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Artykuły w czasopismach na temat "Center for Studying Health System Change"
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Kiepek, Wendy, i Patricia P. Sengstack. "An Evaluation of System End-User Support during Implementation of an Electronic Health Record Using the Model for Improvement Framework". Applied Clinical Informatics 10, nr 05 (październik 2019): 964–71. http://dx.doi.org/10.1055/s-0039-3402450.
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Abstract Background Electronic health record (EHR) system implementation is complex. Strong support for clinicians and other end-users during the initial phase of implementation requires dedicated resources and commitment to ensure a smooth transition, reduce frustration, and assist in adoption. Objectives Evaluate end-user support processes and personnel employed during the initial phase of EHR implementation at an academic medical center and identify facilitators of success, challenges, and lessons learned. Methods Using the model for improvement framework, this case report describes the activities that follow the concepts of planning, doing, studying, and acting (PDSA) when providing on-site support to system end users during an EHR implementation in a complex health care system. Results Strengths included engaged and supportive leadership, use of internal support personnel, use of zone leaders, daily huddles for effective dissemination of information, and an evaluation survey tool to provide data supporting rapid changes in support personnel allocation. Challenges primarily surrounded the management of over 1,000 external support personnel which included limited EHR system knowledge, scheduling, and transportation logistics. Conclusion Implementation of EHR systems continues. Supporting end users is one aspect of these complex projects that require dedicated resources to manage effectively. Organizations taking a more proactive approach, based on learning from experiences, as well as from other health care organizations, can improve their ability to take on this challenge armed with best practices and lessons learned.
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Perederiy, Veronika A., i Anastasiya V. Getun. "Potential of Student Youth of HEIs as a Factor of Influence on the Economy of the Republic of Crimea". Теория и практика общественного развития, nr 8 (30.08.2023): 60–66. http://dx.doi.org/10.24158/tipor.2023.8.6.
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Geographical location, natural resource potential, landscape and climatic conditions, health resort treatment, beach recreation, cultural and historical traditions define the Russian Crimea as one of the most popular do-mestic tourism destinations. Along with this, the peninsula is also an important regional center of education and science. The authors examined the state of the republic's higher education system and its impact on the eco-nomic sphere, emphasizing student youth as the main subject capable of making a significant contribution to the economic development of the region. In this regard, the task was set to investigate the potential of the stu-dent population studying in higher educational institutions of the Republic of Crimea, and their involvement in the socio-economic, labor and innovation spheres of the region. The article contains analytical data on the ac-tivities of higher educational institutions operating in the territory of the Republic, a brief review of educational programs, achievements in the field of scientific research. The authors point out the changes in the system of higher education of the peninsula, positively affecting its economic, social and cultural development.
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Ivanov, I., V. Gordienko i E. Popova-Petrosyan. "THE CLINICAL COURSE OF SIMPLE AND PROLIFERATING UTERINE FIBRODS IN WOMEN OF REPRODUCTIVE AGE". Tavricheskiy Mediko-Biologicheskiy Vestnik 23, nr 3 (19.10.2022): 21–27. http://dx.doi.org/10.29039/2070-8092-2020-23-3-21-27.
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Uterine fibroids are widespread among diseases of the female system. The significance of this problem has increased in recent years as a result of increased complications of pregnancy, childbirth and the postpartum period in women with uterine myoma. In such women, fetal retardation syndrome, premature birth, abnormal position of the fetus, anomalies of labor activity were more often observed. Therefore, medicine and the state have an urgent task to maintain reproductive health in women with a diagnosis of uterine fibroids.
The aim of our study was to compare the picture of the clinical course of simple and proliferating fibroids in women of reproductive age. Materials and methods. A study of 22 non-pregnant women of reproductive age with a diagnosis of uterine fibroids (intramural, subserous, submucous) was performed. Clinical studies were conducted on the basis of the Center for Women’s Health «LLC Company Ethel» in Simferopol during 2018-2019. All women included in the study underwent an ultrasound examination of the pelvic organs using three-dimensional energy dopplerometry of intratumoral blood flow. A sample was taken into groups depending on the clinical course of the disease. Group A n = 14 (women of reproductive age with proliferating myoma), group B n = 8 (women of reproductive age with simple myoma). Research results. When studying the clinical course of simple and proliferating fibroids in women of reproductive age, it was found that with proliferating uterine fibroids, menstrual irregularities of the type of hyperpolymenorrhea, rapid growth and development of complications of the disease, than with simple fibroids were much more common. Conclusions. It is proved that with proliferating uterine fibroids, the clinical course of the disease is much more aggressive and faster, compared with the clinic with simple myoma, therefore it is necessary to change treatment approaches depending on the form.
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Samardžić, Ljiljana. "Characteristics of Patients Treated Psychoterapeutically in the Outpatient Clinical Setting". Acta Facultatis Medicae Naissensis 30, nr 3 (1.09.2013): 151–58. http://dx.doi.org/10.2478/afmnai-2013-0007.
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Summary The influence of social changes in transitional country and transitional times, among other things, have made changes in the structure of the patients seeking psychotherapeutic treatment. However, there has not been any research studying characteristics of patients in psychotherapeutic treatment. The aim of our study was to establish socio-demographic, clinical and psychodynamic characteristics of patients psychotherapeutically treated in the outpatient clinical setting. Our sample consisted of 61 non-psychotic patients, randomly selected by the method of consecutive admissions and treated with psychoanalytic psychotherapy in the outpatient clinical setting. The study was conducted from January 2009 to January 2012 at the Mental Health Clinic, Clinical Center Niš. Mini International Neuropsychiatric Interview, Global Assessment of Functioning Scale and a Semi-structured interview for the Operationalized Psychodynamic Diagnosis were used for collecting data. Our results have shown that patients treated with psychotherapy in the outpatient clinical setting have specific socio-demographic, clinical and psychodynamic characteristics. They are young, post-adolescent individuals, mainly with the diagnosis personality disorder and co-morbidity, with a moderate level of structural integration and individuation vs. dependency as the main psychological conflict. We suggest a long-term psychodynamic psychotherapy as the treatment of choice for patients with presented clinical and psychodynamic characteristics and operationalized psychodynamic diagnostic system as a valuable tool for establishing treatment focus and treatment planning.
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Manuel, Vladimir, Moira Inkelas i Brandon Shelton. "563 Team Science to Assess Effectiveness and Impact in Public Healthcare Delivery System Contracting". Journal of Clinical and Translational Science 8, s1 (kwiecień 2024): 168. http://dx.doi.org/10.1017/cts.2024.479.
