Science.gov

Sample records for improve patient understanding

  1. Improving Patient Understanding of Prescription Drug Label Instructions

    PubMed Central

    Davis, Terry C.; Federman, Alex D.; Bass, Pat F.; Jackson, Robert H.; Middlebrooks, Mark; Parker, Ruth M.

    2008-01-01

    Background Patient misunderstanding of instructions on prescription drug labels is common and a likely cause of medication error and less effective treatment. Objective To test whether the use of more explicit language to describe dose and frequency of use for prescribed drugs could improve comprehension, especially among patients with limited literacy. Design Cross-sectional study using in-person, structured interviews. Patients Three hundred and fifty-nine adults waiting for an appointment in two hospital-based primary care clinics and one federally qualified health center in Shreveport, Louisiana; Chicago, Illinois; and New York, New York, respectively. Measurement Correct understanding of each of ten label instructions as determined by a blinded panel review of patients’ verbatim responses. Results Patient understanding of prescription label instructions ranged from 53% for the least understood to 89% for the most commonly understood label. Patients were significantly more likely to understand instructions with explicit times periods (i.e., morning) or precise times of day compared to instructions stating times per day (i.e., twice) or hourly intervals (89%, 77%, 61%, and 53%, respectively,  < 0.001). In multivariate analyses, dosage instructions with specific times or time periods were significantly more likely to be understood compared to instructions stating times per day (time periods — adjusted relative risk ratio (ARR) 0.42, 95% Confidence Interval (CI) 0.34–0.52; specific times — ARR 0.60, 95% CI 0.49–0.74). Low and marginal literacy remained statistically significant independent predictors of misinterpreting instructions (low - ARR 2.70, 95% CI 1.81–4.03; marginal -ARR 1.66, 95% CI 1.18–2.32). Conclusions Use of precise wording on prescription drug label instructions can improve patient comprehension. However, patients with limited literacy were more likely to misinterpret instructions despite use of more explicit language. PMID

  2. Improving illiterate patients understanding and adherence to discharge medications

    PubMed Central

    Clayton, Matthew; Syed, Faizan; Rashid, Amjid; Fayyaz, Umer

    2012-01-01

    Abstract Adherence to a hospital discharge medication regime is crucial for successful treatment and to avoid increasing rates of drug resistance. A patient's success in adhering to their medication regime is dependent on many social, cultural, economic, illness and therapy-related factors, and these are often more pronounced in the developing world. Anecdotal evidence in Services Hospital, Lahore (Pakistan) suggested that the relatively high levels of illiteracy in the patient population was a major factor in poor adherence. Baseline measurement revealed that 48% of all the hospital's patients were illiterate with just 5%–12% of illiterate patients being able to interpret their handwritten discharge prescription after leaving hospital. Unsurprisingly follow-up clinics reported very poor adherence. This quality improvement project intervened by designing a new discharge prescription proforma which used pictures and symbols rather than words to convey the necessary information. Repeated surveys demonstrated large relative increases in comprehension of the new proformas amongst illiterate patients with between 23%–35% of illiterate patients understanding the new proformas. PMID:26734151

  3. Improving health outcomes with better patient understanding and education.

    PubMed

    Adams, Robert John

    2010-01-01

    A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual's competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been

  4. UNDERSTANDING OR NURSES' REACTIONS TO ERRORS AND USING THIS UNDERSTANDING TO IMPROVE PATIENT SAFETY.

    PubMed

    Taifoori, Ladan; Valiee, Sina

    2015-09-01

    The operating room can be home to many different types of nursing errors due to the invasiveness of OR procedures. The nurses' reactions towards errors can be a key factor in patient safety. This article is based on a study, with the aim of investigating nurses' reactions toward nursing errors and the various contributing and resulting factors, conducted at Kurdistan University of Medical Sciences in Sanandaj, Iran in 2014. The goal of the study was to determine how OR nurses' reacted to nursing errors with the goal of having this information used to improve patient safety. Research was conducted as a cross-sectional descriptive study. The participants were all nurses employed in the operating rooms of the teaching hospitals of Kurdistan University of Medical Sciences, which was selected by a consensus method (170 persons). The information was gathered through questionnaires that focused on demographic information, error definition, reasons for error occurrence, and emotional reactions for error occurrence, and emotional reactions toward the errors. 153 questionnaires were completed and analyzed by SPSS software version 16.0. "Not following sterile technique" (82.4 percent) was the most reported nursing error, "tiredness" (92.8 percent) was the most reported reason for the error occurrence, "being upset at having harmed the patient" (85.6 percent) was the most reported emotional reaction after error occurrence", with "decision making for a better approach to tasks the next time" (97.7 percent) as the most common goal and "paying more attention to details" (98 percent) was the most reported planned strategy for future improved outcomes. While healthcare facilities are focused on planning for the prevention and elimination of errors it was shown that nurses can also benefit from support after error occurrence. Their reactions, and coping strategies, need guidance and, with both individual and organizational support, can be a factor in improving patient safety. PMID

  5. Tablets in trauma: using mobile computing platforms to improve patient understanding and experience.

    PubMed

    Furness, Nicholas D; Bradford, Oliver J; Paterson, Maurice P

    2013-03-01

    Tablets are becoming commonplace in the health care setting. Patients often request to view their radiographs after sustaining trauma. This can be challenging, especially if patients are immobile. The authors performed a prospective, questionnaire-based study to assess inpatient desire to view radiographs on tablets and whether viewing images affected patient-rated outcomes of understanding and satisfaction. Enabling trauma patients to view their images on a tablet is a worthwhile practice because it improves patient involvement in decision making, satisfaction, perceived understanding, and overall experience. PMID:23464939

  6. Understanding the needs of relatives of patients within a special hospital for mentally disordered offenders: a basis for improved services.

    PubMed

    McCann, G; McKeown, M; Porter, I

    1996-02-01

    This paper outlines one component of a major research study, which will form the basis for a new service for relatives of schizophrenia sufferers within a special hospital. The aim of this initial component has been twofold: firstly to identify and understand the needs of relatives in terms of their present knowledge and understanding of schizophrenia; and secondly to establish what stress the relatives are presently experiencing in maintaining contact with patients and whether this stress may have an impact on the management of schizophrenia at the hospital. A purposive sample of 17 relatives were interviewed using two semi-structured interview protocols. All interviews were audio-taped and later transcribed for analysis. The data have provided an illuminating insight into the thoughts and feelings of relatives and indicate many ways in which a service for relatives could be tailored. It is apparent that many relatives are currently not being supported, involved or allowed to contribute to the care of their family member at Ashworth Hospital. This present situation is stressful for relatives and is likely to have a detrimental effect on the course of schizophrenia in patients at Ashworth Hospital. PMID:8708249

  7. Understanding Fire Through Improved Technology

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Aztec(TradeMark) is the commercial name for Southwest Sciences laser. The laser has coarse tuning ranges of 10 nanometers (nm) to 30 nm at wavelengths ranging from 630 nm to 2,300 nm, making it the only commercially available external cavity diode laser with wavelengths beyond 1,650 nm. The laser's high-speed tuning in both coarse and fine wavelength regimes allows for increased trace gas detection. With the automated coarse tuning option, the Aztec sweeps through its wavelength range in less than 1 millisecond. While some diode lasers can only detect one type, or species, of a trace gas, the Aztec's broad wavelength tuning provides access to multiple trace gas species. The Aztec has a wide range of applications for both NASA and commercial users, from protecting astronauts in space to improving combustion processes on Earth. It may serve as a new tool for planetary exploration, as it can detect a wide range of multiple gas species in planetary atmospheres. The laser could optically detect gaseous indicators of incipient fires on the International Space Station and Space Shuttle, as well as detect low concentrations of potentially toxic gases in spacecraft crew habitats. The laser could also provide more accurate fire detection in aircraft cargo compartments. Since the Aztec can detect several gases that only evolve during an actual fire, its implementation could reduce the large number of commercial aircraft landings that currently occur due to false alarms. Other applications include environmental and industrial process monitoring.

  8. Measuring improved patient choice.

    PubMed

    Holmes-Rovner, M; Rovner, D R

    2000-08-01

    Patient decision support (PDS) tools or decision aids have been developed as adjuncts to the clinical encounter. Their aim is to support evidence-based patient choice. Clinical trials of PDS tools have used an array of outcome measures to determine efficacy, including knowledge, satisfaction, health status and consistency between patient choice and values. This paper proposes that the correlation between 'subjective expected utility' (SEU) and decision may be the best primary endpoint for trials. SEU is a measure usually used in behavioural decision theory. The paper first describes how decision support tools may use decision analysis to structure the presentation of evidence and guide patient decision-making. Uses of expected utility (EU) are suggested for evaluating PDS tools when improving population health status is the objective. SEU is the theoretically better measure when internal consistency of patient choices is the objective. PMID:11083037

  9. Improving Students' Understanding of Quantum Measurement

    SciTech Connect

    Zhu Guangtian; Singh, Chandralekha

    2010-10-24

    We describe the difficulties advanced undergraduate and graduate students have with quantum measurement. To reduce these difficulties, we have developed research-based learning tools such as the Quantum Interactive Learning Tutorial (QuILT) and peer instruction tools. A preliminary evaluation shows that these learning tools are effective in improving students' understanding of concepts related to quantum measurement.

  10. Improving Student Understanding of Spatial Ecology Statistics

    ERIC Educational Resources Information Center

    Hopkins, Robert, II; Alberts, Halley

    2015-01-01

    This activity is designed as a primer to teaching population dispersion analysis. The aim is to help improve students' spatial thinking and their understanding of how spatial statistic equations work. Students use simulated data to develop their own statistic and apply that equation to experimental behavioral data for Gambusia affinis (western…

  11. Teleophthalmology: improving patient outcomes?

    PubMed

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients' assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  12. Teleophthalmology: improving patient outcomes?

    PubMed Central

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  13. Quality improvement techniques to improve patient satisfaction.

    PubMed

    Torres, E Joseph; Guo, Kristina L

    2004-01-01

    This paper describes several approaches for implementing quality improvement initiatives to improve patient satisfaction, which enables health-care organizations to position themselves for success in today's global and increasingly competitive environment. Specifically, measuring the views of patients, improving patient satisfaction through a community-wide effort, and using a Six Sigma program are discussed. Each of these programs can be an effective mechanism for quality improvement. A key component to quality improvement techniques involves collaborative efforts by all health-care professionals and managers as they seek to increase patient satisfaction. PMID:15552388

  14. Improving Student Conceptual Understanding of Forces

    NASA Astrophysics Data System (ADS)

    Griffin, Frank; Townsend, Greg

    1997-05-01

    A widely accepted measure of student understanding of Newton's Laws is the Hestenes Force Concept Inventory. In the past several years we have made several modifications in both lecture methods, labs and requirements on homework in an attempt to get a larger fraction of the students to assimilate a Newtonian model of the universe. Although FCI scores of 70% are achieved in most classes now, for those questions involving the second law, scores are closer to the 50% range, a substantial improvement over traditional instruction for these large lecture groups but still quite disappointing. A description of recent modifications in the lecture and homework will be presented along with plans for future changes.

  15. Simulation: improving patient outcomes.

    PubMed

    Smith, Abi; Siassakos, Dimitrios; Crofts, Joanna; Draycott, Tim

    2013-06-01

    Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants. PMID:23721770

  16. Improving students' understanding of quantum mechanics

    NASA Astrophysics Data System (ADS)

    Zhu, Guangtian

    2011-12-01

    Learning physics is challenging at all levels. Students' difficulties in the introductory level physics courses have been widely studied and many instructional strategies have been developed to help students learn introductory physics. However, research shows that there is a large diversity in students' preparation and skills in the upper-level physics courses and it is necessary to provide scaffolding support to help students learn advanced physics. This thesis explores issues related to students' common difficulties in learning upper-level undergraduate quantum mechanics and how these difficulties can be reduced by research-based learning tutorials and peer instruction tools. We investigated students' difficulties in learning quantum mechanics by administering written tests and surveys to many classes and conducting individual interviews with a subset of students. Based on these investigations, we developed Quantum Interactive Learning Tutorials (QuILTs) and peer instruction tools to help students build a hierarchical knowledge structure of quantum mechanics through a guided approach. Preliminary assessments indicate that students' understanding of quantum mechanics is improved after using the research-based learning tools in the junior-senior level quantum mechanics courses. We also designed a standardized conceptual survey that can help instructors better probe students' understanding of quantum mechanics concepts in one spatial dimension. The validity and reliability of this quantum mechanics survey is discussed.

  17. Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project

    PubMed Central

    2010-01-01

    Background Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. Methods/Design We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery). In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted at hospital and multilevel

  18. Understanding Patient Satisfaction Ratings for Radiology Services

    PubMed Central

    Lang, Elvira V.; Yuh, William T.C.; Kelly, Ronda; Macadam, Luke; Potts, Richard; Mayr, Nina A.

    2015-01-01

    Under the Hospital Value-Based Purchasing Program of the Centers for Medicare & Medicaid Services patient satisfaction accounts for 30% of the measures of and payments for quality of care. Understanding what drives satisfaction data, how it is obtained, converted into scores, and formulated into rankings, is increasingly critical for imaging departments. PMID:24261356

  19. Understanding the role of physician attire on patient perceptions: a systematic review of the literature— targeting attire to improve likelihood of rapport (TAILOR) investigators

    PubMed Central

    Petrilli, Christopher Michael; Mack, Megan; Petrilli, Jennifer Janowitz; Hickner, Andy; Saint, Sanjay; Chopra, Vineet

    2015-01-01

    Objectives Despite a growing body of literature, uncertainty regarding the influence of physician dress on patients’ perceptions exists. Therefore, we performed a systematic review to examine the influence of physician attire on patient perceptions including trust, satisfaction and confidence. Setting, participants, interventions and outcomes We searched MEDLINE, Embase, Biosis Previews and Conference Papers Index. Studies that: (1) involved participants ≥18 years of age; (2) evaluated physician attire; and (3) reported patient perceptions related to attire were included. Two authors determined study eligibility. Studies were categorised by country of origin, clinical discipline (eg, internal medicine, surgery), context (inpatient vs outpatient) and occurrence of a clinical encounter when soliciting opinions regarding attire. Studies were assessed using the Downs and Black Scale risk of bias scale. Owing to clinical and methodological heterogeneity, meta-analyses were not attempted. Results Of 1040 citations, 30 studies involving 11 533 patients met eligibility criteria. Included studies featured patients from 14 countries. General medicine, procedural (eg, general surgery and obstetrics), clinic, emergency departments and hospital settings were represented. Preferences or positive influence of physician attire on patient perceptions were reported in 21 of the 30 studies (70%). Formal attire and white coats with other attire not specified was preferred in 18 of 30 studies (60%). Preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs; four of five studies in intensive care and emergency settings also found no attire preference. Only 3 of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions. Conclusions

  20. Continuous Improvement in Schools: Understanding the Practice

    ERIC Educational Resources Information Center

    Anderson, Stephen; Kumari, Roshni

    2009-01-01

    This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts…

  1. Patients Provide Recommendations for Improving Patient Satisfaction.

    PubMed

    Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J

    2016-04-01

    National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. PMID:27046182

  2. Toward an improved understanding of MCS propagation

    NASA Astrophysics Data System (ADS)

    Peters, J. M.

    2015-12-01

    Processes that drive the propagation of elevated mesoscale convective systems (MCSs) have been the topic of a growing body of recent research. Elevated MCSs are responsible for a large percentage of warm season rainfall in the continental United States, and produce flash floods more frequently than other modes of convection. A comprehensive understanding of the dynamics of MCS propagation is important, since propagation sometimes opposes other environmental forces that influence MCS motion. This leads to nearly stationary MCSs that produce prolific local rainfall totals. The ingredients-based Propagation index (IPI) is introduced in this research. IPI is defined as the normalized product of horizontal warm thermal advection (a proxy for lifting), convective available potential energy (CAPE), and relative humidity. Horizontal plots of IPI are useful in identifying regions of probable convective initiation, including the intersections between potentially unstable flow and outflow boundaries, regions of mesoscale lift along the nose of the low-level jet, convectively induced gravity waves, and frontogenesis. Effective inflow-layer shear vectors are also introduced, and found to be useful for scenarios where IPI does yield predictive insight, such as the traditional "RKW" scenario where the forward propagation of an MCS is driven by thunderstorm outflow. It is argued that horizontal maps of IPI and EILS vectors will contribute significantly to short-term (e.g. 1-2 hr) predictions of the movement of MCSs, and to the subsequent assessment of their potential for flash flood production.

  3. What constitutes our understanding of a patient?

    PubMed

    Chessick, R D

    1993-01-01

    A number of approaches to the search for methodology in the human sciences are reviewed. Heidegger's use of Husserl's phenomenology led to his exploration of the background practices on which he believed all our understanding is based. This use of phenomenology was adopted by Sartre and R. D. Laing, and existential psychiatrists and psychoanalysts in their emphasis on the here-and-now encounter between the patient and the therapist, along with various embellishments and emendations on Heidegger's notion of what it meant to live authentically or inauthentically. Foucault maintained that there is a politics embedded in all the human sciences such as psychiatry and psychoanalysis, and this politics revolves around the use of power and its operations, including the actual use of the human sciences in the culture and what the different theories imply in the way of an ideology. Lacan emphasized this when he challenged the prevailing ideology of United States psychoanalysis, in which adaptation was seen as the crucial task of the ego. The existence of background practices and outer horizons required for any understanding in the human sciences leads to a situation that questions the use of empirical methods to establish what is accepted as "truth" in the human sciences. A predominant alternative, that of hermeneutics, has gained acceptance by eminent analysts such as Gill and certain interpersonal theorists. But the term hermeneutics is used in many ways by many authors and runs the danger of a relativism and a nihilism. This leads to a discussion of the value of various philosophical positions in throwing light on our search for a methodology in the human sciences. A review of arguments invoking the "end of philosophy" such as those of Rorty reveals that they are paradoxical and based on premises which in turn represent a philosophy. This debate remains unresolved. In general the postmodern view sees "truth" as more relative and emphasizes the role of social and cultural

  4. Patient safety: helping medical students understand error in healthcare

    PubMed Central

    Patey, Rona; Flin, Rhona; Cuthbertson, Brian H; MacDonald, Louise; Mearns, Kathryn; Cleland, Jennifer; Williams, David

    2007-01-01

    Objective To change the culture of healthcare organisations and improve patient safety, new professionals need to be taught about adverse events and how to trap and mitigate against errors. A literature review did not reveal any patient safety courses in the core undergraduate medical curriculum. Therefore a new module was designed and piloted. Design A 5‐h evidence‐based module on understanding error in healthcare was designed with a preliminary evaluation using self‐report questionnaires. Setting A UK medical school. Participants 110 final year students. Measurements and main results Participants completed two questionnaires: the first questionnaire was designed to measure students' self‐ratings of knowledge, attitudes and behaviour in relation to patient safety and medical error, and was administered before and approximately 1 year after the module; the second formative questionnaire on the teaching process and how it could be improved was administered after completion of the module. Conclusions Before attending the module, the students reported they had little understanding of patient safety matters. One year later, only knowledge and the perceived personal control over safety had improved. The students rated the teaching process highly and found the module valuable. Longitudinal follow‐up is required to provide more information on the lasting impact of the module. PMID:17693671

  5. Patient Care Partnership: Understanding Expectations, Rights and Responsibilities

    MedlinePlus

    ` e Patient Care Partnership Understanding Expectations, Rights and Responsibilities What to expect during your hospital stay: • High ... e Patient Care Partnership Understanding Expectations, Rights and Responsibilities W hen you need hospital care, your doctor ...

  6. Orthogeriatric care: improving patient outcomes

    PubMed Central

    Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

    2016-01-01

    Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

  7. Improving Students' Understanding of Electricity and Magnetism

    ERIC Educational Resources Information Center

    Li, Jing

    2012-01-01

    Electricity and magnetism are important topics in physics. Research shows that students have many common difficulties in understanding concepts related to electricity and magnetism. However, research to improve students' understanding of electricity and magnetism is limited compared to introductory mechanics. This thesis explores issues…

  8. Improving Patient's Primary Medication Adherence

    PubMed Central

    Leguelinel-Blache, Géraldine; Dubois, Florent; Bouvet, Sophie; Roux-Marson, Clarisse; Arnaud, Fabrice; Castelli, Christel; Ray, Valérie; Kinowski, Jean-Marie; Sotto, Albert

    2015-01-01

    Abstract Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge. This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge. We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10−7). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89). This study highlights that discharge counseling sessions are

  9. Understanding Why Patients With COPD Get Readmitted

    PubMed Central

    Churpek, Matthew M.; Coca Perraillon, Marcelo; Konetzka, R. Tamara

    2015-01-01

    BACKGROUND: The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for 30-day readmissions and was extended to COPD in October 2014. There is limited evidence available on readmission risk factors and reasons for readmission to guide hospitals in initiating programs to reduce COPD readmissions. METHODS: Medicare claims data from 2006 to 2010 in seven states were analyzed, with an index admission for COPD defined by discharge International Classification of Diseases, Ninth Revision, codes as stipulated in the HRRP guidelines. Rates of index COPD admission and readmission, patient demographics, readmission diagnoses, and use of post-acute care (PAC) were investigated. RESULTS: Over the study period, there were 26,798,404 inpatient admissions, of which 3.5% were index COPD admissions. At 30 days, 20.2% were readmitted to the hospital. Respiratory-related diseases accounted for only one-half of the reasons for readmission, and COPD was the most common diagnosis, explaining 27.6% of all readmissions. Patients discharged home without home care were more likely to be readmitted for COPD than patients discharged to PAC (31.1% vs 18.8%, P < .001). Readmitted beneficiaries were more likely to be dually enrolled in Medicare and Medicaid (30.6% vs 25.4%, P < .001), have a longer median length of stay (5 days vs 4 days, P < .0001), and have more comorbidities (P < .001). CONCLUSIONS: Medicare patients with COPD exacerbations are usually not readmitted for COPD, and these reasons differ depending on PAC use. Readmitted patients are more likely to be dually enrolled in Medicare and Medicaid, suggesting that the addition of COPD to the readmissions penalty may further worsen the disproportionately high penalties seen in safety net hospitals. PMID:25539483

  10. Understanding Patient Portal Use: Implications for Medication Management

    PubMed Central

    Mayberry, Lindsay Satterwhite; Wallston, Kenneth A; Johnson, Kevin B; Elasy, Tom A

    2013-01-01

    Background The Internet can be leveraged to provide disease management support, including medication adherence promotion that, when tailored, can effectively improve adherence to medications. The growing adoption of patient portals represents an opportunity to support medication management and adherence more broadly, but virtually no data exist about the real and potential impact of existing portals on these outcomes. Objective We sought to (1) understand who uses an existing patient portal and reasons for use and nonuse, (2) understand how portal users are using a portal to manage their medications, and (3) explore participants’ ideas for improving portal functionality for medication management and adherence support. Methods A total of 75 adults with type 2 diabetes participated in a mixed-methods study involving focus groups, a survey, and a medical chart review. We used quantitative data to identify differences between portal users and nonusers, and to test the relationship between the frequency of portal use and glycemic control among users. We used qualitative methods to understand how and why participants use a portal and their ideas for improving its medication management functionality. Results Of the enrolled participants, 81% (61/75) attended a focus group and/or completed a survey; portal users were more likely than nonusers to participate in that capacity (Fisher exact test; P=.01). Users were also more likely than nonusers to be Caucasian/white (Fisher exact test; P<.001), have higher incomes (Fisher exact test; P=.005), and be privately insured (Fisher exact test; P<.001). Users also tended to have more education than nonusers (Mann–Whitney U; P=.05), although this relationship was not significant at P<.05. Among users, more frequent use of a portal was associated with better A1C (Spearman rho =–0.30; P=.02). Reasons for nonuse included not knowing about the portal (n=3), not having access to a computer (n=3), or having a family member serve as

  11. Improving patient safety in haemodialysis

    PubMed Central

    Bray, Benjamin D.; Metcalfe, Wendy

    2015-01-01

    Thomas Inman (1820–76) wrote ‘Practice two things in your dealings with disease: either help or do not harm the patient’, echoing writings from the Hippocratic school. The challenge of practicing safely with the avoidance of complications or harm is perhaps only heightened in the context of modern medical settings such as the haemodialysis unit where complex interventions and treatment are routine. The current issue of CKJ reports two studies aimed at improving the care of haemodialysis patients targeting early use of arteriovenous grafts as access for haemodialysis and the implementation of a dialysis checklist to ensure the prescribed dialysis treatment is delivered. The further challenge of ensuring that such evidence-based tools are used appropriately and consistently falls to all members of the clinical team. PMID:26034585

  12. Using Science Notebooks to Improve Writing Skills and Conceptual Understanding

    ERIC Educational Resources Information Center

    Butler, Malcolm B.; Nesbit, Catherine

    2008-01-01

    The purpose of this article is to provide teachers with strategies for improving students' writing and deepening their conceptual understanding through the use of science notebooks. The strategies include using various resources and providing a variety of feedback opportunities for students. A sample science investigation and an accompanying…

  13. Understanding the Change Styles of Teachers to Improve Student Achievement

    ERIC Educational Resources Information Center

    Bigby, Arlene May Green

    2009-01-01

    The topic of this dissertation is the understanding of teacher change styles to improve student achievement. Teachers from public schools in a state located in the northern plains were surveyed regarding their Change Styles (preferred approaches to change) and flexibility scores. The results were statistically analyzed to determine if there were…

  14. Improving At-Risk Learners' Understanding of Fractions

    ERIC Educational Resources Information Center

    Fuchs, Lynn S.; Schumacher, Robin F.; Long, Jessica; Namkung, Jessica; Hamlett, Carol L.; Cirino, Paul T.; Siegler, Robert; Changas, Paul

    2013-01-01

    The purposes of this study were to investigate the effects of an intervention designed to improve at-risk 4th graders' understanding of fractions and to examine the processes by which effects occurred. The intervention focused more on the measurement interpretation of fractions; the control condition focused more on the part-whole…

  15. Improving At-Risk Learners' Understanding of Fractions

    ERIC Educational Resources Information Center

    Fuchs, Lynn S.; Schumacher, Robin F.; Long, Jessica; Namkung, Jessica; Hamlett, Carol L.; Cirino, Paul T.; Jordan, Nancy C.; Siegler, Robert; Gersten, Russell; Changas, Paul

    2013-01-01

    The purposes of this study were to investigate the effects of an intervention designed to improve at-risk 4th graders' understanding of fractions and to examine the processes by which effects occurred. The intervention focused more on the measurement interpretation of fractions; the control condition focused more on the part-whole interpretation…

  16. Patient and parent understanding of informed consent in orthodontics.

    PubMed

    Mortensen, Micah G; Kiyak, H Asuman; Omnell, Lena

    2003-11-01

    In both medical and dental settings, researchers have found that patients do not adequately comprehend the information given during informed consent discussions, especially the less educated, low-income patients. Because of the importance of patient compliance with orthodontic treatment regimens, this study examined patient and parent understanding of the child's Phase I orthodontic treatment in a public dental clinic with ethnically diverse, low-income patients. Interviews were conducted with 29 children (ages 6-12) and their parents or guardians at the orthodontic case presentation appointment. The orthodontist explained the reasons for treatment, the orthodontic procedures to be used, the risks, the alternatives, and patient and parent responsibilities during treatment; the session was audiotaped. Interviews were conducted immediately after this discussion and the results compared with the orthodontists' presentations. In general, both children and parents recalled significantly fewer reasons for treatment (1.10, 1.66, and 2.34 items, respectively), procedures (1.55, 1.59, and 2.45, respectively), risks associated with treatment (0.66, 1.48, and 4.66, respectively), and responsibilities of the child during treatment (2.21, 2.07, and 3.38, respectively) than what the orthodontist had told them. They were also less likely to recall the reasons, procedures, and risks that were most frequently cited by the orthodontist. These findings raise concerns about the effectiveness of current informed consent techniques with public health populations, especially the low recall rates within 30 minutes of the case presentations. Low recall of risks by children and their parents, particularly for critical risks such as relapse, caries, and periodontal problems, raises concerns about treatment compliance, success, and more importantly, the effectiveness of the informed consent process itself. Future research should focus on methods to improve the informed consent process among

  17. Understanding cognition in older patients with cancer.

    PubMed

    Karuturi, Meghan; Wong, Melisa L; Hsu, Tina; Kimmick, Gretchen G; Lichtman, Stuart M; Holmes, Holly M; Inouye, Sharon K; Dale, William; Loh, Kah P; Whitehead, Mary I; Magnuson, Allison; Hurria, Arti; Janelsins, Michelle C; Mohile, Supriya

    2016-07-01

    Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps. PMID:27282296

  18. Understanding cognition in older patients with cancer

    PubMed Central

    Karuturi, Meghan; Wong, Melisa L.; Hsu, Tina; Kimmick, Gretchen G.; Lichtman, Stuart M.; Holmes, Holly M.; Inouye, Sharon K.; Dale, William; Loh, Kah P.; Whitehead, Mary I.; Magnuson, Allison; Hurria, Arti; Janelsins, Michelle C.; Mohile, Supriya

    2016-01-01

    Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps. PMID:27282296

  19. Effective pain management and improvements in patients' outcomes and satisfaction.

    PubMed

    Glowacki, Diane

    2015-06-01

    Adequate pain management is a compelling and universal requirement in health care. Despite considerable advancements, the adverse physiological and psychological implications of unmanaged pain remain substantially unresolved. Ineffective pain management can lead to a marked decrease in desirable clinical and psychological outcomes and patients' overall quality of life. Effective management of acute pain results in improved patient outcomes and increased patient satisfaction. Although research and advanced treatments in improved practice protocols have documented progressive improvements in management of acute and postoperative pain, little awareness of the effectiveness of best practices persists. Improved interventions can enhance patients' attitudes to and perceptions of pain. What a patient believes and understands about pain is critical in influencing the patient's reaction to the pain therapy provided. Use of interdisciplinary pain teams can lead to improvements in patients' pain management, pain education, outcomes, and satisfaction. PMID:26033099

  20. Improving student understanding of lock-in amplifiers

    NASA Astrophysics Data System (ADS)

    DeVore, Seth; Gauthier, Alexandre; Levy, Jeremy; Singh, Chandralekha

    2016-01-01

    The lock-in amplifier is a versatile instrument frequently used in physics research. We find that students tend to struggle with its basic operating principles, leading to a variety of difficulties. To improve their understanding, we have developed a research-based tutorial that makes use of a computer simulated lock-in amplifier. The tutorial allows students to realize their conceptual difficulties by comparing their predictions with the outcome of the simulations, hopefully leading them to a better understanding of the process of lock-in amplification.

  1. Investigators Share Improved Understanding of the North American Carbon Cycle

    NASA Astrophysics Data System (ADS)

    Birdsey, Richard A.; Cook, Robert; Denning, Scott; Griffith, Peter; Law, Beverly; Masek, Jeffrey; Michalak, Anna; Ogle, Stephen; Ojima, Dennis; Pan, Yude; Sabine, Christopher; Sheffner, Edwin; Sundquist, Eric

    2007-06-01

    The U.S. North American Carbon Program (NACP) sponsored an "all-scientist" meeting to review progress in understanding the dynamics of the carbon cycle of North America and adjacent oceans, and to chart a course for improved integration across scientific disciplines, scales, and Earth system boundaries. The meeting participants also addressed the need for better decision support tools for managing the carbon cycle of North America, so that strong science can inform policy as interest in taking action increases across the nation. Herein we report on themes to integrate the diversity of NACP science and fill significant gaps for understanding and managing the North American carbon cycle: integration among disciplines involving land, atmosphere, and ocean research; strengthening data management infrastructure to support modeling and analysis; identification of study regions that are critical for reducing uncertainties in the North American carbon balance; and integrating biophysical science with the human dimensions of carbon management and decision support.

  2. Do patients with mild cognitive impairment understand numerical health information?

    PubMed

    Pertl, Marie-Theres; Benke, Thomas; Zamarian, Laura; Martini, Caroline; Bodner, Thomas; Karner, Elfriede; Delazer, Margarete

    2014-01-01

    Patients with mild cognitive impairment (MCI) are by definition still autonomous in daily life and therefore make their own decisions, for example, concerning their own or their partners' health care. Health care information typically contains complex mathematical constructs like proportions, probabilities, and survival rates. The purpose of this study was to investigate whether patients with MCI have difficulties with understanding health numeracy questions and to explore the impact of declining cognitive functions. The performance of 25 patients with MCI in a health numeracy questionnaire was compared with the performance of a control sample including 164 healthy older adults, matched in age and educational level. Participants were asked to convert percentages, assess different probabilities, or understand the dosage of a short patient information leaflet. Additionally, neuropsychological background tests were administered. Patients with MCI answered fewer items correctly than controls in the health numeracy questionnaire. A correlation analysis showed statistically significant associations between performance in the health numeracy task and mental arithmetic, executive functions (psychomotor speed, conceptualization), and global cognitive status, respectively. Patients with MCI show problems in understanding numerical information concerning health care. Since patients with MCI are confronted with several health care decisions, special attention has to be paid to presenting information in an easily understandable way, to make additional sources of information available, and to provide adequate support. PMID:24473188

  3. Investigators Share Improved Understanding of the North American Carbon Cycle

    SciTech Connect

    Birdsey, Richard A.; Cook, Robert B; Denning, Scott; Griffith, Peter; Law, Beverly E.; Masek, Jeffrey; Michalak, Anna; Ogle, Stephen; Ojima, Dennis; Pan, Yude; Sabine, Christopher; Sheffner, Edwin; Sundquist, Eric

    2007-06-01

    U.S. North American Carbon Program Investigators Meeting, Colorado Springs, Colorado, 22-25 January 2007. The U.S. North American Carbon Program (NACP) sponsored an "all-scientist" meeting to review progress in understanding the dynamics of the carbon cycle of North America and adjacent oceans, and to chart a course for improved integration across scientific disciplines, scales, and Earth system boundaries. The meeting participants also addressed the need for better decision support tools for managing the carbon cycle of North America, so that strong science can inform policy as interest in taking action increases across the nation.

  4. Bedside Reporting: Protocols for Improving Patient Care.

    PubMed

    Ferguson, Teresa D; Howell, Teresa L

    2015-12-01

    Bedside reporting continues to gain much attention and is being investigated to support the premise that "hand-off" communications enhance efficacy in delivery of patient care. Patient inclusion in shift reports enhances good patient outcomes, increased satisfaction with care delivery, enhanced accountability for nursing professionals, and improved communications between patients and their direct care providers. This article discusses the multiple benefits of dynamic dialogue between patients and the health care team, challenges often associated with bedside reporting, and protocols for managing bedside reporting with the major aim of improving patient care. Nursing research supporting the concept of bedside reporting is examined. PMID:26596661

  5. A Method to Quantify and Compare Clinicians’ Assessments of Patient Understanding during Counseling of Standardized Patients

    PubMed Central

    Farrell, Michael H.; Kuruvilla, Pramita; Eskra, Kerry L.; Christopher, Stephanie A.; Brienza, Rebecca S.

    2009-01-01

    OBJECTIVES to introduce a method for quantifying clinicians’ use of assessment of understanding (AU) questions, and to examine medicine residents’ AU usage during counseling of standardized patients about prostate or breast cancer screening. METHODS Explicit-criteria abstraction was done on 86 transcripts, using a data dictionary for 4 AU types. We also developed a procedure for estimating the “load” of informational content for which the clinician has not yet assessed understanding. RESULTS Duplicate abstraction revealed reliability κ=0.96. Definite criteria for at least one AU were found in 68/86 transcripts (79%). Of these, 2 transcripts contained a request for a teach-back (“what is your understanding of this?”), 2 contained an open-ended AU, 46 (54%) contained only a close-ended AU, and 18 (21%) only contained an “OK?” question. The load calculation identified long stretches of conversation without an AU. CONCLUSION Many residents’ transcripts lacked AUs, and included AUs were often ineffectively phrased or inefficiently timed. Many patients may not understand clinicians, and many clinicians may be unaware of patients’ confusion. PRACTICE IMPLICATIONS Effective AU usage is important enough to be encouraged by training programs and targeted by population-scale quality improvement programs. This quantitative method should be useful in population-scale measurement of AU usage. PMID:19380210

  6. What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care

    PubMed Central

    Tierney, M; Bevan, R; Rees, C J; Trebble, T M

    2016-01-01

    Understanding and addressing patient attitudes to their care facilitates their engagement and attendance, improves the quality of their experience and the appropriate utilisation of resources. Gastrointestinal endoscopy is a commonly performed medical procedure that can be associated with patient anxiety and apprehension. Measuring patient attitudes to endoscopy can be undertaken through a number of approaches with contrasting benefits and limitations. Methodological validation is necessary for accurate interpretation of results and avoiding bias. Retrospective post-procedure questionnaires measuring satisfaction are easily undertaken but have limited value, particularly in directing service improvements. Patient experience questionnaires indicate areas of poor care but may reflect the clinician's not the patient's perspective. Directly assessing patient priorities and expectations identifies what is important to patients in their healthcare experience (patient-reported value) that can also provide a basis for other forms of evaluation. Published studies of patient attitudes to their endoscopy procedure indicate the importance of ensuring that endoscopists and their staff control patient discomfort, have adequate technical skill and effectively communicate with their patient relating to the procedure and results. Environmental factors, including noise, privacy and the single-sex environment, are considered to have less value. There are contrasting views on patient attitudes to waiting times for the procedure. Implementing patient-centred care in endoscopy requires an understanding of what patients want from their healthcare experience. The results from available studies suggest implications for current practice that relate to the training and practice of the endoscopist and their staff.

  7. Understanding patient management: the need for medication adherence and persistence.

    PubMed

    Chia, Yc

    2008-01-01

    Poor patient adherence to medication is one of the major factors contributing to poor disease control, in particular in asymptomatic chronic diseases like hypertension and dyslipidaemia. The physical and economic burden on patients and the health care system as a result of non-adherence is great. It is estimated that poor adherence to hypertension medication accounts for as many as 7.1 million preventable deaths annually. Hence recognising and identifying non-adherence is the first step to addressing this problem. Medication adherence can be measured in various ways including self-report to electronic monitoring. In order to be more successful in managing non-adherence, attention must be paid to barriers to adherence, namely the interplay of patient factors, the health care providers themselves and the health care system itself. Taking these into account will probably have the greatest impact on improving medication adherence. Consequently strategies to help overcome these barriers are of paramount importance. Some of these strategies will include education of patients, improving communication between patients and health care providers, improving dose scheduling, providing drugs with less adverse effects, and improving accessibility to health care. Poor mediation adherence continues to be a huge challenge. While the patient is ultimately responsible for the taking of medication, good communication, involving the patient in decision making about their care and simplifying drug regimens go a long way in improving it. PMID:25606104

  8. Understanding catchment behavior through stepwise model concept improvement

    NASA Astrophysics Data System (ADS)

    Fenicia, Fabrizio; Savenije, Hubert H. G.; Matgen, Patrick; Pfister, Laurent

    2008-01-01

    Lack of data is one of the main limitations for hydrological modeling. However, it is often used as a justification for over simplifying, poorly performing models. If we want to enhance our understanding of hydrological systems, it is important to fully exploit the information contained in the available data, and to learn from model deficiencies. In this paper, we propose a methodology where we systematically update the model structure, progressively incorporating new hypotheses of catchment behavior. We apply this methodology to the Alzette river basin in Luxembourg, showing how stepwise model improvement helps to identify the behavior of this catchment. We show that the most significant improvement of the evolving model structure is associated to the characterization of antecedent wetness. This is improved accounting for interception, which affects vertical storage distribution, and accounting for rainfall spatial heterogeneity, which influences storage variations in the horizontal dimension. Overall, our results suggested that, due to the damping effect of the basin, the description of fast catchment response benefits more from spatially distributed information than that of slow catchment response.

  9. Understanding and improving inpatient mortality in academic medical centers.

    PubMed

    Behal, Raj; Finn, Jeannine

    2009-12-01

    The purpose of this article is to describe factors contributing to potentially preventable mortality in academic medical centers and the organizational characteristics associated with success in reducing mortality. Sixteen U.S. academic medical centers that wished to improve risk-adjusted inpatient mortality rates requested a consultation that included interviews with physicians, nurses, and hospital leaders; review of medical records; and evaluation of systems and processes of care. The assessments took place on-site; they identified key factors contributing to preventable mortality, and each hospital received specific recommendations. Changes in observed mortality and in the ratio of observed to expected mortality were measured from 2002 to final follow-up in 2007. Evaluations determined each hospital's success factors and key barriers to improvement. The key factors contributing to preventable mortality were delays in responding to deteriorating patients, suboptimal critical care, hospital-acquired infections, postoperative complications, medical errors, and community issues such as the availability of hospice care. Of the 16 hospitals, 12 were able to reduce their mortality index. The five hospitals that had the greatest improvement in mortality were the only hospitals with a broad level of engagement among hospital and physician leaders, including the department chairs. In the hospitals whose performance did not improve, the department chairs were not engaged in the process. The academic medical centers that focused on mortality reduction and had engagement of physicians, especially department chairs, were able to achieve meaningful reductions in hospital mortality. The necessary ingredients for achieving meaningful improvement in clinical outcomes included good data, a sound method for change, and physician leadership. PMID:19940569

  10. Prognostic understanding, quality of life and mood in patients undergoing hematopoietic stem cell transplantation.

    PubMed

    El-Jawahri, A; Traeger, L; Kuzmuk, K; Eusebio, J; Vandusen, H; Keenan, T; Shin, J; Gallagher, E R; Greer, J A; Pirl, W F; Jackson, V A; Ballen, K K; Spitzer, T R; Graubert, T A; McAfee, S; Dey, B; Chen, Y-B A; Temel, J S

    2015-08-01

    Little is known about how patients undergoing hematopoietic stem cell transplantation (HCT) and their family caregivers (FC) perceive their prognosis. We examined prognostic understanding in patients undergoing HCT and their FC and its relationship with quality of life (QOL) and mood. We conducted a longitudinal study of patients (and FC) hospitalized for HCT. We used a questionnaire to measure participants' prognostic understanding and asked the oncologists to estimate patients' prognosis prior to HCT. We assessed QOL and mood weekly and evaluated the relationship between prognostic understanding, and QOL and mood using multivariable linear mixed models. We enrolled 90 patients undergoing (autologous (n=30), myeloablative (n=30) or reduced intensity allogeneic (n=30)) HCT. About 88.9% of patients and 87.1% of FC reported it is 'extremely' or 'very' important to know about prognosis. However, 77.6% of patients and 71.7% of FC reported a discordance and more optimistic prognostic perception compared to the oncologist (P<0.0001). Patients with a concordant prognostic understanding with their oncologists reported worse QOL (β=-9.4, P=0.01) and greater depression at baseline (β=1.7, P=0.02) and over time ((β=1.2, P<0.0001). Therefore, Interventions are needed to improve prognostic understanding, while providing patients with adequate psychological support. PMID:25961772

  11. Patient Portals: An Underused Resource for Improving Patient Engagement.

    PubMed

    Tulu, Bengisu; Trudel, John; Strong, Diane M; Johnson, Sharon A; Sundaresan, Devi; Garber, Lawrence

    2016-01-01

    The potential of patient portals to improve patient engagement and health outcomes has been discussed for more than a decade. The slow growth in patient portal adoption rates among patients and providers in the United States, despite external incentives, indicates that this is a complex issue. We examined evidence of patient portal use and effects with a focus on the pulmonary domain. We found a paucity of studies of patient portal use in pulmonary practice, and highlight gaps for future research. We also report on the experience of a pulmonary department using a patient portal to highlight the potential of these systems. PMID:26066707

  12. Improving Students' Understanding of Lock-In Amplifiers

    NASA Astrophysics Data System (ADS)

    DeVore, Seth; Gauthier, Alexandre; Levy, Jeremy; Chandralekha, Singh

    2014-03-01

    A lock-in amplifier is a versatile instrument frequently used in physics research. However, many students struggle with the basic operating principles of a lock-in amplifier which can lead to a variety of difficulties. To improve students' understanding, we have been developing and evaluating a research-based tutorial which makes use of a computer simulation of a lock-in amplifier. The tutorial is based on a field-tested approach in which students realize their difficulties after predicting the outcome of simulated experiments involving a lock-in amplifier and check their predictions using the simulated lock-in amplifier. Then, the tutorial guides and helps students develop a coherent understanding of the basics of a lock-in amplifier. The tutorial development involved interviews with physics faculty members and graduate students and iteration of many versions of the tutorial with professors and graduate students. The student difficulties and the development and assessment of the research-based tutorial are discussed. We thank National Science Foundation for award NSF-1124131.

  13. Assessing and improving student understanding of quantum mechanics

    NASA Astrophysics Data System (ADS)

    Singh, Chandralekha

    2006-02-01

    We developed a survey to probe student understanding of quantum mechanics concepts at the beginning of graduate instruction. The survey was administered to 202 graduate students in physics enrolled in first-year quantum mechanics courses from seven different universities at the beginning of the first semester. We also conducted one-on-one interviews with fifteen graduate students or advanced undergraduate students who had just finished a course in which all the content on the survey was covered. We find that students share universal difficulties about fundamental quantum mechanics concepts. The difficulties are often due to over-generalization of concepts learned in one context to other contexts where they are not directly applicable and difficulty in making sense of the abstract quantitative formalism of quantum mechanics. Instructional strategies that focus on improving student understanding of these concepts should take into account these difficulties. The results from this study can sensitize instructors of first-year graduate quantum physics to the conceptual difficulties students are likely to face.

  14. Understanding and improving longevity in RF MEMS capacitive switches

    NASA Astrophysics Data System (ADS)

    Goldsmith, Chuck; Forehand, David; Scarbrough, Derek; Peng, Zheng; Palego, Cris; Hwang, James; Clevenger, Jason

    2008-02-01

    This paper discusses issues relating to the reliability and methods for employing high-cycle life testing in capacitive RF MEMS switches. In order to investigate dielectric charging, transient current spectroscopy is used to characterize and model the ingress and egress of charges within the switch insulating layer providing an efficient, powerful tool to investigate various insulating materials without constructing actual MEMS switches. Additionally, an in-situ monitoring scheme has been developed to observe the dynamic evolution of switch characteristics during life testing. As an alternative to high-cycle life testing, which may require days or weeks of testing, a method for performing accelerated life tests is presented. Various methods for mitigating dielectric charging are presented including: reduced operating voltage, reduced dielectric area, and improved control waveforms. Charging models, accelerated life test results, and high-cycle life test results for state-of-the-art capacitive RF MEMS switches aid in the better understanding of MEMS switch reliability providing direction for improving materials and mechanical designs to increase the operation lifetime of MEMS capacitive switches.

  15. Prognostic Understanding, Quality of Life, and Mood in Patients Undergoing Hematopoietic Stem Cell Transplantation

    PubMed Central

    El-Jawahri, Areej; Traeger, Lara; Kuzmuk, Kailyn; Eusebio, Justin; Vandusen, Harry; Keenan, Tanya; Shin, Jennifer; Gallagher, Emily R.; Greer, Joseph A.; Pirl, William F.; Jackson, Vicki A.; Ballen, Karen K; Spitzer, Thomas R.; Graubert, Timothy A.; McAfee, Steven; Dey, Bimalangshu; Chen, Yi-Bin A.; Temel, Jennifer S.

    2015-01-01

    Little is known about how patients undergoing stem cell transplantation (HCT) and their family caregivers (FC) perceive their prognosis. We examined prognostic understanding in patients undergoing HCT and their FC and its relationship with quality of life (QOL) and mood. We conducted a longitudinal study of patients (and FC) hospitalized for HCT. We used a questionnaire to measure participants’ prognostic understanding and asked the oncologists to estimate patients’ prognosis prior to HCT. We assessed QOL and mood weekly and evaluated the relationship between prognostic understanding and QOL and mood using multivariable linear mixed models. We enrolled 90 patients undergoing (autologous n=30); myeloablative (n=30) or reduced intensity allogeneic (n=30)) HCT. 88.9% of patients and 87.1% of FC reported it is ‘extremely’ or ‘very’ important to know about prognosis. However, 77.6% of patients and 71.7% of FC reported a discordance and more optimistic prognostic perception compared to the oncologist (P’s < 0.0001). Patients with a concordant prognostic understanding with their oncologists reported worse QOL (β = −9.4, P = 0.01) and greater depression at baseline (β = 1.7, P = 0.02) and over time ((β = 1.2, P < 0.0001). Therefore, Interventions are needed to improve prognostic understanding, while providing patients with adequate psychological support. PMID:25961772

  16. Characterizing emergency departments to improve understanding of emergency care systems

    PubMed Central

    2011-01-01

    International emergency medicine aims to understand different systems of emergency care across the globe. To date, however, international emergency medicine lacks common descriptors that can encompass the wide variety of emergency care systems in different countries. The frequent use of general, system-wide indicators (e.g. the status of emergency medicine as a medical specialty or the presence of emergency medicine training programs) does not account for the diverse methods that contribute to the delivery of emergency care both within and between countries. Such indicators suggest that a uniform approach to the development and structure of emergency care is both feasible and desirable. One solution to this complex problem is to shift the focus of international studies away from system-wide characteristics of emergency care. We propose such an alternative methodology, in which studies would examine emergency department-specific characteristics to inventory the various methods by which emergency care is delivered. Such characteristics include: emergency department location, layout, time period open to patients, and patient type served. There are many more ways to describe emergency departments, but these characteristics are particularly suited to describe with common terms a wide range of sites. When combined, these four characteristics give a concise but detailed picture of how emergency care is delivered at a specific emergency department. This approach embraces the diversity of emergency care as well as the variety of individual emergency departments that deliver it, while still allowing for the aggregation of broad similarities that might help characterize a system of emergency care. PMID:21756328

  17. Patients' understanding of the regulation of dietary supplements.

    PubMed

    Ashar, Bimal H; Miller, Redonda G; Pichard, Carmen P; Levine, Rachel; Wright, Scott M

    2008-02-01

    The Dietary Supplement Health and Education Act (DSHEA) permits manufacturers to sell products without providing pre-market evidence of safety or efficacy. One fundamental reason for the passage of the DSHEA was to empower consumers to make their own choices, free from governmental restriction. Yet, little is known about the public's understanding of the supplement regulatory process. We undertook a study to assess patients' knowledge regarding governmental oversight of product marketing and advertising. A survey of 300 adult patients from the Baltimore Metropolitan area was administered after showing participants an advertisement for a dietary supplement. Patients were asked questions regarding their understanding of federal regulation of the advertised product. A total of 52% of respondents were unaware that the dietary supplement had not been approved by the government while 63% were unaware that the advertisement for that supplement had not been pre-approved. Factors associated with a lack of understanding of the product approval process included lower education level (OR 2.52; 95% CI 1.52-4.19) and non-Caucasian race (OR 1.99; 95% CI 1.17-3.36). Lower education level was also associated with confusion regarding the advertisement approval process (OR 2.60; 95% CI 1.48-4.57). Based on these results, patients seem unclear about the government's role in the regulation of dietary supplements. Educational efforts should be geared towards clarifying these issues. PMID:18080205

  18. Improving Diabetes Care for Hospice Patients.

    PubMed

    Lee, Sei J; Jacobson, Margaret A; Johnston, C Bree

    2016-07-01

    Although type 2 diabetes guidelines recommend less aggressive glycemic control for patients with limited life expectancy, many hospice patients continue their glucose-lowering medications, resulting in an increased risk of hypoglycemia. Three common reasons for overly tight glycemic control in hospice patients include (1) discussions about reducing or stopping chronic medications are uncomfortable; (2) many patients and families believe that mild hyperglycemia can cause symptoms; and (3) until 2014, Healthcare Information and Data Information Set (HEDIS) quality indicators for glycemic control included hospice patients. To address these issues, we recommend (1) providers discuss with patients and families upon hospice enrollment that diabetes medications can be reduced or discontinued as their life-limiting disease progresses; (2) keeping blood glucose levels between 200 and 300 mg/dL; and (3) educate providers that HEDIS measures now exclude hospice patients. Implementing these recommendations should decrease the risk of hypoglycemia in hospice patients and improve their quality of life. PMID:25852204

  19. Illness understanding in patients with advanced lung cancer: curse or blessing?

    PubMed

    Janssens, Annelies; Kohl, Sisca; Michielsen, Toke; Van Langendonck, Shana; Hiddinga, Birgitta I; van Meerbeeck, Jan P

    2016-04-01

    Early palliative care (EPC) should be introduced from the start of the treatment of patients with advanced lung cancer. Unfortunately, this is often not integrated in daily oncologic care. This letter wants to emphasize the importance of offering a holistic approach, meaning EPC to optimize quality of life (QoL). Illness understanding is important because patients with better understanding of their disease choose more often for symptom control and less for an aggressive treatment at the end of life. This illness understanding should be achieved during communication with the treating oncologist. Based on the limited available literature about illness understanding, it seems that an EPC program is necessary when breaking bad news, in order to maintain or improve QoL in patients. PMID:27121741

  20. Improved Understanding of ice and dust processes using Data Assimilation

    NASA Astrophysics Data System (ADS)

    Lee, C.; Richardson, M. I.

    2013-12-01

    We use the DART Data Assimilation (DA) framework to ingest radiance observations from the Thermal Emission Spectrometer (TES) into the PlanetWRF Mars General Circulation Model (GCM) and measure the skill of the model in reproducing the observations, and hence to test and improve understanding of the aerosol processes at the heart of Martian climate. The DA framework is used to constrain the surface ice properties in the model using the TES radiance observations and lander pressure measurements as independent constraints on the ice properties. We compare the skill of two ice models in reproducing the TES radiance observations while simultaneously matching lander pressure observations. In one model the effect of subsurface ice is contained within the surface albedo and emissivity parameterization, in the second model subsurface ice is parameterized based on Gamma Ray Spectrometer (GRS) data. Both models reproduce the pressure cycle observed by the Viking Lander instruments, but the model with subsurface ice performs significantly better at reproducing the TES radiance observations over the ice-covered poles. We also use the DA framework to investigate the model skill using the Conrath vertical dust profile (with a near surface maximum dust abundance) and a modified dust profile with high altitude maximum that has been inferred from limb observations by the Mars Climate Sounder (MCS) and the Thermal Emission Spectrometer (TES). The GCM using the modified dust profile produces an atmosphere with thermal lapse rate closer to that measured using nadir observations from TES.

  1. Patient understanding of the revised USPSTF screening mammogram guidelines: need for development of patient decision aids

    PubMed Central

    2012-01-01

    Background The purpose of the study was to examine patients’ understanding of the revised screening mammogram guidelines released by the United States Preventive Services Task Force (USPSTF) in 2009 addressing age at initiation and frequency of screening mammography. Methods Patients from the Departments of Family Medicine, Internal Medicine, and Obstetrics and Gynecology (n = 150) at a tertiary care medical center in the United States completed a survey regarding their understanding of the revised USPSTF guidelines following their release, within four to six months of their scheduled mammogram (March 2010 to May 2010). Results Of the patients surveyed, 97/147 (67%) indicated increased confusion regarding the age and frequency of screening mammography, 61/148 (41%) reported increased anxiety about mammograms, and 58/146 (40%) reported anxiety about their own health status following the release of the revised screening guidelines. Most of the patients surveyed, 111/148 (75%), did not expect to change their timing or frequency of screening mammograms in the future. Conclusion Results from this survey suggested increased confusion and possibly an increase in patients’ anxiety related to screening mammography and their own health status following the release of the revised USPSTF screening mammogram guidelines to the public and subsequent media portrayal of the revised guidelines. Although the study did not specifically address causality for these findings, the results highlight the need for improvements in the communication of guidelines to patients and the public. Development of shared decision-making tools and outcomes should be considered to address the communication challenge. PMID:23051022

  2. Toward an Improved Understanding of the Global Fresh Water Budget

    NASA Technical Reports Server (NTRS)

    Hildebrand, Peter H.

    2005-01-01

    priorities for future improvements in global fresh water budget monitoring. The priorities are based on the potential of new approaches to provide improved measurement and modeling systems, and on the need to measure and understand the potential for a speed-up of the global water cycle under the effects of climate change.

