Theoretical analysis of the hydrodynamic filtering system in the balaenid whales suspension feeding

Balaenid whales are giant filter feeders that feed on the dense aggregations of prey. Through their unique oral filters, they can effectively filter water out and leave prey in their mouths. In this study, a theoretical model is established to analyze the hydrodynamic filtering system in the balaenid whales suspension feeding. First, the appropriate velocity profiles in the anteroposterior and mediolateral directions are adopted to approximate the flow field in the anteroposterior channel along the tongue (APT channel). Then, a four-stage Runge-Kutta method is used to calculate the particle trajectories and predict the corresponding filter cake profile by solving the particle motion equations. Finally, the effects of three crucial parameters, i.e. the APT channel widthD_T, the fringe layer permeabilityK, and the food particle diameterd_p, are discussed. The results show that the particle trajectories consist of a series of backward-outward arcs and the food particles tend to accumulate in the posterior region of the oral cavity. The growing parabolic filter cake profiles are formed except for the case of extremely low permeability. A smallD_Tand largeKmake the tendency of particle posterior aggregation obviously. So squeezing the tongue and having larger fringe layer permeability are both conducive to the swallowing process. But the change ind_phas less influence on this tendency. The proposed theoretical analysis method is a fast and low-cost calculation method. The study on the balaenid whales' filter feeding biomechanics and hydrodynamics is helpful to guide the design of the high-efficiency bionic filters.

Allostatic load and the cannabinoid system: implications for the treatment of physiological abnormalities in post-traumatic stress disorder (PTSD)

It is becoming clear that post-traumatic stress disorder (PTSD) is not simply a psychiatric disorder, but one that involves pervasive physiological impairments as well. These physiological disturbances deserve attention in any attempt at integrative treatment of PTSD that requires a focus beyond the PTSD symptoms themselves. The physiological disturbances in PTSD range over many systems, but a common thread thought to underlie them is that the chronic effects of PTSD involve problems with allostatic control mechanisms that result in an excess in what has been termed "allostatic load" (AL). A pharmacological approach to reducing AL would be valuable, but, because of the large range of physiological issues involved - including metabolic, inflammatory, and cardiovascular systems - it is unclear whether there exists a simple comprehensive way to address the AL landscape. In this paper, we propose that the cannabinoid system may offer just such an approach, and we outline evidence for the potential utility of cannabinoids in reducing many of the chronic physiological abnormalities seen in PTSD which are thought to be related to excess AL.

A theoretical model of financial burden after cancer diagnosis

Current models of financial burden after cancer do not adequately define types of financial burden, moderators or causes. We propose a new theoretical model to address these gaps. This model delineates the components of financial burden as material and psychological as well as healthcare-specific (affording treatment) versus general (affording necessities). Psychological financial burden is further divided into worry about future costs and rumination about past and current financial burden. The model hypothesizes costs and employment changes as causes, and moderators include precancer socioeconomic status and post-diagnosis factors. The model outlines outcomes affected by financial burden, including depression and mortality. Theoretically derived measures of financial burden, interventions and policy changes to address the causes of financial burden in cancer are needed.

Theoretical Investigation on Failure Behavior of Ogive-Nose Projectile Subjected to Impact Loading

Experimental and theoretical investigations on the failure behaviors of projectile during high-speed impact into concrete slabs were performed in this study. The ogive-nose projectiles after impact experiments were recovered and their microstructures were observed by scanning electron microscope and metallographic microscope. Mass abrasion and nose blunting are the typical failure models of steel projectile. Furthermore, thermal melting and cutting are the two main failure mechanisms. Based on the microscopic experimental results, a theoretical model of ogive-nose projectile subjected to impact loading considering the melting and cutting mechanisms was proposed. A modified cap model is introduced for describing the failure behavior of concrete targets, and then the dynamic cavity expansion theory is used to determine the resistance of projectiles during penetration. Besides, combining with the two-dimensional heat conduction equation and abrasive wear theory, the two main abrasion mechanisms of melting and cutting are included in the proposed model, which breaks through the framework of previous abrasion models with single abrasion mechanism. The predicted results of the present abrasion model are in good agreement with the experimental data, which indicates that the proposed model can effectively predict the failure behavior and penetration performance parameters of high-speed projectiles during penetration into concrete targets, such as mass loss, nose blunting, and depth of penetration.

