Experience of primary care among homeless individuals with mental health conditions

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers

Modelling the Impact of Anisotropy on Hydrocarbon Production in Heterogeneous Reservoirs

Effective and optimal hydrocarbon production from heterogeneous and anisotropic reservoirs is a developing challenge in the hydrocarbon industry. While experience leads us to intuitive decisions for the production of these heterogeneous and anisotropic reservoirs, there is a lack of information concerning how hydrocarbon and water production rate and cumulative production as well as water cut and water breakthrough time depend on quantitative measures of heterogeneity and anisotropy. In this work, we have used Generic Advanced Fractal Reservoir Models (GAFRMs) to model reservoirs with controlled heterogeneity and vertical and/or horizontal anisotropy, following the approach of Al-Zainaldin et al. (Transp Porous Media 116(1):181–212, 2017). This Generic approach uses fractal mathematics which captures the spatial variability of real reservoirs at all scales. The results clearly show that some anisotropy in hydrocarbon production and water cut can occur in an isotropic heterogeneous reservoir and is caused by the chance placing of wells in high-quality reservoir rock or vice versa. However, when horizontal anisotropy is introduced into the porosity, cementation exponent and grain size (and hence also into the permeability, capillary pressure, water saturation) in the reservoir model, all measures of early stage and middle stage hydrocarbon and water production become anisotropic, with isotropic flow returning towards the end of the reservoir’s lifetime. Specifically, hydrocarbon production rate and cumulative production are increased in the direction of anisotropy, as is water cut, while the time to water breakthrough is reduced. We found no such relationship when varying vertical anisotropy because we were using vertical wells but expect there to be an effect if horizontal wells were used

Validation of a maritime usability study with eye tracking data

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The impact of formative testing on study behaviour and study performance of (bio)medical students: a smartphone application intervention study.

BACKGROUND: Formative testing can increase knowledge retention but students often underuse available opportunities. Applying modern technology to make the formative tests more attractive for students could enhance the implementation of formative testing as a learning tool. This study aimed to determine whether formative testing using an internet-based application ("app") can positively affect study behaviour as well as study performance of (bio)medical students. METHODS: A formative testing app "Physiomics, to the next level" was introduced during a 4-week course to a large cohort (n = 461) of Dutch first year (bio)medical students of the Radboud University. The app invited students to complete 7 formative tests throughout the course. Each module was available for 3-4 days to stimulate the students to distribute their study activities throughout the 4-week course. RESULTS: 72% of the students used the app during the course. Study time significantly increased in intensive users (p < 0.001), while no changes were observed in moderate (p = 0.07) and non-users (p = 0.25). App-users obtained significantly higher grades during the final exam of the course (p < 0.05). Non-users more frequently failed their final exam (34%, OR 3.6, 95% CI: 2.0-6.4) compared to moderate users (19%) and intensive users (12%). Students with an average grade <6.5 during previous courses benefitted most from the app, as intensive (5.8 ± 0.9 / 36%) and moderate users (5.8 ± 0.9 / 33%) obtained higher grades and failed their exam less frequently compared to non-users (5.2 ± 1.1 / 61%). The app was also well appreciated by students; students scored the app with a grade of 7.3 ± 1.0 out of 10 and 59% of the students indicated that they would like the app to be implemented in future courses. CONCLUSIONS: A smartphone-based application of formative testing is an effective and attractive intervention to stimulate study behaviour and improve study performance in (bio) medical students

Accurate Visuomotor Control below the Perceptual Threshold of Size Discrimination

Background: Human resolution for object size is typically determined by psychophysical methods that are based on conscious perception. In contrast, grasping of the same objects might be less conscious. It is suggested that grasping is mediated by mechanisms other than those mediating conscious perception. In this study, we compared the visual resolution for object size of the visuomotor and the perceptual system. Methodology/Principal Findings: In Experiment 1, participants discriminated the size of pairs of objects once through perceptual judgments and once by grasping movements toward the objects. Notably, the actual size differences were set below the Just Noticeable Difference (JND). We found that grasping trajectories reflected the actual size differences between the objects regardless of the JND. This pattern was observed even in trials in which the perceptual judgments were erroneous. The results of an additional control experiment showed that these findings were not confounded by task demands. Participants were not aware, therefore, that their size discrimination via grasp was veridical. Conclusions/Significance: We conclude that human resolution is not fully tapped by perceptually determined thresholds