  3. Care Coordination for the Chronically Ill: Understanding the Patient's Perspective

    PubMed Central

    Maeng, Daniel D; Martsolf, Grant R; Scanlon, Dennis P; Christianson, Jon B

    2012-01-01

    Objective To identify factors associated with perception of care coordination problems among chronically ill patients. Methods Patient-level data were obtained from a random-digit dial telephone survey of adults with chronic conditions. The survey measured respondents' self-report of care coordination problems and level of patient activation, using the Patient Activation Measure (PAM-13). Logistic regression was used to assess association between respondents' self-report of care coordination problems and a set of patient characteristics. Results Respondents in the highest activation stage had roughly 30–40 percent lower odds of reporting care coordination problems compared to those in the lowest stage (p < .01). Respondents with multiple chronic conditions were significantly more likely to report coordination problems than those with hypertension only. Respondents' race/ethnicity, employment, insurance status, income, and length of illness were not significantly associated with self-reported care coordination problems. Conclusion We conclude that patient activation and complexity of chronic illness are strongly associated with patients' self-report of care coordination problems. Developing targeted strategies to improve care coordination around these patient characteristics may be an effective way to address the issue. PMID:22985032

  4. Understanding and Improving High Voltage Vacuum Insulators for Microsecond Pulses

    SciTech Connect

    Javedani, J B; Goerz, D A; Houck, T L; Lauer, E J; Speer, R D; Tully, L K; Vogtlin, G E; White, A D

    2007-03-05

    High voltage insulation is one of the main areas of pulsed power research and development, and dielectric breakdown is usually the limiting factor in attaining the highest possible performance in pulsed power devices. For many applications the delivery of pulsed power into a vacuum region is the most critical aspect of operation. The surface of an insulator exposed to vacuum can fail electrically at an applied field more than an order or magnitude below the bulk dielectric strength of the insulator. This mode of breakdown, called surface flashover, imposes serious limitations on the power flow into a vacuum region. This is especially troublesome for applications where high voltage conditioning of the insulator and electrodes is not practical and for applications where relatively long pulses, on the order of several microseconds, are required. The goal of this project is to establish a sound fundamental understanding of the mechanisms that lead to surface flashover, and then evaluate the most promising techniques to improve vacuum insulators and enable high voltage operation at stress levels near the intrinsic bulk breakdown limits of the material. The approach we proposed and followed was to develop this understanding through a combination of theoretical and computation methods coupled with experiments to validate and quantify expected behaviors. In this report we summarize our modeling and simulation efforts, theoretical studies, and experimental investigations. The computational work began by exploring the limits of commercially available codes and demonstrating methods to examine field enhancements and defect mechanisms at microscopic levels. Plasma simulations with particle codes used in conjunction with circuit models of the experimental apparatus enabled comparisons with experimental measurements. The large scale plasma (LSP) particle-in-cell (PIC) code was run on multiprocessor platforms and used to simulate expanding plasma conditions in vacuum gap regions

  5. Sound source information to improve cardiothoracic patients' comfort.

    PubMed

    Mackrill, Jamie; Cain, Rebecca; Jennings, Paul; England, Michelle

    Hospital sound has been well documented through acoustic measurement and the classification of its adverse effects on patients and nurses. However, little consideration has been given to how the perception of these unavoidable soundscapes can be improved. For instance, does a better understanding of the variety of sounds improve patients' feeling? This paper begins to answer this and documents a pilot questionnaire-based study looking at the effects and potential benefits of sound source information (SSI) on patients' subjective reactions to a ward soundscape. The study was carried out from July to September 2011 with 31 patients in a cardiothoracic ward. Although strong inferences were not made, it was found that this simple intervention created a 21-26% positive change perception (p<0.05). The paper discusses the results in relation to nursing practice, concluding that SSI could be beneficial in helping patients to feel more comfortable. PMID:23588015

  6. Prenatal Training Improves New Mothers’ Understanding of Jaundice

    PubMed Central

    Zhang, Ling; Hu, Peng; Wang, Jian; Zhang, Min; Zhang, Qing Ling; Hu, Bo

    2015-01-01

    Background Mothers’ knowledge of neonatal jaundice (NNJ) is grossly deficient or inaccurate, which may adversely affect the actions of mothers in the recognition of NNJ and cause a delay in seeking medical attention. Material/Methods A total of 1036 primiparas were separated randomly into the intervention group and the control group, with 518 primiparas in each group. Results All (100%) mothers in the intervention group understood that NNJ is a yellow discoloration of the skin and sclera; 94.19% of them considered that NNJ is a common problem in newborns; 82.80% and 95.27% replied that jaundice appearing within the first 36 hours and lasting more than 2 weeks usually indicates pathological NNJ; 96.34%, 80.86%, and 90.32% realized that premature newborns, low birth weight, and perinatal asphyxia, respectively, are more likely to be accompanied by NNJ; 97.41%, 78.71%, and 64.95% knew that maternal-fetal blood group incompatibility, infection, and glucose-6-phosphate dehydrogenase deficiency, respectively, are the common inducements to NNJ; 94.84% could associate NNJ with brain damage; 92.26%, 93.12%, and 74.62% agreed that phototherapy, strengthen feeding, and exchange blood transfusion, respectively, can greatly relieve NNJ. However, some respondents in the control group responded in other ways, such as stopping breastfeeding (9.19%), placing newborns in sunlight (10.24%) and traditional Chinese medicine (10.24%), which was significantly higher than that of the intervention group. There was also a significant delay for respondents in the control group in consulting a pediatrician, and 6.30% of them did not seek medical help until after the interview. Conclusions Prenatal training could significantly improve new mothers’ understanding of NNJ. PMID:26056164

  7. A handoff is not a telegram: an understanding of the patient is co-constructed.

    PubMed

    Cohen, Michael D; Hilligoss, Brian; Kajdacsy-Balla Amaral, André Carlos

    2012-01-01

    Hospital handoffs are believed to be a key locus of communication breakdown that can endanger patient safety and undermine quality of care. Substantial new efforts to better understand handoffs and to improve handoff practices are under way. Many such efforts appear to be seriously hampered, however, by an underlying presumption that the essential function of a handoff is one-way information transmission. Here, we examine social science literature that supports a richer framing of handoff conversations, one that characterizes them as co-constructions of an understanding of the patient. PMID:22316097

  8. A handoff is not a telegram: an understanding of the patient is co-constructed

    PubMed Central

    2012-01-01

    Hospital handoffs are believed to be a key locus of communication breakdown that can endanger patient safety and undermine quality of care. Substantial new efforts to better understand handoffs and to improve handoff practices are under way. Many such efforts appear to be seriously hampered, however, by an underlying presumption that the essential function of a handoff is one-way information transmission. Here, we examine social science literature that supports a richer framing of handoff conversations, one that characterizes them as co-constructions of an understanding of the patient. PMID:22316097

  9. Communicating with Parents: Understanding the Process, Improving Your Skills

    ERIC Educational Resources Information Center

    American Federation of Teachers (NJ), 2007

    2007-01-01

    Communication is the exchange of information, ideas and/or feelings from one person to another. The goal of communication is understanding. Without understanding, there is no communication. The communication process consists of verbal and nonverbal communication and listening. The spoken word is self-explanatory. Communication problems between…

  10. Quality of life and disease understanding: impact of attending a patient-centered cancer symposium

    PubMed Central

    Padrnos, Leslie; Dueck, Amylou C; Scherber, Robyn; Glassley, Pamela; Stigge, Rachel; Northfelt, Donald; Mikhael, Joseph; Aguirre, Annette; Bennett, Robert M; Mesa, Ruben A

    2015-01-01

    To evaluate the impact of a patient-centered symposium as an educational intervention on a broad population of cancer patients. We developed a comprehensive patient symposium. Through voluntary questionnaires, we studied the impact of this cancer symposium on quality of life, cancer-specific knowledge, and symptom management among cancer patients. Symposium attendees were provided surveys prior to and 3 months following the educational intervention. Surveys included (1) EORTC-QLQ-C30; (2) disease understanding tool developed for this conference; (3) validated disease-specific questionnaires. Changes over time were assessed using McNemar's tests and paired t-tests for categorical and continuous variables, respectively. A total of 158 attendees completed the pre-convention survey. Most respondents reported at least “quite a bit” of understanding regarding treatment options, screening modalities, symptomatology, and cancer-related side effects. Attendees endorsed the least understanding of disease-related stress, risk factors, fatigue management, and legal issues related to disease/treatment. At 3 months, there was improvement in understanding (12 of 14 areas of self-reported knowledge especially regarding nutrition, and stress/fatigue management). However, no significant change was seen in QLQ-C30 functioning, fatigue, pain, or insomnia. A patient symposium, as an educational intervention improves a solid knowledge base amongst attendees regarding their disease, increases knowledge in symptom management, but may be insufficient to impact QoL as a single intervention. PMID:25641947

  11. Communicating the results of randomized clinical trials: do patients understand multidimensional patient-reported outcomes?

    PubMed

    McNair, Angus G K; Brookes, Sara T; Davis, Christopher R; Argyropoulos, Miltiadis; Blazeby, Jane M

    2010-02-10

    PURPOSE Evidence suggests that patient-reported outcomes (PROs) from randomized trials in oncology may not influence clinical decision making and patient choice. Reasons for this are currently unclear and little is known about patients' interpretation of PROs. This study assessed patients' understanding of multidimensional PROs in a graphical format. PATIENTS AND METHODS Semistructured interviews in which patients interpreted a series of graphs depicting simple, then multiple different hypothetical PROs associated with two treatments with identical chances of survival were audio recorded. The interviewer and a blinded observer (listening to audio recordings) scored patients' understanding of the graphs. Logistic regression examined the associations between patient understanding of the graphs and clinical and sociodemographic details. Results One hundred thirty-two patients with esophageal and gastric cancer were interviewed and 115 understood the first two graphs depicting different PROs of two treatments (87%; 95% CI,81 to 93). Simultaneous interpretation of adverse and beneficial treatment effects was achieved by 74 (66%; 95% CI, 57 to 75). Graphs showing complex, longitudinal data were correctly interpreted by 97 (73%; 95% CI, 66 to 81) and 108 (81%; 95% CI, 75 to 88), respectively. Univariable analyses demonstrated associations between patient understanding and patient age, educational level, and cancer site (P < or = .02 for all); however, in a multivariable model each of these associations was attenuated. CONCLUSION Most patients understand graphical multidimensional PROs, although a smaller majority were able to interpret more complex, or simultaneous, presentations. Additional work is needed to define methods for communicating clinical and PRO data from trials to allow patients to make informed treatment choices. PMID:20065187

  12. Applied Strategies for Improving Patient Safety: A Comprehensive Process To Improve Care in Rural and Frontier Communities

    ERIC Educational Resources Information Center

    Westfall, John M.; Fernald, Douglas H.; Staton, Elizabeth W.; VanVorst, Rebecca; West, David; Pace, Wilson D.

    2004-01-01

    Medical errors and patient safety have gained increasing attention throughout all areas of medical care. Understanding patient safety in rural settings is crucial for improving care in rural communities. To describe a system to decrease medical errors and improve care in rural and frontier primary care offices. Applied Strategies for Improving…

  13. Understanding and treating patients with alcoholic cirrhosis: an update.

    PubMed

    Addolorato, Giovanni; Russell, Marcia; Albano, Emanuele; Haber, Paul S; Wands, Jack R; Leggio, Lorenzo

    2009-07-01

    Alcoholic cirrhosis represents the terminal stage of alcoholic liver disease (ALD) and one of the main causes of death among alcohol abusers. The aim of this review was to provide an update on alcoholic cirrhosis, with an emphasis on recent findings. Increased alcohol consumption in developing countries is expected to increase cirrhosis mortality. There is a need, therefore, to develop new approaches to the prevention of ALD, including more attention to co-factors that may increase risk of ALD (i.e., obesity and diabetes, chronic HCV infection, and smoking). Furthermore, a better understanding of the pathological mechanisms on the basis of alcohol cirrhosis represents a cornerstone in order to develop new pharmacological treatments. Inflammatory and immune responses along with oxidative stress and alterations in adipokine secretion might contribute in different ways to the evolution of alcohol-induced fibrosis/cirrhosis. As of this date, patients with severe alcoholic hepatitis with a Maddrey Discriminant Factor (MDF) 32 should be offered pentoxifylline and/or corticosteroids unless contraindications exist. For ambulatory patients, S-adenosylmethionine (SAMe) may be considered in a motivated patient with nutritional support. Current studies do not support use of anti-tumor necrosis factor (TNF)-alpha antibody. Finally, achieving total alcohol abstinence should represent the main aim in the management of patients affected by any stage of cirrhosis. In the last decades, several drugs able to increase abstinence and prevent alcohol relapse have been evaluated and some of them have obtained approval for alcohol dependence. Patients with alcoholic cirrhosis; however, are usually excluded from such treatments. A recent study demonstrated the efficacy and safety of baclofen in inducing and maintaining alcohol abstinence in cirrhotic alcohol-dependent patients with cirrhosis. All together the information available suggests the need of a multimodal approach in the clinical

  14. Understanding patient preferences and willingness to pay for hemophilia therapies

    PubMed Central

    Chaugule, Shraddha S; Hay, Joel W; Young, Guy

    2015-01-01

    Background Despite clearly improved clinical outcomes for prophylaxis compared to on-demand therapy, on average only 56% of patients diagnosed with severe hemophilia receive prophylactic factor replacement therapy in the US. Prophylaxis rates generally drop as patients transition from childhood to adulthood, partly due to patients becoming less adherent when they reach adulthood. Assessment of patient preferences is important because these are likely to translate into increased treatment satisfaction and adherence. In this study, we assessed preferences and willingness to pay (WTP) for on-demand, prophylaxis, and longer acting prophylaxis therapies in a sample of US hemophilia patients. Methods Adult US hemophilia patients and caregivers (N=79) completed a discrete-choice survey that presented a series of trade-off questions, each including a pair of hypothetical treatment profiles. Using a mixed logit model for analysis, we compared the relative importance of five treatment characteristics: 1) out-of-pocket treatment costs (paid by patients), 2) factor dose adjustment, 3) treatment side effects, 4) availability of premixed factor, and 5) treatment effectiveness and dosing frequency. Based on these attribute estimates, we calculated patients’ WTP. Results Out-of-pocket treatment costs (P<0.001), side effects (P<0.001), and treatment effectiveness and dosing frequency (P<0.001) were found to be statistically significant in the model. Patients were willing to pay US $410 (95% confidence interval: $164–$656) out of pocket per month for thrice-weekly prophylaxis therapy compared to on-demand therapy and $360 (95% confidence interval: $145–$575) for a switch from thrice-weekly to once-weekly prophylaxis therapy. Conclusion Improvements in treatment effectiveness and dosing frequency, treatment side effects, and out-of-pocket costs per month were the greatest determinants of hemophilia treatment choice and WTP. The positive preferences and WTP for longer acting

  15. Understanding Emergency Department 72-Hour Revisits Among Medicaid Patients Using Electronic Healthcare Records.

    PubMed

    Ryan, James; Hendler, James; Bennett, Kristin P

    2015-12-01

    Electronic Healthcare Records (EHRs) have the potential to improve healthcare quality and to decrease costs by providing quality metrics, discovering actionable insights, and supporting decision-making to improve future outcomes. Within the United States Medicaid Program, rates of recidivism among emergency department (ED) patients serve as metrics of hospital performance that help ensure efficient and effective treatment within the ED. We analyze ED Medicaid patient data from 1,149,738 EHRs provided by a hospital over a 2-year period to understand the characteristics of the ED return visits within a 72-hour time frame. Frequent flyer patients with multiple revisits account for 47% of Medicaid patient revisits over this period. ED encounters by frequent flyer patients with prior 72-hour revisits in the last 6 months are thrice more likely to result in a readmit than those of infrequent patients. Statistical L1-logistic regression and random forest analyses reveal distinct patterns of ED usage and patient diagnoses between frequent and infrequent patient encounters, suggesting distinct opportunities for interventions to improve efficacy of care and streamline ED workflow. This work forms a foundation for future development of predictive models, which could flag patients at high risk of revisiting. PMID:27441405

  16. Understanding the influence of educational attainment on kidney health and opportunities for improved care.

    PubMed

    Green, Jamie A; Cavanaugh, Kerri L

    2015-01-01

    Educational attainment is an important but often overlooked contributor to health outcomes in patients with kidney disease. Those with lower levels of education have an increased risk of ESRD, complications of peritoneal dialysis, worse transplant outcomes, and mortality. Mediators of these associations are poorly understood but involve a complex interplay between health knowledge, behaviors, and socioeconomic and psychosocial factors. Interventions targeting these aspects of care have the potential to reduce disparities related to educational attainment; however, few programs have been described that specifically address this issue. Future research efforts should not only systematically assess level of educational attainment but also report the differential impact of interventions across educational strata. In addition, routine measurement of health literacy may be useful to identify high-risk patients independent of years of schooling. A better understanding of the influence of educational attainment on kidney health provides an opportunity to improve the care and outcomes of vulnerable patients with kidney disease. PMID:25573509

  17. Increasing Patient Activation Could Improve Outcomes for Patients with Inflammatory Bowel Disease.

    PubMed

    Shah, Shawn L; Siegel, Corey A

    2015-12-01

    Inflammatory bowel disease (IBD) is a complex disease process that often requires the integration of skills from various health care providers to adequately meet the needs of patients with IBD. The medical and surgical treatment options for IBD have become more complicated and are frequently a source of angst for both the patient and provider. However, it has become more important than ever to engage patients in navigating the treatment algorithm. Although novel in the IBD world, the concept of patients' becoming more active and effective managers of their care has been well studied in other disease processes such as diabetes mellitus and mental illness. This idea of patient activation refers to a patient understanding his or her role in the care process and having the skill sets and self-reliance necessary to manage his or her own health care. Over the past decade, evidence supporting the role of patient activation in chronic illness has grown, revealing improved health outcomes, enhanced patient experiences, and lower overall costs. Patient activation can be measured, and interventions have been shown to improve levels of activation over time and influence outcomes. A focus on patient activation is very appropriate for patients with IBD because this may potentially serve as a tool for IBD providers to not only improve patient outcomes and experience but also reduce health care costs. PMID:26422517

  18. Toward a better understanding of patient-reported outcomes in clinical practice.

    PubMed

    Bitton, Asaf; Onega, Tracy; Tosteson, Anna N A; Haas, Jennifer S

    2014-04-01

    Current shifts toward patient-centered healthcare and accountable payment options point to the more personalized production of better health, not just healthcare, as a next organizational paradigm. Transformation to a system geared toward promoting health requires us to think broadly about what it means to engage patients meaningfully, to give them a voice in their health and care, and to capture more of their varied experience and attitudes beyond the provider visit. The collection and use of patient-reported outcome data into electronic health records represents an important step forward for the transition to a more patient-centered health system. We set out an agenda for better understanding how and when patient-reported outcomes may improve patient health and care experience. PMID:24884859

  19. Understanding Synthesis Across Disciplines to Improve Nursing Education.

    PubMed

    Blondy, Laurie C; Blakeslee, Ann M; Scheffer, Barbara K; Rubenfeld, M Gaie; Cronin, Brenda M; Luster-Turner, Rose

    2016-06-01

    Nursing students must learn higher-order thinking skills of analysis and synthesis to manage complex data for decision making in healthcare. Teaching synthesis, however, is challenging and elusive due to lack of understanding of the concept and an explicit pedagogy for teaching it. A qualitative, multi-phased research project was designed to gain understanding of what synthesis is, how professionals acquire synthesis skills, and how to best teach synthesis. The first phase explored interdisciplinary descriptions of synthesis. Three focus groups were conducted, and interdisciplinary participants responded to several questions. Several themes emerged suggesting that synthesis depends on cognitive skills and competencies, situational and contextual factors, preparation and knowledge acquisition skills, interpersonal and interaction skills, and personal qualities. Participants also supported use of multi-modal teaching strategies to reinforce students' use of synthesis in learning. This project provided a beginning understanding of the synthesis process, revealing striking similarities in synthesis across professional disciplines. PMID:26689219

  20. CEOs say patient deposits improve cash flow.

    PubMed

    Anderson, H J

    1991-02-20

    CEOs say it makes good business sense to require patients to make cash deposits toward their bills prior to admission, because improved cash flow is vital to financially strapped hospitals. But hospitals that require cash deposits should also be aware of the sensitive public relations issues involved, experts caution. PMID:1993531

  1. Medical Interpreting: Improving Communication with Your Patients.

    ERIC Educational Resources Information Center

    Tebble, Helen

    The guide is designed for physicians and other medical practitioners who need to work with medical interpreters to improve communication with patients. Special attention is given to the Australian context. An introductory section discusses the need for medical interpreters and explains the guide's organization. Subsequent sections address these…

  2. Lectures and Simulation Laboratories to Improve Learners' Conceptual Understanding

    ERIC Educational Resources Information Center

    Brophy, Sean P.; Magana, Alejandra J.; Strachan, Alejandro

    2013-01-01

    We studied the use of online molecular dynamics simulations (MD) to enhance student abilities to understand the atomic processes governing plastic deformation in materials. The target population included a second-year undergraduate engineering course in the School of Materials Engineering at Purdue University. The objectives of the study were to…

  3. Improving Reading Strategies through an Understanding of Culture and Language.

    ERIC Educational Resources Information Center

    Wen, Xiaohong

    This paper contends that many of the difficulties students of Chinese have in reading comprehension are directly related to their level of understanding of Chinese language and culture, and that these difficulties could be alleviated by providing students with knowledge about the value system, social customs, formation of Chinese characters and…

  4. Understanding and Reducing Faculty Reluctance to Improve Teaching

    ERIC Educational Resources Information Center

    McCrickerd, Jennifer

    2012-01-01

    Many believe college instructors resist new teaching practices. In this article, the author develops a hypothesis to understand resistant faculty members, focusing on their likely educational experiences and on insights from psychology. Using Dweck's conception of self-theories and Fischer's conception of dynamic skill-theory, she defends the…

  5. Changing the Conversation: Messages for Improving Public Understanding of Engineering

    ERIC Educational Resources Information Center

    National Academies Press, 2008

    2008-01-01

    Can the United States continue to lead the world in innovation? The answer may hinge in part on how well the public understands engineering, a key component of the "innovation engine." A related concern is how to encourage young people--particularly girls and under-represented minorities--to consider engineering as a career option.…

  6. Standing in the Hallway Improves Students' Understanding of Conformity

    ERIC Educational Resources Information Center

    Lawson, Timothy J.; Haubner, Richard R.; Bodle, James H.

    2013-01-01

    To help beginning psychology students understand how they are influenced by social pressures to conform, we developed a demonstration designed to elicit their conformity to a small group of students standing in the hallway before class. Results showed the demonstration increased students' recognition of their own tendency to conform, knowledge of…

  7. Understanding and improving the Fermilab booster high field orbit

    SciTech Connect

    Chao, Y.; Ketcham, L.; Moore, C.D.

    1989-03-01

    This note is an account of the authors' effort in both understanding the Booster high field orbit and controlling it through displacements of the main combined function magnets. We were able to achieve the second goal with considerable accuracy while having limited success with the first, due to insufficient knowledge of the Booster dynamics. This work was initiated in Spring 1987 with the orbit control via magnet moves the chief purpose. A series of magnet moves in 1987 and 1988 resulting from this study testified to its reliability. The understanding of the Booster orbit in general remains an ongoing process in which we keep modifying our model with the hope of eventually having a quantitative grasp of the closed orbit and being able to manipulate it with more flexibility and accuracy. In this paper we give a brief description of the Booster environment in which the magnet moves are carried out, together with background information concerning the magnet moves. The method we use is discussed. The result of the moves is documented, and our effort to understand the Booster high field orbit is given a detailed account. 12 figs., 5 tabs.

  8. Hearing the patient's voice? Factors affecting the use of patient survey data in quality improvement

    PubMed Central

    Davies, E; Cleary, P

    2005-01-01

    Objective: To develop a framework for understanding factors affecting the use of patient survey data in quality improvement. Design: Qualitative interviews with senior health professionals and managers and a review of the literature. Setting: A quality improvement collaborative in Minnesota, USA involving teams from eight medical groups, focusing on how to use patient survey data to improve patient centred care. Participants: Eight team leaders (medical, clinical improvement or service quality directors) and six team members (clinical improvement coordinators and managers). Results: Respondents reported three types of barriers before the collaborative: organisational, professional and data related. Organisational barriers included lack of supporting values for patient centred care, competing priorities, and lack of an effective quality improvement infrastructure. Professional barriers included clinicians and staff not being used to focusing on patient interaction as a quality issue, individuals not necessarily having been selected, trained or supported to provide patient centred care, and scepticism, defensiveness or resistance to change following feedback. Data related barriers included lack of expertise with survey data, lack of timely and specific results, uncertainty over the effective interventions or time frames for improvement, and consequent risk of perceived low cost effectiveness of data collection. Factors that appeared to have promoted data use included board led strategies to change culture and create quality improvement forums, leadership from senior physicians and managers, and the persistence of quality improvement staff over several years in demonstrating change in other areas. Conclusion: Using patient survey data may require a more concerted effort than for other clinical data. Organisations may need to develop cultures that support patient centred care, quality improvement capacity, and to align professional receptiveness and leadership with

  9. Improving Access to and Understanding of Regulations through Taxonomies

    ERIC Educational Resources Information Center

    Cheng, Chin Pang; Lau. Gloria T.; Law, Kincho H.; Pan, Jiayi; Jones, Albert

    2009-01-01

    Industrial taxonomies have the potential to automate information retrieval, facilitate interoperability and, most importantly, improve decision making - decisions that must comply with existing government regulations and codes of practice. However, it is difficult to find those regulations and codes most relevant to a particular decision, even…

  10. Social Judgment Analysis: Methodology for Improving Interpersonal Communication and Understanding.

    ERIC Educational Resources Information Center

    Rohrbaugh, John; Harmon, Joel

    Research has found the Social Judgment Analysis (SJA) approach, with its focus on judgment policy and cognitive feedback, to be a significant factor in developing group member agreement and improving member performance. A controlled experiment was designed to assess the relative quality of the judgment making process provided by SJA.…

  11. Understanding Leadership Paradigms for Improvement in Higher Education

    ERIC Educational Resources Information Center

    Flumerfelt, Shannon; Banachowski, Michael

    2011-01-01

    Purpose: This research article is based on the Baldrige National Quality Program Education Criteria for Performance Excellence's conceptualization of improvement as a dual cycle/three element initiative of examining and bettering inputs, processes, and outputs as driven by measurement, analysis and knowledge management work. This study isolates a…

  12. A Practical Approach to Improving Pain Control in Cancer Patients

    PubMed Central

    Brigden, Malcolm L.; Barnett, Jeffrey B.

    1987-01-01

    Despite a wealth of recent articles, many patients with cancer pain continue to suffer needlessly. The satisfactory treatment of cancer pain requires a variety of practical management strategies. Practicing physicians need a wider understanding of both the basic principles of analgesic therapy and the pharmacologic features of analgesics. Certain analgesics are best not used in cancer care. The use of pharmacologic adjuncts may lessen overall narcotic requirements and side effects. The appropriate use of alternative therapies can dramatically improve the quality of patients' overall survival. PMID:2884781

  13. Understanding and working with the psychodynamics of practitioner-patient relationships in the manual therapies.

    PubMed

    Sher, Danny; Sher, Mannie

    2016-04-01

    In this paper, we argue that practitioner-patient relationships in the manual therapies would be strengthened by a deeper understanding of the psychodynamics and emotions of those relationships. We suggest that in many cases, a purely bio-mechanical approach may neglect underlying psychological and emotional reasons of the patient's presenting condition, and consequently, lead to a less than adequate outcome for the patient. We offer easily adopted suggestions that could enhance the practice of practitioners of manual therapies as well as other professions that rely on the application of physical methods of diagnosis and treatment. These suggestions could lead to improved prognosis and increased professional satisfaction for practitioners. This paper describes five key dynamics that characterize practitioner-patient relationships: (i) pain as a form of communication; (ii) the 'heart-sink' patient; (iii) dependency; (iv) the erotic transference; (v) endings and loss. PMID:27210846

  14. Using biological networks to improve our understanding of infectious diseases

    PubMed Central

    Mulder, Nicola J.; Akinola, Richard O.; Mazandu, Gaston K.; Rapanoel, Holifidy

    2014-01-01

    Infectious diseases are the leading cause of death, particularly in developing countries. Although many drugs are available for treating the most common infectious diseases, in many cases the mechanism of action of these drugs or even their targets in the pathogen remain unknown. In addition, the key factors or processes in pathogens that facilitate infection and disease progression are often not well understood. Since proteins do not work in isolation, understanding biological systems requires a better understanding of the interconnectivity between proteins in different pathways and processes, which includes both physical and other functional interactions. Such biological networks can be generated within organisms or between organisms sharing a common environment using experimental data and computational predictions. Though different data sources provide different levels of accuracy, confidence in interactions can be measured using interaction scores. Connections between interacting proteins in biological networks can be represented as graphs and edges, and thus studied using existing algorithms and tools from graph theory. There are many different applications of biological networks, and here we discuss three such applications, specifically applied to the infectious disease tuberculosis, with its causative agent Mycobacterium tuberculosis and host, Homo sapiens. The applications include the use of the networks for function prediction, comparison of networks for evolutionary studies, and the generation and use of host–pathogen interaction networks. PMID:25379138

  15. 3D printing of patient-specific anatomy: A tool to improve patient consent and enhance imaging interpretation by trainees.

    PubMed

    Liew, Yaoren; Beveridge, Erin; Demetriades, Andreas K; Hughes, Mark A

    2015-01-01

    We report the use of three-dimensional or 3D printed, patient-specific anatomy as a tool to improve informed patient consent and patient understanding in a case of posterior lumbar fixation. Next, we discuss its utility as an educational tool to enhance imaging interpretation by neurosurgery trainees. PMID:25822093

  16. Concepts first, jargon second improves student articulation of understanding.

    PubMed

    McDonnell, Lisa; Barker, Megan K; Wieman, Carl

    2016-01-01

    In this experiment, students in a large undergraduate biology course were first exposed to the concepts without new technical vocabulary ("jargon") in a pre-class reading assignment. Their learning of the concepts and jargon was compared with that of an equivalent group of students in another section of the same course, whose pre-class reading presented both the jargon and concepts together in the traditional manner. Both groups had the same active-learning classes with the same instructor, and then completed the same post-test. Although the two groups performed the same on the multiple choice questions of the post-test, the group exposed to concepts first and jargon second included 1.5 times and 2.5 times more correct arguments on two free-response questions about the concepts. The correct use of jargon between the two groups was similar, with the exception of one jargon term that the control group used more often. These results suggest that modest instructional changes whereby new concepts are introduced in a concepts-first, jargon-second manner can increase student learning, as demonstrated by their ability to articulate their understanding of new concepts. PMID:26537537

  17. Bootstrapping Q Methodology to Improve the Understanding of Human Perspectives

    PubMed Central

    Zabala, Aiora; Pascual, Unai

    2016-01-01

    Q is a semi-qualitative methodology to identify typologies of perspectives. It is appropriate to address questions concerning diverse viewpoints, plurality of discourses, or participation processes across disciplines. Perspectives are interpreted based on rankings of a set of statements. These rankings are analysed using multivariate data reduction techniques in order to find similarities between respondents. Discussing the analytical process and looking for progress in Q methodology is becoming increasingly relevant. While its use is growing in social, health and environmental studies, the analytical process has received little attention in the last decades and it has not benefited from recent statistical and computational advances. Specifically, the standard procedure provides overall and arguably simplistic variability measures for perspectives and none of these measures are associated to individual statements, on which the interpretation is based. This paper presents an innovative approach of bootstrapping Q to obtain additional and more detailed measures of variability, which helps researchers understand better their data and the perspectives therein. This approach provides measures of variability that are specific to each statement and perspective, and additional measures that indicate the degree of certainty with which each respondent relates to each perspective. This supplementary information may add or subtract strength to particular arguments used to describe the perspectives. We illustrate and show the usefulness of this approach with an empirical example. The paper provides full details for other researchers to implement the bootstrap in Q studies with any data collection design. PMID:26845694

  18. New Views of the Moon: Improved Understanding Through Data Integration

    NASA Technical Reports Server (NTRS)

    Jolliff, B. L.; Gaddis, L. R.; Ryder, G.; Neal, C. R.; Shearer, C. K.; Elphic, R. C.; Johnson, J. R.; Keller, L. P.; Korotev, R. L.; Lawrence, D. J.

    2000-01-01

    Understanding the Moon is crucial to future exploration of the solar system.The Moon preserves a record of the first billion years of the Earth-Moon system's history, including evidence of the Moon's origin as accumulated debris from a giant impact into early Earth. Lunar rocks provide evidence of early differentiation and extraction of a crust. Lacking an atmospheric shield, the Moon's regolith retains a record of the activity of solar wind over the past 4 billion years. It also holds a complete record of impact cratering, and analysis of samples has allowed calibration of ages, and thus dating of other planetary surfaces. And because of its proximity to Earth, it's low gravity well, and stable surface, the Moon's resources will be useful both in establishing lunar habitations and as fuel for exploration beyond the Moon. Lunar science has advanced tremendously in the 30 years since the Apollo and Luna missions. We know that the Moon is strongly differentiated, and recent tungsten isotope studies indicate that this differentiation occurred soon after solar system formation. The Moon probably accreted rapidly from debris that formed as a large planetesimal struck the early Earth. Ancient highland rocks provide evidence of early lunar differentiation, and basalts formed by later melting within the mantle reveal it cumulus nature. However, the timing, extent, and depth of differentiation, variations within the mantle, and lateral and vertical variations within the crust can only be surmised from the limited sample suites,gravity studies,and surface geophysics of the Apollo era. Data from the recent Lunar Prospector and Clementine missions permit reassessment of the global characteristics of the Moon and a reexamination of the distribution of elemental components, rock and soil types, and resources, as well as remanent magnetism, gravity field, and global topography New research provides some answers, but also leads to new questions.

  19. Mechanistic Understanding of Microbial Plugging for Improved Sweep Efficiency

    SciTech Connect

    Steven Bryant; Larry Britton

    2008-09-30

    Microbial plugging has been proposed as an effective low cost method of permeability reduction. Yet there is a dearth of information on the fundamental processes of microbial growth in porous media, and there are no suitable data to model the process of microbial plugging as it relates to sweep efficiency. To optimize the field implementation, better mechanistic and volumetric understanding of biofilm growth within a porous medium is needed. In particular, the engineering design hinges upon a quantitative relationship between amount of nutrient consumption, amount of growth, and degree of permeability reduction. In this project experiments were conducted to obtain new data to elucidate this relationship. Experiments in heterogeneous (layered) beadpacks showed that microbes could grow preferentially in the high permeability layer. Ultimately this caused flow to be equally divided between high and low permeability layers, precisely the behavior needed for MEOR. Remarkably, classical models of microbial nutrient uptake in batch experiments do not explain the nutrient consumption by the same microbes in flow experiments. We propose a simple extension of classical kinetics to account for the self-limiting consumption of nutrient observed in our experiments, and we outline a modeling approach based on architecture and behavior of biofilms. Such a model would account for the changing trend of nutrient consumption by bacteria with the increasing biomass and the onset of biofilm formation. However no existing model can explain the microbial preference for growth in high permeability regions, nor is there any obvious extension of the model for this observation. An attractive conjecture is that quorum sensing is involved in the heterogeneous bead packs.

  20. Vaccine adjuvants--understanding molecular mechanisms to improve vaccines.

    PubMed

    Egli, Adrian; Santer, Deanna; Barakat, Khaled; Zand, Martin; Levin, Aviad; Vollmer, Madeleine; Weisser, Maja; Khanna, Nina; Kumar, Deepali; Tyrrell, Lorne; Houghton, Michael; Battegay, Manuel; O'Shea, Daire

    2014-01-01

    Infectious pathogens are responsible for high utilisation of healthcare resources globally. Attributable morbidity and mortality remains exceptionally high. Vaccines offer the potential to prime a pathogen-specific immune response and subsequently reduce disease burden. Routine vaccination has fundamentally altered the natural history of many frequently observed and serious infections. Vaccination is also recommended for persons at increased risk of severe vaccine-preventable disease. Many current nonadjuvanted vaccines are poorly effective in the elderly and immunocompromised populations, resulting in nonprotective postvaccine antibody titres, which serve as surrogate markers for protection. The vaccine-induced immune response is influenced by: (i.) vaccine factors i.e., type and composition of the antigen(s), (ii.) host factors i.e., genetic differences in immune-signalling or senescence, and (iii.) external factors such as immunosuppressive drugs or diseases. Adjuvanted vaccines offer the potential to compensate for a lack of stimulation and improve pathogen-specific protection. In this review we use influenza vaccine as a model in a discussion of the different mechanisms of action of the available adjuvants. In addition, we will appraise new approaches using "vaccine-omics" to discover novel types of adjuvants. PMID:24844935

  1. Understanding improved osteoblast behavior on select nanoporous anodic alumina.

    PubMed

    Ni, Siyu; Li, Changyan; Ni, Shirong; Chen, Ting; Webster, Thomas J

    2014-01-01

    The aim of this study was to prepare different sized porous anodic alumina (PAA) and examine preosteoblast (MC3T3-E1) attachment and proliferation on such nanoporous surfaces. In this study, PAA with tunable pore sizes (25 nm, 50 nm, and 75 nm) were fabricated by a two-step anodizing procedure in oxalic acid. The surface morphology and elemental composition of PAA were characterized by field emission scanning electron microscopy and X-ray photoelectron spectroscopy analysis. The nanopore arrays on all of the PAA samples were highly regular. X-ray photoelectron spectroscopy analysis suggested that the chemistry of PAA and flat aluminum surfaces were similar. However, contact angles were significantly greater on all of the PAA compared to flat aluminum substrates, which consequently altered protein adsorption profiles. The attachment and proliferation of preosteoblasts were determined for up to 7 days in culture using field emission scanning electron microscopy and a Cell Counting Kit-8. Results showed that nanoporous surfaces did not enhance initial preosteoblast attachment, whereas preosteoblast proliferation dramatically increased when the PAA pore size was either 50 nm or 75 nm compared to all other samples (P<0.05). Thus, this study showed that one can alter surface energy of aluminum by modifying surface nano-roughness alone (and not changing chemistry) through an anodization process to improve osteoblast density, and, thus, should be further studied as a bioactive interface for orthopedic applications. PMID:25045263

  2. A systems approach to understanding and improving health systems.

    PubMed

    Erazo, Álvaro

    2015-09-01

    Health systems face the challenge of helping to improve health conditions. They occupy a priority place in middle- and lower-income countries, since the absence or fragility of health systems adversely impacts expected health outcomes. Thus, due to the direct relationship between programs and systems, the absence or weakness of either will result in a consequent deficiency in public health and the very execution of the programs. In the same vein, weakened health systems are one of the main bottlenecks to attaining the Millennium Development Goals. Systems thinking is one of the "four revolutions in progress" that are helping to transform health and health care systems. Within that framework, this article identifies conceptual and operational elements of systems applicable to health systems that contribute to overcoming the obstacles and inertia that hinder health activities and outcomes. It discusses relevant concepts characteristic of systems thinking, such as structural variables and dynamic complexity, the relationship between programs and health systems, and the monitoring and evaluation function, together with the role of innovation and systems integration as high-priority elements. This will aid in the development of designs that also stress the context of the components that guide management, identifying processes and outcomes in a health management continuum. PMID:26758004

  3. Understanding improved osteoblast behavior on select nanoporous anodic alumina

    PubMed Central

    Ni, Siyu; Li, Changyan; Ni, Shirong; Chen, Ting; Webster, Thomas J

    2014-01-01

    The aim of this study was to prepare different sized porous anodic alumina (PAA) and examine preosteoblast (MC3T3-E1) attachment and proliferation on such nanoporous surfaces. In this study, PAA with tunable pore sizes (25 nm, 50 nm, and 75 nm) were fabricated by a two-step anodizing procedure in oxalic acid. The surface morphology and elemental composition of PAA were characterized by field emission scanning electron microscopy and X-ray photoelectron spectroscopy analysis. The nanopore arrays on all of the PAA samples were highly regular. X-ray photoelectron spectroscopy analysis suggested that the chemistry of PAA and flat aluminum surfaces were similar. However, contact angles were significantly greater on all of the PAA compared to flat aluminum substrates, which consequently altered protein adsorption profiles. The attachment and proliferation of preosteoblasts were determined for up to 7 days in culture using field emission scanning electron microscopy and a Cell Counting Kit-8. Results showed that nanoporous surfaces did not enhance initial preosteoblast attachment, whereas preosteoblast proliferation dramatically increased when the PAA pore size was either 50 nm or 75 nm compared to all other samples (P<0.05). Thus, this study showed that one can alter surface energy of aluminum by modifying surface nano-roughness alone (and not changing chemistry) through an anodization process to improve osteoblast density, and, thus, should be further studied as a bioactive interface for orthopedic applications. PMID:25045263

  4. Caring for LGBTQ patients: Methods for improving physician cultural competence.

    PubMed

    Klein, Elizabeth W; Nakhai, Maliheh

    2016-05-01

    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. PMID:27497452

  5. Functional dysphonia: strategies to improve patient outcomes.

    PubMed

    Behlau, Mara; Madazio, Glaucya; Oliveira, Gisele

    2015-01-01

    Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient's perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient's recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for

  6. Improving outcomes in patients with psoriasis.

    PubMed

    Tidman, Michael J

    2013-01-01

    Psoriasis is a heterogeneous inflammatory disorder that targets the skin and joints. It affects 1.3-2% of the population. The diagnosis of plaque psoriasis is usually straightforward, a helpful diagnostic clue is the tendency for silver scales to appear after gentle scratching of a lesion. Stress, streptococcal infection and drugs including beta-blockers, antimalarials and lithium may precipitate or exacerbate psoriasis. Psoriasis, especially when severe, predisposes to metabolic syndrome, and patients with psoriasis are at increased risk of ischaemic heart disease, hypertension, stroke, type 2 diabetes and hyperlipidaemia. Additionally, psoriasis sufferers appear at increased risk of uveitis, inflammatory boweldisease, lymphoma, non-melanoma skin cancer, COPD and venous thromboembolism. Psoriasis should be assessed on the basis of: severity, impact on physical, psychological and social wellbeing, symptoms of arthritis and the presence of comorbidities. Poor response to topical therapy may be as much to do with lack of compliance as with lack of efficacy. The number of treatments each day should be kept to a minimum, and patients should be reviewed after four weeks when initiating or changing topical therapy to improve adherence to treatment and assess response. The majority of patients with psoriasis can be managed in primary care, although specialist care may be necessary at some point in up to 60% of cases. Patients with erythrodermic or generalised pustular psoriasis should be referred for a same day dermatological opinion, and if psoriatic arthritis is suspected, early referral for a rheumatological opinion is recommended. PMID:23469725

  7. Understanding Goals of Care Statements and Preferences among Patients and Their Surrogates in the Medical ICU.

    PubMed

    Brandt, Debra S; Shinkunas, Laura A; Gehlbach, Thomas G; Kaldjian, Lauris C

    2012-03-01

    BACKGROUND: Treatment decisions should be based on patients' goals of care to provide an ethical, patient-centered framework for decision-making. OBJECTIVES: The purpose of this study is to improve our understanding about how patients' and surrogates' goals of care are communicated and interpreted in an MICU. METHODS: One hundred patients admitted to an MICU, or their surrogates, responded to an open-ended question about goals of care for their hospitalization followed by a closed-ended question regarding their most important goal of care. Investigators interpreted participants' open-ended responses and compared these interpretations with participants' closed-ended, most-important-goal selections. RESULTS: Investigators' interpretations of participants' open-ended goals of care responses matched participants' closed-ended most important goal of care in only 28 of 100 cases. However, there was good inter-rater reliability between investigators in their interpretation of participants' open-ended responses, with agreement in 78 of 100 cases. CONCLUSIONS: Clinicians should be cautious in interpreting patients' or surrogates' responses to open-ended questions about goals of care. A shared understanding of goals of care may be facilitated by alternating open-ended and closed-ended questions to clarify patients' or surrogates' responses. PMID:22423214

  8. Improving acute care for patients with dementia.

    PubMed

    Simpson, Kate

    People with dementia are more likely to experience a decline in function, fall or fracture when admitted to hospital than the general hospital population. Informal carers' views were sought on the care their relative with dementia received in hospital. Participants were concerned about a lack of essential nursing care, harmful incidents, a decline in patient function, poor staff communication and carers' needs not being acknowledged. Care can be improved through further training, more effective communication, consideration of the appropriate place to care for people and more use of carers' knowledge. PMID:27017677

  9. Improving communication among nurses and patients.

    PubMed

    Unluturk, Mehmet S; Ozcanhan, Mehmet H; Dalkilic, Gokhan

    2015-07-01

    Patients use nurse call systems to signal nurses for medical help. Traditional push button-flashing lamp call systems are not integrated with other hospital automation systems. Therefore, nurse response time becomes a matter of personal discretion. The improvement obtained by integrating a pager system into the nurse call systems does not increase care efficiency, because unnecessary visits are still not eliminated. To obtain an immediate response and a purposeful visit by a nurse; regardless of the location of nurse in hospital, traditional systems have to be improved by intelligent telephone system integration. The results of the developed Nurse Call System Software (NCSS), the Wireless Phone System Software (WPSS), the Location System Software (LSS) and the communication protocol are provided, together with detailed XML message structures. The benefits of the proposed system are also discussed and the direction of future work is presented. PMID:25935361

  10. An Evaluation of Understandability of Patient Journey Models in Mental Health

    PubMed Central

    2016-01-01

    Background There is a significant trend toward implementing health information technology to reduce administrative costs and improve patient care. Unfortunately, little awareness exists of the challenges of integrating information systems with existing clinical practice. The systematic integration of clinical processes with information system and health information technology can benefit the patients, staff, and the delivery of care. Objectives This paper presents a comparison of the degree of understandability of patient journey models. In particular, the authors demonstrate the value of a relatively new patient journey modeling technique called the Patient Journey Modeling Architecture (PaJMa) when compared with traditional manufacturing based process modeling tools. The paper also presents results from a small pilot case study that compared the usability of 5 modeling approaches in a mental health care environment. Method Five business process modeling techniques were used to represent a selected patient journey. A mix of both qualitative and quantitative methods was used to evaluate these models. Techniques included a focus group and survey to measure usability of the various models. Results The preliminary evaluation of the usability of the 5 modeling techniques has shown increased staff understanding of the representation of their processes and activities when presented with the models. Improved individual role identification throughout the models was also observed. The extended version of the PaJMa methodology provided the most clarity of information flows for clinicians. Conclusions The extended version of PaJMa provided a significant improvement in the ease of interpretation for clinicians and increased the engagement with the modeling process. The use of color and its effectiveness in distinguishing the representation of roles was a key feature of the framework not present in other modeling approaches. Future research should focus on extending the pilot

  11. Listening to patients with cancer: using a literary-based research method to understand patient-focused care

    PubMed Central

    Begley, Amanda; Pritchard-Jones, Kathy; Biriotti, Maurice; Kydd, Anna; Burdsey, Tim; Townsley, Emma

    2014-01-01

    Objective In spite of considerable attention, patients diagnosed with cancer continue to report poor experiences of care. The root causes of this remain unclear. This exploratory study aimed to investigate new ways of understanding the experience of patients with cancer, using a literary-based research approach. Design Interviews were undertaken with four patients diagnosed with high-grade brain cancers at least 6 months from diagnosis and with people (n=5) identified by the patients as important in their care pathway. Interview transcripts were analysed by humanities academics as pieces of literature, where each patient's story was told from more than one person's perspective. The academics then came together in a facilitated workshop to agree major themes within the patient experiences. The themes were presented at a patient and carer event involving 70 participants to test the validity of the insights. Results Insights into the key issues for patients with cancer could be grouped into six themes: accountability; identity; life context; time; language; rigour and emotion. Patients often held a different perspective to the traditionally held medical views of what constitutes good care. For example, patients did not see any conflict between a doctor having scientific rigour and portraying emotion. Conclusions One key feature of the approach was its comparative nature: patients often held different views from those traditionally held by physicians of what constitutes health and good outcomes. This revealed aspects that may be considered by healthcare professionals when designing improvements. Proposals for further testing are discussed, with a particular emphasis on the need for sensitivity to individual differences in experiences. PMID:25324319

  12. Health innovation for patient safety improvement.

    PubMed

    Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

    2013-01-01

    Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare. PMID:23423150

  13. Functional dysphonia: strategies to improve patient outcomes

    PubMed Central

    Behlau, Mara; Madazio, Glaucya; Oliveira, Gisele

    2015-01-01

    Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for

  14. Expecting Understanding, Understanding Expectations: Continuing Medical Education and the Doctor-Patient Relationship.

    ERIC Educational Resources Information Center

    Frenette, Jacques; Sindon, Andre; Jacques, Andre; Lalonde, Viateur; Belisle, Claude

    1998-01-01

    A continuing medical education course on the physician-patient relationship used on such topics as patient-centered interviews. A majority of 406 respondents (including 205 in a follow-up survey) were using what they learned in practice. Additional workshops on issues of intimacy and difficult relationships were developed. (SK)

  15. Early Palliative Care Improves Patients' Quality of Life

    MedlinePlus

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end- ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also ...

  16. Understanding the factors that influence patient satisfaction with ambulance services.

    PubMed

    Bogomolova, Svetlana; Tan, P J; Dunn, S P; Bizjak-Mikic, M

    2016-01-01

    The quality of ambulance services has an immense impact on patients' future well-being and quality of life. Patient satisfaction is one of the key metrics for evaluating the quality of this service. Yet, the patient satisfaction measurement may be limited in its ability to accurately reflect this service quality, and even reflect factors beyond the patient experiences. We analyze 10 years of survey data to reveal a number of factors that systematically bias ambulance satisfaction ratings. Taking into account these biases provides more robust comparison of ambulance performance over time or across different jurisdictions. PMID:27295008

  17. Understanding the conditions for improvement: research to discover which context influences affect improvement success.

    PubMed

    Øvretveit, John

    2011-04-01

    Context can be defined as all factors that are not part of a quality improvement intervention itself. More research indicates which aspects are 'conditions for improvement', which influence improvement success. However, little is known about which conditions are most important, whether these are different for different quality interventions or whether some become less or more important at different times in carrying out an improvement. Knowing more about these conditions could help speed up and spread improvements and develop the science. This paper proposes ways to build knowledge about the conditions needed for different changes, and to create conditional-attribution explanations to provide qualified generalisations. It describes theory-based, non-experimental research designs. It also suggests that 'practical improvers' can make their changes more effective by reflecting on and revising their own 'assumption-theories' about the conditions which will help and hinder the improvements they aim to implement. PMID:21450764

  18. Improving patient safety by examining pathology errors.

    PubMed

    Raab, Stephen S

    2004-12-01

    A considerable void exists in the information available regarding anatomic pathology diagnostic errors and their impact on clinical outcomes. To fill this void and improve patient safety, four institutional pathology departments (University of Pittsburgh, Western Pennsylvania Hospital, University of Iowa Hospitals and Clinics, and Henry Ford Hospital System) have proposed the development of a voluntary, Web-based, multi-institutional database for the collection and analysis of diagnostic errors. These institutions intend to use these data proactively to implement internal changes in pathology practice and to measure the effect of such changes on errors and clinical outcomes. They believe that the successful implementation of this project will result in the study of other types of diagnostic pathology error and the expansion to national participation. The project will involve the collection of multi-institutional anatomic pathology diagnostic errors in a large database that will facilitate a more detailed analysis of these errors, including their effect on patient outcomes. Participating institutions will perform root cause analysis for diagnostic errors and plan and execute appropriate process changes aimed at error reduction. The success of these interventions will be tracked through analysis of postintervention error data collected in the database. Based on their preliminary studies, these institutions proposed the following specific aims: Specific aim #1: To use a Web-based database to collect diagnostic errors detected by cytologic histologic correlation and by second-pathologist review of conference cases. Specific aim #2: To analyze the collected error data quantitatively and generate quality performance reports that are useful for institutional quality improvement programs. Specific aim #3: To plan and implement interventions to reduce errors and improve clinical outcomes, based on information derived from root cause analysis of diagnostic errors. Specific

  19. Understanding the Code: exceptions to the duty of patient confidentiality.

    PubMed

    Griffith, Richard

    2015-07-01

    Last month's article considered the scope of a district nurse's duty to maintain the confidentiality of patient information under the Nursing and Midwifery Council (NMC) Code, their contract of employment, and the law. This month, Richard Griffith considers the exceptions to these duties and sets out when a district nurse would be justified in disclosing patient information. PMID:26140322

  20. Understanding diabetes in patients with HIV/AIDS

    PubMed Central

    2011-01-01

    This paper reviews the incidence, pathogenetic mechanisms and management strategies of diabetes mellitus in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). It classifies patients based on the aetiopathogenetic mechanisms, and proposes rational methods of management of the condition, based on aetiopathogenesis and concomitant pharmacotherapy. PMID:21232158

  1. Understanding the Transformation of Compassion in Nurses Who Become Patients

    ERIC Educational Resources Information Center

    Pucino, Carrie L.

    2013-01-01

    The purpose of this study was to examine how nurses who become patients learn compassion toward patients in their professional practice, and examine the role of empathy in the process of learning compassion. The process of learning compassion represents a significant change in the way nurses perceive this aspect of practice. Therefore,…

  2. Understanding the impact of pulmonary arterial hypertension on patients' and carers' lives.

    PubMed

    Guillevin, Loïc; Armstrong, Iain; Aldrighetti, Rino; Howard, Luke S; Ryftenius, Henrik; Fischer, Aryeh; Lombardi, Sandra; Studer, Sean; Ferrari, Pisana

    2013-12-01

    Pulmonary arterial hypertension (PAH) is a rare, debilitating and rapidly progressive disease. Although there have been important medical advances in PAH management, the search for a cure continues. Despite an increased understanding of the disease, data on the wider effect of PAH on patients and carers, beyond the clinical symptoms, are still limited. In order to explore this, a large-scale international survey investigated four key areas affected by PAH (physical and practical, emotional, social, and information needs) and provides new insight into patients' and carers' experiences of living with the disease. The results from the survey highlight not only the limited ability of patients to carry out everyday tasks, but also the financial impact and social isolation experienced by both patients and carers. The study confirmed that a decline in a patient's World Health Organization functional class, which indicates an increase in clinical severity of the disease, is associated with greater limitations. Results from the survey demonstrate the need for multidisciplinary PAH management and a comprehensive standard of care to assess and improve all aspects of well-being for both patients and carers. In addition, they underline the need for updated PAH guidelines that address these needs. PMID:24293469

  3. Understanding and Utilizing Patient Preferences in Cancer Treatment Decisions.

    PubMed

    Ubel, Peter A

    2016-05-01

    Shared decision-making is a complex endeavor that should take into account the patient's personal preferences regarding treatment options. To truly empower patients to be partners in decision-making, especially in situations in which their preferences are important, physicians must learn to communicate better and to distinguish between what is "medical fact" versus a "value judgement." Knowing what are, when to ask, and how to ask the right questions will help physicians be effective in guiding patients toward the right treatments. PMID:27226516

  4. Understanding the conditions for improvement: research to discover which context influences affect improvement success

    PubMed Central

    2011-01-01

    Context can be defined as all factors that are not part of a quality improvement intervention itself. More research indicates which aspects are ‘conditions for improvement’, which influence improvement success. However, little is known about which conditions are most important, whether these are different for different quality interventions or whether some become less or more important at different times in carrying out an improvement. Knowing more about these conditions could help speed up and spread improvements and develop the science. This paper proposes ways to build knowledge about the conditions needed for different changes, and to create conditional-attribution explanations to provide qualified generalisations. It describes theory-based, non-experimental research designs. It also suggests that ‘practical improvers’ can make their changes more effective by reflecting on and revising their own ‘assumption-theories’ about the conditions which will help and hinder the improvements they aim to implement. PMID:21450764

  5. Improving Graphing Interpretation Skills and Understanding of Motion Using Microcomputer Based Laboratories.

    ERIC Educational Resources Information Center

    Svec, Michael

    1999-01-01

    Examines the relative effectiveness of the traditional lab method and the microcomputer-based laboratory (MBL) for improving student understanding. Examines three areas of achievement: graphing interpretation skills, and interpreting motion graphs and understanding of motion. Results indicate that MBL laboratories are more effective than…

  6. Understanding Student and Faculty Life. Using Campus Surveys to Improve Academic Decision Making.

    ERIC Educational Resources Information Center

    Baird, Leonard L.; And Others

    A comprehensive guide to the use of environmental assessments for understanding and improving student and faculty life is presented. Environmental assessments are examined as tools for academic decision-makers in understanding the extent and quality of the communication among its members, their sense of community, their emphasis on academic rigor,…

  7. Understanding cultural difference in caring for dying patients.

    PubMed Central

    Koenig, B A; Gates-Williams, J

    1995-01-01

    Experiences of illness and death, as well as beliefs about the appropriate role of healers, are profoundly influenced by patients' cultural background. As the United States becomes increasingly diverse, cultural difference is a central feature of many clinical interactions. Knowledge about how patients experience and express pain, maintain hope in the face of a poor prognosis, and respond to grief and loss will aid health care professionals. Many patients' or families' beliefs about appropriate end-of-life care are easily accommodated in routine clinical practice. Desires about the care of the body after death, for example, generally do not threaten deeply held values of medical science. Because expected deaths are increasingly the result of explicit negotiation about limiting or discontinuing therapies, however, the likelihood of serious moral disputes and overt conflict increases. We suggest a way to assess cultural variation in end-of-life care, arguing that culture is only meaningful when interpreted in the context of a patient's unique history, family constellation, and socioeconomic status. Efforts to use racial or ethnic background as simplistic, straightforward predictors of beliefs or behavior will lead to harmful stereotyping of patients and culturally insensitive care for the dying. PMID:7571587

  8. Understanding the will to live in patients nearing death.

    PubMed

    Chochinov, Harvey Max; Hack, Thomas; Hassard, Thomas; Kristjanson, Linda J; McClement, Susan; Harlos, Mike

    2005-01-01

    This study examined concurrent influences on the will to live in 189 patients with end-stage cancer The authors found significant correlations between the will to live and existential, psychological, social, and, to a lesser degree, physical sources of distress. Existential variables proved to have the most influence, with hopelessness, burden to others, and dignity entering into the final model. Health care providers must learn to appreciate the importance of existential issues and their ability to influence the will to live among patients nearing death. PMID:15765815

  9. Improving Marking Reliability of Scientific Writing with the Developing Understanding of Assessment for Learning Programme

    ERIC Educational Resources Information Center

    Bird, Fiona L.; Yucel, Robyn

    2013-01-01

    The Developing Understanding of Assessment for Learning (DUAL) programme was developed with the dual aims of improving both the quality and consistency of feedback students receive and the students' ability to use that feedback to improve. DUAL comprises a range of processes (including marking rubrics, sample reports, moderation discussions and…

  10. Improving the revenue cycle by taking the patient's perspective.

    PubMed

    Langford, April; Dye, Lyda; Moresco, Jessica; Riefner, Donald C

    2010-09-01

    UPMC revenue cycle operations analyzed front-end processes to improve them, thereby also improving the patient experience. UPMC focused on scheduling, eligibility/insurance verification, and financial counseling to develop an integrated work flow ensuring data integrity and expediting account resolution. Automating the processes increased efficiency and reduced errors, while improving patient satisfaction. PMID:20831000

  11. Improving patient flow at a family health clinic.

    PubMed

    Bard, Jonathan F; Shu, Zhichao; Morrice, Douglas J; Wang, Dongyang Ester; Poursani, Ramin; Leykum, Luci

    2016-06-01

    This paper presents an analysis of a residency primary care clinic whose majority of patients are underserved. The clinic is operated by the health system for Bexar County and staffed primarily with physicians in a three-year Family Medicine residency program at The University of Texas School of Medicine in San Antonio. The objective of the study was to obtain a better understanding of patient flow through the clinic and to investigate changes to current scheduling rules and operating procedures. Discrete event simulation was used to establish a baseline and to evaluate a variety of scenarios associated with appointment scheduling and managing early and late arrivals. The first steps in developing the model were to map the administrative and diagnostic processes and to collect time-stamped data and fit probability distributions to each. In conjunction with the initialization and validation steps, various regressions were performed to determine if any relationships existed between individual providers and patient types, length of stay, and the difference between discharge time and appointment time. The latter two statistics along with resource utilization and closing time were the primary metrics used to evaluate system performance.The results showed that up to an 8.5 % reduction in patient length of stay is achievable without noticeably affecting the other metrics by carefully adjusting appointment times. Reducing the no-show rate from its current value of 21.8 % or overbooking, however, is likely to overwhelm the system's resources and lead to excessive congestion and overtime. Another major finding was that the providers are the limiting factor in improving patient flow. With an average utilization rate above 90 % there is little prospect in shortening the total patient time in the clinic without reducing the providers' average assessment time. Finally, several suggestions are offered to ensure fairness when dealing with out-of-order arrivals. PMID:25155098

  12. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes

    PubMed Central

    Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

    2015-01-01

    Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. PMID:25324556

  13. Understanding situation awareness and its importance in patient safety.

    PubMed

    Gluyas, Heather; Harris, Sarah-Jane

    2016-04-20

    Situation awareness describes an individual's perception, comprehension and subsequent projection of what is going on in the environment around them. The concept of situation awareness sits within the group of non-technical skills that include teamwork, communication and managing hierarchical lines of communication. The importance of non-technical skills has been recognised in safety-critical industries such as aviation, the military, nuclear, and oil and gas. However, health care has been slow to embrace the role of non-technical skills such as situation awareness in improving outcomes and minimising the risk of error. This article explores the concept of situation awareness and the cognitive processes involved in maintaining it. In addition, factors that lead to a loss of situation awareness and strategies to improve situation awareness are discussed. PMID:27097212

  14. Patient-centered medicine and patient-oriented research: improving health outcomes for individual patients

    PubMed Central

    2013-01-01

    Background Patient-centered medicine is developing alongside the concepts of personalized medicine and tailored therapeutics. The main objective of patient-centered medicine is to improve health outcomes of individual patients in everyday clinical practice, taking into account the patient’s objectives, preferences, values as well as the available economic resources. Discussion Patient-centered medicine implies a paradigm shift in the relationship between doctors and patients, but also requires the development of patient-oriented research. Patient-oriented research should not be based on the evaluation of medical interventions in the average patient, but on the identification of the best intervention for every individual patient, the study of heterogeneity and the assignment of greater value to observations and exceptions. The development of information-based technologies can help to close the gap between clinical research and clinical practice, a fundamental step for any advance in this field. Summary Evidence-based medicine and patient centered medicine are not contradictory but complementary movements. It is not possible to practice patient-centered medicine that is not based on evidence, nor is it possible to practice evidence-based medicine at a distance from the individual patient. PMID:23294526

  15. Improving patient-centered care through advance care planning.

    PubMed

    Motley, Molly

    2013-06-01

    Advance care planning is crucial for patients confronting incurable, debilitating, or terminal disease. Discussing end-of-life issues can reduce overtreatment and undertreatment as defined by the patient, and improve satisfaction with care. PMID:23805592

  16. Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer.

