Case-based fracture image retrieval.

PubMed

Zhou, Xin; Stern, Richard; Müller, Henning

2012-05-01

Case-based fracture image retrieval can assist surgeons in decisions regarding new cases by supplying visually similar past cases. This tool may guide fracture fixation and management through comparison of long-term outcomes in similar cases. A fracture image database collected over 10 years at the orthopedic service of the University Hospitals of Geneva was used. This database contains 2,690 fracture cases associated with 43 classes (based on the AO/OTA classification). A case-based retrieval engine was developed and evaluated using retrieval precision as a performance metric. Only cases in the same class as the query case are considered as relevant. The scale-invariant feature transform (SIFT) is used for image analysis. Performance evaluation was computed in terms of mean average precision (MAP) and early precision (P10, P30). Retrieval results produced with the GNU image finding tool (GIFT) were used as a baseline. Two sampling strategies were evaluated. One used a dense 40 × 40 pixel grid sampling, and the second one used the standard SIFT features. Based on dense pixel grid sampling, three unsupervised feature selection strategies were introduced to further improve retrieval performance. With dense pixel grid sampling, the image is divided into 1,600 (40 × 40) square blocks. The goal is to emphasize the salient regions (blocks) and ignore irrelevant regions. Regions are considered as important when a high variance of the visual features is found. The first strategy is to calculate the variance of all descriptors on the global database. The second strategy is to calculate the variance of all descriptors for each case. A third strategy is to perform a thumbnail image clustering in a first step and then to calculate the variance for each cluster. Finally, a fusion between a SIFT-based system and GIFT is performed. A first comparison on the selection of sampling strategies using SIFT features shows that dense sampling using a pixel grid (MAP = 0.18) outperformed the SIFT detector-based sampling approach (MAP = 0.10). In a second step, three unsupervised feature selection strategies were evaluated. A grid parameter search is applied to optimize parameters for feature selection and clustering. Results show that using half of the regions (700 or 800) obtains the best performance for all three strategies. Increasing the number of clusters in clustering can also improve the retrieval performance. The SIFT descriptor variance in each case gave the best indication of saliency for the regions (MAP = 0.23), better than the other two strategies (MAP = 0.20 and 0.21). Combining GIFT (MAP = 0.23) and the best SIFT strategy (MAP = 0.23) produced significantly better results (MAP = 0.27) than each system alone. A case-based fracture retrieval engine was developed and is available for online demonstration. SIFT is used to extract local features, and three feature selection strategies were introduced and evaluated. A baseline using the GIFT system was used to evaluate the salient point-based approaches. Without supervised learning, SIFT-based systems with optimized parameters slightly outperformed the GIFT system. A fusion of the two approaches shows that the information contained in the two approaches is complementary. Supervised learning on the feature space is foreseen as the next step of this study.

Cognitive Orientation to (daily) Occupational Performance (CO-OP) with children with Asperger's syndrome who have motor-based occupational performance goals.

PubMed

Rodger, Sylvia; Brandenburg, Julia

2009-02-01

Motor difficulties associated with Asperger's syndrome (AS) are commonly reported, despite these not being diagnostically significant. Cognitive Orientation to daily Occupational Performance (CO-OP) is a verbal problem-solving intervention developed for use with children with developmental coordination disorder to address their motor-based difficulties. This paper reports on two case studies of children with AS illustrating the outcomes of CO-OP to address motor-based occupational performance goals. A case study approach was used to document how two children with AS engaged in 10 weekly sessions of CO-OP addressing child-chosen motor-based occupational performance goals and the outcomes of this intervention. Pre and post-intervention assessment using the Canadian Occupational Performance Measure, Vineland Adaptive Behaviour Scales and the Performance Quality Rating Scale indicated that both children were able to engage in CO-OP intervention to successfully improve their occupational performance. Further research into the application of CO-OP with children with AS is warranted based on preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties in two children with AS.

Cooperation, Technology, and Performance: A Case Study.

ERIC Educational Resources Information Center

Cavanagh, Thomas; Dickenson, Sabrina; Brandt, Suzanne

1999-01-01

Describes the CTP (Cooperation, Technology, and Performance) model and explains how it is used by the Department of Veterans Affairs-Veteran's Benefit Administration (VBA) for training. Discusses task analysis; computer-based training; cooperative-based learning environments; technology-based learning; performance-assessment methods; courseware…

Development and Evaluation of Computerized Problem-based Learning Cases Emphasizing Basic Sciences Concepts.

ERIC Educational Resources Information Center

Abate, Marie A.; Meyer-Stout, Paula J.; Stamatakis, Mary K.; Gannett, Peter M.; Dunsworth, Teresa S.; Nardi, Anne H.

2000-01-01

Describes development and evaluation of eight computerized problem-based learning (PBL) cases in medicinal chemistry and pharmaceutics concepts. Case versions either incorporated concept maps emphasizing key ideas or did not. Student performance on quizzes did not differ between the different case versions and was similar to that of students who…

A KPI-based process monitoring and fault detection framework for large-scale processes.

PubMed

Zhang, Kai; Shardt, Yuri A W; Chen, Zhiwen; Yang, Xu; Ding, Steven X; Peng, Kaixiang

2017-05-01

Large-scale processes, consisting of multiple interconnected subprocesses, are commonly encountered in industrial systems, whose performance needs to be determined. A common approach to this problem is to use a key performance indicator (KPI)-based approach. However, the different KPI-based approaches are not developed with a coherent and consistent framework. Thus, this paper proposes a framework for KPI-based process monitoring and fault detection (PM-FD) for large-scale industrial processes, which considers the static and dynamic relationships between process and KPI variables. For the static case, a least squares-based approach is developed that provides an explicit link with least-squares regression, which gives better performance than partial least squares. For the dynamic case, using the kernel representation of each subprocess, an instrument variable is used to reduce the dynamic case to the static case. This framework is applied to the TE benchmark process and the hot strip mill rolling process. The results show that the proposed method can detect faults better than previous methods. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

Analytical study of effect of casing treatment on performance of a multistage compressor

NASA Technical Reports Server (NTRS)

Snyder, R. W.; Blade, R. J.

1972-01-01

The simulation was based on individual stage pressure and efficiency maps. These maps were modified to account for casing treatment effects on the individual stage characteristics. The individual stage maps effects on overall compressor performance were observed. The results show that to improve the performance of the compressor in its normal operating range, casing treatment of the rear stages is required.

Work-related olfactory disorder: a case series and review.

PubMed

Park, Soon Woo; Kang, Young Joong; Eom, Huisu; Cho, Hyun-Jin; Ahn, Jungho; Lee, Sang-Gil

2018-01-01

The olfactory bulb is anatomically exposed and thus can be directly damaged by external stimulation. This can occur as an occupational injury owing to contact with organic solvents or other causes. We present cases of eight patients who sustained occupation-related exposure to potentially toxic substances and later presented with signs and symptoms of anosmia. We examined the occupational and medical characteristics of the patients and evaluated their work-relatedness. Case 1: A 50-year-old man performed high-frequency heat treatments for approximately 11 years. He experienced decreased senses for olfaction and taste during the later years culminating in the diagnosis of anosmia after 3 years (high work-relatedness). Case 2: A 54-year-old man whose work involved exposure to various organic solvents, such as spray painting and application of paint and thinners for approximately 4 years, was subsequently diagnosed with anosmia based on rhinorrhea, headache, and loss of olfaction (high work-relatedness). Case 3: A 44-year-old-man who performed spray painting for approximately 17 years developed anosmia (high work-relatedness). Case 4: A 44-year-old man was involved in ship engine cleaning once a month, for approximately 7 h per cleaning session; he was diagnosed with anosmia based on loss of olfaction (low work-relatedness). Case 5: A 41-year-old man worked in ship building block construction for approximately 13 years; anosmia diagnosis was based on loss of olfaction (low work-relatedness). Case 6: A 47-year-old woman performed product inspection and labeling at a plant manufacturing automobile parts; anosmia diagnosis was based on decreased olfaction and taste (low work-relatedness). Case 7: A 50-year-old woman performed epoxy coating in a plant manufacturing automobile parts; anosmia diagnosis was based on diminishing olfaction (low work-relatedness). Case 8: A 57-year-old woman performed cleaning of the area where mobile phone parts were manufactured; anosmia diagnosis was based on diminishing olfaction (low work-relatedness). The study results confirmed work-relatedness when the subject was young, and the duration of exposure was long without any other cause of anosmia. Regarding compensation for occupational diseases, work-relatedness can be recognized as a relative concept.

Physician-owned Surgical Hospitals Outperform Other Hospitals in the Medicare Value-based Purchasing Program

PubMed Central

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-01-01

Background The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design 2015 hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Results Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC members (36.8, 95% CI 34.51, 39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index. Conclusions The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. PMID:27502368

Academic performance in a pharmacotherapeutics course sequence taught synchronously on two campuses using distance education technology.

PubMed

Steinberg, Michael; Morin, Anna K

2011-10-10

To compare the academic performance of campus-based students in a pharmacotherapeutics course with that of students at a distant campus taught via synchronous teleconferencing. Examination scores and final course grades for campus-based and distant students completing the case-based pharmacotherapeutics course sequence over a 5-year period were collected and analyzed. The mean examination scores and final course grades were not significantly different between students on the 2 campuses. The use of synchronous distance education technology to teach students does not affect students' academic performance when used in an active-learning, case-based pharmacotherapeutics course.

Physician-Owned Surgical Hospitals Outperform Other Hospitals in Medicare Value-Based Purchasing Program.

PubMed

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-10-01

The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals and creates financial incentives for quality improvement and fosters increased transparency. Limited information is available comparing hospital performance across health care business models. The 2015 Hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Of 3,089 hospitals with total performance scores, categories of representative health care business models included 104 physician-owned surgical hospitals, 111 University HealthSystem Consortium, 14 US News & World Report Honor Roll hospitals, 33 Kaiser Permanente, and 124 Pioneer accountable care organization affiliated hospitals. Estimated mean total performance scores for physician-owned surgical hospitals (64.4; 95% CI, 61.83-66.38) and Kaiser Permanente (60.79; 95% CI, 56.56-65.03) were significantly higher compared with all remaining hospitals, and University HealthSystem Consortium members (36.8; 95% CI, 34.51-39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included physician-owned surgical hospitals (mean 2.32; p < 0.0001), US News & World Report honorees (mean 2.24; p = 0.0140), and University HealthSystem Consortium members (mean 1.99; p < 0.0001), and Kaiser Permanente hospitals had lower case mix value (mean 1.54; p < 0.0001). Re-estimation of total performance scores did not change the original results after adjustment for differences in hospital case mix index. The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals can guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Congenital Heart Surgery Case Mix Across North American Centers and Impact on Performance Assessment.

PubMed

Pasquali, Sara K; Wallace, Amelia S; Gaynor, J William; Jacobs, Marshall L; O'Brien, Sean M; Hill, Kevin D; Gaies, Michael G; Romano, Jennifer C; Shahian, David M; Mayer, John E; Jacobs, Jeffrey P

2016-11-01

Performance assessment in congenital heart surgery is challenging due to the wide heterogeneity of disease. We describe current case mix across centers, evaluate methodology inclusive of all cardiac operations versus the more homogeneous subset of Society of Thoracic Surgeons benchmark operations, and describe implications regarding performance assessment. Centers (n = 119) participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 through 2014) were included. Index operation type and frequency across centers were described. Center performance (risk-adjusted operative mortality) was evaluated and classified when including the benchmark versus all eligible operations. Overall, 207 types of operations were performed during the study period (112,140 total cases). Few operations were performed across all centers; only 25% were performed at least once by 75% or more of centers. There was 7.9-fold variation across centers in the proportion of total cases comprising high-complexity cases (STAT 5). In contrast, the benchmark operations made up 36% of cases, and all but 2 were performed by at least 90% of centers. When evaluating performance based on benchmark versus all operations, 15% of centers changed performance classification; 85% remained unchanged. Benchmark versus all operation methodology was associated with lower power, with 35% versus 78% of centers meeting sample size thresholds. There is wide variation in congenital heart surgery case mix across centers. Metrics based on benchmark versus all operations are associated with strengths (less heterogeneity) and weaknesses (lower power), and lead to differing performance classification for some centers. These findings have implications for ongoing efforts to optimize performance assessment, including choice of target population and appropriate interpretation of reported metrics. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Selection of examples in case-based computer-aided decision systems

PubMed Central

Mazurowski, Maciej A.; Zurada, Jacek M.; Tourassi, Georgia D.

2013-01-01

Case-based computer-aided decision (CB-CAD) systems rely on a database of previously stored, known examples when classifying new, incoming queries. Such systems can be particularly useful since they do not need retraining every time a new example is deposited in the case base. The adaptive nature of case-based systems is well suited to the current trend of continuously expanding digital databases in the medical domain. To maintain efficiency, however, such systems need sophisticated strategies to effectively manage the available evidence database. In this paper, we discuss the general problem of building an evidence database by selecting the most useful examples to store while satisfying existing storage requirements. We evaluate three intelligent techniques for this purpose: genetic algorithm-based selection, greedy selection and random mutation hill climbing. These techniques are compared to a random selection strategy used as the baseline. The study is performed with a previously presented CB-CAD system applied for false positive reduction in screening mammograms. The experimental evaluation shows that when the development goal is to maximize the system’s diagnostic performance, the intelligent techniques are able to reduce the size of the evidence database to 37% of the original database by eliminating superfluous and/or detrimental examples while at the same time significantly improving the CAD system’s performance. Furthermore, if the case-base size is a main concern, the total number of examples stored in the system can be reduced to only 2–4% of the original database without a decrease in the diagnostic performance. Comparison of the techniques shows that random mutation hill climbing provides the best balance between the diagnostic performance and computational efficiency when building the evidence database of the CB-CAD system. PMID:18854606

Effects of an Incentive Based Budgeting System on Institutional Performance Indicators: An Exploratory Longitudinal Case Study of a Public University

ERIC Educational Resources Information Center

Willett, Michael S.

2013-01-01

The purpose of this exploratory longitudinal case study was to examine how the implementation of an Incentive Based Budgeting (IBB) system (i.e., Responsibility-Centered Management [RCM]) affected selected institutional performance indicators at the campus level and two comparable schools at a large Mid-Western public University. The value of…

Knowledge-light adaptation approaches in case-based reasoning for radiotherapy treatment planning.

PubMed

Petrovic, Sanja; Khussainova, Gulmira; Jagannathan, Rupa

2016-03-01

Radiotherapy treatment planning aims at delivering a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour-surrounding area. It is a time-consuming trial-and-error process that requires the expertise of a group of medical experts including oncologists and medical physicists and can take from 2 to 3h to a few days. Our objective is to improve the performance of our previously built case-based reasoning (CBR) system for brain tumour radiotherapy treatment planning. In this system, a treatment plan for a new patient is retrieved from a case base containing patient cases treated in the past and their treatment plans. However, this system does not perform any adaptation, which is needed to account for any difference between the new and retrieved cases. Generally, the adaptation phase is considered to be intrinsically knowledge-intensive and domain-dependent. Therefore, an adaptation often requires a large amount of domain-specific knowledge, which can be difficult to acquire and often is not readily available. In this study, we investigate approaches to adaptation that do not require much domain knowledge, referred to as knowledge-light adaptation. We developed two adaptation approaches: adaptation based on machine-learning tools and adaptation-guided retrieval. They were used to adapt the beam number and beam angles suggested in the retrieved case. Two machine-learning tools, neural networks and naive Bayes classifier, were used in the adaptation to learn how the difference in attribute values between the retrieved and new cases affects the output of these two cases. The adaptation-guided retrieval takes into consideration not only the similarity between the new and retrieved cases, but also how to adapt the retrieved case. The research was carried out in collaboration with medical physicists at the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK. All experiments were performed using real-world brain cancer patient cases treated with three-dimensional (3D)-conformal radiotherapy. Neural networks-based adaptation improved the success rate of the CBR system with no adaptation by 12%. However, naive Bayes classifier did not improve the current retrieval results as it did not consider the interplay among attributes. The adaptation-guided retrieval of the case for beam number improved the success rate of the CBR system by 29%. However, it did not demonstrate good performance for the beam angle adaptation. Its success rate was 29% versus 39% when no adaptation was performed. The obtained empirical results demonstrate that the proposed adaptation methods improve the performance of the existing CBR system in recommending the number of beams to use. However, we also conclude that to be effective, the proposed adaptation of beam angles requires a large number of relevant cases in the case base. Copyright © 2016 Elsevier B.V. All rights reserved.

A prototype case-based reasoning human assistant for space crew assessment and mission management

NASA Technical Reports Server (NTRS)

Owen, Robert B.; Holland, Albert W.; Wood, Joanna

1993-01-01

We present a prototype human assistant system for space crew assessment and mission management. Our system is based on case episodes from American and Russian space missions and analog environments such as polar stations and undersea habitats. The general domain of small groups in isolated and confined environments represents a near ideal application area for case-based reasoning (CBR) - there are few reliable rules to follow, and most domain knowledge is in the form of cases. We define the problem domain and outline a unique knowledge representation system driven by conflict and communication triggers. The prototype system is able to represent, index, and retrieve case studies of human performance. We index by social, behavioral, and environmental factors. We present the problem domain, our current implementation, our research approach for an operational system, and prototype performance and results.

Watching the clock

PubMed Central

Fetterman, J. Gregor; Killeen, Peter R.; Hall, Scott

2008-01-01

Four rats and four pigeons were monitored while performing retrospective timing tasks. All animals displayed collateral behaviors which could have mediated their temporal judgements. Statistical analysis made a good case for such mediation in the case of two pigeons performing on a spatially-differentiated response, but not for the two responding on a color-differentiated response. For the rats, all of which performed on a spatially-differentiated task, prediction of their temporal judgements was always better if based on collateral activity than if based on the passage of time. PMID:19701487

Effects of a Case-Based Reasoning System on Student Performance in a Java Programming Course

ERIC Educational Resources Information Center

Schmidt, Cecil

2007-01-01

The purpose of this study was to determine if a case-based reasoning tool would improve a student's understanding of the complex concepts in a Java programming course. Subjects for the study were randomly assigned from two sections of an introductory Java programming course. Posttests were used to measure the effects of the case-based reasoning…

The impact of case specificity and generalisable skills on clinical performance: a correlated traits-correlated methods approach.

PubMed

Wimmers, Paul F; Fung, Cha-Chi

2008-06-01

The finding of case or content specificity in medical problem solving moved the focus of research away from generalisable skills towards the importance of content knowledge. However, controversy about the content dependency of clinical performance and the generalisability of skills remains. This study aimed to explore the relative impact of both perspectives (case specificity and generalisable skills) on different components (history taking, physical examination, communication) of clinical performance within and across cases. Data from a clinical performance examination (CPX) taken by 350 Year 3 students were used in a correlated traits-correlated methods (CTCM) approach using confirmatory factor analysis, whereby 'traits' refers to generalisable skills and 'methods' to individual cases. The baseline CTCM model was analysed and compared with four nested models using structural equation modelling techniques. The CPX consisted of three skills components and five cases. Comparison of the four different models with the least-restricted baseline CTCM model revealed that a model with uncorrelated generalisable skills factors and correlated case-specific knowledge factors represented the data best. The generalisable processes found in history taking, physical examination and communication were responsible for half the explained variance, in comparison with the variance related to case specificity. Conclusions Pure knowledge-based and pure skill-based perspectives on clinical performance both seem too one-dimensional and new evidence supports the idea that a substantial amount of variance contributes to both aspects of performance. It could be concluded that generalisable skills and specialised knowledge go hand in hand: both are essential aspects of clinical performance.

An AUC-based permutation variable importance measure for random forests

PubMed Central

2013-01-01

Background The random forest (RF) method is a commonly used tool for classification with high dimensional data as well as for ranking candidate predictors based on the so-called random forest variable importance measures (VIMs). However the classification performance of RF is known to be suboptimal in case of strongly unbalanced data, i.e. data where response class sizes differ considerably. Suggestions were made to obtain better classification performance based either on sampling procedures or on cost sensitivity analyses. However to our knowledge the performance of the VIMs has not yet been examined in the case of unbalanced response classes. In this paper we explore the performance of the permutation VIM for unbalanced data settings and introduce an alternative permutation VIM based on the area under the curve (AUC) that is expected to be more robust towards class imbalance. Results We investigated the performance of the standard permutation VIM and of our novel AUC-based permutation VIM for different class imbalance levels using simulated data and real data. The results suggest that the new AUC-based permutation VIM outperforms the standard permutation VIM for unbalanced data settings while both permutation VIMs have equal performance for balanced data settings. Conclusions The standard permutation VIM loses its ability to discriminate between associated predictors and predictors not associated with the response for increasing class imbalance. It is outperformed by our new AUC-based permutation VIM for unbalanced data settings, while the performance of both VIMs is very similar in the case of balanced classes. The new AUC-based VIM is implemented in the R package party for the unbiased RF variant based on conditional inference trees. The codes implementing our study are available from the companion website: http://www.ibe.med.uni-muenchen.de/organisation/mitarbeiter/070_drittmittel/janitza/index.html. PMID:23560875

An AUC-based permutation variable importance measure for random forests.

PubMed

Janitza, Silke; Strobl, Carolin; Boulesteix, Anne-Laure

2013-04-05

The random forest (RF) method is a commonly used tool for classification with high dimensional data as well as for ranking candidate predictors based on the so-called random forest variable importance measures (VIMs). However the classification performance of RF is known to be suboptimal in case of strongly unbalanced data, i.e. data where response class sizes differ considerably. Suggestions were made to obtain better classification performance based either on sampling procedures or on cost sensitivity analyses. However to our knowledge the performance of the VIMs has not yet been examined in the case of unbalanced response classes. In this paper we explore the performance of the permutation VIM for unbalanced data settings and introduce an alternative permutation VIM based on the area under the curve (AUC) that is expected to be more robust towards class imbalance. We investigated the performance of the standard permutation VIM and of our novel AUC-based permutation VIM for different class imbalance levels using simulated data and real data. The results suggest that the new AUC-based permutation VIM outperforms the standard permutation VIM for unbalanced data settings while both permutation VIMs have equal performance for balanced data settings. The standard permutation VIM loses its ability to discriminate between associated predictors and predictors not associated with the response for increasing class imbalance. It is outperformed by our new AUC-based permutation VIM for unbalanced data settings, while the performance of both VIMs is very similar in the case of balanced classes. The new AUC-based VIM is implemented in the R package party for the unbiased RF variant based on conditional inference trees. The codes implementing our study are available from the companion website: http://www.ibe.med.uni-muenchen.de/organisation/mitarbeiter/070_drittmittel/janitza/index.html.

Weather-based prediction of Plasmodium falciparum malaria in epidemic-prone regions of Ethiopia II. Weather-based prediction systems perform comparably to early detection systems in identifying times for interventions.

PubMed

Teklehaimanot, Hailay D; Schwartz, Joel; Teklehaimanot, Awash; Lipsitch, Marc

2004-11-19

Timely and accurate information about the onset of malaria epidemics is essential for effective control activities in epidemic-prone regions. Early warning methods that provide earlier alerts (usually by the use of weather variables) may permit control measures to interrupt transmission earlier in the epidemic, perhaps at the expense of some level of accuracy. Expected case numbers were modeled using a Poisson regression with lagged weather factors in a 4th-degree polynomial distributed lag model. For each week, the numbers of malaria cases were predicted using coefficients obtained using all years except that for which the prediction was being made. The effectiveness of alerts generated by the prediction system was compared against that of alerts based on observed cases. The usefulness of the prediction system was evaluated in cold and hot districts. The system predicts the overall pattern of cases well, yet underestimates the height of the largest peaks. Relative to alerts triggered by observed cases, the alerts triggered by the predicted number of cases performed slightly worse, within 5% of the detection system. The prediction-based alerts were able to prevent 10-25% more cases at a given sensitivity in cold districts than in hot ones. The prediction of malaria cases using lagged weather performed well in identifying periods of increased malaria cases. Weather-derived predictions identified epidemics with reasonable accuracy and better timeliness than early detection systems; therefore, the prediction of malarial epidemics using weather is a plausible alternative to early detection systems.

The 1992-1993 advanced design program. Part 1: The Mars methane engine project. Part 2: The Mars oxygen processor new furnace

NASA Astrophysics Data System (ADS)

Lauer, Stephen; Hoover, Scott; Lawrence, Lori; Paparistodemou, Christos; Taylor, Doug

1993-04-01

Three constituents of the Martian atmosphere, methane, carbon dioxide, and oxygen, can be used for internal combustion in engines utilized for future space exploration on Mars. These three gases, considered as the test case in this research, will be examined to determine required flow rates needed for combustion and optimization of engine performance. Results of the test case are examined in relation to a base case of methane and air for comparative purposes. Testing of exhaust temperatures, cylinder pressure, and exhaust gas analysis were performed for the base case and test case. Also described is a study utilizing a zirconia cell to convert carbon dioxide into usable oxygen to help support future Mars missions.

The 1992-1993 advanced design program. Part 1: The Mars methane engine project. Part 2: The Mars oxygen processor new furnace

NASA Technical Reports Server (NTRS)

Lauer, Stephen; Hoover, Scott; Lawrence, Lori; Paparistodemou, Christos; Taylor, Doug

1993-01-01

Three constituents of the Martian atmosphere, methane, carbon dioxide, and oxygen, can be used for internal combustion in engines utilized for future space exploration on Mars. These three gases, considered as the test case in this research, will be examined to determine required flow rates needed for combustion and optimization of engine performance. Results of the test case are examined in relation to a base case of methane and air for comparative purposes. Testing of exhaust temperatures, cylinder pressure, and exhaust gas analysis were performed for the base case and test case. Also described is a study utilizing a zirconia cell to convert carbon dioxide into usable oxygen to help support future Mars missions.

Fuel Cycle Analysis Framework Base Cases for the IAEA/INPRO GAINS Collaborative Project

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

Brent Dixon

Thirteen countries participated in the Collaborative Project GAINS “Global Architecture of Innovative Nuclear Energy Systems Based on Thermal and Fast Reactors Including a Closed Fuel Cycle”, which was the primary activity within the IAEA/INPRO Program Area B: “Global Vision on Sustainable Nuclear Energy” for the last three years. The overall objective of GAINS was to develop a standard framework for assessing future nuclear energy systems taking into account sustainable development, and to validate results through sample analyses. This paper details the eight scenarios that constitute the GAINS framework base cases for analysis of the transition to future innovative nuclear energymore » systems. The framework base cases provide a reference for users of the framework to start from in developing and assessing their own alternate systems. Each base case is described along with performance results against the GAINS sustainability evaluation metrics. The eight cases include four using a moderate growth projection and four using a high growth projection for global nuclear electricity generation through 2100. The cases are divided into two sets, addressing homogeneous and heterogeneous scenarios developed by GAINS to model global fuel cycle strategies. The heterogeneous world scenario considers three separate nuclear groups based on their fuel cycle strategies, with non-synergistic and synergistic cases. The framework base case analyses results show the impact of these different fuel cycle strategies while providing references for future users of the GAINS framework. A large number of scenario alterations are possible and can be used to assess different strategies, different technologies, and different assumptions about possible futures of nuclear power. Results can be compared to the framework base cases to assess where these alternate cases perform differently versus the sustainability indicators.« less

Can a totally different approach to soft tissue computer aided detection (CADe) result in affecting radiologists' decisions?

NASA Astrophysics Data System (ADS)

Gur, David

2018-03-01

We tested whether a case based CADe scheme, developed only on negatively interpreted screening mammograms, has predictive value for cancer detection during subsequent screening and how this approach may affect radiologists' performances when alerting them to a small subset ( 15%) of exams on which radiologists tend to miss cancers. A series of six parameters case based CADe schemes, using 200 negative mammograms (800 images 100 women with breast cancer at subsequent screening and 100 women who remained negative), carefully matched by age and breast density, were optimized. CADe alone schemes performed at AUC=0.68 (+/- 0.01). Five radiologists and 4 residents interpreted the same cases and performed at AUC =0.71 (experienced radiologists) and AUC= 0.61 (residents). With the "CADe warnings" shown to the interpreters only if they did not recall one of 24 highest CADe scoring cases, assisted performance of radiologists and residents respectively, were 0.71 and 0.63 (p>0.05). However, when the CADe alone performance was raised to an AUC=0.78, by artificially increasing the number of possible warnings from 16 to 24, radiologists' performances significantly improved from an AUC of 0.68 to 0.72 (p<0.05). In conclusion, the use case based information other than breast density could highlight a small fraction of women whose cancers are more likely to be missed by radiologists and later detected during subsequent mammograms, thereby, leading to an assisted approach that improves radiologists' performances. However, to be effective, the performance of the CADe alone should be substantially higher (e.g. ΔAUC >=0.07) than that of the un-assisted radiologist.

Performance Prediction of a MongoDB-Based Traceability System in Smart Factory Supply Chains

PubMed Central

Kang, Yong-Shin; Park, Il-Ha; Youm, Sekyoung

2016-01-01

In the future, with the advent of the smart factory era, manufacturing and logistics processes will become more complex, and the complexity and criticality of traceability will further increase. This research aims at developing a performance assessment method to verify scalability when implementing traceability systems based on key technologies for smart factories, such as Internet of Things (IoT) and BigData. To this end, based on existing research, we analyzed traceability requirements and an event schema for storing traceability data in MongoDB, a document-based Not Only SQL (NoSQL) database. Next, we analyzed the algorithm of the most representative traceability query and defined a query-level performance model, which is composed of response times for the components of the traceability query algorithm. Next, this performance model was solidified as a linear regression model because the response times increase linearly by a benchmark test. Finally, for a case analysis, we applied the performance model to a virtual automobile parts logistics. As a result of the case study, we verified the scalability of a MongoDB-based traceability system and predicted the point when data node servers should be expanded in this case. The traceability system performance assessment method proposed in this research can be used as a decision-making tool for hardware capacity planning during the initial stage of construction of traceability systems and during their operational phase. PMID:27983654

Performance Prediction of a MongoDB-Based Traceability System in Smart Factory Supply Chains.

PubMed

Kang, Yong-Shin; Park, Il-Ha; Youm, Sekyoung

2016-12-14

In the future, with the advent of the smart factory era, manufacturing and logistics processes will become more complex, and the complexity and criticality of traceability will further increase. This research aims at developing a performance assessment method to verify scalability when implementing traceability systems based on key technologies for smart factories, such as Internet of Things (IoT) and BigData. To this end, based on existing research, we analyzed traceability requirements and an event schema for storing traceability data in MongoDB, a document-based Not Only SQL (NoSQL) database. Next, we analyzed the algorithm of the most representative traceability query and defined a query-level performance model, which is composed of response times for the components of the traceability query algorithm. Next, this performance model was solidified as a linear regression model because the response times increase linearly by a benchmark test. Finally, for a case analysis, we applied the performance model to a virtual automobile parts logistics. As a result of the case study, we verified the scalability of a MongoDB-based traceability system and predicted the point when data node servers should be expanded in this case. The traceability system performance assessment method proposed in this research can be used as a decision-making tool for hardware capacity planning during the initial stage of construction of traceability systems and during their operational phase.

Impact of Virtual Patients as Optional Learning Material in Veterinary Biochemistry Education.

PubMed

Kleinsorgen, Christin; von Köckritz-Blickwede, Maren; Naim, Hassan Y; Branitzki-Heinemann, Katja; Kankofer, Marta; Mándoki, Míra; Adler, Martin; Tipold, Andrea; Ehlers, Jan P

2018-01-01

Biochemistry and physiology teachers from veterinary faculties in Hannover, Budapest, and Lublin prepared innovative, computer-based, integrative clinical case scenarios as optional learning materials for teaching and learning in basic sciences. These learning materials were designed to enhance attention and increase interest and intrinsic motivation for learning, thus strengthening autonomous, active, and self-directed learning. We investigated learning progress and success by administering a pre-test before exposure to the virtual patients (vetVIP) cases, offered vetVIP cases alongside regular biochemistry courses, and then administered a complementary post-test. We analyzed improvement in cohort performance and level of confidence in rating questions. Results of the performance in biochemistry examinations in 2014, 2015, and 2016 were correlated with the use of and performance in vetVIP cases throughout biochemistry courses in Hannover. Surveys of students reflected that interactive cases helped them understand the relevance of basic sciences in veterinary education. Differences between identical pre- and post-tests revealed knowledge improvement (correct answers: +28% in Hannover, +9% in Lublin) and enhanced confidence in decision making ("I don't know" answers: -20% in Hannover, -7.5% in Lublin). High case usage and voluntary participation (use of vetVIP cases in Hannover and Lublin >70%, Budapest <1%; response rates in pre-test 72% and post-test 48%) indicated a good increase in motivation for the subject of biochemistry. Despite increased motivation, there was only a weak correlation between performance in final exams and performance in the vetVIP cases. Case-based e-learning could be extended and generated cases should be shared across veterinary faculties.

Piloting case-based instruction in a didactic clinical immunology course.

PubMed

Hoag, Kathleen; Lillie, Janet; Hoppe, Ruth

2005-01-01

To assess (1) the effect of case-based instructional modules on student critical thinking, class attendance, and satisfaction and (2) student opinion of case formats. University-based upper division course in clinical immunology and serology. The course was taught by the same instructor for two consecutive semesters with the intervention introduced in the second semester. Sixty-seven students experienced the intervention and 56 students were in the baseline cohort. Nine cases were interspersed between lectures during the semester. Each case took one 50-minute class in which students worked in groups of five or six. Student performance on five critical thinking multiple-choice examination questions and percent student attendance on case days versus lecture days were analyzed using the Mann-Whitney test. Student ratings on course evaluations were analyzed using t-test comparing semesters with and without intervention. Student opinion of cases was obtained through surveys and a focus group. Student performance on critical thinking exam questions was similar in the two groups. Student attendance was significantly higher on case days (95.6%) versus lecture days (80.3%; p < 0.0001). Only composite ratings for instructor involvement, student-instructor interaction, and course organization were significantly improved in the semester with cases compared to the semester with lecture only (p < 0.0001 for all indices). Although case studies did not significantly improve student performance on critical thinking questions, they still proved to be a valuable instructional method. Student attendance, student-instructor interaction, and instructor involvement in the course were all positively affected by incorporation of case studies. Discussion of cases also helped to uncover student misconceptions of course material.

Comparison of three problem-based learning conditions (real patients, digital and paper) with lecture-based learning in a dermatology course: a prospective randomized study from China.

PubMed

Li, Jie; Li, Qing Ling; Li, Ji; Chen, Ming Liang; Xie, Hong Fu; Li, Ya Ping; Chen, Xiang

2013-01-01

The precise effect and the quality of different cases used in dermatology problem-based learning (PBL) curricula are yet unclear. To prospectively compare the impact of real patients, digital, paper PBL (PPBL) and traditional lecture-based learning (LBL) on academic results and student perceptions. A total of 120 students were randomly allocated into either real-patients PBL (RPBL) group studied via real-patient cases, digital PBL (DPBL) group studied via digital-form cases, PPBL group studied via paper-form cases, or conventional group who received didactic lectures. Academic results were assessed through review of written examination, objective structured clinical examination and student performance scores. A five-point Likert scale questionnaire was used to evaluate student perceptions. Compared to those receiving lectures only, all PBL participants had better results for written examination, clinical examination and overall performance. Students in RPBL group exhibited better overall performance than those in the other two PBL groups. Real-patient cases were more effective in helping develop students' self-directed learning skills, improving their confidence in future patient encounters and encouraging them to learn more about the discussed condition, compared to digital and paper cases. Both real patient and digital triggers are helpful in improving students' clinical problem-handling skills. However, real patients provide greater benefits to students.

Work, Productivity, and Human Performance: Practical Case Studies in Ergonomics, Human Factors and Human Engineering.

ERIC Educational Resources Information Center

Fraser, T. M.; Pityn, P. J.

This book contains 12 case histories, each based on a real-life problem, that show how a manager can use common sense, knowledge, and interpersonal skills to solve problems in human performance at work. Each case study describes a worker's problem and provides background information and an assignment; solutions are suggested. The following cases…

Performance-based classrooms: A case study of two elementary teachers of mathematics and science

NASA Astrophysics Data System (ADS)

Jones, Kenneth W.

This case study depicts how two elementary teachers develop classrooms devoted to performance-based instruction in mathematics and science. The purpose is to develop empirical evidence of classroom practices that leads to a conceptual framework about the nature of performance-based instruction. Performance-based assessment and instruction are defined from the literature to entail involving students in tasks that are complex and engaging, requiring them to apply knowledge and skills in authentic contexts. In elementary mathematics and science, such an approach emphasizes problem solving, exploration, inquiry, and reasoning. The body of the work examines teacher beliefs, curricular orientations, instructional strategies, assessment approaches, management and organizational skills, and interpersonal relationships. The focus throughout is on those aspects that foster student performance in elementary mathematics and science. The resulting framework describes five characteristics that contribute to performance-based classrooms: a caring classroom community, a connectionist learning theory, a thinking and doing curriculum, diverse opportunities for learning, and ongoing assessment, feedback, and adjustment. The conclusion analyzes factors external to the classroom that support or constrain the development of performance-based classrooms and discusses the implications for educational policy and further research.

Individualised training to address variability of radiologists' performance

NASA Astrophysics Data System (ADS)

Sun, Shanghua; Taylor, Paul; Wilkinson, Louise; Khoo, Lisanne

2008-03-01

Computer-based tools are increasingly used for training and the continuing professional development of radiologists. We propose an adaptive training system to support individualised learning in mammography, based on a set of real cases, which are annotated with educational content by experienced breast radiologists. The system has knowledge of the strengths and weakness of each radiologist's performance: each radiologist is assessed to compute a profile showing how they perform on different sets of cases, classified by type of abnormality, breast density, and perceptual difficulty. We also assess variability in cognitive aspects of image perception, classifying errors made by radiologists as errors of search, recognition or decision. This is a novel element in our approach. The profile is used to select cases to present to the radiologist. The intelligent and flexible presentation of these cases distinguishes our system from existing training tools. The training cases are organised and indexed by an ontology we have developed for breast radiologist training, which is consistent with the radiologists' profile. Hence, the training system is able to select appropriate cases to compose an individualised training path, addressing the variability of the radiologists' performance. A substantial part of the system, the ontology has been evaluated on a large number of cases, and the training system is under implementation for further evaluation.

Worked Examples Leads to Better Performance in Analyzing and Solving Real-Life Decision Cases

ERIC Educational Resources Information Center

Cevik, Yasemin Demiraslan; Andre, Thomas

2012-01-01

This study compared the impact of three types of case-based methods (worked example, faded worked example, and case-based reasoning) on preservice teachers' (n=71) decision making and reasoning related to realistic classroom management situations. Participants in this study received a short-term implementation of one of these three major…

An Evaluation of Gender Differences in Computer-Based Case Simulations.

ERIC Educational Resources Information Center

Scheuneman, Janice Dowd; And Others

As part of the research leading to the implementation of computer-based case simulations (CCS) for the licensing examinations of the National Board of Medical Examiners, gender differences in performance were studied for one form consisting of 18 cases. A secondary purpose of the study was to note differences in style or approach that might…

A Case for Competencies: Assessing the Value of Trait-Based Performance Appraisal for Non-Faculty University Employees

ERIC Educational Resources Information Center

Messa, Emily A.; Horn, Catherine L.; Longacre, Teri Elkins; Olenchak, F. Richard; Penney, Lisa M.

2016-01-01

A case study analyzed how supervisors at one university selected competencies, or trait-based skills, for non-faculty employees. This case study provides a valuable contribution by focusing on employees at one institution type--a large, public research university. While it has been documented that non-faculty employees provide important…

Improving classification with forced labeling of other related classes: application to prediction of upstaged ductal carcinoma in situ using mammographic features

NASA Astrophysics Data System (ADS)

Hou, Rui; Shi, Bibo; Grimm, Lars J.; Mazurowski, Maciej A.; Marks, Jeffrey R.; King, Lorraine M.; Maley, Carlo C.; Hwang, E. Shelley; Lo, Joseph Y.

2018-02-01

Predicting whether ductal carcinoma in situ (DCIS) identified at core biopsy contains occult invasive disease is an import task since these "upstaged" cases will affect further treatment planning. Therefore, a prediction model that better classifies pure DCIS and upstaged DCIS can help avoid overtreatment and overdiagnosis. In this work, we propose to improve this classification performance with the aid of two other related classes: Atypical Ductal Hyperplasia (ADH) and Invasive Ductal Carcinoma (IDC). Our data set contains mammograms for 230 cases. Specifically, 66 of them are ADH cases; 99 of them are biopsy-proven DCIS cases, of whom 25 were found to contain invasive disease at the time of definitive surgery. The remaining 65 cases were diagnosed with IDC at core biopsy. Our hypothesis is that knowledge can be transferred from training with the easier and more readily available cases of benign but suspicious ADH versus IDC that is already apparent at initial biopsy. Thus, embedding both ADH and IDC cases to the classifier will improve the performance of distinguishing upstaged DCIS from pure DCIS. We extracted 113 mammographic features based on a radiologist's annotation of clusters.Our method then added both ADH and IDC cases during training, where ADH were "force labeled" or treated by the classifier as pure DCIS (negative) cases, and IDC were labeled as upstaged DCIS (positive) cases. A logistic regression classifier was built based on the designed training dataset to perform a prediction of whether biopsy-proven DCIS cases contain invasive cancer. The performance was assessed by repeated 5-fold CrossValidation and Receiver Operating Characteristic(ROC) curve analysis. While prediction performance with only training on DCIS dataset had an average AUC of 0.607(%95CI, 0.479-0.721). By adding both ADH and IDC cases for training, we improved the performance to 0.691(95%CI, 0.581-0.801).

Neurocognitive performance in family-based and case-control studies of schizophrenia.

PubMed

Gur, Ruben C; Braff, David L; Calkins, Monica E; Dobie, Dorcas J; Freedman, Robert; Green, Michael F; Greenwood, Tiffany A; Lazzeroni, Laura C; Light, Gregory A; Nuechterlein, Keith H; Olincy, Ann; Radant, Allen D; Seidman, Larry J; Siever, Larry J; Silverman, Jeremy M; Sprock, Joyce; Stone, William S; Sugar, Catherine A; Swerdlow, Neal R; Tsuang, Debby W; Tsuang, Ming T; Turetsky, Bruce I; Gur, Raquel E

2015-04-01

Neurocognitive deficits in schizophrenia (SZ) are established and the Consortium on the Genetics of Schizophrenia (COGS) investigated such measures as endophenotypes in family-based (COGS-1) and case-control (COGS-2) studies. By requiring family participation, family-based sampling may result in samples that vary demographically and perform better on neurocognitive measures. The Penn computerized neurocognitive battery (CNB) evaluates accuracy and speed of performance for several domains and was administered across sites in COGS-1 and COGS-2. Most tests were included in both studies. COGS-1 included 328 patients with SZ and 497 healthy comparison subjects (HCS) and COGS-2 included 1195 patients and 1009 HCS. Demographically, COGS-1 participants were younger, more educated, with more educated parents and higher estimated IQ compared to COGS-2 participants. After controlling for demographics, the two samples produced very similar performance profiles compared to their respective controls. As expected, performance was better and with smaller effect sizes compared to controls in COGS-1 relative to COGS-2. Better performance was most pronounced for spatial processing while emotion identification had large effect sizes for both accuracy and speed in both samples. Performance was positively correlated with functioning and negatively with negative and positive symptoms in both samples, but correlations were attenuated in COGS-2, especially with positive symptoms. Patients ascertained through family-based design have more favorable demographics and better performance on some neurocognitive domains. Thus, studies that use case-control ascertainment may tap into populations with more severe forms of illness that are exposed to less favorable factors compared to those ascertained with family-based designs.

Influence of case-based e-learning on students' performance in point-of-care ultrasound courses: a randomized trial.

PubMed

Hempel, Dorothea; Sinnathurai, Sivajini; Haunhorst, Stephanie; Seibel, Armin; Michels, Guido; Heringer, Frank; Recker, Florian; Breitkreutz, Raoul

2016-08-01

Theoretical knowledge, visual perception, and sensorimotor skills are key elements in ultrasound education. Classroom-based presentations are used routinely to teach theoretical knowledge, whereas visual perception and sensorimotor skills typically require hands-on training (HT). We aimed to compare the effect of classroom-based lectures versus a case-based e-learning (based on clinical cases only) on the hands-on performance of trainees during an emergency ultrasound course. This is a randomized, controlled, parallel-group study. Sixty-two medical students were randomized into two groups [group 1 (G1) and group 2 (G2)]. G1 (n=29) was subjected to a precourse e-learning, based on 14 short screencasts (each 5 min), an on-site discussion (60 min), and a standardized HT session on the day of the course. G2 (n=31) received classroom-based presentations on the day of the course before an identical HT session. Both groups completed a multiple-choice (MC) pretest (test A), a practical postcourse test (objective structured clinical exam), and MC tests directly after the HT (test B) and 1 day after the course (test C). The Mann-Whitney U-test was used for statistical analysis. G1 performed markedly better in test A (median 84.2, 25%; 75% percentile: 68.5; 92.2) compared with G2 (65.8; 53.8; 80.4), who had not participated in case-based e-learning (P=0.0009). No differences were found in the objective structured clinical exam, test B, and test C. e-learning exclusively based on clinical cases is an effective method of education in preparation for HT sessions and can reduce attendance time in ultrasound courses.

A balanced perspective: using nonfinancial measures to assess financial performance.

PubMed

Watkins, Ann L

2003-11-01

Assessments of hospitals' financial performance have traditionally been based exclusively on analysis of a concise set of key financial ratios. One study, however, demonstrates that analysis of a hospital's financial condition can be significantly enhanced with the addition of several nonfinancial measures, including case-mix adjusted admissions, case-mix adjusted admissions per full-time equivalent, and case-mix adjusted admissions per beds in service.

Early antibiotic treatment for BAL-confirmed ventilator-associated pneumonia: a role for routine endotracheal aspirate cultures.

PubMed

Michel, Fabrice; Franceschini, Bruno; Berger, Pierre; Arnal, Jean-Michel; Gainnier, Marc; Sainty, Jean-Marie; Papazian, Laurent

2005-02-01

To test whether routine quantitative cultures of endotracheal aspirates obtained before the onset of ventilator-associated pneumonia (VAP) could help to predict the causative microorganisms and to select early appropriate antimicrobial therapy before obtaining BAL culture results. Prospective observational study. French medical ICU. A total of 299 patients received mechanical ventilation for at least 48 h. Endotracheal aspiration (EA) was performed twice weekly in all mechanically ventilated patients. A diagnosis of VAP was made by BAL culture. Only the EA performed just before the suspicion of VAP (EA-pre) were evaluated. This strategy (ie, the EA-pre-based strategy) was compared with an antibiotic therapy that would have been prescribed if the recommendations of both the American Thoracic Society (ATS) and Trouillet et al (Am J Respir Crit Care Med 1998; 157:531-539) had been applied. VAP was diagnosed (by BAL culture) in 41 of the 75 patients in whom BAL was performed. Among the 41 BAL specimens that were positive for VAP, EA-pre had identified the same microorganisms (with the same antibiotic resistance patterns) in 34 cases (83%). In one case, EA-pre was not available at the time BAL was performed (a case of early-onset VAP), but the empiric antibiotic therapy was adequate. While EA-pre did not give the same results as the BAL culture, the antibiotic therapy based on the results of the EA-pre was adequate in four other cases. Finally, antibiotic therapy was delayed in only two cases. Antibiotic treatment was therefore adequate in 38 of the 40 assessable cases (95%). If the Trouillet-based strategy had been used, the antibiotic treatment would have been adequate in 34 of the 41 cases (83%; p = 0.15 [vs EA-pre strategy]). Based on the ATS classification, the antibiotic treatment would have been adequately prescribed in only 28 of the 41 cases (68%; p = 0.005 [vs EA-pre strategy]). Routine EA performed twice a week makes it possible to prescribe adequate antibiotic therapy (while waiting for BAL culture results) in 95% of the patients in whom a VAP is ultimately diagnosed by BAL culture.

Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the "palliative care trial" [ISRCTN 81117481].

PubMed

Abernethy, Amy P; Currow, David C; Shelby-James, Tania; Rowett, Debra; May, Frank; Samsa, Gregory P; Hunt, Roger; Williams, Helena; Esterman, Adrian; Phillips, Paddy A

2013-03-01

Evidence-based approaches are needed to improve the delivery of specialized palliative care. The aim of this trial was to improve on current models of service provision. This 2×2×2 factorial cluster randomized controlled trial was conducted at an Australian community-based palliative care service, allowing three simultaneous comparative effectiveness studies. Participating patients were newly referred adults, experiencing pain, and who were expected to live >48 hours. Patients enrolled with their general practitioners (GPs) and were randomized three times: 1) individualized interdisciplinary case conference including their GP vs. control, 2) educational outreach visiting for GPs about pain management vs. control, and 3) structured educational visiting for patients/caregivers about pain management vs. control. The control condition was current palliative care. Outcomes included Australia-modified Karnofsky Performance Status (AKPS) and pain from 60 days after randomization and hospitalizations. There were 461 participants: mean age 71 years, 50% male, 91% with cancer, median survival 179 days, and median baseline AKPS 60. Only 47% of individuals randomized to the case conferencing intervention received it; based on a priori-defined analyses, 32% of participants were included in final analyses. Case conferencing reduced hospitalizations by 26% (least squares means hospitalizations per patient: case conference 1.26 [SE 0.10] vs. control 1.70 [SE 0.13], P=0.0069) and better maintained performance status (AKPS case conferences 57.3 [SE 1.5] vs. control 51.7 [SE 2.3], P=0.0368). Among patients with declining function (AKPS <70), case conferencing and patient/caregiver education better maintained performance status (AKPS case conferences 55.0 [SE 2.1] vs. control 46.5 [SE 2.9], P=0.0143; patient/caregiver education 54.7 [SE 2.8] vs. control 46.8 [SE 2.1], P=0.0206). Pain was unchanged. GP education did not change outcomes. A single case conference added to current specialized community-based palliative care reduced hospitalizations and better maintained performance status. Comparatively, patient/caregiver education was less effective; GP education was not effective. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

BIPV: a real-time building performance study for a roof-integrated facility

NASA Astrophysics Data System (ADS)

Aaditya, Gayathri; Mani, Monto

2018-03-01

Building integrated photovoltaic system (BIPV) is a photovoltaic (PV) integration that generates energy and serves as a building envelope. A building element (e.g. roof and wall) is based on its functional performance, which could include structure, durability, maintenance, weathering, thermal insulation, acoustics, and so on. The present paper discusses the suitability of PV as a building element in terms of thermal performance based on a case study of a 5.25 kWp roof-integrated BIPV system in tropical regions. Performance of PV has been compared with conventional construction materials and various scenarios have been simulated to understand the impact on occupant comfort levels. In the current case study, PV as a roofing material has been shown to cause significant thermal discomfort to the occupants. The study has been based on real-time data monitoring supported by computer-based building simulation model.

SU-D-BRD-01: Cloud-Based Radiation Treatment Planning: Performance Evaluation of Dose Calculation and Plan Optimization

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

Na, Y; Kapp, D; Kim, Y

2014-06-01

Purpose: To report the first experience on the development of a cloud-based treatment planning system and investigate the performance improvement of dose calculation and treatment plan optimization of the cloud computing platform. Methods: A cloud computing-based radiation treatment planning system (cc-TPS) was developed for clinical treatment planning. Three de-identified clinical head and neck, lung, and prostate cases were used to evaluate the cloud computing platform. The de-identified clinical data were encrypted with 256-bit Advanced Encryption Standard (AES) algorithm. VMAT and IMRT plans were generated for the three de-identified clinical cases to determine the quality of the treatment plans and computationalmore » efficiency. All plans generated from the cc-TPS were compared to those obtained with the PC-based TPS (pc-TPS). The performance evaluation of the cc-TPS was quantified as the speedup factors for Monte Carlo (MC) dose calculations and large-scale plan optimizations, as well as the performance ratios (PRs) of the amount of performance improvement compared to the pc-TPS. Results: Speedup factors were improved up to 14.0-fold dependent on the clinical cases and plan types. The computation times for VMAT and IMRT plans with the cc-TPS were reduced by 91.1% and 89.4%, respectively, on average of the clinical cases compared to those with pc-TPS. The PRs were mostly better for VMAT plans (1.0 ≤ PRs ≤ 10.6 for the head and neck case, 1.2 ≤ PRs ≤ 13.3 for lung case, and 1.0 ≤ PRs ≤ 10.3 for prostate cancer cases) than for IMRT plans. The isodose curves of plans on both cc-TPS and pc-TPS were identical for each of the clinical cases. Conclusion: A cloud-based treatment planning has been setup and our results demonstrate the computation efficiency of treatment planning with the cc-TPS can be dramatically improved while maintaining the same plan quality to that obtained with the pc-TPS. This work was supported in part by the National Cancer Institute (1R01 CA133474) and by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (MSIP) (Grant No.2009-00420)« less

Case-Mix Adjusting Performance Measures in a Veteran Population: Pharmacy- and Diagnosis-Based Approaches

PubMed Central

Liu, Chuan-Fen; Sales, Anne E; Sharp, Nancy D; Fishman, Paul; Sloan, Kevin L; Todd-Stenberg, Jeff; Nichol, W Paul; Rosen, Amy K; Loveland, Susan

2003-01-01

Objective To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. Data Sources/Study Setting The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. Study Design We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Principal Findings Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. Conclusions Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility. PMID:14596393

Low noise WDR ROIC for InGaAs SWIR image sensor

NASA Astrophysics Data System (ADS)

Ni, Yang

2017-11-01

Hybridized image sensors are actually the only solution for image sensing beyond the spectral response of silicon devices. By hybridization, we can combine the best sensing material and photo-detector design with high performance CMOS readout circuitry. In the infrared band, we are facing typically 2 configurations: high background situation and low background situation. The performance of high background sensors are conditioned mainly by the integration capacity in each pixel which is the case for mid-wave and long-wave infrared detectors. For low background situation, the detector's performance is mainly limited by the pixel's noise performance which is conditioned by dark signal and readout noise. In the case of reflection based imaging condition, the pixel's dynamic range is also an important parameter. This is the case for SWIR band imaging. We are particularly interested by InGaAs based SWIR image sensors.

Combining knowledge discovery from databases (KDD) and case-based reasoning (CBR) to support diagnosis of medical images

NASA Astrophysics Data System (ADS)

Stranieri, Andrew; Yearwood, John; Pham, Binh

1999-07-01

The development of data warehouses for the storage and analysis of very large corpora of medical image data represents a significant trend in health care and research. Amongst other benefits, the trend toward warehousing enables the use of techniques for automatically discovering knowledge from large and distributed databases. In this paper, we present an application design for knowledge discovery from databases (KDD) techniques that enhance the performance of the problem solving strategy known as case- based reasoning (CBR) for the diagnosis of radiological images. The problem of diagnosing the abnormality of the cervical spine is used to illustrate the method. The design of a case-based medical image diagnostic support system has three essential characteristics. The first is a case representation that comprises textual descriptions of the image, visual features that are known to be useful for indexing images, and additional visual features to be discovered by data mining many existing images. The second characteristic of the approach presented here involves the development of a case base that comprises an optimal number and distribution of cases. The third characteristic involves the automatic discovery, using KDD techniques, of adaptation knowledge to enhance the performance of the case based reasoner. Together, the three characteristics of our approach can overcome real time efficiency obstacles that otherwise mitigate against the use of CBR to the domain of medical image analysis.

Supervised machine learning algorithms to diagnose stress for vehicle drivers based on physiological sensor signals.

PubMed

Barua, Shaibal; Begum, Shahina; Ahmed, Mobyen Uddin

2015-01-01

Machine learning algorithms play an important role in computer science research. Recent advancement in sensor data collection in clinical sciences lead to a complex, heterogeneous data processing, and analysis for patient diagnosis and prognosis. Diagnosis and treatment of patients based on manual analysis of these sensor data are difficult and time consuming. Therefore, development of Knowledge-based systems to support clinicians in decision-making is important. However, it is necessary to perform experimental work to compare performances of different machine learning methods to help to select appropriate method for a specific characteristic of data sets. This paper compares classification performance of three popular machine learning methods i.e., case-based reasoning, neutral networks and support vector machine to diagnose stress of vehicle drivers using finger temperature and heart rate variability. The experimental results show that case-based reasoning outperforms other two methods in terms of classification accuracy. Case-based reasoning has achieved 80% and 86% accuracy to classify stress using finger temperature and heart rate variability. On contrary, both neural network and support vector machine have achieved less than 80% accuracy by using both physiological signals.

Case-Mix for Performance Management: A Risk Algorithm Based on ICD-10-CM.

PubMed

Gao, Jian; Moran, Eileen; Almenoff, Peter L

2018-06-01

Accurate risk adjustment is the key to a reliable comparison of cost and quality performance among providers and hospitals. However, the existing case-mix algorithms based on age, sex, and diagnoses can only explain up to 50% of the cost variation. More accurate risk adjustment is desired for provider performance assessment and improvement. To develop a case-mix algorithm that hospitals and payers can use to measure and compare cost and quality performance of their providers. All 6,048,895 patients with valid diagnoses and cost recorded in the US Veterans health care system in fiscal year 2016 were included in this study. The dependent variable was total cost at the patient level, and the explanatory variables were age, sex, and comorbidities represented by 762 clinically homogeneous groups, which were created by expanding the 283 categories from Clinical Classifications Software based on ICD-10-CM codes. The split-sample method was used to assess model overfitting and coefficient stability. The predictive power of the algorithms was ascertained by comparing the R, mean absolute percentage error, root mean square error, predictive ratios, and c-statistics. The expansion of the Clinical Classifications Software categories resulted in higher predictive power. The R reached 0.72 and 0.52 for the transformed and raw scale cost, respectively. The case-mix algorithm we developed based on age, sex, and diagnoses outperformed the existing case-mix models reported in the literature. The method developed in this study can be used by other health systems to produce tailored risk models for their specific purpose.

Multi-probe-based resonance-frequency electrical impedance spectroscopy for detection of suspicious breast lesions: improving performance using partial ROC optimization

NASA Astrophysics Data System (ADS)

Lederman, Dror; Zheng, Bin; Wang, Xingwei; Wang, Xiao Hui; Gur, David

2011-03-01

We have developed a multi-probe resonance-frequency electrical impedance spectroscope (REIS) system to detect breast abnormalities. Based on assessing asymmetry in REIS signals acquired between left and right breasts, we developed several machine learning classifiers to classify younger women (i.e., under 50YO) into two groups of having high and low risk for developing breast cancer. In this study, we investigated a new method to optimize performance based on the area under a selected partial receiver operating characteristic (ROC) curve when optimizing an artificial neural network (ANN), and tested whether it could improve classification performance. From an ongoing prospective study, we selected a dataset of 174 cases for whom we have both REIS signals and diagnostic status verification. The dataset includes 66 "positive" cases recommended for biopsy due to detection of highly suspicious breast lesions and 108 "negative" cases determined by imaging based examinations. A set of REIS-based feature differences, extracted from the two breasts using a mirror-matched approach, was computed and constituted an initial feature pool. Using a leave-one-case-out cross-validation method, we applied a genetic algorithm (GA) to train the ANN with an optimal subset of features. Two optimization criteria were separately used in GA optimization, namely the area under the entire ROC curve (AUC) and the partial area under the ROC curve, up to a predetermined threshold (i.e., 90% specificity). The results showed that although the ANN optimized using the entire AUC yielded higher overall performance (AUC = 0.83 versus 0.76), the ANN optimized using the partial ROC area criterion achieved substantially higher operational performance (i.e., increasing sensitivity level from 28% to 48% at 95% specificity and/ or from 48% to 58% at 90% specificity).

Neurocognitive performance in family-based and case-control studies of schizophrenia

PubMed Central

Gur, Ruben C.; Braff, David L.; Calkins, Monica E.; Dobie, Dorcas J.; Freedman, Robert; Green, Michael F.; Greenwood, Tiffany A.; Lazzeroni, Laura C.; Light, Gregory A.; Nuechterlein, Keith H.; Olincy, Ann; Radant, Allen D.; Seidman, Larry J.; Siever, Larry J.; Silverman, Jeremy M.; Sprock, Joyce; Stone, William S.; Sugar, Catherine A.; Swerdlow, Neal R.; Tsuang, Debby W.; Tsuang, Ming T.; Turetsky, Bruce I.; Gur, Raquel E.

2014-01-01

Background Neurocognitive deficits in schizophrenia (SZ) are established and the Consortium on the Genetics of Schizophrenia (COGS) investigated such measures as endophenotypes in family-based (COGS-1) and case-control (COGS-2) studies. By requiring family participation, family-based sampling may result in samples that vary demographically and perform better on neurocognitive measures. Methods The Penn computerized neurocognitive battery (CNB) evaluates accuracy and speed of performance for several domains and was administered across sites in COGS-1 and COGS-2. Most tests were included in both studies. COGS-1 included 328 patients with SZ and 497 healthy comparison subjects (HCS) and COGS-2 included 1195 patients and 1009 HCS. Results Demographically, COGS-1 participants were younger, more educated, with more educated parents and higher estimated IQ compared to COGS-2 participants. After controlling for demographics, the two samples produced very similar performance profiles compared to their respective controls. As expected, performance was better and with smaller effect sizes compared to controls in COGS-1 relative to COGS-2. Better performance was most pronounced for spatial processing while emotion identification had large effect sizes for both accuracy and speed in both samples. Performance was positively correlated with functioning and negatively with negative and positive symptoms in both samples, but correlations were attenuated in COGS-2, especially with positive symptoms. Conclusions Patients ascertained through family-based design have more favorable demographics and better performance on some neurocognitive domains. Thus, studies that use case-control ascertainment may tap into populations with more severe forms of illness that are exposed to less favorable factors compared to those ascertained with family-based designs. PMID:25432636

IVHS Institutional Issues and Case Studies, Analysis and Lessons Learned, Final Report

DOT National Transportation Integrated Search

1994-04-01

This 'Analysis and Lessons Learned' report contains observations, conclusions, and recommendations based on the performance of six case studies of Intelligent Vehicle-Highway Systems (IVHS) projects. Information to support the development of the case...

Comparing fusion techniques for the ImageCLEF 2013 medical case retrieval task.

PubMed

G Seco de Herrera, Alba; Schaer, Roger; Markonis, Dimitrios; Müller, Henning

2015-01-01

Retrieval systems can supply similar cases with a proven diagnosis to a new example case under observation to help clinicians during their work. The ImageCLEFmed evaluation campaign proposes a framework where research groups can compare case-based retrieval approaches. This paper focuses on the case-based task and adds results of the compound figure separation and modality classification tasks. Several fusion approaches are compared to identify the approaches best adapted to the heterogeneous data of the task. Fusion of visual and textual features is analyzed, demonstrating that the selection of the fusion strategy can improve the best performance on the case-based retrieval task. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluation of the role of incentive structure on student participation and performance in active learning strategies: A comparison of case-based and team-based learning.

PubMed

Carrasco, Gonzalo A; Behling, Kathryn C; Lopez, Osvaldo J

2018-04-01

Student participation is important for the success of active learning strategies, but participation is often linked to the level of preparation. At our institution, we use two types of active learning activities, a modified case-based learning exercise called active learning groups (ALG) and team-based learning (TBL). These strategies have different assessment and incentive structures for participation. Non-cognitive skills are assessed in ALG using a subjective five-point Likert scale. In TBL, assessment of individual student preparation is based on a multiple choice quiz conducted at the beginning of each session. We studied first-year medical student participation and performance in ALG and TBL as well as performance on course final examinations. Student performance in TBL, but not in ALG, was strongly correlated with final examination scores. Additionally, in students who performed in the upper 33rd percentile on the final examination, there was a positive correlation between final examination performance and participation in TBL and ALG. This correlation was not seen in students who performed in the lower 33rd percentile on the final examinations. Our results suggest that assessments of medical knowledge during active learning exercises could supplement non-cognitive assessments and could be good predictors of performance on summative examinations.

Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice.

PubMed

McQueen, Carl; Crombie, Nicholas; Hulme, Jonathan; Cormack, Stef; Hussain, Nageena; Ludwig, Frank; Wheaton, Steve

2015-01-01

In the West Midlands region of the UK, delivery of pre-hospital care has been remodelled through introduction of a 24 h Medical Emergency Response Incident Team (MERIT). Teams including physicians and critical care paramedics (CCP) are deployed to incidents on land-based and helicopter-based platforms. Clinical practice, including delivery of rapid sequence induction of anaesthesia (RSI), is underpinned by standard operating procedures (SOP). This study describes the first 12 months experience of prehospital RSI in the MERIT scheme in the West Midlands. Retrospective review of the MERIT clinical database for the 12 months following the launch of the scheme. Data was collected relating to the number of RSIs performed; indication for RSI; number of intubation attempts; grade of view on laryngoscopy and the base speciality/grade of the operator performing intubation. MERIT teams were activated 1619 times, attending scene in 1029 cases. RSI was performed 142 times (13.80% of scene attendances). There was one recorded case of failure to intubate requiring insertion of a supraglottic airway device (0.70%). In over a third of RSI cases, CCPs performed laryngoscopy and intubation (n=53, 37.32%). Proficiency of obtaining Grade I view at laryngoscopy was similar for physicians (74.70%) and CCPs (77.36%). Intubation was successful at the first attempt in over 90% of cases. This study demonstrates that operation within a system that provides high levels of exposure, underpinned by comprehensive and robust training and governance frameworks, promotes levels of performance in successful prehospital RSI regardless of base speciality or profession. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Evaluation of Oral Performance in Outsourced Call Centres: An Exploratory Case Study

ERIC Educational Resources Information Center

Friginal, Eric

2013-01-01

This case study discusses the development and use of an oral performance assessment instrument intended to evaluate Filipino agents' customer service transactions with callers from the United States (US). The design and applications of the instrument were based on a longitudinal, qualitative observation of language training and customer service…

Implementation and evaluation of a dilation and evacuation simulation training curriculum.

PubMed

York, Sloane L; McGaghie, William C; Kiley, Jessica; Hammond, Cassing

2016-06-01

To evaluate obstetrics and gynecology resident physicians' performance following a simulation curriculum on dilation and evacuation (D&E) procedures. This study included two phases: simulation curriculum development and resident physician performance evaluation following training on a D&E simulator. Trainees participated in two evaluations. Simulation training evaluated participants performing six cases on a D&E simulator, measuring procedural time and a 26-step checklist of D&E steps. The operative training portion evaluated residents' performance after training on the simulator using mastery learning techniques. Intra-operative evaluation was based on a 21-step checklist score, Objective Structured Assessment of Technical Skills (OSATS), and percentage of cases completed. Twenty-two residents participated in simulation training, demonstrating improved performance from cases one and two to cases five and six, as measured by checklist score and procedural time (p<.001 and p=.001, respectively). Of 10 participants in the operative training, all performed at least three D&Es, while seven performed at least six cases. While checklist scores did not change significantly from the first to sixth case (mean for first case: 18.3; for sixth case: 19.6; p=.593), OSATS ratings improved from case one (19.7) to case three (23.5; p=.001) and to case six (26.8; p=.005). Trainees completed approximately 71.6% of their first case (range: 21.4-100%). By case six, the six participants performed 81.2% of the case (range: 14.3-100%). D&E simulation using a newly-developed uterine model and simulation curriculum improves resident technical skills. Simulation training with mastery learning techniques transferred to high level of performance in OR using checklist. The OSATS measured skills and showed improvement in performance with subsequent cases. Implementation of a D&E simulation curriculum offers potential for improved surgical training and abortion provision. Copyright © 2016 Elsevier Inc. All rights reserved.

