Healing the health care system: Summaries from the Department of Health Policy Summer Seminar

Editorial Introduction: The disease management field continues to evolve. The range of chronic diseases treated has expanded to include such conditions as obesity and pain management, and the care continuum now encompasses wellness, prevention, and population health. One population that is an ideal candidate for our collective efforts is that of older adults. Global and national population projections reveal the impending staggering increase in the age 65+ cohort, which will cause a sharp increase in the demand for health care and other services due to such age-related issues as multiple chronic conditions, falls, and depression. To begin to address these issues, the Department of Health Policy at Jefferson Medical College devoted its annual Summer Seminar to providing a forum for collaborative discussion focusing on the needs of the aging population. Two of the presentations focused on Pennsylvania, although the demographics presented by Nora Dowd Eisenhower reflect national and global trends, and the recently passed legislation outlined by Rosemarie Greco can be used as a yardstick against which other states can judge their own progress. Dr Susan Reinhard\u27s presentation keys in on the need for expansion of scope of practice and consumer-oriented care. Our keynote speaker, Dr Robert Butler, details the challenging issues we must face and resolve in order to cope with the impending crisis. And finally, a panel, comprising representatives from payor, practitioner, and consumer groups, offer their candid, unscripted reactions to the presentations in a segment titled Bridging the Gap Between the Vision and Implementation. Summaries of these presentations follow. I hope that you will invest your time in reviewing these materials, and begin to think about the significant role that disease management can play in reforming the health care system to meet the needs of the older adult population. I am, as always, interested in your feedback. You can reach me via email at [email protected]

Reports of Committees

Contains reports from the following committees of the Washington State Bar Association: Annotations to the Restatement of Law, Cooperation with American Bar Association, Corporation Law, Discipline and Disbarment, Judicial Administration, Law Enforcement, Law Examiners, Legislative Committee, Public Relations, Selection of Judges, and Unauthorized Practice of Law. Includes the auditor\u27s report

Augmented Method to Improve Thermal Data for the Figure Drift Thermal Distortion Predictions of the JWST OTIS Cryogenic Vacuum Test

The JWST Optical Telescope Element (OTE) assembly is the largest optically stable infrared-optimized telescope currently being manufactured and assembled, and is scheduled for launch in 2018. The JWST OTE, including the 18 segment primary mirror, secondary mirror, and the Aft Optics Subsystem (AOS) are designed to be passively cooled and operate near 45K. These optical elements are supported by a complex composite backplane structure. As a part of the structural distortion model validation efforts, a series of tests are planned during the cryogenic vacuum test of the fully integrated flight hardware at NASA JSC Chamber A. The successful ends to the thermal-distortion phases are heavily dependent on the accurate temperature knowledge of the OTE structural members. However, the current temperature sensor allocations during the cryo-vac test may not have sufficient fidelity to provide accurate knowledge of the temperature distributions within the composite structure. A method based on an inverse distance relationship among the sensors and thermal model nodes was developed to improve the thermal data provided for the nanometer scale WaveFront Error (WFE) predictions. The Linear Distance Weighted Interpolation (LDWI) method was developed to augment the thermal model predictions based on the sparse sensor information. This paper will encompass the development of the LDWI method using the test data from the earlier pathfinder cryo-vac tests, and the results of the notional and as tested WFE predictions from the structural finite element model cases to characterize the accuracies of this LDWI method

The Technological culture of war

The article proceeds from the argument that war is a social institution and not a historical inevitability of human interaction, that is, war can be “unlearned.” This process involves deconstructing/dismantling war as an institution in society. An important step in this process is to understand the philosophical and cultural bases on which technology is employed as “tools” of war. The article focuses on such questions as, Is technology just viewed as instruments in the hand of its human masters in war? Does technology take on an autonomous role in war? How should we assess the impact of context (political, economic, and cultural) of technology when employed in war? By exploring these points, the article hopes to provide input into the discussion on the control of war technologies and ultimately the dismantling of war as an institution in society

The role of war in deep transitions: exploring mechanisms, imprints and rules in sociotechnical systems

This paper explores in what ways the two world wars influenced the development of sociotechnical systems underpinning the culmination of the first deep transition. The role of war is an underexplored aspect in both the Techno-Economic Paradigms (TEP) approach and the Multi-level perspective (MLP) which form the two key conceptual building blocks of the Deep Transitions (DT) framework. Thus, we develop a conceptual approach tailored to this particular topic which integrates accounts of total war and mechanisms of war from historical studies and imprinting from organisational studies with the DT framework’s attention towards rules and meta-rules. We explore in what ways the three sociotechnical systems of energy, food, and transport were affected by the emergence of new demand pressures and logistical challenges during conditions of total war; how war impacted the directionality of sociotechnical systems; the extent to which new national and international policy capacities emerged during wartime in the energy, food, and transport systems; and the extent to which these systems were influenced by cooperation and shared sacrifice under wartime conditions. We then explore what lasting changes were influenced by the two wars in the energy, food, and transport systems across the transatlantic zone. This paper seeks to open up a hitherto neglected area in analysis on sociotechnical transitions and we discuss the importance of further research that is attentive towards entanglements of warfare and the military particularly in the field of sustainability transitions

The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis

Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.published_or_final_versio

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies

How do parents manage irritability, challenging behavior, non-compliance and anxiety in children with Autism Spectrum Disorders? A meta-synthesis

Although there is increasing research interest in the parenting of children with ASD, at present, little is known about everyday strategies used to manage problem behaviour. We conducted a meta-synthesis to explore what strategies parents use to manage irritability, non-compliance, challenging behaviour and anxiety in their children with ASD. Approaches included: (1) accommodating the child; (2) modifying the environment; (3) providing structure, routine and occupation; (4) supervision and monitoring; (5) managing non-compliance with everyday tasks; (6) responding to problem behaviour; (7) managing distress; (8) maintaining safety and (9) analysing and planning. Results suggest complex parenting demands in children with ASD and problem behaviour. Findings will inform the development of a new measure to quantify parenting strategies relevant to ASD