    PubMed

    Annam, Kiran; Voznesensky, Maria; Kreder, Karl J

    2016-04-01

    Cancer can cause sexual adverse effects by direct and indirect pathways. It can involve sexual organs, indirectly affect body image, or cause fatigue or depression with subsequent effects on libido. Erectile dysfunction (ED), the inability to obtain or maintain an erection firm enough for sexual intercourse, can also result from adverse effects of cancer treatment, such as fatigue, pain, or anxiety about therapy. In addition, depressed feelings about having cancer can affect sexuality, causing a range of signs and symptoms that can lead to ED. Chemotherapy, hormone therapy, surgery, and radiation can all cause sexual adverse effects. Additional factors that play a role include patient age and degree of ED before starting cancer treatment. In this article, we discuss how chemotherapy, hormone therapy, surgery, and radiation affect erectile function as well as possible treatment options for ED. PMID:27072383

  17. Look Through Patients' Eyes to Improve the Delivery of Care.

    PubMed

    2016-07-01

    By developing and implementing a method for seeing the healthcare experience from the standpoint of patients and family members, the University of Pittsburgh Medical Center has improved care delivery, lowered costs, and improved patient satisfaction. Cross-functional, multidisciplinary teams use a six-step patient and family-centered care methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes. Committee members shadow patients and family members to get firsthand knowledge about what they are going through and what goes wrong and what goes right. The teams proposed minor and major changes, but none involve adding more staff and few involve more expenditures. PMID:27434940

  18. Improved patient pathways can prevent overcrowding.

    PubMed

    Emeny, Russell; Vincent, Connolly

    2013-03-01

    Emergency department (ED) crowding is a common problem throughout the western world. Not only does crowding create a miserable environment for patients, and to considerable stress and poor job satisfaction among staff, it can also lead EDs to breach the four-hour standard and other care quality indicators. In addition, crowding in EDs correlates with increases in patient mortality, rates of admission, lengths of inpatient stay and costs. This article argues that crowding is best tackled by the consistent application of eight principles, derived from various guidance, to emergency patient pathways, particularly those in acute settings. PMID:23586168

  19. Understanding and Managing Pregnancy in Patients with Lupus

    PubMed Central

    de Jesus, Guilherme Ramires; Mendoza-Pinto, Claudia; de Jesus, Nilson Ramires; dos Santos, Flávia Cunha; Klumb, Evandro Mendes; Carrasco, Mario García; Levy, Roger Abramino

    2015-01-01

    Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE. The risk of flares depends on the level of maternal disease activity in the 6–12 months before conception and is higher in women with repeated flares before conception, in those who discontinue useful medications and in women with active glomerulonephritis at conception. It is a challenge to differentiate lupus nephritis from preeclampsia and, in this context, the angiogenic and antiangiogenic cytokines are promising. Prenatal care of pregnant patients with SLE requires close collaboration between rheumatologist and obstetrician. Planning pregnancy is essential to increase the probability of successful pregnancies. PMID:26246905

  20. Understanding male cancer patients' barriers to participating in cancer rehabilitation.

    PubMed

    Handberg, C; Lomborg, K; Nielsen, C V; Oliffe, J L; Midtgaard, J

    2015-11-01

    The aim was to describe male cancer survivors' barriers towards participation in cancer rehabilitation as a means to guiding future targeted men's cancer rehabilitation. Symbolic Interactionism along with the interpretive descriptive methodology guided the study of 35 male cancer survivors representing seven cancer types. Data were generated through a 5-month fieldwork study comprising participant observations, semi-structured individual interviews and informal conversations. The analyses revealed two overarching findings shedding light on male cancer survivors' barriers to rehabilitation: 'Fear of losing control' and 'Striving for normality'. While 'Fear of losing control' signified what the men believed rehabilitation would invoke: 'Reduced manliness', 'Sympathy and dependency' and 'Confrontation with death', 'Striving for normality' was based on what the men believed rehabilitation would hinder: 'Autonomy and purpose', 'Solidarity and fellowship' and 'Forget and move on'. This study of male cancer survivors' and cancer rehabilitation documents how masculine ideals may constitute barriers for participation in rehabilitation and provides insights about why men are underrepresented in rehabilitation. The findings can guide practice to develop research-based rehabilitation approaches focused on preserving control and normality. Further empirical evidence is needed to: (1) explore the conduct of health professionals' towards male cancer patients and (2) address gender inequalities in cancer rehabilitation. PMID:26223855

  1. Leadership: improving the quality of patient care.

    PubMed

    Clegg, A

    The satisfaction staff achieve from their work is in part determined by the style of management they work under. This article analyses the impact of a proactive leadership style on team performance and the quality of patient care. PMID:11973895

  2. Improving patient safety: lessons from other disciplines.

    PubMed

    Golemboski, Karen

    2011-01-01

    Other industries and certain healthcare specialties have employed a variety of methods to improve safety and quality of services. Techniques such as industry-wide standardized collection and reporting of error data, standardization of practice through checklists, application of electronic health records, and simulator-based interdisciplinary training have improved outcomes in aviation, anesthesiology, and surgery. Although traditionally the clinical laboratory has concentrated on analytical performance, pre- and post-analytical aspects of laboratory services may also be improved through the application of these methods. PMID:21657145

  3. Understanding the purpose of treatment and expectations in patients with inoperable lung cancer treated with palliative chemotherapy

    PubMed Central

    Woźniak, Karolina; Krajnik, Małgorzata

    2015-01-01

    Aim of the study Informing cancer patients about various types of treatment and their adverse effects and communicating negative information is an important element of diagnostic and therapeutic procedures. Understanding the purpose of treatment and expectations, and socio-demographic factors in patients undergoing palliative chemotherapy because of lung cancer. Material and methods The study included 100 patients with lung cancer at the age of 40–80 years (mean 63.1) in the Oncology Center in Bydgoszcz in 2013–2014. The diagnostic survey method with the author's questionnaire was used. Results Forty-one percent of patients were convinced that the purpose of chemotherapy is to cure the disease. Both inhabitants of small towns (population below 50 thousand) and large villages (p = 0.09) were similarly convinced about the effectiveness of chemotherapy. Seventy-three percent of inhabitants of small towns and 79% of country dwellers (p = 0.005) thought that chemotherapy is aimed at improving the quality of life. Patients with very good economic conditions responded that chemotherapy is designed to improve the quality of life more often than those with good and bad economic conditions, 90%, 88% and 60%, respectively (p = 0.001). With the increase in population the number of people who claimed that palliative chemotherapy prolongs their life increased, 71%, 77% and 90%, respectively (p = 0.03). Conclusions The knowledge of patients with lung cancer about palliative chemotherapy is insufficient. Almost half of them do not understand the purpose of treatment and hope that chemotherapy will cure them of the disease. Most patients know that the aim of chemotherapy is to alleviate symptoms and improve quality of life and prolong their life. Half of the patients want to obtain information on treatment and half of them about life expectancy. Almost half of the patients feel stress and anxiety towards chemotherapy. Most patients do not use the help of a psychologist and do

  4. Using Digital Multimedia to Improve Parents’ and Children’s Understanding of Clinical Trials

    PubMed Central

    Tait, Alan R.; Voepel-Lewis, Terri; Levine, Robert

    2015-01-01

    Objective Data show that many research subjects have difficulty understanding study information using traditional paper consent documents. This study, therefore, was designed to evaluate the effect of an interactive multimedia program on improving parents’ and children’s understanding of clinical trial concepts and participation. Methods Parents (n = 148) and children (n = 135) were each randomized to receive information regarding clinical trials using either a traditional paper format (TF) or an interactive iPad program (IP) with in-line exercises. Participants’ understanding of the information was assessed using semi-structured interviews prior to (pre-test) and after (post-test) receiving the information. Participants also completed a short survey to assess their perceptions of the information delivery and satisfaction with the process. Results Regardless of the mode of information delivery, all participants demonstrated improved pre- to post-test understanding. While there were no statistical differences in parents’ post-test understanding between the TF and IP groups, children in the IP group had significantly greater post-test understanding compared with children in the TF group (11.65(4.1) vs 8.85(4.1) [2.8, 1.4,4.2] 0–18 scale where 18 = complete understanding). Furthermore, the IP was found to be significantly “easier to follow” and “more effective” in presenting information compared with the TF. Conclusions Results demonstrated the importance of providing information regarding clinical trial concepts to parents and children. Importantly, the ability of interactive multimedia to improve understanding of clinical trial concepts and satisfaction with information delivery, particularly among children, supports this approach as a novel and effective vehicle for enhancing the informed consent process. PMID:25829422

  5. Confirming delivery: understanding the role of the hospitalized patient in medication administration safety.

    PubMed

    Macdonald, Marilyn T; Heilemann, MarySue V; MacKinnon, Neil J; Lang, Ariella; Gregory, David; Gurnham, Mary Ellen; Fillatre, Theresa

    2014-04-01

    The purpose of our study was to gain an understanding of current patient involvement in medication administration safety from the perspectives of both patients and nursing staff members. Administering medication is taken for granted and therefore suited to the development of theory to enhance its understanding. We conducted a constructivist, grounded theory study involving 24 patients and 26 nursing staff members and found that patients had the role of confirming delivery in the administration of medication. Confirming delivery was characterized by three interdependent subprocesses: engaging in the medication administration process, being "half out of it" (patient mental status), and perceiving time. We believe that ours is one of the first qualitative studies on the role of hospitalized patients in administering medication. Medication administration and nursing care systems, as well as patient mental status, impose limitations on patient involvement in safe medication administration. PMID:24598773

  6. Improving the Conceptual Understanding in Kinematics Subject Matter with Hypertext Media Learning and Formal Thinking

    ERIC Educational Resources Information Center

    Manurung, Sondang R.; Mihardi, Satria

    2016-01-01

    The purpose of this study was to determine the effectiveness of hypertext media based kinematic learning and formal thinking ability to improve the conceptual understanding of physic prospective students. The research design used is the one-group pretest-posttest experimental design is carried out in the research by taking 36 students on from…

  7. A Hands-On Exercise Improves Understanding of the Standard Error of the Mean

    ERIC Educational Resources Information Center

    Ryan, Robert S.

    2006-01-01

    One of the most difficult concepts for statistics students is the standard error of the mean. To improve understanding of this concept, 1 group of students used a hands-on procedure to sample from small populations representing either a true or false null hypothesis. The distribution of 120 sample means (n = 3) from each population had standard…

  8. Improving the Quality and Scientific Understanding of Trophic Magnification Factors (TMFs)

    EPA Science Inventory

    This short 1000 word report presents a series of research needs for improving the measurement and understanding of trophic magnification factors (TMFs). TMFs are useful measures of trophic magnification and represent the diet-weighted average biomagnification factor (BMF) of che...

  9. A Review of Some Promising Approaches To Understanding and Improving Thinking Skills.

    ERIC Educational Resources Information Center

    Newsome, George L., III

    2000-01-01

    Examines the thinking and reasoning skills today's students need, reviewing promising approaches to understanding and improving these skills offered by cognitive psychologists and philosophers, evaluating the contributions of each approach, and suggesting how explanations offered by cognitive psychologists and criteria for evaluating students'…

  10. Scaffolded Instruction Improves Student Understanding of the Scientific Method & Experimental Design

    ERIC Educational Resources Information Center

    D'Costa, Allison R.; Schlueter, Mark A.

    2013-01-01

    Implementation of a guided-inquiry lab in introductory biology classes, along with scaffolded instruction, improved students' understanding of the scientific method, their ability to design an experiment, and their identification of experimental variables. Pre- and postassessments from experimental versus control sections over three semesters…

  11. Improving Food Safety by Understanding the Evolution of Egg-contaminating Salmonella Enteritidis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Improving Food Safety by Understanding the Evolution of Egg-contaminating Salmonella Enteritidis Jean Guard, Veterinary Medical Officer U. S. Department of Agriculture, Athens, GA USA (jean.guard@ars.usda.gov) The curious case of egg contamination by Salmonella enterica serovar Enteritidis S. ...

  12. Inventory of Federal Programs Involving Educational Activities Concerned with Improving International Understanding and Cooperation.

    ERIC Educational Resources Information Center

    Johnson, Janice M.; Hohman, David E.

    This inventory contains the results of a survey of all Federal programs for fiscal years 1966, 1967, and 1968 that included educational activities aimed at improving international understanding and cooperation. A total of 159 such programs were reported by 31 responding Federal agencies. This inventory contains the following information for each…

  13. Social and Economic Benefits of Improved Adult Literacy: Towards a Better Understanding: Support Document

    ERIC Educational Resources Information Center

    Hartley, Robyn; Horne, Jackie

    2005-01-01

    This document was produced by the authors based on their research for the report, "Social and Economic Benefits of Improved Adult Literacy: Towards a Better Understanding," and is an added resource for further information. The original document is a feasibility study which explores the frameworks and methodologies available for determining and…

  14. Book review: Darwinian agriculture: How understanding evolution can improve agriculture by R. Ford Dennison

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Agricultural research continually seeks to increase productivity while protecting soil, water and genetic resources. The book Darwinian Agriculture: How Understanding Evolution Can Improve Agriculture, by R. Ford Dennison, delivers a thought-provoking view of how principles of ecology and evolution ...

  15. Understanding the Evolving Roles of Improvement-Oriented High School Teachers in Gilgit-Baltistan

    ERIC Educational Resources Information Center

    Ali, Takbir

    2011-01-01

    In this paper the author presents a framework for understanding how improvement-oriented high school teachers' accounts of change experiences portray their evolving roles as change agents in school reform. The data on which this paper is based come from a one-year long in-depth study (doctoral thesis research project) in which the author set out…

  16. Water Literacy in College Freshmen: Could a Cognitive Imagery Strategy Improve Understanding?

    ERIC Educational Resources Information Center

    Ewing, Margaret S.; Mills, Terence J.

    1994-01-01

    Presents a study designed to determine whether levels of water literacy differed between (n=83) college freshman nonscience majors having one versus two years of high school science coursework, visual imagery exercises could improve understanding of the water cycle, and patterns exist in the concept of the water cycle. (Contains 23 references.)…

  17. Improving patient flow: role of the orthopaedic discharge sister.

    PubMed

    Tytler, Beverley

    2016-03-01

    Timely and well-planned discharge improves the patient's experience, contributes to patient safety and reduces the length of hospital stays. The role of orthopaedic discharge sister was developed at James Cook University Hospital in 2007 to provide safe, timely and efficient discharge for patients from the trauma and theatre centre, and to improve patient experience and flow. This article gives an overview of the role and describes how the sister works with colleagues to plan patient discharges from pre-assessment and emergency department admission through their hospital stay until their departure. PMID:26948225

  18. Regional anesthesia for the trauma patient: improving patient outcomes.

    PubMed

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. PMID:26316813

  19. Regional anesthesia for the trauma patient: improving patient outcomes

    PubMed Central

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. PMID:26316813

  20. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    PubMed

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities. PMID:26252725

  1. Accelerating patient-care improvement in the ED.

    PubMed

    Forrester, Nancy E

    2003-08-01

    Quality improvement is always in the best interest of healthcare providers. One hospital examined the patient-care delivery process used in its emergency department to determine ways to improve patient satisfaction while increasing the effectiveness and efficiency of healthcare delivery. The hospital used activity-based costing (ABC) plus additional data related to rework, information opportunity costs, and other effectiveness measures to create a process map that helped it accelerate diagnosis and improve redesign of the care process. PMID:12938618

  2. Social simulation theory: a framework to explain nurses' understanding of patients' experiences of ill-health.

    PubMed

    Nordby, Halvor

    2016-09-01

    A fundamental aim in caring practice is to understand patients' experiences of ill-health. These experiences have a qualitative content and cannot, unlike thoughts and beliefs with conceptual content, directly be expressed in words. Nurses therefore face a variety of interpretive challenges when they aim to understand patients' subjective perspectives on disease and illness. The article argues that theories on social simulation can shed light on how nurses manage to meet these challenges. The core assumption of social simulationism is that we do not understand other people by forming mental representations of how they think, but by putting ourselves in their situation in a more imaginative way. According to simulationism, any attempt to understand a patient's behavior is made on the basis of simulating what it is like to be that patient in the given context. The article argues that this approach to social interpretation can clarify how nurses manage to achieve aims of patient understanding, even when they have limited time to communicate and incomplete knowledge of patients' perspectives. Furthermore, simulation theory provides a normative framework for interpretation, in the sense that its theoretical assumptions constitute ideals for how nurses should seek to understand patients' experiences of illness. PMID:27198752

  3. Application of Bow-tie methodology to improve patient safety.

    PubMed

    Abdi, Zhaleh; Ravaghi, Hamid; Abbasi, Mohsen; Delgoshaei, Bahram; Esfandiari, Somayeh

    2016-05-01

    Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings. PMID:27142951

  4. Applying Transactional Analysis and Personality Assessment to Improve Patient Counseling and Communication Skills

    PubMed Central

    Lawrence, Lesa

    2007-01-01

    Objective To teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling to improve communication. Design A lecture series for a required pharmacy communications class was developed to teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling. Students were asked to apply these techniques and to report their experiences. A personality self-assessment was also conducted. Assessment After attending the lecture series, students were able to apply the techniques and demonstrated an understanding of the psychological factors that may affect patient communication, an appreciation for the diversity created by different personality types, the ability to engage patients based on adult-to-adult interaction cues, and the ability to adapt the interactive patient counseling model to different personality traits. Conclusion Students gained a greater awareness of transactional analysis and personality assessment by applying these concepts. This understanding will help students communicate more effectively with patients. PMID:17786269

  5. Identifying patients at high risk of breast cancer recurrence: strategies to improve patient outcomes

    PubMed Central

    Martei, Yehoda M; Matro, Jennifer M

    2015-01-01

    Identifying patients at high risk of breast cancer recurrence has important implications not only for enabling the ability to provide accurate information to patients but also the potential to improve patient outcomes. Patients at high recurrence risk can be offered appropriate treatment to improve the overall survival. However, the major challenge is identifying patients with early-stage breast cancer at lower risk who may be spared potentially toxic therapy. The successful integration of molecular assays into clinical practice may address the problem of overtreatment and improve overall patient outcomes. PMID:26504408

  6. Using the Health Literacy Universal Precautions Toolkit to Improve the Quality of Patient Materials.

    PubMed

    Brega, Angela G; Freedman, Megan A G; LeBlanc, William G; Barnard, Juliana; Mabachi, Natabhona M; Cifuentes, Maribel; Albright, Karen; Weiss, Barry D; Brach, Cindy; West, David R

    2015-01-01

    Patient materials are often written above the reading level of most adults. Tool 11 of the Health Literacy Universal Precautions Toolkit ("Design Easy-to-Read Material") provides guidance on ensuring that written patient materials are easy to understand. As part of a pragmatic demonstration of the Toolkit, we examined how four primary care practices implemented Tool 11 and whether written materials improved as a result. We conducted interviews to learn about practices' implementation activities and assessed the readability, understandability, and actionability of patient education materials collected during pre- and postimplementation site visits. Interview data indicated that practices followed many action steps recommended in Tool 11, including training staff, assessing readability, and developing or revising materials, typically focusing on brief documents such as patient letters and information sheets. Many of the revised and newly developed documents had reading levels appropriate for most patients and--in the case of revised documents--better readability than the original materials. In contrast, the readability, understandability, and actionability of lengthier patient education materials were poor and did not improve over the 6-month implementation period. Findings guided revisions to Tool 11 and highlighted the importance of engaging multiple stakeholders in improving the quality of patient materials. PMID:26513033

  7. Improving post-intensive care unit neuropsychiatric outcomes: understanding cognitive effects of physical activity.

    PubMed

    Hopkins, Ramona O; Suchyta, Mary R; Farrer, Thomas J; Needham, Dale

    2012-12-15

    Critical illness and its treatment often result in long-term neuropsychiatric morbidities. Consequently, there is a need to focus on means to prevent or ameliorate these morbidities. Animal models provide important data regarding the neurobiological effects of physical activity, including angiogenesis, neurogenesis, and release of neurotrophic factors that enhance plasticity. Studies in noncritically ill patients demonstrate that exercise is associated with increased cerebral blood flow, neurogenesis, and brain volume, which are associated with improved cognition. Clinically, research in both healthy and diseased human subjects suggests that exercise improves neuropsychiatric outcomes. In the critical care setting, early physical rehabilitation and mobilization are safe and feasible, with demonstrated improvements in physical functional outcomes. Such activity may also reduce the duration of delirium in the intensive care unit (ICU) and improve neuropsychiatric outcomes, although data are limited. Barriers exist regarding implementing ICU rehabilitation in routine care, including use of sedatives and lack of awareness of post-ICU cognitive impairments. Further research is necessary to determine whether prior animal and human research, in conjunction with preliminary results from existing ICU studies, can translate into improvements for neuropsychiatric outcomes in critically ill patients. Studies are needed to evaluate biological mechanisms, risk factors, the role of pre-ICU functional level, and the timing, duration, and type of physical activity for optimal patient outcomes. PMID:23065013

  8. Is this the right patient? An educational initiative to improve compliance with two patient identifiers.

    PubMed

    Mollon, Deene' L; Fields, Willa L

    2009-05-01

    A rehabilitation nursing unit implemented an educational initiative to improve compliance with two patient identifiers. The education consisted of a poster presentation and then, 2 months later, a mandatory in-service education program. Compliance with two patient identifiers improved, although more improvement was demonstrated after the mandatory in-service. The results of this performance improvement project suggest that investing time and money in safety initiatives improves staff practice patterns. PMID:19489521

  9. Improving Patient Flow Utilizing a Collaborative Learning Model.

    PubMed

    Tibor, Laura C; Schultz, Stacy R; Cravath, Julie L; Rein, Russell R; Krecke, Karl N

    2016-01-01

    This initiative utilized a collaborative learning approach to increase knowledge and experience in process improvement and systems thinking while targeting improved patient flow in seven radiology modalities. Teams showed improvements in their project metrics and collectively streamlined the flow for 530 patients per day by improving patient lead time, wait time, and first case on-time start rates. In a post-project survey of 50 project team members, 82% stated they had more effective solutions as a result of the process improvement methodology, 84% stated they will be able to utilize the process improvement tools again in the future, and 98% would recommend participating in another project to a colleague. PMID:27514106

  10. RFIDs can improve the patient care supply chain.

    PubMed

    Revere, Lee; Black, Ken; Zalila, Faiza

    2010-01-01

    Technologies that increase efficiency, enhance quality, and improve patient safety are essential for all healthcare organizations. Radio frequency identification devices (RFIDs) seem to be right for this challenge. RFIDs can be integrated into all areas of the internal patient supply chain, serving as clearinghouses of information. By providing timely information on patients, processes, and equipment, RFIDs can save time and reduce costs while simultaneously improving quality and patient safety. Healthcare leaders owe it to all constituencies to take a serious look at what RFIDs can offer. PMID:20194108

  11. Teaching Family Therapy: Ten Key Questions for Understanding the Family as Patient.

    ERIC Educational Resources Information Center

    Resnikoff, Roy O.

    1981-01-01

    Ten questions for understanding the family as patient are presented as one aspect of an overall teaching plan for family therapy. Seeing the family as patient is important in initial stages of evaluation and therapy. A case study of a large, overly close family is used as an illustration. (Author)

  12. Improving care by understanding the way we work: human factors and behavioural science in the context of intensive care.

    PubMed

    Sevdalis, Nick; Brett, Stephen J

    2009-01-01

    Effectiveness and efficiency of care of the critically ill patient are subject to a number of systemic influences, including skills of individual physicians/nurses (technical and non-technical), team-working in the intensive care unit (ICU), and the ICU environment. We first discuss the paper of Fackler and colleagues as a contribution to the systems approach to clinical performance in the context of intensive care. We then highlight features of care delivery that are unique to intensive care and discuss the need for better understanding of human and non-human elements of the system of care of the critically ill patient as a driver for improvement of care delivery. PMID:19439048

  13. Partnering With a Patient and Family Advisory Council to Improve Patient Care Experiences With Pain Management.

    PubMed

    Bookout, Michelle L; Staffileno, Beth A; Budzinsky, Christine M

    2016-04-01

    Patient-centered care is a key driver for the nation's health system, yet patient experience surveys indicate that hospitals are far from achieving favorable outcomes. Partnering with patients and families through a patient and family advisory council (PFAC) advances the practice of patient-centered care to improve outcomes and experiences. This article describes the process of implementing a PFAC and presents outcomes related to patients' perception of pain management in the acute care hospital setting. PMID:26963442

  14. Toward a biopsychosocial understanding of the patient-physician relationship: an emerging dialogue.

    PubMed

    Adler, Herbert M

    2007-02-01

    Complexity theory has been used to view the patient-physician relationship as constituted by complex responsive processes of relating. It describes an emergent, psychosocial relational process through which patients and physicians continually and reciprocally influence each other's behavior and experience. As psychosocial responses are necessarily biopsychosocial responses, patients and physicians must likewise be influencing each other's psychobiology. This mutual influence may be subjectively experienced as empathy, and may be skillfully employed by the clinician to directly improve the patient's psychobiology. PMID:17357001

  15. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    PubMed

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile. PMID:26447343

  16. "What We Breathe Impacts Our Health: Improving Understanding of the Link between Air Pollution and Health".

    PubMed

    West, J Jason; Cohen, Aaron; Dentener, Frank; Brunekreef, Bert; Zhu, Tong; Armstrong, Ben; Bell, Michelle L; Brauer, Michael; Carmichael, Gregory; Costa, Dan L; Dockery, Douglas W; Kleeman, Michael; Krzyzanowski, Michal; Künzli, Nino; Liousse, Catherine; Lung, Shih-Chun Candice; Martin, Randall V; Pöschl, Ulrich; Pope, C Arden; Roberts, James M; Russell, Armistead G; Wiedinmyer, Christine

    2016-05-17

    Air pollution contributes to the premature deaths of millions of people each year around the world, and air quality problems are growing in many developing nations. While past policy efforts have succeeded in reducing particulate matter and trace gases in North America and Europe, adverse health effects are found at even these lower levels of air pollution. Future policy actions will benefit from improved understanding of the interactions and health effects of different chemical species and source categories. Achieving this new understanding requires air pollution scientists and engineers to work increasingly closely with health scientists. In particular, research is needed to better understand the chemical and physical properties of complex air pollutant mixtures, and to use new observations provided by satellites, advanced in situ measurement techniques, and distributed micro monitoring networks, coupled with models, to better characterize air pollution exposure for epidemiological and toxicological research, and to better quantify the effects of specific source sectors and mitigation strategies. PMID:27010639

  17. Big Data and the Atmospheric Science Data Center: Improving Access and Understanding of Data Products

    NASA Astrophysics Data System (ADS)

    Mathews, T. J.; Little, M. M.; Huffer, E.

    2013-12-01

    Working from an Enterprise Architecture, the ASDC has implemented a suite of new tools to provide improved access and understanding of data products related to the Earth's radiation budget, clouds, aerosols and tropospheric chemistry. This poster describes the overall architecture and the capabilities that have been implemented within the past twelve months. Further insight is offered into the issues and constraints of those tools, as well as lessons learned in their implementation.

  18. Database construction for improving patient safety by examining pathology errors.

    PubMed

    Grzybicki, Dana Marie; Turcsanyi, Brian; Becich, Michael J; Gupta, Dilip; Gilbertson, John R; Raab, Stephen S

    2005-10-01

    A critical component of improving patient safety is reducing medical errors. "Improving Patient Safety by Examining Pathology Errors" is a project designed to collect data about and analyze diagnostic errors voluntarily reported by 4 academic anatomic pathology laboratories and to develop and implement interventions to reduce errors and improve patient outcomes. The study database is Web-mediated and Oracle-based, and it houses de-identified error data detected by cytologic-histologic correlation and interdepartmental conference review. We describe the basic design of the database with a focus on challenges faced as a consequence of the absence of standardized and detailed laboratory workload and quality assurance data sets in widely used laboratory information systems and the lack of efficient and comprehensive electronic de-identification of unlinked institutional laboratory information systems and clinical data. Development of these electronic data abstraction capabilities is critical for efforts to improve patient safety through the examination of pathology diagnostic errors. PMID:16146808

  19. Combining Chemotherapy with Bevacizumab Improves Outcomes for Ovarian Cancer Patients

    Cancer.gov

    Results from two phase III randomized clinical trials suggest that, at least for some patients with ovarian cancer, adding the antiangiogenesis agent bevacizumab to chemotherapy increases the time to disease progression and may improve survival.

  20. What Do We Need To Do To Improve Our Understanding of How Volcanoes Affect Stratospheric Ozone?

    NASA Astrophysics Data System (ADS)

    Solomon, S.

    2015-12-01

    This talk will briefly survey what is known and what is not known about stratospheric ozone depletion and volcanic events, and will describe some ways to improve our understanding. Observations of total ozone following the eruption of El Chichon in the 1980s provided some of the earliest and clearest indications of the importance of volcanic aerosol on ozone depletion. In subsequent decades, improved laboratory information, modeling studies, and observations showed how heterogeneous chemical processing on and in volcanic aerosols could enhance chlorine-catalyzed ozone loss in the lower stratosphere, while decreasing nitrogen-catalyzed ozone loss in the upper stratosphere. Recent satellite observations shed important light on this chemistry but major gaps in understanding remain, including for example a lack of knowledge of whether hydrochloric acid can be efficiently taken up in stratospheric particles under cold conditions, interactions and competition between volcanic aerosols and ice clouds, and the effects of volcanic aerosols on chemistry in the tropopause region. Effects of volcanic aerosols on Arctic and Antarctic ozone depletion are also subject to many certainties, owing in large part to observational deficiencies. Implications for gaining an improved understanding through both laboratory studies and new observations will be briefly described.

  1. Understanding the Components of Quality Improvement Collaboratives: A Systematic Literature Review

    PubMed Central

    Nadeem, Erum; Olin, S Serene; Hill, Laura Campbell; Hoagwood, Kimberly Eaton; Horwitz, Sarah McCue

    2013-01-01

    Context In response to national efforts to improve quality of care, policymakers and health care leaders have increasingly turned to quality improvement collaboratives (QICs) as an efficient approach to improving provider practices and patient outcomes through the dissemination of evidence-based practices. This article presents findings from a systematic review of the literature on QICs, focusing on the identification of common components of QICs in health care and exploring, when possible, relations between QIC components and outcomes at the patient or provider level. Methods A systematic search of five major health care databases generated 294 unique articles, twenty-four of which met our criteria for inclusion in our final analysis. These articles pertained to either randomized controlled trials or quasi-experimental studies with comparison groups, and they reported the findings from twenty different studies of QICs in health care. We coded the articles to identify the components reported for each collaborative. Findings We found fourteen crosscutting components as common ingredients in health care QICs (e.g., in-person learning sessions, phone meetings, data reporting, leadership involvement, and training in QI methods). The collaboratives reported included, on average, six to seven of these components. The most common were in-person learning sessions, plan-do-study-act (PDSA) cycles, multidisciplinary QI teams, and data collection for QI. The outcomes data from these studies indicate the greatest impact of QICs at the provider level; patient-level findings were less robust. Conclusions Reporting on specific components of the collaborative was imprecise across articles, rendering it impossible to identify active QIC ingredients linked to improved care. Although QICs appear to have some promise in improving the process of care, there is great need for further controlled research examining the core components of these collaboratives related to patient- and

  2. Practice improvement, part II: update on patient communication technologies.

    PubMed

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. PMID:24261435

  3. Enhancing Nurses' Pain Assessment to Improve Patient Satisfaction.

    PubMed

    Schroeder, Diana L; Hoffman, Leslie A; Fioravanti, Marie; Medley, Deborah Poskus; Zullo, Thomas G; Tuite, Patricia K

    2016-01-01

    Patient satisfaction with pain management has increasing importance with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores tied to reimbursement. Previous studies indicate patient satisfaction is influenced by staff interactions. This single-group pre/post design study aimed to improve satisfaction with pain management in older adults undergoing total joint replacement. This was a single-group pre-/posttest design. Nurse (knowledge assessment) and patient (American Pain Society Patient Outcomes Questionnaire Revised [APS-POQ-R], HCAHPS) responses evaluated pre- and postimplementation of the online educational program. Nurse focus group followed intervention. Nurses' knowledge improved significantly (p < .006) postintervention. HCAHPS scores (3-month average) for items reflecting patient satisfaction improved from 70.2 ± 9.5 to 73.9 ± 6.0. APS-POQ-R scores did not change. Focus group comments indicated need for education regarding linkages between pain management and patient satisfaction. Education on linkages between patient satisfaction and pain management can improve outcomes; education on strategies to further improve practice may enhance ability to achieve benchmarks. PMID:27028687

  4. Beneficent persuasion: techniques and ethical guidelines to improve patients' decisions.

    PubMed

    Swindell, J S; McGuire, Amy L; Halpern, Scott D

    2010-01-01

    Physicians frequently encounter patients who make decisions that contravene their long-term goals. Behavioral economists have shown that irrationalities and self-thwarting tendencies pervade human decision making, and they have identified a number of specific heuristics (rules of thumb) and biases that help explain why patients sometimes make such counterproductive decisions. In this essay, we use clinical examples to describe the many ways in which these heuristics and biases influence patients' decisions. We argue that physicians should develop their understanding of these potentially counterproductive decisional biases and, in many cases, use this knowledge to rebias their patients in ways that promote patients' health or other values. Using knowledge of decision-making psychology to persuade patients to engage in healthy behaviors or to make treatment decisions that foster their long-term goals is ethically justified by physicians' duties to promote their patients' interests and will often enhance, rather than limit, their patients' autonomy. We describe techniques that physicians may use to frame health decisions to patients in ways that are more likely to motivate patients to make choices that are less biased and more conducive to their long-term goals. Marketers have been using these methods for decades to get patients to engage in unhealthy behaviors; employers and policy makers are beginning to consider the use of similar approaches to influence healthy choices. It is time for clinicians also to make use of behavioral psychology in their interactions with patients. PMID:20458111

  5. [Improvement of QOL in osteoporotic patients by calcitonin treatment].

    PubMed

    Tanaka, Kiyoshi; Yoshizawa, Minako; Yoh, Kousei

    2005-03-01

    Quality of life (QOL) is impaired in patients with osteoporosis, to which bodily pain greatly contributes. The presence of vertebral fractures detrimentally affects the patients' QOL in a dose-dependent manner. Calcitonin, with its potent analgesic action, markedly improves the various aspects of patients' QOL. Efficacy for the treatment of osteoporosis should be evaluated in terms of QOL also, in addition to the increase in bone mineral density and fracture prevention. PMID:15741699

  6. Smoking cessation strategies for patients with asthma: improving patient outcomes

    PubMed Central

    Perret, Jennifer L; Bonevski, Billie; McDonald, Christine F; Abramson, Michael J

    2016-01-01

    Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as “lung age” should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large. PMID:27445499

  7. Growing into My White Coat: Improving the Patient-Provider Relationship Through Diverse Patient Interviews

    PubMed Central

    Davis, Katherine J.

    2013-01-01

    The “Patient Diversity” assignment is an integral component for all medical and other health care professional students rotating through the Surgery clerkship at the Yale School of Medicine. Students are instructed to interview a surgical patient who is of a varied social or cultural background to identify how psychosocial factors impact patient coping strategies. In the process, students often appreciate how health care providers’ own social and cultural backgrounds similarly shape their sentiments and reactions in patient care. In this interview with a 26-year-old surgical patient, one student strives to come to terms with her personal insecurities in patient interactions and seeks to overcome them through open conversation and honest introspection. By working to acknowledge and understand patient diversity, health care providers can enhance understanding of their patients’ conditions and form more trustful and empathic relationships with both their patients and colleagues. PMID:24058314

  8. A web-based interactive tool to improve breast cancer patient centredness.

    PubMed

    Gorini, Alessandra; Mazzocco, Ketti; Kondylakis, Haridimos; McVie, Gordon; Pravettoni, Gabriella

    2016-01-01

    The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient's unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient-physician communication, improving the patient's understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient-physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient's profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient's physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient's answers in real time and send them, together with specific recommendations to the physician's computer immediately before physician's first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient's profile). The proposed approach is supposed to improve the patient-physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in patient empowerment

  9. What is the Business Case for Improving Care for Patients with Complex Conditions?

    PubMed Central

    Parkerton, Patricia; Hagigi, Fred

    2007-01-01

    INTRODUCTION Patients with complex conditions account for a disproportionate share of health care spending. Although evidence indicates that care for these patients could be provided more efficiently, the financial impact of mechanisms to improve the care they receive is unclear. DESIGN/METHODS Numerous mechanisms—emphasizing patient self-management, care coordination, and evidence-based guidelines—aim to improve the quality of care and outcomes for patients with complex conditions. Assessing the overall “business case” for these mechanisms requires carefully estimating all relevant costs and financial benefits, then comparing them in present value terms. Mechanisms that are not cost-saving may still be implemented if they are cost-effective. We reviewed articles in peer-reviewed journals, as well as reports available on publicly accessible websites, which contained data about the business case for mechanisms to improve care for patients with complex conditions. MAIN RESULTS Published studies do not provide clear evidence that current mechanisms are cost saving. This literature also has several major methodological shortcomings with respect to providing an understanding of the business case for these mechanisms. CONCLUSIONS Further research using standardized methodologies is needed to understand the business case for mechanisms to improve care for patients with complex conditions. Implications for VA business case analyses include the necessity of establishing appropriate time horizons, scope of services, and target populations, as well as considering the impact of existing VA systems. PMID:18026808

  10. Ranking Multiple Dialogue States by Corpus Statistics to Improve Discourse Understanding in Spoken Dialogue Systems

    NASA Astrophysics Data System (ADS)

    Higashinaka, Ryuichiro; Nakano, Mikio

    This paper discusses the discourse understanding process in spoken dialogue systems. This process enables a system to understand user utterances from the context of a dialogue. Ambiguity in user utterances caused by multiple speech recognition hypotheses and parsing results sometimes makes it difficult for a system to decide on a single interpretation of a user intention. As a solution, the idea of retaining possible interpretations as multiple dialogue states and resolving the ambiguity using succeeding user utterances has been proposed. Although this approach has proven to improve discourse understanding accuracy, carefully created hand-crafted rules are necessary in order to accurately rank the dialogue states. This paper proposes automatically ranking multiple dialogue states using statistical information obtained from dialogue corpora. The experimental results in the train ticket reservation and weather information service domains show that the statistical information can significantly improve the ranking accuracy of dialogue states as well as the slot accuracy and the concept error rate of the top-ranked dialogue states.

  11. How Patients Can Improve the Accuracy of their Medical Records

    PubMed Central

    Dullabh, Prashila M.; Sondheimer, Norman K.; Katsh, Ethan; Evans, Michael A.

    2014-01-01

    Objectives: Assess (1) if patients can improve their medical records’ accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback’s impact on medical record accuracy. Background: Improving medical record’ accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records’ accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists’ accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. Methods: The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists’ medication reconciliation logs. Findings/Discussion: (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency—or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms

  12. Improving patients' and staff's experiences of acute care.

    PubMed

    Chaplin, Rob; Crawshaw, Jacob; Hood, Chloe

    2015-03-01

    The aim of this audit was to assess the effect of the Quality Mark programme on the quality of acute care received by older patients by comparing the experiences of staff and older adults before and after the programme. Data from 31 wards in 12 acute hospitals were collected over two stages. Patients and staff completed questionnaires on the perceived quality of care on the ward. Patients rated improved experiences of nutrition, staff availability and dignity. Staff received an increase in training and reported better access to support, increased time and skill to deliver care and improved morale, leadership and teamwork. Problems remained with ward comfort and mealtimes. Overall, results indicated an improvement in ratings of care quality in most domains during Quality Mark data collection. Further audits need to explore ways of improving ward comfort and mealtime experience. PMID:25727634

  13. Cross-Functional Team Processes and Patient Functional Improvement

    PubMed Central

    Alexander, Jeffrey A; Lichtenstein, Richard; Jinnett, Kimberly; Wells, Rebecca; Zazzali, James; Liu, Dawei

    2005-01-01

    Objective To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. Data Sources/Study Setting Primary data were collected during the period 1992–1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. Study Design A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. Data Collection Methods Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. Principal Findings Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. Conclusions Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the

  14. Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians.

    PubMed

    Broderick-Forsgren, Kathleen; Hunter, Wynn G; Schulteis, Ryan D; Liu, Wen-Wei; Boggan, Joel C; Sharma, Poonam; Thomas, Steven; Zaas, Aimee; Bae, Jonathan

    2016-05-01

    Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition. Conclusions Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools. PMID:27168887

  15. Process Improvements to Reform Patient Flow in the Emergency Department.

    PubMed

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko

    2016-01-01

    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada. PMID:27133605

  16. Machine learning-based augmented reality for improved surgical scene understanding.

    PubMed

    Pauly, Olivier; Diotte, Benoit; Fallavollita, Pascal; Weidert, Simon; Euler, Ekkehard; Navab, Nassir

    2015-04-01

    In orthopedic and trauma surgery, AR technology can support surgeons in the challenging task of understanding the spatial relationships between the anatomy, the implants and their tools. In this context, we propose a novel augmented visualization of the surgical scene that mixes intelligently the different sources of information provided by a mobile C-arm combined with a Kinect RGB-Depth sensor. Therefore, we introduce a learning-based paradigm that aims at (1) identifying the relevant objects or anatomy in both Kinect and X-ray data, and (2) creating an object-specific pixel-wise alpha map that permits relevance-based fusion of the video and the X-ray images within one single view. In 12 simulated surgeries, we show very promising results aiming at providing for surgeons a better surgical scene understanding as well as an improved depth perception. PMID:24998759

  17. Understanding latent tuberculosis: the key to improved diagnostic and novel treatment strategies

    PubMed Central

    Esmail, Hanif; Barry, Clifton E; Wilkinson, Robert J

    2012-01-01

    Treatment of latent tuberculosis (LTBI) is a vital component of tuberculosis elimination but is not efficiently implemented with available diagnostics and therapeutics. The tuberculin skin test and interferon gamma release assays can inform that infection has occurred but do not prove that it persists. Treatment of LTBI with isoniazid targets actively replicating bacilli but not non-replicating populations, prolonging treatment duration. Developing more predictive diagnostic tests and treatments of shorter duration requires a greater understanding of the biology of latent tuberculosis, from both host and bacillary perspectives. In this article we discuss the basis of current diagnosis and treatment of LTBI and review recent developments in understanding the biology of latency that may enable future improved diagnostic and treatment strategies. PMID:22198298

  18. Investigating and Improving Student Understanding of Key Ideas in Quantum Mechanics throughout Instruction

    NASA Astrophysics Data System (ADS)

    Emigh, Paul Jeffrey

    This dissertation describes research on student understanding of quantum mechanics across multiple levels of instruction. The primary focus has been to identify patterns in student reasoning related to key concepts in quantum mechanics. The specific topics include quantum measurements, time dependence, vector spaces, and angular momentum. The research has spanned a variety of different quantum courses intended for introductory physics students, upper-division physics majors, and graduate students in physics. The results of this research have been used to develop a set of curriculum, Tutorials in Physics: Quantum Mechanics, for addressing the most persistent student difficulties. We document both the development of this curriculum and how it has impacted and improved student understanding of quantum mechanics.

  19. A Cognitive Framework for Understanding and Improving Interference Resolution in the Brain

    PubMed Central

    Mishra, Jyoti; Anguera, Joaquin A.; Ziegler, David A.; Gazzaley, Adam

    2014-01-01

    All of us are familiar with the negative impact of interference on achieving our task goals. We are referring to interference by information, which either impinges on our senses from an external environmental source or is internally generated by our thoughts. Informed by more than a decade of research on the cognitive and neural processing of interference, we have developed a framework for understanding how interference impacts our neural systems and especially how it is regulated and suppressed during efficient on-task performance. Importantly, externally and internally generated interferences have distinct neural signatures, and further, distinct neural processing emerges depending on whether individuals must ignore and suppress the interference, as for distractions, or engage with them in a secondary task, as during multitasking. Here, we elaborate on this cognitive framework and how it changes throughout the human lifespan, focusing mostly on research evidence from younger adults and comparing these findings to data from older adults, children, and cognitively impaired populations. With insights gleaned from our growing understanding, we then describe three novel translational efforts in our lab directed at improving distinct aspects of interference resolution using cognitive training. Critically, these training approaches were specifically developed to target improved interference resolution based on neuroplasticity principles and have shown much success in randomized controlled first version evaluations in healthy aging. Our results show not only on-task training improvements but also robust generalization of benefit to other cognitive control abilities. This research showcases how an in-depth understanding of neural mechanisms can then inform the development of effective deficit-targeted interventions, which can in turn benefit both healthy and cognitively impaired populations. PMID:24309262

  20. Current advances in targeted therapies for metastatic gastric cancer: improving patient care.

    PubMed

    Aguiar, Pedro Nazareth; Muniz, Thiago Pimentel; Miranda, Raelson Rodrigues; Tadokoro, Hakaru; Forones, Nora Manoukian; Monteiro, Ines-de-Paula; Castelo-Branco, Pedro; Janjigian, Yelena Y; de Mello, Ramon Andrade

    2016-03-01

    In this article, we review the literature on the current advances in targeted therapies for metastatic gastric cancer aimed at improving patient care. We conclude that the key to guiding targeted therapy is individual biomarkers, which are not completely elucidated. HER2 overexpression is the only predictive biomarker currently in use. Furthermore, it is necessary to understand that gastric tumors are heterogeneous; therefore, is impossible to evaluate a novel biological compound without evaluating personal biomarkers. The selection of patients who are able to receive each treatment is paramount for improving advanced gastric cancer survival and reducing unnecessary costs. PMID:26838766

  1. Improving haemophilia patient care through sharing best practice.

    PubMed

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care. PMID:26338268

  2. Understanding Health Literacy and its Impact on Delivering Care to Patients with Inflammatory Bowel Disease.

    PubMed

    Tormey, Lauren K; Farraye, Francis A; Paasche-Orlow, Michael K

    2016-03-01

    Health literacy (HL) is the extent to which individuals have the capacity to obtain, process, and understand basic health information that is needed to make appropriate health decisions. As adults with inflammatory bowel disease engage in complex health decisions throughout their lives, attention is needed regarding the influence of HL on the lives of people with inflammatory bowel disease. About one-third of adults in the United States have limited HL. Limited HL is a potentially modifiable risk factor that has been associated with barriers to patient-provider communication and worse health outcomes for people with a range of chronic diseases. Gastroenterologists must recognize the role of HL in their practice. Limited HL can affect a patient's ability to understand the purpose of a screening test for colorectal cancer, understand the concept of an asymptomatic yet chronic disease, ask questions in an office visit and engage in shared decision making. Gastroenterologists must approach each patient as potentially having limited HL and use clear communication strategies in all encounters. Currently, there is a lack of training, education, and support for health care providers to meet the needs of patients with limited HL. More research is needed in inflammatory bowel disease to understand the impact of limited health literacy on health outcomes in this population and develop effective systems-based interventions to reduce the health literacy burden on patients. PMID:26595554

  3. Understanding the Dreyfus model of skill acquisition to improve ultrasound training for obstetrics and gynaecology trainees

    PubMed Central

    2014-01-01

    There have been significant problems in ultrasound training since the introduction of the new postgraduate curriculum for obstetrics and gynaecology. It is therefore important to understand how the skill of ultrasound is acquired in order to be able to improve the training program. Here, the potential application of the Dreyfus model of skill acquisition has been analysed to map the progression from novice to master and the progressions between each stage analysed. Although the Dreyfus model is not a perfect match for ultrasound scanning, it provides us with a theoretical framework on which to underpin educational practice in this field.

  4. Improving wait times and patient satisfaction in primary care.

    PubMed

    Michael, Melanie; Schaffer, Susan D; Egan, Patricia L; Little, Barbara B; Pritchard, Patrick Scott

    2013-01-01

    A strong and inverse relationship between patient satisfaction and wait times in ambulatory care settings has been demonstrated. Despite its relevance to key medical practice outcomes, timeliness of care in primary care settings has not been widely studied. The goal of the quality improvement project described here was to increase patient satisfaction by minimizing wait times using the Dartmouth Microsystem Improvement Curriculum (DMIC) framework and the Plan-Do-Study-Act (PDSA) improvement process. Following completion of an initial PDSA cycle, significant reductions in mean waiting room and exam room wait times (p = .001 and p = .047, respectively) were observed along with a significant increase in patient satisfaction with waiting room wait time (p = .029). The results support the hypothesis that the DMIC framework and the PDSA method can be applied to improve wait times and patient satisfaction among primary care patients. Furthermore, the pretest-posttest preexperimental study design employed provides a model for sequential repetitive tests of change that can lead to meaningful improvements in the delivery of care and practice performance in a variety of ambulatory care settings over time. PMID:23480405

  5. Understanding Patient Perspectives on Communication About the Cost of Cancer Care: A Review of the Literature

    PubMed Central

    Hofstatter, Erin W.

    2010-01-01

    Purpose: Patient-physician communication about cost when making treatment decisions has been promoted as a potential solution to the rising cost of oncologic care and suggested as an important component of high-quality oncologic care. However, little is known regarding the perspectives of patients with cancer on such discussions with their physicians. Methods: A literature review was performed in July 2009, with search terms including but not limited to patient-physician communication, cost of cancer care, and cost communication. Results: The cost of cancer care is high and seems to affect decisions that many patients make about the treatment they receive. Yet there is scant oncology literature on patient-physician cost communication, with the only formal study examining oncologist perspectives. Extrapolation from the general medicine literature may not be appropriate for this unique population of patients, and there are some data to suggest that patients with cancer may prefer not to discuss finances with their oncologists. Practical guidelines and tools for discussions of cost with patients with cancer are also limited. Conclusion: To my knowledge, patient preferences surrounding discussion of cost of cancer care have gone largely unstudied and are thus unknown. If the goal is to provide high-quality care while controlling rising health care costs, more research is needed to better understand patient perspectives on communication surrounding the cost of oncologic care, particularly given the significant impact such discussions may have on cancer outcomes, cost, and overall patient satisfaction. PMID:21037869

  6. The CONVEX project - Using Observational Evidence and Process Understanding to Improve Predictions of Extreme Rainfall Change

    NASA Astrophysics Data System (ADS)

    Fowler, Hayley; Kendon, Elizabeth; Blenkinsop, Stephen; Chan, Steven; Ferro, Christopher; Roberts, Nigel; Stephenson, David; Jones, Richard; Sessford, Pat

    2013-04-01

    During the last decade, widespread major flood events in the UK and across the rest of Europe have focussed attention on perceived increases in rainfall intensities. Whilst Regional Climate Models (RCMs) are able to simulate the magnitude and spatial pattern of observed daily extreme rainfall events more reliably than Global Circulation Models (GCMs), they still underestimate extreme rainfall in relation to observations. Particularly during the summer a large proportion of the precipitation comes from convective storms that are typically too small to be explicitly represented by climate models. Instead, convection parameterisation schemes are necessary to represent the larger-scale effect of unresolved convective cells. Given the deficiencies in the simulation of extreme rainfall by climate models, even in the current generation of high-resolution RCMs, the CONVEX project (CONVective EXtremes) argues that an integrated approach is needed that brings together observations, basic understanding and models. This should go hand in hand with a change from a focus on traditional validation exercises (comparing modelled and observed extremes) to an understanding and quantification of the causes of model deficiencies in the simulation of extreme rainfall processes on different spatial and temporal scales. It is particularly true for localised intense summer convection. CONVEX therefore aims to contribute to the goals of enabling society to respond to global climate change and predicting the regional and local impacts of environmental change. In addition to an improved understanding of the spatial-temporal characteristics of extreme rainfall processes (principally in the UK) the project is also assessing the influence of model parameterisations and resolution on the simulation of extreme rainfall events and processes. This includes the running of new RCM simulations undertaken by the UK Meteorological Office at 50km and 12km resolutions (parameterised convection) and

  7. Understanding motivations to participate in an observational research study: Why do patients enroll?

    PubMed

    Soule, Michael C; Beale, Eleanor E; Suarez, Laura; Beach, Scott R; Mastromauro, Carol A; Celano, Christopher M; Moore, Shannon V; Huffman, Jeff C

    2016-01-01

    By understanding common motivations for participating in observational research studies, clinicians may better understand the perceived benefits of research participation from their clients' perspective. We enrolled 164 cardiac patients in a study about the effects of gratitude and optimism. Two weeks post-enrollment, participants completed a four-item questionnaire regarding motivations for study enrollment. Altruistic motivation ranked highest, while intellectual, health-related, and financial motivations rated lower. Four subgroups of participants emerged, each with distinct characteristics and different priorities for participating. These findings may help front-line clinicians to understand which motivations for participation apply to their clients who enroll in non-treatment-based research projects. PMID:26933943

  8. Leveraging information technology to drive improvement in patient satisfaction.

    PubMed

    Nash, Mary; Pestrue, Justin; Geier, Peter; Sharp, Karen; Helder, Amy; McAlearney, Ann Scheck

    2010-01-01

    A healthcare organization's commitment to quality and the patient experience requires senior leader involvement in improvement strategies, and accountability for goals. Further, improvement strategies are most effective when driven by data, and in the world of patient satisfaction, evidence is growing that nurse leader rounding and discharge calls are strategic tactics that can improve patient satisfaction. This article describes how The Ohio State University Medical Center (OSUMC) leveraged health information technology (IT) to apply a data-driven strategy execution to improve the patient experience. Specifically, two IT-driven approaches were used: (1) business intelligence reporting tools were used to create a meaningful reporting system including dashboards, scorecards, and tracking reports and (2) an improvement plan was implemented that focused on two high-impact tactics and data to hardwire accountability. Targeted information from the IT systems enabled clinicians and administrators to execute these strategic tactics, and senior leaders to monitor achievement of strategic goals. As a result, OSUMC's inpatient satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey improved from 56% nines and tens in 2006 to 71% in 2009. PMID:20854357

  9. Magnetic resonance imaging: improving patients tolerance and safety

    SciTech Connect

    Weinreb, J.C.; Maravilla, K.R.; Peshock, R.; Payne, J.

    1984-12-01

    Some physicians have expressed the opinion that patients may not tolerate MR scans as well as they do computed tomographic (CT) scans for several reasons: (1) longer examination time, (2) the confined space in which a patient is placed for scanning, and (3) difficulties in communicating with the patient during scanning because of noise from the gradient coils and the necessity of eliminating all extraneous radiofrequency (RF) sources from the examination room. Furthermore, the presence of a powerful magnet as the heart of an MRI unit introduces management problems in the event of patient emergencies. With these potential difficulties in mind, the University of Texas Health Science Center at Dallas Southwestern Medical School NMR Imaging Center has implemented a program to improve patient tolerance and safety. The anticipated imminent proliferation of MRI units in many radiology departments indicates that it is an opportune time to share our experience with 450 patients and a commerically available 0.35-T superconducting imager.

  10. Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?

    PubMed Central

    2011-01-01

    Background In the last few years there seems to be an emerging interest for including the patients' perspective in assessing methadone maintenance treatment (MMT), with treatment satisfaction surveys being the most commonly-used method of incorporating this point of view. The present study considers the perspective of patients on MMT when assessing the outcomes of this treatment, acknowledging the validity of this approach as an indicator. The primary aim of this study is to evaluate the concordance between improvement assessment performed by two members of the clinical staff (a psychiatrist and a nurse) and assessment carried out by MMT patients themselves. Method Patients (n = 110) and their respective psychiatrist (n = 5) and nurse (n = 1) completed a scale for assessing how the patient's condition had changed from the beginning of MMT, using the Patient Global Impression of Improvement scale (PGI-I) and the Clinical Global Impression of Improvement scale (CGI-I), respectively. Results The global improvement assessed by patients showed weak concordance with the assessments made by nurses (Quadratic-weighted kappa = 0.13, p > 0.05) and by psychiatrists (Quadratic-weighted kappa = 0.19, p = 0.0086), although in the latter, concordance was statistically significant. The percentage of improved patients was significantly higher in the case of the assessments made by patients, compared with those made by nurses (90.9% vs. 80%, Z-statistic = 2.10, p = 0.0354) and by psychiatrists (90.9% vs. 50%, Z-statistic = 6.48, p < 0.0001). Conclusions MMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves. PMID:21871064

  11. Understanding unexpected courses of multiple sclerosis among patients using complementary and alternative medicine: A travel from recipient to explorer

    PubMed Central

    Salamonsen, Anita; Launsø, Laila; Kruse, Tove E.; Eriksen, Sissel H.

