The individualized service plan as a clinical integration tool: qualitative analysis in the Quebec PRISMA experiment

Introduction: One aspect of clinical integration involves case managers' tools and particularly the individualized service plan. Methods: We examined individualized service plan content and use in the PRISMA experiment. We analyzed 50 charts, and conducted and recorded interviews regarding individualized service plan use with all the case managers concerned (n=13). Results: Delays between starting case management and writing the individualized service plan were long and varied (0–596 days, mean: 117 days). During the interviews, the individualized service plan was described as the ‘last step’ once the active planning phase was over. The reasons for formulating plans were mainly administrative. From a clinical viewpoint, individualized service plans were used as memoranda and not to describe services (842 interventions not mentioned in the plans) or needs (694 active problems not mentioned). Case managers felt uncomfortable with the individualized planning task and expected a tool more adapted to their needs. Conclusion: Although a majority of the case managers' charts contained an individualized service plan, implementation of this tool seems tenuous. Because of the discrepancy between the potential usefulness expected by case managers and their actual use, a working committee was created to develop proposals for modifying the instrument

Influence of aerosol and surface reflectance variability on hyperspectral observed radiance

Current aerosol retrievals based on visible and near infrared remote-sensing, are prone to loss of accuracy, where the assumptions of the applied algorithm are violated. This happens mostly over land and it is related to misrepresentation of specific aerosol conditions or surface properties. New satellite missions, based on high spectral resolution instruments, such as PRISMA (Hyperspectral Precursor of the Application Mission), represent a valuable opportunity to improve the accuracy of τ<sup>a</sup><sub>550</sub> retrievable from a remote-sensing system developing new atmospheric measurement techniques. This paper aims to address the potential of these new observing systems in more accurate retrieving τ<sup>a</sup><sub>550</sub>, specifically over land in heterogeneous and/or homogeneous areas composed by dark and bright targets. The study shows how the variation of the hyperspectral observed radiance can be addressed to recognise a variation of Δτ<sup>a</sup><sub>550</sub> = 0.02. The goal has been achieved by using simulated radiances by combining two aerosol models (urban and continental) and two reflecting surfaces: dark (represented by water) and bright (represented by sand) for the PRISMA instrument, considering the environmental contribution of the observed radiance, i.e., the adjacency effect. Results showed that, in the continental regime, the expected instrument sensitivity would allow for retrieval accuracy of the aerosol optical thickness at 550 nm of 0.02 or better, with a dark surface surrounded by dark areas. The study also showed that for the urban regime, the surface plays a more significant role, with a bright surface surrounded by dark areas providing favourable conditions for the aerosol load retrievals, and dark surfaces representing less suitable situations for inversion independently of the surroundings. However, over all, the results obtained provide evidence that high resolution observations of Earth spectrum between 400 and 1000 nm would allow for a significant improvement of the accuracy of the τ<sup>a</sup><sub>550</sub> for anthropogenic/natural aerosols over land

Eficácia da nitazoxanida contra Toxocara canis: recuperação larvária e resposta imune humoral em camundongos experimentalmente infectados

