Tier Model Research Articles

Less Might Not Be More, but May Be Enough for Some.

Mental health concerns among young adult populations have increased in recent years, with standard treatment approaches presenting many undue barriers (e.g., time and cost constraints and limited availability of therapists). Single-session interventions (SSIs) have been explored as an alternative, scalable intervention to address these barriers to care. We evaluated the acceptability and feasibility of a SSI in a real-world setting and found promising effects of the SSI on symptoms of depression in a young adult population. Given these findings, we offer support for the SSI as an accessible treatment alternative to perhaps be integrated into tiered care treatment models or settings with limited access to care.

Developing a community-based model of care for venipuncture in children and young adults with an intellectual disability: a retrospective study

BackgroundRegular blood tests for monitoring metabolic side effects are often unable to be collected for people with an intellectual/developmental disability (ID/DD) and challenging behaviours (CBs) using usual pathways. We aimed...

Personalized Exercise Prescription in Long COVID: A Practical Toolbox for a Multidisciplinary Approach.

To describe our methodology and share the practical tools we have developed to operationalize a multidisciplinary Long COVID clinic that incorporates progressive, personalized exercise prescription as a cornerstone feature. There is a lack of evidence-based guidance regarding optimal rehabilitation strategies for people with Long COVID. Existing guidelines lack precision regarding exercise dosage. As one of Australia's few established multidisciplinary Long COVID clinics, we describe our novel approach to safely incorporating exercise of both peripheral and respiratory muscles, with essential monitoring and management of post-exertional symptom exacerbation. Working closely with primary health-care providers, our multidisciplinary team screens referrals for people aged 16 and older with Long COVID. Staff apply a three tier model of triage, dependent on the consumer's presenting problems. Exercise-based interventions necessitate detailed monitoring for post-exertional symptom exacerbation both in the clinic and at home. Personalized exercise prescription includes resistance training at a submaximal threshold (4-6 exercises, 3 days/week); whole-body endurance exercise titrated to the individual's progress, at an intensity 4-6/10 (Rate of Perceived Exertion); and for those limited by dyspnoea, high-intensity inspiratory muscle training using a threshold-based handheld device (30 repetitions per day, ≥50% of their maximum inspiratory pressure). We have used these approaches for the past 2 years in 250 consumers with no serious adverse events and promising consumer feedback. Our exercise prescription is less conservative than the methods advocated in international guidelines for people with Long COVID, and these more progressive tools may be valuable in other contexts. In our experience, a multidisciplinary clinic-based approach to safely prescribing progressive exercise in Long COVID is feasible. Both peripheral and inspiratory muscle exercise can be effectively titrated to each individual's symptoms, and careful monitoring for post-exertional symptom exacerbation is crucial.

Learning to Implement Dialogic Reading Through Video-Based Online Training: A Preliminary Study.

Dialogic reading (DR) is an evidence-based method for reading with young children that is associated with improvements in children's oral language skills. There is, however, a lack of consensus on (a) how to train educators to deliver the intervention and (b) methods for assessing implementation fidelity. We designed this study to provide preliminary data about the viability of online video modules as an initial training option within a future tiered training model. We employed a within-subject repeated-measures group design to evaluate educators' (N = 20) implementation of DR after viewing training videos. Educators filmed themselves reading three storybooks with a child "as they would typically" to establish pretest reading behaviors. After being given access to a series of DR training videos, the educators recorded themselves reading three storybooks with the child using DR strategies as a posttest measure. Educators improved their use of individual strategies included in the DR instructional sequence at posttest; however, most participants did not consistently follow the entire instructional sequence as designed. Only one educator delivered the complete DR instructional sequence in > 80% of opportunities at posttest. Modifications to video training modules and additional coaching support may be warranted for many educators to achieve the level of implementation fidelity needed to improve the child's oral language skills from the intervention. https://doi.org/10.23641/asha.25749387.

A Profile of Occupational Therapists Working in School-Based Practice in Australian Primary Schools.