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OBJECTIVES/GOALS: Healthcare organizations and payers are moving from accountability to effectiveness frameworks. Static vendor contracts for full-scale implementation limit organizations' ability to evaluate impact before scale-up, or to iteratively improve. Our team science innovation employs science and learning methods as systems engage vendors. METHODS/STUDY POPULATION: Our team science innovation is a method to assess and model impact of interventions at scale in healthcare delivery systems. We are integrating expertise in learning processes of an academic medical center (UCLA CTSI) with the organizational knowledge and methodological expertise of the nation’s largest Medicaid managed care plan (LA Care Health Plan), which has over 2 million members. The LA Care Advanced Analytics Lab has unique capability in machine learning, while enables deep learning of variation. Our innovative product is a template to quickly mobilize evaluation and learning for a diverse population in a varied and distributed delivery system. The template design enables rapid learning for the full-scale policy implementation often imposed by government, and in the short timeframes involved. RESULTS/ANTICIPATED RESULTS: LA Care and the UCLA CTSI partnered to provide subject matter expertise and design effective pilots for interventions such as transitional care services, complex care management, and physician home visit strategies, accounting for confounding factors affecting the intervention and outcome. So far, collaborative modeling and design has produced a successful pilot of a physician home visit program intended to reduce avoidable emergency department visits. This pilot quickly revealed several major changes that would need to be incorporated for the contracted vendor to produce results if operated at scale, further informed by machine learning, in sufficient time to inform the contracting process. There are multiple evolving applications, including housing/homelessness. DISCUSSION/SIGNIFICANCE: Integrating the large data and analytics of a large healthcare organization with learning methods from the CTSI -- including learning from variation and designs for studying impact during scale-up -- fosters academic-community team science that could significantly improve the value of our largest delivery systems, public and commercial.
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Luo, Fang, Qiao Hu i Caihong Sun. "Studying on the psychological contract of farmers behavior of transferring agricultural land in China". CNS Spectrums 28, S1 (marzec 2023): S16—S17. http://dx.doi.org/10.1017/s1092852923000846.
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BackgroundAt present, the social economy is in a period of fast-paced change in China, with various modes of production and life evolving and emerging. The transfer of agricultural land is the transformation of the utilization mode of the main factors of production in rural areas, and it is one of the contents of the social and economic reform in rural areas. In 2021, the area of rural land transfer is up to 3.7×1011 m2 in China, an increase of 4.3% over the previous year. 1,239 counties (cities, districts) and 18,731 townships have established agricultural land management rights transfer centers to provide services such as policy consultation, information release, and contract signing for both sides of the transfer. Farmers are the subjects of agricultural land management and transfer. Their behaviors are affected by their psychology to some extent. In the long-term, dynamic, and gradual process of agricultural land transfer, it is particularly important to respect farmers’ wishes, pay attention to farmers’ psychology, and guide farmers’ behavior. However, only a few written contracts were signed. Most are verbal agreements of spontaneous or collective land transfers. The verbal agreements auto-execute to some extent within certain limits. The goals of farmers in farmland transfer are diversified, and their cognition, willingness and psychological identity affect the performance of the contract and the effect of transfer.Subjects and MethodsThe psychological contract of agricultural land transfer can be defined as the transferor and transferee of agricultural land transfer. Through a certain psychological suggestion mode, through the subjective cognition and understanding of the rights and obligations of both parties, rather than the direct explicit expression, a contract relationship of rights and obligations is formed. The party awarding contract and the contractor are the subjects of agricultural land transfer. Therefore, the subjects of the psychological contract of agricultural land transfer include farmers, village collectives and enterprises, all of whom have equal status, forming their own psychological contracts. The forming process of the psychological contract of agricultural land transfer includes four steps. Step one is cognition and judgment. Both parties to the transfer are aware of and judge their own rights and obligations based on external environmental information and their own circumstances. Step two is psychological expectations. Before information is transmitted, both sides of the transmission transform cognition and judgment into psychological expectations. The third step is to convey psychological expectations. Both sides of transfer transmit psychological expectations by means of direct patterns, such as oral form and written form, and implicit ways, such as perception and comprehension. Step four is the formation of the psychological contract. Both sides of transfer reciprocally admit information of psychological expectations transmitted in implicit ways, forming psychological contracts. If they can’t come to an agreement on psychological contracts, a new four-step cycle is entered.ResultsThe forming of the psychological contract of agricultural land transfer is shown in Figure 1. First, farmers’ behavior background, such as the experiences of land lease and transfer, the targets of land transfer and education, has an effect on the building of psychological contracts and its type. On the one hand, the farmers who have the experience of land transfer and get high benefits from it are much more motivated than those who don’t have that experience or ever have dissension while transferring. On the other hand, the targets of transfer and the education level of farmers affect the type of psychological contracts. Second, Farmers’ subjective norms, mainly reflected in the difference in folk customs, will form various communication modes and take different measures to deal with breaching contracts while transferring. Third, farmers’ behavior cognition reflects in their comprehension of the capability of executing contracts, including bargaining power, decision-making level and managing modes of the rent. The ability of behavior cognition and control of farmers has a positive influence on their behavior intention and happened.ConclusionsAccording to the above results, in order to promote the reposeful transfer and orderly development of agricultural land, the following suggestions are proposed: The first is to improve the agricultural land transfer policy system, establish and improve the institutional environment for agricultural land transfer, create conditions for the establishment of farmers’ behavioral psychological contracts in the process of agricultural land transfers, and guide farmers to establish relationship psychological contracts. The second is to improve the market system, properly cultivate and develop agricultural land transfer intermediaries, reduce transaction costs, and reduce the probability of farmers’ psychological contracts being broken. The third is to guide farmers to establish a positive agricultural land transfer psychology based on their resource endowments such as labor force quality and cultural quality, and encourage farmers to make agricultural land transfer decisions such as subcontracting, leasing, reselling, and interchanging.Figure 1.Psychological contracts of agricultural land transfer forming
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Bogdanov, Dmitriy S., Dmitriy V. Cherkashin, Semen V. Efimov i Alevtina I. Zakharova. "Associations of polymorphisms of the <i>ACE</i> and <i>ACE2</i> genes with clinical manifestations and cardiovascular complications of the coronavirus infection". Bulletin of the Russian Military Medical Academy 25, nr 1 (13.04.2023): 145–54. http://dx.doi.org/10.17816/brmma114802.
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A problem of the novel coronavirus infection pandemic is the absence of specific biomarkers, the determination of which would make it possible to assess the likelihood of a severe disease course, development of complications, immediate and long-term consequences, and effective etiotropic (antiviral) therapy. The severity of the novel coronavirus infection depends on various factors such as the initial state of health, immune status, age, smoking status, concomitant cardiovascular diseases, and diabetes mellitus. However, a severe disease course is also observed in patients without the aforementioned risk factors. The development of the disease and its complications depends on sex and geographical identity. Angiotensin-converting enzyme 2 (ACE2), associated by gene-gene interaction with ACE, plays a main role in the pathogenesis of the penetration of severe acute respiratory syndrome-2 coronavirus into the cell. The main body of information on this problem is represented by systematic meta-analyses and results of single-center cohort studies, which offer insufficient information to unequivocally assert the associations of ACE and ACE2 gene polymorphisms with pathological changes in the circulatory system during and after a new coronavirus infection. Differences in the incidence of ACE and ACE2 alleles may explain the differences between susceptible populations and/or response to the severe coronavirus infection. The above studies were carried out on the effect of the coronavirus in the initial period of the pandemic. For a more complete molecular genetic picture of the influence of polymorphism, persons with different strains of the coronavirus must be considered. In addition, no data are available regarding the expressions of ACE and ACE2 genes in response to a coronavirus infection. Moreover, the identification of the polymorphic variants of the genes of the reninangiotensinaldosterone system and ACE2 associated with a high risk of developing and worsening cardiovascular diseases may be one of the promising areas for the early diagnosis and prevention of post-COVID-19 changes. Therefore, all scientific interest research is aimed at studying genetic factors, such as single nucleotide polymorphisms that affect susceptibility to infection, severity of the disease course, and development of circulatory system consequences. In general, polymorphic variants of ACE and ACE2 and their interaction will help us understand this problem and systematize knowledge for further research in this area.
