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PubMed2005

Enhancing clinician communication skills in a large healthcare organization: a longitudinal case study.

OBJECTIVE: This article describes the approach taken over the past 16 years by one large healthcare organization, Kaiser Permanente (KP), to enhance the clinical communication and relationship skills of their clinicians. METHODS: The centerpiece of KP's approach has been the creation and dissemination of a unifying clinician-patient communication (CPC) framework for teaching and research called the Four Habits Model. RESULTS: The Model has served as the foundation for a diverse array of KP programs. Sustained improvement in patient satisfaction scores has been demonstrated. Clinician-patient communication training has become a well-established component of professional development in KP. DISCUSSION: Enhancing clinicians' communication with patients is a complex task requiring planning and organizational commitment. Factors that have contributed to the success and lessons learned from incorporating clinician communication skills across the organization are described. CONCLUSION: The KP experience attests to the feasibility of bringing the vital skills of effective communication to large numbers of busy clinicians. PRACTICE IMPLICATIONS: Healthcare practices wishing to enhance clinician-patient communication skills should consider using a consistent teaching model, ensuring strong sponsorship from leaders, and emphasizing clinician satisfaction in the design of programs.

California↗
PubMed2004

Lattice Boltzmann method for the compressible Euler equations.

The lattice Boltzmann model for the compressible Euler equations is proposed together with its rigorous theoretical background. The proposed model has completely overcome the defects of the previous model that the specific-heat ratio cannot be chosen freely. The macroscopic variables obtained from the solution are shown to satisfy, in the limit of the small Knudsen number, the compressible Euler equations if the variation of the solution is moderate. This is the case where no shock waves or contact discontinuities appear. In contrast, when the solution makes steep variation at several localized regions due to the appearance of shock waves and contact discontinuities, the corresponding macroscopic variables satisfy the weak form of the Euler equations. Their derivation is carried out rigorously by taking into account the scale of variation of the solution correctly. This is the first study that has laid the theoretical foundation of the lattice Boltzmann model for the simulation of flows with shock waves and contact discontinuities. Numerical examples and the error estimates are also given, which are consistent with the above theoretical arguments.

Journal Article↗
PubMed2005

Application of Bayesian regularized BP neural network model for analysis of aquatic ecological data-a case study of chlorophyll-a prediction in Nanzui water area of Dongting Lake.

Bayesian regularized BP neural network(BRBPNN) technique was applied in the chlorophyll-a prediction of Nanzui water area in Dongting Lake. Through BP network interpolation method, the input and output samples of the network were obtained. After the selection of input variables using stepwise/multiple linear regression method in SPSS 11.0 software, the BRBPNN model was established between chlorophyll-a and environmental parameters, biological parameters. The achieved optimal network structure was 3-11-1 with the correlation coefficients and the mean square errors for the training set and the test set as 0.999 and 0.00078426, 0.981 and 0.0216 respectively. The sum of square weights between each input neuron and the hidden layer of optimal BRBPNN models of different structures indicated that the effect of individual input parameter on chlorophyll-a declined in the order of alga amount > secchi disc depth (SD) > electrical conductivity (EC). Additionally, it also demonstrated that the contributions of these three factors were the maximal for the change of chlorophyll-a concentration, total phosphorus (TP) and total nitrogen (TN) were the minimal. All the results showed that BRBPNN model was capable of automated regularization parameter selection and thus it may ensure the excellent generation ability and robustness. Thus, this study laid the foundation for the application of BRBPNN model in the analysis of aquatic ecological data(chlorophyll-a prediction) and the explanation about the effective eutrophication treatment measures for Nanzui water area in Dongting Lake.

Bayes Theorem↗
PubMed2006

[Combating infectious disease using mathematical modelling].

When determining interventions against threatening infectious diseases such as HIV-infection, severe acute respiratory syndrome (SARS), smallpox and pandemic influenza, the use of mathematical models of the spread of infectious diseases is becoming increasingly popular. These models contribute to the structuring of the knowledge already available in various disciplines, to finding epidemiological connnections, to demonstrating lacunas within the pool of knowledge and to the comparison of the expected effects and costs of preventative and intervention measures. The use of models leads to a 'made-to-measure' analysis ofthe effects and costs of preventative and intervention measures which takes account of the specific characteristics of infectious diseases. The integration of knowledge from various disciplines can be supported by more research into the theoretical epidemiology of infectious disease and by better integration of mathematical models into policy development. The resulting and better foundations of this policy that are achieved by means of infectious disease modelling translate into more effective combating of infectious disease.