Watch what happens: using a web-based multimedia platform to enhance intraoperative learning and development of clinical reasoning.

PubMed

Fingeret, Abbey L; Martinez, Rebecca H; Hsieh, Christine; Downey, Peter; Nowygrod, Roman

2016-02-01

We aim to determine whether observed operations or internet-based video review predict improved performance in the surgery clerkship. A retrospective review of students' usage of surgical videos, observed operations, evaluations, and examination scores were used to construct an exploratory principal component analysis. Multivariate regression was used to determine factors predictive of clerkship performance. Case log data for 231 students revealed a median of 25 observed cases. Students accessed the web-based video platform a median of 15 times. Principal component analysis yielded 4 factors contributing 74% of the variability with a Kaiser-Meyer-Olkin coefficient of .83. Multivariate regression predicted shelf score (P < .0001), internal clinical skills examination score (P < .0001), subjective evaluations (P < .001), and video website utilization (P < .001) but not observed cases to be significantly associated with overall performance. Utilization of a web-based operative video platform during a surgical clerkship is an independently associated with improved clinical reasoning, fund of knowledge, and overall evaluation. Thus, this modality can serve as a useful adjunct to live observation. Copyright © 2016 Elsevier Inc. All rights reserved.

NUMERICAL FLOW AND TRANSPORT SIMULATIONS SUPPORTING THE SALTSTONE FACILITY PERFORMANCE ASSESSMENT

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

Flach, G.

2009-02-28

The Saltstone Disposal Facility Performance Assessment (PA) is being revised to incorporate requirements of Section 3116 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA), and updated data and understanding of vault performance since the 1992 PA (Cook and Fowler 1992) and related Special Analyses. A hybrid approach was chosen for modeling contaminant transport from vaults and future disposal cells to exposure points. A higher resolution, largely deterministic, analysis is performed on a best-estimate Base Case scenario using the PORFLOW numerical analysis code. a few additional sensitivity cases are simulated to examine alternative scenarios andmore » parameter settings. Stochastic analysis is performed on a simpler representation of the SDF system using the GoldSim code to estimate uncertainty and sensitivity about the Base Case. This report describes development of PORFLOW models supporting the SDF PA, and presents sample results to illustrate model behaviors and define impacts relative to key facility performance objectives. The SDF PA document, when issued, should be consulted for a comprehensive presentation of results.« less

Lack of generalizability of observational studies' findings for turnover time reduction and growth in surgery based on the State of Iowa, where from one year to the next, most growth was attributable to surgeons performing only a few cases per week.

PubMed

Dexter, Franklin; Jarvie, Craig; Epstein, Richard H

2018-02-01

Three observational studies at large teaching hospitals found that reducing turnover times resulted in the surgeons performing more cases. We sought to determine if these findings are generalizable to other hospitals, because, if so, reducing turnover times may be an important mechanism for hospitals to use for growing caseloads. Observational cohort study. 116 hospitals in Iowa with inpatient or outpatient surgery from July 1, 2013 through June 30, 2015. Surgeons in Iowa, each with a unique identifier among hospitals. The independent variable was the number of inpatient and outpatient cases that each surgeon performed each week during the first fiscal year beginning July 1, 2013. The dependent variables were surgeons' number of inpatient and outpatient surgical cases, and intraoperative work relative value units (RVU's) for outpatient cases, during the second fiscal year. The average hospital in Iowa had less than half of its growth from year 1 to year 2 in numbers of cases among surgeons who performed >2 cases per week in the baseline year (23.0%±2.5% [SE], P<0.0001 comparing mean to 50%). Less than half the growth in RVU's was among those surgeons (18.1%±2.2%, P<0.0001). The average hospital in Iowa had less than half of its growth in numbers of cases among surgeons who performed 2 or fewer cases per week at the hospital during the baseline year and >2 cases per week at other hospitals in the state during that year (24.4%±2.6%, P<0.0001). Less than half the growth in RVU's was among those surgeons (21.3%±2.5%, P<0.0001). Most (≥50%) annual growth in surgery, both based on the number of total inpatient and outpatient surgical cases, and on the total outpatient RVU's, was attributable to surgeons who performed 2 or fewer cases per week at each hospital statewide during the preceding year. Therefore, the strategic priority should be to assure that the many low-caseload surgeons have access to convenient OR time (e.g., by allocating sufficient OR time, and assigning surgeon blocks, in a mathematically sound, evidence-based way). Although reducing turnover times and anesthesia-controlled times to promote growth will be beneficial for a few surgeons, the effect on total caseload will be small. Copyright © 2017 Elsevier Inc. All rights reserved.

Towards a precise test for malaria diagnosis in the Brazilian Amazon: comparison among field microscopy, a rapid diagnostic test, nested PCR, and a computational expert system based on artificial neural networks

PubMed Central

2010-01-01

Background Accurate malaria diagnosis is mandatory for the treatment and management of severe cases. Moreover, individuals with asymptomatic malaria are not usually screened by health care facilities, which further complicates disease control efforts. The present study compared the performances of a malaria rapid diagnosis test (RDT), the thick blood smear method and nested PCR for the diagnosis of symptomatic malaria in the Brazilian Amazon. In addition, an innovative computational approach was tested for the diagnosis of asymptomatic malaria. Methods The study was divided in two parts. For the first part, passive case detection was performed in 311 individuals with malaria-related symptoms from a recently urbanized community in the Brazilian Amazon. A cross-sectional investigation compared the diagnostic performance of the RDT Optimal-IT, nested PCR and light microscopy. The second part of the study involved active case detection of asymptomatic malaria in 380 individuals from riverine communities in Rondônia, Brazil. The performances of microscopy, nested PCR and an expert computational system based on artificial neural networks (MalDANN) using epidemiological data were compared. Results Nested PCR was shown to be the gold standard for diagnosis of both symptomatic and asymptomatic malaria because it detected the major number of cases and presented the maximum specificity. Surprisingly, the RDT was superior to microscopy in the diagnosis of cases with low parasitaemia. Nevertheless, RDT could not discriminate the Plasmodium species in 12 cases of mixed infections (Plasmodium vivax + Plasmodium falciparum). Moreover, the microscopy presented low performance in the detection of asymptomatic cases (61.25% of correct diagnoses). The MalDANN system using epidemiological data was worse that the light microscopy (56% of correct diagnoses). However, when information regarding plasma levels of interleukin-10 and interferon-gamma were inputted, the MalDANN performance sensibly increased (80% correct diagnoses). Conclusions An RDT for malaria diagnosis may find a promising use in the Brazilian Amazon integrating a rational diagnostic approach. Despite the low performance of the MalDANN test using solely epidemiological data, an approach based on neural networks may be feasible in cases where simpler methods for discriminating individuals below and above threshold cytokine levels are available. PMID:20459613

Towards a precise test for malaria diagnosis in the Brazilian Amazon: comparison among field microscopy, a rapid diagnostic test, nested PCR, and a computational expert system based on artificial neural networks.

PubMed

Andrade, Bruno B; Reis-Filho, Antonio; Barros, Austeclino M; Souza-Neto, Sebastião M; Nogueira, Lucas L; Fukutani, Kiyoshi F; Camargo, Erney P; Camargo, Luís M A; Barral, Aldina; Duarte, Angelo; Barral-Netto, Manoel

2010-05-06

Accurate malaria diagnosis is mandatory for the treatment and management of severe cases. Moreover, individuals with asymptomatic malaria are not usually screened by health care facilities, which further complicates disease control efforts. The present study compared the performances of a malaria rapid diagnosis test (RDT), the thick blood smear method and nested PCR for the diagnosis of symptomatic malaria in the Brazilian Amazon. In addition, an innovative computational approach was tested for the diagnosis of asymptomatic malaria. The study was divided in two parts. For the first part, passive case detection was performed in 311 individuals with malaria-related symptoms from a recently urbanized community in the Brazilian Amazon. A cross-sectional investigation compared the diagnostic performance of the RDT Optimal-IT, nested PCR and light microscopy. The second part of the study involved active case detection of asymptomatic malaria in 380 individuals from riverine communities in Rondônia, Brazil. The performances of microscopy, nested PCR and an expert computational system based on artificial neural networks (MalDANN) using epidemiological data were compared. Nested PCR was shown to be the gold standard for diagnosis of both symptomatic and asymptomatic malaria because it detected the major number of cases and presented the maximum specificity. Surprisingly, the RDT was superior to microscopy in the diagnosis of cases with low parasitaemia. Nevertheless, RDT could not discriminate the Plasmodium species in 12 cases of mixed infections (Plasmodium vivax + Plasmodium falciparum). Moreover, the microscopy presented low performance in the detection of asymptomatic cases (61.25% of correct diagnoses). The MalDANN system using epidemiological data was worse that the light microscopy (56% of correct diagnoses). However, when information regarding plasma levels of interleukin-10 and interferon-gamma were inputted, the MalDANN performance sensibly increased (80% correct diagnoses). An RDT for malaria diagnosis may find a promising use in the Brazilian Amazon integrating a rational diagnostic approach. Despite the low performance of the MalDANN test using solely epidemiological data, an approach based on neural networks may be feasible in cases where simpler methods for discriminating individuals below and above threshold cytokine levels are available.

What is the true definition of a "Do-Not-Resuscitate" order? A Japanese perspective.

PubMed

Hiraoka, Eiji; Homma, Yosuke; Norisue, Yasuhiro; Naito, Takaki; Kataoka, Yuko; Hamada, Osamu; Den, Yo; Takahashi, Osamu; Fujitani, Shigeki

2016-01-01

Japan has no official guidelines for do-not-resuscitate (DNR) orders. Therefore, we investigated the effect of DNR orders on physician decision making in relation to performing noncardiopulmonary resuscitation (CPR) and CPR procedures. A case-scenario-based questionnaire that included a case of advanced cancer, a case of advanced dementia, and a case of nonadvanced heart failure was administered to physicians. The questions determined whether physicians would perform different non-CPR procedures and CPR procedures in the presence or absence of DNR orders. The number of non-CPR procedures each physician would perform and the number of physicians who would perform each non-CPR and CPR procedure in the absence and presence of DNR ocrders were compared. Physicians from three Japanese municipal acute care hospitals participated. We analyzed 111 of 161 (69%) questionnaires. Physicians would perform significantly fewer non-CPR procedures in the presence of DNR orders than in the absence of DNR orders for all three case scenarios (median [interquartile range] percentages: Case 1: 72% [45%-90%] vs 100% [90%-100%]; Case 2: 55% [36%-72%] vs 91% [63%-100%]; Case 3: 78% [55%-88%] vs 100% [88%-100%]). Fewer physicians would perform non-CPR and CPR procedures in the presence of DNR orders than in the absence of DNR orders. However, considerable numbers of physicians would perform electric shock treatment for ventricular fibrillation in the presence of DNR orders (Case 1: 26%; Case 2: 16%; Case 3: 20%). DNR orders affect physician decision making about performing non-CPR procedures. Although some physicians would perform CPR for ventricular fibrillation in the presence of DNR orders, others would not. Therefore, a consensus definition for DNR orders should be developed in Japan, otherwise DNR orders may cause harm.

Measuring Primary Students' Graph Interpretation Skills Via a Performance Assessment: A case study in instrument development

NASA Astrophysics Data System (ADS)

Peterman, Karen; Cranston, Kayla A.; Pryor, Marie; Kermish-Allen, Ruth

2015-11-01

This case study was conducted within the context of a place-based education project that was implemented with primary school students in the USA. The authors and participating teachers created a performance assessment of standards-aligned tasks to examine 6-10-year-old students' graph interpretation skills as part of an exploratory research project. Fifty-five students participated in a performance assessment interview at the beginning and end of a place-based investigation. Two forms of the assessment were created and counterbalanced within class at pre and post. In situ scoring was conducted such that responses were scored as correct versus incorrect during the assessment's administration. Criterion validity analysis demonstrated an age-level progression in student scores. Tests of discriminant validity showed that the instrument detected variability in interpretation skills across each of three graph types (line, bar, dot plot). Convergent validity was established by correlating in situ scores with those from the Graph Interpretation Scoring Rubric. Students' proficiency with interpreting different types of graphs matched expectations based on age and the standards-based progression of graphs across primary school grades. The assessment tasks were also effective at detecting pre-post gains in students' interpretation of line graphs and dot plots after the place-based project. The results of the case study are discussed in relation to the common challenges associated with performance assessment. Implications are presented in relation to the need for authentic and performance-based instructional and assessment tasks to respond to the Common Core State Standards and the Next Generation Science Standards.

Surface-based haemangioma of the tibia: a case report.

PubMed

Di Giorgio, Luigi; Valentini, Matteo Benedetti; Mastantuono, Marco; Touloupakis, Georgios

2008-12-01

We present in this paper a case of surface-based haemangioma of the tibia in a 34-year-old patient which had been misdiagnosed as periostitis. X-ray examination demonstrated a periosteal reaction, confirmed by a MRI showing a soft tissue mass adjacent to bone. We performed an incisional biopsy and made a diagnosis of haemangioma only after examining the histological results. An angiographic study was performed in order to have embolisation of the vessels, but this was not possible because of the excessive number and calibre of afferent arteries. No further symptoms arose after biopsy and therefore an en bloc or radical excision was not performed. Indications for making a correct diagnosis and performing a suitable treatment are presented below.

Case-based surveillance enhanced with measles virus detection/genotyping is essential to maintain measles elimination in Aichi Prefecture, Japan.

PubMed

Minagawa, Hiroko; Yasui, Yoshihiro; Adachi, Hirokazu; Ito, Miyabi; Hirose, Emi; Nakamura, Noriko; Hata, Mami; Kobayashi, Shinichi; Yamashita, Teruo

2015-11-09

Japan was verified as having achieved measles elimination by the Measles Regional Verification Commission in the Western Pacific Region in March 2015. Verification of measles elimination implies the absence of continuous endemic transmission. After the last epidemic in 2007 with an estimated 18,000 cases, Japan introduced nationwide case-based measles surveillance in January 2008. Laboratory diagnosis for all suspected measles cases is essentially required by law, and virus detection tests are mostly performed by municipal public health institutes. Despite relatively high vaccination coverage and vigorous response to every case by the local health center staff, outbreak of measles is repeatedly observed in Aichi Prefecture, Japan. Measles virus N and H gene detection by nested double RT-PCR was performed with all specimens collected from suspected cases and transferred to our institute. Genotyping and further molecular epidemiological analyses were performed with the direct nucleotide sequence data of appropriate PCR products. Between 2010 and 2014, specimens from 389 patients suspected for measles were tested in our institute. Genotypes D9, D8, H1 and B3 were detected. Further molecular epidemiological analyses were helpful to establish links between patients, and sometimes useful to discriminate one outbreak from another. All virus-positive cases, including 49 cases involved in three outbreaks without any obvious epidemiological link with importation, were considered as import-related based on the nucleotide sequence information. Chain of transmission in the latest outbreak in 2014 terminated after the third generations, much earlier than the 2010-11 outbreak (6th generations). Since 2010, almost all measles cases reported in Aichi Prefecture are either import or import-related, based primarily on genotypes and nucleotide sequences of measles virus detected. In addition, genotyping and molecular epidemiological analyses are indispensable to prove the interruption of endemic transmission when the importations of measles are repeatedly observed. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Simple Case Study of a Grid Performance System

NASA Technical Reports Server (NTRS)

Aydt, Ruth; Gunter, Dan; Quesnel, Darcy; Smith, Warren; Taylor, Valerie; Biegel, Bryan (Technical Monitor)

2001-01-01

This document presents a simple case study of a Grid performance system based on the Grid Monitoring Architecture (GMA) being developed by the Grid Forum Performance Working Group. It describes how the various system components would interact for a very basic monitoring scenario, and is intended to introduce people to the terminology and concepts presented in greater detail in other Working Group documents. We believe that by focusing on the simple case first, working group members can familiarize themselves with terminology and concepts, and productively join in the ongoing discussions of the group. In addition, prototype implementations of this basic scenario can be built to explore the feasibility of the proposed architecture and to expose possible shortcomings. Once the simple case is understood and agreed upon, complexities can be added incrementally as warranted by cases not addressed in the most basic implementation described here. Following the basic performance monitoring scenario discussion, unresolved issues are introduced for future discussion.

Knowledge acquisition for case-based reasoning systems

NASA Technical Reports Server (NTRS)

Riesbeck, Christopher K.

1988-01-01

Case-based reasoning (CBR) is a simple idea: solve new problems by adapting old solutions to similar problems. The CBR approach offers several potential advantages over rule-based reasoning: rules are not combined blindly in a search for solutions, solutions can be explained in terms of concrete examples, and performance can improve automatically as new problems are solved and added to the case library. Moving CBR for the university research environment to the real world requires smooth interfaces for getting knowledge from experts. Described are the basic elements of an interface for acquiring three basic bodies of knowledge that any case-based reasoner requires: the case library of problems and their solutions, the analysis rules that flesh out input problem specifications so that relevant cases can be retrieved, and the adaptation rules that adjust old solutions to fit new problems.

A Case-Based Reasoning Method with Rank Aggregation

NASA Astrophysics Data System (ADS)

Sun, Jinhua; Du, Jiao; Hu, Jian

2018-03-01

In order to improve the accuracy of case-based reasoning (CBR), this paper addresses a new CBR framework with the basic principle of rank aggregation. First, the ranking methods are put forward in each attribute subspace of case. The ordering relation between cases on each attribute is got between cases. Then, a sorting matrix is got. Second, the similar case retrieval process from ranking matrix is transformed into a rank aggregation optimal problem, which uses the Kemeny optimal. On the basis, a rank aggregation case-based reasoning algorithm, named RA-CBR, is designed. The experiment result on UCI data sets shows that case retrieval accuracy of RA-CBR algorithm is higher than euclidean distance CBR and mahalanobis distance CBR testing.So we can get the conclusion that RA-CBR method can increase the performance and efficiency of CBR.

Simulated procedure rehearsal is more effective than a preoperative generic warm-up for endovascular procedures.

PubMed

Willaert, Willem I M; Aggarwal, Rajesh; Daruwalla, Farhad; Van Herzeele, Isabelle; Darzi, Ara W; Vermassen, Frank E; Cheshire, Nicholas J

2012-06-01

Patient-specific simulated rehearsal (PsR) of a carotid artery stenting procedure (CAS) enables the interventionalist to rehearse the case before performing the procedure on the actual patient by incorporating patient-specific computed tomographic data into the simulation software. This study aimed to evaluate whether PsR of a CAS procedure can enhance the operative performance versus a virtual reality (VR) generic CAS warm-up procedure or no preparation at all. During a 10-session cognitive/technical VR course, medical residents were trained in CAS. Thereafter, in a randomized crossover study, each participant performed a patient-specific CAS case 3 times on the simulator, preceded by 3 different tasks: a PsR, a generic case, or no preparation. Technical performances were assessed using simulator-based metrics and expert-based ratings. Twenty medical residents (surgery, cardiology, radiology) were recruited. Training plateaus were observed after 10 sessions for all participants. Performances were significantly better after PsR than after a generic warm-up or no warm-up for total procedure time (16.3 ± 0.6 vs 19.7 ± 1.0 vs 20.9 ± 1.1 minutes, P = 0.001) and fluoroscopy time (9.3 ± 0.1 vs 11.2 ± 0.6 vs 11.2 ± 0.5 minutes, P = 0.022) but did not influence contrast volume or number of roadmaps used during the "real" case. PsR significantly improved the quality of performance as measured by the expert-based ratings (scores 28 vs 25 vs 25, P = 0.020). Patient-specific simulated rehearsal of a CAS procedure significantly improves operative performance, compared to a generic VR warm-up or no warm-up. This technology requires further investigation with respect to improved outcomes on patients in the clinical setting.

An Exploratory Multiple Case Study about Using Game-Based Learning in STEM Classrooms

ERIC Educational Resources Information Center

Vu, Phu; Feinstein, Sheryl

2017-01-01

This exploratory multiple case study attempted to examine whether game-based learning activities had any impacts on students' academic performances and behaviors, and what perceptions the teachers had toward implementing games into their classrooms. Data used in this study included 101 students' pre and post-test scores, and four structured…

Re-resection rates after breast-conserving surgery as a performance indicator: introduction of a case-mix model to allow comparison between Dutch hospitals.

PubMed

Talsma, A K; Reedijk, A M J; Damhuis, R A M; Westenend, P J; Vles, W J

2011-04-01

Re-resection rate after breast-conserving surgery (BCS) has been introduced as an indicator of quality of surgical treatment in international literature. The present study aims to develop a case-mix model for re-resection rates and to evaluate its performance in comparing results between hospitals. Electronic records of eligible patients diagnosed with in-situ and invasive breast cancer in 2006 and 2007 were derived from 16 hospitals in the Rotterdam Cancer Registry (RCR) (n = 961). A model was built in which prognostic factors for re-resections after BCS were identified and expected re-resection rate could be assessed for hospitals based on their case mix. To illustrate the opportunities of monitoring re-resections over time, after risk adjustment for patient profile, a VLAD chart was drawn for patients in one hospital. In general three out of every ten women had re-surgery; in about 50% this meant an additive mastectomy. Independent prognostic factors of re-resection after multivariate analysis were histological type, sublocalisation, tumour size, lymph node involvement and multifocal disease. After correction for case mix, one hospital was performing significantly less re-resections compared to the reference hospital. On the other hand, two were performing significantly more re-resections than was expected based on their patient mix. Our population-based study confirms earlier reports that re-resection is frequently required after an initial breast-conserving operation. Case-mix models such as the one we constructed can be used to correct for variation between hospitals performances. VLAD charts are valuable tools to monitor quality of care within individual hospitals. Copyright © 2011 Elsevier Ltd. All rights reserved.

Vital Signs: How Early Can Resident Evaluation Predict Acquisition of Competency in Surgical Pathology?

PubMed Central

Ducatman, Barbara S.; Williams, H. James; Hobbs, Gerald; Gyure, Kymberly A.

2009-01-01

Objectives To determine whether a longitudinal, case-based evaluation system can predict acquisition of competency in surgical pathology and how trainees at risk can be identified early. Design Data were collected for trainee performance on surgical pathology cases (how well their diagnosis agreed with the faculty diagnosis) and compared with training outcomes. Negative training outcomes included failure to complete the residency, failure to pass the anatomic pathology component of the American Board of Pathology examination, and/or failure to obtain or hold a position immediately following training. Findings Thirty-three trainees recorded diagnoses for 54 326 surgical pathology cases, with outcome data available for 15 residents. Mean case-based performance was significantly higher for those with positive outcomes, and outcome status could be predicted as early as postgraduate year-1 (P  =  .0001). Performance on the first postgraduate year-1 rotation was significantly associated with the outcome (P  =  .02). Although trainees with unsuccessful outcomes improved their performance more rapidly, they started below residents with successful outcomes and did not make up the difference during training. There was no significant difference in Step 1 or 2 United States Medical Licensing Examination (USMLE) scores when compared with performance or final outcomes (P  =  .43 and P  =  .68, respectively) and the resident in-service examination (RISE) had limited predictive ability. Discussion Differences between successful- and unsuccessful-outcome residents were most evident in early residency, ideal for designing interventions or counseling residents to consider another specialty. Conclusion Our longitudinal case-based system successfully identified trainees at risk for failure to acquire critical competencies for surgical pathology early in the program. PMID:21975705

COLLABORATE©, Part IV: Ramping Up Competency-Based Performance Management.

PubMed

Treiger, Teresa M; Fink-Samnick, Ellen

The purpose of this fourth part of the COLLABORATE© article series provides an expansion and application of previously presented concepts pertaining to the COLLABORATE paradigm of professional case management practice. The model is built upon a value-driven foundation that: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. As an industry, health care continues to evolve. Terrain shifts and new influences continually surface to challenge professional case management practice. The need for top-performing and nimble professionals who are knowledgeable and proficient in the workplace continues to challenge human resource departments. In addition to care setting knowledge, professional case managers must continually invest in their practice competence toolbox to grow skills and abilities that transcend policies and processes. These individuals demonstrate agility in framing (and reframing) their professional practice to facilitate the best possible outcomes for their clients. Therefore, the continued emphasis on practice competence conveyed through the performance management cycle is an essential ingredient to performance management focused on customer service excellence and organizational improvement. Professional case management transcends professional disciplines, educational levels, and practice settings. Business objectives continue to drive work process and priorities in many practice settings. However, competencies that align with regulatory and accreditation requirements should be the critical driver for consistent, high-quality case management practice. Although there is inherent value in what various disciplines bring to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities.

Case-based Reasoning for Automotive Engine Performance Tune-up

NASA Astrophysics Data System (ADS)

Vong, C. M.; Huang, H.; Wong, P. K.

2010-05-01

The automotive engine performance tune-up is greatly affected by the calibration of its electronic control unit (ECU). The ECU calibration is traditionally done by trial-and-error method. This traditional method consumes a large amount of time and money because of a large number of dynamometer tests. To resolve this problem, case based reasoning (CBR) is employed, so that an existing and effective ECU setup can be adapted to fit another similar class of engines. The adaptation procedure is done through a more sophisticated step called case-based adaptation (CBA) [1, 2]. CBA is an effective knowledge management tool, which can interactively learn the expert adaptation knowledge. The paper briefly reviews the methodologies of CBR and CBA. Then the application to ECU calibration is described via a case study. With CBR and CBA, the efficiency of calibrating an ECU can be enhanced. A prototype system has also been developed to verify the usefulness of CBR in ECU calibration.

Exploring the effect of at-risk case management compensation on hospital pay-for-performance outcomes: tools for change.

PubMed

Granata, Randy L; Hamilton, Karen

2015-01-01

Acute care nurse case managers are charged with compliance oversight, managing throughput, and ensuring safe care transitions. Leveraging the roles of nurse case managers and social workers during care transitions translates into improved fiscal performance under the Affordable Care Act. This article aims to equip leaders in the field of case management with tools to facilitate the alignment of case management systems with hospital pay-for-performance measures. A quality improvement project was implemented at a hospital in south Alabama to examine the question: for acute care case managers, what is the effect of key performance indictors using an at-risk compensation model in comparison to past nonincentive models on hospital readmissions, lengths of stay, and patient satisfaction surrounding the discharge process. Inpatient acute care hospital. The implementation of an at-risk compensation model using key performance indicators, Lean Six Sigma methodology, and Creative Health Care Management's Relationship-Based Care framework demonstrated reduced length of stay, hospital readmissions, and improved patient experiences. Regulatory changes and new models of reimbursement in the acute care environment have created the perfect storm for case management leaders. Hospital fiscal performance is dependent on effective case management processes and the ability to optimize scarce resources. The quality improvement project aimed to further align case management systems and structures with hospital pay-for-performance measures. Tools for change were presented to assist leaders with the change acceleration process.

Quantification of signal detection performance degradation induced by phase-retrieval in propagation-based x-ray phase-contrast imaging

NASA Astrophysics Data System (ADS)

Chou, Cheng-Ying; Anastasio, Mark A.

2016-04-01

In propagation-based X-ray phase-contrast (PB XPC) imaging, the measured image contains a mixture of absorption- and phase-contrast. To obtain separate images of the projected absorption and phase (i.e., refractive) properties of a sample, phase retrieval methods can be employed. It has been suggested that phase-retrieval can always improve image quality in PB XPC imaging. However, when objective (task-based) measures of image quality are employed, this is not necessarily true and phase retrieval can be detrimental. In this work, signal detection theory is utilized to quantify the performance of a Hotelling observer (HO) for detecting a known signal in a known background. Two cases are considered. In the first case, the HO acts directly on the measured intensity data. In the second case, the HO acts on either the retrieved phase or absorption image. We demonstrate that the performance of the HO is superior when acting on the measured intensity data. The loss of task-specific information induced by phase-retrieval is quantified by computing the efficiency of the HO as the ratio of the test statistic signal-to-noise ratio (SNR) for the two cases. The effect of the system geometry on this efficiency is systematically investigated. Our findings confirm that phase-retrieval can impair signal detection performance in XPC imaging.

Application of the Athlete's Performance Passport for Doping Control: A Case Report.

PubMed

Iljukov, Sergei; Bermon, Stephane; Schumacher, Yorck O

2018-01-01

The efficient use of testing resources is a key issue in the fight against doping. The longitudinal tracking of sporting performances to identify unusual improvements possibly caused by doping, so-called "athlete's performance passport" (APP) is a new concept to improve targeted anti-doping testing. In fact, unusual performances by an athlete would trigger a more thorough testing program. In the present case report, performance data is modeled using the critical power concept for a group of athletes based on their past performances. By these means, an athlete with unusual deviations from his predicted performances was identified. Subsequent target testing using blood testing and the athlete biological passport resulted in an anti-doping rule violation procedure and suspension of the athlete. This case demonstrates the feasibility of the APP approach where athlete's performance is monitored and might serve as an example for the practical implementation of the method.

Application of the Athlete's Performance Passport for Doping Control: A Case Report

PubMed Central

Iljukov, Sergei; Bermon, Stephane; Schumacher, Yorck O.

2018-01-01

The efficient use of testing resources is a key issue in the fight against doping. The longitudinal tracking of sporting performances to identify unusual improvements possibly caused by doping, so-called “athlete's performance passport” (APP) is a new concept to improve targeted anti-doping testing. In fact, unusual performances by an athlete would trigger a more thorough testing program. In the present case report, performance data is modeled using the critical power concept for a group of athletes based on their past performances. By these means, an athlete with unusual deviations from his predicted performances was identified. Subsequent target testing using blood testing and the athlete biological passport resulted in an anti-doping rule violation procedure and suspension of the athlete. This case demonstrates the feasibility of the APP approach where athlete's performance is monitored and might serve as an example for the practical implementation of the method. PMID:29651247

Overcoming rule-based rigidity and connectionist limitations through massively-parallel case-based reasoning

NASA Technical Reports Server (NTRS)

Barnden, John; Srinivas, Kankanahalli

1990-01-01

Symbol manipulation as used in traditional Artificial Intelligence has been criticized by neural net researchers for being excessively inflexible and sequential. On the other hand, the application of neural net techniques to the types of high-level cognitive processing studied in traditional artificial intelligence presents major problems as well. A promising way out of this impasse is to build neural net models that accomplish massively parallel case-based reasoning. Case-based reasoning, which has received much attention recently, is essentially the same as analogy-based reasoning, and avoids many of the problems leveled at traditional artificial intelligence. Further problems are avoided by doing many strands of case-based reasoning in parallel, and by implementing the whole system as a neural net. In addition, such a system provides an approach to some aspects of the problems of noise, uncertainty and novelty in reasoning systems. The current neural net system (Conposit), which performs standard rule-based reasoning, is being modified into a massively parallel case-based reasoning version.

Re-defining one's occupational self 2 years after breast cancer: a case study.

PubMed

Newman, Robin M

2013-01-01

Margaret*, a 56 year-old Caucasian Stage III breast cancer survivor, participated in a 5 week occupational therapy pilot program, called Take Action. This program was designed for breast cancer survivors who self-reported changes in cognitive function following completion of chemotherapy. The goals of the program were to improve participants' knowledge and use of strategies to enhance occupational performance and to improve satisfaction and performance of meaningful daily activities or occupations. Through a client-centered and evidence-based approach, this case study highlights the importance of incorporating the survivors' sense of self into an occupation-based intervention. Occupational therapists play an important role in facilitating exploration of sense of self in the survivorship phase of care to support occupational performance in self care, productivity, work, leisure and social participation. This case study highlights the important work of redefining oneself in the survivorship phase of care. (*denotes name change).

Performance analysis and dynamic modeling of a single-spool turbojet engine

NASA Astrophysics Data System (ADS)

Andrei, Irina-Carmen; Toader, Adrian; Stroe, Gabriela; Frunzulica, Florin

2017-01-01

The purposes of modeling and simulation of a turbojet engine are the steady state analysis and transient analysis. From the steady state analysis, which consists in the investigation of the operating, equilibrium regimes and it is based on appropriate modeling describing the operation of a turbojet engine at design and off-design regimes, results the performance analysis, concluded by the engine's operational maps (i.e. the altitude map, velocity map and speed map) and the engine's universal map. The mathematical model that allows the calculation of the design and off-design performances, in case of a single spool turbojet is detailed. An in house code was developed, its calibration was done for the J85 turbojet engine as the test case. The dynamic modeling of the turbojet engine is obtained from the energy balance equations for compressor, combustor and turbine, as the engine's main parts. The transient analysis, which is based on appropriate modeling of engine and its main parts, expresses the dynamic behavior of the turbojet engine, and further, provides details regarding the engine's control. The aim of the dynamic analysis is to determine a control program for the turbojet, based on the results provided by performance analysis. In case of the single-spool turbojet engine, with fixed nozzle geometry, the thrust is controlled by one parameter, which is the fuel flow rate. The design and management of the aircraft engine controls are based on the results of the transient analysis. The construction of the design model is complex, since it is based on both steady-state and transient analysis, further allowing the flight path cycle analysis and optimizations. This paper presents numerical simulations for a single-spool turbojet engine (J85 as test case), with appropriate modeling for steady-state and dynamic analysis.

High School Grades and University Performance: A Case Study

ERIC Educational Resources Information Center

Cyrenne, Philippe; Chan, Alan

2012-01-01

A critical issue facing a number of colleges and universities is how to allocate first year places to incoming students. The decision to admit students is often based on a number of factors, but a key statistic is a student's high school grades. This paper reports on a case study of the subsequent performance at the University of Winnipeg of high…

Measuring Primary Students' Graph Interpretation Skills via a Performance Assessment: A Case Study in Instrument Development

ERIC Educational Resources Information Center

Peterman, Karen; Cranston, Kayla A.; Pryor, Marie; Kermish-Allen, Ruth

2015-01-01

This case study was conducted within the context of a place-based education project that was implemented with primary school students in the USA. The authors and participating teachers created a performance assessment of standards-aligned tasks to examine 6-10-year-old students' graph interpretation skills as part of an exploratory research…

Performance-Based Funding: State Policy Influences on Small Rural Community Colleges

ERIC Educational Resources Information Center

Thornton, Zoë Mercedes; Friedel, Janice Nahra

2016-01-01

Performance-based funding (PBF) models intend to increase efficiency and productivity of the institution, thereby influencing organizational change. This change may be structural, programmatic, or procedural, and it may affect institutional practice and/or policy. The purpose of this qualitative case study was to understand the organizational…

Localized-atlas-based segmentation of breast MRI in a decision-making framework.

PubMed

Fooladivanda, Aida; Shokouhi, Shahriar B; Ahmadinejad, Nasrin

2017-03-01

Breast-region segmentation is an important step for density estimation and Computer-Aided Diagnosis (CAD) systems in Magnetic Resonance Imaging (MRI). Detection of breast-chest wall boundary is often a difficult task due to similarity between gray-level values of fibroglandular tissue and pectoral muscle. This paper proposes a robust breast-region segmentation method which is applicable for both complex cases with fibroglandular tissue connected to the pectoral muscle, and simple cases with high contrast boundaries. We present a decision-making framework based on geometric features and support vector machine (SVM) to classify breasts in two main groups, complex and simple. For complex cases, breast segmentation is done using a combination of intensity-based and atlas-based techniques; however, only intensity-based operation is employed for simple cases. A novel atlas-based method, that is called localized-atlas, accomplishes the processes of atlas construction and registration based on the region of interest (ROI). Atlas-based segmentation is performed by relying on the chest wall template. Our approach is validated using a dataset of 210 cases. Based on similarity between automatic and manual segmentation results, the proposed method achieves Dice similarity coefficient, Jaccard coefficient, total overlap, false negative, and false positive values of 96.3, 92.9, 97.4, 2.61 and 4.77%, respectively. The localization error of the breast-chest wall boundary is 1.97 mm, in terms of averaged deviation distance. The achieved results prove that the suggested framework performs the breast segmentation with negligible errors and efficient computational time for different breasts from the viewpoints of size, shape, and density pattern.

[Training of resident physicians in the recognition and treatment of an anaphylaxis case in pediatrics with simulation models].

PubMed

Enríquez, Diego; Lamborizio, María J; Firenze, Lorena; Jaureguizar, María de la P; Díaz Pumará, Estanislao; Szyld, Edgardo

2017-08-01

To evaluate the performance of resident physicians in diagnosing and treating a case of anaphylaxis, six months after participating in simulation training exercises. Initially, a group of pediatric residents were trained using simulation techniques in the management of critical pediatric cases. Based on their performance in this exercise, participants were assigned to one of 3 groups. At six months post-training, 4 residents were randomly chosen from each group to be re-tested, using the same performance measure as previously used. During the initial training session, 56 of 72 participants (78%) correctly identified and treated the case. Six months after the initial training, all 12 (100%) resident physicians who were re-tested successfully diagnosed and treated the simulated anaphylaxis case. The training through simulation techniques allowed correction or optimization of the treatment of simulated anaphylaxis cases in resident physicians evaluated after 6 months of the initial training.

[Variability and opportunity costs among the surgical alternatives for breast cancer].

PubMed

Angulo-Pueyo, Ester; Ridao-López, Manuel; Martínez-Lizaga, Natalia; García-Armesto, Sandra; Bernal-Delgado, Enrique

2014-01-01

To analyze medical practice variation in breast cancer surgery (either inpatient-based or day-case surgery), by comparing conservative surgery (CS) plus radiotherapy vs. non-conservative surgery (NCS). We also analyzed the opportunity costs associated with CS and NCS. We performed an observational study of age- and sex-standardized rates of CS and NCS, performed in 199 Spanish healthcare areas in 2008-2009. Costs were calculated by using two techniques: indirectly, by using All-Patients Diagnosis Related Groups (AP-DRG) based on hospital admissions, and directly by using full costing from the Spanish Network of Hospital Costs (SNHC) data. Standardized surgery rates for CS and NCS were 6.84 and 4.35 per 10,000 women, with variation across areas ranging from 2.95 to 3.11 per 10,000 inhabitants. In 2009, 9% of CS was performed as day-case surgery, although a third of the health care areas did not perform this type of surgery. Taking the SNHC as a reference, the cost of CS was estimated at 7,078 € and that of NCS was 6,161 €. Using AP-DRG, costs amounted to 9,036 € and 8,526 €, respectively. However, CS had lower opportunity costs than NCS when day-case surgery was performed frequently-more than 46% of cases (following SNHC estimates) or 23% of cases (following AP-DRG estimates). Day-case CS for breast cancer was found to be the best option in terms of opportunity-costs beyond a specific threshold, when both CS and NCS are elective. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

The Microbiology of Subsurface, Salt-Based Nuclear Waste Repositories: Using Microbial Ecology, Bioenergetics, and Projected Conditions to Help Predict Microbial Effects on Repository Performance

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

Swanson, Juliet S.; Cherkouk, Andrea; Arnold, Thuro

This report summarizes the potential role of microorganisms in salt-based nuclear waste repositories using available information on the microbial ecology of hypersaline environments, the bioenergetics of survival under high ionic strength conditions, and “repository microbiology” related studies. In areas where microbial activity is in question, there may be a need to shift the research focus toward feasibility studies rather than studies that generate actual input for performance assessments. In areas where activity is not necessary to affect performance (e.g., biocolloid transport), repository-relevant data should be generated. Both approaches will lend a realistic perspective to a safety case/performance scenario that willmore » most likely underscore the conservative value of that case.« less

Post Pareto optimization-A case

NASA Astrophysics Data System (ADS)

Popov, Stoyan; Baeva, Silvia; Marinova, Daniela

2017-12-01

Simulation performance may be evaluated according to multiple quality measures that are in competition and their simultaneous consideration poses a conflict. In the current study we propose a practical framework for investigating such simulation performance criteria, exploring the inherent conflicts amongst them and identifying the best available tradeoffs, based upon multi-objective Pareto optimization. This approach necessitates the rigorous derivation of performance criteria to serve as objective functions and undergo vector optimization. We demonstrate the effectiveness of our proposed approach by applying it with multiple stochastic quality measures. We formulate performance criteria of this use-case, pose an optimization problem, and solve it by means of a simulation-based Pareto approach. Upon attainment of the underlying Pareto Frontier, we analyze it and prescribe preference-dependent configurations for the optimal simulation training.

Is Performance Feedback for Educators an Evidence-Based Practice? A Systematic Review and Evaluation Based on Single-Case Research

ERIC Educational Resources Information Center

Fallon, Lindsay M.; Collier-Meek, Melissa A.; Maggin, Daniel M.; Sanetti, Lisa M. H.; Johnson, Austin H.

2015-01-01

Optimal levels of treatment fidelity, a critical moderator of intervention effectiveness, are often difficult to sustain in applied settings. It is unknown whether performance feedback, a widely researched method for increasing educators' treatment fidelity, is an evidence-based practice. The purpose of this review was to evaluate the current…

Short-term solar flare prediction using image-case-based reasoning

NASA Astrophysics Data System (ADS)

Liu, Jin-Fu; Li, Fei; Zhang, Huai-Peng; Yu, Da-Ren

2017-10-01

Solar flares strongly influence space weather and human activities, and their prediction is highly complex. The existing solutions such as data based approaches and model based approaches have a common shortcoming which is the lack of human engagement in the forecasting process. An image-case-based reasoning method is introduced to achieve this goal. The image case library is composed of SOHO/MDI longitudinal magnetograms, the images from which exhibit the maximum horizontal gradient, the length of the neutral line and the number of singular points that are extracted for retrieving similar image cases. Genetic optimization algorithms are employed for optimizing the weight assignment for image features and the number of similar image cases retrieved. Similar image cases and prediction results derived by majority voting for these similar image cases are output and shown to the forecaster in order to integrate his/her experience with the final prediction results. Experimental results demonstrate that the case-based reasoning approach has slightly better performance than other methods, and is more efficient with forecasts improved by humans.

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

PubMed

Chang, Hsien-Yen; Weiner, Jonathan P

2010-01-18

Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory power of claims-based risk adjustment models over demographics-only models, Taiwan's government should consider using claims-based models for policy-relevant applications. The performance of the ACG case-mix system in Taiwan was comparable to that found in other countries. This suggested that the ACG system could be applied to Taiwan's NHI even though it was originally developed in the USA. Many of the findings in this paper are likely to be relevant to other diagnosis-based risk adjustment methodologies.

The Effect of Scaffolding Students' Context-Generating Cognitive Activity in Technology-Enhanced Case-Based Learning

ERIC Educational Resources Information Center

Demetriadis, S. N.; Papadopoulos, P. M.; Stamelos, I. G.; Fischer, F.

2008-01-01

This study investigates the hypothesis that students' learning and problem-solving performance in ill-structured domains can be improved, if elaborative question prompts are used to activate students' context-generating cognitive processes, during case study. Two groups of students used a web-based learning environment to criss-cross and study…

Utilization of a virtual patient for advanced assessment of student performance in pain management.

PubMed

Smith, Michael A; Waite, Laura H

2017-09-01

To assess student performance and achievement of course objectives following the integration of a virtual patient case designed to promote active, patient-centered learning in a required pharmacy course. DecisionSim™ (Kynectiv, Inc., Chadsford, PA), a dynamic virtual patient platform, was used to implement an interactive patient case to augment pain management material presented during a didactic session in a pharmacotherapy course. Simulation performance data were collected and analyzed. Student exam performance on pain management questions was compared to student exam performance on nearly identical questions from a prior year when a paper-based case was used instead of virtual patient technology. Students who performed well on the virtual patient case performed better on exam questions related to patient assessment (p = 0.0244), primary pharmacological therapy (p = 0.0001), and additional pharmacological therapy (p = 0.0001). Overall exam performance did not differ between the two groups. However, students with exposure to the virtual patient case demonstrated significantly better performance on higher level Bloom's Taxonomy questions that required them to create pharmacotherapy regimens (p=0.0005). Students in the previous year (exposed only to a paper patient case) performed better in calculating conversions of opioids for patients (p = 0.0001). Virtual patient technology may enhance student performance on high-level Bloom's Taxonomy examination questions. This study adds to the current literature demonstrating the value of virtual patient technology as an active-learning strategy. Copyright © 2017 Elsevier Inc. All rights reserved.

An Approach for Integrating Toxicogenomic Data in Risk Assessment: The Dibutyl Phthalate Case Study

EPA Science Inventory

An approach for evaluating and integrating genomic data in chemical risk assessment was developed based on the lessons learned from performing a case study for the chemical dibutyl phthalate. A case study prototype approach was first developed in accordance with EPA guidance and ...

TH-A-19A-11: Validation of GPU-Based Monte Carlo Code (gPMC) Versus Fully Implemented Monte Carlo Code (TOPAS) for Proton Radiation Therapy: Clinical Cases Study

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

Giantsoudi, D; Schuemann, J; Dowdell, S

Purpose: For proton radiation therapy, Monte Carlo simulation (MCS) methods are recognized as the gold-standard dose calculation approach. Although previously unrealistic due to limitations in available computing power, GPU-based applications allow MCS of proton treatment fields to be performed in routine clinical use, on time scales comparable to that of conventional pencil-beam algorithms. This study focuses on validating the results of our GPU-based code (gPMC) versus fully implemented proton therapy based MCS code (TOPAS) for clinical patient cases. Methods: Two treatment sites were selected to provide clinical cases for this study: head-and-neck cases due to anatomical geometrical complexity (air cavitiesmore » and density heterogeneities), making dose calculation very challenging, and prostate cases due to higher proton energies used and close proximity of the treatment target to sensitive organs at risk. Both gPMC and TOPAS methods were used to calculate 3-dimensional dose distributions for all patients in this study. Comparisons were performed based on target coverage indices (mean dose, V90 and D90) and gamma index distributions for 2% of the prescription dose and 2mm. Results: For seven out of eight studied cases, mean target dose, V90 and D90 differed less than 2% between TOPAS and gPMC dose distributions. Gamma index analysis for all prostate patients resulted in passing rate of more than 99% of voxels in the target. Four out of five head-neck-cases showed passing rate of gamma index for the target of more than 99%, the fifth having a gamma index passing rate of 93%. Conclusion: Our current work showed excellent agreement between our GPU-based MCS code and fully implemented proton therapy based MC code for a group of dosimetrically challenging patient cases.« less

Prenatal diagnostic procedures used in pregnancies with congenital malformations in 14 regions of Europe.

PubMed

Garne, Ester; Loane, Maria; de Vigan, Catherine; Scarano, Gioacchino; de Walle, Hermien; Gillerot, Yves; Stoll, Claude; Addor, Marie-Claude; Stone, David; Gener, Blanca; Feijoo, Maria; Mosquera-Tenreiro, Carmen; Gatt, Miriam; Queisser-Luft, Annette; Baena, Neus; Dolk, Helen

2004-11-01

To investigate outcomes of ultrasound investigations (US) and invasive diagnostic procedures in cases of congenital malformations (CM), and to compare the use of invasive prenatal test techniques (amniocentesis (AC) versus chorionic villus sampling (CVS)) among European populations. Analysis of data from population-based registries of CM. 25 400 cases of CM recorded by 14 EUROCAT registries covering a total population of 1,013,352 births 1995-99. US were performed in 91% of cases, and positively detected CM in 35% of cases. AC was performed in 24% of the cases and CVS in 3% of cases. Thirty-eight percent of invasive tests gave positive results. Fifty-two percent of cases with maternal age > or = 35 years had an invasive test performed compared to 20% of cases with younger mothers. Considerable variation was found between registries in the uptake rate of invasive tests in cases with older maternal age and on the use of invasive tests with only four regions employing CVS techniques in at least a third of the cases having invasive tests. For chromosomal anomalies US gave positive results in 46% of cases with maternal age < 35 years with US performed and in 36% of cases with maternal age > or = 35 years with US performed. Prenatal US was performed in 91% of all pregnancies with CM but the test was only positive in a third of the cases. There was large regional variation in the uptake rate of invasive tests with maternal age of 35 years or more. For every CVS carried out there were nine AC tests. US is an important tool in the prenatal diagnosis of chromosomal anomalies in Europe. Copyright 2004 John Wiley & Sons, Ltd.

Measuring hospital performance in congenital heart surgery: Administrative vs. clinical registry data

PubMed Central

Pasquali, Sara K.; He, Xia; Jacobs, Jeffrey P.; Jacobs, Marshall L.; Gaies, Michael G.; Shah, Samir S.; Hall, Matthew; Gaynor, J. William; Peterson, Eric D.; Mayer, John E.; Hirsch-Romano, Jennifer C.

2015-01-01

Background In congenital heart surgery, hospital performance has historically been assessed using widely available administrative datasets. Recent studies have demonstrated inaccuracies in case ascertainment (coding and inclusion of eligible cases) in administrative vs. clinical registry data, however it is unclear whether this impacts assessment of performance on a hospital-level. Methods Merged data from the Society of Thoracic Surgeons (STS) Database (clinical registry), and Pediatric Health Information Systems Database (administrative dataset) on 46,056 children undergoing heart surgery (2006–2010) were utilized to evaluate in-hospital mortality for 33 hospitals based on their administrative vs. registry data. Standard methods to identify/classify cases were used: Risk Adjustment in Congenital Heart Surgery (RACHS-1) in the administrative data, and STS–European Association for Cardiothoracic Surgery (STAT) methodology in the registry. Results Median hospital surgical volume based on the registry data was 269 cases/yr; mortality was 2.9%. Hospital volumes and mortality rates based on the administrative data were on average 10.7% and 4.7% lower, respectively, although this varied widely across hospitals. Hospital rankings for mortality based on the administrative vs. registry data differed by ≥ 5 rank-positions for 24% of hospitals, with a change in mortality tertile classification (high, middle, or low mortality) for 18%, and change in statistical outlier classification for 12%. Higher volume/complexity hospitals were most impacted. Agency for Healthcare Quality and Research methods in the administrative data yielded similar results. Conclusions Inaccuracies in case ascertainment in administrative vs. clinical registry data can lead to important differences in assessment of hospital mortality rates for congenital heart surgery. PMID:25624057

Massively parallel support for a case-based planning system

NASA Technical Reports Server (NTRS)

Kettler, Brian P.; Hendler, James A.; Anderson, William A.

1993-01-01

Case-based planning (CBP), a kind of case-based reasoning, is a technique in which previously generated plans (cases) are stored in memory and can be reused to solve similar planning problems in the future. CBP can save considerable time over generative planning, in which a new plan is produced from scratch. CBP thus offers a potential (heuristic) mechanism for handling intractable problems. One drawback of CBP systems has been the need for a highly structured memory to reduce retrieval times. This approach requires significant domain engineering and complex memory indexing schemes to make these planners efficient. In contrast, our CBP system, CaPER, uses a massively parallel frame-based AI language (PARKA) and can do extremely fast retrieval of complex cases from a large, unindexed memory. The ability to do fast, frequent retrievals has many advantages: indexing is unnecessary; very large case bases can be used; memory can be probed in numerous alternate ways; and queries can be made at several levels, allowing more specific retrieval of stored plans that better fit the target problem with less adaptation. In this paper we describe CaPER's case retrieval techniques and some experimental results showing its good performance, even on large case bases.

Liquid-Based Endometrial Cytology Using SurePath™ Is Not Inferior to Suction Endometrial Tissue Biopsy in Clinical Performance for Detecting Endometrial Cancer Including Atypical Endometrial Hyperplasia.

PubMed

Yanaki, Fumiko; Hirai, Yasuo; Hanada, Azusa; Ishitani, Ken; Matsui, Hideo

2017-01-01

We evaluated the clinical performance of liquid-based endometrial cytology (SurePath™) for detecting endometrial malignancies by comparison with the performance of suction endometrial tissue biopsy. From November 2011 to May 2013, we consecutively collected 1,118 liquid-based endometrial cytology specimens and 674 suction endometrial tissue biopsy specimens. The rate of nonpositive final histology in nonpositive liquid-based endometrial cytology (98.2%) was higher than the rate of nonpositive final histology in nonpositive suction endometrial tissue biopsy (97.0%). None of the clinical performance values of liquid-based endometrial cytology for detecting the endometrial malignancies were statistically inferior to those of the suction endometrial tissue biopsy. When the positivity threshold was more than "atypical endometrial cells of undetermined significance," the rate of positive liquid-based endometrial cytology from cases with a positive final histology (84.5%) was higher than the rate of positive suction endometrial tissue biopsy from cases with a positive final histology (69.8%). However, there were still no significant differences among all the performance values. Our liquid-based endometrial cytology would be more appropriate in various clinical situations as the initial detection tool for endometrial malignancies, rather than suction endometrial tissue biopsy. In addition, it could be used in screening for endometrial malignancies on a broader scale. © 2017 S. Karger AG, Basel.

Quality of Operative Performance Feedback Given to Thoracic Surgery Residents Using an App-Based System.

PubMed

Karim, Azad S; Sternbach, Joel M; Bender, Edward M; Zwischenberger, Joseph B; Meyerson, Shari L

Residents frequently report inadequate feedback both in quantity and quality. The study evaluates the quality of faculty feedback about operative performance given using an app-based system. Residents requested operative performance evaluation from faculty on a real-time basis using the "Zwisch Me!!" mobile application which allows faculty to provide brief written feedback. Qualitative analysis of feedback was performed using grounded theory. The 7 academic medical centers with thoracic surgery training programs. Volunteer thoracic surgery residents in both integrated and traditional training pathways and their affiliated cardiothoracic faculty. Residents (n = 33) at 7 institutions submitted a total of 596 evaluations to faculty (n = 48). Faculty acknowledged the evaluation request in 476 cases (80%) and in 350 cases (74%) provided written feedback. Initial open coding generated 12 categories of feedback type. We identified 3 overarching themes. The first theme was the tone of the feedback. Encouraging elements were identified in 162 comments (46%) and corrective elements in 230 (65%). The second theme was the topic of the feedback. Surgical technique was the most common category at 148 comments (42.2%) followed by preparation for case (n = 69, 19.7%). The final theme was the specificity of the feedback. Just over half of comments (n = 190, 54.3%) contained specific feedback, which could be applied to future cases. However, 51 comments (14.6%) contained no useful information for the learners. An app-based system resulted in thoracic surgery residents receiving identifiable feedback in a high proportion of cases. In over half of comments the feedback was specific enough to allow improvement. Feedback was better quality when addressing error prevention and surgical technique but was less useful when addressing communication, flow of the case, and assisting. Faculty development around feedback should focus on making feedback specific and actionable, avoiding case descriptions, or simple platitudes. Copyright © 2017. Published by Elsevier Inc.

Creation of an ensemble of simulated cardiac cases and a human observer study: tools for the development of numerical observers for SPECT myocardial perfusion imaging

NASA Astrophysics Data System (ADS)

O'Connor, J. Michael; Pretorius, P. Hendrik; Gifford, Howard C.; Licho, Robert; Joffe, Samuel; McGuiness, Matthew; Mehurg, Shannon; Zacharias, Michael; Brankov, Jovan G.

2012-02-01

Our previous Single Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging (MPI) research explored the utility of numerical observers. We recently created two hundred and eighty simulated SPECT cardiac cases using Dynamic MCAT (DMCAT) and SIMIND Monte Carlo tools. All simulated cases were then processed with two reconstruction methods: iterative ordered subset expectation maximization (OSEM) and filtered back-projection (FBP). Observer study sets were assembled for both OSEM and FBP methods. Five physicians performed an observer study on one hundred and seventy-nine images from the simulated cases. The observer task was to indicate detection of any myocardial perfusion defect using the American Society of Nuclear Cardiology (ASNC) 17-segment cardiac model and the ASNC five-scale rating guidelines. Human observer Receiver Operating Characteristic (ROC) studies established the guidelines for the subsequent evaluation of numerical model observer (NO) performance. Several NOs were formulated and their performance was compared with the human observer performance. One type of NO was based on evaluation of a cardiac polar map that had been pre-processed using a gradient-magnitude watershed segmentation algorithm. The second type of NO was also based on analysis of a cardiac polar map but with use of a priori calculated average image derived from an ensemble of normal cases.

Marketing Education Assessment Guide. Performance-Based Activities with Authentic Assessments Instruments.

ERIC Educational Resources Information Center

Everett, Donna R.

This guide presents performance-based authentic assessment ideas, samples, and suggestions to help marketing teachers and students respond to changes and pressures from outside the classroom. It contains 21 activities, each accompanied by a method of authentic assessment. In most cases, the authentic assessment method is a scoring device. The…

Towards a Better Understanding of the Legibility Bias in Performance Assessments: The Case of Gender-Based Inferences

ERIC Educational Resources Information Center

Greifeneder, Rainer; Zelt, Sarah; Seele, Tim; Bottenberg, Konstantin; Alt, Alexander

2012-01-01

Background: Handwriting legibility systematically biases evaluations in that highly legible handwriting results in more positive evaluations than less legible handwriting. Because performance assessments in educational contexts are not only based on computerized or multiple choice tests but often include the evaluation of handwritten work samples,…

A Study of Fan Stage/Casing Interaction Models

NASA Technical Reports Server (NTRS)

Lawrence, Charles; Carney, Kelly; Gallardo, Vicente

2003-01-01

The purpose of the present study is to investigate the performance of several existing and new, blade-case interactions modeling capabilities that are compatible with the large system simulations used to capture structural response during blade-out events. Three contact models are examined for simulating the interactions between a rotor bladed disk and a case: a radial and linear gap element and a new element based on a hydrodynamic formulation. The first two models are currently available in commercial finite element codes such as NASTRAN and have been showed to perform adequately for simulating rotor-case interactions. The hydrodynamic model, although not readily available in commercial codes, may prove to be better able to characterize rotor-case interactions.

Comparison of NRZ and duo-binary format in adaptive equalization assisted 10G-optics based 25G-EPON

NASA Astrophysics Data System (ADS)

Xia, Junqi; Li, Zhengxuan; Li, Yingchun; Xu, Tingting; Chen, Jian; Song, Yingxiong; Wang, Min

2018-03-01

We investigate and compare the requirements of FFE/DFE based adaptive equalization techniques for NRZ and Duo-binary based 25-Gb/s transmission, which are two of the most promising schemes for 25G-EPON. A 25-Gb/s transmission system based on 10G optical transceivers is demonstrated and the performance of only FFE and combination of FFE and DFE with different number of taps are compared with two modulation formats. The FFE/DFE based Duo-binary receiver shows better performance than NRZ receiver. For Duo-binary receiver, only 13-tap FFE is needed for BtB case and the combination of 17-tap FFE and 5-tap DFE can achieve a sensitivity of -23.45 dBm in 25 km transmission case, which is ∼0.6 dB better than the best performance of NRZ equalization. In addition, the requirements of training sequence length for FFE/DFE based adaptive equalization is verified. Experimental results show that 400 symbols training length is optimal for the two modulations, which shows a small packet preamble in up-stream burst-mode transmission.

Improving Computational Efficiency of Prediction in Model-Based Prognostics Using the Unscented Transform

NASA Technical Reports Server (NTRS)

Daigle, Matthew John; Goebel, Kai Frank

2010-01-01

Model-based prognostics captures system knowledge in the form of physics-based models of components, and how they fail, in order to obtain accurate predictions of end of life (EOL). EOL is predicted based on the estimated current state distribution of a component and expected profiles of future usage. In general, this requires simulations of the component using the underlying models. In this paper, we develop a simulation-based prediction methodology that achieves computational efficiency by performing only the minimal number of simulations needed in order to accurately approximate the mean and variance of the complete EOL distribution. This is performed through the use of the unscented transform, which predicts the means and covariances of a distribution passed through a nonlinear transformation. In this case, the EOL simulation acts as that nonlinear transformation. In this paper, we review the unscented transform, and describe how this concept is applied to efficient EOL prediction. As a case study, we develop a physics-based model of a solenoid valve, and perform simulation experiments to demonstrate improved computational efficiency without sacrificing prediction accuracy.

Training Post-9/11 Police Officers with a Counter-Terrorism Reality-Based Training Model: A Case Study

ERIC Educational Resources Information Center

Biddle, Christopher J.

2013-01-01

The purpose of this qualitative holistic multiple-case study was to identify the optimal theoretical approach for a Counter-Terrorism Reality-Based Training (CTRBT) model to train post-9/11 police officers to perform effectively in their counter-terrorism assignments. Post-9/11 police officers assigned to counter-terrorism duties are not trained…

Academic English Teaching for Postgraduates Based on Self-Regulated Learning Environment: A Case Study of Academic Reading Course

ERIC Educational Resources Information Center

Zhao, Wei

2016-01-01

This study selects postgraduate students in the first grade as the participants, based on their needs analysis, classroom presentations and performance of assignments completion, through the methodology of case study, the results show that students at the university level even the graduate levels still struggle with academic English. Thus, this…

Impact of Active Teaching Methods Implemented on Therapeutic Chemistry Module: Performance and Impressions of First-Year Pharmacy Students

ERIC Educational Resources Information Center

Derfoufi, Sanae; Benmoussa, Adnane; El Harti, Jaouad; Ramli, Youssef; Taoufik, Jamal; Chaouir, Souad

2015-01-01

This study investigates the positive impact of the Case Method implemented during a 4- hours tutorial in "therapeutic chemistry module." We view the Case Method as one particular approach within the broader spectrum of problem based or inquiry based learning approaches. Sixty students were included in data analysis. A pre-test and…

Comparison of Expert-Based and Empirical Evaluation Methodologies in the Case of a CBL Environment: The ''Orestis'' Experience

ERIC Educational Resources Information Center

Karoulis, Athanasis; Demetriadis, Stavros; Pombortsis, Andreas

2006-01-01

This paper compares several interface evaluation methods applied in the case of a computer based learning (CBL) environment, during a longitudinal study performed in three European countries, Greece, Germany, and Holland, and within the framework of an EC funded Leonardo da Vinci program. The paper firstly considers the particularities of the CBL…

The case Conference Assessment Tool (cCAT): a new workplace-based assessment.

PubMed

O'Connor, Rory J; Playford, E Diane

2014-08-01

Rehabilitation medicine is an educational, problem-solving specialty that relies on excellent team communication, honest discussion with patients and their families, and collaborative goal setting. The case conference has been described as the technology of rehabilitation medicine because it encompasses all of these functions. Trainees should have the opportunity to develop skills in chairing case conferences through receipt of constructive feedback on their performance from their trainers. The aim of this project was to develop and evaluate the case Conference Assessment Tool (cCAT), a workplace-based assessment designed to score a trainee's performance on the key elements of chairing a case conference. Experienced rehabilitation medicine educational supervisors participated in a training workshop and then rated a series of simulated case conferences using the cCAT. Internal consistency was high (Cronbach's α =: 0.945) and interrater reliability was acceptable (intraclass correlation coefficient range 0.673-0.777). Following feedback from the workshops, a final version of the cCAT was developed. The cCAT has now been adopted as a workplace-based assessment for specialty trainees in rehabilitation medicine by the Training Board of the Joint Royal Colleges of Physicians. Further work will explore its utility for trainees in other specialties and in communication and leadership skill training for undergraduate students. © 2014 Royal College of Physicians.

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

Rainer, Leo I.; Hoeschele, Marc A.; Apte, Michael G.

This report addresses the results of detailed monitoring completed under Program Element 6 of Lawrence Berkeley National Laboratory's High Performance Commercial Building Systems (HPCBS) PIER program. The purpose of the Energy Simulations and Projected State-Wide Energy Savings project is to develop reasonable energy performance and cost models for high performance relocatable classrooms (RCs) across California climates. A key objective of the energy monitoring was to validate DOE2 simulations for comparison to initial DOE2 performance projections. The validated DOE2 model was then used to develop statewide savings projections by modeling base case and high performance RC operation in the 16 Californiamore » climate zones. The primary objective of this phase of work was to utilize detailed field monitoring data to modify DOE2 inputs and generate performance projections based on a validated simulation model. Additional objectives include the following: (1) Obtain comparative performance data on base case and high performance HVAC systems to determine how they are operated, how they perform, and how the occupants respond to the advanced systems. This was accomplished by installing both HVAC systems side-by-side (i.e., one per module of a standard two module, 24 ft by 40 ft RC) on the study RCs and switching HVAC operating modes on a weekly basis. (2) Develop projected statewide energy and demand impacts based on the validated DOE2 model. (3) Develop cost effectiveness projections for the high performance HVAC system in the 16 California climate zones.« less

Training to Improve New Product Sales Performance: The Case of Samsung in China

ERIC Educational Resources Information Center

Fu, Frank Q.; Yi, Hong; Zhai, Nanji

2013-01-01

The authors report a case study conducted with over 8,000 Samsung salespeople in the Chinese market. Using research-oriented, evidence-based, and systematic approaches, training professionals contributed to Samsung's business outcomes at multiple levels. The case highlights the valuable impacts of training on salespeople's behaviors and new…

An intelligent case-adjustment algorithm for the automated design of population-based quality auditing protocols.

PubMed

Advani, Aneel; Jones, Neil; Shahar, Yuval; Goldstein, Mary K; Musen, Mark A

2004-01-01

We develop a method and algorithm for deciding the optimal approach to creating quality-auditing protocols for guideline-based clinical performance measures. An important element of the audit protocol design problem is deciding which guide-line elements to audit. Specifically, the problem is how and when to aggregate individual patient case-specific guideline elements into population-based quality measures. The key statistical issue involved is the trade-off between increased reliability with more general population-based quality measures versus increased validity from individually case-adjusted but more restricted measures done at a greater audit cost. Our intelligent algorithm for auditing protocol design is based on hierarchically modeling incrementally case-adjusted quality constraints. We select quality constraints to measure using an optimization criterion based on statistical generalizability coefficients. We present results of the approach from a deployed decision support system for a hypertension guideline.

Ultra-wideband polarization conversion metasurface and its application cases for antenna radiation enhancement and scattering suppression.

PubMed

Zheng, Yuejun; Zhou, Yulong; Gao, Jun; Cao, Xiangyu; Yang, Huanhuan; Li, Sijia; Xu, Liming; Lan, Junxiang; Jidi, Liaori

2017-11-23

A double-layer complementary metasurface (MS) with ultra-wideband polarization conversion is presented. Then, we propose two application cases by applying the polarization conversion structures to aperture coupling patch antenna (ACPA). Due to the existence of air-filled gap of ACPA, air substrate and dielectric substrate are used to construct the double-layer MS. The polarization conversion bandwidth is broadened toward low-frequency range. Subsequently, two application cases of antenna are proposed and investigated. The simultaneous improvement of radiation and scattering performance of antenna is normally considered as a contradiction. Gratifyingly, the contradiction is addressed in these two application cases. According to different mechanism of scattering suppression (i.e., polarization conversion and phase cancellation), the polarization conversion structures are utilized to construct uniform and orthogonal arrangement configurations. And then, the configurations are integrated into ACPA and two different kinds of metasurface-based (MS-based) ACPA are formed. Radiation properties of the two MS-based ACPAs are improved by optimizing the uniform and orthogonal arrangement configurations. The measured results suggest that ultra-wideband polarization conversion properties of the MS are achieved and radiation enhancement and scattering suppression of the two MS-based ACPAs are obtained. These results demonstrate that we provide novel approach to design high-performance polarization conversion MS and MS-based devices.

Validation of a GPU-based Monte Carlo code (gPMC) for proton radiation therapy: clinical cases study.

