Convenient Settings Research Articles

The Clinical Utility of Precision Medicine: Properly Assessing the Value of Emerging Diagnostic Tests

Assessments of the clinical utility of biomarkers and genomic tests often ignore individual utility and fail to account for downstream changes to the care delivery model. Tests that identify outliers are often undervalued in favor of those that help direct treatment for the "average" patient. By reducing uncertainty, these tests also enable lower-cost providers and even patients to assume increased responsibility for care in more convenient and affordable settings.

Description of an academic community partnership lifestyle program for lower income minority adults at risk for diabetes.

Translating strategies and approaches from the successful clinically based Diabetes Prevention Program's lifestyle intervention to community settings is a key next step. This article describes a lifestyle program developed in partnership by researchers at a major university and public health professionals at a local health department. The Live Well, Be Well (LWBW) program was designed to meet the needs of lower income, minority, and low-literacy adults at risk for diabetes. It was adapted from interventions with demonstrated efficacy and delivered in Spanish and English by health department staff. The program consisted of a 6-month active phase and a 6-month maintenance phase and was primarily telephone based, with one in-person planning session and several group workshops. In-person and group sessions were held in convenient community-based settings. Counselors provided education and skills training to modify diet and increase physical activity. Self-selected and attainable goal-setting and action plans were emphasized to enhance self-efficacy. LWBW is the intervention component of a randomized trial with primary outcomes of fasting glucose, weight, and other clinical measures. The program provides a unique translational model for implementing diabetes risk reduction programs for underserved populations. Individually tailored and nonprescriptive, it utilized existing health department infrastructure, focused on telephone counseling, used culturally appropriate, low-literacy materials, and was delivered in local, community-based facilities.

Working towards men’s health: Findings from the Sefton men’s health project

Objective: To evaluate a health improvement initiative aimed at enhancing the health of men in deprived areas. Design: A healthy lifestyle programme was undertaken with men to increase their health knowledge, and encourage behaviour modification and access to health improvement services. A peer mentoring programme was implemented and a training programme delivered to community and public sector staff. Setting: The programme was delivered in the most deprived wards in Sefton (Liverpool, UK). Method: Qualitative interviews were conducted with men in the lifestyle and peer mentoring programme five months into the programme ( n = 6). Further telephone interviews with men took place towards the project’s end ( n = 14). Interviews with community staff and health professionals who attended the training were completed ( n = 5), fully transcribed and analysed thematically to meet the evaluation aims. Results: The key themes emerging were issues related to influences on participation (including settings and social networks), experiences of participation (including, for men, issues around control and physical activity) and for staff, the opportunity for reflection. Outcomes for men included: changed bio-medical body condition; increased functional capacity; and improved emotional and experiential well-being. Outcomes for staff included: planned change around individual practice; and networking and organizational change. Conclusion: Men liked the convenient settings for the healthy lifestyle programme and its activities, although peer mentoring involves challenges over recruitment and support, and staff also benefited. Men made recommendations for acceptable locations, support for marginalized men, and appropriate incentives.

Sentinel Node and Bone Marrow Micrometastases and Nanometastases

Step-sectioning and anti-cytokeratin immunohistochemistry allow detection of micrometastases and nanometastases down to the single cell level, but they are labor intensive and time consuming. Reverse-transcription polymerase chain reaction can be performed efficiently, but it cannot currently detect less than several thousand cancer cells per lymph node. Improvements in molecular assays are thus required for reliable use in clinical settings. Whole-axilla dissection maximizes chances of detecting micrometastases and nanometastases. However, sentinel lymph node analysis provides an important fraction of this information in more convenient surgical and laboratory settings. Nanometastases have been shown to be a risk factor for event-free survival and for metastatic relapse. Thus, a re-evaluation of current TNM staging procedures appears needed. Corresponding therapeutic strategies should be tested accordingly in prospective clinical trials with adequate follow-up time. Microinvasion of the bone marrow is an independent prognostic indicator for disease recurrence and death from cancer, but bone marrow analyses are poorly suited to monitor disease course and response to therapy. The detection of circulating tumor cells has been shown to provide useful prognostic information, but it correlates poorly with bone marrow microinvasion, and the latter remains an independent, albeit hard to manage, prognostic determinant.