Foi investigada a eficácia da nitazoxanida (NTZ) na toxocaríase murina experimental e os resultados comparados com os obtidos usando mebendazol (MBZ). Sessenta camundongos BALB/c machos, com idade entre seis e oito semanas foram divididos em grupos de 10 cada, 50 foram infectados oralmente com 300 ovos larvados de T. canise agrupados a seguir: GI: camundongos infectados não tratados; GII: camundongos infectados tratados com MBZ (15 mg/kg/dia) 10 dias pós-infecção (dpi); GIII: camundongos infectados tratados com NTZ (20 mg/kg/dia) 10 dpi, GIV: camundongos infectados tratados com MBZ 60 dpi; GV: camundongos infectados tratados com NTZ 60 dpi; GVI: controle não infectado. Os camundongos foram sangrados via plexo retro orbitário em quatro ocasiões entre o 30º e 120º dpi. Os soros foram processados pela técnica de ELISA para detecção de anticorpos IgG anti- Toxocara.Aos 120 dpi, os animais foram sacrificados para a recuperação larvária do SNC, fígado, pulmões, rins, olhos e carcaça. Os resultados mostraram níveis similares de anticorpos IgG anti- Toxocaraentre os camundongos infectados mas não submetidos a tratamento e os grupos infectados e tratados com MBZ ou NTZ, aos 10 e 60 dpi. Os valores da recuperação larval foram similares nos grupos tratados com NTZ e MBZ 10 dpi. MBZ mostrou melhor eficácia aos 60 dpi, com redução de 72,6% da carga parasitária comparada com NTZ, que mostrou redução somente de 46,5%. Concluímos que a administração destes anti-helmínticos não modificou a resposta humoral na infecção experimental por T. canis. Não foi observada cura parasitológica com nenhuma das drogas; porém maior redução na carga parasitária foi obtida após o tratamento com MBZ.The efficacy of nitazoxanide (NTZ) against toxocariasis was investigated in an experimental murine model and results were compared to those obtained using mebendazole. Sixty male BALB/c mice, aged six to eight weeks-old, were divided into groups of 10 each; fifty were orally infected with 300 larvaed eggs of T. canisand grouped as follows, G I: infected untreated mice; G II: infected mice treated with MBZ (15 mg/kg/day) 10 days postinfection (dpi); G III: infected mice treated with NTZ (20 mg/kg/day) 10 dpi; G IV: infected mice treated with MBZ 60 dpi; G V: infected mice treated with NTZ 60 dpi; GVI: control group comprising uninfected mice. Mice were bled via retro-orbital plexus on four occasions between 30 and 120 dpi. Sera were processed using the ELISA technique to detect IgG anti- Toxocaraantibodies. At 120 dpi, mice were sacrificed for larval recovery in the CNS, liver, lungs, kidneys, eyes and carcass. Results showed similar levels of anti- ToxocaraIgG antibodies among mice infected but not submitted to treatment and groups treated with MBZ or NTZ, 10 and 60 dpi. Larval recovery showed similar values in groups treated with NTZ and MBZ 10 dpi. MBZ showed better efficacy 60 dpi, with a 72.6% reduction in the parasite load compared with NTZ, which showed only 46.5% reduction. We conclude that administration of these anthelmintics did not modify the humoral response in experimental infection by T. canis. No parasitological cure was observed with either drug; however, a greater reduction in parasite load was achieved following treatment with MBZ

Monitoring the degree of implementation of an integrated delivery system

INTRODUCTION: The aim of the study was to develop a method to measure the implementation of specific components of an Integrated Service Delivery system for the frail elderly. The system includes six mechanisms and tools: (1) coordination of all organizations involved in delivering health and social services, (2) a single entry point, (3) case management, (4) a single assessment tool with a case-mix classification system, (5) an individualized service plan, and (6) a computerized clinical chart. METHOD: Focus groups of researchers, clinicians, managers and policy-makers identified quantitative indicators for each component. The six components were weighted according to their relative importance in order to generate a total score. Data were collected every six months over 30 months to establish the implementation degree in the three experimental areas: Sherbrooke, Granit and Coaticook in the Province of Quebec, Canada. RESULTS: After 30 months, coordination is the most developed component in the three experimental areas. Overall, in July 2003, the Integrated Service Delivery system was implemented at the rate of 73%, 71% and 70% in Sherbrooke, Granit and Coaticook, respectively. DISCUSSION: This type of quantitative assessment provides data for managers and researchers to monitor the implementation. Moreover, when there is an outcome study, the results of the outcome study can be correlated with the degree of implementation, thus allowing for dose-response analyzes and helping to decrease the “black box” effect

PRISMA: a new model of integrated service delivery for the frail older people in Canada

PURPOSE: PRISMA is an innovative co-ordination-type Integrated Service Delivery System developed to improve continuity and increase the efficacy and efficiency of services, especially for older and disabled populations. DESCRIPTION: The mechanisms and tools developed and implemented by PRISMA include: (1) co-ordination between decision-makers and managers, (2) a single entry point, (3) a case management process, (4) individualised service plans, (5) a single assessment instrument based on the clients' functional autonomy, and (6) a computerised clinical chart for communicating between institutions for client monitoring purposes. PRELIMINARY RESULTS: The efficacy of this model has been tested in a pilot project that showed a decreased incidence of functional decline, a decreased burden for caregivers and a smaller proportion of older people wishing to be institutionalised. CONCLUSION: The on-going implementation and effectiveness study will show evidence of its real value and its impact on clienteles and cost

Cardiovascular and enjoyment comparisons after active videogame and running in type 1 diabetes patients:A randomized crossover trial

