Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease

<p>Abstract</p> <p>Background</p> <p>The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients.</p> <p>Methods/Design</p> <p>A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts.</p> <p>Discussion</p> <p>The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases.</p

Personal lighting conditions to obtain more evidence in light effect studies

Research demonstrated a large variety regarding effects of light (e.g. health, performance, or comfort effects). Since human health is related to each individual separately, the lighting conditions around these individuals should be analysed individually as well. This paper provides, based on a literature study, an overview identifying the currently used methodologies for measuring lighting conditions in light effect studies. 22 eligible articles were analysed and this resulted in two overview tables regarding the light measurement methodologies. In 70% of the papers, no measurement details were reported. In addition, light measurements were often averaged over time (in 84% of the papers) or location level (in 32% of the papers) whereas it is recommended to use continuous personal lighting conditions when light effects are being investigated. Conclusions drawn in light effect studies based on personal lighting conditions may be more trusting and valuable to be used as input for an effect-driven lighting control system

Power Resources Among Female Military Personnel

The Armed Forces are one of Sweden’sSweden largest governmental organizations and at the same time one of Sweden’s most genderGender-segregated and male-dominated workplaces. Recruiting more women into the organization is one of the organization’s main goals for personnel planning, along with providing them with more opportunities for career developmentCareer development. This study sought a deeper understanding of the power resourcesPower resources that can be identified and which are used by female military personnel within the armed forces. A total of 16 women were interviewed and their ranks ranged from soldier/sailor to general/admiral. The qualitative analysis of the interviews shows that female military personnel use power resources to adapt to the male-dominated organization’s demands and to even out perceived asymmetric power relationships in their daily professional work. The power resources can be explained using four themes: structural power resources, cultural and social power resourcesSocial power resources, emotional power resources, and minority perspective as a power resource. More female military personnel would have increased the task effectiveness of the military organization. To make that possible, the Swedish Armed ForcesSwedish Armed Forces would have to discuss the prevailing masculinity norm, the meaning of being a man, and the gains of a more gender-equal organization.</p

Testing ab initio nuclear structure in neutron-rich nuclei: Lifetime measurements of second 2(+) state in C-16 and O-20

To test the predictive power of ab initio nuclear structure theory, the lifetime of the second 2+ state in neutron-rich 20O,τ(2+2)=150+80−30fs, and an estimate for the lifetime of the second 2+ state in 16C have been obtained for the first time. The results were achieved via a novel Monte Carlo technique that allowed us to measure nuclear state lifetimes in the tens-to-hundreds of femtoseconds range by analyzing the Doppler-shifted γ-transition line shapes of products of low-energy transfer and deep-inelastic processes in the reaction 18O(7.0MeV/u)+181Ta. The requested sensitivity could only be reached owing to the excellent performances of the Advanced γ-Tracking Array AGATA, coupled to the PARIS scintillator array and to the VAMOS++ magnetic spectrometer. The experimental lifetimes agree with predictions of ab initio calculations using two- and three-nucleon interactions, obtained with the valence-space in-medium similarity renormalization group for 20O and with the no-core shell model for 16C. The present measurement shows the power of electromagnetic observables, determined with high-precision γ spectroscopy, to assess the quality of first-principles nuclear structure calculations, complementing common benchmarks based on nuclear energies. The proposed experimental approach will be essential for short lifetime measurements in unexplored regions of the nuclear chart, including r-process nuclei, when intense beams, produced by Isotope Separation On-Line (ISOL) techniques, become available

Testing ab initio nuclear structure in neutron-rich nuclei: Lifetime measurements of second 2(+) state in C-16 and O-20 state in and

To test the predictive power of ab initio nuclear structure theory, the lifetime of the second 2+ state in neutron-rich O20,τ(22+)=150-30+80fs, and an estimate for the lifetime of the second 2+ state in C16 have been obtained for the first time. The results were achieved via a novel Monte Carlo technique that allowed us to measure nuclear state lifetimes in the tens-to-hundreds of femtoseconds range by analyzing the Doppler-shifted γ-transition line shapes of products of low-energy transfer and deep-inelastic processes in the reaction O18(7.0MeV/u)+Ta181. The requested sensitivity could only be reached owing to the excellent performances of the Advanced γ-Tracking Array AGATA, coupled to the PARIS scintillator array and to the VAMOS++ magnetic spectrometer. The experimental lifetimes agree with predictions of ab initio calculations using two-and three-nucleon interactions, obtained with the valence-space in-medium similarity renormalization group for O20 and with the no-core shell model for C16. The present measurement shows the power of electromagnetic observables, determined with high-precision γ spectroscopy, to assess the quality of first-principles nuclear structure calculations, complementing common benchmarks based on nuclear energies. The proposed experimental approach will be essential for short lifetime measurements in unexplored regions of the nuclear chart, including r-process nuclei, when intense beams, produced by Isotope Separation On-Line (ISOL) techniques, become available