Cost-Benefit Analysis↗
PubMed2005

Acute pancreatitis: models, markers, and mediators.

Acute pancreatitis has an incidence of approximately 40 cases per year per 100,000 adults. Although usually self-limiting, 10% to 20% of afflicted patients will progress to severe pancreatitis. The mortality rate among patients with severe pancreatitis may approach 30% when they progress to multisystem organ failure. The development of acute pancreatitis illustrates the requirement for understanding the basic mechanisms of disease progression to drive the exploration of therapeutic options. The pathogenesis of acute pancreatitis involves the interplay of local and systemic immune responses that are often difficult to characterize, particularly when results from animal models are used as a foundation for human trials. Experimental studies suggest that the prognosis for acute pancreatitis depends upon the degree of pancreatic necrosis and the intensity of multisystem organ failure generated by the systemic inflammatory response. This suggests an intricate balance between localized tissue damage with proinflammatory cytokine production and a systemic, anti-inflammatory response that restricts the inappropriate movement of proinflammatory agents into the circulation. The critical players of this interaction include the proinflammatory cytokines IL-1beta, TNF-alpha, IL-6, IL-8, and platelet activating factor (PAF). The anti-inflammatory cytokines IL-10, as well as TNF-soluble receptors and IL-1 receptor antagonist, have also been shown to be intimately involved in the inflammatory response to acute pancreatitis. Other compounds implicated in disease pathogenesis in experimental models include complement, bradykinin, nitric oxide, reactive oxygen intermediates, substance P, and higher polyamines. Several of these mediators have been documented to be present at increased concentrations in the plasma of patients with severe, acute pancreatitis. Preclinical work has shown that some of these mediators are markers for disease activity, whereas other inflammatory components may actually drive the disease process as important mediators. Implication of such mediators suggests that interruption or blunting of an inappropriate immune response has the potential to improve outcome. Although the manipulations of specific mediators in animal models may be promising, they may not transition well to the human clinical setting. However, continued reliance on experimental animal models of acute pancreatitis may be necessary to determine the underlying causes of disease. Full understanding of these basic mechanisms involves determining not only which mediators are present, but also closely documenting the kinetics of their appearance. Measurement of the inflammatory response may also serve to identify diagnostic markers for the presence of acute pancreatitis and provide insight into prognosis. Understanding the models, documenting the markers, and deciphering the mediators have the potential to improve treatment of acute pancreatitis.

Acute Disease↗
PubMed2004

Evaluation of a prediction model for long-term fracture risk.

UNLABELLED: The NOF cost-effectiveness model, based on clinical risk factors and femoral neck aBMD, predicted overall fracture risk in a cohort of postmenopausal women followed for up to 22 years. INTRODUCTION: To assess the ability of a statistical model to predict long-term fracture risk for a population of postmenopausal women, we compared observed fractures to those predicted by the National Osteoporosis Foundation's (NOF) cost-effectiveness model. MATERIALS AND METHODS: In this population-based study, 393 postmenopausal Rochester, MN, women had baseline measurements of femoral neck areal BMD (aBMD) and assessment of the clinical risk factors (personal fracture history, family history of osteoporotic fracture, low body weight, and smoking status) that were included in the NOF model. They were then followed prospectively for up to 22 years. Fractures were ascertained by periodic interview and review of community medical records. Standardized incidence ratios (SIRs) compared observed fractures to predicted numbers. RESULTS: During 4782 person-years of follow-up, 212 women experienced 503 fractures, two-thirds of which were caused by moderate trauma. When undiagnosed (incidentally noted) vertebral and rib fractures were excluded, there was general concordance between observed and predicted fractures of the hip (SIR, 0.78; 95% CI, 0.56-1.01), distal forearm (SIR, 1.22; 95% CI, 0.86-1.68), spine (SIR, 0.76; 95% CI, 0.50-1.11), and all other sites combined (SIR, 1.18; 95% CI, 0.97-1.42). Fracture prediction by the NOF model was about as good after 10 years as it was earlier during follow-up. CONCLUSIONS: This study validates the ability of a statistical model based on femoral neck aBMD and common clinical risk factors to predict the actual occurrence of fractures in a cohort of postmenopausal white women.

