On an Improved Diagnosis Program

Coordinated Science Laboratory was formerly known as Control Systems LaboratoryContract DA-28-043-AMC-00073(E

Analyzing the Triad Diagnosis Requirement for Autism in Arkansas

Autism Spectrum Disorder (ASD) is a developmental disorder that has steadily increased in incidence and prevalence over the last ten years. While the disorder can be diagnosed as early as two years of age, most children do not receive a diagnosis until they are about five years old. The state of Arkansas requires a triad autism diagnosis, mandating that a physician, psychologist, and speech pathologist individually evaluate and agree on a diagnosis of autism for a child. The purpose of this evaluation was to examine diagnostic practices in the 11 states that participate in the Autism and Developmental Disabilities Monitoring Network (ADDM) to compare efficiency of the Arkansas triad diagnosis. The ADDM findings show that Arkansas ranks last in autism detection and evaluation of at-risk children before age 3 years. These practices have not improved in the last 10 years. The participating states with the lowest ages of diagnosis and strongest practices utilized an interdisciplinary team approach and had programs located in multiple cities that were focused solely on early identification, evaluation, and diagnosis. By implementing similar interdisciplinary practices in Arkansas, the triad diagnosis requirement could be re-evaluated, and more resources for evaluation and diagnosis can be created for the state. Arkansas’ identification, evaluation, and diagnostic rates could improve by discontinuing the triad autism diagnosis requirement in favor of implementing similar interdisciplinary team approaches and increasing program locations throughout the state

Native American Weight Loss Movement: Pilot Test of a Culturally Tailored Weight Loss Program for American Indians

American Indians (AIs) have higher rates of obesity than other racial/ethnic groups, placing them at heightened risk for cardiovascular diseases, diabetes, and certain cancers. Culturally appropriate weight loss interventions may be the key to reducing risk. The most successful program used in AI communities has been the Diabetes Prevention Program (DPP), which limits enrollment to individuals with a clinical diagnosis of pre-diabetes. The purpose of this pilot project was to modify and culturally tailor a weight loss intervention to AI communities in Kansas to improve weight loss related behaviors among those who do not qualify for the DPP. The Native American Weight Loss Movement (NAWLM) was developed from 2012-2014 using an iterative process with 4 sequential modifications to the program. Group 1 received a slightly modified version of the DPP that was originally tailored to African Americans. Each group received an improved program based on modifications from the previous group. Our analysis shows 36.1% (95% CI: 25.7, 47.5) of all participants (n=72) lost weight; a majority (63.9%, 95% CI: 52.8-75.0) maintained weight, gained weight, or dropped out. Among individuals who completed the program (n=34), 76.5% lost weight (95% CI: 61.4, 91.5). These individuals lost an average of 2.98% body weight (95% CI: 1.58, 4.37), with 6 participants losing \u3e7% body weight. While most participants who completed the program lost weight, more research is needed to determine factors that discourage drop-out and promote behavioral changes. NAWLM shows promise as a weight loss program for AIs who do not qualify for the DPP

Improving Newborn Hearing Screening Through Collaboration and Communication

Purpose: Hearing loss is the number one birth defect among children. There are significant consequences of delayed diagnosis and failure to obtain timely intervention, particularly for a child’s speech and language development. Design and implementation of successful newborn hearing screening (NHS) programs can be challenging. The purpose of this paper is to demonstrate improved efficiency and effectiveness of a large NHS program through the implementation of a team approach engaging both ambulatory and hospital services. Methodology: A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was used to develop an improved NHS program focused on improving patient care. The SWOT analysis outcomes were used to determine several key factors to be implemented, including dedicated technicians solely assigned to the NHS program and purchase of new equipment to improve accuracy and reduce disposable costs. In addition, a two-tiered approach was implemented whereby the dedicated technicians performed initial screenings, with all rescreens performed by an audiologist. Results: Implementation of the new NHS program demonstrated numerous successes including a significant reduction in the failure rate, improved care coordination, and increased communication between ambulatory and hospital services

Engaging persons with mental illness and/or substance use disorder in care coordination services: an improvement project at a federally qualified community health center