    2010-01-01

    Complementary and alternative medicine (CAM) is frequently used by patients with multiple sclerosis (MS). Some MS patients experience unexpected improvements of symptoms, which they relate to their use of CAM. The aim of this study was to obtain knowledge and develop understandings of such self-defined unexpected improvement of MS symptoms. Two cases were constructed based on documents and 12 qualitative interviews. Our aim was not to make generalisations from the cases, but to transfer knowledge as working hypotheses. We identified four health-related change processes: the process of losing bodily competence; the process of developing responsibility; the process of taking control; and the process of choosing CAM. The patients explained unexpected improvements in their MS symptoms as results of their own efforts including their choice and use of CAM. In our theoretical interpretations, we found the patients’ redefinition of history, the concept of treatment and the importance of conventional health care to be essential, and leading to a change of patients’ position towards conventional health care from recipients to explorers. The explorers can be perceived as boundary walkers reflecting limitations within the conventional health care system and as initiators regarding what MS patients find useful in CAM. PMID:20616888

  12. Improving documentation of clinical care within a clinical information network: an essential initial step in efforts to understand and improve care in Kenyan hospitals

    PubMed Central

    Tuti, Timothy; Bitok, Michael; Malla, Lucas; Paton, Chris; Muinga, Naomi; Gathara, David; Gachau, Susan; Mbevi, George; Nyachiro, Wycliffe; Ogero, Morris; Julius, Thomas; Irimu, Grace; English, Mike

    2016-01-01

    In many low income countries health information systems are poorly equipped to provide detailed information on hospital care and outcomes. Information is thus rarely used to support practice improvement. We describe efforts to tackle this challenge and to foster learning concerning collection and use of information. This could improve hospital services in Kenya. We are developing a Clinical Information Network, a collaboration spanning 14 hospitals, policy makers and researchers with the goal of improving information available on the quality of inpatient paediatric care across common childhood illnesses in Kenya. Standardised data from hospitals’ paediatric wards are collected using non-commercial and open source tools. We have implemented procedures for promoting data quality which are performed prior to a process of semi-automated analysis and routine report generation for hospitals in the network. In the first phase of the Clinical Information Network, we collected data on over 65 000 admission episodes. Despite clinicians’ initial unfamiliarity with routine performance reporting, we found that, as an initial focus, both engaging with each hospital and providing them information helped improve the quality of data and therefore reports. The process has involved mutual learning and building of trust in the data and should provide the basis for collaborative efforts to improve care, to understand patient outcome, and to evaluate interventions through shared learning. We have found that hospitals are willing to support the development of a clinically focused but geographically dispersed Clinical Information Network in a low-income setting. Such networks show considerable promise as platforms for collaborative efforts to improve care, to provide better information for decision making, and to enable locally relevant research. PMID:27398232

  13. Improving Patient Outcomes With Oral Heart Failure Medications.

    PubMed

    Sherrod, Melissa M; Cheek, Dennis J; Seale, Ashlie

    2016-05-01

    Hospitals are under immense pressure to reduce heart failure readmissions that occur within 30 days of discharge, and to improve the quality of care for these patients. Penalties mandated by the Affordable Care Act decrease hospital reimbursement and ultimately the overall cost of caring for these patients increases if they are not well managed. Approximately 25% of patients hospitalized for heart failure are at high risk for readmission and these rates have not changed over the past decade. As a result of an aging population, the incidence of heart failure is expected to increase to one in five Americans over the age of 65. Pharmacologic management can reduce the risk of death and help prevent unnecessary hospitalizations. Healthcare providers who have knowledge of heart failure medications and drug interactions and share this information with their patients contribute to improved long-term survival and physical functioning as well as fewer hospitalizations and a delay of progressive worsening of heart failure. PMID:27145405

  14. Improving risk understanding across ability levels: Encouraging active processing with dynamic icon arrays.

    PubMed

    Okan, Yasmina; Garcia-Retamero, Rocio; Cokely, Edward T; Maldonado, Antonio

    2015-06-01

    Icon arrays have been found to improve risk understanding and reduce judgment biases across a wide range of studies. Unfortunately, individuals with low graph literacy experience only limited benefits from such displays. To enhance the efficacy and reach of these decision aids, the authors developed and tested 3 types of dynamic design features--that is, computerized display features that unfold over time. Specifically, the authors manipulated the sequential presentation of the different elements of icon arrays, the presence of explanatory labels indicating what was depicted in the different regions of the arrays, and the use of a reflective question followed by accuracy feedback. The first 2 features were designed to promote specific cognitive processes involved in graph comprehension, whereas the 3rd feature was designed to promote a more active, elaborative processing of risk information. Explanatory labels were effective in improving risk understanding among less graph-literate participants, whereas reflective questions resulted in large and robust performance benefits among participants with both low and high graph literacy. Theoretical and prescriptive implications are discussed. (PsycINFO Database Record PMID:25938975

  15. Learning from Our Evolving Understanding of Biophysical Interactions to Improve River Restoration Practice.

    NASA Astrophysics Data System (ADS)

    Sear, D. A.

    2014-12-01

    Restoration of riverine habitats has largely proceeded on the assumption that by improving physical habitat, and more latterly processes, biophysical interactions will reassemble to a state similar to that prior to the disturbance event. Whilst there had been little monitoring to support this view, there is increasing evidence that the complexity of ecological systems demands a greater understanding of these biophysical interactions before we can state that a restoration has succeeded. In this paper I will draw on two examples to demonstrate the importance of understanding the spatial as well as the temporal scale of biophysical interactions. In the first example, field and modelling was used to demonstrate how different location of large wood and forest restoration can result in different hydrological outcomes. Similarly, as the forest matures it is possible to see change in restoration outcomes, extending beyond the lifetime of the project. In the second example I demonstrate how climate and land use drive the biophysical interactions within spawning salmonid habitats, research that questions accepted models used in the restoration of salmonid spawning habitat. Finally the paper reflects on the problems of restoring complex ecosystems; and points towards the need for improvements in how we research and communicate with stakeholders who ultimately live by the streams we restore.

  16. [Understanding and reducing the risk of adverse drug reactions in pediatric patients].

    PubMed

    Gotta, Verena; van den Anker, Johannes; Pfister, Marc

    2015-12-01

    Developmental pharmacology influences the safety profile of drugs in pediatrics. Altered pharmacokinetics and/ or pharmacodynamics of drugs make pediatric patients susceptible to adverse drug reactions (ADRs), especially infants and newborns. Since the efficacy/ safety balance of most available drugs has not been formally evaluated in pediatric clinical trials, optimal dosing is rarely known in pediatrics. Suboptimal pediatric drug formulations make dose optimization even more difficult exposing pediatric patients to medication errors like overdosing and associated ADRs. We provide an overview of pediatric ADRs and discuss recent regulatory and pharmacological measures to understand and reduce risk of ADRs in pediatric patients. PMID:26654811

  17. A communication tool to improve the patient journey modeling process.

    PubMed

    Curry, Joanne; McGregor, Carolyn; Tracy, Sally

    2006-01-01

    Quality improvement is high on the agenda of Health Care Organisations (HCO) worldwide. Patient journey modeling is a relatively recent innovation in healthcare quality improvement that models the patient's movement through the HCO by viewing it from a patient centric perspective. Critical to the success of the redesigning care process is the involvement of all stakeholders and their commitment to actively participate in the process. Tools which promote this type of communication are a critical enabler that can significantly affect the overall process redesign outcomes. Such a tool must also be able to incorporate additional factors such as relevant policies and procedures, staff roles, system usage and measurements such as process time and cost. This paper presents a graphically based communication tool that can be used as part of the patient journey modeling process to promote stakeholder involvement, commitment and ownership as well highlighting the relationship of other relevant variables that contribute to the patient's journey. Examples of how the tool has been used and the framework employed are demonstrated via a midwife-led primary care case study. A key contribution of this research is the provision of a graphical communication framework that is simple to use, is easily understood by a diverse range of stakeholders and enables ready recognition of patient journey issues. Results include strong stakeholder buy-in and significant enhancement to the overall design of the future patient journey. Initial results indicate that the use of such a communication tool can improve the patient journey modeling process and the overall quality improvement outcomes. PMID:17945852

  18. Improving organizational climate for excellence in patient care.

    PubMed

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance. PMID:23903945

  19. Different Approaches to Understanding Patients in General Practice in Denmark: A Qualitative Study

    ERIC Educational Resources Information Center

    Davidsen, Annette Sofie; Reventlow, Susanne

    2011-01-01

    General practitioners (GPs) treat more than 90% of common mental disorders. Their approaches to psychological interventions have been little studied and their process of understanding patients remains unexplored. This qualitative interview and observation study aimed to explore Danish GPs' approaches to emotional problems and mental disorders in…

  20. Step Into Patients' Shoes: How to Understand and Apply a Patient-Centered Perspective.

    PubMed

    Rowell, Liz Webler

    2015-01-01

    Is your health plan truly encouraging employees to be health care consumers? Research in health literacy and patient health engagement may unlock new solutions. This article offers concrete ways employers can shift their frame when designing and communicating health plans, empowering employees to be better self-advocates. PMID:26666090

  1. Patient-Provider Communication: Understanding the Role of Patient Activation for Latinos in Mental Health Treatment

    ERIC Educational Resources Information Center

    Cortes, Dharma E.; Mulvaney-Day, Norah; Fortuna, Lisa; Reinfeld, Sarah; Alegria, Margarita

    2009-01-01

    This article highlights results from the Right Question Project-Mental Health (RQP-MH), an intervention designed to teach skills in question formulation and to increase patients' participation in decisions about mental health treatment. Of participants in the RQP-MH intervention, 83% were from a Latino background, and 75% of the interviews were…

  2. What Is in a Name? How Biomedical Language May Derail Patient Understanding of Hypertension.

    PubMed

    Bokhour, Barbara G; Kressin, Nancy R

    2015-07-01

    Despite major advances in treating hypertension, >50% of all individuals diagnosed with the condition remain in poor control. A fundamental issue may be that patients may not fully understand the meaning of the term hypertension or its cause, leading to poor adherence to medications and limiting other effective self-management behaviors. We posit that the word hypertension itself may contribute to these misunderstandings, particularly in regards to the role of stress in causing hypertension, which thus suggests stress management as a primary strategy for control. The word hypertension is often interpreted by patients to mean too much tension. In conjunction with cultural framings of stress causing high blood pressure, many patients turn to stress management to control their hypertension. The word hypertension can thus cause patients to think of it as more of a psychological than physiological condition, thus discounting the value of antihypertensive medications and interfering with medication adherence. We therefore suggest that clinicians reconsider the use of the term hypertension and the ways in which they explain the condition to patients. Reorienting the language to the more patient-centered term of high blood pressure may help patients better understand the condition and to more readily embrace the available efficacious therapies. PMID:26152679

  3. Ecosystem function in waste stabilisation ponds: Improving water quality through a better understanding of biophysical coupling

    NASA Astrophysics Data System (ADS)

    Ghadouani, Anas; Reichwaldt, Elke S.; Coggins, Liah X.; Ivey, Gregory N.; Ghisalberti, Marco; Zhou, Wenxu; Laurion, Isabelle; Chua, Andrew

    2014-05-01

    Wastewater stabilisation ponds (WSPs) are highly productive systems designed to treat wastewater using only natural biological and chemical processes. Phytoplankton, microbial communities and hydraulics play important roles for ecosystem functionality of these pond systems. Although WSPs have been used for many decades, they are still considered as 'black box' systems as very little is known about the fundamental ecological processes which occur within them. However, a better understanding of how these highly productive ecosystems function is particularly important for hydrological processes, as treated wastewater is commonly discharged into streams, rivers, and oceans, and subject to strict water quality guidelines. WSPs are known to operate at different levels of efficiency, and treatment efficiency of WSPs is dependent on physical (flow characteristics and sludge accumulation and distribution) and biological (microbial and phytoplankton communities) characteristics. Thus, it is important to gain a better understanding of the role and influence of pond hydraulics and vital microbial communities on pond performance and WSP functional stability. The main aim of this study is to investigate the processes leading to differences in treatment performance of WSPs. This study uses a novel and innovative approach to understand these factors by combining flow cytometry and metabolomics to investigate various biochemical characteristics, including the metabolite composition and microbial community within WSPs. The results of these analyses will then be combined with results from the characterisation of pond hydrodynamics and hydraulic performance, which will be performed using advanced hydrodynamic modelling and advanced sludge profiling technology. By understanding how hydrodynamic and biological processes influence each other and ecosystem function and stability in WSPs, we will be able to propose ways to improve the quality of the treatment using natural processes, with

  4. Understanding and Improving CRM and GCM Simulations of Cloud Systems with ARM Observations

    SciTech Connect

    Wu, Xiaoqing

    2014-02-25

    The works supported by this ASR project lay the solid foundation for improving the parameterization of convection and clouds in the NCAR CCSM and the climate simulations. We have made a significant use of CRM simulations and ARM observations to produce thermodynamically and dynamically consistent multi-year cloud and radiative properties; improve the GCM simulations of convection, clouds and radiative heating rate and fluxes using the ARM observations and CRM simulations; and understand the seasonal and annual variation of cloud systems and their impacts on climate mean state and variability. We conducted multi-year simulations over the ARM SGP site using the CRM with multi-year ARM forcing data. The statistics of cloud and radiative properties from the long-term CRM simulations were compared and validated with the ARM measurements and value added products (VAP). We evaluated the multi-year climate simulations produced by the GCM with the modified convection scheme. We used multi-year ARM observations and CRM simulations to validate and further improve the trigger condition and revised closure assumption in NCAR GCM simulations that demonstrate the improvement of climate mean state and variability. We combined the improved convection scheme with the mosaic treatment of subgrid cloud distributions in the radiation scheme of the GCM. The mosaic treatment of cloud distributions has been implemented in the GCM with the original convection scheme and enables the use of more realistic cloud amounts as well as cloud water contents in producing net radiative fluxes closer to observations. A physics-based latent heat (LH) retrieval algorithm was developed by parameterizing the physical linkages of observed hydrometeor profiles of cloud and precipitation to the major processes related to the phase change of atmospheric water.

  5. Collaborating With Music Therapists to Improve Patient Care.

    PubMed

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane

    2016-09-01

    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care. PMID:27568531

  6. Interventions to Improve Care for Patients with Limited Health Literacy

    PubMed Central

    Sudore, Rebecca L.; Schillinger, Dean

    2009-01-01

    Objective To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). Methods Review of the literature. Results Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. Conclusion Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care. PMID:20046798

  7. Doctors and their patients: a context for understanding the wish to hasten death.

    PubMed

    Kelly, Brian; Burnett, Paul; Badger, Shirlene; Pelusi, Dan; Varghese, Francis T; Robertson, Marguerite

    2003-06-01

    There is a paucity of research that has directly examined the role of the health professional in dealing with a terminally ill patient's wish to hasten death (WTHD) and the implications of this for the support and services needed in the care for a dying patient. Themes to emerge from a qualitative analysis of interviews conducted on doctors (n=24) involved in the treatment and care of terminally ill patients were (i). the doctors' experiences in caring for their patients (including themes of emotional demands/expectations, the duration of illness, and the availability of palliative care services); (ii). the doctors' perception of the care provided to their respective patients (comprising themes concerning satisfaction with the care for physical symptoms, for emotional symptoms, or overall care); (iii). the doctors' attitudes to euthanasia and (iv). the doctors' perception of their patients' views/beliefs regarding euthanasia and hastened death. When responses were categorised according to the patients' level of a WTHD, the theme concerning the prolonged nature of the patients' illnesses was prominent in the doctor group who had patients with the highest WTHD, whereas there was only a minority of responses concerning support from palliative care services and satisfaction with the level of emotional care in this group.This exploratory study presents a set of descriptive findings identifying themes among a small group of doctors who have been involved in the care of terminally ill cancer patients, to investigate factors that may be associated with the WTHD among these patients. The pattern of findings suggest that research investigating the doctor-patient interaction in this setting may add to our understanding of the problems (for patients and their doctors) that underpins the wish to hasten death in the terminally ill. PMID:12748974

  8. Understanding Patients' Attitudes Toward Communication About the Cost of Cancer Care

    PubMed Central

    Bullock, Andrea J.; Hofstatter, Erin W.; Yushak, Melinda L.; Buss, Mary K.

    2012-01-01

    Purpose: Recent publications have promoted physician-patient communication on cost as a means of decreasing overall spending and minimizing patients' financial burden in oncology. No study has assessed patients' perspectives on cost communication in oncology. We sought to describe oncology patients' attitudes toward cost communication, explore potential predictors for patients' communication preferences, and assess how patients with cancer consider cost when making management decisions. Methods: A 31-item questionnaire was developed to measure oncology patients' communication preferences regarding the cost of cancer care, focusing on out-of-pocket costs. Items were adapted from other instruments when possible. After piloting, patients were recruited from an academic ambulatory oncology practice. Basic descriptive statistics were applied. Results: Of the 771 patients approached, 256 responded (response rate, 33%). Most (68%) preferred to know about out-of-pocket costs before treatment. A majority (59%) wanted their physician to discuss these costs with them. Although 76% reported feeling comfortable discussing cost with their physician, 74% were amenable to discussing cost with someone other than their physician. Most patients did not consider out-of-pocket costs (57%) or the health care costs of the country (61%) in their decision making, nor did they believe their physician should (55%). Patients receiving active chemotherapy were less likely to want to discuss out-of-pocket costs with their physician (P = .035). Conclusion: Patients' comfort with and desire to discuss cancer costs exceed that of oncologists, suggesting a need to educate oncologists on this important topic. A patient's desire to understand treatment-associated cost does not equate with a desire for cost to influence medical decision making. PMID:23180999

  9. Understanding and Improving the Quality of Inter-Layer Interfaces in FDM 3-D Printing

    NASA Astrophysics Data System (ADS)

    Duranty, Edward; Spradlin, Brandon; Stark, Madeline; Dadmun, Mark

    We have studied the effect of thermal history and material diffusion on inter-filament bonding in FDM 3D printed parts and developed methods to improve interlayer adhesion in 3D printed samples. The available thermal energy during the FDM print environment was determined quantitatively by tracking the temperature of the bottom most printed layer using a thermocouple attached to the print bed. The role of the thermal history of the filaments during the deposition process on the quality of inter-layer bonding in an FDM ABS part was monitored using a T-peel test and an innovative sample design. Additionally, the interfacial adhesion between 3D printed layers was improved by the addition of a chemical cross-linking agent 4,4 '-diaminodiphenylmethane (DADPM). These studies have increased our understanding of the importance of the complex thermal history of a filament in the 3D printing process and its impact on the interfaces that form during the fused deposition modeling print process. Furthermore, the chemical crosslinking process demonstrates a potential method to covalently link layers in FDM printed parts, improving the bulk strength of the part. The insight provided in this work may aid in the development of techniques that can produce FDM parts that could be used as replacement parts in structural applications, or as completely standalone products.

  10. Understanding side reactions in K-O2 batteries for improved cycle life.

    PubMed

    Ren, Xiaodi; Lau, Kah Chun; Yu, Mingzhe; Bi, Xuanxuan; Kreidler, Eric; Curtiss, Larry A; Wu, Yiying

    2014-11-12

    Superoxide based metal-air (or metal-oxygen) batteries, including potassium and sodium-oxygen batteries, have emerged as promising alternative chemistries in the metal-air battery family because of much improved round-trip efficiencies (>90%). In order to improve the cycle life of these batteries, it is crucial to understand and control the side reactions between the electrodes and the electrolyte. For potassium-oxygen batteries using ether-based electrolytes, the side reactions on the potassium anode have been identified as the main cause of battery failure. The composition of the side products formed on the anode, including some reaction intermediates, have been identified and quantified. Combined experimental studies and density functional theory (DFT) calculations show the side reactions are likely driven by the interaction of potassium with ether molecules and the crossover of oxygen from the cathode. To inhibit these side reactions, the incorporation of a polymeric potassium ion selective membrane (Nafion-K(+)) as a battery separator is demonstrated that significantly improves the battery cycle life. The K-O2 battery with the Nafion-K(+) separator can be discharged and charged for more than 40 cycles without increases in charging overpotential. PMID:25295518

  11. Improved understanding of factors driving methicillin-resistant Staphylococcus aureus epidemic waves

    PubMed Central

    Chatterjee, Som S; Otto, Michael

    2013-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most important causes of nosocomial infections worldwide. Since the global spread of MRSA in the 1960s, MRSA strains have evolved with increased pathogenic potential. Notably, some strains are now capable of causing persistent infections not only in hospitalized patients but also in healthy individuals in the community. Furthermore, MRSA is increasingly associated with infections among livestock-associated workers, primarily because of transmission from animals to humans. Moreover, many MRSA strains have gained resistance to most available antibiotics. In this review, we will present current knowledge on MRSA epidemiology and discuss new endeavors being undertaken to understand better the molecular and epidemiological underpinnings of MRSA outbreaks. PMID:23861600

  12. Concurrent Chemoradiotherapy Improves Survival in Patients With Hypopharyngeal Cancer

    PubMed Central

    Paximadis, Peter; Yoo, George; Lin, Ho-Sheng; Jacobs, John; Sukari, Ammar; Dyson, Greg; Christensen, Michael; Kim, Harold

    2013-01-01

    Purpose To retrospectively review our institutional experience with hypopharyngeal carcinoma with respect to treatment modality. Methods and Materials A total of 70 patients with hypopharyngeal cancer treated between 1999 and 2009 were analyzed for functional and survival outcomes. The treatments included surgery alone (n = 5), surgery followed by radiotherapy (RT) (n = 3), surgery followed by chemoradiotherapy (CRT) (n = 13), RT alone (n = 2), CRT alone (n = 22), induction chemotherapy followed by RT (n = 3), and induction chemotherapy followed by CRT (n = 22). Results The median follow-up was 18 months. The median overall survival and disease-free survival for all patients was 28.3 and 17.6 months, respectively. The 1- and 2-year local control rate for all patients was 87.1% and 80%. CRT, given either as primary therapy or in the adjuvant setting, improved overall survival and disease-free survival compared with patients not receiving CRT. The median overall survival and disease-free survival for patients treated with CRT was 36.7 and 17.6 months vs. 14.0 and 8.0 months, respectively (p <.01). Of the patients initially treated with an organ-preserving approach, 4 (8.2%) required salvage laryngectomy for local recurrence or persistent disease; 8 (16.3%) and 12 (24.5%) patients were dependent on a percutaneous gastrostomy and tracheostomy tube, respectively. The 2-year laryngoesophageal dysfunction-free survival rate for patients treated with an organ-preserving approach was estimated at 31.7%. Conclusions Concurrent CRT improves survival in patients with hypopharyngeal cancer. CRT given with conventional radiation techniques yields poor functional outcomes, and future efforts should be directed at determining the feasibility of pharyngeal-sparing intensity-modulated radiotherapy in patients with hypopharyngeal tumors. PMID:21658855

  13. Concurrent Chemoradiotherapy Improves Survival in Patients With Hypopharyngeal Cancer

    SciTech Connect

    Paximadis, Peter; Yoo, George; Lin, Ho-Sheng; Jacobs, John; Sukari, Ammar; Dyson, Greg; Christensen, Michael; Kim, Harold

    2012-03-15

    Purpose: To retrospectively review our institutional experience with hypopharyngeal carcinoma with respect to treatment modality. Methods and Materials: A total of 70 patients with hypopharyngeal cancer treated between 1999 and 2009 were analyzed for functional and survival outcomes. The treatments included surgery alone (n = 5), surgery followed by radiotherapy (RT) (n = 3), surgery followed by chemoradiotherapy (CRT) (n = 13), RT alone (n = 2), CRT alone (n = 22), induction chemotherapy followed by RT (n = 3), and induction chemotherapy followed by CRT (n = 22). Results: The median follow-up was 18 months. The median overall survival and disease-free survival for all patients was 28.3 and 17.6 months, respectively. The 1- and 2-year local control rate for all patients was 87.1% and 80%. CRT, given either as primary therapy or in the adjuvant setting, improved overall survival and disease-free survival compared with patients not receiving CRT. The median overall survival and disease-free survival for patients treated with CRT was 36.7 and 17.6 months vs. 14.0 and 8.0 months, respectively (p < .01). Of the patients initially treated with an organ-preserving approach, 4 (8.2%) required salvage laryngectomy for local recurrence or persistent disease; 8 (16.3%) and 12 (24.5%) patients were dependent on a percutaneous gastrostomy and tracheostomy tube, respectively. The 2-year laryngoesophageal dysfunction-free survival rate for patients treated with an organ-preserving approach was estimated at 31.7%. Conclusions: Concurrent CRT improves survival in patients with hypopharyngeal cancer. CRT given with conventional radiation techniques yields poor functional outcomes, and future efforts should be directed at determining the feasibility of pharyngeal-sparing intensity-modulated radiotherapy in patients with hypopharyngeal tumors.

  14. Health professionals' knowledge and understanding about Listeria monocytogenes indicates a need for improved professional training.

    PubMed

    Buffer, Janet L; Medeiros, Lydia C; Kendall, Patricia; Schroeder, Mary; Sofos, John

    2012-07-01

    Listeria monocytogenes causes listeriosis, an uncommon but potentially fatal disease in immunocompromised persons, with a public health burden of approximately $2 billion annually. Those consumers most at risk are the highly susceptible populations otherwise known as the immunocompromised. Health professionals have a considerable amount of interaction with the immunocompromised and are therefore a valuable resource for providing appropriate safe food handling information. To determine how knowledgeable health professionals are about Listeria monocytogenes, a nationwide Web-based survey was distributed targeting registered nurses (RNs) and registered dietitians (RDs) who work with highly susceptible populations. Responses were received from 499 health professionals. Knowledge and understanding of Listeria monocytogenes was assessed descriptively. Parametric and nonparametric analyses were used to detect differences between RNs and RDs. The major finding is that there are gaps in knowledge and a self-declared lack of understanding by both groups, but especially RNs, about Listeria monocytogenes. RDs were more likely than RNs to provide information about specific foods and food storage behaviors to prevent a Listeria infection. Notably, neither group of health professionals consistently provided Listeria prevention messages to their immunocompromised patients. Pathogens will continue to emerge as food production, climate, water, and waste management systems change. Health professionals, represented by RNs and RDs, need resources and training to ensure that they are providing the most progressive information about various harmful pathogens; in this instance, Listeria monocytogenes. PMID:22980015

  15. POST-TRAUMATIC OSTEOARTHRITIS: IMPROVED UNDERSTANDING AND OPPORTUNITIES FOR EARLY INTERVENTION†

    PubMed Central

    Anderson, Donald D.; Chubinskaya, Susan; Guilak, Farshid; Martin, James A.; Oegema, Theodore R.; Olson, Steven A.; Buckwalter, Joseph A.

    2011-01-01

    Even with current treatments of acute joint injuries, more than 40% of people who suffer significant ligament or meniscus tears, or articular surface injuries, will develop osteoarthritis. Correspondingly, 12% or more of all patients with lower extremity osteoarthritis have a history of joint injury. Recent research suggests that acute joint damage that occurs at the time of an injury initiates a sequence of events that can lead to progressive articular surface damage. New molecular interventions, combined with evolving surgical methods, aim to minimize or prevent progressive tissue damage triggered by joint injury. Seizing the potential for progress in the treatment of joint injuries to forestall OA will depend on advances in: (1) quantitative methods of assessing the injury severity, including both structural damage and biologic responses, (2) understanding of the pathogenesis of post-traumatic OA, taking into account potential interactions among the different tissues and the role of post-traumatic incongruity and instability, and (3) application of engineering and molecular research to develop new methods of treating injured joints. This paper highlights recent advances in understanding of the structural damage and the acute biological response following joint injury, and it identifies important directions for future research. PMID:21520254

  16. Galantamine improves sleep quality in patients with dementia.

    PubMed

    Naharci, Mehmet Ilkin; Ozturk, Ahmet; Yasar, Halit; Cintosun, Umit; Kocak, Necmettin; Bozoglu, Ergun; Tasci, Ilker; Doruk, Huseyin

    2015-12-01

    The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality. PMID:25777522

  17. Improving outpatient services for elderly patients in Taiwan: a qualitative study.

    PubMed

    Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin; Chen, Liang-Kung

    2011-01-01

    The rapid pace of population aging poses significant importance of establishing an age-friendly health care system, including outpatient, inpatient, intermediate, and long-term care. The main purpose of this study is to evaluate the quality of outpatient services for elderly patients in Taiwan. Quality function deployment (QFD) is a tool effectively shortening the research-and-development period, reducing costs, and fulfilling customer needs (CNs). This study applied Kano's model and the analytic network process (ANP) to improve the basic framework of QFD. Kano's model enables a thorough understanding of elderly patients' needs and problems with regard to medical care services, so that appropriate outpatient services can be offered to them from the outset. In addition, adapting the supermatrix of ANP to the calculation of the house of quality (HoQ) will reduce subjective judgments. Using Kano's model and an integrated ANP-QFD approach, we extracted five needs of elderly patients and calculated their priorities: 'Professional medical care services convincing patients' (27%), 'With sufficient knowledge to answer patients' questions' (23.5%), 'Providing fast services to solve patients' problems' (19.3%), 'Voluntarily serving patients' (19.1%), and 'Providing proper medical equipment to patients' (11.1%). We then identified six outpatient service attributes deserving of improvement and their priorities: 'Physician with a high level of professionalism and giving clear interpretation of patient's condition' (25%), 'Staff with good communication skills and assistance to patients' (22%), 'High standardization of operating procedures' (18%), 'Staff getting on-the-job training periodically' (15%), 'Facilities sufficient and fitting for elderly patients' (10%), and 'Applying IT (internet) to help patients to receive medical care' (10%). In conclusion, we reconstructed an integrated QFD model which will not only reduce costs but also reveal the crucial outpatient service items

  18. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  19. The CONVEX project - Using Observational Evidence and Process Understanding to Improve Projections of Extreme Rainfall Change

    NASA Astrophysics Data System (ADS)

    Blenkinsop, Stephen; Fowler, Hayley; Kendon, Elizabeth; Chan, Steven; Ferro, Chris; Roberts, Nigel; Sessford, Pat

    2014-05-01

    During the last decade, widespread major flood events in the UK and across Europe have focussed attention on perceived increases in rainfall intensities. Whilst Regional Climate Models (RCMs) are able to simulate the magnitude and spatial pattern of observed daily extreme rainfall events more reliably than Global Circulation Models (GCMs), they still underestimate extreme rainfall in relation to observations and do not capture the properties of sub-daily events that may lead to flooding in urban areas. In the UK and Europe, particularly during the summer, a large proportion of precipitation comes from convective storms that are typically too small to be explicitly represented by climate models. Instead, convection parameterisation schemes are necessary to represent the larger-scale effect of unresolved convective cells. The CONVEX project (CONVective EXtremes) argues that an integrated approach is needed to provide improvements in estimates of change in extreme rainfall, particularly for summer convective events. As usable predictions require the synthesis of observations, understanding of atmospheric processes and models, a change in focus from traditional validation exercises (comparing modelled and observed extremes) to an understanding and quantification of the causes for model deficiencies in the simulation of extreme rainfall processes on different spatial and temporal scales is needed. By adopting this new focus CONVEX aims to contribute to the goals of enabling society to respond to global climate change and predicting the regional and local impacts of environmental change on timescales from days to decades. In addition to an improved understanding of the spatial-temporal characteristics of extreme rainfall processes (principally in the UK) the project is also assessing the influence of model parameterisations and resolution on the simulation of extreme rainfall events and processes. Under the project the UK Meteorological Office has run new RCM simulations

  20. Understanding and Improving High-Temperature Structural Properties of Metal-Silicide Intermetallics

    SciTech Connect

    Bruce S. Kang

    2005-10-10

    The objective of this project was to understand and improve high-temperature structural properties of metal-silicide intermetallic alloys. Through research collaboration between the research team at West Virginia University (WVU) and Dr. J.H. Schneibel at Oak Ridge National Laboratory (ORNL), molybdenum silicide alloys were developed at ORNL and evaluated at WVU through atomistic modeling analyses, thermo-mechanical tests, and metallurgical studies. In this study, molybdenum-based alloys were ductilized by dispersing MgAl2O4 or MgO spinel particles. The addition of spinel particles is hypothesized to getter impurities such as oxygen and nitrogen from the alloy matrix with the result of ductility improvement. The introduction of fine dispersions has also been postulated to improve ductility by acting as a dislocation source or reducing dislocation pile-ups at grain boundaries. The spinel particles, on the other hand, can also act as local notches or crack initiation sites, which is detrimental to the alloy mechanical properties. Optimization of material processing condition is important to develop the desirable molybdenum alloys with sufficient room-temperature ductility. Atomistic analyses were conducted to further understand the mechanism of ductility improvement of the molybdenum alloys and the results showed that trace amount of residual oxygen may be responsible for the brittle behavior of the as-cast Mo alloys. For the alloys studied, uniaxial tensile tests were conducted at different loading rates, and at room and elevated temperatures. Thermal cycling effect on the mechanical properties was also studied. Tensile tests for specimens subjected to either ten or twenty thermal cycles were conducted. For each test, a follow-up detailed fractography and microstructural analysis were carried out. The test results were correlated to the size, density, distribution of the spinel particles and processing time. Thermal expansion tests were carried out using thermo

  1. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    PubMed

    Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

    2016-01-01

    When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear. PMID:27332258

  2. Understanding The Role Played By Medicare's Patient Experience Points System In Hospital Reimbursement.

    PubMed

    Elliott, Marc N; Beckett, Megan K; Lehrman, William G; Cleary, Paul; Cohea, Christopher W; Giordano, Laura A; Goldstein, Elizabeth H; Damberg, Cheryl L

    2016-09-01

    In 2015 the Medicare Hospital Value-Based Purchasing (VBP) program paid hospitals $1.4 billion in performance-based incentives; 30 percent of a hospital's VBP Total Performance Score was based on performance on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures of the patient experience of care. Hospitals receive patient experience points based on three components: achievement, improvement, and consistency. For 2015 we examined how the three components affected reimbursement for 3,152 hospitals, including their impact on low-performing and high-minority hospitals. Achievement accounted for 96 percent of the differences among hospitals in total HCAHPS points. Although achievement had the biggest influence on payments, payments related to improvement and consistency were more beneficial for low-performing hospitals that disproportionately served minority patients. The findings highlight the important inducement that paying for improvement provides to initially low-performing hospitals to improve care and the role this incentive structure plays in minimizing resource redistributions away from hospitals serving minority populations. Additional emphasis on improvement points could benefit hospitals serving disadvantaged patients. PMID:27605650

  3. Animal virus discovery: improving animal health, understanding zoonoses, and opportunities for vaccine development

    PubMed Central

    Delwart, Eric

    2012-01-01

    The characterization of viral genomes has accelerated due to improvement in DNA sequencing technology. Sources of animal samples and molecular methods for the identification of novel viral pathogens and steps to determine their pathogenicity are listed. The difficulties for predicting future cross-species transmissions are highlighted by the wide diversity of known viral zoonoses. Recent surveys of viruses in wild and domesticated animals have characterized numerous viruses including some closely related to those infecting humans. The detection of multiple genetic lineages within viral families infecting a single host species, phylogenetically interspersed with viruses found in other host species, reflects frequent past cross-species transmissions. Numerous opportunities for the generation of novel vaccines will arise from a better understanding of animal viromes. PMID:22463981

  4. Improved understanding of geologic CO{sub 2} storage processes requires risk-driven field experiments

    SciTech Connect

    Oldenburg, C.M.

    2011-06-01

    The need for risk-driven field experiments for CO{sub 2} geologic storage processes to complement ongoing pilot-scale demonstrations is discussed. These risk-driven field experiments would be aimed at understanding the circumstances under which things can go wrong with a CO{sub 2} capture and storage (CCS) project and cause it to fail, as distinguished from accomplishing this end using demonstration and industrial scale sites. Such risk-driven tests would complement risk-assessment efforts that have already been carried out by providing opportunities to validate risk models. In addition to experimenting with high-risk scenarios, these controlled field experiments could help validate monitoring approaches to improve performance assessment and guide development of mitigation strategies.

  5. Exciton Diffusion in Conjugated Polymers: From Fundamental Understanding to Improvement in Photovoltaic Conversion Efficiency.

    PubMed

    Tamai, Yasunari; Ohkita, Hideo; Benten, Hiroaki; Ito, Shinzaburo

    2015-09-01

    Singlet exciton diffusion plays a central role in the photovoltaic conversion in organic photovoltaics (OPVs). Upon light absorption, singlet excitons are promptly generated in organic materials instead of charge carriers because the dielectric constant (εr) is small (∼3-4), which is in sharp contrast to inorganic and perovskite solar cells. In order to convert to charge carriers, excitons need to diffuse into an interface between electron donor and acceptor materials before deactivating to the ground state. Therefore, fundamental understanding of exciton diffusion dynamics is one of the most important issues to further improve OPVs. We highlight recent leading studies in this field and describe several approaches for efficient exciton harvesting at the interface in OPVs. PMID:26269208

  6. Improving understanding of chromatin regulatory proteins and potential implications for drug discovery.

    PubMed

    Rafehi, Haloom; Khan, Abdul Waheed; El-Osta, Assam

    2016-04-01

    Many epigenetic-based therapeutics, including drugs such as histone deacetylase inhibitors, are now used in the clinic or are undergoing advanced clinical trials. The study of chromatin-modifying proteins has benefited from the rapid advances in high-throughput sequencing methods, the organized efforts of major consortiums and by individual groups to profile human epigenomes in diverse tissues and cell types. However, while such initiatives have carefully characterized healthy human tissue, disease epigenomes and drug-epigenome interactions remain very poorly understood. Reviewed here is how high-throughput sequencing improves our understanding of chromatin regulator proteins and the potential implications for the study of human disease and drug development and discovery. PMID:26923902

  7. Does L-carnitine improve endothelial function in hemodialysis patients?

    PubMed Central

    Sabri, Mohammad Reza; Fahimi, Farnaz; Hajialiasgar, Soheila; Etminan, Abbas; Nazemi, Sarir; Salehi, Farzaneh

    2012-01-01

    Background: Atherosclerosis is the leading cause of death in hemodialysis patients. These patients are also very prone to L-carnitine deficiency due to kidney disease. In this clinical trial, we investigated the effect of oral L-carnitine on endothelial function of these patients. Materials ans Methods: We studied 31 adult chronic hemodialysis patients in our center and divided them into two groups. The first group (n = 20) received 1500 mg/dialysis interval (every other day) oral L-carnitine. The control group (n = 11) received placebo for one month. Ultrasonographic measurements of flow mediated dilation and carotid intima-media thickness were performed before and after one month of L-carnitine and placebo therapy. Results: This study showed that after one month of L-carnitine or placebo therapy there was no significant improvement in flow mediated dilation (p = 0.80 and p = 0.59, respectively) or decrease in carotid intima-media thickness (p = 0.12 and p = 0.50, respectively). Conclusions: Our study revealed that one month of oral L-carnitine therapy did not improve endothelial function in hemodialysis patients. Long-term studies with large sample size using intravenous form and higher doses of the drug are required to clarify the questionable role of L-carnitine in hemodialysis patients. PMID:23626603

  8. Improved survival after liver transplantation in patients with hepatopulmonary syndrome.

    PubMed

    Gupta, S; Castel, H; Rao, R V; Picard, M; Lilly, L; Faughnan, M E; Pomier-Layrargues, G

    2010-02-01

    Hepatopulmonary syndrome (HPS) is present in 10-32% of chronic liver disease patients, carries a poor prognosis and is treatable by liver transplantation (LT). Previous reports have shown high LT mortality in HPS and severe HPS (arterial oxygen (PaO(2)) < or =50 mmHg). We reviewed outcomes in HPS patients who received LT between 2002 and 2008 at two transplant centers supported by a dedicated HPS clinic. We assessed mortality, complications and gas exchange in 21 HPS patients (mean age 51 years, MELD score 14), including 11/21 (52%) with severe HPS and 5/21 (24%) with living donor LT (median follow-up 20.2 months after LT). Overall mortality was 1/21 (5%); mortality in severe HPS was 1/11 (9%). Peritransplant hypoxemic respiratory failure occurred in 5/21 (24%), biliary complications in 8/21 (38%) and bleeding or vascular complications in 6/21 (29%). Oxygenation improved in all 19 patients in whom PaO(2) or SaO(2) were recorded. PaO(2) increased from 52.2 +/- 13.2 to 90.3 +/- 11.5 mmHg (room air) (p < 0.0001) (12 patients); a higher baseline macroaggregated albumin shunt fraction predicted a lower rate of postoperative improvement (p = 0.045) (7 patients). Liver transplant survival in HPS and severe HPS was higher than previously demonstrated. Severity of HPS should not be the basis for transplant refusal. PMID:19775311

  9. Topical Therapies for Psoriasis: Improving Management Strategies and Patient Adherence.

    PubMed

    Stein Gold, Linda F

    2016-03-01

    Psoriasis is a chronic disease that has a substantial effect on quality of life of patients and often needs long-term treatment. Topical treatments for psoriasis include corticosteroids, vitamin D derivatives, tazarotene, anthralin, tacrolimus, pimecrolimus, and newer formulations of tar. Although many of these treatments are effective, they must be prescribed appropriately and used consistently for a period of weeks to months before clinical evidence of improvement can be seen and patients perceive that the treatment is working. As such, medication dosage/schedule, choice of vehicle, and especially patient adherence to medication are key factors for a treatment to be effective. Addressing patient preferences about treatments and concerns about treatment-related toxicities and managing their expectations represent additional aspects of patient care. Therapies such as calcipotriene and betamethasone dipropionate (Cal/BD) fixed combination foam and new drugs and vehicles continuously enhance the treatment landscape for psoriasis. Because adherence to topical treatment can be a major difficulty, keeping the treatment regimen simple and using new and sophisticated treatment vehicles that are acceptable to patients can likely improve treatment outcomes. PMID:27074696

  10. An improved conceptual understanding of snowmelt and groundwater dynamics in the semi-arid Andes

    NASA Astrophysics Data System (ADS)

    Sproles, Eric; Hevia, Andres; Soulsby, Chris; Tetzlaff, Doerthe

    2016-04-01

    The contribution of snowmelt to groundwater has long been recognized as an important component of the hydrological cycle in semi-arid northern central Chile (29°-32°S). Despite its importance as a water resource, this transition to groundwater remains poorly understood. Climatically, the High Cordillera in northern central Chile receives approximately 10 times as much annual precipitation as the valley bottoms, falling almost exclusively as snow above 3500 m during the winter months. Geologically, the High Cordillera is characterized by steep topography and a highly dissected landscape underlain by bedrock. Groundwater stores in the mountain headwaters are assumed to be constrained to the valley bottoms. The current working hypothesis of watershed processes in the High Cordillera describes fluxes of spring melt moving through the hillslope via local flowpaths to valley aquifers that recharge streams throughout the headwater reaches. Previous studies in the region indicate Pre-Cordilleran aquifers, located in lower elevation dry ephemeral valleys, are hydrologically disconnected from the High Cordillera. These watersheds have no seasonal snowpack, and recharge occurs primarily during infrequent rain events. These isolated Pre-Cordilleran aquifers serve as an important water resource for rural residents and infrastructure. We present stable isotope, geochemical, and groundwater level data from the wet El Niño winter of 2015 that suggests a topographically disconnected aquifer in the Pre-Cordillera received considerable recharge from High Cordillera snowmelt. These novel findings are indicative of deep groundwater flow paths between the Pre- and High Cordillera during the wet winter and spring of 2015, and improve the conceptual understanding of hydrological processes in the region. Additionally, these results will directly benefit groundwater management in the Pre-Cordillera and better inform modeling efforts in the High Cordillera. While this study is limited to

  11. Designing Cancer-Killing Artificial Viruses to Improve Student Understanding of Microbiology

    PubMed Central

    Kuniyuki, Andy; Sharp, Gwen

    2011-01-01

    Our objective was to assess the effectiveness of a “learning by designing” group project used in a lower-division Microbiology course. Students used knowledge gained from the course to design an artificial virus that would kill cancer cells. The assignment required groups to integrate the individual course topics into a unified, complex understanding of the field of microbiology. Throughout the course, students and the instructor collaborated in creating a rubric to evaluate the groups’ final presentations. This paper reports the results of an assessment of the project by comparing the instructor’s and the students’ scores for the presentations. Students’ and the instructor’s scores were correlated; the Pearson coefficient of 0.52 was statistically significant. The results indicate that students gained sufficient knowledge to accurately evaluate proposed designs. Additionally, the overall course grade distribution improved compared to the semester before the project was introduced. Finally, in order to engage students in thinking about their own learning process, they completed a reflection assignment that required them to discuss the changes in their understanding of microbiology over the course of the semester. Our assessment indicates that a design project can serve as an effective and useful learning technique in undergraduate Microbiology courses, though modifications are suggested. PMID:23653757

  12. How does sport psychology actually improve athletic performance? A framework to facilitate athletes' and coaches' understanding.

    PubMed

    Gee, Chris J

    2010-09-01

    The popularity of sport psychology, both as an academic discipline and an applied practice, has grown substantially over the past two decades. Few within the realm of competitive athletics would argue with the importance of being mentally prepared prior to an athletic competition as well as the need to maintain that particular mindset during a competitive contest. Nevertheless, recent research has shown that many athletes, coaches, and sporting administrators are still quite reluctant to seek out the services of a qualified sport psychologist, even if they believe it could help. One of the primary reasons for this hesitation appears to be a lack of understanding about the process and the mechanisms by which these mental skills affect performance. Unlike the "harder sciences" of sport physiology and biochemistry where athletes can see the tangible results in themselves or other athletes (e.g., he or she lifted weights, developed larger muscles, and is now stronger/faster as a result), the unfamiliar and often esoteric nature of sport psychology appears to be impeding a large number of athletes from soliciting these important services. As such, the purpose of this article is to provide the reader with a simple framework depicting how mental skills training translates into improved within-competition performance. This framework is intended to help bridge the general "understanding gap" that is currently being reported by a large number of athletes and coaches, while also helping sport psychology practitioners sell their valuable services to individual athletes and teams. PMID:20935240

  13. Redefining fine roots improves understanding of belowground contributions to terrestrial biosphere processes

    SciTech Connect

    McCormack, M. Luke; Dickie, Ian A.; Eissenstat, David M.; Fahey, Timothy J.; Fernandez, Christopher W.; Guo, Dali; Helmisaari, Helja -Sisko; Hobbie, Erik A.; Iversen, Colleen M.; Jackson, Robert B.; Leppälammi-Kujansuu, Jaana; Norby, Richard J.; Phillips, Richard P.; Pregitzer, Kurt S.; Pritchard, Seth G.; Rewald, Boris; Zadworny, Marcin

    2015-03-10

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain due to challenges in consistent measurement and interpretation of fine-root systems. We define fine roots as all roots less than or equal to 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. We demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, fine roots are separated into either individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine root pool. Furthermore, using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally a ca. 30% reduction from previous estimates assuming a single fine-root pool. In the future we hope to develop tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi in fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand belowground processes in the terrestrial biosphere.

  14. Redefining fine roots improves understanding of belowground contributions to terrestrial biosphere processes

    DOE PAGESBeta

    McCormack, M. Luke; Dickie, Ian A.; Eissenstat, David M.; Fahey, Timothy J.; Fernandez, Christopher W.; Guo, Dali; Helmisaari, Helja -Sisko; Hobbie, Erik A.; Iversen, Colleen M.; Jackson, Robert B.; et al

    2015-03-10

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain due to challenges in consistent measurement and interpretation of fine-root systems. We define fine roots as all roots less than or equal to 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. We demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, finemore » roots are separated into either individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine root pool. Furthermore, using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally a ca. 30% reduction from previous estimates assuming a single fine-root pool. In the future we hope to develop tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi in fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand belowground processes in the terrestrial biosphere.« less

  15. Redefining fine roots improves understanding of below-ground contributions to terrestrial biosphere processes

    DOE PAGESBeta

    McCormack, M. Luke; Dickie, Ian A.; Eissenstat, David M.; Fahey, Timothy J.; Fernandez, Christopher W.; Guo, Dali; Helmisaari, Heljä-Sisko; Hobbie, Erik A.; Iversen, Colleen M.; Jackson, Robert B.; et al

    2015-03-10

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain due to challenges in consistent measurement and interpretation of fine-root systems. Traditionally, fine roots have been defined as all roots less than or equal to 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. Here, we demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. Inmore » these frameworks, fine roots are separated into either individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine root pool. Using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally a ca. 30% reduction from previous estimates assuming a single fine-root pool. Future work developing tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi in fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand belowground processes in the terrestrial biosphere.« less

  16. Towards an Improved Understanding of Shock Effects in Recovered Samples: Application to Shocked Clay Minerals

    NASA Astrophysics Data System (ADS)

    Spaulding, Dylan; Stewart, Sarah; Hankin, Markos; Wizda, Lee

    2015-06-01

    Samples recovered from shock-compression experiments offer a unique opportunity to understand the response of materials to extreme conditions. Correct interpretation of such experiments requires understanding the independent roles of pressure and temperature upon both compression and release. Previous shock-recovery experiments have largely ignored the thermal history of the sample or have underestimated peak pressures due to strong impedance mismatch between the sample and its surroundings. Here, we present current efforts towards increasingly controlled shock recovery schemes for the study of devolatilization in phyllosilicate clays. Shock effects may influence how volatiles within such clays are preferentially incorporated or lost during planetary accretion as well as spectral observations and interpretations of the aqueous history of planetary surfaces. We present both equation-of-state, post-shock temperature and devolatilization data for Kaolinite and Montmorillonite (up to 21 and 23 GPa, respectively) as well as post-mortem sample analysis using a variety of methods. Performance of sample recovery designs are simulated using a 3D Eulerian hydrodynamic code (CTH) and compared to experiments in order to optimize and improve sample geometries.

  17. On-Ramp: Improving students' understanding of lock-in amplifiers

    NASA Astrophysics Data System (ADS)

    DeVore, Seth; Singh, Chandralekha; Levy, Jeremy

    2013-03-01

    A lock-in amplifier is a powerful and versatile instrument which is used frequently in condensed matter physics research. However, many students struggle with the basics of a lock-in amplifier and they have difficulty in interpreting the data obtained with this device in diverse applications. To improve students' understanding, we are developing an ``On-Ramp'' tutorial based on physics education research which makes use of a computer simulation of a lock-in amplifier. During the development of the tutorial we interviewed several faculty members and graduate students. The tutorial is based on a field-tested approach in which students realize their difficulties after predicting the outcome of experiments that use a lock-in amplifier; students can check their predictions using simulations. The tutorial then guides students toward a coherent understanding of the basics of a lock-in amplifier. This poster will discuss the development and assessment process. This work is supported by NSF NEB (DMR-1124131) and NSF (PHY-1202909).

  18. Active learning to understand infectious disease models and improve policy making.

    PubMed

    Willem, Lander; Stijven, Sean; Vladislavleva, Ekaterina; Broeckhove, Jan; Beutels, Philippe; Hens, Niel

    2014-04-01

    Modeling plays a major role in policy making, especially for infectious disease interventions but such models can be complex and computationally intensive. A more systematic exploration is needed to gain a thorough systems understanding. We present an active learning approach based on machine learning techniques as iterative surrogate modeling and model-guided experimentation to systematically analyze both common and edge manifestations of complex model runs. Symbolic regression is used for nonlinear response surface modeling with automatic feature selection. First, we illustrate our approach using an individual-based model for influenza vaccination. After optimizing the parameter space, we observe an inverse relationship between vaccination coverage and cumulative attack rate reinforced by herd immunity. Second, we demonstrate the use of surrogate modeling techniques on input-response data from a deterministic dynamic model, which was designed to explore the cost-effectiveness of varicella-zoster virus vaccination. We use symbolic regression to handle high dimensionality and correlated inputs and to identify the most influential variables. Provided insight is used to focus research, reduce dimensionality and decrease decision uncertainty. We conclude that active learning is needed to fully understand complex systems behavior. Surrogate models can be readily explored at no computational expense, and can also be used as emulator to improve rapid policy making in various settings. PMID:24743387

  19. Redefining fine roots improves understanding of below-ground contributions to terrestrial biosphere processes.

    PubMed

    McCormack, M Luke; Dickie, Ian A; Eissenstat, David M; Fahey, Timothy J; Fernandez, Christopher W; Guo, Dali; Helmisaari, Heljä-Sisko; Hobbie, Erik A; Iversen, Colleen M; Jackson, Robert B; Leppälammi-Kujansuu, Jaana; Norby, Richard J; Phillips, Richard P; Pregitzer, Kurt S; Pritchard, Seth G; Rewald, Boris; Zadworny, Marcin

    2015-08-01

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain because of the challenges of consistently measuring and interpreting fine-root systems. Traditionally, fine roots have been defined as all roots ≤ 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. Here, we demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, fine roots are either separated into individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine-root pool. Using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally - a c. 30% reduction from previous estimates assuming a single fine-root pool. Future work developing tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi into fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand below-ground processes in the terrestrial biosphere. PMID:25756288

  20. Improving conservation outcomes with a new paradigm for understanding species’ fundamental and realized adaptive capacity

    USGS Publications Warehouse

    Beever, Erik; O’Leary, John; Mengelt, Claudia; West, Jordan M.; Julius, Susan; Green, Nancy; Magness, Dawn; Petes, Laura E.; Stein, Bruce A.; Nicotra, Adrienne B; Hellmann, Jessica J; Robertson, Amanda L; Staudinger, Michelle D.; Rosenberg, Andrew A.; Babij, Eleanora; Brennan, Jean; Schuurman, Gregor W; Hofmann, Gretchen E

    2016-01-01

    Worldwide, many species are responding to ongoing climate change with shifts in distribution, abundance, phenology, or behavior. Consequently, natural-resource managers face increasingly urgent conservation questions related to biodiversity loss, expansion of invasive species, and deteriorating ecosystem services. We argue that our ability to address these questions is hampered by the lack of explicit consideration of species’ adaptive capacity (AC). AC is the ability of a species or population to cope with climatic changes and is characterized by three fundamental components: phenotypic plasticity, dispersal ability, and genetic diversity. However, few studies simultaneously address all elements; often, AC is confused with sensitivity or omitted altogether from climate-change vulnerability assessments. Improved understanding, consistent definition, and comprehensive evaluations of AC are needed. Using classic ecological-niche theory as an analogy, we propose a new paradigm that considers fundamental and realized AC: the former reflects aspects inherent to species, whereas the latter denotes how extrinsic factors constrain AC to what is actually expressed or observed. Through this conceptualization, we identify ecological attributes contributing to AC, outline areas of research necessary to advance understanding of AC, and provide examples demonstrating how the inclusion of AC can better inform conservation and natural-resource management.

  1. Engaging Students Through Classroom Connection Webinars to Improve Their Understanding of the Mars Science Laboratory Mission

    NASA Technical Reports Server (NTRS)

    Graff, Paige V.; Achilles, Cherie

    2013-01-01

    Planetary exploration missions to other worlds, like Mars, can generate a lot of excitement and wonder for the public. The Mars Science Laboratory Mission is one of the latest planetary missions that has intrigued the public perhaps more than most. How can scientists and educational specialists capitalize on the allure of this mission and involve students and teachers in a way that not only shares the story of the mission, but actively engages classrooms with scientists and improves their understanding of the science? The Expedition Earth and Beyond (EEAB) Program [1], facilitated by the Astromaterials Research and Exploration Science (ARES) Directorate Education Program at the NASA Johnson Space Center achieves this by facilitating MSL mission focused classroom connection webinars. Five MSL-focused webinars facilitated through EEAB during the 2012 fall semester engaged almost 3000 students and teachers. Involved STEM experts/role models helped translate the science behind the Mars Science Laboratory mission in a comprehensive, exciting, and engaging manner. These virtual events captured participants attention while increasing their science awareness and understanding of the MSL mission.

  2. Applicability and importance of Caraka's concept of Aaturaparijnana Hetawah in understanding a patient.

    PubMed

    Wadher, Rupesh; Dwivedi, Rambabu R

    2012-04-01

    Many concepts in Ayurveda are untouched or unexplored till date. One of such concepts to understand the healthy and unhealthy persons is that of the Aaturaparijnana Hetawah (APH), which is only mentioned in Caraka Samhita. The descriptions about Dushya, Desha, Bala, Kala, Prakriti, etc. are mentioned very briefly in all the classics. But no standard figure or pattern is maintained while considering them. It is only in the description of Aaturaparijnana Hetawah mentioned in Vimana Sthana that all the factors are pre-arranged in a chronological order to understand an individual according to one's Desha as from birth till grown up stage, and also to understand about the illness and most common disorders. In this article, it is aimed at presenting an in-depth evaluation about description of Aaturaparijnana Hetawah in Ayurveda. For this study, the references of Aturaparijnana Hetu have been collected through the Ayurvedic texts along with their commentaries. By making use of 14 factors described in Aaturaparijnana Hetawah, it is possible to have an in depth understanding about the patient's nature and factors that may be contributing to his health and illness. Aaturaparijnana Hetawah helps in an in-depth understanding of a patient's disease and heath status. More in-depth evaluation studies and application in the modern medical science should be done in order to avail the benefits of this approach. PMID:23559788

  3. Defining lactation acuity to improve patient safety and outcomes.

    PubMed

    Mannel, Rebecca

    2011-05-01

    While substantial evidence exists identifying risks factors associated with premature weaning from breastfeeding, there are no previously published definitions of patient acuity in the lactation field. This article defines evidence-based levels of lactation acuity based on maternal and infant characteristics. Patient acuity, matching severity of illness to intensity of care required, is an important determinant of patient safety and outcomes. It is often used as part of a patient classification system to determine staffing needs and acceptable workloads in health care settings. As acuity increases, more resources, including more skilled clinicians, are needed to provide optimal care. Developing an evidence-based definition of lactation acuity can help to standardize terminology, more effectively distribute health care staff resources, encourage research to verify the validity and reliability of lactation acuity, and potentially improve breastfeeding initiation and duration rates. PMID:21527797

  4. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness

    PubMed Central

    2014-01-01

    Background In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding – and sometimes preventing – disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment. Discussion As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization. Summary Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts. PMID:24969758

  5. Smoking Cessation Related to Improved Patient-Reported Pain Scores Following Spinal Care in Geriatric Patients

    PubMed Central

    Behrend, Caleb; Coombs, Andre; Coyne, Ellen; Prasarn, Mark; Rechtine, Glenn

    2014-01-01

    Introduction: We examined rates of smoking cessation and the effect of smoking cessation on pain and disability scores in a geriatric patient population. Methods: Prospectively maintained database records of 6779 patients treated for painful spinal disorders were examined. The mean duration of care was 8 months. Multivariate statistical analysis was performed with independent variables including smoking status, secondary gain status, gender, treatment type, depression, and age. Results: Of the patients seeking care for painful spinal disorders, 8.9% over the age of 55 smoked compared with 23.9% of those under 55 years of age. Rates of smoking cessation did not differ for those older than 55 years (25.1%) and younger patients (26.1%). Current smokers in both age-groups reported greater pain than those who had never smoked in all pain ratings (P < .001). Mean improvement in reported pain over the course of treatment was significantly different in nonsmokers and current smokers in both age-groups (P < .001). Those who quit smoking during the course of care reported greater improvement in pain than those who continued to smoke. The mean improvement in pain ratings was clinically significant in patients in all 3 groups of nonsmokers whereas those who continued to smoke had no clinically significant improvement in reported pain. Conclusion: The results support the need for smoking cessation programs, given a strong association between improved patient-reported pain and smoking cessation. Fewer older patients smoke but they are equally likely to quit. PMID:26246941

  6. Bovine brucellosis in wildlife: using adaptive management to improve understanding, technology and suppression.

    PubMed

    White, P J; Treanor, J J; Geremia, C; Wallen, R L; Blanton, D W; Hallac, D E

    2013-04-01

    Eradication of brucellosis from bison (Bison bison) and elk (Cervus elaphus) populations in the Greater Yellowstone Area is not possible with current technology. There are considerable uncertainties regarding the effectiveness of management techniques and unintended effects on wildlife behaviour and demography. However, adaptive management provides a framework for learning about the disease, improving suppression techniques, and lowering brucellosis transmission among wildlife and to cattle. Since it takes approximately three years after birth for female bison to become reproductively active and contribute to brucellosis transmission, there is an opportunity to implement actions such as vaccination and the selective removal of infectious bison based on age and assay results to reduce the potential for transmission. Older adult bison that have been exposed to the bacteria, but recovered from acute infection, could be retained in the population to provide some immunity (resistance) against future transmission. Through careful predictions, research, and monitoring, our understanding and technology will be improved and management actions can be adjusted to better achieve desired outcomes. PMID:23837383

  7. Jatropha curcas, a biofuel crop: Functional genomics for understanding metabolic pathways and genetic improvement

    PubMed Central

    Maghuly, Fatemeh; Laimer, Margit

    2013-01-01

    Jatropha curcas is currently attracting much attention as an oilseed crop for biofuel, as Jatropha can grow under climate and soil conditions that are unsuitable for food production. However, little is known about Jatropha, and there are a number of challenges to be overcome. In fact, Jatropha has not really been domesticated; most of the Jatropha accessions are toxic, which renders the seedcake unsuitable for use as animal feed. The seeds of Jatropha contain high levels of polyunsaturated fatty acids, which negatively impact the biofuel quality. Fruiting of Jatropha is fairly continuous, thus increasing costs of harvesting. Therefore, before starting any improvement program using conventional or molecular breeding techniques, understanding gene function and the genome scale of Jatropha are prerequisites. This review presents currently available and relevant information on the latest technologies (genomics, transcriptomics, proteomics and metabolomics) to decipher important metabolic pathways within Jatropha, such as oil and toxin synthesis. Further, it discusses future directions for biotechnological approaches in Jatropha breeding and improvement. PMID:24092674

  8. Jatropha curcas, a biofuel crop: functional genomics for understanding metabolic pathways and genetic improvement.

    PubMed

    Maghuly, Fatemeh; Laimer, Margit

    2013-10-01

    Jatropha curcas is currently attracting much attention as an oilseed crop for biofuel, as Jatropha can grow under climate and soil conditions that are unsuitable for food production. However, little is known about Jatropha, and there are a number of challenges to be overcome. In fact, Jatropha has not really been domesticated; most of the Jatropha accessions are toxic, which renders the seedcake unsuitable for use as animal feed. The seeds of Jatropha contain high levels of polyunsaturated fatty acids, which negatively impact the biofuel quality. Fruiting of Jatropha is fairly continuous, thus increasing costs of harvesting. Therefore, before starting any improvement program using conventional or molecular breeding techniques, understanding gene function and the genome scale of Jatropha are prerequisites. This review presents currently available and relevant information on the latest technologies (genomics, transcriptomics, proteomics and metabolomics) to decipher important metabolic pathways within Jatropha, such as oil and toxin synthesis. Further, it discusses future directions for biotechnological approaches in Jatropha breeding and improvement. PMID:24092674

  9. Understanding consumer preference and willingness to pay for improved cookstoves in Bangladesh.

    PubMed

    Rosenbaum, Julia; Derby, Elisa; Dutta, Karabi

    2015-01-01

    The USAID/WASHplus project conducted a comprehensive assessment to understand consumer needs and preferences as they relate to increasing the uptake and consistent, exclusive, and correct use of improved cookstoves (ICSs) in Bangladesh. The assessment included household ICS trials, fuel and stove use monitoring, and consumers' perceived value of and willingness to pay for ICSs. Results showed that cooks appreciated and liked the ICS, but that no models met consumer needs sufficiently to replace traditional stoves. Initially, many preferred ICSs over traditional stoves, but this preference decreased over the 3-week trial period. Complaints and suggestions for improvement fell into two general categories: those that can be addressed through fairly simple modifications to the stove design, and those more appropriately addressed through point-of-purchase consumer education and follow-up from service agents or health outreach workers. Most households using the ICS realized fuel use reductions, although these were lower than expected, partly because of continued parallel traditional stove use. When given the option to purchase the stoves at market value, only one of 105 households did so; however, a separate assessment showed that 80% of participants (12 of 15 households) preferred to keep the stove rather than receive a cash buyout at market value. This indicates that users value the ICS when acquisition barriers are removed and highlights the need for better financing options. PMID:25839200

  10. Understanding the origin of the solar cyclic activity for an improved earth climate prediction

    NASA Astrophysics Data System (ADS)

    Turck-Chièze, Sylvaine; Lambert, Pascal

    This review is dedicated to the processes which could explain the origin of the great extrema of the solar activity. We would like to reach a more suitable estimate and prediction of the temporal solar variability and its real impact on the Earth climatic models. The development of this new field is stimulated by the SoHO helioseismic measurements and by some recent solar modelling improvement which aims to describe the dynamical processes from the core to the surface. We first recall assumptions on the potential different solar variabilities. Then, we introduce stellar seismology and summarize the main SOHO results which are relevant for this field. Finally we mention the dynamical processes which are presently introduced in new solar models. We believe that the knowledge of two important elements: (1) the magnetic field interplay between the radiative zone and the convective zone and (2) the role of the gravity waves, would allow to understand the origin of the grand minima and maxima observed during the last millennium. Complementary observables like acoustic and gravity modes, radius and spectral irradiance from far UV to visible in parallel to the development of 1D-2D-3D simulations will improve this field. PICARD, SDO, DynaMICCS are key projects for a prediction of the next century variability. Some helioseismic indicators constitute the first necessary information to properly describe the Sun-Earth climatic connection.