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Lake, Johanna K., Paula Tablon Modica, Victoria Chan i Jonathan A. Weiss. "Considering efficacy and effectiveness trials of cognitive behavioral therapy among youth with autism: A systematic review". Autism 24, nr 7 (18.05.2020): 1590–606. http://dx.doi.org/10.1177/1362361320918754.
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Cognitive behavioral therapy is a widely studied and commonly used psychosocial intervention for treating emotional problems in individuals with autism. To date, most studies of cognitive behavioral therapy and autism have focused on efficacy. Effectiveness trials, by contrast, measure whether an intervention produces particular results under “real-world” clinical conditions. We conducted a systematic review of cognitive behavioral therapy interventions targeting affective disorders among youth with autism and (a) classified studies as either efficacy or effectiveness trials and (b) coded how the effectiveness trials reflect the implementation characteristics outlined in the Framework of Dissemination in Health Services Intervention Research. The systematic search yielded 2959 articles, with 33 studies meeting inclusion criteria. Thirteen studies were categorized as effectiveness and 20 as efficacy. We discuss how the effectiveness studies considered elements of the implementation framework and provide recommendations for future studies, including greater consideration and measurement of adoption and sustainability processes, as well as organizational- and system-level outcomes. Results shed light on our understanding of the effectiveness of cognitive behavioral therapy in routine clinical practice, how an implementation framework can be used to guide and improve effectiveness studies, and identify barriers, facilitators, and gaps in the implementation process. Lay abstract Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under “ideal” conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under “real-world” conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
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Qiu, Annie, Sheila Shapouri, Esther N. Drill, Jake Schade, Arliene Ravelo, Ai Ni, Tu My To, Keith Lamont Dawson i Matthew J. Matasar. "Real-world assessment of practice efficiency with the introduction of subcutaneous rituximab." Journal of Clinical Oncology 37, nr 15_suppl (20.05.2019): e18025-e18025. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18025.
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e18025 Background: Rituximab (R), available as an intravenous (IV; R-IV) infusion or subcutaneous (SC; R-SC) injection, is used in the treatment of follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and chronic lymphocytic leukemia (CLL). This study evaluated real-world practice efficiency changes associated with the adoption of R-SC by studying differences in chair time by route of administration. Methods: We conducted a retrospective analysis of practice care delivery measures before and after adoption of R-SC at Memorial Sloan Kettering Cancer Center (MSKCC). Data for patients (pts) with FL, DLBCL, or CLL receiving R-based therapy from September 2016 to September 2018 were extracted from the electronic medical record. A linear mixed effect multivariate model with random intercept was used to analyze the association between treatment type (R-IV vs R-SC) and chair time (defined as the difference in pt room-in and room-out times) in the year prior to and following R-SC adoption at MSKCC. Model covariates included treatment time and location, therapy type (monotherapy vs combination), and pt demographics. Given the prolonged infusion time, patients’ first dose of R-IV was excluded from the analysis. Results: Data were collected during 6744 visits (3018 visits prior to R-SC adoption and 3726 after) for 1503 pts receiving R. Pts receiving R-IV combination therapy had a mean chair time of 203 minutes (min); overall, R-SC injection reduced chair time by a mean of 92 min (p < 0.001 vs R-IV). Monotherapy, regardless of route, reduced chair time by a mean of 30 min (p < 0.001) compared with combination therapy, and mean chair time was further reduced by 39 min (p < 0.001) for R-SC pts receiving monotherapy. Reductions in chair time increased over time following initial adoption of R-SC (p = 0.042), and were greater at the lymphoma-specific site than multispecialty oncology infusion centers (p < 0.001). Conclusions: Adoption of R-SC results in substantial time savings for both the pt and health system as measured by reduced chair time and improved pt throughput. Given increasing constraints on infusion chair space, increased utilization of R-SC may improve practice efficiency and pt access to care.
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Balaev, Magomedbashir Kh, Andrey P. Fisenko i Svetlana I. Aprosimova. "Influence of medical-social and socio-economic factors on infant mortality rate in the Republic of Ingushetia". Russian Medicine 30, nr 2 (17.05.2024): 142–51. http://dx.doi.org/10.17816/medjrf625546.
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BACKGROUND: The infant mortality rate, as one of the indicators of the health and quality of life of the population, is an important factor that determines the country’s healthcare priorities. Despite the steadily decreasing infant mortality rates in the Russian Federation, the value of this indicator varies by region; thus, studying the factors influencing its value is relevant. If the leading medical, social, and socioeconomic factors that influence the level of infant mortality could be determined using data from a representative region (Republic of Ingushetia), the main directions for organizing measures aimed at reducing mortality among children in the first year of life will be identified. AIM: To determine the main medical, social and socio-economic factors that influence the infant mortality rate in the Republic of Ingushetia. MATERIALS AND METHODS: An observational single-center retrospective study was performed to examine the influence of medical, social, and socioeconomic factors on the mortality rate of children aged 1 year in the Republic of Ingushetia. The obtained data were compared with similar indicators for the Russian Federation as a whole and the North Caucasus Federal District. RESULTS: During the study period (2011–2019), significant changes were observed in infant mortality rates in the Republic of Ingushetia: infant mortality has decreased because of the age components, leading to the normal ratio of neonatal and post neonatal mortality. Rates of infant mortality from certain conditions arising in the perinatal period, congenital anomalies, and nervous system and circulatory system diseases have significantly decreased. The proportion of women admitted under the supervision of antenatal clinics in the early pregnancy (up to 12 weeks) has increased, the incidence of morbidity among pregnant women has decreased, and the proportion of normal births has been increasing. Although many medical organizations have employed a sufficient number of medical personnel, the coverage for biochemical screening has decreased, detection of malformations and biochemical abnormalities during prenatal diagnostics was low, medical personnel have low qualifications, and the shortage of obstetric and pediatric beds and pathology beds for newborns and premature infants was significant. A statistically significant dependence of the frequency of deaths of children aged 1 year on socioeconomic indicators−unemployment level, monetary income of the population, and housing conditions−was revealed. CONCLUSION: The main medical, social, and socioeconomic factors that influence infant mortality were analyzed using data from the Republic of Ingushetia. Positive and negative trends in the current state of the healthcare system of this republic have been identified.
Rozprawy doktorskie na temat "Center for Studying Health System Change"
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital". VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
Książki na temat "Center for Studying Health System Change"
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Contois, Emily, i Anastasia Day. The History of Food and Public Health. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190626686.003.0001.
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Economic, political, and social changes prompted the evolution of our current food system. Studying the historical context of these changes helps us to better understand and devise nutrition policy and programs today. This chapter begins with the roots of the modern U.S. food system at the dawn of the 20th century, isolating four key aspects that have shaped nutrition and public health: food production, processing, and consumption, along with state nutritional policy. To begin, government subsidies, in tandem with shifts in farming demographics and business models, have significantly determined what food is available to consumers at what prices. Next, an examination of food processing complicates this story, exploring the growing number of intermediaries between farmers and consumers over the 20th century. In addition, federal dietary advice and resources have sought to guide what and how people eat. At the same time, the consumer culture has influenced eaters through cookbooks, home economics, advertising, and a host of food media, from magazines and radio to blogs and social media. The Example in Practice addresses the history of the National School Lunch Program, combining the themes of production, processing, consumption, and policy in a single case study. This chapter provides readers with key landmarks and a basic historical context to understand the origins of and potential futures for today’s food, nutrition, and public health policy problems.