Der Prozess des Medikamentenselbstmanagements: Eine Modellrevision auf Basis einer qualitativen Sekundäranalyse

The process of medication self-management: a model revision based on a qualitative secondary analysis Abstract. Background: For safe and effective use of medication, specific skills are required which are inherent in the concept of medication self-management. In order to provide adequate counseling, it is important for registered nurses, physicians and pharmacists to know how medication self-management works in everyday life for the people affected. This process was presented in 2013 in a first conceptual model by Bailey et al. Aim: The purpose of this study was to enhance the empirical foundation of the existing model and to gain an in-depth theoretical understanding of the process of medication self-management.

METHOD

A qualitative secondary analysis was conducted based on data from a semi-standardized survey (n = 395) of people in Austria, who regularly take medicine. The data were analysed according to the structuring content analysis.

RESULTS

The extended model shows a new kind of logic. While the steps "fill", "take", "monitor" and "react" are always conducted one after the other, "integrate" and "maintain" form components that are mutually dependent and start after successfully completing the first four steps. "Understand" is a component that influences all steps. The whole process is influenced by personal, socio-economic, disease and medication-related factors, by supportive systems and by the overall health care system.

CONCLUSIONS

Based on the present study, the drug self-management process is a complex, multi-layered and iterative one. In the context of counselling, it is important to focus on "understanding" at every step.

Can a Population Targeted by a CRISPR-Based Homing Gene Drive Be Rescued?

CRISPR-based homing gene drive is a genetic control technique aiming to modify or eradicate natural populations. This technique is based on the release of individuals carrying an engineered piece of DNA that can be preferentially inherited by the progeny. The development of countermeasures is important to control the spread of gene drives, should they result in unanticipated damages. One proposed countermeasure is the introduction of individuals carrying a brake construct that targets and inactivates the drive allele but leaves the wild-type allele unaffected. Here we develop models to investigate the efficiency of such brakes. We consider a variable population size and use a combination of analytical and numerical methods to determine the conditions where a brake can prevent the extinction of a population targeted by an eradication drive. We find that a brake is not guaranteed to prevent eradication and that characteristics of both the brake and the drive affect the likelihood of recovering the wild-type population. In particular, brakes that restore fitness are more efficient than brakes that do not. Our model also indicates that threshold-dependent drives (drives that can spread only when introduced above a threshold) are more amenable to control with a brake than drives that can spread from an arbitrary low introduction frequency (threshold-independent drives). Based on our results, we provide practical recommendations and discuss safety issues.

The association between nutritional status and dental caries in low-income children: A multilevel analysis

BACKGROUND

The possible association between obesity, underweight, and dental caries remains in debate. In addition, the role of sugar consumption on the abovementioned relationship was little explored.

AIM

This study aimed to investigate the relationship between nutritional status and dental caries in 12-year-old low-income children.

DESIGN

This cross-sectional school-based study involved 406 12-year-old children living with limited economic resources. Dental caries was assessed using the decayed component of DMFT and PUFA/pufa index. Children were weighed and measured to assess nutritional status according to z-score/body mass index. Data on socio-economic and demographic characteristics, sugar consumption, sedentary behaviour, and psychosocial factors were collected through validated questionnaires. Multivariable multilevel Poisson regression was performed.

RESULTS

Underweight children had 60% (RR = 1.60; 95% CI 1.13-2.57) higher mean of decayed teeth and had mean PUFA/pufa 2.8 times higher than children with normal nutritional status. Underweight children with high annual sugar intake had a greater mean of decayed teeth (RR = 2.72; 95% CI 1.46-5.06) than underweight children with low sugar intake.

CONCLUSIONS

Our findings suggest that malnutrition is associated with dental caries among children from low-income families.