Background: Mental health and substance use disorders seldom occur in isolation. They frequently accompany each other, as well as a substantial number of chronic general medical illnesses. Consequently, mental health conditions, substance-use disorders, and general health conditions are frequently co-occurring, and coordination of all of these types of health care is essential to improved health outcomes (Institute of Medicine, 2006). The U.S. system of healthcare is failing to identify, engage, and effectively treat people who are suffering from behavioral health conditions (Blanco, Coye, Knickman, Krishnan, Krystal, Pincus, Rauch, Simon, Vitiello, 2016). Because of poor coordination and lack of engagement, people often experience disrupted care and an over-reliance on emergency department and hospital care. At Lowell Community Health Center where this project takes place persons with a primary behavioral health diagnosis contribute to the highest utilization of emergency and inpatient hospital services. In July of 2018, Lowell CHC collaborated with Lowell House, Inc. to form a care coordination program to outreach and engage individuals identified as high utilizers of inpatient and emergency hospital services. Aim: The aim of this project is to describe the attributes of the population of patients who successfully engaged into care for the first six months of this new program, with recommendations for improvement to inform future program design. Method: The population of patients who successfully engaged in care in the first 6 months of the program described by independent variables consisting of age, gender, race, and preferred language. Dependent variable consisting of type of outreach. Data was evaluated to determine attributes of patients who successfully engaged in care and if correlations exist between variables and successful engagement. Results: The first six months of the program implementation demonstrated successful engagement and activation of 17.5% of patients. The average patient is described as low-income, 50-64 years of age, non-English speaking female with dual-diagnosis residing in the greater Lowell area. Themes regarding successful outreach type included telephonic and face-to-face being the most successful method of engagement. Although successful engagement was noted, longer-term efforts and analysis should focus on successful outreach and engagement strategies, emergency room utilization, treatment adherence and service adherence. Conclusions: The findings of this project indicate that having a team-based, multidisciplinary and multi-cultural approach to care coordination has led to successful engagement of 186 individuals within the first 6 months of this new program

Predicting clinically signficant change in an inpatient program for people with severe mental illness

Objective: The first aim of this study was to assess the proportion of patients who achieved reliable and clinically significant change over the course of treatment in an inpatient psychosocial rehabilitation program. The second aim was to determine whether age, gender, length of stay, and diagnosis and co-morbid diagnosis predicted those who were classified as improved or not improved, using clinical significance criteria. Method: Three hundred and thirty-seven patients from inpatient units at Bloomfield Hospital, Orange, New South Wales, Australia were assessed at admission, 3-month reviews and discharge using the expanded Brief Psychiatric Rating Scale, the Health of the Nation Outcome Scales and the Kessler 10. Results: Reliable and clinically significant improvement was found for 32.4% of inpatients on psychiatric symptomatology, 19.5% on psychosocial functioning and 20.2% on psychological distress. Logistic regression analyses found that the predictor variables collectively predicted those who made reliable and clinically significant improvement on psychiatric symptomatology, but not on psychosocial functioning or psychological distress. Those with a primary diagnosis of schizoaffective disorder had higher rates of improvement in psychiatric symptomatology compared to those with a diagnosis of schizophrenia. Those with co-morbid substance abuse disorders showed a trend towards greater improvement. Conclusions: Inpatient treatment is associated with clinically significant improvements for some patients with a severe mental illness. Patients with schizo-affective disorders are proportionally more likely to make improvement

Patient-reported outcomes 6 months after enhanced recovery after colorectal surgery.

BackgroundEnhanced recovery after surgery (ERAS) programs have been established as perioperative strategies associated with improved outcomes. However, intermediate and long-term patient-reported outcome data for patients undergoing ERAS interventions remain limited. We utilized an automated telephone survey 6 months post-colorectal surgery from patients who participated in an ERAS program to determine 6-month patient-reported outcomes and associated predictive factors.MethodsWe conducted a prospective observational study, using an automated telephone survey and researcher-administered telephone questionnaire 6 months after patients underwent abdominal colorectal surgery. Six-month significant outcomes were defined by persistent pain, hospital readmission, and patient satisfaction. Patients reporting these outcome variables were compared with patients who met none of these criteria. Additionally, analysis was performed to determine differences between patients that did and did not respond to the 6-month survey. A chi-square test was used to determine any relationship for categorical variables, a two independent sample t test for length of procedure/stay, and a Wilcoxon-Mann-Whitney test for pain scores.ResultsOne hundred fifty-four of 324 patients contacted 6 months after surgery completed the automated telephone survey (47.53%). There was no statistical difference between patient populations completing and not completing the survey. Hospital 6-month readmission was associated with patients with a diagnosis of cancer (P = .049) and with a longer mean length of index procedure (282 vs. 206 minutes, P = .006). Median 6-month pain scores were higher for patients that underwent an open procedure compared to laparoscopic (Z = - 2.06, P = .04).ConclusionsLong-term benefits of an ERAS program were mostly confirmed. Longer procedure time and patients with cancer correlated with an increased likelihood of hospital 6-month readmission, suggesting that perioperative outcomes in complex cancer patients need to be evaluated over a longer time frame. In addition, invasiveness of procedure continues to have a significant effect on pain scores even 6 months later

