Diabetes mellitus (DM) is a highly prevalent chronic disease that affects 29 million people in the United States including over 2 million veterans who receive care through the Veterans Administration. Patient-aligned care teams (PACTs) are an interprofessional teamwork system designed to improve outcomes of chronic illness, but empirical explorations of the efficacy of the PACTs have been insufficient. Utilizing the chronic care model, the purpose of this retrospective study was to determine if PACTs have been efficient in the diabetic management of veterans receiving care through a Southeastern VA. Medical records for 114 veterans with type 2 DM were randomly selected. A 1-way ANOVA was used to analyze outcomes for 5 evidence-based standards (SBP, DBP, BGL, A1C, & LDL) among 6 outpatient clinics. A repeated measures ANOVA was used for the same 5 evidence-based standards for the clinics to assess if there were any changes from FY2014 to FY2016. Results revealed that blood pressure readings and LDL levels met evidence-based standards, while A1C and BGL levels did not. No significant differences over the 3-year period were noted nor were there significant differences in patterns of performance between the clinics. The findings provide an essential basis for initiating a discussion on the potential of PACTs for the delivery of quality healthcare to U.S. veterans with diabetes and other chronic diseases. Positive social change can result from improving the delivery of healthcare using the PACT model to decrease morbidity, improve clinical outcomes, and increase the quality of life of U.S. veterans with type 2 DM. Future research that examines perceptions of clinical team members, team stability, and the delivery of shared care is warranted.

This thesis applies computer graphics to two important fields of Biomedical Engineering. Firstly, in order to provide new software for interdisciplinary education, an interactive Virtual-based platform was developed, presenting a tridimensional visualization of the neuron and of its major microestructures. Such platform enables an overall view of the neural cell, including particular details in a microcellular level. Several issues regarding the tridimensional reconstruction of neuroanatomical strucutures based on photos taken from real-life tissues are discussed, leading to the implementation of a bidimensional atlas, that establishes connections between neuroanatomy and the clinical practice. Secondly, a system for the efficient and accurate estimation of the time intervals associated with swallow phases was developed, supposing videofluoroscopic images as inputs. The system performs pre-processing of such images by means of file conversions, followed by image analysis, that leads to the final estimation. A clinical experiment was carried out in order to validate the platform, yielding (allowing) a preliminar proposition for a normal pattern of swallow , which is based on the average-estimated swallow times. Results pointed out that the system may be considered, flexible, requiring simple hardware/software configurations, and also providing details on fractioning. / Aplica-se nesta dissertação a computação gráfica a duas áreas relevantes da Engenharia Biomédica. Inicialmente, para propiciar novos instrumentos voltados à educação interdisciplinar em Neurociências, apresenta-se uma plataforma VRML (Virtual Reality Modeling Language) interativa que representa tridimensionalmente o neurônio e suas principais organelas, propiciando enfoques globais da célula e particulares de suas microestruturas. Discutem-se aspectos ligados à reconstrução tridimensional de estruturas neuroanatômicas a partir de fotos tomadas de peças reais, levando à implementação de um atlas bidimensional, que alia a neuroanatomia à prática clínica. Posteriormente, objetivou-se desenvolver um sistema para a contagem precisa e rápida dos intervalos de tempos associados às diversas fases da deglutição, baseado em imagens videofluoroscópicas. O sistema realiza pré-processamento através da conversão de formato de arquivos, seguido de análise de imagens, o que foi validado através de um experimento clínico, permitindo assim refletir a definição de um padrão de normalidade em deglutição , em termos dos valores médios do intervalo de tempo de deglutição. Tal sistema se mostrou viável, simples, flexível, sem a necessidade de hardware/software específicos, possibilitando inclusive detalhar o fracionamento ou não do bolo alimentar. / Mestre em Ciências