A digital computer program for the dynamic interaction simulation of controls and structure (DISCOS), volume 1

A theoretical development and associated digital computer program system for the dynamic simulation and stability analysis of passive and actively controlled spacecraft are presented. The dynamic system (spacecraft) is modeled as an assembly of rigid and/or flexible bodies not necessarily in a topological tree configuration. The computer program system is used to investigate total system dynamic characteristics, including interaction effects between rigid and/or flexible bodies, control systems, and a wide range of environmental loadings. In addition, the program system is used for designing attitude control systems and for evaluating total dynamic system performance, including time domain response and frequency domain stability analyses

Flow intermittence prediction using a hybrid hydrological modelling approach: influence of observed intermittence data on the training of a random forest model

Rivers are rich in biodiversity and act as ecological corridors for plant and animal species. With climate change and increasing anthropogenic water demand, more frequent and prolonged periods of drying in river systems are expected, endangering biodiversity and river ecosystems. However, understanding and predicting the hydrological mechanisms that control periodic drying and rewetting in rivers is challenging due to a lack of studies and hydrological observations, particularly in non-perennial rivers. Within the framework of the Horizon 2020 DRYvER (Drying River Networks and Climate Change) project, a hydrological modelling study of flow intermittence in rivers is being carried out in three European catchments (Spain, Finland, France) characterised by different climate, geology, and anthropogenic use. The objective of this study is to represent the spatio-temporal dynamics of flow intermittence at the reach level in mesoscale river networks (between 120 and 350 km2). The daily and spatially distributed flow condition (flowing or dry) is predicted using the J2000 distributed hydrological model coupled with a random forest classification model. Observed flow condition data from different sources (water level measurements, photo traps, citizen science applications) are used to build the predictive model. This study aims to evaluate the impact of the observed flow condition dataset (sample size, spatial and temporal representativity) on the performance of the predictive model. Results show that the hybrid modelling approach developed in this study allows the spatio-temporal patterns of drying to be accurately predicted in the three catchments, with a sensitivity criterion above 0.9 for the prediction of dry events in the Finnish and French case studies and 0.65 in the Spanish case study. This study shows the value of combining different data sources of observed flow condition to reduce the uncertainty in predicting flow intermittence.</p

Hospital characteristics and patient populations served by physician owned and non physician owned orthopedic specialty hospitals

<p>Abstract</p> <p>Background</p> <p>The emergence of physician owned specialty hospitals focusing on high margin procedures has generated significant controversy. Yet, it is unclear whether physician owned specialty hospitals differ significantly from non physician owned specialty hospitals and thus merit the additional scrutiny that has been proposed. Our objective was to assess whether physician owned specialty orthopedic hospitals and non physician owned specialty orthopedic hospitals differ with respect to hospital characteristics and patient populations served.</p> <p>Methods</p> <p>We conducted a descriptive study using Medicare data of beneficiaries who underwent total hip replacement (THR) (N = 10,478) and total knee replacement (TKR) (N = 15,312) in 29 physician owned and 8 non physician owned specialty orthopedic hospitals during 1999–2003. We compared hospital characteristics of physician owned and non physician owned specialty hospitals including procedural volumes of major joint replacements (THR and TKR), hospital teaching status, and for profit status. We then compared demographics and prevalence of common comorbid conditions for patients treated in physician owned and non physician owned specialty hospitals. Finally, we examined whether the socio-demographic characteristics of the neighborhoods where physician owned and non physician owned specialty hospitals differed, as measured by zip code level data.</p> <p>Results</p> <p>Physician owned specialty hospitals performed fewer major joint replacements on Medicare beneficiaries in 2003 than non physician owed specialty hospitals (64 vs. 678, P < .001), were less likely to be affiliated with a medical school (6% vs. 43%, P = .05), and were more likely to be for profit (94% vs. 28%, P = .001). Patients who underwent major joint replacement in physician owned specialty hospitals were less likely to be black than patients in non physician owned specialty hospitals (2.5% vs. 3.1% for THR, P = .15; 1.8% vs. 6.3% for TKR, P < .001), yet physician owned specialty hospitals were located in neighborhoods with a higher proportion of black residents (8.2% vs. 6.7%, P = .76). Patients in physician owned hospitals had lower rates of most common comorbid conditions including heart failure and obesity (P < .05 for both).</p> <p>Conclusion</p> <p>Physician owned specialty orthopedic hospitals differ significantly from non physician owned specialty orthopedic hospitals and may warrant the additional scrutiny policy makers have proposed.</p

