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PubMedDate not supplied

Analysis of a spacecraft life support system for a Mars mission.

This report summarizes a trade study conducted as part of the Fall 2002 semester Spacecraft Life Support System Design course (ASEN 5116) in the Aerospace Engineering Sciences Department at the University of Colorado. It presents an analysis of current life support system technologies and a preliminary design of an integrated system for supporting humans during transit to and on the surface of the planet Mars. This effort was based on the NASA Design Reference Mission (DRM) for the human exploration of Mars [NASA Design Reference Mission (DRM) for Mars, Addendum 3.0, from the world wide web: http://exploration.jsc.nasa.gov/marsref/contents.html.]. The integrated design was broken into four subsystems: Water Management, Atmosphere Management, Waste Processing, and Food Supply. The process started with the derivation of top-level requirements from the DRM. Additional system and subsystem level assumptions were added where clarification was needed. Candidate technologies were identified and characterized based on performance factors. Trade studies were then conducted for each subsystem. The resulting technologies were integrated into an overall design solution using mass flow relationships. The system level trade study yielded two different configurations--one for the transit to Mars and another for the surface habitat, which included in situ resource utilization. Equivalent System Mass analyses were used to compare each design against an open-loop (non-regenerable) baseline system.

Air Conditioning↗
PubMed2003

IHE: a model for driving adoption of standards.

The development of communication standards in healthcare is a major ongoing engineering effort. While there is little doubt that this effort has made possible significant advances in the performance of healthcare information and imaging systems, overall levels of systems interoperability have not improved as dramatically as one might reasonably expect and the cost of implementing effectively integrated systems remains high. The lag between the development of information standards and their implementation in real systems and institutions is a genuine problem in healthcare. This paper describes an ongoing initiative that attempts to bring together healthcare professionals and industry experts to coordinate the implementation of standards in ways that enhance operational efficiency and the quality of patient care.

Computer Security↗
PubMed1991

The integrated blood-collection system as a vehicle into complete clinical laboratory automation.

A rationale is offered and methodology illustrated for integrating the fundamental steps involved in the collection and processing of blood for laboratory evaluation. The approach taken in the development of these concepts and components greatly extends the possibilities of laboratory systems integration without upsetting established modalities. A prototype design of the integrated blood-collection system integrates blood collection, cellular separations, sample transfer to stable storage without chemical mediators, and sample presentation for chemical analysis (e.g., precision metering) while preserving patient identification. A sophisticated, multi-chambered blood-collection container is the site of all blood sample processing and transfer steps. This device is supported by a compact, robotic centrifuge of unique design and a transfer mechanism to facilitate sample delivery for analysis within a diagnostic instrument. The confluence of these individual components into a single integrated system provides the means to completely automate the processing of blood samples, after sample collection, eliminating all manual transfer steps and any external exposure of blood interfaces outside the diagnostic instrument. Configurational derivatives of the Integrated Blood-Collection System offer choice of skin or venipuncture procedure, rapid plasma extraction for micro- or macro-collected volumes, and sample delivery by either aspiration or direct metering of discrete 10-microL samples from the collection container. The skin-puncture configuration provides the opportunity within a single device to collect and process up to 500 microL of sample by capillarity from a skin prick.

Automation↗
PubMed1994

Tracking risk in integration.

Healthcare systems rushing into integration may be leaving themselves vulnerable to lawsuits involving medical liability--risk that's often ignored. Winners in the fourth annual Excellence in Healthcare Risk Management Awards show how some providers are addressing that vulnerability.

Awards and Prizes↗
PubMed2003

Integrative neuroscience.

A fundamental impediment to an "Integrative Neuroscience" is the sense that scientists building models at one particular scale often see that scale as the epicentre of all brain function. This fragmentation has begun to change in a very distinctive way. Multidisciplinary efforts have provided the impetus to break down the boundaries and encourage a freer exchange of information across disciplines and scales. Despite huge deficits of knowledge, sufficient facts about the brain already exist, for an Integrative Neuroscience to begin to lift us clear of the jungle of detail, and shed light upon the workings of the brain as a system. Integrations of brain theory can be tested using judicious paradigm designs and measurement of temporospatial activity reflected in brain imaging technologies. However, to test realistically these new hypotheses requires consistent findings of the normative variability in very large numbers of control subjects, coupled with high sensitivity and specificity of findings in psychiatric disorders. Most importantly, these findings need to be analyzed and modeled with respect to the fundamental mechanisms underlying these measures. Without this convergence of theory, databases, and methodology (including across scale physiologically realistic numerical models), the clinical utility of brain imaging technologies in psychiatry will be significantly impeded. The examples provided in this paper of integration of theory, temporospatial integration of neuroimaging technologies, and a numerical simulation of brain function, bear testimony to the ongoing conversion of an Integrative Neuroscience from an exemplar status into reality.

