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PubMed1994

Development of a community breast screening promotion program using baseline data.

The process of developing a comprehensive community-based breast screening program for the Breast Screening Program Project is presented in this article. Behavior change theories were used to develop a program effects model which served as the conceptual foundation for a comprehensive breast screening program. This program would enlist professional and lay resources to promote breast screening through public and physician education and through improved access to mammography. Baseline survey data were used to focus program components on educational needs of women ages 40 and older for participating in regular mammography, clinical breast exam, and breast self-exam. The program effects model was also used as an evaluation framework to specify the intermediate changes that will be accomplished to reach a hypothesized 15% increase in screening participation between a study area receiving the program and two comparison areas. Results of this study will be of immediate value to other communities planning breast screening promotion programs.

Adult↗
PubMed1989

Wrestling with the larger picture: placing ethical behavior in clinical situations in context.

This article provides an account of the use of a model-building process as an educational strategy for the teaching of ethics. Designed to integrate students' growing knowledge and skill in nursing with their intellectual and professional development, this model-building process has its theoretical foundations in cognitive moral development theory, and in an integrative approach to nursing education called Multi-Course Sequential Learning (MCSL).

Clinical Competence↗
PubMed1994

A model for clinical teaching as a scholarly endeavor.

The traditional ways that academia has approached documentation of scholarship are relatively narrow and best fit those disciplines whose practice is research and writing. In professional practice disciplines such as nursing, writing and research are critical, but they are not the only scholarly activities in which faculty are involved. A model resulting from work from the Carnegie Foundation for the Advancement of Teaching offers a broader view of scholarship in which clinical teaching has academic legitimacy. The components of scholarship included in the model are discovery, practice, integration, and teaching.

Clinical Competence↗
PubMed2005

Acute vocal fold wound healing in a rabbit model.

Several authors have eloquently described the characteristics of vocal fold scar, a long-term consequence of vocal fold injury. However, events in the acute stage of mucosal injury, which lead up to fibrosis, have been largely overlooked. The current study describes acute events with regard to mucosal re-formation in a rabbit model. Vocal fold injury was induced surgically. A fibrinous clot was present 1 day after injury. Massive cellular infiltration was noted on day 3, and complete epithelial coverage was achieved by day 5. Also, neo-matrix deposition was noted as early as 5 days after injury, and more mature collagen was seen by day 7. The general timetable described in the current study can contribute to the experimental foundation for the development of regenerative models of healing in the vocal folds. Most notably, the proliferation phase of wound healing appears to occur approximately 3 days after injury, indicating a critical time for intervention. Manipulation and/or alteration of naturally occurring neo-matrix deposition and organization may yield improved biophysical function of the injured vocal fold.

Animals↗
PubMed2002

Force and torque production in static multifinger prehension: biomechanics and control. I. Biomechanics.

We studied the coordinated action of fingers during static tasks involving exertion of force and torque on a handheld object. Subjects were asked to keep a handle with an attachment that allowed for independent change of the suspended load (0.5-2.0 kg) and external torque (0.375-1.5 N m) in a vertical position while applying minimal effort. Normal and shear forces were measured from the thumb; normal forces only were measured from the four fingers. EXPERIMENTAL RESULTS: (1) the thumb shear force increased during supination efforts and decreased during pronation efforts; (2) the total moment of the normal finger forces only counterbalanced approximately 50% of the external torque, hence shear forces accounted for approximately one-half of the total torque exerted on the object; (3) the total normal force increased with external torque, and the total force magnitude did not depend on the torque direction; (4) the forces of the 'peripheral' (index and little) fingers depended mainly on the torque while the forces exerted by the 'central' (middle and ring) fingers depended both on the load and torque; (5) there was a monotonic relationship between the mechanical advantage of a finger (i.e., its moment arm during torque production) and the force produced by that finger; and (6) antagonist finger moments acting opposite to the intended direction of the total moment were always observed - at low torques the antagonist moments were as high as 40-60% of the agonist moments. MODELING: A three-zone model of coordinated finger action is suggested. In the first zone of load/torque combinations, activation of antagonist fingers (i.e., fingers that generate antagonist moments) is necessary to prevent slipping. In the second zone, the activity of agonist fingers is sufficient for preventing slips. In the third zone, the performer has freedom to choose between either activating the antagonist fingers or redistributing activities amongst the agonist fingers. The findings of this study provide the foundation for neural network and optimization modeling described in the companion paper [Zatsiorsky et al. (2002) Biol Cybern DOI 10.1007/s00422-002-0320-7].

