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Results for “Competency framework”

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PubMed2002

Affinity ultrafiltration: effects of ligand binding on selectivity and process optimization.

The effective design of affinity ultrafiltration processes using a selective macroligand requires a detailed understanding of the effects of ligand-binding interactions on product yield and purification. Theoretical calculations were performed to evaluate the performance of affinity diafiltration separations with both competitive and independent binding interactions for the product and impurity. The intrinsic selectivity for independent binding decreased during the diafiltration due to the increase in fractional impurity binding as the impurity is selectively removed. The opposite behavior was seen for competitive binding because the strongly bound product displaces the impurity from the binding sites. Purification-yield diagrams were used to examine the effects of affinity-ligand concentration and binding constants on the separation. Model calculations were in excellent agreement with experimental data for the separation of tryptophan isomers using bovine serum albumin as the steroselective macroligand. Simulations with a fixed number of diavolumes show a clear optimum in product yield and purification factor at an intermediate ligand concentration due to the competing effects of the intrinsic selectivity and the rate of impurity removal. These results provide an appropriate framework for the design and optimization of affinity ultrafiltration systems.

Binding, Competitive↗

PubMedDate not supplied

Prevention of intellectual disabilities: early interventions to improve cognitive development.

This paper presents a conceptual framework that has guided three randomized, controlled early intervention trials designed to improve cognitive development and social competence in high-risk young children from birth to 3 years of age. Two of the projects (Abecedarian and CARE) enrolled infants from economically and socially low-resource families and the other project (IHDP) was an eight-site randomized controlled trial with 985 low birth-weight and premature infants and their families. IHDP families varied widely in their economic and social resources. Results consistently indicated positive effects of the intervention on child IQ during the first 3 years of life. Children from the lowest resource families consistently benefited the most from the early intervention.

Child, Preschool↗

PubMed2001

[Is the ICIDH (International Classification of Impairments, Disabilities and Handicaps) suitible for geriatric rehabilitation?].

The International Classification of Impairments, Disabilities, and Handicaps (ICIDH), a manual of disease consequences issued by WHO, at present exists in two versions. ICIDH-1, issued in 1980, has been under revision since 1993. This revision process will result in a more sophisticated and more comprehensive ICIDH-2 in 2001. The ICIDH, based on the biopsychosocial disease model, describes disease consequences in three dimensions: Structural and functional body impairments. Disabilities (ICIDH-1) or restrictions of activities (ICIDH-2) in activities of daily living. Handicaps (ICIDH-1) or participation limitations (ICIDH-2) in social integration. In the field of geriatrics ICIDH is also helpful as a coherent conceptual framework and reference manual to determine and code the disabilities and handicaps with regard to daily living competence. Geriatric assessment instruments are no alternative, but complementary to the ICIDH. In view of the high frequency of geriatric patients with multimorbidity, i.e. multiple impairments, disabilities, and handicaps, the utility of the ICIDH in geriatric care is highly dependent on the flexible application of this classification system.

Activities of Daily Living↗

PubMed2005

Applying educational gaming to public health workforce emergency preparedness.

From natural disasters to terrorism, the demands of public health emergency response require innovative public health workforce readiness training. This training should be competency-based yet flexible, and able to foster a culture of professional and personal readiness more traditionally seen in non-public health first-response agencies. Building on the successful applications of game-based models in other organizational development settings, the Johns Hopkins Center for Public Health Preparedness piloted the Road Map to Preparedness curriculum in 2003. Over 1500 employees at six health departments in Maryland have received training via this program through November 2004. Designed to assist public health departments in creating and implementing a readiness training plan for their workforce, the Road Map to Preparedness uses the core competencies of the Centers for Disease Control and Prevention for all public health workers as its basic framework.

Disaster Planning↗

PubMed1998

Reduction of an eight-state mechanism of cotransport to a six-state model using a new computer program.

