BEhavioral Health Stratified Treatment (B.E.S.T.) to optimize transition to adulthood for youth with intellectual and/or developmental disabilities.

Youth with intellectual and/or developmental disabilities (IDD) often struggle with depression and anxiety, which adversely impacts transition to adulthood. Integrated behavioral health care coordination, wherein care coordinators and behavioral health specialists collaborate to provide systematic, cost-effective, patient-centered care, is a promising strategy to improve access to behavioral health services and address factors that impact transition to adulthood, including depression/anxiety symptoms. Current care coordination models (e.g., Title V Maternal and Child Health Bureau [MCHB]) do not include behavioral health services. The CHECK (Coordinated HealthCarE for Complex Kids) mental health model, hereby refined and renamed BEhavioral Health Stratified Treatment (B.E.S.T.), is a behavioral health intervention delivery program designed for integration into care coordination programs. This study aims to determine whether an integrated behavioral health care coordination strategy (i.e., MCHB care coordination plus B.E.S.T.) would be more acceptable and lead to better youth health and transition outcomes, relative to standard care coordination (i.e., MCHB care coordination alone). Results would guide future investment in improving outcomes for youth with IDD. This study is a two-arm randomized clinical trial of 780 transition-aged youth with IDD (13-20 years) to evaluate the comparable efficacy of MCHB Care Coordination alone vs. MCHB Care Coordination plus B.E.S.T. on the following outcomes: 1) decreased symptoms and episodes of depression and anxiety over time; 2) improved health behaviors, adaptive functioning and health related quality of life; 3) increased health care transition (HCT) readiness; and 4) improved engagement and satisfaction with care coordination among stakeholders.

Automation of structural health monitoring (SHM) system of a bridge using BIMification approach and BIM-based finite element model development.

This research focuses on the automation of an existing structural health monitoring system of a bridge using the BIMification approach. This process starts with the Finite Element Analysis (FEA) of an existing bridge for the numerical calculations of static and dynamic parameters. The validation of the FE model and existing SHM system was carried out by the field load testing (Static and dynamic) of the bridge. Further, this study tries to fill the research gap in the area of automatic FE model generation by using a novel methodology that can generate a BIM-based FE model using Visual Programming Language (VPL) scripts. This script can be exported to any FE software to develop the geometry of the FE model. Moreover, the SHM devices are deployed to the Building Information modelling (BIM) model of the bridge to generate the BIM-based sensory model (as per the existing SHM system). In this way, the BIM model is used to manage and monitor the SHM system and control its sensory elements. These sensors are then linked with the self-generated (Internet of Things) IoT platform (coded in Arduino), developing a smart SHM system of the bridge. Resultantly, the system features visualisation and remote accessibility to bridge health monitoring data.

Finite Element Model Updating of RC Bridge Structure with Static Load Testing: A Case Study of Vietnamese ThiThac Bridge in Coastal and Marine Environment.

Diagnostic load testing refers to the use of the measured historical responses of the structure in the field data to better understand its dynamic and static structural behaviours. It is important and necessary to predict the health state, load capacity, and aging of the structure by updating the finite element (FE) model, which can give useful information to aid the design of retrofits and the maintenance of the existing bridge in the future. The paper presents an update of the full-scale FE model for the reinforced concrete (RC) bridge structure over the seawater river based on the experimental strains under the static load testing in which the representative FE model of the actual structure is determined from the optimisation procedures. The optimisation variables are applied, including the cross-sectional properties and concrete material calibrated through the genetic algorithm (GA) optimisation in the MATLAB software, which interfaces with the FE modelling in the scripting of the SOFISTIK TEDDY software automatically. The bending moments at the mid-span of the RC girders are determined in the FE modelling to compute stresses, which are compared with the measured stresses through optimisation scenarios with a percentage error of the objective function less than 10%. The measured data of concrete strains are recorded from reusable strain transducers installed on the mid-span girders for every bridge span, which are used to calibrate the bridge model in static load testing. The novelty of the solution is to implement innovative techniques using field data as an improved approach for calibrating automatically the analytical FE model parameters of all RC spans of the bridge until its static behaviours are very similar to those of the actual bridge. The final updated FE modelling is used to apply truck load configurations according to bridge design standards such as the AASHTO specifications, which can predict the load limits of the existing bridge structure more accurately and reliably. These proposed approaches can be applied to large bridges as well as complex structures with supporting FE analysis software and data processing software.

Influence of Actual Curing Conditions on Mechanical Properties of Concrete in Bridge Superstructures.