Adult↗
PubMedDate not supplied

Redesigning prenatal care through CenteringPregnancy.

CenteringPregnancy is a model of group prenatal care that provides more than 20 hours of contact time between the childbearing care provider and a cohort of pregnant women with similar due dates. During this time, each woman has the opportunity to build community with other pregnant women, learn self-care skills, get assurance about the progression of her pregnancy, and gain knowledge about pregnancy, birth, and parenting. Ten essential elements have been defined, which contribute to the success of this model of prenatal care delivery. These elements correspond with the Institute of Medicine's 2001 challenge to improve the quality of health care in the United States. Foundational perspectives provide potential explanations for the model's growing influence and success. Implications for clinical practice and further research to link it with perinatal health outcomes are suggested.

Anecdotes as Topic↗
PubMed1996

Modeling and simulation of illumination effects for evaluation of microvessels of the conjunctiva.

We present the development of a comprehensive model that was undertaken to determine the relationships between the components of an image and the light intensity values present in the image of the microvessels of translucent tissues such as the bulbar conjunctiva. Experiments were conducted during the modeling process by use of a cylindrical microvessel embedded in a diffuse medium (phantom) on a reflecting background to affirm model components and simulations. The three-dimensional model was reduced to a single illumination plane with four regions of interest and modeled as Lambertian radiators and surfaces. The modeling showed that the top of the cylinder and its immediate vicinity are diffuse reflectors of light from the source plus light reflected from the background. The limbus of the cylinder is a diffuse reflector of the source and background illumination and a specular reflector of background reflections that achieve a high grazing angle with the cylinder. The immediate vicinity of the cylinder receives direct illumination from the source, but the light is partially obscured by the cylinder. The region beyond the shadow of the cylinder is a diffuse reflector of the overhead light. The diffuse medium additionally reflects the source and also attenuates the illumination reaching the other compo- rents of the scene. The direct and reflected illumination at each region of the model was calculated by use of specific geometric relationships. To verify those calculations, we analyzed a video simulation for the effects of different illumination conditions and their contributing elements. Intensity values were calculated from the relative reflectivity data determined from the video signals. The illumination values at the points along the line at the meridian of the cylinder were due to its reflectivity and also that of the medium. Similarly, the values of points distant from the shadow of the cylinder were due to the reflectivity of the background and the medium. The excellent agreement between the model and the phantom provides a foundation for the detection and precise measurement of microvessel dimensions within a diffuse medium. The additional ability to compute relative depth, from a single view, also permits discrimination between neighboring microvessels in complex images.

Computer Simulation↗
PubMed2000

How the propagation of error through stochastic counters affects time discrimination and other psychophysical judgments.

The performance of fallible counters is investigated in the context of pacemaker-counter models of interval timing. Failure to reliably transmit signals from one stage of a counter to the next generates periodicity in mean and variance of counts registered, with means power functions of input and standard deviations approximately proportional to the means (Weber's law). The transition diagrams and matrices of the counter are self-similar: Their eigenvalues have a fractal form and closely approximate Julia sets. The distributions of counts registered and of hitting times approximate Weibull densities, which provide the foundation for a signal-detection model of discrimination. Different schemes for weighting the values of each stage may be established by conditioning. As higher order stages of a cascade come on-line the veridicality of lower order stages degrades, leading to scale-invariance in error. The capacity of a counter is more likely to be limited by fallible transmission between stages than by a paucity of stages. Probabilities of successful transmission between stages of a binary counter around 0.98 yield predictions consistent with performance in temporal discrimination and production and with channel capacities for identification of unidimensional stimuli.

Cognition↗
PubMed1982

A synthesis of occupational behavior and sensory integration concepts in theory and practice, Part 1. Theoretical foundations.