More+ oral health with ProSorriso Program

INTRODUCTION AND OBJECTIVE. The proactive involvement of health and education professionals with a focus on development transition groups is an important pillar for achieving the oral health goals for 2020 established by the World Health Organization and require reinforcement of actions for health promotion and prevention of oral diseases. Thus, it is justi+ed to develop a program of oral health promotion in schools, such as ProSorriso (Costa, 2014), in order to evaluate the e9ectiveness of the Program. METHODS. Quasi-experimental study, with measures’ application before and after the implementation of the ProSorriso Program, in 200 adolescents, aged between 11-16 years (mean of 13.21±1.014 years). This Program is developed in three phases: diagnosis, intervention and evaluation of the oral health of adolescents. The application of the Questionnaires of Eating Habits, Oral Hygiene and Oral Health Knowledge, as well as mouth observation according to WHO criteria (1997), occurred before and after participation in the program. RESULTS. Adolescents improved their oral health after active participation in ProSorriso, presenting fewer decayed teeth and more +lled teeth. Their dental plaque bio+lm also improved with signi+cant bene+ts for adolescents who bene+ted from the Program interventions (t = 7.389; p = .000). Adolescents’ knowledge about oral health and nutrition enhanced signi+cantly after participation in the ProSorriso Program (t = -6.510; p = .000); (t = 2.523; p = .012). CONCLUSIONS. Adolescents improved their health status, eating habits, hygiene and oral health knowledge, recognizing the e9ectiveness of the implementation of the ProSorriso Program as a determinant of adolescents present and future health.info:eu-repo/semantics/publishedVersio

Advanced Rotor Fault Diagnosis for Medium-Voltage Induction Motors Via Continuous Transforms

[EN] Anumber of field case studies for rotor fault diagnosis on medium-voltage induction motors operating in a petrochemical plant are presented in this paper. The methodology employed is based on analyzing the induction motor startup current with advanced signal processing tools (continuous transforms) that enable a capture of a complete picture of the rotor condition. Indeed, unlike the classical tools that often rely on the detection of few fault frequencies, these new tools allow extraction of the evolution of a wide range of fault components during the startup transient and steady-state evolutions, which enables improved reliability. This is crucial in medium-high-voltage motors, where a false diagnosis may result in significant expense due to inspection, repair, or forced outage. An additional contribution of the study is its immunity to external voltage supply disturbances, which introduce components that are not related to the failure and which are difficult to detect with classical tools. The results of this study prove how the advanced continuous tools enable an improved visualization of the fault components, distinguishing them from the other components that are not linked to the failure.This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, and Technology under Grant NRF-2013R1A1A2010370, and in part by the Human Resources Development Program of the Korea Institute of Energy Technology Evaluation and Planning (KETEP) funded by the Korea Government Ministry of Trade, Industry, and Energy under Grant 20134030200340Antonino-Daviu, J.; Pons Llinares, J.; Lee, SB. (2016). Advanced Rotor Fault Diagnosis for Medium-Voltage Induction Motors Via Continuous Transforms. IEEE Transactions on Industry Applications. 52(5):4503-4509. https://doi.org/10.1109/TIA.2016.2582720S4503450952

Injury Surveillance Among NASA Astronauts Using the Barell Injury Diagnosis Matrix

Astronauts perform physically demanding tasks and risk incurring musculoskeletal injuries during both groundbased training and missions. Increased injury rates throughout the history of the U.S. space program have been attributed to numerous factors, including an aging astronaut corps, increased Weightless Environment Training Facility (WETF) and Neutral Buoyancy Laboratory (NBL) training to construct the International Space Station, and improved clinical operations that promote injury prevention and reporting. With NASA program changes through the years (including retirement of the Shuttle program) and an improved training environment (including a new astronaut gym), there is no surveillance program to systematically track injury rates. A limited number of research projects have been conducted over the past 20 years to evaluate musculoskeletal injuries: (1) to evaluate orthopedic injuries from 1987 to 1995, (2) to describe upper extremity injuries, (3) to evaluate EVA spacesuit training related injuries, and (4) to evaluate in-flight musculoskeletal injuries. Nevertheless, there has been no consistently performed comprehensive assessment of musculoskeletal injuries among astronauts. The Barell Injury Diagnosis Matrix was introduced at the 2001 meeting of the International Collaborative Effort (ICE) on Injury Statistics. The Matrix proposes a standardized method of classifying body region by nature of injury. Diagnoses are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system. The purpose of this study is to assess the usefulness and complexity of the Barell Injury Diagnosis Matrix to classify and track musculoskeletal injuries among NASA astronauts