The importance of continuing education for transplant coordination staff.

PubMed

Tokalak, Ibrahim; Emiroğlu, Remzi; Karakayali, Hamdi; Bilgin, Nevzat; Haberal, Mehmet

2005-06-01

Continuous quality improvement activities are necessary to achieve excellence at any institution. The Başkent University Hospitals have implemented continuous in-service training programs to improve all health services provided. Also, continuing medical education programs are being instituted in organ procurement and transplantation centers. In addition to receiving basic orientation and training upon hiring, transplant coordination staff complete forms that detail their current training status, further job training needed, and other courses of interest. The information is used to monitor skill levels, to determine the success of educational programs, and to identify further education that is needed. Our aim is to improve the quality of transplant coordination activities and increase organ donation at the hospitals in our network through effective monitoring and evaluation of continuous in-service training. These training programs enhance staff members' understanding of and participation in procedures related to transplantation and improves the total quality of the transplantation process. In the near future, this training model may be used to improve the donor hospital education program in Turkey.

Fentanyl by continuous subcutaneous infusion for the management of cancer pain: a retrospective study.

PubMed

Watanabe, S; Pereira, J; Hanson, J; Bruera, E

1998-11-01

Twenty-two patients who received fentanyl by continuous subcutaneous infusion for treatment of cancer pain were evaluated retrospectively. No local toxicities were noted. Five patients were switched from transdermal fentanyl due to uncontrolled pain; three achieved stability, accompanied by improvement in visual analogue scores for pain. Seventeen patients were switched from other opioids due to toxicity; 10 achieved stability, with documented improvement in toxicity in seven. The median dose ratio of opioid prior to switchover (mg/day) to fentanyl at stabilization (mg/day) was 85.4 (range 65-112.5) for morphine and 23.0 (range 10.7-29.7) for hydromorphone. Of six stable patients switched from subcutaneous to transdermal fentanyl, four maintained stability. We conclude that fentanyl by continuous subcutaneous infusion is a useful alternative for cancer patients who experience uncontrolled pain while receiving transdermal fentanyl or who experience toxicity on other opioids.

Shared Decisions & Technology-Assisted Learning

ERIC Educational Resources Information Center

Jacobs, Mary

2005-01-01

In this short article, the author discusses how Henderson Middle School in Jackson, Georgia used shared decision making to improve student achievement through the use of laptop computers. With effective use of technology and shared decision making, administrators at Henderson believe that they can continue to achieve Adequate Yearly Progress under…

LPV Controller Interpolation for Improved Gain-Scheduling Control Performance

NASA Technical Reports Server (NTRS)

Wu, Fen; Kim, SungWan

2002-01-01

In this paper, a new gain-scheduling control design approach is proposed by combining LPV (linear parameter-varying) control theory with interpolation techniques. The improvement of gain-scheduled controllers can be achieved from local synthesis of Lyapunov functions and continuous construction of a global Lyapunov function by interpolation. It has been shown that this combined LPV control design scheme is capable of improving closed-loop performance derived from local performance improvement. The gain of the LPV controller will also change continuously across parameter space. The advantages of the newly proposed LPV control is demonstrated through a detailed AMB controller design example.

Examining the Effects of General Level Course Elimination and Tracking on Student Growth and Achievement in a Suburban High School Mathematics Program

ERIC Educational Resources Information Center

Ellis, Brian E.

2014-01-01

Despite a decade of reform driven by the NCLB legislation, there continues to be a significant gap in mathematics achievement between race/ethnicity and socioeconomic groupings of students. This study examines the practice of tracking and an effort to improve mathematics achievement by eliminating the general level mathematics track. The suburban…

ThedaCare's business performance system: sustaining continuous daily improvement through hospital management in a lean environment.

PubMed

Barnas, Kim

2011-09-01

For 2003-2008, ThedaCare, a community health system in Wisconsin, achieved significant improvements in quality and the elimination of waste through the development of an improvement system, which included Value Stream analysis, rapid improvement events, and projects applied to specific processes. However, to meet its continuous daily improvement goals, particularly the goal of increasing productivity by 10% annually, ThedaCare needed to change the way its managers and leaders (in its hospital division) conduct and manage their daily work. Accordingly, it developed its Business Performance System (BPS) to achieve and sustain continuous daily improvement. BUILDING THE BPS: ThedaCare devised a multipart pilot project, consisting of "learning to see" and then, "problem solving." On completion of the 15-week alpha phase (6 units) in July 2009, the BPS was spread to the beta pilot (12 units; September 2009-January 2010) and then to cohort 3 (10 units; September 2010-January 2011). Each alpha unit improved performance on (1) the key driver metric of increasing productivity from 2008 to year-end 2009 (by 1%-11%) and (2) its respective safety/ quality drivers over the respective 2008 baselines. For 2010, improvements across the alpha, beta, and cohort 3 units were found for 11 of the 14 safety/quality drivers-85% of the 11 customer satisfaction drivers, 83% of 6 people engagement drivers; and 48% of 23 financial stewardship drivers. The tools developed for the BPS have enabled teams to see, prioritize, and pursue continuous daily improvement opportunities. Unit leaders now have a structured management reporting system to reduce variation in their management styles. Leaders all now follow leadership standard work, and their daily work is now consistently aligned with the hospital and system strategy.

Status of nickel/zinc and nickel/iron battery technology for electric vehicle applications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yao, N.P.; Christianson, C.C.; Elliott, R.C.

1980-01-01

Significant progress in nickel/zinc and nickel/iron technology has been made towards achieving the battery technical performance goals necessary for widespread use of these battery systems in electric vehicle applications. This progress is reviewed. Nickel/zinc module test data have shown a specific energy of nearly 70 Whr/kg and a specific power of 130 W/kg. However, cycle life improvements are still needed (presently demonstrated capability of 120 cycles) and are expected to be demonstrated during 1980. Nickel/iron modules have demonstrated a specific energy of nearly 50 Wh/kg and a specific power of 100 W/kg. Indications are that improved performance in these areasmore » can be shown during 1980. Nickel/iron modules cycle lives of 300 have been achieved during early 1980 and testing continues. Energy efficiency has been improved from less than 50% to over 65%. Cost reduction (both initial and operating) continues to receive major emphasis at developers of both nickel/zinc and nickel/iron batteries in order to achieve the lowest possible life cycle cost to the battery user.« less

Increasing Sensitivity In Continuous-Flow Electrophoresis

NASA Technical Reports Server (NTRS)

Sharnez, Rizwan; Sammons, David W.

1994-01-01

Sensitivity of continuous-flow electrophoresis (CFE) chamber increased by introducing lateral gradients in concentration of buffer solution and thickness of chamber. Such gradients, with resulting enhanced separation, achieved in CFE chamber with wedge-shaped cross section and collateral flow. Enables improved separations of homogeneous components of mixtures of variety of biologically important substances.

Can Technology Improve Large Class Learning? The Case of an Upper-Division Business Core Class

ERIC Educational Resources Information Center

Stanley, Denise

2013-01-01

Larger classes are often associated with lower student achievement. The author tested the hypothesis that the introduction of personal response systems significantly improves scores in a 250-seat classroom, through the channels of improved attendance and engagement. She focused on how continuous participation with the technology could change…

Continuous infusion of beta-lactam antibiotics in severe infections: a review of its role.

PubMed

Roberts, Jason A; Paratz, Jennifer; Paratz, Elizabeth; Krueger, Wolfgang A; Lipman, Jeffrey

2007-07-01

Continuous infusion of beta-lactam antibiotics has been widely promoted to optimise their time-dependent activity. Increasing evidence is emerging suggesting potential benefits in patient populations with altered pathophysiology, such as seriously ill patients. From a pharmacokinetic viewpoint, much information supports higher trough concentrations of beta-lactam antibiotics when administered by continuous infusion. This advantage of continuous infusion translates into a superior ability to achieve pharmacodynamic targets, particularly when the minimum inhibitory concentration (MIC) of the pathogen is >or=4 mg/L. One drawback of continuous infusion may be limited physicochemical stability. This issue exists particularly for carbapenem antibiotics whereby prolonged infusions (i.e. >3h) can be used to improve the time above the MIC compared with conventional bolus dosing. Few studies have examined clinical outcomes of bolus and continuous dosing of beta-lactam antibiotics in seriously ill patients. No statistically significant differences have been shown for: mortality; time to normalisation of leukocytosis or pyrexia; or duration of mechanical ventilation, intensive care unit stay or hospital stay. Some evidence suggests improved clinical cure and resolution of illness with continuous infusion in seriously ill patients. Pharmacoeconomic advantages of continuous infusion of beta-lactam antibiotics are well characterised. Available data suggest that seriously ill patients with severe infections requiring significant antibiotic courses (>or=4 days) may be the subgroup that will achieve better outcomes with continuous infusion.

A strategy for company improvement.

PubMed

Howley, L

2000-03-01

Strategies based on the kaizen methodology are designed to continuously improve company performance without the need for large capital investments. This article looks at how one company used simple kaizen principles to its advantage, achieving 67% increase in productivity and 10% reduction in the standard cost of product.

Integrating Curriculum in a Total Quality School.

ERIC Educational Resources Information Center

Jenkins, Kenneth D.; Jenkins, Doris M.

1998-01-01

Examined the changes implemented by teachers at Brown Barge Middle School, in Pensacola, Florida, to improve curriculum. Notes the teachers' use of total quality education principles and describes six propositions of change: achieving constancy of purpose, building quality, continuous improvement, student-centered approach, using data, and…

Schools and Districts Use Resources Wisely to Increase Achievement and Graduate More Students.

ERIC Educational Resources Information Center

Southern Regional Education Board (SREB), 2011

2011-01-01

In a time of reduced funding, schools are meeting the challenge to continue improving classroom practices, student achievement and graduation rates. Many schools and teachers are forming networks to exchange information via the Internet as they tap into free electronic resources. Career/technical (CT) instructors are teaching students about…

Enhancing Student Outcomes through Mentoring, Peer Counselling and Parental Involvement

ERIC Educational Resources Information Center

Sottie, Cynthia Akorfa; Dubus, Nicole; Sossou, Marie-Antoinette

2013-01-01

The government of Ghana has designed various initiatives to achieve the Millennium Development Goals on education and the Education for All goals. Despite these initiatives, student outcomes continue to be poorer than desired. Although access to education has improved, student dropout remains a problem and student scores on achievement tests…

A Qualitative Study on the Impact of Professional Learning Communities in an Elementary School

ERIC Educational Resources Information Center

Evans, Portia LaShan

2012-01-01

Educators are continuously confronted with initiatives to increase student achievement; however, teacher isolation may hinder advancements to improve student learning. Teacher isolation may be a problem at many schools in which student achievement is not progressing, and teachers are not sharing pedagogical knowledge or instructional practices.…

Human Capital Development in Education: Challenges and Policy Options

ERIC Educational Resources Information Center

Best, Jane R.

2010-01-01

Increasing student achievement and narrowing the achievement gap are challenges that states and districts continue to confront as they strive to develop talent that will contribute to our nation's economy. Some strategies to produce authentic improvement in learning are not entirely a mystery. A preponderance of research in recent years provides…

How can we further improve the LDL-cholesterol target level achievement rate based on the Hungarian MULTI GAP 2011 study results and considering the new European dyslipidemia guidelines?

PubMed

Mark, Laszlo; Paragh, György; Karadi, Istvan; Reiber, Istvan; Pados, Gyula; Kiss, Zoltan

2012-09-08

Despite the continuous improvement of the quality of lipid lowering therapy the achievement of target values is still not satisfactory, mainly in the very high cardiovascular risk category patients, where the goal of low density lipoprotein cholesterol (LDL-C) is 1.80 mmol/l. The trends in lipid lowering treatment of 17420 patients from different studies conducted between 2004 and 2010 were compared to that of 1626 patients of MULTI GAP (MULTI Goal Attainment Problem) 2011 treated by general practitioners (GPs) and specialists. In MULTI GAP 2011 the mean LDL-C level ± SD) of patients treated by GPs was found to be 2.87 ±1.01 mmol/l, the target value of 2.50 was achieved by 40% of them, in the specialists' patients the mean LDL-C level proved to be 2.77 ±1.10 mmol/l and the achievement rate was 45%. In the 2.50 mmol/l achievement rate of GPs' patients a satisfactory improvement was observed in the studied years, but the 1.80 mmol/l LDL-C goal in 2011 was attained only in 11% of very high risk cases. There was a linear correlation between the patient compliance estimated by the physicians and the LDL-C achievement rate. As the number of very high risk category patients has been increased according to the new European dyslipidemia guidelines, growing attention needs to be placed on attainment of the 1.80 mmol/l LDL-C level. Based on the results of the MULTI GAP studies, improving patients' adherence and the continuous training of physicians are necessary.

An observational study of the effectiveness of alternative care providers in the management of obstructive sleep apnea.

PubMed

Pendharkar, Sachin R; Dechant, Anthony; Bischak, Diane P; Tsai, Willis H; Stevenson, Ann-Marie; Hanly, Patrick J

2016-04-01

Alternative care providers have been proposed as a substitute for physician-based management of obstructive sleep apnea. The purpose of this study was to describe the clinical course of patients with a new diagnosis of obstructive sleep apnea who were treated with continuous positive airway pressure and followed by alternative care providers at a tertiary care sleep clinic. It was hypothesized that care by alternative care providers would result in improvement of daytime sleepiness and satisfactory treatment adherence, and that a specific number of follow-up visits could be identified after which clinical outcomes no longer improved. The Epworth Sleepiness Scale score was measured for each patient at baseline and at each alternative care provider visit. Patients were discharged when they demonstrated a significant improvement in sleepiness and were adherent to therapy. The Epworth Sleepiness Scale score decreased by 3.9 points from baseline to discharge. Patients with three or more visits required more follow-up time to achieve the same clinical improvement as those with only two visits. Continuous positive airway pressure adherence was comparable to previous studies of physician-led care and improved with ongoing alternative care provider follow-up. The current results suggest that clinical care by alternative care providers leads to continued improvements in sleepiness in patients with obstructive sleep apnea who are treated with continuous positive airway pressure, and that a minority of patients require longer follow-up to achieve a satisfactory clinical response to therapy. © 2015 European Sleep Research Society.

University Continuing Education for Lifelong Learning in Korea

ERIC Educational Resources Information Center

Lee, Haejoo

2008-01-01

Lifelong education achieves its goals when it improves people's quality of life and when it brings social cohesion and development. University continuing education (UCE) has contributed to the expansion of higher education opportunities in terms of its quantity. However, we have to look further than sheer volume of activity. Original ideals of…

Elementary Principal Perceptions on Key Leadership Responsibilities Associated with Increased Student Achievement

ERIC Educational Resources Information Center

Hopper, Lora E.

2009-01-01

Although research has provided a substantial amount of information about key characteristics of effective school leaders, there is a growing need for continued improvement and reflective practice on the continuous development of instructional leaders. The purpose of this study was to determine to what extent elementary principals perceive they are…

Improving sensitivity in micro-free flow electrophoresis using signal averaging

PubMed Central

Turgeon, Ryan T.; Bowser, Michael T.

2009-01-01

Microfluidic free-flow electrophoresis (μFFE) is a separation technique that separates continuous streams of analytes as they travel through an electric field in a planar flow channel. The continuous nature of the μFFE separation suggests that approaches more commonly applied in spectroscopy and imaging may be effective in improving sensitivity. The current paper describes the S/N improvements that can be achieved by simply averaging multiple images of a μFFE separation; 20–24-fold improvements in S/N were observed by averaging the signal from 500 images recorded for over 2 min. Up to an 80-fold improvement in S/N was observed by averaging 6500 images. Detection limits as low as 14 pM were achieved for fluorescein, which is impressive considering the non-ideal optical set-up used in these experiments. The limitation to this signal averaging approach was the stability of the μFFE separation. At separation times longer than 20 min bubbles began to form at the electrodes, which disrupted the flow profile through the device, giving rise to erratic peak positions. PMID:19319908

Reading Achievement: Characteristics Associated with Success and Failure: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," July through December 1980 (Vol. 41 Nos. 1 through 6).

ERIC Educational Resources Information Center

ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 30 titles deal with a variety of topics, including the following: (1) the effect of a series of lessons based on real life experiences for improving reading achievement; (2) reading achievement and the transition from letter to…

School Discipline, Classroom Management, and Student Self-Management: A PBS Implementation Guide

ERIC Educational Resources Information Center

Knoff, Howard M.

2012-01-01

How do you help students who "act out" or "shut down" due to academic frustration or whose social and emotional issues keep them from achieving success in school? Based on Project ACHIEVE, a nationally recognized model of school effectiveness and continuous improvement program, this book shows you how. Educators will find a pragmatic,…

Aim Higher: Lofty Goals and an Aligned System Keep a High Performer on Top

ERIC Educational Resources Information Center

McCommons, David P.

2014-01-01

Every school district is feeling the pressure to ensure higher academic achievement for all students. A focus on professional learning for an administrative team not only improves student learning and achievement, but also assists in developing a systemic approach for continued success. This is how the Fox Chapel Area School District in…

Selecting Effective Teachers for Urban Elementary Charter Schools: Effects of Decentralization on Principals' Decisions

ERIC Educational Resources Information Center

Leaks, Rakeda Antwanece

2013-01-01

In the age of No Child Left Behind and accountability, education stakeholders continue to look for ways to improve student achievement outcomes especially in schools in urban communities. Principal autonomy has been linked to successful results in student achievement. The purpose of this study was to understand how principals' perceptions of their…

Dramatically Improve How and Where Academic Content Is Taught

ERIC Educational Resources Information Center

Hyslop, Alisha

2007-01-01

The fourth recommendation in ACTE's high school reform position statement is to dramatically improve how and where academic content is taught. Even as advanced academic course-taking and high school graduation requirements have increased, student achievement on national benchmarks has remained flat, and college remediation rates continue to…

Achieving Continuous Improvement: Theories that Support a System Change.

ERIC Educational Resources Information Center

Armel, Donald

Focusing on improvement is different than focusing on quality, quantity, customer satisfaction, and productivity. This paper discusses Open System Theory, and suggests ways to change large systems. Changing a system (meaning the way all the parts are connected) requires a considerable amount of data gathering and analysis. Choosing the proper…

Alabama District Improves by Sharpening Data and Goals

ERIC Educational Resources Information Center

Newman, Jane L.

2006-01-01

When students already are achieving at high levels, it can be easy for teachers to become complacent. However, Mountain Brook Schools in suburban Birmingham, Alabama, has developed a culture committed to continuous improvement that has resulted in an excellent system becoming outstanding. The key is professional development. Professional learning…

Developing Transformative Schools: A Resilience-Focused Paradigm for Education

ERIC Educational Resources Information Center

Nicoll, William G.

2014-01-01

For the better part of the past century, the field of education has witnessed repeated calls and initiatives for change, reform and improvement of our schools. Yet today, the problems of improving academic achievement and social adjustment among youth continue unabated. An explanation for this "change without change" phenomenon is…

Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical Setting

PubMed Central

Ogrinc, Greg; Hoffman, Kimberly G.; Stevenson, Katherine M.; Shalaby, Marc; Beard, Albertine S.; Thörne, Karin E.; Coleman, Mary T.; Baum, Karyn D.

2016-01-01

Problem Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. Approach From 2008–2012, an iterative, interactive process was used to develop the ECLS model and its core elements—patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012–2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site’s ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Outcomes Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. Next Steps The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. PMID:26760058

Innovating the Standard Procurement System Through Electronic Commerce Technologies

DTIC Science & Technology

1999-12-01

commerce are emerging almost daily as businesses continue to realize the overwhelming ability of agent applications to reduce costs and improve ...processed using the SPS. The result may reduce cycle time, assist contracting professionals, improve the acquisition process, save money and aid...of innovation processes, and it offers enormous potential for helping organizations achieve major improvements in terms of process cost , time

Progress on glass ceramic ZERODUR enabling nanometer precision

NASA Astrophysics Data System (ADS)

Jedamzik, Ralf; Kunisch, Clemens; Nieder, Johannes; Weber, Peter; Westerhoff, Thomas

2016-03-01

The Semiconductor Industry is making continuous progress in shrinking feature size developing technologies and process to achieve < 10 nm feature size. The required Overlay specification for successful production is in the range one nanometer or even smaller. Consequently, materials designed into metrology systems of exposure or inspection tools need to fulfill ever tighter specification on the coefficient of thermal expansion (CTE). The glass ceramic ZERODUR® is a well-established material in critical components of microlithography wafer stepper and offered with an extremely low coefficient of thermal expansion, the tightest tolerance available on market. SCHOTT is continuously improving manufacturing processes and it's method to measure and characterize the CTE behavior of ZERODUR®. This paper is focusing on the "Advanced Dilatometer" for determination of the CTE developed at SCHOTT in the recent years and introduced into production in Q1 2015. The achievement for improving the absolute CTE measurement accuracy and the reproducibility are described in detail. Those achievements are compared to the CTE measurement accuracy reported by the Physikalische Technische Bundesanstalt (PTB), the National Metrology Institute of Germany. The CTE homogeneity is of highest importance to achieve nanometer precision on larger scales. Additionally, the paper presents data on the short scale CTE homogeneity and its improvement in the last two years. The data presented in this paper will explain the capability of ZERODUR® to enable the extreme precision required for future generation of lithography equipment and processes.

Highly Effective Teachers of Latino English Language Learners: Knowledge, Skills, and Dispositions That Lead to Improved Language Acquisition and Student Achievement

ERIC Educational Resources Information Center

Moore, Wendy V.

2016-01-01

It is predicted that Hispanic school-aged children will outnumber non-Hispanic white students in public schools by 2050 (Wolf, Herman, & Dietel, 2010). While the number of Latino English language learners (ELLs) continues to grow, their educational achievement remains problematic. Data reveal that ELL dropout, mobility, and poverty rates are…

Transition-from-Early-to-Sophisticated-Literacy (TESL) as a Factor in Cross-National Achievement Differences

ERIC Educational Resources Information Center

Galletly, Susan A.; Knight, Bruce Allen

2011-01-01

The PISA studies of reading achievement of 15 year old students in OECD and partner nations show Anglophone nations to have continuing high proportions of weak readers (less than or equal to Level 2), with no improvement in this area from 2000 to 2006 (OECD, "Science competencies for tomorrow's world: Executive summary," 2007). The…

Massachusetts Charter Public Schools: Best Practices Using Data to Improve Student Achievement in Springfield. White Paper No. 142

ERIC Educational Resources Information Center

Candal, Cara Stillings

2016-01-01

Recent studies continue to shine light on high-performing charter schools. While Boston-area charter schools--a concentrated group of high-performers--garner more attention than others, many excellent schools outside of Boston have been quietly chipping away at the achievement gap between advantaged and disadvantaged students. One of these schools…

Making Pre-K Count: Improving Math Instruction in New York City

ERIC Educational Resources Information Center

Morris, Pamela A.; Mattera, Shira K.; Maier, Michelle F.

2016-01-01

In the context of a persistent achievement lag among low-income children despite substantial investments in early education, policymakers and practitioners continue to seek ways to improve the quality of children's preschool experiences. The Making Pre-K Count study addresses whether strengthening prekindergarten (pre-K) instruction in math,…

Antibiotic Dosing in Continuous Renal Replacement Therapy.

PubMed

Shaw, Alexander R; Mueller, Bruce A

2017-07-01

Appropriate antibiotic dosing is critical to improve outcomes in critically ill patients with sepsis. The addition of continuous renal replacement therapy makes achieving appropriate antibiotic dosing more difficult. The lack of continuous renal replacement therapy standardization results in treatment variability between patients and may influence whether appropriate antibiotic exposure is achieved. The aim of this study was to determine if continuous renal replacement therapy effluent flow rate impacts attaining appropriate antibiotic concentrations when conventional continuous renal replacement therapy antibiotic doses were used. This study used Monte Carlo simulations to evaluate the effect of effluent flow rate variance on pharmacodynamic target attainment for cefepime, ceftazidime, levofloxacin, meropenem, piperacillin, and tazobactam. Published demographic and pharmacokinetic parameters for each antibiotic were used to develop a pharmacokinetic model. Monte Carlo simulations of 5000 patients were evaluated for each antibiotic dosing regimen at the extremes of Kidney Disease: Improving Global Outcomes guidelines recommended effluent flow rates (20 and 35 mL/kg/h). The probability of target attainment was calculated using antibiotic-specific pharmacodynamic targets assessed over the first 72 hours of therapy. Most conventional published antibiotic dosing recommendations, except for levofloxacin, reach acceptable probability of target attainment rates when effluent rates of 20 or 35 mL/kg/h are used. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Sense of agency in continuous action: Assistance-induced performance improvement is self-attributed even with knowledge of assistance.

PubMed

Inoue, Kazuya; Takeda, Yuji; Kimura, Motohiro

2017-02-01

In a task involving continuous action to achieve a goal, the sense of agency increases with an improvement in task performance that is induced by unnoticed computer assistance. This study investigated how explicit instruction about the existence of computer assistance affects the increase of sense of agency that accompanies performance improvement. Participants performed a continuous action task in which they controlled the direction of motion of a dot to a goal by pressing keys. When instructions indicated the absence of assistance, the sense of agency increased with performance improvement induced by computer assistance, replicating previous findings. Interestingly, this increase of sense of agency was also observed even when instructions indicated the presence of assistance. These results suggest that even when a plausible cause of performance improvement other than one's own action exists, the improvement can be misattributed to one's own control of action, resulting in an increased sense of agency. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality improvement: the nurse's role.

PubMed

Moran, M J; Johnson, J E

1992-06-01

Continuous quality improvement is a concept which includes: Quality assurance--the provision of services that meet an appropriate standard. Problem resolution--including all departments involved in the issue at hand. Quality improvement--a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients. Deming (1982b) and others have espoused total system reform to achieve quality improvement--not merely altering the current system, but radically changing it. It must be assumed that those who provide services at the staff level are acting in good faith and are not willfully failing to do what is correct (Berwick, 1991). Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse--who is at the heart of the system--is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting. The nurse manager must structure the work setting to facilitate the staff nurse's ability to undertake constructive action for improving care. The use of quality circles, quality councils, or quality improvement forums to facilitate the coordination of quality improvement efforts is an effective way to achieve success. The QA coordinator assists departments in documenting that the quality improvement efforts are effective across all departments of the organization, and aggregates data to demonstrate that they meet the requirements of external regulatory agencies, insurers, and professional standards. The nurse executive provides the vision and secures the necessary resources to ensure that the organization's quality improvement efforts are successful. By inspiring and empowering the staff in their efforts to improve the process by which health care is provided, nurse managers participate in reshaping the health care environment. The professional nurse plays a vital role in the quality improvement of health care services. However, nurses cannot make these improvements in a vacuum; they must include other professionals and ancillary personnel in their efforts. Total quality commitment must include all levels of an organization's structure. Quality patient care services will be achieved as the result of positive interactions among departments working together to build a dynamic mechanism that continuously improves the processes and outcomes of health care services.

Investing in Education Powers U.S. Competitiveness: Education Funding Must Be Preserved

ERIC Educational Resources Information Center

Epstein, Diana

2012-01-01

Education is the key to American competitiveness and a strong economy, and continued federal investment in education is needed in order to support improvements in student achievement and put American economy on the path to sustained growth. The United States must continue to invest in education in order to create a system that is more equitable…

75 FR 45673 - Opportunity To Comment on Proposed and/or Continuing Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... and Observations to Benefit the Environment) based on feedback from participating teachers, students, and partners in order to help meet the Program's goal of improving student achievement in mathematics...

Defense Commissaries: DOD Needs to Improve Business Processes to Ensure Patron Benefits and Achieve Operational Efficiencies

DTIC Science & Technology

2017-03-01

sales, leverage efficiencies, and achieve savings in commissary operations. Second, DeCA has not conducted cost - benefit analyses for costs ...conduct comprehensive cost - benefit analyses for service contracts and distribution options. DOD concurred with GAO’s first two recommendations and...partially concurred with the third recommendation. GAO continues to believe the cost - benefit analysis recommendation is valid

How Schools Can Effectively Plan to Meet the Goal of Improving Student Learning

ERIC Educational Resources Information Center

Grumdahl, Constance Rae

2010-01-01

Purpose. The purpose of the study was to identify the impact on achievement when schools implement a continuous improvement model using Total Quality Management (TQM) principles aligned to strategic planning and the culture of the school. Data collection and analysis. The study combined qualitative and quantitative methods and was conducted in two…

Statewide Data on Supply and Demand of Principals after Policy Changes to Principal Preparation in Illinois

ERIC Educational Resources Information Center

Haller, Alicia; Hunt, Erika

2016-01-01

Research has demonstrated that principals have a powerful impact on school improvement and student learning. Principals play a vital role in recruiting, developing, and retaining effective teachers; creating a school-wide culture of learning; and implementing a continuous improvement plan aimed at increasing student achievement. Leithwood, Louis,…

Quick and continuous improvement through kaizen blitz.

PubMed

McNichols, T; Hassinger, R; Bapst, G W

1999-05-01

It is our objective to provide you with a step-by-step approach to conducting a kaizen blitz within two days and describe how to achieve dramatic performance improvement with employee buy-in through this process. Kaizen blitz has been used dozens of times by the authors, and in some instances the same area has been blitzed as many as four times, with significant improvements each and every time. Employees have even taken it on themselves to conduct informal blitzes as a continuing improvement effort after a formal blitz has been conducted in their area. Blitzes can succeed in a variety of environments. The morning after the employees of one company attended this presentation, they self initiated a mini-blitz and discovered opportunities for improvement that they enthusiastically presented to management.

Clustering-based urbanisation to improve enterprise information systems agility

NASA Astrophysics Data System (ADS)

Imache, Rabah; Izza, Said; Ahmed-Nacer, Mohamed

2015-11-01

Enterprises are daily facing pressures to demonstrate their ability to adapt quickly to the unpredictable changes of their dynamic in terms of technology, social, legislative, competitiveness and globalisation. Thus, to ensure its place in this hard context, enterprise must always be agile and must ensure its sustainability by a continuous improvement of its information system (IS). Therefore, the agility of enterprise information systems (EISs) can be considered today as a primary objective of any enterprise. One way of achieving this objective is by the urbanisation of the EIS in the context of continuous improvement to make it a real asset servicing enterprise strategy. This paper investigates the benefits of EISs urbanisation based on clustering techniques as a driver for agility production and/or improvement to help managers and IT management departments to improve continuously the performance of the enterprise and make appropriate decisions in the scope of the enterprise objectives and strategy. This approach is applied to the urbanisation of a tour operator EIS.

A 24 km fiber-based discretely signaled continuous variable quantum key distribution system.

PubMed

Dinh Xuan, Quyen; Zhang, Zheshen; Voss, Paul L

2009-12-21

We report a continuous variable key distribution system that achieves a final secure key rate of 3.45 kilobits/s over a distance of 24.2 km of optical fiber. The protocol uses discrete signaling and post-selection to improve reconciliation speed and quantifies security by means of quantum state tomography. Polarization multiplexing and a frequency translation scheme permit transmission of a continuous wave local oscillator and suppression of noise from guided acoustic wave Brillouin scattering by more than 27 dB.

Practical Approaches to Quality Improvement for Radiologists.

PubMed

Kelly, Aine Marie; Cronin, Paul

2015-10-01

Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

Strategic Plan for Sustainable Energy Management and Environmental Stewardship for Los Angeles Unified School District

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walker, A.; Beattie, D.; Thomas, K.

2007-11-01

This Strategic Plan for Sustainable Energy Management and Environmental Stewardship states goals, measures progress toward goals and how actions are monitored to achieve continuous improvement for the Los Angeles Unified School District.

Using Formative Reading Assessments and Data Utilization to Improve ELL Spanish Speaking Students' Achievement Test Scores

ERIC Educational Resources Information Center

Hamilton, Maureen Dugan

2013-01-01

The demands and expectations placed on all schools in the United States to meet the needs of a growing and diverse population continue to raise the questions, what needs to be done in order for all students to achieve success, and how can this success be measured? This study, researched and reported in the form of a dissertation, was performed on…

A Quantitative Study of the Use of "DreamBox Learning" and Its Effectiveness in Improving Math Achievement of Elementary Students with Math Difficulties

ERIC Educational Resources Information Center

Grams, Devonee

2018-01-01

Math underachievement is of grave concern with 42% of 4th grade and 36% of 8th grade students achieving at a proficient or advanced level in mathematics, and schools are continually searching for interventions to implement with struggling students. The problem addressed in this study is recently an elementary school purchased access to…

The Proportionate Costs of Title I Supplemental Educational Services: Effect of Time in Treatment on Student Achievement

ERIC Educational Resources Information Center

Cooper, Rebeca Ann

2014-01-01

Since the inception of the No Child Left Behind (NCLB) act (P.L. 107-110), the debate continues regarding supplemental education service (SES) providers and their effectiveness in improving student achievement. NCLB requires districts to use an amount equal to at least 20% out if their Title I, Part A funds (U.S.D.E, 2011) to offer SES to students…

Kaizen method for esophagectomy patients: improved quality control, outcomes, and decreased costs.

PubMed

Iannettoni, Mark D; Lynch, William R; Parekh, Kalpaj R; McLaughlin, Kelley A

2011-04-01

The majority of costs associated with esophagectomy are related to the initial 3 days of hospital stay requiring intensive care unit stays, ventilator support, and intraoperative time. Additional costs arise from hospital-based services. The major cost increases are related to complications associated with the procedure. We attempted to define these costs and identify expense management by streamlining care through strict adherence to patient care maps, operative standardization, and rapid discharge planning to reduce variability. Utilizing methods of Kaizen philosophy we evaluated all processes related to the entire experience of esophageal resection. This process has taken over 5 years to achieve, with quality and cost being tracked over this time period. Cost analysis included expenses related to intensive care unit, anesthesia, disposables, and hospital services. Quality improvement measures were related to intraoperative complications, in-hospital complications, and postoperative outcomes. The Institutional Review Board approved the use of anonymous data from standard clinical practice because no additional treatment was planned (observational study). Utilizing a continuous process improvement methodology, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy. The length of stay has been reduced from 14 days to 5. With intraoperative and postoperative standardization the leak rate has dropped from 12% to less than 3% to no leaks in our current Kaizen modification of care in our last 64 patients. Utilizing lean manufacturing techniques and continuous process evaluation we have attempted to eliminate variability, standardized the phases of care resulting in improved outcomes, decreased length of stay, and improved contribution margins. These Kaizen improvements require continuous interventions, strict adherence to care maps, and input from all levels for quality improvements. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Improved cycling cryopump

DOEpatents

Batzer, T.H.; Call, W.R.

1984-12-04

The present invention is designed to achieve continuous high efficiency cryopumping of a vacuum vessel by improving upon and combining in a novel way the cryopumping in a novel way the cryopumping methods. The invention consists of a continuous operation cryopump, with movable louvres, with a high efficiency pumping apparatus. The pumping apparatus includes three cryogenic tubes. They are constructed of a substance of high thermal conductivity, such as aluminum and their exterior surfaces are cryogenic condensing surfaces. Through their interior liquid or gaseous helium from two reservoirs can be made to flow, alternately promoting extreme cooling or allowing some warming.

The Impact of School Improvement Grants on Achievement: Plans for a National Evaluation Using a Regression Discontinuity Design

ERIC Educational Resources Information Center

Deke, John; Dragoset, Lisa

2015-01-01

Does receipt of School Improvement Grants (SIG) funding to implement a school intervention model have an impact on outcomes for low-performing schools? This study answers this question using a regression discontinuity design (RDD) that exploits cutoff values on the continuous variables used to define SIG eligibility tiers, comparing outcomes in…

Removing Barriers to High School Completion--Technical Report. System Improvement and Reporting.

ERIC Educational Resources Information Center

Alberta Learning, Edmonton.

The ability of every student to successfully complete high school is fundamental to continued success and quality of life. As such, Alberta Learning's 2000-2003 Business Plan has set a target for improving high school completion by 19-year-old students from 70% to 75%. A key step to achieving this target has involved completing a study of barriers…

Using a Client Survey to Support Continuous Improvement: An Australian Case Study in Managing Change

ERIC Educational Resources Information Center

Besch, Janice

2014-01-01

With the arrival of online survey tools that are low-cost, readily available and easy to administer, all organizations have access to one of the most effective mechanisms for determining quality improvement priorities and measuring progress towards achieving those priorities over time. This case study outlines the use made of this simple tool by a…

Focusing on Mathematical Knowledge: The Impact of Content-Intensive Teacher Professional Development. Executive Summary. NCEE 2016-4009

ERIC Educational Resources Information Center

Garet, Michael S.; Heppen, Jessica B.; Walters, Kirk; Parkinson, Julia; Smith, Toni M.; Song, Mengli; Garrett, Rachel; Yang, Rui; Borman, Geoffrey D.

2016-01-01

Improving math achievement among U.S. students remains a high priority as results from recent math assessments continue to show room for improvement. For example, 60 percent of fourth-graders scored below the proficient level on the 2015 National Assessment of Educational Progress. On the most recent Program for International Student Assessment's…

Motivational Factors of Pay-for-Performance Plans in Educational Institutions: A Study of Select Private, Faith-Based Schools

ERIC Educational Resources Information Center

Wrobbel, Paul H.

2009-01-01

In the United States there is considerable focus on the need for continuous improvement in the quality of schools, including student achievement and teacher performance. Performance-based pay has been repeatedly suggested as a way to improve teaching in school systems. Therefore, a more thorough understanding of the differences in the perceptions…

Improvement in electron-beam lithography throughput by exploiting relaxed patterning fidelity requirements with directed self-assembly

NASA Astrophysics Data System (ADS)

Yu, Hao Yun; Liu, Chun-Hung; Shen, Yu Tian; Lee, Hsuan-Ping; Tsai, Kuen Yu

2014-03-01

Line edge roughness (LER) influencing the electrical performance of circuit components is a key challenge for electronbeam lithography (EBL) due to the continuous scaling of technology feature sizes. Controlling LER within an acceptable tolerance that satisfies International Technology Roadmap for Semiconductors requirements while achieving high throughput become a challenging issue. Although lower dosage and more-sensitive resist can be used to improve throughput, they would result in serious LER-related problems because of increasing relative fluctuation in the incident positions of electrons. Directed self-assembly (DSA) is a promising technique to relax LER-related pattern fidelity (PF) requirements because of its self-healing ability, which may benefit throughput. To quantify the potential of throughput improvement in EBL by introducing DSA for post healing, rigorous numerical methods are proposed to simultaneously maximize throughput by adjusting writing parameters of EBL systems subject to relaxed LER-related PF requirements. A fast, continuous model for parameter sweeping and a hybrid model for more accurate patterning prediction are employed for the patterning simulation. The tradeoff between throughput and DSA self-healing ability is investigated. Preliminary results indicate that significant throughput improvements are achievable at certain process conditions.

Glucose Biosensors: An Overview of Use in Clinical Practice

PubMed Central

Yoo, Eun-Hyung; Lee, Soo-Youn

2010-01-01

Blood glucose monitoring has been established as a valuable tool in the management of diabetes. Since maintaining normal blood glucose levels is recommended, a series of suitable glucose biosensors have been developed. During the last 50 years, glucose biosensor technology including point-of-care devices, continuous glucose monitoring systems and noninvasive glucose monitoring systems has been significantly improved. However, there continues to be several challenges related to the achievement of accurate and reliable glucose monitoring. Further technical improvements in glucose biosensors, standardization of the analytical goals for their performance, and continuously assessing and training lay users are required. This article reviews the brief history, basic principles, analytical performance, and the present status of glucose biosensors in the clinical practice. PMID:22399892

New PbSnTe heterojunction laser diode structures with improved performance

NASA Technical Reports Server (NTRS)

Fonstad, C. G.; Kasemset, D.; Hsieh, H. H.; Rotter, S.

1980-01-01

Several recent advances in the state-of-the-art of lead tin telluride double heterojunction laser diodes are summarized. Continuous Wave operation to 120 K and pulsed operation to 166 K with single, lowest order transverse mode emission to in excess of four times threshold at 80 K were achieved in buried stripe lasers fabricated by liquid phase epitaxy in the lattice-matched system, lead-tin telluride-lead telluride selenide. At the same time, liquid phase epitaxy was used to produce PbSnTe distributed feedback lasers with much broader continuous single mode tuning ranges than are available from Fabry-Perot lasers. The physics and philosophy behind these advances is as important as the structures and performance of the specific devices embodying the advances, particularly since structures are continually being evolved and the performance continues to be improved.

Addressing the hidden dimension in nursing education: promoting cultural competence.

PubMed

Carter, Kimberly F; Xu, Yu

2007-01-01

The authors describe a cultural competence quality enhancement process to address the retention challenge of students who speak English as second language and international students as part of a school of nursing's continuous program quality improvement to achieve excellence. The process, strategies, outcomes, and evaluation of the training program are detailed within the given geographical, institutional, and curriculum context. Lessons and continuing challenges are also specified.

Paclitaxel synergizes with exposure time adjusted CD22-targeting immunotoxins against B-cell malignancies.

PubMed

Müller, Fabian; Stookey, Stephanie; Cunningham, Tyler; Pastan, Ira

2017-05-09

CD22-targeted recombinant immunotoxins (rIT) are active in hairy cell leukemia or acute lymphoblastic leukemia (ALL), but not in mantle cell lymphoma (MCL) patients. The goal was to enhance rIT efficacy in vivo and to define a strong combination treatment. Activity of Moxetumomab pasudotox (Moxe) and LR combined with paclitaxel was tested against MCL cell lines in vitro and as bolus doses or continuous infusion in xenograft models. In the KOPN-8 ALL xenograft, Moxe or paclitaxel alone was active, but all mice died from leukemia; when combined, 60% of the mice achieved a sustained complete remission. Against MCL cells in vitro, LR was more active than Moxe and the cells had to be exposed to rIT for more than 24 hours for them to die. To maintain high blood levels in vivo, LR was administered continuously by 7-day pumps achieving a well-tolerated steady plasma concentration of 45 ng/ml. In JeKo-1 xenografts, continuously administered LR was 14-fold more active than bolus doses and the combination with paclitaxel additionally improved responses by 135-fold. Maintaining high rIT-plasma levels greatly improves responses in the JeKo-1 model and paclitaxel substantially enhances bolus and continuously infused rIT, supporting a clinical evaluation against B-cell malignancies.

Analysis on electronic control unit of continuously variable transmission

NASA Astrophysics Data System (ADS)

Cao, Shuanggui

Continuously variable transmission system can ensure that the engine work along the line of best fuel economy, improve fuel economy, save fuel and reduce harmful gas emissions. At the same time, continuously variable transmission allows the vehicle speed is more smooth and improves the ride comfort. Although the CVT technology has made great development, but there are many shortcomings in the CVT. The CVT system of ordinary vehicles now is still low efficiency, poor starting performance, low transmission power, and is not ideal controlling, high cost and other issues. Therefore, many scholars began to study some new type of continuously variable transmission. The transmission system with electronic systems control can achieve automatic control of power transmission, give full play to the characteristics of the engine to achieve optimal control of powertrain, so the vehicle is always traveling around the best condition. Electronic control unit is composed of the core processor, input and output circuit module and other auxiliary circuit module. Input module collects and process many signals sent by sensor and , such as throttle angle, brake signals, engine speed signal, speed signal of input and output shaft of transmission, manual shift signals, mode selection signals, gear position signal and the speed ratio signal, so as to provide its corresponding processing for the controller core.

Chicago Business Leaders Flex Their Muscles.

ERIC Educational Resources Information Center

Hallan, Mary A.

1992-01-01

Describes the establishment, achievements, and continued success of the Big Shoulders Fund, through which Chicago's business community assists local Catholic innercity schools. Explains how the program provides operating grants, building improvements, scholarships, teacher training programs, mobile classrooms, and endowment funds for schools…

Encouraging resilience within SMEs: the Cabinet Office's proposed approach.

PubMed

Sterling, Stuart

2011-06-01

This paper introduces the Cabinet Office's Civil Contingencies Secretariat (CCS). It explains how the National Risk Assessment, produced within the CCS, is created and used. As part of the recent Strategic Defence and Security Review, the Government made a commitment to improve the business continuity of small and medium-sized enterprises (SMEs).This paper describes the CCS's approach to achieving this, and explains why the resilience of SMEs is important to both local communities, at a time of disruption or crisis, and the essential services sectors, such as energy, food and transport. It provides an outline of a strategic approach that will seek to simplify business continuity by making it accessible, achievable and affordable, and, in partnership with the organisations that SMEs turn to for advice, promotes the benefits of business continuity and encourages its use.

Development of Laser Propulsion and Tracking System for Laser-Driven Micro-Airplane

NASA Astrophysics Data System (ADS)

Ishikawa, Hiroyasu; Kajiwara, Itsuro; Hoshino, Kentaro; Yabe, Takashi; Uchida, Shigeaki; Shimane, Yoshichika

2004-03-01

The purposes of this paper are to improve the control performance of the developed laser tracking system and to develop an integrated laser propulsion/tracking system for realizing a continuous flight and control of the micro-airplane. The laser propulsion is significantly effective to achieve the miniaturization and lightening of the micro-airplane. The laser-driven micro-airplane has been studied with a paper-craft airplane and YAG laser, resulting in a successful glide of the airplane. In the next stage of the laser-driven micro-airplane development, the laser tracking is expected as key technologies to achieve continuous propulsion. Furthermore, the laser propulsion system should be combined with the laser tracking system to supply continuous propulsion. Experiments are carried out to evaluate the performance of the developed laser tracking system and integrated laser propulsion/tracking system.

Achieving continuous improvement in laboratory organization through performance measurements: a seven-year experience.

PubMed

Salinas, Maria; López-Garrigós, Maite; Gutiérrez, Mercedes; Lugo, Javier; Sirvent, Jose Vicente; Uris, Joaquin

2010-01-01

Laboratory performance can be measured using a set of model key performance indicators (KPIs). The design and implementation of KPIs are important issues. KPI results from 7 years are reported and their implementation, monitoring, objectives, interventions, result reporting and delivery are analyzed. The KPIs of the entire laboratory process were obtained using Laboratory Information System (LIS) registers. These were collected automatically using a data warehouse application, spreadsheets and external quality program reports. Customer satisfaction was assessed using surveys. Nine model laboratory KPIs were proposed and measured. The results of some examples of KPIs used in our laboratory are reported. Their corrective measurements or the implementation of objectives led to improvement in the associated KPIs results. Measurement of laboratory performance using KPIs and a data warehouse application that continuously collects registers and calculates KPIs confirmed the reliability of indicators, indicator acceptability and usability for users, and continuous process improvement.

The Total Quality Classroom.

ERIC Educational Resources Information Center

Bonstingl, John Jay

1992-01-01

Deming's quality-focused principles contradict Taylor's top-down, authoritarian industrial model. Deming advises educators to fix the system instead of blaming individual teachers for student apathy and low achievement. In the new paradigm, education will be a process that encourages continual progress through improving one's abilities, expanding…

Defining quality of nursing work life.

PubMed

Brooks, Beth A; Anderson, Mary Ann

2005-01-01

As the largest single employee component of hospitals, nurses are critical to the functioning of the organization, and improving employee productivity continues to be a common theme in the health care literature. However, any increased productivity will be transitory if achieved at the expense of the quality of nurses' work life (QNWL), since improvement in the QNWL is prerequisite to improved productivity. The conceptual components of the concept of QNWL that differentiate QNWL from the concept job satisfaction are explored.

Knowledge Sharing Mechanism: Enabling C2 to Adapt to Changing Environments

DTIC Science & Technology

2007-06-01

seeking to improve upon it. This refinement is called kaizen , the Japanese word for continuous improvement process. With each PDCA Cycle, we can either be...in a hoshin or a kaizen mode depending on our purpose. Additionally, a successful innovation achieved during a hoshin PDCA Cycle can directly lead to a...new kaizen PDCA Cycle because the innovation has allowed us to improve an existing process or artifact. A kaizen PDCA Cycle, likewise can directly

Improving indoor air quality through the use of continual multipoint monitoring of carbon dioxide and dew point.

PubMed

Bearg, D W

1998-09-01

This article summarizes an approach for improving the indoor air quality (IAQ) in a building by providing feedback on the performance of the ventilation system. The delivery of adequate quantities of ventilation to all building occupants is necessary for the achievement of good IAQ. Feedback on the performance includes information on the adequacy of ventilation provided, the effectiveness of the distribution of this air, the adequacy of the duration of operation of the ventilation system, and the identification of leakage into the return plenum, either of outdoor or supply air. Keeping track of ventilation system performance is important not only in terms of maintaining good IAQ, but also making sure that this system continues to perform as intended after changes in building use. Information on the performance of the ventilation system is achieved by means of an automated sampling system that draws air from multiple locations and delivers it to both a carbon dioxide monitor and dew point sensor. The use of single shared sensors facilitates calibration checks as well as helps to guarantee data integrity. This approach to monitoring a building's ventilation system offers the possibility of achieving sustainable performance of this important aspect of good IAQ.

Influences of personality traits and continuation intentions on physical activity participation within the theory of planned behaviour.

PubMed

Chatzisarantis, Nikos L D; Hagger, Martin S

2008-01-01

Previous research has suggested that the theory of planned behaviour is insufficient in capturing all the antecedents of physical activity participation and that continuation intentions or personality traits may improve the predictive validity of the model. The present study examined the combined effects of continuation intentions and personality traits on health behaviour within the theory of planned behaviour. To examine these effects, 180 university students (N = 180, Male = 87, Female = 93, Age = 19.14 years, SD = 0.94) completed self-report measures of the theory of planned behaviour, personality traits and continuation intentions. After 5 weeks, perceived achievement of behavioural outcomes and actual participation in physical activities were assessed. Results supported discriminant validity between continuation intentions, conscientiousness and extroversion and indicated that perceived achievement of behavioural outcomes and continuation intentions of failure predicted physical activity participation after controlling for personality effects, past behaviour and other variables in the theory of planned behaviour. In addition, results indicated that conscientiousness moderated the effects of continuation intentions of failure on physical activity such that continuation intentions of failure predicted physical activity participation among conscientious and not among less conscientious individuals. These findings suggest that the effects of continuation intentions on health behaviour are contingent on personality characteristics.

Design and fabrication of absorber coupled TES microbolometers on continuous silicon-nitride windows.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chang, C. L.; Carlstrom, J. E.; Datesman, A.

2008-04-01

The implementation of TES based microbolometer arrays will achieve unprecedented sensitivities for mm and sub-mm astronomy through fabrication of large format arrays and improved linearity and stability arising from strong electro-thermal feedback. We report on progress in developing TES microbolometers using Mo/Au thin films and Au absorbing structures. We present measurements of suppressing the thermal conductance through the etching of features on a continuous Silicon-Nitride window.

Improving Academic Achievement through Continuous Assessment Methods: In the Case of Year Two Students of Animal and Range Sciences Department in Wolaita Sodo University, Ethiopia

ERIC Educational Resources Information Center

Sarka, Samuel; Lijalem, Tsegay; Shibiru, Tilaye

2017-01-01

The aim of this study was to assessing and implementing of continuous assessment to enhance academic performance of 2nd year Animal and Range Sciences department students in Wolaita sodo university; and to take action (train) to raise the academic performance to a desirable state. For the purpose of surveying the students' level of performance…

Using an expanded outcomes framework and continuing education evidence to improve facilitation of patient-centered medical home recognition and transformation.

PubMed

Van Hoof, Thomas J; Kelvey-Albert, Michele; Katz, Matthew; Lalime, Ken; Sacks, Ken; Meehan, Thomas P

2014-01-01

The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.

Achieving and Validating the 1-centimeter Orbit: JASON-1 Precision Orbit Determination Using GPS, SLR, DORIS and Altimeter data

NASA Technical Reports Server (NTRS)

Luthcke, Scott B.; Zelensky, Nikita P.; Rowlands, David D.; Lemoine, Frank G.; Williams, Teresa A.

2003-01-01

Jason-1, launched on December 7, 2001, is continuing the time series of centimeter level ocean topography observations as the follow-on to the highly successful TOPEX/POSEIDON (T/P) radar altimeter satellite. The precision orbit determination (POD) is a critical component to meeting the ocean topography goals of the mission. Jason-1 is no exception and has set a 1 cm radial orbit accuracy goal, which represents a factor of two improvement over what is currently being achieved for T/P. The challenge to precision orbit determination (POD) is both achieving the 1 cm radial orbit accuracy and evaluating and validating the performance of the 1 cm orbit. Fortunately, Jason-1 POD can rely on four independent tracking data types including near continuous tracking data from the dual frequency codeless BlackJack GPS receiver. In addition, to the enhanced GPS receiver, Jason-1 carries significantly improved SLR and DORIS tracking systems along with the altimeter itself. We demonstrate the 1 cm radial orbit accuracy goal has been achieved using GPS data alone in a reduced dynamic solution. It is also shown that adding SLR data to the GPS-based solutions improves the orbits even further. In order to assess the performance of these orbits it is necessary to process all of the available tracking data (GPS, SLR, DORIS and altimeter crossover differences) as either dependent or independent of the orbit solutions. It was also necessary to compute orbit solutions using various combinations of the four available tracking data in order to independently assess the orbit performance. Towards this end, we have greatly improved orbits determined solely from SLR+DORIS data by applying the reduced dynamic solution strategy. In addition, we have computed reduced dynamic orbits based on SLR, DORIS and crossover data that are a significant improvement over the SLR and DORIS based dynamic solutions. These solutions provide the best performing orbits for independent validation of the GPS-based reduced dynamic orbits.

Sustaining a Mature Risk Management Process: Ensuring the International Space Station for a Vibrant Future

NASA Technical Reports Server (NTRS)

Raftery, Michael; Carter-Journet, Katrina

2013-01-01

The International Space Station (ISS) risk management methodology is an example of a mature and sustainable process. Risk management is a systematic approach used to proactively identify, analyze, plan, track, control, communicate, and document risks to help management make risk-informed decisions that increase the likelihood of achieving program objectives. The ISS has been operating in space for over 14 years and permanently crewed for over 12 years. It is the longest surviving habitable vehicle in low Earth orbit history. Without a mature and proven risk management plan, it would be increasingly difficult to achieve mission success throughout the life of the ISS Program. A successful risk management process must be able to adapt to a dynamic program. As ISS program-level decision processes have evolved, so too has the ISS risk management process continued to innovate, improve, and adapt. Constant adaptation of risk management tools and an ever-improving process is essential to the continued success of the ISS Program. Above all, sustained support from program management is vital to risk management continued effectiveness. Risk management is valued and stressed as an important process by the ISS Program.

Adaptive optics for peripheral vision

NASA Astrophysics Data System (ADS)

Rosén, R.; Lundström, L.; Unsbo, P.

2012-07-01

Understanding peripheral optical errors and their impact on vision is important for various applications, e.g. research on myopia development and optical correction of patients with central visual field loss. In this study, we investigated whether correction of higher order aberrations with adaptive optics (AO) improve resolution beyond what is achieved with best peripheral refractive correction. A laboratory AO system was constructed for correcting peripheral aberrations. The peripheral low contrast grating resolution acuity in the 20° nasal visual field of the right eye was evaluated for 12 subjects using three types of correction: refractive correction of sphere and cylinder, static closed loop AO correction and continuous closed loop AO correction. Running AO in continuous closed loop improved acuity compared to refractive correction for most subjects (maximum benefit 0.15 logMAR). The visual improvement from aberration correction was highly correlated with the subject's initial amount of higher order aberrations (p = 0.001, R 2 = 0.72). There was, however, no acuity improvement from static AO correction. In conclusion, correction of peripheral higher order aberrations can improve low contrast resolution, provided refractive errors are corrected and the system runs in continuous closed loop.

Process safety improvement--quality and target zero.

PubMed

Van Scyoc, Karl

2008-11-15

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

Continual Improvement in Shuttle Logistics

NASA Technical Reports Server (NTRS)

Flowers, Jean; Schafer, Loraine

1995-01-01

It has been said that Continual Improvement (CI) is difficult to apply to service oriented functions, especially in a government agency such as NASA. However, a constrained budget and increasing requirements are a way of life at NASA Kennedy Space Center (KSC), making it a natural environment for the application of CI tools and techniques. This paper describes how KSC, and specifically the Space Shuttle Logistics Project, a key contributor to KSC's mission, has embraced the CI management approach as a means of achieving its strategic goals and objectives. An overview of how the KSC Space Shuttle Logistics Project has structured its CI effort and examples of some of the initiatives are provided.

Japanese style total quality control: A first hand experience

NASA Astrophysics Data System (ADS)

Cook, S. C.