Absorptiometry, Photon↗
PubMed2005

Effect of vapor source-building separation and building construction on soil vapor intrusion as studied with a three-dimensional numerical model.

A three-dimensional numerical model of the soil vapor-to-indoor air pathway is developed and used as a tool to anticipate not-yet-measured relationships between the vapor attenuation coefficient, alpha (indoor air concentration/source vapor concentration), and vapor source-building lateral separation, vapor source depth, and building construction characteristics (depth of building foundation) for nondegrading chemicals. The numerical model allows for diffusive and advective transport, multicomponent systems and reactions, spatially distributed foundation cracks, and transient indoor and ambient pressure fluctuations. Simulations involving different lateral separations between the vapor source and building show decreasing alpha values with increasing lateral separation. For example, alpha is 2 orders of magnitude less when a 30 m x 30 m source located 8 m below ground surface is displaced from the edge of the building by 20 m. The decrease in alpha with increasing lateral separation is greater for shallower source depths. For example, alpha is approximately 5 orders of magnitude less when a 30 m x 30 m source located 3 m below ground surface is displaced from the edge of the building by 20 m. To help visualize the effects of changing vapor source-building separations, normalized vapor concentration contour plots for both horizontal and vertical cross sections are presented for a sequence of lateral separations ranging from the case in which the 30 m x 30 m source and 10 m x 10 m building footprint centers are collocated to shifting of the source positioning by 50 m. Simulations involving basement and slab-on-grade constructions produce similar trends. In addition, when buildings are overpressurized to create outflow to soil gas on the order of 1-3 L/min, emissions to indoor air are reduced by over 5 orders of magnitude relative to intrusion rates at zero building underpressurization. The results are specific to simulations involving homogeneous soil properties, nondegrading chemicals, steady source concentrations and building underpressurizations, and the geometries studied in this work.

Air Pollution, Indoor↗
PubMedDate not supplied

An occupation-centered discussion of development and implications for practice.

Children's learning to do everyday activities seems so obvious that the mechanisms bringing about the development of occupations remain essentially unstudied. Therefore, occupational therapy uses developmental models from other disciplines as foundation for practice. We specialists in childhood occupations need a theory-based and empirically tested body of knowledge about the processes leading to change to inform practice and guide interventions during efficacy studies. One body of knowledge about developmental mechanisms views change as originating from within the child and informs practice centered on changing the child. Given the inseparable nature of children and their social environments and daily activities, we introduce the philosophy of contextualism and outline a potential body of knowledge about a change process that is occupation centered. An intervention arising from a contextual perspective illustrates how this way of thinking leads to occupation-centered practice that uses multiple strategies and supports a child's occupation with social participation with peers.

Child↗
PubMed2006

Development of partial thickness articular cartilage injury in an ovine model.

The purpose of this study was to create a controlled partial thickness cartilage lesion in a sheep model, and to provide a foundation to study the natural history of the progression of this lesion. Twenty-eight sheep divided into four groups (1, 12, 24, and 52 weeks, n=7/group) were used in this study. In one stifle, a mechanical tool was used to create a 200 microm partial thickness lesion (1.5x1.5 cm2) on the medial femoral condyle via arthroscopy. Joint fluid was drawn presurgery and after euthanasia for analysis of collage II 3/4 C (long) (C2C). After euthanasia, the condyle was analyzed by gross appearance, confocal laser microscopy (CLM) for cell viability, scanning electronic microscopy (SEM) for surface roughness, Artscan for cartilage stiffness, and histology for cartilage morphology. The gross appearance of the treated area appeared rough, soft, and swollen compared to untreated control over time. CLM demonstrated that the depth of cell death increased to 590 microm at 52 weeks after surgery. SEM demonstrated that the treated area became more irregular over time. Stiffness of the treated area was significantly less than control by 12 weeks after surgery. Histologic analysis demonstrated that the 12, 24, and 52 week groups had significantly poorer histologic scores than the 1 week group. Joint fluid analysis demonstrated that the treatment group at 1 week had significant higher levels of C2C than the pretreatment baseline data. The results of this study demonstrated that partial thickness injury of cartilage continued to propagate and degenerate over time in this sheep model. Options for the prevention or treatment of this lesion may be tested using this model in the future.

