopulations in a simple manner that integrates with the existing flowClust framework and enables downstream data analysis. We demonstrate the performance of our framework on simulated and real FCM data. The software is available in the flowMerge package through the Bioconductor project.

  6. Simulations of Bunch Merging in a Beta Beam Decay Ring

    CERN Document Server

    Heinrich, Daniel Christopher; Chance, Antoine

    2011-01-01

    To further study neutrino oscillation properties a Beta Beam facility has been proposed. Beta decaying ions with high kinetic energy are stored in a storage ring ("Decay Ring") with straight sections to create pure focused (anti) electron neutrino beams. However to reach high sensitivity to neutrino oscillation parameters in the experiment the bunched beam intensity and duty cycle in the DR have to be optimized. The first CERN-based scenario, using 6He and 18Ne as neutrino sources, has been studied using a bunch merging RF scheme. Two RF cavities at different frequencies are used to capture newly injected bunches and then merge them into the stored bunches. It was shown that this scheme could satisfy the requirements on intensity and duty cycle set by the experiment. This merging scheme has now been revised with new simulation software providing new results for 6He and 18Ne. Furthermore bunch merging has been studied for the second CERN-based scenario using 8Li and 8B.

  7. Comparative study of the electron density profiles in the compact torus plasma merging experiments

    International Nuclear Information System (INIS)

    Hayashiya, Hitoshi; Asaka, Takeo; Katsurai, Makoto

    2003-01-01

    Following two previous papers on the comparative studies of the electron density distributions for a single compact torus (CT) and a spherical tokamak (ST), and for the a single ST and a merged ST, a comparative study on the dynamics of the electron density profile and after the CT and ST plasma merging process was performed. The sharpness of the peak in the electron density profile around the mid-plane just after the merging of CT with a low safety factor (q value) such as RFP or spheromak is found to be related to the speed of the magnetic axis during the plasma merging process. It is also found that the electron density gradient near the plasma edge in a high q ST is larger than that of a low q CT. High q ST is found to be provided with the magnetic structure which is able to sustain a large thermal pressure by a strong j x B force. Despite these differences in the electron density profile between CT and ST during merging, the confinement characteristics evaluated from the number of electrons confined within the magnetic separatrix after the completion of the merging is almost similar between in the merging CT and in the merging ST. For all configurations, the electron density profiles after the completion of the merging are analogous to those of the corresponding single configuration produced without the merging process. (author)

  8. Merging Digital Surface Models Implementing Bayesian Approaches

    Science.gov (United States)

    Sadeq, H.; Drummond, J.; Li, Z.

    2016-06-01

    In this research different DSMs from different sources have been merged. The merging is based on a probabilistic model using a Bayesian Approach. The implemented data have been sourced from very high resolution satellite imagery sensors (e.g. WorldView-1 and Pleiades). It is deemed preferable to use a Bayesian Approach when the data obtained from the sensors are limited and it is difficult to obtain many measurements or it would be very costly, thus the problem of the lack of data can be solved by introducing a priori estimations of data. To infer the prior data, it is assumed that the roofs of the buildings are specified as smooth, and for that purpose local entropy has been implemented. In addition to the a priori estimations, GNSS RTK measurements have been collected in the field which are used as check points to assess the quality of the DSMs and to validate the merging result. The model has been applied in the West-End of Glasgow containing different kinds of buildings, such as flat roofed and hipped roofed buildings. Both quantitative and qualitative methods have been employed to validate the merged DSM. The validation results have shown that the model was successfully able to improve the quality of the DSMs and improving some characteristics such as the roof surfaces, which consequently led to better representations. In addition to that, the developed model has been compared with the well established Maximum Likelihood model and showed similar quantitative statistical results and better qualitative results. Although the proposed model has been applied on DSMs that were derived from satellite imagery, it can be applied to any other sourced DSMs.

  9. MERGING DIGITAL SURFACE MODELS IMPLEMENTING BAYESIAN APPROACHES

    Directory of Open Access Journals (Sweden)

    H. Sadeq

    2016-06-01

    Full Text Available In this research different DSMs from different sources have been merged. The merging is based on a probabilistic model using a Bayesian Approach. The implemented data have been sourced from very high resolution satellite imagery sensors (e.g. WorldView-1 and Pleiades. It is deemed preferable to use a Bayesian Approach when the data obtained from the sensors are limited and it is difficult to obtain many measurements or it would be very costly, thus the problem of the lack of data can be solved by introducing a priori estimations of data. To infer the prior data, it is assumed that the roofs of the buildings are specified as smooth, and for that purpose local entropy has been implemented. In addition to the a priori estimations, GNSS RTK measurements have been collected in the field which are used as check points to assess the quality of the DSMs and to validate the merging result. The model has been applied in the West-End of Glasgow containing different kinds of buildings, such as flat roofed and hipped roofed buildings. Both quantitative and qualitative methods have been employed to validate the merged DSM. The validation results have shown that the model was successfully able to improve the quality of the DSMs and improving some characteristics such as the roof surfaces, which consequently led to better representations. In addition to that, the developed model has been compared with the well established Maximum Likelihood model and showed similar quantitative statistical results and better qualitative results. Although the proposed model has been applied on DSMs that were derived from satellite imagery, it can be applied to any other sourced DSMs.

  10. Disentangling the causal relationships between work-home interference and employee health

    NARCIS (Netherlands)

    Hooff, M.L.M. van; Geurts, S.A.E.; Taris, T.W.; Kompier, M.A.J.; Dikkers, J.S.E.; Houtman, I.L.D.; Heuvel, F.M.M. van den

    2005-01-01

    Objectives: The present study was designed to investigate the causal relationships between (time- and strain-based) work-home interference and employee health. The effort-recovery theory provided the theoretical basis for this study. Methods: Two-phase longitudinal data (with a 1-ye ar time lag)

  11. FastStats: Nursing Home Care

    Science.gov (United States)

    ... Submit What's this? Submit Button NCHS Home Nursing Home Care Recommend on Facebook Tweet Share Compartir Data are ... Person’s Health Related Links Adult Day Services Centers Home Health Care Hospice Care National Study of Long-Term Care ...

  12. What makes home health workers think about leaving their job? The role of physical injury and organizational support.

    Science.gov (United States)

    Lee, Ahyoung Anna; Jang, Yuri

    2016-01-01

    Based on the job demands-resources (JD-R) model, this study explored the role of physical injury and organizational support in predicting home health workers' turnover intention. In a sample of home health workers in Central Texas (n = 150), about 37% reported turnover intention. The logistic regression model showed that turnover intention was 3.23 times more likely among those who had experienced work-related injury. On the other hand, organizational support was found to reduce the likelihood of turnover intention. Findings suggest that injury and organizational support should be prioritized in prevention and intervention efforts to promote home health workers' safety and retention.

  13. Effects of electronic health information technology implementation on nursing home resident outcomes.

    Science.gov (United States)

    Pillemer, Karl; Meador, Rhoda H; Teresi, Jeanne A; Chen, Emily K; Henderson, Charles R; Lachs, Mark S; Boratgis, Gabriel; Silver, Stephanie; Eimicke, Joseph P

    2012-02-01

    To examine the effects of electronic health information technology (HIT) on nursing home residents. The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents' subjective assessment of the HIT intervention were generally positive. The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on resident behavior. © The Author(s) 2012

  14. Scaled beam merging experiment for heavy ion inertial fusion

    Directory of Open Access Journals (Sweden)

    P. A. Seidl

    2003-09-01

    Full Text Available Transverse beam combining is a cost-saving option employed in many designs for heavy ion fusion drivers. However, the resultant transverse phase space dilution must be minimized so as not to sacrifice focusability at the target. A prototype combining experiment has been completed employing four 3-mA Cs^{+} beams injected at 160 keV. The focusing elements upstream of the merge consist of four quadrupoles and a final combined-function element (quadrupole and dipole. Following the merge, the resultant single beam is transported in a single alternating gradient channel where the subsequent evolution of the distribution function is diagnosed. The results are in fair agreement with particle-in-cell simulations. They indicate that for some heavy ion fusion driver designs, the phase space dilution from merging is acceptable.

  15. Limited english proficiency, primary language at home, and disparities in children's health care: how language barriers are measured matters.

    Science.gov (United States)

    Flores, Glenn; Abreu, Milagros; Tomany-Korman, Sandra C

    2005-01-01

    Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. "Dose-response" relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar "dose-response" relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP

  16. The Effect of Publicized Quality Information on Home Health Agency Choice.

    Science.gov (United States)

    Jung, Jeah Kyoungrae; Wu, Bingxiao; Kim, Hyunjee; Polsky, Daniel

    2016-12-01

    We examine consumers' use of publicized quality information in Medicare home health care markets, where consumer cost sharing and travel costs are absent. We report two findings. First, agencies with high quality scores are more likely to be preferred by consumers after the introduction of a public reporting program than before. Second, consumers' use of publicized quality information differs by patient group. Community-based patients have slightly larger responses to public reporting than hospital-discharged patients. Patients with functional limitations at the start of their care, at least among hospital-discharged patients, have a larger response to the reported functional outcome measure than those without functional limitations. In all cases of significant marginal effects, magnitudes are small. We conclude that the current public reporting approach is unlikely to have critical impacts on home health agency choice. Identifying and releasing quality information that is meaningful to consumers may help increase consumers' use of public reports. © The Author(s) 2015.

  17. Bringing Your Baby Home

    Science.gov (United States)

    ... for Educators Search English Español Bringing Your Baby Home KidsHealth / For Parents / Bringing Your Baby Home What's ... recall your baby's seemingly endless crying episodes. The Home Front Introducing your baby to others at home ...

  18. The effectiveness of crisis resolution/home treatment teams for older people with mental health problems: a systematic review and scoping exercise.

    Science.gov (United States)

    Toot, Sandeep; Devine, Mike; Orrell, Martin

    2011-12-01

    To assess the effectiveness of crisis resolution/home treatment services for older people with mental health problems. A systematic review was conducted to report on the effectiveness of crisis resolution/home treatment teams (CRHTTs) for older people with mental health problems. As part of the review, we also carried out a scoping exercise to assess the typologies of older people's CRHTTs in practice, and to review these in the context of policy and research findings. The literature contains Grade C evidence, according to the Oxford Centre of Evidence Based Medicine (CEBM) guidelines, that CRHTTs are effective in reducing numbers of admissions to hospitals. Outcomes such as length of hospital stay and maintenance of community residence were reviewed but evidence was inadequate for drawing conclusions. The scoping exercise defined three types of home treatment service model: generic home treatment teams; specialist older adults home treatment teams; and intermediate care services. These home treatment teams seemed to be effectively managing crises and reducing admissions. This review has shown a lack of evidence for the efficacy of crisis resolution/home treatment teams in supporting older people with mental health problems to remain at home. There is clearly a need for a randomised controlled trial to establish the efficacy of crisis resolution/home treatment services for older people with mental health problems, as well as a more focussed assessment of the different home treatment service models which have developed in the UK. Copyright © 2011 John Wiley & Sons, Ltd.

  19. Smart home-based health platform for behavioral monitoring and alteration of diabetes patients.

    Science.gov (United States)

    Helal, Abdelsalam; Cook, Diane J; Schmalz, Mark

    2009-01-01

    Researchers and medical practitioners have long sought the ability to continuously and automatically monitor patients beyond the confines of a doctor's office. We describe a smart home monitoring and analysis platform that facilitates the automatic gathering of rich databases of behavioral information in a manner that is transparent to the patient. Collected information will be automatically or manually analyzed and reported to the caregivers and may be interpreted for behavioral modification in the patient. Our health platform consists of five technology layers. The architecture is designed to be flexible, extensible, and transparent, to support plug-and-play operation of new devices and components, and to provide remote monitoring and programming opportunities. The smart home-based health platform technologies have been tested in two physical smart environments. Data that are collected in these implemented physical layers are processed and analyzed by our activity recognition and chewing classification algorithms. All of these components have yielded accurate analyses for subjects in the smart environment test beds. This work represents an important first step in the field of smart environment-based health monitoring and assistance. The architecture can be used to monitor the activity, diet, and exercise compliance of diabetes patients and evaluate the effects of alternative medicine and behavior regimens. We believe these technologies are essential for providing accessible, low-cost health assistance in an individual's own home and for providing the best possible quality of life for individuals with diabetes. © Diabetes Technology Society

  20. Geographically weighted regression based methods for merging satellite and gauge precipitation

    Science.gov (United States)

    Chao, Lijun; Zhang, Ke; Li, Zhijia; Zhu, Yuelong; Wang, Jingfeng; Yu, Zhongbo

    2018-03-01

    Real-time precipitation data with high spatiotemporal resolutions are crucial for accurate hydrological forecasting. To improve the spatial resolution and quality of satellite precipitation, a three-step satellite and gauge precipitation merging method was formulated in this study: (1) bilinear interpolation is first applied to downscale coarser satellite precipitation to a finer resolution (PS); (2) the (mixed) geographically weighted regression methods coupled with a weighting function are then used to estimate biases of PS as functions of gauge observations (PO) and PS; and (3) biases of PS are finally corrected to produce a merged precipitation product. Based on the above framework, eight algorithms, a combination of two geographically weighted regression methods and four weighting functions, are developed to merge CMORPH (CPC MORPHing technique) precipitation with station observations on a daily scale in the Ziwuhe Basin of China. The geographical variables (elevation, slope, aspect, surface roughness, and distance to the coastline) and a meteorological variable (wind speed) were used for merging precipitation to avoid the artificial spatial autocorrelation resulting from traditional interpolation methods. The results show that the combination of the MGWR and BI-square function (MGWR-BI) has the best performance (R = 0.863 and RMSE = 7.273 mm/day) among the eight algorithms. The MGWR-BI algorithm was then applied to produce hourly merged precipitation product. Compared to the original CMORPH product (R = 0.208 and RMSE = 1.208 mm/hr), the quality of the merged data is significantly higher (R = 0.724 and RMSE = 0.706 mm/hr). The developed merging method not only improves the spatial resolution and quality of the satellite product but also is easy to implement, which is valuable for hydrological modeling and other applications.

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

    Science.gov (United States)

    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.

  2. Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness.

    Science.gov (United States)

    Werner, Nicole E; Jolliff, Anna F; Casper, Gail; Martell, Thomas; Ponto, Kevin

    2018-08-01

    Managing chronic illness requires personal health information management (PHIM) to be performed by lay individuals. Paramount to understanding the PHIM process is understanding the sociotechnical system in which it frequently occurs: the home environment. We combined distributed cognition theory and the patient work system model to investigate how characteristics of the home interact with the cognitive work of PHIM. We used a 3D virtual reality CAVE that enabled participants who had been diagnosed with diabetes (N = 20) to describe how they would perform PHIM in the home context. We found that PHIM is distinctly cognitive work, and rarely performed 'in the head'. Rather, features of the physical environment, tasks, people, and tools and technologies present, continuously shape and are shaped by the PHIM process. We suggest that approaches in which the individual (sans context) is considered the relevant unit of analysis overlook the pivotal role of the environment in shaping PHIM. Practitioner Summary: We examined how Personal Health Information Management (PHIM) is performed in the homes of diabetic patients. We found that approaches to studying cognition that focus on the individual, to the exclusion of their context, overlook the pivotal role of environmental, social, and technological features in shaping PHIM.

  3. [Use of medicinal plants as home remedies in Primary Health Care in Blumenau - State of Santa Catarina, Brazil].

    Science.gov (United States)

    Zeni, Ana Lúcia Bertarello; Parisotto, Amanda Varnier; Mattos, Gerson; Helena, Ernani Tiaraju de Santa

    2017-08-01

    An increase in the use of alternative therapeutic practices has been observed in the past decade, especially in medicinal plants, herbal and home remedies, which has been supported by policies within the scope of the Unified Health System (SUS). This study investigated the use of home remedies by users of Primary Health Care in Blumenau, State of Santa Catarina. It is a cross-sectional, observational and epidemiological study, the data for which were obtained via a questionnaire applied to 701 individuals. An unconditional logistic regression model was used to estimate the association between the use of home remedies and socio-demographic and medical care variables. It was observed that 21.9% of the sample use home remedies and medicinal plants grown in the back yard are the remedies of choice. Lemon balm, chamomile, peppermint and lime were the remedies most frequently mentioned. The use of home remedies was associated with the female gender, older age and the Family Health Strategy care model. The results supported that medicinal plants are used by the population as a therapeutic alternative option. However, it is necessary that primary care services ensure both access to natural products and supply qualified professionals to give instructions regarding the correct usage of home remedies.