Inclusive education has increased the demand for school-based occupational therapy services and has reconceptualised the practice in mainstream schools. Therapists are now expected to work collaboratively with teachers within tiered intervention models to support access and participation of all students, including those with disabilities, within the natural classroom context. School-based occupational therapy has become a specialised area of practice, as therapists work within educational, rather than health, systems and processes. While the growth in demand and expanded scope of practice is positive for the profession, predicted workforce shortages and the necessity for specialised and enhanced practice present significant challenges. The ability of the profession to fully support the demands of an inclusive education system remains unclear. As accurate, up-to-date information on the school-based therapy workforce is the foundation for planning future personnel needs, knowledge of the current state of the workforce is critical. There is a paucity of national data regarding this growing area of practice. The aim of this study is to describe a current profile of school-based occupational therapists to better understand the workforce, practice patterns, and the funding landscape in Australia. A convenient and purposive sample of 108 Australian paediatric occupational therapists working in mainstream primary schools in New South Wales, Queensland, and Victoria was surveyed in this quantitative study, which was analysed using descriptive statistics. Results provide some insights into the workforce and practice of school-based therapy in Australia offering preliminary data for future planning in this important and growing area of paediatric practice. While specific to the local context, results invite cross-national and global comparison to reveal universal trends and localised nuances across diverse settings.

Two-level optimal scheduling of source–storage-load interactive distribution network based on particle swarm optimization algorithm

In response to the difficulties of grid integration and consumption of a high proportion of new energy generation, as well as the high pressure on traditional thermal power generation to regulate peak loads, this paper constructs a wind-solar-fire-water complementary power generation system with “dual energy storage” and proposes a two-layer scheduling optimization strategy for this system. The scheduling model’s higher layer uses the system’s complementary power generation system’s maximum benefit as its objective function. The lower tier model has the minimization of the system’s cost of regulating load peaks as the objective function, and the model is solved by the improved adaptive immune particle swarm optimization algorithm considering various constraints. Taking the improved IEEE30 node system as an example for analysis, according to the operation of the original power system and the different characteristics of pumped storage and storage power plants, pumped storage and energy storage power stations are gradually added to the system for scheduling comparative analysis, and different capacities are configured, respectively. Through the analysis of examples, it is verified that the proposed dual-storage joint scheduling optimization strategy can effectively improve the overall operation of the system, reduce the peaking pressure of thermal power units, and achieve the expected goal of maximizing economic benefits. It also improves the new energy consumption in the region and alleviates the thermal power peaking pressure.

Machine Learning Identifies Higher Survival Profile In Extracorporeal Cardiopulmonary Resuscitation.

Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve neurologically favorable survival in patients with refractory out-of-hospital cardiac arrest (OHCA) caused by shockable rhythms. Further refinement of patient selection is needed to focus this resource-intensive therapy on those patients likely to benefit. This study sought to create a selection model using machine learning (ML) tools for refractory cardiac arrest patients undergoing ECPR. Retrospective cohort study. Cardiac ICU in a Quaternary Care Center. Adults 18-75 years old with refractory OHCA caused by a shockable rhythm. Three hundred seventy-six consecutive patients with refractory OHCA and a shockable presenting rhythm were analyzed, of which 301 underwent ECPR and cannulation for venoarterial extracorporeal membrane oxygenation. Clinical variables that were widely available at the time of cannulation were analyzed and ranked on their ability to predict neurologically favorable survival. ML was used to train supervised models and predict favorable neurologic outcomes of ECPR. The best-performing models were internally validated using a holdout test set. Neurologically favorable survival occurred in 119 of 301 patients (40%) receiving ECPR. Rhythm at the time of cannulation, intermittent or sustained return of spontaneous circulation, arrest to extracorporeal membrane oxygenation perfusion time, and lactic acid levels were the most predictive of the 11 variables analyzed. All variables were integrated into a training model that yielded an in-sample area under the receiver-operating characteristic curve (AUC) of 0.89 and a misclassification rate of 0.19. Out-of-sample validation of the model yielded an AUC of 0.80 and a misclassification rate of 0.23, demonstrating acceptable prediction ability. ML can develop a tiered risk model to guide ECPR patient selection with tailored arrest profiles.