Animals↗
PubMedDate not supplied

Health redefined: a foundation for teaching nursing strategies.

SUMMARY: Current models of health are inadequate to meet nursing education and healthcare needs related to the growth in alternative health. Concepts of energy, holism, and balance expand the current health definition and provide conceptual understanding for mind-body and energy system strategies. As a result, nurses will increase alternatives for promoting health. Nurse educators have an exciting opportunity to be an integral part of this trend by providing a broader, more holistic definition of health.

Complementary Therapies↗
PubMed2001

Expectations for transgenic rodent cancer bioassay models.

The results of the present study have advanced dramatically the database on transgenic mouse abbreviated carcinogenicity bioassay models. As such, it will provide a secure foundation for future evaluations of these assays and for their eventual validation as models for the prediction of possible human carcinogens. Based upon the results derived from the present study, it is suggested that 5 areas require discussion as a prelude to the further evaluation of existing models and the future evaluation of new models. First, there is the need to agree a standard list of calibration chemicals to be studied and to derive agreement on optimal bioassay group sizes, statistical methods, and exposure periods. Second, general agreement must be reached regarding the classes/types of known rodent carcinogens so that it is acceptable for the new models to find negative, by implication, those rodent carcinogens considered not to pose a carcinogenic hazard to humans. Third, current understanding of mechanisms of carcinogenesis should be integrated into the evaluation of new bioassay models. Fourth, any changes made to the standard rodent carcinogenicity bioassay protocol will require compromises being made, and these should be commonly owned between interested parties in order to reduce the number of regional/agency-specific carcinogenicity testing schemes. Fifth, a mechanism needs to be developed by which assays can be adopted or rejected for use in the routine bioassay of chemicals. In the absence of such initiatives the increasing number of new bioassay models will come to exist along side of the standard 2-species bioassay, and this may potentially lead to confusion regarding the true future role of these assays.

Animal Testing Alternatives↗
PubMed1991

Molecular modeling on the Commodore Amiga.

The Amiga 3000 is nearly ideal for desktop molecular modeling. It uses the Motorola 68030 32-bit processor, running at 16 or 25 MHz, with either the 68881 or 68882 math coprocessor and eight custom processing chips. The video system is NTSC compatible 15.75- or 31.5-KHz RGB analog or digital. The system video interface offers user selectable 320 x 200, 640 x 480, 768 x 480 or 1280 x 400 resolution with a displayable palette of 4,096 colors and interlaced, noninterlaced and overscan modes. NTSC compatibility permits simple and inexpensive video signal synchronization, so that composed monitor images can be displayed and recorded with standard video equipment. The processor, in conjunction with the custom video chips, can manipulate models mathematically at a sufficient rate to present moving or animated images in real time. Users can interact with the molecular image with mouse or joystick controls. A third-party manufacturer, Haitex Resources, has produced an inexpensive stereo image display interface for the Amiga. This stereo image display system consists of liquid crystal shutter goggles attached to a control module on one mouse/joystick port and synchronized at 60 Hz with alternating left/right screen displays. Several simple molecular graphics programs for the Amiga have been available in the public domain since 1988. The ease of video interfacing and the availability of stereo image display have stimulated several developers to begin assembling molecular modeling packages. At the National Biomedical Research Foundation the Amiga is being tested as an inexpensive stereo-image color graphics workstation for molecular modeling, biopolymer sequence analysis and medical imaging.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Graphics↗
PubMed2006

Slater-like model for carbon 1s core ionization energies of halomethanes.