This series of two articles presents a model of play development for use in pediatric occupational therapy. Proposing to unify the theoretical approaches of sensory integration and occupational behavior, the model uses play as the unifying link between these two apparently different approaches. This first article reviews the major concepts of sensory integration and occupational behavior, in addition to discussing the differences and similarities between the two. General systems concepts are used as a framework upon which a model of play development is constructed. Three hierarchical levels of play are described--sensorimotor, constructive, and social--with each broken down into several developmental steps.

Biofeedback, Psychology↗
PubMed2005

["A model of joint research"? Cancer research and the funding policies of the German Research Foundation and the Reich Research Council in National Socialist Germany].

In 1936 the German Research Foundation (Deutsche Forschungsgemeinschaft) started planning a programme for tumour research. After discussions between representatives of the German Research Foundation, the Reich Health Office and the Ministry of Science and Education about the extent of the scheme, in December 1936 the first scientists received their grants. The scheme was mainly drawn up by the Munich pathologist Max Borst, who was supported by the German Research Foundation's employee Sergius Breuer. Scientific research on cancer was divided into four sections: (1) etiology, (2) diagnosis, (3) treatment, and (4) constitution, disposition, heredity, and statistics. Well-known German scientists were invited to contribute to the scheme. When the Reich Research Council (Reichsforschungsrat) took over power in decision-making on research funding in 1937, cancer research was not seriously affected. Only in 1943, when further restructuring of the Reich Research Council took place, the situation changed through Kurt Blome's becoming the plenipotentiary for cancer research. Blome's position in cancer research was linked with the task of supporting scientific research on biological and chemical warfare. In general, however, the characteristics of the cancer research scheme remained astonishingly constant up to the end of World War II.

Biomedical Research↗
PubMed1994

Mercy Medical Foundation of Sacramento: a case study.

This is a case study of Mercy Medical Foundation of Sacramento and its affiliation with Medical Clinic of Sacramento, Inc. It provides background on the development of the foundation, factors leading to the affiliation, evaluation of models, and analysis of how the organizational structure was developed. Finally, it discusses how the model is operating and the implications for the parent corporation.

California↗
PubMed2003

Preserving confidentiality when sharing medical database with the Cellsecu system.

We propose a computer system called Cellsecu that maintains the anonymity and the confidentiality of each cell containing sensitive information in medical database. Cellsecu attains this by automatically removing, generalizing, and expanding information. It is designed to enhance data privacy protection so a data warehouse can automatically handle queries. In most cases, health organizations collect medical data with explicit identifiers, such as name, address and phone number. Simply removing all explicit identifiers prior to release of the data is not enough to preserve the data confidentiality. Remaining data can be used to re-identify individuals by linking or matching the data to other database, or by looking at unique characteristics found in the database. A formal model based on Modal logic is the theoretical foundation of Cellsecu. As well, a new confidentiality criteria called "non-uniqueness" is defined and implemented. We believe modeling this problem formally can clarify the issue as well as clearly identify the boundary of current technology. Base on our preliminary performance evaluation, the confidentiality check module and the confidentiality enhancing module only slightly degrade system performance.

Computer Security↗
PubMed1998

Tracking case management accountability: a systems approach.

A review of the evaluation of case management programs in the last two decades reveals a lack of consistency in showing outcome effectiveness. In addition, program evaluation models do not reflect the most prevalent theoretical foundation of case management practice, systems theory. It was the purpose of this article to conceptually establish an evaluation model that reflects systems theory in case management practice, to develop evaluation instruments congruent to collecting data in this model, and then to field-test this evaluation model.

Case Management↗
PubMed2000

A nursing theory for nursing leadership.

For many years nursing practice has found its foundations in nursing theory. A review of theorists such as D. E. Orem, C. Roy, B. Neumen, V. Henderson, M. E. Rogers and others reveals a focus on the management of patient care, not leadership. This has provided most nurses with a solid foundation in 'management', but little in terms of 'leadership.' In more recent years, theories such as the Deming Management Method, Managers as Developer Model, Shared Governance and Transactional Leadership have been introduced, none of which are nursing theories. This article discusses the conceptualized differences between management and leadership theory arguing that there is a difference between 'leadership and management'. A leadership theory is proposed utilizing Ida J. Orlando's model for nursing. This theory provides a nursing foundation for nursing leaders to utilize both in the management of patient care and in leadership.

