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PubMed1997

Problems and solutions in forecasting geographical populations.

"This paper asks the question: How does the multistate population model need to be adjusted to provide forecasts of geographical populations? Following an exposition of the standard model, possible solutions to the problems posed by excessive number of parameters are discussed. Decomposition, aggregation and parameterization are described, drawing on some new results. Issues in the temporal forecasting of model components are outlined and the alternative approach of using a spatial interaction model is considered. The paper concludes by arguing that the design of forecasting models is a powerful learning device for both designers and users."

Forecasting↗
PubMed2007

CT colonography: techniques, indications, findings.

Computed tomographic colonography (CTC) is a minimally invasive technique for imaging the entire colon. Based on a helical thin-section CT of the cleansed and air-distended colon, two-dimensional and three-dimensional projections are used for image interpretation. Several clinical improvements in patient preparation, technical advances in CT, and new developments in evaluation software have allowed CTC to develop into a powerful diagnostic tool. It is already well established as a reliable diagnostic tool in symptomatic patients. Many experts currently consider CTC a comparable alternative to conventional colonoscopy, although there is still debate about its sensitivity for the detection of colonic polyps in a screening population. This article summarizes the main indications, the current techniques in patient preparation, data acquisition and data analysis as well as imaging features for common benign and malignant colorectal lesions.

Colonic Polyps↗
PubMed1996

Application of TQM to mental health: lessons from ten mental health centers.

BACKGROUND: The principles and techniques of total quality management (TQM) have only recently been applied to the field of mental health. This article reviews issues and offers some preliminary observations, based on the author's consultation and training work with ten state-operated mental health organizations in Missouri (Jul 1, 1994-Jun 30, 1995). CULTURAL DIMENSION: Since many mental health organizations have operated in the public sector as part of large, hierarchical state agencies, the legacy of bureaucratic structures and a command and control leadership style may pose additional challenges. TECHNICAL DIMENSION: Two types of training have proven helpful in the Missouri project: general overview or awareness training for all staff and specialized training for team leaders and facilitators. STRATEGIC DIMENSION: To be successful with TQM, mental health organizations should clearly delineate their governing ideas, continuously reinforce them with all staff, and use the ideas as a measuring stick for progress. Some of the organizations in the Missouri project link their governing ideas and strategic planning efforts with critical success factors and the measurement methodology to track them. STRUCTURAL DIMENSION: This dimension, which may include a quality council, a quality department, and quality improvement (QI) teams, also extends to the way in which facilities are organized and function. The structure evolving from a team-oriented, time-limited, data-based, and problem-solving approach can facilitate the functioning of the entire organization. CONCLUSIONS: The philosophy and techniques of TQM are as applicable to mental health as to health care in general--the question is one more of motivation than of fit.

Adult↗
PubMed2006

Transfer from table to wheelchair in men and women with spinal cord injury: coordination of body movement and arm forces.

STUDY DESIGN: A complex set-up was used to investigate kinematics and ground reaction forces. SETTING: Motor Control and Physical Therapy Research Laboratory, Neurotec Department, Karolinska Institutet, Huddinge, Sweden. OBJECTIVE: To investigate how men and women with spinal cord injury (SCI) perform transfers from table to wheelchair with regard to timing and magnitude of force generation beneath the hands and associated body movements. METHODS: A total of 13 subjects (seven men, six women) with thoracic SCI. Kinematics of body movement were recorded (Elite 2000 system) simultaneously with the signals from three force plates (AMTI) placed beneath the buttocks and hands. Temporal and spatial parameters regarding head, trunk and trailing arm displacement, loading amplitudes and loading torque directions of both hands were analyzed for each trial and subject and compared between genders. RESULTS: Men and women used similar amplitudes of head bending and forward displacement of the trailing shoulder, while female subjects had significantly larger trunk rotation. Both genders applied significantly more weight on the trailing hand. Differences between genders were seen in direction and timing of peak torque beneath the hands. CONCLUSIONS: The forces beneath the trailing hand were larger than those in the leading, if there is weakness or pain in one arm, this arm should be selected as the leading. To avoid excessive load on the arms, technical aids and environmental factors should be very well adapted. SPONSORSHIP: This project was funded by the Swedish Research Council and the Health Care Science Committee of Karolinska Institutet.

