AIM: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients. METHODS A framework for quality assessment and improvement was created for IBD based o...AIM: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients. METHODS A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df) offers a logistical and productive perspective and the Clinical Value Compass (CVC) model adds a management and service perspective. The framework creates a pedagogical tool to understand the balance between the dimensions of clinical care (CVC) and the components of clinical outcome (Df). The merged models create a framework of the care process dimensions as a whole, reflecting important parts of the IBD care delivery system in a local setting. Clinical and organizational quality measures were adopted from clinical experience and the literature and were integrated into the framework. Data were collected at the yearly check-up for 481 IBD patients during 2008. The application of the quality assessment framework was tested and evaluated in a local clinical IBD care setting in Jnkping County, Sweden. RESULTS: The main outcome was the presentation of how locally-selected clinical quality measures, integrated into two complementary models to develop a frame-work, could be instrumental in assessing the quality of care delivered to patients with IBD. The selected quality measures of the framework noted less anemia in the population than previously reported, provided information about hospitalization rates and the few surgical procedures reported, and noted good access to the clinic. CONCLUSION: The applied local quality framework was feasible and useful for assessing the quality of care delivered to IBD patients in a local setting.展开更多
Women entrepreneurs are increasingly representing an underexploited potential of the Swiss economy. Although entrepreneurship represents a rapidly expanding phenomenon, women meet specific difficulties that explain th...Women entrepreneurs are increasingly representing an underexploited potential of the Swiss economy. Although entrepreneurship represents a rapidly expanding phenomenon, women meet specific difficulties that explain this lack of exploitation by the economy, The Global Entrepreneurship Monitor （GEM）, a not-for-profit academic research consortium, published its annual report which mentioned in particular a difference between female and male entrepreneurship. According to these results, it can be noticed that the typical profile of the female entrepreneur differs from that of her male counterpart. In Switzerland, those differences can be situated at three levels： （I） In the first place, a natural difference of the female entrepreneurship at the level of activities （service activities, low-added value, and low potential of job creation）; （2） Secondly, a difference in motivation/commitment （part-time work, start-up funds available, skills, received opportunities, and fear of failure）; and （3） Thirdly, a difference at the level of insertion （revealing the importance of networking, access to financing and structures of encouragement）. The present communication points up a typical profile of the woman entrepreneur in Switzerland. The authors also intend to identify the kind of obstacles female entrepreneur is likely to meet as well as the existing initiatives to exceed stereotypes by taking into account her specificities. There are several supports and measures intended to help women entrepreneurship concerning the following aspects： better time management; adapted following and training structures; access to easier financing; and better visibility and networking.展开更多
This paper describes a new weather generator e the 10-state empirical model e that combines a 10-state, first-order Markov chain with a non-parametric precipitation amounts model. Using a doubly-stochastic transition-...This paper describes a new weather generator e the 10-state empirical model e that combines a 10-state, first-order Markov chain with a non-parametric precipitation amounts model. Using a doubly-stochastic transition-matrix results in a weather generator for which the overall precipitation distribution(including both wet and dry days) and the temporal-correlation can be modified independently for climate change studies. This paper assesses the ability of the 10-state empirical model to simulate daily area-average precipitation in the Torne River catchment in northern Sweden/western Finland in the context of 3 other models: a 10-state model with a parametric(Gamma) amounts model; a wet/dry chain with the empirical amounts model; and a wet/dry chain with the parametric amounts model. The ability to accurately simulate the distribution of multi-day precipitation in the catchment is the primary consideration.Results showed that the 10-state empirical model represented accumulated 2- to 14-day precipitation most realistically. Further, the distribution of precipitation on wet days in the catchment is related to the placement of a wet day within a wet-spell, and the 10-state models represented this realistically, while the wet/dry models did not. Although all four models accurately reproduced the annual and monthly averages in the training data, all models underestimated inter-annual and inter-seasonal variance. Even so, the 10-state empirical model performed best.We conclude that the multi-state model is a promising candidate for hydrological applications, as it simulates multi-day precipitation well, but that further development is required to improve the simulation of interannual variation.展开更多