Humans↗
PubMed1999

Long-range Coulomb forces and localized bonds.

The ionic model is shown to be applicable to all compounds in which the atoms carry a net charge and their electron density is spherically symmetric regardless of the covalent character of the bonding. By examining the electric field generated by an array of point charges placed at the positions of the ions in over 40 inorganic compounds, we show that the Coulomb field naturally partitions itself into localized regions (bonds) which are characterized by the electric flux that links neighbouring ions of opposite charge. This flux is identified with the bond valence, and Gauss' law with the valence-sum rule, providing a secure theoretical foundation for the bond-valence model. The localization of the Coulomb field provides an unambiguous definition of coordination number and our calculations show that, in addition to the expected primary coordination sphere, there are a number of weak bonds between cations and the anions in the second coordination sphere. Long-range Coulomb interactions are transmitted through the crystal by the application of Gauss' law at each of the intermediate atoms. Bond fluxes have also been calculated for compounds containing ions with non-spherical electron densities (e.g. cations with stereoactive lone electron pairs). In these cases the point-charge model continues to describe the distant field, but multipoles must be added to the point charges to give the correct local field.

Journal Article↗
PubMedDate not supplied

The Model of Whole-Person Caring: creating and sustaining a healing environment.

At Three Rivers Community Hospital, Grants Pass, Ore, the theoretical Model of Whole-Person Caring has resulted in quantifiable and sustainable results in the areas of increased patient and employee satisfaction and decreased nursing turnover, and serves as the foundation for a comprehensive healing environment. The model is a useful framework for healthcare education and its utilization as the theoretical construct for The New England School of Whole-Health Education illustrates its congruency in an educational setting.

Health Facility Environment↗
PubMed2004

Disruptive visions: predictive simulation--between scientific method and clinical trial is the role of modeling and simulation in scientific discovery and validation.

The foundations of surgery have rested upon the passing of knowledge from generation to generation by mentors and manuscripts. Until the 1900 s, the passage of knowledge was through tradition. Since then, it has changed from observation and experience to the scientific method to clinical trials. A new approach, derived from other scientific disciplines, is that of predicting results from modeling and simulation, which will allow for acceleration of the process of validation of discoveries and optimizing the implementation of clinical trials in order to more rapidly transfer trusted knowledge from generation to generation.

Biomedical Research↗
PubMed2007

Rapid responses of ribosomal RNA synthesis to nutrient shifts.

A major challenge in systems biology is to integrate our mechanistic understanding of gene regulation to predict quantitatively how cells will respond to environmental changes. Living cells respond rapidly to the availability of nutrients in part by altering production of ribosomal RNA (rRNA), a limiting component in the biosynthesis of ribosomes. Studies of rRNA transcription by the RNA polymerase of Escherichia coli have identified regulatory roles for guanosine tetraphosphate (ppGpp), the initiating nucleotide, and the protein DksA. To what extent findings from in vitro studies can be used to quantitatively predict in vivo responses to changing nutrient environments is unknown. We developed a mechanistic mathematical model for rRNA transcriptional responses to such changes. Our model accounts for binding of RNAP to its rRNA promoter to form a closed complex, isomerization from a closed complex to an open complex, reversible incorporation of the initiating NTP (iNTP), transcript elongation, and clearance of the promoter. Further, the model incorporates interactions between ppGpp and DksA with transcription intermediates, and it includes an empirical correction to account for salt effects. The model biophysical parameters were determined using 33 single- and multi-round transcription experiments spanning 487 in vitro measurements. By incorporating in vivo measurements of ppGpp and ATP, the model correctly predicted rRNA production rates for cellular responses to nutrient upshifts, downshifts, and outgrowth into fresh medium. Inclusion of DksA was essential in all three cases. Our work provides a foundation for using data-driven computational models to predict the kinetics of in vivo transcriptional responses.

Adaptation, Physiological↗