1991-11-01

The scope, concepts and practices of Total Quality Control (TQC) as operated in Japan today are described. The following mechanisms and elements are introduced: policy deployment, cross functional management, small group activities, suggestion systems, standardization, the TQC promotion department, and TQC education. It is shown on a practical level, how TQC operates in the research and engineering divisions of the aeroengine and space operation at Ishikawajima Harima Industries in Japan. Japanese style TQC is a well developed, well promoted, well structured, common approach to achieving customer satisfaction through continuous improvements. Furthermore, TQC itself is being continuously improved with the Japanese still refining, extending, and developing TQC.

Coordinated Transformation among Community Colleges Lacking a State System

ERIC Educational Resources Information Center

Russell, James Thad

2016-01-01

Community colleges face many challenges in the face of demands for increased student success. Institutions continually seek scalable interventions and initiatives focused on improving student achievement. Effectively implementing sustainable change that moves the needle of student success remains elusive. Facilitating systemic, scalable change…

The Lao Dong Party of North Vietnam

DTIC Science & Technology

1960-06-17

and consol- idation of the cooperative movement and with the achievement of the task of reforming democracy in the mountain regions. .. . During the...that, on the overall picture of the enlarged cooperative movement , we must continue to improve the degree of enlightenment about socialism of the

Examining the Perceptions of Gwinnett and Cobb County Georgia Principals to Determine the Strategies Needed to Improve Performance and Graduation Rates of African-American Males in Metropolitan U.S. Schools

ERIC Educational Resources Information Center

Henderson, Darren L.

2012-01-01

The purpose of this study was to examine the perceptions of high school administrators in Gwinnett and Cobb Counties, Georgia that have successfully narrowed the achievement gap for high school African-American males as to: (a) why the achievement gap continues to occur in other metropolitan high schools in the United States; (b) what successful…

Mapping modern software process engineering techniques onto an HEP development environment

NASA Astrophysics Data System (ADS)

Wellisch, J. P.

2003-04-01

One of the most challenging issues faced in HEP in recent years is the question of how to capitalise on software development and maintenance experience in a continuous manner. To capitalise means in our context to evaluate and apply new process technologies as they arise, and to further evolve technologies already widely in use. It also implies the definition and adoption of standards. The CMS off-line software improvement effort aims at continual software quality improvement, and continual improvement in the efficiency of the working environment with the goal to facilitate doing great new physics. To achieve this, we followed a process improvement program based on ISO-15504, and Rational Unified Process. This experiment in software process improvement in HEP has been progressing now for a period of 3 years. Taking previous experience from ATLAS and SPIDER into account, we used a soft approach of continuous change within the limits of current culture to create of de facto software process standards within the CMS off line community as the only viable route to a successful software process improvement program in HEP. We will present the CMS approach to software process improvement in this process R&D, describe lessons learned, and mistakes made. We will demonstrate the benefits gained, and the current status of the software processes established in CMS off-line software.

Continuous cryopump with a device for regenerating the cryosurface

DOEpatents

Foster, C.A.

1988-02-16

A high throughput continuous cryopump is provided. The cryopump incorporates an improved method for regenerating the cryopumping surface while the pump is in continuous operation. The regeneration of the cryopumping surface does not thermally cycle the pump, and to this end a small chamber connected to a secondary pumping source serves to contain and exhaust frost removed from the cryopumping surface during such regeneration. The frost is exhausted at a rate substantially independent of the speed of the cryopump which enhances the capability of the pump to achieve a high compression ratio and allow the pump to operate continuously while the cryopumping surface is being regenerated. 8 figs.

Process Control in Production-Worthy Plasma Doping Technology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Winder, Edmund J.; Fang Ziwei; Arevalo, Edwin

2006-11-13

As the semiconductor industry continues to scale devices of smaller dimensions and improved performance, many ion implantation processes require lower energy and higher doses. Achieving these high doses (in some cases {approx}1x1016 ions/cm2) at low energies (<3 keV) while maintaining throughput is increasingly challenging for traditional beamline implant tools because of space-charge effects that limit achievable beam density at low energies. Plasma doping is recognized as a technology which can overcome this problem. In this paper, we highlight the technology available to achieve process control for all implant parameters associated with modem semiconductor manufacturing.

Satisfaction with tolterodine: assessing symptom-specific patient-reported goal achievement in the treatment of overactive bladder in female patients (STARGATE study).

PubMed

Choo, M-S; Doo, C K; Lee, K-S

2008-02-01

Open-label study to evaluate the effect of tolterodine extended-release (ER) on symptom-specific patient-reported goal achievement (PGA) of overactive bladder (OAB) symptoms in females. Eligible patients who had frequency >or= 8 and urgency >or= 2 episodes per 24 h with or without urgency incontinence were treated with 12-week tolterodine ER (4 mg once daily). Primary end-point was the rate of PGA by a visual analogue scale compared with initial expectation with treatment. At baseline, patients were asked to set their personal goals for each OAB symptom with treatment. Secondary efficacy variables were changes in symptom severity, voiding diary and patient perception of bladder condition (PPBC), global impression of improvement (GII), and willingness to continue treatment. A total of 56 patients were entered. The median rate of symptom-specific PGA and reductions in symptom severity were for frequency (60%, 45%), episodes of urgency 60%, 55%), urge incontinence (80%, 71%), nocturia (50%, 52%) and tenesmus (30%, 26%) after 12 weeks treatment. There was a significant improvement in all OAB symptoms in voiding diary. Thirty-five patients (62.5%) experienced an improvement of >or= 2 points in PPBC. Thirty (53.6%) and 22 (39.3%) of patients reported much and little improvement of their symptoms in GII. A total of 41 (73.2%) patients wanted to continue taking the medication at the end of the study. Most OAB patients reported improvement of their OAB symptoms with 12-week tolterodine ER 4 mg treatment. There was a significant achievement of symptom-specific goal on the key OAB symptoms. But, PGA did not correlate with objective outcomes.

Primary water chemistry improvement for radiation exposure reduction at Japanese PWR Plants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nishizawa, Eiichi

1995-03-01

Radiation exposure during the refueling outages at Japanese Pressurized Water Reactor (PWR) Plants has been gradually decreased through continuous efforts keeping the radiation dose rates at relatively low level. The improvement of primary water chemistry in respect to reduction of the radiation sources appears as one of the most important contributions to the achieved results and can be classified by the plant operation conditions as follows

Challenges to achievement of metal sustainability in our high-tech society

DOE Office of Scientific and Technical Information (OSTI.GOV)

Izatt, Reed M.; Izatt, Steven R.; Bruening, Ronald L.

Achievement of sustainability in metal life cycles from mining of virgin ore to consumer and industrial devices to end-of-life products requires greatly increased recycling and improved processing of metals. Electronic and other high-tech products containing precious, toxic, and specialty metals usually have short lifetimes and low recycling rates. Products containing these metals generally are incinerated, discarded as waste in landfills, or dismantled in informal recycling using crude and environmentally irresponsible procedures. Low metal recycling rates coupled with increasing demand for products containing them necessitate increased mining with attendant environmental, health, energy, water, and carbon-footprint consequences. In this tutorial review, challengesmore » to achieving metal sustainability in present high-tech society are presented; health, environmental, and economic incentives for various stakeholders to improve metal sustainability are discussed; a case for technical improvements in separations technology, especially employing molecular recognition, is given; and global consequences of continuing on the present path are examined.« less

SAM in a Nutshell.

ERIC Educational Resources Information Center

Givens, Larry R.

2000-01-01

Explains what the Association of Higher Education Facilities Officers' Strategic Assessment Model (SAM) is and how to use it to achieve organizational excellence through continuous improvement. Showing features of both the Malcolm Baldrige programs and the Balanced Scorecard, the SAM components are described along with an explanation of the four…

The Benefits of Improving Indoor Environmental Quality

ERIC Educational Resources Information Center

Lamping, Jerry

2012-01-01

As school funding levels nationwide continue to plummet amid public demands for increased student performance, an expanding body of research in the field of indoor environmental quality (IEQ) is providing greater statistical validity about the relationship between environmental conditions in school facilities and student achievement. Since the…

Assessment of Barriers to Changing Practice as CME Outcomes

ERIC Educational Resources Information Center

Price, David W.; Miller, Elaine K.; Rahm, Alanna Kulchak; Brace, Nancy E.; Larson, R. Sam

2010-01-01

Introduction: Continuing medical education (CME) is meant to drive and support improvements in practice. To achieve this goal, CME activities must move beyond simply purveying knowledge, instead helping attendees to contextualize information and to develop strategies for implementing new learning. CME attendees face different barriers to…

Cycle-Based Budgeting Toolkit: A Primer

ERIC Educational Resources Information Center

Yan, Bo

2016-01-01

At the core, budgeting is about distributing and redistributing limited financial resources for continuous improvement. Incremental budgeting is limited in achieving the goal due to lack of connection between outcomes and budget decisions. Zero-based budgeting fills the gap, but is cumbersome to implement, especially for large urban school…

Focus on Success

ERIC Educational Resources Information Center

Frey, Susan

2011-01-01

Successful middle schools do not happen by accident--they happen through leadership. Principals promote a shared vision that empowers school staffs to set high standards and continuously improve student achievement. And these middle grade educators also try to help their adolescent students see the connection between their work in school and their…

Educational Goals and Results, 1982-83.

ERIC Educational Resources Information Center

Wilson, Morris D.; Baldwin, Robert

As a function of Des Moines, Iowa's, planning and management system for improving educational services through coordinated, continuous planning and evaluation at all levels from superintendent to classroom teacher, this report measures the success of district administration and individual schools in achieving stated objectives for 1982-83. Five…

Improved ultrasonic TV images achieved by use of Lamb-wave orientation technique

NASA Technical Reports Server (NTRS)

Berger, H.

1967-01-01

Lamb-wave sample orientation technique minimizes the interference from standing waves in continuous wave ultrasonic television imaging techniques used with thin metallic samples. The sample under investigation is oriented such that the wave incident upon it is not normal, but slightly angled.

Strategy for 90% autoverification of clinical chemistry and immunoassay test results using six sigma process improvement.

PubMed

Randell, Edward W; Short, Garry; Lee, Natasha; Beresford, Allison; Spencer, Margaret; Kennell, Marina; Moores, Zoë; Parry, David

2018-06-01

Six Sigma involves a structured process improvement strategy that places processes on a pathway to continued improvement. The data presented here summarizes a project that took three clinical laboratories from autoverification processes that allowed between about 40% to 60% of tests being auto-verified to more than 90% of tests and samples auto-verified. The project schedule, metrics and targets, a description of the previous system and detailed information on the changes made to achieve greater than 90% auto-verification is presented for this Six Sigma DMAIC (Design, Measure, Analyze, Improve, Control) process improvement project.

[Sustainable process improvement with application of 'lean philosophy'].

PubMed

Rouppe van der Voort, Marc B V; van Merode, G G Frits; Veraart, Henricus G N

2013-01-01

Process improvement is increasingly being implemented, particularly with the aid of 'lean philosophy'. This management philosophy aims to improve quality by reducing 'wastage'. Local improvements can produce negative effects elsewhere due to interdependence of processes. An 'integrated system approach' is required to prevent this. Some hospitals claim that this has been successful. Research into process improvement with the application of lean philosophy has reported many positive effects, defined as improved safety, quality and efficiency. Due to methodological shortcomings and lack of rigorous evaluations it is, however, not yet possible to determine the impact of this approach. It is, however, obvious that the investigated applications are fragmentary, with a dominant focus on the instrumental aspect of the philosophy and a lack of integration in a total system, and with insufficient attention to human aspects. Process improvement is required to achieve better and more goal-oriented healthcare. To achieve this, hospitals must develop integrated system approaches that combine methods for process design with continuous improvement of processes and with personnel management. It is crucial that doctors take the initiative to guide and improve processes in an integral manner.

A method to improve the range resolution in stepped frequency continuous wave radar

NASA Astrophysics Data System (ADS)

Kaczmarek, Paweł

2018-04-01

In the paper one of high range resolution methods - Aperture Sampling - was analysed. Unlike MUSIC based techniques it proved to be very efficient in terms of achieving unambiguous synthetic range profile for ultra-wideband stepped frequency continuous wave radar. Assuming that minimal distance required to separate two targets in depth (distance) corresponds to -3 dB width of received echo, AS provided a 30,8 % improvement in range resolution in analysed scenario, when compared to results of applying IFFT. Output data is far superior in terms of both improved range resolution and reduced side lobe level than used typically in this area Inverse Fourier Transform. Furthermore it does not require prior knowledge or an estimate of number of targets to be detected in a given scan.

Computer-based simulation training to improve learning outcomes in mannequin-based simulation exercises.

PubMed

Curtin, Lindsay B; Finn, Laura A; Czosnowski, Quinn A; Whitman, Craig B; Cawley, Michael J

2011-08-10

To assess the impact of computer-based simulation on the achievement of student learning outcomes during mannequin-based simulation. Participants were randomly assigned to rapid response teams of 5-6 students and then teams were randomly assigned to either a group that completed either computer-based or mannequin-based simulation cases first. In both simulations, students used their critical thinking skills and selected interventions independent of facilitator input. A predetermined rubric was used to record and assess students' performance in the mannequin-based simulations. Feedback and student performance scores were generated by the software in the computer-based simulations. More of the teams in the group that completed the computer-based simulation before completing the mannequin-based simulation achieved the primary outcome for the exercise, which was survival of the simulated patient (41.2% vs. 5.6%). The majority of students (>90%) recommended the continuation of simulation exercises in the course. Students in both groups felt the computer-based simulation should be completed prior to the mannequin-based simulation. The use of computer-based simulation prior to mannequin-based simulation improved the achievement of learning goals and outcomes. In addition to improving participants' skills, completing the computer-based simulation first may improve participants' confidence during the more real-life setting achieved in the mannequin-based simulation.

77 FR 38066 - Medicare Program; Announcement of a New Opportunity for Participation in the Advance Payment...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

... achieving better health for populations, better health care for individuals, and lower growth in expenditures through continuous improvement for Medicare, Medicaid, and Children's Health Insurance Program... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-5505-N3...

Early High School Engagement in Students with Attention/Deficit Hyperactivity Disorder

ERIC Educational Resources Information Center

Zendarski, Nardia; Sciberras, Emma; Mensah, Fiona; Hiscock, Harriet

2017-01-01

Background: Students with attention/deficit hyperactivity disorder (ADHD) continue to languish behind their peers with regard to academic achievement and education attainment. School engagement is potentially modifiable, and targeting engagement may be a means to improve education outcomes. Aims: To investigate school engagement for students with…

K-12 Teacher Participation in Online Professional Development

ERIC Educational Resources Information Center

McNamara, Catherine Louise

2010-01-01

Effectiveness in education is a national concern and reform efforts continue to be championed with the hope of stimulating improvement to more effectively meet the needs of all students. Many reform efforts include a focus on teacher professional development to strengthen teacher pedagogy and positively impact student achievement. Rapid expansion…

Urban Principals' Second Order Change Leadership

ERIC Educational Resources Information Center

Taylor, Rosemarye T.; La Cava, Gonzalo S.

2011-01-01

Urban school leaders have challenges in continually improving student achievement and making change as quickly as needed. To address this problem 37 non-Title I principals completed an on-line survey, Principal's Actions Survey (PAS), based on the seven responsibilities for second order change identified by Marzano, Waters, and McNulty (2005).…

NCLB--Year for Change

ERIC Educational Resources Information Center

Odland, Jerry

2007-01-01

Much debate continues about whether the 2001 No Child Left Behind Act (NCLB) has actually improved the academic achievement level of poorly performing students or only created yet another layer of government oversight to an already heavily burdened public school system. Drafted in 2001 and signed into law in January 2002, NCLB provided the…

U.S. Department of Education Federal Student Aid Five-Year Plan, 2006-2010

ERIC Educational Resources Information Center

US Department of Education, 2006

2006-01-01

This document reflects Federal Student Aid's solid progress in meeting strategic objectives since becoming a Performance-Based Organization. Specifically, the plan addresses continuing efforts to increase program integrity, improve customer service and achieve measurable results in the management and administration of the Title IV student…

The Future of Tennessee: Higher Education 1987-1993.

ERIC Educational Resources Information Center

Tennessee Higher Education Commission, Nashville.

This master plan for higher education in Tennessee sketches a framework for the continued improvement of postsecondary institutions and emphasizes the critical links between higher education and other components of the state. A set of principles and achievement targets undergirding the master plan are outlined. Specific action is called for in…

Accreditation Outcome Scores: Teacher Attitudes toward the Accreditation Process and Professional Development

ERIC Educational Resources Information Center

Ulmer, Phillip Gregory

2015-01-01

Accreditation is an essential component in the history of education in the United States and is a central catalyst for quality education, continuous improvement, and positive growth in student achievement. Although previous researchers identified teachers as an essential component in meeting accreditation outcomes, additional information was…

Improving Business-IT Alignment through Business Architecture

ERIC Educational Resources Information Center

Li, Chingmei

2010-01-01

The business and Information Technology (IT) alignment issue has become one of the Top-10 IT management issues since 1980. IT has continually strived to achieve alignment with business goals and objectives. These IT efforts include ERP implementation to benefit from the best practices; data center consolidation and server virtualization to keep…

20 CFR 663.500 - What is the purpose of this subpart?

Code of Federal Regulations, 2010 CFR

2010-04-01

... emphasizes informed customer choice, system performance, and continuous improvement. The eligible provider process is part of the strategy for achieving these goals. Local Boards, in partnership with the State... population groups are served, States and local areas should administer the eligible provider process in a...

Professional Development: Sorting through the Jumble to Achieve Success

ERIC Educational Resources Information Center

Education Week, 2010

2010-01-01

Few in the education field discount the eminently logical idea that teachers should be supported in the continuous improvement of their craft. But as a term for describing ongoing training investments in the teaching force, "professional development" has become both ubiquitous and all but meaningless. Though frequently invoked by…

District Leadership Supporting PLC Implementation in a Rapid Growth District

ERIC Educational Resources Information Center

Tinsley, Laurie

2016-01-01

A growing body of work has emerged regarding the responsibilities required of district leaders in establishing plans that initiate and create conditions for sustainability of continuous improvement achieved through a systemic reform structure such as professional learning communities. However, limited research exists in respect to sustaining…

Singapore Takes Six Steps Forward in 'The Quality of Death Index' Rankings.

PubMed

Lin Goh, Stella Seow

2018-01-01

In the latest 2015 Quality of Death Index, Singapore managed to move SIX steps forward from 18 th to the 12 th position. This advancement has been hard-won, with victories to improve the level of palliative care such as creating awareness of palliative service, improving coordinated care and growing an adequate capacity to meet the demand of care in our fast -growing ageing population. But it hasn't always been easy. Despite being a first world country, Asian societies like Singapore have inherited taboos regarding public dialogue about death and dying. Such dialogue is traditionally avoided. However, through years of continual effort in improving the standard of palliative care delivery, redesigning education module, creating public awareness and improving funding system, Singapore's palliative care providers have improved the lives of those with life-limiting illnesses. Nevertheless, the government will continue to improve and work toward achieving single digits in the next ranking of the Quality of Death Index.

Self-Test: A student Evaluates the Change in His Academic Progress after Receiving a PDA--And Then Tests His Peers

ERIC Educational Resources Information Center

Bick, Alex

2005-01-01

Several years ago, upon entering eighth grade, a student was given a Microsoft iPaq Pocket PC as a birthday present. After using it for several months, he noticed a distinct improvement in my grades. During the rest of the school year, he noticed that the improved academic achievement continued. He wondered if his experience was a mere fluke or…

Quality Improvement on the Acute Inpatient Psychiatry Unit Using the Model for Improvement

PubMed Central

Singh, Kuldeep; Sanderson, Joshua; Galarneau, David; Keister, Thomas; Hickman, Dean

2013-01-01

Background A need exists for constant evaluation and modification of processes within healthcare systems to achieve quality improvement. One common approach is the Model for Improvement that can be used to clearly define aims, measures, and changes that are then implemented through a plan-do-study-act (PDSA) cycle. This approach is a commonly used method for improving quality in a wide range of fields. The Model for Improvement allows for a systematic process that can be revised at set time intervals to achieve a desired result. Methods We used the Model for Improvement in an acute psychiatry unit (APU) to improve the screening incidence of abnormal involuntary movements in eligible patients—those starting or continuing on standing neuroleptics—with the Abnormal Involuntary Movement Scale (AIMS). Results After 8 weeks of using the Model for Improvement, both of the participating inpatient services in the APU showed substantial overall improvement in screening for abnormal involuntary movements using the AIMS. Conclusion Crucial aspects of a successful quality improvement initiative based on the Model for Improvement are well-defined goals, process measures, and structured PDSA cycles. Success also requires communication, organization, and participation of the entire team. PMID:24052768

Quality improvement on the acute inpatient psychiatry unit using the model for improvement.

PubMed

Singh, Kuldeep; Sanderson, Joshua; Galarneau, David; Keister, Thomas; Hickman, Dean

2013-01-01

A need exists for constant evaluation and modification of processes within healthcare systems to achieve quality improvement. One common approach is the Model for Improvement that can be used to clearly define aims, measures, and changes that are then implemented through a plan-do-study-act (PDSA) cycle. This approach is a commonly used method for improving quality in a wide range of fields. The Model for Improvement allows for a systematic process that can be revised at set time intervals to achieve a desired result. We used the Model for Improvement in an acute psychiatry unit (APU) to improve the screening incidence of abnormal involuntary movements in eligible patients-those starting or continuing on standing neuroleptics-with the Abnormal Involuntary Movement Scale (AIMS). After 8 weeks of using the Model for Improvement, both of the participating inpatient services in the APU showed substantial overall improvement in screening for abnormal involuntary movements using the AIMS. Crucial aspects of a successful quality improvement initiative based on the Model for Improvement are well-defined goals, process measures, and structured PDSA cycles. Success also requires communication, organization, and participation of the entire team.

Continuous cryopump with a device for regenerating the cryosurface

DOEpatents

Foster, Christopher A.

1988-01-01

A high throughput continuous cryopump is provided. The cryopump (10) incorporates an improved method for regenerating the cryopumping surface (22) while the pump is in continuous operation. The regeneration of the cryopumping surface (22) does not thermally cycle the pump, and to this end a small chamber (91) connected to a secondary pumping source (60) serves to contain and exhaust frost removed from the cryopumping surface (22) during such regeneration. The frost is exhausted at a rate substantially independent of the speed of the cryopump which enhances the capability of the pump to achieve a high compression ratio and allow the pump to operate continuously while the cryopumping surface is being regenerated.

Blast optimization for improved dragline productivity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Humphreys, M.; Baldwin, G.

1994-12-31

A project aimed at blast optimization for large open pit coal mines is utilizing blast monitoring and analysis techniques, advanced dragline monitoring equipment, and blast simulation software, to assess the major controlling factors affecting both blast performance and subsequent dragline productivity. This has involved collaborative work between the explosives supplier, mine operator, monitoring equipment manufacturer, and a mining research organization. The results from trial blasts and subsequently monitored dragline production have yielded promising results and continuing studies are being conducted as part of a blast optimization program. It should be stressed that the optimization of blasting practices for improved draglinemore » productivity is a site specific task, achieved through controlled and closely monitored procedures. The benefits achieved at one location can not be simply transferred to another minesite unless similar improvement strategies are first implemented.« less

Visit, revamp, and revitalize your business plan: Part 2.

PubMed

Waldron, David

2011-01-01

The diagnostic imaging department strives for the highest quality outcomes in imaging quality, in diagnostic reporting, and in providing a caring patient experience while also satisfying the needs of referring physicians. Understand how tools such as process mapping and concepts such as Six Sigma and Lean Six Sigma can be used to facilitate quality improvements and team building, resulting in staff led process improvement initiatives. Discover how to integrate a continuous staff management cycle to implement process improvements,capture the promised performance improvements, and achieve a culture change away from the "way it has always been done".

[Patterns of coping strategies after bereavement among spouses of cancer patients].

PubMed

Asai, Mariko; Matsui, Yutaka; Uchitomi, Yosuke

2013-12-01

The purposes of this study were (1) to identify healthy and unhealthy patterns of coping strategies after bereavement among spouses of cancer patients and 2) to explore the characteristics of patients and spouses associated with these patterns of coping strategies. The participants were 821 bereaved individuals whose spouses had died at the National Cancer Center Hospital East. Three patterns of coping strategies after bereavement were found: "Distraction Focused" (healthy), "Continuing Bonds Focused" (unhealthy), and "General Coping" (almost healthy). Two strategies for improving the unhealthy coping patterns of "Continuing Bonds Focused" were (1) enhancing "Distraction" and reducing "Continuing Bonds" for achieving "Distraction Focused" (healthy) and (2) enhancing both "Distraction" and "Social Sharing/Reconstruction" for achieving "General Coping" (almost healthy). The patients' characteristics associated with the bereaved spouses' coping strategy of "Continuing Bonds Focused" were "under 65 years", "history of psychiatric consultation", "duration of last hospital admission was less than one week", and "time since cancer diagnosis to death was less than one year". These four characteristics of the deceased patients were considered to be risk factors for spouses who would utilize unhealthy coping patterns after bereavement.

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial

PubMed Central

Engels, Yvonne; van den Hombergh, Pieter; Mokkink, Henk; van den Hoogen, Henk; van den Bosch, Wil; Grol, Richard

2006-01-01

Aim To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management. Design of study Randomised controlled trial. Setting Twenty-six intervention and 23 control primary care practices in the Netherlands. Method Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later. Results Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant. Conclusion The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument. PMID:17007709

Continuous Manufacturing of Recombinant Therapeutic Proteins: Upstream and Downstream Technologies.

PubMed

Patil, Rohan; Walther, Jason

2017-03-07

Continuous biomanufacturing of recombinant therapeutic proteins offers several potential advantages over conventional batch processing, including reduced cost of goods, more flexible and responsive manufacturing facilities, and improved and consistent product quality. Although continuous approaches to various upstream and downstream unit operations have been considered and studied for decades, in recent years interest and application have accelerated. Researchers have achieved increasingly higher levels of process intensification, and have also begun to integrate different continuous unit operations into larger, holistically continuous processes. This review first discusses approaches for continuous cell culture, with a focus on perfusion-enabling cell separation technologies including gravitational, centrifugal, and acoustic settling, as well as filtration-based techniques. We follow with a review of various continuous downstream unit operations, covering categories such as clarification, chromatography, formulation, and viral inactivation and filtration. The review ends by summarizing case studies of integrated and continuous processing as reported in the literature.

Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

PubMed

Tetteh, Hassan A

2012-01-01

Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. Published by Elsevier Inc.

Closing the Social Class Achievement Gap for First-Generation Students in Undergraduate Biology

PubMed Central

Harackiewicz, Judith M.; Canning, Elizabeth A.; Tibbetts, Yoi; Giffen, Cynthia J.; Blair, Seth S.; Rouse, Douglas I.; Hyde, Janet S.

2014-01-01

Many students start college intending to pursue a career in the biosciences, but too many abandon this goal because they struggle in introductory biology. Interventions have been developed to close achievement gaps for underrepresented minority students and women, but no prior research has attempted to close the gap for first-generation students, a population that accounts for nearly a fifth of college students. We report a values affirmation intervention conducted with 798 U.S. students (154 first-generation) in an introductory biology course for majors. For first-generation students, values affirmation significantly improved final course grades and retention in the second course in the biology sequence, as well as overall GPA for the semester. This brief intervention narrowed the achievement gap between first-generation and continuing generation students for course grades by 50% and increased retention in a critical gateway course by 20%. Our results suggest that educators can expand the pipeline for first-generation students to continue studying in the biosciences with psychological interventions. PMID:25049437

Chapter 24: Strategic Energy Management (SEM) Evaluation Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stewart, James

Strategic energy management (SEM) focuses on achieving energy-efficiency improvements through systematic and planned changes in facility operations, maintenance, and behaviors (OM&B) and capital equipment upgrades in large energy-using facilities, including industrial buildings, commercial buildings, and multi-facility organizations such as campuses or communities. Facilities can institute a spectrum of SEM actions, ranging from a simple process for regularly identifying energy-savings actions, to establishing a formal, third-party recognized or certified SEM framework for continuous improvement of energy performance. In general, SEM programs that would be considered part of a utility program will contain a set of energy-reducing goals, principles, and practices emphasizingmore » continuous improvements in energy performance or savings through energy management and an energy management system (EnMS).« less

Principles of continuous quality improvement applied to intravenous therapy.

PubMed

Dunavin, M K; Lane, C; Parker, P E

1994-01-01

Documentation of the application of the principles of continuous quality improvement (CQI) to the health care setting is crucial for understanding the transition from traditional management models to CQI models. A CQI project was designed and implemented by the IV Therapy Department at Lawrence Memorial Hospital to test the application of these principles to intravenous therapy and as a learning tool for the entire organization. Through a prototype inventory project, significant savings in cost and time were demonstrated using check sheets, flow diagrams, control charts, and other statistical tools, as well as using the Plan-Do-Check-Act cycle. As a result, a primary goal, increased time for direct patient care, was achieved. Eight hours per week in nursing time was saved, relationships between two work areas were improved, and $6,000 in personnel costs, storage space, and inventory were saved.

[Organizational capacity for continuous improvement of health services].

PubMed

Saturno-Hernández, Pedro J; Hernández-Avila, Mauricio; Magaña-Valladares, Laura; Garcia-Saisó, Sebastián; Vertiz-Ramírez, José de Jesús

2015-01-01

While the Mexican health system has achieved significant progress, as reflected in the growing improvement in population health, heterogeneity in the quality of services and its impact on health in different population groups is still a challenge. The costs or poor quality represent about 20 to 40% of the health system's expenditure. We need to develop organizational capacity to implement quality management systems in order to identify, evaluate, prevent and eventually overcome the health system's challenges. A competency-based comprehensive strategy for training human resources is proposed including undergraduate and graduate education as well as continuing education, which will contribute to improve the quality function at the various levels of responsibility in the health system. The proposed strategy responds to the context of the Mexican health system, but it could be adapted to other systems and contexts.

Ad Hoc Access Gateway Selection Algorithm

NASA Astrophysics Data System (ADS)

Jie, Liu

With the continuous development of mobile communication technology, Ad Hoc access network has become a hot research, Ad Hoc access network nodes can be used to expand capacity of multi-hop communication range of mobile communication system, even business adjacent to the community, improve edge data rates. For mobile nodes in Ad Hoc network to internet, internet communications in the peer nodes must be achieved through the gateway. Therefore, the key Ad Hoc Access Networks will focus on the discovery gateway, as well as gateway selection in the case of multi-gateway and handover problems between different gateways. This paper considers the mobile node and the gateway, based on the average number of hops from an average access time and the stability of routes, improved gateway selection algorithm were proposed. An improved gateway selection algorithm, which mainly considers the algorithm can improve the access time of Ad Hoc nodes and the continuity of communication between the gateways, were proposed. This can improve the quality of communication across the network.

Performance improvement of eight-state continuous-variable quantum key distribution with an optical amplifier

NASA Astrophysics Data System (ADS)

Guo, Ying; Li, Renjie; Liao, Qin; Zhou, Jian; Huang, Duan

2018-02-01

Discrete modulation is proven to be beneficial to improving the performance of continuous-variable quantum key distribution (CVQKD) in long-distance transmission. In this paper, we suggest a construct to improve the maximal generated secret key rate of discretely modulated eight-state CVQKD using an optical amplifier (OA) with a slight cost of transmission distance. In the proposed scheme, an optical amplifier is exploited to compensate imperfection of Bob's apparatus, so that the generated secret key rate of eight-state protocol is enhanced. Specifically, we investigate two types of optical amplifiers, phase-insensitive amplifier (PIA) and phase-sensitive amplifier (PSA), and thereby obtain approximately equivalent improved performance for eight-state CVQKD system when applying these two different amplifiers. Numeric simulation shows that the proposed scheme can well improve the generated secret key rate of eight-state CVQKD in both asymptotic limit and finite-size regime. We also show that the proposed scheme can achieve the relatively high-rate transmission at long-distance communication system.

A multi-institutional quality improvement initiative to transform education for chronic illness care in resident continuity practices.

PubMed

Stevens, David P; Bowen, Judith L; Johnson, Julie K; Woods, Donna M; Provost, Lloyd P; Holman, Halsted R; Sixta, Constance S; Wagner, Ed H

2010-09-01

There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care. To improve training for residents who provide chronic illness care in teaching practice settings. US teaching hospitals were invited to participate in one of two 18-month Breakthrough Series Collaboratives-either a national Collaborative, or a subsequent California Collaborative-to implement the Chronic Care Model (CCM) and related curriculum changes in resident practices. Most practices focused on patients with diabetes mellitus. Educational redesign strategies with related performance measures were developed for curricular innovations anchored in the CCM. In addition, three clinical measures-HbA1c <7%, LDL <100 mg/dL, and blood pressure

A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices

PubMed Central

Bowen, Judith L.; Johnson, Julie K.; Woods, Donna M.; Provost, Lloyd P.; Holman, Halsted R.; Sixta, Constance S.; Wagner, Ed H.

2010-01-01

BACKGROUND There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care. OBJECTIVE To improve training for residents who provide chronic illness care in teaching practice settings. DESIGN US teaching hospitals were invited to participate in one of two 18-month Breakthrough Series Collaboratives—either a national Collaborative, or a subsequent California Collaborative—to implement the Chronic Care Model (CCM) and related curriculum changes in resident practices. Most practices focused on patients with diabetes mellitus. Educational redesign strategies with related performance measures were developed for curricular innovations anchored in the CCM. In addition, three clinical measures—HbA1c <7%, LDL <100 mg/dL, and blood pressure ≤130/80—and three process measures—retinal and foot examinations, and patient self-management goals—were tracked. PARTICIPANTS Fifty-seven teams from 37 self-selected teaching hospitals committed to implement the CCM in resident continuity practices; 41 teams focusing on diabetes improvement participated over the entire duration of one of the Collaboratives. INTERVENTIONS Teaching-practice teams—faculty, residents and staff—participated in Collaboratives by attending monthly calls and regular 2-day face-to-face meetings with the other teams. The national Collaborative faculty led calls and meetings. Each team used rapid cycle quality improvement (PDSA cycles) to implement the CCM and curricular changes. Teams reported education and clinical performance measures monthly. RESULTS Practices underwent extensive redesign to establish CCM elements. Education measures tracked substantial development of CCM-related learning. The clinical and process measures improved, however inconsistently, during the Collaboratives. CONCLUSIONS These initiatives suggest that systematic practice redesign for implementing the CCM along with linked educational approaches are achievable in resident continuity practices. Improvement of clinical outcomes in such practices is daunting but achievable. PMID:20737232

Improving Science Achievement through Changes in Education Policy

ERIC Educational Resources Information Center

Owens, Tara M.

2009-01-01

Concerns over science education in the United States continue to grow due to the increasing global demands and competitiveness for careers in science and technology. This author contends that educators in the United States must look for ways to increase science proficiency and overall science literacy. Research about how students learn science…

Using Quality Enhancement Processes to Achieve Sustainable Development and Support for Sessional Staff

ERIC Educational Resources Information Center

Lekkas, D.; Winning, T. A.

2017-01-01

Consistent with quality enhancement, we report on how we used a continuous improvement cycle to formalise and embed an academic development and support programme for our School's sessional staff. Key factors in establishing and maintaining the programme included: local change agents supported initially by institutional project funding; School…

Improving Electrical Engineering Education at the American University of Sharjah through Continuous Assessment

ERIC Educational Resources Information Center

Al-Nashash, Hasan; Khaliq, Abdul; Qaddoumi, Nasser; Al-Assaf, Yousef; Assaleh, Khaled; Dhaouadi, Rached; El-Tarhuni, Mohamed

2009-01-01

The electrical engineering (ELE) program at the American University of Sharjah (AUS) is designed to fulfill the ABET criteria. Several assessment tools are used to qualitatively and quantitatively measure the level of achievement of the program's educational objectives and outcomes. These tools include alumni, employer, and graduate advisor…

Using Laptop Technology to Improve Mathematical Achievement Rates: A Quasi-Experimental Study

ERIC Educational Resources Information Center

Brown, Rebecca

2018-01-01

The specific problem that initiated this study was a continually high percentage of students not passing the mathematics section of the state mandated end of course assessment. The purpose of this study centered on determining whether or not laptop interventions, directed towards increasing student success on high stakes standardized assessments…

Achieving the Goals. Goal 4: Teacher Education and Professional Development.

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

Goal 4 of the National Education Goals envisions that teachers will have access to programs for the continued improvement of their professional skills. This book examines what federal agencies are doing to enhance teacher preparation, presents information on career-long development, and offers program descriptions and contact names. The first…

Reacting to 'Irregular' Learning Environments in a Senior Secondary School

ERIC Educational Resources Information Center

Alterator, Scott; Deed, Craig

2016-01-01

Modern school design continues to incorporate openness and irregularity as a means of achieving improvement. Irregular learning environments can act as a catalyst for student unsettling and enable possibilities of teacher practice. We outline a case study of teacher adaptation to irregular environments in a senior school setting. We argue that…

The Relationship between Academic Performance and Elementary Student and Teacher Attitudes towards Departmentalizing

ERIC Educational Resources Information Center

Freiberg, Elizabeth J.

2014-01-01

In response to the continued pressure placed on American public schools to increase academic achievement, some schools have begun to reorganize instructional environments in an effort to improve student outcomes. The current study examined one such elementary school that implemented a departmentalized model of instruction in fourth and fifth-grade…

Achieving excellence--creating customer passion.

PubMed

Scheuing, E E

1999-08-01

Customers are the lifeblood of any organization. Without them, it loses its meaning and purpose. Customers provide incentive, vitality, and growth. Serving them well requires a customer-focused culture and a customer-friendly system. It also requires unrelenting effort toward continuous improvement, but the rewards are well worth the effort: unflinching customer loyalty, sustainable growth, and impressive performance.

Promoting Accountability and Continual Improvement: A Review of the Respective Roles of Performance Measurement, Auditing, Evaluation, and Reporting.

ERIC Educational Resources Information Center

Reid, William

1999-01-01

Provides a synthesis of the literature pertaining to the principles and practices of performance measurement, auditing, evaluation, and reporting. Discusses how bringing these elements together in a performance management system can be achieved through refinement of strategic direction, reporting on key measures, and periodic, systematic…

Revisiting Teacher Adoption of Technology: Research Implications and Recommendations for Successful Full Technology Integration

ERIC Educational Resources Information Center

Buckenmeyer, Janet

2008-01-01

Most teachers are still failing to fully integrate technologies in their classrooms to improve student achievement. If certain conditions exist, however, they are more likely to accept and use appropriate technologies in significant instructional ways. Relevant professional development and continuous access to needed resources are two significant…

Can Comparison of Contrastive Examples Facilitate Graph Understanding?

ERIC Educational Resources Information Center

Smith, Linsey A.; Gentner, Dedre

2011-01-01

The authors explore the role of comparison in improving graph fluency. The ability to use graphs fluently is crucial for STEM achievement, but graphs are challenging to interpret and produce because they often involve integration of multiple variables, continuous change in variables over time, and omission of certain details in order to highlight…

The Best Things May Be Free

ERIC Educational Resources Information Center

Riddile, Mel

2010-01-01

Doing more with less is a familiar theme across the country. For many schools and districts, counting on the adoption of costly, expensive programs is unrealistic. Schools are expected to continue to raise student achievement regardless of the state of the economy. The bad news is that schools must improve with the same resources and the same…

High skew link slab bridge system with deck sliding over backwall or backwall sliding over abutments : part II.

DOT National Transportation Integrated Search

2011-09-30

A new bridge design and construction trend to help improve durability and rideability is to remove expansion joints over piers and abutments. One approach to achieve this is to make the deck continuous over the piers by means of a link slab while the...

The Relationship between Computer-Assisted Language Learning and Student Achievement on Language Tests

ERIC Educational Resources Information Center

Umstead, Lyubov

2013-01-01

The number of English Language Learners (ELLs) is rapidly growing. Teachers continue facing challenges in providing effective content instruction to ELLs while helping them learn English. New and improved approaches are necessary to meet the individual learning needs of this diverse group of students and help them progress academically while…

Urban Youth with Disabilities: Factors Affecting Transition Employment

ERIC Educational Resources Information Center

Fabian, Ellen S.

2007-01-01

Although postsecondary employment outcomes for transition-age youth with disabilities have improved over the past decade, minority youth with disabilities continue to lag behind their peers in achieving a job. This study of predominantly minority youth participating in the Marriott Foundation's Bridges From School to Work Program from 2000 to 2005…

Schools: The Evidence on Academies, Resources and Pupil Performance. Paper No. EA023

ERIC Educational Resources Information Center

McNally, Sandra

2015-01-01

England's performance in international tests of student achievement continues to be disappointing. Further improvement is essential not only for students' themselves but also for economic growth. This briefing considers the impact of Academies, school spending and teacher quality. Research evidence suggests that it is right to protect school…

High skew link slab bridge system with deck sliding over backwall or backwall sliding over abutments : part I.

DOT National Transportation Integrated Search

2011-09-30

A new bridge design and construction trend to help improve durability and rideability is to remove expansion : joints over piers and abutments. One approach to achieve this is to make the deck continuous over the piers by : means of a link slab while...

Collaboration with HEIs: A Key Capacity Building Block for the Uganda Water and Sanitation Public Sector

ERIC Educational Resources Information Center

Kayaga, Sam

2007-01-01

The capacity of public service staff in developing countries is crucial for achieving the Millennium Development Goals. Literature from developed countries shows that, working with higher education institutions (HEIs), industries have improved their human resource capacity through continuing professional development. This paper reports on research…

Effects of Differentiated Instruction on Student Achievement in Reading

ERIC Educational Resources Information Center

Gilbert, Darryl L.

2011-01-01

Reading teachers are faced with the challenge of providing instruction to a population of diverse students with various abilities and styles of learning within local and state school districts. In an effort to improve student performance on high-stake examinations in reading, teachers continue to seek the most effective instructional strategies.…

Refusing analgesics: using continuous improvement to improve pain management on a surgical ward.

PubMed

Carr, Eloise C J

2002-11-01

Despite advances in pain control many patients experience moderate to severe pain whilst in hospital. Contributory factors include inadequate assessment and documentation of pain, as well as patient and professional misconceptions. A 28-bedded surgical ward in a District General Hospital in the South of England was the setting for the project. A small preliminary audit of pain on this ward indicated that some patients experienced postoperative pain, which was not effectively controlled. A 'continuous improvement' framework was used to increase understanding of the problem and identify an aim for the project, which was to reduce the number of patients refusing analgesics when offered by nurses. An audit to ascertain how many patients refused analgesia revealed that, of 133 patients offered, 93 (70%) refused. Using the 'Model for Improvement' (Langley et al., 1996) a number of changes were introduced, including a patient information sheet, regular documented pain assessment and an innovative staff education programme. To evaluate if the changes in practice had been successful, further audit data were collected from 167 patients. Sixty-three (44%) accepted analgesics, indicating a significant decrease in the number refusing (P = 0.005). This small project demonstrated that continuous improvement methodology can improve the management of pain and quality of care for patients. Such an approach brings practitioner and patient into meaningful understanding and offers solutions which are realistic, achievable and sustainable over time. Despite finite resources and increased pressure on staff it is possible to motivate people when they feel they have ownership and change is meaningful. Continuous improvement methods offer an exciting, feasible, patient-centred approach to improving care.

Out in the cold: the hypothermic heart response

PubMed Central

Nabeel, Yassar; Ali, Omair

2014-01-01

We present an interesting case of a 49-year-old woman with hypothermia and associated Osborn waves (also called J waves) on ECG. She was found on the floor of her home and difficult to arouse. On arrival to the emergency department (ED), her rectal temperature was 87.5°F. ECG showed Osborn waves in diffuse leads. She was intubated in the ED and was started on vasopressor support for hypotension refractory to intravenous fluid boluses. She was transferred to the critical care unit for continued respiratory and cardiovascular support. With active external rewarming her core body temperature continued to improve. Blood pressure also improved and vasopressor was tapered off. She was extubated and was transferred to the medical floor for continued supportive care. Osborn waves on ECG resolved within 12 h of achieving normal range body temperature. The patient was eventually discharged home with medical follow-up. PMID:25406217

Out in the cold: the hypothermic heart response.

PubMed

Nabeel, Yassar; Ali, Omair

2014-11-18

We present an interesting case of a 49-year-old woman with hypothermia and associated Osborn waves (also called J waves) on ECG. She was found on the floor of her home and difficult to arouse. On arrival to the emergency department (ED), her rectal temperature was 87.5°F. ECG showed Osborn waves in diffuse leads. She was intubated in the ED and was started on vasopressor support for hypotension refractory to intravenous fluid boluses. She was transferred to the critical care unit for continued respiratory and cardiovascular support. With active external rewarming her core body temperature continued to improve. Blood pressure also improved and vasopressor was tapered off. She was extubated and was transferred to the medical floor for continued supportive care. Osborn waves on ECG resolved within 12 h of achieving normal range body temperature. The patient was eventually discharged home with medical follow-up. 2014 BMJ Publishing Group Ltd.

Continuous in vitro evolution of catalytic function.

PubMed

Wright, M C; Joyce, G F

1997-04-25

A population of RNA molecules that catalyze the template-directed ligation of RNA substrates was made to evolve in a continuous manner in the test tube. A simple serial transfer procedure was used to achieve approximately 300 successive rounds of catalysis and selective amplification in 52 hours. During this time, the population size was maintained against an overall dilution of 3 x 10(298). Both the catalytic rate and amplification rate of the RNAs improved substantially as a consequence of mutations that accumulated during the evolution process. Continuous in vitro evolution makes it possible to maintain laboratory "cultures" of catalytic molecules that can be perpetuated indefinitely.

Continuous in vitro evolution of catalytic function

NASA Technical Reports Server (NTRS)

Wright, M. C.; Joyce, G. F.

1997-01-01

A population of RNA molecules that catalyze the template-directed ligation of RNA substrates was made to evolve in a continuous manner in the test tube. A simple serial transfer procedure was used to achieve approximately 300 successive rounds of catalysis and selective amplification in 52 hours. During this time, the population size was maintained against an overall dilution of 3 x 10(298). Both the catalytic rate and amplification rate of the RNAs improved substantially as a consequence of mutations that accumulated during the evolution process. Continuous in vitro evolution makes it possible to maintain laboratory "cultures" of catalytic molecules that can be perpetuated indefinitely.

Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members.

PubMed

Brandrud, Aleidis Skard; Schreiner, Ada; Hjortdahl, Per; Helljesen, Gro Sævil; Nyen, Bjørnar; Nelson, Eugene C

2011-03-01

The objectives of the Breakthrough Series Collaborative are to close the gap between what we know and what we do, and to contribute to continuous quality improvement (CQI) of healthcare through collaborative learning. The improvement efforts are guided by a systematic approach, combining professional and improvement knowledge. To explore what the improvement teams have learnt from participating in the collaborative and from dealing with promoting and inhibiting factors encountered. Qualitative interviews with 19 team members were conducted in four focus groups, using the Critical Incident Technique. A critical incident is one that makes significant contributions, either positively or negatively, to an activity. The elements of a culture of improvement are revealed by the critical incidents, and reflect the eight domains of knowledge, as a product of collaborative learning. The improvement knowledge and skills of individuals are important elements, but not enough to achieve sustainable changes. 90% of the material reflects the need for a system of CQI to solve the problems that organisations experience in trying to make lasting improvements. A pattern of three success factors for CQI emerges: (1) continuous and reliable information, including measurement, about best and current practice; (2) engagement of everybody in all phases of the improvement work: the patient and family, the leadership, the professional environment and the staff; and (3) an infrastructure based on improvement knowledge, with multidisciplinary teams, available coaching, learning systems and sustainability systems.

Focused process improvement events: sustainability of impact on process and performance in an academic radiology department.

PubMed

Rosenkrantz, Andrew B; Lawson, Kirk; Ally, Rosina; Chen, David; Donno, Frank; Rittberg, Steven; Rodriguez, Joan; Recht, Michael P

2015-01-01

To evaluate sustainability of impact of rapid, focused process improvement (PI) events on process and performance within an academic radiology department. Our department conducted PI during 2011 and 2012 in CT, MRI, ultrasound, breast imaging, and research billing. PI entailed participation by all stakeholders, facilitation by the department chair, collection of baseline data, meetings during several weeks, definition of performance metrics, creation of an improvement plan, and prompt implementation. We explore common themes among PI events regarding initial impact and durability of changes. We also assess performance in each area pre-PI, immediately post-PI, and at the time of the current study. All PI events achieved an immediate improvement in performance metrics, often entailing both examination volumes and on-time performance. IT-based solutions, process standardization, and redefinition of staff responsibilities were often central in these changes, and participants consistently expressed improved internal leadership and problem-solving ability. Major environmental changes commonly occurred after PI, including a natural disaster with equipment loss, a change in location or services offered, and new enterprise-wide electronic medical record system incorporating new billing and radiology informatics systems, requiring flexibility in the PI implementation plan. Only one PI team conducted regular post-PI follow-up meetings. Sustained improvement was frequently, but not universally, observed: in the long-term following initial PI, measures of examination volume showed continued progressive improvements, whereas measures of operational efficiency remained stable or occasionally declined. Focused PI is generally effective in achieving performance improvement, although a changing environment influences the sustainability of impact. Thus, continued process evaluation and ongoing workflow modifications are warranted. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Closing the social-class achievement gap: a difference-education intervention improves first-generation students' academic performance and all students' college transition.

PubMed

Stephens, Nicole M; Hamedani, MarYam G; Destin, Mesmin

2014-04-01

College students who do not have parents with 4-year degrees (first-generation students) earn lower grades and encounter more obstacles to success than do students who have at least one parent with a 4-year degree (continuing-generation students). In the study reported here, we tested a novel intervention designed to reduce this social-class achievement gap with a randomized controlled trial (N = 168). Using senior college students' real-life stories, we conducted a difference-education intervention with incoming students about how their diverse backgrounds can shape what they experience in college. Compared with a standard intervention that provided similar stories of college adjustment without highlighting students' different backgrounds, the difference-education intervention eliminated the social-class achievement gap by increasing first-generation students' tendency to seek out college resources (e.g., meeting with professors) and, in turn, improving their end-of-year grade point averages. The difference-education intervention also improved the college transition for all students on numerous psychosocial outcomes (e.g., mental health and engagement).

[Health reform in the USA].

PubMed

Ganduglia, Cecilia

2010-01-01

The United States of America passed early this year the bill enforcing their health reform. this reform aims at achieving universal insurance, cost containment and improving quality of care. The debate around this reform has been long and unable to arrive to an agreement between the parts. Even if the expansion in the medical coverage system does not reduce to zero the current degree of inaccessibility to the health system, these achievements could be considered a very important first step. Nonetheless, chances are that this reform will continue being as polemic as the negotiations previous to its conception.

Potential of Continuous Manufacturing for Liposomal Drug Products.

PubMed

Worsham, Robert D; Thomas, Vaughan; Farid, Suzanne S

2018-05-21

Over the last several years, continuous manufacturing of pharmaceuticals has evolved from bulk APIs and solid oral dosages into the more complex realm of biologics. The development of continuous downstream processing techniques has allowed biologics manufacturing to realize the benefits (e.g. improved economics, more consistent quality) that come with continuous processing. If relevant processing techniques and principles are selected, the opportunity arises to develop continuous manufacturing designs for additional pharmaceutical products including liposomal drug formulations. Liposome manufacturing has some inherent aspects that make it favorable for a continuous process. Other aspects such as formulation refinement, materials of construction, and aseptic processing need development, but present an achievable challenge. This paper reviews the current state of continuous manufacturing technology applicable to liposomal drug product manufacturing and an assessment of the challenges and potential of this application. This article is protected by copyright. All rights reserved.

Cardiorespiratory dynamics measured from continuous ECG monitoring improves detection of deterioration in acute care patients: A retrospective cohort study

PubMed Central

Clark, Matthew T.; Calland, James Forrest; Enfield, Kyle B.; Voss, John D.; Lake, Douglas E.; Moorman, J. Randall

2017-01-01

Background Charted vital signs and laboratory results represent intermittent samples of a patient’s dynamic physiologic state and have been used to calculate early warning scores to identify patients at risk of clinical deterioration. We hypothesized that the addition of cardiorespiratory dynamics measured from continuous electrocardiography (ECG) monitoring to intermittently sampled data improves the predictive validity of models trained to detect clinical deterioration prior to intensive care unit (ICU) transfer or unanticipated death. Methods and findings We analyzed 63 patient-years of ECG data from 8,105 acute care patient admissions at a tertiary care academic medical center. We developed models to predict deterioration resulting in ICU transfer or unanticipated death within the next 24 hours using either vital signs, laboratory results, or cardiorespiratory dynamics from continuous ECG monitoring and also evaluated models using all available data sources. We calculated the predictive validity (C-statistic), the net reclassification improvement, and the probability of achieving the difference in likelihood ratio χ2 for the additional degrees of freedom. The primary outcome occurred 755 times in 586 admissions (7%). We analyzed 395 clinical deteriorations with continuous ECG data in the 24 hours prior to an event. Using only continuous ECG measures resulted in a C-statistic of 0.65, similar to models using only laboratory results and vital signs (0.63 and 0.69 respectively). Addition of continuous ECG measures to models using conventional measurements improved the C-statistic by 0.01 and 0.07; a model integrating all data sources had a C-statistic of 0.73 with categorical net reclassification improvement of 0.09 for a change of 1 decile in risk. The difference in likelihood ratio χ2 between integrated models with and without cardiorespiratory dynamics was 2158 (p value: <0.001). Conclusions Cardiorespiratory dynamics from continuous ECG monitoring detect clinical deterioration in acute care patients and improve performance of conventional models that use only laboratory results and vital signs. PMID:28771487

Cardiorespiratory dynamics measured from continuous ECG monitoring improves detection of deterioration in acute care patients: A retrospective cohort study.

PubMed

Moss, Travis J; Clark, Matthew T; Calland, James Forrest; Enfield, Kyle B; Voss, John D; Lake, Douglas E; Moorman, J Randall

2017-01-01

Charted vital signs and laboratory results represent intermittent samples of a patient's dynamic physiologic state and have been used to calculate early warning scores to identify patients at risk of clinical deterioration. We hypothesized that the addition of cardiorespiratory dynamics measured from continuous electrocardiography (ECG) monitoring to intermittently sampled data improves the predictive validity of models trained to detect clinical deterioration prior to intensive care unit (ICU) transfer or unanticipated death. We analyzed 63 patient-years of ECG data from 8,105 acute care patient admissions at a tertiary care academic medical center. We developed models to predict deterioration resulting in ICU transfer or unanticipated death within the next 24 hours using either vital signs, laboratory results, or cardiorespiratory dynamics from continuous ECG monitoring and also evaluated models using all available data sources. We calculated the predictive validity (C-statistic), the net reclassification improvement, and the probability of achieving the difference in likelihood ratio χ2 for the additional degrees of freedom. The primary outcome occurred 755 times in 586 admissions (7%). We analyzed 395 clinical deteriorations with continuous ECG data in the 24 hours prior to an event. Using only continuous ECG measures resulted in a C-statistic of 0.65, similar to models using only laboratory results and vital signs (0.63 and 0.69 respectively). Addition of continuous ECG measures to models using conventional measurements improved the C-statistic by 0.01 and 0.07; a model integrating all data sources had a C-statistic of 0.73 with categorical net reclassification improvement of 0.09 for a change of 1 decile in risk. The difference in likelihood ratio χ2 between integrated models with and without cardiorespiratory dynamics was 2158 (p value: <0.001). Cardiorespiratory dynamics from continuous ECG monitoring detect clinical deterioration in acute care patients and improve performance of conventional models that use only laboratory results and vital signs.

Learning from error: leading a culture of safety.

PubMed

Gibson, Russell; Armstrong, Alexander; Till, Alex; McKimm, Judy

2017-07-02

A recent shift towards more collective leadership in the NHS can help to achieve a culture of safety, particularly through encouraging frontline staff to participate and take responsibility for improving safety through learning from error and near misses. Leaders must ensure that they provide psychological safety, organizational fairness and learning systems for staff to feel confident in raising concerns, that they have the autonomy and skills to lead continual improvement, and that they have responsibility for spreading this learning within and across organizations.

Online and unsupervised face recognition for continuous video stream

NASA Astrophysics Data System (ADS)

Huo, Hongwen; Feng, Jufu

2009-10-01

We present a novel online face recognition approach for video stream in this paper. Our method includes two stages: pre-training and online training. In the pre-training phase, our method observes interactions, collects batches of input data, and attempts to estimate their distributions (Box-Cox transformation is adopted here to normalize rough estimates). In the online training phase, our method incrementally improves classifiers' knowledge of the face space and updates it continuously with incremental eigenspace analysis. The performance achieved by our method shows its great potential in video stream processing.

