Search

This paper presents recent innovations in organizing provider work and changes in organizational structure that promote: (1) reduction in fragmentation of care (2) improved continuity and quality of care and (3) improved cost-containment efforts and (4) better decision making. Data is also given on resource utilization. It is anticipated that these models of care and services are prototypes of future models of care for the elderly as this population increases in number. Data is also presented that suggests that, eventually, increases in taxes and social security contributions and/or the rationing of health care may be necessary to meet pensioner health needs. [ABSTRACT FROM AUTHOR]

In Denmark, legislation having the aim to help the elderly to be active as long as possible and prevent or delay institutionalization, is responsible for a number of innovative programs for this segment of the population. It is now the law that no more nursing homes will be constructed in Denmark. Free home nursing and permanent home help and night patrols for home nursing and help is a strategy to delay or prevent institutionalization. In the municipality of Skaevinge, a nursing home was converted to sheltered housing for the same patients and others from the community. Emphasis is on self care and autonomy in decision making. There are no fixed routines or schedules as found in the traditional nursing home. Examples of programs in facilities are given that have health professionals jointly planning and coordinating the delivery of their services that reduce fragmentation and duplication. [ABSTRACT FROM AUTHOR]

Dust accumulation is detrimental to optical elements, electronic devices, and mechanical systems and is a significant problem in space missions and renewable energy deployment. In this paper, we report the demonstration of antidust nanostructured surfaces that can remove close to 98% of lunar particles solely via gravity. The dust mitigation is driven by a novel mechanism, whereby particle removal is facilitated by the formation of particle aggregates due to interparticle forces, allowing the particles to be removed in the presence of other particles. The structures are fabricated using a highly scalable nanocoining and nanoimprint process, where nanostructures with precise geometry and surface properties are patterned on polycarbonate substrates. The dust mitigation properties of the nanostructures have been characterized using optical metrology, electron microscopy, and image processing algorithms to demonstrate that the surfaces can be engineered to remove nearly all of the particles above 2 μm in size in the presence of Earth's gravity. Compared to the 35.0% area coverage on a smooth polycarbonate surface, the particle coverage on nanostructures with 500 nm period is significantly reduced to 2.4%, an improvement of 93%. This work enhances the understanding of the particulate adhesion on textured surfaces and demonstrates a scalable, effective solution to antidust surfaces that can be broadly applied to windows, solar panels, and electronics.

The advanced optical and wetting properties of metamaterials, plasmonic structures, and nanostructured surfaces have been repeatedly demonstrated in lab-scale experiments. Extending these exciting discoveries to large-area surfaces can transform technologies ranging from solar energy and virtual reality to biosensors and anti-microbial surfaces. Although photolithography is ideal for nanopatterning of small, expensive items such as computer chips, nanopatterning of large-area surfaces is virtually impossible with traditional lithographic techniques due to their exceptionally slow patterning rates and high costs. This article presents a high-throughput process that achieves large-area nanopatterning by combining roll-to-roll (R2R) nanoimprint lithography (NIL) and nanocoining, a process that can seamlessly nanopattern around a cylinder hundreds of times faster than electron-beam lithography. Here, nanocoining is used to fabricate a cylindrical mold with nanofeatures spaced by 600 nm and microfeatures spaced by 2 μm. This cylindrical drum mold is then used on a R2R NIL setup to pattern over 60 feet of polymer film. Microscopy is used to compare the feature shapes throughout the process. This scalable process offers the potential to transfer exciting lab-scale demonstrations to industrial-scale manufacturing without the prohibitively high cost usually associated with the fabrication of a master mold.

We use a systematic approach that combines experimental X-ray diffraction (XRD) and computational modeling based on molecular mechanics and two-dimensional XRD simulations to develop a detailed model of the molecular-scale packing structure of poly(2,5-bis (3-tetradecylthiophene-2-yl)thieno[3,2-b]thiophene) (PBTTT-C(14)) films. Both uniaxially and biaxially aligned films are used in this comparison and lead to an improved understanding of the molecular-scale orientation and crystal structure. We then examine how individual polymer components (i.e., conjugated backbone and alkyl side chains) contribute to the complete diffraction pattern, and how modest changes to a particular component orientation (e.g., backbone or side-chain tilt) influence the diffraction pattern. The effects on the polymer crystal structure of varying the alkyl side-chain length from C(12) to C(14) and C(16) are also studied. The accurate determination of the three-dimensional polymer structure allows us to examine the PBTTT electronic band structure and intermolecular electronic couplings (transfer integrals) as a function of alkyl side-chain length. This combination of theoretical and experimental techniques proves to be an important tool to help establish the relationship between the structural and electronic properties of polymer thin films., (© 2012 American Chemical Society)

We compare the solar cell performance of several polymers with the conventional electron acceptor phenyl-C61-butyric acid methyl ester (PCBM) to fullerenes with one to three indene adducts. We find that the multiadduct fullerenes with lower electron affinity improve the efficiency of the solar cells only when they do not intercalate between the polymer side chains. When they intercalate between the side chains, the multiadduct fullerenes substantially reduce solar cell photocurrent. We use X-ray diffraction to determine how the fullerenes are arranged within crystals of poly-(2,5-bis(3-tetradecylthiophen-2-yl)thieno[3,2-b]thiophene) (PBTTT) and suggest that poor electron transport in the molecularly mixed domains may account for the reduced solar cell performance of blends with fullerene intercalation., (© 2012 American Chemical Society)

Both Denmark and Sweden have achieved a reduction in institutionalization of elderly individuals; 23 percent nursing home care in Denmark from 1980-89 and 34 percent overall institutionalization in Sweden from 1970-1985. This was accomplished by increasing home care and housing with services and adaptations. Further increases in growth of the elderly population combined with modest economic expansion will be the forces responsible for finding additional alternatives to costly institutional care. Community-based services and care have not been demonstrated at this time to be less costly than institutional care. An illustration of an innovative model of nursing home care in Denmark is described. The medical model of care was abandoned in favor of a self-care model for the purpose of fostering independent living and decision-making as long as possible. In Sweden, a reduction in demand for beds in a long-term care hospital has been achieved through a tightly coordinated system of care and services among the various health and social service professionals.

The geriatric population in the United States is increasing and is expected to continue to increase through the 21st century. There will be a subject increase in the need and demand for long-term care. This article examines long-term care issues and discusses alternatives to traditional care models.

PPOs are designed to promote competition among providers for the purpose of enhancing cost containment. Business and industry have demonstrated an active interest in PPOs and report savings as a consequence of purchasing health services for employees from these new alternative care organizations. To be effective in reducing the rate of escalation of personal health care expenditures will require demonstration to the business community that they are able to provide quality care at less cost. This will require a strong utilization review program and a need for providers to share some risk as an incentive to be cost efficient. Furthermore, any federal or state legislation or regulation should discourage overburdensome costs for PPOs to do business.

The growth of the health care industry within the last several decades has changed the very nature of health care facilities. Where once these facilities were only concerned with health-related issues, they are now concerned with their status as businesses. These facilities now utilize business functions such as marketing, advertising, sales, and strategic planning. This article explains how health care facilities can use structural entrepreneurship in order to meet the business-related challenges of the future.