Based on the atomic electron affinity EA, the average energy of the valence-shell electrons EI and the polarizability alpha, the charge effect and the relaxation effect were evaluated for the carbon 1s core ionization energies of halomethanes CHnY4-n-mZm (Y, Z=F, Cl, Br, I). The charge effect was scaled by the electronegativity discrepancy (the discrepancy of EA and the discrepancy of EI between the C and H or halogen atom in the C-H or C-halogen chemical bond). The relaxation effect (induced dipole) was scaled by the charge on the carbon atom together with the polarizability of the H and halogen atoms. Further, the electrostatic relaxation shielding DeltaSi of the carbon 1s electron in the halomethane was expressed by the charge effect together with the relaxation effect. By introducing DeltaSi into the Slater model, a Slater-like model was obtained for calculating the carbon 1s core ionization energy E1,C of halomethane, whose correlation coefficient r is 0.99985 and the average absolute error is only 0.041 eV between the calculated and the experimental carbon 1s core ionization energies for 27 halomethanes. Also the cross-correlation was tested by the leave-one-out (LOO) cross-validation method, and the obtained model has good predictive ability and stability (the correlation coefficient rcv is 0.99976, the average absolute error between the predicted and the experimental values is only 0.052 eV). The proposed model perhaps lays a good foundation for computing the core ionization energies of various atoms in more complex molecules.

Journal Article↗
PubMed1999

Equilibrium Shapes of Solid Particles on Elastically Mismatched Substrates.

Small particles or islands bonded to a substrate can be profoundly influenced by both interfacial and elastic driving forces that tend to have opposing influences on the apparent wetting behavior. The superposition of these two driving forces can therefore lead to a rich set of particle properties, most notably their equilibrium shapes. Here we present a variational analysis leading directly to an Euler-Lagrange equation that can be solved to yield the equilibrium shapes of partially wetting particles as a function of their size, interface energy densities, and elastic interaction with a rigid substrate. The solutions are used to gain insight into the variables that most significantly influence the equilibrium morphology, and to derive the approximate driving force for surface area reduction by coarsening among a dispersion of unequally sized particles. The relatively simple analytical model can also form a foundation upon which more realistic numerical simulations may be built and compared. Copyright 1999 Academic Press.

Journal Article↗
PubMed1993

Memory for spatial locations, motor responses, and objects: triple dissociation among the hippocampus, caudate nucleus, and extrastriate visual cortex.

Based on behavioral procedures aimed at measuring working or data-based memory for spatial location, response, and visual object information, it is shown that there is a triple dissociation among the hippocampus, caudate nucleus, and extrastriate visual cortex in mediating spatial location, response, and visual object information, respectively. The hippocampus appears to subserve only spatial location, the caudate nucleus only response, and the extrastriate visual cortex only visual object information. The results support the neurobiological foundation of the attribute memory model.

Animals↗
PubMed1995

Tuberculosis: a health education imperative returns.

The ominous resurgence of tuberculosis after many years of containment necessitates a review of the various factors responsible. An intense collaborative effort is needed to avoid potentially catastrophic consequences of the new epidemic. To provide a basis for health education recommendations, the factors contributing to the resurgence of tuberculosis, the nature of the current epidemic, and past health education efforts are reviewed. Further, an expanded Health Belief Model is offered as a foundation to guide educational campaigns.

AIDS-Related Opportunistic Infections↗
PubMed2002

[Certification according to ISO 9001--waste of time or necessity?].

Quality management (QM) systems are widely established management tools in the industry and business world today. In the health care sector, the need for quality, the implementation of quality management systems and economic orientation of the hospital management are strongly encouraged. Centers of excellence are created to offer special medical services of the highest possible quality. Furthermore, there is a worldwide tendency to establish standards in clinical medical settings, in teaching profession and medical science. These trends make the implementation of a quality management system in health care system highly desirable. The present manuscript reviews the fundamental principles and concepts and the aims of internationally accepted QM systems. It focuses on the ISO-9000 certificates and the European Foundation of Quality Management (EFQM) model. The advantages and disadvantages are discussed. The resources necessary for installation of a QM system and the different phases of implementation are reported. According to the experience of several groups, QM systems can be reliably used in a radiology department and lead to continuous improvement of the quality of services.

Austria↗