Polymer powder processing of cryomilled polycaprolactone for solvent-free generation of homogeneous bioactive tissue engineering scaffolds.

PubMed

Lim, Jing; Chong, Mark Seow Khoon; Chan, Jerry Kok Yen; Teoh, Swee-Hin

2014-06-25

Synthetic polymers used in tissue engineering require functionalization with bioactive molecules to elicit specific physiological reactions. These additives must be homogeneously dispersed in order to achieve enhanced composite mechanical performance and uniform cellular response. This work demonstrates the use of a solvent-free powder processing technique to form osteoinductive scaffolds from cryomilled polycaprolactone (PCL) and tricalcium phosphate (TCP). Cryomilling is performed to achieve micrometer-sized distribution of PCL and reduce melt viscosity, thus improving TCP distribution and improving structural integrity. A breakthrough is achieved in the successful fabrication of 70 weight percentage of TCP into a continuous film structure. Following compaction and melting, PCL/TCP composite scaffolds are found to display uniform distribution of TCP throughout the PCL matrix regardless of composition. Homogeneous spatial distribution is also achieved in fabricated 3D scaffolds. When seeded onto powder-processed PCL/TCP films, mesenchymal stem cells are found to undergo robust and uniform osteogenic differentiation, indicating the potential application of this approach to biofunctionalize scaffolds for tissue engineering applications. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Integrating Continuing Professional Development With Health System Reform: Building Pillars of Support.

PubMed

Davis, David A; Rayburn, William F

2016-01-01

Clinical failures sparked a widespread desire for health system reform at the beginning of the 21st century, but related efforts have resulted in changes that are either slow or nonexistent. In response, academic medicine has moved in two directions: (1) system-wide reform using electronic health records, practice networks, and widespread data applications (a macro pathway); and (2) professional development of individual clinicians through continuous performance improvement (a micro pathway). Both pathways exist to improve patient care and population health, yet each suffers from limitations in widespread implementation. The authors call for a better union between these two parallel pathways through four pillars of support: (1) an acknowledgment that both pathways are essential to each other and to the final outcome they intend to achieve, (2) a strong faculty commitment to educate about quality improvement and patient safety at all education levels, (3) a reengineering of tools for professional development to serve as effective change agents, and (4) the development of standards to sustain this alignment of pathways. With these pillars of support integrating continuing professional development with health system reform, the authors envision a better functioning system, with improved metrics and value to enhance patient care and population health.

Using Goal Achievement Training in juvenile justice settings to improve substance use services for youth on community supervision.

PubMed

Fisher, Jacqueline Horan; Becan, Jennifer E; Harris, Philip W; Nager, Alexis; Baird-Thomas, Connie; Hogue, Aaron; Bartkowski, John P; Wiley, Tisha

2018-04-30

The link between substance use and involvement in the juvenile justice system has been well established. Justice-involved youth tend to have higher rates of drug use than their non-offending peers. At the same time, continued use can contribute to an elevated risk of recidivism, which leads to further, and oftentimes more serious, involvement with the juvenile justice system. Because of these high rates of use, the juvenile justice system is well positioned to help identify youth with substance use problems and connect them to treatment. However, research has found that only about 60% of juvenile probation agencies screen all youth for substance involvement, and even fewer provide comprehensive assessment or help youth enroll in substance use treatment. This paper describes an integrated training curriculum that was developed to help juvenile justice agencies improve their continuum of care for youth probationers with substance use problems. Goal Achievement Training (GAT) provides a platform for continuous quality improvement via two sessions delivered onsite to small groups of staff from juvenile justice and behavioral health agencies. In the first session, participants are taught to identify goals and goal steps for addressing identified areas of unmet need (i.e., screening, assessment, and linkage to treatment services). In the second session, participants learn principles and strategies of data-driven decision-making for achieving these goals. This paper highlights GAT as a model for the effective implementation of cost-efficient training strategies designed to increase self-directed quality improvement activities that can be applied to any performance domain within juvenile justice settings. Efforts to monitor implementation fidelity of GAT within the specific context of the juvenile justice settings are highlighted. Challenges to setting the stage for process improvement generally, as well as specific hurdles within juvenile justice settings are discussed, as are next steps in disseminating findings regarding the fidelity to and effectiveness of GAT in this unique context. Clinical Trials Registration number - NCT02672150 .

Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with psoriatic arthritis and current skin involvement: a phase III, randomised, controlled trial (PALACE 3)

PubMed Central

Edwards, Christopher J; Blanco, Francisco J; Crowley, Jeffrey; Birbara, Charles A; Jaworski, Janusz; Aelion, Jacob; Stevens, Randall M; Vessey, Adele; Zhan, Xiaojiang; Bird, Paul

2016-01-01

Objective To evaluate apremilast treatment in patients with active psoriatic arthritis, including current skin involvement, despite prior therapy with conventional disease-modifying antirheumatic drugs and/or biologic agents. Methods Patients (N=505) were randomised (1:1:1) to placebo, apremilast 20 mg twice daily, or apremilast 30 mg twice daily. Rescue therapy with apremilast was designated at week 16 for placebo patients not achieving 20% improvement in swollen and tender joint counts. At week 24, the remaining placebo patients were then randomised to apremilast 20 mg twice daily or 30 mg twice daily. The efficacy and safety of apremilast were assessed over 52 weeks. Results At week 16, significantly more patients receiving apremilast 20 mg twice daily (28%) and 30 mg twice daily (41%) achieved 20% improvement in American College of Rheumatology response criteria versus placebo (18%; p=0.0295 and p<0.0001, respectively), and mean decrease in the Health Assessment Questionnaire-Disability Index score was significantly greater with apremilast 30 mg twice daily (−0.20) versus placebo (−0.07; p=0.0073). In patients with baseline psoriasis body surface area involvement ≥3%, significantly more apremilast 30 mg twice daily patients achieved 50% reduction from baseline Psoriasis Area and Severity Index score (41%) versus placebo (24%; p=0.0098) at week 16. At week 52, observed improvements in these measures demonstrated sustained response with continued apremilast treatment. Most adverse events were mild to moderate in severity; the most common were diarrhoea, nausea, headache and upper respiratory tract infection. Conclusions Apremilast demonstrated clinically meaningful improvements in psoriatic arthritis and psoriasis at week 16; sustained improvements were seen with continued treatment through 52 weeks. Apremilast was generally well tolerated and demonstrated an acceptable safety profile. Trial registration number NCT01212770. PMID:26792812

A story of success: continuous quality improvement in cystic fibrosis care in the USA.

PubMed

Quon, Bradley S; Goss, Christopher H

2011-12-01

Continuous quality improvement (CQI) in healthcare can be described as a reiterative approach to improving processes to reduce unexpected variation in health outcomes. CQI represents one model to achieve quality improvement (QI) and has long been recognized as a key to success in the manufacturing industry with companies like Toyota leading the way. Healthcare, and specifically pulmonary, critical care and sleep medicine represent ideal settings for the application of CQI. This opinion piece will describe QI and CQI initiatives in the US Cystic fibrosis (CF) population. QI in CF care in the United States has been ongoing since inception of the US CF Foundation (CFF) in 1955. This effort has included work to improve the quality of clinical care provided at CF centers and work to improve clinical outcomes in CF. More recently, QI methods have been applied to the conduct of clinical research. The CF community has become a leader in the area of QI and has pointed out the opportunities for others to follow in the area of lung diseases.

Brazil's National Program for Improving Primary Care Access and Quality (PMAQ)

PubMed Central

Harris, Matthew J.; Rocha, Marcia Gomes

2017-01-01

Despite some remarkable achievements, there are several challenges facing Brazil's Family Health Strategy (FHS), including expanding access to primary care and improving its quality. These concerns motivated the development of the National Program for Improving Primary Care Access and Quality (PMAQ). Although voluntary, the program now includes nearly 39 000 FHS teams in the country and has led to a near doubling of the federal investment in primary care in its first 2 rounds. In this article, we introduce the PMAQ and advance several recommendations to ensure that it continues to improve primary care access and quality in Brazil. PMID:28252498

The process of managerial control in quality improvement initiatives.

PubMed

Slovensky, D J; Fottler, M D

1994-11-01

The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs.

Using statistical process control to make data-based clinical decisions.

PubMed

Pfadt, A; Wheeler, D J

1995-01-01

Applied behavior analysis is based on an investigation of variability due to interrelationships among antecedents, behavior, and consequences. This permits testable hypotheses about the causes of behavior as well as for the course of treatment to be evaluated empirically. Such information provides corrective feedback for making data-based clinical decisions. This paper considers how a different approach to the analysis of variability based on the writings of Walter Shewart and W. Edwards Deming in the area of industrial quality control helps to achieve similar objectives. Statistical process control (SPC) was developed to implement a process of continual product improvement while achieving compliance with production standards and other requirements for promoting customer satisfaction. SPC involves the use of simple statistical tools, such as histograms and control charts, as well as problem-solving techniques, such as flow charts, cause-and-effect diagrams, and Pareto charts, to implement Deming's management philosophy. These data-analytic procedures can be incorporated into a human service organization to help to achieve its stated objectives in a manner that leads to continuous improvement in the functioning of the clients who are its customers. Examples are provided to illustrate how SPC procedures can be used to analyze behavioral data. Issues related to the application of these tools for making data-based clinical decisions and for creating an organizational climate that promotes their routine use in applied settings are also considered.

Factors associated with cognitive achievement in late childhood and adolescence: the Young Lives cohort study of children in Ethiopia, India, Peru, and Vietnam.

PubMed

Crookston, Benjamin T; Forste, Renata; McClellan, Christine; Georgiadis, Andreas; Heaton, Tim B

2014-10-04

There is a well-established link between various measures of socioeconomic status and the schooling achievement and cognition of children. However, less is known about how cognitive development is impacted by childhood improvements in growth, a common indicator of child nutritional status. This study examines the relationship between socioeconomic status and child growth and changes in cognitive achievement scores in adolescents from resource-poor settings. Using an observational cohort of more than 3000 children from four low- and middle-income countries, this study examines the association between cognitive achievement scores and household economic, educational, and nutritional resources to give a more accurate assessment of the influence of families on cognitive development. A composite measure of cognition when children were approximately 8, 12, and 15 years of age was constructed. Household factors included maternal schooling, wealth, and children's growth. A positive and statistically significant relationship between household factors and child cognition was found for each country. If parents have more schooling, household wealth increases, or child growth improves, then children's cognitive scores improve over time. Results for control variables are less consistent. Our findings suggest there is a consistent and strong association between parental schooling, wealth, and child growth with child cognitive achievement. Further, these findings demonstrate that a household's ability to provide adequate nutrition is as important as economic and education resources even into late childhood and adolescence. Hence, efforts to improve household resources, both early in a child's life and into adolescence, and to continue to promote child growth beyond the first few years of life have the potential to help children over the life course by improving cognition.

Motivating Struggling Middle School Readers: Digital Images as an Aid for Self-Monitoring and Enhancing Retellings of Text

ERIC Educational Resources Information Center

Parenti, Melissa A.

2016-01-01

The benefits of motivation, mental imagery, self-monitoring and guided retellings on reading comprehension have long been lauded as effective methods for improving reading achievement. At a time when technology continues to flourish, yet secondary reading performance remains at a level far below proficiency, identifying strategies that assist in…

Using "Giving Voice to Values" to Improve Student Academic Integrity in Information Technology Contexts

ERIC Educational Resources Information Center

Riemenschneider, Cynthia K.; Manly, Tracy S.; Leonard, Lori N. K.

2016-01-01

Academic integrity continues to be a concern for universities and faculty. Yet practical methods for conveying ethical behavior can be difficult to achieve. This study uses the multidimensional ethics scale to gain insight into three situations involving students. The findings from those scenarios are then framed using the "Giving Voice to…

Don't Get Left Behind! Improve Your Experiences as a New Teacher

ERIC Educational Resources Information Center

Chorzempa, Barbara Fink

2011-01-01

Teachers today are expected to meet the diverse needs of all of their students and know an array of instructional methods, which requires continual professional development (Darling-Hammond 1998). Darling-Hammond (1998, 7) stated that the "strongest predictor of student achievement is the percentage of well-qualified teachers in a school,…

When Volunteering Is Mandatory: A Call for Research about Service Learning

ERIC Educational Resources Information Center

Cloyd, Melissa

2017-01-01

Stakeholders have long been concerned about high school drop-out rates and associated achievement gaps between groups, specifically racial, of high school students. While significant improvements have been made to these drop-out rates at the national level, the largest group of drop-out students continues to be those of Hispanic heritage. Research…

Assessing the Impact of Lesson Study on the Teaching Practice of Middle School Science Teachers

ERIC Educational Resources Information Center

Grove, Michael C.

2011-01-01

Despite wave after wave of educational reform in the United States our students continue to lag behind their peers in other industrialized countries on virtually all measures of academic achievement. Effective professional development (PD) is seen as a key to improving instructional practice and therefore student learning, but traditional forms of…

Reading for 11-13-Year-Old Students in the Digital Age: New Zealand Case Studies

ERIC Educational Resources Information Center

Fletcher, Jo; Nicholas, Karen

2018-01-01

ABSTRACT In New Zealand schools, the focus continues to be on improving the reading achievement of all students situated across a range of socio-economic groups. This is particularly so for our young adolescent students, where research investigations have indicated some concerning trends which influence reading development for this age group. This…

Kids Count Data Book, 2012: State Trends in Child Well-Being

ERIC Educational Resources Information Center

Annie E. Casey Foundation, 2012

2012-01-01

The Annie E. Casey Foundation's 2012 KIDS COUNT[R] Data Book shows both promising progress and discouraging setbacks for the nation's children: While their academic achievement and health improved in most states, their economic well-being continued to decline. This year's Data Book uses an updated index of 16 indicators of child well-being,…

Perceptions of the Use of Interactive Whiteboards in Teaching Literacy to Elementary School Students

ERIC Educational Resources Information Center

Brown-Wyatt, Valencia

2011-01-01

Under No Child Left Behind Act 2001, the Reading First initiative was a component geared toward strengthening literacy skills in schools that were in need of improvement. Despite the intervention attempts through this initiative, research shows that students continue to struggle in literacy, which widens the achievement gap in urban school…

MRP (materiel requirements planning) II: successful implementation the hard way.

PubMed

Grubbs, S C

1994-05-01

Many manufacturing companies embark on MRP II implementation projects as a method for improvement. In spite of an increasing body of knowledge regarding successful implementations, companies continue to attempt new approaches. This article reviews an actual implementation, featuring some of the mistakes made and the efforts required to still achieve "Class A" performance levels.

Incentives and Test-Based Accountability in Education

ERIC Educational Resources Information Center

Hout, Michael, Ed.; Elliott, Stuart W., Ed.

2011-01-01

In recent years there have been increasing efforts to use accountability systems based on large-scale tests of students as a mechanism for improving student achievement. The federal No Child Left Behind Act (NCLB) is a prominent example of such an effort, but it is only the continuation of a steady trend toward greater test-based accountability in…

Comparing Graduate Courses Taught by the Same Instructor Using Competing Approaches: Traditional vs. Technology-Infused

ERIC Educational Resources Information Center

Kisicki, Todd

2012-01-01

The use of educational technologies as a tool to improve academic achievement continues to increase as more technologies becomes available to students. However, teachers are entering the classroom not fully prepared to integrate technology into their daily classroom teaching because they have not been adequately prepared to do so. Teacher…

Decision-Making, Information Communication Technology, and Data Analysis by School Leaders about Student Achievement

ERIC Educational Resources Information Center

Akoma, Ahunna Margaux

2012-01-01

This case study of one school district examined how school leaders use student performance data and technology-based data analysis tools to engage in data-informed decision-making for continuous improvement. School leaders in this context included leaders at the district, school, and classroom levels. An extensive literature review provided the…

Optimizing process and equipment efficiency using integrated methods

NASA Astrophysics Data System (ADS)

D'Elia, Michael J.; Alfonso, Ted F.

1996-09-01

The semiconductor manufacturing industry is continually riding the edge of technology as it tries to push toward higher design limits. Mature fabs must cut operating costs while increasing productivity to remain profitable and cannot justify large capital expenditures to improve productivity. Thus, they must push current tool production capabilities to cut manufacturing costs and remain viable. Working to continuously improve mature production methods requires innovation. Furthermore, testing and successful implementation of these ideas into modern production environments require both supporting technical data and commitment from those working with the process daily. At AMD, natural work groups (NWGs) composed of operators, technicians, engineers, and supervisors collaborate to foster innovative thinking and secure commitment. Recently, an AMD NWG improved equipment cycle time on the Genus tungsten silicide (WSi) deposition system. The team used total productive manufacturing (TPM) to identify areas for process improvement. Improved in-line equipment monitoring was achieved by constructing a real time overall equipment effectiveness (OEE) calculator which tracked equipment down, idle, qualification, and production times. In-line monitoring results indicated that qualification time associated with slow Inspex turn-around time and machine downtime associated with manual cleans contributed greatly to reduced availability. Qualification time was reduced by 75% by implementing a new Inspex monitor pre-staging technique. Downtime associated with manual cleans was reduced by implementing an in-situ plasma etch back to extend the time between manual cleans. A designed experiment was used to optimize the process. Time between 18 hour manual cleans has been improved from every 250 to every 1500 cycles. Moreover defect density realized a 3X improvement. Overall, the team achieved a 35% increase in tool availability. This paper details the above strategies and accomplishments.

Effects and safety of 99Tc-MDP in patients with refractory ankylosing spondylitis: a 2-stage (30-week follow-up) clinical trial.

PubMed

Xu, Yunyun; Zhong, Yi; Zhao, Minjing; Tu, Liudan; Fan, Meida; Zhang, Pingping; Wei, Qiujing; Cao, Shuangyan; Li, Qiuxia; Liao, Zetao; Lin, Zhiming; Pan, Yunfeng; Jin, Ou; Gu, Jieruo

2018-01-01

To evaluate the clinical efficacy and safety in patients with refractory ankylosing spondylitis (AS) initiating 99Tc-MDP therapy and explore the mechanisms. Refractory AS patients were enrolled in the clinical trial and received 99Tc-MDP treatments for 3 or 5 courses according to ASAS improvement. Efficacy and safety evaluations were conducted during the follow-up. 37 cytokines were quantified by Luminex at baseline and week 30. p-values<0.05 were considered statistically significant. 51 refractory AS patients were included, with 20 healthy people serving as the control group. The patients were in an active disease state (mean (SD) ASDAS 3.66 (0.83), BASDAI 4.53 (1.92)), 42(82.35%) patients had syndesmophytes. Their cytokines were significantly higher than that in the control group. After 3 courses of 99Tc-MDP treatment, 32 (62.75%) patients achieved ASAS20 improvement, 24 (47.06%) patients achieved a clinically significant improvement (ΔASDAS-CRP≥1.1). 27 patients entered the second stage to complete 5 courses of the treatment, all of whom achieved ASAS20 improvement, 18 (66.67%) patients achieved a clinically significant improvement. All clinical parameters including ASAS and ASDAS significantly improved as the treatment was continued. Cytokines also had significant down-regulation after the treatment, and the reductions had positive correlations with the improvements of disease activity. No serious adverse event was observed. This investigation confirmed the remarkable efficacy of 99Tc-MDP in a large number of refractory AS patients, and highlighted the mechanism by dramatic regulation on cytokines. 99Tc-MDP was safe in clinical application.

Online Continuing Education for Expanding Clinicians' Roles in Breastfeeding Support.

PubMed

Edwards, Roger A; Colchamiro, Rachel; Tolan, Ellen; Browne, Susan; Foley, Mary; Jenkins, Lucia; Mainello, Kristen; Vallu, Rohith; Hanley, Lauren E; Boisvert, Mary Ellen; Forgit, Julie; Ghiringhelli, Kara; Nordstrom, Christina

2015-11-01

Lack of health professional support is an important variable affecting mothers' achievement of breastfeeding goals. Online continuing education is a recognized pathway for disseminating content for improving clinicians' knowledge and supporting efforts to change practices. At the time we developed our project, free, accredited continuing education for physicians related to breastfeeding management that could be easily accessed using portable devices (via tablets/smartphones) was not available. Such resources were in demand, especially for facilities pursuing designation through the Baby-Friendly Hospital Initiative. We assembled a government, academic, health care provider, and professional society partnership to create such a tutorial that would address the diverse content needed for supporting breastfeeding mothers postdischarge in the United States. Our 1.5-hour-long continuing medical and nursing education was completed by 1606 clinicians (1172 nurses [73%] and 434 physicians [27%]) within 1 year. More than 90% of nurses and over 98% of physicians said the tutorial achieved its 7 learning objectives related to breastfeeding physiology, broader factors in infant feeding decisions and practices, the American Academy of Pediatrics' policy statement, and breastfeeding management/troubleshooting. Feedback received from the tutorial led to the creation of a second tutorial consisting of another 1.5 hours of continuing medical and nursing education related to breast examination and assessment prior to delivery, provision of anticipatory guidance to pregnant women interested in breastfeeding, maternity care practices that influence breastfeeding outcomes, breastfeeding preterm infants, breastfeeding's role in helping address disparities, and dispelling common myths. The tutorials contribute to achievement of 8 Healthy People 2020 Maternal, Infant and Child Health objectives. © The Author(s) 2015.

Continuous enzymatic hydrolysis of lignocellulosic biomass in a membrane-reactor system: Continuous enzymatic hydrolysis of lignocellulosic biomass in a membrane-reactor system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stickel, Jonathan J.; Adhikari, Birendra; Sievers, David A.

Converting abundant lignocellulosic biomass to sugars as fungible precursors to fuels and chemicals has the potential to diversify the supply chain for those products, but further process improvements are needed to achieve economic viability. In the current work, process intensification of the key enzymatic hydrolysis unit operation is demonstrated by means of a membrane reactor system that was operated continuously. Lignocellulosic biomass (pretreated corn stover) and buffered enzyme solution were fed to a continuously stirred-tank reactor, and clarified sugar solution was withdrawn via a commercial tubular ultrafiltration membrane. The membrane permeance decline and membrane cleaning efficacy were studied and didmore » not vary significantly when increasing fraction insoluble solids (FIS) from 2.5% to 5%. Continuous enzymatic hydrolysis was successfully operated for more than 80 h. A model for the reactor system was able to predict dynamic behavior that was in reasonable agreement with experimental results. The modeled technical performance of anticipated commercial batch and continuous enzymatic hydrolysis processes were compared and showed that continuous operation would provide at least twice the volumetric productivity for the conditions studied. Further improvements are anticipated by better membrane selection and by increasing FIS.« less

Continuous enzymatic hydrolysis of lignocellulosic biomass in a membrane-reactor system: Continuous enzymatic hydrolysis of lignocellulosic biomass in a membrane-reactor system

DOE PAGES

Stickel, Jonathan J.; Adhikari, Birendra; Sievers, David A.; ...

2018-02-21

Converting abundant lignocellulosic biomass to sugars as fungible precursors to fuels and chemicals has the potential to diversify the supply chain for those products, but further process improvements are needed to achieve economic viability. In the current work, process intensification of the key enzymatic hydrolysis unit operation is demonstrated by means of a membrane reactor system that was operated continuously. Lignocellulosic biomass (pretreated corn stover) and buffered enzyme solution were fed to a continuously stirred-tank reactor, and clarified sugar solution was withdrawn via a commercial tubular ultrafiltration membrane. The membrane permeance decline and membrane cleaning efficacy were studied and didmore » not vary significantly when increasing fraction insoluble solids (FIS) from 2.5% to 5%. Continuous enzymatic hydrolysis was successfully operated for more than 80 h. A model for the reactor system was able to predict dynamic behavior that was in reasonable agreement with experimental results. The modeled technical performance of anticipated commercial batch and continuous enzymatic hydrolysis processes were compared and showed that continuous operation would provide at least twice the volumetric productivity for the conditions studied. Further improvements are anticipated by better membrane selection and by increasing FIS.« less

Assessment of posaconazole salvage therapy in chronic pulmonary aspergillosis by using predefined response criteria.

PubMed

Rodriguez-Goncer, Isabel; Harris, Chris; Kosmidis, Chris; Muldoon, Eavan G; Newton, Pippa J; Denning, David W

2018-06-12

Chronic pulmonary aspergillosis (CPA) is a progressive infection that destroys lung tissue in non-immunocompromised patients. First line therapies for CPA (itraconazole and/or voriconazole) are often curtailed due to toxicity or the development of drug resistance. Posaconazole is a potential alternative for these patients. Use of posaconazole was funded by the NHS Highly Specialised National Commissioners on an individual basis for patients who failed or did not tolerate first line therapy; those who met predefined criteria for improvement at 4 and 6 months (weight gain and/or improvement in St George's Respiratory Questionnaire) continued posaconazole long-term. We recorded response, failure, discontinuation rates, and adverse events. Seventy-eight patients received posaconazole as salvage therapy. Thirty-four (44%) achieved targets for continuation of therapy. Fourteen (18%) failed therapy; 5 (36%) patients did not achieve clinical targets at 4 or 6 months of assessment and 9 (64%) developed clinical and/or radiological failure. Twenty-eight (36%) discontinued their trial early; 8 (29%) died and 20 (71%) had significant side effects. One patient was non-compliant and another was lost to follow up. Establishing criteria for therapeutic success offered a clear, safe and sustainable method of identifying patients who benefit from additional therapy, and minimised continuation of ineffective therapy in those who did not. Copyright © 2018. Published by Elsevier B.V.

An Improved Power Quality Based Sheppard-Taylor Converter Fed BLDC Motor Drive

NASA Astrophysics Data System (ADS)

Singh, Bhim; Bist, Vashist

2015-12-01

This paper deals with the design and analysis of a power factor correction based Sheppard-Taylor converter fed brushless dc motor (BLDCM) drive. The speed of the BLDCM is controlled by adjusting the dc link voltage of the voltage source inverter (VSI) feeding BLDCM. Moreover, a low frequency switching of the VSI is used for electronically commutating the BLDCM for reduced switching losses. The Sheppard-Taylor converter is designed to operate in continuous conduction mode to achieve an improved power quality at the ac mains for a wide range of speed control and supply voltage variation. The BLDCM drive is designed and its performance is simulated in a MATLAB/Simulink environment to achieve the power quality indices within the limits of the international power quality standard IEC-61000-3-2.

The World Health Organization European Health in Prisons Project After 10 Years: Persistent Barriers and Achievements

PubMed Central

Gatherer, Alex; Moller, Lars; Hayton, Paul

2005-01-01

The recognition that good prison health is important to general public health has led 28 countries in the European Region of the World Health Organization (WHO) to join a WHO network dedicated to improving health within prisons. Within the 10 years since that time, vital actions have been taken and important policy documents have been produced. A key factor in making progress is breaking down the isolation of prison health services and bringing them into closer collaboration with the country’s public health services. However, barriers to progress remain. A continuing challenge is how best to move from policy recommendations to implementation, so that the network’s fundamental aim of noticeable improvements in the health and care of prisoners is further achieved. PMID:16186449

Current management of wound healing.

PubMed

Gottrup, F; Karlsmark, T

2009-06-01

While the understanding of wound pathophysiology has progressed considerably over the past decades the improvements in clinical treatment has occurred to a minor degree. During the last years, however, new trends and initiatives have been launched, and we will continue to attain new information in the next decade. It is the hope that increasing parts of the new knowledge from basic wound healing research will be implemented in daily clinical practice. The development of new treatment products will also continue, and especially new technologies with combined types of dressing materials or dressing containing active substances will be accentuated. Further developments in the management structure and education will also continue and consensus of treatment guidelines, recommendations and organization models will hopefully be achieved.

Medical Readiness of the Reserve Component.

PubMed

Brauner, Marygail K; Jackson, Timothy; Gayton, Elizabeth

2012-01-01

The reserve components (RCs) of the U.S. military must ensure that reservists are not only properly equipped and trained, but also medically ready to serve. Medical readiness means that service members are free from health-related conditions, including dental conditions, that could limit their ability to carry out their duties. Medically ready reservists require less medical and dental support in theater and fewer medical evacuations from theater, both of which save money and free assets for other purposes. This article identifies existing medical readiness requirements, quantifies the current status of RC medical readiness, identifies obstacles to achieving compliance, and suggests options for improving medical readiness in a cost-effective manner. The authors find that time and expense are the major barriers to the RCs achieving their overall goals for medical readiness. Recommendations include standardizing medical readiness criteria across services, improving data reporting and archiving processes, providing incentives to individuals and units to achieve medical readiness, and continuing to extend TRICARE coverage to reservists prior to deployment.

Control system to reduce the effects of friction in drive trains of continuous-path-positioning systems. [Patent application

DOEpatents

Green, W.L.

1980-12-01

An improved continuous-path-positioning servo-control system is provided for reducing the effects of friction arising at very low cutting speeds in the drive trains of numerically controlled cutting machines, and the like. The improvement comprises a feed forward network for altering the gain of the servo-control loop at low positioning velocities to prevent stick-slip movement of the cutting tool holder being positioned by the control system. The feed forward network shunts conventional lag-compensators in the control loop, or loops, so that the error signal used for positioning varies linearly when the value is small, but being limited for larger values. Thus, at higher positioning speeds there is little effect of the added component upon the control being achieved.

A multi-level differential item functioning analysis of trends in international mathematics and science study: Potential sources of gender and minority difference among U.S. eighth graders' science achievement

NASA Astrophysics Data System (ADS)

Qian, Xiaoyu

Science is an area where a large achievement gap has been observed between White and minority, and between male and female students. The science minority gap has continued as indicated by the National Assessment of Educational Progress and the Trends in International Mathematics and Science Studies (TIMSS). TIMSS also shows a gender gap favoring males emerging at the eighth grade. Both gaps continue to be wider in the number of doctoral degrees and full professorships awarded (NSF, 2008). The current study investigated both minority and gender achievement gaps in science utilizing a multi-level differential item functioning (DIF) methodology (Kamata, 2001) within fully Bayesian framework. All dichotomously coded items from TIMSS 2007 science assessment at eighth grade were analyzed. Both gender DIF and minority DIF were studied. Multi-level models were employed to identify DIF items and sources of DIF at both student and teacher levels. The study found that several student variables were potential sources of achievement gaps. It was also found that gender DIF favoring male students was more noticeable in the content areas of physics and earth science than biology and chemistry. In terms of item type, the majority of these gender DIF items were multiple choice than constructed response items. Female students also performed less well on items requiring visual-spatial ability. Minority students performed significantly worse on physics and earth science items as well. A higher percentage of minority DIF items in earth science and biology were constructed response than multiple choice items, indicating that literacy may be the cause of minority DIF. Three-level model results suggested that some teacher variables may be the cause of DIF variations from teacher to teacher. It is essential for both middle school science teachers and science educators to find instructional methods that work more effectively to improve science achievement of both female and minority students. Physics and earth science are two areas to be improved for both groups. Curriculum and instruction need to enhance female students' learning interests and give them opportunities to improve their visual perception skills. Science instruction should address improving minority students' literacy skills while teaching science.

Quality, Safety and Patient Centered Care--A Dream Come True in the Mountains of Northern Pakistan. An Award winning project of "2015 Quality, Safety & Patient Centered Care Award" at, Chicago USA.

PubMed

Jassani, Kashif; Essani, Rozina Roshan; Abbas, Syed Nadeem Husain

2016-01-01

Northern Pakistan remains very challenging terrain due to harsh weather all year round presenting an infrastructura, human resource and supply chain challenge of its own. Many times the facility had to move to different locations on emergency and ad hoc basis due to landslides, earthquakes affecting continuity of care. Providing quality healthcare to often resource constraint hard-to-reach areas has always been AKHS,P's unique forte. Breaking barriers for catchment population to access quality healthcare, AKHS,P embarked on an initiative of implementing, achieving and sustaining ISO 9001:2008 Quality Management System international standards certification. This article shares the unique experience of AKHS,P in achieving and sustaining ISO 9001:2008 International Quality Management System Certification. After untiring efforts and the hard work of ground staff; AKHS,P achieved ISO 9001:2008 International Quality Management System Certification as well as 1st Surveillance Audit which itself proved that AKHS,P sustained quality systems and ensured continuous quality improvement in the Mountains of Northern Pakistan.

The Effect of Using Concept Maps on Student Achievement in Selected Topics in Chemistry at Tertiary Level

ERIC Educational Resources Information Center

Singh, Indra Sen; Moono, Karren

2015-01-01

The performance in chemistry at tertiary level in Zambia has not been as expected. It has therefore been a matter of concern. There has been a continuous focus on exploring new teaching strategies to improve the understanding of this difficult subject. This study investigated the effectiveness of composite use of concept maps and traditional…

The Effects of the American Dream Academy on Hispanic Parents' Beliefs, Knowledge, and Behaviors Regarding Pre-Kinder to Post-Secondary Education

ERIC Educational Resources Information Center

Portillo, Danelia

2013-01-01

The high percentage and the steady growth of Hispanic/Latino students in Arizona demand that special attention be placed on improving academic achievement and attainment. The need to support Hispanic/Latino parents in becoming meaningful positive contributors to their children's schooling continues to surface as a critical issue in school…

The Dissemination of Teacher Learning: A Study of the Similarities and Differences between Public School Levels and Locations

ERIC Educational Resources Information Center

Krohn, Jacqueline M.

2010-01-01

Teacher learning, whether in-service, continued education, or experience based, is a key component of school reform. Specific research on the use of teacher learning to improve student achievement and instructional practices in and across schools is limited. The research questions addressed in this study were: (a) the degree to which teacher…

Changing the Developmental Trajectory in Early Math through a Two-Year Preschool Math Intervention

ERIC Educational Resources Information Center

Starkey, Prentice; Klein, Alice; DeFlorio, Lydia

2013-01-01

There is a national need for effective interventions to improve school readiness and subsequent achievement in mathematics for students from low-income families. The purpose of this study was to implement and evaluate a 2-year preschool math intervention that began at preschool entry when children were 3 years of age and continued through the end…

Factors Affecting the Distribution and Access to Athletic Opportunities for New Jersey High School Students

ERIC Educational Resources Information Center

Casarico, Paul

2013-01-01

The requirement for continuous improvements and the lack of funds for schools to properly implement all the mandates puts schools in the inevitable position of having to make tough decisions with regards to programs. The central theme of NCLB requires states to adopt a plan for accountability that will lead to increased achievement for all…

Teachers' Awareness of Cultural Diversity and Academic Achievement in Ninth Grade Academies and Senior High Schools

ERIC Educational Resources Information Center

Whipps-Johnson, Jamellah Renee

2016-01-01

High school graduation rates are higher than they have ever been in 40 years, but disparities continue to exist for students of color and students from poverty when compared to their counterparts. High school reform efforts like creating small learning communities are promising, but small schools alone do not improve student outcomes.…

Association of Small Computer Users in Education (ASCUE) Summer Conference Proceedings (30th, North Myrtle Beach, South Carolina, June 7-12, 1997).

ERIC Educational Resources Information Center

Smith, Peter, Ed.

Papers from a conference on small college computing issues are: "An On-line Microcomputer Course for Pre-service Teachers" (Mary K. Abkemeier); "The Mathematics and Computer Science Learning Center (MLC)" (Solomon T. Abraham); "Multimedia for the Non-Computer Science Faculty Member" (Stephen T. Anderson, Sr.); "Achieving Continuous Improvement:…

Building the Capacity of Principals and Teacher-Leaders to Implement Effective School and Classroom Practices.

ERIC Educational Resources Information Center

Southern Regional Education Board (SREB), 2012

2012-01-01

Great leaders make great schools. The most successful school leaders create a school climate of high achievement and continuous improvement, give teachers a voice in decision-making, use data to drive curriculum and instruction, and assure students and parents that everyone at the school is focusing on student success. They know what is going on…

Composite Materials for Maxillofacial Prostheses.

DTIC Science & Technology

1982-11-01

1(AXILLOFACIAL PROSTHESES; PROSTHETIC MATERIALS: MICROCAPSULES : SOFT FILLERS; ELASTOMER COMPOSITES *ASTRAC7 lCofIflU Ir F*vsda Side It neceOaeen anud...composite systems are elastomeric-shelled, liquid-filled microcapsules . Experiments continued on the interfacial polymerization process, with spherical...sealed, capsules achieved. The diamine bath has been E] improved and an automatic system has been developed for producing the microcapsules . The one

Promoting Secondary Teachers' Diagnostic Competence with Respect to Functions: Development of a Scalable Unit in Continuous Professional Development

ERIC Educational Resources Information Center

Busch, Julia; Barzel, Bärbel; Leuders, Timo

2015-01-01

Diagnosing student achievement in a formative way is a crucial skill for planning and carrying out effective mathematics lessons. This study takes a subject-specific view and aims at investigating diagnostic competence in the field of mathematical functions at secondary level and how to improve it. Following three evidence-based design principles,…

Availability of School Resources and TIMSS Grade 8 Students' Science Achievement: A Comparative Study between Malaysia and Singapore

ERIC Educational Resources Information Center

Lay, Yoon Fah; Chandrasegaran, A. L.

2016-01-01

Studies have shown that resources are crucial for improving schooling, perhaps even more so in developing countries than in economically developed countries, where adequate school structures and material resources may be taken for granted. Recent research reviews suggest that computer use continues to grow in mathematics and science instruction,…

Therapeutics of diabetes mellitus: focus on insulin analogues and insulin pumps.

PubMed

Valla, Vasiliki

2010-01-01

Inadequately controlled diabetes accounts for chronic complications and increases mortality. Its therapeutic management aims in normal HbA1C, prandial and postprandial glucose levels. This review discusses diabetes management focusing on the latest insulin analogues, alternative insulin delivery systems and the artificial pancreas. Intensive insulin therapy with multiple daily injections (MDI) allows better imitation of the physiological rhythm of insulin secretion. Longer-acting, basal insulin analogues provide concomitant improvements in safety, efficacy and variability of glycaemic control, followed by low risks of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) provides long-term glycaemic control especially in type 1 diabetic patients, while reducing hypoglycaemic episodes and glycaemic variability. Continuous subcutaneous glucose monitoring (CGM) systems provide information on postprandial glucose excursions and nocturnal hypo- and/or hyperglycemias. This information enhances treatment options, provides a useful tool for self-monitoring and allows safer achievement of treatment targets. In the absence of a cure-like pancreas or islets transplants, artificial "closed-loop" systems mimicking the pancreatic activity have been also developed. Individualized treatment plans for insulin initiation and administration mode are critical in achieving target glycaemic levels. Progress in these fields is expected to facilitate and improve the quality of life of diabetic patients.

UK Renal Registry 17th Annual Report: Chapter 9 Clinical, Haematological and Biochemical Parameters in Patients Receiving Renal Replacement Therapy in Paediatric Centres in the UK in 2013: National and Centre-specific Analyses.

PubMed

Hamilton, Alexander J; Pruthi, Rishi; Maxwell, Heather; Casula, Anna; Braddon, Fiona; Inward, Carol; Lewis, Malcolm; O'Brien, Catherine; Stojanovic, Jelena; Tse, Yincent; Sinha, Manish D

2015-01-01

The Paediatric Registry analyses renal replacement therapy (RRT) data in children. All 13 UK paediatric nephrology centres submit electronic data. To provide centre specific data and to determine adherence to relevant audit standards. Data analysis to calculate summary statistics and achievement of an audit standard. The median height z-score for children on dialysis was -2.0 and for children with a functioning transplant -1.3. Children transplanted before age 11 years improved their height z score subsequently, whereas those >11 maintained their height z-score, with all transplanted patients having a similar height z-score after 3 years of starting RRT.The median weight z-score for children on dialysis was -1.2, and for children with a functioning transplant -0.2.Of those with data, 75% of the prevalent paediatric RRT population had .1 risk factors for cardiovascular disease, with 1 in 10 having all three risk factors evaluated. For transplant patients, 76% achieved the systolic blood pressure (SBP)standard and 91% achieved the haemoglobin standard. For haemodialysis patients, 53% achieved the SBP standard,66% the haemoglobin standard, 84% the calcium standard,43% the phosphate standard and 43% achieved the parathyroid hormone (PTH) standard. For peritoneal dialysis patients, 61% achieved the SBP standard, 83% the haemoglobin standard, 71% the calcium standard, 56% the phosphate standard and 36% achieved the PTH standard. Quarterly data collection will improve quality and reporting. Continued focus on improving height and avoiding obesity is needed. Awareness and management of cardiovascular risk is an important long term strategy.

Tofacitinib in Rheumatoid Arthritis: Lack of Early Change in Disease Activity Predicts a Low Probability of Achieving Low Disease Activity at Month 6.

PubMed

Van Vollenhoven, Ronald F; Lee, Eun Bong; Fallon, Lara; Zwillich, Samuel H; Wilkinson, Bethanie; Chapman, Douglass; Demasi, Ryan; Keystone, Edward

2018-04-26

Optimal targeted treatment in rheumatoid arthritis requires early identification of failure to respond. This post-hoc analysis explored the relationship between early disease activity changes and achievement of low disease activity (LDA) and remission targets with tofacitinib. Data were from two randomized, double-blind, Phase 3 studies. In ORAL Start (NCT01039688), methotrexate (MTX)-naïve patients received tofacitinib 5 or 10 mg BID, or MTX, for 24 months. In placebo-controlled ORAL Standard (NCT00853385), MTX-inadequate responder (MTX-IR) patients received tofacitinib 5 or 10 mg BID or adalimumab 40 mg Q2W, with MTX, for 12 months. Probabilities of achieving LDA (CDAI ≤10; DAS28-4[ESR] ≤3.2) at months 6 and 12 were calculated, given failure to achieve threshold improvement from baseline (change in CDAI ≥6; DAS28-4[ESR] ≥1.2) at month 1 or 3. In ORAL Start, 7.2% and 5.4% of patients receiving tofacitinib 5 and 10 mg BID, respectively, failed to improve CDAI ≥6 at month 3; of those who failed, 3.8% and 28.6%, respectively, achieved month 6 CDAI-defined LDA. In ORAL Standard, 18.8% and 17.5% of patients receiving tofacitinib 5 and 10 mg BID, respectively, failed to improve CDAI ≥6 at month 3; of those who failed, 0% and 2.9%, respectively, achieved month 6 CDAI-defined LDA. Findings were similar when considering month 1 improvements or DAS28-4(ESR) thresholds. In MTX-IR patients, lack of response to tofacitinib after 1 or 3 months predicted low probability of achieving LDA at month 6. Lack of early response may be considered when deciding whether to continue treatment with tofacitinib. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Intermittent sizing on carbon fiber for composite application

DOE Office of Scientific and Technical Information (OSTI.GOV)

Norris, Jr, Robert E.; Paulauskas, Felix L.; Ozcan, Soydan

Intermittent sizing is a technique designed to improve the bonding of carbon fiber to a resin when manufacturing composite parts. The purpose of this technique is to improve Sheet Molding Composites (SMC) made of non-continuous carbon fibers while using regular material. At the end of the project, tests showed that improved mechanical properties have been achieved using this technique compared to conventional process. Mechanical properties have been improved by 110% for the peak tensile stress and by 60% for the modulus at the laboratory scale. In this project, Continental Structural Plastics and ORNL have worked to demonstrate the scalability andmore » viability of commercialization of this technique.« less

Quality comparison of continuous steam sterilization segmented-flow aseptic processing versus conventional canning of whole and sliced mushrooms.

PubMed

Anderson, N M; Walker, P N

2011-08-01

This study was carried out to investigate segmented-flow aseptic processing of particle foods. A pilot-scale continuous steam sterilization unit capable of producing shelf stable aseptically processed whole and sliced mushrooms was developed. The system utilized pressurized steam as the heating medium to achieve high temperature-short time processing conditions with high and uniform heat transfer that will enable static temperature penetration studies for process development. Segmented-flow technology produced a narrower residence time distribution than pipe-flow aseptic processing; thus, whole and sliced mushrooms were processed only as long as needed to achieve the target F₀  = 7.0 min and were not overcooked. Continuous steam sterilization segmented-flow aseptic processing produced shelf stable aseptically processed mushrooms of superior quality to conventionally canned mushrooms. When compared to conventionally canned mushrooms, aseptically processed yield (weight basis) increased 6.1% (SD = 2.9%) and 6.6% (SD = 2.2%), whiteness (L) improved 3.1% (SD = 1.9%) and 4.7% (SD = 0.7%), color difference (ΔE) improved 6.0% (SD = 1.3%) and 8.5% (SD = 1.5%), and texture improved 3.9% (SD = 1.7%) and 4.6% (SD = 4.2%), for whole and sliced mushrooms, respectively. Segmented-flow aseptic processing eliminated a separate blanching step, eliminated the unnecessary packaging of water and promoted the use of bag-in-box and other versatile aseptic packaging methods. Segmented-flow aseptic processing is capable of producing shelf stable aseptically processed particle foods of superior quality to a conventionally canned product. This unique continuous steam sterilization process eliminates the need for a separate blanching step, reduces or eliminates the need for a liquid carrier, and promotes the use of bag-in-box and other versatile aseptic packaging methods. © 2011 Institute of Food Technologists®

Variable Coupling Scheme for High Frequency Electron Spin Resonance Resonators Using Asymmetric Meshes

PubMed Central

Tipikin, D. S.; Earle, K. A.; Freed, J. H.

2010-01-01

The sensitivity of a high frequency electron spin resonance (ESR) spectrometer depends strongly on the structure used to couple the incident millimeter wave to the sample that generates the ESR signal. Subsequent coupling of the ESR signal to the detection arm of the spectrometer is also a crucial consideration for achieving high spectrometer sensitivity. In previous work, we found that a means for continuously varying the coupling was necessary for attaining high sensitivity reliably and reproducibly. We report here on a novel asymmetric mesh structure that achieves continuously variable coupling by rotating the mesh in its own plane about the millimeter wave transmission line optical axis. We quantify the performance of this device with nitroxide spin-label spectra in both a lossy aqueous solution and a low loss solid state system. These two systems have very different coupling requirements and are representative of the range of coupling achievable with this technique. Lossy systems in particular are a demanding test of the achievable sensitivity and allow us to assess the suitability of this approach for applying high frequency ESR to the study of biological systems at physiological conditions, for example. The variable coupling technique reported on here allows us to readily achieve a factor of ca. 7 improvement in signal to noise at 170 GHz and a factor of ca. 5 at 95 GHz over what has previously been reported for lossy samples. PMID:20458356

Immobilization Increases the Stability and Reusability of Pigeon Pea NADP+ Linked Glucose-6-Phosphate Dehydrogenase.

PubMed

Singh, Siddhartha; Singh, Amit Kumar; Singh, M Chandrakumar; Pandey, Pramod Kumar

2017-02-01

Immobilization of enzymes is valuably important as it improves the stability and hence increases the reusability of enzymes. The present investigation is an attempt for immobilization of purified glucose-6-phosphate dehydrogenase from pigeon pea on different matrix. Maximum immobilization was achieved when alginate was used as immobilization matrix. As compared to soluble enzyme the alginate immobilized enzyme exhibited enhanced optimum pH and temperature. The alginate immobilized enzyme displayed more than 80% activity up to 7 continuous reactions and more than 50% activity up to 11 continuous reactions.

Enhanced biodiesel production in Neochloris oleoabundans by a semi-continuous process in two stage photobioreactors.

PubMed

Yoon, Se Young; Hong, Min Eui; Chang, Won Seok; Sim, Sang Jun

2015-07-01

Under autotrophic conditions, highly productive biodiesel production was achieved using a semi-continuous culture system in Neochloris oleoabundans. In particular, the flue gas generated by combustion of liquefied natural gas and natural solar radiation were used for cost-effective microalgal culture system. In semi-continuous culture, the greater part (~80%) of the culture volume containing vegetative cells grown under nitrogen-replete conditions in a first photobioreactor (PBR) was directly transferred to a second PBR and cultured sequentially under nitrogen-deplete conditions for accelerating oil accumulation. As a result, in semi-continuous culture, the productivities of biomass and biodiesel in the cells were increased by 58% (growth phase) and 51% (induction phase) compared to the cells in batch culture, respectively. The semi-continuous culture system using two stage photobioreactors is a very efficient strategy to further improve biodiesel production from microalgae under photoautotrophic conditions.

Why the Quality Oncology Practice Initiative Matters: It's Not Just About Cost.

PubMed

Chiang, Anne C

2016-01-01

The nature and cost of cancer care is evolving, affecting more patients and often involving expensive treatment options. The upward cost trends also coincide with a national landscape of increasing regulatory mandates that may demand improved outcomes and value, but that often require significant up-front investment in infrastructure to achieve safety and quality. Oncology practices participating in the American Society of Clinical Oncology (ASCO) Institute for Quality's Quality Oncology Practice Initiative (QOPI) and the QOPI Certification Program (QCP) continue to grow in number and reflect changing demographics of the provision of cancer care. QOPI and QCP benchmarking can be used to achieve quality improvement and to build collaborative quality communities. These programs may be useful tools for oncology practices to comply with new legislation such as the Medicare Access and CHIP Reauthorization Act (MACRA).

Opportunities to improve the conversion of food waste to lactate: Fine-tuning secondary factors.

PubMed

RedCorn, Raymond; Engelberth, Abigail S

2017-11-01

Extensive research has demonstrated the potential for bioconversion of food waste to lactate, with major emphasis on adjusting temperature, pH, and loading rate of the fermentation. Each of these factors has a significant effect on lactate production; however, additional secondary factors have received little attention. Here we investigate three additional factors where opportunities exist for process improvement: freezing of samples during storage, discontinuous pH control, and holdover of fermentation broth between fermentations. Freezing samples prior to fermentation was shown to reduce the production rate of lactate by 8%, indicating freeze-thaw should be avoided in experiments. Prior work indicated a trade-off in pH control strategies, where discontinuous pH control correlated with higher lactate accumulation while continuous pH control correlated with higher production rate. Here we demonstrate that continuous pH control can achieve both higher lactate accumulation and higher production rate. Finally, holding over fermentation broth was shown to be a simple method to improve production rate (by 18%) at high food waste loading rates (>140 g volatile solids L -1 ) but resulted in lower lactate accumulation (by 17%). The results inform continued process improvements within the waste treatment of food waste through fermentation to lactic acid.

Bone marrow chimerism as a strategy to produce tolerance in solid organ allotransplantation.

PubMed

Hu, Min; Alexander, Stephen I; Yi, Shounan

2016-12-01

Clinical transplant tolerance has been most successfully achieved combining hematopoietic chimerism with kidney transplantation. This review outlines this strategy in animal models and human transplantation, and possible clinical challenges. Kidney transplant tolerance has been achieved through chimerism in several centers beginning with Massachusetts General Hospital's success with mixed chimerism in human leukocyte antigen (HLA)-mismatched patients and the Stanford group with HLA-matched patients, and the more recent success of the Northwestern protocol achieving full chimerism. This has challenged the original view that stable mixed chimerism is necessary for organ graft tolerance. However, among the HLA-mismatched kidney transplant-tolerant patients, loss of mixed chimerism does not lead to renal-graft rejection, and the development of host Foxp3+ regulatory T cells has been observed. Recent animal models suggest that graft tolerance through bone marrow chimerism occurs through both clonal deletion and regulatory immune cells. Further, Tregs have been shown to improve chimerism in animal models. Animal studies continue to suggest ways to improve our current clinical strategies. Advances in chimerism protocols suggest that tolerance may be clinically achievable with relative safety for HLA-mismatched kidney transplants.

The estimation of the Earth's gravity field

NASA Astrophysics Data System (ADS)

Szabo, Bela

1986-06-01

The various methods for the description of the Earth's gravity field from direct and/or indirect observations are reviewed. Geopotential models produced by various organizations and in use during the past 15 years are discussed in detail. Recent and future programs for the improvement of global gravity fields are reviewed and the expected improvements from new observation and data processing techniques are estimated. The regional and local gravity field is also reviewed. The various data types and their spectral properties, the sensitivities of the different gravimetric quantities to datatypes are discussed. The techniques for the estimation of gravimetric quantities and the achievable accuracies are presented (e.g., integral formulae, collocation). The results of recent works in this area by prominent authors are reviewed. The prediction of gravity outside the earth from surface data is discussed in two forms: a) prediction of gravity disturbance at high altitudes and b) upward continuation of gravity anomalies. The achievable improvements of the high frequency field by airborne gradiometry are summarized utilizing recent investigations.

Health workforce development planning in the Sultanate of Oman: a case study.

PubMed

Ghosh, Basu

2009-06-11

Oman's recent experience in health workforce development may be viewed against the backdrop of the situation just three or four decades ago, when it had just a few physicians and nurses (mostly expatriate). All workforce categories in Oman have grown substantially over the last two decades. Increased self-reliance was achieved despite substantial growth in workforce stocks. Stocks of physicians and nurses grew significantly during 1985-2007. This development was the outcome of well-considered national policies and plans. This case outlines how Oman is continuing to turn around its excessive dependence on expatriate workforce through strategic workforce development planning. The Sultanate's early development initiatives focused on building a strong health care infrastructure by importing workforce. However, the policy-makers stressed national workforce development for a sustainable future. Beginning with the formulation of a strategic health workforce development plan in 1991, the stage was set for adopting workforce planning as an essential strategy for sustainable health development and workforce self-reliance. Oman continued to develop its educational infrastructure, and began to produce as much workforce as possible, in order to meet health care demands and achieve workforce self-reliance. Other policy initiatives with a beneficial impact on Oman's workforce development scenario were: regionalization of nursing institutes, active collaboration with universities and overseas specialty boards, qualitative improvement of the education system, development of a strong continuing professional development system, efforts to improve workforce management, planned change management and needs-based micro/macro-level studies. Strong political will and bold policy initiatives, dedicated workforce planning and educational endeavours have all contributed to help Oman to develop its health workforce stocks and gain self-reliance. Oman has successfully innovated workforce planning within a favorable policy environment. Its intensive and extensive workforce planning efforts, with the close involvement of policy-makers, educators and workforce managers, have ensured adequacy of suitable workforce in health institutions and its increased self-reliance in the health workforce. Oman's experience in workforce planning and development presents an illustration of a country benefiting from successful application of workforce planning concepts and tools. Instead of being complacent about its achievements so far, every country needs to improve or sustain its planning efforts in this way, in order to circumvent the current workforce deficiencies and to further increase self-reliance and improve workforce efficiency and effectiveness.

Health workforce development planning in the Sultanate of Oman: a case study

PubMed Central

Ghosh, Basu

2009-01-01

Introduction Oman's recent experience in health workforce development may be viewed against the backdrop of the situation just three or four decades ago, when it had just a few physicians and nurses (mostly expatriate). All workforce categories in Oman have grown substantially over the last two decades. Increased self-reliance was achieved despite substantial growth in workforce stocks. Stocks of physicians and nurses grew significantly during 1985–2007. This development was the outcome of well-considered national policies and plans. This case outlines how Oman is continuing to turn around its excessive dependence on expatriate workforce through strategic workforce development planning. Case description The Sultanate's early development initiatives focused on building a strong health care infrastructure by importing workforce. However, the policy-makers stressed national workforce development for a sustainable future. Beginning with the formulation of a strategic health workforce development plan in 1991, the stage was set for adopting workforce planning as an essential strategy for sustainable health development and workforce self-reliance. Oman continued to develop its educational infrastructure, and began to produce as much workforce as possible, in order to meet health care demands and achieve workforce self-reliance. Other policy initiatives with a beneficial impact on Oman's workforce development scenario were: regionalization of nursing institutes, active collaboration with universities and overseas specialty boards, qualitative improvement of the education system, development of a strong continuing professional development system, efforts to improve workforce management, planned change management and needs-based micro/macro-level studies. Strong political will and bold policy initiatives, dedicated workforce planning and educational endeavours have all contributed to help Oman to develop its health workforce stocks and gain self-reliance. Discussion and evaluation Oman has successfully innovated workforce planning within a favorable policy environment. Its intensive and extensive workforce planning efforts, with the close involvement of policy-makers, educators and workforce managers, have ensured adequacy of suitable workforce in health institutions and its increased self-reliance in the health workforce. Conclusion Oman's experience in workforce planning and development presents an illustration of a country benefiting from successful application of workforce planning concepts and tools. Instead of being complacent about its achievements so far, every country needs to improve or sustain its planning efforts in this way, in order to circumvent the current workforce deficiencies and to further increase self-reliance and improve workforce efficiency and effectiveness. PMID:19519912

Systems approach to managing educational quality in the engineering classroom

NASA Astrophysics Data System (ADS)

Grygoryev, Kostyantyn

Today's competitive environment in post-secondary education requires universities to demonstrate the quality of their programs in order to attract financing, and student and academic talent. Despite significant efforts devoted to improving the quality of higher education, systematic, continuous performance measurement and management still have not reached the level where educational outputs and outcomes are actually produced---the classroom. An engineering classroom is a complex environment in which educational inputs are transformed by educational processes into educational outputs and outcomes. By treating a classroom as a system, one can apply tools such as Structural Equation Modeling, Statistical Process Control, and System Dynamics in order to discover cause-and-effect relationships among the classroom variables, control the classroom processes, and evaluate the effect of changes to the course organization, content, and delivery, on educational processes and outcomes. Quality improvement is best achieved through the continuous, systematic application of efforts and resources. Improving classroom processes and outcomes is an iterative process that starts with identifying opportunities for improvement, designing the action plan, implementing the changes, and evaluating their effects. Once the desired objectives are achieved, the quality improvement cycle may start again. The goal of this research was to improve the educational processes and outcomes in an undergraduate engineering management course taught at the University of Alberta. The author was involved with the course, first, as a teaching assistant, and, then, as a primary instructor. The data collected from the course over four years were used to create, first, a static and, then, a dynamic model of a classroom system. By using model output and qualitative feedback from students, changes to the course organization and content were introduced. These changes led to a lower perceived course workload and increased the students' satisfaction with the instructor, but the students' overall satisfaction with the course did not change significantly, and their attitude toward the course subject actually became more negative. This research brought performance measurement to the level of a classroom, created a dynamic model of the classroom system based on the cause-and-effect relationships discovered by using statistical analysis, and used a systematic, continuous improvement approach to modify the course in order to improve selected educational processes and outcomes.

