The second aim was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. First, to analyse population-based health risk assessment strategies, including assessment tools and health indicators, in the five ACT regions, in order to identify current barriers and to elaborate recommendations for large scale deployment of integrated care at the European level. The study, therefore, addresses two specific aims. However, it is acknowledged that modelling tools addressing specific clinical issues with a high predictive power may present limitations for their general application outside the source population. Moreover, clinical risk prediction may contribute to patient classification in the optimal healthcare tier, helping to define shared care arrangements between primary care and specialists. In the clinical management domain, risk prediction of well-defined medical problems (ie, prediction of survival in acute exacerbations of chronic obstructive pulmonary disease (COPD)) 12 can support health professionals in the decision-making process. 10, 11 Likewise, performing screening for discovery of cases with non-manifest illnesses may benefit from early diagnosis and cost-effective preventive interventions. The former, case finding, identifies highly vulnerable patients, allocated at the tip of the risk pyramid, who are prone to major deleterious health events such as unplanned hospital admissions/readmissions, fast functional decline and/or death. It allows identification of subsets of citizens with similar healthcare requirements facilitating both case finding and screening. In the healthcare services domain, population-based risk predictive modelling facilitates the elaboration of stratification maps characterising risk strata distribution of the entire population in a given geographic location. The four key drivers addressed in the ACT programme were: risk assessment and stratification, workflows and organisational structures, staff engagement and patient adherence. By specifically investigating four key drivers influencing the effective deployment of integrated care services and generating ‘best practice’ examples, ACT intended to provide the foundation to help overcome current barriers for extensive adoption of integrated care. The 2.5-year ACT programme, initiated in 2013, explored the organisational and structural processes needed to successfully implement integrated care services on a large scale. Integrated care was defined as the organisation of activities among participants involved in a patient's care to facilitate the appropriate delivery of healthcare services. The current study was carried out within the frame of the Advancing Care Coordination and Telehealth (ACT) programme ( ) 9 involving five leading European Union (EU) regions in terms of scaling up integrated care: Basque Country (ES), Scotland (UK), Lombardy (I), Groningen (NL) and Catalonia (ES). 1–4 It is well recognised that health risk assessment can be relevant for regional adoption of integrated care 5–7 because of its impact on the design of healthcare services, as well as for stratification and clinical management of chronic patients. Large scale deployment and adoption of integrated care services in Europe seek health efficiencies with simultaneous reduction of outcome variability within and among regions.
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![]() Grab a bag of peanuts for this one, and enjoy the ride, because it's over much too soon. Dumbo gets a boost, too, from a merry band of crows, who are a spirited bunch, but the animation treads perilously close to trafficking in Stepin Fetchit stereotypes of African Americans.īut goodness knows these aren't as egregious as some of the stuff you'll find in the long-suppressed Song of the South, and looking to hash out the politics of a movie like Dumbo cannot be time well spent. (It's got nothing on the opening moments of Bambi, though.) The animation is extraordinarily lush throughout, and perhaps the most notable sequence is when Dumbo and Timothy accidentally imbibe champagne, leading to a drunken, surrealistic parade of pink elephants, plaid elephants, elephants of every shape and color and size-a discussion about the hallucinatory powers of alcohol may not be what you had in mind for after the movie, but be prepared. He helps our hero find his way in the world, and eventually turns Dumbo's most notable feature from a negative to a positive-it's hard not to read this as a parable for those kids who are just a little bit different in some respect, and gives the comforting notion that we can all find our place in this world.Īs so many of the classic Disney films are, this one is at its heart a parent/child story, and though of course it ends well, it could still provoke some anxiety over issues of abandonment. Mouse, cut from the same bolt of cloth as Jiminy Cricket. ![]() So our friend Dumbo is all alone in the world, but, this being a Disney movie, he makes his one necessary friend-here it's Timothy Q. ![]() This last becomes problematic, for Dumbo's mother stomps to his defense-what we know is the maternal instinct gets interpreted as a stampeding, irrational pachyderm, leading to her quarantine. Mom loves him, no matter what he looks like-moms are like that, especially in Disney movies-but the sweet mute little guy takes heaps of abuse, from a passel of gossipy elephants, from other animals, and from little kids. All is bliss between mother and child, and then the other elephants get a peek at the freakishly huge ears on the boy. Better late than never, though-a tardy stork comes through with a baby elephant, and he's got the doe eyes of the cutest little puppy you've ever seen. Cute little pups and cubs get deposited by an army of storks to all the mommies in the circus-no fear of a talk about the birds and the bees here-but left out, sadly, is a hopeful mother elephant. To begin with, the movie revels in the magic of the circus-it's not a seedy place of dark characters and questionable morals (as is, say, the circus in A Bug's Life), but rather it's an anthropomorphic animals' paradise, in which all are pleased to perform, and even more pleased for the annual visit from the stork. The extras package reveals that, as animated features go, this one was done in a hurry, and perhaps that accounts for its success-nothing here feels overthought or unreasonably schematic, and it clocks in at just over an hour, so even the smallest among us with their wee little attention spans will hang with this one.
It was a spark of the thrill that I remembered from my childhood. Hopping aboard, a sense of child-like excitement washed over me. Traveling to the nearby station, trains await to shuttle you in. When your traveler - named Dick Hasenbuhler, in my case - receives a radio signal regarding passage to the once great attraction, they simply must see what all the fuss is about. It’s ridiculous, sure no one would ever go to Coca-Cola World, but in the Fallout universe where the mentality of the 1950’s prevailed and consumerism was met with a strangely innate sense of pride, Nuka-Cola was marketed as healthy, nutritious, a staple of the family. Nuka-World is basically Walt Disney World but with soda. So much so that it even has its own theme park. In the Fallout universe, Nuka-Cola is the fizzy soft drink to end all soft drinks. I ran into something that stole away the illusion. ![]() Entering the dazzling interiors of the theme park, I was promised a world of wonder the likes of which I had never seen, and witnessing that splendor fall victim to forces beyond my control felt similar to every vacation to every tourist trap I have ever embarked upon. See, I met a game breaking bug at what I imagine to be about halfway through my character’s story in Nuka-World. Entering Nuka-World brought forth memories of vacations from the past, of barking carnival employees and brilliantly-lit attractions, but in the way that my childhood memories always seem to fade, so too did my experience in Nuka-World slip away. ![]() Playing through the recent DLC for Fallout 4, I found that Nuka-World parallels these memories in a way that was almost hilarious. The funny thing about these memories, however, is that they always seem to come to abrupt end. For me, rare family vacations to theme parks are one of those instances. Seldom do we make memories that, in their reflection, allow us to travel back and relive an entire experience, to literally feel every interaction, smell every smell, hear every sound. |
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