摘要 :
A RAND team conducted an independent implementation evaluation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) Program, a system of care designed to screen, assess, and treat posttraumatic str...
展开
A RAND team conducted an independent implementation evaluation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) Program, a system of care designed to screen, assess, and treat posttraumatic stress disorder and depression among active duty service members in the Army s primary care settings. Evaluating the Implementation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) presents the results from RAND s assessment of the implementation of RESPECT-Mil in military treatment facilities and makes recommendations to improve the delivery of mental health care in these settings. Analyses were based on existing program data used to monitor fidelity to RESPECT-Mil across the Army s primary care clinics, as well as discussions with key stakeholders. During the time of the evaluation, efforts were under way to implement the Patient Centered Medical Home, and uncertainties remained about the implications for the RESPECT-Mil program. Consideration of this transition was made in designing the evaluation and applying its findings more broadly to the implementation of collaborative care within military primary care settings.
收起
摘要 :
The United States has been at war longer than any time in its history. While thousands have been wounded in these conflicts, advances in battlefield medicine mean many of our troops survive catastrophic wounds. The nature of many ...
展开
The United States has been at war longer than any time in its history. While thousands have been wounded in these conflicts, advances in battlefield medicine mean many of our troops survive catastrophic wounds. The nature of many of their wounds, however, means some require long-term caregiving support. The Elizabeth Dole Foundation commissioned RAND Corp to assess the needs of military caregivers, scan the services available to them, and identify how their needs are -- and are not -- being met. This report reviews existing research on the needs of caregivers in general, and assesses how lessons learned can be applied to military caregivers. We also present information gleaned from military caregivers themselves and from policymakers and program officials who either directly support, or advocate on behalf of, military caregivers. We provide a snapshot of the number and characteristics of military caregivers, the roles they serve, the physical and emotional impact caregiving has on their lives, and the resources available to them. Military caregivers tend to be younger women with dependent-age children, dealing with a different set of patient variables than the general caregiver population. Along with typical caregiver responsibilities, military caregivers also act as case managers navigating multiple health systems, advocates for new treatment, and financial and legal representatives. Many are also raising children and holding jobs outside the home. Studies indicate that caregivers in general suffer from physical strain and overall worse health and tend to put their own concerns behind those of the individuals for whom they are caring. Military caregivers suffer disproportionately from mental health problems and emotional distress. Many government programs are still in their infancy, and community resources are scattered and uncoordinated. Difficulties are presented by differing eligibility criteria, lack of access, and the way caregivers' needs change over time.
收起
摘要 :
The purpose of this report is to present findings based upon an independent assessment of the content, design, and dissemination of the Real Warriors Campaign. The assessment was conducted between January and August 2011. Launched...
展开
The purpose of this report is to present findings based upon an independent assessment of the content, design, and dissemination of the Real Warriors Campaign. The assessment was conducted between January and August 2011. Launched in 2009, the Real Warriors Campaign is a large-scale multimedia program designed to promote resilience, facilitate recovery, and support the reintegration of returning servicemembers, veterans, and their families. The campaign itself is fairly new; at the time of this report, there was the possibility of changes to the content or dissemination of the campaign because the contract to manage the campaign was being re-competed. Therefore, the assessment described in this report focuses on identifying which aspects of the campaign adhere to best practices for health communication campaigns and ways the campaign could improve both its content and its dissemination activities. To conduct the assessment we convened an expert panel, conducted telephone discussions with organizations that partnered with the campaign, performed a content analysis of the campaign s website, analyzed communication measures collected by the campaign, and reviewed relevant documents describing the design and development of the campaign.
收起
摘要 :
The RTI International-University of North Carolina Evidence-based Practice Center (RTIUNC EPC) prepared this report, under the auspices of the Agency for Healthcare Research and Quality, for the National Institutes of Health (NIH)...
展开
The RTI International-University of North Carolina Evidence-based Practice Center (RTIUNC EPC) prepared this report, under the auspices of the Agency for Healthcare Research and Quality, for the National Institutes of Health (NIH) State-of-the-Science Conference on Enhancing Use and Quality of Colorectal Cancer Screening, which is scheduled for February 2010. This report is a systematic review of evidence about the use and quality of screening for CRC focusing on four primary key questions (KQs). It also includes an initial background section (KQ 1) on trends and the current situation of use and quality, and it presents a concluding discussion on needed research (KQ 6).
收起
摘要 :
Dementia is a large and growing problem but is often not diagnosed in its earlier stages. Screening and earlier treatment could reduce the burden of suffering of this syndrome. Purpose: To review the evidence of benefits and harms...
展开
Dementia is a large and growing problem but is often not diagnosed in its earlier stages. Screening and earlier treatment could reduce the burden of suffering of this syndrome. Purpose: To review the evidence of benefits and harms of screening for and earlier treatment of dementia. The authors developed eight key questions representing a logical chain between screening and improved health outcomes, along with eligibility criteria for admissible evidence for each question. Admissible evidence was obtained by searching the data sources.
