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PubMedDate not supplied

Modeling nursing interventions in the act class of HL7 RIM Version 3.

The proposed Health Level 7 Reference Information Model (HL7 RIM) Version 3 is the foundation for expressing data to be communicated across health care information systems. The general objective of this analysis was to examine whether the RIM supports the expression of nursing interventions, considering both terminological and structural perspectives. The Nursing Terminology Summit Interventions Group focused on patient education about breast cancer, an intervention that differs sufficiently from other medical processes already considered by HL7 and represents issues surrounding both definition and execution of nursing process. Relevant actors, actions, and action relationships were culled from use cases and modeled into the proposed RIM structure and attributes by using modified instance diagrams. This method was effective and reproducible, and the RIM proved to be an adequate model for supporting breast cancer education. Additional interventions must be studied to fully assess the adequacy of the model to support all aspects of nursing process and terminology.

Computational Biology↗
PubMedDate not supplied

Evidence for competitive inhibition of iodide uptake by perchlorate and translocation of perchlorate into the thyroid.

Various published data sets that investigate the potential effect of exogenous perchlorate (ClO4-) on the uptake of iodide in the thyroid and subsequent changes in thyroid hormone levels are available. In order to best use the data towards the prediction of human health effects resulting from ClO4- exposure, the available literature data must be integrated into a self-consistent, coherent, and parsimonious quantitative model based on the most likely mode of action of perchlorate effect on thyroid function. We submit that the simplest mode of action for ClO4- in the thyroid that remains consistent with all available data involves competitive inhibition of iodide transport into the thyroid follicle, transport of perchlorate into the thyroid follicle against a concentration gradient, further transport into the thyroid lumen (where it may again interfere with iodide transport), and, finally, passive diffusion back into the blood. We believe this description of perchlorate's kinetic behavior should serve as the foundation for predictive physiologically based pharmacokinetic (PBPK) models and as a working hypothesis for further experimental exploration.

Animals↗
PubMed2002

A critical reexamination of the morphology, neurovasculature, and fiber architecture of knee extensor muscles in animal models and humans.

The purposes of the present study were to resolve a number of major inconsistencies found in the literature on the structure of the quadriceps femoris muscle and to extend knowledge of its structure using descriptive, qualitative methodology. The quadriceps femoris muscle was investigated in 41 cats, and the findings were confirmed in 6 human cadavers. Two aponeuroses with major biomechanical functions (rectus-vastus and vastus aponeurosis), neither of which had been previously described in the literature, were characterized in both species. The study also resolved many major inconsistencies in the literature: The muscle sometimes described as vastus intermedius (VI) was found to be the articularis genu, the muscle sometimes described as vastus medialis (VM) was found to be the VI, the rectus femoris head was found to have an additional proximal nerve branch not previously recognized, no anomalous 5th head was everfound, and the distal VM were not found to have 2 heads (in either cats or humans). The authors' anatomical descriptions and bimechanical models of the muscles, tendons, and neurovascular should provide a helpful foundation for future studies on the quadriceps. Two general recommendations are made: 1) that the feline model be considered a viable model to elucidate human knee pathomechanics; and 2) that regardless of the anatomical structure of interest, orthopedic nurses, orthopedic surgeons, and research investigators should routinely use the research literature for anatomical guidance instead of standard anatomical textbooks.

Animals↗
PubMedDate not supplied

Family-centered care in Ontario general hospitals: the views of pediatric nurses.

Registered nurses and registered practical nurses working on pediatric units in 35 Ontario general hospitals participated in a study that examined their perceptions and practices of family-centered care (FCC). The Family-Centered Care Questionnaire-Revised (FCCQ-R) was used to collect the data. The participants were asked to rate their level of agreement regarding necessary elements (perceptions) of family-centered care and whether these elements are part of their current work (practice). The participants had a reasonable knowledge of the necessary elements of family-centered care, but were not consistently including these in their every day work. A number of barriers to the implementation of family-centered care were also identified. Perception and practice scores were higher among those who had participated in continuing education on family-centered care than those who had not. The findings suggest that some nurses may be having difficulties shifting from a medical helping model of care to an enabling helping model of care, which is considered the foundation of family-centered care. Difficulties in implementing family-centered care appear to be systemic, both at the unit and organizational level. Based on the findings, implications for practice, education and research are suggested.

Adult↗
PubMed2001

Conclusions: Considerations regarding SERMs.

