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

Physical restraint use among nursing home residents: A comparison of two data collection methods

BACKGROUND: In view of the issues surrounding physical restraint use, it is important to have a method of measurement as valid and reliable as possible. We determined the sensitivity and specificity of physical restraint use a) reported by nursing staff and b) reviewed from medical and nursing records in nursing home settings, by comparing these methods with direct observation. METHODS: We sampled eight care units in skilled nursing homes, seven care units in nursing homes and one long-term care unit in a hospital, from eight facilities which included 28 nurses and 377 residents. Physical restraint use was assessed the day following three periods of direct observation by two different means: interview with one or several members of the regular nursing staff, and review of medical and nursing records. Sensitivity and specificity values were calculated according to 2-by-2 contingency tables. Differences between the methods were assessed using the phi coefficient. Other information collected included: demographic characteristics, disruptive behaviors, body alignment problems, cognitive and functional skills. RESULTS: Compared to direct observation (gold standard), reported restraint use by nursing staff yielded a sensitivity of 87.4% at a specificity of 93.7% (phi = 0.84). When data was reviewed from subjects' medical and nursing records, sensitivity was reduced to 74.8%, and specificity to 86.3% (phi = 0.54). Justifications for restraint use including risk for falls, agitation, body alignment problems and aggressiveness were associated with the use of physical restraints. CONCLUSIONS: The interview of nursing staff and the review of medical and nursing records are both valid and reliable techniques for measuring physical restraint use among nursing home residents. Higher sensitivity and specificity values were achieved when nursing staff was interviewed as compared to reviewing medical records. This study suggests that the interview of nursing staff is a more reliable method of data collection

Évaluation d’implantation d’une expérience novatrice : le réseau intégré de services aux aînés des Bois-Francs