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Ferraro, Kenneth F. Multifaceted Change. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190665340.003.0004.
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Aging involves multiple related systems; change in one system influences other systems. Nathan Shock referred to aging as a dynamic equilibrium and argued that studying the interrelationships of multiple systems is essential for gerontology. A growing number of researchers study relations across systems, but many focus on syndromes of declining health or function, without much regard for alternative scenarios such as nonlinear change and compensatory mechanisms. The axiom of multifaceted change contends that viewing aging as a syndrome of decline oversimplifies the changes involved. Instead, gerontology needs a biopsychosocial model to study aging as a multidirectional change process across multiple systems. Research on how social factors influence telomere length is used to illustrate this axiom.
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Hoff, Timothy J. Saving the Doctor-Patient Relationship and Raising Expectations. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190626341.003.0007.
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We are moving quickly toward a corporately controlled, transactionally focused health care delivery system, one that sees patients as “consumers.” Retail thinking continues to take hold in the industry, emitting a rhetoric that promises much and places the organization at the center of the patient’s interactions with the system. Preserving strong, effective doctor-patient relationships in the midst of such change requires the medical profession to focus more on relational care in its training and advocacy; raising the importance of relational features such as trust and empathy in performance measurements and incentive plans for doctors; and trying to “monetize” relational care between doctor and patient in ways that make health care delivery organizations and the industry as a whole want to focus on it more as a source of brand-building and consumer loyalty.
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Daley, Dennis C., i Antoine B. Douaihy. Managing Substance Use Disorder. Oxford University Press, 2019. http://dx.doi.org/10.1093/med-psych/9780190926717.001.0001.
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This practitioner guide reviews screening, assessment, and treatment of substance use disorders (SUDs). It is designed to accompany Managing Your Substance Use Disorder: Client Workbook and A Family Guide to Coping with Substance Use Disorders. The latter guide was added because each person with a SUD affects the family and concerned significant others. The information and strategies that the authors present can be used with clients who have any type of SUD. The guide focuses on strategies to reduce or stop substance use and change behaviors that challenge recovery. The information presented is derived from research, clinical, and recovery literature and from the authors’ extensive experience developing and managing a large continuum of clinical services, providing direct care, conducting quality improvement initiatives, participating in clinical trials, and teaching all disciplines in a large medical center and the community. This guide discusses professional approaches and attitudes toward individuals with SUDs, assessment, diagnostic formulation, psychosocial and pharmacotherapeutic treatments, and mutual support programs. It provides an overview of the recovery and relapse processes and practical strategies to address issues associated with SUDs. This guide is for practitioners from any discipline who encounter individuals with SUDs in addiction, mental health, psychiatric, private practice, or other settings such as social services and the criminal justice system. Even medical practitioners who do not specialize in addiction treatment can benefit from the information in this guide because individuals with SUDs are found in all types of healthcare settings.
Części książek na temat "Center for Studying Health System Change"
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Kent, Amy, Karin Leiderman, Anna C. Nelson, Suzanne S. Sindi, Melissa M. Stadt, Lingyun Xiong i Ying Zhang. "Studying the Effects of Oral Contraceptives on Coagulation Using a Mathematical Modeling Approach". W Mathematical Modeling for Women’s Health, 83–132. Cham: Springer Nature Switzerland, 2024. http://dx.doi.org/10.1007/978-3-031-58516-6_4.
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AbstractThe use of oral contraceptives (OCs) is known to increase the risk of thrombosis, but the mechanisms underlying this risk and the determinants of the tests that assess this risk are not fully understood. In this study, we used a mathematical model to study the effects of an OC containing levonorgestrel (lev) on blood clotting. Lev is reported to change the plasma levels of blood clotting factors. The mathematical model used in this study simulates coagulation reactions in a small injury under flow, takes clotting factors as inputs, and outputs time courses of the coagulation enzyme thrombin. To study the effects of lev, we created a virtual patient population with factor levels before and after lev use based on published patient data and conducted simulations to predict thrombin response for each individual virtual patient. After analyzing the simulated thrombin, we found that changes in factor levels due to lev increased the amount and speed of thrombin generation for all virtual patients. This suggested that the factor level changes alone can heighten the prothrombotic state of the model system. We extended the model to include generation of the inhibitor activated protein C (APC), so we could test the effects of lev on the systems’ sensitivity to APC. In line with literature reports, the use of lev increased the APC sensitivity, which correlates with increased thrombosis risk.
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Cerveny, Gislaine Cecília de Oliveira, Marina Zambon Orpinelli Coluci, Renata Wey Berti Mendes i Rodolfo Andrade de Gouveia Vilela. "The Clash Between New and Old Models of Surveillance System: A Case Study of Change Laboratory in a Workers’ Health Reference Center". W Collaborative Development for the Prevention of Occupational Accidents and Diseases, 191–204. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-24420-0_13.
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Keltgen, Jaciel Elizabeth. "Inequality in Pay Ranks Among Factors Impacting Job Satisfaction Among Female Physicians". W Women Empowerment and Well-Being for Inclusive Economic Growth, 1–23. IGI Global, 2021. http://dx.doi.org/10.4018/978-1-7998-3737-4.ch001.
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Job satisfaction has fallen among doctors, and beyond lack of pay parity that averages 25%, female physician job satisfiers differ from male colleagues. Health systems can build upon female physicians' confidence in their abilities to communicate with patients, show empathy, build trust, and elicit patient compliance with treatment plans. Systems must attend to work conditions for young and female cohorts, thereby retaining half of the workforce offering critical care to 7.8 billion people. Ordinal logistic regression was used to analyze data gathered in the U.S. by the Center for Studying Health System Change. Data were used to build a predictive statistical model in concert with independent variables linked to generational and job satisfaction literature. This study revealed statistically significant correlations between factors not only by gender, but also by generational membership. Statistically significant factors affecting job satisfaction among female physicians include provision of quality care to all patients, adequate time spent with patients and income.
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Entico, Gladys Joy E. "Knowledge Management and the Medical Health Librarians". W Advances in Library and Information Science, 52–77. IGI Global, 2016. http://dx.doi.org/10.4018/978-1-4666-9542-9.ch003.
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Knowledge management can make healthcare organizations to become more collaborative, transparent, and proactive. If implemented well, it can change the health care delivery system over the next few decades into a more economical, error-averse, and responsible public resource. This study focused on the roles of medical head librarians in the knowledge management programs of the seven (7) selected tertiary hospitals in the Philippines (The Medical City, Makati Medical Center, Far Eastern University - Nicanor Reyes Medical Foundation, St. Luke's Medical Center, Fatima University Medical Center, Iloilo Doctors' College for the Iloilo Doctors' Hospital, and the University of Perpetual Help-Dr. Jose G. Tamayo Medical Center). The data gathered from survey questionnaires and interview showed that medical head librarians from the selected private tertiary hospitals in the Philippines do have roles in the knowledge management programs of their organizations. These roles can be a leader role, a key role, or a non-key role.