The "considerations" addressed in this section consist of a number of thought-provoking issues and unresolved questions that emerge from the papers in this volume. The evidence for tamoxifen carcinogenicity in animal models and, to a more restricted extent, in humans has led some investigators to question whether SERMs are ready or appropriate for clinical testing--specifically, in a disease prevention setting involving healthy but high-risk individuals. There is, however, inconsistency in both efficacy and toxicity--specifically, carcinogenicity--between animal models and humans, leading others to question the value of basing the decision to proceed with clinical studies on preclinical results in animals. Although the molecular basis for SERM action is rapidly being clarified, the cellular activity of these agents is still elusive. We discuss the view that the efficacy of tamoxifen in breast cancer is based on its treatment of "occult cancers," or small collections of cancer cells that are not clinically apparent, not only in the context of prevention but also in the treatment setting. As part of our approach that assumes estrogen activity to be the foundation upon which SERM development is being modeled, we discuss the inconsistency between the epidemiologic data and prospective randomized data with respect to the relationship between estrogen use and cardiovascular disease. The need to validate surrogate markers of SERM action is discussed in relation to bone but is clearly relevant to all disease sites. The semantics used in describing SERM action as agonistic or antagonistic in relation to estrogen at various target sites has been inconsistent, especially in the clinical context. We attempt to dissect out some of the inconsistencies in semantics in the hope that this will contribute to improved communication of data resulting from SERM research. In the clinical arena, we begin with the premise that the large, simple randomized trial offers the optimal design for the testing of SERMs. In view of limited resources, however, we counter this position with alternative, if less desirable, approaches to the clinical format for SERM testing. Finally, we explore the process by which statistically meaningful results from clinical trials are extrapolated into the specific drug indications that apply to clinical practice.

Animals↗
PubMed2006

A reference model for clinical tumour documentation.

The definition of common system semantics is an explicit and generally accepted precondition for comparability and exchangeability of data from different systems. We have looked back on 15 years of experience with a data model that was developed in a co-operative effort by experts from various hospital cancer registries as the foundation of a new tumour documentation system (GTDS). The data model is based on the definition of a common basic data set for hospital cancer registries which is agreed by the German Association of Comprehensive Cancer Centres (ADT). This paper presents an "entity relationship" view of this model. Since data exchange among registries and with hospital or practice information systems is becoming increasingly important we describe our method to import data from such systems. We discuss the requirements that systems have to have for a most effective way of exchanging data with a hospital cancer registry. The most important feature is the possibility to associate disease phenomena and therapies with each other and with an entity that represents the tumour across encounters. The reference model we present respectively the requirements we propose for other communicating systems might also fit for other chronic diseases.

Germany↗
PubMed2000

A multilevel analysis of the demands--control model: is stress at work determined by factors at the group level or the individual level?

This study explored the extent to which negative health-related outcomes are associated with differences between work groups and with differences between individuals within work groups using R.A. Karasek's (1979) demands-control model. The sample consisted of 260 employees in 31 working groups of a national bank in the Netherlands. Results suggest that job demands and job control should be conceptualized as having both group- and individual-level foundations. Support for Karasek's demands-control model was found only when these variables were split into the 2 parts, reflecting shared perceptions and employees' subjective assessment, respectively. One of the most appealing practical implications is that absence rates among homogeneous work groups can be reduced by enhancing actual control on the job.

Adult↗
PubMedDate not supplied

Telephone prescreening enhancing a model for proactive healthcare practice.

