Evaluation of the Wellspring Model for Improving Nursing Home Quality

Examines how successfully the Wellspring model improved the quality of care for residents of eleven nonprofit nursing homes in Wisconsin. Looks at staff turnover, and evaluates the impact on facilities, employees, residents, and cost

Online plan modification in uncertain resource-constrained environments

This paper presents an approach to planning under uncertainty in resource-constrained environments. We describe our novel method for online plan modification and execution monitoring, which augments an existing plan with pre-computed plan fragments in response to observed resource availability. Our plan merging algorithm uses causal structure to interleave actions, creating solutions online using observations of the true state without introducing significant computational cost. Our system monitors resource availability, reasoning about the probability of successfully completing the goals. We show that when the probability of completing a plan decreases, by removing low-priority goals our system reduces the risk of plan failure, increasing mission success rate. Conversely, when resource availability allows, by including additional goals our system increases reward without adversely affecting success rate. We evaluate our approach using the example domain of long-range autonomous underwater vehicle (AUV) missions, in which a vehicle spends months at sea with little or no opportunity for intervention. We compare the performance to a state-of-the-art oversubscription planner. Planning within such domains is challenging because significant resource usage uncertainty means it is computationally infeasible to calculate the optimal strategy in advance. We also evaluate the applicability of our plan merging algorithm to existing IPC domains, presenting a discussion of the domain characteristics which favour the use of our approach

Effect of the National Resident Assessment Instrument on Selected Health Conditions and Problems

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111253/1/j.1532-5415.1997.tb02972.x.pd

Association of the Resident Assessment Instrument (RAI) with Changes in Function, Cognition, and Psychosocial Status

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111069/1/j.1532-5415.1997.tb02971.x.pd

Changes in Hospitalization Associated with Introducing the Resident Assessment Instrument

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111190/1/j.1532-5415.1997.tb02973.x.pd

Changes in Advance Care Planning in Nursing Homes Before and After the Patient Self‐Determination Act: Report of a 10‐State Survey

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111179/1/j.1532-5415.1997.tb02963.x.pd

Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study of scales using supplemented interRAI items

<p>Abstract</p> <p>Background</p> <p>To test the validity and reliability of scales intended to measure activity limitations faced by children with chronic illnesses living in the community. The scales were based on information provided by caregivers to service program personnel almost exclusively trained as social workers. The items used to measure activity limitations were interRAI items supplemented so that they were more applicable to activity limitations in children with chronic illnesses. In addition, these analyses may shed light on the possibility of gathering functional information that can span the life course as well as spanning different care settings.</p> <p>Methods</p> <p>Analyses included testing the internal consistency, predictive, concurrent, discriminant and construct validity of two activity limitation scales. The scales were developed using assessment data gathered in the United States of America (USA) from over 2,700 assessments of children aged 4 to 20 receiving Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, specifically Personal Care Services to assist children in overcoming activity limitations. The Medicaid program in the USA pays for health care services provided to children in low-income households. Data were collected in a single, large state in the southwestern USA in late 2008 and early 2009. A similar sample of children was assessed in 2010, and the analyses were replicated using this sample.</p> <p>Results</p> <p>The two scales exhibited excellent internal consistency. Evidence on the concurrent, predictive, discriminant, and construct validity of the proposed scales was strong. Quite importantly, scale scores were not correlated with (confounded with) a child's developmental stage or age. The results for these scales and items were consistent across the two independent samples.</p> <p>Conclusions</p> <p>Unpaid caregivers, usually parents, can provide assessors lacking either medical or nursing training with reliable and valid information on the activity limitations of children. One can summarize these data in scales that are both internally consistent and valid. Researchers and clinicians can use supplemented interRAI items to provide guidance for professionals and programs serving children, as well as older persons. This research emphasizes the importance of developing medical information systems that allow one to integrate information not only across care settings but also across an individual's life course.</p

