Community-partnered evaluation of depression services for clients of community-based agencies in under-resourced communities in Los Angeles.

BACKGROUND: As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. OBJECTIVE: To understand the distribution of need and current burden of services for depression in under-resourced, diverse communities in Los Angeles. DESIGN: Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. PARTICIPANTS: Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. MAIN MEASURES: Comparisons by setting in 6-month retrospective recall of depression services use. KEY RESULTS: Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. CONCLUSIONS: Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.

Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities.

BACKGROUND: Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors. OBJECTIVE: To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients' mental health-related quality of life (HRQL) and services use. DESIGN: Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles. PARTICIPANTS: From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up. MEASURES: Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use. RESULTS: CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p < 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p > 0.05). CONCLUSION: Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.

Uso de un sistema experto en ambiente web para facilitar la identificación de géneros de bacilos gramnegativos no fermentadores de la glucosa / Use of a web expert system to facilitate the identification of glucose non fermentative gram-negative bacillus

Resumen La identificación de bacilos gramnegativos no fermentadores de la glucosa (BGNNF) es una tarea compleja y laboriosa que exige la participación de expertos. Para facilitar la toma de decisiones se desarrolló y puso a prueba un Sistema Experto (SE) con una base de conocimientos construida aplicando el algoritmo C4.5 modificado, capaz de inducir un árbol de decisión (reglas primarias) para un conjunto de géneros, y la diferenciación entre éstos (reglas complementarias) para la identificación de géneros específicos. La incertidumbre del sistema es tratada mediante el esquema de factores de certeza. En este trabajo se sometió a prueba el SE con una selección de cultivos de BGNNF de diferente origen, identificados y preservados en el Centro Venezolano de Colecciones de Microorganismos (CVCM): géneros Achromobacter, Acinetobacter, Alcaligenes, Brevundimonas, Burkholderia, Chryseobacterium, Comamonas, Delftia, Moraxella, Myroides, Ochrobactrum, Oligella, Pseudomonas, Shewanella, Sphingobacterium y Stenotrophomonas. Mediante la aplicación de 11 pruebas (características primarias) se obtuvo una aproximación entre varios de los géneros posibles. Las pruebas complementarias sugeridas (entre 1 y 9), permitieron una mayor aproximación al género posible. Los resultados muestran una coincidencia del 95.8% con los reportados por el CVCM. En base a estos resultados se estudia la ampliación de la base conocimiento para la identificación de especies de BGNNF, y de otros grupos de bacterias.

Abstract The identification of glucose non fermentative gram-negative bacilli (NFGNB) is a complex and laborious task. In order to facilitate genera identification an Expert System (ES) was developed applying a modified C4.5 algorithm able to induce a decision tree (primary rules) for a set of genera, and the differentiation between these (complementary rules) for the identification of specific genera- The uncertainty of the system is treated by means of a certainty factors scheme. In this work the ES was put on approval using a selection of cultures of NFGNB of different origin, identified and preserved in the Venezuelan Center for Microbial Collections (CVCM): genera Achromobacter, Acinetobacter, Alcaligenes, Brevundimonas, Burkholderia, Chryseobacterium, Comamonas, Delftia, Moraxella, Myroides, Ochrobactrum, Oligella, Pseudomonas, Shewanella, Sphingobacterium y Stenotrophomonas. By means of the application of 11 tests (primary characteristics) an approach between several of possible genera was obtained, The suggested complementary testes (between 1 to 9) allowed great approach to the possible generas.-.The results show a coincidence of the 95.8% with the reported ones by the CVCM. An extent of the ES for the identification of other genera is under study.

CMACPAR neurocontrolador paralelo modificado para controll de processos / CMACPAR an modified parallel neurocontroller for control processes

CMACPAR es un Neurocontrolador Paralelo orientado a sistemas que operan en tiempo real como los sistemas de control de processos. Sus principales características son: un rápido algoritmo de aprendizaje, un reducido número de cálculos, alta capacidad de generalización, aprendizaje local y paralelismo intrínseco. Este tipo de neurocontroladores es muy utilizado en aplicaciones en tiempo real como las requeridas en refinerías, plantas hidroeléctricas, fábricas, etc. En este trabajo se presenta el análisis y la implementación paralela de un esquema modificado del Modelo Cerebelar CMAC para el mapeo de aspacios n-dimensionales mediante la utilización de un algoritmo paralelo de granularidad media. La modificación propuesta al esquema de manejo de memoria permite una reducción significativa de los tiempos de entrenamiento y de la cantidad de memoria requerida.