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

Plasma proteomic signatures of enteric permeability among hospitalized and community children in Kenya and Pakistan

We aimed to establish if enteric permeability was associated with similar biological processes in children recovering from hospitalization and relatively healthy children in the community. Extreme gradient boosted models predicting the lactulose-rhamnose ratio (LRR), a biomarker of enteric permeability, using 7,500 plasma proteins and 34 fecal biomarkers of enteric infection among 89 hospitalized and 60 community children aged 2–23 months were built. The R2 values were calculated in test sets. The models performed better among community children (R2: 0.27 [min-max: 0.19, 0.53]) than hospitalized children (R2: 0.07 [min-max: 0.03, 0.11]). In the community, LRR was associated with biomarkers of humoral antimicrobial and cellular lipopolysaccharide responses and inversely associated with anti-inflammatory and innate immunological responses. Among hospitalized children, the selected biomarkers had few shared functions. This suggests enteric permeability among community children was associated with a host response to pathogens, but this association was not observed among hospitalized children

Plasma proteomic signatures associated with enteric permeability among hospitalized and community children under two years of age in Kenya and Pakistan

We aimed to establish if enteric permeability was associated with similar biological processes in children recovering from hospitalization and relatively healthy children in the community. Extreme gradient boosted models predicting the lactulose-rhamnose ratio (LRR), a biomarker of enteric permeability, using 7,500 plasma proteins and 34 fecal biomarkers of enteric infection among 89 hospitalized and 60 community children aged 2–23 months were built. The R2 values were calculated in test sets. The models performed better among community children (R2 : 0.27 [min-max: 0.19, 0.53]) than hospitalized children (R2 : 0.07 [min-max: 0.03, 0.11]). In the community, LRR was associated with biomarkers of humoral antimicrobial and cellular lipopolysaccharide responses and inversely associated with anti-inflammatory and innate immunological responses. Among hospitalized children, the selected biomarkers had few shared functions. This suggests enteric permeability among community children was associated with a host response to pathogens, but this association was not observed among hospitalized children

Enteric permeability, systemic inflammation, and post-discharge growth among a cohort of hospitalized children in Kenya and Pakistan

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