Formative Modeling of Foster Care Work: A Cognitive Work Analysis Approach

In this paper we present the promise of the Cognitive Work Analysis (CWA) methodology, particularly abstraction hierarchy modeling, in the foster care domain. There is increasing interest in applying machine learning decision aids to foster care decision making, but that interest is accompanied by concerns that those aids may perpetuate systemic bias or be largely context-blind. Modeling the work conducted at different levels of the domain offers unique insights into where bias may enter the system as well as possible design implications for these future decision aids. This project models two major areas of work in the domain, management of individual cases and management of overall programs offered. These work areas are then considered in the first 3 levels of the abstraction hierarchy to display the promise that this model can hold for the domain in future work, particularly when supported with more naturalistic studies.

Heterogeneous identity trust management method based on risk assessment

The cross-trust domain environment in which heterogeneous identity alliances are located often does not have a completely trusted centralized trust root, and different trust domains and entities also have specific security requirements. In view of the above problems, we believe that trust measurement of cross-domain identities based on risk assessment is an effective method to achieve decentralized proof of user identities in heterogeneous cyberspace. There are various risk assessment models. We choose the more mature attack graph theory in the existing research to apply to the new field of cross-trust domain management of heterogeneous identities. We propose an attribute attack graph evaluation model to evaluate cross-domain identities through risk measurement of attributes. In addition, heterogeneous identity alliances also have architectural risks, especially the risk of decentralized underlying structures. In response to this problem, we identify the risk of the identity alliance infrastructure, and combine the risk assessment and presentation system design to verify the principle.

The Public Institution for Integrated Maritime Domain Management in Croatia – role and functions

The aim of this article is the analysis of the existing maritime domain management system in Croatia, with a special attention to the port system management compared to maritime domain and port management systems in Italy, Spain and France. The research shows that Croatia does not have the strategy for integrated management of maritime domain. In respect of the size of national territory covered by maritime domain and its importance for the general Croatian economy, especially for tourism, we believe that is undeniable that this issue should be regulated as follows: the newly established Public Institution for Integrated Maritime Domain Management should manage the maritime domain and it should have branches on regional level. Thereby the management system of maritime domain would finally be consistent, managed from one place and under management of experts. At the same time, the strategy would be the base for the reform of the existing MDSA or for the completely new law on maritime domain and seaports.

Stakeholder perceptions of components of a Parkinson disease care management intervention, care coordination for health promotion and activities in Parkinson’s disease (CHAPS)

Background A recent nurse-led proactive care management intervention, Care Coordination for Health Promotion and Activities in Parkinson Disease (CHAPS), improved care quality when compared to usual care in a randomized controlled trial. Therefore, stakeholder (patient participants, nurse care managers, and Parkinson disease (PD) specialists) perceptions of key intervention components merit evaluation to inform decisions about dissemination. Methods This multi-site study occurred in five southwest United States Veterans Health Administration medical centers. Stakeholders were surveyed on their perceptions of CHAPS including the CHAPS Assessment, CHAPS nurse care managers, the Siebens Domain Management Model™ (a practical clinical model), and the Siebens Health Care Notebook (Notebook) (self-care tool). Participants’ electronic medical records were abstracted for perceptions of the Notebook. Statistical analysis software was used to provide summary statistics; open card sorting methodology was used to identify themes and attributes in qualitative data including usability of some components. Results Participants, overall, highly rated their medication self-management, acknowledged some challenges with the CHAPS self-care tools, reported knowledge of PD specialist follow-up and PD red flags, and rated CHAPS nurse care managers as helpful. Nurse care manager responses indicated the CHAPS Assessment and Program highly facilitated care of their patients. Most all PD specialists would refer other patients to CHAPS. Nurse care manager and PD specialist responses indicated improved participant management of their PD. Three themes emerged in participant perceptions of the Notebook: Notebook Assets (e.g., benefits and features-liked); Deferring Notebook Review (e.g., no time to review); and Reasons for Not Using (e.g., participant preference). Shared attributes regarding the Siebens Domain Management Model and Notebook usability, reported by nurse care managers, were user-friendly, person/patient-centered, and organized. Some challenges to their use were also reported. Conclusions Overall, stakeholder perceptions of the proactive nurse-led CHAPS intervention indicated its value in the care of individuals with PD. Responses about the CHAPS Assessment, Siebens Domain Management Model, and Notebook self-care tool signified their usefulness. Stakeholders’ constructive suggestions indicated their engagement in CHAPS. These findings support CHAPS dissemination and contribute to research in care management. Trial registration ClinicalTrials.gov as NCT01532986, registered on January 13, 2012.