Modeling of the Transmission of Coronaviruses, Measles Virus, Influenza Virus, Mycobacterium tuberculosis, and Legionella pneumophila in Dental Clinics

Dental health care workers are in close contact to their patients and are therefore at higher risk for contracting airborne infectious diseases. The transmission rates of airborne pathogens from patient to dental health care workers are unknown. With the outbreaks of infectious diseases, such as seasonal influenza, occasional outbreaks of measles and tuberculosis, and the current pandemic of the coronavirus disease COVID-19, it is important to estimate the risks for dental health care workers. Therefore, the transmission probability of these airborne infectious diseases was estimated via mathematical modeling. The transmission probability was modeled for Mycobacterium tuberculosis, Legionella pneumophila, measles virus, influenza virus, and coronaviruses per a modified version of the Wells-Riley equation. This equation incorporated the indoor air quality by using carbon dioxide as a proxy and added the respiratory protection rate from medical face masks and N95 respirators. Scenario-specific analyses, uncertainty analyses, and sensitivity analyses were run to produce probability rates. A high transmission probability was characterized by high patient infectiousness, the absence of respiratory protection, and poor indoor air quality. The highest transmission probabilities were estimated for measles virus (100%), coronaviruses (99.4%), influenza virus (89.4%), and M. tuberculosis (84.0%). The low-risk scenario leads to transmission probabilities of 4.5% for measles virus and 0% for the other pathogens. From the sensitivity analysis, it shows that the transmission probability is strongly driven by indoor air quality, followed by patient infectiousness, and the least by respiratory protection from medical face mask use. Airborne infection transmission of pathogens such as measles virus and coronaviruses is likely to occur in the dental practice. The risk magnitude, however, is highly dependent on specific conditions in each dental clinic. Improved indoor air quality by ventilation, which reduces carbon dioxide, is the most important factor that will either strongly increase or decrease the probability of the transmission of a pathogen.

On the time-course of functional connectivity: theory of a dynamic progression of concussion effects

The current literature presents a discordant view of mild traumatic brain injury and its effects on the human brain. This dissonance has often been attributed to heterogeneities in study populations, aetiology, acuteness, experimental paradigms and/or testing modalities. To investigate the progression of mild traumatic brain injury in the human brain, the present study employed data from 93 subjects (48 healthy controls) representing both acute and chronic stages of mild traumatic brain injury. The effects of concussion across different stages of injury were measured using two metrics of functional connectivity in segments of electroencephalography time-locked to an active oddball task. Coherence and weighted phase-lag index were calculated separately for individual frequency bands (delta, theta, alpha and beta) to measure the functional connectivity between six electrode clusters distributed from frontal to parietal regions across both hemispheres. Results show an increase in functional connectivity in the acute stage after mild traumatic brain injury, contrasted with significantly reduced functional connectivity in chronic stages of injury. This finding indicates a non-linear time-dependent effect of injury. To understand this pattern of changing functional connectivity in relation to prior evidence, we propose a new model of the time-course of the effects of mild traumatic brain injury on the brain that brings together research from multiple neuroimaging modalities and unifies the various lines of evidence that at first appear to be in conflict.

The Development of Chinese Assessment and Evaluation of Physical Literacy (CAEPL): A Study Using Delphi Method

The aim of this study is to introduce the development of the Chinese Assessment and Evaluation of Physical Literacy (CAEPL), to present the theoretical model of the CAEPL, and to quantify the weight of each domain of the CAEPL. 34 experts took part in the Delphi survey, and 23 experts completed all the three rounds of the survey. Experts’ opinions are used to develop the theoretical model of the CAEPL. The analytical hierarchy process (AHP) was employed for determining the weights of subdomains and items of the CAEPL. The CAEPL is a comprehensive model, including intention of physical activity (IPA), knowledge of physical activity (KPA), motor/sport skill (MSS), behavior of physical activity (BPA) and physical fitness (PF). Specific weights of IPA, KPA, MSS, BPA and PF are 17.25%, 16.23%, 27.01%, 23.72% and 15.79%, respectively. The CAEPL provides an important and useful instrument to measure and improve physical literacy (PL) among young Chinese people. Studies on the feasibility, reliability, validity and sensitivity of the CAEPL should be conducted to improve it in the future.