Parametric links for binary choice models: A Fisherian–Bayesian colloquy

The familiar logit and probit models provide convenient settings for many binary response applications, but a larger class of link functions may be occasionally desirable. Two parametric families of link functions are investigated: the Gosset link based on the Student t latent variable model with the degrees of freedom parameter controlling the tail behavior, and the Pregibon link based on the (generalized) Tukey λ family, with two shape parameters controlling skewness and tail behavior. Both Bayesian and maximum likelihood methods for estimation and inference are explored, compared and contrasted. In applications, like the propensity score matching problem discussed below, where it is critical to have accurate estimates of the conditional probabilities, we find that misspecification of the link function can create serious bias. Bayesian point estimation via MCMC performs quite competitively with MLE methods; however nominal coverage of Bayes credible regions is somewhat more problematic.

Using Conjoint Analysis to Model the Preferences of Different Patient Segments for Attributes of Patient-Centered Care

A consensus regarding the components of a patient-centered approach to healthcare does not exist. Although patient-centered care should be predicated on patient preferences, existing models provide little evidence regarding the relative importance of different care processes to patients themselves. To involve patients in the design of a model of patient-centered care for a corporation of Canadian teaching hospitals. Using themes from focus groups and interviews, a conjoint survey was developed comprising 14 four-level patient-centered care attributes. Sawtooth Software's Choice Based Conjoint module (version 2.6.7) was used to design the survey. Each participant completed 15 choice tasks, each task presenting a choice between three hospitals described by a different combination of patient-centered care attribute levels. Latent class analysis was used to identify segments of participants with similar patient-centered care choice patterns. Randomized First Choice simulations were used to predict the percentage of participants in each segment who would choose different approaches to improving patient-centered care.Representative hospital service users were recruited from a corporation of five Canadian teaching hospitals serving a regional population of 2.2 million. A total of 508 patients and family members of children completed a choice-based conjoint survey. Latent class analysis revealed two segments: an informed care segment and a convenient care segment. Participants in the informed care segment (71.3% of the sample) were more likely to have higher education, be non-immigrants, speak English as a first language, and be outpatients or family members.The information needed to understand health concerns, an opportunity to learn health improvement skills, teams that communicated effectively, short waiting times, and collaborative treatment planning were more important to the informed care segment than to the convenient care segment. Convenient settings, a welcoming environment, and ease of internal access exerted a greater influence on the choices made by the convenient care segment. Both segments preferred hospitals that provided health information and gave prompt feedback on patient progress. This study suggests that many patients would exchange an increase in waiting times for prompt feedback, information, and the skills to improve their health.

Activity Recognition for Context-aware Hospital Applications: Issues and Opportunities for the Deployment of Pervasive Networks

Hospitals are convenient settings for the deployment of context-aware applications. The information needs of hospital workers are highly dependent on contextual variables, such as location, role and activity. While some of these parameters can be easily determined, others, such as activity are much more complex to estimate. This paper describes an approach to estimate the activity being performed by hospital workers. The approach is based on information gathered from a workplace study conducted in a hospital, in which 196 h of detailed observation of hospital workers was recorded. Contextual information, such as the location of hospital workers, artifacts being used, the people with whom they collaborate and the time of the day, is used to train a back propagation neural network to estimate hospital workers activities. The activities estimated include clinical case assessment, patient care, preparation, information management, coordination and classes and certification. The results indicate that the user activity can be correctly estimated 75% of the time (on average) which is good enough for several applications. We discuss how these results can be used in the design of activity-aware applications, arguing that recent advances in pervasive and networking technologies hold great promises for the deployment of such applications.

Care closer to home: past mistakes, future opportunities.

The Government White Paper on improving community health and care services (Our Health, Our Care, Our Say) proposes shifting care within particular specialties from hospital into community settings. The intention is to provide seamless care for patients when and where they want it, in more local and convenient settings. Professionals in primary and secondary care will need to respond by developing new ways of working to enable this policy to be effective. In this paper, we discuss the evidence of the effect of initiatives during previous health care reconfigurations to shift the balance of power from secondary to primary care. We also suggest a partnership model for primary and secondary care clinicians and discuss the potential advantages of working practices across the primary-secondary care divide. Summary Shifting care within particular specialties into community settings is emphasized in the Government's recent White Paper; Two innovations in recent years involving the primary-secondary health care interface have been specialist outreach clinics and general practitioners (GPs) with specialist interests; Both models demonstrate increased levels of patient satisfaction, but may not be cost-effective; It is essential that mistakes of the past are not repeated, but opportunities for better integration of primary and secondary care are not missed.