PURPOSE: This article explicates the process of developing and implementing a contemporary, innovative program using the telephone as a tool for prescreening newly diagnosed cancer patients before their arrival at the cancer center. As another element of existing models of psychosocial care, this service lays the foundation for the efficient delivery of clinical social work services. DESCRIPTION OF PROGRAM: In the Surgical Oncology Clinic of the M.D. Anderson Cancer Center in Houston, Tex, 28 patients were contacted as part of a telephone prescreening model of a practice program from February 1, 1995 through March 31, 1995. Using a structured telephone interview format, two clinic social workers contacted patients and provided information on social work services. Patients needing resource assistance were provided with community referrals. Using the information from the telephone call, a brief outpatient assessment was completed for each patient before his or her arrival at the clinic. During the initial clinic visit, each new patient was met by the social worker to conduct a qualitative interview and address specific treatment-related concerns. OUTCOME OF PROGRAM: The patients expressed their appreciation of the interest of the social work staff and their satisfaction with the information provided. In addition, obtaining patient information and identifying patient needs before the initial visit allowed social workers to use clinic time more efficiently. Because of restructuring, the Surgical Oncology Clinic was eliminated and use of the intervention suspended. Based on the encouraging results of the telephone prescreening model of care program, reinstating the program in the future would include expanding its hours of operation to reach individuals who are not at home during the hours of 8:00 am 25:00 pm and including language assistance to address the needs of the increasingly multicultural population. CLINICAL IMPLICATIONS: Telephone prescreening is one strategy for personalizing psychosocial assessment. In this era of outpatient day surgery and cost-controlled managed healthcare, the benefits of prescreening are empowerment for both patients and multidisciplinary team members. The future holds promise for telephone prescreening to become part of the collaborative clinical pathways model of the disease-site centers concept.

Adult↗
PubMed2001

Single molecule measurements of titin elasticity.

Titin, with a massive single chain of 3--4MDa and multiple modular motifs, spans the half-sarcomere of skeletal and cardiac muscles and serves important, multifaceted functions. In recent years, titin has become a favored subject of single molecule observations by atomic force microscopy (AFM) and laser optical trap (LOT). Here we review these single titin molecule extension studies with an emphasis on understanding their relevance to titin elasticity in muscle function. Some fundamental aspects of the methods for single titin molecule investigations, including the application of dynamic force, the elasticity models for filamentous titin motifs, the technical foundations and calibrations of AFM and LOT, and titin sample preparations are provided. A chronological review of major publications on recent single titin extension observations is presented. This is followed by summary evaluations of titin domain folding/unfolding results and of elastic properties of filamentous titin motifs. Implications of these single titin measurements for muscle physiology/pathology are discussed and forthcoming advances in single titin studies are anticipated.

Amino Acid Motifs↗
PubMed2002

Health policy. Who's got the master card?

The last decade has seen huge shifts away from the command and control model which dominated health policy since the foundation of the NHS. The current Labour government Initially favoured a system based on collaboration and partnership working but the incentives to achieve this were not sufficiently strong. Competition is now once again openly cited as a driver for improved performance. Political demands mean that command and control are likely to remain key features of government health policy. But this, in turn, is likely to place major limitations on the local autonomy pledged by the government.

Cooperative Behavior↗
PubMed2005

Buoyancy-drag mix model obtained by multifluid interpenetration equations.

In this paper, a buoyancy drag equation for describing the motion of the edges of a mixing zone driven by Rayleigh-Taylor or Richtmyer-Meshkov instabilities is derived from the multifluid interpenetration mix model equations of Scannapieco and Cheng [Phys. Letters A 299, 49 (2002)]. This derivation provides a physics foundation for a large class of phenomenological buoyancy-drag mix models and also establishes a physical connection between the microscopic collision frequency and the macroscopic fluid drag coefficient. The predicted values for model parameter a(ss') in the multifluid interpenetration mix model, from the Rocket-Rig experiments, is in the range of 0.043-0.125 depending upon the Atwood number. The results are also in good agreement with inertial confinement fusion capsule implosions.

Journal Article↗
PubMed2002

Multicenter clinical research in adult critical care.

OBJECTIVE: To describe the development, organization, and operation of several collaborative groups conducting investigator-initiated multicenter clinical research in adult critical care. DESIGN: To review the process by which investigator-initiated critical care clinical research groups were created using examples from Europe, Australia, the United States, and Canada. Various models of group structure and function are discussed, highlighting complementary approaches to protocol development, multicenter study management, and project funding. DATA SOURCES: Published peer review research and unpublished terms of reference documents on the structure and function of these groups. DATA SYNTHESIS: The overall goal of clinical critical care research groups engaged in multicenter studies is to improve patient outcomes through conducting large, rigorous investigations. Research programs we reviewed included the following: a) multicenter epidemiologic studies and surveys; b) technology evaluations of mechanical ventilation; c) investigations focused on three priority fields (acute lung injury, infection, and acute brain injury); d) a series of randomized trials of treatments for one syndrome (acute respiratory distress syndrome); and e) diverse methodologies addressing several clinical problems. The structure and function of these research groups differ according to their historical development, research culture, and enabling resources. Specific protocols emerge from clinical questions generated by investigators or from collectively prioritized research agendas. Project funding includes government support, peer-review grants, intensive care foundations, industry, local hospital funds, and hybrid models. Infrastructure for study management varies widely. CONCLUSIONS: Several national and international groups have engaged in investigator-initiated multicenter critical care research. The development, organization, and operational methods of these groups illustrate several collaborative models for clinical investigations in the intensive care unit. Common characteristics of these groups are a cohesive spirit, a sense of mission to achieve shared research goals, and acknowledgment that such an organization is much more than the sum of its parts.