A computer program was developed to allow easy derivation of steady-state velocity and binding equations for multireactant mechanisms including or without rapid equilibrium segments. Its usefulness is illustrated by deriving the rate equation of the most general sequential iso ordered ter ter mechanism of cotransport in which two Na+ ions bind first to the carrier and mirror symmetry is assumed. It is demonstrated that this mechanism cannot be easily reduced to a previously proposed six-state model of Na+-D-glucose cotransport, which also includes a number of implicit assumptions. In fact, the latter model may only be valid over a restricted range of Na+ concentrations or when assuming very strong positive cooperativity for Na+ binding to the glucose symporter within a rapid equilibrium segment. We thus propose an equivalent eight-state model in which the concept of positive cooperativity is best explained within the framework of a polymeric structure of the transport protein involving a minimum number of two transport-competent and identical subunits. This model also includes an obligatory slow isomerization step between the Na+ and glucose-binding sequences, the nature of which might reflect the presence of functionally asymmetrical subunits.

Biological Transport↗

PubMedDate not supplied

[An analysis of survival data in the epidemiological context].

The present work reviews the methodology of survival analysis in the epidemiological field, especially within the framework of cancer registries. The main concepts used in survival analysis are presented, and the problems of competing mortality, as well as variable and stage adjustment are also discussed. Although the estimation and comparison of survival data distributions obtained from epidemiologic observations is technically possible nowadays thanks to a variety of statistical methods which take into account multiple proGnostic factors, it is proposed that pilot studies should be undertaken to look at the main problems related with potential selection biases and the standardization of prognostic factors to be evaluated.

Epidemiologic Methods↗

PubMed1999

Quantitative anatomy: power beyond the images. An emerging characteristic of PET imaging.

Positron emission tomography (PET) is a frontier medical technology that, in contrast to the other computer-assisted technologies providing anatomical pictures, produces functional images. I argue that PET also opens up an avenue for shifting from images (as a tool for representation of biomedical data) back to analysis of measurements (as a tool for quantification of physiology). Admittedly, quantification of function requires structural constraints. I coined the emerging interpretational framework quantitative anatomy in an attempt to conceptualize the PET merger between measuring and imaging, the two competing means medicine uses to examine the human body. Anatomy justifies interpretations that fit the existing knowledge of a larger clinical audience, while statistical data possess an unexplored potential to introduce mathematical rigor in the evaluation of function, but are still a black box for the majority of clinicians. This epistemological change is being carried out by PET users in action as well as in discourse.

Humans↗

PubMed2003

The R-I-M-E method for evaluation of medical students on an obstetrics and gynecology clerkship.

OBJECTIVE: The purpose of this study was to implement and assess the R-I-M-E (Reporter, Interpreter, Manager, Educator) system as a method for evaluation for medical students during the obstetrics and gynecology core clerkship. STUDY DESIGN: With the R-I-M-E method (which is an objective framework for evaluation), mid clerkship review sessions are held during which residents verbally assess each student on competencies that include problem identification and reasoning skills, communication skills, physical examination skills, written documentation, and professional attributes. The clerkship director provides timely feedback to the students. Residents and students were surveyed to assess their attitudes about the R-I-M-E method. RESULTS: Most of the attitudes of residents and students were positive about the R-I-M-E evaluation system. The directors feel that R-I-M-E method allows more meaningful, complete, and timely feedback to students, especially in areas that are traditionally difficult to assess, such as professionalism. CONCLUSIONS: The R-I-M-E method is an effective evaluation tool for medical students during an obstetrics and gynecology clerkship and is well received by teachers and learners.

Clinical Clerkship↗

PubMed2002

Quality improvement as an investment.

Health care organizations are experiencing increasing internal and external pressures to improve the quality of care that they provide. However, there is not a framework that can be used to help understand the value of quality improvement projects and to prioritize competing projects. By understanding the current processes, costs and outcomes of care, enumerating the costs and benefits of change, anticipating the timing of the costs and benefits, and performing a financial analysis, quality improvement efforts can be evaluated as investments. Only by understanding and adapting to the financial environments in which health care organizations operate can continuous quality improvement in health care succeed.