Adult↗
PubMed1989

Leslie matrix models.

A review of the Leslie matrix model theory and its literature 1941-1987 is presented. The point of view is that of a mathematician who focuses on the parts of the theory which are relevant to demography. Works of a decidedly applied nature are not dealt with.

Age Factors↗
PubMed2005

The PDS-XADS reference accelerator and its radioprotection issues.

At the start-up of the FP5 project PDS-XADS, the main initial specifications for the accelerator system (e.g. beam energy, beam intensity, beam profile, their stability and the accelerator availability and reliability) have been defined by Working Package 1 (WP1), 'Global Coherence', in connection with the other WPs of the project. From this, WP3 ('The Accelerator') has assessed the main requirements and the corresponding technical answers. A reference solution, based on a linear superconducting accelerator with its associated doubly achromatic beam line has been worked out to some detail. For high reliability, the proposed design is intrinsically fault tolerant, relying on highly modular 'de-rated' components associated with a fast digital feedback system. The proposed solution also appears to be robust in terms of operational aspects like maintenance and radioprotection. A programme for the remaining R&D required has been elaborated and is proposed within the FP6 project EUROTRANS.

Equipment Design↗
PubMed1983

Utility of the routine left lateral view in gated blood pool studies.

One hundred twenty-four sequential gated blood pool studies were examined by four observers in order to determine the impact on overall interpretation created by the addition of a routine left lateral view to supplement the standard LAO and RAO projections. Of these 124 studies, 114 studies in 87 patients were considered technically adequate. Forty-one of the 114 studies revealed differences in the perception of apex motion in the LAO as compared with the left lateral view. In seven of these 41 cases, the overall diagnostic impression was altered by the left lateral view. A 15-minute increase in technician time at an incremental cost of $3.00 is attributed to the added view. Approximately 6% of overall diagnostic impressions were altered because of this additional routine view.

Coronary Disease↗
PubMedDate not supplied

Whole body skeletal imaging with [18F]fluoride ion and PET.

Using our recently reported whole body PET imaging technique, we performed whole body PET studies of the skeletal system with [18F]fluoride ion in 19 patients with a range of malignant and benign skeletal conditions and in 19 normal male volunteers. The technique produces two-dimensional projection images of the entire skeletal system ("a PET bone scan"), in addition to coronal, sagittal, and axial tomographic images of the skeletal system. The tomographic images had a 13% higher lesion detection sensitivity than the projection images. Whole body PET skeletal imaging with [18F]fluoride ion is technically feasible, provides images of excellent quality, and may be coupled with more quantitatively precise kinetic PET [18F]fluoride ion studies (over limited regions of the body) when numerical estimates of skeletal [18F]fluoride ion uptake are desired. The method is potentially useful in clinical applications where the high resolution and numerical precision of PET are of particular value (e.g., in accurately defining the anatomic location and extent of lesions and in assessing changes in bone metabolism on serial studies).

Adult↗
PubMedDate not supplied

A framework for an institutional high level security policy for the processing of medical data and their transmission through the Internet.