Standing Air Bubble-Based Micro-Hydraulic Capacitors for Flow Stabilization in Syringe Pump-Driven Systems

Unstable liquid flow in syringe pump-driven systems due to the low-speed vibration of the step motor is commonly observed as an unfavorable phenomenon, especially when the flow rate is relatively small. Upon the design of a convenient and cost-efficient microfluidic standing air bubble system, this paper studies the physical principles behind the flow stabilization phenomenon of the bubble-based hydraulic capacitors. A bubble-based hydraulic capacitor consists of three parts: tunable microfluidic standing air bubbles in specially designed crevices on the fluidic channel wall, a proximal pneumatic channel, and porous barriers between them. Micro-bubbles formed in the crevices during liquid flow and the volume of the bubble can be actively controlled by the pneumatic pressure changing in the proximal channel. When there is a flowrate fluctuation from the upstream, the flexible air-liquid interface would deform under the pressure variation, which is analogous to the capacitive charging/discharging process. The theoretical model based on Euler law and the microfluidic equivalent circuit was developed to understand the multiphysical phenomenon. Experimental data characterize the liquid flow stabilization performance of the flow stabilizer with multiple key parameters, such as the number and the size of microbubbles. The developed bubble-based hydraulic capacitor could minimize the flow pulses from syringe pumping by 75.3%. Furthermore, a portable system is demonstrated and compared with a commercial pressure-driven flow system. This study can enhance the understanding of the bubble-based hydraulic capacitors that would be beneficial in microfluidic systems where the precise and stable liquid flow is required.

[Research advancements of motor imagery for motor function recovery after stroke]

Neurological damage caused by stroke is one of the main causes of motor dysfunction in patients, which brings great spiritual and economic burdens for society and families. Motor imagery is an important assisting method for the rehabilitation of patients after stroke, which is easy to learn with low cost and has great significance in improving the motor function and the quality of patient's life. This paper mainly summarizes the positive effects of motor imagery on post-stroke rehabilitation, outlines the physiological performance and theoretical model of motor imagery, the influencing factors of motor imagery, the scoring criteria of motor imagery and analyzes the shortcomings such as the few kinds of experimental subject, the subjective evaluation method and the low resolution of the experimental equipment in the process of rehabilitation of motor function in post-stroke patients. It is hopeful that patients with stroke will be more scientifically and effectively using motor imagery therapy.

A Theoretical Model for Urban Walking Among People With Disabilities

This paper is an attempt to advance research on walking at a neighborhood level of analysis for people with disabilities by proposing a theoretical model that combines the knowledge of two disciplines: traffic planning and environmental psychology. The aim is to provide guidance for a discussion and a plan for future interdisciplinary investigations by proposing a model that accounts for the dynamic interaction between environmental characteristics, human processes, and walking experience among individuals with a disability. For this purpose, traffic planners, and environmental psychologists came together to discuss theories, concepts, and thematic relevance in a series of focus group meetings. These meetings led to the selection of the Human Environment Interaction (HEI) model, originally developed from the field of environmental psychology and operationalized to describe how walking experiences result from the interplay between individual abilities, emotional processes, and the physical and social characteristics of the environment (Küller, 1991). The proposed model aims to sustain interdisciplinary discussion and research planning around the topic of neighborhood walking for people with disabilities. By operationalizing each dimension in the model, a good fit between groups with disabilities and individual differences associated with walking experiences is assumed, which, in turn, will have the potential to provide a more conscious analysis of wellbeing-related outcomes, such as usability of the environment, frequency of mobility, and quality of life. However, to improve understanding of urban walking at a neighborhood level for people with disabilities, empirical studies must be carried out to test the proposed model.