The TOMS V9 Algorithm for OMPS Nadir Mapper Total Ozone: An Enhanced Design That Ensures Data Continuity

NASA Astrophysics Data System (ADS)

Haffner, D. P.; McPeters, R. D.; Bhartia, P. K.; Labow, G. J.

2015-12-01

The TOMS V9 total ozone algorithm will be applied to the OMPS Nadir Mapper instrument to supersede the exisiting V8.6 data product in operational processing and re-processing for public release. Becuase the quality of the V8.6 data is already quite high, enchancements in V9 are mainly with information provided by the retrieval and simplifcations to the algorithm. The design of the V9 algorithm has been influenced by improvements both in our knowledge of atmospheric effects, such as those of clouds made possible by studies with OMI, and also limitations in the V8 algorithms applied to both OMI and OMPS. But the namesake instruments of the TOMS algorithm are substantially more limited in their spectral and noise characterisitics, and a requirement of our algorithm is to also apply the algorithm to these discrete band spectrometers which date back to 1978. To achieve continuity for all these instruments, the TOMS V9 algorithm continues to use radiances in discrete bands, but now uses Rodgers optimal estimation to retrieve a coarse profile and provide uncertainties for each retrieval. The algorithm remains capable of achieving high accuracy results with a small number of discrete wavelengths, and in extreme cases, such as unusual profile shapes and high solar zenith angles, the quality of the retrievals is improved. Despite the intended design to use limited wavlenegths, the algorithm can also utilitze additional wavelengths from hyperspectral sensors like OMPS to augment the retreival's error detection and information content; for example SO2 detection and correction of Ring effect on atmospheric radiances. We discuss these and other aspects of the V9 algorithm as it will be applied to OMPS, and will mention potential improvements which aim to take advantage of a synergy with OMPS Limb Profiler and Nadir Mapper to further improve the quality of total ozone from the OMPS instrument.

A Cross-Cohort Exploratory Study of a Student Perceptions on Mobile Phone-Based Student Response System Using a Polling Website

ERIC Educational Resources Information Center

Wong, Adam; Wong, Simon

2016-01-01

Student engagement in the classroom is important for the achievement of learning outcomes. As digital technologies continue to improve and become more economically viable to students and schools, many schools have adopted the Student Response System (SRS) with the purpose of increasing student engagement. In an SRS, students answer the teacher's…

JPRS Report, Science & Technology, Europe, FRG: Official Report om Multiyear Research Funding, Trends

DTIC Science & Technology

1988-08-23

research institutions. The special recognition of performance and the chal- lenge to top performance in research, development, and innovation will...continue to be a central concern of the federal government. Top performances , the achievement of internationally recognized breakthroughs, and suc...government places on improving busi- ness framework conditions for more growth and employ- ment, for strengthening the power of performance , com

Long-Term Impacts of Professional Development on Teachers Using a Math-Enhanced Curriculum in Agricultural Power and Technology: A 10-Year Retrospect

ERIC Educational Resources Information Center

Mukembo, Stephen C.; Edwards, M. Craig

2015-01-01

Professional development (PD) on approaches to curriculum integration (CI) continues to be essential for teachers to stay abreast of developments to improve student performance in their courses while also supporting learning and achievement in core subjects. We aimed to explore and derive meaning from the shared experiences of six agriculture…

NASA total quality management 1990 accomplishments report

NASA Technical Reports Server (NTRS)

1991-01-01

NASA's efforts in Total Quality Management are based on continuous improvement and serve as a foundation for NASA's present and future endeavors. Given here are numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. These accomplishment benefit our Agency and help to achieve our primary goal, keeping American in the forefront of the aerospace industry.

A Comparison of Two After School Strategies for Improving the Parenting Knowledge and Parenting Perceptions of Preschool Families Enrolled in a Title 1 Program

ERIC Educational Resources Information Center

Newman, Rae Ette Veronna

2013-01-01

A parent is a child's first educator in communication, social/emotional skills, motor development, and academics. As the achievement expectations placed on schools increase and the schooling population continually diversifies, the need to increase the overall parental involvement in schools and their ability to assist with academics in the home…

An All-vanadium Continuous-flow Photoelectrochemical Cell for Extending State-of-charge in Solar Energy Storage.

PubMed

Wei, Zi; Shen, Yi; Liu, Dong; Liu, Fuqiang

2017-04-04

Greater levels of solar energy storage provide an effective solution to the inherent nature of intermittency, and can substantially improve reliability, availability, and quality of the renewable energy source. Here we demonstrated an all-vanadium (all-V) continuous-flow photoelectrochemical storage cell (PESC) to achieve efficient and high-capacity storage of solar energy, through improving both photocurrent and photocharging depth. It was discovered that forced convective flow of electrolytes greatly enhanced the photocurrent by 5 times comparing to that with stagnant electrolytes. Electrochemical impedance spectroscopy (EIS) study revealed a great reduction of charge transfer resistance with forced convective flow of electrolytes as a result of better mass transport at U-turns of the tortuous serpentine flow channel of the cell. Taking advantage of the improved photocurrent and diminished charge transfer resistance, the all-V continuous-flow PESC was capable of producing ~20% gain in state of charge (SOC) under AM1.5 illumination for ca. 1.7 hours without any external bias. This gain of SOC was surprisingly three times more than that with stagnant electrolytes during a 25-hour period of photocharge.

Feasibility of a virtual learning collaborative to implement an obesity QI project in 29 pediatric practices.

PubMed

John, Tamara; Morton, Michaela; Weissman, Mark; O'Brien, Ellen; Hamburger, Ellen; Hancock, Yolandra; Moon, Rachel Y

2014-04-01

Quality improvement (QI) activities are required to maintain board certification in pediatrics. However, because of lack of training and resources, pediatricians may feel overwhelmed by the need to implement QI activities. Pediatricians also face challenges when caring for overweight and obese children. To create a virtual (online) QI learning collaborative through which pediatric practices could easily develop and implement a continuous QI process. Prospective cohort. Pediatric practices that were part of the Children's National Health Network were invited to participate, with the option to receive continuing medical education and maintenance of certification credits. s) Practices conducted baseline and monthly chart audits, participated in educational webinars and selected monthly practice changes, using Plan-Do-Study-Act cycles. Practices reported activities monthly and periodic feedback was provided to practices about their performance. s) Improvement in (i) body mass index (BMI) percentile documentation, (ii) appropriate nutritional and activity counseling and (iii) follow-up management for high-risk patients. Twenty-nine practices (120 providers) participated, and 24 practices completed all program activities. Monthly chart audits demonstrated continuous improvement in documentation of BMI, abnormal weight diagnosis, nutrition and activity screening and counseling, weight-related health messages and follow-up management of overweight and obese patients. Impact of QI activities on visit duration and practice efficiency was minimal. A virtual learning collaborative was successful in providing a framework for pediatricians to implement a continuous QI process and achieve practice improvements. This format can be utilized to address multiple health issues.

Continuity Clinic Model and Diabetic Outcomes in Internal Medicine Residencies: Findings of the Educational Innovations Project Ambulatory Collaborative

PubMed Central

Francis, Maureen D.; Julian, Katherine A.; Wininger, David A.; Drake, Sean; Bollman, KeriLyn; Nabors, Christopher; Pereira, Anne; Rosenblum, Michael; Zelenski, Amy B.; Sweet, David; Thomas, Kris; Varney, Andrew; Warm, Eric; Francis, Mark L.

2016-01-01

Background Efforts to improve diabetes care in residency programs are ongoing and in the midst of continuity clinic redesign at many institutions. While there appears to be a link between resident continuity and improvement in glycemic control for diabetic patients, it is uncertain whether clinic structure affects quality measures and patient outcomes. Methods This multi-institutional, cross-sectional study included 12 internal medicine programs. Three outcomes (glycemic control, blood pressure control, and achievement of target low-density lipoprotein [LDL]) and 2 process measures (A1C and LDL measurement) were reported for diabetic patients. Traditional, block, and combination clinic models were compared using analysis of covariance (ANCOVA). Analysis was adjusted for continuity, utilization, workload, and panel size. Results No significant differences were found in glycemic control across clinic models (P = .06). The percentage of diabetic patients with LDL < 100 mg/dL was 60% in block, compared to 54.9% and 55% in traditional and combination models (P = .006). The percentage of diabetic patients with blood pressure < 130/80 mmHg was 48.4% in block, compared to 36.7% and 36.9% in other models (P < .001). The percentage of diabetic patients with HbA1C measured was 92.1% in block compared to 75.2% and 82.1% in other models (P < .001). Also, the percentage of diabetic patients with LDL measured was significantly different across all groups, with 91.2% in traditional, 70.4% in combination, and 83.3% in block model programs (P < .001). Conclusions While high scores on diabetic quality measures are achievable in any clinic model, the block model design was associated with better performance. PMID:26913099

Characterization and optimization of the visualization performance of continuous flow overhauser DNP hyperpolarized water MRI: Inversion recovery approach.

PubMed

Terekhov, Maxim; Krummenacker, Jan; Denysenkov, Vasyl; Gerz, Kathrin; Prisner, Thomas; Schreiber, Laura Maria

2016-03-01

Overhauser dynamic nuclear polarization (DNP) allows the production of liquid hyperpolarized substrate inside the MRI magnet bore as well as its administration in continuous flow mode to acquire MR images with enhanced signal-to-noise ratio. We implemented inversion recovery preparation in order to improve contrast-to-noise ratio and to quantify the overall imaging performance of Overhauser DNP-enhanced MRI. The negative enhancement created by DNP in combination with inversion recovery (IR) preparation allows canceling selectively the signal originated from Boltzmann magnetization and visualizing only hyperpolarized fluid. The theoretical model describing gain of MR image intensity produced by steady-state continuous flow DNP hyperpolarized magnetization was established and proved experimentally. A precise quantification of signal originated purely from DNP hyperpolarization was achieved. A temperature effect on longitudinal relaxation had to be taken into account to fit experimental results with numerical prediction. Using properly adjusted IR preparation, the complete zeroing of thermal background magnetization was achieved, providing an essential increase of contrast-to-noise ratio of DNP-hyperpolarized water images. To quantify and optimize the steady-state conditions for MRI with continuous flow DNP, an approach similar to that incorporating transient-state thermal magnetization equilibrium in spoiled fast field echo imaging sequences can be used. © 2015 Wiley Periodicals, Inc.

Hydrolysis kinetics of tulip tree xylan in hot compressed water.

PubMed

Yoon, Junho; Lee, Hun Wook; Sim, Seungjae; Myint, Aye Aye; Park, Hee Jeong; Lee, Youn-Woo

2016-08-01

Lignocellulosic biomass, a promising renewable resource, can be converted into numerous valuable chemicals post enzymatic saccharification. However, the efficacy of enzymatic saccharification of lignocellulosic biomass is low; therefore, pretreatment is necessary to improve the efficiency. Here, a kinetic analysis was carried out on xylan hydrolysis, after hot compressed water pretreatment of the lignocellulosic biomass conducted at 180-220°C for 5-30min, and on subsequent xylooligosaccharide hydrolysis. The weight ratio of fast-reacting xylan to slow-reacting xylan was 5.25 in tulip tree. Our kinetic results were applied to three different reaction systems to improve the pretreatment efficiency. We found that semi-continuous reactor is promising. Lower reaction temperatures and shorter space times in semi-continuous reactor are recommended for improving xylan conversion and xylooligosaccharide yield. In the theoretical calculation, 95% of xylooligosaccharide yield and xylan conversion were achieved simultaneously with high selectivity (desired product/undesired product) of 100 or more. Copyright © 2016. Published by Elsevier Ltd.

Organizational learning and continuous quality improvement: examining the impact on nursing home performance.

PubMed

Rondeau, Kent V; Wagar, Terry H

2002-01-01

Interest is growing in learning more about the ability of total quality management and continuous quality improvement (TQM/CQI) initiatives to contribute to the performance of healthcare organizations. A major factor in the successful implementation of TQM/CQI is the seminal contribution of an organization's culture. Many implementation efforts have not succeeded because of a corporate culture that failed to stress broader organizational learning. This may help to explain why some TQM/CQI programs have been unsuccessful in improving healthcare organization performance. Organizational performance variables and organizational learning orientation were assessed in a sample of 181 Canadian long-term care organizations that had implemented a formal TQM/CQI program. Categorical regression analysis shows that, in the absence of a strong corporAte culture that stresses organizational learning and employee development, few performance enhancements are reported. The results of the assessment suggest that a TQM/CQI program without the backing of a strong organizational learning culture may be insufficient to achieve augmented organizational performance.

Analyzing locomotion synthesis with feature-based motion graphs.

PubMed

Mahmudi, Mentar; Kallmann, Marcelo

2013-05-01

We propose feature-based motion graphs for realistic locomotion synthesis among obstacles. Among several advantages, feature-based motion graphs achieve improved results in search queries, eliminate the need of postprocessing for foot skating removal, and reduce the computational requirements in comparison to traditional motion graphs. Our contributions are threefold. First, we show that choosing transitions based on relevant features significantly reduces graph construction time and leads to improved search performances. Second, we employ a fast channel search method that confines the motion graph search to a free channel with guaranteed clearance among obstacles, achieving faster and improved results that avoid expensive collision checking. Lastly, we present a motion deformation model based on Inverse Kinematics applied over the transitions of a solution branch. Each transition is assigned a continuous deformation range that does not exceed the original transition cost threshold specified by the user for the graph construction. The obtained deformation improves the reachability of the feature-based motion graph and in turn also reduces the time spent during search. The results obtained by the proposed methods are evaluated and quantified, and they demonstrate significant improvements in comparison to traditional motion graph techniques.

Effective Charge Carrier Utilization in Photocatalytic Conversions.

PubMed

Zhang, Peng; Wang, Tuo; Chang, Xiaoxia; Gong, Jinlong

2016-05-17

Continuous efforts have been devoted to searching for sustainable energy resources to alleviate the upcoming energy crises. Among various types of new energy resources, solar energy has been considered as one of the most promising choices, since it is clean, sustainable, and safe. Moreover, solar energy is the most abundant renewable energy, with a total power of 173 000 terawatts striking Earth continuously. Conversion of solar energy into chemical energy, which could potentially provide continuous and flexible energy supplies, has been investigated extensively. However, the conversion efficiency is still relatively low since complicated physical, electrical, and chemical processes are involved. Therefore, carefully designed photocatalysts with a wide absorption range of solar illumination, a high conductivity for charge carriers, a small number of recombination centers, and fast surface reaction kinetics are required to achieve a high activity. This Account describes our recent efforts to enhance the utilization of charge carriers for semiconductor photocatalysts toward efficient solar-to-chemical energy conversion. During photocatalytic reactions, photogenerated electrons and holes are involved in complex processes to convert solar energy into chemical energy. The initial step is the generation of charge carriers in semiconductor photocatalysts, which could be enhanced by extending the light absorption range. Integration of plasmonic materials and introduction of self-dopants have been proved to be effective methods to improve the light absorption ability of photocatalysts to produce larger amounts of photogenerated charge carriers. Subsequently, the photogenerated electrons and holes migrate to the surface. Therefore, acceleration of the transport process can result in enhanced solar energy conversion efficiency. Different strategies such as morphology control and conductivity improvement have been demonstrated to achieve this goal. Fine-tuning of the morphology of nanostructured photocatalysts can reduce the migration distance of charge carriers. Improving the conductivity of photocatalysts by using graphitic materials can also improve the transport of charge carriers. Upon charge carrier migration, electrons and holes also tend to recombine. The suppression of recombination can be achieved by constructing heterojunctions that enhance charge separation in the photocatalysts. Surface states acting as recombination centers should also be removed to improve the photocatalytic efficiency. Moreover, surface reactions, which are the core chemical processes during the solar energy conversion, can be enhanced by applying cocatalysts as well as suppressing side reactions. All of these strategies have been proved to be essential for enhancing the activities of semiconductor photocatalysts. It is hoped that delicate manipulation of photogenerated charge carriers in semiconductor photocatalysts will hold the key to effective solar-to-chemical energy conversion.

IMPROVED TUBULARS FOR BETTER ECONOMICS IN DEEP GAS WELL DRILLING USING MICROWAVE TECHNOLOGY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dinesh Agrawal; Paul Gigl; Mahlon Dennis

2005-03-01

The main objective of the research program has been to improve the rate-of-penetration in deep hostile environments by improving the life cycle and performance of coiled-tubing, an important component of a deep well drilling system for oil and gas exploration, by utilizing the latest developments in the microwave materials technology. Originally, it was proposed to accomplish this by developing an efficient and economically viable continuous microwave process to sinter continuously formed/extruded steel powder for the manufacture of seamless coiled tubing and other tubular products. However, based on the results and faced with insurmountable difficulties in the extrusion and de-waxing processes,more » the approach of achieving the goals of the program has been slightly changed. In the continuation proposal an approach of microwave sintering combined with Cold Isostatic Press (CIP) and joining (by induction or microwave) is adopted. This process can be developed into a semi-continuous sintering process if the CIP can produce parts fast enough to match the microwave sintering rates. Originally, the entire program was spread over three phases with the following goals: Phase I: Demonstration of the feasibility concept of continuous microwave sintering process for tubular steel products. Phase II: Design, building and testing of a prototype microwave system which shall be combined with a continuous extruder for steel tubular objects. Phase III: Execution of the plan for commercialization of the technology by one of the industrial partners. However, since some of the goals of the phase I were not completed, an extension of nine months was granted and we continued extrusion experiments, designed and built semicontinuous microwave sintering unit.« less

Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based training: a randomized controlled trial.

PubMed

Stefanidis, Dimitrios; Scerbo, Mark W; Montero, Paul N; Acker, Christina E; Smith, Warren D

2012-01-01

We hypothesized that novices will perform better in the operating room after simulator training to automaticity compared with traditional proficiency based training (current standard training paradigm). Simulator-acquired skill translates to the operating room, but the skill transfer is incomplete. Secondary task metrics reflect the ability of trainees to multitask (automaticity) and may improve performance assessment on simulators and skill transfer by indicating when learning is complete. Novices (N = 30) were enrolled in an IRB-approved, blinded, randomized, controlled trial. Participants were randomized into an intervention (n = 20) and a control (n = 10) group. The intervention group practiced on the FLS suturing task until they achieved expert levels of time and errors (proficiency), were tested on a live porcine fundoplication model, continued simulator training until they achieved expert levels on a visual spatial secondary task (automaticity) and were retested on the operating room (OR) model. The control group participated only during testing sessions. Performance scores were compared within and between groups during testing sessions. : Intervention group participants achieved proficiency after 54 ± 14 and automaticity after additional 109 ± 57 repetitions. Participants achieved better scores in the OR after automaticity training [345 (range, 0-537)] compared with after proficiency-based training [220 (range, 0-452; P < 0.001]. Simulator training to automaticity takes more time but is superior to proficiency-based training, as it leads to improved skill acquisition and transfer. Secondary task metrics that reflect trainee automaticity should be implemented during simulator training to improve learning and skill transfer.

Improving the seniors' transition from hospital to the community: a case for intensive geriatric service workers.

PubMed

McAiney, Carrie A; Hillier, Loretta M; Paul, Janice; McKinnon Wilson, Jane; Tersigni Phelan, Anna; Wagner, Fred; O'Connor, Sheli

2017-01-01

Limited continuity of care, poor communication between healthcare providers, and ineffective self-management are barriers to recovery as seniors transition back to the community following an Emergency Department (ED) visit or hospitalization. The intensive geriatric service worker (IGSW) role is a new service developed in southern Ontario, Canada to address gaps for seniors transitioning home from acute care to prevent rehospitalization and premature institutionalization through the provision of intensive support and follow-up to ensure adherence to care plans, facilitate communication with care providers, and promote self-management. This study describes the IGSW role and provides preliminary evidence of its impact on clients, caregivers and the broader health system. This mixed methods evaluation included a chart audit of all clients served, tracking of the achievement of goals for IGSW involvement, and interviews with clients and caregivers and other key informants. During the study period, 632 clients were served. Rates of goal achievement ranged from 25%-87% and in cases where achieved, the extent of IGSW involvement mostly exceeded recommendations. IGSWs were credited with improving adherence with treatment recommendations, increasing awareness and use of community services, and improving self-management, which potentially reduced ED visits and hospitalizations and delayed institutionalization. The IGSW role has the potential to improve supports for seniors and facilitate more appropriate use of health system resources, and represents a promising mechanism for improving the integration and coordination of care across health sectors.

Optimal Control Allocation with Load Sensor Feedback for Active Load Suppression, Flight-Test Performance

NASA Technical Reports Server (NTRS)

Miller, Christopher J.; Goodrick, Dan

2017-01-01

The problem of control command and maneuver induced structural loads is an important aspect of any control system design. The aircraft structure and the control architecture must be designed to achieve desired piloted control responses while limiting the imparted structural loads. The classical approach is to utilize high structural margins, restrict control surface commands to a limited set of analyzed combinations, and train pilots to follow procedural maneuvering limitations. With recent advances in structural sensing and the continued desire to improve safety and vehicle fuel efficiency, it is both possible and desirable to develop control architectures that enable lighter vehicle weights while maintaining and improving protection against structural damage. An optimal control technique has been explored and shown to achieve desirable vehicle control performance while limiting sensed structural loads to specified values. This technique has been implemented and flown on the National Aeronautics and Space Administration Full-scale Advanced Systems Testbed aircraft. The flight tests illustrate that the approach achieves the desired performance and show promising potential benefits. The flights also uncovered some important issues that will need to be addressed for production application.

Designing and implementing a trust-wide quality assurance programme.

PubMed

Coope, Sally-Ann

2018-04-02

Derbyshire Community Health Services (DCHS) NHS Foundation Trust provides a wide range of community-based health services. After the Care Quality Commission (CQC) found gaps in the trust's assurance process, its board decided to develop a method of continuous quality improvements that could be used as a basis for the trust's quality assurance system. The trust adapted and built on an acute model so it was suitable for community services. The final assurance system, Quality Always, has four elements: the clinical assessment and accreditation scheme; leadership development; 'champions' within clinical teams to support and promote the scheme; and dashboards to record and monitor progress. A system to recognise and reward achievement was essential for success. Quality Always has resulted in better care quality, an improved CQC rating, a sense of achievement among staff, the development of support networks, learning (especially among support staff) and good practice being shared.

Decreasing trends in patient satisfaction, accessibility and continuity of care in Finnish primary health care - a 14-year follow-up questionnaire study.

PubMed

Raivio, Risto; Jääskeläinen, Juhani; Holmberg-Marttila, Doris; Mattila, Kari J

2014-05-15

The aim here was to explore trends in patient satisfaction with primary health care and its accessibility and continuity, and to explore whether through reforms and improvements some of the essential goals had been achieved over a 14-year period of time in Finland. Nine questionnaire surveys were conducted over a period of 14 years among patients attending within one week in the 65 health centres in the Tampere University Hospital catchment area. A total of 147,394 responded out of a sample of 333,648 patients. The response rate varied yearly from 53% to 37%. Patient satisfaction with care in Finnish health centres decreased by nearly 9 percentage units from 1998 to 2011. The fall-off was most marked in the age-group over 64 years. There was a 20 percentage unit's reduction in ease of access as reported by patients. Respondents also reported that the continuity of care had deteriorated. Despite major reforms in Finnish health care policy, patients seem to be less satisfied. Our findings challenge both Finnish authorities and GPs to improve the accessibility and continuity of care in primary health services.

Free Flyer Total and Spectral Solar Irradiance Sensor (TSIS) and Climate Services Mission

NASA Technical Reports Server (NTRS)

Cahalan, R.; Pilewskie, P.; Woods, T.

2012-01-01

NOAA's planned Total and Spectral Solar Irradiance Sensor (TSIS) mission will fly along with the NOAA user service payloads Advanced Data Collection System (ADCS) and Search and Rescue Satellite Aided Tracking (SARSAT). In ' order to guarantee continuity in the 33-year solar irradiance climate data record, TSIS must be launched in time to overlap with current on-orbit solar irradiance instruments. Currently TSIS is moving towards a launch rcadinss date of January 2015. TSIS provides for continuation of the Total Irradiance Monitor (TIM) and the Spectral Irradiance Monitor (SIM) ,currently onboard NASA's Solar Radiation and Climate Experiment (SORCE) platform, launched in January 2003. The difficulty of ensuring continuity has increased due to the launch failure of NASA's Glory mission with its improved TIM. Achieving the needed overlap must now rely on extending SORCE. and maintaining the TSIS schedule. TSIS is one component of a NASA-NOAA joint program (JPSS) planned to transition certain climate observations to operational mode. We summarize issues of continuity, improvements being made to the TIM and 81M sensors, and plans to provide for traceability of total and spectral irradiance measurements to ground-based cryogenic standards.

State of the art of aerobic granulation in continuous flow bioreactors.

PubMed

Kent, Timothy R; Bott, Charles B; Wang, Zhi-Wu

In the wake of the success of aerobic granulation in sequential batch reactors (SBRs) for treating wastewater, attention is beginning to turn to continuous flow applications. This is a necessary step given the advantages of continuous flow treatment processes and the fact that the majority of full-scale wastewater treatment plants across the world are operated with aeration tanks and clarifiers in a continuous flow mode. As in SBRs, applying a selection pressure, based on differences in either settling velocity or the size of the biomass, is essential for successful granulation in continuous flow reactors (CFRs). CFRs employed for aerobic granulation come in multiple configurations, each with their own means of achieving such a selection pressure. Other factors, such as bioaugmentation and hydraulic shear force, also contribute to aerobic granulation to some extent. Besides the formation of aerobic granules, long-term stability of aerobic granules is also a critical issue to be addressed. Inorganic precipitation, special inocula, and various operational optimization strategies have been used to improve granule long-term structural integrity. Accumulated studies reviewed in this work demonstrate that aerobic granulation in CFRs is capable of removing a wide spectrum of contaminants and achieving properties generally comparable to those in SBRs. Despite the notable research progress made toward successful aerobic granulation in lab-scale CFRs, to the best of our knowledge, there are only three full-scale tests of the technique, two being seeded with anammox-supported aerobic granules and the other with conventional aerobic granules; two other process alternatives are currently in development. Application of settling- or size-based selection pressures and feast/famine conditions are especially difficult to implement to these and similar mainstream systems. Future research efforts needs to be focused on the optimization of the granule-to-floc ratio, enhancement of granule activity, improvement of long-term granule stability, and a better understanding of aerobic granulation mechanisms in CFRs, especially in full-scale applications. Copyright © 2018 Elsevier Inc. All rights reserved.

Asynchronous variational integration using continuous assumed gradient elements.

PubMed

Wolff, Sebastian; Bucher, Christian

2013-03-01

Asynchronous variational integration (AVI) is a tool which improves the numerical efficiency of explicit time stepping schemes when applied to finite element meshes with local spatial refinement. This is achieved by associating an individual time step length to each spatial domain. Furthermore, long-term stability is ensured by its variational structure. This article presents AVI in the context of finite elements based on a weakened weak form (W2) Liu (2009) [1], exemplified by continuous assumed gradient elements Wolff and Bucher (2011) [2]. The article presents the main ideas of the modified AVI, gives implementation notes and a recipe for estimating the critical time step.

Training Strategies to Mitigate Expectancy-Induced Response Bias in Combat Identification: A Research Agenda

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greitzer, Frank L.; Andrews, Dee H.

Historical assessments of combat fratricide reveal principal contributing factors in the effects of stress, continuous operations or sleep deprivation, poor situational awareness, emotions, and lack of training. This paper discusses what and how improvements in combat identification (CID) may be achieved through training. In addition to skill-based training, CID training must focus on countering the negative effects of expectancy in the face of heightened anxiety and stressors of continuous operations that lead to combat errors or fratricide. The paper examines possible approaches to training for overcoming erroneous expectancies and emotional factors that may distort or limit accurate "blue force" identification.

Training Strategies to Mitigate Expectancy-Induced Response Bias in Combat Identification: A Research Agenda

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greitzer, Frank L.; Andrews, Dee H.

2008-04-15

Historical assessments of combat fratricide reveal principal contributing factors in the effects of stress, continuous operations or sleep deprivation, poor situational awareness, emotions, and lack of training. This paper discusses what and how improvements in combat identification (CID) may be achieved through training. In addition to skill-based training, CID training must focus on countering the negative effects of expectancy in the face of heightened anxiety and stressors of continuous operations that lead to combat errors or fratricide. The paper examines possible approaches to training for overcoming erroneous expectancies and emotional factors that may distort or limit accurate "blue force" identification.

The spark-ignition aircraft piston engine of the future

NASA Technical Reports Server (NTRS)

Stuckas, K. J.

1980-01-01

Areas of advanced technology appropriate to the design of a spark-ignition aircraft piston engine for the late 1980 time period were investigated and defined. Results of the study show that significant improvements in fuel economy, weight and size, safety, reliability, durability and performance may be achieved with a high degree of success, predicated on the continued development of advances in combustion systems, electronics, materials and control systems.

Next-generation pushbroom filter radiometers for remote sensing

NASA Astrophysics Data System (ADS)

Tarde, Richard W.; Dittman, Michael G.; Kvaran, Geir E.

2012-09-01

Individual focal plane size, yield, and quality continue to improve, as does the technology required to combine these into large tiled formats. As a result, next-generation pushbroom imagers are replacing traditional scanning technologies in remote sensing applications. Pushbroom architecture has inherently better radiometric sensitivity and significantly reduced payload mass, power, and volume than previous generation scanning technologies. However, the architecture creates challenges achieving the required radiometric accuracy performance. Achieving good radiometric accuracy, including image spectral and spatial uniformity, requires creative optical design, high quality focal planes and filters, careful consideration of on-board calibration sources, and state-of-the-art ground test facilities. Ball Aerospace built the Landsat Data Continuity Mission (LDCM) next-generation Operational Landsat Imager (OLI) payload. Scheduled to launch in 2013, OLI provides imagery consistent with the historical Landsat spectral, spatial, radiometric, and geometric data record and completes the generational technology upgrade from the Enhanced Thematic Mapper (ETM+) whiskbroom technology to modern pushbroom technology afforded by advanced focal planes. We explain how Ball's capabilities allowed producing the innovative next-generational OLI pushbroom filter radiometer that meets challenging radiometric accuracy or calibration requirements. OLI will improve the multi-decadal land surface observation dataset dating back to the 1972 launch of ERTS-1 or Landsat 1.

Aryl sulfonates as neutral photoacid generators (PAGs) for EUV lithography

NASA Astrophysics Data System (ADS)

Sulc, Robert; Blackwell, James M.; Younkin, Todd R.; Putna, E. Steve; Esswein, Katherine; DiPasquale, Antonio G.; Callahan, Ryan; Tsubaki, Hideaki; Tsuchihashi, Tooru

2009-03-01

EUV lithography (EUVL) is a leading candidate for printing sub-32 nm hp patterns. In order for EUVL to be commercially viable at these dimensions, a continuous evolution of the photoresist material set is required to simultaneously meet the aggressive specifications for resolution, resist sensitivity, LWR, and outgassing rate. Alternative PAG designs, especially if tailored for EUVL, may aid in the formation of a material set that helps achieve these aggressive targets. We describe the preparation, characterization, and lithographic evaluation of aryl sulfonates as non-ionic or neutral photoacid generators (PAGs) for EUVL. Full lithographic characterization is reported for our first generation resist formulation using compound H, MAP-1H-2.5. It is benchmarked against MAP-1P-5.0, which contains the well-known sulfonium PAG, triphenylsulfonium triflate (compound P). Z-factor analysis indicates nZ32 = 81.4 and 16.8 respectively, indicating that our first generation aryl sulfonate formulations require about 4.8x improvement to match the results achieved with a model onium PAG. Improving the acid generation efficiency and use of the generated byproducts is key to the continued optimization of this class of PAGs. To that end, we believe EI-MS fragmentation patterns and molecular simulations can be used to understand and optimize the nature and efficiency of electron-induced PAG fragmentation.

Improving comparability of international migration statistics: contributions by the Conference of European Statisticians from 1971 to date.

PubMed

Kelly, J J

1987-01-01

This article summarizes the 3 main types of interrelated activities which the Conference of European Statisticians has worked on to improve the measurement and international comparability of international migration flows. The work has encompassed collaborating with the UN Statistical Commission on the preparation and implementation of the revised international recommendations on statistics of international migration, organizing a regular exchange of data on immigration and emigration flows among the UN Economic Commission for Europe countries and selected countries in other regions, and conducting bilateral studies on international migration within the framework of the Conference's program of work in this field of statistics. The bulk of the work which has been carried out to date by the conference has been conducted rather anonymously and even unobtrusively by the staff of national statistical offices in Economic Commission for Europe countries; they have achieved a modest but important amount of progress during the past 15 years. There is reason to expect that further progress will be made over the next decade, particularly if national statistical offices in the region continue to undertake bilateral studies and endeavor to improve their migration statistics. However, more substantial progress could be achieved if additional countries and organizations established projects aimed at achieving these ends (author's modified).

Library Service to the People of New York State. A Long-Range Program, October 1, 1987-September 30, 1992, for the Improvement of Library Services Utilizing Local, State and Federal Resources. Supplement 1: LSCA Program Purposes: Needs and Intended Actions. Supplement 2: Policy Guidelines on the Administration of LSCA funds, 1987-88.

ERIC Educational Resources Information Center

New York State Library, Albany.

This annual report on the comprehensive five-year program for the enhancement of libraries in New York State achieves the following: (1) provides a benchmark for the continuing planning, development, and evaluation of state library services; (2) summarizes the objectives, policies, and programs undertaken for the improvement of those services; (3)…

Development of a business plan for women's health services, using Malcolm Baldrige Performance Excellence Criteria.

PubMed

Caramanica, L; Maxwell, S; Curry, S

2000-06-01

A new process for business planning at Hartford Hospital was needed to achieve critical business results. This article describes the Hospital's use of the Malcolm Baldrige Performance Excellence Criteria as a way to standardize and improve business planning. Women's Health Services is one of Hartford Hospital's "centers for excellence" and one of the first to use these criteria to improve its service. Staff learned how to build their business plan upon a set of core values and concepts such as customer-driven quality, leadership that sets high expectations, continuous improvement and learning, valuing employees, faster response to market demands, management by fact, and a long-range view of the future.

An investigation of signal performance enhancements achieved through innovative pixel design across several generations of indirect detection, active matrix, flat-panel arrays

PubMed Central

Antonuk, Larry E.; Zhao, Qihua; El-Mohri, Youcef; Du, Hong; Wang, Yi; Street, Robert A.; Ho, Jackson; Weisfield, Richard; Yao, William

2009-01-01

Active matrix flat-panel imager (AMFPI) technology is being employed for an increasing variety of imaging applications. An important element in the adoption of this technology has been significant ongoing improvements in optical signal collection achieved through innovations in indirect detection array pixel design. Such improvements have a particularly beneficial effect on performance in applications involving low exposures and∕or high spatial frequencies, where detective quantum efficiency is strongly reduced due to the relatively high level of additive electronic noise compared to signal levels of AMFPI devices. In this article, an examination of various signal properties, as determined through measurements and calculations related to novel array designs, is reported in the context of the evolution of AMFPI pixel design. For these studies, dark, optical, and radiation signal measurements were performed on prototype imagers incorporating a variety of increasingly sophisticated array designs, with pixel pitches ranging from 75 to 127 μm. For each design, detailed measurements of fundamental pixel-level properties conducted under radiographic and fluoroscopic operating conditions are reported and the results are compared. A series of 127 μm pitch arrays employing discrete photodiodes culminated in a novel design providing an optical fill factor of ∼80% (thereby assuring improved x-ray sensitivity), and demonstrating low dark current, very low charge trapping and charge release, and a large range of linear signal response. In two of the designs having 75 and 90 μm pitches, a novel continuous photodiode structure was found to provide fill factors that approach the theoretical maximum of 100%. Both sets of novel designs achieved large fill factors by employing architectures in which some, or all of the photodiode structure was elevated above the plane of the pixel addressing transistor. Generally, enhancement of the fill factor in either discrete or continuous photodiode arrays was observed to result in no degradation in MTF due to charge sharing between pixels. While the continuous designs exhibited relatively high levels of charge trapping and release, as well as shorter ranges of linearity, it is possible that these behaviors can be addressed through further refinements to pixel design. Both the continuous and the most recent discrete photodiode designs accommodate more sophisticated pixel circuitry than is present on conventional AMFPIs – such as a pixel clamp circuit, which is demonstrated to limit signal saturation under conditions corresponding to high exposures. It is anticipated that photodiode structures such as the ones reported in this study will enable the development of even more complex pixel circuitry, such as pixel-level amplifiers, that will lead to further significant improvements in imager performance. PMID:19673228

UK Renal Registry 16th annual report: chapter 12 biochemical variables amongst UK adult dialysis patients in 2012: national and centre-specific analyses.

PubMed

Nicholas, Johann; Shaw, Catriona; Pitcher, David; Dawnay, Anne

2013-01-01

The UK Renal Association clinical practice guidelines include clinical performance measures for biochemical variables in dialysis patients. The UK Renal Registry (UKRR) annually audits dialysis centre performance against these measures as part of its role in promoting continuous quality improvement. Cross sectional performance analyses were undertaken to compare dialysis centre achievement of clinical audit measures for prevalent haemodialysis (HD) and peritoneal dialysis (PD) cohorts in 2012. The biochemical variables studied were phosphate, adjusted calcium, parathyroid hormone, bicarbonate and total cholesterol. In addition, longitudinal analyses were performed (2002-2012) to show changes in achievement of clinical performance measures over time. Fifty-six percent of HD and 61% of PD patients achieved a phosphate within the range recommended by the RA clinical practice guidelines. Seventy-seven percent of HD and 78% of PD patients had adjusted calcium between 2.2-2.5 mmol/L. Fifty-eight percent of HD and 65% of PD patients had parathyroid hormone between 16-72 pmol/L. Fifty-nine percent of HD and 80% of PD patients achieved the audit measure for bicarbonate. There was significant inter-centre variation for all variables studied. The UKRR consistently demonstrates significant inter-centre variation in achievement of biochemical clinical audit measures. Understanding the causes of this variation is an important part of improving the care of dialysis patients in the UK.

Chapter 9 Biochemical variables amongst UK adult dialysis patients in 2010: national and centre-specific analyses.

PubMed

Pruthi, Rishi; Pitcher, David; Dawnay, Anne

2012-01-01

The UK Renal Association clinical practice guidelines include clinical performance measures for biochemical variables in dialysis patients. The UK Renal Registry (UKRR) annually audits dialysis centre performance against these measures as part of its role in promoting continuous quality improvement. Cross sectional performance analyses were undertaken to compare dialysis centre achievement of clinical audit measures for prevalent haemodialysis (HD) and peritoneal dialysis (PD) cohorts in 2010. The biochemical variables studied were phosphate, adjusted calcium, parathyroid hormone, bicarbonate and total cholesterol. In addition longitudinal analyses were performed (2000-2010) to show changes in achievement of clinical performance measures over time. Fifty-six percent of HD and 69% of PD patients achieved a phosphate within the range recommended by the RA clinical practice guidelines. Seventy-five percent of HD and 76% of PD patients had adjusted calcium between 2.2-2.5 mmol/L. Twenty-eight percent of HD and 31% of PD patients had parathyroid hormone between 16- 32 pmol/L. Sixty percent of HD and 80% of PD patients achieved the audit measure for bicarbonate. There was significant inter-centre variation for all variables studied. The UKRR consistently demonstrates significant inter-centre variation in achievement of biochemical clinical audit measures. Understanding the causes of this variation is an important part of improving the care of dialysis patients in the UK. Copyright © 2012 S. Karger AG, Basel.

Organisational performance and business continuity management: a theoretical perspective and a case study.

PubMed

Sawalha, Ihab Hanna Salman

2013-01-01

This paper seeks to extend the research relating to the strategic view of business continuity management (BCM) to the context of organisational performance (OP). It discusses potential performance consequences resulting from applying BCM aspects/elements within an organisation. The paper contributes to the understanding of the role of BCM in OP by discussing how deployment of BCM key aspects/elements can improve OP. Two main issues are discussed: first, background to performance and the elements of OP; and secondly, the role of BCM in achieving optimised OP. These issues are significant, as they go further than the extant literature relating to the significance of BCM and its potential influence on OP. The study focuses on Jordanian banks as a case study and as a way of illustrating how BCM helps improve OP for those organisations facing performance shortcomings or difficulties.

Using ergonomics checkpoints to support a participatory ergonomics intervention in an industrially developing country (IDC)--a case study.

PubMed

Helali, Faramarz

2009-01-01

To achieve ergonomics awareness in 3 subsidiary companies, an intervention team was formed. The aims of this study were to implement basic ergonomics through a participatory ergonomics intervention process that can support a continuous learning process and lead to an improvement in health and safety as well as in the work systems in the organization. The findings of this study (i.e., method, continuous learning and integration) were key to making the participatory ergonomics intervention successful. Furthermore, 4 issues of the ergonomics checkpoints (i.e., work schedules, work tasks, healthy work organization and learning) for assessing the work system were found suitable for both changing work schedules and for improving the work system. This paper describes the result of this project and also the experiences gained and the conclusions reached from using the International Labour Office's ergonomics checkpoints in the industries of industrially developing country.

Improved Stability and Stabilization Results for Stochastic Synchronization of Continuous-Time Semi-Markovian Jump Neural Networks With Time-Varying Delay.

PubMed

Wei, Yanling; Park, Ju H; Karimi, Hamid Reza; Tian, Yu-Chu; Jung, Hoyoul; Yanling Wei; Park, Ju H; Karimi, Hamid Reza; Yu-Chu Tian; Hoyoul Jung; Tian, Yu-Chu; Wei, Yanling; Jung, Hoyoul; Karimi, Hamid Reza; Park, Ju H

2018-06-01

Continuous-time semi-Markovian jump neural networks (semi-MJNNs) are those MJNNs whose transition rates are not constant but depend on the random sojourn time. Addressing stochastic synchronization of semi-MJNNs with time-varying delay, an improved stochastic stability criterion is derived in this paper to guarantee stochastic synchronization of the response systems with the drive systems. This is achieved through constructing a semi-Markovian Lyapunov-Krasovskii functional together as well as making use of a novel integral inequality and the characteristics of cumulative distribution functions. Then, with a linearization procedure, controller synthesis is carried out for stochastic synchronization of the drive-response systems. The desired state-feedback controller gains can be determined by solving a linear matrix inequality-based optimization problem. Simulation studies are carried out to demonstrate the effectiveness and less conservatism of the presented approach.

On-line early fault detection and diagnosis of municipal solid waste incinerators

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhao Jinsong; Huang Jianchao; Sun Wei

A fault detection and diagnosis framework is proposed in this paper for early fault detection and diagnosis (FDD) of municipal solid waste incinerators (MSWIs) in order to improve the safety and continuity of production. In this framework, principal component analysis (PCA), one of the multivariate statistical technologies, is used for detecting abnormal events, while rule-based reasoning performs the fault diagnosis and consequence prediction, and also generates recommendations for fault mitigation once an abnormal event is detected. A software package, SWIFT, is developed based on the proposed framework, and has been applied in an actual industrial MSWI. The application shows thatmore » automated real-time abnormal situation management (ASM) of the MSWI can be achieved by using SWIFT, resulting in an industrially acceptable low rate of wrong diagnosis, which has resulted in improved process continuity and environmental performance of the MSWI.« less

[Innovations in vaccinology: challenge and opportunities for Africa].

PubMed

Diop, Doudou; Sanicas, Melvin

2017-01-01

Immunization is undoubtedly one of the most effective and most cost-effective health interventions. Vaccines continue to revolutionize our ability to prevent diseases and improve health. With all the technological advances, we are able to extend the benefits of vaccines to more people and to provide better protection from life-threatening infectious diseases. Nevertheless, thanks to the unceasing implementation of novel microbial strains on a worldwide basis, research in vaccinology must innovate continuously. African countries have made great progress in increasing routine immunization coverage rates and in introducing newly developed vaccines. New types of vaccines associated with vectorization, administration and specific licensing tools as well as with adjuvants designed to finely modulate immune responses are expected to be achieved in the near future. African countries need to work to develop a regional approach to respond effectively to the many challenges. Providing better information, implementing healthcare personnel vaccinology training programs and well targeted research projects are the keys to future achievements in the field.

An integrated parity-time symmetric wavelength-tunable single-mode microring laser

PubMed Central

Liu, Weilin; Li, Ming; Guzzon, Robert S.; Norberg, Erik J.; Parker, John S.; Lu, Mingzhi; Coldren, Larry A.; Yao, Jianping

2017-01-01

Mode control in a laser cavity is critical for a stable single-mode operation of a ring laser. In this study we propose and experimentally demonstrate an electrically pumped parity-time (PT)-symmetric microring laser with precise mode control, to achieve wavelength-tunable single-mode lasing with an improved mode suppression ratio. The proposed PT-symmetric laser is implemented based on a photonic integrated circuit consisting of two mutually coupled active microring resonators. By incorporating multiple semiconductor optical amplifiers in the microring resonators, the PT-symmetry condition can be achieved by a precise manipulation of the interplay between the gain and loss in the two microring resonators, and the incorporation of phase modulators in the microring resonators enables continuous wavelength tuning. Single-mode lasing at 1,554.148 nm with a sidemode suppression ratio exceeding 36 dB is demonstrated and the lasing wavelength is continuously tunable from 1,553.800 to 1,554.020 nm. PMID:28497784

Defective TiO 2 with high photoconductive gain for efficient and stable planar heterojunction perovskite solar cells

DOE PAGES

Li, Yanbo; Cooper, Jason K.; Liu, Wenjun; ...

2016-08-18

Formation of planar heterojunction perovskite solar cells exhibiting both high efficiency and stability under continuous operation remains a challenge. Here, we show this can be achieved by using a defective TiO 2 thin film as the electron transport layer. TiO 2 layers with native defects are deposited by electron beam evaporation in an oxygen-deficient environment. Deep-level hole traps are introduced in the TiO 2 layers and contribute to a high photoconductive gain and reduced photocatalytic activity. The high photoconductivity of the TiO 2 electron transport layer leads to improved efficiency for the fabricated planar devices. A maximum power conversion efficiencymore » of 19.0% and an average PCE of 17.5% are achieved. In addition, the reduced photocatalytic activity of the TiO 2 layer leads to enhanced long-Term stability for the planar devices. Under continuous operation near the maximum power point, an efficiency of over 15.4% is demonstrated for 100 h.« less

An integrated parity-time symmetric wavelength-tunable single-mode microring laser.

PubMed

Liu, Weilin; Li, Ming; Guzzon, Robert S; Norberg, Erik J; Parker, John S; Lu, Mingzhi; Coldren, Larry A; Yao, Jianping

2017-05-12

Mode control in a laser cavity is critical for a stable single-mode operation of a ring laser. In this study we propose and experimentally demonstrate an electrically pumped parity-time (PT)-symmetric microring laser with precise mode control, to achieve wavelength-tunable single-mode lasing with an improved mode suppression ratio. The proposed PT-symmetric laser is implemented based on a photonic integrated circuit consisting of two mutually coupled active microring resonators. By incorporating multiple semiconductor optical amplifiers in the microring resonators, the PT-symmetry condition can be achieved by a precise manipulation of the interplay between the gain and loss in the two microring resonators, and the incorporation of phase modulators in the microring resonators enables continuous wavelength tuning. Single-mode lasing at 1,554.148 nm with a sidemode suppression ratio exceeding 36 dB is demonstrated and the lasing wavelength is continuously tunable from 1,553.800 to 1,554.020 nm.

Simultaneous nitrification-denitrification achieved by an innovative internal-loop airlift MBR: comparative study.

PubMed

Li, Y Z; He, Y L; Ohandja, D G; Ji, J; Li, J F; Zhou, T

2008-09-01

This study assessed the performance of different single-stage continuous aerated submerged membrane bioreactors (MBR) for nitrogen removal. Almost complete nitrification was achieved in each MBR irrespective of operating mode and biomass system. Denitrification was found to be the rate-limiting step for total nitrogen (T-N) removal. The MBR with internal-loop airlift reactor (ALR) configuration performed better as regards T-N removal compared with continuous stirred-tank reactor (CSTR). It was demonstrated that simultaneous nitrification and denitrification (SND) is the mechanism leading to nitrogen removal and the contribution of microenvironment on SND is more remarkable for the MBRs with hybrid biomass. Macroenvironment analyses showed that gradient distribution of dissolved oxygen (DO) level in airlift MBRs imposed a significant effect on SND. Higher mixed liquor suspended solid (MLSS) concentration led to the improvement in T-N removal by enhancing anoxic microenvironment. Apparent nitrite accumulation coupled with higher nitrogen reduction was accomplished at MLSS concentration exceeded 12.6 g/L.

[Continual improvement of quantitative analytical method development of Panax notogineng saponins based on quality by design].

PubMed

Dai, Sheng-Yun; Xu, Bing; Shi, Xin-Yuan; Xu, Xiang; Sun, Ying-Qiang; Qiao, Yan-Jiang

2017-03-01

This study is aimed to propose a continual improvement strategy based on quality by design (QbD). An ultra high performance liquid chromatography (UPLC) method was developed to accomplish the method transformation from HPLC to UPLC of Panax notogineng saponins (PNS) and achieve the continual improvement of PNS based on QbD, for example. Plackett-Burman screening design and Box-Behnken optimization design were employed to further understand the relationship between the critical method parameters (CMPs) and critical method attributes (CMAs). And then the Bayesian design space was built. The separation degree of the critical peaks (ginsenoside Rg₁ and ginsenoside Re) was over 2.0 and the analysis time was less than 17 min by a method chosen from the design space with 20% of the initial concentration of the acetonitrile, 10 min of the isocratic time and 6%•min⁻¹ of the gradient slope. At last, the optimum method was validated by accuracy profile. Based on the same analytical target profile (ATP), the comparison of HPLC and UPLC including chromatograph method, CMA identification, CMP-CMA model and system suitability test (SST) indicated that the UPLC method could shorten the analysis time, improve the critical separation and satisfy the requirement of the SST. In all, HPLC method could be replaced by UPLC for the quantity analysis of PNS. Copyright© by the Chinese Pharmaceutical Association.

Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change

PubMed Central

2013-01-01

Background Variation in effectiveness of continuous quality improvement (CQI) interventions between services is commonly reported, but with little explanation of how contextual and other factors may interact to produce this variation. Therefore, there is scant information available on which policy makers can draw to inform effective implementation in different settings. In this paper, we explore how patterns of change in delivery of services may have been achieved in a diverse range of health centers participating in a wide-scale program to achieve improvements in quality of care for Indigenous Australians. Methods We elicited key informants’ interpretations of factors explaining patterns of change in delivery of guideline-scheduled services over three or more years of a wide-scale CQI project, and inductively analyzed these interpretations to propose fine-grained realist hypotheses about what works for whom and in what circumstances. Data were derived from annual clinical audits from 36 health centers operating in diverse settings, quarterly project monitoring reports, and workshops with 12 key informants who had key roles in project implementation. We abstracted potential context-mechanism-outcome configurations from the data, and based on these, identified potential program-strengthening strategies. Results Several context-specific, mechanism-based explanations for effectiveness of this CQI project were identified. These were collective valuing of clinical data for improvement purposes; collective efficacy; and organizational change towards a population health orientation. Health centers with strong central management of CQI, and those in which CQI efforts were more dependent on local health center initiative and were adapted to resonate with local priorities were both favorable contexts for collective valuing of clinical data. Where health centers had prior positive experiences of collaboration, effects appeared to be achieved at least partly through the mechanism of collective efficacy. Strong community linkages, staff ability to identify with patients, and staff having the skills and support to take broad ranging action, were favorable contexts for the mechanism of increased population health orientation. Conclusions Our study provides evidence to support strategies for program strengthening described in the literature, and extends the understanding of mechanisms through which strategies may be effective in achieving particular outcomes in different contexts. PMID:24098940

A proposed adaptation of the European Foundation for Quality Management Excellence Model to physical activity programmes for the elderly - development of a quality self-assessment tool using a modified Delphi process

PubMed Central

2011-01-01

Background There has been a growing concern in designing physical activity (PA) programmes for elderly people, since evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Complete programme evaluations are a necessary prerequisite to continuous quality improvements. Being able to refine, adapt and create tools that are suited to the realities and contexts of PA programmes for the elderly in order to support its continuous improvement is, therefore, crucial. Thus, the aim of this study was to develop a self-assessment tool for PA programmes for the elderly. Methods A 3-round Delphi process was conducted via the Internet with 43 national experts in PA for the elderly, management and delivery of PA programmes for the elderly, sports management, quality management and gerontology, asking experts to identify the propositions that they considered relevant for inclusion in the self-assessment tool. Experts reviewed a list of proposed statements, based on the criteria and sub-criteria from the European Foundation for Quality Management Excellence Model (EFQM) and PA guidelines for older adults and rated each proposition from 1 to 8 (disagree to agree) and modified and/or added propositions. Propositions receiving either bottom or top scores of greater than 70% were considered to have achieved consensus to drop or retain, respectively. Results In round 1, of the 196 originally-proposed statements (best practice principles), the experts modified 41, added 1 and achieved consensus on 93. In round 2, a total of 104 propositions were presented, of which experts modified 39 and achieved consensus on 53. In the last round, of 51 proposed statements, the experts achieved consensus on 19. After 3 rounds of rating, experts had not achieved consensus on 32 propositions. The resulting tool consisted of 165 statements that assess nine management areas involved in the development of PA programmes for the elderly. Conclusion Based on experts' opinions, a self-assessment tool was found in order to access quality of PA programmes for the elderly. Information obtained with evaluations would be useful to organizations seeking to improve their services, customer satisfaction and, consequently, adherence to PA programmes, targeting the ageing population. PMID:21958203

Excerpts from Managing CQI in Radiology and Diagnostic Imaging Services: A CQI Handbook.

PubMed

Joseph, E D; Lesher, C; Zage, R

1994-01-01

Continuous quality improvement (CQI) is currently the most popular and influential quality management program used in healthcare organizations. It is an effective methodology for identifying and acting on opportunities to improve the efficiency, effectiveness and value of services provided to customers. CQI implementation can be broken down into four components: (1) achievement objectives and goal identification, (2) system process analysis, (3) action planning and implementation, and (4) performance measurement and follow-up. As the project team establishes goals, it should consider customer and staff needs, what constitutes "quality," existing guidelines and regulations, and how results will be measured. Many techniques can be used to analyze the procedure or function targeted for improvement, including charts and diagrams, formal monitoring, data collection and statistical analysis. After the project team has identified potential service improvements, they develop an action plan, which may include education, recruitment, reassignment or equipment acquisition. The team must consider the impact of proposed changes and the financial and logistical feasibility of various proposals. The dynamic challenges of radiology and diagnostic imaging cannot be addressed through single, isolated actions; efforts to improve quality should be continuous. Accordingly, the project team should measure and analyze results of the action plan, reappraise goals and look for opportunities to further improve service.

Discontinuation of tofacitinib after achieving low disease activity in patients with rheumatoid arthritis: a multicentre, observational study.