  4. Effectiveness of home visits by mental health nurses for Japanese women with post-partum depression.

    Science.gov (United States)

    Tamaki, Atsuko

    2008-12-01

    Post-partum depression affects 10-13% of Japanese women, but many do not receive appropriate treatment or support. This intervention study evaluated the effectiveness of home visits by mental health nurses for Japanese women with post-partum depression. Eighteen post-partum women met the inclusion criteria and were randomly allocated into the intervention (n = 9) or control (n = 9) group at 1-2 months after giving birth. The intervention group received four weekly home visits by a mental health nurse. Control group participants received usual care. Two women in the intervention group did not complete the study. Depressive symptoms and quality of life were measured at 1 and 6 weeks' postintervention. In addition, participants completed an open-ended questionnaire on satisfaction and meaning derived from the home visits. Women in the intervention group had significant amelioration of depressive symptoms over time and reported positive benefits from the home visits, but there were no statistically significant differences between groups. Significant differences (P post-partum depression. A larger trial is warranted to test this approach to care.

  5. Inequality in access to health care in Cambodia: socioeconomically disadvantaged women giving birth at home assisted by unskilled birth attendants.

    Science.gov (United States)

    Hong, Rathavuth; Them, Rathnita

    2015-03-01

    Cambodia faces major challenges in its effort to provide access to health care for all. Although there is a sharp improvement in health and health care in Cambodia, 6 in 10 women still deliver at home assisted by unskilled birth attendants. This practice is associated with higher maternal and infant deaths. This article analyzes the 2005 Cambodia Demographic and Health Survey data to examine the relationship between socioeconomic inequality and deliveries at home assisted by unskilled birth attendants. It is evident that babies in poorer households are significantly more likely to be delivered at home by an unskilled birth attendant than those in wealthier households. Moreover, delivery at home by an unskilled attendant is associated with mothers who have no education, live in a rural residence, and are farmers, and with higher birth order children. Results from this analysis demonstrate that socioeconomic inequality is still a major factor contributing to ill health in Cambodia. © 2011 APJPH.

  6. Ecosystem and population health: the role of Canadian physicians at home and abroad.

    OpenAIRE

    Woollard, R F

    1995-01-01

    Seemingly intractable problems of overpopulation, ecologic degradation, diminishing resources and regional warfare are having a profound effect on global population health. Canadian physicians can assist in ameliorating these problems by helping to modify the overconsumption of natural resources at home and by participating in international health projects focused at the community level, where the health of individuals and that of their environment intersect. The author describes the work of ...

  7. Sound and speech detection and classification in a Health Smart Home.

    Science.gov (United States)

    Fleury, A; Noury, N; Vacher, M; Glasson, H; Seri, J F

    2008-01-01

    Improvements in medicine increase life expectancy in the world and create a new bottleneck at the entrance of specialized and equipped institutions. To allow elderly people to stay at home, researchers work on ways to monitor them in their own environment, with non-invasive sensors. To meet this goal, smart homes, equipped with lots of sensors, deliver information on the activities of the person and can help detect distress situations. In this paper, we present a global speech and sound recognition system that can be set-up in a flat. We placed eight microphones in the Health Smart Home of Grenoble (a real living flat of 47m(2)) and we automatically analyze and sort out the different sounds recorded in the flat and the speech uttered (to detect normal or distress french sentences). We introduce the methods for the sound and speech recognition, the post-processing of the data and finally the experimental results obtained in real conditions in the flat.

  8. Modeling merging behavior at lane drops.

    Science.gov (United States)

    2015-02-01

    In work-zone configurations where lane drops are present, merging of traffic at the taper presents an operational concern. In : addition, as flow through the work zone is reduced, the relative traffic safety of the work zone is also reduced. Improvin...

  9. Review series: Examples of chronic care model: the home-based chronic care model: redesigning home health for high quality care delivery.

    Science.gov (United States)

    Suter, Paula; Hennessey, Beth; Florez, Donna; Newton Suter, W

    2011-01-01

    Individuals with chronic obstructive pulmonary disease (COPD) face significant challenges due to frequent distressing dyspnea and deficits related to activities of daily living. Individuals with COPD are often hospitalized frequently for disease exacerbations, negatively impacting quality of life and healthcare expenditure burden. The home-based chronic care model (HBCCM) was designed to address the needs of patients with chronic diseases. This model facilitates the re-design of chronic care delivery within the home health sector by ensuring patient-centered evidence-based care. This HBCCM foundation is Dr. Edward Wagner s chronic care model and has four additional areas of focus: high touch delivery, theory-based self management, specialist oversight and the use of technology. This article will describe this model in detail and outline how model use for patients with COPD can bring value to stakeholders across the health care continuum.

  10. Moral distress experienced by health care professionals who provide home-based palliative care.

    Science.gov (United States)

    Brazil, Kevin; Kassalainen, Sharon; Ploeg, Jenny; Marshall, Denise

    2010-11-01

    Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. Studies on Plasmoid Merging using Compact Toroid Injectors

    Science.gov (United States)

    Allfrey, Ian; Matsumoto, Tadafumi; Roche, Thomas; Gota, Hiroshi; Edo, Takahiro; Asai, Tomohiko; Sheftman, Daniel; Osin Team; Dima Team

    2017-10-01

    C-2 and C-2U experiments have used magnetized coaxial plasma guns (MCPG) to inject compact toroids (CTs) for refueling the long-lived advanced beam-driven field-reversed configuration (FRC) plasma. This refueling method will also be used for the C-2W experiment. To minimize momentum transfer from the CT to the FRC two CTs are injected radially, diametrically opposed and coincident in time. To improve understanding of the CT characteristics TAE has a dedicated test bed for the development of CT injectors (CTI), where plasmoid merging experiments are performed. The test bed has two CTIs on axis with both axial and transverse magnetic fields. The 1 kG magnetic fields, intended to approximate the magnetic field strength and injection angle on C-2W, allow studies of cross-field transport and merging. Both CTIs are capable of injecting multiple CTs at up to 1 kHz. The resulting merged CT lives >100 μs with a radius of 25 cm. More detailed results of CT parameters will be presented.

  12. Comparison of online and offline based merging methods for high resolution rainfall intensities

    Science.gov (United States)

    Shehu, Bora; Haberlandt, Uwe

    2016-04-01

    Accurate rainfall intensities with high spatial and temporal resolution are crucial for urban flow prediction. Commonly, raw or bias corrected radar fields are used for forecasting, while different merging products are employed for simulation. The merging products are proven to be adequate for rainfall intensities estimation, however their application in forecasting is limited as they are developed for offline mode. This study aims at adapting and refining the offline merging techniques for the online implementation, and at comparing the performance of these methods for high resolution rainfall data. Radar bias correction based on mean fields and quantile mapping are analyzed individually and also are implemented in conditional merging. Special attention is given to the impact of different spatial and temporal filters on the predictive skill of all methods. Raw radar data and kriging interpolation of station data are considered as a reference to check the benefit of the merged products. The methods are applied for several extreme events in the time period 2006-2012 caused by different meteorological conditions, and their performance is evaluated by split sampling. The study area is located within the 112 km radius of Hannover radar in Lower Saxony, Germany and the data set constitutes of 80 recording stations in 5 min time steps. The results of this study reveal how the performance of the methods is affected by the adjustment of radar data, choice of merging method and selected event. Merging techniques can be used to improve the performance of online rainfall estimation, which gives way to the application of merging products in forecasting.

  13. Towards enhanced emotional interactions with older persons: findings from a nursing intervention in home health care.

    NARCIS (Netherlands)

    Veenvliet, C.; Eide, H.; Lange, M.A. de; Dulmen, S. van

    2016-01-01

    Background. Living at home with a physical condition that requires assistance places high emotional burden on older persons that needs to be attended to by nurses. However, nurses in home health care have previously been found to communicate primarily in an instrumental way. This increases the risk

  14. Ensuring Quality Nursing Home Care

    Science.gov (United States)

    ... cases, you can also call the Department of Health. Nursing homes are required to post information on how you ... nursing homes in your area, go to Medicare’s Nursing Home Compare website at ... information is not intended to diagnose health problems or to take the place of medical ...

  15. 78 FR 46421 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Science.gov (United States)

    2013-07-31

    ... State homes providing nursing home and adult day health services care to Veterans. VA requires... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality...

  16. Combining logistic regression with classification and regression tree to predict quality of care in a home health nursing data set.

    Science.gov (United States)

    Guo, Huey-Ming; Shyu, Yea-Ing Lotus; Chang, Her-Kun

    2006-01-01

    In this article, the authors provide an overview of a research method to predict quality of care in home health nursing data set. The results of this study can be visualized through classification an regression tree (CART) graphs. The analysis was more effective, and the results were more informative since the home health nursing dataset was analyzed with a combination of the logistic regression and CART, these two techniques complete each other. And the results more informative that more patients' characters were related to quality of care in home care. The results contributed to home health nurse predict patient outcome in case management. Improved prediction is needed for interventions to be appropriately targeted for improved patient outcome and quality of care.

  17. Computing and visualizing time-varying merge trees for high-dimensional data

    Energy Technology Data Exchange (ETDEWEB)

    Oesterling, Patrick [Univ. of Leipzig (Germany); Heine, Christian [Univ. of Kaiserslautern (Germany); Weber, Gunther H. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Morozov, Dmitry [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Scheuermann, Gerik [Univ. of Leipzig (Germany)

    2017-06-03

    We introduce a new method that identifies and tracks features in arbitrary dimensions using the merge tree -- a structure for identifying topological features based on thresholding in scalar fields. This method analyzes the evolution of features of the function by tracking changes in the merge tree and relates features by matching subtrees between consecutive time steps. Using the time-varying merge tree, we present a structural visualization of the changing function that illustrates both features and their temporal evolution. We demonstrate the utility of our approach by applying it to temporal cluster analysis of high-dimensional point clouds.

  18. 77 FR 45719 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Science.gov (United States)

    2012-08-01

    ... per diem to State homes providing nursing home and adult day health services care to Veterans. VA... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality...

  19. Program Merges SAR Data on Terrain and Vegetation Heights

    Science.gov (United States)

    Siqueira, Paul; Hensley, Scott; Rodriguez, Ernesto; Simard, Marc

    2007-01-01

    X/P Merge is a computer program that estimates ground-surface elevations and vegetation heights from multiple sets of data acquired by the GeoSAR instrument [a terrain-mapping synthetic-aperture radar (SAR) system that operates in the X and bands]. X/P Merge software combines data from X- and P-band digital elevation models, SAR backscatter magnitudes, and interferometric correlation magnitudes into a simplified set of output topographical maps of ground-surface elevation and tree height.

  20. Guelph Family Health Study's Home-Based Obesity Prevention Intervention Increases Fibre and Fruit Intake in Preschool-Aged Children.

    Science.gov (United States)

    Mirotta, Julia A; Darlington, Gerarda A; Buchholz, Andrea C; Haines, Jess; Ma, David W L; Duncan, Alison M

    2018-06-01

    The Guelph Family Health Study (GFHS) pilot was designed to examine the feasibility and effectiveness of a home-based obesity prevention intervention on health behaviours and obesity risk. The objective of this analysis was to determine the effect of the 6-month intervention on preschool-aged children's dietary intakes. Families with children aged 1.5-5 years old were randomized to receive one of the following: 4 home visits with a health educator as well as tailored emails and mailed incentives (4HV; n = 19 children); 2 home visits with a health educator as well as tailored emails and mailed incentives (2HV; n = 14 children); or general health advice through emails (control; n = 12 children). Three-day food records were completed by parents for their children before and after the 6-month intervention and analyzed for 3-day average intakes of energy, nutrients, and MyPlate food groups. After the 6-month intervention, the 4HV group had significantly higher fibre intake and the 4HV and 2HV groups had significantly higher fruit intake, both compared with the control group. This study provides support for a home-based intervention approach to improve the diet quality of preschool-aged children.

  1. Remote Health Care Provision in Care Homes.

    Science.gov (United States)

    Newbould, Louise; Mountain, Gail; Hawley, Mark; Ariss, Steve

    2017-01-01

    A survey was developed to map provision, knowledge, attitudes and views towards videoconferencing in care homes in Yorkshire and The Humber. The survey was sent to 859 care homes, with a 14% response rate. Twelve homes reported using videoconferencing. Non-users appeared skeptical, managers using the system reported improvements in outcomes.

  2. An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms

    Science.gov (United States)

    2014-01-01

    Background Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services. Methods A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation. Results Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. Conclusions Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion

  3. Effects of government policies on the work of home care personnel and their occupational health and safety.

    Science.gov (United States)

    Cloutier, Esther; David, Hélène; Ledoux, Elise; Bourdouxhe, Madeleine; Gagnon, Isabelle; Ouellet, François

    2008-01-01

    The health sector in Québec (Canada) is dealing with profound macro-economic and macro-organizational changes. This article is interested in the impact of these changes on the work of home health aides (HHAs) and home care nurses and their occupational health and safety (OHS). The study was carried out in the home care services (HCS) of four local community service centres (CLSC) with different organizational characteristics. It is based on an analysis by triangulation of 66 individual and group interviews, 22 observed workdays and 35 observed multidisciplinary or professional meetings, as well as on administrative documents. HHAs are experiencing an erosion of their job because the relational and affective aspects of their work are disappearing. This may be due to an increase in their physical workload, leading to an increase in musculoskeletal problems and, to a lesser extent, in psychological health problems. Nurses are seeing an increase in the volume of invisible work that they have to do, which also has the effect of decreasing the relational aspects of their activity. The increasingly numerous psychological health problems are the consequence of this change in their profession. This study also shows that managers' decisions at the local level can reduce or increase the work constraints of HHAs and nurses. Examples of good practices for HHAs are the stabilization of clienteles and the possibility of organizing their itinerary, while for nurses, it is in how clientele follow-up tools are implemented. This article discusses the effects of government policies and decisions on the work and OHS of home care personnel. To address this subject, we use a specific analysis of the workload of home health aides (HHAs) and nurses. We will show the relationships between managers' organizational choices to respond to governmental constraints and the resulting work changes. We will also look at their consequences on occupational health and safety (OHS) and on the work of

  4. Effectiveness of Home Visits in Pregnancy as a Public Health Measure to Improve Birth Outcomes.

    Directory of Open Access Journals (Sweden)

    Kayoko Ichikawa

    Full Text Available Birth outcomes, such as preterm birth, low birth weight (LBW, and small for gestational age (SGA, are crucial indicators of child development and health.To evaluate whether home visits from public health nurses for high-risk pregnant women prevent adverse birth outcomes.In this quasi-experimental cohort study in Kyoto city, Japan, high-risk pregnant women were defined as teenage girls (range 14-19 years old, women with a twin pregnancy, women who registered their pregnancy late, had a physical or mental illness, were of single marital status, non-Japanese women who were not fluent in Japanese, or elderly primiparas. We collected data from all high-risk pregnant women at pregnancy registration interviews held at a public health centers between 1 July 2011 and 30 June 2012, as well as birth outcomes when delivered from the Maternal and Child Health Handbook (N = 964, which is a record of prenatal check-ups, delivery, child development and vaccinations. Of these women, 622 women were selected based on the home-visit program propensity score-matched sample (pair of N = 311 and included in the analysis. Data were analyzed between January and June 2014.In the propensity score-matched sample, women who received the home-visit program had lower odds of preterm birth (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.39 to 0.98 and showed a 0.55-week difference in gestational age (95% CI: 0.18 to 0.92 compared to the matched controlled sample. Although the program did not prevent LBW and SGA, children born to mothers who received the program showed an increase in birth weight by 107.8 g (95% CI: 27.0 to 188.5.Home visits by public health nurses for high-risk pregnant women in Japan might be effective in preventing preterm birth, but not SGA.

  5. Simulations of Merging Helion Bunches on the AGS Injection Porch

    Energy Technology Data Exchange (ETDEWEB)

    Gardner, C. J. [Brookhaven National Lab. (BNL), Upton, NY (United States). Collider-Accelerator Dept.