  11. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis

    PubMed Central

    Santos, Roberto Sávio Silva; Coelho, Fernando Morgadinho Santos; da Silva, Bruno Caldin; Graciolli, Fabiana Giorgeti; Dominguez, Wagner Velasquez; de Menezes Montenegro, Fabio Luiz; Jorgetti, Vanda; Moysés, Rosa Maria Affonso; Elias, Rosilene Motta

    2016-01-01

    Background Restless leg syndrome (RLS) is a sleep disorder with high prevalence among patients on hemodialysis. It has been postulated that high phosphate and high parathyroid hormone may be implicated in its pathogenesis. Standard international criteria and face-to-face interview are not always applied. Methods this was an interventional prospective study in which 19 patients (6 men, aged 48±11 years) with severe hyperparathyroidism were evaluated. RLS diagnosis and rating scale were accessed based on the International RLS Study Group pre- and post-parathyroidectomy. Patients also underwent standard polysomnography. Results At baseline, RLS was present in 10 patients (52.6%), and pain was the most reported symptom associated with the diagnosis. Patients with RLS had higher serum phosphate (p = 0.008) that remained independently associated with RLS in a logistic regression model, adjusted for hemoglobin, age and gender (HR = 7.28;CI = 1.14–46.3, p = 0.035). After parathyroidectomy, there was a reduction of serum parathyroid hormone, phosphate, calcium and alkaline phosphatase, and an increase of 25(OH)-vitamin D, and Fetuin-A. Parathyroidectomy alleviated RLS (from 52% to 21%; p = 0.04), which was accompanied by a decrease in severity scale, in association with relief of pain and pruritus. Polysomnography in these patients showed an improvement of sleep parameters as measured by sleep efficiency, sleep latency and percentage of REM sleep. Conclusion RLS is associated with high levels of phosphate in patients with severe secondary hyperparathyroidism on hemodialysis. Pain is most reported complain in these patients. Parathyroidectomy provided an opportunity to relief RLS. Whether the reduction of serum phosphorus or parathyroid hormone contributed to this improvement merits further investigation. PMID:27196740

  12. Improving our understanding of papillary renal cell carcinoma with integrative genomic analysis

    PubMed Central

    Modi, Parth K.

    2016-01-01

    Papillary renal cell carcinoma (pRCC) is a heterogeneous and incompletely understood histologic subtype of kidney cancer. Recently, authors from The Cancer Genome Atlas Research Network performed a comprehensive molecular characterization of pRCC. Using multiple analytic methods, they identified 4 subgroups of pRCC with varied genotypic anomalies and probabilities of overall survival. This analysis elucidated the differences between type 1 and type 2 pRCC. Furthermore, type 2 pRCC was found to be heterogeneous itself, with at least 3 subtypes with distinct molecular features. This improved characterization and insight about potential driver mutations and altered pathways may lead to the development of more targeted agents and better patient stratification in clinical trials for pRCC. PMID:27162793

  13. Improving our understanding of papillary renal cell carcinoma with integrative genomic analysis.

    PubMed

    Modi, Parth K; Singer, Eric A

    2016-04-01

    Papillary renal cell carcinoma (pRCC) is a heterogeneous and incompletely understood histologic subtype of kidney cancer. Recently, authors from The Cancer Genome Atlas Research Network performed a comprehensive molecular characterization of pRCC. Using multiple analytic methods, they identified 4 subgroups of pRCC with varied genotypic anomalies and probabilities of overall survival. This analysis elucidated the differences between type 1 and type 2 pRCC. Furthermore, type 2 pRCC was found to be heterogeneous itself, with at least 3 subtypes with distinct molecular features. This improved characterization and insight about potential driver mutations and altered pathways may lead to the development of more targeted agents and better patient stratification in clinical trials for pRCC. PMID:27162793

  14. Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

    PubMed Central

    Shuler, Kimberly M

    2014-01-01

    Purpose In patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams. Materials and methods A systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia. Results Of 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports

  15. Improving Compliance with Statins in Patients with Peripheral Arterial Disease: A Quality Improvement Study

    PubMed Central

    Agha, Riaz A.; Camm, Christian F.; Edison, Eric; Browning, Neil

    2012-01-01

    Atherosclerosis is an inflammatory disease affecting medium sized arteries. The prevalence, health, and financial impact of the disease has made it a key target for public health and large scale intervention. The statin class of drugs improve morbidity and mortality for patients with peripheral arterial disease (PAD) through polymodal actions. This quality improvement study aimed to determine, and subsequently reduce, the percentage of patients with PAD discharged without statins. According to the Vascular Society of Great Britain and Ireland, and draft National Institute of Health and Clinical Excellence guidance, all patients undergoing major vascular procedures should be prescribed a statin. A baseline audit of patients with PAD under the care of the vascular team at our instituted was undertaken for the period Dec 2009–July 2010. Electronic discharge letters (EDLs) were analysed and compliance with statin prescription were recorded. A number of interventions aimed at improving compliance were then enacted and monitored through weekly PDSA cycles. Junior doctor leadership was key to identifying the problem and conceiving, implementing, and measuring changes. A second cycle was run, using similar data collection methods to the first, for the period August-October 2010. In the first cycle, EDLs pertaining to 113 patient admissions, involving 96 patients with PAD, were examined. Statins were not prescribed in 30.1%. In the second cycle, 86 patient admissions, involving 76 patients, were examined. Statins were not prescribed in 24.4%, representing an 18.9% decrease. Poorly compliant sub-groups included patients presenting with embolism or those for elective angioplasty. PMID:26257905

  16. Optimizing hemodialysis practices in Canada could improve patient survival.

    PubMed

    Yeates, Karen E; Mendelssohn, David C; Ethier, Jean; Trpeski, Lilyanna; Na, Jingbo; Bragg-Gresham, Jennifer L; Eichleay, Margaret A; Pisoni, Ronald L; Port, Fritz K

    2007-01-01

    Data from the Canadian Organ Replacement Registry (CORR) and the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to determine whether practice patterns have changed in Canada since the introduction of the Canadian Society of Nephrology (CSN) Guidelines in 1999. DOPPS data were then used to calculate the impact of not meeting the proposed guideline targets and to estimate the potential life years gained if all Canadian hemodialysis patients achieved guideline targets. For dialysis dose and hemoglobin targets, Canadian facility performance has significantly improved over time. The vascular access use patterns show trends toward a worse pattern with increased catheter use. A calculation of the percentage of attributable risk suggests that 49% of deaths could possibly be averted if all patients currently outside the guidelines achieved them over the next five years. This corresponds to a decrease in the annual death rate from 18 to 10.1 per hundred patient years. These data support the need for improved adherence to guidelines. If Canadian caregivers were to optimize practice patterns, patient outcomes could be improved. PMID:17691708

  17. Understanding and Predicting Social Media Use Among Community Health Center Patients: A Cross-Sectional Survey

    PubMed Central

    2014-01-01

    Background The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. Objective The aim was to determine the use and factors predicting the use of social media for health care–related purposes among medically underserved primary care patients. Methods A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. Conclusions Understanding use and factors predicting use can increase adoption and utilization of social media for health care–related purposes among underserved patients in community health centers. PMID:25427823

  18. Improving Door to Needle time in Patients for Thrombolysis

    PubMed Central

    Fernandes, Darren; Umasankar, Udayaraj

    2016-01-01

    Ischaemic stroke can result in approximately 2 million brain neurones being damaged for each minute that it is left untreated. Various trials and studies such as the National Institute of Neurologic Disorders (NINDS) trial, the European Cooperative Acute Stroke Study (ECASS), ECASS II, and the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study have clearly demonstrated the beneficial effects of intravenous tissue plasminogen activator (tPA) for treatment of acute stroke. Therefore to minimise damage and improve clinical outcome, we need to identify patients who present within 4.5 hours of symptom onset and reduce the time taken to adminster a thrombolytic agent. This time is commonly referred to as the ‘door to needle’ (DTN) time. Our standard, set by the Clinical Commissioning Group (CCG) is to achieve a median time of scanning and thrombolysis within 55 minutes from the time that the patient enters the hospital. The aim of our QIP was to collect data on what the DTN time was during November 2015, December 2015, and January 2016 and to evaluate how this can be improved after each month. This Quality Improvement Project in the DTN time in patients for thrombolysis has identified areas in the pathway that leads to delays. One major contributing factor is the time for a doctor to come and assess and administer the thrombolytic agent to the patient. Change was implemented by ensuring that the core medical trainee on call is allocated to respond as a priority to all possible thrombolysis calls. This has resulted in a reduction of mean DTN time, from 74 minutes in November to 43 minutes in January. As well as improving patient outcomes, it is proposed that the implementation of change has benefitted the training experience and development of key skills of the core medical trainees. PMID:27559475

  19. Multidisciplinary in-hospital teams improve patient outcomes: A review

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    Background: The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Methods: Acting like “well-oiled machines,” multidisciplinary in-hospital teams include “staff” from different levels of the treatment pyramid (e.g. staff including nurses’ aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the “silo effect” by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Results: Multiple articles across diverse disciplines incorporate a variety of concepts of “teamwork” for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient “staff” satisfaction. Conclusion: Within hospitals, delivering the best medical/surgical care is a “team sport.” The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers’ performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their “well-oiled machines” enhancing the quality/safety of patient care, while enabling “staff” to optimize their performance and enhance their job satisfaction. PMID:25289149

  20. Continuous Quality Improvement for Patients with Back Pain

    PubMed Central

    Deyo, Richard A; Schall, Marie; Berwick, Donald M; Nolan, Tom; Carver, Penny

    2000-01-01

    Recent evidence has changed traditional approaches to low back pain, suggesting minimal bed rest, highly selective imaging, and early return to normal activities. However, there are wide geographical variations in care, and substantial gaps between practice and evidence. This project sought to merge scientific evidence about back pain and knowledge about behavior change to help organizations improve care for back pain. Participating insurance plans, HMOs, and group practices focused on problems they themselves identified. The year-long program included quarterly meetings, coaching for rapid cycles of change, a menu of potential interventions, and recommendations for monitoring outcomes. Participants interacted through meetings, e-mail, and conference calls. Of the 22 participating organizations, 6 (27%) made major progress. Typical changes were reduced imaging, bed rest, and work loss, and increased patient education and satisfaction. Specific examples were a 30% decrease in plain x-rays, a 100% increase in use of patient education materials, and an 81% drop in prescribed bed rest. Despite the complexity of care for back pain, rapid improvements appear feasible. Several organizations had major improvements, and most experienced at least modest improvements. Key elements of successful programs included focus on a small number of clinical goals, frequent measurement of outcomes among small samples of patients, vigilance in maintaining gains; involvement of office staffs as well as physicians, and changes in standard protocols for imaging, physical therapy, and referral. PMID:11029679

  1. Traditional Japanese Medicine Daikenchuto Improves Functional Constipation in Poststroke Patients

    PubMed Central

    Numata, Takehiro; Takayama, Shin; Tobita, Muneshige; Ishida, Shuichi; Katayose, Dai; Shinkawa, Mitsutoshi; Oikawa, Takashi; Aonuma, Takanori; Kaneko, Soichiro; Tanaka, Junichi; Kanemura, Seiki; Iwasaki, Koh; Ishii, Tadashi; Yaegashi, Nobuo

    2014-01-01

    Poststroke patients with functional constipation, assessed by the Rome III criteria, from 6 hospitals were recruited in a study on the effects of the traditional Japanese medicine Daikenchuto (DKT) on constipation. Thirty-four patients (17 men and 17 women; mean age: 78.1 ± 11.6 years) were randomly assigned to 2 groups; all patients received conventional therapy for constipation, and patients in the DKT group received 15 g/day of DKT for 4 weeks. Constipation scoring system (CSS) points and the gas volume score (GVS) (the measure of the intestinal gas volume calculated from plain abdominal radiographs) were recorded before and after a 4-week observation period. The total score on the CSS improved significantly in the DKT group compared to the control (P < 0.01). In addition, scores for some CSS subcategories (frequency of bowel movements, feeling of incomplete evacuation, and need for enema/disimpaction) significantly improved in the DKT group (P < 0.01, P = 0.049, and P = 0.03, resp.). The GVS was also significantly reduced in the DKT group compared to the control (P = 0.03). DKT in addition to conventional therapy is effective in treating functional constipation in poststroke patients. This study was a randomized controlled trial and was registered in the UMIN Clinical Trial Registry (no. UMIN000007393). PMID:25089144

  2. Understanding Patient Preference for Integrative Medical Care: Results from Patient Focus Groups

    PubMed Central

    Pugh, Guy F.; O’Connor, Bonnie B.

    2007-01-01

    Background Integrative medicine (IM), a combination of conventional and complementary and alternative medicine (CAM), has become a popular source of medical care, yet little is known about its use. Objective To identify the motivations of people who choose IM for their primary care needs. Design Qualitative study from focus group data of regular users of IM. Participants Six focus groups that include a total of 37 regular users of IM who consented to participate in a study of IM use. Approach Focus group meetings were audiotaped and transcribed verbatim. Qualitative analysis using grounded theory was used to derive the motivations for use of IM. Results Participants beliefs include the following: the combination of CAM and conventional medicine is better than either alone; health is a combination of physical, emotional, and spiritual well being; nutrition and lifestyle play a role in wellness; and pharmaceuticals should be avoided except as a last resort. Participants suffer from health problems that are not well treated by conventional medicine. Participants want to discuss CAM with physicians and obtain guidance on its use. Participants want time with their providers, to feel listened to and to have the opportunity for shared decision-making. Conclusion Much of what patients are seeking in integrative medical care is likely universally shared: a strong therapeutic relationship with providers who listen and provide time and knowledgeable advice. Users believe a combined approach of CAM and conventional medicine is better than either alone and want to be able to discuss CAM use with their providers. PMID:17846846

  3. End-of-Life Discussion, Patient Understanding and Determinants of Preferences in Very Severe COPD Patients: A Multicentric Study.

    PubMed

    Carlucci, Annalisa; Vitacca, Michele; Malovini, Alberto; Pierucci, Paola; Guerrieri, Aldo; Barbano, Luca; Ceriana, Piero; Balestrino, Antonella; Santoro, Carmen; Pisani, Lara; Corcione, Nadia; Nava, Stefano

    2016-10-01

    Discussion about patients' end-of-life (E-o-L) preferences should be part of the routine practice. Using a semi-structured interview with a scenario-based decision, we performed a prospective multicentre study to elicit the patients' E-o-L preferences in very severe chronic obstructive pulmonary disease (COPD). We also checked their ability to retain this information and the respect of their decisions when they die. Forty-three out of ninety-one of the eligible patients completed the study. The choice of E-o-L practice was equally distributed among the three proposed options: endotracheal intubation (ETI), 'ceiling' non-invasive ventilation (NIV), and palliation of symptoms with oxygen and morphine. NIV and ETI were more frequently chosen by patients who already experienced them. ETI preference was also associated with the use of anti-depressant drugs and a low educational level, while a higher educational level and a previous discussion with a pneumologist significantly correlated with the preference for oxygen and morphine. Less than 50% of the patients retained a full comprehension of the options at 24 hours. About half of the patients who died in the follow-up period were not treated according to their wishes. In conclusion, in end-stage COPD more efforts are needed to improve communication, patients' knowledge of the disease and E-o-L practice. PMID:27027671

  4. Commentary on the article 'Understanding Muslim patients: cross-sectional dental hygiene care'.

    PubMed

    Musrati, Ahmed Ali

    2015-08-01

    I have read with interest the article ''Understanding Muslim patients: cross-sectional dental hygiene care'' by ML Sirois et al. In the time that I see their article as a faithful, unbiased image showing a Muslim's religious life and conduct from the oral and systemic health perspective, I still have two main concerns about certain facts which were denoted with imprecise connotations. These are related to food and Ramadan fasting. PMID:25399787

  5. Understanding remission in real-world lupus patients across five European countries.

    PubMed

    Schneider, M; Mosca, M; Pego-Reigosa, J M; Hachulla, E; Teh, L-S; Perna, A; Koscielny, V; Pike, J; Lobosco, S; Apolone, G

    2016-04-01

    Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with increased mortality and significant personal, psychological and socioeconomic consequences. An agreed definition of remission is needed and lacking. We sought to visualize 'remission in SLE' in European patients considered by their physicians to be 'in remission' by comparing the reported symptom burden as reported by treating physicians for patients considered to be 'in remission' and those not considered to be 'in remission'. Data for 1227 patients drawn from a multinational, real-world survey of patients with SLE consulting practising rheumatologists and nephrologists in France, Germany, Italy, Spain, and the UK show that physicians classed their patients as 'in remission' despite a considerable ongoing symptom burden and intensive immunosuppressive medication. Patients considered to be 'in remission' still had a mean of 2.68 current symptoms vs 5.48 for those considered to be not 'in remission' (p < 0.0001). The most common symptoms among those seen to be 'in remission' were joint symptoms, fatigue, pain, mucocutaneous involvement, haematological manifestations and kidney abnormalities. The current analysis highlights important ongoing disease activity, symptom burden and immunosuppressive medication in European patients with SLE considered by their treating physician to be 'in remission'. For a further improvement of outcome, there is an urgent need for an international consensus on the definitions for remission among patients with SLE. PMID:26635245

  6. Talk to each other to improve patient care, reduce readmissions.

    PubMed

    2016-01-01

    Lack of communication prevents clinicians from delivering coordinated care, which often results in adverse effects on the patient and the hospital's bottom line. Healthcare providers need to move from a fragmented system to an integrated one where entities across the continuum communicate and work together to improve patient care. Case managers should develop strong working relationships with post-acute providers, case managers at community organizations, and their counterparts at health plans. Multidisciplinary rounds are essential for breaking down organizational silos and ensuring that all clinicians are on the same page. PMID:26688997

  7. Does hands-free drinking improve patient hydration?

    PubMed

    Sutton, Debbie; Stroud, Mike

    Hospital patients are at risk of dehydration, especially if they cannot drink unaided due to physical or mental incapacity. Dehydration may lead to complications and result in costly interventions. A sports-style bottle has been developed into a hands-free drinking system by fitting a drinking tube into the screw top. We trialled the bottle on acute wards and in the community to test claims that it improves hydration and reduces infection risks and length of hospital stays. The Hydrant is useful and even transformative for some patients. However, it is less suitable for older people, especially those in rehabilitation programmes. PMID:23980460

  8. Triheptanoin improves brain energy metabolism in patients with Huntington disease

    PubMed Central

    Adanyeguh, Isaac Mawusi; Rinaldi, Daisy; Henry, Pierre-Gilles; Caillet, Samantha; Valabregue, Romain; Durr, Alexandra

    2015-01-01

    Objective: Based on our previous work in Huntington disease (HD) showing improved energy metabolism in muscle by providing substrates to the Krebs cycle, we wished to obtain a proof-of-concept of the therapeutic benefit of triheptanoin using a functional biomarker of brain energy metabolism validated in HD. Methods: We performed an open-label study using 31P brain magnetic resonance spectroscopy (MRS) to measure the levels of phosphocreatine (PCr) and inorganic phosphate (Pi) before (rest), during (activation), and after (recovery) a visual stimulus. We performed 31P brain MRS in 10 patients at an early stage of HD and 13 controls. Patients with HD were then treated for 1 month with triheptanoin after which they returned for follow-up including 31P brain MRS scan. Results: At baseline, we confirmed an increase in Pi/PCr ratio during brain activation in controls—reflecting increased adenosine triphosphate synthesis—followed by a return to baseline levels during recovery (p = 0.013). In patients with HD, we validated the existence of an abnormal brain energy profile as previously reported. After 1 month, this profile remained abnormal in patients with HD who did not receive treatment. Conversely, the MRS profile was improved in patients with HD treated with triheptanoin for 1 month with the restoration of an increased Pi/PCr ratio during visual stimulation (p = 0.005). Conclusion: This study suggests that triheptanoin is able to correct the bioenergetic profile in the brain of patients with HD at an early stage of the disease. Classification of evidence: This study provides Class III evidence that, for patients with HD, treatment with triheptanoin for 1 month restores an increased MRS Pi/PCr ratio during visual stimulation. PMID:25568297

  9. Can spectroscopic analysis improve our understanding of biogeochemical processes in agricultural streams?

    NASA Astrophysics Data System (ADS)

    Bieroza, Magdalena; Heathwaite, Ann Louise

    2015-04-01

    In agricultural catchments diffuse fluxes of nutrients, mainly nitrogen (N) and phosphorus (P) from arable land and livestock are responsible for pollution of receiving waters and their eutrophication. Organic matter (OM) can play an important role in mediating a range of biogeochemical processes controlling diffuse pollution in streams and at their interface with surrounding land in the riparian and hyporheic zones. Thus, a holistic and simultaneous monitoring of N, P and OM fractions can help to improve our understanding of biogeochemical functioning of agricultural streams. In this study we build on intensive in situ monitoring of diffuse pollution in a small agricultural groundwater-fed stream in NW England carried out since 2009. The in situ monitoring unit captures high-frequency (15 minutes to hourly) responses of water quality parameters including total phosphorus, total reactive phosphorus and nitrate-nitrogen to changing flow conditions. For two consecutive hydrological years we have carried out additional spectroscopic water analyses to characterise organic matter components and their interactions with nutrient fractions. Automated and grab water samples have been analysed using ultraviolet-visible (UV-Vis) absorbance and excitation-emission (EEM) fluorescence spectroscopy. In addition, a tryptophan sensor was trialled to capture in situ fluorescence dynamics. Our paper evaluates patterns in nutrient and OM responses to baseflow and storm flow conditions and provides an assessment of storage-related changes of automated samples and temperature and turbidity effects on in situ tryptophan measurements. The paper shows the value of spectroscopic measurements to understand biogeochemical and hydrological nutrient dynamics and quantifies analytical uncertainty associated with both laboratory-based and in situ spectroscopic measurements.

  10. Improving our understanding of flood forecasting using earlier hydro-meteorological intelligence

    NASA Astrophysics Data System (ADS)

    Shih, Dong-Sin; Chen, Cheng-Hsin; Yeh, Gour-Tsyh

    2014-05-01

    In recent decades, Taiwan has suffered from severe bouts of torrential rain, and typhoon induced floods have become the major natural threat to Taiwan. In order to warn the public of potential risks, authorities are considering establishing an early warning system derived from an integrated hydro-meteorological estimation process. This study aims at the development and accuracy of such a warning system. So it is first necessary to understand the distinctive features of flood forecasting in integrated rainfall-runoff simulations. Additionally the adequacies of a warning system that is based on extracting useful intelligence from earlier, possibly faulty numerical simulation results are discussed. In order to precisely model flooding, hydrological simulations based upon spot measured rainfall data have been utilized in prior studies to calibrate model parameters. Here, precipitation inputs from an ensemble of almost 20 different realizations of rainfall fields have been used to derive flood forecasts. The flood warning system therefore integrates rainfall-runoff calculations, field observations and data assimilations. Simulation results indicate that the ensemble precipitation estimates generated by a Weather Research Forecasting (WRF) mesoscale model produce divergent estimates. Considerable flooding is often shown in the simulated hydrographs, but the results as to the peak time and peak stage are not always in agreement with the observations. In brief, such forecasts can be good for warning against potential damaging floods in the near future, but the meteorological inputs are not good enough to forecast the time and magnitude of the peaks. The key for such warning system is not to expect highly accurate rainfall predictions, but to improve our understanding from individual ensemble flood forecasts.

  11. Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach.

    PubMed

    Courtney-Pratt, Helen; Ford, Karen; Marlow, Annette

    2015-11-01

    Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders. PMID:26256817

  12. Thyroplasty to improve the voice in patients with a unilateral vocal fold paralysis.

    PubMed

    Rosingh, H J; Dikkers, F G

    1995-04-01

    Unilateral vocal fold paralysis may cause incomplete closure of the glottis and a poor voice. Thyroplasty is a relative new operation to improve the voice by 'medialization' of the paralysed vocal fold. In our series of 29 patients 24 (83%) were satisfied and 26 (90%) had a better voice. After the operation the voice was louder, clearer and easier to understand. The dynamic and melodic ranges on the phonetogram were wider; maximum loudness and maximum phonation time were improved. There were no complications during the follow-up of 4 months to 5 years. In the three patients whose voice was not improved, the vocal fold paralysis was due to local trauma and scarring. PMID:7634516

  13. Toward an improved understanding of the role of transpiration in critical zone dynamics

    NASA Astrophysics Data System (ADS)

    Mitra, B.; Papuga, S. A.

    2012-12-01

    Evapotranspiration (ET) is an important component of the total water balance across any ecosystem. In subalpine mixed-conifer ecosystems, transpiration (T) often dominates the total water flux and therefore improved understanding of T is critical for accurate assessment of catchment water balance and for understanding of the processes that governs the complex dynamics across critical zone (CZ). The interaction between T and plant vegetation not only modulates soil water balance but also influences water transit time and hydrochemical flux - key factors in our understanding of how the CZ evolves and responds. Unlike an eddy covariance system which provides only an integrated ET flux from an ecosystem, a sap flow system can provide an estimate of the T flux from the ecosystem. By isolating T, the ecohydrological drivers of this major water loss from the CZ can be identified. Still, the species composition of mixed-conifer ecosystems vary and the drivers of T associated with each species are expected to be different. Therefore, accurate quantification of T from a mixed-conifer requires knowledge of the unique transpiration dynamics of each of the tree species. Here, we installed a sap flow system within two mixed-conifer study sites of the Jemez River Basin - Santa Catalina Mountains Critical Zone Observatory (JRB - SCM CZO). At both sites, we identified the dominant tree species and installed sap flow sensors on healthy representatives for each of those species. At the JRB CZO site, sap sensors were installed in fir (4) and spruce (4) trees; at the SCM CZO site, sap sensors were installed at white fir (4) and maple (4) and one dead tree. Meteorological data as well as soil temperature (Ts) and soil moisture (θ) at multiple depths were also collected from each of the two sites. Preliminary analysis of two years of sap flux rate at JRB - SCM CZO shows that the environmental drivers of fir, spruce, and maple are different and also vary throughout the year. For JRB fir

  14. Performance indicators--a quest to improve patient care.

    PubMed

    Morris, Clare; Pritchard, Barbara

    Nurses working in the field of tissue viability constantly strive to improve pressure ulcer prevention and management in their clinical areas, knowing that pressure ulcers cause pain and suffering to patients while costing the NHS millions of pounds to treat. The aim of this initiative was for the tissue viability team to develop an audit tool based on recently devised performance indicators. The purpose of the audit was to provide the mechanism for reviewing the quality of everyday care. The tool utilizes the 'traffic light' system to categorize the results. The initiative has improved clinical outcomes for patients and increased the awareness, education, knowledge and confidence of nurses in pressure ulcer prevention and management across a combined primary and secondary care Trust. PMID:18073696

  15. Improving Patient Safety in Anesthesia: A Success Story?

    SciTech Connect

    Botney, Richard

    2008-05-01

    Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety.

  16. [Geriatric fracture centers. Improved patient care and economic benefits].

    PubMed

    Kates, S L

    2016-01-01

    The world's population is aging resulting in changes in the way we manage geriatric care. Furthermore, this population has a considerable risk of fragility fractures, most notably hip fractures. Hip fractures are associated with significant morbidity and mortality and have large economic consequences. It is due to these factors that the concept of an elderly trauma center was developed. These trauma centers utilize the expertise in orthopedic and geriatric disciplines to provide coordinated care to the elderly hip fracture patient. As a result, studies have demonstrated improvements in clinical outcomes within the hospital stay, a reduction in iatrogenic complications, and improvements in 1-year mortality rates compared to the usual care given at a similar facility. Furthermore, economic models have demonstrated that there is a role for regionalized hip fracture centers that can be both profitable and provide more efficient care to these patients. PMID:26658903

  17. Understanding the suffering of a patient with an illness: signs, context and strategies.

    PubMed

    Hueso Montoro, César; Siles González, José; Amezcua, Manuel; Bonill de Las Nieves, Candela; Pastor Montero, Sonia; Celdrán Mañas, Miriam

    2012-01-01

    The aim of this study is to understand the suffering of a patient with an illness, by using a secondary research method, that is, a qualitative meta-study. The primary data source of the meta-study includes "biographical reports". This project is based on a case study, in which the first-hand experiences of a patient with an illness were collected. The findings of the reports were compiled using the Archivos de la Memoria collection of the Index Foundation (Granada, Spain) and journals specialized in editing these materials. A selection of 20 biographical reports was targeted. The results of the meta-study show that suffering is a multidimensional process within a framework of ambiguous feelings. The suffering involves family and social network participation. Patients develop a range of strategies to overcome the illness. One of the effects is the fear of illness relapse or worsening. PMID:22991127

  18. Brain metastasis in lung cancer: Building a molecular and systems-level understanding to improve outcomes.

    PubMed

    Ebben, Johnathan D; You, Ming

    2016-09-01

    metastasis over the course of their disease, while 18% of small cell lung cancer patients without previous metastasis went on to develop brain metastasis as their disease progressed (Goncalves et al., 2016).The reasons underlying this predilection for the central nervous system, as well as the recent increase in the frequency of brain metastasis identified in patients remain important questions for both clinicians and basic scientists. More than ever, the question of how brain metastasis develop and how they can be treated and managed requires the involvement of interdisciplinary teams-and more importantly-scientists who are capable of thinking like clinicians and clinicians who are capable of thinking like scientists. This review aims to present a translational perspective on brain metastasis. We will investigate the scope of the problem of brain metastasis and the current management of the metastatic disease process in lung cancer. From this clinical starting point, we will investigate the literature surrounding the molecular underpinnings of lung tumor metastasis and seek to understand the process from a biological perspective to generate new hypotheses. PMID:27474492

  19. Improving pain management in orthopedic surgical patients with opioid tolerance.

    PubMed

    Doi, Kathleen; Shimoda, Rosanne; Gibbons, Gregory

    2014-09-01

    As increasing numbers of the baby boomer generation seek health care, nursing staff educated in the evidence-based practice process can make significant contributions to successful patient outcomes. Health care providers who anticipate the approaching perfect storm in health care and thoughtfully plan, collaborate, and incorporate evidence-based practice methods will be well prepared to improve the quality of care, realize cost savings, and meet the challenges ahead. PMID:25155539

  20. Music as intervention: a notable endeavor to improve patient outcomes.

    PubMed

    White, J M

    2001-03-01

    Music interventions have been used in medicine and nursing throughout history. Music therapy is an easy-to-administer, relatively inexpensive, noninvasive intervention that has been used to reduce heart rate, blood pressure, myocardial oxygen consumption, gastrointestinal function, anxiety, and pain. A review of theoretic and empirical base for the use of music therapy to improve patient outcomes in a variety of areas of clinical practice is presented. Implications for practice and future research are suggested. PMID:11342404

  1. Reconstructive Osteotomy for Ankle Malunion Improves Patient Satisfaction and Function

    PubMed Central

    Tohyama, Masahiko; Yasuda, Hiroyuki; Konishi, Sadahiko; Waseda, Akeo

    2015-01-01

    Treatment of chronic symptoms caused by a malunion is a difficult problem in orthopedic surgery. We encountered a case of ankle malunion at our hospital about 1 year after the first operation. The patient had been unable to walk with weight-bearing but regained the ability to walk after reconstructive osteotomy of the fibula. Functional scores for the foot and ankle were significantly improved after intervention. Reconstructive osteotomy appears to represent a good option for ankle malunion. PMID:26064743

  2. Real time patient safety audits: improving safety every day

    PubMed Central

    Ursprung, R; Gray, J; Edwards, W; Horbar, J; Nickerson, J; Plsek, P; Shiono, P; Suresh, G; Goldmann, D

    2005-01-01

    Background: Timely error detection including feedback to clinical staff is a prerequisite for focused improvement in patient safety. Real time auditing, the efficacy of which has been repeatedly demonstrated in industry, has not been used previously to evaluate patient safety. Methods successful at improving quality and safety in industry may provide avenues for improvement in patient safety. Objective: Pilot study to determine the feasibility and utility of real time safety auditing during routine clinical work in an intensive care unit (ICU). Methods: A 36 item patient safety checklist was developed via a modified Delphi technique. The checklist focused on errors associated with delays in care, equipment failure, diagnostic studies, information transfer and non-compliance with hospital policy. Safety audits were performed using the checklist during and after morning work rounds thrice weekly during the 5 week study period from January to March 2003. Results: A total of 338 errors were detected; 27 (75%) of the 36 items on the checklist detected ⩾1 error. Diverse error types were found including unlabeled medication at the bedside (n = 31), ID band missing or in an inappropriate location (n = 70), inappropriate pulse oximeter alarm setting (n = 22), and delay in communication/information transfer that led to a delay in appropriate care (n = 4). Conclusions: Real time safety audits performed during routine work can detect a broad range of errors. Significant safety problems were detected promptly, leading to rapid changes in policy and practice. Staff acceptance was facilitated by fostering a blame free "culture of patient safety" involving clinical personnel in detection of remediable gaps in performance, and limiting the burden of data collection. PMID:16076794

  3. Understanding Variability in Beach Slope to Improve Forecasts of Storm-induced Water Levels

    NASA Astrophysics Data System (ADS)

    Doran, K. S.; Stockdon, H. F.; Long, J.

    2014-12-01

    The National Assessment of Hurricane-Induced Coastal Erosion Hazards combines measurements of beach morphology with storm hydrodynamics to produce forecasts of coastal change during storms for the Gulf of Mexico and Atlantic coastlines of the United States. Wave-induced water levels are estimated using modeled offshore wave height and period and measured beach slope (from dune toe to shoreline) through the empirical parameterization of Stockdon et al. (2006). Spatial and temporal variability in beach slope leads to corresponding variability in predicted wave setup and swash. Seasonal and storm-induced changes in beach slope can lead to differences on the order of a meter in wave runup elevation, making accurate specification of this parameter essential to skillful forecasts of coastal change. Spatial variation in beach slope is accounted for through alongshore averaging, but temporal variability in beach slope is not included in the final computation of the likelihood of coastal change. Additionally, input morphology may be years old and potentially very different than the conditions present during forecast storm. In order to improve our forecasts of hurricane-induced coastal erosion hazards, the temporal variability of beach slope must be included in the final uncertainty of modeled wave-induced water levels. Frequently collected field measurements of lidar-based beach morphology are examined for study sites in Duck, North Carolina, Treasure Island, Florida, Assateague Island, Virginia, and Dauphin Island, Alabama, with some records extending over a period of 15 years. Understanding the variability of slopes at these sites will help provide estimates of associated water level uncertainty which can then be applied to other areas where lidar observations are infrequent, and improve the overall skill of future forecasts of storm-induced coastal change. Stockdon, H. F., Holman, R. A., Howd, P. A., and Sallenger Jr, A. H. (2006). Empirical parameterization of setup

  4. Does using active learning in thermodynamics lectures improve students’ conceptual understanding and learning experiences?

    NASA Astrophysics Data System (ADS)

    Georgiou, H.; Sharma, M. D.

    2015-01-01

    Encouraging ‘active learning’ in the large lecture theatre emerges as a credible recommendation for improving university courses, with reports often showing significant improvements in learning outcomes. However, the recommendations are based predominantly on studies undertaken in mechanics. We set out to examine those claims in the thermodynamics module of a large first year physics course with an established technique, called interactive lecture demonstrations (ILDs). The study took place at The University of Sydney, where four parallel streams of the thermodynamics module were divided into two streams that experienced the ILDs and two streams that did not. The programme was first implemented in 2011 to gain experience and refine logistical matters and repeated in 2012 with approximately 500 students. A validated survey, the thermal concepts survey, was used as pre-test and post-test to measure learning gains while surveys and interviews provided insights into what the ‘active learning’ meant from student experiences. We analysed lecture recordings to capture the time devoted to different activities in a lecture, including interactivity. The learning gains were in the ‘high gain’ range for the ILD streams and ‘medium gain’ for the other streams. The analysis of the lecture recordings showed that the ILD streams devoted significantly more time to interactivity while surveys and interviews showed that students in the ILD streams were thinking in deep ways. Our study shows that ILDs can make a difference in students’ conceptual understanding as well as their experiences, demonstrating the potential value-add that can be provided by investing in active learning to enhance lectures.

  5. Studying large-scale programmes to improve patient safety in whole care systems: challenges for research.

    PubMed

    Benn, Jonathan; Burnett, Susan; Parand, Anam; Pinto, Anna; Iskander, Sandra; Vincent, Charles

    2009-12-01

    Large-scale national and multi-institutional patient safety improvement programmes are being developed in the health care systems of several countries to address problems in the reliability of care delivered to patients. Drawing upon popular collaborative improvement models, these campaigns are ambitious in their aims to improve patient safety in macro-level systems such as whole health care organisations. This article considers the methodological issues involved in conducting research and evaluation of these programmes. Several specific research challenges are outlined, which result from the complexity of longitudinal, multi-level intervention programmes and the variable, highly sociotechnical care systems, with which they interact. Organisational-level improvement programmes are often underspecified due to local variations in context and organisational readiness for improvement work. The result is variable implementation patterns and local adaptations. Programme effects span levels and other boundaries within a system, vary dynamically or are cumulative over time and are problematic to understand in terms of cause and effect, where concurrent external influences exist and the impact upon study endpoints may be mediated by a range of organisational and social factors. We outline the methodological approach to research in the United Kingdom Safer Patients Initiative, to exemplify how some of the challenges for research in this area can be met through a multi-method, longitudinal research design. Specifically, effective research designs must be sensitive to complex variation, through employing multiple qualitative and quantitative measures, collect data over time to understand change and utilise descriptive techniques to capture specific interactions between programme and context for implementation. When considering the long-term, sustained impact of an improvement programme, researchers must consider how to define and measure the capability for continuous safe and

  6. Understanding HIV-positive patients' preferences for healthcare services: a protocol for a discrete choice experiment

    PubMed Central

    Youssef, Elaney; Cooper, Vanessa; Miners, Alec; Llewellyn, Carrie; Pollard, Alex; Lagarde, Mylene; Sachikonye, Memory; Sabin, Caroline; Foreman, Claire; Perry, Nicky; Nixon, Eileen; Fisher, Martin

    2016-01-01

    Introduction While the care of HIV-positive patients, including the detection and management of comorbidities, has historically been provided in HIV specialist outpatient clinics, recent years have seen a greater involvement of non-HIV specialists and general practitioners (GPs). The aim of this study is to determine whether patients would prefer to see their GP or HIV physician given general symptoms, and to understand what aspects of care influence their preferences. Methods/analysis We have developed and piloted a discrete choice experiment (DCE) to better understand patients' preferences for care of non-HIV-related acute symptoms. The design of the DCE was informed by our exploratory research, including the findings of a systematic literature review and a qualitative study. Additional questionnaire items have been included to measure demographics, service use and experience of non-HIV illnesses and quality of life (EQ5D). We plan to recruit 1000 patients from 14 HIV clinics across South East England. Data will be analysed using random-effects logistic regression and latent class analysis. ORs and 95% CIs will be used to estimate the relative importance of each of the attribute levels. Latent class analysis will identify whether particular groups of people value the service attribute levels differently. Ethics/dissemination Ethical approval for this study was obtained from the Newcastle and North Tyneside Research Ethics Committee (reference number 14/NE/1193). The results will be disseminated at national and international conferences and peer-reviewed publications. A study report, written in plain English, will be made available to all participants. The Patient Advisory Group will develop a strategy for wider dissemination of the findings to patients and the public. PMID:27431895

  7. Patient-specific instrumentation does not improve radiographic alignment or clinical outcomes after total knee arthroplasty.

    PubMed

    Huijbregts, Henricus J T A M; Khan, Riaz J K; Sorensen, Emma; Fick, Daniel P; Haebich, Samantha

    2016-08-01

    Background and purpose - Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) has been introduced to improve alignment and reduce outliers, increase efficiency, and reduce operation time. In order to improve our understanding of the outcomes of patient-specific instrumentation, we conducted a meta-analysis. Patients and methods - We identified randomized and quasi-randomized controlled trials (RCTs) comparing patient-specific and conventional instrumentation in TKA. Weighted mean differences and risk ratios were determined for radiographic accuracy, operation time, hospital stay, blood loss, number of surgical trays required, and patient-reported outcome measures. Results - 21 RCTs involving 1,587 TKAs were included. Patient-specific instrumentation resulted in slightly more accurate hip-knee-ankle axis (0.3°), coronal femoral alignment (0.3°, femoral flexion (0.9°), tibial slope (0.7°), and femoral component rotation (0.5°). The risk ratio of a coronal plane outlier (> 3° deviation of chosen target) for the tibial component was statistically significantly increased in the PSI group (RR =1.64). No significance was found for other radiographic measures. Operation time, blood loss, and transfusion rate were similar. Hospital stay was significantly shortened, by approximately 8 h, and the number of surgical trays used decreased by 4 in the PSI group. Knee Society scores and Oxford knee scores were similar. Interpretation - Patient-specific instrumentation does not result in clinically meaningful improvement in alignment, fewer outliers, or better early patient-reported outcome measures. Efficiency is improved by reducing the number of trays used, but PSI does not reduce operation time. PMID:27249110

  8. Advanced MRI techniques to improve our understanding of experience-induced neuroplasticity.

    PubMed

    Tardif, Christine Lucas; Gauthier, Claudine Joëlle; Steele, Christopher John; Bazin, Pierre-Louis; Schäfer, Andreas; Schaefer, Alexander; Turner, Robert; Villringer, Arno

    2016-05-01

    Over the last two decades, numerous human MRI studies of neuroplasticity have shown compelling evidence for extensive and rapid experience-induced brain plasticity in vivo. To date, most of these studies have consisted of simply detecting a difference in structural or functional images with little concern for their lack of biological specificity. Recent reviews and public debates have stressed the need for advanced imaging techniques to gain a better understanding of the nature of these differences - characterizing their extent in time and space, their underlying biological and network dynamics. The purpose of this article is to give an overview of advanced imaging techniques for an audience of cognitive neuroscientists that can assist them in the design and interpretation of future MRI studies of neuroplasticity. The review encompasses MRI methods that probe the morphology, microstructure, function, and connectivity of the brain with improved specificity. We underline the possible physiological underpinnings of these techniques and their recent applications within the framework of learning- and experience-induced plasticity in healthy adults. Finally, we discuss the advantages of a multi-modal approach to gain a more nuanced and comprehensive description of the process of learning. PMID:26318050

  9. Long-range correlations improve understanding of the influence of network structure on contact dynamics.

    PubMed

    Peyrard, N; Dieckmann, U; Franc, A

    2008-05-01

    Models of infectious diseases are characterized by a phase transition between extinction and persistence. A challenge in contemporary epidemiology is to understand how the geometry of a host's interaction network influences disease dynamics close to the critical point of such a transition. Here we address this challenge with the help of moment closures. Traditional moment closures, however, do not provide satisfactory predictions close to such critical points. We therefore introduce a new method for incorporating longer-range correlations into existing closures. Our method is technically simple, remains computationally tractable and significantly improves the approximation's performance. Our extended closures thus provide an innovative tool for quantifying the influence of interaction networks on spatially or socially structured disease dynamics. In particular, we examine the effects of a network's clustering coefficient, as well as of new geometrical measures, such as a network's square clustering coefficients. We compare the relative performance of different closures from the literature, with or without our long-range extension. In this way, we demonstrate that the normalized version of the Bethe approximation-extended to incorporate long-range correlations according to our method-is an especially good candidate for studying influences of network structure. Our numerical results highlight the importance of the clustering coefficient and the square clustering coefficient for predicting disease dynamics at low and intermediate values of transmission rate, and demonstrate the significance of path redundancy for disease persistence. PMID:18262579

  10. Knowledge of the crime context: improving the understanding of why the cognitive interview works.

    PubMed

    Campos, L; Alonso-Quecuty, M L

    1998-01-01

    Since the Cognitive Interview (CI) was devised under laboratory conditions (Geiselman, Fisher, MacKinnon, & Holland, 1985), researchers have performed many experiments where a variety of variables and conditions have been reported. Nevertheless, few studies have attempted to delve into the theoretical aspects on which the CI is based. A variable that might help us to improve our understanding of why the CI works is prior knowledge of the crime context. Some studies have included familiar contexts and others unfamiliar ones, but no study has been performed to test the effect of the familiarity of the crime context as an independent variable. The aim of this research is to study the effect of prior knowledge on subjects' memory when they are interviewed by means of the CI in contrast to a Spanish Standard Interview (SSI). A significant effect of prior knowledge that subjects had of the context where the crime took place was expected, especially for those subjects who were interviewed by means of the CI. Results confirmed this hypothesis. PMID:9640435

  11. Improving our understanding of clouds in the Earth's climate using polarimetry (Invited)

    NASA Astrophysics Data System (ADS)

    Knobelspiesse, K. D.; Dunagan, S.; van Diedenhoven, B.; Marshak, A.; Holben, B. N.

    2013-12-01

    Water and ice clouds play a fundamental role in the radiative balance (and therefore climate) of the Earth, so understanding their distribution and optical properties is crucial. Recently, new data products from the ground-based NASA Aerosol Robotic Network (AERONET) have been created. These products expand the scope of AERONET to provide data about clouds in addition to atmospheric aerosols for which the network was originally designed. The main AERONET cloud data product is the Cloud Optical Depth (COD), which describes the amount of light extinction due to clouds in a vertical atmospheric column. AERONET measurements of COD must rely, however, on assumptions about the cloud thermodynamic phase. If the thermodynamic phase can be identified, AERONET COD errors can be significantly reduced. AERONET sun photometers determine aerosol and cloud optical properties by observing both the direct solar beam and sky scattered radiation at a variety of wavelengths. Newer instruments are also sensitive to light polarization, which we show can be used to determine cloud thermodynamic phase and therefore improve AERONET cloud data products. This work has two components. First, we performed atmospheric radiative transfer simulations to verify that polarization does contain information about cloud phase, and how to best exploit this in an algorithm. Observations were then compared to theoretical simulations. The second component of this research is to build our own polarization sensitive radiometer that is optimized for cloud observations. Initial results from both of these efforts will be presented.

  12. The Use of an Informational Video to Improve Patient Satisfaction, Preparedness, Mood, and Empowerment

    PubMed Central

    Baskwill, Amanda; Sumpton, Bryn

    2015-01-01

    Background Massage therapy is commonly used in Canada for the treatment of a wide range of health concerns. Massage therapy is changing to meet the health care needs of Canadians. Rapid changes to the profession may create a gap between patient expectations of massage therapy treatment based on historic views of the profession and their experience in today’s practice. This gap could lead to patient confusion, dissatisfaction, or other negative outcomes. Purpose This study sought to understand whether patient satisfaction, preparedness, mood, and patient empowerment are improved when new patients who attend a student massage therapy clinic watch an informational video, compared to those who receive the standard paper information sheet. Participants The study used a convenience sample of new patients who presented for their first massage therapy appointment to the Humber College Student Massage Therapy Clinic. Participants were randomized either to the intervention group (video and paper information) or the comparison group (paper information only). The outcomes of interest in this study were patient preparedness, satisfaction, mood, and empowerment. Data were collected using two questionnaires, one before treatment and one after. Results A total of 108 patients participated in the study (55 comparison group; 53 intervention group). Demographic and clinical characteristics were comparable between the two groups. A statistically significant difference was seen between the two groups when comparing their responses to the pre-appointment statement: “I know what will happen in my initial massage therapy appointment” (p < .001). There was no statistically significant difference seen when comparing the responses of the related post-appointment statement (p = .63). Conclusion This study found that an informational video improved perceived knowledge as patients entered the massage therapy treatment, but did not have a significant effect on satisfaction, mood, or

  13. Improving patient flow in pre-operative assessment

    PubMed Central

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  14. Improving patient flow in pre-operative assessment.

    PubMed

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  15. Polymer Solar Cells: Understanding Solvent Interactions and Morphology, and Strategies for Efficiency Improvements

    NASA Astrophysics Data System (ADS)

    Chang, Lilian

    Organic solar cells have the potential to be unrivaled in terms of processing cost, speed, and simplicity. The simplest of such devices consists of a single bulk-heterojunction (BHJ) active layer, in which the electron donor (conjugated polymer) and electron acceptor (fullerene) are deposited from a common solvent. The performance of BHJ solar cells is strongly correlated with the nanoscale structure of the active layer. Various processing techniques have been explored to improve the nanoscale morphology of the BHJ layer, e.g. by varying the casting solvent, thermal annealing, solvent annealing, and solvent additives. An understanding of the role of residual solvent in the BHJ layer is imperative in order to develop strategies for morphology stabilization and preserve the longevity of the device. This work highlights the effect of residual solvents on acceptor, (6,6)-phenyl-C61-butyric acid methyl ester (PCBM) diffusion and ultimately the stability of the morphology. We first show that solvent is retained within the BHJ film despite prolonged heat treatment, leading to extensive phase separation between poly(3-hexylthiophene) (P3HT) and PCBM. We then show that the addition of a small volume fraction of nitrobenzene to the casting solution inhibits the diffusion of PCBM in the film and improves the fill factor of the BHJ device without further tempering. Other commonly used additives for morphology improvement were also investigated, i.e. 1,8-diiodooctane and 1-chloronaphthalene. We show that the choice of solvent additives has direct implications on morphological evolution, i.e. P3HT:PCBM BHJ films processed with a small amount of 1,8-diiodooctane or 1-chloronaphthalene have more crystalline PCBM domains compared to crystalline P3HT domains, while the opposite is true for films cast with nitrobenzene additive and films cast purely from chlorobenzene. The BHJ film cross-links when annealed at 300°C in the presence of 1,8-diiodooctane. Cross-linking is found to

  16. What Do Children Learn about Biology from Factual Information? A Comparison of Interventions to Improve Understanding of Contagious Illnesses

    ERIC Educational Resources Information Center

    Myant, Katherine A.; Williams, Joanne M.

    2008-01-01

    Background: Children have been shown to hold misconceptions about illness, and previous work has indicated that their knowledge can be improved through the use of interventions. Aims: This study aims to evaluate interventions based on the provision of factual information for improving understanding of contagious illness. Sample: The participants…

  17. Understanding Teacher Effectiveness: Significant State Data Capacity Is Required to Measure and Improve Teacher Effectiveness. Data for Action 2012

    ERIC Educational Resources Information Center

    Data Quality Campaign, 2012

    2012-01-01

    States are increasingly focused on understanding and improving teacher effectiveness. There are several funding opportunities that incentivize states to use data to inform measurements of teacher effectiveness. Local, state, and federal efforts support using data to improve teacher preparation programs. Preparation programs seek "access to data…

  18. ACCURATE ACCUMULATION OF DOSE FOR IMPROVED UNDERSTANDING OF RADIATION EFFECTS IN NORMAL TISSUE

    PubMed Central

    Jaffray, David A.; Lindsay, Patricia E.; Brock, Kristy K.; Deasy, Joseph O.; Tomé, W. A.

    2013-01-01

    The actual distribution of radiation dose accumulated in normal tissues over the complete course of radiation therapy is, in general, poorly quantified. Differences in the patient anatomy between planning and treatment can occur gradually (e.g., tumor regression, resolution of edema) or relatively rapidly (e.g., bladder filling, breathing motion) and these undermine the accuracy of the planned dose distribution. Current efforts to maximize the therapeutic ratio require models that relate the true accumulated dose to clinical outcome. The needed accuracy can only be achieved through the development of robust methods that track the accumulation of dose within the various tissues in the body. Specific needs include the development of segmentation methods, tissue-mapping algorithms, uncertainty estimation, optimal schedules for image-based monitoring, and the development of informatics tools to support subsequent analysis. These developments will not only improve radiation outcomes modeling but will address the technical demands of the adaptive radiotherapy paradigm. The next 5 years need to see academia and industry bring these tools into the hands of the clinician and the clinical scientist. PMID:20171508

  19. Accurate Accumulation of Dose for Improved Understanding of Radiation Effects in Normal Tissue

    SciTech Connect

    Jaffray, David A.; Lindsay, Patricia E.; Brock, Kristy K.; Deasy, Joseph O.; Tome, W.A.

    2010-03-01

    The actual distribution of radiation dose accumulated in normal tissues over the complete course of radiation therapy is, in general, poorly quantified. Differences in the patient anatomy between planning and treatment can occur gradually (e.g., tumor regression, resolution of edema) or relatively rapidly (e.g., bladder filling, breathing motion) and these undermine the accuracy of the planned dose distribution. Current efforts to maximize the therapeutic ratio require models that relate the true accumulated dose to clinical outcome. The needed accuracy can only be achieved through the development of robust methods that track the accumulation of dose within the various tissues in the body. Specific needs include the development of segmentation methods, tissue-mapping algorithms, uncertainty estimation, optimal schedules for image-based monitoring, and the development of informatics tools to support subsequent analysis. These developments will not only improve radiation outcomes modeling but will address the technical demands of the adaptive radiotherapy paradigm. The next 5 years need to see academia and industry bring these tools into the hands of the clinician and the clinical scientist.

  20. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

    PubMed Central

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2016-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient’s departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre–post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia. PMID:26779043

  1. Understanding graft-versus-host disease. Preliminary findings regarding the effects of exercise in affected patients.

    PubMed

    Fiuza-Luces, Carmen; Garatachea, Nuria; Simpson, Richard J; Berger, Nathan A; Ramírez, Manuel; Lucia, Alejandro

    2015-01-01

    Advances in this century regarding allogeneic hematopoietic stem cell transplantation (allo-HSCT) have led to an expanding population of long-term survivors, many of whom suffer severe side effects, particularly those related to graft-versushost disease (GVHD), a potentially multi-systemic disorder caused by immunoeffector donor lymphocytes that destroy host tissues. The GVHD, especially in its chronic form (cGVHD), generates considerable morbidity and compromises the physical capacity of patients. We have reviewed the main pathophysiological aspects of the disease as well as the data available on the effects of exercise in GVHD, based on animal and human patient research. Although exercise training as an adjunct therapy to improve health outcomes after allo-HSCT shows promise (particularly, this lifestyle intervention can improve physical fitness and possibly immune function while attenuating fatigue), there is a need for more randomized control trials that focus specifically on GVHD. PMID:25826127

  2. Understanding reasons for treatment interruption amongst patients on antiretroviral therapy – A qualitative study at the Lighthouse Clinic, Lilongwe, Malawi

    PubMed Central

    Tabatabai, Julia; Namakhoma, Ireen; Tweya, Hannock; Phiri, Sam; Schnitzler, Paul; Neuhann, Florian

    2014-01-01

    Background In recent years, scaling up of antiretroviral therapy (ART) in resource-limited settings moved impressively towards universal access. Along with these achievements, public health HIV programs are facing a number of challenges including the support of patients on lifelong therapy and the prevention of temporary/permanent loss of patients in care. Understanding reasons for treatment interruption (TI) can inform strategies for improving drug adherence and retention in care. Objective To evaluate key characteristics of patients resuming ART after TI at the Lighthouse Clinic in Lilongwe, Malawi, and to identify their reasons for interrupting ART. Design This study uses a mixed methods design to evaluate patients resuming ART after TI. We analysed an assessment form for patients with TI using pre-defined categories and a comments field to identify frequently stated reasons for TI. Additionally, we conducted 26 in-depth interviews to deepen our understanding of common reasons for TI. In-depth interviews also included the patients’ knowledge about ART and presence of social support systems. Qualitative data analysis was based on a thematic framework approach. Results A total of 347 patients (58.2% female, average age 35.1±11.3 years) with TI were identified. Despite the presence of social support and sufficient knowledge of possible consequences of TI, all patients experienced situations that resulted in TI. Analysis of in-depth interviews led to new and distinct categories for TI. The most common reason for TI was travel (54.5%, n=80/147), which further differentiated into work- or family-related travel. Patients also stated transport costs and health-care-provider-related reasons, which included perceived/enacted discrimination by health care workers. Other drivers of TI were treatment fatigue/forgetfulness, the patients’ health status, adverse drug effects, pregnancy/delivery, religious belief or perceived/enacted stigma. Conclusions To adequately

  3. Heliophysics 2009 Roadmap and Global Change: Possibilities for Improved Understanding of the Connection

    NASA Technical Reports Server (NTRS)

    Spann, Jim

    2010-01-01

    Heliophysics is the science that includes all aspects of the research needed to understand the Sun and its effects on the Earth and the solar system. Six science targets: 1. Origins of Near-Earth Plasma - to understand the origin and transport of terrestrial plasma from its source to the magnetosphere and solar wind. 2. Solar Energetic Particle Acceleration and Transport - to understand how and where solar eruptions accelerate energetic particles that reach Earth. 3. Ion-Neutral Coupling in the Atmosphere - to understand how neutral winds control ionospheric variability. 4. Climate Impacts of Space Radiation - to understand our atmosphere s response to auroral, radiation belt, and solar energetic particles, and the associated effects on nitric oxide (NO) and ozone. 5. Dynamic Geospace Coupling - to understand how magnetospheric dynamics provides energy into the coupled ionosphere-magnetosphere system. 6. Heliospheric Magnetics - to understand the flow and dynamics of transient magnetic structures form the solar interior to Earth.

