All systems including health systems may be described in terms of processes that convert inputs to valued outputs. 'Management processes' set the strategy for 'demand/supply processes' which address health priority needs for quality of care services delivered via 'implementation processes'. These systems are very complex. Management processes involve many different perspectives, dimensions, objectives and systems, each with many states. Demand/supply processes involve numerous types of event chains, value streams and pathways of variable maturity, also with many states. Implementation processes involve several types of pathway flows, and interdependencies leading to decision tradeoffs. Taken together, these process variables and their states pose several billion process interaction options. This complexity complicates decision-making for optimizing health care benefits. A transparent common framework architecture has been developed within which all of these processes and their attributes and states many be inter-related and transparently navigated. It provides the ability to develop a common process knowledge base for understanding individual process events, pathway workflows, information flows, and value flows. It also facilitates assessment of key process interdependency tradeoffs that are required for business intelligence and informed management decision-making. A description of the framework, process operands and states is provided. An example illustrates an example of types of physiological/social tradeoffs for guiding breast cancer treatment options. A second example provides a navigation thread for prevention treatments such as vitamin D and related implications for adjustment of prevention, screening and diagnostic protocols.
We investigated the effect of plantar cutaneous inputs on the postural sway during quiet standing in older adults.Eight healthy elderly individuals (age 72.3 ± 4.4 years) stood on a force platform for 30 seconds without and with mechanical facilitation of sensation from the forefoot (a small coin-shaped object under the sole), and their eyes closed. Ellipse area and mean velocity of center of pressure, rambling and trembling trajectories in the anterior-posterior (AP) and medial-lateral directions were analyzed.The ellipse area in the stimulation condition was significantly reduced as compared to the control condition. Significant decreases were also observed in the stimulation condition for the velocity of the center of pressure in both AP and medial-lateral directions and for velocity of the trembling trajectory in the AP direction.The findings indicate that mechanical facilitation of sensation on the plantar soles enhanced postural stability in older adults. The results show that plantar cutaneous inputs provide information that leads to reduced postural sway in healthy older adults. This could have implications in clinical and rehabilitative areas.
A uranium mill tailings, located in Guangdong, was selected for spatial distribution of the radon exhalation rates measured by local static method. The two-dimension surface of radon exhalation rates was established by Surfer using the data of spatial distribution of radon exhalation rates measured at August 14, 2007 to 19 and 21, which was analyzed by fractal method of projective covering. The results show that the two-dimension surface of radon exhalation rates is of fractal structure. The fractal dimension of surface of radon exhalation rates from August 14, 2007 to 19 and 21 are 2.0535, 2.0173, 2.0029, 2.0084, 2.0079, 2.0057 and 2.0034, respectively, which indicates that the complexity of spatial distribution of the radon exhalation rates at 14 and 15 are larger than that of the other days. The phenomenon results from the change of precipitation and temperature, as well as the features of uranium mill tailings, including mineral composition, particle size, radium content, porosity and pore connectivity, etc.
The gastrointestinal (GI) tract of a fetus in utero is sterile but it becomes colonized with environmental microorganisms shortly after birth. Since the gut microbiota undergoes substantial changes in early life, healthy gut microflora is essential to an infant's gut health and immune system and probably also has an effect on overall health status in later life. Probiotics, defined as viable microbial preparations that have a beneficial effect on the health of the host, represent a rapidly expanding field. Although randomized controlled trials using probiotics in infants have shown promising results in the prevention and treatment of common diseases such as diarrhea and allergy, little is known about whether probiotics could offer benefits to healthy infants. We have designed a randomized controlled trial to test the hypothesis that an oral preparation of probiotics is superior to placebo in improving digestive and immune function in healthy infants. The trial will be a randomized, double-blind, placebo-controlled, 2-parallel-group study in Shanghai, China. After a 2-week run-in period, 200 exclusively formula-fed healthy infants aged 4 to 6 months will be randomly allocated to receive either a probiotic product containing Bifidobacterium infantis R0033, Bifidobacterium bifidum R0071, and Lactobacillus helveticus R0052 or an identical placebo once daily for 4 weeks and will be followed up for 8 weeks. The duration of the subject's participation will be 14 weeks, with a total of 5 visits: inclusion (Visit 1, Day 1), start of intervention (V2, D15), end of intervention (V3, D44), and follow-up (V4 and V5, D72 and D100). Stool and saliva samples will be collected at the first 3 visits to measure microbial populations and secretory immunoglobulin A (SIgA), respectively. Physical examination will be performed at each visit, and tolerance records will be completed 1 day prior to each visit. The primary endpoints will be the changes in the composition of fecal microbiota, particularly the Bifidobacterium bifidum population. The secondary endpoints will include the change in salivary SIgA level, growth parameters, digestive tolerance, and adverse events. An effective, practical, and acceptable probiotic intervention in manipulating the gut microbiota and boosting the immune system in formula-fed infants would represent a major clinical advance. The administration of probiotic supplementation or follow-on formula to infant may be associated with some clinic benefits.
Objective: To develop a rule-based algorithm that detects temporal information of clinical events during pregnancy for women with COVID-19 by inferring gestational weeks and delivery dates from Electronic Health Records (EHR) from the National COVID Cohort Collaborate (N3C). Materials and Methods: The EHR are normalized by the Observational Medical Outcomes Partnership (OMOP) Clinical Data Model (CDM). EHR phenotyping resulted in 270,897 pregnant women (2018-06-01 to 2021-05-31). We developed a rule-based algorithm and performed a multi-level evaluation to test content validity and clinical validity of the algorithm; and extreme value analysis for individuals with <150 or >300 days of gestation. Results: The algorithm identified 296,194 pregnancies (16,659 COVID-19 174 and 744 without COVID-19 peri-pandemic) in 270,897 pregnant women. For inferring gestational age, 95% cases (n=40) have moderate-high accuracy (Cohen Kappa = 0.62); 100% cases (n=40) have moderate-high granularity of temporal information (Cohen Kappa = 1). For inferring delivery dates, the accuracy is 100% (Cohen Kappa = 1). Accuracy of gestational age detection for extreme length of gestation is 93.3% (Cohen Kappa = 1). Mothers with COVID-19 showed higher prevalence in obesity (35.1% vs. 29.5%), diabetes (17.8% vs. 17.0%), chronic obstructive pulmonary disease (COPD) (0.2% vs. 0.1%), respiratory distress syndrome (ARDS) (1.8% vs. 0.2%). Discussion: We explored the characteristics of pregnant women by different timing of COVID-19 with our algorithm: the first to infer temporal information from complete antenatal care and detect the timing of SARS-CoV-2 infection for pregnant women using N3C. Conclusion: The algorithm shows excellent validity in inferring gestational age and delivery dates, which supports national EHR cohorts on N3C studying the impact of COVID-19 on pregnancy.
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