Soft Rod-Climbing Robot Inspired by Winding Locomotion of Snake

Soft climbing robots have attracted much attention of researchers for their potential applications on the wall or inside the tube. However, making a soft robot climb on the outer surface of a rod or tube by agile and efficient motion has long been a challenge. Inspired by the winding climbing locomotion of arboreal snakes, a tethered pneumatic-actuated winding-styled soft rod-climbing robot that consists of two winding actuators and a telescopic actuator is proposed in this work. Based on constant curvature assumption, we develop a theoretical model to analyze the linear and bending motion of the actuators. We demonstrate that our robot can perform climbing locomotion similar to snakes, including turning around a corner along a rod, climbing a vertical rod with a maximum speed of 30.85 mm/s (0.193 body length/s), and carrying a larger payload (weight, 500 g, more than 25 times its self-weight) than existing soft climbing robots do on a vertical surface. In addition, the experimental tests exhibit the potential applications of the robot in special environments such as high-voltage cables, nuclear power plants, and underwater sites.

Six-Step Model of Nature-Based Therapy Process

Several studies have confirmed that the natural environment has psychophysiological healing effects. However, few studies have investigated the healing process involved in the effect of the natural environment. To date, no theoretical model on the nature-based therapy process has been clearly established. Thus, the aim of this study was to develop a theoretical model of the nature-based therapy process by analyzing individual empirical data. Research materials were 180 self-reported essays on “Forest Therapy Experiences” submitted to the Korea Forest Service. This study was conducted based on grounded theory. Data were analyzed through open coding. A total of 82 concepts, 21 subcategories, and six categories were derived. Results revealed that the nature-based therapy process contained six categories: Stimulation, acceptance, purification, insight, recharging, and change. When in the natural environment, participants first experienced positive emotional change, followed by cognitive and behavioral changes. Based on these results, a nature-based therapy process model was derived. This study revealed that the nature-based therapy process did not consist of just a single element or step, but involved an integrated way of healing with emotional and cognitive changes. This study is significant in that it derives a theoretical model of the nature-based therapy process with comprehensive mechanisms. Further research is needed to establish more systematic theoretical model.

[Construction of theoretical model of traditional Chinese medicine intelligent manufacturing]

In the process of transforming and upgrading of traditional Chinese medicine( TCM) intelligent manufacturing,the TCM enterprises lack systematic and in-depth research on intelligent manufacturing of TCM,leading to insufficient understanding of relevant concepts,development direction,development content and other aspects,to some extent,causing fuzzy and chaotic phenomena. The theoretical model,as a higher expression level of scientific thinking,has the function of interpretation and prediction,and can provide theoretical basis as well as guide for scientific research. Therefore,this article aims to construct a theoretical model of TCM intelligent manufacturing based on the concept of flexible production and intelligent equipment for some unhealthy phenomena in the development process of TCM intelligent manufacturing. In the TCM intelligent manufacturing system,with theory model as the core,the new-generation information technology was integrated with the TCM manufacturing technology to realize the integration of informationization and industrilization as well as the landing of theoretical model. Then,a 3 D simulation model was established to provide a visual environment for intelligent manufacturing of TCM and simulate the virtual reality throughout the TCM intelligent manufacturing process. The new theoretical model in this paper,to a certain extent,can play a guiding role in the development of TCM intelligent manufacturing,and can also provide reference for the realization of TCM intelligent manufacturing.

Therapy-related stress in parents of children with a physical disability: a specific concept within the construct of parental stress

PURPOSE

The aim of this article is to conceptualise the phenomenon of therapy-related parental stress in parents of children with a physical disability.

METHODS

Three models related to parental stress were reviewed, i.e., general parental stress, burden of caregiving in parents of children with physical disabilities, and experiences of these parents with their child's therapy.

RESULTS

The proposed definition of therapy-related parental stress is "the subjective stress and subsequent changes of functioning and health experienced by a parent of a child with a physical disability in response to paramedical therapies (i.e., physical, occupational, and/or speech and language therapy)". A theoretical model is proposed to describe the process of therapy-related parental stress. Available questionnaires will most likely not be valid and responsive to capture the (changes in) stress parents experience related to therapy their child receives.