    2014-08-29

    During the setup of helions for the FY2014 RHIC run it was discovered that the standard scheme for merging bunches on the AGS injection porch required an injection kicker pulse shorter than what was available. To overcome this difficulty, K. Zeno proposed and developed an interesting and unusual alternative which uses RF harmonic numbers 12, 4, 2 (rather than the standard 8, 4, 2) to merge 8 helion bunches into 2. In this note we carry out simulations that illustrate how the alternative scheme works and how it compares with the standard scheme. This is done in Sections 13 and 14. A scheme in which 6 bunches are merged into 1 is simulated in Section 15. This may be useful if more helions per merged bunch are needed in future runs. General formulae for the simulations are given in Sections 9 through 12. For completeness, Sections 1 through 8 give a derivation of the turn-by-turn equations of longitudinal motion at constant magnetic field. The derivation is based on the work of MacLachlan. The reader may wish to skip over these Sections and start with Section 9.

  6. Simulations of Merging Helion Bunches on the AGS Injection Porch

    International Nuclear Information System (INIS)

    Gardner, C. J.

    2014-01-01

    During the setup of helions for the FY2014 RHIC run it was discovered that the standard scheme for merging bunches on the AGS injection porch required an injection kicker pulse shorter than what was available. To overcome this difficulty, K. Zeno proposed and developed an interesting and unusual alternative which uses RF harmonic numbers 12, 4, 2 (rather than the standard 8, 4, 2) to merge 8 helion bunches into 2. In this note we carry out simulations that illustrate how the alternative scheme works and how it compares with the standard scheme. This is done in Sections 13 and 14. A scheme in which 6 bunches are merged into 1 is simulated in Section 15. This may be useful if more helions per merged bunch are needed in future runs. General formulae for the simulations are given in Sections 9 through 12. For completeness, Sections 1 through 8 give a derivation of the turn-by-turn equations of longitudinal motion at constant magnetic field. The derivation is based on the work of MacLachlan. The reader may wish to skip over these Sections and start with Section 9.

  7. Passive in-home health and wellness monitoring: overview, value and examples.

    Science.gov (United States)

    Alwan, Majd

    2009-01-01

    Modern sensor and communication technology, coupled with advances in data analysis and artificial intelligence techniques, is causing a paradigm shift in remote management and monitoring of chronic disease. In-home monitoring technology brings the added benefit of measuring individualized health status and reporting it to the care provider and caregivers alike, allowing timely and targeted preventive interventions, even in home and community based settings. This paper presents a paradigm for geriatric care based on monitoring older adults passively in their own living settings through placing sensors in their living environments or the objects they use. Activity and physiological data can be analyzed, archived and mined to detect indicators of early disease onset or changes in health conditions at various levels. Examples of monitoring systems are discussed and results from field evaluation pilot studies are summarized. The approach has shown great promise for a significant value proposition to all the stakeholders involved in caring for older adults. The paradigm would allow care providers to extend their services into the communities they serve.

  8. 6. Home deliveries

    African Journals Online (AJOL)

    Sitwala

    determine factors associated with home deliveries. Main outcome ... deliver at home than a health facility compared to those who .... regression analysis, women who had four years of schooling or .... by report bias, the burden of home deliveries is a real challenge .... Journal of Econometrics 1987; 36: 185-204. 14. Michelo ...

  9. MERGE-ETL: An Optimisation Equilibrium Model with Two Different Endogeneous Technological Learning Formulations

    Energy Technology Data Exchange (ETDEWEB)

    Bahn, O.; Kypreos, S.

    2002-07-01

    In MERGE-ETL, endogenous technological progress is applied to eight energy technologies: six power plants (integrated coal gasification with combined cycle, gas turbine with combined cycle, gas fuel cell, new nuclear designs, wind turbine and solar photovoltaic) and two plants producing hydrogen (from biomass and solar photovoltaic). Furthermore, compared to the original MERGE model, we have introduced two new power plants (using coal and gas) with CO{sub 2} capture and disposal into depleted oil and gas reservoirs. The difficulty with incorporating endogenous technological progress in MERGE comes from the resulting formulation of the MERGE-ETL model. Indeed, technological learning is related to increasing returns to adoption, and the mathematical formulation of MERGE-ETL corresponds then to a (non-linear and) non-convex optimisation problem. To solve MERGE-ETL, we have devised a three-step heuristic approach, where we search for the global optimum in an iterative way. We use in particular for this a linearisation, following mixed integer programming techniques, of the bottom-up part of MERGE-ETL. To study the impacts of modelling endogenous technological change in MERGE, we have considered several scenarios related to technological learning and carbon control. The latter corresponds to a 'soft landing' of world energy related CO{sub 2} emissions to a level of 10 Gt C by 2050, and takes into account the recent (2001) Marrakech Agreements for CO{sub 2} emission limits by 2010. Notice that our baseline scenario (without emission control and endogenous technological change) is consistent, in particular in terms of population and CO{sub 2} emissions, with the IPCC B2 scenario. Our numerical application with MERGE-ETL shows that technological learning yields an increase of primary energy use and of electricity generation. Indeed, energy production, and in particular electricity generation, become less expensive over-time. Energy (electricity, but also non

  10. Droplets formation and merging in two-phase flow microfluidics.

    Science.gov (United States)

    Gu, Hao; Duits, Michel H G; Mugele, Frieder

    2011-01-01

    Two-phase flow microfluidics is emerging as a popular technology for a wide range of applications involving high throughput such as encapsulation, chemical synthesis and biochemical assays. Within this platform, the formation and merging of droplets inside an immiscible carrier fluid are two key procedures: (i) the emulsification step should lead to a very well controlled drop size (distribution); and (ii) the use of droplet as micro-reactors requires a reliable merging. A novel trend within this field is the use of additional active means of control besides the commonly used hydrodynamic manipulation. Electric fields are especially suitable for this, due to quantitative control over the amplitude and time dependence of the signals, and the flexibility in designing micro-electrode geometries. With this, the formation and merging of droplets can be achieved on-demand and with high precision. In this review on two-phase flow microfluidics, particular emphasis is given on these aspects. Also recent innovations in microfabrication technologies used for this purpose will be discussed.

  11. A Volunteer Program to Connect Primary Care and the Home to Support the Health of Older Adults: A Community Case Study

    Directory of Open Access Journals (Sweden)

    Doug Oliver

    2018-02-01

    Full Text Available Primary care providers are critical in providing and optimizing health care to an aging population. This paper describes the volunteer component of a program (Health TAPESTRY which aims to encourage the delivery of effective primary health care in novel and proactive ways. As part of the program, volunteers visited older adults in their homes and entered information regarding health risks, needs, and goals into an electronic application on a tablet computer. A total of 657 home visits were conducted by 98 volunteers, with 22.45% of volunteers completing at least 20 home visits over the course of the program. Information was summarized in a report and electronically sent to the health care team via clients’ electronic medical records. The report was reviewed by the interprofessional team who then plan ongoing care. Volunteer recruitment, screening, training, retention, and roles are described. This paper highlights the potential role of a volunteer in a unique connection between primary care providers and older adult patients in their homes.

  12. The collaborative effect of ram pressure and merging on star formation and stripping fraction

    Science.gov (United States)

    Bischko, J. C.; Steinhauser, D.; Schindler, S.

    2015-04-01

    Aims: We investigate the effect of ram pressure stripping (RPS) on several simulations of merging pairs of gas-rich spiral galaxies. We are concerned with the changes in stripping efficiency and the time evolution of the star formation rate. Our goal is to provide an estimate of the combined effect of merging and RPS compared to the influence of the individual processes. Methods: We make use of the combined N-body/hydrodynamic code GADGET-2. The code features a threshold-based statistical recipe for star formation, as well as radiative cooling and modeling of galactic winds. In our simulations, we vary mass ratios between 1:4 and 1:8 in a binary merger. We sample different geometric configurations of the merging systems (edge-on and face-on mergers, different impact parameters). Furthermore, we vary the properties of the intracluster medium (ICM) in rough steps: the speed of the merging system relative to the ICM between 500 and 1000 km s-1, the ICM density between 10-29 and 10-27 g cm-3, and the ICM direction relative to the mergers' orbital plane. Ram pressure is kept constant within a simulation time period, as is the ICM temperature of 107 K. Each simulation in the ICM is compared to simulations of the merger in vacuum and the non-merging galaxies with acting ram pressure. Results: Averaged over the simulation time (1 Gyr) the merging pairs show a negligible 5% enhancement in SFR, when compared to single galaxies under the same environmental conditions. The SFRs peak at the time of the galaxies first fly-through. There, our simulations show SFRs of up to 20 M⊙ yr-1 (compared to 3 M⊙ yr-1 of the non-merging galaxies in vacuum). In the most extreme case, this constitutes a short-term (<50 Myr) SFR increase of 50 % over the non-merging galaxies experiencing ram pressure. The wake of merging galaxies in the ICM typically has a third to half the star mass seen in the non-merging galaxies and 5% to 10% less gas mass. The joint effect of RPS and merging, according

  13. Electron-ion recombination in merged beams

    International Nuclear Information System (INIS)

    Wolf, A.; Habs, D.; Lampert, A.; Neumann, R.; Schramm, U.; Schuessler, T.; Schwalm, D.

    1993-01-01

    Detailed studies of recombination processes between electrons and highly charged ions have become possible by recent improvements of merged-beams experiments. We discuss in particular measurements with stored cooled ion beams at the Test Storage Ring (TSR) in Heidelberg. The cross section of dielectronic recombination was measured with high energy resolution for few-electron systems up to the nuclear charge of Cu at a relative energy up to 2.6 keV. At low energy (∼0.1 eV) total recombination rates of several ions were measured and compared with calculated radiative recombination rates. Laser-stimulated recombination of protons and of C 6+ ions was investigated as a function of the photon energy using visible radiation. Both the total recombination rates and the stimulated recombination spectra indicate that in spite of the short interaction time in merged beams, also collisional capture of electrons into weakly bound levels (related to three-body recombination) could be important

  14. Relationship Between Leaving Children at Home Alone and Their Mental Health: Results From the A-CHILD Study in Japan

    Directory of Open Access Journals (Sweden)

    Satomi Doi

    2018-05-01

    Full Text Available Leaving children at home alone is considered a form of “neglect” in most developed countries. In Japan, this practice is not prohibited, probably because this country is considered to have relatively safe communities for children. The impact of leaving children at home alone on their mental health is a controversial issue, and few studies have examined it to date. The aim of this study was to examine the impact of leaving children aged 6 or 7 years at home alone on their mental health, focusing on both the positive and negative aspects; that is, resilience, difficult behavior, and prosocial behavior. Data from the Adachi Child Health Impact of Living Difficulty (A-CHILD study were used. The caregivers of all children in the first grade in Adachi City, Tokyo, were targeted, of whom 80% completed the questionnaire (n = 4,291. Among the analytical sample which comprises those who completed both exposure and outcome variables (n = 4,195, 2,190 (52.2% children had never been left at home alone, 1,581 (37.7% children were left at home alone less than once a week, and 424 (10.1% children were left at home alone once a week or more. Child resilience was measured using the Children's Resilient Coping Scale, and difficult behavior (emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems and prosocial behavior using the Strength and Difficulty Questionnaire. Multivariate regression analyses were performed to examine the dose-response association between leaving children at home alone and child mental health, followed by propensity-score matching as a pseudo-randomized controlled trial to reduce potential confounding. The results showed that leaving children at home alone once a week or more, but not less than once a week, was associated with total difficulties scores, especially conduct problems, hyperactivity/inattention, and peer relationship problems. These findings indicate that leaving children at home alone

  15. Eliminating Health Disparities through Action on the Social Determinants of Health: A Systematic Review of Home Visiting in the United States, 2005-2015.

    Science.gov (United States)

    Abbott, Laurie S; Elliott, Lynn T

    2017-01-01

    The purpose of this systematic literature review was to synthesize the results of transdisciplinary interventions designed with a home visit component in experimental and quasi-experimental studies having representative samples of racial and ethnic minorities. The design of this systematic review was adapted to include both experimental and quasi-experimental quantitative studies. The predetermined inclusion criteria were studies (a) having an experimental or quasi-experimental quantitative design, (b) having a home visit as a research component, (c) including a prevention research intervention strategy targeting health and/or safety issues, (d) conducted in the United States, (e) having representation (at least 30% in the total sample size) of one or more racial/ethnic minority, (f) available in full text, and (g) published in a peer-reviewed journal between January, 2005 and December, 2015. Thirty-nine articles were included in the review. There were 20 primary prevention, 5 secondary prevention, and 14 tertiary prevention intervention studies. Community and home visitation interventions by nurses can provide an effective means for mitigating social determinants of health by empowering people at risk for health disparities to avoid injury, maintain health, and prevent and manage existing disease. © 2016 Wiley Periodicals, Inc.

  16. PEAR: a fast and accurate Illumina Paired-End reAd mergeR.

    Science.gov (United States)

    Zhang, Jiajie; Kobert, Kassian; Flouri, Tomáš; Stamatakis, Alexandros

    2014-03-01

    The Illumina paired-end sequencing technology can generate reads from both ends of target DNA fragments, which can subsequently be merged to increase the overall read length. There already exist tools for merging these paired-end reads when the target fragments are equally long. However, when fragment lengths vary and, in particular, when either the fragment size is shorter than a single-end read, or longer than twice the size of a single-end read, most state-of-the-art mergers fail to generate reliable results. Therefore, a robust tool is needed to merge paired-end reads that exhibit varying overlap lengths because of varying target fragment lengths. We present the PEAR software for merging raw Illumina paired-end reads from target fragments of varying length. The program evaluates all possible paired-end read overlaps and does not require the target fragment size as input. It also implements a statistical test for minimizing false-positive results. Tests on simulated and empirical data show that PEAR consistently generates highly accurate merged paired-end reads. A highly optimized implementation allows for merging millions of paired-end reads within a few minutes on a standard desktop computer. On multi-core architectures, the parallel version of PEAR shows linear speedups compared with the sequential version of PEAR. PEAR is implemented in C and uses POSIX threads. It is freely available at http://www.exelixis-lab.org/web/software/pear.

  17. Burnout in the nursing home health care aide: A systematic review

    Directory of Open Access Journals (Sweden)

    Sarah L. Cooper

    2016-09-01

    Conclusion: Factors associated with burnout in health care aides are similar to those reported among nurses, although the level of evidence and low methodological rigor of these studies suggest more robust study designs are warranted. Our findings suggest research focused on this important but largely invisible group of care providers could yield important advances in understanding burnout in this group and yield potential interventions to buffer burnout and its consequences. Without mitigating the effects of burnout on nursing home health care aides, vulnerable older adults in residential care are at risk.

  18. "No place like home": Gender, family, and the politics of home care in post-world war II Ontario.

    Science.gov (United States)

    Struthers, James

    2003-01-01

    Since the early 1990s home care increasingly has emerged as a favoured policy response to the growing costs which an aging population poses for our health care system. This paper explores the early history of home care for the elderly in Ontario during the first three decades after World War II. It demonstrates that policy debates over the merits of home versus institutional care for the elderly, and community-based over hospital-based approaches to home care are not recent phenomenon but have been on going since the 1940s within the public health and social services sector. The paper examines why home care failed for so long to develop beyond the margins of Ontario's highly institutionalized health care system. It also explores how earlier visions of community-based home care, designed to help the elderly age in place, increasingly were obscured by an exclusive preoccupation with home care's "cost effectiveness" as an alternative to hospital or residential care, a rationale which discounted home care's costs to unpaid and principally female care givers. The paper concludes that the Ontario health ministry's systematic devaluing of caregiving and home maker skills, the fear of undermining the family's willingness to provide care, as well as the failure to develop effective mechanisms for integrated regional health care planning, also impeded the progress of home care's development before the 1980s.

  19. The Adolescent "Expanded Medical Home": School-Based Health Centers Partner with a Primary Care Clinic to Improve Population Health and Mitigate Social Determinants of Health.