This article presents the research on the mechanical characteristics of concrete in the construction of three concrete bridges. A system of recording the internal temperature of concrete and automatic control of laboratory ovens was used for specimen curing. This allowed the specimens to be cured under conditions similar to those occurring in the structure. Before the construction, reference blocks were used to define similar curing conditions. Maximum setting temperatures ranged from 47.6 °C to 62.0 °C and had a favorable effect on the properties of the concrete at an early age. For concretes with the use of CEM I cement, after 3 days of curing, the strength obtained was up to 8.2 MPa (23%) higher than that for specimens cured under standard conditions. The modulus of elasticity was higher up to 4.9 GPa (21%). For concrete with the use of CEM III cement, these differences were 26.9 MPa (174%) and 10.3 GPa (64%), respectively. After 7 days of curing, the results were close to each other and after 14, 28, and 56 days, higher values were obtained for specimens cured under standard conditions. The value of the modulus of elasticity of concrete was determined using the direct method according to Eurocode and the standard A method. A test load of the bridge was carried out to verify the modulus values obtained from laboratory tests. The highest consistency (99%) between the theoretical deflections and those measured in the test load was achieved when using the stabilized modulus values obtained on specimens cured under structure conditions in the FEM model. The research confirms the necessity of determining the mechanical characteristics of concrete with taking into account the curing conditions of concrete in the structure. A procedure for determining the mechanical properties of concrete for the correct construction of a bridge is proposed. These results can also be used in the development of a digital twin for bridge management.

Spaced Education With ABSITE Quest Resulting in Improved American Board of Surgery In-Training Examination Performance.

OBJECTIVE: The American Board of Surgery In-Training Examination (ABSITE) is an annual exam taken by general surgery residents as a cognitive assessment of the knowledge gained throughout each year of training. Several question banks are available for ABSITE preparation. However, ABSITE Quest (AQ) utilizes a method called spaced education which has been demonstrated to help with retaining information longer and improve exam performance. This study hypothesizes that using this method will help residents improve their ABSITE performance. DESIGN: Retrospective survey data was collected from residents who participated in AQ, including postgraduate year (PGY) level, as well as 2019 and 2020 ABSITE percentiles. AQ user data was used to match respondent's total number of questions completed and daily engagement level to the survey data. Paired, single-tailed student's t test was used to evaluate the significance of ABSITE percentile change between 2019 and 2020 among AQ users. SETTING: ChristianaCare, Newark, DE, United States. Nonclinical. PARTICIPANTS: All ABSITE Quest users were surveyed (n = 390), of which 104 responded. 21 responses were from PGY1 residents and were excluded, resulting in a total of 83 responses. RESULTS: The mean percentile difference of AQ users from 2019 to 2020 was +15.8 (p < 0.00001). When categorizing by the total number of questions completed, high users demonstrated a mean percentile difference of +15.3 (p = 0.00002), average users had a difference of +19.1 (p = 0.00029), and low users showed a percentile difference of +1.2 (p = 0.45244). When categorizing by daily engagement level, high users demonstrated a mean percentile difference of +17.9 (p < 0.00001), low users had a mean percentile difference of +15.3 (p = 0.00124), and minimal users showed a mean percentile change of -5.7. CONCLUSIONS: The use of the spaced education method with ABSITE Quest, especially in users with a greater number of questions completed and high levels of daily engagement, correlated with a significant improvement on ABSITE performance.

Work-Sampling Study of an Innovative Care Coordination Program Aimed at Children With Chronic Health Conditions.

PURPOSE OF STUDY: To estimate time allocation and labor cost for care coordinators (CCs), community health workers (CHWs), and mental health workers (MHWs) to conduct care coordination tasks in a pediatric care coordination program. PRIMARY PRACTICE SETTING: A public tertiary academic medical center in Chicago, IL. METHODOLOGY AND SAMPLE: A work-sampling study was conducted using a text message-based survey on 5 CCs, 20 CHWs, and 4 MHWs who volunteered to participate. Workers were randomly sampled within working hours to collect information on who was the subject of interaction and what service was being delivered over a 6-month period. Time allocation of workers to different subjects and services was summarized using descriptive statistics. RESULTS: Care coordinators allocated 41% of their time to managing CHW teams. Community health workers allocated 37% of time providing services directly to children and 26% to the parent/caregiver. Mental health workers allocated 16% of time providing services to children and 29% to the parent/caregiver. The care coordination program serviced 5,965 patients, with a total annual labor cost of $1,455,353. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Community health workers spent the majority of time working with patients and their families to conduct assessments. Mental health workers primarily addressed children's needs through their caregivers. Care coordinators primarily supported CHWs in coordinating care. Results may be used to inform development of such programs by determining services most often utilized, and labor cost may be used to inform program implementation and reimbursement.

Paraganglioma of the Spermatic Cord With Spinal Metastasis: A Case Report.