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Cui, Wanting, i Joseph Finkelstein. "Impact of COVID-19 Pandemic on Use of Telemedicine Services in an Academic Medical Center". W Studies in Health Technology and Informatics. IOS Press, 2021. http://dx.doi.org/10.3233/shti210190.
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The COVID-19 pandemic changed the landscape of telehealth services. The goal of this paper was to identify demographic groups of patients who have used telemedicine services before and after the start of the pandemic, and to analyze how different demographic groups’ telehealth usage patterns change throughout the course of the pandemic. A de-identified study dataset was generated by querying electronic health records at the Mount Sinai Health System to identify all patients. 129,625 patients were analyzed. Demographic shifts in patients seeking telemedicine service were identified. There was significant increase in the middle age and older population using telehealth services. During the pandemic use of telemedicine services was increased among male patients and racial minority patients. Furthermore, telehealth services had expanded to a broader spectrum of medical specialties.
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Irwin, Charles E. "Topical Areas of Interest for Promoting Health: From the Perspective of the Physician". W Promoting the Health oi Adolescents, 328–32. Oxford University PressNew York, NY, 1993. http://dx.doi.org/10.1093/oso/9780195074543.003.0017.
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Abstract Chapters 8 to 14 of this book highlight the critical problems confronting adolescents today and raise the complex issues involved in studying or trying to under stand health-related behaviors. The authors note that each system that interacts with adolescents (school, health clinics, drug stores, restaurants, churches, transit systems) needs to assume responsibility for the health of our youth. Efforts must be broad-based, with the assistance of regulating agencies and clinicians. For example, in the State of California during the l 990’s, there is a major effort to change the social environment regarding tobacco use through laws that restrict access to cigarette machines and prohibit smoking in all public places.
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Selthafner, M., XC Liu, F. Ellis, C. Tassone, J. Thometz i B. Escott. "Effect of PSSE on postural sway in AIS using center of pressure". W Studies in Health Technology and Informatics. IOS Press, 2021. http://dx.doi.org/10.3233/shti210449.
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We haven’t known whether the center of pressure (COP) could be considered as a better indicator in the evaluation of posture and balance change after the physiotherapeutic scoliosis specific exercise (PSSE) during level walking. The objective of this study was: 1) to determine changes in COP displacement in anterior-posterior (COP-AP) and medial-lateral (COP-ML) for AIS following the PSSE; 2) to find out COP oscillation(COP-OS) from the midline for the left and right foot; 3) to investigate max pressure at the forefoot, midfoot and hindfoot bilaterally. AIS patients with three reflective markers on their back walked on the pressure sensors embedded treadmill at 2 km/h and their trunks were also registered by DIERS Formetric 4D system. Each child received the PSSE for 12 weeks by the same physical therapist and had a dynamic pressure analysis before and after the PSSE. Six AIS children at a mean age of 13 years and with averaged major Cobb angle of 26° were enrolled. There was an increase in COP-AP (15%) and a decrease in the COP-ML (-25%) following the PSSE. COP-OS on the left foot shifted farther away from the midline (about 16%) as the right side moved closer (-1%), which becomes more symmetrical (Pre-PSSE: 0.86mm & Post-PSSE: 0.32mm). There were increased pressures on the left (35%) and right (26%) hallux after PSSE. Pressure metrics, especially including COP-ML, COP-AP, COP-OS, and peak pressures on the forefoot, may be opted as optimal predictors to posture improvements by the means of PSSE.
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Yadav, S. L., A. Bhargava i Arham Tater. "Climate Change Impacts on Soil Ecosystems". W Current Trends in Soil Science: Challenges and Innovations for Effective Ecosystem Management, 73–82. Iterative International Publishers, Selfypage Developers Pvt Ltd, 2024. http://dx.doi.org/10.58532/nbennurch317.
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The relationship between soil systems and conservation tactics in relation to the effects of climate change is addressed in climate change and soil interaction, introducing modern research facilities on plants, soil carbonization, and soil biodiversity studies. A useful tool for maintaining the different relationships necessary for environmental sustainability, it includes information on soil remediation techniques, microbiological reactions to climate change, and soil health. Restoring soil system vitality under changing climatic circumstances requires an understanding of soil systems, including diverse physical, chemical, and biological interactions. This chapter discusses how numerous positive interactions in soil systems are impacted by changing climatic circumstances and offers suitable solutions to maintain these interactions. Researchers studying agriculture, ecology, and the environment can better comprehend cultivation by consulting Climate and Soil Interactions, which offers current, reliable, and novel data on how diverse soil interactions are affected by changing climatic circumstances. It will provide insights with pertinent information regarding environmental science, climate change, and biodiversity
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Polyakhova, Elena, i Vladimir Korolev. "Astrodynamics in Photogravitational Field of the Sun: Space Flights with a Solar Sail". W Gravitational Field [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.102005.
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Mathematical models of the controlled motion of a spacecraft with a solar sail and the possibilities are considered, taking into account the translational motion in the gravitational field, the forces of light pressure, and rotational motion relative to the center of mass. The structure of possible problems of photogravitational celestial mechanics is proposed. To control movement, it is possible to change the size, shape, surface properties, and orientation of the elements of the sail system in relation to the flow of sunlight. The equations of motion can be presented on the basis of the problem of motion in a photogravitational field, taking into account the action of other disturbing forces. When studying the orbits of motion in the vicinity of the Earth, one should use a more general model of the photogravitational field of the restricted three-body problem. In this case, the gravitational action of the Sun and the Earth is supplemented by the field of forces of light pressure, which makes it possible to simulate real problems of dynamics.
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Noteboom, Cherie. "Physician Interaction with EHR". W Healthcare Administration, 1088–100. IGI Global, 2015. http://dx.doi.org/10.4018/978-1-4666-6339-8.ch058.
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Research Medical Center is a regional medical center that meets the needs of residents of a rural area in the Midwest. It is part of a large healthcare system. The primary care hospital implemented the Electronic Health Record (EHR). The endeavor to implement Health IT applications including Computerized Physician Order Entry (CPOE), EHRs, nursing documentation, and paperless charts, adverse drug reaction alerts, and more were introduced with the corporate initiative. The core applications were clinical and revenue cycle systems, including CPOE. The planning, implementation, and training was developed by the parent operating company and efforts to engage the local physicians were minimal. There were over 300 physicians involved. The physicians were primarily not hospital employees. They had the ability to choose to adopt the EHR and adapt their social, work, and technology practices, or to avoid usage. Follow up research indicated the change management and support efforts were not successful for the physician stakeholder.
Streszczenia konferencji na temat "Center for Studying Health System Change"
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Volodashchik, T. P., i T. R. Romanovskaya. "INFORMATION OF NEPHELOMETRIC AND HEMOLYTIC METHODS FOR STUDYING THE COMPLEMENT SYSTEM". W SAKHAROV READINGS 2021: ENVIRONMENTAL PROBLEMS OF THE XXI CENTURY. International Sakharov Environmental Institute of Belarusian State University, 2021. http://dx.doi.org/10.46646/sakh-2021-2-34-37.