收起
摘要 :
The Objective of this report is to produce an evidence-based review to support recommendations from the US Preventive Services Task Force (USPSTF) concerning dementia syndrome screening in primary care settings. We developed an an...
展开
The Objective of this report is to produce an evidence-based review to support recommendations from the US Preventive Services Task Force (USPSTF) concerning dementia syndrome screening in primary care settings. We developed an analytic framework comprising 9 key questions on dementia screening and treatment to be answered by systematic review. Next, we developed inclusion and exclusion criteria for each question. For questions of prevalence and accuracy of screening, we required cross-sectional or cohort studies in a primary care population with an acceptable reference standard test. For questions of treatment, we included randomized controlled studies (RCTs) of subjects with mild to moderate dementia. We included studies of 6 potential outcome domains: (a) cognitive, physical, and social function; (b) health care utilization rates; (c) behavioral symptoms of dementia; (d) caregiver stress; (e) accidents and injuries; and (f) health-related quality of life.
收起
摘要 :
The authors examined the ability of a halophilic bacterium (WIPP 1A) isolated from the Waste Isolation Pilot Plant (WIPP) site to accumulate uranium in order to determine the potential for biocolloid facilitated actinide transport...
展开
The authors examined the ability of a halophilic bacterium (WIPP 1A) isolated from the Waste Isolation Pilot Plant (WIPP) site to accumulate uranium in order to determine the potential for biocolloid facilitated actinide transport. The bacterial cell surface functional groups involved in the complexation of the actinide were determined by titration. Uranium, added as uranyl nitrate, was removed from solution at pH 5 by cells but at pH 7 and 9, very little uranium was removed due to its limited solubility. Although present as soluble species, uranyl citrate at pH 5, 7, and 9, and uranyl carbonate at pH 9 were not removed by the bacterium because they were not bioavailable due to their neutral or negative charge. Addition of uranyl EDTA to brine at pH 5, 7, and 9 resulted in the immediate precipitation of U. Transmission electron microscopy (TEM) and energy dispersive X-ray spectroscopy (EDS) analysis revealed that uranium was not only associated with the cell surface but also accumulated intracellularly as uranium-enriched granules. Extended X-ray absorption fine structure (EXAFS) analysis of the bacterial cells indicated the bulk sample contained more than one uranium phase. Nevertheless, these results show the potential for the formation of actinide bearing bacterial biocolloids that are strictly regulated by the speciation and bioavailability of the actinide.
收起
摘要 :
The report presents findings from the North Carolina Medicare Preventive Services demonstration. A randomized field experiment was conducted to assess the cost savings and improvements in health-related quality of life associated ...
展开
The report presents findings from the North Carolina Medicare Preventive Services demonstration. A randomized field experiment was conducted to assess the cost savings and improvements in health-related quality of life associated with the introduction of clinical screening services and health promotion counseling under Medicare reimbursement for elderly patients age 65 and over. Eligible subjects were randomly assigned to one of four groups: clinical screening only, health promotion only, clinical screening plus health promotion, or usual care (control group). Reimbursement and organization of the intervention dramatically increased the delivery of clinical screening procedures, but there was a lack of physician follow-up of abnormal findings. The study supports the conclusion that the preventive health services intervention is reimbursement-cost neutral.
收起
摘要 :
A behavioral simulation of the CDF data acquisition system was written in the Verilog modeling language in order to investigate the effects of various improvements to the existing system. This system is modeled as five separate co...
展开
A behavioral simulation of the CDF data acquisition system was written in the Verilog modeling language in order to investigate the effects of various improvements to the existing system. This system is modeled as five separate components that communicate with each other via Fastbus interrupt messages. One component of the system, the CDF event builder, is modeled in substantially greater detail due to its complex structure. This simulation has been verified by comparing its performance with that of the existing DAQ system. Possible improvements to the existing systems were studied using the simulation, and the optimal upgrade path for the system was chosen on the basis of these studies. The overall throughput of the modified system is estimated to be double that of the existing setup. Details of this modeling effort will be discussed, including a comparison of the modeled and actual performance of the existing system.
收起
摘要 :
We report new results from the LLNL test of Newton's law of gravity being conducted at the Nevada Test Site with a stable 465-m tower and a denser ground gravity survey than any used to date (823 locations within 4 km of the tower...
展开
We report new results from the LLNL test of Newton's law of gravity being conducted at the Nevada Test Site with a stable 465-m tower and a denser ground gravity survey than any used to date (823 locations within 4 km of the tower). Measurements of gravity at 12 heights on the tower were compared to predictions obtained with our surface gravity data and 60,000 measurements within 300 km provided by the USGS and NOAA. The predictions of gravity on the tower platforms were obtained using two different methods, which gave similar results. The results are consistent with Newton's law; we obtain chi-square = 4.9 with eleven degrees of freedom. We set constraints on the parameters of a hypothesized single Yukawa potential and properly included correlated uncertainties in this analysis. We show that if correlated errors are not included, the resulting constraints on the potential parameters are incorrect and appear to be stronger than in the correct analysis. 10 refs., 3 figs.
收起