Consciente de l'existence de problèmes liés à la coordination des services rendus aux aînés sur son territoire, la Table de concertation des services de santé et de services sociaux des Bois-Francs dans la région Mauricie et du Centre-du-Québec implanta en février 1997, après deux ans de planification, un nouveau modèle de coordination des soins et des services aux personnes âgées en perte d'autonomie. Ce modèle est novateur car il combine le guichet ou porte d'entrée unique, la gestion de cas, le plan de services individualisé et la présence de trois niveaux de concertation : stratégique, tactique et clinique. Il a aussi la particularité de couvrir tout le continuum de soins et de services aux aînés. Le présent article décrit les principaux résultats de l'évaluation d'implantation et de processus. Cette évaluation visait à documenter les activités et fonctions centrales du mécanisme de coordination des services afin de voir dans quelle mesure le modèle implanté et son fonctionnement s'approchent ou non du modèle visé et ce, dans la perspective d'apporter des ajustements qui pourraient s'avérer nécessaires. Les principaux résultats sur la clientèle rejointe, sur les fonctions assumées par l'équipe de gestion de cas et sur l'organisation de travail sont ici abordés et discutés à la lumière d'autres études sur la coordination des soins et des services aux personnes âgées en perte d'autonomie. Des suggestions sont faites en regard de ces résultats et de ceux portant sur l'efficacité et les coûts tirés d'une autre recherche afin d'améliorer l'efficacité et l'efficience de ce modèle de coordination de soins et de services aux aînés. Sans être généralisables d'emblée, plusieurs composantes de ce nouveau modèle pourraient être réutilisées auprès d'autres clientèles.Assessment of the implementation of an innovative experience: network of integrated services for the elderly in the Bois-Franc region Conscious of problems related to coordination of services for the elderly on its territory, the working group on health and social services of the Bois-Francs in the Mauricie and Centre-du-Québec regions implemented in February 1997, after two years of planning, a new coordination model of services for the frail elderly. This model is innovative because it combines the unique entry, case management, individualized services plan as well as the presence of three levels of concertation : strategic, tactical and clinical. The model also has the characteristic of offering comprehensive services to the elderly. This article describes the major results of an assessment of the implementation and process of this model. This assessment aimed at documenting the activities and functions of the coordination mecanism of services in order to see to what extent the model implemented and its functionning is close or not to the one proposed and this, in a perspective of bringing the necessary adjustments. The major results on clientele reached, various functions of a team of case managers and organization of work are discussed in the light of other studies on coordination of services for frail older people. Suggestions regarding these results and those pertaining to efficiency and cost in another study are made in order to improve the efficiency of the model. Many components of this new model could be applied to other clientele.Evaluación de la implantación de una experiencia novedosa: la red integrada de servicios para ancianos de los Bois-Francs Consciente de la existencia de problemas de coordinación de servicios para ancianos de su teritorio, la mesa de concertación de los servicios de salud y de servicios sociales de los Bois-Francs en la región Mauricie y del Centro-del-Québec estableció en febrero 1997, despues de dos años de planificación, un modelo nuevo de coordinación de cuidados y de servicios a los ancianos con perdida de autonomia. Este modelo es novedoso porque combina el portillo único de entrada, la gestión de caso, el plan de servicios individualisados y la presencia de tres niveles de concertación: estrategico, táctico y clínico. Tiene tambien la particularidad de cubrir el continuum de cuidados y de servicios a los ancianos. Este articulo describe los resultados principales de la evaluación y del proceso de establecimiento. Esta evaluación queria documentar las actividades y funciones centrales del mecanismo de coordinación para ver como el modelo establecido y su funcionamiento se acercan o no del modelo previstado a dentro una perspectiva de llevar ajustos si necesario. Los resultados principales sobre la clientela, sobre las funciones asumidas por el equipo de gestión de caso y sobre la organisación del trabajo estan discudidos a la luz de otras investigaciones sobre la coordinación de cuidados y de servicios a personas ancianas en perdida de autonomia. Se hacen sugerencias a la vista de estos resultados y de los apuntados sobre la eficacia y de los costos de otra investigación para mejorar la eficacia de este modelo de coordinación de cuidados y de servicios a los ancianos. Sin ser generalizables de entrada componentes del modelo nuevo podrian ser reutilisadas con otras clientelas.Avaliação da implantação de uma experiência inovadora: rede integrada de serviços aos idosos de Bois-Francs Consciente da existência de problemas relacionados à coordenação dos serviços prestados aos idosos em seu território, a mesa redonda sobre os serviços de saúde e os serviços sociais de Bois-Francs na região de Mauricie e do Centro do Quebec implantou, em fevereiro de 1997, após dois anos de planejamento, um novo modelo de coordenação dos cuidados e serviços prestados às pessoas idosas com perda de autonomia. Este modelo é inovador porque ele inclui o balcão ou a porta de entrada única, a gestão de casos, o plano de serviços individualizado e a presença de três níveis de acordo: estratégia, tática e clínica. Ele também tem a particularidade de englobar todo o processo de cuidados e serviços prestados aos idosos. O presente artigo descreve os principais resultados da avaliação da implantação e do processo. Esta avaliação teve como objetivo documentar as atividades e funções centrais do mecanismo de coordenação dos serviços, para verificar em que medida o modelo implantado e seu funcionamento se aproximam ou não do modelo esperado e estudar as possíveis mudanças necessárias. Os principais resultados obtidos junto a esta clientela, nas funções assumidas pela equipe de gestão de caso e na organização de trabalho, são abordadas aqui e discutidas em relação a outros estudos sobre a coordenação de cuidados e de serviços aos idosos com perda de autonomia. Os autores trazem algumas sugestões com respeito a estes resultados, e aos que tratam sobre a eficácia e os custos, tirados de uma outra pesquisa para melhorar a eficácia e a eficiência deste modelo de coordenação de cuidados e de serviços prestados aos idosos. Sem que este novo modelo possa ser aplicado a todas as circunstâncias, várias de suas características poderiam ser utilizadas junto a outros clientes

Amplitude equations for systems with long-range interactions

We derive amplitude equations for interface dynamics in pattern forming systems with long-range interactions. The basic condition for the applicability of the method developed here is that the bulk equations are linear and solvable by integral transforms. We arrive at the interface equation via long-wave asymptotics. As an example, we treat the Grinfeld instability, and we also give a result for the Saffman-Taylor instability. It turns out that the long-range interaction survives the long-wave limit and shows up in the final equation as a nonlocal and nonlinear term, a feature that to our knowledge is not shared by any other known long-wave equation. The form of this particular equation will then allow us to draw conclusions regarding the universal dynamics of systems in which nonlocal effects persist at the level of the amplitude description.Comment: LaTeX source, 12 pages, 4 figures, accepted for Physical Review