    Science.gov (United States)

    Riley, Margaret; Laurie, Anna R; Plegue, Melissa A; Richarson, Caroline R

    2016-01-01

    Access to high-quality health care is a crucial social determinant of health. We describe the implementation of an "expanded medical home" partnering a primary care practice (the Ypsilanti Health Center [YHC]) with local school-based health centers (the Regional Alliance for Healthy Schools [RAHS]), and to assess whether this model improves access to and quality of care for shared patients. Using the Consolidated Framework for Implementation Research, we define the steps in, barriers to, and facilitating factors in implementing the expanded medical home model. Visits and quality measures were assessed for patients seen by YHC only versus YHC/RAHS at baseline and during the intervention. At baseline, patients seen at YHC/RAHS had higher compliance with most quality metrics compared with those seen at YHC only. The proportion of shared patients significantly increased because of the intervention (P partnership between primary care physicians and school-based health centers increases the number of shared high-risk adolescent patients. Shared patients have improved compliance with quality measures, which may lead to long-term improved health equity. © Copyright 2016 by the American Board of Family Medicine.

  20. Older Adults’ Attitudes to Self-Management of Health and Wellness through Smart Home Data

    Directory of Open Access Journals (Sweden)

    Julie Doyle

    2015-11-01

    Full Text Available Smart homes have significant potential to enhance the lives of older adults, extending the period of healthy ageing, through monitoring wellbeing, detecting decline and applying interventions to prevent or slow down this decline. In this paper we present results from interviews with 7 older adults who have been living in smart homes for over 4 years. Our aims were to 1 examine attitudes to living with sensors and AAL technology over time; 2 gather opinions on the usefulness of this data for supporting self-management of health and wellbeing and 3 evaluate the effectiveness of various visualization techniques for presenting sensor-based health and wellness data. Our findings show that older adults are interested in receiving feedback from sensor technology to support them self-managing their wellbeing. Potential beneficial information includes time spent inside and outside the home, walking time, sleep, activity, blood pressure and weight. This information needs to be enhanced by education and goal-setting and by representing data using visualisations that are simple and intuitive.

  1. Design of a terminal solution for integration of in-home health care devices and services towards the Internet-of-Things

    Science.gov (United States)

    Pang, Zhibo; Zheng, Lirong; Tian, Junzhe; Kao-Walter, Sharon; Dubrova, Elena; Chen, Qiang

    2015-01-01

    In-home health care services based on the Internet-of-Things are promising to resolve the challenges caused by the ageing of population. But the existing research is rather scattered and shows lack of interoperability. In this article, a business-technology co-design methodology is proposed for cross-boundary integration of in-home health care devices and services. In this framework, three key elements of a solution (business model, device and service integration architecture and information system integration architecture) are organically integrated and aligned. In particular, a cooperative Health-IoT ecosystem is formulated, and information systems of all stakeholders are integrated in a cooperative health cloud as well as extended to patients' home through the in-home health care station (IHHS). Design principles of the IHHS includes the reuse of 3C platform, certification of the Health Extension, interoperability and extendibility, convenient and trusted software distribution, standardised and secured electrical health care record handling, effective service composition and efficient data fusion. These principles are applied to the design of an IHHS solution called iMedBox. Detailed device and service integration architecture and hardware and software architecture are presented and verified by an implemented prototype. The quantitative performance analysis and field trials have confirmed the feasibility of the proposed design methodology and solution.

  2. Home Features and Assistive Technology for the Home-Bound Elderly in a Thai Suburban Community by Applying the International Classification of Functioning, Disability, and Health

    Directory of Open Access Journals (Sweden)

    Supawadee Putthinoi

    2017-01-01

    Full Text Available The ageing population is having an impact worldwide and has created a serious challenge in Thailand’s healthcare systems, whereby healthcare practitioners play a major role in promoting independent interaction of their client’s abilities, as well as environmental factors. The purpose of this study was to survey features of the home and assistive technology (AT for the home-bound elderly in the community of Chiang Mai, Thailand. Home evaluation included features inside and outside the home, and AT was based on the International Classification of Functioning, Disability, and Health (ICF concept. Methods included observation and an interview that were used by the researcher for evaluation. The study found that every home had at least one hazardous home feature such as inappropriate width of the door, high door threshold, tall stair steps, no bedside rail, and inappropriate height of the toilet pan. AT was found in houses as general products and technology for personal use in daily living and for personal indoor and outdoor mobility as well as transportation. Therefore, home features and AT can afford the home-bound elderly independent living within the community. Perspective AT according to the ICF concept could provide a common language for ageing in place benefits.

  3. Team Climate Inventory with a merged organization.

    Science.gov (United States)

    Dackert, Ingrid; Brenner, Sten-Olof; Johansson, Curt R

    2002-10-01

    The present study examines the team climate for innovation in work teams within a newly merged organization. Four teams working at a regional head office of a Social Insurance organization answered the Team Climate Inventory. The results were compared to those of a study by Agrell and Gustafson of more stable teams. The comparison showed that participative safety and support for innovation were rated lower and that vision was rated higher in the newly merged teams. The 38-item original inventory was used and based on the results, a 1999 proposed shortened version of 14 items by Kivimäki and Elovainio was compared with the original one. Analysis indicated that the short version can be a valid alternative to the original version but that further testing of the short version is needed.

  4. Home and community care services: a major opportunity for preventive health care

    Directory of Open Access Journals (Sweden)

    Lujic Sanja

    2010-05-01

    Full Text Available Abstract Background In Australia, the Home and Community Care (HACC program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk. Methods We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models. Results 4,978 (4.8% participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis

  5. Supporting the information domains of fall-risk management in home care via health information technology.

    Science.gov (United States)

    Alhuwail, Dari; Koru, Güneş; Mills, Mary Etta

    2016-01-01

    In the United States, home care clinicians often start the episode of care devoid of relevant fall-risk information. By collecting and analyzing qualitative data from 30 clinicians in one home health agency, this case study aimed to understand how the currently adopted information technology solutions supported the clinicians' fall-risk management (FRM) information domains, and explored opportunities to adopt other solutions to better support FRM. The currently adopted electronic health record system and fall-reporting application served only some information domains with a limited capacity. Substantial improvement in addressing the FRM information domains is possible by effectively modifying the existing solutions and purposefully adopting new solutions.

  6. Hospital information technology in home care.

    Science.gov (United States)

    Zhang, Xiao-Ying; Zhang, Pei-Ying

    2016-10-01

    The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.

  7. Unravelling merging behaviors and electrostatic properties of CVD-grown monolayer MoS2 domains

    International Nuclear Information System (INIS)

    Hao, Song; Yang, Bingchu; Gao, Yongli

    2016-01-01

    The presence of grain boundaries is inevitable for chemical vapor deposition (CVD)-grown MoS 2 domains owing to various merging behaviors, which greatly limits its potential applications in novel electronic and optoelectronic devices. It is therefore of great significance to unravel the merging behaviors of the synthesized polygon shape MoS 2 domains. Here we provide systematic investigations of merging behaviors and electrostatic properties of CVD-grown polycrystalline MoS 2 crystals by multiple means. Morphological results exhibit various polygon shape features, ascribed to polycrystalline crystals merged with triangle shape MoS 2 single crystals. The thickness of triangle and polygon shape MoS 2 crystals is identical manifested by Raman intensity and peak position mappings. Three merging behaviors are proposed to illustrate the formation mechanisms of observed various polygon shaped MoS 2 crystals. The combined photoemission electron microscopy and kelvin probe force microscopy results reveal that the surface potential of perfect merged crystals is identical, which has an important implication for fabricating MoS 2 -based devices.

  8. The reliability of in-home measures of height and weight in large cohort studies: Evidence from Add Health

    Directory of Open Access Journals (Sweden)

    Jon Hussey

    2015-05-01

    Full Text Available Background: With the emergence of obesity as a global health issue, an increasing number of major demographic surveys are collecting measured anthropometric data. Yet little is known about the characteristics and reliability of these data. Objective: We evaluate the accuracy and reliability of anthropometric data collected in the home during Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health, compare our estimates to national standard, clinic-based estimates from the National Health and Nutrition Examination Survey (NHANES and, using both sources, provide a detailed anthropometric description of young adults in the United States. Methods: The reliability of Add Health in-home anthropometric measures was estimated from repeat examinations of a random subsample of study participants. A digit preference analysis evaluated the quality of anthropometric data recorded by field interviewers. The adjusted odds of obesity and central obesity in Add Health vs. NHANES were estimated with logistic regression. Results: Short-term reliabilities of in-home measures of height, weight, waist and arm circumference - as well as derived body mass index (BMI, kg/m2 - were excellent. Prevalence of obesity (37Š vs. 29Š and central obesity (47Š vs. 38Š was higher in Add Health than in NHANES, while socio-demographic patterns of obesity and central obesity were comparable in the two studies. Conclusions: Properly trained non-medical field interviewers can collect reliable anthropometric data in a nationwide, home visit study. This national cohort of young adults in the United States faces a high risk of early-onset chronic disease and premature mortality.

  9. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: design and methods.

    Science.gov (United States)

    Fulkerson, Jayne A; Neumark-Sztainer, Dianne; Story, Mary; Gurvich, Olga; Kubik, Martha Y; Garwick, Ann; Dudovitz, Bonnie

    2014-05-01

    Informed and engaged parents and healthful home environments are essential for the health of youth. Although research has shown health benefits associated with family meals, to date, no randomized controlled trial (RCT) has been developed to examine the impact of a family meals intervention on behavioral and health outcomes. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study is a two-arm (intervention versus attention-only control) RCT being conducted in Minneapolis/St. Paul. Built on previous pilot research, HOME Plus aims to increase the frequency and healthfulness of family meals and snacks and reduce children's sedentary behavior, particularly screen time, to promote healthier eating and activity behaviors and prevent obesity. HOME Plus is delivered to families in community settings. The program includes 10 monthly sessions focused on nutrition and activity education, meal planning and preparation skill development. In addition, five motivational goal-setting phone calls are conducted with parents. The primary outcome measure is age- and gender-adjusted child BMI-z score at post-intervention by treatment group. Secondary household-level outcomes include family meal frequency, home availability of healthful foods (fruits/vegetables) and unhealthful foods (high-fat/sugary snacks) and beverages (sugar-sweetened beverages), and the quality of foods served at meals and snacks. Secondary child outcomes include dietary intake of corresponding foods and beverages and screen time. The HOME Plus RCT actively engages whole families of 8-12 year old children to promote healthier eating and activity behaviors and prevent obesity through promotion of family meals and snacks and limited media use. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Comparing the Effects of Group and Home-based Physical Activity on Mental Health in the Elderly.

    Science.gov (United States)

    Mortazavi, Seyede Salehe; Shati, Mohsen; Ardebili, Hassan Eftekhar; Mohammad, Kazem; Beni, Reza Dorali; Keshteli, A H

    2013-11-01

    The present study focuses on comparing the effects of home-based (HB) and group-based (GB) physical activity on mental health in a sample of older adults in Shahr-e-kord. In this quasi-experimental study, a twice-weekly physical activity program for 2 months was provided either individually at home or in a group format for 181 people who were divided into two groups (HB and GB). The outcome, mental health, was measured with the 28-item General Health Questionnaire (GHQ-28). Mental health status improved after participation in the physical activity program. The decrease in GHQ-28 total score in GB group, 3 months after intervention, was 3.61 ± 2.28 (P effects of GB physical activity on mental health compared with HB physical activity, adjusted for related baseline variables, were significant. These findings reveal the probable effects of GB rather than HB physical activity on mental health among the elderly.

  11. Health, wellbeing and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision

    Directory of Open Access Journals (Sweden)

    Bolton Joanne

    2010-05-01

    Full Text Available Abstract Background Food and drink are important determinants of physical and social health in care home residents. This study explored whether a pragmatic methodology including routinely collected data was feasible in UK care homes, to describe the health, wellbeing and nutritional status of care home residents and assess effects of changed provision of food and drink at three care homes on residents' falls (primary outcome, anaemia, weight, dehydration, cognitive status, depression, lipids and satisfaction with food and drink provision. Methods We measured health, wellbeing and nutritional status of 120 of 213 residents of six care homes in Norfolk, UK. An intervention comprising improved dining atmosphere, greater food choice, extended restaurant hours, and readily available snacks and drinks machines was implemented in three care homes. Three control homes maintained their previous system. Outcomes were assessed in the year before and the year after the changes. Results Use of routinely collected data was partially successful, but loss to follow up and levels of missing data were high, limiting power to identify trends in the data. This was a frail older population (mean age 87, 71% female with multiple varied health problems. During the first year 60% of residents had one or more falls, 40% a wound care visit, and 40% a urinary tract infection. 45% were on diuretics, 24% antidepressants, and 43% on psychotropic medication. There was a slight increase in falls from year 1 to year 2 in the intervention homes, and a much bigger increase in control homes, leading to a statistically non-significant 24% relative reduction in residents' rate of falls in intervention homes compared with control homes (adjusted rate ratio 0.76, 95% CI 0.57 to 1.02, p = 0.06. Conclusions Care home residents are frail and experience multiple health risks. This intervention to improve food and drink provision was well received by residents, but effects on health

  12. Work-home interference among nurses: reciprocal relationships with job demands and health

    NARCIS (Netherlands)

    van der Heijden, Beatrice; Demerouti, Evangelia; Bakker, Arnold B.; Hasselhorn, Hans Martin

    2008-01-01

    Aims: This paper is a report of a study with three aims: (i) to investigate whether emotional, quantitative and physical demands have a causal, negative impact on nurses' health; (ii) to examine whether work-home interference can explain this effect, by playing a mediating role; and (iii) to test

  13. The relationship between weight status and the need for health care assistance in nursing home residents

    DEFF Research Database (Denmark)

    Beck, Anne Marie

    2012-01-01

    Objective: The purpose of this study was to evaluate the relationship between underweight status and weight loss events on the need for health care assistance among a sample of Danish nursing home residents over 12-months. Design: Longitudinal, repeated measures design with three data collection...... points at baseline (2004) and six and 12 months post baseline. Setting: 11 Danish nursing home facilities. Participants: 441 Danish nursing home residents over the age of 65. Measurements: Resident Assessment Instrument (RAI-NH) data were abstracted for each participant at each of three data collection...... of this study suggest that elderly nursing home residents with a low BMI or weight loss may add to the substantial and costly burden of nursing home care due to the associated need for higher levels of ADL assistance....

  14. Home Health Nursing Care and Hospital Use for Medically Complex Children.

    Science.gov (United States)

    Gay, James C; Thurm, Cary W; Hall, Matthew; Fassino, Michael J; Fowler, Lisa; Palusci, John V; Berry, Jay G

    2016-11-01

    Home health nursing care (HH) may be a valuable approach to long-term optimization of health for children, particularly those with medical complexity who are prone to frequent and lengthy hospitalizations. We sought to assess the relationship between HH services and hospital use in children. Retrospective, matched cohort study of 2783 hospitalized children receiving postdischarge HH services by BAYADA Home Health Care across 19 states and 7361 matched controls not discharged to HH services from the Children's Hospital Association Case Mix database between January 2004 and September 2012. Subsequent hospitalizations, hospital days, readmissions, and costs of hospital care were assessed over the 12-month period after the initial hospitalization. Nonparametric Wilcoxon signed rank tests were used for comparisons between HH and non-HH users. Although HH cases had a higher percentage of complex chronic conditions (68.5% vs 65.4%), technology assistance (40.5% vs 35.7%), and neurologic impairment (40.7% vs 37.3%) than matched controls (P ≤ .003 for all), 30-day readmission rates were lower in HH patients (18.3% vs 21.5%, P = .001). At 12 months after the index admission, HH patients averaged fewer admissions (0.8 vs 1.0, P < .001), fewer days in the hospital (6.4 vs 6.6, P < .001), and lower hospital costs ($22 511 vs $24 194, P < .001) compared with matched controls. Children discharged to HH care experienced less hospital use than children with similar characteristics who did not use HH care. Further investigation is needed to understand how HH care affects the health and health services of children. Copyright © 2016 by the American Academy of Pediatrics.