  4. Preparation and Support of Patients through the Transplant Process: Understanding the Recipients' Perspectives.

    PubMed

    Mauthner, Oliver; De Luca, Enza; Poole, Jennifer; Gewarges, Mena; Abbey, Susan E; Shildrick, Margrit; Ross, Heather

    2012-01-01

    Preparation for heart transplant commonly includes booklets, instructional videos, personalized teaching sessions, and mentorship. This paper explores heart transplant recipients' thoughts on their preparation and support through the transplant process. Twenty-five interviews were audio-/videotaped capturing voice and body language and transcribed verbatim. Coding addressed language, bodily gesture, volume, and tone in keeping with our visual methodology. Recipients reported that only someone who had a transplant truly understands the experience. As participants face illness and life-altering experiences, maintaining a positive attitude and hope is essential to coping well. Healthcare professionals provide ongoing care and reassurance about recipients' medical status. Mentors, family members, and close friends play vital roles in supporting recipients. Participants reported that only heart transplant recipients understood the experience, the hope, and ultimately the suffering associated with living with another persons' heart. Attention needs to be focused not solely on the use of teaching modalities, but also on the development of innovative support networks. This will promote patient and caregiver engagement in self-management. Enhancing clinicians' knowledge of the existential aspects of transplantation will provide them with a nuanced understanding of the patients' experience, which will ultimately enhance their ability to better prepare and support patients and their caregivers. PMID:23125923

  5. Talking about your health to strangers: understanding the use of online social networks by patients

    NASA Astrophysics Data System (ADS)

    Colineau, Nathalie; Paris, Cécile

    2010-04-01

    The internet has become a participatory place where everyone can contribute and interact with others. In health in particular, social media have changed traditional patient-physician relationships. Patients are organising themselves in groups, sharing observations and helping each other, although there is still little evidence of the effectiveness of these online communities on people's health. To understand why and how people use health-related sites, we studied these sites and identified three dimensions characterising most of them: informational/supportive; general/focused; and new relationships/existing ones. We conducted an online survey about the use of health-related social networking (SN) sites and learnt that, consistent with previous research, most patients were seeking information about their medical condition online, while, at the same time, still interacting with health professionals to talk about sensitive information and complex issues. We also found that, while people's natural social network played an important role for emotional support, sometimes, people chose to not involve their family, but instead interact with peers online because of their perceived support and ability to understand someone's experience, and also to maintain a comfortable emotional distance. Finally, our results show that people using general SN sites do not necessarily use health-related sites and vice versa.

  6. A Pilot Program: Using Text Messaging to Improve Timely Communication to Tonsillectomy Patients.

    PubMed

    Newton, Laurie; Sulman, Cecille

    2016-01-01

    Approximately 1,500 tonsillectomies are performed annually at a large pediatric academic medical center each year. Families need to be educated on how to care for their child after this surgery. Most tonsillectomy patients are discharged home either the same day as surgery or after one night of observation, resulting in post-operative tonsillectomy recovery and care falling upon the patient's family. Multiple quality improvement efforts to improve family education post tonsillectomy surgery have been performed over the last several years at a large pediatric academic medical center. None of these efforts, however, have focused on the use of technology to provide innovative patient education. The purpose of this project is to provide information to parents via text messages and videos to improve patient experience and outcomes following tonsillectomy. Families provided positive feedback, including that the texts were helpful, easy to understand, and reduced pre-operative and recovery anxiety. Also, none of these families needed to call the ENT clinic for any other questions or concerns. The recovery from tonsillectomy is not easy and this pediatric otolaryngology practice is always searching for new ways to improve care and education. Use of technology is an innovative approach and likely one that will be used more often in the future. PMID:27305731

  7. Understanding and improving the mechanical stability of semiconducting polymers for flexible and stretchable electronics

    NASA Astrophysics Data System (ADS)

    Printz, Adam David

    Polymeric semiconductors offer the promise of low-cost, printable, and mechanically robust electronic devices for use in outdoor, portable, and wearable applications such as organic photovoltaics, biosensors, and electronic skins. However, many organic semiconductors are unable to accommodate the mechanical stresses these applications require, and it is therefore important to understand the factors and parameters that govern the mechanical stability of these materials. Chapter 1 provides a gentle introduction to the electronic and mechanical properties relevant to flexible and stretchable organic semiconductor devices. The idea of inherent competition between electronic performance and mechanical robustness is explored. Chapter 2 investigates the inherent competition between good electronic performance and mechanical robustness in poly(3-alkylthiophene)s. A key finding is a critical alkyl side-chain length that allows for good electronic performance and mechanical compliance. Chapter 3 and Appendix A are further studies on the properties of poly(3-alkylthiophene)s with side-chains close to the critical length to gain better understanding of the transition from good electronic properties and poor mechanical properties to poor electronic properties and good mechanical properties. Chapter 4 and Appendix B detail the effects on mechanical and electronic properties of statistical incorporation of unlike monomer into a low-bandgap polymer backbone in an effort to disrupt aggregation and improve mechanical compliance. Chapter 5 explores how the extent of molecular mixing of polythiophenes and fullerenes---materials common in organic photovoltaics---affects their mechanical properties. Chapter 6 describes the invention of a new technique to determine the yield point of thin films. A dependence on the alkyl-side chain length is observed, as well as a critical film thickness below which the yield point increases substantially. In Chapter 7, the weakly interacting H

  8. Periglacial process research for improved understanding of climate change in periglacial environments

    NASA Astrophysics Data System (ADS)

    Hvidtfeldt Christiansen, Hanne

    2010-05-01

    Periglacial landscapes extend widely outside the glaciated areas and the areas underlain by permafrost and with seasonal frost. Yet recently significant attention has in cryosphere research, related to periglacial geomorphology, been given to a direct climate permafrost relationship. The focus is on the permafrost thermal state including the thickness of the active layer, and often simplifying how these two key conditions are directly climatically controlled. There has been less focus on the understanding and quantification of the different periglacial processes, which largely control the consequences of changing climatic conditions on the permafrost and on seasonal frost all over the periglacial environments. It is the complex relationship between climate, micro-climate and local geomorphological, geological and ecological conditions, which controls periglacial processes. In several cases local erosion or deposition will affect the rates of landform change significantly more than any climate change. Thus detailed periglacial process studies will sophisticate the predictions of how periglacial landscapes can be expected to respond to climatic changes, and be built into Earth System Modelling. Particularly combining direct field observations and measurements with remote sensing and geochronological studies of periglacial landforms, enables a significantly improved understanding of periglacial process rates. An overview of the state of research in key periglacial processes are given focusing on ice-wedges and solifluction landforms, and seasonal ground thermal dynamics, all with examples from the high Arctic in Svalbard. Thermal contraction cracking and its seasonal meteorological control is presented, and potential thermal erosion of ice-wedges leading to development of thermokarst is discussed. Local and meteorological controls on solifluction rates are presented and their climatic control indicated. Seasonal ground thermal processes and their dependence on local

  9. Donepezil Improved Cognitive Deficits in a Patient With Neurosyphilis.

    PubMed

    Wu, Yi-Shan; Lane, Hsien-Yuan; Lin, Chieh-Hsin

    2015-01-01

    A large number of patients with neurosyphilis present dementia with a progressive course and psychiatric symptoms such as depression, mania, and psychosis. Despite prompt and proper antibiotic treatment, the recovery is often incomplete, especially when tissue damage has occurred. We reported a patient with persisted cognitive decline associated with neurosyphilis that improved substantially after donepezil therapy. A 43-year-old man manifested significant psychiatric symptoms such as mania, psychosis, and cognitive impairment due to neurosyphilis. Subsequently, the patient was treated with antipsychotics and donepezil concurrent with an adequate antibiotic treatment for neurosyphilis. During the 1-year follow-up, his rapid plasma reagin titer approached from 1:256 to 1:64. His Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale scores improved from 12 to 25 and 42.3 to 6.3, respectively, after a 6-month donepezil treatment. Donepezil was discontinued. Three months later, worsening of cognitive impairment (MMSE score, 23) was noted. After donepezil was started again for 3 months, his MMSE score improved to 26. Persistent cognitive impairment is commonly associated with neurosyphilis despite adequate penicillin treatment. Treatment of the cognitive impairment is important but difficult. Cholinergic pathways are considered as involving in the cognitive deficit induced by neurosyphilis and donepezil, a cholinesterase inhibitor, which may be useful for the improvement of cognition. In this case report, we described for the first time the successful use of donepezil in treating cognitive impairment associated with neurosyphilis. The role of cholinesterase inhibitors in the treatment of cognitive impairments caused by neurosyphilis needs further studies. PMID:26166240

  10. Evaluating and improving patient-specific QA for IMRT delivery

    NASA Astrophysics Data System (ADS)

    Yan, Guanghua

    2009-12-01

    Modern radiation therapy techniques such as intensity-modulated radiation therapy (IMRT) and newly-emerging volumetric modulated arc therapy (VMAT) aim to deliver highly conformal radiation dose to the target volume while sparing nearby critical organs as much as possible with the complex motion of multi-leaf collimator (MLC) leaves. Pre-treatment patient specific quality assurance (QA) has become an essential part of IMRT in making sure the delivered dose distributions agree with the planned ones. This dissertation evaluates the performance of current patient-specific QA process and proposes solutions to improve its sensitivity, accuracy and efficiency. In step and shoot IMRT, the study on the sensitivity of patient-specific QA to minor MLC errors reveals tighter criterion such as 2%/2mm must be employed to detect systematic MLC positioning errors of 2 mm. However, such criterion results in low average passing rate which leads to excessive false alarms, mainly due to inadequate treatment planning system (TPS) beam modeling on beam penumbra. An analytical deconvolution approach is proposed to recover true photon beam profiles to obtain a true beam model which significantly improves agreement between calculated and measured dose distributions. Thus a tighter criterion could be employed to enhance the sensitivity of patient-specific QA to minor errors in the delivery system. Measurement based patient-specific IMRT QA is a time-consuming process. A fast and accurate independent planar dose calculation algorithm is proposed to replace measurement based QA. The algorithm analytically models photons coming out from the accelerator and computes dose distribution from first principles. Accuracy of the algorithm is validated against 2D diode array measurements. The algorithm is found to be fast and accurate enough to replace time consuming measurement based QA. Patient-specific QA for VMAT differs significantly from step and shoot IMRT due to the increased use of dynamic

  11. Patient-Reported Use of Personalized Video Recordings to Improve Neurosurgical Patient-Provider Communication

    PubMed Central

    Porter, Randall

    2015-01-01

    Background: Providing patients with a video recording of their visit with a medical professional is a common-sense method for improving patient-provider communication. Objective: To describe the patient and provider experiences to video recording clinical medical encounters and providing the patient with a copy of the video for informational purposes. Methods: Since 2009, over 2,800 patients of eight different neurosurgeons chose to be video recorded during their encounter with the doctor and were provided access to the recording to watch over again as a way to recall what the doctor had said. The video system was set up as a handheld video camera, and video files were downloaded and made accessible to patients via a secure Internet patient portal. Between 2012 and 2014, patients who participated were surveyed regarding their use of the video and what was recorded on the video. The experience of the providers from a clinical and medico-legal standpoint was also reviewed. Results: Three hundred and thirty-three responses to the survey were received (39.2% response rate). More than half of patients (N=333; 56.2%) watched their video more than once, and over two-thirds (N=333; 68.6%) shared their video with a family member, friend, or another physician. Patients self-reported improved memory after watching their videos (N=299; 73.6% could remember more) and 50.2% responded that having the video made them feel more “at ease” with their medical problem (N=299). Overall, 88.0% of respondents indicated that their video had been helpful to them, and 98.5% would recommend having future visits video recorded. No patient made a comment that the video was intrusive or had prevented them from being open with their doctor. Finally, in the high-risk specialty of neurosurgery, none of the 2,807 patients who have been recorded since 2009 have used a video in a medico-legal action. Conclusions: Patient responses to the recording system and having a copy of their video

  12. Understanding CAM Natural Health Products: Implications of Use Among Cancer Patients and Survivors

    PubMed Central

    Fouladbakhsh, Judith M.; Balneaves, Lynda; Jenuwine, Elizabeth

    2013-01-01

    Herbs, vitamins, and other natural health products are being used by cancer patients and survivors with increasing prevalence in the United States. These complementary and alternative medicine (CAM) products, which are also referred to as natural health products in Canada and abroad, are used during cancer treatment and the survivorship period to ease the burden of symptoms such as pain, fatigue, insomnia, anxiety, and depression and hence improve overall quality of life. Data indicate that while patients choose these products for self-treatment, they often do not inform their health-care providers, thereby presenting the potential for negative interactions. This article gives an overview of CAM natural health products, including discussion of herbs, vitamins, and other supplements such as minerals, enzymes, and more. Related research is presented, and implications for advanced practitioners are discussed. Insights into guiding safe and effective use among patients as well as appropriate decision-making strategies are explored. PMID:25032009

  13. [Patient education and treatment documentation - Law to Improve the Rights of Patients].

    PubMed

    Meltendorf, G; Meltendorf, C

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the (German) Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should themselves acquaint with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation. PMID:23824480

  14. [Patient education and treatment documentation - law to improve the rights of patients].

    PubMed

    Meltendorf, Gerhard; Meltendorf, Christian

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the German Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should acquaint themselves with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation. PMID:23888409

  15. Rare disease policies to improve care for patients in Europe.

    PubMed

    Rodwell, Charlotte; Aymé, Ségolène

    2015-10-01

    Rare diseases are those with a particularly low prevalence; in Europe, diseases are considered to be rare when they affect not more than 5 in 10000 persons in the European Union. The specificities of rare diseases make the area a veritable public health challenge: the limited number of patients and scarcity of knowledge and expertise single rare diseases out as a distinctive domain of high European added-value. The Orphan Medicinal Product Regulation of 1999 was the first European legislative text concerning rare diseases, followed by many initiatives, including recommendations by the Council of Ministers of the European Union in 2009. These initiatives contributed to the development of rare diseases policies at European and national level aimed at improving care for patients with rare diseases. A review of the political framework at European level and in European countries is provided to demonstrate how legislation has created a dynamic that is progressively improving care for patients with rare diseases. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)". PMID:25725454

  16. Towards an Enhanced Understanding of Plant–Microbiome Interactions to Improve Phytoremediation: Engineering the Metaorganism

    PubMed Central

    Thijs, Sofie; Sillen, Wouter; Rineau, Francois; Weyens, Nele; Vangronsveld, Jaco

    2016-01-01

    Phytoremediation is a promising technology to clean-up contaminated soils based on the synergistic actions of plants and microorganisms. However, to become a widely accepted, and predictable remediation alternative, a deeper understanding of the plant–microbe interactions is needed. A number of studies link the success of phytoremediation to the plant-associated microbiome functioning, though whether the microbiome can exist in alternative, functional states for soil remediation, is incompletely understood. Moreover, current approaches that target the plant host, and environment separately to improve phytoremediation, potentially overlook microbial functions and properties that are part of the multiscale complexity of the plant-environment wherein biodegradation takes place. In contrast, in situ studies of phytoremediation research at the metaorganism level (host and microbiome together) are lacking. Here, we discuss a competition-driven model, based on recent evidence from the metagenomics level, and hypotheses generated by microbial community ecology, to explain the establishment of a catabolic rhizosphere microbiome in a contaminated soil. There is evidence to ground that if the host provides the right level and mix of resources (exudates) over which the microbes can compete, then a competitive catabolic and plant-growth promoting (PGP) microbiome can be selected for as long as it provides a competitive superiority in the niche. The competition-driven model indicates four strategies to interfere with the microbiome. Specifically, the rhizosphere microbiome community can be shifted using treatments that alter the host, resources, environment, and that take advantage of prioritization in inoculation. Our model and suggestions, considering the metaorganism in its natural context, would allow to gain further knowledge on the plant–microbial functions, and facilitate translation to more effective, and predictable phytotechnologies. PMID:27014254

  17. Learning from model improvement: On the contribution of complementary data to process understanding

    NASA Astrophysics Data System (ADS)

    Fenicia, Fabrizio; McDonnell, Jeffrey J.; Savenije, Hubert H. G.

    2008-06-01

    A priori determined model structures are common in catchment rainfall-runoff modeling. While this has resulted in many ready-to-use modeling tools, there are several shortcomings of a one-size-fits-all model structure. The uniqueness of catchments with respect to their hydrological behavior and the need to adapt model complexity to data availability challenge this status quo. We present a flexible approach to model development where the model structure is adapted progressively based on catchment characteristics and the data described by the experimentalist. We demonstrate this approach with the Maimai catchment in New Zealand, a location with a large availability of data, including stream discharge, groundwater levels, and stream isotope measurements. Different types of data are introduced progressively, and the architecture of the model is adjusted in a stepwise fashion to better describe the processes suggested by the new data sources. The revised models are developed in a way to strike a balance between model complexity and data availability, by keeping models as simple as possible, but complex enough to explain the dynamics of the data. Our work suggests that (1) discharge data provides information on the dynamics of storage (represented by the "free" water in the reservoirs) subject to pressure wave propagation generated by rainfall into the catchment, (2) groundwater data provides information on thresholds and on the contribution of different portions of the catchment to stream discharge, and (3) isotope data provides information on particle transport and mixing of the rainfall with the storage present in the catchment. Moreover, while groundwater data appear to be correlated with discharge data, and only a marginal improvement could be obtained adding this information to the model development process, isotope data appear to provide an orthogonal view on catchment behavior. This result contributes to understanding the value of data for modeling, which may

  18. Towards an Enhanced Understanding of Plant-Microbiome Interactions to Improve Phytoremediation: Engineering the Metaorganism.

    PubMed

    Thijs, Sofie; Sillen, Wouter; Rineau, Francois; Weyens, Nele; Vangronsveld, Jaco

    2016-01-01

    Phytoremediation is a promising technology to clean-up contaminated soils based on the synergistic actions of plants and microorganisms. However, to become a widely accepted, and predictable remediation alternative, a deeper understanding of the plant-microbe interactions is needed. A number of studies link the success of phytoremediation to the plant-associated microbiome functioning, though whether the microbiome can exist in alternative, functional states for soil remediation, is incompletely understood. Moreover, current approaches that target the plant host, and environment separately to improve phytoremediation, potentially overlook microbial functions and properties that are part of the multiscale complexity of the plant-environment wherein biodegradation takes place. In contrast, in situ studies of phytoremediation research at the metaorganism level (host and microbiome together) are lacking. Here, we discuss a competition-driven model, based on recent evidence from the metagenomics level, and hypotheses generated by microbial community ecology, to explain the establishment of a catabolic rhizosphere microbiome in a contaminated soil. There is evidence to ground that if the host provides the right level and mix of resources (exudates) over which the microbes can compete, then a competitive catabolic and plant-growth promoting (PGP) microbiome can be selected for as long as it provides a competitive superiority in the niche. The competition-driven model indicates four strategies to interfere with the microbiome. Specifically, the rhizosphere microbiome community can be shifted using treatments that alter the host, resources, environment, and that take advantage of prioritization in inoculation. Our model and suggestions, considering the metaorganism in its natural context, would allow to gain further knowledge on the plant-microbial functions, and facilitate translation to more effective, and predictable phytotechnologies. PMID:27014254

  19. Use of NOMADSS Observations to Improve Our Understanding of the Land and Ocean Fluxes of Mercury

    NASA Astrophysics Data System (ADS)

    Song, S.; Selin, N. E.; Jaffe, D. A.; Jaegle, L.; Gratz, L.; Ambrose, J. L., II; Shah, V.; Giang, A.

    2014-12-01

    We use measurements during the 2013 Nitrogen Oxidants Mercury and Aerosol Distributions Sources and Sinks (NOMADSS) campaign to constrain the land and ocean emissions of mercury, using a combination of forward and inverse modeling. Mercury emissions from land and ocean drive the global cycling of mercury. A recent bottom-up assessment of global mercury emissions estimated that the land and ocean sources release about 1500 and 2700 Mg yr-1 of mercury into the atmosphere, respectively. Thus, the average emission per unit area from the land is thought to exceed the ocean (Pirrone et al., Atmos. Chem. Phys., 10, 5951-5964, 2010). Considering that there are additional mercury sources from the land (e.g., anthropogenic emission and biomass burning), this emission difference should lead to higher observed mercury levels over the land compared to over the ocean. However, several very recent measurement and modeling studies challenge such understanding. The NOMADSS campaign provided a first opportunity to measure speciated mercury concentrations over both land and ocean surfaces. As shown in Table 1, the median Total Mercury (TM) concentration in 0-1 km (within the planetary boundary layer) for over-ocean flights is 0.11 ng m-3 higher (p < 0.05) than for over-land flights, whereas the over-ocean flights have lower TM concentrations in > 1 km than the over-land flights. We combine analysis of NOMADDS mercury measurements with the GEOS-Chem model, to better constrain land and ocean mercury sources. The standard GEOS-Chem model cannot reproduce the mercury concentration differences between over the land and the ocean. We improve the GEOS-Chem model's ability to reproduce these observations by implementing updated air-sea and air-land exchange mechanisms. We find that increased ocean emissions are necessary to explain this discrepancy. These results are consistent with the inverse analysis of global GEM concentrations.

  20. Improving the likelihood of neurology patients being examined using patient feedback

    PubMed Central

    Appleton, Jason Philip; Ilinca, Andreea; Lindgren, Arne; Puschmann, Andreas; Hbahbih, Majed; A. Siddiqui, Khurram; de Silva, Rajith; Jones, Matthew; Butterworth, Richard; willmot, mark; Hayton, Tom; Lunn, Michael; Nicholl, David

    2015-01-01

    We aimed to establish whether recall of elements of the neurological examination can be improved by use of a simple patient assessment score. In a previous study we demonstrated that in-patients referred to neurology at two United Kingdom (UK) hospitals were not fully examined prior to referral; we therefore designed a larger quality improvement report with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention. In-patients referred to neurology over a four month period (in hospitals in the UK (10), Jordan (1), Sweden (2), and the United Arab Emirates (1)) were asked whether they recalled being examined with a tendon hammer (T), ophthalmoscope (O), and stethoscope (S) since admission. The results were disseminated to local medical teams using various techniques (including Grand Round presentations, email, posters, discounted equipment). Data were then collected for a further four month period post-intervention. Pre-intervention and post-intervention data were available for 11 centres with 407 & 391 patients in each arm respectively. Median age of patients was 51 (range 13-100) and 49 (range 16-95) years respectively, with 44.72% and 44.76% being male in each group. 264 patients (64.86%) recalled being examined with a tendon hammer in the pre-intervention arm, which significantly improved to 298 (76.21%) (p<0.001). Only 119 patients (29.24%) recollected examination with an ophthalmoscope pre-intervention, which significantly improved to 149 (38.11%)(p=0.009). The majority of patients (321 (78.87%)) pre-intervention recalled examination with a stethoscope, which significantly improved to 330 (84.4%) to a lesser extent (p=0.045). Results indicate that most patients are not fully examined prior to neurology referral yet a simple assessment score and educational intervention can improve recall of elements of the neurological examination and thus the likelihood of patients being examined neurologically. This is the

  1. Nasal highflow improves ventilation in patients with COPD

    PubMed Central

    Bräunlich, Jens; Köhler, Marcus; Wirtz, Hubert

    2016-01-01

    Background Nasal highflow (NHF) provides a warmed and humidified air stream up to 60 L/min. Recent data demonstrated a positive effect in patients with acute hypoxemic respiratory failure, especially when caused by pneumonia. Preliminary data show a decrease in hypercapnia in patients with COPD. Therefore, NHF should be evaluated as a new ventilatory support device. This study was conducted to assess the impact of different flow rates on ventilatory parameters in patients with COPD. Materials and methods This interventional clinical study was performed with patients suffering from severe COPD. The aim was to characterize flow-dependent changes in mean airway pressure, breathing volumes, breathing frequency, and decrease in partial pressure of CO2 (pCO2). Mean airway pressure was measured in the nasopharyngeal space (19 patients). To evaluate breathing volumes, we used a polysomnographic device (18 patients). All patients received 20 L/min, 30 L/min, 40 L/min, and 50 L/min and – to illustrate the effects – nasal continuous positive airway pressure and nasal bilevel positive airway pressure. Capillary blood gas analyses were performed in 54 patients with hypercapnic COPD before and two hours after the use of NHF. We compared the extent of decrease in pCO2 when using 20 L/min and 30 L/min. Additionally, comfort and dyspnea during the use of NHF were surveyed. Results NHF resulted in a minor flow dependent increase in mean airway pressure. Tidal volume increased, and breathing rate decreased. The calculated minute volume decreased under NHF breathing. In spite of this fact, hypercapnia decreased with increasing flow (20 L/min vs 30 L/min). Additionally, an improvement in dyspnea was observed. The rapid shallow breathing index shows a decrease when using NHF. Conclusion NHF leads to a flow-dependent reduction in pCO2. This is most likely achieved by a washout of the respiratory tract and a functional reduction in dead space. In summary, NHF enhances effectiveness of

  2. Preparing the patient for surgery to improve outcomes.

    PubMed

    Levett, Denny Z H; Edwards, Mark; Grocott, Mike; Mythen, Monty

    2016-06-01

    The time between contemplation of surgery and the procedure offers a window of opportunity to optimize patients' nutritional, functional and psychological state prior to surgery. Traditionally, preoperative pathways have focused on the underlying disease process and 'fitness for surgery' with physical pre-assessment and risk counselling late in the pathway when little time is available to intervene. With an increasingly elderly and co-morbid surgical population, early physiological assessment and multidisciplinary collaborative decision-making is increasingly important. Multimodal prehabilitation programmes may improve surgical outcome, facilitating rapid recovery from surgery and limiting post-operative functional dependence. Patient education and engagement is important if compliance with behavioural change is to be achieved and maintained. To date, there has been evidence supporting preoperative exercise training, smoking cessation, reduction in alcohol intake, anaemia management and psychosocial support. Further research is needed to identify the most effective elements of these complex preoperative interventions, as well as their optimum timing and duration. PMID:27396803

  3. Understanding Symptoms and Quality of Life in Patients With Dry Eye Syndrome.

    PubMed

    Barabino, Stefano; Labetoulle, Marc; Rolando, Maurizio; Messmer, Elisabeth M

    2016-07-01

    Dry eye disease (DED) is one of the most common reasons for patients (particularly those over the age of 50) to seek ophthalmic care. There is a wide array of causes for DED that can induce an alteration of the ocular surface system and determine the chronicity of the disease, including low blink rates (eg, computer use), systemic and topical drugs, autoimmune diseases, contact lens wear, and cataract and refractive surgery. Patients with dry eye experience numerous symptoms that can reduce their productivity and overall quality of life. This article presents the results of a roundtable focused on patients' symptoms. The goal was to better understand the symptoms reported by patients, the possible effects on visual function, the consequences on the quality of life, and the methodologies that can be used to measure and monitor symptoms in clinical practice and in clinical studies. The discrepancies between clinical signs and symptoms reported in some cases are considered in the context of the ocular surface system. PMID:27224876

  4. Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients

    PubMed Central

    Wouters, Hans; Van Dijk, Liset; Geers, Harm C. J.; Winters, Nina A.; Van Geffen, Erica C. G.; Stiggelbout, Anne M.; Bouvy, Marcel L.

    2016-01-01

    Background Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences. Objectives To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients' 'perceived self-efficacy' moderated these associations. Methods Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data. Results Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13–2.10, P < 0.01), whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17–3.08, P < 0.01). Higher 'perceived self-efficacy' did not moderate these associations. Conclusions Insight into patients' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician-patient

  5. A Versatile Module to Improve Understanding of Scientific Literature through Peer Instruction

    ERIC Educational Resources Information Center

    Jacques-Fricke, Bridget T.; Hubert, Amy; Miller, Sarah

    2009-01-01

    Using primary literature in undergraduate science classes helps teach students both scientific information and process. However, students' lack of understanding of scientific techniques can hinder their understanding of the papers. This article describes a "technique module" that uses peer teaching and active learning to facilitate integration of…

  6. Improving Students' Understanding of, and Ability to Identify Independent and Dependent Variables

    ERIC Educational Resources Information Center

    Aldrich, Rosalie S.

    2015-01-01

    Students need to have a basic understanding of research methods before obtaining a communication degree in order to become an intelligent consumer of research--someone who is able to read, understand, explain, and critically evaluate communication and other research reported in scholarly journals as well as in the popular press. These skills are…

  7. Improving Students' Understanding of Waves by Plotting a Displacement-Time Graph in Class

    ERIC Educational Resources Information Center

    Wei, Yajun

    2012-01-01

    The topic of waves is one that many high school physics students find difficult to understand. This is especially true when using some A-level textbooks used in the U.K., where the concept of waves is introduced prior to the concept of simple harmonic oscillations. One of the challenges my students encounter is understanding the difference between…

  8. Toward a Research Agenda for Understanding and Improving the Use of Research Evidence

    ERIC Educational Resources Information Center

    Nelson, Steven R.; Leffler, James C.; Hansen, Barbara A.

    2009-01-01

    Many researchers and research funders want their work to be influential in educational policy and practice, but there is little systematic understanding of how policymakers and practitioners use research evidence, much less how they acquire or interpret it. By understanding what does shape policymakers' and practitioners' decision making and the…

  9. Improving Social Understanding of Preschool Children: Evaluation of a Training Program

    ERIC Educational Resources Information Center

    Esteban, Moises; Sidera, Francesc; Serrano, Jessica; Amado, Anna; Rostan, Carles

    2010-01-01

    Introduction: This study tested the effects of a training program intending to foster social understanding or the capacity which enables them to understand themselves and others in terms of intentions, beliefs, desires, and emotions in children at preschool age. A number of studies have shown that in the context of shared narratives, children are…

  10. Improving outpatient access and patient experiences in academic ambulatory care.

    PubMed

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume. PMID:22193182

  11. Patient Safety in Plastic Surgery: Identifying Areas for Quality Improvement Efforts

    PubMed Central

    Hernandez-Boussard, Tina; McDonald, Kathryn M.; Rhoads, Kim F.; Curtin, Catherine M.

    2016-01-01

    Summary Background Improving quality of healthcare is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events. This project assessed risk-adjusted rates of inpatient adverse events for soft tissue reconstructive procedures. Methods Patients receiving soft tissue reconstructive procedures from 2005–2010 were extracted from the Nationwide Inpatient Sample. Inpatient adverse events were identified using patient safety indicators (PSI), established measures developed by Agency for Healthcare Research and Quality. Results We identified 409,991 patient with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. PSIs were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (p<.01). Patient characteristics associated with a higher risk-adjusted rate per 1,000 patients at risk (RAR) included older age, men, non-white, and public payer (p<.05). Overall, plastic surgery patients had significantly lower RAR compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. RAR of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by gender and payer. Conclusions In general, plastic surgery patients had lower rates of in-hospital adverse events than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of adverse events identified in this population. PMID:24108144

  12. Community pharmacist–administered influenza immunization improves patient access to vaccination

    PubMed Central

    Folkins, Chris; Li, Wilson; Zervas, John

    2014-01-01

    Objectives: To describe the demographic characteristics and risk factors of patients receiving influenza vaccination in community pharmacies and to understand patient experiences and perceptions surrounding being vaccinated by a pharmacist. Methods: Survey data were collected by research pharmacists at 4 different community pharmacy locations in Toronto throughout a period of 8 weeks during October and November 2013. Participation in the survey was voluntary, and all patients vaccinated by pharmacists were invited to complete a survey following immunization. Results: During the course of the study, 2498 vaccine doses were administered among all study sites, and 1502 surveys were completed. Our data showed a high degree of patient satisfaction, with 92% of patients indicating they were very satisfied with the pharmacist’s injection technique and the services they received. Furthermore, 86% of patients were very comfortable with being vaccinated by a pharmacist, and 99% of patients reported they would recommend that friends and family be vaccinated by a pharmacist. Convenience and accessibility were major determinants of patient satisfaction, as shown by 46% of all written comments specifically addressing these factors. Of the patients surveyed, 25% were not regular annual vaccine recipients, and 47% were classified as being at high risk for influenza complications according to Public Health Agency of Canada criteria. Notably, 28% of total patients and 21% of high-risk patients reported that they would not have been immunized this year if pharmacy-based vaccination were not available. Conclusions: Our findings suggest that pharmacists provide a highly convenient and accessible option for seasonal flu vaccination that is viewed favourably by patients. Administration of the flu vaccine by pharmacists has the potential to positively affect public health by improving vaccination rates among high-risk patients, first-time or occasional vaccine recipients, and patients

  13. Training and Action for Patient Safety: Embedding Interprofessional Education for Patient Safety within an Improvement Methodology

    ERIC Educational Resources Information Center

    Slater, Beverley L.; Lawton, Rebecca; Armitage, Gerry; Bibby, John; Wright, John

    2012-01-01

    Introduction: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based…

  14. Improving the provision of meals in hospital. The patients' viewpoint.

    PubMed

    Johns, Nick; Hartwell, Heather; Morgan, Michael

    2010-02-01

    This study examines the provision of hospital meals from the patients' viewpoint, with the aim of improving hospital food service. Patients were approached in early 2008 in a National Health Service hospital in the South of England and invited to comment on the good and bad aspects of eating in hospital. Comments were collected in an abbreviated "key word" format which incurred the minimum of bias and allowed emergent themes to be analysed both quantitatively and qualitatively. Seven main themes emerged, of which "food" and "choice" were mentioned most frequently, but had a low ratio (1.8 and 1.7, respectively) of approving over disapproving comments. The next most mentioned theme, "service staff", showed the highest approving/disapproving ratio (4.8) overall. Less frequent themes were: "meals and lifestyle", "timing and routine", "service quality" and "food quantity". These data, together with qualitative analysis of the responses showed patients' views of hospital food to be positive, on the whole meeting or surpassing their expectations. However, these expectations were low, the experience of eating in hospital contrasted unfavourably with home, and the meals were at best a distraction from the rigours of hospital treatment. Service staff were positively regarded because they offered an important opportunity for "normal" discourse with a non-medical person. On the basis of the findings, changes are recommended in the management of service staff, menus, food presentation, nutritional intake and patients' lifestyle. Of these, the first is likely to have most impact on the experience and viewpoint of hospital patients. PMID:19857535

  15. Using Informatics to Improve the Care of Patients Susceptible to Malignant Hyperthermia.

    PubMed

    Denholm, Bonnie G

    2016-04-01

    Perioperative nurses and nurse leaders should understand how to apply a nursing informatics framework and informatics concepts to strengthen data interpretation, transitions in care, and engagement with patients susceptible to malignant hyperthermia (MH) and their family members. Patient outcomes can be improved when informatics solutions facilitate identifying risks, clinical decision making in a crisis situation, retrieving priority information during transitions of care, and involving patients in planning care. Incorporating informatics solutions into existing quality improvement processes can help evaluate knowledge and preparedness related to managing care for a patient in an MH crisis. Informatics solutions can also help enhance interoperability by evaluating workflow related to transitions in care. Perioperative nurses and nurse leaders should advocate for diligence in submitting reports of MH-suspected events to databases. Improved data collection and data sharing enhance aggregated standardized data sets, which can advance research and increase the quality of evidence available with which to guide practice. PMID:27004500

  16. [Orally administered polaprezinc significantly improves taste disorders in ovarian cancer patient undergoing chemotherapy].

    PubMed

    Nishijima, Shota; Yanase, Toru; Hata, Yuki; Tamura, Ryo; Tsuneki, Ikunosuke; Tamura, Masaki; Kurabayashi, Takumi

    2011-04-01

    The subject was a 75-year-old female who was receiving paclitaxel and carboplatin(TC)chemotherapy every other week after surgery for ovarian cancer. She greatly complained of taste disorders after four cycles(of every other week administration) of TC chemotherapy. To understand how the taste disorder was caused by chemotherapy objectively, taste examinations were conducted for the patient in our department. These examinations were conducted after receiving the informed consent from the patient. The authors conducted taste examinations for the patient using serum zinc measurement, tongue cell culture, electrogustometry, and filter paper disc tests(before and after starting chemotherapy), and found that her serum zinc level fell significantly after four cycles of chemotherapy. Orally disintegrating tablets of polaprezinc were then administered to the patient, after which the subjective symptom of taste disorder improved. Her serum zinc level increased, and the electrogustometric threshold rapidly fell(an improvement). The filter paper disc test showed some improvement, particularly in the glossopharyngeal nerve and the greater petrosal nerve field. PMID:21499007

  17. Success of patient training in improving proficiency of eyedrop administration among various ophthalmic patient populations

    PubMed Central

    Feng, Alexander; O’Neill, John; Holt, Mitchell; Georgiadis, Catherine; Wright, Martha M; Montezuma, Sandra R

    2016-01-01

    Purpose The purpose of this study is to evaluate the success and usefulness of patient education in eyedrop self-administration technique via an educational handout and a short instructional video. Patients and methods We conducted a prospective study that included 34 patients who were self-administering ophthalmic drops. Of the total patients included, 12% had used drops for <12 months, and 88% had used drops for >12 months. Average age of patients in the study was 67 years, with an age range of 19–91 years. Of the total patients included, 82% had glaucoma, 6% had dry eyes, and 12% did not have a specific diagnosis. Subjects were video recorded and assessed by a trained observer on two occasions: at baseline and after they viewed a demonstrational video and handout. A maximum score of 15 points was awarded based on 15 criteria. A written self-assessment was administered at the end of each study. Results Pre- and post-teaching assessment scores improved significantly with education. Patients initially scored an average 2.53 points compared to a post-education score of 6.15 out of 15 points, demonstrating a 2.43 (P=0.008) factor of improvement. After education, 94% of patients versus 47% pre-teaching (P=0.0001) pulled down their lower eyelids. A total of 91% pre-teaching versus 59% post-teaching (P=0.0042) patients squeezed one drop into the lower fornix, 74% pre-teaching versus 26% post-teaching (P=0.0002) patients released the eyelid and closed the eye for 1 minute, and 56% pre-teaching versus 3% post-teaching (P=0.0001) patients applied nasal digital pressure on each eye. We found no significant difference in score changes between those who previously received education and those who had not (P=0.37). A total of 91% patients responded in a postassessment survey that they now feel more confident of their ability to self-administer eyedrops as their doctor prescribed and that the educational materials were responsible. Conclusion Participants demonstrated an

  18. Improving handover of patient care using a new weekend proforma with a focus on ceiling of care

    PubMed Central

    Akhunbay-Fudge, Christopher Yusuf; Buss, Imogen; Ward, Abigail; Snead, Charlotte; Cole, Miranda; Coulter, Archie

    2014-01-01

    Patient handover is paramount for effective patient care and is often poorly documented or incomplete. North Bristol NHS Trust weekend handover proformas identify medical patients requiring weekend review. Many patients seen during on-call shifts are not handed over. Our aim was to develop Friday ward round proforma sheets for medical patients, to encourage clear documentation of management plans in order to improve handover of important information, particularly ceiling of care decisions. Questionnaires were completed by F1 doctors regarding current handover systems. Baseline data collected by on-call F1s included time of understanding a patient's ceiling of care decision, and difficulty of comprehension of medical notes. Repeat data were collected with novel proformas in situ. Multiple cycles were performed to refine the sheets and target problems arising in their use. Ninety-three percent of F1s wanted improved patient handover, with ceiling of care (87%) and management plans (73%) being the most difficult areas to understand. Time taken to ascertain ceiling of care decisions improved with the introduction of Friday handover proformas; mean time 153 seconds before and 5 seconds after. Clarity and documentation of management plans improved, with 50% improvement in ease of understanding medical notes. Results demonstrate that introducing Friday ward round proformas for medical patients improves communication between weekday and on-call teams, highlights current escalation of care plans, and leads to faster decision-making. Future plans include the introduction of a short educational session to the new F1 doctors and continued progress with introduction into hospital stationary. PMID:27493739

  19. Influenza vaccination for patients with chronic obstructive pulmonary disease: understanding immunogenicity, efficacy and effectiveness.

    PubMed

    Sanei, Farzaneh; Wilkinson, Tom

    2016-08-01

    Influenza infection is an important cause of global mortality and morbidity with the greatest impact on older people and those with chronic disease. Patients with chronic obstructive pulmonary disease (COPD) are particularly vulnerable to influenza, with evidence for increased incidence and severity of infection. In this patient group influenza is associated with exacerbations and pneumonia which result in a significant healthcare burden and premature mortality. Influenza vaccination and in particular the use of the seasonal trivalent influenza vaccine (TIV) is recommended for patients with COPD. The evidence base for its effects in this population is, however, limited. Available data suggest that immunogenicity is variable in COPD but the underlying mechanisms are not completely understood. The contribution of age, disease severity, comorbidity and treatments to vaccine responses has only been investigated in a limited manner. Existing data suggest that key immune mechanisms governing T- and B-cell responses are adversely affected by these factors. The efficacy of TIV has been studied in a number of small clinical trials which form the basis of a Cochrane review. Here evidence for effect is conflicting depending on individual trial design and inclusions. Overall, TIV offers protection against influenza infection in the trial setting but further studies are required to stratify patients and enable prediction of inadequate responses. Larger-scale clinical studies have largely been observational and have often been conducted in consort with pneumonia vaccination. Overall the mortality benefit of TIV in COPD is suggested by a number studies but the impact on exacerbation prevention is less clear. Influenza vaccination currently plays an important role in disease prevention in COPD. However, we postulate that a more in-depth understanding of mechanisms of response in the context of a highly heterogeneous disease will lead to a more informed approach to vaccination and

  20. A web-based interactive tool to improve breast cancer patient centredness

    PubMed Central

    Gorini, Alessandra; Mazzocco, Ketti; Kondylakis, Haridimos; McVie, Gordon; Pravettoni, Gabriella

    2016-01-01

    The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient’s unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient–physician communication, improving the patient’s understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient–physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient’s profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient’s physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient’s answers in real time and send them, together with specific recommendations to the physician’s computer immediately before physician’s first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient’s profile). The proposed approach is supposed to improve the patient–physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in

  1. Patient-powered research networks aim to improve patient care and health research.

    PubMed

    Fleurence, Rachael L; Beal, Anne C; Sheridan, Susan E; Johnson, Lorraine B; Selby, Joe V

    2014-07-01

    The era of big data, loosely defined as the development and analysis of large or complex data sets, brings new opportunities to empower patients and their families to generate, collect, and use their health information for both clinical and research purposes. In 2013 the Patient-Centered Outcomes Research Institute launched a large national research network, PCORnet, that includes both clinical and patient-powered research networks. This article describes these networks, their potential uses, and the challenges they face. The networks are engaging patients, family members, and caregivers in four key ways: contributing data securely, with privacy protected; including diverse and representative groups of patients in research; prioritizing research questions, participating in research, and disseminating results; and participating in the leadership and governance of patient-powered research networks. If technical, regulatory, and organizational challenges can be overcome, PCORnet will allow research to be conducted more efficiently and cost-effectively and results to be disseminated quickly back to patients, clinicians, and delivery systems to improve patient health. PMID:25006148

  2. Improving patient safety in radiology: concepts for a comprehensive patient safety program.

    PubMed

    Donnelly, Lane F; Dickerson, Julie M; Goodfriend, Martha A; Muething, Stephen E

    2010-04-01

    A comprehensive safety program can have a positive influence on safety performance and safety culture within a department of radiology. The program should include both vertical interventions aimed at specific areas of potential safety errors as well as horizontal interventions aimed at improving safety culture and decreasing the baseline rate of human error. In our opinion, the key cultural transformations that must occur to improve safety culture include recognition that safety is an issue, emphasis that everyone is accountable for patient safety, and creating a culture where people are expected and encouraged to speak up in the face of uncertainty. The article describes the horizontal interventions to improve patient safety used in our department. PMID:20304316

  3. Perceived accuracy in continuous glucose monitoring: understanding the impact on patients.

    PubMed

    Polonsky, William H; Hessler, Danielle

    2015-03-01

    In terms of accuracy and reliability, the technology of real-time (RT) continuous glucose monitoring (CGM) is advancing quickly. Still, current devices are imperfect; as a result, patient complaints and frustrations are not uncommon. How do patients' perceptions of device accuracy affect their experience with RT-CGM? In this article, we argue that patients' satisfaction, or dissatisfaction, with accuracy has a major impact on how much they are likely to trust the device and how confident they may feel in using the information that is displayed. The available data suggest that greater satisfaction with accuracy is linked to better RT-CGM adherence, more confident and aggressive insulin adjustments, improvements in quality of life, reduced reliance on self-monitoring of blood glucose, and--potentially--less alarm fatigue. As the technology continues to mature, RT-CGM will become increasingly accurate and patients' confidence and trust in the available devices will likely grow, leading to greater uptake and more proactive use of RT-CGM. PMID:25385947

  4. A Real-Time Screening Alert Improves Patient Recruitment Efficiency

    PubMed Central

    Weng, Chunhua; Batres, Candido; Borda, Tomas; Weiskopf, Nicole G.; Wilcox, Adam B.; Bigger, J Thomas; Davidson, Karina W.

    2011-01-01

    The scarcity of cost-effective patient identification methods represents a significant barrier to clinical research. Research recruitment alerts have been designed to facilitate physician referrals but limited support is available to clinical researchers. We conducted a retrospective data analysis to evaluate the efficacy of a real-time patient identification alert delivered to clinical research coordinators recruiting for a clinical prospective cohort study. Data from log analysis and informal interviews with coordinators were triangulated. Over a 12-month period, 11,295 were screened electronically, 1,449 were interviewed, and 282 were enrolled. The enrollment rates for the alert and two other conventional methods were 4.65%, 2.01%, and 1.34% respectively. A taxonomy of eligibility status was proposed to precisely categorize research patients. Practical ineligibility factors were identified and their correlation with age and gender were analyzed. We conclude that the automatic prescreening alert improves screening efficiency and is an effective aid to clinical research coordinators. PMID:22195213

  5. QT variability improves risk stratification in patients with dilated cardiomyopathy.

    PubMed

    Fischer, C; Seeck, A; Schroeder, R; Goernig, M; Schirdewan, A; Figulla, H R; Baumert, M; Voss, A

    2015-04-01

    Recently it could be demonstrated that systolic and diastolic blood pressure variability (BPV) as well as segmented Poincare plot analysis (SPPA) contribute to risk stratification in patients suffering from dilated cardiomyopathy (DCM). The aim of this study was to improve the risk stratification applying a multivariate technique including QT variability (QTV). We enrolled and significantly separated 56 low risk and 13 high risk DCM patients by nearly all applied BPV and QTV methods, but not with traditional heart rate variability analysis. The optimum set of two indices calculating the multivariate discriminate analysis (DA) included one BPV index calculated by symbolic dynamics method (DBP(Shannon)) and one index calculated from QTV (QTV(log)) achieving an area under the receiver operating characteristics curve (AUC) of 92%, sensitivity of 92.3% and specificity of 89.3%. Performing only electrocardiogram analysis, the optimum multivariate approach including indices from segmented Poincaré plot analysis and QTV still achieved a remarkable AUC of 88.3%. Increasing the number of indices for multivariate DA up to three, we achieved an AUC of 95.7%, sensitivity of 100% and specificity of 85.7% including one clinical, one BPV and one QTV index. Summarizing, we identified DCM patients with an increased risk of sudden cardiac death applying QTV analysis in a multivariate approach. PMID:25799313

  6. Mini incision open pyeloplasty - Improvement in patient outcome

    PubMed Central

    Singh, Vishwajeet; Garg, Manish; Sharma, Pradeep; Sinha, Rahul Janak; Kumar, Manoj

    2015-01-01

    ABSTRACT Purpose: To assess the subjective and objective outcomes of mini-incision dismembered Anderson-Hynes pyeloplasty in the treatment of primary ureteropelvic junction obstruction (UPJO). Materials and Methods: Between January 2008 to January 2013, Anderson-Hynes pyeloplasty was performed in 71 patients diagnosed with primary UPJO. Small subcostal muscle splitting incision was used in all cases. Sixteen patients with renal calculi underwent concomitant pyelolithotomy. Subjective outcome was assessed using visual pain analogue score (VAS). For objective assessment, the improvement in differential renal function (DRF) and radio-tracer wash out time (T1/2) on Tc-99m DTPA scan and decrease in hydronephrosis (HDN) on renal ultrasound (USG) and urography (IVU) were assessed. Results: Mean incision length was 5.2 cm. The average operating time and postoperative hospital stay was 63 (52-124) minutes and 2.5 (2–6) days respectively. Concomitant renal calculi were successfully removed in all the patients. Overall complication rates were 8.4% and overall success rate was 98.6% at median follow-up of 16 months. There was significant improvement in pain score (p=0.0001) and significant decrease in HDN after the procedure. While preoperative mean T1/2 was 26.7±6.4 minutes, postoperative half-time decreased to 7.8±4.2 minutes at 6 months and to 6.7±3.3 minutes at 1 year. Mean pre-operative DRF was 26.45% and it was 31.38% and 33.19% at 6 months and 1 year respectively. Conclusions: Mini-incision pyeloplasty is a safe and effective technique with combined advantage of high success rates of standard open pyeloplasty with decreased morbidity of laparoscopic approach. Excellent functional and objective outcomes can be achieved without extra technical difficulty. PMID:26689518

  7. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction

    PubMed Central

    Gausvik, Christian; Lautar, Ashley; Miller, Lisa; Pallerla, Harini; Schlaudecker, Jeffrey

    2015-01-01

    Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR) on an acute care for the elderly (ACE) unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication. PMID:25609978

  8. Provider and patient directed financial incentives to improve care and outcomes for patients with diabetes.

    PubMed

    Lorincz, Ilona S; Lawson, Brittany C T; Long, Judith A

    2013-04-01

    Incentive programs directed at both providers and patients have become increasingly widespread. Pay-for-performance (P4P) where providers receive financial incentives to carry out specific care or improve clinical outcomes has been widely implemented. The existing literature indicates they probably spur initial gains which then level off or partially revert if incentives are withdrawn. The literature also indicates that process measures are easier to influence through P4P programs but that intermediate outcomes such as glucose, blood pressure, and cholesterol control are harder to influence, and the long-term impact of P4P programs on health is largely unknown. Programs directed at patients show greater promise as a means to influence patient behavior and intermediate outcomes such as weight loss; however, the evidence for long-term effects are lacking. In combination, both patient and provider incentives are potentially powerful tools but whether they are cost-effective has yet to be determined. PMID:23225214

  9. Patient engagement and patient support programs in allergy immunotherapy: a call to action for improving long-term adherence.

    PubMed

    Demoly, Pascal; Passalacqua, Giovanni; Pfaar, Oliver; Sastre, Joaquin; Wahn, Ulrich

    2016-01-01

    Allergy immunotherapy (AIT) is acknowledged to produce beneficial mid- and long-term clinical and immunologic effects and increased quality of life in patients with allergic respiratory diseases (such as allergic rhinoconjunctivitis and allergic asthma). However, poor adherence to AIT (due to intentional and/or non-intentional factors) is still a barrier to achieving these benefits. There is an urgent need for patient support programs (PSPs) that encompass communication, educational and motivational components. In the field of AIT, a PSP should be capable of (1) improving adherence, (2) boosting patient engagement, (3) explaining how AIT differs from pharmacological allergy treatments; (4) increasing health literacy about chronic, progressive, immunoglobulin-E-mediated immune diseases, (5) helping the patient to understand and manage local or systemic adverse events, and (6) providing and/or predicting local data on aeroallergen levels. We reviewed the literature in this field and have identified a number of practical issues to be addressed when implementing a PSP for AIT: the measurement of adherence, the choice of technologies, reminders, communication channels and content, the use of "push" messaging and social networks, interactivity, and the involvement of caregivers and patient leaders. A key issue is "hi-tech" (i.e. approaches based mainly on information technology) vs. "hi-touch" (based mainly on interaction with humans, i.e. family members, patient mentors and healthcare professionals). We conclude that multistakeholder PSPs (combining patient-, provider and society-based actions) must now be developed and tested with a view to increasing adherence, efficacy and safety in the field of AIT. PMID:27478445

  10. Improving Bariatric Patient Transport and Care with Simulation

    PubMed Central

    Gable, Brad D.; Gardner, Aimee K.; Celik, Dan H.; Bhalla, Mary Colleen; Ahmed, Rami A.

    2014-01-01

    Introduction Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics’ knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Methods Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree) to 5 (strongly agree) on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p ≤0.05. Proportions

  11. Patient attitudes and understanding about biosimilars: an international cross-sectional survey

    PubMed Central

    Jacobs, Ira; Singh, Ena; Sewell, K Lea; AL-Sabbagh, Ahmad; Shane, Lesley G

    2016-01-01

    Objective To understand the levels of awareness, usage, and knowledge of biosimilars among patients, caregivers, and the general population in the US and the European Union; perceptions of biosimilars compared to originator biologics; perceived benefits and drawbacks of clinical trials; and whether advocacy groups impact patients’ willingness to try a biosimilar. Methods An international survey was conducted which contained up to 56 closed-ended (requiring yes/no or ranking answers) and open-ended questions, depending on the population assigned. The survey was divided into distinct sections, including medication-class awareness, usage, and knowledge about biologic and biosimilar therapies; perceptions of clinical trials; and involvement in advocacy groups. Interviews were conducted in adults categorized as: 1) diagnosed: patients with inflammatory bowel disease including Crohn’s disease and ulcerative colitis, rheumatoid arthritis, psoriasis, breast cancer, lung cancer, colorectal cancer, or non-Hodgkin’s lymphoma; 2) diagnosed advocacy: individuals with these diseases who participated in patient support groups; 3) caregiver: has a loved one with these conditions and is involved in medical decisions; 4) general population: aged 18–64 years, without these conditions. Statistical analyses among groups within a region (US or EU) used column proportions test with a 95% confidence interval. Results In all, 3,198 individuals responded. Awareness about biologic therapies was significantly higher in diagnosed, diagnosed advocacy, and caregiver groups (45%–78%) versus general population (27%; P<0.05). Across all groups, awareness of biosimilars was low; only 6% of the general population reported at least a general impression of biosimilars. Awareness was significantly higher in the diagnosed advocacy group (20%–30%; P<0.05). Gaps in knowledge about biosimilars included safety, efficacy, and access to these agents. Respondents had generally positive perceptions

  12. Improved Climate Prediction through a System Level Understanding of Arctic Terrestrial Ecosystems

    NASA Astrophysics Data System (ADS)

    Wullschleger, S. D.; Graham, D. E.; Hinzman, L. D.; Hubbard, S. S.; Liang, L.; Liljedahl, A. K.; Norby, R. J.; Rogers, A.; Rowland, J. C.; Thornton, P. E.; Torn, M. S.; Riley, W. J.; Wilson, C. J.

    2012-12-01

    Characterized by vast amounts of carbon stored in permafrost and a rapidly evolving landscape, the Arctic has emerged as an important focal point for the study of climate change. These are sensitive systems, yet the mechanisms responsible for those sensitivities are not well understood and many remain uncertain in terms of their representation in Earth System models. Increasing our confidence in climate projections for high-latitude regions of the world will require a coordinated set of investigations that target improved process understanding and model representation of important ecosystem-climate feedbacks. The Next-Generation Ecosystem Experiments (NGEE Arctic) seeks to address this challenge by quantifying the physical, chemical, and biological behavior of terrestrial ecosystems in Alaska. Initial research focuses on the highly dynamic landscapes of the North Slope where thaw lakes, drained thaw lake basins, and ice-rich polygonal ground offer distinct land units for investigation and modeling. Activities in the early stage of the project are focused on the Barrow Environmental Observatory (BEO), where a multi-disciplinary team of scientists will study interactions that drive critical climate feedbacks within these environments through greenhouse gas fluxes and changes in surface energy balance associated with permafrost degradation, and the many processes that arise as a result of these landscape dynamics. Our scaling approach builds on the hypothesis that the transfer of information across spatial scales can be organized around these discrete geomorphological units for which processes are represented explicitly at finer scales, with information passed to coarser scales through sub-grid parameterization of Earth System models. By extending an already well-established framework for fractional sub-grid area representations to allow dynamic sub-grid areas and hydrological and geophysical connections among sub-grid units, we expect to be able to characterize

  13. Harnessing quantitative genetics and genomics for understanding and improving complex traits in crops

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Classical quantitative genetics aids crop improvement by providing the means to estimate heritability, genetic correlations, and predicted responses to various selection schemes. Genomics has the potential to aid quantitative genetics and applied crop improvement programs via large-scale, high-thro...