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The complement system refers to important homeostatic active systems that are under stress from environmental factors. Taking into account the significance and role of the complement system in the effector reactions of immunity and the relationship of complement with various homeostatic systems of the body, it is important to understand how complement changes in various pathological conditions of the body. To do this, we need to have a clear understanding of the state of the complement system in a clinically healthy body.
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Mazzi, Angela, Gregory Coni, Shan Jiang i Tiffany Broyles Yost. "Improving Healthcare Resilience Through an Equity Focused Framework". W 2022 AIA/ACSA Intersections Research Conference. ACSA Press, 2022. http://dx.doi.org/10.35483/acsa.aia.inter.22.8.
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Resilience is an equity issue. It is directly linked to the resources one has to cope with environmental stressors. These resources occur at multiple scales and involve social, physical, and economic components. Resilience can be considered at the scale of the individual human, the building, or municipal infrastructure. Because resilience issues are also health issues, we are studying how it is approached within the healthcare industry in the United States. This industry is currently experiencing a paradigm shift from providing episodic care, focused on the treatment of disease, to a holistic focus on maintaining health. This article shares research on the factors that contribute to resilience and a framework we developed to measure effectiveness of applying these factors at each scale. This framework and the methodology for applying it helps architects and our clients make better decisions about design. We believe this multifactor approach centers equity in developing resilient approaches to energy, air quality, and water use. At the macro scale, climate change has wrought havoc on infrastructure. This impacts us all, but vulnerable populations bear the brunt of the health burden. Within the United States, adverse weather events linked to climate change such as flooding, heat waves, extreme cold and violent storms often occur in areas with poor air, water, and soil quality exacerbating challenges. Health facilities are also under new stressors. Weather events impact aging structures, challenging their ability to operate in an emergency. Structural integrity, access to power, and indoor air quality are among the life safety issues that may arise. As we build new hospitals, it is important to consider these impacts and potential future impacts on what we design. As we renovate existing structures, we need to consider how to build resilience within the existing systems so that future problems don’t occur. The impacts of the pandemic have magnified the need to consider individual resilience. Stress undermines a person’s short-term ability to function and make decisions. Chronic stress has been shown to create inflammation in the body. This inflammation contributes to physical and mental disease. Personal resilience is tied to the ability to return to homeostasis after experiencing an adverse event. Our research in salutogenic (health generating) design shows environmental resources can help activate the parasympathetic nervous system and turn off the stress response. Additionally, there are beneficial effects even with temporary exposure to a salutogenic space. Our framework will demonstrate how each of the resilience factors operates at all three scales. We will show the research supporting each factor and how it impacts the individuals and communities. Through this metric, we aim to make resilience a more visible and quantifiable concept. Looking at social determinants to health in conjunction with the exposome (environmental factors) at all three scales, we can begin to think more comprehensively about resilience. We can create an equitable built world that contributes to everyone’s well-being.
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LIN, TZU-KANG, YI-TING LIN i KAI-WEI KUO. "APPLICATION OF NEURAL NETWORK ENTROPY ALGORITHM AND CONVOLUTION NEURAL NETWORK FOR STRUCTURAL HEALTH MONITORING". W Structural Health Monitoring 2023. Destech Publications, Inc., 2023. http://dx.doi.org/10.12783/shm2023/36758.
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This study combines Neural Network Entropy (NNetEn) and Convolutional Neural Network (CNN) to develop a practical structural health monitoring system. In order to verify the feasibility of the system, the failure experiment of a seven-story steel frame has been carried out with a numerical model of the same structural characteristics as the steel frame. The state space method is used to simulate the sixteen failure modes on the steel frame, where the acceleration signals of each floor at the time of failure are analyzed by neural network entropy. An entropy database is established based on the model to train the neural network model. To avoid the misjudgment and automatic interpretation of human factors, this study uses the visualized heatmap to quantify the change of entropy value, and the convolutional neural network analysis is selected for image processing. By converting the entropy value into image data, not only the number of parameters in the model can be reduced, but its operation speed can be improved. During the training process, the neural network model extracts and learns the damage features in the entropy value. After the training is completed, the model can allocate the damage area of the structure by identifying the damage features of the input data. Finally, through the verification of 16 failure cases simulated on the seven-story steel frame of the National Center for Research on Earthquake Engineering (NCREE), the performance of the proposed SHM system is evaluated by both numerical simulation and experimental verification with confusion matrix. The SHM system proposed in this study combines the emerging entropy analysis method with a neural network. The test results of the final verification have an accuracy rate of 93.13%.
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Karelina, Inna B., Alena A. Bondareva i Natalia N. Bal. "Teaching phonemic analysis of children with dysarthria at individual speech therapy classes". W Особый ребенок: Обучение, воспитание, развитие. Yaroslavl state pedagogical university named after К. D. Ushinsky, 2021. http://dx.doi.org/10.20323/978-5-00089-474-3-2021-319-326.
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The article describes a method of teaching phonemic analysis to children with dysarthria in individual speech therapy classes, developed by one of the authors I. B. Karelina, which has been tested in practical speech therapy work with children with dysarthria in the health care system and in a private habilitation center. The analysis of the most well-known methods of teaching literacy to children with general speech underdevelopment in educational institutions is presented. The article describes the difficulties experienced by school-age children who have a history of speech disorders when studying at school.
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Laboy, Michelle, Amy Mueller, Dean Massey, Moira Zellner i Dan O'Brien. "Decentralizing infrastructure: expanding architectural practice towards equity and health". W 112th ACSA Annual Meeting. ACSA Press, 2024. http://dx.doi.org/10.35483/acsa.am.112.43.
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Climate change impacts are not evenly distributed across the globe. Inequities also emerge at a local scale where buildings have the most perceivable impact, affecting anything from access and continuity of the public realm to microclimates.Design decisions can exacerbate or mitigate microspatial inequities—i.e. significant local variation in environmentalhazard exposures, like heat, air pollution, and flooding. Green Infrastructure (GI) is a range of nature-based solutionswith the potential to mitigate environmental hazards. Decentralizing GI is critical to health and resilience, buildingredundancy and capacity through a distributed network of smaller system nodes that are less prone to cascading failures.Architecture projects can support decentralization, targeted mitigation, and incremental implementation; however theircontribution to urban resilience, health, and environmental justice needs to be better characterized to support rationalizedexpansion of such approaches. This requires ways to explore complex and dynamic interactions of buildings within and beyond site boundaries, including: (1) methods for measuring local variation in hazards at relevant spatial scales and (2) tools for modeling the impacts of interventions in inclusive conversations with local stakeholders. This research examines an equity-focused approach to co-designing GI in architecture projects, using data and tools to inform and measure the impact of individual building projects and, eventually, networks of projects. In collaboration with the city of Chelsea, MA, our transdisciplinary team is studying sensor networks and a participatory modeling process to demonstrate how architecture projects can generate and leverage local knowledge about microspatial inequities and mitigation by GI to advance broader community health goals. Co-design activities around one pilot site reveal how decentralization becomes a significant paradigm shift—even among practitioners—eliciting ideas about maximizing capacity, connectivity, co-benefits, and shared responsibility. This paper examines the term decentralization in a multidisciplinary discourse, shares lessons from a specific context, and discusses implications to architectural practice.