Adult↗
PubMed2005

The baboon as a good model for studies of human kidney development.

Because of the improved survival of premature neonates in recent years, it is important to investigate the effects of premature delivery on the kidney, in which nephrogenesis is still ongoing during the third trimester. Hence, an appropriate animal model that is similar to humans is essential. The aim of the current study is to determine the time course of nephrogenesis in the baboon, to establish whether it is a suitable model of human nephrogenesis. At the Southwest Foundation for Biomedical Research (San Antonio, TX), fetal baboons were delivered prematurely by cesarean delivery and at term by natural delivery. Fixed kidneys from 125-, 140-, 175-, and 185-d gestation baboons were assessed morphologically for evidence of a nephrogenic zone. Nephron number, kidney volume, and glomerular and corpuscle volume were also estimated using unbiased stereology. Morphologic assessment confirmed the presence of metanephric mesenchyme and immature glomeruli in the nephrogenic zone of the kidneys from the prematurely delivered fetuses at 125 and 140 d gestation. At 175 d gestation and at term, the nephrons seemed to be mature. Both kidney weight (R2= 0.918, p = 0.0002) and kidney volume (R2= 0.837, p = 0.001) were very strongly correlated with nephron number. There was also a direct relationship between gestational age (R2= 0.589, p = 0.03) and birth weight (R2= 0.562, p = 0.03) with nephron number. In conclusion, in this study, nephrogenesis in the baboon is complete before term by 175 d gestation, which is similar to humans. Hence, the baboon is a suitable model for future studies to investigate human kidney development.

Animals↗
PubMed2026

Multi-Ancestry Survival GWAS of Substance Use Initiation in the ABCD Study.

BACKGROUND: Substance use initiation in adolescence is influenced by both genetic and environmental factors; however, large-scale genetic studies often treat initiation as a binary outcome and underuse longitudinal timing information. METHODS: We conducted time-to-event (survival) genome-wide association analyses (GWAS) of initiation for four outcomes-alcohol, nicotine, cannabis, and any substance use-using longitudinal follow-up data from the Adolescent Brain Cognitive Development (ABCD) Study. We performed ancestry-stratified GWAS within European (EUR), African (AFR), and Hispanic (HISP) groups, applying consistent quality control and covariate adjustment. Summary statistics were harmonized across ancestries and meta-analyzed using inverse-variance weighted fixed-effects and DerSimonian-Laird random-effects models. We evaluated genomic inflation and heterogeneity (Cochran's Q and I 2), identified independent lead variants at genome-wide and suggestive significance thresholds, and assessed cross-trait overlap of associated loci. RESULTS: In the multi-ancestry meta-analysis, we observed suggestive association signals across traits (minimum p-values: alcohol ~ 1 &#xd7; 10-7, any ~ 1 &#xd7; 10-7, cannabis ~ 5 &#xd7; 10-8, nicotine ~ 1 &#xd7; 10-8). Nicotine initiation showed one genome-wide significant variant in both fixed- and random-effects meta-analyses (p < 5 &#xd7; 10-8). Across traits, suggestive loci demonstrated limited overlap, with the strongest concordance between alcohol and any substance use, consistent with shared liability. Heterogeneity statistics indicated that some loci exhibited cross-ancestry variation in effect estimates. CONCLUSIONS: Survival GWAS leveraging initiation timing can identify genetic signals that may be missed by binary designs and enables principled multi-ancestry synthesis. Our results highlight both shared and trait-specific genetic contributions to early substance initiation and provide a foundation for downstream functional annotation and integrative modeling with environmental risk factors. These findings demonstrate the value of incorporating developmental timing into genetic discovery and provide a framework for integrating longitudinal risk modeling with genomic analyses.

ABCD↗
PubMed2005

Molecular chain stretch is a multiaxial failure criterion for conventional and highly crosslinked UHMWPE.