Hospital Performance Trends on National Quality Measures and the Association With Joint Commission Accreditation

BackgroundEvaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS).ObjectivesTo examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases.Design, setting, and patientsPerformance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data.MeasurementsChanges in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores.ResultsHospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores.ConclusionsWhile Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458-465. © 2011 Society of Hospital Medicine

"Then you get a teacher" - Guidelines for excellence in teaching

Background: Current literature calls for the explicit teaching to health-science educators of the skills, knowledge and dispositions that are required for successful teaching in higher education. Aims: This paper draws on evidence from an Oral Hygiene department at a South African university in order to illustrate these teaching-competency needs. Insights from the evidence are synthesised with current literature regarding best teaching practice, in support of an appropriate framework for the development of teaching competencies to health-science educators. Description: A qualitative approach, using a case study, was adopted. The cohort comprised fifteen students in the first-year Oral Hygiene cohort class and the ten educators who taught their programme. Data was collected through semistructured interviews and open-ended questionnaires. The topics that emerged from the combined analysis of the interviews and the questionnaires were organised into a grid so that common themes could be identified. Current literature regarding teaching and learning was used as a framework for interpreting the empirical evidence, from which three categories emerged. The first category included suggestions from students regarding what to do to teach better. A review of the literature indicates that these competencies can be effectively learnt from self-help guides. The second category included requests for skills development. Literature review suggests that these might effectively be learnt from single-event workshops facilitated by more able peers. Responses in the final category highlighted the need for an underpinning theory of teaching and learning, and signalled the need for a more theoretically grounded and detailed approach to teacher development. Conclusion: The framework developed from the empirical study and current literature makes it possible for individual clinical teachers, and staff developers, to construct teaching-competency development plans that are pertinent to individual teachers’ needs, relevant and practical, educationally sound, and cost-effective in terms of time and effort

Parents’ Disclosure of Their HIV Infection to Their Children in the Context of the Family

We interviewed 33 HIV-infected parents from the HIV Cost and Services Utilization Study (HCSUS), 27 of their minor children, 19 adult children, and 15 caregivers about the process of children learning that their parents were HIV positive. We summarize the retrospective descriptions of parents’ disclosure of their HIV status to their children, from the perspective of multiple family members. We analyzed transcripts of these interviews with systematic qualitative methods. Both parents and children reported unplanned disclosure experiences with positive and negative outcomes. Parents sometimes reported that disclosure was not as negative as they feared. However, within-household analysis showed disagreement between parents and children from the same household regarding disclosure outcomes. These findings suggest that disclosure should be addressed within a family context to facilitate communication and children’s coping. Parents should consider negative and positive outcomes, unplanned disclosure and children’s capacity to adapt after disclosure when deciding whether to disclose

Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system

<p>Abstract</p> <p>Background</p> <p>Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system.</p> <p>Methods</p> <p>Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models.</p> <p>Results</p> <p>More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration.</p> <p>Conclusions</p> <p>More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.</p

Conceptualizing historical organization studies

© 2016 Academy of Management Review. The promise of a closer union between organizational and historical research has long been recognized. However, its potential remains unfulfilled: The authenticity of theory development expected by organization studies and the authenticity of historical veracity required by historical research place exceptional conceptual and empirical demands on researchers. We elaborate the idea of historical organization studies-organizational research that draws extensively on historical data, methods, and knowledge to promote historically informed theoretical narratives attentive to both disciplines. Building on prior research, we propose a typology of four differing conceptions of history in organizational research: History as evaluating, explicating, conceptualizing, and narrating. We identify five principles of historical organization studies-dual integrity, pluralistic understanding, representational truth, context sensitivity, and theoretical fluency-and illustrate our typology holistically from the perspective of institutional entrepreneurship. We explore practical avenues for a creative synthesis, drawing examples from social movement research and microhistory. Historically informed theoretical narratives whose validity derives from both historical veracity and conceptual rigor afford dual integrity that enhances scholarly legitimacy, enriching understanding of historical, contemporary, and future-directed social realities