  15. Home visits as a strategy for health promotion by nursing

    Directory of Open Access Journals (Sweden)

    Jucelia Salgueiro Nascimento

    2014-09-01

    Full Text Available Objective: To analyze the domiciliary visit performed by nurses in the Family Health Strategy as an activity to promote health. Methods: Exploratory/descriptive study with qualitative approach. The subjects were nine nurses of the Primary Health Units from Health Districts in Maceió-AL. Data was collected through semi-structured interviews in the months from April to August 2012 and were analyzed using content analysis and in light of the theoretical framework of Health Promotion. Results: The nurses recognize that the domiciliary visit can be a way to promote the health of individuals, families and community, but, in daily life, action maintains focus on disease, with curative actions of individual character, which do not take into account the social context where the user and his family are inserted. Conclusion: It is considered that the use of home visits by nurses in the family health strategy as a health promotion activity is still incipient because, although the nurses recognize the need for change in the model of care, in practice, it is observed that the focus of this action is directed to the biological model. doi:http://dx.doi.org/10.5020/18061230.2013.p513

  16. Enhancement method for rendered images of home decoration based on SLIC superpixels

    Science.gov (United States)

    Dai, Yutong; Jiang, Xiaotong

    2018-04-01

    Rendering technology has been widely used in the home decoration industry in recent years for images of home decoration design. However, due to the fact that rendered images of home decoration design rely heavily on the parameters of renderer and the lights of scenes, most rendered images in this industry require further optimization afterwards. To reduce workload and enhance rendered images automatically, an algorithm utilizing neural networks is proposed in this manuscript. In addition, considering few extreme conditions such as strong sunlight and lights, SLIC superpixels based segmentation is used to choose out these bright areas of an image and enhance them independently. Finally, these chosen areas are merged with the entire image. Experimental results show that the proposed method effectively enhances the rendered images when compared with some existing algorithms. Besides, the proposed strategy is proven to be adaptable especially to those images with obvious bright parts.

  17. Paraprofessional Home Visitors' Perspectives on Addressing Poor Mental Health, Substance Abuse, and Domestic Violence: A Qualitative Study

    Science.gov (United States)

    Tandon, S. Darius; Mercer, Constance D.; Saylor, Elizabeth L.; Duggan, Anne K.

    2008-01-01

    This research was conducted to understand paraprofessional home visitors' perceptions of their training in addressing poor mental health, substance abuse, and domestic violence, and their actions in working with families in addressing these issues. Five focus groups were conducted with a total of 28 paraprofessional home visitors. Three main…

  18. Interlayer magnetoresistance in multilayer Dirac electron systems: motion and merging of Dirac cones

    OpenAIRE

    Assili, Mohamed; Haddad, Sonia

    2013-01-01

    We theoretically study the effect of the motion and the merging of Dirac cone on the interlayer magnetoresistance in multilayer graphene like systems. This merging, which could be induced by a uniaxial strain, gives rise in monolayer Dirac electron system to a topological transition from a semi-metallic phase to an insulating phase where Dirac points disappear. Based on a universal Hamiltonian proposed to describe the motion and the merging of Dirac points in two dimensional Dirac electron cr...

  19. Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa.

    Science.gov (United States)

    van Heerden, Alastair; Harris, Danielle M; van Rooyen, Heidi; Barnabas, Ruanne V; Ramanathan, Nithya; Ngcobo, Nkosinathi; Mpiyakhe, Zukiswa; Comulada, W Scott

    2017-06-01

    mHealth has been proposed to address inefficiencies in the current South African healthcare system, including home-based HIV testing and counseling (HTC) programs. Yet wide-scale adoption of mHealth has not occurred. Even as infrastructure barriers decrease, a need to better understand perceived adoption barriers by stakeholders remains. We conducted focus group discussions (FGD) in South Africa in 2016 with 10 home-based HTC field staff, 12 community health workers (CHWs) and 10 persons living with HIV (PLH). Key informant (KI) interviews were conducted with five health officials. Perceptions about current home-based HTC practices, future mHealth systems and the use of biometrics for patient identification were discussed, recorded and transcribed for qualitative analysis. Themes were based on a conceptual model for perceived mHealth service quality. Stakeholders brought up a lack of communication in sharing patient health information between clinics, between clinics and CHWs, and between clinics and patients as major barriers to care that mHealth can address. CHWs need better patient information from clinics in terms of physical location and health status to plan visitation routes and address patient needs. CHWs perceive that communication barriers create distrust towards them by clinic staff. PLH want automated appointment and medication reminders. KI see mHealth as a way to improve health information transfer to government officials to better allocate healthcare resources. Stakeholders are also optimistic about the ability for biometrics to improve patient identification but disagreed as to which biometrics would be acceptable, especially in older patients. All stakeholders provided useful information towards the development of mHealth systems. Hospitals are adopting patient-centered approaches that solicit feedback from patients and incorporate them into decision-making processes. A similar approach is needed in the development of mHealth systems. Further, such

  20. Out of sight but not out of mind: Home countries' macroeconomic volatilities and immigrants' mental health.

    Science.gov (United States)

    Nguyen, Ha Trong; Connelly, Luke Brian

    2018-01-01

    We provide the first empirical evidence that better economic performances by immigrants' countries of origin, as measured by lower consumer price index (CPI) or higher gross domestic product, improve immigrants' mental health. We use an econometrically-robust approach that exploits exogenous changes in macroeconomic conditions across immigrants' home countries over time and controls for immigrants' observable and unobservable characteristics. The CPI effect is statistically significant and sizeable. Furthermore, the CPI effect diminishes as the time since emigrating increases. By contrast, home countries' unemployment rates and exchange rate fluctuations have no impact on immigrants' mental health. Copyright © 2017 John Wiley & Sons, Ltd.

  1. Home safe home: Evaluation of a childhood home safety program.

    Science.gov (United States)

    Stewart, Tanya Charyk; Clark, Andrew; Gilliland, Jason; Miller, Michael R; Edwards, Jane; Haidar, Tania; Batey, Brandon; Vogt, Kelly N; Parry, Neil G; Fraser, Douglas D; Merritt, Neil

    2016-09-01

    The London Health Sciences Centre Home Safety Program (HSP) provides safety devices, education, a safety video, and home safety checklist to all first-time parents for the reduction of childhood home injuries. The objective of this study was to evaluate the HSP for the prevention of home injuries in children up to 2 years of age. A program evaluation was performed with follow-up survey, along with an interrupted time series analysis of emergency department (ED) visits for home injuries 5 years before (2007-2013) and 2 years after (2013-2015) implementation. Spatial analysis of ED visits was undertaken to assess differences in home injury rates by dissemination areas controlling differences in socioeconomic status (i.e., income, education, and lone-parent status) at the neighborhood level. A total of 3,458 first-time parents participated in the HSP (a 74% compliance rate). Of these, 20% (n = 696) of parents responded to our questionnaire, with 94% reporting the program to be useful (median, 6; interquartile range, 2 on a 7-point Likert scale) and 81% learning new strategies for preventing home injuries. The median age of the respondent's babies were 12 months (interquartile range, 1). The home safety check list was used by 87% of respondents to identify hazards in their home, with 95% taking action to minimize the risk. The time series analysis demonstrated a significant decline in ED visits for home injuries in toddlers younger than2 years of age after HSP implementation. The declines in ED visits for home injuries remained significant over and above each socioeconomic status covariate. Removing hazards, supervision, and installing safety devices are key facilitators in the reduction of home injuries. Parents found the HSP useful to identify hazards, learn new strategies, build confidence, and provide safety products. Initial finding suggests that the program is effective in reducing home injuries in children up to 2 years of age. Therapeutic/care management study

  2. Effect of the economic crisis on the use of health and home care services among Spanish COPD patients.

    Science.gov (United States)

    de Miguel-Diez, Javier; Lopez-de-Andres, Ana; Herandez-Barrera, Valentin; Jimenez-Trujillo, Isabel; Puente-Maestu, Luis; Cerezo-Lajas, Alicia; Jimenez-Garcia, Rodrigo

    2018-01-01

    Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. Consequently, COPD patients are frequent users of health and social resources. Therefore, they are highly vulnerable to decreases in investment in healthcare services. We aimed to describe the utilization of health and home care services among Spanish COPD patients during the economic crisis to identify factors independently associated with changes in the utilization of these services and to study the time trends from 2009 to 2014. We used data from the European Health Interview Surveys for Spain (EHSS) conducted between 2009/2010 (n=22,188) and 2014 (n=22,842). We included responses from adults with COPD aged 40 years or over. Dependent variables included self-reported hospitalizations during the previous year, general practitioner (GP) visits during the last 4 weeks, other health care services used during the previous year (nursing, rehabilitation, and psychological services), and home care services use during the previous year. Independent variables included demographic and socioeconomic characteristics, health status variables, and lifestyles. We identified 1,328 and 1,008 COPD patients from EHSS 2009 and EHSS 2014, respectively. We observed a significant increase in non-GP services use (30.6% in 2009 vs 39.11% in 2014; p home care services use over time. Multivariable models showed that associated factors with a higher use included any chronic comorbidity and worse self-rated health. Physical activity was a strong predictor of fewer hospitalizations and less home care service use. Female sex was associated with significantly fewer hospitalizations (OR 0.72; 95% CI 0.58-0.89). We found an increase in the use of non-GP services (nursing, rehabilitation, and psychological) but not in other health and home care services. The only differences in hospitalizations were observed according to sex. Therefore, the effect of the economic crisis, if any, seems to have been of

  3. Droplets Formation and Merging in Two-Phase Flow Microfluidics

    Directory of Open Access Journals (Sweden)

    Hao Gu

    2011-04-01

    Full Text Available Two-phase flow microfluidics is emerging as a popular technology for a wide range of applications involving high throughput such as encapsulation, chemical synthesis and biochemical assays. Within this platform, the formation and merging of droplets inside an immiscible carrier fluid are two key procedures: (i the emulsification step should lead to a very well controlled drop size (distribution; and (ii the use of droplet as micro-reactors requires a reliable merging. A novel trend within this field is the use of additional active means of control besides the commonly used hydrodynamic manipulation. Electric fields are especially suitable for this, due to quantitative control over the amplitude and time dependence of the signals, and the flexibility in designing micro-electrode geometries. With this, the formation and merging of droplets can be achieved on-demand and with high precision. In this review on two-phase flow microfluidics, particular emphasis is given on these aspects. Also recent innovations in microfabrication technologies used for this purpose will be discussed.

  4. Optimized distributed systems achieve significant performance improvement on sorted merging of massive VCF files.

    Science.gov (United States)

    Sun, Xiaobo; Gao, Jingjing; Jin, Peng; Eng, Celeste; Burchard, Esteban G; Beaty, Terri H; Ruczinski, Ingo; Mathias, Rasika A; Barnes, Kathleen; Wang, Fusheng; Qin, Zhaohui S

    2018-06-01

    Sorted merging of genomic data is a common data operation necessary in many sequencing-based studies. It involves sorting and merging genomic data from different subjects by their genomic locations. In particular, merging a large number of variant call format (VCF) files is frequently required in large-scale whole-genome sequencing or whole-exome sequencing projects. Traditional single-machine based methods become increasingly inefficient when processing large numbers of files due to the excessive computation time and Input/Output bottleneck. Distributed systems and more recent cloud-based systems offer an attractive solution. However, carefully designed and optimized workflow patterns and execution plans (schemas) are required to take full advantage of the increased computing power while overcoming bottlenecks to achieve high performance. In this study, we custom-design optimized schemas for three Apache big data platforms, Hadoop (MapReduce), HBase, and Spark, to perform sorted merging of a large number of VCF files. These schemas all adopt the divide-and-conquer strategy to split the merging job into sequential phases/stages consisting of subtasks that are conquered in an ordered, parallel, and bottleneck-free way. In two illustrating examples, we test the performance of our schemas on merging multiple VCF files into either a single TPED or a single VCF file, which are benchmarked with the traditional single/parallel multiway-merge methods, message passing interface (MPI)-based high-performance computing (HPC) implementation, and the popular VCFTools. Our experiments suggest all three schemas either deliver a significant improvement in efficiency or render much better strong and weak scalabilities over traditional methods. Our findings provide generalized scalable schemas for performing sorted merging on genetics and genomics data using these Apache distributed systems.

  5. Developing an eHealth Tool to Support Patient Empowerment at Home.

    Science.gov (United States)

    Schildmeijer, Kristina; Wannheden, Carolina; Nilsson, Lina; Frykholm, Oscar; Hellström, Amanda; Flink, Maria; Ekstedt, Mirjam

    2018-01-01

    In previous research we have learned that patients with chronic or complex diseases often experience difficulties when transitioning from hospital care to self-care in their home. We address these difficulties by developing an eHealth tool for patients - ePATH (electronic Patient Activation in Treatment at Home) - intended to empower each patient to manage their individual situation. We have employed a user-centered design process involving both patients and healthcare personnel to specify the content and functionality of ePATH. The system is deployed as a web application with secure login for patients. In this article, we describe the main content and functionality of the system that makes it possible for a patient to manage symptoms development in relation to treatment progression Interactive functionality, e.g., reminders and social support, is included to make the ePATH a useful and informative bridge between patients, next-of-kin and different caregivers. One lesson learned is that it is necessary to incorporate motivational components in the development of an eHealth tool to successfully overcome the "intention-behavior" gap. The self-determination theory of motivation can be used to ensure that important aspects are not missed.

  6. Association of public health initiatives with outcomes for out-of-hospital cardiac arrest at home and in public locations

    DEFF Research Database (Denmark)

    Christopher B., Fordyce; Carolina M., Hansen; Kragholm, Kristian

    2017-01-01

    Importance  Little is known about the influence of comprehensive public health initiatives according to out-of-hospital cardiac arrest (OHCA) location, particularly at home, where resuscitation efforts and outcomes have historically been poor.Objective  To describe temporal trends in bystander...... cardiopulmonary resuscitation (CPR) and first-responder defibrillation for OHCAs stratified by home vs public location and their association with survival and neurological outcomes.Design, Setting, and Participants  This observational study reviewed 8269 patients with OHCAs (5602 [67.7%] at home and 2667 [32.......3%] in public) for whom resuscitation was attempted using data from the Cardiac Arrest Registry to Enhance Survival (CARES) from January 1, 2010, through December 31, 2014. The setting was 16 counties in North Carolina.Exposures  Patients were stratified by home vs public OHCA. Public health initiatives...

  7. Children's Health and Indoor Air Quality in Primary Schools and Homes in Portugal-Study Design.

    Science.gov (United States)

    Madureira, Joana; Paciência, Inês; Ramos, Elisabete; Barros, Henrique; Pereira, Cristiana; Teixeira, João Paulo; Fernandes, Eduardo de Oliveira

    2015-01-01

    The main aim of the research project "On the Contribution of Schools to Children's Overall Indoor Air Exposure" is to study associations between adverse health effects, namely, allergy, asthma, and respiratory symptoms, and indoor air pollutants to which children are exposed to in primary schools and homes. Specifically, this investigation reports on the design of the study and methods used for data collection within the research project and discusses factors that need to be considered when designing such a study. Further, preliminary findings concerning descriptors of selected characteristics in schools and homes, the study population, and clinical examination are presented. The research project was designed in two phases. In the first phase, 20 public primary schools were selected and a detailed inspection and indoor air quality (IAQ) measurements including volatile organic compounds (VOC), aldehydes, particulate matter (PM2.5, PM10), carbon dioxide (CO2), carbon monoxide (CO), bacteria, fungi, temperature, and relative humidity were conducted. A questionnaire survey of 1600 children of ages 8-9 years was undertaken and a lung function test, exhaled nitric oxide (eNO), and tear film stability testing were performed. The questionnaire focused on children's health and on the environment in their school and homes. One thousand and ninety-nine questionnaires were returned. In the second phase, a subsample of 68 children was enrolled for further studies, including a walk-through inspection and checklist and an extensive set of IAQ measurements in their homes. The acquired data are relevant to assess children's environmental exposures and health status.

  8. Medicare home health: a description of total episodes of care.

    Science.gov (United States)

    Branch, L G; Goldberg, H B; Cheh, V A; Williams, J

    1993-01-01

    The purpose of this study was to present descriptive information on the characteristics of 2,873 Medicare home health clients, to quantify systematically their patterns of service utilization and allowed charges during a total episode of care, and to clarify the bivariate associations between client characteristics and utilization. The model client was female, 75-84 years of age, living with a spouse, and frail based on a variety of indicators. The mean total episode was approximately 23 visits, with allowed charges of $1,238 (1986 dollars). Specific subgroups of clients, defined by their morbidities and frailties, used identifiable clusters of services. Implications for case-mix models and implications for capitation payments under health care reform are discussed.