PubMed

Giantsoudi, Drosoula; Schuemann, Jan; Jia, Xun; Dowdell, Stephen; Jiang, Steve; Paganetti, Harald

2015-03-21

Monte Carlo (MC) methods are recognized as the gold-standard for dose calculation, however they have not replaced analytical methods up to now due to their lengthy calculation times. GPU-based applications allow MC dose calculations to be performed on time scales comparable to conventional analytical algorithms. This study focuses on validating our GPU-based MC code for proton dose calculation (gPMC) using an experimentally validated multi-purpose MC code (TOPAS) and compare their performance for clinical patient cases. Clinical cases from five treatment sites were selected covering the full range from very homogeneous patient geometries (liver) to patients with high geometrical complexity (air cavities and density heterogeneities in head-and-neck and lung patients) and from short beam range (breast) to large beam range (prostate). Both gPMC and TOPAS were used to calculate 3D dose distributions for all patients. Comparisons were performed based on target coverage indices (mean dose, V95, D98, D50, D02) and gamma index distributions. Dosimetric indices differed less than 2% between TOPAS and gPMC dose distributions for most cases. Gamma index analysis with 1%/1 mm criterion resulted in a passing rate of more than 94% of all patient voxels receiving more than 10% of the mean target dose, for all patients except for prostate cases. Although clinically insignificant, gPMC resulted in systematic underestimation of target dose for prostate cases by 1-2% compared to TOPAS. Correspondingly the gamma index analysis with 1%/1 mm criterion failed for most beams for this site, while for 2%/1 mm criterion passing rates of more than 94.6% of all patient voxels were observed. For the same initial number of simulated particles, calculation time for a single beam for a typical head and neck patient plan decreased from 4 CPU hours per million particles (2.8-2.9 GHz Intel X5600) for TOPAS to 2.4 s per million particles (NVIDIA TESLA C2075) for gPMC. Excellent agreement was demonstrated between our fast GPU-based MC code (gPMC) and a previously extensively validated multi-purpose MC code (TOPAS) for a comprehensive set of clinical patient cases. This shows that MC dose calculations in proton therapy can be performed on time scales comparable to analytical algorithms with accuracy comparable to state-of-the-art CPU-based MC codes.

Monte Carlo simulations within avalanche rescue

NASA Astrophysics Data System (ADS)

Reiweger, Ingrid; Genswein, Manuel; Schweizer, Jürg

2016-04-01

Refining concepts for avalanche rescue involves calculating suitable settings for rescue strategies such as an adequate probing depth for probe line searches or an optimal time for performing resuscitation for a recovered avalanche victim in case of additional burials. In the latter case, treatment decisions have to be made in the context of triage. However, given the low number of incidents it is rarely possible to derive quantitative criteria based on historical statistics in the context of evidence-based medicine. For these rare, but complex rescue scenarios, most of the associated concepts, theories, and processes involve a number of unknown "random" parameters which have to be estimated in order to calculate anything quantitatively. An obvious approach for incorporating a number of random variables and their distributions into a calculation is to perform a Monte Carlo (MC) simulation. We here present Monte Carlo simulations for calculating the most suitable probing depth for probe line searches depending on search area and an optimal resuscitation time in case of multiple avalanche burials. The MC approach reveals, e.g., new optimized values for the duration of resuscitation that differ from previous, mainly case-based assumptions.

Improving results for carotid artery stenting by validation of the anatomic scoring system for carotid artery stenting with patient-specific simulated rehearsal.

PubMed

Willaert, Willem I M; Cheshire, Nicholas J; Aggarwal, Rajesh; Van Herzeele, Isabelle; Stansby, Gerard; Macdonald, Sumaira; Vermassen, Frank E

2012-12-01

Carotid artery stenting (CAS) is a technically demanding procedure with a risk of periprocedural stroke. A scoring system based on anatomic criteria has been developed to facilitate patient selection for CAS. Advancements in simulation science also enable case evaluation through patient-specific virtual reality (VR) rehearsal on an endovascular simulator. This study aimed to validate the anatomic scoring system for CAS using the patient-specific VR technology. Three patients were selected and graded according to the CAS scoring system (maximum score, 9): one easy (score, <4.9), one intermediate (score, 5.0-5.9), and one difficult (score, >7.0). The three cases were performed on the simulator in random order by 20 novice interventionalists pretrained in CAS. Technical performances were assessed using simulator-based metrics and expert-based ratings. The interventionalists took significantly longer to perform the difficult CAS case (median, 31.6 vs 19.7 vs 14.6 minutes; P<.0001) compared with the intermediate and easy cases; similarly, more fluoroscopy time (20.7 vs 12.1 vs 8.2 minutes; P<.0001), contrast volume (56.5 vs 51.5 vs 50.0 mL; P=.0060), and roadmaps (10 vs 9 vs 9; P=.0040) were used. The quality of performance declined significantly as the cases became more challenging (score, 24 vs 22 vs 19; P<.0001). The anatomic scoring system for CAS can predict the difficulty of a CAS procedure as measured by patient-specific VR. This scoring system, with or without the additional use of patient-specific VR, can guide novice interventionalists in selecting appropriate patients for CAS. This may reduce the perioperative stroke risk and enhance patient safety. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Evaluation of the Diagnostic Utility of the Traditional and Revised WHO Dengue Case Definitions

PubMed Central

Gutiérrez, Gamaliel; Gresh, Lionel; Pérez, María Ángeles; Elizondo, Douglas; Avilés, William; Kuan, Guillermina; Balmaseda, Ángel; Harris, Eva

2013-01-01

Dengue, a mosquito-borne viral illness, is a major public health problem worldwide, and its incidence continues to increase. In 2009, the World Health Organization published guidelines that included a revision of the dengue case definition. Compared to the traditional definition, the revised case definition relies more on signs than on symptoms, making it more applicable to young children. We evaluated the diagnostic utility of both case definitions in two studies of pediatric dengue in Managua, Nicaragua. In a community-based cohort study, we included data from 3,407 suspected dengue cases, of which 476 were laboratory-confirmed. In the second study, we collected information from 1,160 participants recruited at the national pediatric reference hospital (723 laboratory-confirmed). In the cohort study, the traditional definition had 89.3% sensitivity and 43.1% specificity, while the revised definition yielded similar sensitivity (86.6%) and higher specificity (55.2%, p<0.001). In the hospital study, the traditional case definition yielded 96.7% sensitivity and 22.0% specificity, whereas the revised case definition had higher sensitivity (99.3%, p<0.001) but lower specificity (8.5%, p<0.001). We then evaluated the performance of two diagnostic models based on the signs/symptoms included in each definition by analyzing the effect of increasing numbers of signs/symptoms on the sensitivity and specificity of case capture. Receiver operating characteristic analysis showed a slightly better performance for the revised model in both studies. Interestingly, despite containing less symptoms that cannot be readily expressed by children aged less than 4 years, the revised definition did not perform better in this age group. Overall, our results indicate that both case definitions have similar capacity to diagnose dengue. Owing to their high sensitivity and low specificity, they should be primarily used for screening purposes. However, in a primary care setting, neither of the case definitions performed well as a screening test in younger children. PMID:23991237

Toward Understanding the Role of Web 2.0 Technology in Self-Directed Learning and Job Performance in a Single Organizational Setting: A Qualitative Case Study

ERIC Educational Resources Information Center

Caruso, Shirley J.

2016-01-01

This single instrumental qualitative case study explores and thickly describes job performance outcomes based upon the manner in which self-directed learning activities of a purposefully selected sample of 3 construction managers are conducted, mediated by the use of Web 2.0 technology. The data collected revealed that construction managers are…

Using a contextualized sensemaking model for interaction design: A case study of tumor contouring.

PubMed

Aselmaa, Anet; van Herk, Marcel; Laprie, Anne; Nestle, Ursula; Götz, Irina; Wiedenmann, Nicole; Schimek-Jasch, Tanja; Picaud, Francois; Syrykh, Charlotte; Cagetti, Leonel V; Jolnerovski, Maria; Song, Yu; Goossens, Richard H M

2017-01-01

Sensemaking theories help designers understand the cognitive processes of a user when he/she performs a complicated task. This paper introduces a two-step approach of incorporating sensemaking support within the design of health information systems by: (1) modeling the sensemaking process of physicians while performing a task, and (2) identifying software interaction design requirements that support sensemaking based on this model. The two-step approach is presented based on a case study of the tumor contouring clinical task for radiotherapy planning. In the first step of the approach, a contextualized sensemaking model was developed to describe the sensemaking process based on the goal, the workflow and the context of the task. In the second step, based on a research software prototype, an experiment was conducted where three contouring tasks were performed by eight physicians respectively. Four types of navigation interactions and five types of interaction sequence patterns were identified by analyzing the gathered interaction log data from those twenty-four cases. Further in-depth study on each of the navigation interactions and interaction sequence patterns in relation to the contextualized sensemaking model revealed five main areas for design improvements to increase sensemaking support. Outcomes of the case study indicate that the proposed two-step approach was beneficial for gaining a deeper understanding of the sensemaking process during the task, as well as for identifying design requirements for better sensemaking support. Copyright © 2016. Published by Elsevier Inc.

Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure.

PubMed

Edler, Gertrud; Axelsson, Inge; Barker, Gillian M; Lie, Susanne; Naumburg, Estelle

2016-07-01

More than 7000 male circumcisions are performed in Scandinavia every year. Circumcision is regulated in different ways in Sweden and Denmark and Norway. This study reviewed and described factors associated with complications of circumcision in infant boys in Scandinavia over the last two decades and discussed how these complications could be avoided. Data on significant complications following circumcision on boys under the age of one in Scandinavia over the last 20 years were collected. Information was retrieved from testimonies of circumcisers, witnesses, medical records and verdicts. A systematic review was performed of fatal cases in the literature. We found that 32 cases had been reported to the health authorities in the three countries, and we identified a total of 74 complications in these cases. These included four boys with severe bleeding and circulatory shock, which ended in the death of one boy. Other less serious complications may have occurred in other boys, but not been reported. Complications following male circumcision in Scandinavia were relatively rare, but serious complications did occur. Based on the analyses of the severe cases, we argue that circumcision should only be performed at hospitals with 24-hour emergency departments. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Numerical simulation on dimension decrease for annular casing of one centrifugal boiler circulation pump

NASA Astrophysics Data System (ADS)

Fan, Y. Z.; Zuo, Z. G.; Liu, S. H.; Wu, Y. L.; Sha, Y. J.

2012-11-01

Primary formulation derivation indicates that the dimension of one existing centrifugal boiler circulation pump casing is too large. As great manufacture cost can be saved by dimension decrease, a numerical simulation research is developed in this paper on dimension decrease for annular casing of this pump with a specific speed equaling to 189, which aims at finding an appropriately smaller dimension of the casing while hydraulic performance and strength performance will hardly be changed according to the requirements of the cooperative company. The research object is one existing centrifugal pump with a diffuser and a semi-spherical annular casing, working as the boiler circulation pump for (ultra) supercritical units in power plants. Dimension decrease, the modification method, is achieved by decreasing the existing casing's internal radius (marked as "Ri0") while keeping the wall thickness. The research analysis is based on primary formulation derivation, CFD (Computational Fluid Dynamics) simulation and FEM (Finite Element Method) simulation. Primary formulation derivation estimates that a design casing's internal radius should be less than 0.75 Ri0. CFD analysis indicates that smaller casing with 0.75 Ri0 has a worse hydraulic performance when working at large flow rates and a better hydraulic performance when working at small flow rates. In consideration of hydraulic performance and dimension decrease, an appropriate casing's internal radius is determined, which equals to 0.875 Ri0. FEM analysis then confirms that modified pump casing has nearly the same strength performance as the existing pump casing. It is concluded that dimension decrease can be an economical method as well as a practical method for large pumps in engineering fields.

Leadership Behaviour in High-Performing Government Boys Secondary Schools in Quetta: A Grounded Theory Analysis

ERIC Educational Resources Information Center

Bahadur, Waheed; Bano, Amir; Waheed, Zarina; Wahab, Abdul

2017-01-01

The performance of schools is highly dependent on the leadership of school heads, and, flexible leaders accelerate school performance. The purpose of this qualitative study was to examine leadership behavior in selected boys' secondary schools that are performing well. Based on multiple-case study design, four high-performing schools from Quetta…

The SAFE-T assessment tool: derivation and validation of a web-based application for point-of-care evaluation of gastroenterology fellow performance in colonoscopy.

PubMed

Kumar, Navin L; Kugener, Guillaume; Perencevich, Molly L; Saltzman, John R

2018-01-01

Attending assessment is a critical part of endoscopic education for gastroenterology fellows. The aim of this study was to develop and validate a concise assessment tool to evaluate real-time fellow performance in colonoscopy administered via a web-based application. The Skill Assessment in Fellow Endoscopy Training (SAFE-T) tool was derived as a novel 5-question evaluation tool that captures both summative and formative feedback adapted into a web-based application. A prospective study of 15 gastroenterology fellows (5 fellows each from years 1 to 3 of training) was performed using the SAFE-T tool. An independent reviewer evaluated a subset of these procedures and completed the SAFE-T tool and Mayo Colonoscopy Skills Assessment Tool (MCSAT) for reliability testing. Twenty-six faculty completed 350 SAFE-T evaluations of the 15 fellows in the study. The mean SAFE-T overall score (year 1, 2.00; year 2, 3.84; year 3, 4.28) differentiated each sequential fellow year of training (P < .0001). The mean SAFE-T overall score decreased with increasing case complexity score, with straightforward cases compared with average cases (4.07 vs 3.50, P < .0001), and average cases compared with challenging cases (3.50 vs 3.08, P = .0134). In dual-observed procedures, the SAFE-T tool showed excellent inter-rater reliability with a kappa agreement statistic of 0.898 (P < .0001). Correlation of the SAFE-T overall score with the MCSAT overall hands-on and individual motor scores was excellent (each r > 0.90, P < .0001). We developed and validated the SAFE-T assessment tool, a concise and web-based means of assessing real-time gastroenterology fellow performance in colonoscopy. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Comparison of Quantity Versus Quality Using Performance, Reliability, and Life Cycle Cost Data. A Case Study of the F-15, F-16, and A-10 Aircraft.

DTIC Science & Technology

1985-09-01

CoC S~04 COMPARISON OF QUANTITY VERSUS QUALITY USING PERFORMANCE, RELIABILITY, AND LIFE CYCLE COST DATA. A CASE STUDY OF THE F-15, F-16, AND A-10...CYCLE COSTIATU.AT CAE AIR ORE HEO OG .- jAITR UIVERSITY W right.,Patterson Air Force Base, Ohio .! 5ൔ ,6 198 C.IT. U AF’IT/GSL,4/L3Q/65:S Ŗ J...COMPARISON OF QUANTITY VERSUS QUALITY USING PERFORMANCE, RELIABILITY, AND LIFE CYCLE COST DATA. A CASE STUDY OF THE F-15, F-16, AND A-10 AIRCRAFT THESIS David

Implementation of probe data performance measures.

DOT National Transportation Integrated Search

2017-04-03

This report presents results from a 12-month project where three arterial analysis tools based on probe vehicle segment speed data were developed for District 6. A case study of 5 arterials and two incidents was performed.

Evaluating Web-Based Learning and Instruction (WBLI): A Case Study and Framework for Evaluation.

ERIC Educational Resources Information Center

Michalski, Greg V.

The purpose of this paper is to suggest an alternative approach to perform relevant and useful evaluations of Web-based learning and instruction (WBLI) that will accommodate performance and keep pace with the growing capabilities of the Internet. Discussion includes the advantages of WBLI, multimedia and streaming use in WBLI, building the…

Scenario-based and scenario-neutral assessment of climate change impacts on operational performance of a multipurpose reservoir

Treesearch

Allison G. Danner; Mohammad Safeeq; Gordon E. Grant; Charlotte Wickham; Desirée Tullos; Mary V. Santelmann

2017-01-01

Scenario-based and scenario-neutral impacts assessment approaches provide complementary information about how climate change-driven effects on streamflow may change the operational performance of multipurpose dams. Examining a case study of Cougar Dam in Oregon, United States, we simulated current reservoir operations under scenarios of plausible future hydrology....

A Qualitative Study about Performance Based Assesment Methods Used in Information Technologies Lesson

ERIC Educational Resources Information Center

Daghan, Gökhan; Akkoyunlu, Buket

2014-01-01

In this study, Information Technologies teachers' views and usage cases on performance based assesment methods (PBAMs) are examined. It is aimed to find out which of the PBAMs are used frequently or not used, preference reasons of these methods and opinions about the applicability of them. Study is designed with the phenomenological design which…

The Preliminary Investigation of the Factors that Influence the E-Learning Adoption in Higher Education Institutes: Jordan Case Study

ERIC Educational Resources Information Center

Al-hawari, Maen; Al-halabi, Sanaa

2010-01-01

Creativity and high performance in learning processes are the main concerns of educational institutions. E-learning contributes to the creativity and performance of these institutions and reproduces a traditional learning model based primarily on knowledge transfer into more innovative models based on collaborative learning. In this paper, the…

Why IEP Teams Assign Low Performers with Mild Disabilities to the Alternate Assessment Based on Alternate Achievement Standards

ERIC Educational Resources Information Center

Cho, Hyun-Jeong; Kingston, Neal

2013-01-01

The purpose of this case study was to determine teachers' rationales for assigning students with mild disabilities to alternate assessment based on alternate achievement standards (AA-AAS). In interviews, special educators stated that their primary considerations in making the assignments were low academic performance, student use of extended…

Examining the Role of the Principal: Case Study of a High-Poverty, High-Performing Rural Elementary School

ERIC Educational Resources Information Center

Coleman, Howard D.

2013-01-01

Since the inception of high-stakes standardized testing, schools have been labeled as either succeeding or failing based on student standardized assessment performance. If students perform adequately, the building principal receives acknowledgement for being an effective instructional leader. Conversely, if students perform poorly, the principal…

A performance study of unmanned aerial vehicle-based sensor networks under cyber attack

NASA Astrophysics Data System (ADS)

Puchaty, Ethan M.

In UAV-based sensor networks, an emerging area of interest is the performance of these networks under cyber attack. This study seeks to evaluate the performance trade-offs from a System-of-Systems (SoS) perspective between various UAV communications architecture options in the context two missions: tracking ballistic missiles and tracking insurgents. An agent-based discrete event simulation is used to model a sensor communication network consisting of UAVs, military communications satellites, ground relay stations, and a mission control center. Network susceptibility to cyber attack is modeled with probabilistic failures and induced data variability, with performance metrics focusing on information availability, latency, and trustworthiness. Results demonstrated that using UAVs as routers increased network availability with a minimal latency penalty and communications satellite networks were best for long distance operations. Redundancy in the number of links between communication nodes helped mitigate cyber-caused link failures and add robustness in cases of induced data variability by an adversary. However, when failures were not independent, redundancy and UAV routing were detrimental in some cases to network performance. Sensitivity studies indicated that long cyber-caused downtimes and increasing failure dependencies resulted in build-ups of failures and caused significant degradations in network performance.

Implementation of Performance-Based Acquisition in Non-Western Countries

DTIC Science & Technology

2009-03-01

narratives , phenomenologies , ethnographies , grounded theory studies , or case studies . The researcher collects...are biography, phenomenological study , grounded theory study , ethnography , and case study . The approach used for qualitative data collection method ... qualitative methods , such as the grounded theory approach to

Comparison of exposure assessment methods in a lung cancer case-control study: performance of a lifelong task-based questionnaire for asbestos and PAHs.

PubMed

Bourgkard, Eve; Wild, Pascal; Gonzalez, Maria; Févotte, Joëlle; Penven, Emmanuelle; Paris, Christophe

2013-12-01

To describe the performance of a lifelong task-based questionnaire (TBQ) in estimating exposures compared with other approaches in the context of a case-control study. A sample of 93 subjects was randomly selected from a lung cancer case-control study corresponding to 497 jobs. For each job, exposure assessments for asbestos and polycyclic aromatic hydrocarbons (PAHs) were obtained by expertise (TBQ expertise) and by algorithm using the TBQ (TBQ algorithm) as well as by expert appraisals based on all available occupational data (REFERENCE expertise) considered to be the gold standard. Additionally, a Job Exposure Matrix (JEM)-based evaluation for asbestos was also obtained. On the 497 jobs, the various evaluations were contrasted using Cohen's κ coefficient of agreement. Additionally, on the total case-control population, the asbestos dose-response relationship based on the TBQ algorithm was compared with the JEM-based assessment. Regarding asbestos, the TBQ-exposure estimates agreed well with the REFERENCE estimate (TBQ expertise: level-weighted κ (lwk)=0.68; TBQ algorithm: lwk=0.61) but less so with the JEM estimate (TBQ expertise: lwk=0.31; TBQ algorithm: lwk=0.26). Regarding PAHs, the agreements between REFERENCE expertise and TBQ were less good (TBQ expertise: lwk=0.43; TBQ algorithm: lwk=0.36). In the case-control study analysis, the dose-response relationship between lung cancer and cumulative asbestos based on the JEM is less steep than with the TBQ-algorithm exposure assessment and statistically non-significant. Asbestos-exposure estimates based on the TBQ were consistent with the REFERENCE expertise and yielded a steeper dose-response relationship than the JEM. For PAHs, results were less clear.

Noninvasive prenatal testing of trisomies 21 and 18 by massively parallel sequencing of maternal plasma DNA in twin pregnancies.

PubMed

Huang, Xuan; Zheng, Jing; Chen, Min; Zhao, Yangyu; Zhang, Chunlei; Liu, Lifu; Xie, Weiwei; Shi, Shuqiong; Wei, Yuan; Lei, Dongzhu; Xu, Chenming; Wu, Qichang; Guo, Xiaoling; Shi, Xiaomei; Zhou, Yi; Liu, Qiufang; Gao, Ya; Jiang, Fuman; Zhang, Hongyun; Su, Fengxia; Ge, Huijuan; Li, Xuchao; Pan, Xiaoyu; Chen, Shengpei; Chen, Fang; Fang, Qun; Jiang, Hui; Lau, Tze Kin; Wang, Wei

2014-04-01

The objective of this study is to assess the performance of noninvasive prenatal testing for trisomies 21 and 18 on the basis of massively parallel sequencing of cell-free DNA from maternal plasma in twin pregnancies. A double-blind study was performed over 12 months. A total of 189 pregnant women carrying twins were recruited from seven hospitals. Maternal plasma DNA sequencing was performed to detect trisomies 21 and 18. The fetal karyotype was used as gold standard to estimate the sensitivity and specificity of sequencing-based noninvasive prenatal test. There were nine cases of trisomy 21 and two cases of trisomy 18 confirmed by karyotyping. Plasma DNA sequencing correctly identified nine cases of trisomy 21 and one case of trisomy 18. The discordant case of trisomy 18 was an unusual case of monozygotic twin with discordant fetal karyotype (one normal and the other trisomy 18). The sensitivity and specificity of maternal plasma DNA sequencing for fetal trisomy 21 were both 100% and for fetal trisomy 18 were 50% and 100%, respectively. Our study further supported that sequencing-based noninvasive prenatal testing of trisomy 21 in twin pregnancies could be achieved with a high accuracy, which could effectively avoid almost 95% of invasive prenatal diagnosis procedures. © 2013 John Wiley & Sons, Ltd.

The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes.

PubMed

Keller, Deborah S; Pedraza, Rodrigo; Flores-Gonzalez, Juan Ramon; LeFave, Jean Paul; Mahmood, Ali; Haas, Eric M

2016-08-01

Population-based studies evaluating laparoscopic colectomy and outcomes compared with open surgery have concentrated on elective resections. As such, data assessing non-elective laparoscopic colectomies are limited. Our goal was to evaluate the current usage and outcomes of laparoscopic in the urgent and emergent setting in the USA. A national inpatient database was reviewed from 2008 to 2011 for right, left, and sigmoid colectomies in the non-elective setting. Cases were stratified by approach into open or laparoscopic groups. Demographics, perioperative clinical variables, and financial outcomes were compared across each group. A total of 22,719 non-elective colectomies were analyzed. The vast majority (95.8 %) was open. Most cases were performed in an urban setting at non-teaching hospitals by general surgeons. Colorectal surgeons were significantly more likely to perform a case laparoscopic than general surgeons (p < 0.001). Demographics were similar between open and laparoscopic groups; however, the disease distribution by approach varied, with significantly more severe cases in the open colectomy arm (p < 0.001). Cases performed laparoscopically had significantly better mortality and complication rates. Laparoscopic cases also had significantly improved outcomes, including shorter length of stay and hospital costs (all p < 0.001). Our analysis revealed less than 5 % of urgent and emergent colectomies in the USA are performed laparoscopically. Colorectal surgeons were more likely to approach a case laparoscopically than general surgeons. Outcomes following laparoscopic colectomy in this setting resulted in reduced length of stay, lower complication rates, and lower costs. Increased adoption of laparoscopy in the non-elective setting should be considered.

Measuring hospital performance in congenital heart surgery: administrative versus clinical registry data.

PubMed

Pasquali, Sara K; He, Xia; Jacobs, Jeffrey P; Jacobs, Marshall L; Gaies, Michael G; Shah, Samir S; Hall, Matthew; Gaynor, J William; Peterson, Eric D; Mayer, John E; Hirsch-Romano, Jennifer C

2015-03-01

In congenital heart surgery, hospital performance has historically been assessed using widely available administrative data sets. Recent studies have demonstrated inaccuracies in case ascertainment (coding and inclusion of eligible cases) in administrative versus clinical registry data; however, it is unclear whether this impacts assessment of performance on a hospital level. Merged data from The Society of Thoracic Surgeons (STS) database (clinical registry) and the Pediatric Health Information Systems (PHIS) database (administrative data set) for 46,056 children undergoing cardiac operations (2006-2010) were used to evaluate in-hospital mortality for 33 hospitals based on their administrative versus registry data. Standard methods to identify/classify cases were used: Risk Adjustment in Congenital Heart Surgery, version 1 (RACHS-1) in the administrative data and STS-European Association for Cardiothoracic Surgery (STAT) methodology in the registry. Median hospital surgical volume based on the registry data was 269 cases per year; mortality was 2.9%. Hospital volumes and mortality rates based on the administrative data were on average 10.7% and 4.7% lower, respectively, although this varied widely across hospitals. Hospital rankings for mortality based on the administrative versus registry data differed by 5 or more rank positions for 24% of hospitals, with a change in mortality tertile classification (high, middle, or low mortality) for 18% and a change in statistical outlier classification for 12%. Higher volume/complexity hospitals were most impacted. Agency for Healthcare Quality and Research (AHRQ) methods in the administrative data yielded similar results. Inaccuracies in case ascertainment in administrative versus clinical registry data can lead to important differences in assessment of hospital mortality rates for congenital heart surgery. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

The "aid contract" and its compensation scheme: a case study of the performance of the Ugandan health sector.

PubMed

Oliveira Cruz, Valeria; McPake, Barbara

2010-10-01

Current literature on aid effectiveness describes increasing use of a more contractual approach to the relationship between donor and recipient government in which a system of rewards and penalties for good and bad performance operates. The purpose of this case study of the Ugandan health sector was to understand the extent to which this approach is influencing processes and effectiveness. This qualitative study used a conceptual framework based on agency theory and 'realistic evaluation'. Our results showed that the main official mechanism to assess and reward performance established through the Sector Wide Approach lacked objective criteria and was based on an unstructured system of discussions and agreements among donors. The achievement of a satisfactory performance rating was facilitated by the agreeing to undertakings that were under-demanding, vaguely formulated and lacking quantitative benchmarks against which progress could be measured. However, even when poor performance was readily observable, penalties failed to be applied by donors. This was always the case in relation to health sector performance and mostly so in relation to general governance and accountability. Funds continued to be disbursed despite the lack of progress made in achieving targets and undertakings and other evident performance problems (e.g. in the area of governance). A series of explanations of the failure to penalise were put forward by donor representatives in relation to this behaviour including the need to maintain long-term relationships based on trust and not to undermine health sector performance by withdrawing aid. Thus there are likely to be incentives to disburse funds and report success, irrespective of the realities of aid programmes in the context of large foreign aid volumes associated with increased political visibility of aid in donor countries.

Disk MHD generator study

NASA Technical Reports Server (NTRS)

Retallick, F. D.

1980-01-01

Directly-fired, separately-fired, and oxygen-augmented MHD power plants incorporating a disk geometry for the MHD generator were studied. The base parameters defined for four near-optimum-performance MHD steam power systems of various types are presented. The finally selected systems consisted of (1) two directly fired cases, one at 1920 K (2996F) preheat and the other at 1650 K (2500 F) preheat, (2) a separately-fired case where the air is preheated to the same level as the higher temperature directly-fired cases, and (3) an oxygen augmented case with the same generator inlet temperature of 2839 (4650F) as the high temperature directly-fired and separately-fired cases. Supersonic Mach numbers at the generator inlet, gas inlet swirl, and constant Hall field operation were specified based on disk generator optimization. System pressures were based on optimization of MHD net power. Supercritical reheat stream plants were used in all cases. Open and closed cycle component costs are summarized and compared.

The preparedness level of final year medical students for an adequate medical approach to emergency cases: computer-based medical education in emergency medicine

PubMed Central

2014-01-01

Background We aimed to observe the preparedness level of final year medical students in approaching emergencies by computer-based simulation training and evaluate the efficacy of the program. Methods A computer-based prototype simulation program (Lsim), designed by researchers from the medical education and computer science departments, was used to present virtual cases for medical learning. Fifty-four final year medical students from Ondokuz Mayis University School of Medicine attended an education program on June 20, 2012 and were trained with Lsim. Volunteer attendants completed a pre-test and post-test exam at the beginning and end of the course, respectively, on the same day. Results Twenty-nine of the 54 students who attended the course accepted to take the pre-test and post-test exams; 58.6% (n = 17) were female. In 10 emergency medical cases, an average of 3.9 correct medical approaches were performed in the pre-test and an average of 9.6 correct medical approaches were performed in the post-test (t = 17.18, P = 0.006). Conclusions This study’s results showed that the readiness level of students for an adequate medical approach to emergency cases was very low. Computer-based training could help in the adequate approach of students to various emergency cases. PMID:24386919

High-performance sparse matrix-matrix products on Intel KNL and multicore architectures

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

Nagasaka, Y; Matsuoka, S; Azad, A

Sparse matrix-matrix multiplication (SpGEMM) is a computational primitive that is widely used in areas ranging from traditional numerical applications to recent big data analysis and machine learning. Although many SpGEMM algorithms have been proposed, hardware specific optimizations for multi- and many-core processors are lacking and a detailed analysis of their performance under various use cases and matrices is not available. We firstly identify and mitigate multiple bottlenecks with memory management and thread scheduling on Intel Xeon Phi (Knights Landing or KNL). Specifically targeting multi- and many-core processors, we develop a hash-table-based algorithm and optimize a heap-based shared-memory SpGEMM algorithm. Wemore » examine their performance together with other publicly available codes. Different from the literature, our evaluation also includes use cases that are representative of real graph algorithms, such as multi-source breadth-first search or triangle counting. Our hash-table and heap-based algorithms are showing significant speedups from libraries in the majority of the cases while different algorithms dominate the other scenarios with different matrix size, sparsity, compression factor and operation type. We wrap up in-depth evaluation results and make a recipe to give the best SpGEMM algorithm for target scenario. A critical finding is that hash-table-based SpGEMM gets a significant performance boost if the nonzeros are not required to be sorted within each row of the output matrix.« less

Investigation of crew performance in a multi-vehicle supervisory control task

NASA Technical Reports Server (NTRS)

Miller, R. A.; Plamondon, B. D.; Jagacinski, R. J.; Kirlik, A. C.

1986-01-01

Crew information processing and decision making in a supervisory control task which is loosely based on the mission of future generation helicopters is measured and represented. Subjects control the motion and activities of their own vehicle and direct the activities of four additional craft. The task involves searching an uncertain environment for cargo and enemies, returning cargo to home base and destroying enemies while attempting to avoid destruction of the scout and the supervised vehicles. A series of experiments with two-person crews and one-person crews were performed. Resulting crew performance was modeled with the objective of describing and understanding the information processing strategies utilized. Of particular interest are problem simplification strategies under time stress and high work load, simplification and compensation in the one-person cases, crew coordination in the two-person cases, and the relationship between strategy and errors in all cases. The results should provide some insight into the effective use of aids, particularly aids based on artificial intelligence, for similar tasks. The simulation is described which is used for the study and some preliminary results from the first two-person crew study are discussed.

Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation.

PubMed

Calderwood, Michael S; Huang, Susan S; Keller, Vicki; Bruce, Christina B; Kazerouni, N Neely; Janssen, Lynn

2017-09-01

OBJECTIVE To assess hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validation METHODS Infection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency). RESULTS Upon validation review, CDPH IPs identified 239 SSIs following colon surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For colon surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone colon surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing colon surgery and 35% of validation hospitals performing abdominal hysterectomy. CONCLUSIONS Claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation. Infect Control Hosp Epidemiol 2017;38:1091-1097.

On the Analysis of Case-Control Studies in Cluster-correlated Data Settings.

PubMed

Haneuse, Sebastien; Rivera-Rodriguez, Claudia

2018-01-01

In resource-limited settings, long-term evaluation of national antiretroviral treatment (ART) programs often relies on aggregated data, the analysis of which may be subject to ecological bias. As researchers and policy makers consider evaluating individual-level outcomes such as treatment adherence or mortality, the well-known case-control design is appealing in that it provides efficiency gains over random sampling. In the context that motivates this article, valid estimation and inference requires acknowledging any clustering, although, to our knowledge, no statistical methods have been published for the analysis of case-control data for which the underlying population exhibits clustering. Furthermore, in the specific context of an ongoing collaboration in Malawi, rather than performing case-control sampling across all clinics, case-control sampling within clinics has been suggested as a more practical strategy. To our knowledge, although similar outcome-dependent sampling schemes have been described in the literature, a case-control design specific to correlated data settings is new. In this article, we describe this design, discuss balanced versus unbalanced sampling techniques, and provide a general approach to analyzing case-control studies in cluster-correlated settings based on inverse probability-weighted generalized estimating equations. Inference is based on a robust sandwich estimator with correlation parameters estimated to ensure appropriate accounting of the outcome-dependent sampling scheme. We conduct comprehensive simulations, based in part on real data on a sample of N = 78,155 program registrants in Malawi between 2005 and 2007, to evaluate small-sample operating characteristics and potential trade-offs associated with standard case-control sampling or when case-control sampling is performed within clusters.

Coding response to a case-mix measurement system based on multiple diagnoses.

PubMed

Preyra, Colin

2004-08-01

To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

Filament wound data base development, revision 1, appendix A

NASA Technical Reports Server (NTRS)

Sharp, R. Scott; Braddock, William F.

1985-01-01

Data are presented in tabular form for the High Performance Nozzle Increments, Filament Wound Case (FWC) Systems Tunnel Increments, Steel Case Systems Tunnel Increments, FWC Stiffener Rings Increments, Steel Case Stiffener Rings Increments, FWC External Tank (ET) Attach Ring Increments, Steel Case ET Attach Ring Increments, and Data Tape 8. The High Performance Nozzle are also presented in graphical form. The tabular data consist of six-component force and moment coefficients as they vary with angle of attack at a specific Mach number and roll angle. The six coefficients are normal force, pitching moment, side force, yawing moment, axial force, and rolling moment. The graphical data for the High Performance Nozzle Increments consist of a plot of a coefficient increment as a function of angle of attack at a specific Mach number and at a roll angle of 0 deg.

How to get the most out of your orthopaedic fellowship: thinking about practice-based learning.

PubMed

Templeman, David

2012-09-01

Practice-based learning and improvement is an important skill set to develop during an orthopaedic trauma fellowship and is 1 of the 6 core competencies stated by the ACGME. The review of clinic cases is best done using a few simple models to develop a structured approach for studying cases. Three common sense and easy-to-use strategies to improve clinical practice are as follows: performing each case three times, studying the 4 quadrants of patient outcomes, and the application of the Pareto 80/20 rule. These principles help to develop a structured approach for analyzing and thinking about practice-based experiences.

Cluster and Sporadic Cases of Herbaspirillum Species Infections in Patients With Cancer

PubMed Central

Chemaly, Roy F.; Dantes, Raymund; Shah, Dimpy P.; Shah, Pankil K.; Pascoe, Neil; Ariza-Heredia, Ella; Perego, Cheryl; Nguyen, Duc B.; Nguyen, Kim; Modarai, Farhad; Moulton-Meissner, Heather; Noble-Wang, Judith; Tarrand, Jeffrey J.; LiPuma, John J.; Guh, Alice Y.; MacCannell, Tara; Raad, Issam; Mulanovich, Victor

2015-01-01

Background. Herbaspirillum species are gram-negative Betaproteobacteria that inhabit the rhizosphere. We investigated a potential cluster of hospital-based Herbaspirillum species infections. Methods. Cases were defined as Herbaspirillum species isolated from a patient in our comprehensive cancer center between 1 January 2006 and 15 October 2013. Case finding was performed by reviewing isolates initially identified as Burkholderia cepacia susceptible to all antibiotics tested, and 16S ribosomal DNA sequencing of available isolates to confirm their identity. Pulsed-field gel electrophoresis (PFGE) was performed to test genetic relatedness. Facility observations, infection prevention assessments, and environmental sampling were performed to investigate potential sources of Herbaspirillum species. Results. Eight cases of Herbaspirillum species were identified. Isolates from the first 5 clustered cases were initially misidentified as B. cepacia, and available isolates from 4 of these cases were indistinguishable. The 3 subsequent cases were identified by prospective surveillance and had different PFGE patterns. All but 1 case-patient had bloodstream infections, and 6 presented with sepsis. Underlying diagnoses included solid tumors (3), leukemia (3), lymphoma (1), and aplastic anemia (1). Herbaspirillum species infections were hospital-onset in 5 patients and community-onset in 3. All symptomatic patients were treated with intravenous antibiotics, and their infections resolved. No environmental source or common mechanism of acquisition was identified. Conclusions. This is the first report of a hospital-based cluster of Herbaspirillum species infections. Herbaspirillum species are capable of causing bacteremia and sepsis in immunocompromised patients. Herbaspirillum species can be misidentified as Burkholderia cepacia by commercially available microbial identification systems. PMID:25216687

Case-based lung image categorization and retrieval for interstitial lung diseases: clinical workflows.

PubMed

Depeursinge, Adrien; Vargas, Alejandro; Gaillard, Frédéric; Platon, Alexandra; Geissbuhler, Antoine; Poletti, Pierre-Alexandre; Müller, Henning

2012-01-01

Clinical workflows and user interfaces of image-based computer-aided diagnosis (CAD) for interstitial lung diseases in high-resolution computed tomography are introduced and discussed. Three use cases are implemented to assist students, radiologists, and physicians in the diagnosis workup of interstitial lung diseases. In a first step, the proposed system shows a three-dimensional map of categorized lung tissue patterns with quantification of the diseases based on texture analysis of the lung parenchyma. Then, based on the proportions of abnormal and normal lung tissue as well as clinical data of the patients, retrieval of similar cases is enabled using a multimodal distance aggregating content-based image retrieval (CBIR) and text-based information search. The global system leads to a hybrid detection-CBIR-based CAD, where detection-based and CBIR-based CAD show to be complementary both on the user's side and on the algorithmic side. The proposed approach is in accordance with the classical workflow of clinicians searching for similar cases in textbooks and personal collections. The developed system enables objective and customizable inter-case similarity assessment, and the performance measures obtained with a leave-one-patient-out cross-validation (LOPO CV) are representative of a clinical usage of the system.

Effect of digital problem-based learning cases on student learning outcomes in ophthalmology courses.

PubMed

Kong, Jun; Li, Xiaoyan; Wang, Youdong; Sun, Wei; Zhang, Jinsong

2009-09-01

To assess the impact of digital problem-based learning (PBL) cases on student learning in ophthalmology courses. Ninety students were randomly divided into 3 classes (30 students per class). The first class studied under a didactic model. The other 2 classes were divided into 6 groups (10 students per group) and received PBL teaching; 3 groups studied via cases presented in digital form and the others studied via paper-form cases. The results of theoretical and case analysis examinations were analyzed using the chi(2) test. Student performance on the interval practice was analyzed using the Kruskal-Wallis test. Questionnaires were used to evaluate student and facilitator perceptions. Students in the digital groups exhibited better performance in the practice procedures according to tutorial evaluations compared with the other groups (P < .05). The 2 PBL classes had significantly higher mean results of theoretical and case analysis examinations (P < .001), but there was no significant difference between the 2 PBL classes. Ninety-three percent of students in the digital groups (vs 73% in the paper groups) noted that the cases greatly stimulated their interest. Introducing PBL into ophthalmology could improve educational quality and effectiveness. Digital PBL cases stimulate interest and motivate students to further improve diagnosis and problem-handling skills.

The Performance Blueprint: An Integrated Logic Model Developed To Enhance Performance Measurement Literacy: The Case of Performance-Based Contract Management.

ERIC Educational Resources Information Center

Longo, Paul J.

This study explored the mechanics of using an enhanced, comprehensive multipurpose logic model, the Performance Blueprint, as a means of building evaluation capacity, referred to in this paper as performance measurement literacy, to facilitate the attainment of both service-delivery oriented and community-oriented outcomes. The application of this…

[Two cases of curative resection by laparoscopic surgery following preoperative chemotherapy with bevacizumab for locally advanced colon cancer].

PubMed

Sakaguchi, Masazumi; Kan, Takatsugu; Tsubono, Michihiko; Kii, Eiji

2014-04-01

Here we report 2 cases of curative resection following preoperative chemotherapy with bevacizumab for locally advanced colon cancer. Case 1 was a 62-year-old man admitted with constipation, abdominal distention, and abdominal pain. An abdominal computed tomography(CT)scan revealed an obstructive tumor of the sigmoid colon with invasion into the bladder. A diverting colostomy was performed, and chemotherapy with mFOLFOX6(infusional 5-fluorouracil/Leucovorin+ oxaliplatin) plus bevacizumab was initiated. The tumor shrunk markedly after 6 courses of this treatment. Thereafter, laparoscopy- assisted sigmoidectomy was successfully performed. Case 2 was a 61-year-old woman admitted with diarrhea, abdominal pain, and fever. An abdominal CT scan revealed an obstructive tumor of the sigmoid colon with invasion into the ileum, uterus and retroperitoneum. A diverting colostomy was performed, and chemotherapy with XELOX(capecitabine+ oxaliplatin)plus bevacizumab was initiated. The tumor shrunk markedly after 6 courses of this treatment. Thereafter, laparoscopy- assisted sigmoidectomy was successfully performed. Both cases demonstrated partial clinical responses to chemotherapy; thus, curative resection surgeries were performed. There were no perioperative complications. Therefore, we conclude that oxaliplatin-based chemotherapy plus bevacizumab and laparoscopic resection could be very effective for locally advanced colon cancer.

Evaluating performance of local case-mix system by international comparison: a case study in Beijing, China.

PubMed

Jian, Wei-Yan; Lu, Ming; Cui, Tao; Hu, Mu

2011-01-01

Case-mix is an important tool for health planning and management in many countries. As a major developing country, China is considering the introduction of the case-mix system in the health reform. Beijing, the capital of China, developed a local case-mix version whose performance needs to be evaluated before utilization. The objective of this study was to evaluate the performance of the case-mix system developed in Beijing by comparing it with those used in Australia and the U.S.A. A total of 1.3 million inpatient records from 154 hospitals in Beijing in 2008 were grouped respectively using three case-mix systems: (i) Beijing Diagnosis Related Groups (BJ-DRGs); (ii) US-based All Patient DRGs; and (iii) Australian Refined DRGs. Coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of DRGs system. The BJ-DRGs produced the best CV and RIV results for expenditure. However, at the level of Major Diagnostic Category (MDC), three MDCs of BJ-DRGs gave the poorest RIVs for both expenditure and length of stay. Although the performance of BJ-DRGs was acceptable, further revision and improvement is needed. Comparisons with other mature DRGs versions can assist in identifying the improvement priorities of the local version. Copyright © 2011 John Wiley & Sons, Ltd.

Parametric study of prospective early commercial MHD power plants (PSPEC). General Electric Company, task 1: Parametric analysis

NASA Technical Reports Server (NTRS)

Marston, C. H.; Alyea, F. N.; Bender, D. J.; Davis, L. K.; Dellinger, T. C.; Hnat, J. G.; Komito, E. H.; Peterson, C. A.; Rogers, D. A.; Roman, A. J.

1980-01-01

The performance and cost of moderate technology coal-fired open cycle MHD/steam power plant designs which can be expected to require a shorter development time and have a lower development cost than previously considered mature OCMHD/steam plants were determined. Three base cases were considered: an indirectly-fired high temperature air heater (HTAH) subsystem delivering air at 2700 F, fired by a state of the art atmospheric pressure gasifier, and the HTAH subsystem was deleted and oxygen enrichment was used to obtain requisite MHD combustion temperature. Coal pile to bus bar efficiencies in ease case 1 ranged from 41.4% to 42.9%, and cost of electricity (COE) was highest of the three base cases. For base case 2 the efficiency range was 42.0% to 45.6%, and COE was lowest. For base case 3 the efficiency range was 42.9% to 44.4%, and COE was intermediate. The best parametric cases in bases cases 2 and 3 are recommended for conceptual design. Eventual choice between these approaches is dependent on further evaluation of the tradeoffs among HTAH development risk, O2 plant integration, and further refinements of comparative costs.

Validating the WHO Maternal Near Miss Tool in a high-income country.

PubMed

Witteveen, Tom; de Koning, Ilona; Bezstarosti, Hans; van den Akker, Thomas; van Roosmalen, Jos; Bloemenkamp, Kitty W

2016-01-01

This study was performed to assess the applicability of the WHO Maternal Near Miss Tool (MNM Tool) and the organ dysfunction criteria in a high-income country. The MNM tool was applied to 2552 women who died of pregnancy-related causes or sustained severe acute maternal morbidity between August 2004 and August 2006 in one of the 98 hospitals with a maternity unit in the Netherlands. Fourteen (0.6%) cases had insufficient data for application. Each case was assessed according to the three main "MNM categories" specified in the MNM tool and their subcategory criteria: five disease-, four intervention- and seven organ dysfunction-based criteria. Potentially life-threatening conditions (disease-based inclusions) and life-threatening cases (organ dysfunction-based inclusions) were differentiated according to WHO methodology. Outcomes were incidence of all (sub)categories and case-fatality rates. Of the 2538 cases, 2308 (90.9%) women fulfilled disease-based, 2116 (83.4%) intervention-based and 1024 (40.3%) organ dysfunction-based criteria. Maternal death occurred in 48 women, of whom 23 (47.9%) fulfilled disease-based, 33 (68.8%) intervention-based and 31 (64.6%) organ dysfunction-based criteria. Case-fatality rates were 23/2308 (1.0%) for cases fulfilling the disease-based criteria, 33/2116 (1.6%) for intervention-based criteria and 31/1024 (3.0%) for women fulfilling the organ dysfunction-based criteria. In the Netherlands, where advanced laboratory and clinical monitoring are available, organ dysfunction-based criteria of the MNM tool failed to identify nearly two-thirds of sustained severe acute maternal morbidity cases and more than one-third of maternal deaths. Disease-based criteria remain important, and using only organ dysfunction-based criteria would lead to underestimating severe acute maternal morbidity. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Multidisciplinary life cycle metrics and tools for green buildings.

PubMed

Helgeson, Jennifer F; Lippiatt, Barbara C

2009-07-01

Building sector stakeholders need compelling metrics, tools, data, and case studies to support major investments in sustainable technologies. Proponents of green building widely claim that buildings integrating sustainable technologies are cost effective, but often these claims are based on incomplete, anecdotal evidence that is difficult to reproduce and defend. The claims suffer from 2 main weaknesses: 1) buildings on which claims are based are not necessarily "green" in a science-based, life cycle assessment (LCA) sense and 2) measures of cost effectiveness often are not based on standard methods for measuring economic worth. Yet, the building industry demands compelling metrics to justify sustainable building designs. The problem is hard to solve because, until now, neither methods nor robust data supporting defensible business cases were available. The US National Institute of Standards and Technology (NIST) Building and Fire Research Laboratory is beginning to address these needs by developing metrics and tools for assessing the life cycle economic and environmental performance of buildings. Economic performance is measured with the use of standard life cycle costing methods. Environmental performance is measured by LCA methods that assess the "carbon footprint" of buildings, as well as 11 other sustainability metrics, including fossil fuel depletion, smog formation, water use, habitat alteration, indoor air quality, and effects on human health. Carbon efficiency ratios and other eco-efficiency metrics are established to yield science-based measures of the relative worth, or "business cases," for green buildings. Here, the approach is illustrated through a realistic building case study focused on different heating, ventilation, air conditioning technology energy efficiency. Additionally, the evolution of the Building for Environmental and Economic Sustainability multidisciplinary team and future plans in this area are described.

A case control study of association between cognition and functional capacity in schizophrenia.

PubMed

Narayanan, Sreelatha S; Bhatia, Triptish; Velligan, Dawn I; Nimgaonkar, Vishwajit L; Deshpande, Smita N

2015-12-01

Cognitive functions are important prognostic factors for schizophrenia (SZ), while ability to perform activities of daily living are important measures of functional capacity. The relationship between cognition and functional capacity has not been tested extensively in India. To compare persons with SZ with controls on measures of cognition and functional capacity, and evaluate correlations between cognitive performance and functional capacity. Schizophrenia outpatients and controls without psychiatric illness (DSM IV) who completed the MATRICS Consensus Cognitive Battery and Functional Assessment Battery comprised of two tests from University of California San Diego (UCSD) Performance Based Skill Assessment (UPSA), one Test of Adaptive Behavior in Schizophrenia (TABS) and one test from University of California San Diego Performance Based Skill Assessment Brief edition (UPSA-B). Cognitive and functional domains were examined using regression analyses, with relevant covariates. Cases (N=51) though younger, were more educated than controls (N=41). Adjusting for education, controls performed better than cases in 3/7 cognitive and 4/5 domains of functional capacity but similarly in 'household management'. Among both cases and controls, cognitive measures of verbal learning and speed of processing overlapped with functional capacity (3 domains). Working memory was associated with one functional domain. Consistent with other studies, Indian patients with schizophrenia performed worse than controls on several domains of cognition and functional capacity; these domains were correlated. Speed of processing and verbal learning are most frequently associated with functional capacity indices and should be targeted to improve skills of daily living among persons with SZ. Copyright © 2015. Published by Elsevier B.V.

The oral case presentation: toward a performance-based rhetorical model for teaching and learning.

PubMed

Chan, Mei Yuit

2015-01-01

The oral case presentation is an important communicative activity in the teaching and assessment of students. Despite its importance, not much attention has been paid to providing support for teachers to teach this difficult task to medical students who are novices to this form of communication. As a formalized piece of talk that takes a regularized form and used for a specific communicative goal, the case presentation is regarded as a rhetorical activity and awareness of its rhetorical and linguistic characteristics should be given due consideration in teaching. This paper reviews practitioners' and the limited research literature that relates to expectations of medical educators about what makes a good case presentation, and explains the rhetorical aspect of the activity. It is found there is currently a lack of a comprehensive model of the case presentation that projects the rhetorical and linguistic skills needed to produce and deliver a good presentation. Attempts to describe the structure of the case presentation have used predominantly opinion-based methodologies. In this paper, I argue for a performance-based model that would not only allow a description of the rhetorical structure of the oral case presentation, but also enable a systematic examination of the tacit genre knowledge that differentiates the expert from the novice. Such a model will be a useful resource for medical educators to provide more structured feedback and teaching support to medical students in learning this important genre.

The oral case presentation: toward a performance-based rhetorical model for teaching and learning

PubMed Central

Chan, Mei Yuit

2015-01-01

The oral case presentation is an important communicative activity in the teaching and assessment of students. Despite its importance, not much attention has been paid to providing support for teachers to teach this difficult task to medical students who are novices to this form of communication. As a formalized piece of talk that takes a regularized form and used for a specific communicative goal, the case presentation is regarded as a rhetorical activity and awareness of its rhetorical and linguistic characteristics should be given due consideration in teaching. This paper reviews practitioners’ and the limited research literature that relates to expectations of medical educators about what makes a good case presentation, and explains the rhetorical aspect of the activity. It is found there is currently a lack of a comprehensive model of the case presentation that projects the rhetorical and linguistic skills needed to produce and deliver a good presentation. Attempts to describe the structure of the case presentation have used predominantly opinion-based methodologies. In this paper, I argue for a performance-based model that would not only allow a description of the rhetorical structure of the oral case presentation, but also enable a systematic examination of the tacit genre knowledge that differentiates the expert from the novice. Such a model will be a useful resource for medical educators to provide more structured feedback and teaching support to medical students in learning this important genre. PMID:26194482

Subjective and objective quantification of physician's workload and performance during radiation therapy planning tasks.

PubMed

Mazur, Lukasz M; Mosaly, Prithima R; Hoyle, Lesley M; Jones, Ellen L; Marks, Lawrence B

2013-01-01

To quantify, and compare, workload for several common physician-based treatment planning tasks using objective and subjective measures of workload. To assess the relationship between workload and performance to define workload levels where performance could be expected to decline. Nine physicians performed the same 3 tasks on each of 2 cases ("easy" vs "hard"). Workload was assessed objectively throughout the tasks (via monitoring of pupil size and blink rate), and subjectively at the end of each case (via National Aeronautics and Space Administration Task Load Index; NASA-TLX). NASA-TLX assesses the 6 dimensions (mental, physical, and temporal demands, frustration, effort, and performance); scores > or ≈ 50 are associated with reduced performance in other industries. Performance was measured using participants' stated willingness to approve the treatment plan. Differences in subjective and objective workload between cases, tasks, and experience were assessed using analysis of variance (ANOVA). The correlation between subjective and objective workload measures were assessed via the Pearson correlation test. The relationships between workload and performance measures were assessed using the t test. Eighteen case-wise and 54 task-wise assessments were obtained. Subjective NASA-TLX scores (P < .001), but not time-weighted averages of objective scores (P > .1), were significantly lower for the easy vs hard case. Most correlations between the subjective and objective measures were not significant, except between average blink rate and NASA-TLX scores (r = -0.34, P = .02), for task-wise assessments. Performance appeared to decline at NASA-TLX scores of ≥55. The NASA-TLX may provide a reasonable method to quantify subjective workload for broad activities, and objective physiologic eye-based measures may be useful to monitor workload for more granular tasks within activities. The subjective and objective measures, as herein quantified, do not necessarily track each other, and more work is needed to assess their utilities. From a series of controlled experiments, we found that performance appears to decline at subjective workload levels ≥55 (as measured via NASA-TLX), which is consistent with findings from other industries. Copyright © 2013 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

DEVELOPMENT OF A NOVEL GAS PRESSURIZED STRIPPING (GPS)-BASED TECHNOLOGY FOR CO 2 CAPTURE FROM POST-COMBUSTION FLUE GASES Topical Report: Techno-Economic Analysis of GPS-based Technology for CO 2 Capture

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

Chen, Shiaoguo

This topical report presents the techno-economic analysis, conducted by Carbon Capture Scientific, LLC (CCS) and Nexant, for a nominal 550 MWe supercritical pulverized coal (PC) power plant utilizing CCS patented Gas Pressurized Stripping (GPS) technology for post-combustion carbon capture (PCC). Illinois No. 6 coal is used as fuel. Because of the difference in performance between the GPS-based PCC and the MEA-based CO2 absorption technology, the net power output of this plant is not exactly 550 MWe. DOE/NETL Case 11 supercritical PC plant without CO2 capture and Case 12 supercritical PC plant with benchmark MEA-based CO2 capture are chosen as references.more » In order to include CO2 compression process for the baseline case, CCS independently evaluated the generic 30 wt% MEA-based PCC process together with the CO2 compression section. The net power produced in the supercritical PC plant with GPS-based PCC is 647 MW, greater than the MEA-based design. The levelized cost of electricity (LCOE) over a 20-year period is adopted to assess techno-economic performance. The LCOE for the supercritical PC plant with GPS-based PCC, not considering CO2 transport, storage and monitoring (TS&M), is 97.4 mills/kWh, or 152% of the Case 11 supercritical PC plant without CO2 capture, equivalent to $39.6/tonne for the cost of CO2 capture. GPS-based PCC is also significantly superior to the generic MEA-based PCC with CO2 compression section, whose LCOE is as high as 109.6 mills/kWh.« less

Self-Recirculating Casing Treatment Concept for Enhanced Compressor Performance

NASA Technical Reports Server (NTRS)

Hathaway, Michael D.

2002-01-01

A state-of-the-art CFD code (APNASA) was employed in a computationally based investigation of the impact of casing bleed and injection on the stability and performance of a moderate speed fan rotor wherein the stalling mass flow is controlled by tip flow field breakdown. The investigation was guided by observed trends in endwall flow characteristics (e.g., increasing endwall aerodynamic blockage) as stall is approached and based on the hypothesis that application of bleed or injection can mitigate these trends. The "best" bleed and injection configurations were then combined to yield a self-recirculating casing treatment concept. The results of this investigation yielded: 1) identification of the fluid mechanisms which precipitate stall of tip critical blade rows, and 2) an approach to recirculated casing treatment which results in increased compressor stall range with minimal or no loss in efficiency. Subsequent application of this approach to a high speed transonic rotor successfully yielded significant improvements in stall range with no loss in compressor efficiency.

[Diagnostic difficulties in Grave's orbitopathy--case report].

PubMed

Jedrzejowski, Maciej; Grzesiuk, Wiesław; Szwejda, Elzbieta; Bar-Andziak, Ewa

2004-03-01

Graves' orbitopathy is caused by intraorbital inflammatory reaction due to autoimmune thyroid disease. In most cases the diagnosis is based on the coexistence of typical eye signs and hyperthyroidism symptoms. In presented case, the absence of thyroid dysfunction implicated performance of differential diagnosis. Among many available diagnostic tools nuclear magnetic resonance seems to be the most accurate in confirmation of diagnosis of Graves' orbitopathy.

Brief Report: Maternal Smoking during Pregnancy and Autism Spectrum Disorders

ERIC Educational Resources Information Center

Lee, Brian K.; Gardner, Renee M.; Dal, Henrik; Svensson, Anna; Galanti, Maria Rosaria; Rai, Dheeraj; Dalman, Christina; Magnusson, Cecilia

2012-01-01

Prenatal exposure to tobacco smoke is suggested as a potential risk factor for autism spectrum disorders (ASD). Previous epidemiological studies of this topic have yielded mixed findings. We performed a case-control study of 3,958 ASD cases and 38,983 controls nested in a large register-based cohort in Sweden. ASD case status was measured using a…

Fusion of Scores in a Detection Context Based on Alpha Integration.

PubMed

Soriano, Antonio; Vergara, Luis; Ahmed, Bouziane; Salazar, Addisson

2015-09-01

We present a new method for fusing scores corresponding to different detectors (two-hypotheses case). It is based on alpha integration, which we have adapted to the detection context. Three optimization methods are presented: least mean square error, maximization of the area under the ROC curve, and minimization of the probability of error. Gradient algorithms are proposed for the three methods. Different experiments with simulated and real data are included. Simulated data consider the two-detector case to illustrate the factors influencing alpha integration and demonstrate the improvements obtained by score fusion with respect to individual detector performance. Two real data cases have been considered. In the first, multimodal biometric data have been processed. This case is representative of scenarios in which the probability of detection is to be maximized for a given probability of false alarm. The second case is the automatic analysis of electroencephalogram and electrocardiogram records with the aim of reproducing the medical expert detections of arousal during sleeping. This case is representative of scenarios in which probability of error is to be minimized. The general superior performance of alpha integration verifies the interest of optimizing the fusing parameters.

A stochastic approach for automatic generation of urban drainage systems.

PubMed

Möderl, M; Butler, D; Rauch, W

2009-01-01

Typically, performance evaluation of new developed methodologies is based on one or more case studies. The investigation of multiple real world case studies is tedious and time consuming. Moreover extrapolating conclusions from individual investigations to a general basis is arguable and sometimes even wrong. In this article a stochastic approach is presented to evaluate new developed methodologies on a broader basis. For the approach the Matlab-tool "Case Study Generator" is developed which generates a variety of different virtual urban drainage systems automatically using boundary conditions e.g. length of urban drainage system, slope of catchment surface, etc. as input. The layout of the sewer system is based on an adapted Galton-Watson branching process. The sub catchments are allocated considering a digital terrain model. Sewer system components are designed according to standard values. In total, 10,000 different virtual case studies of urban drainage system are generated and simulated. Consequently, simulation results are evaluated using a performance indicator for surface flooding. Comparison between results of the virtual and two real world case studies indicates the promise of the method. The novelty of the approach is that it is possible to get more general conclusions in contrast to traditional evaluations with few case studies.

[Acquiring skills in malignant hyperthermia crisis management: comparison of high-fidelity simulation versus computer-based case study].

PubMed

Mejía, Vilma; Gonzalez, Carlos; Delfino, Alejandro E; Altermatt, Fernando R; Corvetto, Marcia A

The primary purpose of this study was to compare the effect of high fidelity simulation versus a computer-based case solving self-study, in skills acquisition about malignant hyperthermia on first year anesthesiology residents. After institutional ethical committee approval, 31 first year anesthesiology residents were enrolled in this prospective randomized single-blinded study. Participants were randomized to either a High Fidelity Simulation Scenario or a computer-based Case Study about malignant hyperthermia. After the intervention, all subjects' performance in was assessed through a high fidelity simulation scenario using a previously validated assessment rubric. Additionally, knowledge tests and a satisfaction survey were applied. Finally, a semi-structured interview was done to assess self-perception of reasoning process and decision-making. 28 first year residents finished successfully the study. Resident's management skill scores were globally higher in High Fidelity Simulation versus Case Study, however they were significant in 4 of the 8 performance rubric elements: recognize signs and symptoms (p = 0.025), prioritization of initial actions of management (p = 0.003), recognize complications (p = 0.025) and communication (p = 0.025). Average scores from pre- and post-test knowledge questionnaires improved from 74% to 85% in the High Fidelity Simulation group, and decreased from 78% to 75% in the Case Study group (p = 0.032). Regarding the qualitative analysis, there was no difference in factors influencing the student's process of reasoning and decision-making with both teaching strategies. Simulation-based training with a malignant hyperthermia high-fidelity scenario was superior to computer-based case study, improving knowledge and skills in malignant hyperthermia crisis management, with a very good satisfaction level in anesthesia residents. Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Automated rule-base creation via CLIPS-Induce

NASA Technical Reports Server (NTRS)

Murphy, Patrick M.

1994-01-01

Many CLIPS rule-bases contain one or more rule groups that perform classification. In this paper we describe CLIPS-Induce, an automated system for the creation of a CLIPS classification rule-base from a set of test cases. CLIPS-Induce consists of two components, a decision tree induction component and a CLIPS production extraction component. ID3, a popular decision tree induction algorithm, is used to induce a decision tree from the test cases. CLIPS production extraction is accomplished through a top-down traversal of the decision tree. Nodes of the tree are used to construct query rules, and branches of the tree are used to construct classification rules. The learned CLIPS productions may easily be incorporated into a large CLIPS system that perform tasks such as accessing a database or displaying information.

Education research: a case-based bioethics curriculum for neurology residents.

PubMed

Tolchin, Benjamin; Willey, Joshua Z; Prager, Kenneth

2015-03-31

In 2012, the American Academy of Neurology (AAN) updated and expanded its ethics curriculum into Practical Ethics in Clinical Neurology, a case-based ethics curriculum for neurologists. We piloted a case-based bioethics curriculum for neurology residents using the framework and topics recommended by the AAN, matched to clinical cases drawn from Columbia's neurologic services. Our primary outcome was residents' ability to analyze and manage ethically complex cases as measured on precurriculum and postcurriculum multiple-choice quizzes. Secondary outcomes included precurriculum and postcurriculum self-assessed comfort in discussing and managing ethically complex cases, as well as attendance at ethics discussion sessions as compared to attendance at other didactic sessions. Resident performance on quizzes improved from 75.8% to 86.7% (p = 0.02). Comfort in discussing ethically complex cases improved from 6.4 to 7.4 on a 10-point scale (p = 0.03). Comfort in managing such cases trended toward improvement but did not reach statistical significance. Attendance was significantly better at ethics discussions (73.5%) than at other didactic sessions (61.7%, p = 0.04). Our formal case-based ethics curriculum for neurology residents, based on core topics drawn from the AAN's published curricula, was successfully piloted. Our study showed a statistically significant improvement in residents' ability to analyze and manage ethically complex cases as measured by multiple-choice tests and self-assessments. © 2015 American Academy of Neurology.

Vaccine adverse event text mining system for extracting features from vaccine safety reports.

PubMed

Botsis, Taxiarchis; Buttolph, Thomas; Nguyen, Michael D; Winiecki, Scott; Woo, Emily Jane; Ball, Robert

2012-01-01

To develop and evaluate a text mining system for extracting key clinical features from vaccine adverse event reporting system (VAERS) narratives to aid in the automated review of adverse event reports. Based upon clinical significance to VAERS reviewing physicians, we defined the primary (diagnosis and cause of death) and secondary features (eg, symptoms) for extraction. We built a novel vaccine adverse event text mining (VaeTM) system based on a semantic text mining strategy. The performance of VaeTM was evaluated using a total of 300 VAERS reports in three sequential evaluations of 100 reports each. Moreover, we evaluated the VaeTM contribution to case classification; an information retrieval-based approach was used for the identification of anaphylaxis cases in a set of reports and was compared with two other methods: a dedicated text classifier and an online tool. The performance metrics of VaeTM were text mining metrics: recall, precision and F-measure. We also conducted a qualitative difference analysis and calculated sensitivity and specificity for classification of anaphylaxis cases based on the above three approaches. VaeTM performed best in extracting diagnosis, second level diagnosis, drug, vaccine, and lot number features (lenient F-measure in the third evaluation: 0.897, 0.817, 0.858, 0.874, and 0.914, respectively). In terms of case classification, high sensitivity was achieved (83.1%); this was equal and better compared to the text classifier (83.1%) and the online tool (40.7%), respectively. Our VaeTM implementation of a semantic text mining strategy shows promise in providing accurate and efficient extraction of key features from VAERS narratives.

All-sky photogrammetry techniques to georeference a cloud field

NASA Astrophysics Data System (ADS)

Crispel, Pierre; Roberts, Gregory

2018-01-01

In this study, we present a novel method of identifying and geolocalizing cloud field elements from a portable all-sky camera stereo network based on the ground and oriented towards zenith. The methodology is mainly based on stereophotogrammetry which is a 3-D reconstruction technique based on triangulation from corresponding stereo pixels in rectified images. In cases where clouds are horizontally separated, identifying individual positions is performed with segmentation techniques based on hue filtering and contour detection algorithms. Macroscopic cloud field characteristics such as cloud layer base heights and velocity fields are also deduced. In addition, the methodology is fitted to the context of measurement campaigns which impose simplicity of implementation, auto-calibration, and portability. Camera internal geometry models are achieved a priori in the laboratory and validated to ensure a certain accuracy in the peripheral parts of the all-sky image. Then, stereophotogrammetry with dense 3-D reconstruction is applied with cameras spaced 150 m apart for two validation cases. The first validation case is carried out with cumulus clouds having a cloud base height at 1500 m a.g.l. The second validation case is carried out with two cloud layers: a cumulus fractus layer with a base height at 1000 m a.g.l. and an altocumulus stratiformis layer with a base height of 2300 m a.g.l. Velocity fields at cloud base are computed by tracking image rectangular patterns through successive shots. The height uncertainty is estimated by comparison with a Vaisala CL31 ceilometer located on the site. The uncertainty on the horizontal coordinates and on the velocity field are theoretically quantified by using the experimental uncertainties of the cloud base height and camera orientation. In the first cumulus case, segmentation of the image is performed to identify individuals clouds in the cloud field and determine the horizontal positions of the cloud centers.

Public hospital resource allocations in El Salvador: accounting for the case mix of patients.

PubMed

Fiedler, J L; Schmidt, R M; Wight, J B

1998-09-01

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

Drugs & the Brain: Case-based Instruction for an Undergraduate Neuropharmacology Course.