Integrating equifinality and multifinality into the of prevention programs in early childhood: The conceptual case for use of tiered models.

Introduced in the context of developmental psychopathology by Cicchetti and Rogosh in the Journal, the current paper incorporates the principles of equifinality and multifinality to support the use of tiered models to prevent the development of emerging child psychopathology and promote school readiness in early childhood. We use the principles of equifinality and multifinality to describe the limitations of applying one intervention model to address all children presenting with different types of risk for early problem behavior. We then describe the potential benefits of applying a tiered model for having impacts at the population level and two initial applications of this approach during early childhood. The first of these tiered models, Smart Beginnings, integrates the use of two evidenced-based preventive interventions, Video Interaction Project, a universal parenting program, and Family Check-Up, a selective parenting program. Building on the strengths of Smart Beginnings, the second trial, The Pittsburgh Study includes Video Interaction Project and Family Check-Up, and other more and less-intensive programs to address the spectrum of challenges facing parents of young children. Findings from these two projects are discussed with their implications for developing tiered models to support children's early development and mental health.

A Ceph S3 Object Data Store for HEP

In CMS, data access and management is organized around the data tier model: a static definition of what subset of event information is available in a particular dataset, realized as a collection of files. We present a novel data management model that obviates the need for data tiers by exploding files into individual event data product objects. The objects are stored and retrieved through Ceph S3 technology, with a layout designed to minimize data and metadata volume while maximizing data processing parallelism. We demonstrate that this object data format shows promise in reducing total storage requirements while allowing more flexible data access patterns. Performance benchmarks of a prototype data processing framework using this object data format and a test Ceph cluster are presented, showing good scaling behavior in a distributed processing task.

Digging deeper: Assessing the predictive power of common greenhouse gas accounting tools for soil carbon sequestration under organic amendment

Effective project implementation and quantification of emissions reduction in climate-smart agriculture initiatives face challenges in measurement, monitoring, and verification. To address these challenges, predictive models are regularly used to estimate the emissions reduction potential of land management changes and to prioritize funding for projects. Despite their growing utility, few studies have evaluated the performance of publicly available model tools using site specific data. This study evaluated the performance and utility of four common model tools that represent the three Intergovernmental Panel on Climate Change model tiers to predict soil organic carbon storage and estimate greenhouse gas emissions on working lands under organic matter amendment. Field data from two long-term, compost application experiments in Washington State formed the basis for model simulations using DayCent, COMET-Farm, Cool Farm, and the Washington State Climate Smart Estimator (WaCSE). Soil carbon sequestration and emissions estimates varied among the evaluated models, which was expected given their differential data requirements and input capabilities. COMET-Farm, although easier to use, exhibited a higher level of bias compared to DayCent, which was expected as a mixed tier model. The DayCent model, the model engine for the COMET-Farm tool, demonstrated the ability to explain ∼50% more of the variation in the observed values compared to COMET-Farm when initiated using the same parameters. Cool Farm was unsuitable for estimating SOC sequestration benefits from compost application primarily because it did not add carbon to the soil pool following amendment. The differences in emissions estimates derived from WaCSE compared with other tools could be attributed solely to its highly constrained input parameters and basis in tier 1 emissions factors. We conclude that online tools can provide rapid estimates of greenhouse gas emissions reduction potential over larger areas or groups of farms but should be used with caution for site-specific estimates. Hence, it is crucial to clarify the intended purpose of an assessment and the designed function of model tools when evaluating their suitability for prioritizing funding for climate-smart agriculture initiatives at the individual farm level.

Outcomes for young people in out of home care accessing tiered mental health services in Sydney, Australia.