Cost-Benefit Analysis↗

PubMed2006

Coevolutionary dynamics in large, but finite populations.

Coevolving and competing species or game-theoretic strategies exhibit rich and complex dynamics for which a general theoretical framework based on finite populations is still lacking. Recently, an explicit mean-field description in the form of a Fokker-Planck equation was derived for frequency-dependent selection with two strategies in finite populations based on microscopic processes [A. Traulsen, J. C. Claussen, and C. Hauert, Phys. Rev. Lett. 95, 238701 (2005)]. Here we generalize this approach in a twofold way: First, we extend the framework to an arbitrary number of strategies and second, we allow for mutations in the evolutionary process. The deterministic limit of infinite population size of the frequency-dependent Moran process yields the adjusted replicator-mutator equation, which describes the combined effect of selection and mutation. For finite populations, we provide an extension taking random drift into account. In the limit of neutral selection, i.e., whenever the process is determined by random drift and mutations, the stationary strategy distribution is derived. This distribution forms the background for the coevolutionary process. In particular, a critical mutation rate uc is obtained separating two scenarios: above uc the population predominantly consists of a mixture of strategies whereas below uc the population tends to be in homogeneous states. For one of the fundamental problems in evolutionary biology, the evolution of cooperation under Darwinian selection, we demonstrate that the analytical framework provides excellent approximations to individual based simulations even for rather small population sizes. This approach complements simulation results and provides a deeper, systematic understanding of coevolutionary dynamics.

Animals↗

PubMed1993

Quality of care from a patient perspective--a grounded theory study.

The aim of the present study was to develop a theoretical understanding of quality of care from a patient perspective, using a grounded theory approach. Thirty-five interviews were conducted with a sample of 20 adult hospitalized patients (mean age: 60 years) in a clinic for infectious diseases. Data were analysed according to the constant comparative method. A model was formulated according to which quality of care can be understood in the light of two conditions, the resource structure of the care organization and the patient's preferences. The resource structure of the care organization consists of person-related and physical- and administrative environmental qualities. The patient's preferences have a rational and a human aspect. Within this framework, patients' perceptions of quality of care may be considered from four dimensions: the medical-technical competence of the caregivers; the physical-technical conditions of the care organization; the degree of identity-orientation in the attitudes and actions of the caregivers and the socio-cultural atmosphere of the care organization. The model is discussed in relation to existing theories in the field.

Adult↗

PubMed1965

THE DISTRIBUTION OF OBSERVING RESPONSES IN A MIXED FI-FR SCHEDULE.

In Exp I, three pigeons were trained on an observing response procedure where observing responses produced a stimulus correlated either with FI or with FR. Stimulus duration was 30 sec. During FR, the subjects completed the ratio before the stimulus terminated. During FI, the subjects usually observed the stimulus only once. Observing responses occurred immediately after food reinforcement. In Exp II, stimulus duration was shortened to 5 sec and the FR for food was increased. The results were similar to those of Exp 1. During most FIs and FRs, only one observing response occurred. The results of both experiments could be interpreted in a response competition framework. Immediately after food reinforcement, observing behavior is strong. When behavior on the food key begins it competes with further observing behavior.

Animals↗

PubMed2004

The legal protection of test subjects in clinical trials of medicinal products for human use in the European Union.

On the international as well as on the level of the European Union a legal framework has been developed on the protection of test subjects has been developed. In 2000, the Declaration of Helsinki, issued by the World Medical Association, was revised and the previous distinction between therapeutic and non-therapeutic trial situations has been eliminated. Non-therapeutic trials that only aim at the progress of scientific knowledge and do not benefit the patient are now admissible. This is not to the benefit of the position of the test subject and most certainly not when the test subject should be given special protection. The question arises what this recent revision means for the group of incompetent adult patients in clinical trials on medicinal products (hereinafter called drugs) in the European Union (EU). This group needs special protection. Also relevant are national and international legal frameworks and the protection offered by informed consent procedures and screening by ethics committees and member states' competent authorities.

Adult↗

PubMed2006

Commentary: toward resolving some dilemmas concerning psychiatric advance directives.