PubMed

Nagel, Anastasia; Nicholas, Andrea

2017-01-01

In order to transform a traditional large non-majors general education (GE) neurobiology lecture (Drugs & the Brain) into an active learning course, we developed a series of directed mini-cases targeting major drug classes. Humorous and captivating case-based situations were used to better engage and motivate students to solve problems related to neuropharmacology and physiology. Here we provide directed cases, questions and learning outcomes for our opiates mini-cases. In addition, we describe how case studies were incorporated into our course and assessed using peer review and online quizzing. An in-depth analysis of the overall course transformation on student exam performance, opinions and instructor evaluations can be found in the JUNE article Don't Believe the Gripe! Increasing Course Structure in a Large Non-majors Neuroscience Course.

Mobility based multicast routing in wireless mesh networks

NASA Astrophysics Data System (ADS)

Jain, Sanjeev; Tripathi, Vijay S.; Tiwari, Sudarshan

2013-01-01

There exist two fundamental approaches to multicast routing namely minimum cost trees and shortest path trees. The (MCT's) minimum cost tree is one which connects receiver and sources by providing a minimum number of transmissions (MNTs) the MNTs approach is generally used for energy constraint sensor and mobile ad hoc networks. In this paper we have considered node mobility and try to find out simulation based comparison of the (SPT's) shortest path tree, (MST's) minimum steiner trees and minimum number of transmission trees in wireless mesh networks by using the performance metrics like as an end to end delay, average jitter, throughput and packet delivery ratio, average unicast packet delivery ratio, etc. We have also evaluated multicast performance in the small and large wireless mesh networks. In case of multicast performance in the small networks we have found that when the traffic load is moderate or high the SPTs outperform the MSTs and MNTs in all cases. The SPTs have lowest end to end delay and average jitter in almost all cases. In case of multicast performance in the large network we have seen that the MSTs provide minimum total edge cost and minimum number of transmissions. We have also found that the one drawback of SPTs, when the group size is large and rate of multicast sending is high SPTs causes more packet losses to other flows as MCTs.

Task 7: Endwall treatment inlet flow distortion analysis

NASA Technical Reports Server (NTRS)

Hall, E. J.; Topp, D. A.; Heidegger, N. J.; McNulty, G. S.; Weber, K. F.; Delaney, R. A.

1996-01-01

The overall objective of this study was to develop a 3-D numerical analysis for compressor casing treatment flowfields, and to perform a series of detailed numerical predictions to assess the effectiveness of various endwall treatments for enhancing the efficiency and stall margin of modern high speed fan rotors. Particular attention was given to examining the effectiveness of endwall treatments to counter the undesirable effects of inflow distortion. Calculations were performed using three different gridding techniques based on the type of casing treatment being tested and the level of complexity desired in the analysis. In each case, the casing treatment itself is modeled as a discrete object in the overall analysis, and the flow through the casing treatment is determined as part of the solution. A series of calculations were performed for both treated and untreated modern fan rotors both with and without inflow distortion. The effectiveness of the various treatments were quantified, and several physical mechanisms by which the effectiveness of endwall treatments is achieved are discussed.

Performance Contracting: Meeting the Challenge of Deferred Maintenance.

ERIC Educational Resources Information Center

Singer, Terry E.; Johnson, Mary E.

2001-01-01

Discusses the magnitude of the problem of deferred maintenance on today's university campuses and the solving this problem using performance-based energy efficiency retrofit as implemented by energy service companies (ESCO). Several case studies of ESCO designed retrofits are examined. (GR)

An experimental investigation of the flow physics of high-lift systems

NASA Technical Reports Server (NTRS)

Thomas, Flint O.; Nelson, R. C.

1995-01-01

This progress report is a series of overviews outlining experiments on the flow physics of confluent boundary layers for high-lift systems. The research objectives include establishing the role of confluent boundary layer flow physics in high-lift production; contrasting confluent boundary layer structures for optimum and non-optimum C(sub L) cases; forming a high quality, detailed archival data base for CFD/modelling; and examining the role of relaminarization and streamline curvature. Goals of this research include completing LDV study of an optimum C(sub L) case; performing detailed LDV confluent boundary layer surveys for multiple non-optimum C(sub L) cases; obtaining skin friction distributions for both optimum and non-optimum C(sub L) cases for scaling purposes; data analysis and inner and outer variable scaling; setting-up and performing relaminarization experiments; and a final report establishing the role of leading edge confluent boundary layer flow physics on high-lift performance.

A Case-Based Study with Radiologists Performing Diagnosis Tasks in Virtual Reality.

PubMed

Venson, José Eduardo; Albiero Berni, Jean Carlo; Edmilson da Silva Maia, Carlos; Marques da Silva, Ana Maria; Cordeiro d'Ornellas, Marcos; Maciel, Anderson

2017-01-01

In radiology diagnosis, medical images are most often visualized slice by slice. At the same time, the visualization based on 3D volumetric rendering of the data is considered useful and has increased its field of application. In this work, we present a case-based study with 16 medical specialists to assess the diagnostic effectiveness of a Virtual Reality interface in fracture identification over 3D volumetric reconstructions. We developed a VR volume viewer compatible with both the Oculus Rift and handheld-based head mounted displays (HMDs). We then performed user experiments to validate the approach in a diagnosis environment. In addition, we assessed the subjects' perception of the 3D reconstruction quality, ease of interaction and ergonomics, and also the users opinion on how VR applications can be useful in healthcare. Among other results, we have found a high level of effectiveness of the VR interface in identifying superficial fractures on head CTs.

Improving the performance of lesion-based computer-aided detection schemes of breast masses using a case-based adaptive cueing method

NASA Astrophysics Data System (ADS)

Tan, Maxine; Aghaei, Faranak; Wang, Yunzhi; Qian, Wei; Zheng, Bin

2016-03-01

Current commercialized CAD schemes have high false-positive (FP) detection rates and also have high correlations in positive lesion detection with radiologists. Thus, we recently investigated a new approach to improve the efficacy of applying CAD to assist radiologists in reading and interpreting screening mammograms. Namely, we developed a new global feature based CAD approach/scheme that can cue the warning sign on the cases with high risk of being positive. In this study, we investigate the possibility of fusing global feature or case-based scores with the local or lesion-based CAD scores using an adaptive cueing method. We hypothesize that the information from the global feature extraction (features extracted from the whole breast regions) are different from and can provide supplementary information to the locally-extracted features (computed from the segmented lesion regions only). On a large and diverse full-field digital mammography (FFDM) testing dataset with 785 cases (347 negative and 438 cancer cases with masses only), we ran our lesion-based and case-based CAD schemes "as is" on the whole dataset. To assess the supplementary information provided by the global features, we used an adaptive cueing method to adaptively adjust the original CAD-generated detection scores (Sorg) of a detected suspicious mass region based on the computed case-based score (Scase) of the case associated with this detected region. Using the adaptive cueing method, better sensitivity results were obtained at lower FP rates (<= 1 FP per image). Namely, increases of sensitivities (in the FROC curves) of up to 6.7% and 8.2% were obtained for the ROI and Case-based results, respectively.

Negotiating accommodations so that work-based education facilitates career development for youth with disabilities.

PubMed

Hutchinson, Nancy L; Versnel, Joan; Chin, Peter; Munby, Hugh

2008-01-01

Workers with disabilities are entitled to have their individual needs accommodated in a way that allows them to perform the essential duties of their job. However, adults with disabilities are often lacking in career development and are ill-prepared to negotiate workplace accommodations. This has led educators to seek workplaces that can accommodate the needs of adolescents with disabilities, so these adolescents can learn to negotiate accommodations and enhance their career development through work-based education. This paper reports on two case studies in which employers had agreed to accommodate the needs of adolescents with disabilities participating in work-based education. Social Cognitive Career Theory (SCCT) framed the analyses of these two cases - a case of a student with physical disabilities and a case of a student with developmental disabilities. SCCT proves valuable in understanding the role of work-based education in the career development of disabled youth.

Screening of pollution control and clean-up materials for river chemical spills using the multiple case-based reasoning method with a difference-driven revision strategy.

PubMed

Liu, Rentao; Jiang, Jiping; Guo, Liang; Shi, Bin; Liu, Jie; Du, Zhaolin; Wang, Peng

2016-06-01

In-depth filtering of emergency disposal technology (EDT) and materials has been required in the process of environmental pollution emergency disposal. However, an urgent problem that must be solved is how to quickly and accurately select the most appropriate materials for treating a pollution event from the existing spill control and clean-up materials (SCCM). To meet this need, the following objectives were addressed in this study. First, the material base and a case base for environment pollution emergency disposal were established to build a foundation and provide material for SCCM screening. Second, the multiple case-based reasoning model method with a difference-driven revision strategy (DDRS-MCBR) was applied to improve the original dual case-based reasoning model method system, and screening and decision-making was performed for SCCM using this model. Third, an actual environmental pollution accident from 2012 was used as a case study to verify the material base, case base, and screening model. The results demonstrated that the DDRS-MCBR method was fast, efficient, and practical. The DDRS-MCBR method changes the passive situation in which the choice of SCCM screening depends only on the subjective experience of the decision maker and offers a new approach to screening SCCM.

A Model-Based Anomaly Detection Approach for Analyzing Streaming Aircraft Engine Measurement Data

NASA Technical Reports Server (NTRS)

Simon, Donald L.; Rinehart, Aidan W.

2014-01-01

This paper presents a model-based anomaly detection architecture designed for analyzing streaming transient aircraft engine measurement data. The technique calculates and monitors residuals between sensed engine outputs and model predicted outputs for anomaly detection purposes. Pivotal to the performance of this technique is the ability to construct a model that accurately reflects the nominal operating performance of the engine. The dynamic model applied in the architecture is a piecewise linear design comprising steady-state trim points and dynamic state space matrices. A simple curve-fitting technique for updating the model trim point information based on steadystate information extracted from available nominal engine measurement data is presented. Results from the application of the model-based approach for processing actual engine test data are shown. These include both nominal fault-free test case data and seeded fault test case data. The results indicate that the updates applied to improve the model trim point information also improve anomaly detection performance. Recommendations for follow-on enhancements to the technique are also presented and discussed.

A Model-Based Anomaly Detection Approach for Analyzing Streaming Aircraft Engine Measurement Data

NASA Technical Reports Server (NTRS)

Simon, Donald L.; Rinehart, Aidan Walker

2015-01-01

This paper presents a model-based anomaly detection architecture designed for analyzing streaming transient aircraft engine measurement data. The technique calculates and monitors residuals between sensed engine outputs and model predicted outputs for anomaly detection purposes. Pivotal to the performance of this technique is the ability to construct a model that accurately reflects the nominal operating performance of the engine. The dynamic model applied in the architecture is a piecewise linear design comprising steady-state trim points and dynamic state space matrices. A simple curve-fitting technique for updating the model trim point information based on steadystate information extracted from available nominal engine measurement data is presented. Results from the application of the model-based approach for processing actual engine test data are shown. These include both nominal fault-free test case data and seeded fault test case data. The results indicate that the updates applied to improve the model trim point information also improve anomaly detection performance. Recommendations for follow-on enhancements to the technique are also presented and discussed.

Data Recording in Performance Management: Trouble With the Logics

ERIC Educational Resources Information Center

Groth Andersson, Signe; Denvall, Verner

2017-01-01

In recent years, performance management (PM) has become a buzzword in public sector organizations. Well-functioning PM systems rely on valid performance data, but critics point out that conflicting rationale or logic among professional staff in recording information can undermine the quality of the data. Based on a case study of social service…

Credentials versus Performance: Review of the Teacher Performance Pay Research

ERIC Educational Resources Information Center

Podgursky, Michael; Springer, Matthew G.

2007-01-01

In this article we examine the economic case for merit or performance-based pay for K-12 teachers. We review several areas of germane research. The direct evaluation literature on these incentive plans is slender; highly diverse in terms of methodology, targeted populations, and programs evaluated; and primarily focused on short-run motivational…

Using School Performance Data to Drive School and Education District Office Accountability and Improvement: The Case of Ghana

ERIC Educational Resources Information Center

Prew, Martin; Quaigrain, Kenneth

2010-01-01

This article looks at a school management tool that allows school managers and education district offices to review the performance of their schools and use the broad-based data to undertake orchestrated planning with districts planning delivery based on the needs of schools and in support of school improvement plans. The review process also…

From Symbols to Movement: "LANTD", the Design and Implementation of a Laban Notation-Based Method for Teaching Dance

ERIC Educational Resources Information Center

Dania, Aspasia; Tyrovola, Vasiliki; Koutsouba, Maria

2017-01-01

The aim of this paper is to present the design and evaluate the impact of a Laban Notation-based method for Teaching Dance (LANTD) on novice dancers' performance, in the case of Greek traditional dance. In this research, traditional dance is conceived in its "second existence" as a kind of presentational activity performed outside its…

A comparison of case volumes among urologic surgeons identified on an industry-sponsored website to an all provider peer group.

PubMed

See, William A; Jacobson, Kenneth; Derus, Sue; Langenstroer, Peter

2014-11-01

Industry-sponsored websites for robotic surgery direct to surgeons listed as performing specific robotic surgical procedures. The purpose of this study was to compare average annual, surgeon-specific, case volumes for those procedures for which they were listed as performing on the commercial website with the volumes of all providers performing these same procedures across a defined geographic region. A list of providers within the state of Wisconsin cited as performing specific urologic procedures was obtained through the Intuitive Surgical website 〈http://www.davincisurgery.com/da-vinci-urology/〉. Surgeon-specific annual case volumes from 2009 to 2013 for these same cases were obtained for all Wisconsin providers through DataBay Resources (Warrendale, PA) based on International classification of diseases-9 codes. Procedural activity was rank ordered, and surgeons were placed in "volume deciles" derived from the total annual number of cases performed by all surgeons. The distribution of commercially listed surgeon volumes, both 5-year average and most recent year, was compared with the average and 2013 volumes of all surgeons performing a specific procedure. A total of 35 individual urologic surgeons listed as performing robotic surgery in Wisconsin were identified through a "search" using the Intuitive Surgical website. Specific procedure analysis returned 5, 12, 9, and 15 surgeon names for cystectomy, partial nephrectomy, radical nephrectomy, and prostatectomy, respectively. This compared with the total number of surgeons who had performed the listed procedure in Wisconsin at least 1 time during the prior 5 years of 123, 153, 242, and 165, respectively. When distributed by surgeon-volume deciles, surgeons listed on industry-sponsored sites varied widely in their respective volume decile. More than half of site-listed, procedure-specific surgeons fell below the fifth decile for surgeon volume. Data analysis based solely on 2013 case volumes had no effect on the number of website-listed surgeons whose volumes fell below the fifth decile. Surgeons listed on an industry-sponsored website demonstrate wide variation in the actual volume of specific procedures performed. The inferred endorsement of competence by commercial sites has the potential to mislead patients seeking surgical expertise. Providers should consider the ethical and legal implications of these commercial advertising that do not have volume or outcome data. Published by Elsevier Inc.

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

PubMed Central

Preyra, Colin

2004-01-01

Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

The Use of Performance Based Funding in a Sport Organization: A Case Study of the United States Olympic Committee

DTIC Science & Technology

2009-08-01

programs has intrigued me since I was a freshman water polo player at the United States Air Force Academy1. At that time, the Academy’s Athletic...on- field performance? 7     Need for the Study There is a wealth of information regarding performance-based funding systems and their...wide variety of sport organizations from team 9     sports like basketball and baseball to individual sports like swimming and track and field

[Lung and heart-lung transplantation in respiratory tract diseases. Evaluation and development of the indications based on our first 15 cases].

PubMed

Couraud, L; Baudet, E; Martigne, C; Roques, X; Velly, J F; Laborde, N; Clerc, P

1989-01-01

Since January 1988, the Bordeaux group has performed 15 transplantations for lung disease: 9 heart-lung transplants, 1 heart + left lung, 1 double lung, 2 right lungs and 2 left lungs. The transplantations were performed for pulmonary emphysema (10 cases), pulmonary artery hypertension (2 cases), cystic fibrosis (1 case), pulmonary fibrosis (2 cases). Cardiopulmonary transplantation was not always performed because of associated heart failure but sometimes because of large intrahilar adenopathy or intractable bronchial infection. Pulmonary transplantation is recommended on the right side in cases of pulmonary fibrosis. One patient died postoperatively (ischaemia of the transplant). Four others died during the 2nd and 3rd months from poorly defined but probably infectious pulmonary syndromes. The tracheobronchial patency of the 10 survivors was 80% or 100% of the predicted value. The respiratory functional result was excellent in the short and intermediate term. Specific difficulties essentially consisted of pleural symphyses, hilar adenopathy, bronchial infection, steroid dependence of certain subjects, the difficulty of identifying the cause and treating lung opacities during the 2nd and 3rd months.

A practical material decomposition method for x-ray dual spectral computed tomography.

PubMed

Hu, Jingjing; Zhao, Xing

2016-03-17

X-ray dual spectral CT (DSCT) scans the measured object with two different x-ray spectra, and the acquired rawdata can be used to perform the material decomposition of the object. Direct calibration methods allow a faster material decomposition for DSCT and can be separated in two groups: image-based and rawdata-based. The image-based method is an approximative method, and beam hardening artifacts remain in the resulting material-selective images. The rawdata-based method generally obtains better image quality than the image-based method, but this method requires geometrically consistent rawdata. However, today's clinical dual energy CT scanners usually measure different rays for different energy spectra and acquire geometrically inconsistent rawdata sets, and thus cannot meet the requirement. This paper proposes a practical material decomposition method to perform rawdata-based material decomposition in the case of inconsistent measurement. This method first yields the desired consistent rawdata sets from the measured inconsistent rawdata sets, and then employs rawdata-based technique to perform material decomposition and reconstruct material-selective images. The proposed method was evaluated by use of simulated FORBILD thorax phantom rawdata and dental CT rawdata, and simulation results indicate that this method can produce highly quantitative DSCT images in the case of inconsistent DSCT measurements.

A qualitative and quantitative assessment for a bone marrow harvest simulator.

PubMed

Machado, Liliane S; Moraes, Ronei M

2009-01-01

Several approaches to perform assessment in training simulators based on virtual reality have been proposed. There are two kinds of assessment methods: offline and online. The main requirements related to online training assessment methodologies applied to virtual reality systems are the low computational complexity and the high accuracy. In the literature it can be found several approaches for general cases which can satisfy such requirements. An inconvenient about those approaches is related to an unsatisfactory solution for specific cases, as in some medical procedures, where there are quantitative and qualitative information available to perform the assessment. In this paper, we present an approach to online training assessment based on a Modified Naive Bayes which can manipulate qualitative and quantitative variables simultaneously. A special medical case was simulated in a bone marrow harvest simulator. The results obtained were satisfactory and evidenced the applicability of the method.

Backscattered electron simulations to evaluate sensitivity against electron dosage of buried semiconductor features

NASA Astrophysics Data System (ADS)

Mukhtar, Maseeh; Thiel, Bradley

2018-03-01

In fabrication, overlay measurements of semiconductor device patterns have conventionally been performed using optical methods. Beginning with image-based techniques using box-in-box to the more recent diffraction-based overlay (DBO). Alternatively, use of SEM overlay is under consideration for in-device overlay. Two main application spaces are measurement features from multiple mask levels on the same surface and buried features. Modern CD-SEMs are adept at measuring overlay for cases where all features are on the surface. In order to measure overlay of buried features, HV-SEM is needed. Gate-to-fin and BEOL overlay are important use cases for this technique. A JMONSEL simulation exercise was performed for these two cases using 10 nm line/space gratings of graduated increase in depth of burial. Backscattered energy loss results of these simulations were used to calculate the sensitivity measurements of buried features versus electron dosage for an array of electron beam voltages.

Private content identification based on soft fingerprinting

NASA Astrophysics Data System (ADS)

Voloshynovskiy, Sviatoslav; Holotyak, Taras; Koval, Oleksiy; Beekhof, Fokko; Farhadzadeh, Farzad

2011-02-01

In many problems such as biometrics, multimedia search, retrieval, recommendation systems requiring privacypreserving similarity computations and identification, some binary features are stored in the public domain or outsourced to third parties that might raise certain privacy concerns about the original data. To avoid this privacy leak, privacy protection is used. In most cases, privacy protection is uniformly applied to all binary features resulting in data degradation and corresponding loss of performance. To avoid this undesirable effect we propose a new privacy amplification technique that is based on data hiding principles and benefits from side information about bit reliability a.k.a. soft fingerprinting. In this paper, we investigate the identification-rate vs privacy-leak trade-off. The analysis is performed for the case of a perfect match between side information shared between the encoder and decoder as well as for the case of partial side information.

Transnasal endoscopic partial maxillectomy: Operative nuances and proposal for a comprehensive classification system based on 1378 cases.

PubMed

Turri-Zanoni, Mario; Battaglia, Paolo; Karligkiotis, Apostolos; Lepera, Davide; Zocchi, Jacopo; Dallan, Iacopo; Bignami, Maurizio; Castelnuovo, Paolo

2017-04-01

Despite the development of functional endoscopic endonasal surgery, there are still areas of the maxillary sinus that remain technically difficult to access using a standard middle meatal antrostomy as well as deep-seated skull base lesions requiring expanded transmaxillary approaches. All patients who underwent transnasal endoscopic partial maxillectomy (TEPM) in a single institution from 2000 to 2014 were retrospectively reviewed. The TEPM was classified into 5 types according to the anatomic structures progressively removed and to the access provided. The TEPM was performed in 1378 patients for the management of: inflammatory diseases in 513 cases (37%), benign sinonasal tumors in 425 cases (31%), skull base malignancies in 285 cases (21%), and as a corridor to address deep-seated skull base lesions in 155 cases (11%). The TEPM is a stepwise approach offering increasing access that can be tailored to different maxillary, sinonasal, and skull base pathologies with minimal morbidity for patients. © 2016 Wiley Periodicals, Inc. Head Neck 39: 754-766, 2017. © 2016 Wiley Periodicals, Inc.

Robust differences in antisaccade performance exist between COGS schizophrenia cases and controls regardless of recruitment strategies.

PubMed

Radant, Allen D; Millard, Steven P; Braff, David L; Calkins, Monica E; Dobie, Dorcas J; Freedman, Robert; Green, Michael F; Greenwood, Tiffany A; Gur, Raquel E; Gur, Ruben C; Lazzeroni, Laura C; Light, Gregory A; Meichle, Sean P; Nuechterlein, Keith H; Olincy, Ann; Seidman, Larry J; Siever, Larry J; Silverman, Jeremy M; Stone, William S; Swerdlow, Neal R; Sugar, Catherine A; Tsuang, Ming T; Turetsky, Bruce I; Tsuang, Debby W

2015-04-01

The impaired ability to make correct antisaccades (i.e., antisaccade performance) is well documented among schizophrenia subjects, and researchers have successfully demonstrated that antisaccade performance is a valid schizophrenia endophenotype that is useful for genetic studies. However, it is unclear how the ascertainment biases that unavoidably result from recruitment differences in schizophrenia subjects identified in family versus case-control studies may influence patient-control differences in antisaccade performance. To assess the impact of ascertainment bias, researchers from the Consortium on the Genetics of Schizophrenia (COGS) compared antisaccade performance and antisaccade metrics (latency and gain) in schizophrenia and control subjects from COGS-1, a family-based schizophrenia study, to schizophrenia and control subjects from COGS-2, a corresponding case-control study. COGS-2 schizophrenia subjects were substantially older; had lower education status, worse psychosocial function, and more severe symptoms; and were three times more likely to be a member of a multiplex family than COGS-1 schizophrenia subjects. Despite these variations, which were likely the result of ascertainment differences (as described in the introduction to this special issue), the effect sizes of the control-schizophrenia differences in antisaccade performance were similar in both studies (Cohen's d effect size of 1.06 and 1.01 in COGS-1 and COGS-2, respectively). This suggests that, in addition to the robust, state-independent schizophrenia-related deficits described in endophenotype studies, group differences in antisaccade performance do not vary based on subject ascertainment and recruitment factors. Published by Elsevier B.V.

Robust differences in antisaccade performance exist between COGS schizophrenia cases and controls regardless of recruitment strategies

PubMed Central

Radant, Allen D.; Millard, Steven P.; Braff, David; Calkins, Monica E.; Dobie, Dorcas J.; Freedman, Robert; Green, Michael F.; Greenwood, Tiffany A.; Gur, Raquel E.; Gur, Ruben C.; Lazzeroni, Laura; Light, Gregory A.; Meichle, Sean; Nuechterlein, Keith H.; Olincy, Ann; Seidman, Larry J.; Siever, Larry; Silverman, Jeremy; Stone, William S.; Swerdlow, Neal R.; Sugar, Catherine; Tsuang, Ming T.; Turetsky, Bruce I.; Tsuang, Debby W.

2015-01-01

The impaired ability to make correct antisaccades (i.e., antisaccade performance) is well documented among schizophrenia subjects, and researchers have successfully demonstrated that antisaccade performance is a valid schizophrenia endophenotype that is useful for genetic studies. However, it is unclear how the ascertainment biases that unavoidably result from recruitment differences in schizophrenia subjects identified in family versus case-control studies may influence patient-control differences in antisaccade performance. To assess the impact of ascertainment bias, researchers from the Consortium on the Genetics of Schizophrenia (COGS) compared antisaccade performance and antisaccade metrics (latency and gain) in schizophrenia and control subjects from COGS-1, a family-based schizophrenia study, to schizophrenia and control subjects from COGS-2, a corresponding case-control study. COGS-2 schizophrenia subjects were substantially older; had lower education status, worse psychosocial function, and more severe symptoms; and were three times more likely to be a member of a multiplex family than COGS-1 schizophrenia subjects. Despite these variations, which were likely the result of ascertainment differences (as described in the introduction to this special issue), the effect sizes of the control-schizophrenia differences in antisaccade performance were similar in both studies (Cohen’s d effect size of 1.06 and 1.01 in COGS-1 and COGS-2, respectively). This suggests that, in addition to the robust, state-independent schizophrenia-related deficits described in endophenotype studies, group differences in antisaccade performance do not vary based on subject ascertainment and recruitment factors. PMID:25553977

The importance of improving the quality of emergency surgery for a regional quality collaborative.

PubMed

Smith, Margaret; Hussain, Adnan; Xiao, Jane; Scheidler, William; Reddy, Haritha; Olugbade, Kola; Cummings, Dustin; Terjimanian, Michael; Krapohl, Greta; Waits, Seth A; Campbell, Darrell; Englesbe, Michael J

2013-04-01

Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.

Music Composition in the High School Curriculum: A Multiple Case Study

ERIC Educational Resources Information Center

Menard, Elizabeth A.

2015-01-01

Student and teacher perceptions regarding composition instruction were investigated using case study techniques in two high school music programs: a general music program providing accelerated instruction to gifted musicians in small classes and a typical performance-based band program. Students in both programs participated in a composition…

Case Study: eCoaching in a Corporate Environment

ERIC Educational Resources Information Center

Warner, Teri L. C.

2012-01-01

This qualitative particularistic case study was an exploration and evaluation of an online, asynchronous, non-human coaching system called an "eCoaching system." Developed by the researcher, the eCoaching system combined performance coaching with the latest technologies in eLearning. The coaching was based on the appreciative inquiry approach, and…

A business case for quality improvement in addiction treatment: evidence from the NIATx collaborative.

PubMed

Quanbeck, Andrew R; Madden, Lynn; Edmundson, Eldon; Ford, James H; McConnell, K John; McCarty, Dennis; Gustafson, David H

2012-01-01

The Network for the Improvement of Addiction Treatment (NIATx) promotes treatment access and retention through a customer-focused quality improvement model. This paper explores the issue of the "business case" for quality improvement in addiction treatment from the provider's perspective. The business case model developed in this paper is based on case examples of early NIATx participants coupled with a review of the literature. Process inefficiencies indicated by long waiting times, high no-show rates, and low continuation rates cause underutilization of capacity and prevent optimal financial performance. By adopting customer-focused practices aimed at removing barriers to treatment access and retention, providers may be able to improve financial performance, increase staff retention, and gain long-term strategic advantage.

Web-based unfolding cases: a strategy to enhance and evaluate clinical reasoning skills.

PubMed

Johnson, Gail; Flagler, Susan

2013-10-01

Clinical reasoning involves the use of both analytical and nonanalytical intuitive cognitive processes. Fostering student development of clinical reasoning skills and evaluating student performance in this cognitive arena can challenge educators. The use of Web-based unfolding cases is proposed as a strategy to address these challenges. Unfolding cases mimic real-life clinical situations by presenting only partial clinical information in sequential segments. Students receive immediate feedback after submitting a response to a given segment. The student's comparison of the desired and submitted responses provides information to enhance the development of clinical reasoning skills. Each student's set of case responses are saved for the instructor in an individual-student electronic file, providing a record of the student's knowledge and thinking processes for faculty evaluation. For the example case given, the approaches used to evaluate individual components of clinical reasoning are provided. Possible future uses of Web-based unfolding cases are described. Copyright 2013, SLACK Incorporated.

[Diagnosis accuracy of endoscopy (laparoscopy, hysteroscopy, fertiloscopy, cystoscopy, colonoscopy) in case of endometriosis: CNGOF-HAS Endometriosis Guidelines].

PubMed

Tardieu, A; Sire, F; Gauthier, T

2018-03-01

To provide clinical practice guidelines from the French college of obstetrics and gynecology (CNGOF) with the Haute Autorité de santé (HAS), based on the best evidence available, concerning the diagnosis accuracy of endoscopy (laparoscopy, hysteroscopy, fertiloscopy, cystoscopy, colonoscopy) in case of endometriosis. English and French review of literature about the diagnosis accuracy of endoscopy in case of endometriosis. Laparoscopy is useful in case of suspected endometriosis in patients with symptoms or infertility when appropriate preoperative assessment is negative (grade C). Biopsies during diagnosis laparoscopy are recommended in case of typical or atypical lesions to confirm endometriosis (grade B). It is not recommended to perform fertiloscopy in case of suspected endometriosis (grade C). Hysteroscopy could be performed in case of suspected endometriosis and infertility to eliminate endometrial polyp or septate uterus (grade C). Colonoscopy is not recommended in case of suspected deep posterior endometriosis (grade C). Copyright © 2018 Elsevier Masson SAS. All rights reserved.

[Breast cancer screening process indicators in Mexico: a case study].

PubMed

Uscanga-Sánchez, Santos; Torres-Mejía, Gabriela; Ángeles-Llerenas, Angélica; Domínguez-Malpica, Raúl; Lazcano-Ponce, Eduardo

2014-01-01

To identify, measure and compare the performance indicators of productivity, effective access and quality service for the early detection breast cancer program in Mexico. By means of a study case based on the 2011 Women Cancer Information System (SICAM), the indicators were measured and compared with the Mexican official standard NOM-041-SSA2-2011 and international standards. The analysis showed insufficient installed capacity (37%), low coverage in screening (15%), diagnostic evaluation (16%), biopsy (44%) and treatment (57%), and very low effectiveness in confirmed cases by the total number of screening mammograms performed (0.04%). There was no information available, from SICAM, to estimate the rest of the indicators proposed. Efficient health information systems are required in order to monitor indicators and generate performance observatories of screening programs.

Trends in performance of the National Measles Case-Based Surveillance System, Ministry of Health and Child Welfare, Zimbabwe (1999 - 2008)

PubMed Central

Choto, Regis; Chadambuka, Addmore; Shambira, Gerald; Gombe, Notion; Tshimanga, Mufuta; Midzi, Stanley; Mberikunashe, Joseph

2012-01-01

Introduction Since adoption of the measles case-based surveillance system in Zimbabwe in 1998, data has been routinely collected at all levels of the health delivery system and sent to national level with little or no documented evidence of use to identify risky populations, monitor impact of interventions and measure progress towards achieving measles elimination. We analysed this data to determine trends in the national measles case-based surveillance system (NMCBSS). Methods A retrospective record review of the NMCBSS dataset for period 1999 –2008 was conducted, assessing trends in proportions of investigated cases; timeliness and nature of specimens received at laboratory; timeliness of feedback of serology results, proportion of cases confirmed as measles and national annualized rates of investigation. Comparisons with WHO performance indicators were done. The secondary data analysis was done in Excel and Epi-Info statistical software. Results Cumulatively 4994 suspected cases were reported and investigated between 1999 and 2008. Reported suspected and confirmed measles cases declined from 24, 5% and 5.9% respectively in 2000 to 3.9% and 1.0% respectively in 2008. Proportion of cases with blood specimens collected and proportion reaching laboratory timely increased from 83% and 65% respectively in 1999, to 100% and 82% respectively in 2008. Proportion of specimens arriving at laboratory in good condition improved from 65% in 2004 to 94% in 2008 while timeliness of feedback of serology results improved from 4% in 2004 to 65% in 2008. Sensitivity of the NMCBSS however has been weakening, declining from 9.04 cases investigated per 100 000 population per year in 2000 to 1.58 cases/100 000/year in 2008. Conclusion The NMCBSS improved in quality, timeliness and feedback of laboratory results of specimens sent for investigation, but its sensitivity declined mainly due to reduced capacity to detect and confirm measles cases. We recommend training staff on active surveillance of cases and more support and supervisory visits to strengthen EPI surveillance. PMID:22368745

A performance analysis method for distributed real-time robotic systems: A case study of remote teleoperation

NASA Technical Reports Server (NTRS)

Lefebvre, D. R.; Sanderson, A. C.

1994-01-01

Robot coordination and control systems for remote teleoperation applications are by necessity implemented on distributed computers. Modeling and performance analysis of these distributed robotic systems is difficult, but important for economic system design. Performance analysis methods originally developed for conventional distributed computer systems are often unsatisfactory for evaluating real-time systems. The paper introduces a formal model of distributed robotic control systems; and a performance analysis method, based on scheduling theory, which can handle concurrent hard-real-time response specifications. Use of the method is illustrated by a case of remote teleoperation which assesses the effect of communication delays and the allocation of robot control functions on control system hardware requirements.

Rehabilitation in semantic dementia: Study of effectiveness of lexical reacquisition in three patients

PubMed Central

Senaha, Mirna Lie Hosogi; Brucki, Sonia Maria Dozzi; Nitrini, Ricardo

2010-01-01

Although language rehabilitation in patients with primary progressive aphasia (PPA) is recommended, rehabilitation studies in this clinical syndrome are scarce. Specifically, in relation to semantic dementia (SD), few studies have shown the possibility of lexical relearning. Objective To analyze the effectiveness of rehabilitation for lexical reacquisition in SD. Methods Three SD patients were submitted to training for lexical reacquisition based on principles of errorless learning. Comparisons between naming performance of treated items (pre and post-training) and non-treated items of the Boston Naming Test (BNT) were made. Results All patients improved their performance in naming treated words after intervention. However, decline in performance in naming of non-treated items was observed. Case 1 named zero items at baseline while her performance post-training was 29.4% correct responses without cueing, and 90.7% correct with and without cueing. Case 2 named 6.9% of items correctly at baseline and his performance in post-training was 52.9% without cueing and 87.3%, with and without cueing. Case 3 named zero items at baseline and his performance in post-training was 100% correct responses without cueing. Considering the performance in naming the non-treated items of the BNT, the percentages of correct responses in the first evaluation and in the re-evaluation, respectively were: 16.7% and 8.3% (case 1; 14 month-interval); 26.7% and 11.6% (case 2; 18 month-interval) and 11.6% and 8.3% (case 3; 6 month-interval). Conclusions The reacquisition of lost vocabulary may be possible in SD despite progressive semantic deterioration. PMID:29213703

Evaluation of Counter-Based Dynamic Load Balancing Schemes for Massive Contingency Analysis on Over 10,000 Cores

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

Chen, Yousu; Huang, Zhenyu; Rice, Mark J.

Contingency analysis studies are necessary to assess the impact of possible power system component failures. The results of the contingency analysis are used to ensure the grid reliability, and in power market operation for the feasibility test of market solutions. Currently, these studies are performed in real time based on the current operating conditions of the grid with a set of pre-selected contingency list, which might result in overlooking some critical contingencies caused by variable system status. To have a complete picture of a power grid, more contingencies need to be studied to improve grid reliability. High-performance computing techniques holdmore » the promise of being able to perform the analysis for more contingency cases within a much shorter time frame. This paper evaluates the performance of counter-based dynamic load balancing schemes for a massive contingency analysis program on 10,000+ cores. One million N-2 contingency analysis cases with a Western Electricity Coordinating Council power grid model have been used to demonstrate the performance. The speedup of 3964 with 4096 cores and 7877 with 10240 cores are obtained. This paper reports the performance of the load balancing scheme with a single counter and two counters, describes disk I/O issues, and discusses other potential techniques for further improving the performance.« less

Practical dose point-based methods to characterize dose distribution in a stationary elliptical body phantom for a cone-beam C-arm CT system

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

Choi, Jang-Hwan, E-mail: jhchoi21@stanford.edu; Constantin, Dragos; Ganguly, Arundhuti

2015-08-15

Purpose: To propose new dose point measurement-based metrics to characterize the dose distributions and the mean dose from a single partial rotation of an automatic exposure control-enabled, C-arm-based, wide cone angle computed tomography system over a stationary, large, body-shaped phantom. Methods: A small 0.6 cm{sup 3} ion chamber (IC) was used to measure the radiation dose in an elliptical body-shaped phantom made of tissue-equivalent material. The IC was placed at 23 well-distributed holes in the central and peripheral regions of the phantom and dose was recorded for six acquisition protocols with different combinations of minimum kVp (109 and 125 kVp)more » and z-collimator aperture (full: 22.2 cm; medium: 14.0 cm; small: 8.4 cm). Monte Carlo (MC) simulations were carried out to generate complete 2D dose distributions in the central plane (z = 0). The MC model was validated at the 23 dose points against IC experimental data. The planar dose distributions were then estimated using subsets of the point dose measurements using two proposed methods: (1) the proximity-based weighting method (method 1) and (2) the dose point surface fitting method (method 2). Twenty-eight different dose point distributions with six different point number cases (4, 5, 6, 7, 14, and 23 dose points) were evaluated to determine the optimal number of dose points and their placement in the phantom. The performances of the methods were determined by comparing their results with those of the validated MC simulations. The performances of the methods in the presence of measurement uncertainties were evaluated. Results: The 5-, 6-, and 7-point cases had differences below 2%, ranging from 1.0% to 1.7% for both methods, which is a performance comparable to that of the methods with a relatively large number of points, i.e., the 14- and 23-point cases. However, with the 4-point case, the performances of the two methods decreased sharply. Among the 4-, 5-, 6-, and 7-point cases, the 7-point case (1.0% [±0.6%] difference) and the 6-point case (0.7% [±0.6%] difference) performed best for method 1 and method 2, respectively. Moreover, method 2 demonstrated high-fidelity surface reconstruction with as few as 5 points, showing pixelwise absolute differences of 3.80 mGy (±0.32 mGy). Although the performance was shown to be sensitive to the phantom displacement from the isocenter, the performance changed by less than 2% for shifts up to 2 cm in the x- and y-axes in the central phantom plane. Conclusions: With as few as five points, method 1 and method 2 were able to compute the mean dose with reasonable accuracy, demonstrating differences of 1.7% (±1.2%) and 1.3% (±1.0%), respectively. A larger number of points do not necessarily guarantee better performance of the methods; optimal choice of point placement is necessary. The performance of the methods is sensitive to the alignment of the center of the body phantom relative to the isocenter. In body applications where dose distributions are important, method 2 is a better choice than method 1, as it reconstructs the dose surface with high fidelity, using as few as five points.« less

Speaker verification using committee neural networks.

PubMed

Reddy, Narender P; Buch, Ojas A

2003-10-01

Security is a major problem in web based access or remote access to data bases. In the present study, the technique of committee neural networks was developed for speech based speaker verification. Speech data from the designated speaker and several imposters were obtained. Several parameters were extracted in the time and frequency domains, and fed to neural networks. Several neural networks were trained and the five best performing networks were recruited into the committee. The committee decision was based on majority voting of the member networks. The committee opinion was evaluated with further testing data. The committee correctly identified the designated speaker in (50 out of 50) 100% of the cases and rejected imposters in (150 out of 150) 100% of the cases. The committee decision was not unanimous in majority of the cases tested.

24 CFR 200.944 - Supplementary specific requirements under the HUD building product standards and certification...

Code of Federal Regulations, 2012 CFR

2012-04-01

... rated wood-based structural-use panels. 200.944 Section 200.944 Housing and Urban Development... product standards and certification program for plywood and other performance rated wood-based structural... building product certification program. In the case of plywood and wood-based structural-use panels...

24 CFR 200.944 - Supplementary specific requirements under the HUD building product standards and certification...

Code of Federal Regulations, 2014 CFR

2014-04-01

... rated wood-based structural-use panels. 200.944 Section 200.944 Housing and Urban Development... product standards and certification program for plywood and other performance rated wood-based structural... building product certification program. In the case of plywood and wood-based structural-use panels...

24 CFR 200.944 - Supplementary specific requirements under the HUD building product standards and certification...

Code of Federal Regulations, 2013 CFR

2013-04-01

... rated wood-based structural-use panels. 200.944 Section 200.944 Housing and Urban Development... product standards and certification program for plywood and other performance rated wood-based structural... building product certification program. In the case of plywood and wood-based structural-use panels...

24 CFR 200.944 - Supplementary specific requirements under the HUD building product standards and certification...

Code of Federal Regulations, 2011 CFR

2011-04-01

... rated wood-based structural-use panels. 200.944 Section 200.944 Housing and Urban Development... product standards and certification program for plywood and other performance rated wood-based structural... building product certification program. In the case of plywood and wood-based structural-use panels...

24 CFR 200.944 - Supplementary specific requirements under the HUD building product standards and certification...

Code of Federal Regulations, 2010 CFR

2010-04-01

... rated wood-based structural-use panels. 200.944 Section 200.944 Housing and Urban Development... product standards and certification program for plywood and other performance rated wood-based structural... building product certification program. In the case of plywood and wood-based structural-use panels...

Role of HPC in Advancing Computational Aeroelasticity

NASA Technical Reports Server (NTRS)

Guruswamy, Guru P.

2004-01-01

On behalf of the High Performance Computing and Modernization Program (HPCMP) and NASA Advanced Supercomputing Division (NAS) a study is conducted to assess the role of supercomputers on computational aeroelasticity of aerospace vehicles. The study is mostly based on the responses to a web based questionnaire that was designed to capture the nuances of high performance computational aeroelasticity, particularly on parallel computers. A procedure is presented to assign a fidelity-complexity index to each application. Case studies based on major applications using HPCMP resources are presented.

Comparison of linear and nonlinear programming approaches for "worst case dose" and "minmax" robust optimization of intensity-modulated proton therapy dose distributions.

PubMed

Zaghian, Maryam; Cao, Wenhua; Liu, Wei; Kardar, Laleh; Randeniya, Sharmalee; Mohan, Radhe; Lim, Gino

2017-03-01

Robust optimization of intensity-modulated proton therapy (IMPT) takes uncertainties into account during spot weight optimization and leads to dose distributions that are resilient to uncertainties. Previous studies demonstrated benefits of linear programming (LP) for IMPT in terms of delivery efficiency by considerably reducing the number of spots required for the same quality of plans. However, a reduction in the number of spots may lead to loss of robustness. The purpose of this study was to evaluate and compare the performance in terms of plan quality and robustness of two robust optimization approaches using LP and nonlinear programming (NLP) models. The so-called "worst case dose" and "minmax" robust optimization approaches and conventional planning target volume (PTV)-based optimization approach were applied to designing IMPT plans for five patients: two with prostate cancer, one with skull-based cancer, and two with head and neck cancer. For each approach, both LP and NLP models were used. Thus, for each case, six sets of IMPT plans were generated and assessed: LP-PTV-based, NLP-PTV-based, LP-worst case dose, NLP-worst case dose, LP-minmax, and NLP-minmax. The four robust optimization methods behaved differently from patient to patient, and no method emerged as superior to the others in terms of nominal plan quality and robustness against uncertainties. The plans generated using LP-based robust optimization were more robust regarding patient setup and range uncertainties than were those generated using NLP-based robust optimization for the prostate cancer patients. However, the robustness of plans generated using NLP-based methods was superior for the skull-based and head and neck cancer patients. Overall, LP-based methods were suitable for the less challenging cancer cases in which all uncertainty scenarios were able to satisfy tight dose constraints, while NLP performed better in more difficult cases in which most uncertainty scenarios were hard to meet tight dose limits. For robust optimization, the worst case dose approach was less sensitive to uncertainties than was the minmax approach for the prostate and skull-based cancer patients, whereas the minmax approach was superior for the head and neck cancer patients. The robustness of the IMPT plans was remarkably better after robust optimization than after PTV-based optimization, and the NLP-PTV-based optimization outperformed the LP-PTV-based optimization regarding robustness of clinical target volume coverage. In addition, plans generated using LP-based methods had notably fewer scanning spots than did those generated using NLP-based methods. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

RTDS-Based Design and Simulation of Distributed P-Q Power Resources in Smart Grid

NASA Astrophysics Data System (ADS)

Taylor, Zachariah David

In this Thesis, we propose to utilize a battery system together with its power electronics interfaces and bidirectional charger as a distributed P-Q resource in power distribution networks. First, we present an optimization-based approach to operate such distributed P-Q resources based on the characteristics of the battery and charger system as well as the features and needs of the power distribution network. Then, we use the RTDS Simulator, which is an industry-standard simulation tool of power systems, to develop two RTDS-based design approaches. The first design is based on an ideal four-quadrant distributed P-Q power resource. The second design is based on a detailed four-quadrant distributed P-Q power resource that is developed using power electronics components. The hardware and power electronics circuitry as well as the control units are explained for the second design. After that, given the two-RTDS designs, we conducted extensive RTDS simulations to assess the performance of the designed distributed P-Q Power Resource in an IEEE 13 bus test system. We observed that the proposed design can noticeably improve the operational performance of the power distribution grid in at least four key aspects: reducing power loss, active power peak load shaving at substation, reactive power peak load shaving at substation, and voltage regulation. We examine these performance measures across three design cases: Case 1: There is no P-Q Power Resource available on the power distribution network. Case 2: The installed P-Q Power Resource only supports active power, i.e., it only utilizes its battery component. Case 3: The installed P-Q Power Resource supports both active and reactive power, i.e., it utilizes both its battery component and its power electronics charger component. In the end, we present insightful interpretations on the simulation results and suggest some future works.

Comparative effectiveness of incorporating a hypothetical DCIS prognostic marker into breast cancer screening.

PubMed

Trentham-Dietz, Amy; Ergun, Mehmet Ali; Alagoz, Oguzhan; Stout, Natasha K; Gangnon, Ronald E; Hampton, John M; Dittus, Kim; James, Ted A; Vacek, Pamela M; Herschorn, Sally D; Burnside, Elizabeth S; Tosteson, Anna N A; Weaver, Donald L; Sprague, Brian L

2018-02-01

Due to limitations in the ability to identify non-progressive disease, ductal carcinoma in situ (DCIS) is usually managed similarly to localized invasive breast cancer. We used simulation modeling to evaluate the potential impact of a hypothetical test that identifies non-progressive DCIS. A discrete-event model simulated a cohort of U.S. women undergoing digital screening mammography. All women diagnosed with DCIS underwent the hypothetical DCIS prognostic test. Women with test results indicating progressive DCIS received standard breast cancer treatment and a decrement to quality of life corresponding to the treatment. If the DCIS test indicated non-progressive DCIS, no treatment was received and women continued routine annual surveillance mammography. A range of test performance characteristics and prevalence of non-progressive disease were simulated. Analysis compared discounted quality-adjusted life years (QALYs) and costs for test scenarios to base-case scenarios without the test. Compared to the base case, a perfect prognostic test resulted in a 40% decrease in treatment costs, from $13,321 to $8005 USD per DCIS case. A perfect test produced 0.04 additional QALYs (16 days) for women diagnosed with DCIS, added to the base case of 5.88 QALYs per DCIS case. The results were sensitive to the performance characteristics of the prognostic test, the proportion of DCIS cases that were non-progressive in the model, and the frequency of mammography screening in the population. A prognostic test that identifies non-progressive DCIS would substantially reduce treatment costs but result in only modest improvements in quality of life when averaged over all DCIS cases.

Empirical test of the performance of an acoustic-phonetic approach to forensic voice comparison under conditions similar to those of a real case.

PubMed

Enzinger, Ewald; Morrison, Geoffrey Stewart

2017-08-01

In a 2012 case in New South Wales, Australia, the identity of a speaker on several audio recordings was in question. Forensic voice comparison testimony was presented based on an auditory-acoustic-phonetic-spectrographic analysis. No empirical demonstration of the validity and reliability of the analytical methodology was presented. Unlike the admissibility standards in some other jurisdictions (e.g., US Federal Rule of Evidence 702 and the Daubert criteria, or England & Wales Criminal Practice Directions 19A), Australia's Unified Evidence Acts do not require demonstration of the validity and reliability of analytical methods and their implementation before testimony based upon them is presented in court. The present paper reports on empirical tests of the performance of an acoustic-phonetic-statistical forensic voice comparison system which exploited the same features as were the focus of the auditory-acoustic-phonetic-spectrographic analysis in the case, i.e., second-formant (F2) trajectories in /o/ tokens and mean fundamental frequency (f0). The tests were conducted under conditions similar to those in the case. The performance of the acoustic-phonetic-statistical system was very poor compared to that of an automatic system. Copyright © 2017 Elsevier B.V. All rights reserved.

Performance Evaluation of Wearable Sensor Systems: A Case Study in Moderate-Scale Deployment in Hospital Environment.

PubMed

Sun, Wen; Ge, Yu; Zhang, Zhiqiang; Wong, Wai-Choong

2015-09-25

A wearable sensor system enables continuous and remote health monitoring and is widely considered as the next generation of healthcare technology. The performance, the packet error rate (PER) in particular, of a wearable sensor system may deteriorate due to a number of factors, particularly the interference from the other wearable sensor systems in the vicinity. We systematically evaluate the performance of the wearable sensor system in terms of PER in the presence of such interference in this paper. The factors that affect the performance of the wearable sensor system, such as density, traffic load, and transmission power in a realistic moderate-scale deployment case in hospital are all considered. Simulation results show that with 20% duty cycle, only 68.5% of data transmission can achieve the targeted reliability requirement (PER is less than 0.05) even in the off-peak period in hospital. We then suggest some interference mitigation schemes based on the performance evaluation results in the case study.

Data Clustering and Evolving Fuzzy Decision Tree for Data Base Classification Problems

NASA Astrophysics Data System (ADS)

Chang, Pei-Chann; Fan, Chin-Yuan; Wang, Yen-Wen

Data base classification suffers from two well known difficulties, i.e., the high dimensionality and non-stationary variations within the large historic data. This paper presents a hybrid classification model by integrating a case based reasoning technique, a Fuzzy Decision Tree (FDT), and Genetic Algorithms (GA) to construct a decision-making system for data classification in various data base applications. The model is major based on the idea that the historic data base can be transformed into a smaller case-base together with a group of fuzzy decision rules. As a result, the model can be more accurately respond to the current data under classifying from the inductions by these smaller cases based fuzzy decision trees. Hit rate is applied as a performance measure and the effectiveness of our proposed model is demonstrated by experimentally compared with other approaches on different data base classification applications. The average hit rate of our proposed model is the highest among others.

A trial of team-based versus small-group learning for second-year medical students: does the size of the small group make a difference?

PubMed

Willett, Laura Rees; Rosevear, G Craig; Kim, Sarang

2011-01-01

Team-based learning is a large-group instructional modality intended to provide active learning with modest faculty resources. The goal is to determine if team-based learning could be substituted for small-group learning in case sessions without compromising test performance or satisfaction. One hundred and sixty-seven students were assigned to team-based or small-group learning for 6 case discussion sessions. Examination scores and student satisfaction were compared. Instruction modality had no meaningful effect on examination score, 81.7% team based versus 79.7% small-group, p=.56 after multivariate adjustment. Student satisfaction was lower with team-based learning, 2.45 versus 3.74 on a 5-point scale, p<.001. Survey responses suggested that the very small size (8-10 students) of our small groups influenced the preference for small-group learning. Team-based learning does not adversely affect examination performance. However, student satisfaction may be inferior, especially if compared to instruction in very small groups of 10 or fewer students.

Performation Metrics Development Analysis for Information and Communications Technology Outsourcing: A Case Study

ERIC Educational Resources Information Center

Travis, James L., III

2014-01-01

This study investigated how and to what extent the development and use of the OV-5a operational architecture decomposition tree (OADT) from the Department of Defense (DoD) Architecture Framework (DoDAF) affects requirements analysis with respect to complete performance metrics for performance-based services acquisition of ICT under rigid…

Did case-based payment influence surgical readmission rates in France? A retrospective study

PubMed Central

Vuagnat, Albert; Yilmaz, Engin; Roussot, Adrien; Rodwin, Victor; Gadreau, Maryse; Bernard, Alain; Creuzot-Garcher, Catherine; Quantin, Catherine

2018-01-01

Objectives To determine whether implementation of a case-based payment system changed all-cause readmission rates in the 30 days following discharge after surgery, we analysed all surgical procedures performed in all hospitals in France before (2002–2004), during (2005–2008) and after (2009–2012) its implementation. Setting Our study is based on claims data for all surgical procedures performed in all acute care hospitals with >300 surgical admissions per year (740 hospitals) in France over 11 years (2002–2012; n=51.6 million admissions). Interventions We analysed all-cause 30-day readmission rates after surgery using a logistic regression model and an interrupted time series analysis. Results The overall 30-day all-cause readmission rate following discharge after surgery increased from 8.8% to 10.0% (P<0.001) for the public sector and from 5.9% to 8.6% (P<0.001) for the private sector. Interrupted time series models revealed a significant linear increase in readmission rates over the study period in all types of hospitals. However, the implementation of case-based payment was only associated with a significant increase in rehospitalisation rates for private hospitals (P<0.001). Conclusion In France, the increase in the readmission rate appears to be relatively steady in both the private and public sector but appears not to have been affected by the introduction of a case-based payment system after accounting for changes in care practices in the public sector. PMID:29391376

The Role of Reliability, Vulnerability and Resilience in the Management of Water Quality Systems

NASA Astrophysics Data System (ADS)

Lence, B. J.; Maier, H. R.

2001-05-01

The risk based performance indicators reliability, vulnerability and resilience provide measures of the frequency, magnitude and duration of the failure of water resources systems, respectively. They have been applied primarily to water supply problems, including the assessment of the performance of reservoirs and water distribution systems. Applications to water quality case studies have been limited, although the need to consider the length and magnitude of violations of a particular water quality standard has been recognized for some time. In this research, the role of reliability, vulnerability and resilience in water quality management applications is investigated by examining their significance as performance measures for water quality systems and assessing their potential for assisting in decision making processes. The importance of each performance indicator is discussed and a framework for classifying such systems, based on the relative significance of each of these indicators, is introduced and illustrated qualitatively with various case studies. Quantitative examples drawn from both lake and river water quality modeling exercises are then provided.

Machine-Learning Based Channel Quality and Stability Estimation for Stream-Based Multichannel Wireless Sensor Networks.

PubMed

Rehan, Waqas; Fischer, Stefan; Rehan, Maaz

2016-09-12

Wireless sensor networks (WSNs) have become more and more diversified and are today able to also support high data rate applications, such as multimedia. In this case, per-packet channel handshaking/switching may result in inducing additional overheads, such as energy consumption, delays and, therefore, data loss. One of the solutions is to perform stream-based channel allocation where channel handshaking is performed once before transmitting the whole data stream. Deciding stream-based channel allocation is more critical in case of multichannel WSNs where channels of different quality/stability are available and the wish for high performance requires sensor nodes to switch to the best among the available channels. In this work, we will focus on devising mechanisms that perform channel quality/stability estimation in order to improve the accommodation of stream-based communication in multichannel wireless sensor networks. For performing channel quality assessment, we have formulated a composite metric, which we call channel rank measurement (CRM), that can demarcate channels into good, intermediate and bad quality on the basis of the standard deviation of the received signal strength indicator (RSSI) and the average of the link quality indicator (LQI) of the received packets. CRM is then used to generate a data set for training a supervised machine learning-based algorithm (which we call Normal Equation based Channel quality prediction (NEC) algorithm) in such a way that it may perform instantaneous channel rank estimation of any channel. Subsequently, two robust extensions of the NEC algorithm are proposed (which we call Normal Equation based Weighted Moving Average Channel quality prediction (NEWMAC) algorithm and Normal Equation based Aggregate Maturity Criteria with Beta Tracking based Channel weight prediction (NEAMCBTC) algorithm), that can perform channel quality estimation on the basis of both current and past values of channel rank estimation. In the end, simulations are made using MATLAB, and the results show that the Extended version of NEAMCBTC algorithm (Ext-NEAMCBTC) outperforms the compared techniques in terms of channel quality and stability assessment. It also minimizes channel switching overheads (in terms of switching delays and energy consumption) for accommodating stream-based communication in multichannel WSNs.

Machine-Learning Based Channel Quality and Stability Estimation for Stream-Based Multichannel Wireless Sensor Networks

PubMed Central

Rehan, Waqas; Fischer, Stefan; Rehan, Maaz

2016-01-01

Wireless sensor networks (WSNs) have become more and more diversified and are today able to also support high data rate applications, such as multimedia. In this case, per-packet channel handshaking/switching may result in inducing additional overheads, such as energy consumption, delays and, therefore, data loss. One of the solutions is to perform stream-based channel allocation where channel handshaking is performed once before transmitting the whole data stream. Deciding stream-based channel allocation is more critical in case of multichannel WSNs where channels of different quality/stability are available and the wish for high performance requires sensor nodes to switch to the best among the available channels. In this work, we will focus on devising mechanisms that perform channel quality/stability estimation in order to improve the accommodation of stream-based communication in multichannel wireless sensor networks. For performing channel quality assessment, we have formulated a composite metric, which we call channel rank measurement (CRM), that can demarcate channels into good, intermediate and bad quality on the basis of the standard deviation of the received signal strength indicator (RSSI) and the average of the link quality indicator (LQI) of the received packets. CRM is then used to generate a data set for training a supervised machine learning-based algorithm (which we call Normal Equation based Channel quality prediction (NEC) algorithm) in such a way that it may perform instantaneous channel rank estimation of any channel. Subsequently, two robust extensions of the NEC algorithm are proposed (which we call Normal Equation based Weighted Moving Average Channel quality prediction (NEWMAC) algorithm and Normal Equation based Aggregate Maturity Criteria with Beta Tracking based Channel weight prediction (NEAMCBTC) algorithm), that can perform channel quality estimation on the basis of both current and past values of channel rank estimation. In the end, simulations are made using MATLAB, and the results show that the Extended version of NEAMCBTC algorithm (Ext-NEAMCBTC) outperforms the compared techniques in terms of channel quality and stability assessment. It also minimizes channel switching overheads (in terms of switching delays and energy consumption) for accommodating stream-based communication in multichannel WSNs. PMID:27626429

Patient ratings of case managers in a medical home: associations with patient satisfaction and health care utilization.

PubMed

Jubelt, Lindsay E; Graham, Jove; Maeng, Daniel D; Li, Huilin; Epstein, Andrew J; Metlay, Joshua P

2014-11-18

Case managers are employed in medical homes to coordinate care for clinically complex patients. To measure the association of patient perceptions of case manager performance with overall satisfaction and subsequent health care utilization. Retrospective cohort study. Integrated health system in Pennsylvania. Members of the health system-owned health plan who 1) received primary care in the health system's clinics, 2) were exposed to clinic-embedded case managers, and 3) completed a survey of satisfaction with care. Survey assessment of case manager performance and overall satisfaction with care and claims-based assessment of case manager performance and subsequent hospitalizations or emergency department visits. Survey measures were dichotomized into very good versus less than very good. A total of 1755 patients (44%) completed the survey and 1415 met study criteria. Survey respondents who reported very good ratings of case manager performance across all items had a higher probability of reporting very good overall satisfaction with care (92.2% vs. 62.5%; P < 0.001) and had a lower incidence of subsequent emergency department visits (incidence rate ratio, 0.79 [95% CI, 0.64 to 0.98]; P = 0.029) but not hospitalizations (incidence rate ratio, 0.92 [CI, 0.75 to 1.11]; P = 0.37) up to 2 years after the survey compared with survey respondents who reported less-than-very good case manager performance on 1 or more questions on the survey. Satisfaction data demonstrated substantial ceiling effects. Survey nonresponse may have introduced bias in the results. Patients' favorable perceptions of case managers are associated with higher overall satisfaction with care and may lower risk for future acute care use. Robert Wood Johnson Foundation and the U.S. Department of Veterans Affairs.

An Evidence-Based Approach to the Management of Children with Morquio A Syndrome Presenting with Craniocervical Pathology.

PubMed

Williams, Nicole; Narducci, Alessandro; Eastwood, Deborah M; Cleary, Maureen; Thompson, Dominic

2018-06-12

Retrospective case series OBJECTIVE.: To review clinical and radiological outcomes of craniovertebral surgery in children with Morquio A syndrome (Mucopolysaccharidosis type IVA) and develop an evidence-based management algorithm. Myelopathy secondary to craniovertebral pathology is a common cause of neurological disability in Morquio A syndrome. Previously unresolved surgical controversies include the value of surveillance, surgical indications and operative technique. A retrospective case-based review of children with Morquio A syndrome and craniovertebral pathology seen in a tertiary referral paediatric centre from 1992-2016 was performed. Patients treated non-operatively and operatively were included. Medical records and imaging were reviewed to determine clinical and radiological findings at initial assessment, prior to cervical spine surgery, early post-operative period and final follow-up. The clinical outcomes of interest were neurological status and mobility at follow-up, complications and need for further surgery. Twenty-seven patients were included. Surgical indications were radiological evidence of cervicomedullary compression alone (6 cases) or with clinical evidence of myelopathy (12 cases). Eighteen patients (median age 6.2 years, range 3.5 - 15.9 years) underwent surgery, with median follow-up of 8.5years. Occiput to upper cervical spine fusion with C1 decompression was performed in all cases with the addition of autologous calvarial graft in young patients (12 cases) and occipital-cervical plate fixation in older children (6 cases). Neurological improvement occurred in 38% of cases but by one functional level only. Six of 9 conservatively treated patients remained independent walkers. Surgery for craniovertebral pathology is required in the majority of children with Morquio A syndrome. Close clinical and radiological surveillance is essential for timely intervention. Occiput to cervical fusion is safe and feasible even in young patients and improves clinical and radiological parameters. 4.

TU-AB-BRC-10: Modeling of Radiotherapy Linac Source Terms Using ARCHER Monte Carlo Code: Performance Comparison of GPU and MIC Computing Accelerators

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

Liu, T; Lin, H; Xu, X

Purpose: (1) To perform phase space (PS) based source modeling for Tomotherapy and Varian TrueBeam 6 MV Linacs, (2) to examine the accuracy and performance of the ARCHER Monte Carlo code on a heterogeneous computing platform with Many Integrated Core coprocessors (MIC, aka Xeon Phi) and GPUs, and (3) to explore the software micro-optimization methods. Methods: The patient-specific source of Tomotherapy and Varian TrueBeam Linacs was modeled using the PS approach. For the helical Tomotherapy case, the PS data were calculated in our previous study (Su et al. 2014 41(7) Medical Physics). For the single-view Varian TrueBeam case, we analyticallymore » derived them from the raw patient-independent PS data in IAEA’s database, partial geometry information of the jaw and MLC as well as the fluence map. The phantom was generated from DICOM images. The Monte Carlo simulation was performed by ARCHER-MIC and GPU codes, which were benchmarked against a modified parallel DPM code. Software micro-optimization was systematically conducted, and was focused on SIMD vectorization of tight for-loops and data prefetch, with the ultimate goal of increasing 512-bit register utilization and reducing memory access latency. Results: Dose calculation was performed for two clinical cases, a Tomotherapy-based prostate cancer treatment and a TrueBeam-based left breast treatment. ARCHER was verified against the DPM code. The statistical uncertainty of the dose to the PTV was less than 1%. Using double-precision, the total wall time of the multithreaded CPU code on a X5650 CPU was 339 seconds for the Tomotherapy case and 131 seconds for the TrueBeam, while on 3 5110P MICs it was reduced to 79 and 59 seconds, respectively. The single-precision GPU code on a K40 GPU took 45 seconds for the Tomotherapy dose calculation. Conclusion: We have extended ARCHER, the MIC and GPU-based Monte Carlo dose engine to Tomotherapy and Truebeam dose calculations.« less

Distributed Deliberative Recommender Systems

NASA Astrophysics Data System (ADS)

Recio-García, Juan A.; Díaz-Agudo, Belén; González-Sanz, Sergio; Sanchez, Lara Quijano

Case-Based Reasoning (CBR) is one of most successful applied AI technologies of recent years. Although many CBR systems reason locally on a previous experience base to solve new problems, in this paper we focus on distributed retrieval processes working on a network of collaborating CBR systems. In such systems, each node in a network of CBR agents collaborates, arguments and counterarguments its local results with other nodes to improve the performance of the system's global response. We describe D2ISCO: a framework to design and implement deliberative and collaborative CBR systems that is integrated as a part of jcolibritwo an established framework in the CBR community. We apply D2ISCO to one particular simplified type of CBR systems: recommender systems. We perform a first case study for a collaborative music recommender system and present the results of an experiment of the accuracy of the system results using a fuzzy version of the argumentation system AMAL and a network topology based on a social network. Besides individual recommendation we also discuss how D2ISCO can be used to improve recommendations to groups and we present a second case of study based on the movie recommendation domain with heterogeneous groups according to the group personality composition and a group topology based on a social network.

Characteristics and Implications of Diagnostic Justification Scores Based on the New Patient Note Format of the USMLE Step 2 CS Exam.

PubMed

Yudkowsky, Rachel; Park, Yoon Soo; Hyderi, Abbas; Bordage, Georges

2015-11-01

To determine the psychometric characteristics of diagnostic justification scores based on the patient note format of the United States Medical Licensing Examination Step 2 Clinical Skills exam, which requires students to document history and physical findings, differential diagnoses, diagnostic justification, and plan for immediate workup. End-of-third-year medical students at one institution wrote notes for five standardized patient cases in May 2013 (n = 180) and 2014 (n = 177). Each case was scored using a four-point rubric to rate each of the four note components. Descriptive statistics and item analyses were computed and a generalizability study done. Across cases, 10% to 48% provided no diagnostic justification or had several missing or incorrect links between history and physical findings and diagnoses. The average intercase correlation for justification scores ranged from 0.06 to 0.16; internal consistency reliability of justification scores (coefficient alpha across cases) was 0.38. Overall, justification scores had the highest mean item discrimination across cases. The generalizability study showed that person-case interaction (12%) and task-case interaction (13%) had the largest variance components, indicating substantial case specificity. The diagnostic justification task provides unique information about student achievement and curricular gaps. Students struggled to correctly justify their diagnoses; performance was highly case specific. Diagnostic justification was the most discriminating element of the patient note and had the greatest variability in student performance across cases. The curriculum should provide a wide range of clinical cases and emphasize recognition and interpretation of clinically discriminating findings to promote the development of clinical reasoning skills.