PubMed

Kubo, Satoshi; Yamaoka, Kunihiro; Amano, Koichi; Nagano, Shuji; Tohma, Shigeto; Suematsu, Eiichi; Nagasawa, Hayato; Iwata, Kanako; Tanaka, Yoshiya

2017-08-01

To determine whether tofacitinib can be discontinued in patients with RA who achieve low disease activity (LDA). RA patients with LDA after tofacitinib treatment in a phase III and long-term extension study were enrolled in this multicentre, non-randomized, open, prospective, observational study. The decision of discontinuation or continuation of tofacitinib was determined based on patient-physician decision making with informed consent. The primary endpoint was the proportion of patients who remained tofacitinib-free at post-treatment week 52. Clinical outcome was compared between those who continued and those who discontinued tofacitinib. The last observation carried forward method was used for patients who could not discontinue tofacitinib before week 52. Of 64 patients, 54 discontinued and 10 continued tofacitinib therapy. At post-treatment week 52, 20 of the 54 patients (37%) of the discontinuation group remained tofacitinib-free without disease flare. Disease activity at post-treatment week 52 was higher in the discontinuation group than the continuation group. Among the discontinuation group, the RF titre at baseline was significantly lower in patients who remained tofacitinib-free than those who did not (40 vs 113 U/ml). In fact, a higher proportion of patients with lower RF remained tofacitinib-free at week 52 compared with those with higher RF at baseline. In patients who could not achieve tofacitinib-free status, re-initiation of tofacitinib or other biologics improved disease activity. It is possible to discontinue tofacitinib without flare in about a third of patients with RA. A low RF predicts maintenance of LDA after discontinuation of tofacitinib. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Testing of Front End Electronics for 10ps Time of Flight Detectors

NASA Astrophysics Data System (ADS)

Kimball, Matthew; EIC PID Consortium Collaboration

2016-09-01

To fully achieve the physics goals of the future Electron Ion Collider (EIC), continued development of the detectors involved is needed. One area of research involves improving the timing resolution of Time of Flight (ToF) detectors from 100ps to 10ps. When the timing resolution of these ToF detectors is improved, better particle identification can be achieved. In addition, as ToF detectors are being constructed with ever improving timing resolution, the need to improve the high speed performance of the fast electronics used in their front-end electronics (FEE) increases. A series of careful measurements has been performed to investigate the performance and efficiency of each element in the FEE chain. The focus of these tests lies on the amplitude transmission efficiency of the high speed signals as a function of frequency, also known as the bandwidth. The components tested include balanced to unbalanced (balun) boards, signal pre-amps, and waveform digitizers. These tests were performed on individual components and with all elements connected over a frequency range of 1MHz to 1GHz. The results of these tests will be presented. This research was supported by US DOE MENP Grant DE-FG02-03ER41243.

Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition.

PubMed

Holte, K; Kehlet, H

2002-06-01

Surgical injury leads to an endocrine-metabolic and inflammatory response with protein catabolism, increased cardiovascular demands, impaired pulmonary function and paralytic ileus, the most important release mechanisms being afferent neural stimuli and inflammatory mediators. Epidural local anaesthetic blockade of afferent stimuli reduces endocrine metabolic responses, and improve postoperative catabolism. Furthermore, dynamic pain relief is achieved with improved pulmonary function and a pronounced reduction of postoperative ileus, thereby providing optimal conditions for improved mobilization and oral nutrition, and preservation of body composition and muscle function. Studies integrating continuous epidural local anaesthetics with enforced early nutrition and mobilization uniformly suggest an improved recovery, decreased hospital stay and convalescence. Epidural local anaesthetics should be included in a multi-modal rehabilitation programme after major surgical procedures in order to facilitate oral nutrition, improve recovery and reduce morbidity.

A Phase III, Randomized, Controlled Trial of Apremilast in Patients with Psoriatic Arthritis: Results of the PALACE 2 Trial.

PubMed

Cutolo, Maurizio; Myerson, Gary E; Fleischmann, Roy M; Lioté, Frédéric; Díaz-González, Federico; Van den Bosch, Filip; Marzo-Ortega, Helena; Feist, Eugen; Shah, Kamal; Hu, ChiaChi; Stevens, Randall M; Poder, Airi

2016-09-01

Apremilast, an oral phosphodiesterase 4 inhibitor, downregulates intracellular inflammatory mediator synthesis by elevating cyclic adenosine monophosphate levels. The PALACE 2 trial evaluated apremilast efficacy and safety in patients with active psoriatic arthritis (PsA) despite prior conventional disease-modifying antirheumatic drugs and/or biologic therapy. Eligible patients were randomized (1:1:1) to placebo, apremilast 20 mg BID, or apremilast 30 mg BID. At Week 16, patients with swollen and tender joint count improvement < 20% entered early escape, with placebo patients rerandomized (1:1) to apremilast 20 mg BID or 30 mg BID while apremilast patients continued on their initial apremilast dose. At Week 24, patients remaining on placebo were rerandomized to apremilast 20 mg BID or 30 mg BID. The primary endpoint was the proportion of patients achieving > 20% improvement in American College of Rheumatology response criteria (ACR20) at Week 16. In the intent-to-treat population (N = 484), ACR20 at Week 16 was achieved by more patients receiving apremilast 20 mg BID [37.4% (p = 0.0002)] and 30 mg BID [32.1% (p = 0.0060)] versus placebo (18.9%). Clinically meaningful improvements in signs and symptoms of PsA, physical function, and psoriasis were observed with apremilast through Week 52. The most common adverse events were diarrhea, nausea, headache, and upper respiratory tract infection. Diarrhea and nausea generally occurred early and usually resolved spontaneously with continued treatment. Laboratory abnormalities were infrequent and transient. Apremilast demonstrated clinical improvements in PsA for up to 52 weeks, including signs and symptoms, physical function, and psoriasis. No new safety signals were observed. ClinicalTrials.gov identifier: NCT01212757.

kW-class diode laser bars

NASA Astrophysics Data System (ADS)

Strohmaier, S. G.; Erbert, G.; Meissner-Schenk, A. H.; Lommel, M.; Schmidt, B.; Kaul, T.; Karow, M.; Crump, P.

2017-02-01

Progress will be presented on ongoing research into the development of ultra-high power and efficiency bars achieving significantly higher output power, conversion efficiency and brightness than currently commercially available. We combine advanced InAlGaAs/GaAs-based epitaxial structures and novel lateral designs, new materials and superior cooling architectures to enable improved performance. Specifically, we present progress in kilowatt-class 10-mm diode laser bars, where recent studies have demonstrated 880 W continuous wave output power from a 10 mm x 4 mm laser diode bar at 850 A of electrical current and 15°C water temperature. This laser achieves < 60% electro-optical efficiency at 880 W CW output power.

[Blood transfusion and supply chain management safety].

PubMed

Quaranta, Jean-François; Caldani, Cyril; Cabaud, Jean-Jacques; Chavarin, Patricia; Rochette-Eribon, Sandrine

2015-02-01

The level of safety attained in blood transfusion now makes this a discipline better managed care activities. This was achieved both by scientific advances and policy decisions regulating and supervising the activity, as well as by the quality system, which we recall that affects the entire organizational structure, responsibilities, procedures, processes and resources in place to achieve quality management. So, an effective quality system provides a framework within which activities are established, performed in a quality-focused way and continuously monitored to improve outcomes. This system quality has to irrigate all the actors of the transfusion, just as much the establishments of blood transfusion than the health establishments. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Prioritizing Research to Reduce Youth Suicide and Suicidal Behavior

PubMed Central

Bridge, Jeffrey A.; Horowitz, Lisa M.; Fontanella, Cynthia A.; Grupp-Phelan, Jackie; Campo, John V.

2014-01-01

The goal of the National Action Alliance for Suicide Prevention (Action Alliance) is to reduce suicide and suicide attempts in the U.S. by 40% in the next decade. In this paper, a public health approach is applied to suicide prevention to illustrate how reductions in youth suicide and suicidal behavior might be achieved by prioritizing research in two areas: (1) increasing access to primary care–based behavioral health interventions for depressed youth; and (2) improving continuity of care for youth who present to emergency departments after a suicide attempt. Finally, some scientific, clinical, and methodologic breakthroughs needed to achieve rapid, substantial, and sustained reductions in youth suicide and suicidal behavior are discussed. PMID:25145744

Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care.

PubMed

Chung, Vincent Ch; Yip, Benjamin Hk; Griffiths, Sian M; Yu, Ellen Lm; Liu, Siya; Ho, Robin St; Wu, Xinyin; Leung, Albert Wn; Sit, Regina Ws; Wu, Justin Cy; Wong, Samuel Ys

2015-12-21

Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients' experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients' perspective; and (ii) to investigate how quality varies with patients' demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of "coordination of patient information", "continuity of care", and "range of service provided". Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.

Current Status of the Milky Stork Re-introduction Programme in Malaysia and Its Challenges

PubMed Central

Ismail, Ahmad; Rahman, Faid

2016-01-01

This review discussed the current status of the Milky Stork Re-introduction Programme in Malaysia and the challenges it faced. Although it has continued for almost seven years, more challenges appeared as time elapsed mainly due to the arising conflicts between the implementation of conservation policy versus the development projects in Kuala Gula. Hence, the released population is struggling to adapt mainly due to the reduction of suitable habitat for nesting and disturbed foraging areas by the continuous anthropogenic activities. Furthermore, the lack of appropriate training among captive storks prior to being released also slows the adaptation of the birds in their new habitat. The increasing pattern of pollution in the area is also highlighted. Several suggestions were given to help improve the current re-introduction programme. These include improvements to the captive training method, improvement of the existing enclosure’s condition and environment, protection of remaining mangrove forest, creation of a buffer zone to mitigate the increasing pollution level in the area, close monitoring of the released population, and maintaining continuous support and awareness among the public. Considering the ongoing anthropogenic activities that may impair the status of Kuala Gula as an important bird sanctuary, emphasis should be given to achieve sustainable development throughout the area. PMID:27688848

Overview of Automotive Core Tools: Applications and Benefits

NASA Astrophysics Data System (ADS)

Doshi, Jigar A.; Desai, Darshak

2017-08-01

Continuous improvement of product and process quality is always challenging and creative task in today's era of globalization. Various quality tools are available and used for the same. Some of them are successful and few of them are not. Considering the complexity in the continuous quality improvement (CQI) process various new techniques are being introduced by the industries, as well as proposed by researchers and academia. Lean Manufacturing, Six Sigma, Lean Six Sigma is some of the techniques. In recent years, there are new tools being opted by the industry, especially automotive, called as Automotive Core Tools (ACT). The intention of this paper is to review the applications and benefits along with existing research on Automotive Core Tools with special emphasis on continuous quality improvement. The methodology uses an extensive review of literature through reputed publications—journals, conference proceedings, research thesis, etc. This paper provides an overview of ACT, its enablers, and exertions, how it evolved into sophisticated methodologies and benefits used in organisations. It should be of value to practitioners of Automotive Core Tools and to academics who are interested in how CQI can be achieved using ACT. It needs to be stressed here that this paper is not intended to scorn Automotive Core Tools, rather, its purpose is limited only to provide a balance on the prevailing positive views toward ACT.

Fenestration system energy performance research, implementation, and international harmonization

DOE Office of Scientific and Technical Information (OSTI.GOV)

McGowan, Raymond F

The research conducted by the NFRC and its contractors adds significantly to the understanding of several areas of investigation. NFRC enables manufacturers to rate fenestration energy performance to comply with building energy codes, participate in ENERGY STAR, and compete fairly. NFRC continuously seeks to improve its ratings and also seeks to simplify the rating process. Several research projects investigated rating improvement potential such as • Complex Product VT Rating Research • Window 6 and Therm 6 Validation Research Project • Complex Product VT Rating Research Conclusions from these research projects led to important changes and increased confidence in the existingmore » NFRC rating process. Conclusions from the Window 6/Therm 6 project will enable window manufacturers to rate an expanded array of products and improve existing ratings. Some research lead to an improved new rating method called the Component Modeling Approach. A primary goal of the CMA was a simplification of the commercial energy rating process to increase participation and make the commercial industry more competitive and code compliant. The project below contributed towards CMA development: • Component Modeling Approach Condensation Resistance Research NFRC continues to implement the Component Modeling Approach program. The program includes the CMA software tool, CMAST, and several procedural documents to govern the certification process. This significant accomplishment was a response the commercial fenestration industry’s need for a simplification of the present NFRC energy rating method (named site built). To date, most commercial fenestration is self-rated by a variety of techniques. The CMA enables commercial fenestration manufacturers to rate according to the NFRC 100/200 as most commercial energy codes require. International Harmonization NFRC achieved significant international harmonization success by continuing its licensing agreements with the Australian Fenestration Rating Council and the Association of Architectural Aluminum Manufacturers of South Africa (AAAMSA) to produce NFRC certified product ratings in their respective nations. NFRC worked in several other nations to introduce the NFRC ratings system: • India • China • Japan • Canada • Thailand • South Africa • Brazil • Korea NFRC attended or hosted several meetings in each of these nations establishing academic, commercial, industrial, and governmental contacts. NFRC presented the NFRC process and then necessary infrastructure steps necessary to achieve harmonization with the NFRC labeling system. NFRC looks forward to continued work toward harmonization in these nations and potentially others.« less

Quality in restorative dentistry: a report of an advanced postgraduate dental symposium.

PubMed

Wilson, N H

1996-08-01

A joint Royal College of Surgeons of Edinburgh--Royal College of Physicians and Surgeons of Glasgow Advanced Postgraduate Dental Symposium addressed the issue of quality in restorative dentistry. The overall view was that quality in clinical care, including all aspects of restorative dentistry, is the consistent achievement of successful outcome. Ongoing developments and effective audit processes were recognized to provide important opportunities for continuous quality improvement in restorative dentistry.

A resolution recognizing the 20th anniversary of the National Institutes of Health Office of Research on Women's Health and the continuing leadership and achievements of the Office on Women's Health in conducting and supporting biomedical research to improve women's health.

THOMAS, 111th Congress

Sen. Mikulski, Barbara A. [D-MD

2010-12-06

Senate - 12/06/2010 Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent. (All Actions) Tracker: This bill has the status Agreed to in SenateHere are the steps for Status of Legislation:

The pursuit of colostomy continence.

PubMed

Roberts, D J

1997-03-01

The lifelong management required by patients with permanent colostomies leads to dissatisfaction with quality of life for many. Through the years, multiple techniques have been attempted to improve the quality of life by pursuing colostomy continence. Such endeavors include surgical interventions, nonsurgical devices and management, and behavior modification techniques. Efforts in research and development continue, and the desire to achieve continence of the stoma remain common cause among persons with on ostomy and those involved in their care.

Applying Lean to the AC-130 Maintenance Process for the Royal Saudi Air Force

DTIC Science & Technology

2016-09-01

inventory management. Quality Management Poor quality of maintenance contributes to rework , which is an obvious form of waste. It would be very...consequences of rework are very significant. Within the C-130 maintenance squadron, quality must be achieved through continual process improvements, rather...maintenance “product” quality by lowering measurable process outputs such as amount of rework , number of maintenance-induced failures, and so on. 71

Design of PH sensor signal acquisition and display system

NASA Astrophysics Data System (ADS)

Qian, Huifa; Zhang, Quanzhu; Deng, Yonghong

2017-06-01

With the continuous development of sensor manufacturing technology, how to better deal with the signal is particularly important. PH value of the sensor voltage generated by the signal as a signal, through the MCU acquisition A / D conversion, and ultimately through the digital display of its PH value. The system uses hardware and software to achieve the results obtained with the high-precision PH meter to strive to improve the accuracy and reduce error.

Improved Pulse Transit Time Estimation by System Identification Analysis of Proximal and Distal Arterial Waveforms

DTIC Science & Technology

2011-10-01

response; pulse wave velocity ACCORDING TO THE MOENS-KORTEWEG equation, pulse wave ve- locity ( PWV ) increases as the arteries stiffen. Indeed, PWV is the...and mortality in hypertensive patients (2, 4, 12, 14). In addition, because arterial stiffness increases with arterial blood pressure (ABP), PWV and...ABP often show positive correlation, suggesting that PWV could provide a means to achieve continuous, noninvasive, and cuffless ABP monitoring (18

Mozambique's journey toward accreditation of the National Tuberculosis Reference Laboratory.

PubMed

Viegas, Sofia O; Azam, Khalide; Madeira, Carla; Aguiar, Carmen; Dolores, Carolina; Mandlaze, Ana P; Chongo, Patrina; Masamha, Jessina; Cirillo, Daniela M; Jani, Ilesh V; Gudo, Eduardo S

2017-01-01

Internationally-accredited laboratories are recognised for their superior test reliability, operational performance, quality management and competence. In a bid to meet international quality standards, the Mozambique National Institute of Health enrolled the National Tuberculosis Reference Laboratory (NTRL) in a continuous quality improvement process towards ISO 15189 accreditation. Here, we describe the road map taken by the NTRL to achieve international accreditation. The NTRL adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme as a strategy to implement a quality management system. After SLMTA, the Mozambique National Institute of Health committed to accelerate the NTRL's process toward accreditation. An action plan was designed to streamline the process. Quality indicators were defined to benchmark progress. Staff were trained to improve performance. Mentorship from an experienced assessor was provided. Fulfilment of accreditation standards was assessed by the Portuguese Accreditation Board. Of the eight laboratories participating in SLMTA, the NTRL was the best-performing laboratory, achieving a 53.6% improvement over the SLMTA baseline conducted in February 2011 to the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) assessment in June 2013. During the accreditation assessment in September 2014, 25 minor nonconformities were identified and addressed. In March 2015, the NTRL received Portuguese Accreditation Board recognition of technical competency for fluorescence smear microscopy, and solid and liquid culture. The NTRL is the first laboratory in Mozambique to achieve ISO 15189 accreditation. From our experience, accreditation was made possible by institutional commitment, strong laboratory leadership, staff motivation, adequate infrastructure and a comprehensive action plan.

Plasma-sprayed titanium coating to polyetheretherketone improves the bone-implant interface.

PubMed

Walsh, William R; Bertollo, Nicky; Christou, Chrisopher; Schaffner, Dominik; Mobbs, Ralph J

2015-05-01

Rapid and stable fixation at the bone-implant interface would be regarded as one of the primary goals to achieve clinical efficacy, regardless of the surgical site. Although mechanical and physical properties of polyetheretherketone (PEEK) provide advantages for implant devices, the hydrophobic nature and the lack of direct bone contact remains a limitation. To examine the effects of a plasma-sprayed titanium coated PEEK on the mechanical and histologic properties at the bone-implant interface. A preclinical laboratory study. Polyetheretherketone and plasma-sprayed titanium coated PEEK implants (Ti-bond; Spinal Elements, Carlsbad, CA, USA) were placed in a line-to-line manner in cortical bone and in a press-fit manner in cancellous bone of adult sheep using an established ovine model. Shear strength was assessed in the cortical sites at 4 and 12 weeks, whereas histology was performed in cortical and cancellous sites at both time points. The titanium coating dramatically improved the shear strength at the bone-implant interface at 4 weeks and continued to improve with time compared with PEEK. Direct bone ongrowth in cancellous and cortical sites can be achieved using a plasma-sprayed titanium coating on PEEK. Direct bone to implant bonding can be achieved on PEEK in spite of its hydrophobic nature using a plasma-sprayed titanium coating. The plasma-sprayed titanium coating improved mechanical properties in the cortical sites and the histology in cortical and cancellous sites. Copyright © 2015 Elsevier Inc. All rights reserved.

Comparative total and unbound pharmacokinetics of cefazolin administered by bolus versus continuous infusion in patients undergoing major surgery: a randomized controlled trial.

PubMed

Naik, B I; Roger, C; Ikeda, K; Todorovic, M S; Wallis, S C; Lipman, J; Roberts, J A

2017-06-01

Perioperative administration of cefazolin reduces the incidence of perioperative infections. Intraoperative re-dosing of cefazolin is commonly given between 2 and 5 h after the initial dose. This study was undertaken to determine whether intraoperative continuous infusions of cefazolin achieve better probability of target attainment (PTA) and fractional target attainment (FTA) than intermittent dosing. Patients undergoing major surgery received cefazolin 2 g before surgical incision. They were subsequently randomized to receive either an intermittent bolus (2 g every 4 h) or continuous infusion (500 mg h -1 ) of cefazolin until skin closure. Blood samples were analysed for total and unbound cefazolin concentrations using a validated chromatographic method. Population pharmacokinetic modelling was performed using Pmetrics ® software. Calculations of PTA and FTA were performed for common pathogens. Ten patients were enrolled in each arm. A two-compartment linear model best described the time course of the total plasma cefazolin concentrations. The covariates that improved the model were body weight and creatinine clearance. Protein binding varied with time [mean (range) 69 (44-80)%] with a fixed 21% unbound value of cefazolin used for the simulations (120 min post-initial dosing). Mean ( sd ) central volume of distribution was 5.73 (2.42) litres, and total cefazolin clearance was 4.72 (1.1) litres h -1 . Continuous infusions of cefazolin consistently achieved better drug exposures and FTA for different weight and creatinine clearances, particularly for less susceptible pathogens. Our study demonstrates that intraoperative continuous infusions of cefazolin increase the achievement of target plasma concentrations, even with lower infusion doses. Renal function and body weight are important when considering the need for alternative dosing regimens. NCT02058979. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com

WFH: closing the global gap--achieving optimal care.

PubMed

Skinner, Mark W

2012-07-01

For 50 years, the World Federation of Hemophilia (WFH) has been working globally to close the gap in care and to achieve Treatment for All patients, men and women, with haemophilia and other inherited bleeding disorders, regardless of where they might live. The WFH estimates that more than one in 1000 men and women has a bleeding disorder equating to 6,900,000 worldwide. To close the gap in care between developed and developing nations a continued focus on the successful strategies deployed heretofore will be required. However, in response to the rapid advances in treatment and emerging therapeutic advances on the horizon it will also require fresh approaches and renewed strategic thinking. It is difficult to predict what each therapeutic advance on the horizon will mean for the future, but there is no doubt that we are in a golden age of research and development, which has the prospect of revolutionizing treatment once again. An improved understanding of "optimal" treatment is fundamental to the continued evolution of global care. The challenges of answering government and payer demands for evidence-based medicine, and cost justification for the introduction and enhancement of treatment, are ever-present and growing. To sustain and improve care it is critical to build the body of outcome data for individual patients, within haemophilia treatment centers (HTCs), nationally, regionally and globally. Emerging therapeutic advances (longer half-life therapies and gene transfer) should not be justified or brought to market based only on the notion that they will be economically more affordable, although that may be the case, but rather more importantly that they will be therapeutically more advantageous. Improvements in treatment adherence, reductions in bleeding frequency (including microhemorrhages), better management of trough levels, and improved health outcomes (including quality of life) should be the foremost considerations. As part of a new WFH strategic plan (2012-2014) the WFH has identified several key initiatives for particular emphasis - continuation of the Global Alliance for Progress (GAP) program, a new initiative to address underserved countries and regions (The Cornerstone Initiative), enhancing health outcomes research and analysis, and a new research mentorship program. Despite our progress to date in closing the global gap in care, our work is not complete. Too many patients remain undiagnosed and too few receive adequate treatment. This paper will also discuss historical, present and future challenges and opportunities to close the gap in care and achieve Treatment for All. © 2012 Blackwell Publishing Ltd.

VVER Reactor Safety in Eastern Europe and Former Soviet Union

NASA Astrophysics Data System (ADS)

Papadopoulou, Demetra

2012-02-01

VVER Soviet-designed reactors that operate in Eastern Europe and former Soviet republics have heightened international concern for years due to major safety deficiencies. The governments of countries with VVER reactors have invested millions of dollars toward improving the safety of their nuclear power plants. Most of these reactors will continue to operate for the foreseeable future since they provide urgently-needed electrical power. Given this situation, this paper assesses the radiological consequences of a major nuclear accident in Eastern Europe. The paper also chronicles the efforts launched by the international nuclear community to improve the safety of the reactors and notes the progress made so far through extensive collaborative efforts in Armenia, Bulgaria, the Czech Republic, Hungary, Kazakhstan, Lithuania, Russia, Slovakia, and Ukraine to reduce the risks of nuclear accidents. Western scientific and technical staff collaborated with these countries to improve the safety of their reactor operations by strengthening the ability of the regulator to perform its oversight function, installing safety equipment and technologies, investing time in safety training, and working diligently to establish an enduring safety culture. Still, continued safety improvement efforts are necessary to ensure safe operating practices and achieve timely phase-out of older plants.

Telecom technology based continuous wave terahertz photomixing system with 105 decibel signal-to-noise ratio and 3.5 terahertz bandwidth.

PubMed

Göbel, Thorsten; Stanze, Dennis; Globisch, Björn; Dietz, Roman J B; Roehle, Helmut; Schell, Martin

2013-10-15

A modified photoconductive receiver significantly improves the performance of photomixing-based continuous wave (cw) THz systems driven at the optical telecommunication wavelength of 1.5 μm. The achieved signal-to-noise ratio of 105 dB at 100 GHz and 70 dB at 1 THz, both for an integration time of 200 ms, are to our knowledge the highest numbers reported in literature for any optoelectronic cw THz system, including classical setups operating at 800 nm. The developed receiver allows for combining low cost and high performance in one system for the first time to our knowledge.

NASA Aeropropulsion Research: Looking Forward

NASA Technical Reports Server (NTRS)

Seidel, Jonathan A.; Sehra, Arun K.; Colantonio, Renato O.

2001-01-01

NASA has been researching new technology and system concepts to meet the requirements of aeropropulsion for 21st Century aircraft. The air transportation for the new millennium will require revolutionary solutions to meet public demand for improving safety, reliability, environmental compatibility, and affordability. Whereas the turbine engine revolution will continue during the next two decades, several new revolutions are required to achieve the dream of an affordable, emissionless, and silent aircraft. This paper reviews the continuing turbine engine revolution and explores the propulsion system impact of future revolutions in propulsion configuration, fuel infrastructure, and alternate energy systems. A number of promising concepts, ranging from the ultrahigh to fuel cell-powered distributed propulsion are also reviewed.

Integrating MRP (materiel requirements planning) into modern business.

PubMed

Lunn, T

1994-05-01

Time is the commodity of the '90s. Therefore, we all must learn how to use our manufacturing systems to shorten lead time and increase customer satisfaction. The objective of this article is to discuss practical ways people integrate the techniques of materiel requirements planning (MRP) systems with just-in-time (JIT) execution systems to increase customer satisfaction. Included are examples of new ways people use MRP systems to exemplify the process of continuous improvement--multiple items on work orders, consolidated routings, flexing capacity, and other new developments. Ways that successful companies use MRP II for planning and JIT for execution are discussed. There are many examples of how to apply theory to real life situations and a discussion of techniques that work to keep companies in the mode of continuous improvement. Also included is a look at hands-on, practical methods people use to achieve lead time reduction and simplify bills of material. Total quality management concepts can be applied to the MRP process itself. This in turn helps people improve schedule adherence, which leads to customer satisfaction.

Final analysis of survival outcomes in the phase 3 FIRST trial of up-front treatment for multiple myeloma.

PubMed

Facon, Thierry; Dimopoulos, Meletios A; Dispenzieri, Angela; Catalano, John V; Belch, Andrew; Cavo, Michele; Pinto, Antonello; Weisel, Katja; Ludwig, Heinz; Bahlis, Nizar J; Banos, Anne; Tiab, Mourad; Delforge, Michel; Cavenagh, Jamie D; Geraldes, Catarina; Lee, Je-Jung; Chen, Christine; Oriol, Albert; De La Rubia, Javier; White, Darrell; Binder, Daniel; Lu, Jin; Anderson, Kenneth C; Moreau, Philippe; Attal, Michel; Perrot, Aurore; Arnulf, Bertrand; Qiu, Lugui; Roussel, Murielle; Boyle, Eileen; Manier, Salomon; Mohty, Mohamad; Avet-Loiseau, Herve; Leleu, Xavier; Ervin-Haynes, Annette; Chen, Guang; Houck, Vanessa; Benboubker, Lotfi; Hulin, Cyrille

2018-01-18

This FIRST trial final analysis examined survival outcomes in patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM) treated with lenalidomide and low-dose dexamethasone until disease progression (Rd continuous), Rd for 72 weeks (18 cycles; Rd18), or melphalan, prednisone, and thalidomide (MPT; 72 weeks). The primary endpoint was progression-free survival (PFS; primary comparison: Rd continuous vs MPT). Overall survival (OS) was a key secondary endpoint (final analysis prespecified ≥60 months' follow-up). Patients were randomized to Rd continuous (n = 535), Rd18 (n = 541), or MPT (n = 547). At a median follow-up of 67 months, PFS was significantly longer with Rd continuous vs MPT (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.59-0.79; P < .00001) and was similarly extended vs Rd18. Median OS was 10 months longer with Rd continuous vs MPT (59.1 vs 49.1 months; HR, 0.78; 95% CI, 0.67-0.92; P = .0023), and similar with Rd18 (62.3 months). In patients achieving complete or very good partial responses, Rd continuous had an ≈30-month longer median time to next treatment vs Rd18 (69.5 vs 39.9 months). Over half of all patients who received second-line treatment were given a bortezomib-based therapy. Second-line outcomes were improved in patients receiving bortezomib after Rd continuous and Rd18 vs after MPT. No new safety concerns, including risk for secondary malignancies, were observed. Treatment with Rd continuous significantly improved survival outcomes vs MPT, supporting Rd continuous as a standard of care for patients with transplant-ineligible NDMM. This trial was registered at www.clinicaltrials.gov as #NCT00689936 and EudraCT as 2007-004823-39. © 2018 by The American Society of Hematology.

Final analysis of survival outcomes in the phase 3 FIRST trial of up-front treatment for multiple myeloma

PubMed Central

Dimopoulos, Meletios A.; Dispenzieri, Angela; Catalano, John V.; Belch, Andrew; Cavo, Michele; Pinto, Antonello; Weisel, Katja; Ludwig, Heinz; Bahlis, Nizar J.; Banos, Anne; Tiab, Mourad; Delforge, Michel; Cavenagh, Jamie D.; Geraldes, Catarina; Lee, Je-Jung; Chen, Christine; Oriol, Albert; De La Rubia, Javier; White, Darrell; Binder, Daniel; Lu, Jin; Anderson, Kenneth C.; Moreau, Philippe; Attal, Michel; Perrot, Aurore; Arnulf, Bertrand; Qiu, Lugui; Roussel, Murielle; Boyle, Eileen; Manier, Salomon; Mohty, Mohamad; Avet-Loiseau, Herve; Leleu, Xavier; Ervin-Haynes, Annette; Chen, Guang; Houck, Vanessa; Benboubker, Lotfi; Hulin, Cyrille

2018-01-01

This FIRST trial final analysis examined survival outcomes in patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM) treated with lenalidomide and low-dose dexamethasone until disease progression (Rd continuous), Rd for 72 weeks (18 cycles; Rd18), or melphalan, prednisone, and thalidomide (MPT; 72 weeks). The primary endpoint was progression-free survival (PFS; primary comparison: Rd continuous vs MPT). Overall survival (OS) was a key secondary endpoint (final analysis prespecified ≥60 months’ follow-up). Patients were randomized to Rd continuous (n = 535), Rd18 (n = 541), or MPT (n = 547). At a median follow-up of 67 months, PFS was significantly longer with Rd continuous vs MPT (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.59-0.79; P < .00001) and was similarly extended vs Rd18. Median OS was 10 months longer with Rd continuous vs MPT (59.1 vs 49.1 months; HR, 0.78; 95% CI, 0.67-0.92; P = .0023), and similar with Rd18 (62.3 months). In patients achieving complete or very good partial responses, Rd continuous had an ≈30-month longer median time to next treatment vs Rd18 (69.5 vs 39.9 months). Over half of all patients who received second-line treatment were given a bortezomib-based therapy. Second-line outcomes were improved in patients receiving bortezomib after Rd continuous and Rd18 vs after MPT. No new safety concerns, including risk for secondary malignancies, were observed. Treatment with Rd continuous significantly improved survival outcomes vs MPT, supporting Rd continuous as a standard of care for patients with transplant-ineligible NDMM. This trial was registered at www.clinicaltrials.gov as #NCT00689936 and EudraCT as 2007-004823-39. PMID:29150421

Design and operation of a continuous integrated monoclonal antibody production process.

PubMed

Steinebach, Fabian; Ulmer, Nicole; Wolf, Moritz; Decker, Lara; Schneider, Veronika; Wälchli, Ruben; Karst, Daniel; Souquet, Jonathan; Morbidelli, Massimo

2017-09-01

The realization of an end-to-end integrated continuous lab-scale process for monoclonal antibody manufacturing is described. For this, a continuous cultivation with filter-based cell-retention, a continuous two column capture process, a virus inactivation step, a semi-continuous polishing step (twin-column MCSGP), and a batch-wise flow-through polishing step were integrated and operated together. In each unit, the implementation of internal recycle loops allows to improve the performance: (a) in the bioreactor, to simultaneously increase the cell density and volumetric productivity, (b) in the capture process, to achieve improved capacity utilization at high productivity and yield, and (c) in the MCSGP process, to overcome the purity-yield trade-off of classical batch-wise bind-elute polishing steps. Furthermore, the design principles, which allow the direct connection of these steps, some at steady state and some at cyclic steady state, as well as straight-through processing, are discussed. The setup was operated for the continuous production of a commercial monoclonal antibody, resulting in stable operation and uniform product quality over the 17 cycles of the end-to-end integration. The steady-state operation was fully characterized by analyzing at the outlet of each unit at steady state the product titer as well as the process (HCP, DNA, leached Protein A) and product (aggregates, fragments) related impurities. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 33:1303-1313, 2017. © 2017 American Institute of Chemical Engineers.

Development and Evaluation of a Continuing Education Program for Nursing Technicians at a Pediatric Cardiac Intensive Care Unit in a Developing Country.

PubMed

Borim, Bruna Cury; Croti, Ulisses A; Silveira, Patricia C; De Marchi, Carlos H; Moscardini, Airton C; Hickey, Patricia; Jenkins, Kathy

2017-11-01

The nursing profession faces continuous transformations demonstrating the importance of professional continuing education to extend knowledge following technological development without impairing quality of care. Nursing assistants and technicians account for nearly 80% of nursing professionals in Brazil and are responsible for uninterrupted patient care. Extensive knowledge improvement is needed to achieve excellence in nursing care. The objective was to develop and evaluate a continuing education program for nursing technicians at a pediatric cardiac intensive care unit (PCICU) using a virtual learning environment entitled EDUCATE. From July to September 2015, a total of 24 nursing technicians working at the PCICU at a children's hospital located in the northwestern region of São Paulo state (Brazil) fully participated in the continuing education program developed in a virtual learning environment using Wix platform, allowing access to video classes and pre- and post-training theoretical evaluation questionnaires outside the work environment. The evaluation tools recorded participants' knowledge evolution, technological difficulties, educational, and overall rating. Knowledge development was descriptively presented as positive in more than 66.7%. Content and training were considered "excellent" by most participants and 90% showed an interest in the use of technological resources. Technical difficulties were found and quickly resolved by 40% of participants including Internet access, login, and lack of technical expertise. The continuing education program using a virtual learning environment positively contributed to the improvement in theoretical knowledge of nursing technicians in PCICU.

EUV process improvement with novel litho track hardware

NASA Astrophysics Data System (ADS)

Stokes, Harold; Harumoto, Masahiko; Tanaka, Yuji; Kaneyama, Koji; Pieczulewski, Charles; Asai, Masaya

2017-03-01

Currently, there are many developments in the field of EUV lithography that are helping to move it towards increased HVM feasibility. Targeted improvements in hardware design for advanced lithography are of interest to our group specifically for metrics such as CD uniformity, LWR, and defect density. Of course, our work is focused on EUV process steps that are specifically affected by litho track performance, and consequently, can be improved by litho track design improvement and optimization. In this study we are building on our experience to provide continual improvement for LWR, CDU, and Defects as applied to a standard EUV process by employing novel hardware solutions on our SOKUDO DUO coat develop track system. Although it is preferable to achieve such improvements post-etch process we feel, as many do, that improvements after patterning are a precursor to improvements after etching. We hereby present our work utilizing the SOKUDO DUO coat develop track system with an ASML NXE:3300 in the IMEC (Leuven, Belgium) cleanroom environment to improve aggressive dense L/S patterns.

Improved methodologies for continuous-flow analysis of stable water isotopes in ice cores

NASA Astrophysics Data System (ADS)

Jones, Tyler R.; White, James W. C.; Steig, Eric J.; Vaughn, Bruce H.; Morris, Valerie; Gkinis, Vasileios; Markle, Bradley R.; Schoenemann, Spruce W.

2017-02-01

Water isotopes in ice cores are used as a climate proxy for local temperature and regional atmospheric circulation as well as evaporative conditions in moisture source regions. Traditional measurements of water isotopes have been achieved using magnetic sector isotope ratio mass spectrometry (IRMS). However, a number of recent studies have shown that laser absorption spectrometry (LAS) performs as well or better than IRMS. The new LAS technology has been combined with continuous-flow analysis (CFA) to improve data density and sample throughput in numerous prior ice coring projects. Here, we present a comparable semi-automated LAS-CFA system for measuring high-resolution water isotopes of ice cores. We outline new methods for partitioning both system precision and mixing length into liquid and vapor components - useful measures for defining and improving the overall performance of the system. Critically, these methods take into account the uncertainty of depth registration that is not present in IRMS nor fully accounted for in other CFA studies. These analyses are achieved using samples from a South Pole firn core, a Greenland ice core, and the West Antarctic Ice Sheet (WAIS) Divide ice core. The measurement system utilizes a 16-position carousel contained in a freezer to consecutively deliver ˜ 1 m × 1.3 cm2 ice sticks to a temperature-controlled melt head, where the ice is converted to a continuous liquid stream and eventually vaporized using a concentric nebulizer for isotopic analysis. An integrated delivery system for water isotope standards is used for calibration to the Vienna Standard Mean Ocean Water (VSMOW) scale, and depth registration is achieved using a precise overhead laser distance device with an uncertainty of ±0.2 mm. As an added check on the system, we perform inter-lab LAS comparisons using WAIS Divide ice samples, a corroboratory step not taken in prior CFA studies. The overall results are important for substantiating data obtained from LAS-CFA systems, including optimizing liquid and vapor mixing lengths, determining melt rates for ice cores with different accumulation and thinning histories, and removing system-wide mixing effects that are convolved with the natural diffusional signal that results primarily from water molecule diffusion in the firn column.

Decreasing trends in patient satisfaction, accessibility and continuity of care in Finnish primary health care – a 14-year follow-up questionnaire study

PubMed Central

2014-01-01

Background The aim here was to explore trends in patient satisfaction with primary health care and its accessibility and continuity, and to explore whether through reforms and improvements some of the essential goals had been achieved over a 14-year period of time in Finland. Methods Nine questionnaire surveys were conducted over a period of 14 years among patients attending within one week in the 65 health centres in the Tampere University Hospital catchment area. A total of 147,394 responded out of a sample of 333,648 patients. The response rate varied yearly from 53% to 37%. Results Patient satisfaction with care in Finnish health centres decreased by nearly 9 percentage units from 1998 to 2011. The fall-off was most marked in the age-group over 64 years. There was a 20 percentage unit’s reduction in ease of access as reported by patients. Respondents also reported that the continuity of care had deteriorated. Conclusions Despite major reforms in Finnish health care policy, patients seem to be less satisfied. Our findings challenge both Finnish authorities and GPs to improve the accessibility and continuity of care in primary health services. PMID:24885700

The research of single intersection sensor signal control based on section data

NASA Astrophysics Data System (ADS)

Liu, Yunxiang; Huang, Yue; Wang, Hao

2016-12-01

Propose a sensing signal intersection control design electronic license based on the design by setting the intersection readers to interact with active electronic tags equipped vehicles, vehicle information obtained on the road section. In the vehicle detection sensor may control the green density as evaluation criteria are extended when the vehicle is higher than the threshold, the green density continuity, whereas the switching phases. Induction showed improved control strategy can achieve real-time traffic signal control effectively in high saturation intersection, to overcome the traditional sensor control failure at high saturation drawbacks and improve the utilization of urban Intersection comparative analysis by simulation.

A neuro approach to solve fuzzy Riccati differential equations

NASA Astrophysics Data System (ADS)

Shahrir, Mohammad Shazri; Kumaresan, N.; Kamali, M. Z. M.; Ratnavelu, Kurunathan

2015-10-01

There are many applications of optimal control theory especially in the area of control systems in engineering. In this paper, fuzzy quadratic Riccati differential equation is estimated using neural networks (NN). Previous works have shown reliable results using Runge-Kutta 4th order (RK4). The solution can be achieved by solving the 1st Order Non-linear Differential Equation (ODE) that is found commonly in Riccati differential equation. Research has shown improved results relatively to the RK4 method. It can be said that NN approach shows promising results with the advantage of continuous estimation and improved accuracy that can be produced over RK4.

Communicating with Pet Owners About Obesity: Roles of the Veterinary Health Care Team.

PubMed

Churchill, Julie; Ward, Ernie

2016-09-01

Obesity continues to be the most prevalent nutritional problem of dogs and cats as well as one of the most frustrating conditions to treat successfully. Educating and assigning roles to all members of the health care team will improve staff engagement and the consistency and effectiveness of nutritional counseling for preventive care and weight loss treatment plans. Excellent communication skills can be used to assess the client's ability to change and implement a weight loss plan at the right time in the right way to achieve better adherence and improve patient health. Copyright © 2016 Elsevier Inc. All rights reserved.

Structural Pain Compensating Flight Control

NASA Technical Reports Server (NTRS)

Miller, Chris J.

2014-01-01

The problem of control command and maneuver induced structural loads is an important aspect of any control system design. Designers must design the aircraft structure and the control architecture to achieve desired piloted control responses while limiting the imparted structural loads. The classical approach is to build the structure with high margins, restrict control surface commands to known good combinations, and train pilots to follow procedural maneuvering limitations. With recent advances in structural sensing and the continued desire to improve safety and vehicle fuel efficiency, it is both possible and desirable to develop control architectures that enable lighter vehicle weights while maintaining and improving protection against structural damage.

A neuro approach to solve fuzzy Riccati differential equations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shahrir, Mohammad Shazri, E-mail: mshazri@gmail.com; Telekom Malaysia, R&D TM Innovation Centre, LingkaranTeknokrat Timur, 63000 Cyberjaya, Selangor; Kumaresan, N., E-mail: drnk2008@gmail.com

There are many applications of optimal control theory especially in the area of control systems in engineering. In this paper, fuzzy quadratic Riccati differential equation is estimated using neural networks (NN). Previous works have shown reliable results using Runge-Kutta 4th order (RK4). The solution can be achieved by solving the 1st Order Non-linear Differential Equation (ODE) that is found commonly in Riccati differential equation. Research has shown improved results relatively to the RK4 method. It can be said that NN approach shows promising results with the advantage of continuous estimation and improved accuracy that can be produced over RK4.

Chemotherapy of prostate cancer: present and future.

PubMed

Trump, Donald; Lau, Yiu-Keung

2003-06-01

The role of chemotherapy in prostate cancer continues to evolve. In men with symptomatic androgen-independent prostate cancer, significant reduction in pain and analgesic requirements are achievable with mitoxantrone and glucocorticoid combinations compared with glucocorticoids alone. However, survival rates are not improved. Taxane-based combinations with estramustine phosphate or other new agents show promise. Prostate-specific antigen response rates with these combinations appear to be 1.5 to 2 times more frequent than with mitoxantrone-based combinations. Randomized trials of taxane versus mitoxantrone-based therapies are underway. New agents and applications of current agents in adjuvant settings should be explored if survival in men with prostate cancer is to be improved.

[Quality concept in health care. Methodology for its measurement].

PubMed

Morera Guitart, J

2003-12-01

It is increasingly necessary that the neurologists achieve basic knowledgement in clinical management and medical care quality. We will review the concepts of medical care quality (MCQ). Of the definitions checked, we want to emphasize the following aspects. a) application of current scientific knowledge; b) interpersonal relationship; c) environment where the assistance is dispensed; d) results in health; e) cost of assistance; f) risks for the patient and g) patient satisfaction. For the analysis of the MCQ we could distinguish several components: scientific-technical component, efficacy, effectiveness, efficiency, accessibility, continuity, equity, appropriateness, and satisfaction of the patient and of the professional. One of the main objectives to measure the MCQ is to improve the assistance itself. For its measurement we can employ diverse methods depending on our objective: to improve the process, to do Benchmarking, to know the satisfaction of the patients or to guarantee the quality of the medical attention. The most used tools for this measurement are: establishment of criteria-indicator-standard for quality, elaboration of satisfaction questionnaires, interviews to key informant, analysis of complaints and claims of patients and professionals, and clinical audits. The role of the neurologist in the achievement of a high quality neurological attention if fundamental. Therefore, it is necessary some specific formation on: scientific and technical matter, communicative abilities, teamworking, management and organisation of tasks and pharmaco-economic evaluation, and a cultural change that involves every professional on the co-responsibility of the continuous improvement of the processes and of the results of his work, advancing gradually towards the excellence of medical assistance.

DUV light source availability improvement via further enhancement of gas management technologies

NASA Astrophysics Data System (ADS)

Riggs, Daniel J.; O'Brien, Kevin; Brown, Daniel J. W.

2011-04-01

The continuous evolution of the semiconductor market necessitates ever-increasing improvements in DUV light source uptime as defined in the SEMI E10 standard. Cymer is developing technologies to exceed current and projected light source availability requirements via significant reduction in light source downtime. As an example, consider discharge chamber gas management functions which comprise a sizable portion of DUV light source downtime. Cymer's recent introduction of Gas Lifetime Extension (GLXTM) as a productivity improvement technology for its DUV lithography light sources has demonstrated noteworthy reduction in downtime. This has been achieved by reducing the frequency of full gas replenishment events from once per 100 million pulses to as low as once per 2 billion pulses. Cymer has continued to develop relevant technologies that target further reduction in downtime associated with light source gas management functions. Cymer's current subject is the development of technologies to reduce downtime associated with gas state optimization (e.g. total chamber gas pressure) and gas life duration. Current gas state optimization involves execution of a manual procedure at regular intervals throughout the lifetime of light source core components. Cymer aims to introduce a product enhancement - iGLXTM - that eliminates the need for the manual procedure and, further, achieves 4 billion pulse gas lives. Projections of uptime on DUV light sources indicate that downtime associated with gas management will be reduced by 70% when compared with GLX2. In addition to reducing downtime, iGLX reduces DUV light source cost of operation by constraining gas usage. Usage of fluorine rich Halogen gas mix has been reduced by 20% over GLX2.

Calibration of transonic and supersonic wind tunnels

NASA Technical Reports Server (NTRS)

Reed, T. D.; Pope, T. C.; Cooksey, J. M.

1977-01-01

State-of-the art instrumentation and procedures for calibrating transonic (0.6 less than M less than 1.4) and supersonic (M less than or equal to 3.5) wind tunnels were reviewed and evaluated. Major emphasis was given to transonic tunnels. Continuous, blowdown and intermittent tunnels were considered. The required measurements of pressure, temperature, flow angularity, noise and humidity were discussed, and the effects of measurement uncertainties were summarized. A comprehensive review of instrumentation currently used to calibrate empty tunnel flow conditions was included. The recent results of relevant research are noted and recommendations for achieving improved data accuracy are made where appropriate. It is concluded, for general testing purposes, that satisfactory calibration measurements can be achieved in both transonic and supersonic tunnels. The goal of calibrating transonic tunnels to within 0.001 in centerline Mach number appears to be feasible with existing instrumentation, provided correct calibration procedures are carefully followed. A comparable accuracy can be achieved off-centerline with carefully designed, conventional probes, except near Mach 1. In the range 0.95 less than M less than 1.05, the laser Doppler velocimeter appears to offer the most promise for improved calibration accuracy off-centerline.

The impact of epilepsy on academic achievement in children with normal intelligence and without major comorbidities: A systematic review.

PubMed

Wo, S W; Ong, L C; Low, W Y; Lai, P S M

2017-10-01

To systematically examine published literature which assessed the prevalence of academic difficulties in children with epilepsy (CWE) of normal intelligence, and its associating factors. A search was conducted on five databases for articles published in English from 1980 till March 2015. Included were studies who recruited children (aged 5-18 years), with a diagnosis or newly/recurrent epilepsy, an intelligent quotient (IQ) of ≥70 or attending regular school, with or without a control group, which measured academic achievement using a standardised objective measure, and published in English. Excluded were children with learning difficulties, intellectual disabilities (IQ<70) and other comorbidities such as attention deficits hyperactive disorder or autism. Two pairs of reviewers extracted the data, and met to resolve any differences from the data extraction process. Twenty studies were included. The majority of the studies assessed "low achievement" whist only two studies used the IQ-achievement discrepancy definition of "underachievement". Fourteen studies (70%) reported that CWE had significantly lower academic achievement scores compared to healthy controls, children with asthma or reported norms. The remaining six studies (30%) did not report any differences. CWE had stable academic achievement scores over time (2-4 years), even among those whose seizure frequency improved. Higher parental education and children with higher IQ, and had better attention or had a positive attitude towards epilepsy, were associated with higher academic achievement score. Older children were found to have lower academic achievement score. In CWE of normal intelligence, the majority of published literature found that academic achievement was lower than controls or reported norms. The high percentages of low achievement in CWE, especially in the older age group, and the stability of scores even as seizure frequency improved, highlights the need for early screening of learning problems, and continued surveillance. Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluating the care cascade after antiretroviral therapy initiation in Latin America

PubMed Central

Wolff, Marcelo J; Cortes, Claudia P; Mejìa, Fernando A; Padgett, Denis; Belaunzarán-Zamudio, Pablo; Grinsztejn, Beatriz; Giganti, Mark J; McGowan, Catherine C; Rebeiro, Peter F

2018-01-01

Accelerating antiretroviral therapy (ART) administration, improving retention, and achieving viral suppression in low- and middle-income countries must be prioritized. We evaluated trends and disparities in these milestones in a large Latin American cohort. Adults starting ART (ARTstart) from 2003 to 2014 at Caribbean, Central, and South America network for HIV epidemiology sites were assessed for care cascade outcomes: CD4 cell count >200 cells/mm3 at ARTstart; retention (≥1 visit at one year after ARTstart); viral suppression (≥1 HIV-1 RNA <200 copies/ml at one year after ARTstart). Modified Poisson regression provided adjusted prevalence ratios by age, gender, and HIV transmission risk, accounting for site and year of ARTstart. Proportions achieving ARTstart and suppression improved over time (p < 0.05). Older age was associated with better retention and viral suppression, but not ARTstart at CD4 cell count >200 cells/mm3. Females and men who have sex with men (MSM) were more likely to have CD4 cell count >200 cells/mm3 at ARTstart. Injection drug users (IDUs) were less likely to be retained while MSM were more likely to achieve viral suppression (all p <0.05). Despite improvements in these outcomes over the course of a decade in this cohort, significant disparities existed, disadvantaging younger patients, men, and IDUs. These gaps indicate continued progress in providing early diagnosis and ARTstart remain critical. PMID:28618980

Complex problems and unchallenged solutions: Bringing ecosystem governance to the forefront of the UN sustainable development goals.

PubMed

Vasseur, Liette; Horning, Darwin; Thornbush, Mary; Cohen-Shacham, Emmanuelle; Andrade, Angela; Barrow, Ed; Edwards, Steve R; Wit, Piet; Jones, Mike

2017-11-01

Sustainable development aims at addressing economic, social, and environmental concerns, but the current lack of responsive environmental governance hinders progress. Short-term economic development has led to limited actions, unsustainable resource management, and degraded ecosystems. The UN Sustainable Development Goals (SDGs) may continue to fall short of achieving significant progress without a better understanding of how ecosystems contribute to achieving sustainability for all people. Ecosystem governance is an approach that integrates the social and ecological components for improved sustainability and includes principles such as adaptive ecosystem co-management, subsidiarity, and telecoupling framework, as well as principles of democracy and accountability. We explain the importance of ecosystem governance in achieving the SDGs, and suggest some ways to ensure that ecosystem services are meaningfully considered. This paper reflects on how integration of these approaches into policies can enhance the current agenda of sustainability.

Professional development for science teachers.

PubMed

Wilson, Suzanne M

2013-04-19

The Next Generation Science Standards will require large-scale professional development (PD) for all science teachers. Existing research on effective teacher PD suggests factors that are associated with substantial changes in teacher knowledge and practice, as well as students' science achievement. But the complexity of the U.S. educational system continues to thwart the search for a straightforward answer to the question of how to support teachers. Interventions that take a systemic approach to reform hold promise for improving PD effectiveness.

The Efficacy of Radiotherapy in the Treatment of Orbital Pseudotumor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matthiesen, Chance, E-mail: chance-matthiesen@ouhsc.ed; Bogardus, Carl; Thompson, J. Spencer

Purpose: To review institutional outcomes for patients treated with external-beam radiotherapy (EBRT) for orbital pseudotumor. Methods and Materials: This is a single-institution retrospective review of 20 orbits in 16 patients diagnosed with orbital pseudotumor that received EBRT at the University of Oklahoma, Department of Radiation Oncology. Treated patients had a median follow-up of 16.5 months. Results: Fifteen patients (93.7%) were initially treated with corticosteroids. Eight had recurrence after steroid cessation, six were unable to taper corticosteroids completely or partially, and one experienced progression of symptoms despite corticosteroid therapy. Fourteen patients (87.5%) initially responded to radiotherapy indicated by clinical improvement ofmore » preradiation symptoms and/or tapering of corticosteroid dose. Mean EBRT dose was 20 Gy (range, 14-30 Gy). Thirteen patients (81.2%) continued to improve after radiation therapy. Patient outcomes were complete cessation of corticosteroid therapy in nine patients (56.3%) and reduced corticosteroid dose in four patients (25%). Radiotherapy did not achieve long-term control for three patients (18.7%), who still required preradiation corticosteroid dosages. Three patients received retreatment(s) of four orbits, of which two patients achieved long-term symptom control without corticosteroid dependence. One patient received retreatment to an orbit three times, achieving long-term control without corticosteroid dependence. No significant late effects have been observed in retreated patients. Conclusions: Radiotherapy is an effective treatment for acute symptomatic improvement and long-term control of orbital pseudotumor. Orbital retreatment can be of clinical benefit, without apparent increase in morbidity, when initial irradiation fails to achieve complete response.« less

Evaluation of cardiovascular risk-lowering health benefits accruing from laboratory-based, community-based and exercise-referral exercise programmes.

PubMed

Webb, R; Thompson, J E S; Ruffino, J-S; Davies, N A; Watkeys, L; Hooper, S; Jones, P M; Walters, G; Clayton, D; Thomas, A W; Morris, K; Llewellyn, D H; Ward, M; Wyatt-Williams, J; McDonnell, B J

2016-01-01

To evaluate the ability of community-based exercise programmes to facilitate public participation in exercise and hence improved cardiovascular health, we assessed the respective impacts of: a continuously monitored exercise programme based within our university (study 1); a Valleys Regional Park-facilitated community-based outdoor exercise programme (study 2); a Wales National Exercise Referral Scheme-delivered exercise-referral programme (study 3). Biomolecular (monocytic PPARγ target gene expression), vascular haemodynamic (central/peripheral blood pressure, arterial stiffness), clinical (insulin sensitivity, blood lipids) and anthropometric (body mass index, waist circumference, heart rate) parameters were investigated using RT-PCR, applanation tonometry, chemical analysis and standard anthropometric techniques. In studies 1-3, 22/28, 32/65 and 11/14 participants adhered to their respective exercise programmes, and underwent significant increases in physical activity levels. Importantly, beneficial effects similar to those seen in our previous studies (eg, modulations in expression of monocytic PPARγ target genes, decreases in blood pressure/arterial stiffness, improvements in blood lipids/insulin sensitivity) were observed (albeit to slightly differing extents) only in participants who adhered to their respective exercise programmes. While study 1 achieved more intense exercise and more pronounced beneficial effects, significant cardiovascular risk-lowering health benefits related to biomolecular markers, blood pressure, arterial stiffness and blood lipids were achieved via community/referral-based delivery modes in studies 2 and 3. Because cardiovascular health benefits were observed in all 3 studies, we conclude that the majority of benefits previously reported in laboratory-based studies can also be achieved in community-based/exercise-referral settings. These findings may be of use in guiding policymakers with regard to introduction and/or continued implementation of community/referral-based exercise programmes.

Deliberate Learning in Health Care: The Effect of Importing Best Practices and Creative Problem Solving on Hospital Performance Improvement

PubMed Central

Nembhard, Ingrid M.; Cherian, Praseetha; Bradley, Elizabeth H.