CONCLUSIONS

This article provides a first definition of therapy-related parental stress and a theoretical model to visualise the processes with regard to this topic. Empirical testing of the presented components and their coherence is needed to confirm or improve the model. A questionnaire that specifically measures the concept of therapy-related parental stress is needed, along with evaluating therapy-related parental stress in clinical practice and research.Indications for rehabilitationIt is imperative to recognise paramedical therapies (i.e., physical, occupational, and speech and language therapy) as a potential stressor for parents of children with a physical disability, both in paediatric rehabilitation practice and research.A definition and theoretical model of therapy-related parental stress is proposed and the need for measures to evaluate this phenomenon is argued.The authors provide a starting point for the evidence base of the concept of therapy-related parental stress.

The Sialic Acid-Dependent Nematocyst Discharge Process in Relation to Its Physical-Chemical Properties Is A Role Model for Nanomedical Diagnostic and Therapeutic Tools

Formulas derived from theoretical physics provide important insights about the nematocyst discharge process of Cnidaria (Hydra, jellyfishes, box-jellyfishes and sea-anemones). Our model description of the fastest process in living nature raises and answers questions related to the material properties of the cell- and tubule-walls of nematocysts including their polysialic acid (polySia) dependent target function. Since a number of tumor-cells, especially brain-tumor cells such as neuroblastoma tissues carry the polysaccharide chain polySia in similar concentration as fish eggs or fish skin, it makes sense to use these findings for new diagnostic and therapeutic approaches in the field of nanomedicine. Therefore, the nematocyst discharge process can be considered as a bionic blue-print for future nanomedical devices in cancer diagnostics and therapies. This approach is promising because the physical background of this process can be described in a sufficient way with formulas presented here. Additionally, we discuss biophysical and biochemical experiments which will allow us to define proper boundary conditions in order to support our theoretical model approach. PolySia glycans occur in a similar density on malignant tumor cells than on the cell surfaces of Cnidarian predators and preys. The knowledge of the polySia-dependent initiation of the nematocyst discharge process in an intact nematocyte is an essential prerequisite regarding the further development of target-directed nanomedical devices for diagnostic and therapeutic purposes. The theoretical description as well as the computationally and experimentally derived results about the biophysical and biochemical parameters can contribute to a proper design of anti-tumor drug ejecting vessels which use a stylet-tubule system. Especially, the role of nematogalectins is of interest because these bridging proteins contribute as well as special collagen fibers to the elastic band properties. The basic concepts of the nematocyst discharge process inside the tubule cell walls of nematocysts were studied in jellyfishes and in Hydra which are ideal model organisms. Hydra has already been chosen by Alan Turing in order to figure out how the chemical basis of morphogenesis can be described in a fundamental way. This encouraged us to discuss the action of nematocysts in relation to morphological aspects and material requirements. Using these insights, it is now possible to discuss natural and artificial nematocyst-like vessels with optimized properties for a diagnostic and therapeutic use, e.g., in neurooncology. We show here that crucial physical parameters such as pressure thresholds and elasticity properties during the nematocyst discharge process can be described in a consistent and satisfactory way with an impact on the construction of new nanomedical devices.

Novel Method of Specifying Low and High Threshold Temperatures Using Thermodynamic SSI Model of Insect Development

For ectotherms such as insects, their low- and/or high-temperature tolerance is one of the most important traits not only for their physiological as well as ecological and evolutional processes. Here, we review the temperature tolerance of insects in relation to their development and suggest a novel method of specifying low and high threshold temperatures. To date, the upper and lower critical thermal threshold for development as Tmin and Tmax, respectively, which are derived from nonlinear empirical models, has been extensively used. These indicators, which originated from the artificial empirical models, however, may not be reliable. Consequently, the Sharpe-Schoolfield-Ikemoto (SSI) model which is a nonlinear theoretical model based on thermodynamics, was implemented as an alternative tool to express tolerance temperatures. In the model equation constructed with subunits, when the reversed denominator (P2 function) is maximum (nearly 100% in general), it denotes the probability of an enzyme being in the almost fully-active state of the intrinsic optimum temperature (TΦ). The profile of the P2 function shows a peak at the TΦ temperature and the two temperatures of TL50 and TH50 which indicate the 50% active and 50% inactive state (P2 = 50%), respectively, are given as parameters in the P2 function of the SSI model. Even so, it is possible to select any values within the range of 0<P2<100% to determine the lower and upper threshold. Namely, the two temperatures associated with a specified P2 value could be determined also within the range of real-medium temperature in which ectotherms is living in nature.