Young people in OOHC have complex mental health concerns, therefore the South Western Sydney Local Health District (SWSLHD) has trialled a tiered model of mental health care. Under this model the OOHC mental health team (OOHC-MHT) provides specialist tier four service delivery for those with the most severe, intense mental health needs. OOHC consumers with a reduced level of severity access services at a tier three centre-based iCAMHS. This study aims to understand the characteristics of young people in OOHC accessing different service provision options in Sydney, Australia. Sixty-six OOHC consumers 8-17years accessing mental health services across SWSLHD from January 2020-December 2021 participated in the study. Group differences in OOHC-MHT and iCAMHS outcome measures were compared. HoNOSCA scores were significantly worse for OOHC-MHT than iCAMHS, indicating more severe psychopathology for OOHC-MHT at baseline. In OOHC-MHT, HoNOSCA decreased significantly from admission to discharge and scores on the CGAS increased significantly, indicating significant improvements in psychopathology and functioning. In the iCAMHS group scores on the HoNOSCA significantly decreased indicating improved psychopathology over this period. These findings support a tiered model of service delivery for OOHC consumers, with this tailored level of care resulting in significantly improved outcomes across a range of complexity.

Rural Prenatal Care by Nurse Practitioners: A Narrative Review.

Rural Canadian populations face many challenges due to their geographical isolation, including inaccessible and inequitable primary health care. Specifically, pregnant women are at risk of not receiving prenatal care (PNC) due to physical and social barriers. Inadequate PNC can have detrimental effects on both maternal and neonatal health outcomes. Nurse practitioners (NPs) are an essential group of alternative primary care providers who can provide specialized care, including PNC, to these underserved populations. The purpose of this narrative review was to identify existing NP-led rural PNC programs in other health care systems to support maternal and neonatal outcomes. A systematic search was performed to identify articles published between 2002 and 2022 on CINAHL (EBSCO host) and MEDLINE (OVID). Literature was excluded if (1) the context was based in urban centers; (2) the study focused on specialized obstetrical/gynecological-based care; or (3) the study was published in a language other than English. The literature was assessed and synthesized into a narrative review. The initial search identified 34 potentially relevant articles. Five broad themes were identified, including (1) barriers to care; (2) mobile health clinics; (3) collaborative or tiered models of care; (4) telemedicine; and (5) NPs as essential primary care providers. The introduction of a collaborative NP-led approach to rural Canadian settings has the potential to address barriers to PNC and provide efficient, equitable, and inclusive health care.

A nonlinear mathematical model on the Covid-19 transmission pattern among diabetic and non-diabetic population

In this paper, a three tier mathematical model describing the interactions between susceptible population, Covid-19 infected, diabetic population and Covid-19 infected, non diabetic population is proposed. Basic properties of such a dynamic model, namely, non negativity, boundedness of solutions, existence of disease-free and disease equilibria are studied and sufficient conditions are obtained. Basic reproduction number for the system is derived. Sufficient conditions on functionals and parameters of the system are obtained for the local as well as global stability of equilibria, thus, establishing the conditions for eventual prevalence of disease free or disease environment, as the case may be. The stability aspects are discussed in the context of basic reproduction number and vice versa. An important contribution of this article is that a novel technique is presented to estimate some key, influencing parameters of the system so that a pre-specified, assumed equilibrium state is approached eventually. This enables the society to prepare itself with the help of these key, influencing parameters so estimated. Several examples are provided to illustrate the results established and simulations are provided to visualize the examples.

Development of a microphysiological skin-liver-thyroid Chip3 model and its application to evaluate the effects on thyroid hormones of topically applied cosmetic ingredients under consumer-relevant conditions.