2015-01-01

This article examines the effect on quality improvement of two common but distinct approaches to organizational learning: importing best practices (an externally oriented approach rooted in learning by imitating others’ best practices) and internal creative problem solving (an internally oriented approach rooted in learning by experimenting with self-generated solutions). We propose that independent and interaction effects of these approaches depend on where organizations are in their improvement journey – initial push or later phase. We examine this contingency in hospitals focused on improving treatment time for patients with heart attacks. Our results show that importing best practices helps hospitals achieve initial phase but not later phase improvement. Once hospitals enter the later phase of their efforts, however, significant improvement requires creative problem solving as well. Together, our results suggest that importing best practices delivers greater short-term improvement, but continued improvement depends on creative problem solving. PMID:24876100

The Sustainable Development Goal for Urban Sanitation: Africa's Statistical Tragedy Continues?

PubMed

Buckley, Robert M; Kallergis, Achilles

2018-06-01

Sanitation delivery in the urban areas of sub-Saharan African countries has been a chronic issue, particularly difficult to tackle. Under the Millennium Development Goals, the sanitation target in urban sub-Saharan Africa was missed by a wide margin and witnessed almost no improvement. After 2 years of review, the WHO/UNICEF Joint Monitoring Programme published a new measure of access to sanitation as a baseline for the Sustainable Development Goals. There are a number of improvements in the new measure. However, despite the improvements, the new measure continues to be characterized by an important flaw: it continues to disregard how shared toilet facilities contribute towards the SDG sanitation target. As a result, the new measure does not indicate whether progress is being made in low-income urban areas where a large number of households rely on shared sanitation; nor does it provide a goal that can be achieved in cities of the poorest countries over the measurement period. But, its most egregious failing is that it directs resources towards investments which will often fail cost/benefit tests. In sum, it is not a surprise that a Working Group recommended that the measure should be changed to include some shared facilities. Following the Working Group's recommendation would have avoided the adverse consequences of continued reliance on a key component of the methodology used for monitoring sanitation improvements under the Millennium Development Goals. The paper discusses the limitations of this methodology in the context of urban sub-Saharan Africa, where current sanitation conditions are seriously lacking, and the significant future urban population growth will add more pressure for the delivery of vital sanitation services.

Benefits of regular walking exercise in advanced pre-dialysis chronic kidney disease.

PubMed

Kosmadakis, George C; John, Stephen G; Clapp, Emma L; Viana, Joao L; Smith, Alice C; Bishop, Nicolette C; Bevington, Alan; Owen, Paul J; McIntyre, Christopher W; Feehally, John

2012-03-01

There is increasing evidence of the benefit of regular physical exercise in a number of long-term conditions including chronic kidney disease (CKD). In CKD, this evidence has mostly come from studies in end stage patients receiving regular dialysis. There is little evidence in pre-dialysis patients with CKD Stages 4 and 5. A prospective study compared the benefits of 6 months regular walking in 40 pre-dialysis patients with CKD Stages 4 and 5. Twenty of them were the exercising group and were compared to 20 patients who were continuing with usual physical activity. In addition, the 40 patients were randomized to receive additional oral sodium bicarbonate (target venous bicarbonate 29 mmol/L) or continue with previous sodium bicarbonate treatment (target 24 mmol/L). Improvements noted after 1 month were sustained to 6 months in the 18 of 20 who completed the exercise study. These included improvements in exercise tolerance (reduced exertion to achieve the same activity), weight loss, improved cardiovascular reactivity, avoiding an increase in blood pressure medication and improvements in quality of health and life and uraemic symptom scores assessed by questionnaire. Sodium bicarbonate supplementation did not produce any significant alterations. This study provides further support for the broad benefits of aerobic physical exercise in CKD. More studies are needed to understand the mechanisms of these benefits, to study whether resistance exercise will add to the benefit and to evaluate strategies to promote sustained lifestyle changes, that could ensure continued increase in habitual daily physical activity levels.

A benchmarking program to reduce red blood cell outdating: implementation, evaluation, and a conceptual framework.

PubMed

Barty, Rebecca L; Gagliardi, Kathleen; Owens, Wendy; Lauzon, Deborah; Scheuermann, Sheena; Liu, Yang; Wang, Grace; Pai, Menaka; Heddle, Nancy M

2015-07-01

Benchmarking is a quality improvement tool that compares an organization's performance to that of its peers for selected indicators, to improve practice. Processes to develop evidence-based benchmarks for red blood cell (RBC) outdating in Ontario hospitals, based on RBC hospital disposition data from Canadian Blood Services, have been previously reported. These benchmarks were implemented in 160 hospitals provincewide with a multifaceted approach, which included hospital education, inventory management tools and resources, summaries of best practice recommendations, recognition of high-performing sites, and audit tools on the Transfusion Ontario website (http://transfusionontario.org). In this study we describe the implementation process and the impact of the benchmarking program on RBC outdating. A conceptual framework for continuous quality improvement of a benchmarking program was also developed. The RBC outdating rate for all hospitals trended downward continuously from April 2006 to February 2012, irrespective of hospitals' transfusion rates or their distance from the blood supplier. The highest annual outdating rate was 2.82%, at the beginning of the observation period. Each year brought further reductions, with a nadir outdating rate of 1.02% achieved in 2011. The key elements of the successful benchmarking strategy included dynamic targets, a comprehensive and evidence-based implementation strategy, ongoing information sharing, and a robust data system to track information. The Ontario benchmarking program for RBC outdating resulted in continuous and sustained quality improvement. Our conceptual iterative framework for benchmarking provides a guide for institutions implementing a benchmarking program. © 2015 AABB.

Reliability improvements in tunable Pb1-xSnxSe diode lasers

NASA Technical Reports Server (NTRS)

Linden, K. J.; Butler, J. F.; Nill, K. W.; Reeder, R. E.

1980-01-01

Recent developments in the technology of Pb-salt diode lasers which have led to significant improvements in reliability and lifetime, and to improved operation at very long wavelengths are described. A combination of packaging and contacting-metallurgy improvements has led to diode lasers that are stable both in terms of temperature cycling and shelf-storage time. Lasers cycled over 500 times between 77 K and 300 K have exhibited no measurable changes in either electrical contact resistance or threshold current. Utilizing metallurgical contacting process, both lasers and experimental n-type and p-type bulk materials are shown to have electrical contact resistance values that are stable for shelf storage periods well in excess of one year. Problems and experiments which have led to devices with improved performance stability are discussed. Stable device configurations achieved for material compositions yielding lasers which operate continuously at wavelengths as long as 30.3 micrometers are described.

Quality in health care: what are the problems and what are the solutions?

PubMed

Shipon, D M; Nash, D B

2000-10-01

The health care industry must define quality as achieving "desired health outcomes" that are "consistent with current professional knowledge." Once a single definition is established, health care professionals can begin to measure quality and improve the process of health care in this country. Clinical variation and an increasing number of medical mistakes have contributed to rising health care costs and poor quality. Once the industry establishes what is wrong, it can begin to devise some solutions to improve the quality of health care. A six-step strategy to improve quality is suggested: increasing accountability at all levels of the industry, continuous quality improvement, standardization of medicine using guidelines, patient empowerment, improved access to health information through a centralized database, and the need for incentives for patients and medical professionals. Although many physicians are skeptical of such changes, the health care industry clearly must work together to address the issue of quality appropriately.

Improving cardiac surgical care: a work systems approach.

PubMed

Wiegmann, Douglas A; Eggman, Ashley A; Elbardissi, Andrew W; Parker, Sarah Henrickson; Sundt, Thoralf M

2010-09-01

Over the past 50 years, significant improvements in cardiac surgical care have been achieved. Nevertheless, surgical errors that significantly impact patient safety continue to occur. In order to further improve surgical outcomes, patient safety programs must focus on rectifying work system factors in the operating room (OR) that negatively impact the delivery of reliable surgical care. The goal of this paper is to provide an integrative review of specific work system factors in the OR that may directly impact surgical care processes, as well as the subsequent recommendations that have been put forth to improve surgical outcomes and patient safety. The important role that surgeons can play in facilitating work system changes in the OR is also discussed. The paper concludes with a discussion of the challenges involved in assessing the impact that interventions have on improving surgical care. Opportunities for future research are also highlighted throughout the paper. 2010 Elsevier Ltd. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lower, Mark D; Christopher, Timothy W; Oland, C Barry

The Facilities and Operations (F&O) Directorate is sponsoring a continuous process improvement (CPI) program. Its purpose is to stimulate, promote, and sustain a culture of improvement throughout all levels of the organization. The CPI program ensures that a scientific and repeatable process exists for improving the delivery of F&O products and services in support of Oak Ridge National Laboratory (ORNL) Management Systems. Strategic objectives of the CPI program include achieving excellence in laboratory operations in the areas of safety, health, and the environment. Identifying and promoting opportunities for achieving the following critical outcomes are important business goals of the CPImore » program: improved safety performance; process focused on consumer needs; modern and secure campus; flexibility to respond to changing laboratory needs; bench strength for the future; and elimination of legacy issues. The Steam Pressure-Reducing Station (SPRS) Safety and Energy Efficiency Improvement Project, which is under the CPI program, focuses on maintaining and upgrading SPRSs that are part of the ORNL steam distribution network. This steam pipe network transports steam produced at the ORNL steam plant to many buildings in the main campus site. The SPRS Safety and Energy Efficiency Improvement Project promotes excellence in laboratory operations by (1) improving personnel safety, (2) decreasing fuel consumption through improved steam system energy efficiency, and (3) achieving compliance with applicable worker health and safety requirements. The SPRS Safety and Energy Efficiency Improvement Project being performed by F&O is helping ORNL improve both energy efficiency and worker safety by modifying, maintaining, and repairing SPRSs. Since work began in 2006, numerous energy-wasting steam leaks have been eliminated, heat losses from uninsulated steam pipe surfaces have been reduced, and deficient pressure retaining components have been replaced. These improvements helped ORNL reduce its overall utility costs by decreasing the amount of fuel used to generate steam. Reduced fuel consumption also decreased air emissions. These improvements also helped lower the risk of burn injuries to workers and helped prevent shrapnel injuries resulting from missiles produced by pressurized component failures. In most cases, the economic benefit and cost effectiveness of the SPRS Safety and Energy Efficiency Improvement Project is reflected in payback periods of 1 year or less.« less

The Canadian Methotrexate and Etanercept Outcome Study: a randomised trial of discontinuing versus continuing methotrexate after 6 months of etanercept and methotrexate therapy in rheumatoid arthritis

PubMed Central

Pope, Janet E; Haraoui, Boulos; Thorne, J Carter; Vieira, Andrew; Poulin-Costello, Melanie; Keystone, Edward C

2014-01-01

Objective To determine if withdrawing methotrexate (MTX) after 6 months of combination etanercept (ETN)+MTX, in MTX-inadequate responders with active rheumatoid arthritis (RA), is non-inferior to continuing ETN+MTX. Methods Tumour necrosis factor-inhibitor naïve RA patients with disease activity score 28 (DAS28)≥3.2, swollen joint count≥3, despite stable MTX, were treated with ETN+MTX for 6 months, followed by randomisation to either continue ETN+MTX or switch to ETN monotherapy for an additional 18 months. The primary endpoint was change in DAS28 from 6-month randomisation to 12 months. The non-inferiority margin of change in DAS28 was 0.6, with prespecified analyses (DAS28<3.2 vs DAS28≥3.2). Results 205 patients were randomised. DAS28 was stable in patients on ETN+MTX and increased slightly in patients on ETN monotherapy from 6 to 12 months. Non-inferiority was not achieved, with an adjusted difference of 0.4 (0.1 to 0.7) between the ETN and the ETN+MTX groups, for the month 6–12 change in DAS28. However, patients who achieved low disease activity (LDA; DAS28<3.2) at 6 months had a similar disease activity at 12 months, whether on monotherapy or combination therapy (DAS28 change 0.7 ETN vs 0.57 ETN+MTX, p=0.8148). Conversely, for patients who did not reach LDA at 6 months, those on ETN monotherapy had increased disease activity at 12 months, while disease activity continued to decrease for patients on combination therapy, at 12 months (DAS28 change 0.4 ETN vs −0.4 ETN+MTX, p=0.0023). Conclusions Non-inferiority was not achieved. Withdrawing MTX after 6 months of continuation ETN+MTX in MTX inadequate responders did not yield the same degree of improvement between 6 and 12 months compared with continuing ETN+MTX. Trial Registration ClinicalTrials.gov−NCT00654368. PMID:23979914

Design and implementation of a system for laser assisted milling of advanced materials

NASA Astrophysics Data System (ADS)

Wu, Xuefeng; Feng, Gaocheng; Liu, Xianli

2016-09-01

Laser assisted machining is an effective method to machine advanced materials with the added benefits of longer tool life and increased material removal rates. While extensive studies have investigated the machining properties for laser assisted milling(LAML), few attempts have been made to extend LAML to machining parts with complex geometric features. A methodology for continuous path machining for LAML is developed by integration of a rotary and movable table into an ordinary milling machine with a laser beam system. The machining strategy and processing path are investigated to determine alignment of the machining path with the laser spot. In order to keep the material removal temperatures above the softening temperature of silicon nitride, the transformation is coordinated and the temperature interpolated, establishing a transient thermal model. The temperatures of the laser center and cutting zone are also carefully controlled to achieve optimal machining results and avoid thermal damage. These experiments indicate that the system results in no surface damage as well as good surface roughness, validating the application of this machining strategy and thermal model in the development of a new LAML system for continuous path processing of silicon nitride. The proposed approach can be easily applied in LAML system to achieve continuous processing and improve efficiency in laser assisted machining.

Shuttle propellant loading instrumenation development

NASA Technical Reports Server (NTRS)

Hamlet, J.

1975-01-01

A continuous capacitance sensor was developed and an analog signal conditioner was evaluated to demonstrate the acceptability of these items for use in the space shuttle propellant loading system. An existing basic sensor concept was redesigned to provide capability for cryogenic operation, to improve performance, and to minimize production costs. Sensor development verification consisted of evaluation of sensor linearity, cryogenic performance, and stability during vibration. The signal conditioner evaluation consisted mainly of establishing the effects of the variations in temperature and cable parameters and evaluating the stability. A sensor linearity of 0.04 in. was achieved over most of the sensor length. The sensor instability caused by vibration was 0.04 percent. The cryogenic performance data show a maximum instability of 0.19 percent at liquid hydrogen temperature; a theoretical calibration can be computed a within 1 percent. The signal conditioner evaluation showed that, with temperature compensation, all error sources typically contribute much less than 1 percent. An estimate of the accuracy achievable with the sensor and signal conditioner shows an rss estimate of 0.75 in. for liquid oxygen and 1.02 in. for liquid hydrogen. These are approximately four times better than the shuttle requirements. Comparison of continuous sensor and discrete sensor performance show the continuous sensor to be significantly better when there is surface activity due to sloshing, boiling, or other disturbances.

40 CFR 430.94 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2013 CFR

2013-07-01

... achievable (BAT). 430.94 Section 430.94 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... reduction attainable by the application of the best available technology economically achievable (BAT... economically achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass...

40 CFR 430.94 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2014 CFR

2014-07-01

... achievable (BAT). 430.94 Section 430.94 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... reduction attainable by the application of the best available technology economically achievable (BAT... economically achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass...

Green Propulsion Technologies for Advanced Air Transports

NASA Technical Reports Server (NTRS)

Del Rosario, Ruben

2015-01-01

Air transportation is critical to U.S. and Global economic vitality. However, energy and climate issues challenge aviations ability to be sustainable in the long term. Aviation must dramatically reduce fuel use and related emissions. Energy costs to U.S. airlines nearly tripled between 1995 and 2011, and continue to be the highest percentage of operating costs. The NASA Advanced Air Transports Technology Project addresses the comprehensive challenge of enabling revolutionary energy efficiency improvements in subsonic transport aircraft combined with dramatic reductions in harmful emissions and perceived noise to facilitate sustained growth of the air transportation system. Advanced technologies and the development of unconventional aircraft systems offer the potential to achieve these improvements. The presentation will highlight the NASA vision of revolutionary systems and propulsion technologies needed to achieve these challenging goals. Specifically, the primary focus is on the N+3 generation; that is, vehicles that are three generations beyond the current state of the art, requiring mature technology solutions in the 2025-30 timeframe, which are envisioned as being powered by Hybrid Electric Propulsion Systems.

Using quality and safety education for nurses to guide clinical teaching on a new dedicated education unit.

PubMed

McKown, Terri; McKeon, Leslie; McKown, Leslie; Webb, Sherry

2011-12-01

Gaps exist in health professional education versus the demands of current practice. Leveraging front-line nurses to teach students exemplary practice in a Dedicated Education Unit (DEU) may narrow this gap. The DEU is an innovative model for experiential learning, capitalizing on the expertise of staff nurses as clinical teachers. This study evaluated the effectiveness of a new academic-practice DEU in facilitating quality and safety competency achievement among students. Six clinical teachers received education in clinical teaching and use of Quality and Safety Education for Nurses (QSEN) competencies to guide acquisition of essential knowledge, skills, and attitudes for continuous health care improvement. Twelve students assigned to the six teachers completed daily logs for the 10-week practicum. Findings suggest that DEU students achieved QSEN competencies through clinical teacher mentoring in interdisciplinary collaboration, using electronic information for best practice and patient teaching, patient/family decision making, quality improvement, and resolution of safety issues.

Optimal Control Allocation with Load Sensor Feedback for Active Load Suppression, Experiment Development

NASA Technical Reports Server (NTRS)

Miller, Christopher J.; Goodrick, Dan

2017-01-01

The problem of control command and maneuver induced structural loads is an important aspect of any control system design. The aircraft structure and the control architecture must be designed to achieve desired piloted control responses while limiting the imparted structural loads. The classical approach is to utilize high structural margins, restrict control surface commands to a limited set of analyzed combinations, and train pilots to follow procedural maneuvering limitations. With recent advances in structural sensing and the continued desire to improve safety and vehicle fuel efficiency, it is both possible and desirable to develop control architectures that enable lighter vehicle weights while maintaining and improving protection against structural damage. An optimal control technique has been explored and shown to achieve desirable vehicle control performance while limiting sensed structural loads. The subject of this paper is the design of the optimal control architecture, and provides the reader with some techniques for tailoring the architecture, along with detailed simulation results.

Green Propulsion Technologies for Advanced Air Transports

NASA Technical Reports Server (NTRS)

Del Rosario, Ruben

2015-01-01

Air transportation is critical to U.S. and Global economic vitality. However, energy and climate issues challenge aviation's ability to be sustainable in the long term. Aviation must dramatically reduce fuel use and related emissions. Energy costs to U.S. airlines nearly tripled between 1995 and 2011, and continue to be the highest percentage of operating costs. The NASA Advanced Air Transports Technology Project addresses the comprehensive challenge of enabling revolutionary energy efficiency improvements in subsonic transport aircraft combined with dramatic reductions in harmful emissions and perceived noise to facilitate sustained growth of the air transportation system. Advanced technologies and the development of unconventional aircraft systems offer the potential to achieve these improvements. The presentation will highlight the NASA vision of revolutionary systems and propulsion technologies needed to achieve these challenging goals. Specifically, the primary focus is on the N+3 generation; that is, vehicles that are three generations beyond the current state of the art, requiring mature technology solutions in the 2025-30 timeframe.

Hydrophobic/Hydrophilic Cooperative Janus System for Enhancement of Fog Collection.

PubMed

Cao, Moyuan; Xiao, Jiasheng; Yu, Cunming; Li, Kan; Jiang, Lei

2015-09-09

Harvesting micro-droplets from fog is a promising method for solving global freshwater crisis. Different types of fog collectors have been extensively reported during the last decade. The improvement of fog collection can be attributed to the immediate transportation of harvested water, the effective regeneration of the fog gathering surface, etc. Through learning from the nature's strategy for water preservation, the hydrophobic/hydrophilic cooperative Janus system that achieved reinforced fog collection ability is reported here. Directional delivery of the surface water, decreased re-evaporation rate of the harvested water, and thinner boundary layer of the collecting surface contribute to the enhancement of collection efficiency. Further designed cylinder Janus collector can facilely achieve a continuous process of efficient collection, directional transportation, and spontaneous preservation of fog water. This Janus fog harvesting system should improve the understanding of micro-droplet collection system and offer ideas to solve water resource crisis. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Barrio Adentro and the reduction of health inequalities in Venezuela: an appraisal of the first years.

PubMed

Armada, Francisco; Muntaner, Caries; Chung, Haejoo; Williams-Brennan, Leslie; Benach, Joan

2009-01-01

This article presents an update on the characteristics and performance of Venezuela's Bolivarian health care system, Barrio Adentro (Inside the Neighborhood). During its first five years of existence, Barrio Adentro has improved access and utilization of health services by reaching approximately 17 million impoverished and middle-class citizens all over Venezuela. This was achieved in approximately two years and provides an example of an immense "South-South" cooperation and participatory democracy in health care. Popular participation was achieved with the Comités de Salud (health committees) and more recently with the Consejos Comunales (community councils), while mostly Cuban physicians provided medical care. Examination of a few epidemiological indicators for the years 2004 and 2005 of Barrio Adentro reveals the positive impact of this health care program, in particular its primary care component, Barrio Adentro I. Continued political commitment and realistic evaluations are needed to sustain and improve Barrio Adentro, especially its primary care services.

Continuous quality improvement interventions to improve long-term outcomes of antiretroviral therapy in women who initiated therapy during pregnancy or breastfeeding in the Democratic Republic of Congo: design of an open-label, parallel, group randomized trial.

PubMed

Yotebieng, Marcel; Behets, Frieda; Kawende, Bienvenu; Ravelomanana, Noro Lantoniaina Rosa; Tabala, Martine; Okitolonda, Emile W

2017-04-26

Despite the rapid adoption of the World Health Organization's 2013 guidelines, children continue to be infected with HIV perinatally because of sub-optimal adherence to the continuum of HIV care in maternal and child health (MCH) clinics. To achieve the UNAIDS goal of eliminating mother-to-child HIV transmission, multiple, adaptive interventions need to be implemented to improve adherence to the HIV continuum. The aim of this open label, parallel, group randomized trial is to evaluate the effectiveness of Continuous Quality Improvement (CQI) interventions implemented at facility and health district levels to improve retention in care and virological suppression through 24 months postpartum among pregnant and breastfeeding women receiving ART in MCH clinics in Kinshasa, Democratic Republic of Congo. Prior to randomization, the current monitoring and evaluation system will be strengthened to enable collection of high quality individual patient-level data necessary for timely indicators production and program outcomes monitoring to inform CQI interventions. Following randomization, in health districts randomized to CQI, quality improvement (QI) teams will be established at the district level and at MCH clinics level. For 18 months, QI teams will be brought together quarterly to identify key bottlenecks in the care delivery system using data from the monitoring system, develop an action plan to address those bottlenecks, and implement the action plan at the level of their district or clinics. If proven to be effective, CQI as designed here, could be scaled up rapidly in resource-scarce settings to accelerate progress towards the goal of an AIDS free generation. The protocol was retrospectively registered on February 7, 2017. ClinicalTrials.gov Identifier: NCT03048669 .

Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA's Clinical Trials Network.

PubMed

Hien, Denise A; Jiang, Huiping; Campbell, Aimee N C; Hu, Mei-Chen; Miele, Gloria M; Cohen, Lisa R; Brigham, Gregory S; Capstick, Carrie; Kulaga, Agatha; Robinson, James; Suarez-Morales, Lourdes; Nunes, Edward V

2010-01-01

The purpose of the analysis was to examine the temporal course of improvement in symptoms of posttraumatic stress disorder (PTSD) and substance use disorder among women in outpatient substance abuse treatment. Participants were 353 women randomly assigned to 12 sessions of either trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and posttreatment at 1 week and after 3, 6, and 12 months. A continuous Markov model was fit on four defined response categories (nonresponse, substance use response, PTSD response, or global response [improvement in both PTSD and substance use]) to investigate the temporal association between improvement in PTSD and substance use symptom severity during the study's treatment phase. A generalized linear model was applied to test this relationship over the follow-up period. Subjects exhibiting nonresponse, substance use response, or global response tended to maintain original classification; subjects exhibiting PTSD response were significantly more likely to transition to global response over time, indicating maintained PTSD improvement was associated with subsequent substance use improvement. Trauma-focused treatment was significantly more effective than health education in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions. PTSD severity reductions were more likely to be associated with substance use improvement, with minimal evidence of substance use symptom reduction improving PTSD symptoms. Results support the self-medication model of coping with PTSD symptoms and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.

Effect of Discontinuation or Initiation of Methotrexate or Glucocorticoids on Tofacitinib Efficacy in Patients with Rheumatoid Arthritis: A Post Hoc Analysis.

PubMed

Fleischmann, Roy; Wollenhaupt, Jürgen; Cohen, Stanley; Wang, Lisy; Fan, Haiyun; Bandi, Vara; Andrews, John; Takiya, Liza; Bananis, Eustratios; Weinblatt, Michael E

2018-06-01

Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We evaluated the effect of concomitant methotrexate (MTX) or glucocorticoid (GC) use on tofacitinib clinical efficacy. Data were pooled from two open-label, long-term extension studies of tofacitinib 5 or 10 mg twice daily in patients with RA. Response according to Clinical Disease Activity Index (CDAI) was assessed separately in patients who discontinued (no MTX/GC use within 30 days prior to year-3 visit; assessment at month 3/year 3) or initiated (on/before year 3; assessment at initiation and year 3) MTX/GC. By year 3, among patients receiving background MTX at baseline, 186/1608 (11.6%) discontinued MTX, and 319/1434 (22.2%) patients receiving GC at baseline discontinued GC. Overall, 70.4/69.1% of patients who discontinued/continued MTX and 72.7/65.9% who discontinued/continued GC achieved CDAI remission or low disease activity (LDA) at year 3. Month 3 remission/LDA rates were maintained at year 3 in the majority of patients, irrespective of MTX/GC discontinuation/continuation. By year 3, 6.2% of patients receiving tofacitinib without MTX at baseline had initiated concomitant MTX, and 25.1% receiving tofacitinib without GC initiated GC; 69.0% and 45.4% initiating MTX or GC, respectively, had a CDAI-defined incomplete response prior to initiation. RA signs/symptoms improved following MTX initiation; only modest improvement was observed with GC initiation. Patients achieving remission/LDA with tofacitinib may discontinue MTX or GC and maintain treatment response. Patients with an incomplete response may benefit from adding concomitant MTX. Pfizer Inc. Study A3921024 [NCT00413699] and Study A3921041 [NCT00661661].

Mobile Telestroke During Ambulance Transport Is Feasible in a Rural EMS Setting: The iTREAT Study.

PubMed

Lippman, Jason M; Smith, Sherita N Chapman; McMurry, Timothy L; Sutton, Zachary G; Gunnell, Brian S; Cote, Jack; Perina, Debra G; Cattell-Gordon, David C; Rheuban, Karen S; Solenski, Nina J; Worrall, Bradford B; Southerland, Andrew M

2016-06-01

The use of telemedicine in the diagnosis and treatment of acute stroke, or telestroke, is a well-accepted method of practice improving geographic disparities in timely access to neurological expertise. We propose that mobile telestroke assessment during ambulance transport is feasible using low-cost, widely available technology. We designed a platform including a tablet-based end point, high-speed modem with commercial wireless access, external antennae, and portable mounting apparatus. Mobile connectivity testing was performed along six primary ambulance routes in a rural network. Audiovisual (AV) quality was assessed simultaneously by both an in-vehicle and an in-hospital rater using a standardized 6-point rating scale (≥4 indicating feasibility). We sought to achieve 9 min of continuous AV connectivity presumed sufficient to perform mobile telestroke assessments. Thirty test runs were completed: 93% achieved a minimum of 9 min of continuous video transmission with a mean mobile connectivity time of 18 min. Mean video and audio quality ratings were 4.51 (4.54 vehicle; 4.48 hospital) and 5.00 (5.13 in-vehicle; 4.87 hospital), respectively. Total initial cost of the system was $1,650 per ambulance. In this small, single-centered study we maintained high-quality continuous video transmission along primary ambulance corridors using a low-cost mobile telemedicine platform. The system is designed to be portable and adaptable, with generalizability for rapid assessment of emergency conditions in which direct observational exam may improve prehospital diagnosis and treatment. Thus mobile telestroke assessment is feasible using low-cost components and commercial wireless connectivity. More research is needed to demonstrate clinical reliability and efficacy in a live-patient setting.

Potential Universal Application of High-intensity Interval Training from Athletes and Sports Lovers to Patients.

PubMed

Azuma, Koichiro; Matsumoto, Hideo

2017-06-25

Recently, high-intensity interval training (HIIT) has received much attention as a promising exercise option not only to improve aerobic fitness, but also to prevent and improve lifestyle-related diseases. Epidemiological studies have shown that the exercise volume, as determined by the product of exercise intensity, duration, and frequency, has been shown to be important for improvements in muscle mitochondrial activity and subsequent improvements in aerobic fitness, insulin sensitivity, and metabolic variables. Therefore, continuous moderate-intensity training has been widely recommended. On the other hand, the main contributor of HIIT to improvements in aerobic fitness and metabolic variables is its high-intensity nature, and many recent studies have shown results favoring HIIT when compared with conventional continuous training, despite its shorter exercise duration and smaller exercise volume. In this review, we aim to show the possible universal application of HIIT in a hospital setting, where athletes, sports lovers, and patients have sought medical advice and have the opportunity to undergo detailed evaluations, including an exercise stress test. For athletes, HIIT is mandatory to achieve further improvements in aerobic fitness. For patients, though higher levels of motivation and careful evaluation are required, the time constraints of HIIT are smaller and both aerobic and resistance training can be expected to yield favorable results because of the high-intensity nature of HIIT.

Prioritizing research to reduce youth suicide and suicidal behavior.

PubMed

Bridge, Jeffrey A; Horowitz, Lisa M; Fontanella, Cynthia A; Grupp-Phelan, Jackie; Campo, John V

2014-09-01

The goal of the National Action Alliance for Suicide Prevention is to reduce suicide and suicide attempts in the U.S. by 40% in the next decade. In this paper, a public health approach is applied to suicide prevention to illustrate how reductions in youth suicide and suicidal behavior might be achieved by prioritizing research in two areas: (1) increasing access to primary care-based behavioral health interventions for depressed youth and (2) improving continuity of care for youth who present to emergency departments after a suicide attempt. Finally, some scientific, clinical, and methodologic breakthroughs needed to achieve rapid, substantial, and sustained reductions in youth suicide and suicidal behavior are discussed. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research.

PubMed

Purnell, Tanjala S; Calhoun, Elizabeth A; Golden, Sherita H; Halladay, Jacqueline R; Krok-Schoen, Jessica L; Appelhans, Bradley M; Cooper, Lisa A

2016-08-01

In the United States, racial/ethnic minority, rural, and low-income populations continue to experience suboptimal access to and quality of health care despite decades of recognition of health disparities and policy mandates to eliminate them. Many health care interventions that were designed to achieve health equity fall short because of gaps in knowledge and translation. We discuss these gaps and highlight innovative interventions that help address them, focusing on cardiovascular disease and cancer. We also provide recommendations for advancing the field of health equity and informing the implementation and evaluation of policies that target health disparities through improved access to care and quality of care. Project HOPE—The People-to-People Health Foundation, Inc.

Current achievements and future directions in genetic engineering of European plum (Prunus domestica L.).

PubMed

Petri, Cesar; Alburquerque, Nuria; Faize, Mohamed; Scorza, Ralph; Dardick, Chris

2018-06-01

In most woody fruit species, transformation and regeneration are difficult. However, European plum (Prunus domestica) has been shown to be amenable to genetic improvement technologies from classical hybridization, to genetic engineering, to rapid cycle crop breeding ('FasTrack' breeding). Since the first report on European plum transformation with marker genes in the early 90 s, numerous manuscripts have been published reporting the generation of new clones with agronomically interesting traits, such as pests, diseases and/or abiotic stress resistance, shorter juvenile period, dwarfing, continuous flowering, etc. This review focuses on the main advances in genetic transformation of European plum achieved to date, and the lines of work that are converting genetic engineering into a contemporary breeding tool for this species.

Membrane-integrated fermentation system for improving the optical purity of D-lactic acid produced during continuous fermentation.

PubMed

Sawai, Hideki; Na, Kyungsu; Sasaki, Nanami; Mimitsuka, Takashi; Minegishi, Shin-ichi; Henmi, Masahiro; Yamada, Katsushige; Shimizu, Sakayu; Yonehara, Tetsu

2011-01-01

This report describes the production of highly optically pure D-lactic acid by the continuous fermentation of Sporolactobacillus laevolacticus and S. inulinus, using a membrane-integrated fermentation (MFR) system. The optical purity of D-lactic acid produced by the continuous fermentation system was greater than that produced by batch fermentation; the maximum value for the optical purity of D-lactic acid reached 99.8% enantiomeric excess by continuous fermentation when S. leavolacticus was used. The volumetric productivity of the optically pure D-lactic acid was about 12 g/L/h, this being approximately 11-fold higher than that obtained by batch fermentation. An enzymatic analysis indicated that both S. laevolacticus and S. inulinus could convert L-lactic acid to D-lactic acid by isomerization after the late-log phase. These results provide evidence for an effective bio-process to produce D-lactic acid of greater optical purity than has conventionally been achieved to date.

Implementation of continuous-variable quantum key distribution with composable and one-sided-device-independent security against coherent attacks.

PubMed

Gehring, Tobias; Händchen, Vitus; Duhme, Jörg; Furrer, Fabian; Franz, Torsten; Pacher, Christoph; Werner, Reinhard F; Schnabel, Roman

2015-10-30

Secret communication over public channels is one of the central pillars of a modern information society. Using quantum key distribution this is achieved without relying on the hardness of mathematical problems, which might be compromised by improved algorithms or by future quantum computers. State-of-the-art quantum key distribution requires composable security against coherent attacks for a finite number of distributed quantum states as well as robustness against implementation side channels. Here we present an implementation of continuous-variable quantum key distribution satisfying these requirements. Our implementation is based on the distribution of continuous-variable Einstein-Podolsky-Rosen entangled light. It is one-sided device independent, which means the security of the generated key is independent of any memoryfree attacks on the remote detector. Since continuous-variable encoding is compatible with conventional optical communication technology, our work is a step towards practical implementations of quantum key distribution with state-of-the-art security based solely on telecom components.

Implementation of continuous-variable quantum key distribution with composable and one-sided-device-independent security against coherent attacks

PubMed Central

Gehring, Tobias; Händchen, Vitus; Duhme, Jörg; Furrer, Fabian; Franz, Torsten; Pacher, Christoph; Werner, Reinhard F.; Schnabel, Roman

2015-01-01

Secret communication over public channels is one of the central pillars of a modern information society. Using quantum key distribution this is achieved without relying on the hardness of mathematical problems, which might be compromised by improved algorithms or by future quantum computers. State-of-the-art quantum key distribution requires composable security against coherent attacks for a finite number of distributed quantum states as well as robustness against implementation side channels. Here we present an implementation of continuous-variable quantum key distribution satisfying these requirements. Our implementation is based on the distribution of continuous-variable Einstein–Podolsky–Rosen entangled light. It is one-sided device independent, which means the security of the generated key is independent of any memoryfree attacks on the remote detector. Since continuous-variable encoding is compatible with conventional optical communication technology, our work is a step towards practical implementations of quantum key distribution with state-of-the-art security based solely on telecom components. PMID:26514280

Pacific Northwest Aquatic Monitoring Partnership 2017 Annual Report

USGS Publications Warehouse

Puls, Amy L.; Scully, Rebecca A.; Dethloff, Megan M.; Bayer, Jennifer M.; Olson, Sheryn J.; Cimino, Samuel A.

2018-01-01

The Pacific Northwest Aquatic Monitoring Partnership (PNAMP) continued to promote the integration of monitoring resources and development of tools to support monitoring in 2017. Improved coordination and integration of goals, objectives, and activities among Pacific Northwest monitoring programs is essential to improving the quality and consistency of monitoring in the region.PNAMP operates through inter-organizational teams to make progress on a variety of projects identified to support partner needs and PNAMP goals. These teams are largely ad hoc and formed for the specific purpose of achieving the objectives of the identified projects. For each project, the PNAMP Coordination Team identified interested Steering Committee (SC) members and subject matter experts to form the working teams that provide guidance and leadership. In addition, the teams acted as an intermediate between the larger group of interested participants and the SC, thus maintaining the concept of better SC/participant exchange. The PNAMP Coordination Team continued to facilitate dialog among experts to move forward with ongoing and new projects. In addition, the Coordination Team continued their efforts to track in-kind contributions of time from participants at meetings, workshops, and other PNAMP hosted events; in 2017 this estimate amounted to 2,039 hours by 67 organizations.

Psychology, technology, and diabetes management.

PubMed

Gonder-Frederick, Linda A; Shepard, Jaclyn A; Grabman, Jesse H; Ritterband, Lee M

2016-10-01

Use of technology in diabetes management is rapidly advancing and has the potential to help individuals with diabetes achieve optimal glycemic control. Over the past 40 years, several devices have been developed and refined, including the blood glucose meter, insulin pump, and continuous glucose monitor. When used in tandem, the insulin pump and continuous glucose monitor have prompted the Artificial Pancreas initiative, aimed at developing control system for fully automating glucose monitoring and insulin delivery. In addition to devices, modern technology, such as the Internet and mobile phone applications, have been used to promote patient education, support, and intervention to address the behavioral and emotional challenges of diabetes management. These state-of-the-art technologies not only have the potential to improve clinical outcomes, but there are possible psychological benefits, such as improved quality of life, as well. However, practical and psychosocial limitations related to advanced technology exist and, in the context of several technology-related theoretical frameworks, can influence patient adoption and continued use. It is essential for future diabetes technology research to address these barriers given that the clinical benefits appear to largely depend on patient engagement and consistence of technology use. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Development Status of Adjustable X-Ray Optics with 0.5 Arcsecond Resolution

NASA Technical Reports Server (NTRS)

Reid, P. B.; ODell, Stephen; Elsner, Ron; Ramsey, Brian; Gubarev, Misha; Aldcroft, T.; Allured, R.; Cotroneo, V.; Johnson-Wilke, R. L.; McMuldroch, S.;

An Orthogonal Evolutionary Algorithm With Learning Automata for Multiobjective Optimization.

PubMed

Dai, Cai; Wang, Yuping; Ye, Miao; Xue, Xingsi; Liu, Hailin

2016-12-01

Research on multiobjective optimization problems becomes one of the hottest topics of intelligent computation. In order to improve the search efficiency of an evolutionary algorithm and maintain the diversity of solutions, in this paper, the learning automata (LA) is first used for quantization orthogonal crossover (QOX), and a new fitness function based on decomposition is proposed to achieve these two purposes. Based on these, an orthogonal evolutionary algorithm with LA for complex multiobjective optimization problems with continuous variables is proposed. The experimental results show that in continuous states, the proposed algorithm is able to achieve accurate Pareto-optimal sets and wide Pareto-optimal fronts efficiently. Moreover, the comparison with the several existing well-known algorithms: nondominated sorting genetic algorithm II, decomposition-based multiobjective evolutionary algorithm, decomposition-based multiobjective evolutionary algorithm with an ensemble of neighborhood sizes, multiobjective optimization by LA, and multiobjective immune algorithm with nondominated neighbor-based selection, on 15 multiobjective benchmark problems, shows that the proposed algorithm is able to find more accurate and evenly distributed Pareto-optimal fronts than the compared ones.

Online adaptive optimal control for continuous-time nonlinear systems with completely unknown dynamics

NASA Astrophysics Data System (ADS)

Lv, Yongfeng; Na, Jing; Yang, Qinmin; Wu, Xing; Guo, Yu

2016-01-01

An online adaptive optimal control is proposed for continuous-time nonlinear systems with completely unknown dynamics, which is achieved by developing a novel identifier-critic-based approximate dynamic programming algorithm with a dual neural network (NN) approximation structure. First, an adaptive NN identifier is designed to obviate the requirement of complete knowledge of system dynamics, and a critic NN is employed to approximate the optimal value function. Then, the optimal control law is computed based on the information from the identifier NN and the critic NN, so that the actor NN is not needed. In particular, a novel adaptive law design method with the parameter estimation error is proposed to online update the weights of both identifier NN and critic NN simultaneously, which converge to small neighbourhoods around their ideal values. The closed-loop system stability and the convergence to small vicinity around the optimal solution are all proved by means of the Lyapunov theory. The proposed adaptation algorithm is also improved to achieve finite-time convergence of the NN weights. Finally, simulation results are provided to exemplify the efficacy of the proposed methods.

Motivational Factors in Continuing Education an Academic Achievement of Adult Learners

ERIC Educational Resources Information Center

Lee, Pei Ling; Pang, Vincent

2013-01-01

Purpose: The purpose of this study is to examine the relationship between motivational factors in continuing education and academic achievement of adult learners. The study is conducted due to a lack of research pertaining to academic achievement among adult learners particularly in Malaysia. Methodology: A random sample of 150 part-time adult…

40 CFR 430.34 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2014 CFR

2014-07-01

... achievable (BAT). 430.34 Section 430.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... attainable by the application of the best available technology economically achievable (BAT). Except as... achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass limitations in kg...

40 CFR 430.64 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2014 CFR

2014-07-01

... achievable (BAT). 430.64 Section 430.64 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... by the application of the best available technology economically achievable (BAT). Except as provided... achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass limitations in kg...

40 CFR 430.14 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2013 CFR

2013-07-01

... achievable (BAT). 430.14 Section 430.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... attainable by the application of the best available technology economically achievable (BAT). Except as... achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass limitations in kg...

40 CFR 430.34 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2013 CFR

2013-07-01

... achievable (BAT). 430.34 Section 430.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... attainable by the application of the best available technology economically achievable (BAT). Except as... achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass limitations in kg...

40 CFR 430.44 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2013 CFR

2013-07-01

... achievable (BAT). 430.44 Section 430.44 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... attainable by the application of the best available technology economically achievable (BAT). Except as... achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass limitations in kg...

40 CFR 430.64 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2013 CFR

2013-07-01

... achievable (BAT). 430.64 Section 430.64 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... by the application of the best available technology economically achievable (BAT). Except as provided... achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass limitations in kg...

40 CFR 430.14 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2014 CFR

2014-07-01

... achievable (BAT). 430.14 Section 430.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... attainable by the application of the best available technology economically achievable (BAT). Except as... achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass limitations in kg...

40 CFR 430.44 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2014 CFR

2014-07-01

... achievable (BAT). 430.44 Section 430.44 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... attainable by the application of the best available technology economically achievable (BAT). Except as... achievable (BAT). Non-continuous dischargers shall not be subject to the maximum day mass limitations in kg...

How to reconcile the multiculturalist and universalist approaches to science education

NASA Astrophysics Data System (ADS)

Hansson, Sven Ove

2017-06-01

The "multiculturalist" and "universalist" approaches to science education both fail to recognize the strong continuities between modern science and its forerunners in traditional societies. Various fact-finding practices in indigenous cultures exhibit the hallmarks of scientific investigations, such as collectively achieved rationality, a careful distinction between facts and values, a search for shared, well-founded judgments in empirical matters, and strivings for continuous improvement of these judgments. Prominent examples are hunters' discussions when tracking a prey, systematic agricultural experiments performed by indigenous farmers, and remarkably advanced experiments performed by craftspeople long before the advent of modern science. When the continuities between science and these prescientific practices are taken into account, it becomes obvious that the traditional forms of both multiculturalism and universalism should be replaced by a new approach that dissolves the alleged conflict between adherence to modern science and respect for traditional cultures.

Continuous formation of N-chloro-N,N-dialkylamine solutions in well-mixed meso-scale flow reactors

PubMed Central

Jolley, Katherine E

2015-01-01

Summary The continuous flow synthesis of a range of organic solutions of N,N-dialkyl-N-chloramines is described using either a bespoke meso-scale tubular reactor with static mixers or a continuous stirred tank reactor. Both reactors promote the efficient mixing of a biphasic solution of N,N-dialkylamine in organic solvent, and aqueous sodium hypochlorite to achieve near quantitative conversions, in 72–100% in situ yields, and useful productivities of around 0.05 mol/h with residence times from 3 to 20 minutes. Initial calorimetric studies have been carried out to inform on reaction exotherms, rates and safe operation. Amines which partition mainly in the organic phase require longer reaction times, provided by the CSTR, to compensate for low mass transfer rates in the biphasic system. The green metrics of the reaction have been assessed and compared to existing procedures and have shown the continuous process is improved over previous procedures. The organic solutions of N,N-dialkyl-N-chloramines produced continuously will enable their use in tandem flow reactions with a range of nucleophilic substrates. PMID:26734089

Outcomes-focused knowledge translation: a framework for knowledge translation and patient outcomes improvement.

PubMed

Doran, Diane M; Sidani, Souraya

2007-01-01

Regularly accessing information that is current and reliable continues to be a challenge for front-line staff nurses. Reconceptualizing how nurses access information and designing appropriate decision support systems to facilitate timely access to information may be important for increasing research utilization. An outcomes-focused knowledge translation framework was developed to guide the continuous improvement of patient care through the uptake of research evidence and feedback data about patient outcomes. The framework operationalizes the three elements of the PARIHS framework at the point of care. Outcomes-focused knowledge translation involves four components: (a) patient outcomes measurement and real-time feedback about outcomes achievement; (b) best-practice guidelines, embedded in decision support tools that deliver key messages in response to patient assessment data; (c) clarification of patients' preferences for care; and (d) facilitation by advanced practice nurses and practice leaders. In this paper the framework is described and evidence is provided to support theorized relationships among the concepts in the framework. The framework guided the design of a knowledge translation intervention aimed at continuous improvement of patient care and evidence-based practice, which are fostered through real-time feedback data about patient outcomes, electronic access to evidence-based resources at the point of care, and facilitation by advanced practice nurses. The propositions in the framework need to be empirically tested through future research.

CD25 Preselective Anti-HIV Vectors for Improved HIV Gene Therapy

PubMed Central

Kalomoiris, Stefanos; Lawson, Je'Tai; Chen, Rachel X.; Bauer, Gerhard; Nolta, Jan A.

2012-01-01

Abstract As HIV continues to be a global public health problem with no effective vaccine available, new and innovative therapies, including HIV gene therapies, need to be developed. Due to low transduction efficiencies that lead to low in vivo gene marking, therapeutically relevant efficacy of HIV gene therapy has been difficult to achieve in a clinical setting. Methods to improve the transplantation of enriched populations of anti-HIV vector-transduced cells may greatly increase the in vivo efficacy of HIV gene therapies. Here we describe the development of preselective anti-HIV lentiviral vectors that allow for the purification of vector-transduced cells to achieve an enriched population of HIV-resistant cells. A selectable protein, human CD25, not normally found on CD34+ hematopoietic progenitor cells (HPCs), was incorporated into a triple combination anti-HIV lentiviral vector. Upon purification of cells transduced with the preselective anti-HIV vector, safety was demonstrated in CD34+ HPCs and in HPC-derived macrophages in vitro. Upon challenge with HIV-1, improved efficacy was observed in purified preselective anti-HIV vector-transduced macrophages compared to unpurified cells. These proof-of-concept results highlight the potential use of this method to improve HIV stem cell gene therapy for future clinical applications. PMID:23216020

Multiscale decoding for reliable brain-machine interface performance over time.

PubMed

Han-Lin Hsieh; Wong, Yan T; Pesaran, Bijan; Shanechi, Maryam M

2017-07-01

Recordings from invasive implants can degrade over time, resulting in a loss of spiking activity for some electrodes. For brain-machine interfaces (BMI), such a signal degradation lowers control performance. Achieving reliable performance over time is critical for BMI clinical viability. One approach to improve BMI longevity is to simultaneously use spikes and other recording modalities such as local field potentials (LFP), which are more robust to signal degradation over time. We have developed a multiscale decoder that can simultaneously model the different statistical profiles of multi-scale spike/LFP activity (discrete spikes vs. continuous LFP). This decoder can also run at multiple time-scales (millisecond for spikes vs. tens of milliseconds for LFP). Here, we validate the multiscale decoder for estimating the movement of 7 major upper-arm joint angles in a non-human primate (NHP) during a 3D reach-to-grasp task. The multiscale decoder uses motor cortical spike/LFP recordings as its input. We show that the multiscale decoder can improve decoding accuracy by adding information from LFP to spikes, while running at the fast millisecond time-scale of the spiking activity. Moreover, this improvement is achieved using relatively few LFP channels, demonstrating the robustness of the approach. These results suggest that using multiscale decoders has the potential to improve the reliability and longevity of BMIs.

Continuous Indoor Positioning Fusing WiFi, Smartphone Sensors and Landmarks

PubMed Central

Deng, Zhi-An; Wang, Guofeng; Qin, Danyang; Na, Zhenyu; Cui, Yang; Chen, Juan

2016-01-01

To exploit the complementary strengths of WiFi positioning, pedestrian dead reckoning (PDR), and landmarks, we propose a novel fusion approach based on an extended Kalman filter (EKF). For WiFi positioning, unlike previous fusion approaches setting measurement noise parameters empirically, we deploy a kernel density estimation-based model to adaptively measure the related measurement noise statistics. Furthermore, a trusted area of WiFi positioning defined by fusion results of previous step and WiFi signal outlier detection are exploited to reduce computational cost and improve WiFi positioning accuracy. For PDR, we integrate a gyroscope, an accelerometer, and a magnetometer to determine the user heading based on another EKF model. To reduce accumulation error of PDR and enable continuous indoor positioning, not only the positioning results but also the heading estimations are recalibrated by indoor landmarks. Experimental results in a realistic indoor environment show that the proposed fusion approach achieves substantial positioning accuracy improvement than individual positioning approaches including PDR and WiFi positioning. PMID:27608019

On-Orbit Propulsion and Methods of Momentum Management for the International Space Station

NASA Technical Reports Server (NTRS)

Russell, Samuel P.; Spencer, Victor; Metrocavage, Kevin; Swanson, Robert A.; Krajchovich, Mark; Beisner, Matthew; Kamath, Ulhas P.

2010-01-01

Since the first documented design of a space station in 1929, it has been a dream of many to sustain a permanent presence in space. Russia and the US spent several decades competing for a sustained human presence in low Earth orbit. In the 1980 s, Russia and the US began to openly collaborate to achieve this goal. This collaboration lead to the current design of the ISS. Continuous improvement of procedures for controlling the ISS have lead to more efficient propellant management over the years. Improved efficiency combined with the steady use of cargo vehicles has kept ISS propellant levels well above their defined thresholds in all categories. The continuing evolution of propellant and momentum management operational strategies demonstrates the capability and flexibility of the ISS propulsion system. The hard work and cooperation of the international partners and the evolving operational strategies have made the ISS safe and successful. The ISS s proven success is the foundation for the future of international cooperation for sustaining life in space.

Continuous Indoor Positioning Fusing WiFi, Smartphone Sensors and Landmarks.

PubMed

Deng, Zhi-An; Wang, Guofeng; Qin, Danyang; Na, Zhenyu; Cui, Yang; Chen, Juan

2016-09-05

To exploit the complementary strengths of WiFi positioning, pedestrian dead reckoning (PDR), and landmarks, we propose a novel fusion approach based on an extended Kalman filter (EKF). For WiFi positioning, unlike previous fusion approaches setting measurement noise parameters empirically, we deploy a kernel density estimation-based model to adaptively measure the related measurement noise statistics. Furthermore, a trusted area of WiFi positioning defined by fusion results of previous step and WiFi signal outlier detection are exploited to reduce computational cost and improve WiFi positioning accuracy. For PDR, we integrate a gyroscope, an accelerometer, and a magnetometer to determine the user heading based on another EKF model. To reduce accumulation error of PDR and enable continuous indoor positioning, not only the positioning results but also the heading estimations are recalibrated by indoor landmarks. Experimental results in a realistic indoor environment show that the proposed fusion approach achieves substantial positioning accuracy improvement than individual positioning approaches including PDR and WiFi positioning.

76 FR 75603 - Family Educational Rights and Privacy

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-02

...The Secretary of Education (Secretary) amends the regulations implementing section 444 of the General Education Provisions Act (GEPA), which is commonly referred to as the Family Educational Rights and Privacy Act (FERPA). These amendments are needed to ensure that the U.S. Department of Education (Department or we) continues to implement FERPA in a way that protects the privacy of education records while allowing for the effective use of data. Improved access to data will facilitate States' ability to evaluate education programs, to ensure limited resources are invested effectively, to build upon what works and discard what does not, to increase accountability and transparency, and to contribute to a culture of innovation and continuous improvement in education. The use of data is vital to ensuring the best education for our children. However, the benefits of using student data must always be balanced with the need to protect student privacy. Protecting student privacy helps achieve a number of important goals, including avoiding discrimination, identity theft, as well as other malicious and damaging criminal acts.

Informatics methodologies for evaluation research in the practice setting.

PubMed

Grant, A; Buteau, M; Richards, Y; Delisle, E; Laplante, P; Niyonsenga, T; Xhignesse, M

1998-06-01

A continuing challenge in health informatics and health evaluation is to enable access to the practice of health care so that the determinants of successful care and good health outcomes can be measured, evaluated and analysed. Furthermore the results of the analysis should be available to the health care practitioner or to the patient as might be appropriate, so that he or she can use this information for continual improvement of practice and optimisation of outcomes. In this paper we review two experiences, one in primary care, the FAMUS project, and the other in hospital care, the Autocontrol project. Each project demonstrates an informatics approach for evaluation research in the clinical setting and indicates ways in which useful information can be obtained which with appropriate feed-back and education can be used towards the achievement of better health. Emphasis is given to data collection methods compatible with practice and to high quality information feedback, particularly in the team context, to enable the formulation of strategies for practice improvement.

Continuous flow electrophoresis: The effect of sample concentration on throughput and resolution in an upward flowing system

NASA Technical Reports Server (NTRS)

Jandebeur, T. S.

1980-01-01

The effect of sample concentration on throughput and resolution in a modified continuous particle electrophoresis (CPE) system with flow in an upward direction is investigated. Maximum resolution is achieved at concentrations ranging from 2 x 10 to the 8th power cells/ml to 8 x 10 to the 8th power cells/ml. The widest peak separation is at 2 x 10 to the 8th power cells/ml; however, the sharpest peaks and least overlap between cell populations is at 8 x 10 to the 8th power cells/ml. Apparently as a result of improved electrophoresis cell performance due to coasting the chamber with bovine serum albumin, changing the electrode membranes and rinse, and lowering buffer temperatures, sedimentation effects attending to higher concentrations are diminished. Throughput as measured by recovery of fixed cells is diminished at the concentrations judged most likely to yield satisfactory resolution. The tradeoff appears to be improved recovery/throughput at the expense of resolution.

A brief history of the unit of mass: continuity of successive definitions of the kilogram

NASA Astrophysics Data System (ADS)

Davis, Richard S.; Barat, Pauline; Stock, Michael

2016-10-01

The very first definition of the kilogram was in terms of a constant of nature, although this idea could not be fully realized at the end of the 18th century. Instead the kilogram was defined by an artefact whose mass was made to approximate as closely as possible a physical constant with unit kg m-3—the maximum density of distilled water at atmospheric pressure. For the next two centuries, mass comparators improved greatly as did the materials from which artefacts could be constructed. These improvements put tighter constraints on the realization of a non-artefact definition of the kilogram. However, it is now expected that the goal of redefining the kilogram in terms of fundamental constants will be achieved in 2018. We present a history of the kilogram with emphasis on continuity of this unit of mass each time it has been redefined and the stability of a unit defined by the mass of an artefact.

