Colocating Health Services: A Way to Improve Coordination of Children's Health Care?

Based on a literature review and interviews, outlines the benefits, costs, and issues of pediatric practices' co-location with other providers and services. Examines strategies, structures, and levels of integration, as well as barriers to implementation

Referral and use of heart failure clinics: What factors are related to utilization?

Background: Due to its growing prevalence, heart failure (HF) has become a major burden worldwide. HF clinics have been shown to reduce hospital readmissions, and generally have favorable effects on quality of life, survival and care costs. This study investigated the rates of referral and utilization of HF clinics, and examined factors related to program use. Methods: This study represents a secondary analysis of a larger prospective cohort study conducted in Ontario. In hospital, 474 HF inpatients from 11 hospitals across Ontario completed a survey that examined predisposing, enabling and need factors affecting HF clinic use. Clinical and demographic data were extracted from medical charts. One-year later, 271 HF patients completed a mailed survey that assessed referral to and use of HF clinics. Data were collected between the years 2006-2008 and analyses ensued in 2010. Results: Forty-one patients(15.1%) self-reported referral, and 35(12.9%) reported attending a HF clinic (85% of those referred) at 1 of 16 sites. Generalized estimating equations showed that factors related to greater program use were: having a HF clinic at the site of hospital recruitment(Odds Ratio[OR]=8.40,p=0.04), referral to other disease management programs(OR= 4.87,p=0.04), higher education(OR=4.61,p=0.02), lower stress(OR=0.93,p=0.03) and lower functional status(OR=0.97,p=0.03). Conclusion: Similar to previous research, only one-seventh of HF patients were referred and used a HF clinic. Both patient-level and health-system factors were related to HF clinic use. Given the benefits of HF clinics, more research examining how equitable access can be increased is needed. Also, the appropriateness and cost repercussions of use of multiple disease management programs should be investigated

The International Linear Collider Technical Design Report

The International Linear Collider Technical Design Report (TDR) describes in four volumes the physics case and the design of a 500 GeV centre-of-mass energy linear electron-positron collider based on superconducting radio-frequency technology using Niobium cavities as the accelerating structures. The accelerator can be extended to 1 TeV and also run as a Higgs factory at around 250 GeV and on the Z0 pole. A comprehensive value estimate of the accelerator is give, together with associated uncertainties. It is shown that no significant technical issues remain to be solved. Once a site is selected and the necessary site-dependent engineering is carried out, construction can begin immediately. The TDR also gives baseline documentation for two high-performance detectors that can share the ILC luminosity by being moved into and out of the beam line in a "push-pull" configuration. These detectors, ILD and SiD, are described in detail. They form the basis for a world-class experimental programme that promises to increase significantly our understanding of the fundamental processes that govern the evolution of the Universe