Improving performance of breast cancer risk prediction using a new CAD-based region segmentation scheme

NASA Astrophysics Data System (ADS)

Heidari, Morteza; Zargari Khuzani, Abolfazl; Danala, Gopichandh; Qiu, Yuchen; Zheng, Bin

2018-02-01

Objective of this study is to develop and test a new computer-aided detection (CAD) scheme with improved region of interest (ROI) segmentation combined with an image feature extraction framework to improve performance in predicting short-term breast cancer risk. A dataset involving 570 sets of "prior" negative mammography screening cases was retrospectively assembled. In the next sequential "current" screening, 285 cases were positive and 285 cases remained negative. A CAD scheme was applied to all 570 "prior" negative images to stratify cases into the high and low risk case group of having cancer detected in the "current" screening. First, a new ROI segmentation algorithm was used to automatically remove useless area of mammograms. Second, from the matched bilateral craniocaudal view images, a set of 43 image features related to frequency characteristics of ROIs were initially computed from the discrete cosine transform and spatial domain of the images. Third, a support vector machine model based machine learning classifier was used to optimally classify the selected optimal image features to build a CAD-based risk prediction model. The classifier was trained using a leave-one-case-out based cross-validation method. Applying this improved CAD scheme to the testing dataset, an area under ROC curve, AUC = 0.70+/-0.04, which was significantly higher than using the extracting features directly from the dataset without the improved ROI segmentation step (AUC = 0.63+/-0.04). This study demonstrated that the proposed approach could improve accuracy on predicting short-term breast cancer risk, which may play an important role in helping eventually establish an optimal personalized breast cancer paradigm.

[Nasolabial muscle finite-element study and clinical application].

PubMed

Yin, Ningbei; Wu, Jiajun; Chen, Bo; Wang, Yongqian; Song, Tao; Ma, Hengyuan

2015-05-01

To investigate the nasolabial muscle anatomy and biomechanical characteristics. Micro-computed tomography scan was performed in 8 cases of spontaneous abortion fetus lip nasal specimens to construct a three-dimensional model. The nasolabial muscle structure was analyzed using Mimics software. The three-dimensional configuration model of nasolabial muscle was established based on local anatomy and tissue section, and compared with tissue section. Three dimensional finite element analysis was performed on lip nasal muscle related biomechanics and surface deformation in Application verification was carried out in 263 cases of microform cleft lip surgery. There was close relationship between nasolabial muscle. The nasolabial muscle tension system was constituted, based on which a new cleft lip repair surgery was designed and satisfied results were achieved. There is close relationship among nasolabial muscle in anatomy, histology and biomechanics. To obtain better effect, cleft lip repair should be performed on the basis of recovering muscle tension system.

Assessing the Effectiveness of Case-Based Collaborative Learning via Randomized Controlled Trial.

PubMed

Krupat, Edward; Richards, Jeremy B; Sullivan, Amy M; Fleenor, Thomas J; Schwartzstein, Richard M

2016-05-01

Case-based collaborative learning (CBCL) is a novel small-group approach that borrows from team-based learning principles and incorporates elements of problem-based learning (PBL) and case-based learning. CBCL includes a preclass readiness assurance process and case-based in-class activities in which students respond to focused, open-ended questions individually, discuss their answers in groups of 4, and then reach consensus in larger groups of 16. This study introduces CBCL and assesses its effectiveness in one course at Harvard Medical School. In a 2013 randomized controlled trial, 64 medical and dental student volunteers were assigned randomly to one of four 8-person PBL tutorial groups (control; n = 32) or one of two 16-person CBCL tutorial groups (experimental condition; n = 32) as part of a required first-year physiology course. Outcomes for the PBL and CBCL groups were compared using final exam scores, student responses to a postcourse survey, and behavioral coding of portions of video-recorded class sessions. Overall, the course final exam scores for CBCL and PBL students were not significantly different. However, CBCL students whose mean exam performance in prior courses was below the participant median scored significantly higher than their PBL counterparts on the physiology course final exam. The most common adjectives students used to describe CBCL were "engaging," "fun," and "thought-provoking." Coding of observed behaviors indicated that individual affect was significantly higher in the CBCL groups than in the PBL groups. CBCL is a viable, engaging, active learning method. It may particularly benefit students with lower academic performance.

Medical professional responsibility for postvasectomy pregnancy.

PubMed

Vargas-Blasco, C; Arimany-Manso, J; Gómez-Durán, E L; Martin Fumadó, C; Piqueras-Bartolomé, M; Capdevila-Querol, S; Laborda-Rodriguez, A

2016-01-01

The follow-up of patients postvasectomy is frequently limited to a seminogram at 3months if azoospermia is observed. This study evaluates a series of cases of complaints for postvasectomy pregnancy to establish follow-up recommendations that increase the clinical safety and reduce the risk of complaints. We reviewed the database of the Department of Professional Responsibility of the Council of the College of Physicians of Catalonia, finding 28 complaints for postvasectomy pregnancy between 1992 and 2011. We analysed the clinical and legal variables of the cases. A total of 13 extrajudicial complaints (46.43%), 13 civil lawsuits (46.43%) and 2 criminal lawsuits (7.14%) were recorded. Only 10 cases had a signed document of informed consent specific to vasectomy. In 26 cases, the data from the spermogram was available. A single spermogram was conducted in 20 cases (76.92%), 2 spermograms were conducted in 4 cases (15.38%) and none were performed in 2 cases (7.69%). For 9 of the cases (45%) where only a single spermogram was performed, the test was performed before 3months postvasectomy. In 17 cases (65.38%), the result of the last spermogram was azoospermia, and 3 cases had oligospermia (11.54%). There were 2 failures of interpretation of the spermogram (7.69%) and 2 of normospermia (7.69%). In 2 cases, a spermogram was not performed (7.69%). Pregnancy occurred between 4 and 50 months after the intervention. In 12 cases (42.86%), it was considered that the practitioner was responsible. It is recommended that physicians emphasise (during the patient information stage) the possibility of spontaneous recanalisation and to request 2 spermograms, whose result should be azoospermia. Performing the test in the 3months after vasectomy is risky, as is basing the waiting time on the number of ejaculations. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Ear, nose and throat day-case surgery at a district general hospital.

PubMed

Pézier, T; Stimpson, P; Kanegaonkar, R G; Bowdler, D A

2009-03-01

In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety. Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery. Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures. ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery.

Graph theoretic framework based cooperative control and estimation of multiple UAVs for target tracking

NASA Astrophysics Data System (ADS)

Ahmed, Mousumi

Designing the control technique for nonlinear dynamic systems is a significant challenge. Approaches to designing a nonlinear controller are studied and an extensive study on backstepping based technique is performed in this research with the purpose of tracking a moving target autonomously. Our main motivation is to explore the controller for cooperative and coordinating unmanned vehicles in a target tracking application. To start with, a general theoretical framework for target tracking is studied and a controller in three dimensional environment for a single UAV is designed. This research is primarily focused on finding a generalized method which can be applied to track almost any reference trajectory. The backstepping technique is employed to derive the controller for a simplified UAV kinematic model. This controller can compute three autopilot modes i.e. velocity, ground heading (or course angle), and flight path angle for tracking the unmanned vehicle. Numerical implementation is performed in MATLAB with the assumption of having perfect and full state information of the target to investigate the accuracy of the proposed controller. This controller is then frozen for the multi-vehicle problem. Distributed or decentralized cooperative control is discussed in the context of multi-agent systems. A consensus based cooperative control is studied; such consensus based control problem can be viewed from the algebraic graph theory concepts. The communication structure between the UAVs is represented by the dynamic graph where UAVs are represented by the nodes and the communication links are represented by the edges. The previously designed controller is augmented to account for the group to obtain consensus based on their communication. A theoretical development of the controller for the cooperative group of UAVs is presented and the simulation results for different communication topologies are shown. This research also investigates the cases where the communication topology switches to a different topology over particular time instants. Lyapunov analysis is performed to show stability in all cases. Another important aspect of this dissertation research is to implement the controller for the case, where perfect or full state information is not available. This necessitates the design of an estimator to estimate the system state. A nonlinear estimator, Extended Kalman Filter (EKF) is first developed for target tracking with a single UAV. The uncertainties involved with the measurement model and dynamics model are considered as zero mean Gaussian noises with some known covariances. The measurements of the full state of the target are not available and only the range, elevation, and azimuth angle are available from an onboard seeker sensor. A separate EKF is designed to estimate the UAV's own state where the state measurement is available through on-board sensors. The controller computes the three control commands based on the estimated states of target and its own states. Estimation based control laws is also implemented for colored noise measurement uncertainties, and the controller performance is shown with the simulation results. The estimation based control approach is then extended for the cooperative target tracking case. The target information is available to the network and a separate estimator is used to estimate target states. All of the UAVs in the network apply the same control law and the only difference is that each UAV updates the commands according to their connection. The simulation is performed for both cases of fixed and time varying communication topology. Monte Carlo simulation is also performed with different sample noises to investigate the performance of the estimator. The proposed technique is shown to be simple and robust to noisy environments.

Development and pilot testing of an online case-based approach to shared decision making skills training for clinicians.

PubMed

Volk, Robert J; Shokar, Navkiran K; Leal, Viola B; Bulik, Robert J; Linder, Suzanne K; Mullen, Patricia Dolan; Wexler, Richard M; Shokar, Gurjeet S

2014-11-01

Although research suggests that patients prefer a shared decision making (SDM) experience when making healthcare decisions, clinicians do not routinely implement SDM into their practice and training programs are needed. Using a novel case-based strategy, we developed and pilot tested an online educational program to promote shared decision making (SDM) by primary care clinicians. A three-phased approach was used: 1) development of a conceptual model of the SDM process; 2) development of an online teaching case utilizing the Design A Case (DAC) authoring template, a well-tested process used to create peer-reviewed web-based clinical cases across all levels of healthcare training; and 3) pilot testing of the case. Participants were clinician members affiliated with several primary care research networks across the United States who answered an invitation email. The case used prostate cancer screening as the clinical context and was delivered online. Post-intervention ratings of clinicians' general knowledge of SDM, knowledge of specific SDM steps, confidence in and intention to perform SDM steps were also collected online. Seventy-nine clinicians initially volunteered to participate in the study, of which 49 completed the case and provided evaluations. Forty-three clinicians (87.8%) reported the case met all the learning objectives, and 47 (95.9%) indicated the case was relevant for other equipoise decisions. Thirty-one clinicians (63.3%) accessed supplementary information via links provided in the case. After viewing the case, knowledge of SDM was high (over 90% correctly identified the steps in a SDM process). Determining a patient's preferred role in making the decision (62.5% very confident) and exploring a patient's values (65.3% very confident) about the decisions were areas where clinician confidence was lowest. More than 70% of the clinicians intended to perform SDM in the future. A comprehensive model of the SDM process was used to design a case-based approach to teaching SDM skills to primary care clinicians. The case was favorably rated in this pilot study. Clinician skills training for helping patients clarify their values and for assessing patients' desire for involvement in decision making remain significant challenges and should be a focus of future comparative studies.

A Human Proximity Operations System test case validation approach

NASA Astrophysics Data System (ADS)

Huber, Justin; Straub, Jeremy

A Human Proximity Operations System (HPOS) poses numerous risks in a real world environment. These risks range from mundane tasks such as avoiding walls and fixed obstacles to the critical need to keep people and processes safe in the context of the HPOS's situation-specific decision making. Validating the performance of an HPOS, which must operate in a real-world environment, is an ill posed problem due to the complexity that is introduced by erratic (non-computer) actors. In order to prove the HPOS's usefulness, test cases must be generated to simulate possible actions of these actors, so the HPOS can be shown to be able perform safely in environments where it will be operated. The HPOS must demonstrate its ability to be as safe as a human, across a wide range of foreseeable circumstances. This paper evaluates the use of test cases to validate HPOS performance and utility. It considers an HPOS's safe performance in the context of a common human activity, moving through a crowded corridor, and extrapolates (based on this) to the suitability of using test cases for AI validation in other areas of prospective application.

Educating resident physicians using virtual case-based simulation improves diabetes management: a randomized controlled trial.

PubMed

Sperl-Hillen, JoAnn; O'Connor, Patrick J; Ekstrom, Heidi L; Rush, William A; Asche, Stephen E; Fernandes, Omar D; Appana, Deepika; Amundson, Gerald H; Johnson, Paul E; Curran, Debra M

2014-12-01

To test a virtual case-based Simulated Diabetes Education intervention (SimDE) developed to teach primary care residents how to manage diabetes. Nineteen primary care residency programs, with 341 volunteer residents in all postgraduate years (PGY), were randomly assigned to a SimDE intervention group or control group (CG). The Web-based interactive educational intervention used computerized virtual patients who responded to provider actions through programmed simulation models. Eighteen distinct learning cases (L-cases) were assigned to SimDE residents over six months from 2010 to 2011. Impact was assessed using performance on four virtual assessment cases (A-cases), an objective knowledge test, and pre-post changes in self-assessed diabetes knowledge and confidence. Group comparisons were analyzed using generalized linear mixed models, controlling for clustering of residents within residency programs and differences in baseline knowledge. The percentages of residents appropriately achieving A-case composite clinical goals for glucose, blood pressure, and lipids were as follows: A-case 1: SimDE = 21.2%, CG = 1.8%, P = .002; A-case 2: SimDE = 15.7%, CG = 4.7%, P = .02; A-case 3: SimDE = 48.0%, CG = 10.4%, P < .001; and A-case 4: SimDE = 42.1%, CG = 18.7%, P = .004. The mean knowledge score and pre-post changes in self-assessed knowledge and confidence were significantly better for SimDE group than CG participants. A virtual case-based simulated diabetes education intervention improved diabetes management skills, knowledge, and confidence for primary care residents.

Exploring the Effectiveness of a Virtual Learning Methodology in Occupational Therapy Education

ERIC Educational Resources Information Center

Bebeau, Deborah

2016-01-01

This quantitative, randomly controlled study sought to find relationships between occupational therapy students' participation in a virtual situated-case scenario (VSCS) and enhanced perceived self-efficacy as well as academic performance when compared to participation in a text-based case study. To determine effects of participation in a virtual…

Intelligent Case Based Decision Support System for Online Diagnosis of Automated Production System

NASA Astrophysics Data System (ADS)

Ben Rabah, N.; Saddem, R.; Ben Hmida, F.; Carre-Menetrier, V.; Tagina, M.

2017-01-01

Diagnosis of Automated Production System (APS) is a decision-making process designed to detect, locate and identify a particular failure caused by the control law. In the literature, there are three major types of reasoning for industrial diagnosis: the first is model-based, the second is rule-based and the third is case-based. The common and major limitation of the first and the second reasonings is that they do not have automated learning ability. This paper presents an interactive and effective Case Based Decision Support System for online Diagnosis (CB-DSSD) of an APS. It offers a synergy between the Case Based Reasoning (CBR) and the Decision Support System (DSS) in order to support and assist Human Operator of Supervision (HOS) in his/her decision process. Indeed, the experimental evaluation performed on an Interactive Training System for PLC (ITS PLC) that allows the control of a Programmable Logic Controller (PLC), simulating sensors or/and actuators failures and validating the control algorithm through a real time interactive experience, showed the efficiency of our approach.

Demultiplexing based on frequency-domain joint decision MMA for MDM system

NASA Astrophysics Data System (ADS)

Caili, Gong; Li, Li; Guijun, Hu

2016-06-01

In this paper, we propose a demultiplexing method based on frequency-domain joint decision multi-modulus algorithm (FD-JDMMA) for mode division multiplexing (MDM) system. The performance of FD-JDMMA is compared with frequency-domain multi-modulus algorithm (FD-MMA) and frequency-domain least mean square (FD-LMS) algorithm. The simulation results show that FD-JDMMA outperforms FD-MMA in terms of BER and convergence speed in the cases of mQAM (m=4, 16 and 64) formats. And it is also demonstrated that FD-JDMMA achieves better BER performance and converges faster than FD-LMS in the cases of 16QAM and 64QAM. Furthermore, FD-JDMMA maintains similar computational complexity as the both equalization algorithms.

Performance metrics for the assessment of satellite data products: an ocean color case study

EPA Science Inventory

Performance assessment of ocean color satellite data has generally relied on statistical metrics chosen for their common usage and the rationale for selecting certain metrics is infrequently explained. Commonly reported statistics based on mean squared errors, such as the coeffic...

The Long and Winding Path (from Instructional Design to Performance Technology).

ERIC Educational Resources Information Center

Carr, Clay; Totzke, Larry

1995-01-01

Presents a case study based on experiences at Amway Corporation that explains how the Human Resources Development Department progressed from providing training to providing a broader range of human performance technology interventions. Strategic planning is described, including identifying incentives and required competencies, providing for…

A rule-based software test data generator

NASA Technical Reports Server (NTRS)

Deason, William H.; Brown, David B.; Chang, Kai-Hsiung; Cross, James H., II

1991-01-01

Rule-based software test data generation is proposed as an alternative to either path/predicate analysis or random data generation. A prototype rule-based test data generator for Ada programs is constructed and compared to a random test data generator. Four Ada procedures are used in the comparison. Approximately 2000 rule-based test cases and 100,000 randomly generated test cases are automatically generated and executed. The success of the two methods is compared using standard coverage metrics. Simple statistical tests showing that even the primitive rule-based test data generation prototype is significantly better than random data generation are performed. This result demonstrates that rule-based test data generation is feasible and shows great promise in assisting test engineers, especially when the rule base is developed further.

Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients

PubMed Central

Spera, Allison L.; Saxen, Mark A.; Yepes, Juan F.; Jones, James E.; Sanders, Brian J.

2017-01-01

The number of children with caries requiring general anesthesia to achieve comprehensive dental care and the demand for dentist anesthesiologists to provide ambulatory anesthesia for these patients is increasing. No current published studies examine the safety and outcomes of ambulatory anesthesia performed by dentist anesthesiologists for dental procedures in pediatric patients, and there is no national requirement for reporting outcomes of these procedures. In 2010, the Society for Ambulatory Anesthesia Clinical Outcomes Registry was developed. This Web-based database allows providers of ambulatory anesthesia to track patient demographics and various outcomes of procedures. Our study is a secondary analysis of data collected in the registry over a 4-year period, 2010–2014. Of the 7041 cases reviewed, no cases resulted in serious complications, including death, anaphylaxis, aspiration, cardiovascular adverse events, or neurologic adverse events. Of the 7041 cases reviewed, 196 (3.0%) resulted in a predischarge or postdischarge adverse event. The predischarge adverse event occurring with the highest frequency was laryngospasm, occurring in 35 cases (0.50%). The postdischarge adverse event occurring with the highest frequency was nausea, reported by 99 patients (5.0%). This study provides strong clinical outcomes data to support the safety of office-based anesthesia as performed by dentist anesthesiologists in the treatment of pediatric dental patients. PMID:28858554

Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients.

PubMed

Spera, Allison L; Saxen, Mark A; Yepes, Juan F; Jones, James E; Sanders, Brian J

The number of children with caries requiring general anesthesia to achieve comprehensive dental care and the demand for dentist anesthesiologists to provide ambulatory anesthesia for these patients is increasing. No current published studies examine the safety and outcomes of ambulatory anesthesia performed by dentist anesthesiologists for dental procedures in pediatric patients, and there is no national requirement for reporting outcomes of these procedures. In 2010, the Society for Ambulatory Anesthesia Clinical Outcomes Registry was developed. This Web-based database allows providers of ambulatory anesthesia to track patient demographics and various outcomes of procedures. Our study is a secondary analysis of data collected in the registry over a 4-year period, 2010-2014. Of the 7041 cases reviewed, no cases resulted in serious complications, including death, anaphylaxis, aspiration, cardiovascular adverse events, or neurologic adverse events. Of the 7041 cases reviewed, 196 (3.0%) resulted in a predischarge or postdischarge adverse event. The predischarge adverse event occurring with the highest frequency was laryngospasm, occurring in 35 cases (0.50%). The postdischarge adverse event occurring with the highest frequency was nausea, reported by 99 patients (5.0%). This study provides strong clinical outcomes data to support the safety of office-based anesthesia as performed by dentist anesthesiologists in the treatment of pediatric dental patients.

Mother and child characteristics at birth and early age leukemia: a case-cohort population-based study.

PubMed

Reis, Rejane de Souza; Silva, Neimar de Paula; Santos, Marceli de Oliveira; Oliveira, Julio Fernando Pinto; Thuler, Luiz Claudio Santos; de Camargo, Beatriz; Pombo-de-Oliveira, Maria S

The population-based cancer registries (PBCR) and the Information System on Live Births in Brazil (Sistema de Informações sobre Nascidos Vivos [SINASC]) have information that enables the test for risk factors associated with leukemia at an early age. The aim of this study was to identify maternal and birth characteristics associated with early-age acute leukemia (EAL) in Brazil. A case-cohort study was performed using secondary dataset information of PBCR and SINASC. The risk association variables were grouped into (i) characteristics of the child at birth and (ii) characteristics of maternal exposure during pregnancy. The case-control ratio was 1:4. Linkage was performed using R software; odds ratio (OR) and 95% confidence interval (CI) were calculated by logistic regression models. EAL was associated with maternal occupational exposure to chemicals (agricultural, chemical, and petrochemical industry; adjOR: 2.18, 95% CI: 1.16-4.10) and with birth defects (adjOR: 3.62, 95% CI: 1.19-11.00). The results of this study, with the identification of EAL risk factors in population-based case-cohort study, strengthen the knowledge and improve databases, contributing to investigations on risk factors associated with childhood leukemia worldwide. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Comparing the Performance of NoSQL Approaches for Managing Archetype-Based Electronic Health Record Data

PubMed Central

Freire, Sergio Miranda; Teodoro, Douglas; Wei-Kleiner, Fang; Sundvall, Erik; Karlsson, Daniel; Lambrix, Patrick

2016-01-01

This study provides an experimental performance evaluation on population-based queries of NoSQL databases storing archetype-based Electronic Health Record (EHR) data. There are few published studies regarding the performance of persistence mechanisms for systems that use multilevel modelling approaches, especially when the focus is on population-based queries. A healthcare dataset with 4.2 million records stored in a relational database (MySQL) was used to generate XML and JSON documents based on the openEHR reference model. Six datasets with different sizes were created from these documents and imported into three single machine XML databases (BaseX, eXistdb and Berkeley DB XML) and into a distributed NoSQL database system based on the MapReduce approach, Couchbase, deployed in different cluster configurations of 1, 2, 4, 8 and 12 machines. Population-based queries were submitted to those databases and to the original relational database. Database size and query response times are presented. The XML databases were considerably slower and required much more space than Couchbase. Overall, Couchbase had better response times than MySQL, especially for larger datasets. However, Couchbase requires indexing for each differently formulated query and the indexing time increases with the size of the datasets. The performances of the clusters with 2, 4, 8 and 12 nodes were not better than the single node cluster in relation to the query response time, but the indexing time was reduced proportionally to the number of nodes. The tested XML databases had acceptable performance for openEHR-based data in some querying use cases and small datasets, but were generally much slower than Couchbase. Couchbase also outperformed the response times of the relational database, but required more disk space and had a much longer indexing time. Systems like Couchbase are thus interesting research targets for scalable storage and querying of archetype-based EHR data when population-based use cases are of interest. PMID:26958859

Comparing the Performance of NoSQL Approaches for Managing Archetype-Based Electronic Health Record Data.

PubMed

Freire, Sergio Miranda; Teodoro, Douglas; Wei-Kleiner, Fang; Sundvall, Erik; Karlsson, Daniel; Lambrix, Patrick

2016-01-01

This study provides an experimental performance evaluation on population-based queries of NoSQL databases storing archetype-based Electronic Health Record (EHR) data. There are few published studies regarding the performance of persistence mechanisms for systems that use multilevel modelling approaches, especially when the focus is on population-based queries. A healthcare dataset with 4.2 million records stored in a relational database (MySQL) was used to generate XML and JSON documents based on the openEHR reference model. Six datasets with different sizes were created from these documents and imported into three single machine XML databases (BaseX, eXistdb and Berkeley DB XML) and into a distributed NoSQL database system based on the MapReduce approach, Couchbase, deployed in different cluster configurations of 1, 2, 4, 8 and 12 machines. Population-based queries were submitted to those databases and to the original relational database. Database size and query response times are presented. The XML databases were considerably slower and required much more space than Couchbase. Overall, Couchbase had better response times than MySQL, especially for larger datasets. However, Couchbase requires indexing for each differently formulated query and the indexing time increases with the size of the datasets. The performances of the clusters with 2, 4, 8 and 12 nodes were not better than the single node cluster in relation to the query response time, but the indexing time was reduced proportionally to the number of nodes. The tested XML databases had acceptable performance for openEHR-based data in some querying use cases and small datasets, but were generally much slower than Couchbase. Couchbase also outperformed the response times of the relational database, but required more disk space and had a much longer indexing time. Systems like Couchbase are thus interesting research targets for scalable storage and querying of archetype-based EHR data when population-based use cases are of interest.

Evaluation of a Cubature Kalman Filtering-Based Phase Unwrapping Method for Differential Interferograms with High Noise in Coal Mining Areas

PubMed Central

Liu, Wanli; Bian, Zhengfu; Liu, Zhenguo; Zhang, Qiuzhao

2015-01-01

Differential interferometric synthetic aperture radar has been shown to be effective for monitoring subsidence in coal mining areas. Phase unwrapping can have a dramatic influence on the monitoring result. In this paper, a filtering-based phase unwrapping algorithm in combination with path-following is introduced to unwrap differential interferograms with high noise in mining areas. It can perform simultaneous noise filtering and phase unwrapping so that the pre-filtering steps can be omitted, thus usually retaining more details and improving the detectable deformation. For the method, the nonlinear measurement model of phase unwrapping is processed using a simplified Cubature Kalman filtering, which is an effective and efficient tool used in many nonlinear fields. Three case studies are designed to evaluate the performance of the method. In Case 1, two tests are designed to evaluate the performance of the method under different factors including the number of multi-looks and path-guiding indexes. The result demonstrates that the unwrapped results are sensitive to the number of multi-looks and that the Fisher Distance is the most suitable path-guiding index for our study. Two case studies are then designed to evaluate the feasibility of the proposed phase unwrapping method based on Cubature Kalman filtering. The results indicate that, compared with the popular Minimum Cost Flow method, the Cubature Kalman filtering-based phase unwrapping can achieve promising results without pre-filtering and is an appropriate method for coal mining areas with high noise. PMID:26153776

[Neurophysiological identification of the cranial nerves in endoscopic endonasal surgery of skull base tumors].

PubMed

Shkarubo, A N; Ogurtsova, A A; Moshchev, D A; Lubnin, A Yu; Andreev, D N; Koval', K V; Chernov, I V

2016-01-01

Intraoperative identification of the cranial nerves is a useful technique in removal of skull base tumors through the endoscopic endonasal approach. Searching through the scientific literature found one pilot study on the use of triggered electromyography (t-EMG) for identification of the VIth nerve in endonasal endoscopic surgery of skull base tumors (D. San-Juan, et al, 2014). The study objective was to prevent iatrogenic injuries to the cranial nerves without reducing the completeness of tumor tissue resection. In 2014, 5 patients were operated on using the endoscopic endonasal approach. Surgeries were performed for large skull base chordomas (2 cases) and trigeminal nerve neurinomas located in the cavernous sinus (3). Intraoperatively, identification of the cranial nerves was performed by triggered electromyography using a bipolar electrode (except 1 case of chordoma where a monopolar electrode was used). Evaluation of the functional activity of the cranial nerves was carried out both preoperatively and postoperatively. Tumor resection was total in 4 out of 5 cases and subtotal (chordoma) in 1 case. Intraoperatively, the IIIrd (2 patients), Vth (2), and VIth (4) cranial nerves were identified. No deterioration in the function of the intraoperatively identified nerves was observed in the postoperative period. In one case, no responses from the VIth nerve on the right (in the cavernous sinus region) were intraoperatively obtained, and deep paresis (up to plegia) of the nerve-innervated muscles developed in the postoperative period. The nerve function was not impaired before surgery. The t-EMG technique is promising and requires further research.

Evaluation of annual efficiencies of high temperature central receiver concentrated solar power plants with thermal energy storage.

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

Ehrhart, Brian David; Gill, David Dennis

The current study has examined four cases of a central receiver concentrated solar power plant with thermal energy storage using the DELSOL and SOLERGY computer codes. The current state-of-the-art base case was compared with a theoretical high temperature case which was based on the scaling of some input parameters and the estimation of other parameters based on performance targets from the Department of Energy SunShot Initiative. This comparison was done for both current and high temperature cases in two configurations: a surround field with an external cylindrical receiver and a north field with a single cavity receiver. There is amore » fairly dramatic difference between the design point and annual average performance, especially in the solar field and receiver subsystems, and also in energy losses due to the thermal energy storage being full to capacity. Additionally, there are relatively small differences (<2%) in annual average efficiencies between the Base and High Temperature cases, despite an increase in thermal to electric conversion efficiency of over 8%. This is due the increased thermal losses at higher temperature and operational losses due to subsystem start-up and shut-down. Thermal energy storage can mitigate some of these losses by utilizing larger thermal energy storage to ensure that the electric power production system does not need to stop and re-start as often, but solar energy is inherently transient. Economic and cost considerations were not considered here, but will have a significant impact on solar thermal electric power production strategy and sizing.« less

A network function-based definition of communities in complex networks.

PubMed

Chauhan, Sanjeev; Girvan, Michelle; Ott, Edward

2012-09-01

We consider an alternate definition of community structure that is functionally motivated. We define network community structure based on the function the network system is intended to perform. In particular, as a specific example of this approach, we consider communities whose function is enhanced by the ability to synchronize and/or by resilience to node failures. Previous work has shown that, in many cases, the largest eigenvalue of the network's adjacency matrix controls the onset of both synchronization and percolation processes. Thus, for networks whose functional performance is dependent on these processes, we propose a method that divides a given network into communities based on maximizing a function of the largest eigenvalues of the adjacency matrices of the resulting communities. We also explore the differences between the partitions obtained by our method and the modularity approach (which is based solely on consideration of network structure). We do this for several different classes of networks. We find that, in many cases, modularity-based partitions do almost as well as our function-based method in finding functional communities, even though modularity does not specifically incorporate consideration of function.

Autogrid-based clustering of kinases: selection of representative conformations for docking purposes.

PubMed

Marzaro, Giovanni; Ferrarese, Alessandro; Chilin, Adriana

2014-08-01

The selection of the most appropriate protein conformation is a crucial aspect in molecular docking experiments. In order to reduce the errors arising from the use of a single protein conformation, several authors suggest the use of several tridimensional structures for the target. However, the selection of the most appropriate protein conformations still remains a challenging goal. The protein 3D-structures selection is mainly performed based on pairwise root-mean-square-deviation (RMSD) values computation, followed by hierarchical clustering. Herein we report an alternative strategy, based on the computation of only two atom affinity map for each protein conformation, followed by multivariate analysis and hierarchical clustering. This methodology was applied on seven different kinases of pharmaceutical interest. The comparison with the classical RMSD-based strategy was based on cross-docking of co-crystallized ligands. In the case of epidermal growth factor receptor kinase, also the docking performance on 220 known ligands were evaluated, followed by 3D-QSAR studies. In all the cases, the herein proposed methodology outperformed the RMSD-based one.

Locating, characterizing and minimizing sources of error for a paper case-based structured oral examination in a multi-campus clerkship.

PubMed

Kumar, A; Bridgham, R; Potts, M; Gushurst, C; Hamp, M; Passal, D

2001-01-01

To determine consistency of assessment in a new paper case-based structured oral examination in a multi-community pediatrics clerkship, and to identify correctable problems in the administration of examination and assessment process. Nine paper case-based oral examinations were audio-taped. From audio-tapes five community coordinators scored examiner behaviors and graded student performance. Correlations among examiner behaviors scores were examined. Graphs identified grading patterns of evaluators. The effect of exam-giving on evaluators was assessed by t-test. Reliability of grades was calculated and the effect of reducing assessment problems was modeled. Exam-givers differed most in their "teaching-guiding" behavior, and this negatively correlated with student grades. Exam reliability was lowered mainly by evaluator differences in leniency and grading pattern; less important was absence of standardization in cases. While grade reliability was low in early use of the paper case-based oral examination, modeling of plausible effects of training and monitoring for greater uniformity in administration of the examination and assigning scores suggests that more adequate reliabilities can be attained.

A comparison of fitness-case sampling methods for genetic programming

NASA Astrophysics Data System (ADS)

Martínez, Yuliana; Naredo, Enrique; Trujillo, Leonardo; Legrand, Pierrick; López, Uriel

2017-11-01

Genetic programming (GP) is an evolutionary computation paradigm for automatic program induction. GP has produced impressive results but it still needs to overcome some practical limitations, particularly its high computational cost, overfitting and excessive code growth. Recently, many researchers have proposed fitness-case sampling methods to overcome some of these problems, with mixed results in several limited tests. This paper presents an extensive comparative study of four fitness-case sampling methods, namely: Interleaved Sampling, Random Interleaved Sampling, Lexicase Selection and Keep-Worst Interleaved Sampling. The algorithms are compared on 11 symbolic regression problems and 11 supervised classification problems, using 10 synthetic benchmarks and 12 real-world data-sets. They are evaluated based on test performance, overfitting and average program size, comparing them with a standard GP search. Comparisons are carried out using non-parametric multigroup tests and post hoc pairwise statistical tests. The experimental results suggest that fitness-case sampling methods are particularly useful for difficult real-world symbolic regression problems, improving performance, reducing overfitting and limiting code growth. On the other hand, it seems that fitness-case sampling cannot improve upon GP performance when considering supervised binary classification.

Effect of the collector tube profile on Pitot pump performances

NASA Astrophysics Data System (ADS)

Komaki, K.; Kanemoto, T.; Sagara, K.; Umekage, T.

2013-12-01

The pitot pump is composed of the rotating casing with the impeller channel and the pitot tube type collector as the discharge line. The radial impeller feeds water to the rotating casing. The water rotating together with the casing is caught by the stationary pitot tube type collector, and then discharges to the outside. This type pump, as the extra high head pump, is provided mainly for boiler feed systems, and has been designed by trial and error. To optimize the pump profiles, it is desirable to investigate not only performances but also internal flow conditions. This paper discusses experimentally and numerically the relation between the pump performances and the flow conditions in the rotating casing. The moderately larger dimensions of the collector make the pump head and the discharge high with the higher hydraulic efficiency. The flow in the casing is almost the forced vortex type whose velocity is in proportion to the radius but the core velocity is affected with the drag force of the stationary collector. Based upon the above results, the profile of the pitot tube type collector was optimized with the numerical simulation.

Occupational physicians' perceived value of evidence-based medicine intervention in enhancing their professional performance.

PubMed

Hugenholtz, Nathalie I R; Schaafsma, Frederieke G; Schreinemakers, Jos F; van Dijk, Frank J H; Nieuwenhuijsen, Karen

2008-06-01

This study evaluated how physicians in a nonclinical setting perceive the value of an intervention with multifaceted evidence-based medicine with regard to enhancing their professional performance. A qualitative study was conducted using focus groups and face-to-face interviews with 14 of the 48 Dutch occupational physicians who participated in the intervention. The intervention combined a didactic course in evidence-based medicine with recurrent case-method learning sessions. During the sessions, the participants were challenged to discuss their cases and to give one another feedback on how to find information on cases. Five main themes and four subthemes were identified: professional behavior and quality of care (subtheme: transparency): occupational physicians associated being up-to-date with quality of care, and evidence-based medicine was associated with improvements in professional standards; critical attitude and improved recommendations: occupational physicians asked themselves more-profound questions and searched more for information; sharing knowledge: the peer-group sessions facilitated the sharing of knowledge; communication (subthemes: colleagues, clients and other specialists): the more soundly based recommendations enhanced self-confidence positively and therefore altered interaction with medical specialists in particular; and satisfaction and barriers: the occupational physicians were especially content with the structured discussion in the peer-group sessions. However, the intervention was very time consuming. The participants regarded the intervention as a useful method for enhancing their professional performance. They stated that they became more up-to-date and more self-confident by searching for and sharing knowledge. These actions resulted in more scientifically based recommendations and improved interaction with clients and other specialists. However, time constraints remain an important barrier.

Peripleural lung disease detection based on multi-slice CT images

NASA Astrophysics Data System (ADS)

Matsuhiro, M.; Suzuki, H.; Kawata, Y.; Niki, N.; Nakano, Y.; Ohmatsu, H.; Kusumoto, M.; Tsuchida, T.; Eguchi, K.; Kaneko, M.

2015-03-01

With the development of multi-slice CT technology, obtaining accurate 3D images of lung field in a short time become possible. To support that, a lot of image processing methods need to be developed. Detection peripleural lung disease is difficult due to its existence out of lung region, because lung extraction is often performed based on threshold processing. The proposed method uses thoracic inner region extracted by inner cavity of bone as well as air region, covers peripleural lung diseased cases such as lung nodule, calcification, pleural effusion and pleural plaque. We applied this method to 50 cases including 39 peripleural lung diseased cases. This method was able to detect 39 peripleural lung disease with 2.9 false positive per case.

Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso.

PubMed

Ridde, Valéry; Turcotte-Tremblay, Anne-Marie; Souares, Aurélia; Lohmann, Julia; Zombré, David; Koulidiati, Jean Louis; Yaogo, Maurice; Hien, Hervé; Hunt, Matthew; Zongo, Sylvie; De Allegri, Manuela

2014-10-12

The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications. The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods. Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.

Application research of 3D additive manufacturing technology in the nail shell

NASA Astrophysics Data System (ADS)

Xiao, Shanhua; Yan, Ruiqiang; Song, Ning

2018-04-01

Based on the analysis of hierarchical slicing algorithm, 3D scanning of enterprise product nailing handle case file is carried out, point cloud data processing is performed on the source file, and the surface modeling and innovative design of nail handling handle case are completed. Using MakerBot Replicator2X-based 3D printer for layered 3D print samples, for the new nail product development to provide reverse modeling and rapid prototyping technical support.

The effect of repair costs on the profitability of a ureteroscopy program.

PubMed

Tosoian, Jeffrey J; Ludwig, Wesley; Sopko, Nikolai; Mullins, Jeffrey K; Matlaga, Brian R

2015-04-01

Ureteroscopy (URS) is a common treatment for patients with stone disease. One of the disadvantages of this approach is the great capital expense associated with the purchase and repair of endoscopic equipment. In some cases, these costs can outpace revenues and lead to an unprofitable and unsustainable enterprise. We sought to characterize the profitability of our URS program when accounting for endoscope maintenance and repair costs. We identified all URS cases performed at a single hospital during fiscal year 2013 (FY2013). Charges, collection rates, and fixed and variable costs including annual equipment repair costs were obtained. The net margin and break-even point of URS were derived on a per-case basis. For 190 cases performed in FY2013, total endoscope repair costs totaled $115,000, resulting in an average repair cost of $605 per case. The vast majority of cases (94.2%) were conducted in the outpatient setting, which generated a net margin of $659 per case, while inpatient cases yielded a net loss of $455. URS was ultimately associated with a net positive margin approaching $600 per case. On break-even analysis, URS remained profitable until repair costs reached $1200 per case. Based on these findings, an established URS program can sustain profitability even with large equipment repair costs. Nonetheless, our findings serve to emphasize the importance of controlling costs, particularly in the current setting of decreasing reimbursement. A multifaceted approach, based on improving endoscope durability and exploring digital and disposable platforms, will be critical in maintaining the sustainability of URS.

Defining the performance gap: Conducting a self-assessment

NASA Technical Reports Server (NTRS)

Braymer, Susan A.; Stoner, David L.; Powell, William C.

1992-01-01

This paper presents two different approaches to performing self-assessments of continuous improvement activities. Case Study 1 describes the activities performed by JSC to assess the implementation of continuous improvement efforts at the NASA Center. The JSC approach included surveys administered to randomly selected NASA personnel and personal interviews with NASA and contractor management personnel. Case Study 2 describes the continuous improvement survey performed by the JSC Safety, Reliability, and Quality Assurance (SR&QA) organization. This survey consisted of a short questionnaire (50 questions) administered to all NASA and contractor SR&QA personnel. The questionnaire is based on the eight categories of the President's Award for Quality and Productivity Improvement. It is designed to objectively determine placement on the TQ benchmark and identify a roadmap for improvement.

Development, Implementation, and Evaluation of an Interdisciplinary Women's Health and Laboratory Course.

PubMed

Guarner, Jeannette; Winkler, Ann M; Flowers, Lisa; Hill, Charles E; Ellis, Jane E; Workowski, Kimberly; Reid, Michelle D; Goedken, Jennifer

2016-09-01

To describe the creation, implementation, and evaluation of a case-based, interdisciplinary course that highlights laboratory principles for students who have selected a career in obstetrics and gynecology. We developed four case-based modules with questions that emphasize laboratory principles required to establish a diagnosis and treat and monitor each case-based scenario. The cases were offered as a 4-hour elective course during the medical school capstone. A clinician and a clinical pathologist pair facilitated the case discussions with groups of six to nine medical students during 2 consecutive years. Pre- and postknowledge quizzes were given to the students. In addition, a structured evaluation of the course was performed. Twenty-two students participated in the courses. Most found the format effective and the information useful. There was a significant increase in their related knowledge as established by pre- and posttesting. Case-based discussions gave learners a better understanding of the function and complexity of the clinical laboratories, and multidisciplinary facilitation highlighted the value of interacting with laboratory professionals to enhance clinical care. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Characteristics of the group of radiologists that benefits the most using Breast Screen Reader Assessment Strategy (BREAST)

NASA Astrophysics Data System (ADS)

Ganesan, A.; Alakhras, M.; Brennan, P. C.; Lee, W.; Tapia, K.; Mello-Thoms, C.

2018-03-01

Purpose: To determine the impact of Breast Screen Reader Assessment Strategy (BREAST) over time in improving radiologists' breast cancer detection performance, and to identify the group of radiologists that benefit the most by using BREAST as a training tool. Materials and Methods: Thirty-six radiologists who completed three case-sets offered by BREAST were included in this study. The case-sets were arranged in radiologists' chronological order of completion and five performance measures (sensitivity, specificity, location sensitivity, receiver operating characteristics area under the curve (ROC AUC) and jackknife alternative free-response receiver operating characteristic (JAFROC) figure-of-merit (FOM)), available from BREAST, were compared between case-sets to determine the level of improvement achieved. The radiologists were then grouped based on their characteristics and the above performance measures between the case-sets were compared. Paired t-tests or Wilcoxon signed-rank tests with statistical significance set at p < 0.05 were used to compare the performance measures. Results: Significant improvement was demonstrated in radiologists' case-set performance in terms of location sensitivity and JAFROC FOM over the years, and radiologists' location sensitivity and JAFROC FOM showed significant improvement irrespective of their characteristics. In terms of ROC AUC, significant improvement was shown for radiologists who were reading screen mammograms for more than 7 years and spent more than 9 hours per week reading mammograms. Conclusion: Engaging with case-sets appears to enhance radiologists' performance suggesting the important value of initiatives such as BREAST. However, such performance enhancement was not shown for everyone, highlighting the need to tailor the BREAST platform to benefit all radiologists.

Targeted exome sequencing and chromosomal microarray for the molecular diagnosis of nevoid basal cell carcinoma syndrome.

PubMed

Matsudate, Yoshihiro; Naruto, Takuya; Hayashi, Yumiko; Minami, Mitsuyoshi; Tohyama, Mikiko; Yokota, Kenji; Yamada, Daisuke; Imoto, Issei; Kubo, Yoshiaki

2017-06-01

Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder mainly caused by heterozygous mutations of PTCH1. In addition to characteristic clinical features, detection of a mutation in causative genes is reliable for the diagnosis of NBCCS; however, no mutations have been identified in some patients using conventional methods. To improve the method for the molecular diagnosis of NBCCS. We performed targeted exome sequencing (TES) analysis using a multi-gene panel, including PTCH1, PTCH2, SUFU, and other sonic hedgehog signaling pathway-related genes, based on next-generation sequencing (NGS) technology in 8 cases in whom possible causative mutations were not detected by previously performed conventional analysis and 2 recent cases of NBCCS. Subsequent analysis of gross deletion within or around PTCH1 detected by TES was performed using chromosomal microarray (CMA). Through TES analysis, specific single nucleotide variants or small indels of PTCH1 causing inferred amino acid changes were identified in 2 novel cases and 2 undiagnosed cases, whereas gross deletions within or around PTCH1, which are validated by CMA, were found in 3 undiagnosed cases. However, no mutations were detected even by TES in 3 cases. Among 3 cases with gross deletions of PTCH1, deletions containing the entire PTCH1 and additional neighboring genes were detected in 2 cases, one of which exhibited atypical clinical features, such as severe mental retardation, likely associated with genes located within the 4.3Mb deleted region, especially. TES-based simultaneous evaluation of sequences and copy number status in all targeted coding exons by NGS is likely to be more useful for the molecular diagnosis of NBCCS than conventional methods. CMA is recommended as a subsequent analysis for validation and detailed mapping of deleted regions, which may explain the atypical clinical features of NBCCS cases. Copyright © 2017 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.

Study on multiple-hops performance of MOOC sequences-based optical labels for OPS networks

NASA Astrophysics Data System (ADS)

Zhang, Chongfu; Qiu, Kun; Ma, Chunli

2009-11-01

In this paper, we utilize a new study method that is under independent case of multiple optical orthogonal codes to derive the probability function of MOOCS-OPS networks, discuss the performance characteristics for a variety of parameters, and compare some characteristics of the system employed by single optical orthogonal code or multiple optical orthogonal codes sequences-based optical labels. The performance of the system is also calculated, and our results verify that the method is effective. Additionally it is found that performance of MOOCS-OPS networks would, negatively, be worsened, compared with single optical orthogonal code-based optical label for optical packet switching (SOOC-OPS); however, MOOCS-OPS networks can greatly enlarge the scalability of optical packet switching networks.

IDACstar: A MCNP Application to Perform Realistic Dose Estimations from Internal or External Contamination of Radiopharmaceuticals.

PubMed

Ören, Ünal; Hiller, Mauritius; Andersson, M

2017-04-28

A Monte Carlo-based stand-alone program, IDACstar (Internal Dose Assessment by Computer), was developed, dedicated to perform radiation dose calculations using complex voxel simulations. To test the program, two irradiation situations were simulated, one hypothetical contamination case with 600 MBq of 99mTc and one extravasation case involving 370 MBq of 18F-FDG. The effective dose was estimated to be 0.042 mSv for the contamination case and 4.5 mSv for the extravasation case. IDACstar has demonstrated that dosimetry results from contamination or extravasation cases can be acquired with great ease. An effective tool for radiation protection applications is provided with IDACstar allowing physicists at nuclear medicine departments to easily quantify the radiation risk of stochastic effects when a radiation accident has occurred. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The need for the use of XACML access control policy in a distributed EHR and some performance considerations.

PubMed

Sucurovic, Snezana; Milutinovic, Veljko

2008-01-01

The Internet based distributed large scale information systems implements attribute based access control (ABAC) rather than Role Based Access Control (RBAC). The reason is that the Internet is identity less and that ABAC scales better. EXtensible Access Control Markup Language is standardized language for writing access control policies, access control requests and access control responses in ABAC. XACML can provide decentralized administration and credentials distribution. In year 2002 version of CEN ENV 13 606 attributes have been attached to EHCR components and in such a system ABAC and XACML have been easy to implement. This paper presents writing XACML policies in the case when attributes are in hierarchical structure. It is presented two possible solutions to write XACML policy in that case and that the solution when set functions are used is more compact and provides 10% better performances.

Convolutional Neural Network-Based Finger-Vein Recognition Using NIR Image Sensors

PubMed Central

Hong, Hyung Gil; Lee, Min Beom; Park, Kang Ryoung

2017-01-01

Conventional finger-vein recognition systems perform recognition based on the finger-vein lines extracted from the input images or image enhancement, and texture feature extraction from the finger-vein images. In these cases, however, the inaccurate detection of finger-vein lines lowers the recognition accuracy. In the case of texture feature extraction, the developer must experimentally decide on a form of the optimal filter for extraction considering the characteristics of the image database. To address this problem, this research proposes a finger-vein recognition method that is robust to various database types and environmental changes based on the convolutional neural network (CNN). In the experiments using the two finger-vein databases constructed in this research and the SDUMLA-HMT finger-vein database, which is an open database, the method proposed in this research showed a better performance compared to the conventional methods. PMID:28587269

Convolutional Neural Network-Based Finger-Vein Recognition Using NIR Image Sensors.

PubMed

Hong, Hyung Gil; Lee, Min Beom; Park, Kang Ryoung

2017-06-06

Conventional finger-vein recognition systems perform recognition based on the finger-vein lines extracted from the input images or image enhancement, and texture feature extraction from the finger-vein images. In these cases, however, the inaccurate detection of finger-vein lines lowers the recognition accuracy. In the case of texture feature extraction, the developer must experimentally decide on a form of the optimal filter for extraction considering the characteristics of the image database. To address this problem, this research proposes a finger-vein recognition method that is robust to various database types and environmental changes based on the convolutional neural network (CNN). In the experiments using the two finger-vein databases constructed in this research and the SDUMLA-HMT finger-vein database, which is an open database, the method proposed in this research showed a better performance compared to the conventional methods.

Investigating the Effect of Damage Progression Model Choice on Prognostics Performance

NASA Technical Reports Server (NTRS)

Daigle, Matthew; Roychoudhury, Indranil; Narasimhan, Sriram; Saha, Sankalita; Saha, Bhaskar; Goebel, Kai

2011-01-01

The success of model-based approaches to systems health management depends largely on the quality of the underlying models. In model-based prognostics, it is especially the quality of the damage progression models, i.e., the models describing how damage evolves as the system operates, that determines the accuracy and precision of remaining useful life predictions. Several common forms of these models are generally assumed in the literature, but are often not supported by physical evidence or physics-based analysis. In this paper, using a centrifugal pump as a case study, we develop different damage progression models. In simulation, we investigate how model changes influence prognostics performance. Results demonstrate that, in some cases, simple damage progression models are sufficient. But, in general, the results show a clear need for damage progression models that are accurate over long time horizons under varied loading conditions.

Do Concomitant Cranium and Axis Injuries Predict Worse Outcome? A Trauma Database Quantitative Analysis

PubMed Central

Chittiboina, Prashant; Banerjee, Anirban Deep; Nanda, Anil

2011-01-01

We performed a trauma database analysis to identify the effect of concomitant cranial injuries on outcome in patients with fractures of the axis. We identified patients with axis fractures over a 14-year period. A binary outcome measure was used. Univariate and multiple logistic regression analysis were performed. There were 259 cases with axis fractures. Closed head injury was noted in 57% and skull base trauma in 14%. Death occurred in 17 cases (6%). Seventy-two percent had good outcome. Presence of abnormal computed tomography head findings, skull base fractures, and visceral injury was significantly associated with poor outcome. Skull base injury in association with fractures of the axis is a significant independent predictor of worse outcomes, irrespective of the severity of the head injury. We propose that presence of concomitant cranial and upper vertebral injuries require careful evaluation in view of the associated poor prognosis. PMID:22470268

Fan Performance From Duct Rake Instrumentation on a 1.294 Pressure Ratio, 725 ft/sec Tip Speed Turbofan Simulator Using Vaned Passage Casing Treatment

NASA Technical Reports Server (NTRS)

Fite, E. Brian

2006-01-01

A 1.294 pressure ratio, 725 ft/sec tip speed, variable pitch low noise fan was designed and tested in the NASA Glenn 9- by 15-foot Wind Tunnel. The design included a casing treatment that used recirculation to extend the fan stall line and provide an acceptable operating range. Overall aerodynamic experimental results are presented for this low tip speed, low noise fan without casing treatment as well as using several variants of the casing treatment that moved the air extraction and insertion axial locations. Measurements were made to assess effects on performance, operability, and noise. An unusual instability was discovered near the design operating line and is documented in the fan operating range. Measurements were made to compare stall margin improvements as well as measure the performance impact of the casing treatments. Experimental results in the presence of simulated inlet distortion, via screens, are presented for the baseline and recirculation casing treatment configurations. Estimates are made for the quantity of recirculation weight flow based on limited instrumentation in the recirculation system along with discussion of results and conclusions

Learning outcomes of "The Oncology Patient" study among nursing students: A comparison of teaching strategies.

PubMed

Roca, Judith; Reguant, Mercedes; Canet, Olga

2016-11-01

Teaching strategies are essential in order to facilitate meaningful learning and the development of high-level thinking skills in students. To compare three teaching methodologies (problem-based learning, case-based teaching and traditional methods) in terms of the learning outcomes achieved by nursing students. This quasi-experimental research was carried out in the Nursing Degree programme in a group of 74 students who explored the subject of The Oncology Patient through the aforementioned strategies. A performance test was applied based on Bloom's Revised Taxonomy. A significant correlation was found between the intragroup theoretical and theoretical-practical dimensions. Likewise, intergroup differences were related to each teaching methodology. Hence, significant differences were estimated between the traditional methodology (x-=9.13), case-based teaching (x-=12.96) and problem-based learning (x-=14.84). Problem-based learning was shown to be the most successful learning method, followed by case-based teaching and the traditional methodology. Copyright © 2016 Elsevier Ltd. All rights reserved.

Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity.

PubMed

Eberbach, Helge; Mehl, Julian; Feucht, Matthias J; Bode, Gerrit; Südkamp, Norbert P; Niemeyer, Philipp

2017-03-01

Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. The purposes of this study were (1) to analyze the coronal geometry of patients with valgus malalignment and identify the location of the underlying deformity and (2) to investigate the proportion of cases that require realignment osteotomy at the tibia, the femur, or both locations to avoid an oblique joint line. Cross-sectional study; Level of evidence, 3. The analysis included 420 standing full-leg radiographs of patients with valgus malalignment (mechanical femorotibial angle [mFTA], ≥4°). A systematic analysis of the coronal leg geometry was performed including the mFTA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). The localization of the deformity was determined according to the malalignment test described by Paley, and patients were assigned to 1 of 4 groups: femoral-based valgus deformity, tibial-based valgus deformity, femoral- and tibial-based valgus deformity, or intra-articular/ligamentary-based valgus deformity. Subsequently, the ideal osteotomy site was identified with the goal of a postoperative change of the joint line of two different maximum values, ±2° and ±4°, from its physiological varus position of 3°. Measurements of the coronal alignment revealed a mean (±SD) mFTA of 7.4° ± 4.3° (range, 4°-28.2°). The mean mLDFA and mean mMPTA were 84.8° ± 2.4° and 90.9° ± 2.6°, respectively. The mean JLCA was 1.2° ± 3.1°. The majority (41.0%) of valgus deformities were tibial based, 23.6% were femoral based, 26.9% were femoral and tibial based, and 8.6% were intra-articular/ligamentary based. To achieve a straight-leg axis and an anatomic postoperative joint line with a tolerance of ±4°, the ideal site of a corrective osteotomy was tibial in 55.2% of cases and femoral in 19.5% of cases. A double-level osteotomy would be necessary in 25.2% of cases. With a tolerance of ±2°, the ideal osteotomy site was the proximal tibia in 41.0% of cases and the distal femur in 13.6% of cases; a double-level osteotomy would be necessary in 45.5% of cases. In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.

Quality assurance in surgical practice through auditing.

PubMed

Wong, W T

1980-05-01

An efficient auditing method is presented which involves objective criteria-based numerical screening of medical process and treatment outcome by paramedical staff and detailed analysis of deviated cases by surgeons. If properly performed it requires the study of no more than 50 cases in a diagnostic category to provide sufficient information about the quality of care. Encouraging points as well as problems are communicated to the surgeons to induce the maintenance or improvement of the standard of care. Graphic documentation of case performance is possible, allowing surgeons to compare results with their colleagues. The general performance level of several consecutive studies can be compared at a glance. In addition, logical education programs to improve the medical process can be designed on the basis of the problems identified. As all the cases with an unacceptable outcome are traceable to inadequate medical process, improvement in this area will decrease outcome defects. With the use of auditing and the follow-up technique described, the quality of care in surgery may be assured.

The value of case-based teaching vignettes in clinical microbiology rounds.

PubMed

Spicer, Jennifer O; Kraft, Colleen S; Burd, Eileen M; Armstrong, Wendy S; Guarner, Jeannette

2014-03-01

To describe the implementation and evaluation of a case-based microbiology curriculum during daily microbiology rounds. Vignettes consist of short cases with images and questions that facilitate discussion among microbiologists, pathologists, infectious disease physicians, and trainees (residents and fellows). We performed a survey to assess the value of these vignettes to trainees. Motivation to come to rounds on time increased from 60% to 100%. Trainees attending rounds after implementation of the vignettes perceived the value of microbiology rounds to be significantly higher compared with those who attended rounds before implementation (P = .04). Pathology residents found that vignettes were helpful for retaining knowledge (8.3 of 10 points). The vignettes have enhanced the value of microbiology rounds by serving as a formalized curriculum exposing trainees from multiple specialties to various microbiology topics. Emphasis on interdisciplinary interactions between clinical and laboratory personnel was highlighted with this case-based curriculum.

Earthquake Damage Assessment Using Objective Image Segmentation: A Case Study of 2010 Haiti Earthquake

NASA Technical Reports Server (NTRS)

Oommen, Thomas; Rebbapragada, Umaa; Cerminaro, Daniel

2012-01-01

In this study, we perform a case study on imagery from the Haiti earthquake that evaluates a novel object-based approach for characterizing earthquake induced surface effects of liquefaction against a traditional pixel based change technique. Our technique, which combines object-oriented change detection with discriminant/categorical functions, shows the power of distinguishing earthquake-induced surface effects from changes in buildings using the object properties concavity, convexity, orthogonality and rectangularity. Our results suggest that object-based analysis holds promise in automatically extracting earthquake-induced damages from high-resolution aerial/satellite imagery.

Personal Development Plans: Insights from a Case Based Approach

ERIC Educational Resources Information Center

Greenan, Peter

2016-01-01

Purpose: In light of contemporary shifts away from annual appraisals, this study aims to explore the implications of using a personal development plan (PDP) as a means of focussing on continuous feedback and development to improve individual performance and ultimately organisational performance. Design/methodology/approach: Data were collected…

Achieving High Performance with FPGA-Based Computing

PubMed Central

Herbordt, Martin C.; VanCourt, Tom; Gu, Yongfeng; Sukhwani, Bharat; Conti, Al; Model, Josh; DiSabello, Doug

2011-01-01

Numerous application areas, including bioinformatics and computational biology, demand increasing amounts of processing capability. In many cases, the computation cores and data types are suited to field-programmable gate arrays. The challenge is identifying the design techniques that can extract high performance potential from the FPGA fabric. PMID:21603088

Myeloid leukaemia in systemic lupus erythematosus--a nested case-control study based on Swedish registers.

PubMed

Löfström, Björn; Backlin, Carin; Sundström, Christer; Hellström-Lindberg, Eva; Ekbom, Anders; Lundberg, Ingrid E

2009-10-01

To assess the risk factors for leukaemic transformation and myeloid leukaemia in patients with SLE. A national SLE cohort identified through SLE discharge diagnoses in the Swedish hospital discharge register during 1964 to 1995 (n = 6438) was linked to the national cancer register. A nested case-control study in SLE patients who developed acute or chronic myeloid leukaemia was performed with SLE patients without malignancy as controls. Medical records from cases and controls were reviewed and bone marrow specimens were re-evaluated. A Medline search of previously published cases of SLE and myeloid leukaemia was performed. After confirmation of SLE diagnosis according to the ACR criteria, eight patients with SLE and myeloid leukaemia and 18 SLE controls were included in the study. Preceding leucopenia was significantly associated with leukaemia development, whereas other SLE manifestations were not. Two cases had a preceding bone marrow confirming myelodysplastic syndrome (MDS). Only two cases were significantly treated with cyclophosphamide or AZA. A Medline search resulted in only 15 previously published cases of coincident SLE and myeloid leukaemia. Preceding MDS was reported in five of these, whereas only eight had been treated with cytotoxic drugs. Low-dose chemotherapy was not a major cause of myeloid malignancy in our population-based cohort of SLE patients nor in the reported cases from literature. Leucopenia was a risk factor for myeloid leukaemia development and an MDS was frequently seen. Therefore bone marrow investigation should be considered in SLE patients with long-standing leucopenia and anaemia.

Endoscopic Approach to Remove Intra-extracranial Tumors in Various Skull Base Regions: 10-year Experience of a Single Center

PubMed Central

Zhang, Qiu-Hang; Wang, Zhen-Lin; Guo, Hong-Chuan; Kong, Feng; Yan, Bo; Li, Ming-Chu; Chen, Ge; Liang, Jian-Tao; Bao, Yu-Hai; Ling, Feng

2017-01-01

Background: Some problems have been found in the usually adopted combined approach for the removal of intra-extracranial tumors in skull base. Herein, we described a pure endoscopic transnasal or transoral approach (ETA) for the removal of intra-extracranial tumors in various skull base regions. Methods: Retrospectively, clinical data, major surgical complications, pre- and postoperative images, and follow-up information of a series of 85 patients with intra-extracranial tumors in various skull base regions who were treated by surgery via ETA in our skull base center during the past 10 years were reviewed and analyzed. Results: Gross total tumor removal was achieved in 80/85 cases (94.1%) in this study. All 37 cases with tumors in anterior skull base and all 14 cases with tumors in jugular foramen received total tumor removal. Thirteen and three cases with tumors in clivus received total and subtotal tumor removal, respectively. Total and subtotal tumor removal was performed for 16 cases and 2 cases in lateral skull base, respectively. The complications in this study included: cerebrospinal fluid leakage (n = 3), meningitis (n = 3), and new cranial nerve deficits (n = 3; recovered in 3 months after surgery). In the follow-up period of 40–151 months (median: 77 months), seven patients (8.8%) out of the 80 cases of total tumor removal experienced recurrence. Conclusions: Complete resection of intra-extracranial growing tumors in various skull base regions can be achieved via the pure ETA in one stage in selected cases. Surgical procedure for radical removal of tumors is feasible and safe. PMID:29237926

Chemical and biological sensors based on defect-engineered graphene mesh field-effect transistors.

PubMed

Cho, Seunghee H; Kwon, Sun Sang; Yi, Jaeseok; Park, Won Il

2016-01-01

Graphene has been intensively studied for applications to high-performance sensors, but the sensing characteristics of graphene devices have varied from case to case, and the sensing mechanism has not been satisfactorily determined thus far. In this review, we describe recent progress in engineering of the defects in graphene grown by a silica-assisted chemical vapor deposition technique and elucidate the effect of the defects upon the electrical response of graphene sensors. This review provides guidelines for engineering and/or passivating defects to improve sensor performance and reliability.

A splay tree-based approach for efficient resource location in P2P networks.

PubMed

Zhou, Wei; Tan, Zilong; Yao, Shaowen; Wang, Shipu

2014-01-01

Resource location in structured P2P system has a critical influence on the system performance. Existing analytical studies of Chord protocol have shown some potential improvements in performance. In this paper a splay tree-based new Chord structure called SChord is proposed to improve the efficiency of locating resources. We consider a novel implementation of the Chord finger table (routing table) based on the splay tree. This approach extends the Chord finger table with additional routing entries. Adaptive routing algorithm is proposed for implementation, and it can be shown that hop count is significantly minimized without introducing any other protocol overheads. We analyze the hop count of the adaptive routing algorithm, as compared to Chord variants, and demonstrate sharp upper and lower bounds for both worst-case and average case settings. In addition, we theoretically analyze the hop reducing in SChord and derive the fact that SChord can significantly reduce the routing hops as compared to Chord. Several simulations are presented to evaluate the performance of the algorithm and support our analytical findings. The simulation results show the efficiency of SChord.

SU-E-J-102: Performance Variations Among Clinically Available Deformable Image Registration Tools in Adaptive Radiotherapy: How Should We Evaluate and Interpret the Result?

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

Nie, K; Pouliot, J; Smith, E

Purpose: To evaluate the performance variations in commercial deformable image registration (DIR) tools for adaptive radiation therapy. Methods: Representative plans from three different anatomical sites, prostate, head-and-neck (HN) and cranial spinal irradiation (CSI) with L-spine boost, were included. Computerized deformed CT images were first generated using virtual DIR QA software (ImSimQA) for each case. The corresponding transformations served as the “reference”. Three commercial software packages MIMVista v5.5 and MIMMaestro v6.0, VelocityAI v2.6.2, and OnQ rts v2.1.15 were tested. The warped contours and doses were compared with the “reference” and among each other. Results: The performance in transferring contours was comparablemore » among all three tools with an average DICE coefficient of 0.81 for all the organs. However, the performance of dose warping accuracy appeared to rely on the evaluation end points. Volume based DVH comparisons were not sensitive enough to illustrate all the detailed variations while isodose assessment on a slice-by-slice basis could be tedious. Point-based evaluation was over-sensitive by having up to 30% hot/cold-spot differences. If adapting the 3mm/3% gamma analysis into the evaluation of dose warping, all three algorithms presented a reasonable level of equivalency. One algorithm had over 10% of the voxels not meeting this criterion for the HN case while another showed disagreement for the CSI case. Conclusion: Overall, our results demonstrated that evaluation based only on the performance of contour transformation could not guarantee the accuracy in dose warping. However, the performance of dose warping accuracy relied on the evaluation methodologies. Nevertheless, as more DIR tools are available for clinical use, the performance could vary at certain degrees. A standard quality assurance criterion with clinical meaning should be established for DIR QA, similar to the gamma index concept, in the near future.« less

Development of the Spacecraft Materials Selector Expert System

NASA Technical Reports Server (NTRS)

Pippin, H. G.

2000-01-01

A specific knowledge base to evaluate the on-orbit performance of selected materials on spacecraft is being developed under contract to the NASA SEE program. An artificial intelligence software package, the Boeing Expert System Tool (BEST), contains an inference engine used to operate knowledge bases constructed to selectively recall and distribute information about materials performance in space applications. This same system is used to make estimates of the environmental exposures expected for a given space flight. The performance capabilities of the Spacecraft Materials Selector (SMS) knowledge base are described in this paper. A case history for a planned flight experiment on ISS is shown as an example of the use of the SMS, and capabilities and limitations of the knowledge base are discussed.

Current practices of laparoscopic inguinal hernia repair: a population-based analysis.

PubMed

Trevisonno, M; Kaneva, P; Watanabe, Y; Fried, G M; Feldman, L S; Andalib, A; Vassiliou, M C

2015-10-01

The selection of a laparoscopic approach for inguinal hernias varies among surgeons. It is unclear what is being done in actual practice. The purpose of this study was to report practice patterns for treatment of inguinal hernias among Quebec surgeons, and to identify factors that may be associated with the choice of operative approach. We studied a population-based cohort of patients who underwent an inguinal hernia repair between 2007 and 2011 in Quebec, Canada. A generalized linear model was used to identify predictors associated with the selection of a laparoscopic approach. 49,657 inguinal hernias were repaired by 478 surgeons. Laparoscopic inguinal hernia repair (LIHR) was used in 8 % of all cases. LIHR was used to repair 28 % of bilateral hernias, 10 % of recurrent hernias, 6 % of unilateral hernias, and 4 % of incarcerated hernias. 268 (56 %) surgeons did not perform any laparoscopic repairs, and 11 (2 %) surgeons performed more than 100 repairs. These 11 surgeons performed 61 % of all laparoscopic cases. Patient factors significantly associated with having LIHR included younger age, fewer comorbidities, bilateral hernias, and recurrent hernias. An open approach is favored for all clinical scenarios, even for situations where published guidelines recommend a laparoscopic approach. Surgeons remain divided on the best technique for inguinal hernia repair: while more than half never perform LIHR, the small proportion who perform many use the technique for a large proportion of their cases. There appears to be a gap between the best practices put forth in guidelines and what surgeons are doing in actual practice. Identification of barriers to the broader uptake of LIHR may help inform the design of educational programs to train those who have the desire to offer this technique for certain cases, and have the volume to overcome the learning curve.