基金Supported by The Futurum Research Council, Jnkping County Council, the Foundation for Clinical Cancer Research in Jnkping CountyVINNVRD-research program for more effective and better health care
文摘AIM: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients. METHODS A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df) offers a logistical and productive perspective and the Clinical Value Compass (CVC) model adds a management and service perspective. The framework creates a pedagogical tool to understand the balance between the dimensions of clinical care (CVC) and the components of clinical outcome (Df). The merged models create a framework of the care process dimensions as a whole, reflecting important parts of the IBD care delivery system in a local setting. Clinical and organizational quality measures were adopted from clinical experience and the literature and were integrated into the framework. Data were collected at the yearly check-up for 481 IBD patients during 2008. The application of the quality assessment framework was tested and evaluated in a local clinical IBD care setting in Jnkping County, Sweden. RESULTS: The main outcome was the presentation of how locally-selected clinical quality measures, integrated into two complementary models to develop a frame-work, could be instrumental in assessing the quality of care delivered to patients with IBD. The selected quality measures of the framework noted less anemia in the population than previously reported, provided information about hospitalization rates and the few surgical procedures reported, and noted good access to the clinic. CONCLUSION: The applied local quality framework was feasible and useful for assessing the quality of care delivered to IBD patients in a local setting.
文摘Women entrepreneurs are increasingly representing an underexploited potential of the Swiss economy. Although entrepreneurship represents a rapidly expanding phenomenon, women meet specific difficulties that explain this lack of exploitation by the economy, The Global Entrepreneurship Monitor （GEM）, a not-for-profit academic research consortium, published its annual report which mentioned in particular a difference between female and male entrepreneurship. According to these results, it can be noticed that the typical profile of the female entrepreneur differs from that of her male counterpart. In Switzerland, those differences can be situated at three levels： （I） In the first place, a natural difference of the female entrepreneurship at the level of activities （service activities, low-added value, and low potential of job creation）; （2） Secondly, a difference in motivation/commitment （part-time work, start-up funds available, skills, received opportunities, and fear of failure）; and （3） Thirdly, a difference at the level of insertion （revealing the importance of networking, access to financing and structures of encouragement）. The present communication points up a typical profile of the woman entrepreneur in Switzerland. The authors also intend to identify the kind of obstacles female entrepreneur is likely to meet as well as the existing initiatives to exceed stereotypes by taking into account her specificities. There are several supports and measures intended to help women entrepreneurship concerning the following aspects： better time management; adapted following and training structures; access to easier financing; and better visibility and networking.
基金Financial support for this study by the Swedish Civil Contingencies Agency (2011-3778), though the project "Future rainfall and flooding in Sweden:a framework to support climate adaptation actions"
文摘This paper describes a new weather generator e the 10-state empirical model e that combines a 10-state, first-order Markov chain with a non-parametric precipitation amounts model. Using a doubly-stochastic transition-matrix results in a weather generator for which the overall precipitation distribution(including both wet and dry days) and the temporal-correlation can be modified independently for climate change studies. This paper assesses the ability of the 10-state empirical model to simulate daily area-average precipitation in the Torne River catchment in northern Sweden/western Finland in the context of 3 other models: a 10-state model with a parametric(Gamma) amounts model; a wet/dry chain with the empirical amounts model; and a wet/dry chain with the parametric amounts model. The ability to accurately simulate the distribution of multi-day precipitation in the catchment is the primary consideration.Results showed that the 10-state empirical model represented accumulated 2- to 14-day precipitation most realistically. Further, the distribution of precipitation on wet days in the catchment is related to the placement of a wet day within a wet-spell, and the 10-state models represented this realistically, while the wet/dry models did not. Although all four models accurately reproduced the annual and monthly averages in the training data, all models underestimated inter-annual and inter-seasonal variance. Even so, the 10-state empirical model performed best.We conclude that the multi-state model is a promising candidate for hydrological applications, as it simulates multi-day precipitation well, but that further development is required to improve the simulation of interannual variation.