Animals↗
PubMed1995

Control of food-borne infections and intoxications.

Most food-borne diseases are caused by microorganisms that initially contaminate the living plant or animal or recontaminate the food during handling or processing. Control measures are intended to (1) prevent microorganisms from contaminating food and involve all hygienic production measures (raw material, premises, equipment, cleaning and disinfection, personnel); (2) prevent microorganisms both from growing or forming toxins, e.g. through chilling, freezing or other processes that do not destroy microbes, such as reduction of aw or pH; (3) eliminate microorganisms, e.g. through thermal processing. Integrated systems for control of the microbiology and hygiene of foods aim at a gradual or stepwise reduction of health hazards at all stages of production and processing until final operations. As a further development of HACCP (Hazard Analysis Critical Control Point), other systems such as the LISA (Longitudinally Integrated Safety Assurance) concept, include also the primary stages of harvesting. With respect to food animals, this clearly involves veterinary control of the livestock as an initial stage of food production. As with salmonellosis, the implementation of control systems is helpful in reducing risks at particular critical points. However, isolated measures do not solve the problem as a whole and cannot meet the demands of consumer protection. At least in the case of salmonellosis a global strategy of control is needed which requires political decisions from the relevant public health bodies.

Animal Husbandry↗
PubMed2003

Children's oral health in the medical curriculum: a collaborative intervention at a university-affiliated hospital.

The purpose of this study was to 1) describe the structure of the oral health program in a university-affiliated hospital; 2) evaluate staff's knowledge and attitudes toward oral health; and 3) propose ways to strengthen the incorporation of oral health prevention for children into clinical medical education. Qualitative methods were used to evaluate the program. Structured interviews with seventeen medical center personnel were conducted, and clinic utilization reports provided ICD-9 diagnostic frequency and visits. Clinic staff, pediatric residents, dental and pediatric faculty, hospital administrators, and clinic directors were interviewed. The themes identified during these interviews were motivation, roles, operational and organizational issues, and integration into the larger medical care system. Integration of an early childhood caries prevention program into the clinical medical education curriculum can be accomplished. After implementation of the oral health program described in this paper, dental caries became the eleventh most common diagnosis seen in the clinic when previously it did not appear in the top forty. However, institutional and organizational barriers are significant. Barriers identified were 1) lack of clarity in defining leadership and roles regarding oral health, 2) time and work overload in a busy pediatric clinic, 3) a tracking system was not available to quickly determine which children needed caries prevention procedures and education, and 4) billing and medical record form changes could not be fully established prior to starting the program.

Attitude of Health Personnel↗
PubMed2002

Attenuated Salmonella enterica serovar typhi live vector with inducible chromosomal expression of the T7 RNA polymerase and its evaluation with reporter genes.

Attenuated Salmonella strains with defined gene deletions have been extensively evaluated as suitable live carriers of passenger antigens. A number of strategies for antigen delivery by these strains have been attempted, ranging from plasmid-based to chromosomal integration systems. We report here the chromosomal integration of the T7 RNA polymerase gene (T7pol) in the attenuated strain Salmonella enterica serovar Typhi (Salmonella typhi) CVD908 (aroC(-), aroD(-)). The T7pol gene was amplified by PCR from Escherichia coli BL21(DE3) and cloned in the pNir3 plasmid under the control of the anaerobically inducible nirB promoter. Then it was subcloned in a pKTN701 derivative, suicide plasmid with the R6K ori, and flanked by the aroC gene. After evaluation of its functionality in E. coli SY327, the aroC-T7pol-aroC cassette was integrated into the aroC locus of S. typhi CVD908 by homologous recombination. The resulting strain, S. typhi CVD908-T7pol, was able to transcomplement two plasmids bearing the luc or the lacZ reporter genes controlled by the T7 promoter and produce luciferase and beta-galactosidase under anaerobic culture conditions. Therefore, an inducible system for recombinant antigen production in attenuated S. typhi was achieved.

Bacterial Proteins↗
PubMedDate not supplied

Longitudinal assessment of a diabetes care management system in an integrated health network.

