BackgroundPublic insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care.MethodsThis community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.DiscussionThe information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities.Trial registrationThis protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404. Registered June 6, 2018.
This paper will briefly outline major activities in Department of Energy (DOE) Laboratories focused on mobile platforms, both Unmanned Ground Vehicles (UGV's) as well as Unmanned Air Vehicles (UAV's). The activities will be discussed in the context of the science and technology construct used by the DOE Technology Roadmap for Robotics and Intelligent Machines (RIM) 1 published in 1998; namely, Perception, Reasoning, Action, and Integration. The activities to be discussed span from research and development to deployment in field operations. The activities support customers in other agencies. The discussion of "perception" will include hyperspectral sensors, complex patterns discrimination, multisensor fusion and advances in LADAR technologies, including real-world perception. "Reasoning" activities to be covered include cooperative controls, distributed systems, ad-hoc networks, platform-centric intelligence, and adaptable communications. The paper will discuss "action" activities such as advanced mobility and various air and ground platforms. In the RIM construct, "integration" includes the Human-Machine Integration. Accordingly the paper will discuss adjustable autonomy and the collaboration of operator(s) with distributed UGV's and UAV's. Integration also refers to the applications of these technologies into systems to perform operations such as perimeter surveillance, large-area monitoring and reconnaissance. Unique facilities and test beds for advanced mobile systems will be described. Given that this paper is an overview, rather than delve into specific detail in these activities, other more exhaustive references and sources will be cited extensively.
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