INTRODUCTION: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires.METHODS: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires.RESULTS: Both questionnaires showed good feasibility (overall missing rate < 20%) and reliability (Cronbach's Alpha coefficient > 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration).DISCUSSION: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept.
Background: Patient Reported Experience Measures are promoted to be used as an integrated measurement approach in which outcomes are used to improve individual care (micro level), organisational quality (meso level) and external justification (macro level). However, a deeper understanding of implementation issues of these measures is necessary. The narrative Patient Reported Experience Measure “Dit vind ik ervan!” (English “How I feel about it!”) is used in the Dutch disability care sector, but insight into its’ current use is lacking. We aimed to provide insight into experiences with the implementation and current ways of working with “Dit vind ik ervan!” as an integrated measurement strategy. A descriptive qualitative study was done at a disability care organisation. Data were collected by nine documentations, seven observations, 11 interviews and three focus groups. We applied deductive content analysis using the Consolidated Framework for Implementation Research as a framework. Results: Our analysis revealed facilitators and barriers for the implementation of “Dit vind ik ervan!”. We found most barriers at the micro level. Professionals and clients appreciated the measure’s narrative approach, but struggled to perform it with communication vulnerable clients. Some clients, professionals and team leaders were unfamiliar with the measure’s aim and benefit. On the meso level, implementation was done top-down, and the management’s vision using the measure as an integrated measurement approach was insufficiently shared throughout the organisation. Conclusions: Our study shows that Patient Reported Experience Measures have the potential to be used as an integrated measurement strategy. Yet, we found barriers at the micro level, which might have influenced using the measurement outcomes at the meso and macro level. Tailored implementation strategies, mostly focusing on designing and preparing the implementation on themicro level, need to be developed in co-creation with all stakeholders.
BACKGROUND: The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. To translate and adapt the original care provider version of the RMIC-MT and evaluate its psychometric properties by a pilot study in Chinese primary care systems.METHODS: The translation and adaptation process were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a cross-sectional study with 1610 community care professionals in all 79 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method and promax rotation was used to assess the construct validity. Cronbach's alpha was utilized to ascertain the internal consistency reliability. Lastly, confirmation factor analysis was used to evaluate the exploratory factor analysis model fit.RESULTS: During the translation and adaptation process, all 48 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Six factors (person- & community-centeredness, care integration, professional integration, organizational integration, cultural competence and technical competence) with 45 items were determined by exploratory factor analysis, accounting for 61.46% of the total variance. A standard Cronbach's alpha of 0.940 and significant correlation among all items in the scale (> 0.4) showed good internal consistency reliability of the tool. And, the model passed the majority of goodness-to-fit test by confirmation factor analysis.CONCLUSIONS: The results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT provider version. Its application in China will promote the development of people-centered integrated primary care. However, further psychometric testing is needed in multiple primary care settings with both public and private community institutes.