  14. Understanding Evidence-Based Improvement in Higher Education: The Case of Student Engagement

    ERIC Educational Resources Information Center

    McCormick, Alexander C.; Kinzie, Jillian; Korkmaz, Ali

    2011-01-01

    This paper uses time series data from a widely used assessment to identify colleges and universities that demonstrate positive trends on a range of educational effectiveness measures, describe observed patterns of improvement, and examine informants' accounts of factors that contributed to the improvements. This study informs broad questions about…

  15. Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients

    PubMed Central

    2013-01-01

    Background To develop a Consumer Quality Index (CQI) Cancer Care questionnaire for measuring experiences with hospital care of patients with different types of cancer. Methods We derived quality aspects from focus group discussions, existing questionnaires and literature. We developed an experience questionnaire and sent it to 1,498 Dutch cancer patients. Another questionnaire measuring the importance of the quality aspects was sent to 600 cancer patients. Data were psychometrically analysed. Results The response to the experience questionnaire was 50 percent. Psychometric analysis revealed 12 reliable scales. Patients rated rapid and adequate referral, rapid start of the treatment after diagnosis, enough information and confidence in the healthcare professionals as most important themes. Hospitals received high scores for skills and cooperation of healthcare professionals and a patient-centered approach by doctors; and low scores for psychosocial guidance and information at completion of the treatment. Conclusions The CQI Cancer Care questionnaire is a valuable tool for the evaluation of the quality of cancer care from the patient’s perspective. Large scale implementation is necessary to determine the discriminatory powers of the questionnaire and may enable healthcare providers to improve the quality of cancer care. Preliminary results indicate that hospitals could improve their psychosocial guidance and information provision. PMID:23617741

  16. Educational Intervention Improves Anticoagulation Control in Atrial Fibrillation Patients: The TREAT Randomised Trial

    PubMed Central

    Clarkesmith, Danielle E.; Pattison, Helen M.; Lip, Gregory Y. H.; Lane, Deirdre A.

    2013-01-01

    Background Stroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its treatment may contribute to the patient’s willingness to adhere to recommendations. Method A theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1–6 patients) utilising an “expert-patient” focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions. Main Findings Intervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; p<0.01), but there were no differences between groups (F (1, 47) = 3.3; p = 0.07). At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04). Patients’ scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months. Conclusions A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients’ understanding of

  17. Color-coding Improves Parental Understanding of Body Mass Index Charting

    PubMed Central

    Oettinger, Matthew D.; Finkle, Joanne P.; Esserman, Denise; Whitehead, Lisa; Spain, Thomas K.; Pattishall, Steven R.; Rothman, Russell; Perrin, Eliana M.

    2009-01-01

    Objectives To assess parental understanding of body mass index (BMI) and BMI percentiles using standard versus color-coded charts and investigate how parental literacy and/or numeracy (quantitative skills) impacts that understanding. Methods A convenience sample of 163 parents of children aged 2–8 years at two academic pediatric centers completed a demographics questionnaire, the mathematics portion of the Wide Range Achievement Test (WRAT-3R), the Short Test of Functional Health Literacy in Adults (S-TOFHLA), and an “Understanding BMI” questionnaire, which included parallel BMI charting questions to compare understanding of standard versus color-coded BMI charting. Outcomes included parental-reported versus actual understanding of BMI, the odds (obtained by generalized estimating equations) of answering parallel questions correctly using standard versus color-coded charting, and odds of answering questions correctly based on numeracy and literacy. Results Many parents (60%) reported knowing what BMI was, but only 30% could define it even roughly correctly. Parents using color-coded charts had greater odds of answering parallel BMI charting questions correctly than parents using standard charts (mean 88% vs. 65% correct; pooled AOR=4.32, 95% CI: 3.14–5.95; p<.01). Additionally, parents with lower numeracy (K-5 level) benefited more from color-coded charts (increased from 51% to 81% correct) than did higher numeracy parents (≥ high school level), who performed well using both charts (89% vs. 99% correct). Conclusions Parents consistently performed better using color-coded than standard BMI charts. Color-coding was particularly helpful for lower numeracy parents. Future studies should investigate whether these results translate into offices and whether understanding motivates parents toward important lifestyle change. PMID:19679524

  18. Research Plans for Improving Understanding of Effects of Very Low-Frequency Noise of Heavy Lift Rotorcraft

    NASA Technical Reports Server (NTRS)

    Fidell, Sanford; Horonieff, Richard D.; Schmitz, Fredric H.

    2010-01-01

    This report reviews the English-language technical literature on infrasonic and low-frequency noise effects; identifies the most salient effects of noise produced by a future large civil tiltrotor aircraft on crew, passengers, and communities near landing areas; and recommends research needed to improve understanding of the effects of such noise on passengers, crew, and residents of areas near landing pads.

  19. Improving Individualized Educational Program (IEP) Mathematics Learning Goals for Conceptual Understanding of Order and Equivalence of Fractions

    ERIC Educational Resources Information Center

    Scanlon, Regina M.

    2013-01-01

    The purpose of this Executive Position Paper project was to develop resources for improving Individual Educational Program (IEP) mathematics learning goals for conceptual understanding of fractions for middle school special education students. The investigation surveyed how IEP mathematics learning goals are currently determined and proposed a new…

  20. WWC Review of the Report "Improving At-Risk Learners' Understanding of Fractions." What Works Clearinghouse Single Study Review

    ERIC Educational Resources Information Center

    What Works Clearinghouse, 2013

    2013-01-01

    The study examined the effects of "Fraction Challenge," a supplemental small-group tutoring math program that focuses on improving student understanding of fractions. Study authors randomly assigned fourth grade "at-risk" students in 53 classrooms in 13 schools to either an intervention group that received "Fraction Challenge" or to a comparison…

  1. Improving New Family Child Care Providers' Understanding of Standard Business Practices through the Development of a Resource Manual.

    ERIC Educational Resources Information Center

    Taylor, Joanne Labish

    New family child care (FCC) providers often have little understanding of standard business practices, including zoning, contracts and policies, insurance, and record keeping for tax purposes. This lack of knowledge contributes to low income, high turnover, and other problems. A practicum project set out to improve entry-level FCC providers'…

  2. An information theory application to improve understanding of subsurface flow and transport conditions at the BARC OPE3 site

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Improving understanding of subsurface conditions includes comparison and discrimination of concurrent models. Additional observations can be useful for that purpose. The objective of this work was to implement and test a novel method for optimization of selecting locations for additional observation...

  3. Using Targeted Active-Learning Exercises and Diagnostic Question Clusters to Improve Students' Understanding of Carbon Cycling in Ecosystems

    ERIC Educational Resources Information Center

    Maskiewicz, April Cordero; Griscom, Heather Peckham; Welch, Nicole Turrill

    2012-01-01

    In this study, we used targeted active-learning activities to help students improve their ways of reasoning about carbon flow in ecosystems. The results of a validated ecology conceptual inventory (diagnostic question clusters [DQCs]) provided us with information about students' understanding of and reasoning about transformation of inorganic and…

  4. Ofqual's Reliability Programme: A Case Study Exploring the Potential to Improve Public Understanding and Confidence

    ERIC Educational Resources Information Center

    Newton, Paul E.

    2013-01-01

    In May 2008, Ofqual established a two-year programme of research to investigate the nature and extent of (un)reliability within the qualifications, examinations and assessments that it regulated. It was particularly concerned to improve understanding of, and confidence in, this technically complex and politically sensitive phenomenon. The…

  5. Improving Students' Understanding of Waves by Plotting a Displacement-Time Graph in Class

    NASA Astrophysics Data System (ADS)

    Wei, Yajun

    2012-04-01

    The topic of waves is one that many high school physics students find difficult to understand. This is especially true when using some A-level textbooks1,2used in the U.K., where the concept of waves is introduced prior to the concept of simple harmonic oscillations. One of the challenges my students encounter is understanding the difference between displacement-time graphs and displacement-position graphs. Many students wonder why these two graphs have the same sinusoidal shape. Having the students use multimedia simulations allows them to see, in a hands-on fashion, the relationship between the two graphs.

  6. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries

    PubMed Central

    Secanell, Mariona; Groene, Oliver; Arah, Onyebuchi A.; Lopez, Maria Andrée; Kutryba, Basia; Pfaff, Holger; Klazinga, Niek; Wagner, Cordula; Kristensen, Solvejg; Bartels, Paul Daniel; Garel, Pascal; Bruneau, Charles; Escoval, Ana; França, Margarida; Mora, Nuria; Suñol, Rosa; Klazinga, N; Kringos, DS; Lopez, MA; Secanell, M; Sunol, R; Vallejo, P; Bartels, P; Kristensen, S; Michel, P; Saillour-Glenisson, F; Vlcek, F; Car, M; Jones, S; Klaus, E; Bottaro, S; Garel, P; Saluvan, M; Bruneau, C; Depaigne-Loth, A; Shaw, C; Hammer, A; Ommen, O; Pfaff, H; Groene, O; Botje, D; Wagner, C; Kutaj-Wasikowska, H; Kutryba, B; Escoval, A; Lívio, A; Eiras, M; Franca, M; Leite, I; Almeman, F; Kus, H; Ozturk, K; Mannion, R; Arah, OA; Chow, A; DerSarkissian, M; Thompson, CA; Wang, A; Thompson, A

    2014-01-01

    Introduction and Objective This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. Design DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. Setting and Participants We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. Main outcome measures A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Results Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. Conclusions This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers

  7. A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home

    PubMed Central

    Gabbay, Robert A.; Friedberg, Mark W.; Miller-Day, Michelle; Cronholm, Peter F.; Adelman, Alan; Schneider, Eric C.

    2013-01-01

    PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and financial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices’ baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices’ structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care. PMID:23690393

  8. Interferometric Measurement for Improved Understanding of Boundary Effects in Micromachined Beams

    SciTech Connect

    Bitsie, Fernando; Jensen, Brian D.; de Boer, Maarten

    1999-07-15

    Micromachined beams are commonly used to measure material properties in MEMS. Such measurements are complicated by the fact that boundary effects at the ends of the beams have a significant effect on the properties being measured. In an effort to improve the accuracy and resolution of such measurements, we are conducting a study of support post compliance in cantilever and fixed-fixed beams. Three different support post designs have been analyzed by finite element modeling. The results are then compared to measurements made on actual devices using interferometry. Using this technique, the accuracy of measurements of Young's modulus has been improved. Continuing work will also improve the measurement of residual stress.

  9. [Errors in medicine. Causes, impact and improvement measures to improve patient safety].

    PubMed

    Waeschle, R M; Bauer, M; Schmidt, C E

    2015-09-01

    The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing

  10. Drafting Exercises to Improve Understanding. Industrial Arts Series No. 10,007.

    ERIC Educational Resources Information Center

    Hinrichs, Roy S., Comp.

    These materials, which can be used to supplement a drafting program, are designed to assist the instructor in helping students develop a better understanding of certain areas of drafting. The materials are divided into exercises that allow the student to devote full attention to one aspect of drafting at a time, and tests, which can be used either…

  11. Teachers and Game-Based Learning: Improving Understanding of How to Increase Efficacy of Adoption

    ERIC Educational Resources Information Center

    Ketelhut, Diane Jass; Schifter, Catherine C.

    2011-01-01

    Interest in game-based learning for K-12 is growing. Thus, helping teachers understand how to use these new pedagogies is important. This paper presents a cross-case study of the development of teacher professional development for the River City project, a games-based multi-user virtual environment science curriculum project for middle school…

  12. Improving Students' Understanding and Explanation Skills through the Use of a Knowledge Building Forum

    ERIC Educational Resources Information Center

    Hamel, Christine; Turcotte, Sandrine; Laferriere, Therese; Bisson, Nicolas

    2015-01-01

    Education research has shown the importance of helping students develop comprehension skills. Explanation-seeking rather than fact-seeking pedagogies have been shown to warrant deeper student understanding. This study investigates the use of Knowledge Forum (KF) in K-6 classrooms (n = 251) to develop students' explanation skills. To this end, we…

  13. Using Art-Based Chemistry Activities to Improve Students' Conceptual Understanding in Chemistry

    ERIC Educational Resources Information Center

    Danipog, Dennis L.; Ferido, Marlene B.

    2011-01-01

    This study aimed to determine the effects of art-based chemistry activities (ABCA) on high school students' conceptual understanding in chemistry. The study used the pretest-posttest control group design. A total of 64 third-year high school students from two different chemistry classes participated in the study. One class was exposed to art-based…

  14. Understanding Change for Effective School Improvement Initiatives: Critical Elements of School Reform

    ERIC Educational Resources Information Center

    Schnautz, Dee Ann Piercy

    2012-01-01

    With the historical political and social changes, which ultimately affect education, it is easy to see why teachers sometimes balk at new initiatives and perceived new best practices. For change to occur it is important to understand how perception of critical elements of change impact student academic growth. It is also important to have a…

  15. Blending Physical and Virtual Manipulatives: An Effort to Improve Students' Conceptual Understanding through Science Laboratory Experimentation

    ERIC Educational Resources Information Center

    Olympiou, Georgios; Zacharia, Zacharias C.

    2012-01-01

    This study aimed to investigate the effect of experimenting with physical manipulatives (PM), virtual manipulatives (VM), and a blended combination of PM and VM on undergraduate students' understanding of concepts in the domain of "Light and Color." A pre-post comparison study design was used for the purposes of this study that involved 70…

  16. Using biotechnology to improve resistance to environmental stress in fruit crops: The importance of understanding physiology

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Environmental stress can significantly impact the yield, fruit quality, and longevity of fruit trees. In particular, freeze injury can result in the loss of an entire crop or even an entire orchard. Over the past two decades, significant advances have been made in understanding the genetic regulat...

  17. Improved understanding and testing for salinity tolerance in cool-season turfgrasses

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Utah State University and the USDA-ARS in Logan, Utah, were funded to conduct research towards understanding how cool season turf specied tolerate salt stress. Salt tolerant and salt susceptible varieties of Kentucky bluegrass, perennial ryegrass, and the check alkaligrass were planted in a replica...

  18. An Integrated Academic Literacy Approach to Improving Students' Understanding of Plagiarism in an Accounting Course

    ERIC Educational Resources Information Center

    Powell, Lisa; Singh, Nishani

    2016-01-01

    Plagiarism in higher education is a widespread and complex issue. Students' understanding of plagiarism differs as a result of combining their prior learning about referencing with their current experience of institutional policies and generic resources. Plagiarism was identified as a major learning issue in a core second-year undergraduate…

  19. Effective Use of Discovery Learning to Improve Understanding of Factors That Affect Quality

    ERIC Educational Resources Information Center

    Mukherjee, Arup

    2015-01-01

    Undergraduate business majors are required to take a course in operations management. In this course, a great deal of emphasis is put on developing a good understanding of quality because this is likely to be the only required course that covers this important topic. Quality of output exhibits a great deal of variation. To produce high quality on…

  20. Improving Children's Well-Being: Understanding, Nurturing Fatherhood. Research on Today's Issues.

    ERIC Educational Resources Information Center

    Population Reference Bureau, Inc., Washington, DC.

    This brief focuses on the role of fathers in contributing to children's well-being. The brief notes that collecting better data on fathers is vital to federal and state efforts to reform the welfare and child support systems and that understanding fathers' roles in their children's lives could help parents and social service providers better…

  1. Can Dynamic Visualizations Improve Middle School Students' Understanding of Energy in Photosynthesis?

    ERIC Educational Resources Information Center

    Ryoo, Kihyun; Linn, Marcia C.

    2012-01-01

    Dynamic visualizations have the potential to make abstract scientific phenomena more accessible and visible to students, but they can also be confusing and difficult to comprehend. This research investigates how dynamic visualizations, compared to static illustrations, can support middle school students in developing an integrated understanding of…

  2. Improving High School Students' Understanding of Potential Difference in Simple Electric Circuits

    ERIC Educational Resources Information Center

    Liegeois, Laurent; Chasseigne, G'erard; Papin, Sophie; Mullet, Etienne

    2003-01-01

    This paper reports two studies into the understanding of the concept of potential difference in the current-potential difference-resistance context among 8th-12th graders (Study 1), and the efficiency of a learning device derived from Social Judgment Theory (Study 2). These two studies showed that: (a) when asked to infer potential difference from…

  3. Improving efficacy of landscape interventions in the (sub) humid Ethiopian highlands by improved understanding of runoff processes

    NASA Astrophysics Data System (ADS)

    Tebebu, Tigist; Steenhuis, Tammo; Dagnew, Dessalegn; Guzman, Christian; Bayabil, Haimanote; Zegeye, Assefa; Collick, Amy; Langan, Simon; MacAlister, Charlotte; Langendoen, Eddy; Yitaferu, Birru; Tilahun, Seifu

    2015-09-01

    Despite millions of dollars invested in soil and water conservation practices in the (sub) humid Ethiopian highlands and billions of hours of food-for-work farm labor, sediment concentration in rivers is increasing. This paper reports on the research to reverse the current trend. Based on the understanding of the hydrology of highlands, we provide evidence on sources of surface runoff and sediment and on mechanisms that govern the erosion processes and approaches and how they affect soil and water conservation practices. We suggest that priority in landscape interventions should be given to re-vegetation of the degraded areas so as to reduce the sediment concentration contributions originating from these areas. Additionally, efforts should be directed to gully rehabilitation in the saturated bottom landscape that may consist of vegetating shallow gullies and stabilizing head cuts of deeper gullies Finally, rehabilitation efforts should be directed to increase the rain water infiltration in the upland areas through the hard pan layer by connecting the land surface to the original deep flow paths that exist below about 60 cm. It will reduce the direct runoff during the rainy season and increase baseflow during the dry season.

  4. How can we improve our understanding of cardiovascular safety liabilities to develop safer medicines?

    PubMed Central

    Laverty, HG; Benson, C; Cartwright, EJ; Cross, MJ; Garland, C; Hammond, T; Holloway, C; McMahon, N; Milligan, J; Park, BK; Pirmohamed, M; Pollard, C; Radford, J; Roome, N; Sager, P; Singh, S; Suter, T; Suter, W; Trafford, A; Volders, PGA; Wallis, R; Weaver, R; York, M; Valentin, JP

    2011-01-01

    Given that cardiovascular safety liabilities remain a major cause of drug attrition during preclinical and clinical development, adverse drug reactions, and post-approval withdrawal of medicines, the Medical Research Council Centre for Drug Safety Science hosted a workshop to discuss current challenges in determining, understanding and addressing ‘Cardiovascular Toxicity of Medicines’. This article summarizes the key discussions from the workshop that aimed to address three major questions: (i) what are the key cardiovascular safety liabilities in drug discovery, drug development and clinical practice? (ii) how good are preclinical and clinical strategies for detecting cardiovascular liabilities? and (iii) do we have a mechanistic understanding of these liabilities? It was concluded that in order to understand, address and ultimately reduce cardiovascular safety liabilities of new therapeutic agents there is an urgent need to: Fully characterize the incidence, prevalence and impact of drug-induced cardiovascular issues at all stages of the drug development process. Ascertain the predictive value of existing non-clinical models and assays towards the clinical outcome. Understand the mechanistic basis of cardiovascular liabilities; by addressing areas where it is currently not possible to predict clinical outcome based on preclinical safety data. Provide scientists in all disciplines with additional skills to enable them to better integrate preclinical and clinical data and to better understand the biological and clinical significance of observed changes. Develop more appropriate, highly relevant and predictive tools and assays to identify and wherever feasible to eliminate cardiovascular safety liabilities from molecules and wherever appropriate to develop clinically relevant and reliable safety biomarkers. PMID:21306581

  5. Driving improvement in patient care: lessons from Toyota.

    PubMed

    Thompson, Debra N; Wolf, Gail A; Spear, Steven J

    2003-11-01

    Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)--a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care. PMID:14608217

  6. Metformin Use Is Associated with Improved Survival in Patients Undergoing Resection for Pancreatic Cancer.

    PubMed

    Cerullo, Marcelo; Gani, Faiz; Chen, Sophia Y; Canner, Joe; Pawlik, Timothy M

    2016-09-01

    = 0.005). Metformin use was associated with an improved overall survival among patients undergoing pancreatic surgery for pancreatic cancer. Further work is necessary to better understand its role in modifying cancer-specific and overall health outcomes. PMID:27255657

  7. Interferon-Gamma Improves Macrophages Function against M. tuberculosis in Multidrug-Resistant Tuberculosis Patients

    PubMed Central

    Mazhar, Humaira; Muhammad, Niaz; Abbas, Muhammad Nasser

    2016-01-01

    Background. Mycobacterium tuberculosis (M. tuberculosis) that causes tuberculosis (TB) kills millions of infected people annually especially multidrug-resistant tuberculosis (MDR-TB). On infection, macrophages recognize the mycobacteria by toll-like receptor (TLR) followed by phagocytosis and control of mycobacteria. In addition, macrophages also secrete IL-12 to induce IFN-γ production by T, which, in turn, increases the phagocytosis and oxidative burst. Individuals with defects in innate or adaptive immunity exhibit increased susceptibility to M. tuberculosis. Understanding these immunologic mechanisms will help in TB control. We aimed to investigate the immunopathologic mechanisms in MDR-TB and role of recombinant human interferon-gamma (rhIFN-γ). Study Design and Methods. Monocyte-derived macrophages (MDMs) were generated from peripheral blood mononuclear cells of MDR-TB patients and healthy subjects and were investigated for immunologic response by ELISA and flow cytometry. Results. Different functional and molecular anomalies were observed in macrophages. In addition, a defective immune response to M. tuberculosis from the patient's MDMs was characterized, which in turn improved by pretreatment with rhIFN-γ. Conclusion. This work highlights the fact that rhIFN-γ improves macrophages function against M. tuberculosis and treatment of patients with poor responsiveness to TB therapy may be needed in future to include IFN-γ as adjuvant therapy after the full characterization of pathological and molecular mechanisms in these and in other more multidrug-resistant TB patients. PMID:27478636

  8. The role of previously untreated patient studies in understanding the development of FVIII inhibitors.

    PubMed

    Carcao, M; Re, W; Ewenstein, B

    2016-01-01

    Development of inhibitors against factor VIII (FVIII), the major complication of haemophilia A treatment today, is influenced by multiple factors. Genetic (F8 mutation, family history, ethnicity, polymorphisms in immune modulating genes) and non-genetic (intensive exposure to FVIII, presence of pro-inflammatory signals as might occur with large bleeds, infections, surgery, or other immune stimulants [e.g. vaccines]) risk factors as well as their complex inter-relationships contribute to the inhibitor risk profile of haemophilia patients, particularly in the previously untreated patient (PUP) population. Studies in PUPs have been fundamental to furthering the understanding of FVIII inhibitor development, as well as discovering previously unappreciated risk factors. The multi-factorial nature of inhibitor development makes it difficult to ascertain the contribution of FVIII products in inhibitor development through individual PUP studies. Sufficiently powered studies of large cohorts may overcome these limitations but interpretations should be conducted cautiously. Proper design and implementation of PUP safety studies will become even more important with the introduction of new molecules, such as extended half-life or human cell-line derived FVIII that propose reduced immunogenicity. Despite these difficulties, carefully performed clinical studies in PUPs may provide important insights into the natural history of the immune response to FVIII and may suggest targets for intervention to reduce immunogenicity. PMID:26315604

  9. Recent advances in understanding the pathogenesis of atherosclerosis in CKD patients.

    PubMed

    Shah, Sudhir V; Shukla, Ashutosh M; Bose, Chhanda; Basnakian, Alexei G; Rajapurkar, Mohan

    2015-03-01

    A need exists for developing new therapies to improve cardiovascular outcomes in end-stage kidney disease. Three new areas that address novel pathophysiological mechanisms and/or therapeutic approaches toward cardiovascular events in chronic kidney disease patients include the use of an anti-inflammatory agent, the role of catalytic iron, and protein carbamylation. In preliminary studies, hydroxychloroquine, which has multiple anti-inflammatory properties, preserved vascular compliance for the aorta and major vessels, as well as reduced the extent of severity of atherosclerosis in ApoE-/- mice. The ability of iron to rapidly and reversibly cycle between 2 oxidation states makes iron potentially hazardous by enabling it to participate in the generation of powerful oxidant species. We have shown that high catalytic iron in the general population is associated with a 4-fold increase in prevalent cardiovascular disease (CVD), even after accounting for traditional risk factors. In addition, the highest levels of catalytic iron are present in dialysis patients and, more specifically, patients with prevalent CVD have several-fold higher catalytic iron levels compared with controls without CVD. These data suggest the utility of iron chelators for preventing and treating CVD in patients with chronic kidney disease and should be further investigated. Carbamylation of proteins results from nonenzymatic chemical modification by isocyanic acid derived from urea and an alternative route, the myeloperoxidase-catalyzed oxidation of thiocyanate. We have shown carbamylated low-density lipoprotein to have all the major biological effects relevant to atherosclerosis including endothelial cell injury, increased expression of cell adhesion molecules, and vascular smooth muscle cell proliferation. In 2 separate clinical studies, plasma levels of carbamylated protein independently predicted an increased risk of CVD and death. PMID:25556310

  10. Effective colonoscopy training techniques: strategies to improve patient outcomes

    PubMed Central

    Papanikolaou, Ioannis S; Karatzas, Pantelis S; Varytimiadis, Lazaros T; Tsigaridas, Athanasios; Galanopoulos, Michail; Viazis, Nikos; Karamanolis, Dimitrios G

    2016-01-01

    Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists. PMID:27099542

  11. Download Alert: Understanding Gastroenterology Patients' Perspectives on Health-Related Smartphone Apps

    PubMed Central

    Zia, Jasmine K; Le, Thai; Munson, Sean; Heitkemper, Margaret M; Demiris, George

    2015-01-01

    Objectives: The aims of this study were to understand patients' willingness to use different types of health-related smartphone apps and to explore their attitudes on the overall value, usability, feasibility, credibility, intrusiveness, and obtrusiveness of these apps. Methods: Questionnaires were distributed to adult patients presenting to gastroenterology clinics at an academic medical center. The 25-question survey consisted of 5-point Likert-type scale statements, multiple-choice questions, and open-ended questions. Results: Participants were mainly White (N=94, 78%) and smartphone owners (N=125, 93%). The mean age was 40.8 years (N=121, s.d.=13.2). Participants were willing to use most types of apps unless it monitored their location or social networking activity. Half were less willing to use an app if it required a visible accessory. Most participants were willing to use a health-related app up to 5 min a day indefinitely but unwilling to pay out-of-pocket for it. Participants generally disagreed that an app would be hard to learn how to use, interfere with their daily routine, or be embarrassing to use in public. Overall, participants felt that health-related apps could help them and their doctors better manage their medical problems, but were neutral in trusting their quality. Most worried that personal information used for an app would fall into the wrong hands. Conclusion: Gastroenterology patients were willing to use and valued most types of health-related apps. They perceived this technology as feasible, usable, and relatively unobtrusive unless a visible accessory was required. However, many were concerned about their privacy. PMID:26133109

  12. Shared Medical Appointments: A Promising Innovation to Improve Patient Engagement and Ease the Primary Care Provider Shortage.

    PubMed

    Stults, Cheryl D; McCuistion, Mary H; Frosch, Dominick L; Hung, Dorothy Y; Cheng, Peter H; Tai-Seale, Ming

    2016-02-01

    The Affordable Care Act has extended coverage for uninsured and underinsured Americans, but it could exacerbate existing problems of access to primary care. Shared medical appointments (SMAs) are one way to improve access and increase practice productivity, but few studies have examined the patient's perspective on participation in SMAs. To understand patient experiences, 5 focus group sessions were conducted with a total of 30 people in the San Francisco Bay Area. The sessions revealed that most participants felt that they received numerous tangible and intangible benefits from SMAs, particularly enhanced engagement with other patients and physicians, learning, and motivation for health behavior change. Most importantly, participants noted changes in the power dynamic during SMA visits as they increasingly saw themselves empowered to impart information to the physician. Although SMAs improve access, engagement with physicians and other patients, and knowledge of patients' health, they also help to ease the workload for physicians. PMID:26090793

  13. Goal-Driven Development of a Patient Surveillance Application for Improving Patient Safety

    NASA Astrophysics Data System (ADS)

    Behnam, Saeed Ahmadi; Amyot, Daniel; Forster, Alan J.; Peyton, Liam; Shamsaei, Azalia

    Hospitals strive to improve the safety of their patients. Yet, every year, thousands of patients suffer from adverse events, which are defined as undesirable outcomes caused by health care business processes. There are few tools supporting adverse event detection and these are ineffective. There is hence some urgency in developing such a tool in a way that complies with the organizations goals and privacy legislation. In addition, governments will soon require hospitals to report on adverse events. In this paper, we will show how a pilot application we developed contributes to the patient safety goals of a major teaching hospital and how our goal-driven approach supported the collaboration between the university researchers and hospital decision makers involved. Benefits and challenges related to the modeling of requirements, goals, and processes, and to the development of the application itself, are also discussed.

  14. Understanding and improving the high field orbit in the Fermilab Booster

    SciTech Connect

    Chao, Y.; Ketcham, L.; Moore, C.D.

    1989-03-01

    With the implementation of the BPM system in the Fermilab Booster, complete survey data of the main magnets have been employed to determine magnet moving schemes to correct the high field orbit at 8 GeV kinetic energy and to understand the global pattern of the high field orbit in both planes. Considerable success has been achieved in the former task. We also obtained reasonable understanding in the later effort, given the multitude of factors that have to be dealt with. In this paper an account is given of the survey record, the orbit correction exercise, and the effort to reconstruct the high field orbit based on the survey records. 2 refs., 7 figs., 1 tab.

  15. Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

    PubMed Central

    2012-01-01

    Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above

  16. Museum Monsters and Victorious Viruses: Improving Public Understanding of Emerging Biomedical Research

    PubMed Central

    Diamond, Judy; Jee, Benjamin; Matuk, Camilla; McQuillan, Julia; Spiegel, Amy N.; Uttal, David

    2015-01-01

    Although microbes directly impact everyone's health, most people have limited knowledge about them. In this article, we describe a museum and media public education campaign aimed at helping diverse audiences better understand emerging knowledge about microbes and infectious disease. Funded primarily by the Science Education Partnership (SEPA) program of the National Institutes of Health, this campaign involved crosscutting programs designed to extend impacts throughout a broad public audience. PMID:26392634

  17. The solar activity measurements experiments (SAMEX) for improved scientific understanding of solar activity

    NASA Technical Reports Server (NTRS)

    1989-01-01

    The Solar Activity Measurements Experiments (SAMEX) mission is described. It is designed to provide a look at the interactions of magnetic fields and plasmas that create flares and other explosive events on the sun in an effort to understand solar activity and the nature of the solar magnetic field. The need for this mission, the instruments to be used, and the expected benefits of SAMEX are discussed.

  18. Improving the Process of Informed Consent for PCI: Patient Outcomes from the ePRISM Study

    PubMed Central

    Spertus, John A.; Bach, Richard; Bethea, Charles; Chhatriwalla, Adnan; Curtis, Jeptha P.; Gialde, Elizabeth; Guerrero, Mayra; Gosch, Kensey; Jones, Philip; Kugelmass, Aaron; Leonard, Bradley M.; McNulty, Edward J.; Shelton, Marc; Ting, Henry H.; Decker, Carole

    2014-01-01

    Background While the process of informed consent is designed to transfer knowledge of the risks and benefits of treatment and to engage patients in shared medical decision-making, this is poorly done in routine clinical care. We assessed the impact of a novel informed consent form for percutaneous coronary intervention (PCI) that is more simply written, includes images of the procedure and embeds individualized estimates of outcomes on multiple domains of successful informed consent and shared decision-making. Methods We interviewed 590 PCI patients receiving traditional consent documents and 527 patients receiving novel ePRISM consents at 9 US centers and compared patients' perceptions, knowledge transfer and engagement in medical decision-making. Heterogeneity across sites was assessed and adjusted for using hierarchical models. Results Site-adjusted analyses revealed more frequent review (72% for ePRISM vs. 45% for original consents) and better understanding of the ePRISM consents (odds ratios (ORs)=1.8–3.0, depending upon the outcome) with marked heterogeneity across sites (median relative difference (MRD) in the ORs of ePRISM's effect = 2–3.2). Patients receiving ePRISM consents better understood the purposes and risks of the procedure (ORs=1.9–3.9, MRDs=1.1–6.2), engaged more in shared decision-making (proportional OR=2.1 [95%CI=1.02–4.4], MRD=2.2) and discussed stent options with their physicians (58% vs. 31%; site-adjusted odds ratio=2.7 [95% CI=1.2, 6.3], MRD=2.6) more often. Conclusions A personalized consent document improved the process of informed consent and shared decision-making. Marked heterogeneity across hospitals highlights that consent documents are but one aspect of engaging patients in understanding and participating in treatment. PMID:25641532

  19. Data-model fusion to better understand emerging pathogens and improve infectious disease forecasting.

    PubMed

    LaDeau, Shannon L; Glass, Gregory E; Hobbs, N Thompson; Latimer, Andrew; Ostfeld, Richard S

    2011-07-01

    Ecologists worldwide are challenged to contribute solutions to urgent and pressing environmental problems by forecasting how populations, communities, and ecosystems will respond to global change. Rising to this challenge requires organizing ecological information derived from diverse sources and formally assimilating data with models of ecological processes. The study of infectious disease has depended on strategies for integrating patterns of observed disease incidence with mechanistic process models since John Snow first mapped cholera cases around a London water pump in 1854. Still, zoonotic and vector-borne diseases increasingly affect human populations, and methods used to successfully characterize directly transmitted diseases are often insufficient. We use four case studies to demonstrate that advances in disease forecasting require better understanding of zoonotic host and vector populations, as well of the dynamics that facilitate pathogen amplification and disease spillover into humans. In each case study, this goal is complicated by limited data, spatiotemporal variability in pathogen transmission and impact, and often, insufficient biological understanding. We present a conceptual framework for data-model fusion in infectious disease research that addresses these fundamental challenges using a hierarchical state-space structure to (1) integrate multiple data sources and spatial scales to inform latent parameters, (2) partition uncertainty in process and observation models, and (3) explicitly build upon existing ecological and epidemiological understanding. Given the constraints inherent in the study of infectious disease and the urgent need for progress, fusion of data and expertise via this type of conceptual framework should prove an indispensable tool. PMID:21830694

  20. Socioscientific Issues: A Path Towards Advanced Scientific Literacy and Improved Conceptual Understanding of Socially Controversial Scientific Theories

    NASA Astrophysics Data System (ADS)

    Pinzino, Dean William

    This thesis investigates the use of socioscientific issues (SSI) in the high school science classroom as an introduction to argumentation and socioscientific reasoning, with the goal of improving students' scientific literacy (SL). Current research is reviewed that supports the likelihood of students developing a greater conceptual understanding of scientific theories as well as a deeper understanding of the nature of science (NOS), through participation in informal and formal forms of argumentation in the context of SSI. Significant gains in such understanding may improve a student's ability to recognize the rigor, legitimacy, and veracity of scientific claims and better discern science from pseudoscience. Furthermore, students that participate in significant SSI instruction by negotiating a range of science-related social issues can make significant gains in content knowledge and develop the life-long skills of argumentation and evidence-based reasoning, goals not possible in traditional lecture-based science instruction. SSI-based instruction may therefore help students become responsible citizens. This synthesis also suggests that that the improvements in science literacy and NOS understanding that develop from sustained engagement in SSI-based instruction will better prepare students to examine and scrutinize socially controversial scientific theories (i.e., evolution, global warming, and the Big Bang).

  1. Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

    PubMed Central

    McGrice, Melanie; Don Paul, Kathlene

    2015-01-01

    Bariatric surgery aims to provide long-term weight loss and improvement in weight-related comorbidities. Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2–10 years postsurgery. A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments. PMID:26150731

  2. How Do Cancer Patients Navigate the Public Information Environment? Understanding Patterns and Motivations for Movement Among Information Sources

    PubMed Central

    Romantan, Anca; Kelly, Bridget J.; Stevens, Robin S.; Gray, Stacy W.; Hull, Shawnika J.; Ramirez, A. Susana; Hornik, Robert C.

    2010-01-01

    Little is known about how patients move among information sources to fulfill unmet needs. We interviewed 43 breast, prostate, and colorectal cancer patients. Using a grounded theory approach, we identified patterns and motivations for movement among information sources. Overall, patients reported using one source (e.g., newspaper) followed by the use of another source (e.g., Internet), and five key motivations for such cross-source movement emerged. Patients’ social networks often played a central role in this movement. Understanding how patients navigate an increasingly complex information environment may help clinicians and educators to guide patients to appropriate, high-quality sources. PMID:20204573

  3. Improving Patient Safety in Clinical Oncology: Applying Lessons From Normal Accident Theory.

    PubMed

    Chera, Bhishamjit S; Mazur, Lukasz; Buchanan, Ian; Kim, Hong Jin; Rockwell, John; Milowsky, Matthew I; Marks, Lawrence B

    2015-10-01

    Concerns for patient safety persist in clinical oncology. Within several nonmedical areas (eg, aviation, nuclear power), concepts from Normal Accident Theory (NAT), a framework for analyzing failure potential within and between systems, have been successfully applied to better understand system performance and improve system safety. Clinical oncology practice is interprofessional and interdisciplinary, and our therapies often have narrow therapeutic windows. Thus, many of our processes are, in NAT terms, interactively complex and tightly coupled within and across systems and are therefore prone to unexpected behaviors that can result in substantial patient harm. To improve safety at the University of North Carolina, we have applied the concepts of NAT to our practice to better understand our systems' behavior and adopted strategies to reduce complexity and coupling. Furthermore, recognizing that we cannot eliminate all risks, we have stressed safety mindfulness among our staff to further promote safety. Many specific examples are provided herein. The lessons from NAT are translatable to clinical oncology and may help to promote safety. PMID:26182183

  4. Differential Improvement in Student Understanding of Mathematical Principles following Formative Assessment Intervention

    ERIC Educational Resources Information Center

    Phelan, Julia; Choi, Kilchan; Vendlinski, Terry; Baker, Eva; Herman, Joan

    2011-01-01

    The authors describe results from a study of a middle school mathematics formative assessment strategy. They employed a randomized, controlled design to address the following question: Does using our strategy improve student performance on assessments of key mathematical ideas relative to a comparison group? Eighty-five teachers and 4,091 students…

  5. Understanding Effective Program Improvement Schools through a Distributed Leadership Task Context Model

    ERIC Educational Resources Information Center

    Gipson, Frances Marie

    2012-01-01

    Federal, state, and local agencies face challenges organizing resources that create the conditions necessary to create, sustain, and replicate effective high performing schools. Knowing that leadership does impact achievement outcomes and that school districts tackle growing numbers of sanctioned Program Improvement schools, a distributed…

  6. Understanding and Improving the Use of Writing Portfolios in One French Immersion Classroom

    ERIC Educational Resources Information Center

    Armstrong, Christine L.

    2011-01-01

    This study investigates the use of writing portfolios in improving the accuracy of French immersion students' written French. It emerged from regularly observed notable and repeated errors in many of the author's students' writing (entitled fossilized errors due their resistance to correction). This study reaffirms that students of French…

  7. Using Sap Flow Monitoring for Improved Process-based Ecohydrologic Understanding 2022

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sap flow measurements can be an important tool for unraveling the complex web of ecosystem fluxes, especially when it is combined with other measurements like eddy covariance, isotopes, remote sensing, etc. In this talk, we will demonstrate how sap flow measurements have improved our process-level u...

  8. Improving Students' Understanding of Quantum Measurement. II. Development of Research-Based Learning Tools

    ERIC Educational Resources Information Center

    Zhu, Guangtian; Singh, Chandralekha

    2012-01-01

    We describe the development and implementation of research-based learning tools such as the Quantum Interactive Learning Tutorials and peer-instruction tools to reduce students' common difficulties with issues related to measurement in quantum mechanics. A preliminary evaluation shows that these learning tools are effective in improving students'…

  9. Using Technology and Inquiry to Improve Student Understanding of Watershed Concepts

    ERIC Educational Resources Information Center

    Smith, Julie M.; Edwards, Patrick M.; Raschke, Jason

    2006-01-01

    This paper presents the design, implementation and assessment of the Columbia River Basin Environmental Research Project (CERP) curriculum. CERP is an online inquiry-based, regional geographic curriculum designed to improve technology skills and content knowledge about water quality and watershed-level processes. Student attitudes and knowledge…

  10. Improving Textbooks as a Way to Foster Civic Understanding and Engagement. CIRCLE Working Paper 54

    ERIC Educational Resources Information Center

    Chambliss, Marilyn; Richardson, Wendy; Torney-Purta, Judith; Wilkenfeld, Britt

    2007-01-01

    Efforts to improve civic education face a conundrum. On the one hand, students report that they are more likely to learn about democracy and citizenship through reading textbooks than through any other activity and according to the National Education Association, reading is the gateway to learning in all content areas. However, reviews of textbook…

  11. Engineering in K-12 Education: Understanding the Status and Improving the Prospects

    ERIC Educational Resources Information Center

    Katehi, Linda, Ed.; Pearson, Greg, Ed.; Feder, Michael, Ed.

    2009-01-01

    Engineering education in K-12 classrooms is a small but growing phenomenon that may have implications for engineering and also for the other STEM subjects--science, technology, and mathematics. Specifically, engineering education may improve student learning and achievement in science and mathematics, increase awareness of engineering and the work…

  12. Understanding the "How" of Quality Improvement: Lessons from the Rhode Island Program Quality Intervention

    ERIC Educational Resources Information Center

    Devaney, Elizabeth; Smith, Charles; Wong, Kenneth

    2012-01-01

    Over the past 10 years, afterschool and youth development programming has moved from providing childcare for working parents to being an integral component of the learning day, supporting the academic, social, and emotional development of young people. An important part of that transition has been a growing emphasis on improving program quality.…

  13. Improving Students' Conceptual Understanding of a Specific Content Learning: A Designed Teaching Sequence

    ERIC Educational Resources Information Center

    Ahmad, N. J.; Lah, Y. Che

    2012-01-01

    The efficacy of a teaching sequence designed for a specific content of learning of electrochemistry is described in this paper. The design of the teaching draws upon theoretical insights into perspectives on learning and empirical studies to improve the teaching of this topic. A case study involving two classes, the experimental and baseline…

  14. Plan for Quality to Improve Patient Safety at the Point of Care

    PubMed Central

    Ehrmeyer, Sharon S.

    2011-01-01

    The U.S. Institute of Medicine (IOM) much publicized report in “To Err is Human” (2000, National Academy Press) stated that as many as 98 000 hospitalized patients in the U.S. die each year due to preventable medical errors. This revelation about medical error and patient safety focused the public and the medical community's attention on errors in healthcare delivery including laboratory and point-of-care-testing (POCT). Errors introduced anywhere in the POCT process clearly can impact quality and place patient's safety at risk. While POCT performed by or near the patient reduces the potential of some errors, the process presents many challenges to quality with its multiple tests sites, test menus, testing devices and non-laboratory analysts, who often have little understanding of quality testing. Incoherent or no regulations and the rapid availability of test results for immediate clinical intervention can further amplify errors. System planning and management of the entire POCT process are essential to reduce errors and improve quality and patient safety. PMID:21808107

  15. Patient or treatment centre? Where are efforts invested to improve cancer patients' psychosocial outcomes?

    PubMed Central

    Carey, ML; Clinton-McHarg, T; Sanson-Fisher, RW; Campbell, S; Douglas, HE

    2011-01-01

    The psychosocial outcomes of cancer patients may be influenced by individual-level, social and treatment centre predictors. This paper aimed to examine the extent to which individual, social and treatment centre variables have been examined as predictors or targets of intervention for psychosocial outcomes of cancer patients. Medline was searched to find studies in which the psychological outcomes of cancer patient were primary variables. Papers published in English between 1999 and 2009 that reported primary data relevant to psychosocial outcomes for cancer patients were included, with 20% randomly selected for further coding. Descriptive studies were coded for inclusion of individual, social or treatment centre variables. Intervention studies were coded to determine if the unit of intervention was the individual patient, social unit or treatment centre. After random sampling, 412 publications meeting the inclusion criteria were identified, 169 were descriptive and 243 interventions. Of the descriptive papers 95.0% included individual predictors, and 5.0% social predictors. None of the descriptive papers examined treatment centre variables as predictors of psychosocial outcomes. Similarly, none of the interventions evaluated the effectiveness of treatment centre interventions for improving psychosocial outcomes. Potential reasons for the overwhelming dominance of individual predictors and individual-focused interventions in psychosocial literature are discussed. PMID:20646035

  16. Improving Student Understanding of Magmatic Differentiation Using an M&M Magma Chamber

    NASA Astrophysics Data System (ADS)

    Wirth, K. R.

    2003-12-01

    Many students, especially those in introductory geology courses, have difficulty developing a deep understanding of the processes of magmatic differentiation. In particular, students often struggle to understand Bowen's reaction series and fractional crystallization. The process of fractional crystallization by gravity settling can be illustrated using a model magma chamber consisting of M&M's. In this model, each major cation (e.g., Si, Ti, Al, Fe, Mg, Ca, Na, K) is represented by a different color M&M; other kinds of differently colored or shaped pieces could also be used. Appropriate numbers of each color M&M are combined to approximate the cation proportions of a basaltic magma. Students then fractionate the magma by moving M&M's to the bottom of the magma chamber forming a series of cumulus layers; the M&M's are removed in the stoichiometric proportions of cations in the crystallizing minerals (e.g., olivine, pyroxene, feldspars, quartz, magnetite, ilmenite). Students observe the changing cation composition (proportions of colors of M&M's) in the cumulus layers and in the magma chamber and graph the results using spreadsheet software. More advanced students (e.g., petrology course) can classify the cumulates and resulting liquid after each crystallization step, and they can compare the model system with natural magmatic systems (e.g., absence of important fractionating phases, volatiles). Students who have completed this exercise generally indicate a positive experience and demonstrate increased understanding of Bowen's reaction series and fractionation processes. They also exhibit greater familiarity with mineral stoichiometry, classification, solid-solution in minerals, element behavior (e.g., incompatibility), and chemical variation diagrams. Other models (e.g., paths of equilibrium and fractional crystallization on phase diagrams) can also be used to illustrate differentiation processes in upper level courses (e.g., mineralogy and petrology).

  17. Using Scientific Argumentation in a Science Methods Course to Improve Preservice Teachers' Understanding of Climate Change

    NASA Astrophysics Data System (ADS)

    Lambert, J. L.; Bleicher, R. E.; Soden, B. J.

    2014-12-01

    Given that K-12 students have numerous alternative conceptions, it is critical that teachers have an understanding of the fundamental science underlying climate change (Feldman et al., 2010). Many teachers, however, do not demonstrate adequate understanding of these concepts (Daskolia et al., 2006). Argumentation has been identified as a mechanism for conceptual change (Mercer et al., 2004). Even with several educational initiatives promoting and supporting the use of argumentation as an instructional practice, teachers often struggle to implement argumentation in the classroom (Sampson & Blanchard, 2012). To remedy both issues above, we have designed an innovative methods course to provide background in climate change knowledge and argumentation instruction. In our methods course, we utilize Climate Science Investigations (CSI), an online, interactive series of modules and teaching resources funded by a NASA grant to support teachers learning about the basic science concepts underlying climate change. A key assignment is to develop and present an evidence-based scientific argument. The teachers were assigned a typical question and claim of climate skeptics and asked to conduct research on the scientific findings to prepare a counter-argument (rebuttal). This study examined changes in 60 preservice teachers' knowledge and perceptions about climate change after participation in the course. The teachers' understanding of fundamental concepts increased significantly. Their perceptions about climate change became more aligned to those of climate scientists. Findings suggest that scientific argumentation can play an effective role in the preparation of science educators. In addition to reporting findings in more detail, methods course activities, particularly in argumentation, will be shared in our presentation.

  18. It Takes Two to Tango: Improving Patient Referrals from the Emergency Department to Inpatient Clinicians

    PubMed Central

    Lawrence, Sean; Spencer, Lyndall M.; Sinnott, Michael; Eley, Robert

    2015-01-01

    Background The transfer of responsibility for patient care across clinical specialties is a complex process. Published and anecdotal data suggest that referrals often fail to meet the needs of one or both parties and that patient focus can be lost during the process. Little is known about the Australian situation. Methods To obtain a more complete understanding of the referral process, including the nature of communication in an Australian context, we conducted semistructured interviews in a convenience sample of 25 volunteers. Two established strategies for analyzing qualitative data were used. Results All respondents considered the following information essential components of a referral: an account of the patient's current condition, a working diagnosis or problem statement and history of the presenting concern, key test results or tests awaiting results, a potential management plan, and any special characteristics of the patient. Respondents acknowledged implied, if not literal, power to accept or reject an emergency department (ED) referral and said the imbalance of power was reinforced when the ED physician was junior to the inpatient clinician. Respondents also noted that in addition to the predominant organizational culture, an independent culture is associated with specific shifts. Foremost among the nonclinical aspects of a referral considered to be important was the timeliness of the contact made to achieve the transition. Respondents also said the success of a referral depended on the speaking and listening abilities of all parties. The individual's motivation to accept or reject a referral can also have an impact on communication. Conclusion Respondents attributed the difficulty of negotiating the transfer of a patient's care across the ED and inpatient interface to three distinct factors: variations in the clinical information required, the culture of the organization and of the clinical team in which the transaction takes place, and the

  19. Developing a patient information leaflet to improve information offered to patients undergoing appendicectomy

    PubMed Central

    Smith, Radford; cross, Katie

    2016-01-01

    An appendicectomy is one of the most common operations performed in North Devon District Hospital (NDDH) with over 200 carried out between 2013 to 2014. Despite this, a patient information leaflet (PIL) about appendicectomy is unavailable, which is compromising standards of care and uncompliant with Trust policy. This project aimed to establish levels of written information offered to patients undergoing an appendicectomy, develop a PIL, and assess its impact on the provision of written information using Plan-Do-Study-Act (PDSA) methodology. Case notes of patients operated on between January 2013 to October 2014 were randomly sampled at baseline. The primary outcome measure was whether written information was offered, retrospectively determined by reviewing the medical record. A PIL was then designed following a standard protocol, published on NDDH's website and distributed onto surgical wards. Posters were displayed in staff rooms to encourage use of the PIL for PDSA cycle 1. An article further promoting the PIL was written for the wards monthly newsletter and a local presentation was delivered for PDSA cycle 2. Patients views about the PIL were assessed prospectively using a questionnaire. The primary outcome was measured at 10 weeks following PDSA cycle 1 and at 5 months following PDSA cycle 2. 17% (5/30) of patients were offered written information at baseline. Following PDSA cycle 1, this rose substantially to 53% (8/15) but rates fell to 46% (7/15) following PDSA cycle 2. 89% of patients (8/9) surveyed agreed or strongly agreed that the PIL was helpful. This project indicates that provision of written information is poor despite it being highly valued by patients. The first ever Trust appendicectomy PIL has been established which substantially improved provision of written information after 10 weeks. However, continued education of staff is essential to embed good practice over the long term. PMID:27158496

  20. Developing a patient information leaflet to improve information offered to patients undergoing appendicectomy.

    PubMed

    Smith, Radford; Cross, Katie

    2016-01-01

    An appendicectomy is one of the most common operations performed in North Devon District Hospital (NDDH) with over 200 carried out between 2013 to 2014. Despite this, a patient information leaflet (PIL) about appendicectomy is unavailable, which is compromising standards of care and uncompliant with Trust policy. This project aimed to establish levels of written information offered to patients undergoing an appendicectomy, develop a PIL, and assess its impact on the provision of written information using Plan-Do-Study-Act (PDSA) methodology. Case notes of patients operated on between January 2013 to October 2014 were randomly sampled at baseline. The primary outcome measure was whether written information was offered, retrospectively determined by reviewing the medical record. A PIL was then designed following a standard protocol, published on NDDH's website and distributed onto surgical wards. Posters were displayed in staff rooms to encourage use of the PIL for PDSA cycle 1. An article further promoting the PIL was written for the wards monthly newsletter and a local presentation was delivered for PDSA cycle 2. Patients views about the PIL were assessed prospectively using a questionnaire. The primary outcome was measured at 10 weeks following PDSA cycle 1 and at 5 months following PDSA cycle 2. 17% (5/30) of patients were offered written information at baseline. Following PDSA cycle 1, this rose substantially to 53% (8/15) but rates fell to 46% (7/15) following PDSA cycle 2. 89% of patients (8/9) surveyed agreed or strongly agreed that the PIL was helpful. This project indicates that provision of written information is poor despite it being highly valued by patients. The first ever Trust appendicectomy PIL has been established which substantially improved provision of written information after 10 weeks. However, continued education of staff is essential to embed good practice over the long term. PMID:27158496

  1. Anatomy of Teaching Anatomy: Do Prosected Cross Sections Improve Students Understanding of Spatial and Radiological Anatomy?

    PubMed Central

    Vithoosan, S.; Kokulan, S.; Dissanayake, M. M.; Dissanayake, Vajira; Jayasekara, Rohan

    2016-01-01

    Introduction. Cadaveric dissections and prosections have traditionally been part of undergraduate medical teaching. Materials and Methods. Hundred and fifty-nine first-year students in the Faculty of Medicine, University of Colombo, were invited to participate in the above study. Students were randomly allocated to two age and gender matched groups. Both groups were exposed to identical series of lectures regarding anatomy of the abdomen and conventional cadaveric prosections of the abdomen. The test group (n = 77, 48.4%) was also exposed to cadaveric cross-sectional slices of the abdomen to which the control group (n = 82, 51.6%) was blinded. At the end of the teaching session both groups were assessed by using their performance in a timed multiple choice question paper as well as ability to identify structures in abdominal CT films. Results. Scores for spatial and radiological anatomy were significantly higher among the test group when compared with the control group (P < 0.05, CI 95%). Majority of the students in both control and test groups agreed that cadaveric cross section may be useful for them to understand spatial and radiological anatomy. Conclusion. Introduction of cadaveric cross-sectional prosections may help students to understand spatial and radiological anatomy better. PMID:27579181

  2. Using Authentic Oceanographic, Climatic, and Polar Data with Students: Improving Student Understanding of Environmental Phenomena

    NASA Astrophysics Data System (ADS)

    Mckay, M.; Albrecht, M.

    2011-12-01

    Background: Information on climatic change, ocean acidification, and the melting of polar ice sheets fill today's headlines. Students typically lack experience in finding, collecting, or interpreting real oceanographic or climatic data. They are usually provided with data-sets that are not current or representative of actual environmental conditions, or of interest to current scientific investigations. As a result, most students do not have an appreciation of the scope or impact of environmental changes occurring both in the past and in the present day. The focus of this study included climate change, ocean drilling core data from the Integrated Ocean Drilling Program (IODP), phytoplankton/zooplankton studies, and satellite studies of the Monterey Bay, the Arctic, and areas of Paleoclimate interest. Methods: Researchers compared student understanding of paleoclimatic concepts, along with present day oceanographic, climatic, and polar phenomena, when taught using authentic data and data analysis with non-inquiry based instruction. Techniques used in the study by students included the visualization of ocean cores and analysis of cataloged ocean core data. Techniques also included the use of Geographic Information Systems (GIS) and Remote Sensing techniques to analyze present day oceanographic, climatic, and polar phenomena. Results: Study results indicate that students gained a greater understanding of paleoclimate and contemporary environmental phenomena when using authentic data-sets when compared with non-current data-sets. Students also performed better in designing investigations and interpreting results.

  3. How evolutionary principles improve the understanding of human health and disease

    PubMed Central

    Gluckman, Peter D; Low, Felicia M; Buklijas, Tatjana; Hanson, Mark A; Beedle, Alan S

    2011-01-01

    An appreciation of the fundamental principles of evolutionary biology provides new insights into major diseases and enables an integrated understanding of human biology and medicine. However, there is a lack of awareness of their importance amongst physicians, medical researchers, and educators, all of whom tend to focus on the mechanistic (proximate) basis for disease, excluding consideration of evolutionary (ultimate) reasons. The key principles of evolutionary medicine are that selection acts on fitness, not health or longevity; that our evolutionary history does not cause disease, but rather impacts on our risk of disease in particular environments; and that we are now living in novel environments compared to those in which we evolved. We consider these evolutionary principles in conjunction with population genetics and describe several pathways by which evolutionary processes can affect disease risk. These perspectives provide a more cohesive framework for gaining insights into the determinants of health and disease. Coupled with complementary insights offered by advances in genomic, epigenetic, and developmental biology research, evolutionary perspectives offer an important addition to understanding disease. Further, there are a number of aspects of evolutionary medicine that can add considerably to studies in other domains of contemporary evolutionary studies. PMID:25567971

  4. Improving Physician-Patient Communication through Coaching of Simulated Encounters

    ERIC Educational Resources Information Center

    Ravitz, Paula; Lancee, William J.; Lawson, Andrea; Maunder, Robert; Hunter, Jonathan J.; Leszcz, Molyn; McNaughton, Nancy; Pain, Clare

    2013-01-01

    Objective: Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees. Methods: Twenty-six family…

  5. Understanding and Improving Cardiovascular Health: An Update on the American Heart Association's Concept of Cardiovascular Health.

    PubMed

    Shay, Christina M; Gooding, Holly S; Murillo, Rosenda; Foraker, Randi

    2015-01-01

    The American Heart Association's 2020 Strategic Impact Goal is "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." To monitor progress towards this goal, a new construct "ideal cardiovascular health" (iCVH) was defined that includes the simultaneous presence of optimal levels of seven health behaviors (physical activity, smoking, dietary intake, and body mass index) and factors (total cholesterol, blood pressure and fasting blood glucose). In this review, we present a summary of major concepts related to the concept of iCVH and an update of the literature in this area since publication of the 2020 Strategic Impact Goal, including trends in iCVH prevalence, new determinants and outcomes related to iCVH, strategies for maintaining or improving iCVH, policy implications of the iCVH model, and the remaining challenges to reaching the 2020 Strategic Impact Goal. PMID:25958016

  6. Understanding How the "Open" of Open Source Software (OSS) Will Improve Global Health Security.

    PubMed

    Hahn, Erin; Blazes, David; Lewis, Sheri

    2016-01-01

    Improving global health security will require bold action in all corners of the world, particularly in developing settings, where poverty often contributes to an increase in emerging infectious diseases. In order to mitigate the impact of emerging pandemic threats, enhanced disease surveillance is needed to improve early detection and rapid response to outbreaks. However, the technology to facilitate this surveillance is often unattainable because of high costs, software and hardware maintenance needs, limited technical competence among public health officials, and internet connectivity challenges experienced in the field. One potential solution is to leverage open source software, a concept that is unfortunately often misunderstood. This article describes the principles and characteristics of open source software and how it may be applied to solve global health security challenges. PMID:26889576

  7. Translating improved quality of care into an improved quality of life for patients with inflammatory bowel disease.

    PubMed

    Siegel, Corey A; Allen, John I; Melmed, Gil Y

    2013-08-01

    The term quality of care has been interpreted in different ways in medicine. Skeptics of the quality movement insist that checkboxes and government and payer oversight will not lead to better patient outcomes. Supporters refer to areas in medicine in which quality improvement efforts have led to improved survival, such as in cystic fibrosis and cardiovascular disease. For quality improvement to be effective, the process demands rigorous documentation, analysis, feedback, and behavioral change. This requires valid metrics and mechanisms to provide dynamic point-of-care (or close to point of care) feedback in a manner that drives improvement. For inflammatory bowel disease, work has been performed in Europe and the United States to develop a framework for how practitioners can improve quality of care. Improve Care Now has created a sophisticated quality improvement program for pediatric patients with inflammatory bowel disease. The American Gastroenterology Association has worked within the National Quality Strategy framework to develop quality measures for patients with inflammatory bowel disease that have been incorporated into Federal programs that are moving Medicare reimbursement from a volume-based to a value-based structure. The Crohn's and Colitis Foundation of America is initiating a quality intervention program that can be implemented in community and academic practices to stimulate continual improvement processes for patients with inflammatory bowel disease. All of this work is intended to make quality improvement programs both feasible and useful, with the ultimate goal of improving quality of life for our patients. PMID:23747710

  8. Understanding HIV Risk Behavior among Tuberculosis Patients with Alcohol Use Disorders in Tomsk, Russian Federation

    PubMed Central

    Miller, Ann C.; Nelson, A. Katrina; Livchits, Viktoria; Greenfield, Shelly F.; Yanova, Galina; Yanov, Sergei; Connery, Hilary S.; Atwood, Sidney; Lastimoso, Charmaine S.; Shin, Sonya S.