Information Entropy Theory Applied to the Dip-Phenomenon Analysis in Open Channel Flows

The knowledge of the fluid discharge in free surface flows requires a great number of velocity measurements along the whole cross-section, taking up a large amount of time, using expensive equipment, and employing specialized labor. To overcome these obstacles, various models have been developed thus far that show how to estimate the mean velocity through the maximum velocity. In three-dimensional open channels, the maximum velocity can be located below the free surface because of the presence of secondary flows mainly originating by the sidewalls, an occurrence known as dip-phenomenon. In this condition, predicting the maximum velocity position is quite difficult and has always represented a challenge to most hydraulic engineers and researchers. In the present study, a mathematical model derived from the information entropy theory is proposed to evaluate the velocity-dip-position over the entire cross-section of both wide and narrow open channels, thus overcoming the limitations of the existing methods. Large literature measurement sets, collected in uniform and non-uniform flows, were used to test the validity of the model, showing good agreement with the experimental data and providing an accurate estimation of the dip-position.

Health Care Coordination Theoretical Frameworks: a Systematic Scoping Review to Increase Their Understanding and Use in Practice

BACKGROUND

Care coordination is crucial to avoid potential risks of care fragmentation in people with complex care needs. While there are many empirical and conceptual approaches to measuring and improving care coordination, use of theory is limited by its complexity and the wide variability of available frameworks. We systematically identified and categorized existing care coordination theoretical frameworks in new ways to make the theory-to-practice link more accessible.

METHODS

To identify relevant frameworks, we searched MEDLINE®, Cochrane, CINAHL, PsycINFO, and SocINDEX from 2010 to May 2018, and various other nonbibliographic sources. We summarized framework characteristics and organized them using categories from the Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE (SELFIE) framework. Based on expert input, we then categorized available frameworks on consideration of whether they addressed contextual factors, what locus they addressed, and their design elements. We used predefined criteria for study selection and data abstraction.

RESULTS

Among 4389 citations, we identified 37 widely diverse frameworks, including 16 recent frameworks unidentified by previous reviews. Few led to development of measures (39%) or initiatives (6%). We identified 5 that are most relevant to primary care. The 2018 framework by Weaver et al., describing relationships between a wide range of primary care-specific domains, may be the most useful to those investigating the effectiveness of primary care coordination approaches. We also identified 3 frameworks focused on locus and design features of implementation that could prove especially useful to those responsible for implementing care coordination.

DISCUSSION

This review identified the most comprehensive frameworks and their main emphases for several general practice-relevant applications. Greater application of these frameworks in the design and evaluation of coordination approaches may increase their consistent implementation and measurement. Future research should emphasize implementation-focused frameworks that better identify factors and mechanisms through which an initiative achieves impact.

Incorporating Theory into Practice: Reconceptualizing Exemplary Care Coordination Initiatives from the US Veterans Health Delivery System

This perspective paper seeks to lay out an efficient approach for health care providers, researchers, and other stakeholders involved in interventions aimed at improving care coordination to partner in locating and using applicable care coordination theory. The objective is to learn from relevant theory-based literature about fit between intervention options and coordination needs, thereby bringing insights from theory to enhance intervention design, implementation, and troubleshooting. To take this idea from an abstract notion to tangible application, our workgroup on models and measures from the Veterans Health Administration (VA) State of the Art (SOTA) conference on care coordination first summarizes our distillation of care coordination theoretical frameworks (models) into three common conceptual domains-context of an intervention, locus in which an intervention is applied, and specific design features of the intervention. Then we apply these three conceptual domains to four cases of care coordination interventions ("use cases") chosen to represent various scopes and stages of interventions to improve care coordination for veterans. Taken together, these examples make theory more accessible and practical by demonstrating how it can be applied to specific cases. Drawing from theory offers one method to anticipate which intervention options match a particular coordination situation.