Variation in Aptitude of Trainees in Endoscopic Ultrasonography, Based on Cumulative Sum Analysis

PubMed Central

Wani, Sachin; Hall, Matthew; Keswani, Rajesh N.; Aslanian, Harry R.; Casey, Brenna; Burbridge, Rebecca; Chak, Amitabh; Chen, Ann M.; Cote, Gregory; Edmundowicz, Steven A.; Faulx, Ashley L.; Hollander, Thomas G.; Lee, Linda S.; Mullady, Daniel; Murad, Faris; Muthusamy, Raman; Pfau, Patrick R.; Scheiman, James M.; Tokar, Jeffrey; Wagh, Mihir S.; Watson, Rabindra; Early, Dayna

2017-01-01

BACKGROUND & AIMS Studies have reported substantial variation in the competency of advanced endoscopy trainees, indicating a need for more supervised training in endoscopic ultrasound (EUS). We used a standardized, validated, data collection tool to evaluate learning curves and measure competency in EUS among trainees at multiple centers. METHODS In a prospective study performed at 15 centers, 17 trainees with no prior EUS experience were evaluated by experienced attending endosonographers at the 25th and then every 10th upper EUS examination, over a 12-month training period. A standardized data collection form was used (using a 5-point scoring system) to grade the EUS examination. Cumulative sum analysis was applied to produce a learning curve for each trainee; it tracked the overall performance based on median scores at different stations and also at each station. Competency was defined by a median score of 1, with acceptable and unacceptable failure rates of 10% and 20%, respectively. RESULTS Twelve trainees were included in the final analysis. Each of the trainees performed 265 to 540 EUS examinations (total, 4257 examinations). There was a large amount of variation in their learning curves: 2 trainees crossed the threshold for acceptable performance (at cases 225 and 245), 2 trainees had a trend toward acceptable performance (after 289 and 355 cases) but required continued observation, and 8 trainees needed additional training and observation. Similar results were observed at individual stations. CONCLUSIONS A specific case load does not ensure competency in EUS; 225 cases should be considered the minimum caseload for training because we found that no trainee achieved competency before this point. Ongoing training should be provided for trainees until competency is confirmed using objective measures. PMID:25460557

Variation in Aptitude of Trainees in Endoscopic Ultrasonography, Based on Cumulative Sum Analysis.

PubMed

Wani, Sachin; Hall, Matthew; Keswani, Rajesh N; Aslanian, Harry R; Casey, Brenna; Burbridge, Rebecca; Chak, Amitabh; Chen, Ann M; Cote, Gregory; Edmundowicz, Steven A; Faulx, Ashley L; Hollander, Thomas G; Lee, Linda S; Mullady, Daniel; Murad, Faris; Muthusamy, V Raman; Pfau, Patrick R; Scheiman, James M; Tokar, Jeffrey; Wagh, Mihir S; Watson, Rabindra; Early, Dayna

2015-07-01

Studies have reported substantial variation in the competency of advanced endoscopy trainees, indicating a need for more supervised training in endoscopic ultrasound (EUS). We used a standardized, validated, data collection tool to evaluate learning curves and measure competency in EUS among trainees at multiple centers. In a prospective study performed at 15 centers, 17 trainees with no prior EUS experience were evaluated by experienced attending endosonographers at the 25th and then every 10th upper EUS examination, over a 12-month training period. A standardized data collection form was used (using a 5-point scoring system) to grade the EUS examination. Cumulative sum analysis was applied to produce a learning curve for each trainee; it tracked the overall performance based on median scores at different stations and also at each station. Competency was defined by a median score of 1, with acceptable and unacceptable failure rates of 10% and 20%, respectively. Twelve trainees were included in the final analysis. Each of the trainees performed 265 to 540 EUS examinations (total, 4257 examinations). There was a large amount of variation in their learning curves: 2 trainees crossed the threshold for acceptable performance (at cases 225 and 245), 2 trainees had a trend toward acceptable performance (after 289 and 355 cases) but required continued observation, and 8 trainees needed additional training and observation. Similar results were observed at individual stations. A specific case load does not ensure competency in EUS; 225 cases should be considered the minimum caseload for training because we found that no trainee achieved competency before this point. Ongoing training should be provided for trainees until competency is confirmed using objective measures. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Precipitation Estimate Using NEXRAD Ground-Based Radar Images: Validation, Calibration and Spatial Analysis

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

Zhang, Xuesong

2012-12-17

Precipitation is an important input variable for hydrologic and ecological modeling and analysis. Next Generation Radar (NEXRAD) can provide precipitation products that cover most of the continental United States with a high resolution display of approximately 4 × 4 km2. Two major issues concerning the applications of NEXRAD data are (1) lack of a NEXRAD geo-processing and geo-referencing program and (2) bias correction of NEXRAD estimates. In this chapter, a geographic information system (GIS) based software that can automatically support processing of NEXRAD data for hydrologic and ecological models is presented. Some geostatistical approaches to calibrating NEXRAD data using rainmore » gauge data are introduced, and two case studies on evaluating accuracy of NEXRAD Multisensor Precipitation Estimator (MPE) and calibrating MPE with rain-gauge data are presented. The first case study examines the performance of MPE in mountainous region versus south plains and cold season versus warm season, as well as the effect of sub-grid variability and temporal scale on NEXRAD performance. From the results of the first case study, performance of MPE was found to be influenced by complex terrain, frozen precipitation, sub-grid variability, and temporal scale. Overall, the assessment of MPE indicates the importance of removing bias of the MPE precipitation product before its application, especially in the complex mountainous region. The second case study examines the performance of three MPE calibration methods using rain gauge observations in the Little River Experimental Watershed in Georgia. The comparison results show that no one method can perform better than the others in terms of all evaluation coefficients and for all time steps. For practical estimation of precipitation distribution, implementation of multiple methods to predict spatial precipitation is suggested.« less

Twelve months of implementation of health care performance-based financing in Burkina Faso: A qualitative multiple case study.

PubMed

Ridde, Valéry; Yaogo, Maurice; Zongo, Sylvie; Somé, Paul-André; Turcotte-Tremblay, Anne-Marie

2018-01-01

To improve health services' quantity and quality, African countries are increasingly engaging in performance-based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post-launch in late 2014. The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents. Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community-based audits had yet been done. Distribution of bonuses varied from one centre to another. This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies. © 2017 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

Quality of diagnosis and monitoring of tuberculosis in Northern Ethiopia: medical records-based retrospective study.

PubMed

Mala, George; Spigt, Mark G; Gidding, Luc G; Blanco, Roman; Dinant, Geert-Jan

2015-10-01

To determine quality of diagnosis and monitoring of treatment response of patients with smear-negative pulmonary tuberculosis (TB) compared with smear-positive cases in Ethiopia. A retrospective analysis of medical records of newly diagnosed pulmonary TB cases that were registered for taking anti-TB medication and had completed treatment between 2010 and 2012. We evaluated the percentage of cases that were managed according to the International Standards of Tuberculosis Care (ISTC) and compared smear-negative with smear-positive cases. We analysed 1168 cases of which 742 (64%) were sputum smear-negative cases. Chest radiography examination at diagnosis and microbiological testing at the end of the intensive phase of treatment was performed in a smaller proportion than in smear-positive TB cases (70% vs. 79%, P value <0.001) and (70% vs. 95%, P value <0.001), respectively. Clinical actions recommended in the ISTC are of greatest importance in minimising pitfalls in care of smear-negative TB yet were performed less often in smear-negative than smear-positive TB cases. © The Author(s) 2015.

Tuberculosis in indigenous children in the Brazilian Amazon.

PubMed

Gava, Caroline; Malacarne, Jocieli; Rios, Diana Patrícia Giraldo; Sant'Anna, Clemax Couto; Camacho, Luiz Antônio Bastos; Basta, Paulo Cesar

2013-02-01

Assess the epidemiological aspects of tuberculosis in Brazilian indigenous children and actions to control it. An epidemiological study was performed with 356 children from 0 to 14 years of age in Rondônia State, Amazon, Brazil, during the period 1997-2006. Cases of TB reported to the Notifiable Diseases Surveillance System were divided into indigenous and non-indigenous categories and analyzed according to sex, age group, place of residence, clinical form, diagnostic tests and treatment outcome. A descriptive analysis of cases and hypothesis test (χ²) was carried out to verify if there were differences in the proportions of illness between the groups investigated. A total of 356 TB cases were identified (125 indigenous, 231 non-indigenous) of which 51.4% of the cases were in males. In the indigenous group, 60.8% of the cases presented in children aged 0-4 years old. The incidence mean was much higher among indigenous; in 2001, 1,047.9 cases/100,000 inhabitants were reported in children aged < 5 years. Pulmonary TB was reported in more than 80% of the cases, and in both groups over 70% of the cases were cured. Cultures and histopathological exams were performed on only 10% of the patients. There were 3 cases of TB/HIV co-infection in the non-indigenous group and none in the indigenous group. The case detection rate was classified as insufficient or fair in more than 80% of the indigenous population notifications, revealing that most of the diagnoses were performed based on chest x-ray. The approach used in this study proved useful in demonstrating inequalities in health between indigenous and non-indigenous populations and was superior to the conventional analyses performed by the surveillance services, drawing attention to the need to improve childhood TB diagnosis among the indigenous population.

Progress Toward Measles Elimination - Nepal, 2007-2014.

PubMed

Khanal, Sudhir; Sedai, Tika Ram; Choudary, Ganga Ram; Giri, Jagat Narain; Bohara, Rajendra; Pant, Rajendra; Gautam, Mukunda; Sharapov, Umid M; Goodson, James L; Alexander, James; Dabbagh, Alya; Strebel, Peter; Perry, Robert T; Bah, Sunil; Abeysinghe, Nihal; Thapa, Arun

2016-03-04

In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR) established a goal to eliminate measles and to control rubella and congenital rubella syndrome (CRS) in SEAR by 2020. Current recommended measles elimination strategies in the region include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets minimum recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. In 2013, Nepal, one of the 11 SEAR member states, adopted a goal for national measles elimination by 2019. This report updates a previous report and summarizes progress toward measles elimination in Nepal during 2007-2014. During 2007-2014, estimated coverage with the first MCV dose (MCV1) increased from 81% to 88%. Approximately 3.9 and 9.7 million children were vaccinated in SIAs conducted in 2008 and 2014, respectively. Reported suspected measles incidence declined by 13% during 2007-2014, from 54 to 47 cases per 1 million population. However, in 2014, 81% of districts did not meet the measles case-based surveillance performance indicator target of ≥2 discarded non-measles cases per 100,000 population per year. To achieve and maintain measles elimination, additional measures are needed to strengthen routine immunization services to increase coverage with MCV1 and a recently introduced second dose of MCV (MCV2) to ≥95% in all districts, and to enhance sensitivity of measles case-based surveillance by adopting a more sensitive case definition, expanding case-based surveillance sites nationwide, and ensuring timely transport of specimens to the accredited national laboratory.

Task-Based Interaction and Incidental Vocabulary Learning: A Case Study.

ERIC Educational Resources Information Center

Newton, Jonathan

1995-01-01

This case study examined the vocabulary gains made by an adult learner of English as a Second Language as a result of performing four communication tasks. It found that explicit negotiation of word meaning appeared less deterministic of posttest improvements than use of words in the process of completing the task. (13 references) (MDM)

The Role of Prosody in a Case of Foreign Accent Syndrome (FAS)

ERIC Educational Resources Information Center

Katz, William F.; Garst, Diane M.; Levitt, June

2008-01-01

Foreign accent syndrome (FAS) is a rare disorder characterized by the emergence of a perceived foreign accent following brain damage. The symptomotology, functional bases, and neural substrates of this disorder are still being elucidated. In this case study, acoustic analyses were performed on the speech of a 46-year old monolingual female who…

The Effects of Mobile Natural-Science Learning Based on the 5E Learning Cycle: A Case Study

ERIC Educational Resources Information Center

Liu, Tzu-Chien; Peng, Hsinyi; Wu, Wen-Hsuan; Lin, Ming-Sheng

2009-01-01

This study has three major purposes, including designing mobile natural-science learning activities that rest on the 5E Learning Cycle, examining the effects of these learning activities on students' performances of learning aquatic plants, and exploring students' perceptions toward these learning activities. A case-study method is utilized and…

Environmental Education Technologies in a Social Void: The Case of "Greendrive"

ERIC Educational Resources Information Center

Delicado, Ana

2012-01-01

This article is based on a case study that follows the trajectory of a technological device aimed at environmental education from the engineering laboratory in which it was designed into the contexts in which it is used. "Greendrive" is a driving simulator that accurately reproduces the performance of a vehicle in terms of fuel…

Comparison of two case-based learning conditions with real patients in teaching occupational medicine.

PubMed

Braeckman, Lutgart; 't Kint, Lode; Bekaert, Micheline; Cobbaut, Luc; Janssens, Heidi

2014-04-01

To investigate the impact of three different training formats in occupational medicine (OM) on perceptions and performance of undergraduate students. A comparative study which included all fourth-year medical students was conducted over a three-year period. The year group in 2010 (211 students) received paper case studies followed by one small group session. The format used in 2011 actively engaged 188 students in the learning process by adding collaborative work and group discussions to the written information. In 2012, the approach comprised no longer constructed text cases but 212 students encountered real patients. Students' perceptions were obtained by questionnaire. Their learning performance was assessed through review of written reports and score on oral presentations. Statistical differences in ratings were analyzed using Fisher's exact and Kruskal-Wallis tests. All three formats were found to equally achieve the stated learning objectives. The year groups with incorporation of active learning strategies and patient contacts had significant better test performance compared to those receiving only written case studies. Real patient students gave statistically significant higher rates for relevance, authenticity and appropriate difficulty level of the training than did students who discussed written case studies. Both approaches with augmented interaction in 2011 and 2012, improved performance and satisfaction among students. However, students valued the use of real patients higher than paper-form cases.

Histologic and immunohistochemical analyses of endometrial carcinomas: experiences from endometrial biopsies in 358 consultation cases.

PubMed

Wei, Jian-Jun; Paintal, Ajit; Keh, Pacita

2013-11-01

Uterine serous carcinoma is biologically more aggressive than the endometrioid carcinoma. Because uterine serous carcinoma has a high propensity for lymphovascular invasion and intraperitoneal and extra-abdominal spread, accurate diagnosis of this tumor type in endometrial biopsies/curettings is critical for appropriate clinical management. To share our experience in the evaluation of endometrial biopsy specimens in type I and type II endometrial adenocarcinoma. We retrospectively reviewed 358 biopsies containing endometrial carcinoma during a recent 3 year period of our consultation records. In cases in which our interpretation differed from the submitting diagnosis, a panel of immunostains was performed. The performance characteristics of each antibody in our panel was calculated in this group of challenging cases. Among the endometrial carcinomas we examined, a diagnosis of type I carcinoma accounted for 91% of cases (327 of 358) and type II carcinoma for 9% of cases (31 of 358); 41 cases (11.5%) were ambiguous or discordant (differing from submitted diagnoses and reviewed) based on histology alone. All 41 ambiguous and discordant cases were further evaluated with a battery of immunohistochemical markers. Of the 41 cases, 36 (88%) were ultimately classified (10 cases [24%] were endometrioid carcinoma; 18 cases [44%] were uterine serous carcinoma; 8 cases [20%] resulted in various other outcomes) and 5 cases (12%) remained indeterminate. Making the distinction between type I and II endometrial carcinoma remains a common problem in general practice. Although no one biomarker provides excellent statistical performance, a panel of immunohistochemical markers is often useful in difficult cases.

Newly developed liquid-based cytology. TACAS™: cytological appearance and HPV testing using liquid-based sample.

PubMed

Kubushiro, Kaneyuki; Taoka, Hideki; Sakurai, Nobuyuki; Yamamoto, Yasuhiro; Kurasaki, Akiko; Asakawa, Yasuyuki; Iwahara, Minoru; Takahashi, Kei

2011-09-01

Cell profiles determined by the thin-layer advanced cytology assay system (TACAS™), a liquid-based cytology technique newly developed in Japan, were analyzed in this study. Hybrid capture 2 (HC-2) was also performed using the liquid-based samples prepared by TACAS to ascertain its ability to detect human papillomavirus (HPV). Cell collection samples from uterine cervix were obtained from 359 patients and examined cytologically. A HC-2 assay for HPV was carried out in the cell specimens. All specimens were found to show background factors such as leukocytes. After excluding the 5 unsatisfactory cases from the total 354 cases, 82 cases (23.2%) were positive and 272 cases (76.8%) were negative for HPV. Cell specimens from 30 HPV-positive cases and 166 HPV-negative cases were subjected to 4 weeks of preservation at room temperature. Then, when subsequently re-assayed, 28 cases (93.3%) in the former group were found to be HPV positive and 164 cases (98.8%) in the latter group were found to be HPV negative. These results supported the excellent reproducibility of TACAS for HPV testing. A reasonable inference from the foregoing analysis is that TACAS may be distinguished from other liquid-based cytological approaches, such as ThinPrep and SurePath, in that it can retain the cell backgrounds. Furthermore, this study raises the possibility that cell specimens prepared using TACAS could be preserved for at least 4 weeks prior to carrying out a HC-2 assay for HPV.

Gastric and enteric anisakiasis successfully treated with Gastrografin therapy: A case report.

PubMed

Fujikawa, Hiroki; Kuwai, Toshio; Yamaguchi, Toshiki; Miura, Ryoichi; Sumida, Yuki; Takasago, Takeshi; Miyasako, Yuki; Nishimura, Tomoyuki; Iio, Sumio; Imagawa, Hiroki; Yamaguchi, Atsushi; Kouno, Hirotaka; Kohno, Hiroshi

2018-03-16

We report a case of a 59-year-old woman who was diagnosed with gastric and small intestinal anisakiasis, which was successfully treated with endoscopic extraction and Gastrografin therapy. She was admitted to our hospital with epigastric pain and vomiting one day after eating raw fish. She exhibited tenderness in the epigastrium without obvious rebound tenderness or guarding. Computed tomography (CT) demonstrated segmental edema of the intestinal wall with proximal dilatation and a small number of ascites. Because enteric anisakiasis was suspected based on the patient's history of recent raw fish consumption and abdominal CT, we performed gastroscopy and confirmed that nine Anisakis larvae were attached to the gastric mucosa. All of the Anisakis larvae were extracted via endoscopy, and the patient was diagnosed with gastric and enteric anisakiasis. Additionally, in the hospital, we performed ileography twice using Gastrografin, which led to shortened hospital stay. Based on the clinical results of this case, we suggest that Gastrografin therapy is a safe, convenient, and useful method to extract enteric Anisakis larvae.

Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains†

PubMed Central

Bonney, Kevin M.

2015-01-01

Following years of widespread use in business and medical education, the case study teaching method is becoming an increasingly common teaching strategy in science education. However, the current body of research provides limited evidence that the use of published case studies effectively promotes the fulfillment of specific learning objectives integral to many biology courses. This study tested the hypothesis that case studies are more effective than classroom discussions and textbook reading at promoting learning of key biological concepts, development of written and oral communication skills, and comprehension of the relevance of biological concepts to everyday life. This study also tested the hypothesis that case studies produced by the instructor of a course are more effective at promoting learning than those produced by unaffiliated instructors. Additionally, performance on quantitative learning assessments and student perceptions of learning gains were analyzed to determine whether reported perceptions of learning gains accurately reflect academic performance. The results reported here suggest that case studies, regardless of the source, are significantly more effective than other methods of content delivery at increasing performance on examination questions related to chemical bonds, osmosis and diffusion, mitosis and meiosis, and DNA structure and replication. This finding was positively correlated to increased student perceptions of learning gains associated with oral and written communication skills and the ability to recognize connections between biological concepts and other aspects of life. Based on these findings, case studies should be considered as a preferred method for teaching about a variety of concepts in science courses. PMID:25949753

Case study teaching method improves student performance and perceptions of learning gains.

PubMed

Bonney, Kevin M

2015-05-01

Following years of widespread use in business and medical education, the case study teaching method is becoming an increasingly common teaching strategy in science education. However, the current body of research provides limited evidence that the use of published case studies effectively promotes the fulfillment of specific learning objectives integral to many biology courses. This study tested the hypothesis that case studies are more effective than classroom discussions and textbook reading at promoting learning of key biological concepts, development of written and oral communication skills, and comprehension of the relevance of biological concepts to everyday life. This study also tested the hypothesis that case studies produced by the instructor of a course are more effective at promoting learning than those produced by unaffiliated instructors. Additionally, performance on quantitative learning assessments and student perceptions of learning gains were analyzed to determine whether reported perceptions of learning gains accurately reflect academic performance. The results reported here suggest that case studies, regardless of the source, are significantly more effective than other methods of content delivery at increasing performance on examination questions related to chemical bonds, osmosis and diffusion, mitosis and meiosis, and DNA structure and replication. This finding was positively correlated to increased student perceptions of learning gains associated with oral and written communication skills and the ability to recognize connections between biological concepts and other aspects of life. Based on these findings, case studies should be considered as a preferred method for teaching about a variety of concepts in science courses.

A Comparison of Trajectory Optimization Methods for the Impulsive Minimum Fuel Rendezvous Problem

NASA Technical Reports Server (NTRS)

Hughes, Steven P.; Mailhe, Laurie M.; Guzman, Jose J.

2003-01-01

In this paper we present, a comparison of trajectory optimization approaches for the minimum fuel rendezvous problem. Both indirect and direct methods are compared for a variety of test cases. The indirect approach is based on primer vector theory. The direct approaches are implemented numerically and include Sequential Quadratic Programming (SQP). Quasi- Newton and Nelder-Meade Simplex. Several cost function parameterizations are considered for the direct approach. We choose one direct approach that appears to be the most flexible. Both the direct and indirect methods are applied to a variety of test cases which are chosen to demonstrate the performance of each method in different flight regimes. The first test case is a simple circular-to-circular coplanar rendezvous. The second test case is an elliptic-to-elliptic line of apsides rotation. The final test case is an orbit phasing maneuver sequence in a highly elliptic orbit. For each test case we present a comparison of the performance of all methods we consider in this paper.

Impact of SurePath® liquid-based preparation in cytological analysis of peritoneal washing in practice of gynecologic oncology

PubMed Central

Tyagi, Ruchita; Gupta, Nalini; Bhagat, Priyanka; Gainder, Shalini; Rai, Bhavna; Dhaliwal, L K; Rajwanshi, Arvind

2017-01-01

Context: Peritoneal washing is performed for staging of gynecologic tumors to detect subclinical intraperitoneal metastases. Aim: The aim of the present study was to assess the impact of SurePath™ liquid-based cytology (LBC) in peritoneal washing in various gynecological malignancies. Settings and Design: An audit of peritoneal-fluid/washing (January 2012 to July 2013) was performed with corresponding gynecologic specimens. All peritoneal washings were processed using both conventional and LBC technique. Suspicious cases on cytology were reported along with gynecologic specimens. Results: There were a total of 393 peritoneal fluids. Eighty-three (21.1%) were positive for malignancy, and the corresponding histology was available in 352 (89.6%) cases. Sixty-nine positive samples had ovarian malignancies and 5 had uterine causes. There were 9 cases of peritoneal washings in which no histopathology was available. The most common cause of positive peritoneal cytology was ovarian serous carcinoma in 55/84 (65.5%) cases. Other causes included mucinous cystadenocarcinoma, dysgerminoma, squamous cell carcinoma in teratoma, yolk sac tumor, and granulosa cell tumor. Uterine causes included 2/45 (4.4%) cases of endometrioid adenocarcinoma, ¼ (25%) cases of clear cell carcinoma, ½ (50%) cases of carcinosarcoma, and ¼ (25%) cervix carcinoma. On review of positive cases (n = 83), 10 cases were identified, which had nil (n = 4) to low cellularity (<3 tumor clusters/smear; n = 6) on conventional smears, and were confirmed malignant on LBC. Conclusions: The most common ovarian malignancy causing positive peritoneal cytology is papillary serous carcinoma. Endometrioid adenocarcinoma rarely leads to positive peritoneal cytology. LBC technique leads to concentration of tumor cells causing reduction in false negative cases, especially in hemorrhagic and low-cellular cases. PMID:28469317

Computer versus Paper-Based Reading: A Case Study in English Language Teaching Context

ERIC Educational Resources Information Center

Solak, Ekrem

2014-01-01

This research aims to determine the preference of prospective English teachers in performing computer and paper-based reading tasks and to what extent computer and paper-based reading influence their reading speed, accuracy and comprehension. The research was conducted at a State run University, English Language Teaching Department in Turkey. The…

[Effects of performance-volume limit on the institutional financing of the Clinical Centre of the University of Pécs, Hungary].

PubMed

Endrei, Dóra; Kollár, Lajos; Bódis, József; Imhof, Gábor; Zemplényi, Antal; Vas, Gábor; Boncz, Imre

2010-08-01

The aim of our study is to demonstrate the effects of performance-volume limit (PVL) on the institutional financing of the Clinical Centre of the University of Pécs (CC UP). The data involved in the analysis are based on the reports towards the National Health Insurance Fund Administration (NHIFA), concerning the active inpatient care by specialist in the period between 2004 and 2008. We determined the real NHIFA reimbursement per weighted case number and the financial loss caused by the PVL. We analyzed the proportion of local health care obligation and urgency cases in comparison of various clinics. The reimbursement per weighted case number of CC UP has been less than the pre-announced NHIFA amounts after the installation of PVL. During the examined 5 years, i.e. 2004-2008, the loss in case of CC UP has been up to 3.256 million HUF due to the PVL. Concerning the whole of CC UP it means that 25.3 % of the treated cases and 24.5 % of the executed weighted case number has been out of local health care obligation. Studying the ratio of urgency cases inside the total volume of medical attendance, it is represented that 31.5 % of the cases and 36.1 % of the weighted case numbers came from the treatment of urgency cases. The introduction of performance-volume limit considerably reduced the health insurance financing of CC UP between 2004 and 2008.

Performance of Panfungal- and Specific-PCR-Based Procedures for Etiological Diagnosis of Invasive Fungal Diseases on Tissue Biopsy Specimens with Proven Infection: a 7-Year Retrospective Analysis from a Reference Laboratory

PubMed Central

Bernal-Martinez, L.; Castelli, M. V.; Rodriguez-Tudela, J. L.; Cuenca-Estrella, M.

2014-01-01

A retrospective analysis of real-time PCR (RT-PCR) results for 151 biopsy samples obtained from 132 patients with proven invasive fungal diseases was performed. PCR-based techniques proved to be fast and sensitive and enabled definitive diagnosis in all cases studied, with detection of a total of 28 fungal species. PMID:24574295

Generic project definitions for improvement of health care delivery: a case-based approach.

PubMed

Niemeijer, Gerard C; Does, Ronald J M M; de Mast, Jeroen; Trip, Albert; van den Heuvel, Jaap

2011-01-01

The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.

European specialist porphyria laboratories: diagnostic strategies, analytical quality, clinical interpretation, and reporting as assessed by an external quality assurance program.

PubMed

Aarsand, Aasne K; Villanger, Jørild H; Støle, Egil; Deybach, Jean-Charles; Marsden, Joanne; To-Figueras, Jordi; Badminton, Mike; Elder, George H; Sandberg, Sverre

2011-11-01

The porphyrias are a group of rare metabolic disorders whose diagnosis depends on identification of specific patterns of porphyrin precursor and porphyrin accumulation in urine, blood, and feces. Diagnostic tests for porphyria are performed by specialized laboratories in many countries. Data regarding the analytical and diagnostic performance of these laboratories are scarce. We distributed 5 sets of multispecimen samples from different porphyria patients accompanied by clinical case histories to 18-21 European specialist porphyria laboratories/centers as part of a European Porphyria Network organized external analytical and postanalytical quality assessment (EQA) program. The laboratories stated which analyses they would normally have performed given the case histories and reported results of all porphyria-related analyses available, interpretative comments, and diagnoses. Reported diagnostic strategies initially showed considerable diversity, but the number of laboratories applying adequate diagnostic strategies increased during the study period. We found an average interlaboratory CV of 50% (range 12%-152%) for analytes in absolute concentrations. Result normalization by forming ratios to the upper reference limits did not reduce this variation. Sixty-five percent of reported results were within biological variation-based analytical quality specifications. Clinical interpretation of the obtained analytical results was accurate, and most laboratories established the correct diagnosis in all distributions. Based on a case-based EQA scheme, variations were apparent in analytical and diagnostic performance between European specialist porphyria laboratories. Our findings reinforce the use of EQA schemes as an essential tool to assess both analytical and diagnostic processes and thereby to improve patient care in rare diseases.

Expanding the user base beyond HEP for the Ganga distributed analysis user interface

NASA Astrophysics Data System (ADS)

Currie, R.; Egede, U.; Richards, A.; Slater, M.; Williams, M.

2017-10-01

This document presents the result of recent developments within Ganga[1] project to support users from new communities outside of HEP. In particular I will examine the case of users from the Large Scale Survey Telescope (LSST) group looking to use resources provided by the UK based GridPP[2][3] DIRAC[4][5] instance. An example use case is work performed with users from the LSST Virtual Organisation (VO) to distribute the workflow used for galaxy shape identification analyses. This work highlighted some LSST specific challenges which could be well solved by common tools within the HEP community. As a result of this work the LSST community was able to take advantage of GridPP[2][3] resources to perform large computing tasks within the UK.

Towards the Engineering of Dependable P2P-Based Network Control — The Case of Timely Routing Control Messages

NASA Astrophysics Data System (ADS)

Tutschku, Kurt; Nakao, Akihiro

This paper introduces a methodology for engineering best-effort P2P algorithms into dependable P2P-based network control mechanism. The proposed method is built upon an iterative approach consisting of improving the original P2P algorithm by appropriate mechanisms and of thorough performance assessment with respect to dependability measures. The potential of the methodology is outlined by the example of timely routing control for vertical handover in B3G wireless networks. In detail, the well-known Pastry and CAN algorithms are enhanced to include locality. By showing how to combine algorithmic enhancements with performance indicators, this case study paves the way for future engineering of dependable network control mechanisms through P2P algorithms.

The role of the case manager in a disease management program.

PubMed

Huston, Carol J

2002-01-01

Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.

The role of the case manager in a disease management program.

PubMed

Huston, C J

2001-01-01

Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.

Proxy case mix measures for nursing homes.

PubMed

Cyr, A B

1983-01-01

Nursing home case mix measures are needed for the same purposes that spurred the intensive development of case mix measures for hospitals: management and planning decisions, organizational performance research, and reimbursement policy analysis. This paper develops and validates a pair of complementary measures that are simple to compute, are easy to interpret, and use generally available data. They are not, however, definitive. A secondary purpose of this paper is thus to galvanize the development of data bases that will give rise to superior case mix measures for nursing homes.

Current status of cardiovascular surgery in Japan, 2013 and 2014: A report based on the Japan Cardiovascular Surgery Database 3. Coronary artery bypass surgery.

PubMed

Saito, Aya; Hirahara, Norimichi; Motomura, Noboru; Miyata, Hiroaki; Takamoto, Shinichi

2018-01-01

Data on isolated coronary artery bypass grafting (CABG) performed in 2013 and 2014, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Isolated CABG was performed off-pump in 54.7% of cases, and graft material for the LAD was left internal thoracic artery in 74.3% and right internal thoracic artery in 15.6%. Operative mortality was 2.0% in elective cases, 8.2% in emergency cases, and 3.0% overall. In elective cases, operative mortality was 1.1% for off-pump CABG compared with 3.0% for on-pump CABG. Clinical results of our isolated CABG were reasonable and acceptable.

The effect of induced abortion on the incidence of Down's syndrome in Hawaii.

PubMed

Smith, R G; Gardner, R W; Steinhoff, P; Chung, C S; Palmore, J A

1980-01-01

There was a decrease in the recorded number of cases and in the incidence rate of Down's syndrome in Hawaii between 1963-1969 and 1971-1977. Independent of all other factors, induced abortion accounted for 43 percent of the decline in the number of cases, based on the assumption that a substantial number of clandestine abortions were being performed in Hawaii before the 1970 legalization of abortion. However, if we assume that very few illegal abortions were performed prior to 1970, there would have been an actual 3.5 percent increase in the number of cases of Down's syndrome in the absence of legal abortion. Declining pregnancy rates and decreasing age-specific incidence rates of Down's syndrome also contributed to the drop in the number of cases between 1963-1969 and 1971-1977.

Large-eddy simulation of turbulent flow with a surface-mounted two-dimensional obstacle

NASA Technical Reports Server (NTRS)

Yang, Kyung-Soo; Ferziger, Joel H.

1993-01-01

In this paper, we perform a large eddy simulation (LES) of turbulent flow in a channel containing a two-dimensional obstacle on one wall using a dynamic subgrid-scale model (DSGSM) at Re = 3210, based on bulk velocity above the obstacle and obstacle height; the wall layers are fully resolved. The low Re enables us to perform a DNS (Case 1) against which to validate the LES results. The LES with the DSGSM is designated Case 2. In addition, an LES with the conventional fixed model constant (Case 3) is conducted to allow identification of improvements due to the DSGSM. We also include LES at Re = 82,000 (Case 4) using conventional Smagorinsky subgrid-scale model and a wall-layer model. The results will be compared with the experiment of Dimaczek et al.

Effectiveness of cognitive orientation to (daily) occupational performance (CO-OP) on children with cerebral palsy: A mixed design.

PubMed

Ghorbani, Neda; Rassafiani, Mehdi; Izadi-Najafabadi, Sara; Yazdani, Farzaneh; Akbarfahimi, Nazila; Havaei, Naser; Gharebaghy, Soraya

2017-12-01

Cerebral palsy (CP) is the most common cause of physical disabilities during childhood. Therapeutic interventions mainly focus on impairment reduction to address motor-based difficulties. In contrast, Cognitive Orientation to daily Occupational Performance (CO-OP) is a cognitive approach, providing intervention at the level of activity and participation. This study aims to determine whether the CO-OP approach improves motor skills and achievement in motor-based occupational performance goals in children with CP. In this mixed design research (i.e., a multiple baseline single case experimental design and a one-group pretest-posttest design), five children with CP participated in 12 CO-OP intervention sessions. Repeated measures of motor skills for the multiple baseline single case experimental design were taken using the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP); pre- and post-measures of parent/child perception of performance and satisfaction were identified using the Canadian Occupational Performance Measure (COPM); level of achievement was identified using Goal Attainment Scaling (GAS). According to the BOTMP results, all children were able to engage in the CO-OP intervention to improve motor performance. Significant differences after treatment were found in both performance and performance satisfaction ratings using the COPM as rated by parents and children. The GAS results showed progress in achievement levels for all children; all goals were achieved or exceeded. CO-OP intervention can be helpful in improving motor skills and achieving self-identified, motor-based goals in children with CP. Copyright © 2017. Published by Elsevier Ltd.

Biomechanical behavior of a cemented ceramic knee replacement under worst case scenarios

NASA Astrophysics Data System (ADS)

Kluess, D.; Mittelmeier, W.; Bader, R.

2009-12-01

In connection with technological advances in the manufacturing of medical ceramics, a newly developed ceramic femoral component was introduced in total knee arthroplasty (TKA). The motivation to consider ceramics in TKA is based on the allergological and tribological benefits as proven in total hip arthroplasty. Owing to the brittleness and reduced fracture toughness of ceramic materials, the biomechanical performance has to be examined intensely. Apart from standard testing, we calculated the implant performance under different worst case scenarios including malposition, bone defects and stumbling. A finite-element-model was developed to calculate the implant performance in situ. The worst case conditions revealed principal stresses 12.6 times higher during stumbling than during normal gait. Nevertheless, none of the calculated principal stress amounts were above the critical strength of the ceramic material used. The analysis of malposition showed the necessity of exact alignment of the implant components.

Biomechanical behavior of a cemented ceramic knee replacement under worst case scenarios

NASA Astrophysics Data System (ADS)

Kluess, D.; Mittelmeier, W.; Bader, R.

2010-03-01

In connection with technological advances in the manufacturing of medical ceramics, a newly developed ceramic femoral component was introduced in total knee arthroplasty (TKA). The motivation to consider ceramics in TKA is based on the allergological and tribological benefits as proven in total hip arthroplasty. Owing to the brittleness and reduced fracture toughness of ceramic materials, the biomechanical performance has to be examined intensely. Apart from standard testing, we calculated the implant performance under different worst case scenarios including malposition, bone defects and stumbling. A finite-element-model was developed to calculate the implant performance in situ. The worst case conditions revealed principal stresses 12.6 times higher during stumbling than during normal gait. Nevertheless, none of the calculated principal stress amounts were above the critical strength of the ceramic material used. The analysis of malposition showed the necessity of exact alignment of the implant components.

Memory-Intensive Benchmarks: IRAM vs. Cache-Based Machines

NASA Technical Reports Server (NTRS)

Biswas, Rupak; Gaeke, Brian R.; Husbands, Parry; Li, Xiaoye S.; Oliker, Leonid; Yelick, Katherine A.; Biegel, Bryan (Technical Monitor)

2002-01-01

The increasing gap between processor and memory performance has lead to new architectural models for memory-intensive applications. In this paper, we explore the performance of a set of memory-intensive benchmarks and use them to compare the performance of conventional cache-based microprocessors to a mixed logic and DRAM processor called VIRAM. The benchmarks are based on problem statements, rather than specific implementations, and in each case we explore the fundamental hardware requirements of the problem, as well as alternative algorithms and data structures that can help expose fine-grained parallelism or simplify memory access patterns. The benchmarks are characterized by their memory access patterns, their basic control structures, and the ratio of computation to memory operation.

Morphology and Mobility of the Reconstructed Basilar Joint of the Pollicized Index Finger.

PubMed

Strugarek-Lecoanet, Clotilde; Chevrollier, Jérémie; Pauchard, Nicolas; Blum, Alain; Dap, François; Dautel, Gilles

2016-09-01

To evaluate outcome and function of the reconstructed basilar thumb joint after index finger pollicization in patients presenting congenital thumb deficiency. Plain radiographs and 4-dimensional dynamic volume computed tomography scan were used to evaluate the outcome of 23 pollicizations performed on 14 children between 1996 and 2009. The mean follow-up was 8 years. Patients performed continuous movements of thumb opposition during the imaging studies. Four-dimensional scan images made it possible to visualize mobility within the reconstructed joint. In 14 cases, union occurred in the metacarpal head/metacarpal base interface. In the 9 other cases, there was a nonunion at this interface. The reconstructed joint was mobile in 20 cases, including 3 in which there was also mobility at the site of the nonunion. In 3 cases in our series, mobility was present only at the site of the nonunion, between the base and the head of the second metacarpal. Remodeling and flattening out of the metacarpal head occurred in 16 of 23 cases. The transposed metacarpal head remained spherical in 7 cases. The reconstructed joint adapts, both morphologically and functionally, allowing movement on all 3 spatial planes. Existing mechanical constraints on the reconstructed joint may explain its remodeled appearance. Therapeutic IV. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Chlamydial partner notification in the British Association for Sexual Health and HIV (BASHH) 2011 UK national audit against the BASHH Medical Foundation for AIDS and Sexual Health Sexually Transmitted Infections Management Standards.

PubMed

McClean, H; Carne, C A; Sullivan, A K; Radcliffe, K W; Ahmed-Jushuf, I

2012-10-01

This paper reports on chlamydial partner notification (PN) performance in the 2011 BASHH national audit against the British Association for Sexual Health and HIV (BASHH) Medical Foundation for AIDS Sexual Health (MedFASH) Sexually Transmitted Infection Management Standards (STIMS). There was wide regional variation in level 3 clinic PN performance against the current standard of index case-reported chlamydial PN, with 43% (regional range 0-80%) of clinics outside London meeting the ≥0.6 contacts seen per index standard, and 85% of clinics (regional range 82-88%) in London meeting the ≥0.4 standard. For level 2 clinics, 39% (regional range 0-100%) of clinics outside London met the ≥0.6 standard, and 43% (regional range 40-50%) of clinics in London met the ≥0.4 standard. Performance for health-care worker (HCW)-verified contact attendance is also reported. New standards for each of these performance measures are proposed for all level 3 clinics: ≥0.6 contacts seen per index case based on index case report, and ≥0.4 contacts seen per index case based on HCW verification, both within four weeks of the first partner notification interview. The results are discussed with regard to the importance of adoption of standards by commissioners of services, relevance to national quality agendas, and the need for development of a national system of PN quality assurance measurement and reporting.

The importance of calorimetry for highly-boosted jet substructure

DOE PAGES

Coleman, Evan; Freytsis, Marat; Hinzmann, Andreas; ...

2018-01-09

Here, jet substructure techniques are playing an essential role in exploring the TeV scale at the Large Hadron Collider (LHC), since they facilitate the efficient reconstruction and identification of highly-boosted objects. Both for the LHC and for future colliders, there is a growing interest in using jet substructure methods based only on charged-particle information. The reason is that silicon-based tracking detectors offer excellent granularity and precise vertexing, which can improve the angular resolution on highly-collimated jets and mitigate the impact of pileup. In this paper, we assess how much jet substructure performance degrades by using track-only information, and we demonstratemore » physics contexts in which calorimetry is most beneficial. Specifically, we consider five different hadronic final states - W bosons, Z bosons, top quarks, light quarks, gluons - and test the pairwise discrimination power with a multi-variate combination of substructure observables. In the idealized case of perfect reconstruction, we quantify the loss in discrimination performance when using just charged particles compared to using all detected particles. We also consider the intermediate case of using charged particles plus photons, which provides valuable information about neutral pions. In the more realistic case of a segmented calorimeter, we assess the potential performance gains from improving calorimeter granularity and resolution, comparing a CMS-like detector to more ambitious future detector concepts. Broadly speaking, we find large performance gains from neutral-particle information and from improved calorimetry in cases where jet mass resolution drives the discrimination power, whereas the gains are more modest if an absolute mass scale calibration is not required.« less

The importance of calorimetry for highly-boosted jet substructure

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

Coleman, Evan; Freytsis, Marat; Hinzmann, Andreas

2017-09-25

Jet substructure techniques are playing an essential role in exploring the TeV scale at the Large Hadron Collider (LHC), since they facilitate the efficient reconstruction and identification of highly-boosted objects. Both for the LHC and for future colliders, there is a growing interest in using jet substructure methods based only on charged-particle information. The reason is that silicon-based tracking detectors offer excellent granularity and precise vertexing, which can improve the angular resolution on highly-collimated jets and mitigate the impact of pileup. In this paper, we assess how much jet substructure performance degrades by using track-only information, and we demonstrate physicsmore » contexts in which calorimetry is most beneficial. Specifically, we consider five different hadronic final states - W bosons, Z bosons, top quarks, light quarks, gluons - and test the pairwise discrimination power with a multi-variate combination of substructure observables. In the idealized case of perfect reconstruction, we quantify the loss in discrimination performance when using just charged particles compared to using all detected particles. We also consider the intermediate case of using charged particles plus photons, which provides valuable information about neutral pions. In the more realistic case of a segmented calorimeter, we assess the potential performance gains from improving calorimeter granularity and resolution, comparing a CMS-like detector to more ambitious future detector concepts. Broadly speaking, we find large performance gains from neutral-particle information and from improved calorimetry in cases where jet mass resolution drives the discrimination power, whereas the gains are more modest if an absolute mass scale calibration is not required.« less

The importance of calorimetry for highly-boosted jet substructure

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

Coleman, Evan; Freytsis, Marat; Hinzmann, Andreas

Here, jet substructure techniques are playing an essential role in exploring the TeV scale at the Large Hadron Collider (LHC), since they facilitate the efficient reconstruction and identification of highly-boosted objects. Both for the LHC and for future colliders, there is a growing interest in using jet substructure methods based only on charged-particle information. The reason is that silicon-based tracking detectors offer excellent granularity and precise vertexing, which can improve the angular resolution on highly-collimated jets and mitigate the impact of pileup. In this paper, we assess how much jet substructure performance degrades by using track-only information, and we demonstratemore » physics contexts in which calorimetry is most beneficial. Specifically, we consider five different hadronic final states - W bosons, Z bosons, top quarks, light quarks, gluons - and test the pairwise discrimination power with a multi-variate combination of substructure observables. In the idealized case of perfect reconstruction, we quantify the loss in discrimination performance when using just charged particles compared to using all detected particles. We also consider the intermediate case of using charged particles plus photons, which provides valuable information about neutral pions. In the more realistic case of a segmented calorimeter, we assess the potential performance gains from improving calorimeter granularity and resolution, comparing a CMS-like detector to more ambitious future detector concepts. Broadly speaking, we find large performance gains from neutral-particle information and from improved calorimetry in cases where jet mass resolution drives the discrimination power, whereas the gains are more modest if an absolute mass scale calibration is not required.« less

Comparative Study of IS6110 Restriction Fragment Length Polymorphism and Variable-Number Tandem-Repeat Typing of Mycobacterium tuberculosis Isolates in the Netherlands, Based on a 5-Year Nationwide Survey

PubMed Central

de Beer, Jessica L.; van Ingen, Jakko; de Vries, Gerard; Erkens, Connie; Sebek, Maruschka; Mulder, Arnout; Sloot, Rosa; van den Brandt, Anne-Marie; Enaimi, Mimount; Kremer, Kristin; Supply, Philip

2013-01-01

In order to switch from IS6110 and polymorphic GC-rich repetitive sequence (PGRS) restriction fragment length polymorphism (RFLP) to 24-locus variable-number tandem-repeat (VNTR) typing of Mycobacterium tuberculosis complex isolates in the national tuberculosis control program in The Netherlands, a detailed evaluation on discriminatory power and agreement with findings in a cluster investigation was performed on 3,975 tuberculosis cases during the period of 2004 to 2008. The level of discrimination of the two typing methods did not differ substantially: RFLP typing yielded 2,733 distinct patterns compared to 2,607 in VNTR typing. The global concordance, defined as isolates labeled unique or identically distributed in clusters by both methods, amounted to 78.5% (n = 3,123). Of the remaining 855 cases, 12% (n = 479) of the cases were clustered only by VNTR, 7.7% (n = 305) only by RFLP typing, and 1.8% (n = 71) revealed different cluster compositions in the two approaches. A cluster investigation was performed for 87% (n = 1,462) of the cases clustered by RFLP. For the 740 cases with confirmed or presumed epidemiological links, 92% were concordant with VNTR typing. In contrast, only 64% of the 722 cases without an epidemiological link but clustered by RFLP typing were also clustered by VNTR typing. We conclude that VNTR typing has a discriminatory power equal to IS6110 RFLP typing but is in better agreement with findings in a cluster investigation performed on an RFLP-clustering-based cluster investigation. Both aspects make VNTR typing a suitable method for tuberculosis surveillance systems. PMID:23363841

Occipital Condyle Syndrome: A Red Flag for Malignancy. Comprehensive Literature Review and New Case Report.

PubMed

Rodríguez-Pardo, Jorge; Lara-Lara, Manuel; Sanz-Cuesta, Borja E; Fuentes, Blanca; Díez-Tejedor, Exuperio

2017-05-01

To perform a literature review of the epidemiology, clinical presentation, diagnostic evaluation, and clinical course of occipital condyle syndrome, including a new case report. Occipital condyle syndrome (OCS) is a rare clinical syndrome, consisting of unilateral occipital headache accompanied by ipsilateral hypoglossal palsy. This headache typically radiates to the temporal region, and is triggered by contralateral head rotation. It is usually associated with skull base metastasis, often unrevealed in basic neuroimaging studies. OCS might be the first manifestation of malignancy, and its unfamiliarity can lead to a delay in the diagnosis. We performed a systematic literature review using PubMed and Embase for OCS, along with a new case report. A total of 35 cases (mean age 59 years, range 25-77), 24 (70%) men, presented typical unilateral headache followed by ipsilateral hypoglossal palsy from 0 to 150 days after headache presentation. In 16 patients (46%), initial neuroimaging studies were normal. OCS was due to skull base metastasis in 32 cases (91%). In 18 patients (51%), OCS was the first symptom of disease. OCS represents a warning sign and requires an exhaustive search for underlying neoplasm. An appropriate clinical evaluation can lead to an earlier diagnosis in patients with consistent headache. © 2016 American Headache Society.

A public health decision support system model using reasoning methods.

PubMed

Mera, Maritza; González, Carolina; Blobel, Bernd

2015-01-01

Public health programs must be based on the real health needs of the population. However, the design of efficient and effective public health programs is subject to availability of information that can allow users to identify, at the right time, the health issues that require special attention. The objective of this paper is to propose a case-based reasoning model for the support of decision-making in public health. The model integrates a decision-making process and case-based reasoning, reusing past experiences for promptly identifying new population health priorities. A prototype implementation of the model was performed, deploying the case-based reasoning framework jColibri. The proposed model contributes to solve problems found today when designing public health programs in Colombia. Current programs are developed under uncertain environments, as the underlying analyses are carried out on the basis of outdated and unreliable data.

Endoscopic Endonasal Approach in Skull Base Chondrosarcoma Associated with Maffucci Syndrome: Case Series and Literature Review.

PubMed

Beer-Furlan, André; Balsalobre, Leonardo; Vellutini, Eduardo A S; Stamm, Aldo C

2016-01-01

Maffucci syndrome is a nonhereditary disorder in which patients develop multiple enchondromas and cutaneous, visceral, or soft tissue hemangiomas. The potential malignant progression of enchondroma into a secondary chondrosarcoma is a well-known fact. Nevertheless, chondrosarcoma located at the skull base in patients with Maffuci syndrome is a very rare condition, with only 18 cases reported in the literature. We report 2 other cases successfully treated through an expanded endoscopic endonasal approach and discuss the condition based on the literature review. Skull base chondrosarcoma associated with Maffucci syndrome is a rare condition. The disease cannot be cured, therefore surgical treatment should be performed in symptomatic patients aiming for maximal tumor resection with function preservation. The endoscopic endonasal approach is a safe and reliable alternative for the management of these tumors. Copyright © 2016 Elsevier Inc. All rights reserved.

[Research and development of medical case database: a novel medical case information system integrating with biospecimen management].

PubMed

Pan, Shiyang; Mu, Yuan; Wang, Hong; Wang, Tong; Huang, Peijun; Ma, Jianfeng; Jiang, Li; Zhang, Jie; Gu, Bing; Yi, Lujiang

2010-04-01

To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.

Exploring a Framework for Consequential Validity for Performance-Based Assessments

ERIC Educational Resources Information Center

Kim, Su Jung

2017-01-01

This study explores a new comprehensive framework for understanding elements of validity, specifically for performance assessments that are administered within specific and dynamic contexts. The adoption of edTPA is a good empirical case for examining the concept of consequential validity because this assessment has been implemented at the state…

Performance Tasks and the Pedagogy of Broadway

ERIC Educational Resources Information Center

Chun, Marc

2012-01-01

If educators want students to practice and prepare for challenges they might eventually face, there are a number of useful strategies to connect academic learning to the "real world." One is to ask students to complete what are variously called "performance tasks," "case studies," "simulations," or "project- or problem-based learning units."…

Driving Performance Improvements by Integrating Competencies with Human Resource Practices

ERIC Educational Resources Information Center

Lee, Jin Gu; Park, Yongho; Yang, Gi Hun

2010-01-01

This study explores the issues in the development and application of a competency model and provides implications for more precise integration of competencies into human resource (HR) functions driving performance improvement. This research is based on a case study from a Korean consumer corporation. This study employed document reviews,…

Improving Learning Performance in Laboratory Instruction by Means of SMS Messaging

ERIC Educational Resources Information Center

Martinez-Torres, M. R.; Toral, S. L.; Barrero, F.; Gallardo, S.

2007-01-01

The study described in this paper outlines an attempt to explore those factors that contribute to learning performance improvement in laboratory instruction. As a case study, the educational methodology involved in a basic microcontroller course was analyzed. Traditional lab sessions based on the control of peripherals with low interactivity have…

Communication Performance of Children with down Syndrome: An ICF-CY Based Multiple Case Study

ERIC Educational Resources Information Center

Deckers, Stijn R. J. M.; Van Zaalen, Yvonne; Stoep, Judith; Van Balkom, Hans; Verhoeven, Ludo

2016-01-01

Enhancing communication performance skills may help children with Down Syndrome (DS) to expand their opportunities for participation in daily life. It is a clinical challenge for speech-language pathologists (SLP) to disentangle various mechanisms that contribute to the language and communication problems that children with DS encounter. Without…

Assessing Vocal Performances Using Analytical Assessment: A Case Study

ERIC Educational Resources Information Center

Gynnild, Vidar

2016-01-01

This study investigated ways to improve the appraisal of vocal performances within a national academy of music. Since a criterion-based assessment framework had already been adopted, the conceptual foundation of an assessment rubric was used as a guide in an action research project. The group of teachers involved wanted to explore thinking…

Real-time volcano monitoring using GNSS single-frequency receivers

NASA Astrophysics Data System (ADS)

Lee, Seung-Woo; Yun, Sung-Hyo; Kim, Do Hyeong; Lee, Dukkee; Lee, Young J.; Schutz, Bob E.

2015-12-01

We present a real-time volcano monitoring strategy that uses the Global Navigation Satellite System (GNSS), and we examine the performance of the strategy by processing simulated and real data and comparing the results with published solutions. The cost of implementing the strategy is reduced greatly by using single-frequency GNSS receivers except for one dual-frequency receiver that serves as a base receiver. Positions of the single-frequency receivers are computed relative to the base receiver on an epoch-by-epoch basis using the high-rate double-difference (DD) GNSS technique, while the position of the base station is fixed to the values obtained with a deferred-time precise point positioning technique and updated on a regular basis. Since the performance of the single-frequency high-rate DD technique depends on the conditions of the ionosphere over the monitoring area, the ionospheric total electron content is monitored using the dual-frequency data from the base receiver. The surface deformation obtained with the high-rate DD technique is eventually processed by a real-time inversion filter based on the Mogi point source model. The performance of the real-time volcano monitoring strategy is assessed through a set of tests and case studies, in which the data recorded during the 2007 eruption of Kilauea and the 2005 eruption of Augustine are processed in a simulated real-time mode. The case studies show that the displacement time series obtained with the strategy seem to agree with those obtained with deferred-time, dual-frequency approaches at the level of 10-15 mm. Differences in the estimated volume change of the Mogi source between the real-time inversion filter and previously reported works were in the range of 11 to 13% of the maximum volume changes of the cases examined.

A framework for sustainable nanomaterial selection and design based on performance, hazard, and economic considerations.

PubMed

Falinski, Mark M; Plata, Desiree L; Chopra, Shauhrat S; Theis, Thomas L; Gilbertson, Leanne M; Zimmerman, Julie B

2018-04-30

Engineered nanomaterials (ENMs) and ENM-enabled products have emerged as potentially high-performance replacements to conventional materials and chemicals. As such, there is an urgent need to incorporate environmental and human health objectives into ENM selection and design processes. Here, an adapted framework based on the Ashby material selection strategy is presented as an enhanced selection and design process, which includes functional performance as well as environmental and human health considerations. The utility of this framework is demonstrated through two case studies, the design and selection of antimicrobial substances and conductive polymers, including ENMs, ENM-enabled products and their alternatives. Further, these case studies consider both the comparative efficacy and impacts at two scales: (i) a broad scale, where chemical/material classes are readily compared for primary decision-making, and (ii) within a chemical/material class, where physicochemical properties are manipulated to tailor the desired performance and environmental impact profile. Development and implementation of this framework can inform decision-making for the implementation of ENMs to facilitate promising applications and prevent unintended consequences.

A sham case-control study of effectiveness of DTP-Hib-hepatitis B vaccine against rotavirus acute gastroenteritis in Kenya

PubMed Central

2014-01-01

Background In many GAVI-eligible countries, effectiveness of new vaccines will be evaluated by case-control methodology. To inform the design and assess selection bias of a future case-control study of rotavirus vaccine effectiveness (VE) in western Kenya, we performed a sham case-control study evaluating VE of pentavalent vaccine (DTP-Hib-HepB) against rotavirus acute gastroenteritis (AGE). Methods From ongoing rotavirus surveillance, we defined cases as children 12 weeks to 23 months old with EIA-confirmed rotavirus AGE. We enrolled one community-based and two hospital-based control groups. We collected vaccination status from cards at enrollment, or later in homes, and evaluated VE by logistic regression. Results We enrolled 91 cases (64 inpatient, 27 outpatient), 252 non-rotavirus AGE facility-based controls (unmatched), 203 non-AGE facility-based controls (age-matched) and 271 community controls (age-matched). Documented receipt of 3 pentavalent doses was 77% among cases and ranged from 81-86% among controls. One percent of cases and 0-2% of controls had no pentavalent doses. The adjusted odds ratio of three versus zero doses for being a case was 3.27 (95% CI 0.01-1010) for community controls and 0.69 (95% CI 0.06-7.75) for non-rotavirus hospital-based AGE controls, translating to VE of -227% and 31%, respectively, with wide confidence intervals. (No facility-based non-AGE controls were unvaccinated.) Similar results were found for ≥2 pentavalent doses and for severe rotavirus AGE. Conclusions The study showed that it is feasible to carry out a real case control in the study area, but this needs to be done as soon as the vaccine is introduced to capture the real impact. Sham case-control or pilot studies before vaccine introduction can be useful in designing case-control VE studies. PMID:24517198

A sham case-control study of effectiveness of DTP-Hib-hepatitis B vaccine against rotavirus acute gastroenteritis in Kenya.

PubMed

Khagayi, Sammy; Tate, Jacqueline E; Onkoba, Reuben; Parashar, Umesh; Odhiambo, Frank; Burton, Deron; Laserson, Kayla; Feikin, Daniel R

2014-02-11

In many GAVI-eligible countries, effectiveness of new vaccines will be evaluated by case-control methodology. To inform the design and assess selection bias of a future case-control study of rotavirus vaccine effectiveness (VE) in western Kenya, we performed a sham case-control study evaluating VE of pentavalent vaccine (DTP-Hib-HepB) against rotavirus acute gastroenteritis (AGE). From ongoing rotavirus surveillance, we defined cases as children 12 weeks to 23 months old with EIA-confirmed rotavirus AGE. We enrolled one community-based and two hospital-based control groups. We collected vaccination status from cards at enrollment, or later in homes, and evaluated VE by logistic regression. We enrolled 91 cases (64 inpatient, 27 outpatient), 252 non-rotavirus AGE facility-based controls (unmatched), 203 non-AGE facility-based controls (age-matched) and 271 community controls (age-matched). Documented receipt of 3 pentavalent doses was 77% among cases and ranged from 81-86% among controls. One percent of cases and 0-2% of controls had no pentavalent doses. The adjusted odds ratio of three versus zero doses for being a case was 3.27 (95% CI 0.01-1010) for community controls and 0.69 (95% CI 0.06-7.75) for non-rotavirus hospital-based AGE controls, translating to VE of -227% and 31%, respectively, with wide confidence intervals. (No facility-based non-AGE controls were unvaccinated.) Similar results were found for ≥2 pentavalent doses and for severe rotavirus AGE. The study showed that it is feasible to carry out a real case control in the study area, but this needs to be done as soon as the vaccine is introduced to capture the real impact. Sham case-control or pilot studies before vaccine introduction can be useful in designing case-control VE studies.

Comparisons of the Outcome Prediction Performance of Injury Severity Scoring Tools Using the Abbreviated Injury Scale 90 Update 98 (AIS 98) and 2005 Update 2008 (AIS 2008).

PubMed

Tohira, Hideo; Jacobs, Ian; Mountain, David; Gibson, Nick; Yeo, Allen

2011-01-01

The Abbreviated Injury Scale (AIS) was revised in 2005 and updated in 2008 (AIS 2008). We aimed to compare the outcome prediction performance of AIS-based injury severity scoring tools by using AIS 2008 and AIS 98. We used all major trauma patients hospitalized to the Royal Perth Hospital between 1994 and 2008. We selected five AIS-based injury severity scoring tools, including Injury Severity Score (ISS), New Injury Severity Score (NISS), modified Anatomic Profile (mAP), Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). We selected survival after injury as a target outcome. We used the area under the Receiver Operating Characteristic curve (AUROC) as a performance measure. First, we compared the five tools using all cases whose records included all variables for the TRISS (complete dataset) using a 10-fold cross-validation. Second, we compared the ISS and NISS for AIS 98 and AIS 2008 using all subjects (whole dataset). We identified 1,269 and 4,174 cases for a complete dataset and a whole dataset, respectively. With the 10-fold cross-validation, there were no clear differences in the AUROCs between the AIS 98- and AIS 2008-based scores. With the second comparison, the AIS 98-based ISS performed significantly worse than the AIS 2008-based ISS (p<0.0001), while there was no significant difference between the AIS 98- and AIS 2008-based NISSs. Researchers should be aware of these findings when they select an injury severity scoring tool for their studies.

Single-Step Syngas-to-Distillates (S2D) Process Based on Biomass-Derived Syngas – A Techno-Economic Analysis

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

Zhu, Yunhua; Jones, Susanne B.; Biddy, Mary J.

2012-08-01

This study reports the comparison of biomass gasification based syngas-to-distillate (S2D) systems using techno-economic analysis (TEA). Three cases, state of technology (SOT) case, goal case, and conventional case, were compared in terms of performance and cost. The SOT case and goal case represent technology being developed at Pacific Northwest National Laboratory for a process starting with syngas using a single-step dual-catalyst reactor for distillate generation (S2D process). The conventional case mirrors the two-step S2D process previously utilized and reported by Mobil using natural gas feedstock and consisting of separate syngas-to-methanol and methanol-to-gasoline (MTG) processes. Analysis of the three cases revealedmore » that the goal case could indeed reduce fuel production cost over the conventional case, but that the SOT was still more expensive than the conventional. The SOT case suffers from low one-pass yield and high selectivity to light hydrocarbons, both of which drive up production cost. Sensitivity analysis indicated that light hydrocarbon yield, single pass conversion efficiency, and reactor space velocity are the key factors driving the high cost for the SOT case.« less

Effects of electrical loads containing non-resistive components on electromagnetic vibration energy harvester performance

NASA Astrophysics Data System (ADS)

Zhang, Hui; Corr, Lawrence R.; Ma, Tianwei

2018-02-01

To further advance the existing knowledge base on rectified vibration energy harvester design, this study investigates the fundamental effects of electrical loads containing non-resistive components (e.g., rectifiers and capacitors) on electromagnetic energy harvester performance. Three types of electrical loads, namely (I) a resistor with a rectifier, (II) a resistor with a rectifier and a capacitor, and (III) a simple charging circuit consisting of a rectifier and a capacitor, were considered. A linear electromagnetic energy harvester was used as an illustrative example. Results have verified that device performance obtained from pure-resistive loads cannot be generalized to applications involving rectifier and/or capacitor loads. Such generalization caused not only an overestimation in the maximum power delivered to the load resistance for cases (I) and (II), but also an underestimation of the optimal load resistance and an overestimation of device natural frequency for case (II). Results obtained from case (II) also showed that it is possible to tune the mechanical natural frequency of device using an adjustable regulating capacitor. For case (III), it was found that a larger storing capacitor, with a low rectifier voltage drop, improves the performance of the electromagnetic harvester.

Competency-Based Human Resource Development Strategy

ERIC Educational Resources Information Center

Gangani, Noordeen T.; McLean, Gary N.; Braden, Richard A.

2004-01-01

This paper explores issues in developing and implementing a competency-based human resource development strategy. The paper summarizes a literature review on how competency models can improve HR performance. A case study is presented of American Medical Systems (AMS), a mid-sized health-care and medical device company, where the model is being…

A Competency-Based Human Resource Development Strategy

ERIC Educational Resources Information Center

Gangani, Noordeen; McLean, Gary N.; Braden, Richard A.

2006-01-01

This article explores some of the major issues in developing and implementing a competency-based human resource development strategy. The article summarizes a brief literature review on how competency models can be developed and implemented to improve employee performance. A case study is presented of American Medical Systems (AMS), a mid-sized…

Implementing Outcomes Based Accountability in Children's Services. Case Studies

ERIC Educational Resources Information Center

Bergeron, Caroline; Chamberlain, Tamsin; George, Nalia; Golden, Sarah; Mundy, Ellie; Southcott, Clare; Walker, Fiona

2010-01-01

Outcomes Based Accountability (OBA) is an approach that Children's Trusts and Children's Services can use to assist with planning services and assessing their performance. The OBA approach focuses on outcomes that are desired and monitoring and evidencing progress towards those desired outcomes. OBA makes a distinction between two types of…

Standards-Based Accountability in South Africa

ERIC Educational Resources Information Center

Taylor, Nick

2009-01-01

The implementation of standards-based accountability (SBA) interventions aimed at improving school performance often focuses on the testing component, at the expense of capacity building. This was the case in South Africa when a SBA programme was instituted by government in 2000, which was accompanied by substantial rises in senior certificate…

Workplace-Based Management of Retinitis Pigmentosa: A Case Report.

ERIC Educational Resources Information Center

Herse, Peter; Yapp, Michael

1999-01-01

Discusses the workplace-based accommodations that allowed a 45-year-old Southeast Asian woman with a moderate hearing deficit, who was diagnosed with retinitis pigmentosa, to continue to perform her duties as a checkout operator. Emphasizes the importance of conducting workplace evaluations before providers offer advice on vocational matters. (CR)

Testing CMAQ chemistry sensitivities in base case and emissions control runs at SEARCH and SOS99 surface sites in the southeastern US

NASA Astrophysics Data System (ADS)

Arnold, J. R.; Dennis, Robin L.

CMAQ was run to simulate urban and regional tropospheric conditions in the southeastern US over 14 days in July 1999 at 32, 8 and 2 km grid spacings. Runs were made with either of two older mechanisms, Carbon Bond IV (CB4) and the Regional Acid Deposition Model, version 2 (RADM2), and with the more recent and complete California Statewide Air Pollution Research Center, version 1999 mechanism (SAPRC99) in a sensitivity matrix with a full emissions base case and separate 50% control scenarios for emissions of nitrogen oxides (NO X) and volatile organic compounds (VOC). Results from the base case were compared to observations at the Southeastern Aerosol Research and Characterization Study (SEARCH) site at Jefferson Street in Atlanta, GA (JST) and the Southern Oxidant Study (SOS) Cornelia Fort Airpark (CFA) site downwind of Nashville, TN. In the base case, SAPRC99 predicted more ozone (O 3) than CB4 or RADM2 almost every hour and especially for afternoon maxima at both JST and CFA. Performance of the 8 km models at JST was better than that of the 32 km ones for all chemistries, reducing the 1 h peak bias by as much as 30 percentage points; at CFA only the RADM2 8 km model improved. The 2 km solutions did not show improved performance over the 8 km ones at either site, with normalized 1 h bias in the peak O 3 ranging from 21% at CFA to 43% at JST. In the emissions control cases, SAPRC99 was generally more responsive than CB4 and RADM2 to NO X and VOC controls, excepting hours at JST with predicted increased O 3 from NO X control. Differential sensitivity to chemical mechanism varied by more than ±10% for NO X control at JST and CFA, and in a similar range for VOC control at JST. VOC control at the more strongly NO X- limited urban CFA site produced a differential sensitivity response of <5%. However, even when differential sensitivities in control cases were small, neither their sign nor their magnitude could be reliably determined from model performance in the full emissions case, meaning that the degree of O 3 response to a change in chemical mechanism can differ substantially with the level of precursor emissions. Hence we conclude that properly understanding the effects of changes in a model's chemical mechanism always requires emissions control cases as part of model sensitivity analysis.

The impact of instructional design in a case-based, computer-assisted instruction module on learning liver pathology in a medical school pathology course

NASA Astrophysics Data System (ADS)

Latham, Patricia S.