OBJECTIVE: To describe the results of longitudinal assessment of the results of a disease management process developed in a large integrated health care system that successfully improved care for patients with diabetes. Outcome measures included rates of testing of hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL), rate of annual eye exams, and LDL and HbA1c values. METHODS: Intermountain Health Care (IHC) initiated the development of a Diabetes Care Management System (DCMS) in early 1998. The DCMS was developed as a comprehensive population-based disease management system. It includes provider education programs; performance feedback to physicians; clinical quality performance incentives for physicians; patient education programs; patient incentive, reminder systems to encourage compliance with best care process models; and tracking of physician behavior change and patient compliance with diabetes therapy. A multifaceted intervention and education approach was chosen because of the complexity of the diabetes treatment process. RESULTS: The percentage of patients with at least one annual HbA1c test increased from 78.5% in 1998 to 90.5% in 2002. During the same time period, the percentage of patients whose most recent HbA1c was less than 7.0 increased from 33.5% to 52.8%, average HbA1c decreased from 8.1 to 7.3, and the percentage of patients whose most recent HbA1c was greater than 9.5 decreased from 34.6% to 21.4%. The percentage of patients who had an LDL cholesterol screening test within the prior 2 years increased from 65.9% in 1998 to 91.7% in 2002. During the same time period, the percentage of patients whose most recent LDL cholesterol was less than 130 mg/dL increased from 39.9% to 69.8%. The percentage of diabetes patients who had an annual eye exam increased from 52% in 1998 to 62% in 2002. CONCLUSION: A multifaceted approach to improving diabetes management has led to improved performance in clinical measures related to diabetes care that have been shown to reduce the risk of patients with diabetes developing diabetes- related complications. All components of the diabetes management continuum of care, including primary care physicians, specialists, office staff, patients, diabetes educators, and others, were involved in the care improvement activities.

Delivery of Health Care, Integrated↗
PubMed2003

Skin-conditioning products in occupational dermatology.

Moisturizers are frequently used in the prevention of occupational contact dermatitis. This review discusses their chemistry and mode of action. Methods to prove their preventive efficacy are presented. In addition to pharmacological efficacy, subjective factors that influence application of the products and compliance come into play. In conclusion, moisturizers are only one element of skin-disease prevention at the workplace that should be viewed as a complex, inter-dependent system. The efficacy of the complete, integrated system of occupational skin care has to be proven.

Dermatitis, Occupational↗
PubMed2000

Functional characteristics of neutrophils collected and stored after administration of G-CSF.

BACKGROUND: Granulocyte transfusion may be used in neutropenic patients with severe bacterial or fungal infections that are unresponsive to antibiotic therapy. However, the inability to store granulocyte concentrates limits their clinical usefulness. STUDY DESIGN AND METHODS: Neutrophil chemotaxis and NADPH oxidase activity and the integrity of the neutrophil NADPH oxidase system were examined after apheresis collection and during storage to 48 hours. Neutrophils were mobilized in vivo by G-CSF, collected by apheresis techniques, and stored in apheresis bags in the presence and absence of additional G-CSF. For all experiments, cells were further purified by standard techniques of dextran sedimentation and hypotonic RBC lysis. RESULTS: Neutrophil chemotaxis was preserved to 24 hours of storage but was not affected by the G-CSF added to storage units. The NADPH oxidase system was also preserved as a functioning complex, and both cytosolic proteins and membrane-associated proteins were normal to 48 hours. However, there were divergent responses by intact cells to activating stimuli and reduced oxidase activity in the cell-free system. G-CSF did not appear to significantly affect NADPH oxidase activity or NADPH oxidase system integrity during storage. CONCLUSION: Neutrophils collected after the administration of G-CSF retained functional and biochemical characteristics for at least 24 hours of storage, which suggests additional effects of G-CSF mobilization beyond enhancing PMN yields and the possibility of storage of these components after collection.

Adult↗
PubMedDate not supplied

Case management information systems: how to put the pieces together now and beyond year 2000.

The case management process is a critical management and operational component in the delivery of customer services across the patient care continuum. Case management has transcended time and will continue to be a viable infrastructure process for successful organizations in the future. A key component of the case management infrastructure is information systems and technology support. Case management challenges include effective deployment and use of systems and technology. As more sophisticated, integrated systems are made available, case managers can use these tools to continue to expand effectively beyond the patient's episodic event to provide greater levels of cradle-to-grave management of healthcare. This article explores methods for defining case management system needs and identifying automation options available to the case manager.