  9. Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study

    Science.gov (United States)

    2012-01-01

    Background Maternal mortality among poor rural women in the Lao People’s Democratic Republic (Lao PDR) is among the highest in Southeast Asia, in part because only 15% give birth at health facilities. This study explored why women and their families prefer home deliveries to deliveries at health facilities. Methods A qualitative study was conducted from December 2008 to February 2009 in two provinces of Lao PDR. Data was collected through eight focus group discussions (FGD) as well as through in-depth interviews with 12 mothers who delivered at home during the last year, eight husbands and eight grandmothers, involving a total of 71 respondents. Content analysis was used to analyze the FGD and interview transcripts. Results Obstacles to giving birth at health facilities included: (1) Distance to the health facilities and difficulties and costs of getting there; (2) Attitudes, quality of care, and care practices at the health facilities, including a horizontal birth position, episiotomies, lack of privacy, and the presence of male staff; (3) The wish to have family members nearby and the need for women to be close to their other children and the housework; and (4) The wish to follow traditional birth practices such as giving birth in a squatting position and lying on a “hot bed” after delivery. The decision about where to give birth was commonly made by the woman’s husband, mother, mother-in-law or other relatives in consultation with the woman herself. Conclusion This study suggests that the preference in rural Laos for giving birth at home is due to convenience, cost, comfort and tradition. In order to assure safer births and reduce rural Lao PDR’s high maternal mortality rate, health centers could consider accommodating the wishes and traditional practices of many rural Laotians: allowing family in the birthing rooms; allowing traditional practices; and improving attitudes among staff. Traditional birth attendants, women, and their families could be

  10. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: Design and methods1

    Science.gov (United States)

    Fulkerson, Jayne A.; Neumark-Sztainer, Dianne; Story, Mary; Gurvich, Olga; Kubik, Martha Y.; Garwick, Ann; Dudovitz, Bonnie

    2014-01-01

    Background Informed and engaged parents and healthful home environments are essential for the health of youth. Although research has shown health benefits associated with family meals, to date, no randomized controlled trial (RCT) has been developed to examine the impact of a family meals intervention on behavioral and health outcomes. Methods/Design The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study is a two-arm (intervention versus attention-only control) RCT being conducted in Minneapolis/St. Paul. Built on previous pilot research, HOME Plus aims to increase the frequency and healthfulness of family meals and snacks and reduce children’s sedentary behavior, particularly screen time, to promote healthier eating and activity behaviors and prevent obesity. HOME Plus is delivered to families in community settings. The program includes 10 monthly sessions focused on nutrition and activity education, meal planning and preparation skill development. In addition, five motivational goal-setting phone calls are conducted with parents. The primary outcome measure is age- and gender-adjusted child BMI-z score at post-intervention by treatment group. Secondary household-level outcomes include family meal frequency, home availability of healthful foods (fruits/vegetables) and unhealthful foods (high-fat/sugary snacks) and beverages (sugar-sweetened beverages), and the quality of foods served at meals and snacks. Secondary child outcomes include dietary intake of corresponding foods and beverages and screen time. Conclusions The HOME Plus RCT actively engages whole families of 8–12 year old children to promote healthier eating and activity behaviors and prevent obesity through promotion of family meals and snacks and limited media use. PMID:24480729

  11. Exploring workplace violence among home care workers in a consumer-driven home health care program.

    Science.gov (United States)

    Nakaishi, Lindsay; Moss, Helen; Weinstein, Marc; Perrin, Nancy; Rose, Linda; Anger, W Kent; Hanson, Ginger C; Christian, Mervyn; Glass, Nancy

    2013-10-01

    Nominal research has examined sexual harassment and workplace violence against home care workers within consumer-driven home care models such as those offered in Oregon. This study examined home care workers' experiences of violence while providing care to consumer employers, the patients who hire and manage home care workers. Focus groups and interviews were conducted in Oregon with 83 home care workers, 99 Oregon Department of Human Services (DHS) employees, and 11 consumer employers. Home care workers reported incidents of workplace physical violence (44%), psychological abuse (65%), sexual harassment (41%), and sexual violence (14%). Further, three themes were identified that may increase the risk of workplace violence: (1) real and perceived barriers to reporting violence; (2) tolerance of violence; and (3) limited training to prevent violence. To ensure worker safety while maintaining quality care, safety policies and training for consumer employers, state DHS employees, and home care workers must be developed. Copyright 2013, SLACK Incorporated.

  12. Variations in levels of care between nursing home patients in a public health care system.

    Science.gov (United States)

    Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

    2014-03-05

    Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients' own needs, but also on the needs of all the other residents.

  13. Internet protocol television for personalized home-based health information: design-based research on a diabetes education system.

    Science.gov (United States)

    Gray, Kathleen Mary; Clarke, Ken; Alzougool, Basil; Hines, Carolyn; Tidhar, Gil; Frukhtman, Feodor

    2014-03-10

    The use of Internet protocol television (IPTV) as a channel for consumer health information is a relatively under-explored area of medical Internet research. IPTV may afford new opportunities for health care service providers to provide health information and for consumers, patients, and caretakers to access health information. The technologies of Web 2.0 add a new and even less explored dimension to IPTV's potential. Our research explored an application of Web 2.0 integrated with IPTV for personalized home-based health information in diabetes education, particularly for people with diabetes who are not strong computer and Internet users, and thus may miss out on Web-based resources. We wanted to establish whether this system could enable diabetes educators to deliver personalized health information directly to people with diabetes in their homes; and whether this system could encourage people with diabetes who make little use of Web-based health information to build their health literacy via the interface of a home television screen and remote control. This project was undertaken as design-based research in two stages. Stage 1 comprised a feasibility study into the technical work required to integrate an existing Web 2.0 platform with an existing IPTV system, populated with content and implemented for user trials in a laboratory setting. Stage 2 comprised an evaluation of the system by consumers and providers of diabetes information. The project succeeded in developing a Web 2.0 IPTV system for people with diabetes and low literacies and their diabetes educators. The performance of the system in the laboratory setting gave them the confidence to engage seriously in thinking about the actual and potential features and benefits of a more widely-implemented system. In their feedback they pointed out a range of critical usability and usefulness issues related to Web 2.0 affordances and learning fundamentals. They also described their experiences with the system in

  14. Design and methodology of a randomized clinical trial of home-based telemental health treatment for U.S. military personnel and veterans with depression.

    Science.gov (United States)

    Luxton, David D; Pruitt, Larry D; O'Brien, Karen; Stanfill, Katherine; Jenkins-Guarnieri, Michael A; Johnson, Kristine; Wagner, Amy; Thomas, Elissa; Gahm, Gregory A

    2014-05-01

    Home-based telemental health (TMH) treatments have the potential to address current and future health needs of military service members, veterans, and their families, especially for those who live in rural or underserved areas. The use of home-based TMH treatments to address the behavioral health care needs of U.S. military healthcare beneficiaries is not presently considered standard of care in the Military Health System. The feasibility, safety, and clinical efficacy of home-based TMH treatments must be established before broad dissemination of home-based treatment programs can be implemented. This paper describes the design, methodology, and protocol of a clinical trial that compares in-office to home-based Behavioral Activation for Depression (BATD) treatment delivered via web-based video technology for service members and veterans with depression. This grant funded three-year randomized clinical trial is being conducted at the National Center for Telehealth and Technology at Joint-base Lewis-McChord and at the Portland VA Medical Center. Best practice recommendations regarding the implementation of in-home telehealth in the military setting as well as the cultural and contextual factors of providing in-home care to active duty and veteran military populations are also discussed. Published by Elsevier Inc.

  15. [Effects of an infant/toddler health program on parenting knowledge, behavior, confidence, and home environment in low-income mothers].

    Science.gov (United States)

    Lee, Gyungjoo; Yang, Soo; Jang, Mi Heui; Yeom, Mijung

    2012-10-01

    This study was conducted to evaluate the effectiveness of a mother/infant-toddler health program developed to enhance parenting knowledge, behavior and confidence in low income mothers and home environment. A one-group pretest-posttest quasi-experimental design was used. Sixty-nine dyads of mothers and infant-toddlers (aged 0-36 months) were provided with weekly intervention for seven session. Each session consisted of three parts; first, educating to increase integrated knowledge related to the development of the infant/toddler including nutrition, first aid and home environment; second, counseling to share parenting experience among the mothers and to increase their nurturing confidence; third, playing with the infant/toddler to facilitate attachment-based parenting behavior for the mothers. Following the programs, there were significant increases in parenting knowledge on nutrition and first aid. A significant improvement was found in attachment-based parenting behavior, but not in home safety practice. Nurturing confidence was not significantly increased. The program led to more positive home environment for infant/toddler's health and development. The findings provide evidence for mother-infant/toddler health program to improve parenting knowledge, attachment-based parenting behavior and better home environment in low income mothers. Study of the long term effectiveness of this program is recommended for future research.

  16. Smart homes, private homes? An empirical study of technology researchers? perceptions of ethical issues in developing smart-home health technologies

    OpenAIRE

    Birchley, Giles; Huxtable, Richard; Murtagh, Madeleine; ter Meulen, Ruud; Flach, Peter; Gooberman-Hill, Rachael

    2017-01-01

    Background Smart-home technologies, comprising environmental sensors, wearables and video are attracting interest in home healthcare delivery. Development of such technology is usually justified on the basis of the technology?s potential to increase the autonomy of people living with long-term conditions. Studies of the ethics of smart-homes raise concerns about privacy, consent, social isolation and equity of access. Few studies have investigated the ethical perspectives of smart-home engine...

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

    Science.gov (United States)

    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.

  18. 2013 NOAA Coastal California TopoBathy Merge Project

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This project merged recently collected topographic, bathymetric, and acoustic elevation data along the entire California coastline from approximately the 10 meter...

  19. A Prospect for Evolutionary Adequacy: Merge and the Evolution and Development of Human Language

    Directory of Open Access Journals (Sweden)

    Koji Fujita

    2009-09-01

    Full Text Available Biolinguistic minimalism seeks a deeper explanation of the design, development and evolution of human language by reducing its core domain to the bare minimum including the set-formation operation Merge. In an attempt to open an avenue of research that may lead to an evolutionarily adequate theory of language, this article makes the following proposals: (i Merge is the elementary combinatorial device that requires no more decomposition; (ii the precursor to Merge may be found in the uniquely human capacity for hierarchical object manipulation; (iii the uniqueness of the human lexicon may also be captured in terms of Merge. Empirical validations of these proposals should constitute one major topic for the biolinguistic program.

  20. Unravelling merging behaviors and electrostatic properties of CVD-grown monolayer MoS{sub 2} domains

    Energy Technology Data Exchange (ETDEWEB)

    Hao, Song; Yang, Bingchu, E-mail: bingchuyang@csu.edu.cn [College of Physics and Electronics, Institute of Super Microstructure and Ultrafast Process in Advanced Materials, Central South University, 605 South Lushan Road, Changsha 410012 (China); Hunan Key Laboratory for Super-Microstructure and Ultrafast Process, Central South University, 932 South Lushan Road, Changsha 410012 (China); Gao, Yongli [College of Physics and Electronics, Institute of Super Microstructure and Ultrafast Process in Advanced Materials, Central South University, 605 South Lushan Road, Changsha 410012 (China); Hunan Key Laboratory for Super-Microstructure and Ultrafast Process, Central South University, 932 South Lushan Road, Changsha 410012 (China); Department of Physics and Astronomy, University of Rochester, Rochester, New York 14534 (United States)

    2016-08-28

    The presence of grain boundaries is inevitable for chemical vapor deposition (CVD)-grown MoS{sub 2} domains owing to various merging behaviors, which greatly limits its potential applications in novel electronic and optoelectronic devices. It is therefore of great significance to unravel the merging behaviors of the synthesized polygon shape MoS{sub 2} domains. Here we provide systematic investigations of merging behaviors and electrostatic properties of CVD-grown polycrystalline MoS{sub 2} crystals by multiple means. Morphological results exhibit various polygon shape features, ascribed to polycrystalline crystals merged with triangle shape MoS{sub 2} single crystals. The thickness of triangle and polygon shape MoS{sub 2} crystals is identical manifested by Raman intensity and peak position mappings. Three merging behaviors are proposed to illustrate the formation mechanisms of observed various polygon shaped MoS{sub 2} crystals. The combined photoemission electron microscopy and kelvin probe force microscopy results reveal that the surface potential of perfect merged crystals is identical, which has an important implication for fabricating MoS{sub 2}-based devices.

  1. Transient and intermittent magnetic reconnections in TS-3/UTST merging startup experiments

    International Nuclear Information System (INIS)

    Ono, Y.; Imazawa, R.; Imanaka, H.; Hayamizu, T.; Inomoto, M.; Sato, M.; Kawamori, E.; Ejiri, A.; Takase, Y.; Asai, T.; Takahashi, T.

    2007-01-01

    The high-power reconnection heating has been developed in the TS-3 merging experiments, leading us to a new pulsed high-beta spherical tokamak (ST) formation. Two ST plasmas were produced inductively by two or four PF coils without using any central solenoid (CS) coil and were merged together for MW-GW reconnection heating. The magnetic reconnection transformed the magnetic energy of reconnecting magnetic field through the outflow kinetic energy finally to the ion thermal energy, increasing the plasma beta of ST up to 0.5. A new finding is that ejection of current sheet (or plasmoid) causes high-speed merging/ reconnection as well as high-power heating. In the high-q ST merging, the sheet resistivity was almost classical due to the sheet thickness much longer than ion gyroradius. Large inflow flux and low current-sheet dissipation resulted in flux pileup followed by rapid growth of the current sheet. When the flux pileup exceeded a critical limit, the sheet was ejected mechanically from the squeezed X-point area. The reconnection (outflow) speed was slow during the flux pileup and was fast during the ejection, indicating that intermittent reconnection similar to the solar flare increased the averaged reconnection speed. These transient effects enable us to have the fast reconnection as well as the high-power reconnection heating, even if the merging high-q tokamaks have low current-sheet resistivity. (author)

  2. Automated cloud screening of AVHRR imagery using split-and-merge clustering

    Science.gov (United States)

    Gallaudet, Timothy C.; Simpson, James J.

    1991-01-01

    Previous methods to segment clouds from ocean in AVHRR imagery have shown varying degrees of success, with nighttime approaches being the most limited. An improved method of automatic image segmentation, the principal component transformation split-and-merge clustering (PCTSMC) algorithm, is presented and applied to cloud screening of both nighttime and daytime AVHRR data. The method combines spectral differencing, the principal component transformation, and split-and-merge clustering to sample objectively the natural classes in the data. This segmentation method is then augmented by supervised classification techniques to screen clouds from the imagery. Comparisons with other nighttime methods demonstrate its improved capability in this application. The sensitivity of the method to clustering parameters is presented; the results show that the method is insensitive to the split-and-merge thresholds.

  3. Practical improvements and merging of POWHEG simulations for vector boson production

    International Nuclear Information System (INIS)

    Aliolo, Simone; Hamilton, Keith; Re, Emanuele

    2011-10-01

    In this article we generalise POWHEG next-to-leading order parton shower (NLOPS) simulations of vector boson production and vector boson production in association with a single jet, to give matrix element corrected MENLOPS simulations. In so doing we extend and provide, for the first time, an exact and faithful implementation of the MENLOPS formalism in hadronic collisions. We also consider merging the resulting event samples according to a phase space partition defined in terms of an effective jet clustering scale. The merging scale is restricted such that the component generated by the associated production simulation does not impact on the NLO accuracy of inclusive vector boson production observables. The dependence of the predictions on the unphysical merging scale is demonstrated. Comparisons with Tevatron and LHC data are presented. (orig.)

  4. Practical improvements and merging of POWHEG simulations for vector boson production

    Energy Technology Data Exchange (ETDEWEB)

    Aliolo, Simone [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany); Hamilton, Keith [Istituto Nazionale di Fisica Nucleare, Milan (Italy); Re, Emanuele [Durham Univ. (United Kingdom). Dept. of Physics

    2011-10-15

    In this article we generalise POWHEG next-to-leading order parton shower (NLOPS) simulations of vector boson production and vector boson production in association with a single jet, to give matrix element corrected MENLOPS simulations. In so doing we extend and provide, for the first time, an exact and faithful implementation of the MENLOPS formalism in hadronic collisions. We also consider merging the resulting event samples according to a phase space partition defined in terms of an effective jet clustering scale. The merging scale is restricted such that the component generated by the associated production simulation does not impact on the NLO accuracy of inclusive vector boson production observables. The dependence of the predictions on the unphysical merging scale is demonstrated. Comparisons with Tevatron and LHC data are presented. (orig.)