International audienceBackground: Active videogames (AVG) have been primarily studied in healthy individuals. To use the technology in type-1 diabetes (T1DM) patients, cardiovascular and enjoyment responses should be studied and compared with traditional exercises.Objective: To compare the effects of AVG and running exercises on cardiovascular and enjoyment responses in T1DM patients. Methods: Cardiovascular (heart rate–HR, blood pressure–BP, double product–DP, vessel size–VD, and endothelial function–%EF) and enjoyment levels were recorded during three weeks and twice per week. On the first day, patients completed baseline assessments, familiarization, and a 30-minute control session. On the second day and after 24 hours, the measurements were repeated. Patients repeated the same protocol in the second and third weeks and performed randomized active sessions.Results: T1DM patients had similar cardiovascular responses during active exercises without significant post-exercise hypotension to HR, BP, and DP over time. However, VD and %EF values were higher in AVG, followed by running and rest, 30 minutes and after 24 hours (VDAVG: 39.6 ± 9.5, 48.8 ± 12.3, and 56.6 ± 13.9 mm; VDRunning: 41.5 ± 9.9, 47.4 ± 10.1, and 46.4 ± 12.4 mm; %EFAVG: 9.6 ± 8.5, 29.6 ± 17.1, and 45.4 ± 25.9 %; %EFRunning: 7.3 ± 9.4, 14.8 ± 14.1, and 26.8 ± 18.9 %, p < 0.05). Enjoyment was also higher in AVG compared to the running session (9.4 ± 0.7 vs. 7.7 ± 1.6; p < 0.05).Conclusions: AVG presented similar cardiovascular responses to running with higher endothelial and enjoyment levels

A video-rate hyperspectral camera for monitoring plant health and biodiversity

Hyperspectral cameras are a key enabling technology in precision agriculture, biodiversity monitoring, and ecological research. Consequently, these applications are fueling a growing demand for devices that are suited to widespread deployment in such environments. Current hyperspectral cameras, however, require significant investment in post-processing, and rarely allow for live capture assessments. Here, we introduce a novel hyperspectral camera that combines live spectral data and high-resolution imagery. This camera is suitable for integration with robotics and automated monitoring systems. We explore the utility of this camera for applications including chlorophyll detection and live display of spectral indices relating to plant health. We discuss the performance of this novel technology and associated hyperspectral analysis methods to support an ecological study of grassland habitats at Wytham Woods, UK

The effectiveness of the PRISMA integrated service delivery network: preliminary report on methods and baseline data

Purpose: The PRISMA study analyzes an innovative coordination-type integrated service delivery (ISD) system developed to improve continuity and increase the effectiveness and efficiency of services, especially for older and disabled populations. The objective of the PRISMA study is to evaluate the effectiveness of this system to improve health, empowerment and satisfaction of frail older people, modify their health and social services utilization, without increasing the burden of informal caregivers. The objective of this paper is to present the methodology and give baseline data on the study participants. <br><br> Methods: A quasi-experimental study with pre-test, multiple post-tests, and a comparison group was used to evaluate the impact of PRISMA ISD. Elders at risk of functional decline (501 experimental, 419 control) participated in the study. <br><br> Results: At entry, the two groups were comparable for most variables. Over the first year, when the implementation rate was low (32%), participants from the control group used fewer services than those from the experimental group. After the first year, no significant statistical difference was observed for functional decline and changes in the other outcome variables. <br><br> Conclusion: This first year must be considered a baseline year, showing the situation without significant implementation of PRISMA ISD systems. Results for the following years will have to be examined with consideration of these baseline results

Integrated care: What can be done at the micro level to influence integration in primary health care?

Consumers require health services that meet their needs, are connected and well-integrated. They want to experience ‘one health system’ regardless of service structure, funding or governance. The provider-patient interface is the critical environment in which the needs and expectations of both providers and patients are considered

Assessing Generalization of Behavioral Interventions in Teaching Independent Play Skills to Individuals with Autism Spectrum Disorder: A Systematic Review

A myriad of evidence-based practices has been effective in teaching independent play skills to individuals with Autism Spectrum Disorder (ASD). These interventions include video modeling, activity schedules, task correspondence training, task organization, individual work systems, and matrix training. This systematic review is aimed at examining the various behavioral interventions used to teach independent play skills to children and adolescents with ASD as the independent play literature will be evaluated to see if generalization was programmed for and assessed within the study. As one of the main dimensions of behavior analysis, generalization of skills, specifically independent play skills, is important to examine as a valuable characteristic of the field of applied behavior analysis (ABA). Generalization of independent play skills is essential for a child’s development and overall well-being. Independent play refers to a child’s ability to engage in play and activities without constant adult supervision or direct involvement. When these skills are generalized, it means the child can apply them across various settings, toys, and situations. The PRISMA program was used to screen potential articles for inclusion in the review. The final analysis included seven articles that met the predetermined inclusionary and exclusionary criteria. Six out of the seven included articles demonstrated generalization to either novel environments, people, or objects. More specifically, three out of the seven articles both programmed for and assessed for generalization. Similarities existed amongst the studies in that most generalized to new environments. Future research should continue investigating the benefits of the acquisition of independent play skills and how well these skills generalize to various stimuli so that these skills can transfer across new conditions