Pollinator monitoring more than pays for itself

1. Resilient pollination services depend on sufficient abundance of pollinating insects over time. Currently, however, most knowledge about the status and trends of pollinators is based on changes in pollinator species richness and distribution only. 2. Systematic, long‐term monitoring of pollinators is urgently needed to provide baseline information on their status, to identify the drivers of declines and to inform suitable response measures. 3. Power analysis was used to determine the number of sites required to detect a 30% change in pollinator populations over 10 years. We then evaluated the full economic costs of implementing four national monitoring schemes in the UK: (a) professional pollinator monitoring, (b) professional pollination service monitoring, (c) volunteer collected pan traps and (d) volunteer focal floral observations. These costs were compared to (a) the costs of implementing separate, expert‐designed research and monitoring networks and (b) the economic benefits of pollination services threatened by pollinator loss. 4. Estimated scheme costs ranged from £6,159/year for a 75‐site volunteer focal flower observation scheme to £2.7 M/year for an 800‐site professional pollination service monitoring network. The estimated research costs saved using the site network as research infrastructure range from £1.46–4.17 M/year. The economic value of UK crop yield lost following a 30% decline in pollinators was estimated at ~£188 M/year. 5. Synthesis and applications. We evaluated the full costs of running pollinator monitoring schemes against the economic benefits to research and society they provide. The annual costs of monitoring are <0.02% of the economic value of pollination services that would be lost after a 30% decline in pollination services. Furthermore, by providing high‐quality scientific data, monitoring schemes would save at least £1.5 on data collection per £1 spent. Our findings demonstrate that long‐term systematic monitoring can be a cost‐effective tool for both answering key research questions and setting action points for policymakers. Careful consideration must be given to scheme design, the logistics of national‐scale implementation and resulting data quality when selecting the most appropriate combination of surveyors, methods and site networks to deliver a successful scheme

Enteric Permeability, Systemic Inflammation, and Post-Discharge Growth among a Cohort of Hospitalized Children in Kenya and Pakistan

Funding Information: Sources of Funding: The CHAIN Network is supported by the Bill & Melinda Gates Foundation [OPP1131320]. For the purpose of Open Access, the authors have applied a CC-BY public copyright license to any author accepted manuscript version arising from this submission. The lactulose-rhamnose testing was funded by an Early Career Award from the Thrasher Research Foundation. The funders had no role in conduct of the study, interpretation, writing the manuscript or decision to submit. No authors were paid to write this article by any company, organization or agency. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.Objectives: To determine whether gut permeability is associated with post-discharge growth and systemic inflammation among hospitalized children in low- and middle-income countries. Methods: Children aged 2-23 months being discharged from Civil Hospital Karachi (Pakistan) and Migori County Referral Hospital (Kenya) underwent lactulose-rhamnose ratio (LRR) permeability testing and were compared to age-matched children from their home communities. Linear mixed effect models estimated the associations between LRR among discharged children with change in length-for-age (LAZ) and weight-for-age z score (WAZ) at 45, 90, and 180 days after discharge. Linear regression tested if relationships between LRR, systemic inflammation [C-reative protein (CRP), Cluster of Differentiation 14 (CD14), Tumour Necrosis Factor Alpha (TNFα), Interleukin-6 (IL-6)], and enterocyte damage [Intestinal Fatty-Acid Binding protein (I-FABP)] differed between the hospitalized and community groups. Results: One hundred thirty-seven hospitalized and 84 community participants were included. The hospitalized group had higher log-LRR [0.43, 95% confidence interval (CI): 0.15-0.71, P = 0.003] than the community children. Adjustment for weight-for-length z score at discharge attenuated this association (0.31, 95% CI: 0.00-0.62, P = 0.049). LRR was not associated with changes in WAZ or LAZ in the post-discharge period. Associations between LRR and CRP (interaction P = 0.036), TNFα (P = 0.017), CD14 (P = 0.078), and IL-6 (P = 0.243) differed between community and hospitalized groups. LRR was associated with TNFα (P = 0.004) and approached significance with CD14 (P = 0.078) and IL-6 (P = 0.062) in community children, but there was no evidence of these associations among hospitalized children. Conclusions: Although increased enteric permeability is more prevalent among children being discharged from hospital compared to children in the community, it does not appear to be an important determinant of systemic inflammation or post-discharge growth among hospitalized children.Peer reviewe