The integration of renewable energy resources, controllable devices and energy storage into electricity distribution grids requires Decentralized Energy Management to ensure a stable distribution process. This demands the full integration of information and communication technology into the control of distribution grids. Supervisory Control and Data Acquisition (SCADA) is used to communicate measurements and commands between individual components and the control server. In the future this control is especially needed at medium voltage and probably also at the low voltage. This leads to an increased connectivity and thereby makes the system more vulnerable to cyber-attacks. According to the research agenda NCSRA III, the energy domain is becoming a prime target for cyber-attacks, e.g., abusing control protocol vulnerabilities. Detection of such attacks in SCADA networks is challenging when only relying on existing network Intrusion Detection Systems (IDSs). Although these systems were designed specifically for SCADA, they do not necessarily detect malicious control commands sent in legitimate format. However, analyzing each command in the context of the physical system has the potential to reveal certain inconsistencies. We propose to use dedicated intrusion detection mechanisms, which are fundamentally different from existing techniques used in the Internet. Up to now distribution grids are monitored and controlled centrally, whereby measurements are taken at field stations and send to the control room, which then issues commands back to actuators. In future smart grids, communication with and remote control of field stations is required. Attackers, who gain access to the corresponding communication links to substations can intercept and even exchange commands, which would not be detected by central security mechanisms. We argue that centralized SCADA systems should be enhanced by a distributed intrusion-detection approach to meet the new security challenges. Recently, as a first step a process-aware monitoring approach has been proposed as an additional layer that can be applied directly at Remote Terminal Units (RTUs). However, this allows purely local consistency checks. Instead, we propose a distributed and integrated approach for process-aware monitoring, which includes knowledge about the grid topology and measurements from neighboring RTUs to detect malicious incoming commands. The proposed approach requires a near real-time model of the relevant physical process, direct and secure communication between adjacent RTUs, and synchronized sensor measurements in trustable real-time, labeled with accurate global time-stamps. We investigate, to which extend the grid topology can be integrated into the IDS, while maintaining near real-time performance. Based on topology information and efficient solving of power flow equation we aim to detect e.g. non-consistent voltage drops or the occurrence of over/under-voltage and -current. By this, centrally requested switching commands and transformer tap change commands can be checked on consistency and safety based on the current state of the physical system. The developed concepts are not only relevant to increase the security of the distribution grids but are also crucial to deal with future developments like e.g. the safe integration of microgrids in the distribution networks or the operation of decentralized heat or biogas networks.
MSEs have encountered limitations while pushing the limits of catheter tip sensors performance. The limitations summarized: - sensors are not immune to electrical signal noise, cross talk, and EM fields; - sensors are not immune to high magnetic fields, i.e. not suitable for MR imaging; - extending the amount of sensors on the catheter tip is limited due to cluttering of wires. A fundamentally different approach using integrated optics is chosen for developing a new generation catheter sensors. The complexity of the design and production problems represents a knowledge gap, that can be bridged in the proposed consortium. This project consists of four work packages, total duration two years, subdivided into four phases. A crucial deliverable of the project is presented at the end of phase IV (WP4), namely a demonstrator integrating pressure and temperature sensors (obtained from WP1) with a newly designed readout system. This system is modularly extendable for future catheter tip sensors. In WP1, pressure- and temperature sensors are developed using two design approaches. In WP2 the influence of downscaling an ultrasound MZI device is explored and the microfabrication process parameters are studied. An additional goal of WP2 is to find the most suitable method for measuring lactate concentration. Among the deliverables five manuscripts: manuscript 1 includes simulations and measurements of the developed pressure and temperature sensors, manuscript 2 answers the question: can a grated fiber be used for measuring pressure and temperature on a tip? Manuscript 3 answers the question: which method is most suitable for measuring lactate concentration on a tip? Manuscript 4 answers the question: does a US intensity detector fit on a catheter tip while obeying the LoR? Manuscript 5 describes the performance of the demonstrator (Phase IV), i.e. integration of T/P sensing with a modular read out system.
Thermal batteries, which store and release energy by hydrating and dehydrating salt crystals, hold great promise for domestic heating. Such batteries can be charged from waste heat from industrial processes, and discharged to provide neighbourhood heating. Unlike hot water storage systems, the energy is stored at room temperature, so the thermal losses are very low, making a salt battery highly efficient. However, the electrochemical change of the salt due to hydration and dehydration is very small, making it difficult to measure how much energy is stored in a battery. One promising technique is to measure the absolute humidity of the inlet and outlet air flow. The difference in humidity, combined with a rate equation model allows the total mass of water stored in the battery to be calculated, which can then be used to calculate the energy storage and battery power flow. However, there are several uncertainties in this approach. Commercially available sensors age over time, sometimes quite suddenly. It is not yet known if software can be used to compensate for sensor aging, or if a different sensor type is required. In addition to aging, each measurement is subject to random noise, which will be integrated into the model used to calculate the charge of the battery. It is not yet known how the noise will influence charge estimates. On the other hand, the sensor system must be as durable as domestic heating systems (decades). Hence, it is required to understand sensor aging in order to validate the sensor system for its intended use.