Association between participation and compliance with Continuing Medical Education and care production by physicians: a cross-sectional study

PubMed Central

Carrera, Renato Melli; Cendoroglo, Miguel; Gonçales, Paulo David Scatena; Marques, Flavio Rocha Brito; Sardenberg, Camila; Glezer, Milton; dos Santos, Oscar Fernando Pavão; Rizzo, Luiz Vicente; Lottenberg, Claudio Luiz; Schvartsman, Cláudio

2015-01-01

Objective Physician participation in Continuing Medical Education programs may be influenced by a number of factors. To evaluate the factors associated with compliance with the Continuing Medical Education requirements at a private hospital, we investigated whether physicians’ activity, measured by volumes of admissions and procedures, was associated with obtaining 40 Continuing Medical Education credits (40 hours of activities) in a 12-month cycle. Methods In an exclusive and non-mandatory Continuing Medical Education program, we collected physicians’ numbers of hospital admissions and numbers of surgical procedures performed. We also analyzed data on physicians’ time since graduation, age, and gender. Results A total of 3,809 credentialed, free-standing, private practice physicians were evaluated. Univariate analysis showed that the Continuing Medical Education requirements were more likely to be achieved by male physicians (odds ratio 1.251; p=0.009) and who had a higher number of hospital admissions (odds ratio 1.022; p<0.001). Multivariate analysis showed that age and number of hospital admissions were associated with achievement of the Continuing Medical Education requirements. Each hospital admission increased the chance of achieving the requirements by 0.4%. Among physicians who performed surgical procedures, multivariate analysis showed that male physicians were 1.3 time more likely to achieve the Continuing Medical Education requirements than female physicians. Each surgical procedure performed increased the chance of achieving the requirements by 1.4%. Conclusion The numbers of admissions and number of surgical procedures performed by physicians at our hospital were associated with the likelihood of meeting the Continuing Medical Education requirements. These findings help to shed new light on our Continuing Medical Education program. PMID:25807247

Mozambique’s journey toward accreditation of the National Tuberculosis Reference Laboratory

PubMed Central

Madeira, Carla; Aguiar, Carmen; Dolores, Carolina; Mandlaze, Ana P.; Chongo, Patrina; Masamha, Jessina

2017-01-01

Background Internationally-accredited laboratories are recognised for their superior test reliability, operational performance, quality management and competence. In a bid to meet international quality standards, the Mozambique National Institute of Health enrolled the National Tuberculosis Reference Laboratory (NTRL) in a continuous quality improvement process towards ISO 15189 accreditation. Here, we describe the road map taken by the NTRL to achieve international accreditation. Methods The NTRL adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme as a strategy to implement a quality management system. After SLMTA, the Mozambique National Institute of Health committed to accelerate the NTRL’s process toward accreditation. An action plan was designed to streamline the process. Quality indicators were defined to benchmark progress. Staff were trained to improve performance. Mentorship from an experienced assessor was provided. Fulfilment of accreditation standards was assessed by the Portuguese Accreditation Board. Results Of the eight laboratories participating in SLMTA, the NTRL was the best-performing laboratory, achieving a 53.6% improvement over the SLMTA baseline conducted in February 2011 to the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) assessment in June 2013. During the accreditation assessment in September 2014, 25 minor nonconformities were identified and addressed. In March 2015, the NTRL received Portuguese Accreditation Board recognition of technical competency for fluorescence smear microscopy, and solid and liquid culture. The NTRL is the first laboratory in Mozambique to achieve ISO 15189 accreditation. Conclusions From our experience, accreditation was made possible by institutional commitment, strong laboratory leadership, staff motivation, adequate infrastructure and a comprehensive action plan. PMID:28879162

An Empirical Study of Re-sampling Techniques as a Method for Improving Error Estimates in Split-plot Designs

DTIC Science & Technology

2010-03-01

sufficient replications often lead to models that lack precision in error estimation and thus imprecision in corresponding conclusions. This work develops...v Preface This work is dedicated to all who gave and continue to give in order for me to achieve some semblance of success. Benjamin M. Lee vi...develop, examine and test methodologies for an- alyzing test results from split-plot designs. In particular, this work determines the applicability

An Improved Search Approach for Solving Non-Convex Mixed-Integer Non Linear Programming Problems

NASA Astrophysics Data System (ADS)

Sitopu, Joni Wilson; Mawengkang, Herman; Syafitri Lubis, Riri

2018-01-01

The nonlinear mathematical programming problem addressed in this paper has a structure characterized by a subset of variables restricted to assume discrete values, which are linear and separable from the continuous variables. The strategy of releasing nonbasic variables from their bounds, combined with the “active constraint” method, has been developed. This strategy is used to force the appropriate non-integer basic variables to move to their neighbourhood integer points. Successful implementation of these algorithms was achieved on various test problems.

Pendulum Shifts, Context, Error, and Personal Accountability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harold Blackman; Oren Hester

This paper describes a series of tools that were developed to achieve a balance in under-standing LOWs and the human component of events (including accountability) as the INL continues its shift to a learning culture where people report, are accountable and interested in making a positive difference - and want to report because information is handled correctly and the result benefits both the reporting individual and the organization. We present our model for understanding these interrelationships; the initiatives that were undertaken to improve overall performance.

CrossTalk: The Journal of Defense Software Engineering. Volume 23, Number 1, Jan/Feb 2010

DTIC Science & Technology

2010-02-01

during implementation have been minimal, but Warren and Abler’s method may change that. by Ron Abler and Ted Warren CMMI, Swiss Cheese , and Pareto...Corbin’s case study of a CMMI appraisal preparation—including Alan Lakein’s “ Swiss Cheese Method” and the Pareto Principle—shows a way other...Stealth CPI: Managing Work Products to Achieve Continuous Process Improvement. Darrell Corbin’s CMMI, Swiss Cheese , and Pareto comes to us from an

Method of chaotic mixing and improved stirred tank reactors

DOEpatents

Muzzio, F.J.; Lamberto, D.J.

1999-07-13

The invention provides a method and apparatus for efficiently achieving a homogeneous mixture of fluid components by introducing said components having a Reynolds number of between about [le]1 to about 500 into a vessel and continuously perturbing the mixing flow by altering the flow speed and mixing time until homogeneity is reached. This method prevents the components from aggregating into non-homogeneous segregated regions within said vessel during mixing and substantially reduces the time the admixed components reach homogeneity. 19 figs.

Design of continuous surface-relief phase plates by surface-based simulated annealing to achieve control of focal-plane irradiance

NASA Astrophysics Data System (ADS)

Lin, Y.; Kessler, T. J.; Lawrence, G. N.

1996-10-01

High-performance phase plates are of vital concern for controlling the far-field irradiance of laser-fusion systems. Several designs for solving this difficult problem have been reported in Optics Letters [e. g., S. N. Dixit et al., Opt. Lett. 19, 417 (1994)]. We report a surface-based form of simulated annealing that significantly improves the irradiance control while eliminating the high-scatter problems that have plagued other methods.

MRP (materiel requirements planning) II education: a team-building experience.

PubMed

Iemmolo, G R

1994-05-01

Conestoga Wood Specialties, a leader in the woodworking industry, is constantly striving for continuous improvement in manufacturing and service. Recently, the company embarked on a major MRP II education effort that served as a framework for team building. This team building concept has carried over into other aspects related to the business, such as the formalization of the sales and operations planning meeting. At Conestoga Wood, it is recognized that successful team building is necessary to achieve and maintain world-class performance.

Living for Six Days at 2200 M Improves Time-Trial Performance of Sea-Level Residents Exposed to 4300 M

DTIC Science & Technology

2008-02-01

breathing circuit by a rubber mouthpiece and nose clip, and to a finger pulse oximeter unit (Model 8600, Nonin Medical, Inc., Plymouth, MN) to...SaO2 via noninvasive finger pulse oximetry (Model 8600, Nonin Medical, Inc, Plymouth, MN) were monitored continuously, and ratings of perceived...respectively. Arterialization was achieved by warming the hand in 43ºC water for 5 min prior to obtaining a 150 µL fingertip blood sample for the

Method of chaotic mixing and improved stirred tank reactors

DOEpatents

Muzzio, Fernando J.; Lamberto, David J.

1999-01-01

The invention provides a method and apparatus for efficiently achieving a homogeneous mixture of fluid components by introducing said components having a Reynolds number of between about .ltoreq.1 to about 500 into a vessel and continuously perturbing the mixing flow by altering the flow speed and mixing time until homogeniety is reached. This method prevents the components from aggregating into non-homogeneous segregated regions within said vessel during mixing and substantially reduces the time the admixed components reach homogeneity.

NASA Excellence Award for Quality and Productivity 1989 highlights. The 1989 recipient: Lockheed Engineering and Sciences Company

NASA Technical Reports Server (NTRS)

1990-01-01

The NASA Excellence Award for Productivity and Quality is the result of NASA's desire to encourage superior quality and the continuous improvement philosophy in the aerospace industry. It is awarded to NASA contractors, subcontractors, and suppliers who have demonstrated sustained excellence, customer orientation, and outstanding achievements in a total quality management (TQM) environment. The 'highlights' booklet is intended to transfer successful techniques demonstrated by the performance and quality of major NASA contractors.

United States Army Annual Financial Statement FY00. The Army in Transformation Responsive to the Needs of the Nation

DTIC Science & Technology

2000-01-01

continuing cost-cutting measures. Improvements have included establishing clearer customer-provider relationships, adopting private market mechanisms...measured by dividing these costs by gross wholesale sales. In FY 2000, the wholesale division achieved a $1.007 unit cost goal ( UCG ). Target UCG was...0.99. The over-execution of the UCG was due to higher than expected credit. Credit was over plan as a result of the Retail activities turning in more

Early boost and slow consolidation in motor skill learning.

PubMed

Hotermans, Christophe; Peigneux, Philippe; Maertens de Noordhout, Alain; Moonen, Gustave; Maquet, Pierre

2006-01-01

Motorskill learning is a dynamic process that continues covertly after training has ended and eventually leads to delayed increments in performance. Current theories suggest that this off-line improvement takes time and appears only after several hours. Here we show an early transient and short-lived boost in performance, emerging as early as 5-30 min after training but no longer observed 4 h later. This early boost is predictive of the performance achieved 48 h later, suggesting its functional relevance for memory processes.

Lessons from school: what nurse leaders can learn from education.

PubMed

Davies, Nigel

2015-07-01

The drive to improve quality in the education sector is similar to that in health care, and lessons from the schools system are relevant to nursing leadership. This article discusses these shared traits, and details how school improvement was achieved in London and how a model of learning-centred leadership helped to transform pupil attainment in schools that had been performing poorly. Parallels are drawn between the education inspection system undertaken by Ofsted and the hospital inspections undertaken by the Care Quality Commission, and between the practice discipline-based managerial roles of nurse directors and head teachers. The article suggests that a learning-centred approach to improving the quality of patient care is needed, with a focus on the education and continuing professional development of staff.

Ultrasound-Guided Cryoanalgesia of Peripheral Nerve Lesions.

PubMed

Djebbar, Sahlya; Rossi, Ignacio M; Adler, Ronald S

2016-11-01

The real-time nature of ultrasound makes it ideally suited to provide guidance for a variety of musculoskeletal interventional procedures involving peripheral nerves. Continuous observation of the needle ensures proper placement and allows continuous monitoring when performing localized ablative therapy and therefore more accurate positioning of a cryoprobe, use of smaller needles, as well as access to small structures. We describe our experience performing cryoablative procedures. Patients undergoing cryoneurolysis have largely reported varying degrees of long-term pain relief and improvement in function; no serious complications have yet been identified. Ultrasound-guided cryoneurolysis can provide a useful, safe alternative to other ablative techniques to achieve long-term analgesia from painful peripheral nerve lesions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Large Area Silicon Sheet by EFG

NASA Technical Reports Server (NTRS)

Wald, F. V.

1979-01-01

Displaced die concepts were explored along with some initial work on buckle characterization. Convective impurity redistribution was further studied. Growth from single cartridges was continued to create a quality baseline to allow comparison of the results with those in the upcoming multiple run and to choose the most appropriate die design. Fabrication and assembly work on the actual five ribbon furnace continued. Progress was made toward the development of the video optical system for edge position and meniscus height control. In preparation for a detailed program, designed to explore the buckling problem, ribbon guidance in the machine was improved. Buckle free, full width ribbon was grown under stable conditions without a cold shoe, an achievement essential to finally arrive at quantitative correlations between growth conditions and buckle formation.

A Continuous Quality Improvement Project to Implement Infant-Driven Feeding as a Standard of Practice in the Newborn/Infant Intensive Care Unit.

PubMed

Chrupcala, Kimberly A; Edwards, Taryn M; Spatz, Diane L

2015-01-01

To increase the number of neonates who were fed according to cues prior to discharge and potentially decrease length of stay. Continuous quality improvement. Eighty-five bed level IV neonatal intensive care unit. Surgical and nonsurgical neonates of all gestational ages. Neonates younger than 32 weeks gestation, who required intubation, continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), or did not have suck or gag reflexes were excluded as potential candidates for infant-driven feeding. The project was conducted over a 13-month period using the following methods: (a) baseline data collection, (b) designation of Infant Driven Feeding (IDF) Champions, (c) creation of a multidisciplinary team, (d) creation of electronic health record documentation, (e) initial staff education, (f) monthly team meetings, (g) reeducation throughout the duration of the project, and (h) patient-family education. Baseline data were collected on 20 neonates with a mean gestational age of 36 0/7(th) weeks and a mean total length of stay (LOS) of 43 days. Postimplementation data were collected on 150 neonates with a mean gestational age of 36 1/7(th) weeks and a mean total LOS of 36.4 days. A potential decrease in the mean total LOS of stay by 6.63 days was achieved during this continuous quality improvement (CQI) project. Neonates who are fed according to cues can become successful oral feeders and can be safely discharged home regardless of gestational age or diagnosis. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Preoperative PROMIS Scores Predict Postoperative Success in Foot and Ankle Patients.

PubMed

Ho, Bryant; Houck, Jeff R; Flemister, Adolph S; Ketz, John; Oh, Irvin; DiGiovanni, Benedict F; Baumhauer, Judith F

2016-09-01

The use of patient-reported outcomes continues to expand beyond the scope of clinical research to involve standard of care assessments across orthopedic practices. It is currently unclear how to interpret and apply this information in the daily care of patients in a foot and ankle clinic. We prospectively examined the relationship between preoperative patient-reported outcomes (PROMIS Physical Function, Pain Interference and Depression scores), determined minimal clinical important differences for these values, and assessed if these preoperative values were predictors of improvement after operative intervention. Prospective collection of all consecutive patient visits to a multisurgeon tertiary foot and ankle clinic was obtained between February 2015 and April 2016. This consisted of 16 023 unique visits across 7996 patients, with 3611 new patients. Patients undergoing elective operative intervention were identified by ICD-9 and CPT code. PROMIS physical function, pain interference, and depression scores were assessed at initial and follow-up visits. Minimum clinically important differences (MCIDs) were calculated using a distribution-based method. Receiver operating characteristic (ROC) curves were calculated to determine whether preoperative PROMIS scores were predictive of achieving MCID. Cutoff values for PROMIS scores that would predict achieving MCID and not achieving MCID with 95% specificity were determined. Prognostic pre- and posttest probabilities based off these cutoffs were calculated. Patients with a minimum of 7-month follow-up (mean 9.9) who completed all PROMIS domains were included, resulting in 61 patients. ROC curves demonstrated that preoperative physical function scores were predictive of postoperative improvement in physical function (area under the curve [AUC] 0.83). Similarly, preoperative pain interference scores were predictive of postoperative pain improvement (AUC 0.73) and preoperative depression scores were also predictive of postoperative depression improvement (AUC 0.74). Patients with preoperative physical function T score below 29.7 had an 83% probability of achieving a clinically meaningful improvement in function as defined by MCID. Patients with preoperative physical function T score above 42 had a 94% probability of failing to achieve MCID. Patients with preoperative pain above 67.2 had a 66% probability of achieving MCID, whereas patients with preoperative pain below 55 had a 95% probability of failing to achieve MCID. Patients with preoperative depression below 41.5 had a 90% probability of failing to achieve MCID. Patient-reported outcomes (PROMIS) scores obtained preoperatively predicted improvement in foot and ankle surgery. Threshold levels in physical function, pain interference, and depression can be shared with patients as they decide whether surgery is a good option and helps place a numerical value on patient expectations. Physical function scores below 29.7 were likely to improve with surgery, whereas those patients with scores above 42 were unlikely to make gains in function. Patients with pain scores less than 55 were similarly unlikely to improve, whereas those with scores above 67 had clinically significant pain reduction postoperatively. Reported prognostic cutoff values help to provide guidance to both the surgeon and the patient and can aid in shared decision making for treatment. Level II, prognostic study. © The Author(s) 2016.

GP training in out-of-hours care: implications for the future workforce.

PubMed

Hayward, Gail; Drinkwater, Jessica; El-Gohary, Magdy; Burgess, Hana; Heneghan, Carl

2015-03-01

To understand GP trainees' experience of out-of-hours (OOH) training in England; whether it is achieving educational aims, and to highlight potential improvements. Additionally to explore factors that influence the decision to work in OOH care. An online survey was sent to 1091 GP trainees in England. Odds ratios were calculated for factors correlating with intention to work in OOH, or confidence and effectiveness in OOH work. Free text responses were coded and organised thematically. Trainees' experience of OOH care influences the decision to work there once qualified. Although this experience has positively influenced over three-quarters of trainees, it can be improved. Training is not achieving competencies in managing psychiatric emergencies and personal safety. Half of trainees received formal teaching in OOH skills; 3% receiving assessments in telephone triage. Only a quarter of trainees had worked with their usual GP trainer. Influential features of training included trainer enthusiasm and continuity, familiarity with the workplace, and confidence in OOH skills. Financial and lifestyle considerations were also important. OOH training in England has an impact on the future workforce and could be improved. The planned transition to a 4-year GP training structure offers an opportunity to address this.

Conceptual design study of an improved automotive gas turbine powertrain

NASA Technical Reports Server (NTRS)

Wagner, C. E. (Editor); Pampreen, R. C. (Editor)

1979-01-01

Automotive gas turbine concepts with significant technological advantages over the spark ignition (SI) engine were assessed. Possible design concepts were rated with respect to fuel economy and near-term application. A program plan which outlines the development of the improved gas turbine (IGT) concept that best met the goals and objectives of the study identifies the research and development work needed to meet the goal of entering a production engineering phase by 1983. The fuel economy goal is to show at least a 20% improvement over a conventional 1976 SI engine/vehicle system. On the basis of achieving the fuel economy goal, of overall suitability to mechanical design, and of automotive mass production cost, the powertrain selected was a single-shaft engine with a radial turbine and a continuously variable transmission (CVT). Design turbine inlet temperature was 1150 C. Reflecting near-term technology, the turbine rotor would be made of an advanced superalloy, and the transmission would be a hydromechanical CVT. With successful progress in long-lead R&D in ceramic technology and the belt-drive CVT, the turbine inlet temperature would be 1350 C to achieve near-maximum fuel economy.

Two-channel microwave radiometer for observations of total column precipitable water vapor and cloud liquid water path

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liljegren, J.C.

1994-01-01

The Atmospheric Radiation Measurement (ARM) Program is focused on improving the treatment of radiation transfer in models of the atmospheric general circulation, as well as on improving parameterizations of cloud properties and formation processes in these models (USDOE, 1990). To help achieve these objectives, ARM is deploying several two-channel, microwave radiometers at the Cloud and Radiation Testbed (CART) site in Oklahoma for the purpose of obtaining long time series observations of total precipitable water vapor (PWV) and cloud liquid water path (LWP). The performance of the WVR-1100 microwave radiometer deployed by ARM at the Oklahoma CART site central facility tomore » provide time series measurements precipitable water vapor (PWV) and liquid water path (LWP) has been presented. The instrument has proven to be durable and reliable in continuous field operation since June, 1992. The accuracy of the PWV has been demonstrated to achieve the limiting accuracy of the statistical retrieval under clear sky conditions, degrading with increasing LWP. Improvements are planned to address moisture accumulation on the Teflon window, as well as to identity the presence of clouds with LWP at or below the retrieval uncertainty.« less

From local adaptation to activism and global solidarity: framing a research and innovation agenda towards true health equity.

PubMed

Friedman, Eric A; Gostin, Lawrence O

2017-02-21

The proposal for a global health treaty aimed at health equity, the Framework Convention on Global Health, raises the fundamental question of whether we can achieve true health equity, globally and domestically, and if not, how close we can come. Considerable knowledge currently exists about the measures required to, at the least, greatly improve health equity. Why, then, do immense inequities remain? Building on this basic question, we propose four areas that could help drive the health equity research and innovation agenda over the coming years.First, recognizing that local contexts will often affect the success of policies aimed at health equity, local research will be critical to adapt strategies to particular settings. This part of the research agenda would be well-served by directly engaging intended beneficiaries for their insights, including through participatory action research, where the research contributes to action towards greater health equity.Second, even with the need for more local knowledge, why is the copious knowledge on how to reduce inequities not more frequently acted upon? What are the best strategies to close policymakers' knowledge gaps and to generate the political will to apply existing knowledge about improving health equity, developing the policies and devoting the resources required? Linked to this is the need to continue to build our understanding of how to empower the activism that can reshape power dynamics.Today's unequal power dynamics contribute significantly to disparities in a third area of focus, the social determinants of health, which are the primary drivers of today's health inequities. Continuing to improve our understanding of the pathways through which they operate can help in developing strategies to change these determinants and disrupt harmful pathways.And fourth, we return to the motivating question of whether we can achieve health equity. For example, can all countries have universal health coverage that comprehensively meets all of people's health needs? How to foster the national and global solidarity to achieve such equity? The answers to questions such as these can help point the way to measures, often well outside the narrow realm of technical solutions, to realize the right to health, and to achieve and sustain substantive health equality.

Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda

PubMed Central

Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

2015-01-01

Background Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Methods and Findings Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the “good” range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring “good” rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Conclusion Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach. PMID:26207986

An assisted-living home architecture with integrated healthcare services for elderly people.

PubMed

Marsh, Andy; Biniaris, Christos; Vergados, Dimitrios; Eppler, Arnold; Kavvadias, Christoforos; Bigalke, Olaf; Robert, Eric; Jerabek, Boro; Alevizos, Alevizos; Caragiozidis, Michael

2008-01-01

Since the population of elderly people grows absolutely and in relation to the overall population in the world, the improvement of the quality of life of elderly people at home is of a great importance. This can be achieved through the development of generic technologies for managing their domestic ambient environment consisting of medical sensors, entertainment equipment, home automation systems and white goods, increasing their autonomy and safety. In this context, the provision intelligent interactive healthcare services will improve their daily life and allowing at the same time the continuous monitoring of their health and their effective treatment. This work is supported by the INHOME Project EU IST-045061-STP, http://www.ist-inhome.eu.

Integrated manufacturing approach to attain benchmark team performance

NASA Astrophysics Data System (ADS)

Chen, Shau-Ron; Nguyen, Andrew; Naguib, Hussein

1994-09-01

A Self-Directed Work Team (SDWT) was developed to transfer a polyimide process module from the research laboratory to our wafer fab facility for applications in IC specialty devices. The SDWT implemented processes and tools based on the integration of five manufacturing strategies for continuous improvement. These were: Leadership Through Quality (LTQ), Total Productive Maintenance (TMP), Cycle Time Management (CTM), Activity-Based Costing (ABC), and Total Employee Involvement (TEI). Utilizing these management techniques simultaneously, the team achieved six sigma control of all critical parameters, increased Overall Equipment Effectiveness (OEE) from 20% to 90%, reduced cycle time by 95%, cut polyimide manufacturing cost by 70%, and improved its overall team member skill level by 33%.

Interprofessionalism: Educating to meet patient needs.

PubMed

Kirch, Darrell G; Ast, Cori

2015-01-01

Interprofessional teams in health care are showing promise in achieving the triple aim-providing better care for the individual patient, reducing costs, and improving population health. To complement current changes in health care delivery in the United States, there is a growing consensus among health professions educators that students should be trained in interprofessional models prior to entering clinical practice. Current interprofessional education (IPE) efforts in anatomy education are producing positive results in enhancing professional respect, collaboration, and teamwork among health professions students. In spite of existing structural and cultural barriers to IPE, health professions educators must continue to lead and grow IPE efforts as a critical component to improving the health of our nation. © 2014 American Association of Anatomists.

Institutional Computing: Final Report Quantum Effects on Cosmology: Probing Physics Beyond the Standard Model with Big Bang Nucleosynthesis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paris, Mark W.

The current one-year project allocation (w17 burst) supports the continuation of research performed in the two-year Institutional Computing allocation (w14 bigbangnucleosynthesis). The project has supported development and production runs resulting in several publications[1, 2, 3, 4] in peer-review journals and talks. Most signi cantly, we have recently achieved a signi cant improvement in code performance. This improvement was essential to the prospect of making further progress on this heretofore unsolved multiphysics problem that lies at the intersection of nuclear and particle theory and the kinetic theory of energy transport in a system with internal (quantum) degrees of freedom.

Career ladder program for registered nurses in ambulatory care.

PubMed

Nelson, Joan; Sassaman, Becky; Phillips, Alison

2008-01-01

RN ladder programs are designed to inspire and reward clinical excellence. Kaiser Permanente Colorado's (KPCO) career ladder program emerged as a result of a labor-management partnership. Career ladder point assignments are reflective of the organization's priorities and values. KPCO's career ladder point tool awards RNs for formal and continuing education, professional presentations, organizational experience and experience as an RN, certifications and active professional memberships, leadership activities, research and publications, and nursing-related volunteer work. Participation in the RN career ladder requires that the nurse achieve a self-determined, manager-approved, measurable goal that will improve patient care. Career ladder nurses at KPCO were significantly more involved in leadership and interdisciplinary activities, quality improvement projects, and preceptorship.

The Importance of and the Complexities Associated With Measuring Continuity of Care During Resident Training: Possible Solutions Do Exist.

PubMed

Carney, Patricia A; Conry, Colleen M; Mitchell, Karen B; Ericson, Annie; Dickinson, W Perry; Martin, James C; Carek, Peter J; Douglass, Alan B; Eiff, M Patrice

2016-04-01

Evolutions in care delivery toward the patient-centered medical home have influenced important aspects of care continuity. Primary responsibility for a panel of continuity patients is a foundational requirement in family medicine residencies. In this paper we characterize challenges in measuring continuity of care in residency training in this new era of primary care. We synthesized the literature and analyzed information from key informant interviews and group discussions with residency faculty and staff to identify the challenges and possible solutions for measuring continuity of care during family medicine training. We specifically focused on measuring interpersonal continuity at the patient level, resident level, and health care team level. Challenges identified in accurately measuring interpersonal continuity of care during residency training include: (1) variability in empanelment approaches for all patients, (2) scheduling complexity in different types of visits, (3) variability in ability to attain continuity counts at the level of the resident, and (4) shifting make-up of health care teams, especially in residency training. Possible solutions for each challenge are presented. Philosophical issues related to continuity are discussed, including whether true continuity can be achieved during residency training and whether qualitative rather than quantitative measures of continuity are better suited to residencies. Measuring continuity of care in residency training is challenging but possible, though improvements in precision and assessment of the comprehensive nature of the relationships are needed. Definitions of continuity during training and the role continuity measurement plays in residency need further study.

Advances in public health accreditation readiness and quality improvement: evaluation findings from the National Public Health Improvement Initiative.

PubMed

McLees, Anita W; Thomas, Craig W; Nawaz, Saira; Young, Andrea C; Rider, Nikki; Davis, Mary

2014-01-01

Continuous quality improvement is a central tenet of the Public Health Accreditation Board's (PHAB) national voluntary public health accreditation program. Similarly, the Centers for Disease Control and Prevention launched the National Public Health Improvement Initiative (NPHII) in 2010 with the goal of advancing accreditation readiness, performance management, and quality improvement (QI). Evaluate the extent to which NPHII awardees have achieved program goals. NPHII awardees responded to an annual assessment and program monitoring data requests. Analysis included simple descriptive statistics. Seventy-four state, tribal, local, and territorial public health agencies receiving NPHII funds. NPHII performance improvement managers or principal investigators. Development of accreditation prerequisites, completion of an organizational self-assessment against the PHAB Standards and Measures, Version 1.0, establishment of a performance management system, and implementation of QI initiatives to increase efficiency and effectiveness. Of the 73 responding NPHII awardees, 42.5% had a current health assessment, 26% had a current health improvement plan, and 48% had a current strategic plan in place at the end of the second program year. Approximately 26% of awardees had completed an organizational PHAB self-assessment, 72% had established at least 1 of the 4 components of a performance management system, and 90% had conducted QI activities focused on increasing efficiencies and/or effectiveness. NPHII appears to be supporting awardees' initial achievement of program outcomes. As NPHII enters its third year, there will be additional opportunities to advance the work of NPHII, compile and disseminate results, and inform a vision of high-quality public health necessary to improve the health of the population.

The UK Government's global partnership programme - Its achievements over the past five years and challenges ahead

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heyes, Alan

2007-07-01

Through the Global Partnership the UK continues to make a significant contribution to improve national and global security. Over the past year the UK has continued to implement a wide range of projects across the breadth of its Global Partnership Programme. As well as ensuring the Programme is robust and capable of dealing with new challenges, the UK has cooperated with other donor countries to help them progress projects associated with submarine dismantling, scientist redirection, enhancing nuclear security and Chemical Weapons Destruction. The Global Partnership, although only five years old, has already achieved a great deal. Some 23 states, plusmore » the European Union, are now working closer together under the Global Partnership, and collectively have enhanced global regional and national security by reducing the availability of Weapons of Mass Destruction (WMD) materials and expertise to both states of concern and terrorists. Considerable progress has already been made in, for example: - Improving the security of fissile materials, dangerous biological agents and chemical weapons stocks; - Reducing the number of sites containing radioactive materials; - Working towards closure of reactors still producing weapon-grade plutonium; - Improving nuclear safety to reduce the risks of further, Chernobyl style accidents; - Constructing facilities for destroying Chemical Weapons stocks, and starting actual destruction; - Providing sustainable employment for former WMD scientists to reduce the risk that their expertise will be misused by states or terrorists. By contributing to many of these activities, the UK has helped to make the world safer. This paper reports on the UK's practical and sustainable contribution to the Global Partnership and identifies a number of challenges that remain if it is to have a wider impact on reducing the threats from WMD material. (authors)« less

[Improved methods for monitoring sleep state and respiratory rhythm in freely moving rats].

PubMed

Wang, Qi-Min; Dong, Hui; Zhang, Cheng; Zhang, Yong-He; Ma, Jing; Wang, Guang-Fa

2014-01-01

To improve the method for monitoring sleep state and respiratory rhythm of SD rats, providing a solution for rats' chewing on the wires, signal loss and instability problems in the animal model of sleep apnea syndrome (SAS). We improved monitoring electrodes of both electrocorticogram (ECoG) and electromyogram (EMG), signal circuit and animal operation. Operation time was shortened and wound exposure time was reduced, which made it easier for postoperative recovery. The ECoG and EMG signals were more stable with sharp image, and signal circuit lines had better conductivity and material durability, achieving continuous monitoring for a long time and high success rate. We could precisely distinguish the sleep wake state and the sleep apnea events in rats according to these signals. The improved method is more reliable and practical to test the small animal model of SAS, and is more easily to operate and the signals are more stable.

NASA total quality management 1989 accomplishments report

NASA Technical Reports Server (NTRS)

Tai, Betty P. (Editor); Stewart, Lynne M. (Editor)

1990-01-01

NASA and contractor employees achieved many notable improvements in 1989. The highlights of those improvements, described in this seventh annual Accomplishments Report, demonstrate that the people who support NASA's activities are getting more involved in quality and continuous improvement efforts. Their gains solidly support NASA's and this Nation's goal to remain a leader in space exploration and in world-wide market competition, and, when communicated to others through avenues such as this report, foster improvement efforts across government and industry. The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories in this report reflect NASA principles set forth in the 1980's and are more commonly known today as Total Quality Management (TQM): top management leadership and support; strategic planning; focus on the customer; employee training and recognition; employee empowerment and teamwork; measurement and analysis; and quality assurance.

Laboratory System Improvement Program: First in the Nation— New Hampshire Reassessment

PubMed Central

Bean, Christine L.; Cosser, Amanda; Vazquez, Alma

2013-01-01

The New Hampshire Public Health Laboratories (NH PHL) conducted an initial Laboratory System Improvement Program (L-SIP) assessment in March 2007 and a reassessment in May 2011. New Hampshire was a pilot state for the initial L-SIP assessment in 2007 and was the first laboratory system in the United States to conduct an L-SIP reassessment. The New Hampshire reassessment was also used as a pilot for revising the assessment tool. The NH PHL performed a high-level comparison benchmarking the work done between the two assessments. This comparison revealed areas of improvement and other areas that needed continued focus to align with model standards of the 10 Essential Public Health Services. This article outlines achievements, improvements, and outcomes made since 2007, as well as participants, activities, plans, resources, and other factors that contributed to the change in scores between assessments. PMID:23997303

Laboratory System Improvement Program: first in the nation--New Hampshire reassessment.

PubMed

Power, Jill J; Bean, Christine L; Cosser, Amanda; Vazquez, Alma

2013-01-01

The New Hampshire Public Health Laboratories (NH PHL) conducted an initial Laboratory System Improvement Program (L-SIP) assessment in March 2007 and a reassessment in May 2011. New Hampshire was a pilot state for the initial L-SIP assessment in 2007 and was the first laboratory system in the United States to conduct an L-SIP reassessment. The New Hampshire reassessment was also used as a pilot for revising the assessment tool. The NH PHL performed a high-level comparison benchmarking the work done between the two assessments. This comparison revealed areas of improvement and other areas that needed continued focus to align with model standards of the 10 Essential Public Health Services. This article outlines achievements, improvements, and outcomes made since 2007, as well as participants, activities, plans, resources, and other factors that contributed to the change in scores between assessments.

Damage-Mitigating Control of Space Propulsion Systems for High Performance and Extended Life

NASA Technical Reports Server (NTRS)

Ray, Asok; Wu, Min-Kuang

1994-01-01

A major goal in the control of complex mechanical system such as spacecraft rocket engine's advanced aircraft, and power plants is to achieve high performance with increased reliability, component durability, and maintainability. The current practice of decision and control systems synthesis focuses on improving performance and diagnostic capabilities under constraints that often do not adequately represent the materials degradation. In view of the high performance requirements of the system and availability of improved materials, the lack of appropriate knowledge about the properties of these materials will lead to either less than achievable performance due to overly conservative design, or over-straining of the structure leading to unexpected failures and drastic reduction of the service life. The key idea in this report is that a significant improvement in service life could be achieved by a small reduction in the system dynamic performance. The major task is to characterize the damage generation process, and then utilize this information in a mathematical form to synthesize a control law that would meet the system requirements and simultaneously satisfy the constraints that are imposed by the material and structural properties of the critical components. The concept of damage mitigation is introduced for control of mechanical systems to achieve high performance with a prolonged life span. A model of fatigue damage dynamics is formulated in the continuous-time setting, instead of a cycle-based representation, for direct application to control systems synthesis. An optimal control policy is then formulated via nonlinear programming under specified constraints of the damage rate and accumulated damage. The results of simulation experiments for the transient upthrust of a bipropellant rocket engine are presented to demonstrate efficacy of the damage-mitigating control concept.

Ergonomics, quality and continuous improvement--conceptual and empirical relationships in an industrial context.

PubMed

Eklund, J

1997-10-01

This paper reviews the literature comparing the fields of ergonomics and quality, mainly in an industrial context, including mutual influences, similarities and differences. Relationships between ergonomics and the factors: work conditions, product design, ISO 9000, continuous improvements and TQM are reviewed in relation to the consequence, application, and process domains. The definitions of ergonomics and quality overlap substantially. Quality deficiencies, human errors and ergonomics problems often have the same cause, which in many cases can be traced to the design of work, workplace and environment e.g. noise, light, postures, loads, pace and work content. In addition, the possibility of performing to a high standard at work is an important prerequisite for satisfaction and well-being. Contradictions between the two fields have been identified in the view of concepts such as standardization, reduction of variability and copying of best practice, requiring further research. The field of quality would gain by incorporating ergonomics knowledge, especially in the areas of work design and human capability, since these factors are decisive for human performance and also therefore the performance of the systems involved. The field of ergonomics, on the other hand, would benefit from developing a stronger emphasis on methodologies and structures for improvement processes, including a clearer link with leadership and company strategies. Just as important is a further development of practicable participative ergonomics methods and tools for use at workplaces by the workers themselves, in order to integrate the top-down and the bottom-up processes and achieve better impact. Using participative processes for problem-solving and continuous improvement, focusing ergonomics and quality jointly has a great potential for improving working conditions and quality results simultaneously, and satisfying most of the interested parties.

Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation

PubMed Central

Maruta, Talkmore; Ndlovu, Nqobile; Moyo, Sikhulile; Yahaya, Ali Ahmed; Coulibaly, Sheick Oumar; Kasolo, Francis; Turgeon, David; Abrol, Angelii P.

2016-01-01

Background The increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis, management and treatment of diseases. In response, the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program. SLIPTA implementation process WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1–5 stars were issued. Preliminary results By March 2015, 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries, competent in the Portuguese (3), French (12) and English (83) languages, were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62–77). Of these audited laboratories, 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action), which both had mean scores below 50%. Conclusion The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment, ownership and investment in continuous quality improvement are integral components of the process. PMID:28879103

Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation.

PubMed

Ndihokubwayo, Jean-Bosco; Maruta, Talkmore; Ndlovu, Nqobile; Moyo, Sikhulile; Yahaya, Ali Ahmed; Coulibaly, Sheick Oumar; Kasolo, Francis; Turgeon, David; Abrol, Angelii P

2016-01-01

The increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis, management and treatment of diseases. In response, the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program. WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1-5 stars were issued. By March 2015, 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries, competent in the Portuguese (3), French (12) and English (83) languages, were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62-77). Of these audited laboratories, 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action), which both had mean scores below 50%. The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment, ownership and investment in continuous quality improvement are integral components of the process.

Process improvement to enhance existing stroke team activity toward more timely thrombolytic treatment.

PubMed

Cho, Han-Jin; Lee, Kyung Yul; Nam, Hyo Suk; Kim, Young Dae; Song, Tae-Jin; Jung, Yo Han; Choi, Hye-Yeon; Heo, Ji Hoe

2014-10-01

Process improvement (PI) is an approach for enhancing the existing quality improvement process by making changes while keeping the existing process. We have shown that implementation of a stroke code program using a computerized physician order entry system is effective in reducing the in-hospital time delay to thrombolysis in acute stroke patients. We investigated whether implementation of this PI could further reduce the time delays by continuous improvement of the existing process. After determining a key indicator [time interval from emergency department (ED) arrival to intravenous (IV) thrombolysis] and conducting data analysis, the target time from ED arrival to IV thrombolysis in acute stroke patients was set at 40 min. The key indicator was monitored continuously at a weekly stroke conference. The possible reasons for the delay were determined in cases for which IV thrombolysis was not administered within the target time and, where possible, the problems were corrected. The time intervals from ED arrival to the various evaluation steps and treatment before and after implementation of the PI were compared. The median time interval from ED arrival to IV thrombolysis in acute stroke patients was significantly reduced after implementation of the PI (from 63.5 to 45 min, p=0.001). The variation in the time interval was also reduced. A reduction in the evaluation time intervals was achieved after the PI [from 23 to 17 min for computed tomography scanning (p=0.003) and from 35 to 29 min for complete blood counts (p=0.006)]. PI is effective for continuous improvement of the existing process by reducing the time delays between ED arrival and IV thrombolysis in acute stroke patients.

New concept for in-line OLED manufacturing

NASA Astrophysics Data System (ADS)

Hoffmann, U.; Landgraf, H.; Campo, M.; Keller, S.; Koening, M.

2011-03-01

A new concept of a vertical In-Line deposition machine for large area white OLED production has been developed. The concept targets manufacturing on large substrates (>= Gen 4, 750 x 920 mm2) using linear deposition source achieving a total material utilization of >= 50 % and tact time down to 80 seconds. The continuously improved linear evaporation sources for the organic material achieve thickness uniformity on Gen 4 substrate of better than +/- 3 % and stable deposition rates down to less than 0.1 nm m/min and up to more than 100 nm m/min. For Lithium-Fluoride but also for other high evaporation temperature materials like Magnesium or Silver a linear source with uniformity better than +/- 3 % has been developed. For Aluminum we integrated a vertical oriented point source using wire feed to achieve high (> 150 nm m/min) and stable deposition rates. The machine concept includes a new vertical vacuum handling and alignment system for Gen 4 shadow masks. A complete alignment cycle for the mask can be done in less than one minute achieving alignment accuracy in the range of several 10 μm.

High-efficient Extraction of Drainage Networks from Digital Elevation Model Data Constrained by Enhanced Flow Enforcement from Known River Map

NASA Astrophysics Data System (ADS)

Wu, T.; Li, T.; Li, J.; Wang, G.

2017-12-01

Improved drainage network extraction can be achieved by flow enforcement whereby information of known river maps is imposed to the flow-path modeling process. However, the common elevation-based stream burning method can sometimes cause unintended topological errors and misinterpret the overall drainage pattern. We presented an enhanced flow enforcement method to facilitate accurate and efficient process of drainage network extraction. Both the topology of the mapped hydrography and the initial landscape of the DEM are well preserved and fully utilized in the proposed method. An improved stream rasterization is achieved here, yielding continuous, unambiguous and stream-collision-free raster equivalent of stream vectors for flow enforcement. By imposing priority-based enforcement with a complementary flow direction enhancement procedure, the drainage patterns of the mapped hydrography are fully represented in the derived results. The proposed method was tested over the Rogue River Basin, using DEMs with various resolutions. As indicated by the visual and statistical analyses, the proposed method has three major advantages: (1) it significantly reduces the occurrences of topological errors, yielding very accurate watershed partition and channel delineation, (2) it ensures scale-consistent performance at DEMs of various resolutions, and (3) the entire extraction process is well-designed to achieve great computational efficiency.

Customer quality and type 2 diabetes from the patients' perspective: a cross-sectional study.

PubMed

Tabrizi, Jafar S; Wilson, Andrew J; O'Rourke, Peter K

2010-12-18

Quality in health care can be seen as having three principal dimensions: service, technical and customer quality. This study aimed to measure Customer Quality in relation to self-management of Type 2 diabetes. A cross-sectional survey of 577 Type 2 diabetes people was carried out in Australia. The 13-item Patient Activation Measure was used to evaluate Customer Quality based on self-reported knowledge, skills and confidence in four stages of self-management. All statistical analyses were conducted using SPSS 13.0. All participants achieved scores at the level of stage 1, but ten percent did not achieve score levels consistent with stage 2 and a further 16% did not reach the actual action stage. Seventy-four percent reported capacity for taking action for self-management and 38% reported the highest Customer Quality score and ability to change the action by changing health and environment. Participants with a higher education attainment, better diabetes control status and those who maintain continuity of care reported a higher Customer Quality score, reflecting higher capacity for self-management. Specific capacity building programs for health care providers and people with Type 2 diabetes are needed to increase their knowledge and skills; and improve their confidence to self-management, to achieve improved quality of delivered care and better health outcomes.

Improved fed-batch production of high-purity PHB (poly-3 hydroxy butyrate) by Cupriavidus necator (MTCC 1472) from sucrose-based cheap substrates under response surface-optimized conditions.

PubMed

Dey, Pinaki; Rangarajan, Vivek

2017-10-01

Experimental investigations were carried out for Cupriavidus necator (MTCC 1472)-based improved production of poly-3 hydroxy butyrate (PHB) through induced nitrogen limiting fed-batch cultivation strategies. Initially Plackett-Burman design and response surface methodology were implemented to optimize most influencing process parameters. With optimized process parameter values, continuous feeding strategies ware applied in a 5-l fermenter with table sugar concentration of 100 g/l, nitrogen concentration of 0.12 g/l for fed-batch fermentation with varying dilution rates of 0.02 and 0.046 1/h. To get enriched production of PHB, concentration of the sugar was further increased to 150 and 200 g/l in feeding. Maximum concentrations of PHB achieved were 22.35 and 23.07 g/l at those dilution rates when sugar concentration maintains at 200 g/l in feeding. At maximum concentration of PHB (23.07 g/l), productivity of 0.58 g/l h was achieved with maximum PHB accumulation efficiency up to 64% of the dry weight of biomass. High purity of PHB, close to medical grade was achieved after surfactant hypochlorite extraction method, and it was further confirmed by SEM, EDX, and XRD studies.

A Multiple Regression Analysis of Factors Concerning Superintendent Longevity and Continuity Relative to Student Achievement

ERIC Educational Resources Information Center

Plotts, Timothy

2011-01-01

The purpose of this quantitative study was to examine the relationship between the length of superintendent tenure, longevity, and continuity relative to student achievement as evidenced by the 2008-2009 3rd Grade New Jersey Assessment of Skills and Knowledge (NJASK) in language arts. Achievement in the study was defined as those students who…

Perovskite photonic sources

NASA Astrophysics Data System (ADS)

Sutherland, Brandon R.; Sargent, Edward H.

2016-05-01

The field of solution-processed semiconductors has made great strides; however, it has yet to enable electrically driven lasers. To achieve this goal, improved materials are required that combine efficient (>50% quantum yield) radiative recombination under high injection, large and balanced charge-carrier mobilities in excess of 10 cm2 V-1 s-1, free-carrier densities greater than 1017 cm-3 and gain coefficients exceeding 104 cm-1. Solid-state perovskites are -- in addition to galvanizing the field of solar electricity -- showing great promise in photonic sources, and may be the answer to realizing solution-cast laser diodes. Here, we discuss the properties of perovskites that benefit light emission, review recent progress in perovskite electroluminescent diodes and optically pumped lasers, and examine the remaining challenges in achieving continuous-wave and electrically driven lasing.

Lessons from malaria control to help meet the rising challenge of dengue.

PubMed

Anders, Katherine L; Hay, Simon I

2012-12-01

Achievements in malaria control could inform efforts to control the increasing global burden of dengue. Better methods for quantifying dengue endemicity-equivalent to parasite prevalence surveys and endemicity mapping used for malaria-would help target resources, monitor progress, and advocate for investment in dengue prevention. Success in controlling malaria has been attributed to widespread implementation of interventions with proven efficacy. An improved evidence base is needed for large-scale delivery of existing and novel interventions for vector control, alongside continued investment in dengue drug and vaccine development. Control of dengue is unlikely to be achieved without coordinated international financial and technical support for national programmes, which has proven effective in reducing the global burden of malaria. Copyright © 2012 Elsevier Ltd. All rights reserved.

A reference architecture for the component factory

NASA Technical Reports Server (NTRS)

Basili, Victor R.; Caldiera, Gianluigi; Cantone, Giovanni

1992-01-01

Software reuse can be achieved through an organization that focuses on utilization of life cycle products from previous developments. The component factory is both an example of the more general concepts of experience and domain factory and an organizational unit worth being considered independently. The critical features of such an organization are flexibility and continuous improvement. In order to achieve these features we can represent the architecture of the factory at different levels of abstraction and define a reference architecture from which specific architectures can be derived by instantiation. A reference architecture is an implementation and organization independent representation of the component factory and its environment. The paper outlines this reference architecture, discusses the instantiation process, and presents some examples of specific architectures by comparing them in the framework of the reference model.

Relative Navigation of Formation-Flying Satellites

NASA Technical Reports Server (NTRS)

Long, Anne; Kelbel, David; Lee, Taesul; Leung, Dominic; Carpenter, J. Russell; Grambling, Cheryl

2002-01-01

This paper compares autonomous relative navigation performance for formations in eccentric, medium and high-altitude Earth orbits using Global Positioning System (GPS) Standard Positioning Service (SPS), crosslink, and celestial object measurements. For close formations, the relative navigation accuracy is highly dependent on the magnitude of the uncorrelated measurement errors. A relative navigation position accuracy of better than 10 centimeters root-mean-square (RMS) can be achieved for medium-altitude formations that can continuously track at least one GPS signal. A relative navigation position accuracy of better than 15 meters RMS can be achieved for high-altitude formations that have sparse tracking of the GPS signals. The addition of crosslink measurements can significantly improve relative navigation accuracy for formations that use sparse GPS tracking or celestial object measurements for absolute navigation.

New developments in ALFT's soft x-ray point sources

NASA Astrophysics Data System (ADS)

Cintron, Dario F.; Guo, Xiaoming; Xu, Meisheng; Ye, Rubin; Antoshko, Yuriy; Antoshko, Yuriy; Drew, Steve; Philippe, Albert; Panarella, Emilio

2002-07-01

The new development in ALFT soft X-ray point source VSX-400 consists mainly of an improvement of the nozzle design to reduce the source size, as well as the introduction of a novel trigger system, capable of triggering the discharge hundreds of million of times without failure, and a debris removal system. Continuous operation for 8 hours at 20 kHz allows us to achieve 400 mW of useful soft X-ray radiation around 1 nm wavelength. In another regime of operation with a high energy machine, the VSX-Z, we have been able to achieve consistently 10 J of X-rays per pulse at a repetition rate that can reach 1 Hz with an input electrical energy of approximately 3 kJ and an efficiency in excess of 10-3.

Universal health coverage in Turkey: enhancement of equity.

PubMed

Atun, Rifat; Aydın, Sabahattin; Chakraborty, Sarbani; Sümer, Safir; Aran, Meltem; Gürol, Ipek; Nazlıoğlu, Serpil; Ozgülcü, Senay; Aydoğan, Ulger; Ayar, Banu; Dilmen, Uğur; Akdağ, Recep

2013-07-06

Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003-13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its effects. Our findings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifiable and beneficial effects on all health system goals, with an improved level and distribution of health, greater fairness in financing with better financial protection, and notably increased user satisfaction. After the HTP, five health insurance schemes were consolidated to create a unified General Health Insurance scheme with harmonised and expanded benefits. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country-in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Several factors helped to achieve universal health coverage and improve outcomes. These factors include economic growth, political stability, a comprehensive transformation strategy led by a transformation team, rapid policy translation, flexible implementation with continuous learning, and simultaneous improvements in the health system, on both the demand side (increased health insurance coverage, expanded benefits, and reduced cost-sharing) and the supply side (expansion of infrastructure, health human resources, and health services). Copyright © 2013 Elsevier Ltd. All rights reserved.

An evaluation of the Well at Dell health management program: health risk change and financial return on investment.

PubMed

Musich, Shirley; McCalister, Tre'; Wang, Sara; Hawkins, Kevin

2015-01-01

To investigate the effectiveness of the Well at Dell comprehensive health management program in delivering health care and productivity cost savings relative to program investment (i.e., return on investment). A quasi-experimental design was used to quantify the financial impact of the program and nonexperimental pre-post design to evaluate change in health risks. Ongoing worksite health management program implemented across multiple U.S. locations. Subjects were 24,651 employees with continuous medical enrollment in 2010-2011 who were eligible for 2011 health management programming. Incentive-driven, outcomes-based multicomponent corporate health management program including health risk appraisal (HRA)/wellness, lifestyle management, and disease management coaching programs. Medical, pharmacy, and short-term disability pre/post expenditure trends adjusted for demographics, health status, and baseline costs. Self-reported health risks from repeat HRA completers. Analysis: Propensity score-weighted and multivariate regression-adjusted comparison of baseline to post trends in health care expenditures and productivity costs for program participants and nonparticipants (i.e., difference in difference) relative to programmatic investment. The Well at Dell program achieved an overall return on investment of 2.48 in 2011. Most of the savings were realized from the HRA/wellness component of the program. Cost savings were supported with high participation and significant health risk improvement. An incentive-driven, well-managed comprehensive corporate health management program can continue to achieve significant health improvement while promoting health care and productivity cost savings in an employee population.

Target fuel quality standards performance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hublin, M.; Renault, S.A.

Concerned by a large number of in-service incident due to insufficient quality of market fuels that happened in the 1980s in France and Europe, the two major French car manufacturers-PSA Peugeot Citroen and Renault-decided to define new technical requirements for these fuels. By publishing the fuel charter in July 1989, a whole fuel quality monitoring system was established. Forthcoming fuel refiners and distributors were invited to produce and sell fuels of higher quality. Major French distributors joined the charter, and soon, an improvement on French market fuels was observed. Undoubtedly, the two oil crises, in 1973 and 1979, have boostedmore » technological progress of combustion engines, improving specific power, operating noise, exhaust emissions and fuel consumption. That technological progress was achieved by defining and carrying out research that contributed to a better understanding of combustion engines. Continuous and gradual evolution in the design of engines was achieved in areas such as: combustion, internal air motion, multi-valve technology, fuel injection, engine management systems, friction reduction and after-treatment devices. As long as national fuel specifications define fuel characteristics in a rough and insufficient way, there will be the need for quality fuel certification. Different countries, bearing different cultures, will probably produce slightly different variations, but will continue to exist and increase in number. Fuel quality is a key issue for the future to guarantee trouble-free and comfortable vehicle operation and also to maintain its original emissions characteristics.« less

Getting Under the Hood: How and for Whom Does Increasing Course Structure Work?

PubMed Central

Eddy, Sarah L.

2014-01-01

At the college level, the effectiveness of active-learning interventions is typically measured at the broadest scales: the achievement or retention of all students in a course. Coarse-grained measures like these cannot inform instructors about an intervention's relative effectiveness for the different student populations in their classrooms or about the proximate factors responsible for the observed changes in student achievement. In this study, we disaggregate student data by racial/ethnic groups and first-generation status to identify whether a particular intervention—increased course structure—works better for particular populations of students. We also explore possible factors that may mediate the observed changes in student achievement. We found that a “moderate-structure” intervention increased course performance for all student populations, but worked disproportionately well for black students—halving the black–white achievement gap—and first-generation students—closing the achievement gap with continuing-generation students. We also found that students consistently reported completing the assigned readings more frequently, spending more time studying for class, and feeling an increased sense of community in the moderate-structure course. These changes imply that increased course structure improves student achievement at least partially through increasing student use of distributed learning and creating a more interdependent classroom community. PMID:25185229

System-wide hybrid MPC-PID control of a continuous pharmaceutical tablet manufacturing process via direct compaction.

PubMed

Singh, Ravendra; Ierapetritou, Marianthi; Ramachandran, Rohit

2013-11-01

The next generation of QbD based pharmaceutical products will be manufactured through continuous processing. This will allow the integration of online/inline monitoring tools, coupled with an efficient advanced model-based feedback control systems, to achieve precise control of process variables, so that the predefined product quality can be achieved consistently. The direct compaction process considered in this study is highly interactive and involves time delays for a number of process variables due to sensor placements, process equipment dimensions, and the flow characteristics of the solid material. A simple feedback regulatory control system (e.g., PI(D)) by itself may not be sufficient to achieve the tight process control that is mandated by regulatory authorities. The process presented herein comprises of coupled dynamics involving slow and fast responses, indicating the requirement of a hybrid control scheme such as a combined MPC-PID control scheme. In this manuscript, an efficient system-wide hybrid control strategy for an integrated continuous pharmaceutical tablet manufacturing process via direct compaction has been designed. The designed control system is a hybrid scheme of MPC-PID control. An effective controller parameter tuning strategy involving an ITAE method coupled with an optimization strategy has been used for tuning of both MPC and PID parameters. The designed hybrid control system has been implemented in a first-principles model-based flowsheet that was simulated in gPROMS (Process System Enterprise). Results demonstrate enhanced performance of critical quality attributes (CQAs) under the hybrid control scheme compared to only PID or MPC control schemes, illustrating the potential of a hybrid control scheme in improving pharmaceutical manufacturing operations. Copyright © 2013 Elsevier B.V. All rights reserved.

Vendor management: a model for collaboration and quality improvement.

PubMed

Friedman, M D; Bailit, M H; Michel, J O

1995-11-01

The Massachusetts Medicaid agency, also known as the Division of Medical Assistance, has developed a quality-driven approach for managing its managed care suppliers. Such an approach has, as its foundation, principles of continuous quality improvement (CQI). Suppliers participate in an annual process whereby CQI goals are negotiated between the division and its suppliers. The division then works with suppliers to achieve such goals. A cornerstone of the division's approach is the notion that data can highlight an unlimited number of opportunities for improvement and that pursuit of such opportunities will ultimately result in meaningful improvements in the health status of recipients who are served by the division. The agency's approach involves five key steps: 1) the development of contractual terms and purchasing specifications; 2) the identification of improvement priorities; 3) the negotiation of improvement goals; 4) efforts directed at meeting improvement goals and measurement of success; and 5) collaboration to achieve mutual objectives. Overall, suppliers report many benefits of collaborative participation in CQI activities with the division. Suppliers have enhanced their understanding of the importance of meeting the needs of the customer and have further accrued benefits resulting from discussions with managed care vendors throughout the site regarding benchmarking of efforts and CQI efforts. Conversely, suppliers are challenged by the need to balance and allocate resources to meet increasing demands, which are not always consistent, from various purchasers, including the division. The division has been challenged in the evolution of its contract management strategy by an uneven level of knowledge among managed care vendors regarding CQI; goal setting and measurement issues; the length of time and level of effort required to develop good relationships with suppliers; and the critical importance of comparable, valid, and timely submission of data. Over the last three years, the division has seen a dramatic increase in the responsiveness of managed care suppliers to meet its needs as a purchaser. Specifically, this has been expressed through supplier ability to meet mutually negotiated improvement goals. The division is also pleased that it is beginning to achieve some measurable improvements in outcomes of care.

Use of continuous glucose monitoring in patients with type 1 diabetes.