A 40-year-old male with presented to the clinic with the chief complaint of right inguinal pain radiating to his right testicle and right thigh with no history of trauma, fever, chills, dysuria, hematuria, or unprotected sexual activity. Physical exam revealed right testicular tenderness with no palpable abnormality of the bilateral testes or spermatic cords. Scrotal ultrasound was performed and was unremarkable for testicular or other intrascrotal pathology. Concurrently, chronic low back pain had prompted a lumbar CT to be performed, which was indeterminate, but subsequent lumbar MRI performed three months later revealed abnormal signals in the vertebral bodies of T12, L3, and L5, concerning for occult metastatic disease or multiple myeloma. PET-CT was performed revealing hypermetabolic lesions throughout the axial skeleton and, most notably, hypermetabolic lesions in the left inguinal and left upper scrotum. At this time, about 4 months after the original visit, physical exam revealed a palpable mobile mass in the left upper scrotum that was distinct from the left testicle, and another mass palpable near the left inguinal ring.

Exploring Racial Disparities in Mental Health Diagnoses and Neighborhood Disorganization Among an Urban Cohort of Children and Adolescents with Chronic Medical Conditions.

Objective: This article describes the demographic distribution of, and association between, neighborhood disorganization and mental health diagnosis by race in a large cohort of urban children with chronic medical conditions. Methods: Data for this study were from Coordinated Healthcare for Complex Kids (CHECK), a health care demonstration project funded by the Center for Medicare and Medicaid Innovation. We conducted regression analyses to examine the relationship between neighborhood disorganization and mental health diagnosis among 6,458 children enrolled in CHECK. Results: The most common mental health diagnoses were mood disorders (8.6%), Attention-Deficit/Hyperactivity Disorder (7.4%), conduct disorders (6.1%), and anxiety disorders (4.8%). Black children had the highest neighborhood disorganization scores compared with other racial/ethnic categories. However, Black children had the lowest proportion of mental health diagnoses. Lower neighborhood disorganization was associated with having a mental health diagnosis; however, when adding race/ethnicity to the model, neighborhood disorganization no longer was significant. Conclusions: Level of neighborhood disorganization was highly correlated with racial/ethnic composition of the neighborhoods, and Black children disproportionately resided in highly disorganized neighborhoods compared with other groups. Neighborhood disorganization may not have sufficient variability within the racial/ethnic categories, which may explain the absence of an interaction between race/ethnicity and mental health diagnosis.

A multivariable analysis of childhood psychosocial behaviour and household functionality.

BACKGROUND: Social determinants of health play a vital role in population health. Awareness of household social factors and their impact on health can help health professionals to provide effective strategies in health promotion, especially for children and adolescents showing signs of psychosocial dysfunction. The objective of this study was to explore the association between parents' perceptions of the psychosocial behaviour of their children and the functionality of their household. METHODS: This cohort study analysed data from the Coordinated Health Care for Complex Kids programme. The sample included 293 parents of children aged 4-17 years with chronic conditions, and from urban, low-income families. Psychosocial behaviour of the child was measured using the Pediatric Symptom Checklist (PSC-17), which included subscales for internal, external, and attention symptoms. Household functionality was measured using the Confusion, Hubbub, and Order Scale. Responses to both assessments were scored in a standard manner. RESULTS: There was a significant association between parents' perceptions of the psychosocial behaviour of their children and the functionality of the home environment. The mean Confusion, Hubbub, and Order Scale scores in the home environment improved from baseline to the first reassessment (the period between the two assessments ranged from 4 to 8 months). Additionally, positive PSC-17 screening results of the children decreased by 11% in the first reassessment. The odds of having a positive PSC-17 screening result also decreased in the first reassessment after receiving interventions. CONCLUSION: The association between psychosocial dysfunction and household functionality indicates the importance of family-centred care and taking the home environment into consideration when administering health services to low-income children with chronic conditions. This study brings attention to the more hidden factors that influence child mental health, which must be addressed to improve care delivery and child health outcomes.

An innovative health-care delivery model for children with medical complexity.

Children with medical complexity (CMC) account for a disproportionate share of pediatric health-care utilization and cost that is largely attributable to long hospitalizations, frequent hospital readmissions, and high use of emergency departments. In response, the Centers for Medicare and Medicaid Services Health Care Innovation Center supports the development and testing of innovative health-care payment and service delivery models. The purpose of this article is to describe the CMS-funded coordinated health care for complex kids (CHECK) program, an innovative system of health-care delivery that provides improved, comprehensive, and well-coordinated services to CMC. The CHECK program uses a combination of high-tech and low-tech interventions to connect patients, stakeholders, and providers. It is anticipated that the investment in additional support services to CMC will result in improved quality of care that leads to a reduction in unnecessary inpatient hospitalizations, readmissions, and emergency department visits and a total cost savings. The CHECK program has the potential to inform future cost-effective health-care models aimed at improving the quality of life and care for CMC and their families.