The purpose of this quantitative experimental study was to test the impact of three learning interventions on student learning and satisfaction when the interventions were embedded in the instructional design of case-based, Computer-Assisted Instruction (CAI) modules for learning liver pathology in an in-class, self-study, laboratory exercise during a Year-2 medical school Pathology course. The hypothesis was that inclusion of the learning interventions would enhance student satisfaction in using the CAI and improve subsequent CAI-directed exam performance. Three learning interventions were studied, including the use of microscopic virtual slides instead of only static images, the use of interactive image annotations instead of only still annotations, and the use of guiding questions before presenting new information. Students were randomly assigned to with one of eight CAI learning modules configured to control for each of the three learning interventions. Effectiveness of the CAI for student learning was assessed by student performance on questions included in subsequent CAI-directed exams in a pretest and on posttests immediately after the lab exercise, at two weeks and two months. Student satisfaction and perceived learning was assessed by a student survey. Results showed that the learning interventions did not improve subsequent student exam performance, although satisfaction and perceived learning with use of the CAI learning modules was enhanced. Student class rank was evaluated to determine if the learning interventions might have a differential effect based on class rank, but there were no significant differences. Class rank at the time of the lab exercise was itself the strongest predictor of exam performance. The findings suggest that the addition of virtual slides, interactive annotations and guiding questions as learning interventions in self-study, case-based CAI for learning liver pathology in a medical class room setting are not likely to increase performance on subsequent MCQ-based exams, but student satisfaction with use of the CAI can be enhanced, which could provide to be an incentive for students to use similar CAI learning modules for future self-directed learning.

Paroxysmal paralytic attacks secondary to excessive cola consumption.

PubMed

Dubey, Divyanshu; Sawhney, Anshudha; Sharma, Abhishek; Dubey, Devashish

2014-09-01

We report a rare case of cola-induced hypokalemia presenting as recurrent attacks of lower extremity weakness and falls. Excessive consumption of cola-based drinks has been associated with dental enamel erosion, obesity, and diabetes. There are very few published cases depicting the correlation between cola drinks and hypokalemic manifestations. In our patient an extensive workup was performed, and common causes were ruled out before making the diagnosis of cola-induced hypokalemia. Improvement in the patient's symptoms and electrolyte levels after reducing the consumption of cola-based drinks further confirmed our diagnosis. This case also emphasizes the importance of obtaining a detailed history and consideration of broad differential diagnoses in identifying uncommon but reversible etiologies. © 2014 Marshfield Clinic.

Paroxysmal Paralytic Attacks Secondary to Excessive Cola Consumption

PubMed Central

Dubey, Divyanshu; Sawhney, Anshudha; Sharma, Abhishek; Dubey, Devashish

2014-01-01

We report a rare case of cola-induced hypokalemia presenting as recurrent attacks of lower extremity weakness and falls. Excessive consumption of cola-based drinks has been associated with dental enamel erosion, obesity, and diabetes. There are very few published cases depicting the correlation between cola drinks and hypokalemic manifestations. In our patient an extensive workup was performed, and common causes were ruled out before making the diagnosis of cola-induced hypokalemia. Improvement in the patient’s symptoms and electrolyte levels after reducing the consumption of cola-based drinks further confirmed our diagnosis. This case also emphasizes the importance of obtaining a detailed history and consideration of broad differential diagnoses in identifying uncommon but reversible etiologies. PMID:24573702

Quantitative comparison of randomization designs in sequential clinical trials based on treatment balance and allocation randomness.

PubMed

Zhao, Wenle; Weng, Yanqiu; Wu, Qi; Palesch, Yuko

2012-01-01

To evaluate the performance of randomization designs under various parameter settings and trial sample sizes, and identify optimal designs with respect to both treatment imbalance and allocation randomness, we evaluate 260 design scenarios from 14 randomization designs under 15 sample sizes range from 10 to 300, using three measures for imbalance and three measures for randomness. The maximum absolute imbalance and the correct guess (CG) probability are selected to assess the trade-off performance of each randomization design. As measured by the maximum absolute imbalance and the CG probability, we found that performances of the 14 randomization designs are located in a closed region with the upper boundary (worst case) given by Efron's biased coin design (BCD) and the lower boundary (best case) from the Soares and Wu's big stick design (BSD). Designs close to the lower boundary provide a smaller imbalance and a higher randomness than designs close to the upper boundary. Our research suggested that optimization of randomization design is possible based on quantified evaluation of imbalance and randomness. Based on the maximum imbalance and CG probability, the BSD, Chen's biased coin design with imbalance tolerance method, and Chen's Ehrenfest urn design perform better than popularly used permuted block design, EBCD, and Wei's urn design. Copyright © 2011 John Wiley & Sons, Ltd.

An Improved Rank Correlation Effect Size Statistic for Single-Case Designs: Baseline Corrected Tau.

PubMed

Tarlow, Kevin R

2017-07-01

Measuring treatment effects when an individual's pretreatment performance is improving poses a challenge for single-case experimental designs. It may be difficult to determine whether improvement is due to the treatment or due to the preexisting baseline trend. Tau- U is a popular single-case effect size statistic that purports to control for baseline trend. However, despite its strengths, Tau- U has substantial limitations: Its values are inflated and not bound between -1 and +1, it cannot be visually graphed, and its relatively weak method of trend control leads to unacceptable levels of Type I error wherein ineffective treatments appear effective. An improved effect size statistic based on rank correlation and robust regression, Baseline Corrected Tau, is proposed and field-tested with both published and simulated single-case time series. A web-based calculator for Baseline Corrected Tau is also introduced for use by single-case investigators.

Psychological Assessment through Performance-Based Techniques and Self-Reports: A Case Study of a Sexually Abused Girl at Preschool Age

ERIC Educational Resources Information Center

Khalily, Muhammad Tahir; Hallahan, Brian

2011-01-01

We investigated the implicit psychological and behavioral consequences of sexual abuse in an adolescent girl who suffered child sexual abuse at preschool age in this case report. We report the manifestations of this abuse on her personality and psychological functioning using a structured clinical interview and a comprehensive psychological…

What Cognitive Science May Learn from Instructional Design: A Case Study in Introductory Computer Programming.

ERIC Educational Resources Information Center

van Merrienboer, Jeroen J. G.

The contributions of instructional design to cognitive science are discussed. It is argued that both sciences have their own object of study, but share a common interest in human cognition and performance as part of instructional systems. From a case study based on experience in teaching introductory computer programming, it is concluded that both…

All Students Are Not Equal: A Case Study of Geometry Teachers' Instructional Strategies When Trained in Multiple-Intelligence-Based Practices in Secondary Classrooms

ERIC Educational Resources Information Center

Davis, Cassandre Y.

2017-01-01

Over 50% of secondary students failed the geometry end-of-course test in a Florida school district, indicating a need to improve academic performance. Secondary school students' learning characteristics and the effectiveness of teachers' instructional strategies are imperative to educational success. In this qualitative case study, geometry…

An Examination of Resource Allocation Strategies That Promote Student Achievement: Case Studies of Rural Elementary Schools in Hawaii

ERIC Educational Resources Information Center

Acopan-Tuasivi, C. K.

2012-01-01

This study presents case studies of rural elementary schools in Hawaii that examine resource allocation strategies that promote student achievement. The combined frame work of the Evidence Based Model (Odden & Picus, 2008) and the 10 Strategies for Doubling Student Performance (Odden, 2009) were utilized to compare actual school resources and…

An open source software for fast grid-based data-mining in spatial epidemiology (FGBASE).

PubMed

Baker, David M; Valleron, Alain-Jacques

2014-10-30

Examining whether disease cases are clustered in space is an important part of epidemiological research. Another important part of spatial epidemiology is testing whether patients suffering from a disease are more, or less, exposed to environmental factors of interest than adequately defined controls. Both approaches involve determining the number of cases and controls (or population at risk) in specific zones. For cluster searches, this often must be done for millions of different zones. Doing this by calculating distances can lead to very lengthy computations. In this work we discuss the computational advantages of geographical grid-based methods, and introduce an open source software (FGBASE) which we have created for this purpose. Geographical grids based on the Lambert Azimuthal Equal Area projection are well suited for spatial epidemiology because they preserve area: each cell of the grid has the same area. We describe how data is projected onto such a grid, as well as grid-based algorithms for spatial epidemiological data-mining. The software program (FGBASE), that we have developed, implements these grid-based methods. The grid based algorithms perform extremely fast. This is particularly the case for cluster searches. When applied to a cohort of French Type 1 Diabetes (T1D) patients, as an example, the grid based algorithms detected potential clusters in a few seconds on a modern laptop. This compares very favorably to an equivalent cluster search using distance calculations instead of a grid, which took over 4 hours on the same computer. In the case study we discovered 4 potential clusters of T1D cases near the cities of Le Havre, Dunkerque, Toulouse and Nantes. One example of environmental analysis with our software was to study whether a significant association could be found between distance to vineyards with heavy pesticide. None was found. In both examples, the software facilitates the rapid testing of hypotheses. Grid-based algorithms for mining spatial epidemiological data provide advantages in terms of computational complexity thus improving the speed of computations. We believe that these methods and this software tool (FGBASE) will lower the computational barriers to entry for those performing epidemiological research.

Shear-wave velocity-based probabilistic and deterministic assessment of seismic soil liquefaction potential

USGS Publications Warehouse

Kayen, R.; Moss, R.E.S.; Thompson, E.M.; Seed, R.B.; Cetin, K.O.; Der Kiureghian, A.; Tanaka, Y.; Tokimatsu, K.

2013-01-01

Shear-wave velocity (Vs) offers a means to determine the seismic resistance of soil to liquefaction by a fundamental soil property. This paper presents the results of an 11-year international project to gather new Vs site data and develop probabilistic correlations for seismic soil liquefaction occurrence. Toward that objective, shear-wave velocity test sites were identified, and measurements made for 301 new liquefaction field case histories in China, Japan, Taiwan, Greece, and the United States over a decade. The majority of these new case histories reoccupy those previously investigated by penetration testing. These new data are combined with previously published case histories to build a global catalog of 422 case histories of Vs liquefaction performance. Bayesian regression and structural reliability methods facilitate a probabilistic treatment of the Vs catalog for performance-based engineering applications. Where possible, uncertainties of the variables comprising both the seismic demand and the soil capacity were estimated and included in the analysis, resulting in greatly reduced overall model uncertainty relative to previous studies. The presented data set and probabilistic analysis also help resolve the ancillary issues of adjustment for soil fines content and magnitude scaling factors.

Modelling the Longevity of Dental Restorations by means of a CBR System

PubMed Central

Aliaga, Ignacio J.; Vera, Vicente; García, Alvaro E.

2015-01-01

The lifespan of dental restorations is limited. Longevity depends on the material used and the different characteristics of the dental piece. However, it is not always the case that the best and longest lasting material is used since patients may prefer different treatments according to how noticeable the material is. Over the last 100 years, the most commonly used material has been silver amalgam, which, while very durable, is somewhat aesthetically displeasing. Our study is based on the collection of data from the charts, notes, and radiographic information of restorative treatments performed by Dr. Vera in 1993, the analysis of the information by computer artificial intelligence to determine the most appropriate restoration, and the monitoring of the evolution of the dental restoration. The data will be treated confidentially according to the Organic Law 15/1999 on 13 December on the Protection of Personal Data. This paper also presents a clustering technique capable of identifying the most significant cases with which to instantiate the case-base. In order to classify the cases, a mixture of experts is used which incorporates a Bayesian network and a multilayer perceptron; the combination of both classifiers is performed with a neural network. PMID:25866792

Contracting and Procurement for Evidence-Based Interventions in Public-Sector Human Services: A Case Study.

PubMed

Willging, Cathleen E; Aarons, Gregory A; Trott, Elise M; Green, Amy E; Finn, Natalie; Ehrhart, Mark G; Hecht, Debra B

2016-09-01

Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this case study, we conducted qualitative interviews with key government and CBO stakeholders to examine implementation of the Best Value-Performance Information Procurement System to contract for EBIs in a child welfare system. Findings suggest that stakeholder relationships may be compromised when procurement disregards local knowledge, communication, collaboration, and other factors supporting EBIs and public health initiatives.

[Managerial performance in public health services: a case study in Mato Grosso do Sul, Brazil].

PubMed

Barbieri, Ana Rita; Hortale, Virginia Alonso

2005-01-01

This paper presents part of a doctoral dissertation that developed a theoretical model capable of identifying managerial performance in various administrative levels of a Municipal Health Secretariat. The methodology was a case study of the Municipal Health Secretariat in Campo Grande, capital of the State of Mato Grosso do Sul, Brazil. The theoretical model was based on recent debates emphasizing the need to modernize public administration, with an emphasis on efficacy and efficiency in the organizations as a whole. Some 31 interviews were conducted with the objective of identifying the managers' performance, through questions based on their daily practices in planning, organization, direction, and control. Managers from higher hierarchical levels obtained better results, while those in basic health units generally developed activities and complied with decisions passed down by imposition, with limited capacity to plan, organize, or control activities pertaining to their management sphere. These results stem partially from the charismatic leadership and centralizing administration of the current management in the municipal health system.

Feasibility and design study of a frictionless air mover for thermal management of electronics

NASA Astrophysics Data System (ADS)

Schacht, R.; Hausdorf, A.; Wunderle, B.

2014-07-01

A frictionless air mover concept is introduced in this paper. As opposed to a piezoelectric driven fan, the air mover is based on a flexible blade whose vibration is driven by means of a magnetic field. The blade is based on a polymer material. The paper presents the results of a feasibility analysis and an on-going comprehensive design study. The performance of the prototype amounted to 65% of a comparable piezoelectric fan. To enhance the performance, two different blade materials were investigated, as well as the influence of the coil shape and value. A further goal is to reduce the size and to investigate the influence of a casing. The design study resulted in a prototype of size of 50 × 14 × 35 mm2 including a casing. The performance could be doubled, to attain a volumetric flow rate of dot V ~14 l/min and a static pressure of ρstat = 3 Pa.

Intraventricular and skull base neuroendoscopy in 2012: a global survey of usage patterns and the role of intraoperative neuronavigation.

PubMed

Esposito, Felice; Di Rocco, Federico; Zada, Gabriel; Cinalli, Giuseppe; Schroeder, Henry W S; Mallucci, Conor; Cavallo, Luigi M; Decq, Philippe; Chiaramonte, Carmela; Cappabianca, Paolo

2013-12-01

During the past decade, endoscopic intraventricular and skull base operations have become widely used for a variety of evolving indications. A global survey of practicing endoscopic neurosurgeons was performed to characterize patterns of usage regarding endoscopy equipment, instrumentation, and the indications for using image-guided surgery systems (IGSs). An online survey consisting of 8 questions was completed by 235 neurosurgeons with endoscopic surgical experience. Responses were entered into a database and subsequently analyzed. The median number of operations performed per year by intraventricular and skull base endoscopic surgeons was 27 and 25, respectively. Data regarding endoscopic equipment brand, diameter, and length are presented. The most commonly reported indications for IGSs during intraventricular endoscopic surgery were tumor biopsy/resection, intraventricular cyst fenestration, septostomy/pellucidotomy, endoscopic third ventriculostomy, and aqueductal stent placement. Intraventricular surgeons reported using IGSs for all cases in 16.6% and never in 24.4%. Overall, endoscopic skull base surgeons reported using IGSs for all cases in 23.9% and never in 18.9%. The most commonly reported indications for IGSs during endoscopic skull base operations were complex sinus/skull base anatomy, extended approaches, and reoperation. Many variations and permutations for performing intraventricular and skull base endoscopic surgery exist worldwide. Much can be learned by studying the patterns and indications for using various types of equipment and operative adjuncts such as IGSs. Copyright © 2013 Elsevier Inc. All rights reserved.

Combining matched and unmatched control groups in case-control studies.

PubMed

le Cessie, Saskia; Nagelkerke, Nico; Rosendaal, Frits R; van Stralen, Karlijn J; Pomp, Elisabeth R; van Houwelingen, Hans C

2008-11-15

Multiple control groups in case-control studies are used to control for different sources of confounding. For example, cases can be contrasted with matched controls to adjust for multiple genetic or unknown lifestyle factors and simultaneously contrasted with an unmatched population-based control group. Inclusion of different control groups for a single exposure analysis yields several estimates of the odds ratio, all using only part of the data. Here the authors introduce an easy way to combine odds ratios from several case-control analyses with the same cases. The approach is based upon methods used for meta-analysis but takes into account the fact that the same cases are used and that the estimated odds ratios are therefore correlated. Two ways of estimating this correlation are discussed: sandwich methodology and the bootstrap. Confidence intervals for the pooled estimates and a test for checking whether the odds ratios in the separate case-control studies differ significantly are derived. The performance of the method is studied by simulation and by applying the methods to a large study on risk factors for thrombosis, the MEGA Study (1999-2004), wherein cases with first venous thrombosis were included with a matched control group of partners and an unmatched population-based control group.

Test-Enhanced Learning in Competence-Based Predoctoral Orthodontics: A Four-Year Study.

PubMed

Freda, Nicolas M; Lipp, Mitchell J

2016-03-01

Dental educators intend to promote integration of knowledge, skills, and values toward professional competence. Studies report that retrieval, in the form of testing, results in better learning with retention than traditional studying. The aim of this study was to evaluate test-enhanced experiences on demonstrations of competence in diagnosis and management of malocclusion and skeletal problems. The study participants were all third-year dental students (2011 N=88, 2012 N=74, 2013 N=91, 2014 N=85) at New York University College of Dentistry. The 2013 and 2014 groups received the test-enhanced method emphasizing formative assessments with written and dialogic delayed feedback, while the 2011 and 2012 groups received the traditional approach emphasizing lectures and classroom exercises. The students received six two-hour sessions, spaced one week apart. At the final session, a summative assessment consisting of the same four cases was administered. Students constructed a problem list, treatment objectives, and a treatment plan for each case, scored according to the same criteria. Grades were based on the number of cases without critical errors: A=0 critical errors on four cases, A-=0 critical errors on three cases, B+=0 critical errors on two cases, B=0 critical errors on one case, F=critical errors on four cases. Performance grades were categorized as high quality (B+, A-, A) and low quality (F, B). The results showed that the test-enhanced groups demonstrated statistically significant benefits at 95% confidence intervals compared to the traditional groups when comparing low- and high-quality grades. These performance trends support the continued use of the test-enhanced approach.

Performability modeling based on real data: A case study

NASA Technical Reports Server (NTRS)

Hsueh, M. C.; Iyer, R. K.; Trivedi, K. S.

1988-01-01

Described is a measurement-based performability model based on error and resource usage data collected on a multiprocessor system. A method for identifying the model structure is introduced and the resulting model is validated against real data. Model development from the collection of raw data to the estimation of the expected reward is described. Both normal and error behavior of the system are characterized. The measured data show that the holding times in key operational and error states are not simple exponentials and that a semi-Markov process is necessary to model system behavior. A reward function, based on the service rate and the error rate in each state, is then defined in order to estimate the performability of the system and to depict the cost of apparent types of errors.

Wlan-Based Indoor Localization Using Neural Networks

NASA Astrophysics Data System (ADS)

Saleem, Fasiha; Wyne, Shurjeel

2016-07-01

Wireless indoor localization has generated recent research interest due to its numerous applications. This work investigates Wi-Fi based indoor localization using two variants of the fingerprinting approach. Specifically, we study the application of an artificial neural network (ANN) for implementing the fingerprinting approach and compare its localization performance with a probabilistic fingerprinting method that is based on maximum likelihood estimation (MLE) of the user location. We incorporate spatial correlation of fading into our investigations, which is often neglected in simulation studies and leads to erroneous location estimates. The localization performance is quantified in terms of accuracy, precision, robustness, and complexity. Multiple methods for handling the case of missing APs in online stage are investigated. Our results indicate that ANN-based fingerprinting outperforms the probabilistic approach for all performance metrics considered in this work.

Centralization of Penile Cancer Management in the United States: A Combined Analysis of the American Board of Urology and National Cancer Data Base.

PubMed

Matulewicz, Richard S; Flum, Andrew S; Helenowski, Irene; Jovanovic, Borko; Palis, Bryan; Bilimoria, Karl Y; Meeks, Joshua J

2016-04-01

To assess the potential benefit of centralization of care in penile cancer. Centralization of care in other disease processes standardizes treatment and improves outcomes. Because penile cancer is a rare malignancy with unchanged mortality rates over the last two decades, we hypothesize that there may be a benefit to centralization. We identified surgeon, patient, and hospital characteristics captured by the National Cancer Data Base (1998-2012) and American Board of Urology case logs (2003-2013) for all penile cancer cases and procedures. Differences in patient demographics, stage of disease, referral patterns, and surgical quality indicators were assessed between academic and community hospitals. Using case logs to evaluate the distribution of penile cancer care, we found that only 4.1% of urologists performed a penile surgery and 1.5% performed a lymph node dissection (LND). Academic centers treated higher-stage cancers and saw more cases/year than community centers, suggesting informal centralization. Two guideline-based quality indicators demonstrated no difference in use of penile-sparing surgery but a higher likelihood of having an LND performed at an academic center (48.4% vs 26.6%). The total lymph node yield was significantly greater at academic centers (18.5 vs 12.5). Regression modeling demonstrated a 2.29 increased odds of having an LND at an academic center. Our data provide the first evidence for centralization of penile cancer in the US. At the time of diagnosis, equal number of patients is treated with penile-sparing surgery but there is greater use of LND and higher lymph node yield at academic centers. Ultimately, longer follow-up is necessary to determine if this improves survival of patients with penile cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

[Comparison of screening performance between primary high-risk HPV screening and high-risk HPV screening plus liquid-based cytology cotesting in diagnosis of cervical precancerous or cancerous lesions].

PubMed

Zhao, X L; Remila, Rezhake; Hu, S Y; Zhang, L; Xu, X Q; Chen, F; Pan, Q J; Zhang, X; Zhao, F H

2018-05-06

Objective: To evaluate and compare the screening performance of primary high-risk HPV(HR-HPV) screening and HR-HPV screening plus liquid-based cytology (LBC) cotesting in diagnosis of cervical cancer and precancerous lesions (CIN2+). Methods: We pooled 17 population-based cross-sectional studies which were conducted across China from 1999 to 2008. After obtaining informed consent, all women received liquid-based cytology(LBC)testing, HR-HPV DNA testing. Totally 28 777 women with complete LBC, HPV and biopsy results were included in the final analysis. Screening performance of primary HR-HPV DNA screening and HPV screening plus LBC co-testing in diagnosis of CIN2+ were calculated and compared among different age groups. Results: Among the whole population, the detection rates of primary HR-HPV screening and HR-HPV screening plus LBC co-testing are 3.05% (879 CIN2+) and 3.13%(900 CIN2+), respectively. The sensitivity were 96.4% and 98.7% (χ(2)=19.00, P< 0.001), and the specificity were 86.2% and 78.8% (χ(2)=2 067.00, P< 0.001), respectively. Areas under the receiver operating characteristic (ROC) curve (AUC) showed that the primary HR-HPV screening performed better than co-testing (AUC were 0.913 and 0.888; Z= 6.16, P< 0.001). Compared with primary HR-HPV screening, co-testing showed significantly higher colposcopy referral rates (16.5% and 23.6%, respectively, χ(2)=132.00, P< 0.001) and the number of colposcopy examination for detecting per CIN2+ (5.4 and 7.6, respectively).In the group aged 25-29, the colposcopy referral rates was 8.7 (10.9%(199 cases) vs 1.3%(23 cases)) times as much as the detection rate of primary HR-HPV screening in diagnosis of CIN2+, and was 12.5 (15.7%(288 cases) vs 1.3%(23 cases)) times as much as the detection rate of HR-HPV screening plus cytology contesting. Conclusion: Compared with primary HR-HPV screening, HR-HPV screening plus cytology co-testing does not show better results in the screening performance for CIN2+ detection, and the cost-effectiveness is not good enough, especially in younger age group.

[Therapeutic factors affecting the healing process in patients with gangrene of the perineum].

PubMed

Baraket, Oussama; Triki, Wissem; Ayed, Karim; Hmida, Sonia Ben; Lahmidi, Mohamed Amine; Baccar, Abdelamjid; Bouchoucha, Samy

2018-01-01

Fournier gangrene is a rare and severe necrotizing fasciitis. It is burdened with high morbi-mortality, requiring early and massive medical and surgical management. Initial treatment is based on patient's resuscitation associated with surgical debridement. Subsequently, the main challenge is the healing process and its possible sequelae. Several therapeutic approaches are currently available to improve and accelerate the healing process. We conducted a retrospective study of 20 cases. The median age of our patients was 56 years. The study included 16 men and 7 women. Comorbidity was present in 15 patients. Antibiotic therapy was administered in all cases, with a median duration of 15 days. All patients underwent surgery. Iterative reviews were necessary in all patients, who needed, on average, 3 dressing changes. Colostomy was performed in 6 cases. Hyperbaric oxygen therapy was performed in 4 cases. Vacuum assisted closure was performed in 1 case. Soft tissue coverage was necessary in 2 cases. The mean duration of healing was 15 days with oxygen therapy versus 24 days in the absence of this treatment. The mean duration of hospitalization was 20 days. Four patients died. Healing process without sequelae is a therapeutic challenge. Despite the addition of new therapeutic approaches, outcomes are not satisfactory. However, multidisciplinary approach associated with oxygen therapy and vacuum assisted closure might improve patients outcomes.

A Distance Instructional System with Learning Performance Evaluation Mechanism: Moodle-Based Educational System Design

ERIC Educational Resources Information Center

Lee, Ying-Chen; Terashima, Nobuyoshi

2012-01-01

In this paper, a Moodle-based educational system has been constructed by providing friendly interface to fit most students in e-learning. For the website implementation, the authors take the course "Multimedia Implementation Using JAVA" as a case study. From the modified Moodle-based educational system, the browsing time of each web page for…

Creating A Data Base For Design Of An Impeller

NASA Technical Reports Server (NTRS)

Prueger, George H.; Chen, Wei-Chung

1993-01-01

Report describes use of Taguchi method of parametric design to create data base facilitating optimization of design of impeller in centrifugal pump. Data base enables systematic design analysis covering all significant design parameters. Reduces time and cost of parametric optimization of design: for particular impeller considered, one can cover 4,374 designs by computational simulations of performance for only 18 cases.

Use of clinical simulations for patient education: targeting an untapped audience.

PubMed

Siwe, Karin; Berterö, Carina; Pugh, Carla; Wijma, Barbro

2009-01-01

In most cases, the health professional has been the target for simulation based learning curricula. We have developed a simulation based curriculum for patient education. In our curriculum lay-women learn how to perform the clinical female pelvic examination using a manikin-based trainer. Learner assessments show that prior negative expectations turned into positive expectations regarding future pelvic examinations.

Air Force Nuclear Enterprise Organization: A Case Study

DTIC Science & Technology

2016-09-15

will improve the performance of the AFNE. Based on analysis of commercial and industrial business models, what organizational structure , or...Business Dictionary 2015). Organizational structures will be developed based on decisions made with regards to design. The core of an...work flows. Based on design parameter decisions, senior leaders will establish an organizational structure that includes the layout of the

Transforming Undergraduate Students into Junior Researchers: Oxidation-Reduction Sequence as a Problem-Based Case Study

ERIC Educational Resources Information Center

Saloranta, Tiina; Lo¨nnqvist, Jan-Erik; Eklund, Patrik C.

2016-01-01

In our upper-level undergraduate laboratory course in organic chemistry we focus on a research-oriented task in a context-based and problem-based learning approach. The course starts with a preliminary training period where the students learn how to safely and independently perform synthesis and purification procedures and to operate the most…

The Case for Unit-Based Teams: A Model for Front-line Engagement and Performance Improvement

PubMed Central

Cohen, Paul M; Ptaskiewicz, Mark; Mipos, Debra

2010-01-01

Unit-based teams (UBTs)—defined as natural work groups of physicians, managers, and frontline staff who work collaboratively to solve problems, improve performance, and enhance quality—were established by the 2005 national agreement between Kaiser Permanente (KP) and the Coalition of KP Unions. They use established performance-improvement techniques and employee-engagement principles (including social-movement theory) to achieve clinical and operational goals. UBT members identify performance gaps and opportunities within their purview—issues they can address in the course of the day-to-day work, such as workflow or process improvement. By focusing on clear, agreed-on goals, UBTs encourage greater accountability and allow members to perform their full scope of work. UBTs are designed to deliver measurable benefits in clinical outcomes and operations, patient-experience enhancements, and physician-team performance or work life. For many physicians, UBTs will require new ways of engaging with their teams. However, evidence suggests that with organizational and physician support, these teams can achieve their goals. This article presents case examples of successful UBTs' outcomes; physicians' comments on their experience working with teams; an overview of UBTs' employee-engagement principles; and advice on how physicians can support and participate in the work of such teams. PMID:20740124

Usage of skin care products and risk of rheumatoid arthritis: results from the Swedish EIRA study

PubMed Central

2012-01-01

Introduction The aim of this study was to investigate the association between exposure to cosmetics, often containing mineral oil, and the risk of developing rheumatoid arthritis (RA). The study was performed against the background that occupational exposure to mineral oil has recently been shown to be associated with an increased risk for RA in man, and that injection of or percutaneous exposure to mineral-oil-containing cosmetics can induce arthritis in certain rat strains. Methods A population-based case-control study of incident cases of RA was performed among the population aged 18 to 70 years in a defined area of Sweden during May 1996 to December 2003. A case was defined as an individual from the study base, who received for the first time a diagnosis of RA according to the 1987 American College of Rheumatology criteria. Controls were randomly selected from the study base with consideration taken for age, gender and residential area. Cases (n = 1,419) and controls (n = 1,674) answered an extensive questionnaire regarding environmental and lifestyle factors including habits of cosmetic usage. The relative risk of developing RA was calculated for subjects with different cosmetic usage compared with subjects with low or no usage. Analysis was also performed stratifying the cases for presence/absence of rheumatoid factor and antibodies to citrulline-containing peptides. Results The relative risks of developing RA associated with use of cosmetics were all close to one, both for women and men, for different exposure categories, and in relation to different subgroups of RA. Conclusion This study does not support the hypothesis that ordinary usage of common cosmetics as body lotions, skin creams, and ointments, often containing mineral oil, increase the risk for RA in the population in general. We cannot exclude, however, that these cosmetics can contribute to arthritis in individuals carrying certain genotypes or simultaneously being exposed to other arthritis-inducing environmental agents. PMID:22455933

Relevance of the c-statistic when evaluating risk-adjustment models in surgery.

PubMed

Merkow, Ryan P; Hall, Bruce L; Cohen, Mark E; Dimick, Justin B; Wang, Edward; Chow, Warren B; Ko, Clifford Y; Bilimoria, Karl Y

2012-05-01

The measurement of hospital quality based on outcomes requires risk adjustment. The c-statistic is a popular tool used to judge model performance, but can be limited, particularly when evaluating specific operations in focused populations. Our objectives were to examine the interpretation and relevance of the c-statistic when used in models with increasingly similar case mix and to consider an alternative perspective on model calibration based on a graphical depiction of model fit. From the American College of Surgeons National Surgical Quality Improvement Program (2008-2009), patients were identified who underwent a general surgery procedure, and procedure groups were increasingly restricted: colorectal-all, colorectal-elective cases only, and colorectal-elective cancer cases only. Mortality and serious morbidity outcomes were evaluated using logistic regression-based risk adjustment, and model c-statistics and calibration curves were used to compare model performance. During the study period, 323,427 general, 47,605 colorectal-all, 39,860 colorectal-elective, and 21,680 colorectal cancer patients were studied. Mortality ranged from 1.0% in general surgery to 4.1% in the colorectal-all group, and serious morbidity ranged from 3.9% in general surgery to 12.4% in the colorectal-all procedural group. As case mix was restricted, c-statistics progressively declined from the general to the colorectal cancer surgery cohorts for both mortality and serious morbidity (mortality: 0.949 to 0.866; serious morbidity: 0.861 to 0.668). Calibration was evaluated graphically by examining predicted vs observed number of events over risk deciles. For both mortality and serious morbidity, there was no qualitative difference in calibration identified between the procedure groups. In the present study, we demonstrate how the c-statistic can become less informative and, in certain circumstances, can lead to incorrect model-based conclusions, as case mix is restricted and patients become more homogenous. Although it remains an important tool, caution is advised when the c-statistic is advanced as the sole measure of a model performance. Copyright © 2012 American College of Surgeons. All rights reserved.

A Classification System to Guide Physical Therapy Management in Huntington Disease: A Case Series.

PubMed

Fritz, Nora E; Busse, Monica; Jones, Karen; Khalil, Hanan; Quinn, Lori

2017-07-01

Individuals with Huntington disease (HD), a rare neurological disease, experience impairments in mobility and cognition throughout their disease course. The Medical Research Council framework provides a schema that can be applied to the development and evaluation of complex interventions, such as those provided by physical therapists. Treatment-based classifications, based on expert consensus and available literature, are helpful in guiding physical therapy management across the stages of HD. Such classifications also contribute to the development and further evaluation of well-defined complex interventions in this highly variable and complex neurodegenerative disease. The purpose of this case series was to illustrate the use of these classifications in the management of 2 individuals with late-stage HD. Two females, 40 and 55 years of age, with late-stage HD participated in this case series. Both experienced progressive declines in ambulatory function and balance as well as falls or fear of falling. Both individuals received daily care in the home for activities of daily living. Physical therapy Treatment-Based Classifications for HD guided the interventions and outcomes. Eight weeks of in-home balance training, strength training, task-specific practice of functional activities including transfers and walking tasks, and family/carer education were provided. Both individuals demonstrated improvements that met or exceeded the established minimal detectible change values for gait speed and Timed Up and Go performance. Both also demonstrated improvements on Berg Balance Scale and Physical Performance Test performance, with 1 of the 2 individuals exceeding the established minimal detectible changes for both tests. Reductions in fall risk were evident in both cases. These cases provide proof-of-principle to support use of treatment-based classifications for physical therapy management in individuals with HD. Traditional classification of early-, mid-, and late-stage disease progression may not reflect patients' true capabilities; those with late-stage HD may be as responsive to interventions as those at an earlier disease stage.Video Abstract available for additional insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A172).

A fuzzy-ontology-oriented case-based reasoning framework for semantic diabetes diagnosis.

PubMed

El-Sappagh, Shaker; Elmogy, Mohammed; Riad, A M

2015-11-01

Case-based reasoning (CBR) is a problem-solving paradigm that uses past knowledge to interpret or solve new problems. It is suitable for experience-based and theory-less problems. Building a semantically intelligent CBR that mimic the expert thinking can solve many problems especially medical ones. Knowledge-intensive CBR using formal ontologies is an evolvement of this paradigm. Ontologies can be used for case representation and storage, and it can be used as a background knowledge. Using standard medical ontologies, such as SNOMED CT, enhances the interoperability and integration with the health care systems. Moreover, utilizing vague or imprecise knowledge further improves the CBR semantic effectiveness. This paper proposes a fuzzy ontology-based CBR framework. It proposes a fuzzy case-base OWL2 ontology, and a fuzzy semantic retrieval algorithm that handles many feature types. This framework is implemented and tested on the diabetes diagnosis problem. The fuzzy ontology is populated with 60 real diabetic cases. The effectiveness of the proposed approach is illustrated with a set of experiments and case studies. The resulting system can answer complex medical queries related to semantic understanding of medical concepts and handling of vague terms. The resulting fuzzy case-base ontology has 63 concepts, 54 (fuzzy) object properties, 138 (fuzzy) datatype properties, 105 fuzzy datatypes, and 2640 instances. The system achieves an accuracy of 97.67%. We compare our framework with existing CBR systems and a set of five machine-learning classifiers; our system outperforms all of these systems. Building an integrated CBR system can improve its performance. Representing CBR knowledge using the fuzzy ontology and building a case retrieval algorithm that treats different features differently improves the accuracy of the resulting systems. Copyright © 2015 Elsevier B.V. All rights reserved.

Measuring the performance of telephone-based disease surveillance systems in local health departments.

PubMed

Dausey, David J; Chandra, Anita; Schaefer, Agnes G; Bahney, Ben; Haviland, Amelia; Zakowski, Sarah; Lurie, Nicole

2008-09-01

We tested telephone-based disease surveillance systems in local health departments to identify system characteristics associated with consistent and timely responses to urgent case reports. We identified a stratified random sample of 74 health departments and conducted a series of unannounced tests of their telephone-based surveillance systems. We used regression analyses to identify system characteristics that predicted fast connection with an action officer (an appropriate public health professional). Optimal performance in consistently connecting callers with an action officer in 30 minutes or less was achieved by 31% of participating health departments. Reaching a live person upon dialing, regardless of who that person was, was the strongest predictor of optimal performance both in being connected with an action officer and in consistency of connection times. Health departments can achieve optimal performance in consistently connecting a caller with an action officer in 30 minutes or less and may improve performance by using a telephone-based disease surveillance system in which the phone is answered by a live person at all times.

Summary and evaluation of the parametric study of potential early commercial MHD power plants (PSPEC)

NASA Technical Reports Server (NTRS)

Staigner, P. J.; Abbott, J. M.

1980-01-01

Two parallel contracted studies were conducted. Each contractor investigated three base cases and parametric variations about these base cases. Each contractor concluded that two of the base cases (a plant using separate firing of an advanced high temperature regenerative air heater with fuel from an advanced coal gasifier and a plant using an intermediate temperature metallic recuperative heat exchanger to heat oxygen enriched combustion air) were comparable in both performance and cost of electricity. The contractors differed in the level of their cost estimates with the capital cost estimates for the MHD topping cycle and the magnet subsystem in particular accounting for a significant part of the difference. The impact of the study on the decision to pursue a course which leads to an oxygen enriched plant as the first commercial MHD plant is described.

Safety in out-of-hours operating in trauma and orthopaedics at a district general hospital.

PubMed

Gulamhussein, M A; Chaudhry, S; Noor, S; Chaudhry, T; Guha, A; Knebel, R

2017-05-01

INTRODUCTION According to the National Confidential Enquiry into Perioperative Deaths (NCEPOD), out-of-hours operating in trauma and orthopaedics should be reserved for life or limb threatening cases only. The aim of our study was to determine the nature of non-emergency work carried out in our trust at night in 2015. The overall efficacy and clinical safety of the services provided was evaluated. METHODS Surgical activity undertaken after 9pm was reviewed along with patient ASA (American Society of Anesthesiologists) grade, grade of operating surgeon and any complications that occurred following the procedure. Furthermore, the clinical urgency and safety of cases was assessed based on whether there was any record of life or limb threatening indications at the time of admission. RESULTS Overall, 131 procedures were performed after 9pm, with 102 performed between 9pm and midnight, and 29 after midnight. Consultants performed 16 cases and the remaining 115 cases were operated on by middle grades or specialty trainees. A fifth (20%) of the cases were genuinely life or limb threatening. A total of 123 procedures were classed as having good outcomes. The complication rate was 8%. CONCLUSIONS In our study, 80% of the procedures performed after 9pm could not be categorised as life or limb threatening. Appropriate NCEPOD classification would ensure that only life or limb threatening cases were listed for theatre after 9pm. Alternative methods of operating within working hours should be considered.

Safety in out-of-hours operating in trauma and orthopaedics at a district general hospital

PubMed Central

Chaudhry, S; Noor, S; Chaudhry, T; Guha, A; Knebel, R

2017-01-01

INTRODUCTION According to the National Confidential Enquiry into Perioperative Deaths (NCEPOD), out-of-hours operating in trauma and orthopaedics should be reserved for life or limb threatening cases only. The aim of our study was to determine the nature of non-emergency work carried out in our trust at night in 2015. The overall efficacy and clinical safety of the services provided was evaluated. METHODS Surgical activity undertaken after 9pm was reviewed along with patient ASA (American Society of Anesthesiologists) grade, grade of operating surgeon and any complications that occurred following the procedure. Furthermore, the clinical urgency and safety of cases was assessed based on whether there was any record of life or limb threatening indications at the time of admission. RESULTS Overall, 131 procedures were performed after 9pm, with 102 performed between 9pm and midnight, and 29 after midnight. Consultants performed 16 cases and the remaining 115 cases were operated on by middle grades or specialty trainees. A fifth (20%) of the cases were genuinely life or limb threatening. A total of 123 procedures were classed as having good outcomes. The complication rate was 8%. CONCLUSIONS In our study, 80% of the procedures performed after 9pm could not be categorised as life or limb threatening. Appropriate CEPOD classification would ensure that only life or limb threatening cases were listed for theatre after 9pm. Alternative methods of operating within working hours should be considered. PMID:27917666

Relationship between Hyperactivity of Depressor Septi Nasi Muscle and Changes of Alar Base and Flaring during Smile.

PubMed

Beiraghi-Toosi, Arash; Rezaei, Ezatollah; Zanjani, Elham

2016-01-01

Hyperactivity of depressor septi nasi muscle leads to smiling deformity and nasal tip depression. Lateral fascicles of this muscle help in widening the nostrils. The purpose of this study was to evaluate the relationship between the nasal length changes and the alar base and the alar flaring changes during smile. Standard photographs are performed in the face and lateral views with forward gaze in the repose and maximum smile. Nasal length, alar base, and alar flaring were measured on the prints of the photographs. To decrease possible errors in the size of the printed photographs, middle face height from glabella to ANS was measured in the lateral view and the interpupil distance in the face view to standardize the measurements. Fifty cases were enrolled in this study. In 39 cases (78%), the nasal length was increased during smile. Forty-six cases (92%) had an increase in alar base diameter during smile. Alar flaring during smile increased in 48 cases (96%). Nasal length and alar base changes during smiling were not significantly correlated. Nasal length and alar flaring changes during smiling were not significantly related too. On the other hand, alar base and alar flaring changes during smile showed correlation. Alar base and alar flaring changes during smile were not significantly different in hyperactive and non-hyperactive cases. Nasal length change during smiling and hypertrophy of the medial fascicles of depressor septi nasi were not related to alar base or alar flaring change during smile.

Routes for virtually guided endoscopic liver resection of subdiaphragmatic liver tumors.

PubMed

Aoki, Takeshi; Murakami, Masahiko; Fujimori, Akira; Koizumi, Tomotake; Enami, Yuta; Kusano, Tomokazu; Matsuda, Kazuhiro; Yamada, Kosuke; Nogaki, Koji; Wada, Yusuke; Hakozaki, Tomoki; Goto, Satoru; Watanabe, Makoto; Otsuka, Koji

2016-03-01

Laparoscopic and thoracoscopic/laparoscopic hepatectomy is a safe procedure that has potential advantages over open surgery. However, deeply positioned liver tumors require expert laparoscopic and thoracoscopic/laparoscopic hepatectomy techniques. Using simulated preoperative three-dimensional virtual endoscopy (P3DVE) guidance, we demonstrate herein that a thoracoscopic approach (TA), thoracoscopic-laparoscopic approach (TLA), and laparoscopic approach (LA) are all feasible and safe routes for performing pure laparoscopic and thoracoscopic/laparoscopic resection of liver tumors located in the 4a, 7, and 8 liver subdiaphragmatic areas. Thirty-eight patients underwent laparoscopic and thoracoscopic/laparoscopic partial liver resection (TA 13 cases, TLA two cases, and LA 23 cases) of the subdiaphragmatic area at Showa University Hospital. All surgical approaches were preoperatively determined based on preoperative 3D virtual endoscopic simulation (P3DVES) visualization and findings using the image processing software SYNAPSE VINCENT(®). Laparoscopic and thoracoscopic/laparoscopic liver resection was successfully performed for all cases under P3DVE instruction. The mean operative times using TA, TLA, and LA approaches were 193, 185, and 190 min, respectively. Mean blood loss during TA, TLA, and LA was 179, 138, and 73 g, respectively. No patients required conversion to open surgery, and there were no deaths, although there were three cases of Clavien-Dindo grade I in TA along with three cases of grade I and one case of grade II in LA. TA, TLA, and LA routes performed under P3DVE instruction are feasible and safe to perform for pure laparoscopic and thoracoscopic/laparoscopic liver resection in selected patients with lesions located in the hepatic subdiaphragmatic area.

Enterprise architecture availability analysis using fault trees and stakeholder interviews

NASA Astrophysics Data System (ADS)

Närman, Per; Franke, Ulrik; König, Johan; Buschle, Markus; Ekstedt, Mathias

2014-01-01

The availability of enterprise information systems is a key concern for many organisations. This article describes a method for availability analysis based on Fault Tree Analysis and constructs from the ArchiMate enterprise architecture (EA) language. To test the quality of the method, several case-studies within the banking and electrical utility industries were performed. Input data were collected through stakeholder interviews. The results from the case studies were compared with availability of log data to determine the accuracy of the method's predictions. In the five cases where accurate log data were available, the yearly downtime estimates were within eight hours from the actual downtimes. The cost of performing the analysis was low; no case study required more than 20 man-hours of work, making the method ideal for practitioners with an interest in obtaining rapid availability estimates of their enterprise information systems.

SU-E-J-71: Spatially Preserving Prior Knowledge-Based Treatment Planning

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

Wang, H; Xing, L

2015-06-15

Purpose: Prior knowledge-based treatment planning is impeded by the use of a single dose volume histogram (DVH) curve. Critical spatial information is lost from collapsing the dose distribution into a histogram. Even similar patients possess geometric variations that becomes inaccessible in the form of a single DVH. We propose a simple prior knowledge-based planning scheme that extracts features from prior dose distribution while still preserving the spatial information. Methods: A prior patient plan is not used as a mere starting point for a new patient but rather stopping criteria are constructed. Each structure from the prior patient is partitioned intomore » multiple shells. For instance, the PTV is partitioned into an inner, middle, and outer shell. Prior dose statistics are then extracted for each shell and translated into the appropriate Dmin and Dmax parameters for the new patient. Results: The partitioned dose information from a prior case has been applied onto 14 2-D prostate cases. Using prior case yielded final DVHs that was comparable to manual planning, even though the DVH for the prior case was different from the DVH for the 14 cases. Solely using a single DVH for the entire organ was also performed for comparison but showed a much poorer performance. Different ways of translating the prior dose statistics into parameters for the new patient was also tested. Conclusion: Prior knowledge-based treatment planning need to salvage the spatial information without transforming the patients on a voxel to voxel basis. An efficient balance between the anatomy and dose domain is gained through partitioning the organs into multiple shells. The use of prior knowledge not only serves as a starting point for a new case but the information extracted from the partitioned shells are also translated into stopping criteria for the optimization problem at hand.« less

Cheating and Anti-Cheating in Gossip-Based Protocol: An Experimental Investigation

NASA Astrophysics Data System (ADS)

Xiao, Xin; Shi, Yuanchun; Tang, Yun; Zhang, Nan

During recent years, there has been a rapid growth in deployment of gossip-based protocol in many multicast applications. In a typical gossip-based protocol, each node acts as dual roles of receiver and sender, independently exchanging data with its neighbors to facilitate scalability and resilience. However, most of previous work in this literature seldom considered cheating issue of end users, which is also very important in face of the fact that the mutual cooperation inherently determines overall system performance. In this paper, we investigate the dishonest behaviors in decentralized gossip-based protocol through extensive experimental study. Our original contributions come in two-fold: In the first part of cheating study, we analytically discuss two typical cheating strategies, that is, intentionally increasing subscription requests and untruthfully calculating forwarding probability, and further evaluate their negative impacts. The results indicate that more attention should be paid to defending cheating behaviors in gossip-based protocol. In the second part of anti-cheating study, we propose a receiver-driven measurement mechanism, which evaluates individual forwarding traffic from the perspective of receivers and thus identifies cheating nodes with high incoming/outgoing ratio. Furthermore, we extend our mechanism by introducing reliable factor to further improve its accuracy. The experiments under various conditions show that it performs quite well in case of serious cheating and achieves considerable performance in other cases.

Using SRAM Based FPGAs for Power-Aware High Performance Wireless Sensor Networks

PubMed Central

Valverde, Juan; Otero, Andres; Lopez, Miguel; Portilla, Jorge; de la Torre, Eduardo; Riesgo, Teresa

2012-01-01

While for years traditional wireless sensor nodes have been based on ultra-low power microcontrollers with sufficient but limited computing power, the complexity and number of tasks of today’s applications are constantly increasing. Increasing the node duty cycle is not feasible in all cases, so in many cases more computing power is required. This extra computing power may be achieved by either more powerful microcontrollers, though more power consumption or, in general, any solution capable of accelerating task execution. At this point, the use of hardware based, and in particular FPGA solutions, might appear as a candidate technology, since though power use is higher compared with lower power devices, execution time is reduced, so energy could be reduced overall. In order to demonstrate this, an innovative WSN node architecture is proposed. This architecture is based on a high performance high capacity state-of-the-art FPGA, which combines the advantages of the intrinsic acceleration provided by the parallelism of hardware devices, the use of partial reconfiguration capabilities, as well as a careful power-aware management system, to show that energy savings for certain higher-end applications can be achieved. Finally, comprehensive tests have been done to validate the platform in terms of performance and power consumption, to proof that better energy efficiency compared to processor based solutions can be achieved, for instance, when encryption is imposed by the application requirements. PMID:22736971

Using SRAM based FPGAs for power-aware high performance wireless sensor networks.

PubMed

Valverde, Juan; Otero, Andres; Lopez, Miguel; Portilla, Jorge; de la Torre, Eduardo; Riesgo, Teresa

2012-01-01

While for years traditional wireless sensor nodes have been based on ultra-low power microcontrollers with sufficient but limited computing power, the complexity and number of tasks of today's applications are constantly increasing. Increasing the node duty cycle is not feasible in all cases, so in many cases more computing power is required. This extra computing power may be achieved by either more powerful microcontrollers, though more power consumption or, in general, any solution capable of accelerating task execution. At this point, the use of hardware based, and in particular FPGA solutions, might appear as a candidate technology, since though power use is higher compared with lower power devices, execution time is reduced, so energy could be reduced overall. In order to demonstrate this, an innovative WSN node architecture is proposed. This architecture is based on a high performance high capacity state-of-the-art FPGA, which combines the advantages of the intrinsic acceleration provided by the parallelism of hardware devices, the use of partial reconfiguration capabilities, as well as a careful power-aware management system, to show that energy savings for certain higher-end applications can be achieved. Finally, comprehensive tests have been done to validate the platform in terms of performance and power consumption, to proof that better energy efficiency compared to processor based solutions can be achieved, for instance, when encryption is imposed by the application requirements.

Interchangeability of counts of cases and hours of cases for quantifying a hospital's change in workload among four-week periods of 1 year.

PubMed

Dexter, Franklin; Epstein, Richard H; Ledolter, Johannes; Wanderer, Jonathan P

2018-05-16

Recent studies have made longitudinal assessments of case counts using State (e.g., United States) and Provincial (e.g., Canada) databases. Such databases rarely include either operating room (OR) or anesthesia times and, even when duration data are available, there are major statistical limitations to their use. We evaluated how to forecast short-term changes in OR caseload and workload (hours) and how to decide whether changes are outliers (e.g., significant, abrupt decline in anesthetics). Observational cohort study. Large teaching hospital. 35 years of annual anesthesia caseload data. Annual data were used without regard to where or when in the year each case was performed, thereby matching public use files. Changes in caseload or hours among four-week periods were examined within individual year-long periods using 159 consecutive four-week periods from the same hospital. Series of 12 four-week periods of the hours of cases performed on workdays lacked trend or correlation among periods for 49 of 50 series and followed normal distributions for 50 of 50 series. These criteria also were satisfied for 50 of 50 series based on counts of cases. The Pearson r = 0.999 between hours of anesthetics and cases. For purposes of time series analysis of total workload at a hospital within 1-year, hours of cases and counts of cases are interchangeable. Simple control chart methods of detecting sudden changes in workload or caseload, based simply on the sample mean and standard deviation from the preceding year, are appropriate. Copyright © 2018 Elsevier Inc. All rights reserved.

Exome-based analysis of cardiac arrhythmia, respiratory control, and epilepsy genes in sudden unexpected death in epilepsy.

PubMed

Bagnall, Richard D; Crompton, Douglas E; Petrovski, Slavé; Lam, Lien; Cutmore, Carina; Garry, Sarah I; Sadleir, Lynette G; Dibbens, Leanne M; Cairns, Anita; Kivity, Sara; Afawi, Zaid; Regan, Brigid M; Duflou, Johan; Berkovic, Samuel F; Scheffer, Ingrid E; Semsarian, Christopher

2016-04-01

The leading cause of epilepsy-related premature mortality is sudden unexpected death in epilepsy (SUDEP). The cause of SUDEP remains unknown. To search for genetic risk factors in SUDEP cases, we performed an exome-based analysis of rare variants. Demographic and clinical information of 61 SUDEP cases were collected. Exome sequencing and rare variant collapsing analysis with 2,936 control exomes were performed to test for genes enriched with damaging variants. Additionally, cardiac arrhythmia, respiratory control, and epilepsy genes were screened for variants with frequency of <0.1% and predicted to be pathogenic with multiple in silico tools. The 61 SUDEP cases were categorized as definite SUDEP (n = 54), probable SUDEP (n = 5), and definite SUDEP plus (n = 2). We identified de novo mutations, previously reported pathogenic mutations, or candidate pathogenic variants in 28 of 61 (46%) cases. Four SUDEP cases (7%) had mutations in common genes responsible for the cardiac arrhythmia disease, long QT syndrome (LQTS). Nine cases (15%) had candidate pathogenic variants in dominant cardiac arrhythmia genes. Fifteen cases (25%) had mutations or candidate pathogenic variants in dominant epilepsy genes. No gene reached genome-wide significance with rare variant collapsing analysis; however, DEPDC5 (p = 0.00015) and KCNH2 (p = 0.0037) were among the top 30 genes, genome-wide. A sizeable proportion of SUDEP cases have clinically relevant mutations in cardiac arrhythmia and epilepsy genes. In cases with an LQTS gene mutation, SUDEP may occur as a result of a predictable and preventable cause. Understanding the genetic basis of SUDEP may inform cascade testing of at-risk family members. © 2016 American Neurological Association.

Alleged biological father incest: a forensic approach.

PubMed

Gomes, Vânia; Jardim, Patrícia; Taveira, Francisco; Dinis-Oliveira, Ricardo J; Magalhães, Teresa

2014-01-01

Paternal incest is one of the most serious forms of intrafamilial sexual abuse with clinical, social, and legal relevance. A retrospective study was performed, based on forensic reports and judicial decisions of alleged cases of biological paternal incest of victims under 18 years old (n = 215) from 2003 to 2008. Results highlight that in a relevant number of cases: victims were female; the abuse begun at an early age with reiteration; the alleged perpetrator presented a history of sexual crimes against children; sexual practices were physically poorly intrusive, which associated with a forensic medical evaluation performed more than 72 h after the abuse, explain partially the absence of physical injuries or other evidence-these last aspects are different from extrafamilial cases. In conclusion, observations about paternal incest are likely to exacerbate the psychosocial consequences of the abuse and may explain the difficulty and delay in detect and disclose these cases. Few cases were legally prosecuted and convicted. © 2013 American Academy of Forensic Sciences.

Making the Case for a Positive Approach to Improving Organizational Performance in Higher Education Institutions: The Community College Abundance Model

ERIC Educational Resources Information Center

Shults, Christopher

2008-01-01

Increasingly hostile and turbulent environments have rendered top-down, problem-focused management structures inadequate for competing in the ever-changing postsecondary knowledge industry. The community college abundance model (CCAM), a strengths-based approach to performance enhancement in community colleges, is presented as a viable…

Performing the Grade: Urban Latino Youth, Gender Performance, and Academic Success

ERIC Educational Resources Information Center

Foiles Sifuentes, A. M.

2015-01-01

This article examines the intersection of race, gender, class, and academic success through an ethnographic case study in a Texas charter high school. The 98% working-class, Latino student population was exposed to an array of stigmas ascribed to their persons based on negative social stereotypes of race, ethnicity, gender, and class due to the…

The Effect of Interactive Technology on Informal Learning and Performance in a Social Setting

ERIC Educational Resources Information Center

Boileau, Timothy

2011-01-01

This study is based on a qualitative multiple case study research design using a mixed methods approach to provide insight into the effect of interactive technology on informal learning and performance in a social business setting inhabited by knowledge workers. The central phenomenon examined is the variance in behavioral intention towards…

A Case Study on the Relationships between Participation in Online Discussion and Achievement of Project Work

ERIC Educational Resources Information Center

Chang, Chi-Cheng

2008-01-01

The objective of the study is to discuss about the correlation between each group's performances of participation in online discussion and their achievements of project-based works. Performances of online discussion consist of content, frequency, and frequency of participation in discussion after each login into the Web community system. Research…

Old Players--New Rules: Higher Education Institutions' Response to Educational Demand

ERIC Educational Resources Information Center

Frolich, Nicoline; Waagene, Erica; Aamodt, Per Olaf

2011-01-01

Performance indicators and performance-based funding are becoming integral components of higher education (HE) policy around the globe. We explore some of the implications of this type of policy on Norwegian HE. We believe the case will be of significant interest to policy-makers, stakeholders and academics alike, not least because our empirical…

An Explanatory Item Response Theory Approach for a Computer-Based Case Simulation Test

ERIC Educational Resources Information Center

Kahraman, Nilüfer

2014-01-01

Problem: Practitioners working with multiple-choice tests have long utilized Item Response Theory (IRT) models to evaluate the performance of test items for quality assurance. The use of similar applications for performance tests, however, is often encumbered due to the challenges encountered in working with complicated data sets in which local…

The Effect of Classroom Web Applications on Teaching, Learning and Academic Performance among College of Education Female Students

ERIC Educational Resources Information Center

Aljraiwi, Seham Salman

2017-01-01

The current study proposes web applications-based learning environment to promote teaching and learning activities in the classrooms. It also helps teachers facilitate learners' contributions in the process of learning and improving their motivation and performance. The case study illustrated that female students were more interested in learning…

A New Approach to Integrate Internet-of-Things and Software-as-a-Service Model for Logistic Systems: A Case Study

PubMed Central

Chen, Shang-Liang; Chen, Yun-Yao; Hsu, Chiang

2014-01-01

Cloud computing is changing the ways software is developed and managed in enterprises, which is changing the way of doing business in that dynamically scalable and virtualized resources are regarded as services over the Internet. Traditional manufacturing systems such as supply chain management (SCM), customer relationship management (CRM), and enterprise resource planning (ERP) are often developed case by case. However, effective collaboration between different systems, platforms, programming languages, and interfaces has been suggested by researchers. In cloud-computing-based systems, distributed resources are encapsulated into cloud services and centrally managed, which allows high automation, flexibility, fast provision, and ease of integration at low cost. The integration between physical resources and cloud services can be improved by combining Internet of things (IoT) technology and Software-as-a-Service (SaaS) technology. This study proposes a new approach for developing cloud-based manufacturing systems based on a four-layer SaaS model. There are three main contributions of this paper: (1) enterprises can develop their own cloud-based logistic management information systems based on the approach proposed in this paper; (2) a case study based on literature reviews with experimental results is proposed to verify that the system performance is remarkable; (3) challenges encountered and feedback collected from T Company in the case study are discussed in this paper for the purpose of enterprise deployment. PMID:24686728

A new approach to integrate Internet-of-things and software-as-a-service model for logistic systems: a case study.

PubMed

Chen, Shang-Liang; Chen, Yun-Yao; Hsu, Chiang

2014-03-28

Cloud computing is changing the ways software is developed and managed in enterprises, which is changing the way of doing business in that dynamically scalable and virtualized resources are regarded as services over the Internet. Traditional manufacturing systems such as supply chain management (SCM), customer relationship management (CRM), and enterprise resource planning (ERP) are often developed case by case. However, effective collaboration between different systems, platforms, programming languages, and interfaces has been suggested by researchers. In cloud-computing-based systems, distributed resources are encapsulated into cloud services and centrally managed, which allows high automation, flexibility, fast provision, and ease of integration at low cost. The integration between physical resources and cloud services can be improved by combining Internet of things (IoT) technology and Software-as-a-Service (SaaS) technology. This study proposes a new approach for developing cloud-based manufacturing systems based on a four-layer SaaS model. There are three main contributions of this paper: (1) enterprises can develop their own cloud-based logistic management information systems based on the approach proposed in this paper; (2) a case study based on literature reviews with experimental results is proposed to verify that the system performance is remarkable; (3) challenges encountered and feedback collected from T Company in the case study are discussed in this paper for the purpose of enterprise deployment.

Notification and management of congenital syphilis in the Northern Territory 2009 to 2014.

PubMed

McLeod, Charlie; Su, Jiunn-Yih; Francis, Joshua R; Ishwar, Alice; Ryder, Nathan

2015-09-30

To determine whether cases of congenital syphilis in the Northern Territory between 2009 and 2014 were correctly notified based on probable or confirmed case criteria stipulated by the Communicable Diseases Network Australia (CDNA). Pregnant women with positive syphilis serology defined as reactive treponemal test and rapid plasma reagin titre ≥1:8 were identified from the Northern Territory Syphilis Register Information System. Risk classification was performed based on local guidelines, and CDNA criteria for probable/confirmed cases of congenital syphilis were applied to determine whether cases were appropriately notified. Thirty-four cases of positive maternal syphilis serology in pregnancy were identified from 31 women; all were Indigenous. Twenty-one cases fulfilled criteria for probable congenital syphilis; 1 case was formally notified to the Centre for Disease Control. Twenty cases (95%) fulfilling CDNA criteria for probable congenital syphilis were not notified over the study period. Application of standard case definitions significantly increases the rate of congenital syphilis cases in the Northern Territory. Improved education regarding CDNA criteria for notification of congenital syphilis is necessary for clinicians and public health staff. Emerging evidence has supported the recent simplification of CDNA criteria for notification of congenital syphilis, effective 1 July 2015.

Reinvestigations of six unusual paternity cases by typing of autosomal single-nucleotide polymorphisms.

PubMed

Børsting, Claus; Morling, Niels

2012-02-01

In some relationship cases, the initial investigations of autosomal short tandem repeats (STRs) lead to an ambiguous conclusion and supplementary investigations become necessary. Six unusual paternity cases were previously investigated by other researchers and published as case work examples in forensic journals. Here, the cases were reinvestigated by typing the samples for 49 autosomal single-nucleotide polymorphisms (SNPs) using the SNPforID multiplex assay. Three cases were solved by the SNP investigation without the need for any additional testing. In two cases, the SNP results supported the conclusions based on STRs. In the last case, the SNP results spoke in favor of paternity, and the combined paternity index based on autosomal STRs and SNPs was 12.3 billion. Nevertheless, the alleged father was excluded by X-chromosome typing. The case work examples underline the importance of performing supplementary investigations, and they advocate for the implementation of several panels that may be used in the highly unusual cases. Panels with SNPs or other markers with low mutation probabilities are preferable as supplementary markers, because the risk of detecting (additional) mutations is very low. © 2012 American Association of Blood Banks.

Two cases of Cokeromyces recurvatus in liquid-based Papanicolaou tests and a review of the literature.

PubMed

Odronic, Shelley I; Scheidemantel, Thomas; Tuohy, Marion J; Chute, Deborah; Procop, Gary W; Booth, Christine N

2012-12-01

We present 2 cases of Cokeromyces recurvatus in routine, liquid-based Papanicolaou tests (ThinPrep). Patient 1 is a healthy, asymptomatic, 26-year-old woman with no pertinent past medical history. Patient 2 is a healthy, asymptomatic, 47-year-old woman with no pertinent past medical history. The Papanicolaou tests from both patients showed many fungal-like elements as globose, yeastlike forms measuring 10 to 30 µm in diameter with multiple, narrowly attached apparent "daughter" buds. This morphology was consistent with Paracoccidioides brasiliensis. However, broad-range fungal polymerase chain reaction and deoxyribonucleic acid sequence analysis performed with GenBank Basic Local Alignment Search Tool showed an exact match for C recurvatus. Our cases highlight the importance of molecular techniques to prevent misdiagnosis of C recurvatus as P brasiliensis, based on morphology alone. There have been 8 previously published cases of C recurvatus infection in humans, 3 of which were reported in the female genital tract.

Initial experience using a femtosecond laser cataract surgery system at a UK National Health Service cataract surgery day care centre

PubMed Central

Dhallu, Sandeep K; Maurino, Vincenzo; Wilkins, Mark R

2016-01-01

Objectives To describe the initial outcomes following installation of a cataract surgery laser system. Setting National Health Service cataract surgery day care unit in North London, UK. Participants 158 eyes of 150 patients undergoing laser-assisted cataract surgery. Interventions Laser cataract surgery using the AMO Catalys femtosecond laser platform. Primary and secondary outcome measures Primary outcome measure: intraoperative complications including anterior and posterior capsule tears. Secondary outcome measures: docking to the laser platform, successful treatment delivery, postoperative visual acuities. Results Mean case age was 67.7±10.8 years (range 29–88 years). Docking was successful in 94% (148/158 cases), and in 4% (6/148 cases) of these, the laser delivery was aborted part way during delivery due to patient movement. A total of 32 surgeons, of grades from junior trainee to consultant, performed the surgeries. Median case number per surgeon was 3 (range from 1–20). The anterior capsulotomy was complete in 99.3% of cases, there were no anterior capsule tears (0%). There were 3 cases with posterior capsule rupture requiring anterior vitrectomy, and 1 with zonular dialysis requiring anterior vitrectomy (4/148 eyes, 2.7%). These 4 cases were performed by trainee surgeons, and were either their first laser cataract surgery (2 surgeons) or their first and second laser cataract surgeries (1 surgeon). Conclusions Despite the learning curve, docking and laser delivery were successfully performed in almost all cases, and surgical complication rates and visual outcomes were similar to those expected based on national data. Complications were predominately confined to trainee surgeons, and with the exception of intraoperative pupil constriction appeared unrelated to the laser-performed steps. PMID:27466243

Anatomical classification of breast sentinel lymph nodes using computed tomography-lymphography.

PubMed

Fujita, Tamaki; Miura, Hiroyuki; Seino, Hiroko; Ono, Shuichi; Nishi, Takashi; Nishimura, Akimasa; Hakamada, Kenichi; Aoki, Masahiko

2018-05-03

To evaluate the anatomical classification and location of breast sentinel lymph nodes, preoperative computed tomography-lymphography examinations were retrospectively reviewed for sentinel lymph nodes in 464 cases clinically diagnosed with node-negative breast cancer between July 2007 and June 2016. Anatomical classification was performed based on the numbers of lymphatic routes and sentinel lymph nodes, the flow direction of lymphatic routes, and the location of sentinel lymph nodes. Of the 464 cases reviewed, anatomical classification could be performed in 434 (93.5 %). The largest number of cases showed single route/single sentinel lymph node (n = 296, 68.2 %), followed by multiple routes/multiple sentinel lymph nodes (n = 59, 13.6 %), single route/multiple sentinel lymph nodes (n = 53, 12.2 %), and multiple routes/single sentinel lymph node (n = 26, 6.0 %). Classification based on the flow direction of lymphatic routes showed that 429 cases (98.8 %) had outward flow on the superficial fascia toward axillary lymph nodes, whereas classification based on the height of sentinel lymph nodes showed that 323 cases (74.4 %) belonged to the upper pectoral group of axillary lymph nodes. There was wide variation in the number of lymphatic routes and their branching patterns and in the number, location, and direction of flow of sentinel lymph nodes. It is clinically very important to preoperatively understand the anatomical morphology of lymphatic routes and sentinel lymph nodes for optimal treatment of breast cancer, and computed tomography-lymphography is suitable for this purpose.