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KLEIN, JORDAN, STEVEN BUNKLEY, CHARLES ELLISON, GARRY GLASPELL, KENNETH NILES, CAROLINE WEBB, RICHARD BROWN, CHARLES DICKERSON i ANTON NETCHAEV. "DAMBOTTM: AN UNMANNED AMPHIBIOUS VEHICLE FOR EARTH DAM OUTLET INSPECTION". W Structural Health Monitoring 2023. Destech Publications, Inc., 2023. http://dx.doi.org/10.12783/shm2023/36977.
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The US Army Corps of Engineers (USACE) owns, maintains and operates several hundred locks and dams across the United States. A large portion of these structures have met or exceeded their design life, therefore the need to perform detailed inspections regularly has become increasingly important. Some of the challenges for inspection personnel are the hazardous conditions associated with entering dam outlet works, and the need to conduct the inspection within a short time frame so that the dam can resume normal operations and maintain downstream water levels. These subterranean conduits are classified as confined spaces and can be several hundred meters long, have flowing water, and in some instances have toxic gases present. The USACE Engineer Research and Development Center (ERDC) has developed an unmanned amphibious vehicle, called DamBot™, to enter these outlet works with a sensor suite and perform first-look inspections of the conduit and closure gates. In order to carry out these inspections, DamBot™ is equipped with cameras and LiDARs to capture 360 degrees situational awareness around the platform, and a five-meter robotic arm with nine degrees of freedom to perform up close inspection of closure gates, which can be over six meters tall. Additionally, the DamBot™ is able to capture data of the entire conduit during inspections, collecting a dataset that provides a comprehensive picture of the infrastructure. DamBot™ uses techniques such as simultaneous localization and mapping (SLAM) to assure positional accuracy of data collection in these GPS denied environments. These datasets can be post-processed into 3D models and can be used for structural health monitoring by way of change detection when compared with previous inspections. DamBot™ has been successfully demonstrated at several active USACE projects, and this paper will detail the specifications of the system and discuss the results of field demonstrations, lessons learned, and future improvements to the system.
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AlSuwaij, Ahmed, Tracey Jackson i Manuel Hoegerl. "Brief Perspective on the Design and Operational System of the H2S Lab at the Dhahran Technology Center, Baker Hughes in Saudi Arabia". W International Petroleum Technology Conference. IPTC, 2022. http://dx.doi.org/10.2523/iptc-22626-ms.
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Abstract 40% of the world gas reserves are located in in the Middle East, of which most contain high amounts of corrosive gases H2S and CO2, this with other environmental factors exerts stress on metallic and nonmetallic materials. For Baker Hughes to address these challenges, one answer was to establish local competencies in the Kingdom of Saudi Arabia as a H2S lab and materials science focused team, ultimately targeting the reduction of total expense of corrosion, and to tap into the research capabilities and expertise available in the ecosystem. H2S gas is a major health and safety challenge to deal with, as it is a lethal, flammable, corrosive. The analysis to design the lab was supported by methods of Asset Integrity Risk Management looking on barriers, process, and industry standards. The human factor was considered to ensure competency, mindset & culture. Among others, OSHA standards were followed to develop the Chemical Hygiene Plan (CHP) and respiratory protection program and Emergency Response and Operations Plan (EROP). An unexpected challenge arose during the COVID-19 pandemic where measures were taken to limit infection while maintaining lab operation. The lab started operation with a narrow scope to focus on critical lab operational skill development, successive new competencies and workflows are added following a Management of Change (MOC) process. Current developments leverage the labs growing competence to address arising challenges on ultra-high H2S, CO2 for CCUS, and hydrogen for the energy transaction.
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Thomas, Joyce, i Megan Strickfaden. "Design for the Real World: a look back at Papanek from the 21st Century". W 13th International Conference on Applied Human Factors and Ergonomics (AHFE 2022). AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1002010.
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This paper presents an overview of Victor Papanek’s book Design for the Real World (1971) from the perspective of current 3rd year industrial design students, members of GenZ, combined with the perspectives of the educators/authors who read the original edition of the book in the 70s and 80s. Students read individual chapters the 2019 edition of this book, wrote a critical review, and presented their overviews and findings in two lengthy class discussions that allowed them to ‘read’ the entire book. The perspectives of the students and educators (from very different generations) reveal an interesting story about the Austrian-born American designer and educator’s writings. In this paper we reveal the continued relevance and critically analyze Papanek’s writings by illustrating how his views on socially and environmentally responsible design live on.Taking his early design inspiration from Raymond Loewy, Papanek went on to study architecture with Frank Lloyd Wright. An early follower and ally of Buckminster Fuller, a designer and systems theorist, Papanek applied principles of socially responsible design, both in theory and practice ultimately working on collaborative projects with UNESCO and the World Health Organization. In Design for the Real World, Papanek professed his philosophy that objects or systems work as political tools for change. He became a controversial voice within that time frame as he declared that many consumer products were frivolous, excessive, and lacked basic functionality causing them to be recklessly dangerous to the users. His ideas seemed extreme, echoed by many other environmental philosophers at the time, at that point in history, but perhaps viewed from the 21st century seem prophetic. An advocate for responsible design, Papanek had visionary ideas on design theory. Papanek felt it was important to put the user first when designing. He spent time observing indigenous communities in developing countries, working directly with, and studying people of different cultures and backgrounds. Papanek designed for people with disabilities often in pursuit of a better world for all. He also addressed themes that have continue to be overlooked in design in the 21st century - inclusion, social justice, appropriate technology, and sustainability.Papanek ultimately earned the respect of many talented colleagues. He would go on to design, teach, and write for future generations. Opposing the ideals of planned obsolescence and the mass consumerism that fuels it, his work encompassed what would become the idea of sustainable design and decreasing overproduction for the consumer market. Themes from Design for the Real World remain relevant, and today it has become one of the most widely read books on design; resulting in Papanek’s voice continuing to push designers to uplift their morals and standards in practicing design.This paper highlights Papanek’s values of designing thoughtfully and for all, while revealing the details on the relevance of his writings five decades after the original publication.
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Miller, N. "TEMPORAL LIGHT MODULATION (“FLICKER”): A SET OF WAVEFORM AND METRIC TARGETS FOR INDUSTRY DISCUSSION". W CIE 2023 Conference. International Commission on Illumination, CIE, 2023. http://dx.doi.org/10.25039/x50.2023.po027.
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Networked lighting controls hold promise for energy savings, asset tracking, simplification of maintenance, and options for setting scenes or moods in architectural and treatment spaces. Tunability of light intensity and colour may support biological health, especially in healthcare and senior living spaces. However, in the US, their complexity too frequently results in systems hard to coordinate in colour, intensity, and timing, and frustrating for staff and users to use. This paper describes a Mild Cognitive Impairment center in Atlanta, with the design, installation, and extensive rework of the control system to achieve the controls intent. The research motivation was originally to document the effect of lighting and controls on MCI patients. When it became clear the networked system was behaving unpredictably, the motivation morphed into studying what went wrong and why, and how to avoid similar problems in the future. Standardization, interoperability of components, and a common vocabulary is needed.
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Miller, N. "A CASE STUDY OF TUNABLE WHITE LED LIGHTING WITH NETWORKED LIGHTING CONTROLS". W CIE 2023 Conference. International Commission on Illumination, CIE, 2023. http://dx.doi.org/10.25039/x50.2023.po026.
