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This paper presents an investigation of the fiber orientation within a field-cast reinforced ultra-high-performance concrete (UHPC) shear key replica. To simulate field conditions, replica shear key forms were constructed to be identical to keys of an adjacent box-beam bridge undergoing construction at the time of the research. The replica keys were then placed on site along with the actual keys of the constructed bridge. Cores were taken from the replicas and analyzed using a micro-computed tomography (micro-CT) method to determine the fiber orientation. Fibers tended to align parallel to the flow direction, except in shear reinforcement locations and at the shear key wall. Regions with higher fiber density were found on the upstream side of the shear reinforcement, while low-fiber regions were found immediately downstream of the reinforcement. Finite element analysis of a core revealed an increase in the stresses within the UHPC matrix in the low-fiber region due to pullout of a shear reinforcement bar. [ABSTRACT FROM AUTHOR]

Over 500 nurses in New Jersey responded to a survey on education and training in the area of developmental disabilities. Respondents provided information on their work experience, experience with patients who have developmental disabilities, and opportunities for continuing medical education. Results showed that although many nurses thought educational activities related to developmental disabilities were important, only about 10% said that they received "a lot" of training. Most respondents (almost 60%) said that they received little or no training in the area, and most received no specific training on developmental disabilities since receiving their licenses or in their current job. Implications of these findings in light of the movement of people with developmental disabilities into community-living and managed care plans are discussed.

Health care quality issues for people with developmental disabilities under managed care were explored. Health-related quality was defined in terms of four domains: structure, process, outcome, and satisfaction. Three general problems in the assessment of health care quality were identified: lack of quality measures, patient response problems, and lack of system elements. Selected current measurement systems were described in relation to their use for people with developmental disabilities. An approach to developing quality measures was outlined using Healthy People 2000, Health Plan Employer Data Information Set, and clinical practice issues. The movement toward quality improvement was examined and recommendations presented for steps in developing and measuring health care quality.

We presented a general model of the structure and functioning of managed care and described elements (provider networks, fiscal elements, risk estimation, case-mix, management information systems, practice parameters, and quality improvement) critical to service delivery for people with developmental disabilities. A number of technical elements of managed care systems were delineated and reviewed in relation to the inclusion of people with developmental disabilities. Several managed care demonstration projects were described and, finally, a multi-year hypothetical budget model, including long-term care, was presented as a framework for considering how managed care affects specific service structures. Implications for people with developmental disabilities were discussed.

The inclusion of people with developmental disabilities in managed care as part of general efforts by states to enroll and Medicaid recipients in such plans was reviewed. Managed care was defined and the processes by which managed care organizations deliver services were explained. Escalating costs and utilization were discussed as the primary reason for the shift to managed care. The use of Medicaid Section 1115 waivers by states to include Medicaid recipients was explored. The relation between acute health care and long-term care, and the utilization patterns in each, were briefly described. Finally, elements of managed care that are particularly important to people with developmental disabilities, such as care coordination, maintenance of quality, and individual and family support, were discussed.

To determine if magnesium sulfate has an effect on the development of cystic periventricular leukomalacia in preterm infants, this retrospective case control study was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight < 1750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life. Infants exposed to magnesium sulfate in utero were less likely to develop periventricular leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p = 0.035) (OR = 0.196, 95% CI = 0.039-0.988). Pre-eclampsia as an independent factor was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% CI = 0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to have a reduced risk of developing cystic periventricular leukomalacia.

All admissions of people with developmental disabilities to a community hospital over 3 years were examined to evaluate the impact of a coordinated care model on length of stay and hospital charges. Admissions were divided into two groups, those receiving either coordinated care (program group) or routine care by community physicians (usual care group). The program group had shorter average lengths of stay and lower hospital charges than did the usual care group, especially when charges were adjusted for case mix. Similarity of severity across the groups was measured by number of discharge diagnoses and Medicaid case weights. Over the 3 years, for the 115 admissions in the program group, these differences amounted to more than $200,000 in potentially unnecessary hospital charges. Implications of care coordination services for community-based health care planning were presented.

All admissions of people with mental retardation to a community hospital during one year were examined to determine the effects of a managed-care model on selected outcome variables. Hospitalization outcomes for patients receiving health care services through the program (care coordination group) were compared to those not enrolled (usual care group). Patients in the care coordination group were found to have shorter hospital stays, when adjusted for diagnosis-related groups; fewer readmissions; and were less severely ill upon admission. Cost data were extrapolated to show that costs of care coordination activities were partially offset by reductions in inpatient utilization.

This article contrasts two clinical cases using a relatively new paradigm and theory, modelling and role-modelling. The concepts and linkages from modelling and role-modelling are presented and are the basis for analysing the outcomes of of two patients. The case study approach communicates an understanding of the theory modelling and role-modelling and assists nurses to develop expertise in its use.