Case Management for Patients with Complex Multimorbidity: Development and Validation of a Coordinated Intervention between Primary and Hospital Care

PubMed Central

Giménez-Campos, María Soledad; Villar-López, Julia; Faubel-Cava, Raquel; Donat-Castelló, Lucas; Valdivieso-Martínez, Bernardo; Soriano-Melchor, Elisa; Bahamontes-Mulió, Amparo; García-Gómez, Juan M.

2017-01-01

In the past few years, healthcare systems have been facing a growing demand related to the high prevalence of chronic diseases. Case management programs have emerged as an integrated care approach for the management of chronic disease. Nevertheless, there is little scientific evidence on the impact of using a case management program for patients with complex multimorbidity regarding hospital resource utilisation. We evaluated an integrated case management intervention set up by community-based care at outpatient clinics with nurse case managers from a telemedicine unit. The hypothesis to be tested was whether improved continuity of care resulting from the integration of community-based and hospital services reduced the use of hospital resources amongst patients with complex multimorbidity. A retrospective cohort study was performed using a sample of 714 adult patients admitted to the program between January 2012 and January 2015. We found a significant decrease in the number of emergency room visits, unplanned hospitalizations, and length of stay, and an expected increase in the home care hospital-based episodes. These results support the hypothesis that case management interventions can reduce the use of unplanned hospital admissions when applied to patients with complex multimorbidity. PMID:28970745

A cloud-based multimodality case file for mobile devices.

PubMed

Balkman, Jason D; Loehfelm, Thomas W

2014-01-01

Recent improvements in Web and mobile technology, along with the widespread use of handheld devices in radiology education, provide unique opportunities for creating scalable, universally accessible, portable image-rich radiology case files. A cloud database and a Web-based application for radiologic images were developed to create a mobile case file with reasonable usability, download performance, and image quality for teaching purposes. A total of 75 radiology cases related to breast, thoracic, gastrointestinal, musculoskeletal, and neuroimaging subspecialties were included in the database. Breast imaging cases are the focus of this article, as they best demonstrate handheld display capabilities across a wide variety of modalities. This case subset also illustrates methods for adapting radiologic content to cloud platforms and mobile devices. Readers will gain practical knowledge about storage and retrieval of cloud-based imaging data, an awareness of techniques used to adapt scrollable and high-resolution imaging content for the Web, and an appreciation for optimizing images for handheld devices. The evaluation of this software demonstrates the feasibility of adapting images from most imaging modalities to mobile devices, even in cases of full-field digital mammograms, where high resolution is required to represent subtle pathologic features. The cloud platform allows cases to be added and modified in real time by using only a standard Web browser with no application-specific software. Challenges remain in developing efficient ways to generate, modify, and upload radiologic and supplementary teaching content to this cloud-based platform. Online supplemental material is available for this article. ©RSNA, 2014.

Effect of the Axial Spacing between Vanes and Blades on a Transonic Gas Turbine Performance and Blade Loading

NASA Astrophysics Data System (ADS)

Chang, Dongil; Tavoularis, Stavros

2013-03-01

Unsteady numerical simulations have been conducted to investigate the effect of axial spacing between the stator vanes and the rotor blades on the performance of a transonic, single-stage, high-pressure, axial turbine. Three cases were considered, the normal case, which is based on the geometry of a commercial jet engine and has an axial spacing at 50% blade span equal to 42% of the vane axial chord, as well as two other cases with axial spacings equal to 31 and 52% vane axial chords, respectively. Present interest has focused on the effect of axial gap size on the instantaneous and time-averaged flows as well as on the blade loading and the turbine performance. Decreasing the gap size reduced the pressure and increased the Mach number in the core flows in the gap region. However, the flows near the two endwalls did not follow monotonic trends with the gap size change; instead, the Mach numbers for both the small gap and the large gap cases were lower than that for the normal case. This Mach number decrease was attributed to increased turbulence due to the increased wake strength for the small gap case and an increased wake width for the large gap case. In all considered cases, large pressure fluctuations were observed in the front region of the blade suction side. These pressure fluctuations were strongest for the smaller spacing. The turbine efficiencies of the cases with the larger and smaller spacings were essentially the same, but both were lower than that of the normal case. The stator loss for the smaller spacing case was lower than the one for the larger spacing case, whereas the opposite was true for the rotor loss.

Automated detection of tuberculosis on sputum smeared slides using stepwise classification

NASA Astrophysics Data System (ADS)

Divekar, Ajay; Pangilinan, Corina; Coetzee, Gerrit; Sondh, Tarlochan; Lure, Fleming Y. M.; Kennedy, Sean

2012-03-01

Routine visual slide screening for identification of tuberculosis (TB) bacilli in stained sputum slides under microscope system is a tedious labor-intensive task and can miss up to 50% of TB. Based on the Shannon cofactor expansion on Boolean function for classification, a stepwise classification (SWC) algorithm is developed to remove different types of false positives, one type at a time, and to increase the detection of TB bacilli at different concentrations. Both bacilli and non-bacilli objects are first analyzed and classified into several different categories including scanty positive, high concentration positive, and several non-bacilli categories: small bright objects, beaded, dim elongated objects, etc. The morphological and contrast features are extracted based on aprior clinical knowledge. The SWC is composed of several individual classifiers. Individual classifier to increase the bacilli counts utilizes an adaptive algorithm based on a microbiologist's statistical heuristic decision process. Individual classifier to reduce false positive is developed through minimization from a binary decision tree to classify different types of true and false positive based on feature vectors. Finally, the detection algorithm is was tested on 102 independent confirmed negative and 74 positive cases. A multi-class task analysis shows high accordance rate for negative, scanty, and high-concentration as 88.24%, 56.00%, and 97.96%, respectively. A binary-class task analysis using a receiver operating characteristics method with the area under the curve (Az) is also utilized to analyze the performance of this detection algorithm, showing the superior detection performance on the high-concentration cases (Az=0.913) and cases mixed with high-concentration and scanty cases (Az=0.878).

Optimal Contractor Selection in Construction Industry: The Fuzzy Way

NASA Astrophysics Data System (ADS)

Krishna Rao, M. V.; Kumar, V. S. S.; Rathish Kumar, P.

2018-02-01

A purely price-based approach to contractor selection has been identified as the root cause for many serious project delivery problems. Therefore, the capability of the contractor to execute the project should be evaluated using a multiple set of selection criteria including reputation, past performance, performance potential, financial soundness and other project specific criteria. An industry-wide questionnaire survey was conducted with the objective of identifying the important criteria for adoption in the selection process. In this work, a fuzzy set based model was developed for contractor prequalification/evaluation, by using effective criteria obtained from the percept of construction professionals, taking subjective judgments of decision makers also into consideration. A case study consisting of four alternatives (contractors in the present case) solicited from a public works department of Pondicherry in India, is used to illustrate the effectiveness of the proposed approach. The final selection of contractor is made based on the integrated score or Overall Evaluation Score of the decision alternative in prequalification as well as bid evaluation stages.

High-performance liquid chromatographic enantioseparation of monoterpene-based 2-amino carboxylic acids on macrocyclic glycopeptide-based phases.

PubMed

Sipos, László; Ilisz, István; Pataj, Zoltán; Szakonyi, Zsolt; Fülöp, Ferenc; Armstrong, Daniel W; Péter, Antal

2010-10-29

The enantiomers of five monoterpene-based 2-amino carboxylic acids were directly separated on chiral stationary phases containing macrocyclic glycopeptide antibiotics such as teicoplanin (Astec Chirobiotic T and T2) and teicoplanin aglycone (Chirobiotic TAG) as chiral selectors. The effects of pH, the mobile phase composition, the structure of the analyte and temperature on the separations were investigated. Experiments were performed at constant mobile phase compositions in the temperature range 10-40°C to study the effects of temperature and thermodynamic parameters on separations. Apparent thermodynamic parameters and T(iso) values were calculated from plots of ln k or ln α versus 1/T. Some mechanistic aspects of the chiral recognition process are discussed with respect to the structures of the analytes. It was found that the enantioseparations were in most cases enthalpy driven. The sequence of elution of the enantiomers was determined in all cases. Copyright © 2010 Elsevier B.V. All rights reserved.

Noninvasive Prenatal Paternity Testing (NIPAT) through Maternal Plasma DNA Sequencing: A Pilot Study.

PubMed

Jiang, Haojun; Xie, Yifan; Li, Xuchao; Ge, Huijuan; Deng, Yongqiang; Mu, Haofang; Feng, Xiaoli; Yin, Lu; Du, Zhou; Chen, Fang; He, Nongyue

2016-01-01

Short tandem repeats (STRs) and single nucleotide polymorphisms (SNPs) have been already used to perform noninvasive prenatal paternity testing from maternal plasma DNA. The frequently used technologies were PCR followed by capillary electrophoresis and SNP typing array, respectively. Here, we developed a noninvasive prenatal paternity testing (NIPAT) based on SNP typing with maternal plasma DNA sequencing. We evaluated the influence factors (minor allele frequency (MAF), the number of total SNP, fetal fraction and effective sequencing depth) and designed three different selective SNP panels in order to verify the performance in clinical cases. Combining targeted deep sequencing of selective SNP and informative bioinformatics pipeline, we calculated the combined paternity index (CPI) of 17 cases to determine paternity. Sequencing-based NIPAT results fully agreed with invasive prenatal paternity test using STR multiplex system. Our study here proved that the maternal plasma DNA sequencing-based technology is feasible and accurate in determining paternity, which may provide an alternative in forensic application in the future.

The Beast of Aggregating Cognitive Load Measures in Technology-Based Learning

ERIC Educational Resources Information Center

Leppink, Jimmie; van Merriënboer, Jeroen J. G.

2015-01-01

An increasing part of cognitive load research in technology-based learning includes a component of repeated measurements, that is: participants are measured two or more times on the same performance, mental effort or other variable of interest. In many cases, researchers aggregate scores obtained from repeated measurements to one single sum or…

Universities and Innovation in a Factor-Driven Economy: The Performance of Universities in Egypt

ERIC Educational Resources Information Center

El Hadidi, Hala; Kirby, David A.

2016-01-01

In the contemporary knowledge-based global economy, universities are required to operate more entrepreneurially, commercializing the results of their research and spinning out new knowledge-based enterprises. In this article, the third in a series by the authors, case studies are presented of activities in three Egyptian universities to…

78 FR 18865 - Defense Federal Acquisition Regulation Supplement: Proposal Adequacy Checklist (DFARS Case 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-28

..., applicable CLIN, Work Breakdown Structure, rationale for estimate, applicable history, and time-phasing... price adjustments, not just those based on indices. Checklist item 45 (final rule item 35) is modified to read ``If the offeror is proposing Performance-Based Payments did the offeror comply with FAR...

Evaluating Automatic Speech Recognition-Based Language Learning Systems: A Case Study

ERIC Educational Resources Information Center

van Doremalen, Joost; Boves, Lou; Colpaert, Jozef; Cucchiarini, Catia; Strik, Helmer

2016-01-01

The purpose of this research was to evaluate a prototype of an automatic speech recognition (ASR)-based language learning system that provides feedback on different aspects of speaking performance (pronunciation, morphology and syntax) to students of Dutch as a second language. We carried out usability reviews, expert reviews and user tests to…

CSER 01-008 Canning of Thermally Stabilized Plutonium Oxide Powder in PFP Glovebox HC-21A

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

ERICKSON, D.G.

This document presents the analysis performed to support the canning operation in HC-21A. Most of the actual analysis was performed for the operation in HC-18M and HA-20MB, and is documented in HNF-2707 Rev I a (Erickson 2001a). This document will reference Erickson (2001a) as necessary to support the operation in HC-21A. The plutonium stabilization program at the Plutonium Finishing Plant (PFP) uses heat to convert plutonium-bearing materials into dry powder that is chemically stable for long term storage. The stabilized plutonium is transferred into one of several gloveboxes for the canning process, Gloveboxes HC-18M in Room 228'2, HA-20MB in Roommore » 235B, and HC-21A in Room 230B are to be used for this process. This document presents the analysis performed to support the canning operation in HC-21A. Most of the actual analysis was performed for the operation in HC-I8M and HA-20MB, and is documented in HNF-2707 Rev l a (Erickson 2001a). This document will reference Erickson (2001a) as necessary to support the operation in HC-21A. Evaluation of this operation included normal, base cases, and contingencies. The base cases took the normal operations for each type of feed material and added the likely off-normal events. Each contingency is evaluated assuming the unlikely event happens to the conservative base case. Each contingency was shown to meet the double contingency requirement. That is, at least two unlikely, independent, and concurrent changes in process conditions are required before a criticality is possible.« less

Template-directed instrumentation in total knee arthroplasty: cost savings analysis.

PubMed

Hsu, Andrew R; Gross, Christopher E; Bhatia, Sanjeev; Levine, Brett R

2012-11-01

The use of digital radiography and templating software in total knee arthroplasty (TKA) continues to become more prevalent as the number of procedures performed increases every year. Template-directed instrumentation (TDI) is a novel approach to surgical planning that combines digital templating with limited intraoperative instruments. The purpose of this study was to evaluate the financial implications and radiographic outcomes of using TDI to direct instrumentation during primary TKA. Over a 1-year period, 82 consecutive TKAs using TDI were retrospectively reviewed. Patient demographics and preoperative templated sizes of predicted components were recorded, and OrthoView digital planning software (OrthoView LLC, Jacksonville, Florida was used to determine the 2 most likely tibial and femoral component sizes for each case. This sizing information was used to direct component vendors to prepare 3 lightweight instrument trays based on these sizes. The sizes of implanted components and the number of total trays required were documented. A cost savings analysis was performed to compare TDI and non-TDI surgical expenses for TKA. In 80 (97%) of 82 cases, the prepared sizes determined by TDI using 3 instrument trays were sufficient. Preoperative templating correctly predicted the size of the tibial and femoral component sizes in 90% and 83% of cases, respectively. The average number of trays used with TDI was 3.0 (range, 3-5 trays) compared with 7.5 (range, 6-9 trays) used in 82 preceding non-TDI TKAs. Based on standard fees to sterilize and package implant trays (approximately $26 based on a survey of 10 orthopedic hospitals performing TKA), approximately $9612 was saved by using TDI over the 1-year study period. Overall, digital templating and TDI were a simple and cost-effective approach when performing primary TKA. Copyright 2012, SLACK Incorporated.

An approach to checking case-crossover analyses based on equivalence with time-series methods.

PubMed

Lu, Yun; Symons, James Morel; Geyh, Alison S; Zeger, Scott L

2008-03-01

The case-crossover design has been increasingly applied to epidemiologic investigations of acute adverse health effects associated with ambient air pollution. The correspondence of the design to that of matched case-control studies makes it inferentially appealing for epidemiologic studies. Case-crossover analyses generally use conditional logistic regression modeling. This technique is equivalent to time-series log-linear regression models when there is a common exposure across individuals, as in air pollution studies. Previous methods for obtaining unbiased estimates for case-crossover analyses have assumed that time-varying risk factors are constant within reference windows. In this paper, we rely on the connection between case-crossover and time-series methods to illustrate model-checking procedures from log-linear model diagnostics for time-stratified case-crossover analyses. Additionally, we compare the relative performance of the time-stratified case-crossover approach to time-series methods under 3 simulated scenarios representing different temporal patterns of daily mortality associated with air pollution in Chicago, Illinois, during 1995 and 1996. Whenever a model-be it time-series or case-crossover-fails to account appropriately for fluctuations in time that confound the exposure, the effect estimate will be biased. It is therefore important to perform model-checking in time-stratified case-crossover analyses rather than assume the estimator is unbiased.

Affordable Design: A Methodolgy to Implement Process-Based Manufacturing Cost into the Traditional Performance-Focused Multidisciplinary Design Optimization

NASA Technical Reports Server (NTRS)

Bao, Han P.; Samareh, J. A.

2000-01-01

The primary objective of this paper is to demonstrate the use of process-based manufacturing and assembly cost models in a traditional performance-focused multidisciplinary design and optimization process. The use of automated cost-performance analysis is an enabling technology that could bring realistic processbased manufacturing and assembly cost into multidisciplinary design and optimization. In this paper, we present a new methodology for incorporating process costing into a standard multidisciplinary design optimization process. Material, manufacturing processes, and assembly processes costs then could be used as the objective function for the optimization method. A case study involving forty-six different configurations of a simple wing is presented, indicating that a design based on performance criteria alone may not necessarily be the most affordable as far as manufacturing and assembly cost is concerned.

Optimizing the arrival, waiting, and NPO times of children on the day of pediatric endoscopy procedures.

PubMed

Smallman, Bettina; Dexter, Franklin

2010-03-01

Research in predictive variability of operating room (OR) times has been performed using data from multidisciplinary, tertiary hospitals with mostly adult patients. In this article, we discuss case-duration prediction for children receiving general anesthesia for endoscopy. We critique which of the several types of OR management decisions dependent on accuracy of prediction are relevant to series (lists) of brief pediatric anesthetics. OR information system data were obtained for all children (aged 18 years and younger) undergoing a gastroenterology procedure with an anesthesiologist over 21 months. Summaries of data were used for a qualitative, systematic review of prior studies to learn which apply to brief pediatric cases. Patient arrival times were changed to be based on the statistical method relating actual and scheduled start times (Wachtel and Dexter, Anesth Analg 2007;105:127-40). Even perfect case-duration prediction would not affect whether a brief case was performed on a certain date and/or in a certain OR. There was no evidence of usefulness in calculating the probability that one case would last longer than another or in resequencing cases to influence postanesthesia care unit staffing or patient waiting from scheduled start times. The only decision for which the accuracy of case-duration prediction mattered was for the shortest time that preceding cases in the OR may take. Knowledge of the preceding procedures in the OR was not useful for that purpose because there were hundreds of combinations of preceding procedures and some cases cancelled. Instead, patient ready times were chosen based on 5% lower prediction bounds for ratios of actual to scheduled OR times. The approach was useful based on a 30% reduction in patient waiting times from scheduled start times with corresponding expected reductions in average and peak numbers of patients in the holding area. For brief pediatric OR anesthetics, predictive variability of case durations matters principally to the extent that it affects appropriate patient ready times. Such times should not be chosen by having patients start fasting, arrive, and be ready fixed numbers of hours before their scheduled start times.

Accounting for estimated IQ in neuropsychological test performance with regression-based techniques.

PubMed

Testa, S Marc; Winicki, Jessica M; Pearlson, Godfrey D; Gordon, Barry; Schretlen, David J

2009-11-01

Regression-based normative techniques account for variability in test performance associated with multiple predictor variables and generate expected scores based on algebraic equations. Using this approach, we show that estimated IQ, based on oral word reading, accounts for 1-9% of the variability beyond that explained by individual differences in age, sex, race, and years of education for most cognitive measures. These results confirm that adding estimated "premorbid" IQ to demographic predictors in multiple regression models can incrementally improve the accuracy with which regression-based norms (RBNs) benchmark expected neuropsychological test performance in healthy adults. It remains to be seen whether the incremental variance in test performance explained by estimated "premorbid" IQ translates to improved diagnostic accuracy in patient samples. We describe these methods, and illustrate the step-by-step application of RBNs with two cases. We also discuss the rationale, assumptions, and caveats of this approach. More broadly, we note that adjusting test scores for age and other characteristics might actually decrease the accuracy with which test performance predicts absolute criteria, such as the ability to drive or live independently.

Emergency canine surgery in a deployed forward surgical team: a case report.

PubMed

Beitler, Alan L; Jeanette, Joseph P; McGraw, Andrew L; Butera, Jennifer R; Vanfosson, Christopher A; Seery, Jason M

2011-04-01

Forward surgical teams (FSTs) perform a variety of non-doctrinal functions. During their deployment to Afghanistan, the 541st FST (Airborne) performed emergency surgery on a German shepherd military working dog (MWD). Retrospective examination of a case of veterinary surgery in a deployed FST. A 5 1/2-year-old German shepherd MWD presented with extreme lethargy, tachycardia, excessive drooling, and a firm, distended abdomen. These conditions resulted from gastric dilatation with volvulus. Since evacuation to a veterinarian was untenable, emergency laparotomy was performed in the FST. The gastric dilatation with volvulus was treated by detorsion and gastropexy, and the canine patient fully recovered. Canine surgery can be safely performed in an FST. Based on the number of MWDs deployed throughout the theater, FSTs may be called upon to care for them in the absence of available veterinary care.

A study of a nursing department performance measurement system: using the Balanced Scorecard and the Analytic Hierarchy Process.

PubMed

Chu, Hsuan-Lien; Wang, Chen-Chin; Dai, Yu-Tzu

2009-01-01

The health care industry is under pressure from government and private entities as well as from market conditions to contain costs. In an effort to respond to these pressures, the case hospital in this study implemented a Balanced Scorecard (BSC) in January 2003 and integrated it with the hospital's formal incentive plan for non-physicians in January 2005. The nursing department's performance improved in the 2 years following the introduction of the plan. This study contributes to the literature by demonstrating the performance improvement that results from integrating the BSC with an incentive plan in the nursing field. The results provide insight into the current BSC performance metrics applied by the case nursing department, and could be used as guidelines by other health care organizations that wish to implement BSC-based incentive plans.

Modeling of Radiotherapy Linac Source Terms Using ARCHER Monte Carlo Code: Performance Comparison for GPU and MIC Parallel Computing Devices

NASA Astrophysics Data System (ADS)

Lin, Hui; Liu, Tianyu; Su, Lin; Bednarz, Bryan; Caracappa, Peter; Xu, X. George

2017-09-01

Monte Carlo (MC) simulation is well recognized as the most accurate method for radiation dose calculations. For radiotherapy applications, accurate modelling of the source term, i.e. the clinical linear accelerator is critical to the simulation. The purpose of this paper is to perform source modelling and examine the accuracy and performance of the models on Intel Many Integrated Core coprocessors (aka Xeon Phi) and Nvidia GPU using ARCHER and explore the potential optimization methods. Phase Space-based source modelling for has been implemented. Good agreements were found in a tomotherapy prostate patient case and a TrueBeam breast case. From the aspect of performance, the whole simulation for prostate plan and breast plan cost about 173s and 73s with 1% statistical error.

What is the Current Knowledge About the Cardiovascular Risk for Users of Cannabis-Based Products? A Systematic Review.

PubMed

Jouanjus, Emilie; Raymond, Valentin; Lapeyre-Mestre, Maryse; Wolff, Valérie

2017-06-01

The purpose of the study was to examine the published evidence on the cardiovascular risk related to the use of cannabis-based products by performing a systematic review of recent literature. The World Health Organization (WHO) emphasizes that cannabis use represents a risky behavior as it may lead to many adverse effects, and in particular, cardiovascular effects. A systematic review of articles published between January 1, 2011 and May 31, 2016 was performed in agreement with the PRISMA statement. Articles presenting data on humans exposed to cannabis-based products and suffering from any cardiovascular condition were eligible for inclusion. The inclusion process was based on a search algorithm and performed in a blinded standardized manner. Overall, 826 articles were found in the literature search, 115 of which remained after performing the inclusion procedure. These were 81 case reports, 29 observational studies, 3 clinical trials, and 2 experimental studies. A total of 116 individuals was the subject of case reports. The mean age was 31 years (95%CI = 29-34), and patients were more frequently men (81.9%) than women (18.1%). They mainly suffered from ischemic strokes or myocardial infarctions. Data provided by the 29 included observational studies evidenced an association between exposure to cannabis-based products and cardiovascular disease. Currently, this evidence is stronger for ischemic strokes than for any other cardiovascular diseases. While the data are limited, there is some suggestion that cannabis use may have negative cardiovascular consequences, particularly at large doses.

Rare variant association analysis in case-parents studies by allowing for missing parental genotypes.

PubMed

Li, Yumei; Xiang, Yang; Xu, Chao; Shen, Hui; Deng, Hongwen

2018-01-15

The development of next-generation sequencing technologies has facilitated the identification of rare variants. Family-based design is commonly used to effectively control for population admixture and substructure, which is more prominent for rare variants. Case-parents studies, as typical strategies in family-based design, are widely used in rare variant-disease association analysis. Current methods in case-parents studies are based on complete case-parents data; however, parental genotypes may be missing in case-parents trios, and removing these data may lead to a loss in statistical power. The present study focuses on testing for rare variant-disease association in case-parents study by allowing for missing parental genotypes. In this report, we extended the collapsing method for rare variant association analysis in case-parents studies to allow for missing parental genotypes, and investigated the performance of two methods by using the difference of genotypes between affected offspring and their corresponding "complements" in case-parent trios and TDT framework. Using simulations, we showed that, compared with the methods just only using complete case-parents data, the proposed strategy allowing for missing parental genotypes, or even adding unrelated affected individuals, can greatly improve the statistical power and meanwhile is not affected by population stratification. We conclude that adding case-parents data with missing parental genotypes to complete case-parents data set can greatly improve the power of our strategy for rare variant-disease association.

The Effect of Theme Preference on Academic Word List Use: A Case for Smartphone Video Recording Feature

ERIC Educational Resources Information Center

Gromik, Nicolas A.

2017-01-01

Sixty-seven Japanese English as a Second Language undergraduate learners completed one smartphone video production per week for 12 weeks, based on a teacher-selected theme. Designed as a case study for this specific context, data from students' oral performances was analyzed on a weekly basis for their use of the Academic Word List (AWL). A…

Designing Multimedia Learning Application with Learning Theories: A Case Study on a Computer Science Subject with 2-D and 3-D Animated Versions

ERIC Educational Resources Information Center

Rias, Riaza Mohd; Zaman, Halimah Badioze

2011-01-01

Higher learning based instruction may be primarily concerned in most cases with the content of their academic lessons, and not very much with their instructional delivery. However, the effective application of learning theories and technology in higher education has an impact on student performance. With the rapid progress in the computer and…

Changing behavior and accuracy with time on task in mammography screening

NASA Astrophysics Data System (ADS)

Taylor-Phillips, Sian; Jenkinson, David; Stinton, Chris; Wallis, Matthew G.; Clarke, Aileen

2017-03-01

Background: The vigilance decrement and prevalence effect both describe changes to speed and accuracy with time on task. Whilst there is much laboratory based research on these effects, little is known about whether they occur in real world mammography practice. Methods: The Changing Case Order to Optimise Patterns of Performance in Screening (CO-OPS) trial randomised 37,724 batches containing 1.2 million women attending breast screening to intervention or control (222,208 from the Midlands of England). In the control arm the batch was examined in the same order by both readers, in the intervention arm it was examined in a different order by both readers. Time taken, recall decision by both readers, and cancers detected were recorded for each case, and used to examine patterns of performance with time on task. Results: 49,575 women were recalled and 10,484 had cancer detected. Median time taken to examine each case was 35 seconds (out of cases where time taken was 10 minutes or less). The intervention did not affect overall cancer detection rates or recall rates. A more detailed analysis of the Midlands data indicates cancer detection rate did not change when reading up to 60 cases in a batch, but recall rate reduced. Time taken per case reduced with time on task, from a median 41 seconds when examining the second case in the batch to 28.5 seconds examining the 60th case. Conclusion: Reader behavior and performance systematically changes with time on task in breast screening.

Practice Characteristics of Emergency Department Extracorporeal Cardiopulmonary Resuscitation (eCPR) Programs in the United States: The Current State of the Art of Emergency Department Extracorporeal Membrane Oxygenation (ED ECMO)

PubMed Central

Tonna, Joseph E.; Johnson, Nicholas J; Greenwood, John; Gaieski, David F; Shinar, Zachary; Bellezo, Joseph M.; Becker, Lance; Shah, Atman P.; Youngquist, Scott T.; Mallin, Michael P; Fair, James Franklin; Gunnerson, Kyle J.; Weng, Cindy; McKellar, Stephen

2017-01-01

Purpose To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. Methods We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel. Results Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤ 3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow®. Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (>85%) involve CT surgeons, perfusionists, and pharmacists. Conclusions Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable. PMID:27523953

The impact of charge on the cooling performance of an air-to-air heat pump for R-22 and three binary blends of R-32 and R-134a

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

Robinson, J.H.; O`Neal, D.L.

1994-12-31

An experimental study was conducted in which the performance of three blends of R-134a and R-32 was compared to that of R-22. The effect of refrigerant charge on the performance of these refrigerants in an air-to-air heat pump operating in the cooling mode was quantified The mixtures consisted of 40%/60%, 30%/70%, and 20%/80% ratios (by mass) of R-32 and R-134a. Charge levels of 5.00, 5.45, 5.90, and 6.00 kg (11, 12, 13, and 14 lb) were tested. At each charge level, outdoor room conditions of 27.8 C, 35.0 C, and 40.6 C (82 F, 95 F, and 105 F) weremore » tested The expansion device for all tests was a 1.96 mm (0.077 in.) diameter orifice. Three variables were used to quantify refrigerant performance-total capacity, total electrical power consumption, and coefficient of performance (COP). The performance of the heat pump with any of the three mixtures was not as good as with R-22. The capacities were between 7% and 17% less than with R-22. The best COPs with the mixtures were within 3% of that with R-22 in some cases, but the corresponding capacities at these COPs were approximately 12% lower than that in the R-22 base case. The best results for a mixture were with the 40%/60% blend. The capacity was 7.3% less than the base case and the COP was 8.5% lower.« less

Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO).

PubMed

Tonna, Joseph E; Johnson, Nicholas J; Greenwood, John; Gaieski, David F; Shinar, Zachary; Bellezo, Joseph M; Becker, Lance; Shah, Atman P; Youngquist, Scott T; Mallin, Michael P; Fair, James Franklin; Gunnerson, Kyle J; Weng, Cindy; McKellar, Stephen

2016-10-01

To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel. Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow(®). Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (>85%) involve CT surgeons, perfusionists, and pharmacists. Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context.

PubMed

Smith, Neale; Mitton, Craig; Hall, William; Bryan, Stirling; Donaldson, Cam; Peacock, Stuart; Gibson, Jennifer L; Urquhart, Bonnie

2016-08-01

Priority setting and resource allocation, or PSRA, are key functions of executive teams in healthcare organizations. Yet decision-makers often base their choices on historical patterns of resource distribution or political pressures. Our aim was to provide leaders with guidance on how to improve PSRA practice, by creating organizational contexts which enable high performance. We carried out in-depth case studies of six Canadian healthcare organizations to obtain from healthcare leaders their understanding of the concept of high performance in PSRA and the factors which contribute to its achievement. Individual and group interviews were carried out (n = 62) with senior managers, middle managers and Board members. Site observations and document review were used to assist researchers in interpreting the interview data. Qualitative data were analyzed iteratively with the literature on empirical examples of PSRA practice, in order to develop a framework of high performance in PSRA. The framework consists of four domains - structures, processes, attitudes and behaviours, and outcomes - within which are 19 specific elements. The emergent themes derive from case studies in different kinds of health organizations (urban/rural, small/large) across Canada. The elements can serve as a checklist for 'high performance' in PSRA. This framework provides a means by which decision-makers in healthcare might assess their practice and identify key areas for improvement. The findings are likely generalizable, certainly within Canada but also across countries. This work constitutes, to our knowledge, the first attempt to present a full package of elements comprising high performance in health care PSRA. Copyright © 2016 Elsevier Ltd. All rights reserved.

Advanced Shock Position Control for Mode Transition in a Turbine Based Combined Cycle Engine Inlet Model

NASA Technical Reports Server (NTRS)

Csank, Jeffrey T.; Stueber, Thomas J.

2013-01-01

A dual flow-path inlet system is being tested to evaluate methodologies for a Turbine Based Combined Cycle (TBCC) propulsion system to perform a controlled inlet mode transition. Prior to experimental testing, simulation models are used to test, debug, and validate potential control algorithms. One simulation package being used for testing is the High Mach Transient Engine Cycle Code simulation, known as HiTECC. This paper discusses the closed loop control system, which utilizes a shock location sensor to improve inlet performance and operability. Even though the shock location feedback has a coarse resolution, the feedback allows for a reduction in steady state error and, in some cases, better performance than with previous proposed pressure ratio based methods. This paper demonstrates the design and benefit with the implementation of a proportional-integral controller, an H-Infinity based controller, and a disturbance observer based controller.

The occupational safety and health scorecard--a business case example for strategic management.

PubMed

Köper, Birgit; Möller, Klaus; Zwetsloot, Gerard

2009-12-01

Human resources and health issues are crucial in terms of corporate competitiveness. However, systematic, continuous and strategically aligned occupational safety and health (OSH) management is scarcely applied in companies. One major reason for this could be the lack of generally accepted and standardised OSH control methods. Our objective was thus to conceptualize a method by which qualitative factors such as human resources and OSH aspects contribute to the performance or value-added layer of an organization. We developed a business case based on the well-known and accepted Balanced Scorecard approach, which we adapted and applied to the management of OSH issues. The concept was implemented in the course of a comprehensive case study at a German automobile manufacturer. We gathered health as well as finance data in order to test which health-related indicators had an impact on financial performance. The demonstration of, and reporting on, how the promotion of workplace health contributes strategically to the organization is crucial for both health and human resource managers. Based on multivariate regression analyses, our main finding was that the Balanced Scorecard approach is an adequate means to control OSH issues in terms of strategic health management. Our analyses demonstrated that health-related interventions contribute significantly to performance aspects such as quality, productivity, absenteeism, and cost reduction. Therefore, the financial impact of health-related aspects / interventions could be demonstrated by means of the OSH scorecard. The availability and quality of health data within the context of overall corporate performance data needs to be improved in order to bridge OSH-related and performance issues of an organization.

Comparisons of the Outcome Prediction Performance of Injury Severity Scoring Tools Using the Abbreviated Injury Scale 90 Update 98 (AIS 98) and 2005 Update 2008 (AIS 2008)

PubMed Central

Tohira, Hideo; Jacobs, Ian; Mountain, David; Gibson, Nick; Yeo, Allen

2011-01-01

The Abbreviated Injury Scale (AIS) was revised in 2005 and updated in 2008 (AIS 2008). We aimed to compare the outcome prediction performance of AIS-based injury severity scoring tools by using AIS 2008 and AIS 98. We used all major trauma patients hospitalized to the Royal Perth Hospital between 1994 and 2008. We selected five AIS-based injury severity scoring tools, including Injury Severity Score (ISS), New Injury Severity Score (NISS), modified Anatomic Profile (mAP), Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). We selected survival after injury as a target outcome. We used the area under the Receiver Operating Characteristic curve (AUROC) as a performance measure. First, we compared the five tools using all cases whose records included all variables for the TRISS (complete dataset) using a 10-fold cross-validation. Second, we compared the ISS and NISS for AIS 98 and AIS 2008 using all subjects (whole dataset). We identified 1,269 and 4,174 cases for a complete dataset and a whole dataset, respectively. With the 10-fold cross-validation, there were no clear differences in the AUROCs between the AIS 98- and AIS 2008-based scores. With the second comparison, the AIS 98-based ISS performed significantly worse than the AIS 2008-based ISS (p<0.0001), while there was no significant difference between the AIS 98- and AIS 2008-based NISSs. Researchers should be aware of these findings when they select an injury severity scoring tool for their studies. PMID:22105401

Intraoperative Magnetic Resonance Imaging in Skull Base Surgery: A Review of 71 Consecutive Cases.

PubMed

Ashour, Ramsey; Reintjes, Stephen; Park, Michael S; Sivakanthan, Sananthan; van Loveren, Harry; Agazzi, Siviero

2016-09-01

Although intraoperative magnetic resonance imaging (iMRI) increasingly is used during glioma resection, its role in skull base surgery has not been well documented. In this study, we evaluate our experience with iMRI for skull base surgery. Medical records were reviewed retrospectively on all neurosurgical cases performed at our institution in the IMRIS iMRI suite between April 2014 and July 2015. During the study period, the iMRI suite was used for 71 skull base tumors. iMRI was performed in 23 of 71 cases. Additional tumor resection was pursued after scanning in 7 of 23 patients. There was a significant difference in procedure length between the scanned versus nonscanned groups, and this was likely attributable to a greater proportion of petroclival meningiomas in the scanned group. Further analyses revealed significant increases in procedure length for the following scanned subgroups: anterolateral approach, anterolateral and petroclival lesion locations, and meningiomas. The rate of non-neurologic complications was significantly greater in the scanned group, particularly for patients with tumors >3 cm. Despite the unique challenges associated with skull base tumor surgery, iMRI can be safely obtained while adding a modest although not prohibitive amount of time to the procedure. The immediate evidence of residual tumor with a patient still in position to have additional resection may influence the surgeon to alter the surgical plan and attempt further resection in a critical area. Copyright © 2016 Elsevier Inc. All rights reserved.

Detection of fetal sex chromosome aneuploidy by massively parallel sequencing of maternal plasma DNA: initial experience in a Chinese hospital.

PubMed

Yao, H; Jiang, F; Hu, H; Gao, Y; Zhu, Z; Zhang, H; Wang, Y; Guo, Y; Liu, L; Yuan, Y; Zhou, L; Wang, J; Du, B; Qu, N; Zhang, R; Dong, Y; Xu, H; Chen, F; Jiang, H; Liu, Y; Zhang, L; Tian, Z; Liu, Q; Zhang, C; Pan, X; Yang, S; Zhao, L; Wang, W; Liang, Z

2014-07-01

To evaluate the performance of a massively parallel sequencing (MPS)-based test in detecting fetal sex chromosome aneuploidy (SCA) and to present a comprehensive clinical counseling protocol for SCA-positive patients. This was a retrospective study in a large patient cohort of 5950 singleton pregnancies which underwent MPS-based testing as a prenatal screening test for trisomies 21, 18 and 13, with X and Y chromosomes as secondary findings, in Southwest Hospital in China. MPS-based SCA-positive women were offered the choice of knowing whether their SCA results were positive and those who did commenced a two-stage post-test clinical counseling protocol. In Stage 1, general information about SCA was given, and women were given the option of invasive testing for confirmation of findings; in Stage 2, those who had chosen to undergo invasive testing were informed about the specific SCA affecting their fetus and their management options. Thirty-three cases were classified as SCA-positive by MPS-based testing. After Stage 1 of the two-stage post-test clinical counseling session, 33 (100%) of these pregnant women chose to know the screening test results, and 25 (75.76%) underwent an invasive diagnostic procedure and karyotype analysis, in one of whom karyotyping failed. In thirteen cases, karyotyping confirmed the MPS-based test results (two X0 cases, seven XXX cases, three XXY cases and one XYY case), giving a positive predictive value of 54.17% (13/24 cases confirmed by karyotyping). After post-test clinical counseling session Stage 2, seven women chose to terminate the pregnancy: one X0 case, two XXX cases, the three XXY cases and the single XYY case. Six women decided to continue with pregnancy: one X0 case and five XXX cases. Our study showed the feasibility of clinical application of the MPS-based test in the non-invasive detection of fetal SCA. Together with a two-stage post-test clinical counseling protocol, it leads to a well-informed decision-making procedure. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Evaluation of computing systems using functionals of a Stochastic process

NASA Technical Reports Server (NTRS)

Meyer, J. F.; Wu, L. T.

1980-01-01

An intermediate model was used to represent the probabilistic nature of a total system at a level which is higher than the base model and thus closer to the performance variable. A class of intermediate models, which are generally referred to as functionals of a Markov process, were considered. A closed form solution of performability for the case where performance is identified with the minimum value of a functional was developed.

Academic Job Placements in Library and Information Science Field: A Case Study Performed on ALISE Web-Based Postings

ERIC Educational Resources Information Center

Abouserie, Hossam Eldin Mohamed Refaat

2010-01-01

The study investigated and analyzed the state of academic web-based job announcements in Library and Information Science Field. The purpose of study was to get in depth understanding about main characteristics and trends of academic job market in Library and Information science field. The study focused on web-based version announcement as it was…

Exploring Young Children's Performance on and Acceptance of an Educational Scenario-Based Digital Game for Teaching Route-Planning Strategies: A Case Study

ERIC Educational Resources Information Center

Lin, Yi-Hui; Hou, Huei-Tse

2016-01-01

Researchers suggest that game-based learning (GBL) can be used to facilitate mathematics learning. However, empirical GBL research that targets young children is still limited. The purposes of the study is to develop a scenario-based digital game to promote children's route-planning ability, to empirically explore children's learning performance…

Linear Parameter Varying Control Synthesis for Actuator Failure, Based on Estimated Parameter

NASA Technical Reports Server (NTRS)

Shin, Jong-Yeob; Wu, N. Eva; Belcastro, Christine

2002-01-01

The design of a linear parameter varying (LPV) controller for an aircraft at actuator failure cases is presented. The controller synthesis for actuator failure cases is formulated into linear matrix inequality (LMI) optimizations based on an estimated failure parameter with pre-defined estimation error bounds. The inherent conservatism of an LPV control synthesis methodology is reduced using a scaling factor on the uncertainty block which represents estimated parameter uncertainties. The fault parameter is estimated using the two-stage Kalman filter. The simulation results of the designed LPV controller for a HiMXT (Highly Maneuverable Aircraft Technology) vehicle with the on-line estimator show that the desired performance and robustness objectives are achieved for actuator failure cases.

Comparisons of two moments‐based estimators that utilize historical and paleoflood data for the log Pearson type III distribution

USGS Publications Warehouse

England, John F.; Salas, José D.; Jarrett, Robert D.

2003-01-01

The expected moments algorithm (EMA) [Cohn et al., 1997] and the Bulletin 17B [Interagency Committee on Water Data, 1982] historical weighting procedure (B17H) for the log Pearson type III distribution are compared by Monte Carlo computer simulation for cases in which historical and/or paleoflood data are available. The relative performance of the estimators was explored for three cases: fixed‐threshold exceedances, a fixed number of large floods, and floods generated from a different parent distribution. EMA can effectively incorporate four types of historical and paleoflood data: floods where the discharge is explicitly known, unknown discharges below a single threshold, floods with unknown discharge that exceed some level, and floods with discharges described in a range. The B17H estimator can utilize only the first two types of historical information. Including historical/paleoflood data in the simulation experiments significantly improved the quantile estimates in terms of mean square error and bias relative to using gage data alone. EMA performed significantly better than B17H in nearly all cases considered. B17H performed as well as EMA for estimating X100 in some limited fixed‐threshold exceedance cases. EMA performed comparatively much better in other fixed‐threshold situations, for the single large flood case, and in cases when estimating extreme floods equal to or greater than X500. B17H did not fully utilize historical information when the historical period exceeded 200 years. Robustness studies using GEV‐simulated data confirmed that EMA performed better than B17H. Overall, EMA is preferred to B17H when historical and paleoflood data are available for flood frequency analysis.

Comparisons of two moments-based estimators that utilize historical and paleoflood data for the log Pearson type III distribution

NASA Astrophysics Data System (ADS)

England, John F.; Salas, José D.; Jarrett, Robert D.

2003-09-01

The expected moments algorithm (EMA) [, 1997] and the Bulletin 17B [, 1982] historical weighting procedure (B17H) for the log Pearson type III distribution are compared by Monte Carlo computer simulation for cases in which historical and/or paleoflood data are available. The relative performance of the estimators was explored for three cases: fixed-threshold exceedances, a fixed number of large floods, and floods generated from a different parent distribution. EMA can effectively incorporate four types of historical and paleoflood data: floods where the discharge is explicitly known, unknown discharges below a single threshold, floods with unknown discharge that exceed some level, and floods with discharges described in a range. The B17H estimator can utilize only the first two types of historical information. Including historical/paleoflood data in the simulation experiments significantly improved the quantile estimates in terms of mean square error and bias relative to using gage data alone. EMA performed significantly better than B17H in nearly all cases considered. B17H performed as well as EMA for estimating X100 in some limited fixed-threshold exceedance cases. EMA performed comparatively much better in other fixed-threshold situations, for the single large flood case, and in cases when estimating extreme floods equal to or greater than X500. B17H did not fully utilize historical information when the historical period exceeded 200 years. Robustness studies using GEV-simulated data confirmed that EMA performed better than B17H. Overall, EMA is preferred to B17H when historical and paleoflood data are available for flood frequency analysis.

Case Study for the ARRA-funded GSHP Demonstration at University at Albany

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

Liu, Xiaobing; Malhotra, Mini; Xiong, Zeyu

High initial costs and lack of public awareness of ground-source heat pump (GSHP) technology are the two major barriers preventing rapid deployment of this energy-saving technology in the United States. Under the American Recovery and Reinvestment Act (ARRA), 26 GSHP projects have been competitively selected and carried out to demonstrate the benefits of GSHP systems and innovative technologies for cost reduction and/or performance improvement. This report highlights the findings of a case study of one of the ARRA-funded GSHP demonstration projects—a distributed GSHP system at a new 500-bed apartment-style student residence hall at the University at Albany. This case studymore » is based on the analysis of detailed design documents, measured performance data, published catalog data of heat pump equipment, and actual construction costs. Simulations with a calibrated computer model are performed for both the demonstrated GSHP system and a baseline heating, ventilation, and airconditioning (HVAC) system to determine the energy savings and other related benefits achieved by the GSHP system. The evaluated performance metrics include the energy efficiency of the heat pump equipment and the overall GSHP system, as well as the pumping performance, energy savings, carbon emission reductions, and cost-effectiveness of the demonstrated GSHP system compared with the baseline HVAC system. This case study also identifies opportunities for improving the operational efficiency of the demonstrated GSHP system.« less

Agency for Healthcare Research and Quality

MedlinePlus

... improve patient outcomes Opioids Supporting HHS' Opioid Initiative Comparative Health System Performance Initiative AHRQ Releases Compendium of ... the U.S. Health system. More AHRQ IMPACT CASE STUDIES AHRQ’s evidence-based tools and resources are used ...

Green and sustainable remediation (GSR) evaluation: framework, standards, and tool. A case study in Taiwan.

PubMed

Huang, Wen-Yen; Hung, Weiteng; Vu, Chi Thanh; Chen, Wei-Ting; Lai, Jhih-Wei; Lin, Chitsan

2016-11-01

Taiwan has a large number of poorly managed contaminated sites in need of remediation. This study proposes a framework, a set of standards, and a spreadsheet-based evaluation tool for implementing green and sustainable principles into remediation projects and evaluating the projects from this perspective. We performed a case study to understand how the framework would be applied. For the case study, we used a spreadsheet-based evaluation tool (SEFA) and performed field scale cultivation tests on a site contaminated with total petroleum hydrocarbons (TPHs). The site was divided into two lots: one treated by chemical oxidation and the other by bioremediation. We evaluated five core elements of green and sustainable remediation (GSR): energy, air, water resources, materials and wastes, and land and ecosystem. The proposed evaluation tool and field scale cultivation test were found to efficiently assess the effectiveness of the two remediation alternatives. The framework and related tools proposed herein can potentially be used to support decisions about the remediation of contaminated sites taking into account engineering management, cost effectiveness, and social reconciliation.

Wavelet-based multiscale performance analysis: An approach to assess and improve hydrological models

NASA Astrophysics Data System (ADS)

Rathinasamy, Maheswaran; Khosa, Rakesh; Adamowski, Jan; ch, Sudheer; Partheepan, G.; Anand, Jatin; Narsimlu, Boini

2014-12-01

The temporal dynamics of hydrological processes are spread across different time scales and, as such, the performance of hydrological models cannot be estimated reliably from global performance measures that assign a single number to the fit of a simulated time series to an observed reference series. Accordingly, it is important to analyze model performance at different time scales. Wavelets have been used extensively in the area of hydrological modeling for multiscale analysis, and have been shown to be very reliable and useful in understanding dynamics across time scales and as these evolve in time. In this paper, a wavelet-based multiscale performance measure for hydrological models is proposed and tested (i.e., Multiscale Nash-Sutcliffe Criteria and Multiscale Normalized Root Mean Square Error). The main advantage of this method is that it provides a quantitative measure of model performance across different time scales. In the proposed approach, model and observed time series are decomposed using the Discrete Wavelet Transform (known as the à trous wavelet transform), and performance measures of the model are obtained at each time scale. The applicability of the proposed method was explored using various case studies-both real as well as synthetic. The synthetic case studies included various kinds of errors (e.g., timing error, under and over prediction of high and low flows) in outputs from a hydrologic model. The real time case studies investigated in this study included simulation results of both the process-based Soil Water Assessment Tool (SWAT) model, as well as statistical models, namely the Coupled Wavelet-Volterra (WVC), Artificial Neural Network (ANN), and Auto Regressive Moving Average (ARMA) methods. For the SWAT model, data from Wainganga and Sind Basin (India) were used, while for the Wavelet Volterra, ANN and ARMA models, data from the Cauvery River Basin (India) and Fraser River (Canada) were used. The study also explored the effect of the choice of the wavelets in multiscale model evaluation. It was found that the proposed wavelet-based performance measures, namely the MNSC (Multiscale Nash-Sutcliffe Criteria) and MNRMSE (Multiscale Normalized Root Mean Square Error), are a more reliable measure than traditional performance measures such as the Nash-Sutcliffe Criteria (NSC), Root Mean Square Error (RMSE), and Normalized Root Mean Square Error (NRMSE). Further, the proposed methodology can be used to: i) compare different hydrological models (both physical and statistical models), and ii) help in model calibration.

Towards high performing hospital enterprise systems: an empirical and literature based design framework

NASA Astrophysics Data System (ADS)

dos Santos Fradinho, Jorge Miguel

2014-05-01

Our understanding of enterprise systems (ES) is gradually evolving towards a sense of design which leverages multidisciplinary bodies of knowledge that may bolster hybrid research designs and together further the characterisation of ES operation and performance. This article aims to contribute towards ES design theory with its hospital enterprise systems design (HESD) framework, which reflects a rich multidisciplinary literature and two in-depth hospital empirical cases from the US and UK. In doing so it leverages systems thinking principles and traditionally disparate bodies of knowledge to bolster the theoretical evolution and foundation of ES. A total of seven core ES design elements are identified and characterised with 24 main categories and 53 subcategories. In addition, it builds on recent work which suggests that hospital enterprises are comprised of multiple internal ES configurations which may generate different levels of performance. Multiple sources of evidence were collected including electronic medical records, 54 recorded interviews, observation, and internal documents. Both in-depth cases compare and contrast higher and lower performing ES configurations. Following literal replication across in-depth cases, this article concludes that hospital performance can be improved through an enriched understanding of hospital ES design.

Finding Value in Surgical Didactics: Longitudinal Resident Feedback From Case-Based and Traditional Lectures in an Orthopaedic Residency.

PubMed

Barnwell, Jonathan C; Halvorson, Jason J; Teasdall, Robert D; Carroll, Eben A

To evaluate orthopedic resident perceptions of a didactic curriculum presented in traditional and case-based formats. Prospective cohort study using anonymous web-based survey after each conference evaluating resident perceptions of faculty participation, didactic delivery, content, and overall conference value. Conferences were structured as primarily case-based or traditional lecture. Logistic analysis was performed to determine factors predictive of rating a conference as valuable time spent. Orthopedic residency training program at single institution over an academic year. Orthopedic residents in postgraduate training year 1 to 5 attending mandatory didactic conference. Cased-based conferences received higher Likert ratings on residents' perception of faculty participation, instructor delivery, and improvement in topic understanding when compared to traditional lecture-based conferences (p < 0.0001 for each factor). Residents also were more likely to rate case-based conferences as valuable time spent (p < 0.0001). In our logistic model, factors associated with a negative likelihood of rating a conference as valuable were lecture format (odds ratio [OR] = 0.155, 95% CI: 0.115-0.208), PGY-2 level presenter (OR = 0.288, 95% CI: 0.169-0.490), and PGY-3 level presenter (OR = 0.433, 95% CI: 0.269-0.696). Timing in the year, surgical subspeciality, and conference identity were not significant predictors of conference value rating. Longitudinal resident feedback demonstrates highly favorable resident perceptions toward case-based formats in didactic sessions. Junior levels residents are not perceived as effective as senior residents and faculty in presenting material in either format. These methods allow for a dynamic approach to identifying strengths and weaknesses in a resident curriculum as a well as a means for more focused and real-time improvements. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Continued Evaluation of Gear Condition Indicator Performance on Rotorcraft Fleet

NASA Technical Reports Server (NTRS)

Delgado, Irebert R.; Dempsey, Paula J.; Antolick, Lance J.; Wade, Daniel R.

2013-01-01

This paper details analyses of condition indicator performance for the helicopter nose gearbox within the U.S. Army's Condition-Based Maintenance Program. Ten nose gearbox data sets underwent two specific analyses. A mean condition indicator level analysis was performed where condition indicator performance was based on a 'batting average' measured before and after part replacement. Two specific condition indicators, Diagnostic Algorithm 1 and Sideband Index, were found to perform well for the data sets studied. A condition indicator versus gear wear analysis was also performed, where gear wear photographs and descriptions from Army tear-down analyses were categorized based on ANSI/AGMA 1010-E95 standards. Seven nose gearbox data sets were analyzed and correlated with condition indicators Diagnostic Algorithm 1 and Sideband Index. Both were found to be most responsive to gear wear cases of micropitting and spalling. Input pinion nose gear box condition indicators were found to be more responsive to part replacement during overhaul than their corresponding output gear nose gear box condition indicators.

Facility cost analysis in outpatient plastic surgery: implications for the academic health center.

PubMed

Pacella, Salvatore J; Comstock, Matthew C; Kuzon, William M

2008-04-01

The authors examined the economic patterns of outpatient aesthetic and reconstructive plastic surgical procedures performed within an academic health center. For fiscal years 2003 and 2004, the University of Michigan Health System's accounting database was queried to identify all outpatient plastic surgery cases (aesthetic and reconstructive) from four surgical facilities. Total facility charges, cost, revenue, and margin were calculated for each case. Contribution margin (total revenue minus variable direct cost) was compared with total case time to determine average contribution margin per operating suite case minute for subsets of aesthetic and reconstructive procedures. A total of 3603 cases (3457 reconstructive and 146 aesthetic) were identified. Payer mix included Blue Cross (36.7 percent), health maintenance organization (28.7 percent), other commercial payers (17.4 percent), Medicare/Medicaid (13.5 percent), and self-pay (3.7 percent). The most profitable cases were reconstructive laser procedures ($66.20; n = 361), scar revision ($36.01; n = 25), and facial trauma ($32.17; n = 64). The least profitable were hand arthroplasty ($13.93; n = 35), arthroscopy ($17.25; n = 15), and breast reduction ($17.46; n = 210). Aesthetic procedures (n = 144) yielded a significantly higher contribution margin per case minute ($24.21) compared with reconstructive procedures ($22.28; n = 3093) (p = 0.01). Plastic surgical cases performed at dedicated ambulatory surgery centers ($28.60; n = 1477) yielded significantly higher contribution margin per case minute compared with those performed at hospital-based facilities ($25.58; n = 2123) (p < 0.01). Use of standardized accounting (contribution margin per case minute) can be a strategically effective method for determining the most profitable and appropriate case mix. Within academic health centers, aesthetic surgery can be a profitable enterprise; dedicated ambulatory surgery centers yield higher profitability.

The Spacecraft Materials Selector: An Artificial Intelligence System for Preliminary Design Trade Studies, Materials Assessments, and Estimates of Environments Present

NASA Technical Reports Server (NTRS)

Pippin, H. G.; Woll, S. L. B.

2000-01-01

Institutions need ways to retain valuable information even as experienced individuals leave an organization. Modern electronic systems have enough capacity to retain large quantities of information that can mitigate the loss of experience. Performance information for long-term space applications is relatively scarce and specific information (typically held by a few individuals within a single project) is often rather narrowly distributed. Spacecraft operate under severe conditions and the consequences of hardware and/or system failures, in terms of cost, loss of information, and time required to replace the loss, are extreme. These risk factors place a premium on appropriate choice of materials and components for space applications. An expert system is a very cost-effective method for sharing valuable and scarce information about spacecraft performance. Boeing has an artificial intelligence software package, called the Boeing Expert System Tool (BEST), to construct and operate knowledge bases to selectively recall and distribute information about specific subjects. A specific knowledge base to evaluate the on-orbit performance of selected materials on spacecraft has been developed under contract to the NASA SEE program. The performance capabilities of the Spacecraft Materials Selector (SMS) knowledge base are described. The knowledge base is a backward-chaining, rule-based system. The user answers a sequence of questions, and the expert system provides estimates of optical and mechanical performance of selected materials under specific environmental conditions. The initial operating capability of the system will include data for Kapton, silverized Teflon, selected paints, silicone-based materials, and certain metals. For situations where a mission profile (launch date, orbital parameters, mission duration, spacecraft orientation) is not precisely defined, the knowledge base still attempts to provide qualitative observations about materials performance and likely exposures. Prior to the NASA contract, a knowledge base, the Spacecraft Environments Assistant (SEA,) was initially developed by Boeing to estimate the environmental factors important for a specific spacecraft mission profile. The NASA SEE program has funded specific enhancements to the capability of this knowledge base. The SEA qualitatively identifies over 25 environmental factors that may influence the performance of a spacecraft during its operational lifetime. For cases where sufficiently detailed answers are provided to questions asked by the knowledge base, atomic oxygen fluence levels, proton and/or electron fluence and dose levels, and solar exposure hours are calculated. The SMS knowledge base incorporates the previously developed SEA knowledge base. A case history for previous flight experiment will be shown as an example, and capabilities and limitations of the system will be discussed.

Joint Smoothed l₀-Norm DOA Estimation Algorithm for Multiple Measurement Vectors in MIMO Radar.

PubMed

Liu, Jing; Zhou, Weidong; Juwono, Filbert H

2017-05-08

Direction-of-arrival (DOA) estimation is usually confronted with a multiple measurement vector (MMV) case. In this paper, a novel fast sparse DOA estimation algorithm, named the joint smoothed l 0 -norm algorithm, is proposed for multiple measurement vectors in multiple-input multiple-output (MIMO) radar. To eliminate the white or colored Gaussian noises, the new method first obtains a low-complexity high-order cumulants based data matrix. Then, the proposed algorithm designs a joint smoothed function tailored for the MMV case, based on which joint smoothed l 0 -norm sparse representation framework is constructed. Finally, for the MMV-based joint smoothed function, the corresponding gradient-based sparse signal reconstruction is designed, thus the DOA estimation can be achieved. The proposed method is a fast sparse representation algorithm, which can solve the MMV problem and perform well for both white and colored Gaussian noises. The proposed joint algorithm is about two orders of magnitude faster than the l 1 -norm minimization based methods, such as l 1 -SVD (singular value decomposition), RV (real-valued) l 1 -SVD and RV l 1 -SRACV (sparse representation array covariance vectors), and achieves better DOA estimation performance.

ALL-PATHWAYS DOSE ANALYSIS FOR THE PORTSMOUTH ON-SITE WASTE DISPOSAL FACILITY

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

Smith, F.; Phifer, M.

A Portsmouth On-Site Waste Disposal Facility (OSWDF) All-Pathways analysis has been conducted that considers the radiological impacts to a resident farmer. It is assumed that the resident farmer utilizes a farm pond contaminated by the OSWDF to irrigate a garden and pasture and water livestock from which food for the resident farmer is obtained, and that the farmer utilizes groundwater from the Berea sandstone aquifer for domestic purposes (i.e. drinking water and showering). As described by FBP 2014b the Hydrologic Evaluation of Landfill Performance (HELP) model (Schroeder et al. 1994) and the Surface Transport Over Multiple Phases (STOMP) model (Whitemore » and Oostrom 2000, 2006) were used to model the flow and transport from the OSWDF to the Points of Assessment (POAs) associated with the 680-ft elevation sandstone layer (680 SSL) and the Berea sandstone aquifer. From this modeling the activity concentrations radionuclides were projected over time at the POAs. The activity concentrations were utilized as input to a GoldSimTM (GTG 2010) dose model, described herein, in order to project the dose to a resident farmer over time. A base case and five sensitivity cases were analyzed. The sensitivity cases included an evaluation of the impacts of using a conservative inventory, an uncased well to the Berea sandstone aquifer, a low waste zone uranium distribution coefficient (Kd), different transfer factors, and reference person exposure parameters (i.e. at 95 percentile). The maximum base case dose within the 1,000 year assessment period was projected to be 1.5E-14 mrem/yr, and the maximum base case dose at any time less than 10,000 years was projected to be 0.002 mrem/yr. The maximum projected dose of any sensitivity case was approximately 2.6 mrem/yr associated with the use of an uncased well to the Berea sandstone aquifer. This sensitivity case is considered very unlikely because it assumes leakage from the location of greatest concentration in the 680 SSL in to the Berea sandstone aquiver over time and does not conform to standard private water well construction practices. The bottom-line is that all predicted doses from the base case and five sensitivity cases fall well below the DOE all-pathways 25 mrem/yr Performance Objective.« less

Btu accounting: Showing results

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

Nelson, K.E.

1994-10-01

In the preceding article in this series last month, the author showed how to calculate the energy consumed to make a pound of product. To realize a payoff, however, the results must be presented in graphs or tables that clearly display what has happened. They must call attention to plant performance and ultimately lead to more efficient use of energy. Energy-consumption reporting is particularly valuable when viewed over a period of time. The author recommend compiling data annually and maintaining a ten-year performance history. Four cases are considered: individual plant performance; site performance for sites having more than one plant;more » company performance, for companies having more than one site; and performance based on product, for identical or similar products made at different plants or sites. Of these, individual plant performance is inherently the most useful. It also serves as the best basis for site, company and product performance reports. A key element in energy accounting is the relating of all energy consumption to a common basis. As developed last month in Part 1 in this series, the author chose Btu[sub meth] (i.e., Btu of methane equivalent, expressed as its higher heating value) for this purpose. It represents the amount of methane that would be needed to replace (in the case of fuels) or generate (in the case of steam and power) the energy being used.« less

Lunar in-core thermionic nuclear reactor power system conceptual design

NASA Technical Reports Server (NTRS)

Mason, Lee S.; Schmitz, Paul C.; Gallup, Donald R.

1991-01-01

This paper presents a conceptual design of a lunar in-core thermionic reactor power system. The concept consists of a thermionic reactor located in a lunar excavation with surface mounted waste heat radiators. The system was integrated with a proposed lunar base concept representative of recent NASA Space Exploration Initiative studies. The reference mission is a permanently-inhabited lunar base requiring a 550 kWe, 7 year life central power station. Performance parameters and assumptions were based on the Thermionic Fuel Element (TFE) Verification Program. Five design cases were analyzed ranging from conservative to advanced. The cases were selected to provide sensitivity effects on the achievement of TFE program goals.

Contracting and Procurement for Evidence-Based Interventions in Public-Sector Human Services: A Case Study

PubMed Central

Willging, Cathleen E.; Aarons, Gregory A.; Trott, Elise M.; Green, Amy E.; Finn, Natalie; Ehrhart, Mark G.; Hecht, Debra B.

2016-01-01

Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this case study, we conducted qualitative interviews with key government and CBO stakeholders to examine implementation of the Best Value-Performance Information Procurement System to contract for EBIs in a child welfare system. Findings suggest that stakeholder relationships may be compromised when procurement disregards local knowledge, communication, collaboration, and other factors supporting EBIs and public health initiatives. PMID:26386977

Numerical analysis of Hall effect on the performance of magnetohydrodynamic heat shield system based on nonequilibrium Hall parameter model

NASA Astrophysics Data System (ADS)

Li, Kai; Liu, Jun; Liu, Weiqiang

2017-01-01

Magnetohydrodynamic (MHD) heat shield system, a novel thermal protection technique in the hypersonic field, has been paid much attention in recent years. In the real flight condition, not only the Lorentz force but also the Hall electric field is induced by the interaction between ionized air post shock and magnetic field. In order to analyze the action mechanisms of the Hall effect, numerical methods of coupling thermochemical nonequilibrium flow field with externally applied magnetic field as well as the induced electric field are constructed and validated. Based on the nonequilibrium model of Hall parameter, numerical simulations of the MHD heat shield system is conducted under two different magnetic induction strengths (B0=0.2 T, 0.5 T) on a reentry capsule forebody. Results show that, the Hall effect is the same under the two magnetic induction strengths when the wall is assumed to be conductive. For this case, with the Hall effect taken into account, the Lorentz force counter stream diminishes a lot and the circumferential component dominates, resulting that the heat flux and shock-off distance approach the case without MHD control. However, for the insulating wall, the Hall effect acts in different ways under these two magnetic induction strengths. For this case, with the Hall effect taken into account, the performance of MHD heat shield system approaches the case neglecting the Hall effect when B0 equals 0.2 T. Such performance becomes worse when B0 equals 0.5 T and the aerothermal environment on the capsule shoulder is even worse than the case without MHD control.

Illness script development in pre-clinical education through case-based clinical reasoning training

PubMed Central

Keemink, Yvette; van Dijk, Savannah; ten Cate, Olle

2018-01-01

Objectives To assess illness script richness and maturity in preclinical students after they attended a specifically structured instructional format, i.e., a case based clinical reasoning (CBCR) course. Methods In a within-subject experimental design, medical students who had finished the CBCR course participated in an illness script experiment. In the first session, richness and maturity of students’ illness scripts for diseases discussed during the CBCR course were compared to illness script richness and maturity for similar diseases not included in the course. In the second session, diagnostic performance was tested, to test for differences between CBCR cases and non-CBCR cases. Scores on the CBCR course exam were related to both experimental outcomes. Results Thirty-two medical students participated. Illness script richness for CBCR diseases was almost 20% higher than for non-CBCR diseases, on average 14.47 (SD=3.25) versus 12.14 (SD=2.80), respectively (p<0.001). In addition, students provided more information on Enabling Conditions and less on Fault-related aspects of the disease. Diagnostic performance was better for the diseases discussed in the CBCR course, mean score 1.63 (SD=0.32) versus 1.15 (SD=0.29) for non-CBCR diseases (p<0.001). A significant correlation of exam results with recognition of CBCR cases was found (r=0.571, p<0.001), but not with illness script richness (r=–0.006, p=NS). Conclusions The CBCR-course fosters early development of clinical reasoning skills by increasing the illness script richness and diagnostic performance of pre-clinical students. However, these results are disease-specific and therefore we cannot conclude that students develop a more general clinical reasoning ability. PMID:29428911

Validation of the GreenLight™ Simulator and development of a training curriculum for photoselective vaporisation of the prostate.

PubMed

Aydin, Abdullatif; Muir, Gordon H; Graziano, Manuela E; Khan, Muhammad Shamim; Dasgupta, Prokar; Ahmed, Kamran

2015-06-01

To assess face, content and construct validity, and feasibility and acceptability of the GreenLight™ Simulator as a training tool for photoselective vaporisation of the prostate (PVP), and to establish learning curves and develop an evidence-based training curriculum. This prospective, observational and comparative study, recruited novice (25 participants), intermediate (14) and expert-level urologists (seven) from the UK and Europe at the 28th European Association of Urological Surgeons Annual Meeting 2013. A group of novices (12 participants) performed 10 sessions of subtask training modules followed by a long operative case, whereas a second group (13) performed five sessions of a given case module. Intermediate and expert groups performed all training modules once, followed by one operative case. The outcome measures for learning curves and construct validity were time to task, coagulation time, vaporisation time, average sweep speed, average laser distance, blood loss, operative errors, and instrument cost. Face and content validity, feasibility and acceptability were addressed through a quantitative survey. Construct validity was demonstrated in two of five training modules (P = 0.038; P = 0.018) and in a considerable number of case metrics (P = 0.034). Learning curves were seen in all five training modules (P < 0.001) and significant reduction in case operative time (P < 0.001) and error (P = 0.017) were seen. An evidence-based training curriculum, to help trainees acquire transferable skills, was produced using the results. This study has shown the GreenLight Simulator to be a valid and useful training tool for PVP. It is hoped that by using the training curriculum for the GreenLight Simulator, novice trainees can acquire skills and knowledge to a predetermined level of proficiency. © 2014 The Authors. BJU International © 2014 BJU International.