PubMed

Ellis, Samuel L; Naik, Ramachandra G; Gemperline, Kate; Garg, Satish K

2008-08-01

The prevalence of type 1 diabetes continues to increase worldwide at a rate higher than previously projected, while the number of patients achieving American Diabetes Association (ADA) glycated hemoglobin (A1c) goals remains suboptimal. There are numerous barriers to patients achieving A1c targets including increased frequency of severe hypoglycemia associated with lowering plasma glucose as measured by lower A1c values. Continuous glucose monitoring (CGM) was first approved for retrospective analysis and now has advanced to the next step in diabetes management with the approval of real-time glucose sensing. Real-time CGM, in short term studies, has been shown to decrease A1c values, improve glucose variability (GV), and minimize the time and number of hypoglycemic events in patients with type 1 diabetes. These products are approved for adjunctive use to self-monitoring of blood glucose (SMBG), but future long-term studies are needed to document their safety, efficacy, ability to replace SMBG as a tool of monitoring, and ultimately utility into closed-loop insulin delivery systems. New algorithms will need to be developed that account for rapid changes in the glucose values, so that accuracy of the sensor data can be maintained. In addition, for better clinical care and usage, algorithms also need to be developed for both patients and the providers to guide them for their ongoing diabetes care.

Performance of a newly designed continuous soot monitoring system (COSMOS).

PubMed

Miyazaki, Yuzo; Kondo, Yutaka; Sahu, Lokesh K; Imaru, Junichi; Fukushima, Nobuhiko; Kano, Minoru

2008-10-01

We designed a continuous soot monitoring system (COSMOS) for fully automated, high-sensitivity, continuous measurement of light absorption by black carbon (BC) aerosols. The instrument monitors changes in transmittance across an automatically advancing quartz fiber filter tape using an LED at a 565 nm wavelength. To achieve measurements with high sensitivity and a lower detectable light absorption coefficient, COSMOS uses a double-convex lens and optical bundle pipes to maintain high light intensity and signal data are obtained at 1000 Hz. In addition, sampling flow rate and optical unit temperature are actively controlled. The inlet line for COSMOS is heated to 400 degrees C to effectively volatilize non-refractory aerosol components that are internally mixed with BC. In its current form, COSMOS provides BC light absorption measurements with a detection limit of 0.45 Mm(-1) (0.045 microg m(-3) for soot) for 10 min. The unit-to-unit variability is estimated to be within +/- 1%, demonstrating its high reproducibility. The absorption coefficients determined by COSMOS agreed with those by a particle soot absorption photometer (PSAP) to within 1% (r2 = 0.97). The precision (+/- 0.60 Mm(-1)) for 10 min integrated data was better than that of PSAP and an aethalometer under our operating conditions. These results showed that COSMOS achieved both an improved detection limit and higher precision for the filter-based light absorption measurements of BC compared to the existing methods.

A trial of scheduled deep brain stimulation for Tourette syndrome: moving away from continuous deep brain stimulation paradigms.

PubMed

Okun, Michael S; Foote, Kelly D; Wu, Samuel S; Ward, Herbert E; Bowers, Dawn; Rodriguez, Ramon L; Malaty, Irene A; Goodman, Wayne K; Gilbert, Donald M; Walker, Harrison C; Mink, Jonathan W; Merritt, Stacy; Morishita, Takashi; Sanchez, Justin C

2013-01-01

To collect the information necessary to design the methods and outcome variables for a larger trial of scheduled deep brain stimulation (DBS) for Tourette syndrome. We performed a small National Institutes of Health-sponsored clinical trials planning study of the safety and preliminary efficacy of implanted DBS in the bilateral centromedian thalamic region. The study used a cranially contained constant-current device and a scheduled, rather than the classic continuous, DBS paradigm. Baseline vs 6-month outcomes were collected and analyzed. In addition, we compared acute scheduled vs acute continuous vs off DBS. A university movement disorders center. Five patients with implanted DBS. A 50% improvement in the Yale Global Tic Severity Scale (YGTSS) total score. RESULTS Participating subjects had a mean age of 34.4 (range, 28-39) years and a mean disease duration of 28.8 years. No significant adverse events or hardware-related issues occurred. Baseline vs 6-month data revealed that reductions in the YGTSS total score did not achieve the prestudy criterion of a 50% improvement in the YGTSS total score on scheduled stimulation settings. However, statistically significant improvements were observed in the YGTSS total score (mean [SD] change, -17.8 [9.4]; P=.01), impairment score (-11.3 [5.0]; P=.007), and motor score (-2.8 [2.2]; P=.045); the Modified Rush Tic Rating Scale Score total score (-5.8 [2.9]; P=.01); and the phonic tic severity score (-2.2 [2.6]; P=.04). Continuous, off, and scheduled stimulation conditions were assessed blindly in an acute experiment at 6 months after implantation. The scores in all 3 conditions showed a trend for improvement. Trends for improvement also occurred with continuous and scheduled conditions performing better than the off condition. Tic suppression was commonly seen at ventral (deep) contacts, and programming settings resulting in tic suppression were commonly associated with a subjective feeling of calmness. This study provides safety and proof of concept that a scheduled DBS approach could improve motor and vocal tics in Tourette syndrome. Refinements in neurostimulator battery life, outcome measure selection, and flexibility in programming settings can be used to enhance outcomes in a future larger study. Scheduled stimulation holds promise as a potential first step for shifting movement and neuropsychiatric disorders toward more responsive neuromodulation approaches. clinicaltrials.gov Identifier: NCT01329198.

Achieving High Performance Perovskite Solar Cells

NASA Astrophysics Data System (ADS)

Yang, Yang

2015-03-01

Recently, metal halide perovskite based solar cell with the characteristics of rather low raw materials cost, great potential for simple process and scalable production, and extreme high power conversion efficiency (PCE), have been highlighted as one of the most competitive technologies for next generation thin film photovoltaic (PV). In UCLA, we have realized an efficient pathway to achieve high performance pervoskite solar cells, where the findings are beneficial to this unique materials/devices system. Our recent progress lies in perovskite film formation, defect passivation, transport materials design, interface engineering with respect to high performance solar cell, as well as the exploration of its applications beyond photovoltaics. These achievements include: 1) development of vapor assisted solution process (VASP) and moisture assisted solution process, which produces perovskite film with improved conformity, high crystallinity, reduced recombination rate, and the resulting high performance; 2) examination of the defects property of perovskite materials, and demonstration of a self-induced passivation approach to reduce carrier recombination; 3) interface engineering based on design of the carrier transport materials and the electrodes, in combination with high quality perovskite film, which delivers 15 ~ 20% PCEs; 4) a novel integration of bulk heterojunction to perovskite solar cell to achieve better light harvest; 5) fabrication of inverted solar cell device with high efficiency and flexibility and 6) exploration the application of perovskite materials to photodetector. Further development in film, device architecture, and interfaces will lead to continuous improved perovskite solar cells and other organic-inorganic hybrid optoelectronics.

Modelling the implications of reducing smoking prevalence: the public health and economic benefits of achieving a 'tobacco-free' UK.

PubMed

Hunt, Daniel; Knuchel-Takano, André; Jaccard, Abbygail; Bhimjiyani, Arti; Retat, Lise; Selvarajah, Chit; Brown, Katrina; Webber, Laura L; Brown, Martin

2018-03-01

Smoking is still the most preventable cause of cancer, and a leading cause of premature mortality and health inequalities in the UK. This study modelled the health and economic impacts of achieving a 'tobacco-free' ambition (TFA) where, by 2035, less than 5% of the population smoke tobacco across all socioeconomic groups. A non-linear multivariate regression model was fitted to cross-sectional smoking data to create projections to 2035. These projections were used to predict the future incidence and costs of 17 smoking-related diseases using a microsimulation approach. The health and economic impacts of achieving a TFA were evaluated against a predicted baseline scenario, where current smoking trends continue. If trends continue, the prevalence of smoking in the UK was projected to be 10% by 2035-well above a TFA. If this ambition were achieved by 2035, it could mean 97 300 +/- 5 300 new cases of smoking-related diseases are avoided by 2035 (tobacco-related cancers: 35 900+/- 4 100; chronic obstructive pulmonary disease: 29 000 +/- 2 700; stroke: 24 900 +/- 2 700; coronary heart disease: 7600 +/- 2 700), including around 12 350 diseases avoided in 2035 alone. The consequence of this health improvement is predicted to avoid £67 +/- 8 million in direct National Health Service and social care costs, and £548 million in non-health costs, in 2035 alone. These findings strengthen the case to set bold targets on long-term declines in smoking prevalence to achieve a tobacco 'endgame'. Results demonstrate the health and economic benefits that meeting a TFA can achieve over just 20 years. Effective ambitions and policy interventions are needed to reduce the disease and economic burden of smoking. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A continuous quality improvement project to reduce medication error in the emergency department.

PubMed

Lee, Sara Bc; Lee, Larry Ly; Yeung, Richard Sd; Chan, Jimmy Ts

2013-01-01

Medication errors are a common source of adverse healthcare incidents particularly in the emergency department (ED) that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED. In 2009, a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems. Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed, discussed, endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents (MI) from 16 to 6 was achieved before and after the improvement work. This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

Achieving hemostasis in dermatology – Part 1: Preoperative, intraoperative, and postoperative management

PubMed Central

Kaur, Ravneet Ruby; Glick, Jaimie B.; Siegel, Daniel

2013-01-01

As dermatological procedures continue to become increasingly complex, improved methods and tools to achieve appropriate hemostasis become necessary. The methods for achieving adequate hemostasis are variable and depend greatly on the type of procedure performed and the unique characteristics of the individual patient. In Part 1 of this review, we discuss the preoperative, intraoperative, and postoperative management of patients undergoing dermatologic surgery. We address oral medications and supplements that affect hemostasis, hemostatic anesthesia, and intraoperative interventions such as suture ligation and heat-generating cautery devices. In Part 2 of this review, we will discuss topical hemostats. The authors conducted an extensive literature review using the following keywords: “hemostasis,” “dermatology,” “dermatological surgery,” “dermatologic sutures,” “electrosurgery,” “hemostatic anesthesia,” and “laser surgery.” Sources for this article were identified by searching the English literature in the Pubmed database for the time period from 1940 to March 2012. A thorough bibliography search was also conducted and key references were examined. PMID:23741660

[Teaching performance assessment in Public Health employing three different strategies].

PubMed

Martínez-González, Adrián; Moreno-Altamirano, Laura; Ponce-Rosas, Efrén Raúl; Martínez-Franco, Adrián Israel; Urrutia-Aguilar, María Esther

2011-01-01

The educational system depends upon the quality and performance of their faculty and should therefore be process of continuous improvement. To assess the teaching performance of the Public Health professors, at the Faculty of Medicine, UNAM through three strategies. Justification study. The evaluation was conducted under a mediational model through three strategies: students' opinion assessment, self-assessment and students' academic achievement. We applied descriptive statistics, Student t test, ANOVA and Pearson correlation. Twenty professors were evaluated from the Public Health department, representing 57% of all them who teach the subject. The professor's performance was highly valued self-assessment compared with assessment of student opinion, was confirmed by statistical analysis the difference was significant. The difference amongst the three evaluation strategies became more evident between self-assessment and the scores obtained by students in their academic achievement. The integration of these three strategies offers a more complete view of the teacher's performance quality. Academic achievement appears to be a more objective strategy for teaching performance assessment than students' opinion and self-assessment.

Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation

PubMed Central

Sheikh, Zeeshan; Sima, Corneliu; Glogauer, Michael

2015-01-01

Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.

On Winning the Race for Predicting the Indian Summer Monsoon Rainfall

NASA Astrophysics Data System (ADS)

Goswami, Bhupendra

2013-03-01

Skillful prediction of Indian summer monsoon rainfall (ISMR) one season in advance remains a ``grand challenge'' for the climate science community even though such forecasts have tremendous socio-economic implications over the region. Continued poor skill of the ocean-atmosphere coupled models in predicting ISMR is an enigma in the backdrop when these models have high skill in predicting seasonal mean rainfall over the rest of the Tropics. Here, I provide an overview of the fundamental processes responsible for limited skill of climate models and outline a framework for achieving the limit on potential predictability within a reasonable time frame. I also show that monsoon intra-seasonal oscillations (MISO) act as building blocks of the Asian monsoon and provide a bridge between the two problems, the potential predictability limit and the simulation of seasonal mean climate. The correlation between observed ISMR and ensemble mean of predicted ISMR (R) can still be used as a metric for forecast verification. Estimate of potential limit of predictability of Asian monsoon indicates that the highest achievable R is about 0.75. Improvements in climate models and data assimilation over the past one decade has slowly improved R from near zero a decade ago to about 0.4 currently. The race for achieving useful prediction can be won, if we can push this skill up to about 0.7. It requires focused research in improving simulations of MISO, monsoon seasonal cycle and ENSO-monsoon relationship by the climate models. In order to achieve this goal by 2015-16 timeframe, IITM is leading a Program called Monsoon Mission supported by the Ministry of Earth Sciences, Govt. of India (MoES). As improvement in skill of forecasts can come only if R & D is carried out on an operational modeling system, the Climate Forecast System of National Centre for Environmental Prediction (NCEP) of NOAA, U.S.A has been selected as our base system. The Mission envisages building partnership between operational forecasting agency and National and International R & D Organizations to work on improving modeling system. MoES has provided substantial funding to the Mission to fund proposals from International R & D Organizations to work with Indian Organizations in this Mission to achieve this goal. The conceptual framework and the roadmap for the Mission will be highlighted. Indian Institute of Tropical Meteorology is funded by Ministry of Earth Sciences, Govt. of India.

Cross-continuum Care Continuity: Achieving Seamless Care and Managing Comorbidities.

PubMed

Boston-Fleischhauer, Carol; Rose, Robert; Hartwig, Laurie

As healthcare systems continue to design care models responsive to payment changes and the assumption of clinical and financial risk, the need exists for a comprehensive approach to address cross-continuum care transitions. This article will highlight key learnings from the Nurse Executive Center's research on achieving care continuity. The business case for developing a cross-continuum care transition strategy will be discussed, as well as systemic enablers for the achievement of seamless care. A case study example of 1 system's solution for supporting the multiple comorbid patient population as part of its cross-continuum care transition strategy will be examined.

The History, Role, and Value of Public Directors on Certifying Boards: The American Board of Ophthalmology Experience.

PubMed

Anderson, Suzanne T; Nora, Lois M; McEntee, Christine W; Fitzgerald, Matthew E; Nugent, Samantha Guastella

2016-09-01

The mission of the American Board of Ophthalmology (ABO) is to serve the public by improving the quality of ophthalmic practice through a continuing certification process that fosters excellence and encourages continual learning. Since 2001, achieving this mission has been enhanced by including public directors in the ABO governance. We review the evolution of including nonprofessional members on the governing boards of professional regulatory and self-regulatory organizations generally, provide history about the incorporation of non-professional public directors into the governance structure of the American Board of Medical Specialties and the ABO, and offer insights about the perceived impact of public directors on the ABO. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Honda humanoid robots development.

PubMed

Hirose, Masato; Ogawa, Kenichi

2007-01-15

Honda has been doing research on robotics since 1986 with a focus upon bipedal walking technology. The research started with straight and static walking of the first prototype two-legged robot. Now, the continuous transition from walking in a straight line to making a turn has been achieved with the latest humanoid robot ASIMO. ASIMO is the most advanced robot of Honda so far in the mechanism and the control system. ASIMO's configuration allows it to operate freely in the human living space. It could be of practical help to humans with its ability of five-finger arms as well as its walking function. The target of further development of ASIMO is to develop a robot to improve life in human society. Much development work will be continued both mechanically and electronically, staying true to Honda's 'challenging spirit'.

Week 4 viral load predicts long-term suppression of hepatitis B virus DNA during antiviral therapy: improving hepatitis B treatment in the real world.

PubMed

Truong, J; Shadbolt, B; Ooi, M; Chitturi, S; Kaye, G; Farrell, G C; Teoh, N C

2017-01-01

Entecavir and tenofovir potently suppress hepatitis B virus (HBV) replication so that serum HBV DNA levels <20 IU/mL can be achieved after 2 years. Despite this, inadequate suppression is reported in >20% of cases for unclear reasons. We tested whether 4-week viral load (VL) assessment could improve 96-week treatment outcome. Data on all chronic hepatitis B patients treated with entecavir or tenofovir between 2005 and 2014 were entered prospectively. Full data capture included pre-treatment, weeks 4, 24, 48 and 96 HBV DNA titre, HBeAg, age, gender, antiviral agent and dose escalation. Compliance data were compiled from pharmacy records, doctors' letters and clinic bookings/attendance. Time to achieve complete viral suppression (HBV DNA < 20 IU/mL) was graphed using Kaplan-Meier curves. Factors affecting this were examined using a multivariate Cox Proportional Hazard model. Among 156 patients treated, 72 received entecavir and 84 tenofovir. Pre-treatment HBV DNA titre, 4-week assessment and compliance impacted significantly on time to complete viral suppression. At 96 weeks, 90% of those assessed as compliant by 4-week HBV DNA had complete viral suppression versus 50% followed by 6-month VL estimation. Continuing care by the same physician was related to 4-week VL testing and optimal compliance. Medium-term outcomes of HBV antiviral therapy are improved by early on-treatment VL testing, facilitating patient engagement and improved compliance. The observation that 90% complete viral suppression after 2 years monotherapy is achievable in a routine clinic setting questions the need for combination therapy in HBV cases with suboptimal response. © 2016 Royal Australasian College of Physicians.

BAUM: improving genome assembly by adaptive unique mapping and local overlap-layout-consensus approach.

PubMed

Wang, Anqi; Wang, Zhanyu; Li, Zheng; Li, Lei M

2018-06-15

It is highly desirable to assemble genomes of high continuity and consistency at low cost. The current bottleneck of draft genome continuity using the second generation sequencing (SGS) reads is primarily caused by uncertainty among repetitive sequences. Even though the single-molecule real-time sequencing technology is very promising to overcome the uncertainty issue, its relatively high cost and error rate add burden on budget or computation. Many long-read assemblers take the overlap-layout-consensus (OLC) paradigm, which is less sensitive to sequencing errors, heterozygosity and variability of coverage. However, current assemblers of SGS data do not sufficiently take advantage of the OLC approach. Aiming at minimizing uncertainty, the proposed method BAUM, breaks the whole genome into regions by adaptive unique mapping; then the local OLC is used to assemble each region in parallel. BAUM can (i) perform reference-assisted assembly based on the genome of a close species (ii) or improve the results of existing assemblies that are obtained based on short or long sequencing reads. The tests on two eukaryote genomes, a wild rice Oryza longistaminata and a parrot Melopsittacus undulatus, show that BAUM achieved substantial improvement on genome size and continuity. Besides, BAUM reconstructed a considerable amount of repetitive regions that failed to be assembled by existing short read assemblers. We also propose statistical approaches to control the uncertainty in different steps of BAUM. http://www.zhanyuwang.xin/wordpress/index.php/2017/07/21/baum. Supplementary data are available at Bioinformatics online.

Long-term treatment of epilepsy with everolimus in tuberous sclerosis

PubMed Central

Wilfong, Angus A.; Mays, Maxwell; Talley, Christina M.; Agricola, Karen; Tudor, Cindy; Capal, Jamie; Holland-Bouley, Katherine; Franz, David Neal

2016-01-01

Objective: To evaluate the long-term benefit and safety of everolimus for the treatment of medically refractory epilepsy in patients with tuberous sclerosis complex (TSC). Methods: Everolimus was titrated over 4 weeks and continued an additional 8 weeks in a prospective, open-label, phase I/II clinical trial design. Participants demonstrating initial benefit continued treatment until study completion (48 months). The primary endpoint was percentage of patients with a ≥50% reduction in seizure frequency compared to baseline. Secondary endpoints assessed absolute seizure frequency, adverse events (AEs), behavior, and quality of life. Results: Of the 20 participants who completed the initial study phase, 18 continued extended treatment. Fourteen of 18 (78%) participants completed the study, all but 1 of whom reported ≥50% reduction in seizure frequency at 48 months. All participants reported at least 1 AE, the vast majority (94%) of which were graded mild or moderate severity. Improvements in behavior and quality of life were also observed, but failed to achieve statistical significance at 48 months. Conclusions: Improved seizure control was maintained for 4 years in the majority of patients with TSC with medically refractory epilepsy treated with everolimus. Long-term treatment with everolimus is safe and well-tolerated in this population. Everolimus may be a therapeutic option for refractory epilepsy in TSC. Classification of evidence: This study provides Class IV evidence that for patients with TSC with medically refractory epilepsy everolimus improves seizure control. PMID:27815402

Adaptive deep brain stimulation in advanced Parkinson disease.

PubMed

Little, Simon; Pogosyan, Alex; Neal, Spencer; Zavala, Baltazar; Zrinzo, Ludvic; Hariz, Marwan; Foltynie, Thomas; Limousin, Patricia; Ashkan, Keyoumars; FitzGerald, James; Green, Alexander L; Aziz, Tipu Z; Brown, Peter

2013-09-01

Brain-computer interfaces (BCIs) could potentially be used to interact with pathological brain signals to intervene and ameliorate their effects in disease states. Here, we provide proof-of-principle of this approach by using a BCI to interpret pathological brain activity in patients with advanced Parkinson disease (PD) and to use this feedback to control when therapeutic deep brain stimulation (DBS) is delivered. Our goal was to demonstrate that by personalizing and optimizing stimulation in real time, we could improve on both the efficacy and efficiency of conventional continuous DBS. We tested BCI-controlled adaptive DBS (aDBS) of the subthalamic nucleus in 8 PD patients. Feedback was provided by processing of the local field potentials recorded directly from the stimulation electrodes. The results were compared to no stimulation, conventional continuous stimulation (cDBS), and random intermittent stimulation. Both unblinded and blinded clinical assessments of motor effect were performed using the Unified Parkinson's Disease Rating Scale. Motor scores improved by 66% (unblinded) and 50% (blinded) during aDBS, which were 29% (p = 0.03) and 27% (p = 0.005) better than cDBS, respectively. These improvements were achieved with a 56% reduction in stimulation time compared to cDBS, and a corresponding reduction in energy requirements (p < 0.001). aDBS was also more effective than no stimulation and random intermittent stimulation. BCI-controlled DBS is tractable and can be more efficient and efficacious than conventional continuous neuromodulation for PD. Copyright © 2013 American Neurological Association.

Collaborative Effort for a Centralized Worldwide Tuberculosis Relational Sequencing Data Platform.

PubMed

Starks, Angela M; Avilés, Enrique; Cirillo, Daniela M; Denkinger, Claudia M; Dolinger, David L; Emerson, Claudia; Gallarda, Jim; Hanna, Debra; Kim, Peter S; Liwski, Richard; Miotto, Paolo; Schito, Marco; Zignol, Matteo

2015-10-15

Continued progress in addressing challenges associated with detection and management of tuberculosis requires new diagnostic tools. These tools must be able to provide rapid and accurate information for detecting resistance to guide selection of the treatment regimen for each patient. To achieve this goal, globally representative genotypic, phenotypic, and clinical data are needed in a standardized and curated data platform. A global partnership of academic institutions, public health agencies, and nongovernmental organizations has been established to develop a tuberculosis relational sequencing data platform (ReSeqTB) that seeks to increase understanding of the genetic basis of resistance by correlating molecular data with results from drug susceptibility testing and, optimally, associated patient outcomes. These data will inform development of new diagnostics, facilitate clinical decision making, and improve surveillance for drug resistance. ReSeqTB offers an opportunity for collaboration to achieve improved patient outcomes and to advance efforts to prevent and control this devastating disease. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Improvements in State and Local Planning for Mass Dispensing of Medical Countermeasures: The Technical Assistance Review Program, United States, 2007-2014.

PubMed

Renard, Paul G; Vagi, Sara J; Reinold, Chris M; Silverman, Brenda L; Avchen, Rachel N

2017-09-01

To evaluate and describe outcomes of state and local medical countermeasure preparedness planning, which is critical to ensure rapid distribution and dispensing of a broad spectrum of life-saving medical assets during a public health emergency. We used 2007 to 2014 state and local data collected from the Centers for Disease Control and Prevention's Technical Assistance Review. We calculated descriptive statistics from 50 states and 72 local Cities Readiness Initiative jurisdictions that participated in the Technical Assistance Review annually. From 2007 to 2014, the average overall Technical Assistance Review score increased by 13% for states and 41% for Cities Readiness Initiative jurisdictions. In 2014, nearly half of states achieved the maximum possible overall score (100), and 94% of local Cities Readiness Initiative jurisdictions achieved a score of 90 or more. Despite challenges, effective and timely medical countermeasure distribution and dispensing is possible with appropriate planning, staff, and resources. However, vigilance in training, exercising, and improving plans from lessons learned in a sustained, coordinated way is critical to ensure continued public health preparedness success.

A Functional-Genetic Scheme for Seizure Forecasting in Canine Epilepsy.

PubMed

Bou Assi, Elie; Nguyen, Dang K; Rihana, Sandy; Sawan, Mohamad

2018-06-01

The objective of this work is the development of an accurate seizure forecasting algorithm that considers brain's functional connectivity for electrode selection. We start by proposing Kmeans-directed transfer function, an adaptive functional connectivity method intended for seizure onset zone localization in bilateral intracranial EEG recordings. Electrodes identified as seizure activity sources and sinks are then used to implement a seizure-forecasting algorithm on long-term continuous recordings in dogs with naturally-occurring epilepsy. A precision-recall genetic algorithm is proposed for feature selection in line with a probabilistic support vector machine classifier. Epileptic activity generators were focal in all dogs confirming the diagnosis of focal epilepsy in these animals while sinks spanned both hemispheres in 2 of 3 dogs. Seizure forecasting results show performance improvement compared to previous studies, achieving average sensitivity of 84.82% and time in warning of 0.1. Achieved performances highlight the feasibility of seizure forecasting in canine epilepsy. The ability to improve seizure forecasting provides promise for the development of EEG-triggered closed-loop seizure intervention systems for ambulatory implantation in patients with refractory epilepsy.

Factors Associated with Adherence to the HEDIS Quality Measure in Medicaid Patients with Schizophrenia

PubMed Central

Lafeuille, Marie-Hélène; Frois, Christian; Cloutier, Michel; Duh, Mei Sheng; Lefebvre, Patrick; Pesa, Jacqueline; Clancy, Zoe; Fastenau, John; Durkin, Mike

2016-01-01

Background Treatment continuity is a major challenge in the long-term management of patients with schizophrenia; poor patient adherence to antipsychotic drugs has been associated with negative clinical outcomes. Long-acting injectable therapies may improve adherence and lessen the risk for psychiatric-related relapse, often leading to rehospitalization and higher healthcare costs. Therefore, understanding the determinants of adherence to antipsychotics is critical in the management of patients with schizophrenia. Objective To assess the impact of baseline patient characteristics on adherence as measured by the Healthcare Effectiveness Data and Information Set (HEDIS) measure of continuity of antipsychotic medications among patients with Medicaid coverage. Methods Medicaid healthcare claims data between 2008 and 2011 from 5 states were used to identify patients who were diagnosed with schizophrenia (aged 25–64 years) and received ≥1 antipsychotic prescriptions in baseline year 2010 and in measurement year 2011. The HEDIS continuity of antipsychotic medications (ie, adherence) measure was defined as the proportion of days covered with any antipsychotic medication ≥80% during the measurement year. The 2 cohorts compared paliperidone palmitate with any other antipsychotics, including quetiapine, risperidone, and haloperidol. The baseline-year characteristics were evaluated as potential predictive factors of adherence in the measurement year using multivariate logistic regressions. The regression models incorporated the inverse probability of treatment weights to control for differences in baseline characteristics between the paliperidone palmitate and the other antipsychotics cohort. Results Among the 12,990 patients who received an antipsychotic during the study period, 48.6% successfully achieved the continuity criteria in the measurement year. After controlling for other covariates, the odds of adherence were improved by adherence at baseline (odds ratio [OR], 9.42; 95% confidence interval [CI], 8.55–10.39). The use of paliperidone palmitate was associated with a 26% increase in the odds of achieving adherence compared with the use of the other antipsychotics studied (OR, 1.26; 95% CI, 1.14–1.39). In addition, female sex (OR, 1.11; 95% CI, 1.01–1.22), age 55 to 64 years (OR, 1.26; 95% CI, 1.09–1.46) versus age 25 to 34 years, Hispanic race (OR, 1.37; 95% CI, 1.05–1.81) versus white race, and an increase of $10,000 in baseline inpatient costs (OR, 1.11; 95% CI, 1.08–1.15) were associated with greater odds of treatment continuity. Conclusions In addition to sex, age, and race, the baseline characteristics that were associated with achieving the HEDIS continuity of antipsychotic medication measure included previous-year adherence, inpatient costs, and the use of paliperidone palmitate. These findings offer insight to healthcare plans that cover Medicaid populations on the effects that patient characteristics and treatment types may have on adherence among patients with schizophrenia. PMID:27994714

Monitoring technologies for the evaluation of a Soil-Aquifer-Treatment system in coastal aquifer environments.

NASA Astrophysics Data System (ADS)

Kallioras, Andreas; Tsertou, Athanasia; Foglia, Laura; Bumberger, Jan; Vienken, Thomas; Dietrich, Peter; Schüth, Christoph

2014-05-01

Artificial recharge of groundwater has an important role to play in water reuse. Treated sewage effluent can be infiltrated into the ground for recharge of aquifers. As the effluent water moves through the soil and the aquifer, it undergoes significant quality improvements through physical, chemical, and biological processes in the underground environment. Collectively, these processes and the water quality improvement obtained are called soil-aquifer-treatment (SAT) or geopurification. Recharge systems for SAT can be designed as infiltration-recovery systems, where all effluent water is recovered as such from the aquifer, or after blending with native groundwater. SAT typically removes essentially all suspended solids, biochemical oxygen demand (BOD), and pathogens (viruses, bacteria, protozoa, and helminthic eggs). Concentrations of synthetic organic carbon, phosphorous, and heavy metals are greatly reduced. The pilot site of LTCP will involve the employment of infiltration basins, which will be using waters of impaired quality as a recharge source, and hence acting as a Soil-Aquifer-Treatment, SAT, system. T he LTCP site will be employed as a pilot SAT system complemented by new technological developments, which will be providing continuous monitoring of the quantitative and qualitative characteristics of infiltrating groundwater through all hydrologic zones (i.e. surface, unsaturated and saturated zone). This will be achieved through the development and installation of an integrated system of prototype sensors, installed on-site, and offering a continuous evaluation of the performance of the SAT system. An integrated approach of the performance evaluation of any operating SAT system should aim at parallel monitoring of all hydrologic zones, proving the sustainability of all involved water quality treatment processes within unsaturated and saturated zone. Hence a prototype system of Time Domain Reflectometry (TDR) sensors will be developed, in order to achieve continuous quantitative monitoring of the unsaturated zone through the entire soil column down to significant depths below the SAT basin. The above technique will offer continuous monitoring of infiltration rates and possible mechanical clogging effects. The qualitative monitoring of the unsaturated zone will be achieved through the installation of appropriate pore-water samplers within a multi-level basis, ensuring repeatability of sampling of infiltrating water of impaired quality. This study also involves the qualitative and quantitative assessment of the Lavrion multi-aquifer system through continuous monitoring of the performance of (i) the alluvial aquifer and its potential for additional water treatment as well as (ii) the effects of the SAT system for countermeasuring seawater intrusion in the area of Lavrion. Additionally, setup and calibration of numerical flow and transport models for evaluating and optimizing different operational modes of the SAT system within both saturated and unsaturated zones will be conducted. The monitoring system will be connected to an ad-hoc wireless network for continuous data transfer within the SAT facilities. It is envisaged that the development and combined application of all the above technologies will provide an integrated monitoring platform for the evaluation of SAT system performance.

Optimizing outcome after cardiac arrest.

PubMed

Nolan, Jerry P

2011-10-01

To discuss recent data relating to survival rates after cardiac arrest and interventions that can be used to optimize outcome. A recent analysis of 70 studies indicates that following out-of-hospital cardiac arrest (OHCA), 7.6% of patients will survive to hospital discharge (95% confidence interval 6.7-8.4). Following in-hospital cardiac arrest, 18% of patients will survive to hospital discharge. Survival may be optimized by increasing the rate of bystander cardiopulmonary resuscitation (CPR), which can be achieved by improving recognition of cardiac arrest, simplifying CPR and training more of the community. Feedback systems improve the quality of CPR but this has yet to be translated into improved outcome. One study has shown improved survival following OHCA with active compression-decompression CPR combined with an impedance-threshold device. In those who have no obvious extracardiac cause of OHCA, 70% have at least one significant coronary lesion demonstrable by coronary angiography. Although generally reserved for those with ST-elevation myocardial infarction, primary percutaneous coronary intervention may also benefit OHCA survivors with ECG patterns other than ST elevation. The term 'mild therapeutic hypothermia' has been replaced by the term 'targeted temperature management'; its role in optimizing outcome after cardiac arrest continues to be defined. In several centres, survival rates following OHCA are increasing. All links in the chain of survival must be optimized if a good-quality neurological outcome is to be achieved.

Continuous-wave lasing in an organic-inorganic lead halide perovskite semiconductor

NASA Astrophysics Data System (ADS)

Jia, Yufei; Kerner, Ross A.; Grede, Alex J.; Rand, Barry P.; Giebink, Noel C.

2017-12-01

Hybrid organic-inorganic perovskites have emerged as promising gain media for tunable, solution-processed semiconductor lasers. However, continuous-wave operation has not been achieved so far1-3. Here, we demonstrate that optically pumped continuous-wave lasing can be sustained above threshold excitation intensities of 17 kW cm-2 for over an hour in methylammonium lead iodide (MAPbI3) distributed feedback lasers that are maintained below the MAPbI3 tetragonal-to-orthorhombic phase transition temperature of T ≈ 160 K. In contrast with the lasing death phenomenon that occurs for pure tetragonal-phase MAPbI3 at T > 160 K (ref. 4), we find that continuous-wave gain becomes possible at T ≈ 100 K from tetragonal-phase inclusions that are photogenerated by the pump within the normally existing, larger-bandgap orthorhombic host matrix. In this mixed-phase system, the tetragonal inclusions function as carrier recombination sinks that reduce the transparency threshold, in loose analogy to inorganic semiconductor quantum wells, and may serve as a model for engineering improved perovskite gain media.

Continuous detection of weak sensory signals in afferent spike trains: the role of anti-correlated interspike intervals in detection performance.

PubMed

Goense, J B M; Ratnam, R

2003-10-01

An important problem in sensory processing is deciding whether fluctuating neural activity encodes a stimulus or is due to variability in baseline activity. Neurons that subserve detection must examine incoming spike trains continuously, and quickly and reliably differentiate signals from baseline activity. Here we demonstrate that a neural integrator can perform continuous signal detection, with performance exceeding that of trial-based procedures, where spike counts in signal- and baseline windows are compared. The procedure was applied to data from electrosensory afferents of weakly electric fish (Apteronotus leptorhynchus), where weak perturbations generated by small prey add approximately 1 spike to a baseline of approximately 300 spikes s(-1). The hypothetical postsynaptic neuron, modeling an electrosensory lateral line lobe cell, could detect an added spike within 10-15 ms, achieving near ideal detection performance (80-95%) at false alarm rates of 1-2 Hz, while trial-based testing resulted in only 30-35% correct detections at that false alarm rate. The performance improvement was due to anti-correlations in the afferent spike train, which reduced both the amplitude and duration of fluctuations in postsynaptic membrane activity, and so decreased the number of false alarms. Anti-correlations can be exploited to improve detection performance only if there is memory of prior decisions.

Predictive models of lameness in dairy cows achieve high sensitivity and specificity with force measurements in three dimensions.

PubMed

Dunthorn, Jason; Dyer, Robert M; Neerchal, Nagaraj K; McHenry, Jonathan S; Rajkondawar, Parimal G; Steingraber, Gary; Tasch, Uri

2015-11-01

Lameness remains a significant cause of production losses, a growing welfare concern and may be a greater economic burden than clinical mastitis . A growing need for accurate, continuous automated detection systems continues because US prevalence of lameness is 12.5% while individual herds may experience prevalence's of 27.8-50.8%. To that end the first force-plate system restricted to the vertical dimension identified lame cows with 85% specificity and 52% sensitivity. These results lead to the hypothesis that addition of transverse and longitudinal dimensions could improve sensitivity of lameness detection. To address the hypothesis we upgraded the original force plate system to measure ground reaction forces (GRFs) across three directions. GRFs and locomotion scores were generated from randomly selected cows and logistic regression was used to develop a model that characterised relationships of locomotion scores to the GRFs. This preliminary study showed 76 variables across 3 dimensions produced a model with greater than 90% sensitivity, specificity, and area under the receiver operating curve (AUC). The result was a marked improvement on the 52% sensitivity, and 85% specificity previously observed with the 1 dimensional model or the 45% sensitivities reported with visual observations. Validation of model accuracy continues with the goal to finalise accurate automated methods of lameness detection.

Delivering preference for place of death in a specialist palliative care setting.

PubMed

Oxenham, David; Finucane, Anne; Arnold, Elizabeth; Russell, Papiya

2013-01-01

Over the last 10 years, one of the key themes of public policy in palliative care has been achievement of choice in place of death. In Marie Curie Hospice Edinburgh a baseline audit conducted in 2006 showed that only a small proportion (18%) of patients referred to hospice services died at home. The audit also revealed that only 31% of those who expressed a preference to die at home were able to do so, whereas 91% of those who chose a setting other than home achieved their preference. Overall achievement of preferred place of death was 56%. However a significant number of patients (29%) did not have a recorded preference. A programme of quality improvement has continued over the last 7 years to improve identification, communication and achievement of preferred place of death for all patients. The mechanisms to change practice have been: changes to documentation; changes to clinical systems to support use of documentation; support for clinical staff to recognise the value of discussing preferences; and support for clinical staff to develop new skills. In addition the programme has been incorporated into local clinical strategy and this has enabled gaps in service to be addressed with a new service to support early discharge of those patients who wish to die at home. A recent audit showed that all patients had a recorded preference or a documented reason why their preference was unclarified. One third of patients died at home - nearly double the proportion that died at home in the baseline audit. Seventy one per cent of patients who wished to die at home actually died at home - a substantial increase from 31% at baseline. Achievement of preferred place of death for patients wishing to die in the hospice remained high at 88%. The focus on assessment of preference for place of death has led to substantial improvements in the identification and achievement of preference for patients dying under the care of the hospice. Furthermore, it has been associated with an increase in the overall proportion of patients who die at home.

Perceived Factors Associated with Sustained Improvement Following Participation in a Multicenter Quality Improvement Collaborative.

PubMed

Stone, Sohini; Lee, Henry C; Sharek, Paul J

2016-07-01

The California Perinatal Quality Care Collaborative led the Breastmilk Nutrition Quality Improvement Collaborative from October 2009 to September 2010 to increase the percentage of very low birth weight infants receiving breast milk at discharge in 11 collaborative neonatal ICUs (NICUs). Observed increases in breast milk feeding and decreases in necrotizing enterocolitis persisted for 6 months after the collaborative ended. Eighteen to 24 months after the end of the collaborative, some sites maintained or further increased their gains, while others trended back toward baseline. A study was conducted to assess the qualitative factors that affect sustained improvement following participation. Collaborative leaders at each of the 11 NICUs that participated in the Breastmilk Nutrition Quality Improvement Collaborative were invited to participate in a site-specific one-hour phone interview. Interviews were recorded and transcribed and then analyzed using qualitative research analysis software to identify themes associated with sustained improvement. Eight of 11 invited centers agreed to participate in the interviews. Thematic saturation was achieved by the sixth interview, so further interviews were not pursued. Factors contributing to sustainability included physician involvement within the multidisciplinary teams, continuous education, incorporation of interventions into the daily work flow, and integration of a data-driven feedback system. Early consideration by site leaders of how to integrate best-practice interventions into the daily work flow, and ensuring physician commitment and ongoing education based in continuous data review, should enhance the likelihood of sustaining improvements. To maximize sustained success, future collaborative design should consider proactively identifying and supporting these factors at participating sites.

Design of continuous surface-relief phase plates by surface-based simulated annealing to achieve control of focal-plane irradiance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, Y.; Kessler, T.J.; Lawrence, G.N.

1996-10-01

High-performance phase plates are of vital concern for controlling the far-field irradiance of laser-fusion systems. Several designs for solving this difficult problem have been reported in {ital Optics} {ital Letters} [e.g., S. N. Dixit {ital et} {ital al}., Opt. Lett. {bold 19}, 417 (1994)]. We report a surface-based form of simulated annealing that significantly improves the irradiance control while eliminating the high-scatter problems that have plagued other methods. {copyright} {ital 1996 Optical Society of America.}

Evaluation and management of head and neck squamous cell carcinoma of unknown primary.

PubMed

Martin, Jeffrey M; Galloway, Thomas J

2015-07-01

The diagnostic evaluation and therapeutic management of a patient with squamous cell carcinoma of an unknown primary (SCCUP) has considerably evolved over recent decades and will likely continue to change as a result of the improving ability to identify small primary tumors and better tailor the implementation of multimodality therapy. By application of the general principles of head and neck oncology, physicians and surgeons are often able to achieve satisfactory control of the disease in patients with SCCUP. Copyright © 2015 Elsevier Inc. All rights reserved.

Focal brainstem gliomas

PubMed Central

Sabbagh, Abdulrahman J.; Alaqeel, Ahmed M.

2015-01-01

Improved neuronavigation guidance as well as intraoperative imaging and neurophysiologic monitoring technologies have enhanced the ability of neurosurgeons to resect focal brainstem gliomas. In contrast, diffuse brainstem gliomas are considered to be inoperable lesions. This article is a continuation of an article that discussed brainstem glioma diagnostics, imaging, and classification. Here, we address open surgical treatment of and approaches to focal, dorsally exophytic, and cervicomedullary brainstem gliomas. Intraoperative neuronavigation, intraoperative neurophysiologic monitoring, as well as intraoperative imaging are discussed as adjunctive measures to help render these procedures safer, more acute, and closer to achieving surgical goals. PMID:25864061

Control system of an excitation power supply for fast axial flow CO2 lasersupda

NASA Astrophysics Data System (ADS)

Li, Bo; Jia, Xinting; Yuan, Hao; Gao, Yuhu; Wang, Youqing

2009-08-01

A switching power control system of fast axial flow CO2 lasers based on DSP is presented. The key techniques are described in detail, include the control principle, realization method and program design. The experiment showed that the system make the laser discharge stably and work in multi-mode. The discharge current can be adjusted from 3mA to 85mA continuously. 20-2000Hz frequency, 0-100% duty cycle laser pulse is achieved. The power supply can improve the processing efficiency and quality.

Single-step preparation of TiO2/MWCNT Nanohybrid materials by laser pyrolysis and application to efficient photovoltaic energy conversion.

PubMed

Wang, Jin; Lin, Yaochen; Pinault, Mathieu; Filoramo, Arianna; Fabert, Marc; Ratier, Bernard; Bouclé, Johann; Herlin-Boime, Nathalie

2015-01-14

This paper presents the continuous-flowand single-step synthesis of a TiO2/MWCNT (multiwall carbon nanotubes) nanohybrid material. The synthesis method allows achieving high coverage and intimate interface between the TiO2particles and MWCNTs, together with a highly homogeneous distribution of nanotubes within the oxide. Such materials used as active layer in theporous photoelectrode of solid-state dye-sensitized solar cells leads to a substantial performance improvement (20%) as compared to reference devices.

Relationship-centered health care as a Lean intervention.

PubMed

Dunsford, Jennifer; Reimer, Laura E

2017-12-01

Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success. The complexity of the health care system is magnified by the sheer number of processes and sub processes required to deliver value within a bureaucratic environment, while maintaining some level of compassionate and personalized care. There is inherent tension between what is required to be efficient and what is required to be caring and this conflict presses against Lean practice at the level of delivery.Administration and care intersect at the point of the patient's experience. In order to achieve the dual goals of improved value and lower costs, the application of Lean thinking for meaningful health care reform must acknowledge the fundamental dichotomy between the impersonal tasks required to provide health services, and human interactions. Meaningful health care reform requires an acknowledgement of this distinction, currently not recognized in literature. While administrative process improvements are necessary, they are insufficient to achieve a sustainable and caring health care system. Lean thinking must be applied differently for administrative processes and patient care encounters, because these are fundamentally different processes. In this way, Lean principles will effectively contribute to sustainable health system improvements. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Measurement of customer satisfaction and participation of citizens in improving the quality of healthcare services.].

PubMed

Degrassi, Flori; Sopranzi, Cristina; Leto, Antonella; Amato, Simona; D'Urso, Antonio

2009-01-01

Managing quality in health care whilst ensuring equity is a fundamental aspect of the provision of services by healthcare organizations. Measuring perceived quality of care is an important tool for evaluating the quality of healthcare delivery in that it allows the implementation of corrective actions to meet the healthcare needs of patients. The Rome B (ASL RMB) local health authority adopted the UNI EN 10006:2006 norms as a management tool, therefore introducing the evaluation of customer satisfaction as an opportunity to involve users in the creation of quality healthcare services with and for the citizens. This paper presents the activities implemented and the results achieved with regards to shared and integrated continuous improvement of services.

Quaternary and quinary modifications of eutectic superalloys strengthened by delta Ni3Cb lamellae and gamma prime Ni3Al precipitates

NASA Technical Reports Server (NTRS)

Lemkey, F. D.; Mccarthy, G. P.

1975-01-01

By means of a compositional and heat treatment optimization program based on the quaternary gamma/gamma prime-delta, a tantalum modified gamma/gamma prime-delta alloy with improved shear and creep strength combined with better cyclic oxidation resistance was identified. Quinary additions, quaternary adjustments, and heat treatment were investigated. The tantalum modified gamma/gamma prime-delta alloy possessed a slightly higher liquidus temperature and exhibited rupture strength exceeding NASA VIA by approximately three and one-half Larson-Miller parameters (C = 20) above 1000 C. Although improvements in longitudinal mechanical properties were achieved, the shear and transverse strength property goals of the program were not met and present a continuing challenge to the alloy metallurgist.

Opioid adjuvant strategy: improving opioid effectiveness.

PubMed

Bihel, Frédéric

2016-01-01

Opioid analgesics continue to be the mainstay of pharmacologic treatment of moderate to severe pain. Many patients, particularly those suffering from chronic pain, require chronic high-dose analgesic therapy. Achieving clinical efficacy and tolerability of such treatment regimens is hampered by the appearance of opioid-induced side effects such as tolerance, hyperalgesia and withdrawal syndrome. Among the therapeutic options to improve the opioid effectiveness, this current review focuses on strategies combining opioids to other drugs that can modulate opioid-mediated effects. We will discuss about experimental evidences reported for several potential opioid adjuvants, including N-methyl-D-aspartate receptor antagonists, 5-HT7 agonists, sigma-1 antagonists, I2-R ligands, cholecystokinin antagonists, neuropeptide FF-R antagonists and toll-like receptor 4 antagonists.

The people side of MRP (materiel requirements planning).

PubMed

Lunn, T

1994-05-01

A montage of ideas and concepts have been successfully used to train and motivate people to use MRP II systems more effectively. This is important today because many companies are striving to achieve World Class Manufacturing status. Closed loop Materiel Requirements Planning (MRP) systems are an integral part of the process of continuous improvement. Successfully using a formal management planning system, such as MRP II, is a fundamental stepping stone on the path toward World Class Excellence. Included in this article are techniques that companies use to reduce lead time, simplify bills of materiel, and improve schedule adherence. These and other steps all depend on the people who use the system. The focus will be on how companies use the MRP tool more effectively.

A review of failure models for unidirectional ceramic matrix composites under monotonic loads

NASA Technical Reports Server (NTRS)

Tripp, David E.; Hemann, John H.; Gyekenyesi, John P.

1989-01-01

Ceramic matrix composites offer significant potential for improving the performance of turbine engines. In order to achieve their potential, however, improvements in design methodology are needed. In the past most components using structural ceramic matrix composites were designed by trial and error since the emphasis of feasibility demonstration minimized the development of mathematical models. To understand the key parameters controlling response and the mechanics of failure, the development of structural failure models is required. A review of short term failure models with potential for ceramic matrix composite laminates under monotonic loads is presented. Phenomenological, semi-empirical, shear-lag, fracture mechanics, damage mechanics, and statistical models for the fast fracture analysis of continuous fiber unidirectional ceramic matrix composites under monotonic loads are surveyed.

[Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

PubMed

Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

2010-01-01

To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

Hemoporfin Photodynamic Therapy for Port-Wine Stain: A Randomized Controlled Trial

PubMed Central

Zhou, Zhanchao; Lin, Xiaoxi; Yang, Huilan; Lu, Zhong; Gao, Tianwen; Tu, Yating; Xie, Hongfu; Zheng, Qingshan; Gu, Ying; Tao, Jining; Zhu, Xuejun

2016-01-01

Background and Objectives Photodynamic therapy (PDT) has shown potentially beneficial results in treating port-wine stain, but its benefit–risk profile remains undefined. This study aimed to evaluate the efficacy and safety of PDT conducted with hemoporfin and a 532 nm continuous wave laser to treat port-wine stain clinically. Patients and Methods This randomized clinical trial was conducted in eight hospitals in China. Participants were adolescent and adult patients (age range: 14–65 years old) with port-wine stain. During stage 1 (day 1 to week 8) all patients were randomized at a 3:1 ratio to treatment (532 nm laser irradiation (96–120 J/cm2) with hemoporfin (5mg/kg; PDT-hemoporfin, n = 330)) or placebo groups (irradiation with placebo (PDT-placebo, n = 110)); during stage 2 (week 8 to 16) patients in both groups were offered treatment. Clinician-evaluators, who were blind to the study, classified each case on the following four-level scale according to assessment of before and after standardized pictures of the lesion area: no improvement: <20%; some improvement: 20–59%; great improvement: 60–89%; or nearly completely resolved: ≥90%. The primary efficacy endpoint was proportion of patients achieving at least some improvement at week 8. The secondary efficacy endpoints were proportion of patients achieving nearly completely resolved or at least great improvement at week 8, proportion of patients achieving early completely resolved, at least great improvement, or at least some improvement at week 16, and the corresponding satisfaction of the investigators and the patients (designated as ‘excellent’, ‘good’, ‘moderate’, or ‘ineffective’) at weeks 8 and 16. Results Compared to the PDT-placebo group, the PDT-hemoporfin group showed a significantly higher proportion of patients that achieved at least some improvement (89.7% [n = 295; 95% CI, 85.9%-92.5%] vs. 24.5% [n = 27; 95% CI, 17.4%-33.3%]) at week 8 (P < 0.0001) and higher improvements for all secondary efficacy endpoints. Treatment reactions occurred in 99.5% (n = 731; 95% CI, 98.7%-99.8%) of the PDT-hemoporfin treatments (n = 735). Hyperpigmentation occurred in 22.9 per 100 patient-treatments (n = 168; 95% CI, 20.0–26.0) in the PDT-hemoporfin treated patients. Conclusions Hemoporfin-mediated PDT is an effective and safe treatment option for adolescent and adult patients with port-wine stain. Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-08000213 PMID:27227544

Periosteal infusion of bupivacaine/morphine post sternal fracture: a new analgesic technique.

PubMed

Duncan, Michael A; McNicholas, Walter; O'Keeffe, Declan; O'Reilly, Maeve

2002-01-01

Sternal fracture pain is severe and is difficult to alleviate due to the forces acting on the chest wall during respiration. We describe a continuous infusion regional analgesic technique for pain due to sternal fracture. A 47-year-old woman presented with a spontaneous sternal fracture, precluding effective coughing. Diclofenac and increasing doses of opioids did not give adequate pain relief and led to opioid toxicity. Two brief periods of analgesia were achieved with deep subcutaneous infiltration of bupivacaine. An epidural catheter was positioned periosteally, and an infusion of bupivacaine was commenced at 5 mL/h, achieving long-lasting analgesia. The bupivacaine concentration was reduced in a stepwise fashion from 0.5% to 0.25% and was changed to levobupivacaine after 3 days. Adding morphine (5 mg/60 mL levobupivicaine) permitted a reduction in infusion rate. The catheter was removed after 14 days because a local infection developed that resolved uneventfully with antibiotic therapy. Continuous infusion of local anesthetic and opioid to a sternal fracture site using a periosteally positioned catheter led to successful analgesia and hence improved respiratory function. Clinicians should consider placing a periosteal catheter when pain associated with sternal fracture cannot be adequately controlled with conventional methods.

Holistic Context-Sensitivity for Run-Time Optimization of Flexible Manufacturing Systems.

PubMed

Scholze, Sebastian; Barata, Jose; Stokic, Dragan

2017-02-24

Highly flexible manufacturing systems require continuous run-time (self-) optimization of processes with respect to diverse parameters, e.g., efficiency, availability, energy consumption etc. A promising approach for achieving (self-) optimization in manufacturing systems is the usage of the context sensitivity approach based on data streaming from high amount of sensors and other data sources. Cyber-physical systems play an important role as sources of information to achieve context sensitivity. Cyber-physical systems can be seen as complex intelligent sensors providing data needed to identify the current context under which the manufacturing system is operating. In this paper, it is demonstrated how context sensitivity can be used to realize a holistic solution for (self-) optimization of discrete flexible manufacturing systems, by making use of cyber-physical systems integrated in manufacturing systems/processes. A generic approach for context sensitivity, based on self-learning algorithms, is proposed aiming at a various manufacturing systems. The new solution encompasses run-time context extractor and optimizer. Based on the self-learning module both context extraction and optimizer are continuously learning and improving their performance. The solution is following Service Oriented Architecture principles. The generic solution is developed and then applied to two very different manufacturing processes.

Report of the Panel on Computer and Information Technology

NASA Technical Reports Server (NTRS)

Lundstrom, Stephen F.; Larsen, Ronald L.

1984-01-01

Aircraft have become more and more dependent on computers (information processing) for improved performance and safety. It is clear that this activity will grow, since information processing technology has advanced by a factor of 10 every 5 years for the past 35 years and will continue to do so. Breakthroughs in device technology, from vacuum tubes through transistors to integrated circuits, contribute to this rapid pace. This progress is nearly matched by similar, though not as dramatic, advances in numerical software and algorithms. Progress has not been easy. Many technical and nontechnical challenges were surmounted. The outlook is for continued growth in capability but will require surmounting new challenges. The technology forecast presented in this report has been developed by extrapolating current trends and assessing the possibilities of several high-risk research topics. In the process, critical problem areas that require research and development emphasis have been identified. The outlook assumes a positive perspective; the projected capabilities are possible by the year 2000, and adequate resources will be made available to achieve them. Computer and information technology forecasts and the potential impacts of this technology on aeronautics are identified. Critical issues and technical challenges underlying the achievement of forecasted performance and benefits are addressed.

The benefits of convergence.

PubMed

Chang, Gee-Kung; Cheng, Lin

2016-03-06

A multi-tier radio access network (RAN) combining the strength of fibre-optic and radio access technologies employing adaptive microwave photonics interfaces and radio-over-fibre (RoF) techniques is envisioned for future heterogeneous wireless communications. All-band radio spectrum from 0.1 to 100 GHz will be used to deliver wireless services with high capacity, high link speed and low latency. The multi-tier RAN will improve the cell-edge performance in an integrated heterogeneous environment enabled by fibre-wireless integration and networking for mobile fronthaul/backhaul, resource sharing and all-layer centralization of multiple standards with different frequency bands and modulation formats. In essence, this is a 'no-more-cells' architecture in which carrier aggregation among multiple frequency bands can be easily achieved with seamless handover between cells. In this way, current and future mobile network standards such as 4G and 5G can coexist with optimized and continuous cell coverage using multi-tier RoF regardless of the underlying network topology or protocol. In terms of users' experience, the future-proof approach achieves the goals of system capacity, link speed, latency and continuous heterogeneous cell coverage while overcoming the bandwidth crunch in next-generation communication networks. © 2016 The Author(s).

Design of discrete and continuous super-resolving Toraldo pupils in the microwave range.

PubMed

Olmi, Luca; Bolli, Pietro; Mugnai, Daniela

2018-03-20

The concept of super-resolution refers to various methods for improving the angular resolution of an optical imaging system beyond the classical diffraction limit. In optical microscopy, several techniques have been successfully developed with the aim of narrowing the central lobe of the illumination point spread function. In astronomy, however, no similar techniques can be used. A feasible method to design antennas and telescopes with angular resolution better than the diffraction limit consists of using variable transmittance pupils. In particular, discrete binary phase masks (0 or π ) with finite phase-jump positions, known as Toraldo pupils (TPs), have the advantage of being easy to fabricate but offer relatively little flexibility in terms of achieving specific trade-offs between design parameters, such as the angular width of the main lobe and the intensity of sidelobes. In this paper, we show that a complex transmittance filter (equivalent to a continuous TP, i.e., consisting of infinitely narrow concentric rings) can achieve more easily the desired trade-off between design parameters. We also show how the super-resolution effect can be generated with both amplitude- and phase-only masks and confirm the expected performance with electromagnetic numerical simulations in the microwave range.