BACKGROUND: The Internet provides many advantages when used for interaction and data sharing among health care providers, patients, and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality, integrity, and availability of information. It is therefore essential that Health Care Establishments processing and exchanging medical data use an appropriate security policy. OBJECTIVE: To develop a High Level Security Policy for the processing of medical data and their transmission through the Internet, which is a set of high-level statements intended to guide Health Care Establishment personnel who process and manage sensitive health care information. METHODS: We developed the policy based on a detailed study of the existing framework in the EU countries, USA, and Canada, and on consultations with users in the context of the Intranet Health Clinic project. More specifically, this paper has taken into account the major directives, technical reports, law, and recommendations that are related to the protection of individuals with regard to the processing of personal data, and the protection of privacy and medical data on the Internet. RESULTS: We present a High Level Security Policy for Health Care Establishments, which includes a set of 7 principles and 45 guidelines detailed in this paper. The proposed principles and guidelines have been made as generic and open to specific implementations as possible, to provide for maximum flexibility and adaptability to local environments. The High Level Security Policy establishes the basic security requirements that must be addressed to use the Internet to safely transmit patient and other sensitive health care information. CONCLUSIONS: The High Level Security Policy is primarily intended for large Health Care Establishments in Europe, USA, and Canada. It is clear however that the general framework presented here can only serve as reference material for developing an appropriate High Level Security Policy in a specific implementation environment. When implemented in specific environments, these principles and guidelines must also be complemented by measures, which are more specific. Even when a High Level Security Policy already exists in an institution, it is advisable that the management of the Health Care Establishment periodically revisits it to see whether it should be modified or augmented.

Access to Information↗
PubMed1997

Overview of DOD activities in ecological risk assessment.

Under the Comprehensive Environmental Response, Compensation and Liability Act, Congress has mandated that all designated hazardous waste sites will be remediated to protect human health and the environment. This law is the driving force behind the Department of Defense (DOD) ecological risk assessment (ERA) program. Ecological risk assessments are currently underway at many DOD sites with budgets ranging from five thousand to ten million dollars. However, with the advent of downsizing government and shrinking funds, efforts are being made within DOD to better refine these assessments. Two DOD work groups function to develop guidance for and assist project managers with the ERA process. These groups are the Army Biological Technical Assistance Group chaired by the Army Environmental Center and the Tri-Service Ecological Risk Assessment Work Group (ERWG) chartered by the Tri-Service Environmental Support Centers Coordinating Committee. Membership in the Tri-Service ERWG includes all facets of DOD. In the research arena, the Fate & Effects Research and Development Program is one of four primary thrust areas under the Army's Environmental Quality Technology Program "Clean Up" pillar. This program is currently being executed by three laboratories, the Waterways Experiment Station, Vicksburg, MS, the Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD, and the Army Center for Environmental Health Research (Provisional), Ft. Detrick, MD. The goal of this program is to provide tools to improve environmental risk assessments, both human and ecological. The research is geared toward addressing user requirements and is defined by the Fate and Effects Research Program.

Ecology↗
PubMed1989

The living anatomy of the knee.

A brief account is given of the subject chosen by a candidate for the IMBI Higher Examination. His major project was to produce a video programme about the knee. With limited technical equipment at his disposal, but with plenty of visual imagination and technical ingenuity, a programme was produced that not only gave him a distinction award in his examination, but also received wide acclaim and won him several awards.

Humans↗
PubMed2000

Ryan White CARE Act Title IV: building networks to improve healthcare delivery to the HIV infected.

There has been little evaluation of the implementation of HIV consortia that were created under Title IV of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. In 1993, Mor and colleagues reported that the effectiveness of networks established by the Robert Wood Johnson Foundation had been compromised by the inability of the participating agencies to work together, given their competing goals and varied institutional cultures. In a study published in 1995, Roy and colleagues identified the following as determinants of successful project implementation: federal and local government support, management-level support and technical assistance, and linkages between participating agencies. This article describes the role that network infrastructure can play in developing interagency collaboration, and the importance of network infrastructure in coordinating the delivery of care at the service-delivery level. The authors describe the efforts of the Lower New York Consortium for Families with HIV (hereafter, "the Consortium") to develop integrative mechanisms at both the network level and the program level. As the number of infected women grows, so does the need to improve the delivery of services and to reduce barriers to the receipt of care. In itself, the support of individual agencies that provide case-management services may not be enough to improve service delivery and reduce barriers; the experiences of networks such as the Consortium may help inform the development of guidelines for creating and enhancing the coordination of services to assure improvements in care. Systematic studies are needed to evaluate different models of collaboration and of coordinating care to determine whether the effort to develop consortia is justified by improved access to care and improved health.

Case Management↗