Longer Home Research Articles

Visual Analytics for Pattern Discovery in Home Care. Clinical Relevance for Quality Improvement.

Visualization can reduce the cognitive load of information, allowing users to easily interpret and assess large amounts of data. The purpose of our study was to examine home health data using visual analysis techniques to discover clinically salient associations between patient characteristics with problem-oriented health outcomes of older adult home health patients during the home health service period. Knowledge, Behavior and Status ratings at discharge as well as change from admission to discharge that was coded using the Omaha System was collected from a dataset on 988 de-identified patient data from 15 home health agencies. SPSS Visualization Designer v1.0 was used to visually analyze patterns between independent and outcome variables using heat maps and histograms. Visualizations suggesting clinical salience were tested for significance using correlation analysis. The mean age of the patients was 80 years, with the majority female (66%). Of the 150 visualizations, 69 potentially meaningful patterns were statistically evaluated through bivariate associations, revealing 21 significant associations. Further, 14 associations between episode length and Charlson co-morbidity index mainly with urinary related diagnoses and problems remained significant after adjustment analyses. Through visual analysis, the adverse association of the longer home health episode length and higher Charlson co-morbidity index with behavior or status outcomes for patients with impaired urinary function was revealed. We have demonstrated the use of visual analysis to discover novel patterns that described high-needs subgroups among the older home health patient population. The effective presentation of these data patterns can allow clinicians to identify areas of patient improvement, and time periods that are most effective for implementing home health interventions to improve patient outcomes.

Persistence and adherence in multiple sclerosis patients starting glatiramer acetate treatment: assessment of relationship with care received from multiple disciplines.

BackgroundIn multiple sclerosis patients, the persistence of, and adherence to, disease-modifying treatment are often insufficient. The degree of persistence and adherence may relate to the care received from various disciplines.MethodsIn an observational study of 203 patients treated with glatiramer acetate 20 mg subcutaneous daily, we assess the persistence and adherence in relation to the amount of care received in various disciplines. The frequencies and durations of care per discipline were reported by patients online, as were missed doses and eventual treatment discontinuation. The associations between the care provided by neurologists, nurses, psychologists, pharmacists, and rehabilitative doctors and persistence and adherence were the primary outcomes; the associations between care received from general practitioners, occupational therapists, physiotherapists, social workers, dieticians, home caregivers, informal caregivers, other medical specialists, and other caregivers and persistence and adherence were secondary outcomes.ResultsIt was found that the 12-month persistence rate was 62% and that 85% of the persistent patients were 95% adherent (missed <5% of doses). Patients who discontinued treatment in the fourth quarter (Q) had received less-frequent and shorter psychological care in Q3 than persistent patients (P=0.0018 and P=0.0022). Adherent patients had received more frequent home care and informal care than nonadherent patients (P=0.0074 and P=0.0198), as well as longer home care and informal care (P=0.0074 and P=0.0318). Associations between care in other disciplines and persistence or adherence were not observed. As to the relationship between adherence and persistence, nonadherence in Q2 was related to discontinuation after Q2 (P=0.0001).ConclusionWe obtained no evidence that, in multiple sclerosis patients, persistence of and adherence to disease-modifying treatment are associated with the amount of neurological, nursing, pharmaceutical, or rehabilitative care. However, findings suggest that the treatment of psychological problems in Q3 may relate to persistence and that home care and informal care may relate to adherence.

A service-based system for malnutrition prevention and self-management

Malnutrition is considered one of the root causes for the occurrence of other diseases. It is particularly common in the ageing population, where it requires more efficient handling and management to enable longer home independent living. However, to achieve this, a number of related challenges need to be overcome, especially those related to management of health and disease let alone other social and logistical barriers. This paper presents the design of a distributed system that enables homecare management in the context of self-feeding and malnutrition prevention through balanced nutritional intake. The design employs a service-based system that incorporates a number of services including monitoring of activities, nutritional reasoning for assessing feeding habits, diet recommendation for food planning, and marketplace invocation for automating food shopping to meet dietary requirements. The solution is deployed in a small pilot in 12 elder adult houses that, in early results, demonstrates its holistic user-centred scalable approach for malnutrition self-management.

Ecology of the Water Opossum Chironectes minimus in Atlantic Forest Streams of Southeastern Brazil

Abstract We studied the population structure, spatial patterns, and activity patterns of the water opossum (Chironectes minimus) via capture–mark–recapture and radiotelemetry from October 2004 to October 2006 in Atlantic Forest streams in southeastern Brazil. We tested the hypothesis of reproductive seasonality, the usual pattern in neotropical marsupials, by examining recruitment of juveniles. The hypothesis was rejected, supporting the alternative hypothesis that breeding by water opossums was better explained by its habitat characteristics and prey availability than by its phylogenetic ancestry. The observed sex ratio was significantly biased toward males. The home lengths of individual water opossums varied from 844 to 3,724 m. Males had larger home lengths than females, and there were male–male and male–female overlaps. The longer home lengths for males may explain the observed sex ratio bias, because males are more exposed to capture. All individuals used stream stretches with preserved riparian for...

Predictors of Chapter 13 Completion Rates: The Role of Socioeconomic Variables and Consumer Debt Type

This study examined whether demographic or financial variables best predict completion of Chapter 13 bankruptcy plans. Multinomial logistic regression revealed that demographic variables were more important than financial variables in predicting completion. Completion of a Chapter 13 repayment plan was not associated with a debtor’s monthly income or expenses. Never married debtors, dependent children, a previous filing, and higher mortgage arrears increased the likelihood of dismissal. Longer job tenure and home ownership improved completion rates. Discharge was associated with higher unsecured debts. Results can help improve Chapter 13 completion rates. Debtors need guidance in setting up realistic repayment plans. Financial counselors could help ensure that repayment plans are feasible and to counsel debtors who miss a plan payment.