Privacy-Aware Autonomous Agents for Pervasive Healthcare

Hospitals are convenient settings for deploying pervasive computing technology, but they also raise important privacy concerns. Hospital work imposes significant demands on staff, including high availability, careful attention to patients, confidentiality, rapid response to emergencies, and constant coordination with colleagues. These demands shape the way hospital workers experience and understand privacy. In addition, healthcare professionals experience a high level of mobility because they must collaborate with colleagues and access information and artifacts distributed throughout the premises. Autonomous agents can help developers design privacy-aware systems that handle the threats raised by pervasive technology

Volunteerism and Virtual Community Business Success: The Case of the Internet Chess Club

Prior work has identified, in piecemeal fashion, desirable characteristics of virtual community businesses (VCBs) such as inimitable information assets, persistent handles fomenting trust, and an economic infrastructure. To date, researchers have lacked convenient settings to collect participant data to gain insight into VCB governance and success factors. In this work, we addressed this gap and studied the Internet Chess Club (ICC), a successful business that offers a rich and accessible data source for the researcher. We started with an idealized VCB success framework that stressed the key role of the volunteers. We then used an integrated data collection architecture and performed statistical analysis on the ICC members' attitudes and activities. We identified specific attitude and use segments that represent regular member and volunteer subgroups and we show that these segments and their interplay support the framework we advanced at the outset. In our conclusion, we point out the general lessons that can be taken from this case and applied to other VCBs.

Laser transformation hardening of a tool steel: Simulation-based parameter optimization and experimental results

Laser surface heat treatments comprise a wide variety of techniques by which hard and wear-resistant layers can be obtained on surface without affecting the bulk material. It is known that the performance of these kinds of treatments is highly influenced by the different parameters involved in the process, such as the thermophysical properties of the material or the laser beam settings: width, power and relative velocity to the workpiece. A careful parameter selection is therefore needed in order to get the desired results. In this sense, simulation models constitute a powerful tool not only to predict the more convenient experimental settings but also to provide a more comprehensive view of the laser process. In this work, a 3D numerical model for laser surface treatment is presented. The model couples the solution of a transient heat conduction equation with a metallurgical phase transformation model based on the Johnson–Mehl–Avrami and Koistinen–Marburger equations. The model is applied to the laser transformation hardening of a hot-work tool steel AISI H13. Several combinations of parameters, fulfilling the process requirements, have been derived from the model and tested on the laboratory. A hardened surface layer of about 0.3 mm depth and 5 GPa hardness is obtained. Measured hardness depth profiles are favourably compared with numerical expectations.

Results of a Comprehensive Workplace Program for the Prevention and Treatment of Smoking Addiction

To assess a comprehensive smoking prevention and treatment program in an electrical appliances company with 1600 employees. The program included smoking restrictions with the designation of smoking areas and the offer of smoking cessation treatment for the smokers affected. Study variables were age, sex, nicotine dependence (Fagerström Test), carbon monoxide in expired air, adherence to therapy, and smoking abstinence at 1 week, 1 month, 3 months (end of treatment), and 6 months. Successful smoking abstinence was defined as continuous abstinence from the beginning of treatment. Smoking prevalence was 34.8% and 19.5% of smokers requested treatment (77.4% men and 22.6% women). Mean (SD) age was 41.3 (10.3) years. Mean score of nicotine dependence was 5.3 (2.6) and the mean quantity of carbon monoxide in expired air was 35.6 (23.7) ppm. Adherence to therapy was good in 80% of patients. Rate of abstinence was 57.5% at 6 months, signifying a 4% reduction in prevalence. Workplace smoking cessation programs reduce prevalence and facilitate the establishment of smoking restrictions at the worksite. Companies are convenient settings for the implementation of programs aimed at smoking prevention and treatment.

Saliva alcohol concentrations in accident and emergency attendances

Objectives—Although alcohol is known to play a key part in accidents, no UK study has assessed alcohol concentrations in a comprehensive sample of accident and emergency (A&E) attenders. This study...

On categorical notions of compact objects

Due to the nature of compactness, there are several interesting ways of defining compact objects in a category. In this paper we introduce and study an internal notion of compact objects relative to a closure operator (following the Borel-Lebesgue definition of compact spaces) and a notion of compact objects with respect to a class of morphisms (following Áhn and Wiegandt [2]). Although these concepts seem very different in essence, we show that, in convenient settings, compactness with respect to a class of morphisms can be viewed as Borel-Lebesgue compactness for a suitable closure operator. Finally, we use the results obtained to study compact objects relative to a class of morphisms in some special settings.

A Theory Driven Health Promotion Program in a University Setting

Article: In an attempt to improve employees' health, increase productivity, decrease medical costs, and increase employee morale, many businesses and industries are offering health promotion and disease prevention programs for their employees. Colleges and universities as worksites are no exception and may be one of the more convenient settings in which to initiate health promotion activities due to the abundance of resources within the university community, such as recreational/fitness facilities, health/medical centers, academic resources, and employee benefits/human resources offices.