Case Management↗
PubMed2006

Lack of ethnic disparities in adult immunization rates among underserved older patients in an urban public health system.

BACKGROUND: In some settings, immunization rates for ethnic minorities are less than those of non-Hispanic white populations. This study examines demographic differences in the rate of pneumococcal and influenza immunization in an ethnically diverse older patient population seeking care at an urban primary care clinic system. METHODS: The setting is an integrated system of 11 federally qualified community health centers serving approximately 100,000 unduplicated patients annually. We linked data from chart audits performed in 2001-2003 for quality assurance purposes with patient registration data to evaluate vaccination rates in 740 patients age 66 years and older who had at least 3 primary care visits in the previous 2 years. RESULTS: Factors significantly associated with receipt of pneumococcal vaccination in multivariable analysis were Hispanic ethnicity (odds ratio [OR] 1.66-1.77, P = 0.01), medical comorbidities (OR 1.48, P = 0.03), psychiatric comorbidities (OR 2.0, P = 0.001), use of a family medicine versus internal medicine clinic (OR 2.3, P < 0.001), and age (OR 1.04 for 1 year increase, P = 0.004). Factors significantly associated with influenza vaccination were having insurance (OR 2.25, P = 0.014), medical comorbidities (OR 1.71, P = 0.036), age (OR 1.03 for 1 year increase, P = 0.045), later year of audit (OR 1.68-1.73, P = 0.015), and a greater number of clinic visits (OR 1.69, P = 0.006). CONCLUSIONS: Among older regular users of our public community health centers, minority populations have equal or higher immunization rates compared with non-Hispanic whites.

Age Factors↗
PubMed2006

Neurological abnormalities in young adults born preterm.

OBJECTIVE: Individuals born before 33 weeks' gestation (very preterm, VPT) have an increased likelihood of neurological abnormality, impaired cognitive function, and reduced academic performance in childhood. It is currently not known whether neurological signs detected in VPT children persist into adulthood or become attenuated by maturation of the CNS. METHOD: We assessed 153 VPT individuals and 71 term-born controls at 17-18 years old, using a comprehensive neurological examination. This examination divides neurological signs into primary and integrative domains, the former representing the localising signs of classical neurology, and the latter representing signs requiring integration between different neural networks or systems. Integrative signs are sub-divided into three groups: sensory integration, motor confusion, and sequencing. The VPT individuals have been followed up since birth, and neonatal information is available on them, along with the results of neurological assessment at 4 and 8 years of age and neuropsychological assessment at 18 years of age. RESULTS: The total neurology score and primary and integrative scores were significantly increased in VPT young adults compared to term-born controls. Within the integrative domain, sensory integration and motor confusion scores were significantly increased in the VPT group, but sequencing was not significantly different between the VPT and term groups. Integrative neurological abnormalities at 18 were strongly associated with reduced IQ but primary abnormalities were not. CONCLUSIONS: Neurological signs are increased in VPT adults compared to term-born controls, and are strongly associated with reduced neuropsychological function.

Adolescent↗
PubMed2001

EthoVision: a versatile video tracking system for automation of behavioral experiments.

The need for automating behavioral observations and the evolution of systems developed for that purpose is outlined. Video tracking systems enable researchers to study behavior in a reliable and consistent way and over longer time periods than if they were using manual recording. To overcome limitations of currently available systems, we have designed EthoVision, an integrated system for automatic recording of activity, movement, and interactions of animals. The EthoVision software is presented, highlighting some key features that separate EthoVision from other systems: easy file management, independent variable definition, flexible arena and zone design, several methods of data acquisition allowing identification and tracking of multiple animals in multiple arenas, and tools for visualization of the tracks and calculation of a range of analysis parameters. A review of studies using EthoVision is presented, demonstrating the system's use in a wide variety of applications. Possible future directions for development are discussed.

Animals↗
PubMed1995

Evolution of markets and integration mechanisms.

Start a PHO or MSO too early, or too late, and it could be a roadblock rather than a building block toward an integrated system. HSL explains how to time integration mechanisms to the evolution of managed care in the local market.

Capitation Fee↗
PubMed1998

How to find who.

Master person indexes are considered the cornerstone of many health care systems integration projects. Although a fundamental first step, mastering the master person index is an IT challenge when organizations expand.

Abstracting and Indexing↗