NectarCAM : a camera for the medium size telescopes of the Cherenkov Telescope Array

NectarCAM is a camera proposed for the medium-sized telescopes of the Cherenkov Telescope Array (CTA) covering the central energy range of ~100 GeV to ~30 TeV. It has a modular design and is based on the NECTAr chip, at the heart of which is a GHz sampling Switched Capacitor Array and a 12-bit Analog to Digital converter. The camera will be equipped with 265 7-photomultiplier modules, covering a field of view of 8 degrees. Each module includes the photomultiplier bases, high voltage supply, pre-amplifier, trigger, readout and Ethernet transceiver. The recorded events last between a few nanoseconds and tens of nanoseconds. The camera trigger will be flexible so as to minimize the read-out dead-time of the NECTAr chips. NectarCAM is designed to sustain a data rate of more than 4 kHz with less than 5\% dead time. The camera concept, the design and tests of the various subcomponents and results of thermal and electrical prototypes are presented. The design includes the mechanical structure, cooling of the electronics, read-out, clock distribution, slow control, data-acquisition, triggering, monitoring and services.Comment: In Proceedings of the 34th International Cosmic Ray Conference (ICRC2015), The Hague, The Netherlands. All CTA contributions at arXiv:1508.0589

A comparative study of some properties of cassava and tree cassava starch films

Cassava and tree cassava starch films plasticized with glycerol were produced by casting method. Different glycerol contents (30, 35, 40 and 45 wt. % on starch dry basis) were used and the resulting films were fully characterized. Their water barrier and mechanical properties were compared. While increasing glycerol concentration, moisture content, water solubility, water vapour permeability, tensile strength, percent elongation at break and Young's modulus decreased for both cassava and tree cassava films. Tree cassava films presented better values of water vapour permeability, water solubility and percent elongation at break compared to those of cassava films, regardless of the glycerol content

Studying the Boundary Layer Late Afternoon and Sunset Turbulence (BLLAST)

At the end of the afternoon, when the surface heat fluxes start to sharply decrease, the CBL turns from a convective well-mixed layer to an intermittently turbulent residual layer overlying a stably-stratified boundary layer. This transition raises several observational and modelling issues. Even the definition of the boundary layer during this period is fuzzy, since there is no consensus on what criteria to use and no simple scaling laws to apply. Yet it plays an important role in such diverse atmospheric phenomena as transport and diffusion of trace constituents or wind energy production. This phase of the diurnal cycle remains largely unexplored, partly due to the difficulty of measuring weak and intermittent turbulence, anisotropy, horizontal heterogeneity, and rapid time changes. The Boundary Layer Late Afternoon and Sunset Turbulence (BLLAST) project is gathering about thirty research scientists from the European Union and the United States to work on this issue. A field campaign (BLLAST-FE) is planned for spring or summer 2011 in Europe. BLLAST will utilize these observations, as well as previous datasets, large-eddy and direct numerical simulations, and mesoscale modelling to better understand the processes, suggest new parameterisations, and evaluate forecast models during this transitional period. We will present the issues raised by the late afternoon transition and our strategy to study it.Peer ReviewedPostprint (published version

Trait matching and sampling effort shape the structure of the frugivory network in Afrotropical forests

Frugivory in tropical forests is a major ecological process as most tree species rely on frugi-vores to disperse their seeds. However, the underlying mechanisms driving frugivore-plant networks remain understudied. Here, we evaluate the data available on the Afrotropical fru-givory network to identify structural properties, as well as assess knowledge gaps. We assembled a database of frugivory interactions from the literature with > 10 000 links, between 807 tree and 285 frugivore species. We analysed the network structure using a block model that groups species with similar interaction patterns and estimates interaction probabilities among them. We investigated the species traits related to this grouping structure. This frugivory network was simplified into 14 tree and 14 frugivore blocks. The block structure depended on the sampling effort among species: Large mammals were better-studied, while smaller frugivores were the least studied. Species traits related to frugivory were strong predictors of the species composition of blocks and interactions among them. Fruits from larger trees were consumed by most frugivores, and large frugivores had higher probabilities to consume larger fruits. To conclude, this large-scale frugivory network was mainly structured by species traits involved in frugivory, and as expected by the distribution areas of species, while still being limited by sampling incompleteness