    2016-01-01

    Russian Federation’s (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed. PMID:26871943

  9. Understanding HIV Risk Behavior among Tuberculosis Patients with Alcohol Use Disorders in Tomsk, Russian Federation.

    PubMed

    Miller, Ann C; Nelson, A Katrina; Livchits, Viktoria; Greenfield, Shelly F; Yanova, Galina; Yanov, Sergei; Connery, Hilary S; Atwood, Sidney; Lastimoso, Charmaine S; Shin, Sonya S

    2016-01-01

    Russian Federation's (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed. PMID:26871943

  10. A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care.

    PubMed

    Koh, Howard K; Brach, Cindy; Harris, Linda M; Parchman, Michael L

    2013-02-01

    Improving health outcomes relies on patients' full engagement in prevention, decision-making, and self-management activities. Health literacy, or people's ability to obtain, process, communicate, and understand basic health information and services, is essential to those actions. Yet relatively few Americans are proficient in understanding and acting on available health information. We propose a Health Literate Care Model that would weave health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model). Our model calls for first approaching all patients with the assumption that they are at risk of not understanding their health conditions or how to deal with them, and then subsequently confirming and ensuring patients' understanding. For health care organizations adopting our model, health literacy would then become an organizational value infused into all aspects of planning and operations, including self-management support, delivery system design, shared decision-making support, clinical information systems to track and plan patient care, and helping patients access community resources. We also propose a measurement framework to track the impact of the new Health Literate Care Model on patient outcomes and quality of care. PMID:23381529

  11. Anticipated Improvements in Precipitation Physics and Understanding of Water Cycle from GPM Mission

    NASA Technical Reports Server (NTRS)

    Smith, Eric A.

    2003-01-01

    The GPM mission is currently planned for start in the late-2007 to early-2008 time frame. Its main scientific goal is to help answer pressing scientific problems arising within the context of global and regional water cycles. These problems cut across a hierarchy of scales and include climate-water cycle interactions, techniques for improving weather and climate predictions, and better methods for combining observed precipitation with hydrometeorological prediction models for applications to hazardous flood-producing storms, seasonal flood/draught conditions, and fresh water resource assessments. The GPM mission will expand the scope of precipitation measurement through the use of a constellation of some 9 satellites, one of which will be an advanced TRMM-like core satellite carrying a dual-frequency Ku-Ka band precipitation radar and an advanced, multifrequency passive microwave radiometer with vertical-horizontal polarization discrimination. The other constellation members will include new dedicated satellites and co-existing operational/research satellites carrying similar (but not identical) passive microwave radiometers. The goal of the constellation is to achieve approximately 3-hour sampling at any spot on the globe -- continuously. The constellation s orbit architecture will consist of a mix of sun-synchronous and non-sun-synchronous satellites with the core satellite providing measurements of cloud-precipitation microphysical processes plus calibration-quality rainrate retrievals to be used with the other retrieval information to ensure bias-free constellation coverage. GPM is organized internationally, involving existing, pending, projected, and under-study partnerships which will link NASA and NOAA in the US, NASDA in Japan, ESA in Europe, ISRO in India, CNES in France, and possibly AS1 in Italy, KARI in South Korea, CSA in Canada, and AEB in Brazil. Additionally, the program is actively pursuing agreements with other international collaborators and

  12. a Radiocarbon Database for Improved Understanding of Global Soil Carbon Dynamics: Part II

    NASA Astrophysics Data System (ADS)

    Trumbore, S.; Torn, M. S.; Sierra, C. A.; Smith, L. J.; Nave, L. E.; Workshop Paritipants, R.

    2011-12-01

    We report results of a workshop to initiate a global database of radiocarbon measurements in soil and other ecosystem compartments. Radiocarbon provides critical information for understanding the rate of exchange of soil carbon with the atmosphere and hydrosphere. For example, radiocarbon has been used to demonstrate the importance of short range order minerals in stabilizing organic carbon on millennial timescales in some soils. On decadal to centennial timescales, the infiltration of 'bomb' radiocarbon provides a measure of the amount and nature of soil carbon that responds on the timescale of most human impacts. The radiocarbon sigature of chemically or physically fractionated soil, or even in specific organic compounds, can yield clues as to controls on organic matter cycling on a range of timescales. Radiocarbon in microbial biomass or respiration can be a sensitive indicator of shifts in substrate use with vegetation, nutrient availability or temperature change. Taken toghether, such measurements can provide critical tests for models of soil carbon dynamics, while patterns in soil C dynamics with edaphic factors can be used to help parameterize models at spatial scales ranging from profile to landscape to global. The advent and proliferation of accelerator mass spectrometry since the early 1990s has vastly increased the number of radiocarbon analyses carried out in soils. However, these studies have usually been carried out by individual investigators within specific sites or regions, and to date the results have not been assembled, interpreted or compared at larger spatial scales. Given the expense of radiocarbon measurements, and the need for global synthesis products to evaluate and/or develop models of soil carbon response to climate and land use changes across a range of spatial scales, our goals are to: (1) bring together in one place existing radiocarbon measurements and provide a continuing common repository for new analyses; (2) supply ancillary

  13. Neurologic improvement without angiographic improvement after antithyroid therapy in a patient with Moyamoya syndrome.

    PubMed

    Ishigami, Akiko; Toyoda, Kazunori; Suzuki, Rieko; Miyashita, Fumio; Iihara, Koji; Minematsu, Kazuo

    2014-01-01

    Moyamoya disease with special complications, including Graves' disease, is called as moyamoya syndrome. A 22-year-old Japanese woman had left middle cerebral artery (MCA) territory infarction complicated with Graves' disease. She had right-sided hemiparesis that deteriorated on day 8 with the infarct growth and thyrotoxicosis. On angiogram, the left MCA was occluded at the origin without moyamoya vessels. Positron emission tomography (PET) revealed misery-perfusion phenomenon in the left MCA territory. After initiation of the antithyroid therapy, her hemiparesis became milder. Seventeen months later, her thyroid function was normalized and net-like collateral moyamoya vessels proliferated in the left MCA territory. Misery-perfusion phenomenon persisted on PET. This report is unique in the point of neurologic recovery of the moyamoya patient right after initiation of antithyroid medication without radiological improvement. PMID:24119625

  14. Exploiting new electrochemical understanding of niobium electropolishing for improved performance of SRF cavities for CEBAF

    SciTech Connect

    Reece, Charles E.; Tian, Hui

    2010-09-01

    Recent incorporation of analytic electrochemistry into the development of protocols for electropolishing niobium SRF cavities has yielded new insights for optimizing this process for consistent, high-performance results. Use of reference electrodes in the electrolyte, electrochemical impedance spectroscopy (EIS), rotating disk electrodes (RDE), and controlled sample temperatures has greatly clarified the process dynamics over the empirical understanding developed via years of practice. Minimizing RF losses at high operational gradients is very valuable for CW linacs. Jefferson Lab is applying these new insights to the low-loss 7-cell cavity design developed for the CEBAF 12 GeV Upgrade. Together with controlled cleaning and assembly techniques to guard against field-emission-causing particulates, the resulting process is yielding consistent cavity performance that exceeds project requirements. Cavity tests show BCS-limited Q well above 30 MV/m. Detailed process data, interpretation, and resulting rf performance data will be presented.

  15. MoFlow: visualizing conformational changes in molecules as molecular flow improves understanding

    PubMed Central

    2015-01-01

    Background Current visualizations of molecular motion use a Timeline-analogous representation that conveys "first the molecule was shaped like this, then like this...". This scheme is orthogonal to the Pathline-like human understanding of motion "this part of the molecule moved from here to here along this path". We present MoFlow, a system for visualizing molecular motion using a Pathline-analogous representation. Results The MoFlow system produces high-quality renderings of molecular motion as atom pathlines, as well as interactive WebGL visualizations, and 3D printable models. In a preliminary user study, MoFlow representations are shown to be superior to canonical representations for conveying molecular motion. Conclusions Pathline-based representations of molecular motion are more easily understood than timeline representations. Pathline representations provide other advantages because they represent motion directly, rather than representing structure with inferred motion. PMID:26361501

  16. RNA-Seq: Improving Our Understanding of Retinal Biology and Disease.

    PubMed

    Farkas, Michael H; Au, Elizabeth D; Sousa, Maria E; Pierce, Eric A

    2015-01-01

    Over the past several years, rapid technological advances have allowed for a dramatic increase in our knowledge and understanding of the transcriptional landscape, because of the ability to study gene expression in greater depth and with more detail than previously possible. To this end, RNA-Seq has quickly become one of the most widely used methods for studying transcriptomes of tissues and individual cells. Unlike previously favored analysis methods, RNA-Seq is extremely high-throughput, and is not dependent on an annotated transcriptome, laying the foundation for novel genetic discovery. Additionally, RNA-Seq derived transcriptomes provide a basis for widening the scope of research to identify potential targets in the treatment of retinal disease. PMID:25722474

  17. On the Concept of Force: How Understanding its History can Improve Physics Teaching

    NASA Astrophysics Data System (ADS)

    Coelho, Ricardo Lopes

    2010-01-01

    Some physicists have pointed out that we do not know what force is. The most common definition of force in textbooks has been criticized for more than two centuries. Many studies have shown that the concept of force is a problem for teaching. How to conceive force on the basis of the concepts and criticism of force in the works of Newton, Euler, d’Alembert, Lagrange, Lazare Carnot, Saint-Venant, Reech, Kirchhoff, Mach, Hertz and Poincaré is the question of the present article. This part of the article is followed by an overview of definitions of force in contemporary textbooks. In the next part, an answer to the question is given: how to understand force within the framework of the laws of motion and in applications. Finally, some educational implications are considered.

  18. Integrating flux, satellite, and proximal optical data for an improved understanding of ecosystem carbon uptake

    NASA Astrophysics Data System (ADS)

    Gamon, J. A.; Huemmrich, K. F.; Garrity, S. R.

    2015-12-01

    The different scales and methods of satellite observations and flux measurements present challenges for data integration that can be partly addressed by the addition of scale-appropriate optical sampling. Proximal optical measurement facilitates experimental approaches that can inform upscaling, satellite validation, and lead to better understanding of controls on carbon fluxes and other ecosystem processes. Using the framework of the light-use efficiency model, this presentation will review efforts to explore the controls on ecosystem-atmosphere carbon fluxes using a variety of novel optical sensors and platforms. Topics of appropriate sampling methodology, scaling and data aggregation will also be considered, with examples of how information content and interpretation of optical data can be scale-dependent. Key challenges include informatics solutions that handle large, multi-dimensional data volumes and contextual information, including information about sampling protocols and scale. Key opportunities include the assessment of vegetation functional diversity with optical sensors.

  19. Interactive tutorial to improve student understanding of single photon experiments involving a Mach-Zehnder interferometer

    NASA Astrophysics Data System (ADS)

    Marshman, Emily; Singh, Chandralekha

    2016-03-01

    We have developed and evaluated a quantum interactive learning tutorial (QuILT) on a Mach-Zehnder interferometer with single photons to expose upper-level students in quantum mechanics courses to contemporary quantum optics applications. The QuILT strives to help students develop the ability to apply fundamental quantum principles to physical situations in quantum optics and explore the differences between classical and quantum ideas. The QuILT adapts visualization tools to help students build physical intuition about counter-intuitive quantum optics phenomena with single photons including a quantum eraser setup and focuses on helping them integrate qualitative and quantitative understanding. We discuss findings from in-class evaluations.

  20. How online learning modules can improve the representational fluency and conceptual understanding of university physics students

    NASA Astrophysics Data System (ADS)

    Hill, M.; Sharma, M. D.; Johnston, H.

    2015-07-01

    The use of online learning resources as core components of university science courses is increasing. Learning resources range from summaries, videos, and simulations, to question banks. Our study set out to develop, implement, and evaluate research-based online learning resources in the form of pre-lecture online learning modules (OLMs). The aim of this paper is to share our experiences with those using, or considering implementing, online learning resources. Our first task was to identify student learning issues in physics to base the learning resources on. One issue with substantial research is conceptual understanding, the other with comparatively less research is scientific representations (graphs, words, equations, and diagrams). We developed learning resources on both these issues and measured their impact. We created weekly OLMs which were delivered to first year physics students at The University of Sydney prior to their first lecture of the week. Students were randomly allocated to either a concepts stream or a representations stream of online modules. The programme was first implemented in 2013 to trial module content, gain experience and process logistical matters and repeated in 2014 with approximately 400 students. Two validated surveys, the Force and Motion Concept Evaluation (FMCE) and the Representational Fluency Survey (RFS) were used as pre-tests and post-tests to measure learning gains while surveys and interviews provided further insights. While both streams of OLMs produced similar positive learning gains on the FMCE, the representations-focussed OLMs produced higher gains on the RFS. Conclusions were triangulated with student responses which indicated that they have recognized the benefit of the OLMs for their learning of physics. Our study shows that carefully designed online resources used as pre-instruction can make a difference in students’ conceptual understanding and representational fluency in physics, as well as make them more aware

  1. Understanding the systemic nature of cities to improve health and climate change mitigation.

    PubMed

    Chapman, Ralph; Howden-Chapman, Philippa; Capon, Anthony

    2016-09-01

    Understanding cities comprehensively as systems is a costly challenge and is typically not feasible for policy makers. Nevertheless, focusing on some key systemic characteristics of cities can give useful insights for policy to advance health and well-being outcomes. Moreover, if we take a coevolutionary systems view of cities, some conventional assumptions about the nature of urban development (e.g. the growth in private vehicle use with income) may not stand up. We illustrate this by examining the coevolution of urban transport and land use systems, and institutional change, giving examples of policy implications. At a high level, our concern derives from the need to better understand the dynamics of urban change, and its implications for health and well-being. At a practical level, we see opportunities to use stylised findings about urban systems to underpin policy experiments. While it is now not uncommon to view cities as systems, policy makers appear to have made little use so far of a systems approach to inform choice of policies with consequences for health and well-being. System insights can be applied to intelligently anticipate change - for example, as cities are subjected to increasing natural system reactions to climate change, they must find ways to mitigate and adapt to it. Secondly, systems insights around policy cobenefits are vital for better informing horizontal policy integration. Lastly, an implication of system complexity is that rather than seeking detailed, 'full' knowledge about urban issues and policies, cities would be well advised to engage in policy experimentation to address increasingly urgent health and climate change issues. PMID:27126780

  2. Using multispecies occupancy models to improve the characterization and understanding of metacommunity structure.

    PubMed

    Mihaljevic, Joseph R; Joseph, Maxwell B; Johnson, Pieter T J

    2015-07-01

    Two of the most prominent frameworks to develop in ecology over the past decade are metacommunity ecology, which seeks to characterize multispecies distributions across space, and occupancy modeling, which corrects for imperfect detection in an effort to better understand species occurrence patterns. Although their goals are complementary, metacommunity theory and statistical occupancy modeling methods have developed independently. For instance, the elements of metacommunity structure (EMS) framework uses species occurrence data to classify metacommunity structure and link it to underlying environmental gradients. While the efficacy of this approach relies on the quality of the data, few studies have considered how imperfect detection, which is widespread in ecological surveys and the major focus of occupancy modeling, affects the outcome. We introduce a framework that integrates multispecies occupancy models with the current EMS framework, detection error-corrected EMS (DECEMS). This method offers two distinct advantages. First, DECEMS reduces bias in characterizing metacommunity structure by using repeated surveys and occupancy models to disentangle species-specific occupancy and detection probabilities, ultimately bringing metacommunity structure classification into a more probabilistic framework. Second, occupancy modeling allows estimation of species-specific responses to environmental covariates, which will increase our ability to link species-level effects to metacommunity-wide patterns. After reviewing the EMS framework, we introduce a simple multispecies occupancy model and show how DECEMS can work in practice, highlighting that detection error often causes EMS to assign incorrect structures. To emphasize the broader applicability of this approach, we further illustrate that DECEMS can reduce the rate of structure misclassification by more than 20% in some cases, even proving useful when detection error rates are quite low (-10%). Integrating occupancy

  3. Walking improvements with nabiximols in patients with multiple sclerosis.

    PubMed

    Coghe, G; Pau, M; Corona, F; Frau, J; Lorefice, L; Fenu, G; Spinicci, G; Mamusa, E; Musu, L; Massole, S; Massa, R; Marrosu, M G; Cocco, E

    2015-11-01

    Recently, nabiximols was approved as a treatment in MS spasticity. Data leading to approval and clinical use of nabiximols, although widely recognised, are based on subjective scales. Movement analysis procedures would obtain more detailed data about the impact on mobility. The aim of the study was to quantitatively assess the functional modification of gait patterns induced by nabiximols in MS. We evaluated three-dimensional gait analysis (spatial-temporal and kinematic) variation by means of one-way ANOVA. Twenty patients were enrolled-9 male and 11 female-with mean EDSS of 5.3 (SD ± 0.81) and mean reduction of numerical rating scale during nabiximols treatment of 1.88. The spatial-temporal parameters of gait revealed an increased speed (+15 %, p < 0.001), cadence (+6 %, p < 0.001) and stride length (+10 %, p < 0.001) after treatment. Regarding the kinematics data, the Gait Profile Score after treatment was reduced by 10 % (p < 0.001): Significant changes involved the pelvic area, hip rotation and knee flexion-extension. We found that nabiximols is able to improve the speed, cadence and stride length. Furthermore, the dynamics of the proximal segment of the legs and the knee movement results after treatment are closer to the physiologic values. PMID:26239223

  4. Training of Manual Actions Improves Language Understanding of Semantically Related Action Sentences

    PubMed Central

    Locatelli, Matteo; Gatti, Roberto; Tettamanti, Marco

    2012-01-01

    Conceptual knowledge accessed by language may involve the reactivation of the associated primary sensory-motor processes. Whether these embodied representations are indeed constitutive to conceptual knowledge is hotly debated, particularly since direct evidence that sensory-motor expertise can improve conceptual processing is scarce. In this study, we sought for this crucial piece of evidence, by training naive healthy subjects to perform complex manual actions and by measuring, before and after training, their performance in a semantic language task. Nineteen participants engaged in 3 weeks of motor training. Each participant was trained in three complex manual actions (e.g., origami). Before and after the training period, each subject underwent a series of manual dexterity tests and a semantic language task. The latter consisted of a sentence-picture semantic congruency judgment task, with 6 target congruent sentence-picture pairs (semantically related to the trained manual actions), 6 non-target congruent pairs (semantically unrelated), and 12 filler incongruent pairs. Manual action training induced a significant improvement in all manual dexterity tests, demonstrating the successful acquisition of sensory-motor expertise. In the semantic language task, the reaction times (RTs) to both target and non-target congruent sentence-picture pairs decreased after action training, indicating a more efficient conceptual-semantic processing. Noteworthy, the RTs for target pairs decreased more than those for non-target pairs, as indicated by the 2 × 2 interaction. These results were confirmed when controlling for the potential bias of increased frequency of use of target lexical items during manual training. The results of the present study suggest that sensory-motor expertise gained by training of specific manual actions can lead to an improvement of cognitive-linguistic skills related to the specific conceptual-semantic domain associated to the trained actions

  5. Developing an in vitro understanding of patient experience with hydrofluoroalkane-metered dose inhalers.

    PubMed

    Doub, William H; Shah, Vibhakar; Limb, Susan; Guo, Changning; Liu, Xiaofei; Ngo, Diem

    2014-11-01

    As a result of the Montreal Protocol on Substances that Deplete the Ozone Layer, manufacturers of metered dose inhalers began reformulating their products to use hydrofluoroalkanes (HFAs) as propellants in place of chlorofluorocarbons (CFCs). Although the new products are considered safe and efficacious by the US Food and Drug Administration (FDA), a large number of complaints have been registered via the FDA's Adverse Events Reporting System (FAERS)-more than 7000 as of May 2013. To develop a better understanding of the measurable parameters that may, in part, determine in vitro performance and thus patient compliance, we compared several CFC- and HFA-based products with respect to their aerodynamic performance in response to changes in actuator cleaning interval and interactuation delay interval. Comparison metrics examined in this study were: total drug delivered ex-actuator, fine particle dose (<5 μm), mass median aerodynamic diameter, plume width, plume temperature, plume impaction force, and actuator orifice diameter. Overall, no single metric or test condition distinguishes HFA products from CFC products, but, for individual products tested, there were a combination of metrics that differentiated one from another. PMID:25228114

  6. Moving Research to Patient Applications through Commercialization: Understanding and Evaluating the Role of Intellectual Property

    PubMed Central

    2010-01-01

    The advancement of research from discovery to the delivery of medical care can be limited without the support of industry to sponsor its continued development. Federal government financial support is generally crucial in early-stage development through funding from the NIH, National Science Foundation, and other federal agencies; however, government support generally stops shortly after basic research discoveries have been reported. Much of the cessation of financial support derives from the government's regulatory responsibilities, as sponsoring the commercialization of a product conflicts with regulation of the approval for clinical use of a drug or device. Furthermore, differences in goals, resources, and flexibility render government, as compared with private industry, inefficient and less responsive to market demands with regard to stream-lining the development of and enhancing the quality of products and services offered. Thus, industry and private investment provide the bridge that converts new discoveries into healthcare products that are available to consumers and patients. This conversion occurs through commercialization, which involves both high risks and high rewards. Taking advantage of the commercialization option for research development requires an understanding of the technology transfer process. This article reviews 5 topics: 1) industry motivation to invest in academic research; 2) institutional considerations in partnering with industry; 3) academia's interactions with inventors in the commercialization process; 4) the research institution's route to commercialization, and 5) the role of intellectual property and commercialization in the advancement of healthcare. PMID:20353687

  7. Improving self-efficacy in spinal cord injury patients through “design thinking" rehabilitation workshops

    PubMed Central

    Wolstenholme, Daniel; Downes, Tom; Leaver, Jackie; Partridge, Rebecca; Langley, Joseph

    2014-01-01

    Advances in surgical and medical management have significantly reduced the length of time that patients with spinal cord injury (SCI) have to stay in hospital, but has left patients with potentially less time to psychologically adjust. Following a pilot in 2012, this project was designed to test the effect of “design thinking” workshops on the self-efficacy of people undergoing rehabilitation following spinal injuries. Design thinking is about understanding the approaches and methods that designers use and then applying these to think creatively about problems and suggest ways to solve them. In this instance, design thinking is not about designing new products (although the approaches can be used to do this) but about developing a long term creative and explorative mind-set through skills such as lateral thinking, prototyping and verbal and visual communication. The principles of “design thinking” have underpinned design education and practice for many years, it is also recognised in business and innovation for example, but a literature review indicated that there was no evidence of it being used in rehabilitation or spinal injury settings. Twenty participants took part in the study; 13 (65%) were male and the average age was 37 years (range 16 to 72). Statistically significant improvements were seen for EQ-5D score (t = -3.13, p = 0.007) and Patient Activation Measure score (t = -3.85, p = 0.001). Other outcome measures improved but not statistically. There were no statistical effects on length of stay or readmission rates, but qualitative interviews indicated improved patient experience. PMID:27493735

  8. Improving self-efficacy in spinal cord injury patients through "design thinking" rehabilitation workshops.

    PubMed

    Wolstenholme, Daniel; Downes, Tom; Leaver, Jackie; Partridge, Rebecca; Langley, Joseph

    2014-01-01

    Advances in surgical and medical management have significantly reduced the length of time that patients with spinal cord injury (SCI) have to stay in hospital, but has left patients with potentially less time to psychologically adjust. Following a pilot in 2012, this project was designed to test the effect of "design thinking" workshops on the self-efficacy of people undergoing rehabilitation following spinal injuries. Design thinking is about understanding the approaches and methods that designers use and then applying these to think creatively about problems and suggest ways to solve them. In this instance, design thinking is not about designing new products (although the approaches can be used to do this) but about developing a long term creative and explorative mind-set through skills such as lateral thinking, prototyping and verbal and visual communication. The principles of "design thinking" have underpinned design education and practice for many years, it is also recognised in business and innovation for example, but a literature review indicated that there was no evidence of it being used in rehabilitation or spinal injury settings. Twenty participants took part in the study; 13 (65%) were male and the average age was 37 years (range 16 to 72). Statistically significant improvements were seen for EQ-5D score (t = -3.13, p = 0.007) and Patient Activation Measure score (t = -3.85, p = 0.001). Other outcome measures improved but not statistically. There were no statistical effects on length of stay or readmission rates, but qualitative interviews indicated improved patient experience. PMID:27493735

  9. Perspective: a road map for academic departments to promote scholarship in quality improvement and patient safety.

    PubMed

    Neeman, Naama; Sehgal, Niraj L

    2012-02-01

    The fields of quality improvement and patient safety (QI/PS) continue to grow with greater attention and awareness, increased mandates and incentives, and more research. Academic medical centers and their academic departments have a long-standing tradition for innovation and scholarship within a multifaceted mission to provide patient care, educate the next generation, and conduct research. Academic departments are well positioned to lead the science, education, and application of QI/PS efforts nationally. However, meaningful engagement of faculty and trainees to lead this work is a major barrier. Understanding and developing programs that foster QI/PS work while also promoting a scholarly focus can generate the incentives and acknowledgment to help elevate QI/PS into the academic mission. Academic departments should define and articulate a QI/PS strategy, develop individual and departmental capacity to lead scholarly QI/PS programs, streamline and support access to data, share information and improve collaboration, and recognize and elevate academic success in QI/PS. A commitment to these goals can also serve to cultivate important collaborations between academic departments and their respective medical centers, divisions, and training programs. Ultimately, the elevation of QI/PS into the academic mission can improve the quality and safety of our health care delivery systems. PMID:22189889

  10. Understanding Low-cycle Fatigue Life Improvement Mechanisms in a Pre-twinned Magnesium Alloy

    SciTech Connect

    Wu, Wei; An, Ke

    2015-10-03

    The mechanisms of fatigue life improvement by pre-twinning process in a commercial rolled magnesium (Mg) alloy have been investigated using real-time in situ neutron diffraction under a continuous-loading condition. It is found that by introducing the excess twinned grains through pre-compression along the rolling direction the fatigue life was enhanced approximately 50%, mainly resulting from the prolonged detwinning process and inhibited dislocation slip during reverse tension. Moreover, after pre-twinning process, the removal of the rapid strain hardening during reverse tension leads to a compressive mean stress value and more symmetric shape of stress-strain hysteresis loop. The pre-twinning has significant impacts on the twinning-detwinning characteristics and deformation modes during cyclic loading and greatly facilitates the twinning-detwinning activities in plastic deformation. The cyclic straining leads to the increase of contribution of tensile twinning deformation in overall plastic deformation in both the as-received and pre-deformed sample. The mechanisms of load partitioning in different groups of grains are closely related to the deformation modes in each deformation stage, while the fatigue cycling has little influence on the load sharing. The pre-twinning process provides an easy and cost-effective route to improve the low-cycle fatigue life through manufacturing and processing, which would advance the wide application of light-weight wrought Mg alloys as structural materials.

  11. Understanding Low-cycle Fatigue Life Improvement Mechanisms in a Pre-twinned Magnesium Alloy

    DOE PAGESBeta

    Wu, Wei; An, Ke

    2015-10-03

    The mechanisms of fatigue life improvement by pre-twinning process in a commercial rolled magnesium (Mg) alloy have been investigated using real-time in situ neutron diffraction under a continuous-loading condition. It is found that by introducing the excess twinned grains through pre-compression along the rolling direction the fatigue life was enhanced approximately 50%, mainly resulting from the prolonged detwinning process and inhibited dislocation slip during reverse tension. Moreover, after pre-twinning process, the removal of the rapid strain hardening during reverse tension leads to a compressive mean stress value and more symmetric shape of stress-strain hysteresis loop. The pre-twinning has significant impactsmore » on the twinning-detwinning characteristics and deformation modes during cyclic loading and greatly facilitates the twinning-detwinning activities in plastic deformation. The cyclic straining leads to the increase of contribution of tensile twinning deformation in overall plastic deformation in both the as-received and pre-deformed sample. The mechanisms of load partitioning in different groups of grains are closely related to the deformation modes in each deformation stage, while the fatigue cycling has little influence on the load sharing. The pre-twinning process provides an easy and cost-effective route to improve the low-cycle fatigue life through manufacturing and processing, which would advance the wide application of light-weight wrought Mg alloys as structural materials.« less

  12. Understanding and controlling nanoporosity formation for improving the stability of bimetallic fuel cell catalysts.

    PubMed

    Gan, Lin; Heggen, Marc; O'Malley, Rachel; Theobald, Brian; Strasser, Peter

    2013-03-13

    Nanoporosity is a frequently reported phenomenon in bimetallic particle ensembles used as electrocatalysts for the oxygen reduction reaction (ORR) in fuel cells. It is generally considered a favorable characteristic, because it increases the catalytically active surface area. However, the effect of nanoporosity on the intrinsic activity and stability of a nanoparticle electrocatalyst has remained unclear. Here, we present a facile atmosphere-controlled acid leaching technique to control the formation of nanoporosity in Pt-Ni bimetallic nanoparticles. By statistical analysis of particle size, composition, nanoporosity, and atomic-scale core-shell fine structures before and after electrochemical stability test, we uncover that nanoporosity formation in particles larger than ca. 10 nm is intrinsically tied to a drastic dissolution of Ni and, as a result of this, a rapid drop in intrinsic catalytic activity during ORR testing, translating into severe catalyst performance degradation. In contrast, O2-free acid leaching enabled the suppression of nanoporosity resulting in more solid core-shell particle architectures with thin Pt-enriched shells; surprisingly, such particles maintained high intrinsic activity and improved catalytic durability under otherwise identical ORR tests. On the basis of these findings, we suggest that catalytic stability could further improve by controlling the particle size below ca. 10 nm to avoid nanoporosity. Our findings provide an explanation for the degradation of bimetallic particle ensembles and show an easy to implement pathway toward more durable fuel cell cathode catalysts. PMID:23360425

  13. Manipulating Light to Understand and Improve Solar Cells (494th Brookhaven Lecture)

    SciTech Connect

    Eisaman, Matthew

    2014-04-16

    Energy consumption around the world is projected to approximately triple by the end of the century, according to the 2005 Report from the U.S. Department of Energy's Basic Energy Sciences Workshop on Solar Energy Utilization. Much will change in those next 86 years, but for all the power the world needs—for everything from manufacturing and transportation to air conditioning and charging cell phone batteries—improved solar cells will be crucial to meet this future energy demand with renewable energy sources. At Brookhaven Lab, scientists are probing solar cells and exploring variations within the cells—variations that are so small they are measured in billionths of a meter—in order to make increasingly efficient solar cells and ultimately help reduce the overall costs of deploying solar power plants. Dr. Eisaman will discuss DOE's Sunshot Initiative, which aims to reduce the cost of solar cell-generated electricity by 2020. He will also discuss how he and collaborators at Brookhaven Lab are probing different material compositions within solar cells, measuring how efficiently they collect electrical charge, helping to develop a new class of solar cells, and improving solar-cell manufacturing processes.

  14. Acute care of older patients in the emergency department: strategies to improve patient outcomes

    PubMed Central

    McCabe, John J; Kennelly, Sean P

    2015-01-01

    Older patients in the emergency department (ED) are a vulnerable population who are at a higher risk of functional decline and hospital reattendance subsequent to an ED visit, and have a high mortality rate in the months following an ED attendance. The delivery of acute care in a busy environment to this population presents its own unique challenge. The purpose of this review is to detail the common geriatric syndromes encountered in the ED as well as the appropriate strategies and instruments, which can be utilized to support the clinical decision matrix and improve outcomes. PMID:27147890

  15. An Innovative Lab-Based Training Program to Help Patient Groups Understand Their Disease and the Research Process

    PubMed Central

    Mathieu, Marion; Hammond, Constance; Karlin, David G.

    2015-01-01

    Genuine partnership between patient groups and medical experts is important but challenging. Our training program meets this challenge by organizing hands-on, lab-based training sessions for members of patient groups. These sessions allow “trainees” to better understand their disease and the biomedical research process, and strengthen links between patients and local researchers. Over the past decade, we and our partner institutes have received more than 900 French patients, with the participation of over 60 researchers and clinicians. PMID:25668201

  16. Fundamentals of Melt-Water Interfacial Transport Phenomena: Improved Understanding for Innovative Safety Technologies in ALWRs

    SciTech Connect

    M. Anderson; M. Corradini; K.Y. Bank; R. Bonazza; D. Cho

    2005-04-26

    The interaction and mixing of high-temperature melt and water is the important technical issue in the safety assessment of water-cooled reactors to achieve ultimate core coolability. For specific advanced light water reactor (ALWR) designs, deliberate mixing of the core-melt and water is being considered as a mitigative measure, to assure ex-vessel core coolability. The goal of this work is to provide the fundamental understanding needed for melt-water interfacial transport phenomena, thus enabling the development of innovative safety technologies for advanced LWRs that will assure ex-vessel core coolability. The work considers the ex-vessel coolability phenomena in two stages. The first stage is the melt quenching process and is being addressed by Argonne National Lab and University of Wisconsin in modified test facilities. Given a quenched melt in the form of solidified debris, the second stage is to characterize the long-term debris cooling process and is being addressed by Korean Maritime University in via test and analyses. We then address the appropriate scaling and design methodologies for reactor applications.

  17. Leveraging Conceptual Frameworks to Improve Students' Mental Organization of Astronomy Understanding

    NASA Astrophysics Data System (ADS)

    Slater, Timothy F.; Lee, K. M.

    2006-06-01

    Many different types of schematic diagrams are useful in helping students organize and internalize their developing understanding in introductory astronomy courses. These include Venn Diagrams, Flowcharts, Concept Maps, among others, which illustrate the relationships between astronomical objects and dynamic concepts. These conceptual framework diagrams have been incorporated into the NSF-funded ClassAction project. ClassAction is a collection of electronic materials designed to enhance the metacognitive skills of college and university introductory astronomy survey students by promoting interactive engagement and providing rapid feedback in a highly visual setting. The main effort is targeted at creating dynamic think-pair-share questions supported by simulations, animations, and visualizations to be projected in the lecture classroom. The infrastructure allows instructors to recast these questions into alternative forms based on their own pedagogical preferences and feedback from the class. The recourses can be easily selected from a FLASH computer database and are accompanied by outlines, graphics, and numerous simulations which the instructor can use to provide student feedback and, when necessary, remediation. ClassAction materials are publicly available online at URL: http://astro.unl.edu and is funded by NSF Grant #0404988.

  18. Improvements in Students' Understanding from Increased Implementation of Active Learning Strategies

    NASA Astrophysics Data System (ADS)

    Hayes-Gehrke, Melissa N.; Prather, E. E.; Rudolph, A. L.; Collaboration of Astronomy Teaching Scholars CATS

    2011-01-01

    Many instructors are hesitant to implement active learning strategies in their introductory astronomy classrooms because they are not sure which techniques they should use, how to implement those techniques, and question whether the investment in changing their course will really bring the advertised learning gains. We present an example illustrating how thoughtful and systematic implementation of active learning strategies into a traditionally taught Astro 101 class can translate into significant increases in students' understanding. We detail the journey of one instructor, over several years, as she changes the instruction and design of her course from one that focuses almost exclusively on lecture to a course that provides an integrated use of several active learning techniques such as Lecture-Tutorials and Think-Pair-Share questions. The students in the initial lecture-only course achieved a low normalized gain score of only 0.2 on the Light and Spectroscopy Concept Inventory (LSCI), while the students in the re-designed learner-centered course achieved a significantly better normalized gain of 0.43. This material is based upon work supported by the National Science Foundation under Grant No. 0715517, a CCLI Phase III Grant for the Collaboration of Astronomy Teaching Scholars (CATS), and Grant No. 0847170, a PAARE Grant for the Calfornia-Arizona Minority Partnership for Astronomy Research and Education (CAMPARE). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation.

  19. Your Planetarium: A Friend Indeed; or How to improve the public understanding of Science

    NASA Astrophysics Data System (ADS)

    Ratcliffe, Martin

    1995-05-01

    Astronomical research requires public funding, and thment on public support. The greatest contact between the public and astronomy occurs through the nationUs planetariums, and the staff of these facilities are frequently asked to com'ent on recent discoveries. It is in our best interest to use and support the work of planetariums as an already existing outlet, not only to build public support for research, but as a nationUs commitment to the greater public understanding o" science. AAS President Frank Shu notes in newsletter 74, "failure to prepare the general citizenry to face an increasingly complex technological future indeed puts the nation at risk". Indeed, the issue is an important one. The efforts of the Henry Buhl Jr. Planetarium in Pittsburgh to provide up-to-date, accurate information about current astronomical research, the collaborative effort between STScI and the Buhl Planetarium to produce a new planetarium show, Through the Eyes of Hubble, and future efforts for collaborative projects to present science in an informed, yet entertaining way will be presented, and reflect similar efforts of the entire planetarium communty. Following the presented papers, a discussion session will offer the opportunity to explore new links between the planetarium ommunity and the astronomical community. The ideas will be presented to the newly constituted Astronomy Education Policy Board of the AAS as part of the national astronomy education initiative.

  20. Communicating environmental health issues using GIS or improving response to citizens with understandable maps and data

    SciTech Connect

    Mann, J.H.

    1998-07-01

    People living near a Superfund site are understandably concerned about the effects of hazardous waste releases on the health of their families and themselves. These concerns often turn to anger if the residents believe investigators and public health officials are withholding critical details. In many communities with Superfund sites, residents are demanding detailed information on site investigations and public health assessments, even before such activities are completed. Investigators and public health officials can provide on-going public briefings using a geographic information system (GIS) as part of an interactive public presentation. A GIS is an excellent tool to answer questions about locations of multi-media site investigations and the analytical results because it combines computer mapping and graphics with a database. Rather than incorporate a multitude of slides and overheads into a detailed public presentation that too often never addresses the citizen concerns, a GIS can be used as a query system to answer citizen's questions. The GIS can be incorporated into a laptop or desktop computer for a one-on-one session with a resident or can be plugged into a computer projector to answer questions at public meetings.

  1. Bevacizumab improves survival for patients with advanced cervical cancer

    Cancer.gov

    Patients with advanced, recurrent, or persistent cervical cancer that was not curable with standard treatment who received the drug bevacizumab (Avastin) lived 3.7 months longer than patients who did not receive the drug, according to an interim analysis

  2. Use of Airport Noise Complaint Files to Improve Understanding of Community Response to Aircraft Noise

    NASA Technical Reports Server (NTRS)

    Fidell, Sanford; Howe, Richard

    1998-01-01

    This study assessed the feasibility of using complaint information archived by modem airport monitoring systems to conduct quantitative analyses of the causes of aircraft noise complaints and their relationship to noise- induced annoyance. It was found that all computer-based airport monitoring systems provide at least rudimentary tools for performing data base searches by complainant name, address, date, time of day, and types of aircraft and complaints. Analyses of such information can provide useful information about longstanding concerns, such as the extent to which complaint rates are driven by objectively measurable aspects of aircraft operations; the degree to which changes in complaint rates can be predicted prior to implementation of noise mitigation measures; and the degree to which aircraft complaint information can be used to simplify and otherwise improve prediction of the prevalence of noise-induced annoyance in communities.

  3. Understanding Interactions between Cellular Matrices and Metal Complexes: Methods To Improve Silver Nanodot-Specific Staining.

    PubMed

    Choi, Sungmoon; Yu, Junhua

    2016-08-26

    Metal complexes are frequently used for biological applications due to their special photophysical and chemical characteristics. Due to strong interactions between metals and biomacromolecules, a random staining of cytoplasm or nucleoplasm by the complexes results in a low signal-to-background ratio. In this study, we used luminescent silver nanodots as a model to investigate the major driving force for non-specific staining in cellular matrices. Even though some silver nanodot emitters exhibited excellent specific staining of nucleoli, labeling with nanodots was problematic owing to severe non-specific staining. Binding between silver and sulfhydryl group of proteins appeared to be the major factor that enforced the silver staining. The oxidation of thiol groups in cells with hexacyanoferrate(III) dramatically weakened the silver-cell interaction and consequently significantly improved the efficiency of targeted staining. PMID:27380586

  4. Understanding stress in the operating room: a step toward improving the work environment.

    PubMed

    Vowels, Anthony; Topp, Robert; Berger, Jill

    2012-01-01

    Job-related stress is an important factor predicting staff satisfaction and position turnover among nursing staff, particularly in the operating room. The purpose of this study was to examine the perceived amount of stress elicited by events in the perioperative environment, the frequency of those events, and the impact of those events on the perceived stress of operating room nurses (ORNs) and operating room technologists (ORTs). The Survey on Stress in the OR instrument, which was used to query the subjects, exhibited high internal consistency of all items. The findings indicated that the ORNs and the ORTs exhibited remarkable similarities between stressful events perceived as high and low impact. The two groups agreed that the highest impact stressful event was "pressure to work more quickly." Using the results of this study, OR administrators may be able to redesign the OR environment to minimize the impact of stressful events and thereby improve job satisfaction and minimize nursing staff turnover. PMID:22545480

  5. The Cryogenic Dark Matter Search: First 5-Tower Data and Improved Understanding of Ionization Collection

    SciTech Connect

    Bailey, Catherine N.

    2010-01-01

    The Cryogenic Dark Matter Search (CDMS) is searching for Weakly Interacting Massive Particles (WIMPs) with cryogenic particle detectors. These detectors have the ability to discriminate between nuclear recoil candidate and electron recoil background events by collecting both phonon and ionization energy from recoils in the detector crystals. The CDMS-II experiment has completed analysis of the first data runs with 30 semiconductor detectors at the Soudan Underground Laboratory, resulting in a world leading WIMP-nucleon spin-independent cross section limit for WIMP masses above 44 GeV/c2. As CDMS aims to achieve greater WIMP sensitivity, it is necessary to increase the detector mass and discrimination between signal and background events. Incomplete ionization collection results in the largest background in the CDMS detectors as this causes electron recoil background interactions to appear as false candidate events. Two primary causes of incomplete ionization collection are surface and bulk trapping. Recent work has been focused on reducing surface trapping through the modification of fabrication methods for future detectors. Analyzing data taken with test devices has shown that hydrogen passivation of the amorphous silicon blocking layer worsens surface trapping. Additional data has shown that the iron-ion implantation used to lower the critical temperature of the tungsten transition-edge sensors causes a degradation of the ionization collection. Using selective implantation on future detectors may improve ionization collection for events near the phonon side detector surface. Bulk trapping is minimized by neutralizing ionized lattice impurities. Detector investigations at testing facilities and in situ at the experimental site have provided methods to optimize the neutralization process and monitor running conditions to maintain full ionization collection. This work details my contribution to the 5-tower data taking, monitoring, and analysis effort as

  6. Quality assurance of radiotherapy in cancer treatment: toward improvement of patient safety and quality of care.

    PubMed

    Ishikura, Satoshi

    2008-11-01

    The process of radiotherapy (RT) is complex and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to give high confidence that patients will receive the prescribed treatment correctly. Recent advances in RT, including intensity-modulated and image-guided RT, focus on the need for a systematic RTQA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis, to focus available QA resources optimally on process components. External audit programs are also effective. The International Atomic Energy Agency has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Several countries have adopted a similar approach for national clinical auditing. In addition, clinical trial QA has a significant role in enhancing the quality of care. The Advanced Technology Consortium has pioneered the development of an infrastructure and QA method for advanced technology clinical trials, including credentialing and individual case review. These activities have an impact not only on the treatment received by patients enrolled in clinical trials, but also on the quality of treatment administered to all patients treated in each institution, and have been adopted globally; by the USA, Europe and Japan also. PMID:18952706

  7. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    DOE PAGESBeta

    Binley, Andrew; Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-06-15

    Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of “hydrogeophysics” arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field-based investigativemore » techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time-lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of “biogeophysics.” Early hydrogeophysical studies often concentrated on relatively small “plot-scale” experiments. More recently, however, the translation to larger-scale characterization has been the focus of a number of studies. In conclusion, geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services.« less

  8. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    SciTech Connect

    Binley, Andrew; Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-06-15

    Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of “hydrogeophysics” arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field-based investigative techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time-lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of “biogeophysics.” Early hydrogeophysical studies often concentrated on relatively small “plot-scale” experiments. More recently, however, the translation to larger-scale characterization has been the focus of a number of studies. In conclusion, geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services.

  9. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    PubMed Central

    Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-01-01

    Abstract Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of “hydrogeophysics” arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field‐based investigative techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time‐lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of “biogeophysics.” Early hydrogeophysical studies often concentrated on relatively small “plot‐scale” experiments. More recently, however, the translation to larger‐scale characterization has been the focus of a number of studies. Geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services. PMID:26900183

  10. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    NASA Astrophysics Data System (ADS)

    Binley, Andrew; Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-06-01

    Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of "hydrogeophysics" arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field-based investigative techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time-lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of "biogeophysics." Early hydrogeophysical studies often concentrated on relatively small "plot-scale" experiments. More recently, however, the translation to larger-scale characterization has been the focus of a number of studies. Geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services.

  11. Surveillance should be strengthened to improve epidemiological understandings of mosquito-borne Barmah Forest virus infection

    PubMed Central

    Eastwood, Keith; Webb, Cameron; Durrheim, David

    2012-01-01

    Introduction Barmah Forest virus (BFV) is a mosquito-borne virus causing epidemic polyarthritis in Australia. This study used case follow-up of cases from the surveillance system to demonstrate that routinely collected BFV notification data were an unreliable indicator of the true location of exposure. Methods BFV notifications from June 2001 to May 2011 were extracted from the New South Wales (NSW) Notifiable Conditions Information Management System to study case distribution. Disease cluster analysis was performed using spatial scan statistics. Exposure history data were collected from cases notified in 2010 and 2011 to accurately determine travel to high-risk areas. Results Cluster analysis using address data identified an area of increased BFV disease incidence in the mid-north coast of NSW contiguous with estuarine wetlands. When travel to this area was investigated, 96.7% (29/30) cases reported having visited coastal regions within four weeks of developing symptoms. Discussion Along the central NSW coastline, extensive wetlands occur in close proximity to populated areas. These wetlands provide ideal breeding habitats for a range of mosquito species implicated in the transmission of BFV. This is the first study to fully assess case exposure with findings suggesting that sporadic cases of BFV in people living further away from the coast do not reflect alternative exposure sites but are likely to result from travel to coastal regions. Spatial analysis by case address alone may lead to inaccurate understandings of the true distribution of arboviral diseases. Subsequently, this information has important implications for the collection of mosquito-borne disease surveillance information and public health response strategies. PMID:23908926

  12. Toward Better Understanding and Improved Performance of Silicon Heterojunction Solar Cells: Preprint

    SciTech Connect

    Wang, T. H.; Page, M. R.; Iwaniczko, E.; Levi, D. H.; Yan, Y.; Branz, H. M.; Yelundur, V.; Rohatgi, A.; Bunea, G.; Terao, A.; Wang, Q.

    2004-08-01

    The double-sided silicon heterojunction (SHJ) solar cell is more appropriate for n-type crystal silicon (c-Si) wafers than for p-type c-Si wafers because there is a larger band offset to the valence band edge of hydrogenated amorphous silicon than to the conduction band edge. Thin intrinsic and doped hydrogenated amorphous silicon (a Si:H) double layers by hot-wire chemical vapor deposition (HWCVD) are investigated as passivation layers, emitters, and back-surface-field (BSF) contacts to both p- and n-type wafers. Passivation quality is studied by characterizing the SHJ solar cells and by photoconductive decay (PCD) minority-carrier lifetime measurements. The crystal-amorphous heterointerface is studied with real-time spectroscopic ellipsometry (RTSE) and high-resolution transmission electron microscopy (HRTEM) to detect phase change and material evolution, with a focus on better understanding the factors determining passivation effectiveness. A common feature in effective passivation, emitter, and BSF layers is immediate a-Si:H deposition and an abrupt and flat interface to the c-Si substrate. In this case, good wafer passivation or an excellent heterojunction is obtained, with a low interface recombination velocity (S) or a high open-circuit voltage (Voc). Voc greater than 640 mV, S less than 15 cm/sec, and efficiency of 14.8% have been achieved on polished p type Czochralski-grown (CZ) Si wafers. Collaboration between NREL and Georgia Tech resulted in a 15.7%-efficient HWCVD-deposited SHJ cell on non-textured FZ-Si with a screen-printed Al back surface field (BSF), the highest reported HWCVD SHJ cell. Collaboration between NREL and SunPower demonstrated that HWCVD a-Si:H passivation can be better than the conventional oxides, with a low surface recombination velocity of 42 cm/sec on textured n-type FZ-Si.

  13. A New and Improved Carbon Dioxide Isotope Analyzer for Understanding Soil-Plant-Atmosphere Interactions

    NASA Astrophysics Data System (ADS)

    Huang, Y. W.; Berman, E. S.; Owano, T. G.; Verfaillie, J. G.; Oikawa, P. Y.; Baldocchi, D. D.; Still, C. J.; Gardner, A.; Baer, D. S.; Rastogi, B.

    2015-12-01

    Stable CO2 isotopes provide information on biogeochemical processes that occur at the soil-plant-atmosphere interface. While δ13C measurement can provide information on the sources of the CO2, be it photosynthesis, natural gas combustion, other fossil fuel sources, landfills or other sources, δ18O, and δ17O are thought to be determined by the hydrological cycling of the CO2. Though researchers have called for analytical tools for CO2 isotope measurements that are reliable and field-deployable, developing such instrument remains a challenge. The carbon dioxide isotope analyzer developed by Los Gatos Research (LGR) uses LGR's patented Off-Axis ICOS (Integrated Cavity Output Spectroscopy) technology and incorporates proprietary internal thermal control for high sensitivity and optimal instrument stability. This new and improved analyzer measures CO2 concentration as well as δ13C, δ18O, and δ17O from CO2 at natural abundance (150-2500 ppm). The laboratory precision is ±200 ppb (1σ) in CO2 at 1 s, with a long-term (2 min) precision of ±20 ppb. The 1-second precision for both δ13C and δ18O is 0.7 ‰, and for δ17O is 1.8 ‰. The long-term (2 min) precision for both δ13C and δ18O is 0.08 ‰, and for δ17O is 0.18 ‰. The instrument has improved precision, stability and user interface over previous LGR CO2 isotope instruments and can be easily programmed for periodic referencing and sampling from different sources when coupled with LGR's multiport inlet unit (MIU). We have deployed two of these instruments at two different field sites, one at Twitchell Island in Sacramento County, CA to monitor the CO2 isotopic fluxes from an alfalfa field from 6/29/2015-7/13/2015, and the other at the Wind River Experimental Forest in Washington to monitor primarily the oxygen isotopes of CO2 within the canopy from 8/4/2015 through mid-November 2015. Methodology, laboratory development and testing and field performance are presented.

  14. Using patient passports to improve A&E asthma care.

    PubMed

    Newell, Karen; Bunce, Rebecca; Hume, Shenagh

    The asthma patient passport (APP) is a patient-specific asthma plan that details what to do when asthma is out of control. It helps patients who have severe, difficult-to-manage asthma, and health professionals when these patients present at accident and emergency. This article shows that, while the APP acts as a patient's advocate, it also facilitates accessing emergency care by making it more streamlined. Case studies explore why people with asthma have avoided going to A&E, putting their lives at risk, and provide an insight into how difficult it can be for people to navigate the healthcare system when they are at their most vulnerable. PMID:26021030

  15. Lung cancer diagnosed following emergency admission: a mixed methods study protocol to improve understanding of patients’ characteristics, needs, experiences and outcomes

    PubMed Central

    2013-01-01

    Background Lung cancer is the leading cause of death from cancer in England. About 40% of patients with lung cancer are diagnosed following an emergency admission (DFEA) to hospital. DFEA is more common in women, and more likely with increasing age and deprivation. Most have advanced disease and survival is poor, but little else is known about this group. The aim of this study is to obtain a detailed understanding of the characteristics, needs, experiences and outcomes of this group. Methods/Design This is a single centre study with quantitative and qualitative work packages (WP). WP1 gathers basic details about all patients diagnosed with lung cancer during a 12 month period, focusing on demographics, diagnostic and treatment pathways and selected outcomes. WP2 obtains information from those patients DFEA or, when unable, their carers, about their holistic needs and experiences, using the Sheffield Profile for Assessment and Referral to Care questionnaire and selected questions from the National Cancer Patient Experience Survey. WP3 uses in-depth qualitative interviews with patients and carers to obtain detailed accounts of their symptoms, help-seeking behaviours prior to admission and subsequent experiences of care. Discussion Relatively little is known about the experiences of lung cancer patients DFEA and this study will provide detailed information about their needs, characteristics, experiences and outcomes. It should identify areas in the diagnostic and treatment pathway where there is scope to improve the care provided to this group of patients and their carers. The findings will also inform the need for further focused research. PMID:23714682

  16. Understanding and Modulating Mammalian-Microbial Communication for Improved Human Health

    PubMed Central

    Mani, Sridhar; Boelsterli, Urs A.; Redinbo, Matthew R.

    2013-01-01

    The fact that the bacteria in the human gastrointestinal (GI) tract play a symbiotic role was noted as early as 1885, well before we began to manage microbial infections using antibiotics. However, even with the first antimicrobial compounds used in humans, the sulfa drugs, microbes were recognized to be critically involved in the biotransformation of these therapeutics. Thus, the roles played by the microbiota in physiology and in the management of human health have long been appreciated. Detailed examinations of GI symbiotic bacteria that started in the early 2000s and the first phases of the Human Microbiome Project that were completed in 2012 have ushered in an exciting period of granularity with respect to the ecology, genetics, and chemistry of the mammalian-microbial axes of communication. Here we review aspects of the biochemical pathways at play between commensal GI bacteria and several mammalian systems, including both local-epithelia and nonlocal responses including inflammation, immunology, metabolism, and neurobiology. Finally, we discuss how the microbial biotransformation of therapeutic compounds, such as anticancer or nonsteroidal anti-inflammatory drugs, can be modulated to reduce toxicity and potentially improve therapeutic efficacy. PMID:24160697

  17. NASA Contributions to Improve Understanding of Extreme Events in the Global Energy and Water Cycle

    NASA Technical Reports Server (NTRS)

    Lapenta, William M.

    2008-01-01

    The U.S. Climate Change Science Program (CCSP) has established the water cycle goals of the Nation's climate change program. Accomplishing these goals will require, in part, an accurate accounting of the key reservoirs and fluxes associated with the global water and energy cycle, including their spatial and temporal variability. through integration of all necessary observations and research tools, To this end, in conjunction with NASA's Earth science research strategy, the overarching long-term NASA Energy and Water Cycle Study (NEWS) grand challenge can he summarized as documenting and enabling improved, observationally based, predictions of water and energy cycle consequences of Earth system variability and change. This challenge requires documenting and predicting trends in the rate of the Earth's water and energy cycling that corresponds to climate change and changes in the frequency and intensity of naturally occurring related meteorological and hydrologic events, which may vary as climate may vary in the future. The cycling of water and energy has obvious and significant implications for the health and prosperity of our society. The importance of documenting and predicting water and energy cycle variations and extremes is necessary to accomplish this benefit to society.

  18. Recent Advances in Improvement of Forecast Skill and Understanding Climate Processes Using AIRS Version-5 Products

    NASA Technical Reports Server (NTRS)

    Susskind, Joel; Molnar, Gyula; Iredell, Lena; Rosenberg, Robert

    2012-01-01

    AIRS/AMSU is the state of the art infrared and microwave atmospheric sounding system flying aboard EOS Aqua. These observations, covering the period September 2002 until the present, have been analyzed using the AIRS Science Team Version-5 retrieval algorithm. AIRS is a high spectral resolution infrared grating spectrometer with spect,ral coverage from 650 per centimeter extending to 2660 per centimeter, with low noise and a spectral resolving power of 2400. A brief overview of the AIRS Version-5 retrieval procedure will be presented, including the AIRS channels used in different steps in the retrieval process. Many researchers have used these products to make significant advances in both climate and weather applications. Recent significant results of these experiments will be presented, including results showing that 1) assimilation of AIRS Quality Controlled temperature profiles into a General Circulation Model (GCM) significantly improves the ability to predict storm tracks of intense precipitation events; and 2) anomaly time-series of Outgoing Longwave Radiation (OLR) computed using AIRS sounding products closely match those determined from the CERES instrument, and furthermore explain that the phenomenon that global and especially tropical mean OLR have been decreasing since September 2002 is a result of El Nino/La Nina oscillations during this period.

  19. Understanding Sarason's concepts of school cultures and change: joining a community in school improvement efforts.

    PubMed

    Lorion, Raymond P

    2011-12-01

    This paper describes an evolving transformative partnership between a large comprehensive university, an urban school system and a predominantly African-American, low-income neighborhood. The partnership's originating intent was to apply an array of university, civic and local resources to improve the academic performance of a neighborhood's schools and the health, welfare and economic well-being of its residents. The extent to which that partnership would precipitate transactional (Sameroff and Fiese, Handbook of early childhood intervention, Cambridge University Press, Cambridge, pp. 119-149 in 1990) synergies among the partners was unanticipated; the long-term implications for each of the partners of such unfamiliar interactional processes remain unclear but are being systematically monitored over time. Evident at this point, however, it that a process has been initiated that has impacted how the university community, the local public school system, city government and the target neighborhood relate to each other, collaborate with each other and are changing each other. The pace of that process has varied over the years and challenged each partners' expectations and assumptions about the nature and consequences of their involvement. With time and perseverance, however, it appears that all are moving toward a sense of mutual learning and trust and toward extending to each other the benefit of the doubt. This paper discusses the evolution of that process and its implications for university-school-community collaborations. PMID:20857327

  20. Can Simulation Credibility Be Improved Using Sensitivity Analysis to Understand Input Data Effects on Model Outcome?

    NASA Technical Reports Server (NTRS)

    Myers, Jerry G.; Young, M.; Goodenow, Debra A.; Keenan, A.; Walton, M.; Boley, L.

    2015-01-01

    Model and simulation (MS) credibility is defined as, the quality to elicit belief or trust in MS results. NASA-STD-7009 [1] delineates eight components (Verification, Validation, Input Pedigree, Results Uncertainty, Results Robustness, Use History, MS Management, People Qualifications) that address quantifying model credibility, and provides guidance to the model developers, analysts, and end users for assessing the MS credibility. Of the eight characteristics, input pedigree, or the quality of the data used to develop model input parameters, governing functions, or initial conditions, can vary significantly. These data quality differences have varying consequences across the range of MS application. NASA-STD-7009 requires that the lowest input data quality be used to represent the entire set of input data when scoring the input pedigree credibility of the model. This requirement provides a conservative assessment of model inputs, and maximizes the communication of the potential level of risk of using model outputs. Unfortunately, in practice, this may result in overly pessimistic communication of the MS output, undermining the credibility of simulation predictions to decision makers. This presentation proposes an alternative assessment mechanism, utilizing results parameter robustness, also known as model input sensitivity, to improve the credibility scoring process for specific simulations.