The development of accurate theoretical failure, fatigue, and wear models for ultra-high molecular weight polyethylene (UHMWPE) is an important step towards better understanding the micromechanisms of the surface damage that occur in load bearing orthopaedic components and improving the lifetime of joint arthoplasties. Previous attempts to analytically predict the clinically observed damage, wear, and fatigue failure modes have met with limited success due to the complicated interaction between microstructural deformations and continuum level stresses. In this work, we examined monotonic uniaxial and multiaxial loading to failure of UHMWPE using eight failure criteria (maximum principal stress, Mises stress, Tresca stress, hydrostatic stress, Coulomb stress, maximum principal strain, Mises strain, and chain stretch). The quality of the predictions of the different models was assessed by comparing uniaxial tension and small punch test data at different rates with the failure model predictions. The experimental data were obtained for two conventional (unirradiated and gamma radiation sterilized in nitrogen) and two highly crosslinked (150kGy, remelted and annealed) UHMWPE materials. Of the different failures models examined, the chain stretch failure model was found to capture uniaxial and multiaxial failure data most accurately for all of the UHMWPE materials. In addition, the chain stretch failure criterion can readily be calculated for contemporary UHMWPE materials based on available uniaxial tension data. These results lay the foundation for future developments of damage and wear models capable of predicting multiaxial failure under cyclic loading conditions.

Arthroplasty, Replacement↗
PubMed1990

The CIO and IRM (information resources management) alliance: maneuvering for the competitive edge in hospital information management.

In 1986, Johns noted that "The hospital industry was caught unprepared for the external demands and information needs required in a case-mix reimbursement environment." Lack of a data-processing philosophy and inattention to external forces were cited as having hampered technology upgrade and integration of financial and clinical databases. The intervening years have witnessed a growth of information dissemination in the health care industry concerning information value and resource management. The frequency of appearance of articles on information management in the professional literature and the number of workshops and professional meetings addressing the topic attest to the current visibility of the information resource. Despite this flurry of interest, the industry has not developed its own models of information resources management nor validated its information evolution with accepted management information systems models. While interest in health care information resource management exists, understanding of the complex issues in this area has not developed as one would expect. While there are a myriad of reasons for this, a contributing factor is the lack of a research foundation for development and application of theory and models. Even though various graduate programs exist in medical informatics and biomedical computing, few concentrate on the study of health information resource management from an organizational perspective. Because of this, academic research in the area has been minimal. The scarcity of graduate-level programs has also meant that few individuals have been educated to deal with the challenges of managing the many disparate functional activities associated with health care information resource management. Due to a variety of internal and external forces, extreme demands were placed on the hospital information resource during the past decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Administrators↗
PubMed1999

Stiffening response of a cellular tensegrity model.

Living cells exhibit, as most biological tissues, a stiffening (strain-hardening) response which reflects the nonlinearity of the stress-strain relationship. Tensegrity structures have been proposed as a comprehensive model of such a cell's mechanical response. Based on a theoretical model of a 30-element tensegrity structure, we propose a quantitative analysis of its nonlinear mechanical behavior under static conditions and large deformations. This study provides theoretical foundation to the passage from large-scale tensegrity models to microscale living cells, as well as the comparison between results obtained in biological specimens of different sizes. We found two non-dimensional parameters (L*-normalized element length and T*-normalized elastic tension) which govern the mechanical response of the structure for three types of loading tested (extension, compression and shear). The linear strain-hardening is uniquely observed for extension but differed for the two other types of loading tested. The stiffening response of the theoretical model was compared and discussed with the living cells stiffening response observed by different methods (shear flow experiments, micromanipulation and magnetocytometry).

Animals↗
PubMed1993

School heart health promotion: the National Heart Foundation (Western Australian) approach.

The National Heart Foundation of Australia's commitment to school health promotion expanded progressively since 1983. Following establishment of health education curriculum documents by the state Ministries of Education, the Foundation targeted schoolchildren with primary prevention programs and resources. The Foundation looked beyond instructional settings to examine the influence of the school environment on the health of students and school personnel. This paper describes a school heart health promotion model implemented by the Western Australian Division of the National Heart Foundation, serving one of Australia's eight states and territories. The model incorporates elements of policy, curriculum, environment, health services, and community interaction. Though similar to comprehensive models of school health education, this model limits its application to heart health. The program operates in a nongovernment agency with unmatched potential for national reach.

Adolescent↗