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Networked lighting controls hold promise for energy savings, asset tracking, simplification of maintenance, and options for setting scenes or moods in architectural and treatment spaces. Tunability of light intensity and colour may support biological health, especially in healthcare and senior living spaces. However, in the US, their complexity too frequently results in systems hard to coordinate in colour, intensity, and timing, and frustrating for staff and users to use. This paper describes a Mild Cognitive Impairment center in Atlanta, with the design, installation, and extensive rework of the control system to achieve the controls intent. The research motivation was originally to document the effect of lighting and controls on MCI patients. When it became clear the networked system was behaving unpredictably, the motivation morphed into studying what went wrong and why, and how to avoid similar problems in the future. Standardization, interoperability of components, and a common vocabulary is needed.
Raporty organizacyjne na temat "Center for Studying Health System Change"
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Paez, Kathryn, Rachel Shapiro, Lee Thompson, Erica Shelton, Lucy Savitz, Sarah Mossburg, Susan Baseman i Amy Lin. Health System Panel To Inform and Encourage Use of Evidence Reports: Findings From the Implementation and Evaluation of Two Evidence-Based Tools. Agency for Healthcare Research and Quality (AHRQ), sierpień 2022. http://dx.doi.org/10.23970/ahrqepchealthsystempanel.
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Objectives. The Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program wants learning health systems (LHSs) to use the evidence from its reports to improve patient care. In 2018, to improve uptake of EPC Program findings, the EPC Program developed a project to enhance LHSs’ adoption of evidence to improve the quality and effectiveness of patient care. AHRQ contracted with the American Institutes for Research (AIR) and its partners to convene a panel of senior leaders from 11 LHSs to guide the development of tools to help health systems use findings from EPC evidence reports. The panel’s contributions led to developing, implementing, and evaluating two electronic tools to make the EPC report findings more accessible. AIR evaluated the LHSs’ use of the tools to understand (1) LHSs’ experiences with and impressions of the tools, (2) how well the tools helped them access evidence, and (3) how well the tools addressed barriers to LHS use of the EPC reports and barriers to applying the evidence from the reports. Data sources. (1) Implementation meetings with 6 LHSs; (2) interviews with 27 health system leaders and clinical staff who used the tools; and (3) website utilization metrics. Results. The tools were efficient and useful sources of summarized evidence to (1) inform systems change, (2) educate trainees and clinicians, (3) inform research, and (4) support shared decision making with patients and families. Clinical leaders appreciated the thoroughness and quality of the evidence reviews and view AHRQ as a trusted source of information. Participants found both tools to be valuable and complementary. Participants suggested optimizing the content for mobile device use to facilitate health system uptake of the tools. In addition, they felt it would be helpful to have training resources about tool navigation and interpreting the statistical content in the tools. Conclusions. The evaluation shows that LHSs find the tools to be useful resources for making the EPC Program reports more accessible to health system leaders. The tools have the potential to meet some, but not all, LHS evidence needs, while exposing health system leaders to AHRQ as a resource to help meet their information needs. The ability of the EPC reports to support LHSs in improving the quality of care is limited by the strength and robustness of the evidence, as well as the relevance of the report topics to patient care challenges faced by LHSs.
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Ossoff, Will, Naz Modirzadeh i Dustin Lewis. Preparing for a Twenty-Four-Month Sprint: A Primer for Prospective and New Elected Members of the United Nations Security Council. Harvard Law School Program on International Law and Armed Conflict, grudzień 2020. http://dx.doi.org/10.54813/tzle1195.
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Under the United Nations Charter, the U.N. Security Council has several important functions and powers, not least with regard to taking binding actions to maintain international peace and security. The ten elected members have the opportunity to influence this area and others during their two-year terms on the Council. In this paper, we aim to illustrate some of these opportunities, identify potential guidance from prior elected members’ experiences, and outline the key procedures that incoming elected members should be aware of as they prepare to join the Council. In doing so, we seek in part to summarize the current state of scholarship and policy analysis in an effort to make this material more accessible to States and, particularly, to States’ legal advisers. We drafted this paper with a view towards States that have been elected and are preparing to join the Council, as well as for those States that are considering bidding for a seat on the Council. As a starting point, it may be warranted to dedicate resources for personnel at home in the capital and at the Mission in New York to become deeply familiar with the language, structure, and content of the relevant provisions of the U.N. Charter. That is because it is through those provisions that Council members engage in the diverse forms of political contestation and cooperation at the center of the Council’s work. In both the Charter itself and the Council’s practices and procedures, there are structural impediments that may hinder the influence of elected members on the Security Council. These include the permanent members’ veto power over decisions on matters not characterized as procedural and the short preparation time for newly elected members. Nevertheless, elected members have found creative ways to have an impact. Many of the Council’s “procedures” — such as the “penholder” system for drafting resolutions — are informal practices that can be navigated by resourceful and well-prepared elected members. Mechanisms through which elected members can exert influence include the following: Drafting resolutions; Drafting Presidential Statements, which might serve as a prelude to future resolutions; Drafting Notes by the President, which can be used, among other things, to change Council working methods; Chairing subsidiary bodies, such as sanctions committees; Chairing the Presidency; Introducing new substantive topics onto the Council’s agenda; and Undertaking “Arria-formula” meetings, which allow for broader participation from outside the Council. Case studies help illustrate the types and degrees of impact that elected members can have through their own initiative. Examples include the following undertakings: Canada’s emphasis in 1999–2000 on civilian protection, which led to numerous resolutions and the establishment of civilian protection as a topic on which the Council remains “seized” and continues to have regular debates; Belgium’s effort in 2007 to clarify the Council’s strategy around addressing natural resources and armed conflict, which resulted in a Presidential Statement; Australia’s efforts in 2014 resulting in the placing of the North Korean human rights situation on the Council’s agenda for the first time; and Brazil’s “Responsibility while Protecting” 2011 concept note, which helped shape debate around the Responsibility to Protect concept. Elected members have also influenced Council processes by working together in diverse coalitions. Examples include the following instances: Egypt, Japan, New Zealand, Spain, and Uruguay drafted a resolution that was adopted in 2016 on the protection of health-care workers in armed conflict; Cote d’Ivoire, Kuwait, the Netherlands, and Sweden drafted a resolution that was adopted in 2018 condemning the use of famine as an instrument of warfare; Malaysia, New Zealand, Senegal, and Venezuela tabled a 2016 resolution, which was ultimately adopted, condemning Israeli settlements in Palestinian territory; and A group of successive elected members helped reform the process around the imposition of sanctions against al-Qaeda and associated entities (later including the Islamic State of Iraq and the Levant), including by establishing an Ombudsperson. Past elected members’ experiences may offer some specific pieces of guidance for new members preparing to take their seats on the Council. For example, prospective, new, and current members might seek to take the following measures: Increase the size of and support for the staff of the Mission to the U.N., both in New York and in home capitals; Deploy high-level officials to help gain support for initiatives; Partner with members of the P5 who are the informal “penholder” on certain topics, as this may offer more opportunities to draft resolutions; Build support for initiatives from U.N. Member States that do not currently sit on the Council; and Leave enough time to see initiatives through to completion and continue to follow up after leaving the Council.