Abstract

The conceptualization of the Household/Neighborhood Model for skilled nursing facilities began in 1987 at Evergreen Retirement Community in Oshkosh, WI, USA in the search for the “perfect” nursing home. Being able to see perfection required being freed from the mental constraints of regulations, reimbursement systems, and existing staff training programs so that visionary thinking was possible. Conceptualization was followed by a pilot project to test various aspects of the vision. The result was (1) a management philosophy built on Continuous Quality Improvement, (2) a team-based organization structure, (3) cross-functional staff roles, (4) social-model activity programming, and (5) a residential style physical setting that won strong support from the State of Wisconsin. With this support, we had the opportunity to open in 1997 the first full-scale model of a Household/Neighborhood in the United States based upon providing “resident and relationship centered services and care”. The model was validated through a year-long evaluative research study. In 2004 we opened a second full-scale model incorporating significant improvements identified through experience. The opportunity to further develop the model has been provided through its adoption in China by China Senior Care, which will open their first facility in 2014.

Abstract

hough heavy goods vehicles (HGVs) were only involved in 4.4% out of more than 1 million crashes that occurred on European roads in 2017, their share in crashes with fatal outcome was almost three times larger (12%). Advanced Driver Assistance Systems (ADAS) have the potential to mitigate the consequences of these crashes or avoid them altogether. In order to prioritise the most promising system, several types of safety benefit assessment are performed separately and independently of each other. These assessments miss however a combination into a common output, i.e. they are not able to provide a holistic overview but only show compartmentalised results. The first objective of this thesis is to provide a framework that can incorporate multiple data sources and combine their results into one common safety benefit output. The proposed framework within this thesis is based on Bayesian modelling and can update prior information (e.g. simulation results of a new ADAS) with new observations (e.g. test track results of the ADAS). The framework can incorporate additional information such as user acceptance and market penetration of the ADAS for an improved benefit assessment. The output of the framework can easily be incorporated as prior knowledge in new safety benefit assessments, e.g. when new data is available. The second objective is to prepare the application of the framework for the assessment of the safety benefit associated to the introduction of new ADAS for long-haul trucks. In order to specify the most critical crash scenarios for HGVs in Europe, a detailed, three-level analysis of crashes involving long-haul trucks was performed, starting on a general European level and going to in-depth crash data. The identified target scenarios are (a) rear-end crashes with the truck as the striking vehicle, (b) crashes between a right-turning truck and adjacent cyclist and (c) crashes between a truck and a pedestrian crossing in front of the truck. These three scenarios should be the basis for ADAS development and further addressed by driver behaviour modelling in the future. Future work will focus on improving simulation results by incorporating more accurate driver models, that are better able to represent truck driver behaviour, e.g. brake or steering reactions. These models will help to obtain more valid simulation results, and thereby increase the output quality of the framework.

Abstract

Background: Diabetes mellitus is considered a worldwide chronic metabolic pathology, same that comprises a group of metabolic disorders which is considered in an elevated blood glucose level (hyperglycemia). Aim: to analyze perceived social support in patients with diabetes mellitus. Methods: a quantitative, descriptive, cross-sectional, descriptive study was carried out in patients with Type 2 Diabetes Mellitus attending the Loma Grande Type A Health Center. The sample consisted of 105 voluntary patients with DM2 over 60 years of age. A 12-item survey was used, which are closed questions previously validated for the topic of perceived social support in individuals with DM in the province of Cotopaxi. Results: With respect to perceived social support, it is evident that 57% use the help of family members and that they always need emotional or physical support from them; in addition, 20% of patients need social support from a figure other than a family member. Conclusions: Social support from the perspective of patients with DM2 at the Loma Grande Health Center shows a high level and is mostly provided by the family. The family environment was fundamental as a means of support for the patients, and to a lesser extent, but no less important, the support received from health personnel and friends. It is evident in this study how the presence and role of the family is constituted as a form of social support.