  5. Community Nursing Home (CNH)

    Data.gov (United States)

    Department of Veterans Affairs — The Community Nursing Home (CNH) database contains a list of all Community Nursing Home facilities under local contract to Veterans Health Administration (VHA). CNH...

  6. Articulation Matrix for Home Health Aide, Nursing Assistant, Patient Care Assistant, Practical Nursing.

    Science.gov (United States)

    Florida State Univ., Tallahassee. Center for Instructional Development and Services.

    This document demonstrates the relationships among four Florida nursing education programs (home health aide, nursing assistant, patient care assistant, and practical nursing) by listing student performance standards and indicating which ones are required in each program. The 268 student performance standards are arranged in 23 areas of…

  7. Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

    Science.gov (United States)

    Behkami, Nima A.

    2012-01-01

    It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

  8. eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop.

    Science.gov (United States)

    Barakat, Ansam; Woolrych, Ryan D; Sixsmith, Andrew; Kearns, William D; Kort, Helianthe S M

    2013-01-01

    The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. This paper describes the health care professionals' competencies and requirements needed for the use of eHealth

  9. Determinants of Job Satisfaction and Turnover Intent in Home Health Workers: The Role of Job Demands and Resources.

    Science.gov (United States)

    Jang, Yuri; Lee, Ahyoung A; Zadrozny, Michelle; Bae, Sung-Heui; Kim, Miyong T; Marti, Nathan C

    2017-01-01

    Based on the job demands-resources (JD-R) model, this study explored the impact of job demands (physical injury and racial/ethnic discrimination) and resources (self-confidence in job performance and recognition by supervisor/organization/society) on home health workers' employee outcomes (job satisfaction and turnover intent). Using data from the National Home Health Aide Survey (N = 3,354), multivariate models of job satisfaction and turnover intent were explored. In both models, the negative impact of demands (physical injury and racial/ethnic discrimination) and the positive impact of resources (self-confidence in job performance and recognition by supervisor and organization) were observed. The overall findings suggest that physical injury and discrimination should be prioritized in prevention and intervention efforts to improve home health workers' safety and well-being. Attention also needs to be paid to ways to bolster work-related efficacy and to promote an organizational culture of appreciation and respect. © The Author(s) 2015.

  10. The clinical effectiveness and cost-effectiveness of home-based, nurse-led health promotion for older people: a systematic review.

    Science.gov (United States)

    Tappenden, P; Campbell, F; Rawdin, A; Wong, R; Kalita, N

    2012-01-01

    In older age, reduction in physical function can lead to loss of independence, the need for hospital and long-term nursing or residential home care, and premature death. Home-visiting programmes for older people, carried out by nurses and other health-care professionals (e.g. occupational therapists and physiotherapists), aim to positively affect health and functional status, and may promote independent functioning of older people. The main research question addressed by this assessment is 'What is the clinical effectiveness and cost-effectiveness of home-based, nurse-led health promotion intervention for older people in the UK?' A comprehensive literature search was undertaken across 12 different databases and research registries from the year 2001 onwards (including MEDLINE, MEDLINE in Process & Other Non-Indexed Citations, EMBASE, Science Citation Index Expanded, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Health Economic Evaluation Database, Health Technology Assessment Database, Database of Abstracts of Reviews of Effects, Cumulative Index to Nursing and Allied Health Literature). Published systematic reviews were also hand searched to identify other trials previously published. Potentially relevant studies were sifted by one reviewer, and inclusion decisions were agreed among the broader research team. The methodological quality of included studies was assessed using the Cochrane Risk of Bias tool. The results of included studies were synthesised using narrative and statistical methods. A separate systematic search was undertaken to identify existing health economic analyses of home-based, nurse-led health promotion programmes. Included studies were critically appraised using a published checklist. Owing to resource constraints, a de novo health economic model was not developed. Eleven studies were included in the systematic review of clinical effectiveness. There was considerable heterogeneity among the

  11. Creating an Excellence Oriented Post-merged Organisational ...

    African Journals Online (AJOL)

    This article specifically focuses on the importance of a structured approach to the implementation of employee engagement strategies in creating a post-merged organisational culture of excellent work performance. Theoretical insights from existing literature illustrate how a structured approach to the implementation of ...

  12. Getting home safe and sound: occupational safety and health administration at 38.

    Science.gov (United States)

    Silverstein, Michael

    2008-03-01

    The Occupational Safety and Health Act of 1970 (OSHAct) declared that every worker is entitled to safe and healthful working conditions, and that employers are responsible for work being free from all recognized hazards. Thirty-eight years after these assurances, however, it is difficult to find anyone who believes the promise of the OSHAct has been met. The persistence of preventable, life-threatening hazards at work is a failure to keep a national promise. I review the history of the Occupational Safety and Health Administration and propose measures to better ensure that those who go to work every day return home safe and sound. These measures fall into 6 areas: leverage and accountability, safety and health systems, employee rights, equal protection, framing, and infrastructure.

  13. LP MOON MERGED TELEMETRY DATA V1.0

    Data.gov (United States)

    National Aeronautics and Space Administration — The Lunar Prospector merged telemetry data set is a result of comparing the two Lunar Prospector telemetry data streams and selecting one of them. The Lunar...

  14. Eldercare at Home: Problems of Daily Living

    Science.gov (United States)

    ... suggestions and provide education or other support. A social worker with the home health agency may make a few visits to discuss options ... carry out needed medical procedures. They often have social workers and ... When home health agency staff are visiting the home because of physical ...

  15. Using existing population-based data sets to measure the American Academy of Pediatrics definition of medical home for all children and children with special health care needs.

    Science.gov (United States)

    Bethell, Christina D; Read, Debra; Brockwood, Krista

    2004-05-01

    National health goals include ensuring that all children have a medical home. Historically, medical home has been determined by the presence of a usual or primary source of care, such as a pediatrician or a family physician. More recent definitions expand on this simplistic notion of medical home. A definition of medical home set forth by the American Academy of Pediatrics (AAP) includes 7 dimensions and 37 discrete concepts for determining the presence of a medical home for a child. Standardized methods to operationalize these definitions for purposes of national, state, health plan, or medical practice level reporting on the presence of medical homes for children are essential to assessing and improving health care system performance in this area. The objective of this study was to identify methods to measure the presence of medical homes for all children and for children with special health care needs (CSHCN) using existing population-based data sets. Methods were developed for using existing population-based data sets to assess the presence of medical homes, as defined by the AAP, for children with and without special health care needs. Data sets evaluated included the National Survey of Children With Special Health Care Needs, the National Medical Expenditures Panel Survey, the Consumer Assessment of Health Plans Study Child Survey (CAHPS), and the Consumer Assessment of Health Plans Study Child Survey--Children With Chronic Conditions (CAHPS-CCC2.0H). Alternative methods for constructing measures using existing data were compared and results used to inform the design of a new method for use in the upcoming National Survey of Children's Health. Data from CAHPS-CCC2.0H are used to illustrate measurement options and variations in the overall presence of medical homes for children across managed health care plans as well as to evaluate in which areas of the AAP definition of medical home improvements may be most needed for all CSHCN. Existing surveys vary in

  16. Toolsets for Airborne Data (TAD): Customized Data Merging Function

    Science.gov (United States)

    Benson, A.; Peeters, M. C.; Perez, J.; Parker, L.; Chen, G.

    2013-12-01

    NASA has conducted airborne tropospheric chemistry studies for about three decades. These field campaigns have generated a great wealth of observations, including a wide range of the trace gases and aerosol properties. The ASDC Toolset for Airborne Data (TAD) is being designed to meet the user community needs for manipulating aircraft data for scientific research on climate change and air quality relevant issues. Prior to the actual toolset development, a comprehensive metadata database was created to compensate for the absence of standardization of the ICARTT data format in which the data is stored. This database tracks the Principal Investigator-provided metadata, and links the measurement variables to a common naming system that was developed as a part of this project. This database is used by the data merging module. Most aircraft data reported during a single flight is not on a consistent time base and is difficult to intercompare. This module provides the user with the ability to merge original data measurements from multiple data providers into a specified time interval or common time base. The database development, common naming scheme and data merge module development will be presented.

  17. Bundle Payment Program Initiative: Roles of a Nurse Navigator and Home Health Professionals.

    Science.gov (United States)

    Peiritsch, Heather

    2017-06-01

    With the passage of the Affordable Care Act, The Centers for Medicare and Medicaid (CMS) introduced a new value-based payment model, the Bundle Payment Care Initiative. The CMS Innovation (Innovation Center) authorized hospitals to participate in a pilot to test innovative payment and service delivery models that have a potential to reduce Medicare expenditures while maintaining or improving the quality of care for beneficiaries. A hospital-based home care agency, Abington Jefferson Health Home Care Department, led the initiative for the development and implementation of the Bundled Payment Program. This was a creative and innovative method to improve care along the continuum while testing a value-based care model.

  18. Development of the International Guidelines for Home Health Nursing.

    Science.gov (United States)

    Narayan, Mary; Farris, Cindy; Harris, Marilyn D; Hiong, Fong Yoke

    2017-10-01

    Throughout the world, healthcare is increasingly being provided in home and community-based settings. There is a growing awareness that the most effective, least costly, patient-preferred setting is patients' home. Thus, home healthcare nursing is a growing nursing specialty, requiring a unique set of nursing knowledge and skills. Unlike many other nursing specialties, home healthcare nursing has few professional organizations to develop or support its practice. This article describes how an international network of home healthcare nurses developed international guidelines for home healthcare nurses throughout the world. It outlines how the guidelines for home healthcare nursing practice were developed, how an international panel of reviewers was recruited, and the process they used for reaching a consensus. It also describes the plan for nurses to contribute to future updates to the guidelines.

  19. Nursing Home Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses quality...

  20. The 'Cancer Home-Life Intervention'

    DEFF Research Database (Denmark)

    Pilegaard, Marc Sampedro; la Cour, Karen; Gregersen Oestergaard, Lisa

    2018-01-01

    , occupational therapy-based and adaptive programme for people with advanced cancer targeting the performance of their prioritised everyday activities. SETTING/PARTICIPANTS: Home-living adults diagnosed with advanced cancer experiencing functional limitations were recruited from two Danish hospitals. They were......BACKGROUND: People with advanced cancer face difficulties with their everyday activities at home that may reduce their health-related quality of life. To address these difficulties, we developed the 'Cancer Home-Life Intervention'. AIM: To evaluate the efficacy of the 'Cancer Home Life......-Intervention' compared with usual care with regard to patients' performance of, and participation in, everyday activities, and their health-related quality of life. DESIGN AND INTERVENTION: A randomised controlled trial ( ClinicalTrials.gov NCT02356627). The 'Cancer Home-Life Intervention' is a brief, tailored...

  1. Incorporating Edge Information into Best Merge Region-Growing Segmentation

    Science.gov (United States)

    Tilton, James C.; Pasolli, Edoardo

    2014-01-01

    We have previously developed a best merge region-growing approach that integrates nonadjacent region object aggregation with the neighboring region merge process usually employed in region growing segmentation approaches. This approach has been named HSeg, because it provides a hierarchical set of image segmentation results. Up to this point, HSeg considered only global region feature information in the region growing decision process. We present here three new versions of HSeg that include local edge information into the region growing decision process at different levels of rigor. We then compare the effectiveness and processing times of these new versions HSeg with each other and with the original version of HSeg.

  2. Health Behaviors and Overweight in Nursing Home Employees: Contribution of Workplace Stressors and Implications for Worksite Health Promotion.

    Science.gov (United States)

    Miranda, Helena; Gore, Rebecca J; Boyer, Jon; Nobrega, Suzanne; Punnett, Laura

    2015-01-01

    Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors. A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity. Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity. Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health.

  3. [Descriptive Analysis of Health Economics of Intensive Home Care of Ventilated Patients].

    Science.gov (United States)

    Lehmann, Yvonne; Ostermann, Julia; Reinhold, Thomas; Ewers, Michael

    2018-05-14

    Long-term ventilated patients in Germany receive intensive care mainly in the patients' home or in assisted-living facilities. There is a lack of knowledge about the nature and extent of resource use and costs associated with care of this small, heterogeneous but overall growing patient group. A sub-study in the context of a research project SHAPE analyzed costs of 29 patients descriptively from a social perspective. Direct and indirect costs of intensive home care over a period of three months were recorded and analyzed retrospectively. Standardized recorded written self-reports from patients and relatives as well as information from the interviewing of nursing staff and from nursing documentation were the basis for this analysis. There was an average total cost of intensive home care for three months per patient of 61194 € (95% CI 53 884-68 504) including hospital stays. The main costs were directly linked to outpatient medical and nursing care provided according to the Code of Social Law V and XI. Services provided by nursing home care service according to § 37(2) Code of Social Law V (65%) were the largest cost item. Approximately 13% of the total costs were attributable to indirect costs. Intensive home care for ventilated patients is resource-intensive and cost-intensive and has received little attention also from a health economics perspective. Valid information and transparency about the cost structures are required for an effective and economic design and management of the long-term care of this patient group. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study.

    Science.gov (United States)

    Irani, Elliane; Hirschman, Karen B; Cacchione, Pamela Z; Bowles, Kathryn H

    2018-04-13

    Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency's protocols to develop the personalized visit plan. They revised the plan based on changes in the patient's clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients.

  5. Smart homes, private homes? An empirical study of technology researchers' perceptions of ethical issues in developing smart-home health technologies.

    Science.gov (United States)

    Birchley, Giles; Huxtable, Richard; Murtagh, Madeleine; Ter Meulen, Ruud; Flach, Peter; Gooberman-Hill, Rachael

    2017-04-04

    Smart-home technologies, comprising environmental sensors, wearables and video are attracting interest in home healthcare delivery. Development of such technology is usually justified on the basis of the technology's potential to increase the autonomy of people living with long-term conditions. Studies of the ethics of smart-homes raise concerns about privacy, consent, social isolation and equity of access. Few studies have investigated the ethical perspectives of smart-home engineers themselves. By exploring the views of engineering researchers in a large smart-home project, we sought to contribute to dialogue between ethics and the engineering community. Either face-to-face or using Skype, we conducted in-depth qualitative interviews with 20 early- and mid-career smart-home researchers from a multi-centre smart-home project, who were asked to describe their own experience and to reflect more broadly about ethical considerations that relate to smart-home design. With participants' consent, interviews were audio-recorded, transcribed and analysed using a thematic approach. Two overarching themes emerged: in 'Privacy', researchers indicated that they paid close attention to negative consequences of potential unauthorised information sharing in their current work. However, when discussing broader issues in smart-home design beyond the confines of their immediate project, researchers considered physical privacy to a lesser extent, even though physical privacy may manifest in emotive concerns about being watched or monitored. In 'Choice', researchers indicated they often saw provision of choice to end-users as a solution to ethical dilemmas. While researchers indicated that choices of end-users may need to be restricted for technological reasons, ethical standpoints that restrict choice were usually assumed and embedded in design. The tractability of informational privacy may explain the greater attention that is paid to it. However, concerns about physical privacy may

  6. Algorithm 426 : Merge sort algorithm [M1

    NARCIS (Netherlands)

    Bron, C.

    1972-01-01

    Sorting by means of a two-way merge has a reputation of requiring a clerically complicated and cumbersome program. This ALGOL 60 procedure demonstrates that, using recursion, an elegant and efficient algorithm can be designed, the correctness of which is easily proved [2]. Sorting n objects gives

  7. Inclusive cross sections in ME+PS merging

    International Nuclear Information System (INIS)

    Plaetzer, Simon

    2013-07-01

    We discuss an extension of matrix element plus parton shower merging at leading and next-to-leading order. The algorithm does preserve inclusive cross sections at the respective input order. This constraint avoids potentially large logarithmic contributions, which would require approximate (N)NLO contributions to cancel against.

  8. Merging Satellite Precipitation Products for Improved Streamflow Simulations

    Science.gov (United States)

    Maggioni, V.; Massari, C.; Barbetta, S.; Camici, S.; Brocca, L.

