This document summarizes microsystem tools used in health care. It begins with an overview of microsystems and their elements, including health professional teams, defined target populations, knowledge support, and support staff/equipment. Several tools are then described, including the 5 P Tool, Clinical Microsystem Assessment Tool, Clinical Compass Worksheet, Clinical Improvement Worksheet, and STAR Mapping Worksheet. An example case study application of the Clinical Improvement Worksheet during a care delivery model redesign is provided. References conclude the summary.
Outline of ideas to advance the science of transforming health care organizations. 81. “Advancing Transformational Science”, Bridges to Sustainable Healthcare Transformation Through Evidence, Partnerships & Technology: 19th International Conference San Francisco, CA, January 19-22, 2011.
Our Southwest Baptist BSN nursing course assigned this project. This project covers modern Computer Information Systems that are specially designed for healthcare. The purpose of the project is to promote a knowledgable selection
Presenting on an expert panel on the topic of "eHealth Technologies to leverage patient engagement and compliance" at Health Care Unbound conference, San Diego in July 2010.
Outline of ideas to advance the science of transforming health care organizations. 81. “Advancing Transformational Science”, Bridges to Sustainable Healthcare Transformation Through Evidence, Partnerships & Technology: 19th International Conference San Francisco, CA, January 19-22, 2011.
Our Southwest Baptist BSN nursing course assigned this project. This project covers modern Computer Information Systems that are specially designed for healthcare. The purpose of the project is to promote a knowledgable selection
Presenting on an expert panel on the topic of "eHealth Technologies to leverage patient engagement and compliance" at Health Care Unbound conference, San Diego in July 2010.
Supporting paper for NPT Master Class 'Getting ideas into Practice: normalising implementation of complex interventions across the healthcare system' - Collaborating for Better Care Partnership Master Class 23rd October 2014
The Impact of Online Resilience Training for Sales Managers on Wellbeing and...happier.com
In a randomised controlled trial, the internet-based ResilienceOnline (ROL) program was evaluated among sales managers from an Australian industrial organisation. This program is designed to enhance resilience by teaching seven skills to help improve ability to cope with challenges and setbacks and maximise potential achievements. Sales managers were allocated to complete the ROL program (n = 26) or to be in a waitlist-control condition (n = 27) and were compared on pre- and post-intervention measures of happiness, quality of life, depression, anxiety, stress and work performance.
Sales managers found the resilience training very enjoyable and believed it would improve their work performance and life skills. However, a high proportion of sales managers did not complete the ROL program and it was not found to significantly reduce distress or improve quality of life or work performance.
The Dietary Data Recording System supports the dietary assessment of participants by facilitating collection of more objective measurement of dietary intake in real time and with moderate cost
Supporting paper for NPT Master Class 'Getting ideas into Practice: normalising implementation of complex interventions across the healthcare system' - Collaborating for Better Care Partnership Master Class 23rd October 2014
The Impact of Online Resilience Training for Sales Managers on Wellbeing and...happier.com
In a randomised controlled trial, the internet-based ResilienceOnline (ROL) program was evaluated among sales managers from an Australian industrial organisation. This program is designed to enhance resilience by teaching seven skills to help improve ability to cope with challenges and setbacks and maximise potential achievements. Sales managers were allocated to complete the ROL program (n = 26) or to be in a waitlist-control condition (n = 27) and were compared on pre- and post-intervention measures of happiness, quality of life, depression, anxiety, stress and work performance.
Sales managers found the resilience training very enjoyable and believed it would improve their work performance and life skills. However, a high proportion of sales managers did not complete the ROL program and it was not found to significantly reduce distress or improve quality of life or work performance.
The Dietary Data Recording System supports the dietary assessment of participants by facilitating collection of more objective measurement of dietary intake in real time and with moderate cost
Great Basin Primary Care Association: Overview of Patient Centered Medical Home - Standards and Preparation to obtain recognition. This presentation is targeted toward federally qualified health centers and safety net providers (primary care practices) in Nevada. Information current as of 02.25.13.
Slide deck from 2008 Symposium "Developing an Expert-System for Health Promotion: An Experimental E-Learning Platform" from the APA-NIOSH International Conference on Work, Stress, and Health
DII - Mapping Organizational Readiness Assessments to an Implementation Frame...UCLA CTSI
November 1, 2017
Isomi Miake-Lye, PhD
VA Greater Los Angeles Healthcare System
“Unpacking Organizational Readiness for Change: Mapping Organizational Readiness Assessments to an Implementation Framework”
A presentation of the Southern California Regional Dissemination, Implementation and Improvement Science Webinar Series
Provided by the UCLA CTSI
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Microsystems in Health Care:
Tools for Application
Hloniphani
Juta
Rachel Duffy
Lara Kesteloo
Macrosystem
Microsystem
Tools
2. Microsystem
Tools
Elements of a Microsystem in Health
Care
Health professional team
Defined target population
Knowledge support
Support staff, equipment
and working environment
3. Microsystem
Tools
Tools used in Health Care
5 P Tool Clinical Microsystem Assessment Tool Clinical Compass Worksheet
• A way to ensure that teams gather a • Used to identify a microsystems areas of • A balanced approach to measuring and
comprehensive understanding of their functioning strengths and developmental improvements. displaying value.
and can identify areas of development. • Definitions of characteristics and three functional • Four points: functional, satisfaction, costs and
• Purpose, Patients, People, Processes and levels within clinical aspects of health care.