All cosmetic ingredients registered in Europe must be evaluated for their safety using non-animal methods. Microphysiological systems (MPS) offer a more complex higher tier model to evaluate chemicals. Having established a skin and liver HUMIMIC Chip2 model demonstrating how dosing scenarios impact the kinetics of chemicals, we investigated whether thyroid follicles could be incorporated to evaluate the potential of topically applied chemicals to cause endocrine disruption. This combination of models in the HUMIMIC Chip3 is new; therefore, we describe here how it was optimized using two chemicals known to inhibit thyroid production, daidzein and genistein. The MPS was comprised of Phenion® Full Thickness skin, liver spheroids and thyroid follicles co-cultured in the TissUse HUMIMIC Chip3. Endocrine disruption effects were determined according to changes in thyroid hormones, thyroxine (T4) and 3,3',5-triiodothyronine (T3). A main part of the Chip3 model optimization was the replacement of freshly isolated thyroid follicles with thyrocyte-derived follicles. These were used in static incubations to demonstrate the inhibition of T4 and T3 production by genistein and daidzein over 4days. Daidzein exhibited a lower inhibitory activity than genistein and both inhibitory activities were decreased after a 24h preincubation with liver spheroids, indicating metabolism was via detoxification pathways. The skin-liver-thyroid Chip3 model was used to determine a consumer-relevant exposure to daidzein present in a body lotion based on thyroid effects. A "safe dose" of 0.235μg/cm2 i.e., 0.047% applied in 0.5mg/cm2 of body lotion was the highest concentration of daidzein which does not result in changes in T3 and T4 levels. This concentration correlated well with the value considered safe by regulators. In conclusion, the Chip3 model enabled the incorporation of the relevant exposure route (dermal), metabolism in the skin and liver, and the bioactivity endpoint (assessment of hormonal balance i.e., thyroid effects) into a single model. These conditions are closer to those in vivo than 2D cell/tissue assays lacking metabolic function. Importantly, it also allowed the assessment of repeated doses of chemical and a direct comparison of systemic and tissue concentrations with toxicodynamic effects over time, which is more realistic and relevant for safety assessment.

How does materiality ‘bite back’? Investigating cassette tapes in local, translocal and virtual music scenes

Despite its status as an analogue sound carrier, the cassette has shown remarkable resilience in the digital era. Drawing on qualitative data gathered in three significant markets for cassettes, Japan, Australia and the USA, during 2018 and 2019, this article explores how the cassette tape’s material significance in the 21st century manifests itself in a complex network of interrelated local, translocal and virtual practices of music creation, distribution and consumption. The article draws on Magaudda’s ‘circuit of practice’ concept and Peterson and Bennett’s three tier model of scenes (local, trans-local and virtual). Taking the cassette’s hybrid occurrence and usage throughout a plethora of highly distinctive music scenes in Japan, Australia and the United States as a basis, we argue that Magaudda’s ‘circuit of practice’ theory needs to be structurally extended to grasp the multifaceted circuits of music in the digital age. This requires that the occurrence of a single audio format such as the cassette is recurringly analysed within different cultural contexts in order to map and delineate the format’s overall significance for contemporary music practices.

Mobility in the context of exposure-based assessment of chemicals for drinking water resourceprotection.

In order to protect European Union (EU) drinking water resources from chemical contamination, criteria for identifying persistent, mobile, and toxic (PMT) chemicals and very persistent and very mobile (vPvM) chemicals under the EU REACH Regulation were proposed by the German Environment Agency (Umweltbundesamt-UBA). Additionally, new hazard classes for PMT and vPvM substances in the revised EU classification, labeling, and packaging (CLP Regulation) are intended. Therefore, a reliable approach in theidentificationof potential drinking water resource contaminants is needed. The scientific basis of the property-based PMT/vPvM criteria, focusing on mobility, which dictates the migration of chemicaldrinking water sources, was evaluated, and a critical analysis of the deviation of sorption metrics from simple behavior was carried out. Based on our evaluation, a Koc may be used for nonionic substances on a screening level only, requiring a higher tier assessment. It is considered inappropriate for hydrophilic and ionizable chemicals, particularly for soils with low organic carbon contents. The nonextractable residue formation is complex and not well understood but remains significant in limiting the mobility of chemicals through soils and sediments. In order to inform the EU commission's work on the introduction of new hazard classes for PMT and vPvM substances into the European legislation, the derivation of a tiered approach is proposed,which utilizes the weight of evidence available, with adoption of appropriate higher tier models commensurate with the nature of the substance and the data available. Integr Environ Assess Manag 2023;19:775-791. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Impact on Vectran/Epoxy composites: Experimental and numerical analysis