Transitioning Youth from Residential Treatment to the Community: A Preliminary Investigation

Systematic transition planning through family involvement, service coordination, and community involvement is critical for achieving change for youth with emotional and behavioral disorders in residential treatment centers (RTCs). Sixty-two individuals (21 staff members, 21 parents, and 20 adolescents) from an RTC were interviewed regarding these practices. Results indicated that the RTC involved adolescents and parents in discharge planning, taught youth skills for success in the community, and facilitated community involvement. However, other areas needed improvement, such as communication between the residence and the adolescents’ home schools, more frequent and longer home visits, and aftercare services.

After oz

after oz* Lucille Clifton (bio) midnight we slip into her room and fill her pockets with stones so that she is weighted down so that storms cannot move her she disappears for hours then staggers back smelling of straw of animal perhaps we have lost her perhaps home is no longer comfort or comfort no longer home evenings we sit awake in our disenchanted kitchen listening to the dog whine to dorothy clicking her heels Lucille Clifton Lucille Clifton, Poet Laureate of the State of Maryland (1975–85), was recently awarded the National Book Award for her Blessing the Boats (2000). For her numerous books of poetry she has received many fellowships and awards, including the Shelly Memorial Prize, a Charity Randall Citation, an Emmy Award from the American Academy of Television Arts and Sciences, a selection as Literary Lion by the New York Public Library, a Lannan Achievement Award in Poetry, and the 1999 Lila Wallace-Readers Digest Writers Award. She serves on the board of Chancellors of the Academy of American Poets and was recently elected as a Fellow of the American Academy of Arts. Her poetry collection, The Terrible Stories, was a finalist for the National Book Award, the Lenore Marshall Prize and the Los Angeles Times Book Award. Footnotes Reprinted from Mercy (Boa Editions, 2004) by permission of the author. Copyright © 2004 Charles H. Rowell

The association between gender, race and marital status on functional outcome at rehabilitation discharge after thromboembolic stroke: a prospective analysis1

Appropriate allocation of rehabilitation resources requires that the rehabilitation professional have a knowledge of reliable predictors of functional outcome. To determine what influence pre-morbid demographic variables have on functional outcome following thromboembolic stroke, we analyzed prospectively collected demographic and functional data from consecutive patients admitted to rehabilitation at a tertiary university medical center. Data from 117 patients were statistically analyzed for correlations between demographic factors and functional outcome as measured by the FIM scale and hospital length of stay (LOS). While no significant correlations were found between race or gender and functional outcome, Caucasians were found to stay an average of 5 days longer in acute care than African-Americans. Non-married patients were found to have significantly longer rehabilitation LOS and return home following discharge less often. It is concluded that non-married status is a significant negative prognostic factor for functional outcome after thromboembolic stroke, while gender and race have no correlation.

An Examination of the Effect of Reimbursement and Organizational Structure on the Allocation of Hospice Staff Time

The unique needs of the terminally ill patient may require more planning and service coordination than those of the non-terminal patient. The hospice interdisciplinary team was a response to these additional needs. This paper examines the pattern of patient care and administrative activities of paid hospice staff by hospice organizational type and demonstration status in the National Hospice Study. Data gathered over a one year period revealed that demonstration hospices, in which all allowable costs were Medicare reimbursed, spent significantly more time in general and patient related administrative activities than non-demonstration hospices, which operated within existing Medicare cost limits. Staff in demonstration home care-based hospices reported significantly longer home visits than staff in non-demonstration hospices. In both groups, home care-based hospice visits were of longer duration than those home visits conducted by staff of hospital-based hospices.

The Mountainous Country at the Boundary, North New Guinea

FROM Manokwari in Dutch New Guinea there is only one recognized route to England, namely, by local steamer to Makassar, thence to Batavia, from which is regular steamer service with Europe. There is an alternative, though too unconventional to be even considered by officials: that is, to go east from Manokwari to Humboldt Bay, over the Dutch boundary into the Mandated Territory of New Guinea, by steamer from Wewak to Sydney and so to England. There is no regular communication of any kind between the two Territories. During the south-east monsoon one or two native praus may cross the boundary, and at very rare intervals, sometimes of several years, a white man may make that trip either by prau or partly on foot. When I reached Manokwari in December I938, after spending a year on two islands, Waigeu and Japen, I had already decided to take the longer route home because it gave me the opportunity of going to the very interesting Torricelli Range in the Mandated Territory. It is never possible to calculate beforehand exactly how much work can be undertaken on these collecting expeditions, but I had promised the Trustees of the South Australian Museum in Adelaide that, if it could be managed, I would collect insects for them in the Torricelli Mountains after finishing my work for the British Museum. So when the collections were duly packed and despatched, I caught a steamer going east. At Hollandia I hired carriers and walked over Djoea Bluff and Mount Oinake (Mount Bougainville) to Vanimo, the first government station in the Mandated Territory, then took the coastal road to Aitape. A native trade route crosses the plain south of Aitape and passes over the Torricelli Range into the interior. I encamped on this road at 2000 feet on Mount Lucreu, and worked on mountain slopes and in river beds and sago swamps for a month, with the intention of forming a camp on the highest mountain when the rainy season was over. But owing to official quibbles, I was obliged to leave the Torricelli Mountains and return to Dutch New Guinea. This change of plan proved to be rather fortunate as it happened, 12