Abstract 15323: Patients With Heart Failure With Preserved Ejection Fraction Contend With Deficits Across Multiple Domains of Health

Introduction: The domain management approach to caring for heart failure patients outlines the importance of considering deficits from multiple health domains including: medical, mental and emotional, physical, and social. The extent to which these deficits exist in patients with HFpEF is unknown. We sought to characterize deficits across multiple domains among patients seen in an outpatient HFpEF program. Hypothesis: We hypothesized that HFpEF patients would have a high prevalence of deficits across multiple domains. Methods: We conducted a retrospective study of 134 patients with HFpEF seen between July 2018 and December 2019 in the Weill Cornell HFpEF Program, which incorporates the domain management approach through several assessments. The medical domain includes an assessment of multimorbidity (≥ 2 comorbid conditions), polypharmacy (≥ 5 medications), malnutrition (Mini Nutritional Assessment < 12), and hearing and vision impairment (self-report). The mental and emotional domain includes cognitive impairment (Mini-Cog < 3), depression (PHQ-9 ≥ 10), and anxiety (GAD-7 ≥ 10). The physical function domain includes frailty (Short Physical Performance Battery < 10), functional impairment (Katz Index < 6), and fall within the past year (self-report). The social domain includes loneliness (UCLA 3-Item Loneliness Scale ≥ 6) and living situation (self-report). Results: The median age was 75 years (IQR 69-82), 60% were women, and 64% were White. The Figure shows the prevalence for each deficit across the four domains. The most common deficits were multimorbidity (100%), polypharmacy (98%), frailty (79%), and loneliness (62%). Notably, 13% of patients had deficits in all four domains, 31% in three domains, 47% in two domains, and 9% in one domain. Conclusions: HFpEF patients have deficits spanning multiple domains. This supports the importance of considering issues such as multimorbidity, polypharmacy, frailty, and loneliness when caring for these patients.

Domain-Management der Herzinsuffizienz beim geriatrischen Patienten

Geriatrische Patienten mit chronischer Herzinsuffizienz (CHI) sind aufgrund von Multimorbität, Einschränkungen der Mobilität und Kognition sowie reduzierter sozialer Netzwerke Hochrisikopatienten. Eine einfache kardiologisch fokussierte medikamentöse/interventionelle Behandlung führt daher oftmals nicht allein zum Ziel. Das vom American College of Cardiology vorgeschlagene System des Domain-Managements bei geriatrischen Patienten mit CHI ergänzt daher sinnvoll die strukturellen Versorgungskonzepte und gliedert die Problembereiche der Patienten in 4 große Blöcke:Durch systematische Bearbeitung der 4 Blöcke reduziert sich das Risiko, prognoserelevante Probleme zu übersehen, erheblich.Insgesamt bietet das Domain-Management einen Ansatz, die Komplexität prognoserelevanter Probleme des geriatrischen Patienten mit CHI zuverlässiger zu erkennen und in Therapieentscheidungen einzubeziehen.

Régimen de los puertos deportivos de competencia de Euskadi

LABURPENA: Kirol-portuak Euskadiko Autonomia Erkidegoaren eskumenekoak dira, eta, beraz, arestian onartutako Euskadiko Portuen eta Itsas Garraioaren ekainaren 28ko 2/2018 Legearen aplikazio-eremu objektiboaren barruan daude. Lan honen aztergai dira Legeak kirol-portuen inguruan dakartzan alderdirik aipagarrienak, hala nola antolaketa-eredu berria eta portuetako zerbitzuen eta jabari publikoaren kudeaketa-araubidea, batez ere amarratze edo amarralekuen araubidea eta hertsiki portu-erabilera ez direnak halako portuetan garatzeko araubidea. Azterlan honetan azaltzen dira, halaber, Legeak ebatzi gabeko zenbait alderdi, gainerako autonomia‑erkidegoetan eman diren portu-arauekiko konparazioaren ikuspegitik. ABSTRACT: Marinas fall within the competence of the Autonomous Community of the Basque Country and therefore part of the objective scope of the recent Law 2/2018, of 28 June, on Ports and Maritime Transport of the Basque Country. The paper examines the most important aspects introduced concerning marinas, such as the new organisational model, the services and public domain management, with particular consideration of the regime of moorings and possible non-strictly port uses that may develop in such ports. The research also reviews those aspects that the Law does not resolve and from a comparative perspective of the regulation of marinas in Autonomous Communities. RESUMEN: Los puertos deportivos son de competencia de la Comunidad Autónoma de Euskadi y parte, por tanto, del ámbito objetivo de aplicación de la reciente Ley 2/2018, de 28 junio, de Puertos y Transporte Marítimo del País Vasco. El trabajo examina los aspectos de mayor relieve que introduce la Ley en relación a los puertos deportivos, tales como el nuevo modelo organizativo, el régimen de gestión de los servicios y del dominio público portuarios, con especial consideración del régimen de los amarres y de los posibles usos no estrictamente portuarios que pueden desarrollarse en este tipo de puertos. El estudio se realiza exponiendo, también, aquellos aspectos que la Ley no resuelve y desde una perspectiva comparativa de la regulación de puertos que se ha dictado en el resto de Comunidades Autónomas.

Cognitive models for creating information systems for managing the costs of the industrial sector of the economy

The article notes the tasks associated with cognitive models of domain management. The patterns of development of the industrial sector of the economy are highlighted and the cost component is designated as a key composition of the development of production. With the use of the decision system “IGLA”, the connectedness of the system to the concept and the concept to the system on the basis of the constructed cognitive map was determined, which served as the basis for constructing development scenarios on the example of textile production.