AbstractThe aim of this paper is to present a plane-stress damage model based on the Classical Lamination Theory (CLT), developed for polymer fibre-based composite. The proposed numerical model utilises a damage mechanics methodology coupled with fracture mechanics to predict composite failure, particularly under quasi-static and dynamic loadings. In addition, the proposed constitutive equations consider a single secant modulus to describe its tensile and compressive modulus, as opposed to the physically proposed tier models for polymer fibres which possesses a ‘skin-core’ structure. The result of single element and coupon-level modelling showed excellent correlation with the experimental results. In addition, it was also found that the proposed numerical model showed considerable accuracy on the response of the composite under low and high velocity impact loadings.

Interior of glycogen probed by pyrene excimer fluorescence

A glycogen sample from oyster (O) and another from corn (C) were fluorescently labeled with 1-pyrenebutyric acid to yield two series of pyrene-labeled glycogen samples (Py-Glycogen(O/C)). Analysis of the time-resolved fluorescence (TRF) measurements of the Py-Glycogen(O/C) dispersions in dimethyl sulfoxide yielded the maximum number (<Nblobexp>) of anhydroglucose units (AGUs), that could separate two pyrene-labeled AGUs and still allow efficient pyrene excimer formation (PEF) between an excited and a ground-state pyrene. Molecular mechanics optimizations (MMOs) were conducted on a lattice of hexagonally close packed oligosaccharide helices to determine how the theoretical Nblobtheo varied as a function of the lattice density. Comparing <Nblobexp> and <Nblobtheo>, obtained after integrating Nblobtheo along the local density profile ρ(r) across the glycogen particles, led to the conclusion that ρ(r) took a maximum value at the center of the glycogen particles contrary to expectations based on the Tier Model.

A three tier model to promote the institutional adoption of learning analytics

&#x0D; &#x0D; &#x0D; Many institutions are making significant investments to build their learning analytics capability. However, creating a successful platform for large scale adoption of learning analytics (LA) is not simple. In this case study we describe the adoption of a three tier model designed for cross institutional engagement and implementation of LA at a medium sized tertiary education institution. We outline the actions taken at the three differentiated but interconnected levels of governance, projects and community. We analyse the results from activity in each of these three areas and, mark out a set of recommendations for future action that we anticipate will continue to drive and gain value from LA deployment across the institution.&#x0D; &#x0D; &#x0D;

Creating a Model for Developing and Evaluating Technical Instructions that use Extended Reality

Purpose: Extended reality (XR) is an umbrella term for the many ways that we can now design 3D, interactive, and real-time environments as in combining virtual and real elements, and experience immersion in a completely virtual reality (VR). The use of XR is increasing in popularity across a range of industries. Although researchers are becoming increasingly interested in the benefits and challenges of using XR to convey technical instructions, more comprehensive research is required. I aim to address this need in the present article by introducing an affordance model of Technical Instructions in Extended Reality, the TIER model. Two earlier categorizations, the affordances of technical instructions, and the phases of data handling in XR, formed the point of departure for this article. The analysis utilized a four-category model of affordances by Rantakokko and Nuopponen (2019) that comprised: accessing, finding, understanding, and relying on. Data handling in XR drew on a phase-based model by Rantakokko (2022) featuring: collection, processing, storage, transfer, combining, and presentation. Methods:The two sets of categorizations were combined into a holistic model with an iterative process in order to offer a tool for analyzing and describing the possibilities and challenges that XR brings to designing technical instructions. The iterative process was conducted by adding examples from existing research into matrix tables to understand how the affordances of technical instructions and the phases of data handling in XR are connected. Results: The TIER model is introduced with examples to illustrate how it can be used to view every phase of XR data handling in terms of the affordances of technical instructions based on the laws, regulations, principles of good guidance, and the design process. Conclusion: The TIER model can be used as a tool for an organized, step-by-step design process as well as testing XR-based technical instructions to ensure that the features of XR support the intended affordances of technical instructions. technical instructions, affordances, extended reality, mixed reality,