Preparation and Characterization of Gradient Compressed Porous Metal for High-Efficiency and Thin-Thickness Acoustic Absorber

Increasing absorption efficiency and decreasing total thickness of the acoustic absorber is favorable to promote its practical application. Four compressed porous metals with compression ratios of 0%, 30%, 60%, and 90% were prepared to assemble the four-layer gradient compressed porous metals, which aimed to develop the acoustic absorber with high-efficiency and thin thickness. Through deriving structural parameters of thickness, porosity, and static flow resistivity for the compressed porous metals, theoretical models of sound absorption coefficients of the gradient compressed porous metals were constructed through transfer matrix method according to the Johnson–Champoux–Allard model. Sound absorption coefficients of four-layer gradient compressed porous metals with the different permutations were theoretically analyzed and experimentally measured, and the optimal average sound absorption coefficient of 60.33% in 100–6000 Hz was obtained with the total thickness of 11 mm. Sound absorption coefficients of the optimal gradient compressed porous metal were further compared with those of the simple superposed compressed porous metal, which proved that the former could obtain higher absorption efficiency with thinner thickness and fewer materials. These phenomena were explored by morphology characterizations. The developed high-efficiency and thin-thickness acoustic absorber of gradient compressed porous metal can be applied in acoustic environmental detection and industrial noise reduction.

Membrane Electroporation and Electropermeabilization: Mechanisms and Models

Exposure of biological cells to high-voltage, short-duration electric pulses causes a transient increase in their plasma membrane permeability, allowing transmembrane transport of otherwise impermeant molecules. In recent years, large steps were made in the understanding of underlying events. Formation of aqueous pores in the lipid bilayer is now a widely recognized mechanism, but evidence is growing that changes to individual membrane lipids and proteins also contribute, substantiating the need for terminological distinction between electroporation and electropermeabilization. We first revisit experimental evidence for electrically induced membrane permeability, its correlation with transmembrane voltage, and continuum models of electropermeabilization that disregard the molecular-level structure and events. We then present insights from molecular-level modeling, particularly atomistic simulations that enhance understanding of pore formation, and evidence of chemical modifications of membrane lipids and functional modulation of membrane proteins affecting membrane permeability. Finally, we discuss the remaining challenges to our full understanding of electroporation and electropermeabilization.

The contributions of socioeconomic status, perceived stress, and depression to disability in adults with systemic lupus erythematosus

Purpose: Psychological and sociodemographic factors contribute to disability in systemic lupus erythematosus. Yet the pathways by which these factors influence disability remain unclear. The objective of this study was to evaluate a model examining socioeconomic status (SES), perceived stress, and depressive symptoms as determinants of lupus-related disability.Methods: The sample included 134 patients receiving treatment at an academic hospital. Structural equation modeling examined the direct and indirect effects of SES (income, education, and subjective social status), perceived stress (Perceived Stress Scale), and depressive symptoms (Hospital Depression Anxiety Scale depression subscale) on disability (Lupus Patient-Reported Outcome measure Physical Health and Pain-Vitality subscales).Results: Structural equation modeling confirmed that the model fit the data well. The SES exerted a direct negative effect on perceived stress (β = -0.40, p < 0.001). In turn, perceived stress predicted higher levels of depression (β = 0.72, p < 0.001), which ultimately contributed to greater disability (β = 0.53, p < 0.001). The influence of SES on disability was indirect (mediated by perceived stress and depression).Conclusions: Findings support the socioeconomic gradient in disability as mediated by perceived stress and depression, such that lower SES contributed to lupus-related disability via perceived stress and depressive symptoms.Implications for RehabilitationLow socioeconomic status, perceived stress, and depression are prognostic factors for the disability in systemic lupus erythematosus.Study findings indicate that perceived stress and depression fully mediate (account for) the negative impact of low socioeconomic status on lupus-related disability.Screening for and addressing psychological distress may enhance management of disability in lupus patients.This research demonstrates the value of a conceptual framework for identifying potentially modifiable risk factors for disability in lupus and other chronic disabling diseases.