Patterns . Leadership, staff, patients, performance, and
information technology.
Clinical Improvement Worksheet STAR Mapping Worksheet
• A 6-step flow chart to implement • Prediction of future relationships
change at the microsystem level. or improvement of existing ones.
• S- Separateness
• T- Talking
• A- Action
• R-Reason
4. Microsystem
Clinical Improvement Tools
Worksheet:
Aim: A Closer Look
“To accelerate clinical improvement by linking outcome measurements, structures, process and
pattern knowledge with the design and implementation knowledge of pilot tests of change.”
(Godfrey, Nelson, Batalden, Wasson, Mohr, Huber, & Headrisk, 2004, p.
136)
Outcomes Pilot
Process Changes
Patterns Structure
5. Microsystem
Tools
Case Study
Care delivery model redesign (CDMR)
roll
out for Vancouver Island Health
Authority
(VIHA)
A bottom-up improvement design (Unit
System)
Clinical Improvement Worksheet application
Aim:
To maintain pre-hospitalization
6. Microsystem
Tools
Clinical Improvement Worksheet
and the CDMR
•Select Population: All Admissions
Outcomes •Goal: To maintain pre-hospitalization function of patients and optimize
care.
•Analyze: Bottom-up process with change initiated at the unit level
Process through a redesign of assessment forms and the implementation of 48/6
•Knowledge of pre-hospitalization status is unacceptable
•Identify patterns: ie. Lack of staff or time, poor assessments, no
Patterns continuity
•Consider working relationships, meetings and previous changes made
•Actual setting: Diverse cultures
Structure •What and who is/are present?
•Ideas for change: Care delivery model redesign – routes for change ie.
Changes 48/6 and new assessment sheets.
•Roll out
Pilot •Implement PDSA method to direct change
7. Microsystem
Tools
REFERENCES
Godfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L.
(2004). Clinical microsystem action guide: Improving health care by improving your
microsystem [Action Guide 2.1]. Retrieved from Microsystem Academy:
http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdf
Nelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A
clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission
Resources.
Nelson, E. C., Mohr, J. J., Batalden, P. B., & Plume, S. K. (1996). Improving health care, part 1:
The clinical value compass. The Joint Commission Journal on Quality
Improvement, 22(4), 243-258. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8743061
Stevenson, L. (Vancouver Island Health Authority). (2010, March 30-31). Care delivery model
redesign [PDF file]. Retrieved from
http://www.chspr.ubc.ca/files/publications/2010/conference/Stevenson,Lynn.pdf
8. Search Microsystem
Tools
Strategies to get oriented by finding an
Our goal was
overview of microsystems then to find a small
number of tools used by microsystems with
relation to heath care then to chose one tool and
apply it to a case study.
This narrowed our search dramatically, especially
with the focus on health care.
Once the tools were found it was merely a matter
of
synthesizing a general knowledge of the tools we
are
mentioning with a deeper knowledge of a single
9. Collaboration Microsystem
Tools
Process
Once the scope of our portion of the presentation
was determined, we split the work into three
parts:
1. Overview of Microsystems to give us
background knowledge (Juta)
2. Overview of some tools used by
microsystems with relation to health care
(Rachel)
3. Case study, PowerPoint
development, references and fine-tuning
(Lara)
Editor's Notes
ReferencesNelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.Nelson, E. C., Mohr, J. J., Batalden, P. B., & Plume, S. K. (1996). Improving health care, part 1: The clinical value compass. The Joint Commission Journal on Quality Improvement, 22(4), 243-258. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8743061
Definition of Microsystems in Health Care: “Microsystems are a unique part of the health system and they are composed of people who come together to care for a defined population of patients,” (Nelson,Mohr, Batalden & Plume, 2000).Microsystems produce quality, safety and cost outcomes at the front line of care.Microsystems: caregivers, clinical and administrative support persons, information technology and patients.ReferencesNelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.Nelson, E. C., Mohr, J. J., Batalden, P. B., & Plume, S. K. (1996). Improving health care, part 1: The clinical value compass. The Joint Commission Journal on Quality Improvement, 22(4), 243-258. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8743061
5 P’sMicrosystems use the 5p tool as a way to ensure that teams gather a comprehensive understanding of their functioning and can identify areas of development.Purpose of the microsystemPatients are the focus of the microsystemPeople who work together in the micro systemProcesses the Microsystems uses to provide carePatterns that characterise the MicrosystemsClinical Microsystem Assessment Tool -The Clinical Microsystem Assessment tool can be used in health care to identify a microsystems areas of strengths and developmental improvements. This tool provides a definition of each success characteristic and three descriptions with a range of low functioning to high performing behaviours. Leadership, staff, patients, performance and information and information technology are the areas assessed by the tool. Recommended use of the tool includes explaining to the staff/people of the clinical microsystem the background of clinical microsystems and to then ask each member of the staff to rate each characteristic, thinking of the clinical microsystem they work in everyday. Use the findings to guide selection of aspects of the clinical microsystem that appear to be top priorities for recognition and those that appear to be critical for improvement. A plan for change within the microsystem can be developed based on the