    2017-12-01

    Accurate quantitative precipitation estimation is of great importance for water resources management, agricultural planning and forecasting and monitoring of natural hazards such as flash floods and landslides. In situ observations are limited around the Earth, especially in remote areas (e.g., complex terrain, dense vegetation), but currently available satellite precipitation products are able to provide global precipitation estimates with an accuracy that depends upon many factors (e.g., type of storms, temporal sampling, season, etc.). The recent SM2RAIN approach proposes to estimate rainfall by using satellite soil moisture observations. As opposed to traditional satellite precipitation methods, which sense cloud properties to retrieve instantaneous estimates, this new bottom-up approach makes use of two consecutive soil moisture measurements for obtaining an estimate of the fallen precipitation within the interval between two satellite overpasses. As a result, the nature of the measurement is different and complementary to the one of classical precipitation products and could provide a different valid perspective to substitute or improve current rainfall estimates. Therefore, we propose to merge SM2RAIN and the widely used TMPA 3B42RT product across Italy for a 6-year period (2010-2015) at daily/0.25deg temporal/spatial scale. Two conceptually different merging techniques are compared to each other and evaluated in terms of different statistical metrics, including hit bias, threat score, false alarm rates, and missed rainfall volumes. The first is based on the maximization of the temporal correlation with a reference dataset, while the second is based on a Bayesian approach, which provides a probabilistic satellite precipitation estimate derived from the joint probability distribution of observations and satellite estimates. The merged precipitation products show a better performance with respect to the parental satellite-based products in terms of categorical

  9. Merging of gamma radiographic and ultrasonic inspection data: bibliographical survey

    International Nuclear Information System (INIS)

    Gautier, S.

    1995-01-01

    This paper presents a number of experimental data processing notions with the aim of developing an NDT method based on merging ultrasonic and gamma radiographic data. We first review the industrial context concerned and, before moving on to specific data merging problems, we discuss the difficulties of reconstruction using only one type of data (radiographic or ultrasonic). The main part of the report begins with a brief reminder of gamma radiation and ultrasonic wave propagation principles. Certain imaging and reconstruction methods conventionally used for each type of measurement are also presented. Reconstruction problems are then directly approached in algebraic form. For the type of problem studied, the inspection data alone cannot lead to satisfactory reconstructions and we evidence the need to regulate the problem by introducing deductive information on the object to be reconstructed. The Bayes' approach provides a self-consistent means of integrating both the data information and the deductive information. It is based on probabilistic models of the variables involved, notably those of the object sought. We discuss at some length certain models of images used in gamma radiography (independent variable fields, variables having a Markov-type structure) and the Bernoulli-Gauss-type models used for ultrasonic trace deconvolution. Finally, we outline data merging paths. A formal Bayes' framework is used to present two merging approaches, after which we briefly describe our projects for the processing of already available experimental data. (author)

  10. Frequency of eating home cooked meals and potential benefits for diet and health: cross-sectional analysis of a population-based cohort study.

    Science.gov (United States)

    Mills, Susanna; Brown, Heather; Wrieden, Wendy; White, Martin; Adams, Jean

    2017-08-17

    Reported associations between preparing and eating home cooked food, and both diet and health, are inconsistent. Most previous research has focused on preparing, rather than eating, home cooked food; used small, non-population based samples; and studied markers of nutrient intake, rather than overall diet quality or health. We aimed to assess whether frequency of consuming home cooked meals was cross-sectionally associated with diet quality and cardio-metabolic health. We used baseline data from a United Kingdom population-based cohort study of adults aged 29 to 64 years (n = 11,396). Participants self-reported frequency of consuming home cooked main meals. Diet quality was assessed using the Mediterranean Diet Score, Dietary Approaches to Stop Hypertension (DASH) score, fruit and vegetable intake calculated from a 130-item food frequency questionnaire, and plasma vitamin C. Markers of cardio-metabolic health were researcher-measured body mass index (BMI), percentage body fat, haemoglobin A 1c (HbA 1c ), cholesterol and hypertension. Differences across the three exposure categories were assessed using linear regression (diet variables) and logistic regression (health variables). Eating home cooked meals more frequently was associated with greater adherence to DASH and Mediterranean diets, greater fruit and vegetable intakes and higher plasma vitamin C, in adjusted models. Those eating home cooked meals more than five times, compared with less than three times per week, consumed 62.3 g more fruit (99% CI 43.2 to 81.5) and 97.8 g more vegetables (99% CI 84.4 to 111.2) daily. More frequent consumption of home cooked meals was associated with greater likelihood of having normal range BMI and normal percentage body fat. Associations with HbA 1c , cholesterol and hypertension were not significant in adjusted models. Those consuming home cooked meals more than five times, compared with less than three times per week, were 28% less likely to have overweight BMI (99

  11. Identifying Challenges Associated With the Care Transition Workflow From Hospital to Skilled Home Health Care: Perspectives of Home Health Care Agency Providers.

    Science.gov (United States)

    Nasarwanji, Mahiyar; Werner, Nicole E; Carl, Kimberly; Hohl, Dawn; Leff, Bruce; Gurses, Ayse P; Arbaje, Alicia I

    2015-01-01

    Older adults discharged from the hospital to skilled home health care (SHHC) are at high risk for experiencing suboptimal transitions. Using the human factors approach of shadowing and contextual inquiry, we studied the workflow for transitioning older adults from the hospital to SHHC. We created a representative diagram of the hospital to SHHC transition workflow, we examined potential workflow variations, we categorized workflow challenges, and we identified artifacts developed to manage variations and challenges. We identified three overarching challenges to optimal care transitions-information access, coordination, and communication/teamwork. Future investigations could test whether redesigning the transition from hospital to SHHC, based on our findings, improves workflow and care quality.

  12. Drivers' Visual Characteristics when Merging onto or Exiting an Urban Expressway.

    Directory of Open Access Journals (Sweden)

    Ying Cheng

    Full Text Available The aim of this study is to examine drivers' visual and driving behavior while merging onto or exiting an urban expressway with low and high traffic densities. The analysis was conducted according to three periods (approaching, merging or exiting, and accelerating or decelerating. A total of 10 subjects (8 males and 2 females with ages ranging from 25 to 52 years old (M = 30.0 years old participated in the study. The research was conducted in a natural driving situation, and the drivers' eye movements were monitored and recorded using an eye tracking system. The results show that the influence of traffic density on the glance duration and scan duration is more significant when merging than when exiting. The results also demonstrate that the number of glances and the mean glance duration are mainly related to the driving task (e.g., the merging period. Therefore, drivers' visual search strategies mainly depend on the current driving task. With regard to driving behavior, the variation tendencies of the duration and the velocity of each period are similar. These results support building an automated driving assistant system that can automatically identify gaps and accelerate or decelerate the car accordingly or provide suggestions to the driver to do so.

  13. Study of flow behaviors of droplet merging and splitting in microchannels using Micro-PIV measurement

    Science.gov (United States)

    Li, Yi; Liu, Zhaomiao

    2017-01-01

    Droplet merging and splitting are important droplet manipulations in droplet-based microfluidics. However, the fundamental flow behaviors of droplets were not systematically studied. Hence, we designed two different microstructures to achieve droplet merging and splitting respectively, and quantitatively compared different flow dynamics in different microstructures for droplet merging and splitting via micro-particle image velocimetry (micro-PIV) experiments. Some flow phenomena of droplets different from previous studies were observed during merging and splitting using a high-speed microscope. It was also found the obtained instantaneous velocity vector fields of droplets have significant influence on the droplets merging and splitting. For droplet merging, the probability of droplets coalescence (η) in a microgroove is higher (50% T-junction microchannel (15% < η < 50%), and the highest coalescence efficiency (η = 92%) comes at the two-phase flow ratio e of 0.42 in the microgroove. Moreover, compared with a cylinder obstacle, Y-junction bifurcation can split droplets more effectively and the droplet flow during splitting is steadier. The results can provide better understanding of droplet behaviors and are useful for the design and applications of droplet-based microfluidics. PMID:28890680

  14. Study of flow behaviors of droplet merging and splitting in microchannels using Micro-PIV measurement.

    Science.gov (United States)

    Shen, Feng; Li, Yi; Liu, Zhaomiao; Li, XiuJun

    2017-04-01

    Droplet merging and splitting are important droplet manipulations in droplet-based microfluidics. However, the fundamental flow behaviors of droplets were not systematically studied. Hence, we designed two different microstructures to achieve droplet merging and splitting respectively, and quantitatively compared different flow dynamics in different microstructures for droplet merging and splitting via micro-particle image velocimetry (micro-PIV) experiments. Some flow phenomena of droplets different from previous studies were observed during merging and splitting using a high-speed microscope. It was also found the obtained instantaneous velocity vector fields of droplets have significant influence on the droplets merging and splitting. For droplet merging, the probability of droplets coalescence ( η ) in a microgroove is higher (50% < η < 92%) than that in a T-junction microchannel (15% < η < 50%), and the highest coalescence efficiency ( η = 92%) comes at the two-phase flow ratio e of 0.42 in the microgroove. Moreover, compared with a cylinder obstacle, Y-junction bifurcation can split droplets more effectively and the droplet flow during splitting is steadier. The results can provide better understanding of droplet behaviors and are useful for the design and applications of droplet-based microfluidics.

  15. Sociodemographic and health profile of inmates of old age homes in and around Belgaum city, Karnataka.

    Science.gov (United States)

    Viveki, R G; Halappanavar, A B; Joshi, A V; Pujar, Kirankumar; Patil, Sandhya

    2013-10-01

    A new trend of admitting more and more senior citizens hailing from the Indian middle class background to old age homes is being observed in recent times. The objectives of this study were to study sociodemographic dimensions and common health problems of inmates of old age homes and to know various reasons for their admissions and their leisure time activities in old age homes. The present cross-sectional study was conducted during March and April 2010 in 4 different old age homes in and around Belgaum city, North Karnataka, by interviewing the inmates of old age homes using predesigned, pretested, structured questionnaire followed by thorough clinical examination and haemoglobin estimation by Sahli's method. The collected data was compiled and analysed using SPSS software version 14. Out of 73 elderly, 54 were females (74.0%). Majority were in the age group of 61-70 years (50.7%) and 56 were belonging to nuclear family (76.7%). Thirty-nine inmates were widow/widower (53.4%) and 42 were having no children (57.5%). Forty-seven inmates were admitted as there was nobody to take care of them (64.4%). Common health problems observed were locomotive/joint and muscle disorders (35.6%), hypertension (34.2%), diabetes mellitus (26.0%), respiratory disorders (23.3%), hearing loss (21.9%) etc. Forty-nine were having normal body mass index (67.1%) while 19.2% were underweight. Majority were having haemoglobin levels between 10-12 g/dl (58.9%). Old age homes definitely will enable the elderly to remain sociopsychologically healthy and lead active lives if effective medical and emotional support is given.

  16. Interlayer magnetoresistance in multilayer Dirac electron systems: motion and merging of Dirac cones

    International Nuclear Information System (INIS)

    Assili, M; Haddad, S

    2013-01-01

    We theoretically study the effect of the motion and the merging of Dirac cones on the interlayer magnetoresistance in multilayer graphene-like systems. This merging, which can be induced by a uniaxial strain, gives rise in a monolayer Dirac electron system to a topological transition from a semi-metallic phase to an insulating phase whereby Dirac points disappear. Based on a universal Hamiltonian, proposed to describe the motion and the merging of Dirac points in two-dimensional Dirac electron crystals, we calculate the interlayer conductivity of a stack of deformed graphene-like layers using the Kubo formula in the quantum limit where only the contribution of the n = 0 Landau level is relevant. A crossover from a negative to a positive interlayer magnetoresistance is found to take place as the merging is approached. This sign change of the magnetoresistance can also result from a coupling between the Dirac valleys, which is enhanced as the magnetic field amplitude increases. Our results describe the behavior of the magnetotransport in the organic conductor α-(BEDT) 2 I 3 and in a stack of deformed graphene-like systems. The latter can be simulated by optical lattices or microwave experiments in which the merging of Dirac cones can be observed. (paper)

  17. Interlayer magnetoresistance in multilayer Dirac electron systems: motion and merging of Dirac cones

    Science.gov (United States)

    Assili, M.; Haddad, S.

    2013-09-01

    We theoretically study the effect of the motion and the merging of Dirac cones on the interlayer magnetoresistance in multilayer graphene-like systems. This merging, which can be induced by a uniaxial strain, gives rise in a monolayer Dirac electron system to a topological transition from a semi-metallic phase to an insulating phase whereby Dirac points disappear. Based on a universal Hamiltonian, proposed to describe the motion and the merging of Dirac points in two-dimensional Dirac electron crystals, we calculate the interlayer conductivity of a stack of deformed graphene-like layers using the Kubo formula in the quantum limit where only the contribution of the n = 0 Landau level is relevant. A crossover from a negative to a positive interlayer magnetoresistance is found to take place as the merging is approached. This sign change of the magnetoresistance can also result from a coupling between the Dirac valleys, which is enhanced as the magnetic field amplitude increases. Our results describe the behavior of the magnetotransport in the organic conductor α-(BEDT)2I3 and in a stack of deformed graphene-like systems. The latter can be simulated by optical lattices or microwave experiments in which the merging of Dirac cones can be observed.

  18. Interlayer magnetoresistance in multilayer Dirac electron systems: motion and merging of Dirac cones.

    Science.gov (United States)

    Assili, M; Haddad, S

    2013-09-11

    We theoretically study the effect of the motion and the merging of Dirac cones on the interlayer magnetoresistance in multilayer graphene-like systems. This merging, which can be induced by a uniaxial strain, gives rise in a monolayer Dirac electron system to a topological transition from a semi-metallic phase to an insulating phase whereby Dirac points disappear. Based on a universal Hamiltonian, proposed to describe the motion and the merging of Dirac points in two-dimensional Dirac electron crystals, we calculate the interlayer conductivity of a stack of deformed graphene-like layers using the Kubo formula in the quantum limit where only the contribution of the n = 0 Landau level is relevant. A crossover from a negative to a positive interlayer magnetoresistance is found to take place as the merging is approached. This sign change of the magnetoresistance can also result from a coupling between the Dirac valleys, which is enhanced as the magnetic field amplitude increases. Our results describe the behavior of the magnetotransport in the organic conductor α-(BEDT)2I3 and in a stack of deformed graphene-like systems. The latter can be simulated by optical lattices or microwave experiments in which the merging of Dirac cones can be observed.

  19. Predictors for assessing electronic messaging between nurses and general practitioners as a useful tool for communication in home health care services: a cross-sectional study.

    Science.gov (United States)

    Lyngstad, Merete; Hofoss, Dag; Grimsmo, Anders; Hellesø, Ragnhild

    2015-02-17

    Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. The aim of this study was to explore home health care nurses' assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, Pcommunicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services.

  20. Integrated working between residential care homes and primary care: a survey of care homes in England

    Directory of Open Access Journals (Sweden)

    Gage Heather

    2012-11-01

    Full Text Available Abstract Background Older people living in care homes in England have complex health needs due to a range of medical conditions, mental health needs and frailty. Despite an increasing policy expectation that professionals should operate in an integrated way across organisational boundaries, there is a lack of understanding between care homes and the National Health Service (NHS about how the two sectors should work together, meaning that residents can experience a poor "fit" between their needs, and services they can access. This paper describes a survey to establish the current extent of integrated working that exists between care homes and primary and community health and social services. Methods A self-completion, online questionnaire was designed by the research team. Items on the different dimensions of integration (funding, administrative, organisational, service delivery, clinical care were included. The survey was sent to a random sample of residential care homes with more than 25 beds (n = 621 in England in 2009. Responses were analysed using quantitative and qualitative methods. Results The survey achieved an overall response rate of 15.8%. Most care homes (78.7% worked with more than one general practice. Respondents indicated that a mean of 14.1 professionals/ services (other than GPs had visited the care homes in the last six months (SD 5.11, median 14; a mean of .39 (SD.163 professionals/services per bed. The most frequent services visiting were district nursing, chiropody and community psychiatric nurses. Many (60% managers considered that they worked with the NHS in an integrated way, including sharing documents, engaging in integrated care planning and joint learning and training. However, some care home managers cited working practices dictated by NHS methods of service delivery and priorities for care, rather than those of the care home or residents, a lack of willingness by NHS professionals to share information, and low