Dilemmas about when psychiatric advance directives (PADs) should be overridden are complicated by conflicting legal frameworks that may nonetheless operate concurrently-a legal scheme based on decision-making capacity (or competency) set against a legal scheme based on civil commitment, in which the latter may "trump" the former. A single statute in which the strengths of both schemes are "fused" may be possible. There is evidence that the promise of PADs in enhancing patients' control over their treatment can be achieved without legislation for PADs and where civil commitment is given legal precedence. An example is the "joint crisis plan" in which, through a negotiation facilitated by an independent third party, a joint agreement is reached between patient and service provider about what treatment should be given when, as a result of a relapse of mental illness, the patient loses the ability to make treatment decisions. This clinical instrument may significantly reduce later involuntary treatment.

Advance Directives↗

PubMed1994

[Alveolitis and pulmonary fibrosis in chronic diverticulitis and ulcerative colitis].

Associated reactions of the connective tissue of the lungs are by no means rare in several extrapulmonary disorders, for example, with the "so-called" collagenoses. They are less frequent in chronic inflammatory intestinal diseases. The mechanism of this pulmonary reaction is largely unclarified. The situation is complicated further by the fact that a drug side reaction may compete with the underlying disease. The problem of a change in the connective lung tissue within the framework of a chronic inflammatory intestinal disease or as a result of drug therapy of that disease, is described and demonstrated via the cases of two patients.

Adult↗

PubMed1996

Retrieval feedback for query design in MEDLINE. A comparison with expert network and LLSF approaches.

Query design is a vibrant research focus in information retrieval. The objective is to modify a user's original query into one that is more effective for retrieval. Researchers have proposed and investigated a variety of strategies to support query design in MEDLINE. This paper examines a query design method built within the framework of retrieval feedback. In particular, the effectiveness of this method is compared with the effectiveness of competing methods that utilize query mapping functions constructed in an expert network or built using the Linear Least Squares Fit approach. The comparison indicates that retrieval feedback offers an approach that is just as effective as these alternative approaches. Moreover, it has the advantage of being simpler to implement.

Abstracting and Indexing↗

PubMed2002

A Web-based program for implementing evidence-based patient safety recommendations.

BACKGROUND: In response to increasing national concerns about medical safety, product developers from a health services research and software group recently created a commercial Web-based program to address a wide variety of patient safety issues in the acute care setting. They also wanted to provide a program with credible, referenced, and up-to-date content, not just a technology infrastructure for reporting errors. SAFETY OPTIMIZER: This Web-based program, which has evolved over time, now features seven modules for assessing organizational risk and for implementing strategies to reduce risk. The Literature Module features detailed synopses that are graded and organized into summary statements to provide recommendations for improving patient safety. The Implementation/Tracking Module includes numerous risk-reduction strategies. The Incident Reporting Module enables the collection of data at the point of care on a variety of incidents, using either paper-based or on-line forms. Other modules offer opportunities to assess adherence to JCAHO patient safety standards, forecast the benefits of certain evidence-based guidelines, evaluate staff competency, and obtain information from a variety of key safety Web sites. EXPERIENCE TO DATE: The program is in use at more than 30 health care organization facilities and systems. It is still too early to provide quantitative data on the impact of this program on patient safety. CONCLUSIONS: It is hoped that vendor solutions such as the one described in this article will help organizations develop a practical and effective framework for addressing the wide range of issues in patient safety.

Clinical Competence↗

PubMedDate not supplied

Fundamental elements of the quality of care: a simple framework.

This article argues for attention to a neglected dimension of family planning services--their quality. A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services). The literature is reviewed regarding evidence that improvements in these various dimensions of care result in gains at the individual level; an even scarcer body of literature is reviewed for evidence of gains at the level of program efficiency and impact. A concluding section discusses how to make practical use of the framework and distinguishes three vantage points from which to view quality: the structure of the program, the service-giving process itself, and the outcome of care, particularly with respect to individual knowledge, behavior, and satisfaction with services.

Contraception↗