results of the assessment.Clinical Compass Worksheet- Clinical Value Compass Worksheet- Another tool used in the health care setting is the “Clinical Value Compass Worksheet”. It is a worksheet that is set out like a compass, and each point on the compass focuses on a different element of the health care system- functional, satisfaction, costs and clinical. The Clinical Value Compass presents a balanced approach to measuring and displaying value in health care. It is a measurement system that is designed for identifying and monitoring those keyindicators of care that enable one to assess the quality of health care.North - functional status, risk status, and well-being.South - the cost of the care delivered, including medical expenses, lost days of work, and other non-health care costs incurred by the patient and his or her family.East - the patient's satisfaction with and expectations of health care.West - the presenting clinical problem and its manifestations.Clinical Improvement Tool – will describe later in this presentation through the application of a case study.STAR Mapping Worksheet- This tool was talked about briefly last week, we’ll just go through it again, as it is a valuable tool within microsystems, and gives users an opportunity to improve working relationships. The STAR mapping worksheet is useful when exploring relationships across boundaries and is based on improved tuning and intentional action, with a focus on improving patient care. The STAR mapping worksheet is similar to the clinical value compass worksheet- there are four points on the star and each point represents a different element of the working relationshipS - Separateness or Differences to allow for “facts” to be seen as “interpretations”T - Tuning - talking and listening opportunities to challenge status quo and implicit assumptions -+ve affect and precisionA - Action opportunities - Permission or potential to act or create something newR - Reason to work together - Mutual BenefitsReferencesGodfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L. (2004). Clinical microsystem action guide: Improving health care by improving yourmicrosystem [Action Guide 2.1]. Retrieved from Microsystem Academy: http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdfNelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.Nelson, E. C., Mohr, J. J., Batalden, P. B., & Plume, S. K. (1996). Improving health care, part 1: The clinical value compass. The Joint Commission Journal on Quality Improvement, 22(4), 243-258. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8743061
Is similar to a flow chart directing change over 6 steps.1) Outcomes:Select a populationWhat is the general aim/results?2) Process:Analyze the processWhat is the process for giving care to this type of patient?3) Patterns:Identify the common patterns at workConsider working relationshipsDo you meet regularly?Have you successfully changed anything?What patterns can you identify?4) Structure:Visualize the actual settingWhat and who is there?5) Changes:Develop ideas for changeWhat are the ideas for creating change?6) Pilot:Select change to pilot testImplement PDSA method to direct changeReferencesGodfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L. (2004). Clinical microsystem action guide: Improving health care by improving yourmicrosystem [Action Guide 2.1]. Retrieved from Microsystem Academy: http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdf
ReferencesStevenson, L. (Vancouver Island Health Authority). (2010, March 30-31). Care delivery model redesign [PDF file]. Retrieved from http://www.chspr.ubc.ca/files/publications/2010/conference/Stevenson,Lynn.pdf
1) Outcomes:Select a population: All patientsWhat is the general aim/results? To maintain pre-hospitalization function of patients and optimize care2) Process:Analyze the process: Bottom-up process with change initiated at the unit level through a redesign of admission assessment forms, during care and discharge including the implementation of 48/6.What is the process for giving care to this type of patient? Currently knowledge of pre-hospitalization status is unacceptable and often leads to patients leaving the hospital with less functioning than they had when entering3) Patterns:Identify the common patterns at work: Lack of staff, lack of time, admission and inpatient assessment sheets have no continuity across units and do not address pre-hospital functioning appropriately.Consider working relationships: Often strained, opposing pressures from top-down management, differences in training.Do you meet regularly? Some unitsHave you successfully changed anything? Depends on the changeWhat patterns can you identify?4) Structure:Visualize the actual setting: All Units – diverse cultures, all have basic equipment but vary from there.What and who is there? Elderly are most common and the most likely to leave with reduced functioning due to vulnerability, social constructs, etc.5) Changes:Develop ideas for change: Care Delivery Model Redesign – redesign how care is delivered. Accomplished through multiple routes. One being 48/6.What are the ideas for creating change? New admission, inpatient and discharge assessment sheets. 48/6 for getting to know the real patient within an acceptable amount of time.Etc6) Pilot: Roll out 48/6 and redesigned assessment sheetsSelect change to pilot testImplement PDSA method to direct changeReferencesGodfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L. (2004). Clinical microsystem action guide: Improving health care by improving yourmicrosystem [Action Guide 2.1]. Retrieved from Microsystem Academy: http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdfStevenson, L. (Vancouver Island Health Authority). (2010, March 30-31). Care delivery model redesign [PDF file]. Retrieved from http://www.chspr.ubc.ca/files/publications/2010/conference/Stevenson,Lynn.pdf